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Home My WebLink AboutBuilding Permit #Exception - 93 CRICKET LANE 11/26/2013 ' y TOWN OF NORTH ANDOVER . APPLICATION FOR PLAN EXAMINATION ' Permit N0: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION- Print Print PROPERTY OWNER Print '100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: _ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic q Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Sign tine of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ' f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYP1-'OF-:SEWERAGE:DISROSAL a Public Sewer ❑ Tanning/Massage/Body Art ❑. . . Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ j Private(septic tank,etc._ ❑ Permanent Dumpster ori Site ❑ THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM - DATE REJECTED DATE.APPROVED PLANNING & DEVELOPMENT' ❑ ❑ COMMENTS i CONSERVATION Reviewed on 1 ? ' 1,3 Si nature �t/CJA-,,- U � COMMENTS 112 In 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 Tow;2 Engineer: Signature: Located 384 Osgood Street "EIRE DEPA111M Nt -Ternp Dumpster on site yes no Located7at 124 Mair Street t Fire Departifid tsignatu"re/date ' -OOIVIM.ENTS t s -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 i D Notified for pickup - Date Doc.Building Permit Revised 2010 } Building Department The fol?-3wing is-=a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits Ll ; 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 o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o 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) o Building Permit Application ❑ Certified Proposed Plot Plan o 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) Li Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?ding permit Revised 2012 I IN h , ver, Mass, COCMIC Hl WICiI �d A04ATEo )"If S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT .v BUILDING INSPECTOR p g ,`. Foundation has permission to erect .......................... buildin s on ..... .�. ......... .4.�r. ..... ............. ..... Rough tobe occupied as .............I.. ...,. 1.4.................... . ........................................ Chimney provided that the person accepting this permit shall in a respect conform to the terms of the application Final on file in 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 NTH ELECTRICAL INSPECTOR 3f' UNLESS CONSTRUCTIO Rough I Service ................. ......... .............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 L�Ao 9�a Cloop �gX a gXZ c AS%CL`� Z �'.o It , JAN,�u as�� License or registration valid for individul use only faeaaaaas rapun before the expiration date. If found return to: MW'0'131dSd01Office of Consmer I 3Ndl H081EI 5 r 0 Park Plaza USuite 5170s and Business Regulation l SVO 0(38V2130 Boston,MA 02116 F1183Sd0 OC18 J I 1enpinrpul i40Z/Z•1/W :uol;ejldx3 1</' a �(1. 9b9191 :uol;e�;sl6aa P 11010b211NOO1N3W3AO8dW13woA ` uotaeln&ag ssaurs = Not valid without signature $'8.Sa1e13t.1atuRO��aa�30 g60Z/V0/£0 .auolssiwuaov u0�fa:iq•.- £86T �H4Sd0d, 6TV'I MWEI S �� 10'L2IS�O OQ2I�'II�O • J 90£S60-SO :CSuaai-I p,ppuos flue 8U0Ij iP&I+j buipJ!nH 10 JDA`-`r'�] o+lgnd ;o;uaw;jedsQ- s;;asngoesse jN i i I ter~ OERAD-1 OP ID:JT CERTIFICATE OF LIABILITY INSURANCE DATE(6fM/DD/YYYY} 11/1$12013 THIS CERTIFICATE IS ISSUED AS A 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: OLDERIMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the polioy(ies)must be endorsed, It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certIflcate does not confer rights to the certificate holder in lieu of such endorsement). PRODUCER CONTACT Chas.F.Hartshorne. FH-ONE _ 3 Chestnut.St PHOoft I WC No). Wakefield,MA 01880 W L - _-_.---.•- MICHAEL A LAURANO -..... _..-- IMW 3 AFFORDING COVERAGE NMC S DNS URA;NCM Insurance Company 14788 IBSURM GeradoCaserta ,NsLIRERe:Commerce Insurance Company 34754 Vendor#88743 5 Birch Lane >,NsuRER c Topsfield,MA 01983 INSURER D: WSURER E INSUR F. COVERAGES CERTIFICATE NUMBER: 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 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 CONDITIQNS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR�- -•- WJBA —_..._ .... .._.... ._. LTR TYPE OF INSURANCE wyDPOLICY NUNDUR POLICY m—mfixyyy POLICY EJB LIFTS GENERALJTY LIA9R EACH OCCURRENCE S 1,000,0 A x COMMERCIAL GENERAL LIABILITY MPK5183X 10/18/2013 10/1812014 =M19E8 Ea oaa0 7- $ 5110,00 CLAIM$.MADE aX OCCUR MED EXP(Ally we person) i 10,00 _-•---.___._._._._...... PERSONAL&ADV INmRY I _1_,000.00 GENERAL AGGREGATP_ S 2,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY FX IjFr,PR F1 LOC s AUTON09I.E LIABILITY COMBIIrd D SINIGLE LUT(En accirtl 300 00 B ANYAUTO LQSZ75 04/24/2013 04/244 M4 BODILY INJURY(Par per5pn)ALL OWNED X AUTOS U�D AUTOBODILY IMAM(Par acoWq) $ X HIRED AUTOS X NON-OWNER ---•- AUTOS (i'EFl ACCIDENT $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAWS-MADE DG .- AGGREGATE ED $ DRETENTION 3 S WORKERS CONATION WC STATU D'rrr AND EMPLOYER$`LIADH W Y/N TER ANY PROPRIETORIPARTNERMEMME OFFICERIMEMBER GXt WDf,!W N/A E.L.EACH ACCIDENT $ (NlandamryInNH) , _."...•,�'•.. �ws dvisliba undue E.L.DISEASE•EA EMPLOYE $ DESGIRIP TION OF OPERATIONSbefow f:1.DISEASE-POLICY LOW S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Afl3dr ACORD 101,AddkImM Remarte 5c91 WWs,R Uwe apace is rmpdred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POuCY PROVISIONS. Andover,MA AUTHORIZED REPRESENTATIVE MICHAEL A LAURANO ®1988-2010 ACORD CORPORATION. An rights reserved. ACORD 25(201 OMS) The ACORD name and logo are registered marks of ACORD T/T :Ed BV:91 ET—BT—TT TZ : fiq }uas xva i I CASERTA CONSTRUCTION 5 Birch Lane-Topsfield, Ma 01983 978-804-2987 Proposal Submitted to: Work to be performed at: Gerry Fluth 95 Crickett Lane SAME North Andover, Ma We hereby propose to furnish materials and perform the labor necessary for the completion of: Build 16 x16 deck with composite decking and rails All materials is guaranteed to be specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work, and completed in a substantial workmanlike manner for the sum of$11242.50. With payments to be made as follows:$3500.00 at signing; $4500.00 at framing and balance at completion. " a r Respectfully submitted:- Date: &VI3 The above prices,specification and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature_ iL Signature Date--41)13,)11 Any alterations or deviation from above specifications involving extra costs will be executed only upon written order,and will become an extra charge over and above the estimates.All agreements contingent upon strikes,accidents,or delays beyond our control. The Commonwealth of Massachusetts Department of Industrial Accidents H W Office of Investigations ' a 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 5— 161 t-c dt Lane City/State/Zip: 6APhone#: Are you an employer? Ch k the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 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 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#I 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: Policy#or Self-ins. Lic. #: 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 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 certify un azns penaftip.of perjury that the information provided above is true and correct. Signature. Date:' / I!� /3 Phone#: 1061zq�+— 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#: