Loading...
HomeMy WebLinkAboutBuilding Permit # 11/22/2016 BUILDING PERMIT V/ RT TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Permit No : Date Received SRCHUS� Date Issued:--I _ _ t - MTORTANT. Applicant must coD-t1)1cte all items on this page LOCATION Print PROPERTY OWNER � � '00, �° < Print 100 Year Structure yes MAP` � �. � � �� PARM; ZONING GISTRIGT: 1 Historic district yes Machine Shop Village yes 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 17 Assessory Bldg ❑ Others: Demolition ❑ Other ❑ Septic [] Well ❑ Floodplain 0 Wetlands ❑ Watershed District Water/Sewer DESCRIPTION, � d BE PERFORMED: � ®F WORK T --- -- Identil4cation- Please T7nt1.-1- or Print Clearly --- — � �r DINNER: Dame: � �° ����� - " � J.111Phone:, Address: 4 Contractor Marne Phone: , Address. ° °w Supervisor's Construction License,. 1� / 't-. Exp. Date: —;11- ,; Horne Improvement License: r 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: $_ r Check No.: i Receipt No'.,: DOTE: Persons contracting with unregistered contractors do not have:access to the gu az^anty fund Signature of AgentlC7wner Signature of contrcta 'T- IAOR owe.. of 2 t n over ® 0 h ver, Mass, Uft//ftal & O! 0 LAN! COCNIC HE WICK ~1. Ogren A4�,c'45 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........f..s.4A.............. .. ............... .......................................... BUILDING INSPECTOR p g 1�... CO .9..W ......$4.-t Foundation has permission to erect .......................... buildings ......... .... ,,, . .... .. Rough tobe occupied as ...............D#llm. ... .................... ............. ,................................................... Chimney provided that the person accepting this permit shall in every respectco orm to the terms of the application Fina 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 CONSTRUCTIMN STA Rough Service .. Final d ..........�. .. ... ................... "' ..... BUILDING. INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Puildin 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 pet. Oct.26 .2016 09 :41 AM 7819353031 PAGE. 1 Town of North Andover I %%ORT .q BuildingDepartment o ��`'� '� °1600 good Street Bldg 20, Suite 2035 � �,� > ,+ North Andover MA 01845 2 Tel: 978-688-9545 Fax: 976-6009542 DEMOLITION OF BUILDING AFFIDAVIT '�� coc"c:w,cK,,,1�� .S'sACHUS�R DATE OWNER'S NAME&ADDRESS ' LOCATION OF PROPERTY TO DEMOLISH lel > +' DESCRIPTION CONTRACTOR'S NAME &ADDRESS DEPARTMEN IGN-OFFS ,,,. nit fNc/� . � SEWER. �, ., t r DEPT. OF PUBLIC WOR T c ' TREE WARDEN TOWN ENGINEER DEPT. OF CONSRV01C2N _ HEALTH DEPT. SEPTIC WELL I HISTORIC COMMISSION 'w PLANNING 10''11 UO 6 3S GAS O ELECTRIC --j TELEPHONE b TAXES i U lIC/M . POLICE FIRE EXTERMINATOR ' /d� — DUMPSTER ON/OFF STREET DIG SAFE NUMBER Q :3 BLDG. INSPECTOR Building Demolition Affidavit Environmental 1 Demolition Contractors Commercial!Industrial/Residential ASBESTOS REMOVAL CERTIFICATE OF COMPLETION October 29, 2016 BELFORD CONSTRUCTION 55 MARBLEHEAD ROAD NORTH ANDOVER, MA 01845 ATTN: MARK RAE RE: 66 LONGWOOD AVENUE, NORTH ANDOVER, MA E & F ENVIRONMENTAL SERVICES, LLC,hereby certifies that all contracted asbestos has been properly removed from the above named project and that surfaces have been subsequently sealed, if required,with specifications and applicable laws and regulations. Required procedures specifications in the contract documents and/or federal and state laws and regulations have been strictly adhere to with respect to asbestos transportation and disposal at an approved landfill site. On behalf of the above narned company, I am authorized to certify the statements set forth above and have personally taken all steps to assure myself of the validity and accuracy of the statements contained herein. TyHNK )1041, Frak Balogh F/��9AIK BHLDGti/ 7 puzzle Lane, Unit 2, Newnan, NH 03658 Phone: (603)97q-2503 Fax: (603)97q-2471 Massachusetts Department of Environmental Protection --�� � BiWP A �4 ANF-001) 104252865 ..., Q Asbestos Project# Asbestos Notification Form j- Project Revision Project Cancellation A. Asbestos Abatement Description 1.Facility location: RESDENCE 66 LONGWDOD AVENUE Instructions 1.All a.Name of Facility b.Street Address sections of this form NORTHANDOVER MA 01845 5085099430 must be completed in order to comply with c,City/Town d.State e.Zip Code f.Telephone MassDEP notification MARKRAE OVO ER requirements of 310 CMR 7.15 and g•Facility Contact Person Name h.Facility Contact Person Titre Department of Labor Worksite Location: OUTSIDE,BASEMENT Standards(OLS) i.Building Name,Wing,Floor,Room,etc. notification requirements of 453 2. Is the facility occupied? l�_a.Yes 1 b.No CMR 6.12 3. Is this a fee exempt notification (city,town, district, municipal housing authority, state facility, or owner-occupied residential property of four units or less)? ry a.Yes ly b.No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval IQ# Form To: Commonwealth of Massachusetts 6.Asbestos Contractor: P.O.Box 4062 86 CAROLAN AVE Boston,MA 02211 E&FENVIRONMENTAL SERVICES LLC b.Address a Name HAMPTON Ni 03842 6032345581 C.Corrown d.State e.Zip Code f."telephone AC000767 h.Contract Type: JV 1.Written F 2.Verbal g.OLS License# 7 GUILLERMO A MARGARiN FRIAS AS060373 a.Name of Contractor's Onsite Supervisor/Foreman b.DLS Certification# NIA 8.a.Name of Project Monitor b.DLS Certification# 9. ASBESTOS NOTIFICATION LABORATORY AA00208 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 1012612096 10128/2016 a.Project Start Dale{MMIDDIYYYY) b.End Date(MMIDDNYYY) 7-330 NIA e.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11.What type of project is this? Jw a.Demolition F- b.Renovation r- c.Repair iv— d.Other-Please Specify: REMOVAL - Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection �X100252865 �- BMT AQ 04 (ANF-001) _ Asbestos Project# 4. Asbestos Notification Form r Project Revision r Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): F a.Glove Bag r b.Encapsulation r c.Enclosure.ry d.Disposal Only f- e.Cleanup 1++ f.Full Containment W, g.Other-Please Specify: POLY SOURROUNDING STRUCTURE 13.Job is being conducted: ry a.Indoors 91 b.Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 350 1000 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, c.Transite Pipe Tank Surface Coatings 1.Lin.Ft. 2.Sq.Ft. t.Lin.Ft. 2.Sq.Ft. d.Pipe insulation e.Transite Shingles soo 1.Lin.Ft. 2.Sq.Ft. i.Lin.Ft. 2.Sq.Ft. f.Spray-On Fireproofing, g.Transite Panels 1.Lin.Ft_ 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. h.Cloths,Woven Fabrics i.Other-Please Specify: 1.Lin.Ft. 2.Sq.Ft. j.Insulating,Cement FLOOR TILE I MASTIC WINDO 350 200 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.5q.Ft. 15.Describe the decontamination system(s)to be used: FULLCONTAINMENr POLY SURROUNDING STRUCTURE 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g)• ALLMEfHODS WILL COMPLY 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: a.Name of MassDEP Official b.Tide of MassDEP Official c.Date of Authorization(MMl001YYYY) d.Waiver# e.Name of OLS Official f.Title of DLS Official g.Date of Authorization(MMIDDlYYYY) h.Waiver# . 18.Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to this 1J a.Yes 1✓ b.No project? Revised: 11/13/2013 Page 2 of 4 Massachusetts Department of Environmental Protection Asbestos tp252g65 �� BWP AQ 04 (ANF-001} _-- Pro ...� jP�-aeGt# Asbestos Notification Form I Project Revision +. r Project Cancellation & Facility Description 1.Current or prior use of facility: RESIDENCE 2.Is the facility owner-occupied residential with 4 units or less? W a.Yes 1— b.No MARK RAE 66 LONGWOOD AVENUE 3.a.Facility Owner Name b.Address NORTH ANDOVER MA 01845 5085099430 c.City/Town d.State e.Zip Code f.Telephone 4 NIA NIA a.Name of Facility Owner's Onsite Manager b.Address NIA MA 00000 0000000000 c.Cityfrown d.state e.zip Code f.Telephone NIA N/A 54 Name of General Contractor b.Address NIA MA 00000 0000900000 c.City/Town d.State e.Zip Code f.Telephone LIBERTY MUTUAL INSURANCE g.Contractor's Worker's Compensation Insurer 000009 42/43/2046 00 *.. h.000cy# i.Expiration Date(MMIDDIYYYY) (Ili4200 4 6.What is the size of this facility? a.Square Feet b.#of Floors C.Asbestos Transportation & Disposal 1.Transporter of asbestos-containing waste material from site of generation: r a.Directly to Landfill or re- b.To Temporary Storage Location/Transfer Station E&F ENMRONMENTALSERVICES IlC 86 CAROLAN AVENUE c.Name of Transporter d.Address Note:Temporary MPTON NH Q3842 6039742503 storage of Asbestos containing waste e.Cily/rown f.State g.Zip Code h.Telephone material is only allowed at the place of business of a DLS 2,If a temporary storage location/transfer station is used,list name of transporter of asbestos containing licensed Asbestos waste material frnm temporary storage locationitransfer station to final is site: contractor or a transfer station that is 58 PYLES LANE permitted by SEPVICETRANSPORT GROUP,INC. MassDEP and a.Name of Transporter b.Address operated in EE 19720 8770899559 compliance with Solid NEVrASTLE Waste Regulations c,City/Town d.State e.Zip Code f.Telephone 310 CMR 19.000 Page 3 of 4 Revised: 11/13/2013 Massachusetts Department of Environmental Protection ------—--- .. BWP AQ 04 (ANF-001) 1100252865 _ Asbestos Project# , t Asbestos Notification Form r Project Revision ' l— Project Cancellation C.Asbestos Transportation&Disposal: (cont) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material, N1A NIA a.Temporary Storage Location Name b.Address NIA MA 00000 0000000000 C.City/Town d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA LANDFILL NIA a.Final Disposal Site Name b.Final Disposal Site Owner Name 9000 MINERVA ROAD c.Address WAYNESBURG CH 44688 3308663435 d.City/Town e.State t Zip Code g.Telephone A Certification FRANKSALOGH FRANKSALOGH "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am OMER 1Oil 312016 familiar with the information contained in this document and 3.Positionffitte 4.Date(MMloD1YYYY) Note:Contractor must 6039742016 E&F ENVIRO sign this form for DLS all attachments and that, based notification purposes on my inquiry of those S.Telephone 6.Representing individuals immediately 86CAROLANAVENUE HAMPTON responsible for obtaining the 7.Address 8.City/Town information,l believe that the M4 03842 information is true,accurate,and 8.State 10.Zip Code complete. I am aware that there are significant penalties for submitting false information, including possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." a Revised: 11/13/2013 Page 4 of 4 BELFO-1 OP ID: KM ACORO" 7-10E(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE !2712016 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(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 endorsement(s). PRODUCER CONTACTEPeter J.Lennon,CPCU Lennon Insurance Agency,Inc. PHONE FAX �� 629 Main Street _cAfC.No.Ext):781-937-0050 AIC No),,-181-1333-8198 E-MPost Office Box 232 Ao aE$S: m lennon tennoninsurance.co Woburn,MA 09801-0332 @ Peter J.Lennon,CPCU INSURER S AFFORDING COVERAGE NAIL# INSURER A:Lloyds Of London INSURED Belford Construction,Inc. rNSURERB: Mark Rae INSURER C: 130 Marbleridge Road --- North Andover,MA 01845 INSURERD: INSURER E: INSURER 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !NSR I TYPE OF INSURANCE B POLICY NUMBER -- MWDR EFF MM DD EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,()00,00 CLAIMS-MADE OCCUR XSZ74817 10!0712076 10/07/2077 PREMISES Ea occurrence $ 5(),00 MED EXP(Any one person) $ EXC PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY F—I SE'T F—]LOC PRODUCTS-COMPIOP AGG $ EXC OTHER: Ded. $ 50 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accid_eni ANY AUTO BODILY INJURY(Per person) $ T ALLOWNED SCHEDULED BODILY INJURY(Per acoident) $ AUTOS AUTOS - NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccidenl $ UMBRELLA LIAROCCUR EACH OCCURRENCE $ d EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION AND EMPLOYERS`LIABILITY YIN STATUTE EH R ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ A BUILDING-COMPL VAL XSZ74817 10107/2016 10/07/2017 BUILDING 300,00 DED, 2,50 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 191,Additional Remarks Schedule,may be atlechW if more space Is regalred) 66 Longwood Ave North Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION TOWNNAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 1600 Osgood Street Bid 20 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE Peter J.Lennon,CPCU ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered(narks of ACORD Massachusetts Department of Public Safety r' ,.Board of Building Regulations and Standards License: CS-014997 Construction Supervisor MARK F RAE 130 MARBLERIDGE RD;' NORTH ANDOVER MA .01845 ! f Expiration: Commissioner 0412412018 . .- �'����'urtrtttntrtrrertl/�n/nF'Crr��rtc•�r%lr//a..7 -Office of Consumer Affairs&Business Regulation { - lOME IMPROVEMENT CONTRACTOR j I egistration: 106025 Type: I t� Expiration =4119/2018; Corporation !. BELFORD CONSTRUCTION INC. ` Mark Rae 55 MARBLERIDGE RD. I' N.ANDOVER,MA 01845 Undersecretary f