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HomeMy WebLinkAboutBuilding Permit #254-2017 - 35 FLAGSHIP DRIVE 9/8/2016 BUILDING PERMIT NORTy q 1 •`SLED /6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: �� ztJ J Date Received 29 R � Date Issued: I I I I ORTANT:Applicant must complete all items on this page '7 �. LOCATION 35 ' t PROPERTY OWNERY Print 100 Year Structure yes no MAP IGS _PARCEL: �f ZONING DISTRICT: Z�- Historic District ye no ! Machine Shop Village ye n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family Xndustrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement - ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 04 Septic 0 We11 U Floodplain ' n Wetlands a.-Watershed.-District DESCRIPTION OF WORK TO BE PERFORMED, r ii � l Iden tificatio - Please Type or Print Clearly q-78 (Qg�J 002-7OWNER: Name: Phone: r C.Af I S ttik .. V rte/ Address: Contractor Name: � Phone: 6G5 610� Email: Address: Supervisor's Construction License: Exp. Date: me Improvement License: Exp. Date: Wddre ITECT/ENGINEER �NNUN k.a, Phone: D� Li5�)ss. I�.NSt NgA-.i 5okLz--A N v79 Reg. No. Q7 S p FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ x C) d D _FEE: $ /ho Check No.: Receipt No.: Ab�3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund _ I Location -� No. " 2 t Date r. • - TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ �(�O Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL. Check# 161 d �� Building Inspector V Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWER-.GE 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 PLANNING & DEVELOPMENT Reviewed On y Signature_ COMMENTS n 4t� CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori 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: y _ Located 384 Osgood FIRE DEPAR�TME_NT Tempa®umpster onsite vesw4 o �d o� +p Street Locatediat'-j241Mairi eett -~ Z4/Fiire�Department signature �lP __� COMMENTS _ _ 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.$10041000 fine NOTES and DATA— (For department use) 1 0�� ❑ 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 Permits 4 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 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 4r 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 PH0rJE C L.L. OF 0 FOR DATE TIME�� P. M 00, PHONED. OF Ej FAX y 3 RETURNED PHONE ❑Moe1LE J YOUR.CALL AREA CODE KAJME3ER EXTENSION PLEASE CALL MESSAGE WILL CALL''. AGAIN Nn � — CAMETO SEE YOU;..'. WANTS iTO:. SEE YOU': SIGNED SECOND NATURE- g)RECYCLED V�, FORM 74620 October 4, 2016 North Andover Building Inspector Mr. Donald Belanger 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 RE: 35 Flagship Drive, North Andover Building Permit Mr. Belanger, Please be advised the General Contractor for the job, Tim Peters, will be taking over responsibility for the building permit from Robert W. Hannon, AIA. The reason we need the transfer is that Mr. Hannon found out his liability insurance would not cover commercial work. Plea),feelfree to ntact me with any questions. Chrrnardini CrossFit North Andover Direct: (781)858-9863 i 10/6/2016 Town of North Andover Mail-FW:RE:COI NORlI VER Massachusetts Donald Belanger<dbelanger@northandoverma.gov> FW: RE: COI 2 messages Christine Bernardini <christine@bernardinilaw.com> Thu, Oct 6, 2016 at 12:48 PM To: dbelanger@northandoverma.gov Cc: petershomes4u@gmail.com, william Rivera <wrivera152@hotmail.com> Hi Donald, Tim Peters,the General Contractor,will be in this afternoon with his license to transfer the building permit. I dropped the letter regarding the transfer off on Tuesday to Maura. Tim's insurance is attached to this email. Thank you, Christine Christine M. Bernardini, Esquire Bernardini Law P.C. 800 Turnpike Street,Suite 300 North Andover, Massachusetts 01845 Telephone (978) 794-5525 Facsimile (978) 794-5508— Efax(978) 824-2311 christine@bernardinilaw.com Like us on Facebook:www.facebook.com/bernardinilaw `ruse 'Verified � tt�tod This message contains confidential information, intended only for the person(s) named above,which may also be privileged. Any use,distribution, copying or disclosure by any other person is strictly prohibited. If you have received this message in error, please notify the e-mail sender immediately, and delete the original message without making a copy. https://mail.google.com/m ai I/?ui=2&ik=3e2lOfea7g&view=pt&search=i nbox&th=157gae628dfdOf79&sim l=157gae628dfdOf7g 1/4 OP ID: PW CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10106/2016 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 Se rave&Hall InSur.Assoc.Inc NAME: FAX 305 North Main St. HONE o Ext): A1C No): Andover,MA 01810 E-MAIL Lawrence J.Hall ADDRESS: PRODUCER TIMOT-2 CUSTOMER ID#: INSURERS)AFFORDING COVERAGE NAIC# INSURED Timothy Peters D/B/A INSURER A:Commerce Insurance Co. 34754 Peters General Contracting INSURERB:A.I.M.Mutual Ins.Co. 33758 112 Lillian Terrace Dracut,MA 01826 INSURER C: INSURER D: INSURER E: INSURER F: 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 TYPE OF INSURANCE R POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY =TOO ACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY BGHPYY 06/17/2016 06/17/2017 HENIED PREMISES Ea occurrence $ 100,00 CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 17 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (PER ACCIDENT) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X JT RY LIMITS I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE 5013819 08/29/2016 08/29/2017 E.L.EACH ACCIDENT $ 100,00 OFFICERIMEMBER EXCLUDED? ❑Y N/A B (Mandatory In NH) 5013819 08/29/2015 08/29/2016 E.L.DISEASE.EA EMPLOYE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE `eam er Pease THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 32 Flagship North Andover, MA \ ( AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD y� �e a��Lmaryauiea�f/a/�.aaar Wwjeffa Massachusetts Department of Public Safety Office f Consumer Affairs&Business Rei ulaf on a -- .: ', Board of Building Regulations and Standards SME IMPROVEMENT CONTRACR : License: CS-092507 �Sr egistration: 161622 Type: xpiration 11/12/20-16 Construction Supervisor DBA r / S3 I PETERS GENERAL CONTRACTING`" TIMOTHY J PETEI}S` { 112LILLIAN TERRAC# s� % DRACUT MA 04j26�' � � = " TIMOTHY PETERS _ � ', 11,2'LILLIAN TERRACE'' n` DRACUT,MA 01826:` ' ��i C v �• �`s'- ./l1^"'� l� Expiration: Commissioner 07/04/2017 µ j 10/6/2016 Town of North Andover Mail-FW:RE:COI From: petershomes4u [ma iIto:petershomes4u@gmail.com] Sent:Thursday, October 06, 2016 12:45 PM To: Christine Bernardini <christine@bernardinilaw.com> Subject: Fwd: RE: COI Sent from my Sprint Phone. ------Original message -------- From: Peggy Welch <pwelch@segrevehall.com> Date:10/06/2016 12:44 PM (GMT-05:00) To: petershomes4u <petershomes4u@gmail.com> Cc: Subject: RE: COI Here is the certificate of insurance you had requested Thank you, Peggy From: petershomes4u [mailto:petershomes4u@gmail.com] Sent: Thursday, October 06, 2016 11:59 AM To: Peggy Welch Subject: RE: COI Leander Pease Sent from my Sprint Phone. ------Original message -------- From: Peggy Welch <pwelch@segrevehall.com> Date:10/05/2016 5:05 PM (GMT-05:00) To: Tim Peters <petershomes4u@gmail.com> Cc: Subject: RE: COI Hi Tim, https://mai I.google.com/mai I/?ui=2&i k=3e210fea79&view=pt&search=i nbox&th=1579ae628dfdOf79&sim l=1579ae628dfdOf79 2/4 10/6/2016 Town of North Andover Mail-FW:RE:C01 Who should the certificate be made out to? Thanks, Peggy From: Tim Peters [mai Ito:peters homes4u@gmail.com] Sent: Wednesday, October 05, 2016 4:06 PM To: Peggy Welch Subject: COI Can you send me a COI with the address: 32 Flagship North Andover. Thank you, Timothy J Peters Peters General Contracting Waters Edge Kitchen Designs 552 Lincoln Ave Saugus, Ma 01906 978-596-8753 www.watersedgekitchens.com Image removed by sender. I tim peters-leander pease.pdf 32K petershomes4u <petershomes4u@gmail.com> Thu, Oct 6, 2016 at 1:25 PM To: dbelanger@northandoverma.gov [Quoted text hidden] https://mai l.google.com/mai I/?ui=2&i k=3e2l Ofea79&view=pt&search=i nbox&th=1579ae628dfdOf79&si m 1=1579ae628dfdOt7g 3/4 10/6/2016 Town of North Andover Mail-FW:RE:COI tim peters- leander pease.pdf 32K hUps://m ai l.google.com/mai I/?ui=2&i k=3e2l Ofea7g&view=pt&search=i nbox&th=1579ae628dfdOf79&sim l=1579ae628dfdOf79 4/4 NORT11 q .� r � - - . w. .. . . _ _ s �. .c ve. o - � No. - h ver, Mass, cocHcNe iw.cw �A°R,TED s U BOARD OF HEALTH Food/Kitchen PER IT LD Septic System THIS CERTIFIES THAT' MJW ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,, ,,,,,,, ,, ,,,,, ,, , BUILDING INSPECTOR .................e�......................... ... has permission to erect .. buildings on .� .. .. �► Foundation ............ .... ... ! .... .............. Rough .... .... .. . . .. to be occupied as .4e .. .... ......... .. .....�.... ... .... ..... ....l.. .... .... ...... . .. Chimney provided that the person accepting tl l ermit shall�in every respect conform to the terms of the application Final 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO T Rough Service .. . .... . .......... ... Fina BUIL G SPECT R 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. 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiunming Pools ❑ Well ❑ Tobacco Sales El Food Packaging/Sales ElPrivate(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING a DEVELOPMENT Reviewed On Signature_ COMMENTS G r q( OTA1 11 r � 0a �lYvl1S� CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori Si nature COMMENTS Zoning Board of Appeals:variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments ' Wafter& Sewer Connection/si nature &`Qa e q Driveway Permit DPW Town Engineer: Signature: I FIREjsDEPAR�TMENT Terri' Located 384 Osgood Street Locafed�at�j12.4jIVIainESt�e COMMENTS Location \� i No. J 1� ?�'� Date • - TOWN OF NORTH ANDOVER X * ' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# I' ,_ Building Inspector dc� y TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 30 Days from September 12, 2016 BuildingPermit Number 254-2017 on 9/8/2016 Date: September 12 2016 p , THIS CERTIFIES THAT THE BUILDING LOCATED ON 35 Flagship Drive MAY BE OCCUPIED AS a tenant fit up — Cross Fit North Andover - IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Leander Pease 35 Flagship Drive North Andover, MA 01845 Building Inspector Fee: $50.00 Receipt: Check CNORTM q t a TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 30 Days from September 12, 2016 Building Permit Number 254-2017 on 9/8/2016 Date: September 12, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED ON 35 Flagship Drive MAY BE OCCUPIED AS a tenant fit up — Cross Fit North Andover - IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Leander Pease 35 Flagship Drive North Andover, MA 01845 Building Inspector Fee: $50.00 Receipt: Check : 1 1 T , , v k x' t t. Af ' fly 41 yS D L i .A ' .. b�� *� +F•a.�f"'`� ��, �'� It �" � �.w_"�` �°� ��` � ;g� NZZ. ` •a � INS ow s is a tVr" t" I ' .. .., IPW Ade 0 Av iWOV Moll iN a -. g y _ The Commonwealth of Massgx husefts Department ofIaclastrzalAceldlents 1 Congress street,suite 100 - Bostou,.DIA 021142017 4` wwly mass govy'dia Workers'Compe*nsatiortlusuranceA-Tfldavit:Builders/ContractorsfM?etxiczansl lwnbers. TO BE Ff ED WSP.H THE PERAM 0TG AUTECORITX. A licant Information Please Print iegibl Name, (Susiess/Organizalionllndividnal): Address: �7i- �'JSI 141 le�4' Cityltate/dip: Phone#: Are you an employer? Check, e appropriaie box: Type of project(regrdrt d employerv&h employees(full andlarpart ane).* ]. New coIisfrtzctiou I am a sole proprietor or partnership and have no employees"Working for in $. Remo delirig any capacity INo workers'comp.insurance required l 9, ❑Demolition 3-Q I am a homeovnerdoiag alt workmyseli LNo workers'comp.dwazance squired.] 10 Building addition 4.❑lam a homeownerandv U behiring contractors to conduct all work onmyproperty. Ivi71 II.E]Electrical repairs re airs ox.additions ensure that all contra"cbs either have wormers'compensation insurmiee or are sole _ pr6piietors•withno employees. I2:0 plumbing repairs or additions 5.nIamageneralconfraaEorand lbavehired thesub-contractorslisted onthe attached Sheet �3_QRoa Tepai2s llzesesnb-coniracbr]S9 aveemployees andhaveworkers'oom ,ra p.in� rnre•� 1d•.Q Ooef 6.Q We are acorpozatipn audits off�cers have exercisedtheir right of"egempiion puMGL c. - 152,§I(4),andwehaveno.,employees.LNoworkers,comp.insmancerequired] 'Anyapplicant-ff t checksbax#1 must also fff outthe seetionbelowshoT&gtheirworkes'compensaiionpolicyiniomiation. iHomeownus-whosuhSifWfffl6avitmdicatingtheya'edoingallworkandthenhireoutsidecontractosmustsamitanew, affidav:Lmdicaimgsuch. ?Contractor that check-#it box mnsragaghed an additional sheet showing the name of the sub-contractor and s``ate whether ornotrizose entities have employees.'If the sub-corairkdbshaveeiaployees,&8 mustpravidethesworkers'comp.policynumber. I L&n ars en ployer th at aspioviZzglvorkers'compensation insurance for MY ern pl6yees.,Below is the pofiey ayidjob site infor7natior�. . Insurance Company Name: policy#or Self-ins.Zic.#: ExpiratronDate: Job Site Address: City/State/Zip: Attach a copy ofthewo?'kers' compensation policy declaration page(showingthe policynumbexand egpixafzoudate). Failure to secure coverage as required under MOL c. 152, §25A is a criminal violation punishable by a fine up to$1,50 0.00 and/or one�year imprisonment,as well as civil penalties in Iffie form of a STOP WORK ORDER anal a fm e of up to$250.00 a day against the violator.A,copy of.his statement may be forwarded to the,Ofiice of Investigations of the DIA for insurance coverage verification. I do hereby certify uy"Tef• " al" and p - es of pej�zry that the information provided above is tue and coor,ect Signature: Date: b Phone#: f+ o 5 w Official rise only. JIo not-tvxzte iYz this area,to he completed by city or to-wiz officiaL. City or Town: Permit/License# IssuingAuthoxity-(circle one): i I.Board of HealtTa 2.Buff ding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbingluspector 6.Other Contact Pearson: 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 bf hire, express or ress implied, oral or written." p 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 enferprise,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 anotherwho 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 b6 deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or to cal licensissg agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the cougmonwealih fox•any applicantwho liar not produced acceptable evidence of compliance-with the msux'ance 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 PIease fzll•out-the workers' compensation affidavit completely,by checkingfihe boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and•phone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited LiabilityPartnerships(LLP)withno employees'otherthan the members or partners,are notrequired to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy-is required. Ba advised that this affidavit maybe submitted to the D epat tm.ent of•In.dustrsal Accidents fol-conf� tion ofinsurance coverage. Also be sure to sign and date the affidavit. The af$davit should be returned to the city or town that the application for the permit or license is being requested,not the Department of IndustrialAccidenis. should you have any questions regarding the law ox if you'are_T mr d to obtain a workers' compensataoA policy,please call the Department at the number listed below. self-insured.companies s2 ould'enter th eir 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 fillin the permit/license number whicli will be used as areference 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 maybe 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 oitizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burrs leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston.,MA 02114-207.7 Tel.# 617-727-4900 est. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02--23-15 wwwmass.gov/dia I LEGEND CODE INFORMATION GENERAL NOTES 1. ALL CONSTRUCTION SHALL COMPLY WITH MASSACHUSETTS BUILDING CODE, O EXISTING WALL TO REMAIN APPLICABLE CODES AND STANDARDS- CURRENT EDITION. MASSACHUSETTS BUILDING CODE,8TH EDITION(IBC 2009 W/MA AMENDMENTS) 2. COORDINATE DOOR SELECTION WITH OWNER. ca :-I EXISTING TO BE REMOVED 521 CMR—MASSACHUSETTS ARCHITECTURAL ACCESS BOARD(MAAB)REGULATIONS 3. EXISTING STRUCTURE SHOWN IS DIAGRAMMATIC ONLY. IF NATIONAL FIRE PROTECTION ASSOCIATION(NFPA)101 LIFE SAFETY CODE 2012 4. PROVIDE MOISTURE RESISTANT GYPSUM BOARD IN WET LOCATIONS NEW PARTITION 5. TACTILE SIGNAGE,WITH PICTOGRAM WHERE REWIRED,SHALL BE ROBERT WILLIAM PROJECT IS TO RENOVATE EXISTING OFFICE/WAREHOUSE SPACE FOR CROSSFIT. PROVIDED AT INTERIOR DOORS. INSTALL SIGNAGE ON THE LATCH SIDE NNON ARCHITECT OF THE DOOR AT 60 INCHES ABOVE FINISH FLOOR TO HORIZONTAL 12 O H N ALf1vL PARTIAL WALL INFILL CENTER OF SIGN.REFER TO ICC A117.1-2009 FOR ADDITIONAL SAUEN DRIVE CONSTRUCTION TYPE OB(GENERAL CONTRACTOR TO VERIFY) INFORMATION. NH 03079OCCUPANCY CLASSIFICATION: 6. NEW WALLS TO BE%'GYPSUM BOARD ON 3W METAL STUDS O 16"ON MIXED—USE,UNSEPARATED. CENTER WALLS EXTENDING TO DECK TO RECEIVE DEFLECTION TRACK. ©coPrRIGHr 9716 ' J BUSINESS USE(GROUP B) 7. TOILET ROOM CE NCS TO BE A MINIMUM OF 7'-6'ABOVE FINISH FLOOR AREA GROSS SF: 51B SF 9 SHORE EXISTING MEZZANINE AS REWIRED TO CONSTRUCT NEW TOILET 'i DEMOLISH DOOR a' iµ AREA MAXIMUM OCCUPANT LOAD: 6 PERSONS ROOM PARTITIONS ^I ASSEMBLY(GROUP A-3) I�J AREA GROSS g: 2434 SF y y AREAMAXIMUM OCCUPANT LOAD: 49 PERSONS �T WHENOCCUPANCY IS LESS THAN 50,ENTIRE SPACE MAY BE CONSIDERED BUSINESS USE. ( EXISTING DOOR REVISED OCCUPANT LOAD IS 30 PERSONS(BUSINESS USE). PROJECT NORTH 1014.3 COMMON PATH OF EGRESS TRAVEL(NFPA 101—38.2.5.3.1) MAXIMUM COMMON PATH =100' 1018.4 DEAD ENDS(NFPA 101—392.5.2.1) SEREO ARC�r ONEW DOOR&NUMBER 0p MAX DEAD END =50'(FULLY SPRINKLED) 1016 EXIT ACCESS TRAVEL DISTANCE(NEPA 101—38.2.6.3) ® NEW WINDOW MAX TRAVEL DISTANCE =300'(FULLY SPRINKLED) 1015.1 EXITS OR EXIT ACCESS DOORWAYS FROM SPACES OF LESSups ITEM HIDDEN OR ABOVE LTHAN 49 OCCUPANTS—1 EXIT ALLOWED,2 PROVIDED. ® EXIT SIGN,MOUNTED Q ABOVE DOOR O C O Q Z ILL O N O NEW WALLS SHOWN HATCHED SOLIDZ ANGIE HATCH INDICATES BUSINESS USE CROSS HATCH INDICATES FITNESS USE Q O IN 518 GROSS SF IN 2434 GROSS SQUARE FEET. > � > MECHANICAL UNIT TO REMAIN PROVIDE(2)2'-6'x 7'-0" Z U Ec 518 SF/100 GROSS=6 OCCUPANTS DOORS WITH UTILITY LOCKSET 2434 SF/50 GROSS=49 OCCUPANTS 0 W/KNURLED LEVER HANDLE IXR SIGN TO REM/JN I I DEMWSH GUARDRAIL AND TOILET ROOM OMEN \M N / II CONSTRUCTION BELOW. PROVIDE `A -3 'A'-04 � `` ERRE ISH II TEMPORARY SHORING FOR MECHANICAL / I I UNIT AS REQUIRED. N z C ARD F ON ` `moi a- / \• \ \ A=D PROVIDE�%----- REMOVABLE GUARDRAIL OR GATE N WHEN OVERHEAD H SECTIONAL DOOR IS W OPEN WHILE SPACE IS OCCUPIED. 590SF E(NJ�IIO.DEMO K � — � —_ REPfACE DO� D�f1H A _ _ _ _` ��•• /a i � W 737 SF CE'N TOTALI / ehS51(G�lA SQ ty OLE$ (ND s11X+NEAunxEn) I NxtwiEx Lo�7A(_ J�: o2S I ! sl TED I GUARDRAIL TO BE DEMOLISHED AND EXIT SIGN R N \R I— — W COMPLIANT WIM CODE COMPNT GUARDRAILS. j\,( I � FlR �E#TINGUIS � I I ` MU VEL i15TANC' 1 0 I 9� V I I \.. 1 I ,\ REVISIONS I n I � + n ti FITN65 EQUIPMENT LOCATED ALONG WALLS, ACTUAL EQUIPMENT WILL VARY,TYP. O PERMIT 9/2/16 MK. DATE wee 2 SEPTEMBER 2016 56VE AS NOTED EQUIPMENT PLATFORM PLAN CODE & EGRESS PLAN 1 16-014 SCALE: 1/4'=1'-D" A10D SCALE: 1/4"=1'-0" A100 SHEET NO. A100 LEGEND GENERAL NOTES MOUNTING HEIGHTS FOR ACCESSIBLE FIXTURES I. ALL CONSTRUCTION SHALL COMPLY WITH MASSACHUSETTS BUILDING CODE, O EXISTING WALL TO REMAIN CURRENT EDITION. 2, COORDINATE DOOR SELECTION WITH OWNER. EXISTING TO BE REMOVED 3. EXISTING STRUCTURE SHOWN IS DIAGRAMMATIC ONLY. 4. PROVIDE MOISTURE RESISTANT GYPSUM BOARD IN WET LOCATIONS. S. TACTILE SIGNAGE,WITH PICTOGRAM WHERE REQUIRED,SHALL BE ROBERT WILLIAM t NEW PARTITION PROVIDED AT INTERIOR DOORS INSTALL SIGNAGE ON THE LATCH SDE OF THE DOOR AT 60 INCHES ABOVE FINISH FLOOR TO HORIZONTAL HANNON ARCHITECT O PARTIAL WALL INFILL CENTER OF SIGN.REFER TO ICC A117.1-2009 FOR ADDITIONAL 12 WG DRIVE INFORMATION. SALEM NH 03079 6. NEW WALLS TO BE W GYPSUM BOARD ON 3W METAL STUDS 0 16'ON 0 CENTER. WALLS EXTENDING TO DECK TO RECEIVE DEFLECTION TRACK. ©C0PrRIGHT2Dl6 ROOM 7. TOILET OM CEILINGS TO BE A MINIMUM OF Y-6'ABOVE FINISH FLOOR. ii 6 SHORE EXISTING MEZZANINE AS REWIRED TO CONSTRUCT NEW TOILET ii ROOM PARTITIONS. A y, DEMOLISH DOOR 8. CLEAR DIMENSIONS ARE INDICATED FOR FINISHED INTERIOR DIMENSIONS, INCLUDING ANY WALL FINISHES . 42"GB 24%36'METAL FRAMED MIRROR T.P.D. EXISTING DOOR S'D' " PROJECT NORTH 42"G.B. 6• TO REFLECTING HAND 3_0 SERFAGE c NEW DOOR&NUMBER D O F/E eaEO^Rc O t s � ��a o _ 8 INSULATE U = - V.IN. o SKIRT TO o sc ® NEW WINDOW 7 PIPES,TW. _ MATCH UNIT ITEM HIDDEN OR ABOVE 11• 6- ® EXIT SIGN,MOUNTED MIN. H.C.WATER COOLER/ PAPER TOWEL SANITARY NAPKIN FIRE EXTINGUISHER Q ABOVE DOOR WATER CLOSET( SIDE ) WATER CLOSET(FRONT) WALL HUNG LAVATORY DRINKING FOUNTAIN HAND DRYER DISPENSER DISPENSER CABINET < 111 O p O LL ~ 2 O� O a0 Z > L6 MECHANICAL UNIT TO REMAIN PROVIDE 3'-3"x 7'-0" O U DOOR WITH UTTUTY LDCKSET MOP SINK p W/KNURLED LEVER HANDLE 2 UTILITY " MODIFY MEZZANINE& I GUARDRAILS TO SUIT NEW I A-0 O CONSTRUCTION BELOW I 7�-3" —i W/ 7'-3" ) 0 ( LlF1R CIFAP � rr—_____�_ ---J II ppp I I WOMEN MEN EXIT SIGN TO REMAIN A-0A-04 FIRE II EXTINGUISHER II )� TINE OF EXISTING MEZZANINE u PROVIDE 3'-0"x 7'-0"DOOR WITH FITNESS Z NEW GUARDRAILS AROUND PRIVACY LOCKEV SEF W/LER HANDLE, T-072 ------ PROVIDE REMOVABLE EXPANDED MEZZANINE 3 HINGES,&CLOSER,TTP.OF 2 I GUARDRAIL OR GATE WHEN OVERHEAD ...1 HI/LO ACCESSIBLE SECTIONAL DOOR IS OFFICE RECEPTION DRINKING FOUNTAIN i OOPPENPHILE SPACE IS a- A-Ot REPLACE DOOR HANDLE WITH A I �/ MUPMIXf PLATFORM PASSAGE LATCHSET W/LEVER HANDLES I (NO SIORME AVOWED) 5� O NEW EXIT SIGN LOCATED MODIFY OR REPLACE ABOVE DOOR(SINGLE EXIT). I O GUARDRAILS TO BE CODE n I 0 COMPLIANT. SEE GENERAL EXIT SIGN TO REMAIN NOTES. RELOCATE Li FIRE EXTINGUISHER REVISIONS SSQSfI a a i - FITNESS EQUIPMENT LOCATED ALONG WALLS, ACTUAL EQUIPMENT WILL VARY,TYP. ,, O PERMIT 9/2/16 MK. DATE w"2 SEPTEMBER 2016 AS NOTED EQUIPMENT PLATFORM PLAN FLOOR PLAN , 76-014 . SCALE: 1/4'=1'-0" A101 SCALE: 1/4"=1'-O" A,Ot SH-NO A101 LEGEND DEMOLITION NOTES 1. PERFORM DEMOUTION NECESSARY TO ACCOMPLISH DESIGN AS DEPICTED IN ALL DRAWINGS. O EXISTING WALL TO REMAIN 2. WHEREVER NEW OPENINGS ARE CREATED, ALL SURROUNDING FINISHES SHALL BE PATCHED TO MATCH ADJACENT FINISH OR NEW FINISH DESIGNATED. C==C EXISTING TO BE REMOVED 3. RELOCATE AS NECESSARY ANY PIPING,ELECTRICAL,OR OTHER INFRASTRUCTURE EXPOSED WHEN EXISTING WALLS ARE MODIFIED OR DEMOLISHED. NEW PARTITION 4. COORDINATE&FIELD VERIFY THE EXTENT OF ALL NEW OPENINGS IN EXISTING CONSTRUCTION PRIOR TO ROBERT WILLIAM DEMOLITION ACTIVITIES. 5. DEMOLITION INCLUDES REMOVAL AND PROPER DISPOSAL HANNON ARCHITECT C-----i PARTIAL WALL INFILL S. 00 NOT ALTER OR DEMOLISH ANY MECHANICAL,ELECTRICAL,PLUMBING,OR FIRE PROTECTION ITEMS 12IANSINGDMI E THAT MAY EFFECT DOWNSTREAM OPERATION OF THE CONDOMINIUM WITHOUT WRITTEN APPROVAL BY THE S7LLE NH 03079 OWNER OF THE BUILDING. --n 7. PRIOR TO DEMOLITION,REVIEW ALL DRAWINGS WITH OWNER&LANDLORD. ©COPYRIGHT 2016 I A iti DEMOLISH DOOR t . N .�s EXISTING DOOR PROTECT NORTH �tERFn RRC' O NEW DOOR&NUMBER Hj1L11�' �Um ® NEW WINDOW F Ci Ni55R4 -------- ITEM HIDDEN OR ABOVE ® EXIT SIGN,MOUNTED ABOVE DOOR Q f O K O 0 ON O a0 ? > O:f > MECHANICAL UNIT TO REMAIN 0 U � d MODIFY MEZZANINE& I SII I LC�J O GUARDRAILS TO SUR NEW i /' CONSTRUCTION BELOW DEMOLISH PORTION OF WALL TO SUIT NEW WORK rL--------�— ---J I uL-=J L—� uJ EXISTING SQMCES TO REMA N II — ppp I EXIT SIGN TO REMAIN FIRE DEMOLISH TOILET ROOMI IN TO REMAIN WALL EN`nREIYDOORS, INCLUDING I WALLS,DOORS,FIXTURES, I I &FINISHES. II II DEMOLISH PSUI OF TO SUR I I MEZZANINE TO NEW WORK Z II Q REMOVE FIRE EXTINGUISHER II &RELOCATE PER PIAN J II ____--- a- II I j OFFICE/RECEPTION I Z jl DEMOLISH LATCHSEI WAREHOUSE I O EQUIPMENTPLATFORM 590 SF (ND STORAGE ALLOWED) MODIFY OR REPLACE GUARDRAILS TO BE CODEI Q ERA I COMPLIANT. SEE GENERAL 11 SIGN TO REMAIN L_______ I I NOTES. Lu I� Q I~� ~j REVISIONS I I I • a 0 PERMIT 9/2/16 :* MK. DATE °tR 2 SEPTEMBER 2016 AS NOTED EQUIPMENT PLATFORM DEMOLITION PLAN z DEMOLITION PLAN , -014 SCALE: 1/4"=1'-O" D101SHEE NNO. SCALE: 1/4"=1'-0" D101 D101