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HomeMy WebLinkAboutBuilding Permit #819 - 1600 OSGOOD STREET 6/20/2006 OE NORTH F n TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �SSACHuSet Permit NO: D ceive J Date Issued: SW IMPORTANT: Applicant must comple all items ohqllis pag LOCATION r0 � % ® .� 2-6_2 Print ,O PROPERTY OWNER J- v Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential E New Building ❑ One family 11 Addition ❑ Two or more family ❑ Industrial LL Alteration No. of units: Repair, replacement ❑ Assessory Bldg ❑Commercial G Demolition E Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMEDIt y ` L-7 " e d- 0,/' o _o � Identification Please Type or Print Clearly) OWNER: Name: hone: 7SS� Address: A G CONTRACTOR Name: Phone: 25- Address:Address: �✓ Supervisor's Construction License:_ `! Exp. Date: t10 f Home Improvement License: Exp. Date: ARCHITECT/ENGINEER �� S S� Name: Phone: Z / Address:�� �� �� T �1 r� Wig. No. FEE SCHEDULE:BULDING PERMIT.$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ Z S� x10.00=FEE:$ Check No.: (0 Receipt No.: � Page Iof4 TYPE OF SEWARGE DISPOSAL �j Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ LJ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ Permanent Dumpster on Site ElPrivate(septic tank,etc. Electric Meter location to project NOTE: Persons contracting n e on ct rs do not have access to the guaranty fund Signature of A ent/Owner � � Signature of Contractor Plans Submitted ❑ Plans Waived ❑ e ified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Temp Dumpster on site yes no Fire Department signature/date Building Permit Approved and Issued by: Pan 2 of a 1 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: No'rES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:13PFORM05 Created 1MC.Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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 Dor.INSPECTIONAL SERVICES DF.PARTME\TMFORh105 Page 4 of 4 Location F--T Qo LZ " 1 60o OSi©od. 4ZO No. _ r Date i ^,M TOWN OF NORTH ANDOVER + Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s�cHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ' Check # +' Building Inspector Location f r3 ' -a� No. �� S' Date `7/ �oRTM TOWN OF NORTH ANDOVER # Certificate of Occupancy $ 14 ��s'•^°^E<� Building/Frame Permit Fee $ ncMus Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # t 19639 .. .. _ Building Inspector pOWTN SSACM�t CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 819 (6/20/2006) Date: September 15; 2006 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood Street Blgd 420, MAY BE OCCUPIED A Commercial Tenant Fit Un - E-Trolz ' IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: OZgy Properties 1600 Osgood Street North Andover MA 01845 Building Inspector Town of 4Andover _ I" No. oo vz-- ti� o dower, Mass., ' ZO . O G AK COCMICME WICK AD'9A-rE D 's BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �tBUILDING INSPECTOR THIS CERTIFIES THAT..6,-.orn Z........1(�i0.....�ao l.......T.� ...... 1 ..0 Foundation ,? has permission to erect. .............. buildings on ...01.11.7... o.0 ....... ....... .....l........................ Rough "00 tobe occupied as......... ................ ...1............40 0.. . . ....✓ .....'................................................................................. Chimney thprovided that the perso accepting this permit shall in every respect conform to the terms of the application on file in is office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR �D UNLESS CONSTRUC.Rft STARTS j �Rough_�` ......... .......... ................ ... ce G INSPECTO i' Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. s i (� TOWN OF NORTH ANDOVER Final Design Affidavit Project Number: 0602011 Project Title: E-Trolz Project Location 1600 Osgood St. 2nd floor—south wing Name of Building: 1600 Osgood St. —Osgood Landing Nature of Project: Tenant Fit-up for Office space. In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory P. Smith Registration No. 8688 being a Registered PFOfessienal EngineeF/Architect, HEREBY CERTIFY that I have prepared or directly.supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural X)00( 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 HAVE PERFORMED THE NECESSARY PROFESSIONAL SERVICES AND EITHER MY REPRESENTATIVE OR I HAVE BEEN PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK HAS PROCEEDED IN ACCORDANCE WITH THE DOCUMENTS SUBMITTED FOR THE BUILDING PERMIT, AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN 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 state of construction 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. I AM SUBMITTING THIS FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. Subject to the completion of items listed in observation report, 8-29-2006. See attached observation report. Signature and Stamp (no facsimile) S��FIED Aq� �.ease ti o NORTH APIpOVER, Mk q�7Y OF SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 2006 MY COMMISSION EXPIRES 61710 7 NO RY PUB C / � MARY LEAKY-IPPOLITO * Notary Public Common;wQoith of Massachusetts My Ccmmission Expires k ne 7,2007 GSD Associates, LLC iI:1:'i!!.�. .•�-._..'..I�:I!!!,iIII''...............,...C�....,..�!E,,A3i1iCi1II(i✓��./.J12t�'.��C.-/(...y;s/,i1tii,ii 11;fEt1t;i11 �!.I�_.`...llI..-.._(.l......rd.-.._..;�-1t1It31i7Fk,€�!i1'1!1tifk L._...._...'l�/..�8J►+1t':Et1t1i111tifFi�r_..�._...'.__..i.-3I11it!:1tt�/€fFII!I�I ..�/�.-..v+,..`vt�.7...�..�.+�f��':Ge�'..-,r..L...�.�.::III:i.L..r.......l�....••I:IF:�.../i._. ...._�1....48IIIIItII c_r...Main a1IIIi.�n......�.S..� t.�refet `F.,.cBuilding ut�".:I���-il.vdte' -in.Y�':I�rg..7..s�. .__....cyrA.i- , . N.,•.../.i.`o�'_k_�."!11EYtE1j3!ti�1 r r•_.ie.t..�h..'._...'f.Andover �1Yiititit1i,�1iI�eE n..Pd.-.._._..�..o....-;..ii,i1IItiEiI!1tt E .v�...,_...er...�i.IiIIIt�I;ittI!IkI M .TA...r..._... t�t0�::' 1..�...�8✓4 �5 Tel: 978 688 5422 Fax: 978 688 5717 Web: www.gsd-assoc.com Computer Aided Design • Architecture • Planning • Interiors • Development Consulting ? bC TO: DATE: ]OB NAME AND #: T � Z TIME START: TEMP: 70� WEATHER: Ztry I LOCATION: IV 00 CS ~Cc V) S7 P 2 v 2 "'j 3 TIME END: jj SITE OBSERVATION/PRGJEC-T-MEETIi4G-REPO# i2aTC-, A)6 //J S7Ae;t61) �Di� ` h ofile r � c4 46 7 Tf .-I E .... I . 1 : i I .. .More Z_ _.�..... - _! ...... _. .. 1 ...... ... t ......A ... .. .. I , 1 1 3 1 t 1 t i t I 1 1 E. 1..... ...t .. _] ......i..... ..:. ...... .._. _. _. .I... ......._I... ..........t ...1._._. i ...!. k x 3 1 � A k 3 I f 3 t Recorded By Reviewed by Page No: F NpRTH Town 0 . 4Andover 0 No. j520 o ;= dover, Mass., 2-5: COCHICMEWICK y�' ADRATED PPS\ � `r BOARD OF HEALTH ' Food/Kitchen PERMIT T D Septic System . BUILDING INSPECTOR THIS CERTIFIES THAT.. f/.. .....x".40.4................................................................. ...................... Foundation 1 has permission to erect.- �1�rN�.. buildings on ....../ .. ............. ........S. !.4 Rough t Chimney to be occupied as...a t.i<.*w..................... .. .,�f. .... �...... y provided that the person accepting this permit shall in eve respect conform to te2 rms ofthe a icatifn on file in P P P g P every P PP 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. 3 5� 17' PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations aids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU ARTS ELECTRICAL INSPECTOR Rough .. ............ .... ...... ........................... ... Service BUILDING INS 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. GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip- Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations '/2"air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min.22x30 w/3'headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. %of required glazing shall be openable. Bedrooms required min.20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber- Finish Smooth parging, clean joints, 8"solid @ combust. DECKS: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8' above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure. TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: 0602011 Project Title: E-TROLZ —Tenant Fit-up Project Location: 1600 Osgood Street, Building 20, 2nd Floor South Corridor Name of Building: Osgood Landing Nature of Project: Tenant Fit-up of office space. In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory P. Smith, AIA Registration No. 8688 being a Registered PFefessienal /Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural _XXXX_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 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 state of construction 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. 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 REA HE PROJECT FOR OCCUPANCY. AR�'�'T Signature and Sta (no facsimile) Q�, GaaYP•s�i,��o� No.8688 ti 3 NORTH OVER, gS c �7j� SUBSCRIB DAN SWOR T EFORE ME THIS DAY OF "�lflV� 2006 MY COMMISSION EXPIRES /0/zz NOTARY �LI {( l DOWGIERT CONSTRUCTION CO. INC. 616 ESSEX STREET LAWRENCE, MA 01840 978 685-0306 fax 978 685-1290 CONTRACT Customer Name 1600 Osgood Street-LLC Ozzy Property Mgmt Date 5/26/2006 Address 1600 Osgood St Job Loc City N. Andover State MA ZIP 01845 Job Name E-Trolz Phone y Description Unit Price TOTAL Supply necessary material and labor and frame out offices with metal studs as per preliminary plan by GSD on 5/02/06. Supply and install electrical service and interior wiring (Ozzy Standard). Supply and install 2x4 parabolic lighting in suspended ceiling areas. Supply and install duct distribution system using existing units. Install 5/8" drywall.Tape and sand to smooth finish. Install doors as per plan(ozzy standard). Adjust and install sprinkler heads as per layout. Install fire alarm and exit signs as needed. Paint new walls and wood work. Install carpets and covebase(ozzy standard*colors picked by others).Ozzy allowance$12 per sq yard installed. 1 Total Material and Labor $70,888.00 Price does not include architectural or engineering costs, data,telephone wiring, equipment or SubTotal furniture installation. Price does not include Shipping&Handling anti-static file and will be priced seperately depending on ch o en tiles. TOTAL $70,888.00 Nov 08 05 09:30a 6038900192 P. 1 FROM :ROBERTS I WAAqNm FAX NO. :9786833147 Nov. 08 2005 10:44AM P2/1 AQ�tl� CERTIFICATE OF LIABILITY INSURANCE 2 00 11/8 005 MS CERTWWATE 19 MUED AS A MATTER OF MIFORMATION H-P. RpHLRTS rus. Amey, SNC. ONLY AND CONFERS NO RIGHTS UPON THE CERT F=TE 1060 0srA= STREET HOLDER THIS CERW)FICATP- DOER NOT AMEND, EXTEND OR NOM AtiDOR/>eR, 10 01895 ALTER THE COVERAGE AFFORDED BY THE POUCRDf BELOW. 978-683-8073 _ INSURERS AFFORDING COVERAGE NNCN frsuREo DMrERT C(NSTRUCTICK COMANY WC. IMSURtlilp 1lSS)s]C CE - --- ---- INsunF.R a; 175 BRAD? AVE "SDRER C: MUM, WH 03079 smRER U. GtTARD iis—uiigiN i COVERAGES THE POL(GES OF INSURANCE OSTEO 8ELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTYY MTANDL40 ANY MAY PERTAIN�THE'NSURANC E AFFTERM OR ORDED BAY ANY POLICIES DESCRIBED HER SUBJNTRACT OR OTHER DocuMENT ECT RESPECT LTHE RM.EXCLUSIONS�CO!Y13E WVEID OR MWN.S OF SUCH POLICIES.AOGREGATEILOMS_H_O_W NMAYMAVEBEEN REOUCEDBYPAW CLAN& L POLICY NIIkOER ROY T 1 LIMITS --— GGNERAL LUleam eAC"OCCUNtENCt • 1,000,000 X COAAMENCULL OEN RAL LIABILITY TO csasEs�E. _._000.wc.) s 000 txAIMSMADE OCCUR ►aOEXP(MywwWw) ! A 3CP3616 NIE10/26/05 10/26/06 PERswm#ADvwuR,r (ii®IGNAL ArQREGATE s 000 000 GrWL ArcREPATE Ls r APPLES PES PRODUCTS-COfa9pP AGL: S1,000,000 POLICYf—1 LOG AwOmosu wiry ANVAUTO ! ALL OWNWAUTOO BDDILYINJURY 6CWEDVLEAAUfOS (Pwpwn : HULEDAUTOS WX4AV EDAUTOS pODILY1NAM ! (Par�adOml) _.... PROPERTY DAMAGE f (ParraddeNi GARAGE LLApII/TV AUTOOWLV-EAACCIDENT t ANVAUTO •—`--- --.... OYWRTTIAN EAACC S AUTOONLY. AGO S IMLCE6tSAlLIBRELUI LUtaLIrY EA M OCCURRENCE ! OCCUR LJ GAMLSMADE AMRFOXIE i OEDUCTWE i R>�iNTION t i W DR%ENSCaMPENSATtONAND ETLPLOYERS UmLITY TDRI!}/AK[8_ a =2=42w— rE cNAwoENr t . ..500.000 DOMCGO0548 10/26/05 10/26/06 ELEA D eX�LwmT ..� Ifrsw dmauwldw EL DISEASE-EA WKOV4 S 500,000 SPECML OMou OT►rEN E.L 013EA6f.•Paum umir s so Q D;)0 DEICRPTgNdPOPERAIWNSILOCAT►ONSr VFIIId.6gr EXCLUSIONS ADOEDBY EN00RSEMENi r SPCCNLPf1ov1510N9 2 CERTIFNCALTE HOLDER CANCELLATION 088Y PROPERTIES, LLC. SHOULD ANY OF THE MOW OESCRIMEO POLICES K Up^MLI.W IKF(=TWE EX MyloN 8 DUMZZ PAM DATE TNEAEOF-THE LMIWG WJSUBER VYLLL ENDEAVOR TO Lim 10 DAYS vllre nm ANDOVER MA 01810 NOTIC[TO THE CERMICATE WOLOER NAMED TO THE LEFT.pW FALUWt 10 UO SO SHALL OWPOSE NO OULrGATION OR U MILITY OF ANY KOLA UPON TiE KSUREN.I'rS ADEWTb OR REPPIWAT"E A TAT ACOR025(2001I88) V ACORO CORPORATioN ism — �ie �omzm:a7uae ULPM 8OARd OF' BUILDING R JCONSTRUCTION'SURERVISOR. License: 048040 Rumber• CS µy 1012g1i955 '' Birthdate. Tr:no: $053:0 �' moires;1012912007 Restricted: 00 TADEUSZ DOWGIEERT 175 BRADY AVE SALEM, NH 0307 9 Co�toner 1 ------.._..------- Depernnent of Indast"Accidents Offla of Innsd9ago" 600 Waslninpon Sinai DONO14 M4 02111 www MaUaov/dW Workers'Compensation Insurance AMdavit: Builders/ContractorslElectrldane/Plumber: ADDUcant]Information Please P Name(Buainesalorgurizatia®/Iaaiviauai): oy Q Address: City/State/Zip: _ Phone#- g Are y employer?Check the appropriate boz: Type of project(required): I.nl am it employa with �-5— 4• ❑ I am a genal contractor and I cnployees(fbU and/or part-time).* have hind the cab-contractors 6• ❑New coaatrutction 2.❑ I am a sole pmprietor or partner- listed on the alldied sheet.t 7• ❑ Remodeling ship and have no employees These sub-contractor bwe 8. ❑ Demolition working for me in any capacity. WORM'COUP.insuuance. 9. ❑ Building adilition [No worker'comp.insurance 5. ❑ Weare a corporation and its rewind,] otTioer have ecercised their 10.0 Electrical repairs or additions 3.❑ 1 am a bomeowner doing all work >i&of exemption per MGL 11-❑ Plumbing repairs or additions mrysel£[No workers' comp. C. 152,)1(4),and we have no 12.[]Roof repass insurance required.]t employ [No workers' camp.insurance required.] 13*.[3 Other •Any applicant tba cbecb boat#1 mutt dao MI out 6e aectiao bdowr Aawiog itch w=b n-pompe Udw polity inhunsdon; t Honwwnos who sdua this it8dsvit iodwaiea dwy are doiaa d1 w wk cad then hire astide coattr 0MU Moet submit a mw aMnk amficating smk tcont wk=that cbeck this boat mat attaebw an additional sheet dhows the mum of Sm ob•eormama and thdr Worms •comps.tdb9 infornneion. I arm an emygoyer that Is prot►ldIng>w*en eompenseden knurence for�'tarptoyees: aslow b the pallq►awii,fob ate hrjont�lia� Insurance Company Name: _ v Policy#or Self-ins.Lie.#: Expiration Date: o job Site Address: City/State2ip: v!�✓ Attach a copy of the workers'compensation poft dedaradon pap(shows the �i policy somber and espiratioe elate). Failure to sewn coverage as 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-yearThpisonment,as well as civil penalties in the form of s STOIC WORK ORDER and a fine of up to$250.00 a day against die violator- Be advised that a copy of this statement may be forwarded to the Oilgice of Investigations of the DIA for insurance coverage virificatim I do hereby nen*under the paths and peeabtes ojpe*uy tl int tors la anwdlost _ provldtd above tr iniac ctrl cwrect: PheUt s: — 2 Offleld use only- Do nog write to this area,to be cocap/eted by CIO or town alkIaL City or Town: Termif/Ijcls>se g Issuing Authority(drde one): 1.Board of Health 2.Building Department I CKy/rown Clerk 4.Electrical Inspector S.Tlnmbing Iospeactor 6.Other Contact Tenon: Phan M: The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P.0.Box 1025 State Road,Stow,MA 01775 PERMIT Date: 'F s�� North Andover permit No Dig Safe Number —(City of Town) (If Applicable) In accordance with the provisions of M.G-L1/4 8 Chapm*14_as provided in motion 5 2 7 ('.M R 34 Start Date This Permit is granted to: I/ Full name of person,Finn or Corporation Pernissionto locate dumpster for construction/renovation/demolition of building Comments: dumpster must be 25' from structure if unable to place with required Restrictions:clearance dumpster must be covered with plywood or tarp end of work day at (Give location by street and no.,or describe in such manner as to provted adequate identification of location) FeePaids 50.00 �� 1/�i ,--- Fire Chief This Permit will expire (Signature of of6cal granting permit) Offical granting permit (Title) mmm*' T141Q PERMIT Mt ICT RF r-nrjCPirl inn ICI V Pt1CTt=n I tPntJ Tt41= PRt=MICf✓C �� r10RTiy Town of Andover V" No. _ dover, Mass., _6 T O LAKE �1 COCHICHEWICK 7,4 RATED S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... �.��d�.�..........I&�.....avad ...l........ .....la*/...... � Foundation has permission to erect........................................ buildings on....Q.Z.3.7... .............................. Rough to be occupied as......Jitziizo ...... �.. .. �....•................................................................................. Chimney provided that the perthis permit 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 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 b MONTHS ELECTRICAL INSPECTOR 1D UNLESS CONSTRU S TARTS, Rough - ' service ......... .......... ................. . ... .............. G INSPECTO Final j 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.