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HomeMy WebLinkAbout- Permits - 101 CRICKET LANE 10/28/2019 BUILDING PERMIT of NORTH q �t�eo 6 ti TOWN OF NORTH ANDOVER or APPLICATION FOR PLAN EXAMINATION '' 7D Permit NO: 7o-3 Date Received �q,T.o / Z'-/b SSACHUSE Date Issued: IMPORTANT: Applicant must complete all items on this page i LOCATION P int PROPERTY OWNER 4 ,¢` �ic' e,. 'j ,4 it,`` Print MAP 210. '% ` ",'ARCEL: - ZONING DISTRICT: Historic District yes no Machine Shop Village yes ',"no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One fami Addition Two or more family Industrial Alteration ---- No. of units: Commercial Repair, replac Assessory Bldg Others: — m o tion Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: _,>y entification Please Type or Print Clearly) _ OWNER: Name: Phone: Address: ? - lad-ex— C CONTRACTOR Name: _ Phone: Address: �c`� —fir t LA cc-,A Q Supervisor's Construction License: 1 Exp. Date: Home Improvement License: 1 �I Exp. Date: I ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Id,I 5:7S6 ► bC� FEE: $ /K-/.-� Check No.: 3 V Receipt No.: )3 f V Y NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Own �Signature of contractorr,Fy-�, 71 ,I 565 Turnpike Street Suite 61 CAriceptS North Andover,MA 01845 1 3 5q� 27 9'2,3 -+ Ph: (978) 681-868 78)975 7280 www.adconceptsi nc.com Location Uz rf/Gz�T No. 203 Date hT� O� NORTk TOWN OF NORTH ANDOVER � 0 1 41 i ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ s�IC NU5 Foundation Permit Fee $ _ Other Permit Fee $ TOTAL $ Check # 26 Building Inspector r The Commonwealth of Massachusetts Department o f Industrial Accidents Office of investigations 600 Nashineaton Street Boston, M4 0211, wrvi`+'.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A Iicant Information �- Please Print Leaibl Name(Business/Organization/Individual): Address: City/State/Zip: ©p-(s 0 Phone#: Q v A re,You an employer?Check the appropriate box: a employer with 4. ❑ I am a general contractor and I Type of project(required): employees(full and/orpart-time).* have hired the sub-contractors 6. ❑Near construction I am a sole proprietor or partner- listed on the atxached sheet I ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers' comp.insurance. 8' ❑Demolition [No workers' comp. insurance 5. ❑ We are a corporation and its 9. ❑Building addition 3.❑ required-] officers hake exercised their 10.❑Electrical repairs 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. r airs [No workers' comp.Msurance required] 13.0 Other a)'=�pI3cafft thatt the Lr box ? mus?sls{ fu cLt tnn section ceeov.'s^Ov^^•. ' 'Aomeowners who submit this affidavit indicating thw are doing aC,work and rti worl:ws corffpeffstion E th®hire outside contractors mast submit a new affidavit indicating such. +Contractors that chezk this box must attached an additional sheet showing the name of the sub-contractors and their workers'com p.policy information. I am an employer that is providing workers'compensation insurance for my information employees Below is the Policy and fob site Insurance Company Name: ,r Policy#or Self-ins.Lic. #: S r Expiration Date: Sob Site Address:_.)('� � Q�Y'����� Jn City/State/Zip:A)dLJJ��� 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 imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the sins and penalties ofperiury that the information provided above is true and correct Si--nal4;;L: � Date: Phone#: , F al use only. Do not write in this area, tobecompleted bycitl'or town official r Town: Permit/License g Authority(circle one): rd of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Ins ector er pct Person: Phone#: I ACOR& CERTIFICATE OF LIABILITY INSURANCE °"'�`"�� — ---------- L V2 910 9 THIS CERTIFICATE IS ISSUED AS A MATCER OF WFOIRMATION� Bar_-y C McHugh Age= ONLY AND CONFER$ NO RIGHTS UPON THE RERT00.1%Te HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND t« Ska ,Ia^.gs Rd I ALTER THE COVERAGE ,AFFORDED 8Y THE POL G1E9 EELOW.CFt j 4inchaast_r, M& 01890 INSURER$AFFORL7ING COVERAft NNC 9 Jtt>a BaG !INSURER A; VeJcJKnt lftzlial ;N$Vmp 0 Dw. _'PH GcrItracting ;INSLJP�Rc: i P.C. 2.x 694 ! IN4UF9 ft A Gro�or„ MA 01C3G _ ;ftgv!e_aa; 11iE"-C7iY19SOFN&MAKEUST£pOELC'I+ IEp HAyECENISSI, TOTHEY+ISUREDNRMc"pABOVEFORTHEPOLICYPERIODINDICATEC.NOMNITi6TA.Nafks i �.W OR r.OND1TNJN OF ANY CONEANCT OR Crf4ER 0OCUt fNT W Rtd RESPECT-0 i KCH THIS CW FICATB MAY BE 1881299 CR MAY M-WrAW THE IMURANCE AFFORDED BY THE PCLICI FS DESCRIBED HEREIN IS SUBIECT T7A;L THE TERMS.EXCLUSIONS AfVO CONDITION$OF SLI 4 PiXCIES-AGGREGAELIMMS9CM. MAY HAVE SEEM REDUCED BYPRIDCLAIMS, itI R i TyaROi 4LtRAWCE L POLIOf PP IA R ha Fr$fT717E POUG1 DG�1 A71 �4FJVlIRAL.M811.^.Y I r�acr O NCE —T-g 1 PA mmmppy S00.009 � A CORJIEMOLG2►rEw�L0,316'r!BPI 7021703 6!6/09i, 616!10'alawi 50.0G0 ' f i CLMNSinOE G^�uR i OAEUW(AN craoat& _$'A §.QQQ agawiara P w4lkLaAPvrrQURY js + -- IRG6 79 00 p• 4rt.MALAGG � I G€MLA;GH6' aIIMIT+tPPllc6 PER --{S-- � �I �""PRG �'� I � I 1 PIt0001C!'$•COAA�lOP AO(3 16 I I ,IMQ LE UAS;1TY i I �pp,g tNED SINGLGLPIIT I ANYAU D (Gnaaader"I I f ALLOw%EDAUTO$ —' , BCOfL.Y INJJRY SCHEO'UOAUrC$ Iforperyprl) I s rIIRCDALTOB t`— 80OLY AJUiY I NONv'MGP AJTOa .(Par acciam, j I PROPEflT1 DAVAt3E — '� j (Pei pC wwX1 i tiARALiE W1alt.'T1' �. --"I—'•�-----'� I ;AUTO QJLY•to ACCI AW S ANYAliT' 11 OTHERTHAN EAACC S AUTO ONLY. AGG d mE$9 U"NEL►ALWILTTY ;fiACH OCCIRRENCE %CIA _ LY..OAS MADE � � AWRY E AM 1�DEDUL-,.0 I t IAORKM 0090w-MATlt]N WC STATU- —� ! ANC WPLOnitli'LUSPLITY Y i N J.,YGrev;�r-t. t A!vrPRAPki P;;L CxPCUTNE , ( 1 QFFIaRAC.� ExCItEED9 I 1•.L.L�ACN A�.CI M N, t5_ IuAeiaor,Ir. f -CA Ehrl'LQYE&i 8 i 3P1iL7Al PR (fPNyS!>90w _^ I ° F- L1C L T Cr/ER ( I t _ i W8^RIPT$MiOFOFINU "tL9GT4N3IYCFtCLft,EAQ.UM %6AOOEL'8YE!�DO/8'lYB1T1SP'E04i�RC�11181ONS i (1 CANCELLATK?N SHOULD ANY OftVE ASOiC fW*69010CUCI6l6iCA0,CjUXQ BERM TNES7p11RATM j GATE TWO90F,"t 135U!NG INSURER WILL ENDEAVOR TO MAIL DAYS WPYs* 8. NOTICE TO TNH MIMMATE HOLMR NAMAD TO NE LIFT,WrIl (LURE IC CO SO VIA" NPOSE NO OYLPGATft OR LIABILITY OP ANY KP4D UPON THE MWRM ITS ACsEM OR IIIIpW a W1 YAraIs _ I AJ7!!�R4Pre?SEIrrATlui �— �'�"—'� LACORD 26;Z009f ) 089-2009 ACORD CORPORATION. A11 rights reserved. The ACCFM name and logo are r"Istered marks of ACORD Proposal _ J. B. Contracting P.O. Box 694 Groton, MA 01450 978-375-6024 or 978-449-0423 Mass. Lic. #135391 PROPOSAL SUBMITTED TO PHONE q ( DATE STREET JOB NAME C CI ,STATE AND ZIP CODE 1, JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: (` � UCH C V �s 4> C,k CQ al W E' v. c \� Cc.S,.E'' .�t vS . kz17 .v cl c r Frapasr hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: dollars($ -� ) Payment to be made as follows: `C_ ` A� — V_�, fly . v t1'2 AA C All material is guaranteed to a specified.All work to be complete in a workmanlike Authorized -- manner according to stands ac es.Any alteration or deviation from above specifi- `- cations involving extra costs will be executed only upon written orders,and will become SlgnatU an extra charge over and above the estimate.All agreements contingent upon strikes. Note:(This OpOSaI maybe accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance.Our workers are fully covered by Workmen's Compensation insurance. Withdrawn by us f not accepted within days. a *rrpfnnrr of ProyasttX - The above prices,specifications and conditions are satisfactory and are hereby Signature accepted. You are authorized to do the work as specified. Payment will be made as outlined above. L e--C3( � ` Q Signature Date of Acceptance: F N®RTH own of 4 ove r O tt No. o �A E dover, Mass., Jr / COCMICHEWICK ADRATED S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System r BUILDING INSPECTOR THIS CERTIFIES THAT............. ......... h.dl.......... ....................................................... " ""' Foundation has permission to erect........................................ buildings on ......1Q1...........G.. t..c..4�•.:T.................... Rough to be occupied as...... ..!�ce " .......... ............. .. . .A. . ............................................................................. ..... Chimney provided that the person this permit shall in every rasp 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 ITI 'l ELECTRICAL INSPECTOR UNLESS CONSTRU ARTS Rough .......... ...... ............. .......................................................... . Service 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. .�*. ✓�e 't,am»a�yntucal� r��,2�aau,.r/ucaelXa 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: 135391 Office of Consumer Affairs and Business Regulation Expiration: -4/1/2012 Tr# 293900 10 Park Plaza-Suite 5170 Type: Individual Boston,MA 02116 JOE BUE JOE BUE f PO BOX 694 GROTON, MA 01450 Undersecretary -- -- ------ Not lid without signature DePartfuent of Public ,ateel B+tartl eP Builtlin-o Re-,ulations ;ttitl Stanflau•tfs Construction S"Perrisor Specialty License License: CS SL 99133 Restricted to: RF,WS 1;^s' JOE BUE P.O. BOX 694 GROTON, MA 01450 cr- -�f Expiration. 1/25QA12 � Ei111i13�xlr.i{t•i. Trg: 99133 ACORD. CERTIFICATE OF INSURANCE PRODUCER DATE(MMtDD\YY) 12-17-09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BARRY&VICHUGH NS AGCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1I)SK11.1.1NGs 141) HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WINCREST}:R.4MA 018W COMPANIES AFFORDING COVERAGE 2SWKS COMPANY A HAR'IFORD GROUP INSURED COMPANY RUE )OSEPH DBA J B B CONTRAC'MNG COMPANY P O BOX 094 GROTON,MA 01450 C COMPANY D COVERAGE THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN tS"ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, MAY PERTAIN. DBCONTRACT OR NAMEDAIN. THE VOURANCE AFFORDED B'Y THE POUC636 DESCRIBED ED N i8 BOTHECTo AL�rEWITHRP,EXCLUSIONS TO WHICH AND M CEATIM T MACH E ISSUE OR LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA CIE CO LTR TYPE OF INSURANCE POLICY EFF POLICY EXP GENERAL LIABILITYPOLICY NUMBER DATE(MWMYY) DATE LIMITS COMMERCIAL GENERAL GENERAL AGGREGATE $ CLAIMS MADE OCCUR. PRUDUCTS-COMP/OP AGO. S OWNER'S 58 CONTRACTOR'S PROT PERSONAL 38 AUV.INJURY $ EACH OCCURRENCE S FIRF DAMAGE(Arty onn fir*) S AUTOMOBILE LIABILITY MED.EXPENSE(Any one person) 3 ANY AU r0 ALL OWNED AUTOS COMBINED SINULE LIMI f 5 SCHEDULE AUTOS BODILY INJURY(Per Perron) $ HIRED AUTOS BODILY INJURY(Per Accident) NON-OWNFO AUTAB PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT S OTHER THAN AUTO ONLY: EACH ACCIDENT 8 EXCESS LIABILITY AGREGATE $ UMBRELLA FORM OTHER THAN UMEAFLLA FORM EACH OCCURRENCE $ y, WORKER'S COMPENSATION AND ACISREEGATF A EMPOLYER'S LIABILITY LIG-98291-245-09 12-15-09 12-15-10 STATUTORY LIMITS X THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL EACH ACCIDENT $ 100.000 OFFICERS ARE: X EXCL DISEASE-POLICY LIMIT 5 500,000 OTHER DISEASE-EACH EMPLOYEE $ 100,000 DESCRIPTION OFOPERA'nOMS/LOCATIONS/VZHICLESMESTRiCTIONS/SPECIAL ITEMS THIS RTPI.ACPS A'dY PRIOR rl'R'f-IFTC.ATr It.4(f1T)TO Tlir•.rrRTIFIC ATF 1407mm AF7TC`1114Ci WOR1:i?R4 COMP CX)Vr.R A011 TI'E:-WORKI-AS'COMPENSATION POLICY DOES NOT PROVIDES m V P-RACF FOR Hli£-. Jt)SI:PII. CANCELLATION SHOULD ANY OF TIIE ABOVE DECCNBED POLICIES f3E CANCELLED BEFORE TIM EXPIRATION DATE THEREOF.THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS W Rrl-f«N NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LCFT.BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY.ITS AOENTS OF,REPRES6NTATT4ES. AUTHORIZED REPRESENTATIVE ACORD 2S-5(3193) Ramani Ayer