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Home My WebLink AboutBuilding Permit # 4/19/2016 (2) ........ A"o R T«,H BUILDINGPERMIT .X6 TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received C"� ) Y/J a°�arcD Pei yGa AC5�C Date Issued: Ll 19 F__ Applicant must complete all items on this page LOCATION '4 / ` Print PROPERTY OWNER Print I00.Year Structure yes no MAP C__PARCEL: a ZONING DISTRICT:_Historic District yes no Machine Shop Village yes, no . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition [i Two or more family EI Industrial Ll Alteration No. of units: El Commercial p epair, replacement ❑Assessory Bldg ❑ Others: ❑ DemolitionElOther "yrm; ou ,p y„lyv'm„r/r� r'f � %� J 1// ,K�r ti>i Qty/(Ila7!�l� flTiw'i,�'Y1,(r�ri� 9`.,! � � / F� �.r r:h✓�' �eJ.: ed�"�'��t ��i��f%r�/i. u ,r '' of I iii t D t DESCRIPTION OF WORK TO DE PERFORMED. Identificatio Please Type or Print Cleanly OWNER: Name: Phone: Address: eg, vt, Contractor Name: a Pho -.. Email: . ,. „�wg �. p rIry AAT+.m Address: Supervisor's Construction License: Exp. Date: , Home Improvement License: I Ik,,- Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ P 00C;� FEE: Receipt No.: Check No.: � �. q f NOTE: ,Persons contracting with unregistere contractors da not have access to the g caw my fr�nc� --,r-,,,-,w. r i rrr ,�r,r- ,,r„U,,,, a r,r,i /,o iii / / i / ,. n ,�n-Tr;r rr i�,Jr. /rTjr�ii7,G,i/�J/r. ./%/.. r �, r ///i.. // % rr. ,,. Nf,ll ,groin i�Jim ,.. G// i r//r irJ%/i,///�./%//ii /i/�////rA✓:1j r//i�% ;. � ,' i i -9,”, �S�g_rt_atur � N/��A'r�enf/ �r�ai,/%/ii//,,i�,S�_n�t -- NORTH v e r own of t ..It, Alidu No. _ h r ver, Mass, U COCNIC ew.c. 1' �qS RATEe) lkPa`11 �•(y U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System ....... BUILDING INSPECTOR THIS CERTIFIES THAT ,� �7 ............................................................................. .............. ... ...... Foundation .......... buildings on f ....................... has permission to erect .................�.. ............................... Rough .. n ��f.�� Chimney tobe occupied as ...........�F,,�.�a.:t:.. ..................................................................................... provided that the person accepting this permit shall in every respect conform to the terms-of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service •i . ................... ...... ...�x %"'�„ U ................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises — Do Not Remove-. FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Burner Until Inspected and Approved by the Building Inspector. Street No. Smoke Det. B&MRESTORATIONAArD CONTRACTING, INC. 218 PARIS STREET EAST BOSTON, MA. 02128 (617) 561-9998 (781) 342-5178 fax (617) 293-1722 cell PROPOSAL AIMCO 2 Greenwood Square 3331 Street Road, Ste 450 Bensalem, PA. 19020 JOB LOCATION: Royal Crest Estates, 19 Royal Crest Drive,N.Andover,MA. WE PROPOSE THE FOLLOWING: Work to be performed on Builuings: 14 Set up protection around the work area. Install safety fence around perimeter of work. Replace brick as needed. After flashing is completed,cut and point building 100%. Building 14: $50,000.00 We hereby propose to furnish all labor and material complete in accoruance with the above specifications for the sums stated above. AUTHORIZED SIGNATURE ---RATE: 4-11-2016 Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified. AUTHORIZED SIGNATURE G� DATE: 411qll e The Commonwealth of Massachusetts Department ofIndustrialAceldents I Congress Street,Suite 100 Boston,AM 02114-2017 www mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectriclans/Plumbers. TOBEFILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib, Name (13iisiness/Organization/fndividtial): Address: rX 14 k City/State/Zip: A,E Phone#: 6, Are you an employer?Check the ap0opriate box: Type of project(Tcquired): l.niamaerriployerwith-- employees(full and/or part-time).* 7. F1 New construction 2.[]I am a sole proprietor or partnership and have no employees working for me in 8. F]Remodeling any capacity,[No workers'comp.insurance required.] 9. El Demolition 3.F1 I am a homeowner doing all work myself.[go workers'comp.-insurance required.]t 10 E]Building addition 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[J Electrical repairs or additions roprictors with no employees. p 12.F1 Plumbing repairs or additions 5.n I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs Thes'e siib-contrac'torshav�'c' ci�plqye'G's and have we I rkers'comp.insurance.1 14.EjUthi A -4 or 6.n We are a corporation'and its officers have exercised their right of'exemption per MGL c. _Z2�- 152,§1(4),and we have [No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy inform'ation. T Homeowners who subrulf this affidavit indicating they are doing all work and then hire outside contractors rnust submit a new affidavit indicating such. fContractors tbat check this box must'attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.' fain an employer that ispiavidiiig workers'compensation insurance for my employees.'Below is the policy andjob site Information. Insurance Company Name: 1-�4h4yc"' Policy#or Self-ins.Lie.It: 4 A / k9 ez' "2 6'/- ) Expiration Date: Job Site Address: 11-4 o i. (v-e 1.,j/" L� City/State/Zip: A 1A �'JAewln Attach a copy of the workers'capepsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a Eno of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifynn ert z pains andpenalties qfpeijuiy that the information provided above is true and correct Sign re: 117- - Date: V Phone# A 9 / 4 e?ej r" Qfjicial use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6,Other Contact Person: Phone#: