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HomeMy WebLinkAboutBuilding Permit # 7/14/2015 �oerH BUILDING IT 0 I'FD ,6�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ® Permit No#: °" Date Received RATED P•P •�� SSS�c HUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION fY)S2'iJM 6Y-e- 6 - �JQZTkL Campul. Print PROPERTY OWNER M-.'- rmAck CocL4F4 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building_ ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other „u " 17 taxa A.• hiud.I6Wo I rviril,r,yj////lf�-; ,l%/!!. 11I! l ,, trn� ,�✓k i�rllVf(u,"fi0',44dU%/��i'-1 I/rr��ry �,i%fora%J'l�ifP,f lYl dkJJy / , I rF tfifp„/kiY qk3 fl✓f,fill((-.u B 1l!�.Ww((A�r�ar , o ir'r�ioi ll� 'cv�',t�C �,,W� �l (�1��% ✓ �✓,�r � �� ,p,�IQm, ari • a'�t� iir � '1 'i��� �J ,�l�/� /J� � �� ,I /I�� , � ,„ i � ������,�e�,�J��� i ,,,�� ,, , �!, � ) ,! ��r i�� DESCRIPTION OF WORK TO BE PERFORMED: COMvL%9-T1A1G C-,ccS-CiNG C®mmt,A,� EPacc ®F uyo," j&-Q, [A.rcn A CAFE. Identification- Please Type or Print Clearly OWNER: Name: rAM1QQitn4CjA COLLaGa Phone: 97$- 835-7 3 Address: t5 Tctila,PckC %T,. NOS7cR Alup®vCF- MA Contractor Name: 9Q000N t A)C. Phone:G03- ? 6 9 3- 86 tt Email: Address: 1395' J1(C msa-Tw 9-0, 1-t uSaEjc A)g (pSLO& Supervisor's Construction License:C ®06E673 Exp. Date: lZQ1OL6 Home Improvement License: sVA Exp. Date: n,A 3Ame-S A. Lc)rr ARCHITECT/ENGINEER ®ti I,vC. Phone: 60 -693- u. Address: 1359 R S z 0 % AA 4 406 Reg. No. FEE SCHEDULE;BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $__'0�03.000,0o FEE: $ r1 s Check No.: w Receipt No.:� 9=15A NOTE: Persons contra Ing with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR. OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m H FOR PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS mak° HEALTH Reviewed on ' � Si nater wM COMMENTS n C12-- 7.. Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Conneefiion/signature& Date Driveway Permit DPW Town Engineer: Signature: . Located 384 Osgood Street F I R Ee D E PA RT M E N T,,", Temp Durnp onsite es ,no Located at 124 MamFStreet r'❑` y' ,f'%"r°r,; Fparfimenfi signafiure/daite ;ryF„ f %f i , %i , ^.. ' %❑%% i. COMMENTS t4ORTH Town of ndover ® - 0% t ��.ca h ever, ass, COCKICHt WICK ya' A°Rareo a,`�C� S U BOARD OF HEALTH ERMIT I LD Food/Kitchen Septic System THIS CERTIFIES THAT .. fm. #W . o BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ....... IS ... .....A•••.••• -- Rough to be occupied as ...... ... .� .. .......... .�..F.r/........................................... Chimney provided that the person accepting thl ermit 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. A' Final PERMIT EXPIRES 1 ® ELECTRICAL INSPECTOR UNLESSCTI Rough Service ..................M ........... 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 One FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Initial Construction Control Document z W To be submitted with the building permit application by a d Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Residences @ Austin Field—Cafe Addition Date: July 10, 2015 Property Address: 315 Turnpike Street,North Andover MA Project: Check(x) one or both as applicable: X New construction Existing Construction Project description: This project will consist of adding a small"Cafe"to the new Student Community Room within Building 2 of the New Student Residences. Work will include metal stud framing, Drywall, paint,millwork,Plumbing,Mechanical and Electrical. I James A.Loft,AIA MA Registration Number: 10833 Expiration date: , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information,and belief 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 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. 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. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. 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 Constr ocument'. w SEs A.to�� Enter in the space to the right a"wet"or No.10833 electronic signature and seal: HOPKINTON, int#. Phone number: Email: o� {ril OF M� ' r Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 Initial Construction Control Document z To be submitted with the building permit application by a d Registered Design Professional a for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Residences @ Austin Field—Cafe Addition Date: July 10,2015 Property Address: 315 Turnpike Street,North Andover MA Project: Check(x) one or both as applicable: X New construction Existing Construction Project description: This project will consist of adding a small"Cafe"to the new Student Community Room within Building 2 of the New Student Residences. Work will include metal stud framing, Drywall,paint,millwork, Plumbing,Mechanical and Electrical. I James A.Loft,AIA MA Registration Number: 10833 Expiration date: ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information,and belief 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 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. 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. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. 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`F' GA ontrol Document'. 108 Enter in the space to the right a"wet"or pF!(rrT N, CIO electronic signature and seal: . rH OF MPS�'���� Phone number: - @ Email 4 Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 JAB--NO" PRO CON INC PAGE NO.....L. ..........................) ............................................ .. ..................................... DATE.....k ea .............................................................. JOB NAME.........k"11 t -��l ',"=— JOBIOCATION........................................................................................................TYPE OF WORK........ ................................................................... WORK CLASSIFICATION ESTIMATED COST Code DESCRIPTION Estimated MATERIAL LABOR No, Units Unit Total Cost Unit Total Cost Cost Cost 2 3 4 5 6 7 000 ce,f/vi lj�, 01- 4-140 6 I2- 0-c ?,Zo The Commonwealth of Massachusetts Department of Industrial Accidents m I Congress Street,Suite 100 Boston, MA 02114-2017 wwry mass.gov/ditt Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Pro Con, Inc. Address: P.O. Box 4430 City/State/Zip: Manchester, NH 03108 Phone#:603-623-8811 Are you an employer?Check the appropriate box: Type of project(required): 1.®I am a employer with employees(full and/or part-time). 7. 0 New construction 2.®I am a sole proprietor or partnership and have no employees working for me in $, ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.[:)I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 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 11.❑Electrical repairs or additions proprietors with no employees. 12.Fl Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs 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. 14.[:]Other 152,§1(4),and we have no employees.[No workers'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. tContractors 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:Charter Oak Fire Insurance Company Policy#or Self-ins.Lic. #:VTO-UB-8207AO62-15 Expiration Date:4/1/2016 Job Site Address:315 Turnpike Street City/State/Zip:N. 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 MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceiliftunder the pair and penalties of pei jury that the information provided above is true and correct. Si nature: ~) Phone it:603-623-8811 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#: DATE V CERTIFICATE ® LIABILITY INSURANCE 710201 TWIS 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 CONTACT Danielle Rice NAME: THE ROWLEY AGENCY INC. a/CNNo Ext: (603)224-2562 C No: (603)229-0012 139 Loudon Road E-MAIL ADDRESS: enc drice@rowley g ya •com P.O. BOX 511 INSURER(S)AFFORDING COVERAGE NAIC# Concord NH 03302-0511 INSURERA:Travelers Indemnity Co 25658 INSURED INSURERB:Travelers Prop Cas Co of Amer INSURERC:National Liability & Fire Ins Pro Con, Inc. INSURERD:Charter Oak Fire Ins Co 25615 P.O. BOX 4430 INSURER E: Manchester NH 03108 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 GENERAL 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY '... GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000MA TO RENTE '.. X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurence $ 300,000 '... A CLAIMS-MADE Fx_1 OCCUR C2K0-CO8207A049-IND-15 /1/2015 /1/2016 MED EXP(Any one person) $ 5,000 Per Project Aggregate PERSONAL&ADV INJURY $ 2,000,000 pplies only if required GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: y written contract. PRODUCTS-COMP/OP AGG $ 4,000,000 '.. POLICY X PRO- ] LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT '.. Ea accident 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED J-CAP8207AO50-15 4/1/2015 4/1/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 C, EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I X RETENTION$ 10,000 43-UMO-301180-01 4/1/2015 4/1/2016 $ D WORKERS COMPENSATION O-UB-8207AO62-15 X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 3A States: NH, CT, MA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? IN I N/A (Mandatory in NH) RI, NY, ME, VT, NJ 4/1/2015 4/1/2016 E.L.DISEASE-EA EMPLOYE9$ 1,000,000 '... If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Merrimack College - Starbucks Cafe, No. Andover, MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Commonwealth of Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. Department of Industrial Accidents Office of Investigations AUTHORIZED REPRESENTATIVE 600 Washington Street Boston, MA 02111 Danielle Rice/DJR ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INQn,)r­­cf n, Tr... Al+A011...............r 1.....................L.......J........I...—8 A11^Mr% Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License:CS-OsW3. DAVID B RAICIW is 56 BUUMALE RD - BEDFORD NH 03110 Jam' er Expiration °-" oImWs Commissioner