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Home My WebLink AboutBuilding Permit #676 - 1600 OSGOOD STREET 4/16/2013 ev r,4 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must com Tete all items on this page ,v LOCAT ION'.,1 Print PROPERTYOWNER 0-?Z !;r A4t'�� 7-V `.'' tif'I 4( 2 - GNU q, Print 100 Year Id Structure yes no*. 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 ❑ Septics ❑Well ❑ Floodplain, ❑Wetlands ❑ Watershed District: ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name:SAEt lea- M V eco h Phone:999-- Address:/-? 7&'-Address:/,3 CONTRACTOR Name: & Clta 461461d, Phone 98- Jrs0 Address: 5 fc' �`-?' ?1 rid - Supervisor's Construction License: Exp. Date: Home Improvement License: Exp: Date: ARCHITECT/ENGINEER Phone: i Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ &Old FEE: Check No.03ie?— Receipt No.: ° / NOTE: Persons contracti cnregistered contractors do not have access to t guarantyfund of Agerit/Ovv Signature of co�ntracto . Plans Submitted ❑ ns aived ❑ Certified Plot Plan ❑ Stamped Plans ❑ t 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 ❑ v 1 Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS s HEALTH Reviewed on Signature j COMMENTS I Zoning Board of Appeals: Variance, Petition No: Zoning p Y Decision/receipt t submitted es Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Towp Engineer: Signature: Located 384 Os ood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Departmerit signatUtb/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 Doc.Building Permit Revised 2010 i Building Department The fol(awing is a list of the required forms to be filled out for the appropriate permit to be obtained. l Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application Li Workers Comp Affidavit I o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 Li Building Permit Application } o Certified Surveyed Plot Plan f o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract L3 Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) o Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit d 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 ❑ 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 app;-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 ----- --- � NORTIi Town. of _ : Andover O `° to No. (9110 h ver, Mass, (AiATO' coc"Ic«ewe o RATED U BOARD OF HEALTH Food/Kitchen .PERMIT T LD Septic System THIS CERTIFIES THAT . .. .� .. 444)�'!' ... .......... BUILDING INSPECTOR 041bunclation has permission to erect.......................... buildings on ........A-900....�. .. ... .. ..�- Rough. tobe occupied as ....... G ®........................................................................................ Chimney provided that the person accepting this permit shall in every respect conform to the 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 JD • PERMIT EXPIRES IN64L ELECTRICAL INSPECTOR UNLESS CONSTRUCTRough Service ............. ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SEE REVERSE SIDE 1 A�® ESC CERTIFICATE OF DATE LIABILITY INSURANCE R0°I 04-12/- 20113 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATIONIS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PAYCHEX INSURANCE AGENCY INC PHONEExtl: IA C, (888)443-6112 210705 P: () - F: (888) 443-6112 E-MAIL PO BOX 33015 ADDRESS: SAN ANTONIO TX 78265 INSURER(S)AFFORDING COVERAGE NAIC N INSURER A: Sentinel Ins Co LTD INSURED INSURER B: Twin City Fire Ins Co INSURER C CUBICLE CONNECTIONS INC INSURER D 13A LYMAN ST INSURER E BEVERLY MA 01915 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE /NSR WVD POLICY NUMBER 1MM/DD/YYYY) (MM/OD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 DAM 0 RENTED $ 1 000, 000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) , A CLAIMS-MADE IX] OCCUR MED EXP(Any one person) $ 10, 000 X General Liab 0 1-1 76 SBU IV2443 07/28/2012 07/28/2013 PERSONAL&ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE S 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2, 000, 000 POLICY " JECT ❑LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ IEa accident) BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ❑ ❑ PROPERTY DAMAGE $ HIRED AUTOS NON-OWNED (Per accident) AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _S_1_000_1_0_00_ A EXCESS LIAB CLAIMS-MADE 76 SBU IV2443 07/28/2012 07/28/2013 AGGREGATE $ 1 000, 000 DED X RETENTION $ 10 000__ S WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY X TORY LIMITS ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1, 000, 000 B OFFICER/MEMBER EXCLUDED? N/A 76 WEG EU1185 07/30/2012 07/30/2013 (Mandatory in NH/ E.L.DISEASE-EA EMPLOYE $ 1, 000, 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1, 0 0 0 1_0__o DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remadrs Schedule,if more space is required) Those usual to the Insured' s Operations . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Flight Land Data, Inc . DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD ST AUTHOR/ZED REPRESENTATIVE NORTH ANDOVER, MA 01845 �2, A 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD cubicle connection inc. Estimate 13 Lyman Street Beverly,MA 01915 Date Estimate# 4/12/2013 1083 �> Name/Address Flight Land Data 1600 Osgood Street North Andover Ma. Project Description Qty Rate Total Quote To Remove Conference Table,And Reconfigure 6 1,100.00 1,100.00 Workstations Total $1,100.00 ■MEN O■MM■■■■■■ ■■■ ■O■■wM■■■■OO■ ■■■MO■O■ ■E�■ ■■�■■ �A ■ ■■ ■■■ ■■■Mw■�ME im ■■■■■ No 0 1 IS, ME ■■■ ■ ■�■ ■■■ ■■ - i l ■■■■ ■■■■■ No w■■ O■ 0� ■■■■ ■ ■■■ MEMO■OM ■■■EOE■■O■ �■■■ L. , Milo ;0■ w/�■■■■ MEMO SME■O■ ■�, r _ p ,� ■ ■■■ � ■fit■l� wr ■ ��®MEQ Ew ■ �■ ■■� ■■ ■■ � , /�■® ■■Mr�i� M ��■■� ■■M ■ www ■w■ wwNo M 0 ON ■M■ . �Ea■ww�■w ■ w - Mw MEMO �■ ■Mz, mis 0 sommm mlmmwlmm� M ■■ M�■�w ■ - MINION MEN 0 0 WWI ME rA�■ rM ■w■ra■ �w E®E raw 1 � ■■■www ■wOEM 11MOM MEN IMOMME gig ■■ ■ �■■Mw■wwM■■a ■■ ww■Ew � ■►■■■ ■�■ m 1691, MEN p a ME ciao, fi9ai Moi ` IwOwl/v11■■■■■ ■■■■i�m��■NEI■wiM 3� E - NOME an a Mid= �wME.mom ME IM:■■O■■■LOOM ■■ EE S ■■■■■M■o��0■■Mw■eNO ■�w��■■■■■w■ ��■■M■ww� ■ Simi■Mrs, �� ■■■■■w■ ■��iiE■■wE��EMM■■iNEE■i�1i■EL■ ■wE■w■■ T I ■�■■■ii■ �! ■■O■■ ■E■■■■ Ei■Ori 1 Location-4400 No. c� / Date .2 MORT► TOWN OF NORTH ANDOVER • • Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ 7 s,+cMust 9 - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ s Check # 7612- 2 1 6 3 761221613 Building Inspector Locatior�� i _ �V/f' No. Date • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ kl Other Permit Fee $ ' ��TFA r�4 • TOTAL $ Check 44- 26294 Building Inspector