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Home My WebLink AboutBuilding Permit # 11/7/2016 NOF2Ty o& BUILDINGPERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION - r. Date Received .- 1, , Permit No##: �s h �4Cf hUS Date Issued: jZ -- Il` PORTANT: Applicant nnust complete all items on this page L, Paint PROPERTY OWNER � ,r�'„ Pnnt 30�Yearfr`acture yes no MAP PARCEL: Z�JNING DISTRICT. Histciric District yes no Machine Slop Village yes no TYPE OF IMPROVE MENT PROPOSED USE _ Residential Non- Residential New Building ❑ One family F%_ ddition ❑ Two or more family 0 C us nal [.]Alteration No. of units: ommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - 11Septic 0Well [IFloodplain 11 Wetlands F] Watershed District L]Water/Sewer - DESCRIPTION OF WORK TO BE PERFORMED: t. w �.�..6X 4�.a '-Y m Identification Pleas ear rant f le rly OWNER: Name: Address; Contractor dame: " Phone: Email Address O Supervisor's Construction License: ..�� Exp_ Date: Horne Improvement License. Exp. Date " ARCHITECT/ENGINEER � Phone: " Address:_p _ 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. $ —FEE: $ Check No.: - __.______Receipt No.: NOTE: Persons contracting with unregistered contractors Flo not have access to the g uaaF anty fiance ature of contractor Signature of Agent/Owner NORTH r Town of 3z ndover No. . 4�� o h , ver, Klass, / , • A. COC MtC f{lwK:K`�' °RATeo S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System As THIS CERTIFIES THAT ...� .... .v.........V A, BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ,.,.,,?.!Ql .v t„ .,, .�,,., , �,�.....$� f .,. ... ..................... .... � Rough to be occupied as .. 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TS Rough ................ ... ,. ... simm .......... ............ Service Final BUILDING INSPECTOR GAS INSPECTOR Occuizancy Permit Re uired to QccupE BujUUm 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. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. p s Total land area, sq. ft.: 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 rnin.$100-$1000 fine NOTES and DATA-- (For department use) is tT ti ❑ Notified for pickup Call Email I Date Time Contact Name Doc.Building Peanut Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans TYPE OR SEWERAGE DISPOSAL Public Sever ❑ 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 - U FORM PLANNING & DEVELOPMENT Reviewed On n ZD Signature_ COMMENTSAw ' n 'Wavv 11 in tr � CONSERVATION Reviewed on 'a l� Signature ',--b Lk OMNhENTSj Cgr- wf HEALTH Reviewed on Signature (:�OMMENTSV'9rsi 4n ZoninglBoard of Appeals: Variance, Petition leo: Zoning Decision/receipt submitted yes Planninb Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/ nature& Qate Drivewa Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE AR DEPTMENT Temp Dumpst&on site yes., ria Located at,124 Main Stye Fire DOpartmentaignatureldate COMMENTS through facility)_ Fast Food 15.0 per ksf GFA Fast Food(with-drive through 12.0 per Icsf GFA --------------- Office and Business Services Data Processing/Telemarketing/Operations 6.0 per ksf GFA Medical Offices (multi-tenant) 4.5 per ksf GFA Clinic (medical offices with outpatient treatment: no overnight stays) 5.5 per ksf GFA Veterinary Establishment,Kennel or Pet Shop or 0.3 per ksf GFA Similar Establishments Bank Branch with Drive-in 5.5 per ksf GFA Funeral or Undertaking Establishment 0.05 per ksf GFA Other Business or Office Uses Not Otherwise Listed 3.0 per ksf GFA Above .Industrial R&D establishment, manufacturing, industrial 0.8 per ksf GFA services, or extractive industry ------------- Industrial 2.0 per ksf GFA MamrfacquriLigjj ht Industrial (Single-Use) 1.5 per ksf GFA Industrial Park(Multi-tenant or mix of service, 2.0 per ksf GFA warehouse) Warehouse 0.7- er ksf GFA Storage 0.25 per Icsf GFA Other Industrial and'Transportation Uses Not As determined by the Planning Board,but Otherwise Listed not less than 0.25�erksf�GI�A Governmental and Educational Elementary, and Secondary Schools 0.35 per student; plus I per 2 employees College University Determined by parking study specific to subject institution Cultural/Recreational/Entertainment Public Assembly 0.25 per person in permitted capacity Museum 1.5 per 1,000 annual visitors Library 4.5 per ksf GFA Religious Centers 0.6 per seat. Cinemas Single-Screen: 0.5 per seat;Up to 5 screens: 0.33 per seat; 5 to 10 screens: 0.3 per seat -,.Theaters(live performance) 0.4 per seat Arenas and Stadiums 0.33 per seat ---——----- 50 per nine(holes);plus the parking Golf Course or Country Club requirements for food or beverage uses described above Health Clubs and Recreational Facilities 2 per player or I per 3 persons permitted capacity 90 Wa Its F� 1 ten, !A-) All 3900 Dr.Greaves Rd.,Kansas City,MO 64030 (816)761-7476►Fax(816)765-8955 9 Emait ruskin®ruskin.com 11/3/2016 1060 Osgood St-Google Maps Go,,./gle Maps 1060 Osgood St i rrl J� I J` Imagery 02016 Google,Map data 02016 Google 50 ft I VI VVVVVV V uuuuuui i i v V G MOw��/ d� �v �j 1060 Osgood St North Andover, MA 01 845 „ J At this location https://www.goog!e.com/m apslplace/1060+Osgood+St,+North+Andover,+MA+01845/@42.7147605,-71,1172796,120m/data=!3m 1!1 e3!4m 5!3m4!1 sGx89e3O692... 1/3 Important BERKSHIRE HATHAWAY InformationGUARD INSURANcIE INCOMPANIES 398 Insured RICHARD SOO HOO INSURANCE AGENCY, INC, H & BROTHERS CONSTRUCTION INC 1148 Washington Street 118 RUSSELL PARK Boston, MA 02118 QUINCY, MA 021.69 Changes to Your workers" Compensation Policy with AmGUARD Insurance Company Policy Number R2WC525224 Policy Period From Decersiber 4, 201..4 to December 4, 2015, 12:01 AM, standard time at the insured's mailing address. Party Requesting the Change and Type of Endorsement - Deleted Forms effactfve 12/04/2014 WC 0004210 - CATASTROPHE(OTHER THAN CERT ACTS OF TERR Premium change: n/a This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. {The information below is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective See Above Policy No. R2WC525224 Endorsement No. Insured H&BROTHERS CONSTRUCTION INC Premium N/A Insurance Company Countersigned by AmGUARD Insurance Company Thank You Again for Choosing Berkshire Hathaway GUARD Insurance Companies! fe Call Customer Service at 800-673-2465 with any questions. I Endorsement DZU CONSTRUCTION, INC. 20 Labadine Street Quincy, MA 02170 Tel: (617) 719-6192 License #: CS-086642 Registration #: 180409 Contract Home Owner Name: Yen Hal Tran Location: 1060 Osgood Street North Andover, MA 10845 Description of work performed: 1)Add a waxroom 2) Add an employee room F 3) Add blueboard, sheetrock and paint where agreed upon 4) Add new flooring We Propose hereby to furnish material and labor complete in accordance with the above specifications, for the sum of FIFTY-FIVE THOUSAND dollars ($55,000.00) Payment Terms will be as followed: 1 st Payment: Deposit of $18,000.00 prior to work being done. 2nd Payment: Payment of$18,000.00 Upon passing rough inspection. 3rd Payment: Balance due of $19,000.00 prior to calling for final inspection. Date of Acceptance: Home Owner Signature: Date of Acceptance: Contractor Signature: �lo� I t ® DATE(MMIDDIYYYY) ''. A�o CERTIFICATE OF LIABILITY INSURANCE 10/27/2016 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(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 w certificate holder in lieu of such endorsement(s). CONTPRODUCER r NAME: Carol Chin NAME: RICHARD SOO HOO INSURANCE AGENCY PHS"o E 617)338-8168 FAX No: ADOREss: carolchin@soohooinsurance.cem 1148 WASHINGTON ST. INSURERS AFFORDING COVERAGE NAIC# BOSTON MA 02118 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER H: H & BROTHERS CONSTRUCTION INC INSURERC: INSURER D: 118 RUSSELL PARK INSURER E: QUINCY MA 02169 INSURER F: COVERAGES CERTIFICATE NUMBER: 97881 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. ILTR TYPE OF INSURANCE AADL SUER POLICY NUMBER MMIpDY EFF MMIb01YYPOLICY YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE RENTED $ CLAIMS-MADE OCCUR PR M SESOEa occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY L]PRO•JECT ❑ LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY Co SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPPER DAMAGE $ HIRED AUTOS AUTOS e $ UMBRELLALIAa OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE NIA AGGREGATE $ '... DED I I RETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY /� STATUTE IRK ANYPRE OPRITORIPARTNERIEXECUTIVE -- E.L.EACH ACCIDENT $ 100,000 '.. A OFFICERIMEMBEREXCLUDED? NIA NIA NIA R2WC653020 12/04/2015 12/04/2016 '.. (Mandatory In NH) E.L.DISEASE»EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L,DISEASE-POLICY LIMIT 1$ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits Will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govllwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of N. Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St. ArUTTHHORIZEDREPRESENTATIVE N.Andover MA 01845 �'— C Daniel M.Cro r By,CPCU,Vice President–Residual Market–WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD .,,The Commonwealth of Massachusetts Department of IndustrialAceldents a 1 Congress Street,Suite 100 n Boston,MA.02114-2017 �' w= -lwww.mass.govfdia • �4ih Syy 34 ' "VPa�shexs" Compensation:[nsuxance.A�f�claviS:z:E3u�ir�ex,5/Coutxaetaxs/I�;Xec�•aicataxts/k'Xu�,xn exs. TO BE FILED WITA THE PEIUMMNGA-UTjSORA'' - Wease Print Tie 'bl A '•licant"Worxnation y�y� atiaxJlndiidvual)• '�`� �-✓ —� — x,yLIme (Business�ftahiv - Lq City/Stat eJZ,i . _ ------- _ '�—-- — — : Type ofk Xsroject(Nequixed); Are you an employer?Check the approprlate box: _employees(full and/or part-time).* /, [] llCti NdW'd6Mtron l,E]T am a craployer with : 2.E]1 am a sole proprietor ar partnership and have no employees working t'or me in 8. o R modcl.hig ally capacity.[No workers comp,insurance required.] 9. Demolition 3,E]T am a homcowmr doing all workmyself[No workers'comp,insurance required.]t ]0 Building addition 4. T am a homeowner and will be hiring contractors to conduct all work an my property. Twill 11.[�Electrical repairs ox•additigns A7 re that all contractors either have workers'compensation insurance or are solo 12� -pljIn.� g repairs or additions oprictors with no employees• 5. Tama general contractor and T hava hired the sub-contractors listed on.the attached sheet. ]3 � ' „ -repairs Theca sub••contractoxs have employces and have workers'comp.insurancc,t 4 Other 6, Wo aco a carporatiorn and its,officers have exercised their right of'exemption per MGT.c. 152,§1(4),and We have no empldyees.[i7°workers'comp.insurance required.] _ _ -- *Any applicant that aheclts bbi i€1 txrirst also fill ant the section below showing the 3rworkers'compensation policy in£armatian. t TTomeowners who sribmrt this affidavit indicating tbey are doing all work and then hire outside contractors must subnalt a new atPldavt indicating such, tContraown that check ibis box must attached an additional sheet showing the name of the sub-contractors and state whether of pot those entities aVa employees. if the s� ub contractors have employees,they must pro=vide their workers'comp.policy number. F. Below zs tlae/aalicy arz j o i szt �x�am e ployer Haat is pravidingFvorlsepscompensation insurance far^m exnpCoyees, information. rV 60 ,, /fes < " Insurance '�-�- ExpiratianD4.te:_ /° /r6 Policy i#or Self-ins.Lie.1�: _____ ____._, . City/State/:dip:_ Job Site Ad _, •. :_� (lress:_ . ( Attach a copy aifthe Workers,compensation policy declaration a a(showing policy and e�pxxatioxx date). 0-00 Fafte to secure coverage as requited under MGL C. 12t,§25 form aF criminalis a �CP a punishable a Eno Of up to :25Q.d 0 a and/or one-year imprisonment,as well as civil penalties day against the violator.A copy of this statement nxay be forwarded to the O Plica afSnvest7gatians aFthe DJA Fox instarance coverage Verification. race rpx � � X r/a Iiereliy cel°t fy unc%rthe airs andperrarti�s of�erjary that thein.farrzzatian provided alcove is tand car�r'ect. official usv only. Do not-Write in this area,to lie completed by city or'town official: City OrTown: Permit/License ii -- -- Xssuing Authority(circle one): �..I3oard of.EZ�al.tlz 2.J3xxilding�epartxutent 3.City/TownClerk 4.�lectricalZnspectox 5.:i'lnmbingJnspector 6.Other �.— Phone ._ _. �— Contact I 1f�w .-\J Massachusetts a Departmetat'af Public Safety' Board of Building Regulation-,arid Standards f.inlree`rUC.iiii il�t License: CS-086642 %r t, ,i r " .ti SO V CHAD 20 LABARDM�ft WINCY MA 021F70 r r Expiration Commissioner 06/96/2017 P/1010 OP office of consumer Affairs&136siness �ME IfJlPRC7VElkAE1VT CCJPf7d3AC1"C>ft Ks gistration: 160409 xpiration: =11/1212016 CorporMion p2U Cf7NSTRUCTION. INC. 1 SC VAN CHAU 20LABAdINEST, i QUINCY,1VA02170 � f�ndersec,retpary t