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HomeMy WebLinkAboutBuilding Permit #777 - 85 FLAGSHIP DRIVE 6/27/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: MPORTANT: Applicant must complete all items on this nate LOCAT 15 G Print � PROPERTY OWNER '5C -0`f4' $ 5 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes 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 Re ai re lacement Assessory Bldg Others: emolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer OWNER: Name: Address: CONTRACTOR Address: DESCRIPTON OF WORK TO BE PREFORMED: Please Type or Print Clearly) T ., t -E t Phone: e_a -# -r 0 AJSS'r Ca . Supervisor's Construction License: CS d L4 Exp. Date: 1� A -.e-4— a BAIR4 fVl , mt�'35 a AAA- &T, 2r3 c— Home Improvement License: Exp. Date: -7g--s©� ARCHITECT/ENGINEER ,�� G��- C.�S Phone: P( Address: ✓ % C5WICAA Reg. No. © � naJ ev FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ p Q f e cb FEE: $ Check No.: / �� C� Sr Receipt No.: 2 / ;2 F 2 - NOTE: Persons contracting with un gist re contractors do not have access to the uaranty and Signature of Agent/Owner nature of contractor �I ff J/ 1 Location �S �1 C04 S�7 / f� _J/'l Uf 6141 � No. -2 7 _7 Date 2 7 NORT1y TOWN OF NORTH ANDOVER Certificate of Occupancy $ scMust�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # l A��� 2,262 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS r HEALTH COMMENTS F _ �����7t1• ' ' ell ��: Reviewed on Signature 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: FIRE DEPARTMENT Temp Dui Located at 124 Main Street Fire Department signature/date Located 384 Osgo Y no COMMENTS ✓ -,,.,,Vv, y.,vi3 Street 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 (�O r ��e_rs CQ'I'll tp ❑ 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 North Andover Board of Assessors Public Access f p0 RTp � t r � '�i wino •A' ,ri ,SSACHUSEt Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 North Andover Board of Assessors 'ZiProperty Record Card Parcel ID :210/107.C-0113-OOOO.G FY:2013 Community :North Andover Location: 85 FLAGSHIP DRIVE Owner Name: FLAGSHIP NA, LLC Owner Address: 85 FLAGSHIP DRIVE UNIT: G City: NORTH ANDOVER State: MA Zip: .01845 Neighborhood: 0 Land Area: 0.00 acres Use Code: 405 Total Finished Area: 6024 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 498,500 489,100 Building Value: 498,500 489,100 Land Value: 0 0 Market Land Value: 0 Chapter Land Value: Arms Length Sale Code: Y -YES -VALID Grantor: EIGHTY FIVE FLAGSHIP, Cert Doc: Book: 12461 Page: 0080 http://csc-ma.us/PROPAPP/display.do?linkId=2258994&town=NandoverPubAcc 4/1/2013 M 0 N LL W O CL 0 Q J LL 00 U) U) W O 0 U � �Q J W �U >. Q c. O a OO cz O 09 O J Cl) O Y U O J m V a to to o'o y! 00 00 N`N � R 1 r 45 0 `O y COD O -0,0 0 M N .. N m Op V In Y Y .0 c�Uiia! OL Z. ' Q�N NiOQ, O��s t`tJ 00 a) CO w �U +5 � CL O Q q �LL 10 0 O o O LLFt9� . Q iii a.I 1..) W LO M M O0 II`V2 a LL 00 m 1 d ' Zoo — In .- ! '0 , 0 U N O (A � Z at)00 0) C; to - N jm' Q � j I C3I&LO W }OD 'LLItM Q a -p m m ,.. G i i V , � 00 W W O O OO O� I.. a !N O N LC) —- •O 0)00 � v 4i 0:1 0 O Ey0 � OY�:! O'03 ) LL md'UI O U co m W o F- c� ov — in 0 c Tf6 _ >,Oio y M M M 1� j r 3 ik ! � r• )a)BUJYn.i "IN The Commonwealth of Massachusetts Department of Industrial Accidents fil�lI : Office of Investigations lu.,13 J. 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): G or -r 5—, yZ wur la 1tj Address: P0 r City/State/Zip: MA- 6 68'3 ' Phone #: 179-31q — 0 9)31 Are you an employer? Check the appropriate ox: 1. ❑ I am a employer with 4. l am a general contractor and I employees (full and/or part-time).* have hired the sub -contra t 2. ❑ I am a sole proprietor or partner- ship and have no employees working 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 c ors listed on the attached sheet. $ 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. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I 1.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 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 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. Insurance Company Name:�� Policy # or Self -ins. Lic. #: W MZ9DO- _SQ x,1009 Expiration Date: Job Site Address: rz A.s b pr i VZ City/State/Zip: 14A AJa% 105- Attach a copy of the workers compensation policy declaration page (showing the policy number and expiration date). 7 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 pair andtpenalties of perjury that the information provided above is true and correct. —.17 - Phone #: 178--" 36 0- OA 3-3 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 #: 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 infonnation (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 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia 06/27/2008 14:01 FAX 10786853147 M.P.ROBERTS INSURANCE 16001 COVERAGE$ THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 '- CERTIFICATE OF LIABILITY INSURANCE 6/27/200 PRODUCER M.P. ROBERTS TNS AGCY INC 1060 Osgood Street North Az>daver, MR 01845 (978)663-'8073_, POLICY NUMBER 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 COVIERAGE AFFORDED BY THE POLICIES ISELOW. INSURERS AFFORDING COVERAGE NAICS aweuR� SCOTT CONSTRUCTION CO . , INC. SCOTT COWANIES 12 ROGERS ROAD HAVERHILL, MA 01835-6925 KWMR A INSURER D: MRQ= INSURANCE C-0 "WREN c: Imam a AIM NUT= INS CO LNBURER E: COVERAGE$ THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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, TIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.AGtiREQATE LIMITS SHOWN MAY NAVE BEEN REOUCEDBY PAID CLAW. ML E POLICY NUMBER DAT EC T LIMITS EACH OCCURRENCE t 1.000.0go GENERA. LIAVU7Y $ COMMERCYIIGEhERALUAeILrrY CUAMSMADE OCCUR PRDAS G M= i 00 MEDEXP wwpa"m t 5. 00a PGRSONALtADvwuRv t 1,000,000 A 621963706002 09/01/07 09/01/08 GENERAL AGGREGATE f 2.000,000 OEMI AOSREGATI! LBAR APPM PER: Potrcv rRa M. LOC PRODUCTS - COMPIOP AM 1_2,00 L 000 AUTOMOEALE WBLITY A VAUTO Nc oN) E LwaT s 1,000,000 ALLCAYNEDAUTOS R SCIVOUIED AUTOS BODILVINJURY i (Prat pNem) g MOM)AUTOS NON-CWNEDAUTOB AHI -8005020-01 12/01/07 12/01/08 Epp LYP Y i PROPERTY DAMAGE t OARAOELbtB1LIlY AUTOONLY-EAACCIOW i EAACC t Zr 7 oTNI"YA" AGO S ANYMTO ■LCESSAL WELIA LIAN "Y OCCUN 71 CLAIMSMADS EACH OCCURRENCE i AGGREGATE i i s oEar•TreLE ; RETENTION S C WORKER6COI0-*AM"ONANDRMPLOVER Aw m8Knv ,, N d�oa�un:kr 1UN3 b I0. PROlV1lbelowE.L WMZ8005435012007 03/06/08 03/06/09 A $ LLFACHACCIDENT s 1, 000.000 E.L OtSEASE • EA EMPLOYLI t OISEASE - POLICY LIMIT i 1 0O ,000 OTHER5,160 E INLAND MARINE nm8390989 11/20/07 11/20/08 IRENTED: EQUIPMENT LERSED OR $23,000 Ln4IT QESCRIPTK>w10FOPff1ATIOISlLOCATIDNSNV,I.iSlOLClUSIONBAODED9Y ENDORSEMENT/SPECIALPROVISION6 TOWN OF NORTH ANDOVER, NA 120 MAIN STMT NMTH ANDOVER, MR 01945 SHOULD ANY OF THE A90YE DESCRIBED PMMS BE CANCELLED BEFORE THE EXPIRATION GATE THEREOF, THE 188LNNG INSURER WILL ENDEAVOR TO MAIL 1O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT, BUT iA1WRE TO 00 80 8HALL RN M NO OBUOATION OR LIABILITY OF ANV K NO UPON THE WkMER. ITS AQEWS OR March 14, 2006 Scott Companies Attn: Joe Scott 12 Rogers Rd Haverhill, Ma •. q8truchoq C0.0 . DIVISION OF SCOTT COMPANY Budget cost for 85 Flagship Dr N. Andover, MA to split Unit G -H -J into 2 Units. 1. Permit 3,000. 2. Plans and controlled construction 2,000. 3. Condo documents by others. 4. �----� Make safe G -H -J. 4,000. 5. Demolition and removal of 2"d floor walls, mezzanine, first Floor walls and flooring. 52,000. 6. Sprinklers 8,000. 7. Electrical 40,000. 8. Plumbing 20,000. 9. HVAC 5,000. 10. Miscellaneous carpentry 5,000. 11. Drywall repair 10000. 12. Concrete work 6,000. 13. Paint 10,000. 14. Carpet 10,000. 15. Roof curb removal 5,000. 16. Roof repairs 10 000. 17. Dumpster and final cleanup 5000. 18. Supervision 5,000. Subtotal 200,000. Overhead and profit 30,000. Total 230,000. 395 Main Street Salem, New Hampshire 03079 12 Rogers Road Wardhill, Haverhill, Massachusetts 01835 Telephone: (603) 894-4952 (978) 374-0034 Fax: (978) 373-6944 Construction Control Affidavit Project: 85 FLAGSHIP DRiVE Project Number: 60420 Interior Improvements to Suite G, H and J North Andover MA Date: June 27, 2008 In accordance with 780 CMR (Commonwealth of Massachusetts Building Code) Section 116.0 Construction Control, and specifically Sections 116.2.2 Architect's I Engineer's Responsibilities during Construction and 116.4 On Site Project Representation, I . .......................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 I will 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: 38 Essex Road, Ipswich, Massachusetts 01938 - 2532 electronic: kocha rchitects,00verizon. net telephone: 1.978.356.5065 facsimile: 1.978.356.6056 Building Departmentti1 Client - Architect Contractor / Field BOARD OF'BUILDIN ,REGULAtl6NS License: CONSTRUCTION SUPE,RVIOR I� Numbe f bS 045263 iBirthdate 09/14/y1956 iL r; i �Expres 09J1A/2008 Tr.'no:"2161:0' f Restrict 009 WILLIAM L SCHF EIt� 33 SOUTH RIVER fE1IusSF�'%,(' HAVERHILL, MA 01`895 coni missioner i V� m x m e m x m mm _v, F C � — d CA Cl) O CD O Z y CD CO LC!� r Poo CL c O y aCo -0 �- C v CD CD o Q �dCD CCD o CD C CD y. 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