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Building Permit #141-14 - 8 MARBLEHEAD STREET 8/13/2013
r. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION - - - ------ Print- PROPERTY -- Print.PROPERTY OWNER Print io0`Year'Old Structure yes no MAP NO: _- PARCEL: ZONING DISTRICT: e 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 0 Septic ❑Well ❑,Floodplain ❑Wetlands ❑ Watershed District- ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: - - Supervisor's Construction License: Exp. Date: _ Home Improvement License: _ Exp:_ 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of:AgenUOwner S'anafure-of contractor 4 ' _ l_ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The foEowing isa list of the required forms to be filled out for the appropriate.permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits Q Building Permit Application u Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract o Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application u Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o 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) Li 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) u Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract a 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 cas<s 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 submAted with the building application Doc: Doc.Building Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ stamped Plans ❑ TYPE-OF SEWERAGE.DISP.OSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 0 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 f PLANNING & DEVELOPMENT ❑ ❑ r COMMENTS .CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS b 1 x 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 Tow;!.Engineer: Signature: Located 384 Osgood Street FIRE DEPARTNi1NT - Temp bumpster on site yes no i Located-at 124 Main Street . Fire De 'rt'- signature/date COMMENTS _ — l 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 i M ' ® Notified for pickup - Date Doc.Building Permit Revised 2010 OMO oT� 1. ' O �7 O4n.✓410 . SSAClNS CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 141-14 on 8/13/2013 Date: November 15, 2613 THIS CERTIFIES THAT THE BUILDING LOCATED ON 8 Marblehead Street MAY BE OCCUPIED AS Tenant Fitup for E Keys 4 Cars_IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: E Keys 4 Realty 8 Marblehead Street North Andover,MA 01845 r B ilding Inspector Fee: PrePaid $100.00 Receipt: 26726 Check : 1314 NORTH Town o _ Andover 9 AO No. 4 _ ( - �`y Zh ver, Mass T O CANE 1 COC NIC N!WICK BOARD OF HEALT�I�F PERMIT �. Food/Kitchen Septic System THIS CERTIFIES THAT ......4..... .. . ;`11Y.. : ,;;; � - " �: j BUILDING INSPECTOR has permission to erect buildings on ... Foundation 0 U09 to be occupied as .................. .... .............. ..�..2 . .. :.:.:'......... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application al 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. = ' =' PLUMBI II PECTOR Rough VIOLATION.of the Zoning or Building Regulations Voids this Permit. Fi PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S R Service ........................ Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final AK vp(1-7/j: No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. t IF SEE REVERSE SIDE Smoke Det. �� /LH NORTH own oAndover 0 No. III L - Co' LAKIh ." ver, Mass, COCMIC"t W/CK 1' i / U BOARD OF HEALTk,,+__ PERM17 D Food/Kitchen Septic System THIS CERTIFIES THAT rh ,,: ' : •,. BUILDING INSPECTOR .... �.... .. •� y. . Foundation has permission to erect .......................... buildings on ... ... .... ..... ........ ........................ 0OU 6A yj ��� �6✓f to be occupied as 'M Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application al 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. = -' PLUMBI . I PECTOR _ VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough �/� ��, Fi PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S R u �y �l Service Fina BUILDING INSPECTOR �S• ��_��-� GAS INSPECTOR Occupancy Permit Required-to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final 19K U(1- 1p; 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. //� Al-42 of NORTH.1N . O M io M a 8y ,.9 �SSAC•N1156t4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 141-14 on 8/13/2013 Date: November 15, 2013 THIS CERTIFIES THAT THE BUILDING LOCATED ON 8 Marblehead Street MAY BE OCCUPIED AS Tenant Fitup for E Keys 4 Cars_IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: E Keys 4 Realty 8 Marblehead Street North Andover,MA 01845 B ilding Inspector Fee: PrePaid$100.00 Receipt: 26726 Check : 1314 Final Construction Control Document To be submitted at completion of construction by a Registered Design Professional for work per the 8h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: E Keys 4 Cars Date:l 1-18-13 Permit No.141-14 ZBA 2013-004 06.18.13 Property Address:,,8 Marblehead Street North Andover,Massachusetts Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Interior Fitup for a Storage and Automobile Key Service Center I,Joel David Silverwatch, a MA Registration Number: 9671 Expiration date:2014 ,am a registered design professional, and I have prepared or directly supervised the construction of design plans prepared by others of all design plans,computations and specifications concerning: X Architectural Structuml Mechanical Fire Protection Electrical X Other:Describe Construction Control Only for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,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. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been 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 was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the v' 'o s of 780 CMR 107. ED A9 Enter in the space to the right a"wet"or electronic signature and seal: � No.9 0 1 EM O NH Phone number: 603-894-4450 Email:joel@silverwatch.com `�q�TH OF MQSSP Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 o o Wsr��icic Ass©�o���s, Inc. oao vov A R C H I T E C T U R E ARCHITECT'S FIELD OBSERVATION REPORT Project: Existing Building Modifications Owner/Project Manager: Ekeys4cars 8 Marblehead Street,North Andover MA Date: 20 August 2013 Arrived 2:00 PM Weather:Sunny 80 deg Present @ site: Mark Blanchard,Contractor, MVP Work In Process: Demolition for Accessible Toilet Room Installation Items Noted: 1) Permit posted#141-14 per ZBA 2013-004 06.18.13 2) Glazing has been removed from bay to receive overhead door installation. Any proposed re-use of this glazing in locations requiring safety glazing will require stencils or certification by glazing installer. 3) Limited existing wood partition framing uncovered. Recommend removal and replacement with steel stud framing. 4) Recommend new partition framing have a minimum of 5/8"gypsum drywall on shop side for durability and a minimum of 1/2"on front finished area side. Recommend 3.5"unfaced batt insulation be installed between shop and front finished area to isolate HVAC zones and provide for sound control. 5) All new and existing sill plates adjacent to the shop area need to be well sealed continuously to control air infiltration. 6) Rough opening for overhead door has existing structure exposed. Structural elements are outside of the demo area and the building structural integrity will not be affected or compromised in any way. Letter of concurrence needed from Structural Engineering Consultant. 7) Submittal for proposed packaged roof top mechanical units reviewed. ( Mechanical Contractor is NB Kenney Co., Inc., Devens MA.) a) Unit for front area is Carrier/Bryant equipt with economizer per IECC requirement. Unit is 58J05 4 ton w/low MBH 82/66 w/top MBH 115/93 Unit sizing appears appropriate for space. This unit needs to be balanced with a positive pressure per the IMC requirements. b) Unite for shop area is Carrier/Bryant equipt with economizer per IECC requirements. Unit is 58J1210 ton 120/98 low MBH w/top MBH 250/205. Unit sizing appears appropriate for space. 151 Main St.Ste. 1 Tel:(603)894-5117 Salem NH 03079-3109 This unit needs to have economizer adjusted for the fresh air changes required by the IMC for this type of area. 8) Proposed size and location of existing concrete roof slab penetrations for the new roof top HVAC unit duct drops need to be reviewed by the Structural Engineering Consultant. 9) Exhaust air needs to be provided for in toilet rooms. 10) Existing metal clad cable servicing ceiling lighting is noted to be two conductor with no ground. Cable requires complete removal and replacement with code compliant wiring. 11) Recommend that existing wall receptacles be investigated for proper wiring and replaced as required. 12) Contractor requested clarifications for the accessible toilet room area,with recommendation for slop sink location.(Sketch attached.) C Submitted by: tai Tim Warnick,Architect Warnick Associates, Inc. Circulation: Jim Broadhurst Ekes4cars Y Gerald Brown, Inspector of Buildings Dan Smith,Wentworth Partners,Structural Engineering Consultants 8 Marblehead Street,North Andover MA Existing Building Modification Architect's Field Observation Report Page 2 20 August 2013 C V D /� II 4.-0„ II MIN. CLEAR RAMP 6'-0" RAMP I F LJ 2'-0" \ LEL 5'-6" II PLAT OR 4 .6 MIN. SK 082013 CLEAR SCALE, 1/4" - 1'-0" II 4 �Q1�= WA R C H I T E C T U R E 05 September 2013 I Town of North Andover 1600 Osgood Street, Suite 2035 North Andover MA 01845 ATTN: Gerald Brown, Inspector of Buildings RE: Ekeys4cars Construction Control Services Affidavit for Permit @ 8 Marblehead Street Dear Inspector Brown: I respectfully request dismissal as the 'registered design professional in responsible charge', on this permit. Due to current circumstances, I am not able to provide for the necessary compliance requirements. Please feel free to call if you would like any further clarifications. Submitted by: a Tim Warnick, Architect Warnick Associates, Inc. ARCHITECTURE cc: Jim Broadhurst 151 Main Street Tel: (603)894-5117 Salem NH 03079-3109 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 72,5'500.00 m 870.00 Plumbing Fee $ 108.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 108.75 Total fees collected $ 1,187.50 8 Marblehead Street 141-14 on 8/13/2013 Commercial Alt and Fit Up NORTH Town of T E ndover 0 No. I _ I Z h L h ver, Mass T O 41 t WIC C OC NIC Nl N A�RATEO S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT �....... y ... ..t. r.'F.'..f.. /.. ../.7...a� :!�r� �.4: .,.... BUILDING INSPECTOR has permission to erect buildings on Foundation .......................... ...�.........4..........�........... .................. � Rough to be occupied as ................................................................................. Q?a/ .::e'mc.......... 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 lispection, Alteration and Construction of Buildings in the Town of North Andover. ov C_� /e-2 al.' PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION SI TS Rough Service ................... ..... ... .. .. ... ............:................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. SEE REVERSE SIDE NORTH Town of , t E 11, Andover 0 'Am-�awm K. t No. WWW"WIP, h , ver, Mass, COCMICMlwl K 7d TE 90) S V BOARD OF HEALTH Food/Kitchen PERMIT T LD�/ p Septic System THIS CERTIFIES THAT .... .. / Y� r'�"..f..�/.:�.,'<. 7� ..I.R 1�/:!� �e.� : ...... BUILDING INSPECTOR � ,��� Foundation has permission to erect.......................... buildings on ................................................. ........................... Rough tobe occupied as ................................................................................. 9 �........ 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 I spection,Alteration and Construction of Buildings in the Town of North Andover. CA.,,Le- /tl�2 C" PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ................................................................................ Final BUILDING INSPECTOR 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. SEE REVERSE SIDE j I I WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 01 A 07 11 Issuing Company: Firemen's Insurance Company of Washington, D.C. 4 Bedford Farms Drive Suite 400 Bedford, NH 03110 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY RENEWAL INFORMATION PAGE NCCI Carrier Code No.: 27723 Policy No.:WPA 0289693- 16 Previous Policy No.: 0289693-15 1.Name Insured and Address Agency Name and Address 03393 MVP Home Improvements, Inc (603)669-3218 60 Rockingham Road, Unit#11 Cross Insurance-Manchester Windham,NH 03087 1100 Elm Street Manchester, NH 03101 Other workplaces not shown above: Refer to Name and Location Schedule FEIN: 020462674 Risk ID No.: 918126589 Bureau File No.: Entity of Insured: Corporation POLICY PERIOD 2. The Policy Period is from 06/01/2013 to 06/01/2014 12:01 AM Standard Time at the insured's mailing address. COVERAGE 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: NH MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part two are: Bodily Injury by Accident$ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states,if any, listed here: All states except ND, OH,WA, WY and states designated in item 3.A.of the information page. D. This policy includes these endorsements and schedules: See "Schedule Of Endorsements" WC 00 00 01 A 07 11 Includes copyrighted material of The National Council on Compensation Page 1 of 5 Insurance,with their permission. DATE(MM/DDN A� CERTIFICATE OF LIABILITY INSURANCE 8/13/20113) 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(les) 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 Judith George NAME: g FIAI/Cross Insurance PHONE 603-206-9904 AIC No: (603)645-4331 1100 Elm Street E-MAIL eor a@crossa enc ADDRESS:J g g g y.corn INSURERS AFFORDING COVERAGE NAIC# Manchester NH 03101 INSURER A:Fireman Is Ins. Co. of INSURED INSURER B Acadia Insurance Group, LLC 31325 MVP Home Improvements, Inc. INSURER C: 60 Rockingham Road, Unit #11 INSURER D: INSURER E: Windham NH 03087 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1361787383 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. ILTR TYPE OF INSURANCE I L UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PAMAGE ToREMISES Ea oc ur ence $ 250,000 A CLAIMS-MADE 1_x_1 OCCUR CPA5044756 9/7/2012 9/7/2013 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- jECT F7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED (Per ac SCHEDULED BODILY INJURY Pcident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION M STATU- OTH- AND EMPLOYERS'LIABILITY Y I N I ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory in NH) A0289693-16 6/1/2013 6/1/2014 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Issued on behalf of inured for residential carpentry and related operations of the insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of No Andover ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Building Permit Department 1600 Osgood Street AUTHORIZED REPRESENTATIVE No Andover, MA 01845 Judith George/NJL ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25t9n1nn5tnl Tha Ar:r1Rr1 nnma nnri Inn^arc ranie4arari marlre of Armon a.� Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-085571 MARC J BLANCH 1RDF 60 ROCHINGHAM RD UMTI1i WINDHAMNH 0308'lt `"x " `Jw l Expiration Commissioner 04/30/2015 riorynim4nu Office of Consumer Affairs&Bdsiness Regulation —_r� HOME IMPROVEMENT CONTRACTOR Type" Registration: 129837 private Corporatio Expiration: 11%9/2013 MVVP HOME IMPi20UENIENTS INC MARC BLANCHARD` .._ 60 ROCKINGHAM RD`UNIT.11 undersecretary WINDHAM,NH 03076 ® 60 Rockingham Rd. Unit I 1 ' Windham,NH 03087 ' Toll Free: (877)937-4336 PROPOSAL Office: (603)635-1050 MP Fax: (603)386-6198 ® � marc@mvphi.com August 1,2013 E-Keys 8 Marblehead St N. Andover Ma Fit Up • Demo Existing Non-Structural Walls & Area for Garage Door • Frame New Interior Walls • Install Garage Door • Ramp & Excavation for New Garage Door • New HVAC System • New Handy Cap Bathroom • Dumpster Fees • Permit Fee Not Included Total $ 72,500 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8a'edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title:EKeys4Cars Date: August 5th 2013 Property Address: 8 Marlbehead Street,North Andover Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Minor modifications to existing building including installation of overhead garage door,in-filling existing partitions,providing accessible toilet facilities,and providing accessible access to the building. I, M.Timothy Warnick MA Registration Number:8001 Expiration date:August 31st 2013 ,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 Mechanical Fire Protection Electrical 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: 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'. �Z�aED Agyf Enter in the space to the right a"wet"or ® Hy electronic signature and seal: No.S olL 'i ! Phone number:603 894-5117 Email:timwarnick@waidesign.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations v I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �`' V/P f alvl Address: 60 /Z dy City/State/Zip: IBJ i,.,Aavy UA 92P Phone #: 66 G 3,5--/0Src9 Are you an employer? Check the appropriate box: . I am a general contractor and I Type of project(required): 4 1.[A I am a employer with I ❑ g 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. 7. [ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. f Insurance Company Name: r;fPCr-l�r.s !.D �i.r S / L racr Policy#or Self-ins. Lic. #: 1aZ Pa 0 ] %�1 (e 9 Expiration Date: Job Site Address: fidY t 1 S City/State/Zip: AJ, MCA 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 certify under the pains and enal 'es o er'ur that the information provided above is true and correct. _..._ _ Signature: Date.l Phone#: G {y-3.57— /O SEQ Official use only. Do not write in this area,to be completed by city or town official. 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#: i 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 of hire, express or implied, oral or written." An employer is defined as an individual, partnership, association corporation or other legal entity, or an two or more Y 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 or local licensing agency shall withhold 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 of 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." I 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 affidavit may be 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 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-insured companies should enter their self-insurance license number on the appropriate line. i 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/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary)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 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 Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 7-2010 Fax# 617-727-7749 www.mass.gov/dia