HomeMy WebLinkAboutBuilding Permit # 7/30/2015 _7RT
BUILDING PERMIT
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received ATE 1 0
Date Issued:
(IMPbRTANT: Applicant must complete all items on this page
LOCATION '6ovvQl
PROPERTY OWNER r
117,1CL4e-L, C IV xuj
Print ' 100 Year Structureyesno
MAP PARCEL: ZONING DISTRICT: Historic District s no,
"c")
Machine Shop Village yes Cno
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
El New Building [] One family
11 Addition 11 Two or more family 11 Industrial
11 Alteration No. of units: 11 Commercial
11 Repair, replacement ri Assessory Bldg 11 Others:
emolition 11 Other
D te� sewe /// �,,f%�1,,�r� ,// 1 ����//�/�//ii r�l����/� 11��r�����,�`� I
DESCRIPTION OF WORK TO BE PERFORMED:
ef"
Identification- Please Type or Print Clearly
OWNER: Name: Ljerkfir t, , il i A i L , Phone: 2 U!
Address: i--5() SLOk" /IA4
Contractor Name: Phone: .?,,,1,a (.-,(I
Email:
Address: —1 L o-4,,)(Ir L c �J C;>
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.,BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ Cala-2 FEE: $ 1 p-7o Lit
Check No.: & Receipt No.: e
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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COCKICMEWICK / 1
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BOARD OF HEALTH
Food/Kitchen
rvERMIT T LD Septic System
THIS CERTIFIES THAT ....Zli .� . °::r.. .lr �.'� . :.y!"!...I. !%�1: . :. .. > ...................... BUILDING INSPECTOR
Foundation
has permission to erect .......................... buildings on ..::• .. ... °�� .` ................................
� a� Rough
to be occupied as . r: G.::.,l .c r.. ...j. ��cj.`f ..F :�. ..�:�`� ................. 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 Ins ction,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
!' ,
�X Final
PERMIT E IRE IN 6 MONTHS ELECTRICAL INSPECTOR
.UNLESS CONSTRUCTION STARTS Rough
f Service
...................
.............. ° •��r�.:?;: ........................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® Occupy BuiUWk Rough
Display in a Conspicuous Place on the Premises'— Do Not Remove Final
,o Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. - Burner
Street No.
Smoke Det.
Proud To Partner With:
Southeast New Nampsfilre Servicing an Of Ura New
° Habitat England Area:
for Humanity'
NH,MA,ME& VT
NAmpa's-1 E -:101113"wN
,
www.nhdemolition.com
(A Division of Nixon Site&Demolition)
Celebrating 25 Years of Service
Specializing in Building Wrecking,Asbestos/Hazardous Material Abatement for 25 Years
792 Londonderry Turnpike I Auburn,NH 030321 Phone(603)641-11111 Fax(603)647-8372
E-mail:info@nhdemolition.com
NIXON HYDRAULIC HAMMER RENTALS
PROPOSAL
DATE:April 27 2015
SUBMITTED TO: Pilot Construction JOB INFORMATION:
ATTN: Kevin S ADDRESS: 16 Berry St
ADDRESS: CITY: North Andover
CITY,STATE: STATE: MA
PHONE:
FAX: Email: kevins@pilotconstructionine.com
Complete demolition of multiple structures.
Remove concrete slab and foundations.
Price includes removal of all debris to an approved LEED certified recycling facility.
All salvage from structure is the property of New Hampshire Demolition.
Price is based on salvage unless otherwise noted. — SV-e� s-\
General Contractor will notify utility companies before starting work and comply with their requirements.
General Contractor Will disconnect and cap all utilities.
General Contractor will obtain required permits from authorities.
Keep work sprinkled with water to minimize dust. General Contractor will supply water or hydrant and pay for
permitting.
Price is based on normal eight-hour workdays.Overtime,nights,weekends,and holidays will be charged extra.
Price includes grading out foundation hole and making the slope safe
Removal of one oil tank
NHD will protect areas of demolition
Price includes asbestos abatement as identified by NEE labs
If listed above please disregard the corresponding exclusive below:
Exclusions: ])Price does not include Fire watch or Police detail,2.)Additional Charges will be incurred if cutting and capping has
to be performed at the main in the street 3.)No backfill, Pie esof-any kfid.5).Not responsible for any hazardous
waste,PCB's,asbestos,oil and chemicals of any kind.6),Not responsible for oil larnk(s).Oil tank(s)must be drained before arrival 7.)Not
responsible for asphalt,sidewalks,curb lawn,sprinkler,or landscape damage of any kind,not responsible for any damage to underground utilities
of any kind-&+Peve4s-bo6ed en up to3—Mats 5sttrtdrrr+f nte5it dd<!{tiettal-thiekna5e orf rek�ar-wire(entre) g)Rr+rte rr basad en star and
fourtdatmn+ rhiok up•ta•single wliarreYtrlrtkiekrtav of steel•fex+rct} +B.N'+iea i rtu+sect+xr wndartt roofings 2=widertnd I t#xek s}ngJe steel
11.)Ewa ihielmess of steel is extra 12.) Winter 00flaitieffi
13.)Structurestbuildings are required to be clean and free of trash and debris unless otherwise specified. 14.)Price is based on no retainage
withheld!f retainage is withheld,price is subject to a 10%increase. 15.)Price is based on steel market value rate as of date on proposal.
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We propose to complete the job in accordance with above specifications for the sum of:
Terms of Payment:25%deposit,25%when building is down,balance upon completion.No retainage withheld. $141,962.00
Town of North Andover %A0 T11
Building Department D 16 Alt
1600 Osgood Street Bldg 20, Suite 2035 0
North Andover MA 01845
Tel: 978-688-9545 Fax: 978-688-9542
(b
DEMOLITION OF BUILDING AFFIDAVITLAKI
coc"Ic"awle"
oArED 0 1:,o
DATE /1-3/-4 ol�� US
OWNER'S NAME &ADDRESS qq 4)�dyVv � t& 160 tdljou�,,A hg//P/
LOCATION OF PROPERTY TO DEMOLISH
DESCRIPTION
CONTRACTOR'S NAME &ADDRESS 14aLMJ��k(-V-P bt.Wtp LcwidoodewV-Fkvv):p ,
DEPARTMENT SIGN-OFFS
DEPT. OF PUBLIC WORKS -WATER:OP- SEWER: —41-4 ,
TREE WARDEN V/4
TOWN ENGINEER
/A�116-
DEPT, OF CONS ERVATbON -5
Z
HEALTH DEPT.
S4KCWELL
4-
HISTORIC COMMISSIO6 Allx-7
PLANNING
GAS
ELECTRIC
TELEPHONE
TAXES
POLICE f4,1
FIRE
EXTERMINATOR-
DUMPSTER - ON OFF STREET DIG SAFE NUMBER �016-aY0332
BLDG. INSPECTOR
Building Demolition Affidavit
OP ID: SU
,�►CC»z[a CERTIFICATE OF LIABILITY INSURANCE DATE 0712012015 '
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 endorsements).
CLME�CT Michael Ripley
MALONEY ASSOC INS-MANCHESTER ptionE 603-277-9500 I•ta, pot,603-626-5580
1650 Elm Street Suite 501 (9�c�q Fx1Ia __.. - "' -
Manchester, 003101.1217 ADDRESS.__._
cusrrb aEgDr_TAYL_29..__.,.._._ •._ �`
INSURER$)AFFORDING COVERAGE NAIC M_
INSURED Tayla Nixon Site Developers INSURERA:First Mercury Insurance Co.
Inc.dba New Hampshire INSURERS:Progressive_
Demolition
792 Londonderry Turnpike NSURERC:Libe Mutual Insurance Corp. ___._• _. _ _._
Auburn, NH 03032 INSURERD ---
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: 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 CONDrrION 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.
ADDL'SU "1�6LTl V,9 -POLTcy EAIs__ _..._.-..._......_.__.,_�_ m
ISR._.... _..�_�__�.._._..._.._.__.______ LIMITS
TYPE OF INSURANCE POLICY NUMBER M 1DDIYYYY M IDDIY YY
GENERAL LIABILITY EACFIOGCtJFt•:Ei"dC:E $ 1,000,000
,MX(,'E_"6Rr.'T ED50,000
A X COMr�er c:IAL rat:Nt:iiAL UA.eIL TY X X MACGL000004914701 11/04/2014 11104/2015 PREYII.E'S(Ea occurrence)
CLAIMSWADE t "J C?CC!!R MED E,-,P(Any one cersont�..$_____...._.. _.._._5,000
A X ISO Form CG0001 BLANKET BASIS FORM 11/04/2014 11/04/2015 PERSONAL&ADV INJURY 1,000,000
A X CG2010&CG2037 BLANKET BASIS FORM 11/04/2014 11/04/2015 GENERAL AGGREGAI-E s 2,000,000
__.._...-__-.__.._._. ._...-----..__._.--._---•
-'-'—
2,000,000
GEN'L.A GGRE-..>ATE LIMIT AFPUES PEP. FROGt1CT5 CGMPIGP A38 $
PRO
POLk;'f X .CT •�.
AUTOMOBILE LIABILITY COA- Ir SIP:(I f LIrpT 1,000,000
!En a�oden t}
B Al,IY AUTO 034213560 12/19/2014 12/19/2015 ---------•--- —�
B:)@I,'r INJURY(Per p?ryor) $
Al 1. AUl'OS 1:30DIL.Y IN•.11JRY(P?t
X [HJI_L7)AUTOS FRQPE:l7f
SC;HE:: l(DFJf A� '"""____....,.._..........,-_w.._ -
_.-._ WER ACC;DE1;T)
X 141RE0AUIWil
XNUN-,�WNEL)A0I'JS .___--_..__..._....._...._
UMBRELLA LIAB X OC'CUP EACHiCL:PRE^ICk T I3 5,000,000
�( EXCESS LIAR :;LAI'A:S.MAJi° ftitiR*GATE _.._._._ $ ^5,000,000
A — - -- - X X NJ-EX-0000053405-01 04/08/2015 11/04/2015
DEDUCTIBFollow-
T RETENTION $ Form 3
WORKERS COMPENSATION X WCS"Aitl• OT i•
AND EMPLOYERS'LIABILITY E 7
B APdYPROPRIETC?RB:IAf:fNFRrXFCUFIVE YIN C5.31S608236014 12/26/2014 12/26/2015 �EL EACH ACCIDENT 3 500,000
aPFi Er�rtvu_MeL:h e;;a;L.uDED> I r 1 N r A NH IS LISTED AS 3A STATE E DI.EASE-EA r_�IPLOYFF t 500,000
(Mandatory in NH)
ryes•dyscjibe under E L DISEASE-POI Iry l.it In 5001000
DESCRPTION OF OPERAI'ICNS below
A 1Inland Marine IM9006615 12/05/2014 12/05/2015 Rented 100,000
Equip
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
xcJusia of Eecutive Officers a pie to Frederick Ni on.
roJect: �erry arms Apa mentsp 1 erry Street Nol Andover,MA. Pilot
Cqnstructlon, Inc.,North Andover Ho��ddmqs LLC, a oiben Com anY,Inc;
Min o Development Corp.and David fVl.Uvhi#e,Arc ltect are gqddibonal
Insureds on a rima , non-contribu#o basis on eneral/lobi// for both
CERTIFICATE HOLDER CANCELLATION
PILOTCO
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Pilot Construction
24 Ladd Street AUTHORIZED REPRESENTATIVE
Portsmouth, NH 03801
I
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
NOTEPAD: HOLDER CODE PILOTCO TAYL-29 PAGE 2
INSURED'SNAME Tayla Nixon Site Developers OP ID:SU Data 07120/2015
Eanqoing and completed operations per :forms CG2033 (4/13) and 02037
(4T13)and excess liabilitliyy as required by written contract. Waiver of
subrogation in favor of the additional. insureds is provided on the General
Liabity and Excess Liability as required by written contract.
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