HomeMy WebLinkAboutBuilding Permit # 4/6/2015Permit No#:
Date Issued: 1\
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
5.
IMPORTANT: Applicant must complete all items on this page
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4-11577441,;ki?4,;4;!:;AtaillitLAU: tsika4114.
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
0 Addition
0 Alteration
D One family
0 Two or more family
No. of units:
0 Industrial
CI Commercial
- El Repair, replacement
CI Demolition
0 Assessory Bldg
CI Others:
Districtv,
CI Other
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OF WORK TO BE PERFORMED:
60 ler Well IP_ -1,,,-, 4
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Identification - Please Type or Print Clearly
OWNER: Name: tj 4 t Phone:
Address:
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ARCHITECT/ENGINEER Phone: IL?'
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Address:
Reg. No.
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FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
Total Project Cost: $ < FEE: $
Check No.: 112°
Receipt
NOTE: Persons contractingi. unre tered contractors do not haveaccess to the guarantyfund
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BUILDING INSPECTOR
Foundation
Rough
Chimney
Final
BOARD OF HEALTH
Food/Kitchen
Septic System
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1800Kitchens.com
1361 'am St., SIIke 408
1\11nchr,..“cv,f,,H I 03101
(60,3) 625-4.550
MTh
MIMIREMMEMEMEMONSIMMINIMIMEEMM 11,1TEMIIMILEMMENZINESEUMMIMMIIIMMEEMENEWMINEMEN
Date: 2-Apr-15
Builder: 1800Kitchens.com
Location: 6 Village Green Drive, .Apt A.
Client: Lisa Emmons
Phone: (978) 828-6870
PAYMENT TERMS
50% Deposit prior to ordering, remaining 50% due at delivery. Ceiling Ht = 89"
Description
1
Provide and Install Fabuwood GENEVA Cabinets, Specifications as follows:
3/4" full overlay MDF door with thermofoil finish.
Sides, back panel, top & bottom: 3/4" combi-plywood
Base Cabinet Bottom: 3/4" combi-plywood
Interior: Matches door color
Hinges: Concealed 6-way adjustable clip -on hinges. Hinges open to 110°
Shelves: 3/4" Combi-Plywood
Drawers: 3/4" combi-plywood with epoxy mounted slides
Based on Site Visit and 1800Kitchen Layout dated 3/2/15
Wall Cabinet Height = 30" Crown = 2" Riser = Yes- Partial
2
Furnish and Install White Quartz Counters with Hand Made Sink
Model # AH2218 - 22" w x 18" d x 8" depth, 20" x 16" net bowl size, 8" deep
Sidesplashes - NONE Backsplash-Included to fit to brick
Height of backiplash to align to brick coursing 2" min 6" max.
3
Cabinet Hardware: Included as described below with specs and quantities.
Installation of all of the above.
5
Building Permit, Electrical and Plumbing Permit Included.
6
Demo and removal of existing kitchen. Appliances to remain.
7
Re -installation and connection of appliances
Pulls = 13- Jamison K106 bar Satin Nickel
Trash Pullout = none Rattail Video.
:8,895.00
Sink Tiltout Trays = none 27% Daacrumi
$2,395.00
EZ DW Bracket = One Included 6.25% 701a4i.t. cra/c.A. 9-0.7C
$406.25
Touch up Kit Included - I. per kitchen. VuurE Pfacm.
$6,906.25
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH T H 14 PERMITTING AUTHORITY.
Applicant Information
Name (Business/Organization/Individual): I P t• �' G( s • Cc�it�
Address:
l o ( c—w\ SA • -08
Please Print Legibly
City/State/Zip: PW-tNL"3 o /O I Phone #: — 6 2 S— 4 6 ``aC:::.
Are you an employer? Check the appropriate box:
1.0 Tama employer with . employees (full and/or part-time).*
2.1Y1-I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3.0 I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
4.0 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
proprietors with no employees.
5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractor's have employees and have workers' comp. insurance.t
6.0 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.] ,
Type of project (rrequired):
7. El New construction
8. ,emodeling
9. ❑ Demolition
10 0 Building addition
11.0 Electrical repairs or additions
12.0 Plumbing repairs or additions
13.0 Roof repairs
14.0 Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must 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-cimiractors have employees, they must provide their workers' comp. policy number.
I ant an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site
irrf0r'mation.
Insurance Company Name:
Policy # or Self -ins. Lie. #:
Job Site Address: C. U I G
of ac
Orr—. ) City/State/Zip: P P. O -
Expiration Date:
Attach a copy of the workers' compensation policy declaration page (showing the policy number 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 WORK 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,
Signature:
Phone #: 40S "
the pat
2• "
andpeties
ofperjury that the information provided ahove is true and correct.
Date:
• t
Official use only. Do not write in 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
Contact Person:
Phone #:
..;..'.)......: .-te, / '.4
...()O-111/MOlitilea&ti?, 0/,/ ''?, ,..:4Jadt(4,64/2
..
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 51.70
Boston, Massachusetts 0211.6
Home Improvement Contractor Registration.
Registration: 169993
Type: Individual
Expiration: 8/29/2015
NORRIS VIVIERS
NORRIS VIVIERS
1361 ELM STE 408
MANCHESTER, NH 03101
'CA ' 20M-05/1
//t, Mh(r ,Mrfe71,4 /(ar
Office of Cousunter Affairs & Business Regulation
HOME IMPROVEMENT CONTRACTOR
fttegistration: 169993 Type:
Expiration: 8/29/2015 Individual
NORRIS VIVIERS
NORRIS VIVIERS
1361 ELM STE 408
MANCHESTER, NH 03101
Undersecretary
Tr# 262714
Update Address and return card. Mark reason for change.
Address Renewal Employment Lost Card
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
Not vaIi1l without signature
assachuse s - Depavtment of PubUr; Safety
Board of IBuilding Re9tdations and Standards
118P4Mtf
ffiAbh U4,04,h
Liicensoa CS-108023
NORRIS P VIVIERS
1361 ELM STREET SLffl4ft
Manchester NH 0310L
-4Y
comeniiss.ioner
ExOrafion
09/27/2015
Unrestricted - Buildings of any use group which
contain less than 35,000 cubic feet (991m3) of
enclosed space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For DPS Licensing information visit: www.Mass.Gov/DPS
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