HomeMy WebLinkAboutBuilding Permit #032 - 85 FLAGSHIP DRIVE 7/25/2006 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION of"O DT 6 gtio
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Permit NO: Date Received �fit
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Date Issued: --2,C-fA°q�ro P.? 4y
�SSACNUSS�
IMPORTANT: Applicant must complete all items on this page
LOCATION
/ 413-1 •nt
PROPERTY OWNER` � �° �J� s f�/� 4 -
Print
MAP NO.: /0 • C: PARCEL: ZONING DISTRICT: / Ax,5
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building ❑One family
❑Addition ❑ Two or more family ❑ Industrial
VAlteration No. of units:
❑Repair,replacement ❑ Assessory Bldg ❑ Commercial
❑Demolition
❑Moving(relocation) ❑Other ❑ Others:
❑Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
76,-
Identification Please Type or Print Clearly)
OWNER: Name: _ i,��Z fG ° �� ,�p-9 S��d .�.��C Phone: 97e- 3z(Z01
Address: 12
CONTRACTOR Name: r `' k4hone: 9)r-,
Address:T_/J� c!
T�
Supervisor's Construction License:_02 A Cl 7 . Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER 0 Name: Phone: �—Z
Address: ,`�� 'SSP 5� 1 ' ' �� 7M4. Reg. No. 5 S1�
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S F.
Total Project Cost:$ /q, x12.00=FEE:$
Check No.:
1®b Receipt No.: 2�
Page 1 of 4
Location ��4C Ch•, A 7r�,�
No. Date
Ti, TOWN OF NORTH ANDOVER
9
+ Certificate of Occupancy $
CMU Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ ,
TOTAL $
Check #
5 27 0 U uilding Inspector
TYPE OF SEWERAGE DISPOSAL Swimming Pools 11Tanning/Massage/B Art ❑
Public Sewer ❑ ❑
Tobacco Sales Food Packaging/Sales ❑
Well ❑ El
Dumpster on Site
Private(septic tank,etc. ❑ .Electric Meter location to
project
NOTE: I Persons contracting with unregistered contractors do not have access to th4guarantyfun
Signature of Agent/Owner Signature of contractPlans Submitted ❑ Plans Waived ❑ Certified Plot Plan Eled Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING& DEVELOPMENT ❑ ❑
❑Water Shed Special Permit
i
❑ Site Plan Special Permit
❑ Other
COMMENTS
f
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/Si2nature&Date Driveway Permit n
TempDum ster on site yes—no Fire Department signature/date
- I
I
L
I
I
Building Setback (
Front Yard Side Yard Rear Yard
Re wired Provided Require Provides Required Provided
Dimension
Number of Stories: Total square feet of floor area,based on Exterior dimensions.
Total land area,sq.ft.:
NOTES and DATA— For department use)
'I
Page 3 of 4
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC.Jan.2006
i
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be
obtained.
1 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
Addition Or Decks
❑ Building Permit Application
'❑ Surveyed Plot Plan
❑ Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
d Copy Of Contract
Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculationslicable If Applicable)
pP )
❑ Mass check Energy Compliance Report (If Applicable)
j New Construction (Single and Two Family)
❑ Building Permit Application j
❑ 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
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
i
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
PROP 4 of 4
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Commonwealth of Massachusetts Official Use Only
Permit No. Z7j
Department of Fire Services
( Occupancy and Fee Checked
F' BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -i - -i -o6
City or Town oh 9'14-JO /cy To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) $5 Kct!g l .z r- x j� 0
Owner or Tenant cc'.' ';. Ac Telephone No.G\lk- Ilk-0QVJ
Owner's Address r,
Is this permit in conjunction with building permit? Yes Ff No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
i
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ago o,w a reletd e�- (�e c) scc.
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans r Total
Transformers KVA
• No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of LuminairesSwimmin Above In- o.o Emergency Lighting
g g Pool rnd. El In- ❑ Battery Units
No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of SwitchesNo.of Gas Burners No.of Detection an
LA Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons No.o Self-Contained
Totals: Detection/Alerting Devices
No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances Kir Security Systems.
No.of Devices or Equivalent
No.of Water KW No.o No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
.• No. Hydromassage Bathtubs No.of Motors Total HP Te eco o f Deviceso r Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work)(1-0 0-CIO (When required by municipal policy.)
Work to Start: 'I--l 0 6 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [�— BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NA �wwrc =��c�r: S.. LIC. NO.:
Licensee: 4 ,� Si h nature LIC. NO.: t23z
fS g 3
(If applicable,enter "exempt"in the license number(ine.) Bus.Tel. No.:R 11-311-S 81'1
Address: GS AaC13 ILI 4c"/- Lc,. Alt.Tel. No.:SON-:CgC=gl1`c2
*Security System Contractor License required for this work; if applicable,enter the license number here:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. 1 am the(check one)❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $
, � c(,C 7 a Y-0
Location
,
No. f'a' Date
1401ITk TOWN OF NORTH ANDOVER
AL
C?O:t . o .•,epos
`• : ; Certificate of Occupancy $
Building/Frame Permit Fee $
s�CHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL .-
Check #
'� 1' Building Inspector
MOT1
F �
+�oy�+tom�«�f!•
•1JgA�6[ .
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 803 (6/15/2006) Date: July 26, 2006
I
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 85 Flagship Drive
MAY BE OCCUPIED AS Tenant Fit un - Unit D IN ACCORDANCE WITH THE
PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH
OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: Bay State Anesthesia
85 Flay-shin Drive
North Andover MA 01845
rtisl-w3�
H
Building Inspector
i
i
{ NORTH
Town of sAndover
No
C"O LA dower, Mass.,
I� COCMICMEWICK
7�A�RATED
`S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
• • BUILDING INSPEC'T'OR
THIS CERTIFIES THAT �. r`d .... /� ...�'.... .� �... �ir •
Foundation _
has permission to erect........... ........... buildings on.�.'.S ��. ...�/' ,(I *^ 00Rough_
to be occupied as......0 .... ........h ..... '.....` .a � ���' ........:................... .. .� chi
provided that the pe accep
Ing this permit shall in every respect conform o the terms of the application on file In Final..._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. PLUMBING INSPECTOR
1 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN b MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIOTS Rough ,
.... . ... ....... .......
Service
BUILDING INSPECTOR
1 7
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal
No Lathing or Dry Wall To BeDone FIRE DEPARTM ' v
Until Inspected and Approved by the Building Inspector. Burner V
Street No.
1J
SEE REVERSE SIDE Smoke Det.
� NORTy
Town of over
No. a 3 z �.�
.w....
1 4
0 *0dover, Mass.,
COCHICMEMCK
ADRATE D PPS` �C-1
RMITPE `s E BOARD OF HEALTH
Food/Kitchen Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT...............a., ...... .4.;.Skip..... .......
................................................................... Foundation
•
has permission to erect........................................ buildings on ...... 5..... +.�C. ..a40. .................................... Rough
to be occupied asa_14.1kobt.A.�p.....10.4 HI.�j.......�r..... ��. �.............................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
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. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRU N STARTS„ Rough
...... ... ........... ...... ........... ...................... ..................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Require to Occupy Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.
Construction Control Affidavit
Project: 85 Flagship Drive Project Number: N/N
IMPROVEMENTS to SUITE C
North Andover MA
Date: July 19, 2006
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,
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 maybe 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: tttED �
' `NE R
QP
I y
O J
OF ate..
Distribution: Building Department
Client
Architect
Contractor/Field
38 Essex Road, Ipswich, Massachusetts 01938-2532
electronic: kocharchitects®verizon.net
telephone: 1.978.356.5065 facsimile: 1.978.356.6056
i
FROM :M.P. Roberts Insurance FAX NO. :19786833147 Jun. 26 2006 10:06AM P1
ACORO-- CERTIFICATE OF LIABILITYDATE(MMIDDM/VY)INSURANCE 06 26 20
rrtonucrrt 06
THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION
M.P.ROBERTS 1I14SURANCE AGENCY INC, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
:.060 OSGOOD 'STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
NORTH ANDOVER MA 01845
978-683-8073 INSURERS AFFORDING COVERAGE NAIC#
_. _.
{NSVRED SCOTT CONSTRUCTION CO. , INC. INBIIRER A: .ACE INSURANCE
SCOTT COMPANIES IN_lTrR B: •,,,HANOVER INSURANCE
12 ROGERS ROAD INe1,RFR c: E
HAVERHILL, MA 01835-6925 INBURERO: AIM MUTUAI. INSURANCE COMPANY !� _
IN8URER E: HANOVER INSURANCE COMPANY
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE RFEN ISSUEDTO THE INSURED NAMED MOVE FOR THE POLICY PERIOD INDICATEn•NOTWITHS'T'ANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITI RESPECT TO WHICH'THIS CERTIRICATC MAY DE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DCSCRIRFn HRRRN IS SUBJECT TO ALL THE TERMS,CXCL(MIONS ANU CONDITIONS OF SUCI I
POLICIES.AGGREGATC LIMIT$SHnWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
--' _.... ...— ..
INBR Tri' POLICY EFFECTIVF PQLICYUXPIRATION
Lm Ncno TYPE OF INSURANCE POLICY NUMBER DATE MIDDM DATE M/DD LIMITS
QENERAL LIABILITYI EACH OCCURRENCF L 1 O O O'Q O O
XCOMMERCIAL GENERAL.�LIAB�IL1)AMA'(7[TA'
ITY t`RFMISL"_{h[e tx curence) � 50,000
CLAIMSMADE I X I UC;f;IJri MED EXP(Any Olin poisorO ..... S 5,000
_ 621983706 09/01/05 09/01/06 PENUONAL&AOV INJURY $ 1,000 "600
GENERAL ACCRECATF. S 2,000.f.000
e.;ENL Af(:RL(+API:UI MI1 AMILIES PER: PRCr11X)TR-(:)MH101-AUG s 2,000,000
POLICY PRO•
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GUNII?INUO KINGLG LIMIT S
ANYAUTO (Eq,Ifa:pinpl) 1,0 0 0 1,0 0 0
ALLOWNEDAUTOS ._ _ •- -
BODILY INJURY
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s X HIRED AUTOS AHN805005020 12/1/05'5 12/1/06 m,,I.YINJIMY
X NCN-OWNFDAlITOS (I'erncclflent) 3
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GARAGE LIABILITY AUTO ONLY.EAACCIDF•NT $
... ANYAUTO �... ..
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D OPHGL•II/,MmfwnGXCLUUL'07 WMZ 8005435012006 03/06/06 03/06/07 L.L.UIGFAUt-EA EMPLOYEE 8 1 ,000,000
Ifyoc,flovAbounflor - 1,000.1000 SPECIAL PROVISIONS WOW F,I,MAFARF-POLICY LIMyI I 5 O O 0 0 0
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DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES I EXCLUSIONS ADDF.O RY FNCOREFMFNTI P.r`ECIAL PRQVICIONB
CHAMPAGNE REALTY TRUST IS LISTED AS ADDITIONAL, INSURED IN REGARDS TO TETE
GENERAL LIABILITY POLICY FOR WORK PERFORMED AT CHAMPAGNE REALITY TRUST,
85 FLAGSHIP DRIVE, NORTH ANDOVER, MA 01845
CERTIFICATE HOLDER CANCELLATION
f 1-10111 0 ANY DI'T NC ABOVE DESCRIBED POLICIES.RF 6ANOM I FU I1LI;QIiL I'I IL-EXPIRATION
CHAMPAGNE REALTY TRUST
P.O. BOX 101 DATE THEREOF,THE ISSUING IN8I1RFR WILL LNIDUAVON TO MAIL 10 DAYS WRITTEN
BYFI4LD, MA 01922 NOTICE TO THE CCWI IFIUATC 110lDr_R NAMM To TIu IxFT•PI IT FAILI IRE TO 00 d0 HALL
IMPOSE NO OBLIGATION OR LLA8I.ITY OF ANY NINU IJP uN'I I IL'INGLIRER,R3 AGENTS OR
I IY,pngrvN I' IVlr•.
AUTHORIZED F ATIVF m�""I"I ���✓
ACORD26(2001108) %�ACORD ORPORATION 1988
Cott
truc 0., Inc.e
10
July 25, 2006 DIVISION OF SCOTT COMPANY
Eighty-Five Flagship, LLC
Attn: Paul Westcott
85 Flagship Dr., Unit C
Proposal for Renovations of Unit C, at 85 Flagship Drive, N.Andover, MA
1. Permit.
2. Plans.
3. Frame walls using 2x4 wood studs, 3 '/2" fiberglass insulation and 5/8" fire
code drywall per plans.
4. Install 3 doors—3 x70 with hinges and locksets.
5. Stairs—to build per plans.
6. Paint—prime and paint 2 coats using latex eggshell paint.
7. Electrical—install 2 bathroom fans and re-switch lights on the first and
second floor.
8. Plumbing—install 2 toilets, 2 lavatories, one 6 gallon water heater.
9. Sprinklers—to install 2 additional heads in men and ladies room.
10. Flooring—install VCT tile in the men and ladies room and direct cement
carpet in the first floor office only. Second floor to leave as is.
11. Clean up and removal of debris.
12. Supervision.
Total $23,500
395 Main Street Salem, New Hampshire 03079
12 Rogers Road Wardhill, Haverhill, Massachusetts 01835
Telephone: (603)89474952 (978) 374-0034 Fax: (978) 373-6944
-cott
ori(Structiort Co.,Inc.
..aKN CE'.'r:41T i:GMPAHr
Page 2: Eighty-Five Flagship, LLC Proposal, 7/25/06
We Propose hereby to furnish material and labor — complete in accordance with the
above specifications, for the following:
Twenty-Three Thousand Five Hundred Dollars $23,500
The above-proposed prices are valid for 30 days from the date of this proposal. After 30
days,prices are subject to change.
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above
specifications involving extra costs will be executed only upon written orders, and will
become an extra charge over and above the estimate. All agreements contingent upon
strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other
necessary insurance. Our workers are fully covered by Worker's Compensation
Insurance.
Acceptance of Proposal - the above prices, specifications and conditions are satisfactory
and are her ccepted. You are authorized to do the work as specified.
Owner : & Contractor- Scott Constructi o.;
ignature Signature:
Date of Acceptance Date CQ
I
,BOARD OF BUILDING PN
License 'CONSTRUCTION SUPERVISOR
_ ►Vumber,�C$
026517
` Bihhdafe O j j0J1954
Izprres1/04/20'08 Tr.no: 14250
MAURICE C MIGHAUD �
28
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`METHUEN A: 1844
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