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Home My WebLink AboutBuilding Permit # 10/5/2015 NORTH B ,XV.D 6 1 -UILDING PERMIT �,- - .6 - ..' 0 ................ W- TOWN OF NORTH ANDOVER b APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received "ATIED Date Issued: CHU IMPORTANT: A2plicant must complete all items on this page LOCATION C' 6A H, A,tf _S L-ANff Print PROPERTY OWNER L E 4) N Ef' NN - Print MAP NO: 7 PARCEL W2,',S ZONING DISTRICT: Historic District yesn Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building r: ne family 11 Addition [i Two or more family Ll Industrial 11 Alteration No. of units: [I Commercial kkepair, replacement [i Assessory Bldg 11 Others: 11 Demolition 11 Other [I Septic F1 Well 1-i Floodplain 1-1 Wetlands o Watershed District 11 Water/Sewer C1 '77ftiff: ffi ,-2SE`— LN,D R �- R , k5?/+AL,'T A� C H Or---: H I H (11-45 S C T", 1,A slfi'3 H A2 I Identification Please Type or Print Clearly) OWNER: Name: FPA t-o�- Phone: Address: CONTRACTOR Name: (00�- 3l" 5-18? Phone: C 4 `7 —33""? (,SQ IR Address: ry '' o, 7r-Z8 6v -1b, ' 03 ?Y"o Supervisor's Construction License: Exp. Date: CSF,A,—, ICESEV"I t6, Home Improvement License: Exp. Date* 16 ARCHITECT/ENGINEER ' Phone: Address: Reg. No. FEE SCHEDULE:BOLDING 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.: ml- NOTE: Persons contracti,,ng4*ynregistered,,contractors do not have access to the guaranty fund Signature of Agent/Owner Signature,of contractor OORT9-p ' over - A01 w n o f nu ® ® _ C,® LANE h y ver, ass,Ab COC NIC NEWICK-��• ��S RATED PP¢R.�� U BOARD OF HEALTH Food/Kitchen PERMI �T �T L RU Septic System Q/y BUILDING INSPECTOR THIS CERTIFIES THAT ................................................. ......................................................................... has permission to erect buildings on ��4�h ��+✓ S /i 6-iVe Foundation Rough tobe occupied as ..........................................::� p.....4`:... ..�.�7.1.�x .� �o ��................ 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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOTARTS Rough /® Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired t® 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. Builders Custom AGREEMENT R. B. Holmes, Inc. Custom Builders shall perform the following work on the Home of Frank and Angela Leone, North Andover,MA 1. Scope of the work (this work shall be defined by the area over the garage and the rear of the house and does not included the front of the home which does not need re-roofing) * Protect house with tarps and remove the old roofing and underlayment. * Inspect sheathing for condition. If major nailing or replacement of sheathing is necessary, it shall be billed as an extra charge. * Install new metal drip edge and apply Grace Ice and Water (HT) to the first 6' of all eaves, 3' in valleys, and around 4 skylights, 10 vents, and 2 chimneys. The remainder of the roof to have Tri-Flex roofing underlayment installed. * Install Certainteed Landmark shingles. * Install roll ridge vent as required. * Inspect chimney flashing and try to work with existing flashing Place all waste in on site dumpster and final clean of property. Price for above work: $ 15,500.00 Agreed: 0, —7 ._ � • Owner Date Ray Holmes . Date Architectural Design New Homes Renovations P. O. Box 758, 1 Bayside Road, Suite #9, Greenland, NH 03840 Phone and Fax 603. 431. 5787 Cell 207. 337. 2630 The Commonwealth of Massachusetts Department ofIndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgovIdia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aunlicant Information Please Print Legibly u,,:, LJ cb Name(Business/Organization/Individual): c -r6 tj ( Address: Y. -7 (�j 4 L A f-f b N 4 Q'S "6V City/State/Zip: 6 T!F,IF M LeVH(), f4(4 03'Plu Phone#: ( (9C) `_,S� Cf`3 1 V S'�7 Are you an employer?Check the appropriate box- Type of project(required): 1,[-]1 am a employer with employees(full and/or part-time).* 7. []New construction 2.[J 1 am a sole proprietor or partnership and have no employees working for me in 8. FJ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.FJ Plumbing repairs or additions 5,F]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.P<Oof repairs These sub-contractors have employees and have workers'comp,insurance.t 14.F1 Other 6,EE[(Ve are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] _JL *Any applicant that checks box#1 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. Iaitiair employer tliatispi-ovidiitgipoi-Irens'compensation insurance foi-niyemployees. Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofpeilmy that the information provided above is true and correct 5 Signature: Date: 7 's 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other Contact Person: Phone#: f / . Ix Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169391 Type: Corporation Expiration: 6/16/2017 Tr# 268538 R.B. HOLMES, CUSTOM BUILDERS, INC: . RAYMOND HOLMES P.O. BOX 758 -- GREENLAND, NH 03840 - Update Address and return card.Mat-It reason for change. Address Renewal 71 Employment Lost Card r ;/� i„:rnr�a�r,eeaQso"l✓r r�',”I��r�a'�R°�"Tar�<^�fi' Office of Consumer Affairs&Business Regulation License or registration valid for individul use only Al TOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: � � 2egistration: 169391 Type: Office of Consumer Affairs and Business Regulation Expiration: 6116/2017 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 R.B.HOLMES,CUSTOM BUILDERS, INC. RAYMOND HOLMES d 1 BAYSIDE RD No.9 GREENLAND,NH 03840 Undersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards 1-icense: CSFA-105544 Construction Supervisor 1 2 Family RAYMOND B HOLMES0-5 399 CIDER HILL ROAD YORK ME 03909 r r '(�_JZ7 CA-- Expiration: Commissioner 07/22/2017 Construction Supervisor 1&2 Family Restricted to: e Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS