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HomeMy WebLinkAboutBuilding Permit #844 - 1600 OSGOOD STREET 5/29/2012 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO• y~ Date Received R • Date Issued: �� �SSACHUS�� IMPORTANT:Applicant must complete all items on this page 'S� �`-'1•'a;,,SCt si'i.-'+"�v'.2'1s�s`'4iy.ut �.t+fJ-7`_a;�i !1'Xr t'"�t i u i,'�,�t1+s 3+s r�'', Q1i x`?'t !}�0�r.+'6a'Ow�x5;J'+'r*1{tit1` ��J'"iiY6;rt�.}Sp x�-.} F ft*,- s•4} .dr.. fie�OCATIONt ,NLPST '4 - t �!' zx.+x � '�,�.{'� tl'�. 7c°F;�. •� � fix* �:.i r` 3�Xar ''{ [ { 'tf" :e ".�., t+'.'"".-: �,''=r "'-a,lya..` Y K-.f .,, ,t�ru+g ,a-• y, '';v� 3 sd^'=A� j%i i''r..• ,�. �, t< G.�- -`� Print , =�aa'`� �� �` S' ` r MAPNO �r: I. .�zZ®NING DISTRICT Historicl'Distrnct �'•1 iry'c'{ ,�..e". - Y•.n. '.fit�,'.'�a s• t t- �r c.�S.t { c,F;s "FT.< sr, �_ _ , �>F�': ~: + , t .� :#, y •:, � �ry. j:S;Machine Sho Willa 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 x'S ptic `WellYaf °�`k �t;-Floodplain' , Wetlands= `VI/aters`hedDistnct{ YwZ': 't'-F` •x' e -�s +. �.1-; e t �- C t Z 2 J i-.<;�.^art, a 1.�,x'r j. r tl t+. 's tis sir ,� ,�„ •iw�y i+. �,;. Water/Sewer _.: � :�, :. ." :S�a: ,;<� �.• " �� ' lt" fF+€ r ti's f+ V'4`'- f, DESCRIPTION OF WORK TO BE PREFORMED: &I/C//w Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: �}S``3 ..� .��4 CONTRyAC�T®R,°iiName .Y { :� ; his �t ,� rx -�, r Y �*f' r ° . - i� is 7...ruVt, ._ +..�.:�, , ttr3-.' .a • t :.'p.Phorne '�4�"Y,�whti r'+3 zrk',:�.+�i at. '` i a k rte.. r2 ii."f a. fi)y' •� � .! � jk.f q'S r �' ,•; 33. 4y,M r,f }}ter 3' S .,* : A , ddress-C r �F� `a vaf :,'i� ci£3 ei '" x [{� _'y �� t"; h;dtr g� s✓r;-rf.�n� � uT —�3 s*{' ra .. ►'Y"-` x,� s Y '} �k t}' k �.�t K7,wi ��L�j, x k-N. t}a�'+�i ,fi.:�3.iri. ti�'+1.�`�r#,r r�.`_° *r #.-'y"`,�,Fe }..'+r t ��j ^"�'S�.K. i. 5• �a.,�„yt.S•.r '� " y„ t.4sr.fi,�+2s. fes+ k r-�1yT f t`::4'13-.�--- i' y1 ~ :• 4 a`'r r. '_' I >t"ti.,%�.��e �.r •S�uperyisorbs}Cons�tru�cionLicenser, ." ,�= zExp� ®ate '' �-"Mrs + t t aX �C % ��r aro S a psi^�•`1 r t -1 ��Y`a`IL, i r ! �. r*+ �t c t� _ �� , �HomeflmprovementlLicense 's _ '.at •�' ���e.: _._' ..Exp °Date � t :' 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: $ �25 5 FEE: $ Check No. Receipt No. NOTE: Persons contractin wi contractors do not have access to the guar my fund Signature of:Agent/OWhe ignattare:of'contractor i 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 E I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT I COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS ening Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes inning Board Decision: Comments 1®TE Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: . Located 384 Osgood Street .FIRE DEPARTMENT --Temp Dumpster on site. .,y no. Located at 124 MaintStreet 4 4:�r F<ire 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 Doc.Building Perrait Revised 2008 Building Department .I 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 ❑ 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 Addition Or Decks ❑ Buildin g Permlt 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 90TE: 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 DOTE: 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 Doe:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 I ,� NORT►y y ` o o over No. a44 - ,� o o , doves, Mass., CO CHIC,HEWICK ADRATE D P'Q�\�.�� S BOARD OF HEALTH PERMIT T _ D Food/Kitchen Septic System V I, BUILDING INSPECTOR THIS CERTIFIES THAT.......................................................................... ......... ;... ..................................................................... Foundation has permission to erect..0,.�... MAA............ buildings on .....zee 0..,`...6s, C/ .. .................................. Rough to be occupied asC*-! ..... ...G��....L. .... . .............. ..j. :..... O�-r ....:................... Chimney provided that the er"son acce this permit shall in eve respect cbriform 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 • y VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TS Rough "m..............'. 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 LathingD Wall To Be Done or � FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner r Q Street No. SEE REVERSE SIDE Smoke Det. GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..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. WalJs 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. %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"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. cubicle connection inc. Estimate 13 Lyman Street Beverly, MA 01915 Date Estimate# 5/25/2012 1078 Name/Address Pragmatic Works 1600 Osgood Street North andover,Ma Project J Description Qty Rate Total Labor Reg rate to build 5 Steelcase Workstations. 875.00 875.00 Total $875.00 OP ID:JP CERTIFICATE OF LIABILITY INSURANCE DATE 1 05/25D/YYYY) 05/25/12 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(ies) 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 978-975-1300 NAME: Segreve 8,Hall Insur.ASSOC.InC978-975-7596 PHONE FAX 305 North Main St. A/c No Ext): AIC No): Andover,MA 01810 E-MAIL ADDRESS: Lawrence J.Hall PRODUCER CUSTOMER ID#:CUBIC-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Cubicle Connection Inc INSURERA:Arbella Protection Ins.Co. 41360 Sheila Mulcahehy INSURERB:Travelers Ins.Co. 13A Lyman Street INSURER C: Beverly, MA 01915 INSURER D INSURER E: 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 INSURANCE DL POLICY NUMBER MSUBR M/DDYIYYYY EFF MM DDY LLICY EXP TR /YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY 8500052083 07/28/11 07/28/12 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE I—XI OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,00 JECT X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS 1020001211 04/06/12 04/06/13 PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS Underinsured $ 100/30 Uninsured $ 100/30 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,00 A TO BE ISSUED 05111/12 05/11113 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVEYN/A 4786P40A 07/30/11 07/30/12 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION PRAGMAT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Pragmatics THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 OsgoOd Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE AQJ� ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 34 Or c .� 4f 3o f � F 47- Location No. Date e • TOWN OF NORTH ANDOVER r Certificate of Occupancy Building/Frame Permit Fee $ �� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 4�1 (::� 25335 Building Inspector ,_�_ v' �f r �� 1 I F i 0349 Date....l.D.. ....�. ..... �y NORTIq TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACMUS� This certifies that ................`.....I t'........CZ.GT has permission to perform � �C .i..4J�f.................... ...... ...... ............. wiring in the building of 5w, ��� . at.. p .......P�0 `r..7... ................ 1North Andover,Mass. / /�s-a3 Fee....J..........`.. .ic.No.............. ...... �* f�!r..:..... ELECTRICAL INSPECTOR Check # f ��� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No.WEE=?3; � Occupancy and Fee Checked k BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention erfotm the electrical work described below. Location(Street&Number)J&0 to�SCj()G� � � u Te 2— y3 Owner o Tenant Sv i z 3 Telephone No. IIS Owner's Address ( Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and.Am aci P tY Location and Nature of Proposed Electrical Work: 1600 0<0'0W Zi"rk �vi tt�Cn4 .202Nd Pl-dcl1 --TAuhd po--1 1�S✓)op*r t l0 ofii o< c u id e s Q n. /116h C ID e+td r4o--s Completion of the following table may be waived by the Inspector of Wires. No.of Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total f R Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting grnd. grnd. BatterX Units Receptacle Outlets No.of Oil Burners FIFE ALARMS No.of Zones No.of Switches No.of Gas Burners No.-of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Dis osers Heat Pump Number Tons J.KW No.of Self-Contained P Totals: -- ........... Deteetion/Alerting Devices No.of Dishwashers 5 ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection No.of Dryers Heating Appliances Imo' Security Systems:* rY No.of Devices or E uivalent No.of Water ICS' No.of No.of Data Wiring: Heaters Signs Ballasts. No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:No.of Devices or Equivalent OTHER: 3 ^ 12 OJ 2_0A L f-c tA, C k T-S Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: I/�d (When required by municipal policy.) Work to Start:/O- Inspections to be requested in accordance with MEG Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pTns andpenalties o�f perjury,that the information on this application is true and complete. FIRM NAME: I Lt Ut ec It c 0, -DNC LIC.NO.: Licensee: WoLqvi e W.Ski J Signature LIC.NO.: S6 (Ifapplicable t' " �m�p "in elicensenumber I'm) O v.7 Bus.Tel.No.:�493-W 5722 1 S� /J 3 t: 1. o.• Address: �� � � AI Te N -- *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents i • Office of Investigations tiii600 Washington Street ;� t - Boston, MA 02111 www.nzass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Atpylicant Information Please Print Legibly Name(Business/Organization/individual): Address: City/State/Zip: Phone#: . Are you an employer?Check.the appropriate box: F7. Re oject(required): 1.❑ I'aro a employer with 4, ❑ l am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors construction 2.❑ I am.a.sole proprietor.or partner- listed on the attached sheet.$ odeling ship and.have no employees These su&contractors have olitionworking for mein any capacity, workers' comp.insurance. ing addition [Noworkers'comp,insurance 5. ❑ We are a corporation and itsrequired.] officershave exercisedtheir trical repairs or additions 3.❑ I am a homeowner doing ail work right of exemption per MGL bing repairs or additions myself.[No-worke'rs'comp. c. 1.52, §1(4),and we have no 12.[]Roof repairs r insurance required.]t employees. [No workers' comp. insurance required_] 13-M Other 'Any applicant that checks bor;'#I must also fill out the section below showing their workers'compensation policy in t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box mustattaehed an additional sheet showing the name of the sub-contractors and their workers'comp.policy intonation. I ant an employer that is prgvidingp:workers'compensation insurance for m1'employees. Below is lite policy and job site information ` Insurance Company Name: ' Policy#or Self-ins.Lie.#; Expiration Date: Job Site Address: 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 t 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. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct Signa t ire: Date: Phone#: Official use only. Do not write in this area,to be completed by city or fawn.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.Eftbingnspector 6.Othe'r Contact Person: Phone#: