HomeMy WebLinkAboutBuilding Permit #874-14 - 140 WILLOW STREET 6/3/2014 � L
TOWN OF NORTH ANDOVER
J APPLICATION FOR PLAN EXAMINATION
Permit NO: v 7�! Date Received
Date Issued: . K�
IMPORTANT: Applicant must complete all items on this page
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PROPERTY 0)wi. . t_� i4 .5 UTA ��L N►-� -
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'Print' 1 OO Year Old Structure yes �nq
PARC ZON_,NG �11STRICT _. 'Histone Distract ye no r
MAP NO: U G � _
Mac - o,
hineShop Village yes n
TYPE OF IMPROVEMENT, PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Indu real
❑Alteration No. of units: 4oeommercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
SepticF. ❑UVell 0 Floodplain, D UVetlands —❑ 1lVatersliedt®tstnctt
❑Wate(/Sewer
DESCRIPTION OF WORK TOB PERFORMED:
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cOS e-� r-oR ,gt-zAcfkoic 0,- `
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Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
a, n
CQNTRACTORMAName._� C_0 e, ��U,g Phone:Z
Address --
---
Supervtsor's C,oristruction LIcense C_S 9_ �_ Exp Date 1 l T
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0 _Exp Cate _
Wome�lm rovement License._ _
,
ARCHITECT/ENGINEER Phone:
. No.
Address: Reg.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL rs�TED COST BASED ON$125.00 PER S.F.
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Total Project Cost: $ FEE: $
Check No.: ` �Sv Receipt No.: ;2 �3y
NOTE: Persons contracting registered contractors do not have access to the guaranty fund
Sit, f"c d ` ^.i�u�
Signatu e,of Agent/Own z -- �. - Ig�►a_ure o ty,_ontractorz"- .
Plans Submitted LI: I a d ❑ Certified Plot Plan ❑ Stamped Plans ❑
-= Plans Submitted ❑ Plans Waived ❑.: Certified Plot Plan ❑ Stamped Plans
TYPE 0Y.SEWERACEDISEOSAL
.Public Sewer ❑ Tanning/Massage/Body Art ❑ .. Swimming Pools ❑
Well ❑ . Tobacco Sales Food Packaging/Sales ❑
Private(septic tank,etc._ . permanent Dempster oa-Site
THE.:FO.LLOWING SECTIONS FOR-OFFICE USE ONLY
f
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED . DATE.APPROVED
PLANNING& DEVELOPMENT' D ❑
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/sig
nature& Date Driveway Permit
DPW TovvO Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTK NT.;-.Ternp Dumpstetoh site -.yes no
Located at 124sMair Street -
Fire•De'partme'rt.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
DANGERZONE LITERATURE: -Yes No
MGL.Chapter 166.Section.21A.-F and G min.$100=$1000fine
NOTES and DATA — (For department use
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® Notified for pickup - Date
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Doc.Building Permit Revised 2010
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Building Department
The foi?lowing is'a Iistof:the-required.forms to be filled out for:the.appropriate.permit to be,obtained.
Roofii g, Siding, Interior Rehabilitation Permits
o , 13.1-ailding Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/0'r=C`.S.L Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
o 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
o 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 cascs if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apo,?al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm-+.ted with the building application
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Doc: Doc.Bui?ding Permit Revised 2012 .
Location
No. k'7 y Date /
I
o -i TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
t = Foundation Permit Fee $
Other Permit Fee $
TOTAL $/�1��
Check it
27639
Building Inspector
140 Willow Street
North Andover, MA 01845
ndover^�
� � phone(978) 686-3500
ndodyRtICS fax(978) 686-3514
www.andoverendo.com
Julie'A. Saviano, DMD
Diplomate, American Board of Endodontics
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
$ 83,887.00 m
$ - $ 1,006.64
Plumbing Fee $ 125.83
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 125.83
Total fees collected $ 1,358.31
140 Willow Street
874-14 on 6/3/2014
Tenant Fit Up
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Town sAndover
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Yf COh ver, Mass, �✓ �,�� , l�
COC"ic„ewLAIKI �c« �1
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,95°R�reo �PP��S
lI BOARD OF HEALTH
Food/Kitchen
PE IT T LU Septic System
_. C�/(�, �Ct //!G D ���� BUILDING INSPECTOR
THISCERTIFIES THAT ............................................................................................................................
l� P Foundation
has permission to erect .......................... buildings on ..��`.�.............°�................................................
irrC"'g4 IZ�” _� v Rough
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to be occupied as i�`fis�0 `'` y
...................................yC.......... ... ...................................................... .. Chimney
. ...
provided that the person accepting this permit shall in every respect conform to the terms of he application Final
on file in 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 CONSTRUCTION TARTS Rough
........ ...... �.
.................................. Service
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place onthePremises — Do Not Remove Final dY
No Lathing or Dry all To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
The Commonwealth ofMassachusetts _
Department o f'I'ndustrialAccMiks
Office of Investigations
600 Washington Street
Boston,MA 02111
-www.mass gov/aza
Workers,Compensation bmurance Affidavit:Builders/Cony°actors/ElectriciansTluin.ber.s
.A CheantlWormation Please Print Logibk
Name(Business/organization/1n&idual): 5 Gt N 5/` u f�
Address.'-2,
City/StatelZip: R^An /� l " ' ��� d� Phone
Are you an.employer?Check the appropriate box: Type of project(required):
i.[] I am a employer with 4. ❑ I am a general contractor and I 6. []New cOnstruction
employees(full and/or part time)* have nedthe sub-contractors
2.[] I am a sole proprietor or partner
listed on the attached sheet. 7• El Remodeling
ship and`have na employees These sub-contractors have 8. E]Demolition
working forme in any capacity. workers'comp.insurance, 9, [�Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions.
required.) officers have exerelsed.their
3.El X 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.❑Roo£repaixs
insurancere ed. employees.[No workers'
l 13.❑Other
comp.insurance required.]
'Any applicantthat checks box01 must also fiff butthe section below showingtheir vrorkers'compensationpoHoy information.
i Homeowners who sabmitWs affidavit indicating they kedging all work and then hire outside contractors must submit anew affidavit indicating suoh..
TContractors that checkthis box must attached an additional sheet showingthe name of the sub.-contractors andtheir workers'comp.policy information.
I am are employer'that is pYoviding woo ers'compensation insurance for my employees Below is thepolley andjob site
information.
Insurance Company Name% A A� 5,1115f ✓-t hAlea - -- -
Policy##or Self ins.Lic.#: V 7 �--{- Expiration Date:
rob Site Address:_
qU W l IGS S/ NGS I /4/d#1V-FA City/State/Zip:
r
Attach a copy of tiie workers'compensation-poliey declaration page(showing the policy number and expiration date).
Fail-are to secure coverage as requft d under Section 25A ofMGL o.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 WORD ORDER.and a fine
ofup to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
X do Izereby cent under the pains and penalties ofper/jgiythat the information provided above is true and correct.
0,(/ Date:
Signature:
�j
Plione##-
Oficial use only. vo not write N this area,to be completed by city or town official.
City or Town: Permit/License 9
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other - -ContactPerson: Phoney.,
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Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide woxkexs'compensation for their employees.
Pursuazit to this statute,an ern
ployee is defined as",..every person id the service of another under any contract of hire-
express o
xp r•unplied,oral orwxitten.
An employes is defined as"an individual,partnership,association,corporation or.other legal entity,or anytwo or moxe
of the foregoing engaged in a joint enterprise,and including the legal representatives of aAeceased employer,.or the
receiver or.trustee of au individual,partnership,assc elation or other legal entity,employing employees. However the
owner of a dwelling house having notmore than three apartments and who xesides therein,or the occupant ofthe
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds orbuilding appurtenant thereto shall not because of such employment be deemedto 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 iu the commonwealth fox any
applicant who has not produced-acceptable evidence of compliance 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 ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapter have,b con presented ta the contracting authority."
Applicants
Please fill out the workers,compensailon affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)andphonenumber(s)along with theircertificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other that,the
members or partners,are not required to cairyworkers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe submitted tothe Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for thepermit or license is being requested,not;the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a*arkexs'
compensationpollcy,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 andprinfed legibly. The Department has provided a space at the bottom
of the afffdavitfoxyouto fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be-sure to fill in the permit/ficense number whichwill be used as a reference number. In addition,an applicant
thatmust submitmultiple permit/licemo applications is any * year,Hoed only submit one affidavit indicating current
policy information(if necessmy)and under"Job Site Address"ihe•applicant should write"all locations in (city or
town):'A copy of the affidavit that has b een officially stamped or marked by the city or town may be provided to the
applicant as p-roofthat a valid affidavit-is ou file for future p ermits or licenses. .A new affidavit must be Med out each
year.Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture
(i.e.a dog license orpexmit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like 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 abd fax number:
Tho CQ-m-.m-ouwroa
Ith oSssac,byetts
Dep rtmenl Qfk4u�Wal,A,cexdelim
Office ofTuvesff a-Uga,%
6b0 WW—vgon xe�
I 4QQ� 4q6 ox Z� ` .:11AA
Revised 5-26-05 Fax#617-727-7749
u
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-092946
FRANCISCO N DIL
3 Mocidngbird Lafie T
Kingston NH 03848
-721�j '� �" ` Expiration
Commissioner 12/22/2015
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REAR
ENTRANCE
-r T TI
o ,
t
21.00 FILING
NEIG14T
17.58'
.._.. ILING
® HEIGHT
FIRST
vd 31xF fir' is ' 11ra✓`f '^ ;
V4 cl, i ,� �' x -a•
8.92' y'
- � �� x {.�• .. K� `�" '" -° � z xrn +ti c rte-Z`� �_;sz $.0
YTING._
l ^S 5 },�...d..t.�.�- h...�.t. � 'W�'e
BUILDING SECTION A-A
1"=20'
UNIT
1 N I certify that this plan shows Unit 2, 140 Willow St. (Willow St. Business F
Condominium)Floor Plan, being conveyed and of the immediate adjoinin
unit(s)and that it fully and accurately depicts the layout, location,dimens
1.83' approximate area, main entrance and immediate common area to which
9.2Y access. I hereby certify that this plan fully and accurately depicts the layc
location, unit number, and dimensions"as-built"for units. I certify that thi:
20.17
,;... ,;: . ; , .;: . �. has been prepared in conformity with the rules and regulations of the Rel
of Deeds.
UNIT 2
1,308 SF
No.4953
1 o ANDOVER,
IST RED ARCH T CT DATE
c
20.17' e�yNOF YAggp
_ .A-A
FRONT
ENTRANCE FLOOR PLAN
I"=10'-0"
1
0
Constructionbysilva.inc
3 Mockingbird lane CONST CTION
Kingston N.H 03848 CONTRACT
r_Q7R-t73_466d
THIS contract,made this 20 day of May,2014 A.D.,by and between,JULIE A.SAVIANO,and CONSTRUCTION BY SILVA,
hereinafter called the Contractor.
For the consideration hereinafter named,the said Owner covenants and agrees with said Contractor,as follows:
FIRST: The Contractor agrees to furnish all material and perform all work necessary to complete the WORK AT. #140 WILLOW
STREET.,NORTH ANDOVER,MASS 01846,for the above named structure,according to the plans and specifications of(details thereof
to be fiunished as needed),and to the full satisfaction of said Architect or Owner.
SECOND: The Contractor agrees to promptly begin said work as soon as notified by said Architect or Owner,and to complete the
work as follows:
CLOSET 800.00 MATERIALS AND LABOR,CLOSE THE TWO SIDES,ONE DOOR A POLL FOR CLOSET WITH A SHELF.
AND A LIGHT WITH BASE VINYL IN THE BOTTOM,THE IN SIDE LIGHT IS CODE.
CLOSE THE WALL FOR THE CONFERENCE ROOM WITH A DOOR$2,500.00 MATERIALS AND LABOR THAT IS A
DOOR WITH NOCK DOWN SYSTEM ITS A COMMERCIAL DOOR,METAL STTUDS,INSULATION AND DRYWALL AND
TAPE.
PLUMBING FOR SINK AND WASHER AND DRYER$1,700.00 MATERIALS AND LABOR AND TERMINATE THE ONE
WHERE THE SINK WAS.WORKED PERFORMED BY A LICENSE PLUMBER,PERMIT INCLUDID.
NEW VENT TO THE OUT SIDE$700.00 DONE BY THE CONTRACTOR-
ELECTRIC
ONTRACTORELECTRIC LIGHT OVER THE DOOR FOR EXIT,LIGHT FOR THE CLOSET,SPECIAL PLUG FOR THE EX RAY MACHINE
AND A TUCH BOTTON.
electrical, networking and bracing specks for the 3D unit. $1,800.00 PERMIT INCLUDID.
NEED TO INTAL BLOOCKING FOR THE EXRAY MACHINE,REMOVE DRYWALL AND INSTAL THE BLOOKING AND
RE INSTAL THE DRYWALL.$450.00
PAINTING OF ROOMS THAT I HAVE WORKED ON $1,200.00 MATERIALS AND LABOR-
PERMIT
ABORPERMIT$1,200.00
TOTAL=$ 10,350.00(ten thousand three hundred fifty dollars)
FLOORING:
rip up carpet,rep the base trim dispose of it prep floor.$1000.00
on the hallway to use Priemere amp995pr American maple golden.
On the dental areas to be premiere du4826pr durango bone and the bathroom,plus the room that will have the wash and dryer.
Materials boxes$4,268.88
boxes $1,951.18
labor$2885.00
5 gallons of glue$134.00
supply plus instal vinyl base trim$910.00
taxes 388.75
total $11,537.81
GRAND TOTAL $21,887.81(twenty four thousand eight hundred eighty seven and eighty one cents)
Pagel of 3
Construetionbysilva.ine
3 Mockingbird lane
CONSTRUCTION ,
Kingston N.H 03848 CONTRACT BY
r-07R-471-4664 "
cost to buy and install the X-ray machine was$62.000.00 dollars
THIS transaction was between the company that is installing the machine and JULIE A. SAVIANO.DMD.
I show this amount here for the purpose of records for the city of NORTH ANDOVER ETC.
THIS IS aded to the contract for this perpose,which JULIE A. SAVIANO.DMD,is reposable to pay for the fee of$12.00 per thousand to
the building inspectors office of NORTH ANDOVER if more she is to pay the deferents.
THIRD: The Contractor shall take out and pay for Workers'Compensation and Public Liability Insurance,also Property Damage
and all other necessary insurance,as required by the Owner,Architect,or by the State in which this work is performed.
FOURTH: The Contractor shall pay all Sales Taxes,Old Age Benefit and Unemployment Compensation Taxes upon the material
and labor furnished under this contract,as required by the United States Government and the State in which this work is performed.
FIFTH: No extra work or changes under this contract will be recognized or paid for,unless agreed to in writing before the work is
done or the changes made.
SIXTH: This contract shall not be assigned by the Contractor without first obtaining permission in writing from the Architect or
Owner.All Sub-contracts shall be subject to the approval of the Architect or Owner.
SEVENTH: IN CONSIDERATION WHEREOF,the said Owner agrees that they will pay to the said Contractor$21,887.81 for said
materials and work,where said payment amount is to be paid in four installments as follows:
(1)INITIAL DEPOSIT OF$5,000.00.00 FOR PERMIT.
(2)WHEN WORK STARTS$6,000.00
(3)WORK IN PROGRESS PAYMENT OF$6.000.00
(4)FINAL PAYMENT OF$4,887.81 WHEN THE JOB IS COMPLET.
The Contractor and the Owner for themselves,their successors,executors,administrators,and assigns hereby agree to the full
performance of the covenants of this CONTRACT
Signatures:
Owner
Contractor
Page 2 of 3
Dr.Julie Saviano
Carestream Dental
CS 9000 3D
'Lett End'of
mounting Wall
t End of
mounting Wall
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