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HomeMy WebLinkAboutBuilding Permit #144 - 1600 OSGOOD STREET 8/21/2012 NORTH B.UILDING PERMIT OF ,,UZI> �6'q7.� TOWN OF NORTH ANDOVER 0 24yE"4- c_ APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ��Ss ArIEDZj2,_-- Date Issued: IMPORTANT Applicant must complete all items on this page 77-71!-F LOCATION. +d0 a ✓ fit G'd7 '�' r , } } 4 -� Pnnt; F- ROPERTiY, OIIVNERt �. ''MAPINO PARCEL ZONINGt©IS;TRICT ..•o,istoricstrict ' ye {Dis a e 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• Sepfic* Well` fi' '' IFloodplamj '"'t �Wetlands� ' -:.AE, ';WatershedDisfric# . Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: v ev cxp Identification Please Type or Print Clearly) OWNER: Name: 51) Aq I'!'l�' �c J, •( �� Phone: g7fr" �S Fs �/S/ Address: 1v� /I~ L 1�4,<t r 4�E O s CONTRACTOR 'Nbnfe: l��� �OJII►Z�c tS1�t�" Phone t i F +' ' `Superdisorf's+C'onstructioniLicense : _ Expo Date JE Date r t . �Home�lmpr`ovement License:_. . F 1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. ' g�O Total Project Cost: $ �, FEE: $ Check No.: Receipt No.: T� NOTE: Persons contractin 'h unregistered contractors do not have access to the guaran fund Signature of Agent/Own „ 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 I PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature i COMMENTS f HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planr)'ing Board Decision: Comments ' r Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os oo I Street ...FIRE DEPARTMENT Temp Dumpster on,site. yes no. Located at 124-Main Street Fire:Department signature/date y 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) LI Notified for pickup - Date Doe.Building Permit Revised 2008 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 ❑ 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 i Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products DOTE: 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 ❑ 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 o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products OTE: 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 2.2008 NORT" Town of t E ndover No. _- o h ver, Mass, 'Z/ COC KICKIWICK RATIO S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ... a BUILDING INSPECTOR has permission to erect ............ g � �,, ,,,, �,� „� ,/�—! �. F undation .............. buildings ...... L� ........... ...... 6d70 tobe occupied as .... L4.............................................................................................. 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 CONSTRUCT" RTS 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 ACOR[]� CRC CERTIFICATE OF LIABILITY INSURANCE R054 08-166 /D2Y0Y1YTE 2 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 INSURERIS),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 PHONE FAX (A/C,No Ext): (A/C,Nor (8 8 8)4 4 3-6112 210705 P: () - F: (888) 443-6112 E-MAIL PO BOX 33015 ADDRESS: SAN ANTONIO TX 78265 INSURERS)AFFORDING COVERAGE NAIC k INSURER A: Sentinel Ins Co LTD INSURED INSURER B: Twin City Fire Ins Co INSURER C CUBICLE CONNECTIONS INC INSURER D 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. INSR TYPE OF INSURANCE S POLICY EFF POLICY EXP UMTS LTR /NSR WVD POLICY NUMBER /MM/DD/YYYY/ IMM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 S O RENTED— COMMERCIAL E COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 1 000 000 A CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10, 000 X General Liab R F1 76 SSU IV2443 07/28/2012 07/28/2013 PERSONAL&ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE S 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 5 2, 000, 000 POLICY PRO- D LOC 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED El El BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED (Per accident) S AUTOS S X UMBRELLA MAB X OCCUR EACH OCCURRENCE _ $ 1, 0 0 0_, O O O A EXCESS LIAB CLAIMS-MADE 76 SBU IV2443 07/28/2012 07/28/2013 AGGREGATE $ 1, 000, 000 DED1,X1RETENTION $ 10, 000 S WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIAB/L/TY Y/N X TORY LIMITS ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 11000, 000 B OFFICER/MEMBEREXCLUDED? NIA 76 WEG EU1185 07/30/2012 07/30/2013 /Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1, 000, 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1, 000, 000 F1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remadrs Schedule,if mme space is required) Those usual to the Insured' s Operations . Certificate holder is an additional insured per the Business Liability Coverage Form SS00080405, attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Hudson Design DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD ST At/rHOR/gD REPRESENTATIVE ` NORTH ANDOVER, MA 01845 �_ ,.t� ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD cubicle connection inc. Estimate f 13 Lyman Street l Beverly, MA 01915 Date Estimate# 8/16/2012 1080 Name/Address Hudson Design 1600 Osgood Street North Andover,Mass Project Description Qty Rate Total Cubicle Connection To Knock Down Estimated 25 Station,Move 4,800.00 4,800.00 To 2nd Floor And Reinstall According to print supplied by Hudson Design,all work to be done during reg business hrs,estimated 3 to 4 days for completion also misc files and Confernce room and private offices Be moved and Installed. Moving of personals to be determined Total $4,800.00 Locatior� �,� !�!�!2 ltu244 No. Dat L_ o ' TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ �2C2 '¢ Foundation Permit Fee $ y, Other Permit Fee $ � 41'r, "SY��,. TOTAL $_ Check 25633 Building Inspector