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Home My WebLink AboutBuilding Permit #886 - 116 MARBLERIDGE ROAD 6/19/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: Cfi t IMPORTANT:Applicant must complete all items on this page LOCATION' //4 IWb/e P,.not PROPERTY OWNER I�I/#�i'r/erz�le�-�i` pint; 100,Year,01d'Structure, yes no MAP NO: '/ , PARCEL: •act/ ZONING:DIST+RIOT: /-Z .Historic=District yes o ,(1t� L - ' 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 11 Repair, replacement ElAssessory Bldg El Others: W6emolition ❑ Other El Septic ❑We' ll ❑ Floodplain El Wetlands_ ❑ Watershed District: ❑Water/Sewer DESCRIPTION.OF WORK TO BE PERFORMED: t�elwoale, K','-I-GheAe CAhlAte i�s, &9,44 ooA4 'x re 51 ��A Sir 4Aid 14-1-Ae 14" /Q vd seco.'J A11,61 D b ,r2A4 /44 yb;�14 lVew,6 (J' ee i-1 G q Identification lease Type or Print Clearly) 6'--7- 9so-ag OWNER: Name: Phone: 781- Address: CONI TRACTOR Name: G_' _s _. ea,.rfc ___-Phone: '.7�- y& -. _J /' -- _ S rdr' L lii�Jccsa/c� A4ft Address: iva - - - - - Supervisor's-Construction°License: cs s�� Z�_ . Exp1.. Rate: Homelmprovement,Licenrse lyS C.j? Exp. Dater " 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: $'4 �yOO FEE: $ Check No.: Z-0 Receipt No.: J_ (�e Y3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signoture:of Agent/Owner , r. _ Signature of contractor. Plans Submitted ❑ Plans W ived ❑ Certified Plot Plan ❑ Stamped Plans Building Department Tree following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, 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 o 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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 o 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 apse•-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must bf- submitted with the building application Doc: Doc.Building permit Revised 2012 ■ 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 Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments j Water & Sewer Connection/Signature& Date Driveway Permit DPW T owi! Engineer: Signature: Located 384 Osgood Street FIRE'DEPARTMENT - Temp Dumpster on site yes no Located at 124 Mair'Street Fire Departiner-it signature/date COMMENTS i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions_ Total land area, sq. ft.: I ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes fro MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine f NOTES and DATA— (For department use I D Notified for pickup - Date Doc.Building Permit Revised 2010 I 1 1 Location 1L&__�l2J y w No. Date �5' • - TOWN OF NORTH ANDOVER BY . Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ TOTAL $ Check# 26533 Building Inspector r , V NORTH A. .. .c . : ver 0 h , ver, Mass, Q • 1 3 C OCNIC HE WICK ��• 0'0�ATE0 PP�,��(y U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System NN • THIS CERTIFIES THAT VT � 0QI io BUILDING INSPECTOR ...... ... ........................f.............. ... .. ..... . . .... .... ...... has permission to erec g .1 10............. g .b �. Foundation .................... buildings • .... .... ... ... ........ Rough to be occupied as ....... . ... .. ... ... ...... ............... ..................... Chimney provided that the person accepting th,it permit shall in every respect 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 WONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STAR Service ...................................... ........ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 141 r , tkORTH : :. .c . : ve" 'o 0 No. t - h , ver, Mass, Q • 1 3 A_ [OC NIC Hl W.C.c �1' '7.95 RATeD �PP��S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System N • THIS CERTIFIES THAT ►.`.... BUILDING INSPECTOR ........ ... ............ ... ..... . . ..... .... ...... has permission to erec .................... building on � b ? ... Foundation . . ........... .......... ..... ... ... ........ ........,.. Rough to be occupied as ....... . ... . ... .. ...�. . .. .... `�...... .........�� ......04=4 ..... ....... Chimney provided that the person accepting thi permit shall in every respect 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 i ONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STAR 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 The Commonwealth of Massachusetts Department of IndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 qu www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): kw- �,D V5 Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate ,box: Type of project(required): 1.El am a employer with 4. 1Z I am a general contractor and I 6. ❑N construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. [J Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.FJ Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]f employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is thepolley and job site information. Insurance Company Name:. Policy#or Self ins.Lie.#: Expiration Date: Job Site Address: /16 /1,Yj6e fog", City/State/Zip:_ 01&'11S_ . Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby rt' under the pains and penalties of perjury that the information provided above is true and correct. Date: a Phone#: Official use only. Do not write in this area,to be con pleted 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#: JUN. 18. 2013 10:45AM ASSOCIATED INSURANCE -N0, 8506-P. 1/1- I CERTIFICATE OF LIABILITY INSURANCE =08/1 M) 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(les)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 no certificate holder In lieu of such endorset confer rights to the ment(s), PRODUCER 04817-001 TRER Risk Strategies Company81)968ri400 pAx15Pacella Park Drive Ste 240 �o... (781)985-4420Randolph,MA 02368JIySOE@(Sfl3758 INsuREoM.Mutual Insurance Company K Hoyle Construction Company Inc19 Kimball Avenue Wenham,MA 01984 COVERAGES CERTIFICATE 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. I TYPE OF INSURANCE � � POLICY NUMBER P GENERAL LIABILITY Mrd A _ LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCVRRENCIE S DAMAGETO"RENTED $ ` CLAIMS-MADE �OCCUR MED EXP(Any one person) $ PERSONAL b ADV INJURY S EN'LAGGREGATELIMITAPPLIESPER. GENERALAGGREOATE g OLICY � RO. ��GC PRODUCTS-COMNOPAGG $ AUTOMO@TLE LIABILITY -L— �^ COMBI EEci ED 81NGLE RIT ANY AUTO c ALL OWNED SCNEDULED BODILY INJURY(Por person) >a AUTOS AUTOS NON-OWNED BODILY INJURY(Peracc(dent) $ HIRED AUTOS AUTOS PROPERTY DAMAGE Ji'lLiGLidorl0—', 5 tEXCE6S LIAB OCCUR - RCLAIMS MADEEACH OCCURRENCE $ RETENTION 5 AGGREGATE $ ANMyD EgM�PpLIRS�YETl��1gR��P`AS�gTN�q�EX T .. TH_ $ A OFEICER/ME6ER EXCLU�Ep7 ECUTIVE(X; X TORI'LIMIT§ OR �([MyanQddatto�ryi�gNyHH)) I �v 1 INIAMZ8006283012012 10/2112012 10121/2013 E.L.EACH ACCIDENT, 3 100,000;00 r��IiAT10N5 below E L DISEASE•EA EMPLOYEE S 4, L..IP��N� - 100,000,00 El DISEASE•POLICY LIMIT 8 800,000.00 i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Atltllllonal Ran, Schetlulo,It more space le required) :ERTIFICATE HOLDER CANCELLATION Vex Caruso 16 Marble Ridge Road forth AndoV@r,MA 01846 SHOULD ANY OF THE ABOVE DESCRIBED POLICIESiBE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i AUTHORIZED REPRESENTATIVE6198-8.2010 _ CORD 25(2010105) The ACORD name and logo are registered marks of ACORpACORD CORPORATION.All rights reserved. Date .... ...... t4ORT" 0 TOWN OF NORTH ANDOVER RECEIPT CHU This certifies that haspaid.. ......................................................................... 7, /1 ............................................... .................. ........ Receive d,b ./.. -.-Q............................. Department ....../11�7 ................................................................. WHITE: Applicant CANARY:Department PINK:Treasurer The -C®.MmOnW10%�alth of Massachusetts t of Fire Se* rvic'es JI Departmen. Office of the State Fire Mrsh2l P.0.Box 10225 Stiritc Road,Stow,ZvLk 01775 PERMIT North Andover Date: Peraift No (Cita of—TOW.) Dig(If Applicable•) Number In accordance with the provisions of NL,G_L.1 4 8 Chap.tcr 1 G asprovidddinsection=1--GER 34 a IL This Permit is granted to: Stare DatL U�filTitf ..c-ter' Fun name of person,Firm'or CorporationPcanissionto locate d.umpster .. for construction/renovation/demolition of building. Comments:- -dumpster must be . 25 from structure if R1CstI7ictioUs: unable to place with reguire'd clearance dumps-ter- must be covered with [—' t a r p end of 'work -d a y at —Z/—/ eefcl (Give Iccation-by sLTc--t aad no.,d-r"dcscnbc W* such maomer as to provlcd adequate idcatification of 16catiou JecPaids 50.00 Fire Chief This Pcrrait jyi(j expire It grc an (�Tidc) tit Massachusetts - Depa tment of Public Safety Board of Building Regulations and Standards Construction Supen icor •_icense: CS-051123 M SCOTT MCINNIS 100 HESPERUS ArVE Gloucester MA OI930 pira`ion Commissioner 02/27/2015 r- , NORTH 2 � tE ve . 0 No. ,1 : _- LA h , ver, Mass,0 4�. 1 3 COC MICMlwKM 1' 0R^7EO S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System f BUILDING INSPECTOR THIS CERTIFIES THAT ........ ... ........................................ .... ...... .............................. . .. .t... has permission to erec g .1 1.10 � b RZ,,�„ Foundation .................... buildings • . . .......A.01!e!�04*41 .......... .... ... ... ........ ® Rough u h to be occupied as ....... . ... .. ... .. ..:. ...... ... ..................... Chimney provided that the person accepting thi permit shall in every respect 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 &MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STAR Rough ' _ Service ...................................... ......... ..................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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. SEE REVERSE SIDE