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HomeMy WebLinkAboutBuilding Permit #486-14 - 700 CHICKERING ROAD 12/10/2013BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date eqL2& EWPORTAN'T: / Applicant must complete all items n this LOCATION -76-z)C�'c.� C' y k pring PROPERTY OWNER 0E&c.kn,.ot4 e-w)b*r- MAP NAH_PARCELA/ Print V ZONING DISTRICT: Historic District yes no Machine Shop Village yes i no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition / Two or more family Industrial Alteration v No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer Ak. _ll5��� C_�Irl- Identification Please Type or Print Clearly) OWNER: Name: Address: CONTRACTOR Name:w 1� SQ,a Phone: G o 7-J d l 7-6 I, Address: C�� �r U\,� Supervisor's Construction License: CS -O 47<f3/ Exp. Date: Home Improvement License:Exp. Date: /6 dovS� f/_l7/ile ARCHITECT/ENGINEER JAA-1A /W be'1)Pr__ Phone: Address: POT ,M ig i L-_ 1AJt1J Reg. No. 6 Q t) -t� FEE SCHEDULE. BULDING PERMIT. $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Costa ���,��� FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with nnregist red contractors do not have access to the gttaran f fttttd Signature of Agent/Owner ignature of contractor i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Iss IMPORTANT: Applicant must complete all items on this page LOCATION Print_ PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no .TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition ❑ Two or more family El Industrial ❑ Alteration No. of units: [I Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer - DESCRIPTION OF WUKK i U tat rtrcrUKivicU: Identification Please Type or Print Clearly) OWNER: Name: Phone: Haaress: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp.. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $, EE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sig; Lure of Agent%Owner Signature of contractor Plans Submitted 1] Plans Waived 11 Certified Plot Plan ❑ Stamped Plans 11 LLocation // d 6.1--• ' No.5 � dI& - I zv Date//.X// i I Check # Q�o 3 TOWN OF NORTH ANDOVER i Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector It Plans Submitted ❑ PlansWaived-11 Certified Plot Plan ❑ Stamped Plans ❑ TYPE -OF-- SEWERAGEDISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ .. .Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc.. ❑ - ..:_.Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS ...,DATE REJECTED: DAT'E.APPR-OVED ❑ <❑ CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 3 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: t Conservation Decision: Comments Comm Water & Sewer Connection/Signature Date Driveway Permit DPW ToNvo Engineer: Signature: Located 384 C FIRE DEPARTtII ENT °Temp Dumpster onsite yes no t ; Located -at 124 Mair, Street -Fire"Departure►it signature/date`' - COMMENTS d Street 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-Chapter166 Section 21A -F and G min.$10041000.fiine Ali)TF_q nnrl r)®T® _ (Fnr r1PnnrfmP_nt usel 0 Co., U coas \j a � o EI Notified for pickup - Date [3 i Doc.Building Permit Revised 2010 Building Department The folf-iwing is --Mist of the required.forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u 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 o Certified Surveyed Plot Plan a Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 a 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 o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+.ted with the building application Doc: Doc.Building permit Revised 2012 Project Title: Property Address: Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8u' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Benchmark Ashland Farms Kitchenette Wall Removal Date: December 11, 2013 700 Chickering Road, Andover, MA Project: Check one or both as applicable: :1 New construction x Existing Construction Project description: Removal of existing kitchenette walls and cabinets and redesign of area as seating open to the corridor. I Mark Moeller MA Registration Number: 6946 Expiration date: 8/31/14 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ x Architectural [) Structural [ ] Fire Protection [ ] Electrical ] Mechanical ] Other _ 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: I. 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'. Enter in the space to the right a "wet" or electronic signature and seal: Phone number: LN 0 3 — 4 3(D - 66-( Building Official Name: Version 06 11 2013 f; -D A-;- t No. 6-^0 s Email: mmoeller@jsainc.com MEWtE.wvsl iir-, Building Official Use Only Permit No.: Date: 41 u Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 35,550.00 m $ - $ 426.60 Plumbing Fee $ 53.33 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 53.33 Total fees collected $ 633.25 700 Chickering Road 486-14 on 12/10/13 Remove Kitchens LUO 2 U. cc m C N u Y Y \6 O LL E 41 N CL (n cc O N Z Z —0 D J m C . O m C 7 LL to 7 W T cu C E U _ LL O Z Z m J d to O:E 0 CC _ LL Z LJ F- J W to 7 K v N _ LL oc N Q 40 O w _ LL z Q W w d' LL � i m p Z 01 N N Y O N In J w 0 0 Oam LLJ c _O yr _• . Cc O r, V ++ O. aD t 4) �o O U E Q. L N O O O .' E O7 o cc �j c c as C CL Cc J L m CDccL CD cn CD O -a O N O i CF) • t U :a U) a) Q -Ev 0 o 0 � L a� z N_0= c o Q- 4 t —O, -y C Qf v O C C CzC Q L L cc FS CL •.�. N "•'cc =Mm w _ O O LL 'M N N C -P La Q - O UW E V CL (D> y= c N .Q O F— .. n 0 v ti LF w a O w CLZ Z in C/) v+ � E a Z :E Cl) Z c x U) W c W J a = m O C .E O N O t O , z O Q J ti LF w a The Commonwealth of 1fassachusetts Print Form DeTartmerr t of lndrts n ial Accidents �- - Uffrce ofInvesti,ations 1 Congress Street, Suite 100 Boston, .H4 0_114-:01 " 1Vmmr. mass., or dia Worli:ers' Compensation Insurance _Affidis-it: Bi ildti-s/C'onti.ictoi-s/Electi icitins/Pltmlbei-s -Applicant Information /j / { Ple ase Paint Le gibh- Name (Iiusmes .Or<_mmmtnnInda•xAhib: / ' t °� t-/� �� C L C `•, fiddle; /0 12%k�rZ eS ff ( -'ih-. State. Zil): AJ A,1 kL#— P�� O-7U6Y micilie . 6 ()3' � D'7 Z Are you an employer? Check die appropriate box: 1 I un a elrq)loyer nidi 4 I un a general contractor mi(I I enq)1c,yees ititllalul or pa-tillel * have hue(l the smb-colttfactors ❑ I ani a :ole proprietor or partner - shit) m(I hate lv., e11q).klyees Nvoiki);z for Hie in ani- capacity [No ivorkers ' c'o1q) 111S'lti'ame requied ] 3 ❑ I am a hoineomler doitz, allNvolic iiBself [No -xyorkers' c•onq) ilsau <m e reclti ed ] I listed on the attached sheet These sait)-colltractors ha -,-e elil)b�_ -ees m(I 1we n-orkers` (-ont) i1�lu alu e 1 ❑ IV are a colpot<ationalul its officers have exercise([ their r�4ht of exenq)tionper MCTL c 152, ;1(-t), ui(I we lhm-e no enj)Ioyees [No Nyorkers' cont) nlsiu eau e 1 T�I-)e of project (r egidred) : 6 ❑ New construction ❑ Renio(lekig S ❑ Dellic'Rioll 14 ❑ Electricalrepais or Aditlrnis 11 ❑ Philibigrepai•s or additions 12 ❑ Roof repais 13 ❑ Other *Any applicant that checks box #1 mast also fiR out the section below showing thea workers' compensation policy information 1 Homeowners who submit this affidavit indicating they are doing allwork and then hire outside contractors must submit a new affidavit indicating such lConiractors that check this box mast attached an additional sheet showing the name ofthe sub -contactors and state whether or not those entities have employees. ffthe sub -contractors have employees, theyrnutprovide thea workers' comp. policynnker. I oil# ail emplo.1-e • that h prm'idin wonkf7'1', romp47I.Vation insit7mi efor no- emlirO}'Pf'.v. Bf 1mv isth polic - !1711 fob! site igf0l7,l41ti07l. Ills-va lance C'on;)mn- Nance : L _Uc-t1, j T.Wj ��— Polio- = or Self-i>,s Lk =:_M 14 w C 7 6 51 �`Fq.4atioliDate : � JQ / t Job Site Acicll•ess: - �Ov� Cil `/�- _ t'`G _ _ (,it-\-StaW4— �Vl 4 " Nt,&, Attach a copy of the - olterx' corrqmusation poli(V-c odaintion Page (sho"Ning the polio- nmriber and expiation date). Faihlre to secilre co-,-efa.. as fegt>iecliulder Section2j;A ofM(TL e 152 canlead to the iig)t,sitiollofcriitnvdpemlties ofa tale up to $1,500 00 and or one-ve'•n- ilq)fisolnllent, is NX-ellas CMIpelialties ii the firm of STOP W.,()RI:ORDER an() a face Drag) to $2�f► 00 a (1�- a�ailst clic t-1oLator Re ach-ised t11at a cop�-oftliis stateltleltt 1i11�• be fi�11t<'uclec) to the t.>ti"rce of Investirantiol-v of the DIA for ilei ante cox-erage z-erificitioll I rlo Ir4-14-i)° Cellifi tl/lflf7' thf' p itl.s 1411! pf7raltif s fid per jrrly 11111 tl�f• it ffen�Ilrrtiorl prot'iclf l nbm•r is• 11714- 4111# roll f•e� S�><ahue: — — — ---- - — — ..._Date J %� 1� 3 -J- C)fcial rue ortly. Do [lot mire in this area, to be completed tn- city or tom gIfiriat City or Town: Pennit:Zicense = Issuing Authority- (circle one): 1. Board of Health 2. Bidldhig Department 3. C'ity'Tot-vii. Qeri: 4. Electrical Inspector 5. P'hunbirig Inspector 6. Other Contact Penoir Phone =: s�•�4��',,``�w�' AZO oAZI CD 3 ani t' {� b vy oD aD ; c m ! 0\, 1 O !D m c, o v a y u1 J ID - `C ewt -(240) 581-9899 kARKSECCONSTRUCTION Nodh AndbveFrMA. vi 8-w PURCHASE ORDER Whow.0 MARS -0000; ----'-~--'---- - '- -- Benchmark Senior LiVingby email. kvvogis(§bencfima ' '? -' no; Park Sen GUARD MINSURANCE it GROUP a Berkshire Hathaway company Workers' Com ensation and Em to er's LiabilitPolic NorGUARD Insurance Company - A Stock Company Policy Number MAWC463053 Renewal of MAWC3S2323 NCCI No.[25844] Policy Information Page [1) Named Insured and Mailing Address Mark Seo Construction LLC 10 Burgess Street Nashua, NH 03064 Federal Employer's ID 20-8200621 Agency PAYCHEX INSURANCE AGENCY 1S0 Sawgrass Drive Rochester, NY 14620 Agency Code:NYPAYC10 Insured is Limited Liability Co. (LLC) [2] Policy Period From August 28, 2013 to August 28, 2014, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts, New Hampshire B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident Bodily Injury by Disease - each employee $500,000 $500,000 Bodily Injury by Disease - policy limit C. Other States Insurance - Part Three of this policy applies to all s, a0tes, except an state item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. y listed in D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium 761 Total Surcharges/Assessments $ 3. 113 $ 113 Total Estimated Cost $ 3,874 INTERNAL USE XX MGA : MAWC463053 Page - 1 - Date : 07/29/2013 Information Page MANOTE WC 000001A 16 South River Street • P.O. Box A -H • Wilkes-Barre, PA 18703-0020 • www.guard.com Fr-, \ f5- AREA "A" 1 1 N �-�� mss � AREAn n B �T '�, to ; oRTs:. aur,;F tja t GSA A f AREA OF RENOVATION Project Job No. Reference Drawing Ashland Farms Renovations 807 TBIe Key Plan Scale NTS ASI Reference 1 Drawn By CSK A R .r N T T E C T S 273 Corporate Drive T.603.436.2551 PJB A l INTERIORS www.jsainc.com Portsmouth, NH PLANNERS Date 12.5.13 P:\P807.00 — BENCHMARK ASHLAND FARM NORTH ANDOVER MA\X807 ASHLAND PLANS.DWG 12/6/2013 11:43 AM © Copyright 2013, JSA, Inc REMOVE VINYL FLOORING `REMOVE DRYWALL CEILING - MAINTAIN VAPOR BARRIER / / / REMOVE VCT FLOORING THIS REMOVE CARPET TH G� DEMOLITION NOTES: 1. MAINTAIN VAPOR BARRIER ABOVE CEILING FINISH. DEMOLISH WALLS. NTAIN DEMOLISH WALLS "n"O" Ashland Farms Renovations Title Demolition Plans A R C N I r E E T s vmw.j5ainc.com Portsmouth, NH 7.603.436.2551 INTERIO273 Corporate Drive RS PLANNERS CEILING SEE PLAN 0 No.00'G OR 3,;v w';i- r SHIM WALL TO BE C DEMOLISHED EXISTING WALLS Job No. Reference Drawing 807 Scale ASI Reference 1/8N= 1 l Drawn By CSK PJB A2Dale 12.5.13 P:\P807.00 — BENCHMARK ASHLAND FARM NORTH ANDOVER MA\X807 ASHLAND PLANS.DWG 12/6/2013 11:43 AM © Copvright2013,JSA,Inc PROVIDE NEW VINYL FLOORING AND TRANSITION STRIP - PROVIDE NEW VINYL FLOORINQU" D 1 HOUR RATING AT ENCLOSURES - 'REQUIRED _ Project Ashland Farms Renovations Title Partition Plans 273 Corporate Drive INTT SRIORS ARCHITECTS www.lsainc.com Portsmouth, NH E P L A N N E R S PARTITION NOTES: 1. PATCH AND REPAIR ADJACENT SURFACES AS REQUIRED. 2. PROVIDE INVISIBLE JOINT BETWEEN DISSIMILAR MATERIALS. 0 G�NGA�`° No.6946 'ORTSF1JU H NEW, HAPAPS41 R WALL TO BE C DEMOLISHED EXISTING WALLS Job No. Reference Drawing 807 Scale ASI Reference 1/8 N = I t Drown By CSK 7.603.436.2551 P� B t') A3 2.5.13 P:\P807.00 — BENCHMARK ASHLAND FARM NORTH ANDOVER MA\X807 ASHLAND PLANS.DWG 12/6/2013 11:44 AM © Copyright 2013,JSA,Inc CEILING NOTES: 1. MAINTAIN EXISTING 2X2 ACOUSTIC TILE CEILING GRID, LIGHTS, AND EQUIPMENT. 2. PATCH AND REPAIR CEILING AS REQUIRED TO MATCH ADJACENT CEILING SURFACES TO REMAIN. 3. MAINTAIN VAPOR BARRIER ABOVE CEILING FINISH. EXTEND ADJACENT ACOUSTICAL TILE CEILING INTO SPACE. `EXISTING LIGHTING TO REMAIN Prole° Ashland Farms Renovations Title Reflected Ceiling Plan I 273 Corporate Drive INTT S RIORS A R ITEC T S www,lsainc.com Portsmouth, NH E P L A N N E R S - ` ev r; No. 6946 :ORTSNIOUTH i RAJ IJAIMPSHiR WALL TO BE DEMOLISHED EXISTING WALLS-� Job No. Reference Drawing 807 Scale ASI Reference 1/811= 11 /8"=1' Drawn By CSK 7.603.436.2551 PJB A4 Date 12.5.13 P:\P807.00 — BENCHMARK ASHLAND FARM NORTH ANDOVER MA\X807 ASHLAND PLANS.DWG 12/6/2013 11:44 AM © Copyright 2013,JSA,Inc 98 9M i.n N T 3 U248424fU U248424{R} U248424fU U248424TF3 4 U308424B U3084246 U308424B SWC CA) Merillat Somerton Hill Cherry Paprika Classic Construction 31i Merillat Classic Construction Somerton Hill Square Cherry Paprika Finish \A t W3630 W3012B W3015BWFc A BB9FH 30 RANGEI 30REF-2D m 00 LO UMerillat Somerton Hill Cherry C31 Paprika Classic Deluxe 00 rn m Giallo Granite Flat Deck with ini loose BS 'n U :BF 51RHDSI SB30B 24.DISHW m' LM 984 — All dimensions size designations given are subject to verification on job site and adjustment to fit job 20This TECHNOLOGIES _J is an original design and must not be released or copied unless applicable fee has been paid or job Designed: 6/4/2013 Printed: 10/11/2013 conditions. order placed. Seo Ashland Farms No Andover Kitchen All Drawing #: I