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HomeMy WebLinkAboutBuilding Permit #006 - 1 HIGH STREET 7/2/2008 BUILDING PERMITo�"°eT "qti TOWN OF NORTH ANDOVER c? 4 '`- *° v APPLICATION FOR PLAN EXAMINATION Permit NO: �6 PPRO ED Date Received Z• Date Issued: IMPORTANT:Applicant must complete all items on this page :LOCATION y 'Print "PROPERTY OWNER > ~°,Print k _ EMAP NO. 'PARCEL ZONING DISTRICT. Historic Distfict ��}res no ��.: Maeliirie S17op Village yes nor, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addi Two or more family Industrial Iterati No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Septic ,Well :Flood lainWetlands Watershed DstndtT T Water/Seaver s01 _ _0 DESCRIPTION OF WORK TO BE PREFORMED: Identification Please T e or Print Clearly) OWNER: Name: Phone: 6 M13 3�'50 Address: aN C � l-4 ��� �✓� A v , CONTRACTORName: rAUC i t,.lh `�. � Pte! 5 ;r3z7 } R.P.hone: Address I EXp DatSupervisor's Coni#ruction;Licrrse: c ? *0�.s R a %Z1 J x ,,Home Im-provement°'L-cense Exp. Date` �• '. ARCHITECT/ENGINEER � AS<c 10(3(7- Phone: V" Z 3-7 4,S Address: 1,;,2 & L�W(zu 154" cam. `v!'0 Reg. No. L002 5- FEE FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ fggo C) FEE: $ = 109RF6 ! V o Check No.: 0 5�111 Receipt No.: 0212 NOTE: Persons contracting with unregistered contractors do not have accg Vsk the guaranty fund igriature .,gen. , Wrier. ti� Gt�Ct •ice Signa#use of°contrad t r h ;,: Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer ``Tanning/Massage/Body Art , A S'wi'm ngP,00ls Well ,'� Tobacco Sale's ' „Food_P_agJkagi_ng/Sales`' --Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT • COMMENTS i CONSERVATION Reviewed on Signature COMMENTS HEALTH ., ti Reviewed on _Signature_ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning.Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments �., , Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street +IRE,'DEPARTMENT -:7emD Dumpster on asite yes _. Lbcated.at 124 Main Stree# Eire Deparfinent ignatureldate 4 ' C MMENTS E Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or,service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use i f ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ' ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit li I, Addition Or Decks 1 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit f New Constructiono Sin le and Two Family) � 9 _ Y) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And.C.S.L. Licenses ❑, Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract g ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit f In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location �� '� ' �� n` No. tl� Date NORTH TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ SAC NUS t� Building/Frame Permit Fee -$� Foundation Permit Fee $ �F Other Permit Fee $ s TOTAL $�/ �� U Check #� 2 ,1296 Building Inspector ✓!p Lrnrr�sxo�zulea� �,�rla�aacl,,cc�.� Board of Building Regulations and Standards t Construction Supervisor License Licen a CS 70708 Birthdate: 2/29/1968 Explr iti zj�g/2009 Tt# 10964 Rest-ictl— DO.' �EDWARD SI 'z 21 R TOW PATH DR WILMINGTON, MA 01887 Commissioner a� a A, CORD CERTIFICATE OF LIABILITY INSURANCE OP IDKG DATE(MM/DD/YYYY) VANTA-1 12/27/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Capstone Insurance LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Suite 230 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Two Newton Place ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Newton MA 02458 Phone: 617-658-7100 Fax: 617-658-7198 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Insurance INSURER B: St. Paul Travelers Vantage Builders, Inc. INSURERC. AIG Insurance Companies John Connor P 281 Winter Street - Suite 340 INSURER D: Waltham MA 02451 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRO TYPE OF INSURANCE POLICYNUMBER DATE(MMR)D/YY) DAM(MM/OD/YY) LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED B X COMMERCIAL GENERAL LIABILITY DTC0463D9837IND07 12/01/07 12/01/08 PREMISES(E.o¢°r ) $ 300,000 CLAIMS MADE FX—]OCCUR _ MEDEXP(Anyoneperson) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S 2,000,000 Poucr PRO- JECT LOc EBL 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 B X ANY AUTO DTA0810463D9849COF07 12/01/07 12/01/08 (Ee sccltlem) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per ecte,M) $ PROPERTY DAMAGE (Per ecutlenq $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ON LY: AGO S EXCESSNMBRELLA LIABILITY EACH OCCURRENCE S 6,000,000 B ]{ OCCUR ❑CLAIMSMADE DTSMCUP463D9580TIL07 12/01/07 12/01/08 AGGREGATE $ 6,000,000 S RX CEO UCTIBLE $ RETENTION $10,000 $ WORKERSCOMPENBATIONAND X WC STATOTH- EMPLOYERS'LIABILITY TORY LIMITSS E0. C ANY PROPRIETORIPARTNER/EXECUTNE WC7224583 12/01/07 12/01/08 E.L.EA CH ACCIDENT & 500,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 11 yes,describe antler SPECIAL PROVISIONS Debw E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER A Domestic Property 08SEAUP3565 12/01/07 12/01/08 BPP 107,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT(SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION PROOFOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUI NG INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BLJT FAILURE TO DO SO SHALL Proof of Coverage IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE -'ACORD 25(2001108) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) i The Commonwealth of Massachusetts .Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 021.11 Workers' Compensation Insurance Affidavit Name: Vantage Builders, Inc. Location: 281 Winter St, Suite 340 City: Waltham, MA 02451 Phone: 781-895-3270 I am a homeowner performing all work myself _I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company Name: Vantage Builders, Inc, Address: 281 Winter St, Suite 340 City: Waltham, AIA 02451 Phone: 781-895-3270 Insurancecompany:Americal International Policy# WC 897-53-90 Group I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation policies: Company Name: Wall Tech Systems Address: 94 River Rd Hudson NH City: Phone: 603--886-8797 . i InsuranceCompany: Travlers Ins. Policy# WC731S225190024 Company Name: Plunkett Painting. 11 Jackson St Address: City: Hopkinton, AIA 01748 phone: 508-435-5234 Insurance Company: Policy#1 Travlers Ins. VB-7528A77-5-04 Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me.I understand that a copy ofthis statement may be fonvarded to the Office of Investigation of the DIA for coverage vcrification. 1 do hereby cerltfy under the pain and penalties ofperjury that the injormation provided above is true and correct. Signature: Date: Print Name: Phone# Official Use Onlyl, Do not write in this area,to be completed by City or Town Official City or Town: PermittLicense# Contact Person:BUILDING,PLOMBNG,ELECTRICAL INSPECTOR Phone 4 781—794—8071 CONSTRUCTION CONTROL AFFIDAVIT PROJECT LOCATION: One High Street,North Andover MA PROJECT NAME: New Exterior Awnings for Converse Inc. NATURE OF PROJECT: New Construction of awnings at 2 existing side entrances. ARCHITECT: Siemasko+Verbridge,Inc. ADDRESS: 126 Dodge Street,Beverly,MA 01915 TELEPHONE: 978-927-3745 In accordance with Section 110 and 116.0 of the Massachusetts State Building Code, I,Thaddeus S Siemasko,Registration No. 6028,being a registered professional Architect,hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning, ARCHITECTURAL,for the above named project and that,to the best of my knowledge,such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,all accepted engineering practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2. 1. Review of shop drawings,samples and other submittals of the contractor as required by the construction contract documents as submitted for the building permit,and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code required controlled materials. 3. Special architectural or engineering professional inspection of critical .construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix G. Pursuant to Section 116.2.2,I shall submit an affidavit at completion of rough framing and final inspection together with pertinent comments to the Town of North Andover Building Department. i .i.ai, Current"Converse A-nings\200? 5 9 Cons:..recti r: __ -- retro Z�t idavit.d,o,,- Upon completion of the work,Architect, and/or Engineers, shall submit final affidavits as to the satisfactory completion and readiness of the project for occupancy. X,S' at-ure Then personally appeared the above named� � Q/�jj/ nd made oath that the above statement by him is true. I TARA KATHLEEN HURLEY *l Notts.ry Public Commonwrea'-h of Massachusetts My Commission Expires I February 15, 2013 Before Me, �a a ~ aevLy o Ir MA ' I \ t,-s fs3\Current. Projects\Commercial, Current\Converse Awri*:gs\2008_5_9_;:o_.structi,.1 Control Afiidavit.doc `lp'NYAG F BUILDERS, INC. Job Proposal For: Scott Fairbanks Global Facilities Manager Converse One High Street North Andover MA Job Name: Converse Exterior Awnings Date: 20-May-08 To Provide All labor, material,equipment,and associated fees for all items as defined per Siemasko&Verbridge Drawings Dated 5/6/2008: Scope of Work: Modify exsting brick walls at both sides Entrances along High Street Parking Lot Side entrance and front end entrance Modify exsisting adjacent groundscape as required for new 7'-1" brick wall New Linear Drain at door New brick post with Granite Tops Eithier Side of walk as shown New Metal awnin with supports as shown Verify materilas in field to match existing Front entry Awning New Overhead outdoor light as shown Subtotal Fee Total Job $85,000 Qualifications 1. No money has been allocated for Architectural or engineering. 2. No money has been allocated for unforeseen site conditions. 3. No money has been allocated for hazardous material removal T BUILDERS, INC. Approved by: Joe M ggiore, P antage Builders, Inc Scott air ank Converse Somerset Court,281 Winter St.,Suite 340,Waltham,MA 02451 Phone 781-895-327o Fax 781-895-3271 Online www.vb-inc.com V4ORTH TO" of . Andover I O +gar�w�.,• '�4� ,f �•� In No. 004 ]( CN o . '� dower, 1Viass., Q LAKE COCHICHE WICK �,q A°RAre° PP���S S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING .INSPECTOR THISCERTIFIES THAT.............�5^'C:.11 !4�.<.:� .�....1..:.:. c..:..................................... .................................................. Foundation has permission ;o erect........................................ buildings on ..... 1............-��................................... Rough to be occupied as 1 !: ... rGF ra/ {l!� Chimney .......................... ............ provided that the person accepting this,-permit shall in every respect confor 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service BUIL 6TSPECTOR 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.