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Home My WebLink AboutBuilding Permit #201-14 - 1570 Osgood St Bldg 30 Suite 2200 9/4/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: D O � Date Received Date Issue 7 (c IMPORTANT:Applicant must complete all items on this page LOCATION P , t. PROPERTY OWNER Print 100 Year Old Structure yes o 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 ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well Q Floodplain ❑Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: ��? /�+- /Yfv & Phone:9?It -360 913 Address:`S� Gy wt A-7u s �� /5t-?, 4 CONTRACTOR Name.41gle�lf 217LeAS Ziy7 Phone: Address:A5 ��A4 Supervisor's Construction License: Exp. Date: -' Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PgRMIT:$ 00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total project Cost. � o�j000, FEE: �Ll 12 � .� Check No.: Receipt No.: n NOTE: Persons contracting with u gistered contractors do not have access to guava tyfund Signature of Agent/Owner C Sig1ature of contracto - Plans Submitted ❑ '� Plans1w.: ed ❑ Certified Plot Plan ❑ Stamped Plans ❑ I I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_0F:SEW-ERAGEDISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS -CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS A 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 Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT ='Temp Dumpster on site yes no Located-at 124 Mair, Street Fire Departinerit signature/date COMMENTS 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 i DANGER ZONE LITERATURE: Yes No MGL Chapter-166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For de artment use i LI Notified for pickup - Date t t i 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. Roofivg, 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 apu%-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Buhding Permit Revised 2012 / Location/"d o No. ` Date / r • - TOWN OF NORTH ANDOVER . 6 . • e Certificate of Occupancy ` Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $_ TOTAL $ Check# U c. L3 :J uilding Inspector NORTI, own of . E : . Andover Ito T Z o h , ver, Mass, coc"'C"l—c" q°RATED P', S U BOARD OF HEALTH PERMIT Food/Kitchen Septic System THIS CERTIFIES THAT ....a '+!. " �Ya; 10LBUILDING INSPECTOR has permission to erect ...... buildings on/&.0.0..........�r/. A �.... .. Foundation ........ ..... Rough to be occupieq"as ...... .�1.�.�.........� r.4..L.r......a ..................................... 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 MO HS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO RT Rough Service ....................... ..... ..... ......................................... 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 NORTfy Town of E : Andover o : t - �+ Y O LANE h , ver, Mass, �� COC NIC N9-.CK AO�wTEO ►'P�,�,�y s � BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ....��I7!. " � r>�. .. rL BUILDING INSPECTOR has permission to erect ...... buildings on/.4.0.0..........cl �,,,�.. Foundation ................. ..... Rough ammma to be occupied as ...... .��.�.�.........�.k.. �� .. .. ...... ..................................... 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 MO HS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOWTART Rough Service ....................... .... ..... ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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 cubicle connection inc. Estimate 13 Lyman Street Beverly, MA 01915 Date Estimate# 9/4/2013 1085 Name/Address New England Tractor Trailer 1600 Osgood Street North Andover Ma. Project Description Qty Rate Total Cubicle Connections to install as follows 3 Cubes,And 3 dividing 2,000.00 2,000.00 walls no electrical needed.Cubicle Connections Inc To do all work during reg business hour. Total $2,000.00 ACS® LSF CERTIFICATE OF LIABILITY INSURANCE R054 097E03-201)3 THIS CERTIFICATEIS 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 SUBROGATIONIS 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: PAYCHEX INSURANCE AGENCY INC PHONEExtl: FAX (A/C,No): (8 8 8)443-6112 210705 P: () - F: (888) 443-6112 E-MAIL PO BOX 33015 ADDRESS: SAN ANTONIO TX 78265 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Sentinel Ins Co LTD INSURED INSURER B: Twin City Fire Ins Co INSURER C CUBICLE CONNECTIONS INC INSURERD: 13A LYMAN ST BEVERLY MA 01915 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. DDL SURR POLICY EFF INSR LTR TYPE OF INSURANCE /NSR WVD POLICY NUMBER (MMA)D/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 DAMAGEoaf D $ 1 000 000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) r A CLAIMS-MADE IX-1 OCCUR MED EXP(Any one person) $ 10, 000 X General Liab ❑ El 76 SBU IV2443 07/28/2013 07/28/2014 PERSONAL&ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE S 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2, 000, 000 POLICY [X]PE?T_ E] LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ❑ ❑ BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED (Per accident) $ AUTOS $ X UMBRELLA "AB X OCCUR EACH OCCURRENCE $ 11000. 000 A EXCESS LIAB CLAIMS-MADE F] 76 SBU IV2443 07/28/2013 07/28/2014 AGGREGATE $ 1, 000, 000 DE X RETENTION S 10, 000 $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'L/ABILITY Y I N X TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1, 0 0 0, 000 B 0FFICER/MEMBER EXCLUDED? N/A 76 WEG EU1185 07/30/2013 07/30/2014 "— (Mandatory/n NH) E.L.DISEASE-EA EMPLOYE $ 1, 000, 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 1, 000, 000 0 0 DESCRIPTION OF OPERATIONS/LOCA71ONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is re used) Those usual to the Insured' s Operations . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE NEW ENGLAND TRACTOR TRAILER SCHOOL DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD ST AUTHORIZED REPRESENTATIVE ` NORTH ANDOVER, MA 01845 7A-r- 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD