HomeMy WebLinkAboutBuilding Permit # 12/16/2015 I
OORYH
BUILDING PERMIT
TOWN OF NORTH ANDOVER A�- 6
APPLICATION FOR PLAN EXAMINATION
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Permit No#: .p" Date Received ��Ssacwus`���y
Date Issued: 1 J
IMPORTANT: Applicant must complete all items on this page
LOCATION ro /" "
Print
PROPERTY OWNER
Print 100 Year Structure yes
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
la'Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: A e2 Phone: 2,5
Address: 17 r°
Contractor Name: � Phone
Email: _
Address: „ , � , r �� �
Supervisor's Construction License: Exp.Exp. Date: u ; ”
Home Improvement License; ' Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT,,$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925,00 PER SX,
Total Project Cost: $ > FEE: $ q
III
Check No.: Receipt No.: °”
MOTE: Persons contracting with unregistered contractors do not have ac(!ess to the guaranty fund
_ _ II
NORT1
Town of Andover
0
® �, ver, Mass, '1161 (TV
® COCHIC(WICK 1'
A04ATED PPP�`��y
S U BOARD OF HEALTH
Food/Kitchen
PEKMIT T D Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT ........ .. ............ g111 41111 ..............................................................
Foundation
has permission to erect ...... buildings on .... . t...................... ............ .....................
.................... Rough
ormto be occupied as .... ... ...... .................... .9...!®`..... .... .... .. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of a application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to.the Inspection,Alteration and PLUMBING INSPECTOR
Construction of Buildings in the Town of North Andover.
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Final
PERMIT EXPIRESIN ® B ELECTRICAL INSPECTOR
UNLESST TI A Rough
f Service
.................... ... .. ........................ . Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildin Rough
Display in s Conspicuous Place on the Premises — ® Not Remove Final
r allBe Done
FIRE DEPARTMENT
No Lathing
Until Inspected and Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
CONSTRUCTION CONTRACT
Cheryl Reade,the property owner, desires to contract with,Head Above Builders LLC,the contractor,to
perform certain work on property located at 17 Gray Street,North Andover,Ma.
1. Job Description
The work to be performed under this agreement consists of and is limited to the following:
Demolition of second story bathroom,installing new stand up shower,toilet, vanity,medicine
cabinet, insulation R-21,vent, sheetrock,paint,new subfloor, linoleum,and trim door, window
and baseboard.
II. Payment Terms
In exchange for the specified work,Cheryl Reade agrees to pay Head Above Builders LLC as follows:
$10,200.00 payable one half at the beginning of the specified work,and one half at the completion of the
specified work by cash or check.
III. Time of Performance
The work specified in this contract shall begin upon signature of contract and be completed by the 18th of
January 2016.
IV. Liability Waiver
If the contractor is injured in the course of performing the specific work, Cheryl Reade shall be exempt from
liability for those injuries to the fullest extent allowed by law.
V. Additional Agreements and Amendments
a. All agreements between Cheryl Reade and Head Above Builders LLC,related to the specified work are
incorporated iin` this contract. Any modification to the contract shall be in writing.
Homeowner: ✓ L'� Dated: 5 ��
Contractor: Dated: ! �S�
The Commonwealth ofmassachusetts
Department of1ndustrialAceldents
z. 1 Congress street,Suite 100
r
Boston,AM 02114-2017
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www mass.gov/dia
Whrkers'Compensation Insurance HTHEPERN del xIl`C�nATJT OX2TTY /plumbers.1e 'bl
TO BE J'ff Tease Print
A lxcant Tnformmtion
Name,(Businessloxganization&dividual):_
.A.ddxess: �� `` C�,
Phono#:
City/State/Zip: Type of project(required):
Are you all employe,?Check tVe aplii opiate box: 7. []Now construction
],.�am a employer with__
employees(full and/or part time).` 8. ®.Remodeling
2.Q I am a sole proprietor or parEnership aanrdnhav required,]cr pl yees working forme in 9. Demolition
any capacity.[No workers'comp.
o workers'comp.insurance required.]f 10❑Building addition
3.,❑Iamahomeowner doing allwoxkmyseli;[N roe Twill
q,❑I am a homeowner and will be hiring contractors to conduct ail work on my p pY• 11.�Di leetl Ioa1 xepa pairs or additions
ensurefhat all contractors either have workers'compensation insurance or are sole 12. Plumbing repairs-ox-additions
proprietors with-no employees. 13.O Roof zepairs
5.E]I am a general contractor and T have hired the sub contractors listed on the attached sheet.
These sub-contxactors bade employees and have workers'comp.insurance# 14.El Other
(•❑We are a corporation and ifs ofl gars have exercised their right of exemption per MGI,c. _
152,§l(4), ees. oworkers'comp.insurance required.]
and we have na efplay [N
e doing all work andthen hire outside contractors must submit an eo those entitiesindicating
have such-
*Any applicant that checks box#1 must also fill.outtho section below show compensationpolicylnformation
i Ilorneowners who stljaf tins affidavit indicating they ar g
tContraofors that checkthlsb x mfi-e tach Yall ea eY i st pr vide theirsheet showing twor els'comp Spolicy number and state whether
employees. Tfthc sub-c•Y P
em toY ees. Below is thepolicy and j0h site
X am an employer that is p�ovidzng-workers'compensation insurance for MY
information. 1-7
Insurance Company Name'
ExpirationDate:
Policy g or Self-inS,UG-#:
CitglState/Zip:
fob Site Address: page showingthe policy number and expiration date).
Attach a copy of the worker's' compensation policy declaration a criminal
Failure)to sec .152,§
ure coverage as required under MGL che form i of a STOP violation
ORDER and a fine of p to$250.00 a
and/or
one-year imprisonment,as well as civil penalties in
an against the violator.A copy of tbis statement may be forwarded to the Office of Investigations of the DTA for insurance
an
y
coverage verification.
X do hereby certify under trae paths andpenalties of pejjar.1 treat the information provided above rs true and correct
Date: fS
Si nature: (1
Phone##: '
official use onry. Do notwrite in this area,to be completed ley city or town official..
• Perznit/License#
City or Town:
Issuing.Authority(circle one):
1.Board of Health 2.Building Department 3.City]Town Clerk 4.ElectrieaT Inspector �.Plumbing Tnspec or
6.Other •
Phone#:
Contact Person:
'. Office of Consumrrer Affairs&Business Regulation�� �
SOME IMP96VEMENT CONTRACTOR
egistratioii: 171422
Type:
xpiration: - 3/1612016 DBA .
MFCO
i
BARRY.MURPHY
22 SALEM STREET.
i
BRADFORD,MA 01835
Undersecretary
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License: CS-040278
BARRY T
22 SALEM S _
TREET
HApj-HLL MA 01VE
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E.xpiratio+7
06/14/2016