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HomeMy WebLinkAboutBuilding Permit #472-2017 - 350 WINTHROP AVENUE 11/4/2016I BUILDING PERMIT TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION'-* Permit No#:- 1479" 9077 Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 0 Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic 0 Well ❑ Floodplain 0 Wetlands � Watershed Disf�ict ❑ WateriSevver" y DESCRIPTION OF WORK TO DE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: AririrP.q.q- Phone: f� Address IDS^ 4.45'T S.7� e7` vc✓ S_ i✓�z •/ '. z t �'i'; .. "'7" .•^ v •y°+x.v.ri+ .,.-. ,- • - - - ,+*:.� war r�-.r'�-•"`ti �- - .moi^F-- +.-t -c i stn EWFise'#-, 1 �. < . x Da D =� - .1_, E to ` (-.. t 'Home4n rovement License = -� r Exp sDatew _ r. p R. ARCHITECT/ENGINEER Address: Phone: .:- Reg. No. _ FEE SCHEDULE: BULDING PERMIT,$12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. �d b �- .Total Project Cost: $za FEE: $ Check No.: t ® `i Receipt No,: 3/ 0 7 0 NOTE: Persons contracting with unregistered contractors do not have. access to g ran u d ;S_ignatu�e of Agent/Owner Signature of coritracto r Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ TYPE )F 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 e U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature. CONSERVATION Reviewed on Signature COMMENTS r HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes /� Planning Board Decision: _ 1 4 Conservation Decision: Comments Co Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT = Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS uocatea Jb4 Usgood Street no limension 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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc.Building Permit Revised 2014 r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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 ❑ 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 ❑ 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 40TE: 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 Wo y r d'o, A d C No. Y7�L(/-7 Date t, TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 1Y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /0 Y'7 f I t " Building Inspector O Z Q = LL O Q m .0 u +' \ LL E ate+ Ln U (n C9 W N z Q z O J m O t d' T c U LL cc W N z _z m J d S LL W N z Q U F W W t d' U V1 LL O U ui z Q O Z Q = LL O Q m .0 u +' \ LL E ate+ Ln U (n C9 W N z Q z O J m C O m -0 LL t d' T c U LL cc W N z _z m J d S LL W N z Q U F W W t d' U V1 LL O U ui z Q t D' LL °c nQ. LLI W IL N co O z (% N O N �JC O �= CL as m " V dp .-. 0 • y- O EQ� • L 1 r• D 0,2 N J i m d r N c w CD M co oE -0 0 0 co) tm o� > VQ c y �v -4 ° mC ° 5 T otm • w •> 3 c co H �CL CL 4) } a)t� m O tm cn F- o c Q i L Ri 'a O = d Q '� N 1- O to 2 m m Nr, W -a +-E•+ O O y.. ti •� to C o Q t O O 0 m o-00. .0 o O F w aov > 2 z O 2 coz W w a w H W a 0 W C7 m Q� Z z v J �v N LQ 2 w H � C CD mo O O- CL �tQ C a � J O zCL� U) C AW BRANAGAN ENGINEERING, INC, 160 OLD DERBY ST., SUITE 0335 HINGHAM, MA 02043 (781) 749-5400 JOB: NEW TENANT ROOF TOP UNITS MARKET BASKET #12 350 WINTHROP AVE. NORTH ANDOVER, MASSACHUSETTS DATE: OCT. 17, 2016 SKETCH NO. SK -4 A (E) CMU WALL 4 ss90 (oma PETER B. tiN ------------- - ii--- - - BR.ANAGAN I � I---II--•r-------- o STRUCTURAL� Wa:Y I I I No.32748 Flo LENS` WALL MU L4x4x1/4 UNDER CURB, TYP. I I N I I VERIFY RTU LOCATION WITH MECH'L. DWGS. (TYP.) uj NEW 10 TON RTU ® WEIGHT= 1,250 -- i ----------I---fir--- L3x3x1/4 AROUND I II I II DUCT OPENING NEW 8.5 TON RTU ®I WEIGHT=1.200# GO I I I II GENTLE DENTAL II NAIL SALON II I I II I NI II I I II I 3� II -------- �----------I---ate-- =- �-------- W'------ I ii I i II PARTIAL EXISTING ROOF FRAMING PLAN SCALE: 1/8"=V-0" '-0" NOTES: 1.) ALL CONSTRUCTION IS NEW, EXCEPT THAT WHICH IS NOTED (E) EXISTING. 2.) COORDINATE FRAME DIMENSIONS WITH "APPROVED" RTU. 3.) SEE SK -3 FOR "NOTES" AND "TYPICAL DETAILS". 4.) NO OTHER NEW OR EXISTING MECHANICAL EQUIPMENT TO SHARE JOISTS WITH NEW RTU. C:\DRAWINGS\16129 C -A - W Commonwealth ®f Massachusetts Sheet Metal Permit Date: )H-1� Estimated Job Cost: Plans Submitted: YES NO Business License # •67 i Business Information: Name: Street: /®� City/Town` Telephone: Photo I.D. required / Copy of Photo I.D. attached: Building Type: Permit / 7 Permit Fee: $ y Plans Reviewed: YES NO Applicant License # M7/ Property Ovmer / Job Location Information: Name: Street: 350 L)0-7- City/Town: AA ® .� Telephone: 9 78- (96:1- OeVo YES ✓ NO Residential: 1-2 family Multi -family Condo / Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. ,,-"over 35,000 cu. ft. Sheet metal work to �be completed: New Work: Renovation: --f HVAC 1 Metal Roofing Kitchen.Exhaust System Chimney / Vents Provide brief description of work to be done: . e'O n A l INSURANCE GOVERAOE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch.112 Yes [�r`N o ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[], I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Date Progress Inspections Comments Final Inspection Type of License: By ❑ Master Title Master -Restricted lity/Town []Journeyperson 'ermit # ❑Journeyperson-Restricted 'ee$ ❑ nspector Signature of Permit Approval Comments Signature of Licensee License Number: �d�l Check at www.rnass.cYov/dpl 6 eA;71-4- ( de'A-ft-/ lie Commonwearth of massaehusetts _ _ F Department of Industrial Accidents M f X Congress Street, S�Ite 100 d021'4 20X7 Boston, MA www rnassgovldia •p`'a'fM SJ'v Workers, Compensationlnsurance Affidavit: Builders/Co � aTHORTJC*Y-ixxczaxzs/Z'lumbers. TO BE FILED WITHTHE?'E1f olo�aaPrint CP - Name (Business/Oigauizationadividual): Address: 4EA, z7 M Old ?6 _ Phone ,� S^1�� _ City/State/Zip: Tppe of project (required) - Are you an employer? Cheekthie appropriate box: s employees (mIl andlor pari time). 7, [[ N�vr consixaction 1. I am a employer with_ _ __ 2.❑I am a sole proprietor or parfnershiP and have no employees Working forme in 8. Remo deg any capacity. [Noworkmrs' comp. insurance required] 9. ElDemolition o workers' comp. insurance required] t 10 [] Building addition 3-C] I am ahomeownez doing allworkmysel� [N 4.[] I am ahomeowner and will be hiring contractors to conduct all work on my property. I will 11.0 Electrical repairs or additions ensure that all contractbis either have workers' compensation insurance or are sole Plmnbin airs or additions pzoprietors -with no enigloyees. �' 0 g rep 5. ❑ I am a general conisactox and Ihavehiredthe snb-confractors listed onthe attached sheet. 13•. [] Rbof repairs These sub -contractors have employees and have workers' comp. insurance 14.n Other 6. ❑We are a corporation and tis, officers have exercised their light of 'exemption per MGL o. 152, §i(4), and Wa have no employees. [No workers' comp. insurance required ] *Any applicantthat checks bbX#t must also fill outtho sectionbelow showing theirworkers' compensationpolicy information.' fi Homeowners who submit'this affidavit indicating mea' are doing all work andthenhire outside contractors must submit a new affidavit indicating such TConfractors that checkth box must attached an additional sheet showing the name ofthe snb-contractors and sfiate whether or not those entities have employees. If the sub -contractors have employees, they must provide thein workers' comp. policy number. eeS. 'Below is t72e policy and job Site jam an employer tliat is providingworke.W compensation insuran ce for my employ information. �"-- y- Insurance Company Name: l D/1/� ExpiraiionDate= 02 Policy # or Self -ins. Lic. #: City/State/Zip /y�D7tli ,4 NG(�d 1dP� Job Site Address: J J' the otic number and expiratiou date). Attach a copy of the workers' coMpensationpolrcy declaratzoupage (showiazg policy Failure to secure coverage as required under MGL t152es i, the form ofrminalviolationpun OP WORK ORDF -ishabIaud of p to $250.00 a and/or one-yearimprisonment, as well as civil penal day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for izssut ince coverage verification. X do Ziereby cerci u Werpains alti fPerjury that the information providedabove is/true and corn act ll air • �/ / C//" 6 Phone #: Official use only. Do notwrite in this area, to be complet�hyty or town official. permit/License # City or Toyvn' issuing Authority (circle one):actor 1. Board of ldealth 2.Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing hisp 6. Other Phone Contact Person' ACORO0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 9/19/2016 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 Tonry Northwest Insurance Agency, Inc. 238 Bedford Street Lexington MA 02420 CONTACT Patricia Capadanno aCONNo Ext: (781) 861-1800 FA No: (781)861-1804 E-MAIL ADDRESS: Certs@tonry' Com INSURERS AFFORDING COVERAGE NAIC # INSURER A:Harle sville Preferred Ins. 35696 INSURED Commercial Comfort Service Inc. 1059 East Street Tewksbury MA 01876 INSURER B:Harle sville Insurance 23582 INSURER C:Harle sville Worcester Ins Co 26182 INSURERDAmGUARD Insurance Company 42390 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER CL1621912526 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR DAMAGE TO RENTED 50,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,000 SPP00000029087Q 2/22/2016 2/22/2017 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 7 RO JECTPF—] LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ B ANY AUTO ALL OSCHEDULED AUUTOSS x AUTOS BA00000029086Q 2/22/2016 2/22/2017 BODILY INJURY (Per accident) $ X X NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Peraccident PIP -Basic $ 8,000 X UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 C EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ CMB00000029085Q 2/22/2016 2/22/2017 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E OFFICE R/MEMBER EXCLUDED? (Mandatory In NH) NIA COWC700192 2/22/2016 2/22/2017 x PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1 000,000 If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is an Additional Insured, when required by written contract, but only to the extent provided in the Additional Insured endorsement(s) attached to the policy, a copy of which is available upon request. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014101) INS025 pmnnn ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE L Tonry Jr./PCAPAD e5�^ ACORD 25 (2014101) INS025 pmnnn ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD &'COMMONWEALTH OF MA�§- 7N WIMPRPROMN.Momm.m. HUSET-rS Fold, Then Detach Along All Perforations ;-#j...COMMONWEALTH OF MASSACHUSETTS NUA\ 11 kNIIItiIIIRIII 141560021 tDOW 04/0111*60 40 -Up, 0410V20iT 141560021 tDOW 04/0111*60 40 -Up, 0410V20iT