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HomeMy WebLinkAboutBuilding Permit #140-15 - 510 TURNPIKE STREET 8/7/2014 BUILDING PERMIT of "°RDT#1 tt 9,y a TOWN OF NORTH ANDOVER o ° 6' APPLICATION FOR PLAN EXAMINATION yy� h T Permit No#:Na Date ReceivedrED :o ACHUS���� Date Issued: i4—TANT: Applicant must complete all items on this page LOCATION O �e Sle e'cri rl'tnc�t College Print PROPERTY O /i - 71 - _ -- i Print 100 Year Struc ure .__ yes 0 MAP PARCEL: . ZONING DISTRICT: Historic District yes no Machine Shop Village yes 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 W Others.- ❑ Demolition ❑ Other U41V¢'�'S� ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Tr br 04,W1C.e rg-noy&A.' &mo1+Aion. r .rk irNe-ILcdes all nis1Ies, tr dentification- Please Type or Print Cie ly OWNER: Name: d S Phone: Address: Contractor Name: hu i llac oPhone: (o l ;-- 5f:� -4T46 Address: !'3 Fa1Y.rak - _ S4-re-e4, S c Mfty'►«*. , MA 62144 Supervisor's Construction License:_(i S— Exp. Date: 61 al of b 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: $ 01000 FEE: $ ')-0 Check No.: - 3 -Receipt No.: � NOTE: Persons contracting with unregistered contr ors do not have access to e gu my fund Signature of Agent/Owner Signature of contracto 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/S11 ales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ' PLANNING & DEVELOPMENT Reviewed On Signature_ I COMMENTS I CONSERVATION Reviewed on Signature R COMMENTS It HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 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 Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS L Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I 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) i I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 I 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 9 ` VBuilding Permit Application I m/Workers Comp Affidavit m/Photo Copy Of H.I.C. And/Or C.S.L. Licenses eCopy of Contract Floor Plan Or Proposed Interior Work 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) j ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department q g p rtment 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:Building Permit Revised 2014 Location s �U12r✓�sOl1��— No. Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ t� Foundation Permit Fee $_ 4 Other Permit Fee $ TOTAL $ Check# Y94L-�- 'f Building Inspector f i Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 102000.00 m $ - $ 120.00 Plumbing Fee $ 15.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 15.00 Total fees collected $ 250.00 510 Turnpike Street 140-15 on 8/7/14 Office Reno NORTH F Town of : _ No. T. h h , ver, Mass, A_ COCMIc"l WIC" y1. S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System s ' THIS CERTIFIES THAT MAa tow.404.. e...0.1 . .. .... ............................................ BUILDING INSPECTOR ........ Foundation' has.permission to erect .......................... buildings on Sto....7 . A 1!q ��....... 01� Rough Sam to be occupied as ........ y provided that the person accepting this permit shall in 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC N RTS Rough Service .......... ...:, .... .... .................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. i Construction Corporation August 7, 2014 Ms. Maria Monks Serrao Merrimack College 315 Turnpike Street North Andover, MA 01845 RE: Merrimack College —Office Renovation, 510 Turnpike Street, North Andover Siena Project# 14175 Dear Maria, Siena Construction Corporation is pleased to submit this Letter of Intent for the Interior Renovations to the office space located on 510 Turnpike Street being leased by 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 NTE to be $10,000. 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 Anthon Di o Project Manager Cc: Terry Hayes — Siena Construction Corp. X Aar i q 90nkS--S4LrT ao Page 1 of 1 Pages i 1 ne uommonweattn of lvlassacnusettsIlk Department of Industrial Accidents I� Office of Investigations _ 1 Congress Street, Suite 100 ,s Boston, MA 02114-2017 = www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (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: Type of project(required): 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 6. E] 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 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. $ 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.F-1 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. lContractors 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. #:4087070676 Expiration Date:01/01/2015 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. Ido hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date:� � 07/08/2014 Phone#: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#• v Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-083597 .r. ANTHONY S DlCftRW , 43 FAIRFAX ST -" s Somerville MA 02144 9,21 ,vi_ Expiration Commissioner ' 01/12/2016 i IE DATE(MMIDDIYYYY) ACC)RD CERTIFICATE OF LIABILITY INSURANCE 12/20/2013 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(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 CONTACT NAME: The Driscoll Agency, Inc. PHONE exti7 _ AX(AJC No: 1 -681-6686 93 Longwater Circle E-MAIL P.O. Box 9120 ADDRESS:bdd)driscollaciency.com Norwell MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURERA:United States Fire Ins.Co. INSURED 1758 INSURER B:Safety Insurance Siena Construction Corporation INSURER C:North River Insurance n 25 Birch Street INSURER D: Cambridge MA 02139-4514 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:643313664 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY A GENERAL LIABILITY 5037722046 1/1/2014 /1/2015 EACH OCCURRENCE $1,000,000 XCOMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $300,000 CLAIMS-MADE 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 $ B AUTOMOBILE LIABILITY 6226594 1/1/2014 /1/2015 Ea acNED SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ C X UMBRELLA LIAB X OCCUR 5811024132 1/1/2014 /1/2015 EACH OCCURRENCE $$5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $$5,000,000 DED X I RETENTION$None $ A WORKERS COMPENSATION 4087070676 1/1/2014 /1/2015 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TQRY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? FN—] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Leased/Rented 5037722046 1/1/2014 /1/2015 Per Single Unit $100,000 Equipment Aggregate $100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Siena Construction Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 25 Birch Street ACCORDANCE WITH THE POLICY PROVISIONS. 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