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HomeMy WebLinkAboutMiscellaneous - 50 MAIN STREET 4/30/2018 (7) I� I I, I I Date/0 �- .J.k 9429 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSA US � s This certifies that �. . . . . . �. . .� . . . . . . . . . . . . . ,'',nn has permission to perform Q1'?^. . . . D �r rsr plumbing in the buildi�nygs of . at . . . . . . 5Q. . .!t l+oi . . (S.,/. . . . . ., North Andover, Ma . �u c,� �j Fee. ��.l.ic. No.. ..• l0 !. . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # 3�' �v p� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY 6 MA DATE PERMIT# JOBSITE ADDRESSG( 'j(� H 5' OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: ®I RENOVATION;,. REPLACEMENT: PLANS SUBMITTED: YES® NO®I FIXTURES 7 FLOOR- BSM 1 2 3 4 5 ffi67 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE I I I I 1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM j DEDICATED WATER RECYCLE SYSTEM DISHWASHER a� _/ �} { ^J DRINKING FOUNTAINS _ FOOD DISPOSER _ FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 11 URINAL _ WASHING MACHINE CONNECTION _ WATER HEATER ALL TYPES WATER PIPING OTHER f _ _J j INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESQ NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY®f OTHER TYPE OF INDEMNITY © 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 ❑J 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 m knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance ,it q'P. ine -pr of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# .� SIGNATURE MPO JP PI CORPORATION# PARTNERSHIP D# ( LLC COMPANY NAME0 le 6; ADDRESS CITY` 'STATE � ZIP d/ 8'f�— TEL� �'C�f5`"' FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ d �S lt�41 EE: $ PERMIT# W LR-td Geo PLAN REVIEW NOTES D;• {1% YIV ry The Commonwealth oflMassachusetis . - Department oflndustriglAccidents Office of Investigations 600 Washington Street .Foston,MA.02111 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contrractors)Electriciansfplumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_ �/ �R6LFZ_ ZZ-1 C- Address• :::�Z City/State/Zip: /2`5 yZ2 (� IA19-d/ Phone#: -75, c-!Z `1 Are you an employer?Check the appropriate box: Type of project(required): 1�a er with 4 t em o . ❑ I' am l contractord I aa generaan ' employer .—� 6. ❑New construction employees(full and/orpart-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.x 7• ❑Remodeling ship and'have no employees These El have 8. Demolition working forme in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑I am a homeowner doing all work right of exemption per MGL 11 .Plumbing.repairs or additions myself.[No workers'comp, 0. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.] employees.[No workers' comp.insurance required.] 13J:1 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. tContractors 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 thepolicy andjob site information. Insurance Company Name% Policy#or Self-ins.Mo.M 73 ExpirationDate: Job Site Address-, Cify/State/Zip Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. Ido hereby certiq under th W and altie of ' ry that the information provided above is true and correct. - Signature: qDate: Phone#: / 7 I:fr 757 5 C, 2 �z F only. Do not write in this area,to be completedby city or town official.n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector son: Phone#: Information and Instructi®�s 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 ofhire.,. 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapterhave been presentedto 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. Man 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 information(ifnecessary)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. Anew affidavit must be filled out each year.Where a homeowner 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 NOTxequired 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 Dep.aztmeRt ot'Wdustrial Accidents Office ofI11vestigations 600 WasWVQa Stxeet Basten?MA,021.X I TQL#617�7274900 cxt406 or S-AFE Revised 5-26-05 Fax#61.7"727-7749 WWW.Mass.govfdis. Date. . .�. .. � ... NOR TIy Oy.'�.ao ,e 1tiOL TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION 'a . 9 SACKU This certifies that . .. � . . "—'' ' ' '� . . . . . ... . . . has permission for gas installation .camm:. h^?.�. . . in the buildings of . .%-'5.7.BVt ... at . . . . . . Vv . . .( Ll�!� N ndover, Mass. a .Fee. Lic. No..�7. �. .� � . . . . . GA NSPECTOR Check# 8'175 •` � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I CITY OD�/ _��� MA DATE of PERMIT# JOBSITE ADDRESS �-A_ A "- OWNER'S NAME �Jtte _On-sW- m_ Ri1- GOWNER ADDRESS TEL TPYPPENOTR OCCUPANCYTYPE COMMERCIAL EDUCATIONAL ® RESIDENTIALM CLEARLY NEWT-1 RENOVATION:9 REPLACEMENT: 1 PLANS SUBMITTED: YES n__I OEJI APPLIANCES-4 FLOORS- BSM 1 2 1 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE - FRYOLATOR FURNACE GENERATOR _ I GRILLE [`_�_.1 f _._ �— INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN I.—JAJ POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER F _ INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY a OTHER TYPE INDEMNITY 0 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 F—j1 AGENT 0 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 compli n it P inent)rov is' o1 the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME µ �'1F(CL� � ( LICENSE# SIGNATURE MPTA MGF EJ JP 0 JGF Q LPGI D CORPORATION,# ,� G PARTNERSHIP 0#1=.=--.---_ _=I LLC D# COMPANY NAME: ADDRESS CITY STATE ZIP O/ TELyKJ ' FAX � )1 CELL 7 /[ EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ Z`i'^- t PK;1 -Sa I-20 FEE: $ PERMIT# Svc c_►�� / PLAN REVIEW NOTES +1 A The Commonwealth of Massachusetts Department of industrial Accidents Office ofInvestigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Euilders/Contractors/Electricians/Plumbers Applicant Information Please Pruit Legibly Name(Business/Organization/Individual): - - Address: . . City/State/Zip; %' � t� l� Phone#: B"�� Are you an employer?Check the appropriate boa: 1KI am a employer with,'_ 4. ❑ I am a general contractor and IF roject(required):'coo employees(full and/or part-time).*' have hired the sub-contractorsew construction 2.❑ I am a sole proprietor or partner- Jisted on the attached sheet.t modeling ship and have no employees These sub=contractors have molition working for me in any capacity. workers'comp.insurance. [No workers'comp.insurance 5. ❑ We are a corporation and its ilding addition required.] officers have exercised their ctrical repairs or additions 3.[:].1 am a homeowner doing all work right of exemption per MGL mbing repairs or additions myself.[Noworkers'comp. c. 152,§1(4),andwehaveno of repairsinsurance required.]fi employees. [No workers'comp.insurance required.] er "Any appEcant that checks box P1 m,MI.also fill out the section b?ow shownng Weir wo j-c,—,'compmsad on policyinformation. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam an employer that is providing workers'compensation insurance far my employees Below is the policy and job site information. Insurance Company Name:_ ' '` Policy#or Self-ins.Lie. _ �/, /, � . Expiration Date: C Job Site Address:_ City/State/Zip:_ LV •X,�40q-- 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 of MGL c.152 can lead to the imposition of"minal 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. 1 do hereby certify under a pains and peva 'e of erju at the information provided above is true and correct Sianature: �u12 • Date; Phone M. 3P Z f f [6.0 use only. Do not write in this area,to be completed by city or town offcw Town Permit/License# Authority(circle one): I. d of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing,Inspector Person: Phone#: • Y 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 a " s ...every person in the service of another under any contract of hire, express 6r 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 coinpliance 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=contractor(s)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 rotuaned to the city c,r tovm th-^t the a p IAI'M on for the-- s ,cer F a a i 4A' 4 c�;,�G oa�__.:5�.is b�.mg r,.gaes�.c;mea,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 pormithicense number which will be-used as a reference number. In addition,an applicant that rpust 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 writs"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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of lnvesiigations woiild'like to thank you in advance f6r 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 ef-£ndustrial Acoidents Office of lnvestigat ons 600 Washington Street Boston,MA.02111 Tel. #617-72.7-4900 ext 406 or 1-8.77-M.ASSAFE Revised 5-26-05 Fax 4 6.17-727-7749 Date..�......�. t 0*. 9. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ �� has permission to perform w l wiring in the building of... .-.................................. at.. L:. . �........... ....... ,North Andover,( ass. Fee k. �......... Lic.No.Zo/ . .. . .��r . . .. ."?...:�... � Check # 2� �-- �ICAL INSP ECTO 10877 Date • �y TOWN OF NORTH ANDOVER PERMIT FOR WIRINar- l This certifies that . . '` AjT /. . . . .2 . has permission to perform .oza &.#f wiring i ,the building of . . . , orth Andover, Mass. ct) Fee .( . ... . . Lic. No. . . . . . . . . . /�fa. . . . , - 1 . Check# //,a 6-tZ ELECTRICAL INSPECTOR ' ► 28 7 D�77 ,--" 19 , -2, y Commonwealth of Massachusetts Official Use Only/y %: Permit No. �� ! / A .?, Department of Fire Services Occupancy and Fee Checked II BOARD OF FIRE PREVENTION REGULATIONS ,[Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfomed in accordance win:he Massad:usens Elecricai Code(NMI EQ.527 CMR 12.00 (PLEASE PRINT LV I_YK OR TYPE ALL I_ FOR;vL4TIO-N) Date: ( p L t D, City or Town of: CM(7yIb PfyiWy To the Inspector of Wires' By this application the undersigned gives notice of his or her intention to perform the electrical work described below. r Location (Street& Number) Owner or Tenant 1 ) jh . LtTelephone No. Owner's address Is this permit in conjunction with a building permit? Yes "i No (Check Appropriate Box) Purpose of Building Utilitv Authorization No. Existing Service Amps i Volts Overhead L Undgrd L No. of Meters New Service Amps Volts Overhead ❑ L'ndgrd IJ No. of deters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: L9C aur o-rral rs M k �S O nDletiorz of tine jo-!o:^ring tabie rnav be'waived by the ln.oecior o Ve'ires. t No. of Recessed Fixtures No. of Ceil.-Susp.(Paddle)Fans 1o. of Total Transformers KVA No. of Lighting Outlets Zaj No. of Hot Tubs Generators KVA No. of Lighting Fixtures Z-.-[] Swimming Pool Above r^ In- � : 'o. o mergency ig ting , arnd- " arnd. Battery Units 4a No. of Receptacle Outlets �i0 JNo. of Oil Burners !!FIRE ALARMS INo. of Zones No. of Switches ;�o. of Detection and � 020 No. of Gas Burners , II �J Initiating Devices q ,.�) No. of Ranges 2 No. of Air Cond. TotaTons l No. of Alerting Devices No- of Waste Disposers Heat Pum—'Number Tons KW jlNo. of Self-Contained Z p �,: Totals: Detection/Alertina Devices j 6. No. of Dishwashers Local ❑ Municipal ;jam 2. SpacetArea Heating KW l Other 1i Connection No. of Dryers Heating Appliances Security Svstems: V KW No.of Devices or Equivalent No. of Water INo. of Heaters K� No. of Data Wiring: Sians Ballasts j No.of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors (Telecommunications Wiring: Total HP OTHER: nt�! ANo.of Devices or E uivalent ,+ INSURANCE COVERAGE: Unless waived by t:e ow: ad:nonai det°`'FV ed,os os required by the inspector of Wires. 1 ! ce" no permit for the per ormance of electrical work may issue unless the licensee provides proof of liability insurance includira `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, 9 CHECK ONE: INSURANCE [,' OTHER 1 BOND � �' '(Spec:"/:) Estimated Value of Electrical Work: ( co tp /� (When required by municipal policy.) (Expiration Date) Work to Start: �Ll � Inspections to be requested in accordance with MEC Rule 10; and upon completion. .1 certifad under the pains and penalties of perjury that t{ze information on this application is true and complete. FIRM NAME. BE�Tu au;� JCTRIC i iC Licensee: BEN'' MORE- LIG NO..- 2 0-1 8 8A Signatur ���� (Ifapplieable. enter "e em i it [. LI . p .t;ze terse ru;tt � C. NO.. Address: ber itne. OWNER 5 JERCNE �. TE:vKSBURJ, 'r� 0_876 Bus. Tel. No.-�_c -8800 S INSURANCE WAIVER: I am aware that the Licensee does not ha e the liability insurance ante coverage normally required bylaw. By my signature below, I hereby�ti^give this requirement. I am the(check one))❑ owner ❑ owner's agent. Signature Telephone No. PERMIT FEE: $ Y,5 L/ CU44 19 k- Ok qs _ ZPM i Print Form The Commonwealth of Massachusetts Department of Industrial Accidents JOffice of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Inc. Name (Business/Organization/Individual):Benjamin Electric, _ Address:6 Jerome Road City/State/Zip:Tewksbury, MA 01876 Phone #:978-640-8800 Are you an employer?Check the appropriate box: Type of project(required): 1.2 I am a employer with 5 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E] New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. F] Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its 10.❑✓ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] '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 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 insurance for my employees. Below is the policy and job site information. Insurance Company Name:Peerless Insurance Policy#or Self-ins.Lic.#:WC8673446 Expiration Date:06/06/2013 Job Site Address: 44- 0 W_Lf-) ST. City/State/Zip: �) A Ttoy C M7�" 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 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 cerhW under the pains andpenalties ofperjury that the information provided above is true and correct. Si ature: ���� ��_ � Datell CC Phone#:978'-640- 0 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#: A Joseph D. Lagrasse & Associates, Inc. Distribution to: 1 Elm Square, Andover, MA 0)810 OWNER ❑ Tel. 978-470-3675 F a x.9 7 8-4 7 0-3 6 7 0 ARCHITECT ❑ CONTRACTOR ❑ A R C H I T E C T S F I E L D R E P O R T BUILD.INSP. X PROJECT: "v-T-.50 Mia(M 5TeGr f FIELD REPORT NO: 01 CONTRACT: (�f�ECp GarSl(sy�� ARCHITECT'S PROJECT NO: 2-, +` DATE: Date �unfE Zr�, (.L. TIME 9�Cw d-fA TEMP.RANGE '72- EST. ZEST.%OF COMPLETION 1*3 % CONFORMANCE WITH SCHEDULE(+,-) + WORK IN PROGRESS PRESENT AT SITE 1FA6:5(CY cc o 5%2cJ ctcr Q L W&U,5 Mr-k-L ccc ej OBSERVATIONS: i A- LrtI�, 5Eco»sem e -`-w c, (jm tt'5 1") W cR,-;'C�5 5 i►J'�;LL -5-cup tUA LL-5 11'j PLA'cid wow V ja L5T C,e(L(Ng5 g-2C- uj Przrcc,55� 4,\39 *-)©Ai< c5 rKA5-My e-'w -CvcE Z . �0 O��Lt Yr..►�.? ���T�'1� r�T ���si FC.�e. �PrvCc�cr� sraa� V-LGwT 5519C, TCNdrkj-! (00c>fl STr2csc-CQ2F— tN RCL it-, P�ocE�5 aN (5T fiCMT '5(PC- --rOOMQ i F�TY eoq-*>v t sc c&►5 (r--) p L-4 ce Ar v rnr cC,j v f,5 w i N-jPa cv �'j4 a�i�Ct' �.O P.11'Lla'c(� t�s-t?C.C� �J�--tL�l �C��2t�•�' �' Z't L t T[�'� C'v�T2trc-�co� ITEMS TO VERIFY: �G�'G O L LFi 1�"(�T aF cii G'�s5 INFORMATION OR ACTION REQUIRED: 0 ATTACHMENTS: REPORTED BY : 4 ` From: "Dan Webb"<dan@webbss.neb8 Subject: 44-50 Mian Street-Intermediate site visit to observe complete framing to date Date: June 26,2012 3:31:37 PM EDT To: "'Mark Yanowitz'"<mark@verdecodesigns.com> 3 Attachments.300 KB Mark, On June 24,2012 Webb Structural services completed a site visit to observe the wood framing completed to date. The second floor ceiling/roof framing was completed at the time of the site visit. To the best of my knowledge,information,and belief,the structural work associated with this area of work complies with our original framing plans and approved field modifications,and with accepted construction practice. The competition of this area will be noted in our project file for reference when generating the final affidavit for the project upon the completion of the complete structural scope. Please call with any questions. Dan Webb P.E. Webb Structural Services. Inc. 670 Main Street Reading MA, 01867 (781)779 1330 WeIleChiaie, Pamela From: Enright, Jean Sent: Wednesday, March 21, 2012 10:54 AM To: Tymon, Judy; Sawyer, Susan; DelleChiaie, Pamela; Grant, Michele; Hughes, Jennifer; Brown, Gerald; Fitzgibbons, Karen; McCarthy, Fred; Melnikas, Andrew; Carney, John; Willis, Gene; Willett, Tim Cc: Bradshaw, Joyce; Enright, Jean Subject: TRC Meeting Attachments: Application.pdf Hi, A TRC meeting has been scheduled for Wednesday, March 28,2012 at 10:00 am. The applicant is proposing to renovate 44-50 Main Street. The project will include exterior improvements(re-siding, new windows, new handicap access ramp). The building is in the Downtown Overlay District/General Business and has commercial business on the first floor and residential on the second floor. Attached is the TRC application. Additional plans will be forwarded when they are received. Jean Enright Planning Assistant Town of North Andover 1600 Osgood Street Bldg.20,Suite 2-36 North Andover,MA 01845 Phone 978.688.9535 Fax 978.688.9542 Email 0enriaht(o)townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:hftp://www.sec.state.ma.us/r)re/preidx.htm. Please consider the environment before printing this email. 1 Big :F.... koad La#�cing,Town of North Andover, 1604 Osgood Street—Bldg,20, Suite 2-36, , 9rth Andover,MA 01845 Phone:978-688-9535 Fax 978-688-9542 'enri ht townofnorthandover com Planning Department Technical Review Committee Meeting(information form). Please submit this information to the North Andover PIanning Department c/o Jean Enright no later than.the Wednesday preceding the scheduled Technical Review Committee Meeting, Applicant will confirm with Ms Enright the date and time of the meeting on Wednesday prior to the•actual TRC meeting date. It is important that.either the applicant or the applicant's representative attend the TRC meeting. Please type or print clearly. 1.Applicant: •— 0C� �, boJ 2-Applicant's Address: uz r fl 3.Applicant's phone number �' a 4.Address of proposed location: -- �O /�'j4,^►� S' K{,A A'�a„�r S.Zoning District of proposed location: a�c�.h a� � ,iDe�r 2 / riero / 6.Square Footage of proposed project: tf"16 S7CE,tr,�e1 cs� fscv;•,Cff 7.Number of employees Y1 8.Hours of operation 9.Parking requirements 10.Is there food preparation required? p 11.D scription of project; ,r, r- o r C.. r` If you are proposing to open a business in an existing location please submit a copy of a site plan(you can obtain this from the landlord). It is not the intention of the Planning Department to have the applicant incur Architectural or Engineering expenses for submittal of a plan of land for purposes for a TRC meeting. TRC Applicant Form DelleChiaie, Pamela From: Mark Yanowitz[mark@verdecodesigns.com] Sent: Wednesday, March 21, 2012 5:32 PM To: Enright, Jean Subject: Technical review-44-50 Main St Attachments: 3.20.2012_MainSt_SitePlan.pdf; 3.20.2012 MainSt ExistingFirstFloor.pdf; 3.20.2012 _MainSt_ExistingSecondFloor.pdf; 3.20.2012 MainSt_Existing ElevationsA.pdf; 3.20.2012 _MainSt_Existing ElevationsB.pdf; 3.20.2012_Main St A.0_ProposedBasement.pdf; 3.20.2012 —Mai nSt_A.1_Proposed FirstFloor.pdf; 3.20.2012_MainSt_A.2_ProposedSecond Floor.pdf; 3.20.2012_MainSt A.3.0_ProposedWestElevation.pdf; 3.20.2012 MainSt_A.3.1 _Proposed North Elevation.pdf; 3.20.2012_MainSt_A.3.2_ProposedSouthElevation.pdf; 3.20.2012_MainSt A.3.3_ProposedEastElevation.pdf Jean, I meant to get these drawings to you earlier today..... please let me know you received all - thanks! Mark Yanowitz LEED AP, Associate AIA, UCSL Verdeco Designs, LLC 978-409-2217 mark@verdecodesi ng s i Nld O lVJINtlH03W n - Kn 0 w r N NF- N 6"X18"STEEL BEAM 2"X8" 11 27X8" 16O.C. � 16" O.C. z c� � Z � Z mo 6X12 COLUMN o _ 2"X8" 6X12 v r2-2X8 V V 6X10 HEADER 6X10 HEADER A Il At_ _ _• A A e . LOT O o O O . 0 . e 0 F-- 0 0 0 0 44-50 Main Street S� Scale: Date: verde Existing Second Floor Plan EXISTING 1/8" = V-0" 03/20/2012 of � N.Andover, MA N ON N M O 0 FEOCE O eN-� RS STREETS SANDE �sm o tD� S84'53 05"E 93.00' � d L O� o in N W w nu�v 10 Z F• `n LL 0 9, to fC14 LU z F- Y gU11A1N0 v/ 2 sTOR _gg � 5�9 0`N rn NOTECApE 01FBUIIANTOIFAIyr ()'20'OF MAIN Cp 'n 0.t5' TO `( x z SIJG,11 WA W Q u 0 � � L aoaai 62.75' N85r09"W co 3 _ wNc C 1 N O •� 0 1� Cli O C N �a. � L Q Z 0 DU„ N' 00 as --D ME] as 44-50 Main Street Sheet Scale: Date: Proposed East Elevation A3.3 3/16° = 1'- 0" 03/20/2012 veLq co N.Andover, MA SIGNS o o o 0 El F--(-D] 44-50 Main Street Sheet Stile: Dab: Proposed South Elevation A3 2 3/16" = 1�- 0" 03/20/2012 ve co N,Andover, MA 6iGVS � ❑ ❑ ❑ ❑ ❑ ---------------- 0 0 0 Sheet Scale: Date: 44-50 Main Street proposed North Elevation A3 1 3/16" = 1�- o" 03/20/2012 verdeco N.AndOVer, MA -6 114' 12-4 t 2 23-4 3/4' 12 ADDLAUNDRY © wm HOOKUP o C ch REMODEL M EXISTINOWCHEN © ® ® N A BATH O e : _ 0 o � � o o - ADD LAUNDRY ° o Wm HOOIWP V) 10 ® 10 ® ® .O ® +OFFJ Second Floor Total SF=2185 SF -46 Main St=1085 SF -6 g' 13'-11 -48 Main St=875 SF -Common Area(Stairs) =225 SF -6 1 6 Sheet: Scale: Date: 44-50 Main Street Proposed Second Floor Plan A 2 1/8n = V-0° 03/20/2012 verdeco N.Andover, MA • GENERAL NOTE: REMOVE EXISTING SIDING TO EXISTING SHEATHIING, REFRAME NEW OPENINGS& PROVIDE NEW TYVEK&HOMESLICKER BUILDING WRAP W/INTEGRAL RAINSCREEN MESH THROUGHOUT -REPLACE EXISTING 2ND FLOOR WINDOWS W/ VINYL REPLACEMENT UNITS, PROVIDE AZEK EXTERIOR WINDOW TRIM & HARDI-LAP SIDING(4- EXPOSURE)THROUGHOUT NEW PARAPET EXISTING SLOPED E[BnH ::I== - ROOFBEYOND ]E E 1 F -------�_i 00 00 REFRAME EXISTING COMMERCIAL STOREFRONT LEVEL W/NEW ALUMINUM FIXED WINDOW UNITS&AZEK PVC EXTERIOR TRIM 44-50 Main Street Sheet stele: Date: verdeeo Proposed West Elevation A3 3/16" = 1'-0" 03/20/2012 EeiGN3 N.Andover, MA • 68-SI '-7 4' 44'-51 4" ZV o• '-6 1 1 • Zv v 0 I � REFRAME WOODSiEPS RISERS TO CODE REMOVE EXISTING BRICK VENEER-FRAME NEW WINDOW WALL W1$c4 FRAME a 11r CDX PLYWOOD SHEATHING ON I I EXISTING CONCRETE BRICK — LEDGE 44-50 Main Street Shy: Scale: Data:verdeco Proposed First Floor Plan A 1/8" = V-01103/20/2012 oEs.o�= N.Andover, MA IC31 . . . . . . .... . ❑ ❑ ❑ ❑ ❑ III LIUII 11 11 IIU I WLUWLLL 11 ILIR MR 44-50 Main Street Existing South & North Sheet scale: DaW: verdeco N.Andover, MA Elevations EXISTING 1/8" = V-0° 03/20/2012 I 1 11 11 11111 Hill 1111 IIIIIIIIII IIIII Jill IIIII Hill Hill 11111 199M L.1"I IIIULJIIIII III, 1 111111 111111 11111111 111111 111 11 111111 111111 liillLLIJJLW-L]LujULU-LULIi-WLLLWL DD ❑ ❑ 111111 lim#911 milffil 11111111 IIH 11 Hill 11 11 NMI 11 111 ❑ ❑ Illf 1 11 11 0 III 111 11 111 �111H mll Jill 11 11111111111 99 DD 44-50 Main Street Existing West & East Sheet scene: Date: verdeco N.Andover, MA Elevations EXISTING 1/8" = 1'-0° 03/20/2012 1 70 12--9 3 23'-1 3/4' 12-10 7 PROVIDE NEW 2d FRAME WAII GENERAL NOTE: "INSUL.ATE WI R-IR BAT M a b0 INSULATE RIM JOISTS PROVIDE Off TYPE 7c DRYWALL THROUGHOUT EXISTING Q BUILDING PERIMETER W/ R-19(MIN.)INSULATION NNl 0314 _ o IIS NEW CONCRETE I I FOUNDATION FOR ________ PROPOSED H II d311 EXISTING V CMU HANDICAP RAMP FOUNDATION WALL d ° CONCRETE SLAB ON /f GRADE ABOVE /r r --- %r b0 b0 ,i M I I I /r II I I I r II i I I ,r II I I ii I r/ II o I I rr I I I I I I r/ II I I I I 4 II I I I f t1 I I I 1 f II I I I I f I II I I I I I II I I 1 I I II I I I I I II I I I I I II I I I I I II I I I I 1 II I L 12-9 318" 36' " 48'-9 7/9' 44-50 Main Street Pro posed Basement Floor Sheet scale: Dells:: ver 0's N.Andover, MA & Foundation Plan A,0 1/s" = 1'-0" 3/20/2012