The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 6/15/2015 OORTH BUILDING PERMIT TOWN OF NORTHA V 0 APPLICATION FOR PLAN EXAMINATION 0 Permit Nolos— Date Received SS US Date Issued: I............ 1 t IMPORTANT: Applicant must complete all items on this page LOCATION R) Print Wi PROPERTY OWNER Ce 100 Year Structure yes no MAP PARCEL:2Fb53'_3 Print ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT_ PROPOSED USE Residential Non- Residential ❑ New Building One family 0 w [I Addition o wo or more family 11 Industrial Alteration No. of units: [I Commercial ri 'Repair, replacement El Assessory Bldg [I Others: 11 Demolition [I Other WE', R1, i I 1 111", I,lME 111, pg F, ANO ,0 BE PERFORMED: .DESCRIPTION O 7"A 11 z,7 n, Iden ifica ion- I rlease Type or Print Clearly OWNER: Name: eP r-,r e Phone: 0(� 3 Address: Cl 5�3 1111,1' e,-A VI VL 'I 'I" Contractor Namel-7 6N/- ,� Ple,7 Phone: 17, Email: VO4/71 /011 0 Email Address T' rw Supervisor's Construction License: :t> �� ,21��5_EXP. Date: C) C Exp. Date: [Home Improvement License: I 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 C t: $ FEE: $ Check No.: 0 Receipt No.: NOTE: Persons ting with unregistered contractors do not have access to the gu ranty fund ......... nt/h 6,if W�W Mile tt®R'TH -Tow-n of ndover ® `w' 0% . i - _- V 5 0 LAKE h ver O Mass COCNICNEWICK A0 ATED p.P��,�S S U BOARD OF HEALTH Food/Kitchen PERMIT T� D Septic System THIS CERTIFIES THAT ............... ... ...14*.V.. {�.......... BUILDING INSPECTOR has permission to erect . ....................... buildings o �� 1.., yH!�/�.... Foundation .................... ....... 4 .% .. Rough to be occupied ....... ..... ........�d10&*`'.........0�!1. .. Chimney provided that the person accepting this permit shall in every respect conform to the ter 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 AV 1110 PERMIT EXPIRES 16 o TkR ELECTRICAL INSPECTOR 1,00V .VU LESS C S CT10 Rough Service momw .................. .. ... ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SHEET NO. f r ✓ C �/ DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME / ADDRESS ADDRESS DATE OF PLANS PHONE N0. � � �� .� � ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of 1-7 All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars ($ )with payments to be made as follows. Any alteration or deviation from above specifications involving extra costs i will be executed only upon written order,and will become an extra charge Respectfully .- over and above the estimate. All agreements contingent upon strikes, submitted ✓ accidents,or delays beyond our control. Per ::�: Note—this proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices,specifications,and conditions are satisfactory and are hereby accepted. You are th 'zed to do th ork as s ecified. Payments will be made as outlined above. Signature 0 Date Signature '.;.adams•D8118 - - — --- 3-12 The Commonwealtli of Massachusetts 2 .Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,llTA 021142017 www.mass.gov/dia ',. Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Le 'bl A :Information Name(Business/Organization/lndividual): Address: " City/State/Zip: , _tee 3 one#: Are you an employer?Check the appropriate box: Type of project(required): 1.Q I ama employer with employees(full and/or part-time).^' 7. F1New'construction 2.�am a sole proprietor or partnership and have no employees herring forme in 8. Remodeling any capacity.[No workers'comp,insurance required.] 9• 'Demolition 3.01 am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.[]Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12:0 Plumbing repairs or additions 5,❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.C]Other 6,❑We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we 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 lire outside contractors must submit a new affidavit indicating such. $Contractors 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 have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy andjob site infor-oration. Insurance Company Name: sExpiration Date: Policy#or Self-in .Lic.#: City/State/Zip: t Job Site Address: policy declaration page(showing the policy number and expiration date). Attach a copy of the workers' compensation 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 dohereby Certify un er the pains andpenalties ofperjury that the information provided above i true and correct. � Date: Sranatme 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#: � r ikla sa,:hu ett .:�r1' '-parf:. Brit of Rubs c 'iatety- r,ard of.Buc:-Jjng Regulations. and _tan6ards� License: CS-087785 FELIX RAMOS 48A EVE RETT AVE#8 CHELSEA MA 02150 7 F_xpirati-*n Co€lmissin„er 09114/2015 POffice of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR. egistratiort: 1,81206 Type: Expiration: 3/12/2017 DBA RAMOS DRYWALL FELIX RAMOS 26-28 BROADWAY CHELSEA,MA 02150 Undersecretary k - J