The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #230 - 240 MARBLERIDGE ROAD 10/2/2008 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �SSACH�1`-+�� Date Issued: �� IMPORTANT:Applicant must complete all items on this page LOCATION ' Jnot PROPERTY OWNER C `�J (� M d✓-!* CL Print MAP NO: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 - 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 PREFORMED: Pa. Identification Nase Type or Print Clearly) OWNER: Name: C—CA o\n, 'C�ti�.G �n Phone: Address: V)-xo--c i,-i C(�'' I cue-fV) Q Tn L CONTRACTOR Name: r`S rU(`te Phone: Address: Gh: r �Q ( 4 o A Od Supervisor's Construction License: 3 9 b a� __ Exp. Date: /d-i1 to Home.-Improvement license: 10 9 c - Exp. Date:. 17 &0 1 C 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: $ �, g` �1 FEE: $ 1 Check No.: 5 fP 2 ® Receipt No.: I_q 18-5 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund r y � Cignature,of�Agent/Owner r--,Signature of contracto Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, 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 ❑ 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 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 Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT --Temp Dumpster onsiteryes . .... no Located at 124 MaiwStreet w Fire Department signatureldate ;COMMENTS i 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.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location Q40 ncct(- No. --�3 D 14 Date Id r 2- TOWN TOWN OF NORTH ANDOVER + ; . Certificate of Occupancy $ �ss� sEt�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �2v 2 1 5 5 9 ,�---- � Building Inspector Oct 02 08 09: 12a Richard Hertolino JR 9785310718 p. 1 DATE ACORD . CERTIFICATE OF LIABILITY INSURANCE 01/25/2WS Richard sortonno jr Zasuraaae Agency ONLY AND CONFERS NO RKMB UPON 111E CERYMCATE HOLDML 7!164 CERTWICATE DOES NOT Ake, onwo OR 1200 galea St #121 WER INE COVERAGE AFFORDED BY THE POLICIES BELOW. Lyanfield, X& 01940 iNSTRERB AFFORDING COVERAGE NAIL DsomEo swjRmx Brbella Protection ntzgerald Construction Services summa Mass Workers Coup Rating Buresn 2 Orchid Circle E*Rmmc: Burlington Mass 01803 VJSURMV. sIaX1HtE: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE QED NAMED ABOVE FOR THE POLICY PERDD WDICATEO. NOTW MTANDM ANY REWIRE&IIENr. MU OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO Y*UCH THE CERTIFICATE MAY BE ISSUED OR WAY PERTNK THE INSURANCE AFFORD® BY THE POLICIES DESCRIBED NEREN LS SUBJECT TO ALL THE Tom. EXCLUSIONS AM CONDITIONS OF SUCH POLICIES.AGt,IM6ATE LINTS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS. LYR.ea$m TMOFMSTMMEX 10UCYaMATmeI DATE MEONIGINM LIMITS 1► GENIMLTA,uun 8500027957 04/29/2009 04/27/2009 FAmOO 31,000,000 x C0kVm9tCW.6ENSj&UaLnY PRBiWSMIacpusmp $1,000,000 R clAalsTa+ACE Q occur IRwmPwVamPm" $1,000 PERSONN.aAMINALM $1,000,000 oENEMAGOMOATE x2,000,000 CAM AGGRIMATE LOOTAPPUES PM PRODUM-COMPMPA00 $1,000,000 - -Uv —MT Loc AUTOVAMULL46UW COLBOMSINGIELIMIT $ ANY AUTO (EA800"Ml AuoYMED Amos 90MLY 94JU1w sehEouF�AUTos (P-Pa-0s "MDAUros SO M.Y*LOW s N)N.O70MAUTDS 1 4 8 PROPERTY 0AIME $ .IParacpAenAl OARAOE UARIM ALTO ONLY•EA ACODW $ ANYAL;fO OTIERTNAN FAA= $ t AUTO OFY.Y: AG s EHC!lISN�itBiA L,tA81m EACI1 OCCURROICE t 00cm ❑CI mMAOE AOGREMIX t s CFDArcTTWE $ xleanon s s B woRtasoo�esmATiowAOlb R6-V2-20098967-387 01125/2008 01/2512009 TOWuWt5 I I GR sAwLnrmstsuAUTY E.L LiAa1AOCI0HiF - $100,000 AM TORWRYNSVEXECUTTVE OFF e06MGXCLVoms ELD -GAEMPUNis s 500,000 u�aemT7b E.L.OMEASE-POLICY UWr 6100,000 0 OVICOP11 NOF.OPORAM"ILOGTM114rVB/CI.migxcJsmm AnI ov9bOH61GU oapwmLPkOYBKM Separate Cert Has been ordered for holder Mass Workers Coup Bureau Efate Morgan 240 Lyarbleri8ge Rd Worth Andover Mus 01045 CERTIFICATE HOLDER CANCELLATION Town of north Andover SM" ARV OF TRE ADWE OESCMD POUCES BE CnNCE•M 6rFOFM WN 6"011M Attn Building Dept 0AIM Y40 tWF TM MUM L IPM WLL dSMAVOR TO K%L DAYS v9dra w ewTAeE To ITE eeT11AaA1E notAlF WAM TO TLIE LEFT. On FARE To 00 90 $HALL UPOIM N0 Oe.4AWK OR UMM OF AMIY MSMr UPON TW NWJPMK ft AOENTB OR North Andover loss 01845 8dIAilY28 Fez - 978-588-9542 fAupumtmD1�+I1!' RMTYE Richard sartolinc, A 2512+D0VOSj O 9 Oct 02 08 09: 11a Richard Bertolino JR 9785310718 p. 1 ACORD ,� CERTIFICATE OF LIABILITY INSURANCE 01/25/2008 .eooum TM CeWMCM IS ISSUED AS K-WMM OF WROMMTHM Ri.ohard 9ertolino Jr ZnaaragAS AOGRaY ONLY AND CONRM NO RIGHTS UPON 7!E CE'RTMATE MOL IDER. 'pa COMMA? DOES NOT AMM MMMD OR 13.200 Sales St 0121 ALM ME COVERAGE AFFORD® BY THE POLICIES BELOW. Lyanfteld, Mi, 01940 INSMF3tS AFFORDING COVELiAGE MAIC AI LRA® mmmetA Arbella Protection Fitzgerald Construction Services INlLURETt .Was Workers Coup Hating Surean 2 Orchid Circle 991satc Burlington )!lass 01803 a BURSt O. SOMME: COVERAGES THE POLICIES OF Il1.''iLRAME LISTED BELOW HAVE BEEN ISSUED TO THE MSURED NAMED ABOVE FOR THE POLICY PERIOD WpICATED. NOTWITHSTANDINti ANY REOURR90ENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER ODCLM r-W WITH RESPECT 70 WHICH THIS CeRTMATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED VY THE POLICES DESCRIBED HERON 0 SUBJECT TO ALL. THE TERMS, EXCLUSIONS AND CONDITKMS OF SUCH PtHL=S.AGGREGAITE L&M SHOWN AALAY HAVE BEEN REDUCED BY PAID CWMS. ITRHTROPRMIA1MYJa POLACYIRRO6I DA1E MTE tD1015 EAD VP A 09MEMSLU14mu Y 8500027957 04/27/2008 04/27/2009 FACHOCCURRUCE 11,000,000 qxx —1 mmtCukLaEMw.L mmM s1,000,000 cuaMSLttDE OCCiAR tulmBo°payRAAPemiO 61,000 PI3ISONALanmIllwRv $1,_000,000 OgeFUR"QMMATE s2,000,000 OMAAscaIMMICUMITAVPUIMMM PRO(MTS-COMPIOPACW :1,000,000 PAXICY x Loc /W1OMOiCaJ6UADRJTY (zewVINIOS MEULIT $ aWa AWAUM wrH ALLOWI WMnOS A�LYM $ . SCVMVAMAUTO13 HVMAVM aOdI,Y OLAIRY $ liwrKeMlnO PROPOMDAMWE S (Pwaeda" OARUGLAILM PMOOMVY-BAAOCMJf $ AW)MM OYMMTINN 15AAM $ AUM OPLY: AGG $ A11Ad1 LLAI EACHOCCLWOU34 E $ MCAM �I IMAM AGGRBWTrE s DE37UCTIS E s At£IENLION : s B rIOP1tBIScoww"TMAW UC-V2-20099967-397 01/25/2008 01/25/2009 TOAtY LDN18 fR AaROYaWUA$LILY E.LFACNAOCMEW S100,000 ANYPROMMORVARMSMOMAM pOFFIC OCCUMED? E1.BSEAM-EAEIAPLDVff $500,000 =rmbob=I»nw ELOI -POUGYUMIT $100,000 OTIH! oesclw m0Pa0Dta11f MILOCAJMIVEACLMIMDCLJX MAGOG'RV@EO/OEXMWI PECRL.NIOVCpm Separate Cart Las bees ordered for holder Maes T7orlcers COW 3lareau L-J" 240 Mambleridge Rd North Aad vete Hass 01645 CERi1FiCA7E HOLDER CANCELLM ON Toun of North Andover SHOULD ANY OF TIE ADM OEC POUCIS BE CA MCMM soon TB EYPIRSIM Attu Building DYPt DATE TIRABOF. Im IP- I I NaERA01 YRL). BeEwaR TO MLL oAVS VRUTI@I wnm 10 TAE Col}wan IIKM NAMED YO THE LM OUf FAR>tIRE TO 00 m M" @AOS[ No OOLLGATAOM OR LAMM OF AW WHO RIPON M tl UPM LLS AOOILB OR North Andover Mass 01845 � Fa: - 978-688-9542 11110R®D "'Ra"N Richard Bertoliao GACORID C010510"'nou 111=1 A 's The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations L, 600 Washington Street Boston, MA 02111 www-Mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): '-1 �z(N-Ac'c C-0 `�' �t-1Ctl f t i U ��f V i e z� /lC Address: r C C �, r-C (t City/State/Zip:eu r(i✓1.g" 01 %0-? Phone #: -7F �2, Are you an employer?Check the appropriate box: Type of project(required): I.'�I am a employer with `2/ J2-14., '1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 ?. ,2-PCiemodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. 7 Building addition [No workers' comp. insurance 5. ❑ We area corporation and its required.] officers have exercised their ME] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' . comp. insurance required.] 13.7 Other "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this aflidavit indicating they ace doing at',work arid then hire outside coniraciors must submit a now 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 the policy and job site information. Insurance Company Name: Rtf.be Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: �L4 0 fh (e r Id �,�_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 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 cert#yunder the pains andpenaldes ofperjury that the information provided above is true and correct Simature: l Date: Phone#: Official use only. Do not write inthis 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined.as ...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit:to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC.or LLP does have _ employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/iicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street j Boston, MA 02111 i Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26=05 Fax#617-727-7749 www.mass.gov/dia °J Board of Building Regulations and Standards Construction Supervisor License License: CS 39692 .. E�'p ' a 91-29/2009 Tr# 19138 IMP- I $strl �on `00 �`' Construction CS' RAYMOND H FITZL`D , 2 ORCHID CIR BURLINGTON,MA 0180 Commissioner HOME IMPROVEMENT CONTRACTOR Registra"on 109432 Tr# 273711 Expiration,. ;911612010 pAA FITZGERALD Co NSTEtUCTIpN ` �n._j r RAYMOND i 2 Orchid Circle Administrator BURLINGTON,MA 01803: b ` ........... F 9' p I v.y. h� r� M p v _ s1T,�-m k _........._ __ _ _.__ ._ ___ _ _______________.____ __ Uc i, s Lou Brockway-Smith company www.brosco.com TM (� o7_ f , ! I i 60 sm- i I i �� — ----- 'Q- 01 i i I it I ANDOVER, MA 01 10 CO�XSACKIE, IY 12051 ATFIELD, A 0 3 PORTLAND, ME 04103 scomb Roa Hudson Valle Com�erci 1 Pa 125 Chest ut tr .et. 203 Read Street Y ! S eet 1-800-222-7981 1-800-222-)7303 ! 1-800-92 -0191', $ 1-800-442-6734 Fax: 1-800-242-453 Fax: 1-800-222-7304 ` Fax: 1-800-,22-0 6 Fax: 1-800/-443-0331 1 , � b N ! i I I Brockway-Smith company ' www.brosco.com ,M J a 41 tAr JL i E _ I l L I � T T i t f 1 t i f - - - s I i t � — I I ANDOVER, MA 01810 COXSACKIE, NY 12051 HATFIELD, MA 01038 PORTLAND, ME 04103 146 Dascomb Road Hudson Valley Commercial Park 125 Chestnut Street 203 Read Street 1-800-222-7981 1X800-222-7303 1-800-922-0191 _ 1-800-442-6734 Fax: 1-800-242-4533 Fax. 1-800-222-7304 Fax: 1-800-922-0296 Fax: 1-800-443-0331 2 Orchid Circle Burlington,MA 01803 FitzGerald CONSTRUCTION FRemodelivig Services! Kate and Rob Morgan 240 Marbleridge Road North Andover, MA September 30, 2008 Basement Remodel Permit- Obtain building permit. Demo existing room—Remove all paneling from walls and soffet,baseboard and door entrance. Remove carpet and pad. Remove framing inside room next to stairs. Remove all nails from walls and ceiling. Framing—Frame inside wall next to stairs for furring out to extend treads into the new office. Frame new wall on left side of stairs looking up to 1St floor. Frame in rough opening for 36" door. Frame in wall around drain pipes. Frame two opening for clean outs for access panels. Strap landing wall for board and plaster. Electrical—Install wiring for lights on single-pole switch for unfinished side of basement. Install new 3-way switching set-up for light at bottom of cellar stairs. Install 2 cat-5 data/phone lines. Install 2 RG-6 cable lines. Install 8 receptacles on separate circuit. Install 6 5-inch recessed lights. Install 3 dimmer switches to control lights in sections of 1 two. HVAC—Install two new return lines in ceiling. Cut into existing plenum. Frame in strapping for grille mounting. Cut in opening , left side of wall for fresh air return grille. Insulation—Insulate plumbing wall in rear of office. Insulate to grade on wall next to foundation. All insulation on outside walls will cover any exposed areas. Plaster—Board and plaster all walls, ceiling and soffet, smooth finish. Plaster separation wall inside and outside wall. Also board and plaster bottom area ceiling and walls. Finish work—Install baseboards in office, landing area and outside of partition wall. Install 36"raised panel door with right hand swing in. Install casing on door, both sides. Install door passage set. Reinstall stair railing,both sides. ON open side install railing support post. Install all grilles for two new supply lines and cold air return. Install all lighting trim and bulbs, wall plates and data plates. 2 Orchid Circle Burlington,MA 01803 FitzGerald CONSTRUCTION Carpet—Install pad and heavy knapp carpet in office, stairs and top and bottom stair landings. Remove all construction debris and clean job site,ready for use on completion. Painting is not included,but can be quoted on request. Labor and material $14,895.00 Payment Terms $1,200 Down $5,000 On Start $3,850 Rough electrical, framing,HVAC $3,845 Plastered,carpeted and finish work complete $1,000 Final payment on completion Accepted