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HomeMy WebLinkAboutBuilding Permit #515-14 - 485 ANDOVER STREET 12/27/2013t* BUILDING PERMIT �r aft,;._ °`'\ TOWN OF NORTH ANDOVER I� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: Z� 9SS�CHUS�� IMPORTANT: Applicant must complete all items on this nage LOCATION 485 Lb'1D0i1/,E2 S%, A -k, A,4,4 Print PROPERTY OWNER i7,r ,04-071,geK. <, a r Cr 4E Print MAP NO: 0Z PARCEL:t,7.1' ZONING DISTRICT: Historic District yesno Machine Shop Villaae ves 0 no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: %Commercial X Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: "Ay -LAA- M!ad '_S !�;rc-i2A-A-6 Phone: 97 8,3-7 -5`16-7 Address: 515 Tc112rJpl Its SrarcC-t' , 06 _ A<w ocav ccJ2- CONTRACTOR Name:_ Phone: 0-1-5r6- 'e :37 Address: 11- LZ 12pto Ena- > ST _ , FLu r -" TT , M Supervisor's Construction License: Exp. Date: cs-bq 3�51", CO /2 2-12,6 ks 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. Total Project Cost: $ 3o, X36.66 FEE: $ � I� Check No.: Receipt No.: 2 -11 °I �A NOTE: Persons contracting wit unregistered contractors do not have access to ke gp-&�anty fund Signature of A_ gent/Own r Signature of contractorf Location � J '�`-' a jP' No. r) IS -4 Date Check # � 1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $370'v0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ; / s Building Inspector Plans Submitted ❑ Plans Waived -0 -Certified Plot Plan ❑ --c Stamped Plans ❑ TYPE_OF_=SEWERAGE:DISPDSAL _ . Public Sewer ❑ Tanning/MassageBody Art ❑ _... Swnnmmg Pools ❑ ` . Well ❑ Tobacco.Sales E Food Packaging/Sales ❑ Private (septic tank, etc._ ❑ - _ . Permanent Dempster on Site ❑ THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM -DATE REJECTED - PLANNING & DEVELOPMENT ❑El COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATEAPPR.OVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decisionfreceipt submitted yes Planning Board Decision: Com Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit t DPW Town Engineer: Signature: Located 384 Osgood Street - FIRE "DEPARTMr_NTTemp Dempster on site yes= no Located Fire'Departinerittignatureldate �t »- x COMMENTS . F. 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 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 El Notified for pickup - Date Doc.Building Permit Revised 2010 j. �i Building Department z The foli'?.wang is'-a'li'st of the required forms to befilled 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-G.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 apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Buil\iing Permit Revised 2012 r -►1 FSO �-1 J W LL DZ Q m C L Y Y m o O LL E +O+ TO N u a N N p d z Z m C m a O LL t O KU v c E t m C LL O d z C J d c °�° O d' C 11 0 d a Q �.% W W rGi °�° O W u ` O N m C LL O a Z Ln Q en O O W cuL C LL z LLA C w W LL ` 3 m O z v O i {% O Y O In y d O = m c U) 0 =�-0 Q E o C Oz — N o 0 _ _ N co oo w CJ I'- v O = _ L =a -0 CL ' 0 y V m N W w O O a:~'' to .N .= CLL O uml N =,.- = V 0 w 0 c = v Q 0-0�„ co (D c N -0L.. C 0 b. OCL 0 0 0 LU z C!) m ��� 0 W Z V W XCO Z W V 1_— �cn Lu W J w w V O E O Z CL O N tm � 0 � M� •M� .E W W CL O �, d v D O O CL C. � Q O _ .Q O �Z U CL c^^ m = O O _ Cc � 0 Z c o r E CD LU• N 4: _ d N �R y0+ O O = 1: O CD • N d Q Cc JJ �•� � L W � � L y d O = m c U) 0 =�-0 Q E o C Oz — N o 0 _ _ N co oo w CJ I'- v O = _ L =a -0 CL ' 0 y V m N W w O O a:~'' to .N .= CLL O uml N =,.- = V 0 w 0 c = v Q 0-0�„ co (D c N -0L.. C 0 b. OCL 0 0 0 LU z C!) m ��� 0 W Z V W XCO Z W V 1_— �cn Lu W J w w V O E O Z CL O N tm � 0 � M� •M� .E W W CL O �, d v D O O CL C. � Q O _ .Q O �Z U CL c^^ m = SIENA Construction Corporation December 24, 2013 Ms. Maria Monks Serrao Merrimack College 315 Turnpike Street North Andover, MA 01845 RE: Merrimack College — Alumni House, 485 Andover Street, No. Andover Siena Project # 13311 Dear Maria, Siena Construction Corporation is pleased to submit this Letter of Intent for the Interior Renovations to the Alumni House — Merrimack College. This Letter of Intent is being issued for the purpose of establishing the costs of the work associated with our approved proposal. We agree that the basis of payment is a Lump Sum Proposal. The current cost of the work associated with the installed products on the project is estimated to be $30,836.00. If the "Project" does not proceed for any reason, or if Siena Construction does not build the "Project", Merrimack College agrees that Siena will be reimbursed for expenditures and costs, including General Conditions, of work performed to termination of services except in the event that the aforesaid failure of Siena Construction to build the "Project" is due solely to an action or election of Siena Construction. If you have any questions, please do not hesitate to call me at 617-547-4546, X324. Sincerely, SIENA CONSTRUCTION CORPORATION Anthony D rlo Pr ect Manager Cc: Terry Hayes — Siena Construction Corp. Page 1 of 1 Pages ACORO® CERTIFICATE OF LIABILITY INSURANCE F10312013DS) 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 pollcy(ies) 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 endorsement(s). PRODUCER NTACT NAME: Karen Deal PA"/c° N Ext :7 1 421 2496 a No :781 930 1352 The Driscoll Agency, Inc. 93 Longwater Circle P.O. Box 9120 E-MAIL A Ess:kdeal(c-Ddriscollagency.com INSURERS AFFORDING COVERAGE NAIC # Norwell MA 02061 INSURER A:UnEted States Fore ins. Co. /1/2013 INSURED 1758 INSURER B :North River Insurance Company INSURER C: Siena Construction Corporation 25 Birch Street Cambridge MA 02139-4514 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1653367295 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 LTR TYPE OF INSURANCE ADDL INSR UB WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/D LIMITS GENERAL LIABILITY 5037699123 /1/2013 /1/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence$300,000 CLAIMS -MADE 1XI OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ A AUTOMOBILE LIABILITY1337330448 /1/2013 /1/2014 Ea accident) $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident NON -OWNED HIRED AUTOS AUTOS B X UMBRELLA LIAB X OCCUR 5811011631 /1/2013 /1/2014 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $None $ A WORKERS COMPENSATION 4087055178 1/1/2013 /1/2014 X WC STATU-OTH- ER TORY LIM TS 1 AND EMPLOYERS' LIABILITY Y / N —1 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N/A E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 A Leased Rented Equipment 037699123 /1/2013 /1/2014 Per Single Unit $100,000 Aggregate $100,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION 30 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Siena Construction Corporation ACCORDANCE WITH THE POLICY PROVISIONS. 25 Birch Street Cambridge MA 02138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 _� Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Hanle (Business/Organization/Individual): Siena Construction Corporation Address:25 Birch Street City/State/Zip: Cambridge, MA 02138 Phone #:617-547-4546 Are you an employer? Check the appropriate box: 1. ❑✓ I am a employer with 20 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' coma. insurance reauired.l Type of project (required): 6. ❑ New construction 7. ❑✓ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other *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. Insurance Company Name: United States Fire Ins. Co. Policy # or Self -ins. Lic. #:4087055178 Expiration Date:01 /01 /2014 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 617-547-4546 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 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 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 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, 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 pen-nit/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 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 7-2010 Fax # 617-727-7749 www.mass.gov/dia