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HomeMy WebLinkAboutMiscellaneous - 420 MARBLERIDGE ROAD 4/30/2018 420 MARBLERIDGE ROAD 210/038.0-0080-0000.0 l iP_�v.!! _, vlewpdradoud com)sr ecordsYtfO 2j+2 Pr tjf' "PAm6tg Per 2.fzt072 v.x Maura , •� Town of North Andover,IVIA Ct i Search... - Home 21072 --d--j— A my Profile *Plumbing Permit-Replacement of Fixture/Appliance(Commercial or Residential) Records TIMELINE Approvals Submission received [7!,Payments Aug 9,2016ac 3:05pm Permit Fee inspections Plumbing Permit Review ® - .. i Tota!single family per Documents mpro$reu fixtures/appliances replacement $2.50 x 0 Permit Fee ..__.__ _....____ ....... Paymcm. Minimum single family I - fixtures/appliances price $30.00 x map Permit issuance Tc OocunaEor +Add Fee- Total Fee Amounts $3250 i i Say something about this _ t i L fb J v to in Mr` ® �dH>G erolza�a�'IE I Tuesday,Aug 09,2016 03:05 PM MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERIFORM PLUMBING WORK CITY MA ATE PERMIT# JORSITS ADDRESS OWNER'S NAM Q°Vl j OWNER ADDRESS 74 17 onL TE 6M. TYPE OR OCCUPANCY TYPE COMMERCIAL _ EDUCATIONAL Z RESIDENTIAL PRINT _ CLEARLY NEW RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES_ NO— FIXTURES 1 FLOOR- 68M 1 j 2 3 4 5 6- -7 8 T 9 1011 12 13 14 BATHTUB _ CROSS CONNECTION DEVICE_ _ DEDICATED SPECIAL WASTE SYSTEM DEDICATED GOOILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ! I , _DEDICATED WATER RECYCLE SYSTEM__ DISHWASHER - t I . DRINKING FOUNTAIN t F DISPOSER _ Ft,AOR/AREA GRAIN INTERCEPTOR INTERIOR _ _ -_ a . -KITCHEN SINK t LAVATORY _-_ _ i t ROOF DRAIN r- I t SHOWER STALL i SERVICE t MOP SINK i TOILET URINAL WASHING MACHINE CONNECTION____ t WATER HEATER ALL TYPES WATER PIPING I t OTMER t INSURANCE COVERAGE: have a current II2d insurance policy or Its substantial equlvalent which meets the requirements of MGL Ch.142. YES eNO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIA T E BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDENINI 7Y BOND OWNER'S INSURANCE WAIVER;f arh aware that the licensee d o ave the Insurance coverage required.by Chapter 142 of the Maas chusetb General Law,and that my signature on this permit application WALVA this requirement, CHECK ONE ONLY: OWNER _ AGENT SIGNATURE 0 ' -- F OWNER OR AGENT.- I hereby certify that all of the details and information I have submitted.or entered regarding this application true and accu to the beat of my knauA ge and that all plumbing work and ingtallations performed under the permit issued for this application will be lance Ith I ertinent provlsm f the Mmachusette State PI ing Code and Gha ter 142 of the General Laws. • PLUMBER'S NAME LICENSE NATURE MP.,I�'S JP_ CORPORATION 20# PARTNERSHIP®# LLC_# COMPANY NAMS � oF in CITY 1,0 STATE ZIP ABOR7 TEL 01 FAX CELL EMAI The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 r y'II www.mzs gov1dia Workers'Compensation Insurance Affidavit.,Builders/Contractors/Electrieian&l%mbei's:•, TO BE PMED WITH THE PERMITTING AUTHORITY. Analleant InformationPlftm Print Legibly Name(Business/Organization/Individual): Address:__ 2 3) 14 i2ra V -1,0,n ���l City/Staxe/Zip: d a one k /1,S— Are you an employer?Check the appropriate b6x:; Type of project(required): 1.13 I am a employer with employees(full and/or part-time).' 7. ❑New consttuction 2.❑I am a sole proprietor or partnership and have no employees working for me in S. Remodeling any oapaotty.[No workers'comp.insurance required] 9. E-1 Demolition 3.01 an a homeowner doing all work myself.[Na workers'comp.insurance required]' 4.[]l am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition erntn that all contractors either have workers'compensation insurance or are sole i I.[]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions SC31 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof r airs T sub-contractors have employees and have workers'comp.insurance? 6. a are a corporation and its officers have exercised their right of exemption per MQL e. 14.Q Other 1S2.$101 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'oompensadIon policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside oontractors must submit a new aBldavit indicating such, $Contractors that cheek 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. Ion an employer that is providing workers'compensation insurance for nV employees. Below is the policy andlob site Wormadon. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 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 MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonVn6tt,.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'oopy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby a under th pal and p Of perJury at the Wormadon provided above is true and conn Phone QjWd use only. Do not write In this area,to be completed by city or town offlelal 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#: i COMMONWEALTH OFMANACHIUSETTS • • • • • • BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A JOURNEYMEN PLUMBER ROBERT A SAMMATARO 8 DUNRAVEN RD WINDHAM,NH 03087-1263 18214 05/01/2018 4039 COMMONWEALTH OF MASSACHUSETTS BOARD O PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A MASTER PLUMBER ROBERT A SAMMATARO 8 DUNRAVEN RD WINDHAM,NH 03087.1263 9333 06/01/2018 403 COMMONWEALTH OFSACHUSETTS • • • • • • . BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE REGISTERED AS A PLUMBING CORP ROBERT A SAMMATARO ROBERT A SAMMATARO P&H,INC 8 DUNRAVEN RD WINDHAM,NH 03087 3373 05/0112018 34142 i May 1, 2015 NORTH ANDOVER BUILDING COMMISSIONER NORTH ANDOVER TOWN HALL NORTH ANDOVER, MA 01845 Claim Number: 033552680 Policy Number: 69160400001 Company Name: Arbella Mutual Insurance Company Date of Loss: 02/09/2015 Insured: JOYCE PIEKARSKI Property Location: 420 MARBLERIDGE RD NORTH ANDOVER, MA 01845 To whom it may concern: Claim has been made involving loss, damage, or destruction of the above captioned property,which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. i If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Very truly yours, Laura Barber CC: City/Town Fire Dept., City/Town Health Dept. I I i •BrightClaim, LLC. PO Box 502048 Atlanta, GA 30350 • Dat( ......................... TOWN OFMORTH ANDOVER PERMIT FOR GAS INSTALLATION HU L This certifies that-3--L6Q.P..................................... .............................................. q ...... ..... has permission for as installation in the buildings of at...42-0 .................................................... North Andover, Mass. FeAQQ-.(�D Lic. No. 8 .-4o...... NJO.......................................................... GASINSPECTOR Check# 9 (oil 9460 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK E y CITY I N.Andover MA DATE 7/31/2014 PERMIT# j. JOBSITE ADDRESS 420 Marble Ride Rd OWNER'S NAME GOWNER ADDRESS I Same 1TE FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL® RESIDENTIALE] PRINT CLEARLY NEW:E] RENOVATION:El REPLACEMENT:® PLANS SUBMITTED: YES NDE] APPLIANCES 7 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER i DRYER FIREPLACE i FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER 4NVENTED ROOM HEATER WATER HEATER OTHER Re lace 1 Gas Meters x and Associated Piping INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ED OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn liance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph Marino LICENSE# 87369 SIGNATURE MP El MGF® JP❑ JGF LPGI[j CORPORATION[]# 3285C PARTNERSHIP®# LLC # COMPANY NAME: RH White Construction Co ADDRESS 41 Central St CITY Auburn STATE MA ZIP 11 01501 LJTEL 508 832-3295 FAX 508-926-4347 CELL 508-832-4614 JEMAIL JMarino@RHWhite.com 41111 f ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 4 ':-Gd2JllpdO�tVi11l�AL.TH OF 14tBA,SS >F—'LUI�1,t6ERS :ANQ GAS Fm-lq.E:1�s :T - .ED A '��j l=• IUES TFiB`IiHQUE"Li06NSE • '<J�^_i?S�E_`PSN_,`._D •#�'A-R.I t�Q "_..- - `- _�: -=-- . ?�JGTON 87 W E`ST`ER MA 031s cgY 05!01/14 ;®i7lIW ,4L'Clf�®FIdASSC�= . : 'i;fS" <=' _— PLU711fBERS AND GASF(7T�RS:�: ;: �• =°`_-;=! AS A. JOU.RNEYA AN'�R ll: - - L TSSUES THE ABOVLOE ENSE i4FR1NGTQN ST ;4-:=- W.. 05!01114 «?' ''CCERTIFICATE OF LIABILITY (MM/DD/Y}13 Tl( INSURANCEPage 1 oP X /fig/2013 .THIS CERTIFICATE IS ISSUED ASA 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 mn ADDITIONAL INSURED,the polley(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 cartifleate does not conferrights to the certificate holder in lieu of such endorsement(s). PROpUCER t1OTACTMaseachuaette, Inc. NEc/o 26 cartery Blvd. NO_F>i- 877-945-7378 FAX'NO), 886-467-2378 P. o. Hoe 305191 3 De s. eel;t�.fit:ateagwillia_corn Naghvilla, TN 37230-5191 INSURER(S)AFFORDING COVERAGE NA100 INSURED INSURERA:Ths Cb=tAr Oak rixo Snsurancg Company 25615-001 R. �• White Construction Company, rnc. INSURER9.TrELVOIAX2 Property Casualty Corpany of Am 25674-003 41 Cmnrrdl, Street INSURERC:Nat:iOAAl Union Firs) Ineuranaa Ccmpany OE 7.9445-001 P. 0, Box 257 Auburn, MA 01501 INSURER D;Travelers indamnity Company 25658-001 INSURER F,: INSURER F; COVERAGES CERTIFICATE NUMBER.20287680 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 IN171CATED. 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. I-ro TYPE OF INSURANCE pD' SUH P POLICYEFF POLICYE7(P 4LIGY NUMBER LIMITS A GENERAL LIABILITY VTC2000 977X9948-13 9/1./2013 '5/1/2014 EACHOCCURRENCE � 2,0001000 X COMMERCIAL GENERAL LIARIL17Y TORENTF,O ��g(Eaoceurtn�:1 ,s _ 300.p00 CLAIMS-MADE OCCUR MEDEXP(Anyone ereon $ IP"000 PERSONAL&ADV INJURY $ 2 000,000 GFNERALAGGREGATE $ 4�O Q 01000 GEN'LAGGREGATFLIIMRTOAPPUESPER; PRODUCTS-COMP/OpAGG ,QOQ Q00 POLICY LOO p AUTOMOBILE LIABILITY VT,TCAP 977K955.A.-1,3 /1/2413 9/1/2014 $ OMBI EDSINGLF,LIMIT aco�dent s 21000,00a X ANYAUTO ALLOWNED BODILY INJURY(Perpemon) $ LOWNESCHEDULED �. AUTOS AUTOS BODILY INJURY(Peraceldont) g X HIREDAUTOS X NON OWNED AUTO$ ,)reold eent $ X Co Ped X Call ped Is C' UMBRELLALIAB $ OCCURSE8766140 /1/2013 9/1/2014 EACH OCCU RRENCF.: 9 S,000,000 X BXCES8 LIAR CLAIMS-MADE AGGREGATE S $,000,000 DED JAETENTIONS 10,000l S D WORKFRBGCMPENSATION VxRRUF3 B205A165-13 9/1/2013 9/1 2014 $ O AND EMPLOYER8'LIABILITY y/N / rd7f{yu D ANY PROPRIETORIPARTNERIEXEOUTIVENIA VTC2KUP 9203.A71A-13 OFFICER9/1/2013 9/1/4014 E.L.EACH ACCIDENT fi 1,000,000 /MEMBI;REXOLUDW? �LJJ (fgijdeaIrIlotin E.L.DISEASE-EAEMPI,QYP.E S 1,000,000 U 45L�Kll- UN OFOl'hRATiON3heloW F_L�DISEASE-POLICY LIMIT $ 1,000,000 )ESC RIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Agnch Acord 107,Addltonpl Remarka 3chodula,It more ep eee la raquirgd) I :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZ0 REPRESENTATNE Evidence of Inmuxance I Coll1-4197604 Tp1:1694012 Cezt.202876$0 ©1988-2010ACORDCORPORATION.All rights reserved. CORD 25'(2010105) The ACORD name and logo are registered marks of ACORD I Date. .. . . .`. . „pRT„ 41 TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ,SSACMUS(c� This certifies that . . . f. 'a -. . . l'''',!£'!. .. . . . . has permission to perform �cf.1+.w. !? ��!- . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . .. at. ./ V. 1??I^ . . . . . . . . . ., North Andover, Mass. 3 Fee. . . . .Lie. No.. . .9G. . . . . . . . . . . . . . . . . . . . . . . . . _ PLUMBING INSPECTOR Check # 7803 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ate Building Location iq W ��� wners Name J D �� / S`5/permit# Type of Occupancy Amount New Renovation Replacement ' Plans Submitted Yes No ❑ FIXTURES z � � � a O O W Ca WJ A W w W W H Z p 5TSS41� �i41��1I' za g—OCR pan FLOOR 4M K-OCIR sMK-0CR 6M110C[z r _ �rlEro� (Print or type) Check one: Certificate Installing Company Name 4yz/- O a Corp. Address /'( �' Partner. BusinessTelephone- 4 — Firm/Co. (� Name of Licensed Plumber: Insurance Coverage: Indicate the type surance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond " Q F1 Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitt r tered)in a are true and accurate to the best of my knowledge and that all plumbing work and installations erfo dun su or this application will be in compliance with all pertinent provisions of the Massachusetts S Plu in a and ter 14 the General Laws. By: igre kens u er Typ of u in License Title City/Town icense um er MasterKIP Journeyman F1APPROVED(OFFICE USE ONLY a I TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER,MASSACHUSETTS 01845-2909 J. WILLIAM HM-URCIAK,DIRECTOR,P.E. Timothy J. Willettof NoeTTelephone (978) 685-0950 ^` "°o Water Superintendent Fax(978) 688-9573 3 t P •.9 �R4T0 At� February 9, 2006 SSACHUS� Ms. Elizabeth Piekarski 420 Marbleridge Road North Andover,MA 01845 RE: Request for Abatement for Sewer Betterment Assessment Assessor's map 38,parcel 84 Phase 4A Sewer Project Dear Ms. Piekarski: You are pursuing the abatement of the recent sewer assessment on the vacant lot shown on assessor's map 38,parcel 84, on the basis that the lot is non-buildable. The determination of whether a lot is buildable or not is beyond the scope of the Division of Public Works. According to the'town's policy for-sewer betterment assessment, abatements are made on a case by case basis by the.Board of Selectmen. You will have to make your case to the board that the lot is non-buildable.: Code 132 on your tax bill indicates that the lot is non-buildable,however,the code may have been applied if the lot failed soil testing and could not support a septic system at that time. With a town sewer now available,this situation would no longer apply. The lot maybe considered non-buildable under the North Andover Wetlands Bylaw. I have asked.the Conservation Agents,Alison McKay and Pam Merrill,to review the matter. The lot may also be considered non-buildable under the Zoning Bylaw. I have asked the Director of Community Development, Curt Bellavance, to look into this as well. You may want to get their findings in writing to strengthen your case to the Board of Selectmen. You can arrange to appear before the Selectmen through the Town Manager's Office at 120 Main Street. Very truly yours, Timothy J.Willett Water& Sewer Superintendent CC: Mark Rees, Town Manager Bill Hmurciak,Director of Public Works