The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 10/5/2015 t%oRTJJ BUILDING PERMIT 1 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 0 t No#: Date Received Permi S ac�A ED US Date Issued: complete all items on this page IMPORTANT:Applicant must COMPI '?) LOCATION Pri t PROPERTY OWNER M, , C--' , Print 100 Year Structure yes no toricistrict yes no MAP PARCEL: ZONING DISTRICT:-MachineShop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential [I New Building [I one family El Industrial [I Addition Li Two or more family [I CgRifilercial El Alteration No. of units: Others: [I Repair, replacement El Assessory Bldg [I Demolition El Other DESCRIPTION OF WORK TO BE PERFORMED: CP -C> . lyv��r Print Clearly Id ficabon,Plea T e o ,e Phone: OWNER: Name: I e dicat ��d r Address: rN Q) Contractor Name: K` MA-vu�_ hone: Email, Address: Supervisor's Construction License: Exp. Date: Home improvement License: � GP � (DC Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 PER$1000-00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. C)2) Total Project Cost: $ FEE: $ Receipt No.: Check No.: ered contractors do not have access I to th guaranty fund NOTE: Persons contracting with unre is .......... OORTH town of ndover ® ver, Mass, cocw'c..ew.c.. y1' �®A04AYE® U BOARD OF HEALTH Food/Kitchen PERMIT T D!I / Septic System THIS CERTIFIES THAT ...... ✓.� ...:..... . 1: .✓.................................................................................. BUILDING INSPECTOR r r Foundation has permission to erect ........................... buildings on �........................ Rough tobe occupied as ................ ...�.1.'�. ................................................................... 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESSCTI STARTS Rough I" X", Service ........................l.... ✓.�Cj �r.....--T ..........' .46. Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required to 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. The Commonwealth of Massachusetts Department of.IndustrialAceldents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dza Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Plea s Print L,a 'bl Name (Business/Organization/Individual): -7 Address: City/State/Zip: Phone#: Areyo employer?Check the appropriate box: Type of project(required): 1. I am a employerwith . employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] ' 9. El Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 E]Building addition 4.❑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.[�Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5. I am a general contractor and,I have hired the sub-contractors listed on the attached sheet. ❑ 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its offrcers have exercised their right of exemption per MGL G. 14.❑Other 152,§1(4),and we have nn employees.[No workers'comp.insurance required.] *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. (Contractors 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-conlraciors have employees,they must provide their workers'comp.policy number. lam an employer that is providing ivorlters'compensation insurancefor my employees.'Belot/is the policy and job site information. Insurance Company Name: I Policy#or Self-ins.Lic.#: q"--,C,,C-) 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 7 ify u d pain an penalties ofpeijrrry that the information provided above is true and correct. Si nature: Date: Phone#: '" Official use ot�� 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#: t;" —-" ��e Qpan��aoazruealff a�C�/jlc�ovac�uctel� Office of Consumer Affairs&Business Regulation IMPROVEMENT CONTRACTOR egistration: r-�A 661 Type' jjqo�E xpiration: 6/21}2016 Corporation EDMUNDS GENERAL CONTRACTING,LLC. i DAVID EDMUNDS I 18 ASHFORD RD gx = HAMPSTEAD,NH 03841 Undersecretary i License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation i 10 Park Plaza-Suite 5170 Boston,MA 02116 Not id i ' ut signature 9/24/2015 Paybill-Extemal Post A,pplication Submitted Your application has been submitted and all fees have been applied to your credit card. Please print this page as your proof of submission and receipt of payment. Date Submitted: Thursday, September 24, 2015 Applicant Name: DAVID C EDMUNDS License Number: CS-104728 Agency: MADPS Process: Renew License process PLiX!!j4�irjt h�r atdc�-ii Authorization Code: 01718G Received Date: 9/2412015 3:07:23 PM Received Amount: $100.00 Massachusetts -De-pa ' rtment of Public S Board of Building afety g Regulations Construction Supervisor ,, Stanciard's License: CS-104728 DAVID CED \\\. t 61,/, "s BOX 2214 V SALEM NU 03079 CoCommissionerExpiration 10/03/2015 https:llelicense.ebs.state.ma.us/eGov[Web/PaymentResult.aspx?answer--processed&paymenCtd=15568&process=REN&fee—amount=100.0&total—amount=100.0&p... 1/1