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HomeMy WebLinkAboutBuilding Permit #405 - 55 CRICKET LANE 11/15/2006 TOWN OF NORTH ANDOVER pORTH APPLICATION FOR PLAN EXAMINATION o #6, o Permit NO: 6 Date Received o Date Issued: ` � l�'��� 9sSS '� IMPORTANT: Applicant must complete all items on this page LOCATION —6�5' C 'tel(QFC �r 'id�1 Print PROPERTY OWNER k-annk( � JYK'1 Print MAP NO 0? PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Reside tial Non- Residential ❑New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Ayoeration No. of units: epair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF W OBE PREF 11/0 �I) LJ Al S�Ua,�� aham e,- : Identification Please Type olrtrint Clearly) `, OWNER: Name: /26�/, K/ 119 Phone:l�'/ 78) R 7 ` -1W Address: 55, Ori 6 Lave- A CONTRACTOR Name: \/nk)I,,� 65,;1er Phonc(64) 7(Y - Address: 624 a Supervisor's Construction License: � � Exp. Date: 3 -9-&7 Home Improvement License: f (�Q r Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PER IT: 2.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ `7 FEE:$ ro Check No.: a-31 Receipt No.: Page I of 4 Location No. 440 S_ Date M011TM TOWN OF NORTH ANDOVER F • L9 S C ' Certificate of Occupancy $ ' • O° •r�i�:�. ti• � �' b'••°•'<� Building/Frame Permit Fee $ �Ss+cHust Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # J q1- 19809 Building Inspector TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ 11Tanning/Massage/Body Art ❑ Public Sewer Well F1Tobacco Sales ❑ Food Packaging/Sales [I lPermanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Pl ns Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFOU'FORM ' DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED ;CONSERVATION ❑ ❑ `COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Si2nature& Date Driveway Permit Temp Dumpster on site yes—no— Fire Department signature/date Building Setback (ft.) Front Yard Side Yard Rear Yard Required= Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 DEPARTMENT:BPFORM05 Pave 4 of 4 NORTH Town of : t _ 4Andover No. �►!0 �I = _ o dover, Mass., ► �' — �. COC MIC MEWICK A0RATEO AP�� �5 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT Li ..ISR �. !!. .... .... Foundation has permission to erect........................................ buildings on ...�..... P.1J.4*. .1V%................................................ Rough to be occupied as � � �. S'L .�. Chimney .. ..................... . .. ....... ..... .... . .. ........................................................................ provided that the person accepting this permit all In every respect conform to the terms of the application on No 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 I S*O i Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU ELECTRICAL INSPECTOR Rough Service BUILDING Il C R Final Occupancy Permit Required to Omtpy 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. sumer Street No. SEE REVERSE SIDE Smoke Det. renewal BY ANDERSEN'Iwid—rcplacamrnc Customer Service 500-573-7606 104 Ofis St.-Northborough,MA 01532•Main:(508)919-0900-Fax:(508)919.0903 J&L Windows,Inc.dba Renewal by Andersen-Contractor License#144318-Expiration Date 09/23/2006 / WINDOW AGREEMENT SOLD TO: � � Gti DATE: / O ADDRESS:nS3—�,I"( 2ir_1k 14V2_5 PHONE—Home:(� 70 CITY: /'77IJrkl STAT112. , ZIP:_�&CPHONE—Work: (_) JOB SITE ADDRESS(if different): 11t/1mr— Approximate Start Date: G at e Approximate Completion Date: 11� � f SPECIFICATIONS Renewal by Andersenapproved materials will be furnished and installed to these specifications: 1. Install total of: . windows. 2. Quantity of windo s: I . ouble Hung(DB)f<EquRastI Kc sash(1/3 top,2/3 bottom) ❑Oriel sash(2/3 top,1/3 bottom) _Casement(CW) ❑Hinge right ❑Hinge left(as viewed from exterior):❑Standard handle ❑Metro handle _Double Casement(CDW) ❑Standard handle ❑Metro handle —Casement/Picture/Casement(CPW) ❑1:1:1 or ❑1:2:1❑Standard handle ❑Metro handle _2 Lite Gliding Window(GW) _Glider I Picture I Glider(GPW) 111:11 or ❑1:2:1 _Awning Window(AW) _Picture Window(PW) _Bay or Bow Window. 3. Yes ❑No #Windows to be Custom Fit Replacement:_ 4. ❑Yes)KNo #of sills to be replaced: 5. ❑Yes Q,No #Windows to be New Construction Full frame(includes new interior&exterior casings): Exterior casings: ❑Pine ❑Maintenance-free material ❑Factory applied 908 Fibrex brickmold 6. Glazing to be: XHigh Performance ❑Other If other,please specify: AOW 7. Exterior color to be: White C1 Sand 13 Canvas ❑Terratone 8. Interior color to be: White ❑Sand ❑Canvas ❑Terratone ❑Wood Note:Interior color can only be white,wood or same color as exterior. Wood interiors need to be finished by cust. �, 9. Hardware: White ❑Stone ❑Canvas❑Brass Double Hung: Install lifts? ❑Yes KNo u—.} 10. ❑Yes XNo Removal of metal frames or grilles #of Units: 11. 11 Yes No Install new paint-ready or stain-ready casings. Inside or�gu�t�side stops#of openings:_ Interior casing#of openings: Exterior casings#of openings: � ❑Pine ❑Maintenance free material Customer aware that RbA does not do any painting. Cust.initials .; o Wrap exterior casings with aluminum coil stock: color. 12. 11 Yes �N Note:Required with storm window removal.Removal of storm windows will leave screw holes in casing. n� 13. New windows to have: ❑Half or WFull screens Screens to be: Fiberglass ❑Aluminum 14. Windows to have grilles:/511 Y-es ❑No If Yes: ❑Grille Between lass(GBG) ( R-movable Interior Wood(INTW) ? ❑Fyll Divided Light(FDL) Grille patterns: #:_ Ey3 CA . DH DH DH DH CW/Picture Glider CPW or GPW "use additional sheet if needed Customer approved(initials):_ J 15. Yes ❑No Insulate,caulk and seal windows with three-point system to prevent water and air infiltration. J 16. Yes ❑No Remove and dispose of existing windows and storm 17. 'Yes ❑No Clean Up. All job related debris removed.Vacuum nightly. - 18. Yes O No Insurance. All workers compensation and liability insurance maintained. 19. Yes ❑No Warranty. ven to us omer upo com letion and r Of fulLpa�e t. s 20. d Itional information: /sem � �/(,� /JIsC©f/lr+r/, /rpm W / 21. Regular Retail Price:$1/ 3? V 46' 5'7Z5_4,-75 22.Total Project Amount:$ '/ All available discounts have been applied:'❑Yes ❑Fl/• 23. Is Project to be paid in❑Cash ❑Financed ❑Combination of Cash and Finance 24.Cash Deposit(1/3):$ 1/3 of balance due at start of job and final 1/3 due at completion of job. If remaining 2/3 payment is ma by credit card,an additional fee f 3%wilt be added to cover fee charged by Credit Card 25. Yes 11No Financed, If Yes,Amount Financed: (Account#: ) 26. es ❑No Customer agrees to be present on the final day of installation for final inspection and to deliver final payment. 27. es ❑No Homeowner gives RBA approval to place a yard sign on their lawn at the time of measure. 28. es ❑No Building Permit—As a convenience the company will secure the building permit.The fee for the 1iit is not included in the agreement price and a separate check is required at the time of sale for this fee. 'RENEWAL BY ANDERSEN"IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS OR CONDITIONS THAT COULD NOT HAVE BEEN SEEN PRIOR TO OPENING THE WALLS.PLEASE REMOVE ALL SHADES,VERTICALS,BLINDS,CURTAINS,DRAPES OR WINDOW MOUNTED AIR CONDITIONERS,AND ANY FURNITURE AT LEAST SIX FEET AWAY FROM WINDOWS AND DOORS PRIOR TO THE INSTALLATION OF YOUR NEW WINDOWS. INSTALLERS ARE NOT RESPONSIBLE FOR THE REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS. "SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE ANY REPRESENTATIONS OTHER THAN CONTAINED IN THIS AGREEMENT AND"OWNER"REPRESENTS THAT NONE HAVE BEEN MADE TO,OR RELIED UPON BY"OWNER"YOU ARE ENTITLED TO A COMPLETELY FILLED IN DUPLICATE OF THIS AGREEMENT.*CONTRACT SUBJECT TO FINAL INSPECTION BY RENEWAL BY ANDERSEN CONSTRUCTION DEPARTMENT.*TERMS AND CONDITIONS THAT GOVERN THIS CONTRACT ARE PRINTED ON THE REVERSE SIDE.This contract(s a legal documNO en Your Renewal by Andersen products will be especially made-to-order for you.UNDER NIRCUMSTANCES WILL REVI IONS R AN ;:l N BE POSSIBLE SEYON DAY AFTER THE CONI RA HAS BEEN SIGNED AND 2LPQ§I1 PAID.BY SIGNIN IIELOW.YOU ARR=NOWLEDGINGTHAT THEABOVE SPECIFICATIONS FOR THE RSA PRODUCTS YOU ARE QRDERING ARE CORRE aT RbA Re ignature: Date: `' l& �p a Customer stomer SignatureA/ White—Renewal by A dersen Yellow—Installation Pink•Hbmeowner OS-ll•U6 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ',M s�•� www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual): 2 Address: l th 6Tr 4_ City/State/Zip: c Phone#:&a) w `0,?C0 Are y�an employer?Check the appropriate box: Type of project(required): 1.11 I am a employer with 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors ❑ 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• [4Kemodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. .F-1Buildingaddition [No workers' comp.insurance 5• ❑ We are a corporation and its. required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am'a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13 ❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their worker;'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am-an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n Insurance Company Name: kMme Policy#or Self-ins.Lic. #:_ ��V1J /r )� Expiration Date:- /- / - o7 Job Site Address: �� L-1 '� (QCT �- � City/State/Zip:A�4t/ei'4 T 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 MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment; 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. 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 certi nder 0epains and penalties ofperjury that the information provided above is true and correct: Si ature: Date:.._. Phone#:6;'o ( �® L�& Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#' Information and Instructions I Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee.is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing.engaged in a joint enterprise, and including the legal repiesentatives of a deceased employer,or the receiver or trustee of an individual,partnership;association or other7egal entity,employing employees. However.the owner of a dwelling house having not more than three.apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es) and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required..Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and,date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents._Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations hasto contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the cityor town may provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each, year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,. please do not liesitate to give us a calla The Department's address,telephone and fax number: The Commonwealth.of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900.ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia „ f GTme TDom�,e4nweca �✓uaaaaa(u�eeQra BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Numbei:1-_1-4--s 1, 074251 963 l[ ;` _dlT7 Tr.no: 8556.0 t Re JOHN K ESLER 78 TURNPIKE RD WESTBORO, MA COMMISSIorier Board of Building Regutatiom and Standards License or registration yalio for indiyidul use only HOME 1(iAPROVEMENT CONTRACTOR before the expiration date, If found return to; A•' Board of Building Reeulalions add Standards a�pi .l. (i.9n�_;lassol One Ashburton Place Rm•1301 4/2008 . .-:1')�. Boston, Ma, 01108 Corporation C° tq RENEWAL BY`kw $§ fil`' JOHN ESLER 78 TURNPIKE ROAD',_:'. ^' �.- j��✓ WESTBORO, MA01581 kdministrator Not valid witAout signature A.CORD. CERTIFICATE. OF .LIABILITY INSURANCET019/12/2006"'""'°°"""' M00�"R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP McKeone Insurance Agency, Inc. HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. BOX 333 ALTER THE COVERAGE AFFORDED'BY THE POLICIES BELOW. Ann Arbor, MI 48106.0333 INSURERS AFFORDING COVERAGE NAIC II' rlsuRm Renewal by Anderson INSURER A: Mardord Insurance J&L Windows, Inc. INSURER B: 104 OSIS St INSURER C:. Northborough, MA 01532 INSURER D: INSURER E7 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 114SURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT, TERM.OR CONDITION-OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CrRTIFICATE 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. AX L. POLICY NUMER POLICY EFPECTIVE POLICY EIVRATION LIMIT'S HER8858850 9/7/06, 9/7/07 EACH OCCURRENCE : 1 COMMERCIAL.GENERALL"ILITY Tri H 0 ! 100,000 CLAIMS MADE ®OCCUR MEO EXP om 1 11 ---'1 0 000 PERSONAL S ADV INJURY t 1 GENERAL AGGREGATE i OW GER.AGOREGATE LIMIT APPLIES PER: PRODUCTS-COMPgPAGG t 2.600 POLICY PRO LOC A AUTOM000.LIANKM 35 MCC XD 6388 10/1/05 10/1/07 coM oIsINCLELIMIT 000000 ANY AUTO � t 1 X ALL OWNEOAUTOS" BODILY INJURY Es SGHEDUCEO AVTOS (PK PK10m)HIREDAUTOS INIU NONOWNED AUTOS P�4Yd")INJURY PROPERTY DAMAGE t (Pa oodO�M) DARAOE LIAEEJTr AUTO ONLY-EA ACCIDENT 1 ANY AUTO OTHER THAN EA AGC S AUTOONLY: AGG f OICESSAAIDRdLA LIASKJYY EACH OCCURRENCE OCCUR 0 CLAIMS MADE AGGREGATE i i DEDUCTIBLE f RETE"ON t t A vocimmm r'�;", ,"ONANO 35 WBGNC8861 1/1/06 1/1/07 MIEL,DtS H LIMITS rp, ANY IROPIIIETOWT+AIITNER/EXECUTIVE CCIDENT f 0174 AAEMPERExCLUCEDI y� -EAFMPLOYEE i500,000U. Wow OAR .L.DISEASE-POLICY LIMIT Z DESCRIPTION OF OPERATIONS I LOCATIONS/VENK:LLS I"CLUS*NS ADDED EY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AMOVE DCSCRWO POLICES NS CANCELLED EEFORE TIE EAPIRATION INSURED COPY DATE TMiREOF, roe ISaINO INSURER vmLL INOEAVOR TO MAIL 1 O DAY$ WITTIIH NOTICE TO THE CFATWICA71 HOLDER NAMED TO THE LIFT,OUT fAlUNIE TO Do SO SHALL OBUGATKW OR LIABILITY OF ANY KIND ME INSURER,ITS AGENTS OR EPRf ATRIii, W RfIRESENT - ACORD 26(2001/Or!) m AACoRQZOFjPORATION 1988