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Building Permit #283-15 - 1600 OSGOOD STREET 9/19/2014
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Jrint Q PROPERTY OWNER ( !P Print i oeryear 11d Structure) yes no MAP NO: �PARCEL:�11 ZONING DISTRICT: Historic District ye no Machine Shop Village yes no )— TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family M Industrial Iteration No. of units: mercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer I .F. DESCRIPTION OF WORK T9 BE PE FORMED: ` > bi &IA9 JA2 czd P IV 1, . den ification ease Type or Prin 1early OWNER: Name: / �' `T 16 e� Phone: y 7"a�19 Address: CONTRACTOR Name: D044-"MPhone: Address: V— Supervisor's Construction License: qg f0� Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: s�v Address: e 9. 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: $ �-(,7� ©/2 FEE: $ Check No.: 9 75�� 42 Receipt No.: ago'? NOTE: Persons contra n 'th nreg&tere�dWrntractors do not have access to the guarantyfund Signature of Agent/Ow r Signature of contractor, f Plans Submitted ❑ Pla isWaiA Certified Plot Plan ❑ Stamped Plans ❑ 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: Doc.Building Permit Revised 2012 I Type of Sewerage Disposal - Public Sewer Septic Tank Type of Water Supply - Town Water Well I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF Historic District: Approved Rejected i Subdivision: Approved Rejected _Water Shed: Approved Rejected _ Health: Approved Rejected Conservation: Approved Rejected Comment COMMERCIAL SIGN OFFS _ DPW: Approved Rejected _ Engineering:Driveway Approved Rejected Comment Fire Department:Review Approved Rejected 124 Main Street Comment Planning Department Approved Rejected Comment Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date ."DPW Town Engineer: Signature: Located 384 Osgood Street "FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire 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.$10041000 fine NOTES and DATA— For de artment use ❑ Notified for pickup - Date i E i Doc:.Building Permit Revised 2012 i J 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 Li 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) o 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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract ❑ Mass check Energy Compliance Report o 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: Doc.Building Permit Revised 2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: e— Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATIONcoo � J Irint � Q PROPERTY OWNER l !P 17 Print 100 Year Id Structure) yes 7noMAP NO: PARCEL:��� ZONING DISTRICT: Historic District ye Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family 0 Industrial Iteration No. of units mercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DES IPTION OF WORK T� BE PEFORMED: ` G JA2 O!d A.,,,CO--� Z en ificationease ype or Prin learly OWNER: Name: ��, 1 T f G� P�� e�� Phone: 9? Lf 7z Address: 6 CONTRACTOR Name: < Phone: Address: Supervisor's Construction License: —Exp. Date: L26= Home Improvement License: Exp. Date: ARCHITECT/ENGINEER �' Phone:—Cf 7 Address: 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: $ FEE: $ Check No.: 7Receipt No.: �7 NOTE: Persons contra n 'th nregistered ntractors do not have access to the guaranty fund y. Signature of Agent/Ow r Signature of contractor 6 Plans Submitted 11 Pla s Wai, Certified Plot Plan ❑ Stamped Plans ❑ Location �� �� G;�d0 n � No. (� r Date 9 /y . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ CU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3�?2 w Check# -7f Building Inspector __------- --------------� IZ � 1'� ' ' �, ���� _� � S� �� �� �l�- r NOTE: ALL MATERIALS TO BE PAINTED 7 WITH INTUMESCENT PAINT 0 N N EXI5TINCz P05T c1t i. I X 8 - PAINTED PROVIDE 2x4 ,4T TOP, MIppLE ANp a i} BOTTOM OF POST - SPAN THREE POSTS (STAGGER JOINTS) N F Lo } PROVIDE BLOCKING - A5 REQUIRED 00 EXISTING RAILING � � 51'STEM C�, z 3/4" THICK INTERIOR GRAPE PLYWOOD, GOOD ONE FACE (STAGGER JOINTS AT POST LO(—ATION5) - PAINT {{ o 1 k SECURE TO SIDE OF PECK { ro" LAP MINIMUM a EXIaTING EDGE OF m PLATFORM i" m X N LL ACT THEATER , PISHBROOK architecture DRAWING NO. DESIGN consulting A S K TITLE:SECTION �� STU DI O exhibits A PROJECT NO.: 2014.09 DAT E. 11.2 1.13 O z Lawrence Road V 978.56i.3ooq o o SCALE-. REVISED: Boxford. F9Y8.88Z.>oY9 E 0 LL EXISTING WALL TO REMAIN "' (TYPICAL) o cc 7 o 45< 002 N TYPICAL MINIMUM 10 ❑ co NEW RAILING SYST€ a 0 EXISTINCz SEATING RLATF ORM cm D FIXED SEATS rASTENED NOTES: SECURELY TO €IRE RE TED 1, SEATS SHALL HAVE FIRE co oo F_____ IX A 1 2x5 ON THE rLAT, P INTD TREATED FABRIC. — L --- -- 49 SAT WITH INTUMESCENT AIN 2. T O AIISLE SEAS SHALL REMO — — --- ---- — — — — ------- —-- -- AISLE: P€ OWING LACE G TA ARMRESTS. P L u_ 6 6 d AT NOSING OF COLOR CONTRACTING ING THE U R UND _. I' ' SURFACE �• � CD CD E: ~ � I Lj O o r+ , M co m m co r— m X ' 10 LL ACT THEATER a. , FISHSR00K architecture DRAWING N0. ------ —..—..._....._.._.—........__......_........._........._......._...._....._......_.._....... D E S I G N consulting TITLE. S K \l TITLE:FLOOR PLAN �m�-' STUD 1 O echibits m PROJECT NO: 2014.09 DATE:11.21.13 6 _- -- — z lawrence Road v 978.56i.3ooq o o SCALE:1/8'=1'-0� REVISED: Boxford,MAotg2x F948.88z.io79 E I 0 u_ i From:Mark Gravy Fax:(978)984-3107 To: Fax: +1 (978)688-9542 Page 2 of 4 11/2612014 11:03 r< m I 21 November,2014 CODE SUMMARY for Raised Seating Area ACT Theater Building 34 Osgood Landing 1620 Osgood Street North Andover, MA 01845 This summary lists the sections of the Massachusetts State Building Code(MSBC)and Massachusetts Architectural Access Code(MAAB)pertaining to the installation of fixed seating on the existing raised structure in the theater. Number of Seats: 149. Seats shall have fire treated fabric. MAAB: 14.2 Number of Accessible Seats.Total Seating: 149.Wheel Chair Spaces Required:4. 14.2.1 Armless Seats. 1%of seats shall have removable or folding arm-rests. 14.4.3 Companion Seats. At least one(1) companion seat shall be provided for each Wheelchair Space. MSBC: 1013.1 Guard Rails shall be provided for platforms located more than 30"above the floor and conform to the requirements of 1607.7 1607.1 Gard Rails shall be able to resist a load of 50 pounds per linear foot applied in any direction at the top. 1607.7.1.1 Concentrated Load.Guard Rails shall be able to resist a single concentrated load of 200 pounds applied in any direction at any point along the top. 1013.2 Height.Guard Rails shall be not less than 42" high. 1028.6.1 Aisle Width.0.3"per occupant served. 149 occupants=44.7"<48" provided. 1028.8 Common Path of Exit Travel shall not exceed 30'from any seat to the point of two paths of egress.As built the furthest seat is 42'from two paths of egress. 1028.9.1 Minimum Aisle Width: 48."48"are provided. 1028.11.3Tread contrasting marking stripe. Provide a 1"contrasting marking stripe at the nosing of each step. 91 FISHBROOK DESIGN STUDIO Matthew E.Juros,A.I.A. 52 Wingate Street Haverhill,MA 01832 v: 978-914-6876 e:miuros@fishbrook.com w:www.fishbrook.com EC",`;/,t tat From:Mark Gracy Fax:(978)984-3107 To: Fax: +1 (978j 688-9542 Page 2 of 2 1112612014 1:30 Final Construction Control Document To be submitted at completiozn of construction by a M � p Registered Design Professional y7 for work per the 81h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Act Theater Company Date:10/22/14 Permit No. Property,Address. 1632 Osgood St, Suite 102 Project: Check(x)one or both as applicable: New construction. x Existing Construction Project description: Installation of custom built seating risers I Sean Fennell, PE MA Registration Number:41790 Expiration date.6/30/16 , am a registered design professional, and 1 have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ,architectural x Structural Mechanical Fire Protections Electrical Other. Describe for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents_ 2. .Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 VA of--,�s S9 Enter in the space to the right a"wet" or electronic signature and sea]: s pF�L UI No.41[t?�90 y lfl � y Phone number:978-352-6500 Email: sfennell@n fennell-engineering.conn Building Official Use Only Building Qfficial Name; Fennit No.: Date: Version 06 11 2013 Mark Gracy Fax:(978)984-3107 To: Fax: +1 (978)688-9542 Page 1 of 4 11/2612014 11:03 .c. y Maura, Attached please find the plans and code summary drafted by our architect to install the perm seating and reinforce the rail per Brian's conversation with our architect. I can come in this afternoon during office hours if Brian has not left for the holiday. Please let me know. Thank you in advance for your assistance. All my best, Mark Gracy Mark Gracy I Executive Producer ACT Theater Company 1632 Osgood Street I Suite 102 North Andover, MA 01845 mobile/text: (978) 476-6041 box office: (978) 276-9568 email: mark@)ac-ttheatercompany.com web: www.acttheatercornpany.,com .0 This e-mail message may contain confidential or legally privileged information and is intended only for the use of the intended recipient(s). Any unauthorized disclosure, dissemination, distribution, copying or the taking of any action in reliance on the information herein is prohibited. E-mails are not secure and cannot be guaranteed to be error free as they can be intercepted, amended, or contain viruses. Anyone who communicates with us by e-mail is deemed to have accepted these risks. ACT is not responsible for errors or omissions in this message. Emails sent or received shall neither constitute acceptance of conducting transactions via electronic means nor create a binding contract unless a written contract is signed by the parties. i Mark Gracy Fax:(978)984-3107 To: Fax: +1 (978)688-9542 Page 1 of 2 11/2612014 1:17 FAX Date:( rl1/26/201 Pages inc -u Ing cover sheet: 2 To: From : Mark Gracy KW Real Estate Partners 11 S Main Street Topsfield MA 01983 Phone Phone (978) 984-3107 * 101 Fax Number +1 (978) 688-9542 Fax Number (978) 984-3107 • Send and receive faxes with RingCentral, www.ringcentral.com R ' i 'J�O4..e♦E,A9 SSAC/NS CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 283-15 on 9/19/2014 Date: December 15, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood Street—Building 34 MAY BE OCCUPIED AS ACT Theater IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Ozzy Properties 1600 Osgood Street North Andover,MA 01845 Bui ding Inspector Fee: PrePaid$100.00 Receipt: 28037 Check :9735 i i i i � � n ► y �7S 4r.o N"',19 SACINSE CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 283-15 on 9/19/2014 Date: December 15, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood Street—Building 34 MAY BE OCCUPIED AS ACT Theater IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDI_NG CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Ozzy Properties 1600 Osgood Street North Andover, MA 01845 Bui ding Inspector Fee: PrePaid$100.00 Receipt: 28037 Check :9735 From:Mark Gracy Fax:(978)984-3107 To:: -Fax:-+1 (978)688-9542 -Page._2-_of-2-1211512014 8:00 --------- a: s. a: Final Construction Control Document To be submitted at completion of construction by a i ' Registered Design Professional for work per the 8`h edition of the l:' v Massachusetts State Building Code, 780 CMR,Section 107 Project Title: AC-T TFt0M 'IN`-124OP-I(A Pp OVEN O-I)tbate: (2 IZ 70i 4- Permit No.'28 3- L5 Property Address: ;.: Project: Check one or both as applicable: 0 New construction xisting Construction ;.: Project description: .49&-,'['R-tAC.J'IQJ Gl.? OGU.i lA�101Ce1��'P� i. 1�f�t•tl'l�/J t.1S1�4t,.S_�t.l �'. ��C' �pal'1 t�G- &fie Z5Q?-OS MA Registration Number: 10 Expiration date: C ,am a registered desi8T Professional,and I have prepared or directly supervised the preparation of all design Plans computations and specifications concerning: Architectural [ ) Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical j ] oiher: for the above named project. I,or my designee,,!a vctier:a nx+d�`.A�accessary professional services and was present at the construction site on a regular and periodic basis.'i'::rt;°:h( c;;:r} knowledge,information,and belief the work proceeded in accordance with the requirements of 7 8 it ' +;1i<acid d e c:,:f:gn documents approved as part of the building permit and that I or my designee: I. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with.the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code, AAA Nothing in this document relieves the contractor of its responsibility regardingf¢ P� MR 107. vi IM Enter in the space to the right a"wee'or 4 electronic signature and seal: XFOPS9 .. '. ted Phone number: �` ¢�` � ? Email: v S 1 ep Building Official Use Only Building Official Name: PermitNo.: Date: Version 06 11 2013 i y, 116 H 01)O 0 It e• r N y.i oil lots .._ v r IFINa CONSTRUCTION AFFMAVIT 10 December,7014 A[TTheater Interior InWovemem is Permit Number:783-15 Project:Tenant Fit-out Project Location: 1610 osgaod Street Wte 102 North Andover,VA O1B45 scope of Work: Construction of new wheel chaff accessib!e toilet rooms,egress doors, exit signs,interior partition wails and raised seating area. In accordance with Section 116A of the Massachusetts State BOding Code,i,Matthew E-.Iuros,beia a registered Architect hereby certify,to the best of my knowledge and belief,based on,periodic fie4d vWts that the completed wont described above confmins to the provisions of the Massachusetts state BuMng Code. r" r V 1(VJ Matthew E-luros,Architect MA Registration 2W7 C FISHBROGK DESIGN STUDIO W-'Mb a E.LtN,,%Ai U Wb:sta%wee as"rhlf,MA VIAD w:610• 11-LOTS a:er�u a:f` atlaro-�t ern v:u+iro 1kMtos�.Mn �I From: Matthew Jurosmjuros@fishbrook.com Subject: Affidavit Date: December 11,2014 at 4:59 PM To: Mark Gracy mark@acftheatercompany.com Let me know if you need further assistance. -Matt. Matthew E. Juros, A.I.A. FISHBROOK DESIGN STUDIO 52 Wingate Street Haverhill, MA 01832 voice: 978-914-6876 cell: 978-561-3009 http:/tfishbrook.com http://linkedin.com/in/fishbrook FbDS ON THE RADIO! htt ://p nerej.comAmages/radio/archive/ 2013/08August/08-10-13rndex.htmi Please consider the environment before printing this e-mail u NOTICE OF CONFIDENTIALITY This E-mail message and its attachments(if any)are intended solely for the use of the addressees hereof. In addition, this message and the attachments(if any)may contain information that is confidential,privileged and exempt from disclosure under applicable law. If you are not the intended recipient of this message,you are prohibited from reading,disclosing, reproducing, distributing,disseminating or otherwise using this transmission. Delivery of this message to any person other than the intended recipient is not intended to waive any right or privilege. If you have received this message in error,please promptly notify the sender by reply E-mail and immediately delete this message from your system. December 11 , 2014 All installed theater seats were recoated with fire retardant with Inspecta - Shield Plus per the manufacturers instruction for application. Inspecta- Shield Plus is a durable, non-toxic, penetrating, fire retardant. Inspecta- Shield Plus meets or exceeds the criteria for a "Class A" rating. aIz J ark Gracy Date jt6Ulf AN O. JOSEPHNotary Public EALTH OF MASSACHUSETTS ommission Expires arch 12, 2021 i oHOR7y 4ti ♦o �a �Ss�cHuStt TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Good for Thirty (30)days from date of Issuance Building Permit Number 283-15 on 9/19/2014 Date: October 23, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood Street—Building 34 MAY BE OCCUPIED AS ACT Theatre IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: ACT Theatre 1600 Osgood Street Building 34 North Andover, MA 01845 Building Inspector Fee: PrePaid$100.00 Receipt: 28037 Check : 9735 I of,,ORIN 1M O o � SSAC/NSEt TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Good for Thirty (30)days from date of Issuance Building Permit Number 283-15 on 9/19/2014 Date: October 23, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood Street— Building 34 MAY BE OCCUPIED AS ACT Theatre IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: ACT Theatre 1600 Osgood Street Building 34 North Andover, MA 01845 Building Inspector Fee: PrePaid$100.00 Receipt: 28037 Check : 9735 NORTH own of T E : ., Andover o No. h ver, > L.: x Massr T O LANE T / / A- COC KIG KE WICK �� � 7�A°R ATE 0 S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ......,f.��!..C� ...... s ��.. .....� '.f,�,l„ ........... . � � ,,, BUILDING INSPECTOR has permission to erect ......................... A- Zee •� ' :'�}Q f `�-.� Foundation ............: ... 'uildings on ....... ......... �, P/7 ISF tobe occupied as ............. .. ........... ............................................�..:.. �,:�..... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application rew Cs D �� 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. ���� `�/�"N� PLUMBING INSPEC - R VIOLATION of the Zoning or Building Regulations Voids this Permit. Roughd l inz�; PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECT UNLESS CONSTRUCTI ARTS Rough e� In- �4 Service ................... ....................... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 Flo •Smoke Det.►% . I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 24,200.00 m $ - $ 290.40 Plumbing Fee $ 36.30 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 36.30 Total fees collected $ 463.00 i 1600 Osgood Street Building 34 283-15 on 9/19/2014 Tenant Fit Up for ACT Theater Company I 2014-2015 Insuranc The completion of this form is necessary for every vaccine re out as much as possible using existing information. Information about the person to receive vaccine (please Name: (Last, First, MI)* a Street Address:* City:* State: Insurance Information: Include the whole member ID numbe Name of Insurance Company:* Member ID N Medicare Number: Is Medicare F If person getting vaccinated is not the subscriber, please Subscriber's Name: (Last, First, MI)* Subscriber's Street Address:*(If different from address above) City:* I State:* Final Construction Control Document w To be submitted at completion of construction by a Registered Design Professional for work per the 8t' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Act Theater Company Date:10/22/14 Permit No. Property Address: 1632 Osgood St, Suite 102 Project: Check(x)one or both as applicable: New construction x Existing Construction Project description.Installation of custom built seating risers I Sean Fennell,PE MA Registration,Number:41790 Expiration date:6/30/16 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural x Structural Mechanical Fire Protection Electrical Other:Describe for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge, information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept, shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 1 �^(H OF; s s� Enter in the space to the right a"wet" or ° ay c electronic signature and l: " � seaN0.49 r y Phone number:978-352-6500 Email: sfennell@fennell-engineering.com 'ONNAL. � Building Official Use Only Building Official Name. Permit No.: Date: Version 06 11 2013 F!S NO R 00 K rurhttedum DESIGN r.�n$uitu FINAL CONSTRUCTION AFFIDAVIT 23 October, 2014 ACT Theater Interior Improvements Permit Number: 283-15 Project: Tenant Fit-out Project Location: 1610 Osgood Street Suite 102 North Andover, MA 01845 Scope of Work: Construction of new wheel chair accessible toilet rooms, egress doors, exit signs and interior partition walls. In accordance with Section 116.0 of the Massachusetts State Building Code, I, Matthew E.Juros, being a registered Architect hereby certify,to the best of my knowledge and belief, based on periodic field visits that the completed work described above conforms to the provisions of the Massachusetts State Building Code. Note: In addition to the scope described above, I take note that a temporary seating riser not designed by me has been installed. It appears to be constructed of wood and coated with intumescent paint,with 36" high hand rails and has yellow caution stripes painted at the nosing of each 7" riser. Matthew E.Juros,Architect MA Registration 20447 Q FISHBROOK DESIGN STUDIO Matthew E.Juros,A.I.A. 52 Wingate Street Haverhill,MA 01832 v:978-914-6876 e: mjuros@fishbrook.com w:www.fishbrook.com n F I S H B R O O K architecture ta D E S I G N consulting S T U D 10 exhibits DESIGN AFFIDAVIT(Architectural) 23 September, 2014 Project: ACT Theater Company Project Location: 1600 Osgood Street Building 34 North Andover, MA 01845 To the Inspectional Services Commissioner: I certify to the best of my knowledge, information and belief: the plans conform to the Massachusetts State Building Code, Town of North Andover Zoning Code, and all other applicable codes, laws and regulations. Signed, Architect: Matthew E.Juros, Registered Architect MA 20447 Firm: Fishbrook Design Studio A 52 Wingate Street Haverhill, MA 01832 447 978-914-6876 OXFORD ktA A ® FISHBROOK DESIGN STUDIO Matthew E.Juros,A.I.A. 52 Wingate Street Haverhill, MA 01832 v:978-914-6876 e: miuros@fishbrook.com w:www.fishbrook.com i NORT1y Town of _E : �, Andover o �. < <„ No. h ver, Mass, Ll '�.q A�R�TEO PPp��S s � BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CE vs' O (� LD � BUILDING INSPECTOR CERTIFIES THAT ......,, -r.. .......... .. `.'1.................d .h................... ?. .. ........... ......... ............. D �has permission to erect .......................... uildings on . /Zo� ... ` y j� Foundation . .`� .... Rough tobe occupied as .................. ..................................................................... ..... ... 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. �' II g lF ��vs VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ARTS Rough 1 Service I .................... ............. �.2:'........................ 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. r+�-a,.n►s %om 11fi IVH 1 C Vr LIMOIL1 1 T 11V0U1%M11t+G 8/29/2014 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(les)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). PRODUCER NAME: M P ROBERTS INS AGCY INC a"CDNo Ext: 978 683-8073 AIc No:(978)583-3147 1060 Osgood Street AODRESS:paula@ robertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE MAIC# INSURER A: INSURED DOWGIERT CONSTRUCTION COMPANY INC- INSURER B: 175 BRADY AVE INSURER C: SALEM, NH 03079 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. DDL UBPOLICY FOLIC LIMITS INSR TYPE OF INSURANCE INSD VJ1lD POLICY NUMBER MM/DD MM/DD LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE C1 OCCUR PREMISES Ea occurrence $ 1 WQ f 000 MED EXP(Any one person) $ CMP9151606 03/23/14 03/23/15 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000 CI PRO- CI PRODUCTS-COMP/OP AGG $ 2, 00,000... POLICY I JECT I LOC $ OTHER: -COMBINED SINGLELIMIT AUTOMOBILE LIABILITY Ea accident) $ 1,000,000 BODILY INJURY(Per person) $ ANYAUTO 03/31/14 03j13/15 ALL OWNED SCHEDULED CAPI054894 BODILY INJURY(Per accident) $ AUTOS X AUTOS p NON-OWNED Per accident) $ HIRED AUTOS AUTOS $ X UMBRELLA LIAR X OCCUR03/23/14 03/23/15 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CUP9142034 AGGREGATE $ 1,000,OQO DED RETENTION$ WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY YIN10/26/13 10/26/14 EL.EACH ACCIDENT RI $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ DOWC446554 OFFICEMEMBER EXCLUDED NIA E.L.DISEASE-EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THE CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS PER THE TERMS OF THE WRITTEN CONTRACT AND AS PER THEIR INTERESTS IN THE INSUREDS OPPERATIONS ON A PRIMARY AND NON-CONTRIBUTORY BASIS CERTIFICATE HOLDER CANCELLATION OZZY PROPERTIES INC 1600 OSGOOD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ST LLC DUNDEE OFFICE PARK LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RED SPRING LLC HERITAGE PLACE LLC 21 HOWE ST LP ZORCON LP C/O OZZY AUTHORIZED REPRESENTA PROPERTIES 1600 OSGOOD ST NORTH ANDOVER ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth ofMassachusetts Department of Ir�clustricclAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): i ms Address: City/State/Zip: A Phone#: 79- 16��!�7Vfa of Are you an employer?Check the appropriate box: Type of project(required): 1.Rlkam a employer with /g 4• ❑ I am a general contractor and I 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.x 7• F1 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp,insurance. g• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance �ired.re q u ► employees.[No workers' 13.❑Otu,,-or comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 thepolicy and job site information. Insurance Company Name: „{ J'� �n S 0 Policy#or Self-ins.Lic.#: tE'�� �{ ����`Z Expiration Date: IL 4 Job Site Address: L2 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 requiredunder 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 of up to$250.00 a day against the violator. De advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certlo under the pains andpenalties ofperjury that the information provided jabove is true and correct. Signature: ; �J Date: Phone#: q Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/I,icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: Information and ffustr uction Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ofthe foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be,advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any regarding e ardin the law or compensation policy,please call the Department at the number listed below.ySelf-insured companies should enter their SOY-insurance license number on the appropriate line. City or Town Officials -Please be sure that-the affidavit is-complete-and printed legibly: The Deparfinent has pr6vid6d a space at the boftoin of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permithicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture i.e.a dog g 1'icense or permit to bum leaves etc.)saiderso p n is NOT required to compete this faffidavit. The Office of Investigations would like to thankou in advance Y for your cooperation and should you have an uestions please do not hesitate to give us a call. Y . The Department's address,telephone and fax number: The . own lonwealthofMlassarl?u utts Depaftent of fadustrial Accideats Office of Investigations 600 Wwbiugtou Street Boston?MA 02111 T01,#617-727-4900 ext 406 or 1-877%, ASSAFF, Revised 5-26-05 B40 617-727-7749 www.mass,govaa DOWGIERT CONSTRUCTION CO. INC. 173 BRADY AVENUE SALEM, NH 03079 978 685-0306 fax 603 458-1090 ESTIMATE Customer Name ACT Theater Date 8/2912014 Address 1600 Osgood St_ ------------- 34 City North Andover State MA ZIP 01845 — _ Job Name I g Phone _ ——._. .— ----- ---------- _------ -------T --- TOTAL -- - -------------------------------_-------------- i Unit Price �- ----- -- --- _Description ---- -- 1------ -- i _ Qty-- -- - _ _ ------- Supply necessary material and labor to build approximately F 50 ft of wall with metal studs and 5/8 drywall each side. Tape and finish wall. Build 2 handicap bathrooms with necessary plumbing. Install 2 oak door units in to bathrooms. Install VCT flooring in bathrooms. Install 6ft X 8 ft doors in place of where existing garage door is now. Paint new walls and woodwork. Electrical and fire alarm work to be done by others and is not included in this contract. j � I 1 Total estimate $24,200.00 ! $24,200.00 1 -------�--- ----------—--------- ---- --------- -- SubTotal-I----$_2_4,200.00 *Price is based on preliminary drawings and Shipping&Handling could chang upon final plan. --___--- TOTAL r $24,200.00 /' ---— - Office Use Only --------------- Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-048040 TADEUSZ DOWG)ER 175 BRADY AVE; ' s SALEM NH 030 9 ` ,,A 92, A "' Expiration Commissioner 10129/2015