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HomeMy WebLinkAboutBuilding Permit # 6/4/2015 1 1 % (ORTN BUILDING PERMIT ®� 'Bv�tio TO F T V °L APPLICATION FOR PLAN EXAMINATION Permit No#: Date ReceivedQBArED ATED M SS�CHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page / r,,, r,� /, ✓ Y,..(.,, r�, ,/ /, r/., ,��/ r/, ,. r D ,,,,,.,i,. r ✓���,� r�������/��1� � ,. / /,./:. .r „ ,r r/, >o/ / /iiia/G�//,%//„� // r///. / //�.,� /i r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg 1K Others: Demolition ❑ Other ` � 1 / 0 Floodplain ❑Wetlands UVatershed District / /%rIWer/Se er%ii G; / ,�ioi,� ,,, DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: e. Phone: Address: eve. id Phone r / r r r r / / o. e en...... ,GGn.r/cir�1,e,d/prr,�r{1r+Orr r//,0/�r Yl/r/in��lc/iYeoyi r r „iir,,,, ARCHITECT/ENGINEER bewtw%. SAm'IJ keatil S Phone: NQ Address: SL4e 2-oog , - ., e , Re No. '� 61+1M9 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ jo, 00 FEE: $ g &c) Check No.: µ ( ' p Recei t No.: NOTE: Persons con a ivatli uiar ontractors do not have access t the uaranty fund .mm Signature of Agent/Owner Signature of contract r-mg-4 tkORTH dover town of An _E. ._ 1� 0 ® T V lA1(E h " ver, Mass, COCNIC Kl WICK �� x,95 RATE® ►P``�,�'i� . UER MBOARD OF HEALTH Food/Kitchen 1 �1 L mDm�' Septic System THIS CERTIFIES THATF. f� �® c� / �l2/G�F��F` �'' BUILDING INSPECTOR ............................ ................ ............................................................................. v z/� C+,�p `Ike s Foundation has permission to erect .......................... buildings ori............... .....�J.................................................... Rough tobe occupied as ........,,.�......................( ...�:.�r. ............................................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES ELECTRICAL INSPECTOR UNLESS CTTARTS Rough Service I Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. M SIENA Construction Corporation May 19, 2015 Mr. Felipe Schwarz Merrimack College 315 Turnpike Street North Andover, MA 01845 RE: Merrimack College- Engineering Workshop Siena Project# 15099 Dear Felipe, Siena Construction Corporation is pleased to submit this Letter of Intent for the Interior Demolition to the Engineering Workshop - Merrimack College. This Letter of Intent is being issued for the purpose of establishing the costs of the work associated with our approved proposal. We agree that the basis of payment is a Lump Sum Proposal. The current cost of the work associated with the installed products on the project is estimated NTE to be $19,600.00. 1 % - If the "Project" does not proceed for any reason, or if Siena Construction does not build the "Project", Merrimack College agree-- that Siena will be reimbursed for expenditures and costs, including General Conditions, of work performed to termination of services except in the event that the aforesaid failure of Siena Construction to build the "Project" is due solely to an action or election of Siena Construction. If you have any questions, please do not hesitate to call me at 617-547-4546, X324. Sincerely, SIENA CONSTRUCTION CORPORATION Anthony Di Carlo Project Manager tte11�10--�014 -MIerrimack College Cc: George Poulos - Siena Construction Corp. Terry Hayes-Siena Construction Corp. Page 1 of 1 Pages NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: e ( 4 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I 0A. The debris will be disposed of in: V exe (Location of Facility) Signature of Permit Applicant Date 5 S 1/1 e- ��2 4 reg Department of IndustrialAccidents Office of Investigations - _ 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aipolleant Information Please Print Legibly Name (Business/Organization/lndividual): Siena Construction Corporation Address:25 Birch Street City/State/Zip:Cambridge, MA 02138 Phone M 617-547-4546 Are you an employer? Check the appropriate box: Type of project(required): 1.]0_1 I am a employer with 30 4. [] I am a general contractor and I b. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y p tY• # 9. E]Building addition [Nc workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions re 13.[] I qu a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs insurance required.] t c. 152, §1(4},and we have no employees. [No workers' 13.❑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 woricers'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:Selective insurance Company of Southeast Policy#or Self-ins. Lic. #:WC9008328 Expiration Date:01/01/21716 Job Site Address: City/State/Zip: 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 f ni 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 DTA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Z22 Signature Date: 01/05/2015 Phone#: 6175474546 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#: CERTIFICATE OF LIABILITY INSURANCE ACCMOFLDATE(MM1DDlYYYif) 72/3012014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lief:of such endorsement(s). PRODUCER C NAME: The Driscoll Agency, Inc. PHONE -66 aC No: 1- 93 Longwater Circle MAIL P.O.Box 9120 ADDRE S: d dr c c .corn Norwell MA 02061 INSURERS AFFORDING COVERAGE MAIC 6 INSURER A.-SelfiCtiVe In raneeSoutheast-39926 INSURED 1758 INSURER 0: Siena Construction Corporation INSURER C: 25 Birch Street INSURER D: Cambridge MA 02139-4514 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:259111424 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICYEFF I POLICYEXP LTR TYPEOPINSURANCE NSR WVD POLICY NUMBER M DDFYYM IDD LIMITS A GENERAL LIABILITY 2139630 1/1/2015 /1/2016 EACH OCCURRENCE $1,000;000 X COMMERCIAL GENERAL LIABILITY I DAMA�E PREMISES Eaoccurcenoe $100000 CLAIMS-MADE OCCUR MED EXP(Any Dnaperson) $10,000 PERSONALB,AOVINJURY $1,000000 GENERAL AGGREGATE $3,000,000 GEN'LAGGREIGGA'T�ELIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $3,000,000 POLICY I^ 'PRO- .7 LOC $ A AUTOMOBILE LIABILITY A9099881 1/1/2015 /1/2016OMBIN D SINGLE LIMIT 1000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 'UTOS X .AUTOS BODILY INJURY(Per accident) ,$ X HIRED AUTOS X AUTOSWNEU P OPER nDAMAGE�.� s V A X UMBRELLA LIAS X OCCUR S2139638 111/2015 /1/2016 EACHOCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X I RETENTION&None A WORKERS COMPENSATION VVC9008328 111/2015 /112016 X WcsrATu- OTH- AND EMPLOYERS'LIABILITY YIN OFFICERIMEMBEREXC UDED4ANY £CUIiVE� NTA E.L.EACHACClOENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yyes ascribe E.L.DISEASE-POLICY LIMIT $1,000,000 A Leased/Rented 2139838 1/1/2015 /112016 Per Single Unit $100000 Equipment Aggregate 1000D0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,Ir more space Is required) CERTIFICATE HOLDER CANCELLATION Siena Construction Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 25 Birch Street ACCORDANCE WITH THE POLICY PROVISIONS. Cambridge, MA 02138 AUTHORIZED REPRESENTATIVE �r 1 01 i�rul�r�` s0o ©1988-2010 ACORD CORPORATION. All rights reserver ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD j Massachusetts -Department of Public Safety j Board of Building Regulations and Standards Const"tiction Supervisor License: CS-083507 ANTHONY S DIC i 43 FAIRFAX ST ` i Somerville MA 02144� 1 r Expiration i Commissioner -0111212016 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991M )of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS