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Home My WebLink AboutBuilding Permit # 6/23/2015 BUILDING PERMIT �eaRrH qp'. a��.cLED 'g�•r� TOWN OF NORTHA V � - APPLICATION FOR PLAN EXAMINATION b® Permit No -. , Date ReceivedATEoWPP"'�y � H �t Date Issued: SSHCUS� I4V6� RTANT: Applicant must complete all items on this page n LOCATION T P ' PROPERTY OWNER °°I°""" % "relo Print �— 100 Year Structure yes no MAP ' PARCEL ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes 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 ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p r , � 0 f DESCRIPTION OF WORK TO BE PERFORMED:hem i I E4 Iden cation- Ple se T pe or Print Clearly OWNER: Name: Phone: Address: a ` Contractor Name: ryrO14, SQvze1 � " Phone Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT,MOO 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 contracting wit unregistered contractors do not have access to the guaranty fund wn SICI v / ., f t%®RTH ' f " AAT-w% 0 ' 4 E ..'1e; -ft clover All . ® _ o �.K. h ver, SSS, COC MCHe WICK[ ��' a°RAreo � U BOARD OF HEALTH Food/Kitchen R"M I i T L D I Septic System THIS CERTIFIES THAT ............... .ek.V.I, .. ..YI............................................................ BUILDING INSPECTOR .. .. ...... ..... Foundation has permission to erect .......................... buildings on .......�4.[.......� ..� .Q.✓.C..... . Rough �� to be occupied as ..... ( '.'�.�......... ..... ...........le .160 .........:................................................................ 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 IT EXPIRES IN 6 MONTHSELECTRICAL INSPECTOR v0 UNLESS CONSTRUCTION T TS 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. TOWN OF NORM ANDOVER b ^ a OFIRICE Ot-V '1600 Q,400dStrobtBurfft20,•Svite,236 z �q��A+t�o F4��d5 •X0.A AndDvex,Massadhus Dtta 0 845 S�RetzuS . Gerald A.Brown Telepl3.one(979)6S8 9545 nspeetorofn ldings vax (97.8)658-9542 tylm&if ON -PHP M- T Al?)MICATf ON ' 1'leaseprint ' DATE: SOB LOCATfON: • 4 i%� bv-� Huznbex Street Address Map): of r IN Pa&-O 97�`�7' S-34,� lame. . Home,Phone WozTc�Tione 3 —vip Code '�$e current exemption lox"13omeo�v3aers"''teas UX tentled ownex oectipied&velings to t4vo units o;r:mss�� tD allow such honteo„vers to mug.- an L-1r[Vvidual.for h're vrho t7oes notpossess a lice338e,.provided that the owzter acts as supervisor). MOW ding (Code seofzon.109,3.5, ) , .DEF.t I TION OEHOMEO•W, PI , Berson(s)who awns a parcel of:land on which helsbs resines ox intends to reside,on which there p,ox is i ufended to � ,a one or fwo Family struefures. .Apers(m who oonstructs more that one haute in a two yearpexiod shall not be c4nSidered�.�lorgeDWrlex, . Th a undersigned"homeowzzer"assumesresponszbxlity for-compliances with the State Building Code anti other Applicable codes,by-laws,rales and-xegalations. The xYndersigned"homeownex"Corti Resthat helshet3nderstands the Town Of146rthAndoverBuildingDoe arfmGnt minnuznins.Pop6o.nproceduresandx-ecluirezrtenfs C, athelshowzilcamplywith;saidpzacetTuresautl mquixeznents, , H01vM0WbMRS SI011T.AT C AWROVA L OF MUDWO OF`,EZCfAL Revised 7.x.049 ' • 1~'ozm.�omeownersExemption - ' xy •r 30ARD OPAPPBAYS-689-9541 CONTSEAWAMN 688-9534 MALTH685-954 1'L,4.N14WG 689-9535 . The Commonwealth of Massachusetts r Department of Xndustrial Accidents .em I Congress Street,Suite 100 Boston,MA.021142017 9t4 www.mass.gov/dia tib Sy.v Workers' Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PFP,?MTTING AUTHORITY. please Print Le 'bl Applicant Information Name(Business/Organization/Individual): Address: U ) v , City/State/Zip: A" V6V Are you an employer?Checlt the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).' 7. 0 New'constraetion 2.F]I am a sole proprietor or partnership and have no employees working for me in 8, emodeling any capacity.[No workers'comp.insurance required.] 9. 0 Demolition 3,Vam a homeowner doing all work myself..[No workers'comp.insurance required.]t 10 0 Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.0 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole Z-0 fetors with no employees. 1Z,[]Plumbing repairs or additions 5. a general contractor and I have hired the sub-contractors listed on the attached sheet. 13,0 Ro6f repairs These sub-contractors have employees and have workers'comp.insurance.t 14.Q Other 6.Q We are a corporation and its,officers have exercised their right o£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 'Any applicant who checksubms affidavit indicating they are doing all work and then hire 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. X 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.Lic.#: City/State/Zip: fob Site Address: ' compensation policy declaration page(showing the policy number and expiration date). Attach a copy of the workers Failure to secure coverage as required under MGL c•i52s in tviolation 0 he form of STOPWORK ORDER and a fine of up to$250.00 a and/or one-year imprisonment,as well as civil t may against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certify und�r t ains andpenalties of perjury that the information provided above is true ar d.correct. Date: 7167 Signature: 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: ABJEC HOME IMPROVEMENT Estimate DEMOLITION & DISPOSAL 48 STONE STREET Number: E261 DRACUT, MA. 01826 Date: November 28, 2014 978 458-3739 OR 978 853-4026 Ship To: Bill To: PAULANDERSON 1901 JOHNSON STREET N ANDOVER, MA 01845 978 973-3163 Amount Description BASEMENT REMODEL PREP AREA . BUILD 2X4 WALLS AROUND FOUNDATION FRAME UP CLOSET AROUND ELECTRICAL SUPPLIES. FRAME UP CLOSET AROUND HEATING SYSEM AND CLOSET UNDER STEPS. INSTALL STRAPPING ON FLOOR JOYCES FOR CEILING INSTULATION. BOX IN PIPES. INSTALL 1/2 INCH SHEET ROCK ON CEILING AND WALLS . - 1 TAPE SEAMS-AND COMPOUND WALLS AND CEILINGS. TWO COATS SAND WALLS AND CEILING FOR FINAL FINISH INSTALL SLIDING DOORS ON ELECTICAL CLOSET AND HEATING CLOSET , INSTALL HINGED DOOR UNDER STAIRS. INSTALL IX4 INCH BASEBOARD AND COLONIAL TRIM AROUND WINDOWS AND CLOSETS , PRIME AND PAINT WALLS , CEILING AND DOORS AND TRIM CLEANUP AND DISPOSAL LABOR AND MATERIALS 8,825.00 Total $8,825.001 IF YOU WOULD LIKE THIS WORK DONE, PLEASE CALL TO SCHEDULE START DATE.