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HomeMy WebLinkAboutBuilding Permit #193 - 1600 OSGOOD STREET 5/1/2018 t,`° BUILDING PERMIT TOWN OF NORTH ANDOVER F ti 9 APPLICATION FOR PLAN EXAMINATION * ; 0* Date Received / Permit N0: �SSACHU`��� Date Issued: IMPORTANT Applicant must complete all items on this page 777 P- cs u i a ice. 3i MR�r ry r t W", ngygj tstoic TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family )5-Addition ❑ Two or more family 'Industrial ❑ Alteration No. of units: 0 Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolitionft❑ Other �' I Welf � x gMeo � _ DESCRIPTION OF WORK TO BE PREFORMED: 75 " ��" �'u b r��S %�( bR- des c.an rl 2-9S l Y � i�oo os�� cSf Identification Please Type or Print Clearly) OWNER: Name: /�G2� 1),5�SrUei', 1-L� Phone: 97& &! cz�`f Address /6? 00 66&D0t7 Si- n16r4k P MPr oftfgS k sM3 ,fr0 �d iii hW25 .PF"R FOR xn s z s s rzr' tx -+ s d '• 3 AGI � � s b 3 5 tea\ .1 „tz �x 'xz .,. §� k � � .����"t - v""x �R �w��'-�Q��` �-'�'.y F3' �•�.(���'s�C" ARCHITECT/ENGINEER Phone: Address: Reg. 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: $ // . 40 FEE: $ ff47 -"— C heck "—Check No.: '/h4 2 Receipt No.: .2.y.s'�2---NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 Zoning 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 ARTMEN � Te 3 fie ` site awes �} �LOCatedt� 4 �a�fie t $ °. ` e, c Iter E�al"tt�1 M SIC�hat�i vgateA,,'_, r ' ,^ h 3 ""T�. "� � r t iE, � y�act �.z .� r-z °a•:.°"%'�'�'�."�a 'm , �„�'—+zY'" s+ .r � .f+:"s-. r`s, x 77 `aa^ js 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 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 /c oo / o No. Date2z/—Oz 7 NORTH TOWN OF NORTH ANDOVER 3? OL f 9 ' Certificate of Occupancy $ �'�a'••°''t�' Buildin (Frame Permit Fee $ s�cMus9 e Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1062- 205L2 0v2205 . 2 ,Building Inspector Christopher Meyer Regional Manager—MA JM�lyde 1538 Turnpike Street CODSO �� North Andover MA 01845 (978)794-2425 office Pharmaceutical Process and OP/SIP Systems Expertise (978)794-3686,fax Design Consultation (508)472-8235 mobile Control Systems chris.meyer@jmhyde.com Validation Services www.jmhyde.com Compliance Services Location �G�o u 't`� 1. cw- j�S"• No. 9 Date �-x? MORTPf TOWN OF NORTH ANDOVER � F? ow 9 0'd s • i ; , Certificate of Occupancy $ A", cNuEta Building/Frame Permit Fee $ s� s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I-0 205 i ��� � � Building Ins4btor CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 193 (9/10/2007) Date: S ember 18. 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood St MAY BE OCCUPIED AS Tenant Fit Up J. Hyde Consulting Inc IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPL,Y. Certificate Issued to: Ozzy Properties 1600 Osgood Street North Andover MA 01845 '11Wilding Inspector t% TH Town of No. 193 S,' O` over, Mass., d06 �. COCHIC HE WICK V RATED F"' C7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System > /C� J ` DING INSPECTOR THIS CERTIFIES THAT...............�....................... ......................./.............. /.......:..:.... ..... .... 1' �,. C.-h!..... Anaa... .... has permission to erect........................................ buildings on f 6. ... ��� � ...� .`. �....... Rou ... ......... >. l / 1,�/�h�✓/��r.,�� ' imneyto be occupied as................... - ..�..... ............... :.: ... . Provided that the person accepting this permit shall in every respect conform to the terms the aPPcationonfiiin / Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of r Buildings in the Town of North Andover. PLUMBING INOECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS - UNLESS CONSTRUCTION TS ' ELECTRICAL INSPECTOR Rough ................. ............................................................ ............................... Service BUILDIN ECTOR �. Final �� 1. /(Y -i) 7 F-� 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. NORTH del own ofr4 Andover O No. 19 over, Mass., � Do o � LA COC HICHEWICK ADRA7ED S ` BOARD OF HEALTH Food/Kitchen PEI am 1 -1Septic System ��` �r DING INSPECTOR THIS CERTIFIES THAT....................................(.`. � /.. � ...... ........ �.......... ...... '/.> . . .. .......h. /. / oundatio has permission to erect........................................ buildings on C . :% /...7 t 67` t v Com .................L'.:. Jl l.. ` ..../�/t.--(~�✓i"t N 1 >imney to be occupied as................... ..................... /..`. provided that the person accepting this permit shall in every respect conform to the terms of the application on fill 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 PERMIT EXPIRES IN 6 MONTHS - ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TS Rough ............... .. ............................................................ ............................... Service BUILDIN ECTOR 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 (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. � 200 CONFERENCE 00 � FAX AREA P X' �120 PLOTTER OFFICE AL ps iR IS -` m / �? The Commonwealth of Massachusetts 6t:E A`]`W-REID Department of Industrial Accidents cQ _ ~�AI Office of Investigations t h'..�a� t� U. '�' 600 Washington Street Boston, MA 02111 {'w www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling 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 required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 121-1 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks boz#I 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 the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: 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 required under 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. 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#: « a Information and Instructions 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 ormore of the 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-contractor(s)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 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 fill in the permit/license 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. 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia Sap 06 67 01:33p Calvin Highfield 603-382-6360 p.2 inaunnn6t WLUi tuna W taxa-bUJ-JSZ-ZUJ4 Sea 6 2007 13:03 P.02 flop 06 07 11248 Cabin WgKeld sman4m P.1 Bap 06 07 tK;FB& JMHCwser 978-784-9886 p.6 7"eaafMwrows i�Affr raoelfraerla Offm ofrA d"wsslrf om Sf ew daffaAA.MA OI?lll ' atv4rlta ". 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