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Home My WebLink AboutDEMOLITION OF INTERIOR %AORT� BUILDING IT o� Ong TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: f Date Received pRnr¢n � �Ssac wus�� Date Issued: IMPORTANT:Applicant must complete all items on this page a i r la i Y " � dd ,��, y�r� �„r "rr, �,� � I� �� n✓� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other , , ,,,,, N r, r rnr I n,i e r r r r r r/ t r r Ir.it r, r /, r ., /r1 G, m , rY�li, w n.�-„o ov,� r „... or «'«ll,q. (r..r/i/rr fl r 1 + .,1 p«nr lU n1J/,✓,Yr,lroira,r¢N0 «a 1,�i ,I;(f.,,n!/1,+11,.,L I r: pr. 1 rdll.Old%VMW..JIr��Gi rG 4,,h«rIy¢.r/fir//I ) , /.EN yi 14 lfir101YN J ! !W/ J✓, / / 11 /f „r A/JlYlfl,rWe /1 �17W1 r!W NfJ ,/ 7y !r, rlN IrNI Iy,«U , f / / IJ 1,rY�1W ,! � ,�� lr l OOC�� , ,e'�IaI1,l�S, � / ,yl�/'t�erS,,�")rlk S.I' � �r DESCRIPTION OF WORK TO BE PERFORMED Identification- Please Type or Print Clearly OWNER: Name: /_ Phone: Address: , p/” i r r4 l I Mrd l c � e � � N � ! t �� / G Y01 OWN= e. p ARCHITECT/ENGINEER � , Phone: Address: tzft& " �A Reg. No. 7 FEE SCHEDULE;BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: � NOTES Persons contracting with unregistered contractors do not have access to the guaranty fund C ,T/TTi,,,,,�/'i//�lJ'lGl//l 'T/T.%/,i/r ,,,,/O.� /-/.. / Il i/ i i .,/i ,✓� ,/G /:/T „T' r,,. /,I /r�,./ „r./,/i�i�!/i, ,/// i .moi% „r / � .. �Signature;,of/Agent/Owner, %, �„J�� <Stgnature of,contractor��r;%�/�%% �/%!J%%'%/ ,/��! I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Pacicaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dwnpster on Site ❑ j THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed o n 5 Si nature COMMENTS o` ulj -w)((, -0 j b� oonnn(c Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street MISS i r ,x, r�-,r_... � �IrlYr y r l ,IRE DEPART E T Te , t(m ,ster'on�sif Jf y,,esG �� ISS � � I tkORTH Town of , nc'mtover 0% No. C, kl5fl-Ah ver, Mass, g C'"e 0 .. 1, COCHICNEWICK C5 ATED P- Ll BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System le� fit/ d- ' ��' � x_/C__ BUILDING INSPECTOR THIS CERTIFIES THAT ... ................................ ....................................................................... Foundation has permission to erect .......................... buildings on .. ...... . ............................. Rough to be occupied as .............. e.v.Ll: .. ..... ...... .......... . Chimney provided that the person accepting this permit shall in every respect conform o 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 I Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO� STARTS Rough Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t'® Occugy told lid®" 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 Good Burger 111 Turnpike street North Andover Contractor Pro. Design&Construction co.LLC Contact Wallace Wallace Cell 617-448-8998 E-mail wallaceho@comcast.net 218 Willard street Quincy mass 02169 Description Performed By Architectural Jordan N/A BOH Application B Good N/A Fire dept. Review Pro Design No Cost Site prep. Demo Complete Gutted Pro Design $4,000,00 Electrical corp.finishes Pro Design $17,500 Temp lights&power During demo Pro Design $3,500 Plumbing&gas corp,finishes Pro Design 25,000 Big Dipper Pro Design 7,500 HVAC Pro Design $8,000 Hood exhaust&fresh air Non-heated Pro Design $14,000 Interior hardware's corp.finishes Pro Design 3,800 Walls framing&finishes corp.finishes Pro Design 20,000 Slab cut/removed For plumbing Pro Design 8,000 General carpentry corp.finishes Pro Design 5,000.00 Flooring corp.finishes Pro Design 14,000.00 Millwork corp.finishes Pro Design 6,000.00 Mint Box corp.finishes Pro Design 4,000.00 Lightings corp.finishes Pro Design 6,000.00 Roofing Mall roofer Mall roofer 4,200.00 Ceilings Drop Pro Design 6,000.00 Bathrooms corp.finishes Pro Design 8,500.00 Masonry work Trenching Pro Design $2,000.00 General building supply Pro Design 23,000 Dumpster&trash Pro Design $5,000.00 permits Pro Design $1,200.00 Permits Pro Design $3,800.00 Grand total $200,000.00 1 . The Commonwealth of Massachusetts z Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE,MED WITH THE PERAUTTING AUTHORITY. Applicant Information Please Print Legibly NaMe (Business/Organizationfhdividual): , C Address:—Z-1 (,Oa City/State/Zip: `, (4 L Phone#: Are you an employer?Check&e appiro riafe box: Type of project(required): 1.❑1 am a employerwith ; employees(full and/or part-time).* 7, E]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Re oolition doling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. Dem 100 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.Q Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp,insurance.t 13. Roof repairs 6.FJ We are a corporation and its offtcers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] , �t: . . *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. 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 Tuve employees,they must provide their workers'comp.policy number.' X ain an employert/iat is pi oviding workers'compensation insurance for•my employees.'.below is the policy and job site information. Insurance Company Name: ►" f l L /`` Policy#or Self-ins,Lic.#: C 2 i ,/ r �` ( piration Date:_ r/ Job Site Address: 7t City/State/Zip: 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 e. 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 under the pains and penalties ofperjury that the information provided above is true and correct, Signature: Date: Phone#: / 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#: Massachusetts C parte ent of ll,)Hc Safe.1 ��r1 'A"� office o fCsonsumerAffAirs&BusinessrB rguiaram� ation Board of laHdnU Regualnflo and Standards t, oannwnn`arm:rusuen ."knain� ir n ��,ar� OME IMPROVEMENT CONTRACTOR egistration: 146592 Type: 8_ce nse: CS-060186 ,�Expiration: 51512015 DBA SING Y HO ��, �� "°' PRO DESIGN&CONTRUCTION 21 WOLCOTT RIIM ��2' ��' UINCY MA 02169 1 %� Q SING HO 21 WOLCOTT RD. &' tnha° uwn:ar� QUINCY,MA 02169 Undersecretary ¢:u�iaau°owner 04/28/2015 -PRO Y a M,.