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HomeMy WebLinkAboutBuilding Permit #90 - 1600 OSGOOD STREET 8/3/2007 NORT#1 BUILDING PERMIT 0 41UN'° #6 q�o TOWN OF NORTH ANDOVER °3 - o� APPLICATION FOR PLAN EXAMINATION * _ Permit NO: 90 Date Received s s ACHU Date Issued: Y3/07 IMPORTANT Applicant must complete all items on this page OCAS Its „ .- � 0,PER Y�O1t a M/�P 1 0 � RCE1 ZO1�II G IS 1C�1' l t`ariC t)is#r)trt -- r ropt ine Sh i TYPE OF IMPROVEMENT PROPOSED USE Residential - Non- Residential ❑ New Building ❑ One family 11 Addition El Two or more family [I Industrial 4clteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ® Septi ell y ❑ i, dpIal .. 11� d , 4� atersCeci�3 �i :� D SCRI 'Tf N OF WT04B E P ORMED: p Z Identificat Ple e Ty e or Print Clearl OWNER: Name: 00 O o Phone: Address: Aw ®off C6ITRAC � � T ' �hbn f s, ae� " � Adress: d A 1 StaperV150t'S cah"st C 101] L 3U e, 5 a' _EXE ate x E x . . .•. Phpr ARCHITECT/ENGINEER 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. Total Project Cost: $ FEE: $ Check No.: 65�J Receipt No.: �716 416 I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ' wS,i nature o#ycontractor x �' S)gnatureAgent�• ner . n, _. �.. .. __ _ _ _, . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimmin ❑ Tanning/Massage/Body Art ❑ g 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS d 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 Located at 384 Osgood Street -IRE DEPARTi MENT - tMp Du `pster situ. yeses Located at 124 Maih Street Fire titonIt s�gnatute/dete '" Wr'� ,. � �; 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.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date ............................................................................................................................................................................................................................................................................-.........................-.............................................................................................................................................. Doc.Building Permit Revised 2007 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 o Building Permit Application a Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract a Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks q o Building Permit Application L3 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) Li 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 o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No Date A) ACRT" TOWN OF NORTH ANDOVER 3?0�,,..o 00 L -1e Certificate of Occupancy $ cNus Building/Frame Permit Fee $ s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � Check #,�� 20653 Building Inspe of µORT1, CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 9058/3/2007) Date: October 4,_2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood Street Bldg#20 MAY BE OCCUPIED AS Tenant Fit Up—Hudson Design Group IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Ozzv Properties 1600 Ostood Street North Andover MA 01845 Building Inspector ORTIy Town ® NAndover �..I. rV0 No. - C% o lover, Mass., COCHICHEwICK �^ �ADRArE DPPS` 5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....................:..... ....... .............................. _-y ......................r _.. Foundation has permission to erect.......... ............................. buildings on :('.....:� � �= Rough to be occupied as Chimney _ p . ................. ................ .......... ..... ... ...:....:.................:....................................:......:................ provided that the person accepting this permits II in every r sped conform to the terms of the application 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. i Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS n....-� f e ou�l� Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No, Lathing or Dry Wall To Be Done FIRE DEPARTMEN Until Inspected and Approved by the Building Inspector. Burner ___ In� Street No. r SEE REVERSE SIDE Smoke Det. I /� Q NORTH 0 of over 0 0 ... _ ;. s No. Q� dover, Mass., LAKE COCHICMEWICK y s r ORATED 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System /� BUILDING INSPECTOR THIS CERTIFIES THAT /c �-� ..............................: Foundation has permission to erect........................................ buildings on ./I�.ao...ncr- o.a/��.....S/ .: 2�' Rough tf�/ Chimney to be occupied as .............3.0..P.0... ?........ ....................................................., .............................................cam, y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Aiinal this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of&/a 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 STARTS Rough ` ,..._.. .... Service . ... . ...... ................ ........ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final Na Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: 0705059 Project Title: Hudson Design Group LLC Tenant Fit-up— Project Location: 1600 Osgood Street- 2nd Floor—Building 20 North Hallway Name of Building: Osgood Landing Nature of Project: Tenant fit-up for office space. In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory Smith Registration No. 8688 being a Registered PFefesskmal €+lgipeer/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural X0000(Structural Mechanical Fire Protection Electrical Other(specify) FOR THE ABOVE-NAMED PROJECT AND THAT SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE 780 CMR MASSACHUSETTS STATE BUILDING CODE. ALL ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE 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 BUILDING UILDI ALL BE RESP NG PERMIT AND RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2 I. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance nce with the requirements q menu 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 state of construction to become, generally familiar with the 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. UNDER SECTION 116.4, I SHALL PERIODICALLY SUBMIT A PROGRESS REPORT, TOGETHER WITH PERTINENT COMMENTS, TO THE BUILDING INSPECTOR UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMP tvk DINESS OF THE PROJECT FOR OCCUPANCY. Signature and Stamp(no facsimile) Q�t.�Q�GpRYP.S. No.6668 OFFICIAL SEAL GRACE HACHEY o NORTH AW NOTARY PUBLIC MA COMMONWEALTH OF MASSACHUSETTS My Comm.Expires Jan.17.2014 O� � F pgS SUB BED AND SW TO BEFORE ME THIS DAY OF 2007 0TA Y PUBLIC MY COMMISSION EXPIRES ;liie arv»zau a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 048040 Birthdate: l0l29/1955 Tr.no: 8053.0 ExQires: 10/2912007 1 ----Restricted: 00 TADEUSZ DOWGIEERT 175 BRADY AVE SALEM, NH 03079 Commissioner 4s� The Commonwealth of Massachusetts • Department of Industrial Accidents Office of Investigations 600 Washington Street M Boston,CLIA 02111 �` - www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print UPON r f Name(Busincya/t)rgani-r.:ttion/Individuah: l tom.- _ _ _ . Address: _ -4 4e-- City/State/Zip: l.r� to f--f, GL t /&,Phone#: �f ra kS D 3 Cie, Are you an employer?Check the appropriate box: Type of project(required): 1.9��am a employer with 4..❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors- 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t ? emodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers'camp. insurance. g, ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[1 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL {I.[] 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.] 13.F1 Other *Any applicant that checks box#I most also fill out the section below showing their workers'compensation policy information. *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'eomp.policy information. I am an employer drat is providing workers'compensation insurance for my employees. Below is the policy and job.site information- Insurance ` Insurance Company Name: &X_42s=V`4 / z. Policy#or Self-ins.Lic.#: ID 0 L-2� ? 9 3 SO Expiration Date: D Job Site Address: ®© 49City/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 tine 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. I do hereby eert6&under the pains and penalties of rjury that the information provided above is true and.•..— r Si nature: Date: Phone ft: �7 --,`-7 2-!2 2-, 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#: Location /a 00 No. Date 0/7X NORTM TOWN OF NORTH ANDOVER f 9 + �OV Certificate of Occupancy $ �'�s'•••°•'t�' Building/Frame/Frame Permit Fee $ � cMuso 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # b 20461 '3uilding Inspector