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HomeMy WebLinkAboutBuilding Permit #779-12 - 240 CHARLES STREET 4/27/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: ' Date Received 41 Date IMPORTANT: Applicant must complete all items on this page I _LOCATION Q 4q C_k ,,Na c_5 -S+. (Q. A o boo& 2 0 A. Print PROPERTY OWNER (, a.&- Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes 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: ❑ Demolition ❑ Other }` 11O ods -lain ` ®Wetlands ' �f r- '`l ap �' " .. .�a �-I ''€��2�' ., .fF �c. c �, r 0 �AWa ershedtDi� IN -1 �y rr �sR �?vsaa s� '`''a�� �_.��� � ��..° i5 ��-� DESCRIPTIO OF WORK TO BE PERFORMED: Sn�-t( (\EcJ C:(*�rz; crL €© rnc•y i+� 5"� (� �nc b��;a(� AC -21}4-& ati , i n54-oq Svcs- (Identification Please Type or Print Clearly) OWNER: Name: (7 nE Pt -6--vt V.�w) ILC -N( -F- ; any �; 5 � �Phone: q 72 X8.5 14p a - Address: c;?40 �R•�;QIE7r2 MA ©\,�� 4 CONTRACTOR Name: ME koi=r\1 6. Phone: /,,CLS3,E a Address: _-S VA` c ryl Supervisor's Construction License:- C 74:,,-,V4 Exp. Date: 9 `o>d Home Improvement License: Exp. Date: ARCHITECT/ENGINEER '`_� �G H� _ � � �` �� Phone: "Z o-1 " '7 ZS- X72-1 Address: '-I S �,J ASN k P G7 00 -.DS -N, ?0C-��"-r\,_A iM E Reg. No. FEE SCHEDULE. B ULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 1,56, ov FEE: $ Check No.: �'�� Receipt No.:`�'� 2 - NOTE: NOTE: Persons contracting with unregistered contractors do not have access to.the guaranty fun Location R7 � No. 7 7/ �� 2 Date `Z ?1112 - TOWN 12 TOWN OF NORTH ANDOVER �.- Certificate of Occupancy $ Building/Frame Permit Fee $-j et Foundation Permit Fee $ Other Permit Fee $ � E1) TOTAL $ Check #-/ 25242ildi°iig Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ 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 PLANNING & DEVELOPMENT COMMENTS DATE REJECTED J DATE APPROVED 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: Conservation Decision: Comments Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date Located 384 Osgood Street no 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 Doc:.Building permit Revised 20117une/mi 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 a 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) o 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 E, Workers Comp Affidavit o 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 MOTE: 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 WRIGHT—PIERCE Water Wastewater Engineering a Better Environment Infrastructure June 17, 2013 W -P Proj. No. 12284E Mr. Gerald Brown, Building Commissioner Division of Community Development & Services Town of North Andover 1600 Osgood Street, Building 20 North Andover, MA 01845 Subject: GLSD Primary Clarifier and Aeration System Improvements Town of North Andover Building Permit No. 779 Engineers Construction Control Affidavit Dear Mr. Brown: In accordance with Article 116 of the Massachusetts State Building Code, Wright -Pierce is the engineer responsible for construction control of the GLSD WWTF Primary Clarifier and Aeration System Improvements Project (Building Permit No. 779). I am the licensed engineer responsible for managing construction control on this project for Wright -Pierce overseeing all disciplines including structural, mechanical, and electrical. I am also the licensed engineer that directly supervised the preparation of all design plans, computations, and specifications in accordance with applicable provisions of the Massachusetts State Building Code. Wright -Pierce, through its representatives and agents has performed construction control in accordance with the requirements of 780 CMR 116.2. These services included the following: 1. Reviewed for conformance to the design concept, shop drawings, samples and other submittals which were submitted by the contractor in accordance with the requirements of the construction documents 2. Reviewed and approved of the quality control procedures for all code -required controlled materials. 3. Provided inspection services by a resident project representative, and carried out supplemental site inspections by licensed engineers to become generally familiar with the progress and quality of the work and to determine, in general, that the work was being performed in a manner consistent with the construction documents. 4. Reviewed start-up reports on systems throughout construction. We have completed inspections of the Project and all interrelated construction elements by all building design disciplines. To the best of our knowledge, information, and belief based on our construction control efforts, the Project and all interrelated elements have been completed in a satisfactory manner in accordance with the requirements of the Contract Documents and the Massachusetts State Building Code. Offices Throughout New England I www.wright-piercci.com 99 Main Street Topsham, ME 04086 USA Phone 207.725.8721 1 Fax 207.729.8414 , "`f Brown 6-17-13~" Page 2 of 2 Please feel free to contact me if you have any questions in regards to this matter. Very truly yours, WRIGHT-PIERCE Jeffrey R. Pinnette, Mass. P.E. No. 35236 Project Manager cc: Richard Weare, GLSD Jason Babbidge, Methuen Construction Co. ti RIGHT -PIERCE Water Wastewater Engineering a Setter Environment Infrastructure June 17, 2013 W -P Proj. No. 12284E Mr. Gerald Brown, Building Commissioner Division of Community Development & Services Town of North Andover 1600 Osgood Street, Building 20 North Andover, MA 01845 Subject: GLSD Primary Clarifier and Aeration System Improvements Town of North Andover Building Permit No. 779 Engineers Construction Control Affidavit Dear Mr. Brown: In accordance with Article 116 of the Massachusetts State Building Code, Wrigbt-Pierce is the engineer responsible for construction control of the GLSD WWTF Primary Clarifier and Aeration System Improvements Project (Building Permit No. 779). I am the licensed engineer responsible for managing construction control on this project for Wright -Pierce overseeing all disciplines including structural, mechanical, and electrical. I am also the licensed engineer that directly supervised the preparation of all design pians, computations, and specifications in accordance with applicable provisions of the Massachusetts State Building Code. Wright -Pierce, through its representatives and agents has performed construction control in accordance with the requirements of 780 CMR 116.2. These services included the following: 1. Reviewed for conformance to the design concept, shop drawings, samples and other submittals which were submitted by the contractor in accordance with the requirements of the construction documents 2. Reviewed and approved of the quality control procedures for all code -required controlled materials. 3. Provided inspection services by a resident project representative, and carried out supplemental site inspections by licensed engineers to become generally familiar with the progress and quality of the work and to determine, in general, that the work was being performed in a manner consistent with the construction documents. 4. Reviewed start-up reports on systems throughout construction. We have completed inspections of the Project and all interrelated construction elements by all building design disciplines. To the best of our knowledge, information, and belief based on our construction control efforts, the Project and all interrelated elements have been completed in a satisfactory manner in accordance with the requirements of the Contract Documents and the Massachusetts State Building Code. Offices Throughout New England I www.wright-pierce.com 99 Main Street Topsham, ME 04086 USA Phone 207.725.8721 1 Fax 207.729.8414 w Brown 6-17-13 Page 2 of 2 Please feel free to contact me if you have any questions in regards to this matter. Very truly yours, WRIGHT-PIERCE Jeffrey R. Pinnette, Mass. P.E. No. 35236 Project Manager cc: Richard Weare, GLSD Jason Babbidge; Methuen Construction Co. U) m m m �o m VI mm _v, C � _ = Ly y Cl) CD n Z y CDo-o CL c CL CO) O 0 CD a� O cr CD CD O CD c CD y� a. v co)o to. CD S- CA O 'v Z O O .nr r -r O CD C CD 0 n 0 C n 0 d`. 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Ca r d w to cn rt O 7C C � CD a1 v W W v z 0 J O C �s . 2a �� ) w I � RSG o >y �W\ \ \ wk/ \ W 0) w � The Commonwealth oflVlassachusetis DepaJ'tment ofkdustrria[Accidents Office of Investigationg 600 Washington Street 5� Boston, MA 021.11 www.massogov/�'ia Workers Compensation Insurance Affidavit: BuildersiCont)ractors/Electricians/Plwnhers OhLeant Informatinn Name (Business/Organization/fadividual): M(�e Vt,,e 0 (` o vtS-i tZ u Address: `io Le w,- 1 k d �� City/State/Zip: Sale -nn ; +yE0307 q Phone #:_ G2 o •3 - 3 2-'a -Z 2ZZ Are y an employer? Check the appropriate box - 1 I� I am • a employer with 9 C) 4. [+�'i am a general contractor and Z employees (full and/orpart-time).* 2-E] I am a sole proprietor or have hire.dthe sub -contractors listed partner- on the attached 5h5et. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp, insurance 5. ❑ We ate a corporation and its required.] 3. I am a homeowner doing ,officers have exercised their all work right of exemption per MGL myself. [No workers' comp, c. 152, §1(4), andwehave no insurance required] t employees. [No workers' comp, insurance required j Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. [] Demolition 9. [] Building addition 1011 Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.C1 Roofrepairs I3.[;�dther 'P—qu, peer, Jnr Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information, Homeowners who submit this affidavitindicating they are doing all work and then hire outside contractors must submit a new 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. Xam an employeY that is providing workers' com information. pensation insuranceformy employees Below is tltepolicy and job site . . Insurance Company Name: \ S S" V -C, f\ L� Policy # or Self -ins. Lic. #: A 13 C M A CD 0 i O `-1 --I i a, Expiration Date: .%b Site Address:_ aSoC,tiQ�\ems St- City(State/Zip:� (Nl jR O \ 4 S 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 WORD 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. I do hereby certry under the ains and ena[ties o j ry ` P P fper u that t/ze information pro above is true and correct. Si ature: Date: 2�-1 IZ Ofj7clal 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/Tg vn Clerk 6. Other 4. Electrical Inspector S. PIumbing Inspector 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 shallnot because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "everystate 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants PIease fill out the worke'rs', compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es) andphonenumber(s) along withtheir certificates) 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 Depallment 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 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 referencd 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 b@ 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 notrelated to any business or commercial venture (Lo. 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: ` O Commonwaith of Arjassa huc efts Depaztment of Industrial_ .A.cczdeats Office of Investigations 600 Washington St'oet Boston; .MA, 02111 Tel. # 617-727-4900 ext 4406 or i-s77.MASSAFE Revised 5-26-05 Fax # 647"727^7749 WWw.wass.l av4a METHUEN CONSTRUCTION CO. 40 LOWELL ROAD SALEM, NH 03079 AS OF THIS DATE, 4/24/12, SUBCONTRACTORS HAVE NOTYET BEEN IDENTIFIED FOR THIS PROJECT GLSD - PRIMARY CLARIFIER METHCON-01 JRABTOR CERTIFICATE OF LIABILITY INSURANCE DAT4/2/2 DIYYYY) /2/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER TD Insurance, Inc. PO Box 406 Portland, ME 04112 CONTACT Ruth Reny Y PHONE g(ro 723-2$77 FOX 877 775-0110 (AJJo Ext): ) ac, Nc): ) ADDRIESS: ruth.reny@tdinsure.com INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Wausau Business Insurance Company 26069 INSURED Methuen Construction Co., Inc. 40 Lowell Road Salem, NH 03079 INSURER B: Wausau Underwriters Insurance Company 26042 INSURER C: Starr Indemnity 81 Liability Co 38318 INSURER D: ABC MA WC SELF-INSURED GROUP INSURER E: HANOVER INSURANCE COMPANY 22292 INSURER F: LIBERTY MUTUAL INSURANCE COMPANIES X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR_ SUER WVD POLICYNUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MWDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 A X COMMERCIAL GENERAL LIABILITY X X YVJZ11260415011 7/1/2011 7/1/2012 CLAIMS -MADE X OCCUR MED EXP (Anyone person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICYFX I jr"' LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ BODILY INJURY (Per person) $ BX ANY AUTO X X ASJZ11260415031 7/1/2011 7/1/2012 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per acddent) $ PROPERTY DAMAGE $ Per accident X HIRED AUTOS X NON -OWNED AUTOS UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 11,000,000 _ AGGREGATE $ 11,000,000 C X EXCESS LIAB CLAIMS -MADE X X SISCCCLO1525611 7/1/2011 7/1/2012 DED I X I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YI ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N / A ABCMA00104712 1/1/2012 111/2013 X I WCSTATU- OTH- TORY LIMITS ER _ E.L. EACH ACCIDENT $ r 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 E Builders Risk IHE9200738 611/2011 6/1/2012 Ded $5,000 10,000,000 F Owners/Contr. Protec TF1Z11260415.202 511/2012 5/1/2013 $1MM/$2MM Limit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Greater Lawrence Sanitary District (GLSD) The Greater Lawrence Sanitary District (owner) & Wright Pierce (engineer) are Additional Insured when required as per written contract. Additional Insured and Waiver of Subrogation applies per written contract and is subject to policy terms and conditions. Coverage is primary for owner & engineer. CERTIFICATE HOLDER CANCELLATION Greater Lawrence Sanitary District 215 First Street, Suite 320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE TD Insurance, Inc. ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD