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HomeMy WebLinkAboutBuilding Permit #Exception - 67 CRICKET LANE 5/1/2018 (3) y BUILDING PERMIT of"° Th q� 2. 4`yl. ,.:N6�6 O TOWN OF NORTH ANDOVE to APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received .2 h/O 4qG V� ��SSACHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION C'e(C K,e I i% not PROPERTY'OWNER_ts2�y + �i�r.( , N1�fZKac� i�v, Print .MAP NO: PARCEL: ZONING DISTRICT__ Historic Distric# yes no Machine Shap Village des no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne fami Addition Two or more family Industrial eration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic ` Well. Floodplain etlands Wetland" 1Natershed District Nater/Sewer DESCRIPTION OF WORK TO BE PREFO• MED: /4 -rD I )C'I Z Lnid6s ( 7 t-W6CiL rf 2-0 X!Z' AA�J' (,bu. LTX Z ' ��e / I z x z' �y f -r(4 A--r, Identification Please Type or Print Clearly) OWNER: Name: (iJA((W f&6eB J 1-1�rKow K,/ Phone: 97i7- _9'?-6 69 Address: CONTRACT ,R,Name: } C j2z 'Phone:: 56 .Address, 0 P'bN�0,It . 5t. 5upervisot'.s Construction License Exp. Date: Hone Improvement License: Exp. Date: 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: $_ J42,6 45,W FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unre istered contractors do not have access to the guar ty fu signature of/�gent/0wner ,S�gnature of contractor 3 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 DATE REJECTED DATE APPROVED CONSERVATION w a/►3�o7 COMMENTS Qork Loti`n IDD' 4 UYJL�,d Re50u.rce- CLr-eo,-- );Il aJvioe. O-Q P1f'onr;ate.. �oh fr` DATE REJECTED .17 DATE APPROVED HEALTH , o. -4/P-7 COMMENTS Cr " ro 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 Located at 384 Osgood Street FIRE"DEP,ARTM'ENT Temp Dumpsteron site eyes no Located at 124"Main Street Fire Department signatureldate 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 2007 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 af yORTH OL O 9 41 4,E 0 4, SSACHUSE CONSERVATION DEPARTMENT Community Development Division January 11,2008 Robin Markowsky 67 Cricket Lane North Andover,MA 01845 67 Cricket Lane, North Andover Expansion of an Existing Deck Conservation Conditions of Approval, NACC #38 Pursuant to section 4.4.2 K of the North Andover Wetlands Protection Regulations,Robin Markowski, applicant/ homeowner,filed for a small project for work proposed at 67 Cricket Lane,North Andover. The work consists of expansion of an existing addition by six feet and the construction of a 28' x 12' deck with a 24' x 12' pyramid deck off that with associated stairway. Approximately 288 total s.f. of work (deck and stairs) is within the 100-foot buffer zone to a wetland resource area which is located across the street. Soil disturbance for the work is limited to the installation of nine (9)new 12-inch sonotube footings. Installation of the sonotubes will be performed using a small bobcat type piece of equipment because of the number of footings required. Work will be conducted approximately 88 feet from the edge of a Bordering Vegetated Wetland (BVW) located across Cricket Lane at its closest point. The Conservation Department conducted a field inspection on December 10, 2007 and agreed with the location of the wetland boundary. During the January 9,2008 public meeting,the North Andover Conservation Commission (NACC) voted unanimously to approve this project as described above. The following conditions were hereby mandated for the proposed work: RECORD DOCUMENTS: Scaled Sketch prepared by the contractor,Dan Gobeil; Copy of a portion of the record Walnut Ridge Plan for the site (242- 904); Letter of proposal/description of work prepared by Dan Gobeil dated December 16,2007. CONDITIONS: 1. A row of staked hay bales backed by trenched siltation fence shall be placed at the toe of slope between the construction area and the roadway. The erosion control barrier will be properly installed and shall be inspected and approved by the NACC prior to the start of construction and shall remain intact until all disturbed areas have been permanently stabilized to prevent erosion. 1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www. http://www.townofnorthandover.com/conservel.htm Further, erosion control measures consisting of either haybales and stone or filter fabric shall j be placed around the existing catch basin located in the driveway. All erosion prevention and sedimentation protection measures found necessary during construction shall be implemented at the direction of the NACC. The NACC reserves the right to impose additional conditions on portions of this project to mitigate any impacts which could result from site erosion, or any noticeable degradation of surface water quality discharging from the site. For example, installation of erosion control measures may be required in areas not mentioned herein. Should such installation be required, they shall be installed within 48 hours of the Commissions request. 2. Upon installation of the aforementioned erosion controls and prior to the commencement of construction, the Conservation Department shall be contacted at least 48 hours in advance to verify that said erosion controls have been properly installed. 3. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 4. Access for construction shall be limited to the existing driveway unless otherwise discussed with and approved by the Conservation Department. 5. Excess material and construction debris shall be properly disposed of off site. 6. Upon completion of the approved project and site stabilization, please contact the Conservation Department for a final inspection. 7. This permit shall expire on July 31,2008. Please do not hesitate to contact me should you have any further questions or concerns in this regard. Thank you in advance for your anticipated cooperation. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT Alison E. McKay Conservation Administrator 1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www.http://www.to-,vnofnorthandover.com/consenrel.htm ► 09:33 DEC 07, 2007 ID: FRED C. CHLRCH It.L- I`W• ZPrv -�-- DATE(MMIDWYYYY) ACORD, CERTIFICATE OF LIABILITY INSURANCE 12!07!200709:32 PRODUCER (800)225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Fred C.Church,Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 40Kenoza Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Haverhill,MA 01830 800-225-1865 INSURERS AFFORDING COVERAGE NAIC# INSURED NSURER A: Patrons Mutual Group of Connecticut Dan Gobeil Home Improvement INSURER B: 80 Munroe St INSURER C: Haverhill MA 01930 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORT ITH RESPECT T POLICY PERIOD INDICATED.MAYNOTWITHSTANDING ANY MAY PERTAIN,THE HE I SURANCE AFFORDED BY THE POLICIES DESCRIBED H CT EROR OTHER THES SUBCUMENT JYECT O ALL THE TERMS,EXCLUSIONS AND O WHICH THIS TCONDITION OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. OLIO EFFECTIVE POLICY EXPIRATION INGR M. POLICY NUMBER LIMITS OF INSU EACMOCCURRENCE $1,000,00(1.00 GENERAL LIABILITY DAMAGE TO RENTED $50 000.00 X COMMERCIAL GENERAL LIABILITY PREMISES Fe o¢urence OCCUR MED EXP(Any one person $5,000. 0 CLAIMSMADE A CTR0004458 11/24/2007 11/24f2008 PERSONAL BADV INJURY $ 1,000,0(10 00 GENERAL AGGREGATE $2,000,000.00 PRODUCTS-COMPIOP AGG $ 2,000,000.00 GEN1 AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) AUTO ONLY-EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE RETENTION $ WC STAN- OTH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTWE OFFICERMIEMBMEXCLUDED? E.L.DISEASE-EA EMPLOYEE $ Ifyes,descnIbe under E.L.DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS bebw OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION 1600 Osgood Street DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN North Andover,MA 01845 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Q 07!08 Cert ©ACOTRD CORPORATION 1988 ACORD 25(2001108) Client# 30188 Mst b, 07!08 i BOARD OF BUILDING REGULATIONS ` License: CONSTRUCTION SUPERVISOR Number: CS 063220 a Y Birthdate: 01/31/1966 Expires:01/31/2008 Tr.no: 13112 Restricted: 00 DANIEL L GOBEIL 80 MONROE ST HAVERHiLL, MA 01830 Commissioner --- - � — —✓Lce (�omineo�uuea� a�,��Crr�acleccaella Board of Building Regulations and Standards License or registration valid for individul use only lug HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 132182 Board of Building Regulations and Standards One Ashburton Place Rm 130.1 Expiration: 11!30/2008 Boston,Ma.02108 Type: DAN GOBEIL CONTRACTING DANIEL GOBEIL 80 MONROE ST. � - -- HAVERHILL,MA 01830 Administrator Not valid without signature 0 The Commonwealth of Massachusetts Department of Industrial Accidents " Office of Investigations m d 600 Washington Street Boston,MA 02111 s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information !/ Please Print Le ibl Name(Business/Organization/Individual): Address: Sb (-tuAI F6 q- St—, City/State/Zip: /-U-t C(L' Phone#: ,�69 Are you an employer?Check the appropriate box: Type of project(required)': 1.❑ I am a employer with ' 4. E] I am a general contractor and I �, mP yer w 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. 7. [ Remodeling ship and have no employees These sub-con tractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10..❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: (I[�d�Y Policy#or Self-ins. Lic.#: C` 6LO6044 5 Expiration Date: Job Site Address: City/State/Zip:_ • co a4$_ 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 cern under th ain and peva c s of perjury that the information provided above is true and correct Sijznafore: Date: 0) Phone#: 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 Massachusetts General Laws chapter 152 requires all employ6rs 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 representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal 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"ever 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 certificate(s)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 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 has to 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 city or town may be 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 hesitate to give us a call. 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. #617-7274900 ext.406 or 1-877-NIASSAFE Revised 11,22-06 Fax# 617-727-7749 www.mass.gov/dia Z x ZS W �Z'XZ$f d7��Kr. t�R OC. L< �i1.' til �•.,,t s .} 1 F V C fzA ��-- 6x f ci� IZ`X14' 6CCE- hl � r'7iC (,(?097-100/ Dan Gobeil Home Improvement 80 Munroe Street Haverhill, MA 01830 (508) 451-0493 C.S. 063220 CONTRACT REG. 132182 CUSTOMER :Robin & Warren Markowsky DATE: January 26,2008 67 Cricket Ln. North Andover 01845 978-6876869 PLAN: Add on to screen room & build deck THE JOB WILL INCLUDE THE FOLLOWING: PRICE • Add approximately 6' on to existing screen room,making it 12'x20'. • Create an opening on left side for one Storm door, and two screened in openings. • Create three symmetrical openings in rear for three screened in openings. • Create opening on right side for two screened openings. • Vault ceiling leaving existing roof line and add two"Velux"manual skylights. • Apply tongue& groove pine to entire area. • Electrical: Switches and outlets to code and install ceiling fan. Fan to be provided by homeowner. $550.00 • Painting and staining to be done by others. TOTAL MATERIAL AND LABOR $17,348.00 • Build a12'x28' deck with a 24'x12' pyramid off of that. • Stairs will go down a few steps to a landing then proceed towards driveway. Back steps will be 4' to 6' wide with no rails. • Full Skirt around entire deck with trim. • Price for Reserve Rail and Pro-Cell decking style deck. TOTAL MATERIAL AND LABOR $20,639.00 Payments will be scheduled in quarter increments through different phases of`ob. • DUMPSTER AND PERMIT FEES INCLUDED • Anything above and beyond said work will be done on a time and material basis at a rate of$45.00 an hour. Payments will be in quarter increments TOTAL MATERIAL AND LABOR: through different phases of job $38537.00 ACCEPTED & AGREED TO BY: W)"7n o obin Marko D el Gobeil DATE: / DATE: d� r C7 c H 14 � E7 lob IV C cTN° /(a O/C- .Y 2 xto z x g _.w.. 5gi-i p,soAj f6 J4' W2rU,,.c�s f 1 I