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Home My WebLink AboutBuilding Permit #370 - 21 HIGH STREET 11/9/2007 yORTH BUILDING PERMIT 00 TOWN OF NORTH ANDOVER 02 a'7•'• _ O� APPLICATION FOR PLAN EXAMINATION o ey Permit NO: Date Received '�S9p°gArgo•°°'`4`� 9SSACHus Date Issued: �- - IMPORTANT Applicant must complete all items on this page - LOCATIQ'N `L-1 PRUPERTY-O NER "bwM •t ,�C�i�:�r� P �c--C_ . Pnnt MAP NO PARCEL:-, ZONING DISTRICT Historic District yes no Machine,Shop\/�Ilage :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 ep ic: IyUell - Floodplain Wetlands IlVatershed Distract Water/S:ewet uf _ . DESCRIPTION OF WORK TO BE PREFORMED: s ti o S F >e,�c`re Jul -I A-4)1,a(j-u- C i<�i� a4 t c—ra-61Y) � mr&v I IJ til Identification Please Type or Print Clearly) OWNER: Name:��no— �"r ac�c.- Phone: Address: 1-7 r CONTRACTOR Name di 1 Phone Aticlress j -t _ y a _ 4 Supervisor's Construction License �.� 6 Exp Date Home.provemenl1icense. r =E p. Date, i n ARCHITECT/ENGINEER Ugig Phone: a �u,-�G>-�Gc. Q�f -I `� Re No. l 0 a � Address._ �• I FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ b u o `-� FEE: $ �- I ` Check No.: 0 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of Agent/Qwner: � Signature of contractor-:: - 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 c 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 Located at 384 Osgood Street 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 de artment 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 i 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 d must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 ot Location % h No. Date E 4011ThTOWN OF NORTH ANDOVER ` F O�t . o Certificate of Occupancy $ s' •Eta Building/Frame Permit Fee $ ACMUS Foundation Permit Fee $ t Other Permit Fee $ TOTAL $ Check # 20765 ��--- Building Inspector i CONTRACT SC/PO No. N13000-TR0010-1 DATE: 06-Nov-07 Job No. NB 17 Ivaloo Street Somerville,MA 02143 ALL PACKING SLIPS,PKGS_INVOICES MUST BE MARKED WITH ABOVE P.O. JOB NUMBERS TRADE CONTRACTOR: PROJECT: Troy&Son Inc Nelson Bach Office Fit-Out 532 Adams Street 21 High Street Milton,MA 02186 North Andover,MA TRADE CONTRACT WORK:I Demolition AGREEMENT CONDITIONS: Provide all labor&material to demolish approximately 9,000 sf of the Nelsons Corporation Headquarters Include: Remove all carpet Remove existing walls Remove wall infill within brick walls Remove and properly dispose of all debris generated by the work of this trade Relocate reception desk,if feasible Temporary dust barriers separating spaces adjacent to the demolition area are to be by this contractor. No additional dumpsters by the general contractor are anticipated for this operation Leave all work areas clean and acessible at end of each work day. All lighting fixtures to remain All window treatment to remain MANDATORY ATTENDENCE AT SAFETY MEETING EVERY MONDAY @9 AM[ALL PERSONNEL MUST ATTEND].THERE WILL BE A FINE OF$100 PER ABSENCE ENFORCING THIS REQUIREMENT ADD ALTERNATE:Remove and properly dispose of all lighting fixtures-$1,000.00 ALL REQUISITIONS SHALL BE SUBMITTED ON AN Cost Breakdown APPROVED AIA G702 APPLICATION&CERTIFICATE FOR Spec Section Description Award Amount PAYMENT. NO PAYMENTS SHALL BE MADE OTHERWISE! 02050 Demolition $6,000.00 FURTHERMORE, NO PAYMENTS SHALL BE MADE UNLESS THIS FORM IS RETURNED EXECUTED! TOTAL CONTRACT VALUE: 6 000.00 Troy&Son Inc 16te RCG Builders LLC Date SEE ATTACHED FOR TERMS AND CONDITIONS NORTH 0 0 : tAndover 0 �, A. w ', No. Q __ 31 A E dower, Mass., • COCHICHEW1CK V 7�AERATED APS\ `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....N.�..... J� r... ` ..., Foundation has permission to or . buildings on.....401. M. . .14�.................... Rough 0T. . to be occupied as.:...... ..��!�►...�...........�..... ....................I.�......................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S Rough ............... Service BUILDING Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ThP Commonwealth of Massachusetts : Department of Fire Serv;;�:as _ Q ce o tie State Fire Marshal, P O.$oma l025 o� State Roac Stow,MA 01775 North Andover Dace. A'ermit No (Gitg of Town) (If Applicable Dig Safe Nnm er In accordance with theprovisions ofNE GI 14 8 cb4tcr1Q_as.provided in section 7 7 r y� l/ R 3 4 start Dace /T This Pesimt is granted to.. Full name ofpersoq Fum Or Corporation Pertnusionto locate dumps,ter. for. construction/renovation/demolition of building. Comments dumps.ter must be , 25 ' from structure if unable to lace with required Resirictzons:clearance dumps-ter must. :be covered with DlvwOod or tar end of work d at. a Y (`Give location by street and no. des�Cf sh.m r r is adequate identification of location) Fee Paid S 50-00 Fire Chief This Pemut will cxpir% Signature of olfical granting permit) Offical granting.p'crrrii[ (Title) NOTICE NOTICE if 6d 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 5005531012007 05/10/2007 - 05/10/2008 POLICY NUMBER EFFECTIVE DATES 24 Federal Street 4th Floor Boston Insurance Brokerage Inc Boston, MA 02110 (617)556-7000 NAME OF INSURANCE AGENT ADDRESS PHONE RCG Builders LLC 17 lvaloo Street-Suite 100 Somerville, MA 02143 EMPLOYER `` ADDRESS —V`�� M� r`�c►.i�f� �� 03/19/2007 EMPLOYER'S WORKERS OMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee 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 that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER � 1! BoaAd of B'Wldmgmgg� oo�andpSta� ._. ! Construction Supervisor License' LM No CS 663 �! BirthIN ZA 9 26/,1956, L = t Frat�on g/28�20Q9 Ti# 3'060 ke�riCt►�n- 00� KIERAN T•WHE Fz"' f 31 RICHMOND ST j _ WEYMOUTH,MA 0218fc � Commissioner