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HomeMy WebLinkAboutMiscellaneous - 35 FLAGSHIP DRIVE 4/30/2018Location `� ICc r 5jL -,.o 1 /1-r C" \i Date 16 TOWN OF NORTH ANDOVER 441 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee -IP ,Yoe $ TOTAL Check # `r Building Inspector / 1 TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 30 Days from October 12, 2016 Building Permit Number 254-2017 on 9/8/2016 Date: October 12, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED ON 35 Flagship Drive MAY BE OCCUPIED AS a tenant fit up — Cross Fit North Andover - IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Leander Pease 35 Flagship Drive North Andover, MA 01845 Building Inspector Fee: $50.00 Receipt: 31020 Check: 1154 CONSULTING ENGINEERS 100 Crescent Road, Suite I A Needham, MA 02494-1457 p 781 444-51 56 f 781 444-5157 www.dmberg.com October 6, 2016 STRUC�TUR�At ENGINEERS DM BERG CONSULTANTS, P.C. SERVING THE INOU5TRY 51NCE 1963 Chris Casiraghi RPTC, LLC - Reilly Green Mountain Platform Tennis 300 Boston Post Road Orange, CT 06477 RE: NORTH ANDOVER COUNTRY CLUB 500 GREAT POND ROAD, NORTH ANDOVER, MASSACHUSETTS Subject: Platform Tennis Court Footings Dear Chris: PRINCIPALS Thomas G. Heger, PE, LEED AP Ali R. Borojerdi, PE, LEED AP David M. Berg, PE Peter M. Shedlock ASSOCIATES William H. Barry, PE As per photographs you have provided to this office, we understand that the BF36, 36 -inch diameter Big - Foot brand, footings specified on the permit drawings have not been utilized. You have indicated that unreinforced 1'-0" thick by 3'-0" square footings with dowels to the piers were prefabricated and then installed in each hole with the 18" diameter piers subsequently installed on top of the footings. This change is structurally acceptable. If you have any questions or comments, please do not hesitate to contact our office. Sincerely, DM BERG CONSULTANTS, P.C. 7 William H. Barry, P.E. Senior Associate p:\projl6\001-099\16061\cleical\16061-101.doc Design • Analysis • Forensics • Construction Administration • Structural Tests and Inspections Peer Reviews • Feasibility Studies • Historical Preservation • Building Envelope • Specialty rv. St ltD /6716/1O 0 Town of North Andover * D.B.A. — Zoning Compliance Form 978-688-9545 This form must be reviewed with the Inspector of Buildings. Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday. Applicant Name: Name of Business: 4 ,-2g Addres's of Business: 3-f 1l X -r Zoning District: j Map %,,7 , c Lot CAV > r Phone: _ Email Wri ve.-,, /-s -? W Nature of Business: br-, I/ >� o you own thi roperty? Yes If no, written permission is required from your landlord. Will you have clients coming to this property? Yes V"' No Will you have any employees? Yes No Will you have any major deliveries? Yes No ✓_ Description of Business Activity (Must be Completed) Ga, f' Signature of Applicant( For Signage Refer to North Andover Zoning Bylaw Section 6 The proposed use is an e u e i tlfis zoning district. d Issued By v �'k"_i'ate Q 1-4u 41 Date..... 1.9 ... .......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that.. - 0� - e- .. . ....................... . ...... has permission for gas installation 474 .... in the buildings of ...... f1p.) ... 5.2 . ..................................... I ......................................... at ...... �2.6 ..... --.n. it .. r -k; ......... . North Andover, Mass. Fee..3) .. . ..... Lic. No. ....... ..................................................................... -3 r-) � _q GAS INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY Q, MA DATE /%L � S PERMIT# JOBSITEADDRESSOWNER'S NAME GOWNER ADDRESS TEL�� —� FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL,@ EDUCATIONAL RESIDENTIAL CLEARLY NEW: [j RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES [I NOEJI APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER- CONVERSION BURNER COOK STOVEDIRECT VENT HEATER DRYER _- I FIREPLACE FRYOLATOR FURNACE GENERATOR���� GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN._h POOL HEATER ROOM /SPACE HEATER RQQE TOP UNIT TEST -TIVHEATER UNVENTED ROOM HEATER WATER HEATER - OTHER! INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch.142 YES 10 NO El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ri OTHER TYPE INDEMNITY E] BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER EI AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc6mith all Pertinent provision of- e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' PLUM BER-GASFITTER NAME 4Fd LA Ptkj 4v LICENSE# BS'Q SI MP M MGF Eil JP 0 JGF LPGI F1 CORPORATION Ej# � PARTNERSHIP ©#= LLC D# COMPANY NAME:,.�,�-��2 ✓6 �„ ADDRESS CITY�STATE` ZIP y FAX CELL EMAIL - - - - — - - \ Affi- C/] h O z H w of a z O N� W } W tLU a u w q* I- W F=- � a w IL w a O �+ w U) o a a a J - CL w = w t-- LL W H z O H U a Un C�7 C�7 O The Commonwealth of Massachusetts . ' r Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, Mfl 02114-2017 www mass.gov/dia • Y �-fAl SV�y Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY_ Name (Business/Organization/Individual): Address: City/State/Zip:�'� Are you an employer? Check the appropriate box: r t, /It �,`/ Phone #: 1.Q I am a employer with_ -_-l9—_ .employees (full and/or part-time).* 2. �41 am a sole proprietor or partnership 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 4. ❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and 1 have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 6. ❑ We are a corporation and its, officers have exercised their right of exemption per MGL c. 152, §1(4), and We have no empldyees. [No workers' comp. insurance required.] Type of project (xequired) 7. ❑ New'donstraction 8. Fj Remodeliiig 9. ❑ Demolition 10 [] Building addition 11.0 Electrical repairs or additions l2T[f Plumbing repairs or additions 13•.0 Ro6f repairs_ 14. [� Other l e 5 *Arty applicant that checks bbx #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submitthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached' n additional sheet showing the name of the sub contractors and state whether or not those,entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #:. Expiration Date: City/State/Zip: Job Site Address: s' compepsation policy declaration page (showing the policy number and expiration date). Attach a copy of the vvoxkered under MGL c.152, §25A is a criminal violation punishable by a iuie up to $1,500.00 Failure to secure coverage ass' 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 ay be forwarded to the Office of Investigations of the DIA for insurance day against the violator. A copy of this statement m coverage verification. I do hereby certify under the pains and penalt�s of perjury that the information provided above true and correct 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 empl'o`yees. 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' defuied as "an individual, partnership, association, corporation or other legal entity, or any two or more ofthe 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 certificates) 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 thai must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia PIRATION DA Date 4 . ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ............. ............. .............................. has permission to wiring in the building of ............................................................ .............. at.t3r ............ . ................. . North Andover, Mass. Fee-k.��: ........ Lic. 4......... Check # "// - ��-<Z�R - ICAL INSPECTOR EcroR ................. '�,s cs �� �� /'s� S�GA2 C � ,, � / �i 11 V: Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIC / Official Use Only Permit No. �57 O=Wancy and Fee Checked Iwo tev. l 1/99] nem blaakl APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacht6tti Electrical Code (MEC) 5ra9v 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) V Date: S City or Town oh. 41Q/ J. Qom' To the Inspector o Wir . By this application the undersigned gives notice of his or her intention to perform the electrical work escribt Location (Street & Number) 35, FA P ,S' C .. r () Owner or Tenant Grv,, r t in Alt 0 r- .c► • Telep ne No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Purpose of -Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: jPa+r -P,4- Alghfn9 �ro9 P'a w Utility Overhead ❑ Overhead ❑ (Check Appropriate Box) No. s;?/i Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters Z.. leh& mou he Wah"d ln, the or of fres_ No. of Red Fixtures Recessed No. of Ce "asp. {Paddle) Fans Transformers KVA No. of Lighting Outlets No. of Hot Tabs Generators KVA No. of Lighting Faftres Swimming Pool Above ❑ d. ❑ MAL Bat o Emergency Upting Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches Na of Gas Burners o' n aII Devices No. of Ranges Na of Air Coad. Total Tons No. of Alerting Devices No. of Waste Disposers Beaed Totals~ ons Deteclfion/ onNo. of Devices No. of Dishwashers SpmdArea Heating KW Local ❑ C nn •O, ❑ Other No. of Dryers Heating Appliances KW Security bWenis: No. or Equivalent No. of Water KW Beaten No. of signs B Rof ests In Data Wiringg• Na of lievices or uivalent No. Hydromasage Bathtubs No. of Motors Total HPT No, of Devices or FAmlyident OTHER: dllaCh addlttanal detail y aestrm, or as requnra Dy lee inspector of sires. 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 farce, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND [I OTHER [:1(Specify �orChn ti.�s S'. ,2 05- 'ration ) . Estimated Value of Electrijoal Work: 6i 0 (When required by municipal policy.) Work to Start: inspections to be requested in accordance with MEC Rule 10, and upon completion. I cort'ly, wdw i0ep&ns p Jolpcilmy, dwt dke1ft fa madon an is true and complete. RM FINAME: �Q f� / 0b a.���G TY' i r _ / �_ LIC. NO.: Licensee: "'�Gt U I (Ifapplrcawe, diner ""m pt" in Addrew:_:?W �i h fe OWNER'S INSURANCE WAIVER: 1 am aware that the Uctnsce does not have the fiat required by law By my signature below, l hereby waive this requiremeaL 1 am the (check Owner/Agent Signature Telephone No. LIc. No.: - Bas. Tel. Na:,6e3 tlf j -R Alt. Tel. No.; l insurance coverage normally ❑ owner ❑ owner's awns. PERMIT FEE. $ 10a, crO Iw-a4-?0 14 15:25 FROM:WATSON INSURANCE 603 668 2400 IU:bW ffW c:rcts r.1111 ACM CERTIFICATE OF LIABILITY INSURANCE 03/29/2064 0400cm (603)666-0600 FAX (603)663-2400 Watson Insurance Agency, Inc. SO S. (rain Street lbacbester, NN 03102 Watson. Tim TINS CER7FICATE IS ISSUED AS A NIAT M OF NFORMATION ONLY AND CONFERS NO RWn UPON THE CERTFICATE ALTM TTHIE COVEERAGE AA 0� D NOTOR THE S BELOOW. INSURERS AFFORDING COVERAGE NAIL Iw w" Paul Obin E ectric 371 Whitehall Road Hooksett, NH 03106 *mom& Nwvbants Mutual Vm—rance Co 23329 wsuSMa WSURI D R�sIRaxl a MLSIIRER THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITMANDI I ANY REOUI &WIT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHVN 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. ABATE LWM SHOWN MAY FIVE BEEN REDUCED BY PAD CLAW man I V re OF ROURUNOE PO CY EFF ECIMA Mw England El ECtric System Lon SS Barefoot Road OFAMIUPONIMNOXtOLffSAGEInSORREPREWWATr4L GIIII&ASta1111.1TT CCP9233OZ1 03/ZZ/2004 03/ZZ 00S VIS : 1.000.000 aTO Ntl7TEDma : 100. X Cmm"L (;FAIL LOMM CAM MAW Q OCCUR NWE9PWwalloawag s S PERSONAL a AM MURY s 1 O00DO A GENMALA ReUTE t 2,000.000 GINLAGGRGMI UMAPPLESPER. PR{DDUCTS-COUFMA= s Z.0001001 AUTONOBREUHAMITY X ANYAUTO 255391 03/It%2004 03/22/2005 COMMSIMELMRT IF'� ; 19000100( 9MY INJURY i A AIL OWNED AUTOS SCHEMXW AMS(Peepenon) MM AUTOS NON.OVOM MOs 00 _ O~,E : GARAGBLIAGIL 1Y AUTOONLY-EAACCBM t THAN EA ACC S AtR00ror. AcG s ANY /WTOOTNER B10ClitA/IRRBLLALM11BRY CW9132899 03/22/200403/22/2005 EACKMIMEW2 s 1,000 OCCUR n CLAM WOE AGG1REWE S A L000000 s 1.000. t DEGUMM E : RET9Al01J s YTORKERi COTRENSA710M AND Ami O F-1- EACH ACCIOW $ lYPLOYERSLM LM E)OLTUIDEDT E.I. DISEASE -FA S w&pww"= pVp,. EL 06EASE - POLR:Y I.AW I S WHIM OF OPERA�o�a f I.QCA J11E�MCtES / EKCWlIDIq ADDED dY FlOORRdIBIT f SrECIALPaoIRslola rtT Icate Holder Ys AOdit�NawiT Insured as respects to wrok done by LHsur4d at various job sites or Certificate Holder M..RTUPW-AT& MAK-DER CANCELLATION ACORD ZS (200WOB) OACORD CORPORATION 1988 sllouloANraFTIEAsore DESCR!®H'OLJCL'SBe GANGED eEroRE T!E EWVATIDN DATE THMW. TIE TSSUND OTSURM TILL ENDEAVOR TO MAL 30 oms TNInTEN @*TcE To im CERTIRCATE mum MANED TO TIE LEFT, Mw England El ECtric System BUT FAIWRE To NAL MM ND M SHALL IMPOSE ND OBLOATION OR LIAM RV SS Barefoot Road OFAMIUPONIMNOXtOLffSAGEInSORREPREWWATr4L AUTIOCNI MJemReaeNrATAre North oro, MA 01S32 13im Watson ACORD ZS (200WOB) OACORD CORPORATION 1988