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Home My WebLink AboutMiscellaneous - 47 MARBLEHEAD STREET 4/30/2018 47 MARBLEHEAD STREET 210/008.0-0019-0000.0 I III Location J /� No. Date NaRTM TOWN OF NORTH ANDOVER Of••mow ,�,h ' Certificate of Occupancy $ MUEta' Building/Frame Permit Fee $ S ' ACS ' Foundation Permit Fee $ Other Permit Fee $ + TOTAL $ C> Check # 14334 Building Inspector TOWN OF NORTH TH ANDOVER BUILDING DEPARTMENT APPLICATION'To CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH AaRON��EORTWO FAMILY DWELLING °Y 'iY x`yd `" g i S - -•-.,; , � .. _<.v. ... itY�tilsu36.Y1S M.,T,.,1WRu ..:...�1.,I PS] 2µ TiS^ ,4 T"t w BUILDING PERMIT NUMBER: S d DATE ISSUED: SIGNATURE: CLQ- Building Commissioner for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage 11 Z" 1.6 BUILDING SETBACKS ft ]Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided n o ev 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record ��r��Ic,��-1n Q r�a �\� 3�-./�arb le.lua.� �, � rN�/► �J Name(Print) Address for Service OLT) Signature Telephone 2.2 Owner of Record: N e Pnnt Address for Serviicce�:: 0 Si a re Tele hone SteTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: f� ne�— �.�r� W�-� 1`� �"� G-�- ; (S 3 735 License Number Address t d - 7 W Expiirat� Da� Signature Tolepfforr6 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name /0-7S/0 Registration Number Address d2 ExpiraliodDate Signature Telephone i r SECTION 4-WORKERS COMPENSATION(ALG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes...... No.......❑ _ SECTION 5 Description of Proposed Work check all a lLable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be '?-Z� OIz'LY Completed by permit applicant v= k 1. Building (a) Building Permit Fee c�0 0 . O 0 Multiplier 2 Electrical (b) Estimated Total Cost of Construction oZ Q G. 3 PlumbiiEE Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owne/Authorized Agent of bject property Hereby authorize C 1l��170 1u�h.� _ to act on My behalf,in all matters relative to work authorized by this building permit application. 11A-7AV Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, c ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief On b A!!,V) u r Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2ND 3RD • SPAN DEvIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE DkMkRiT'T vc- ,INC,"' 4 �`MeetingGYour complete Insurance NeecYs n:l . , T �. Six Center Street, 13. 248 Exeter,N',03833! 248,E (6.03)77&7304%.NII($OU)9i�-7304 Since 1894FAX(603)'772=8339° CEtZTIElCATE.OF I11lSi TRANCE I ` r We'.are pleased to forward the enclos"ed Certificate$f Insurance on,behalf of our client ;If you have-any`questions regarding theti enclosed.,"P'lease do not hesitate to contact our office. ` � I l� 1t ti a Sincerely yours, DeMeritt Agency,Inr �; ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID D ` DATILTWfM/DD/YY) DEN-1 11/29/00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DeMeritt Agency Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 6 Center St, P O Box 248 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Exeter NH 03833-0248 Phone: 603-778-7304 Fax:603-772-8339 INSURERS AFFORDING COVERAGE INSURED INSURER A: The Hartford INSURER B: Bob Ridenour General Contractor INSURER C: 5 Wallace Rd INSURER D: Exeter NH 03833 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,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPOLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $300000 A X COMMERCIAL GENERAL LIABILITY 04SBALF7136 09/28/00 09/28/01 FIRE DAMAGE(Any one fire) $300000 CLAIMS MADE Fx—1 OCCUR MED EXP(Any one person) $5000 PERSONAL&ADV INJURY s300000 GENERAL AGGREGATE $ 600000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 600000 POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS T EMPLOYERS'LIABILITY ER E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E,L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER N I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION FOTHERG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Fothergill 37 Marblehead Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR North Andover MA 01845 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE DeMeritt AqencV Inc. ACORD 25-S(7/97) OACOM CORPORATION 1988 l n I Pro 0 ;5 p-cl h 0.10,i 37 PO-,r6�e- �C,j S-� Nori-L Anotre- f�,xA (T-75)i 3,? �I (!f{00, I ✓tae 'fJanvm4ttu�r,¢jitc a�J�l�'dda�uGP,fld BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 050240 i Birthdate: 06/20/1951 Expires:06/20/2002 Tr.no: 26359 L Restricted To: 1G BOB J RIDENOUR 5 WALLACE RD ��' EXETER, NH 03833 Administrator - aRTH Town of North Andover a� N - �SL4U �� MO Building Department o 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 �SSACHIJS�� DEBRIS DISPOSAL FORM In accordance with theP rovisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: 'r\:s Faci14 location Signature of Applicant l Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. i I/IC 1.,V111111V11VVCd1ll1 Ul /WQJJdl.1/UJC(LJ Department of Industrial Accidents Office of Investigations Boston, Mass. 62911 Workers'Compensation Insurance Affidavit Please Print Name Location: wad a c ,e- Q44 n,3 ?0 3 Phone(603) 1 S' -- Qc ,_�g am a homeowneO performing all work myself. ®I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this lob. Company name. - Address City' Phone Ins urance Co. - Policy.# Company name - Address City: Phone# Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage ver cation. I do herby cer*under the pains and penalties of perjury that the information provided above is true and correct Signature Date r Print name (3o6 E2V_1 o U Y .-Phone 3gam( Official use only do not write in this area to be completed by city or town official- Building Dept ❑Check if immediate response is required Building Dept p Licensing Board F-1 Selectman's Office Contact person:_ Phone#. Health Department 0 Other FORM WORKMAN'S COMPENSATION i NORTH Town of 4 over pw r. ,. 9 ""'. 70 L A o dover, Mass., �02`� too CoCMC.EwICK DRATED P`9 "\C '9S H BOARD OF HEALTH Food/Kitchen PERMI Septic System O ��r BUILDING INSPECTOR /{� // .............kl�h .......................... Foundation THIS CERTIFIES THAT...... I�/Q......I ........... ........................ . .�.�....... �A ICI . ... buildin s on .... ..... ........ .I�.R. . .. .��..5.. Rough has permission to erect..AAJ#.C*.P... 9 to be occupied as.................��..PP................. .......R 1101W.... .............................................. ......................................... Chimney ... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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. M 8 p PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START Rough CService ............ .............. .......................... ........................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE