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HomeMy WebLinkAboutBuilding Permit #367-2017 - 350 WINTHROP AVENUE 10/6/2016 e✓ NORTH BUILDING PERMIT °�,4LED F6 A�0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION . 1. Date Received �2 oLo ��p°RAre° ���°� - gssgc►+ Permit No#: Date Issued: to - i �' IMPORTANT: Applicant must complete all items on this page _ LOCATION y^ Is'Z'-�-�1 (3r—5 Print PROPERTY OWNER _ 900 Year Structure yes no Print MAP PARCEL:. ZONING DISTRICT:-.Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential i Residential ❑ New Building ❑ One family ❑ Industrial f ❑Addition ❑Two or more family ❑ Commercial ❑Alteration No. of units: Bldg ❑ Others: El Repair, Assesso Repair, replacement rY ❑ Demolition ❑ Other 0 Septic ❑Well Floodplain [I Wetlands ❑ Watershed District _ ❑ p p Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly Phone: OWNER: Name: Address: Contractor Name: ri1� rw PV.? VrG��-APhone: Email:._ Address: "7 I _ t9e- Ex Date: Supervisor's Construction License: 'y�`f P - lI Home Improvement License: ARCHITECT/ENGINEER Phone: Reg. eg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$ 0 PER S.F. Total Project Cost: 11 U00 FEE: $ S � Check No.: ®® (© O Receipt No.: 3/ ® O NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund of A ent/Qwner Signature of coR®nntractor Gignature g 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 C f PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS i Pning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Manning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENaT - Temp. Dumpster on siteyes no L©cated at 124 Main.Street - Fire Department signature/date 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 roval ofElectricalInspector 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 Pennit Revised 2014 i 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 o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products r NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 1 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o 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 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 o Certified Proposed Plot Plan o 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 require sign off from Fire Department prior to issuance of Bldg. Permit NOTE: All dumpster permits req g 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. 3b'7 -,?or-7 Date 1 o • !o • }o,,& E.. • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# n Building Inspector NORTfy q Town of s _ a ndover �o * h ver, Mass, /� 6 CoCMIC141WKR ��• RATED 100 U BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT ........... ...... .��I",� .Of ....... , ,,, '� c,R,,,,,,,,,,,,,. BUILDING INSPECTOR a. .. . .... .ro... � � i has permission to erect .......................... buildings on ...'35...... .......ffec...... Foundation Rough tobe occupied as ................................................................................................................................... chimney provided that the person accepting this permit 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 CONSTRUCT N START 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. b � �a�- a� FP6(rev.3/00) APPLICATION FOR PERMIT DIG SAFE NUMBER City or Town Date 9— Start Date: nce with the provisions of M.G.L. Chapter 148, as provided in Section 2700 application is hereby made In accordance (Full name of person,Firm or Corporavon) Address (Street or P.O.Box)(City or Town) For permission to (state clearly purpose for which permit is requested) Name of competent operator(If Applicable) f '� " /aI( Cert. No. Date issued-rejected By (Signature of Applicant) Date of expiration Fee � ` $ Paid �v� _ Due —�------------------------------------------ C77 C-29 al"145rlz V P/fU?* X fr FP6(rev.3/00) p. g. C c j025, (Y& 0/ 75 PERMIT np D11101 SAFE NUMBER City or Town f-�►� R tl - Date Gg [StaLrtDa:te: Permit Number (if applicable) In accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted to rill (Full name of person,Firm or Corporation) pp �C. f J Citi- ��� for �u '•'� " Restrictions: at _ Give locatidn by street and no.,or describ in such manner as to provide adequate identification of location) Fee Paid $—� '� This Permit will expire on T-ttle A 41.6 Signature of Official Granting Permit R p $ pq W R�9 (� &_BPB v%r%a*=r1 aarwr n he R.D6eB8 iS "�'•:•i EXISTING MEN'S EXISTING MEAT COOLER DUCT 1 DUCT DUCTS TO BE REMOVED 1 I (TYP,) 1 EXISTING WOMEN'S L r — — — r — , 1 L DUCT I T — � — —�-� +oo L-1IJ 1 1 1 ! A.H. ~ I A.H. 1 j Mgt 91 . . L J — 1 IH OF lygss oy q DUCT I ( DUCT I / ,17 NATHANIEL 11p PHILLIPS m CATWALK 1 I I/ /— j U FIRE PROTECTION N I I I ( 0 1 I I I i t ! ,o NO.M50 ==t----=- ----_-_--------f===-=-- ------_-_-----___ ... .............................................................. NOTE, Mammoth Fire Protection Systems, inc. EXISTING DUCTS AND AIR HANDLERS TO BE REMOVED AND NEW ROOF TOP UNIT TO BE INSTALLED, MT%_01-978-569-1111 176 Walker Street Lowell, MA 01854 EXISTING SPRINKLERS (4) INSTALLED UNDERNEATH THE Scaie; i�4' ::Approved Byl Drawn By;...K.,A,Y,.. DUCTS WILL BE REMOVED AS THEY ARE NO LONGER : .......................................... NECCESSARY, :Date 10/4/16: : Job No. ........................................................................................................................... MARKET BASKET 350 WINTHROP AVE. NORTH ANDOVER, MASSACHUSETTS DroLwing No, FP1 MAMM04 OP ID: CEI onrE(MM/O CERTIFICATE OF LIABILITY INSURANCE E(MMID15D/Yvvv) THIS ERTIFICATE 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 eertifleate holder in lieu of such endorsement(s). PRODUCER Phone:978 59-8681 NAME:CONTACT Ftanois Provencher Insurance. _.. Agency,Ince Fax:978-454-9343 A/CNt o Ext: _._.__.._ ..._�FAAic No: 630 Lagers Street E-MAIL Lowell,MA 01862 aDOREss: _ INSURE�tAFFORDING COVERAGE , NAIC k - — INSURER A:WeSCO Insurance CO:'. Mammoth Fire Protection INSURER B:Gotham Insurance Company25569 Systems Inc.S INSURER c:Merchants Insurance Group 23329 176 Walker Street- -- _ Lowell,MA 01854 INSURER D:Preferred Mutual Insurance Co. 15024 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. Y Y_YPE UP INSURANCE POLICY NUMBER MMIDDmYY POLICY M DDY EXP LIMITS tlLNIERAL LIA131LITY Ii- EACH OCCURRENCE $ 1,000,000 COMMEgCiAIGENERAL LIABILITY GL2015FSC00959 11/17/15 11/17/16 PREMISES Ea occurrenceL__ 100,000 CLAIMS-MAGE E A I OCCUR MED EXP(Any one person) $ 5,000" PERSONAL&ADV INJURY $ 1,000,000 lvrrors t)rnl$slon _GENERAL AGGREGATE A _ 2,000,000 fi€N'L AGCI2E13ATE LIMIT APPLIES PER; PRODUCTS-COMP/OP AGG $ 2,000,00Q PR -- ... hOLICV ,C O LOG $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT 1,000,000 Ea acc dent 3 C ANY AUTO CAPI047171 12/02/15 12/02/16 BODILY INJURY(Per person) S ALL OWNED x SCHEDULED BODILY INJURY Per accident S AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE X HIREDAUTtl5 AUTOS (Per accident S S UMBRELLA LIAR X OCCUR EACH OCCURRENCE S_ 5_,000,000 Q X EXCESS LIAR CLAIMS-MADE UM2015FSC00446 11/17/15 11/17/16 - AGGREGATE S S,OOO,000 DED I X I RETENTION 1 10000 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N S__. ER A ANY PROPRIETOR/PARTNER/EXECUTIVEWWC3166264 11/01/15 11!01/16 OFFICER/MEMBER EXCLUDED? N N/A E.L.EACH g 1_— ,000,000 (Myyandatory In NH) E.L.DISEASE-EA EMPLOYEE S -1,000,000 OEes sc'Ibo under SCRl PT ON-OF OPERATIONS below E.L.DISEASE POLICY LIMIT S 1,000,000 E installatlon CPP0120599407 11/20/15 11/20/16 Property 20,000 Floater Ded S00 bEa9 OYIDN OF OPERATIONS f LOCATIONS I VEHICLES (Aftach ACORD 101,Addltional Remarks Schedule,If more space Is required) 8PP11NKLEft SYSTEM II _ I Ct RTII 1CATL 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. AUTHORIZED REPRESENTATIVE @,1988-2010 ACORD CORPORATION- All rights reserved. A00F0 26(201'0/05) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Department of Public Safety Mprinkler..onur8i.iiir License: SC-003065 , GARY C ROBIDO�TX 5 RIVERBEND IN MO. : a PELHAM NH 0076 .y Expiration: Commissioner 06/04/2017 _1 f Commonwealth.,of'Massachusetts Department of Public Safety License: SJ-004054 + Sprinkler Journeyman EDWARD L VERLOOVE ;.. 10 MOUNT PAUL ROAD ^;� .� TYNGSBORO MA 01879 - t ��M Expiration: Commissioner -- 11/08/2017 1 Commonwealth of Massachusetts Department of Public Safety .�nr iunrcr �,onu bii6i License: SC-003065 GARY C ROBIDOf7X 5 RWERBEND PELHAM Nfi 0076 a Expiration: Commissioner 06/04/2017 1