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HomeMy WebLinkAboutBuilding Permit #126-2016 - 16 BERRY STREET 7/30/2016 I NoRTy BUILDING PERMIT of tLeD ,6gtio TOWN OF NORTH ANDOVER �? y ::'` _ �•; APPLICATION FOR PLAN EXAMINATION =T .� Permit No#: Date Received Date Issued: �SSHCHUs�t IMPORTANT:Applicant must complete all items on this page LOCATION S I/VQ, ( + �" Pnqt PROPERTY OWNER Print 100 Year Structure yes no MAP,_PARCEL:VDT ZONING DISTRICT: Historic District s Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: emolition ❑ Other ZSeptic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer _ (� < DESCRIPTION OF WORK TO BE PERFORMED: 77- UA Identification- Please Type or Print Clearly OWNER: N a m e Ller a1da,,ok t-1[di!d4S f� Phone:7 '/-Y�S�- z� Address: So tic a�u­, AA+ Contractor Name-.&J" Phone: 6(2-,�- f-,q(- /I / Email: Address: '711 L a✓J (2 3 o"3v Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. t Total Project Cost: $�` r910.1 FEE: $ 't,-70'? Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .- [ Location 114 No.�2 'c�d �� / Date 7 3a r • • TOWN OF NORTH ANDOVER IED y�4�' . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ wr Check#� ✓� Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swhoming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. Id/ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments t s _Water&Sewer ConnectioniSignature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street Pn.'A-MENT 'Tem Du ' FIRE DE r ;R �_d tet # .z � � ` .mpsterronsite .iY�eSta ,�. � .dnay I�Locatatr124 Maintreet r Fireepartme gnature/dateu_ 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 Time Contact Name f Doc.Building Permit Revised 2014 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 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 IECC 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 NORTH own of EAndover O - 0 No. CIO h h ver, Mass, 2 it COCNIC Nl WICK y7' AERATE() S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System f THIS CERTIFIES THAT !.�. !1... .�'/. ff' ��%tif, � BUILDING INSPECTOR has permission to erect.......................... buildings on . ?.. " ....:!!....................................... Foundation Rough to be occupied as . .���.G':. .el .. � ..���...���.c/.J .F 't`..�.. .7.............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the I�sp�ction,Alteration and Construction of Buildings in the Town of North Andover. �iy ���s'" PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 9 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR .UNLESS CONSTRUCTION S ARTS Rough Service .......... �ti- - ........................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Smoke Det. Proud To Partner With: Servicing All Of the New • ` Southeast New Hampshire + i- England Area: Habitat NH,MA,ME& VT for Humanity' l �EN ITI N www.nhdemolition.com (A Division of Nixon Site&Demolition) Celebrating 25 Years of Service Specializing in Building Wrecking,Asbeslos/Hazardous Material Abatement for 25 Years 792 Londonderry Turnpike I Auburn,NH 030321 Phone(603)641-11111 Fax(603)647-8372 E-mail:info(a,nhdemolition,com NIXON HYDRAULIC HAMMER RENTALS PROPOSAL DATE:April 27 2015 - Jul S. Lcvu�yr� SUBMITTED T0: Pilot Construction JOB rNFORMAnON: ATTN: Kevin S ADDRESS: 16 Berry St ADDRESS: CITY: North Andover CITY,STATE: STATE: MA PHONE: Email: kevins@pilotconstructioninc.com FAX: Complete demolition of multiple structures. Remove concrete slab and foundations. Price includes removal of all debris to an approved LEED certified recycling facility. All salvage from structure is the property of New Hampshire Demolition. Price is based on salvage unless otherwise noted. d SVke_ 5­4\ 1 General Contractor will notify utility companies before starting work and comply with their requirements. General Contractor will disconnect and cap all utilities. General Contractor will obtain required permits from authorities. Keep work sprinkled with water to minimize dust. General Contractor will supply water or hydrant and pay for permitting. Price is based on normal eight-hour workdays.Overtime,nights,weekends,and holidays will be charged extra. Price includes grading out foundation hole and making the slope safe Removal of one oil tank NHD will protect areas of demolition Price includes asbestos abatement as identified by NEE labs If listed above please disregard the corresponding exclusive below: Exclusions: l.)Price does not include Fire watch or Police detail.2.)Additional Charges will be incurred if cutting and capping has to be performed at the main in the street,3.)No backfill. .5).Not responsible ror any hazardous waste,PCB's,asbestos,oil and chemicals of any kind.6.).Not responsible for oil tank(s).Oil tank(s)must be drained before arrival.7.)Not responsible for asphalt,sidewalks,curb lawn,sprinkler,or landscape damage of any kind,not responsible for any damage to underground utilities of any kih: . Rrioe;i;based on staodaird Wndauen ' le4ekiat,esara-thielertess-ef eel- ngae steed 13.)Structures/buildings are required to be clean and free of trash and debris unless otherwise specified. 14.)Price is based on no readnage withheld if retainage is withheld,price is subject to a 10%increase.15.)Price is based on steel market value rate as of date on proposal. We propose to complete the job in accordance with above specifications for the sum of: Terms of Payment:25%deposit,25%when building is down,balance upon completion.No retainage withheld. $141,962.00 it Town of North Andover vaORTH Building Department o�.IiJ�ED 16 �N 1600 Osgood Street Bldg 20, Suite 2035 .�� y �:; F° 0 North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 n0 DEMOLITION OF BUILDING AFFIDAVIT o LAN■ COCMIC Kl WICK DATE 7 23�z US a!S CH OWNER'S NAME &ADDRESS 6yfk &doy e Afbb is , LLL t 5o P�tsrdPq&f tVj /-f/p� LOCATION OF PROPERTY TO DEMOLISH t 1, ;qovA Ay,,� DESCRIPTION CONTRACTOR'S NAME &ADDRESS Aid, 4wW i tb''w 'M Lcmdcldekrg "IV14 0303 y DEPARTMENT SIGN-OFFS DEPT. OF PUBLIC WORKS -WATER:©e_ SEWER: 4- TREE WARDEN A/ TOWN ENGINEER 1 • DEPT. OF CONS A N S HEALTH DEPT. l Z3/ SE13 C WELL HISTORIC COMMISSI tA/L PLANNING !✓/f4 GAS ELECTRIC TELEPHONE TAXES POLICE4u( "�J �jiclr5 XFIRE EXTERMINATOR- l - __ i DUMPSTER—ON OFF STREET DIG SAFE NUMBER BLDG. INSPECTOR Building Demolition Affidavit Town of North Andover VIORTH Building Department O�.1i1,ED 06 1600 Osgood Street Bldg 20, Suite 2035 s'V y `{'- 4° �0 North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 � Z, ' 0h � DEMOLITION OF BUILDING AFFIDAVIT OLAKE COCNic"ItCNl WICN rEo j,PiCO DATE /13/4 0/5� SSgCHLIS ti OWNER'S NAME &ADDRESS AU(tjS{ ZL& 150 Pk5ldPA•u f W�a lr1a�O�r� d�kU� LOCATION OF PROPERTY TO DEMOLISH &VLij �5t, /4VVA Av,,� DESCRIPTION ��w�o�t�r�v► v Fc�s ,�� S�t�,�us �o-Pv /� l�ael�e�[_ p(& CONTRACTOR'S NAME &ADDRESS � � f-Haysl�� Ith'crvi 7�2 LwldU�dehyT /�-v17i 0,303 y DEPARTMENT SIGN-OFFS DEPT, OF PUBLIC WORKS -WATER:Ok SEWER: All4 TREE WARDEN A/ t TOWN ENGINEER • DEPT. OF CONS A N S HEALTH DEPT. SEP C WELL HISTORIC COMM ISSI A14,W PLANNING Iy d GAS /V/A ELECTRIC TELEPHONE TAXES POLICE f-I Fi41.(cc�r. - !;:�eT• FIRE EXTERMINATOR DUMPSTER-ON OFF STREET DIG SAFE NUMBER av«'a 90n32 BLDG. INSPECTOR Building Demolition Affidavit OP ID:SU ,�coRra" CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDIYYYY) 07/2012015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. 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). NT PRODUCER NAh4E:CT_ Michael Ripley _ MALONEY ASSOC INS-MANCHESTER PHONE 1650 Elm Street Suite 501 ,Nq gyp;603-277-9500 _ c :603-626560 Manchester,NRO3101-1217 ADOREss: 11OtAJCEFt"" INSURER 9 AFFORDING COVERAGE NAIC N INSURED Tayla Nixon Site Developers INSURERA:First Mercury Insurance Co. Inc.dba New Hampshire R p INSURER e:Pro re Demolition INSURERC:LibagMutual Insurance Cor . _ 792 Londonderry Turnpike Auburn,NH 03032 INSURER 0; _ ` INSURER E II INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tTe �FF-.....-PO CICf umrrs TYPE OF INSURANCE POLICY NUMBER MMIDDJYYYYM ID YY _._. GENERAL LIABILITY EAC`1OCCU12'•'EN1:. $ 1,000,000 A X COMMf_RI:IAI ,I`.NER`aL.LIABIf.ff X X ACGL000004914701 11/0412014 11104(2015 lR cES Eaoccursnc' $ 50,000 :L AIMS-MADE X OC DJR MED EXE(Ar:Y one person} $ 5,000 A X ISO Form CG0001 BLANKET BASIS FORM 1110412014 11/0412015 PERSONAL&ADV INJURY $ 1,000,000 A X CG2010&CG2037 BLANKET BASIS FORM 11/04/2014 11/04/2015 0ENERAI.A07GREG41E $ 2,000,000 _m ........._....._._........................_.__,..- _..._.. _ .... .. G'-PJ'(.,rrL.A,,=Ret>arE LIMIT aPPUEs P.P. RRo�ur..Ts COM RIOI'a: $ _ 2,000,000 (—� ' I P01_li"r X PRC� "';.. JL AUTOMOBILE LIABILITY OM aJf.11 I-:GLC:i.R,trT $ 1,000,000 .Ea acude,t) B Arly AuTU 034213560 12/19/2014 12/19/2015 — m �.._ 6'00 IN-10PY{Per Px>cr.) S IiY)DII,.Y INa1.1S2'({f>•�r dccid?np $ X 504:DU11. AUTOS I P"ROPER'Y UAAAA(,f $ X HIREiiE:lAl.iTi)ri I x fJOtJ-:rJi?N°;ii:)Al.!'1'ti:i $ UMBRELLA LIAR X JC::!.;R EACH GCCL!RREN::6 `$ 5,000,00 �( EXCESS LIAB ^Lki:"dr,-Mni)FiiGGRGF;T� A -- - X X NJ-EX-0000053405-01 04108!2015 11!0412015 Follow $ $ 5,000,000 DEDUCTIBLE RETENTION $ Form $ WORKERS COMPENSATIONOTH- AND EMPLOYERSLIABILITY �T'?r d'T3 ER B ANYIPROfIRIFTORIPAf INFIRAE,YFCU'IVF.: YIN C5-31S608236014 12126/2014 12/2612015 j EL EACH ACCIDENT $ 500,00 (Mandatory n N )EXCLUDED` C',i N f A NH IS LISTED AS 3A STATE I E L DISEASE-EA EMP/OvFE a 500,00 (Mandatory m NH) If ves,dasaibe ur:der j 500,00 OESCR;PI ON r OPERATIGNS helow 1 E i. i)I SF4SF-PDL.IC:Y t.l'dIT "ro A Inland Marine IM9006615 1210512014 12105/2015 Rented 100,00 I Equip DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more apace Is required) Exclusio of Eecutive Officers a pl'e to FredericNi ori t'roJJect: el- arms.Agartmentsp 1t;Derry Streeet o Andover,MA. Pilot Cortstructio ,Inc.,North Andover HaIdin�qs.LLC;the olben Com oan ,Inc; Mlnco Development Corp.and David flA.U9hite,Architect are Additionaaal insureds on a primary, non-contributory basis on general liabtll for both CERTIFICATE HOLDER CANCELLATION PILOTCO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Pilot Construction 24 Ladd Street Portsmouth,NH 03801 AUTHORIZED REPRESENTATIVE O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD NOTEPAD: MOLDER CODE PILOTCO TAYL-29 PACE 2 1MsuRED's NAME Tayla Nixon Site Developers OP ID:SU Die 07120/2015 3o.ing and completed operations per forms GG2033 (4/13) and CG2037 13)and excess liabilityas required by written contract. Waiver of rogqation in favor of the addifional insureds is provided on the General Liability and Excess Liability as required by written contract. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-024109` FREDERICK CLM*KE 124 RANGE AVE: Lynn MA 01902 tj r aJ elf „ ?��'��` Expiration 08!25/2015 Commissioner