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Home My WebLink AboutBuilding Permit #200-14 - 1600 OSGOOD STREET 9/4/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Ulm Date Received Date Issued:W' / 41PO-RTANT: A licant must complete all items on this page :. LOCATION Print . PROPERTY OWNER�V �/'O�5 .. ( — Print lob Year Old.Structure yeZno MAP NO: PARCEL: _ ZONING DISTRICT: Historic District yeMachine Shop Village ye 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 11Assessory Bldg 11Others: ❑ Demolition 11 Other _ 1 Septic ❑Well El Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: viev c/e- � 1 Identification Please Type or Print Clearly) OWNER: Name: .�kF1 /4 Phone: Address: / &&Cf 0 �IYN6 AOY/S_ 1(:-- Phone: �7o1� j CONTRACTOR Name:_ Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING P RMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Y� Total Project Cost: $ �Jx �oc FEE: Check No.: `'1 Receipt No.: 16a, 6 uaran NOTE: Persons contracting with unregistered contractors do not have access to th ty.fun Signature of_Agent/Owne Signature of contractor - t Plans Submitted ❑ _Plan aived 0 Certified Plot Plan ❑ Stamped Plans ❑ 1 f 4 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF`:SEWERAGE:DISPOSAL M Public Sewer ❑ Tanning/Massage/BodyArt ❑ 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 _CONSERVATION Reviewed on Signature COMMENTS HEAL. M Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decisionfreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT ='Temp Durrmpster on site yes no Located at 124 Mair. Street - Fire Departmer'it-signature/date r 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 i Doc.Building Permit Revised 2010 Building Department I The foEswing is"a list of the required forms to be filled out for the appropriate permit to be obtained. Roofiiiag, Siding, Interior Rehabilitation Permits ❑ Building Permit Application f ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o Building Permit Application o 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 o 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) o 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 apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:4ted with the building application Doc: Doc.Buiiding Permit Revised 2012 NORTH own of 0 . - : No. y - Lw�, h , ver, Mass, COCNICKl WICK �'►• �ds RATED pPp��S U BOARD OF HEALTH Food/Kitchen PERM T LD Septic System THIS CERTIFIES THAT .. Fi.4 r .E,.�3. �� e, .�� BUILDING INSPECTOR / Foundation has permission to erect.......................... buildin s on .`(W!.....0='. .. ....�....'......................... C&ILte-owRough tobe occupied as . . Z ...�L.!/.1......... ......................... .......................................................................... Chimne� provided that the person accepting this permit shall in every respect conform to the terms of the application ina 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. PLUMBIN INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final t C/ PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T SRough 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. SEE REVERSE SIDE Smoke Det. NORTH Town of t E ndover O - 0 No. t - h . h , ver, Mass, Q ( is 10L�J COCNICNIWICK y1. 7�AD4ATED S U BOARD OF HEALTH Food/Kitchen PERI T T LD Lisw Septic System THIS CERTIFIES THAT 1 G� .... ........................................................ BUILDING INSPECTOR / has permission to erect.......................... buil din son .`rp,��.....�;�`•y.. ....��'......................... Foundation � � Rough to be occupied as .:.........✓.....�G!4;.Z-.......l ...�L.vt w ... ........................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms 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 t cf PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T S Rough Service .................. ........... ....................................... Fina 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. SEE REVERSE SIDE i kr O I I I t� Af 1 Vol i,'� co r NT �' lit 1 , lit •9 yl°Y I i �� ' i I I ACQ® LSF CERTIFICATE OF LIABILITY INSURANCE R054 09-03/-201)3 THIS CERTIFICATEIS 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 SUBROGATIONIS 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). PRODUCER CONTACT NAME: PAYCHEX INSURANCE AGENCY INC PHONE FAX 210705 P: () - F: (888) 443-6112 (A/C, (A/c,N°): (888)443IL -6112 PO BOX 33015 ADDRESS: SAN ANTONIO TX 78265 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Sentinel Ins Co LTD INSURED INSURER B: Twin City Fire Ins Co INSURER C CUBICLE CONNECTIONS INC INSURER D 13A LYMAN ST BEVERLY MA 01915 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. /NSR TYPE OF INSURANCE DL SUER POLICY EFF POLICY EXP LIMITS LTR /NSR WVD POLICY NUMBER (MMR)D/YYYY) IMM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 AMAO RENTED $ 1 0 0 0 000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) r A CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 10, 000 X General Liab [I F1 76 SBU IV2443 07/28/2013 07/28/2014 PERSONAL&ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE 5 2, 000, 000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2, 000, 000 POLICY [XD PECT RO n LOC $ J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED [I F1 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1, 000, 000 A EXCESS LIAB CLAIMS-MADE L 76 SBU IV2443 07/28/2013 07/28/2014 AGGREGATE S 1, 000, 000 DE X RETENTION $ 10 000_ $ WORKERS COMPENSATION X I TORY LIMITS OT AND EMPLOYERS'LIABILITY ER I ANY PROPRIETOR/PARTNER/EXECUTIVE Y/" E.L.EACH ACCIDENT $ Z 000, 000 B OFFICER/MEMBEREXCLUDED? N/A 76 WEG EU1185 07/30/2013 07/30/2014 /Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1, 000, 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 701,Additional Remarks Schedule,if more space is required) Those usual to the Insured' s Operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEALERFOCUS LLC DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD ST ALITHOR12ED REPRESENTATIVE s NORTH ANDOVER, MA 01845 7g--r- 0 1988-2010 ACORD CORPORATION- MI tffnjhu mswwe& ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD cubicle connection inc. Estimate 13 Lyman Street Beverly, MA 01915 Date Estimate# 9/4/2013 1084 Name/Address Dealer Focus LLC 1600 Osgood Streeet North Andover Ma 01845 Project Description Qty Rate Total Quote for bCubicle Connections to install as follows 29 Call 3,800.00 3,800.00 stations,Supervisor station,2 Printer Fax areas,2 Private Offices,l Conference room,CCI also to supply All Seating Required.All work to be done during reg business hours. Total $3,800.00 Location C u dFf Cod S No - Date e - TOWN OF NORTH ANDOVER • s LEu z�s ti Certificate of Occupancy $ Building/Frame Permit Fee q $ Foundation Permit Fee $ Other Permit Fee $ o ATED XV TOTAL $ I e Check# q r U 04 Building Inspector (t