Loading...
HomeMy WebLinkAboutBuilding Permit # 12/11/2015 ILO R Yy BUILDING PERMIT of tLED ,��tio TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received QDRRTE76, �SSACHUS Date lssued.jr--)�-"Oz� J76 P®RTANT: Applicant must complete all items on this page LOCATION �� Print PROPERTY OWNER/ "Il _ �;✓�r;�, 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 ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septict ❑Well ❑ Floodpla[n ❑Wetlands ❑ WatersnedDistnct r >rR r [�Water/Sewer ,, ,. . ., v, DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: r, Contractor Name: O)- dwloro � �� ?e Phone: Email: a�.til�� 1 A4 Address: `i uf`1Q v,' 3f Supervisor's Construction License: Exp. Date: 20 f Home Improvement License: / / Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASr ON$125.00 PER S.F. $ Total Project Cost: $ 6) FEE: j Check No.: Receipt No.: DOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ----— – - -- - - —--- -----.. .- -..- --- --- ---- — --- --- ttOR T H Town ofAndover2 0 ;�- ":' 0 ® ® t _ C, �.KE h ver, ass, COC HICHEWICK �1` ®S 4A-rED 11 BOARD OF HEALTH Food/Kitchen Pr= KMIT U L D Septic System THIS CERTIFIES THAT . .. BUILDING INSPECTOR . .. . . . ....... . OIL has permission to erect build' on . Foundation p .......................... .... .... .. ...... ... ................................... �� Rough tobe occupied as ..................... ..................... .................... ............................................................. Chimney provided that the person accepti g this permit shall in every res t 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 O T S ELECTRICAL INSPECTOR CONSTRUCTUNLESS T Rough TML�� Service ............. .... ........................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy BulldinRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingr Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. --- ------------ n(/ �.. � �. �,", ()v"I �j pa s MgaN t PROPOSAL NO, DATE BID NO. ARU' TELT TO PHONE NO. DATE OF PLANS PKAC-e�� ADDRESSTWORK TO BE PERFORMED AT: FA 70 /')i Af pej(,4, 0 )-t r- We hereby propose to furnish the materials And nprfnrm fhp labor necessary for the co letion of I / , T , j f 6 Area below for=dditlonal description and/or colmpleted ltpfdork to be performedin accqrdalce with the rawings d submitted for above work and 1a7l)STIT in a substantial workmanlike manner for the sum of Dollars ($ with payments to be made as follows ACCEPTANCE OF PROPOSAL The above prices,specifications,and conditions are satisfa0pry and pr6e)rby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. '01 Signaturya Date Signaturb"�, M.*..adains°N 3818-50 11-12 The Commonwealth of Ma OW Usetts .Department of IndiustrialAceldents M P s 1 Congress Street,Suite 100 Boston,MA 02114-2017 5yiy� www.mass.gov/dia Workers:,Compensation InsuranceA_f:rjdavit:Builders/Contractors/EXectFicians/Plumbexs. TO BE FILED VfT-H THE PERMITTING A.UTiIORT.TY. A. lxcan-Information Please Print Ileaibly Name($usiness/Organization/ludividual): 9 • 4 .A.ddxess: G /State/Zi c, Phone#: / �C� ZC P—S V,ty p• • Are you an employer?Checktlie appiropriate box: Type of project(r;equired): em to ees full and/or art time , 7. []New, construction 1. I am a employer with •.. _ P Y ( p )'• 2. I am'a sole proprietor or partnership and have no employees Working£or me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am ahomeowner doing allworkmyself[No workers'comp.insurance required.]t 10 0 Biffl(�ing addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.[(Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole . .1 proprietors with no employees. 12: _}Plumbing repa7xs-Or additions 5.F]I am a general contractor and I have hired the sub-coiztractors listed on the attached sheet. 13._W Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.❑Other 6.F]We are a corporation and its offigers have exercised their right of exemption per MGL c. 152,§1(4),and we have etnpl ky s.[No workers'comp.insurance required.] - FAny applicant that checks liox#i must also fill outthe section below showing theirworkers'compensationpolicy information. Homeowners wfio subriiit this affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such. zContractors 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-contracfozs Tuve employees,they must provide their workeis'comp.policy number. X that is ps ovidirzg wor hers'eompensatiorz insurance for•my employees.' below is the policy and job site am an erriployer information. rnsuxance Company Name: Policy#or Self-im.Lie.#: Expiration Date: rob Site Address- City/State/Zip: Attach a copy of the workers' compepsation 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 inthe 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 luvestigations of the DrA for insurance coverage verification. X do hereby cerci rider th anus rtdpenalttes ofperjurn,�treat the znforrrtation pr ovided above is true �e�� Si nature: C Date: C. /jj Phone#: Offtcial use only. Do riot write in this area,to be completed by city or town official.. City or Town: # Issuting Authority(circle one): 1.Board of ITealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Sa,ct44 'I i 3aa�A1� 0 0 ' c �or»icg 9Q ,, rase- B O V sig A C�CI3� J®��OCTOR �196U 51 Office of Consur,:cr Uaari s&Business Re:;ulation O�17E.IMPROVEMENT CONTRACTC• " egistrtion`. 181116. Typa: { Expiratio:jc' -2/25/2017-- DBA-, I ANALORO CONSTRUCTION . JOSEPH ANALORO 51 PROCTOR CIRCLE PEABODY,MA 01960 Undersecretary