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HomeMy WebLinkAboutBuilding Permit #676 - 60 WILLOW STREET 5/5/2010Permit NO: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: (7 IMPORTANT: Applicant must complete all items on this nage LOCATION �QQ N-kPeJ ^(L , y AA Print PROPERTY OWNER "3 NOV'AY,�C_C—`Q ri11atT�=fZ„I,pct..� / Print MAP 210 IV`PARCEL: f ZONING DISTRICT: Historic District yes Machine Shoo Villaoe ves no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: ommercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: L�.K-E(� Zdo tri 1�C' Tl oy A Identification Please Type or Print Clearly) OWNER: Name: tNAftr--(LS&-L1_1, Phone: Address: (,-n "l, CONTRACTOR Name: 4,7c-, _7an_s« Address: MoL� (L N/1 , t �. IjZZ . M AA Aft- , &LA . n 1--i C A Supervisor's Construction License: CS &-L%55S LA Exp. Date: (o -S' - 20 \,4 Home Improvement License: T,NDv➢STiLcRL64ZS%C-.A WC - ARCH ITECT/ENG I NEER C•ARCHITECT/ENGINEER Phone:Lq�--' Address: 'Z5 MwsoK Si' t4 Pk N, ruA _ Reg. No. C71 i FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 835 FEE: $ 1 -11 -<!QL-- Check No.: /5� D SZ Receipt No.: %!Fc NOTE: Persons contracting with unregistered contractors do not have access to the guaranty ,fund Signature of Agent/Owner Signature of contractor Plans Submitted (-- __ ___ Plans Waived Certified Plot Plan Stamped Plans ERAGE 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 COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Locatea J64 USgooa Street no X 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 ❑ Notified for pickup - Date I Doc.Building Permit Revised 2010 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 ,,oz, Workers Comp Affidavit ❑ Photo Copy .. . nd/ r C.S.L. L'censes Copy of Contract ❑ 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 ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan Hydraulic Calculations (If Applicable) And ❑ 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 A that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One co must be submitted with the building application Appeals copy and proof of recording Doc: Building Permit Revised 2008 Location Q &co Y�,— No. .S /U Date ��x TOWN OF NORTH ANDOVER Certificate of Occupancy $ �'��°'^•° •'t�' Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check # A;('4 f- 22556 Building Inspector uo��iA dnoA 2-IP7!ng *DNI CIIflo:) Wf E E 0 cv) 10 C) C) Ou 6 0 E n 2 %0 ol E Q (D -q c,4 0 U -00 c O� C� N N 2 0 c 0, 0, CD 0 U-1 Lu LU 0 H L�o U u �: uj uo��iA dnoA 2-IP7!ng *DNI CIIflo:) Wf FQ � p � m � o L. a cn 0 u U z z c w° : n°G c U m w o E-. U a m o w w x o w a W ono �° c1 w O a c� 'Con � wcz ON rA 0 s. ui z hal z 0 U U) 1� f co O E G3 L O V Z °o Q O y o c CD W Q A02 f m m CD 0 CD CL - .0-0 co t O � O Lft C L2 O CD L a. cma ca S C � C Cc Cc V .Q O CD CO C CD Q CL C.3 CO) � C CL � C CO) 0 Q v 0 0 U) W W 09 //Www vI C � •cp C C ts O O O y v V •O.o CL C cum m OC J: y E a �g mo -- JL m y 4EC m C w cc.*2 O V V: Os C m C .L'. E H �O ca CD ` C m � y ��m s m yL. O y v: CD O cc E i CLS e m D J t v CD y A Z O Cf C Q � H O C •C _ Re ~ F - +O+ m W C S fl � �-• LL m O CA E CL:5 COD C-0 O W V d c,= O'00:CC CO)� O'a _ �=aaSm5 o = O hal z 0 U U) 1� f co O E G3 L O V Z °o Q O y o c CD W Q A02 f m m CD 0 CD CL - .0-0 co t O � O Lft C L2 O CD L a. cma ca S C � C Cc Cc V .Q O CD CO C CD Q CL C.3 CO) � C CL � C CO) 0 Q v 0 0 U) W W 09 //Www vI 4r Building Your Vision 1� November 19, 2009 i. (Ivf ej 100'�ek I �/ 1 010 Gardner Peters The Dow Chemical Company; Electronic Materials/Growth Technologies 60 Willow Street North Andover, MA 01845 Re: Proposed Locker Rooms Design -Build Services Proposal Dear Gardner, We are pleased to submit this lump sum proposal for designing, securing permits, and building the pair of Locker Rooms in your existing building in North Andover as illustrated on the conceptual floor plan A-104 (B) prepared by IFDI dated September 1, 2009. Our price, including design, permits, and construction, and as qualified below is Fifty Nine Thousand Eight Hundred Thirty Five dollars ($59,835). This proposal is based on the following qualifications: We have included the following in our price: a. building & trade permit fees b. sales tax (@6'/4%) c. Full-time (working) supervision, and minimal part-time project management & construction administration d. general liability, completed operations, and other insurances (see our certificate) e. 24 new painted metal lockers, similar to the existing lockers which will be relocated along with the existing benches f. Relocation & reassembly of the existing office cubicles g. A new fiberglass shower unit similar to the existing shower in the Men's Toilet Room h. Finishes in the new rooms will match the existing Toilet Rooms... painted GWB walls, suspended 2x4 acoustical ceiling, VCT Floors, vinyl cove base i. Replacement of or capacity enhancements to the existing exhaust fan serving the Toilet Rooms, and connection to the existing exhaust duct system. j. Relocation as required, and connection to the existing supply & return air system(s). No new zones will be created. k. Power and tel/data wiring & devices for the 5 cubicles to be installed aginst the new Locker Room wall JM COULL, .INC. Construction Alanagers ■ Design Builders 20 Powder Mill Road - Maynard, Massachusetts 01754 TEL: 978-461-0330 - FAX: 978-461-0275 - WEB: jmcoull.com Building Yom, Vision 2. We have not included the following in our price: a. testing for or abatement of hazardous building materials b. Repair or relocation of hidden/buried utilities or structural components that might get uncovered and/or damaged during the sawcutting of the floor, digging of the plumbing trench, or the selective demolition c. handling and/or offsite storage of existing equipment, furniture, and furnishings d. Fire alarm programming (assumed by an outside 3rd party) e. Renovations or improvements to the existing Locker Rooms after the lockers & benches are removed f. Renovations or improvements to the existing Toilet Rooms other than a fresh coat of paint where necessary to blend in with the new rooms g. Construction administration by IFDI except only as required to satisfy the Town Authorities Having Jurisdiction (the Bldg Inspector & Fire Dept). Provisions for IFDI's attendance @ weekly meetings has not been included. 3. Our price assumes that, for and during construction, we can draw electrical power and water, free of charge, from the existing building's systems. We also assume that we can use an existing telephone line and existing toilet facilities for and during construction. 4. This proposal is based on the use of Rohm & Haas' standard fixed priced (lump sum) construction contract between an owner and a design-builder/contractor. Retainage from monthly progress payments will be limited to 5%, and payments will be due within 45 days of the date of the invoice. Sincerely, J.M. Coull, Inc. Charlie Spicer Preconstruction Project Manager Cc: Tom Dube, Chris Oldham, Mike Vogel Page 2 of 3 The Commonwealth of A:Iassachusetts Department of £ndustrial _accidents Office OfLnvestigations 600 N'ashi so on Street Boston, MA 02111 www -Mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 124cant Information riease . Name (Business/organization/Individual): J.. i`% co Address: U IV-kl,,6rx- /f/&c. ;-p. City/State/Zip:y✓AI-,D A0 017,S, Phone #: 9'78- iK6/ -6330 Are you an employer? Check the appropriate box: L ® I am a employer with Z S 4. ❑ lama. aneral contractor 2. ❑employees (full and/or part-time).* I am a sole and I have hired the sub -contractors proprietor or partner_ listed on the attached sheet ship and have no employees These subcontractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation 3. ❑required) I am a homeowner doing and its officers have exercised their all work Myself [No workers' comp. right of exemption per MGL c. 152, § 1(4), and we have insurance required.] t no employees - [No workers, comp. irmill' c Type of project (required): . 6- ❑ New construction 7.] Remodeling 8• ❑ Demolition 9• ❑ Building addition 10.❑ Electrical repairs or additions .11- 17 Plumbing repairs or additions 12.❑ Roof repairs e requued.] I3.❑ Other `- nZ =Ya 1--nt that checks- bo::.41 must also iii ULl fue sermon QetoP' Shoving -� omeowners who submit this affidavit indicating the} are do' b workers, com^���cn . s. Ghon. H +Contractors that check this box must attached an additional sheet showing th a� h Outside contractors must, submit a new affidavit indicating such. name of the subcontractors and their wnrl--, . UML an empeoyer that is providing workers' compensation insurance y employees.or m information, .f Below is the policy and job site Insurance Company Name: r)"VEGC" /i✓fv"AotE Policy # or Self -ins. Lic. #: /JTA GQ4/16 -563g- LS/ - S- 07 Expiration Date: 9" /-/O Job Site Address: 6 O w/Lvov/ s r City/State/Zip: N ANOo✓el- Attach acopy of the workers' compensation policy declaration page (showing the policy number and expiration dat Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imp e) fine up to 00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP ay osition of criminal WORK ORDER and a fine penalties of a of up to $250.50. d00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office a Investigations of the DIA for insurance coverage verification T.r„ L— --Z—. - y --JY uJY KRuer me paens and penalties ofPerjury that the information. provided above is true and correct -0g30 Cir? /Z/ 0• fiCial use only. Do not write in this area, to be completed bjr city or town offciaL City or Town: Permit/I.ii Issuing Authority (circle one): cense # L Board of Health 2• Building Department 3. Ci /Town 6. Other t3' Clerk 4. Electrical Inspector 5. Plumbing Inspector ,S-3 /0 Contact Person: Phone #: Information an- d .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 apartuzents and who resides therein, or the occupant of the dwelling house of another who employs persons to do mainte;3nance, 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 co=mpliance 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 un -til 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 -contractors) name(s), addresses) and phone numbers) 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' comp emation 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 perzsoit or license is being r eauested, not theDepa=--pa=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.numbe—r 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 home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to than 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__ The Commonweal& Gf Massachusetts Department of Industrial Accidents Office of Investigations 640 Washington Street Boston, MA 0.2111. Tel. # 617-727-4900 eat 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 6.17-72.7- 7749 mrVirVi mass- gov/dia. ACORDM CERTIFICATE OF LIABILITY INSURANCE 04/28/2o o' PRODUCER (978) 392-4567 FAX (978) 392-9696 E.J. Wells Insurance Agency, Inc. Regency Park 9 Y 238 Littleton Road Westford, MA 01886 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED J.M. Coull, Inc. 20 Powder Mill Road Maynard, MA 01754 INSURERA: Travelers Indemnity Co. INSURERB: Travelers Property Casualty Co INSURERc: Travelers Casualty & Surety INSURERD: 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 ADDT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONDATE (MMIDDNY) LIMITS GENERAL LIABILITY DT -CO -463D5003 -IND -09 09/01/2009 09/01/2010 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300 00 CLAIMS MADE Fy OCCUR MED EXP (Any one person) $ 5,00( A PERSONAL 8 ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00( POLICYFX PRO LOC JECT AUTOMOBILE LIABILITY DT 0-810-463D5015-COF-09 09/01/2009 09/01/2010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) B BODILY INJURY $ X HIRED AUTOS X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY DT M -CUP -463D5040 -IND -09 09/01/2009 09/01/2010 EACH OCCURRENCE $ 10, 000, 00 X OCCUR F-1 CLAIMS MADE AGGREGATE $ 10,000,000 B $ $ DEDUCTIBLE X RETENTION $ 10,000 $ WORKERS COMPENSATION AND UB -5635L515-09 09/01/2009 09/01/2010 X I WCSATU_I JOTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000C E.L. DISEASE - EA EMPLOYEE $ 1,000,000 OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 42810 Evidence of insurance. ow Chemical/Rohm & Haas are listed as additional insured with respect to General Liability where required by written contract. "Except 10 days for non-payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Dow Chemical/Rohm & Haas BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 60 Willow Street OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.. / p North Andover , MA AUTHORIZED REPRESENTATIVE Paul Coffey/NAM ACORD 25 (2001/08) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) IFDI Industrial Facilities Design, Inc. CONSTRUCTION CONTROL AFFIDAVIT (ARCHITECTURAL) (PRIOR TO START OF CONSTRUCTION) PROJECT LOCATION: 60 Willow Street, North Andover MA PROJECT DESCRIPTION: Dow — Locker Room Renovation In accordance with Section 116.0 of the Massachusetts State Building Code, Seventh Edition, being a registered ARCHITECT, I hereby certify that I have prepared or directly supervised the preparation of the plans and specifications for the above named project and that, to the best of my knowledge, such plans and specifications meet the applicable provisions of the Massachusetts Sate Building Code, all acceptable architectural practices and all applicable laws pertaining to the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in section 116.2.2: 1. Review of shop drawings, samples and other submittals of the contactor as required by the construction contract documents as submitted for building permit, for conformance to the design concept. 2. Review of the quality control procedures for all code required controlled materials. 3. Where appropriate, review of critical building components requiring controlled materials or construction when specified in the accepted practice standards listed in Appendix B of the Massachusetts State Building Code, Sixth Edition. Pursuant to section 116.2.3, I shall submit periodically progress reports together with pertinent comments to the building inspector. Upon completion of the work, I shall submit a report as to the satisfactory completion and readiness of the project for occupancy. 0\S,� RED ARC, 0 a No. 6011 NA -n CK, $ MAS$ oy kFq�TH OF 11:4 Robert C. Troccolo, A.I.A. Name 6011 SEAL Architect/Engineer Mass. Reg. # 85 Main Street Phone: 508-544-1695 Hopkinton MA 01748 Fax: 508-544-1694 Massachusetts -. Department of Public Safety Board of Building Re, zulatio ns and Standards Construction Supervisor License License: CS 62854 Restricted to: 00 I THOMAS D ROCHE 116 HOUGHTONS MILL LUNENBURG, MA 01462 ('ununjssiuncl• Expiration: 6/5/2010 Tr#: 25042