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HomeMy WebLinkAboutBuilding Permit #35 - 1600 OSGOOD STREET 5/1/2018 p BUILDING PERMIT Q90 ORT►.� TOWN OF NORTH OVER APPLICATION FOR P ! MINATION Permit NO: G �1i� a Received p � 1 �9SS�iCHUS���� Date Issued: �d-?I IMPORTANT:Applicant must complete all items on this page LOCATION ` - PROPERTY OWNER Print MAP NO PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Aa#e`ration No. of units: Commercial Repair, replacement Assessory Bldg O Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer / DESCRIPT OF WO TO E PREFORMED: Identification Plea e T pe or Print Clearly) OWNER: Name: E 40 C hone: 9� Address: 12 CONTRACTOR Name — Phone: �- Address: Supervisor's Construction Licenser , Y Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEERO Rhone: �;1 2`2 Address: I Lf,;g-7 ,, Sid // Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. I Total Project Cost: $ aa- L,::>!l' S FEE: Check No.: ` �� Receipt No.: V NOTE: Person co�itracting with unregistered contractors do not have access to the guaranty fund gnature of Agent/Owner Signature of contractor -z--� 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Q Zoninj 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 Located at 384 Osgood Street 157 FIRE DEPARTMENT - Temp Dumpsterp site yes X711 no Located at 124 Main Street Fire Departmentsignaturefdate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I 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 2007 Building Department 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 ❑ 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 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 Location No. Date ,40RTq TOWN OF NORTH ANDOVER 0 p a Certificate of Occupancy $ ��a Eta Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ �- TOTAL $ Check # 3 205 , 1 NQBt�Izring Inspector TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: 0703045 Project Title: J.M. Hyde Consulting Tenant Fit-up— Project Location: 1600 Osgood Street- 2nd Floor— Building 20 North Hallway Name of Building: Osgood Landing Nature of Project: Tenant fit-up for office space. 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 mal €ngiReeF/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural )OOOOIX 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 COMPL ..tEi)qqD READINESS OF THE PROJECT FOR OCCUPANCY. S.� �� Signature and Stamp (no facsimile) Q��GARyP NO.8688 ti WFI-M AMOlva. MA. 7;10 NIPS SUBSCRIBED AND SWORN TO BEFORE ME THIS AY OF 2007 C_;1w, (2 MY COMMISSION EXPIRES OFFICIAL BRA Al JOYCE A.BRADSHAW NOTARY PU NOTARY PUBLIC `., CtMl0Gi,,4�'W�EALTH OF MASSACHUSETTS �9M.E*M Feb.18,2011 ffie �o�srn?aanu TIONS ARD OF BUILDING REGULA BO _._-- CONSTRUCTION SUPERVISOR..-.. L'++cense: 048040 ' Number: CS Be: 10t2g11955 irthdat Tr.no: 8053.0 Expires: 1012912007 Restricted; 00 i .. 61 / TAD DOWGIEERT z. /��- 175 BRADY AVE -' SALEM, NIj 03079 COmrnlssioner The Commonwealth of Massachusetts Department of Industrial Accidents 1 ri; . ; .414 Office of Investigations 6'sf 600 Washington Street 10 >� Boston,AM 02111 �i www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name([3usincss/Organiration/Individual): ( r. Z / e Address: S �� City/State/Zip: e /&--Phone Are you an employer?Check the appropriate box: Type of project(required): 1. am a employer with, � `) ❑ 1 am a general contractor and[ 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet t emodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL }I.[] Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees.[No workers' 13.❑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. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is thepo/icy and job site information. Insurance Company Name: s.t is 4z Policy#or Self-ins.Lic. O ?2 r 3 �D Expiration Date: Job Site Address: ZCity/State/Zip: B re._..._ .Attach a copy of the workerscompensation 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 tine 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby certijyunder the pains and penalties of erjury that the information provided above is true and r Signature: Date: Phone/P C/ �—�(�`7 Z Oficial use on6. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: • Phone#: Mar 06 07 12:48p 6038900192 P•1 Vli 101 idVt sa.w ••ao ��-•---���^ INSURANCE 1 2 ACM_ OF LLiTY CERTIFICATE BUXOM,�AM R UD OR toOu� ? ZIOC. ONLCERT mn DOG$COWM NO K.P. 3w$ 0 iowg MA 01645 8AtC4 — Willi co wu� D04R�Z8'AZ C101iSTDACY'IGlT t7D-. �- swaesa ee i rar�ER e 8 DtR1D1= PARK or �pvSR, Mi► 01810 . c MOItEF01e74[EP011C1►PWOD�M�► D.11;-O iiil 01NG OR CONDITM OF msm OR � 113114.00M O 7 rt tr a 011 SONS. OF SAH My poffW WE RM PatwY*�u aeon a L 0 tater r s 50 010 pcua�utr aa�E� o,aw,.� s 0 a"""'a"OE ®O�'p to/Z6loe 10/Z$/� a, 1 o�Q_ CpP006a43? „ s 2 b .mutt Lac cow surYtELOW s ANT,UM ,LLOWNwAMS Mvv!O AUiva NOW,1101AMMMIM — turroa�t�-� * a GAl UASLM ESRtc a 1wtwtRo �ON7xAT.tt A_ac s e�ocxv�E� a p y J►tthsatrY ALGA iE a OCCUR Q aurone s s rw ogpjcl =E a s a SflO.OQG sovusrws u�samr a 5100 000 D � gteaa.aa� ZX=703930 10186!06 10126!0? ° '�" E4psEJ�lE_vpuctrt� s 500 00 oma+ �o�ullONsttOC1�7�DM61tlBa�t��E �� �Sp�pIILlOAMmmo Luz,-60 -.8 —ol CER'1�iC/►TE st+ou�D Saar aft�wsoreo was eu�et►su ncoa�taa� oro ,�asuaa aaa�wnL ro Maio Cm worm 97 In 088Y E+RQP TSS To nE cmT w oe Naas W"'a°'O�uar.amFatunE M 00 50 WALL _ aO OmADO h OR UQWW aF AW WO UP"IME•16tlNitt RS OR 00 15MOR=H AtlDdVIM, UK 01845 aures� eno0r+o t�o�atatnoN sae NORTH Town of over S0 0 o , dover, Mass., 7?�n /4 O LAKE W COCHICEWICK qS BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System .... •.,� .. � � ��...•........•,.....•.......•.. BUILDING INSPECTOR THIS CERTIFIES THAT.... . . ..... . .. ..................... . Foundation has permission to erect................. ...................... buildings on/4...40...Q,�. .........10_0.1110........w. Rough to be occupied as............. . .........A#ta ..I.. .. ................................................................. Chimney provided that the person ac ptmg this permit shall in every respect conform to the terms of the application 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 Final 6 PERMIT EXPIRES IN 6 MON ELECTRICAL INSPECTOR UNLESS CONSTRU S S Rough ..... Service . .. .. .................................... . .... . . .... . BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det.