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HomeMy WebLinkAboutBuilding Permit #923 - 1600 OSGOOD STREET 6/22/2012 I ' I BUILDING PERMITof "°pT" qti TOWN OF NORTH ANDOVER F °s '_,,6• o p APPLICATION FOR PLAN EXAMINATION Permit NO: Z �w 0. Date Received DRgTlD Pp'y�y Date Issued: 0 LI✓ ce 9SSACNt1' 1 'i IMPORTANT: Applicant must complete all items on this page LflC4TlON h PROPERTY°OWNER Gee / '-'n nt r MAP'21:0PARCEL fi ` ZON1 NG D1STR)CT titstoflc District yeso 'Mechne Sfiop Village mo 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 T'Floodplarn 1�1/etlands Watershed Dastrict 1/1ate�/Sewer' DESCRIPTIOIrF W1 TO BE P,REFO MED: �J r�- 40 t to R-� Identification Please e or Print Clearly) OWNER: Name: E �C n Phone: gLP Address: nrr COIRACTOR Narr�e � `' =' one, `Address , . . w , Su ervjsor's Cores#ruc#ion L�cense�' P + �f Exp ;Date , Tyne,lmprpv L. License ' Exp . Date ARCHITECT/ENGINEER 11to-114cg !1 j�� 'n,, Phone: Address: Z IC 0(4:2 0 s a o o �� S� Reg. No.- 7 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. o Total Project Cost: $ FEE: $ �� d . � Check No.: Receipt No.: V NOTE: Persons conttacti 1• stel•ed contractors do not have access to the g ua1•an und Signature of Agent/Ovine `` Signature of contractor i Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art 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 0 f Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes n planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located .384 Osgood Street FIRE*DEPARTMET Terrrp Dunpst n site e ` no 'Located at:124',-,Main.Stree# � atetFire-Depme , COMMENTS f 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 2010 Building Department artment 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 j ❑ 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) ❑ BuildingPermit Application ppl cation ❑ Certified Proposed Piot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of BuildingPlans 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 Doc:Building Permit Revised 2008 i o R ACHUS i CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 923 on June 22, 2012 Date: August 31, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood Street, Third Floor, North Andover, MA MAY BE OCCUPIED AS Hudson Design IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Hudson Design 1600 Osgood Street, Third Floor North Andover MA 01845 Bui ding Insp ctor W Fee: $100.00 prepaid Receipt: 25446 Check No#8861 TOWN OF NORTH ANDOVER FINAL DESIGN AFFIDAVIT Project Title: Hudson Design Group,LLC Offices Project Location: 1600 Osgood Street, Yd Floor, Bldg. 20 North Scope of Project: Fit-up of new tenant space In accordance with Section 107.6 of the Massachusetts State Building Code,780 CMR,80'Edition I Daniel P.Hamm PE of Hudson Design Group LLC submit that I have prepared or directly supervised the preparation of all design plans,computations and specifications,for the following portions of work- Entire orkEntire Project ❑ Architectural ❑ Structural ❑ Mechanical ❑ Fire Protection ❑ Electrical ❑ Other(specify) For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code,780 CMR,8`s Edition,and all acceptable engineering practices all applicable laws and ordinances for the proposed use and occupancy. I further certify that 1, or my designee,performed the necessary professional services and either I or my representative were present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the be responsible for the following as specified in Section 107.6,2.2: 1. Review for conformance to the design concept, shop drawings, samples, and other submittals which were submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approved the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction,and complexity of the project,to become generally familiar with the progress and quality of the work and determined,in general,that the work was performed in a manner consistent with the construction documents. Pursuant to Section 107.6.33, 1: am submitting this final report as to the satisfactory completion of the project in accordance with the plans and the MSBC and readiness of the project for occupancy. ,(A OF �o QANIEL R HAM Signature: �9J91AA1-4A_,-_ 0 CIVIL No.40720 Massachusetts Regi'tration Number:40720 SIAL� NOTARY STATEMENT: MA/7s Subscribed and sworn to before me this day of ,24L. otary Public My commission expires: _ l y�r..•INO••. V F NORTH _ .. own of E �,' n over - NO. � O LAMS h ver, Mass, �a• �� COCMICMlwIC S U BOARD OF HEALTH PERMIT T V D Food/Kitchen Septic System THIS CERTIFIES THAT .02 ...... ,,, ,.,,, BUILDING INSPECTOR ....zq.. . ..�......... ..... .. .... has permission to erect .rn.. U....... buildings onrw.. 0 ..... Q_. Foundation s Rough to be occu p ied as 1 ..... ...... .......... ..... ......0�....... ...:. .. `~ neY 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. PLUMBIIV'G'INSP'ECT R / VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough4k Final C ����J�z✓ �6® PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR' UNLESS CONSTRUCTI T , %meService ................ ...... ..:... .............................. ........... FI BUILDING INSPECTOR 3 GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises Do Not Remove 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 AL _ . NORTH . -T-own o . '-Andover Z 3 � iy V h ver, Mass, �a► t A_ COCMIC.1 WICK 7�A�R�ITED PPP,`'�5 S V BOARD OF HEALTH i Food/Kitchen PE RMIT T D Septic System THIS CERTIFIES THAT .lr.I�'�� ' ......... .. .. ...... BUILDI INSPECTOR Foundation has permission to erect .rw.. .... buildings onrra& .. .......a. .! �.C � �.�f:,,y . d. ...... .. ..... ........ .. ... Rough f to be occupied as ......... .... . . . ... .. .. ..:....... . Chimney f provided that the person accepting this permit shall in every respect conform to the terms of the:application Final k on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and i Construction of Buildings in the Town of North Andover. PLUM BIN'i 'INSP'ECTOR Roughs- VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS �. ELECTRICAL INSPECTOR - UNLESS CONSTRUCTI T 0/,- r�-rs-d'2-P-71 Service ................ ...... .:.... .............................. ........... Fi BUILDING INSPECTOR t GAS INSPECTOR Occupancy Permit Required to Occupy Buildin_ Rough Display in a Conspicuous Place on the Premises Do Not Remove �Einai"' 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 NORTH Town of t E ndover O - 0 No. - . _ ,� Z 3 � z y . C' . LAK. h ver, Mass, �a► coc"Ic"IWICK ��• ��A�RgTED NP���S S V - BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT M. P ............ ......... .n...... ... , „�!�,,,,,,,,,, BUILDING INSPECTOR has permission to erect .. buildings o4az...05P ......,�.� ,,, ' .6.&& Foundation ���� � �� Rough to be occupied as .......0.0�..... :... 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 d�S60, PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T 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 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER `•'�' `•' CONSTRUCTION CONTROL J�awsa PROJECT NUMBER: PROJECTTITLE: �fOpOs(,(�j �� � nr 1'ityiO L0.n sor H,) So jasi7-N�raup CQ, PROJECT LOCATION:_ C3 d G S(2 60 h kAAC1MA NAME OF BUILDING: 6 0O O S G, O a (1 NATURE OF PROJECT: r C-A sv"r F t t]T' O S" IN ACCO R N E WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, �� C& REGISTRATION NO.%Z2- D BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT 01 ARCHITECTURAL 0 STRUCTURAL 0 MECHANICAL 0 FIRE PROTECTION 0 ELECTRICAL 0 OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE ,�,,,jjjjQQfACTORY COMPLETION AND READINESS OF THE PROJECT FOR O P M A s� Z, NF411 • B lb AND WORN TO BEFORE flAE THIS � - DAY OFwn� Z.o l Z q P LIC 'MY COMMISSION EXPIRES �4pj.'� oFMPS G ����,e•` /23/2012 14:05 9786633147 rmur= riot 0' CERTIFICATE OF LIABILITY INSURANCE z3 THIS CEERIIFICArE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONF'HRS NO RIGHTS UPON THE: C1ERtIRCATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS GERTIFICATE OF INSURANCE DOES NOT CONSTMJTE A CONTRACT BETWEEN THE ISSUINO MSURER(S), AUrHDMZEED REEPREiSENTAIWE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMP ANT; If the cefffWaft holder Is an rODIRWAL INURE , poficy(Ies)must , if SUNUUMIN187vwxym'suweat to th9 terns and caiditlons of the poNoy,oerbdn policies may require an erdomement. A dement on this oortifimte dogs not confer rights to the Cer0cat8 holder In lieu of such endorsernen PROOUCSR ACT M.P. Roberts) Insurance A.y*Acy 1060 Osgood Street A I No Bud North Arid©vclx, MA 01845 irrtgur�R(>�A bRanueGQwet�es NAIGe 94URED iNSuREke;Gttasd Taousagi .. DC=3:ElRT CONSTRUCTION CO. , INC ! C 616 ESSEX STREET ?.A, MINCE, MA 01841 INBtrR F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFr THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80NIE FOR THE POLICY PERIOD INDICATE]. NOTWITHSTANDINup,ANY RMUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE RUED 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, N _ . .A� P "sir• Fou Imo.. _ _.... TYPE OIf INSURANCE POLICr NUMBERNrAlp UNITE A MERALLIAGILITY CMP9151606 9/23/12 3/23/13 EACHOCCURRENC6 S .'AIM1 C MuIERCIALC•£NERALLIARIUTY A STx1•-mT11* CtnM410E occuR MED EXP&IM pneb $ S __!j._000 —• PERSONAI,B ADV INJURY $ 1,00g,P0Q_ GENERAL AGGREGATE a 2-0 0"QQ-p GEN'LAGGREGATE INITAPPUCSPER PRODUOTS-ODMP6FAGG S O 2 O POLICY PI4 IOC ffi J�� AUTONIDBII•£MAERUTY � KOLE L I M f F 9 ANYAUTO BODILY INJURY(Per Pawn) St AUTOS AEU AUTOS LED EOOILY INJURY(Per ecoidiml) S NON• "ED HIREDAUTO$ gU7�� GE m A UMQRILLALIAII OCCUR CUP9142034 3/23/13 3/23/13 EACROCCURRENCE S 8 W QEcc{tsE ua5R _ OAM$MA/NE EGAT£ ,1,00q"_0 00,000 NIII 12000,000 OM :ETO ANDEMPL4YER8LA61LiTY DOWC122432 12' 11MPfS R_ ANY PROPRIK1pyPARTN ExECUTAIE DFFICERANEAQ REI(CL pq NIA �LEACMA CLQPsNT ,.QQ„Q,OQQ A4lerr�b►y In N) E.L,,O.IaEA36. 1•000,000 IF a a eI o urxaer !; I�I NOF OPE TON I w E. .015 E• O 10 S Q() Q Q DESCRIPTION OFOPERATIOINSI4OCAnDNSIVEMCLOO rArm,AW 01161,AdVdnmlR60aftadmwle,ErmoreepembmgUrudl COVERING OPERATIONS OF THE NAMED INSURED AS REQU19ED FOR WORK PERFOF=n AT DUNDEE OFFICE PARE! 1-6 DUNDEE PAPX DRIVE ANDOVER' MA. DMMEE OFFICE PAERIK,LLC .AM OZZY PROPERTZES,INC, ARE LISTED AS AN AD1DTT102+ kL INSman CE'RTIFICATEE HOLDER CANCELLATION DUNDEE OFFICE mix, LLC 8F10UL9 ANY 8P THE ABOVE DESCRIBED PO( CED SLY CANCELLED BgpoRE C/O OZZY PROPERTIES, INC. Act EXPIRATION XP RATIOCE kN DIN IS TWrgRr;OF,OLICY VlNOTIe Wet, OE DELIVERSD IN 1600 OSGOOD STREET NORTH IMMR, MA 01945 AUT40MMREPRESGNTA ( f 1985 90 ACORD CORPt9RATiON. All rights ACORD 26(20101%) The AC ORD nan'le and logo are r9!plateredmarks of ACORD rasa>PVed. Imme; Fla: fi•MaIL• 4 I iVlassachusetts- Department of Puhlic Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 48040 ,r 1 , TADEUSZ DOWGIERT 175 BRADY AVE H SALEM, NH 03079 ?` Expiration: 10/29/2013 `('ununissiuncr Tr#: 5561 i I i The Commonwealth of Massachusetts ( Department oflndustrial Accidents Py ` � Office of Investigations a 600 Washington Street a rr Boston,MA 02111 www.mass ov/dia r� g . Workers' Compensation Insurance Affidadit.Builders/Contractors/Electricians/Plumbers Applicant Information Please Printi Leg bly Name (Business/Organization/Individual): C,0 Li Address: 1erf a City/State/Zip: 4�z ) r '`f Phone#: i Are y9m an employer?Check the appropriate box: Type of project(required): 1. I am a employer with (_— ` 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/orpart-time).* have hired the sub-contractors 2.❑ I alai a sole proprietor or partner- listed on the attached sheet t 7• ❑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 I0.❑Electrical repairs or additions required.] officers have exercised their 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.]i employees.[No workers' 13.❑Other 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 add 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: Lana V^1V l..-c2 Policy#or Self-ins.Lie.#: D U-9 2 —2 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 maybe forwarded to the Office of Investigations of the DIA for insurance'coverage verification. X do hereby certify under the pains and penaltles o_perjury that the information pro vided above is true and colrec4 Signature: 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: l(O / H-JAs°� Location 6 G� �Gf '600 r/ 1 No. Date v� r • - TOWN OF NORTH ANDOVER �,. Certificate of Occupancy $ . Building/Frame Permit Fee 0 Foundation Permit Fee $ Other Permit Fee $_# TOTAL Check#6��P / 25446 Building Inspector