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Home My WebLink AboutBuilding Permit #335 - 1600 OSGOOD STREET 10/26/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Tint C PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: D Identification PI se T e or Print Clearl ) OWNER: Name: Phone: 97Zy 7s—y. � Address: 16oC D CONTRACTOR Name: �- '-e Phone; Address: Supervisor's Construction License: 1FR0 Lr—) Exp. Date: /f '' ••t Home Improvement License: Exp. Date: ARCHITECT/ENGINEER f ti C. _ hone: ?2,5- Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED 0125.00 PER S.F. Total Project Cost: $ 1 c) ,o �0 FEE: $ �� Check No.: F0,C Receipt No.: , -Z � NOTE: Persons contractin a registered contractors do not have access to the guaranty fund c Signature of Agent/Ow Signature-of contractor 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 DPW Town Engineer: Signature: Lo d 384 Osgood Street FIRE DEPARTMENT -Temp Dumpstpon ite yno Located at 124 Main Street Fire Department signature/date 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 l__....__........----..........................._..._..__..._.._..._—._...__........_._..._..__ -.....---..._...................._..---................._... ...._........._ ..........................----........... _......... --.._.. –._ Doc:.Building Permit Revised 2008 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: Doc.Building Permit Revised 2008 WORTH ;t ovm Of : over . No.3 oo dover, Mass., - � COC MICA WICK y1. AERATED PPS` -`� `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.. .Lz. .... .2�G�.. ..... ............ .. . .. ._...�. ...... . /{ ,�1` """""' " ` Fo ation has ermission to erect.............................. A..6 . ...... _�C .... .. ........... . ... .� h p .......... buildings on ...... to be occU ed as .. . .....1............C/:......................................................................... Chimney i p provided that the person accepting this permit shall in every respect co form 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 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 CONSTRUCTION STARTS Rough �Bui7ur ..................... Service ............... G 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 DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Uet. DWY ACM) 5' R CERTIFICATE QF LIABILITY INSURANCE °�'�'MA12610 so s o9 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION M.P. Roberts Insurance Agency ONLY,C% b CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 1060 Osgood Street ALTER T.FIE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, MA 01845 INSURERS,AFFORDING COVERAGE NAIL# INSURED INSURERA: VtoyI dente Mutual DOWGIERT CONSTRUCTION CO. , INC INSURERS: 61ard Insurance 616 ESSEX STREET INSURER C: LAWRENCE, MA 01841 INSURER D: INSURERS . 4 COVERAGES THE POLICESOF INSURANCE USTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED 4BOVE FOR THE POUCY PERIOD INDICATED.NOMNITHSTANDIN3 ANY REQUIREMENT,TERM OR CONDITION OF ANY COMPACT OR OTHER DOCUMENT Wh•H RESPECT TO WHICH THIS CERTIFICATE MNY OE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED 13Y THE POLICIES DESCRIBED HEREIN IS SUBJEI;T TO Ali,THE:TERMS.MCCLUSIONS AND CONDITIONS OF SUCH PC L CIFA AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN POLICY NUMBER �� POLICY E7IWRl►1RNd LIMITS GENERALLIANLITY HOCCU ENCE a 1,,000 000 X COMuIERCALGENE RAL LIASIUTY o OETORENTEO a 100 000 .E�.g.E918LD1SdrDIl1T �......�. CWIMB MADE MX OCCUR acD EW"Ore emm a 5,000 A CPP0064437 10/26/09 10/26/10 PERSONALaADVINIURY a 1,000 000 GENERAL Aqq tgATt S 2,000,000 GENI.AOGREGATEI.MITAPPLRESPER PRODUCTS-COMP/OPAGG $ _2,000 000 POLICY Pte' I.00 AUTOMOBILE UAEI UTY E ANYAUTO COMBINED BIN(R,ELIMIT S e NCddarl) ALLOWNEOAUTOS BOOILYINIURY a SCHEDULED AUTOS (Per person) HIREDAUTOS BODILY INJURY S NON-OWNED AUTOS (P er accidem) PROPERTY DAMAGE _ (Pat*wJdDM) OARAOEWBIUTY AUTO ONLY-EA ACCIDENT S ANY AUTO _ OTHERTHAN EA Ate S AUTO ONLY; AGG a EXCESS I UMBRELLA LIABILITY EACNOCCURRENCE a OCCUR _CLAMS MADE AGGREGATE DEDUCTIBLE s a WORKERS COMPENSATION STA OTH- AND EMPLOYERS'LIABILITY B ANYPROPRI Zm ARTNEwE)MTIvE YIN DOWC911544 10/26/OSI 10/26/10 E.L.FACNAconEw a 1,000,000 OFACERm(EMBf32E71CLUDED9 _1 04am4iminNMI E.L.DISEASE.EAEMFLOYE S 1,000,000 ISx-d ROV ONS below EL DISEASE•PO CYLMIT S 1,000,000 OTHER DESCRIPTION OF oPERmoN8/LOCATIONS I VO4CLES/EXCLUSIONS ADDED BY eNDORSEMENT I SPECIAL PRCH4910NS CERTIFICATE BOLDER CANCEL TION SHOULD ANY OFTMAEIOVE DESCRIOEOPOUCM3 BECANCELLEDBEFORE THEE)MpAnoN DATE THERMP,THE ISSUING INSURER WILL ENDEAVOR TO MAIL iO DAYS WRITTEN C/O OSGOOD STREET LLC NOTICE TO7►E CERTIFICATE HOLDER NAMED TO THE LEFT,OUT FAILURE TO oD SO SMALL C/0 02 SG ODSTEETPROPERTIES, INC. IMPOSE NO 149LIGATION OR LIABILITY OF ANY KIND(MON THE INSURER,ITS AGENTS OR 1600 OSGOOD STREET REPREsENrl eves, NORTH ANDOVER, MA 01845 AU-7W—O tXD ''sPRESENTATNE / f ACORD 25(2009/01) 4D 7988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registarecl marks of ACORD The Commonwealth of Massachusetts k j )�1A F Department of Industrial Accidents Office of Investigations 600 N ashinaton Street Boston, MA 02111 www_mass gov/dia . Workers' Compensation Iasitrance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Leaibl Nanle (BusinessloTw.ization/Individual):�, c Address: City/StateJZip: Phone#: . Are yo an employer?Check-the appropriate box: -- I.5 Imam a employer with O' 4. Type of proled(required): _�-/ ❑ I am a genera!contractor and 1 L (full and/or part-time).* have hired the sub-contractors 6 ❑Naw construction 2.❑ I am.a.sole proprietor or partner_ listed on the attached sheet: ?• [D-Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity, workers' comp.insurance. [No workers'comp. insurance 5. 9• ❑Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I air a homeowner doing all work right of exemption per MGL 1 I.Q PIumbing repairs or additions myself.[No-workers'comp, c. 152, §1(4),and we have no insurance required.]t 12.0 Roof repairs �1 ] .employees. [No woriCers' comp. insurance required.] 13.M Other *AnY applicant that checks boz if l must also fill out the section below showing theirworkets'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work end then hire outside commcton trust submit a new affidavit indicating such. ;Contractors that check this box frust�ol!ed an addition al sheet showhV the name of't;e sub-const etots and their wotkm, ,__ p-affidavit it:�indicating such. mae 1 am an employer that is pr?rWWg:workers'compensation insurance for tM employee.L Below is the policy and job ZZ site information Insurance Company Name: Policy#or Self--ins. Lie.#: Expiration Dater 07� Sob Site Address-__zQ � City/State/Zip: �-�/ compensation policy declar Attach a copy of the workers' ation page(Showing the policy number and expiration date) Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the farm 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 cerci r the pains and penalties of perjury that the information provided above ' twee and correct Si Phone#: 7 PS` 114-- E7iaOnly. Do not write in this area,to be conrleted by city or town of ciaL n: Permit/License# ority(circle one): ealth ?Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plambing Inspectoron: Phone#: Sep 08 09 04: 24p NORTH ANDOVER 9786889542 p. 1 "h•'` OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER ,;•;,, ,r CONSTRUCTION CONTROL PROJECT NUMBER:. D O PROJECT TITLE: ari., PROJECT LOCATION: I O NAME OF BUILDING: NATURE OF PROJECT: V Cf S IN OR ANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUII PG COD . I' �L1�e/'tMcv-t REGISTRATION NO. M BEING A REGISTERED PROFESSIONAL.ENGINEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS.'CONCERNING: ENTIRE PROJECTY ARCHITECTURAL STRUCTURAL 0 MECHANICAL 0 FIRE PROTECTION 0 ELECTRICAL 0 OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MAPLANS, SSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. . AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. FURTHER CERTIFY EPR THAT I SHALL PERFORM THE NECESSARY PROF ESENT ON THE CON PROFESSIONAL SERVICES E TR S CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE T THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings,samples and other submittals Mich 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 to become,generally familiar with5the 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. PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL,REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FO . PANCY. SUBSCRIBED AND SWORN TO BEFORE ME THIS ao , URE DAY OF U � �kCoq - NO RY PUBLIC MY COMMISSION EXPIRES 2616�.-. Massachusetts-Department of Public Safety vo Board of Building Re�-ulations and Standards Construction Supervisor License License: CS 48040 si Restricted o:.,.00 TADEUSZ DOWGIEERT 175 BRADY AVE R% , SALEM NR 03079 Expiration: 10/29(2011 t't,tnnt. iinc•r Tr#: 6839 1 Location �� D � � 30 No. Date NORTH TOWN OF NORTH ANDOVER f w A • ; , Certificate of Occupancy $ J�CMusttBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ p TOTAL $ Check # D 004 2256E A Building Inspector