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HomeMy WebLinkAboutBuilding Permit #634-12 - 1600 OSGOOD STREET 3/5/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 'lam Date Received I Date Issued: 2— EMTORTANT:Applicant must complete all items on this page i LOCATION { Print PROPERTY OWNER 1 D aa� I nit# Print MAP N0: PARCEL: ZONING DISTRICT: Historic District yes 6no Machine Shop Village yes 100 year-old structure yes 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 ElAssessory Bldg ❑ Others: ❑ Demolition ❑Other ' .0 V`4 ` g �: o`"od"lain VJ,e lands ; #" fmWa_'shea stnct 1` S�pti� ❑Well y �{ ry ' ++-- �} f # } ` ,}f.�,;,1 -s i ,' Sc€.r�, a_ v �t�' f€ZsE -d� tk i! •F��i"' �hair��'. a.f�{k J �-�r S; a'{:-.� _.�'. '� ,�,�-i"v . 4 4,.y-fit` � ��' 1�s{"�f� (,� ca,.� �' S i•'-u DESCRIPTION OF WO TO B PERFORMED: O (Identification PleaseType or Print Clearly) OWNER: Name: e Phone: 7 g� Address: © D CONTRACTOR Name: Phone: Address: r Supervisor's Construction Licenser Exp. Date: c Home Improvement License: Exp. Date: NEERS Phone: Address: ?,_5 -^� Sl" ���P -J./,-,Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: S FEE: $ I i Check No.: Receipt No.: NOTE: Persons contracts i ed contractors do not have access to the guaranty fund i. •. x..u. .. . - g atu're'of eon ractor_::.;x : I -�ci nature_of�Agent/©wne...: Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools Tamiing/MassageBody Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales D 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 COMMENTS HEALTH Reviewed on Signature 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 Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Durimpst o site yes no Located at 124 Main Street -,7_, 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 DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— For department use i ® Notified for pickup - Date DomBuilding Permit Revised 2011 Junelmi A r Building Department f The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits g� . ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed.Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior Lo issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To BE�Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit -Tin all cases if a variance or special permit was required the Town Clerksoffice must stamp the decision from the Board of Appeals Ithat the appeal period is over. The applicant must then get this recorded at the]Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi I Location Zje�do exlala A$k0e) 4" 47a-0,1- loe No. �6 Date 4- 6L • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ T Foundation Permit Fee ; $ a Other Permit Fee TOTAL $. Check#�� '1 � 25068 Building Inspector y p1',AO DiN 1 i o SS�CHUS� 'CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 634-12 Date: April 20, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON _1600 Osgood Street #20, Second Floor MAY BE OCCUPIED AS Office Build Out for Watts Regulator IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Ozzy Properties 1600 Osgood Street North Andover,MA 01845 Building Inspector Fee: Prepaid Receipt: 25068 Check : 8757 o over, Mass., T O LAKE 1 COCKICKEWICK 7� ORATED j"Pa��� S BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ .a... ... ... . .... . ........... .................. Foundation t has permission to erect........................................ buildings on ..... Im �ou 1Z- to be occupied as.......... . � ..�. ........ / ..ok. .. .� rovided that the person accepting this permit shall in eve res cd t confor to the terms of the application 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final �t�� • PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTO UNLESS CONSTRUC S TS ou h 0� >� 1 .................................................. C_1LO Service Off- ................. mum ................................BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building l GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises -- Do Not Remove Final T No Lathing or Dry Wall 1 o Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street, No. �dQ f SEE REVERSE SIDEgL Smoke Det. • r • �:r �BsACHUT, CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 634-12 Date: April 20, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON _1600 Osgood Street #20, Second Floor MAY BE OCCUPIED AS Office Build Out for Watts Regulator & Ozzy Property Office IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Ozzy Properties 1600 Osgood Street North Andover, MA 01845 Building Inspector Fee: Prepaid Receipt: 25068 Check : 8757 tAORTH To'" oAndover ­ No. 63 -/7- 0 o , � over, Mass., is 'Y' O LAKE COCMICMEWICK �70 RATED 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System I BUILDING INSPECTOR THIS CERTIFIES THAT....... ?t. .a.............. . .................. .................. Foundation has permission to erect.......................... ............. buildings onglhb....& Z10. ..FL Rough • C to be occupied as............ M... .. .......0... ......................... ................. ...... a/ .. !...................................... Chimney provided that the person accepting this permit shall in eve res ct confor to the terms of the application 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final ��� • PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC S TS Rough . . ................. .................................................................................. Service . . BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building dGAS INSPECTOR Rough ,i Display in a Conspicuous Place on the Premises — Do Not Remove Final i No Lathing or Dry Wall To Be Done FIRE-DEPARTMENT i Until Inspected and Approved by the Building Inspector. Burner V Street No. SEE REVERSE SIDE Smoke Det. Jan, 20, 2011 9:33AM No. 1191 P. 1 OFFICE OF BUILDING INSPECTOR SQL TOWN OF NORTH ANIDOVER CONSTRUCTION CONTROL J PROJECT NUMBER: �I � �e� • � �� . PROJECT TITLE: GP/ PROJECT LOCATION: G� NAME OF HUILDINO: �_ NATURE OF PROJECT: IN AgOPRDA CE WITH ARTICLE 118, OF THE MASSACHUSETTS STATE-BUIL I G GO E, 1, G•Ni L' )'I' �i REGISTRATION NO. BEING A REGISTERED PROFESSIONAL-fIdAiPCHITECH HERESY CERTIFY THAT 1 HAVE PREPARED OR DIRECTLY SUPERVISE D�7HREP REPARATION OF ALL DESIGN PLANS, COMPUTATIONS•AND SPECIFICATIONS'CONCERNING: ENTIRE PROJECT Q ARCHITECTURAL^STRUCTURAL MECHANICAL 0 FIRE PROTECTION ELECTRICAL, d 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 OkDINANCEQ 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 PROCEEEDINO IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 11e.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. Z. 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 with8the progress and quality of the worts and to determine,In general,If the work is being performed In a manner consistent with the construction documents, PURSUANT TO SECTION 110.2.2 1 SHALL SUBMIT W3SKL.Y, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SfiALL'SUEIMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR CY. SUBSCRIBED AND SWORN TO BEFORE ME THIS 'a1}�` DAY OF IG E a0\'a NOTARY PUBLIC MY COMMISSION EXPIRES kO I Massachusetts- pepartment of Public Sat'etc Board of Building�L Rei'gulations and Standards Construction Supervisor License License: CS 48040 sr TADEUSZ DOWGIERT 175 BRADY AVE k SALEM, NH 03079 Expiration: 10/29/2013 ~Commissioner Tr#: 5561 AcoRU CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE I12L.1 i--R. THII CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TH POLI'1 $ BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), i%1 'FHORI:?1' 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 WAIVEI:I,subject tl. the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confe r rig"tts to IT I; certificate holder in lieu of such endorsement(s). _� _,,,,, _„I—•„„,,, .. PRODUCER NAME: M P ROBERTS INS AGCY INC PHONE Arc No Ext: (978) 683-8073 _—L-ucJ,. - 1060 Osgood Street E-MAIL ADDRESS: North Andover, MA 01845 INSURERS) AFFORDING COVERAGE _ II AICu ! _ INSURER A:MERCHANTS INSURANCL ._...._._..- INSURER DOWGIERT CONSTRUCTION CO, , INC. INSURER B:GUARD INSURANCE 175 BRADY AVENUE INSURER C, INSURER D: SALEM, NH 03079 INSURER E: _ - _---.. -_ -- —••, ._.,. _ INSURER F: .. COVERAGES CERTIFICATE NUMBER: REVISION 1„ATRi(3EFt: _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A13011`I OR THF INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITF': REi ;PELT 1 I ::1 Ti S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED.HEREIN IS S,IE;J1 CT TO .L L rl 'r:Mi-, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIL CLAIMS, tNSR TYPE OF INSURANCE ADDL SUBRI POLICY EFF POLICY EXP LINLTR INSR 17VV0 POLICY NUMBER MMlDD MM1DD _ „�_,,.•,., ,. <. ,,. _.-.,...-..,,..,........., GENERAL LIABILITY EACH OCCUIIRZR`;E I L I01) tiayl;+l,! X COMMERCIAL GENERAL LIABILITY PREMISES E, octlrrennJ_._ i _ .(1 I) a1) _ CLAIMS-MADE OCCUR MED F_XP(Arp xic rson) A CMP9151606 03/23/11 03/23/12 PERSONAL&ICV '4JURY I( I�r �`•I' GENERAL AC 3131:;ATE ', 1(`I�, I-a 01”;�. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-:OM'!OP AG . POLICY PE LOC AUTOMOBILE LIABILITY Ea accident BODILY INJUI1 fl' perso:; ANYAUTO 9 _ CAPI054894 03/31/1103/31/12 ALL OWNED SCHEDULED BODILY INJUI'r(P r acade A AUTOS X AUTOS — NON-OWNED Per accident X HIRED AUTOS X AUTOS 6 UMBRELLA LIAR EACH OCCl1 iREl!f;E $ )f_ ',`00"I~ X X ocCUR CUP9142034 03/23/11 103/23/12 .. — -- ----- — A EXCESS LIAR CLAIMS-MADE I AGGREGATE. DED RETENTION$ — �. '__. .._.�., # .. .. .. ,.—..,......,, .___ WC STP I”l7, WORKERS COMPENSATION TORY LIH11 AND EMPLOYERS'LIABILITY YIN DOWC229277 10/26/1?_ 10/26/.._2 -ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH AC ID_F .Ir B OFFICER/MEMBER EXCLUDED? ❑ N!A - fMandatory to NH) E.L.DISE11Sf -E! EMPI O. 9 �_ I If yyees,describe under „' , .. .. .I, 8o i, iJE.ndescION nd OPERATIONS below EL.DISEASE._C--ICY Lliv-' 9 j' 1„„•�,.,,..,_.. DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) _ THE' CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS PER THE TE1110” OF I R:';T':f° �'[<! CONTRACT AND AS PER THEIR INTEREST IN THE INSURED'S OPERATIONS. PRIMARY AND NON-CONTRIBUTORY WORDING .APPLIESI ; CERTIFICATE HOLDER CANCELLATION -- OZZY PROPERTIES INC,DUNTDEE OFFICE SHOULD ANY OF THE ABOVE DESCRIBEC FO (CIESE,f F(>t PARK LLC,1600 OSGOOD ST .LLC, THE EXPIRATION, ON, DATE H THE POLICYEOF, I,.:TI' WILI I? _W HERITAGE I HERITAGE PLACE LLC,'_ORCO'N LP,21 ACC HOWE ST LP,C/O OZZY PRQI:ERTIES AUTHORIZED REPRES— ENTATNF 1600 OSGOOD STREET MA 01845 ' NORTH ANDOVER C 1988-2010 ACORD COW-I.)K,,TION F e:':!rwI d. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts - Department of Indusstrial Accidents Office of Investigations, I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov1dia Workers" Compensation InsuranceAffidavit: Builders/Coretractors/.Electricians/Pl»nbers AiDpHcant Information Please Print LeLbly Name (Business/Organization/Individual): i e r /a r -- �-_ Address:- -73 .r c:- Stn City/State/Zip: Phone#:. CIO Are you'an employer?Check the appropriate box: 'Type of project(required): 4. E] I am a general contractor and I 1'� am a employer with have hired the sub-contractors 6. E]New construction employees(full and/or Part-time)-* listed on the attached sheet. 7. F1 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These subcontractors have employees g_ �Demolition working for me in any capacity. employees and have workers9 []Building addition [No workers' comp.insurance comp.prance F15. We are a corporation and its 10.E]Electrical repairs or additions required.] . officershexercised their have 3.® I am a homeowner doing all work11.0 Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. 12.0 Roof repairs insurance required.]t c. 152, §1(4),and.we have no q ] employees. [No workers' 13.0 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 area an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: L 'L-41. policy#or Self-ins.Lic.#: Ltd 26 2-�`r Expiration Date: f 1 �. Job Site Address: 0 T 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 STORK 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. T do hereby certify under the ains and enalties of 'ury Haat the in ormationproviderd above is trace and correci 'i afore• � -------------- 'Date._--��` ---------- lone#: d e Offficial use only. Do not write in this area,to be completed by city or town official I + :ity or Town: Permit/License# ,suing Authority(circle one): 'Board of Health 2.wilding Department 3.City/Town Clerk' 4.Electrical Inspector S.Plumbing Inspector Other matt Person. Phone#: