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HomeMy WebLinkAboutBuilding Permit #340-12 - 29A-Francis Street 10/18/2011 BUILDING PERMIT of "°ROTH .� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o Permit NO: Date Received X94 Qate Issued: i �SSAC14L, t IMP RTANT•Applicant must complete all items on this page Y�y-x .. ,�,�'-•L''�4F.yy 3 r'^y- 7 l }k. :..Y .t •13� r fi a iz h4- . Y' I���Rt 3 r+S 4a.- ? !" i 4 k F.t ti, t .+`r r♦ dyc' l �„{'G >t �..z` r 7• _ "r�, f � -�t''fx,f Jb' F":n'�' ,9b i{�� µms.,:Y y � yr „r, - s.l rJ•'.a- 'F��n.� f r n zJiw.Kfn•r�E. I .. Itifq• -y z1' +' w "r.L ^ni� ni 14x.•^-� `" v.r,'S=�`�-.r r�-ae 'r , `s;Y > •"y Igor WN '� a€vra E.I: ,I r,. -^,'2''�c, •,.'{'' f zy, f.;�r��Yvc�,_��.y��,�eNn��5r3•�'�c�, b;�"ear�.w.1�-� �����d;:t�r-ecss �Y^': "�J` ra+Y-•v=�' ,'''na s r i -'t5E"-�'t,=1 ME00"�l]1L�IU7 . l Srt��q��+�-�' rrTly. Pk `a z �r'- `` •fir-•rtifr'a��'r3- i f -�- .{' .a>, r V t 1� ;d" T! Y•'' L�•n DOW ���Grt-Yr�..s=•tutt �x�'. � 3 I a TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more.family Industrial Alteration No. of units: Commercial Repair, replacemen Assessory Bldg Others: Demo ition Other {'r��y.��.V�ik d.� f I� Rte,-✓;7�'�rr3.�r�'�-y�';n1�-sf'1� :; � "tiy -,`s;yr+rc5�r ' ,,y. y I `� -� '' �.����� �,• -� r, r� '�� ODI • iadl� ve"i-zs'd t�<�'r'�� kJ ��"z,,�uyy,�` �'�+s�; ".'"'n-�c G �p�j a•�.it's. .+- �s. "�"'"-tx•`�^'�'�c� • �,.F.e;,.�'"�ta'��-• .f„rh �� r .,�zl�r"���'��,�.•�;�r��r,�, .r-�.5..�.e��"��'�,�y�K>��•�,���F •'��!R�L���nt`S'����J,1a�.�L�'�I;Jtx��"+ '�*'.�'y� <a�'�.,�'El'I1�ET�� ;,�t �, � ���� ��.,� �_..,�,Mn�.e� '�-,is``•�7•� `r�y'� �& �y 5N`����..,,�{,','-�-7T'z;x+ rr � .r...,.•... ..<._... .. ._v,_..F 1:�.r #'a' yi �r..-G R�_�7X !'4Yr,.,?1v x ...'+�:°.s��, '���• .e. `����*�'"zs�1J•r�i T.;��ykit�c,.L,��uy���-rA,��rY ? 'M,,�."�Rx =•2.= r •fcq..�_.,.,. ..� I. .:.F 1 s u.,.,..... ...:.i:.3"f tz''L.�,�',: DESCRIPTION OF WORK TO BE PREFORMED: .F19 e7:,-_," 0Ys l 6E a RU t LD ti 6_ PAIN� A.2ew SiOW - Identification PIease Type or Print Clearly) -- OWNER: Name:_&). Al t>6W&K aws/pu6 /Au rqo_,T y Phone: q ;- 68a- 3932- Address:,,::,,,,,,,,,,,,: 932 Address ©ti M 8_11R r M DOc�S N. AIV&)Uek � I'�"aaTMmJ=' iir-+ A+c-ya^ " - .�.'` �•'�`".:W.ky �`- a S^-.� `Y',i .�c'xa5•�, fi ar" �" ' 'C "ca' i �IFv .ma � '`--yC-?•�.,:fr II� M.11111_ .'�'dME oil�y s , -��c r� I �` ti :1.0 H. ..JA 5+ 4 •,+F T• "fye �. i, � {' 4Yfi yk• me v.-J .�ss,.r ­Tp 319 � 9 . �f��`n �et���i�,'n�� F� ' -YY�,�•Ye� fl�'�,f 1+Pt'?t�' �fi S�tp��9 'f"�e �` 4CaM,�r k �:=-ji'5 i ts=-e '$s i f rY:• r;, /n°'Y•rg, °:ayr t it t it � � i� �• ' u'�'Y�rt�.".�}'Fb ' y�.A.LI�.,r T^'pI y�y� A,y�r/a��� yy..y �r "'moi• t.a i� � ���`�. nz`a�7}3',. *�:nib` Y��fif� � �x-.fx .�.t''ga:Y n' ,� �"•,� -�F,Y-�4 ! �'�.z "�'�`r",ex�e?�a?tt,R,+���� ` � Y Cx h tCi�5'f,�='�-•:�o°' �•r�"�}{' �G,.•4 rt""��.z`� n CM' e , ri`'" sem'` •rt,.'n5 •r k-.. -a.s {, ' n�`'-�'-� -u�', �.-fy I�'�F, u�' .r�,lp,�, nF uu• �; r� � s�r'� '� vx 1� �ta7�`�3� �S 1 T�Y:;�`nl�''Ol�` `I���'S�tid�'1�-�-�.�'' �,� ., r-��•u������F-> �af�� .� , , ��� .•tit: ��}, ' •h�.'^`;.r..r.�to � �:�rtca� ,�•-'".�rJ,rr�i: '.�„t-� ARCHITECT/ENGINEER ��� Phone: Address: Reg. No. FEE SCHEDULE.BULD/NG PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �,._"43 FEE: $_ Check No.: / U�DD J Receipt No.: 3 q 4 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fund $199ure f A n /Ou✓ner ,. 5�gnatureo�Fcon ractor = ,.. Location (53: ARgn5(S No. Date A9 /0r// TOWN OF NORTH ANDOVER 00 41 R Certificate of Occupancy $ ..,_:.. CHU t� Building/Frame Perqit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ tt r-- Check # J 247 '47 Building Inspector 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.OFFI1 PSE ONLY t'�11�tTL�q�P" IWETIT�1'L SIGN OAF -=UwFt�RM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on _ Signature COMIf viENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: *Z.acing 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 F?I DEQ Nl fuer p Dur zps..er nstte L-ocafe�tl�f�Z��lain Sfree# 7 T no zz i �re� ,epanrtmen� zighdr 'R,a ,CSM LENTS, ti _ :=: , } 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 j Doc.Building Permit Revised 2010 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 Piot 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:Building Permit Revised 2008 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): Address: Z) "L ytUU 7— City/State/Zip:_ S) Phone #: Sig 3 3 Are you an employer?Check the appropriate box: Type of project(required): 1.fAI am 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. ❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3. ❑ 1 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' 13.kd Other )gl�j 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 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: UN� I QA J,��Q� Policy#or Self-ins.Lic.#: 1 �00' Z S r 6 Expiration Date: Z U Job Site Address: 7-714 r-rWTev L) _� City/State/Zip: 1J)VYy2 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 WORK 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 cer N unde the ai s and penalties of perjury that the information provided above is rue and correct. Signature: Ali— Date: v l f 9 Phone#: 7J� 5 1- 3 '551 q 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I ACORD,, CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 10/12/2011 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 CONTACT NAME: E. 1. Wells Insurance Agency, Inc. acco"N Ext): (978)392-4S67 FAX Regency Park E-MAIL arc No):(978)392-9696 ADDRESS: 238 Littleton Road PRODUCER CUSTOMER ID#: Westford, MA 01886 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Union Insurance (Acadia Group) INSURER B: Acadia Insurance Vareika Construction Co. , Inc. INSURERC: Firemens Insurance Company 219 Walnut Street Suite B INSURER D: W. Bridgewater, MA 02379 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 11-12 Standard 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY GENERAL LIABILITY CPA 0092564-1 06/20/2011 06/20/2012 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 250,000 PREMISES Ea occurnce TI CLAIMS-MADE F�_I OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 17 POLICY X PRO LOC $ JECT AUTOMOBILE LIABILITY MAA 0092568-1 06/20/2011 06/20/2012 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 I B EXCESS LIAB CLAIMS-MADE CUA0121032-1 06/20/2011 06/20/2012 AGGREGATE $ 5,000,00 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLO ERS'LIABILITY YIN WCA 0112029-1 06/20/2011 06/20/2012 X TORY LIMITS OER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 A toned Materials CPA0092564-1 06/20/2011 06/20/2012 $200,000 any one job site $200,000 temp off premises DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) 0-12-11 Repairs at 27A Francis Street orth Andover Housing Authority is listed as additional insured with respect to the General Liability here required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. North Andover Housing Authority AUTHORIZED REPRESENTATIVE One Morkeski Meadows North Andover, MA 01845 Paul Coffey/NAM ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD NORTH Town of Andover .. No. 3 a do o ��(` dover, Mass., Q LAKE COCHICHEWICK Q RATED P C) BOARD OF HEALTH `` Food/Kitchen R M­ T T D Septic System PE • BUILDING INSPECTOR THIS CERTIFIES THAT........./..�I. ...... .✓.'�!!......1140.✓...��I!�f....... ^..... " """"""""""""' Foundation has permission to erect..........................'............ buildings on ..,C� .... ,�/.S. a Rough A....^.. ......... �. , t0 be Occupied as....... �� . . ........... .,I.I^..S�........ o.�.........."� .............. Chimney C e provided that the person accepting this permit shall in everV 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 LJNLESS CONS 1 RUCTI 1 Rough INVANOW u............................................... .................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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. rte-° liasvaihu%vttr- Department of public �afch E34)ard of Building Regulations and Standard% Construction Sup+rvisor Licenso License: CS 76563 Restncted to: 00 , ROBERT G VAREIKA I 86 BEDFORD STREET, LAKEVILLE, MA 02347 Expiration: 12/18/2011 t muur�.ramre Tr#: 11576 r North Andover Housing Authority ��r Joanne M. Comerford, Executive Director One Morkesld Meadows (978)682-3932 North Andover,MA 01845 (978)794-1142 FAX (800)545-1833 Ext.100 TDD icomerford@northandoverha.com October 12,2011 To: Mr.Robert Vareika Vareika Construction,Inc. 219 Walnut Street,Suite B West Bridgewater,MA 02379 Re: Estimate from Vareika Construction,Inc.,in the amount of$6,563,to repair damage caused by a fire at 27A Francis Street,North Andover,MA NOTICE TO PROCEED Pursuant to the terms of the estimate that you submitted to the North Andover Housing Authority,dated August 15, 2011,in the amount of$6,563,to repair damage caused by a fire at 27A-Francis Street in North Andover,MA,you are hereby notified to commence work at the start of business on October 12,2011. The time for completion, including the starting day,is November 10,2011. Please submit a copy of your Workmen's Compensation and Manufacturers' and Contractors'Public Liability Insurance. The contractor shall also contact the North Andover Housing Authority in writing within three days prior to mobilization on the project to enable the North Andover Housing Authority to coordinate this work with others. The contractor shall within ten days after receipt of this notice send to the North Andover Housing Authority copies of all required permits for work to be performed under the contract. Your cooperation on this construction to its conclusion is of the utmost importance to the North Andover Housing Authority. Sincerel , Jon a Comerford,PRMr / Executive Director