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HomeMy WebLinkAboutBuilding Permit #187-2011 - 19 High Street 9/6/2011 TOWN OF NORTH ANDOVER / APPLICATION FOR PLAN EXAMINATION Permit NO: /?7, 2o// Date Received Date issued: 1 //1 NdP RTANT:Applicant must complete all items on this pLge LOCATION_\91" =s- (� x 1 cg N't i 0 . A Vrant PROPERTY OWNER • lam. �G ►y . P , H, I Print MAP NO: PARCEL: �9 ZONING DISTRICT: Historic District es no Machine Shop Villag y s no TYPE OF IMPROVEMENT PROPOSED USE Residential No7'rde7ntial ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ &Alteration No. of units: ❑ ❑ Repair, replacement ❑Assessory Bldg ❑❑ Demolition ❑Other __trict El Wata/si wor DESCRIPTION OF WORK TO BE PERFORMED: LTS1�— M K— 2 trt.Y C-Z e t- f (Identification Please Type or Print Clearly) OWNER: Name: b u 10,s . Address: �� I u �M Zb- CONTRACTOR Name: �G L%4z".VQ Phone: Address: �'� (L\ C-µ qy etc 4 Supervisor's Construction License: CS 12A-1,2 Lk— Exp. Date: ii Home Improvement License: Exp. Date: j ARCHITECT/ENGINEER LbVT �.G 1 _Phone: h 1-7—li-z,3- 0LZ-Icy Address: 3 `JG A Cg e Q Reg. No. 1 0 (0 d FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ (t�. � }-Q -�" FEE: $_ I -L- Check Check No.: 1 -2, 60 6 Receipt No.: ©? S-41,S' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SignatureofAgent/Qwnera} ._ 4 _F_' Sgnatureofcontractor `: -_ 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 I i 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 Dumpster on site yes no Located at 124 Main Street Fire Department signature/date l 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 U Notified for pickup - Date L Doc:.Building Permit Revised 2008mi 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 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 o 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 I"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: Doc.Building Permit Revised 2008mi Location No. ';?p Date �ORTM TOWN OF NORTH ANDOVER 0� .•o y��y f s a � s Certificate of Occupancy $ CMU sEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1114 i J 24545 //B 'lding Inspector NORTH ® Of 0% No. a2® // O ~- l A K E O , dover, Mass., 1.1- z1z; COCHICHEWICK ORATED P'' S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... ��, -��..../Y..r!$:.... °`7�:1�. ..r...... ..G................................................................. Foundation has permission to erect........................................ buildings on .,/7`�. .... j!... .......5 ............................................... Rough ��� to be occupied as........ � �.✓..jt. .C.e�.r• -�r`�':G�Cf..`'°'' ... ................. Chimney .. . .. . ............:.:............:. ....................... provided that the person accepting this permit shall in every respect conform to the terms the applic ion on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION 5TARTS Rough Service ��$IIILDING 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. I 1 2 i 30'-51/2" ® A FINISHES TO MATCH EXISTING STORAGE ROOM,PAINTED GWB WALLS&CEILING(BETWEEN BEAMS)LIGHTING&ELEC TO 7 SCOPE OF WORK LINE ® MEET CODE REQUIREMENTS. DRY STORAGE F"�B1-004 FITO��G�7E L---JI----JKITCHEN NEW DOOR B DINNING ROOM i B1-003 --------- -- - --- -------------------- 1 CAFE EXPANSION PLAN ED A?o 40 hEWSuFNIPcr MAss. ddA OF c CAFE EXPANSION PLAN U r ' H 1 L L Sheet Issued Drawing Number Project Issued 08/24/11 SK01-R ARCHITECTURE ENGINEERING INTERIOR DESIGN LANDSCAPE MASTERPLANNING AUG 5,2011 303 Congress Street 6th Floor Boston,MA 02210 Scale Project No. RCG North Andover Mills LLC TEL: 617 423 4252 FAX:617 423 4333 ©BURTHILLINC. 1/8"=1'-0" 07804.19 Good Day Caft Expansion 600 square feet Fit Out Schedule 8/16/2011 DIV Description Work Budget 1 General Conditions Dum sters, cleaning, supplies $ 1,000.00 2 Demolition Demo existing flooring, lighting and select walls perplan $ 560.00 6 Insulate Walls Insulate new walls per plan $ 500.00 8 Doors&Windows Leave existing hallway configuration and add doorway to kitchen $ 500.00 9 Ceiling Install d all ceiling $ 1,000.00 9 Tape/Prime/Paint Provide painted finish for all drywall finish walls perplan $ 1,200.00 9 Storage Area Flooring Provide new VCT flooring $ 1,800.00 15 HVAC Distribute ductwork to heat and cools ace. $ 500.00 16 Electrical Provide subpanei and new outlets and reattach existing lighting with shielded bulbs $ 2,400.00 Subtotal $ 9,460.00 19 RCG Builders fee RCG Builders fee $ 1,419.00 Total Total $ 10,879.00 Plus Building Permit Plus Building Permit $ 132.00 vrrica t.rr CUILUINU iNsrtt:I UK E �' TOWN OF NORTH ANDOVER 3.1 � �y. CONSTRUCTION CONTROL PROJECT NUMBER: 07804.19 ¢ c PROJECT TITLE: Cafe Expansion Plan LA �- PROJECT LOCATION: East Mills North Andover, 45 High Street NAME OF BUILDING: 45 High Street �a g a room Extension of Tenant Space to create storage 9 NATURE OF PROJECT: � IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, ,I,— Lw-)-VA 5. 5H/L'Qy REGISTRATION NO.—Z00L BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL IX STRUCTURAL ❑ MECHANICAL ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 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. Be present at intervals appropriate to the stage of construction to become,generally familiar with6the progress and quality of the work and to determine, in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK,I SHALL.SUBMIT A FINAL REPORT AS TO THE r SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCC ANCY. 0. SAATR SUBSCRIBED AND SWORN TO BEFORE ME THIS � ' DAY OF use I^14 2,0 NOTARY PUBLIC MY COMMISSION EXPIRES 4��13 4 s� wTor 13 ila No .• 1S 1i� Client#:29552 R OU ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE IMMrDDnrnrY, PRODUM 8122/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE MARKETING AGENCIES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 306 MAIN STREET HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Worcester,MA 01608 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 508 753- INSURERS AFFORDING COVERAGE INSURED NAIL S RCG LLC INSURERA Philadelphia Insurance Companie 23850 17 Ivaloo Street,Suite 100 INSURER e: Wesco Insurance Company 25011 Somerville,MA 021433658 INs"RERC: INSURER O: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING MAY PERTAIN THE INSURANCE AFFORDED B ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR Y 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. TYPE OF INSURANCE POLICY NUMBER POULT A GENERAL LIAe1LRrUlm PHPK697768 03=11 2i"" $1,000,000 X COMMERCIAL GENERAL LIABILITY $1 0000 CLACK MAX R OCCUR $1000 RSONAL&AM $1 000 1000 CETT I AGGREGATE LIMIT APPLIES PER: GENERA<AGGREGATE s2 000 000 PWCY O LOC PRODUCTS-COMPIOP AGG s2 000 000 AUTOMO�LE LIABILITY ANYAUTO COB SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULEDAUTOS BO(PeLP I INJURY $ HIREDAUTOS NON-0WNEDAUTOS ILL TRY s M.PERTYIDAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY-EAACCIDENT $ OTHER THAN EAACC $ AUTO ONLY: AGO S �LIABILITY OCCUR EACH OCCURRENCE $ CLAIMS MADE —•- AGGREGATE $ DEDUC7IBLE s RETENTION s $ B WORKERS COMPENSATION AND W WC302159805115/11 05H 5h2 X WC STATU- OCH- $ EMPLOYERS'LIABILITY ANY ETOR EXCLUDED? fITVE EL EACH ACCIDENTs500 000 OFFICERIMEIABER ExcLUDED'! I deaasa wxw E.L.DISEASE-EA EMPLOYEE $50,00 OTHER EL DISEASE-POLICY LIMIT s500 000 GWAPnON OF OPERATIONS I LOCATIONS I VES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECW PROyISgNg TATIFICATE HOLDER CANCELLATION 10 Dm for Non-Payment Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE OWMTKNN 1600 Osgood Street DATE THEREOF,THE MUDS NORM WILL ENDEAVOR TO NAR 21L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAND To THE LEFT,BUT FAILURE TO DO SO SHALL North Andover,MA 01845 NPOSE NO OeLKIATKIN OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENfAIWEL AUTIORM REPRESENTATIVE CORD 25(2001M)1 of 2 *S2182720218270 GCE a ACORD CORPORATION 1988 vepanment of lnausi M Acctaents Office of Investigations kv . 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 6— Address: –Address: I .—= V A "o ��i V i t`� 0 City/State/Zip: So t` iyw JL b q,% d_-I 4"? Phone #: b 1'? — f Are you an employer?Check the appropriate box: Type of project(required): 1.,f l am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. workers' comp. insurance. 9. Q Building addition [No workers' comp,insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§](4),and we have no 12,Q Roof repairs insurance required.]f employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site information. Insurance Company Name: is cf- v VUPrArl? 1 Policy#or Self-ins.Lic.#: W W 'a ��`,�9 Expiration Date: �� � a.-© vt_ Job Site Address: eat CM 4 �� f9wot�y City/State/Zip: a Wd OU Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 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 WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cern under the pains and penalties ofperjury that the information provided above is true and correct. Si ature: Date: 6 I O Phone#: �" .�~ L -- -�--�-� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#•