HomeMy WebLinkAboutBuilding Permit #702-16 - 450 MARBLERIDGE ROAD 12/9/2015Permit NO: -� d z..—
BUILDING PERMIT �eD..
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3�06 ....,, 6
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
Date Issued: —I ' I
IMPORTANT: Applicant must complete all items on this page
LOCATION t '° fi� i �/eOhj
...Print �..
PROPERTY OWNER PGA4 AW Oe v Le, 5.
Print
MAP NO: PARCEL: " ZONING,nDISTRICT Historic'District yesno
mZ,lMachine,Shop Village ye$ no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential "
Non- Residential
❑ New Building
600ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well 1-
`" ❑ Floodplain. ❑ Wetlands
❑` Watershed District
❑ Water/Sewer
�%4 4?4"�e
Identification Please Type or Print Clearly)
OWNER: Name: AA Uip ge ✓ '1-115 Phone: d')G-D
Address: 4T® �9
CONTRACTOR Name:; ,,.. Phone'
Address:/Q771
fw
Supervisor's Construction License: Exp. Date:
Home Improvement License E) µ Exp. Date:
u.l �, �•
IVI
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING�jPERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $i
Check.Nio.: Receipt No.:
NOTE!, Persons contracting with _'�rxgiw(ed contractors do not have acW'ss'tothi arat fund
W
t"
11
sk,
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
10TE: 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)
r ❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
TOTE: 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
IOTt: 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
Appeal -I 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
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this pag
LOCATI®N - `
.. Pant
PROPERTY ®WNER
Pr'nt 00 Year Str store
MAP PARCELS Z®NING MI S00 - •m Historic District
Machine Sho
,. .
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
' c"€ y �
®Wel
1 a,�7a
�t '�Y,� ��� fi �'etl
Floodplarn ®4t]j�i
�Sy-'
T`Setic
�'Watersr.
DESCRIPTION OF WORK TO BE PERFOR9 hU:
Identification - Please Type or Print Clearly
OWNER: Name: Phone:
A(if{r'PCC'
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost:
Che'(yk No.: Receipt No.:
DOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
signature=of AgentlOvvner-Signaitare of ic6h tactor.- !
The following is a list of the required forms to he 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
DTE: 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
)TE: 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
)TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
oust be submitted with the building application
)Doc: )Building )Permit Revised 2014
Plans Submitted ❑
Q"
Plans Waived.[]Certified Plot Plan ❑ Stamped Pla,ns ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Si' Timing 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 a U FORM
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On Signature.
CONSERVATION Reviewed on Signature
COMMENTS
b
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
onservation Decisio
Comments
Water & Sewer Connection Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood S
FIREDEP�4RjTtVIERII''Terri tDum ster o s ,�F,,.,.,, Street
4
tr fi
F -, �1 p, p n pe eyes .. ► .$ - qor"" �
Locatedat�124 Main Street, c`
F�reDepartmentsignatureidate,
a+SZ?'97 VWO7 P '•s ply '(, ,fit
COWENTS
x.
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
MOTES and DATA -- (For department use)
® Notified for pickup Call Email
Date Time Contact Name
Doe.Building Peimit Revised 2014
Location / V MvyX We 4J T' -
No. �-o Date i2 CI
Check #
29791
TOWN OF NORTH ANDOVER "
d
Certificate of Occupancy $,
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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Building Inspector
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Bid Date:
Owner:
Company:
Street Address:
City, St. Zip:
Phone #:
Phone #:
11/27/2015
Rich+Maureen Fields
450 Marble] a Rd
N. Andover, MA 01845
978-975-8100
United Home Experts
& United Painting Co., Inc.
60 Pleasant St. Suite 1
Full Worker's Compensation Coverage
$4, 000, 000+ Liability Ins. Coverage
Industry leading Warranties
Flexible Payment Plans available
Ashland, MA 01721 Family Owned and Operated
508-881-8555 FAX 508-881-5584 MA HIC License # 157108
www.UnitedHomeExperts.com
MA Constr. Supervisors License
RI REG # 22948
RRP License # NAT -28008-1
Fed ID # 04-3541521
Qty:
Roof Shingle Replacement Remove existing asphalt shingles and install new asphalt shingles, 50 Year Warranty
underlayment, flashing, and proper ventilation: Owens Corning
system.
Brand (if applicable):
Brand (if applicable): Total Cost of Labor and Materials: $14,023
PAYMENT TERMS: A non-refundable deposit of 1/3 of ALL ACCEPTED PROJECTS is due upon contract authorization with 1/3 of
EACH PROJECT due upon half of completion of EACH PROJECT, and the balance of EACH PROJECT due
upon completion of EACH PROJECT along with any additional work requested by customer.
LIENS DISCLOSURE: State law requires us to inform the property owner of contract liens. A lien or security interest has NOT been
placed on the residence. Any contractor, supplier, or subcontractor may lien the real property if the property owner
or the general contractor fail to pay for goods or services delivered or installed at the work location. Some
contractors and suppliers automatically send letters of notification similar to this notice. At the owner's request,
we will provide original lien release documents from anyone who provides said materials or service.
NOTICE OF CANCELLATION: The property owner may cancel this transaction at any time prior to midnight of the third business day after the
date of the contract without any penalty or obligation and has been notified in writing of such.
NOTICE: All home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor
or subcontractor relating to a registration should be directed to; Registration Division, Program Coordinator, One
Ashburton Place Room 1301, Boston, Ma 02108 Tel: (617) 727-3200 ext. 25239
PERMIT: A building permit is required for work being done on the property listed above. The owner has authorized United
Home Experts to obtain such permits as the owner's agent for any work requiring a permit. Owners who secure
their own construction -related permits or deal with unregistered contractors shall be excluded from access to the
Guarantee Fund.
SCHEDULE: The following schedule will be adhered to unless circumstances beyond the contractor's control arise.
Proposed Work Start Date 12/19/2015
Proposed Completion Date 2/2/2016
Date
IS
131313
Au orized Agent Date
The CommonweaO of Massachusetts
Depar6ne* Of lids.►�OAccidents
OffWe of Investigations
i
I Congress Street, , �100 W Boston, MA 02114-2017 r
WWW. numLgovldia
Workers' Compensation Insurance Affida-vit. Benders/Contractors/Electricians/Plumbers
Name
Address:.. 60
A an emploW. CbecWthe-appr
11
am at emp�Ya.
2-0
ship and have no employ=
WOM4 forbe tuarkwkity.
[No workers' C=. insumnce
.1 0 1 am` a 66M,towner #oing aft work
comp.
ini;urainci n4! 1-
4 Phonet a
4. 'M I am a general contractor and I
have hired thcrvb-rontcastors
listed on the maelied sheet
Thek Mlt�!t6rs bAve
amplayea,and have workers'
COMP. insurance.t
S. ❑ We we a ;or porzt1M and its
officers i6Ar
right .0 X—Dogn per
i.l41014' amd qve have no
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at ch
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mpwyem irdw.*b-coauam mhM=*oY.vm toy sto
ployer'"O.
Insurance Company Name:
Policy # or Self -ins. Lic.
Job Site Address;.
Ama<cii a tai of t*. W4
aoure m. F-MR1 qoveq.
r
Type, ofproject -(
'rc""
6. New ;qqqu*on
1 ling
Demolition
9. [� Bii�damg addition
10,[3'Electrical repairs or additions
11.0 , Plwi64 rt -am or additions
.12.Lj Roof repairs
13.0 Other
OM submit a ami: &Mdffvk B such.
ku'=F xid =a wbcdiir or M 6oit enfifia, hm
omw Poky
md)ob. WU
City/State/Zap :
two pok-Y rp (;i�*iag 6be d expiki64 date}
FRIPPM-P-1- m c Policy t
S,a,:d6n zs�"' of k6f 6. 0 1 %an woo- r cs of 4
2 to e im
pqqmqp of
1*4
as well as etvt P—Makics in form of a =6
STOP iIOR� me
advised that a copy of
_n stiiethent ma forwariied Co the C} fit t of
f, and a E
nnedt
y be
eiju�'" i* 0 &jvr*61o4 privWd ibevO 6 &aiie mid iv&ici
Qpd d we only. MW wrfte In &klere;`to be confleedby vi tet affieW
City or Town-, 'Permit/Licesse #
Inning Authority (circle orae):
1. Board of Health 2. Budding Department 3. Chy/Town Cleft 4. Electrical Inspector B. Plumbing Inspector
& Other ;
cootact Person: Pboat#-
OP ID: KG
ACORO DATE IMMIDDfYYYY)
� I CERTIFICATE OF LIABILITY INSURANCE 08/06/2015
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(ies) 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 not confer rights to the i
j certificate holder in lieu of such endorsement(s).
iPRODUCER CONTACT
NAME:
East Douglas Insurance Agency PHONE FAX
PO Box 1370 (AIC, No, Ext): IAX. No
Douglas, MA 01516 E-MAIL
Marc Larocque PRODUCCEER
CUSTOMER ID t. UNITE51
INSURERIS) AFFORDING COVERAGE NA:C =
INSURED United Painting Company, Inc INSURER A: Essex Insurance Company
dba United Home Experts
60 Pleasant St. Ste 1 INsuRER a :Commerce Insurance Company 34754
Ashland, MA 01721 INSURER C: Essex Insurance Company
INSURER D: AEIC
INSURER E
INSURER F
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 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.
INSR AODL SUER POUCY EFF POUCY EXP
LTR TYPE OF INSURANCE POUCY NUMBER MMIDONYYY MM/DOfYYYY
LIMITS
GENERAL UABIUTY
EACH OCCURRENCE
S
1,000,000
A X COMMERCIAL GENERAL LIABILITY 2CU3629 04/15/2015 04/15/2016
DAMAGE TO RENTED
PREMISES IEa occurrences
5
100,00
CLAIMS -MADE X OCCUR
MED EXP (Any one person)
$
5,000
_
PERSONAL & ADV INJURY_ _ _
S
1,000,00
GENERAL AGGREGATE
S
2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMP OP AGG
S
2,000,00
PRO -
POLICY JECT LOC
t�
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
1,000,000
13 ANY AUTO BDGTQN 04/15/2015 04/15/2016
IEa acndent)
BODILY INJURY IPer person;
S
ALL OWNED AUTOS
BODILY INJURY IPer accident;
S
X SCHEDULED AUTOS
X
PROPERTY DAMAGE
S
HIRED AUTOS
IPER ACCIDENT)
X NON -OWNED AUTOS
I
S
S
-
UMBRELLA LIAR X OCCUR
EACH OCCURRENCE
$
4,000,00
C X EXCESS UAB CLAIMS -MADE 10105017AGGREGATE
04/15/2015 04/15/2016
S
4,000,00
DEDUC f IBLL
$
RETENTION S -
S
WORKERS COMPENSATION
WC STATU-OTH-
X
AND EMPLOYERS' LIABILI Y YIN
D
TORY LIMITS ER
AN" PROPRIETOR,PARTNER.EXECUTIVE WCCS010274012014 08/15/2015 08/15/2016
E.L EACH ACCIDENT
$
500,00
II:I:R-W.1BLR LXCLUDEU-> N I A
,,Mandatory
Ory in NMI
If
El DISEASE - EA EMPLOYEE
5
500,00
u yas. descrioe unser
yAs. d nd
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
5
500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Addiltmal Remarks Schedule, if mora space is required)
All corporate officers are covered under the workman's. compensation policy
6rCR r rrn.r� I c nvt_ucR CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED RE
Marc Larocq
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD25 (2009/09) The ACORD name and logo are registered marks of ACORD
L:=
Office of Consumer A airs ao dusiness Regulation
10 Park Plaza - Suite 5170
Boston, Ma achusetts 02116
Home Improvem6- • , ntractor Registration
UNITED HOME EXPERTS
MICHAEL DUDLEY
60 PLEASANT ST STE1
ASHLAND, MA 01721
SCA 1 0 20M-06/11
of Consumer Affairs & Business Regulation
IMPROVEMENT CONTRACTOR
UNITED HOME
MICHAEL DUDLEY
60 PLEASANT ST STE
ASHLAND, MA 01721
Type:
Supplement Carl
Undersecretary
Registration: 157108
Type: Supplement Card
Expiration: 9/5/2017
to Address and return card. Mark reason fbch``ange,
iJ Address LJ Renewal [] Employment F� Lost Card
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Bostr,on, MA 02116
1
Not valid without.$ignature