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HomeMy WebLinkAboutBuilding Permit #246 - 1600 OSGOOD STREET 9/23/2011 TOWN OF NORTH ANDOVER (� APPLICATION FOR PLAN EXAMINATION Permit NO: I�� Date Received Date Issued: �3 EVIPORTANT:Ap licant must coin lete all items on this age LOCATION 1606 S PROPERTY OWNER Print Print MAP NO: PARCEL� ZONING DISTRICT: Historic District yes Machine Shop Village ye no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other QiSepFc, '®t,Well � - > •-� �- -,-- } ,z Watershed Distncf ,0`Water/Sewei _ _ __ _ �.. __ .__ J I•_ - DESCRIPTION OF WORK TO BE PERFORMED: (Id ratification Please Type or Print Clearly) OWNER: Name: �,.F7/cr Wit//c.�a Phone: Address: '�lGj.�raez xh� �/cid d/els CONTRACTOR Name: C),b/G/+� �O/I/�CC�`�pyl Phone: 97 -36o F Address: Z s3 4/9/S� Supervisor's Construction License: /1•k GI Exp. Date: Home Improvement License: �. Exp. Date: � ARCHITECT/ENGINEER Phone: i Address: Reg. No. li FEE SCHEDULE.BULDING PERMIT.•$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. V Total Project Cost: $ FEE: $__( C j / 'COO ' Check No.: - Receipt No.: NOTE: P scot g with unregistered contractors don nave access to the guarantyfund Cinn�fiirc'rifAif ` G� �nmar. Siariature if contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ y I TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ i 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 I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS i CIONSERVATION Reviewed on Signature COMMENTS WEALTH Reviewed on Signature COMMENTS n f /-oning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date DrivewaVPermit 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 I 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 department use Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi i 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) i ❑ 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 VOTE: 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 nust be submitted with the building application Doc: Doc.Buildin Permit Revised 20 g 08mi NORTH Town of �_'7"W_1____V1� --V o , dover, Mass., '0 N: LAKE • COCMICKEWICK ORATED p5 v BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System snow BUILDING INSPECTOR BUI CTO THIS CERTIFIES THAT...............ft4j.......AVOW........ ... ....�........... .......... ............ Foundation .. buiidin s on /� �.� t R ....... ough has permission to erect...................................... ... .. ............... . ..... . ............ ......... TWA h� .. 0� J ....?... imney to be occupied as.....��,.y.��.L►....... ..�........... . / provided that the person accepting 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 30PERMIT EXPIRES IN 6 MO S ELECTRICAL INSPECTOR DO C•0. UNLESS CONSTRUCTIO Rough NOWNWAb ........ Service .. . ..... .... ..... ... ... ........ I� Y BUILDING INSPECTOR s Final Occupancy Permit Required to Occupy 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. OP ID: MH ACORDp DATE(MM/DDIYYYY) �.- CERTIFICATE OF LIABILITY INSURANCE 09/23/11 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). PRODUCER 978-975-1300 NAME:NTACT Segreve 8r Hall Insur.ASSOC.InC978-975-7596 PHONE FAX 305 North Main St. AIC No Ext: AIC No): Andover,MA 01810 E-MAIL ADDRESS: Lawrence J.Hall PRODUCER CUSTOMER ID#:+URIC-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Cubicle Connection Inc INSURER A: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 ADDLSUB TYPE OF INSURANCE POLICY NUMBER MM LICY EFF POLICY EXP LTJUER/DD/YYYY MM DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. 1A AGE A X COMMERCIAL GENERAL LIABILITY 8500052083 07/28/11 07/28/12 PREMISES Ea Occurrence) $ 100,00 CLAIMS-MADE Fx] 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 X POLICY JPERoi L1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 4786P40A 07/30/11 07/30/12 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N I A (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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ozzie Properties THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:JoAnne ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD JOB INVOICE carbonless unit set A-2817-3817/T-3866 I JOB INVOICE �, w 13 s I& DATE QkDERED ORDER TAKEN BY ml SOLD TO: PHONE NO. CUSTOMER ORDER# r ADDRESS JOB LOCATION # r JOB PHONE STARTING DATE ATTENTION - TERMS F TOTAL MISCELLANEOUS , TOTAL MATERIALS TOTAL LABOR WORK ORDERED TOTAL LABOR DATE ORDERED wp _ TOTAL MATERIALS DATE COMPLETED t TOTAL MISCELLANEOUS CUSTOMER SUBTOTAL APPROVAL SIGNATURE TAX AUTHORIZED SIGNATURE °' GRAND TOTAL A-2817-3817/T-3866 MATERIAL RECORD TOTAL LESS RETURNED MATERIALS NET COST OF MATERIALS LABOR RECORD TOTAL LABOR COST NOTES TOTAL MATERIAL COSTS TOTAL SELLING PRICE TOTAL LABOR COSTS LESS TOTAL COST SUBCONTRACT COSTS GROSS PROFIT JOB COMPLETE? ❑ YES F-1NOOTHER DIRECT COSTS LESS OVERHEAD DATE BILLED: TOTAL COST NET PROFIT - --- �..w..c�_�. t•.y y.. `A I i I .�.' -_ .. -- ._.. -_-�'_._• 4--. ' t-- _ _ -�C '� _-_-1._.._..., +_ i_ ._-_. -_.T___T-.. _.... _.-•_.__ - _ i - �'___-_ i_ - _._' - - � I ._ r , lit i , r , , , , 1 t : , t -a'-- 1 I � i ' 1 ` 3 I ir_ i j _�_ i � -"- -�-�� � " �- - i �-� ( -� � - � • � ! 1 I � �_ _ r �-tt-- !!lIIIIII iii��� 5 I ! { I I I , -�- - , , I 1 • I J I ( Locatior 17' fl-IG l vd/l,Cd. No. Date � r NORTH TOWN OF NORTH ANDOVER 3 , Certificate of Occupancy $ Q CNUs<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2460-9 Building Inspector