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Home My WebLink AboutBuilding Permit #668-2017 - 1600 OSGOOD STREET 12/22/2016 ORT BUILDING PERMIT TOWN OF NORTH ANDOVER :z A�vT APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date lssued:..t)�,/-R-;)-106FI,6 IN*ORTANT:Applicant must complete all items on this page VO)Ada&-Tcom ft , Pant i LLMU �YS Tho NINWD 10 'MAP{ - . ...... TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 0 One family 0 Addition 0 Two or more family 0 1 dustrial C [Alteration No. of units: Vommercial 0 Repair, replacement 0 Assessory Bldg 0 Others: 0 Demolition D Other De Septic -QK106 4i" Wetlands Watershed bkfiat' 0.Watdr/Sew DESCRIPTION OF WORK TO BE PERFORMED: A61 b4 tlteo�'!e Cam,4A Ident' ex Type P or Print Clearly OWNER: Name: .Phone: Address: ,0,bntrcib-tor Name; JPhone:. 44 1-7 Address:.. A Su Q4 (A) . q6-P E 1 6rvi"s6N'§t'6'ohs f— ,i - Jo '0 ' —0' babpi';`W )h -q� ' 1 17 Florae Improvement License �`� _ gx, a ek P ARCH ITECT/ENG IN EER 3-14eo �lQv MOT Phone: a 400 Address: 53 � Uto • S &&q, �461 401 Reg. No._5- 39T FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 1.,_,Total Project Cost: $ 95,,, FEE: $ CCv� = 161c) Check No.: Receipt No.: N r ontracting with unregistered contract do not have:access- =to the guaranty fund ' . 16 ff contractor't 'f Agen her n t r Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans FTYPF- F SEWERAGE DISPOSALblic Sewer ElTauning/Massage/Body Art ❑ Swimming Pools ❑ ell 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS i HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes P Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site ye no Located at 124 Main Street Fire Department signature/date COMMENTS r„�/,LL limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: v_ .r u� approval ELECTRICAL. Movement of Meter location, mast or servicedro p,reqes pp 1 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 Call Email ate Time Contact Name Doc.Building Permit Revised 2014 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/Cross Section/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 40TE: 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:Building Permit Revised 2014 I Massachusetts Department of Public Safety 1 � Board of Building Regulations and Standards License:CS-048040 Construction Supervisor TADEUSZ DOWGIERT 175 BRADY AVE SALEM NH 03079 Expiration: Commissioner 10/29/2017 > CERTWICATE OF LIABILITY INSURANCE 1119/S6 THIS CERTIFICATE IS ISSUED AS A MATTER OF WORMATION ONLY AND CONFERS NO RKUM UPON THE CERrtRCIATE:NIOL DER THIS CERTIFICATE DOES NOT AFRMATIVELY OR NEGRTNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TIS POLICIES SELDW. THIS CERMCATE OF INSURANCE DOES MDT CONSTITUTE A CONTRACT BErMIEEN THE ISSUING INSUREP4), ALAS PZ"W5ENT A7VE OR PRODU=,=T1 ttc cmnFICATtE H=ER. PdAtXIR1ANTc If the cern Cate holder Is an ADDITIONAL INSURED,the poIGW-es)Mst be Mdo=d. 1 SU ATIO IS WAIVED,subje+Ct to the Wm and concuo"s of ttm poQcy,certam policies may rewire on endorsem ot, A statement on this cortificata does mat comer rw ts-tD Se certfficM holder in feu of such endorsem nl( . PRCCUCIR rte,- T Vristin u=u- se M.P. Roberts Insuranr..6 Agency " /ONE `_ . 1060 Osgood Stzeet E•raa North Andover, MA 01845 A01 krzatin@ robert;>3insurance.cam INsclrga>�AFFORen+o t oVEw►se ��u�z MURIM I rrJat B:Guard Insurance I)OW IERT CONSTRUCTIaN CO. , INC ir4asRcac: tlarchants Mutual Insuraaace Co - ,616 ESSEX S trJR�a:Provicienc_s_Mutual LAWRENCE, MA, 01841 rates- E: ItIStIRER F' COVERAGES CERTIFICATE N UMBER. REIMSION NLWSER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSLIED TO THE INSURED NAMED ABOVE FOR THE POLICY Pauz V=ATED. NOTVVITHSTANDING ANY REQUIREMENT,TEW OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH'IMIS C1=RTIRCATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY Tt•E POLPCIES DESCRIBED HEREai a SUBJECT TO ALL THE TERMS, eXMI SION6 ANDCONDMONS OF SUCH POLICIES.LIMITS SHOW"MAY HAVE BEEN REDJCEU BY PAID CLAIMS INR ._....._TYPE OF MSMMM pau {Jwm . . cyIm D ► l BOP0086089 1 3/23/16 3.23/17+WHOCCUmmeE g 1.000.000 OAASAVE TO RENT= _ COmweRcmGENERR�LLIABIUTY i ..P.RE'[dISESSE Oco1-_A cc M-MADE Lxx f OCCUR I a+ED w oreparva+) s 5 000 PERSONAL&ADV INJURY $ GENERALaaGREGATE _ s 2 000 X040 kGEN'LAGGREGATELWAPPUESPER PRODUCTS-ODNPAPAGG I S 2,001900 POLICY 7 PRO LOC is D AUTOMOBILEUAD" CAP005151000 3/23/16 3/23/3.7 f, laQOa L000 ANYAUTO $ODtLY pVJURY(Par om m) s AUTOS ALLOVO-ItD X AAUT03UD ) OODILY INJURY(Por aoidmri) S X I4IRM AUTOS X AAUTOOSVNON- tl1YED er eadtl�erk AM4 _ $ S D X 1,101 L-LAt1Ae X OCCUR O COO5137401 3•/23/18 3/23/17 MNOCCUMME S 1 000 000 MISSLJAB .,.�..r.LArMarnAo� ( AGGREGATE s 1.000,000 D ON S S B WRKMCOMAENSATION DOWC798594 10/28116 io/26/X7 g' vVCsrATu- oTH- AND MP10YEF0 UABILM I ANYPROPRM71 PARTNERE>EcuTM E,L,e 1 4�Wr i s 1.000.000 AA ftt » >xCs uDED� b t p0andgrDry M NK) I&DISEASE,_FA'EWLOYE <000,OOQ of�SCRIa1Tro1*IQOF%oPERATIaNsb*ow F..L.DISEASE-P ICY LIMIT S 1 00,000 MSCMPTIONOFOP /L=7Km1VENCL65 tAaea+ACOAblM,AdtlfaastatRarmrka9ct1e0wa.tfrnor�at+�+s+e4��1 OZZY PROPERTIES INC, is listed as additional insured for cpmearal liability, Per wxitten contract. CERTIFICATE HOLDER CANCELLATION 64MOULD ANY OF THE ADOVIt OUSCRISED POLICES BE CANCELLED BI ORE THE EXPIRATION DATE THEREOF, WnCe WILL BE MUVMM to OZ'ZY PROPERTIES INC,1600 OSC-00 ACOORDANC.`E WrM 7HE/POLICY PRO iMNS. ,e,—.$T LLC DUNDEE O> FICE PARK LLC DUNDEE STATION LLC DUNDEE EEPRESINTATIVE RZOSPRING LLC HERITAGE PLACE L _ tItC�Tr3 A�I71� O d � Mee Q N. All(ighbaresemd. ACORD 25(21114 0105) The AICORD name and logo are regisfared ma of 0 r phone: Fac (603) 4SO-1090 E-Mail: -,.The Commonwealth of Massachusetts -- _ Deparftnent of IndustrialAceidents „ - r X Congress Sheet,Siitte 100 - d 0 20X7 Boston,MA21X4 www mass.gov/dia o�M SV'y� Wcorkers'CompensationlnsuranceAffidavit:Builders/Con aT (OSItI7'Y-trScza�s/'lnxn ers. TO BE FILED WITS[THE PERlf' ,]Please Print Le 'bl AMicant Infor_ra ation Name(Business/Organization/Individual): ( it Address. J City/State/Zip: ul U Phone#: Axe you an employer?g4eck the appropriate box: Type of project(Tecluired); em to ees full and/orparbti*. 7. ❑NdVd6nstrudtlon i.[jIamaemployerwith0 _ P Y 2.Q I am a sole proprietor or partnership and have no employees-WO&E—g for me in 8•�R g any capacity.[Noworkers'comp.insurance required] 9. ❑Demolition 3.Q I am a homeowner doing an work myself.[No workers'comp.insurance required] 10❑Building addition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will trical s or additions ensure that all contractors either have workers'compensation insurance or are sole 11.Q Elecrepair proprietors with no employees. I2.[I plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.[l Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.Q Other 6.Q We area corporation and its•offic!r<.have exercised their right of•exemption per MGL c. 152,§1(4),and ire have no employees.[No workers'comp.insurance required.] *Any applicantthat checks box#1 must also fill.out the section below showingtheir workers'compensationpofit s information' Homeowners who submit•this affidavit mducahng fihey are doing all work and then hire outside contractors must submit a new affidavit indicating such Contractors that check this Bob ritust attached an additional sh r ode their workers'come�olic number.�d state whether or not(hose entities have employees. If the sub-contractors have employees,they must p .: , X am an employer that is providingyvorkeNs'compensation insurance for my employees. 73e1o7v is t/ie policy aradjoli site information. Insurance Company Name: ExpirationDate• V N G AY? Policy#or Self-ins.Lic.i _0045 City/State/Zip: O f Job Site Address: ` Attach a copy ofthe workers coamupensaton policy declaration page(showing the policy number and expiratx n date). up Failure to secure coverage as requited underrM 152,§2e f s o f OP WORK ORDER criminal violation Iand.a�ofup to $250.00 a and/or one-year imprisonment,as well penalties of this statement may be forwarded to the Office of Investigations of the DIA.for ins day against the violator.A COPY urance Coverage verification. v hereby certify and tliepai andpenalties o erjury that the information provided alcove is true and correct I do ! Date: G(01 Si ature: Phone#: Official use only. Do not-write in this area,to be completed by city or town official. Permit/License# City or T'ovvn.' Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylT'own Clerk 4.Electrical Inspector 5.Plumbing Insp ector 6.Other Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires 0 employers to provide workers'compensation for their pi Aployees. 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 of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receivbfor trustee Qfan individual,partnership,association or other legal entity,employing emplbyees.•However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant ofthe 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 Incensing agency shall withhold the issuance or renewal of a license or permit to opdrate a business or to construct buildings in the commonwealth for any applicant who Inas not produced-acceptable evidence of compliance with the insurance coverage recfuiired." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter intp 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 contractor(s)name(s),address(es)and phone number(s)along with their certificates)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. B e advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation ofinsurance 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 IndustrialAccidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom 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 fall in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pmmit/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. A new 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 license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Initial Construction Control Document To be submitted with the building permit application by a � W Registered Design Professional for work per the 8`" edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: WJDate: Property Address: 1 ► Project: Check one or both as applicable: n ew construction xisting Construction 1 Project description; I MA Registration Number: �Expiration date;2"1*V Jd, am a r�egrszerc �cs� n prafession�l, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural [ ] Structural [ ] Mechanical. ] Fire Protection [ ] Electrical [ ] Other for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, 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. .Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be 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 is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submi cial a al onstruction Control Document'. Enter in the space to the right a"wet"or electronic signature and seal; Phone number: 1 Email: �i� (� 1 • ��"� - _ Building Official Use Only Building Official Name: Permit No,: pate: Version 06112013 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the Soh edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: b4mla .7krC4rx_+J Date: Property Address, 01 Project: Chock one or both as applicable: i) w construction xisting Construction v Project description: i tJioOYVL4JCk( MA Registration Number,, Expiration date: am a I-egiste-rev desi�n pt,qlssionail, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning., Architectural [ ] Structural j Mechanical Fire Protection [ I Electrical Othcr for the above named project and that to the best of my knowledge, information,and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR), and accepted engineering practices for the proposed project. 1 understand and agree that 1 (or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to; I, Review, for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor in accordancedocuments, with the-,requirements of the construction doe Q1 ts, 2, Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable, 3, So present at intervals appropriate to the stage of construct-ion to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code, Nothing in this document relieves the,contractor of its responsibility regarding the provisions.of 780 CMR 107, When required by the building offlicial. I shall submit fiOd/progress. reports(see item 3.) together with pertinent comments, in a form acceptable to the building offlMal, Ad. Upon completion of the work, 1 shall subtlit R tial a ' '-at Ronstruction Control Document', Enter In the space to the right a"wotil or electronic signature and seal: Phone nvalbor; Al�) Emall" P_0 V1 vv Ouildins OfflOO ugg Only Building MOO Name; hunlit Na„ Dow vwploll 06mi Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 75,836.00 m $ - $ 910.03 Plumbing Fee $ 113.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 113.75 Total fees collected $ 1,237.54 1600 Osgood Street Tenant fit up Suite F3 Mentor Expansion 668-2017 on 12/22/2016 NORTH own of o No. _ ab, 41 , t _- +4 = h ver, Mass • �� C0C.1C"1_.CK V A01#ATE0 ►Pa,�'�y S U BOARD OF HEALTH PERMIT TFood/Kitchen t Septic System THIS CERTIFIES THAT ....I. .QE.�.S. D614- � r.-• •• 4oa 0, 4�Qo • BUILDING INSPECTOR 4 � Foundation has permission to erect .......................... buildings on .� Q........... .• ...... Rough • g to be occupied as ....... .... .... .... .. .... .. ....... .!!1!t.n. %..�!........... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIQNSTART Rough ....................... Service ` ............ ... .. . ... .... Final BUILDING INSPECTOR r 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 No. Smoke Det. DOWGIERT CONSTRUCTION CO. INC. 173 BRADY AVE SALEM,NH 03079 978-815-7292 CONTRACT - Customer Name Ozzy Properties Date 12/11/2016 Address 1600 Osgood St. Contract# City North Andover State MA ZIP 01845 Job Name Mentor Expansion Phone Suite B20F3 Qty Description Unit Price TOTAL Supply necessary material,labor and permits to modify existing office space as per plan by L-Arch on 10/16/2016. Remove and dispose of walls as per plan. Build new walls with metal studs and 5/8"drywall on each side.Tape and sand new walls to a smooth finish. Install solid-core oak doors in metal frames.Install four sidelights as per plan. Install electrical outlets in new walls.Adjust switching and lighting due to new layout. Repair ceilings due to removal of walls. Paint existing and new walls.Colors picked by others. Paint new doors and frames.(Existing doors to be re- used where possible.) Remove existing carpets and cove base,and install new broadloom carpet and cove base. *Price does not include architectural or design costs, removal of any hazardous materials,data wiring,or movable partition wiring. 1 Total Price $75,836.00 $75,836.00 SubTotal $75,836.00 Shipping&Handling $0.00 Taxes TOTAL E $75,836.00 Office Use Only Location Q 0ST No. 017 Date a' ' .2, •�a/ to • • TOWN OF NORTH ANDOVER 140 Certificate of Occupancy $ Building/Frame Permit Fee $J Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# .1 J 7 5 'Building Inspector