HomeMy WebLinkAboutBuilding Permit # 11/10/2015 BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#:57V—.2 D/ Date Received
Date Issued Ii� }v1 `t __
—�IMPORTANT:Applicant must complete all items on Oris page
a
-MAP P=ARCEL,.��ONING DISTRI CL' Hfsj4r4c.�3istncL�Y' '.
�� � ,. Ma¢ane Shop"';Villfige,,,yds
TYPE OF IMPROVEMENT PROPOSED USE
Residential _Non-Residential
❑New Building l One family
❑Addition ❑Two or more family 'Industrial
❑Alteration No.of units: C Commercial
Repair,replacement ❑Assessory Bldg ❑ Others:
XDemolition ❑Other
' p.Septtgz a Weli. 0 Floodpl2in'.: ❑Wetlands "'D"Wa' shed District r:` dy;
" uU�ter/$e�eT r _
DESCRIPTION OF WORK TO BE PERFORMED
SkZ
Identi$catictn-Please Type"Print Clearly
OWNER: Name: W�� 'uJ�'�,'L-Fe,I-l-.r,o�c5-`r-,_ Phone:
Address:
'Contra-forSValne �i ej LS'o eW ane'
:�Su'peri<r$or s Con�ti[Ic�ioh Lleense � ��� k �Exp L�tm�`{Lp"'� �:�
ARCHITECT/ENGINEER Phone:781 335-<e��os
Address:tlA L Y� �t�r2l_ 4�Wa� mpWi2 eg.No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
/ C
Total Project Cost:$ J6S�OOc7,@a FEE:$
0 4iC
Check No.: / <``y Receipt No.: t,2
NOTE: Persons contracting with unregistered contractors o not Kve ,_ssto thegualanTyfund
6 r
-tomn of & �,oRTr�
2 T
Andover
Noe 1 sAl 6161T
® h ver,Mass,
/V
S oU BOARD OF FIEALTn
food/Kitchen
Septic System
PERM I L D
THIS CERTIFIES THAT_............ .. .A�F.. �.dl. ...,................................ ING INSPECTOR
/��� BUILD
has permission to erect..................:.......buildings on.... l ..�MS'6 ..Mode,,,,.•.....••.. ounaannn
C64
.... .... ......................�1 Chugh
to be occupied as.. II .. .,�.. �`... I........... Ra�mney
provided that the person accepting this pe mit shall in every respect conform to the terms of theapplication pmel
on rife 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Finei
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION RTSough
XRervice
... Sinal
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises—Do Not Remove a'
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. eoroef
5-et Na.
Smal<e Det.
VAWATIV
BILL TO:WattsWater@OnlineCaptureCenter.com PURCHASE ORDER NUMBER REVISION PAGE
OR FAX: 978-682-1561 CA734337 0 1 of 1
OR: Watts Water TachnologiesINTA
- --_ arm
rmpa.
PO Box 4926 Is- &p wrr OM
_t�da ri -a��1...,
Portland,OR 97208-4929 {v, ,
USA ACCT NO
ISSUED Knollmeyer Building SHIP To WATTS REGULATOR COMPANY
TO:Corporation 815 CHESTNUT ST
60
Wi Jonspin Rd NORTH ANDOVER,MA 01845-6009
Willington,MA 01887-1019 USA
USA
INCOTERMS/F.O.B.POINTv SHIP VIA 9CREDIT TERMS
NET30DAYS
LINE ITEM NUMBER/DESCRIPTION DUE DATE QUANTITY UNIT UNIT PRICE EXTENDED T
COMMENTS
Please Confirm Price&Delivery Within 48 Hours To
Fax#978-687-7873
Invoice Price Must Match PO Price
ATTENTION:Box weight MUST be 40 lbs maxia um '..
1 CONCRETE TUNNEL 12/15/15 1.0 EA 165,000.00 165,000.00 N
Site: A00
Type: Memo
Item Not In Inventory
CONCRETE TUNNEL REPLACEMENT PROJECT-
ROOF
ROJE T-
ROOF AREA H
PROJECT BASED ON GALE REPORT SUMMA RY
DATED:10/10/15 AND TEST
AND ON TEST CUTS ALSO PERFORMED ON HE
SAME DATE
BASE BID
WATTS WATER TECHNOLOGIES
815 CHESTNUT ST
NORTH ANDOVER,MA01845
Net Total
165,000.90
Tax 0.00
BUYER:Comiskey,J USD Grand Total
165,000.00
Terms&Conditions of Purchase-Rev.jl 5f14-Apply Here-in By Reference
The Commonwealth of Massachusetts
Department oflndustrialAceidents
oz
1 Congress Street,Suite 100
Boston, 0e rm
wwrumass.govIdl017
ov/din
Workers Camt,...don Iro—orce Affidavit:Bwlders/ConhactorsQClc h`'ans/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant If t' Please Print Leeibly
Noun.(Busaess/orgm,i�anonilndi,ianat):j{ —
Address:6D Sa_At �t.�'* \l ..
City/State/Zip: 1 taI o 1Phone 4:��
Areyo¢an employed G,eckthe appioprlate box; Type of project(Tegoired):
1❑Iamaempmyarwitn _empmyees(rwlanamrp¢rt-rima)= 7.❑Nawconstructimr
2.❑Imnasole Proprietor or partnership andhaveno employees working for me hr 8.❑Remodeling
any capaci,w-1,k1es'comp.insumnoe mquie,TJ
3.❑Iomahomeexmer dein Il workm sell'. kara'com d Y 9,
h.❑Iemahomaowner evd wglall be hiringy conh[nNotoowrs otrocovdnot xpi.l hw,soorkmovvcamrequ've,]t
.swill on
10[]Building
addition
Y PcoPer y
re theC all contrnetors Dither have workors'compevsation ivsnmvice orare sole 11.❑Elactlioal l'epairs or additions
p uri,t,,wian.employees 12.❑PI bingrepairs m'additions
s. agcneml contravtor ane Ibave himd the snb,,,,actom listed,,the attachedsheet. 13.VR-.cfa'epah
These sub-contractors haveemployees and have workers comp.invmance.t
6.❑Wen coryomtion evd its of5cers have oxer iced lheirrigM1[afexemp[ion per MGL c. 14.❑Othe1'
152,§1(h),and we have noemployees.[No workers'comp.insurance mgnired.] ,.-.
•My applicant that checks box#1 must also fill out the secnonbelow showing theirworkers'compensotion policy fin,—ar-
tHomeoxmers who submitthis af�d¢vltivdica[u,g Nay ore doing all work and Neniuro outside contractors mase submltxvawafHdavlt indicating woh.
tCovtreatam that checkthig box mustatfaohed an additional eheeC showiv6 No umne o£Nee„b-cankectore avdstak whether or vottMea aniitlas heva
employees,Nth,sub-caolood rs Gave employees,they must pravidefheix workeis'come.Policy number.
I ran an employer flint is providtngrvorke,s'rvmpensadion inswmrce far ny ernpldyees.'Belmu is the policy and job site
in/ormatl o.
Insurance Company Name:T'RS++b�pQ`
Penes a or se f raspp. ie.a 1 L v ���a 1 ZS _exp asonDate: l0%)t b _
lob Site Add res s:ULJ C--s Ayl'_6city/state/ZipwaA,_�ndm, "A-t,e4
Attach a copy of the workers'compensation policy declaration page(showing the policy number and aspiration 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 oneyoar imprisonmern,as well m civil penalties in the form of a STOP WORK ORDER and a fine ofup to$250.00 a
day against the violator.A copy ofthls statement may be forwarded to the Office ofvestigations fdo,DIA to,insurance
coverage verification.
Zdo herebycerdppifyQn.n ,,t,,pa,,,andpe-Ifies ofpeajurythat the if'mationprovided above is tree and correct
S'g h t�IY/1 M] Dt' d(S19lIJ
r
Official use Duly.Do notrvrit,in this area,to be c,oaplehuf by dty m'to-affl i.L
City or Town: Pearnit/Liceose d
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/T.—Clock 4.Electrical Inspector 5.Plumbing Inspector -
6.Other
Contact Person: Phone It:
M h-ett D p t ent 1 Pblim Safety
Board or 3 k1mg P 1,111W- J S nnJggga:a; j
L ens C"76330 .M.
SCOTT P BAILEYy
13 Plckman St—c ..:
Salem 111A 01970
✓,.�.�� Expiration
Commissioner' 07/15/2017
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