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HomeMy WebLinkAboutBuilding Permit #274 - 108 MAIN STREET 10/17/2007 BUILDING PERMIT Otr►ORTh ttOR A TOWN OF NORTH ANDOVER o? b ` »� o°, APPLICATION FOR PLAN EXAMINATION 70 Permit N0: rJ Date Received 'li °NAreD Xrh �SSACHU`+�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 109 Main STREET Pnnt PROPERTY OWNER TD Bank.North Print MAP NO 29 PARCEL?1 ZONING DISTRICT: Historic District yes no Machine5fio.p 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 xxx Repair, replacement xxx Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Interior renovation including new floor covering,paint and millwork Identification ease Type or Print Clearly) OWNER: Name: TD Bank North Phone: 978-556-4834 Address: 2 Saber Way Ward Hill MA 01835 CONTRACTOR" Name: JBR Associates LLC Phone:; 603-57.9-98.90 _Address:: 10 Northern Blvd Unit 16 Amherst NH 03011 'Supervisor's Construction License:. 0024$0 Exp..' Date:. . 8/18/.2009. Home mprovement License NA Exp. Date: ARCHITECT/ENGINEER None 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: $ 34,800.00 (millwork only) FEE: $_ 0 Check No.: 003685 Receipt No.: Dy-4 o o NOTE: Persons contract: g with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ow r' Signature of contractor 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 I I DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Si nature&Date Dfivewav Permit Located at 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at'124.Main Street Fire Department Signature/date COMMENTS 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 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 2.2007 Location O 4 MGI (ti 5- t No. t Date "T NaRTM TOWN OF NORTH ANDOVER F � A * ; ; Certificate of Occupancy $ sACM�s t�' Building/Frame Permit Fee $ � — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # . tGU J 20 ? Lu Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 sY www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly N2TT12 (Business/Organization/Individual): J� -1�sT5 Address: �-t p R�(i�( City/State/Zip: 1���� Phone #: (9 CD 25-79 0 re you an employer? Check the appropria e b XV-f- Type of project(required): 1. I am a employer with 0 4;9,1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12,❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#] must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers' comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: —110 t= \ a L' K3 C, Policy#or Self-ins. Lic.#: (�--PA o �j�j�j� Expiration Date: (o/c I /Op, Job Site Address: / 0 V City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby under the pains and penalties of perjury that the information provided above is true and correct. Si nature: ` Date: l G 7 /6 7 Phone#: U Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ACO!��M CERTIFICATE OF LIABILITY INSURANCE 10102/2 07 PRODUCER (603)669-0704 FAX (603)669-6831 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Infantine Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 5125 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manchester, NH 03108 Kathy Pettit INSURERS AFFORDING COVERAGE NAIC# INSURED JBR Associates, LLC INSURERA: Acadia Insurance Co. 31325 10 Northern Blvd. , Unit 16 INSURER B: Amherst, NH 03031 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.NOTWITHSTANDINI ANY REQUIREM=ivT,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' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLTR INSR LIMITS GENERAL LIABILITY CPA013332113 10/01/2007 10/01/2008 EACH OCCURRENCE $ 1'000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 250,000 CLAIMS MADE I OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1'.000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY f7 PRO- JECT LOC AUTOMOBILE LIABILITY CAA013332213 10/01/2007 10/01/2008 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ A SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGELIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 –R-1 OCCUR FICLAIMS MADE CUA019771911 10/01/2007 10/01/2008 AGGREGATE $ 1,000,000 A $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCA016215412 10/01/2007 10/01/2008 X I WC STATU- I JOTH- EMPLOYERS'LIABILITY — A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS E: Various Work throughout the policy term. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 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, TDBankNorth, N.A. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 2 Saber Way OF ANY KIND UPO SURER,ITS AGENTS OR REPRESENTATIVES. Wardhill , MA AUTHORIZED REPR ENT T ELuk ACORD 25(2001/08) ©ACORD CORPORATION 1988 NORT#q 0 of over No. 0 . ......... .... C' o , �` dower, Mass., Ial ' 1" LAKE A. O COCMICMEWICK V ADRATED pPa��S `s U BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT..... .......... IA. ...... . ... .................................................................... Foundation has permission to erect........................................ buildings on -1.01V..... ..... 4.1-A........C.�...�...................... Rough to be occupied as..... .1. ...... w r............�.w ... . ..��..�......� Chimney provided that the person 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 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 qjj PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI TS ELECTRICAL INSPECTOR Rough . Service BUILDING INSPECTOR 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. `�` ✓lie �anYrizooeuredl�t o��/e�ac`ivaeka Board of Building Regulations and Standards Construction Supervisor License Licensed CS 2480 Birthdatee_'8/.18/1947 i r Expiratioh; 8/18/2009 Tr# 1049 Restriction 00 JOHN W REED 17 MONT VERNON RD.. AMHERST,NH 03031 Commissioner NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 108 Main Street is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws:Chapter 148 Section 10A. The debris will be disposed of in: Epping NH Epping ,Recyc1;ng (Location of Facility) Signature of -mit Applicant Fire Department Sign off: Dumpster Permit Date JBR Associates LLC SUBCONTRACTOR 7037-005 10 Northern Blvd.Unit 16 PURCHASE ORDER SHOW THIS NUMBER ON Amherst,NH 03031 ''' "• ' • Phone:(603)679.9890 SHIPPING PAPERS Fax:(603)679-9891 PACKAGES SUBCONTRACTOR: � JOB NAME AND ADDRESS: Pro Craft Millwork TDBN North Andover Ma TO PO BOX 298 108 Main Street New Boston Nh 03070 North Andover MA Attn: Jim Wilcoxen PURCHASE ORDER DATE SCHEDULED START SUB COMPLETION DATE LSUBMffTAL DUE DATE PURCHASER/PROJECT MANAGER 9/18/2007 10/10/07 10/15/07 NA Jack Reed DESC. .TION OF SERVICES Provide Millwork as per drawings by DRI_Associates Labeld TD Bank North North andover MA tilted T1,EX-1,A-1,A-2,A- 3. Dated 5/29/07&addendum 1 and your quote Please sign on pages one and three and return one copy to this office •- - $34,800.00 •� 7037 0% 7PAYMENTTERMS On or about the 30th day of each month and upon receipt of payment from the project Owner,JBR Associates LLC.shall pay Subcontractors for work completed through the 31 st day of the preceeding month as follows: Total value of labor and materials incorporated by Subcontractor into the work less retainage(if applicable above),plus the value of materials properly stored on the job site fess retainage(if applicable above),less the aggregate of previous payments. THIS ORDER SUBJECT TO THE TERMS AND CONDITIONS ON THE FACE AND BACK HEREOF AUTHORIZED REFER ALL COMMUNICATION REGARDING THIS ORDER To: Jack Reed ack eed SUBCONTRACTOR!AUTHORIZED SIGNATURE/TITLE CONFIRM ORDER: SIGN FIRST(2)PAGES,RETURN(1)PO COPY S��1 • i 1 Printed On: 10/15/07 Page 1 Jul. 20, 2007 10:42AM Procaft No. 1315 P. 1 Architectural Millwork Custom Cabinetry July 20,2007 PKOCKAFT CORPOKATION PO box 296 416 River Road New ftoton, New Hampshire 03070 Website: www,prorraftcorp.com Jack Deed JEW, Associates, LLC 10 Northern Blvd Amherst, NH 03031 VIA BID FAX; 603 579-9891 PI✓: TD 3anknorth Worcester, N. Andover, MA We are pleased to oubmit the following quotation for your review for the above named project, TOTAL FURNISH AND INSTALL N. ANDOVER, MA $34,800. TOTAL FUKN15H AND INSTALL WORCE5TER, MA $30,450, Signed, ame5 ilcoxen President