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HomeMy WebLinkAboutBuilding Permit #319-2017 - 70 Main Street 9/26/2016 BUILDING PERMIT of NQRTl� q TOWN OF NORTH ANDOVER :. APPLICATION FOR PLAN EXAMINATION ~ � o 0 Permit NO3/9-2d/4- ~2d/_ Date Rec ived Q� `' l e 9SS9CHU5���5 Date Issued:0b IMPORTANT: Applicant must complete.all items on this page LOCATION- —10 11 _" not PROPERTY OWNER �J�'Gtp S�T 0-k1 Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT: Historic District yes N Machine Shop Village yes 0 } ' N 0 TYPE OF IMPROVEMENT PROPOSED USE b �� Residential Non- Residential New Building ❑ One family II ❑Addition ❑Two or more family ❑ Industrial 0 ❑Alteration No. of units: ;9-Commercial N ❑ Repair, replacement - ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other o 'Septic (j'.Well' , I Floodplain 0 WetlandsL% '� Watershed®istriet � J (. t. .`. I T N• rn �ffWater/Sewers, DESCRIPTION OF WORK TO BE PERFORMED: h V lel. L` oo-f r gi �(v 2 oor s �?7 2 ci as Y.?, O Identification- Please Type or Print Clearly OWNER: Name: r S P tAX Phone: q,8 qaR 'ZZl Address: t i�- � TTx�" A- otB to f` MArV !T- YANaw1 2- - Contractor Name: Ve r�eco C7 o w wC Phone: 0� 221'7 Email: r, -;i = C® Address: E e e nvIAA 01to f Supervisor's Construction License: © I Exp. Date: -7111 I'7 Home Improvement License: (o lb-7(o Exp. Date: 1 S 1 ARCHITECT/ENGINEER , ®O . yl L r Phone: —T AddressJ OVA GI V44 I Amieve'l- , MA Q(8[10 Reg. No. qti 2 FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEDON-$725.00-P_ER S.F. Total Project Cost: $ 1 ,144 , �0 0 FEE: $ i% 14',- 13K �� Check No.: ` Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty ficncl,5��7-- -SaanaturP of Aaent/Oln/ner 4ffi-�--7 — Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL _ Public Sewer Tanning/Massage/Body.Art ❑ Swimming Pools El, 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 0nq1 02;4 Signature_ COMMENTS ?e( 5)urcr� �zuw ?4fth14 to Z�l Gil 01 CONSERVATION Reviewed on l lQ Si nature COMMENTS VL G HEALTH Reviewed on �l1,6 -.Signature 7. N QS r\ Q f Ir' • COMMENTS D (� 15 fl\ P. 5kttj 0411 . i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/SI nature&Date DrivewaV Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster onsite yes -no Located at 124 Main-Street - - -- •, Fire Department signature/date COMMENTS i �/ L el, Dimension Number of Stories: 2 Total square fleet of floor area, based on Exterior Gmensions. Total land area, sq. ft.: l � ' ELECTRICAL: Movement of Meter location, mast or service drop requis apprroival Electrical a Inspector Yes N® DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine I NOTES and DATA— (For department arse) I 4 I li I El Notified for pickup Call Email Date Time Contact Name Doc.Buildiug Permit Revised 2014 , S 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 4. 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 I: 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 Affida-vits 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 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 4- 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 Doe:Building Permit Revised 2014 Location 7%0 No. +� � Date I " I 1 • • TOWN OF NORTH ANDOVER E Certificate of Occupancy $ Building/Frame Permit Fee � S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � Building Inspector �'" IS 0 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 11344,900.00 m $ - $ 16,138.80 Plumbing Fee $ 2,017.35 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 2,017.35 Total fees collected $ 20,273.50 70 Main Street 319-2017 on 9/26/2016 Shell only commercial building NORTH q Town of t sAndover O - 0 No. I _ - Z oh verLAKE , Mass, Z COCNICNEWICK y1� 4W 4W �a �gATED ►`P�`,�'�� S U BOARD OF HEALTH Food/Kitchen PERM11 T L Septic System THIS CERTIFIES THAT .. . . .s?rA 4`.. . . .. .... .....� ...,..rv...(To*��.�,!� jj� BUILDING INSPECTOR has permission to erect ... Foundation p ....................... buildings on ..��.... .... .��...jG �............. /� Rough tobe occupied as ',�. . . /t. ... rf�..r ........................................................................................ Chimney provided that the person accepting this permit shall in every respect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST 0 Rough Service ... WBU41ED610NN ... ...... Final NSP TOR 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. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL, , Public Sewer Tammg/Ma ss. age/Body Art ❑ Swimming pools ❑<, well Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ pennanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature'_�� COMMENTS ?'C' - �k,�Ic� ��►�,� ^-�` I��m�} �,�3 �, �� CONSERVATION Reviewed on Si nature COMMENTS HEALTH Reviewed on 6Si nature COMMENTS I ups��"� ��(� Qf N.�'� l2 . a Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature ®ate Driveway Permit —]D3PW Town Engineer: Signature: Located 384 Osgood Street FIDE DIEPARTfV1 NT - Temp Durnpster onsite yes. . . n.o. Lwated at 12.4 Main Street - - Fire Depart signature/date C0'MMENrr.(� ifvrl Initial Construction Control Document H To be submitted with the building permit application by a Registered Design Professional f �< for work per the 8t' edition of the SYevey¢ Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Bradstreet On Main Date: 9/12/16 Property Address: 70 Main Street,North Andover Project: Check(x) one or both as applicable:X New construction Project description: Construct a 2-story commercial building(shell only) I Joseph D.LaGrasse, MA Registration Number: 4153 Expiration date: 8/31/17 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural X Structural II for the above named project�and that to the best of my knowledge,information, and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a `Final Construction Control Document'. U Rcy Enter in the space to the right a"wet" or �,�'�� 1*E A Y��o electronic signature and seal: Nft4153 o ER. V �o�� PSSPG� MA Phone number: 978-470-3675 Email:jlagrasse@lagrassearchitects.com Of Building Official Use Only Building Official Name: Permit.No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013 Thi Commonwealth of Massae husefts Depaptment of.IndusMaZAceldents _ 1 Coagre_ss street,Suite 100 .Roston,MA 02114-2017 www mass.govIdid 5Y %3 kers,Compeaisa-tioninsuxanceAffzdavit:Suzl(lers/ContactorslElecirdciaxts/PlyMbers. TO BE YffM WITH THE PERARTTING ATJTSORM. A licant Wormation • Please Print Leaibi i Name (Rusin.ess/Organizationadivxdual): e r d 2 c 2 S w s LAI L Gtr k a,to ow L Address:_ 1 I lM �QVa,�e g o d 2! AAA 01610 city/state/zip: A- o Phone#: VLA Oct: 221-4 Are you an employer? Meekthe ap�r'opriate Pox: Type of project(regrdxed): 1.❑I am a emplopezvlith � employees(fulland/ozpart time).* 7.• �eW coSisiTactlozl 2, I am a sole proprietozorparfnership andhave no employees-wo*kg forme in 8. El Remo delitig any capacity.[No workers'pomp.insurance required] 9 ❑Demolition 3.QIamahomeownerdoing4workmyself.[Now033ers'comp.i sraanceraquirad]t 10❑Building'addition 4.nIamahornowmaxandwillbehiring contractorstoconduct all Work onmyproperty Iwill ensure that all contactors either Irate wadses'compensation in s,rsmee or are sole 11.0.❑Electrical xepairs or additions proprietors widr rio employees. 12;Q Plumbing repairs or additions 5.❑I am a-general comtraotor and lhavehiredthe sub-coniractorslisted on the attached sheet. 13_'[]Roafrepairs These sub-contractorshave employees andhave workers'comp_instuance.� 14.❑Otlz'er 6.E]We are acorpora#�padits pf fices have exercised-ffieirright of'exemption perMUZ c. -' 152,§I(4),andwehaveno employees.VP workers.comp.insurancereqnired] `Any applicantthat checksbox#il must also j rT1 outtbe section below showingthesworkm'compensationpoHcyiDfomration iHomeowners�vhosuliiai#t os aifidavitindicahngtheyaredoingallworkandtheahirsoutsideconractorsmustsi]IrmitanewaffidaviLindicatmgsuch ?Contractois,hat checkth:s baK musi-oaehed.an additional sheet showing the name of the sub-contractors and state whether arnotihose entities have employees.Ifthesub-064jci rshateemployees,&yura tpravidethesworkeis'comp.policy number." I a rt an erriployeN t7i at as pi oviding wo ke�s9 cornpensatzon insrxYaracs for yny employee,.'BdoV is the policy acid job,site infor�rzatio�2. . Insurance Company Tame: Policy.#or Self ins.Zic.#: ExpirafionDate: Job Site Address: City/State/Zip: Attach a copy of thevorkers' com_PeWation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a cximival 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 day against the violator.A copy of this statement may be forwarded to tho Office of Itrvestigations of the DIA for in=ane coverage verifioatiori. ' e mins an enmities of etjtiry Haat the information provided ah ve s—rue and coed Ido hereby ceftify fi r er tri ,� p P Date: q &I b Si afore: Phone#: g ' 90 q Z21^] Official use only. Do not write tri this area,to be eofnpleted by city or town o iiciaL. City or Towxr• Permit/License# IssuingAuthoritf(circle one): i 1.Board of Health 2.BuildingDepartmaent 3.City;rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Cow'act Person: Phone#: Information and 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 contrabt of hire, express or implied, oral or written." An,empkyer is defined as"an ind viduad partnership,association,corporation or oler legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employex,or the receiver-or trustee of-an individual,partnership,association or other legal entity,employing empl6yees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shalt 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 witblrold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth fox any applicant-who lias notproduced acceptable evidence of compliance-with the insurance coverage regmred..' Additionally,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any ofits political subdivisions shall. enter into any Contt'act for the performance of public work until 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 checkingtb.e boxes that apply to your situation and,if necessary, supply sub=contractors)name(s),addresses)and•phonenumber(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with,no employees'other than the members orparta.ers,arenotrequiredto canyworkers' compensationin.surance. IfauLLC or LLP doeshave employees,a policy is required. Beadvised that this affidavit may besubmitted tothe Departmentof-7ndusdal Accidents fol confEtmation ofinsurance coverage. Also be sure to sign and date the affidavit. no affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department 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 number listed below. Self-insure_d.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 Departmout 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 inJae permit/license number which will be used as areference 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`fob 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 fide for fature permits or licenses. A new affidavit must be failed 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address telephone and fax number: P � .p The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext.7406 or 1-877-MA.SSAFE Fax#617•-727-7749 Revised 02-23-15 www.mass.gov/dia ACOO V CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/9/2016 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 endorsement(s). PRODUCER CONTACT m hael Laorenza NAME: MTM Insurance Associates PHONE _(AIC No Ext)_(978)681-5700 1A C'No-: (978)681-5777 1320 Osgood Street E-MAIL certificates@mtminsure.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA Atain Specialty Insurance Company INSURED INSURER B: Verdeco Designs INSURER C: 1 Elm Square . INSURER D: INSURER E. Andover MA 01810 INSURER F COVERAGES CERTIFICATE NUMBER:16-17 Master 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. INSRI TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDPOLIC/YYYY I MM/DD/YYYY LIMITS . 1 Y EFF POLICY LTR EXP _X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X� OCCUR I DAMAGE TO RENTED 100 000 PREMISES(Ea occurrence)— $_ C1P289150 2/17/2016 2/17/2017MED EXP(Any one person) $ 5,000 -------- -- — I I PERSONAL&A_DV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X� POLICY r 1 PRO- j I — —J JECT ] LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Additional insured $ Blanket AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO _ BODILY INJURY(Per person) $ ALL OWNED SCHEDULED L-�AUTOS —I AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED I PROPERTY DAMAGE $ _(Per accident)_ $ i UMBRELLA LIAB OCCUR EACH OCCURRENCE $ � 1 EXCESS LIAB RETENTION g CLAIMS-MADE 'AGGREGATE DED $ WORKERS COMPENSATION I PER I 0TH- AND EMPLOYERS'LIABILITY __;-STATUTE 1— ER Y/N1 ANY PROPRIETOR/PARTNER/EXECUTIVE . OFFICER/MEMBER EXCLUDED? JN/Ai E.L.EACH ACCIDENT $ (Mandatory in NH) L— --'— -- If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I i I I � DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover Mass THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. No Andover, MA 01845 AUTHORIZED REPRESENTATIVE M Laorenza/LAURIN --- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) - a Massachuseetts De Board c Bu tts p rtment of public Safety g Regulations and Standards License: CS-105187 Construction Supervisor 1 MARK J YANO SQUARE' ONE ELM S ` ` { ANDOVER MA 01810 h � 1 i 151�1 Commissioner Expiration: - --- 07/11/2017 I