HomeMy WebLinkAboutBuilding Permit # 5/24/2016 V%0RT11 p
---- pBUILDING PERMIT °L
TOWN OF NORTH ANDOVER ° �
APPLICATION FOR PLAN EXAMINATION - n
Permit NO: � Date Received
Date Issued:
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IM ORTANT:Applicant must complete all items on this page
LOCATI"QCT `1
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PROPERTY(SWNER C''Aaat.
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MAP NO PARCEL ZONING,DISTRICT.;;,e�', orrc D�stnct es no
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 64,One family
❑Addition ❑ Two or more family ❑ Industrial
Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
C7 Demolition ❑ Other
TI
Septic ❑Weil O:Floodplain o UVetfands ❑ Watershed District-.
Water/Sewer
os" V-rrC- l T !,JD 1�-JSV-3 mr1c-- pep-3 / Pp,%
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Identification Please Type or Print Clearly)
OWNER: Name: G�� L� t--L-C— Phone: t1),4Z3
Address: 'r21 P00-W A,"D®y 4-
C,9NTRdOTCSR Phone g18s3 CoS' .
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Address
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Su eruisor's ConstruetrQn License E Date;
p
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iorne Improvement License Exp ,Date
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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: $ Ln® t(OC:) FEE: $
Check No.: (d--31J Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/ 7 nature of con c or _ ,,,;
I
72 Harold Street ® Building Project Costs
090 EXT. DOOR and WIND. $ 3,620
080 FRAMING $ 2,650
100 ROOFING $ 2,790
130 EXTERIOR PAINTING $ 3,500
150 PLUMBING $ 4,700
160 ELECTRICAL $ 6,200
170 HEATING/AC $ 1,500
180 INSULATION $ 450
190 BLUEBOARD and PLASTER $ 4,500
200 INT. DOORS and TRIM $ 3,000
210 INTERIOR PAINT $ 4,000
220 CABINETS and COUNTERS $ 13,000
250 FLOORING $ 6,800
270 DEMOLITION $ 3,450
TOTAL $ 60,160
The Commonwealth ofMassachusetts
Department ofl-ndustrialAceidents
" 1 Congress Street,Suite 100
=` Boston,MA 02114-2017
A,:��t www.mass.gov/dia
yJ• Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY. ,
Applicant Information Please Print Legibly
NaTlle (Business/Organization&dividual): !j4,1'L—AC-G---'C:>
Address: S \ 'P L-E�SP�-�'r
City/State/Zip: tom® Pi M� (�tB��Phone#: ����� �� - foS�l4
Are you an employer?Checktlie appropriate box: Type of project()Vequired):
1.❑I am aemployerwith employees(full and/or part-time).* 7. 0 New construction
2.�I am a sole proprietor or partnership and have no employees working for me in 8. "Remo delhig
any capacity.No workers'comp.insurance required.]
9. El Demolition
3..❑I am a homeowner doing all work myself[No workers'compAnsurance required.]t
10 []Building addition
4.❑l am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12.[]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs
These sub-contractors have employees and have workers'comp.insurance)
6.JWe are a corporation and its officers have exercised their right of exemption per MGL G.
14.n. Other
152,§1(4),and we have no.emp1oyges.[No workers'comp.insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
Homeowners who snbriiit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors Pat check this box must-attached an additional sheet showing the name of the sub-contractors
vand state whether or not those entities have
e employees,they u!ust provide their workers'comp.policy number.
employees. If t re sub-coritraciors fia
X am, an employer that is prdvidii'cg 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: 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance
coverage verification.
X do hereby certify under the pains and penalties ofpeijury that the information provided above is true and correct.
Sin Date: 2® Z®►�R
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 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 oiliire,
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"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 tha boxes that apply to your situation and,if
necessary,supply sub=contractors)name(s),addresses)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 Thdustrial
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-iinsur6d 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 fox 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 burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 1.00
Boston,MA 021.14-2017
Tel.#61.7-727-4900 ext. 7406 or 1-877-AIASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
MA BOC Filing Number: 201542497910 Date: 8/12/2015 4:37:00 PM
The Commonwealth of Massachusetts Minimum Fee:$500.00
`� William Francis Gallvin
Secretary of the Commonwealth,Corporations Division
One Ashburton Place, 17th floor
Boston,MA 02108-1512
Telephone: (617)727-9640
Identification Number: 001185366
1. The exact name of the limited liability company is: GASI REALTY LLC
2a. Location of its principal office:
No. and Street: I OA ORLEANS STREET
City or Town: EAST BOSTON State: MA Zip: 02128 Country: USA
2b. Street address of the office in the Commonwealth at which the records will be maintained:
No, and Street: IOA ORLEANS STREET
City or Town: EAST BOSTON State:MA Zip: 02128 Country:USA
3. The general character of business, and if the limited liability company is organized to render professional
service,the service to be rendered:
TO ENGAGE IN INVESTMENT IN AND OWNERSHIP AND DEVELOPMENT OF REAL ESTATE A
ND INTEREST THEREIN,INCLUDING BUYING,ACQUIRING,OWNING, OPERATING, SELLING,
FINANCING REFINANCING DISPOSING OF AND OTHERWISE DEALING WITH INTEREST IN
REAL ESTATE IN REAL ESTATE DIRECTLY OR INDIRECTLY THROUGH JOINT VENTURES PA
RTNERSHIP OR OTHER ENTITIES AND TO ENGAGE IN ANY ACTIVITIES DIRECTLY OR INDIRE
CTLY RELATED OR INCIDENTAL THERETO,
4. The latest date of dissolution, if specified:
5. Name and address of the Resident Agent:
Name: YEVGENY BERNSHTEIN
No. and Street: IOA ORLEANS STREET
City or Town: EAST BOSTON State: MA Zip: 021.28 Country: USA
I, YEVGENY SERNSHTEIN resident agent of the above limited liability company, consent to my appointment
as the resident agent of the above limited liability company pursuant to G. L. Chapter 156C Section 12.
6. The name and business address of each manager, if any:
Title Individual Name Address (no Po Box)
First,Middle,Last,Suffix Address,City or Town,State,Zip Code
7. The name and business address of the person(s) in addition to the manager(s), authorized to execute
documents to be filed with the Corporations Division, and at least one person shall be named if there are no
managers.
Title Individual Name Address (no PO Box)
First,Middle,Last,Suffix Address,City or Town,State,Zip Code
SOC SIGNATORY YEVGENY BERNSHTEIN 10A ORLEANS STREET
EAST BOSTON,MA 02128 USA
SOC SIGNATORY STEVEN SARACENO
51 PLEASANT STREET
NORTH ANDOVER,MA 01845 USA
SOC SIGNATORY ALFRED SARACENO 51 PLEASANT STREET
NORTH ANDOVER,MA 01845 USA
8. The name and business address of the person(s)authorized to execute, acknowledge, deliver and record
any recordable instrument purporting to affect an interest in real property:
Title Individual Name Address (no PO Box)
First,Middle,Last,Suffix Address,City or Town,State,Zip Code
REAL PROPERTY YEVGENY BERNSHTEIN 10A ORLEANS STREET
EAST BOSTON,MA 02128 USA
REAL PROPERTY STEVEN SARACENO 51 PLEASANT STREET
NORTH ANDOVER,MA 01845 USA
REAL PROPERTY ALFRED SARACENO 51 PLEASANT STREET
NORTH ANDOVER,MA 01845 USA
9. Additional matters:
SIGNED UNDER THE PENALTIES OF PERJURY,this 12 Day of August,2015,
YEVGENY BERNSHTEIN
(The certificate must be signed by the person forming the LLC)
O 2001 -2015 Commonwealth of Massachusetts
All Rights Reserved
MA SOC Filing Number: 201542497910 Date: 8/12/2015 4:37:00 PM
THE COMMONWEALTH OF MASSACHUSETTS
I hereby certify that,upon examination of this document, duly submitted to me, it appears
that the provisions of the General Laws relative to corporations have been complied with,
and I hereby approve said articles; and the filing fee having been paid, said articles are
deemed to have been filed with me on:
August 12, 2015 04:37 PM
WILLIAM FRANCIS GALVIN
Secretary of the Commonwealth
I
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IAM A. ,
CAPANE
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LIAM A.
CAPONE
STRUCTURAL
No.45015
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Proposed First Floor Plan �-
Scale.. NOT TO SCALE
LL=30PSF, DL=IOPSF, L/d=360
ADD NEW FLOOR JOISTS - SPF "2, 2x699" O.C.
EXPOSED FIRST FLOOR CEILING AREA AS SHOWN
ON PROPOSED FIRST FLOOR PLAN
24'-3!/2"
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`` CAPONE
�,I STRUCTURAL y
G etFloor Plan No.45015
Scale: 3/lro��"= 1-0A�b,� 'elav�A�®
Boise Cascade 'Triple 1-3/4" x 9-1/2" VERSA-LAM@ 1.7 2400 DF Floor eam\171301
Dry( 1 span ( No cantilevers 10/12 slope May 19, 2016 13:23:30
BC CALC®Design Report
Build 4516 File Name: BC CALC Project-72 HAROLD
Job Name: HAROLD STREET PROJECT Description: Designs\FB01
Address: 72 HAROLD STREET Specifier:
City, State,Zip:NORTH ANDOVER, MA 01845 Designer: WILLIAM CAPONE
Customer: SARACENO CONSTRUCTION LLC Company:
Code reports: ESR-1040 Misc:
ar <
12-09-00
BO 131
Total Horizontal Product Length=12-09-00
Reaction Summary(Down/Uplift) (lbs)
Bearing Live Dead Snow Wind Roof Live
BO, 5-1/2" 2,327/0 857/0
B1, 5-1/2" 2,327/0 857/0
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125%
1 Standard Load Unf.Area(Ib/ft^2) L 00-00-00 12-09-00 30 10 12-02-00
Controls Summary Value %Allowable Duration Case Location
Pos. Moment 8,928 ft-lbs 55.1% 100% 1 06-04-08
End Shear 2,560 lbs 27% 100% 1 01-03-00
Total Load Defl. 0398(0.36") 60.3% n/a 1 06-04-08
Live Load Defl. U545(0.263") 66.1% n/a 2 06-04-08
Max Defl. 0.36" 36% n/a 1 06-04-08
Span/Depth 15.1 n/a n/a 0 00-00-00
%Allow %Allow
Bearing Supports Dim.(L x W) Value Support Member Material S
BO Post 5-1/2"x 5-1/4" 3,184 lbs 15.2% 14.7% Spruce Pine Fir
B1 Post 5-1/2"x 5-1/4" 3,184 lbs 15.2% 14.7% Spruce Pine Fir WILLIAM A. PGS
CAPON E -+
0 STRUCTURAL 40
Notes No.45015
Design meets Code minimum(L/240)Total load deflection criteria. '®
Design meets Code minimum(L/360)Live load deflection criteria.
Design meets arbitrary(1")Maximum total load deflection criteria.
Calculations assume Member is Fully Braced.
Design based on Dry Service Condition.
Deflections less than 1/8"were ignored in the results.
Fastener Manufacturer:Simpson Strong-Tie, Inc.
Page 1 of 2
Boise Cascade Triple 1®3/4" x 9®1/2" VERSA®LAM® 1.7 2400 DF Floor Beam\F1301
Dry 11 span No cantilevers 0/12 slope May 19, 2016 13:23:30
BC CALCO Design Report
Build 4516 File Name: BC CALC Project-72 HAROLD
Job Name: HAROLD STREET PROJECT Description: Designs\FB01
Address: 72 HAROLD STREET Specifier:
City, State, Zip: NORTH ANDOVER, MA 01845 Designer: WILLIAM CAPONE
Customer: SARACENO CONSTRUCTION LLC Company:
Code reports: ESR-1040 Misc:
Connection Diagram Disclosure
►I b d Completeness and accuracy of input must
LI be verified by anyone who would rely on
a output as evidence of suitability for
® ® ® particular application.Output here based
on building code-accepted design
properties and analysis methods.
o o o Installation of Boise Cascade engineered
wood products must be in accordance with
current Installation Guide and applicable
e building codes.To obtain Installation Guide
or ask questions,please call
a minimum= 1-1/2%=2-3/16" (800)232-0788 before installation.
b minimum =4" d =24"
e minimum= 1" BC CALC®,BC FRAMER®,AJAST'"
ALLJOISTO,BC RIM BOARD-,BCI@),
BOISE GLULAM-,SIMPLE FRAMING
Calculated Side Load =486.7 ib/ft SYSTEM@),VERSA-LAM@,VERSA-RIM
PLUS@),VERSA-RIM@,
Install screws from both sides, staggering screws by half of the spacing to avoid splitting. VERSA-STRAND@,VERSA-STUD@ are
Connectors are: SDS 1/4 x 4-1/2 trademarks of Boise Cascade Wood
Products L.L.C.
LLIAM A.
CAPONE
STRUCTURAL a
No.45015
Massachusetts Department of Public Safety
-Board of Building Regulations and Standards
Construction Supervisor License CS-076963
Restricted to: n� ;_:c in a�.<ne •�,vc
Unrestricted-Buildings of any use group which contain
less than 35,000 cubic feet(991 cubic meters)of STEVEN SARACENO
enclosed space. 51 PLEASANT STREET
NORTH ANDOVER MA 01845
r
FX piratlon:
ommissioner 02/17/2018
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
DPS Licensing information visit:WWW.MASS.GOV/DPS
Office of Consumer Affairs&Business Regulation
ME
yHOME IMPROVEMENT CONTRACTOR
License or registration valid for individul use only registration: 165503 Type:
Ex
before the expiration date. If found return to: ;> �,� piration: 2/26/2018 LLC
Office of Consumer Affairs and Business Regulation '
10 Park Plaza-Suite 5170 SARACENO CONSTRUCTION LLC.
Boston,MA 02116
STEVEN SARACENO
51 PLEASANT ST gP�
NO.ANDOVER,MA 01845 Undersecretary
Not va� ithout sign e