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Home My WebLink AboutBuilding Permit #427 - 65 FLAGSHIP DRIVE 12/3/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 10 7 Date Received Date Issued: I2/r '" F IMPORTANT:A phcant must complete all items on this page LOCATION° 6:-5— V Print PROPERTY OWNER TUR/i ''fie S 4p LLC vuGGr�S La Gce /ntlnt3Qr P nt MAP NO:/d 74ARCEL: 7j� ZONING DISTRICT Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial tera—ti No. of units: ommercia Repair, replacement Assessory Bldg Others: Demolition Other ........... Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: MJ�t/� etnoVA L U F IOM 977?(16TZ10 L r49tt r/ 770.A/- -- ge A L 16d.A/ Identification Please Type or Print Clearly) OWNER: Name: Phone: C/79- �� - 7&3 3& Address: b j � I � - �� Cf �� 1 � c1 , i CONTRACTOR Name: "� Uc_t9 5 &Cke Phone: Address: AQ 13&x` OZo-O d X)COM D tit C�i Z j Supervisor's Construction Licenser T9 C/( Exp. Date: ��/Z Z Home Improvement License: Exp.. Date: ARCHITECT/ENGINEER 69eC, S/✓l Phone: - Z Z Address: 141- /,41x) 5j, 4dtz_i��, K, Reg. No. FEE SCHEDULE:BOLDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /�)I D6d,o o FEE: $ 2 iz'eeo'�' Check No.: 0957 Receipt No.: 22C7 P NOTE: Persons contracts with unregistered contractors do not have acces to the guaranty and ignature of Agent/Owner Signature of contractor Location No. �/� 7 Date gORTM TOWN OF NORTH ANDOVER O f R 9 Certificate of Occupancy $ 9 Buildin /Frame Permit Fee $ �� suMusE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ v Check # 22G `/ � �- Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL u licSewer Tanning/MassageBody 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT i COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 4 M 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 rt Main Street Fire Department signature/date natureldate tz 3 Q COMMENTS 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 t a� ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 II 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 ❑ 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 P P 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 ConstructionSin le and Two Family) � 9 Y) ❑ 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) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department Pri or 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 i Doc: Doc.Building Permit Revised 2008 - NORTH own of 4 over .war .. NO. q ; l O j....T ....v ... _ A o dover, Mass., COCMICMEWIC N ORATED P`P�,`�� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System Z/3. Jai i BUILDING INSPECTOR JJ C . THIS CERTIFIES THAT.........f..U� /e' ...... .............................................. ............�........................................................ Foundation has permission to erect...... ............ ......... buildings on �. /� ..... .. Rough ......................... ............ to be occupied as �011� ,��s � � Chimney ................................................... .......... ....... ...... ............................. .................................. provided that the person accepting this permit shall in 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 Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough 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. 6177 Boo-" u� in' ea/t! Constructiong Regnlatio s ani ndards Su T t Penrisor License } Lipene: CS 99016 BxpiR"t on\ L 512/2011 Tr#`g�016 t Re�trlcgon OQ-r,. OOUGLAS LOCk� PO BOX 220 BOXFORp `i AM 01921 on, R- _ x8 it 2 TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: Architect's Number: #0911113 Project Title: Dance Studio Tenant Fit-Up Project Location: 66 Flagship Drive, North Andover Name of Building: 66 Flagship Drive Nature of Project: Interior Fit-Up to Tenant Space In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory P.Smith Registration No. 8688 being a Registered PFefessienal-EngineeyArchitect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project X)= Architectural Structural Mechanical Fire Protection Electrical Other(specify) FOR THE ABOVE-NAMED PROJECT AND THAT SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE 780 CMR MASSACHUSETTS STATE BUILDING CODE. ALL ACCEPTABLE ENGINEERING PRACTICES 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 j 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, 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 state of construction to become, generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. UNDER SECTION 116.4, I SHALL PERIODICALLY SUBMIT A PROGRESS REPORT, TOGETHER WITH PERTINENT COMMENTS,TO THE ANDOVER BUILDING INSPECTOR UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. �S�c�RED AR��r Signature and Stamp (no facsimile) P. No.8688 p NORTH ANDOVER, ' I SUBSCRIBED AND 71 7,64— FORE ME THIS �y DAY OF /(ave ' 2009 SWO MY COMMISSION EXPIRES �!,/�Lf / a N Y PUBLIC E S SUZANNE M.PELJ NOTARY PUBLIC (DMMDNWEALTH OF MASSAC W Comm.Expires June 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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: City/State/Zip: /,, �UX GO 2L� d�"l�- Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. QI am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ]Remodeling ship 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.[1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.[1 Other *Any applicant that cheeks box#1 must also fill out the section below showing their workers'com�ensat on 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' policy comp. li 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 rtify under the pain nd penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official f 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#: II