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HomeMy WebLinkAboutBuilding Permit #002-2011 - 127 Main Street 7/1/2010 BUILDING PERMIT of NORTy ��. O TOWN OF NORTH ANDOVER L - APPLICATION FOR PLAN EXAMINATION �2 - 20 Permit NO: // * "`~°~•` Date Received ��SSArap CHUS���� Date Issued: 7 FAA#4 IMPORTANT:Applicant must complete all items on this page 'LOCATION t o 7 t a Q ed Print PROPERTY OWNER Print MAP 210 2g -PARCEL: '18 DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration X No. of units: Commercial X Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain, Wetlands Watershed District Water/Sewer K DESCRIPTION OF WORK TO BE PREFORMED: ADAC o �� ���.�cQ. Sal , nle..�Ca.a� leek yQr's"h- 4 - Identification Please Type or Print Clearly) by , OWNER: Name: S Pho e. 3 Address: ?. d. O d2ou o ti CONTRACTOR Name: mA��z l.� �,s . C Phone: &o s-88a- Address: -.6 Cew.�ess � AS�nv.•� Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: . ARCHITECT/ENGINEER �tN—T�cr�; �S Phone: cc3 e5a�- Y3Sa Address: 3 Sq rip„t,., k Spkery\, nt N c�-5ep>et Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 538, cx>a .00 FEE: $ Check No.: y�2�� Receipt No.: NOTE: Persons contracting ith n egistered contractors do not have access to the guaranty fund Signature of Agent/Ovvnerf nature of contractor A 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 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 Temp.Dumpste on sit es no _ Located at 124 Main Street y 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 2010 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:Building Permit Revised 2008 MAPLE LEAF CONSTRUCTION COMPANY INC. BILL FRANCOEUR PROJECT MANAGER/ ESTIMATOR 5 CONGRESS ST. NASHUA,NH 03062 603 882-7498 FAX 603 595-8688 VV'Francoeur@mlccine.com Location No. �QZ — 2 ev Date Of NOR74 TOWN OF NORTH ANDOVER F 9 . • i ; Certificate of Occupancy $ G� �ss,KMust<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 6s- 230 .' ', ,%, s-230 ::; Building Inspector IN1assacbuscits- Department of Public Safct% j Board of Building, Regulations and Standard j Construction Supervisor License j License: CS 56615 Restricted to: 00 WILLIAM W FRANCOEUR 3 MITCHELL ST NASHUA, NH 03060 Expiration: 5/23/2011 ( nnmis�i user TO: 16139 1 ACORDr. CERTIFICATE OF LIABILITY INSURANCE DATE 25201201/ /YYYY) 6 0 PRODUCER Phone: 603-882-2766 Fax: 603-886-4230 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eaton & Berube Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 11 Concord St. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Nashua NH 03060 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:ACadla Insurance Company Maple-Leaf Construction Co. , Inc. INSURER B: P.O. Box 443 Nashua NH 03061 INSURER C: INSURER 0: 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 D' R INSR TYPFOFINSURANCF POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMBS A X GENERAL LIABILITY CPA150054321 4/1/2010 4/1/2011 EACH OCCURRENCE $1, 000,000 X COMMERCIAL GENERAL LIABILITY PREMISESEaoccurence $25O O00 CLAIMS MADE �OCCUR MED EXP(Any one person) PERSONAL&ADV INJURY S1,000,000 GENERAL AGGREGATE $2 0 0 0, 0.00 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000.QQQ POLICY F I PRa LOC A X AUTOMOBILE LIABILITY CAA15 0 0 5 4 4 21 4/1/2010 4/l/2011 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per person) I$ X HIREDAUTOS BODILYINJURY $ X NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTOONLY: AGG.$ A 'EXCESS/UMBRELLA LIABILITY CUA15 0 0 5 4 5 21 4/1/2010 4/1/2011 EACH OCCURRENCE $9, 00 Q 1000 X OCCUR u CLAIMS MADE AGGREGATE $9,000,000 $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WPA150054621 4/1/2010 4/1/2011 }{ WE STATU_ oTH- EMPLOYERS'LIABILITYTORY LITS 1 1 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500, 000 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$500, 000 A OTHER CPP150054322 4/1/2010 '4/1/2011 Leased Equipment $100,000 Inland Marine DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS o Executive Officers or Members are excluded from Workers Compensation coverage. States covered: MA & NH. own of North Andover, Mass. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Town Of North Andover BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 1600 Osgood Street, Bulding 20, Suite 2-36 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO North Andover MA 01845 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 i 0 DUBOIS 0 ENGINEERING 0 ASSOCIATES, INC. CONSULTING ENGINEERS STRUCTURAL, o FORENSIC CONSTRUCTION CONTROL AFFIDAVIT Project Name: Building"G"Renovations A-First&Main Marketplace Project Location: 109-123 Main Street Date: June 23,2010 North Andover, MA Project Description: Renovations of the Existing Buildinq"G"Ccs First&Main Marketplace IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUILDING CODE, I, Dale A. Dubois, Registration No. 36907-ST BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY 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. PURSUANT TO SECTION 116.2.3, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE STATE BUILDING INSPECTOR. THESE INSPECTIONS WILL BE CONCERNING: ENTIRE PROJECT[ ] ARCHITECTURAL[ ] STRUCTURAL[X ] MECHANICAL[ ] FIRE PROTECTION[ ] ELECTRICAL [ ] OTHER(specify) [ ] UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL STRUCTURAL REPORT AS TO THE SATISFACTORY COMPLETION AND REDINESS OF THE PROJECT FOR OCCUPANCY. OF oma' DALE A. yG DUI301S SIGNATURE PE SEAL: STRUCTURAL to No.3eW Ss��f1AL S SCRIBED D O BEFORE ME THIS 23rd DAY OF June,2010. NOTARY NOTARY SEAL: MY COMMISSION EXPIRES PATRICIA A.LEDOUX otary Public-New Hampshire 117 HARRISON STREET, MANCHESTER, NH 03104-3642 o (603) 666-0900 o FAX (603) 669-0900 t t, • - A 7;;;;•:.. '1 CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER PROJECT TITLE BUILDING"G" RENOVATIONS PROJECT LOCATION FIRST&MAIN MARKETPLACE 109-123 MAIN ST—NORTH ANDOVER, MA NAME OF BUILDING BUILDING"G" SCOPE OF PROJECT HVAC, PLUMBING& FIRE PROTECTION(PERFORMANCE ONLY) In accordance with Massachusetts State Building Code, John Panitsas Registration No. 32439 (HVAC), Plumbing (38945) being a Registered Professional Engineer, hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ENTIRE PROJECT ° ARCHITECTURAL ° STRUCTURAL ° HVAC • FIRE PROTECTION • ELECTRICAL ° PLUMBING • OTHER (Specify): ° for the above named project and that, to my knowledge, such plans, computations and specifications have met the applicable provisions of the Massachusetts State Building Code and all acceptable engineering practices for the proposed project. I further certify that I, or my designated representative, will perform the necessary professional services and will be present on the construction site on a regular and periodic basis to determine that the work will proceed in accordance with the following as specified: 1.Review, for conformance to the design concept, shop drawings, samples and other submittals, which are submitted by the contractor in accordance with the requirements of the construction documents. 2.Review and approval of the quality control procedures for all code-required controlled materials. 3.13e present at intervals appropriate to the stage of constructi 6 eneral i with the progress and quality of the work and to dete being performed in a manner consistent with the cons n Upon completion of the work, I herewith submit a final re completion and readiness of the project for occupancy. gnatur On this 21s` day of June, 2010, before me, Michael Moloney, the undersigned notary public, personally appeared John Panitsas, proved to me through satisfactory evidence of identification, which was"PERSONAL KNOWLEDGE OF IDENTITY", to be the person whose name is signed on the document, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his knowledge and belief. f��������ewne�auuu��ueeeeueuu� MICHAEL F MOLONEY l ' - _ �iNotary Public (official signature and seal of nota Commonweaof Massachusetts ✓ Wh y Commission Expires September 16,2016 My commission expires September 16, 2016 """" °°°°°°°°°°` Commonwealth of Massachusetts In the County of. . NORFOLK i � � • %�,�' .. _ ��' � ' �• � ' � { THE COMMONWEALTH OF MASSACHUSETTS STATE BUILDING CODE CONSTRUCTION CONTROL AFFIDAVIT On this 23rd day of June. 2010 A.D. before me, for the State of New Hampshire, personally appeared Richard E. Landry who, being duly sworn, deposed and says that he is registered to practice Architecture in the Commonwealth of Massachusetts and that he has supervised the preparation of all design plans and construction documents for the Renovations to Bldg "G" at First and Main Marketplace 109-123 Main Street North Andover MA and that such plans conform to the applicable provisions of the Massachusetts State Building Code (7 edition), the National Fire Protection Association and that the materials specified for use in the construction conform with the Controlled Construction Procedure therein defined (Section 116); and that a professionally qualified representative of his office will administer the Construction Contract, and that he will make regular and periodic visits to the construction site and prepare written progress reports of said visits to be sent to the permit granting authority to determine that the construction is proceeding in accordance with the approved plans, and that he will inform the Owner and the permit granting authority of any observed tions from the approved plans or applicable codes. �\S.,EAED AR�y�l p No.4496 ?, (Registrati o.)44 6 WINDHAM, v' O N.H. V q�TH OF MPSgP SUBSCRIBED AND SWORN TO BEFORE ME THIS 23rd DAY OF June,2010 A.D. My Commission Expires Z Z✓ (Not c) r •> r�� I �.. ,i, `t.. � � �� L. 1 y �. 'f� Construction Control Affidavit PROJECT NUMBER PROJECT TITLE Building "G" Renovations PROJECT LOCATION First&Main Marketplace 109-123 Main Street North Andover, MA NAME OF BUILDING Building "G" NATURE OF PROJECT Interior Renovations IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUILDING CODE, I, Lawrence A. Farrer Registration No. 30388 BEING A REGISTERED ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ELECTRICAL 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 ACCEPTABLE ENGINEERING PRACTICES AND ALL 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 116.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for 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 if critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix A. PURSUANT TO SECTION 116.2.2.3, [ SHALL SUBMIT PERIODICALLY,A PROGRESS REPORT TOGETH + COMMENTS TO THE BUILDING INSPECTOR. C+y LAWRENCS G� UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPO AS TOT S O PLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. " FARRER 30388 Signature '� �t���. �G)VAL ENG NX\ j�� SUBSCRIBE AND SWORN TO BEFORE ME THIS \�� ;R/1 e,2010 �P-��\SS� Ffi° My Commission Expires t AAj LN: = tember 6,2013 N RY PUBLIC MY N EXPIRES '•yOT1�v 915 �vo� ZZ ��tl/fIFIfI h