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HomeMy WebLinkAboutBuilding Permit #570-15 - 1600 OSGOOD STREET 12/22/2014 tIORTy BUILDING PERMIT OF�t�ev qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * _ J ! : a '/ Date Received t'Z1 ZZI Z0 14— A� Permit No#: 7QA�gArEo (5 gSSACHU5�� Date Issued] Z G IMPORTANT: Applicant must complete all items on this page LOCATION I600QSG0o-Q Print PROPERTY OWNER --QS�Doo .1vr-cr,���-T-1 t 'T i C oP o�J QFCLS!o.. C?t2 p Print 100 Year Structure yes no MAP PARCEL-: tZ __. ZONING DISTRICT: Historic District yes no _. .,<:�>a*kA-r' c4ov--W 96sr►1Aqrolachine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: VCommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 11 Other Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: h WA-LAc O A-,n) L�6 C,C i'7 w o I�--c C.0 /�t�� o d�UJ t✓ h-� t-E, P N I J V. Do Lo C WT?--yL-"0-L) $rA -L. 4N�Z� 1�a0✓L-. G115S'ra'1.1�G��t CEJ br�1 `�Z./I�'6T7F- d�'i't,c.� • Identification- Please Type or Print Clearly OWNER: Name: ffv psa,J O��t �►o G✓Loyd' C i&a�1 Phone: 0 zv J S-r-z-,9 S3 Address: SvLM- 309D L6 v0 65 GOop ST; iv - A-AJO0L) Contractor Name: Phone:._. C 6a3) Zcf-- U e)4-3 _ Address: 3 PC U p�,v�c�' t;m cr- 20 Supervisor's Construction License: C _" ( 0 1. 4-14 Exp. Date- a k-1 7--7/Lv Home Improvement License: __ . Exp. Date: �j�LI,6rJ I' D`17o,vYJ�2� ARCHITECT/ENGINEER H-vos6.► pe-St'4 44-out? LL L Phone: R 70 5-,S- -7 — SSS 3 Address: Suter ' MO (Co(,) OS5c>c)y ST. N, AZW00J(--'tQ Reg. No. 4- G FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -71 00e, &d FEE: $ Check No.: � Receipt No.: NOTE: Verson -c-o t in ith unr gistered contractors do not have access to the guaranty fund Signature of Agent/Owner _ _ Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPF'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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature r CQMMENTS 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on. site yes no Located,at IN Main Street Fire Department signature/date COMMENTS _ _ I 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) e'V a 0S 0 ❑ Notified for pickup Call Email Date 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. I Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ 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 ❑ Building Permit Application Li Certified Surveyed Plot Plan ❑ Workers Comp Affidavit f o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract a Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products r NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Li Building pp Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o 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 2014 tAORTH Town of O �n _ No. 6' 1� _ _ h over, Mass, COCNIc"a WICM RwtED ''P 5 S u . BOARD OF HEALTH PER IT L D Food/Kitchen Septic System • THIS CERTIFIES THAT ......... .. .. .ph........... .. .. BUILDING INSPECTOR has permission to erect .......................... buildings onrffoo. Foundation Rough to be occupied as ..... .... 1, • ......... 4................64. .��.......� .. ............................ Chimney provided that the person accepting this permit shall in every respect conform t e 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 MPNTHA ELECTRICAL INSPECTOR UNLESS CONSTRUCTI11 TS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin-a 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. Initial Construction Control Document HZ To be submitted with the building Permit application by a M Registered Design Professional for work per the 8th edition of the o�M 5„n Massachusetts State Building Code, 780 CMR, Section 107 Project Title: &p0 UFric , Hy19SCVJ D6�(U� �Rr'o (' Date: L2-/Cv✓��t Property Address: 5o Mt 150`W ( [600 (36Goop 5p4�GTy H, A--K)d1o✓5-�f-� Project: Check one or both as applicable: ❑New construction VExisting Construction Project description: t2fi A Kj�-,o cj1,cL-L- ui A J I;-cl snA.)�- DFFC Cx . Svc to l�X�SlZWC l�Jt��tis2 Wth)tfJUW d- ADD Qo00— I05FArlc- 6FUrl-Cr5 I _V,-w-L rzJ 6' noAj ry L1,1— MA Registration Number: 4-L 6 ( Expiration date: hvs 31,Zai t - ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [✓Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other for the above named project and that to the best of my knowledge,information,and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with per comments,in a form acceptable to the building official. g�4ED R�cyi 01DO rF� Upon completion of the work,I shall submit to the building official a Final Construction Control D � n b`c 6{0.4161 r " m Enter in the space to the right a"wet"or Boston electronic signature and seal: `r �tH OF PSS Phone number: ( � S 7— S S S3 Email: o cru -� cv" Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 The Commonwealth offfassachusetts , - - Depar"tm nt of�inclup0gl-Acciclents Office of investigations 600 Washington Street Roston,.lYIA 02111 Uf Vipmmass gov/dra W0>hkelrs' Compensation.Insurance Affidavit:Baders/Contractors/Blecct] Please p t Le�bZ ,A. �[eanf Information dividual. �}U 0 s� Dc=,.-t k3 R U c Name(BusinesslOrganizationitn. )' . Address' Ci�y/Sia elZip: :Ao+-s- Phone#: Ci-76) s-'7 Type orproject(required): Are you an employer?Check the appro�xiate box: F 1. I amt a employer with 4. E] I am a general,contractor and I 6. Q New construction, employees(full and/or parihave r&edthe sub-contractors 7. ❑Remodeling e)�' meted on the attached sheet. 2.❑ I am a sole proprietor or partner • ship and:have,no employees These sub-contractors have 8. [(Demolition working £oxine in any capacity. workers'comp.insurance. 9. 0 Building addition (No workers'comp.znsnraace 5. We area corporation and its 10❑Electrical repairs or additions required.] officers have exercised their 11•[]pluynbing.repairsoxadditions 3.ElxightofexemptionperMGL X am a homeowner doing all work a 152,§l(4,),andwe haven 12,p Roof repairs myself.L No workerscomp. employees.Lao workers' insurancerequirect] 113.0 Other ' comp.insurance required.] "Any applicant that checks box#f must also fdl outtbe section below showingiheir workers'compensation.policy information. -Homeowners who submit this affidavit indicatmgtheY Ara doing allworlc and Eben hire outside contractors must submit a new affidavit indicating such. TContractors that eheAthis boar must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. X am are employer that is providing worlters'eompensadon insur�an for my employees: Below is thepoliey asci job site information. ^"�1 '� � _ � Insurance Company Name:�� y�=A� � `^ ate: -Z -1 Expiration D 1 l '1 5 IC 0: Policy#or Self-ins.L 1 any Job Site Address:) 00 Q CitylState/Zip:► .A�,� oyer,11n141ft�1 Attach a copy of the workers'compensation-policy declaration.page(showing the policy number and expiration date). Failure to secure coverage asrequired under Section 25.A:of MGL o.152 can lead to the imposition of criminal penalties of a p enalties in he, rm of a STOP.WORK ORDER fine up to$1,500.00 andlox one-year imprisonment,as well as civitof this stament may be forwarded to th Offic of d a fine ad ed that a of-up to$250.00 a day against the vxolatoz: Be advised copy Investigations of the DIA.for insurance coverage verification. X do riereby eext udder'tri airs(and penalties ofperjury trial tree information provided above htate and correct. - J �"""� Data• i�i°l�Zc�t �- Sxunature phone#• 9 VS--7- S-S-5 3 Offielal zrse only. Do not write in Mis area,to be completed by city or town 0#1-CIA City or Tawe: Permit/License 0 JssuingAuthority(circle one): .CitylTown Clerk �.Electrical Inspector 5.PlumbingXnspector X.Board of Health I BadingDepartment 3 6.Other - 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'...evexy person in the service of another under any contract of hire,. express or implied,oral orwritten." Aa employei 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 aiinndMdual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not store 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 shallnot because of such employment be deemedto be an employer." MGL chapter 152,§25C(6)also states that"every state or Ideal 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 subdiv ions shall enter into any contract fbr the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have beenpresented to the contracting authority." Applicants Please flu out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of Insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members orpartuers,are notregn1redto carry workers'compensationiumrance. If anLLC orLLP does have employees,apolicyis required. Be advised&atthis affidavitmay be submitted to the Department of ludustrial Accidentsfox confumation of insurance covexage. 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. Selfansured companies should enter their self-insurance,license number on the appropriate line. ` City or Town.Officials Please ba sure that the affidavit is complete andprinted legibly. The Depattmenthas provided a space at the bottom of the affidavit for you to fill out in the event the Office of Tnvestigationns has to contact you regarding the applicant. Please be sure to fill in the permit/license number whichwill be used as a reference number. Th addition,an applicant that must submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Sob Site Address"the applicant should write"all locatfons iii (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 ori file for future permits or licenses. Anew 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 hermit to burn leaves etc)said person is NOTregi*ed to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do nothesitateto give us a call. The Department's address,telephone and fax number. Tho CQ onwealth o;FJ1-usaohmotta.. Dopaximuto£T. wWalAaoldoxts Moet TAVesfigWOM 60 Waaga et TOJ, 6X7-7.2x_4.-00 0A 40,6 or z-877AW. ,9A Revised 5-26-05 Fax#617-727"7749 vv.ma.Ss,gov/c.�a as k #Y. IR"ELERS J 1NORKERS;,COMPENSATION 3w ONE TOWER,-SQUARE. AND HARTFORD', cr obis EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (XVMPHUB-4183T59-6-14) w RENEWAL OF (XVMPAUB-4183T59-6-13) INSURER: THE TRAVELERS INDEMNITY COMPANY OF. AMERICA NCCI CO CODE: 13439 1. INSURED: PRODUCER: HUDSON DESIGN GROUP LLC; POOLE PROFESSIONAL LTD SEE ENDORSEMENT WC 99 06 01 107 AUDUBON RD 1600 OSGOOD STREET BLDG 2 STE 305 SUITE 3090 WAKEFIELD MA 01880 NORTH ANDOVER MA 01845 Insured is A LIMITED LIABILITY COMPANY Other work places and Identification numbers are shown in the schedule(s) attached. 2. The policy period is from 11-27-14 to 11-27-15 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION1NSURANCE:,,. Part One of the policy applies to the Workers Compensation Law of the state(s)'listed here: MA NH NY t I B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 1-000000 Each Accident 02= Bodily Injury by Disease: $ 1000000 Policy Limit Bodily Injury by Disease: $ 1000000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NJ NM NV OK OR PA RI SC SO TN TX UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o. 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 09-11 -14 KA OFFICE: A&E RETAIL 20V DIRECT. BILL PRODUCER: POOLE PROFESSIONAL LTD CGX13 012995 o O C be 11 be 10 be 9 RECEPT. O St55 xj�35 x x x ; N� 22 Am 4-5j'1 L — IIIIII w e a r Y-1 Q 0 E + _ I CL \�f El Z -___;' - a Office No. 5 .i ~ FOR 3W 'REMM WALL -y---- I L—__J Ext. 224 ' v DOOR -• I ' t �; D T m o iR 3 ' -- Office x ----' --- ---- ` w 0�8 No. 6—I Qi ENTRY L__ EXt. — mz w 1 1 1 = 0 1 .• O o. ---- ----E---- i I i i 1 1 \ 1 1 I 1 1 a 1 L__ _ _____ L_____J 1 1 1 ® h n �Li REMOVE TO AT CH PROPOROPO ED LSED LAYOUT A-1 MITI.SPMMQM IE44 -- OFTLISER TO RFJNM F 1F TIB UGHr M AS �■AfATED Q ee, Q 7 X ENLARGED PARTIAL DEMOLITION PLAN ENLARGED REFLECTED CEILING DEMOLITION PLAI`{/i1 6 A� WKS =n or 0 CO 7 OQ w Cbz sma a = w a o a m 1 Office No. 4 Office � OfficeNo. 2 Officee�i x ! ®®®® erek Crease Mike Cabral 'har" . Don Hom € Lunch �xt. 238 Ext. 231Q �xt. 244 Ext. 222 Z Room ® ® O a n C) C) w 0 �—_7 0 Q 1�7 0 J > ConferenceRoom Ext. 243 �rnrn\ Jo ° m -L J O �1 2 a a4 •5 � d. w. E 20T �229 D 12 h l3 14 � Kaat in Botha An,Ya aLano.aay Pla Wq�rn dt GALLERY t.230 �zz5 E.�- - RECEPT. 6 9 Kl P „ O 55 .y qi5 r�E Y 54 Com Y ey Ne 39 5 l rosy 4n r guEtlo opera 239 2l2 24, 228 ——————————————————— II 1 IT7®F , -- 3 Sr Office _� 4Ep Ah,4 REGISTERED ENGINEER i I No. 6-1 Server cam.I9 e ENTRY L__J Ext. — Room Rae RmNa O Q EaL 2zs O 40 .e. ,o e,. 53 z ss a z4s D. 4` `• O I uo��•/' �� HUDSON DESIGN GROUP, Drn CNr'v'a Ni = A Ytli Ni N i ( � LLC. 1600�SrR= N0.4161 �i NORTH amt Mn 01645 ° --- ---------- o co Boston L! 1 Miss. o PROJECT AREA • � S,a� OVERAL THIRD FLOOR DEMOLITION PLANA °' Dml 0 �- ARCH 0(24x36) ~1 @.pyRIGHT BY HUDSON DESIGN GROUP,LCC.2014 n 0 x' m D 4 O ------------------------ Z -- fU I � N ___-_- _ ------ __ 0 WAITING rn z O �o 4m 0 m N —�v z ea �� oo i J S a o G) - 13 -816 0D p 2 I N Zf RIM ;0 D 11 m� r I �N Zp0 r0 O 02 > FF OOH z � O m {no mv_ ;_ O D q0 n Y�n O9 DZ bcb 0 C, 0 c> I Qv/-- m Im A m - ............... 0 x V. BRIAry - - Q G M C3 `� H�SETiS FOR CONSTRUCTION _ = ENLARGED PLANS 3:11 C n PREPARED BY: © PREPARED FOR: REV DATE DESCRIPTION BV CHK APP'D g FZ 12118/2014 ISSUED FOR REVIEW KMS BO DNH Hudson ® Hudson tLYQ�� m Design 6roupuc Design Groupuc Z ® ow m j p BUIL ING20N STREET 1607 ING200STREET Q � BUILDING 20 NORTH,SURE 3090 TEL: (978)557.5553 BUILDING 20 NORTH,SURE 3090 TEL (978)557.5553 [n N.ANDOVER.MA 01845 FAX:(978)336-5586 N.ANDOVER,MA01845 FAX:1978)336-5586 nz BS � BostonSociteyof.Architects/A IA t BSA#: 723 . E Q) Name: Brian P. O'Donnell,AIA Location 411j�l{'L � No. Date 1 7— ,?.-Z- /4� . - TOWN OF NORTH ANDOVER D' 0 o 'h Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $�_ A I-� tNI Other Permit Fee $� TOTAL $ Check# 37 uilding Inspector