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HomeMy WebLinkAboutBuilding Permit # 1/14/2016 P-Th BUILDING PERMIT TOWN OF NORTH ANDOVER to , APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: CHU IMPORTANT:Applicant must complete all items on this page Aa- n......... ...... ri"do ROMEO g N TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building El One family n(Addition 11 Two or more family 11 Industrial 0 Alteration No. of units: MCommercial OkRepair, replacement 11 Assessory Bldg N Others: [I Demolition 11 Other 2 5, POO 77, ,"Wo NO A/F =,N Z da ck",->V t 01 C��t, K Ck S e f-y) c,o,� (>-A A o A4� c� J k C n-\e k'\Y,\c� C41 .0 �Y,\a VO4. Q r cx'x-'N6 f, \r4 C vt �("; �ap, c cix VN c) 0) C 'Ib C 0 a.. oC-0— Identification Please Type or Print Clearly) OWNER: Name: \"-QJ L.)Jj C�J Q �-,6 Phone: (,p F") ---I L/ Address. Al2/2 Ilk' =.......... lii, go, ............................. /, /.. J f.._. n i ei ///, ///,/��/iv, ;/ ,,,,,,„/i G, ,s '"WINE" ARCHITECT/ENGINEERPhone: 2 -7 S6 S S Address:(LC)(',') L�-(Ln L LLupx ry)y,-�Reg. , +1 FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER SJ7,. Total Project Cost: $ ?5-11, 000 FEE: $ 0%k�(D Check No.: Receipt No.: NOTE: ns contracting'wiih unregistered contractors do not have access to the guaranty fund Signat of Agent/Owner �Ce Signature of contractor /4" 14 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/Massage/Body Art ❑ Swimming Pools ❑ Ik 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 U FORM PLANNING & DEVELOPMENT Reviewed On I i q Ir) Signature_ 2�ilt ; 1,5 a,n el.ic���lg �\�r�s°dQ-�ve� l�� COiVIMEi�1T'S ��r�G a �v�ati�5���� �tv�� ��, ��c� � i -����e� �� [fir l�r�t ������e��: �\�� � f-�csY,o c�,��► ����.�1. i� Ptd�c 1�� CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on, Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments `Fater§� Sewer Connection nature Date Driveway Permit DPW 7d6n Engineer: Signature: Located 384 Osgood Street FIFE DEPARTNIENtY--;Temp Dumpsteron site-,;yes no Located at'124 Main Street Fire Depar#men sigatrare/date COMMENTS C 'Town oftt,ORTH Andover 0 ® 2A ; h AR ver, Mass, LAKE . , COCKICN[WIC.t REIT@O Ll BOARD OF HEALTH nn Sol Food/Kitchen P rm �R IV IT LD Septic System THIS CERTIFIES THAT JJ ......................... BUILDING INSPECTOR ........... ...:..! .................................................. has permission to erect buildings on 1 ;271 `� '� Foundation Rough to be occupied as ..........J ..G 1� ....�::�......`::'....': W......sr.. ................................................................. 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 IN c MONTHS ELECTRICAL INSPECTOR UNLESS CTI® STARTS Rough p Service ...............1...,r:.-r.......................................................� cFinal 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. September 22,2015 Bell Atlantic Mobile of Massachusetts Corporation,Ltd,d/b/a Verizon Wireless 400 Friberg Parkway Westborough,MA 01581 Attention:Network Real Estate RE: Verizon Wireless Rooftop Installation 5 Boston Street North Andover,MA 01845 Dear Network Real Estate Manager: Through a leasehold interest Verizon Wireless has radio equipment, antennas and ancillary equipment located at the above referenced site. I have been informed that Verizon Wireless will be replacing the existing antennas and adding the additional remote radio heads with ancillary junction boxes as depicted on the attached construction drawings by Hudson Design Group,LLC. dated 09/01/2015.I understand that there will be nine(9)remote radio heads with corresponding junction boxes and ancillary connecting cables installed at the site after the completion of the project. As an authorized agent I hereby consent to this work and authorize Verizon Wireless to apply for any and all permits that may be required for this project. Sincerely, 2015 enj aurin Farnum 397 Farnum Street North Andover,MA.01845 Hudson Design Groupuc ..:.:.. . ......September l,.2015..... ....�..... .. .�....:�. .. . ..... . .......N.. Um..._..........._.._.... ._.._._........._...__-...._._...__..m..._... _....._.rv.. ...ry...„_ .ry......,_ _. ....._.,,..., verizqp 400 Fdberg Parkway Westborough,MA 01581 RE: Structural Assessment Site Name: N Andover MA Site Address: 5 Boston 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 antenna loading at or near the proposed locations. Reference the HDG drawings dated September i, 2015 for the proposed equipment locations. 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. 5. All components supporting the Verizon equipment are assumed to be designed to all applicable codes and design for identical to or larger than the current loads. Please feel free to contact our office should you have any questions. Respectfully Submitted, OF Hudson Design Group LLC DANIEL P. HAMM IVIL r„ .40720 h16fA1 Michael Cabral Daniel P. Hamm, PE Structural Dept. Head Principal p:978.557.5553 t:978.336.5586 a:1600 Osgood Street,Building 20 North,Suite 3090,N.Andover,MA 01845 p:413.588.8139 f:413.517.0590 a:116 Pleasant Street,Ste 302,Easthampton,MA 01027 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Number: n/a Project Title: N Andover MA Date: September 15,2015 Property Address: 5 Boston St,North Andover,MA 01845 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Verizon Wireless telecommunication facility(AWS) installation on an existing building. Install new antennas and associated radio equipment on building facade. I Daniel P.Hamm, MA Registration Number:40720 Expiration date:6/30/16 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural Structural Mechanical Fire Protection Electrical X Other: Entire Project 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 protosed 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 acc9rdance 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 nstruction Control Document'. "OF DANIEL P Enter in the space to the right a"wet"or HAMM In electronic signature and seal: CIVIL NO.40 Phone number: (978)557-5553 Einail: hilb(a,)hudsondesig Hudson Design Group,LLC 1600 Osgood Lndg, Bldg 20N, Suite 3090 North Andover, MA 018.45 Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an Y project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen, provide a description. Version 06, 112013 The Commoni,vealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www milass.govIdia WorkersCompensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Structure Consulting Group Addi-ess:49 Brattle St. City/State/Zip:Arlington, MA 02474 Phone M 781-791-7724 Are you an employer?Check the appropriate box: Type of project(required): L[Z]I am a employer with 50 employees(full and/or part-time).* 7. E]New construction 2.[:]1 am a sole proprietor or partnership and have no employees working for me in S. [J Remodeling anycapacity.[No workers'comp,insurance required] 9, El Demolition 3,E]I am a homeowner doing all work myself[No workers'comp.insurance required]1 10 0 Building addition 4.E]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.E]Plumbing repairs or additions 5.E]I ant a general contractor and I have hired the sub-contractors listed on die attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp,insunince.1 14, 6.E]We am a corporation and its officers have exercised their right of exemption per MOL.c. OtherTelecorn 152,§1(4),and we have no employees.[No workers'comp,insurance required,] *Any applicant that checks box 41 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 trimt submit a new affidavit indicating such. tContractors that check this box most attached an additional sheet showing the name of the sub-cominctors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I out an eniployer that isproviding workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name:Twin City Fire Ins Co. Policy 9 or Self ins,Lic.#:76 WEG GB2651 Expiration Date:1-3-17 Hill Rd Boston . Job Site Address: 5 BosCity/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 MGL c. 152,§25A is a criminal violation punishable by a fine tip 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 certify der the a4insi �dr �7 ,/ /allies of perjury that the information provided above is true and correct. Sign lure: -,,4, Date: I -S ..I (o Phone M 781-791-7724 z Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License N 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 DATE(MM/DD/YYW) ACC)RV `/ 10/5/2015 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 CONTACT Mike Ta NAME: y Tarpey Insurance Group WNExt): (617)527-6070 FAX No:(617)527-1980 343 Washington Street AIL ADDRESS:michael@tarpeyinsurance.com INSURERS AFFORDING COVERAGE NAIC# Newton MA 02458 INSURER ANorfolk & Dedham 23965 INSURED INSURER B: Structure Consulting Group, Inc. INSURER C: 49 Brattle Street INSURER D: INSURER E: Arlington MA 02474 INSURERF: COVERAGES CERTIFICATE NUMBER:2015-2016 Term 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 SUER POLICY NUMBER MMIDDY(YYl l' POLICY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OCCUR PREM SESDAMAGETOEa oN uE ante $ 50,000 R0105555 10/5/2015 10/5/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECTPRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 '.. OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident AANY AUTO BODILY INJURY(Per person) $ 20,000 ALLOWNED X SCHEDULED 91022321A 1/6/2015 1/6/2016 BODILY INJURY(Per accident) $ 40,000 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident) $ Medical payments $ 5,000 '.. X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESSLIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 1 IU0908417A 10/5/2015 10/5/2016 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN SPTER OERH ANY PROPRIETOR/PARTNERIEXECUTIVE D E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Informational Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Tarpey, VP, CIC, LI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD NS025 001401) q� LAS DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8054 1/6/2016 THIS CERTIFICATEIS 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 SUBROGATIONIS 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 NAME: PAYCHEX INSURANCE AGENCY INC PHONE (A/C,No,Ext): (AIC,No): (8 8 8) 443-6112 210705 P: F: (888) 443-6112 E-MAIL ADDRESS: PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIC# SAN ANTONIO TX 78265 INSURERA: Twin City Fire Insurance Company 29459 INSURED INSURERB: INSURER C: STRUCTURE CONSULTING GROUP, INC INSURERD: 49 BRATTLE ST INSURERE: ARLINGTON MA 02474 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 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 OFIASURANCE ADDL SUER POLICYNIMBER POLICYGFF pOt/CYEAP LIMITSLTR INWR Hilo ,1rdUDD/}T7T COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ CLAIMS-MADE❑OCCUR PREMISES(E oaunence) MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ '.. POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ '.. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) _ $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED "'-- AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTO NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) UMBRELLA LIAB d OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION s $ HUAI*RSCOMP£NSATION �. PER OTH- AA'DEMPLO}ERS'LIABILIT}' STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $1, 000,000 OFFICERIMEMBER EXCLUDED? A (Mandatory In NH) F—] wa 76 WEG GB2651 01/03/2016 01/03/2017 E.L.DISEASE-EA EMPLOYEE 11, 000,000 If DESCRIPTION ON OF OPERATIONS below 11, 000,000 es,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. 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. Town of North Andover, MA AUTHORIZED REPRESENTATIVE - 1600 OSGOOD ST 7 NORTH ANDOVER, MA 01845 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Cs nstruchon supqrAkm. License. CS-078888 John G McGillicudsty 65 Governors Road Tu Milton MA 02186: o--^ Expiration