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Home My WebLink AboutBuilding Permit #1006-16 - 3 GREAT POND ROAD 3/28/2016 BUILDING PERMIT ��°T TOWN OF NORTH ANDOVER T APPLICATION FOR PLAN EXAMINATION Arl : H /O`//-1J1 /6 Date Received Permit No �qA°RAreo �Date Issued:—. cH�s�` IM ORTANT: Applicant must complete all items on this page LOCATION 3 Ceer�� P004 //�� Print PROPERTY OWNER C enee- ee 7—evS Print 100 Year Structure yes no MAP PARCEL: _ZONING DISTRICT: Historic District yes no / Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Mdition ❑Two or more family ❑ Industrial Alteration No. of units: plc�ommercial tair, replacement ❑Assessory Bldg ❑ Others: olition ❑ Other _ ❑, eptr ❑Well` S4 y j ❑ Floodplain U*VV apes ❑; Watersheds®str�icft y ate FI•Sewer DESCRIPTION OF WORK TO BE PERFORMED: ,J / Re-P�}Gix hod e 6,Y) A�4yc�4O F19 Tk.eoylS 3Q%nC, 0 P ¢'a �o 15L S & - �t'4'�2p 121�i�$ �n@ RxP��ca G4k.-Rs`.t6 tv O= Reels Aire*S W.�l4 te•xPeQeq k®By LFaTXY Dopes Fwtuo z-Auto Ee?4" port Tdentificatio Please Type or Print Cle rlyrr OWNER: Name: eler*9 644 —Ie us-f" BF 10v Lo k 9 ae4 Phone: Address: mc=r r`c l 7 - &r&tt, �e ' -Pee Krr'l, ate Contractor Name:3ec►10J*n:,x C.. G-000 Phone: .so$-3ok�-y63a Email: e Address /�5 D.Cd �:'�L L.�K G JVo (4•z �a� u2 t� m�P�s Supervisor's Construction License: C 5 07S3ma Exp. Date: /a r Home Improvement License: Exp. Date: ARCH ITECT/ENGINEER�'.b. -A isse- Phone: rr0 Reg. No. Address:/ L 4Yvl �1'Q�c'� �"n�oaee, W4 0/8% FEE SCHEDULE.BULDING PERMIT.'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ I� Doo• FEE: $ )"� )"— Check No.: 6 o Receipt No.: 38\(.p\ NOTE: ersons con ac ' g with giste d contractors do not have ac s to the guaranty fund - - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOS. Swimming Sewer L��/ Tanning/Massage/Body Art ❑ Swiing Pools ❑ I well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennan.ent Dumpster on Site ❑ I ' THE FOLLOWING SECTIONS FOR OFFICE USE`ONLY INTERDEPARTMENTAL SIGN OFF m U FORM YCAI LNING & DEVELOPMENT Reviewed On 317W)6 signature g MENTS XhA ckQll;;t�& Ll ys NIA d 4 OffP v i CONSERVATION Reviewed on � �( � � Signature COMMENTS l �'" n, 'y - c . ! `jC 19AJ r V HEALTH Revie ed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes F ' Planning Board Decision: Comments { Conservation Decision: Comments Water& Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: - Pa4R+T'N1EIV Located 384 O sgood Street FURS DE Ell T `'Te`rnp�bumpster on�site� no' Locatelepa t'12'4 Main Street '1Fkr ttl flr(l�'h�4 w0.1 '`r 17 i•,1 at�•�t•,tY ' °-'7 C`R i �.�.""' "'--—w----..r- `►`s.+�+.^1l S ;i r•' .y. Ptr �vr� .' S • 1•.1S tt,' Fire Ja !r�tt fe-ffi ignature/date*,s4.��,iti�7� I► Y tt a + Y2 V 6 'moi 3t r'� K'; I {` x �, t. tiic {'I '�i•� ,#t Q -7 .i" '} .tt�.4 ,.err ��a•. r ,S � q 'L -+.F.,CEJ.. ��tbjt.K K"'f5�r'' ' (# 'iC. '7`7,� COMMENTSi• Dimension Number of Stories: P'L 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) ...... ......... ---------- .............. LJ Notified for pickup Call Email Date Time Contact Name ............... Doc.Building Permit Revised 2014 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 Permit .✓ 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 t OTE: 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/Cross Section/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 - OTE: 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 4- 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 2012 IECC Energy code Engineering Affidavits for Engineered products INIOTE: 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 2014 Location No. 1 006_ 2 0 k 7 Date ' • - TOWN OF NORTH ANDOVER p X74• Certificate of Occupancy $ Building/Frame Permit Fee $J '" Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ Check# � Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $; 125,000'.00 m $ - $ 1,500.00 Plumbing Fee $ 187.50 Gas Fee 100 comm. $ 10,0.00; Electrical Fee $ 187.50 Total fees collected $ 1,975.00 3 Great Pond Road 1006-2016 on 3/28/2016 Remodel Old Center Hall I i 1 NORTH own of : ndover No. ��I— +� t - ,� o h , ver, Mass, COCNICMt WKN �q �V �,9 °R�►reo rPa��S ' S U BOARD OF HEALTH PER ��s4 L D Food/Kitchen Septic System THIS CERTIFIES THAT ............... BUILDING INSPECTOR .. ..................`...... Foundation has permission to erect .......................... buildings on .. ........ ...... . ......... . Rough to be occupied as .........i.Am^% - 6oftla......&vaA.....no - .... .. ....... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the ap cation Final on file in this office, and-to the provisions of the Codes and By-Laws relating to the Inspection,Altera 'on and Construction of Buildings in the Town of North Andover. Pi" PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIQN STARTS Rough Service .......... . . . .... :....,............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Massachusetts -Department of Public Safety Board of Buiiding Regulations and Standards •,uTaiii iiCtiuit oupci t is6i License: CS-075302 „p BENJAMINC OSG-bO 69 Old Village Lade North Andover M-A 01 .5fi Expiration Commisssiionnee'r` 12/04/2016 NOTICE vizi M W NOTICE OTICE TO 0 TO EMPLOYEES EMPLOYEES Q,1M Sv b The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017 617-7274900 — http://wwwr.state.ma.us/dia 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: ACE CROUP NAME OF INSURANCE COMPANY P .O. BOX 1450 MIDDLESOR9 MA 02344-1450 _ ADDRESS OF INSURANCE COMPANY ^' (6S62UB-OG23626-9-15) 08-15-15 TO 08-15-16 POLICY NUMBER EFFECTIVE DATES M P ROBERTS INS AGENCY 1060 OSGOOD STREET W NORTH ANDOVER MA 01845 NAME OF INSURANCE AGENT ADDRESS PHONE# OLD SALEM VILLAGE OF NORTH HEPATICA DRIVE & ANDOVER CONDOMINIUM TRUST; MAYFLOWER DRIVE NORTH ANDOVER •� MA 01845 ^-�— EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION 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 � P ys cost of the services provided by the trcatin physician wilt be aid -� € P ys p by the insurer, if the treatment is necessary and reasonably to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 0111910 W20PIC16 O BE POSTED li 1 l' PL!_� R ` Initial Construction Control Document To be submitted with the building permit application by a W R d Registered Design Professional for work per the 8th edition of the ve'�a Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Grange Hall Tenant Fit-Out Phase 1 Date: 24 March 2016 Property Address: 3 Great Pond Road,North Andover,MA 01845 Project: Check(x)one or both as applicable: _New construction X Existing Construction Project description: This submittal is for the first phase of an interior fit-out of an existing two story"Grange Hall" A phase two submittal is anticipated at a later date to integrate specific tenant needs. I Joseph D. LaGrasse,AIA MA Registration Number: 4153 Expiration date: 08/31/2016 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. eo ARCH Upon completion of the work I shall submit p p t to the building official a Final Co current'. A Enter in the space to the right a"wet"or X o aA53 0 electronic signature and seal: 0 Pt4o R 0� MP, 5 OAL H OF MP5 2, 3[2T{WPhone number: 978.470.3675 Email.�la rasse 1a asseare' cts.com P Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013