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HomeMy WebLinkAboutBuilding Permit #009 - 21 HIGH STREET 7/3/2008 BUILDING PERMIT o` pORTf/ +°-?�4t •6 oio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 009 Date Received ^Too �SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION_- 'P. �ti�tt J'�i �1y 0e �v� o nu�7n 1 Print PROPERTY OWNER R, C-•G- tiOvvs� l .> ,i U--L. Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village a 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: emoIition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: ur K 0 W W L.>- S tg QA5 YL- 1 4 t Identification Please Type or Print Clearly �� r OWNER: Name: 1 �g��D .�rsl�Q�cN 2 C.G. N�tiaJ� Phone: b s � --62r 9316 ft Address: °7 Zv %,a a ,el-15, ®d S4 Hd-ruvtc.� 0 -LI CONTRACTOR Name: K'Si►'l,l" K&-'<5r4 Phone: 6 tZ Address: 7 l (Z4(-hn% W 40 .��� W d-W110JCtl.4, OZ,r , Supervisor's Construction License: r" 6 b 3 �- Exp. Date: "L.0( Home Improvement License: I" 0 g�: co 0 Exp. Date: ARCHITECT/ENGINEER K"LSn I&I&N I&C Phone: 6 l2 �cS (`�6 d Address:Scr S tl 0 , l - ,Lv h G' p?" I'e'eq. No. 6 ©�"-Z-- FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0 0 FEE: $ -? a Check No.: 2 S-6 S^Z Receipt No.: -?/ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor J ' I 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments f Conservation Decision: Comments Water & Sewer Connection/signature&Date Driveway Permit f Located at 384 Osgood Street i FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department 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 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 2007 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. Date 7i 9 �aRTM TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ bass,^°• NUttn Building/Frame Permit Fee $ S AC S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t s C / Building Inspector 72. a. ` Board of BuDdinL ILegnlatiom and Standards '} • ` � � ,_ Con$huclion Supe rvisor LiCehae 4' Jl `� : CS 66334 -- Birthdate: VM1956 R ; 9009 Tr# 3960 Restriction: oo � r KIERAN T WHEI.AN i I 31 RICHMOND ST WEYMOUTH,MA 02188 Commissioner 'I N° FD 5932 ? I Date�-:✓4..'..C.�� r►Owrry,� TOWN OF NORTH ANDOVER h � °off.�',•e• RECEIPT SSACHUB�� f This certifies that �.. • 7........... has paid...... ...0 �......... for ....................... Received . ... .. .. . ,j���6!��Q'?��,F7••Saar-G.�................. Department...../�' ........................................ ......... WMITE: Applicant CANARY:DeoartmeM C PINK:Treasurer NOTICE NOTICE TO - : TO EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL. ACCIDENTS 600 Washington Street,Boston,Massachusetts 02111 617.727-4900 As required by Massachusetts General Law,Chapter 152, Sections 21,'22 & 30, this will give you notice that I(we)have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED EMPLOYERS INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE P.O. BOX 4070 BURLINGTON MA 01803-0970 ADDRESS OF INSURANCE COMPANY WCC 5005531012008 05/10/2008 - 05110/2009 POLICY NUMBER EFFECTIVE DATES 24 Federal Street 4th Floor _Boston Insurance Brokerage Inc Boston, MA 02110 (617)55&7000 NAME OF INSURANCE AGENT ADDRESS PHONE RCG Builders LLC 17 Ivalon Street-Suite 100 Somerville, MA 02143 EMPLOYER ADDRESS 03/10/2008 EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREAT RM' The above named insurer is required in cases of personal injuries arising out of and in the course of employment to fainisb adequate and reasonable hospital and medical services in accordance with the provision.of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injoted employee. The emplayee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the.-insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified dud the Insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER Distribution to: -David Steinbergh CHANGE ORDER RCG North Andover Mills LLC RCG Builders LLC -Skip Rose Change Order Number: 9 East Mill-Common Areas 21 High Street Initiation Date: 02-Jul-08 North Andover,MA BLDNCOM Architect's Project No.: Contract For: Lobby Renovations FCG North Andover Mills LLC TO: 17 lvaloo Street (Contractor) Somerville,MA 02143 Phase: -Common Area Improvements/Sitework Contract Date: 12-Jul-07 You are directed to make the following changes in this contract as a result of approved Change Estimates: Amount CE# Date Approved DESCRIPTION Selective Demolition for Southwest Corner-Building 3 $2,000.00 28 7/2/2008 Provide demolition services for the southwest corner of Building 3 in preparation for new restaurant $0.00 General Conditions: Fee: $0.00 Total: $2,000.00 Total AIA Change Order Amount: $0.00 $188,301.31 The original Stipulated Sum was authorized Chane Orders $119,159.53 previously b et change b Y Then g YP The Stipulated Sum prior to this Change Order was $307,460.84 The Stipulated Sum will be unchangedby this Change Order $0.00 The new Stipulated Sum including this Change Order will be $307,460.84 ( )days The Contract Time will be unchanged RCG North Andover Mills LLC RCG Builders_ _ LLC_ ... ___ .... .- CONTRACTOR OWNER 17 lvaloo Street 17 lvaloo Street Address Address Somerville,MA 02143 Somerville, MA 02143 BY BY / DATE 7/2/2008 DATE NORTH c T0 0Andover No. O D -- C,O - LA ©L dover, Mass., COCHICMEWICK �AD'QA T E D '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System / BUILDING INSPECTOR THIS CERTIFIES THAT........... � ... . ..1.7 ......P.. '1.:.. �. / / .1�. 4r...................................... Foundation has permission to erect........................................ buildings on . l".1. �/ .....S..r.......................................... Rough F t0 be OCCUpled as........................ `��Q..�.......... ?. ..rt^............,�Jl/�lkzf.................. :/t�/.. 0... himn y C e 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 AMN7 S UNLESS CONSTRUCTITS ELECTRICAL INSPECTOR Rough .............................................................................................................. Service BUILDIN SPECTOR 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. r.Y; l� .f -.S ,1.r. .^.,,:;::.vi Jr•.' :f?•,..r. 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