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HomeMy WebLinkAboutBuilding Permit # 9/14/2016 V%ORTIJ 9 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 4�Permit NO: 61 Date Received TED � � � 4`�SRC14U5�'� Date Issued: I ORTANT: A licant must com lete all items on this page 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 R . — x`41 a �.. ."!)L.1 . Identification Please Type or Print Clearly) OWNER: Name: s` d Phone: Address: v t o aq5 1 14 n' � /iu �'" .INS ' �' I, ..Y `� „�� V p,"'. ,�,.,, �'. r", ., e� �5 � 'w, i Y � S�,e.`'3'rl^'"'• �• k"m ARCHITECTIENGINEER V',,�tr ;��� -�,e4' S Phone: 7 S `( - 3 Address: Co f%� S� r�� kc al , �1 1 Reg. No. 0 3 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F_ Total Project Cost: $ 9 4 FEE: $ 13 10 . f-f-o Check No.: 5L, Receipt No.: --�uT^ NOTE: Persons contracting wit unregistered ractors do not have access to th gu ranty fund tkORTF1 q Town of s _� �r 6 ndover 0 No. �, a - aa = - it Sq, 4 Ah ver, Mass, rhbgr I . -OAI� � COC+nCnE w'[u 1'� `� ,4 pRR TE A PP�,i'� s U BOARD OF HEALTH Food/Kitchen PER LD Septic System aTHIS CERTIFIES THATM BUILDING INSPECTOR has permission to erect ..... ..... . buildings on ... .. ........ . !, Foundation .y Rough to be occupied as ..... ....... .. .. ..he. t�s................... .......... Chimney provided that the person accepting this per it shall every respect conform totof 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONST CTIA T Rough Service .. . ... .............. ...... ......... Fina[ BUILbI INSP CTOR GAS INSPECTOR .Occupancy Permit Required t® Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Miall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Plans Submitted Plans Waived ❑ m ` Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools Well ❑ Tobacco Sates ❑ Private(septic tank,etc. ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF W U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ (�j tt COMENTS CONSERVATION ❑ ❑ ;OMMENTS HEALTH D DATE REJECTED DATE APPROVED COMMENTS ?'oning Board of Appeals: Variance, Petition iVo: Zoning Decision/receipt subR#ted yes planning Board Decision: Comments :onservation Decision: Comments Vater & Sewer Connection/sinature & Date Drlvewa Permit acated at 384 Osgood Street ° s °' y t 0 nationalgr'old August 22, 2016 Mark Price Project Manager Vantage Builders Inc. 204 Second Ave Waltham, MA 02451 RE: National Grid Storm Center 1101 Turnpike Street North Andover, MA Dear Mr. Price, Please accept this letter of intent in the amount of$109,200.00(One Hundred Nine Thousand, Two Hundred Dollars) to start the renovations to the office space located at 1101 Turnpike Street, North Andover, MA Vantage Builders is hereby authorized to proceed with the application for a building permit until a purchase order can be fully executed. This letter of intent shall be considered effective as of the date of this letter. Thank ou om Wall National Grid Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional ac for work per the 81h edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: National Grid Storm Room Renovations Date:6/3/2016 Property Address: 1.101 Turnpike Street, No.Andover MA Project: Check(x)one or both as applicable: New construction x Existing Construction Project description: Interior Renovations of Office Space 1 , Mark Meche, MA Registration Number 7083 Expiration date: 8/31/2016 , am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning]: Entire Project x Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a.regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. When required by the building official, I shall submit field/progress reports(see item 3.) together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'. Enter in the space to the right a"wet"or electronic signature and sea]: No,708, s,RE,1*'Jl Phone number: 978-744-7379 Email: mmeche@wsarchitects.com Building Official use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an Y project design plans,computations and specifications that you prepared or directly supervised, If'other' is chosen, provide a description, Trial Version 10 09 2012 The Commonwealth of Massachusetts LNWI-orm Department oflndustifialAccidents Office of Investigations } I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Inc. Name (Business/Organization/individual): Vantage Builders, _ Address: 204 2nd Avenue City/State/Zip: Waltham, MA 02451 Phone #: (781) 895-3270 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 1 am a general contractor and T have hired the sub-contractors_ 6. E] New construction — employees-(full-and/or-part-tzme):-- _ 2.El 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' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 1❑ I am a homeowner doing all work officers have exercised their 11.F1Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.] �' c. 152, �1(4}, and we have no employees. [No workers' 13.❑ Other comp. insurance required.] iy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Aomeowners 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 ant arz employer that is providing ivor-lrers'compensation insurance for'rtzy employees. Below is the policy and job site information. Insurance Company Name: AIM Mutual Insurance Company J Policy#or Self-ins. Lie. #: WMZ800-8006601-2014A Expiration Date: 12/01/2016 Job Site Address: Turnpike Street City/State Andover, MA 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 cer7i nder the pains and penalties of per jury that the information provided above is true and correct. Si nature: - -- - Jnate:F77 Phone#;78 95-3270 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 3 Dares..,,. phann#f• q�� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 9/13/2016 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 `EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements J. PRODUCER CONTACT NAME: Woodruff-Sawyer&Co. PHONE 617-658-7100 FAx 617-658-7198 One Gateway Center -1 c N 300 Washington Street, Suite 551 E-©AIL Newton MA 02458 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Admiral Insurance Company 24856 INSURED VANTBUI-01 INSURER B:SafetyInsurance Company 39454 Vantage Builders, Inc. INSURERC:Zurich North America John Connor 204 Second Ave 1NSURERD:A.I.M. Mutual insurance Co. Waltham MA 02451 INSURERE:Travelers Indemnity Company 25658 INSURER F _CERTIFICATENUMBER:-205389964.7 ._ _._..__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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN" WUD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CA000022926-01 11/19/2015 11/19/2016 EACH OCCURRENCE $1,000,000 "IMS-MADE Fx_] OCCUR -DAMAGE TO RENTED PREMISES Ea occurrence $300,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY JECT LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER: EBL $1,000,000 AUTOMOBILE LIABILITY 5004521 11!1912015 11/19/2016 COMBINED SINGLE LIMIT i$ Ea accident 1,000,000 ANYAUTO BODILY INJURY(Per person) $ AUL OS SCHEDULED BODILY INJURY Per amident $ AUTOS AUTOS { ) X HIRED AUTOS ( NON-OWNED PROPERTY DAMAGE AUTOS Peracc,deni $ C UMBRELLA LIAR XLOCR AUC 0217484-00 11119/2015 11/19/2016 EACH OCCURRENCE $10,000,000 X EXCESS LfA6 S-MADE AGGREGATE $10,000,000 DED X RETENTION$0 $ D WORKERS COMPENSATION WMZ-800-8006601-2015A 1211/2015 12/1/2018 X STATUTE» ERH AND EMPLOYERS`LIABILITY y!N ANY PROPRIETORIPARTNERlEXECUTIVE E.L,EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 byes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 Contractors Equipment QT-660-4F384108 12/23/2015 12/23/2016 Leased Equipment 25,000 Scheduled Autos BA-2F991091-14 11/19/2015 11/19/2016 Combined Single Limit 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) The town of North Andover, MA is included as an additional insured as required by written contract:. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Town of North Andover,MA THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATI E O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i i 1 •W Massachusetts Department of Public Safety Board of Building Regulations and Standards i License: CS-067029 Construction Supervisor MARK A PRICE 63-GORDON STREET SOMERVILLE MA 02144 I E -M Expiration: f Commissioner 03/1112018 E i �