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HomeMy WebLinkAboutBuilding Permit #554 - 538 TURNPIKE STREET 3/17/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: S Date Received Date Issued: to { IMPORTANT:Applicant must complete all items on thisT"I page r �� ✓ SC LOCATION 1? PERTY t�17�1NER ry TYPE OF IMPROVEMENT PROPOSED I Residential USE Non- Residential i New Building One family Addition Two or more family Industrial No. of units: Commercial Repai eplacement Assessory Bldg Other Demolition Others: �. O Septic hell y `Ftoodplarn 1 let tands � Wa#ershed£Dstrct terl/Sew _IVa DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: t s a ' S CONT�tACTOR lanae r OF vorae }_ upernsor' ?^ ° � �F7ome�lm_provement L=`tcense � _ d �` ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON � $125.00 PER S.F. Total Project Cost: $_ —45 '`�Op FEE: $ a Check No.: � Receipt NOTE:. Persons contr� cting with unregistered contractors do not have access totheguaranty fund �g __T i nature of A en.t/Owner _ g at of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL � TSite Pools Public Sewer Tanning/MassageBo Well Tobacco Salesaging/Sales Private(septic tank,etc. Permanent Dumpster THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS I CONSERVATION Reviewed on Si nature COMMENTS HEALTH Reviewed on Si nature t COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water & Sewer Connection! Si nature &Date Driveway Permit k DPW Town Engineer: Signature: Located 384 Osgood Street no FOREEPA1211fIENT Ternp77777777T Dumpster on st#e .,:yes " a 7 L:ocatedt 124 :tea m S"ttre F=ire Departrnent:s�ignatureld'ate COMMENTS' i 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 i DANGER ZONE LITERATURE: Yes No I' MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine 1 NOTES and DATA— For department use 1 i ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 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 OfC. And/Or C.S.L. Licenses Copy of Contract a 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit } ❑ Photo Copy of H.I.C. And C.S.L. Licenses ' L3 Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u 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 o Certified Proposed Plot Plan o 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 y Calculations (1f Applicable) ❑ Copy of Contract Li Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products ` I 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 2008 LocationNo. �� Date ?7-I/v NaRTM TOWN OF NORTH ANDOVER f �,y f 9 Certificate of Occupancy $ �1s'••°'E<� cMus Building/Frame Permit Fee $ sw Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22658 Building Inspector NORTH Town of .4 L dover 0 IL C, -._ h - �„KE dover, Mass., COCMICKEWICK A01#A7ED C7 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �j�, THIS CERTIFIES THAT...........C. . . BUILDING INSPECTOR.... P.1 k L.J�/"................................................................... Foundation has permission to erec ........................................ buildings om5. -v Rough to be occu led as l.r' w.f f..-.L. -�- .. ...... 15� Chimney provided that the person accepting this permit shall m 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough ........................................................ . ::�. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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 1 . Smoke Det. ! resachu�ctt.� _ Btr:U'd of Bui ldin��l ra rtrn cnt of ublic S:tiet� COnstructi RP ei. rtiun�.; Lice °n SUPerviso tntl Stand: nse: Cg 55283 r License r►'d.c Restricted to: 00 205FG D RAND {- IAVERH DL M I LL AVE A 01830 ('onrni,.vincr Expiration. 5,/16/2010 Tr#: 27690 f I DATE ACORD,, CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 09/09/2008 PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willis North America, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26.Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 305191 Nashville, TN 372305191 INSURERS AFFORDING COVERAGE NAIC# INSURED Installed Building Products, LLC INSURERA: Zurich American Insurance Company 16535-005 Builders Installed Products - P. O. Sox 5111 p yan INSURER B: Cincinnati Insurance Com 10677-001 Manchester, NE 03108 INSURERC: Steadfast Insurance Company 26387-002 INSURER D: 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. INSR DD' PDOLI EY EFFECTIVE POOLII Y EXPIRATION LIMITS T TYPEOFINSURANCE POLICYNUMBER A GENERAL LIABILITY GL0913952702 10/1/2008 10/1/2009 EACHOCCURRENCE $ 2,000,000 ]( COMMERCIAL GENERAL LIABILITY DAMAGE NT PREMISES(Ea occurence $ 11000,000 CLAIMS MADE 7X OCCUR t MED EXP(Anyone person) $ 10,000 X $350,000 SIR PERSONAL BADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO- X LOC B AUTOMOBILE LIABILITY CAA5878127 10/1/2008 10/1/2009 COMBINED SINGLE LIMIT $ 1,000,000 B X ANYAUTO CAA5878131(NY) 10/1/2008 10/1/2009 (Ea accident) B ALLOWNEDAUTOS BA6000545 (TX) 10/1/2008 10/1/2009 BODILYINJURY SCHEDULEDAUTOS ' (Per person) $ X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $ / (Per accident) GAR AGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ C EXCESSNMBRELLALIABILITY AUC913958002 10/1/2008 10/1/2009 EACHOCCURRENCE $ 10,000,000 X OCCUR FICLAIMS MADE AGGREGATE $ 10.000,000 DEDUCTIBLE RETENTION $ $ A WORKERS COMPENSATION AND WC913952602 10/1/2008 10/1/2009 X TORY LIMITS oTRH- EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE WC913952802 (WI) 10/1/2008 10/1/2009 E.L.EACH ACCIDENT $ 11000,000 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 11000,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B OTHER XSll54851(AOS,NY,TX) 10/1/2008 10 1 2009 Excess Auto $4,000,000. Limit DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS m CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Quinland & Rand Builders E RES%NTATIVES. 34 Trinity Court AUTFrO5WEDREPRESENTA North Andover, MA 01840 ACORD 25(2001/08) Coll:2469379 Tp1:824960 40A 298 U ©ACORDCORPORATION 1988 QUINLAN & RAND BUILDERS Tim Quinlan 34 Trinity Court North Andover, MA 01845 February 10, 2010 Quote for repairs to: 538 Turnpike Street— North Andover, MA 01845 EXTERIOR: - Remove window trim, column, water table board and siding - Remove damaged window - Remove damaged plywood - Fix jack and stud and header of window - Fix broken studs j - Install new plywood, sheathing & Tyvek building wrap - Install new window, Anderson narrowline permashield (special order-earliest delivery March 5 th if ordered by 2/15/10.) - Trim window all sides with 5/4 pine ... Install new column - Install new water table board - Install new siding - Install new trim on left side of door - Replace Handicap sign - Paint trim and siding (Temperature dependant) - Front door has been racked and door closer is loose.***(Labor may be up to $500 more dependant on two commercial doors that have been compromised - unknown damages) INTERIOR: - Place floor protection (protection of brand new flooring) - Remove ceiling as required - Remove drywall from 1' to 2 ' past right side of triple window left to main door and over entrance door, to over second entrance door and the 8' of wall in vestibule that was damaged. - Move wall back into position and refasten to floor - Remove horn strobe and motion detector - Hang new blueboard - Plaster - Replace ceiling & broken tiles - Paint walls - Side light to second entrance door has been shifted and needs to be reset. - Replace baseboard - Remove & replace window blinds QUOTE ALSO INCLUDES: Disposal of all demo waste Obtain building permit Page 1 of 2 , +i+,. ^Y` !7' :.R!�•F Iii._ ,'.oi',i+3 ...'9 haws IL tel. N r _ .yy'y ..., ^; , _ i�•_,i ) ., , r - .i ,.".i e } , r, . :Z l M, QUINLAN & RAND BUILDERS Tim Quinlan 34 Trinity Court North Andover, MA 01845 February 10, 2010 Quote for repairs to: 538 Turnpike Street — North Andover, MA 01845 PRICING: PERMIT $ 120 DISPOSAL $ 100 DEMO & CONSTRUCTION LABOR** $4,000 - $4,500 MATERIALS $1,600 PLASTER $ 850 CEILING $1,200 PAINT INTERIOR & EXTERIOR $1,000 TOTAL** $8,870 - $9,370.00 Page 2 of 2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UT 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: 5 9 _QZ4/0 i7 � 7 City/State/Zip: v9AJJQ p✓r_fZ 6K Phone#: 'Z7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.Nam a sole proprietor or partner- listed on the attached sheet $ 7. ❑Remodeling hip 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 required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 L❑Plumbing repairs airs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] t employees. o workers' 13. Other comp.incur ❑ p once required-] *Any applicant that checks box 41 muss 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. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: 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 cern nder the aims Weeeties o erjury that the information provided above is true and correct Si ature: Date: Phone#: 7 Official use only. o 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#: i 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 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 homeowner 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. 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: T'he 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 Revised 5-26-OS Fax#617-727-7749 www.mass.govfdia / err Date. AORTN TOWN OF NORTH AN' OVER PERMIT FOR PLUMBING p ss i . s � •"a �SS�cNusE� l n j This certifies that �t�� � .? t�st"''�'?` . �'c has permission to perform . . . ..216. . s J plumbing in the buildings of . . . at. . . ��'�� . . ✓ �!�e. . . Ste. . . . . .,., North Andover, Mass. Fee�/ff). . . . .Lic. No.. 27 . . . . . . . . . . . PLUMBING INSPECTOR Check # 0� 7744 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Tyle) y�1�1 V ► W `�V v . -mass. Date � r��rt^it s 1 � e . Building Location l Cner's Narrae \o Nsoc-Type of Occupancy Co f er New Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No FIXTURES Z K V O O ¢ ¢ Y < Nl 4 d X N m U ¢ W r a ~ N Z A < IW LIl Z Z ¢ W " N < J N C ¢ J = A C A 1JL ¢ W .T. < ZL O z x X 0. O h• < Y_ < W k Y W < M�•• 4' < S < < < J j < ¢ ¢ LC LLI < O < F s a �c J m m A n J 3 z !•-, m u. o � A < 3 Lr m o SUB—BSMT, 'y BASEMENT - FL 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR t� Installing Company Name � � � � J��e Check one:. f^,e�klficatc Address �� C �� ny ("Corporation _ ❑ Partnership Business 'Telephone, ('j`t L ❑ I krrvCo: Name of licensed Piumber MlCreA0N INSURANCE COVERAGE: I have a curt nt liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142: Yes No ❑ It you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent❑ &gnature of Owner or Owner's Agent I hereby Lenity that all of the details and information 1 have bmitted(or tered)' above application are true and accurate to the best of my knowledge and that all plumbing waft and installations undo pe for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' Cod t 14 of the oral Laws. BY Titlegnature of L sed Mumber Type of License:Master Journeyman❑ 'Crtylicn APPRJWD(OFFICT U§FJNL License Number brnnoima IHBbEclou O DYlE---J8 bE111711 oHvH1ED brnMBEN rocY110H OE BnIrDINO NYwE r 1AbE ok BAIrDINO YbbfICV11oN Low brunj.L AO DO brnMIBINC No* EEE EINYf IN8bEC110H8 b"O(!iE22 I112bEC11OH2 �r BEroM LOH OkEICE n8E ONrA ~ G