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HomeMy WebLinkAboutBuilding Permit #664 - 1600 OSGOOD STREET 4/13/2007 BUILDING PERMIT NORTH 0�tT1.E0 16��Q TOWN OF NORTH ANDOVER F?•b.' 6 �A APPLICATION FOR PLAN EXAMINATION * _ o Permit NO: Date Received ';9q�RATeo 9SSAC HU`��� Date Issued: a IMPORTANT: Applicant must complete all items on this page ..,LOCATION °ISrint - t PROI~'?�RTY C3WNER � PnntT; MAP NO, PARCEL:{ ZONINGMOtSTRICT; HISTORIC D1STF2ICT yes ,,na- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: 4Z-6mmercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Septic ❑1Nell ❑ Qcodpl in i W4tlands Il 1 fatershed U1Fafer/Sewer ;� DESCRIPTION OF WOPZK TO BE PREFORMED: Y ` gc> -&Cod `)A Identification Pleme T pe-16YIPAnt Cleary OWNER: Name: 00 one: Address: / O© Q l �� 1•' `CONTRACT Name: —�-� c- w Phcre " Addre' ss: :^ tap Supervisor's Construction tcense ,yam z N � Exp Date . ' w --- -� Home lmproement LicenS exp : Date w n ARCH ITECT/ENGINEERPhone: 0/3-rz Address: .I,- amu , c2 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: $ 5726 FEE: $ J U Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of rent/C?wne�--- ,,.__ � —,S gnature of contractor a 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ a COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water & Sewer Connection/Signature& Date Drivewav Permit Located at 384 Osgood Street MIRE DEPARTMENT -Temp Durnpster on site yes no Located at 124 Maim Street Fire Department signature/date ° 4 O O mE lT � 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 i i ❑ 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 Li Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract o Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application L3 Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Li Building Permit Application Li Certified Proposed Plot Plan Li 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) Li Copy of Contract a 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Locatioe)D ,0,0 r!'r Al`s 3d 'n"/rL' No. MaRTN TOWN OF NORTH ANDOVER O 3? Is OL ' Certificate of Occupancy $ �7s'••° E�<' Building/Frame Permit Fee $ s�CHus F Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #e. 6 ol� 20 ,! 2u c _ Building inspector NORTH 0 of _ 4Andover 0 w= t No. _off dover, Mass., • COCMICKEwICK 7�S RATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System go BUILDING INSPECTOR THIS CERTIFIES THAT...162........ ...... R. A. dfw% .. �.��.......... .... �..� ...FL.......... Foundation has permission to erect... .. .. buildings on -1.6-a.0........10 aO ....S.r............ Rough 0 to be occupied as.......... ... Ovid-6.�t- Chimney provided that the perso mg this perm' shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration an Cogstruction of Buildings in the Town of North Andover. IPLUMBING INSPECTOR OQ %T 6�o da VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 30 PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU S LTService ELECTRICAL INSPECTOR Rough ...... ......... .... BUILDIN ...... TOR 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 DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. REMOVE PORTION OF WALL TO CREATE OPENING. N E C H = - --- , M ..0 _^ CLOSET ------------- -- _�. SUE ME TING 1181 X 41 RE N N � C4 6 6 Lu x N z ca a t- _+ Q __ 2' IF' u V_ z OBIT'S OFFICE =�- 3'-L" 2 " v _ 1 2 NEW DOORS Z'EFAX/ SUE MOFFET COPIER I 1 •• 80 XL RECEPTION AREA ELLEN'S OFFICE f SANDY r CAROLYN 80 X V 80 X t, I OZZY TEMPORARY OFFICES. 2ND FLOOR, BLDG. 30 d SLE 2.[11V Lllr 1,082 NSF © 48' X 84 1/2" PANELS 4-5-07 2 30' X 84 1/2' PANELS The Commonwealth of Massachusetts ,^ I Department of Industrial Accidents Office of Investigations 600 Washington Street ti�ltl e a ° Boston,MA 02111 t 1-4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name musinc/sslt)rganization/Individual): ( Address: City/State/Zip: ����Phone 4111 k�570 3 Are you an employer`!Check the appropriate box: Type of project(required): 1.9��am a employer with T c�) `I•-❑ I 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.*+ 7• emodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. Y p tY• 9. [] Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its officers have exercised their 10.[] Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work right of exemption per MGL ILEI.❑ 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' 13.❑Other comp. insurance required.] *Any applicant that checks box#I must also till out the section below showing their workers compensation policy information. b 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*comp.policy information. f am an employer ilial is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: ✓` � Policy#or Self-ins. Lic.#: 0 L.J 2 9 ?j �,O Expiration Date: © d T Job Site Address: 49&12 © tet' 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 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 cerdb,ruiner the pains and penalties o erJu . ry that lite information provided above is true and correct. t Si nature: Date: Phone 11: % 72afL> 7�9 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): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Mar 06 07 12:48p 6038900192 p.1 ERTIRCATE OF LIABILITY INSURANCE 1 20 - C Fl1CATE IS ISSUED M A MA Tre I aF INFOFWATION 910;CE RT1 RTIRCATE PRODUCER ANO CONFERS NO Tt1CsMTS UPON THE CE N.P.1tOs=as losm A= AmN= INC- ALTER THE COVEPA—M AFFORDED 9v TOFS NOT �POu� C�BELOW. 1060 OSG b sz�T NAICi1 NQRzO ANDOVER DA 01845 INSUIUM�0� CCIVMGE 3 78— 9h+si�osm ez >�s co. M INSUAEO DOTTC3IBR1' 1=521==0" CO-, nqC- NeURER� WSURER C 8 vm6E PARR �mmftn o IDIS AmpVBR, m 01810 >I fS _ TME POUC�B OF flSUtiA110E U AL'L011►HAVE aA 155UEO Y'O TME{MBUM ►?IAS R1IE P TD f► CERIIFICA MAY T�OR ABY REOUlREST.YEi1111 OR CONOfflON OF ANY poLie"T SC OTMER ERGNM S – NA { HAFFOR IA FDECI NU�B[Eq� 0 �19 SUBJECT TO ALl T11E 1'ERNIS.2RCt USIQNs AND CONDRIONS OF LWT6 – POLiCrMIRI � eAOH FENCE s 1 0 G cw!NeRAaL on UAEILIIY ae S 0 OO cOMMERCL4LOC EruL "IuTv yBD P{ mnow.eN s_,._ 00 _. lew ocaal rERSONAtaADpuwRY s 00 000 cPF0064437 10/26/06 10/26/01 Ci l wQpREOATt s 2 Ob P„ocual -cowrov ADo i 1,000,00(L tSeRti A08 0GAM L�APFMS PER: ►011CT tOG colmREbilNetELWR i - AurDMoenEwlaa,Isv F'1°DO� AArrAUTO epp4vlwuRY = AUOVR40AUM SCNEDIAEDAUTOS _ NTR1'bAUTOS {PR rFCAb�I PROPEW DAMAGE AUTOONLT-EAAGGOERt GARAGE LMfil11Y EAACC s - = OTMER THAN -. ANYAUTO AUTOONLY: no S EACH OCCURRENCE S EZCEesnINeREluI1vV4111f'f ApgREpATB = O.,m co NSNAoE S s Dr�cnsuE s .. RETEIRION S - u WO COWEN8ATI0NANo E.LEACNACCID£NT s 500.00 L EMPLOTO$LMe1LITY D ¢ERAlyduoAO W=703930 10/26/06 10/26/07 Et_pSEASE-EAEMPLO + 500.000 _ EL,01SlA8E-MO UMIT a 500 Ob s ° KINSONov OTHER OEZCRR'T10NOF oPBi11TI0Ms►LpCATION6/VEHICL86iE11CW81DN6AOOECBYISPEGKPROV►sN1N8 • 603-6 – 2 CANCELLA ` CERTIFlCATE R -- -- SHOULD ANY OFTNE ABOVE pESCRIBED POLIGEe 06 CANCELLED 9EF'ORF TME o1rIRATION DATC TMEREOF.THE 18SUV4 INSURER YMLL ENDEAVOR TO MAIL 1O OATS WFME14 O?.ZY PROPSRITES NOTICE TD TIE cWnFtCATL MOLDER NAMID W TNi LEFT.eur mum TO 00 SD SHALL 1600 4OS600D ST f1rm No OBLWAYION OR LIASEITY CF ANY mm UPON THE*sun rts AGENTS Ok ANDCIV3'7R, Imo! 01.845 frE WENYATNEs. AUTNODPSO RiPRESE111111 1! MACORD WRPORATM 1956 ACOM (2001M) p L a �d�uaelta ✓fie yr rnsr�no�uveu� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 048040 i4 F Birthdate: 10/29/1955 Expires: 10/29/2007 Tr.no: 8053.0 Restricted: 00 TADEUSZ DOWGiEERT C 175 BRADY AVE ,,�.. -41 SALEM NH 03079 Commissioner issioner