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HomeMy WebLinkAboutBuilding Permit #215 - 1 HIGH STREET 9/26/2008 BUILDING PERMITo`"°DT 6gti TOWN OF NORTH ANDOVER F?`'. APPLICATION FOR PLAN EXAMINATION Permit NO: 2 it"' Date Received 74��-cmArno h gsSACHU`��� Date Issued: 9A=19 IMPORTANT: Applicant must complete all items on this page ,LOCA TION J PROPERTY OWNER .Is �- Pnnf ,MAP NO: PARCEL: .:ZONING DISTRICT. Historic. P=" yesh a,no _ X11 a°chi a-Shop.Vitlag�e 'yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Add.itaon-- Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic UVell:. Flo©dplain - 1/1/etfands ° t` Watershed District A :F Water Sewery DESCRIPTION OFWORKTO IDEPR FORMED: Identifigation Please Type or Print Clearly) OWNER:- Name: Czq/ CZ�—'C � /'`t� C� � Phone: Address: CONTRACTOR Name % -rPhone: tW � t. r Supervisor's Construction License'. O z Exp. Date: +Home Improvement License,* - Exp, .:Date ARCHITECT/ENGINEER �io� ° / �` sC Phone: i /�f) P7 Address: Z c - ' Reg. No. Z� FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ MO ovo FEE: $ 1X41 V Check No.: O Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to e n u ii nature of�Agent/O nw er y ignature of contractor a i l Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/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 CONSERVATION Reviewed on Signature r COMMENTS HEALTH 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 FIRE DEPARTMENT -Tern p u.mpster on site, yes , no Located°at 1241M6in Street Fire,Departlnerit signature/date' 4 A COMMENTS : � e 997i7 i j 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 h i ❑ 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 i I ❑ 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 Addition Or Decks ❑ 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 New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ 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 ❑ 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 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 1 Location / r No. a Date a 6� TOWN OF NORTH ANDOVER Certificate of Occupancy $ ;�s'•^�E<� Building/Frame Permit Fee $ 3 Z el d �cwus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a _ Check # ©© 21540 Building Inspector CONSTRUCTION CONTROL AFFIDAVIT PROJECT LOCATION: One High Street,North Andover MA 01845 PROJECT NAME: Converse renovation of 4n'and 5`11 Floors NATURE OF PROJECT: 4a'Floor-Interior partition demo to creating two offices and create open space,subdividing existing storage room,and workstation layout modification. 5a'Floor-Creating one new office as well as workstation layout modification. 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 1 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 116.2.2,1 shall submit periodical progress reports together with pertinent comments to the Town of North Andover Building Department. PACommercial,Current\Converse 2008 4th Floor Reno\01 -Billing and Contracts\Construction Control Affidavitdoc Upon completion of the work,the Architect shall submit final affidavits as to the satisfactory completion and readiness of the project for occupancy. /�i'snature Then personally appeared the above named% ,�, �iGo and made oath that the above statement by him is true. Before Me, TARA KATHLEEN HURLER Notary Public AED AR Commonwea"tl; of Massachusetts 5 S. Se'`+5+►� My Corrtmi:sion Expires Q4r c�, February 15, 2013 O RCY, p MA `�rl tk Q F ►�S'C� P:\Commercial,Ctlrrenf\Converse 2008 4th Floor Reno\0l -Billing and Contracts\Construction Control Affidavitdoc *4 N NT��G BUILDERS, INC. Job Proposal For: Converse One High Street, Building 14 N. Andover, MA ATTN: S. Fairbanks Job Name: Converse 4th and 5th floor renovations ( per drawings ) Date: 15-Sep-08 Division 1 General Requirements Permit 1lot 1,500 Dumpsters 1 each 700 General labor/Misc protection Ls 1,500 Supervision 2weeks 2,160 Final Cleanings 1 lot 1,500 General Requirements sub-total $7,360 Division 8 Doors and Windows New 3070 doors 0 5 ea 975 Door hardware 3 ea. 360 Door and hardware install 3 ea. 225 Mullion caps 2 ea. 150 Glass for window openings 175 s.f. 2,675 Doors and Hardware sub-total $2,591 Division 8 : Glass $6,920 Division 9 Finishes Flooring Carpet 380 s/y: Base 600 LF Flooring sub-total NTE $10,000 Drywall New drywall Openings for wall glass supervisors help) Drywall sub-total $15,930 Painting Walls Doors Painting sub-total $5,880 Division : 15 Sprinkler $1,650 Somerset Court,281 Winter St.,Suite 340,Waltham,MA 02451 Phone 781-895-327o Fax 781-895-3271 Online www.vb-inc.com .4NNTAGF BUILDERS, INC. Division 15 Mechanical HVAC Rework existing system for 4 new offices 1 lot HVAC sub-total $2,475 Division 16 Electric Rework existing lighting New light switches New outlets for offices Misc. materials Mics. Unforseen Electric sub-total $13,225 Allowance Sub total 66,031 Fee $3,969 Total job NTE 70,000 � r G mitted fr� r ApproveyMaggiore Scott Fairbanks ect Manager Global Facilties Manager tage Builders Converse ACORD 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. INSURER 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 OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUEDOR 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. INSRD'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MMIDOnrY) LIMITS GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 DAMAGE TO RENTED B 47ERCI LGENERALLIABILITY DTC0463D9837IND07 12/01/07 12/01/08 PREMISES(Es E 300,000 CLAIMS MADE a OCCUR MED EXP(My...person) S 5,000 PERSONALSADV INJURY E 1,000,000 GENERAL AGGREGATE E 2,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMP/OPAGG S 2,000,000 POLICY JEC Loc EBL 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMITE 1,000,000 B R ANY AUTO DTA0810463D9849COF07 12/01/07 12/01/08 CO BIKED ALL OWNED AUTOS BODILY INJURY E SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY E NONOWNEDAUTOS (Peres rn PROPERTY DAMAGE E (Per W.rd) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG E EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE E 6,000,000 B X OCCUR ❑CLAIMS MADE DTSMCUP463D9580TIL07 12/01/07 12/01/08 AGGREGATE E 6,000,000 E DEDUCTIBLE E X RETENTION $10,000 $ WORKERS COMPENSATION AND X WC TORY LIMITS ER STATU- OTER EMPLOYERS'LIABILITY C ANY PR OPRIETOR/PARTNEWEXECUTIVE WC7224583 12/01/07 12/01/08 E.L.EACH ACCIDENT E 500,000 OFFICER/MEMBER EXCLUDED7 E.L.DISEASE-EA EMPLOYEE S 500,000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER A Domestic Property 08SBAUP3565 12/01/07 12/01/08 BPP 107,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION PROOFOF SHOULDANYOFTHEABOVE DESCRIBED POUCHES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO GO SO SHALL Proof of Coverage IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR � REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©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. 02111 jVorkers' 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, MA 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 belovy who have the following workers'compensation policies: Company Name: Wall Tech Systems Address: 94 River Rd City: Hudson, NH Phone: 603-886-8797 Insurance Company: Travlers Ins. Policy# i1C731S225190024 CompanyName. Plunkett Painting. Address: 11 Jackson St City: Hopkinton, MA 01748 Phone: 508-435-5234 Insurance Company: Travlers Ins. Policy# 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 $1,500.00 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 of this statement may be fonvarded to the Office of Investigation of the DIA for coverage verification. 1 do hereby cenfy under the pain and penalties ofperjury that the Information 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: Permit/License# Contact Person:BUILDING,PLUMBNG,ELECTRICAL INSPECTOR Phone 4 7$1—794—8071 i Board of Building Regulations and Standards gConstruction Supervisor License Licen e: CS 70708 B'r rtfadate.; 2%29/1968 Expi afion:! 2/28/2009 Tr# 10964 Restriction;_. b EDWA{RD J SILVA, 21 R TOW PATH DR — WILMINGTON,MA 01887 Commissioner �®RTIy Town 0 : over o � - - - 0 No. M....�...., ti,.?,.. , 91-a LAKE o dover, Mass., COCMICKEWICK V^ 7�A004.r S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ G....... 0:................... ...... GNF....cr��t�,�,-�� ""' Foundation has permission to erect........................................ buildings on ....�%? �.c..... l ..`S� Rough �6�.�t/� <�.sf Chimney to be occupied as.. .... . . . ... ........................................... -' .... ............ .. `.., :J�........:.................. provided that the per§on accepting this permit shall in every respect conform 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 Inspqctlon, Alteration and Constructjon of Buildings in the Town of North Andover. �'v '��� S��`7`®®'�-�l c�`�r�� 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 g Service BUILDING SPECTOR 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.