Loading...
HomeMy WebLinkAboutBuilding Permit #805 - 100 ANDOVER BY-PASS 6/11/2010 BUILDING PERMIT 01* TAORT" qti TOWN OF NORTH ANDOVER "' `-`6'° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received + _ ��SSACHUS S� Date Issued: '� v IMPORTANT:Applicant must �complete all items on this page LOCATION (OO NWZ Od e-IL B4 -C.b.$s Pnn PROPERTY OWNER iS 1�ej• Print MAP 210 PARCEL:_ZONING DISTRICT: Historic District yes !Machine Shop Village yes (no 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: VooDemolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 'D SYL !?LOOS Q IN !T3�E' 'i1-kLop '�L,cotZ Identification Please T e or Print Clearly) OWNER: Name: I ( tr Phone: Address: i CONTRACTOR Name: Cbfx- 19 t�.n tnn A Phone: Address: '2ew �Pv�v a • � 'k... i "4 , Supervisor's Construction License: O O S 1 l Z Exp. Date: Home Improvement License: Exp. Date: j i ARCH ITECT/ENGINEERC&t_ &,t it �,c5 t��.► Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ log ow FEE: $ x/20 Check No.: 14 3 ReceiptNo.: NOTE: Persons contracting with unregistered contractors do not haveacc ss to the guaranty Signature of Agent/Owner Signature of contractor �1 s Location No. Date ` / 0 A NORTp TOWN OF NORTH ANDOVER A Certificate of Occupancy $ s�cMUsE�� Building/Frame Permit Fee $ v Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1-44j- 232b7 -� 232b7 Building Inspector OELECTRICAL FINAL AFFIDAVIT Permit No.: To the Commissioner, Inspectional Service Department: RE: 100 Andover Bypass I certify that I, or my authorized representative, have inspected the work associated with Permit No. dated, locus, and that to the best of my knowledge, information, and belief the work has been done in conformance with the permit and plans approved by the Inspection Department and with the provisions of the Massachusetts State Building Code and all other pertinent laws and ordinances. I Daniel A. Hurley, P. E. - MA Lic.#41825 gA OF,/Vq 90 Engineer- Mass. Reg. No. DANIELA. yN Fitzemeyer&Tocci Associates, Inc. a HURL Y rn., Company ELEC AL a 25 92 Montvale Ave Suite 4100, Stoneham, MA 02180 Address 3� NHL (781)481-0210 Phone (Registration Stamp) Signature: Date: Z Ulf 2 Here pers ally appear d the above-na Daniel A. Hurley, P.E and made oath that the a ove statement by him is true. Before me, VL(11 Diane K. Gentile, Notary Public *• �* My commission expires May 05, 2017 orn before me at Stoneham, Middlesex • � ounty, Massachusetts, this, the 21st day of eptember, 2010. (tel � O >ALDAROLA DESIGN A S S OC I A T E S P C Architecture ❑ Interior Design September 22,2010 i To: Mr. Gerald Brown,Inspector of Buildings Town of North Andover 1600 Osgood Street North Andover,MA 01845 i Re: 100 Andover Bypass—Third Floor i Winchester Hospital OB/GYN Women's Care Architect's Project No.: 4309 Dear Mr. Brown, Based on the site visit of September 22, 2010 and weekly meetings at the site throughout O construction,to the best of my knowledge,belief and understanding,the above referenced project is substantially complete and in accordance with the approved construction documents. Thank you for your assistance with this project. Sincerely, y E O A Joseph V. Caldarola,AIA CJ��w. No.7728 aLONDONDERRY, h Cc: Robby Robertson(Winchester Hospital) .o^ NH J� Of 0 0 0 4 Birch Street, Derry, NH 03038 (603)432-8404 (fax)432-2706 ORTH Town of And 01&No. . 7- dover, Mass. l • T O -- LAKE co HICHeWICK 7�Soo ATE D p` � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 0 BUILDING INSPECTOR THIS CERTIFIES THAT...........M 1...... .... .. .............. ........... ........ .... Foundation has permission to erect........................................ buildings on.... Va.. ... ......... Rough { l t0 be occupied as......�..,.. ........ u ................................................... ........... Chimney provided that the per ccepting 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 Inspection, Alteration and Construction of E� Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 1@v 900PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUC '1' ELECTRICAL INSPECTOR Rough i ....... ............................................................... .:..:.:.:.: Service BUILDING INSPECT R 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. -7 ACOR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) I 8 1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mathias Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 200 Sutton Street, Suite 160 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, MA 01845 978-688-5531 INSURERS AFFORDING COVERAGE NAIC# INSURED (Cast Builders Inc. INSURER A: Max Specialty Insurance Company 200 Sutton Street INSURER B: Hartford Underwriters Insurance Company North Andover, MA 01845 INSURER C: INSURER D: 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 DDT POLICY EFFECTIVE POLICY EXPIRATION i LTR NSRD TYPE OF INSURANCEPOLICY NUMBER DATE MM D DATE MM D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000 }( COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ CLAIMSMADE CI OCCUR MED EXP(Anyone person) $ rj 000 A MaxO13100002883 12/01/09 12/01/10 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,0 RO —1 00 X POLICY PLOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OW N ED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTOONLY-EAACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CICLAIMSMADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND WCSTATU- OTH- EMPLOYERS'LIABILITY TORYLIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBEREXCLUDED? 6S60UB-4102P23-8 12/11/09 12/11/10 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes•describe under SPEC IAL PROVISIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Additional Insured: DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL20 DAYS WRITTEN Dr. Lemonaire's Suite Winchester Hospital NOTICE T THE ERT KATE OLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMP 0 0 ION OR (ABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 100 Andover By-Pass REP NTA North Andover, MA 01845 AUT SE ACORD 25(2001/O8) ©ACORD CORPORATION 1988 I The Comrraonwealth of Massachusetts Department of jndustrial-.accidents Office of Investigations 600 Washing ton Street -"oston, AL4 02111 Workers' CompensationFnsurance A�fida aSs.bov/dna An licant Information vett. guilders/Contractors/Electricians/plumbers Please Print Legibly Name(Business/Organization/Individual): C U Address: 404.7 City/State/Zip: J Pbone#: j Are you employer?Check the appropriate boa: 1. am a employer with 4 Type of project(required): ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired 2•❑ I am a sole proprietor or partner- listed it the subcontractors 6. ❑Neu+construction ship and have no employees These sub-e attached shaver i• Remodeling working for me in an capacity. contractors have 8. ❑Demolition Y P t3'• workers comp.insurance. [No workers'comp.insurance 5. ❑ We are a c required] orporation and its 9• Building❑ addition 3.[1.1 am a homeoumer doin¢all work nOfficers t D have exercised their 1Q•❑Electrical"Pairs per MGL 11. ePaus ar tions myself[No workers'co- right C. 152, I Plumbing repairs or additions insurance required] t § (4);and we have no employees. [No workers' 12•❑Roof repairs �_ comp.insurance required] 13 ❑ Other t�'"t Lhat �=k bot.. mom!aso tui cue rce secec•, op. I�DffiBOWL`3'S who S .. 4.^„^...: �, uhmit this affidavit indi�tinv they ase dc:••�a;; _ ='a• com�� -- +Contractora that checi:th s box m•�, E work and th_hire outside cDsir'tDn z1i ., o� attached au additional shit showing the submit a new arnoavie indi^ name of the sub coaffectocs and their workers'comp Doiicy D�ali nh �ZZEP= t Providing workers'compensaSoR ins urance for my employees. Below is the poficy and job site Insurance Company NTame: Policy#or Self-ins.Lic. Expiration Date: Job Site Address: Ott 0 Attach a copy of the workers'compensation policy declaration page City/StatelZip: _(� L $Q� Failure to secure coverage as required under Section 2 p be(showing the policy number-and expiration date). fine up to$1,500.00 and/or one-year imprisonment as well 152 can lead to the imposition of criminal Of up to$250.00 a da against Penalties in the form of a STOP WORK ORDER�a.fine Y amsi the violator. ra advised that a copy of this sta=nent may be forwarded to the Office of Investitrations of the DIA for insurance coverage verification. I do hereby a under the pains —� Pq� nal o fPelurJ ¢t the inform , Siffiature: n.provided Ove is true and correct '�...y� Phone# ' "• �'�"� _ FOther e only. Do not write in this area, to be completed 1' bJ'city or town official wn: Permit/License# thority(circle one): f Health 2.Building Department 3. Citv/To%,n P ^ Clerk 4.Electrical Ins ector 5.Plumbing b Inspector rson• Phone"- Information an_ d Instructions Massachusetts General Laws chapter 152 requires all employeers to provide wort-rs'compensation for their employees. Pursuant to this statute;an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise;and including the legal representatives of a deceased employer,or the receiver or trastee of an individual,parmershm,association ox-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartmL ents and who resides therein,or the occupant of the dwelling house of another who employs persons to do mainte�ance,construction or repair work on such dwelling house or on the grounds or budding appurtenant thereto shall not be:cause of such.employment be deemed to be an employer." MGL chapter 152,§25C(6)also stats that"every state or lo►cai licensing agency'shall withhold the issuance or renewal of a license or permit to operate a business or to c onstr'uct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, 925C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public workum-til acceptable evidence of comuliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their cmtincate(s)of insurance. Limited Liability Companies(LL,G)or Limited Liability partnerships(LLP)with.no employees other than the members or partners,are not required to carry workers'comp enation in�ce. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit may be suomitted to the Department of Indust2ia1 Accidents for confirmation of insurance coverage. Also be sture to sigh and date the affidavit:. The affidavit should �„ be turned to the city,or to-am that the applin catiofor ^e the Mmt or licensst i : g s bei the Depar�:ent.of nom:Vgrr,.s4.ed,fiat Industrial Acci6ents. Should you have any questions regardi:ab the law'cr ifyou are r..,�red to obtain a worker's' compensation policy,please call the Department ment at the numbe=r listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, 7be Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to*fill in the p=nit/license number which will be used as a reference number..In addition,an applicant that must submit multiple permit/license applications in any given year,nee only submit one affidavit indicating current policy information(if necessary)and under`.`Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office ofInvestigations would IYe to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a calL The Deparimeut'.s address,t--lephone.and.:fmnumber.___. The CQmmOnwealt i Gf Massachusetts. Department of lmdustzial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-8 -N 4SS 4FE Fai T 617-727-7749 R°t�ised 5-26-05 w'V7V;.1na2..Qov/dia. i 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 I NOTES and DATA— (For department use) i I� ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 i Building Department i 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract f o Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit j ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan,And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (if Applicable) a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Departmentrior to issuance e of Bldg Permit I New Construction (Single and Two Family) I a Building Permit Application o Certified Proposed Plot Plan r a 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) a Li 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:Building Permit Revised 2008 41 I I ' 4 • I O PLUMBING FINAL AFFIDAVIT Permit No.: To the Commissioner, Inspectional Service Department: RE: 100 Andover Bypass I certify that I, or my authorized representative, have inspected the work associated with Permit No. , dated , locus, and that to the best of my knowledge, information, and belief the work has been done in conformance with the permit and plans approved by the Inspection Department and with the provisions of the Massachusetts State Building Code and all other pertinent laws and ordinances. Pti�N of 414 Ethan M. Grossman. P. E. - MA Lic.#47606 �. Engineer- Mass. Reg. No. HAN P N Fitzemever&Tocci Associates, Inc. CHANiCAL Company III No.47605 e o s?EP G�,� 92 Montvale Ave Suite 4100, Stoneham, MA 02180 FSSION& Address (781)481-0210 Phone (Registration Stamp) Signature: Date: Here personally appeared the above-named Ethan M. Grossman, P. E., and made oath that the above statement by him is true. Before me, ��I/ • Diane K. entile, Notary Pub i K• . ►i Spew My commission expires May 05, 2017 Sworn before me at Stoneham, Middlesex • unty, Massachusetts, this, the 21St day of September, 2010. II O , s I s FIRE PROTECTION FINAL AFFIDAVIT Permit No.: To the Commissioner, Inspectional Service Department: RE: 100 Andover Bypass I certify that I, or my authorized representative, have inspected the work associated with Permit No. , dated , locus, and that to the best of my knowledge, information, and belief the work has been done in conformance with the permit and plans approved by the Inspection Department and with the provisions of the Massachusetts State Building Code and all other pertinent laws and ordinances. A Ethan M. Grossman. P. E. - MA Lic.#47606 'A OF,�9 �".+ Engineer- Mass. Reg. No. Fitzemeyer&Tocci Associates. Inc. Company Avi=Cd-AMCAL oq o 4 a 92 Montvale Ave Suite 4100, Stoneham, MA 02180 � �sTE \taw Address IYAL (781)481-0210 Phone (Registration Stamp) Signature: Date: 2i 10 Here personally appeared the above-named Ethan M. Grossman, P. E., and made oath that the above statement by him is true. Before me, K. *:Nri . Diane K.Pentil , Not ubIli c W0 •!� y commission expires May 617 �:°�.,,�, ••. • orn before me at Stoneham, Middlesex w" $M County, Massachusetts, this, the 21 st day of eptember, 2010. O MECHANICAL FINAL AFFIDAVIT Permit No.: To the Commissioner, Inspectional Service Department: RE: 100 Andover Bypass I certify that I, or my authorized representative, have inspected the work associated with Permit No. , dated , locus , and that to the best of my knowledge, information, and belief the work has been done in conformance with the permit and plans approved by the Inspection Department and with the provisions of the Massachusetts State Building Code and all other pertinent laws and ordinances. Joshua W. Smith, P. E. - MA Lic. #46292 Engineer- Mass. Reg. No. 1N OF f 4,4,S, Engineer JOSHUA W. �yN Com paFitzernen &Tocci Associates. Inc. s WITH m p y MECNICA . v No 4629 92 Montvale Ave Suite 4100, Stoneham, MA 02180 Address a QST mrd (781)481-0210 Phone (Registration S p) Signature: Date: 200-Oso 2� Here per nally appeared the above-named Joshua W. Smith, P. E., and made oath that the above statement by him is true. Before me, ,�oDDa,ne K. Gentile, No i Publ c o• aIWION My commission expires ay 5, *Ile Sworn before me at Stoneham, Middlesex County, Massachusetts, this, the 21 day of • September, 2010.