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Home My WebLink AboutBuilding Permit #669 - 451 ANDOVER STREET 6/4/2009BUILDING PERMIT o` t. �o �b Aa TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 70 e" Permit NO: Date Received 4,4.0 %rep Date Issued: IMPORTANT: Applicant must complete all items on this page LOCA PROF MAP NO: PARCEL: ZONING DISTRICT: Historic District Machine Shop yes no ves 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 Well Floodplain Wetlands Watershed District Water/Sewer U OWNER: Name: Address: DESCRIPTION OF WORK TO BE PREFORMED: u jl,n Identification Please Type or Print Clearly) Phone: CONTRACTOR Name: &a yJ;t d Phone: ( -Z 3 r—kospe Address: cli � 'c� t�-.. j' V� - .� '' L4 Supervisor's Construction 'License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER ® CYPQ Ks Phone: (4-)a— -�os Address: S'AA Qom': Reg. No. I FEE SCHEDULE: BOLDING ERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ ,3 le�Llc� FEE: $ Check No.: Receipt No.: A NOTE: Persons conKacog with unregistered contractors do not have accey) to the guaranty fund 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 t THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT 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: Commen Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS m m m m m m CA mm v vi .O C d CO2 C) 10 Q CD V) Z y a r C') c c CL = y C.) o v CD CD O CL Q CD CD o CD c CD y CD O y CD I � v y O CD Z co a Sit oCD CD0 z cn n O cn C W• r: Q • C 0 00 g=c . =61 rC. N C N FL- CO CA GC O _m!t= to = d CS1�• N -•o. 0 -comm o N O m : m = y O C09 O Z�•Cm'J O N C! CD: = o,ec CL CD ma N C -)-o ICD IL N.�4. '• m N CL d Q CO a �� . C m O N m m :,ok N _. WD m C,. CA �h m 100 ^' O: N Im �. �. C', _" :,<'t � m o+ � . CL:K ci n kj z O 49 o Cn d R CC/ `� o w d :p m g, Irl Cn ",L7 Cs7 n ^f w 70 r t :-rl w n ` ',Li oCn 'r1 a R d C/) CC° �, "t1 A 1 2=Adp �.� • N PHYSICAL AUDIT 10�Peerless Insurance Mcmt—of Libcnr Mutual G—p Auriit Period- From 09/29/2007 To 09/29/2008 Policy Number: CCP9266483 Policy Period From 12:01 AM 09/29/2007 To 12:01 AM 09/29/2008 Coverage Is Provided In PEERLESS INSURANCE COMPANY - A STOCK COMPANY Named Insured and Mailing Address: Agent: BEAUDOIN FAMILY EATON & BERUBE INS AGENCY INC ENTERPRISES INC 365 NASHUA ST C/O CLAUDE BEAUDOIN PO BOX 37 16B HARRY BROOK DRIVE MILFORD NH 03055 GOFFSTOWN NH 03045 PER $1000 Agent Code: 0410001 Agent Phone: (603)-673-0500 PREMIUM AUDIT STATEMENT CUSTOM COMMERCIAL PROTECTOR GENERAL LIABILITY COVERAGE PART Class Code Classification Description Premium Base Rates Earned Premium NH 91342 91581 91585 98305 CARPENTRY NOC $ 198,350 $ 21.444 PAYROLL PER $1000 SUBCONTRACTED WORK - IN CONNECTION WTH CONSTRUC- TION RECONSTRUCTION REPAIR OR ERECTIONS NOT BLDG IF ANY $ 1.158 COST PER $1000 SUBCONTRACTED WORK - IN CONNECTION WTH CONSTRUC- TION RECONSTRUCTION REPAIR OR ERECTIONS BLDGS IF ANY $ 1.158 COST PER $1000 PAPE RHANGING/iNTERiOR PAINTING IF ANY $ 18.834 PAYROLL PER $1000 $ 4,253 Terrorism Risk Insurance Act of 2002 Coverage $ 124.00 CCP General Liability Coverage Part Total Earned Premium $ 4,253.00 Total Earned Premium $ 4,377.00 Less Previously Charged* $ 2,616.00 TOTAL ADDITIONAL PREMIUM $ 1,761.00 * If the policy is on an "installment basis", the final premium is subject to the payment of all installment premiums. Date Issued: 01 /29/2009 17-75 (12/94) INSURED COPY 09/29/2007 9266483 NHOPACLP3001 PGDM060D J29435 PCAFPPN 00034960 Page 5 01/25/2002 10:00 9784757664 oeaviftwk Family I 16F Tuts', Brock Dr. f iot `sta'wn, NH 03045 Phot ie c �r pax (601) 384-2076 THIS ESTMATE HAS BEEN FRP.P, BRED FOR: l)r. Reddi WORK TO BIi COMPLETED; Su le 206 No. Andover Demo wall and door way. frame and sheeuock w311s and repair Nall; Insall 3 doors supplied by demo Electrical work and ceiling repairs PAGE 01 17ATE: 05-0309 (, loef / 3 e, Prime and paint affected areas50U.OiJ Also remove cab and countess instil 11 iced cabs and counters � Per unit 150.00 To 300 00 per init Insurance and Material included in prize unless otherwise stated above. Total estimate for the work describe A )O"c' We thank you for your interest in doir g 1 iusiness with us. If I can be of any further assistance tO you please contact me Sincerely CLAUDE J. BEAUDOIN � 00 4 n 0 -no Ni �o r^ o . ;o C- 00 03 .- a o <T t i � p*.»;ti� �fA 3 CAI llN CD g C) sk a CD 93 O ` � C � OD d The Commonweaft of Afmachusetts Department of Industrial Accidents Office of Investigations 600 T ijashington Street Boston, MA 02111 c ? www nzassgov/dia . Workers' Compensation huhr'ance Affidavit: Builders/Contractors/' leatr.cians/plambers ApLcant Warrnatinn Name (Business/orgmiza6arL4ndividual): Address: L K A � City Phone nu an employer? Check. a appropriate box: 1. I am a employer ❑ j with 4. I am a general co rutractor and I employes (full and/or part-time).* have hired the sub-conlzacors I am.a.sole proprietor or partner- iisted on the attached sheet = ship and have no employees These sub -contractors have working for me in any capacity,rkers' [No workers' comp, insurance comp. insurance. required.] 3 • ❑ 1 am a homeowner doing arc a corporation and its officers have exercised their all work right of exemption per MGL myself [No -workers' camp. c 152, § 1(4), and we have no insurance required.) t employees. [No workers' comp. insurance required_] Type of project (requires!): 6. ❑ Now construction 7. ❑ Remodeling 8• ❑ Demolition 9. ❑ Building addition I0.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs I3.❑.Other ;Any applicant that checks boli# I must also fill out the section blow ahow.ir: their workers' nom 1— 1 Homeowniq who submit this affidavit indicating they are doing an work end then hire outside c nuactam must s tuba eanew Affidavit indicating 1Crn►tn ors [feet check this box must attached an additional sheet showing ¢i►e nama of the sol -contractors and their workers' Af fi sig . _ such. r pali–, s„iamsst7ou. arm an VNPloyer that is prpri&ng workers' compensation assurance for my employees Below is the o ' infor7nadon p iccy and job site Insurance Company Name: Policy # or Self -ins. Lie. #:_ Expiration Bate: —Lf� O . Job Site Address: City/state/Zip: ------------ 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. ! do he c under the aims and penalties afPerjurY Mat the information Provided above is true and coned Si tune - P, Dale: --d Phone #: (J3 ^+ 3 •_ �7 b d Official use only. Do not write in this area, to be Convicted by city or town offs w City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrics! Inspector 5. Plumbing inspector 6. Other Contact Person: Phone #: Information a nd Instructions `^ Massachusetts General Laws chapter 152 requires all emp 3 oyers 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." l `. An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the'fomping engaged in a joint enterprise, and includir-ig 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 an 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 it a construct buildings in the commonwealth for any applicant who has not produced acceptable evidencez-t compliance with the insurance 'coverage required." Additionally, MOL chapter 152, §25C(7) states "Neither t3he cornmenwealth nor any of its political subdivisions shall enter into any contract for the pm forimi nce of public work until acceptable evidence of compliance with the insurumee require = s of this chapter have been presented to the coritracting authority." Applicants Please fill out the workers' compensation, affidavit complertely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es). mind 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 cant' workers' compensation insurance. If an LLC or LLP does have empioyees, 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, notthe Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' oampensation policy, please call the Department at the numberlisted below. Self-insured companies should enter their self-insurance license number on the• appropriate tine. 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 A ill 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 appiicant should write "all locations in (city or town)." A copy ofthe 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 bum leaves etc.) said person is NOT required to complete this affidavit Thr Office of Investigations would like to thank you in advance fear 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 Iatvestiations 600 Washington Street Boston, MA 0:2111 TeL 9 617-7274900 ext 406 or 1-8.77-MASSAFE Fax #617-727-7749 Revised 5 -26 -QS wwwmass.gov/dia Architects L LaGrasse & Associates, Inc. Joseph D. LaGrasse, AIA Thomas F. Galvin, AIA Architects, Engineers, & Land Planners Julianna E. Hoch, RA CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: 2161M PROJECT TITLE: North Andover Office Park PROJECT LOCATION: 451 Turnpike Street, 2" a Floor Unit 206 NAME OF BUILDING: Building SCOPE OF PROJECT: Interior Office Renovation for Dr. Reddi, 451 Andover Street. In accordance with Section 116.0 of the Massachusetts State Building Code, I, Joseph D. LaGrasse, AIA MA. Reg. # 4153 being a registered professional engineer/architect hereby certify that I have prepared or directly supervised the preparation of all design plans, computations as specifications concerning: Entire Project Architectural X Structural Mechanical Fire Protection Electrical Other For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2.2: 1. Review of shop drawings, samples, and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix 1. Pursuant to Section 116.4, I shall submit periodically, a progress report together with pertinent comments to the Building Inspector. Upon completion of the work, I shall submit a final report as to the satisfactory completion and readiness of the project for occupancy. Offices One Elm Square Andover, MA 01810 Joseph D. LaGrasse, AIA 5/28/09 1'Stgnature of Architect/Erigineer Date T 978.470.3675 F 978.470.3670 1420 Celebration Blvd. www.lagrassearchitects.com Celebration, FL 34747 JDLoffice@LaGrasseArchitects.com AA26001333 LaGrasse & Associates, Inc. Architects, Engineers, & Land Planners CONSTRUCTION CONTROL AFFIDAVIT Architects Joseph D. LaGrasse, AIA Thomas F. Galvin, AIA Julianna E. Hoch, RA PROJECT NUMBER: 2161M PROJECT TITLE: North Andover Office Park PROJECT LOCATION: 451 Turnpike Street, 2nd Floor Unit 206 NAME OF BUILDING: Building SCOPE OF PROJECT: Interior Office Renovation for Dr. Reddi, 451 Andover Street. In accordance with Section 116.0 of the Massachusetts State Building Code, 1, Joseph D. LaGrasse, AIA MA. Reg. # 4153 being a registered professional engineer/architect hereby certify that I have prepared or directly supervised the preparation of all design plans, computations as specifications concerning: Entire Project- Architectural X Structural Mechanical Fire Protection Electrical Other For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2.2: 1. Review of shop drawings, samples, and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix 1. Pursuant to Section 116.4, I shall submit periodically, a progress report together with pertinent comments to the Building Inspector. Upon completion of the work, I shall submit a final report as to the satisfactory completion and readiness of the project for occupancy. Offices One Elm Square Andover, MA 01810 Joseph D. LaGrasse, AIA k c> L ,r . 5/28/09 S a ngineer Date T 978.470.3675 F 978.470.3670 1420 Celebration Blvd. www.lagrassearchitects.com Celebration, FL 34747 JDLoffice@LaGrasseArchitects.com AA26001333 5XA 0,1 4 AM 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 Doc.Building Permit Revised 2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody 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 & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Ia Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpsteron site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 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 ❑ 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 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 2.2008 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this naize MAP NO: PARCEL: ZONING DISTRICT:Historic District yes Machine Shop Village yes /3? bo , 76 �L\ °. Residential 41 New Building 9 - no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial 7L—, Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer UtbUKIF I IUN OF WORK TO BE PREFORMED: k I th Identification Please Type or Print Clearly) OWNER: Name: Address: Phone: CONTRACTOR Name: ' Q z Phone: Address; Dig t,,ct We Supervisor's Construction License:Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER ® 'Q KS,e-- Phone: / 7�� 36 )s Address: Aml Ui'. L/ Reg. No. — FEE SCHEDULE: BOLDING 4ERMIT: $12.00 PER $$100000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: FEE: $� Check No.: / o / % Receipt No.: NOTE: Persons conKaacog with unregistered contractors do not have a�cceo to the guaranty fund re or co