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Home My WebLink AboutBuilding Permit # 5/1/2015 OORTH BUILDING PERMIT `j4�p � t TOWN OF NORTH ANDOVER - � rit— APPLICATION FOR PLAN EXAMINATION �° V b Permit NO: Date Received i Date Issued:At t �SsAc►eus�� I IMPORTANT:Applicant must complete all items on this page LOCATIONS Print c ( PROPERTY OWNER �"�' -- �;: e... � �-- Print MAP NO: PARCEL:®" ZONING DISTRICT: Historic District yes no `Machine Shop Village yes (no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building u-One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑Septic []Well ❑Floodplain ❑Wetlands ❑ Watershed District Cl Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: k-', —k :� �e� �_S� �..._ Phone: Address: CONTRACTOR Name: Phone:' 1';I Address: Supervisor's Construction, License: Exp. Date: Home Improvement License:: Exp.' Date: ARCHITECT/ENGINEER l`Jc5 '-- � 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 Cost: $ ' ° C> FEE: $ Z602 Check No.: 6%-3 Receipt No.: 2 3 rl NOTE: Persons contracting with unregistered contractors do not have access to the guaranty,fand Signature of Agent/Owner ._ Signature of contractor 4 LL ' t 'Town of Andover h verqMass, owl - LAKE �A COCHICH9W.CK V BOARD OF HEALTH PER Food/Kitchen Septic System T LD THIS CERTIFIES WHAT BUILDING INSPECTOR permission to erect Foundation has VA p .......................... buildings on .... ........................... . .. .............•..................... Rough bcr*to be occupied as ...... .. ..... A .........�V. .... .. . ...................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this offide, 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 the2oning or Building Regulations Voids this Permit. Rough Final E PERMITI ELECTRICAL INSPECTOR UNLESS CONSTRUCT STAI a, Rough 'T Service t ............ ..... ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough j Display i ®ns is s Place on the Premises — Do Not Remove Final No Lathingall O one FIRE DEPARTMENT t Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. I i i i i SALEM PLUMBING / DESIGNER BATH Quotation 97 RIVER ST P.O. BOX 510 r�:atA•TFi�C:�;:::•<:::�:�gt�p3k.t i�14ER�:�>:: ? Y�T7�L,++DDTT 978-921-1200 Fax 978-921-1556 04/27/15 S 210 816 5 ORDER TO: --------- :;:- SALEM PLUMBING /DESIGNER BATH "- 97 RIVER ST P.O. BOX 510 1 '... BEVERLY MA 01915 '.. QUOTE TO: SNIP TO: SARAH TUCKER SARAH TUCKER 50 NUTMEG LANE 50 NUTMEG LANE NORTH ANDOVER, MA 01.845 NORTH ANDOVER, MA 01845 .::•:.•6i!`�"G¢i1EkZ:�:r1lfP!(3;�$::.;:: ;.:::::::::•x•::•:�US�Q136ft:4�i�I3.:;iit!?3Bf3t;•::.-:.;;• •.:::>:•::•::': ::;:. .. . 110860 BATHS HOUSE SALES ACCOUNT ^�,.--; . T.T........... sm.;r;.;tom.,;•:..---�: �T.;.=:::•v.::";•;:- ::-:?OF. a:::::•::- ;:::::•::.: :. .....:::• ::.;:::::::: 5t{•.3lATE...:•: •:::: E EGN3::�•t k.76R.•5: :•::4¢&3T;�{i::::•:::•.: :: ? :??>?:: r:•::::.$NX•.YIx•.:::::•f:•:'•::::• :..:;:::=':::•::::::.TERMS.::::: :•::•::.:•:.: :::•:..rf........................................ Michelle Ritchie OT OUR TRUCK Cash On Delivery 04/27/15 No :::•::.• . :QTfi:•:::::••:::: :=e83: :•-:::•'•:::::•:::::::•:>::•:::: ::;;:•::::•r:•:•>::MES&RTP3:8Q2........... ::•:.:.::::!?mt; rs ......: ...........................:: lea 284409 AMERICAN STD 2461002 011 CAMBRIDGE 524 .550 524 .55 BATH RIGHT HAND OUTLET 60 X 32 X 17 .75 ARCTIC WHITE 284409 * DO NOT USE ANY BEDDING COMPOUND *** P3 - 0806 -22 ** lea 10640 GERBER 41813 TRIP 18 DEEP ROMAN 130.392 130 .39 TUB DRAIN POL. CHROME WITH BRASS NUT 10640 lea 318200 TOTO TS220P14CP VIVIAN PRESSURE 99.280 99 .28 BALANCE TRIM (W/ LEVER HANDLE) - POLISHED CHROME 318200 ** Special Order - Nonreturnable ** lea 318253 TOTO TSPTM VALVE PRESSURE BALANCE 106 . 080 106 .08 ROUGH ONLY 318253 ** P1 - 06135-08 ** lea 362104 TOTO TS220XWl #CP VIVIAN DIVERTER 92 .480 92 .48 TRIM (3-WAY W/ OUT OFF, LEVER HANDLE) - POLISHED CHROME 362104 ** Special Order - Nonreturnable ** lea 362154 TOTO TSMXW 3 WAY DIVERTER VALVE 127 .840 127 .84 ROUGH ONLY 362154 lea 229112 HANSGROHE 04186003 SHOWER ARM AND 41.600 41 .60 FLANGE 9" POL CHROME 229112 lea 318224 TOTO TS300AL61$#CP TRADITIONAL 39 .440 39 .44 COLLECTION SERIES A SHOWERHEAD (6" SINGLE SPRAY 2.0 GPM) - POLISHED CHROME ** Special Order - Nonreturnable ** lea 318191 TOTO TS220E##CP VIVIAN TUB SPOUT (W/ 99.280 99 .28 OUT DIVERTER) - POLISHED CHROME *** Continued on Next Page *** SALEM PLUMBING / DESIGNER BATH Quotation 97 RIVER ST P.O. BOX 510 :.��T£'� Rw3�:z,;��;�": BEVERLY MA 01915 ----------. _ =921142 0_�Y ax = =1556_____....._._...._.__..___.____._...._.___.__. ....__...__._....____.__.._. .04/2.7_/15 S 210 s 16 ORDER TOc---- -----::: A :TKa : ................. ................. SALEM PLUMBING /DESIGNER BATH •"'-•"'- 97 RIVER ST P.O. BOX 510 2 BEVERLY MA 01915 QUOTE TO: SHIP T0: SARAH TUCKER SARAH TUCKER 50 NUTMEG LANE 50 NUTMEG LANE NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 ....... 1 ..... . .........•...• ME = ii:i tMBf3t.. :•...........-::•::•a•::•:•::::•::•::•REtf4c5E:::NUMBER:: ::;:•:::•::::•:::•:::•::•::•>:::•:::::•:SIf�SBf32SOft ...... :: : &ls1B31F{�,tUhBR.::::. •::. ::::::....G}fS3Q. R;Qfit?.............................................................::::•:::::._.......:•:::::::_•:::::_:::_• :_'• x _:__:-:_•::. 110860 BATHS HOUSE SALES ACCOUNT ..T :::•. :L'P..•l�k•:.: .: :::•::::•:.::•::::-. . :.:•..TB:�MS........ ....: :•::c•::•>S:HT£.ilATB:.::;•: •:;:•: E:�Gt13.:8 4...Bt>..::.: Michelle Ritchie OT OUR TRUCK Cash On . .. ,- : ' .: •D-•:e-l•;TifveTr?yf 0y�;.4�/.,p; 21 7/1T;5•; No .. .. . . .� •x. •;:,;•N ..... ... . ... . .:: _1 { %... ...• .—. . �_��.�:T:_ : __ . • .... .....•;::.t•:r:.:t:,;• 318191 ** Special Order - Nonreturnable ** lea 318239 TOTO TS300FL41#CP TRADITIONAL 49 .640 49 .64 COLLECTION SERIES A HANDSHOWER (411 SINGLE SPRAY 2.0 GPM) - POLISHED CHROME lea 318104 TOTO TS101W60#CP SHOWER HOSE 60" 42.840 42 .84 POLISHED CHROME 318104 lea 318095 TOTO TS101R#CP WALL OUTLET - 31.960 31 .96 POLISHED CHROME lea 119181 JACLO 7006VBC VACUUM BREAKER POL 29.250 29 .25 CHROME 119181 lea 318101 TOTO TS101V#CP HANDSHOWER 25.160 25 .16 ADJUSTABLE WALL MOUNT HOOK - POL CHROME 318101 lea 106195 MAA.X 135630900084 TUB SHIELD 300.300 300 .30 DELUXE CLEAR GLASS CHROME FRAME 30" WIDE 56 1/2 STD HEIGHT 106195 ** Special Order - Nonreturnable ** lea 318200 TOTO TS220P1#CP VIVIAN PRESSURE 99.280 99 .28 BALANCE TRIM (W/ LEVER HANDLE) - POLISHED CHROME 318200 ** Special Order - Nonreturnable ** lea 318253 TOTO TSPTM VALVE PRESSURE BALANCE 106 .080 106 .08 ROUGH ONLY 318253 ** Pl - 06135-08 ** lea 362092 TOTO TS220DW1#CP VIVIAN DIVERTER 85.000 85 . 00 TRIM (2-WAY W/ OUT OFF, LEVER HANDLE) - POLISHED CHROME *** Continued on Next Page *** SALEM PLUMBING/ DESIGNER BATH Quotation 97 RIVER ST P.O. BOX 510 BEVERLY MA 01915 04/27/15 s 210 816 5______..... -------------- --------- .6- rmtrm. ORDER T0: SALEM PLDMBING/ DEGIGNER BATH 97 RIVER RIPER ST P.O. BOX 510 3 BEVERLY DSA 01915 QUOTE TO: SHIP TO: SARAH TUCKER SARAH TUCKER 50 NUTMEG LANE 50 NUTMEG LANE NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 ::•:•:&a 1 S)f1k :N�fM&f&::............... iis :=:; :::=:•:• : US34At6it aRR� . .. . ........ .......... . ..................s..:...:......: .:.�..........:..... . .: . . . . . . .... 110860 BATHS HOUSE SALES ACCOUNT 41KJTE� SNTf YTk.... ii? :c; 5:: TERMS.... .. ........... . . fiT�3lAT�....::: ; E:aN3.A1nWEA..:: Michelle Ritchie OT OUR TRUCK Cash On Delivery 04/27j15 No ::•::•::•QRA£iZ-:af........ �A�i3:::N4: :;::;:;: :> ;c: : ::: : .4 Rt }ca 362092 ** Special Order - Nonreturnable ** lea 362152 TOTO TSMVW TWO WAY DIVERTER VALVE 127 .840 127 .84 ROUGH ONLY 362152 362152 lea 229112 HANSGROHE 04186003 SHOWER ARM AND 41.600 41 .60 FLANGE 9" POL CHROME 229112 lea 318224 TOTO TS300AL61#CP TRADITIONAL 39.440 39.44 COLLECTION SERIES A SHOWERHEAD (6" SINGLE SPRAY 2.0 GPM) - POLISHED CHROME ** Special Order - Nonreturnable ** lea 318239 TOTO TS300FL41#CP TRADITIONAL 49 .640 49 .64 COLLECTION SERIES A HANDSHOWER (4" SINGLE SPRAY 2 . 0 GPM) - POLISHED CHROME lea 318104 TOTO TS101W60#CP SHOWER HOSE 60" 42 .840 42 .84 POLISHED CHROME 318104 lea 318095 TOTO TS101R#CP WALL OUTLET - 31 .960 31 .96 POLISHED CHROME lea 318101 TOTO TS101V#CP HANDSHOWER 25.160 25.16 ADJUSTABLE WALL MOUNT HOOK - POL CHROME 318101 lea 119181 JACLO 7006VBC VACUUM BREAKER POL 29.250 29 .25 CHROME 119181 lea 351994 MARX 136671900084 REVEAL PIVOT 617 .500 617 .50 44-47 SILVER WITH CLEAR GLASS 71.5"HT, 3/4" ADJUSTMENT FOR OUT OF SQUARE WALLS 351994 ** Special Order - Nonreturnable ** 4ea 213930 GINGER554DGPC POLISHED CHROME 78 .400 313 .60 *** Continued on Next Page *** i SALEM PLUMBING / DESIGNER PATH Quotation 97 RIVER ST P.O. BOX 514 rm,r ,,rm mTrm, BEVERLY MA 01915 -1556-__._.__..._ ------ ___ _--------- _.___... 04/27/15 S 210 816 5 ORDER TO:--- ------- :....s>` ...... SALEM MUMXNG/ DESIGNER EATH 97 RIVER ST P.O. BOX 510 4 BEVERLY MA 01915 QUOTE TO: SHIP TO: SARAH TUCKER SARAH TUCKER 50 NUTMEG LANE 50 NUTMEG LANE NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 :....:. s ::..... .. .:::•.• 3 t . : R::ftttM6E :: :•:..:. :. t2c ::% Rk f�cSE:-AuNE3:�R............. ..;•;:.:.,.•;.;.•..;:.:. ��t�iSF91ki{.�lfkff?.::::::.•::::.........CIfS.Q�E&.QR➢E........ :::...;:.,•..::.:.,.:•.:..:.5h1E58fit54f:ii: : 110864 BATHS HOUSE SALES ACCOUNT __ __-__m _ __ _ _'X:_: :....lKZ:7:E�::::::•::::::. ::•::: •.::::.•. .: . :. :.Stflt..YJk:•:•:::::. :. . ::.. :• •::. :. :.Ti RAS:::::::::::.:::•::•::::.:�H P>i�ATE: ::•:: •::•: E.ZRtt3.•.�k4..lER.•::•. Michelle Ritchie OT OUR TRUCK Cash On Delivery 04/27/15 No -.: ,T trT t: z r ., r ,: Tr ,, T T�,r ,n t t; ,-:. ........:tTT ,-., QR R,QT.? ?A?3 ?ff?.. �IESr{T�3 tit lam t c. DEEP CORNER BASKET _ ** Special Order - Nonreturnable ** lea 103078 GINGER MOTIV 550-26 HOTELIER SOAP 39 .900 39 . 90 BASKET POLISHED CHROME 103078 lea 134875 ELCOMA 012116STA 16" GRAB BAR 77 .196 77 .20 1 1/4" SMOOTH W/ TWIST CONCEALED FLANGE POL CHROME ** Special Order - Nonreturnable ** ----------------- ----------- ---- — -- ------------- ----- ----Subtotal ------ 3466.38 This is a Quotation. S&H CHCS 0 .00 ---Sales- Tax ---- --216.65 Price are firm for 30 days, .ubj..t to change ui.thout notice after 30 day.. -Amount--Due 3683 .03 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 1600 Osgood Street Building 20,Suite 2-36 North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: 1 Va_C1 JOB LOCATION:— V'j Number Street Address Map/Lot HOMEOWNER—'5 NP'X" + Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSHVATION 688-9530 1 IFALTI 1688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department oflndustrialAceidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 . w immass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricinns/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual): C ✓� �C. �- J "�•. clt/ �1 _. Address: 79Z) City/State/Zip: Phone#: '� 6 ROG Are you an employer?Check the appropriate box: Type of project(required): LQ I am a employer with employees(full and/or part-time).* 7. ❑New Construction 2.Q I am a sole proprietor or partnership and have no employees working for me in $• �tnodeling any capacity,[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 C]Building addition 4.®I am a homeowner andwill be hiring contractors to conduct all work on my property. I will ensure that all contractors eitherhave workers'compensation insurance or are sole 11,E]Electrical repairs or additions proprietors with no employees. 12•Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c, 14.❑Other 152,§1(4),and Nye 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 sueh- tContractom 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. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. I our an employer that is providing tvortrers'compensation insurance for my employees. Below is the policy and job site information. I Insurance Company Name: Policy#or Self-its.Lie.#: Expiration Date: Job Site Address: City/State/Zip: j 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 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 ofperjuty that the information provided above is true and correct. , C t l ° r Signature: - C .-""- ate:_ Phone#• 1 �`2�" cam`- G- Official use only. Do not write in this area,to be completed by city or toivu official, City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerlc 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Pltone#: