HomeMy WebLinkAboutBuilding Permit # 6/11/2015 OF p10 oYH9
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION , y
Permit No#:° 1 Date Received *�9ss+r.HusE 4s
Datelssued:_ f
IMP®DRTANt G(te- P4M AttT'°Applicant must complete all items on this page
LOCATION 1�Y aJG'7/doVe, mT R dqt
PROPERTYOWNER i'b'`: c ty' (Cnt'k'L
Kr, 100 Year Structure Yes J no t
MAP L 5ARCEL:fj ZONING DISTRICT:_ y no
MachineShop Village y s no
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 C Assessory Bldg ❑ Others:
L Demolition L Other
'�Sepi =Welh������ ❑_F'.loodplain\ WetlarL���3 _l rsh.-d°Dls nch���`
DESCRIPTION OF WORK TO BE PERFORMED�_j �� /'
4ze- 1t#eC4ek
Identification-Please Type or Print Clearly
OWNER: Name: - a Phone: ��` �
Address: ICY 'tic 1Z �_ I G3�Y
Contractor Name: - "l'k C�+.v' r� Phone: 9),q r' '7
Email- Weiv=j s pnL4 co
Address:
Supervisor's Construction License:CS--/,o)663 Exp. Date:
Home improvement License: 13�Sy Exp. Date:
'.. ARCHITECT/ENGINEER 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:$
\Z FEE:$
�f
Check No.: Receipt No.: � =��
NOTE: Persons contracting with unregistered contractors do not have access 0 th "no anty fund
�i irP of AgPJ]f/�nai -
Town ofNO r2TFp Andover:`_
No.A.7' � �
h ver,Mass,
��9 pOa.c.E w'vaR,�9
S °U
BOARD OF HEALTH
Food/KitcheP E R M I T "mob' ILD n
�/� L� ! Septic System
THIS CERTIFIES THAT.....L..'.\........ ........ .a{.i. BUILDING INSPECTOR
J �i yI� Foundation
has permission to erect..........................building n.....f. .............8.E!`.AL1... ...... [L..J
P p' person
.g ..... ......... .... ....y .�. pp:............ Rhugh
to be occupied as....... n,ney
provided that the erson acce m this permit shall in ever res a onform to the terms of thea Ilcation mal
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
PERMIT EXPIRES N 6 MON S
IELECTRICAL INSPECTOR
UNLESS CONSTRU N�SRTS Rough
JJ 5erviee
............ ...... ........................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildin.2 Rough
Display in a Conspicuous Place on the Premises—Do Not Remove Fina'
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. game,
street N°.
Smoke Det.
FREE ESTIMATES PROPOSAL —nelinn sapa��iane
,--otic.
FULLY INSURED N I.C.Re d 138569
WRIGHT GUTTERS A"HOME IMPROVEMENT
Specializing in Seandess. All Colors Available
350 BERRY STREET. NORTH ANDOVER,MA 01845
TELEPHONE:978-5$7-2247
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The Commonwealth of Massachusetts Print Form
DepartmentoflndustrialAccidents
Office oflnvestigations
I Congress Street,Suite 100
k Boston,MA 02114-2017 -
' www.mass.gov/dia -
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(eosin orga i�ea malvianap: (A)y-'a h fi w H ems
Address:330 99_.yrm S{.
City/State/Zip: r).cver 0 vs Phone#: 9?8-C8?-ddV 9
Are an employer?Check the appropriate box: Type of project(required):
I. m a employer with dv - 4.❑I am a general contractor and[
employees(full and/or part-time).' have hired the sub-contractors 6.❑New construction
2.❑I am a sole proprietor or partner- listed on the attached sheet. 7.F1 Remodeling
ship and have no employees These sub
-conhactors have g,F1 Demolition
city.
working for me m any capaemployees and have workers' 9 ❑Building addition
[No workers'comp.insurance comp.msurance.t
required.] 5.❑We are a corporation and its 10.[1 Electrical repairs or additions
I-❑I am a homeowner doing all work officers have exercised their 1I.❑Plumbing repairs or additions
myself. o workers'comp. right of exemption per MGL
insurance
p 12.❑ ofrepairs
an required.] c.152,§1(4),and we have no
employees.[No workers' 13. Other 99J�£v-e-roof
comp.insurance required.]
*Any applicant that checks box gl mus[also fill out the section below showing their workers'compensation policy information.
4 Ho--,who submit this.,diindicating they are doiwdl work and Nen hire aide contractors mustsubmit.new affidavit indicating such.
TConirac[ors[hat check this box mus[anached an additional sheet showing the name of rhe subcontractors and smte whether or not those entities have
employees.Ifthe sub-contmcrors have employees,they mast provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees.Below h the policy and job site
information. rr
Insurance Company Name: L 6" M,u U-n-L
Policy#or Self-ins.Lie.#: Ui C$-31 S-39 87-C`1T-/ Expiration Date: 9/30/20/5_
Job Site Address: lay pf ir,UQ- PoA City/State/Zip:/t(. kyev"/IIA 0184'5
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure tosecure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties ofa
fine up to$1,500.00 and/or one-year imprisonment,m well as civil penalties in the form ofa STOP WORK ORDER and a fine
of up to$250.00 a day against the violator.Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the eams and enalties oftiertury that the information provided above is true and correct.
Si 111stel 6 3 i$
Phone#: 4?D'-C 8 olarJ r/
Official use only.Do not write in this area,to be completed by city or town official
City or Town: Permit/Licemw# -
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CS-102663
SCOTT W WRIGUT
359 BERRY ST
NORTH ANDOVER
CONTRACTOR
i�ExpiaOon: 4774P1077 DBA
WRIGHT GUTTERS
$COTT'JVRIGH
350 BERRY ST.
NO.ANDOVER,MA 01845 U.II--,