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HomeMy WebLinkAboutBuilding Permit #728-2017 - 1570 Osgood 5/1/2018 1 I 1 A44 V 1 NORTy BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINAT ON Permit No:-7�' — 61 ` ^ Date Received 1 ♦'qfq-6 17 Date Issued: (', �!J 4sSgcMus� IMPORTANT:Applicant must com tete all items on this page LOCATION- S 70 OV 2M/- Jt K ,�.r/,�o,•�/ Print PROPERTY OWNER DZ Z Print Vic MAP NO: OPARCEL: 7 ZONING DISTRICT: Historic District yes Machine Shop Village yes O TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential 0 New Building 0 One family 0 Addition 11 Two or more family 0 Industrial WAlteration No.of units: SCommercial ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition I-I Other 0 Septic 0 Well 0 Floodplain a Wetlands ❑ Watershed District 0 Water/Sewer Identification Please TTbiz:b?z, Print Clearly) �( OWNER: Name: i � , . - ! Phone: - Address: x 01 � t 1 of s�C 4�► r J CONTRACTOR Name: Phone: 78" �S"�•�89r a eg, c ctfi n Address: ck ClcZwj e.- a Supervisor's Construction License: Exp. Date: oo�y�ll 3 !6i-,2 12 Home Improvement License: Exp, Date: ARCHITECT/ENGINEER Phone: Address. Reg. No. FEE SCHEDULE:BULDING PERM/r°$1100 PER$1000.00 OF THE TOTAL ESTEMATED COST BASED ON$125 00 PER S.F. �• Total Project Cost: $ 00 FEE: $ 3 b Check No.: go Receipt No.: t S NOTE: Persons contracting wBred contractors do not have access to the guaranty fund Signature of Agent/Owner��.�Oprrt�ignature of contractor a!� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF-SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 0 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 t CONSERVATION Reviewed on Signature °I COMMENTS HEALTH Reviewed on Signature COMMENTS r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments t `Cons6rvation Decision: Comments Water & Sewer Connection/Signature& bate Driveway Permit DPW To-*v� Engineer: Signature: Located 384 Osgood Street FIRE DEPARIM NT - Temp Dumpster on site yes no Located at'124 Mair.,'Street Fire Departrnerif signatureldate 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 DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$10041000 fine NOTES and DATA— (For department use B Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department Tine following is a-list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 0: 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 f. ❑ 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 40TE: 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 10TE: 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 apn'al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must b€- submAted with the building application Doc: Doc.Bui!ding Permit Revised 2012 I Location No. '7 0 Date r • TOWN OF NORTH ANDOVER �r Certificate of Occupancy $ Building/Frame Permit Fee s3—O --- Foundation ,—v--- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check# 456 Building Inspector r , - NORTH Wt . s c ve. O h ver, Mass, Q coc"ICt"OWICN �1. N t 4OF �d TEO S U BOARD OF HEALTH Food/Kitchen ERMIT L Septic System 'TIFIES THAT .. .NEW....Cot- „40im,�, .6 .. ......�ri�.....P,10A, BUILDING INSPECTOR ission to erect .......................... buildings on ......I. ...I�...0.......Qst...O o.....Vi.... Foundation Rough upied as ..........A.bb....3-FAR titA014%.....1.!4.06..........wvve........Y... Chimney that the person accepting this permit shall in every respect conform to the terms of the application Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Jon of Buildings in the Town of North Andover. PLUMBING INSPECTOR IN of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR.- UNLESS CONSTRUCTIO TS Rough Service ............... .. ... .. .. ............... ............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough splay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT w Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. New England Fire & Sprinkler Protection, Inc. n'. 80 Brick Kiln Road Chelmsford, MA 01824 (978) 452-2895 (978) 453-5475 -Fax January 18, 2017 North Andover Fire Prevention 124 Main St. North Andover, MA 01845 Attn: Fire Prevention 978-688-5290 Re: 1570 Osgood St. North Andover, MA NARRATIVE The work to be performed is as follows A) Relocate four sprinkler heads B)Add one sprinkler head C) all work will conform to NFPA 13 codes and standards Sincerely, 71 Ted Flanders New England Fire & Sprinkler Protection Inc. 8 7 6 5 4 3 2 1 CURRENT SPRINKLER LAYOUT 17 18 19 20 21 22 23 D O ® p D A=10'6" FROM A A FLOOR B=BELOW DROP CEILING A A C C O ❑ 000 ❑ B ❑ Cg p I RM 1300A RM 13008 B ELEVATOR G-J-1I C) B O ❑ ❑ m 01 DIMENSIONS ARE IN INCHES A 'JHLESSOTHERW6ESPECIFIED TITLE: FLOOR PLAN ROOM 1300 A8 B A tOIERAHCES: ANGULAR:MACHS I Deg— ALL DIMENSIONS ARE APPROXIMATE x 1-070" CUSTOMER: LMS xx:amLY MEDICAL SOLUTIONS xxK!=DOT FROFROARY AND CONFIDEMIAL SIZE DWG. NO. REV THE INFORMADON CONTAINED IN IHIS MATERIAL: 6 ORAW(r 6 mE SOLE PRFRT"OF I7S0 Osgood Sc#ZOTO LEGACY MECICAL SC'U"M_ANY d RE'ROMC I ION N I ARI OR AS A W HO_E W ITHOUI North AII Over ATA OI84$ mEwemoo RiIS P0�HB ACTMEGCAI PROJECT a: 1300 FINISH: SCALE:1:120WT: S IEET 5 OF 5 8 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 —4'o. 7010 3'0" 2r0" 17 1121I 1 19 20 21 22 23 grp" 9rprl D A 2'0" 4,p, grpn ❑ D 3'60'0" 13.'0"11'0" " I �+ Ae 10'6" A FROM 15'6^ Itft[ FLOOR 8 1 0 1631011 I "�E L.LQQ W 11y N �ITgHi4UVJal` 14'0' J 1 24'0 4 '� ' IO b4. Wl� SyRIl1K1�4- 3 011 ✓ Y A aMPQ4 3'9" l0'�o CRA 1,In � C OS�sP�ndr 3 6' 4"DRAIN C B 61pn 7 - ❑ _ - 11'6^ ❑�2 � m❑ 6 k ❑ ❑ ❑ —+ RM_13008 �'; , RM 1300A 0 2' " 1 0^ 4"DRAIN ls'o^ 9f 4r6n r0" .,+ i l 1'0" 2'0 1 B - B _tet 4'0 ❑ I i COLOR KEY PROPOSED FIRE SUPPRESSION SPRINKLER SYSTEM c Sprinkler system water main ------vo Sprinkler lines DIMENSIONSAREIN NCHES A Sprinkler heads UNLESS OTHERW ISE SPECIFIED 10 ERANCES: TITLE: FLOOR PLAN ROOM 1300 A8B A CO Proposed new sprinkler heads ANGULAR:MACH3 1 dlgl— X ='A'°' CUSTOMER: LMS Proposed new wall xx x 1010' MEDICAL SOLUTIONS >","'0s "y'Existing.l0'wall to be extended to ceiling r.orElff"y A Co"' SIZE DWG. NO. REV Proposed new door IHEINFORMAIIONOONTgNED-15 MATERIAL: p Proposed new sprinkler head in suspended ceiling 75 ..µµif DGACENASTHE SOLE PROPER-r OF D g I/SO Osgood SG rtZOIO REPRUDVO WN I ISP ELS L$T WNHOLE w11NC]UI North Andover MA 0I845 Hewemes"oiunosors OILEGAorMEDICAL FRO.ECT N: 1300 FINISH; SCALE:1:120 WT: SHEET 2 OF 2 B 7 6 5 4 3 2 1 Commonwealth of Massachusetts Department of ?u:,;;w Safety Sprinkler Contractor License: SC-000423 GRANT J VANDBRPQ% PO Bog 212 :OMW i a North Chelmsford MA Ql Expiration: Commissioner 04/29/2017 ac�® CERTIFICATE OF LIABILITY INSURANCE 04/19/2016 DATE(MMIDDlYYYY) 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 TE THE POLICIES ,1Z BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ORDEDR(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 Fred C.Church,Inc. NAME: Elaine Domis,AAI 41 Wallman 6veel PHONE 9783127243 FAX Lowell,MA 01851 AIC No A/C No (978)454.1865 (800)2251865 IL A DARESS: edcz0is®fredcchuroh.wm INSURERS)AFFORDING COVERAGE NAIC tt ____.._._._.._....-_...-...._____�_. _ INSURER A: Commerce Insurance ComPeny 34754 INSURED _._._..._..__.____.__.__..._._ __ _ New England Fire 8 Sprinkler Protection,Inc. INSURER e; National Union fire Insurance Company of Pittsburgh.PA 19445 80 Bdck Kiln Rd INSURER C: Assoueled Industries Insurance Company Ine 25372 Chelmsford,MA 01824 INSURER D: National_lability A Fire Insurance Cempany 20052 NSURER E: COVERAGES 57458 INSURER F: 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY REIN IS SUBJECT TO ALL THE TERMS,WITH RESPECT TO WHICH THIS THE POLICIES DESCRIBED HE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -- INSR IADOI.ISUBR —'--"'— LTR TYPE OF INSURANCE �—i POLICY EFF POLICY EXP POLICI'NUMBER r MM/DDIYYYY MM/DDIYYYY LIMITS GENERAL LIABILITY X' i I EACH OCCURRENCE § 1.000,000 COMMERCIAL GENERAL LIABILITY i DA AGE T EN D It 50,000 1 PREMISES Ea occurrence § C CLAIMS-MADE jj OCCUR i I AES1034276 3282016 3/2612017 MED EXP(Arty one arson) §excluded PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEM_AGGREGATE LIMIT APPLIES PER: ' POLICY 1IFCT �PRO- LF-71 1 OC I PRODUCTS-COMP/OP AGO 52.000.000 AUTOMOBILE LIABILITY S i I COMBINED SINGLE LIMIT 1.000,000 ANY AUTO Ea accitlenll A 1 ALL OWNED I BODILY INJURY(Per person) S %(SCHEDULED _ AUTOS AUTOS BHNT95 3JIMIT ODILY INJURY Per ald9nl) 5 X HIRED AUTOS X NON-OWNED f AUTOS I IROPERTY DAMAGE S er accident X,UMBRELLA LIAR I X ,OCCUR $ CH OCCURRENCE § 1.000,000 B EXCESS LIAB BE062458964 A CLAIMSMADEj GGREGATE 1,000,000 T% r---- - -j S DED 1 RETENTIONS None - j - _ _- WORKERSCOMPENSATIISAND EMPLOYERS'LIABILITY i WC STATU- OTH- DPROPRIETOR/PARTNEWEXCUTIVE V/N500,000' FFICERIMEMSER EXCLUDED] N/AV9WC704214 3 .L.EACH ACCIDENT §I(Mandatory in NH) _ _IIyes,describe underL.DISEASE-EA EMPLOYE S.x'0001 DESCRIPTION OF OPERATIONS below ' - - .L.DISEASE-POLICY LIMIT §500,000 I I I I 1 I � I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace Is ret ulmd) 1 Brian Flanders+Kathy Flanders,see BEF CERTIFICATE HOLDER CANCELLATION Town of Nonh Andover 124 Main SI North Andover,MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE 1 cuem z Met tt Cert Holder# ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of IndustrialAccidents N I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORM. Applicant Information Please Print Legibly Name(Business/Orgmization/Individual):_AW E A» d 6Lr� SO,%1 k Lt r p/'d' e-d-io r1 Address: ik X.'Jn Al. o1 afly City/State/Zip: Forot /T� Phone#: n S Are you an employer?Check the appropriate boa: Type of project(required)' 1.a am a employer with___Vemployees(full and/or part-time).* 7. [J New construction 2.]I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 LQ 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.: 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other�� r ✓P t A hL l 152,§1(4),and we have no 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. $Contractors 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:Mahar4l Z,"fld-y ¢ F,'ele_ !rno f, CD _ Policy#or Self-ins.Lic.#: V 9 h/L 70 y j 1 i/ Expiration Date: 3".2 3- 7 Job Site Address: /S'7d Q.S9,00df f: 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 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 certi nde t sand penalties of perjury that the information provided above is true and correct. Signature: Date: /7 Phone#: J 7d- yJ_dl—o�,g,_ Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: PermitlLicense# 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#: