HomeMy WebLinkAboutBuilding Permit #566 - 1600 OSGOOD STREET 2/27/2007 _ I
I
BUILDING PERMIT of "O pTh
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ~
Permit NO:
Date Received a-7-a7
Ac�
Date Issued: Z 7
�4SSgcausE� r
I
IMPORTANT: Applicant must complete all items on this page
LOCATION &a 262
PROPERTY OWNER ,0-2,7-y 0A w
Print.
MAP NO: PARCEL: ZONING DISTRICT:
,HISTORIC DISTRICT yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑ Two or more family ❑ Industrial
iAlteration No. of units: &,Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Public. C] Sewer' 0 Water0 Flood ,Iain t C 'We#lands ❑ Watershed District
DESCRIPTION OF WORK TO BE PREFORMED:
/`lo I
Identification Please Type or Print Clearly)
OWNER: Name: U Z y �'✓ZOj'hone:
Address: /b/ 00 fSG-ooJ
CONTRACTOR Name: Phone: '97oao6
Address ���
Supervisor's Construction License Exp I]ate
Home Improvement License. Exp Date:`
ARCHITECT/ENGINEER f �S 5 GG I�TrS Phonf �7�
f
Address:_ GAS G_ A ��
' l�� /�.�C/li �%, �j Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
' dv
Total Project Cost: $_ �i 000 FEE: $
Check No.: l Receipt No.: a 0 D 8
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Si nature of A ent/Owner �
g 9 Signature of contractor
Plans Submitted ❑ Plans Waived ❑ __. Certified-Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
i
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Privateseptic tank,etc. ❑ Permanent Dumpster on Site ❑
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
R
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/signature& Date Drive/wav Permit
Located at 384 Osgood Street
FIRE DEPARTMENT - Temp Dumps-ter 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
❑ Notified for pickup - Date
............................................................................................................................................................_..._......_................._. I
J
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be
obtained.
i
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
D Copy of Contract
o Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
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
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
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan
And Hydraulic Calculations (If Applicable)
❑ Copy of Contract
Li Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
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 2.2007
i
NORT►y
Town of 4 over
No.
o A dover, Mass., Z 'Z e $oil
COCKICMEWICK V
Ids RATED Oki? 5
7 BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.........002 - 7....... .... � .....oa............ ► ...�w� . ..........................^ Foundation
has permission to erect............................. ........ buildin son 1�... ... ... A4...... ... Rough
to be occupied as.../.?.:AO.,i. A ..............� ........................................... Chimney
....... ................ ........
provided that the person accepting permit shall in every respect conform to the terms of the appiieation 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
%*' PERMIT EXPIRES IN 6 MO Final
ELECTRICAL INSPECTOR
UNLESS CONSTRU N ?..
Rough
... Service
.. .. .... ...... ..... ..........................
BUILDIN TOR
Final
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 BeDone FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE J1 Smoke Det.
f
TOWN OF NORTH ANDOVER
Construction Control Affidavit
Project Number: 0612112-01
Project Title: KEMMcare Tenant Space— Building 20 -Office Furniture Layout
Project Location: 1600 Osgood Street, Building 20, Second Floor- South Side
Name of Building: Osgood Landing
Nature of Project: Tenant Fit-up. and Office Furniture Layout
In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control
of the Massachusetts State Building Code, I, Gregory Smith Registration No. 8688 being a Registered Pre€essional
Eng4veei,/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning:
Entire Project Architectural X)OOOIX 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 READINESS OF THE PROJECT FOR OCCUPANCY.
nature and Stag �RCy✓
P( a
i ile
n fa RY P.S�y�
r
No.8688
NORTH ANDOVER,
MA.
SUBSCRIBED AND SWORN TO BEFORE ME Y OF_ -� 'UAi2 y 2007
MY COMMISSI �
NO ARY PUBLIC DONNA .WDGE
DRAW weuc
1 commoNwMTH OF 10SUCHusEM
My Comm.Expires Aug.7,2009
` ./IIP. "CJ0�770)R03liUPCY /l. f. ✓!("(L3J(LC1LCCdP. :
a BOARD OF BUILDING REGULATIONS
ION SUPERVISOR
License: CONSTRUCT
Number: CS 026684
i Birthdate: 03/1511957
Expires: 03/1512008 Tr.no: 19922
Restricted: 00.
JOSEPH DOWGIERT.
175 BRADY AVE
SALEM, NH 03079
Commissioner
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
` Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Or��atio n/Individual): f jIV j1�//,'",2' -f- /-r— co
Address: 61k 4 y �0— �✓
City/State/Zip: Phone.#: ` 7969
69 G `�
Are you an employer?Check the appropriate box: . Type of project(required):,
1.[kr am a employer with_' 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers'
co insurance.t' 9. Q Building addition
[No workers'comp,insurance mP•
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doingall work officers have exercised their
11.Q Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL
12.[]Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees.(No workers' 13.[1 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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name: 4 L�O
Policy#or Self-ins.Lic.#: i✓9p �( Expiration Date: /0/2 6 Q
Job Site Address: _o6d S/ 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 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 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
1 do hereby certify under the pains and ► ldes f perjury that the information provided above is true and correct
Si tune: Date: 7i a
Phone#: �
Official use only. Do not write in this area,to be completed by city or town offlclaL
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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or snore
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 shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every"state or4ocal licensing agenq,shall withhold the issuance or
renewal of a license or permit 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"Neither 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or townn 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 and printed 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 permittlicense 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(if necessary)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 is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required 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 and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext.406 or 1-877-MASSAFE
Fax#617=727-7749-- -- _
Revised 11-22-06 www.mass.gov/dia
VAfl0f LVV1 e1.JO rAA IVI0004OA41 m.r.nuntKiO is*uramt IL1UU1
DATE(NIMI NYYY)
ACORQn. CERTIFICATE OF LIABILITY INSURANCE
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
M.P.ROSERTS INSURANCE AGENCY INC- HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1060 dSGOOD STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
NORTH ANDOVER MA 01$45 INSURERS AFFORDING COVERAGE NAiCiil _
978-603-0073 INSURER A. pwVjWWCE MUTUAL FIRE naS CO _
INSURED DOWGIERT CONSTRUCTION CO. , INC.
INSURER 0. —
8 DUNDEE PARK INSURER C: —
ANDOVER, MA 01810 INSURER Dr GUARD I SLiMN-CE GROUP
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY POLICIES
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 CONDRIONS OF SUCH
POLICIES.AGoREGATE LUM SHOWN MAY HAVE BEEN REDUCED BY PAIDCUIIMS. N LIMITS
Ta TYP OLICY
mu POLICY NUMBER DATE QA7E MI00 ... ..EACH OCCURRENCE a 1,000,00L
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY PREMIE S IE•exaneo)_ 3 50 0O
00
CLAIMSMADE I M I OCCUR NIEOEXP(At DV`f�I S 5
CPP0064437 10/26/06 10/26/07 PERSONAL
aADVMIJURY 1 000
000
GENERAL AGGREGATE S 2 OOD OO
PRODUCTS-COMPIOPAGO 3 1 D O DO
GENT_AGGREGATE LIMIT APPLIES PER:
POLICY JME M LOC
AUTOMOBILE LIABILITYCOMBINIED
'SINGLE LIMB a
ANYAUTO
ALLOWNEDAUTOS BOpILY1NJURY 3
(Perparaen)
SCHEDULED AUTOS -
HIRED BOOfLYiNJURY 3
, (Perareleanq _
NON-GAINEDAUT03
PROPERTY JAfltwi)DAMAGE 3
AUTO ONLY.EAACCCENT a
GARAGE LIABILITY
ANYAUTO OTHERTHAN EAACC
AUTOONLY: AGO 3
T
EACH OCCURRENCE s J_
ERCESSNMBRELLA LIABILITY
AGGREGATE
OCCUR C�CLAIMSMADE f
8 _
3 _
DEDUCTIBLE a
RETENTION a R if H
W 0 RKERS COMPENSATION AND
EMPLoYERSLIABILITY E.L.EACH ACCIDENT a 500,000
soy pgopMETgRMARTW_WA9EC1 WE E.L.OIBEASE-EA EMPLOYE a SOO 000
oFswEwMElfaEa EKCwoto DONC703930 10/26/06 10/26/07
D uCYLIMIT s 5 0 Ob
E.L,DISEASE PO O
Hyyee0.49eCrb.uROgt --
SPEC W.PROVISIONS Delve.
OTHER
()ESCRWYION OF OPERATIONS/LOCATIONS/VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIALPROV1310N8
603-8 —0192 CANCELLATION
CERTIFICATE HOLD Rr
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EJU+IRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRfTTEN
OZZY PROPERITE+S NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL
1600 OSGOOD ST IMPOSE NO OBLIGATION OR LIABILITY OF ANY KM UPON THE INSURER ITS AGENTS OR
NORTH ANDOVER, MA 01845 REPRESEAITATWES,
AUTHORIZED REPRESENTATIVE W L pYtVtA3
CORD CORPORATION 1988
ACORD 25(2001/08)
00
Ln EXISTING
nku
ELECT.
P EL
NT- 30' 30' 30'
30' 30' C)
LnT �, NEW OFFICE
1 �' -9 1/4"
95'
IO1-C
30' 30' 30'
30
30'
'
L f) 95' 95' 95'
I �� 30•
12' -1 1/4"
do
d 30' 3°' 30' 00 KE M M ca re =op
30' 30' 1 1
L C) 00 7
�4
95' OPEN OFFICE AREA
30' 200
30' 30' 30'
30' 30' 45' 45' 95' CV
SERIES 9000
OFFICE PARTITIONS =
_ RE-USE EXISTING
95" I AND PROVIDE
NJ J 30' -� ADDITIONAL WHEN
30' 30• 30• REQUIRED. _
30' 30' 95' 95° 95' N -
� � TELE � DATA
PANELS
Ln
45' Ln
G\��REO ARO
Qk. GORY P,
No.8688
NORTH AN M
MA.
EXIST. OFFICE EXIST. OFFICE �
201 202
AI.O
( l
NOTE: ALL POWER CONNECTIONS TO
THE PARTITIONS ARE EXISTING AND
PANELS SHALL BE CONNCTED TO THE
EXISTING POWER AND DATA WHIPS
EnE Lo nm: P:\160 Ng \KEM4acre\11A11d Ply 2-15-2D07-,
project/owner sheettf9s: consuffenrr: erchffiv . , Y7
10
xwR®� KEMMcare Furniture Layout PROPOSED FURNITURE PLAN GSD Associates,LLC
d � � N OSGOOD LANDING 148 Main St.Bldg.A
1600 OSGOOD ST. North Andover,MA 01845
C) N.ANDOVER,MA 01810
NOW Tel:978-688-5422
g�➢ s� •
� f �
Fax:978-688-5717 �
ti
Location
No. Date
MaRTM TOWN OF NORTH ANDOVER
f
Certificate of Occupancy $
s�cNus t� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ ,
Check # l
20011
�� Building Inspector