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HomeMy WebLinkAboutBuilding Permit #805-12 - 350 WINTHROP AVENUE 5/8/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 0 o ,- / ? Date Received Date Issued: y�1Z I O TANT: Applicant must complete all items on this naize LOCATION � O /0/), Print PROPERTY OWNER �� 1��G1�9�i� L' 7 - unit # Print i MAP NO: of % PARCEL: a % ZONING DISTRICT: Historic District yes no Machine Shop Village yes n _ 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE 0 Watershed.D,�istncty ' Water/Se¢wer� Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: XCommercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other {® Septic ` Well s ' (®Ilogdpl, ain 4 (©. Wye lands 0 Watershed.D,�istncty ' Water/Se¢wer� DESCRIPTION OF WORK TO BE 6,V (Identification Please Type or Print Clearly) OWNER: Name: ���' �r;i� , G 1 / Phone: 9��l-O�CiIJ Address:a57". Address: 7r Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER ---Phone: Address: Reg. No. �7!/7 FEE SCHEDULE. BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $/G/�FEE: $ % 7 Check No.: �`Receipt No.: '2-4-� . NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Rr 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 ❑ �Io� COMMENTS ;�i� �c�✓1 Gil► G'Gv Lou "yec: CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes s Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: i 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 — (t -or department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/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 ❑ 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 ❑ FloorlCrossection/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 Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract ❑ Mass check Energy Compliance Report o 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 Doe: Doc.Building Permit Revised 2008mi Locationz_Q w," No. 12' Date • - TOWN OF NORTH ANDOVER • ° fi°rr,r;n �� Certificate of Occupancy $ Building/Frame Permit Fee $ 1/i 9F7, I. Foundation Permit Fee $ Other Permit Fee $ Yh ar TOTAL $ Check # �S?/D 7 r' ' 25278 Buildi'n'g Inspector • • O Z 0 O CD Z a O ca G C o CD ._ H O> •E m m CD 0 co CD CD O Q o a C Q o = c CL .� ea as V V! tC C - - CL U) LLI to W W W N W A u•1 E z �. u�•� , w W �1' Q '� ' °a° co z o a o°G w rA cn, cn 0 O CD Z a O ca G C o CD ._ H O> •E m m CD 0 co CD CD O Q o a C Q o = c CL .� ea as V V! tC C - - CL U) LLI to W W W N The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal. J P: 0. Box.1025 State Road, Stow_ NLA 01775 APPLICATION FOR PERMIT Date: N. Andover Permit NO Dig Safe Numb ( City of Town.) . (it Applicable ) In accordance with the provisions of MGL. Chapter 10 as provided in Section 527 CMR 34 appli tica is hereby made Start Date i by ( Full_ name of person, Rini or Corporation) Address 'State clearly r3.cs� purpose for (Street or P.O. Box City or Town) whichpetmit . Forpermissionto locate dumpster for const=l•Qlj-Qa/rPncivati on LIP .mol i ti an is regnested of building Commcnts:. dumpster must be 25' from structure or covered when not i -n use at ( Give location by street and no., or descri e in such rnzancr as. to provird adequate identification of location) Name of competent operator �_ Cc r No. (If Applicable ) Date Issued -rejected aar Date of =piration --cu The Commonwealth Icy • Signature of-Appli=t ) F e S 50.00 Paid Due of Massachusetts Department of Fire Services Office of the State Fire Marshal P. 0. Box 1025 State Road,.Stcw, MA 01775 PERMIT North Andover Permit No _ ( City of Town) (If Applicable ) In accordance with the provisions of IvLGl _j /a $ Chapter_]Q as provided in secti0n_5=_ CMR_ 34 This Permit is granted to:.. Date: Dig :;z7; Start Date Full name of person, Firm or Corporation Pennissionto locate dumpster for construction/renovation/demolition of building. Coaunents: dumpster. must be. 25' from structure if unable to glace with required Restrictions: clearance dumpster must be covered with plywood or tarp end of 'work -day at ( Give location by street and no., or dese e in such manner as to pr ed ad quatc identification .off a ' n ) Fee Paid s 50.00 This Permit will expire �� —12— (S gnature of off cal granting permit) 1 .Ouffical gran ermit (Tide Construction Control Affidavit Project Location Project Name Nature of Project Architect andel/or Engi�merl Address (��-( A , , In accordance with Registration No. _ prepared or directly No.0 N�,HA Nod' ^���5( - 0000 110 and 116.0 of the Massachusetts State Building Code, I,��(C-'VM�G 1-1 _being a registered professional engineer/ architect hereby certify that I have sed the preparation of all design plans, computations and specifications concerning: Entire Project Architectural Structural Mechanical Fire Protection Electrical Other For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all accepted engineering practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code- required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix G. Pursuant to Section 116.2.2, I shall submit periodically, daily, /weekly, or other periods (specify) progress Reports together with pertinent comments to the Town of A /,, J -,_J s4 a _ Building Department. d�- Subscribed and sworn to before me this day of /�— J IM [EACH-VEGA My comm' xpireRUBY nTARY PUBLIC No u lic * COMMONWEALTH OF MASSACHUSETTS My COMMISSION EXPIRES AUGUST 13, 2015 f ` .? �t � , ... .� ` is , —, �� _. `. `� ,� O b �, cry y a �' iri O o a � T G U w a � a� a°' w a W ao' � w a o a w ,w � W_ � v Wzi z u, cn (� cn Cc c 'W c O C N— CL c eo 0 N � i ci Ed 111 _ co y ` m o' �p c „ all U �•` y CO cp m UJ O 5 m o acs m C/� : C o cm W `� •�: w a c c w o m cevo� C O :CaO C 0 p .0 = m :aCLS 0 N H ti 0.2 Z Lu. .c ,.. o W E caca v •cmC.2 4D O C/! CL o O J _ o a$ co zoo I ,R O W i Q O M CD m m .CD ow CL as C2 env o a CL c a CA c R O v J.O 'c. O }; CA Z CD V ti O O c •_ ev � CA W W W cn #691-11 OLYMPIA SPORTS NORTH ANDOVER, EWA. Vanilla box COM -CON CONTRACTOR'S INC. 5/1!2012 Codes COSTS MARKUP GEN LIAB 01 GENERAL REQUIREPn€NITS 01-971 DUMPSTER 1,600.00 $ 48.00 $ 16.00 01-060 10-000 PERMITS (BLDG & DUMPSTER/Ger town) ASBESTOS TESTING (U.T.SI jlj$ 3,000.00 400.00 $ $ 90.00 12.00 $ $ 30.00 4.00 PLANS $ 29.22 $ 0.88 $ 0.29 01-910 SUPERVISION 1 $ 5,280.00 00-600 1% GENERAL LIABILITY 1 $ 1,407.82 3% MARKUP 1 $ 4,223.45 $ 15;940.49 $ 150.8R $ 50.29 i 02 SITE WORK I I$ - 02-070 DEMO 2 $ 8,064.00 02-021 MISC. SLAB CUT 2 $ 896.00 02-021 DIGGING AND CUTTING FLOOR FOR PLUMBING & PADS 2 $ 1,680.00 i S 10,640.00 Is $ - E I $ 03 CONCRETE $ 03-400 STAIRS (SHEA CONCRETE) 3 1 $ 1,334.00 $ 40.02 $ 13.34 iO3-360 MISC CONCRETE (READY MIX) 3 is 625.00 $ 18.75 % 6.25 $ 1,959.00 $ 58.77 $ 19.59 04 MASONRY � 04-040 1JASwNRY (Dracut Const.) 4 $ 1,246.25 1 $ 37.39 $ 12.46 $ 05 METALS $ 11,246.25 1 $ $ 37.39 - I $ 12.46 05-100 SUPERIOR STEEL 5 $ $ - $ $ $ 03 1.1.100D & PLASTIC $ 05-710 INT, FINISH CARPENTRY (COM -CON) 6 $ 4,032.00 06-700 FINISH MATERIALS 6 $ I 350.00 $ $ 10.50 - $ 3.50 $ 4,382.00 $ 10.50 $ 3.50 07-500 07 MOISTURE THERMAL ROOFING PRIME ROOFING! 7 $ 3,419.75 $ g - 102.59 $ 34.20 $ 3,419.75 $ 102.59 $ 34.20 08 DOORS ,AIINDOWR'S & GLASS $ 08-100 08-400 PASS_ DOOR FR HDVVRE.,DOORS FOR DRESSING (KAMCO) ALUM/GLASS (B&CGLASS) 8 8 $ 4,117.65 11,154.91 $ $ 123.53 334.65 $ $ 41.18 111.55 $ 15,272.56 $ 458.18 $ 152.73 $ 09-500 09-010 09-100iSTi 09 FINISHES ACT JHS INTERIORS VCT FLOORING SIMEONE) IE S & DRYWALL (ZODIAC CONST) 9 9 9 $ $ $ 9,600.50 676.00 9,359.81 $ $ $ $ 288.02 2028 280.79 $ $ $ 96.01 6.76 93.60 $ 19,636.31 $ 589.09 $ 196.36 $ 15-300 15 MECHANICAL SYSTEMS � SPRINKLER (MAMMOTH FIRE 15 $ 7,471.69 $ $ 224.15 $ 74.72 15-400 PLUMBING (R4AJASTE PLUMBING) 15 $ 9,200.00 1 $ 276.00 $ 92.00 15-500 HVAC(COMMERICAL COMFORT' 15 $ 40,930.00 1 $ 1,227.90 j $ 409.30 16 ELECTRICAL $ 57,001.69 $ 1,728.05 1 $ 576.02 16-000 LO:"BELL CENTRAL ELEC. 16 $ 31,047.83 $ 931.43 $ 310.48 16-000 LOWELL CENTRAL ELEC. ADDITIONAL WORK IN STORAGE AREA 16 $ 5,219.06 $ 156.57 1 $ 52.19 5 36;266.89 1 $1,088.01 $ 362.67 1$ - E TOTALI Is 166,364.94 11 4,223.45 $ 1,407.52 '4C40R Di CERTIFICATE OF LIABILITY INSURANCE /l n5/2i 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 Infantine Insurance P. 0. Box 5125 Manchester NH 03108 CONTACT Yvette Fanaras (603) 669-0704 FAX .603-669-6831 E-MAIL ette@infantine.com LIMITS OCCURRENCE 1,000,000 iNsuRERA:Peerl2ss Insurgage 24198 INSURED Com -Con Contractors Inc. 13 Surrey Lane Pelham NH 03076 ,Excelsior Insurance 1 4 INSURER c: IN2IJRrzR D. IM500 9: . COVERAGES CERTIFICATE NUMBER -2012/2013 Master 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 )n§k TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF /1/2012 Pll —INSR 4M 1i Ei(11 %1/2013 LIMITS OCCURRENCE 1,000,000 A GENERAL LIABILITYEACH X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR INDER/PRG gym, ) $ 250 OOO MED EXP (Any one on 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: P LICv X P X oc PRODUCTS - COMP/OP AGG 2 000 000 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULEDBINDER/AUTO AUTOS AUTOS XX NON -OWNED HIRED AUTOS AUTOS /1/2012 /1/2013 COMBINED SINGLE LIMIT S I&QUAN _adR BODILY INJURY (Per person) $ BODILY INJURY (Per acodent) $ ROPERTY DAMAGE $ A X UMBRELLA UAB X OCCUR EXCESS UAB CLAIMS -MADE DIED I X 10,00 INDER/Uri /1/2012 /1/2013 EACH OCCURRENCE 10,000,000 AGGREGATE 10,000,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICERIMEMBER EXCLUDED ❑ (Mandatory in NH) If yes, describe under JPTION N / A INDER/WC tHtEa : NH & MA /1/2012 /1/2013 X �TATLI= X O _ LIMITS EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Project: Olympia Sports CFRTIFICATF MAI nFR CANCFI I ATInN (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Gerald Brown AUTHORIZED REPRESENTATIVE 1600 Osgood Street North Andover, MA 01845 Jim Harrison/SYM y"-" V.-.— Massachusetts - De;artme assa�cuse �sartrnent of Public �Safety ,_� _!� �. �ep� Board Of Building Regulations and Standards Construction SuPen icor License: CS -024116 JOAN PLLF - v 13 SURREY r, PEUUM N# 03076 7-2- N VA A Commissioner Expiration 04/24/2014