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HomeMy WebLinkAboutBuilding Permit #386 - 43 HIGH STREET 11/14/2007 BUILDING PERMIT Of NORTy q tt��o .6 ti TOWN OF NORTH ANDOVER 3� ' ''` �Z. APPLICATION FOR PLAN EXAMINATION 7° _ b Permit NO: 0A) Date Received4 r@p ��SSgcHus�� Date Issued: IMPORTANT:Applicant must complete all items on this page _ • -F LOCATION ;- PROPERTYtWNER ,nnt MAP NO: PARCEL ZONING DISTRICT :` =Nistonc Dislnct ryes no `MacF:iin6 ShVillage yryes mo 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 Floodpiam Wetlantls UVatershed Distract Water/Seiruer 1 DESCRIPPPN OFVVORK TO BE PREFORMED* n Identification Please Type or Print Clearly) OWNER: Name: R C L L C . Phone: Address: CONTRACTOR Name Address �tJVy Supernsor's Construction License . Exp Da#e.47 JrJtome Irrpr©vera�ent License Exp, Dake ARCHITECT/ENGINEER rt3>'(�T.e) � Phone: ' qq�- Gi ,3 Address: ' �4 r'Reg. No. �VCJ'Z U FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 P .F. Total Project Cost: $ 6" / 75• 06 FEE: $ Check No.: �'JO Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the 7garantyfund . fthature_of Agent/Owner = - r gnaturecon ,of tractor '.' i 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 DATE REJECTED DATE APPROVED PLANNING & DEVEL PMENT _l J2'�o7 COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on sitp yesZ no j 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 o, t r r ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 L3 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 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/Crossection/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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Ener Compliance Energy p Report ❑ 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. 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. `7 j Date 6. MORTq TOWN OF NORTH ANDOVER Oft..a° ,a1h0 3? ' 0 � n Certificate of Occupancy $ t Building/Frame Permit Fee $� s�cHus Foundation Permit Fee $ 1 Other Permit Fee $/ TOTAL $" 7 Check # __ 20801ZZ Building Inspector §4.2 Payments due and unpaid under the Contract Documents shall bear interest from the date payment is due at the rate of 4%plus Prime ( ) per annum,or in the absence thereof,at the legal rate prevailing at the place of the Proj ect. (Usury laws and requirements under the Federal Truth in Lending Act, similar state and local consumer credit laws and other regulations at the Owner's and Contractor's principal places of business, the location of the Project and elsewhere may affect the validity of this provision.) ARTICLE 5 INSURANCE §5.1 The Contractor shall provide Contractor's Liability and other Insurance as follows: (Insert specific insurance required by the Owner.) Type of insurance Limit of liability($0.00) See Attached:Exhibit B-Vantage Certificate of Insurance §5.2 The Owner shall provide Owner's Liability and Owner's Property Insurance as follows: (Insert specific insurance furnished by the Owner.) Type of insurance Limit of liability($0.00) §5.3 The Contractor shall obtain an endorsement to its general liability insurance policy to cover the Contractor's obligations under Section 3.12 of AIA Document A205,General Conditions of the Contract for Construction of Small Projects. §5.4 Certificates of insurance shall be provided by each party showing their respective coverages prior to commencement of the Work. ARTICLE 6 OTHER TERMS AND CONDITIONS (Insert any other terms or conditions below.) This Agreement entered into as of the day and year first written above. (If required by law, insert cancellation period, disclosures or other warning statements above the signatures.) 9 b� OWNER(Signature) ATE CONTRACTOR(Signature) DATE ow�r- (Printed name and title) (Printed name and title) LICENSE NO.: JURISDICTION: �1I AIA Document A105Tm—1993.Copyright ©1993 by The American Institute of Architects. All rights reserved. WARNING:This AIA°Document is Init. protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIAe Document,or any portion of It, may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. This document was produced 3 / by AIA software at 11:19:02 on 11/08/2007 under Order No.1000287927_1 which expires on 2/23/2008,and is not for resale. User Notes: (2204021109) NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: -�-,3 f� is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: �< < < (Location o cility) `c 1� 14 Sig a re of Permit Appl cant 13 0 Date — s an Standard Bngm Lic ense! ondntsor cion SuCe79454ConstruS License.`~ 212611977 T ro 1218 1 g►rthdate __ 2612009 trsct� n 04% R�x No-5 t PATRICK _ missioner 3 BEAVER gRCOK 0$a3 1 Com gURUNGTON,MA The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): t ,p,, s C Address: City/State/Zip: fl ��-5 I Phone#: Are you an employer?Check the appropriate box: Type of project(required)':., 1.❑ I am a employer with 4. am a general contractor and I 6. ❑New construction employees(full and/orpart-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. E]Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional 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'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. nn Insurance Company Name: Policy#or Self-ins.Lic.#: (l ct �� t� Expiration Date: Job Site Address: t`, kAA Vy N :I"F K-te / City/State/Zip: A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Sign atureQ- Date: Phone#: S Official 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#: 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." i 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 of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall 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,opera'te�a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25CM 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 fill 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 certificate(s)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 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 Industrial Accidents. 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"Job 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 not related to any business or commercial venture (i.e. a dog license or pem-dt to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# Revised 1122-06 617-727-7749 www.mass.govfdia ARTICLE 1 THE CONTRACT DOCUMENTS The Contractor shall complete the Work described in the Contract Documents for the project. The Contract Documents consist of: .1 this Agreement signed by the Owner and Contractor; .2 AIA Document A205,General Conditions of the Contract for Construction of a Small Project,current edition; .3 the Drawings and Specifications prepared by the Architect,dated and enumerated as follows: Drawings: Number Title Date Al Proposed Floor Plan 14Iwo-7 "-, A® S c4cd�dt g I I�qa es (1-4 Si�s*11 I ti/B 7 Specifications: tbt�k��C�CeAt Plow t(f G/®d7 Section Title Pages .4 addenda prepared by the Architect as follows: Number Date Pages .5 written change orders or orders for minor changes in the Work issued after execution of this Agreement;and .6 other documents,if any,identified as follows: I Exhibit A-Vantage Proposal dated 10/24/07 Exhibit B-Vantage Certificat of Insurance ARTICLE 2 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION DATE The date of commencement shall be the date of this Agreement unless otherwise indicated below. The Contractor shall substantially complete the Work not later than ( )days ,subject to adjustment by Change Order. (Insert the date or number of calendar days after the date of commencement.) Substantial Completion: 5 weeks from start ARTICLE 3 CONTRACT SUM §3.1 Subject to additions and deductions by Change Order,the Contract Sum is: ($ 112,975.00 ) §3.2 For purposes of payment,the Contract Sum includes the following values related to portions of the Work: Portion of Work Value($0.00) §3.3 The Contract Sum shall include all items and services necessary for the proper execution and completion of the Work. ARTICLE 4 PAYMENT §4.1 Based on Contractor's Applications for Payment certified by the Architect,the Owner shall pay the Contractor as follows: (Here insert payment procedures and provisions for retainage, if any.) IPayment Terms:n/30 Retainage:None Init. AIA Document A105TM—1993.Copyright ©1993 by The American Institute of Architects. All rights reserved. WARNING:This AIA!Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA°Document,or any portion of It, 2 may result In severe dull and criminal penalties,and will be prosecuted to the maximum extent possible under the law. This document was produced / by AIA software at 11:19:02 on 11/08/2007 under Order No.1000287927_1 which expires on 2/23/2008,and is not for resale. User Notes: (2204021109) e� r. TM =o= Document A105 - 1993 Standard Form of Agreement Between Owner and Contractor for a Small Project where the Basis of Payment is a STIPULATED SUM This AGREEMENT is made: November 8,2007 (Date) ADDITIONS AND DELETIONS: The author of this document has BETWEEN the Owner: �!x added information needed for its completion.The author may also Bik ram Yoga Merrimack Valley have revised the text of the original 35 Sheridan Street AIA standard form.An Additions and Haverhill,Ma 01830 Deletions Reportthat notes added Contact:Teri Al 'st ,(�{- information as well as revisions to ® ���� �(YI the standard form text is available and the Contractor from the author and should be reviewed.A vertical line in the left Vantage Builders,Inc. margin of this document indicates 281 Winter Street-Suite 340 where the author has added Waltham,Ma 02451 necessary information and where Contact:John Connor /J( the author has added to or deleted R" from the original AIA text. for the following Project: ��� This document has important legal consequences. Consultation with an Bikram Yoga Studio attorney is encouraged with respect -ii-lligh Street but�4 to its completion or modification. North Andover,Ma The Architect is: Scott M.Brown AIA 184 Main Street Amesbury,Ma 01913 The Owner and Contractor agree gr as follows. Init. AIA Document A105TM 1993.Copyright ©1993 by The American Institute of Architects. All rights reserved. WARNING:This AIA°Document Is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this A10 Document,or any portion of It, may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. This document was produced / by AIA software at 11:19:02 on 11/08/2007 under Order No.1000287927_1 which expires on 2/23/2008,and is not for resale. User Notes: 2204021109 i I ) I NORTH c TO" of No. 3 f 6 ~ _ _ o dover, Mass., I� COCMICKEWICK 7�ADRATED P �C:) `s BOARD OF HEALTH Food/.Kitchen PERMIT T D , Septic System �� � BUILDING INSPECTOR 7 THIS CERTIFIES THAT................ ............ ..... , ...................... Foundation has permission to erect........................................ buildings on ...`/..1 ... ... ...�. .. ...................................... Rough to be occupied as / Chimney provided that the person accepting this permit shall in every respec conform to the ter sof the application on file in Final 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 pO PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough Service UILDING INS �R Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det.