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HomeMy WebLinkAboutBuilding Permit #66 - Suite 100 7/25/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: r Date Issued: 71a$'1—d 7 MSP 1?1CJ®: ZtON1NI G Date Received must complete all items on this page v'tt�eo ,6 M, *t__� «z r V16.7 c 1• t I'RICT : w #-1IS onc, Disfinat yes no c' ine Stop Villarae jYw ves ' r iMa TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial vAlteration No. of units: I. -Commercial Others: Repair, replacement Assessory Bldg Demolition Other Septic 1 ellg Floodpla n Wetlands:`: V1/atershed. Dis#riot .:',Water/Saruex . utat Klr i wry Ur VVUKK I U t3E PREFORMED: �i s lG Identification Please Type or Print Clearly) OWNER: Name: ?,4A©P; LLC- Phone: `i76 Address: YS -1 r� p0001 S ;- ^104 ra A" 26Vc,-- ��ss CONRP►CTfl12 Name a�ssc�r C�s,n�.,r:�Phone� �'. Address, , '��� � -� �.,.� +, �. - 1 � W ,,rt c,�, , J Superansor's Cons#r�ict on'L�c+erie G7': F�cp Date Hpme lrnprovementIcense ARCHITECT/ENGINEER J .K ►t'l i rci4CLL Assoc,,,r5 xZ�cPhone: 6 ! rl 5-65--X33 `7 Address: Z 3Z 6 !Jc`L5tA S , ., fAs, 3asro,✓ft14 Reg. No. Z-5-6 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: $ Ara, / O n FEE: $ Ci 7 Check No.: l 2 Receipt No.: 4'2 f NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fj ysl Location M �Oyf� No. C6 Date7 ZS- a 7 NORTH TOWN OF NORTH ANDOVER F A. Certificate of Occupancy $ 49 'I'�s'••° tt�' s�cNus Building/Frame Permit Fee $ F7— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #°2y O% 1 1 2042.) PbildingInspector I I /Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer 1/ 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 DATE APPROVED PLANNING & DEVELOPMENT COMMENTS 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 DrivewavPermit Located at 384 Osgood Street .. . FAREEPAR�"MENT po wLocated.at 12 4 Ma7iri:Street F11re De artrnEratesiignaturelda#e _. _ .. 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 i 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 o 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 ❑ m~£eftffied-P+9P Plot Plan �AM -(:—+ s Tom, 4-- • -❑ Photo off. 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 O u o w v cn Cd o C7 CQ b O w C O g2 v q C U C is. a o v a a C p w' G w x 0 w utz W p w sur y CA G tj, p p a G w w W ami co z cn o cn D J =m c O `" U C Ls Cc e,• O C wq' cc O J: 0 CJ d C CD �► E a Cl) m Cl) H t/ COD $ c US z ca ,o m 4\ cc.), �. O �, :E CLU m� a ..m CO �+ y CO Cl) Z +- N Cm v/ M= z c p O w U cm m O c LCD p Cl) �' = � cm�C C C w O 0 N Q w O V NCD O Z c 8 o c Q � y m c o = m O. ca LLI F" 'O,, z ,..cc .y Cw�- Z ac �E e N o HCM a m o i-- = w J2 ` H p i- f- t $ L. 12 f W, U O 0 v i O O c L O z °' CL O y D C e co cm CO2 O CD O .O �E m Co CL �� 3� CD CD O OL O O d CL cma CA c Q Cc C C FL cl CDv C CD 40 CL V y O C CL C CO2 D Tgi s d;j/i °rAIA®ocurrn g mt Al05TM -1993 Standard Form of Agreement Between Owner and Contractor for a Small Project where the Basis of Payment is a STIPULATED SUM This AGREEMENT is made: August 01, 2007 (Date) ADDITIONS AND DELETIONS: The author of this document has BETWEEN the Owner: added information needed for its completion. The author may also Dr. Calhoun have revised the text of the original 451 Andover Street AIA standard form. An Additions and North Andover, Ma. Deletions Report that notes added information as well as revisions to and the Contractor the standard form text is available from the author and should be CAISSON CONSTRUCTION CORPORATION, reviewed. A vertical line in the left 209 WEST CENTRAL STREET (suite 104) margin of this document indicates NATICK, MASS 01760 where the author has added necessary information and where for the following Project: the author has added to or deleted from the original AIA text. Doctor Calhoun Office (suite 100) This document has important legal 451 Andover Street consequences. Consultation with an North Andover, Ma attorney is encouraged with respect to its completion or modification. ' The Architect is: John Kendal Mitchell & Associates, Inc 232 Chelsea Street East Boston, Ma 02128 The Owner and Contractor agree as follows. AIA Document A105TM —1993. Copyright ©1993 by The American Institute of Architects. All rights reserved. WARNING: This AIA® Document is protected by U.S. Copyright Law and International Tren:ies. Urtzjthorized reproduction or distribution of this Ale Document, or any portion of it, may result in severe civil and criminal penalties, and ur�'i be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 16:05:31 on 07/24/2007 under Order No. 1000270175_1 which expires on 11/15/2007, and is not for resale. User Notes: (4241587310) ARTICLE 1 THE CONTRACT DOCUMENTS The Contractor shall complete the Work described in the Contract Documents for the project. The Contract Documents consist of: .1 this Agreement signed by the Owner and Contractor; .2 AIA Document A205, General Conditions of the Contract for Construction of a Small Project, current edition; 1 3 the Drawings and Specifications prepared by the Architect, dated July 23, 2007 , and enumerated as follows: Drawings: Number Title Date see attached Specifications: Section Title Pages N/a 4 addenda prepared by the Architect as follows: Number Date Pages n/a .5 written change orders or orders for minor changes in the Work issued after execution of this Agreement; and .6 other documents, if any, identified as follows: n/a ARTICLE 2 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION DATE The date of commencement shall be the date of this Agreement unless otherwise indicated below. The Contractor shall substantially complete the Work not later than ( 15 ) days , subject to adjustment by Change Order. (Insert the date or number of calendar days of�er the date of commencement.) The date of commencement shall be the later of 1) the receipt of a full bldg permit and /or 2) the date the tenant I space has been vacant by the previous tenant. The 15 day period excludes the reception desk. + ARTICLE 3 CONTRACT SUM § 3.1 Subject to additions and deductions by Change Order, the Contract Sum is: Eight Thousand One Hundred Dollars and Zero. Cents ($ 8,100.00) § 3.2 For purposes of payment, the Contract Si -n includes the following values related to portions of the Work: Portion of Work Value ($ 0.00) § 3.3 The Contract Sum shall include all items .;nd services necessary for the proper execution and completion of the Work. ARTICLE 4 PAYMENT § 4.1 Based on Contractor's Applications for Payment certified by the Architect, the Owner shall pay the Contractor as follows: (Here insert payment procedures and provisiw?s for retainage, if any.) Upon execution of the contract $2,500. Balanc:° at substantial completion of the work. (No Retainage) AIA Document A105TM —1993. Copyright ©1993 by The American Institute of Architects. All rights reserved. WARNING: This Ale Document is protected by U.S. Copyright Law and International Treaci,>>. Unauthorized reproduction or distribution of this Ale Document, or any portion of it, 2 may result in severe civil and criminal penalties, and w ,! Ce prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 16:05:31 on 07/24/2007 under Order No -1000270175_1 which expires on 11/15/2007, and is not for resale. User Notes: (4241587310) § 4.2 Payments due and unpaid under the Contract Documents shall bear interest from the date payment is due at the rate of Eight percent ( 8.00% ) per annum , or in the absence thereof, at the legal rate prevailing at the place of the Project. (Usury laws and requirements under the Federal Truth in Lending Act, similar state and local consumer credit laws and other regulations at the Owner's and Contractor's principal places of business, the location of the Project and elsewhere may affect the validity of this provision.) ARTICLE 5 INSURANCE § 5.1 The Contractor shall provide Contractor's Liability and other Insurance as follows: (Insert specific insurance required by the Owner.) Type of insurance Limit of liability ($ 0.00) General Liability $2,000,000.00 Worker Compensation $500,000.00 § 5.2 The Owner shall provide Owner's Liability and Owner's Property Insurance as follows: (Insert specific insurance furnished by the Owner.) Type of insurance Limit of liability ($ 0.00) N/a § 5.3 The Contractor shall obtain an endorsement to its general liability insurance policy to cover the Contractor's obligations under Section 3.12 of AIA Document A205, General Conditions of the Contract for Construction of Small Projects. § 5.4 Certificates of insurance shall be provided by each party showing their respective coverages prior to commencement of the Work. ARTICLE 6OTHER TERMS AND CONDITIONS (Insert any other terms or conditions below.) IPrice excludes all painting and carpeting ( by owner) The reception desk shall be an extra to the contract. The owner has the right to self perform this work. This Agreement entered into as of the day and year first written above. (If required by law, insert cancellation period, disclosures or other warning statements above the signatures.) i. OWNER (Signature) CONTRA OR (Signature) Dr. Calhoun David Drinkwater, President (Printed name and title) (Printed name and title) LICENSE NO.: JURISDICTION: AIA Document A105TM —1993. Copyright ©1993 by The American Institute of Architects. All rights reserved. WARNING: This Al a Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlAe Document, or any portion of it, 3 may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 16:05:31 on 07/24/2007 under Order No.1000270175_1 which expires on 11/15/2007, and is not for resale. User Notes: (4241587310) �T,m A Scope of Work Dr. Calhoun Office Create new exam room. Drywall partitions to underside of existing ceiling. Furnish and install new door. 2 Remove existing closet in front room Install new reception desk in the same location as closet 4 Install new outlets in new exam room and at reception desk ( 4 double duplex in total) Install new wood base in match existing at the new exam room. Scope of Work Dr. Calhoun Office Create new exam room. Drywall partitions to underside of existing ceiling. Furnish and install new door. 2 Remove existing closet in front room 3 Install new reception desk in the same location as closet 4 Install new outlets in new exam room and at reception desk (4 double duplex in total) Install new wood base in match existing at the new exam room. ✓;ze �anvi�wauueczCC� o�' /jlaa acJucae Board of Building Regulations and Standards Construction Supervisor License License: CS 96797 ` Birthdate: ., -7/10/1955 Expiration ;7/10/2010 Tr# 96797 Restriction = 00 BRUCE JAFFIN 179 PINE STREET MEDFIELD, MA 02052 Commissioner The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone 0 am a homeowner performing all work myself. F1 I am a sole proprietor and have no one working in any capacity 1 4- I I am an employer providing workers' compensation for my employees working on this job. Company name: C© fJ SM Uci70 CO2p . Aririrpcc �� �l � S ; l— Ll�`� �?w� �'i (Zi T1s 1 0 y Citv: Npi n cj < r ni► S S Phone #: 305 C S3 it� 760 Insurance Co. lADUT ?5vog- Policv # kle-V 6o"713600 Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of Signatu the information provided above is true and correct. Print name 13VZJt( �APhone#1 516-07-l0S1 Official use only do not write in this area to be completed by city or town official' ❑ Building Dept F1 Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION ACORD CERTIFICATE OF LIABILITY INSURANCE OP IDS? DATE (MNADDKYYY) 1 CAIss 1 07/17/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I TYPE OF INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NorthStar Ins. Services, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 65 Walnut Street Ste. 380 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wellesley MA 02481 Phone: 781-431-2500 Fax: 781-431-6134 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A, Maxum Indemnity Company INSURERS: Atlantic Charter Insurance Caisson Construction GLP600507301 COrporatlon INSURER C: . wed ty C- n209 INSURER D: Peerless Insurance Company 209 West Central St Suite 104 Natick MA 01760 INSURER E: COVERAGES THE POLICIESOF INSURANCE LISTED BELOW HAVE BEEN ISSUEOTO THE INSURED NAMEDABOVE FOR THE POLICYPERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED ON MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBRIDOL LTR NERD I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE LATE RAWDDYYI POLICY EXPIRATION DATE(MRMDIUM LIMITS GENERAL LIABILITY EACH OCCURRENCE f 1,000,000 A R COMMERCIALGENERALLIABILITY GLP600507301 10/19/06 10/19/07 DAMAGE TO RENTED PREMISES (E. s 50,000 MED EXP (Any oro person) f 5,000 CLAIMS MADE F OCCUR PERSONALSADVINJURY s 1,000,000 GENERAL AGGREGATE f 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGG f 2,000,000 R6 POLICY JECT Ll LOC Al1TOMOBILE LIABILITY ANYAUTO F:A8085C71506SEL 10/19/06 10/19/07 COM SINEDSINGLEUMIT f 1,000,000 (Ea °'�°°'") BODILYINJURY f (Pa M—) C $ ALL OVVNED AUTOS SCHEDULEDAUTOS BODILY INJURY f X HIREDAUTOS NON -0 NEDAUTOS PROPERTYDAMAGE f (T -ddv ) GARAOEL! ILITY AUTOONLY-EAACCIDENT f OTHER THAN EA ACC f ANY AUTO AUTO ONLY: AGG S EXCESSUMBRELIA LIABILITY EACH OCCURRENCE S 2,000,000 A OCCUR ❑ CLAMMSMADE TO BE ISSUED 07/02/07 10/19/08 AGGREGATE s 2,000,000 f f DEDUCTIBLE f X RETENTION $10,000 8 VVORIERS COMPENSATION AND EMRS PLOYELIABILITY OP ANY PRRIETOR/PARTNERrEXECUTNE WCV00743800 10/20/06 10/20/07 x VVC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE EA EMPLOYEE S 500,000 OFFICERMEMBER EXCLUDED? If yes, deauae ~ E.L DISEASE -POLICY LIMIT f 500,000 SPECIAL PROVISIONS ENow OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED By ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION DR. CALH SHOULD ANY OF THE ABOVE DESCRISED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER VNLL ENDEAVOR TO MNL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Dr. Calhoun IMPOSE NO OBLIGATION OR LIABILITY OF ANY NIAID UPON THE INSURER, ITS AGENTS OR 451 Andover Street,Ste.100 North Andover NA 01845 REPRESENTATIVES. AUTHOR®REPRESENTATIVE Edward B. Pierce Jr. ACORD 25 (2001108) ©ACORD CORPORATION 1988 P 0 Date................ .............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 5t.`. t' .`. � '�''2.! % ............. .... ...................... .... ............................ has permission to perform %� l.. � "�' ............................................................................... wiringin the buildingof !n ./ � `� ` ` ? at.......................................................................... ,North Andover, Mass. ..l�5^�Fee......G...Lic. No. .... ELECTRICAL INSPECTOR Check # 755! Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only r Permit No. Occupancy and Fee Checked [Rev. 11/991 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: iF --6- O City or Town of: 4, j05�p* day •+e r 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) yf / 4,1 J O d C f- .11 a- /00 Telephone No. fj 7s' ,2 0.7079% Owner or Tenant Owner's Address %J Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 444 y rf'6J .Iasi.. �1. Completion of the ollowing table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency ig ing Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals:........................Detection/Alerting Number Tons KW No. of Self -Contained Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances g pp Kms' Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liabil- ity 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 X BOND ❑ OTHER ❑ (Specify:) General Liability 12\12\0§47 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. 1_ V 9v FIRM NAME: STALCO Inc. LIC. NO.: Licensee: Signature _—Stamen A&tea—ndry LIC. NO.: (If applicable, enter "exempt" in the license number line.) 001Bus. Tel. No.: 978-459-9139 Address: 850 Lawrence St. Lowell MA 01852 Alt. Tel. No.: 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. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No.