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HomeMy WebLinkAboutBuilding Permit #791 - 129 MAIN STREET 6/4/2010 BUILDING PERMIT of "ORTH TOWN OF NORTH ANDOVER or APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 5 27 -J4OogATOO'�"`c5 /l �SSACHUS�� Date Issued: � -- e IMPORTANT:Applicant must complete all items on this page LOCATION 1 C4t vIV ` Cl d f Print PROPERTY OWNER -- ✓*, v Print, . MAP 210PARCEL:_ ZONING DISTRICT Historic District yes no Maclaine Shap Village -yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family I Alteration No. of units: Commercial Repair, repla nAssessory Bldg Others: Demolition e �6 c'e_ Other Septic Well Floodplain Wetlands , Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Ren,�c��' >�c�s'�� 1��,nV.,•• 17a�1%1 , Ce�ove arch r-etO�ace gax% ` ( %-I� rk �a� ReoqC'e �. Jc-.' o � t - i IG 5 �-e!p oc 'A- T--P cell t wl Identification Please Type or Print Clearly) OWNER: Name: e r dv J L '(--UC Pho e: Ell Address: t d cry a S v6 c� - ''V�l d PA- f� OL Sq CONTRACTOR Name; +" '. ihone, Address: cD cry Nort--, ry ,Supervisor's Construction License: Exp. Date: 107 _ 0 � Home Improvement License; t Exp. Date; 1 .C...a- 2-0 1 t ARCHITECT/ENGINEERy►��S �, �ynke L Phon : (D 38-7 92-0 Address:__ � �r l roQ �.. (� �. �c h���� Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ } Lidi Check No.: 4 (� Receipt No.: a NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner 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 ,. •A 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 �/ �Jc,�-.e 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 "Dumpst r on site. yes no - Located at 124 Main Street` Fire.Department4janatureldate 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 LocationlC�z No. Date TOWN OF NORTH ANDOVER • p ' Certificate of Occupancy $ Building/Frame Permit Fee $ n Foundation Permit Fee $ Other Permit Fee $ LIP' TOTAL $ Check # f 232 1 Building Inspector NORTIy Town of � Andover No. J4 I N: 10 dower, Mass., 6y— T 0 LAKE It. COCKICMEWICK V %S RATED iP�,`�� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System " BUILDING INSPECTOR THIS CERTIFIES THAT....... � .............. .. ... ..............�.A 1{�lJr ...................................................................................... Foundation has permission to erect........................................ buildings on ...... . ........................... Rough to be occupied as.. le-to.............. ...... .....7..................... ... 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU OTS 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. viahsacnusetts- vepartrnent of runttc jaietN Board of Buildin!- Rel-ulations and Standard Construction Supervisor License License: CS 81897 Restricted to: 00 GREGORY J NOLAN ^" 13 WOODLAND AVE f KINGSTON, MA 02364 �.., I Expiration: 10/23/2011 Commissioner Tr#: 8798 ,per ✓fie i�om�mzoozcuea��o�✓vGgoaac�iudr.� �\ Board of Building Regulatiohns and Standards HOME IMPROVEMENT CONTRACTOR Registration: 154517 Expiration: 3/15/2011 Tr# 282647 Type: Individual GREGORY J.NOLAN GREGORY NOLAN I 13 WOODLAND AVE. � I KINGSTON,MA 02364 Administrator `{ The Commonwealth of Massachusetts Department o f industrial Accidents Office of investigations 600 YT`ashinbton Street Boston, 1iL4 02111 , Workers' Compensation Insurance Affidavit Builders/Contractors/Electrici A licant Informafon ens/Plumbers PIease Print Legibly Name (Business/Organizatim/Individual): (v1 l UZIL uC`f d,n Address: 0,00 c)S dtA City/State/Zip: m, ✓1dcV,.r �A A kP O t$ phone#: {j I '� � O t 2-1 F2 . Zg employer?Check the appropriate box: employer with (� 4. ❑ I am a genes contractor and I Tie of project(required): . ees(full and/orpartttim—e).* have hired the sub-contractors 6 ❑New construction ole proprietor or partner_ listed on the attached sheet t ?•/Remodelingd have no employeesThese sub-cone have Vg for me in any capacity, workers' com . ' 8• ❑Demolition rkers'comp. isurance 5. WP insurance. 9. ❑Building addition ❑ V.e are a corporationanditsd.) officers have exercised their IO ❑Electrical repairs 3.❑ I am a homeowner doing all work #ght of ex or additions emption per MGL myself. [Norequired-] workers' � I i.❑Plumbing repairs or additions comp. c. 152,§I(4),and we have no inIsurancq t employees. 12-E]Roof repairs = 'aFpt=�a±that checks bo;;.tl m,st also comp.msuran a regquired,) 13.❑Other M.OL't the D—OW ahov.2:� Homeowners who submit tins affidavit indicating the; are dem au work,and e r workers'comp-mss•.4 Y�t:c�y c -don 'Contractors that check this box must attached an additional sheet saowinP �'hire outside contr�tOn must submit a new a then of the sub-con affidavit indicating such. tractors and their workers'comp.policy information. i am an employer that is providing workers'compensation insurance for my employees. Below is the oli , JFormation. P cl and job site Insurance Company Name: 0a,--,e Policy#or Self-ins.Lic.#:_��C �j `�2,(,+6 dL--�ff�A: ExP ration Date: 9 `' Q`� Job Site Address:_ 1 -9 /'� i , ��A Attach a copy of the workers'compensation poli City/State/Zip:_N•A,-1 -A A of policy declaration pale(sho a the Failure to secure coverage as required under Section 25A ofMGL c. 152 can le d to the impositionolicy bof er�d elation date). fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORD cnminal penalties of a of up to$250.00 a day against the violator. Be advised that a co ER and a fine Investigations of the DIA for insurance coverage verification Py of statement may be forwarded to the Office of Ido hereby certify untie airs ar d nalties o er u th¢re or fP ! rJ information provided ab Signature: Ove is true and correct. Phone#: I (2� ` Z Official use only. Do not write in this area, to be completed c , by dJ or towntImpector Cit}'or Tows: germitUcense Issuing Authority(circle one): ------------- L Board of Health 2.Building Department 3. City/Town Clerk 4•6. Other ElecPlumbing Inspector Contact Person: Phone Information an- d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every pt✓rson 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 t3ie legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not morethan three aparimL ents and who resides therein,or the occupant of the dwelling house of another who employs persons to do mainte3ance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such,employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coimpliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the.performance of public work tm-trl acceptable evidence of compliance 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-contractors)name(s),address(es) and phone number(s)along with their cerdficate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability partnerships(LLP)with no employees other than the members or partners,are not required to C8rry workers' comp a nsation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be stu'e to sign and date the affidavit. The a5davit should be returned to the city or Wwn that the application for the pert nit or license 4s being requested,not the.Department of Industrial Accidents. Should you have any questions regardit--g the law or if you arerequired to obi a workers' compensation policy,please call the Department at the number 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 Ieglbly. The 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 permit/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,need 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 per-imits 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 burn leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would Ince to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and,fax-number-..... The Commonwealth of M&Rsachusetts Department of Industrial Accidents Office Of Investigations 600 Washington Street Boston,MA 0.2111. Tel. # 617-727-4900 ext 406 or 1-977-MASSAFF Revised 5-26-05 Fan # 617-72.7-7749 �'VVUi'.I11aSS._.°Ov�dla. A 1 ACORD,M CERTIFICATE OF LIABILITY INSURANCE DAT20101D/YYYI) 05/26/2010 12:53 PRODUCER (800)225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C.Church,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 41 Wellman Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lowell, an 01851 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 800-225-1865 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: First Mercury Insurance Company St.Miguel Construction,LLC INSURER B: Insurance Company of State of PA 1000 Osgood Street 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 ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONOF INSURANCE DATE IMMIDDIM DATE iMMIDDrrn LIMBS GENERAL LIABILITY EACH OCCURRENCE $1.000.000 DAMAGE TO X COMMERCIAL GENERAL LIABILITY PREMISES EaENTED occure $300,000 CLAIMS MADE Fj�]OCCUR MED EXP(Any one person) $Excluded A FMMA0001325 10/5/2009 10/5/2010 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 17 POLICY PRO- LOC CT F AUTOMOBILE LU161LITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- IEEL EMPLOYERS'LIABILITY 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE WC6784246 7/21/2009 V21/2010 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEEI$ 1,000,000 If yes,describe under 1,000,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re:129 Main St. North Andover,MA Operations Usual to Carpentry and Construction CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 120 Main Street DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL North Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE P ACORD 25(2001/08) Client# %II I Mst# 09-10 GL&WC Cert# ©ACORDf7—CORPORATION 1988 A 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) Saint Miguel Construction Company 1000 Osgood Street North Andover, MA 01845 Phone: 978-682-2382 grenol@msn.com Submitted To. ,lob Type and Location: Fernando Donuts,LLC Dunkin Donuts 1000 Osgood Street 129 Main St North Andover,MA 01845 N.Andover,MA Contract No.: 01-10 CONTRACT This agreement is made between:Fernando Donuts,LLC(hereinafter"Client")and Saint Miguel Construction Company P.G.R.Construction,Inc.hereby submits specifications and estimates for: Construction of new Dunkin'Donuts facility according to Clientspecifications and/or blueprints. Saint MiguelConstruction,LLC.proposes to construct and/or remodel the above-referenced facility by supplying materials and labor according to the specifications submitted by the Client for the sum of$35,000 Client certifies that the signature below is of an authorized representative of said Client who is authorized to execute legally binding contracts. Client understands and agrees that this Contract is a contract under the laws of Maine and Client hereby agrees that any suit brought from this Contract must be filed in the courts of the Maine Payments will be made according to the"Payment Schedule"included within this Contract. If Client fails to make payments,Client will be responsible for all costs incurred by St.Miguel Construction LLC in order to recover any and all monies owed by the Client to St.Miguel Construction,LLC. including but not limited to attorneys'fees and court fees. Any work not specified in this Contract and requested by the Client will be billed separately and in addition to the price quoted in this Contract. By signing below Client accepts all prices,specifications,terms,and conditions of this Contract,acknowledges this contract as legally binding and enforceable,and hereby authorizes St.Miguel Construction,LLC.to perform the work described within this Contract./' /� Authorized Client Signature: ^1J�. w `(' � /V Dat Authorized Signature of 41\ 6 / -3/ � /� l Saint Miguel Construction.: Q / �0 Greg Nolan Date 'This Contract may be terminated by Saint Miguels Construction.within ten(10)days of the signing of this contract.* Demolition Remove existing ceiling. Remove Exterior atas panel Remove all wall finishes at back bar locations. Remove existing front line millwork. Page 1 of 4 Saint Miguel Construction Company 1000 Osgood Street Rough Framing Construction: North Andover, MA 01845 Phone: 978-682-2382 grenol@msn.com Exterior Finish Construction: Supply and Install azek trim around monolith. Supply and Install cement board clap boards on monolith. Paint exterior of building. Interior Sales Area Finish Work: Supply and Install Plastic Laminate Formica on Sales Area Walls Supply and Install jumble wallpaper according to drawings. Supply and Install Cherry Chair Rail Supply and Install Armstrong"Second Look II"Ceiling tile only. Supply and Install 6x6 royal Mosa wall tile. Supply and Install 4x4 white wall the on underside of soffit. Supply and Install Wallpaper on Soffit Supply and install prefabricated Millwork gitchen/Storg&g1 jgLq Room: No work to be done in kitchen area. Office Finish: No work to be done in office. Restrooms: Re tile restroom walls Page 2 of 4 Saint Miguel Construction Company 1000 Osgood Street North Andover, MA 01845 Plumb ins: Phone: 978-682-2382 grenol@msn.com Reconnect drains for front counters. Supply and Install Cuno water filter. Supply and Install water booster. *Plumbing shall be completed according to State and Local Codes Electrical: Check all existing exterior lights and change ballast as necessary. Supply and Install Recessed Lights Supply and Install 2'x 2'Lighting In Sales Area Supply and Install Lighting in Restroom *Note, Speaker and Head-Set System to be supplied by other *Note, Fire Alarm System not included in this Contract *Note,Security System not included in this Contract GLASS WORK Supply and Install"D"door handles. HVAC: Paint existing diffusers. EXHAUST HOODS: Page 3 of 4 Saint Miguel Construction Company 1000 Osgood Street North Andover, MA 01845 Phone: 978-682-2382 grenol@msn.com PAYMENT SCHEDULE At signing of contract $ 10,100.00 At completion of project $ 10,100.00 TOTAL AMOUNT OF CONTRACT $ 20,200.00 Page 4 of 4