The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #846 - 1600 OSGOOD STREET 6/21/2007 f BUILDING PERMITo�"°RT b qti TOWN OF NORTH ANDOVER o� �`;"` �°^,. APPLICATION FOR PLAN EXAMINATION 440 * ORq<oc.icw•wrtw 1' Permit NO: Date Received ORATOP �SSACHUS�� Date Issued: g ,/ Q 7 IMPORTANT: Applicant must complete all items on this page LOCATION ' . :- 'nt PROPERTY OWNER Print a m MAP NC►; PARCELfHISTORIOT" Yes x9 .no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial , eration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Se;aticC Weil 4 Fioodpla n E V1/etlands "Watersl fid`dis#rice 1.WaterlSewer . DESCRIPTION OF WORK TO BE PREFORMED: Af— _f Identification PI ase Zpe or Print Clearly) OWNER: Name: Phone: 4o� 7771 Address: CONTRACTOR Na`rne: Ph4re: A; 'Ad'dress: ' Supervisor's ConstructioLacer e� t p. Date:. Hdme Imprrvement Licen e . '. Exp:. Date` . r, ARCHITECT/ENGINEER hone: 6 Address: zqq- ,� 6/-- ��od�v Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. m� Total Project Cost: $ j `"` FEE: $ Check No.: j� j1�4 Receipt No.: c12 3�S NOTE: Persons contracting with unregistered ontractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor i Plans Submitted 1 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 j i DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED LALTH ❑ ❑ COMMENTS `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 FIRE DEPARTMENT -Temp4Dtxmpster an sits` yea . _nc�� ° Located at'124 Main Strbefi 15'Fire Departtnent sil natureldate CONN T MME E � 2 Dimension i Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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 j NOTES and DATA— For department use 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 ❑ 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 ❑ 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) ❑ Building Permit Application ❑ 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 ❑ 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 A 0 0 LIs4;0 No. Date �A/40 N011T1y TOWN OF NORTH ANDOVER F 9 i Certificate of Occupancy $ ;�a",•°•'<�' Building/Frame Permit Fee $ � 6 JACHUSt Foundation Permit Fee $ Other Permit Fee $ p TOTAL $ s Check # 206 Bu#g Inspector NORTH 0 0 _ Andover � _ . aa_. . : :, � . 0% 1 No. G o over, Mass., /26 A_ COCKICMEWICK ADRATED P �2 `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 14-0.0 /�f BUILDING INSPECTOR THIS CERTIFIES THAT ,l4.0.Q........ ,....... g . .. . .... " '-- -------- Foundation has permission to erect........................................ build' . ®0....Q . .. ....... ......&W�, Rough to be occupied as......., /.6_C.,4'.1Ad ................. -5 ..............`:--.�/ .'�. .. Chimney .. . .. . ... . provided that the person accepting this permit shall in every respect conform to the terms of the ap cation on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration 4fid 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 CONSTRUCTI TS Rough ......... .......... Service BUILDING INSPEC Final Occupancy Permit Required to Occupy Building GAS INSPECTOR j Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No, Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. - ✓lrz C�oarvrrza�u�r t o� cry/-mom BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR .Number: CS 048040 BirthdaW 10/29/1955 " Expires: 10/2912007 Tr.no: 8053.0 4 Restricted: 00 TADEUSZ DOWGIEERT 175 BRADY AVE = SJ SALEM, NH 03079 Commissioner Mar 06 07 12:48p 6038900192 p.1 Yll li,GVVf ca�••v •..o ��•��-��-� ACM- CERTIFICATE OF L1��L'x'Y INSURANCE OF 1 2 ' ifOSpCATE.IS A in cl 78E �CA� wouc� OMLYANDgV.RtgG�ER �Imo. 8 K•p• 8 I1�SLA0.18� �• ��R 7NE �'iliE POUCI�S eRC�W. M g MWVM 148► 01845 — l�i1��` *COAIBb►DE no v0 D086fZBR'� COgS3'�C'L'Im OD C. s+a�AiEs tx 8 D=ms mvz r a 71 MA 01810 s 7MEP�DttC�{OFt s �eBAww►vE e=�Ct cd XIMOF"+ JNiVRE0N8 OR i�ir7lOIOi' � tOIlulilE �s110tlfUtitllYiliglC�N11�11��' a>srt6 Isom pot�ns�► 6� • 2 0 Vr aeeu�UMNUry s 50-oo� wwswr ® aeo s 0 °CY° 20/26/06 zo/aG/07 00 cpro06t43? a� = a -,gra goo s 0 0 2L= _ �rnr+srt0 i ALLOWNWAUM w,sKmKwwTc nv®wtos 1� s NOItONAIe�'� p� � �uro0pc.-e►�� s cpura6u+�sanr sR�tx a x��vto M0 ea0 s EJYN10i�M,l� � �LvuslutY �p�►iE s , s mom*"VjooqMs sM sy,�p, s d sd0,o0u OWVffmLWm"KION r D suppoor-FAMWME,vrsxv+ec�� D=703930 10/86/06 10126107 �D :moucruwmw i 5 0 �0 oY11Ep pE�aPTlpf�oi o►S�1S1MSttOC�»6lVBlMCI��O�Cti191Df1G� ��'! • 60 —6 —0 GTEWOUWRsaout0 Mnr aFTc�wsoVlo00eeoa•twaro�c sure tea'.*s=me emigm waL ems m wa 10 OM VVFMEN 08 pnOpggi NWM TO Tmnc�atVt Nwor iotNi ' aus cbwRE To 00 s0 swu ns�osE eo 0,,MXf dV OR LVWUTV OF NK 00 UM'M OW-WLP-Rs AGMM M ifi00 OS600ti AlwCVDR, "A 01865IL .Wn ��flpRpORAT10Ni9a8 �25(t00lfHeJ I The Commonwealth of Massachusetts 1 Department of Industrial Accidents Office of Investigations 600 Washington Street • uwu ;,•. ;; Boston,JNA 02111 • �� www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly r 2_ Name(liusin�hs/t)rganiratiun(IndividuaO: i _ / L _ - Address: = T / i City/State/Zip: L.,&,o e--,�_.t ra Afphone#: 9� 7 4 S -3 Are you an employer?Check the appropriate box: Type of project(required): 1.RIA`am a employer with r t'c9 4..❑ 1 am a general contractor and I 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 working for me in any capacity. workers'comp.insurance. q, ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its r10.E] Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 LEI Plumbing repairs or additions myself.(No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insuranceuired. t employees.[No workers' j 13.❑Other comp.insurance required.] *Any applicant that checks box 91 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 and their workers'comp.policy information. I am an employer Haat is providing workers'compensation insurance for my employeeL Below is the policy and job site information. .Insurance Company Name: 4g S. V` 4z Policy f#or Self-ins. Lic.#: tJ tt7 C.J G 4 3 Expiration Date: O Q Job Site Address: 'o D 195 0 4,0ze- j_ City/State/Zip- Attach ity/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 certify colder the pains and penalties oerjury that the information provided above is true and.••••� t Sip-nature: Date: �� Q Phone+t: C/ 7:_gfC5_7 Z_ Official use only. Do not write in this area,to be Y city completed b or town o rcial P !T City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk i. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone M TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: 0508084 Project Title: South East Entrance— Building 30 Project Location: 1600 Osgood Street Name of Building: Osgood Landing Nature of Project: Renovation of Entrance&Lobby, New Elevator and Handicap Accessibility. 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 Prefessief� €f@4 eer/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: i Entire Project Architectural )00000(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 PERMIT AND SHALL BE 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 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 state of construction to become, progress and quality of the work and to determine, in general, if the work is penally familiar with the consistent with the construction documents. 9 performed in a manner 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 COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. Signature and Stamp(no facsimile) c�SRFR A��hrT P. No.$baa ti o NORTH ANDOVEA M . SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 2006 �O�TARY PUBLIC MY COMMISSION EXPIRES Notary Public-- iiAy Commission Expires March to,X09 INITIAL CONSTRUCTION CONTROL DOCUMENT (This document is for construction review only. It does not include a design certificate) I PROJECT LOCATION: Osgood Landing- 1600 Osgood Street,North Andover MA NAME OF PROJECT: Southeast entrance modification PROJECT NO: D 1492 SCOPE OF PROJECT: Design of floor modification at new elevator and for new elevator construction I I Robert K. Daigle, P.E. of Daigle Engineers, Inc. submit that our office shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that, generally, the structural work is proceeding in accordance with the construction documents and shall be responsible for the following as specified in Massachusetts State Building Code Section 116.2.2: 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, and complexity of the project, 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. Our office shall submit periodical (after a"periodic" inspection as deemed necessary by the complexity of this project) progress reports,provided the owner notifies our office of when the project has progressed to predetermined stages. At the completion of the construction,we shall submit a final report to the building official. The report shall certify,to the best of our information, knowledge, and belief, that the structural work has been satisfactorily completed in substantial compliance with the intent of the construction documents. We submit this document based on the provision that an occupancy permit will not be issued until a final construction control completion document is submitted to the building official by our office. We shall be released from all construction verification liability for aspects of construction not viewed, if said final affidav' is not received. �rtM Gi!1 Signature: ROBERT KENNETH Massachusetts Registration No. 28583 DAIGLE STRUCTURAL No.2858.3 NOTARY STATEMENT: �4 Subscribed and sworn to before me this day of a Col. Oq fl NOTARY PUBLIC I W ell ag a 00c3- MY COMMISSION EXPIRES ON i D1492 CCA initial 050707.doc j