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Home My WebLink AboutBuilding Permit # 11/8/2016 %,0RT BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION `` L Permit O#: f Date Received �A. .. �, " Rgreo�" a>� a ep i C`-9U5�K Date Issued: r IMPORTANT: Applicant must complcte all items on this page froWM , LUCATION; �' P not PROPERTY,OWNER, � ' mm 10o Year Structure yes no MAP PARCEL. ) ZONING bSTRICT., � Historic C�'istrict yes o :a Machine Shap Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential - _ Non- Residential 0 New Building No0wo ne family Li Addition or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement FJ Assessory Bldg ❑ Others: Ii Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands 0 Watershed District Water/Sewer DESCRIPTION OF WORK TO RE PERFORMED: -- ... m� Identification- Please Type oar Print Clearly OWNER: Name :; , � Phone; �...�� ,..91e . Address: 0 °R Contractor Flame: ^ "� Ph r� ie�� Address: � Supervisors Construction,Licenser Exp. date: Home Improvement License; ) Exp. bate., , P p ARCHITECT/ENGINEER Phone: Address: Reg, No. FEE SCHEDULE:BULDING PERMIT. $92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. °w.. fatal Project Cost: $ ,� FEE: $ Check No.: (0 1 Receipt Na.: NOTE: Persons contracting with unregistered contractors do not have:access to the guarantyfitnd ofAgent/Ownet Signature1 Signature of contractor, � ,NOR7'y own ofAndover _ . : _ _ p 0% Qh , ver, Mass, Co[N1en.weew��1' �RRTEE) s U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �� '& &() BUILDING INSPECTOR ........................ has permission to erect ......... ............. buildings on ...... ...... �. /...... .,19.1�1�p.. Foundation. f ,�PS4.........I�®............................ .. .. , �� Rough to be occupied as ..,. ... ........ ... 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TTS A j Rough t=__-'--A40 Service ................ ........................ ............................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occuav Buildke 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. , 1 - { 3 n { AIZAC-E- g 4 j INV ate+ s A-1 E� H t5 -= f _ j { [ � F f E M E z F f t 1 Y _ 4 4 1 i 4 ,1'he commonwealth of Massachusetts Department ofrndustrialAccidents .' 1 Congress Street,Suite 100 074 201% Boston,MA www.masys.gov/dia QSM sy+� ' ;avlrers' CoaarpensationUsurane'd Affidavit:Builders/Conti•actoxs/�Xc��xcxansC�'1�amTaers. TO BF,Fff,FD WITII Mll PF-`R`A T`C NG AIjTjI"ITV- Please Print Le A •'licant Infor ntation f 'Name (Business/()igabizationitndividual) r ° / i Plorle # __ - -- r _ Type ogproject()required); lxeyorx an omplayem?Checicttie approprlafiebaxz 1. 7, Nem d6nstriiotion. I am a omplayer with employees(ii�ll and/or part time).:# 7..�I an a sole proprietor or partnership and have no employees Working£ar me in ❑lenxocleliiig any capacity.[No workers'comp,insurance required.] 9, Demolition 3. I am a homeowner doing all work rnysel£[No workers'comp,insurance required, ' 10❑Building addition am a homoowrner and will bo hiring contractors to conduct all work on my property. I will 11.�Fl.ectrical xep,�irs or additions orn"".that all contractors either have workers'compensation insurauae ar are solo a2, `l?lutnbing repa#s or additions proprietors with no,6;Apayces. L 1 II D Rbofreliaiz's S.❑I am a general contractor dnd�b"e hired tho sub corzftacfors listed on the attached sheet, y These subcontractors have exnployces and have workers'comp,insurance t 14 Ot}ter 6, We area corporation and its,officers have exercised their right of exemption per MGL c, 152,§1(4),and=wehaveno erapldyees.[Noworkere comp,insurancerequirecl.:� . ponsation cy AxryapplicantthatchecPfslnoica#id mdl° �eyarodomgallwankandtlncnlnirooutsidecontraatorsnuasi submita ewaflidavitindicafingsuch. t Homeowners who submit this, , . . tConftaatars that co sub it-his t as must attaclied an additional sheet showing tho name of the sub cantractars and statg whether or not#}nose entities have e omployeos. Ifthe sub-aonixact'is bavo employees,thoy must prosida their workers'comp.policy number. w' I arae an employer that is pr^ovidIn9-War^kers'compensation insur•ancefor°MY employees. Brow is triepaTr'cy axad�a�i szte irzfor^oration. Insurance company Name: — Fxpir•ationDate:. — I'olicy#or Self-ins.Lie. – __City/State/zip:.--- lob ity/state/zip:•_ -Sob Site Address:— _ --- .Attacb..a copy-Of the WQrlrexs' coxapepsation policy declaration page(sho•wing the policy number and expiration date). Failure to secure coverage as required under MOL oties2m,§25A is a crivainal violation punishable by a ab up to$1,500-00 he rm,of as STOP W O��ORDER and a Eno ti to $250.00 a and/or one-yeixnpxisanxnent,as well as c ar ivil penal day against the violator. A.copy of.this statement may be forwarded to the Officeof Investigations of the DI�1 for irrsuranco coverage verification. __ I da leer^ehy cert fy under tliepai Hautes o peijury that the r�nformation provided have is true arab correct Phonot Official use only. Do not-tvr•to in this area,to he completed by city or^town official City or Town- Issuing own: Permit/.License Issuing.Authority(circle one): ' :t.Board afllealth 2.Building Uepartincnt 3.City/Town Clerk 4.11,jectrical Inspector 5.Plumbing Inspector 6.Other _— Phone Contact dTlle 1(a»v�x6wer"C"7161 o1:b'�Cfjjacllccdat Office of Consumer Affairs&Business Regulation - HOME IMPROVEMENT CONTRACTOR Registration: ;116025 Type, Expiration 5Ifi012018 Private Corporation HASHEM CONST JOHN HASHEM 133 MAIN ST N.READING, MA 01864 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-040870 Construction Supervisor JOHN d HASHEM,JR 136 KARA DR NORTH ANDOVER M:A1 01846 CA Expiration: Commissioner 0710112017