HomeMy WebLinkAboutBuilding Permit # 8/6/2015 tkoRTH
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"UILDING PERMIT ,F.D6"(
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received ATeo PPP`R5
Permit No#:/
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION JX - Nq S+' /V-
Print
PROPERTY OWNER JO On
Print 100 Year Structure yes no
I n)o
District
MAP PARCEL:—� ZONING DISTRICT: Historic District yes no
I V1
Machine Shop Village ye no
TYPE OF IMPROVEMENT— PROPOSED USE
Residential Non- Residential
❑ New Building M One family 11 Industrial
[I Addition N'Two or more family
[I Alteration No. of units: a [I Commercial
ET"Repair, replacement 0 Assessory Bldg_ 0 Others:
11 Demolition 0 Other
,No
DESCRIPTION OF WORK TO BE PERFORMED: F' V�k
06 1 ArrVelldentification- Please Type or Print Clearly
OWNER: Name: t Phone: Cl,?ff-- 63'7® -V7
r7j- � i, fi n« 01�?�
Address:-,
Contractor Name: Phone:
Email:
Address: tj, I A A 0 kV45-
Supervisor's Construction License: _Exp. Date:
Home Improvement License: Exp. Date: L/b 17
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: $ l FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to th guarantyfiund
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tkO T H
Town of Andover
0
Lh ver, Mass, L(Aci�
Q°J •ArED
� U
BOARD OF HEALTH
EmsFood/Kitchen
E RM- IT T L Septic System
THIS CERTIFIES THAT �' � �' BUILDING INSPECTOR
......... .................................. f.....:y...................................................................
haspermission to erect �� �� y.................................................... Foundation
p .......................... buildings on .. ..... .... .........
Rough
to be occupied as ...................... �(:��./shall�in
...,1°.Q.C?. ...................................................... chimney
provided that the person accepting this permi 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 EXPIRES OTHS ELECTRICAL INSPECTOR
UNLESS C TITS Rough
Service
............... _.............
BUILDING INSPECTOR Final
GAS INSPECTOR
Occupancy Permit Required t® Occupy Buildine Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Miall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. - Burner
Street No.
Smoke Det.
FREE ESTIMATES PROPOSAL
3731� /,�OPOS L Construction Supervisor
A 1 Lie.# CS102663
FULLY INSURED ITI.C. Reg,# 138569
WRIGHT GUTTERS A"- HOAM 10"ROVEIKENT
Specializing in Seamless a All Colors Available
350 BERRY STREET 9 NORTH ANDOVER, MA 01845
TELEPHONE:978-687-2247
PROPOSAL SUMMED TO PHONE DATE
STREET JOS NAMF-J LOCATIOU
CITY,STAT@ANDZIPCODE JOSSTARTDATE
goof S'�'l+� e-Kil,S'h'VjA' ra Ir'WWS o1 asl'Ult s41'IL AS doujkk ¢d Ack. Put
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d-owh ®' !`Ci v' sof' on all zave-s of f-cef- -Tc ' Gtd��' r
W 30110
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v-�-►n peAk(s), olck st, daA[P- 1 � � i? t-�[ 'filas,00 �
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We PrOpOSC hereby to furnish material and labor-complete in accordance with above specific 'orae faM sum of:$_ r 3 5 0. 0 0
Payment to be made as follows:.
3,100,00 otyleos (t
All material is guaranteed to be as specified.All work to be completed in a substantial workmanlike AuttfOri�2d
manneraccordingtospecifications submitted;per standard practices.Anyalterationordeviationfrom
above specificationsinvotvingextracostswillbeexecutedonlyuponwrittenorders,andwillbecomean Signature _.. _.
extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays
bayandourcontrnl.owner toCarryfire,tornado andatherrtaddsMry.insiirande.Our warkemarafully NOTE: This proposal may be
covered by Workmen's Compensation Insurance-Nonpayment by agreed party may resultin litigation withdrawn by us if not accepted within days.
with penalties including court cost and compensation both real and punitive.
Acceptance Of Proposal - The above prices, specifications and
conditions are satisfactory and are hereby accepted,making this a valid contract. Signature
'fou are authorized to do the woriras spe ed.Payment will be made as outlined.
Date of Acceptance: Signature
Massachusetts Home Improvement Sample Contract
This form satisfies all basic requirements ofthe state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard
language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A
Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the
Office 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 t Company Name
6�Y,\ h) C(:k\r cKt#trS
Street Address(do not useaPostOfftceBox address) y Contractor/Salesperson/ erName
I a�_ t ,q U.n),O)1 S I., Scoft W rt kf-
Cityrrovm State Zip Code Business Address(must include a stree dress)
A�/, Vel - M✓1 0/8 s 3!�b -Q_tr ,
DaytimePhone Evening Phone City/rown ��' 61ate Zip Code
Mailing Achrress(Itdifferentfromabove) Business Phone Federal Employer ID or S.S.Number
F / HomermprovementC fraclorReg.Numbs Eapkationdste
r 1 i' €9 I/ } �� l.prowuirestbatm f—hte //
// ccc JJl 6�'t L � improvement ca....mb hove � b� q(1Y//7
8„ 0 57� avand resistration number // // /
The Contractor agrees to do the following work for the Homeowner: f
(Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets ifnecessary) �
su_ ct , 'w propc�` r
Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will
and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of j Datewhen contractor will begin contracted work-
MGL chapter 142A.)
3d Date when contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of /j935-0-00
(*)
Payments will be made according to the following schedule:
$ /00.$r upon signing contract(not to exceed 1/3 ofthe total contract price or the cost of special order items,whichever is greater)
$ by / / _ or u on com letion of
$ by or upon completion of - -
$ 6 }�n nn/y
A50,50,V Q upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following material/equipment must be special $ tab&paid£
ordered before the contracted work begins in order
to meet the completion schedule.(**) $ to be paid for
NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may
not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule.
Express Warranty-Is an expresswarranty being provided by the contractor? No❑'Yes(all terms ofthewarranty must be attached to the contract)
Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third
party/subcontractor utilized by the contactor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor under this agreement
Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise rioted within this document,die
contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices
carefully before signing this contract.
• Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear.
• Make sure the contractor has a valid Home Improvement Contactor Reeistration. The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor
registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757.
• Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to
see a copy of a"proof of insurance"document.
• Know your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the
third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
Two identical copies of the contracttmmususttbe completed and signed,one copy should ao to the homeowner.TI 7 tier copy should be kept by the contractor.
_'AAA/
4Ho eowner's Signa a Contractors Signature
Date f Date
The Commonwealth of Massachusetts Print Form
--- r Department of Industrial Accidents
- Office of Investigations
g - _ 1 Congress Street,Suite 100
----tib/
Boston,MA 02114-2017
` www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly_
Name(Business/Organization/Individual): C t -
Address:
City/State/Zip: /'I(, O id VS- Phone#:
Armee,you an employer?Check the appropriate box: Type of project(required):
1.[0, am a employer with �— 4. ❑ I am a general contractor and I
employees Il nd/or part-time).* have hired the sub-contractors 6. EJ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers'comp. insurance comp, insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13. Other Sine
comp. insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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 those 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 insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: b( U e
Policy#or Self-ins. Lic.#: (J C,-- /5 --3$`J/87 0 Expiration Date: 3O'C'/5—
Job Site Address: a `acl U ra 0 S City/State/Zip: /V, 4,4ot/'n/, 0114 (V 19YS
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of
fine 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
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby ceriffy u er the eains and enalties of erury that the information provided above is true and correct.
Signature: _ Date: e Z 6 /
Phone#:
Official use only. Do not write in this area,to be 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
Contact Person: Phone#:
wCS-102663
350 URRY ' mg
Offs ° T Aft;&Mnbfts ar tip i
13069
SCOTT Wi °
360 BERRY 4T.
Nva-AMOVER,MA OIM