HomeMy WebLinkAboutBuilding Permit # 4/19/2016 (3) t%ORTH
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GILDING PERMIT 0. _,LED 1 6"6
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Receive C-6LB5
Date Issued: this page
IMPORTANT: Applicant must complete all items on
/9
LOCATION
Print
PROPERTY OWNER If 0 1
Print 1 00,Year structure yes no
MAP 1 (—) PARCEL: ZONING DISTRICT:—HistoricDShop
achinVillage yes. no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
El New Building El One family El Industrial
0 Addition El Two or more family Ei Commercial
El Alteration No. of units: [I Others:
,repair, replacement El Assessory Bldg
0 Demolition 0 Other
DESCRIPTION OF WORK TO BE PERFORMED:
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1
r Print- learly dentification- Please Type ox' �2
Phone: 2
OWNER: Name. vy,� i C-,
6)'2
q kd,7
Address: �e 61,," 5a
Contractor Name- Phone:
Email: 141-2—LULI�) -f ilk)
Address:
Supervisor's Construction License: 06
Exp. Date: 2"
21
Home Improvement License: Exp. Date: 2 6
ARCH ITECT/ENGINEER Phone:
Address- Reg. No.
FEE SCHEDULE.,BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Pr'oj'ect Cost: $ —FEE:
: 0
Check No.: 63 Receipt No.
NOTE: Persons contracting with unregistered contractors do not have access to the uarantyfund
NORTH
Town - of
2Andover
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C, ' h , ver, Mass, 0
T OLAKE
COC KICK...CK
AERATED
S U
BOARD OF HEALTH
PERMIT T LD Food/Kitchen
�p Septic System
THIS CERTIFIES THAT .:..:: .is.l.. . .... Ct.....1 /. _d............................. BUILDING INSPECTOR
&--t-'sl
.............................
Foundation
has permission to erect �. �.\Jp .......................... buildings on ....... ............ . ....... ........
a Rough
to be occupied as .........................
!'l ........ 6.. ......................................................................... Chimney
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
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR
LESS CONSTRUCTION ARTS Rough
Service
................................................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Reguired to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
The Commonwealth of Massachusetis
Department of industrial accidents
N X Congress Street,Suite 100
Boston,AIA 021142017
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wwwanass.,gov/dia
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Workers'Compensation Insurance Affidavit:Builders/Contractor's/Li lectzicians/Plumbexs.
TO BE:C+LLED WITH THE pERMITTING AUTHORITY. Please Print Le bl
,Applicant Information
Name (Business/Organization/Indivrdual)'
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Address: t
C Phone#: '" .,
City/State/Zip: E"
dim ,�., ,,�
FE
oject(x'@quired):
Are you an employer?Cheel(tlie appropriate box: coristruCtiorr
l, am a employer with employees(full and/or part-time).*
2.❑I am a sole proprie#or or partnership and have no employees working forme in
Remodeling
any capacity.[No workers'comp.insurance required.] olition
o workers'comp..insurance required.]t lding addition3.❑I am a homeowner doing all work myself.[Ntrical repairs or additions4.❑I am a homeowner and will be hiring contractors to conduct allwork on my property. I willensure that all contractors either have workers'compensation insurance or aro sole bing repairs or additions
proprietors with no employees.
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
13`.[]Roof repairs
These sub-contractors bade employees and have workers'comp,insurance) 14, ther aid` Y "
6.F1 We are a corporation and its,officers have exercised their right of•exemption per MGL c.
152,§1(4),and we have no,employees.[No workers'comp.insurance required.]
rAny also fill out the section below showing their workers'compensation policy information.
applicant that checks box#1 must
t Homeowners who sulimiti this affidtaatfindicating they areached anadditional sheetg howall urg thee rk andHomo of the sub con ztactors and state whether or no those avit ant ti s hting.ave such.
tContractors that check this box m ,, ,.
employees. If the sub-cbr&actors Have employees,they must provide their workers'comp.policy number.
X ain an employer that is piyoworkers'wors'compensation insurance for my employees. Below is the policy and)
site
information.
Insurance Company Name: ~
ExpirationDate:
Policy#or Self-ins,Lie.#:
Job Site Address: '
City/State/Zip: �,., .� ;BALL
jrafl
Attach a copy of the worl�er compensation policy declaration page(s violgalio policy
o nishable by a fine up to$1Q5aa d0
Failure to secru e coverage as required under MGL c. 152,§25A is a criminalp
and/or one-year imprisonment,as well as civil penalltiebe forwain the pded to therm of a �Offt e oOP Gf InvGestigations of the DIA for msu a c a
day against the violator.A copy of this statement may
coverage verification.
Z do hereby cert' rid `the pains and penalties of peijury that the information pl'ovided above is tf•u ar2Cl correct.
Date: l
Si nature:
Phone#:
official use only. .Do not write in this area,to be completed by city or,town official.
Permit/License#
City or Town:
Issuing Authority(circle one): '
1.]Board of health 2.Building Department 3.City/Tower Clerk 4.Plectrical Inspector 5.Plumbing Inspector
6.Other
Phone#:
Contact Person:
B&MRESTORATIONAND 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 Buildings: 2
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°/x.
Building 2: $50,000.00
We hereby propose to furnish all labor and material complete in accordance with the above
specifications for the sums stated above.
AUTHORIZED SIGNATURE a 1-'n -- ATE: 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 /�.�_DATE: � ��