HomeMy WebLinkAboutBuilding Permit # 6/4/2015 BUILDING PERMIT 1OORTH1[�FD 16
0,41
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received OlArED If'?
gssaCHUS
Date Issued:
. 4 PORTANT: Applicant must complete all items on this page
LOCATION scoimeI-C./`
Print
PROPERTY OWNER f-A" 'e-Cl:
Print 100 Year Structure yes
0)0 yes
MAP PARCEL: ZONING DISTRICT: Historic District no\\
Machine Shop Village yes, no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
0 New Building El One family 11 Industrial
El Addition Ei Two or more family
11 Alteration No. of units: El Commercial
0 Repair, replacement El Assessory Bldg El Others:
0 DemolitionEi Other
—e'
DESCRIPTION OF WORK TO BE PERFORMED:
t,, ' k I c 'rl VL S,I r
Identification- Please Type or Print Clearly
OWNER: Name: ek-l- V- f Phone:
Address: Lf e r
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License:-C 0 2 Exp. Date:_ ;:2
Home Improvement License: L-) Exp. Date: 3.
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000-00 OF THE TOTAL ESTIMATED COST BAS EDON$125.00PER SA
Total Project Cost: FEE: $
Check Na.: Receipt No.:
TE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Town of 2
tIORTH Andover
No.
Cm- h " ver,Mass, Is—
BOARD OF HEALTH
�U F..d/Klt,he
PERMIT IL Septic
THIS CERTIFIES THAT _J�0.6 ........................... ................. System
BUILDING INSPECTOR
Roundanon
has permission to erect..........................buildings on. ................... Rough
to be Occupied as... &.11 UOJ� L.....Cove--&l---—.r-_-------------_.......................... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application FinA
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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Final
PERMIT EXPIRES IN 6 MONTHS ELECrRICAL INSPECTOR
UNLESS CONSTRUCTION R.�dh
Se,vico
..g
........................................
.........................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildiu Rough
Display in a Conspicuous Place on the Premises—Do Not Remove Fw.1
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. B-.,
Street No.
Smoke Det,
PROPOSAL
"}SERB"ROUSSEAU&SON,INC.
Vinyl&Aluminum Products
316 Plain Street—Lowell,MA 01852
Free Estimates Tel.(978)4538626 or(603)321-4733
Proposal Submitted To: Job Site: Date:
Robert Henderson 414 Summer Street
41 Herrick Drive North Andover,MAS A�;.
Methuen,MA 01844
We hereby submit specifications and estimates for:
Certainteed or Mastic vinyl siding to be installed on house and garage.
Color and size to be chosen by homeowner.
Install 3/8"Styrofoam on entire home garage.
Cover all window and door trim with aluminum.
All soffit and fascia trim to be covered with aluminum and vinyl materials.
Vinyl fight blocks,and dryer vent to be installed where needed.
Yard to be left clean of all debris...........................—....$9,500.00
Optional:Install vinyl shutters....................................$65.00 per pair
All items on interior walls to be removed or secured.
Lifetime warranty on labor and materials.
---------------------------------------------------------------------------------------------------------
W e Propose bereby to famish material end labor-complata in aocordavcc with above specifications,t r the sum
Of: NINETHOUSAND FIVE HUNDRED DOLLARS AND 00/CX— 59,500.00
P bi be g fillows:Ove 0al£down wbev 304 is started avd remainder upov compledoa.
Allll—material bO- fi guaranteed to be as specified.All work to be completed in a workmanlike mariner according it sturdard practices.Any alteration
or,v, ov from above specifies volving extra costs,,b iexecuted only upon written orders,and will become an extra charge over th
above ate estimaze.All agcemenh contingent upon strikes,accidents or delays beyond our wntrol.Owner[o tarty fire,tornado and other
cessary ivsamvice.Price fs good(1, days vvless oMerwise agreed upon.
Authorized SignatureL^:==''=L`^--"
ACCEPTANCE OF PROPOSAL-The above prices,specifioatiovs and—ditions are satisfactory and are hereby accepted. You are
authorized tq dp.thc qrk pe/erZ d.Payment roll be mads as outlined above.
Date o£Acicptan
YOUR RIGHT TO CANCEL-You aR entering into a tmnsac[:om drat will result th a security interest m your home.
You bave a legal right under federal law m cancel this transaction without—t,within duce business days from whichever of the following
events o curs lest
I. the date ofthe transaction,which L the date cusmtner rims etvl sales agreement.
the date youreceved yon TmM-in-Lentling disclosures;of r
3. the date Wed this.6-17ofyour right m cancel.
ifyou cel the transaction,the security Within in acanceled.
lso thin 20.1-d,days after we receive your
t take Me steps.,—M M tot efi,d the JEA thaz Ne s urity,Ni, in your borne hes bce—6,d,,end we must amm eo you
any p
money or roperty You hit a
W
lse wifeMis transaction.You may keep any money or property we have
until we have done the thimgsmevtioaed above but you must Men offu to rehtm the money or property.If it n imp—will a Noir
fo:you to return the property,you must offer i4 reasonable value.You may offer to remm the property at your home or a Me Imam of the
properti,.hfonty must be returned to Me address below.lfwe do not take possession ofthe money or property with,20 calendar days ofyom
off,you may keep it without fitrtha obligation
HOW TO CANCEL-If you decide m—this lmnsac6o you may it,so by notifying us in writing at
316 Plaiv Street,Lowe11,VIA 01852
Yov may use any writtnn stat .t Mat is signed and dated by you and stales your in[entim to cancel,and/or you may use this vodce by dating
and liming below.Keep one copy ofthi,notice because it—Eiins important information a bout yourrigbts.
Ifyou cel by—111 telegram,you must send Ne notice no later Nan rid iig t ofthe third busi—I day Imus(
be dated)after you sign the RSA(or midnight of Me(bird business day following the I—Tthe three events listed in the sectiov`Your Right
to CanceP).[fyou seed or deliver_ r written notioeto ameel same oMer way,it mart be delivered to Me above address no later than thaz time.
I WISH TO CANCEL
Coaaamcrs simaza Date
The Commonwealth ofMassaehusetts
Department oflndustrialAccidents
1 CongressSuite 100
Boston,MAA 021 02IZ4-2027
www.mass.gov1dia
- Rorkers'Compensatlon Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED Wry,THE PERbRTTMG AUTHORITY.
A h t I f ti Please Print Legibly
Name(Businoss/organicarion/Tralwidnaq: t i'<"y is t'.��`.,�l -L—�ga U f
Address: c 1,C 2/A;A_) C,r
City/State/Zip: "� r-A Phone#:
Are yoo au Cmp10 9 Cheek tho apwmf,tbox: Tyne of projeet(required):
t.❑Iamaempinyerwithempinyeea(fml and/or part-vme)* 7.❑New construction
2.❑I am a sole proprietorerparreachip and have no employees wcrkmg forme in 8.❑Remodeling
any capacity.V1.workers'comp.inswmce required] g,❑Demolition
3.❑I a ma homeowner doing all work myself.(T.workers'cemp.insnranc required.]r 10 Building addiiloa
4.❑Iam abomwwn and williflu,ring wntraoterstoeonduetall work ov my pcoperty.Iwill 11. Electrical[epaits o[additions
we tlut ell wnnactors either have workers'compensation insurance or are sole ❑
pelpHoce withno employees. 12.❑Plumbing repairs or additions
5.❑lam ageneral contrnetor avdlhave biced the aubwntrnetms�isted ev the attached sheet 13.❑Roo£repaies
These sub-contractors have employees and have workers'comp.in umn 14.r,I,Other
b. eam acorporation and iss efficers bane ezttcised theirrighte£exempcT p 1MGL c.
152,§1(4),avdwe have no employees.[No workers'wmp.insmancer d
=My a ppliwntthatchecksbox4l mustalso fill outthesectimbdl howingtti,e—kers'compense¢on pelicy intDrmaton.
t}iom who submit[his affidavitindicatmg they aze doing all workand thenbve outside connect must submit a new affidavit indicating such
lCon rsthat checkthic box must attached an additional sludsho inz the wnce oft1w suband stale whether or no[ihose entities have
employees.Ido.b,,ewctorshaveemployees,lL,=stprovide their werkers omp.policy nember.
Z am an player that is providingworkers'compensation inmu cefor my eployees.Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expimtion Date:
Job Site Address: f a"f""' '— -City/state/zip Attics J rv�
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration data)-
Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punisbable by a 8ne 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 ofup to$250.00 a
day against the violator.A copy ofthis statement may be forwarded to the Office ofinvestigations ofthe DIA for insurance
coverage verification.
P do hereby certify an der are jaij 11 a 1 al I-2 lh,-ofpe Jury that the tnformafion provided ho ids tram and correct.
n t-
Phone,' L
Official use only.Do at write in tbis area,to be completed by city or town ofMot
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CityfPowu Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
.9LOZ/LZ/ZO
qq ✓ Z9ZI#XOfl'O'd
VZCe6Pl5S0' u �.
<<a! td 3 Inf N6uip1 �d peo9
q
-
--------------- 4�sli n S eynl
F
'sato bW'uamoi
1s Ncb�dsie .
ea snot'Iae4�W-
tlio�afenud - ON/NOS S()b]s
tlR{ 9Loz/st/9 93fjpy ebN
h113Loll of foReIld
7 InBaN ""211NOJ{N W3 4
d4l�s