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HomeMy WebLinkAboutBuilding Permit #334 - 575 TURNPIKE STREET 11/14/2008 pORT#f BUILDING PERMIT 0* TURD 16 a TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION Permit NO: Ll Date Received �gpDRATED'PP�� SSACHU`+� Date Issued: alm*POiANT:Applicant must complete all items on this page LOCATION ► � Jt PROPERTY UWNER o 1 , t . Uf mrit MAP Nfl p R01=L ZDNINd DISTRICT Historic District Vires no 1Vlachine Shop Village dyes ono ` TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family IndustdaL Alteratio No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic "ell = :l loodplai Wetlands �1lVatershed' istnct DESCRIPTIO OF WORK TO BE PREFOR ED: •�n�.. `n A �n t-eY tb v- SS12F AW) b ink-A f\ C_Ahl!�?�p`t VC`T Id 'ficatio Pies T e or riint Ge ly) OWNER: Name: I 'na� A,,z Phone: 6 t b -748-0Address: �1 I�uaC S-G . S-4 `ew, NV • r I pc�l )6,0" �11.91IOd Vqla: a►�i " C®NTRA"CTOR Narm4 9 v ?' i�ddress. iA ilei 1 Supervisor's Constr bbon',Licerise I,L� .�`71�.31 `,exp bate. , �. &� { Home lmproverraent;License ,s '? $ tl ,Exp Date: zi��. ARCHITECT/ENGINEER rah^ 6!fbr),41 Phone: (�(A� v�- L16 F-3 Address: - Reg. No. yeroe FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ JLz'zo 0 — FEE: $ C,CF-7--- Check No.: �3 Receipt No.: 214P7 NOTE: Persons contracting with unregistered contractors do not have access to the guarp fund 5gnattre of AgentLOwner = Si,gnaftare cf contractors x '�'� 'C� t __ ` ' y 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 "O FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature f 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 y 'x 3 r y � r. • � . Water & Sewer`Connection/Signature& Date "' Drivewav'Permit DPW Town Engineer: Signature: -Located �384 Osgood Street FIRE'DEP 'l1lENT°-,Ter 1p Du ripster:oo tsite", yes now p� . .. Located at 124,Maina Street Fire�Department�si n6turiDMate COMMENTS S 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 E ❑ 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 ZBuilding 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 X 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 i ❑ Floor/Crossection/Elevation Plan Of Proposed Work With'Sprinkler Plan And Hydraulic Calculations (If Applicable) -, -_'Y . z LiMass 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) o 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 F Location No. Date —//-/ MORTh TOWN OF NORTH ANDOVER ` 3? J '• o N 9 i • i : : Certificate of Occupancy $ Building/Frame Permit Fee $ c��"" JAtMU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 21687 Muildigg Inspector OFFICE OF BUILDING INSPECTOR TOWN OF NORWELL, MASSACHUSETTS CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITIN: NORTHEAST REHABILITATION -OUTPATIENT CENTER- RENOVATION PROJECT LOCATION; 575 Turnpike St., Suite 11 NAME ;Chestnut Green Professional Building HATURe OF PROJECT: 1884 sf Renovation to existing medical office space IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1. JOHN T.BRENNAN REGISTRATION NO. 4808 BEING A REGISTERED PROFESSIONAL ENGINIEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT V 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 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 PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED 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 requi.r+efnents of the construction docuroeMs. ' 2. Review and approval d the quality control procedures for all code-required controlled materials. 3. Be present at infiervals appropriate to the stage of construction to become,generally family WOW*progress and quality of the work and to determine,in general,if the work is being performed in a manner consistent with the construc tkm documents. PURSUANT TO SECTION 116.2.2, I SHALL SUBMIT BI-WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE TOWN OF NORTH ANDOVER, BUILDING INSPECT R. UPON COMPLETION OF THE WORK.I SHALL SUBMIT A FINAL REPORT AS O TH . SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR UP Y. SUBSCRIBED AND SWOR ORE ME THIS Ir/ DAY OF D :20 D \\\111111IIII///// NOTARY PUBLIC ���� r1�.•••T• :.!h,�i� MY COMMISSION EXPIRES D7 I`�' ZvOGl --_ � S ATFO 8L\P`���� 328 Nowell Street • Nashua,NH 03060 Cell 207 272-7385 LUCO Enterprises, LLC. Phone 603 880-7427 Fax 603 882-3800 Northeast Rehabilitation Hospital/Health Network Attn: Rachel Davis Paul Celia 70 Butler St. Salem,Ma. 03079 Dear Rachel, Chestnut Green Proposal # 72008b Larco Enterprises, LLC appreciates the opportunity to provide you with this proposal for the renovation to the Chestnut green Facility. The cost for this project will be $57,200.00. Larco Enterprises, LLC will supply all labor,materials and equipment needed to fabricate and install the following; 1.Normal Working Hours • Most work will be conducted during off hours. 5:00 PM—7:00 AM. If work can proceed without the interruption of business, it may proceed during normal business hours at the discretion of the contractor and the client. Contractor will need access to the office during off hours. The flooring schedule may require a Friday or a Monday delayed opening or shut down. 2. Demo • Remove all carpet and VCT • Remove existing curtains and ceiling tracks . . . . . . . . . . . . . . . . . . . . . . . . . . . . November 4, 2008 Page 2 • Remove wall near water Heater • Remove Staff wall and base cabinets • Remove wall and base cabinets with sinks/#2 • Remove sink from Staff room • Remove reception desk • Remove peninsula in corridor#2 3. Carpentry • Install new H/C accessible counter • Install new reception window • Install new reception counter • Infill old reception window • Install wall,new reception door and hardware • Install walls and door/hardware for wheel chair storage • Install#3 14" shelves/hardware, for above • Install walls and door/hardware for linen storage • Install#5 14"shelves/hardware, for above • Install walls and door/hardware for Equipment storage • Install#5 shelves/hardware, for above • Repair walls in office#1 and#2 • Repair walls in dressing room • Install new walls and door/hardware to water heater room • Case column • Repairs to wet walls • Relocate door in Staff room • Infill old doorway to Staff A November 4, 2008 Page 3 • Install#2 new Staff desktops • Install#4 safety glass panels • Install new p-lam sink base and top cabinet 4. Painting • Paint complete interior of the facility 5.Flooring • Install carpet in; Waiting room Reception Office#1 Corridor#1 &#2, closets Multi purpose area • Install VCT Dressing room Offices#2 &#3 In front of hand sink Soiled holding Equip. storage Mechanical and hall Staff Room 6. Plumbing • Relocate gas main • Relocate water heater • Repair sink in Dressing room • Install new hand sink • Sprinkler head relocations November 4, 2008 Page 4 8. HVAC (pricing for HVAC work inclusive in this proposal) • New exhaust for soiled linens and restroom to exterior. • Unit#2, a 4 ton unit was replaced,however a 3 %2 ton unit was installed, Ductwork still needs to be revamped. • Unit#1, a 1 '/Z ton unit is the same year manufacture as the one replaced. To comply with the balance report,recommend we add a 2 ton unit to reception, insuring we will not have problems achieving the proper air flow. $3700.00 • Reconfigure ductwork,add hard duct and short flex runs. Duct work allowance no to exceed$4,000.00. 9. Electrical • Relocate security alarm • Relocate wall switches • Relocate and add exit signs as needed • Relocate emergency lights as needed • Relocate smoke detectors 10. Door Schedule A. New 3-0 x 7-0 RH lockset B. New 2-6 x 7-0 RH lockset C. New 2-6 x 7-0 RH lockset D. New 2-6 x 7-0 LH lockset E. New 2-6 x 7-0 LH lockset F. New 2-6 x 7-0 LH lockset G. Relocate 3-x 7-0 passage set November 4, 2008 Page S Responsibility of NRH (Exclusions) Electrical as Specified, upgrades of inferior equipment or Inspector's adds will be extra. Fire Alarms The attached Acceptance Agreement should be signed and returned to Larco Enterprises, LLC and a schedule of events agreed upon prior to the start of any work stated above. Larco Enterprises, LLC Acceptance Agreement The following terms and conditions will apply to the attached proposal# 72008a and dated 7/20/08. Payment terms: Down payment to be agreed upon. intials 2na requisition when walls constructed,painted,prior to flooring Final requisition upon completion. Conditions No retainage on this project. The undersigned hereby certify that they are authorized to enter into this agreement on behalf of the client/owner. By signing below you agree and accept these terms and conditions. Authorized Si e Northeast Rehab Hospital November 4, 2008 Page 6 Please indicate on the line below any purchase order number or reference number for billing purposes. Please return this completed form to: Larco Enterprises,LLC 328 Nowell Street Nashua,NH 03060 PO/Reference number General Conditions and Exclusions Subject to the terms and conditions as stated above,which are hereby made a part of this quotation. All labor,unless noted, is open shop/non-prevailing wages, subject to normal workday(7:OOAM-5:OOPM,Monday—Friday), some weekend and evening access required, and free and clear access to and around site. Any deviation or modification to this proposal including but not limited to Design, Terms and Conditions Schedule,Etc.,will require review. Prior to acceptance, a schedule of events and payment schedule must be agreed upon. Massachusetts- DrpaJrtment of Public Safety Rt Board'of Building Re-gulations and Standard Construction Supervisor License I License: CS 89337 Restricted to: 00 DANIEL.LITALIEN . x 3 WHITNEY COURT METHUEN., MA 01,844 Expiration:.6/2342010: ('unnni..:;,ncr Tr#: 27030 BoQLicense or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registrations: 144547 One Ashburton Place Rm 1301 Expiration'-',.,10l13/2010 Tr# 275748 Boston,Ma.02108 Type tiMiwCual DANIEL LITALIEN DANIEL LITALIEN 1 3 WHITNEY CT" Not valid without signature NiEtHLIEN,MA 01844 Administratai d The Commonwealth of Massachusetts i Department of Industrial Accidents MCI. Office of Investigations 600 W ashington Street Boston, MA 02111 www.nzass.gov/dia Workers' Compensation Insurance Affidavit: guilders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly p �� Name (Business/Organization/Individual): � � t`z.,\ � �,� C �n A YUV� Address: W `���� r.�,H v,i-� City/State/Zip: ` I U $hone#: 9 - 3(o (Q "�Q11 Are you an employer?Check the appropriate box: Type of project(required): 1.(VI an a employer with 4. ❑ I am a general contractor and I 5. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7. [Vemodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q. ❑ Building addition o workers' comp. insurance 5. ❑ We are a corporation orat [�`1 p rP ton and its required.] officers have exerctsed.therr 1 0. Electrical cal re ai rs or additions ons 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself. [No.workers' comp. C. 152, §1(4), and we have no 12.7 Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13•7 Other {Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners who submil.ibis affidavit fndiC tills they arc duiele&'"fork and then hire Gutsiu0%ofi ful;iucs 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 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: Z, V,r r C.\ iV,\S ,\fC-YN LR.r. Policy#,or Self-.ins. Lic.#: k) C_ G (j '2�'Z D Z 3& Expiration Date: 'Z001 Job Site Address:_ `I 'r,,,�,, , —�--rc City/State/Zip:_ k), u_kt C 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 ce if} under the pains and penalties of perjury that the information provided above is true and correct Simature: '"-- l f 5� Date: Phone#: Official use only. Do not write inn 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#: ACORD TM CERTIFICATE OF LIABILITY INSURANCE ID 30 M: IDD�� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO PRODUCER RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, BREED'S HILL INSURANCE AGENCY INC. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 198 MAIN STREET COMPANIES AFFORDING COVERAGE SALEM,NH 03079 INSURED COMPANY A: ZURICH INSURANCE GROUP Daniel L'Italien CX Constriction COMPANY B: ROYAL.INS.CO. 3 Whitney Ct Methuen MA 01844 COMPANY C: ZURICH INSURANCE GROUP 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. POLICY POLICY POLICY NUMBER EFFECTIVE EXPIRATION INSR DATE DATE LIMITS LTR TYPE OF INSURANCE (MM/DD/YY) (MMIDD/YY) (Minimum) GENERAL LIABILITY 202-2B4018336 AN 3 2008 JAN 3 2009 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIA KLITY FIRE DAMAGE $1,000,000 (Any one fire) ❑CLAIMS MADE X OCCUR MED EXP (An oneperson) A ❑ PERSONAL.&ADV $1,000,000 INJURY ❑ GENERAL $100,000 AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS— $100,000 COMP/OP AGG ❑POLICY ❑PROJECT ❑LOC AUTOMOBILE LIABILITY COMBINED SINGLE $1,000,000 ❑ANY AUTO LIMIT(Each accident) ❑ALL OWNED AUTOS BODILY INJURY $1,000,000 X SCHEDULED AUTOS (Per person) B X HIRED AUTOS PMHX19441 JAN 3 2008 JAN 3 2009 BODILY INJURY X NON—OWNED AUTOS (Per accident) $ ❑ PROPERTY DAMAGE $1,000,000 ❑ (Per accident) GARAGE LIABILITY AUTO ONLY $ (Ea Accident) ❑ANY AUTO EA $ OTHER THAN ACC ❑ AUTO ONLY: $ AGG EXCESS LIABILITY EACH OCCURRENCE $1,000,000 X OCCUR ❑CLAIMS MADE AGGREGATE $1,000,000 $ ❑DEDUCTIBLE $ ❑RETENTION $ $ WORKER'S COMPENSATION AND WC6-0278230 JAN 3 2008 JAN 3 2009 ❑WC STATUTORY EM PLOYER'S LIABILITY LIMITS ❑OTHER E.L.EACH ACCIDENT' $500,000 C E.L.DISEASE —EA EMPLOYEE $500,000 E.L.DISEASE $500,000 —POLICY LIMIT OTHER- DESCRIPTION THER-DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: ADDITIONAL INSURED;INSURER LETTER CANCELLATION CERTIFICATE HOLDER Chestnut Green SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 575 Turnpike st BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL North Andover ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE 01845 HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ATTN: Larry ORIZED REPRESENTATIVE 1t% :)RTH TO" of Andover 0 0 No. 3 3 __ _ C% L 0 dover, Mass., COC NIC AHEWICK 0"?-A E D BOARD OF HEALTH Food/Kitchen PER, M IT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT........... ..........7L 1 ...................................................................................................................... Foundation has permission to erect........................................ buildings on ... ...................... Rough to be occupied as.......................7e�IVA-14/i/7`--F1 ........ .. .......................... Chimney .........................................✓ ... provided that the person accepting this permit shall in every resp6cl: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 Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUELECTRICAL INSPECTOR CTIO STARTS Rough Service �- NUILD s RVO-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 I Street No. SEE REVERSE SIDE Smoke Det.