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HomeMy WebLinkAboutBuilding Permit #703 - 101 CRICKET LANE 5/12/2010 Th BUILDING PERMIT o�r10RkoR TOWN OF NORTH ANDOVER 0?`4, op APPLICATION FOR PLAN EXAMINATION o Permit NO: 70-3 Date Received �SSACHUS�� Date Issued: 2-/� IMPORTANT:Applicant must complete all items on this page LOCATION -20 . T tint PROPER/TY OWNER_ 2 / e4 to Print MAP 2101 r`3' ,FARCEL: , - ZONING DISTRICT: Historic District yes (no o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential---- Non- Residential New Building One family � Addition -Two mroore family Industrial _Altefation- No. of units: Commercial Repair, re lac Assessory Bldg Others: molition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: entification Please.Type or Print Clearly) r� OWNER: Name: Phone: Address: _bli )r r CONTRACTOR Name: Phone: -3 $�-- Address: VO Ln v �ns LA r Supervisor's Construction License: , Exp. Date J' - Home Improvement License: w52:>9 r Exp. Dater 1 - 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: $ �.1 �(> ; 6b FEE: $ Check No.: ql �?_V Receipt No.:_C� yg .NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Own Signature of contractor Location 1 6*G4,eni 7— /-A-- No. -?OS Date �v HORTIy TOWN OF NORTH ANDOVER Certificate of Occupancy $ cMust<� Building/Frame Permit Fee $ Foundation Permit Fee $ _ k Other Permit Fee $ TOTAL $ F Check # 23 ; Building Inspector 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 COMMENTS r 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 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site ye no Located at 124 Main Street ` Fire Department signature/date � AA; 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 No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date ...............................................---....._...._....._...._........................................_._.-...._....._....__..._................................................................_............................................................................._._.__...__....................................................................._..........._._........_................................................................ .... Doc.Building Permit Revised 2010 I ti 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:Building Permit Revised 2008 J. B. Contracting P.O. Box 694 Groton, MA 01450 978-375-6024 or 978-449-0423 Mass. Lic. #135391 PROPOSAL SUBMI D TO PHONE DATE STREET JOB NAME CI STATE�4ND IP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: a?Z sem. 11 ��� �-''Y �.. Yom.��. �,� �+ � �,`�� � fes'�✓l Y- \fid' f/ �1� � �,... �kA J IQ- 1A CC, l,.-... 10---,S' -e t.%+ C ��\ C;CJ.�, it.-A, S, t_S V ]/tk� S C Pr Frnpnsr hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: dollars($ ) Payment to be made as follows: ( �' LAA All material is guaranteed fo /e as specified.All work to be complete in a workmanlike Authorized manner according to standa actices.Any alteration or deviation from above specifi- cations involving extra costs will be executed only upon written orders,and will become Signatu an extra charge over and above the estimate.All agreements contingent upon strikes. accidents or delays beyond our control.Owner to carry fire,tornado and other necessary Nott: This oposal may be insurance.Our workers are fully covered by Workmen's Compensation insurance. wlthdra n by us f not accepted within days. *r-eyfuna of 'rupasal - nature `— The above prices,specifications and conditions are satisfactory and are hereby Si g accepted. You are authorized to do the work as specified. Payment will be made as outlined above. �l , c) Signature Date of Acceptance: V' F N0RTH Town Of No. C% co ME CME dover, Mass., ICW ICK 7�ADRATED `r BOARD OF HEALTH Food/Kitchen PERMIT D Septic System MAI BUILDING INSPECTOR THIS CERTIFIES THAT11jj14h1mi^.1.(1.%S................. ......C h OI........ ........ .... Foundation has permission to erect........................................ buildings on ......1.01......... . . ......&A.44OZ ......................0h Rough to be occupied as......5......... ......."�.:..........�.��1 w. .................................. Chimney provided that the person acce ting this permit shall in every resp 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR I ' UNLESS CONSTRU TS Rough .................................................... Service .......... .....10 . .. .... 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. SEE REVERSE SIDE Smoke Det. �, `'��re fri4m�sit(Ynrur�cr!� r�•1��cr�zcluwelt'a T"fi Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:,, 1.35391 Office of Consumer Affairs and Business Regulation Expiration x/1/2012Tr# 293900 10 Park Plaza-Suite 5170 Type; Boston,MA 02116 _:,_ �ndividua{._-, JOE SUE JOE SUE PO SOX 694 i J GROTON,MA 01450 Undersecretary Z' Not lid without signature `+.Ita.�aclau,c�tt, - Drli,trtataenP <s#•Pttt►lic _� $a.�.trtl of Builtlin ' �E;t►t;tti�snti and �r•trttltta construction su er>isor a1s P and License License: CS SL 99133 Restricted to: RF,WS JOE BUE P.O. BOX 694JL GROTON, MA 01450 E xPirat io n: 1/25/2012 'rr: 99133 AC®RD. CERTIFICATE OF INSURANCE PRODUCER DATE(MNWDIYY) 12-17-09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BARRY&,ICHUGH INS AGCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE It"SK 11.1'INGS 1417 HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW WI CHESTI-X SIA 438W COMPANIES AFFORDING COVERAGE 21SWKS COMPANY INSURED A HARTFORD GROUP COMPANY HVE JOSEPH DBA J B e CONTRACTING P O I3OX 694 ' COMPANY (3-ROTO\,VIA 01450 C COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L18TED BELOW HAVE BEEN ISSiTfiO TO THE OR CONOMON OF ANYINSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, MAY AIN. THE HAVE SEEN REDUCDEDE 8 TI D POLICIES DEBCRIBE�RAN t6 SUBJECT AC'r OR TRTp ALL THE WITH RFsPECt TO WMCH Ties CEmACATE NAY RE ISSUED OR LHWTS SHOWN MAY HAYS ANNE REDUCED BY PAID CLAW. RMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, CO LTR TYPE OF INSURANCE POLICY NUMBER DATE POLICY POLICY = P GENERAL LIABILITY LIMIT$ COMMERCIALOENEHAL GENERAL AGGREGATE $ CLAIMS MADE OCCUR. PRODUCTS-COMP/OP AGG. $ ,OWNER'S&&CONTRACTOR'S PROT. PERSONAL&&AUV.INJURY $ EACH OCCURRENCE $ FIRE DAMAGE.(Any onk firo) g AUTOMOBILE LIABILITY MED.EXPENSE(Any one parson) $ ANY AUTO ALL OWNED AUTOS COMBINED SINULE LIMIT $ SCHEDULE AUTOS BODILY INJURY(Per Person) $ HIRED AUTOS BODILY INJURY(Par Accident) $ NON-OWNED AUTOS PROPERTY DAMAGE _ $ GARARSE LIABILITY ANY AUTOS AUTO ONLY-£A ACCIDENT $ OTHER THAN AUTO ONLY: EAI:H ACCI()ENT S EXCESS LIABILITY AGREGATE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE � WORKER'S COMPENSATION AND AI:nREGATF g A EMPOLYER'S LIABILITY US-9829L24S-09 12-15-09 THF PROPRIETOR! 12-15-10 STATUTORY LIMITS X PARTNERS/EXECUTIVE INCL EACH AC1C`ADENT $ 100.000 OFFICERS ARE: X EXCL DISEASE-POLICY LIMIT $ 500,000 OTHER DISEASE-EACH EMPLOYEE S 100,000 DESCRIPTION OF OPERAT(ON&LOCATION&VEHICLES/RESTRICTIONS/SPEC(AL ITEMS T}itS RT`-.PI ArF'S.ANY PRI/'rR f;F,R nnCATR I.S4Iti'n Try T)iF(nTIr-LCAT P Hhi.T)rIt AT-`FrC 1TN[1 WORIl rRS CO MP CAVARAO)i Tffi-WORKiT'RS'COMpr.,NSATIOY POLICY DOSS NOT PROVIDE COVE(tACF.FOR HUE It)SMI. CANCELLATION SHOULD ANY OF THE ABOVE GESCtbE,ED POLICIES SE CANCELLED SEFORE THE EXPIRATION DATE THEREOF.THE ISSUINO COMPANY WILL ENDEAVOR TO MAIL 10 DAYS W RITTV14 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OSUOATION OR LASLITY OF ANY KIND UPON THE COMPANY.ITS AGENTS OR REPRESENTATIVES. ACORD 25-5(3193) AUTHORIZED REPRESENTATIVE Ramani Ayer COR ` CFERTIFIGATE OF LIABILITY INSURANCE (`�`°�T�l���YYYY; THIS CERTIFICATE 13 MUED AS A MATMR OF fNFOMTil1H� 8ar-y G McHugh Inmwr3140e ,pveng ONLY AND CONFERS NO RIGHTS RIPON THE RERTMATE t sG 8ki2.1ings Rd HOLDER, THIS CERTIFICATE DIES NOT AMEND, EXTEND OR Vinch©ste-r, MA 01890 ; ALTER THE COVERAGE AFFORDED IV T14E POLICIES BLOW. INSUREPS AFFORDING COVERAGE I NAIL# INSURERXyzawnt 4 Joseph Dat D----- — P `trlt Ra P Ow. la CCxtlsaotiaCT — _ J P.C. pOx 694 INSURER G: (Nbgmiti' -HErC-ICESOFJ'4& tNNCEi1MDPELIMY AVE55ENISSUEDTOTHEINSUFEDMMEDA8gUEFORTHEPOLICfPERIODIN01CMC.1107 ITHCTANDIM ANY"E4'J!+EIV TERM OR a NDRIpN OF ANY CONTIa4CT OR OTHER 000A!!!NT WITH RESPECT'O WHIG THIS CT'c1'IFICATF MAY BE issijaD OR WAY MRTAOe THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEP.FJN 1$SULIECT TOALL THE TSI RMS,E)CWWNS AVD CONDITION$OF SU04 P,'X; 6S,AGQREGA'E UhMn SHC?VW MAY i*M SM REDUCED BY PAIDCt.AIMS. �t� _ ---rn.nrNt�utr'a"`^` ..�.,,�„�..tORIOY NUM8�1! .-...i.il8� �.neTE3110116cRI� ��• u'b'� ? ('3ENBItAL i.MOE.".Y '�''" I ( MO CIIRRENGE_ !4 SOO,OQ�1 ! A ! � ?ca�ul�I.tiL�E►r:raaI�an*Y!BEI'7021703 ; 6!6/091 6/6!?.0' __ 54.G00 .l�r�UnlsHoOE X ocxUR _MEOr]6�(k+�CneR�fOri `a _ 5.000 { x e¢owsYera j PtBoreaLa ApvlraURY �3 ' LgVa kALAr.OR Te b .oa oao CEML k nrs '°LINT nPPUc6 Feet: I PRODUGTS•�lIOP 933 1 I KAr"t+ R0. LO9 I 1 YN/:G86,E LIAEI;dTN 1 arrAu s f �O�A�INEosmcLr.LTOT i lk o9tlltlBn) i 7PBODILY iNdJRY SCHED�SEDAlRGB � i 1orPeroonl �= I I'-•-•'I SOOLY!NURY r NOh'v^WN3CA.lTQ? }}I ' t(-Pc-r-as-cl-oe-rx-!---^ i PII Darr DAWAGe Per ocr wql i b � •+UJTD ONLY•EA ACCIO$yi' �b I I ANYAUr' 4 i OrHERTNAN EAACC i s w ! AUTO QlILN, AGG; tItOm UffiMa1AUAe1LtrY a { ----r t BACH OGCt'ttRENC@ .,, %C1A r_CLOAS MADE � I AWR+ E GA'E b —1 W1RICM CG'bIPE-NZIA31X! i NC 8TAATU� ANN I WR LO"RV UASUTY Y i N{ .ye, 1' ' 9w FF.IxLUD,PItr cutivE (V*Wxexy Ir." {S 9 d Vy� am: E. . :S eh V CrWR ��AL�NBbeiow � � `e LACY L T. aESWp"W,aFa is r L*0%7ft3 r'irROLI s lUO-LIMNS A=V BY eIDOMEM Nrr SPIAL ORMSIOW : CANCELLATION SNOIN.O AkYOOVEABOA i'1$SGRIGEDFGUCI6S HiCANXLwp j*FmTNEk'%PIRATm OATS TMPOOr,1?0135UNG INSIAA$R VYILL ENWVM TO RAIL DAYS WpfYM j NOTICE TO TNB CSAnRCATE 40LDAR9AM2j;TC THE LEFT,W?FN.URE TG aQ SOW%" NP03e NO OBLIt:AT10N OR LIABILITY OP ANY RPD UPON THE imsuRER iT8 ACsDWG Ott REPRHSNNY TIVES. f1 AUTNDR!?�! W 1983-410 ACORD CORPORATION. All rFghts rewrynd. The A0 ow name and logo are reglratered ma Acs of ACORD I The Commonwe¢lth of Massachusetts Department o f Iridustriul Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Workers' Compensation insurance Affdavi� guilders! A licant Information Contractors/Electricians/Plumbers Please Print Leaibl Name(Business/Organization/Individual): Address: City/State/Zip CA © (SU phone#: a �17�-3�S•-fQ da.�f Are ou an employer?Check the appropriate boa: a employer with 4. ❑ I am a general contra F7. e of project:(required)l:CCS/ employees(full and/or p�.* have hired the sub-contractors New conson 2.❑ I am a sole proprietor or partner_ listed on the attached sheet Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers com . ' 8. E]Demolition [No workers' c � P ?nsurance. comp. insurance 5. ❑ We are a corporation and its 9. ❑Building addition 3.❑ required] officers have exercised their 10•❑Electrical r epairs or additions I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no insurance required.] t employees. [No workers ` comp.insurance required,] I3.❑ Other 'Any aralicant that.^.h=..ly<:box#1 mnsi also fill eL!these„ 'homeowners who submit this don belor nov r"•g+may work— S,comp—, nion•,.•s:c"info affidavit indicating they are doing a1 work and Y .. , W-dor� 'Contractors that check this box must attached an additional sheet showino the tame hire outside contractors mast submit a new Affidavit indicating such. e name of the sub-contractors and their workers'comp.policy information. i o an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie. �- Expiration Date: �..— Job Site Address:_ Attach a copy of the workers' compensation policy declaration. aQe(showing City/State/Zip: Failure to secure coverage as required under Section 25A of MGL P o-e(sho can lead to policy 'MPnumber u n er ancrimin�matron date). fine up to$1,500.00 and/or one-year imprisonment,as"veli as civil penalties in the form of a STOP WORK O penalties of a of up to $250.00 a day against the violator. Be advised that a co ORDER and a fine Investigations of the DIA for insurance coverage verification PY of flus statement may be forwarded to the Office of Ido hereby certify under the sins andPOnatties ofperjury thcat the information provided above is true and correct Si a Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: # Issuing,Authority(circle one): Permit/License I. Board of Health 2.Building,Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing 6. Other a Inspector Contact Person: Phone#�: