HomeMy WebLinkAboutBuilding Permit #747 - 733 TURNPIKE STREET 5/24/2010BUILDING PERMIT o� t,to 16 �a\
TOWN OF NORTH ANDOVER
02 a o �
APPLICATION FOR PLAN EXAMINATION
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:ommercia
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
peptic -W-e
lood�laln V11e and
Vllatetsh :d District
Wa#er' Sewer:
-
DESCRIPTION OF WORK TO BE PREFORMED:
in Tea- L -,JR- LL S -
Identification
OWNER: Name:
Type or Print Clearly)
(,a p P
Ct
Address:
ARCHITECT/ENGINEER SIS'? )IV Phone:
Address:_ t�(� MAIII sr ALC,- Reg. No. 8� 8
Y4. Pv'JD0L*f2 Ml h
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 0CU FEE: $ 120
Check No.: (oReceipt No.: a -
NOTE: Persons contractin with unregistered contractors do not have access to the guaranty, nd
r
-
., ..
4,1
5ignature of.Agent/Owner Signature of contractor
__�
Plans Submitted Pians Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools LLl
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
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
•t•
Reviewed on Signature
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:
Dimension
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
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
-_.._.:_......... ----........... ------.._.._.—_..__._._._._�_._..._._...__
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
❑ 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
a 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 Revised 2008
Location S
No. Date �� V
NORTH TOWN OF NORTH ANDOVER
> ; Certificate of Occupancy $ (ro
V
Building/Frame Permit Fee V -
Foundation
Foundation Permit Fee $r
Other Permit Fee $�
TOTAL $
Check # l�
23►yJ
Building Inspector
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 747 Date: June 23, 2010
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 733 Turnpike Street
MAY BE OCCUPIED AS Business for a IN ACCORDANCE WITH THE PROVISIONS
OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS
AS MAY APPLY.
Certificate Issued to: New England Acupuncture
North Andover MA 01845
1
Building Inspector
Fee: $100.00
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TOWN OF NORTH ANDOVER
Final Design Affidavit
Project Number: 1005056
Project Title: New England Acupuncture
Project Location: 733 Turnpike St, North Andover, MA
Name of Building: Jasmin Plaza 733 Turnpike St.
Nature of Project: Alterations and modifications to existing space for Accupuncture Studio.
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 Professional E gineef/Architect, HEREBY CERTIFY that I have prepared or directly supervised the
preparation of all design plans, computations and specifications concerning:
Entire Project _ Architectural XXXX 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 HAVE PERFORMED THE NECESSARY PROFESSIONAL SERVICES AND EITHER
MY REPRESENTATIVE OR I HAVE BEEN PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND
PERIODIC BASIS TO DETERMINE THAT THE WORK HAS PROCEEDED IN ACCORDANCE WITH THE
DOCUMENTS SUBMITTED 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. su bmitta Is 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.
I AM SUBMITTING THIS FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE
PROJECT FOR OCCUPANCY.
Signature and Stamp (no facsimile)
No. BUB -
NORTH ANWIM.
q�TM OF N SA !
�e
SUBSCRIBED AND SWORN-TO'B FORE ME THIS DAY OF 'LC 2010
MY COMMISSION EXPIRES. iL r / Gi/S
N T Y PUBLIC '
r�
SUZANNE M. PELICH
NOTARY PUBLIC
COMMONMALTH OF MASSACHUSETTS
Ny Comm. Expires June 11, 2015
TOWN OF NORTH ANDOVER
Final Design Affidavit
Project Number: 1005056
Project Title: New England Acupuncture .�
Project Location: 733 Turnpike St, North Andover, MA
Name of Building: Jasmin Plaza 733 Turnpike St.
Nature of Project: Alterations and modifications to existing space for Accupuncture Studio.
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 Pro€essi gineef/Architect, HEREBY CERTIFY that I have prepared or directly supervised the
preparation of all design plans, computations and specifications concerning:
Entire Project _ Architectural X)00(
Fire Protection
Electrical
Structural Mechanical
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 HAVE PERFORMED THE NECESSARY PROFESSIONAL SERVICES AND EITHER
MY REPRESENTATIVE OR I HAVE BEEN PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND
PERIODIC BASIS TO DETERMINE THAT THE WORK HAS PROCEEDED IN ACCORDANCE WITH THE
DOCUMENTS SUBMITTED 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.
I AM SUBMITTING THIS FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE
PROJECT FOR OCCUPANCY.
,tRU Aft
Signature and Stamp (no facsimile) By P.
No. ease
NORTH HOVER,
Ma
OF1
SUBSCRIBED AND SWORN—T FORE ME THIS /% DAY OF _-Z"Le 2010
�) F' MY COM ISSION EXPIRES,Z_11tr J1 /)
N Y PUBLIC
SUZANNE M. PELICH
NOTARYPU9uC
COMMONWEALTH OF MASSACHUSETTS
My Comm. Expires June 11, 2015
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GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW
POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections
INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final.
FOOTINGS: Continuous Full 2x4 Keyway
Continuous strip footings for interior columns
FOUNDATION: Rebar as required
Anchor bolts or straps
Damproofing
Foundation drain - pipe/stone/fabric filter/cover and outlet connection.
FRAME: Fireblock - over girts/plates between floor joist
Penetrations for plumbing, heat, elec, etc.
WaUs at stair stringers.
Windbrace corners and center bearing partitions.
Size ridge to provide full bearing at rafter cuts.
Hip and Valley rafters - watch bearing at walls.
Ridge & Hip - Provide proper connections.
Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate.
Stair stringers - watch cuts and heal support.
Joist hangers - fully nailed w/ hanger nails.
Sill plates 2-2X6 (1 PT) w/sill seal.
Girls - solid brick or steel plate bearing at foundation's
'/ " air space at sides in foundation pockets.
Lateral bracing at ends.
Certified calculations. required for Beams/LVL's Trusses.
Solid bearing support for Headers/Beams etc.
Check headroom clearances - stairways, under beams
Attic Access. (min. 22x30 w/3' headroom above).
Crawl space access. (min. 18x24).
Bath exhaust fans to have metal duct to exterior (not in soffit).
Firecode S/R wood frame of "0" clearance fireplaces & stoves
Window Schedule or Every Habitable Room Must Have:
Natural light equal to 8% of floor area.
of required glazing shall be openable.
Bedrooms required min. 20x24 egress window or door.
Vent attic spaces - "proper vent", soffit and required ridge vents.
Firecode under stairs if used for storage
FIREPLACES: Separate permit required.
Inspections at Footing - Smoke Chamber - Finish
Smooth parging, clean joints, 8" solid @ combust.
DECKS: Lag to house, provide flashing.
Rails min. 36" high, Baluster max space 5" on center.
Over 8' above grade, use 6x6 posts w/lateral bracing.
Lag all posts and rails.
Pier footings down 48", Conc. pad at stair base.
FINISH: Handrails returned to wall/newall post.
Guardrails required alongside open cellar stairs.
Exterior grading complete.
Certificate or occupancy required prior to occupying structure.
Temporary Stairs required for inspection.
Re -inspection fee - $30.00 (Be Ready).
Certificate of occupancy required prior to occupying structure.
The Commonwealth of Massachusetts
Department o f Industrial Accidents
Office of fnVesz�o amens
..600 Washington Street
Boston, MA 02111
www.masS-govi&a
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electric
Mfiians/Plumbers
cant Information
Name (Business/Organiza6on/Inuividual):
Address-
City/State/Zip: �X gC)&I I\ phone #:
a �8-33
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
2. [employees (full and/or part-time) * have hired the sub -contractors
I am a sole proprietor or partner- listed on the attached sheet I
ship and have no employees
worlring for me in any capacity.
[No workers' comp, insurance
required.]
3 • ❑ I am a homeowner doing all work
Myself [No workers' comp.
insurance required.] t
These sub -contractors have
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp, insuranc
Type of project (required):
6. ❑ New construction
7. [ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
1 L ❑ Plumbing repairs or additions
12.7 Roof repairs
e regwred ] I 13.0 Other
` ,�5, a^aIi�rt *hat -her
boy 41 mus? also :ul out the seciicm het^r! s
I3omeown= who submit this affidavit indica W -cm comp---;. -Y0,:c� :nL L
LP a do `g ""� worl �� thea hire outside eonaacto� lust submit a new affidavit indicting such.
+Contractors that -back this box must attached an additional sheet showing the name of the sub contractors and their workers' affidavit
indicating
A •L, an emp�oyer that u providing workers' compensation insurance for my employees Below is the oli �v �u
information, p c� and job site
Insurance Company Name:
Policy # or Self -ins. Lic. #:
Expiration Date:
Job Site Address: 3 3 TV Vz1y to/ <e—
Attach
,eAttach 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
fine up to $1,500.00 and/or one-year imprisonment, as well as . 152 can lead to the imposition of criminal penalties of a civil penalties in the form of a STOP WORK ORDER nd a fine
of up to $250:00 a day against the violator. Be advised that a copy of this statement maya
be forwarded to the Office a
Investigations of the DIA for insurance coverage verification
I do hereby
penalties of perjury thtrt the information provided above is true 1 e and correct_
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
issuing Authority (circle one):
P ermit/License
L Board of Health 2. Building Department 3. 0ty/Town Clerk 4. Electrical Inspector S. PIumbin,, Inspector
6. Other
Contact Person:
Phone T:
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 t%e legal representatives of a deceased employer, or the
receiver or trustee o, an individual, partnership, association ox other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartnm encs and who resides therein, or the occupant of the
dwelling house of another who employs persons.to do m�teiiance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not be:,c--ause ofsuch. employment be deemed o be an employer."
,.
MGL chapter 152, §25C(6) also states that "every state or bcal,Iicensing agency shall.wi.thhoId the issuance or
renewal of a h1 r, or pdrfait to operate a business ot* to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of coimpUanCe 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 iiitil 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' comp ensation 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 inn,ranne coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or to m that the app hca ion for the r^ermait or hce„.se us being reaaes+.ed, nat the .Depa*ia:ent. of
Industrial Accidents. Should you have any questions regardir><g the lav, or if you =required to obtain a workers'
compensation policy, please call the Department at the number= 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 BE in the permit/license number which will be used :as a>z ' Terence number. In addition, an applicant
that must submit,multiple permit/Iicense applicationsil
'iV any given year, need only submit one affidavit indicating current
policy informatio"(if i ecessary) 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 oflnvestigations 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 Deparmient's.addvess, telephode and:f m number:..
The Commonwealtl2 of Massachusetts
Department of Industrial Accidents
Office of Inrestiga%ons
600 W ashi ngtor street,
Boston, MA 02111,
Tel. # 617-72.7-4900 ext 406 or 1-977-NL4SSAFE
Revised 5-26-05 Fax # 617-72.7-7749
�''RN'.FIlaSS._ g OV/dIa
TOWN OF NORTH ANDOVER
Construction Control Affidavit
Project Number: Architect's Number: #1005056
Project Title: New England Acupuncture Tenant Fit -Up
Project Location: 733 Turnpike St, North Andover
Name of Building: 733 Turnpike St
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 PFefessiefial Engineef/Architect, HEREBY CERTIFY that I have prepared or directly supervised the
preparation of all design plans, computations and specifications concerning:
Entire Project Architectural X000( 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
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 COMPLNESS OF THE
PROJECT FOR OCCUPANCY.
Signature anti Stamp (no facsimile)
No. 8688
NORTH ANDOVER,
NIA.
SUBSCRIBED AND? 51VORN TO BEFORE ME THIS _DAY OF2010
MY COMMISSION EXPIRES UNDAVANDEVOORDk
NOTARY PUBLIC Notary Public • New HampsNr�r. t
MY commission Expires April T
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