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HomeMy WebLinkAboutBuilding Permit #726 - 859 TURNPIKE STREET 5/19/2010BUILDING PERMIT 0 -TUIo 16 16 q~C TOWN OF NORTH ANDOVER 3? 4._:'` .`_ `.. APPLICATION FOR PLAN EXAMINATION ~ Permit NO: Date Received 4 � � �SSgCHr15�� Date Issued- /'7 IMPORTANT: Applicant must complete all items on this page LOCATION j �-- Flint PROPERTY OWNER G Print MAP 210 �rf�?L 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 r/ No. of units: Commercial r/ Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE -PREFORMED: Identificatio Please Type or Print Clearly) OWNER: Name: fl 6- LUG Phone: qIY Address: CONTRACTOR N Address: rl ' A, &G7— / Supervisor's Construction License: 5 `6, Exp [�- Home Improvement ! P yr/ Date: Date: ARCHITECT/ENGINEER Pl LC/CCo %����1/SGS /4/(-, Phone: 2P 1�4 ?-'J00r' Address: �6 �� C J�� %f1C2-�0�(�,�'%� a 7�1 16 Reg. No. 120 3 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: $ 0 0 Check No.: 0�-/15a Receipt No.:�/� y NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owne ignature of contractor Plans Submitted Plans Waiveq 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 HEALTH COMMENTS 41 DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumoster on site ves nn Located at 124 Main Street Fire Department signature/date COMMENTS 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 ❑ Notified for pickup - Date .................. .................. .................. ....................... _... ................. _.............. .............. ........ ................... ....._...................__............ .................................... ........ _...................................................................................................................................................................................................................................... Doc.Building Permit Revised 2010 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 o Building Permit Application ' ❑ Celified Surveye C6Pz> L Cor�,j j, ❑` 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) ❑ Masse 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: Building Permit Revised 2008 Location `" , ` No. ;� IIIt el -- 1774 -- Date NORTry TOWN OF NORTH ANDOVER Of.ao :a'�qe • OL Mi > ; : Certificate of Occupancy $ s�CMust Building/Frame /Frame Permit Fee 9 $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check Jl 23 1 x/4 A Building Inspector ACORDM CERTIFICATE OF LIABILITY INSURANCE 05/19/2 0) PRODUCER (781)890-3740 FAX (781)890-1198 Paul Burrage Incorporated 460 Totten Pond Rd, suite 630 Waltham, MA 02451-1965 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 # INSURED Farmcrest Corporation PO Box 583 Lexington, MA 02420 INSURERA: Essex Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: nAVFRAnPA 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. DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 3DD3446 03/12/2010 03/12/2011 EACH OCCURRENCE $ 1,000,000 rA X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED AnrA�$ 50,000 CLAIMS MADE 7 OCCUR MED EXP (Any one person) $ 1,00( ff PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,00( X POLICY PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC S LIMIT OTH- EMPLOYERS'UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Town of North Andover 1600 Osgood Street North Andover, MA 01845 ACORD 25 (2001108) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INS AUTHORIZED REPRESENTATIVE Lou Fi ITS AGENTS OR REPRESENTATIVES. )21'.7 d"... ©ACORD CORPORATION 1988 O cd � O - c o O go O cca a W o � o z � w ' O ' a a o as U w iaw w w n°' cn w C7 MD cu° ca w w cA o V) o cn �911.' 4.4 • r.a co O co O � w Z CD G. O y CD cm p c CO2 p 'C A O O �E m m 0- ~ �+ O � CD � O cc 0 a a- cmcx c oca CD = c �O. O .0.0 C CD V CO) O C C fr � C d 0 0 N LLI U) W W 19 'WA _/ c o go cca o � O y ' yr C O CJ V ;Qc Cc M m c 0 o � CD �EQ CE ms m •� m O O c r m c cmc m m 3 = V : CA CMm +-' y \y, ,ca = C y fA �p y O r+ \ w = E v CLU ' y mcm m C h Q '8 •O CL �lCi N O O +..� CD c Q O C, c •p Q i i m C x ~ m r0+ :m3 CO w m COD Wuj cc L m .�.. � .m m •y O C-7 o ® C c COD n m P o .0 � om x a CRS 5 �911.' 4.4 • r.a co O co O � w Z CD G. O y CD cm p c CO2 p 'C A O O �E m m 0- ~ �+ O � CD � O cc 0 a a- cmcx c oca CD = c �O. O .0.0 C CD V CO) O C C fr � C d 0 0 N LLI U) W W 19 'WA _/ Farnmcrest Corporation Proposal The MNE LLC 859 Turnpike Street North Andover, MA 01845 May 19, 2010 We propose to perform construction at 859 Turnpike Street, North Andover, MA 01845 according to plans by Di Lullo Associates dated May 18, 2010 and in compliance with State and local building codes. Scope of work to include the following: Secure all necessary permits. Perform demolition, remove debris off site. Infill office walls, relocate office wall, cut in new door opening. Re -switch lighting, add four duplex outlets. Remove two toilets and lavatories,furnish and install one new toilet and lavatory. Remove and replace base and wall cabinets in kitchen area Paint entire area. Remove and replace carpet and base. Contract Price $ 16,000.00 ,proposed: _,.. i John M Lucente Accepted: "Icz el Kristin A Nordahl P.0 Box 583, Lexington, MA 02420 Phone & Fax 781-863-1090 i '.v e Massachusetts - Department of Public Safety Bo: t -d of Building; Regulatifts and Standat-ds Construction Supervisor License License: CS 16466 Restricted to: 00 JOHN M LUCENTE 71 FARMCREST AVENUE LEXINGTON, MA 02421 Expiration: 9/15/2011 Commissioner Tr#: 2008 The Commonweaith o fMassachusetts Department of Industrial Accidents Office of rnvesiigadons IV 600 N,ashinpon Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name (Business/Organizatim/individual):_ I/ t✓� /(�� r Address: �7 .S`(i'-) -3 City/State/Zip: /V Gam/ 1C.: Phone #• Are y an employer? Check a appropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. [] I am a sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insuranCe 5. ❑ We are a corporation and its required.) officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6_ ❑ Neu, construction 7. LJKemodeling 8. EJ Demolition 9. M Building addition 10. F-1 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑'Roof repairs 13.❑ Other. -�-= —_ —.—.—••.• .•.•.......,.+., -..v ,.,. Vci e.ae scr-nan ne.'ON' anOV'%"-9 thc'• work=' eOMF ^...s° iVn POlivi innz1ion. ' homeowners who submit ft's affidavit indicating they are doing all work and thm hire outside contractors must submit a new affidavit indicating such. +Contractors that chat] this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. Pow' information. I am an employer that is providing workers' compensation insurance for my employees. Belo information w is the policy and job site / Insurance Company Name:/UT��r✓ Policy # or Self -ins. Lic. #:_ 7U 72, _ (2 162 ��,, ,,/n / Expiration Date: Job Site Address:ko Z)apli, ��. City/State rzip:6l%dl, O/�� _ 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 ofMGL 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 cov ge verification I do here c nder the p p ' s of feriu -the information provided above is true and correct Sisnature: / U Phone #: F661,ssoOnther l use only. Do not write in this area, to be completed bj, city or sown official Town: Permit/License # ;Authority (circle one): d of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5. Piumbinb Inspector Contact Person: Phone #: ;• OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER '•�.'` :f� CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: PROJECT LOCATION:` NAME OF BUILDING: NATURE OF PROJECT: M I oop. ) y► T -E? -i 00- ?=E 0 //1 i 10 U IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, REGISTRATION NO. &0 ij:?2 BEING A REGISTERED PROFESSIONAL ENGINEER)ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT 0 ARCHITECTURAL I STRUCTURAL 0 MECHANICAL 0 FIRE PROTECTION 0 ELECTRICAL 0 OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. 1 FURTHER CERTIFY THAT 1 SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the 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. PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, 1 SHALL SUBMIT A FINAL REPORT AS TO E SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCU A�VCY. SkPATURE SUBSCRIBED AND SWORN-TO'I§EF0RE.P�E 1r'14IS DAY OF NOTARV PUBLIC MY COMMISSION EXPIRES ' a 7