HomeMy WebLinkAboutREMODEL KITCHEN BUILDING PERMIT OORTH
TOWN OF NORTH 0 ANDOVER 01
APPLICATION FOR PLAN EXAMINATION
Permit No#: 7 Date Received
Date Issued: 10 --——---------
IMPORTANT- Applicant must complete all items on this Page
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a6hine Shop Villag0,
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
............
E New Building E,.?One family
D Addition F1 Two or more family 0 Industrial
17 Alteration No. of units: 0 Commercial
Rl�epair, replacement 0 Assessory Bldg [I Others:
0 Demolition D Other
0 Septic 1-1 WL-11 [I Floodplain El Wetlands Q Watershed District,/",,,,
'n
0,Water/SeWer
DESCRIPTION OF WORK TO BE PERFORMED:
------
.Identification - Please Type or Print Clearly
OWNER: Name: Phone'. -8 t,)Z 22 U
Address: 4
.4
'Contradtor'Name: r a Phone: 'ILI,a'
0
Email: 1�uta',NLO LLC
Address, :,_,, ,iki b rt M CaMt 64A
. .................
Exp.- a e:
Lic'en'se: C!i�/O/.' E"
E�<p. Date:
Ho�me, License: t b ZO,"I . .........
ARCHITECT/ENGINEER- Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ C1.0 000 ,_ FEE: $_ 9- 0
Check Na.: Receipt No.:
NOTE: Persons contracting with unregisteredcontractory do not have access to theguarantyfund
gnature,of Agent/0vv1,,,4i Signature of contractor
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Town of
bAndover
No. 41 76
� 1
ver, Mass, / 0 -
BOARD
0 •BOARD OF HEALTH
PERMIT.. T Food/Kitchen
Septic System
THIS CERTIFIES THAT .............. d. ,.., `.�... . 04A C+ S. ......__.... ..... BUILDING INSPECTOR
has permission to erect '�'�' Foundation
......................... buildings on ... .......... !�!�. .�N...... h..................
Rough
to be occupied as .... S c , ........ ..,.. .L-........................... .. /t.....�11�4[L
Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
u Final
PERMIT EXPIRES I 6 MONTHS ELECTRICAL INSPECTOR. ..
LESS C TRCTI STA TS Rough
Service
......... .. ............Ia. .............,..
BUILDING INSPECTOR Final
GAS INSPECTOR
Occupancy Permit Re aired t® Occupy Buildink Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
JOB
KITCHENS BY10MOCOSHEET NO. OF
�j
1875 Main Street CALCULATED Sy'j' ._. ._ DATE
`TEWKSBU R 1, MASSACHUSETTS Y S V 18/6
(546) 858.0700 CHECKED 6V DATE
SCALE
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All dimensions_size designations This is an original design and must Designed:$/3/2016
given are subject to verification on not be released or copied unless Printed: 1.0/7/2016
,yob site and adjustrnent to fit job �� applicable five has been paid or job
'
conditions. 2 s order placed.
cheever3 All Drawing t/:I No Scale.
10 KITCHEN S
. .
1445 Main Street
Tewksbury, MA 01876
Proposal
Date: 9123116
Name:Meghan Cheever POM 099
Address: 64 Kingston St
City:No.Andover,MA 01845
Quote for: Cabinets
r Cabinet Brand: Cubitac
• Door Style and Finish:Newport Latte Pewter Glaze
• Wood Species:Maple w/MDF
• Price inc.Tax and Delivery: $5,625.60
See Cabinet Items List:
(Attach opaque order form,signed by purchaser, if required)
Quote for:Countertops
• Surface Material and Name:Granite-Azul Platin
• Backsplash: Same as above
• Allowance:$2,000 '
See Countertop Diagram:
Quote for:Hardware
• Hardware Brand:To be Determined
o Style and Finish:
• Allowance:$250
See Hardware Items List:
Note:Prices are subject to change upon final choice of materials,layout,and counter top template.
We propose hereby to furnish the materials complete in accordance with the above specifications for the
sura of:$7,875.60
ALL SALES ARE FINAL
Payments:
50%to place order
50%balance upon befo e 'very
,
Authorized KB'L Signature
Acceptance of Proposal
The Commonwealth of Massachusetts
Department o fXndustrial.A.ccideats
1 Congress Street,SWte 100
s02114 w?01 7
Boston,MA
www.mass.gov/dia
wlilawl,ers' compensatioxrTnsurance Affidavit:Bxxilclers/Canttactoxsll ZectxiciaxasCC'luxribers,
TOBEZ<IC,Elr►WMA THE PLE'WrfTMG.A.C7T""T.'i'. please Print Le 'bl
Information
Name,(BushessfC7rpanxzationl.[nchwadual);
Phone
City/,Stale/Lip: C .l s ._
--- — Type of prosect(TeVired);
Are you an employer?Check the appropriate box:
em la ees hill and/or pazE time}.'` 7. F1 l�e'W,danstru'ation
1. 1 1 am a employer with. - p y
2.A I am a sole proprietor or partnership and have no employees working far me in $, l�emocleling
any capacity.[No workers'comp,insurance required] 9. ❑Demolition
3.❑1 am a homeowner doing all work myscli [No workers'camp,insurance required.]'# 10 Building addition
4.�1 am a homeowner and will be hiring contractors to conduct all work on my prape,ty. 1 will
11.[ Electrical repairs or additin s
ensure that all contractors either have workers'compensation insurance ar are solo 12�E]l'l,'tlin:bing repairs or additions
proprietors with no arripiayees.
54-11 am a general contractor and 1 have hiredtho sub-corrtraatars listed an the attached sheet. 13, Ii'oof reliairs
These sub-contractors have employees and have workers'camp.insurance.t 1.4. Other —
6,E]We aro a carparatiori and its,o�cers,havc exercised their right of exemption per MGI,c.
152,§1(4),and we have no employees.[No workers'comp,insurance required.a
*Any applicant that checks bbx 1 dust also X11 out the sectionbelow showing their workers'compensa#ion policy inmust formation
at ew
t Homeowners who subnrrs contracto
�must attached'an additionale'ating they re sheet showing the name of the sub-contractors oing all workand then hire and st to whether aF no those, ntities,have such.
tContractors that checktht � —
employees. Ifthe sub-contractors have employees,they must provide their workers'camp.policy number.
lana are en ployer�tliat is providing-woi lter:s'cornpelisation insurance fox°my em�Zvyees. X�ela�t�is tlteZralzcy and)0h site
inforination.
Insurance Coarrpany Name: - -�
Policy##or Self-iris.Lic.#:
��l�irationl7ate�
c City/State/Zip:_. ,, , &t- — 1 64 S'.
Jab Sito Address
Attach acagy of the wvoa;•lrers' compelxsatxon policy declaratioxx page(shovrixxg the policy number and expiratioxa date).
Failure to SCUM coverage as required under MG)r ,c. 152,§25A is a criminal violation punishable by a fixe up to$1,500.00
and/or one-year ixnprisonm.ent,as well as civil Penaltiese forwarded to theffi of ORDER
gatlons of the DIA for insura$2,50ce a
day against the violator.A copy ofthis statement may
coverage vex'il7CzatiOn.
X dO hereby certify under{]` pains andperialties ofpexjury that the information provided above is true and correct.
Signatux'e
official use Only. Do Rot wpite lit tens area,to he completed by city or town official.
City or'T'o vm•
�exmit/License#
issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/'T'owrx Clerk 4.Electrical Inspector 5,Plumbing Inspector
b.Other
Phone
Contact --
Mat;sachusetts Department of Public Safety
136ard."of Building Regulations an4 Standards
License: CS-059064
Construction Supervisor
JOHN C MARCHESE
31 SHERWOOD DRIVE
METHUEN MA 01844 y
i
Expiration.:
Coi.oner 12104/2017
7 ��z o�✓ `tc�uGeCi.
Uf`ice of Cnn�G'�e3 AfT .rs Bks CTQR,
Hbit E imPF,0-q VENT Gphi CRA
Registration: 1820'!' individual
Expiration 112-212.P17
SO ` C.MARGHL=SE
JOHN MARCHESr
31 SHERWOOD DR UadQrSucr.efa�y.
METHUEN;MA 01844
Lirepse or registrati'm Valid for'izi.d iidul<tr c eta y 9'
befarE:the expiration da b. if fouhdt�etii n-Xa7
Office of'Cansumer Affairs and Business Regulation i
.10 Park Plaza Sui.W170
Boston,MA,02A16
ri
loot valid w"itho re„ t: