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Home My WebLink AboutBuilding Permit #679-12 - 1011 OSGOOD STREET 3/27/2012 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 6 7 mo / o +' Date Received 9p�wwraD Permit NO: Date Issued: ��SSAc►+us�� IMPORTANT:Applicant must complete all items on this page . LOCATION —T Print PROPERTY OWNER �>�� R1�1 (}3nJI1 CtSSIfLtCr-- /�-ti �- Print MAP NO: PARCEL: ZONING DISTRICT: 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 Iteration No. of units: Q Commercial ❑ Repair, replacement ❑ Assessory Bldg IL Others: ❑ Demolition ❑ Other 0 ff 1 t SPA t>� ❑ Septic ❑Welt 0 Floodplain [IWetlands ❑ Watershed District D Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: r otZ -f0;R% G1 kNo - MAtJAACC- H9d `t" A-/- c Identification Please Type or Print Clearly) � . G �i KPhone: OWNER: Name: �• �� Address: ' CONTRACTOR Name.: ' Phone: Address: � � 'r . — Supervisor's Construction License: S _Exp. ,Date: Home Improvement LicenseJA IA30 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0 .0 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with reregistered contractors do not have access to the guaranty fund 'Signature of Agent/OwnerSignature of contractor Plans Submitted Y' Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ I ❑ Food Packaging/Sales El Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments t Conservation Decision: Comments Water & Sewer Connection/signature& Date Drivewav Permit Located at 384 Osgood Street �.,:: -z ae,{.rr y-.. •,„•,..fie .hz" s 4r, i✓`" , '>'•¢ 't .. P"J "6Y AFIREDEPAR�TMENTT{empDum,psteti.ronisiteFye, i ", o� n s a,{,"�YCA,p9 ifs, Located atwi24�Main Stree r xi �.� '��}�."�.i�^°` •�•1.,y,•3,-�f. -,..'yk ,� , k: n-y.',. o: '^ Ftre De linment sr nature/date ,:. .. Xp V ,g , � � y r= OORT�y BUILDING PERMIT oF�t�ED bq�o TOWN OF NORTH ANDOVER 0?i��:o. 4-�4 0p APPLICATION FOR PLAN EXAMINATION , C, 41 Permit NO: 67 I—12— Date Received �SSACHU`��S Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION_ l Print PROPERTY OWNER �2� Fa►� )h CROSSIrti� �- �c-h- C Print MAP NO. PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residentia{ Non- Residential i i New Building One family Addition I Two or more family Industrial Alteration No. of uriits: Commercial : Repair, replacement Assessory Bldg YL Others: Demolition : Other 0 IFf I c S f A C1 ❑ Septic [] Weir ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: % G I ►•I O M.&ti A G C H e N J— L 4 C Identification Please Type or Print Clearly) OWNER: Name:' R'�� , '�� S'S,.r; .� r r. Phone: Address: M f. logo CONTRACTOR Name: '1� Phone: Address: �t #4* Construction License: Exp. Date: Su Supervisor's C �� P Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. l Total Project Cost: $ FEE: $ �' 13 Check No.: 3 Receipt No.: ��' NOTE: Persons contracting►vith unregistered contractors do not have access to the guaranty=fund Signature of Agent/Owner _ Signature of contractor a Location No. 7 9" 2._ Date a a 7 i • ' TOWN OF NORTH ANDOVER • :��;1^►1;[13` �9 . Certificate of Occupancy $ y �-- Building/Frame Permit Fee $ y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y 7 Check#.37 s33 t 25136 euflding Inspector Location No. �%' / Date G --3 20W, • - TOWN OF NORTH ANDOVER YN, N �d „x Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# / 25264 Building Inspector Cr f`t. `''• .OOw . 3�sS1CNUsf4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 679-12 on 3/27/12 Date: May 3, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1011 Osgood Street MAY BE OCCUPIED AS Office Space IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Trigilio Management LLC 865 Turnpike Street North Andover,MA 01845 Building I4ector Fee: 100.00 Receipt: 25264 f Check : 37590 n ` t4ORTH Tovm of I Andover . No. A K E o dover, Mass., � I� COCKICKEWICK V^ %�RATED U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR .. THIS CERTIFIES THA ...................................................� (. �"® �: ..� Fo tion m a d - has permission to erect........................................ buildings on ../!?.. ... . ...............................................e Roug tobe occupied as............... ° .....�.. ..:..:.. .......... .�...... �• ` .x•. 9.4°'.�.... `� s imney provided that the person accepting this permit shall in every respect conform to the to ms of the application on file in Final , this office, and to the provisbns of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSTOR Rough �T. �l%/f Z VIOLATION of the Zoning or Building Regulations Voids this Permit. �i PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INE R UNLESS CONSTRUCTION ST : TS- - r ough g,Z 7-/7 ..................... ...... M ..�... .. „�u.A. ... Service BLDING INSPECTOR incl �2, Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done i-___DF'IRE-DEPARTMENT Until Inspected and' Approved by the Building Inspector. 'Burner^1 `streetlo. SEE REVERSE SIDE Smoke Det. 5 2.. N ORTH 0" 0 Andov' er . , , No. a dower, Mass. A� COC MIC EWICK ADRATED PPS\ "9S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................... ...................................O...�. if.:..... ........................................................................ Fourl&tion L has permission to erect........................................ buildings on ..A�i. ..... .. ..... S............................................... oughy�r��& to be occupied asp?° .... �.....� d... �.. .�'. .... �s�:� :.'�.....�J ney r • 6 im p ............ provided that the person accepting this permit shall in every respect conform to the to ms of the application on file in Final S /� this office and to the rovisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of P Y 9 P Buildings in the Town of North Andover. PLUMBING INSPECTOR � VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough C'Z V/4//l2 Final PERMIT EXPIRES IN 6 MONTHS ` ELECTRICAL INSPE R UNLESS CONSTRUCTION ST .RTS oug g,�_ z � ':s� s Service 4-91LD'ING INSPECTOR final 2. Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises_ — Do Not Remove Final No Lathing or Dry Wall To Be Done ,� RE-DEPARTMENT Until Inspected and' Approved by the Building Inspector. Burner$ -stmt iso. SEE REVERSE SIDE Smoke Det. r. 2 r10 R T1-o - 0 of - . . aver V0 o� dover, lVMass., Ze— COCHICHEWICK .B ORATED P•P��.�� i 7�l U BOARD OF HEALTH Food/Kitchen PERMIT T AD Septic System THIS CERTIFIES THAT...........................................................69/'a `... BUILDING INSPECTOR Foundation has permission 4o erect........................................ buildings on ../..Q..�� .s�'Q Rough .......... ............................................. ..... to be occupied asr� i'(� `� t ,� O ••••.....:.. .....................�.l�f... l.�. .!'. ....�..l..G e / �� Chimney provided that the person accepting this permit shall in every respect conform to the Wms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final 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 - - - - LESS CONSTRUCTION ST TS Rough .. „-,.......................... Service.BAGING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. a WAV VI Ell i - I o ' 01 I 0 SGOOD { 04 '8 ' w Rorl% � � Massachusetts—Department of Public Safet% Board of Building Regulations andStandards Construction Supervisor License License: CS 22888 JOHN GRASSO 865 TURNPIKE ST NO ANDOVER, MA 01845 Expiration: 10/31/2013 ('�rnunisiuner Tr#: 6177 I Office Aloiu er .w.-A ines"ss"ffe`guu anion License or registration valid for individul use only TGOHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 13130 Type: Office of Consumer Affairs and Business Regulation013 Private Corporatio;1 10 Park Plaza-Suite 5170 Expiration_ 8 Boston;MA 02116 CONST - s, JOHN GRASSO,;0,, 865 TURNPIKE ST ,ri gz N.ANDOVER,MA 01'$15< 'f � Not id without signature ,,. 4/ Undersecretary The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelzibly Name(Business/Organization/Individual): �� t�� Me Address: ru TVIAM fK6 Si City/State/Zip: Phone#: Are ou an employer?Check the appropriate box: Type of project(required): 1.iI am a employer with 4• ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have lured the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ?• Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' .13.❑Other comp.insurance required.] *Any applicant that checks box Of must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they ace 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 their workers'camp,policy information. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. ActTV '� L► Policy#or Self-ins.Lic.#: k� i !Sol Ebi -- rahon Date: • �'� Job Site Address: 0QOM Ar City/State/Zip: J&IN Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Y Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert and he ins and enalties ofperjury that the informationprovidedab ve is tru and correct. - Signature: Date: s 11'a 4C 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): 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 ofhire,• express or implied,oral or written." 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 enterprise,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 grid 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 commonwealth for any applicant who has 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 the performance 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 the 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 Industrial Accidents for confirmation 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 Depaiiment has'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(ifnecessary)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 provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance.for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho Conugonwealth of Massachusetts Department ofJndustdal Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel#617-727-4900 Qxt 406 or 1-877,MASSAFB Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia