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Home My WebLink AboutBuilding Permit #540-14 - 800 TURNPIKE STREET 1/13/2014Permit N0: D t10RTF/ ,_ao qti •• BUILDING PERMIT` ., • °•a TOWN OF NORTH ANDOVER ° < o APPLICATION FOR PLAN EXAMINATION Date Received '�_�9e<o<�,:�;<.,• +`/ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial R-A-literation No. of units: D10101mmercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: 0 Demolition ❑ Other VW [ Septic til , .'` M, F! HCl Wetlar�ds� `� �° ❑ UUatershed DtSt1'� n �> ❑ WAV er/Sewers IITTI C( r , OWNER: Name Address: Identification Please Type or Print Clearly) e e�s�. ��►-�y RiF4krS LEL Ph 566) oS6;o ARCHITECT/ENGIN Address: Ll3 kkeet Phone: (r/ -- wyl • 1z3d Reg. No. M& FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 3,600 00FEE: $ /of(, •o?7 Check No.: L6/ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access o the guaranty fund 6�o .b M IN � '-p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: 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 ❑ 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 PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Orlrlracc- CONTRACTOR Name: ___ Phone: Address: - Supervisor's Construction License: Home Improvement Licensed ARCHITECT/ENGINEER Address: Exp. Date: Date: Phone: 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 VS Batu re of 9ignattare of AAgent/Owner g _ _�— Plans Submitted L.J - Plans Waived ❑ Certified Plot Plan ❑ �, Stamped Plans ❑ r 0 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 COMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ ❑ ❑ 17 DATE REJECTED DATE APPROVED 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 Located at 384 Osgood Street Plans Submitted ❑ `y Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ 3YPI5 MSEWERAGEDiSP_0S-AL Public Sewer ❑ Tanning/Massage/Body Art ❑ .. .Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ :•Food Packaging/Sales ❑ Private (septic tank, :etc._.. - Permanent Diunpster on Site ❑ THE_ FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: PLANNING & DEVELOPMENT' ❑ COMMENTS DATEAPPR-OVED !CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS a 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 Todd;! ]Engineer: Signature: Located 384 Osgood Street SIRE DEPARTII=_Temp Dumpster on site.yes_.... no Located-at:124rMain Street: .. Firebdpar} men f signatureldate ' COMMENTS_ -Dim-ension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area,- sq. ft.: ELECTRICAL: Movement of Meter location, nriast or service drop requires approval of .:Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL -.Chapter -166 Section 21A -F and G min.$10041000 fine NOTES and DATA — (For department use � r - CU ^ nl6 E3 Notified for pickup - Date F Doc.Building Permit Revised 2010 Building Department The fol�,owing is a list of the required -forms to be filled out forAheappropriate. permit to .be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ ` Building Permit Application ❑ Wojrkrrr�A�'f`idavi a.oto=6epy� I.C. And/0'r C.S.L Licenses ❑ Copy of Contract Floor Plan Or Pr ed 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 casts 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.4ted with the building application Doc: Doc.Building Permit Revised 2012 Location No. D / �i' Date / �3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $f eW ' a° Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #! 2, r� s r i �.✓ , G 5 Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 83,000.00 m $ - $ 996.00 Plumbing Fee $ 124.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 124.50 Total fees collected $ 1,345.00 800 Turnpike Street 540-14 on 1/13/2014 Tenant Fit UP x Lau LL.z 0 Q 0: 0uj m cu u ]C O LL J N N C2 N 0 z m c O m 7 LL <� W v U u � 0 a z Ve z m J CL O h 0 a Z J u LL O** U In n 4no oc 0 to HQ z N O I.i - x Lau LL.z 0 Q 0: 0uj m cu u ]C O LL J N N C2 N 0 z m c O m 7 LL 7 W v U LL 0 a z Ve z m J CL t 7cu CL' LL 0 a Z J u LL t :3 U In n LL oc 0 to HQ z N -Cy C] d' I.i - z LY D: w Q LL C CO Z 1% + YC C Ln 0 cc Cc 0 .Q L r as �a - c E Q ► �� L :/i L cc tk Q' J �•� L m >� • d L =� 0 0-0 CL Ch o0 -C U) t L • Q. as ,Lr v .a •I: F. (� 0 = C a L L RS C � � Q 0 • � H N V m cc LU _ 'a- 0 0 M C D; N C W LU E •0 .a a V L V � • =0.0 CL L U) d •> cn U) .Q 0 C 0 � Q 0 V 0 2 Z m coZ W w a w H W CL cj 0 2 V O The Commonwealth of Massachusetts - Department of Indifstrigl Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): t -l• Address: 3 `V'L✓ 654-c, City/StatPhone " (o U Are you an employer? Check the appropriate box: 1. I—.� ram a employer with S— 4. ❑ I am a general contractor and I Type of project (required): 6. ❑ New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7• F1 Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working .for me in any capacity. workers' comp. insurance. 9. El Building addition [No workers' comp. insurance 5. El We are a corporation and its 10. F1 Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing. repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.E] Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. i 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. ^ , / h Insurance Company Name; Policy # or Self --ins. Lic. Expiration Date:, Job Site Address: City/State/Zip: Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 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 tine 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 cert& under the pains and penalties ofN jury Aat the information provide' above is true and correct. 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 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 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 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." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) 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. 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 ComY4ojaweajtbLofMassachusetts - Department ofbidustrial Accidents Off(ce of Investigations 600 Washington. Street Boston,MA02111 TQL # 61.7-72.7-4900 oxt 406 ox 1-87TMASS.FE Revised 5-26-05 Fax # 617-727-7749 w�vw.�tass,govfdia DSH/ DESIGN GROUP Architects ■ Engineers ■ Construction Managers CONSTRUCTION CONTROL AFFIDAVIT PROJECT TITLE: INTERIOR RENOVATION OF SUITE 201A PROJECT LOCATION: 800 TURNPIKE ROAD, NORTH ANDOVER MA SCOPE OF PROJECT: SUBDIVISION OF THE EXISTING SPACE, INSTALLATION OF NEW PARTITIONS. In accordance with 780 CMR Section 107.6.2 of the Massachusetts State Building Code, I Davood Shahin, Registration # 8186 being a registered professional architect with the firm of DSH Design Group, 233 Needham Street, Newton, MA 02464, hereby certify that I have prepared or directly supervised the preparation of the renovation plan indicating addition of new offices, new fire safety and exist devices and relocation of few sprinkler heads within the existing space for the above named project and that, to the best of my knowledge, such plan meet the applicable provisions of the Massachusetts State Building Code, all acceptable architectural practices and all applicable laws and ordinances for the proposed use and occupancy. I fiuther certify that I, or my authorized representative 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 107.6.2.2: mac? JOO D y ti -� G C-) N . .86 a NE' ON MASSF, TTS F M 233 Needham Street, Suite 300 Newton, MA 02464 T- 611- 454-1230 f- 611- 454-1231 www.dshdesigngroup.com Client#: 58856 KSPARTNERS1 ACORD,, CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDDIYYYY) 4/30/2013 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 HUB International New England 299 Ballardvale St Wilmington, MA 01887 CONTACT NAME: PHONE FA No Ext): 657-5100 p/c Ne ; 866-475-7959 E -MAIC SS: nee.certificates@hubinternational.com ADDRESS: --- — NUMBER(MM/DD/..... ----- POLICY EFF 978 657-5100 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: EastGUARD Insurance Company !14702 INSURED KS Partners LLC etal INSURER B: INSURER C Jefferson Equity/ Jefferson Office Park INSURER D 130 New Boston St Ste 303 Woburn, MA 01801 INSURER E: - INSURER F: EACH OCCURRENCE 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 CONTRACTOR 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. INSR LTR TYPE OF INSURANCE _._.._............................._.............._..._.__...._..........._.........__.........._....._.._._..._..............INSR.. ADDL SUBR WVD_....-._.........._._......._.._POLICY --- — NUMBER(MM/DD/..... ----- POLICY EFF ------ POLICY EXP (MM/DD/YYYYJ --- - LIMITS - — GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES0 a ENT ence $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- n _ ...... ........._.L..................--_.._..... _JECT..........1..__._..t._LOC.........__._..............._..._....................._._._......................_................._......._._..........._.............._..........._...............__........_........._...._ � AUTOMOBILE LIABILIN _......_ ......._.._........._................_............................._...._.................................. COMBINED SINGLE LIMIT $ (Ea accident}_ $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) - $ AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY KSWC420995 4/11/2013 04/11/201 T C STATU- OTH- X ER Y/ N ANY PROPRIETOR/PARTNERIEXECUTIVE( OFFICER/MEMBER EXCLUDED? I N I NIA E.L. EACH ACCIDENT $500 O0O (Mandatory in NH) "' If yes, describe under E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below - DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) re 790 Turnpike St, North Andover MA. !`e0r1e1rnr0 Uni Ml - Town of North Andover 120 Main St North Andover, MA 01845 ACORD 25 (2010/05) 1 of 1 #S912430/M908254 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE IUtSU-ZULU ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EH002 JIM Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -086258 JOSEPH H TURNAR `- 694 WESTFORDST °. LOWELL MA 07851 Expiration Commissioner 11/21/2015