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HomeMy WebLinkAboutSHELL ONLY PERMITBUILDING PERMIT TOWN OF NORTH OVER APPLICATION FOR PLAN EXAMINATION A. Permit No#: 2 Date Reqpived Date Issued: 6) -10 LOCATION ' F not PROPERTY OWNER '&r60 9�f-et'* -YQw7f PROPOSED USE — ------ Print 100 Year Structure yes Historic District Non- Residential )K�NewBuildiing MAP PARCEL: ZONING DISTRICT: yes 0 Addition Ll Two or more family E Industrial Machine Shop Village yes No. of units: O -Commercial 11 Repair, replacement - 0 Assessory Bldg [I Others: 11 Demolition TYPE OF IMPROVEMENT PROPOSED USE — ------ Residential Non- Residential )K�NewBuildiing 0 One family 0 Addition Ll Two or more family E Industrial 0 Alteration No. of units: O -Commercial 11 Repair, replacement - 0 Assessory Bldg [I Others: 11 Demolition 11 Other FJ Septic El Well D Floodplain E Wetlands E-1 Watershed District 11 Water/Sewer *WNER: Name:, Address: k G� ma4,v- Contractor Name:Vevc4l Email: MO-rk-("67b ve�lv- Address.- I cld—v" Sn on - PleaseType or Print Clearly q,1 q k "'Qa- Phone: ya 0 0 wi'+-,7 Supervisor's Construction License 192 ( C, Exp. Date: -7 1 1] -7 _I _J Home Improvement License: t & ?d13 �? 1z Exp. Date: qT5 11-7 ARCH ITECT/ENGI NEER LA6­i� Phone: -1/4-76 " 4 70, Address: W G�q V'OV0 o-vtl-, M A _Reg. No. qW27 FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ ep FEE: $ Receipt No.: No. NOTE: Persons eontracting with unregistered contractors do not have access to the guarant))11yun,tJ,,­,..,, i 'r" i- n q- t i- PrP -of " AcI -P,. n -f fib�, -i-v r,i-p, r A I ffill W in nm- tore " -of, c­o­nfra 7- r' Plans Submitted ❑ Pians Waived ❑ TYPE OF SEWERAGE DjSPOSAL Public Sewer Well ❑ Private (septic tank, etc. ❑ Certified Plot Plan ❑ Stamped Plans ❑ Tanning/Massage/Body Art ❑ Tobacco Sates ❑ Permanent Dumpster on Site ❑ Swiauning Pools ❑ Food Packaging/Sates ❑ THE FOLLOWING SECTIONS FOP, OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U'FORM PLANNING DEVELOPMENT Reviewed On n Slgnature COMMENTS CONSERVATION Reviewed on i COMMENTS l/L /HEALTH Reviewed ori T h I 110 COMMENTS i�� ��I�� DQ( QAt Zoning Board of Appeals. Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: , Comments Water & Sewer Connection// nature gate Driveway Permit -DPW ['own. Engineer: Signature: . Located 384 Osgood Street FIDE DEPAWMENT - Temp Durrmpsfer onsite yes . no ..: . f E?eated at I24 Main..Street - . Fire Department signature/date -_ - n 0 s w G1 0 co L O LCL w cn U Q. V) a O z z G D m C fu 'O c Lei L I to_ CC a C E U C LL 0 ULLS LU 0. Z co i L w _ C I.l °C 0 Z U V LU ..G OC ai U > C Ln _ fu C 3.1 0 a z t7 t D' _ C il., W cr < IL Lt! LLA CG LL L N i m z Y [L j 4f Y 0 Ln fn uj 1.L. LU U co r 0 cc 2 cca 0 E 0 o (� L V 7 m > M W L o E w > =-0 0 rn I 4 E c O w z N 0 0 a-. 07 > 0 F— CL CL —QC Ca O O r- 0 as a> 0 w 0 Co -0 +-' O Q N •yO (n C ul •�� � O C L- t� 0 W •E Q 0.O ��-(n 0 m .- CL0ci `.L 'Ira .,., Cl) LU 0 E O O C3 N V W W �0 W V ca CL V .N a U cc Q N F�� �'\ Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8" edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Bradstreet On Main Date: 9/12/16 Property Address: 70 Main Street, North Andover Project: Check (x) one or both as applicable: X New construction Project description: Construct a 2 -story commercial building (shell only) I Joseph D. LaGrasse, MA Registration Number: 4153 Expiration date: 8/31/17 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural X Structural for the above named projectand that to the best of my knowledge, information, and belief 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. Pet -form 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. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. 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'. . & A A . Enter in the space to the right a "wet" or electronic signature and seal: Phone number: 978-470-3675 Email: jlagrasse@lagrassearchitects.com Building Official Use Only Building Official Name: Permit No.: Date: D. La W41`153 ANDOVER, MA Note 1. Indicate with an 'x' project design plans, computations and specifications that you prepared or directly supervised. If 'other' is chosen, provide a description. Version 06.1-112013 no Commonwealth o� li2as��chuseits Dep of �tdastrialAceldents M _ -I Congress stmet, Suite 100 MA 02114-2017 • .' FC rot wwvmaFs.gov1d!a ��c�ers/C�A�k�Os.R�.� TO BE FRM) �WffBl TBE P1MgT M Nam,- arc ticIa ` -)e_ J (?! MA arV- 4f,6r0 fStatef� eta _ Q of Poona #: q` _ �7� ' �i �. 22 t city p Areyou an employer? Cptectl€e appropriate box,. LET am a emplayer�itt�- • :..: employees (fi�i andlor part Vie) 2 I am a sole proprzetoz or partnership andhaVe na epinyees �S+oz7cing for me in any capacity END -yip±ers' comp, insurance rer &rd.] 3Qlam alrameawnerdoiugaliwozkmyseIZ y'owarhere Comp. -iusurmoowpked] i Iuill 4E]xamahnmeownerandwillbehiringcontmecorstacomduetallv�ozk°co aresoe ensrn a i]aat all rorrtra ctnrs either bsve worl�ers' compensation i3a5uran prcipiietors'caitb.no ear�ployees. 3.F, I m, ageuezal aa?afrO_dar and xhageivredthe sub-nontmGtozslista I ontlm aiiaohsd sheet. bese s[l ]-conir'aatnrs3aaYe einplayees and3�avewarlrers' oomp_ iru M=,,ej 6.[l We areacozpnzatinrr andifs ocershaye exernised hri<tight nfexempi3anperMGL c. 152, 81(4) andwelravan,4emplQyoes. jI* aworkers comp. ins uaneeraquired.7 Type ofpxojeet 7.• e� coris�tr[ctio�, 8. [] Remodarardg 9, ❑ Demorition 10 D Bunk ng aclMon 11.[( Electrical repairs or.additians 12; [] Prvmbing repairs or additions 13:�]Rob�'�epairs ou- -A-ay applic tbab ehecl slsrix#f1 mast also' 17 ouithe are damgla73 arkandthenlvre outside cmantractazs .1tsiI Miitaaum a?fidadtindicating S -h- i �Iomenmozsxvlio sulimif isaf davztzurl%ca'dngtTrey ?Contractorn�hat checJ��tb is b�.mns�af�Eac�tett au a ,T„arl.�f: nragidetlieir worl�ers' �. policy numbrs and �aie vdheiher or�no�-those enii�es have X airs an e taproyev & at k 00I;Ic&91v0-Vke1'5' compensatia insrx�ar2eefat rrty exnpiayee�: Tn urauce CompatyName. Policy# ar Serf-hiss.:UG. BeZotu is thepa7icy aridja sxt Bxpixatiou Data: Cary/State/Zip: lob Site Address: otic declaration Page sliowh gthe olityuUmbex and explrau()�JL date). .Attach. a copy Of thByvorkerg caOmPeMatioxt P Y p g p FaTlxxre to sect e cogs as equred underlVZGIr cs. 152, §2SA xs a czamax violaLaon prishable bg ae up io $1,5 51.0 and/or ox�e yaax imprison ze , as v,�elr as civil pM21j,ies i -a the foam. of a STOP WORK ORDI3R and a fine of up to $250.00 a dap against the �raolaf ox_ t� copy afihYs state may bt) forwarded to � e Office of rn�restigataons ofthaDTA farms ra ce X do Iaexehy cexiify the_PaIns and I } 0 �fpejjxry thcrithe info naflofxprovided q(a11� .M1 pf cirxZ zrse axaZy. _po not -ware zjv this area, to,ie coarz rZeier y city ar to-wn of City or Town: Pez�f�icense # is Ulug Authoxi y- (CI t'cl0 o) re)iCll5.1'Imbzuglnspectoz. 1.Bo'grdofMaRT.2.B�d�g1]eparin0 t 3..ecap 6.OtTaer l'la.axie Coxxtaet Pexsos�: CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDNYYY) 9/9/2016 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the Policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME CT Michael Laorenza MTM Insurance Associates �q PHONE - - -- - IAo,Exty. (�78) 681 5700 IC,.NlC NoJ_(978)681-5777 1320 -- -- Osgood Street ADDRESS, certificateslamtminsure , com INSURER(S) AFFORDING COVERAGE NAIC iF North Andover MA 01845 - - _ ---------..__ ir�suRERA.Atain S eecaalty insurance Company INSURED �- -� ` _ - B_: VBrdeCO Designs INSURER ENSURER C :Y` m -___, m ._._.— 1 Elm Square INSURER D: INSURER E Andover MA 01810 INSURER FT7 COVERAGES CERTIFICATE NUMBER:16-17 Master 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. INSR... _ .._......_ ...... _..---- _...._......lAbDLSUBR' ..__._. .._...__.. .__... ---7--- - ..,... ___....-- , EXP LTR TYPE OF INSURANCE I I POLICY NUMBER POLICY YYY tu1110i11DD[yYyY LIMITS 3C I COMMERCIAL GENERAL LIABILITY " EACH OCCURRENCE $ 1,000,000 -DAMAGE TDAN RTED - A CLAIM$ MADE X OCCUR PREMISE SLEa occurrence) $ 100,000 j ' CIP289150 /17/2016 : 2/17/2017 "MED EXP {Any one person) $ 5,000 ,-- - - ----- 2 GENT AGGREGATE LIMIT APPLIES PER: % �` POLICY i PE � LOC AUTOMOBILE LIABILITY 1 ANY AUTO ALL OWNED I----; ' AUTOS SCHEDULED --__' AUTOS HIRED AUTOS NON -OWNED -.....J, .._.... AUTOS UMBRELLA LIAR OCCUR EXCESS LIAB CLAIMS -MADE DED 1 ' RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y! N ANY PROPRIETOWARTNER[EXECUTIVE -'` OFFICERIMEMBER EXCLUDED? ,11 N 1A (Mandalory in NH) -- If yes, describe under PERSONAL & ADV INJURY $ 1 GENERAL AGGREGATE L$ ......-- __ - PRODUCTS - COMPIOP AGG $ Additional Insured $ COMBINED SINGLE LIMIT $ (E„a accidence_-_ _ BODILY INJURY (Per person) s BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) ----_--... $ $ EACH OCCURRENCE $ AGGREGATE STATUTE, ...IER. - E.L, EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L- DISEASE -POLICY LIMIT S 1,000,000 2,000,000 2,000,000 -..._Blanket i DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, AddHlonal Remarks Schedule, may he attached If more space Is required) This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. TE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover Mass THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. No Andover, MA 01845 AUTHORIZED REPRESENTATIVE M Laorenza/LAURIlV ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)