HomeMy WebLinkAboutBuilding Permit #794-14 - 270 MARBLERIDGE ROAD 5/6/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: �1— Date Received f
Date Issued: `� �P
114
IMPORTANT: Applicant must complete all items on this age
_ -
LOC ATION:1�►�St
-k-4 ii �t Pnri '
PROPERTY OWNER 1 t _J°�" ! J.,_ �_ SS -a --
`ss Print 1OOYearOldStructure yesFn
'"j PARCELS ZONING DISTRICT:Historic District yesMAP-NOOI I_Machine ShopVillage yes
.TYPE OF IMPROVEMENT,
PROPOSED USE
Resid ntial
Non- Residential
❑ New Building
P16ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑'Septic ❑Well
❑Floodplain 3. Wetlands
❑ 1N4tershed District'
O Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
or Print Clearly)
OWNER: Name: -r-11., vA �GASS
10A
lone: l k1d '29? -67i.4
CONTRACTORName.
Address:
Supervisor's Construction°License��C2.. _Exp. Pate:_
Home ICnp_rovemeht License:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING P RMIT., $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 0, Q 00,( 0 C> FEE: $
Check No.:� 006 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the gpgranty fund
Plans Submitted L] Funs Waived ❑ Certified Plot Plan 11 (9tamped Plans
Building Department
The fdowingIs"a-list of. -the requiied.forms to be filled outfor.:the appropriate. permit to .be obtained.
Roofivg, Siding, Interior Rehabilitation Permits
u Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or G.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 apo,,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.Building Permit Revised 2012
Plans Submitted ❑ Plans -Waived ❑ . ,
..:.Certified Plot Plan ❑ Stamped Plans ❑
-TYPE.Q'F;SEWERACE.DISPOSAL" '
Public Sewer ❑
Tanning/MassageBodyArt ❑ ..
Swimming Pools ❑
Well ❑
Tobacco Sales
Food Packaging/Sales ❑
Private {septic tank, etc _ .
_. ❑
=permanent Duinpster on=Site
THE, -FOLLOWING SECTIONS FOR -OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM''
DATE. REJECTED:
PLANNING & DEVELOPMENT`El
DATE:APPROVED
COMMENTS
:CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
?oning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
t'lanning Board Decision: Comments
Conservation Decision: :Comments
Water & Sewer ConnectionDriveway Permit
DPW Tow;: Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTIVI `Nf:._Jemp Dumps er on site yes . _. no
Located at124�Mar,`Street - f `�� a�
Fire'Departmdrit signatureltlate " _ � a� `A }k
COMMENTS t ; . •.�_' .,.f.
- imension -
Number of Stories
Total square feet of floor area, based on Exterior dimensions.
Total land -area; sq. ft.:
ELECTRICAL: Movement of.Meter.locat"on, mast or service drop requires approval of
Electrical Inspector Yes No
DANGERZONE LITERATURE: -Yes No
MGL.Chapter•166.Section 21A. -F and G min.$10041000..fine
NU I t5 and USA I A — (I -or de
® Notified for pickup - Date
Doc.Building Permit Revised 2010
ent use
Location to f� l� P4
No. Date 1
TI)
Check 4t
27542
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ a
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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Building Inspector
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Chlimn,ovs
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Mass Toll Free
1 -800 -WAIT -4 -US
(924-8487)
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Residential & Conlli ercial Roofing All Types Of
CHIMNEYS POINTEp RFIMUILT-CAIl=PED
Expert Masonry Work
Licensed & Insured
L.;,Kaily Owned If, t.,)peraied Cr er> 1976 License #034200
I K400 r_.VW 0,r ,' Zj7hff We Work Year ]Found
Proposal To: Thomas & Brigit Blass
Street: 270 Marbleridge Rd.
N. Andover, MA
Roof proposal
Certainteed Landmark
1. Extra caution will be taken to protect house
exterior and landscaping as best as possible.
(tarps etc.) Magnets run at final clean up.
2. Remove all shingles from entire house, breeze-
way and garage.
3. Inspect and re -nail any loose or lifted roof
boards. Any compromised roof boards will be
replaced at an additional cost of $2.75 per lineal
foot of l x8 spruce.
4. Install heavy gauge 8" white aluminum drip
edge to all eaves and rakes.
5. Install 6' of Certainteed Winter Guard ice and
water shield along all eaves. Install full coverage
of.ice and water shield on rear dormer.
6. Install Certainteed Diamond Deck synthetic
underlayment to remaining sheathing up to
ridge.
7. Install all new pipe boots.
8. Install Certainteed Swift Start starter shingles to
all eaves.
9. Install Certainteed Landmark Limited Lifetime
architectural shingles to entire house, breezeway
and garage. 10 year material MFG. warranty.
15 year Streak fighter warranty. All shingles will
be installed and fastened according to mfg.
specs.
10. Counter flash existing chimney flashing and
wall connections with ice and water shield and
tie into new shingles and seal. (Please see note)
11. Install new GAF Cobra ridge vent capped with
color matched Certainteed Shadow ridge
Date 4/25/2014
978-208-0366
thomasblass@me.com
12. Removal of all work related debris. Planks will be
placed under dumpster to prevent any damage to
driveway.
13. Building permit included.
14. Contractor workmanship warranty: 10 years under
normal wind and rain conditions.
Total roof cost: $ 12,200.00
(Angie's list discount applied and included)
• Shingle upgrade: Landmark"Pro $800.00
additional cost
• Note: On chimney box, remove existing
compromised wood. Install new flashing. Install
new composite PVC trimboards and seal. Wire
brush and clean metal chimney top, prime and
paint.
• Direct MFG. Extended warranty. Fully
transferable, 3 Star 100% coverage for a non
pro rated period of 20 years: Please see info
packet in material folder. Offered and included
in this proposal at no additional cost.
*Note*: Please be advised if applicable, valuables in
the attic should be moved or covered due to minor
debris, dust and asphalt particles that will accumulate
during the stripping process. All Under One Roof not
responsible for any damage or clean up that may
occur in attic.
Balance due upon completion
References available upon request
Highly rated member of the accredited BBB and
J
CERTIFICATE OF L1ABlUTY 11MURANCE
oATt (mitioaYY"
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FICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NailO RIGHTS UUm"THE CE48TTFICA O
A
CERTIFICATE DOES NOT AFF111MATNELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIFICATE OF INSURANCE DOES_ NOT CONSTITUTEIACONTRACT BETWEEN THE ISSUING IINSURER(S). AUTHORIZED
i=MENTAWEORPItOIPUICE-R.A_NDTtfESCBDBELTJEIMW-
tMPORTANT: if the certificate holder Is an ADDITIONAL INSwU#ED, the polite ies) must be endorsed. q sueROGATION IS WAIVED, subject to
the terms and conditions of the policy. certain policies may roquire and endorsement A statement on`. this certificate does not confer rights to
dho certificate holder in lieu of such endorsements .
PRODUCER NAME: NAME::
Nei Ext):
AX
DAVID H ZELLFR INS AGC`i PHONE
370 LYNNIVAY (ATC.
EIMAIt
i. Yi N, MA 01901
ADDRESS:
I RER(S) q pING COVERAGE NAIC 11
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INSURED INSURER
A: ACE AMMCANMLMANCE C40heANY
B.
BERRY, 1 RANK & BER:-RY, JAN1FS DBA FRANK 8t SONS INSURER
INSURER C:
45 WDe'DBROOK DR
ttilSumm E
i PPrNG, NH 01042
ttNSkiRERf:
COVERAGES CERTIFICATE NUMBER: ttEVISM t0ifAsm:
11 Nib IS TO - TWE LIM 3F 10MCE M= _' TO THE NItEl� OVE POLICY
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HAVE 98M REDUCED BY PAID CLAPWS
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DESCRIPTION OF OPERATIONSILOCATfONWVE4gCLESIRESTMC'IiONSWEzMAL ITEM
TWS REMAIWES ANY FR1OR CERTMCATE WUED TO THE (MRTMCATE HOLDER AFFECTINti WORKERS COMP'—OVER-A(39
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CERTIFICATE HOLDER
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A? L UNDER ONE R(?C,F
OLICtEs BE CANCELLE
SHOULD ANY OF THE ABOVE Xm PD
BEFORE THt: EXPIRATION DATE'[li REW. NOTICE WILL 9D
ATTN. NORMAN 1014N
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AUTHORIZM RFPRESENTA"VE
30 TEMPLE DRIVE.
MFT1J4T.;F;N, MA 01844
i
erne �C�>!4.'7RiA A£AD5 C DDA 6 - - All rMhte MSerV .
AC0RD 25 I2UTD/iA) ine ALuku name ana wgo are rr9y+rarer+
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aw,
Aff2frs B SOS-eSS Regulai" IOCAOR)
oqetjsjje ry ine rhCe Of COngury*
Consumer Affairs and Ottsiness R"ujabon
HO imosave-eOl
Horne ImProvervient Contractor Registration Lookup
(()u (.an search; tilt" the registration 1i5t by any of the cintena below
Siezii'ichi
Search by Registr3l'On Number
,,parch by Registrant Name Zip Code I
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,earch Registrants
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You can also v6eW,
the ;eG'!-;rai- ',n number to vtew Complaint historyY
r5day. Septembeir 20. 2012,
rhF _;t IS cili-re it. of Thu
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FXpjRATj(3N STATt..)S
REGISTRANT RESPONSIBLE REGISTRATION ADDRESS TE
NAME INDIVIDUAL NUMBER 166 A FINACHARO
13 705 7"
torDEP ONF $- CIO' IANZAFAME 13UILDING
i( -)HN METHEUN. MA 01844
masracmisett,
Selvlep
Rnlrll Df Reg,
CS -069120
JOHN'W LANZAV
30 TEMPLE OR 1 413-1-70
IS"A
METIWEN MA
1 L/LG %-Urfi//Ll//irMuLL/L UJ lIL KJJKI./L LLJGLLJ
Department of Industrial Accidents
Office of Investigations
Y
I Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ledbly
Name (Business/Organization/Individual): Lm 12<J1 CSS /Q
Address: /iz
City/State/Zip: Phone #: �D ' �'T - /W5
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. 'ageneral contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.:
required.]
5. ❑ We are a corporation and its
3. ❑ 1 am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, §1(4), and we have no
employees. [No workers'
insurance
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repa'
13,,9 -Other
*Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are 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 state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company N
Policy # or Self -ins. Lic. #:
Job Site Address:
Expiration Date:
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.
I do hereby certify undeq theAains an4 penalties of perjury that the information provided aboye is true and correct.
Date:
S—/s 1'z J (
`2�--.,7sl t
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 #: