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HomeMy WebLinkAboutBuilding Permit #150 - 400 OSGOOD STREET 8/25/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: d a� 0 IMPORTANT: Applicant must complete all items on this page LOCATION 4100ST' . Print PROPERTY OWNER 0SC.,-o 0eKs 99 Pdnt MAP NO: PARCEL: 0 ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addi ' Two or more family Industrial, Alteration No. of units: excil' Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTI N OF WORK TO BE PERFORMED: �.,Q ��.�Q S��a ti��a-� �-r� 0..,9-e✓ D� 1<<c.re.� '� ��..e.�t�_� f� Identification Please Type or Print Clearly) OWNER: Name: Phone: 2-27-6!R3-?'7 z 7 Address: OS60121IC-i Si kQd • * or��.Ss 4 $ CONTRACTOR Name: 4:2AL - b�Y-IASS Phone: Address: �. A? 7-& I�J,C ,� r � . /''l� ► � �'"/ - D 21 Ste` If Supervisor's Construction License: CS el2l „ ` Exp. Date: v Zt Zol/_ Home Improvement License: Exp. Date: ARCHITECT/ENGINEER SwC-5VyZ�ILEPPHtE t-1 s i="-+hone: 9'76' o 352-®:3z6 Address: f ct-oL � r0. ��'�• � �Y tnu� Reg. No. ?GZO FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -2-6,000- '-4 FEE: $ 5 �- Check No.:�4F0 z Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the g anty fund Signature of Age nt/Ownerl jV Signature,of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans i 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 1: 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 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 - Date i -............ ..... _._............. .......... ----._....----.----- .....-._-......-.........-........... ........................ ...__...----..._.-........... ................................ ................ .-------.-....-........-...............................---....._.............—-------- ----..........................................._........... Doc:.Building Permit Revised 2008 1 Building Department The following is a list of the required forms to be filled out for theappropriate ermit to be obtained. P 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 j' 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: Doc.Building Permit Revised 2008 Location Dd 0� d No. Date �r, 6� OORT" TOWN OF NORTH ANDOVER ",t`•o I•,�O�L F 9 Certificate of Occupancy $ cMuf< Building/Frame Permit Fee $ s� s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #�,� / 2262, /,(Uil d ing Inspector �.1O R TH Town of : 4Andover ..::�_ - 0 No. /,5-p �. s�O � - LAKE -` �OV�Lr,, Mass., COC M I CAKE HE WICK V ADRATE D PPS\ �y `s BOARD OF HEALTH PERMIT T Food/Kitchen Septic System , e BUILDING INSPECTOR THIS CERTIFIES THAT ./... f ... .. ... � .V.�:'':�..... ......... w � Foundation C1.r' F has permission to erect........................................ buildings on .... .................. .. ........... ... ............................... Rough to be occupied a ........... 6.4/l/.t.!r /.' .�.r���".... •f .... ...1.. ......... ........... ....................... Chimney provided that the arson accepting this permit shall in eve respect conform tot a terms o" f thea ' ation on file in P P g P every P PP Final this office, and to t ' ' as__of-the Codes and By-Laws relating to the Inspection, Alteration d 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-ION STARTS Rough ........................ .............. ...... ..... . ......... ..r''�^!''+................ Service B WING INSPECTOR 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. 11 7/8"TJI 110 @ 16"O.C. TJI BLOCKING TJI BLOCKING 2 LAYERS 1/2"PLYWD 2 LAYERS 1/2"PLYWD TJI RIM TJI RIM PROVIDE SIMILAR STRAP OR HOLD- IF CANTILEVER IS USED- DOWN ANCHORS IF CANTILEVER IS USED- MAX=2'-4" MAX=2'-4" MINIMUM TOP PLATE EXISTING 2X4 PARTITIONS NOTE:LOADING NTE 125#/SF DETAIL@ STORAGE PLATFORM o SCALE 3/4"=1'-0" NBlue Sky OSGOOD STREET PROJECT NO.: celtabarative architecture SCALE: 3/4"=1'-0" Stephen Jensen,AIA Andover, MA DATE: 8/6/09 Four Federal Street Beverly,78 232- STORAGE PLATFORM ABOVE OFFICES @ S 1 phone 978.232 16 TENANT#3 fax 978.232•0316 www.blueskyarch.com Massachusetts- Department of Public Safety Board of Building Revelations and Standards 0- 6WA fpR,Supervisor License leense:,CS 42144 .x, Fokicte Q r ARL Q iAS Hl M :0 BRD BEVEF2 .Y, cam= Expiration: 6/29/2011 wgay`' C onun sCOtiBTi >�`�-� Tr#: 17380 e�To: Page 2 of 3 2009-08-21 18:24:52(GMT) From:Welsh and Parker Insurance Agency Inc. ACORD DATE(MM/DD/YYYY) TM. CERTIFICATE OF LIABILITY INSURANCE 08/21/2009 PRODUCER Phone: (978)562-5652 Fax:978-562-7120 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION WELSH& PARKER INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 131 COOLIDGE STREET, SUITE 100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HUDSON MA 01749 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Central Mutual Insurance Company 20230 KNEELAND CONSTRUCTION CORPORATION INSURER B: Central Mutual Insurance Company 20230 407 R MYSTIC AVENUE SUITE 34B INSURER C: AIG MEDFORD MA 02155 INSURER D: Central Mutual Insurance Company 20230 INSURER E: National Federation of Independent Business COVERAGES 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 WTH 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.AGGREGATE LIMITS SHOW" MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR ADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRATION LTR /NSR DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY CLP 7998068 08/01/09 08/01/10 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 PREMISES(Ea o,curan. CLAIMS MADE OCCUR MED.EXP(Anyone person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 29000,000 X POLICY PROJECT LOC AUTOMOBILE LIABILITY BAP 8606345 01/04/09 01/04/10 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ D X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY $ AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS!UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ TU- WORKERS COMPENSATION AND WC6765289 04/26/09 04/26/10 TORSTYUMITs OTHER EMPLOYERS'LIABILITY E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 Ifyes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION KNEELAND CONSTRUCTION CORPORATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 407 R MYSTIC AVENUE SUITE 34B EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS W RITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MEDFORD MA 02155 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,IT'S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: (:orlanhcrn To: Page 3 of 3 2009-08-21 18:24:52(GMT) From:Welsh and Parker Insurance Agency Inc. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend.or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001108) C PrtifiratP#Rnd7a F-13-el.,9 Date. . . . . . . . . . . . . NORTH TOWN OF NORTH ANDOVER PERMIT FOR'PLUMBING ,SSACMUS This certifies that . . . . . . . . �e . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform plumbing in thebuildings of at. Nortft Andover, Mass. -42 e, xg Fee. . . . . . . . .Lic. No.. . . . . . . . . . . . . .ly . . . . . . . . . . PLUMBING S ECTOR Check 8179 r �R MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Qp ,,�` � Date Building Location#a() y'[��S� NO A/�4c(}ACS Name Permit—# / Amount /7LS- Type of Occupancy New Renovation MI Replacement Plans Submitted Yes No FIXTURES W Cx w U 0 `"w �+ W W W W A A W F" ►xy x F Z STSBSW BASDINr in Him M H}x%2 M FLOCIR 4IH Hit M MOOR 6II31tiL00R - 7M ILOOR gm HlOcZ (Print or type) Check one: Certificate Installing Company Name kewin Lo tA/(l ❑ Corp. Address 'S"? f a*'a'� PD, Partner. Business Telephone -.936- 3 m Firm/Co. Name of Licensed Plumber: KP (f 1'a Loa k n Insurance Coverage: Indicate the type of insurance coverage by checking theappropriate box: Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three incur ignatur Owner Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mr s chset tat Plumbing Code and Chapter 142 of the General Laws. By: 1gna ure o icense ^um er Type of Plumbing License Title a ©(38 City/Town icense Num5er Master ❑ Journeyman m/ APPRO VED(or-EtCE USE ONLY K�J ri The Comma►szwealth of Msssachusei& + U 4l Department of Industrial Accidents at ) Office of Investigations �•. J i�psl 600 Mjashingtan Street ti 4b; Boston, MA e2111 c www nnus.gov/dia . Workers' Compensation Inskrance Affidavit: Builders/ContractorsMiectricians/piambers Applicant Information. Please Print Lt-bl Name (Business/Orgaoira6on/Individua! : ) p,lil � •La f K, n Address: City/State/Zip:—W��tl1 f0/l1 (' Phone#: . g r' F2. e you an employer?Cheek the appropriate box: 1 am a employer with_ 4, Type of project(required): ❑ I am a general contractor and Iemployees(full and/orpart-tirn )e .* have hired the sub-contractors 6' ❑New constructionI am.a.sole proprietor.or partner- lis>ed on the attached sheet = 7• [ Remodeling ship and have no employees These sub-contractors have working for me in any capacity workers' comp.insurance. S ❑DemoRtion INo workers'comp, insurance 5. ❑ We are a corporation and its 9• ❑Building addition required.] officers have exercised their 10.0_Electrical repairs or additions 3.❑ I am a homeowner doing ail work right of exemption per MOL 11.❑Plumbing repairs or additions myself,[No-workers'comp. c. 152, §I(4),'and we have no insurance required.].t emPto ces. [No workers- 12.[]Roof repairs COMP. insurance required_] 13.❑.0ther *Any applicant that checks bo;e#l must also fill out the section below showing their workers'6ompenwdion policy information t homeowners who submit this affidavit indicating they ars doing an work and then hire outside connetors must submit a new affidavit indiaetiug such ;Commctors that check this box must atmehed an additional sheet showing the name of the subcontractors and w'stheiworkers'comp.pvit i information. I an.an errnpleyer that is providtng:workera'compensation insuraneorfe infarrrratiorn. my employees: Below is the policy and job site Insurance Company Name.- Policy ame:Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/state/Zip- Attach a copy of the workers''comtpensation policy declaration page(showing the policy number and expiration date), Failure to secure coverage as required.under Section 25A of MGL e. 152 can Lead to the imposition criminal penalties of a er fine up to$1,500.00 and/or one-year imprisonment,as well ELScivil penalties in the farm 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 c`nde the p 'ns and penalties of perjury that the information provided above is true and,orrect Si Date: Phone#: Lf FofHealth only. Do not write in this area,to be compler�ed by city or town official n Permit/License# hority(circle one): Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector son: Phone#: Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp 3 overs 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 or more of the'fomping engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,associatiotn 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 t3he,commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until-acceptable evidence of compliance witb the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation•affidavit compie✓tely,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 re*ed to carry workers'Mrnpensation 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.,nofthe 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 numberlisted below. Self msu+.d comp*-niec sh--LId ent--tTt-r self insurance-license number on tho*appropriate.line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hes 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 v-ill 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.officiaily 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 bum leaves etc.)said persons is NOT required to complete this affidavit The Office of lnvestipations 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 Con=onweaFlth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL#617-727-4900 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 5-26-(?5 www.IItass.govIola