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HomeMy WebLinkAboutBuilding Permit #776 - 71 MARBLERIDGE ROAD 6/27/2008BUILDING PERMIT oF�t��o ,b�+ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received" 9,p ��SSACHUS Date Issued: ,v of IMPORTANT: Applicant must complete all items on this page LOCATION 1 'rG C iC,,i) N. A/vDo Ute— MA PROPERTYOWNERJ l i�e _ y 'Jo ' Print MAP NO: *7 PARCEL: ZONING DISTRICT: Historic District 'Machine Shop yes no ves 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 PREFO MED: VV E E)CIS-n g E.Oz-irL, H#Ctl u'AtS + -7rOtS— �c� &rzs OWNER: Name: Address: -? 1 M4 TviT Au77a -3576 Llel)-3)450–�?6 CONTRACTOR Name:,Phone: Address:% �E'J��.c'✓ �`u ?�`>a illi Supervisor's Construction License: Exp. ©ate: Home Improvement License: ' �� Exp. Date: 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: $ FEE: $ �/Lqo Check No.: Receipt*accthe—iguarta NOTE: Persons contracting with unregistered contractors do not hfund §jgnature of Agent/Owne Sig6,17 nature of co J 10 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 `+ 4 r 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 USgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main :Street Fire "`Department signature/date COMMENTS 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use 0 Notified for pickup - Date Doc.Building Permit Revised 2008 No Location 7/ / w��� 44 nl-� No. Date CX71all Nom,. TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ '�b'••° '<� Building/Frame Permit Fee $ �© Foundation Permit Fee Other Permit Fee TOTAL Check # U 2 1 231 Building Inspector Date: 627/2008 02:32 PM Sender's Fax 10: 603-890-0315 Page 1 of 1 ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID DN INSUR-2 DATE(IIMfDDIYYYY) 06/24/08 PRODUCER Santo Insurance - Salem 224 Main Street Salem NH 03079 Phone:603-890-6439 Sax:603-890-0315 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Insurcomm Construction Inc Matt Wescott 3510 Lafayette Road, Suite 4 Portsmouth NH 03801 INSURER Amzlcan int*rnattenal Group INSURER 8: Travelers Indemnity Co INSURER C: INSURER D., INSURER E: COVERAGES 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, EXCLUSION AND CONDITION OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR SRC TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYY) DATE (MMIM LIMITS North Andover MA 01845 GENERAL LIABILITY EACH OCCURRENCE $1,000,000 B X COMMERCIAL GENERAL LIABILITY 16802295CS60IND06 11/15/06 11/15/07 UVqAP&A- Ili ICU PREMISES(Eaoco„rerim) $100,000 CLAMS MADE � oCCLR MED EXP (Any one person) $5,000 I6802295CS60IND07 11/15/07 11/15/08 PERSONAL &ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEM AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 17 POLICY 7 ,PERa LOC B AUTOMOBILE LIABILITY ANY AUTO BA1725M33A08SEL 03/08/08 11/15/08 COMBINED SINGLE LIMIT $1 ,000,000 (Ee accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS X SCHEDULED AUTOS BOOBY IN,R.RY $ (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ )Per eccidert) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ ANY AUTO EXCESSANABRELLALIABLIn' EACH OCCURRENCE $ 1,000,000 B X OCCUR F-] cLAIMsMADE ISTCUP2743Y682IND07 11/15/07 11/15/08 AGGREGATE $1,000,000 S $ HDEDUCTIBLE X RETENTION $nil $ A WORKERS COMPENSATION AND EMPIUOY8W LIABILITY ANY PROPRIETORIPARTNERIExECUTIVE OFFICMMEMBEREXCLUDED? WC8977059 WC2922559 11/25/06 11/25/07 11/25/07 11/25/08 X TORY LIMITS X ER E.L. EACH ACCIDENT 5500,000 E.L. DISEASE, EA EMPLOYEE $500,000 It yes, describe under SPECIAL PROVISION below 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 TOWNNAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO $ WILL Town of North Andover IMPOSE NO OBIUUTKNI OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1600 Osgood St REPRESENTATIVES. AUTHORIZED REPRESENTATIVE North Andover MA 01845 James A Santo ACORD 25 (2001108) 0 ACORD CORPORATION 1988 0 Licensee Details The Official Website of the Executive Office of Public Safety and Security (EOPS) Public Safety DPS Home EOPSS Home Mass.Gov Home State Agencies State Onfine Services Department of Public Safety Licensee Complaints License Type Home improvement Contractor License # 1 145192 Restriction Company Insurcomm Construction Inc. 1 Name Neil Robbins Address 3510 Lafayette Rd. Suite 4 City, State, Zip Portsmouth, NH, 03801 Expiration Date 12/2212008 Status Current No comQtaints found for this Licensee. Back To Search E s,=fi��2L12DJ6 Corph r5fion O:NANC. x{�-,=afimirri+zrufrit s ST Page l of 1 Mass.Gov Home �J � r; • nQ� �; �r , 1 �I `Ciel®ofLOW z,2��� yi ` dumber: C�OOT/Cry)lkf 8lrthdate•. 092351 l�S Ex 12/20%193 4.0 , bites. 1?/20/�o08 t/ARNE 114WeSTCed: 00 Tr, no: 9''2351 OU` NH°ata 0 '� a• mMisSio�er I httn://db.state.ma.us/dns/licdetails.asr)?wSearchLN=HIC 145192 6/23/2008 4.1 C O N T R A C T �1 This CONTRACT, made This Day Months Year6'00F i By:. MARY JO AND TOM CIESLEWSKI Of: 7(1 MARBLEHEAD ROAD NORTH ANDOVER, MA 01845 -hereinafter called the OWNER) And: Insurcomm Construction Inc. Of: 3510 Lafayatte Road Suite 4 Portsmouth, NH 03802 :6Hereinafter called the CONTRACTOR) WITNESSETH THAT THE PARTIES HERETO AGREE AS FOLLOWS: I (A) The CONTRACTOR will furnish materials and perform the work for the consideration of: THIRTY THREE THOUSAND THREE HUNDRED.TWENTY DOLLARS AND EIGHTY SIX CENTS �( $33,320.86) Dollars !in accordance with the (GENERAL CONDITIONS) shown in this contract and 'Attached detailed estimate number 0624 Dated 06-24-2008 1he(B) CONTRACTOR will start work (weather permitting) by JULY 3 2008 Nith estimated completion date of WEATHER BASED 1 'he OWNER will make payments as follows:. I (��``'( n'°��j of (C) &, with the final payment due on completion i,`2S to satisfication. All payments due on demand in full within 10 days in lincrements of 50.00 percent of time used to complete this contract. !Each invoice is due according to the terms of payment stated herein. 'If not paid if full by due date, OWNER expressly agrees to pay a service charge of one and one-half percent per month, unless applicable laws ,requires a lessor charge, computed on the unpaid deliquent balance until fthe account is paid in full. For any credit which may be extended (pursuant to the terms hereof, OWNER agrees to pay reasonable attorney fees and other costs incurred for collection. GENERAL CONDITIONS (1).11 CHANGES IN WORK: The OWNER who may at any time, with the approval of representative designated by the Financial Institution involved, make changes in the specifications, within the general scope thereof. If such changes may cause an increase or decrease in the amount due under this contract or in the timelrrequired for its performance, an equitable adjustment will be made, and thisl!contract will be modified accordingly by the (Contract Change Order). (20I INSPECTION OF WORK: All materials and workmanship will be subject to inspection and test, by the OWNER or their Representative, who will have the right to reject defective material and workmanship or require its correction. (3).�I NOTICES AND APPROVAL IN WRITING: Any notice, consent, or other act to be given or done hereunder will be valid only if in writing. (4).�l CLEANING UP: The CONTRACTOR shall keep the premises free from excessive accumulation of wasc.e maCeri.al and rubbish, and at the completion of the work shall remove from the premises all implements, surplus materials and rubbish. 4 5 , ..' T � .. I _ .. 1, r 1 � . f . ... � . ` .1 S� - (5)�� WARRANTY: In addition to any additional warranties agreed to by both parties, the contractor warrants that the work will be free from faulty materi6ls; constructed according to the standards of building code applicable forithis location; constructed in a skillful manner and fit for habitation. Our workers are fully covered by Workmans's Compensation & Liabilty Insurance. The warranty rights and remedies set forth in the State Uniform Commercial Code apply to this contract. (6), RESOLUTION OF DISPUTES: If for any reason a dispute arises as to the terms of this contract or the performance of either party, then the parties agree to settle the dispute by jointly paying for the following. MEDIATION: With the parties agreeing to enter into good faith negotiations through_a—neutraJ mediator in order to resolve their differences. IN WIF'tN'NESS WHEREOF: Thep ties hereto date telow written. (CONtAACTOR) r executed this contract as of the DATE: h" b? _ DATE: b/z#107 w � 0 � o o w C/) a u. J) o W W o -co C o w o w v U `� w � a tw o g2 cn q W. a EO. 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