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HomeMy WebLinkAboutBuilding Permit #912-14 - 401 ANDOVER STREET 6/13/2014---& NORTH 9 BUILDING PERMIT 3? ��?`eD. ` TOWN OF NORTH ANDOVER to APPLICATION FOR PLAN EXAMINATIO - - Permit NO: NT HDate Received i 1 3y �gATeo rvP,�q`� Date Issued: I SSACHUS� IMPORTANT: Applicant must complete all items on this page LOCATION yQ)l, ()nC6Ve { a Print PROPERTY OWNER Plum a Tc' off - anho M'- GQ c .t Print MAP NO: 0 Ll PARCEL: ZONING DISTRICT: Historic District yes no Machine Shoo Villaae ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family G�Addition ❑ Two or more family ❑ Industrial Alteration No. of units: V Commercial (4 Repair, replacement ❑ Assessory Bldg Others: Telcco Yn ❑ Demolition ❑ Other R00-9Sj+e ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer Identification Please Type or Print Clearly) OWNER: Name Address: CONTRACTOR Name: c r - Phone: a 9 Address: I Supervisor's Construction License: Exp. Date: `I -I1' Home Improvement License: Exp. Date: ARCHITECT/ENGINEER'i)c Lt�\e\ 0AW Phone: 9 TK -S,57 Address: i 4,G® 0,58=6 ST_ 100[+h A ndov2l- ft%A Reg. No. I J a -I aO FEE SCHEDULE: BULDIN�GG PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ d, 400 FEE: $ 3 Check II 11l q Receipt No.: 2'I L,1 � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner e L dj-krSignature of contractor • o 1 a, Permit No#: Date Issued: °" . '.. ii, � BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this LOCATION, Print PROPERTY OWNER Print f 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 ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic I] Well ❑ Floodplain❑Wetlands ❑ Watershed District ❑ Water/Sewer ucscrur i 1UN ur VVUKK I O BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Address: Contractor Name: -_ Phone:_ Address: Di Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date:. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. J Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors'116 not'have access to the guaranty fund Signature of Agent/Owner Signature of contractor ___7 I Location 4w 4,454&N No. q12 -4 Check #1 27570 Date TOWN OF NORTH"ANDOVER Certificate of Occupancy _ $- Building/Frame Permit Fee $ ?�(, 6 � ou Foundation Permit Fee $ Other Permit Fee $- TOTAL $ Building Inspector 10 A 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 PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS 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/Signature & Date Driveway Permit DPW Town Engineer: Signature: uocatea ;364 us ooa Street FIRE DEPARTMENT -Temp Dumpster on site yes. no Located 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 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 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract a 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 a 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) o 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) o Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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. 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Cc IX 2 0 0 m0 zoN zoNNNz sW20 v N Vwno 00Ocr NOw�mC0 VL COL L-- uls Oi o AL WWW In EaUU0 L-T Ell He OM _(n Lo" d- i Q <OT LdOO N Ln - IL 0au II W� MIIO wz O�11 z 0 8 III w I-ww W Amo �i�� 131 o£££ -0££(80S) 98549££(916) :XV4 M10M'a3A00NV'N IB910 VW'H0n0E09153M £993-L99(@L6) :131 060£ 311ns'HMN 0i`JNI011n9 133a1s a000so oo9l AVM)IaV,l DM1a1 004 �n ssa�aa�nn O N � � Vz»dnoijD u6lsad Q uospnH oo J :a03 03MVd3ad 'A9 a3HVd3ad z 0 2. �FWia I Q a•�F - JH(Z(Q7n ��0Ugg3o0���t�u51 ��GGIN3I���0❑ mo���yggqqqqyJa��>LJ , 1 J �¢=F8�yUsFESSmv�g��L�tGk��f>S]QZ1��nSj1 o !2�Z ONg o m _ � KaiaQ=ww�N�a0w?aQxwN�te_0� zJ0N�nII .�uJjI NC9 N X .6 0 na FoZOw:, 2N 2N0� Ut2 v' p.-4=>} 6 �=N I LLJ 0ZZQ~p0O& Fl � acqq�7gS0 IQ ZCK gO O 6OU z ZJ10 No� O 1 go ZUq b�mpt n 9K Az0 Z 2 g4U�OLLJ U taWpN N Zf/NN6 z�IQvW� !IR E�Q6�ZE WcF.6. R o 1 i F Uoo2gav 8$ O N63 aa$rc8momn��& r& 0 N U rri4 v 160 r.: NM)f G ZZ Z O— ON 0 O W LS m OWZ O z Z ZZw X Z X00 T< I- n � O n W Q W W �B0WXQ�N HmvF:01, OZ U. Cc IX 2 0 0 m0 zoN zoNNNz sW20 v N Vwno 00Ocr NOw�mC0 VL COL L-- uls Oi o AL WWW In EaUU0 L-T Ell He OM _(n Lo" d- i Q <OT LdOO N Ln - IL 0au II W� MIIO wz O�11 z 0 8 III w I-ww W -- May 27, 2014 Bell Atlantic Mobile of Massachusetts Corporation, Ltd., d/b/a Verizon Wireless 400 Friberg Parkway Westborough, MA 01581 Attention: Network Real. Estate RE: Verizon Wireless Rooftop Installation 401 Andover Street North Andover, MA 01 845 Dear Network Real Estate Manager: Through a leasehold interest Verizon Wireless has radio equipment, antennas and ancillary equipment located at the above referenced site. I have been informed that Verizon Wireless will be utilizing remote radio heads at this location. I understand that there will be three (3) remote radio heads with corresponding junction boxes and ancillary connecting cables installed at the site after the completion of the project. As well as swapping antennas of similar size. As an authorized agent I hereby consent to this work and authorize Verizon Wireless to apply for any and all permits that may be required for this project. Sincerely, 3 / (Z" / 2014 John F. McGarry — Trustee Plum 2 Trust 401 Andover Street North Andover, MA 01845 wireless February 17, 2011 RE: Verizon Wireless authorization Structure Consulting Group is a contractor for Verizon Wireless and, therefore, an authorized agent. Please allow Structure Consulting Group to sign on behalf of Verizon Wireless for all permitting and zoning documents. This pertains to all cellular sites where Verizon is changing equipment or performing a new installation Please do not hesitate to contact me if you have any questions. Thank you for your continued assistance. Sincerely, Q a.r4 P, as Daniel Fitzpatrick Verizon Wireless Real Estate Manager - NNE 400 Friberg Parkway Westborough, MA 01581 Desk: (508) 330-3343 Mobile: (617) 645-5833 02/17/2011 10:24AM (GMT -05:00) Massachusetts • Department of Public Safety Board of Building Regulations and Standards Construction Supcn icor License: CS-078888 JOHN G MCGILI�UD 14 BENNINGTON r QUINCY MA 0269 Expiration J�.►. �� � 07111/20U Comrnissioner The Commonwealth ojMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/difa Workers' Compensation Insurance Affidavit: Builde LVIAcant Information rs/Contractors/Electricians/Plumbers na--- . , -- - Name (Business/Organization/Individual): Address: - -" " U ' - Phone #: anemployer? Check the appropriate bo:: employer with 4. [] I 7-emPIOYfts am a general contractor and I (full and/or part-time).' .0 1 am a sole proprietor have hiral the sub -contractors listed or partner- on the attached sheer ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No wormers' comp. insurance comp. insurance.] requite ] 3• ❑ I am a homeowner doing 5. C1 We are a corporation and its all work officers have exercised their myself. [No workers' comp. right of exemption per MGL 3a. 0insurance required_] f 1 am a homeowner acting c. 152, § 1(4), and we have no as a general contractor (refer to #4) employees- [No workers' comp. insurance t Type of project (required): 6. 0 New construction 7. 0 Remodeling 8. 0 Demolition 9. 0 Building addition 10.0 Electrical repairs or addi�taons 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.MOth,, + Any appUcmt that checks box #1 mart also fiU out the section below C4Wt— J I — -- 1 Homeowners who submit this affidavit i"cittin _ �O`tdoing all work and then hm thea worker' eo�ood�oliry iaformapon. tconoactors that chock this box must attached m additional sheet showing nacre ° CoWdeotractots must submit a new affidavit indicating such. —V10Yexa. If the sub-ootttracton have employees, they must provide they worker' c e siib-cll� and state whether or not those entities have I omV Policy -=her. _.-•rwy« saau is proviaing workers' compensation insurance for my eanployees. Below is the polity aid fob si[e informadon Insurance Company NamJLA 1 n l - _ J .1 r—.... 0— Policy — Policy # or Self -ins. Lic. #:� Expiration Date: Job Site Address: City/ShrtelZip: Attach a copy the workers' compensa Failure to securea coverage as tion policy declaration page (showing the policy number and expiration ate). required under Section 25A of MGL c. 152 can lead to the imposition fine up to 51,500.00 and/or one-year imprisonment, as well as civil position of criminal penalties of a of up to $250.00 a day against the violator. Be penalties in the form of a STOP WORK ORDER and a fine Investiadvised that a copy of this statement may be forwarded to the Office of gatiom of the DIA for insurance coverageherification. ,11 do hereby ce"M6A ander the paint and no ray that the informadow provided above it &w and correct i Pone # !i/7..._....4.:-- _...._. O,t'lcia/ use only. Do not write in this arra, to be completed by city or town official City or Town: Issuing Authority (circle one): Permit/License # 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: A ® YPX CERTIFICATE OF LIABILITY INSURANCE 8022 DATE(MM/DD/YYYY) 6/6/2014 THIS CERTIFICATEIS 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(les) must be endorsed. If SUBROGATIONIS 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 PAYCHEX INSURANCE AGENCY INC CONTACT NAME: ac°,No,Exn): INC,No): (888) 443-6112 210705 P: F: (888) 443-6112 E-MAIL ADDRESS: PO BOX 33015 INSURER(S) AFFORDING COVERAGE NAICk SAN ANTONIO TX 78265 INSURERA: Twin City Fire Ins Co INSURED INSURER B: INSURER C: STRUCTURE CONSULTING GROUP, IN INSURER D: 49 BRATTLE ST INSURER E: ARLINGTON MA 02474 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. INSR TYPEOFINSURANCE ADDL SUBR POLICYNUMBER POLICYEFF MM/DD/I' POLICYEXP LIMITS EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE -1 DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-- ❑ LOC POLICYE] JECT PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION I $ WORKERS COMPENSATIONX ANDEMPLOYERS'LIABILITY PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L. EACH ACCIDENT $1,000,000 A OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N/A 76 WEG GB2651 01/03/2014 01/03/2015 E.L. DISEASE -EA EMPLOYEE 1$1,000 000 If yes, describe under DESCRIPTION OF OPERATIONS belowE.L. DISEASE -POLICY LIMIT 1 $ 10 0 0 I 0 0 0 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER rONrFI I ATIr11J U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 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 ` Town of North Andover, MA 1600 OSGOOD ST NORTH ANDOVER, MA 01845 U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD