HomeMy WebLinkAboutBuilding Permit # 11/17/2015 1
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BUILDING PERMIT q1"D ,6�bb
TOWN OF NORTH ANDOVER 0 `}' Qs: ®�
APPLICATION FOR PLAN EXAMINATION
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Permit N®#:
-,..t Date Received �rR'°R^TED Pea c5
Date Issued:
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Nan- Residential
❑ New Building ❑ One family
L1 Addition [I Two or more family El Industrial
teration No. of units: El Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
Demolition ❑ Other
(+ ❑,Floo"d lain` ' „❑,1Netlands ,❑ Watershed,Distr�ct
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DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Plea. a Type or int �Ielvy
OWNER: Name: Phone:
Address: /
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Cgntractor Name r�/ �dlone5. � /
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
$9000.00 OF THE T TAL ESTIMATED COST BASED ON$125.00 PER S.F.
t Cost: ER ' pFE $ 4'T-6-D FEE SCHEDULE:BOLDING PERMIT: 12.00
Total Projec $
Check No.: Receipt N 1
NOTE: Persons contracting with unregistered contractors do not guaranty fund
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Signature of Agent/Owner ignatUr contr c
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BOARD OF HEALTH
Food/Kitchen
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PERIV11T T 111111116--" L) Septic System
f0� BUILDING INSPECTOR
THIS CERTIFIES THAT ......... .............................................. ........ .. . .. .... .....................
® ® Foundation
...
has permission to erect .......................... buildings on1.0 .9�F: .. ................... ..:.....Q.. ............
Rough
to be occupied as ...... ......... .. .-n.......... ...... .�.�. .... Chimney
provided that the person accepting this permit shall in every respect co 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT IRE IN 6 MONTHISA ELECTRICAL INSPECTOR
S
LESS 0 TR TIO Rough
Service
.........:........3. .. .........0000
............................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required 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 Approved by the Building Inspector. Burner
Street No.
Smoke Det.
DJLM Remodel*
Steve Ventola Dave Merrifield
154 Boardman ave, Melrose, Ma,02176 781-223-6629 781-789-8827
Marissa Cerasuolo I
10 Walker rd,
North Andover, Ma
H-781-944-2949
C-617-697-6933
Estimate
Work to be performed as follows:
Windows:
-Remove existing metal window
-Inspect for and repair any minor rot
-Prep opening for new window installation
-Install (4)Harvey Slim line Series white vinyl Double Hung replacement
windows with grids between the glass. Windows to be Energy Star rated with low
E and Argon Glazing.Window in bathroom to have tempered glass per building
code
-Insulate around window with expandable foam insulation and seal with approved
sealant.
-Install interior and exterior trim as needed
-Remove all debris upon completion of work
-Prices includes all labor and material
-Lifetime warrantee on windows
Patio door:
Remove existing door. Inspect for and replace any rot. Prep opening for door.
Install.Jeld Wen sliding patio door. White interior and exterior. Insulate and seal. Install
interior and exterior trim as needed to complete project. Screen door included.
Total investment- $3,950*
Respectfully Submitted- Date: Au st 11, 2015
.................
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f m/
T-'he Commonwealth ofHassc.ehusetts
Department of IndlustrialAceidents
f P d 1 Congress Street,Suite 100
y Boston,MA 02114-2017
www.mass.gov/dia
sJ' Workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING A.UTHO Y-
Applicant Information Please Print Legibly
Nalrle (Business/Organizationlludividual):
.Address: a
City/State/Zip:
Are a an employer?Check the appropriate box: `Type of project(];equired):
Z.
1. am a employer with employees(full and/or part-time).* 7. El New construction
2. I am a sole proprietor or partnership and have no employees working for me in 8. modeling
any capacity.[No workers'comp.insurance required.]
9. Demolition
3,E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 rJ Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will
ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions
proprietors with no employees. 12.Fl Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
14.❑Other
6.Q We 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.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who subniif Us 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-contractors have employees,they,must provide their workers'comp.policy number.
I am an employer that is pi•ovidlhg workers'compensation insurancefor my employees.'Below is the policy and jolt site
information.
Insurance Company Dame:
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 u GL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as w a ci 1 penalties in the Cif a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy o his eme orwarded to the Office of Investigations of the DIA for insurance
coverage verification.
X do hereby certify under t, ties ofperjury Haat the information provided above as tr^u andrect.
Signature: ate:
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.CitylTown Clerk 4.Electrical Inspector 5.PIumbing Inspector
6.Other
Contact Person: Phone#:
(;V/e Cp011.1oozcueecI'l a/CA`1caaccc/1
Office of Consumer Affairs&Business Regulatio-,
OME IMPROVEMENT CONTRACTOR
=Registration 161597 Type:
Expiration' .10129%20716 Individual `
STEPHEN VENTOLA ,-
STEPHEN
STEPHEN VENTOLA' .
154 BOARDMAN AVE.
------------
MELROSE,MA 02176
Undersecretary
Massachusetts Department of Public Safety
i Board of Building Regulations and Standards
License: CS-092687
Construction Supervisor
S
STEPHEN M VENTOLA '
154 BOARDMAN AVE
MELROSE MA 02176
i
Expiration:
Commissioner 10/02/2017