HomeMy WebLinkAboutBuilding Permit # 6/9/2015 TOWN OF NORTH ANDOVER
G1 APPLICATION FOR PLAN EXAMINATION
Permit NO: L 'tv Date Received
Date Issued: '.
IM 1 ANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Rre�s' ential _ Non-Residential
❑New Building r ne family
❑Addition ❑Two or more family ❑Industrial
'1+AZaration No.of units: ❑Commercial
fl
❑Repair,replacement Assessory Bldg II Others:
❑Demolition ❑Other
b Septip q Well ❑Floodplain/ ❑Wetlands ❑Watershed District
b UVater/,ewer'
DESCRIPTION OF WORK TO BE PERFORM D:
�i�RG-61A a49
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
it y
/ ,i r N�
CONTRACTOR Name 4JtfF one
1111/11/
SGpervisorsGonstrucflonLlce�se/,wi /r ExprDate �^�/ Chi
ARCHITECT/ENGINEER ?-' ,.Phone:
Address: Reg.No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost:$ 1-/7 7 FEE:$__
Check No.:� Receipt No.: 2
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/OwnA '(A'-'4` Signature of contractor
Plans Submitted i Plans Waived Certified Plot Plan❑ Stamped Plans❑
i
Dimension
Number of Stories: Total square feet of floor area,based on Exterior dimensions.
Total land area,sq.ft.:
ELECTRICAL:Movement of Meter location,mast or service drop requires approval of
Electrical Inspector Yes—No--
DANGER
esNoDANGER ZONE LITERATURE: Yes —No--
MGL
oMGL Chapter 166 Section 21A-F and G min.$100-$1000 fine
NOTES and DATA— F'or department usel
0 Notified for pickup- Date
D-13taldmg P—it Revised 2010
Town of NORTN Andover
No.
*� h * ver,Mass, a(�
9
PERMIT T 0 S u ILD BOARD OF HEALTH
Food/Kitchen
1_•�- �/y� Septic System
THIS CERTIFIES THAT...............4 ,....... /'?�^7. r.........1..'.�!I�.rI�. BUILDING INSPECTOR
....................................
Foundation
has permission to erect/.jln.....................buildings on.. ........�. . .OIrK,.....��.....
►4�Y/l• ,4.f/f1�! .......................................................... Rough
to be occupied as...... Q.Q.1!!1................ chimney
provided that the person accepting this permit shall in every respect conform to 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. Rough
Final
53 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI ST S R gh
................ .... ...... - ........................... Fnal
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Roagh
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.
Street N°.
Smoke Det.
.NJ ROBERTLAN E 1
ONE Building&Remodeling,LLC
Homeowner Infarnaation Contraetar Informatics.
Name icompany Nam.
SrtP}aN,,is .yktt� .^,IL),, Y ;�Vr�R—' 414-'
Sneer Address(do not use a Port Office Boa address) Conn tor/Salesp-W Owner Name
Cityffown stats zip Code eosin...Address(most include a sneer address)
n.uRt� AN;�i'IPf�7yli} OI�LIS `�5 �,lj.t,� sT
Daytime Phone Evening Phone Cilya— State Zip Code
777,!F/G' l06 1 nl0- AN XE'P VA- C,1211
--_Mulling Addmss(R differeotfmm above) liIr G-- C/ •Federal employer M or S.S.Nmnbey26 C�( +Z4
noma,m�am,��camcvIm 1.11-1
n�i�aooe,rc
r.,a..a�d���a�rm�raome r
i-- ,m�wo�onr�odaen�l��e. �
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The Contractor ag....to do the fallowing w-k to,the Homeowner
(Desoribe in detail the work to completed,specifying tre Type,brand and grade of materials to be—d,upe additional scets'fhne rv.)
t3 v/
PAP,In nom,- ;IJ 8 �ncxd�, /us ,°a- 6-'-e-Z M c €
!j 1NC LIcfJi 99'- RDS
�EAT C
l Required Permits-The following building permits me required Proposed Start and CompletionSchedule-The Rulawing schedule will
I and will be s cored by the contractor as the homeowner's agent: be adhered to unless chmmstan...beyond the connaetots eoatrol arise
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of '7(Date whop eonhaemr will begin eonnacted wodc
MGL chapter 142A.)
Date when eonh'aclad wot9c will be substantially completed.
f
Total Contract Price and Payment Schedule
The Contractor agrees to perfirm the—In Punish the material and labor specified above for the total stun of.
Payments will be made according to the following schedule:
11+1
rupm,completion of
$ by / / r upon completion of
$ �G neon completion ofthe contract(Law forbids demanding full payment until cont—is completed to built party's smisgunion)
The followiugmate..Vannipmem must bespecisi to b.paid for
ordered before the sumeted—1,begins in order
to meet the completion sehedulo.(+s) $ _be paid for
NOTES:f°)Including all finance charges(-)Law requires that any deposit or do—n,symeat regiirxd by the contractor before wodc begins may
not eeceed the greater of(a)ane-third of the total ounnact price or(b)the actual cost of.,special equipment or weNm made mazerial
which must be sp.oiai ordered in advanoc to meet the wmpkli-schedule.
Ex es War v-I Ivo" "ddb t fr [ N ❑Y (1P fh b tlabd 3 t
Snhcoetractors-The contractor agrees to be solely responsible for completop of the wodc described regardless of the actors of any third
pmTy/svbcontl'aelor nliliz»d by the contrectm.The contractor further agrees to be solely respon 7>le for all payments to all subcontlactors for
materials and labor under this a t
Contract Acceptance-Upon signing this document becomes a binding contract under law.Unless otherwise noted within this document,the
contact shall not imply that any lien or otber security interest has been placed on the residence.Review the fu➢owing cautions and notices
carefully before mooing this oat ad.
n Don't be pressured into signing the contract.Take time to read and fully undersiavd it.Ask questuvs if somei'hmg is unclear.
e Makes re the contractor has b valid Rune I n t Cono actor Regishation.The h-req,ures most home improv eat...Poem,and
subconnaeton to be registered with the Director of Home Improv ent Contractor Regisnaton.You may inquire about contractor
registration by writing to the Director at 10 Park Placa,Room 5170,Boston,MA 021 i6 or by calling 617-973-8787 or 888-283-3757.
Does the c-hasm,have insurance?All,the Commoam for his insurance company information so that yen can confirm mveag,.or ask to
I=copy of a"proof of insurance"dumrment
your rights and responsibilities Read the Important Infomratmi on the re—side fthis to=and get a copy of the Consumer
Ovide to the Home Improvement Connaem,Law.
Yon may cancel this agreement if it has been signed at a plane other than the mnneemes normal place of business,provided you notify the
contractor in writing of his/her main of,,,or branch office by ordinary mail posted,by telegnemse u or by delivery,not layer than midnight ofthe
third business day following the signing ofthis agreement.See the attached notice of cancellation farm for an-planatio2 ofthis right
ISO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM
iwo identical cup of the covrcxet conn be comp eted and signad.Ov pyA. go[v@ehomemmer.Theodsercopy—Idbel p yto.ftaavr.
R h
Hume—b",I.mo—b"s siammu e V cmmmemr'a s gnamre
Date Date
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The Commonwealth ofMassachuselts
Department oflndustrialAccidents
t G Office oflnvestigattons
r,. 600 Washington Street
`dna jt Baston,MA027I7
www.mass gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print'Leeibly
Name lsusimss/Orgmintionnndividuap:(�Q iGeR'T I—AQ'�O
Address:-79<- Si
city/State/zip: N +ND c� n4 A phone#: 9 7 ?63 c'o7
Are you as employer?Check the appropriate box: Type of project(required):
1.❑I am a employer with 4.❑I am a general contractor and I 6.❑New construction
employces(Find a nd/orpart-time).x have hired the sub-contractors
2. I am a sole proprietor or parhter-
listed on the attached sheet./ touting
hip and have no employees These sub-contractors have 8.❑Demolition
workingfor mein an workers'comp_insurance. 9. Buildingddition
my 5 ❑We are a co o tion and its ❑ a
[No workers'wmp.insurance officers have exercised their 10.❑Electrical repairs or additions
required] right of exam n e MGL I LE]Plumbing repairs or additions
3.El I am a homeowner doing all work gh pdo per
myself.[No workers'wmp. c.152,§1(4),and we have no 12,❑Roofmpams
insurance required]t - employees.IN.workers' 13.❑Other
comp.insurance required.]
*Any appiiwnt thatchecks box41 most also fill outtEe secrion below sM1owing Ncir workers'wmpevsation polity information.
r uaacaeJ r 6 sub mit this amdavit indictingthey,ldoingallwork sad then hfffi.s-conhsaorsmustsubmitsnew affidavit indicating such.
tContrae[ors that check this box mns[attached an additional sheet showing the name of Ne subcovtmcmrs anl ihcir—&—'—p-polity information.
I am an employer that is providing workers'compensation insurancefor my eytoyees,aetow is the policy andjob stte
information.
Insurance Company Name:
Policy if or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy ofthe workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition ofcriminal penalties of 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.Be advised that a copy ofthis statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
J do herebycl fye¢r ryu ter t airygand penaaiu ofperjury that the information provided above is true artd correct
m fJ/'A_(� l/,.� -e-.-t�� Dat
Phone#: Ft
O.ffctat use only.Do not write in this area,to be completed by cityor town official
City or Town: PermitJLicense#
Issuing Authority(circle one):
I.Board oflfealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone M.
B Rg.1,/en,_
Offae ofC 1T Ars& gulanon
POME IMPROVEMENT CONTRACTOR
;IRegistratton: 111990 Type:
�� 'Exp-tm: J1112017 LLC
ROBERT LANGEVIN BLDG&REMOLDING LLC.
ROBERT LANGEVIN -
795 DALE ST
N ANDOVER,MA 01845
�G Os-002685 C
ROBERT M LANOEV7N hx
795 DALE ST
N ANDOVER NM 01845
02/24/2016