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HomeMy WebLinkAboutBuilding Permit # 6/11/2015 BUILDING PERMIT ��� ``�.�- '6 °d TOWN OF NORTH ANDOVERti v APPLICATION FOR PLAN EXAMINATION it - Permit NO: �° Date Received �pssgcwus Date Issued: I PORTANT: Applicant must complete all items on this paEe caW ar a� �o i �i of ii / as / D i ,ilii a / „��� .ii,� ,i, , ,,�%,%�/,,,,iiia/�,/�i�,,,,/� rt a a �,< � .ii i iii/��R� ,. / i INC T, ,�rio/�ii �����l (� IC✓�� r 0 aiii�� ,els / :,,, r ��/ % / � ✓ �� t5 OG 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 Others: ❑ Demolition ❑ Other ir.�roiiii.ii r ra � iii a r i // / , i / , C.' C:%. p ., Identification Please Type or Print Clearly) OWNER: Name: lmt �, . . `e Phone: 1 Address: L101 �. a i i/ � / r i ✓ � iia,,,, / / a , %�� � i ��✓ ,, ,i � / opo ii � //� / / / .,., i i ,, , ,//;✓ //a/ /%%/ i i�, % i i i „ ✓i/ /,,,!iii . ��.� �� ��a�i�%/�.,,,. / /../,,,,, ,.. ,,,,, a i /_. ,,,,,,✓ % ,✓///i ,a,,,,,, _.��a��✓/ii,i� i ARCHITECT/ENGIN ' w � � Phone: � AddressLock,, � ��� ��:��°���: �, L Reg. No. 0-19.0 FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 4y0 0 FEE: $ Slid Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of AgentlOwner�SeLoo Signature,of contractdr .r, Plans Submitte4x Plans Waived [I Certified Plot Plan El Stamped PlansA TYPE OF SEWERAGE DISPOSAL Public Sewer El Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales [I Private(septic tank,etc. ❑ Permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT El COMENTS UA I E REJEU I EU UA I L 7MPROVED .""�SNSERVAT ER AT ION El El COM NTS N. DATE REJECTED DATE APPROVED H %LTH ElEl - COM FENTS 0 'ing Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Pla'nning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit Located at 384 Osgood Street Oups,,,,erof e"'- m'', n I FIR 'EN DER - I kTV"A T, -`Temp g 0M/1 '///////�......... Located:a, 00,16;Street "04 " F" atq, t ment signature/date 4/340--dy . . ....... . --7 omm' GENTS,,, -7777� NORTH own of 2 Andover 0 No. /4%2;L � i a ,� oh ver, Mass, �o I� COC NIC Nl WICK y1' ADR^TED S U BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT ....... .. .! BUILDING INSPECTOR ...... ...........................................1..�:. .............. Foundation ... . has permission to erect .......................... buildings on . -1......ArYkJovm.....ft.4...... Rough p' .. . .�. ........ .'. .. . ! r.ri y t0 be occupied as ..... .... C ...... Chimney provided that the person accept g this permit shall in ev ry 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 IN 6 M TH ELECTRICAL INSPECTOR UNLESS CONSTRU S S Rough Service ... .... ........ ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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 Approved by the Building Inspector. Burner Street No. Smoke Det. Manh. 13, 2015 13cli Atlantic Mobile of Mawichuse-tts COrpOrafi(Hi Ltd-,dIh/'<u Veri7or, Wircle,.;s -400 Fri Kw rg I'ark-vvja y WcsIboro-u-,,,h, MA 0 1 5�I Alicntion., Network Roal Estatt RE.' Wrizon Wirck-ss Anicnna Install atinn ristallation 401 Andov(�r Street Noilh Andover, MUsSmehusutts 01945 Dear Network R.vll Estate Manage-r: Throe y,h a. leaschold interest IvIcrizoll Wireless hwi rudio equipmcnt, angenTias and a ilia nel -ry equipri'ient located ut the atxwc referenced site_ I 114ve been ivif-OTmed that Ven-zon Wir'Ac-&'s will be modifying the existing antenna imtalla(ion at 401 Andover Street, Nor LI Anclovivr, Massrjcbusctts 0l K.5. 1 utulerstand that Vcri7on 'irelc;. will Replace (3) 700 MHz ,gym enna-swilh, (6) 700.111,CS Duajbpnd antermas, Remove(3) small Juntion 13oxv-sand (3) 2,xl Hybrid cabie.s. Rc-muvc PCS CDMA Equipmerit., Install (3) lark,j unc.don lac s on, the rooftop, ce (i) p.L!rs �tf)r install (3) Jarge junc(ion boxes mar equipment. In-st-all (3) 6x12 Hybrid C.aWS ftf)ITI the Equipment to etiich sector. Install (3)) IJE RR I Fs and(.3.) ITS RR I F."i, As an authoriz,(A agclit I bcreby consent to this work arid authorize Verizon Wire-ICS.';to ap-plyfor any and tall. permits Ilia(may lie required f"Or this project- 2015 Sri 17' Fru. Pfum 2''Fru-st - . 401 ArWover Streot North A ridover., MA 0 184.5 Hudson Design GrOUPLLc May 12,2015(Rev.t) vera n 400 Friberg Parkway Westborough,MA 01581 RE: Structural Assessment Site Name: Andover 2 MA Site Address: 401 Andover Street North Andover,MA 01845 To Whom It May Concern: Hudson Design Group LLC (HDG) has been authorized by Verizon Wireless to perform a structural assessment on the existing antenna mounts located at the above referenced site. Based on our evaluation, we have determined that the existing antenna mounts ARE CAPABLE of supporting the proposed antennas. Reference the HDG lease exhibit drawings dated May 12,2015 for the antenna locations. Wind Iggd will i t a li this case due to the proposed ontenngs being inAtgllgd bphind the exltlngFRP screen walls sterni. HDG is under the assumption that the existing FRP screen wall system has been constructed P-r-operly and located over slrucfi Jral1 ode uate roof beams and/or columns. This assessment was conducted in accordance with EIA/TIA-222-G,Structural Standards for Steel Antenna Towers and Antenna Supporting Structures, Massachusetts State Building Code (8th edition), International Building Code 2009, and ASCE 7-05. This determination was based on the following limitations and assumptions: 1. Equipment and locations should not deviate from the construction drawings without written approval of the engineer. 2. HDG is not responsible for any modifications completed prior to and hereafter which HDG was not directly involved. 3. All structural members and their connections are assumed to be in good condition and are free from defects with no deterioration to its member capacities. 4. All antennas, coax cables and waveguide cables are assumed to be properly installed and supported as per the manufacturer requirements. Please feel free to contact our office should you have any questions. -kkoF p �y Respectfully Submitted, ca DANIEL P. G Hudson Design Group LLC HCAMM 0 o.40720 /SCh Michael Cabral Dan I P. Ha m, PE Structural Dept. Head Prin ipal p:978.557.5553 f:978.336.5586 a:1600 Osgood Street,Building 20 North,Suite 3090,N.Andover,MA 01845 p:413.588.8139 t:413.517.0590 a:116 Pleasant Street,Ste 302,Easthampton,MA 01027 1 1 Massachusetts -Department of Public Safety, Board of Building Regulations and Standards Collstrrrc:&irmn €�lcriho 3 License; CS-07$888 f' 'i John G McGillicudsty 65 Governors RoaB t s Milton MA 02186 r � r 'Ilit ,+ Expiration Commissioner 07/11/2016 Ak ® ?ire Corn n wealth o f)Vsach rWset& DePailment ofInduarklAccidena Office Invesligodons 600 Washington,Street Roston,Af,4 02111 Workers' r mpetasation Insurance Affidavit:SBuilden/Contractors/Electrici>a�ns�/P A licant Information lumbers acne(Bus Please Int L '6l iizalyon✓Irldividusi): "{iJ `��. �(✓i 'SU Address: �I :C C'. `Z �' . �=-- , o t.) ; Ci /State/Zip- C rr r"1 ()(9'- (Phone#: 5 `� Are you an employer?Check a appropriate box; � r -7 -7 L l l am a employer with �. C1 I am a general coucractor and l of Prot (regtadred): employees(full and/or part-tiara).* have hired the n rs 6. Q'New construction 2- t am a sole proprietor or partner- listedon the ship and have no employees These n Wkn have_ ad sheet7. ling working for me in any capacity. employees and have workers' 8. ❑Demolition [No workem'comp.insurance camp.insurance.Y 9. Building addition rNuiredj 3.® I am homeowner doing all work 5 ofFict:rs haveration exercised and ies t O.Q Eloctnical repairs or atir3i 'ons myself 1111 Plumbing a ` Y [Ido workers'comp. right of exemption per MGL 8 rap or additions 3a.❑ T tem a M= rte)t c. 152 §I(4),and we have no 12.�Roof repaira sown=actinng as a employees.(No workers' 13 Other -- geueraT Can (refer to#4) `u+Y apvlieeat dh.c chaclra cO •inaRtrance required t thi.ql renter also fill out rhe nation below war , wtw sut,mit thin afl avit iawd:e.tttag tlarY era tiotng atD wax$t Andhien outaidn none ��inf tContractrs ochat chock this}roar nnM attacbed Ann arahacr th dditionrl uwJin,A hers r"Ma 0(tho ra must=**zit a new atridavit imllutirrg aud. 'tvtploYaa. >t the atl,�uaatt�have evolay ms ,thry nuw p v;de wa�tke",;&a and so"whathe•or not than afitics have tpa',pal IcY wimbw. 1 tin►an rmplvyer that is providing workers'compensation insurance or info .-- / hey etrrpioyees Bebe+is the policy and Job sift Insttrauce Company Name: t-I T 1(Pa, -_ a Policy#or Self-ins. Lic.#:-2L-(--(j El Address-[- Expiration Data: Job Site c y of the workers cora n�� Attach a ca > City/State/Zip/S Polley number . - � Failure to coverage as satiOn policy declaration page(showing the required under Section 25A of MGL c. 152 can lead to the imposition and ertpirat}ott date). fine up to 51,500.00 and/or one-year imprisonment,as well as civil position of criminal ties ora of up to$260.00 a day against the violator. Be Penalties to the form of a STOP WORK ORDER and a fine luvt stigations of the DIA for ir>surance coverage /Verification, a Copy of this statement may be forwarded to the Office of I do hereby,eamN/y under the pains and na! ar>7hwq that the Information Provided above Is tree and correct 6/ - Oig9ric!use Only. Do n®t write in this area,to be complcred by city or taw>y o ff ial C1ty or Town: Issuing Authority(circle one): Permit/License# L Board of Health 2. Building Department 3. Clty/rown Clerk d.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person; Pboae#: DATE.(MM/01)"Y' 4 12/2 7/'YyOyl'�' ACCORV CERTIFICATE OF LIABILITY INSURANCE E2 �7/2_ THIS CERTIFICAIEIS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER'nFICATE HOLDEN,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 714E ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the cerci ate holder is an ADDITIONAL INSURED,the policy(les)must he endorse AIT N If SUBROG0 IS WAIVED,subject to the torrins and conditions of the policy,certain policies may require an andorsement A statement on this cartificate,does not confer rights to the c"ficate holder in lieu of such endersemont(s). PHONE FAX PAYCBEX INSURANCE AGENCY INC (AM,N..U1IY wc'uo 443-6112 210705 P: F: (888) 443-6112 Pi SS-, 130X 33015 INSURER(S)AFFORNNG COVERAGE NAILS PO SAN ANTONIO TX 78265 INSURERA: T611.2 CiLy Fire IFIS 'C) INSURER 8: INSURER C: STRUCTURE CONSULTING GROUP, IN INSURER D: 49 BRATTLE ST INSURER V: ARLINGTON MA 02474 INSURER P: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER, THIS li_�O CERTIFY—THAT THE IPOIJCIES Or 114SURANCE 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,I..IMrFSS"OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ADDI STAIR Palo FPF poi,67K& LLWIS ME OF ININT)RANCE EACH OCCURRENCE COMMERCIAL GENERAL LIA011-ITY DAMAGE TO RENTED JOr-CUR ( U_p Fer1ce CLAIMS MADE ES MED FX1'(Any one person) PERSONAL&ADV INJURY GENERAL AGGREGATE GENT AGGREGATE UNJI'l APPLIES PER: pRODUCTS-COMP)OPAGG JECI POLICY LOC, F1 OTHER, COMBINED SINGLE 1 AUTOMOBILE LIABILITY (Ea niderd) — BODILY INJURY(Per POM011) $ ANY AUTO ALLOWNED SCHEDULED BODILY INJURY(Per oocident) 5 AUTOS AUTOS _PROPERTY_DAMAGE NON-OWNED (Per aocldmt) HIRED AUTOS AUTOS EACH OCCURRENCE UPORELLA HAD OCCUR _� R CLAIM,-MADE AGGREGATEEXCESS LIAB IRETf2MON I ---I i. zra'y =PtARDITE ER J676 _4_NDma1',WTFAfflLUBH_17T E.L.EACH ACCIDENT $1, 000, 000 ANY PROPREIDRJPAI;CfNERIEXFC(JIIVUY/M OFFICERNEtABER EXCLUDED? w ALOYCE '1 000, 000 A (Mandatory in NH) 16 0 3 2.016 F.L-DISEASE-FA VMP —r__ If yes,desc6be under E.L.DISEASE•poliGY LIMIT 11, 000, 000 E RIPTION OFOPERATIONS below DESGtZipMVOFOpFRAVMS/LccA7MSIVEHKMMRD 109,Additional Remarks Schpdula,may be aluchod ifmore rpaca is fraquim,J) Those usual to the Insiired's Operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCCLLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACQqR—PAN(;E WITH THE POI ICY—PR0y--S—'ON­S - Town of North Andover, 14A AUTHORI"RUWrSJEWAM/F 1600 OSGOOD ST NORTH ANDOVER, MA 01845 All r! htsie—r- ed. 9)1988-2014 RD ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD DATE(MMIDDIYYYY) AC R CERTIFICATE ( I I INSURANCE 11/3/2014 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 lieu of such endorsement(s). CONTA PRODUCER NAME:CT Brad Sano Tarpey Insurance Group PHONE . (617)527-6070 FAX o.(617)527-1900 343 Washington Street ADDRESS:brad@tarpeyin5urance.com INSURER(SI AFFORDING COVERAGE NAIC k Newton MA 02458 INSURER ANorfolk & Dedham 23965 INSURED INSURERB:DOrchester Mutual 13706 Structure Consulting Group, Inc. INSURER C: 49 Brattle Street INSURER D: INSURER E: Arlington MA 02474 INSURER F: COVERAGES CERTIFICATE NUMBER:2014-2015 TermREVISION 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, _ M OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS NOTWITHSTANDING ANY REQUIREMENT, TER 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. rA ADDL S BR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MmmDIYYYY MM DDIYYYY GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 AMA ET RE ED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S CLAIMS-MADE 1 OCCUR 0105555 10/5/2014 10/5/2015 MED EXP(An one person) S 5,000 PERSONALS ADV INJURY 3 1,000,000 GENERAL AGGREGATE S 2,000,000 PRODUCTS-COMPIOPAGG S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER S X- I POLICY PRO LOC COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) S 20,000 A ANY AUTO ALL OWNED X SCHEDULED 91022321A 1/6/2019 1/6/2015 BODILY INJURY(Peraccidenl) $ 40,000 AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED Per accident) X HIRED AUTOS X AUTOS medical payments S 5,000 X UMBRELLA LIAR X EACH OCCURRENCE $ 51000,000 OCCUR EXCESS UAB CLAIMS-MADE AGGREGATE $ 51000,000 A 10/5/2014 10/5/2015 $ DED X RETENTIONS 10100 0908417A WC S . WORKERS 'ER AND COMPENSATION I TY 1A AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ ANY PROPRIETOPJPARTNERIEXECUTIVE ___­I " OFFICERIMEMBER EXCLUDED NIA E L DISEASE-EA EMPLOYE S (Mandatory In NH) If yes,desenbe under E L DISEASE-POLICY LIMIT S DESCWPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE M Tarpey, VP, CIC, LT ACORD 25(2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. IN5075r9mnns�nl Tho Ar r)pr)nomas and Innn aro rcni.fararl mark.of Grnpn