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Home My WebLink AboutBuilding Permit # 4/19/2016 (5) OO R TH UILDING PERMIT (9�qqU TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION V, R m� ��"� � D�f1 C`OCNICNlwI[N �� Permit Nod: c Date Received a 4. P aZlTrD C LIS Date Issued: —LOI�— IMARTA T: Applicant must complete all items on this page LOCATION Print,, PROPERTY OWNER rw. Print 100 Year structure yes no MAP r PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family 11 Industrial El Alteration No. of units: ❑ Commercial ❑'"repair, replacement ElAssessory Bldg El Others: ❑ Demolition ❑ Other , xuw us��i M1?"D„n r ri i ,I; �P' i/7�%/�l!/,7 i l�'/y a!i a .�-mnr��!!/T��,'1Yr Tja..�OI,r('rn AGI/ ,ar�rr+'1�r,�/U��1!,✓l�r�'H, /� � /, � :. � � [ „-� ��l%/2 it�.” J DESCRI r .P'TION OF WORK TO DE PERFORMED: Identification- Please Type or Print Clearly .... OWNER: Name: ��Ide �� / o Phone' Address: — — Contractor Name: �^u /,��'� d,.,� �. � Phon Email: Address: f . Supervisor's Construction Livens®; � '�� 626 / Ex p. Date. Home Improvement License: ` ° loam'"" Exp. Date: ' �,, /6 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cit; $ fax aoO„ . FEE: $ Check No.: � Receipt No.: 30S21j NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .�!rui/lt �., 7 �c►p/lAgQn �y nln('r��Gi��iG/�/� �� ti�/� r - -- NORTII Town of ? _ ®ver 0 o h , ver, Mass, COCHIC"t WICK V 5 RATED V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT . .j.�.. C ..............................cilEcal ........................ �......... Foundation has permission to erect ............. buildings on .�.lP.......t:S�?. f. •.•••. ....D•c••......••• p ............. Rough /� .....�.�.l.......... .�. . . .�.. Chimney to be occupied as ............. I ��••••••• � provided that the person accepting this permit shall in every respect conform tot 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 CONSTR CTION STARTS Rough ��/ ................................. Service .u�®�::::s•.•....... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy.hermit Required 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. B&M RESTORATIONAND CONTR,4 CTING, 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,AM WE PROPOSE THE FOLLOWING: Work to be performed on Buildings: 16 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 16: $50,000.00 We hereby propose to furnish all labor and material complete in accordance with the above specifications for the sums stated above. AUTHORIZED SIGNATURE DATE: 4-11-2016 Acceptance of Proposal: The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified. AUTHORIZED SIGNATURE-9/* " DATE: E{ taJ/ 6 The Commonwealth ofMassachusetts i .,department of IndustrialAcchlents w: a 1 Congress Street,Write 100 Boston,AM 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lQdriclans/Plumbers. TO BE TILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeWb Name(Business/Organization/Individual): Address: City/State/Zip: E7 6)10 CA ) r Phone#: 4,0 Are you an employer?Clreck tine appropriate box: Type of project()required).- I.E]I am aemployerwith employees(full and/or part-time).* 7. Q New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. F]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp..insurance required.]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole ILFJ Electrical repairs or additions proprietors with no employees. 12.FIZ'ltimbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 1J.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®-Other 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. fi Homeowners who submit Us affidavit indicating they are doing all work and then hire outside contractors thust submit a new affidavit indicating such. tContractors that 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 leave employees,'they must provide their workers'comp.policy number. Iain an employer that is pi oviding workers'compensation insurance for nay employees.'Below is the policy and lob site information. Insurance Company Name: 461 kJ 64,!Zw " Policy##or Self-ins.Lie.#: ✓ t Expiration Date: rob Site Address: a ^ t..Y. " ' City/State/Zip: f € r " C � Attach a copy of the worker compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 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 WORD.ORDER and a fine 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 certify un der the pains and penalties ofperjury that the information provided above is true and correct. Sign re: JPDate: / Phone#i' I p Official use only. Do not write in this area,to be completer)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 5.Plumbing Inspector 6.Other Contact Person: Phone#: