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Home My WebLink AboutBuilding Permit # 6/19/2015 BUILDING P NORTIi IT of AOR TOWN OF NORTHA \/ o r APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Q�RATEa AC05 Date Issued: PORTANT:Applicant must complete all items on this page LOCATION $µ" - .,� ,r'' ` . PROPERTY OWNER re-,(�> Print 100 Year Structure yes 11yno MAP PARCEL: ZONING DISTRICT: Historic District ye Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building_ ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial .,,Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other IN 11111rm ✓1 Ii a, DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please TT pe or Print Clearly OWNER: Name: 1'r, ; � � "; Phone: C-11 y m Address: ' 6z°, . � Contractor Name: Irv. Phone: . � E' Email , Address: w Supervisor's Construction License e o"D Exp. Date: Home Improvement License: Exp.�� Exp. Date: ARCHITECT/ENGINEER Phone: Address: ,O ,,,�, ,11-11 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: $ M*� FEE: $ q�Check No.: Receipt No.: . , NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ' AOR TH Town of I Andover 0 T' C% E ver, Mass, COC LAN NIC K WICK meq• X19,9 AORATED 10�`�.�5 S V BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ....... . ••• . Foundation has permission to erect .......................... buildings on ....... .. ..... ..... ............ Rough to be occupied as ........ ..... ..� ., .. Chimney provided that the person accepting this permit shall i very respect conform 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final .............. ELECTRICAL INSPECTOR PERMIT EXPIRES I TH. RoughLESS CONSTRUCT A . Service ..... 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. Proposal HOMEOWNER: Mathew Rogers LOCATION: 486 Wood Lane 781 249 6507 REGARDING: water damage repair PREPARATION: Remove damaged blue board,plaster and insulation in following rooms: Master bedroom 1 exterior wall and ceiling, 2nd bedroom small area under window, ceiling in entry/living room. DESCRIPTION: Electrical: N/A Plumbing: N/A Framing: N/A Insulation: Insulate exterior walls where needed with R-15 insulation. Insulate ceilings with R-30. Customer has contracted with Mass Save program and is having entire attic insulated after ceilings are fixed. Plaster: New blue-board and plaster will be installed with 1/8" skim coat and smooth finish where needed. Match and blend ceiling and walls where/if needed Trim: N/A Tile: 1 1 N/A Aardwood Floor: N/A All permits included in pricing. Structural, electrical and plumbing to be completed according to MA State building codes. Price includes on site dumpster for debris removal. As with any home "surprises"can be found with removing walls. Any"surprises"that are found and that need to be addressed with be completely explained to homeowner and repaired on a cost basis. Quote based on a basic plan provided. Costs may change up or down when plan is finalized but new quote will be provided. Estimated Cost as per quote: $ 2,300 Proposed Payment Schedule Payment upon finish l p .M Frank Carta MftthewRogers ` Micaven Contracing The Commonwealth of Massachusetts Department oflndustr"ial Accidents M 1 Congress Street,Suite 100 Boston,MA 02114.2017 N �t www.mass.gov/dia o'fM sV•1'a Workers, compensation insurance Affidavit:Builders/Contractor s/Electricians/1'lum els. TO BE FILED WITH THE PERMITTING AUTHORITI'. „please Print Le 'fol A licant Information Name(Business/Organizationllndividual): Address: - ;7 � � Phone#; Type of project(required): Are you an employer?Check the appropriate box: em to ees full and/orparttime).x 7. F]New`construat[on 1.Q I am employer with P y ain a sole proprietor or partnership and have no employees Working formain 8. Remodeling any capacity.[No workers'comp.insurance required.] 9• ❑Demolition 3.Q lam a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑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 bin repairs Or additions proprietors with no employees. JZ 0 Piutrl- g p 5.FJ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13,o Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.r!Other 6,❑We are a corporation and its,officers have exercised their right of exemption per MGL c. no employees.[No workers'comp.insurance required.] 152,§1(4),andwehave *Any applicant that check's box 41 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not(hose 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 and job site information. Insurance Company Name- Expiration Date' Policy#or Self-ins.Laic.#: City/State/Zip- Job Site Address: ompensation policy declaration page(showing the policy number and expiration date). Attach a copy of the workers'c on punishable by a fifib up to$1,500-00 Failure to secure coverage as required under MGL cies in 152, the one-year imprisonment,as well as civil penalties form of criminalis a TOP W1 ORK 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. Ido lierehy certifyaunder the pains nd penalties of per jury that the information provided above is true and,correct. •, _ Date:.. Si afore: Phone#: Official use only. Do not-write in this area,to be completed by city or town official. Permit/License City or Town: # Issuing Authority(circle one): 1.Board of health 2.Building Department 3,City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: Consumer Affairs&Busij Con erJOffice ofess gdRett OME IMPROVEMENT CONTRACTOR egistration: 3 1 xpiration 8/372379'4379_. Type: Individual FRA E.CARTA FRANK CARTA 107 GLEN RD WILMINGTON,MA 01887 '� - Undersecretary- ft Massachusetts -Department of Public Safety Board of Building Regulations and Standards License: CS-087608 cGTIS FRANK E CARTAf`JR 107 GLEN RD WnZyU NGTON 1qA