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HomeMy WebLinkAboutBuilding Permit #511 - 1600 OSGOOD STREET 1/16/2007 TOWN OF NORTH ANDOVER NORT1t APPLICATION FOR PLAN EXAMINATION aro`+�■o �,•'~oo 'A Permit NO: 5-// Date Received * ! Date Issued. MUs IMPORTANT:Applicant must complete all items on this page LOCATION O Print PROPERTY OWNER © CJ - _� Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑One family ❑ Addition ❑Two or more'family ❑ Industrial �,4lteration No. of units: ❑ Repair, replacement ❑Assessory Bldg O-Commercial ❑ Demolition ❑ Moving relocation ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK T BE PREFQRMED 67- Ide tWeation 914ise Type or Print Clearly) OWNER: Name: hone:.0 Ix Address: s CONTRACTOR Name Phone: Address: Supervisor's Construction License: d Ws- O Exp. Date: Home Improvement License: Exp. Date: ARCHITECUENGINEER -,S_—L7 cmc Name: Phone: KE�g .— z Address: Az Reg. No. FEE SCHEDULE:8ULDING PERM/T.•512.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 3�e FEE:$ ;7P� " -T -- f— f q Check No.: ` Receipt No.: Page 1 of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools El Well Art ❑ g Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales El❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund A gent/ ne r Signature of contracto Plans Submitted M-----�'Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 HEALT ❑ ❑ C-OMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date lit O 4� COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Sienature& Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Re wired Provided Required Provides Re wired Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORMOS Created 1MC.tan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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 DEPARTMENTMFORMOS Page 4 of 4 Location 14OD No. SI-/f Date MORTM TOWN OF NORTH ANDOVER Of .ao ,a',•1•C F w r F F Certificate of Occupancy $ �,ssACHUSE�� Building/Frame Permit Fee $ 0- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # i=-�—� 19939 Building Inspector RGU►.ATiO,u 80ARD OF BUILDING RUCTION SUPERVISOR License: CONST w Number: CS 0&8040 10129(1955 <. Birthdate: Tr.no: 8053.0 Expires: 1012912007 Restricted: 00 k TADEUSZ DOWGIEERT y ' 175 BRADY 003079 SALEM, � Commissioner c1ORTH Town of 0 .� Lo o dover, Mass., . COC M ICNEWICK V AERATED PPS` �y `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT/4i0.40....01rlf.K.W....C. ###ej.!......... BUILDING INSPECTOR......��................. .......... ........ o F undation has permission to erect.... .. . ............... buildings on /16.6.40 � j;�..�'�!�..a U& Rough to be occupied as d � ..... V�... ..�.I�. ... Chimney provided that the person accepting thi 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 1 100000 UNLESS CONSTRU ST Rough ...... ........................... ........................ ............ Service .. ..... ... .. . BUILDING INSPECTOR i Final i 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 1 Until Inspected and Approved by the Building Inspector. 9 Burner Street No. SEE REVERSE SIDE Smoke Det. Jan 16 07 09:46a 6038900192 p.2 V1/1J/ AVVI A.1 09 CA-11 Lop vVOvoLYf ol.0 MV0Qn4-7 LIlj UVl _ OATE(�'YNND/YYYYf ACDRQ. CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIG14TS UPON THE CERTIFICATE M.P.ROBERTS 7NfSUFJWCE AGENCY INC- HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1060 OSGOOD STREET NORTH ANDOVER MA 01845 INSURERS AFFORDING COVERAGE NAlC# _ 978-693-8073 t'INSURER pROV2t�1[QCiZ MUTUAL FIRE TNS CO u+LquaeD D0IOGIEI�T CONSTRUCTION CO. , XNC.8 DUNDEE PARK pLNDpVER, MA 01810 GUAD IIN(SULiANCE GROUP COVERAGES NAMED ABOVE FOR THE POLICY PERIOD INDICATED.N4TWITHs7ANOiNG THE POLICIES OF INSURANCE UMD BELOW HAVE BEEN ISSUED TO THE INSURED C ANY CONTRAT ANY REOVIRR:MENT,TERM OR CONOiT10N OF AOR OTHER DOCUMENT WITH RESPECT TO WHICH TM%S CERTIFICATE MAY BE ISSUED OR AKrANY PERTAIN,7HE INSURANCE APFORDEO 3Y A Y FOL4TRA T 0 RIBE0 HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AILD CONDITIONS OF SUCH POLICIES.AG6REGATE LIMITS SHOW N MkY HAVE BEEN REDUCED BY PAID CLAIMS. 11MIT6 — POU EFFE POLI XPINA N �Tw AorGEN INSU POLICY 14VMBEa DATE DUlYY OATS Woo EACH OCCURRL•NCE 3- GEN I OflQ bOt� ILITY E 5b DU PREMISS Re ocamem CVILOENERALLIA8ILITYMEDEXP(AnyareponMA) S S,�DOQ-,M MADE K OCCUR PER90fiAl8AOVINJURY 0 1 O00 OOD CPP006443? 10/26/06 10/26/07 GENERAL AGGREGATE S 2,000,000 PROOLWM-COWIOPAGO 13 Z O O 0D -_ GEWL AGGREGATE LIMIT APFLIES PER: POLICY F jE LOG AUYDMOBILELIA01L1TY COMBINED SINGLE LMfT b (EN eccfdonll ANYAUTO ALLoWNEDAUTOS gp01LYINIURY : IPerp�rsen) SCHEDULEO AUTOSODILYiNJU T HIREDAUTGS BPwacemoolaY 3 NON•OWNEDAUTOS PROPERTY DAMAGE S (PWeocl6anl) AUTOONLY-EAACCIDEHT 5 GARAOfi LIABILITY OTHERTHAN EAACC 7 ANYAUTO AUTO ONLY: AGG S EACH OCCURRENCE 6 M E)kCFGSWMBRPLLA WNBILITY T AGGREGATE S `OCCUR CLA24SMAOE s DEDUCTIBLE 6 RETENTION i RYII H- W ORKERS COMPS NSATION AND EMPLOYERS'LIABILITY E.L EACH ACCIDENT 3 5001000- OFFIDWUMEMA RL OP7PAKINF.RMLIIECUii4E DOWC703930 10/2G D GlopR*T V06.0T (Q6 1D/26/07 E.L.DISEASE-EA EMPLOYE a 500.0001_ OFr, Myee dfllwribeuMer £L DISEASE-POLICY LIMIT 4 5Q 0 001 SPECIALPROUISIONSbly « OYHEQ OESCRIP TION 0 F OPERATIONS I LOCAT7Or4 S!VEH ICLES I EXCLU 910NS ADD ED 6Y E NoORSEMFscT!SPECIAL PROVISIONS 603—B —0 2 CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE A901lE DESCRIBED POLICIES QE CANCELLED BEFORE 714E EXPIRATION OATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MNI-10 DAYS WRITTEN OZZY >PROPERMS tIOTCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO 90 SHALL 1600 OSGOOD ST IMPOSE NO OBLIGATION OR LIABILITY OF ANY XINO UPON THE INSURER MTS AGENTS OlI NORTH ANDOVER, ISL 01845 REPRESENTATIVES. - AUTHORIZED REPRESENTATIVE u/L 4 OACORD CORPORATION IMOD ACOR025(20011081 TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: 0608075 Project Title: Hoops4Hope Tenant Space— Budding 20 Project Location: 1600 Osgood Street, Building 20, Second Floor- North Side Name of Building: Osgood Landing Nature of Project: Tenant Fit-up. In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory Smith Registration No. 8688 being a Registered Professional €flgineer/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural XOCODO(Structural Mechanical Fire Protection Electrical Other(specify) FOR THE ABOVE-NAMED PROJECT AND THAT SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE 780 CMR MASSACHUSETTS STATE BUILDING CODE. ALL ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the state of construction to become, generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. UNDER SECTION 116.4, I SHALL PERIODICALLY SUBMIT A PROGRESS REPORT, TOGETHER WITH PERTINENT COMMENTS, TO THE BUILDING INSPECTOR UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS- 1 ROJECT FOR OCCUPANCY. AM Signature and Stamp(no facsimile) P. Na 8668 SUBSCRIBED AND SWORN TO BEFORE ME THIS _DAY OF cerin 2006 < � MY COMMISSION EXPIRES LINDA VANDEVOORDE NOTARY PUBLIC Notary Public-New Hmnp"O My commission Expires March 1%20" Department of lndriMdd Acc1denta Offlee ofInvrsdgS ons 600 WiAinvon S&M Boston,MA 02111 www.massaov/dla Workers'Compensation Insurance Affidavit: Bugders/Contractors/Electridans/Pluumbors Applicant Information Please Prot Leamv Name(Busineavorpwz&uanr WMdu84: ` C Address: City/State/Zip: -� �_ Phone#: Are you 'employer?Check theappropriate box: �- 1. am 2MV16yer with 5 — ; 4. ❑ I am a general MM cbr and I 1�w dproject(Ned): employees(fall and/or part-time).* Lave bired the sub-contrac bn 6. ❑New co=unetion 2.❑ I am a sole proprietor or parmer- listed on the attached d wa t 7. ❑ Remodeling slip and have no employees These sub-cont races have working for me in any capacity worhen'co 8- ❑ Denrolitiaa [No workers'comp.insurance 5. ❑ We are a coZporad n and its 9• ❑ Building addrtion requaed.] ods have exercised their 10-0 Electrical repairs or addition 3.❑ I am a bomeowner doing all work right of exemption per MGL 11.❑ myself.[No workers'comp. a 152.11(4),and we have no Roofutg repairs or additiom insurance required.]t employees. [No wow. . 12.❑Roofrgtisin comp-iffiuraace requhc&] 13.❑O&w ;Any Homeowners eowho licdot do sub ma becks�s���tin our ae ae do below fowl d tgobhen wn„t,,,•oaf try mon Icontnrat m 00 check skis box now munchedmdiowkS Yoe aU week nail then tore amide�o mot Submit a new I an awe •�tiOOet dwee Sb"ing the nems*far and erect smarten'=OWL Pdicy .Ye1 dirart b protidtwa rwrkera'cowgMs*w bourance or byorma"L f "7' adow It dtopaq and job afse Insurance Company Name: Policy#or Self-ins.Lie.#: erl d-) Expiration Date: Job Site Address: Attach a copy of the workers'cam City/Staftq* 1 on policy dedaratioa pace(showing the polky number Sad Fates tD secure ODV " under Section 25A of MGL c. I52 can ked b the• espinutioa date). fine up to$1,500.00 and/or one-year t,as well as civil hnPO D of cariminai pt naMes of a of up to$250.00 a day against the violator. Be advised dint a Penalties in the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage vCriScation.0D�'of this statement maybe forwarded b the Office of I do hemby cera fy under dhe p and pewaWa afpMw,MW the s' b, blow pravlded above is&M 8"eannact � Pbo O,oield use only. Do wok twee!w tllub ern,to be conVieted by�m m,ft"#fflcieL City or Town.- Inning own: Iain Authority PWMIV cen*it K rity(deck one): L Board of Health 2-Building Department 3. 6.Other City/rows Clerk 4.Electrical Iwpe�r S.Plumbing Inspector Contact Penon: Phone a: 46 DOWGIERT CONSTRUCTION CO. INC. 616 ESSEX STREET LAWRENCE, MA 01840 978 685-0306 fax 978 685-1290 CONTRACT Customer Y Name 1600 Osgood St. LLC Ozzy Property mgmt Date 1/2/2007 Address 1600 Osgood St Job Loc City North andover State ma ZIP Job Name Hoops for Hope Phone tatty Description Unit Price TOTAL Supply necessary material and labor including necessary permits and build out approximately 1850 sq ft. as per preliminary plan by GSD. Price includes building of walls as per lay out, installation of electrical service. Install parabolic lighting and electrical outlets as per Ozzy standard. Modify duct work and registers as per new lay out. Install oak doors in metal frames. Install 2x4 suspended ceiling as per Ozzy standard. Adjust sprinkler heads as per new lay out. Install emergency lighting and horn strobes per new lay out. Paint new walls and woodwork, colors to be picked by others. 1 TOTAL CONTRACT PRICE $50,300.00 *Price is based on preliminary drawings and is subject to change based on final mechanical and achitectural design. SubTotal $0.00 Price does not include arcitectural or engineering Shipping&Handling costs, data, telephone wiring, equipment, furniture, cubicles, installation or wiring, flooring, floor prep or cove base. TOTAL $50,300.00 Office Use Only