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HomeMy WebLinkAboutBuilding Permit #076-14 - 220 SUTTON STREET 7/22/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 7 �- IMPORTANT:Applicant must complete all items on this page LOCATIONA2 �V'ITU�'.1. ���W.12�r__ m. Print PROPERTY OWNER - �'•} Print -v 100 Year Old Structure yes no. MAP NO: t% PARCEL: ZONING DISTRICT` Historic District yes no Machine Shop_Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑Addition ❑Two or more family ❑ Industrial VAlteration No. of units: li<ommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic ❑Well El Floodplain El Wetlands ❑ Watershed District � ater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: �'�- Nola �Ori.�p•+����-E �v2 E • '�61�d� nc=_r2. ,lx.a :T0 KJ Identification Please Type or Print Clearix) OWNER: Name: 20 Phone: 178-AIS-855 Address: SOO CONTRACTOR Name:C'1WLet , Co o#J Cu , Phone:.178 .GU,--9SZC_ - - Address:--foo S.,• , -- - ._ nnu ter,_, �"-•(/` .__ _ Supervisor's Construction License: 605"711— ___Exp. Date: -J0 l3_ Home Improvement License: __ Exp. Date: ARCHITECT/ENGINEER aoK.4 T . gt�.1 n _ Phone: (*G2;,. S-93 - 4,613 Address: 'PC).130 Y 47-9 �- Reg. No. 4-$0& FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ '1-"15 , 000 •06 FEE: $ Check No.: 0�-' / Receipt No.: 6-e P(°T/ NOTE: Persons contracti ith unregis red contractors do not have access the guara and Signature of Agerit/O�wner Sigafure of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYP ,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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Fanning Board Decision: Comments G°. t5nse rvation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW'Toivo Engineer: Signature: Located 384 Osgood Street FIRE DEPARTML�iT =Temp Dtampster on site yes_. no Located at 124 Main Street . r Fire Departmer t-signatu"re/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 I DANCER 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 Doe.Building Permit Revised 2010 ` .i Building Department The fohowing 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 apr)aal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buhding permit Revised 2012 Location No. 7f� 'I Date 71-7011.3 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ �r. s r izr TOTAL Check# �6 6 6 4 ; BuildingElnspector r �,.tJ' Oi,NOF1M AN O N ♦ ^o �,S ACNUSf549 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 076-14 on 7/22/2013 Date: December 10, 2013 THIS CERTIFIES THAT THE BUILDING LOCATED ON 220 Sutton Street MAY BE OCCUPIED AS Northeast Rehabilitation — Tenant Fit UP IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: 220 Sutton Street LLC 200 Sutton Street North Andover, MA 01845 Building Inspector Fee: Pre Paid $100.00 Receipt: 26649 Check :1659 Ac-. A-A 04 N`ATN�h kJ � X78 ACItt15Et TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 076-14 on 7/22/2013 Date: December 5, 2013 THIS CERTIFIES THAT THE BUILDING LOCATED ON 220 Sutton Street MAY BE OCCUPIED AS Northeast Rehabilatation —Tenant Fit Up IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: 220 Sutton Street LLC 200 Sutton Street North Andover,MA 01845 Building Inspector Fee: PrePaid Receipt: 26649 Check :1659 ORTH . own of g ; - c . vel — h " ver, Mass, No. (5116 V o t a Coc NlC ht WecK%,- S ATED ,-SATED , BOARD OF HEALTH Food/Kitchen Septic System PERMI BUILDING INSPECTOR ............... THIS CERTIFIES THAT .......•.P�1.e�•• •••S ,f� Foundation �� Al ........................... Rough / 4^ .......... .�:.Y........... . has permission to erect.............................. buildings on . r G ney ............................... .. �............. ......... application to be occupied as .......... ....epti .......s Final , . p rovided that the person accepting this permit shall in eyed respect Laws relating to he Inspection Alteration and PLUMBING INSPiCTOR on file in this office, and to the provisions of the Codes an y ,- �� ` V/- -(A_ n Construction of Buildings in the Town of North Andover. Rough f ti VIOLATION of the Zoning or Building Regulations Voids this Permit. Final1z,N�-,�� r ELECTRICAL INSPECTOR PERMIT EXPIRES IN 6 MONTHS P ` _Roh _'�: UNLESS CONSTRUCTIO STARTS �� S vl e� BUILDING INSPECTOR GAS INSPECTOR Occupancy PermitRe�ui�'ed t® Occupy Building Rough Final [ Z7 la in a Conspicuous Place on the Premises- Do Not Remove + FIRE DEPARTMENT Display No Lathing or Dry Wall To. Be Done Burner Until Inspected and Approved by the Building Inspector. Street No. /� 3 Smoke De. �' SEE REVERSE SIDE Qt NORTN,ry 4 r r"19 M�SS.4CI�SEt TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 076-14 on 7/22/2013 Date: December 5, 2013 THIS CERTIFIES THAT THE BUILDING LOCATED ON 220 Sutton Street MAY BE OCCUPIED AS Northeast Rehabilatation—Tenant Fit Up IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: 220 Sutton Street LLC 200 Sutton Street North Andover,MA 01845 Building Inspector Fee: PrePaid Receipt: 26649 Check :1659 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost �� �©00.00 m $ - $ 3,300.00 Plumbing Fee $ 412.50 .......... Gas Fee 100 comm. $ 100.0Q< ................................ Electrical Fee $ 412.50 Total fees collected $ 4,225.00 220 Sutton Street 076-14 on 7/22/2013 Create New Tenant Space for NE Rehab NORTH 1 . ve. . No. � Z , LAKIIh , ver, Mass, Z CoCMICHIWICK S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .........a2.0 ................................................. BUILDING INSPECTOR c, has permission to erect buildings on 4p ©.......`� aM.......27, . Foundation �itr/C/�4 �1.1 l//� '/ ✓ '����s2 Rough tobe occupied as .......... ... ............... ... ............. .... .................................G_ ............ ...... ....... 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 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 CONSTRUCTIO STARTS Rough I I_� Service ............ .... ..�/.rr"' F. ... .. .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin_ 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. SEE REVERSE SIDE 11.+�.achu.ctt.- Department of Public �atell Board of Building Ret-vulatiom an(1 Standard. Construction Supervisor License License: CS 5712 STEVEN C MATSES 202 SUTTON ST { N ANDOVER, MA 01845 t i o-- J"'�' Expiration: 10/23/2013 ( --Milt i,,:mer Tr�-: 5888 The Commonwealth of lilassachusetts - Department ofIndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensations Insurance Affidavit:Builders/Contractors/Electricians/Plumbers .Applicant Information n Please Print Le0bly Name(Business/Organization/Individual): cgj Q �!,, Cjo.1tl&,Z::�noa CO T',. Address: 0 �✓v 1tb.� v, r�-r City/State/Zip: . LM A.L E M Phone#: Q 7 6 686 ' �4 S Z C Are you an employer?Check the appropriate box: Type of project(required): 1.Wam a employer with 4. ❑ I am a general contractor and I ' 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.z 7• E]Remodeling ship and'have no employees '.These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.E]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurance required.]i employees.[No workers' 13.[j Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. mac¢V&66 ,e S Policy#or Self-ins.Lic.#: 8'6 0AR LE'?-/3 Expiration Date: Job Site Address:- ZZ-V Syptj %2X2:?1TV City/State/Zip: JJ.p,j 4u*2t Attach a.copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office sof Investigations of the DIA for insurance coverage verification. Ido hereby certlo under thepains a(ntdpenaH�ies ofperjury that the information provided above is true and correct. Signature: �( ' `�—�" Date: 22 Phone#: 017 915 '855$ 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.CitylTown Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instruction's Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,- express or implied,oral or.written." An employer is defined as"an individual,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 dwellinghouse ha v g n'o't more than three apartments and who resides therein,or the occupant of the dwelling house of another who 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 be deemedto be an employer." - a MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required°' Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements ofthis chapterhave been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of-insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials -Please be,sure that-the affidavit is-complete-and rinted leg lY: The D e artm eriffias rovided a s ace at the bottom p p- p---- of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fillin the pem.Wlicbinse number which will be used as a reference nirinber. In•addit on;an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job 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 for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone anal fax number: The Commonwealth of Massachv.:se-tts Department of Industrial.Accidents . Qf�ice o�In•�estigati�o� , 600 Washington Stroot Boston,MA 02111 Tel,#617-727-4900 est 406 or 1.-877;MASSAFB Revised 5-26-05 Fa V 617-727;7749 VjVXW mace CrAv/41'a Noma ITOWN OF NORTH ANDOVER o} +``°. •'�.°off OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover,Massachusetts 01845 �ITS�cNust�� Gerald Brown Inspector of Buildings PROJECT LOCATION: 220 Sutton St NAME OF BUILDING: N/A SCOPE OF PROJECT: 4;346 sf rehab clinic retrofit. Office Use same as Previous use. In accordance with Section 107.6.2.2 I, John T Brennan Ma. Registration No. 4808 Being a Registered Professional Engineer/Architect hereby certifies that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL FIRE PROTECTION ELECTRICAL MECHANICAL I certify that I, or my designated representative, shall perform the necessary Professional Services and be present on the construction site on a regular and periodic basis to g determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Sec. 1701.1.1 (MA) but not limited to: 1. Review of Shop Drawings 2. Review and approval of the quality control procedures for all code-required controlled materials 3. Special architectural or engineering professional inspection of critical construction specified in the accepted engineering practice standards listed in Appendix B 4. Maintain and provide reports as outlined under Chapter 17.00 2009 IBC PURSUANT TO SEC. 107.6.4(MA) I, OR MY DESIGNATED REPRESENTATIVE, SHALL SUBMIT PERIODICALLY,, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE INSPECTOR OF BUILDINGS. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT, ALONG WITH AN APPLICATION FOR CERTIFICATE OF OCCUPANY, AS TO THE SATISFACT RY COMPLETION AND READINESS OF THE PROJECT FOR OCC �\S�EFED ARCy BAF i� No. 4808 Z I ignature IACTON MA T'yOFNASSA�