HomeMy WebLinkAboutBuilding Permit # 8/26/2015 f %%ORTH
BUO
ILDING PER ZF D"..,1 1, 4,6,
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
'Permit No#: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 11 D Print
PROPERTY OWNER l °. 62 56-2 1(—1
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 11 One family
11 Addition 11 Two or more family D Industrial
[I Alteration No. of units: 0 Commercial
0 Repair, replacement [I Assessory Bldg 11 Others:
D Demolition [I Other
W"'I"' id
aw 1�10 5
xl
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address: A? t-A
Contractor Name: L(�14A.,t "2
Phone S 5"
Email:
Address:
01 /4 tl,)t s
Supervisor's Construction License: el Exp. Date:
Home improvement License: -Exp. Date:
ARCH ITECT/ENGI NEER )'%/6)A', 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: $ z) FEE: $
Check Receipt No..
NOTE: Person'scontracting with unregistered contractors do not have access the gu "a and
4-12
Siqnature of Aqent/Ownpr
Min Affu tkoRTH
' town of Anctover
® .`•. 0%
• 2.0 _
F' �O LAKE ti ver, Ma
SS'
COC NICNEWtCK '_ _
�� ORATED PPp��(5
S V
BOARD OF HEALTH
RM IT T L U Food/Kitchen
Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
............ .. ......... .. . ® ..... ...................... . .....
.. . . .. . ... .... ... .... .. .
has permission to er ct Foundation
.......................... buildings on ..�............ .1'1�.l�.......... ....... g
s �
Rough
tobe occupied as . . . .. ........... ... ... ....:......... ........ ..................................................... Chimney
provided that the person accepting this permit shall in every respect con orm 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
s
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES I MOTS ELECTRICAL INSPECTOR
0® LESS TR T
Rough
Service
........ ........... . .............................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
ccupancy Permit Required to Occupy Ruildin Rough_
Islay 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.
KITCHEN INSTALLATION TIMAT WORKSHEET - USA
smre: Sem�e Pm1der.
2$14 R..�.CDIVSTRUCT/DIW.
Cu3tomer. pate:
f€yl� Dison 719112015
Gate a Break�lOwn
Demo and Haul Away $1,877.00
Electrical $1,275.00
Plumbing $1,340.00
Tile $0.04
Drywall(Repair $1,340.00
Cabinetry/Appliances $2,701.00
Additional Charges f Permits $6Grand Sa.00
• . ii
Customer Signature: Date:
Associate Signature; Date:
C
GC Signature:
Date:
6
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702-
13;" 34;x' 22
41 29.-
2614 Kyle Olson 26 30" 14
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0
IQ
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F
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F, 0
AC/Heat van'.
T 01
1to
M
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na
X- OOR
0
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24" icy„ 1. Sink centered 11,75"off the left wail, no disposal
Z No appliances.
3. Ceiling height 97,5"
12 25."' 4. Drain the same as the sink goes into the wall..
33,„ Soffit starts 65.5"off the 1.09.75"wall, 56"w x 10-25"deep
Small.
vent in the ceiling, heat/Ac, starts 112.5"off the 109.75"
wall. centered 70.5"off the left wall , 12 I2.
All dimensions size desi-nations This is an original deli-n and must Designed: 6/28f20I5
liven are subject to verification on not be released or copied unless Printed: 6,128/2015
job site and adjustment to fit job == applicable fee has been paid or job
conditions. V order placed.
62)8 0 1621 e.k i t All DraNvin- hl: I I-No Scale,
The Commonwealth ofMassachusetts
Department of InirlustrialAceidents
F 1 Congress Sheet,Suite 100
.Boston,MM 02114-2017
www mass go-pldla
- orlsexs'Compensation Insurance Affidavit:Builders/Ctracto R7TX.tricians/1?lumbexs.
TO BEB'ILEDW;!TRTEE PER J[T7LMG please print Le 'bl
A licant Infoxxnad0u
NaMe(Bixsiness/organization/Cndividual): .
Address: -
City/State/Zip:
e.a . Z„ N f. c Phone
. Type of prosect(]'ec]uixed):
Axeyon axl„exnployex?Checltttio apliropxlate box: 7 �New construction
em to ees full andlorpart time).* construction
~
1,6 amaemployerwith____:_�__-. P Y t
2• Z am a sole proprietor or partnership and have no employees working for
me in 8. �" emOdelitig
any capacrty.[No workers'comp_insurance required.] 9, ❑Demolition
3.[A Z am a homeowner doing all work myself,[No workers'comp.insurance required.]t 10 F]Building addition
¢,Elam a homeowner and will.be hiring contractors to conduct all work on MY Property- Twill 11.❑Electrical repairs or additions
ensure that all contractors either have workers'compensation insurance or are sole 12 Plumbing repairs or additions
proprietors withno employees.
5,❑Y am ageneral contracforand Ihave lvredthesub-contractors listed on the attached sheet.
13.[]Roof repairs
These sub contracforshaYe employees andhaveworkers'comp.insruance.t 14 ❑Other
6.F]We are a corporation and ifs of[icereave
152,§ xvtkescomp suranceequrred.]NiGls e
•
zany applicantthat checks box#i must also f711 out the seetionbelow showingtheirworkers'compensation policy inbruit a nowformation.
1 Homeowners who submif khis affidavit hed an additional sheet showing the name of the sub contractoall wor amn en. side rs and state whether cr no rs must sij those entities have such.
rContractors tbat check this box mus,,
employees. if the sub-con[ractors have emplcyees,�liey must proxide their workers'comp.policy num er.
I am an employer tlzatisprdvidingworkers'compensation insur°ancefor•nzy employees.'Below is thepolicy androl�site
information.
Insurance Company Mame: '
Expiration Date:
Policy#or Self-ins,I ic.#: `
(,, /.n J City/State/Zip:
Iola Site Address: r
Attach a copy of the workers' COMis
declaration 12 page(showing the policy number and expiration dfate).
500.00
Failure to secure covdrage as required under MOL C.15 inthe forma of Criminal TOP violation
ORDER and a fine of up to$250.00 a
and/or one-year imprisonment,as well as civil penalties
day against the violator.A copy of this statement may be forwarded to the OfO.ca of Investigations of the JA for insurance
coverage verification.
'led above is true and cor'r'ect.
ai and�penalties ofp �t
ery ur that thein or'rnatzon r•ovi
under'the p
.f p
Y do/iereby cert under ._.,
- ',
Date:
Si nature ~~ a
Phone##: .
Official use only. Do not write in this area,to he completed by city or town official.
PermitlLicense#
City or Town:
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/'I.'own.Clexlr 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Phone#:
Contact Person:
Office of Consumer Affairs&Business Regulation f Licens6 or registration valid for in `
n:
- dividul use only
OME IMPROVEMENT'CONTRACTOR before the expiration.date. If"found return to:.
egistration: 118509 Type: Office of Consumer Affairs and Business Regulation
Expiration: 3/29/2017- DBA 10 Park Plaza-Suite 5170
Boston,MA 02116
R.J.CONSTRUCTION
RICHARD MADISON
3 MADISON AVE
GROVELAND, MA 01834 Undersecretary Rt-dNotvali thout signature
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-030000
Construction Supervisor
RICHARD J MADISON
3 MADISON AVE
GROVELAND MA 01834
Expiration:
Commissioner 07/21/2017