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Home My WebLink AboutBuilding Permit # 12/22/2015 BUILDING PERMIT 6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received CHU5 Date Issued: YMPORTANT: Applicant must complete all items on this page 'i JYF xq,P° PARCEL re gy TYPE OFIMPROVEMENT PROPOSED USE Residential Non- Residential El New Building El One family El Addition 'U , Two or more family El Industrial El Alteration No. of units: El Commercial ',Repair, replacement El Assessory Bldg 0 Others: El Demolition 0 Other aru, epic,,,-,,, , e 5"d 'bt n'd��'"',` ff -d'D- 'U /2 m DESCRI P,..T 1qnQ.F WORK TO BE PERFORMED: Pr le'ociq, /V N r7/-Z., en"C' 7e Jo Please Type or Print Clearly OWNER: Name: f�J-�Q Plhone:6//Zg��3 0 -V Address: 4 7 '13i U,111/"Fol P 'w' e:, Contractor h 177 I 001114"W", 54";,"," ge§ L�2-11 V I a ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.VZOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED.ON$125.00 PER S.F. ATotal Project Cost: 0a FEE: $ Check No.: L/rx�� Receipt No.: NOTE: Persons contrac6g with un d contractors do not have access to the guaranty fund i of,contractor , BUILDING PERMIT 0. t�®DY H .1�o .� yG',,1, O TOWN OF NORTH ANDOVER � - Z. ® i,;. .'. APPLICATION FOR PLAN EXAMINATION _ Permit Noft: Date Received �RA�RgrEoWPe¢y^�� AC US Date Issued: IMPORTANT: Applicant must complete all items on this page ilr'rx ,ra f a r„r'. air .�" �. ✓ r�, rr r r r „1 r f t t tea , f r 1 r tr m' 7 4� .l"R;r JI. r y,. _Y rA..:,l } � J �^..� 4 vy�iftN F x y ?'I-:. r ..:�..`, ±" r" Y'„=,rr✓,7^r�...�r r � �•i 7 , r � yty r-. ,•�;r ,.}�11 �i,.4�. lfrr�rus -r:,,Zu ,. y ,Punta' :d.11 r ,Z s+ „�' .l�`ct��s rJ r � r -.r t j, r r r�J r',+�,, "I.�• r✓� ,r � ,�`w rJl' :SJ .! � r Y i,C /I r' .r'r r'" rx F{rt'•'4r��~ �f vjx ,e Y� 1 .1r�"p-Y� r �::. r xr�.:�.I` �� r -;rr� "r��.:.""c�',r,,•`} Kr s r :.f �,, �r'f r ,.ry rf t^' ar stPJ ,r�� 7�r� ;,."` 1kr� � r... `�✓r yl �, r� �� v f f; � fft��f r fi r N� �,irvr.F�is .'p 1 f y' r r r �;;r r�":• -rr- �r��•. "� ,cr�+x r ...Etcy'C �-. w,� �rx.,rm m?n ,x.,:s ,� �y� - f t.".. r y::: �� arra J ,y.:� ,^�y ,rf`....r ,' ;:?`. fir' ,r%f ley'Y a r. � .€, '� M. .; 'r,>J^ E "" ��,,,•Y�� 1 ',. rrJ<'i'r� € t v v"'.•=. yr;.�rrr,r�� 'm' .� w/1 .?,F'i, rF F��arlra�r rrr:r` r � • -,, ,,..;,.-", �. — et H � _ ^MAPS` r,u lPARCEL� 1, y r h ZONING DISTRICT Historic Districtrfrr,, esti nog r M Y Sho Machine p Village ye no.. - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition R,Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑`Welk ❑�Floodplam ❑ Wetlands• b", District Ai x ❑_ ,UVater/�ewerr = t s ,- x 1 _ DESCRIPTION OF WORK TO BE PERFORMED: ��l�c.li� ,��/�"�7'/.��` ,��2iL��4'°+"l, �=—eJt.i,"' ��(✓.er�� 5 /`"tTC.•✓�"�i`® , d/�G`a� d ®° 1,f c�.. ��i' /� N �✓ a G >�,i>,r Com' C�" Identification- Please Type or Print Cleary OWNER: Name: '�� i✓. - � Phone: ''I l I rl'1 � Address: Contractor Naive ✓ tilPhone: c, Ern"ail Address ` fi id ! ?% i .Gr rf21 v r t 4 l S iG l yd J 0� Supervisors�Construcfion License � �`� t ��` � _ Exp Daterr� r � `r; r ; Home Improvementf License / Exp Date �"� _ "� ARCH ITECT/ENGINEER4. Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.'$12.0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $��aa FEE: $ Check No.: Receipt No.: NOTE: Persons contractin with unregistered contractors do not have access to the guaranty fund Sgnafiure_of g�n, wne_r Signat_tare of_co•ntracfior. AM NORTy own Off 4\Ajt clover h Ver, Mass, COCHICHEWICK 1' ArE0 P'4a��5 U BOARD OF HEALTH PERMIT T Food/Kitchen . LD Septic System .q.0THIS CERTIFIES THAT ........ ........... , „ „ BUILDING INSPECTOR has permission to erect.......................... buildings on Foundation....�.. ..�r..h.?�.�.Il.... ......... .. .... .... ................... Rough to be occupied as ... ... .. .... .... ......... . ................ ... .........- ��.y............ ......... Chimney provided that the person cepting this permit shall in every respe onform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESSCTIO Rough Service .7 ........................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® OccupyBulldin 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. �e 'V most Phis IV The Commonwealth of Massa.Musetts Q .Depai invent of1ndlustr^ial Accidents 1 Congress,street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia i. Workers'Compensation Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Legib Applicant Information Name (Business/organizationftdividual): �Ul!� Address: �� ry�3�/ ✓�t�/ �o�� City/State/Zip:GG, d jr�iG > �� 010 Phone#: Are you an employer?Check the appropriate box: Type of project(Tcquired): 10 I am a employer with -time)." 7. Q New construction 2, I am a sole proprietor or partnership and have no employees working for me in 8. Remo delixig any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑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 withno employees. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F!Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 19 Other 6.F We are a corporation and its officers have exercised their right o£exemption per MGL a 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. homeowners who snbriiiti this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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,&t must provide their workeiis'comp.policy number.. I am an employer that is pi ovidiiig ivoi 6s'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lie.#: ExpirationDate: fob 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 r�t fy , der'tri s rind enalties of per aM ze nformtrtion pf ovicled above is true and correct. ect. Si natu Do 0: 1;2 1-15 Phone#: ��— �'7�"'�g'�" `� • Official use only. Do not write in this area,to he 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.PIumbing Inspector b.Other Contact Person: Phone#: Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-077036 Construction Supervisor DAVID F DODGE 38 CHAPMAN ROAD WAKEFIELD MA,0188 Expiration: Commissioner 09/10/2017 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston,Massachusetta 0-2-146 Home Improvement Contractor Registration Registration: 138375 Type: Individual Expiration: 3/28/2017 Tr# 264432 DAVID F. DODGE DAVID DODGE ----_-.---- 38 CHAPMAN RD. - - - -- ------ WAKEFIELD, MA 01880 — Update Address and return card.Mark reason for change. CA 1 k 2OM-0511 I Address ,—] Renewal F] Employment 7--! Lost Card rife�ar�r.�no�rae�il�n�JC�j�rr:uan�r�ae� ' ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 138375 Type: Office of Consumer Affairs and Business Regulation xpiration: 3/28/2017 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 )AVID F.DODGE )AVID DODGE +8 CHAPMAN RD. VAKEFIELD, MA 01880 Undersecretary Not valid without signature