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HomeMy WebLinkAboutBuilding Permit #473-2017 - 350 WINTHROP AVENUE 11/4/2016:2 mid,) ScANHo-D zl--*, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain Wetlands ❑ Watershed Distnet ❑ Water/Sewer f DESCRIPTION OF WORK TO DE PERFORMED: ; Identification - Please Type or Print Clearly' OWNER: Name: Phone: Address: .x �xA�tJLf�^�Phoriew.� Address !DS f/ Si S `7- 2 '. : • �^t e�n1 C•i�� ," Q+,,,�,K^",..dfkt � .�k '�9 'K t w�sersConstrucfion LicenseZ K .r. ";nw tr n's-b y r - Home Irnprovemert Licensee __ :.� 1 . -_Exp_ rDafe ' ,; z: p::b _ • , ARCHITECT/ENGINEER Phone: Address: Reg. No., < FEE SCHEDULE. BULDING PERMIT.' $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. "'--'Total Project Cost- $ l� y©� . FEE. $ Y b Check No.: t 0 Y Receipt No.,.- NOTE: o._NOTE: Persons contracting with unregistered contractors coo not havoaccess tot g van u d "r .t� f A :enfil0wner Si nature of eoii _�.. _ `nr°:.9 9 . _ tract0- ,Sig' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ " TYPB-bF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools El 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 COMMENTS Signature CONSERVATION Reviewed on Siqnature 1 COMMENTS a, HEALTH COMMENTS Reviewed o Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Comments Sianature Zoning Decision/receipt submitted yes Conservation Decision: Comments Water & Sewer Connection/Siqnature & Date Driveway Permit DPW Towyn Engineer: Signature: Located Jd4 Usgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS -Nmension 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 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. 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 o 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 DOTE: 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 /v Tv t! Y4, V c No. 4%73- X01 -7 Date Check # 1017 01 133 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ IyY-0-- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ j: ' Building Inspector Eq—* i J < LL iz Q m C v \L O LOL E N T N O. Ln p a Z z 23 J =)J m C O i c 7 LL to_ O R' ? U LL O a Z m d 7 2' m LL 0 a z G u_ U W J W 7 2' •� (n LL OF LUW. z Q � K LL Z LU W W LL L v CO O z (% ++ p v 0 (n In J 3 0 ENO O Z LLJ am 0cc 0m r= o i; QL ` a Cl) 0 ♦: E n =� y m co - o O ci L CD3 �= OR E � O i d v ; rcn a� cu y W at > a H 0) xz O �• � t o uJ 2� E o o Q F.. V QNZ a� = o o = W W m) 0 [� c,'> o W J 1� c o I- a z Q a a, m a) � m S �. ca 0y 0 o c c o Q d 'S N w to V m d ca - O O LL 12 to C O H to >Z :E O Z 0� -'-W a O V Q O CD Q cow - 'o W. c OJ H s � a. O U > 9 w ti CD O o z O N I N Q �E m m a �- w O �+ CD 0 O cc O Q CL a cn � Q O _ Co .v 0-0 �z O CL V to c CL _N 0 Commonwealth of Massachusetts Sheet Metal Permit Date. Estimated Job Cost: Plans Submitted: YES NO Business License # J M •q, f Business Information: v Name: Gin�n 1 n JL Street: /D 5-9, ;�&' City/Towt . Telephone: -276- photo 278 Photo I.D. required/ Copy of Photo I.D. attached: Permit # Permit Fee: $ Plans Reviewed: YES NO Applicant License # C 7/ Property Owner / Job Location Information: Name: Wnm�r.� �g i �S�}fo� Street: 350� Z City/Town: A/, aA,*Ia,-e4 Telephone: Q 78.8 e YES ✓ NO Building Type: 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: HVAC Metal Roofsng KitchenExhaust System Chimney / Vents Provide brief description of work to be done: A .r G GJ'_'IP !U - v r - Qf U l 1521 � = -- INSURANCE COVERAGE: 1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes [ No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I 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(], 1 hereby certify that all of the details and information I 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 Comments Type of License: By ❑ Master ritle KDAaster-Restricted :;ity/Town ❑Journeyperson 'ermit # Signature of licensee =ee $ Elio urneyperson-Restricted License Number: 5—dt�i Check at wviw.mass.ciovldpl nspector Signature of Permit Approval BRANAGAN ENGINEERING, INC. 160 OLD DERBY ST., SUITE #335 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 (E) CMU WALL OF PETER 0 s i PETER B. N ------------~------�i--- -- ----=- BRANA,GAN R` ° STRUCTURAL Y ( No. 322748 oI I I I ASO �°�lSTE0.�O��e -_ __ - S C} 10 W I I I II I II, (E) CMU - -----�---- -- --I--- � I--- I WALL L4x4x1/4 UNDER CURB, TYP.(nI VERIFY RTU LOCATION WITH I i MECH'L. DWGS. (TYP.) I II O5 ®I NEW 10 TON RTU ILj I WEIGHT=1.250# L3x3x1/4 AROUND I II I . II DUCT OPENING li NEW 8.5 TON RTU I i WEIGHT=1.200# GENTLE DENTAL I � NAIL SALON 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 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 of hire, express or implied, oral or written." 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 enterprise, 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 ofthe dwelling house of another who employs persons to do maintenance, constmction or repair work on such dwelling house or on the grounds or building appurtenant thereto shalt not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage xequited." 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 Please fall out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub—'contractor(s) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy'is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industxial•Accidenis. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their 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 fill in the permit/license number which will be used as a reference 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 "lob 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 may be 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 citizen is obtaining a license or permit nat related to any business or commercial venture (i.e. a dog license or permit to burn 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 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax 4 617.727-7749 Revised 02-23-15 wwwmass.gov/dia The commonwealth of Massachusetts Department of IndustrialAccidefats I Cong-ress Street, Suite 100 Roston, AfA- 02114-2017 o�M Sv'y� 1Al -ul mass.govIdia Wovkers' Compensation Iusuranc Affidavit, r�u diva rvrrNG AUTHO sRIT Y• tricians/j? lwmbers. Name Address: ff}S, Phonc #: lc' 7,F — City/State/Zip: Axe you as employer? Checktlie appropriate box: Type of project (�reguinred) em to ees(full and/or pari time).* 7. Ne�v'donstruction 1-� T am a employer with P y 2.F]I am a sole proprietor or partnership and have no employees Working for me in 8. Remodeft any capacity. [No workers' comp. insurance required.] 9. Demolition 3. Q I am a homeowner doing all work myself. [No workers' comp. insurance required.] ' 10 ❑ Building addition 4.❑I am a•homeowner and will be hiring contractors to conduct all work on my property. Iwill 11.❑ Electrical reppirs or additions ensure that all contmetbis either have workers' compensation insurance or are sole 12 js `Plmnbffig repairs or additions proprietors with no employees. tor and I have hired the sub contractors listed on the attached sheet 13•. [] Rbof repairs 5.Q I am a general coniiac Those sub -contractors have employees and have workers' comp. insurance.# 14.[] Other 6. Q We are a corporation and its. officers have exercised their right of exemption per MGL 0- 152, §1(4), and We have no empldyees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill. outthe sectioabelow showing their workers' compensation poficy information: • t Homeowners who submit this affidavit indicating they aze doing all work an th nehirre sub contrtside contractors tors and state must submit hether o nowt those ntrtfes�have *Contractors that checkthis boxriuust attached'an additional sheet showing employees. If the sub contractors have employees, they must provide their workers' comp. policy number. X am an employer that is providingworkers' compensation insurance for my employees. Below is thepolicy androb site information. Insurance Company Name: l DNQ ExpirationDate_ e2 Policy # or Self -ins. Lic. #,/ / /i D,o City/State/Zip. 9'd A Job Site Address: c J � �lUe Attach a copy' of the Workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as rea well ased c iv penalties2m the form of criminal ESOP WORK ORDER land fine o� p to $250.00 a and/or one-year imprisonment; Office of Invesiigaiions of the DIA for insurance day against the violator. A copy of this statement may be forwarded to the coverage verification. X do hereby cerci ,,,A that the information provided above i true and correct Phone #: v IfOfficial xrse only. Do not write in this area, to be coYnpleted by city or town official City or Town: Permit/License # "oy/lam issuing Auithoxity (circle one): ector 1. Board of Health 2. Building Department 3. Ciiy/Town Clerk 4. Electrical Inspector 5. Plumbingxnsp 6. Other Phone Contact Person: ACORN® CC CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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 CONTACT Patricia Capadanno Tonry Northwest Insurance Agency, Inc.aC NNo Ext: (81)861-1800 FAX AIC No: (781)861-1804 E-MAIL certs@tonry.com ADDRESS: 238 Bedford Street INSURERS AFFORDING COVERAGE NAIC # INSURER A:Harle sville Preferred Ins. 35696 Lexington MA 02420 INSURED INSURER B:Harle sville Insurance 23582 INSURER C:Harle sville Worcester IRs Co 26182 Commercial Comfort Service Inc. INSURER D AmGUARD Insurance Co an 42390 1059 East Street INSURER E: INSURER F: Tewksbury MA 01876 C(IVFWA(8Fti CFWTIFICATF NIIMRFW'U l.1B2TY1ZNVb RFVICInN NI IMRFR• 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 IVSD WVD SUER POLICY NUMBER POLICY MM DD POLICY EXP 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 � PRC JECT D LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ B ANY AUTO ALLOWNED x SCHEDULED AUTOS AUTOS BA00000029086Q 2/22/2016 2/22/2017 BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ PIP -Basic $ 8,000 X UMBRELLA LIAB OCCUR _ EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 `, EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ I ICNBO0000029085Q 2/22/2016 2/22/2017 WORKERS COMPENSATION- AND EMPLOYERS' LIABILITY YIN PER OTH- x STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 1) ANY PROPRIETOR/PARTNER/EXECUTIVEI OFFICER/MEMBER EXCLUDED? , n (Mandatory in NH) A NIA COWC700192 2/22/2016 2/22/2017 E.L. DISEASE- EA EMPLOYE $ 1,000,000 ff yes, describe under E.L. DISEASE -PCLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I 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. Town of North Andover 1600 Osgood Street North Andover, MA 01845 %,ANt,r_LLA I IUN 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 L Tonry Jr./PCAPAD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INSO25l7n1dM1 LICENSE NUMBER C'I ti'EXPIRATION DATE ,,. i SERIAL°NUMBER Fold, Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS I I RANQALL E BURNS 0 P . yq pgy tit�R R MC r - I I RANQALL E BURNS 450 w �N+�•� p r4v,� r 00 7z� w � U, NN^' M to a�cmi U LU- 0] U z 0 U o �1 W a®L.Je' ,°(o Y mO = 0 aZ o EO ra mW 0_ N m m rl Automatic Fire Sprinkler Systems Backflow Preventers Sales and Services 24 Hrs. 3/28/17 RE. Gloss & Go Nail Salon 350 Winthrop Ave. N. Andover, MA Rmnomuflame Masse Fire Protection Services PO BOX #64 Pelham, NH 03076 603-635-3120 Sprinkler Narrative The sprinkler renovation will consist of relocating 21 sprinkler heads. This will accommodate the new ceiling and wall configurations. The relocated sprinkler heads will be change to new Quick Response style heads. The K-factor(gallon per minute output) of the new Quick Response sprinkler heads, will match the existing style. Therefore, the system's hydraulic output will remain the same. The installation complies with NFPA13, CMR780, and local authorities. Sincerely, Bert Masse Jr. Project Manager Masse Fire Protection Services 603-231-1518 Masse Fire Protection Services Automatic Fire Sprinkler Systems Backflow Preventers Sales and Services 24 Hrs. Sprinkler Narrative 3/28/17 RE. Gloss & Go Nail Salon 350 Winthrop Ave. N. Andover, MA PO BOX #64 Pelham, NH 03076 603-635-3120 The sprinkler renovation will consist of relocating 21 sprinkler heads. This will accommodate the new ceiling and wall configurations. The relocated sprinkler heads will be change to new Quick Response style heads. The K-factor(gallon per minute output) of the new Quick Response sprinkler heads, will match the existing style. Therefore, the system's hydraulic output will remain the same. The installation complies with NFPA13, CMR780, and local authorities. Sincerely, Bert Masse Jr. Project Manager Masse Fire Protection Services 603-231-1518 f o Masse Fire Protection Services Automatic Fire Sprinkler Systems PO BOX #64 Backflow Preventers Pelham, NH 03076 Sales and Services 24 Hrs. 603-635-3120 Sprinkler Narrative 3/28/17 RE: Gloss & Go Nail Salon 350 Winthrop Ave. N. Andover, MA The sprinkler renovation will consist of relocating 21 sprinkler heads. This will accommodate the new ceiling and wall configurations. The relocated sprinkler heads will be change to new Quick Response style heads. The K-factor(gallon per minute output) of the new Quick Response sprinkler heads, will match the existing style. Therefore, the system's hydraulic output will remain the same. The installation complies with NFPA13, CMR780, and local authorities. Sincerely, Bert Masse Jr. Project Manager Masse Fire Protection Services 603-231-1518