HomeMy WebLinkAboutBuilding Permit # 7/21/2015 BUILDING PERMIT 2
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TOWN OF NORTH ANDOVER 3
APPLICATION FOR PLAN EXAMINATION u c.
Permit No#:br'f5 = Date Received #3,yss4.Eo•*"'g!�
Date Issued:
P RTANT:Applicant must complete all items on this age
LOCATION
Print
PROPERTY OWNER "--s
ii
Print loo Year Structure yes no
MAP {t' I PARCEL:tt.Z ZONING DISTRICT: Historic District yes no
Machine Shop Village yes 4 no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
New Building ❑One family
❑Addition [i Two or more family ❑Industrial
G Alteration No.of units: Commercial
❑Repair,replacement Assessory Bldg ❑Others:
❑Demolition ❑Other
I\
DESCRIPTION OF WORK TO BE PERFORMED:
)Y'.,u, tom_✓-' ::err �c.sY.�. <%f.! ; .
Identification-Please Type or Print Clearly
''...... OWNER: Name: Phone:
Address - r
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Contractor Name:�4" -�`- 3'^P' Phone
Email: -•2 r < :Z C .-. -G-,u
Address.
Supervisor's Construction Licenser S —Exp. Date:
Home Improvement License' 11 -"9.2 Exp..
ARCHITECT/ENGINEER Phone:
Address: Reg.No.
FEE SCHEDULE:BUILDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED 0125.00 PER S.F.
Total Project Cost:$ /�:G`k:3_
FEE:$
Check No.: #14 7Y Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
S��nat rP of Agent/OwneL_ Signature of roPirartor
%AO TH
Town of ndover
No.
h ver,Mass, 2�Jl�
o'
ll BOARD 01 HEALTH
PERMIT T ILD S'pti,System
THIS CERTIFIES THAT CL"A', BUILDING INSPECTOR
.......... ........... .......................
C'
vI✓tii_ '.mm,mi
has permission to erect ...................buildings on JAM. ........................................ Rough
on
to be occupied as...........
. ......................................................... Zmn"
provided that the person accepting"Ithis permit shall ry 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
H.1
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUC 161 T _R-m�h
se'vice
................. rlm�l
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy BaildinQ Rm.gh
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
COVER-RIPE
Siding&Window Corp.
Siding&Window Specialists
Haverhill,MA 1015 BROADWAY Atkinson,NH
ea
603-362-9951
9ySIDIFEG60 �Stabxll6%Homeirn oementContraa,,Licx111112 WINDOWS
Sn Construction Supervisor Lic H103535
GUTTERS OSHA Certified BBBROOFING
FREE coverritecorp.com FULLY
ESTIMATES co"rritel976@gmafl.corn -- INSURED
nROPOSAL SUBMITTED TO
f ..
STREET ,.-.F, —"" EMAIL
.t
Or,STATE.AND ZIP JOB LOCATION
Color Style Insul. Window Trimt Trim Colar
JOB OUTLINE COST JOB OUTLINE COST
Siding its<. ;1 "''; Gutters
Insulation 'C> Pipe
-- �Fascia Ccver
Siding Removal -`"'`
`Fascia Board Replmt.Windows
Soffit Cover Windows
`r=e Windows Fuil-Sills '' c--`- Doors
Door Casings f'�-- `�' _ Ceiling
'6'r Shutters Roof
NOTES:
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�P fl OP05e hereby t�rmsh material and labor complete in accordance with above epeafcat ions,for the sum of;,
PAYMEN T08E MADEAS FOLLOWS: f
Note:1-141-1 may be
an o er nas insurance_�rwo ersxrerl, ger rmans om ansa ens_witbdr-,by us if not mecepted witbi days.
REfePtanre Ot PrOt.P05aLTheaeovepr—spear-roes
c 'f ry d h by eoc pt tlY. e authonzetl to do work as ure
acrdtl y' t 1111b,,n a �,nea agpue
Massachusetts Home Improvement Sample Contract
FThi, rtu satisfies all basic requvemente,£the state's Home Imrovement Contractor Law(MGL chapter 142A),but does not include standardagetoprotectkomeowneIs.Seek legaldle,if necessry-Anyperson planning horns improvements should 5t obtain a oopy of"Achusetts Consumer Gide toHomeImprov meat"bforeagreeingtanyworkmyou widen e.You may obtain a free copyby calling the of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website.
Homeowner Information Contractor Information
Name C p yN e \_
Street Addreee(de vo[oseaPost Office Hoz addross) Co0—Nam,
J>!i I
City/Icwn State Zip Code Busioess Add—(noast no lode astrez[adid—)
Daytime Phoso Evening Phone City!— ser, Zip Coda
!'G-ey VL'a- l.E"f ,�� 5 l ,f- J/T3
hailing Ad,l-o,ihdff,,o,[fibmabove) Business Phone Padenrl EarpleyetMor S.S.Num er
ms ima,ar'an-n�camano rtus.Nvm swim""eau
The Contractor agrees to do'he foliowing work for the Home, J-'
tDaccrlbe in detail Ne wmkro completed,speeifymgthe type,band,and grade oP materiels to ba used,use addi%Deal ehwts-Pae rvJ
ftp,-,Lei � S sT'.I' iii'„'.�'�y4-_ U�f� Y,�E �� ✓:J'� }-...�
Required Permits-The fHewingbuildingpermits are requited Proposed Start and Completion Sebedule-The following schedule will
and will be secured by the contractor as the homeowner's agent be adhered to unless circumstances beyond the cmarmetola control arise
(Owners who secure their own per will be
excluded from the Guaranty Fund provisions of ��'-'��.']Szan]tan...tmet,r 71 begin contracted work.
MGL chapter 142A.)
Daft when contracted work will be substantially completed.
Total ComraetPrice and Payment Schedule
The Contractor ogees to perform the work,fiam,h the material and labor specified above for lie total sum of
Payments} e made according to the following schedule'
$ f upon signing contract(not to exceed 1/3 ofthe t-1 contract pric or the sort of special order items,whichever i,greater)
$ ��by_/=/>=-or upon completion of
$ f"L"<,"byr upon completion of
$ % upon completion ofthe contract(Law forbids d,,7 n ng full payment until cowed is completed m both party's satisfaction)
The following kriaVegvipment must be special $ `� mbepaidfor
ordered before the contracted work bee m order
to meet the completion sobodule.(”) n S f to be paidfou S'ti
NOTES:(-)Including atI finance chazges('*)Law requimsths[any deposit ordown-payment required by the contractor before work begins may
not exceed the grata (a)one-[bird of the natal contract price or the acetal cost,£any special equipment or custom made material
which mus[be special to ordered th advance to meet the completion schedule.
E' esa Warr- -Ise abein ovided theeontr-etorl❑N.E11,,owrmsoftM1ewarrantvmoatbe anaeM1od to the contract
Subcontractors-The contractor agrees to be solely responsiblefor ompconn ofthe work described regardless of the actions of any tdrd
party/subeontmctoruh7ized by the cenprom,The contractor Sutter agrees to be solely responsible for all payments to all suboontmetors fr
mater'als d I b d tti nt
C,otract Acceptance-Upon signing,this document becomes a binding contact under law.Unless otherwise noted within this document,the
contract shall not imply that any lien or other,ecmity interest has bean placed on the residence.Review the fllowing eautlo¢,and notices
carefully before signing Nis contract.
• Don't be pressured into signing the contract.Take time to read and fully undemtand it Ask questions ifeomething is unotear.
• Make sure the contractor has a valid Home im t C to[ R n ti .The law remc most home improv ment contractors and
,,boonnacom,to be registered withthe Director,£Home Impmvem,nt Contractor Registration.You may tnqu¢e about oontmctor
registration by writing to the Director at 10 Park Plana,Room st
5170,Boon,NLS 02116 or by calling 617-973-8787 or 888-283-3757.
• Doe, e Do
thnt entorhave m—ance7 Ask Ne Coutraotor for his inseurenoe company rmatlov so Nat you cep confirm coverage,or ask to
see a oopy of a`$[roofof insurance"document.
• Rnowyour rights andrespossibilities.ReadthelmportantNfomiaiononthereversesideofthisfm mdgetacopyofthe Consumer
Guide to the Home Improvement Contactor Law.
You may cancel this ageement if it hes been signed at a place other than the contmc[or's normal place of business,provided you notify the
connector m writing at his/hec main oPlice or branch office by ordinary mail posted,by telegram sect or by delivery,not later Ura¢midnight ofthe
thtrd business day fllowing Ne signing ofthis agreement.See lite attached notice of cancellation fret for an explanation ofthis right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
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Homeownp''s Signrumn bachmactoES Signature
Daze Date- j
NOTICE OF CANCELLATION
YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR
OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.
IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE
BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE
INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN
BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU
CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF
THE TRANSACTION WILL BE CANCELLED.
IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT
YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN
RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR
SALE;OR YOU MAY,IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF
THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE
SELLER'S EXPENSE AND RISK.
IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE
SELLER DOES NOT PICK TIMM UP WITHIN TWENTY DAYS OF THE DATE OF
CANCELLATION,YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT
ANY FURTHER OBLIGATION.IF YOU FAIL TO MAKE THE GOODS AVAILABLE
TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER
AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL
OBLIGATIONS UNDER THE CONTRACT.
TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND
DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN
NOTICE,OR SEND A TELEGRAM TO[Name of Seller],AT[Address of Seller's Place
of Business]NOT LATER THAN MIDNIGHT OF (date).
I HEREBY CANCEL THIS TRANSACTION.
Date: Buyer's Signature:,.4—
_1L...�/ 1 .�•�i„
. The Commonwealth of Massachusetts
Department oflndustrialAceidents
__ _ I Congress Street,Suite 100
114
Boston,Imus 0gov1dl 017
www.mass.gov/dia
Workers Compensation kria-ance Affidavit:Guilders/Contractors/Electricians/Plumbers.
TOBEFILID WITHTHE PERMWIlIaGAUTHORITY.
Anuli tlnformation Please Print Legibly
Name(s,tainess/oxgan;=aaonrznaivianap: fir L=. '�' �.: ' m=
Address: ✓? ami`
City/State/Zip: /l?�kLC Phone#: ? 'ie'
Areyon an employer?Check tho appropr;aeehnt: Type of project(required):
I.❑Iam aemployerwithmployees(firll and/orpaR-time).° 7.Q New constriction
2.Q Iamasole proprietororparhruship and have no employees working for mem 8.[]Remodeling
any cepaciry.[No workem'comp.insurance regvked.] 9.[]Demolitien
3.E]I.ahomeowner d.fir,lworkmyWE(Vo w hvvcomp,ivsrvenceregnired.]t
or me so10[]Building addition
4.L]IamahmIwill
me tbat attcontrctmseitberhaveworkera•compensationinswanee to II.E]Blectdcal repairs or additions
prepiid=,affim employees. 12.[]Plumbing pairs cr additions
S.QIam ageneml com4actoravdI baveliladihe sub-cmilractwslistedonthe a'tacbedsheet 13.0 RoofrepaiTS
These anb-conhactoxs6ave eruploYees wdhaveworkexs'wmp.msuaace..
6.❑Weareacorporatipnendit of5pVrsbave exercisedtbeurigbf of'exemptionpe,NGL c. 14.�Orhei V7=✓yd - f;
152,§3(4),mdwefiave m,emploYees.[\iro workers'eomp.insurance required.] ,.
'Any applicant khat efieck tioxdl must also fill out the see5onbelow shnw'ingkheh workem'compevsationpolicy information.
t Homeownerswhosubmit'tfiis affidavit indicating they are doivgall work andtlmnldre outside contractors must submitanew affidavitieatfd ngsuch
tCon4actom that checled5s boz en¢ties have mvst'attached en additional sheetshowingE khename of Ne sub-contractors andstate vfieNier or not those
employees.IFWe sub.wvhmciurs have esploY�s,tuey must providetbeir wmkeis'wmp.poticy'mmrber.� - - '
I am au eplayer t7:at isprovidtngwarkers'compensation insurancefor my emp[ayees.'Below is thepoTcy and job site
infoaneezon.
lusmance Company Name:
Policy#or Self-ins.Lic.4:�1.t=+>P- 6 XExpiration Date:
Job Site Address: /='F' City/State/Zip:
Attach a copy ofthe workers'compepsa6onpolicy declaration page(showingthe polacynnmber and expiration date).
Failure to secure coverage as required under MGL a 152,§25A is a criminal violation punishable by a two up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to$250.00 a
day against the violator.A copy ofthis statement may be forwarded to the Offce fInvestigations ofthe DIA for insurance
overage verification.
I do hereby m and penaldes ofperjury that the information provided above is true-d correct
Soh
Phone"K-11
Official ase only.Do notwrite in the area,to be completed by city or town official
City or Town: PermittLie-se#
Issuing Authority(circle one):
S.Doardoflfealth 2.1uuilding Department 3.CitylT—Clerk 4.ELecteicallnspector 5.Plumbiaglnspector
6.Other
Contact Person: Phone#:
,klass -I.P—m—A o`°b a S e-y
c d f
C t con S
:CS 103535 �
JOAN J SERRAT91RF
15 Smn Street be