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HomeMy WebLinkAboutBuilding Permit # 11/10/2016 Of,,0.TJ,R'Y BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: m ,y Date Receives l tie Ae t5 4SSRCFdUSE� J f Date Issued: 1 i i,; ZNIPORT NT:Applicant must complete all items on this page i LOCATION Print PROPERTY OWNE3 4D�Yanee' _ es no MAP NOD 'PARCEL: ZONING DISTRICT. NistancDtsfret, .: yes no ,I Machine Shop Village yes no TYPE OF IMPROVEytENT PROPOSED USE j Residential ! Non-Residential New Building One family j U Addition U Two or more family Industrial Alteration No.of units: E Commercial E Repair,replacement Assessory Bldg _ Others: E Demolition Other U Septic ' Well E Floodplain E Wetlands C Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: " zlam _ Phone: Address: 11 Contractor NamPhone e:: r _ Email: f t rq e x Address �--V/AA-:5�� Supervisors Construction License: Exp. Date: k Home Improvement License` Exp, a eg, W W ARCH ITECTIENGINEER Phone: Address: Reg.No. FEE SCHEDULE BULDING PERMIT:$12.00 PER 51000.00 OF THE TOTAL ESTIMATED COSTBASED ON 2125.00 PER SF, Total Project Cost: ' `y%s' # FEE:$ Check No.: Receipt No.: :Sri NOTE- Persons contracting ivith unregistered contractors do not have access to the guaranfy farad r Y Signature o , 0i Signature-ofAgentJQvrner f contractor = ` ____ __� Town of pii, � . \Andover No. All T. ;41 . 4 Ver, Mass, I • i l ���D�AiffD PP¢�•B� U BOARD OF HEALTH PERNW11 10 ILD Food/Kitchen Septic System THIS CERTIFIES THAT....09 .. ® BUILDING INSPECTOR has permission to erect...........I......: ...buildings on. Foundation a ..................................................... t p accepting ...................ry Rough to be occupied as...!,®�i......1 ..... ......................... .. ......... ......................... Chimney provided that the person acce tm this permit shall in eve 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 LESS C STRCTI SART Rough Service ........... .. ....... ................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Pernlit Reauired 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. 11raposal Page No. of Pages CHRISTOPBER J.DAVEY 0030 545 Sharpeners Pond Rd. NO.ANDOVER,MA 01845 (978)975-3736 UC.#034690 HICR#110256 7F"— PHONE JOBNAME JOB LOCATION, ARCHITECT DATE OF PLANS Iffil!PrOPM hereby to furnish material and labor—complete in accordance with specifications below,for the sum of: dollars($ P.ymbht to be made a follows: All Material Is guaractsed to be as specified.All work to be completed in a a Author roke standard practices.Any plemation or deviation from spour catiock be "Ing to sionature �ldw n-Ning extra costs will be executed only upon written orders,and wil become an Ze no extra cimmesele,Or above the as mate.Ali agreements c.onflngent upon stdkc,t,fmnn� is p may dents or de ys beyond our control.Omer to carry fire,tornado and other ra—catry al loscronce,Our workent am fully Covered by Workman's Compensation Inscrence, withdra by a not ccepted within days. a re b it specifications and estimates for: Acceptance of PrOPOSUI The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized Signature to do the work as specified.Payment.will be made as outlined above. Date of Acceptance Signature A=WU To Reorder. 800-225-6380_r nebsusorn __ ' The Cotnnaonwealth ofHassachusetts Department oflndastrialAceldents X Congress Street,Sd Ite 100 = 8oston,NIA 021-14-2017 ` www.nzess.govldia . .Worliers'Compensationlysuranca Affidavit:Builders/Contc'actorslElectricians/Plumbers. To BF,MED F4frE(TMP IT .Please print Legili A 'licantluformathal -� Name(BusinesJOig adizationtlndividuat) fr . Address: ^ ' f y`r ?` City/Statelzip ` Phone# Type of project(required); Are you vn empI}erg Checicffie aPproprIatx box: 7 ONOWdi 'strdction } 'm t ycos(full andior partAiscd, 1.❑Tam aemployerwilh � F° $. eIIAadeliiig 2-Tarn-sole pmprietoror partnership and'n ve no employees working£ozmein 9.rDemolition 'any capacity.[No Workers'camp.insnraueo required] 3.❑I am ahorueovvner doing alt work mysett[No workers'camg.insurance regaired.]r 10 0 Building addition ng eonkacors to-intent all work on my property.I'Al 11. Electrical repairs or additions 4-❑I am afromoakver ad will be fr+n W .or azo sole ono—flat all contmcters aitherhave workers'c= insu'enc --plumbing repairs or additions progxietors with no eplayaes. - eneral confracfor ndIhavebiredtha sub-canftacfos listedoatheaL+acfied sheet 13. s.E]Tamag0, []Roofrepa rs These sub-contractor hemployees andhavewarkers'comp.insurance.t 14.[]Other 5❑Weare a aaxpouni.f and its offieec+;rave oxercisedtheir right of'exeteptionper MGL°. 152§S(4)end 71 by no emgtoyees.[No workexs'comp.msarence icTdi-ed.] *Any applicant that elrecxsbox,0lm statg6iuuutthe sectionbelaw shovring theirworkers'eamperuatieapoliey information:' tGo mv.,c��hwh.v kttus b amnst atfa h 3do"ot 'shnnadditional shegsfiow;ng'hr name entside contioGtoesenot sub contr los and stafevrhethereorn flrasoeati6os,have s employees.Ifthe sub-ceo&torshve cmPloyees,they must Provide their woxkers'comg.r Illyeumlo - an,an enzployer tlsat%sprovidingworkers'compensation insurancefor my emptoyees.Below is t7aepolicy andjob site information. - � _ - 6.- f �`= t Insurance Company Name }# _ :$ . t,n - f, Expiration Date ,i Policy#or Self ins.Lie�# v_r City/State/Zip:f t y Job Site Address ` _ - J t olio number and expiration date). Attach a copy of the worliers'compensation policy declaration page(showing the Y Failure to secure coverage as requ. d uader MGL e.152,§25A is a criminal violation punishable by a fine up to$1,500.00 form ofa STOP civil pGoaffics in the and/or one tiro im rison ent y ofthis oll stat meat may be forwarded to the Office©f InvFJC a�a ons of the DIA for insurER and aline Ofulp to ance a day againstp y coverage verification. Ido Zzereby cerkfy rtdet tlse pazrzs anitgenalfies afPerjury at the inforniafion provided an is true and correct i . .` Date: Si atum: official use only.Do not write in this area,to be completed by eity or town officza7 Permit/Liceuse# City or Tovvn- Issuing Authority(circle one}: 3.CitylTown Cleric 4.Electrical inspector 9.Plumbing Inspector 1.Board of Health 2.Building Department 6.Other Phone# Contact Person: '.. Offlc��ofC m�Affa/(f &8 +tCRetanoo f'fefL7 qq V HOME tMPROVEMEN7CONTse R 8 " TYPE Individual AC70R � rV _ Rea+stration Ex"at(On 110256 t0l13/2078 Christopher J Davey Christopher Davey - 545 Sharpners Pond Rd N Andover,MA 01845 Unde-r ------ Massachusetts Department of Public Safety _. Board of Building Regulations and Standards License:CS-034690 Construction Supervisor CHRISTOPHER J DAVEY 545 SHARPNERS POND RD N ANDOVER MA 01895 Expiration: Commissioner 1210912017