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HomeMy WebLinkAboutBuilding Permit #756 - 1600 OSGOOD STREET 5/26/2010 i BUILDING PERMIT GF NORTIi .1,• SSLED /6 "I TOWN OF NORTH ANDOVER o� 4`' `` �°- APPLICATION FOR PLAN EXAMINATION Permit NO: 7<6 Date Received A �SSACHl1S Date Issued: IMPORTANT: Applicant must complete all items on this page ; LOCT10N print 1� d PROPERTY OWNER t :' L44 , ZZ VIAP10 PARCEL: 777 ZONING b1STR1CT -listonc Dstnct eso e v Machine 5'h j1/j1#a ., P g ye nes, i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration _i No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic We11. "F1oodplain 1✓a/ tlands r Watershed.D] strict aterlSeweT =, ... DES IPTION O WORK TO.BE PREFORMED: Identification1 s7Te or rint Clearly) OWNER: Name: r a� ®. c G . 2'C Phone: g S Address: --� s CONTRACTORjlar�ae 3 c ,. 'Phone. `Address .. <` Superviser.'s C©nstructaon License Expo Date 7711 777 . c Mome``1m .rove neat L''ense P_ xp..:Date ARCH ITECT/ENG IN EER_k.,t_jAtp 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: $ 5`TOd�c/p FEE: $ A Check No.: Receipt No.: 'P 3 ;z NOTE: Persons contractin t 1 unre istered contractors do not have access to the guaranty fund r ignature ef.Agent/Ow Signature of contractor .--- 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 i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT j 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 .oJTE. Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street fIRE"DEPARTMENT Temp Diarnpster on sl#e yes .no. Located-at 124 Main,�Street Eire`Department sinature1date:. . 9 ;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 Doc.Building Permit Revised 2010 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 i ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract I ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products i 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 Li 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 J ORTH Town o 0 �....w.,,. �..�• r. No. ~ - �. LAKo dover, ' Mass. O�A COCKICEWICK ORATED P'P�t"`� i BOARD OF HEALTH PERMIT T/ D Food/Kitchen Septic System /�O BUILDING INSPECTOR C THIS CERTIFIES THAT ' ��.. f:ov .................................................................................................... Foundation has permission to erect..............:..:...............:...... buildings on .16�..r�..�.... ..X/�:l D...01 , ....... ................:............. Rou g h to be occupied as.......... .Ae.g4fjvo.... ... ..... �.5� a:. '.F 1� '............ Chimney C1 �J.. .f.:.. . provided that the person accepting this permit shall in every ec! conform to the terms of the application ation 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 j VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .............................................. Service BUILDING INSPECTOR Final i Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final j 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. I 1l tssachusetts Depairtment of Public Safety Board of Building Regulations and Standards Gonstructtion Supervisor License License: CS 48040 Sf Restricted to: ,00 i TADEUSZ DOWGIEERT 175 BRADY AVE SALEM,.NH'03079 o�L.G- Expiration: 10/29/2011 (7-ner Trr#: 6839 f The Commonwealth of AjassachuseM Department o f Industrial Accidents, Office Of Lnvestigations 600 ff"ashingion Street Boston, AL4 02111 1VW►V,rn[LS&e OV/[tla! Workers' Compensation Insurance Affdavit: Builders/Contractors/Electricians/Plumbers . Applicant Information PIease Print Leon Name(Business/organiza6on/lndividual): / e Address: City/State/Zip: �, �, �- t, r /� Pbone,#: FlAreyou an employer?Checks the appropriate boa: Ilam a employer with C> 4. ❑ I am a Type of project(required):generalcontractor and Iemployees(full andlorpart-time)* have hired the sub-contractors6 ❑Neu'construction. I am a sole proprietor or partner- listed on the attached sheet t �. ❑Remodeling ship and have no employacs These sub-contractors have working for me in any capacity. workers Comp.i 8' Demolition ' P insurance. 9. ❑Building addition [No workers'comp: insurance 5. ❑ We are a corporation and its 3.Elreq'uTed-) officers have exercised their 10.❑Electrical repairs or additions am s homeowner doing all work right of exemption per MGL .1 LO Plumbing myself [No workers'comp, c. 152,§1(4),and we have no g additions insurance required.]t employees. 12.7 Roof repairs [No workers POMP•insurance required 13.❑Other '-Any applicant that checks box#! must also fill cut the ae�io= =owing{=aT A ori ms`com^ va r: .. Homeowners who submit this affidavit indicating they ar_doing all work and theo hire outside contractors mai+submit nen affidavit indicating such. +Contractors that cbc,.l this box must attached an additional sheet showin;the name of the sub-contactors and their workers'comp.policy information. am an employer that is providing workers'compensation information. insurance for my employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic. /f / ---�_ Expiration Date: ® f C5 Sob Site Address: C� ��g�-p "P ` _ Attach a copy of the workers' City/State/Zip:compensation policy declaration.gage(sho Q , ^ Failure to secure coverage as re � �' the policy number and expiration date). g quired under Section 25A ofM'GL C. 152 can lead to the imposition of criminal pises of a enal 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office a Investigations of the DIA for insurance coverage verification I do hereby certifjv under the pains and penalties of perjury that the information. provided above is true and correct SiEnature: '� Phone#: -� Official use only. De not write in this area, to be completed bJ'city or town olciaL City or Town: Permit/License# Issuing Authority(circle one): 6. BoaOthrd of Health 2.Buildinb Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Contact Person: Phone#r: 03/29/2010 15:28 9786833147 -- MTE(MmouvW) �►�e+c�° CERTIFICATEOF LIABILITY INSURANCE _ 3/29j10 D ASA MATTER OF INFORMATIt?N THIS CERTIFlGATE IS ISSUE A T HE CERTIFICATE PRaouOER ONLY AND CONFERS N O RIGH TS UPON M.P. Robert* Insuranoa Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 1060 Osgood Streat ALTER THE COVERAGE (AFFORDED BY THE POLICIES BELOW. North Andoval:, MA 01845 NAIC# INSURERS AFFORDING COVERAGE _.-._........ .. . INSURER A:Marc ante Mutual INSURED —._,._......... _ DC ITRfi CONSTRUCTION C0. , INC (NSI FER 616 ESSEX STREET LAW.REI;4CE, M8, 01841 INSURERD: _—_..____.._...._.. INSURER ; CO RAGES THE POI.IC(ESOF INSURANCE LISTED BELOW HAVE BEEN I",,,SVEO TO THE INSURED NAMED ABOVE POR THE POLICY PERIOD INDIGATirD.NOTWITHSTANDING MAY PERTAIN THf;INSURANCE AFFORDEQ BY TWE Pc3LICIES DESORIBED IN IS SUBJECT TO ALL THE TERMS,EXCLUSION$AN4 CONDITIONS OF SUCH ANY RfYiUiI2EMEN1 TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED CH POLICIES.Af3(iREI'a+ATE LIMITS SHAWN MAY WAVE BEEN REDUOED 8Y PAIDCIAIM _ ... _ �____... ._ '--• "POLICY E�FECrN@ T10N LiNtlTS POLICY NUMBER GENERALLU+UILTIY EACHOGCUf�IENCE $ 1 000,000 Ol NSA ETD FEtFiT&iS S 10P,000 �[ ,COnTAERCIALOI rIEFtAI.L1ABILITY RREM)SE$�F,avFCWret4�1_ —' ^=J CIA14 MADE I X OCCUR, ME4 EXP(�one Peram} $ 5 000 A _ _ CNF9151606 3/23/10' 3/23/11 PtRSONAI$ADVINURY 3 1,000 000 - 0 R_AGGREGATE B 2000,,—OPO. - PRODUCTS- AqG EN' OLAGGRWATF411WTAPPLIESSPER __ _.._...._...CDMPrOP POLICY P LOC AUTOMOBILE I.IABI LITY COMBINED SINGLF LiM IT (Eaaeaiderd) ANYALRD ALLOWN_DAUTOS BOD14YINJURY $ (Per parson} . SGHEDULEO AUTOS .... , .,...__._. �---.._.•. ...— HIREgAUTOS BODILYINJURY S NON O W (per aaaiden flE0 AUTOS t} PROPS RTY DAMAGE $ GARAGE LIAINUTY AUTO ONLY SEA ACCIDENT S i MYAUTC OTHER THAN E�►ACC - AUTO ON LY: AGO $ ETCG@SS IUMMIM.LALIABILI'TY EACH OCCURRENCE AGOFeQATE $ 1,000 X OOCUR CLAIMS MADE __.._. ..._ _.. I A DEDUCTIBLE CVP9142034 3/23/10 3/23/17 g R NTtON WORKERS COMPiENSATION _T�pRY1.IMCG3. ... T AND EMPLOYms,Lm.su'Y 8 AWPROPRtMPJPAFtTTdERIEXEGUIIVE Yom"( X911544 10/26/09 10/26/10;EL.EAGHA%awprr s 1000,000 QFiGER1MENBEREXIxUDEO? _...1 (MatgalbtyinNN) -E .01$EASE-EA,ENPLQYE _$ 0,000 Ityyeas9 9eedibo ndtA $PEGlAL 81 f�bele E.L !S E-POLICY (MIT It 1,000400 OCHER I M SOMPTION OF OP ERATIONS t LOCATIONS r V Eli CLES 10 MUSIONS ADDED BY ENDORS EM ENT r 9PEOAL PROMBIONS COV�;AING OPERATIONS OF TETT NAND INSURED AS REQUIRED rot WORK PE"ORMD AT 1600, 1590, ].610, 1630 OR 1636 OSGOOD STREET NORTH ANDOVER, MA — 1600 OSGOOD STREET LLC AND OZZY PROPERTIES, INC ARE LISTED AS AN ADDITIONAL INSURED F-603-45$-1090 CERTIFICATE HOLDER - CANCELLATION SHOLI DANYOPTHEAgOnDESCRIDIMPOLICIRS;MECANOELLEDBEFORETHEEXPIRATION DATE THEAVOIT,THE 1911I,AnA,i:1 NSURER VO4L ENDEAVOR TO MAIL 11 fl DAYS WRITTEN 1600 OSGOOD STME T LLC NOTICE TO THE CERTIPEATE HOLDER NAMED TO THE LEFT,OUT FAILURE TO D5 90 SMALL C/O O.1.7,Y PROPERTIES, INC. IMPOSE NO OBLIGATION O R LIABILITY OF ANY KIND UPON TWE INSURER,Me AGENTS OR 1600 O$GOOD STREET NORTH ANODVER, MA 011345 AUTRO IIZE0PEPMSENTATive ACORD 25(2008101) 01988.2009 ACORD ORP TION. All rFghts reserved. The ACORD name and logo aIle regLatemdmeft of ACORD e NORTH 1 TOWN OF NORTH ANDOVER OFFICE OF o: ff Siam BUILDING DEPARTMENT ', 04 400 Osgood Street North Andover,Massachusetts 01845 SSACNUSt D.Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 CONTROL CONSTRUCTION- SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 LI*-4V"0fnrf4IEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT ICvd'® DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: AUTHORIZED SIGNATURE: DTE: �241 REGISTRATION: NOTE: ENGINEER"WET STAMP"MUST BE AFFIXED TO THIS FORM No.M4 j Control Construction Form revised 11.15.2004MANI r . ,f BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-95 5 Location G 0 D dS O a� f No. �� �'I 3 Date NORTh TOWN OF NORTH ANDOVER + Certificate of Occupancy $ • : , ACN�s t� Building/Frame Permit Fee $ d Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 232u6 -� Building Inspector