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Home My WebLink AboutBuilding Permit #646 - 110 SUTTON STREET 4/12/2006 Of NORTH 9ti O ° - p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 9gSgCHUSE'( Permit NO: fJ Date Received: Date Issued: 6 I IMPORTANT: Applicant must complete all items on this page LOCATION S✓TT�l S� C �'1 f �e S /O, Pr 'nt tPROPERTY OWNER /MG✓1 , 10141 Prin MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg XCornmercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED te S 1 rg A , Identification Please Type or Print Clearly) �-s / r � OWNER: Name: P h I A,114 Phone: S S 3 Sign ture Address: IJ a. G ._ 66 CONTRACTOR Name: GUt 11 5", Phone: -7 64- Address: 15 kjktKW PI' o1v A&A Supervisor's Construction License: Z7h 1-7 Z Exp. Date: Home Improvement License: I C7 1�)S?/ Exp. Date: Z-d� ARCHITECT/ENGINEER John PQhySen Name: Phone: 975 Address: >�.,.�1� (CJ joJel AAReg. No. FEE SCHEDULE.BULDINGPEPAla. $10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ a x10.00=FEE:$ 2Z� fr. Check No.: ✓ Receipt No.: Page I of 4 TYPE OF SEWARGE DISPOSAL Swimming Pools 1 El❑ Public Sewer Tanning/Massage/Body Art Well Tobacco Sales ❑ Food Packaging/Sales 11❑ ❑ Permanent Dumpster on Site ❑ Private(septic tank, etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyf nd Signature of Agent/Owner f Signature of Contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stam d Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM ' - DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ i S to Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS R Lti 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 signature&date Temp Dumpster on site yes no- Fire Department signature/date 7.p ; Building Permit Approved and Issued by: Page 2 of 4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 1 ❑ 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Page 4 of 4 s, F Location /4v,I No. Date7 ZZO 1-6 �- NORTq TOWN OF NORTH ANDOVER rt • s • ; , Certificate of Occupancy $ ,, MUSE� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ IY. Check # x " Building Inspector V40RTH Town of .� 4Andover ® No. oq (a �,o LA o dover, Mass.,Ix COCHICMEWICK 00 A T E D 7 BOARD OF HEALTH Food/Kitchen rERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT.......,,. .� .... ........ I�I .��.......�. v�.�.............. Foundation has permission to erect........................................ buildings on .1..I....o.......J'�4.. .. ..Vl�..........r. ................ Rough to be occupied as . �� h d am. Chimney . . . . .. ....... . .. . . . . .. . .. . . . • provided that the person accepting this permit shall in every respect confo the term f 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 CONSTRVITI STARTS 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. 10 April 2006 Ms.Nancy Chippendale Nancy Chippendale's Dance Studios 110 Sutton Street North Andover, MA 01845 Dear Nancy: Thank you very much for the opportunity to work with you again at your dance studios. My estimate to provide the work we have been discussing for the last few weeks is$ 8,600.00. Included in this estimate is the following: Building Permit Demolition and debris removal Framing half height walls and office walls Plywood sheathing on hallway side of half walls Sheetrock on Cafd side of half walls and Office walls Solid core door to Office Fixed glass window in Office Acoustic ceiling in Office Paint Office only Cabinets and countertops in Cafd Plastic laminate wall cap with oak trim on half walls 36"high doors to Cafd and Reception Electrical Heat/AC supply to Office Oak bench seating in Waiting Area "Homework"countertop in Waiting Area Excluded from this estimate is the following: Painting,other than Office Tile and carpet Dressing Room stalls, lockers, etc. If you have any questions,please call at any time. Sincerely yours, Kevin Smith NOTES 0 ~ g cnUar W L W cB � M 0 1. Contractor is to verify all dimensons and conditions and notify (� �° o 0 LU _ architect of variances from plan. 0 m g a 2.All work shall comply with the Mass. State Building Code 6th _ c a *-- _ _ \ _ _ _ _ _ _ _ - Edition and other applicable codes. U U co Z 3. Demolition and removal is to be done in strict compliance with L c Q rn T requirements o I Massachusettsf Town of N.Andover and Commonwealth of 0 z L 1_____--T _ 4. Ceilings and lighting in areas of work to match existing fixtures and systems. LL i I \. 5.All finishes to be approved by owner. OFFICE REC PTION Z ��_--' New wood stud - o I ; ; 7'-5° and diywall I o !' n I I partition shownco I a Existing Ipprtition '= shaded to be removed ' N shown d'abhed Eo f��y�fF q � STOM _ s p 1 3/0 x 6/8 I OMA 3/0 x 3/0 WD stud and �o ""A � y � 3, ,A drywall kneewall 1 �� OF 4A�`SSP4 alig New solid core 36" HT with 3 x 3/ hardwood vene r P-Lam cap gate in wood a frame. I z New solid core U) ' hardwood veneer door in wood ---- I o 0 frame. P-Lam work top o on wd stud and drywall win I - � 9 ' walls(shown ' dashed) I o r i 2'-0" � I d m 14'-0" I Z n O a F— L o H o o fA m Z > c '' I O ri _ - s own sh ded a - - - - Limit of Work —T KEY PLAN Q NOTES o ~ s cn U w L- W pcM 0 1. Contractor is to verify all dimensons and conditions and notify (� o 0 a architect of variances from plan. N 2 L6 \ 2.All work shall comply with the Mass. State Building Code 6th _ CU c > \ _ _ _ _ _ _ - - Edition and other applicable codes. U U co z 3. Demolition and removal is to be done in strict compliance with Q rn i71- / requirements of Town of N.Andover and Commonwealth of O Q Massachusetts. Z 1_______T I 4. Ceilings and lighting in areas of work to match existing fixtures o �� En and systems. U i a I OFFICE ,% RECEPTION ' �\ 5.All finishes to be approved by owner. Z rr New vtood s ud o I ' ' 7'-5" and d all ' i � o _ a 0 I I partition sho n I a Existing �prtition shaded to be rerhoved aP'P I shown dabhed _ I II STOM 3/0 x 6/8 I 'Z . Jy 3/0 x:3/0WD stud and-v� �� ;e drywall kneewall I OF 0 alig New solid core 36" HT with hardwood vene r 3 x 3/ P-Lam cap ' 0 gate in wood ' Q frame. ( z New solid core U) ' hardwood veneer / door in wood coo frame. P-Lam work top I N on wd stud and % I ' drywall wing - u, U walls(shown C dashed) I Q o ca 2'-0" I d 14'-0" Z n O n U is U I I V p w ` � o o (n CU ' Z ' o O c I I - - Renovation area shown` shown sh aded _ Limit of Work T KEY PLAN Q ,t„� The Commonwealth of Alassachuselts Department of Industrial Accidents Office of hivestigations ,;:t �/ 600 Washington Street ' »s Boston,,VM 02111 www.tnass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name l t�uanm s.'t)rzanii.aian;n,div idttaU: �tf�r �✓l')'1 Address: ),3 CityrState/Zip:_Lii, l )4, /Lk A- Pig V3 Phone#: 76 1(5-Z-70 b ar ou an employer?Check the appropriate box: Type of project(required): I. I am a employer with `f• ❑ I am a general contractor and 1 6 ❑ New construction employees(full and ilor part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.= ? Remodeling These sub-contractors have $. ❑ Demolition ship and have no employees working for me in any capacity. workers'comp.insurance. q, ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.El 1 am a homeowner doing all work g P � right of exemption r MGL I I.❑ Plumbing repairs or additions myself.[No workers'comp. c: I52, I(4),and we have no 12.❑ Roof repairs insurance required.]r employees. [No workers' 13.❑Other, comp. insurance required.] \11yapplicant that checks box1 must also rill out the section below showing their workers'compensation policy information. . Al°homeowners who submit this atTidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ('ontractors that check this box must attachcd an additional sheet showing the name orthe sub-contractorsand their workers'comp.policy information. l am an employer tliat is providing workers'compensation insurtrnce fur my employees Below is lite policy and job site injormation. Insurance Company Name:,A� _M , --- --- Policy I or Self-ins. Lie. `#: 'Ag w�� 8�� Z. as Expiration Date:_01 a� _ Job Site Address: go CityiState/Zip:_,&)g. 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 tine 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 tine 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 cert”y under, he pains n enalties of perjury dint the information provide�d/above is true and correct Q c rn,thnc: hate: Officitd use only. Do/,,it write in this urea,to be completed by cit)•or urwn r ffreiaL City or Tow n: Permit/License 9 Issuing authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk -t. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Industries of Massachusetts Mutual Insurance Company Burlington, Massachusetts NCCI NO 26158 (800)876-2765 POLICY NO. I AWC 7006978012005 PRIOR NO. AWC 7006978012004 ITEM 1. The Insured Kevin J.Smith dba Smith Construction Mailing Address: 110 High Street North Andover MA 01845 (No. Street Town or City County Stale Zip Code ® Individual ❑ Partnership ❑ Corporation ❑ Other FEIN 02-4483022 Other workplaces not shown above: 2. The policy period is from06/27/2005 to 06/27/2006 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 10 0,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 eachemployee C. Other States Insurance:Coverage Replaced By Endorsement WC 20 03 06A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$loo Estimated Total Annual of Annual No. Remuneration Remuneration premium INTRA 341091 SEE EXT NSION OF INFORI 4ATION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 755.00 As indicated,interim adjustments of premium shall be made: Deposit Premium $ 779.00 ® Annually ❑ Semi Annually ❑ Quarterty ❑ Monthly MA Assessment Chg. $490.00 x 4.9000% $24.00 This policy,including all endorsements,is hereby countersigned by 06/24/2005 JV Authorized Signature Date GOV GOV I KIND PLACING CLAIM NAME SAFETY STATE I CLASS AUDIT OFFICE OFFICE CHECK GROUP James P Hainsworth Ins Agency MA 15645 12 1704 150 Main Street WC 00 00 01 A(11-88) North Andover,MA 01845 Includes copyrighted material of the National Council on Compensation Insurance, used with its permission- ✓/ �onvmoouuecz/l/ �. Board of Building Regulations and Standards i HOME IMPROVEMENT CONTRACTOR i Registration:N 108511 Exp r,a ion B19/2006 'idual SMITH CONSTRUCT Key r� Smth fil,gh.St 1�� r ✓ I 'N Andover,MA 01845 Adiiiuisf�"a •� -� f �� ...�lLP -C�I4mUI7ZM2l�ICQGLfL ��CI�Lll�6�. -, , BOARD O—'till tGU i License CONSTRUCTION SUPERVSOR „ f Number CS 00174 4 4 . Birthdate03/05/1956 `03/05i2008 :Tr"`no .19�ti7 Restated N ANDOVER M'A `0184 Commissloner� ..: zf 4 = . I ARCHITECT/ENGINEER AFFIDAVIT To the Inspector of Buildings in the Town of North Andover, MA: In accordance with Section 116.2.1 of the Massachusetts State Building Code: I hereby certify,the plans accompanying the attached application concerning the locus of Nancy Chippendale's Dance Studios, 110 Sutton Street, North Andover MA are in accordance with the requirements of the Massachusetts State Building Code,and all other pertinent laws or ordinances, including Architectural Access Board Regulations. (CMR 52 1) 4/07/06 RED ARS John P. Pearson Date ��5�p.Peq �TF� Architect/Engineer- Mass Reg. No.4841 r A , John Pearson Architect B•STON. w 8 Chandler Road o A J`' Andover MA 0 18 10 �Fq�TH Address INSPECTION AFFIDAVIT In accordance with Section 116.2.2 of the Massachusetts State Building Code: I hereby certify that the structure shall be built under my observation as per Section 127.2.2 of the Massachusetts State Building Code,and progress reports (Se tion 127.2.3)will be submitted to the Town of North Andover 4/07/06 ohn . Pearson Date Archi ect- Mass Reg. No.4841 o n Pearson Architect 8 Chandler Road Andover MA 0 18 10 Address Then personally appeared the above named vp�dl pili have made oath that the above statement by him/her is true. re e, Date c My commission expires MARY F. HARRIS NOTARY PUBLIC COMMONWEALTH of MASSACHUSETTS MY COMMISSION EXPIRES DECEMBER 19,2008