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Home My WebLink AboutBuilding Permit #729-2017 - 1570 Osgood 5/1/2018 OORTFi 41 ?4�11 QK1 BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINAT - Permit NOJ aq— / Date ReceivedArea -/ � �9SSACHUS t� Date Issued: ''— N J Q IMPORTANT:A2plicant must com Tete items on this page LOCATION ? S D Punt,, �� PROPERTY OWNEEt tr/Z;� �f+n� LAS " L.L.�(/M'� A ' ,r l Int O d Q - (,n ., W .•4 'fits ,.V { .AP'N P 'M 9 "� ARCEL. ZQNINGDISTRfCT Histone District yeslneShop Village `yes TYPEFI IMPROVEMENT M ROVEMENT P P RO OSED 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 �imWell ❑`Floodplain Wetlands �Y❑ Watershed District ►, s� Water/Se er, �w iL4 iwo /A.rrtylorz W414-5 y 6'X l8 '� 7046,6 rzry a A&C, S✓Jd c•F -tIVM Wolk 50,460 . Identification Please Type or Print Clearly) ^ DNS OWNER: Name: �D�L L ��Ql�on`ee: Address: /Sw C-54,00.0 S-T—, -- +..� CONT°R3AC�AOR Name $ ` ' 4Y' = � r ` m ,;- � ,,� Phone A`ddresi w., ,, � v .�,, s '® ,`' i+7< ►s �},o •� � aE v'� .r o' fpr /,.ry/ /�,z •«X y �� syyA ,��,{•� t � a: at7« y T!:� E`+' Supervisors Construct"ioniL71 icerise E�cpDate . a "�_ . u t �Ba�' Hor e l'mprov.ement Licensee " 4 �, Exp Date ,. _ `* � ,�.-. dtz. 'fidAa,,t ."�P/• � ,Y +.,.'* :r3 � :;. �.d�..�. .,,�, Y ARCHITECT/ENGINEER I � Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. c� Total Project Cost: f 1, bo O FEE: $ ��Lob Check No.. 071 Receipt No.:__3 i y S' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,.-+..a.�s--a-r..��n-�.""`7�*v rm- * yin• �r -�,'�•.r r �-^r- S�gnature{ofAgent/ - Si natu,eg ofcon�ractor � hi+ r`i Q .. �� :71g Jkl ., .. -t r Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ [Public YPE 4F SEWERAGE DISPOSAL Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ell ❑ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS s CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes °.a r� Planning Board Decision: Comments Conservation Decision: Comments Wafer & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster onsite yes no Located at 124.Main Street Fire Department signature/date COMMENTS 7'- r dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop., equires approval of Electrical Inspector Yes No ®ANGER 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 ate 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. r 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 o 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 j NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) i ❑ Building Permit Application ❑ Certified Proposed Plot Plan o 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 40TE: 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 J_,pc, hcI YAL� c nL- Sc�fvr�"` Location IS-71b OSCG-f-%b+S 499' No. � v� � " 0-01 ? Date 1 I Ct I dL017 t • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ t '''"o s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � e Check# �' �7 r 0 14 5 8 L11 Building Inspector M R.N.TAMLYN&SONS,LP East USA 800-334-1676 West USA 888-416-9676 Connected to the Industry® Manu dumr Shm 1971 =Trim CornersaverTM'/Weep Hole Cover-/Masonry Accessories Structural Connectors/Flashing/Windstorm&Shear Wall Panels F_ -I - NORTH - w: .. . t c over. O ti y * s h o h ver, Mass, Q COCNICNl WICI{ q�R^rag) S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • THIS CERTIFIES THAT ..�.*.J .19. f.s 4041L BUILDING INSPECTOR has permission to erect .............. ........ buildings on .lv. .q.....ois .... r............... Foundation Rough to be occupied as ......svot* ..... .0...... ..........w4 •�..3 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 CONSTRUCTIO TS Rough ..�.. k Service "" Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. I Plans Submitted F1P1ans 1 a Vied 11 Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL ❑ Swimming Pools ❑ Pubic Sewer Tanning/Massage/Body ody Art 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS e Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes z Planning Board Decision: Comments Conservation Decision: Comments Driveway Water & Sewer Connectionlsi nature&Date - Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster orr site yes no Located at 124.Main Street Fire Department'signature/date // c COMMENTS Enter construction cost for fee cal - North Andover Fee Cakulatlon Construction Cost $ 11 ,000.00 m $ - $ 132.00 Plumbing Fee $ 16.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 16.50 Total fees collected $ 265.00 1570 Osgood Street build offices to separate office from work space 729-2017 on 1/19/17 8 7 6 5 4 3 2 1 q 0" 7 Cf}30 ;,0n,t2 i 2rOx 17 0 1'z" 1 0„ 19 20 21 22 23 D A 2'0" y,o, q,Ox ❑ D 1110" A=10'6" A n 15'0' FROM FLOOR - 15'6' ' 161 3'0 8 0 YE.LL w Q 14'O" N ti1 �v X10 bC`S�T41� 1 ,l/, u31} 24'11 A 9x'h Into caslln _ C s�sP�nd 3'6' 4„DRAIN O 6,0°. C ❑ 11'6" ❑0 2' ' ❑ B ❑ ❑ 2,0x RM.13009 �1` ; ' RM 1300A 1 0^ 4"DRAIN ex 1s1o" 5 111," _. .On 1'0" 2'0 B 1°1I; B O ❑ ❑ i ❑ COLOR KEY PROPOSED FIRE SUPPRESSION SPRINKLER SYSTEM III�Sprinkler system water main sm Sprinkler lines DRAENSIONSAREIN WCfU A UNLESSOTHERWISESPECKI) TITLE: Sprinkler heads FLOOR PLAN ROOM 1300A&B A I0IERANCP3: COi Proposed new sprinkler heads A NG U L A R : ='AMACH="'0'°"° LMS .X '°' CUSTOMER: Proposed new wall .XX Existing.10'wall to be extended to ceiling MEDICAL SOLUTIONS XMt-M5 rroruerARV AM CoNNoeNnu SIZE DWG. NO. REV _ _roposed new door IHEIWo—ON Co ANMtNNG MATERIAL: Proposed new sprinkler head in suspended ceiling DRAWWG E YNE SOLE PROP3YY OF 1750 Osgood St.#?AIO LEGACY MEDICAL U PROP S NJY North Andover MA,01845 R` WDRIUINNPERM ASSONOSLEGACYM ICAALL PRO_ECT0: 1300 FINISH: sownore a PRcwMD. SCALE:1:120 WT: SHEET 2 OF 2 8 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 CURRENT SPRINKLER LAYOUT 17 18 19 20 21 22 23 D O GDO W u u u ❑ D A=10'6" FROM A FLOOR A B=BELOW DROP CEILING A A C C O ❑ 000 ❑ 0 ❑ S ❑ I RM 1300A RM 13008 B ELEVATOR B O ❑ ❑ ❑ DIMENSIONS.ARE IN INCHES A JNLESSOTHERWISE SPECIFIED TITLE: FLOOR PLAN ROOM 1300 A&B A TOLERANCES: ANGULAR:MACNS I tleproef ALL DIMENSIONS ARE APPROXIMATE x ="0-v CUSTOMER: LMS MEDICAL SOLUTIONS ,XX t•.DID"Xxrz=aDr PROPRIETARY AND CONPIDENTMI SIZE DWG. NO. REV 7DRAWING4MESOLEPiCPEP'Of5 MATERIAL: p I750 Os ood St#?AIO LEGACY&4EDICAL SOL0104.ANY D NE*OOUCIION IN PARL GR AS A W MO',E W IINCW Noirb ova MA OI84S niEWRITTENFER.rS1o0 GE EGACYAWHOMEW CAL PROJECT#: 1300 FINISH: SO_UTONSISMO.IenED. SCALE:1:120 WT: SiEET50F5 8 7 6 5 4 3 2 1 The Commonwealth of Massachusetts o Department of Fire Services. r Office of the State Fir e Marshal =1b25 State;Roa&Sto,%,MA 01775'. pe EMIT --.:- . Permits0` ... . (—'cityofTbvm:) Dag'SafeNumher (.Zf Appileable..) In accordance with thepiovbions ofMG.L. Chapter.. . as::provided in secdon Start:Datq This Permit is grantedto: � Ftzli.name ofperson,Eix%n or Corppro in Plan I1ssion t0 t r1A 4, Comments: Restrictions:. J 1 at f; d. 59. J 7� (Give location by street and no.,or describe in such manner as tap vied adequate.identification of location) r Fee Paid$ This Permit mill:. ire bl�i�C ,xs• Si — Yip) �f¢ ( o o c grunt°.: -.---- �g P ) Offical granhngpemiit {Title) TI-1t I GRP�II T ti11:1.6T RG C`f [ti[Cf�it'l it11 l 1 V P6-QTr-n j Ion TNF`PRp1fiJiCt=C ............ ..__........ - ................_ ..............._ N FD � r6l 4:5 Date/o .7-/� - ... }1ORTIy.,'.. 9 TOWN OF NORTH ANDOVER F ;�,o C ty RECEIPT . c14U Tl►is:certifies bas for .r.... ....... ................... Received by.,... "' --�- fir.' .) ........ Department......... /-� .... . ................ WHITE: Applicant 1 CAN,4RY:;Depaitmetrt WNfC Treasurer V� GENES-4 OP ID: NB ACORN" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 0311112016 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). CONTACT PRODUCER NAME: James A Santo Planright Insurance-Salem PHONE 603-890-6439 Alc No:603-890-6521 224 Main Street Suite 3C A1C No Ext Salem,NH 03079 E* ASS:jam ie@santoinsurance.com James A Santo INSURER(S)AFFORDING COVERAGE NAIC 1 INSURERA:Tudor Insurance Company INSURED Genesis Builders LLC,GIO INSURER B:Peerless Insurance Company 24198 Realty LLC,GIO MO Properties INSURER C: 40 Lowell Road Salem,NH 03079 INSURERD: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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. ADDLIX ILTR TYPE OF INSURANCE POLICY NUMBER MMIDDfYYYY MMIDDIYYYY LIMBS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE CLAIMS-MADE TOCCUR NPP8274856 01/0812016 01/08/2017 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO JECT 7 LOC PRODUCTS-COMPIOP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED 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 lPer accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ N 1 A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE.EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ B Equipment Floater BM056667579 04/17/2015 04/17/2016 Leased 11,890 Equipment DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) 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 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aimlicant Information Please Print Legibly Name(Business/Organization/Individual): i 114 hQ.S LLG Address: 100 &7,x ) D/in City/State/Zip: .4;A4L IT 0307 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.UI am a sole proprietor or partnership and have no employees working for me in $•Je Remodeling any capacity.[No workers'comp.insurance required.] 9./u 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t Demolition 4.FJI am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 F1 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.F1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.F-1 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.] *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 I am an employer that is providing ivorkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I 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 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. Ido hereby certify u r the pains and penalti petjuiy that to information provided above is true and correct. Si nature: 4 Date: Phone# 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 Cleric 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 the performance 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 or 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 permittlicense 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-NIASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 1 ' v Massachusetts Department of Public Safety Ur Board of Building Regulations and Standards License: CS-077258 Construction Supervisor THOMASTHOMAS A GIOSEFFI P.O.BOX#1016 _ SALEM NH 03079 - Expiration: I Commissioner 03/13/2018 Af �ie�pamn�xarccoecc oy�C �uc�ivaelZa,. Office of Consumer Affairs&Business Regulatiop OME IMPRO- ENT CONTRACTOR egist-ation r F 4'f40 Type: Expiration 3l. -BST , Individual THQMAS A GIOSE THO.lV1AS GIOSEFFI, 40 LQWELL RD UNIT-1 ::=Q Undersecretary i I .. I 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 I Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ,/o Copy of Contract ❑ Floor Plan Or Proposed Interior Work NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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:, Dor.INSPECTIONAL SERVICES DEPARTMEN'r:BPFORM07 Revised 2.2007 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 - Date Doc.Building Permit Revised 2012 R 1 Genesis Builders LLC Thomas A. Gioseffi P.O. Box 1016 - Salem,NH 03079 Phone: (603)231-5009 - Fax: (603) 894-5732 i Contract November 22,2016 Via email Joel Hughes j3�� • Legacy Medical Solutions 1570 Osgood Street No. Andover,Ma 01845 RE: 1570 Osgood Street-Partition Wall in New Space Dear Joel Here is the contract for the partition wall at the above address. The following items represent the scope of work requested: Included in this bid: 1) Build a 46' long x 18 high partition wall for the above unit, from concrete floor to underside of metal roof deck,to include 6"metal stud framing, insulation, single %2"drywall on both sides,taped,mudded, sanded and one coat of primer on both sides. 2) Build a 26'long x 8'high partition wall on top of an existing wall from the top of that wall to the underside of the metal roof deck to include 4"metal stud framing,insulation, single 1/2"drywall on both sides,taped, mudded, sanded \\ and one coat of primer on sides('1 S4 c- only 3) Includes purchase and installation of a metal knockdown 3' door in location of owner's choice. 4) Includes 2 coats of flat white finish paint up to underside of ductwork on office side only. 5) Included is all material and labor. 6) Building Permit 7) Removal of all drywall debris 8) Unit left broom clean aea • Rating:A+ W. As of BBR lo/o5/r, MA Builders License#CS-077258,MA Real Estate Broker License#107092 NH Real Estate Broker License#011370 Member of Salem Contractors Association and Salem Chamber of Commerce I t Genesis Builders LLC Thomas A. Gioseffi P.O. Box 1016 - Salem,NH 03079 Phone: (603)231-5009 - Fax: (603) 894-5732 i . The cost for the above work If this is aggregable we will collect a deposit othe signing of this contract.A final payment of will be made -idp in 011A upon completion of work. Schedule: This will be started within 5 days of a request to move forward and completed as quickly as is possible. If this contract meets with your approval,please sign below,returning an original and keeping a copy for your records. Thank you for giving us the opportunity to bid this work, and we look forward to working with you. omas A Gioseffi Date Genesis Builders LLC cepted: Joe u es Date Le acy dical SWions B8B Rating:A+ P's of _ BBR ID,,os/-e MA Builders License#CS-077258,MA Real Estate Broker License#107092 NH Real Estate Broker License#011370 Member of Salem Contractors Association and Salem Chamber of Commerce 8 7 6 5 4 3 2 1 M i EPDXY COVERED FLOOR ! 17 18 19 20 21 22 23 O O O O O O O AO o ®o ❑ D ' D 4 METAL STUDDED 6" METAL STUDDED WALL WALL TO 8' HIGH, TO CEILING (APPROX SHEET ROCK BOTH 18'). SHEET ROCK BOTH SIDES SIDES 3 6° DROP CEILING 3 0 c 8'101, 4" DRAIN C OB 6'11" El ❑° ❑ B 11 11 ❑ 4" DRAIN AND 6 461-511 WATER SUPPLY LAUNDY TYPE EXISTING WALLS SINK w/ GRAY WATER PUMP RM 1300B RM 1300A r B LAMINATE WOOD FLOOR B i I Prig s � I _.. .___----- DIMENSIONS ARE IN INCHES UNLESS OTHERWISE SPECIFIED TITLE: A FLOOR PLAN ROOM 1300 ASB j A TOLERANCES: ANGULAR:MACH±I degrees ALL DIMENSIONS ARE APPROXIMATE x ±="°3°" xx =.OIo' CUSTOMER: LMS ± MEDICAL SOLUTIONS! xxx± _ �{ T 4 THE INFORMATION RAWINTIO CONTAINED OLE RTTYOFIN S MATERIAL: _ -- - 1 --- .- -- _- , S� DWG. NO. I REV I750 Osgood St.#2010 LEGACY MEDICAL SOLUTIONS. ANY North Andover NIA, A p A REPRODUCTION IN PART OR AS A WHOLE WITHOUT _ _._ _ ___ _ _ L V orth Andover 1 IA,01845 I THE WRITTEN PERMISSION OF LEGACY MEDICAL PROJECT#: 1 300 j FINISH: CA � � S - UT 1 i S 2 ------- -------- r -. - - _. - —--- - - -- - - -- 1. . - - --- _b�__SCALE: 1:10 W -- SOLUTIONS IS PROHIBITED. E' T' I SHEET 2 OF 2 I 8 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 I i i 17 O 18 2 0 ' o" �"i 19 20 21 22 23 O O O O A ❑ p ! D I I72 ' 0" , n 30 0 24 ' 10" 25 '7 46' 5" j 34 ' 8" 60 ' 10" c B c - ❑ ❑ ® ❑ ❑ ❑ 22'7" 45 ' 3" 4" D.F. DRAIN-7 RM 1300B 18, O„ RM 1300A 1418" 1810" 0.1 .9 13 ' 9" 37 ' 0" 12 '5" 14 ' 8" CC ❑ 011 3 '6 ❑ l� ELECTRICAL PANEL 100 AMP J 8101, , 0„ 810 �..� 120/208 ELECTRICAj '1 - PANEL 100 - 120/208NOV 3PH ELECTRICAL PANEL 200 AMP ' 480 3PH DIMENSIONS ARE IN INCHES UNLESS OTHERWISE SPECIFIED If TITLE: A ! FLOOR PLAN ROOM 1300 ABBTOLERANCi A ANGULAR:MACH+-El.degrees i -- - -- XX +-.010' _ .. _. _ XXX�-.005' _ I X +=.030, CUSTOMER: LM MEDICAL SOLUTIONS, -- M PROPRIETARY AND CONFIDENTIAL SIZE 1 DWG. NO. REV THE INFORMATION CONTAINED IN THIS MATERIAL: I ' .µ'n DRAWING IS THE SOLE PROPERTY OF I I750 OS$$OOC�SC.#ZOIO LEGACY MEDICAL SOLUTIONS. ANY REPRODUCTION IN PART OR AS AIT DOLE WITHOUT North over MA,0I845 THE WRITTEN PERMISSION OF LEGACY MEDICAL PROJECT#: 1300 FINISH: W ---- ----- - --- -- ------ ---__ _._.— - - - -- - - - -- -- _-_------ 120- T_ ! SHEET.._ 2 SCALE: 1' 1 OF 8 7 6 5 4 3 2 1