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HomeMy WebLinkAboutBuilding Permit #552-2017 - 200 OSGOOD STREET 11/22/2016 y/ c a�C� NORTH J 1 BUILDING PERMIT ��tsLE° �b,��o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 1 n 1 Permit No#: S� } - Date Received 1 J •� aaf °RATED gSSACHUS�( Date Issued: I I- a� - :)-u' L? IMPORTANT: Applicant must complete all items on this page �s T LOCATION {,� - PROPERTY OWNERS Print 100 Year Structure yes no MAP PARCEL: I) )—ZONING DISTRICT:rHistoric District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New B 'Iding ❑ One family ❑Ad ' ion ❑Two or more family ❑ Industrial ❑ eration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg El Others: ❑ Demolition ❑ Other ❑ Septic ❑Well 0 Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: y (� cel, f— G/a� v uj S /A/0 fit t-- F0 Identification j PleaV.5117ype or Print Clearly 9�� 0� 6 �� OWNER: Name: f C-e- n✓1,e.-+ IT %'� 5 h -e—r- Phone: Address: ST Contractor Name:A/e w Phone: Email: Address: c o U r ,rn rM c. n i q- 01 Supervisor's Construction License: q �� Exp. Date: Home Improvement License:_ t ! _ Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$12.00 PERK$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5-j c� / FEE: $ 4 ( 3 � Check No.: / 0 F7 7 Receipt No.: 3 1 A-)' I NOTE: Persons contracting with unregistered contractors 0 not hav access to the guaranty fund Signature of Agent/Owner Signature f contr for Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/1v4assage/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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street - Fire Department signatureldate _ 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.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date _ Time Contact Name Doe.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 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 Doe:Building Permit Revised 2014 Location 00 4S,-60/3 S No. 5�oi7 Date • ' TOWN OF NORTH ANDOVER �u • y ,,, ` Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Bu ding Inspector r 1 3gt%ORTH - 0 h ver, Mass, COCNICMl WIC.[ 1' ��s RATED NPa`,��5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT NOW...Pf*. Af4o�I..... .....6o�*ri...kcvpot........ BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .......Amp.......�.�..�.:�!��......F..7..... ................... Rough to be occupied as .........Y........ .?�i/..�! cc wr........W f Ill".ws 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT N STARTS Rough Service ........ .............. .... ..�....................... 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. PAA Reg#146589 � r t- Contract# `✓{ Reg#0605216 `-� l � l d� Federal ID#20-2625129 ?I Reg#26463 Home Imrrovecn—tSolutions 70628 nad Ccrpora:e Hryuarters,26 Cedar St,'Nobu:n.MA,(p)Sort-.342-221f(F)?81•g rg525.vr::;r.newyro.c n THIS CONTPACT MADE THw 'r day of 201 _.between (acme Osvnersj('��,.., /-� /f ;Hcm??horse) t,EpsR'isf, _ne) !Areas) _�r �T tStalei (Z'A1 the'Owrier"and NEWPP,O Operating,LLC,"NEWPRO". (E-Mail) for proprietary use only NEVVPRO hereby agrees that it-411 for the consideraticn hereinafrer mentoned,furnish all labor and material necessary 10 install the fdlrxring described work at the Premises located at: (� The job address is a condominium. (Jon Address) YdifdDOYdOPf[ON3rF_ s .' t 07i',L#= •r t1E7UPJt0 „_ WItiO�YlS SERIE.$ �� Grids: YES O C2CCsdTOUR t�SD_ NEURO DIAMOND 'Nndow color OTY j Window color QTY OBS1-M1P:(Location) TC ��jeC Ca, tollEInL' Screens: (Exterior color Full S:�een r Stand LF rr�StFULL cxt Ext Vent latches: YES t iNO Capping Colonp00RS' �_r 'Y h10DE) s>s<= 4TYr%Please 7nitrat: PVC ZerSmooth LJ No ar No Capping Stilling Gass Diiof`n M©DE"L<NAME - MODEL#? =QTY- Color In: O:# Double Hung ) / Acave: Lett Center Richt OAtonorunde51erd5Uq;rJEWP 00 Slid e HOWR: SN BB BCE WH aoesrotdoany p3r'ingor;talaug. RLa 3 Lite Slider h!+.12 tri ri `Ent poorSl Ie- t9a:at+en remaa'rtd or rapiadrrg iMaicr tY:... _ Y 3 Lite Slider (.a.in.M) '�` calor Irc out sops ort&1),4Ew7ROS is nm Mso- Caserrw_nt(HinyedRight) Fiberglass SIM nsgke for conditions or ok mstancesbey- Casement(Hinged Left) t HDWR: SN BS AGB AB ORB on5'.Is:onwi a.clurrng c:ndensation Twin Casement I ~ €Spites St�711';?=' - lungroner due topre-ers6cg Condit ons Stationary Casement Color In Out: (circlecrel. Triple Casement w4,v21 via) ` §(orm Doo[S Ee- - kSH Trip!eCa<am=_nt oa int.m Color IT Out aalarcepia: atcampieiior, Picture Window HDWR: SN BB AGB A3 Sash Only Left Hlr a RlgMlllinge FINANCE HOpoer I ,Eiifi0c 0l;Slyke € Bam mmotet cnicrm signed at inutagaucn Awni'g color In: Out GardenWndmi r Fberglass Steel :µTOTAL.= Bay'P!btdow(Roorlsetat) HDWR: SN BB AGS AB ORB "CAS13�1 ��cT 60w Window ncft SOIY.) ty / Otlie�edoor S fermi, PE Other Color in: Out: _DEPflSIb ��-��t Other HDWrt r"7NET�1� J� DESCRIBE WORK&PROM0710NSAFPL1ED: cgT �ORDEF; �11N5_TaLL. Est.Start Date ESL Comp.Date:ZL Customer understands this is an'estimated date" Owner has read and agrees to the terms and conditions on the front and the reverse of this Agreement. Owner specifically agrees to the(1)Total Cash Price;(2)work being performed-,and(3)work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NE1lVPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two(2)copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only): Notice to buyer: (1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank. (2)You are entitled to a copy of this Agreement at the time you sign it. (3)You may at any time pay off the full unpaid balance due under this Agreement, and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges, (4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement. (5)You may cancel this Agreement it t has not been signed at the main office or branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not tater than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made. See the accompanying notice of cancellation form for an explanation of buyer's rights. (Rhode Island Sales Only): Owner acknowledges receipt of required Contractor's Registration and Licensing Board consumer education materials. (Owner's initials) EIP:IS Stgred: A- P pecialist(Printed Name) Signed"Porati LL (SrgnatUre) Owner i w now— NEWPRO MANUFACTURING SERIES G NEWPRO 2000 - — SMANOa D'OUBLE-HUNG Cellular PVC frame,Triple glazed, h1dondFanaalrodon Low E 002ting(e=0.427,$2&5), — Retln�Cou"c9e Kryptontair filled,Dividers ORM 2r-69W400H ENERGY PERFORMANCE RATINGS U-Factor(U.S.P) Solar Heat Gain Coddent 0,18 0822 ADDITIONAL PERFORMANCE RATINGS Visible Transmittarice Air leakage(U.SA-P) 0,36 0A Condensation Resistance 70 MM*Cb ert*uidas fimrompfmm toappdico�eNFRCpracedureatadamm pe�ole ptodudp�:pAtlaua�tt .�dolwtuero E�BhamWndlad�kre�edon6�rwtwer�ttlnniWA94yote�pr � uCtNteldepeadlaaOaCalagdiAtau{achne�t�toronlerpro�vtpettomtmea6daromtlon. wwwid=m L — r The Commonwealth of Massachusetts Department of Industrial Accidents a Office of Investigations 1 Congress Street,Suite 100 Boston,M4 02114-2017 •wv�' www massgov/dig Workers'Compensation Insurance affidavit: Builders/Contractors/Electricians/Ptumbers A licant Information Please Print Legibly Name l>;usiness/Jrganizatiotvindrndual): Nr ��0 oPgx�r/,A / 4 r/ Phone#: '00 - 3�� ry Ci /State/Z' : V y Dk%� A-re you an employer. Check the appropriate box: Type of project ct(re uired): 4. I am a general contractor and I ❑ construction 1 1.(�I am a employer with S� * have hired the sub-contractors 6' ❑�� employees (full and/or part-time).* 7. Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ g These sub-contractors have g, E]Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. ❑Building addition ` comp.insurance.t [Nsur o workers' comp.inance 10.❑Electrical repairs or additions 5. ❑ We are a corporation and its , required'] of vers have exercised their ll.[]P11 ing repairs or additions 3.❑ 1 am a homeowner doing all work myself {1`Io workers' comp. right of exemption per MGL 2,❑ ofr airs c. 15_ 1(4),and we have no w � I insurance required] t �' § , 13. Other / to/ti 44 employees. [i o workers icomp.insurance required.] r n �°'�`f I:kny applicant hat checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this iffidavit indicating they are doing an work and then Hire outside contractors muse submit a new affidavit indicating such tcantrsetors that check this box must attached m additional sheet showing the name of the sub-contractors and state whedter or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site i infonnation. /� d Insurance Company Name: v / ti'4 C�,e- I Policy#or Self-ius.rL�ie.#:_ �v� d•• ©j�0 " 01;2 Expiration Date: - r Job Site Address: c _D 0 () 0 0J_ S City/State/Zip: / I ` Al VV 141— Attach a copy of the workers' compensatio policy declaration page(showing the policy number and expiration date). Failure to secure covera;e 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 and penalties of perjury that the information provided above is true and correct Date: l SiQ Phone# O J ! Official use only. Do not write in this area,to be completed by city or town offnciaL i City or Town: Permit/License # Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City('1'owu Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Phone Contact Person: A��® DATE(MMIDD/YYYY) `" CERTIFICATE OF LIABILITY INSURANCE 9/9/2016 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 CONTACT NAME: Melissa Pflug Mackintire Insurance Agency Inc PHONED . (508)366-6161 F (508)366-5202 AX AIC No): 11 West Main Street aDORIEss:melissap@mackintire.com INSURERS AFFORDING COVERAGE NAIC# Westborough MA 01581-1931 INSURER A Netherlands 24171 INSURED INSURERB:Libert Mutual/Peerless 24198 Newpro Operating LLC INSURERcAcadia Insurance Co. 26 Cedar St. INSURER O: INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER:�laster 15-16 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 I ADDLISUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMID01YYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS-MADE a PREMISESSOCCUR DAMAGE-TO( RENTED 100,000 Ea occurrence S CBP8589577 12/31/2015 12/31/2016 MED EXP(Any one person) 5 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 0 PRO- F-]LOC PRODUCTS-COMP/OP AGG S 2,000,000 JECT S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 Ea accident A ANY AUTO BODILY INJURY(Per person) S ALL OWNED X SCHEDULED BA 8584174 12/31/2015 12/31/2016 BODILY INJURY(Per accident) S AUTOS AUTOS X X NON-OWNED 'P Oa RTY DAMAGE S HIRED AUTOS AUTOS Uninsured motorist Blsplit limit S 250,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE S 5,000,000 DED I X RETENTIONS 1.0f000 CU 8582578 12/31/2015 12/31/2016 S WORKERS COMPENSATION X PER 'ET'_ EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE Ly E.L.EACH ACCIDENT S 500 000 OFFICEtoryIn ER EXCLUDED? y WC-20-20-003506-02 5/1/2016 5/1/2017 E.L.DISEASE-EA EMPLOYE S 500,000 C (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Excluded Officer: Nicholas Cogliani CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i � �..� xF' _ ->��t'./�'L•�'/v��•�ii�f frid Off ce oT�onsumer Affairs B�asir�ess �eguulatian .__. 1P k-plaza - Suite.517 Boston M achusew 02116 Home, Improve r star Registration Reglataffon: 148689 r` Type: Supplement lard M Expiratlo"; 5/512017 NEWPRO OPERATING, LLC. ' THOMAS FOKON 26 CEDAR ST. WOBURN, MA 01801 sa$ Update A,ddresg and retara card Mark reason for change. sca 4 zaro-a rt ,}] Address E] Renewal (] Employment Lost Card vftaanvnaPatuiecro o�Jrac�uae JZlftee ofConsumerAffairs&Business Regulation License or registration valid foriadividaiuse only Nib IMPROVE EIWT CONTRACTOR before the expiration date. If foand retard to: Office of Consumer Affairs aW Rusiness Regulation egisfratio t Tyw. 16 Park Plaza-Suite 5178 Expirat � y SupplemeA Cana Boston,NMA 42116 NEbYPRO.OPERAT' THOMAS FOXOK 28 CEDAR ST. `��6•.�--�—' le WOBUR�f,MA 01841 Undersecretary ` 14otvaifd Nithontaignature 1 q E CM Massaclsusetis 0eparfmgin: Of Public Safety Board at Building Regulation; and Standards License: CS-029090 = THOMAS PAUL FOXON = 230 WALNUT Sr READING MA 01867 r �t�irit�cn: �ommission�r 11!19!2017