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HomeMy WebLinkAboutBuilding Permit #714-14 - 1600 OSGOOD STREET 4/15/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 1 I I Date Received Date Issued: A 1'4 I PORTANT: Applicant must com Tete all items on this page w LOCATION __ _ d _ _ P . PROPERTY OWNER. 0 Z-�- y 'rintyod ouy— C1 � Print 100 Year Old Structure yes no MAP NO: _ _) PARCEL 11_ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no j 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 ❑ Septic []Well ❑ Floodplain ❑Wetlands ❑ Watershed District 11 Water/Sewer DESCRIPTION OF WORK T BE PERFOR ED: �4 M vJ v vet�o Wb> zz , MI ISAeel (4S l No Ci (fid &TOK - x I_`f?_r �OWUA 5Iz7_leg e /2 4jr - d & ?10 k,-rd,,O_i A-I rJ l ► u �, 0-00 .S6IC Identification P ae Tyfe or Print Clearly) OWNER: Name: I0 !J l Phone: q Address: CONTRACTOR Name: C I'll. Phone: Kill75 `3J�Tx Address: SAM Supervisor's Construction License:. Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.•$12.00 PER$1000 00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ I li fV q1) FEE: $ Check No.: Receipt No.: NOTE: Persons contracting unr ith egistered contractors do not have access to the guaranty fund ;Signatu[e of Agent/Owner Slgature of contractor Plans Submitted FE Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived❑-: -.'--:Certified Plot Plan ❑ Stamped Plans ❑ � I TYRE-0 SEWFRAGE.DiSP.OSAL _- l Public Sewer ❑ Tanning/Massage/BodyArt ❑.. Swimming Pools ❑ Well ❑ Tobacco.Sales _❑ Food Packaging/Sales ❑ Private--(.septic tank,etc:_ ❑. permanent Dinpster ori-SiteEl -THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM :.- DATE. REJECTED: DATEAPPROVED PLANNING'& DEVELOPMENT` ❑ ❑ COMMENTS I 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 c' Neater& Sewer Connection/Signature& Date Driveway Permit DPW'I owx! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -.Temp Dump'ster on 'site yes.:... - no Located7bt 124,Mair; Street 'Fire-136parture6t signature/date' - • 'COMMENTS 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 Electricallnspector Yes No DANGERZONE LITERATURE: -Yes No MGL-.Chapter 166.Section 21A—F and G niin.$100-$100.0Jin.e NOTES and DATA— (For department use 0\4 c7 ® Notified for pickup - Date E E Doc.Building Permit Revised 2010 - Building Department The fdkwing is—a list ofah6 required,forms to be_filled out#or.:the appropriate.permit to.be obtained. Roofing, Siding, Interior Rehabilitation Permits oB,ailding 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 apwal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+.ted with the building application Doc: Doc.Building permit Revised 2012 Location G�-� v _ No. —�� Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ ` Building/Frame Permit Fee SPP�`►'�"'� Foundation Permit Fee $" Other Permit Fee $ TOTAL $ w Check# e—���/ 1 �- � �• `� � Building Inspector NORT�y S E Town of No. IlLi — iq �oh ver, Mass, A- COC.41c" W1Cw 1' 7,es RATED U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ..........0..V.. .. s',,,� BUILDING INSPECTOR . �*..... ...J ............... ......... has permission to erect ....................r.... buildings on .... .� .......� Q,� �.......... Foundation .. ..., Rough to be occupied as .......(A&#-*�-&A..... ....�Z.. .... ....... ...�.� ..... ..�......... Chimney provided that the person accepting this permit shall in every respect nform to the rms 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 PERMIT EXPIRES IN 6 MON S ELECTRICAL INSPECTOR UNLESS CONSTRUC RTS Rough 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. To: Marion From: Marianne Hochmuth 4/4/201410:19:28 AM (Page 2 of 2) ACORLIe CERTIFICATE OF LIABILITY INSURANCE DATE(MM/nDNYYY) 41....-� 04/04/2014 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(iss)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 Allied Specialty Insurance,Inc. NAAMEcT 10451 Gulf Boulevard PHONE FAX No Ext: ATC No): Treasure Island,FL 33706-4814 AE"RES:: 1-800.237-3355 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:T.H.E.Insurance Company 12866 INSURED Larry Cushing Enterprises, LTD INSURER B: dba:Cushing Amusements INSURERC: 196 Wildwood Street INSURER D: INSURER E Wilmington,MA 01887 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 INSURANCEPOLICY EFF POLICY EXP POLICY NUMBER LINTS A GENERAL LIABILITY CPP0101485.03 06115/2013 06(15/2014 EACH OCCURRENCE $1,000,000 X COMMERCIALCENERALLIABILITY PREMISES Eaorxunence $ CLAIMS MADE OCCUR MED EXP(Any one person $ PERSONAL SADV INJURY $1,000,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-OOMP/OP AGG $1,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IF aocidenti ANY AUTO kiOUILY INJURY(Yer person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aocident) $ HIRED AV-OSNON OWNED PROPERTY DAMAGE AUTOS Peracddent $ $ A UMBRELLA UABX OCCUR jf EXCESS uAB ELP0010338-03 06/15/2013 06/15/2014 FACH OCCIJRRFNCF g CLAMS-MADE AGGREGATE $ DED RETENTION& $ WORKERS COMPENSATION A AND EMPLOYERS'LIABILITY Y/N WC 134213 05/27/2013 05/27/2014 [Yl X _UW 0TH ANYCEWMEMBERIPACLUDEDXECUTiVE E.L.EACH ACCIDENT 51,000,000 OFFlCER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) Nyyeess descr be under E.L.DISEASE-EA EMPLOYE $1,000,000 D96RIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICYLIMIT 51,000,000 A EXCESS LIABILITY ELP0011604-00 04/2012014 04/19/2014 $4,000,000 EACH OCCURRENCE $4,000,000 AGGREGATE DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H mon space Is required) EFFECTIVE FROM 4/20114 THROUGH 4128114 ADDITIONAL INSURED:JOSEPH N.HERMANN YOUTH CENTRE.INC.:NORTH ANDOVER YOUTH SERVICES:OZZY PROPERTIES,INC. S RESPECTS TO THE GENERAL LIABILITY PERTAINING TO THE OPERATIONS OF THE NAMED INSURED ONLY CERTIFICATE HOLDER CANCELLATION Joseph N. Hermann Youth Center,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 33 Johnson Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. Ozzy Properties,INC. 1600 Osgood Street AUTHO EWA North Andover,MA 01845 ©1988.2010 ACO CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Pm !:L .rare 3?revention system SOS3033473 PAGE. 1/ 2. please visit our wells site at http://wAw.mals.gov/dpi/boards/El EZ FIRE PREVENTION SYSTEMS INC GARY C BERGERON (EL) 41 BRI GHAM 5T UNIT 16 lIARL8OR0 MA 01752-51.43 Fold,T mn Dotnts/ftno Ail pwtDfaveft * WEffs : .E 1' i C l'A 1% `t55U.ES 'tlE..FdLtOWI1 E ASA-4'% M-W D MASjA-#->RECTRICIAKI'-,- ' E PREVENTS& SYSTEMS INC =: r~ #V `C s 6 .- . t4�i ot7�2-gi4 '`a0d ' ma ftRD 152 ';'9' `"`� Department of Public Safety License to Operate Amusement Devices Lawrence H_Cushing License#: MA-011-13 -11.Marion V.Cushing Larry Cushing Enterprises,LTD (978)658-3928 Expiration Date: 6/1512014 Cushing Amusements 196 Wildwood Street Certified Maintemwee Mechanic Wilmington MA 0188T Lawrence H.Cashing,III U.S.I.D. # Device -;Device U.S.I.D. #Device 07066 Tnrck Stop : 10602 ;Roil O-Plane 10002 Uo Gator 10802-._14ampu%n Combo . 10003 Taxi Jet 10842 ttieh7.iuS�vir�g Muskat 10004 Round-tip 10853 Dixn`!?raEon t0006 Sv7Jer . 13345 Ferris-Wheel 10007 Merry-Go-Round 13473.: Casino 10009 Super Slide 10029:53--Wacky Arch Bourm 10010 Rio Gmndelrr n 1002856 Fire Dog Belly Bounce 10153 Zipper 10154 Bunocc Jump 10513 GladiaoorFunhouse- Scoah;r Shad: 10566 Tea Cup 10567 Tempest e442 4C0C4 ALJzhs 0Rel of pit NlC.sQ f -- .F Iasued Date p $C i ori To.,MarioIII ad& �s t��utA�east � sse�mr i - � IIMQTM Issarar: s ABgw* 1 T.11.3. immimm ft tso g AlI181 BgKlally Mmmmume Im 106'91 04f d 10651 Gulf Snnlooard Tramomm Is1aa . 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V' Attach a copy of the workers'm p==tioa pokey declaration vAP(shoft at poNcY asuibm clad expiration date)- Failure to secOU�W under Section 25A of IAM c.1S2 can lead to#fie ie�tioa of axim�l es of a fete uP to SI,SItQ 00 aad/or ami-yew mnp�as well as cm1 Venoms in tfie-fmm of a STOP_WORK O D d afox a.up to SM_W a dayqFthe vio�gtar lie edzrtsecl ttmt a copy of$lis smmo t may be finvarded to the Officae Imrestizedons of ttte D1A for insmaucc WVMP YmfficBd= - I do hereby cert_&Mader&apr:ias PeaaMes epe:JW7 Ehret the fnforatat�Fon provfited a[boue S Lrare and aDrttrrL IA 9��•�Sd' 39�d" JA Offs al am q*. Do not write be this atm is be cumpteted by cUy or town offIcIaL City or Town: PermridUeense# Lwgug.Anthortty(drek,oOA: �. L Board of Health Z B�Dcpartm-at.3_t5fi Cterk .4, Piamblag 6.4tber -► :.t _- ..__�.