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HomeMy WebLinkAboutBuilding Permit # 6/22/2015 1 FORTH 0 BUILDING PERMIT `F.D 06 5 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received rED US Date Issued: �TAN�T: Apvjp�31icant Applicant must all items on this page LOCATION Print PROPERTY OWNER 1,10, Print 100 Year Structure yes MAP PARCEL: T))41 ' ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building [4�ne family El Addition D Two or more family El Industrial El Alteration No. of units: El Commercial repair, replacement El Assessory Bldg 0 Others: El Demolition [I Other — YXNONI /[ DESCRIPTION OF WORK TO BE PERFORMED: e— Identification- Please Type or Print Clearly OWNER: Name: �,Aevver_- Phone: Address: Contractor Name: Phone: Email: Address: \j Supervisor's Construction License: C,5 - 01,6, '3� _Exp. Date: I Home Improvement License: Exp. Date: ARCH ITECTIENGI NEER 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: $ FEE: Check No.: Receipt No.: NOTE: Persons contracti g with un:egis 'red contractors do not have access to the guaranty nd TAORT-Town of Andover� a OA ® _- �o LAKE h h ver, ass, - z COCKICME W.CK } ®Ao�ATE0 1'Ir%k 5 BOARD OF HEALTH Food/Kitchen ,7ERMIT T D Septic System THIS CERTIFIES THAT ........... x... ..40..... ... .. .... . . .............i.d ...........,................................. BUILDING INSPECTOR .. has permission to erect .......................... buildings on .. ....... ..tea. .. � .................................... Foundation .................................... Rough to be occupied as ......... ... .. .......%....... ...........................'............................. 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 PERMIT E PIE IN 6 MONTHS ELECTRICAL INSPECTOR LESS C T CTIO' STA S Rough ( 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. *AME R I C A N 04/22/15 CABINET 436 Broadway Methuen,MA o1844 978-687-6825 Bill To: North Andover Housing Authority i Moreski Meadows North Andover,MA o1845 978-682-3932 PROPOSAL -3i Baldwin St. ------------------ DESCRIPTION AMOUNT Cabinets $ 2,040.00 Contractor's Choice Newberry Birch Finish Autumn _ I All Plywood Constntetion .I7o . csoN G Counters $ _. _.._go0.001 Square Edge Laminate ITravertine-#3526-77 4 Inch Backsplash Hardware $ 6g.00 Allison Knobs#53012-EB(16) I.Allison Pulls#53013-EB(7)— Tax n/a I Tax Exempt# U�2 t.., 2'72 ------- __.. Delivery _..__._. $ 85.00 .. ........... .. ._ __. _..._ Installation(cabinets and counters only,does not include disposal of cardboaq $ 775.00 Total $ 3,869.00 Please sign and date below to confirm shown above and return a signed copy to American Cabinet to place your order. A 5o%deposit is required at time of order. The remaining balance is due upon delivery. Please understand that,by signing this proposal,you will not be allowed to cancel or return all or=order. Price is subject to change once a field measurement has been taken. Signature: ( Date: z/ Thank you for your business! 7� ` �, Cabinets: Counters: Customer: Contractors Choice Square Edge Laminate North Andover Housing Authority 1 Moreski Meadows Newberry Autumn Travertine #3526-77 Standard Construction Loose Backsplash ,= North Andover, MA 01845 978-682-3932 Parts: 4 Applied Endcaps Deliver to: 1 - F331 Hardware: 31 Baldwin St. 2 - TOEKICK8 16 Knobs - #53012-EB North Andover, MA 01845 1 - MSW8 7 Pulls - #53103-EB 1 - TKC Contact: Jim Camire 978-815-6567 Installer: Scott Ozana 1072 e J34n 53a„ W1530- W3018 W3630 w M BC42-L t BC42- i I I I U WI I , I (A�'w I 00 00 Pull Blind Corr er Cabinets to appropriate) fit on both ; sides of range. o 1C 2 OD , I I , I 1 00 I 0 r 31 Baldwin I All dimensions-size designations 2 ® This is an original design and must Designed:4/14/2015 given are subject to verification on c oiooi s not be released or copied unless Printed:4/25/2015 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. NA14ousing_31Baldwin All Drawing#: 1 No Scale. The Commonwealth of Massachusetts . F Department of Industrial Accidents • w I Congress Street,Suite 100 Boston,MA 02114.2017 www mass.gov/dia ��M Sys ' Workers' Compensation Insurance Affidavit:Builders/ContractorslElectricians/,Plum els. TO BE FILED WITH THE PERMITTING AUTHOVJ#. Please print Le A ''1 cant Information fry Name (Business/Organization/Individual): eV Address: G � Ci /State/Zi 7 #• 0 x, City/State/Zip:p• A.reyou an employer?C4ecicthe appropriate box: Type of pxojeet(xecluired); ���' / em to ees full and/or parttime).* 7. ❑New'donstrtt`ation 1.I.4-66 a employer with_.---[-- p y 2.❑1 am a sole proprietor or partnership and have no employees Working for me in $• Remodeling any capacity.[No workers'comp.insurance required.] 9• Demolition 3,[]1 am a homeowner doing all workmysel£[No workers'comp,insurance required.]t 10❑Building addition 4.[j 1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole bin .e alts or additions proprietors with no employees. 1 I'llim. g p 5.Q1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 110 Rb6f repairs These sub-contractors have employees andhave workers'comp.insurance.t 14.Q Other 6.Q 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 applicantthat checks box#1 must also fill out the section below showing theirworkers'compensation policy information. Homeowners who submit this affidavit indicating they aze doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and state whether or not those.entities,have employees. 1f the sub-contractors have employees,they must provide their workers'comp.policy number. .. X am an enapioyer°that is pr'ovidingworlcer's'compensation insurance for°my empioyees. .13elow is the policy and j-o7�site information. Insurance Company Name: � Policy#or Self-ins.Lie.#: �-' •! 0 2 Expiration Date'. r/,. Job Site Address: �srr t City/State/Zip: G , �- W Attach a copy of the workers,compepsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL a.152,§25Aoft STOP nal WORK ORDER and a fine of p to $250.00 a ation punishable by a firib up to$1,500-00 and/or one-year imprisonment,as well as civil penalties in the form f this statement may be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A copy o coverage verification. Xdo raer°eby certify nd iep s andpenalties of perjury Haat the informationp;ovidedabove ise and correct _ Date: Si nature: r _1 Phone#: official use only. Do not write in this area,to he 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 Phone#: Contact Person: ' ^ # �� . °s�,s fi r ami Build' » lo ' ,! y 3 S a m� ©` saAd -6, < © k# ! — m;� / to° GS-016534JAAUS _` - « - � } 1 aEDI \ \ 030 - El- Co MmIssioler@! w \ - a�, 10/23/2015 { . \ �