HomeMy WebLinkAboutBuilding Permit #839 - 85 MARBLERIDGE ROAD 6/23/2006Permit NO:
Date Issued: a_1Z .1 e
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received: . �2';"4�
IMPORTANT: Aonlicant must comnlcte all items on this
LOCATION 6 s rwArk 13yc cz,
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PROPERTY OWNS
MAP NO.: 37 C
a `P.q%
PARCEL: 13
TYPE AND USE OF BUILDING
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ZONING DISTRICT:
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
ILJ New Building
`J Addition
C Alteration
0 One family
F] Two or more family
No. of units:
2 Industrial
repair, replacement
r Demolition
El Assessory Bldg
n Commercial
E, Moving (relocation)
0 Other
❑ Others:
.J Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name: )__� e_,v 4 �t J -@ Phone: 6A 6 - .5 D 1_1
Address: $ 5- ✓h tz (die 12� �w 4Z
CONTRACTOR Namef.
Address: 5- (-A pe 1 S'- +;-2-Ar"
Supervisor's Construction License: C S ®5 J) I'S Exp. Date:
Home Improvement License: DO) Exp. Date: l 1 f 15 /ace -1.
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No
FEE SCHEDULE: BULDLVG PERMIT: $10.00 PER $1000.00 OF THE TOT,4L ESTIMATED COST BA ED Opti $125.00 PER S F.
Total Project Cost :$ '7 00 x 10.00=FEE:$
Check No.:�- Receipt No.: C16,�
Page Io1'4
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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
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 DEPARTVIENT:BPFORiM05
Paged 44
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Building and Remodeling
5 APPLETON STREET
NORTH ANDOVER, MA 01845
(978) 682 2023 PHONE / FAX
Proposal Submitted To:
Ben Hyde
85 MarbleRidge Rd.
North Andover MA, 01845
Job: New Roof
Proposal
June 21, 2006
HOME PHONE: (978)686-5087
Obtain permit and Complete removal of all demolition and construction materials
generated by Testa Building and Remodeling and its subcontractors.
Construction:
Remove roofing on the house and the garage. Water and ice shield were required.
Metal drip edge and re shingle the roof with 25 yr.
A finance charge of V/2% per month (18% per year) will apply to all accounts over 30 days past due. In the event collection activity
is required the customer shall be responsible for all costs associated with collection, including reasonable attorney's fees.
I propose hereby to furnish material and labor complete in accordance with above
specifications, for the sum of:
$ 7800 Seven thousand eight hundred Dollars
ONE HALF TO START SECOND HALF UPON COMPLETION
Authorized signature.
I reserve the right to cancel this contract if not accepted in -30_ days
Signature
Signature
The Commonwealth of Massachuselts
Department of Industrial. iccitlents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.tnass.gov/dia
Workers' Compensation Insurance affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Namell)usincssi(hganiiatinnilndividual): -7-Z-5,-VA Z01 K`++`y1 +Address: PP
�✓,o A�1� � %�
City: State; Zip: !'hone -4• ?>l
Are you an employer? Check the appropriate box:
❑ I am a employer with 4. ❑ 1 am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
�. [�1 am a sole proprietor or partner- listed on the attached sheet.
S
hip and have no employees These sub -contractors have
working for me in any capacity.
[No workers' comp. insurance
required.]
❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. [!lietnodeling
S. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
1 I.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
".\ny applicant that checks box ;l l must also IilI out the section below showing their workers' compensation policy information.
+ I Iomeowners who submit this affidavit indicating they are doing ill work and then hire outside contractors most submit a new affidavit indicating :;uch.
Contractors that check this box must attached an additional sheet slowing the name of the sub -contractors and their workers' comp. policy information.
I am nn employer that is providing workers' compensation insurance Jim my empli{yees. Below is the policy and job site
information.
insurance Company Mame:__
Policy 'I or Self -ins. Lie. 4 -
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 `vlGL c. 153 can lead to the imposition of criminal penalties of a
tine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of S'T'OP %k ORK ORDER and a tine
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 anpenalties of perjury thin the information provided above A true and correct.
tii„
I'llone : ! q-7 $ - � % �1--
4 /i Vo 6
,)/ficial n.se only. 1Du nut urine is tlri.� urcvf, to he cn»>pleled hl. r:�) ur «,w» ��frcial.
City or Town: Permit/License #
Issuing Authority (circle one):
I. Hoard of Health 2. (Building Department 3. City/Town Cleric .I. Electrical Inspector a. Plumbing Inspector
6. Other
Contact Pers�rn: ___.-_ Phone #:- — _------------_..__
The Co.mmonw* eal,th of Massachusefts
Department of Fire Services
Office of the State Fire Marshal
P. 0. Box 1025 State Road,.Stow, MA 01775
20
PERMIT Date: Q
North Andover Permill NO DigS
(CityofTown) If Applicable
In accordance with ihe provisions of AG.L.1 4 8 Chaptcr_I_Q_ as provided in secti0n—q22--CMR 34
SwDate
This Pen:nit is granted.to. F1 S' 4'0'1. P, a, r-6
Full name ofperson, Firm or Corporation
Permissionto locat.e dumpster for construction/renovation/demolition of buildinR.
Comments: dumpster must be 25' from structure if unable to -place with required to, -
Restrictions: clearance dum.pster must be covered with plywo . od or tarp end of 'work day
at
Give location by street and no., or describe in such manner as to provicd adequate idm0cation.of location
Feepaids 50.00 40 Fire Chief
This Permitmill cxpir, 0 S i6atrc bf offical gran pcmt—) mwm7wmg-PCnn:if— (Tide)