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HomeMy WebLinkAboutBuilding Permit # 6/29/2015 V%O BUILDING PERMIT %-FRTH D ".6 - TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No# Date Received ArEv Date Issued: T WPORTANT:Applicant must complete all items on this page LOCATION ;-73 0:ecl R�A— P t PROPERTY OWNER D(?i1*,QS cx,�,- Print 100 Year Structure yes n ZONING 6) MAP PARCEL: G DISTRICT: Historic District yes 46, Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Onefamilyfamily [I Addition [I Two or more family El Industrial El Alteration No. of units: El Commercial "KRepair, replacement El Assessory Bldg El Others: /El Demolition El Other I 1,10111'r 06 "K �", "(2fRAIMMAIRM fl, e I In �p► (A , r n f / till I fie s, edrm ' )`1' DESCRIPTION OF WORK TO 13E PERFORMED: C_ Lcoe cle(-Ltv\!� bc,(l d ec K--- Identi�cationL-elevas�.�Te o PrintClearly OWNER: Name: 12 \r\ -3, Phone: C( A�C Address: c��3 keck , .,- �Jn H"Jo-W.'r Contractor Name: tky,k5kr P h o ne:C(ff-ed6` Email: q I Address: S-qS �L-4", ?`-6' ck-"r Supervisor's Construction License: I b, Exp. Date: 0I I Home Improvement License: L d Exp. Date: /0/16 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: $ FEE: hl Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Z". 70MI7770, ✓ IAORTH I own of Andover ® _ Alt Y : C% LAKE ver, ss, lb COCHICKew'c« �'�' Qo�A-rED BOARD OF HEALTH Food/Kitchen L U Septic System THIS CERTIFIES THAT ........ . .... . . . . ® L BUILDING INSPECTOR Foundation has permission to erect .................. buildings on .... ••••••• Rough ......, ..:...........®...... .. .......... s u h moms �1 tobe occupied as .........:�'............. ........................ ...... ... ..... ............... .. ... � .... Chimney provided that the person accepting this permit shall in every respect form 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 , ONTHS S ELECTRICAL INSPECTOR UNLESS CONSTRU Rough Service ............ ....... .............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Lathingor Dry Wall To Be one FIRE DEPARTMENT Until Inspected r e the Building Inspector. Burner Street No. Smoke Det. �I1VUVli1 alU Page No. of Pages Pon(" p° x Ji V I' P 6"v�frdk�,W6 � rp Odsn �"aC.V wl 'fir Pf m "ge°�vrf"AT R, 4"rkiA 0 3 84 5 i 1,011111114 (978) M-3736 PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME CITY,STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE P 1 t 4POSP hereby to furnish material and labor—complete in accordance with specifications below,for the sum of: f d I ' '} dollars($ ). Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike i manner according to standard practices.Any alteration or deviation from specifications be- Authorized low involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, acci- dents or delays beyond our control. Owner to carry fire, tornado and other necessary Note:This proposal may be insurance. Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. We hereby submit specifications and estimates for: 1 j i r r f5 Arreptaurr of Proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature � ax "'` to do the work as specified.p Payment will be made as outlined above. Date of Acceptance: �" 6 Signature P„ttfwk•? r61.k r) "r,k'b ax,uYe'r NOTICE NOTICE w TO a TOA EMPLOYEES W EMPLOYEES INDUSTRIALThe Commonwealth of Massachusetts DEPARTMENT OF ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http®//www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21,22&30, this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-9761 L60-3-1 4) 10-02-14 TO 10-02-15 POLICY NUMBER EFFECTIVE DATES x CHARLES A SLEE AGCY INC 25 ATLANTIC AVENUE 0 MARBLEHEAD MA 01945 NAME OF INSURANCE AGENT ADDRESS PHONE# DAVEY, CHRISTOPHER J . 545 SHARPNERS POND ROAD NORTH ANDOVER MA 01 845 a— EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE h MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services d provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 004680 W20P1G02 T POSTED fllfassachuse�+s soar; tui' inLie �t'.,e--$V P eaulons a I 013 Su n cl '034690 54SIS�Qpj�R N SPNm? pm W 018' _ ICY Ly 1210912016 r. 1 _ c `— ffic � F¢�rtrrzr care�c�cl o. e of consumer Affairs&g r�JC laujac%reel . aME/MPROV 1'1ENT usiness Regulation gistration: 11 COIV7-RgCTOR CHRIS �xpiratio 0256 _ 1011312016 T Type: OPyn:ER J.DAVEY Individual CHRIS TOp8SR DAVEY 545 SHARPNERS N ANDOVER, MA POI\I PON©RD 4 Undersecretary