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HomeMy WebLinkAboutBuilding Permit # 1/19/2017 VkORT$l BUILDING PERMIT TOWN OF NORTH ANDOVER ho I APPLICATION FOR PLAN EXAMIN�AT 4/ON Permit N0-._.___._ Date Received 1 7 -& Date Issued; CHU IMPORTANT: Applicant must complete all items on this pa e LOCATION /,5-Z,0 01f"011 ._(t A' Aww1mee- 6�1 Pdnt P Op TY rROPEIRTY OWNER-_ OZZ4 0, MAP NO: PARCEL: / Print 7 ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT--—— PROPOSED USE Residential Non- Residential D New Building 1-1 One family F)Addition 0 Two or more family 0 Industrial WAIteration No- of units: XCommercial f I Repair, replacement n Assessory Bldg FI Others: _D.Demolition t 1 her 13 Septic L) Well 0 Floodplain IJ—Wetlands "— 7—Watersh-e—d ------------ 0 Water/Sewer District I Al(let" 1L,02,d(,f Identification Please Type or Prin Cle2rly) OWNER Tb1zLL� w / Name- j!Q rf W 1 Phone: "l -r U , k %Ltlf Al Address: i qiCQ! IASSill CONTRACT R Name: —Phone, T7S°' �.l~"��,� 5',� address- S- Address- Supervisor's Construction License: Exp. Date: Home Improvement License.- Exp. [pate- ARCHITECTIENG]NEER Phone: Address: R . No FEE SCHEDULE BULDING PERA11T,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: 00 _FEE, s 3 Check No,--- Receipt No-:::: NOTE: Persons contracting w, ed contraclors do not have access to the guaranYyfund acting W r i"1115,7 Signature of Agent/Owner- ignature of contractor ............. .......... ........... t%C)RT#1 Town of ver ® % ��K® h Ver, Mass, t 0%. 17 coc"Ic"awic V I C 5 BOARD OF HEALTH Food/Kitchen ERMIT L Septic System OT ....6A.0......st.rf.w......p4jee TIFIES THAT .... BUILDING INSPECTOR Foundation ission to erect .......................... buildings on ...... .. 0....... Rough apied as ....... ....... Chimney that the person accepting this permit shall in every respect conform to the terms of the application Finai this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and tion of Buildings in the Town of North Andover, PLUMBING INSPECTOR IN of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR- UNLESS CONSTRUCTIO TS Rough Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit REquired to Occuuildin Rough splay 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. N„ .. New England Fire & Sprinkler Protection, Inc. 80 Brick Kiln Road cr r Chelmsford, MA 01824 (978) 452-2895 (978) 453-5475 - Fax January 18, 2017 North Andover Fire Prevention. 1.24 Main St, North Andover, MAO 1845 Attn: Fire Prevention 978-688-5290 Re: 1570 Osgood St. North Andover, MA NARRATIVE The work to be performed is as follows A) Relocate four sprinkler heads 13)Add one sprinkler head C;) all work will conform to NEPA 13 codes and standards Sincerely, led Flanders New England Fire & Sprinkler Protection. Inc. 8 7 d a` d 3 2 CURRENT SPRINKLER LAYOUT T 1 14 `2 Q 22 23 DI ❑ D A=10 6" FROM Ari A FLOOR ' �� II a=BELOW I DROP CEILING ' I A� A Goo E3 j i II RM 1300A RM 1300B i B I ELEVATOR 'fit-J ❑ ❑ i 17 v l A 1NLESSOTHERWEESPEVFED TITLE: FLOOR PLAN ROOM 1300 A&B A ' s � 'CLaauGFS; A4GLLAP..MACMz i GCyrces ALL DIMENSIONS ARE APPROXIMATE --'IT CUSTOMER: LMS MEDICAL SOLUTIONS uc xr racr ,nar u:c coactacxruu SIZE DWG. NO. REV c: ,aa ccvs. Fv MATERIAL: D2 z 5 M{$ P'CpR � 1750 Osgood SL#2010 c ME S Las North Andover*�.{y 01845 FINISH:, PROjECT#: F SCALE:1:120WT. S-iEETSOr5 8 7 d a 4 3 2 1 $ ? 6 S < 3 ? 1 �—� 1 w 0 f � 17 n, D A 0 D a i A=10'b` 15'0' I { FROM ij A A i F_OOR I, 156^ a S ka i - t AL1 {� !r dp-�% �c., 7�1�1 - C ��s� r� i � ! a•61 �4"DRAIN R 13 9 T—� t121i `2'0^ RM 13003 RM 1300A 1 1 c^ 4"DRAIN lsc^ 11'7" 4,6.: ,0" t �t 1'c—i 210 3 B f q,0" O.__/ I I COLOR KEY PROPOSED FIRE SUPPRESSION SPRINKLER SYSTEM Sprinkler system water main Sprinklerlines s-0 cARE w'N-,Fz AOld-Spnaklerheads uxtess eTHRWISEsvECM TITLE: FLOOR PLAN ROOM 1300 A&B A O Proposed new Sprinkler heads A.GU-.C4j 1 O.V— Proposed new wall x " ' CUSTOMER: LMS Existing_10'wall to be extended to ceiling MEDICAL 5OLUTIONS xxx=-cs rsmAxr awo cewnorwna SIZE DWG. NO. REV Proposed new door u a h b r MATERIAL: Proposed new sprinkler head in suspended ceiling ��cF z op g i1500sgoadSt#F20I0 F +c.is � � North Andov= a rscu u e'c H -x ` MA,QI84$ !.:wRTiEyED xt =RO-ECT#: 130C wti'SH: sat wsvx^ �. SGALE:1:12QWT: SHEET 20F2 8 i 6 t d 3 ? 1 tJ Commonwealth of Massachusetts J 'Depariment o,'ubiio Safety Sltri n kleir C onti-,ictm License: SC-000423 kfI� GRANT 3 VANDB"0 ]9 FO Box 212 -f ':a XA North Chelmsford MA ,u Expiration: Commissioner 04/29/2017 A AC" p� CERTIFICATE OF LIABILITY INSURANCE 0411ma18 DATE 1MMlOtl1YYYYI 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: it the certificate holder is an ADDITIONAL INSURED,the POIICy(B)S}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 certific certificate holder in Pau of such endorsement(s). ate does not cooter rights to the PRODUCER cONTAci Fled C.Church,Ino NAME. Elane Doaals.AAI 41 WCIImen$lreel LoPNONE 9783227243 PAX µpb,MA 01551 A14—Nq.s1' AIC N, 01, (978)454-F865 (800)w5-1803 E-MAIL edoaols�rredW,artll,pam AGO R 53: 1NSUR_ eRiSIAFFORMNG COVERAGE _ NMCN —~Commerce Ineun3nca Cam -� - -'_—"- 34754 New England Free&SP'I V.r PratechOn,Inc, INSURER e; 74a8onal Unwn F'Irg In LPrance CompdnT al Pittsburgh,pq 19445 60 ariCA Kiln Ra INSVRENC: Asaoda16d Iadwe Cs Insurancd Company Ino Y5372 Chch,sFcrd,AIA D1524 INSugER D W6—1 Liablhty A Filo Insurance ewnpany 20052 INSURER E: � INSURER F; ~- COVERAGES CERTIFICATE NUMBER:51458 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATE[), 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 t8 SUBJECT TO AtL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS._ [NSR —_.� LTR GENERAL LIABILITY TYPE OF INSV RANCF IA�tlLrV ...,'—. _.._— _.._..I PO�ECY EFF POLIC E%P " POLICY NUMBER MWoo1Y YY MAVD0fYY Y� LIMITS _ _ ' V I EACH OCCURRENCE 3 LwoAOo COMMERCIAL 6ENERALL481ILTY I 1 DA A ETO NTEEP PREq SES Ea occurs g�• cLA1MSMADE OCCUR I MEDEXP(AAy-. ersonl S excluded . ! AE55034278 12y20T8 12&2017 5 1,010,000 lf€ PERSOMAL&ADVTWURY_ GENERALAGGREGATE g 2.000.100 OENL AGGREGATE LIMIT APPLIES PER � 2000000 POt.ICY M PRD- LOC PRODUCTS-COMPIOP AOG S hUTOh506[LE LIABILITY I COMBINEG SINGLE l3MIT 7,000000 Ea ecciCanl] _ A 1 ANY AUTO BODILY INJURY Per arson S ALL O.; .x. SCHEDULED € P 1 AUTOS _ _ AUTOS BBNT95 y], 030 12.WD17 800 Ur NJURY(A ) S - % X"I NONAN'NEp el atadenl g FIREOAUTOS 'AUTOS j PROPERTYOA0.IAGE fl Peracddenl g % UMBRELLA LIAR' X •OCCUR 3 5.000.000 a t ~EXCESS LIAR EACH OCCURRENCE --„CLAIMSMAOE 1117062458964 AlfiR018 3'288017 _ Hone I AGGREGATE 5 3,OOD,OOfl DEO I RETENTIONS ! '—�-- WORKERSCOIAPENSATION 13 AND EMPLOYERS'LIABILITY % WO STAN- OTN G ANY PROPRIETOWPARTNMEXECUTIVE YIN ^, OFfICERIMEWRR E%CLUDE07 N1AI Vg'ht704714 3888015 8123/2017 EL , HACCIDENT 5 610' jildondatory In Nip PAC ;uYns.deserlLe abler E.L.DISEASE-EA EMPLOYE 3"'o ❑ESCRIPTION OF OPERATIONS below 1 EL.bISEASE-POLICY DMIT 5 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES[Attach ACORD€01,AdditionalR-1*a Schsdu14,If mato a pace is raquTredl Bnan Flanders•Kathy FOVc5-See Ses CERTIFICATE HOLDER CANCELLATION TC—or Noah Andover 144 Alain 51 Noon Andavel.Ala 01845 SHOULD ANY OF THE A80VE DESCRIBED POLICIES BE CANCELLED BEFOHE THE EXPfRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORPANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE y� i J Con bolder if ID 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(20101061 The ACORD name and[ago are registered marks of ACORD i ' - The Commonwealth of Massachusetts Department of Industrial Accidents { I Congress Street, Suite 100 --__ tl � r r Boston,MA 02114-2017 www massgov/dia 4'I'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO 13E FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name(Business/OrganizatiorAndividual): 11&vE � r j.t r d'if'r=Gfi�Q It [ Address: , City/State/Zip: -, v Q Phone#: Are you an employer?Check the appropriate box: Type of project(required); I. am a employer with V employees(full and/or part-time),* ], 0 New construction 2 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.[:]l am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 Q Building addition 4.[:]1 am a homeowner and will he hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]EIectrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance: 13.E]Roof repairs 6.FJWeare a corporation and its officers have exercised their right of exemption per MGL c. 14,©Other t' f l�t. f 152,§1(4),and we have no employees.[No workers'comp,insurance required.) *Arty 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 must submit a new affidavit indicating such. #Contractors 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 have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and joh site information. Insurance Company Name: ,- Policy#or Self-ins.Lie. C 7,0 Ya J V Expiration Date: 3-,2 3-17 Job Site Address: City/State/Zip: ✓tl Q 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 up to$1,500.00 and/or one-year impriso[nncnt,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 cerli nde t s and penalties of perjury that the information provided above is true and correct. Sianature• Date: Phone Official use only. Do not write in this area,to he completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#•