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HomeMy WebLinkAboutBuilding Permit # 5/2/2016 i BUILDING PERMIT °ILMD 1, TOWN OF NORTH ANDOVER ,. .;.:..':. APPLICATION FOR PLAN EXAMINATIONgo Permit No#: d " Date Received,yap���<�.w�pa� �SS�cNusE�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATIONf ✓ rint PROPERTY OWNER p An.... tint 100 Year Structure yes no MAP PARCE ZONIN ISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE _ Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial �giteration No. of units: Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other k Ir r iY I� 6uwe 9:r!/i.. Ol r / I J of maYr�.vom! rYIrr ur.. ,„��IIYIQi�i(IPItlII�9r01�G1GlG� Ir'r f �J�r. VAIJ yyv i 'e'r pf ��rrc��Ydff&�d DESCRIPTION OF WORK TO BE PERFORMED: //�7 2 / o” ~'7"Cls 1 Y el' OWNER: Name: I nt' "' , Deas eor Print 1Clearly y� )G�v 2 ��� lF> ( Phone: q,, Address: 0 d P ,t, 0'/"C ..,.. YJ A a� " Contractor Name: W) `�, e' Ke y,J Phone: Email: W/Y11 Address: - "°," //,) Supervisor's Construction License: tips, ° _Exp. Date:. _ Home Improvement License: Z k Exp. Date: ✓�� o ARCHITECT/ENGINEER r/° C �5() Yk: "Phone: Address: urn s u,rt) �{ X40 i 5�l Reg. No. FEE SCHEDULE. PER$1000.00 OF THE TOTAL ESTIMATED COS BASED ON$125.00 PER S.F. Total Project ��5�' $GPERMIT �00��� FEE: � ~T L ' 1 $ Check No. Receipt No.: � NOTE: Persons contracting with icnregistered contractors do not have access to the guaranty fund m„ L/r//,,J,i✓lir / Ju /c ..�/,�cr,it/ J r7 r� /��i iri r,,..;',r// ✓. / l!/// 9'/. ,. ,1:7/ o, �., ,,l / R/rCOrltraGClri,«ii/ N®RTown otfy fAnctover 0 , to �`k gal �O LANE h vee, aSS, a a 1 COC NICNEWICK RAreo PPp�.cS U BOARD OF HEALTH t-T- Food/Kitchen Septic System THIS CERTIFIES THAT ... ..... ..... . ...,. BUILDING INSPECTOR ........................ .... ................. ......... ........... ............ . Foundation has permission to erect .......................... buildings on ... ...... ... .*. ................. ,�/� Rough to be occupied as ... ...(iu6kaak..... .. .. .1...�...................:...................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESST TIO Rough Service .... ......... .. .... ......... Final BUIL SP CTOR 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. DMC and So-n Construction Company 12 Buckingham St. J Wilmington,--Mass. 978-423-4491 April 28, 2016 Location: 1060 Osgood St Unit 105 Work to be completed by DMC and Son Construction Company shall include, but not limited to: - The elimination of the Wall in the front of the space - The removal of the existing bath and reconfigure as a handicap bath as specified by the plans submitted by JD LaGrasse and Associates. Flooring to be determined at a later date. - Replace and improve the existing ceiling layout Demo wall surface and replace interior walls of storage area. - Repair and replace all interior work as needed - All walls to be repaired as needed and re-painted - All flooring, other than new bath, shall be carpeting determined by building owner. Total cost of labor, materials, and trash removal $19,975.00 A�i ��� I kvi CHARLES D.BAKER GOVERNOR Commonwealth of Massachusetts JOHN C.CHAPMAN UNDERSECRETARY OF KARYN E.POLITO Division of Professional Licensure C AFFAIRS AT OND REGLIEUTENANT GOVERNOR BOARD OF STATE EXAMINERS OF PLUMBERS AND GAS FITTERS CHARLES BORSTEL JAY ASH DIRECTOR,DIVISION OF SECRETARY OF HOUSING AND 1000 Washington Street • Boston . Massachusetts • 02118 PROFESSIONAL LICENSURE ECONOMIC DEVELOPMENT April 28, 2016 TIAM Realty, LLC Attn: David S. Samuels P.O. Box 249 Andover, MA 01810 Re: Variance PV300—Vacant Space— 1060 Osgood Street—North Andover Dear Mr. Samuels: Please be advised on April 27,2016 in the Board Meeting Room, 1000 Washington Street in Boston Massachusetts,the Board of the State Examiners of Plumbers and Gas Fitters deliberated on and voted unanimously to grant your variance from 248 CMR 10.10 (18)to allow the installation of one unisex handicapped accessible rest room for the proposed office space. This variance decision is, based on the presentation, information and documentation provided by the applicant and is applicable to this end user and this site only.All other plumbing and gas fitting work if applicable shall comply with the rules and regulations of 248 CMR 3.00 through 10.00 and all other applicable statutes and codes Sincerely, For the Board, Guy- E VZ, Wayne E. Thomas, Executive Director Board of State Examiners of Plumbers and Gasfitters Cc: James Hurley Plumbing and Gas Inspector ��',� TEL: 617-727-9952 FAX: 617-727-6095 TTY/TDD: 617.727.2099 http://www.mass.govocabr/licensee/dpl-boards/pi/ L-V —J" t ouoN`r rrr ,•,.�r,a.,�, ,,,,,,.e,.o,P.�,.,,n,,.,.r rrr.N.,,.,< �—IL—--j I • I ee .��.,P ver�.,.,a ne, r r, _.xr,•,.n,x.,,.,e,a aanv]laiia amlmad \�/ •� 4 „ r ..... .. a. ,r ?JOlINt7 v r 9oz IIar ...... T Q _9 ¢n u nvo,.vx V,v,in rr r e, ra /� A�I•.p'TVX v,ra,,.,P �ri�d`fd� d lsal-d z Zx]ru^n nv ,] ,—T-7ZLIE sot tlNn SOL 11Nn s L11 n " � 1Nn mroiau awul am�io90L �a boo 90L bOt 90L bOl i[Nn 11Nn llNn 11Nn a, 3010 3OIiaO To r ],e�.v r=,...,a v,... , rr v, erre-.. .. — M li® .........._..... n��w+v,mr r v r,r., u > n.,,�] r9r v ,[•:, aoc c.rmssay- ,nay apo -1-11— a��" aUpv ov�u r r v rvt L _J L_rrJ l .J MMInas 3Qo7 ri 13'1101 µ3'i bl II \L 1 101 I 1. 1I ®� 041 m b.11ro1 14Nr14%-Nl !t � OL 11NIi 4.I M J y p p 4�j ?IOUNd 3SVLOlo sollNV 3'NMOls 11 r le o C Ndid snooi The Commonwealth ofMassgehusetts F Department of IndustrialAccidents 4 m f d 1 Congress Street,Suite 100 Boston,MA 02X14 2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricianslPlumbers. TO BTt,PILED WITH THE PERMITTING AUTHORITY. A licant Information Please Print Leg'bl NaMe(Eusiness/Organization/Individual): Address: x11 4f City/State/Zip: i�appir'op i 4 �� �/� Phone##: %71-V7�11�lfl Are you an employer?Check the late box: Type of project()required): LE]la a a employer with : employees(full and/or part time).* 7. construction a sole proprietor or partnership and have no employees working for me in $, emo 2.W delirig any capacity.[No workers'comp.insurance required.] Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑ 10 []Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL C. 14.FJ Other 152,§1(4),and we have no"employees.[No workers'comp.insurance required.] *Any applicant that checks liox#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who su6mif Nis 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 fiave employees,they must provide their workers'comp.policy number. I am an employer that is providing ivorlcers'compensation insurance for my employees.'Below is the polley and job site information. ` �. Insurance Company Name: / o 111 /'J 4 Policy#or Self-ins,Lic. 712 S-6 70 v j?r1 irationDate: Job Site Address: 4 (i 1�1 City/State/Zip: +i%/,1a _ Attach a copy of the workers'co pensation 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 lnvestigations of the DTA-for insurance coverage verification. I do hereby certifyandpenalties ofperjury that the informationprovided ab ' true ndcorrect. Signature: Date: //7 Phone#: /c f Official use only. Do not write in this area,to be completed by city or toren 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#: ACOR"0 CERTIFICATE OF LIABILITY INSURANCE DaTE(MMIDfXYYYY) `../ 4/28/16 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 NAME: M.P. Roberts Insurance Agency PHONE __- -_- - -- Fax _-__ -- • (978) 683-8073 ! No: (978) 683-3147 1060 Osgood Street E-MAlLDDREss: mike@mprobertsinsurance.com North Andover, MA 01845 INSURER(S)AFFORDING COVERAGE NAICN _ INSURERA:Merchants Mutual Insurance Co INSUREO INSURER B: DAVID M MCCUE INSURERC: DBA DMC AND SON _-___--_-_-- INSURER D 12 BUCKINGHAM ST - - - INSURER E: WILMINGTON, MA 01887 - -- - --- — - 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 - --- - - A 0L SUBf2 POLICY EFF POLICY EXP ---- LTR TYPEOFINSURANCE INSR WVDIINS POLICY NUMBER MMIDDIY MMIDLYYYYY LIMITS A GENERALUABILITY BOPI076622 12/2/15 12/2/16 EACHOCCURRENCE $ 1,000 000 }{ COMMERCIALGENERALLIABILITY DAMAGE -(Ea-- -- n EMI&E�(Ea occurrece $ 500,000 CLAIMS MADE 1XI OCCUR MED EXP(Anyone person) $ 1-5-000 _ PERSONAL&ADV INJURY $ GENERAL AGGREGATE_____ $ 2,000-,000._ '.. GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-.COMP1OP AGG $ 2,000,000 X POLICY � LOC —----- $ A AUTOMOBILE LIABILITY MC+AI001788 12/2/15 12/2/16 COMB INEEDISINGLE LIMIT -- $ 1,000-,_000-- ANYAUTO BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ 1MORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN RYLIMI ANY PROPRIETORIPARTNER/EXECUTNENIA E.LEACH ACGDENT $ OFFICER/MEMBER EXCLUDED? -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ IfKos describe under DES�RIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if mores pace isregrired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE m MICAHEL P. ROBERTS ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: (978) 688-9542 E-Mail: � �J ��i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 168617 Type: Individual Expiration: 3/18/2017- Tr# 263341 DAVID MCCUE JR. DAVID MCCUE 12 BUCKINGHAM ST WILMINGTON, MA 01887 Update Address and return card.Mark reason for change. SCA 1 0 20M-05/11 Address [] Renewal E] Employment ❑ Lost Card Office or Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: 1gg617 Type: Office of Consumer Affairs and Business Regulation e expiration: 3/18/2017 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 DAVID MCCUE JR. DAVID MCCUE 12 BUCKINGHAM ST WILMINGTON,MA 01887 Undersecretary Not valid without signature i i } i I i Massachusetts -Department of Public Safety s Board of Building Regulations and Standards t Construction Supen-isor License: CS-060354 \`.F.r r. DAVIDMMCCU. TR 12 Buckingham Stfreet- v - Wilmington MA 61887 ; c ' Expiration ✓ Commissioner 09/17/2016 Unrestricted-Buildibgs of anyuse group which contain less than 35,000 cubic feet(991m3) of enclosed space. i Failure to possess a current edition of the Massachusetts j State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS