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HomeMy WebLinkAboutBuilding Permit #110-2017 - 1000 OSGOOD STREET 8/3/2016 ( '(� BUILDING PERMIT taoRry -60.16 6 1 TOWN OF NORTH ANDOVER o -:• APPLICATION FOR PLAN EXAMINATION �o Permit No#: Date Received Sys R"TED, S SACH�1`� Date Issued: - IMPORTANT:Applicant lmust complete,all items on this page LOCATION- GGG �-S CCSB' r' s� I Pt PROPERTY OWNER 1if.101 L e Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition ❑Two or more family ❑ Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement - ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other xSeptic ►,Well , . ❑ Floodplain ❑Wetlands; ;Water shedDistridt ater/Sewers-- DESC IPTION OF W K TOB ERFORME aq Identification- Please ype or Print Clearly OWNER: Name: Phone: Address: Contractor Name: f l Phone: Email: 0• Address: xi Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $Y - FEE: $ Check No.: (� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the g ty f d Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL t Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming pools ❑. Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING a DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Si anature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments !Dater& Sewer Connection/Signature�Dafe Driveway Permit DPW gown]Engineer: Signature: Located 384 Osgood Street [FIRE DEPAR-TMONT - Temp Dumpster onsite yesno.ated at 124 Main Street re-Department signature/date MMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. 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 min.$100-$1000 fine NOTES and DATA— (For department use) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department e appropriate ermit to be obtained. The followingis a list of the required forms to be filled out forthp q Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4- Building Permit Application 46 Certified Surveyed Plot Plan a; Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (if Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 I l�Location �I , No. //0- l Datea5 o I • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �! Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i k 1 ? ) f Check# ! A G..- / T 3 011j O n Building Inspector /'.WSP November 6, 2012 North Andover Health Department RFCM E 1600 Osgood Street Building 20; Unit 2035 NOV 0`8'101Z North Andover, MA 01845 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Re: Freedom Of Information Act Request To Whom It May Concern: WSP Environment & Energy would like to review any available information regarding air emissions, (ground water quality, solid and hazardous wastes, spills or releases, aboveground and/or underground storage tanks, records of environmental permits, complaints, violations, or incident reports for the following property: Giant Glass ` 1000 Osgood St et North Andover, MA 01845 If the file is too extensive to photocopy (greater than 100 pages) please call me at 732-564-0888 or email at dan.pula@wspgroup.com. We will reimburse the Department for copying. Certified copies are not requested. Thank you in advance for your assistance. Sincerely, Dan Pula WSP Environment&Energy 200 Cottontail Lane,Suite Al 12W Somerset,NJ 08873 Tel:(732)564-0888 WSP Group plc Fax(732)564-1888 Offices worldwide www.wspenvironmental.com F NORTH T .own of IF 6 ndover to o h ver, Mass, CCCMICNtWKw S � BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ......./lope......(0.6�....... ... ...... ....... ............... .................. Foundation BUILDING INSPECTOR ... has permission to er t .......................... buildings on .................................. .. . Rough to be occupied as ris!permit ...oasr o ...��wfta...sob.... Chimney provided that the person accepting shall in every espect 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 CONS TION Rough .. ... ... ........ BUILDI ECTO Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildinm 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. The Commonwealth ofMassachusetts Department of.IndustrialACcidents I Congress Street,Suite 100 Boston,MA.02114-2017 www nmss.gov/dia sY• Workers'Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plnmbers. TO BE FILED WITH THE pERAMTING AUTHORITY. A lieant Information Please Print Le 'bl Name(Business/Organizatio Audividual): W l Address: City/State/Zip: Phone Areyou n employer?Check&e ap�ropriaie box: Type of project(required)- 1. a a employerwith_J-0_employees(full and/or part-time).* T []New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.Q lam a homeowner doing all work myself[No workers'comp.-insurance required.]t 10 VElea 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. l repairs or.additions proprietors with no employees. 12g repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.'[]Roofrepairs These sub-contractors Bade employees and have workers'comp.insurance.: 6.Q We are a corporation pod its officers have exercised their right of exemption per MGL G. 14. Other 152,§1(4),and we have n4 employees.[No workers'comp.insurance required-] -• 'Any applicant that checks box 4l must alsoEdi out the section below showing theirworkers'compensation policy information. i Homeowners who subriiif dais affidavit indicating they are doing all work and then bire outside contractors must submit anew affidavit indicating such. TContractors that check this box must•attacjed an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.'Ifthe sub-coA6c16rs have employees,4liey must provide their workers'comp.policy number. I am an employer th at is providiing workers'compensation insurance for my employees.'Beloip is the policy acid jab site information. Insurance Company Name: ? Policy#or Self-ins.Lic.#: w J97 Expiration Date: Job Site Address- O���d 4 City/State/Zip: f Attach a copy of a w0irkers' compensation policy declaration page(showing the policy numb r 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 Investigations of the DIA.for insurance coverage verification. Ido hereby certify unifer a ins enalties ofperjury that the information provided above is due and correct q�� 8-- Si ature: ,-71 Date: Phone# Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express implied,oral or written." � or p An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enferprise,and including the legal representatives of a deceased employer,or the receiver-or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a/dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonTealth,for any applicant who lias not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for theperformance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill-out-the workers'compensation affidavit completely,by checking=he boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and-phone,number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees'other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of•Iiudustrial Accidents for con nation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hag provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be ed to providthe applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number' The Commonwealth.of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA.02114-2017 Tel. # 617-727-4900 ext.7406 or 1-877-AIASSAFE Fax#617-727-7749 Revised 02-23-15 www mass.govldia --'1 KANN&PR-01 JONEILL ,acoRO` CERTIFICATE OF LIABILITY INSURANCE P ATE(MMIOD/YYYY) 6/6/2016 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(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: Durso&Jankowski Insurance Agency PHONE FAx 11 Saunders Street (AIC vo,Ex_)_(978)688-7000 (A/C No):(978)688-7001 E-MAIL ----- North Andover,MA 01845 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Concord Group Insurance INSURED INSURERB:Safety Insurance Company 33618 Kannan&Pricone Plumbing& INSURER C:Markel Insurance CO Heating,Inc. ___-_. 3 West Ayer Street INSURER o:Guard Insurance Group Methuen,MA 01844 INSURER E: 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 OF INSURANCEADDL-SUBR: POLICY EFF POLICY EXP LTR � INSD WVD POLICY NUMBER MMIDDlYYYY IVI M/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR 20009105 04/01/2016 04/01/2017 DAMAGETO RENTED _ PREMISES.(Ea occurrence) S MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY _ EPRO- JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: - - _—_. ._$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _(Ea accident).... S 1,000,000 B ANY AUTO 6237590 04/01/2016 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED ( ) AUTOS AUTOS accitlent Per BODILY INJURY S _ _ X NON-OWNED -PROPERTY DAMAGE S HIRED AUTOS X AUTOS (Per accident) i S UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 3,000,000 C X EXCESS LIAB CLAIMS-MADE MKLV10LE107332 04/01/2016 04/01/2017 AGGREGATE S DED RETENTION S S i WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY _STATUTE ER D ANYPROPRIETOR/PARTNER/EXECUTIVE YIN KAWC739294 06/03/2016 '06/03/2017 E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? 1 NIA (Mandatory in NH) - E.L.DISEASE-_EA EMPLOYEE S 1,000,000 If yes,describe under - -- - -- - — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) i i CERTIFICATE HOLDER CANCELLATION I � j - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover Bldg 20 Ste 2-36 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE � I i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Department of Public Safety License: SJ-005206 Sprinkler Journeyman WILLIAM M K.ANNAN 106 GRANDVIEW-RP, METHUEN MA 0,1844 Expiration: k Commissioner 09/05/2017 J