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Home My WebLink AboutBuilding Permit #720 - 85 FLAGSHIP DRIVE 5/4/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION P6rmit NO: Date Received Date Issued: TYPE OF IMPROVEMENT IMPORTANT: Applicant must complete all items on this page Residential 7" 0 New Building LOC4 n Addition Z [I Industrial &AIteration No. of units: . ........ 0 Repair, replacement 11 Assessory Bldg 11 Others: PROPERTY - OWNER 11 Other "Sep�j CVW '7, oodp n Wetlands 41 /P :-MAP 'NO LLL�A�ARCEL"' t ZONING OfSTRIC-f-,L: yHI fRJC',01'-RI , t Ye �--,n v TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family n Addition 0 Two or more family [I Industrial &AIteration No. of units: [I Commercial 0 Repair, replacement 11 Assessory Bldg 11 Others: [I Demolition 11 Other "Sep�j CVW '7, oodp n Wetlands facer Oi tribt, ewer t -,dam DESCRIPTION OF WORK TO BE PREFORMED: A-11, A Identification Please Type or Print Clearly) OWNER: Name: Phone: 917 I Address: a V, A ARCHITECT/ENGINEER Phone: 5_6 11(5 Address:38" %c _k m!y'—Reg. No. c�5 0_0� FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ A ":q FEE: $ 916 r -- Check No.: � i Receipt No.: CQO 3� - NOTE: Persons contrdcttn,& with u gistractors do not have access to the guar fu ",_ ,S_gJ re'ofAg " _entJNvn6 Signature - of contractor – Location �ioqo No. Date-� �oRTM TOWN OF NORTH ANDOVER 3?� _ •OCL F 9 " Certificate of Occupancy $ �'�S'••° •'t�' Building/Frame /Frame Permit Fee $� s,+cMust 9 -� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #/ / 20'1 19 Building Inspector 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 DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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 SIRE DEPARTMENT , -I empDempster on site yes no. Located at,1 Z4 MainStreet ire.Department1 4v iginature/date' i 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 Doc.Building Permit Revised 2007 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 05/03/2007 08:52 FAX 19786833147 M.P.ROBERTS INSURANCE ACORDrw CERTIFICATE OF LIABILIT) PRODUCER M.P.ROSERTS INSURANCE AGENCY INC. 1060 OSGOOD STREET NORTH ANDOVER MA 01845 978-683-8073 INSURED SCOTT CONSTRUCTION CO., INC. SCOTT CCMPA141ES 12 ROGERS ROAD HAVERHILL, MA 01835-6925 2001/001 ' INSURANCE DATE (MIJI/DDIYYYY) 05/03/2007 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 THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURER& ILLINOIS UNION INSURANCE INSURER B; HANOVER. INSURANCE INSURER C: INSURER D: ASSOCIATED INDUSTRIES INSURER E; HMMR INSUJBMCE COVERAGES 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 13 POLICY NUMBER OLIC MMlDD✓rr P TEYMMIDDm N LIMITS LTR N9RD TYPE • I E GENERAL LIABILITY . EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Eaoocurence $ 5-0-1000 CLAIMSMADE Y OCCUR MED F_CP(Any one person) $ 5,000 A621983706002 9/1/06 9/1/07 PERSONAL&ADV INJURY $ 1000 000 GENERAL AGGREGATE $ 2,000,000 G11 AGGREGATE LIMIT APPLIES PER PRODUCTS • COMP/OP AGG, S 2,00 000 POLICY PRO- [ JELOSER AUTOMOBILE LIABILITY, BINE�DD SINGLE LIMIT g 11000 000 (O � ANYAUTO ALLOWNEDAUT06 BODILYINJURY g (Per person) $ SCHEDULED AUTOS $ X HIRED AUTOS AHNOOO5020-01 12/1/06 12/1./07 BODILYINJURY $ X NON-OWNEDAUTO'S (Pereccldent) PROPERTY DAMAGE S (ParaceiEent) GARAGE LIABILITY AUTO ONLY. EAACCIDENT $ ANYAUTO OTHERYHAN EAACC $ AUTOONLY: AGG E EXCESS/VMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EltLAIMSMADE AGGREGATE $ g DEDUCTIBLE $ RETENTION i$ WORKERS COMPENSATIONAND TORY A X ERS EMPLOYERS'LMILITY WXZ800543501.2006 3/6/07 3/6/08 El, EACH ACCIDENT . S 1,000,000 ANY FROPRIETORIPARTNEROXOCUTIVE D OFFICERIML!MBER EXCLUDED? E.L. DISEASE • EA EMPLOYE $ 1 A 000 1 OOO Ifyyes doaeriCeunaer E.L. DISEASE -POLICY LIMIT $ 11000,000 SPE61AL PROVISIONS below OTHER E INLAND MARINE IHN839098900 9/1/06 9/1/07 POLICY LI4IT:$255,150 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS FAX: - 78-373- 944 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A90VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF NORTH ANDOVER, MA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAILIO DAYS WRITTEN 120 MAIN STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL NORTH ANDOVER, MA IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IYS AGENTS OR ACORD26(2001108) v i =. I i =. ✓Ae arrvinona-aa a�✓f/iaoaactiticarlta 'e . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS 026517 , Birthdate 01/04/,1954 ;e 7 xp�res Q1/04/2008 Tr. no: 14250 i Restricted0� MAURICE C MICHAUD�� 28 HADLEY RD" f ` METHUEN, MA Commissioner Construction Control Affidavit Project: 85 FLAGSHIP DRIVE Project Number: N/N Unit E - Mezzanine Toilet Room /Kitchenette Addition North Andover MA Date: April 27, 2007 In accordance with 780 CMR (Commonwealth of Massachusetts Building Code) Section 116.0 Construction Control, and specifically Sections 116.2.2 Architect's / Engineer's Responsibilities during Construction and 116.4 On Site Project Representation, l ,, Rainer Koch.. NCARB........................ Architectural Registration No................... MA. 5056.. being a registered architect, have prepared or directly supervised the preparation of all design plans, computations and specifications for the above named project and I state, that such plans, computations and specifications ,meet the applicable provisions of the Commonwealth of Massachusetts Building Code, all acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. As it may be required and applicable for the project, I will monitor the construction process and provide the following tasks: 1. Review for conformance to the design concept: shop drawings, samples and other materials which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approve the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stages of construction, 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. 4. Be present at the construction site on a regular basis or as proposed in the attached inspection schedule, and/or twill send other appropriately qualified design professionals, to determine that the work is proceeding in accordance with the documents submitted with the building permit application and the applicable provisions of the Commonwealth of Massachusetts Building Code. 5. Provide the building inspector with an original, stamped report for each site visit, scheduled or otherwise. 6. Issue a Statement of Project Completion at the time the construction is considered substantially complete and ready for occupancy I understand, that no CERTIFICATE OF OCCUPANCY will be issued until all reports and a statement of project completion have been submitted to the satisfaction of the building inspector / code enforcement official. Signed and Sealed: -, Distribution: R it W1 \ No. 5056 e wok ��ay of 38 Essex Road, Ipswich, Massachusetts 01938 - 2532 electronic: kocharchitects®verizon.net telephone: 1.978.356.5065 facsimile: 1.978.356.6056 Building Department Client Architect Contractor / Field w O 0 z Y/ W W W N 12 cho cii a a w w U w a w as w w a � x a l P z o v o w O 0 z Y/ W W W N