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HomeMy WebLinkAboutBuilding Permit #325-13 - 1320 OSGOOD STREET 10/18/2012 TOWN OF NORTH ANDOVER APPLICATION FOR, PLAN EXAMINATION Permit NO: Date Received �( Date Issued: PORTANT: Applicant must complete all items on this page LOCATION :' � ;S' ��. ' PROP.ERTY✓:OWNER /LC � Print r 100_Year OId Structure yes MAP NO 7 PARCE(,o ® =ZONING DISTRICTS Historic District yes Machine Shop Village :, yes' no . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑9ddition ❑Two or more family ❑ Industrial Alteration No. of units: tib-'ommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic Well0 Floodplain ❑1Netlarids ❑ Watershed_Districf 0 Water/Sewer :- DESCRIPTION OF WORK TO BE PERFORMED: J-/ /9- U g-' }c, e3 /G kJ 3 O Identification Please Type or Print Clearly) OWNER: Name:/-?-,?G 056nad,-57'GG,,ee z M'4"_7z1y 10 Phone: /0 16'6f1_�C Address: Z3Q0 Q�GG�� �r /�N .� /1�/9' 0/ 9 CONTRACTOR Name. , Phone,;.,..' Address D /L �� ' Supervisor's Construction License 5' �� /. Exp` Date / pt sHome Improvement License Exp Date.- - .......�....-- / ARCHITECT/ENGINEER,41Att JurOb A�.. A Phone: 7 Address: GA)&Mem ED S6 �.� Reg. No. �7` I FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ems, (0 Q 6 • G FEE: $ f,�)r2.G. 00 Check No.. N 1 Receipt No.: ��� 7 NOTE: Persons contracting with unregiNIEI - actors do not have access to the guaranty and .Signature of Agent/Owner - ignature of contractor Plans Submitted ❑ Plans Waivedntified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ s > i TYPF,OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ J 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ j> �- COMMENTS ! W req.1 A,iY�l�[ I i CONSERVATION Reviewed on to 1 /rD- Signature ,.x. COMMENTS_ .(JO Wei �v.�� w� iA ( 00 HEALTH Reviewed on Si nature COMMENTS f j 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 DPW Towi., Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Lo gted at'124 Main Street.F �epartment signature/date ' COMMENTS L 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 I Electrical Inspector yes No DARKER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use i i D Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fol€owing 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 u g pp ❑ 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 subm`: h�hS vo - .�IN""'ot/ S VU 'ail '�� v�Jj mot , -'a ,.� r(NG� s,v�,�c ..�C�� .J��C�•v�'►to �Su�'J r' /'►wi '?'1vW-k� n11 NORTF� own - of . ? E Andover O y' t No. Z . 1 t = , - ti, h ver, Mass, Of /� A- COC NICHT WICK 7q A�RgTED I'PP,`'�5 S U BOARD OF HEALTH Food/Kitchen PERMIT Septic System THIS CERTIFIES THAT / � !'l� �:. ��. ..............�7G �' !:`�� .. BUILDING INSPECTOR has permission to erect ........... buildings on ,� .5,l-.. ...........`� Foundation ............... � .............................. Rough to be occupied as ........... < / �� ,/��..�.�.. ... .C.�r .�t.. ... . .. `:��.................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION RTS Rough /� ......... Service ................ .... �o J• ..�...... ........... Final BUILDING INSPECTOR 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. SEE REVERSE SIDE i --------------------------- Massachusetts-Department of public Safety `Board of Building Regulations and Standards' Construction Supervisor License: CS-095964 % PH L P E LOCHUkTTO 5 FAITH ROAD W w WINDHAM NH 63087) Expiration k'. 05/02/2014 commissioner Enter construction cost for flee cal- North Andover Fee Calculation Construction Cost ��11 85po.OV m $ - $ 1,020.00 Plumbing Fee $ 127.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 127.50 Total fees collected $ 1,375.00 1320 Osgood Street Attach 30.3x31.6 3 Offices and conference room 325-13 on 10/18/12 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/Pltimbers Applicant Information lease Pr-int Le ibl Name(Business/Organization/Individual) LC � � Address: /C Ali City/State/Zip:� Phone#:—fz Are yop4n employer?Check the appropriate box: Type of project(required): 1. I am a employer with_, _ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. PXew construction 2.❑ 1 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 re uired. 10.El Electrical repairs or additions officers have P q ] v exercised thea 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' comp.insurance required.] 1311 Other *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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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. f do hereby cer under tnanes of j d ieinformation provided above is true and correct. 3i nature: Date:?hone Official use only. Do not write in this area,to be completed by city or town offccial 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#: ,aco 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD 10/15/2012012 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 Victoria Lowes CISR NAME: r MTM Insurance Associates PHOFA NE (978)681-5700 A No): (978)681-5777 575 Chickering Rd ADDRIES :vickyl@mtminsure.com INSURERS AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:Twin City Fire Insurance 29459 INSURED INSURER B: COMMERCIAL BUILDING MAINTENANCE, INC INSURERC: PO BOX 64 INSURER D: INSURER E: METHUEN MA 01844 INSURERF: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE To R NTED PREMISES Ea occurrence $ CLAIMS-MADE F—I OCCUR 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 COJECT MBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X YLIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A 1/31/2012 1/31/2013 (Mandatory in NH) 08WECNK2461 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/LOCATIONS/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. AUTHORIZED REPRESENTATIVE N Andover, MA 01845 P MacDonald CPCU, CIC ACORD 25(2010/06) C 1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD A� CERTIFICATE OF LIABILITY INSURANCE DATE (M / DNYY) 10/15/ 2012 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 Victoria Lowes CISR NAME: MTM Insurance Associates PHONE (978)681-5700 FAX (978)681-5777 IC, A/C No): 1320 Osgood Street E-MADDRESS:vickiel@mtminsure.com INSURER(S)AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURER A-admiral Insurance Company INSURED INSURER B:Safety Indemnity Insurance 33618 Kebb Management INSURERC:National Union Ins Co of PA Po BOX 64 INSURER D: 240 Pleasant St INSURERE: Methuen MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER:12-13 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE Fx_1 OCCUR CA000015715 4/27/2012 4/27/2013 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1400,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ 20,000 B ALL OWNEDSCHEDULED 6200840 10/1/2011 10/1/2012 AUTOS X AUTOS BODILY INJURY(Per accident) $ 40,000 X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Underinsured motorist BI split $ 20,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 C EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 3,000,000 DED I I RETENTION$ BE020691443 4/27/2012 4/27/2013 $ WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS FIR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-E4 EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/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. Building Department AUTHORIZED REPRESENTATIVE 1600 Osgood Street North Andover, MA 01845 //II,, P MacDonald CPCU, CIC 107r°!/K44d____ ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD STANDARD DIMENSIONAL REGULATIONS: DIMENSIONAL REQUIREMENT- REQUIRED (B 1-ZONE) PRO VIDED MIN LOT AREA (SF) 25,000 SF 49, 150fSF MIN LOT FRONTAGE (FT) 125 FT 131 FT MIN FRONT YARD (FT) 30 FT 50f FT MIN SIDE/REAR YARDS (FT) 20 FT 28f FT MAX BUILDING COVER (7) 257 5. 19' MAX HEIGHT (FT) 35 FT <JO FT S 88'52'27" E 333.27 PROPOSED EXISTING PROPOSED NEW ADDITION SEPTIC TANK W ROOF LINE 24'-0' X 22'-0' COVERS (2) w u�o r0 N ^ ^ O ^ 00 tl iff z z 0 42 to EXISTING N 21',17'12" E GRAVEL 28.66 PARKING EXISTING O 31 BITUMINOUS 14 PARKING o O ,o STONEWALL N 83' 1'21" N V RECORD O u'NER: w VYNL FENCE (6' HICH) y UJ 1320 OSGOOD CORPORA TION 1320 Osgood Street North Andover, MA DEED: BK: 12,798 / PG: 327 (01/31/2012) ASSESORS• MAP 34 / LOT 30 0' 40' 80' 120' Survey d Plan by: OF�'�s COMMUNITY COUNTY STATE DEED REFERENCE: PLAN REF: I;PO� tl lel a t o 11, ROP+1pLD p N. ANDOVER IESSEX MASSACHUSETTS BK:121e6/ FG:3211 IFL. 3433 Forestry P_O. SOX 1221 11214E=fRE13Y CERTIFY THAT THIS PLAN 3• 1320 OSGOOD STREET, N. ANDOVER, MA, TA6K i3y DATE /,tf/ and TS A SURVEY MADE UNDER t<ATOL1 v,Surveying MILTON, NEUJ H,4MPSI-•TIRE �lsl°N IP.0.3UMO o MTM INSURANCE ASSOCIATES, LLC FIELD WORK 4FE 21.ALIGJ2 Talaphona (603) 923-8966 MASS - 2012fi ROJECT NAME DRAFTING RJN 2SAUG.12 Since 19-11 a-mail: anatolia1111eaimx=om � 8� 13.SEPTEMBER2012 CERTIFIED -'LOT PLAN STAKE out N/A N/A FINAL cHEcK RJN 10-SEPT-12 Location No. �� _l f Date • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ ,r -- Building/Frame Permit Fee $ � i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#-:Y) r r " 25857 BuildingAnspector