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HomeMy WebLinkAboutBuilding Permit #214 - 49 ORCHARD HILL ROAD 9/18/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: ' IMPORTANT:Applicant must complete all items on this page LOCATION Ik I/ Print PROPERTY OWNER �a�`rtN 8fn N Print 100 Year Old Structure yesno MAP NO: PARCEL: ZONING DISTRICT: Historic District y no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition ❑Two or more family El Industrial CIteration No. of units: 6�C ommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: j 3�� �-r►-C�cv( 5)4ud_5 r.�r�rc�+i'ct rl Identification Please Type or Print Clearly) yt�6 �� O Lf OWNER: Name: Al-3& 5©,cf_ ern /V r Phone: X17 Address: tfq Qrdw L4r4 rZd ' CONTRACTOR Name: Cr'n 91-, (�49. Phone: `60 r -L(3 Y Address: Z W4"n a..e 'j'r-cct'r `21 Supervisor's Construction License: G 5 �G 73 715 Exp. Date: 'RJ 2C (y Home Improvement License: Exp. Date: ARCHITECT/ENGINEER fi ''"`r^ yPFP Air Phone: 1'la f �' Zd Address: a�5sc r- Reg. No. g 6 FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Z© 6 Y FEE: $ Z`( Check No.: Q�&.�L_c— Receipt No.: -Z S �' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 'y Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ 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 & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments !later & Sewer Connection/Signature& Date Driveway Permit DPW Torun Engineer: Signature: Located 384 Osgood 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 DANCER 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 - Date Doe.Building Permit Revised 2010 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: Doc.Building Permit Revised 2012 Location C o� Gt `U , No. 3 Date 1 0 I�--- ® • TOWN OF NORTH ANDOVER • Certificate of Occupancy Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ Tt—JI F TOTAL $ Check#--"a `` 25719 Building Inspector E MMONWEALTH OF MASSACHUSETTS TH CO � STATE BUILDING OCDE AFFIDAVIT IN ACCORDANCE WITH SECTION 116.0 rev} On this Thirteenth I day of September A.D., 20 12 before me, for the Commonwealth of Massachusetts; personally appeared Robert P. Arp who, being duly sworn, deposed and says that he is registered to practice ArrhitPrtiu p in the Commonwealth of Massachusetts and that he has supervised the preparation of all the design plans and construction documents of _SAA - Nortb_ Andover and that such plans conform to the applicable provisions of- the Massachusetts State Building Code and National Fire 4rotection Association,-that the materials specified for use in the construction conform with the Controlled Construction Procedure therein defined; and that a prof essionally 'qualif Led representative of his firm will administer the Construction Contract, and that he will, with the assistance of his professional consultants, review the shop drawing details for construction, and that he will provide professional inspection of the construction as -required, .,and that he will,.. _ with the assistance of 'his professional consultants, r,eview.the shop .drawing details for construction, and that.he.:will provide professional inspection of the construction as required, and-tkat 'he will-:inform the Owper and the Approving and- Permit Granting Authority of any observed deviations from the applicable Codes. (Signature) (Registration No.). 9767 SUBSCRIBED AND SWORN TO BEFORE ME THIS ��' DAY Of A.D. . 20-1—A My Commission Expires (Notary Public) �§10ED ARCh,�T OeEST p g9gFC� 0 WARWICK, w � Rl J4 02 ,r c, �Fq��H OF 0 PSyP A S E ONSTRUCTION COMPANY 225 WAMPANOAG TRAIL,EAST PROVIDENCE,RHODE ISLAND 02915 TEL: (401)434-6511 • FAX: (401)438-9559 • EMAIL: CASECONSTRUCTION@VERIZON.NET August 30, 2012 AAA Southern New England Merrimack Valley Division 49 Orchard Hill Road North Andover, MA 01845 Attn: Edward Hart Re: North Andover Renovation Revised Proposals Dear Ed, We are pleased to submit a proposal for labor and material to build the walls at the new office to 12' high in lieu of the 25' height shown on drawing A-1.2. There would be no storage mezzanine built on top of the 12' walls. All other work would remain the same. The existing HVAC unit would not have to be moved which we did not have in our original price quoted 08/13/12. Revised Ease Rid: $20,674.00 ye Alternate#1: Additional cost to relocate the existing HVAC unit so the wails can go up to the deck per original plan. Add: $3,734.00 /VO Alternate 2: Additional cost to install a Sanyo self-contained HVAC unit in the new office in lieu of taking air from the existing unit. Add: $7,892.004 Thank you for the opportunity to submit this proposal and please don't hesitate to contact me if any of the above requires clarification. Very truly, CASE CONSTRUCTION COMPANY Frank N. Gustafson President FNG/kj Cc: Kenneth W. Crossley 9 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Cunstructiun Supers isor License CS-073715 EDWARD J MCDONAq 3171 DIAMOND I:I L4 CUMBERLAND RI 02864 Expiration commissioner 08/20/2014 j Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet (9911n )of enclosed space. i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 ,Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: Z 2- a ��' City/State/Zip: r , d . /Z17- 009"Y-Phone#: L/O r If 3 Y 6 5—/J Are you an employer?Check the appropriate box: Type of project(required): 1.P I am a employer with 4. ❑ I am a general contractor and I 6. ❑�ewstruction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ing ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑Electrical repairs or additions 3.❑ required.]I am a homeowner doing all work right of exemption per MGL 11.[1 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 5���,-.1.6 'rt_S; 69• 0.(. $cs"to OCZ , Insurance Company Name: P__3ecz«V-V. 0'.4H."a �^S-, CC9' Policy#or Self-ins.Lic.#: Z If 617 Expiration Date: Job Site Address: ( 69r4 Y' t t oe'l' City/State/Zip: 19g,-rA 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. Signature: /, - W, Date: GI`l t .Z Phone#: 1'!O f — L(3 Y b 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." 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-contractors)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 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. #617-727-4900 ext 406 or 1-877-MASSAFE wised 5-26-05 Fax#617-727-7749 unmu mace [rnv/rlia ACORQM CERTIFICATE OF LIABILITY INSURANCE DATE(oz/oMM/D7/20122012) 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 policy(les)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 CONTACT NAME: Troy, Pires & Allen, LLC PHONE (401)431-9200 Arc No Ext: AIC No:(401)431-9201 376 Newport Avenue ADDRESS: P.O. BOX 4830 INSURER(S)AFFORDING COVERAGE NAIC N East Providence, RI 02916 INSURERA: Selective Ins Co of Southeast 39926 INSURED THE RHODE ISLAND CASE CONSTRUCTION CO. DBA INSURERS: Beacon Mutual Insurance Co 24017 CASE CONSTRUCTION COMPANY INSURERC: 225 WAMPANOAG TRL INSURER D: RIVERSIDE, RI 02915-2211 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 12/13 Pkg & WC 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY S 175458 02/08/2012 02/08/2013 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY fAG PREMISESES(Ea Ea occurrence) $ 100,00( CLAIMS-MADE I OCCUR MED EXP(Any one person) $ 5,00( A PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 3,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: 1F] PRODUCTS-COMP/OP AGG $ 3,000,00 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY S 175458 02/08/2012 02/08/2013 Ea accident $ 1,000,00 X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS Per accident $ $ X UMBRELLA LIABX OCCUR S 17 S458 02/08/2012 02/08/2013 EACH OCCURRENCE $ 5,000,00( A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,00( DED I X I RETENTION$ 0 $ WORKERS COMPENSATION Z3]O 10101/2011 10/01/2012 X AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTI E.L.EACH ACCIDENT $ B OFFICER/MEMBEREXCLUDED9 � NIA 500,00 (Mandatory In NH)es,describe under If E.L.DISEASE-EA EMPLOYE $ S00,000 y DESCRIPTION OF OPERATIONS below1. E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,M more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AAA Southern New Englad Attn: Lloyd Albert AUTHORIZED REPRESENTATIVE \' 110 Royal Little Drive Pr vidence, RI 02904 Lori LaFlamme/LLL ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Town of VZ' 7• ` ...'ry , Andover No. - 11L Y �� h ver, Mass, ' coc Klc Ke WICK yot• ��A�RATE� ►'4P,t�(5 S U BOARD OF HEALTH Food/Kitchen PER - L D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR .................. ... . . . w........ .�r... ....... ......... ................ .....t......... Foundation has permission to erect......... ............. buildings on ..... ..... /.. ......... .�.. ......... Rough tobe occupied as ............... .�.. .......� .. .... .. ................................................:............... chimney provided that the person accepting this permit shall every respect conform to the terms of the application Final on file in 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 �/ J Final PERMIT EXPIRES .IN ONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC%.; STAR Rough Service ........... ... ... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a- onspicuous 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. Smoke Det. SEE REVERSE SIDE oRF Town of ' Andover O1 - 0 A- G No. Y C, LAN! h " ver, Mass, • ' q_ COC NICKl WICK y1. 9�A�?i1TED I'Pa��S S V BOARD OF HEALTH Food/Kitchen PER Th LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .................. ... . . ....:........ .....4... ....... ......... ................ ..... ...... Foundation has permission to erect....... .......... buildings on ...qq..... /.......... ... ......... .�.. ......... • Rough ia� tobeoccupied as ............... 1.. .......� .. .... .. ................................................................ Chimney provided that the person accepting this permit shall every respect conform to the terms of the application Final on file in 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 WO. NTHS ELECTRICAL INSPECTOR ® UNLESS CONSTRUC 0 STAR Rough Service .............. .... ................ ............................... ... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in al,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. Smoke Det. SEE REVERSE SIDE