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HomeMy WebLinkAboutBuilding Permit #582 - 240 CHARLES STREET 4/1/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � Date Received Date Issued: /D IMPORTANT:Applicant must complete all items on this page :LOCATION , �-r Print - PROPERTY OWNER Print MAP NO RARCI ZONING DISTRICT Historic Distract = yes ' no+ . lMachme:S.hop Village ares 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: C 9000 Demolition Other y Septic -:Well .'" "' Flo = a , s odplam x" Wetlands : Watershed Distract' max. 4 .'K - •ri --+. .`�" _ i`g,.rR.a _ ..,tea+,x fi.''"; `+5: � 1:� »t��,-.r DESCRIPTION OF WORK TO BE PERFORMED: R�PL►�L� -H '�'�f�T�t�-2�lA�.. Cann t'�� f ,�.rr'�` t`.�9�1 �'���5�/�i, identification Please Type or Print arly) OWNER: Name: ,�u�efl ,1ecr Phone 7 (, k/2 t � Address: IL-10 C' p,L�-,5 `2Ee'- CONTRACTOFts Name a= ' �ti,4�i�t'cT►2>x r,� ll�l Phone ��n kt� 81 } 'Address.: �-�l b�A�tl7�r�.� �2 v ' �)= !� "1 .��..� • � 4- �' _�.�� �, �P i '��`� >< E.. r, x � 7s� Y 4.ea "�"aS 3T'i '�� r+' `�}£. �t°�,•�'`'.i.�s•fin}`•s.eW� b -'V h �-. 5upervisor's`Constru�etion License ` k R Exp .y,w - .-..K f ':1.a# . "X � +L`�- • i'; E 4 .s. i fi,� i .w' 4 :HoP-meam rovement°:License ' Exp. ARCH ITECT/ENGINEER SP.A i-4Sul LA-AKA-5 IPhone: Address: Ct,+ U)jp6f/! 2-16 &zST �Trzi Y si► ��?�MAReg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ , ,e, FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owne Signature of contractor i t Location ��ia 777-71 fY No. S�Z Date Mo^TM TOWN OF NORTH ANDOVER � 9 i Certificate of Occupancy $ Eta Building/Frame Permit Fee $ S Imus Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # �Z Building. nspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans public E OF SEWERAGE DISPOSAL 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 Planning Board Decision: Comments Conservation Decision: Comments Water&.Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE=DEPARTM.ENT `-TempaDpmpster on site yes ono y ` a , "F.1 Departrnent sigriatureldate t 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 i I ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 f _ 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 o 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) o 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 i Doc: Doc.Building Permit Revised 2008 NORTH OMM of ? 4 L Andover . No. 8L -_ �� Adower, Mass.,_`/T i I� COLAK E C LAKE ICK �ADRATED �`S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ a" !?✓`.... c,?.(U�....u� ........-S4ti �'f`2 )) ' �c ` ....!�lT..... .......... Foundation has permission to erect........................................ buildings on ...,q..z/o.....i� ?.4/ 1�.r... .................................... Rough to be occupied as.. �!`f/l3c .SOC' �. r! {�' �4�YS Chi ney ...........� . .. .. .......... ............................... provided that the person accepting this permit shall in every respect conform to the terms of the application 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 PENT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ..................... ..... ....��.`'`.............................................. Service BUILDING INSPECTOR 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 -i, -�_kuc_j Street No. SEE REVERSE SIDE Smoke Det. i KLE/NFELDER S E A Bright people.Right Solutions. I S E A CONSULTANTS INC. February 23, 2010 Mr. Gerald Brown Town of North Andover Building Department 400 Osgood Street North Andover, MA 01845 RE: Greater Lawrence Sanitary Distrlct(GLSD) GLSD Project No. 2009-3, Energy Efficiency Project S E A Reference No.: 2009240 Dear Mr. Brown: This letter is to certify the following: 1. S E A Consultants, Inc. is assisting the GLSD with the technical oversight of the above-referenced construction contract, 2. To the best of my knowledge, the design conforms in all respects to the Massachusetts Building Code and applicable Federal Regulations. 3, In accordance with Articles 110,12 and 116,2,2 of the Seventh Edition of Commonwealth of Massachusetts State Building Code(780 CMR), this is to certify that I am a Massachusetts Registered Professional Engineer, and that I will be responsible for carrying out the duties specified in 780 CMR 116.0 (Controlled Construction), Respectfully yours, S E A CONSULTANTS INC, #a+ �IJ�� Mark J. In Mark P.E. cc: Mr. Richard Weare, GLSD file 215 First Street,Suite 320,Cambridge,Massachusetts 02142 T.617.497.7800 F:617.498.4630 wwwseacon.coni Cambridge,MA • Framingham.MA • New Redford.I[A Augusta.MF.. 0 Manchesler.NH • Rocky Hill.CT KLE/NFELDER S E A Bright People.Right Solutions. ,^ ._a. 5 E A CONSULTANTS INC. December 23, 2010 Mr. Gerald Brown Building Department Town of North Andover 120 Main Street North Andover, MA 01845 RE: Greater Lawrence Sanitary District Energy Efficiency Upgrades, Contract No. 2009-3 Dear Mr, Brown: Kleinfelder/S E A designed and performed Construction Administration services for the above- referenced project, The project was designed in accordance with the Massachusetts Building Code. To the best of my knowledge, information and belief the construction has been completed in conformance with the plans and specifications and the Massachusetts Building Code, The project was substantially complete on November 17, 2010. Respectfully yours, KLEINFELDER/S E A CONSULTANTS Mark I Thompson, P,E cc: Mr. Richard Weare, GLSD Ili1 'i t )in 215 First Street,Suite 320,Cambridge,Massachusetts 02142 T:617.497.7800 F:617.498,4630 %1A • 1 r" lingharn,MA 0 New fk lord.Al,' Au ui,ME 0 N-lancw�ler,N11 0 Kock hill,C1 contracting, inc. 12/27/10 10 Nutmeg Drive Ellington, CT 06029 (860) 870-8100 phone (860) 870-9554 fax Mr. Gerald Brown Building Department Town of North Andover 120 Main Street North Andover, MA 01845 RE: Greater Lawrence Sanitary District Energy Efficiency Upgrades, Contract No.2009-3 Dear Mr. Brown: Delray Contracting, Inc. constructed the above-referenced project. To the-best of my knowledge,information and belief the construction has been completed in conformance with the plans and specifications and the Massachusetts Building Code. The project was substantially complete on November 17,2010. Respectfully yours, Joseph Huffman Project iviCnager Delray Contracting, Inc specialiiing''in Wasfewater treatment facilities & pump stations •general contracting S E A 5 E A CONSULTANTS INC. 56enrisls/En9ineers/Ar6ilec,s LETTER OF TRANSMITTAL S E A Consultants Inc. 1.800,489.6689 www,seacon,com i TO: DELRAY CONTRACTING DATE: 1/28/2010 TRANS NO: 001 10 NUTMEG DRIVE JOB NO: 2009240.02-A ELLINGTON,CT 06029 ATTN; MR.JOSEPH HUFFMAN RE: MA CONSTRUCTION CONTROL AFFIDAVIT GLSD-CONTRACT 2009-3 WE ARE SENDING YOU UPS GROUND the following items; ❑ Prints ❑ Invoices ❑Shop Drawings ❑Specifications ❑ Reports ❑ Disk(s) ❑ Copy of Letter/Memo ® Other COPIES DATE DESCRIPTION 1 1/28/2010 Affidavit THESE ARE TRANSMITTED. ❑ For approval ® For your use ®As requested ❑ For Review&Comment REMARKS Joe, Enclosed is the Affidavit per your request. Regards, S E ACONSULT TS INC. Copy to: file f S DAVID T.PETER ON,P.E. MASSACHUSETTS CONSTRUCTION CONTROL AFFIDAVIT PROJECT: Greater Lawrence Sanitary District,Energy Efficiency Project, Contract No..2009-3 LOCATION: 240 Charles Street,North Andover, MA In accordance with Articles 110.12 and 116.2.2 of the Seventh Edition of Commonwealth of Massachusetts State Building Code (780 CMR),this is to certify that I am a Massachusetts Registered Professional Engineer, and that I will be responsible for carrying out the duties specified in 780 CMR 116.0. January 27,2010 Signatur i Date Mark J. Thompson Name (Print) Discipline: Civil/Sanitary 9r, MARK yv, J. m THOMPSON No.30505 Massachusetts Registration Number Registration Seal \1FILE0\Data\_clientsMatertown MA0001583.01 A1CansMaction AdministrationWtidavitslMass_Afdavit_Template.doc D f . f STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION Be it known that DELRAY CONTRACTING INC 9„LAKE LANE ELLINGTdN, �T' 06029 { .y f ' i is certified by the Department of Consimer Protection as a 1dIAJ0 `GONUAPTOR V,f �� • ' Registrat 0.0900004 Effective: 07/01/2009 - 1 Expiration: 06/30/2010' `` ? Jerry Farrell Jr. __._._,__. J- ry__ Commissioner � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations .,600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ��j Address: 10 City/State/Zip: Phone#: Are you an employer?Check the appropriate Ox. Type of project(required): 1.❑ I am a employer with 4. GK I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet $ ?• ❑Remodeling _ ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp,insurance. g. ❑Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required] 13.0 Other `Amy applicant that che•__z boy#1 must also fill out the section beio w 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ' Policy#or Self-ins.Lic.#: Q 0 /� Expiration Date: A t � � Job Site Address: o` Ct City/State/Zi . �D v8rQ Attach a copy of the workers'com nsation 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 vi a advised t a copy of this statement may be forwarded to the Office of Investigations of the DIA for' ance coverage verificatio . I do hereb erkfy u� er the ains d penalties of perjury at the information provided abov is tr and correct Si ature: © ,l Date: d I d Phone#: O V' (�/ !'� Official use only. Do not write in his 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#: Information and Instructions 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 of hire, 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 dwelling house having not 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 deemed to be an employer." 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 of this chapter have 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-contractor(s)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 may be 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 m the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom 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 fill in the permit/license number which will be used as a reference number. In addition,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. A new 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 and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investibations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 wvvw.mass.govfdia NORTH T0VM of 19 over ..... No. gL = AKE dover, Mass., � COCMICMEWICK �� 7 ADRATED PPS` �5 '9S fc BOARD OF HEALTH Food/Kitchen Septic System PERMIT T BUILDING INSPECTOR THIS CERTIFIES THAT........C.��rpt.��� �'`�' ���`'`=�` S(4"r 44�......................................... .....` .. �1�`T/'.!G .......................... Foundation has permission to erect........................................ buildings on....��. ��.....5...:AG/-^lr�f... .................................... Rough to be occupied as........... ' r/ rlP/YS..................................................................... 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 CONSTRUCTION STARTS Rough Service . .�/ ............................................. BUILDING INSPECTOR Final Occupancy Permit Required to Oca tpy 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.