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HomeMy WebLinkAboutBuilding Permit #538-12 - 1600 OSGOOD STREET 1/10/2012 BUILDING PERMIT of"°RT 6 qti TOWN OF NORTH ANDOVER s•2 �`''` ^ '° ° �j APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Ay �4SSACHUS���� Date Issued: /Z/=O// IMPORTANT:Applicant must complete all items on this page LOCATION c� r Print 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 0 One family 0 Addition ❑Two or more family 0 Industrial R�Alteration No. of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg 0 Others: 0 Demolition ❑ Other 0 Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed District ❑Water/Sewer DEF ORK TO BE PRRME S � tF� j Identification Please Type or Print Clearl OWNER: Name: l o 6 Phone: ,69/ Address: CONTRACTOR Name: IPhone: Address: �s (� Supervisor's Construction License: C 1-f Exp. Date: ti Home Improvement License; Exp. Date: ARCHITECT/ENGINEER Phone: 7g-`? 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: $ q/ Seo FEE: Check No.: K79 7 Receipt No.: 5'FY/ NOTE: Persons contracting it a istgred contractors do not have access to the guaranty fund Signature of Agent/0'h -'" -Sig w qature of contractor f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools El 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 I, CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature I COMMENTS s Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes y Planning Board Decision: Comments � r � Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located_ 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster-on site yes no 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 !,f ❑ Notified for pickup - Date Doc.Building Permit Revised 2009 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 o Building Permit Application a Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract L3 Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application u Certified Surveyed Plot Plan o Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) Li 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) a Building Permit Application o Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract o Mass check Energy Compliance Report o 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:Building Permit Revised 2008 r NORTH Town of 2 Andover .. 0 C o , '� dower, 1Vlass., T Q - LAKE A. COCKICKEWICK V 7� 0RATED � BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System mono BUILDING INSPECTOR THIS CERTIFIES THAT............... .. ... ......... ......... �..: .. �A! Foundation has permission to erect............::.................. .. ... buildin son ..., .....0. ....t. �................. .. ...... Pugh 4 t0 be OCCUp18d as.....�) .y.�.�..G, .. ..... ........ r�.. .�.�. �... . i e .. y .. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in nal 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 30 PERMIT EXPIRES IN 6 MO S ELECTRICAL INSPECTOR U NLESS CONSTRUCTIO Rough Service jib BUILDING INSPECTOR n 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 0K)..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 '/"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. 'A 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" P 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. NORTH Town of No. ,P - y I �/ � --_ o o , dover, Mass., COCHICKEWICK D ARATED p`? C, l S U BOARD OF HEALTH Food/Kitchen PE , , MIT T D Septic System /� BUILDING INSPECTOR Q / THIS CERTIFIES THAT..............v. °'" ' JJ�-..�f............................ ..............�..............................�.............. ................................. Foundation / ars Qs�o i has perm to erect........................................ buildings on ..........................,t....... ......��...................................... Rough to be occupied as.............. ....... ... ........... .. ......... t%C1... f.: f:.... . J.�! ,. ?��t.�!5.................. Chimney provided that the person accepting this 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 S -���SUNLESS CONSVCTIP Rough Service 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. Bumer Street No. SEE REVERSE SIDE Smoke Det. OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER '•�� . '� CONSTRUCTION CONTROL PROJECT NUMBER: • V PROJECT TITLE: PROJECT LOCATION: - VAA NAME OF BUILDING: NATURE OF PROJECT: ze n IN AC RDA CE WITH RTICLE 116 OF THE MASSACHUSETTS STATE BUILIN,jGO E I, REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ENGINEER%ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT 0 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 PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE 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 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 to become, generally familiar with6the 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 FOROCC CY. SUBSCRIBED AND SWORN TO BEFORE ME THIS ��'^ DAY OF So. �d�a NOTARY UC MY COMMISSION EXPIRES y 1 The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations . 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant, Information Please Print Le ibl Name (Business/Organization/individual): C Address:� City/State/Zip: �,�„ c✓rei �° :� Phone#: g �� �� Are you an employer? Check the appropriate box: Type of project(required): i.ll am a employer with 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 � �• ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp. insurance. 9. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work i� exemption right of per MGL 11.❑ Plumbing repairs or additions P myself. [No workers' comp: c. 152, §l(4),and we have no 12.0.Roof repairs..., insurance required.] t employees. [No workers' T3.❑ Other comp.insurance required.] *Any applicant that checks box#1 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 tContractors 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 that isproviding workers'compensation insurance for my employees. Below is the.policy andjob site information. --— Insurance Company Name: 41. ,�ce � Policy#or Self-ins. Lic. #: � �L_�) /& ,q, Expiration Date: 1rQ &.4-L�a Job Site Address: City/State/Zip--yz 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 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.fide violator:-Be advised that a copy of this statement may be forwarded.to the Office of Investigations of the DIA-for insurance cover�g.q verification. I do hereby certify under the pains andpenalties ofpeijury that the information provided above is true and correct- Si awe orrectSignature r'% - - _- r Date: Phone#: Official use only. Do not write in this area,to be completed by city-or town official. City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person:. Phone#: i Massachusetts- Department of Public Safct. Board of Building Regulations and Standards Construction Supervisor License License: CS 48440 sF TADELISZ DOWGIERT 175 BRADY AVE H SALEM, NH 03079 " Expiration: 10/29/2013 commissioner Tr#: 5561 I AC V CERTIFICATE OF LIABILITY INSURANCE (( " .1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE I10L.1 ER. TH!1! CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THS= POLJ'A !i BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), Al"THORI;!I! I 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,witlject br, the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confe I'6g°!4s to fl' certificate holder in lieu of such endomement(s). PRODUCER CONTACT NAME: M P ROBERTS INS AGCY INC PHONE f r 3:: "i:I.4 7 ac No E#1: (978) 683-8073 ;yC,Ne);, ••._ .. 10:60 Osgood Street E IL - ADDRESS: North Andover MA 01845 � INSURER(S) AFFORDING COVERAGE AIC+.' _ INSURER A:MERCHANTS INSURANCY, INSURED DOWGIERT CONSTRUCTION CO. , INC. INSURER B,GUARD INSURANCE 175 BRADY AVENUE INSURER c: INSURER D: _...__........... .. SALEM, NH 03079 INSURER E INSURER F COVERAGES CERTIFICATE NIINIBER: REVISION 1:10K'IBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABC,IF: 1 OR THI" '( 'f' iIOC� INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RF,,PECT I 'I I TI'S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SJEIJFC:T TO l 13 171 ;W'11 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIG:CLAIMq. ' 1_­­__­. INSR TYPE OF INSURANCE �LIEI A017-SNR POLICY EFF POLICY-EXP LTR INSR VVVD POLICY NUMBER MM/DD MMIDDIYYW ,,,,•,,, ,,,_,.,,,,,, „ ., ,.. _,..,.—,....__...� GENERAL LIABILITY EACH OCCUIRaN�:.Ftiillll;j 111 F) ...... ._ _ . X COMMERCIAL GENERAL LIABILITY PREMISES E:: ncovrence) I_ - .( CLAIMS-MADE �OCCUR MED EXP(Arq qn arson) 3: 1..i](t I,j A 03/23/11 03/23/12 PERSONAL&IEV 'd.IURY I CMP9151606 _.... .._—_.... ._ . _ _.._... . GENERAL At!:3_RE_-SATE , 1(.'I), l,l(li.i GEN'L AGGREGATE LIMIT APPLIES PER: II;I� „I►[►I"I_ PRODUCTS-::_OAA'!OP AG:. t POLICY PRO- JECT LOC - _.. ... _. I;It311`TiRfff110 Ci AUTOMOBILE LIABILITY Ea accident _ �, _...!....._._...:._ ANYAUTO 03/31/11 03/31/12 BODILY INJUf;f(I' persar - CAPI054894 ALL OWNED SCHEDULED BODILY INJUI1'r(P--accidt, '6 A AUTOS X AUTOS PROPERTY['riTAh"1'—_ ... .6 .. .. _..— X HIRED AUTOS X AUTOSWNED Par accident X UMBRELLA (_IAB ]( OCCUR Ef,CH'OCCIl'?REIlCE�.,, CUA D142034 03/23/11 103/23/12 -- — A EXCESS LIAB CLAIMS MADE AGGREGATE. --^ E _..,�..,.__.._._._.. DED RETENTION$ WC TP U" 0I' — WORKERS COMPENSATION I TRY LIhIIhS -JJ.. AND EMPLOYERS'LIABILITY YINDOWC229277 10/26/11 10/25/12 E.L.EACH AC IDE 1F 9 ANY PROPRIETORMARTNERlEXECUTIVE ❑ NIA B 'OFFICERIMEMBER EXCLUDED? -`'tI•� ` {Mandatory In NH) E.L.DISEASE L•7.EMP(C If yes,describe under — pESCR!PTION OF OPERATIONS balow E.L.DISEASE ,ICV Lliv i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) - THE( CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS PER THE TE11M.> OF lE I R:I;T':i'T,1si CONTRACT AND AS PER THEIR INTEREST IN THE INSURED'S OPERATIONS. PRIMARY AND NON-CONTRIBUTORY WORDING.APPLIES CERTIFICATE HOLDER CANCELLATION . •• :- — - �' OZZY PROPERTIES INC,DUNVEE OFFICE SHOULD ANY OF THE ABOVE DESCRIBEC PO (CIES ':41 C ,I .L,l) FT:r(Di;1E PARK LLC,1600 OSGOOD ST LLC, THE EXPIRATION DATE THEREOF, W,iTIC':E WI!-i ACCOPD.M!CE IAMH THE POLICY PROVISII:IN'.S. i HERITAGE PLACE LLC,::10�tCn'YQ LP,21 HOWE ST LP,C/O OZZY PRc;'M'SRTIES AUTHORIZED REPRESENTATIVF 1600 OSGOOD STREET p ! F 1' ''s'' OVER01845 NORTH AND , MA ©1988-2010 ACORD CORP OR, TIC i I ;; F e> !rvI:`d. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD Location No. 3 /2 Date NORTh TOWN OF NORTH ANDOVER 3? • O O L F R 9 i Certificate of Occupancy $ cMusE�� Building/Frame Permit Fee $ Foundation Permit Fee $ ; Other Permit Fee $ TOTAL $ Check # z 24951 ,I' INuilding Inspector