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HomeMy WebLinkAboutBuilding Permit # 6/11/2015 OORTH q BUILDING PERMIT v. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ` Date Received sA7C0 PS�,�'i' r 'q Li Date Issued: �C FMPbRTANT: Applicant must complete all items on this page < ,,.,/ „/ / r/ / ,/ r ,r r -, / / r / r ✓ /fir „I r I ,, 1,Jr��� ��i�il/Ni,lP��r��iJr71JJ114�/��� � 1�e'Y✓ru��� // ////,/ (, a�,, r//1 ", ' r�'�i,,l� l� Ir���N� �/ //r �� � ��/�1 �: ./�/,✓...r, f ra�/ �n,.l/ /,,./.. ///// /„ a f / f J � r r , �/� �,,;ir(ft����/��orl,,...//... TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family CIndustrial IMIteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other '%'g// i.,r e. ,n loe< ,,r ,y:nr a ,ri, ri .x,,1r ,w/ r.✓.GJ, /rr, ,,.////dl /..,,, r ///,/(f, // ,. r o l,,ar„x: orr r r v. /,,.e , l / / / iJiG„ ,, ./,lilr .,, ,,,f,/ //l ✓l r ri/,J. i/ ,,, r, i�ateM's-f.'I� r i y r r I r / / �N d rr a r , / J Xfo i f r r f I rJl �e�lSee���// //J,�/�//� X11” °11 rf� �s OWLS AAA1 w i(NJS',"OWE Identification Please Type or Print Clearly) OWNER: Name: Nova Flagship LLC Phone: 978-685-4811 Address: 80 Flagship Drive,North Andover,MA 01845 r r.,v y rf,/wr, ✓/,,r r r r /r t 1 / a ry/,r „ irV,r / x rr, / e ✓. �n, Jl 1!1,,, 1 /, / ,c J/ � / /, ., rr / r' 1', lr; 1 9 J7!P_,,➢`,r,.,, J %lyr< /, rI, /, / 0,,/, r ,, ., 1i � / r / r ../ t., e ,tl f ,.. / ! .r// /, ,i /� O reg /( � .,.:.�fi➢,/„vrvr,, ,/ ,/ . �r ,.t .e r , �, ,. , >, „ , � l o ,//.,/ „/._._r/,,,, PI .d r ,(//{/i/,1r /�,,,,n// /////✓ / / -.;; I r ✓/ � � r r r r. !. ✓ of / ) ,. , r, ./ l /./ r. r /y, i � / r, / /./ /.. � ,r r 1 / g 8 r I /, 1 / rl / r //, ✓ /// ! /ii r, � ,! / I IJG / r , G f/a / r r f r, //� / S d �/ /, l� L � I l / 1// /r , , r., ✓, � lfr //I /r 1, r, � /J 1f /. ( r /. 1r / ! CJ l / � � u I „f u , f , /r r! l „/ r r J / U , // f ✓rwi Cr,d iY1/ r,11 /,l i, „ ,.. r J // 1/ �/1©. ��,., 1,�..,. ',., � ,/r/l./, /. J� ,,• r, � r �/ , � r ✓ 1, / /r /, �,, d, r B , /i / �) I1r , r� 7J / /r�.I / , r/� J l 1 ,r✓„ r 1 l J r r // , rl / , r, „/, ✓ f � f/ r li l � / / / - ! r, r r- / ✓ , � N r ".,✓ f � U/ f/i.o ,, / r/r/, r- ,.,/ /., r /.. r� rr.,l„/ ,./ r'. ,r , I. ., ..r/./r� �,� ,../ ,,., 1. /., .,f ✓ r ,. G / ARCHITECT/ENGINEER 3-65EM4 I-:. rA rs#,15 Phone: qt-iS- Z7&- 1%b0 Address: vie P.4zy s►. 1501rE lb Z. n.grAp1 me,Mr4. 0184Y Reg. No. 9D�D FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ t FEE: $fid% Check No.: Receipt No.. NOTE: Persons contracting with unregistered contractors do not have access iol the guaranty fund Signature,of Agent/Ov r� '' Signature,of contractor: G LVSS S Nrgc+�s �G� R �'BS� NORTH Town of . � EAndover ® - T - ®� h ver, Mass, h COC MIC Mf WICK y�' �® RATED S V BOARD OF HEALTH ERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THATA/0 �4 �l'f S.✓.1.�f.�....ZA/ BUILDING INSPECTOR .................................. .......... / ..... ........ ... ........,. ......................... a has permission to erect ................. buildings on .......r /.. .s. �' Foundation Rough to be occupied as ........ .... .��s F/0c a ..... ...�...� ........... ...................................... . 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 IT EXPIRES6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough ....................... Service ................... ...... V� Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8t"edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: Central Metal Finishing Date:05/22/15 Property Address: 94 Flagship Drive,North Andover,MA Project: Check(x)one or both as applicable: [X]New construction [X] Existing Construction Project description:Renovation of the existing building as shown on the architectural drawings. I Joseph Tatone,MA Registration Number 9080 Expiration date: 8/31/2015,am a registered design professional, and hereby certify,to the best of my knowledge, information and belief,that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Entire Project [X] Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services in accordance with the Professional Standard of Care,and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. The contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means,methods,sequences and procedures,and for construction safety. 4. The performance of the services shall not require any special testing or inspections unless specifically stated in the Code. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a'Final Construction Control Document'. Enter in the space to the right a"wet" QED or electronic signature and seal: r E No, M OF Phone number: (978)276-1960 Email: jtatone@jta-architects.com Building Official Use Only Building Official Name: Permit No.: Date: Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El TYPE OF SEWERAGE DISPOSAL Public Sewer / Tanning/Massage/Body Art E] Swimming Pools ❑ Well El Tobacco Sales El Food Packaging/Sales [I Private(septic tank,etc. 11 Permanent Dumpster on Site 11 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATEPPROVED PLANNING & DEVELOPMENT F1 I/,11�x 1 11 COMENTS DA I E REJEC I EU UA I E APPFZMEL) CONSERVATION COMMENTS V DATE REJECTED DATE APPROVED HEALTH COMMENTS-5) 4NL)o Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature&Date Driveway Permit Located at 384 Osgood Street Dimension Number of Stories: 1- Total square feet of floor area, based on Exterior dimensions. 13,3yz Total land area, sq. ft.: el 33 4 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i , l T % mW(Dth of vlass.achusetts Department of Fire Services Office of the State Fire Marshal T P.0.Box 1025 State Road,Stow,Nbk 01775 PERMIT Date: North Andover Permrt3Vo t.Dig Safe Num er (City of Town) (If Applicable,) In accordance with the provisions of NL G.L-1 4 8 Chapter 10 as pmvidea in section 5 7 7 ('AR 34 Start Date This Permit is granted to: y wait FuU name of person,Firm.or Corporation Permissionto locate dumpster - for construction/renovation/demolition of building. Comments: dumpster must be , 25from structure if unable to place with required RcstrictLOmclearance dumpster must be covered with plywood or tarp end of 'work -day at (Give lecado by street and no.,or descn such manner t rovied adequa identification of location) FecPaidS 50.00 Fire Chief This Permit will expire- S-s70%L (Signature,of offical granting permit) Ofcal grantingpemvt (Title) NQ FD M"" 4j 7Date lS .c OF t&ORTH TOWN OF NORTH ANDOVER RECEIPT CQ-IUS This certifies that haspaid.,,5 ..................................... -?........./�........................................ Received b / . .. ................/.�o % ..................... Department ... /.. �� WHITE: Applicant CANARY:Department PINK:Treasurer The Commonivealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 a� Boston, MA 02114-2017 wfvfv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Orgatiization/Individual): Dutton & Garfield, Inc. Address:43 Gigante Drive City/State/Zip: Hampstead, NH 03841 Phone #: 603-329-5300 Are you an employer? Check the appropriate box: Type of project (required): 1.❑ I am a employer with 4. ■❑ I am a general contractor and 1 6. ❑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 g. Demolition workingfor me in an capacity. employees and have workers' Y p Y• 9. [f'Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions 3.❑ 1 am 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.❑ 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 workers'comp.policy number. Iain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Firemen's Insurance Co. of Washington Policy# or Self-ins. Lic. #:WPA517670310 Expiration Date: 11/1/15 Job Site Address: 94 Flagship Drive City/State/Zip: North Andover, MA 01845 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify i n ler$die pains and penalties of perjury that the information provided above is brie and correct. Signature: y4-95ia;;&1r Date: S- 28-201:r' Phone#: 603-3295300 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#: ACO® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE F10/23/2014 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(ies)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). PRODUCER AME:NTA T Pauline Proulx Infantine Insurance PHONE (603)'669-0704 A/C No: P. 0. Box 5125 EMAILADDRESS-pproulx@infantine.com INSURERS AFFORDING COVERAGE MAIC# Manchester NH 03108 INSURER A:Firemen Is Ins Co of Washington 21784 INSURED INSURER B: Dutton & Garfield, Inc. INSURERC: 43 Gigante Drive INSURER D: INSURER E: Hampstead NH 03841 INSURERF: COVERAGES CERTIFICATE NUMBER:14/15 Master 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. IL7R TYPE OF INSURANCE ADDL 5 BR POLICY EFF POLICY EXP LIMITS AVIL POLICYNUMBER f DD M 1 0 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ r A CLAIMS-MADE FxIOCCUR X Y PA517669910 1/1/2014 1/1/2015 MED EXP(Anyone person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY X PRO X LOC $ AUTOMOBILE LIABILITY CEOMBINdEII SINGLE LIMIT 1,000,000 X ANYALTrO BODILY INJURY(Per person) $ ' ALL OWNED SCHEDULED X Y CAA517670110 1/1/2014 1/1/2015 BODILY INJURY(Per accident) $ AUTOS X HIIREDSAUTOS X NON OWNED PROPERTY DAMAGE $ AUTOS Per accident $ X UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DEO I X I RETE"ON 10,000 X Y ZUA517670210 1/1/2019 1/1/2015 $ A WORKERS COMPENSATION 3A States: MA, NH WC STATU- OTH- AND EMPLOYERS'LIABILITY LIMER ANY PROPRIETORIPARTNERrEXECUTIVE aNIA E.L.EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? n?A517670310 1/1/2014 1/1/2015 (Mandatory in NH) E.L.DISEASE-FA EMPLOYE $ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) MASTER WORDING FOR CERTIFICATES: It is agreed and understood that ( ) is included as additional insured on General Liability, Business Auto and Umbrella when required by written contract. General Liability applies on a primary and noncontributory basis when required by written contract. Includes Completed Operations Coverage for Additional Insureds. Waiver of subrogation applies to General Liability, Business Auto, and Umbrella when required by written contract. 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. Dutton & Garfield, Inc 43 Gigante Drive Hampstead, NH 03841 AUTHORIZED REPRESENTATIVE �1 �1 Charles Hamlin/PP1 "64—A A �7/, ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(2otoo5).ol The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Superb icor License: CS-039771 STEVEN R WEBSTER.. 26 PORT WEDELN WOLFEBORO NR 0389 i Expiration Commissioner 03/17/2016 I i,