HomeMy WebLinkAboutBuilding Permit #279-2016 - 148 MAIN STREET 9/14/2016 tt NORT}i �
BUILDING PERMITO` tLF.D /bt'�O
TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION ;
1 itR
Permit No#: Date Received �qs "AI-EVCMOs
Date Issued: TANT: Applicant must complete all items on this page
LOCATION ! -1718)'l �J/V �s
Print _/ S
PROPERTY OWNER S �4Iv �Q,C>
Print 100 Year Structure yes no
MAP PARCEL:_ZONING DISTRICT: Historic District es o
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
[I Addition ❑ Two or more family El Industrial
❑Alteration No. of units- ,Commercial
/Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ElWell n [I Floodplain [IWetlands ❑ Watershed Distract
0 WateTtSewei , _ --
DESCRIPTION OF WORK TO BE PERFORMED:
v
Identification- Please Type or Print Clearly
OWNER: Name: Sv{'f-o� PO4 �N�moylum � oc�`G �fanJ Phone: �j 18 SSS a�3S�
Address: I`IS fN 4md- 141,11N
17
Contractor Name: Phone: -7 zL "7
Email: a /" Coli j
Address:
Supervisor's Construction License: CSTO06L 'g Exp. Date: 1� is
Home Improvement License: Z Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PE $92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $_ 1-151020— FEE: $ �--
Check No.: Receipt No.-
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
actor
- — — -- T
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Permanent Dempster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Siqnature
COMMENTS
Y
1
Q
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 Drivewav Permit _
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIR ELDEPARsTMENT;*- Temp.Dumpster on site ,yes. _ ..,.� no _ `" • °`�i��:;
Located at�12,4IMamFSt�eet
Fire Depditfrient s_ ignatbre/date
COMMENTS
i
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 Call Email
Date _ _ T _—Time Contact Name _
Doc.Building Pennit Revised 2014
i
Building Department
artme
nt
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
:rF 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
OTE: 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/Cross Section/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
OTE: 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
2012 I ECC Energy code
Engineering Affidavits for Engineered products
OTE: 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 2014
Location ► J",*/Al
No. - Date 4
r�
w
• • TOWN OF NORTH ANDOVER-,
Certificate of Occupancy $
Building/Frame Permit Fee $ t r%
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
I
Check#
r Building"lnspector
VtORTfy
Town of
? ?_ 6 ndover
O 0
No. ILQ
�o�hver, Mass,
coc"Ic Mlwl[K 1'
S U
BOARD OF HEALTH
'PERM IT T Food/Kitchen
Septic System
THIS CERTIFIES THAT ........CO ft. t ..�_. ,��V BUILDING INSPECTOR
has permission to erect buildings on ..........�. .. W.. T Foundation
.......................... .... ... ..............
Rough
tobe occupied as ................................................................................................................................... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final
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 CONST CTIO Rough
Service
.. ...... .. .... .. .. ... .. ..... Final
BUILDIVASPEC OR
GAS INSPECTOR
Occupancy Permit Required to Occuov Building 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.
CRW
V
h r
COMPLETE
RESTORATION&
WATERPROOFING
205 NORTHERN BOULEVARD NEWBURYPORT MA 01950
July 6,2016
Mr. Peter Szeidler
Great North Property Management
3 Holland Way Suite 201
Exeter, NH 03833
RE: Sutton Pond-Loading Dock Restoration
Dear Mr.Goode,
Complete Restoration&Waterproofing(CRW, Inc.)is pleased to provide a proposal for work at the above
referenced property.
WORK SCOPE:
1. Remove loose or delaminated concrete in preparation for coating.
2. Install new concrete where removed.
3. Grind entire concrete deck in preparation for coating.
4. Install two part pedestrian grade urethane deck coating system to entire deck.
5. Remove and replace rotted wood and trim with AZEK plastic wood system on loading dock side.
Cost to complete the above work scope is........$15,000.00(Fifteen Thousand Dollars).
_Clarifications/Qualification Items
1. Work to be performed during normal work hours M-F, lam—5 pm.If work is to be performed during off hours
please refer to line six regarding labor rates.
2. Bonds,permits,fees,sidewalk/pedestrian protections, traffic control,police details&fire details are excluded
unless otherwise noted above.
3. Water and electrical outlets/hookups to be supplied by others.
4. Payment terms are due upon receipt of invoicing.
5. No provisions have been made for the removal and disposal of hazardous materials.
6. Straight time and labor rate is$80.00 per man hour. Off hour time and labor rate is:$110.00 per man hour.
Materials and equipment are cost plus 20%.
We appreciate the opportunity to provide pricing for your project. Please contact us if you have questions
or require further information.
Respectfully Submitted,
William Ulchak, President
Complete Restoration&Waterproofing, Inc.
CRW, Inc.ref.#200518-revised Page 1 of 1 WWU/ge
A
CRW
V
y
COMPLETE
RESTORATION&
WATERPROOFING
205 NORTHERN BOULEVARD NEWBURYPORT MA 01950
September 6,2016
Owners/Trustees
The Sutton Pond Condominium Association
148 Main Street
North Andover,MA
RE: THE SUTTON POND CONDOMINIUM- LOADING DOCK RESTORATION
AUTHORIZATION TO PERFORM CONTRACTED WORK
Dear Trustee:
By signing below,you are authorizing Complete Restoration&Waterproofing, Inc. (CRW,Inc.)to
perform the agreed upon project repairs per our proposal#200518-revised.
As a Trustee/Representative for Sutton Pond Condo Association I am signing below to authorize CRW,
Inc.to erform all contracted work:
YUSTE-E REP ENTATIVE
TTON PON CONDOMINIUMS
CRW, Inc. Page 1 of 1 WWU/ge
�. The Commonwealth of.Massa'chusefts
. Dq ayftnent ofIndustrialAceldents
— 1 Congress sh"eef,Suite 100
=1: Boston,MA 02114-:2017
www rias.govIdid
' �Go�kexs'Coxnpe�nsatiaxtTnsuxance.A�davzt:Buz.Iders/Coytxac�orslEleei�icza:aslPlagnbexs.
TO BEFff D'F T:I;tMPEIZilRTTI NC AUTHORITY'.
Applicant hformation Please Print Leel
Name(Rusinass/DsganizaiiomiludMdaal): �i / "
Address: Q �)o
Citylstate zip: r� Phone#:
.reyou an employer? Cheek'„ oxo ate box-, Type of project(x'ecluited):
1. I am a employer employees(fall andlorpart time).* 'J.• Now coAst ction
2.�I am a sole proPd0b3�orpazfnersbip andhaveno employees working forme in 8. Remo delirig
any capacity-[No worTcers'comp.insurance required_] S, Demolition
i n i am a homeownerdaiag all-workmyseli jNo workers'comp-,nsMU ce squired.]
10 [1 Building addition
4.E]lam ahomeownerandvM bebiiing contraetors to conduct all work onmyproperiy. Iwill
ensure that an contractors either have workers'compensation in s=ac or are sole 11.E]Electrical repairs or additions
proprietors whh na employees. Ill[ Plumbing repairs or additions
5.❑I am ageneral copf aobr andlbavahiredthe sub-eantracinrslisted onthe attar-had sheet. 13:Q RoaZ�epaixs
These sub-co.Lractorsliave employees andhaveworkere comp_msm-a ce t
' 14.V1 Other /
6.F]We are a corporation.mdits officers have exureised�fficii ii&of exemption permw,c.
152,§l(4),and w-�7ha?eno... ioyees.TNoworkers,comp.insurawa-Tegnsed-]
-.Any apphcaattbat checksb6c41 mast also'M outthe sectionbelow shawiugthearwarkers'compensationpolicyh fomption.
i Homeowners-who sial Eif�affidavitIO'hGatingthey are doing all workandthenhire om-side contractors must samit anew afdavii indicating sucb.
ConiractorsPatcheck-ffijsbqKmusi a'-acherlanadditi nal sheet showing the.name.ofthesub-conaactorsand state whetherornottioseeutitieshave
employees. Ifthe sub-cnf5 re oiurs have employees,&y must providefihes works'comp.policy number.
�uY�i arz eYripZoyer tli at is,�Yovicing7porkers9 com�ensirizori insrxrc�iceforYriy employees.'BeZo1-v zs thepoZicy aridjag site
znfo��iatiori. _
Insurance Company 24me: (r Ng
Poficy4f or Self ins.Zia. : w° w C 0-7 '�3 Expit'ationDate:
Tab Site Address: I / � /[ ���L City/State/T�.p: -
Attach a copyoftheVorkers' compep4atzonpolicy declaration.page(showing thepoRcynumber and expiration daze).
Failure to secure coverage as required under MGL o. 152, §25A is a criminal violation punishable by a flue up to$1,50 0.00
and/or one-yeax imprisommant,as well as civil penalties 7n.tffie fort ofa.STOP WORK ORDER and a fine of up to$250.00 a
day against the-violator_A,copy of Ibis statement mayb e forwarded to the Ofitce of Investigations of the DIA for insurance
coverage verifoatiorz_
I do hereby certify wider t/i a cZ of ,jam that the!WfornnadanprovidecZaboae is—eiie mdeo��eet
Si ature: Date:
Phone#
Q ff ezaZ rise onry. .Do not-tpTUe in this amac to be completed by city or f0VA officiaZ
City or Town: Permit/lJicense
Issuing AU:aox1ty-(circle one): i
1.Board of Heal%2.JBuildiugDepartment 3.City/Town Clerk 4.Electrical Inspector 5-Plumbing Inspector
6.Other
Cw tact Person: Phone#�:
lnfo:rmation and Instructions
Massachusetts General Laws chapter X52 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,as employee is defined as"...every person in the service of another uader any contract of Dire,
expxes's or implied,oral or written."
An ern is defined as"an fifdividual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the 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 more than three apartments and who resides therein,or the occupant of the
dwelling house of anotherwho employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or to cal licensing agency shall withhold the ismance or
renewal of a license or permit to operate a business or to construct buildings in the commouwealtb,for any
applicant whLo pias riot produced acceptable evidence of compliance with the insurance coverage req=ed."
Additionally,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any ofits political subdivisions shall_
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
-requirements of this chapter have been presented to the contracting authority."
Applicants
Please RRout-the workers' compensation affidavit completely,by checkinglo boxes that apply to your situation and,if
necessary, supplysub-'contractors)name(s),address(es)aud-phonenumber(s)along with theircertifcate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employ9es'otb.erthan the
members orparbaers,arenotreq redto carryworkers' compennsationhasurance. If an LLC orLLP do6shave
employees,a policy is required. Be advised that this affidavitmay be submitted to the Department of-Mdusirial
Accidents for•confirmation ofinsurance coverage_ Also be sure to sign and date the afadavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,riot the Department of
IndustrialAccidents. Should you have any questions regarding the law or if you'are xeggired to obtain a workers'
compensation policy,please call the Department.at the number listed below. Self-ii s 6d companies should'enter thea-'
self-insurance,license number on the appropriate line.
City or'Tovvn Officials
Please be sure that the affidavit is complete and printed legibly. The Department has•pxovided a space at the bottom
of the affidavit for you to fill out bathe event the Office of-Investigations has to contact you regarding the applicant_
Please be sine to fill in the permit/license number which.will.be used as areference number. la addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
poli6y information(ifnecessaty)and under"lob 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 fox future permits or licenses. A new aidavit must be filled out each
year.where a home owner or citizen is obtaining a license or p enmit notrelated to any business or commercial venture
(i.e.a dog license or pezmrt to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number=
The Commonwealth of Massachusetts
Deparbnent of Ind-astrialAccicl-ants
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel_# 617.727-4900 ext. 7406 or 1-877--MA.SSAFE
Fax#617.7277749
Revised 02-23-15 wwwmass.gov/dia
i
;Y Cele rpn-nUnaow.uecc /ry/C�/G�ctjO'c
.' office of Consumer Affairs&Business Regulation
W; HOME IMPROYEMENT CONTRACTOR
( r= egistration: 1176375 Type:
7 Expiration: -8/14/2(}1_7 Corporation
f COMPLETE RESTORATION&WATERPROOFING INC.
-+' t
WILLIAM ULCHAK
F 205 NORTHERN BLVD
NEWBURYPORT,MA 01950 Undersecretary
r
Massachusetts -Department of Public Safety.
Board of Building Regulations and Standards
,.cons.____, -
ati uu�0u aupEi i i5uT � `+
License: CS-085581
WILLIAM W UL
205 NORTHERNBL1', j
Newburyport MAr-019
c
�{S.
�rw
' Expiration i
Commissioner 11115/2016 .
i