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HomeMy WebLinkAboutBuilding Permit #1101-15 - 389 MARBLERIDGE ROAD 7/27/2015 LFNORTil O�t�LE� BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION * _ y Permit No#: I Date Received ArE90) US Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION p Q' �' PROPERTY OWNER Gl 1�- Print 100 Year Structure yes no 'OM1. istrict yes no MAP PARCEL_ t4 ZONING ZONING DISTRICT:�Machine Shop Village yes no T YPE OF IMPROVEMENT PROPOSED USE � Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family [I Industrial � ❑ No. of units: Commercial ❑Alteration ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition El Other _ - - _ ` - Flootlplaitr �Wtlands 0 Watershedlt®i tracts ❑tSeptic ®Well ' p xWater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: R- f �-1 u Identif"icatio - Please Type or Print Clearly OWNER: Name: L-�Li'?- ' ,� (Z-01h Phone: i, Address: [[ Contractor Name: v J Phone: Email: O s �ve�t Address: Supervisor's Construction License: Exp. Date: Home Improvement License: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDINPER PER$1000.00 OF THE TOTAL ESTIMATED COST BASED O4o �5.00 PER S.F. Total Project Cost: $77E �J©l5 FEE: $ zZ4. 6155�1 2.4 Receipt No.: Check No.: � NOTE: Persons contracting with unregistered contractors do not have access to the g anty fund F c 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 4� Building Permit Application 4. Workers Comp Affidavit 4- Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4, Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 P Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimmning 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 PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes i r Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit ]DPW'Town Engineer: Signature: Located 384 Osgood Street ;FIRE isteraon;sit DEP�R�T�ME VTCem Qum' e' esi�. � s« ,;_ � o a-: "' ` r`` ' �Lo ate 124 ��' PT � - •x� ti . �yy� = t' .r �7 tl4 s q i 4,Fire Department spignature/dated , ` '.' �i" .a,...L.�s c3L'`....tc.slr,�.�. 'x'_:, `C 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 I DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ,I I i ® Notified for pickup Call Email f Date Time Contact Name Doc.Building Permit Revised 2014 I Location No. i{U� _,! Date s- . - .TOWN OF NORTH ANDOVER ......-�' Certificate of Occupancy $ . . Building/Frame Permit Fee R7,1 w Foundation Permit Fee $r Other Permit Fee $ •UO-TOTAL $ y Check;Z74 I;',A1 7—j Building Inspector �� NORTH Town of 2Andover O �=M.VVLV low so h ver, Mass, \/we 2pi 63 C OC NIC Nf W.C" y1' A0 R4TED S V BOARD OF HEALTH Food/Kitchen PERMIT T LD/�_�_� Septic System a �I 1�6� J a4 7`C BUILDING INSPECTOR THIS CERTIFIES THAT ..................................................................MAI ....... ......................................... ,/�, .. .�. Foundation has permission to erect .......................... buildings on .-. .1..... ... �! ,� ...... Rough to be occupied as ........15.w6k. p .... ....:. �.....' vt...S.C� ...... .. . ............................: Chimney provided that the person accepting this 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUE10� ST RTS Rough 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. SE Engineering IIII Contractor RIctor Registration No ti MA Contractor Registratlon No i A division of Thielsch Engineering CT Contractor Registration No 60 S6awmntt7oit#2,Canton,MA 02021 CONTRACT 339-502-035 FAX 339 5NS CONTRACT iw07A R I S E Page 1 PROGRAM -MM COfJTRACTis6HTENED ttrf09ETVaaDIRISE CNA--HES 8MINEERINOANOTHECUSM IERFORINOWAs ENGINEIERING oEsciusEoaEunn CUSTOMER :PHONE DALE CUENr0 WORK ORDER. Elizabeth Trainor (978)766-7886 08122/2014 403665 00002 SERVICE STREET 8111JNG STREET . 389 Marbleridge Rd 389 Marbleridge Rd SERWCEc".STAMZIP .. .. 61WNd-C.STXMMP North Andover,MA 01845-4716 North Andover,MA 01845-4716 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure"that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements;attached garages and other unheated areae(windows are not generally addressed.)(10)working hours. At the completion of the weatherization work,and at no additional cost to the homeowner,a final;blowd.door aodfor combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $750.60 DAMMING:Provide labor and materials to install it 12"layer of R-38 unfaced fiberglass batts to(62)square feet for damming purposes. $127.10 ATTIC FLAT:Provide labor and.materials to install an 8"layer ofR 28 Class 1 Cellulose added to(1092)square feet of open attic space. $1,419.60 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. The cover has integral weather-stripping to restrict air leakage. $200.00 VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with soffit mounted flapper vent to exhaust existing bathroom fan(s). $237.50 VENTILATION:Provide labor and materials to install ventilation chutes in(36)rafter bays to maintain airflow. $72.00 VENTILATION:Provide labor and materials to install(12)4"X lb"rectangular aluminum soffit vents to increase ventilation in attic areas.Specify color.White or Gray. $300.00 CRAWLSPACE:Provide labor and materials to install (28)square feet ofR-10 rigid Thermax insulation to the crawlspaee perimeter wall up to the sill and against the band joist. $98.56 BASEMENT CEILING:Provide labor and materials to install(62)linear feet ofR-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $99.20 k tJW NOV 17 2014 f ti 1 o RISE Engineering Fed RI MTaCooneraa � Ctor Registration No INA Contractor Regtstration No A division of Thieisch Engineering CT Contractor Registration No 60 Shawrout Unit#2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 I S E PROGRAM THIS CONTRACT IS ENTERED INTO anwEEN RISE CMA-HES ENGINEERING ANDTHE CUSTOMER FOR WORK AS ENGINEERING OESCRMEDSE OW CUSTOMER PHONE- DATE CUENTO WGRK ORDER Elizabeth Trainor (978)766-7886 08/2212014 403665 00002 SERVICE STREET- �e1U.MG-STREET. 389 Marbleridge.Rd 38,0 Marbleridge Rd SERVICE CITY.S-rATF,W BRLING:C 1V STAIE..J3P North Andover,MA 01845.4716 North Andover,MA,01845-4716 JOB DESCRIPTION Total': $3,303.96 Program Incentive: $2,515.47 Customer Total: $788,49 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WIYH ABOVE SPECIFICATIONS.FOR TME SUM OF ***Seven Hundred Eighty-Eight$491100 Dollars $788,49 UPON FIMA INSPECTION AND APPROVAL BY RM r;NGINEERING..CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL'INiEIiESr OF ix Wa18E CHARGED MOMMY ON ANY UNPAID BALANCE AFTER 70 OAYB.SEE REVERSE FOR IMPORTANT I- TKIN ON GUARANTEES.RIOHTS OF RECISIOK'SCHEDUUNG,AND CONTRACTOR REGISTRATION. DO SIGN THIS CONTRACT IF THEREAREANY BLANK SPACES RUTH �SIGNATURE•RISE ENGIMEERING CUFffiMERkZ1rPTAN NOTE THIS CONTRACTMAY BE WITHDRAWN SY RIF NOT E%ECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-TME ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE DAYS. SATMACTORY TO US AND AREKERBY ACCEPTED.YOU ARE AUTHOR=To no THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE I I I I i The Commonwealth of Massachusetts Department oflndustrialAccidents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 yJ.. www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leidbly • C Name (Business/Organization/Individual): -- Address: ps 1 t3 t -> City/State/Zip: k t?7NL Phone#: v 7�3 Are yon an employer?Check the appropriate box: Type of project(required): 1?'I mei a employer with_employees(fiill and/or part-time).* 7. New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in $, E]Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.FJ I am a homeowner doing all work myself-[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.instuance.1 �^ 14XO 6.❑We are a corporation and its.officers have exercised their right of exemption per MGL c. ther v 152,§1(4),and we have no employees.[No workers'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. $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. Q_,,,, Insurance Company Name: )9 M &tJ 1�_r Policy#or Self-ins.Lie.#: R (Dq �� Expiratio/Zip :ate: J(--� �i� Job Site Address: C� ► 4*A06 "Xt, City/State Attach a copy of the workers'compensation policy dec aration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. Ido hereby certify uun-�der lie pan s a d penalties of perjury that the information provided above is true and correct. Si afar Date: ` �� �/ Phone#: 6t 6.,.-- Official '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#: ---"MON t TDINS-1 OP ID:MR AC®R®" DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 06/10/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AI-FIRMATIVELY 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 pollcy(ies)must 139 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 sui h endorsement(s). CONTACT PRODUCER ( NAME TYG Insurance Agency,Inc. PHONE 68 Freeman Street IAIC.No 781-"1-W02 '(AC. AC No):781-641-3009 Arlington,MA 02474-6614 E-MADDRESS: INSU AFFORDING COVERAGE NAIC& INSURERA,.Scottedale Insurance Company INSURED TD Insulation,Ind.. INsuRERs:AmGuard insurance Company dba Hugh's En"Iy INSURERc:Arbelia Protection Ins Co. 41360 259 Milton Street; Dedham,MA 02026 INSURERD: i INSURER F: INSURERF: 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. NOTWITHSTANDIN�S 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. ILTRNSR TYPE OF INSURANCE E IN POLICY NUMBER MMID LIMITS A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE S 1,000,000 DAMAGE TO R CLAIMS-MADE ®OCCIM CPS2020992 08114/2014 08114/2015 PREMISES Ea tleaurence S 50,00 MED EXP(Airy are person) S _ 5,00 PERSONAL BAOVINJURY S 1,000,00 GEN1 AGGREGATE LIMIT APPLIES FER: GENERALAGGREGATE S 2,000,00 POLICY❑JECT F-1 Li)C PRODUCTS-COMPIOPAGG S 2000100 OTHER: S AUTOMOBILE LIABILITYa BINEelDitSINGLE LIMIT S 1,000,00 C ANY AUTO 1 1020032764 08/14/2014 08/14/2015 BODILY INJURY perpetson) S ALL t AUTOS ED X AUTO TILED BODILY INJURY(Parabct M) S HIRED AUTOS AUTOS iR�ED perraE�emd ) AGE S 5 UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 1,000,00 A EXCESS LIAR CLA MS-MADE XBS0044410 10/07/2014 08/14/2015 AGGREGATE g 1,000,00 DED X RETENTIONS �10000 S WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPME-rOR/PARTNERIEXEcuwE YIN R2WC641660 05/30/2015 05/30/2016 EL EACH ACCIDENT S 500,000 OFFICERIMEMBER EXCLUDED? N❑NIA (Mandatory In NH) s EL DISEASE-EA EMPLOY $ 500,000 If yqes,tl ISCobe under € DESCRIPTION OF OPERATIONS helaw` E.L DISEASE-POLICY LfMrr S 50t),OQ Commercial Applies i DESCRIPTION OF OPERATIONS I LOCA'nON'C/VEHICLES(ACORD LD1,AddMe l Remark.Sehad.to mop 6e attaohod irmo,e opnm b,egW,ppl Conservation Services Group,llnc,National Grid NSTAR and WMEC are added as additional insured as their intgrest may appear Y= r Work contracted with the named insured. i CERTIFICATE HOLDER f CANCELLATION CONSWES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOROD REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD .s K F h 6 F - F f` { I i fy� 77 E Massachusetts-DepartmIrr Of public Safety fandards _ l Bea., cs Sui; iag P gulail ,s ar - License: CS.060784 k Thomas P Dro Tho W9ogle 2591VIiltou Street' 4 F } Y.Y De 036 ., Dedham MA 02 _ P�piration commissioner _ - r i i k P i I I i t i t i i t i l a Office of Consumer Affairs and Business Regulation 10 Park Plaza'- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 104800 s Type: Supplement Card Expiration: 7/15/2016 HUGH'S ENERGY CORPORATION -' THOMAS DROMGOOLE Y 259 MILTON �3TREET DEDHAM, MA 02026 Update Address and return card.Mark reason for change. sea i e: 20M-05i11 L� Address iii Renewal 7. Employment Lost Card !=��c�.•�«i�ar..:�rrunf�l/�n�C-%llia;fr�c�ia;n.CG ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: =� Office of Consumer Affairs and Business Regulation ;Registration XOW0� Type: 10 Park Plaza-Suite 5170 W Expiration 7/15/2016 Supplement Ceid Boston,MA 02116 HUGH'S ENERGY CORPORATIOIV;;; THOMAS DROMGOOLE 259 MILTON STREET DEDHAM,MA 02026 Undersecretary Not valid without signature