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HomeMy WebLinkAboutBuilding Permit #825 - 1600 OSGOOD STREET 5/17/2012 BUILDING PERMIT of"°oT"qti TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received � ��SSACHUTED S���y Date Issued: I �� IMPORTANT:Applicant must complete all items on this page LOCATION - / Print PROPERTY.OWNER t9 v (INS T( 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 In Alteration No. of units: Repair, replacement Assessory Bldg Others: Demolition Other Septic - Well Floodplain -' Wetlands " Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFF07MED: eo Identification Please Type or Print Clearly) OWNER: Name:,,'5/7&7/q Phone: 7 Address: CONTRACTOR `Name: �A/76)'C7z� Q� Phone:: _ .Address: f '�f L ! l 0' / /-5� _ r - Supervisor's Construction License a._: _- - Exp. .Qate _ Home IMprovement License w_ a. -_ Exp: Date: _ ARCHITECT/ENGINEER Phone: Address: Reg. 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: $ ag�o- �` FEE: Check No.: r �Cf Receipt No.: NOTE: Persons contracting wit nregistered contractors do not have access to the guaran fund Signature ofAgent/Owrier Signature of contractor` 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 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 i COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments i Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE:DEPARTMENT - Terrip Dumpster.on.site yes. no µ _ `Locatedrat-124 MainStreet 8 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 0 Notified for pickup - Date i 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 r NORTM T0VM Of Andover O No. dover, Mass., 15 LAKE COCHICHEWICK ADRATED `S BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... .... ... ............. .. ......... .................... ...... ............... Foundation .! . ... �......... A M� hasermission to erect............ .................. buildings on p .......... g IQ).d..........4YVIO. ... ... ..............�..�. ...�..�� Rough _ to be occupied as......... Chimney provided that the persona ep mg his 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough f .................................................. Service II BUILDING 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 Det. cubicle connection inc. Estimate 13 Lyman Street Beverly, MA 01915 Date Estimate# 4/10/2012 1077 Name/Address Mentor Networks 1600 Osgood Street North andover,Ma Project Description Qty Rate Total CUBICLE CONNECTIONS INC.To build out est:60 New 21,250.00 21,250.00 workstation according to print provided by deversified.All work to be done during reg business hrs Total $21,250.00 y >=ntv ce Conference Cat Swags - - IWIII Ro m HRI H THR3HR4 HR5 HR& Green= 4 high 86.5 inches IT Stat1orm MW Blue= 3 high 65.5 inches _ Red=2 high 45 Inches — Green Dotted Line-4 high with HR�rI glass at top Lt.Blue Dotted Line 4 2 panels , ♦ , , ,' ,' UP with 2 glass on top Pink=question: 3or4high? HROW Conlarence (0) .............................. ................................... I 1 ........................................ I I I 46 r -- L r---�10 1 it I 1 L---J L---J 1 1 R.Rumpf&Associates,Inc. I Engineering&Architecture Box 4483I 75 North Street 1 Salem,Massachusetts 01976-4483 I i I I I (978)740-5025 (978)740-5026 fax j I consultants: i I 1 I I _ I I ..� �. Job Number. � I rra "�. � Date: � %4 o3121112 I RNo. Date Revision By: I I I _ I I I,.04/19/@ Layout ewl I I I I 1 - I I _ I Is Rccm I pp I I 1 I i ' Hold t F2 � I It Project: - - - - - - ""° Mentor Network z Faculty Office Ex ansion Project I 1 was sl µey , `"" p =W" " - --- pass *2) = _ - - CPh I I F I i 1 I I I "e Osgood Landin ,sem 1 1600 Osgood Street it �' �� North And ver, MA 24'-0 I 24'0'. 24'-0' 24'-0' 1 24`-0' `t 24'-0' 24'-0' 24'0 ��: I 24'-0' 24'-0' 24'-0' 24'0' 24'0 el ed , " e eL I 1 I � I 24'-0' 24'-0 5 - OfFlces I I J K L General Ledger - 2 - Offices Finance - i -0' x 5-9° UJork Stations Y, - S'-0n x 5'-9' U1ork Stations 32 - 42' x 18° Lateral files 2 PnnROOMr/Copier RooPartial Third Floor I - Printer/Cople' Area1 Plan Auwb�y Work Spaces -I - Large Conference Room Locus Plan 1 - Medalm Conference Room Information Technology - 2 - *'-V x W-0' Work Stations I - Small Conference Room (2 Supervisors) I Reeeptlon/Lobby Seale: 2 - Hotel Offices 2 26 x 5'-V Work Stations i - Huddle Room (Old Reception Area) as noted 2 - c,,tol age Closets sort Spaces - I - Break Room - Drawing Number. 6 - storage Cabinets I Break Room/Kitcherlette I- server Room 2 - supply Closets ® m �g o� Human Resources - 6- Offices t - Men's Rest Room ' A1 . 1a.3 8'-0' x i7-V Work Stations i - Ladles Rest Room 2fo__- 8'0° x 5'-9° Work Stations 1 - coat Closet 3rd Floor Locus 1 lan, +its i -Goat closet I - Pnnter/Copier Area .. ...................................... rra 12-009 (01/12) C�PN�� 1RWvq lwtlrui NIapI+lY�rro2 ..................../ 10I 6 .............- il - -)� .......... � .-... . ... OP ID:JP A�ORO° CERTIFICATE OF LIABILITY INSURANCE 705/17/12 TE( YYYY) THIS CERTIFICATE IS 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 SUBROGATION IS 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). CONTACT PRODUCER 978-975-1300 NAME: Segreve&Hall Insur.ASSOC.InC978-975-7596 PHONE FAX 305 North Main St. A/c No Ext): A/C, /C No): Andover,MA 01810 ADDRESS: Lawrence J.Hall PRODUCER CUSTOMER ID#:CUBIC-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Cubicle Connection Inc INSURERA:Arbella Protection Ins.Co. 41360 Sheila Mulcahehy INSURER B:Travelers Ins.Co. 13A Lyman Street INSURER C: Beverly, MA 01915 INSURER D: INSURER E: 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. INSR TYPE OF INSURANCEADDLSUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY 8500052083 07/28/11 07/28/12 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE 7 OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,00 X POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS 1020001211 04/06/12 04/06/13 PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS Underinsured $ 100/30 Uninsured $ 100/30 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,00 A TO BE ISSUED 05/11/12 05/11/13 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE 4786P40A 07/30/11 07/30/12 E.L EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDE D9 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION MENTORN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mentor Networks THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Osgood Landings ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth ofMassachusetts , - - Department oflndustriglAccitlents - Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/ilia Workers'Compensation Insurance Affidavit:Builders/Contractolrs/FIectritcians/Plumbe3rs Applicant Information Please Print Legibly Name(Business/Organization/Iudividual): eQ61CZJ CyN66-27hM - Address: /3 ��/✓r�..� S city/state/zip: 6canz l�z /Ptae . Ml 7fhone M Cl7 9-- a / V Are you an employer?Check the appropriate box: Type ofproject(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full andlor part time)* have Hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.x 7. ❑Remodeling ship and El no employees These sub-contractors have 8, Demolition working forme in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.�]Electrical repairs or additions 3.❑I am a homeowner doing all work right of exemption per MGL 11.❑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. ther CO i comp,insurance required.] 'Any applicant that checks box#1 mustalso fill outthe section be18w showingtheir workers'compensation policy information. 7 Homeowners who submitthis affidavit indicatingthey tie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. lain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name% Policy#or S elf-ins.Mo.#: Expiration Date: rob Site Address; 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 requiredunder Section 25A of MGL c.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 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 maybe forwarded to the Office sof Investigations of the AIA for insurance coverage verification. lido 1 ereby Certl ttnlder ZepainS andpen ItleS per td1 he I OrmatlOnprOVldedab0ve is true anrICOYYBCt 81 ature: Date: Phone#: F[Fc,,_,_-�,_� use only. Do not write in this area,to he completed by city or town official, n:. Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbingInspector son: Phone#: Information and Instructi®n8 ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employeeis defined as"...every person inthe service of anotherunder any contract ofhire,• express or implied,oral or written" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an Individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shalliiot because of such employment be.deemed to bean employer." MGL chapter 152,§2SC(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license orpermit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states`Wolther the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)andphone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers'compensation insurance. Iran LLC or LLP does have employees,a policy is required. 13 e advised that this affidavit may be submitted to the Department of Industrial Accidents for confnmatior►of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers, compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the,affidavit is complete andprinted legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit ii on file for future permits or licenses. Anew affidavit must be filled out each year.%ore a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license orpermit to bum leaves etc)said person is NOTrequired to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone anal fax number: Tho Gorr oawoalt�of 1\4assaolivSptts Depart cut ofInduMal A,ccldoats 9fl�ee o�Iu�estigat�io.� 6W Was gtoa Sixeet Boston,MA,02111 Tel,#617-727,4900 e,406 ox 1-87TMASS.AFB Revised 5-26-05 Fay,#617^727'7749 Location / 'ir/� ✓� (JG` O /f/�/�/ �(J�Q�' Date No. - TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ _ Building/Frame Permit Fee .1 Foundation Permit Fee $ r Other Permit Fee $ TOTAL e Check# 25312 Building Inspector