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HomeMy WebLinkAboutBuilding Permit #1139-2016 - 1060 OSGOOD STREET 5/1/2018 `-�' 14 �/pppA10 TU BUILDING PERMIT Noery q 16 TOWN OF NORTH ANDOVERo� APPLICATION FOR PLAN EXAMINATION 1 fi Permit No#: 1A0 ° °� Date Received •7R�DRTED 09V ,fig �SSACHU`+�� Date Issued: IMPORTANT: Applicant must.complete all items on this page LOCATION GC© ✓ ���t ,y rint PROPERTY OWNER �/ 1 l� rint 100 Year Structure Vyes. no MAP a 35' PARCEL� �; ZONING/DISTRICT: Historic District Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial NAteration No. of units: B-10�ommercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ® Septics ❑Well . . ❑ Floodplain 0 Wetlands „Watershed pistnct Q Water%Sewer _ . _, .� DESCRIP ION F WORK TO BE PERFORMED: Dvf l4 117Z Identificatign- Please Type or Print Clearly OWNER: Name: �i'�tq ,,ti ( a 1n� LL C OAA, �,z ,P (S Phone: 9715- c6Sa--!3-7 U Address: Q a Ar 0✓-c e- ✓� C) N C61 a Contractor Name: ( Vp C i s-j Phone: Email G/,/W,,vt_C '9 Address: Gv Supervisor's Construction License: _Exp. Date: 9 M y . Home Improvement License: /G 1617 Exp. Date: Xel✓ ;;I ARCHITECT/ENGINEER L�q 6c�Ss, &`��Ihone: Address: �%�uti S� omt/io, /^j uA Reg. No. 10 FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Z0/ nry FEE: $ Check No.: �j� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer u 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 r 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 0 V Olanning Board Decision: Comments i Conservation.Decision: Comments Wafter & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: Located 84 ARa in _ IRE DEQ -NST :`Te.�rr p Dump�stejr�on, Osgood Street L+`ocatecl Yr1MANlain6-tfeetF '— F re Depar`t�rnen. `ignature/dafe 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 The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 4. 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 Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4. 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 4, 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 Location v No. � �.--�r�` 20 l[)0 Date • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $2� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 40 Check# Building Inspector/ 1 � � • i 5/18/2016 Date: May 18,2016 20361 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20361 60 TOWN OF NORTH ANDOVER � PERMIT FOR PLUMBING a� This certifies that Kevin A Scott has permission to perform Bathroom Remodel plumbing in the buildings of TIAM REALTY LLC at 1060 OSGOOD STREET, North Andover, Mass. Lic. No. 13258 OL �a(o� I�� 1/1 i I I Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 20,000.00 m $ - $ 240.00 Plumbing Fee $ 30.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.00 Total fees collected $ 400.00 1060 Osgood Street 1139-2016 on 5/3/2016 Bathroom remodel -commercial NORTH own of ndover iQ •.� 'y`• �� X11 No. h , ver, Mass, J Ja ' � 4 COCNIC.I..'. U BOARD OF HEALTH Food/Kitchen PERM LD Septic System THIS CERTIFIES THAT �... ,, ,,,,, BUILDING INSPECTOR ........................ .... ... ................ ......... ........... .......... ... ............ ...1�� ... .�. Foundation has permission to erect .......................... buildings on ................................ .. Rough 6wft to be occupied as ... �.�. .�i .... .......................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO Rough AM Service I . .. ......... .. .... ......... Final BUIL SP CTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. DMC and So-n Construction Company 12 Buckingham St. Wilmington,-Mass. 978-423-4491 April 28, 2016 Location: 1060 Osgood St Unit 105 Work to be completed by DMC and Son Construction Company shall include, but not Limited to: I - The elimination of the wall in the front of the space - The removal of the existing bath and reconfigure as a handicap bath as specified by the plans submitted by 1D LaGrasse and Associates. Flooring to be determined at.a later date. - Replace and improve the existing ceiling layout Demo wall surface and replace interior walls of storage area. - Repair and replace all interior work as needed All walls to be repaired as needed and re-painted All flooring, other than new bath, shall be carpeting determined by building owner. Total cost of labor, materials, and trash removal $19,975.00 i y z CHARLES D.BAKER Commonwealth of Massachusetts GOVERNOR JOHN C.CHAPMAN UNDERSECRETARY OF Division of Professional Licensure CONSUMER AFFAIRS AND KARYN E.POLITO BUSINESS REGULATION LIEUTENANT GOVERNOR BOARD OF STATE EXAMINERS OF PLUMBERS JAY ASH AND GAS FITTERS CHARLES BORSTEL SECRETARY OF HOUSING AND DIRECTOR,DIVISION OF ECONOMIC DEVELOPMENT 1000 Washington Street • Boston • Massachusetts • 02118 PROFESSIONAL LICENSURE April 28, 2016 TIAM Realty, LLC Attn: David S. Samuels P.O.Box 249 Andover, MA 01810 Re: Variance PV300—Vacant Space— 1060 Osgood Street—North Andover Dear Mr. Samuels: Please be advised on April 27, 2016 in the Board Meeting Room, 1000 Washington Street in Boston Massachusetts,the Board of the State Examiners of Plumbers and Gas Fitters deliberated on and voted unanimously to grant your variance from 248 CMR 10.10(18)to allow the installation of one unisex handicapped accessible rest room for the proposed offices ace. � This variance decision is, based on the presentation, information and documentation provided by the applicant and is applicable to this end user and this site only.All other plumbing and gas fitting work if applicable shall comply with the rules and regulations of 248 CMR 3.00 through 10.00 and all other applicable statutes and codes Sincerely, For the Board, Wayne E. Thomas,Executive Director Board of State Examiners of Plumbers and Gasfitters Cc: James Hurley Plumbing and Gas Inspector L} TEL: 617-727-9952 FAX: 617-727.6095 TTY/TDD: 617.727.2099 http://www.mass.govocabr/licensee/dpi-boards/pl/ V anoxzs' -.�— ozaz waam sz„ I-—�— aOO�� I I „uuf• W ewe,'ri+P..„an,,.a 1i�,,...,„,.,n,,n».Y .,', u'.,.. .e 3"'°,3° �� \ I � I avu n o!WYUT°t aGNAi � - I evv lY% o b.,.. A+I•.h'd.,� as ' OE , a..a,d,w .,. ,,xn.a d sol 11Nn sol 11Nn r S 11 qn u.n ,t , ••b 4 O O P•+ .a... m a,x Vi a,,,, f ,at,� f eu -_ k_ _.---------- 'IT -ern a - _ `°i.oFlTl v,,,.,..,,..frv” va ,•=e ., u°miaai,a t,Niv"°° aol 9M bo1 sol eol M ... ,n 11Nn 11Nn LINn llNn 11Nn llNn a ••,+m.........", ,- C�D r� c C ,.p, a.n a m .b a =,�•m�:o�� a, - �..a� aoads3 ueaay-n ,nay apo9 F L L -J p..6 M31h3�J 3007 - 'i pe 189101 LL391b1 all -,- 101 L Ill f LNfr�//OOl/LO{11N11 {O{LNfI Y ` d Ol11N11 l LNrI aovw18 21011Ntl .r.c y 37MM014 11 f 10 NV W 9f170- C The Commonwealth ofMassa chusetts z f Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,AM 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BT FILED WITH THE PERIVHTTING AUTHORITY. Aimlicant Information Please Print Le 'bl • / e Name(Business/Organization/Individual): V ! (,L PI �� �o ` �'g✓� Address: `/ LA City/State/Zip: i�s�ih� A)- Phone#: 71 5173 1,fl Are you an employer?Check the appro late box: Type of project()required): 1.❑I a employer with employees(full and/or part-time).* 7. [�Ne, construction 2.L_7`am a sole proprietor or partnership and have no employees working for me in 8. emo delirig any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.FJ I am a homeowner doing all work myself[No workers'comp.-insurance required.]t 4.ElI am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical 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. ❑ � 13.(]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of'exemption per MGL c. 14. Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] r: *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who s&niif this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors jhat 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 pr'ovid6ig workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lie.#: Gr — 7,32 5-6 70 �Jx/iration Date: y /3 /� Job Site Address: �D(� G City/State/Zip: ✓� /� Attach a copy of the workers'c6nipensation 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 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. I do hereby certify un the pain and penalties of perjury that the information provided above ' true nd correct. Signature: Date: Z �� Phone#: G Zj —X f 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 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 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 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 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 the boxes that apply to your situation and,if necessary,supply sub=contractor(s)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 may be 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 ' 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 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(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 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 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-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia __ i }`� CERTIFICATE OF LIABILITY INSURANCE DATE(MM4 28 )16 ii 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: M.P. Roberts Insurance Agency PHONE --" — FAX —� -- 1060 Osgood Street EMAIL 1978) 683-8073 No: (97e) E83-314 ADDRESS: mike@mprobertsinsurance.com North Andover, MA 01845 INSURERS)AFFORDING COVERAGE_ NAIC# INSURER A:Merchants Mutual Insurance Co _ ENSURED INSURER B: __.._ ...-..-._ DAVID M MCCUE INSURERC: DBA DMC AND SON INSURER D: _ 12 BUCKINGHAM ST INSURER E: WILMINGTON, MA 01887 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 ADDL SUBR - --- POLICY EFF POLICY EXP- ------- ------- LTR TYPE OF INSURANCE I POLICY NUMBER MIDDIY MMIDD/YYYY LIIATS A GENERAL LIABILITY BOPI076622 12/2/15 12/2/16 EACH OCCURRENCE $ 1000 000 X COMMERCIAL GENERAL LIABILITY DAA44GE TO RENTED EM16L_S­(Ea occurrence) 500,000 CLAIMS-MADE Fx—]OOCUR MED EXP(Anyone person) $ 151.-0-00-- PERSONAL&ADV 5,_0.00 _PERSONAL&ADV INJURY $ GENERAL AGGREGATE­.$ 2,000,900 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS_-_COMPIOPAGG $ 2,000,000 X POLICY PROECr- LOC $ A AUTOMOBILELIABWTY MCAI001788 12/2/15 12/2/16 (EEOaIaccidrtSINGLELIMi- $ 1,000. 000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE --------- X HIREDAUTOS X AUTOS eraccident) $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY YIN 9RY11MI. ANYPROPRIETDWPARTNERIEXECUTNE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? --- (Mandatory In NHJ E.L.DISEASE-EA EMPLOYEE $ _ Ito desaibeunder E.L.DISEASE-POLICYLIMR $ DCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES lAttach ACORD 101,Additional Remarks Schedule,if more space is required) I I CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE � (jm MICAHEL P. ROBERTS ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: (978) 688-9542 E-Mail: Office of Consumer Affairs and Business Regulation 10 Park Plaza.- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 168617 Type: Individual Expiration: 3/18/2017 Tr# 263341 DAVID MCCUE JR. DAVID MCCUE 12 BUCKINGHAM ST WILMINGTON, MA 01887 -- Update Address and return card.Mark reason for change. SCA 1 0 20W05m D Address Renewal Employment Lost Card <-"�� �a�ieiuc�iaectll�t_�"r-�ln,.;uc�irarlf Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - _registration: 168617 Type: Office of Consumer Affairs and Business Regulation piration: :3!18/2017 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 DAVID MCCUE JR. DAVID MCCUE 12 BUCKINGHAM ST WILMINGTON,MA 01887 Undersecretary Not valid without signature I l i 1 i Massachusetts =Department of Public Safety a Board of Building Regulations and Standards Construction Supervisor License: CS-060354 J# DAVID M MCCi7g-7R 12 Bucldngham Street- Wilmington MA 01887, Expiration ✓ Commissioner 09/17/2016 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m)of enclosed space. i I i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. t I For DP5 Licensing information visit: www.Mass.Gov/DPS E r i i