Loading...
HomeMy WebLinkAboutBuilding Permit #437 - 43 HIGH STREET 12/9/2009 VIORTH BUILDING PERMIT 04t```° bf.Yr,. ..!r• O O TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION 3 7 � 044 Permit NO: Date Received • 4SSACH�1`��� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION two PIoPERTY o04 ff. MAP`NQ � Pa4RCEL ©NCNGY DISTIR astfln Distrrct _ no R TYPE OF IMP RO VEM EN T PROPOSED USE Residential . Non- 0 New Building ❑ One family ❑ Industrial 0 Addition 0 Two or more family ❑ Alteration No. of units Commercial F�oRepair, replacement ❑ Assessory Bldg ❑ Others: molition ❑ Othertic 1111e10,Fshter DESCRIPTION OF WORK TOBEPREFORMED: Identification Please Type or Print Clearly) Phone:1z l'Z OWNER: Name- ,-0 Address: %A Wig' 00 s x I #� ~� CONTRACTOR, Narne " � ��ix-� r. Phone Address - ` ` n 7 � i Supervsot's Costruction Lrcense - P T A _ z Home Improuerexit �cense =Exp: Da #e.. - _ r u Phone: e: ARCHITECT/ENGINEER u � P Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. b Total Project Cost: $ 0 ®Q FEE: $ Receipt No.: Check No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund ��r�grattreofaco�atrractor f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans TYPE OF SEWERAGE DISPOSAL ` Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ f Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING.&-DEVELOPMENT ❑ ❑ 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 't Planning Board Decision: Comments Conservation Decision: Comments Water$ Sewer Connection/Signature& Date Drivewav Permit Located at 384 Osgood Street .-5-FJ'RE DEPARTNtENTDttmp5ter:on site y nQ yi' Loca#ed at 124 MainStreet `. Department srgnature{date, /.ApTYt` F 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 droprequires a Electrical Inspector Yes Nq pproval of No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.s100-s1000 fine NOTES and DATA— For department use 3 ❑ Notified for pickup - Date Doc-Building Pen-nit 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 o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract o Floor Plan Or Proposed Interior Work o 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/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 L3 Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o 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 ❑ 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 7 /^ No. L/ Date 4- fL7 NORM TOWN OF NORTH ANDOVER � w • s Certificate of Occupancy $ Building/Frame Permit Fee $ sACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #�— 226o5 By, ding Inspector NORTIy 0 0 : 4 over No. _ dover, Mass., / AF47 O K COC MIC WICK ADRATED P,?�\y�5 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............ ...j.-f.....v".......... / :../...:/./( ............ ............ Foundation . .......... .............................. S�/"k go?(� .. Rough has permission to erect..........:............................. buildings on ......�� .. .T./.%�r.... ..................... ................................... . to be occupied as........................ .... �.0......... ,moi Cl Chimney provided that the person accepting this permit shall in every respect conform to the terms of 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS ARTS Rough ..............s� � ..... Service BUNG INSPECTOR Final Occupancy'Permit Required to Occivy 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street e Boston, MA 02111 wM s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le ibl Name (Business/Organization/Individual): fL c u t VAIZL - Address: AY S7 r:9 2�('rt•3 City/State/Zip:. K0V%Q r 1 c J i v9-" Phone.#: L Z --(a-I- A I- Are,you an employer? Check the appropriate box: Type of project(required);, 1. lam a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have & Demolition working for me in any capacity, employees and have workers' insurance.$ 9. ❑Building addition [No workers' comcomp. insurance p• required.] 5. ❑ We are a corporation and its 10..0 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 13.❑ Other employees. [No workers' 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. .r� Insurance Company Name: f:)( S-4 0 C I Ar H P�-(3 /J, *,'o d IA Policy#or Self-ins. Lic.#: �- S—U CJ , 3 Expiration Date: 0 Job Site Address: Lr i Cr" SIT i v AdIal City/State/Zip: 0 1 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 cert under the pains and penalties ofperjury that the information providedP abov is true nd correct. Si ature: Date: 6 Z 08 Phone#: -7 '4—q L — tlr _ � 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." An employgr 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,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 required." 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 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 permit 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. #6.17-72.7-4900 ext.406 or 1-877-MASSAFE Revised 11,22-06 Fax# 617-727-7749 vrww.mass.gov/dia Massachusetts-Department of Public Safety Board of Building Regulations and Standards construbtii?Sn:supervisor License License: CS 66334 Restiictedto. •UO... KIERAN T WHEllAN .31 RICp{MONb ; WEYMOUTH,MA 02188 Expiration: 91261211 Tr#: 3612 Commissioner- Client#:35588 RCGBU ACORD. CERTIFICATE OF LIABILITY INSURANCE o5�20, °�""' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE MARKETING AGENCIES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 306 MAIN STREET HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WORCESTER,MA 01608 50753-7233 INSURERS AFFORDING COVERAGE NAIC 0 INSURED RCG Builders LLC INSURER A. Associated Employers Insurance 21865 INSURER B: Go RCG-LLC INSURER C: 17 Ivaloo Street,Suite 100 INSURER Or Somerville,MA 02143 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE Y EXPRA LIMITS GENERAL LIABILITY EACH OCCURRENCE ; COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDFa occunencal s CLAIMS MADE F]OCCUR MED EXP(Anyone person);! PERSONAL&ADV INJURY ; GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG ; POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT = ANY AUTO (Ea acddent) ALL OWNED AUTOS BODILY INJURY � SCHEDULED AUTOS (per ) HIRED AUTOS BODILY INJURY ; NON-OMED AUTOS (P- ) PROPERTY DAMAGE s (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDF.NT ; ANY AUTO OTHER THAN EA ACC ; AUTO ONLY: AGO ; E XCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR E]CLAIMS MADE AGGREGATE ; DEDUCTIBLE ; RETENTION ; $ A woRKERs carPENSAmN AND WCC5005531012009 05/10/09 05110110 X we STATIJM'T- DTH ER EMPLOYERS*LIABILITY ANY PROPRIETOWPARTNEWEXECUTNE E.L.EACH ACCIDENT ;500 OOO OFFICEWMEMBER EXCLUDED? E.L.DISEASE-FA EMPLOYEEbeU ;SOO GOO PRo Isv` `ror�s L,eww E.L DISEASE.POucY LIMIT 1$500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECL4jL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE PAM DESCRIBED POLICIES BE CANCELLED BErOW THE EXPIRATION For Informational Purposes DATE TIEVAOF.THE INSURER VM.L BWAVOR TO MAR 10_ DAYS INIaTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,Off FAN.UIE To DO So S"ALL IMPOSE IRO OBLIGATION OR LIABILITY OF ANY WND UPON THE INSURER,ITS AGENTS OR TATIYFS. AYDLORrQFD RF.IrRESFJYTAlm ACORD 25(2001108)1 of 2 8S1589990158998 GCE 0 ACORD CORPORATION 1968 w t. BUILDERS Standard Form of Agreement between Owner and RCG Builders LLC where the basis of payment is the Cost of the Work Plus a Fee without a Guaranteed Maximum Price Date: December 7, 2009 Owner: RCG North Andover Mills LLC C/o RCG LLC 17 Ivaloo Street, Suite 100 Somerville, MA 02143 Contractor: RCG Builders LLC 17 Ivaloo Street, Suite 100 Somerville, MA 02143 Architect: N/A w Project Name: 43 High Street Demolition The Owner and Contractor agree to the terms stated by this contract. This contract supersedes any prior agreements, representations, or negotiations, oral or written. No liquidated damages shall apply to this agreement. This contract consists of the following documents: 1. Obligations of the Parties 2. Contract Sum 3. Project Schedule 4. Signatures Page 1 of 6 4 BUILDERS 1. Obligations of the Parties Obligations of the Contractor: The Contractor accepts the relationship of trust and confidence established by this Agreement and covenants with the Owner to cooperate with the Architect and exercise the Contractor's skill and judgment in furthering the interests of the Owner; to furnish efficient business administration and supervision; to furnish at all times an adequate supply of workers and materials; and to perform the Work in an expeditious and economical manner consistent with the Owner's interests and in compliance with all applicable governmental codes and regulations. The Contractor shall keep full and detailed accounts and exercise such controls as may be necessary for proper financial management under this Contract. The Contractor shall keep full and detailed records of all books, records, permits, licenses, correspondence, receipts, instructions, data, and drawings associated with the Project including all Subcontractor contracts, invoices, vouchers, insurances, lien waivers, and other correspondence. The Owner and Owner's Accountants shall have access to review, audit, and copy all Contractor documentation. The Contractor shall retain these documents for a period of three years after final payment. The Contractor shall maintain insurance at the following levels with the Owner listed as a co- insured: Type of Insurance Limit of Liability Commercial General Liability $1,000,000.00 Upon request, and at the cost of the Owner, the Contractor shall obtain a performance bond up to the total Cost of Work. Such costs shall be added to the Construction Volume. The Contractor understands that the Project will be financed by a construction lender and, then, by a permanent lender. The Owner may assign any of its rights under this Contract to the construction lender and the Contractor hereby consents to any such transfer provided no such assignment shall relieve the Owner of any of its obligations under this Contract, unless agreed to in writing by the Contractor. The Contractor shall execute any certificates, lien waivers, releases, receipts, and other documents as may be reasonably required by the construction lender or permanent lender including a subordination of its mechanic's lien rights to the construction lender's and permanent lender's mortgage or deed of trust. The construction lender for the Project will be: Obligations of the Owner: The Owner agrees to furnish or approve, in a timely manner, information required by the Contractor and to make payments to the Contractor in accordance with the requirements of this Agreement. Dispute Resolution: Claims, disputes or other matters in question between the parties to this Agreement shall be resolved by mediation or by arbitration. Prior to arbitration, the parties shall endeavor to reach settlement by mediation. Page 2 of 6 I BUILDERS 2. Contract Sum Cost of Work: The Contractor shall provide a detailed estimated Cost of Work to the Owner(see Exhibit A). The sum of these costs, including the fee is as shown below: i $3,000.00 Change Orders: The Contractor does not guarantee the Contract Sum in any form. In the event of changes to the Contract Sum, the Contractor will present written changes to the owner for costs that exceed the Contract Sum in the form of a Change Order. The Contractor will review all Subcontractor Change Orders before submittal to the Owner and Architect and make a recommendation for payment or non-payment. The Contractor's Fee will be calculated including any approved Change Orders. The Owner, Architect and Contractor will negotiate disputed Change Orders in good faith. Contractor's Fee: Contractor shall receive a fee of 15% of all cost of work, including hours billed by RCG Builders Management or temporary workers. Payments: The Owner shall make progress payments on the Contract Sum according to the Requisition process described below. The Contractor shall, at the conclusion of each calendar month on the project, present to the Owner an application for payment(Requisition) for costs incurred during that month. The Requisition shall include all invoices, vouchers, partial releases of liens, expense reports, and any other evidence to support the validity of the Requisition amount. The Contractor may requisition for completed, but unpaid work based on an expectation of payment upon receipt of funds. The Owner, the Architect, or their representatives shall be afforded five (5) business days to review such application and question the Contractor about its contents. In the event there are no disputes, the Owner shall pay the Contractor within 10 business days of receipt of the Requisition. Payment by the Owner does not represent that the Owner or Architect have made a detailed examination of the documentation, inspection of the work, or verification of the accounting. At the completion of the project, the Owner shall make a final payment to the Contractor based on a final Cost of Work with a truing up of fees. If further corrections to work are required that are not covered under warranties with Subcontractors, or that are not the outcome of negligence or poor workmanship by the Contractor, the Owner shall pay the Contractor for any work associated with performing the corrections based on the hourly rate agreed to in this contract. Retainage: The Owner shall not hold back any fees to the Contractor to ensure completion of the work. The Contractor will be expected to hold back fees from Subcontractors to ensure their performance based on the terms below: 10%of billed costs, unless otherwise approved b the owner, Page 3 of 6 3. Project Schedule Date of Commencement: The Contract Time shall be measured from the date of commencement. The date of commencement of the Work shall be the date of this Agreement, unless a different date is stated below or provision is made for the date to be fixed in a notice to proceed issued by the Owner. December 7 2009, or such time that Notification to Proceed is given by Owner Contract Time: The Contractor shall provide to the Owner a Project Schedule (see Exhibit B). This Schedule is based on assumptions reached prior to the signing of this contract, which assumptions the Contractor shall attempt to clarify in the Schedule. However, the Schedule always assumes the Owner and the Architect respond promptly to requests for information and do not request any significant changes to the construction program. In the event that the Owner or Architect find any discrepancies with the Schedule or its Assumptions, they will promptly notify the Contractor, who shall make adjustments to the Schedule as necessary. According to the attached Schedule, the Contractor shall achieve Substantial Completion of the entire Work as follows: Date of Substantial Completion to be no later than December 31 2009 The Contractor does not guarantee the date of completion. However, the Contractor shall not be entitled to additional fees based on delays in the project unless those delays can be shown to incur extra costs for the Contractor and were caused.by the actions or requests of the Owner or Architect. The Contractor shall present an updated Project Schedule to the Owner and Architect on a weekly basis for their review. Page 5 of 6 BUILDERS 4. Signatures The Owner's representative is: David Steinbergh, Principal RCG LLC. 17 Ivaloo Street, Suite 100 Somerville, MA 02143 § 14.4 The Contractor's representative is: Kieran Whelan RCG Builders LLC 17 lvaloo Street, Suite 100 Somerville, MA 02143 This agreement is entered into as of the day and year first written above and is executed in at least thre original copies, one for the Owner, one for the Contractor, and one for the Architect. Owner Contractor Signat re Signature b-�V, � N.� to VA 4.r J414 W40A.1 . .SIrS vC FA Printed Name and Title Printed Name and Title Page 6 of 6 -2101 r ICLI 3 (-,-