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HomeMy WebLinkAboutBuilding Permit #587 - 389 MARBLERIDGE ROAD 3/9/2007 T►ORTF� BUILDING PERMIT o`�tLbo gtio TOWN OF NORTH ANDOVER cam.a1' O� APPLICATION FOR PLAN EXAMINATION ~ z' Permit NO: Date'Received �s4 "AT so 4SSACFlu`��� Date Issued: -O IMPORTANT: Applicant must complete all items on this page "Wo TM ,aa S a as 3 £ ,� "� 4Jp �- ,� dz,,, ..�a, IROPERT ERZ I Z(4N'1�fC-CD1ST'RC f � HIS'�'t)RIC�DISTI�(C� e nr TYPE OF IMPROVEMENT PROPOSED USE 4. Residential Non- Residential ❑ New Building pone family ❑ Addition 0 Two or more'family 0 Industrial ❑ Alteration No. of units: 0 Commercial Repair, replacement 0 Assessory Bldg 0 Others: ❑ Demolition 0 Other e tip 1111e11tls p R , I , .ater Sewer RUN DESCRIPTION OF WORK TO BE PREFORMED: 54(�;p z 5k-)Yo, ke o aI i Identification Please Type or Print Clearly) OWNER: Name: Lou y; 5 vb Pe5 Phone: 13� Address: CONTRArORx {Name I I�tone � iffx ':. f ', a ' tea p r 1 y�7 �� �` ,� x ns's; as r F r©©© .� -WK II, f 5 ✓x S As "j^Z^ .EXp� DtV 7Co �c �oi'toense� a .r ;,. �. , d ontelritrovdment Lte s ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. III �7 �— Total Project Cost: $ ��� > " FEE: $ i Check No.: S�� Receipt No.: owlyy� NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contractor 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 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 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 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 2.2007 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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 ❑ 0 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/signature S Date Drivewa Permit Located at 384 Osgood Street FIRS � ADLrpPARTM1 T ;Temp �u ;�ed at 2tiinSreetL�iste�or ste�yebs ono g Ft a Depa31 rtmenfi srgaureAPS te � � s� � 4i01M�NTSr � 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 ............................... ............................................................................................... Location No. 7O Date 5 A NORTH TOWN OF NORTH ANDOVER 3? SOL N 9 Certificate of Occupancy $ • °mob+.._ � �� q,f /'-- �,SSAt►1USEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 15�1a�' Building Inspector 1Z/11/ZUUO 14:UJ rAA arts OJ1 47D1 D n 31U�,AAini -ewVV Client#:13716 JNRGU ACORD. CERTIFICATE OF LIABILITY INSURANCE 12/111106�YYYY, PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION B.K.McCarthy Ins.Agcy.Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10 Centennial Drive ALTER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I Peabody ,MA 01960 978 532"5446 INSURERS AFFORDING COVERAGE MAIC O INSURED INSUFMRA Lexington Insurance Cc 33618 JNR Gutters,Inc. INSURER B: AIM Mutual Insurance Company 3840 Lanoester Street s wmm Q Safety Indemnity Insurance Co. Haverhill,MA 01830 NSURERLT. INSURER E COVERAGES THEPOLICIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IND!CAtED.NOTWITMSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT CR OTHER DOCUMENT WITH RESPECT TO WHICH TMIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORPSO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EWVt T TYPE OF INSURANCE POLICY NUMARR o LTCY IMIOD Tl ORATOUCE M DoLM T ON LIMITo A GBNERALLIABILITY 0443317 08/21106 06/21107 EACH OCCURRENCE 11,000,000 DAInAGT RENTED COMMERCIAL GENERAL LIABILITY850 OOO CLAIMS MADE 7 OCCUR MED EXP(Any OM parson) 115'(100 x 6I1PD Ded,1500 PERwNAL d ADV INJURY $1,0001000 OSNERALAGGREGATO $2,000,000 GEN'LAGGREGA7r6IMITAFF1155rrR; PRODUCTS.COMPIOPAGO S1,0-0-0,0-0m) POLICY 0 PROT LOC C AUTOMOBILE LIABILITY 3945441 06/21/06 06/21107 �OMBINED SINGLE LIMIT ANY AUTO (Cnacalacrd) $1,000,000 ALL OWNED AUTOS BODILY WURY X SCHECULEDAUTOS (Par Parton) $ X MREO AUTOS 8Ct4RY:14Ju RY 8 T NON-OWNED AUTOS 1 (Par accident) XDrive Other Cdr PROPERTY DAMAGE (Per aeaa0nl) S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EAACC S AIJTOONLY; AGO S' EKCESSIUMBRELLAUABIUTY EACHOOCURRENOE S OCCUR CLAIMS MADE AGGREGATE �_ b S DEDUCTIBLE S RETENTION S S B WORKERS CONPENSATION AND AWC7013435012006 09/20/06 09/20/07 X WC STATU OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT SSOO 000 OPFICEW EIMBER EXCLUDED? E.L DISEASE.EA EMFLQYjRj$600,000 R S ysae.LI PR {deotv�a andel M ow E.L.DISEASE•POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AaOYB 0950MBED POLICIES N CANCELLED BEFORE THE EXPIRATION Evidence of Insurance IDAT':THEREOF,THE ISSUING INSURER DILL ENDEAVOR TO MAIL I_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUY FAILURE TO 00 90 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY NNID UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, A,�1T�HORIZED REPRESENTATIVE ACORD 25(2001100).1 of 2 #52926 APD 0 ACORD CORPORATION 1988 , y � 'Al Types of Horne Improverrie'nt; f ,•, . 11'4,Hale Street,,Suite 204 `rill Haverhill;MA 01830 ' Aaverh'ill,MA (978)372'4088 " Boston MA- N -(fi17)423 3539 ": ' Andover,MA (978)475- 23 Nashua NH: (fiO3)595 2272 4 Woburn,MA (181)937-4212 Portsmouth,NH: (603)433 181<I r Natick MA (508)653-2200 Manchester,:NH (603)-666-5502 T www.lnrgutters.com Fax' - (978)372-0360 "} y�, ' r Toll Free Nationwide: (800):966-9238 3_ :. '�� ,""`t ''�`•"E' �""_ - PROPOSAL SUBMITT6D�O.SlOP1:S PHONE, 978-683- E 307! , STREET LLODUII`z:. 3.JOB NAME r 389 Marble Ridge Road Reof CITY,STATE and ZIP;CODE - - "JOB LOCATION - ARCHITECT'• a: JOB PHONEIt}�• - 'E�$J i"VSC hereby to furnish material and labor completeln accordance with specifications•below for the sum of;� Seven Thousand Eight Hundred Se�enDollaas and'S0/100 57,807:50 �.s ^' dollars .r. ..).. Payment to be made as follows 't '�-- - ! 1 Authorized jhiaprgpgsaR yPe , Signattire, withdrawn-by us t rot accepted within �days y , L We hereby submit specifications and estimate's for ,. P J-N-R WILL STRII�THE.SHINGLES FRAM SAID';BUILDING A�TA.;DISPOSE QF IN A LI$GAI FAu"IION a a 'r WELL BE AlP#'1 YIN0 AN AI.IJMINCIMT»RI@jEDCrE AROUND THI I►�RtMETER OF THE ROOF. TfIEN.A 15 i WEIGHT FELT PAPER WILL BE APPLIED TO ROOF.DECK TI SHINGI ES THAT WTLL.BE USED W I vE THE CHOYCE OF i MER WII.I. -HA AR ARCHITECTURAI.,OESI NER•STYLE.{Ci1S 1; - BE A 30 YE SHINGLE COLOR) ANY ROOF BOARDS NEE - N REPLACING WILL BE AN LXT3tA CHAFtE AT 1 'END QF THE' QB. THE 70B.SITE AREA WITI EE eLEAATEIJN A DAII X BASIS. A3d1':REI�INING 1 ..t i 1.., "SPRAY NAILS:WILL f3E PICkjpm UP USING A MAGNET. THIS TS OF COURSE TO'PREVEI�tT A IN FROM HAPPENJNG.: WE CARRY 2 MILLION DOLLARS LIABILITY TT1' IN ADDITION. TO WORK CO]vIPI NSAI IQN INSURANCE THIS IS TO PROTECT YOUR EX`I ENSTVE INVESTMENT}ANIS TQ PUT YO ,.b t, f. r .. ;Iv1IIVDS AT,$lSE KNOWING THAT I TRULY PUT' FORTH EVERY EFFORT TO P1tOVIDE ALL CST'0 S VVITII THE I3IiHES7 QUALITY STOCK AND pgOESSIONAL SEILVICES. c �w, rulv�c. OLJC+� ",.R cft-� PRICE INCLe7bE5 SIX FEET TOPIC AND�ATER SIiIELD i)eYtdx' r+ w• C � NOTE WHEN WE DO THE•ROOF ESYECIALL,X IF YOU HAVE A.5pACE'IN3BETWEEN xOtIR'RO F ;BOARDS, RE WILL.BE SOME:BLACK SOOT(IDEBRIS)FROM TILE ROOIr.`WE RECOMM .TH T e'OI1 COVER YOi112 PQSSEssIONS.'$wITH PLASTIC �.'CiAit 4. r BE ," 1RRSI'C?1VSJBLI� F A3 AN1THlP1G'TJNAT IS IN YOUR A'I"TI:C NOR THE I3EB1i21S CAIQSrD JftROM REMOVING THE SINGLE Y' } CCE #ttxrCE LTL XLt u$2Tr The prices specifications and . ;. x.g xa con{fl const fisted above and on!lhe back of his form are satfstactory and area i a:1, he,eb'Accepted. You are authorized to,do the work'As specified.Payment well 'Signature - be made as outluied a Dete of Accepterice Signature -17 'a , NORTH 6. g Town of O No. ~ LA dover, Mass., • r1. O�— /� COC NIC KE WICK V Ids RATED 1 BOARD OF HEALTH Food/Kitchen . PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ,.O..v�.s..........:.. ... (� ... ................................................................................... Foundation has permission to erect........................................ buildings on.3.�i.. .. ..... ... *r...U&..x.q. .........pd... Rough to be.occupied as......�`Il ........t.. ........ �. Chimney .... ..... .............................................................. _ provided that the person accepting this permit shall i ery respect conf m to the terms-of the application on file in - Final 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU AR -Rough . .... .. . .... .. . Service . ....... ........... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT Street No. SEE REVERSE SIDE J1 Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizationgndividual): :!a- Vt Address: 36 - t( O V1 c City/State/Zip: rl � �^'�( ,n1 / � Phone#: Are youuaan employer?Check the.appropriate box: 1.[—]'I am a employer Type of project(required):with Z 5r 4.:� I am a general contractor and I T6.ype 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 g. Demolition working for me in any capacity. employees and have workers' [No workers'comp,insurance comp.insurance.# 9• ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.[1 Other comp.insurance required.] *Any applicant that checks box#1 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 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 workerscompensation insurance for my employees Below is the policy and job site information. Insurance Company Name: {a 1- V`' vLA, Policy#or Self-ins.Lic.#: 1,W C 7 O 1 Lj 5b I Z G0bExpiration Date: cf�Z�'0 Job Site Address: (( ttAo..-�j�t? K tdS—�' City/State/Zip: (i(, AK&OaA_ 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 under the pains and penalties of perjury that the information provided above is true and correct Signature: � --- Date Phone#: G 1 S 3 7 Z � C>V Offlcial use only. Do not write in this area,to be completed by city or town offlclaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employdrs 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 thea ro riate 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 f the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. o Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 roof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each PP as P 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 bum 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 Boston,MA 02111 Tel. #617-727-4900 ext.406 or 1-877-MASSAFE _._._ Fax#617=727-7749---_.. Revised 11-22-06 www.mass.gov/dia t Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR, Registration- i - --- - 108503 Expiration -8/19/2008 Type :Supplement Card J N R-GUTTERS IN&. _KEVIN FRANCIS- 114 RANCIS 114 Hae St. µ Haverhill,MA 0.1830 i ldministratvc. r BOARD OF BUILDING REGULATIONS ,h License: CONSTRUCTION SUPERVISOR { �.. Number:CS 080515 Birthdate 07121-%1.965 I ExPirf§: 0712112007 Tr.no: 14850 t S� i KEVIN M FRANCIS'S ?' r 31 LAWRENCE HAVERHILL, MA 01830 h k jl Commissioner NORTH O Of _ over O ti .R No. 7 O - dover, Mass., • r1. O�-- I�19COC MIC KE WICK V 7 AERATED PPS` 5 '9S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....L-o-juk............. �...��i .• ... .................................,. ................................................ Foundation has permission to erect........................................ buildings on.,, ..... ... �A►�. .. .4. ........ ... Rough to be occupied rill .. f:. �. Chimney ...... . ........ ..........titte: ....... ..provided that the person acce ing this permitry respect conf m to the terms of the application on-file in Final 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 6 MONTHS UNLESS CONSTRU ELECTRICAL INSPECTOR , � � AR Rough .... Service . .... .. .... .. ... a .................... . BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det.