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HomeMy WebLinkAboutBuilding Permit #1097-15 - 351 WILLOW STREET 6/24/2015 -- NORTH w BUILDING PERMIT yQrp« `�ROo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION / . h Permit NO: �3 Date Received Date Issued: 6 cmu-- IMPORTANT: Applicant must complete all items on this page LOCATION- 3-y/ �ti + w S � Print PROPERTY OWNER -361-�, Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non Residential ❑ New Building ❑ One family I--, ❑Addition ❑ Two or more family 21fidustrial It ration No. of units: o Commercial epair, replacement ❑Assessory Bldg ❑ Others: 11 Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District dater/Sewer r f k-T e- C45t-6 Y J? i.� 0Hs� 42 A RIts±�z ,,k TVek Identification Please Type or Print Clearly) OWNER: Name: Bsep_ h 4 U., Phone: 80o - Address: 0o -Address: CONTRACTOR Name: Phone: 97f li¢? 3'K c, Address: Supervisor's Construction License: Exp. Date: 2 4 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. r FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. a Total Project Cost: $ S, GT FEE: $ /1' Check No.: Receipt No.: NOTE: Persons contracting with unregister d contractors do not have access to the guaraniy fund Signature of Agen#/Owner�/e�.�-�&,�/%_,C�nature of contractor t NORTII BUILDING PERMIT � 0F�tLEo X6,1+ TOWN OF NORTH ANDOVER so _ - APPLICATION FOR PLAN EXAMINATION o� . ,. Permit No#: Date Received �gssACHUSE��S Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family El Industrial ❑Alteration No. of units: El Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑'UVell ❑ Floodplain ❑Wetlands ❑ Watershe_ . istnc ElWater/Sewer - DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: i Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Reg. No. Address: FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund xl - --- -- Plans Submitted CJ 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 m U FORM i PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Sicmafure& Date Driveway Permit DPW Town Engineer: Signature: E, Located 384 Osgood Street FIRE DEPARtTIVIENT t t I_, T.ernptDumpster. onjs,tp ,yes i 124(IVIa F ret - Locatedjat,� in Ste 'Fi`re � pa►�t'ment�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 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 g 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 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) 4, 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 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 I ECC 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 L Location ��//�l� G✓ �i No. A,') Date �.Jr . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ /� Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# `, Building Inspector ! r 1 NORTH E : :. .c ve, O No. r soh , ver, Mass, �� A- KICKl WICK V� -1P COC p°R.,TED %,�•ty S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT N /X4S Foundation has permission to erect .......................... buildings on .5 .. ............. ....................... Rough to be occupied as ............ . l.. :...1/.../l. 'v. :..../.........� 7.'.. .. �l( `�''.. 'l.1 Chimney provided that the person accepting this permit shall in every respect conf6rm"to the ter s of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the I pection,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 CONSTRUCTIO S ARTS Rough Service .......... ........ ........... "/ ................................. ' Final LDING 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. MAILLOUX BRAS. CONST. CO., INC, 55 Chase St. Methuen,MA 01844 Tel. (978) 686-7147 Fax (978) 683-3452 5/27/15 Bake n Joy 351 Willow St, No. Andover, MA 01845 RE: Miscellaneous Projects Mailloux Bros. Const, Co.,Inc. hereby propose to furnish material and labor for the"Bake n Joy Miscellaneous Projects" in accordance with scope of work, allowance, add/alternates, exclusions, qualifications and special provisions; Wet Department Door and Exhaust Fan Relocation- $9,500.00 • Permits and fees • Mobil and demobilization • Temporary protection • Demo and waste removal • Masonry alterations and materials • Miscellaneous metals • Commercial door, frame and hardware • Paint door, frame and concrete block to match as close as possible • Final cleanup • Tools and equipment • Electrical and fire alarm modifications not included Butter Temperi nRoom Wall Curb- $6,400.00 • Permits and fees - • Mobil and demobilization. • Temporary protection • Fabricate custom forms and concrete(4000psi) • Concrete placement and finishing • Foundation pinning and rnbar reinforcement • Final cleanup • Tools and equipment W , Wet Packaging Protective Curb- $4,100.00 X • Permits and fees • Mobil and demobilization • Temporary protection • Fabricate custom forms and concrete(4000psi) • Concrete placement and finisling • Foundation pinning_ and rebar reinforcement • Final cleanup • Tools and equipment Allowances • Permit fees- (combined total) $250,00 Add/Alternates • N/A Exclusions • Unforeseen conditions requiring additional repair, structural support etc. • Additional work required through code enforcement • Architectural and/or engineering services • Additional permit fees or processing;fees • Hazardous waste testing and/or removal • Winter conditions • Electrical and fire alai-in modifications and alterations • Night and/or weekend work Oualifications • Bake N Toy to provide reasonable access for water and electricity • Bake N Joy to provide reasonable access for materials and equipment Special Provisions • Contract type; endorsed proposal - • Payment terms; payment due within ten(10) days of invoice • Project duration;2 weeks(Combined work order) • Project start date; Summer 2015 • MBC is a fully licensed and insured builduig contractor in the state of Massachusetts. Insurance certificates upon request • Mass General Laws apply for all rights and settlement of disputes ;acceptance Mussell Mailloux, Vice President Date Tom Br-d-cy, t ngine Date I — - The Commonwealth of Massachusetts Department of IndustrlalAccidents s 1 Congress Street,Suite 100 Boston,MA 02111=2017 ` www.massgov/da – Workers'Compensation Insurance Affidavit;Builders/Contractors/Electricians/Plumbers, TO BE FELED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Noble(Business/Organization/Individual)' Address: - -- ---- - - -�J - -- - -- - - 69-6-115f?Ci /Mate/Zi : -a one -- --- Are you an employer?Check the appropriate box; Type of project(required): l, m a employer withomployeos(full and/or part-time), 7. El New construction — - 2.E]I am a sole proprietor or partnership and have no employees working for me in 8, 0 Remodeling any capacity.[No workers comp,insurance required.] 3.Q I am a homeowner doing all work myself.(No workers'comp.insurance required.)t 9. El Demolition 10[Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'comp_ensation insurance or are sole 11.0_Electrical repairs or additions proprietors with no employees, 12.0 Plumbing repairs or additions I am a general contractor and I have hired the sub=contractors listed on the attached sheet. 13.POther repairs These sub-contractors have employees and have workers'comp,insurance. of i 14. " 6.0 We aro a corporation and its officers have exercised their right of exemption per MCrL c. �' � j� � •¢'" - 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Gets Ej *Any applicant that checks box 01 must also fill out the section below showing their workcrs'compensation policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such. $Contractors that check this box must attached an additionol sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'camp.policy number. I am an employer that Is providing workers'compensation insurance,jor my employees. Below Is thepolicy andlob site lnformatlon. Tnsurance Company Name: A� t` t - Policy#or Self-ins.Lie.# V 5761 Z 5 Ex iration Date: a/,;2+ /S" Job Site Address: l C�,I�.�!p 6a�$" City/State zip: - Kt r� - L1/ %)— Attach a copy of the workers'compensation policy declaration page(showing the policy number and expir tion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator.A cop_y of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, i I do hereby cert% under the pains andpenoltle_s ofpetymy that the inforttratlonprovided above Is true and correct. Signature:_ 14 Phone#: 6 f7(e OfJlelal use only. Do not write In this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building_ Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone#: OP ID: MH ,4R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDI"YY") - 1 06/09/15 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(ios)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 endorsemen s. PRODUCER 978-975.1300 ,, Russ MaillouX Segreve 8<Hall lnsur.Assoc.lnc - -- - -- 305 North Main St 978975^7596 PHONE alc N9. Andover MA 01810 E-MAIL ` -- _ — - Michael 1=.Segreve _ - --_ PRODUCER n RUSSE4 INSURER(S)AFFORDING COVERAGE MAIC# INSURED Mallloux Brothers - - - --- _-- _._ - HusuRERA:Arbella Protection Ins.Co. 41.360 _ Construction Co,Inc. --__ - ---- 55 Chase Street INSURER 8:A.I.M.Mutual Ins.Co. Methuen,MA 01844 INSURER C -INSURERD: INSURER E _ I SU RF: 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 P=AID CLAIMS, INSR - DL SUOR PO C EFF POLIO L TYPE OF INSURANCE POLICY NUMBER D MM/ LIMITS -- GENERAL LIABILITY - --- - -- EACH OCCURRENCE $ 11000,0001 X COMMERCIAL GENERAL LIABILITY 6500060007 07/13114 07113/15PREMISES Ea occurrence) 100,00 CLAIMS-MADE X MEP EXP(Any one person) $ 10,00 ❑OCCUR PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2_,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $PRO2,000,00 - -- - - - POLICY LOC $ ___ AUTOMOBILE LIABILITY COMBINED SINGLE_LIMIT $ ANY AUTO (Ea accident) — BODILY INJURY(Per person) $ 100,00 ALL OWNED AUTOS - - A X SCHEDULED AUTOS 10200020719 05120115 05/20116 BODILY INJURY(Per accident) $ 300,00 PROPERTY DAMAGE $ 100,00 X HIRED AUTOS (Per acOdent) X NON-OWNEDAUTOS OBI $ 250150 Med-Pay $ 8,00 . UMBRELLA LIA@ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION WC ST4TU= OTH- AND EMPLOYERS'LIABILITY Y/N V LIMIT R B ANY PROPRIETOR/PARTNER/EXECUTIVE 5005012557 10/02114 10/02115 1 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? a NIA - -_ (Mandatory In NH) -- If E.L.DISEASE-EA EMPLOYE $ 500,00 yes,describe under — - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Attach ACORD 101 AddMonal Remarks Schedule It mores ace Is ulrcd) RUSSS,LL M&ILLOUX & RONAT.D MAITz_UX ARE— RI{t'�LUAED FROM WORKERS Cp1IP C()VERA.GE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ISE 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD tit Massachusetts-Department of Pug,9,9_,Safety Boa-Wmf BuQirigj} gulatiotrgand Standards Y .*-Widense: C"4823T-, RUS4 d MAILI;OUX F 551 r6T r" t METIfIUEN MA 81814 F', r s Commissioner 02/11/2016 — - ��/cear,.sxa�zccrra�l.a��/1/�crJ�ecc�use4 Office of Consumer affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: -10:077 Type: Expiration:- 16 ? Priv2te Corpora for MAILLOUX BROS.CONST Rl sse i Mailloux -- 55 CHASE STREET IAETHUEN,MA 01844. — U"dersecretar