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HomeMy WebLinkAboutBuilding Permit #093-2012 - 310 GREENE STREET 8/2/2011 BUILDING PERMIT Of No Dry TOWN OF NORTH ANDOVER 3� 4`t� `-„6.°tio APPLICATION FOR PLAN EXAMINATION ” Permit NO: Date Received 7`"°R,r[o•�"'.�* Date Issued: 2 �� �SSgc►+us�� IMPORTANT Applicant must complete all items on this page y�t•.7 ��� 4Frr f . ,C Ttll�, .0 ��}+[ �'S-.^� 4`=?�s mE'mt� r'r•' a7�G t t2Ytf5t t ��si'a ,'' rh`-Gs•`s Y' -N_"�-inn7 d ^q �c..r�' �r {p -r..._�Y�4.-' h :�.a�r'3 y�fi.L +ffis - ry�TE3I -w 07 s ,�,-„�h t..,,r,^F' r Fn+a"�`�Y"'''� s"a-'" s•.�r. -. �..,.n-$ '"Fes. 4 i': ?�, „ � wr�7i��a'�,`.�`g y�,+r�t�i{�ws'�,r�y�.��`�yW�'"'"4''x'"'F� ��='Wyr". '1tR-x h�fj=''}-�Yc"t ,� r'"b.�.e�.tkt�?nv.rb..c��F-.•t',� ;.o!+f,. y �iwCJt����,��fiR'14 l"� �•-',r -� a�t,�'-.fir�,t z:. t�'7�^ s�sq.A"`�T�-^� -r'-3s� i�Y"\i'�t ..f��L'�Sj-,'. �„2^u ..S-- �r�.�7 � ,{�7�.�,.� �jq �"`���',�ry. 5L- dye by... +r;,_..�.. .....,"'�_..._.. .,.'..a;4��+�r.✓-"is:_ ��-M�X._ �.�.tt�..£��.' �.,-,+�+�cr�rs.,�t fl sti:.'e�.e �.+.j �aJW �� �NJ�l��w4'yn�d ���'��nOT��.E� 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition o or more famil Industrial Alter No. of units: Commercial e air, replacement Assessory Bldg Others: Demo ition Other f Rap- DESCRIPTION -� �rr•.�1d,��>-, i=��7.�ivr,��--,�"��'_ ��.J� ,��' t�' q-t� ,r � DESCRIPTION OF OKTO BE PREFORMED: _fls�i ice [9'" --c.,_.to �7 sYr �rtre�`y ,�y[x• "-+ -f.4,' .k' 1 7�7�`,' a., z7..P"r a �25 ' �d`k"' ° } 'fi rye '-�� .j>e, --er aSmi45� -fid"'�'� ��w. • PAR �©R �� y P1q1Tc-R Not-ES iv DAN WALL FP%.artr f kt ,r 10�ePT.JTJV5U C_ATIE-� A-FIC Identification Please Type or Print Clearly) OWNER: Name: hJ,AV©p(91✓R E(DOyNG A01YOR1 T y Phone: Address:-oiV�- M o ff 8ZK/ t-f AbOWS �,� 1tys� �� s �« .3ad � 74s �3�7" � i>"' �FS � F ?i�ar3�is A ✓ranm'th s.M.,e -.�`r<i•-r�ta`.�c, _�,�, �iL--,r �wy,5c �: z *�� t Rr f �as 'a xt 'Y' r[1e54. a' r Sa� f .x`.^i'+mF.+E7PG[ s•CPyt i7,t°+ y��'�,,", ct s'- "' 's,s '�'rSsVar! �• H } t m 5'd 414 .r a !•Y'e'a-tb r �y � .'.+1,,"a�.�'a+ .�.S,irS� W��Y- rir i.��i�',S^•�'rp 4r-. s �`„Afi aQ� N.a..M1 tlr [Tn'F�" ill � t '' •.lJ, a�T������.,r""3,,`tet �r•� �" - '�'+ i.�. f w����,�•', 1�' y'E:.� 'r c�� �r}"_p. i � f b,,, 't--• ,t, tea!��T �' fi '�7' - 'r � -1 7 3 'u. .+.rz t•Er-sr.»�st .�3•,;!"' .�+��^' r!:`�H`.�.��tr4•j.u:�'%3.` }��,�.� ,H'n�`�`�'-p'�`'i. „�.[ L�,*x,�s�.�+.�>-_n�iy�-k'�,-x'-t`k�ttt+++��,r 2. �t K��+i�a.T� h.-�'�h"��.� ��� �t'N�•vr�"� �[.,=i'f„ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERM/T:$12.00 PER$1000.00 OF THE TOTAL EST/MATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 12 , 9 ( 3 FEE: Check No.: NOS; Persons -acting with unre 'steT^ed contractors do not have access to the guaranty and g- .-turf Aunt 5� naturefcon razor 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 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 Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street Lc E� 3JEiffer���Dur�ps�er�r���te es':� . :. _ Y'.^�r A cr�en �s�ENT.S 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.s1oo-s1oo0 fine NOTES and DATA— For department use PC:3N:otif:ied:f6;rpic:kup - Date t 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 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) ❑ "ass 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 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 Location 31,�, 1 ��<'M� ✓!�J No. v /2— Date .P NOR7► TOWN OF NORTH ANDOVER Oi�t�•a .•,�O Certificate of Occupancy $ JACHUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 0� Building Inspector NORTH TONM of Andover . . No. dover, Mass., () _� COCHICEWICH AORATED PP���S S ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System * BUILDING INSPECTOR THISCERTIFIES THAT......... �....�...`........................................................................................................................... Foundation .................................... Rough has permission to erect........................................ buildings on ....................................................... g to be occupied as.......... /'F..: . n.......... . ' . ��'� /.�. .. . �'.. .... �..................................... Chimney provided that the person accepting;i�.s permit shall in every respect ca form 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 o- PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough .... ` '`'�...,,.................................... Service .. . BUILDING INSPECTOR Final 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 Street No. SEE REVERSE SIDE Smoke Det. North Andover Housing Authority ®r, Joanne M. Comerford, Executive Director One Morkeski Meadows (978)682-3932 North Andover,MA 01845 (978)794-1142 FAX (800)545-1833 Ext.100 TDD icomerford@northandoverha.com July 20,2011 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$15,768,to repair damage caused by a fire at Morkeski Meadows NOTICE TO PROCEED Pursuant to the terms of the estimate that you submitted to the North Andover Housing Authority,dated June 9, 2011,in the amount of$15,768,to repair damage caused by a fire at Morkeski Meadows,you are hereby notified to commence work at the start of business on July 25,2011. The time for completion,including the starting day,is August 31,2011. 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. Sincerely Jo a Comerford,PHM Executive Director The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 sY " www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): VAR l✓ I/1 t'l o S-i-N-?—u c�r I b/J 1)U Ci Address: a 19 tO J-)L ly VN- 5�E S L-) ITC City/State/Zip: R DGe `2 MA Phone #: -270&-. `-93 -3222 Are you an employer?Check the appropriate bog: Type of project(required): 1.�1 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.F_1 I 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. 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.❑ 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.® Other 'Any applicant that checks box#1 must also fill out the section below 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: Fl(t(� H E�'l JS //V S 0 2A/U CFS L'©M PPQk)'( Policy#or Self-ins.Lic.#:W(.A Cil/3,00-9 - 12; Expiration Date: Job Site Address: H 3,S K0 P-BD0CJ5 City/State/Zip:A),,/ P6D U 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 certify under the pains andpenalties of perjury that the information provided above is true and correct. Signature: R,C N ¢ V e,- Date: �-&L-- -R&t Phone#: 016 ' �� 2, -S - 3 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#: ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 08/01/2011 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(les)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. J. Wells Insurance Agency, Inc, a/c°NN Ext; (978)392-4567 �AkX No; (978)392-9696 Regency Park E-MAIL ADDRESS: 238 Littleton Road PRODUCER C ST ID#• Westford, MA 01886 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Union Insurance (Acadia Group) INSURER B: Acadia Insurance Vareika Construction Co. , Inc. INSURER C: Firemens Insurance Company 219 Walnut Street Suite B INSURER D: W. Bridgewater, MA 02379 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: I1-12 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 NUMBER POLICYEFF/YYYY MM ICY EXP LIMITS LTR INSR WVD GENERAL LIABILITY CPA 0092564-I 06/20/2011 06/20/2012 EACH OCCURRENCE $ 1,000,006 X COMMERCIAL GENERAL LIABILITY DAMAGES(RENTED $ 250 00 PREMISES Ea occurrence r CLAIMS-MADE FX]OCCUR MED EXP(Any one person) $ 5'00( A PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00( 1-1 POLICYX PROJECT 7 LOC $ AUTOMOBILE LIABILITY MAA 0092568-1 06/20/2011 06/20/2012 COMBINED SINGLE LIMIT $ (Ea accident) 11000,006 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIREDAUTOS (Per accident) X NON-OWNED AUTOS UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 51000,006 B EXCESS LIAB CLAIMS-MADE CUA0121032-1 06/20/2011 06/20/2012 AGGREGATE $ 5,000,00 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WCA 0112029-1 06/20/2011 06/20/2012 X I TORY IDER ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,00 C OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00C If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500 DESCRIPTION OF OPERATIONS below D ,00C A rtored Materia s CPA0092564-I 06/20/2011 06/20/2012 $200,000 any one job site $200,000 temp off premises DESCRIPTION OF OPERATIONS/LOCATIONS/yEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) 80111 Repairs at MorkGbsk7 Meadows. North Andover Housing Authority is listed as an additional insured with respect to General iability where 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. n North Andover Housing Authority AUTHORIZED REPRESENTATIVE One Morkeski Meadows North Andover , MA 01845 Pau7 Coffey/NAM ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 1la..achuutt.-Department o[Public 1s,:1ct% c;, Board of Building R ,ulanom and standard+ Ctrs trcct o'511r_rv� or Uccn=a Ltamse: CS 76563 Rz-w tmwd to: 00 ROBERT G VAREIKA 86 BEDFORD STREET, LAKEVILLE, MA 02347 Exper tzm 1211&12011 < .w=j *u'z Tr- 11576 •