HomeMy WebLinkAboutBuilding Permit #480 - 733 TURNPIKE STREET 3/16/2007BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: q��Date Received
Date Issued
o-st�eo ,6*•rye\
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I IMIVORTANT: Applicant must complete all items on this Daae I
LOCATION- �-,. L-�.-c'� ! ,""cl t�.t✓ fit �G L',, IJ
Print
PROPERTY OWNER ~ L,,:cAu
Print
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
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION:OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: �,�� �,,a Phone:
al
CONTRACTOR Name:
Address: -�n"-7-, `<<-� _- eta
Supervisor's Construction License: UcA,`,(,: >r-> Exp. Date: `2=z& `
Home Improvement License: t
Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $b FEE: $
Check No.: 02 I y � Receipt No.: o- l 0-(e
NOTE: Persons contracting with unregistered contractors do not have access to he aranty.f #d
Signature of Agent/Owner .Signature of contractor.
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 - 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
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
LUGGICU JO -F VbYUUU OU VUL
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124Main Street
Fire Department signature/date
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 2 1 A —F and G min.$100-$1000 fine
NOTES and DATA — (For department use)
❑ 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
❑ 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
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 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 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: Building Permit Application
Revised 2.2008
Location 13 %�,P�t�
No. T� Date
NO*Tof A TOWN OF NORTH ANDOVER
'
&, Certificate of Occupancy $ Y
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NUst<� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check a
21866
Building Inspector
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Fax sent by : 7817ZY4468
SHIELDS & ASSOC. IHS 83-11-OY 13:13 Fg: Z/Z
ACORD
-------,m. CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DpmrYY)
03/10/2009
PRODUCER Phone; (7al) 729.1060 Fax (781) 729.4460
SHIELDS & ASSOCIATES INSURANCE AGENCY INC.
175 WASHINGTON STREET SUITE 821
WINCHESTER MA 01890
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 OVERAGE AF ORDEB BY THE ES BELOW.
POLICY NUMBER
PGL= EPP�E
INSURERS AFFORDING COVERAGE NAIC Ii
INSURED
O'KEEFE BROTHERS CONSTRUCTION, INC.
397 LINEBROOK ROAD
INSURER A: New England Excess Exchange, LTD
INSURER B: The WC Rating and Inspection Bureau of MA
INSURER C:
IPSWICH MA 01938
INSURER O:
--m—TEDIMPlAym
04/21/08
COVERAGES
I
NSURER E:
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 WFACH 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.
r>sA
LTR
AOa
/NSR
TYPE OF INSURANCE
POLICY NUMBER
PGL= EPP�E
POUCY EMPATION
UwTS
A
ITS AGENTS OR REPRESENTATIVES.
GENERAL
X
LIABILITY
COMMERCIAL GENERAL UABIUTY
CLAIMS MADE � OCCUR
NC785675
--m—TEDIMPlAym
04/21/08
ON21109
EACH OCCURRENCE i 1100,00
DAMAGE TO RENTED
PREMISES (Ea 000 mrm i 100,000
MED. EXP (Arty ona pown) i 5,000
PERSONAL a ADV INJURY i 11000AN
GENERAL AGGREGATE i 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO
J LOC
PRODUCTS-COMPADP AGG. i 2,000,000
AUTOMOBILE
UAINLITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HMO AUTOS
NON -OWNED AUTOS
COMBINED SINGLE UMR
(Ea accident) i
BODILY INJURY
(Per Peen) S
BODILY INJURY
O'eraccident) i
PROPERTY DAMAGE i
er
rjAoELIAINLITY
AUTO
AUTO ONLY . EA ACCIDENTNY
OTHER THAN EA ACC i
AUTO ONLY; AGG i
EXCESS I UMBRELLA LIABILITY
OCCUR E� CLAIMS MADE
DEDUCTIBLE
RETENTION i
EACH OCCURRENCE i
AGGREGATE _
i
i
i
B
WORKERS COMPENSATION ANO
EMPLOYER!' LIABILITY
ANY PROPP&WRIPARTNERIEAECUTIVE
OFFICEMAEMBER FXMUDED?
I yes, describe under
SPECIAL PRWsioos dabw
WC2247M
04WI08
04107/09
TTDDRY i Mi MS oT►IER
E.L. EACH ACCIDENT i 500,000
E.L. DISEASE -EA EMPLOYEE i 500,000
E.L. OISEASE-POLICY LIMIT i 600,0
OTHER:
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Turnpike Flagship LLC
733 Turnpike St,
N. Andover, MA
N. ANDOVER BUILDING DEPT
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
FAX 97S 745 7101
EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 GAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLM NAMED TO THE LEFT, BUT FAILURE
TO DO 50 SHAD. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,
ITS AGENTS OR REPRESENTATIVES.
Attention:
AUTHORIZED REPRESENTATIVE
V
A^^
115I SH L S
.avvna. Aa jawvvvl UeTtmcate s 4207 4) ACORD CORPORATION 1998
_s
The Commonwealth of Massachusetts
4. ❑ I am a general contractor
Department o
f Industrial Accidents
r.'d
Office of .investigations
listed 'n the attached sheet $
sub_contractorsbave
600 Washinojon Street
workers' comp. insurance.
Boston, n, MA 02111
r �-
3. ❑required-]
I am a homeowner doing
WWKI.tr:ass.; ov/dia
Workers' Compensation fnsurance.Affjday.it: guilders/Contractors/Electricians/plumbers
Acant Information
Name (B
Address:
Clty/State/Lip=\_�,� dtg�g,
Please Print T.,-.m6k,
Phone
Are you an employer? Check the appropriate box:
___ an a employer with f�:7�
4. ❑ I am a general contractor
employees (full and/or part-time).*
2. ❑ I am a
and I
have hired the sub -contractors
sole proprietor or partner-
ship and have no employeesThese
listed 'n the attached sheet $
sub_contractorsbave
working forme in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
3. ❑required-]
I am a homeowner doing
officers have -exercised. their
al] 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, Insurance required.]
*Any applic ant.that checks box # 1 .must also fill out the section below showing their workers' com ert at'
+ HEIrneowners who sub i '1 kl
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling .
8. ❑ Demolition
9. ❑ Building addition
.1 0-0 Electrical repairs or additions
1 l.❑ Plumbing repairs or additions
12j[]Roofrepairs
1.3.[] Other
1 it . ) S Wild 11 indicflIIR° 11 -ley ju, uoiit�• Eel L•?;tr}; o - � P _ - On Pul-Y mrormatlon.
Contractors that check this box must attached an additional sheet showing he name of the Uuactors and their workanm ers comp. policindicatingy inronn -::c;
h.
info
/ fo an ermatiomployer that is providing workers' contpensatio►z insurance for ng,
n employees. Below is the policy and job site
Insurance Company Name:
Policy # or Self -.ins. Lid.
Expiration Date: -V�
Sob Site Address: �'�"�`��
Attach s copy of the workers' compensation poli _V declaraf;...,
s required under Section 25A of r --e- w.wV.1LLp WAC poncy number and expiration date.
Failure to secure coverage a
C.
imposition of
fine up to $1,500.00 and/or one-year imprisonment as well as civil penalties in the form52 clead to the of a STOP VJ criminal penalties of a
of up to 1250.00 a day against the violator. Be advised that a co ORK ORDER and a fine
Investigations ofthe DIA for insurance coverage verification. py of this statement may be forwarded to the Office of
I do hereb derttfunder the pain an�pe, ofperjug that the Mf
—k n 1ormation provided above is true and correct
Official use onfp. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/License #
fssuirte Authority (circle one):
L Board of Health 2. Buiiding Department 3. City/Town
6. Other Clerk 4. Electrical inspector 5. Pfumbirtg Inspector
Contact 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 contract ofhire,
express or implied; oral or written."
An employer is defined as `pan 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 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 shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state co r local licensing agency shall withboid 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 o►f compliance 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 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 checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) 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' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this afnticLa.vit maybe 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 ortown that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you h$ve• any questions reg�rdiry the tau, or if you are required to obtain a workers'
compensation policy, please call the Department.at the ntzsnbJhstted 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/iicense applications in arty given year, need only submit one affidavit indicating current
policy information (if necessary) and under ".lob 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. Whore 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 burnleaves etc.) said person is NOT required to complete this affidavit.
The Office of investigations would like to.thank 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 Commonwealth of Massachusetts
Department of lrndustrial Accidents
Office of Investigations
600 WashLington Street
Boston; MLA 02111
Tel. # 617-727-4900 ert 406 or 1-8:77-MASSAFE
Revised 5-2645 Fax 4 617-727-7749
w-W.mass.bov/dia
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Estimate
Doug Locke January 22, 2009
RE: Install aluminum snow skirt to roof @ right side of building; Jasmine Plaza, North Andover
*Strip shingles up 6'
*Remove any rotted wood and replace with new@ $3.00 per foot
*Install 2 courses of Grace ice/water shield
*Install fabricated drip edge
*Install 20"x4' aluminum (.040 Hartford Green) panels to roof, chalking between panels
*Install 18" of ice/water; 9" on panels and 9" on roof
*Shingle 2 courses on panels and tie into existing shingles
*Cap hips as needed
*Clean and removal all debris
Labor & Material: $4,825
Extras: 2/26/09
*Strip off clap boards and corner board from building
*Bring ice/water up wall 1' and cover rest with felt paper
*Continue panels around corner to gable end
*Install roof to wall flashing (same material)
*Install new clap board and comer board
*Install aluminum cap @ hip
Labor & Material: $1,385
-10
Grand Total: 444i
Workers' compensation and liability insurance available upon request. All materials, parts and equipment are warranted by the
manufacturers or suppliers written warranties only. All labor performed by O'Keefe Brothers Construction Inc. Is warranted for five
years or as otherwise indicated in writing. All work to be completed in a professional manner according to standard roofing practices.
Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders, and will
become an extra charge over and above this estimate. All agreements contingent upon strikes, accidents, weather and other delays
beyond our control. This estimate is for completing the job above and is based on our evaluation and does not include material price
increases or additional labor and materials, which may be required should unforeseen problems arise after work has been started.
Respectfully,
Eddie O'Keefe
E
674.
Board
U/ 0477/IHO'IZUfP
o�✓�iaaoac�zuaelia
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registr ti n, 149742
Expiration 2%6/2010 Tr# 263096
Type Private Corporation
OKEEFE BROTHERS CONSTRUCTION INC
KEVIN OKEEFE
Y
397 LINEBROOK ROAD'✓ ��
IPSWICH, MA 01938
Administrator
-- - ✓rze Lanvfn+fr�cve�- �/ `i1�,a�ae�u�ael�.a
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 092960
Birthdate: 12/08/1969
Expires: 12/08/2009 Tr. no: 92960 j
+ _ Restricted: 00
KEVIN M OKEEFE
397 LINEBROOK ROAD_
( � �
IPSWICH, MA 01938
Commissioner