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HomeMy WebLinkAboutBuilding Permit #590-12 - 1320 OSGOOD STREET 2/7/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: "/Z Date Received Date Issued: 2 ' /-- IMPORTANT:Applicant must complete all items on this page LOCATION f'.3a� dv l' d0 2� S/ Print PROPERTY OWNER Sao 0 q 00 c Print MAP NO:X31/ PARCEL: /0 ZONING DISTRICT:I2 Historic District yes <0 Machine Shop Village yes no 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family ❑Addition ❑Two or more family ❑ Industrial ("Alteration No. of units: Wtommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other `iOSe tic D Well �" `' �� r 3 ,! ,(❑Floodplaml� �®3Wetlands teirshed �istnct I Watei/S ` r r► a r ; y' ,. "". . .t ___ _ 1r .,.�.. +:._� t .]' _Y.�--••.�.d+16...-.�_ �_-a.. _r,_ ,�.S.si Y.�vC. :- DESCRIPTION OF WORK TO BE PERFORMED: / 14y;;yf (Identification v Please Type or Print Clearly) OWNER: Name: 17�,4C 7O�l//9L,1� Phone 97,? Address: /3a0 O-56�7001D ST. Ah, AQIOZ)41� CONTRACTOR Name:d/b 1-23IR-M& Irl 19 O R Phone: gT,? - S-0 7- 4114 Address: ,�l ��Xl/llC�✓D/'I /�//� �%�f�l�/y, D/f1'f Supervisor's Construction License: CS f 4e,j Sa Exp. Date: Home Improvement License: _ 134'j 77 Exp. Date: ARCH ITECT/ENGINEER !U//4 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: $ 7 6- DVd FEE: $_ �O Check No.: DD/ ff b Receipt No.: i2s6/ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ISignafu.re ofAgent/Owner' `.. ,' �' {z - {_ 'Signature hofcontraetor{ �' wz,! °� I I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ IJ TYPE OF SEWERAGE DISPOSAL Public Sewer 10/ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Privatetic se t ❑ Private(septic �etc. Permanent Dumpster on Site ❑ ` THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE ffPROVED PLANNING & DEVELOPMENT ❑ ❑ 7///"� COMMENTS S I e eeaul'yoW an1 , Io`Jcz Z2 Z_ r. ej, CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS �I Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/Signature&Date Driveway Permit Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date a r1()1\/R4PATT4z 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.$10041000 fine NOTES and DATA— For department use Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 ❑ 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 NOTE: 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 ❑ Copy Of Contract ❑ Floor/Crossection/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 NOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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 Doe: Doe.Building Permit Revised 2008mi 4 40 CHOSE4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER BuildingPermit Number : 590-12 on February 7 2012 Date: May 3 2012 Y Y THIS CERTIFIES THAT THE BUILDING LOCATED ON 1320 Osgood Street _ MAY BE OCCUPIED AS Insurance Office IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Paul MacDonald 1320 Osgood Street North Andover,MA 01845 Bu' ding Ins ector Fee: PrePaid Receipt: 25013 Check : 001855 VAoRTH To' v' mOf No. CIO o dover, Mass., �Z COCHICHEWSCK ��• s ,9s` RA eo BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING e j INSPECTOR THIS CERTIFIES THAT... . ......G�v/ r�G Cl.�. � . ........�3 �... `t��0 ....... .. t f.... Foon u ti L has permission to erect... buildings on ... - .:..... ..; '. ..0. .... ....s��//....................................... o gh 6 r G. e�C`dO C C /JS 4k. ey ` to be occupied as..r ....... �✓ .. ...... ... cl...........t�. ..............................�.... ..........�'�...... provided that the pe n accepting this p mit shall in every respect conform to the terms of the application on file inP��' al 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. �fa�,, f ,t,��a .: � ff( �.�sc� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final,,-&//✓J .' u�/�?j 2-.. PERMIT EXPIRES IN 6 MONTHS • � ELECTRICAL INSPECTOR . UNLESS CONSTRLJCTIO ARTS Rough f_ i I Service ....BUIL G INSPECTOR F a1 3-z16, t Z' 1 Occupancy Permit Required to Ocmpy Building - GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final, If q%z./ No Lathing or Dry Wall To Be Done FIRE.DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE' SIDE moke De �� TO" of And _ o dover, Mass., 917 / i� COCMICMEWICK 7,9�RATED BOARD OF HEALTH Food/Kitchen Septic System . .PERMIT. T D BUILDING INSPECTOR THIS CERTIFIES THA T....S .............. 5l. "..................... ? / �. ............ 117. o F undation has permission to erecteownla ..................................... buildings on .� YAU)...... 5.�j.Qoc ....5�................................. Rough I�1� �c fav®c%��/ o.Y1- v? G ��Sir eaeAb Chimney to be occupied as.. �,... ��..,*-- � � ....::..:.....�.......................... ...f .. *pp . . / provided that the pcceptingthis permit shall in every respect conform to the terms of the applidation 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. �/'�i. �"•�¢�:%�C- �1 F� �'c'�-� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION Sn4LD16NG S Rough Service INSPECTOR Final 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 FIRE_DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumeri Street No. SEE REVERSE SIDE Smoke Det. f Milssachusetts Departmen Board of Buildint of Public Safeh g Rcul.rtions.and Standard; Construction Supervisor License License: Cs 86282 a BRIAN A MAJOR 21 LEXINGTON AVE 4 METHUEN, MA 01844 Expisation: 4/12/2013 t'onun issioner Tr#: 14452 __� � .-.'.✓�ie �om�reo�uuea��z �✓�.craaac�zuaeG i `Office of-Copsumer Affairs& usiness A%0ath !' HOME IMP20VEMENTOONTRAC70R Registration1 \134277 Expiration 10/9/2011 Tr# 28816 t. Type rndroidual ,MAJOR WINDOW;INSTALLATION , j BF2A,IV MAJOR - i '21 LEXINGTON METHUEN,MA Undersecretary ! , TheQmrnonwealth of • laSsaehuse j Depnrtrr'ent-of Fire Services " Office'of the State Fire Marshal P.0. liox 1025 state'Road,.stow,MA 41775 ' i PERMIT ' North Andover(CJfermit.No Date: /�� 3/,/../ ity of Town) (IfApplicable) Dig Safe Num er In accordanccimith the provisions of M:G-L-14 8 C•hap.ter :LCL as proyided in sectio❑ S� 7 ER 3 4 Start DaL- This Pcnnit is granted to:. ( '() jm f Fo '// _ v C ri e. Full name Ofpevmn,Firm or Corporation Pcrmissinnto locate dumpster for c03%struction/renovation/demolition of building. COrmIIC dumpster. must be , 25 r fi.om structure if clearance dumpunable to lace with re uired Rcstrictiaas: ' dumps-ter must be covered with p17wo-od or tarp end of 'work day •at S J� r+ (Give location by street anal no.,or descrPgurantmng anner as ovied adequac cation.of I'ocation) Fee Paid s 50 .00 " Fire Chief j This Pcnnit tivill expire, .�3 f (S gnature oRofipermit) OfEical granting pcmut T1Ue i I i A� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD 1/25/201212 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(les) 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 NAME: Victoria Lowes, CISR MTM Insurance Associates PHONE (978)681-5700C No:(978)681-5777 575 ChickeringRd E-MAIL ADDRESS:v3.ckyl@mtminsure.com INSURERS AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:Twin City Fire Insurance 29459 INSURED INSURER B COMMERCIAL BUILDING MAINTENANCE, INC INSURER C PO BOX 64 INSURER D INSURER E METHUEN MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER:11-12 Master List 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 LTR TYPE OF INSURANCE POLICY NUMBER MMIUDDYY MM/LDI DY _LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE ElOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED HIRED AUTOS __,_ AUTOS ,.,,. _,.___. ._ ... _. - PROPERTY DAMAGE _UMRRFI I A IM; EXCESS UAB -BE_AC_H-OCCURRE_NCE- $js — A __ CLAIMS-MADE _ AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X EXCLUDED? ANY PROPRIETOR/ R/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? F NIA (Mandatory in NH) 8WECNK2461 /31/2012 /31/2013 E.L.DISEASE-EA EMPLOYE9$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Certificate holder as listed below for work being done at 1320 Osgood St, N Andover MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St. N Andover, MA 01845 AUTHORIZED REPRESENTATIVE P MacDonald CPCU, CIC J6;w, ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r9ntnn-mnt The Ar_r%Dn nmmc mnrl inn^mro ronictararl mmrke of ARr1Rr1 The Commonwealth of Massachusetts Print Form { Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly / Name (Business/Organization/Individual): ��/YI/���e/AL, ,( L� G MPIVT�AIAIU! . ZVC Address: -PQ 3 OX Zo 4 a//a AZ c5WS fiA I;r STX<�6 7- City/State/Zip: S-rlvzm l) M4 6/9Phone#: Are ou an employer? Check the appropriate box: � Type of project(required): 1. I am a employer with a 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. VRemodeling These sub-contractors have ship and have no employees T8. E] Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers'comp. insurance comp. insurance.+ required.] 5. E] We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 131-1 Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 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. tContractors 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 for my employees Below is the policy and job site information. Insurance Company Name: 77WIAl ClTt/ 7—"-/ :Z-AIJ0X)!WeS Policy#or.Self-ins.Lic.#: O? Ir)zrG 6 Expiration Date: t 3! x01.3 Job Site Address:13a Q AS q-6-00' : H4 City/State/Zip: 18%3 Attach a copy of the workers' compensation policy declaration.page(showing the policy number and expiration date). Failure to secure coverage as required under 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. Idoherebcertify under the pains and penalties ofperjury that the information provided above is true and correct. Sianature: - --- - -- Date].-- oZ "+ Phone#: 921 - z 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#: 0 'Y. �- y 14epI .r: !ice ' w r �rwyR Yit•y it#4'W1 R4'J y�i lRNer*eO.wiY MMM Jp� ♦ni M#Mi K.Kt'R.a( �'e' "Ai P.RkRR14e kK♦eAw; «Y nff{ KWy��,, M pip WtA4 tJeYK MM �qw^ .f. ♦Ji wArY 4iR YAY♦iP lil#•t ■B,� i14 A.teXwyt K#YY Wea�•f1# p'W!rlMYe Kl11t�,W♦K�l tii'J w'M:iJ pact #,9Q e!�e*N♦!�iK l4#i>1.M!•IIC.1. Vi�F 0x 48 �r.Wee ei•4e 7pR0lVMt! Y9� . K, r6Y a:l iW .Ji ..eiRt•iJ'#y 4U .'s al i.; �MI'A'4 AfRARiM:f Mwt RiNKWf�eY tkw6M qAM.�,1 M� 762 x 1�y� ,,{{e�y ' wf1KJ}Kt'+wt IIe�.YK Al Mhtil'►.¢ '. ' N •�►•M'K wig#t:R»M.t #.•NK Ll,� . .Arttwwef'6r YiR1 p`!1#KY1MV l.t r w't•J P�.K♦J K w y-wi a P wYlw,�;4,yt„l' ���..,tp;t-+ick. �l..w�'�p3�iw't"'�'.''wR�Y''?S•.p�"!9„�.%'E :r`�.il� +c.v'+M�• .�.^:"W 1 v�':`p4�M.w>t, , y M r + Una x Toilet m- Figure 30d' F' ' 521 CNa „e, 123 ARCMTECTURAL A16CCESS BOARD A� r 914 Aty#t iYw+FA f: y� fie �V •bF�� hF«a Oy,K a+r r lay 'llw+r� ♦dti♦r.w wdN,ff y wk wx RsiN.'Aa iif aMM!Ix � �� ' AkAYril.'Ml,i�rarwYl.y At� , 40;:v;*ilrYiy q to yM se w 1' 320 fi.twaw'F..�n-iuxa':.IR"s!►M' r'i' .M6 f f 4,ylw/i'f 1►•�f lM A F . ++MM i wf+a+FAt MAy.►F a� .� +4:1M'd+Icw+Y.M.+b�i;y�}»,.yAMr.F 11.+IN• ' iV:Nb 1lA,y 71'pt 14 xY i.�M*.M FdV� r iYi 9j#;AiN f=11f'RM+A'a-M+,R.,��. 1 i Alternate Accessible sibl 1kall Location 4fd 0 O> /J UGf k_ No. a" z Date 2 • TOWN OF NORTH ANDOVER �3 O Certificate of Occupancy $ /Ov Building/Frame Permit Fee $��U Foundation Permit Fee $ r� a $ ' � " Other Permit Fee TOTAL $ Ak? 4•'r Check# 0 01,Ys� 25013 Buildfing Inspector