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Home My WebLink AboutBuilding Permit #1054-15 - 98 LYMAN ROAD 6/15/2015 t%ORT6f BUILDING PERMIT O� Tteo 6�R.O TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION oq .coinewmn Permit No : Uj— —(J— Date Received qssATEDACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION � � R yI Print PROPERTY OWNER /(�'�G'r�� 4" �Vt,,C - ��rt Print 100 Year Structure yes no MAP Cw�_,� PARCEL: � ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Re idential Non- Residential El New Building One family El Addition ❑ wo or more family 11 Industrial Alteration No. of units: ❑ Commercial ❑Npair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other F®off tai s 011, dsersME ®strl Ut 5 ESCRIPTION �OF OR TfJ BE PERFORMED: � � a ( -7 4-0 eJ' Iden 'Bic ion- lease Type or Print Clearly _ E39 3_r`o)4;z OWNER: Name: ./(./�r �� C' � Phone: Address: .,s`-% L,� Contractor Name: C_ � � ��P Phone: � Email: 01, �C "`-� d Address: /� 1 C /' Icf Supervisor's Construction License: -:L-�ixp• Date: 0 Home Improvement License: a 6 Exp. Date: ARCHITECT/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 Project C t: $ C FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the gu rarzty fund r t%ORTH P )W1. )f Andover 0 Y' 0 No. 1J5 f- ) Imp ) Illvw� h ver, Mass, coc.uc«ew1c.c �1 RATED i'P��'�� S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ... ...�.�.�1��.......... V.O.V1106.......................................... BUILDING INSPECTOR �'. �..,. has permission to erect . ....................... buildings o ........................ ....... Foundation Rough to be occupied ............................ Chimney provided that the person accepting this permit shall in every respect conform to the ter 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 MOTkR ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO RoughService .................. .. ... ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry (Nall To.Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. PROPOSAL NO. SHEET NO, ellj; Q� DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME ///., Poll- � ADDRESS ADDRESS DATE OF PLANS � A� PHONE N0. � � �� .� � ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars ($ 5- v )with payments to be made as follows. Any alteration or deviation from above specifications involving extra costs Ile- will be executed only upon written order,and will become an extra charge Respectfully over and above the estimate. All agreements contingent upon strikes, submitted accidents,or delays beyond our control. Per Note—this proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices,specifications,and conditions are satisfactory and are hereby accepted. You are th 'zed to do th ork as s ecified. Payments will be made as outlined above. Signature 0 Oate Signature B.?,,adams,D8118 3-12 The Commonwealth of Massachusetts Department of IndustrialAccidents n 1 Congress Street,Suite 100 Boston,MA 02114-2017 9V` www.mass.gov/dia SY•V Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO Bt,FILED WITH THE;PERMITTING AUTHORTTY. Please Print Le 'bl Applicant Information Name(Business/OrganizationAndividual): Address: Tfi 41 City/State/Zip: j'QG�. ..�� ►�►`.phone Are you an employer?Check the appropriate box: Type of project(required): 1 I am a employer with employees(full and/or part-time).* 1. F1 NeW'cOristruetlonIF] 2,Hl`an�n a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. [')emolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑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 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Rbdf repairs These sub-contractors have employees and have workers'comp.insurance? 14.I]Other 6.❑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.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors 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 have employees,they must provide their workers'comp.policy number. X am an employer Mat is providing worlters'compensation insurancefor my employees. Belortv is the policy artd job site information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy n wumber 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 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. c v hereby certify un er thepains andpenalties ofperjury that the information provided above is true and correct. B^ Date: Siggature. Phone#: Official use only. Do not write ill this area,to be 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 5.Plumbing Inspector 6.Other Phone#: Contact Person: i _ 9� iassachusetts, -0--part-Abht of Pui�iic., Oy: $card of.Bu,lda�ag Regulations and Stan fard5�, C� t�•ricti'no Supervitini Mr License: CS-087785 FELIX RAMOS �18A EVERETT AVE#80m 3 1 CHELSEA MA 0150 ,.i �r. ✓. -�' :�r �:�,., Expiration 's` Ccrrrmissin;�er 09114/2015 ca�tma�iiar�ell�r a �i�taurelf... .. Off of Consumer Affairs Bc tiusmess Regulation OME IMPROVEMENT CONTRACTOR. egistration 181206 Type: _ Expiration 3/j2/2017. DBA RANIOS DRYWALL&'<t r FELIX RAMOS 26 28 BROADWAY � w 1, CHELSEA MA 02150. ^ Under,secretary' i