HomeMy WebLinkAboutBuilding Permit # 12/22/2016 BUILDING PERMIT o�N4��
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION � T
Permit Rio : Date Receivedafb°�AYepWPQ�y q`•
RCHUS
Date Issued:_ /
44POWfANT:
— --- - -
T. applicant must coxa�plete all items an this page
u ,
LOCATION
PROPERTY ovvNR t
Print 1NYearstructur' : yes no
MAP PARCEL: ZbNING DISTRICT: Distri yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE _
¢� Residential Non- Residential
- — _ -
-----------
0
--------U New Building ❑ One family
❑Addition El Two or more family ❑ ldustrial
CAlteration _ No. of units lommercialW
11 Repair, replacement El Assessory Bldg 0 Others-
El Demolition ❑ Other
D Septic D Well ❑ Floodplain E1 Wetlands I1 Watershed District
L Water/Sewer
DESCRIPTION OF WORK TO 13E PERFORMED:
-14 11 1'eA,oJ dta I edlwA&o 4� O'n b', L'm
ca OR- ea e Type or Pi ipt Clearly'
OWNER: )Mame: � ,Phone: -
Address:
Contractor Name: ° �° �;� Phone:
Address: �r�. J L)4 N)d A'31,q
Sup �.,
Supervisor's Construction License: ° . i � Exp. Date: , 6
Nome IrnprOyement License: Exp. Date _
ARCHITECTIENGINEER__ t y 1 )�AX Phone-
Reg. No. If
FEL'SCHEDULE:BULDINC PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
-._.. Total Project Cost: $ FEE: $�
Check No.: _
_Receipt No.,, " 1
N l J r ,contracting with ana egister ed eantraetors (Io not have access-to the gtr aranty funat
tan, .ofAgenlwner _ _rignaicnofotractr �:
__
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
-Type-"F SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swi,m,,,;r�g Pools ❑
Well ❑ Tobacco Sales ❑
Food PackagiogSales ❑
Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL. SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
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
Water & Sewer ConnectionlSi nature k Date Drivewa Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site ye no
Located at 124 Main Street
Fire Department signatureldate
COMMENTS al,,Z,-'—
t�RTk
Town ofAndover
:_ * .
O `" to
No.
$4 - L.j. h ver Mass,
a
'41 COC MIC MiWMK •1
V
X7,4 A� wreo
BOARD OF HEALTH
ff In
PERMIT T %,; Food/Kitchen
Septic System
A.& • BUILDING INSPECTOR
THIS CERTIFIES THAT ..��#.�, t.U.5Z.... �. .• ••
Foundation
has permission to erect .......................... buildings on . ®........... .. . Rough
t0 be occupied a5 .......1 ......,.�. .. �.... .. ` ....... .!! .o. . ..4........... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Fina{
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
UNLESS CONSTRUCTIOMSTART Rough
1111!!iit Service
.. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Fina'
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
r.. ^ ... DOWGIERT CONSTRUCTION CO. INC.
173 BRADY AVE
SALEM, NH 03079
978-815-7292 CONTRACT
Customer
Name Ozzy Properties Date 12/11/2016
Address 1600 Osgood St. I'llContract#
Y
Cit North Andover State MA ZIP 01845 Job Name Mentor Expansion
_ _ —
Phone Suite B20 F3
--
q Description Unit Price TOTAL
Supply nece's'sary material, labor and permits to modify
existing office space as per plan by L-Arch on 10/16/2016.
Remove and dispose of walls as per plan.
Build new walls with metal studs and 5/8"drywall on each
side.Tape and sand new walls to a smooth finish.
Install solid-core oak doors in metal frames.Install four
sidelights as per plan. Install electrical outlets in new
walls.Adjust switching and lighting due to new layout.
Repair ceilings due to removal of walls.
Paint existing and new walls.Colors picked by others.
Paint new doors and frames.(Existing doors to be re-
used where possible.)
Remove existing carpets and cove base,and install new
broadloom carpet and cove base.
'Price does not include architectural or design costs,
removal of any hazardous materials,data wiring,or
movable partition wiring.
1 Total Price $75,836.00_ $75,836.00
SubTotal $75,$36.00
Shipping&Handling
Taxes
TOTAL $75,836.00
- _.-...... Office Use Only
c�
.. w
Initial Construction Col'Itrol Document
To lte suhrtti ed with tite building lacrtrrit application by tt
l e utter ed Design PrC►fcssittnrul
liar work per (lice 8°t" edition of"the
+ IVltssachusettrr Stance building Ade, 780 CM R, Section 107
DO m �,
I�^rca,jeret I"itlu; .,... ... ��....� ��� A. �.�..�...... .
Property Address
I rca.lcc,t; Check one car° both as apillicrthle; cww� crart,��__
� `� ^ � �, � ° `tM"MIc"ti(an ��,XiSGitr (:`canstr'trctican
Project descrip°atiran; _. . . . . . . .._ .. __ .. ._ .e, .. . . ....,.. _ _.
MA Rogi trrtttett hhunber � Am
l,�;pairttticarr (Irate ._ ir .. ., ME rr
Y
r°c� t.a�dere let;jrr'gfi!ssicanat and I htrvu pareptrted car directly sulac,rw�i�ed two paremrrttican carrill etc,si „r� lr'rr ,
Computations and Spec concerning;
I
Arclutectur€tl � � Structural Muchanicttl
1 hire Prcatc"t;tican j. 1-ilcctricol j' (alter
RW the above named prcw,jeet tatted that to the hest ca1`my kttcawledge, information, and helici'such p kms, ccatnpantnthns anti
spaecilicrrtion;t tneut the trtatalicuhle parovishns of the NU;,;attclmsetts ,Strtte 11WWhW Code, (780 CMR), and €tccepatcd
r,*ngiuc^urinm prtccticcr'a liar the prcrlxmcd project I undersonr,el trtul agree Int I Or my dusigneO ,Mall Iac rt`earm (lie necessary
I ,. , . present r ;a m . x and p�er odic buds toe
attat;�r;icatrttl �;c�r�^icac� rtrtd he atc�cttt can tktc, ctan;rtructieatt;�itc cera rt regular tar
I, Review, fear conMrntrurcu to (Itis coda and the duA n ccatmepat, shop dmwhW% Samples mated othur Wn rirttrls by alae
contrtrctcar in accordance with ow rcytimmunw or the ccarmuction doc°umonts,
i g �s. Chapter 17, its up�apalictrhle.
I crtitr°rat the elutic� 1�tr rc ,t�tcrccl darn patcttc��;tonal� in 7�I;1 ( �Il
I l I I . u r� y h the Iarcattre;a anti
� �, 1(c present tat haterw�ttl� ata aro err(((s ata tlrc Stage cat ccrtr;�truettcata to hc�cottrc c„cncrttll t�rrttrlittr wit.
cptudity of the work toad to determine rt the work is herrn(perharuted in a manner consistent with the approved
eonstructicatr documents and this code,
Nothing in this doctrmcttt relvas the contrast w o1'W responsibility regarding the provisions, cal"780 CMR. 107,
Wheat roquired by the building ot'tichtl, I shall submit I'icldiparo runs rupaorN (:gee item 1) to cthm with paertinent
communt:Mr, in a Doran rtecepata* to the building;off"tchd,
r�
(,,]poll compaletion of the work, I Shall stthrtut"t i� � ii cid tr `Yiold 'onstruutioll C'otttrol Documunk
Il!"ntear ill the Apace to the right a "wet"" or
elcownie signature and sell; C„t
� r
Phone! number linloil;
""wig CaPHc>W Un Y
i
43trilclirttt tatV'lrJM Mrtrtrr; . . ,.�.. _._.,...,._. lacrrnir No'a
Vc+rAcatr tats_11 1103
Initial Construction Control Docunient
To be submitted with the building punnit application by a
Registei-ed Design Professional
for work per the 8t" edition of the
Massachusetts State Building Code, 780 CMR., Section 107
W,84� 61 Date:
Prqject Title:
WP_
Property Address:
Project: Check one or both as applicable: "Low tt'LlCti011 ',,xisting Construction
Project description: ................................
...... ............... ............ ................... ....................... .............
MA Registration Number: Expiration (,late: aril as
registere I design prqf�ssional, and I have prepared or directly supervised tile preparation of all design pharas,
computations and specifications concerning:
JKArchitectural J Structural Mechanical
Fire Protection Electrical, Other
for the above named prqject and that to the best cat"nay knowledge, inrorination, and belief'such plans, computations and
specifications meetthe applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted
engineering practices 6or the proposed project. I understand and agree that I (or my designee) shall perform the necessary
professional services and be present can the construction site can a regular and periodic basis to:
I, Review, for conformance to this code and the design concept, shop drawings, samples and Other submittals by the
contractor in accordance with the requirements or 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 tile MlgO Of COnStRICtiOn to become generally familiar with tile 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 dOCU1110at 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 t1ve work, I shal I submiL cial a al construction Control Document'.
Enter in the space to the right a "wet"or-
electronic signature and seal-,
Pholle number; _rtEm I i I:
Building of 'tial Use 0111Y
Buildhig Official Maw: Pormit No.:—----------- Date:
Version 06112013
The Commonwealth of Massaehusetts
x De a t�nent oflndastrial.Accidents
I eoxagress Street,Suite.100
Botr��x,1Vl�J 02ZI4 20x7
w7vw massgovldia
.p'Ib�n 5Yti
Wg kers' Compexxsation)I:nsxxrance B� x aT �s7 txxciaxas// ambers.
'CQ 7&E E7DW please Print Lq 'bl
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']!cant Wormnationt "
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Name(l3usincsslOrgavizatipxrllnvidua '
ItatealPlane
city /zip:' :i o xiatebox: Type aprojeet(Tegxxixef
Are yozi an employer? ec tl e aper p
1.�I am a employer with r:�D eraployeas(full andlaz part idme).
7. ]1�Tevl`consixuotia
2-E]I am a sole proprietor or partaership and havano employees working fez zne izr 8. ('3I1xod brig
arry capacity. .low rkeraa
zs'camp.ipsuce required.] 9, ❑Deltx�lYtlOxA
3.Q I am ahorx�eowner doing all workmysell
oworkers'comp.insmancOMluired� 10❑Btading addition
4.F]I am ahomeowner and belururg contractors to candaci all wozk nnzny property. 'Will ILEI Elect!cal.Tepp.8 o-'additigPs
ensure that all contractors either have workers'compensation insurance oz are sale repairs o7r a dcli$io21S
propzietars with nn emplFsyees.
5❑I am a general contractor and I have hiredthesub-corr6 actors listed ontha attached sheet
13'.[ Rooxeaiars
Iheso sub-contractnrs have employees andhaveworkers'comp.insurance 14.n Other
$,❑Trve ora a cnrporatian and its.of cam have exerdsedtheir right of bxemption per MCI c.
152,§1(4),and via Jaave no employees_[No workers'comp.insurauce required l
applicant thatcheoks 6oXkl nri' also fill ouEtbesecfzanbalaw shawingtheu porkers'compensationpolicyinfazmafion`
�Ycy
7 Homeowners y�hn submit°this ai llavit indicatingdir
ditiaztal shegshowing the name ofthe sub contra oras and sta submit wheiher q not flxoseenfifies have b
::.
tcontractors that checkthis liaxrxtusE attached err ad
employees. 7fthe sub-coni�ractors have employees,they mustptovide their worl€ers"comp.policy number.
T am axe erazployer that is providir�gorleNs'co
rnpensatiar�insurancGfor�My erreloyees 8elary rs t/iepoliey azrd f obi site
information.
In sinance Company Name:
i' Expixatioxx Date (1� �vl0!7 —
Policy#ax SON-ins
Lie-#:. � �
CitylState/Zip: v ✓
Sob Site Address: e slxov�ixxg tTze policy 7axxxrxber and e pixatj n date).
Attach a co�pp o e oxker coxnpezxsa oxxPoli-y declaration Page
Pailuse to secure coverage as xcquixed under MGL e. 152,§25A is a axix>7in OP WORD ORDEkZ acid a flee of p to $250.00 a
and/or one-yeaximprisonment, well as civil pezxalties intoe form of a S
day against the violator.Acopy oft/ statement ay
be forwarded to tb.a Office of fnvostigat%ons of_tbel) fori�isuxaxxco
coverage vexification.
fy . o erjury t1iat MY infonn
a_tia;� rav1,5rded agave �a r e and Correct
Z da Xiereliy ceri� ung triepai arLcipenarties
• _ r Date: ���
Si atuxe:
}
Official use only. Do notivrite art Mis area,to he cornpletecl by city o�'to�vPz officiar
7'arruiEl7 !censeF
City or To-wn.-
IssuingAuthority(circle one):
[.Board o �ealtlr 2.Building Department 3.CitylTo-wn Clerk 4.Electrical Inspector 5.plumbing Inspector
6.Other
Phone#:
Contact Person:-_�
- INSURANCE
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THS CERAFICATE IS ISSUED ASA MTTER OF INFORMATION ONLY AM CORMSNO RIGHTS N T14E CE4 InGATE k1MDER'4'4-x`°
CER11FICAM D= NOT AFF! A` WLY OR RE43ATPJELY AMEW, OMND OR ALTER TIM COVERAGE WORDED D BY THE POLICiES
BELOW. TM CERTIFICATE OF INSURANCE DM NOT CMSTITUTE A CONTRACT SEMEEN THE ISSUING INSURES), AUTHORum
PZME—SENTA-111VE OR PRODWER,AND T.-Iv A WNR.
AFITe If t c iii Ird r ada Oj do= I sum ED,--subject to
and Mdlftng Of UM pO t y,CeMh p0ffMy"iM On Grddar rr 4t. A enton this wrlificata don mAconO Y rl %to the
c@t '1cate holder in Neu of such erodarsemn
PRCWCER T Kr„_st ws L nn- Cis
X.P. Roberts lnsur c6 'en P �
1060 Osgood Strom E�enaI„
AOIE35:� ]cx�.aa,xtemr® rts;LE7l6Lil;siiCe.�+3�
North Andover, IA 01845 INSUAEPCS
)AFMRD1W COWRAGE A
DdGIERT ,"` .g 'UCTICN CO. , 1t7 dP1J4ZERC: C�1SS1� Yt3 Ixza Cad _
1616 ESSEX STREET
LUqRzXCZ, MA 0184
' IS�.rRCR F r
OOVERAGES CERTIFICATE NUMBER. R SI NUMGER:
THIS IS TO CErMFY THAT THE POUCIES OF INSURANCE LIMO BELOW HAVE SEe4l$WEDTCT THE INSURED WVED ABOVE fi>OR THE ROLICY P�IOD
amr.ATED, NOrMTta$AP DING ANY F2EqunrzMEW,'1'ERM OR CONINTiON OF AIRY CONTRACT ORS' r=;Z D=MENT WITH RE'SKCr TO WHICH` qIS
CER'71QO,TE MAY BE ISSUED OR MAY P[RTAW,THE,INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN M SUBJECT TO AM THE TERMS,
OCCLMM ANDCbNETi't ONS OF SUCH POLICIES.E.UITS St-sCTM MAY HAVE SM RE1=1ED BY PAI}GLAIMS
LFRR 'TYPE OfINetc Poucy MRSICTlC1RYYYy rl�Yr$
d tA�llG4>3�uIY BOPOO8608 3f23/13/23117 cHOCCIa€ EnICE ,400_.t3QP
�>3navrERcv�l�i;n�€��t`f-.�t,vsn�nr
CLARM-MACE DO OMUFr 5 000
PWSON AL&ACVIWURY S
WN'LAGGRIMATE LWIT APPUrS PER pRpW=ICOMM AGI QQ4s��[�
7C POLICY �0 Lm �
AVTOMoattEUAMTY ilPL?05TaZ000 3f33/ie 312 ! 7 3 °m 1'.000 000
ANYAU'tt} BODILY fwuiR (Per'wmo 3
AUTOS��q AAnUT43IXED DILY INJURY( )w ncmId¢i ) �
NaVEt7 S M $
� IdIREgAU'POs
S
I) X UMMLLALIAO X 0MUR XNCO05137401 3123/17 EACtdWOURRENOE S 1 Oil} Q00
e SUAS 0LAKfmr.MAA I AGGri TE S 1,000,000
UM & I IOAI3
$ VMRK C NSATON 79$594 10/2rfx� 5df��/x7 w0STATU- OTH-
ANfY F]8PLOYER�'UA�69E W
MYPR0PPJEI0PIPARTWEfVEXEC11T v� a to SJL,EAC A (�Cr--;T
(MArpEssmrrtn NHE.L,DrsEAsr-r LOYE �000
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DEWFPPONO€OF9tt471=ILMWONSIMOM(AU*MA=M 101,MdWmfRorm39ft edd)
OZZY MOPMTIES INC, is listed as ad ditiMal ensure for qenqral liability, per written
OWULD ANY 4F THE ABOVE,OtViMBED POUCtR3 BE GAMCMLIE0 BEVO
TK EXPIRATION DAA THEIPMOF, 110110E WILL BE 13CUVEIRS-D IM
CXZY 01PERTXES I£:C r 3.600 A==-1111012=8 IME r°i�Ibl�n Fi�Ci`&i9 s eta.
e T�� ST LLC L9UMEE Car-FTCE PARK
C E STATION LIC 1)I ES junta r� s�aiATavE
I)SPIING LLC HERITAGE PLACE L
R. All rights rwomd.
ACCR0 25(2010XI5(• The ACCRD name and"ea are ragafed ma s of Cl �
I'3tarrar; Filar (603) 459-1090 E-Mail:
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-048040
Construction Supervisor
TADEUSZ DQWGEERT
175 BRADY AVE
SALEM NH 03079
CJ-Expiration:
Commissioner 1012912017