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HomeMy WebLinkAboutBuilding Permit #1051-2016 - 550 TURNPIKE STREET 4/7/2014 M r►ORTN BUILDING PERMIT � `t�eO 16�� TOWN OF NORTH ANDOVERto APPLICATION FOR PLAN EXAMINATION �` a Permit NO: /���� �' Date Received SACH Date Issued: 7 r US IMPORTANT;Applicant must complete all items on this page LOCATION ��� // ( L/ /J �. A k PROPERTY OWNER_NOMA &&V9(!.I� � � n , Print MAP NO& f PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential p New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: P<ommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: il'bemolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer PeAm"adr Identification Please Type or Print Clearly) OWNER: Name:' v, QCV`VX0yCafC0dS Phone: Address: CONTRACTOR Name: Phone: ? 7L Address: A2 Wail/ &Y- lK2y-�1 G.e"v Supervisor's Construction License: �-'(� Exp. Date: l Home Improvement License: ,`�3 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULGING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /J-9") — FEE: $ Check No.: /607— Receipt No.: 3c�.z-/ NOTE: Persons contracting with unregistered co tractors do not have acces the g a. ty fu .Signature of Agent/OwnerZLAY. L ignature of contract=/41( f S 4 r _ k L 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 PLANNING & DEVELOPMENT Reviewed On Signature_ 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: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -.Tern ®urn ster on sit '' - p p yes. a no Located at 1-14 Main Street Fire De :a men signature/date � F t.� c 1..� 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) �I ❑ Notified for pickup Call Email i Date Time Contact Name Doc.Building Permit 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 4 Building Permit Application 4. 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 OTE: 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) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application 46 Certified Proposed Plot Plan 4. Photo of H.I.C. And C.S.L. Licenses 4 Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 1 LocationU /J No. f��1-- c�d/�a Date q1-7 f TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee TOTAL $ Check# f C Building Inspector 214 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 15X5.00 m $ - $ 190.50 Plumbing Fee $ 23.81 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 23.81 Total fees collected $ 338.13 550 Turnpike Street 1051-2016 on 4/7/16 Demo for tenant fit up NORTH - . w: :. . . . .. .c . . ve. . 0 4J�Ah ver, Mass, 44Aeo CIA � O COCNICNEWICK 1' S U BOARD OF HEALTH Food/Kitchen P E IT D Septic System THIS CERTIFIES THAT ... ... ,,,,, ...... � BUILDING INSPECTOR .... .......... ... ........ ........ ....... ...... ............. ..� �G��N Foundation has permission to erect. .................. . build' son .. .... .. .......-.... ............. . .................. Rough to be occupied as .... . . �... ..N ...... .......... .................................... Chimney Ch' e provided that the person accepting this permit shall in every res 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 CONSTRUCTIO ARTS Rough Service .. ..�c..... ................................ 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. CONTRACT ROBERT BOHONDONEY CONSTRUCTION CO. 12 HALL STREET METHUEN,MA 01844 978-685-0970(office)/978-685-8262(fax) Fully Insured Construction Supervisor License#979 Exp 4/21/2018 Home Improvement Contractor#114238 Exp 8/16/2017 bohondoneyconstruction@yahoo.com Customer Name: Scott Management Property Address: North Andover(Dawg City) Contract Type: Interior Demolition Date: April 6,2016 Scope of Services: Interior Demolition 1. Provide demolition building permit(building and plumbing)and necessary inspections. 2. Provide demolition labor for removal of all fixtures and existing furniture iri unit. 3. Provide removal of freestanding columns. 4. Provide demolition of 2 interior room walls and walls located at the mani/pedi area as specified. 5. Plumbing—provide removal of 5 hand sinks,2--.130 gailon.,electric water heaters,jack hammer around 2"pipe in slab and cap, and remove 2 wash boxes in pedi area and 1 laundy box in utility room and cap. 6. Repair concrete floor at pedi station. 7. Supply and install ceiling tiles to match existing in locations of demolition. 8. Repair walls as necessary—mud,tape , 9. Provide job site clean-up and safe work zone. 10. Dispose of debris from site. Payment Terms: Deposit to start project$5,300.00, Progress payment$5,300.00 and remaining contract balance of$5,275.00. TOTAL CONTRACT AMOUNT: $15,875.00 CUSTOMER SIGNATURE: DATE: L G G CONTRACTOR SIGNATURE: L� DATE: l� Page 1 of 1 LINN The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 < Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Avalicant Information Please Print Le 'bl r Name(Business/Organization/Individual): Address: Y—C�(�f (Sy City/State/Zip:/L/e&&a /Ul`.✓Y MPhone#: Are you an employer?Check the appropriate box: Type of project(required): 1. a employer with_k�employecs(full and/or part-time).' 7. ❑New Construction 2.[]I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 9. KI-De4iolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.F1 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole ME]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.E:]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other i 152,§1(4),and we have no employees.[No workers'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. tContractors 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. lam an employer that is providing workers'compensation insurance for my employees. Below Is thepolicy and job site information. Insurance Company NameA IQ ALLIIJ - 9/ i Policy#or Self-ins.Lie;#:• l Expiration Date: fAl 6/ iynm Job Site Address: � fi City/StatelZip: , vs— Attach a copy of the workers'comp nation policy declaration page(showing the policy number and expiration date). i Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 j day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ' I do l ereby cern ender the pai d pen ides of erjury that the information provided above is true and correct. Si nature: Date: Phone#• Official use only. Do not write in this area,to be completed by city or town ofjlcial. 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#: �'�",.'�' Y CERTIFICATE OF LIABILITY INSURANCE DATE(t1�lliil /'15 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 endorsemen s. PRODUCER CONTACT NAME: Bates Insurance Agency Inc. PHONE (781) 396-4985 N ; (781) 395-9454 92 High Street, Suite Bl FA-MAIL ADDRESS: Andrea@Bates Ins.com Medford, MA 02155 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:RCA-Essex Ins Co INSURED INSURERB:A.I.M. Mutual Ins. Co. Robert Bohondoney INSURER C: Bohondoney Construction INSURER D: 12 Hall St INSURER E: Methuen, MA 01844 INSURERF: COVERAGES CERTIFICATE NUMBER: 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 AODL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVDI INSPOLICY NUMBER MIDDY MMM01YYYY LIMITS A GENERALLIABILI Y 2CV1242 2/3/16 2/3/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS-MADE a OOCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 000,000 GEN'L AG GREGA TE L IN T APP UE S PE R PRODUCTS-OOMP/OPAGG $ 1:000,000 POLICY JECT —1 PRO LOC $ AUTOMOBILE LIABILITY COMB INED SINGLE LIMIT a accident $ ANY AUTO BODILY INJURY(Per person) $ ALLOWhED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE t $ HIRED AUTOS _ AUTOS er acciden UMBRELLA UAB L OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ B WORKERS COMPENSATION AWC40070243322015 8/9/15 8/9/16 1 WC STATU- OTH- AND EMPLOYERS'LIABILITY CJ Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NIA, - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 t(yyes,describe undef DESCRIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Affach ACORD 101,Additional Rene Acs Schedule,If more space is required) 550 Turnpike Street North Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Inspectional Services AUTHORIZED REPRESENTATIVE _sjd� © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-000979 ROBERT A BOHONDONEY 12 HALL ST METHUEN MA 01844 Orrnmissioner 04121/2018 eofCons "r _ 1O umcrAffhirs&t3 -_ ME IMPR us, Re guiHtlOh RegistrationOVEAryENT CONTR,4CTOR Expiration: 114238 8/16/2017 Type: � ROSERTBOHONDONEy DSA CONST Co ROBERT BOHONDONEy 12 HALL ST METHUEN,MA 01844 Undersecretary