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Home My WebLink AboutBuilding Permit #011-14 - 0 Blue Ridge Road 7/1/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 1 ' 4 �. 1 ?eke— PROPERTY OWNER Print 100 Year Old Structure yes o MAP NO: PARCELA, ZONING DISTRICT: Historic District yes Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ t ew Building ❑ One family ,Addition 0 Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Jdentifica on Please Type or Print Clearly) 3S� OWNER: Name: '/l / �/S,� Phone: Address: � CONTRACTOR Name��IS /�// � Phone: D 37-4gK -, Address: �� 7 40n73X S Supervisor's Construction License: � �� 3 Exp. Date: o2 I Home Improvement License: S 9� � Exp. Date: l ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PEER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -f FEE: $ Check No.: l l Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t e ar ty nd Signature of AgentiOvuner Signature of.contractor Plans Submitted El Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ (/ ' Location `V/� / �l No. J41— Date 1 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ l L Check# :1 `� Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. .. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes Planning Board Decision: Comments `Conservation Decision: Comments Water & Seger Connection/Signature& Date Driveway Permit DPW To`v;: Engineer: Signature: Located 384 Osgood Street FIRE DEPARTML-NT -'Temp Dumpster on site yes no Located at'124 Mair, Street Fire Departinerit signature/date t COMMENTS NORTH own o . t E ndover O . _. .4 No. Oil— jt4 . ... .... .. C, h ver, Mass, 1109 C OC MIC.'WIC. ��S�R�tTEO tPP�.�y U BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT ................. .... .I��,. ........... .�t,�. ............ .. ................ .... ................. BUILDING INSPECTOR S .has permission to erect .. ............ buildings on Foundation • Rough I ,� �.�. ��.. ria. . tobe occupied as ........ ..... ... .... ..... ..... ..... .......... ........�...... . .... ... .... .. Chimney provided that the person accepting this permit shall in every r pect 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. woo Nf) Di&&W6w 4� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES INfi#0NTHELECTRICAL INSPECTOR UNLESS CONSTRUCTJ&N STA JRowgh f Service .......... ..... .... ........... .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. SEE REVERSE SIDE Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$10041000 fine NOTES and DATA— (For department use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The foli`wing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofii,g, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the app,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buii;iing Permit Revised 2012 CJZA*A)bet COMIUW40n Proposal Matt Bush 35 Blueridge Road North Andover,MA 01845 M(C)617-388-8350 A(C)617-671-8236 bushm127@gmail.com June 30,2013 Work to be completed includes: Remove existing decking on both levels of deck,plus the stair treads. Replace with TimberTech XLM Rustic Bark.Both levels of deck to be picture framed. Center section of deck to be installed with hidden fasteners. Permit $ 84.00 Material $4,615.00 Labor $2,300.00 Disposal $ 150.00 Total Labor and Materials $7,149.00 Terms: $2,383.00 upon signing of contract(not to exceed 1/3 of total contra t ric ) Work to begin on $4,766.00 when job complete Job to be completed o ?fl-)Fll Submitted by: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (H)978-704-1165 North Andover,MA 01845 All Home Improvement Contractors shall be registered.Inquiries about a contractor relating to a registration should be directed to; Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston, MA 02108 Tel: 617-727-3200 ext.25239 All building permits required will be the obtained by the contractor.Homeowners who obtain their own permits are excluded from access to the Guarantee Fund. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payments will be made as outlined above. DO NOT.SIGN THIS CONTRACT IF T ER ARE ANY BLANK SPACES! Date / � �? Homeowners Signature Date / Contractors Signature �. OP ID: SHHE '� Ro CERTIFICATE OF LIABILITY INSURANCE DAT10/12D/YYYY) 10/12/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER 978-688-6921 NAME: Macdonald&Pangione Insurance 9786885350 PHONE FAX . - P.O.BOX 428 _(A/C.No.Extl: I(AIC,No): 104 Main Street E-MAIL North Andover,MA 01845 ADDRESS: PRODUCER CHRIS-5 Michael Pangione CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Christopher Rivet INSURER A:Preferred Mutual Ins Co 115024 207 Winter St. INSURER B: North Andover, MA 01845 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE IADDLISUBR: i POLICY EFF POLICY EXP LTR 1 I POLICY NUMBER I MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY I EACH MERCAL GENERAIABILITY OCCURRENCE $ 1,000,000 A X COMIL LjCPP 0180 57 01 05 09/26/12 09/26/13 DAMAGE TO REN rr ,_PREMISES(Ea occurrence I $ 100,000 i_ CLAIMS-MADE { X OCCUR i !MED EXP(Any one person) I$ 5,000 ii PERSONAL&ADV INJURY (S 1,000,000 GENERAL AGGREGATE I$ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMP/OP AGG $ 2,000,000 rX ' POLICY( PRO- LOC ( { I $ AUTOMOBILE LIABILITY I i I COMBINED SINGLE LIMIT (Ea accident) $ I ANY AUTO I 1 BODILY INJURY(Per person) $ ALL OWNED AUTOS i BODILY INJURY(Per accident) $ SCHEDULED AUTOS ' PROPERTY DAMAGE j HIRED AUTOS (Per accident) $ NON-OWNEDAUTOS , I S j �S UMBRELLA LIAB OCCUR EACH OCCURRENCE S � i EXCESS LIAB - CLAIMS-MADE AGGREGATE $ DEDUCTIBLE I I g RETENTION $ i I ' ($ !WORKERS COMPENSATION WC STATU- 0TH-I I AND EMPLOYERS'LIABILITYY/N I TORY LIMITS ER , ANY PROPRIETOR/PARTNER/EXECUTIVE j E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I N I A (Mandatory in NH) j E.L.DISEASE-EA EMPLOYEE S If yes.describe under DESCRIPTION OF OPERATIONS below i F.DISEASE-POLICY LIMIT I$ i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St No Andover, MA 01845 AUTHORIZED REPRESENTATIVE 19 Michael Pangione ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor '_cense: CS-072173 CHRISTOPHER F-RIVET 207 WINTER ST N ANDOVER MA 01845 _xpiration Commissioner 06/02/2014 ti x ✓lze i�om:�nanule o�✓� mieff off-ice ot Consumer Affairs&Business Regulatias: .. � 0HOME':7FROVEMENTCONTrRACTOR _-, - Registration: 139962 Type: = � s xpiration: 9/8/2013 Individual FT�tTSTOPHER F.RIVET CHRISTOPHER RIVET 2L•%WINTER ST. N ANDOVER,MA 01845 Undersecretary' i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): w, Address: r;K R% ,/,/k)7;60t - ,. ,, , n, F4 Phone#: Ci /State/Zip: .�. ��C�,.S n c , Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction have hired the sub-contractors employees full and/or art-time). 7. 2]Remodeling 2.�I am a sole proprietor or partner- listed on the attached sheet.I _ ship and have no employees These sub-contractors have 8. FJ Demolition working for me in any capacity. workers'comp.insurance. 9, E]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions required.] officers have exercised their right of iper MGL 11.❑Plumbing repairs or additions 3.1-11 exemption I am a homeowner doing all work g pon p c. 152,§1(4),and we have no 12.❑Roof repairs myself. [No workers comp. � insurance required.]t employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 01Y ' Expiration Date- ACi /State/Zi kl? • xJob Site Address Slpve,�Ioe� p' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. [do hereby certify un[, r tl pains and pen les of perjury that the information provided abov is ne and correct. Si nature: � 0 " Date: 3 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: