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Home My WebLink AboutBuilding Permit #824-12 - 562 TURNPIKE STREET 5/1/2018 TOWN OF NORTH ANDOVER g APPLICATION FOR PLAN EXAMINATION Permit NO: '� Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION S T e WJ)iGrA PROPERTY OWNER c �,��Q� Unit# Print MAP NO: PARCEL: ZONING DISTRICT: Historic District . yes no Machine Shop Village yes o 100 year-old structure yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑Addition ❑Two or more family ❑ I dustrial Alteration No. of units: Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑ Other i.. �ptic ® ell ° .`' ;�O,F oodpla ®Wetlands"�� , 0'Wae + n. DWater/Sewer, - R. h r ... L. �� D SCRIPTION OF WORK T B PERFO D: /'h �G 14�,AQ, Ciro SerVte� d ntification Please Type or Print Clearly) OWNER: Name: llN,aM S Sl,�,ti��n Phone: 976-(0e6 7dpp Address: CONTRACTOR Name: Phone: r/2,5-'}�—��ap Address: -o Supervisor's Construction License: C6— O Exp. Date: p/ -a Ag:;7j�e-f Home Improvement License: ` Exp. Date: �� I.Ju�,,'� ARCH ITECT/ENGINEER2Phone: '3/1- 9dy—,91yo0 10 Address: SG .ZReg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: FEE: $ r- . 010 _ Check No.: / Receipt No.: ,VS� // NOTE: Perso c tracting with unregistered contractors do not have access to the gua fund nt/Ovvner Signature of1contractor i Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ I Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I 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 Z-� Z3 A 2– 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 signature/date-A.— COMMENTS ignature/date-COMMENTS Dimension Totalsq square feet of floor area based on Exterior dimensions. Number of Stories:- Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service eodrop requires approval of Electrical Inspector Yes 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 - Date Doc:.Building Permit Revised 2011 June/mi 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 a 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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products MOTE: 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 2008mi Location No. f �Z Date 6 �— • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $_ ' e) Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �y t Check# d" 25311 /Euil&ing Inspector NORTH ToVM Of And 4 824 LAKE dover, Mass., _4_ /k :2 'QA COCMICMEwICK\V�' / ORATED S S BOARD OF HEALTH PEK� MIT T Food/Kitchen Septic System �� BUILDING INSPECTOR THIS CERTIFIES THAT........... ��/� rr ......................... .6.0:ev............................................................................ Foundation 1 has permission to erect............ g Rough to be occupied as.................&,7.,77A4. .....S .�JU� ..... .... Chimney provided that the person accepting this permit Mitil in every respect confo m to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to th 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 CONSTRUCT NN STARTS Rough rt ...................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. �+{ •"•" OFFICE OF BUILDING INSPECTOR n TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: aoM4TA PROJECT LOCATION:-84Z TVK.k.&PIW E SM tt '' _ NAME OF BUILDING, G r4QST.0A= OW N[ iii wow= NATURE OF PROJECT: [,,.M t 4& gravY�lorloyl of- f_,dyar(d '�TAkl3ielGta IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, A. REGISTRATION NO. 100 Z'T BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT • ARCHITECTURAL STRUCTURAL • MECHANICAL • FIRE PROTECTION • ELECTRICAL • OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I OR AUTHORIZED AGENT SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMITAND SHALL BE RESPONSIBLE FOR THE FOLLOWINGAS SPECIDIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being DA performed in a manner consistent with the construction documents. Q��Q�svR A. PURSUANT TO SECTION 116.2.2 1 OR AUTHORIZED AGENT SHALL SUBMIT WEEKLY,A PROGRESS c fP10. 0027 TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR EVANSTON UPON COMPLETION OF THE WORK, I OR AUTHORIZED AGENT SHALL SUBMIT FINA RTAS IL SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. OF t�P SIG A URE SUBSCRIBED AND SWORM TO BEFORE ME THIS ?—$ _DAY OF NA CEIr 20j.'2-- NOTARY VUBLIC Y COMMISSION EXPIRES I'i D& I OFFICIAL SEAL ALEJANDRO J NOBLE JR NOTARY PUBLIC-STATE OF ILLINOIS MY COMMISSION EXPIRES:12ro8/13 i .,g' 1 , IL _� , .a :' •. �.:aw.,cid"s'��.t.+wr«ti �.r�yLl'1f�,�S.P�'�".M°r; 2f(; �'l.l.i!all�A i?•:iiJ:?V''T..:•i'G}; 141assachusetts -Department of Public Safet r Board of Building Regulations and Standards j Cunstructiun SuperNisur License:CS-071398 I `LL DANIEL R STDNE 20 SNIITHFFA�tM RIS STATHAM AJH a Expiration j Commissioner 01/22(2014 i O O VBA O 0 CONSTRUCTION&PROJECT MANAGEMENT April 20,2012 To Whom It May Concern: As general contractor for the forthcoming renovation project at Starbucks,562 Turnpike Street in North Andover,MA 01845,we grant Dan Brennan authorization to apply for a building permit for the aforementioned work on our behalf. Please let us know if you have any additional questions. Sincerely, Votze Butler Associates,Inc. Dan Stone Senior Project Manager DS/blc 44 Stedman Street,Suite 8•Lowell,Massachusetts o1851•Tel.978-459-7600•Fax 978-459-7603 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 Na111c(Business/Organization/Individual): Votze Butler Associates,Inc. Address: 44 Stedman Street, Suite 8 City/State/Zip: Lowell, MA 01851 Phone#: 978-459-7600 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 19 4. ❑ I am a general contractor and I employees(full and/or part-time). r 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 g. ❑ Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑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. 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. I ant an employer that isproviding workers'coniPensation insurancefor my ePtoYees. Below is the policy and1ob site information. Insurance Company Name: Acadia Insurance Co. Policy#or Self-ins.Lic.#: WCA 0217846-14 Expiration Date: 5/30/12 Job Site Address: 562 Turnpike Street City/State/Zip: North Andover, MA 01& 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 cer=—& ti nder the pains andpenalties erjury that thein ormation provided above is true and correct: Signature: r-�-� � � - ----4 Date:. 4/20/12 Phone#: Q [ 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#: