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Home My WebLink AboutBuilding Permit #586 - 400 OSGOOD STREET 5/1/2018 TOWN OF NORTH ANDOVER �yORTF/ APPLICATION FOR PLAN EXAMINA'T'ION 1160 16 q~° 6 16 Permit NO: Date Received—?7 Date Issued: �9SSaCHus�� IMPORTANT: Applicant must complete all items on this page LOCATION 400 QS povcl S�� N�� An�u✓c am � /`1A 01 Y 7 Print PROPERTY OWNER l✓I�-hw �4 r r, ,�� Print MAP NO.: � L/ _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 ❑Alteration No. of units: ❑Repair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition Moving(relocation) ❑Other ❑ Others: ❑Foundation only DESC IPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) / OWNER: Name: �� Phone: Address: q06 CONTRACTOR Name: 1?HoM4 AS M�� -U �77-0 Phone: - Address: 14 $C 2C 1 i t.(. CIO 1 Supervisor's Construction License: CS 1� Exp. Date: �1 07 , Home Improvement License: 13-1 Exp. Date: l I ` 7 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED OST BASED ON$125.00 PER S.F. Total Project Cost :$ FEE:$ Check No.: =Pe y.4 Receipt No.: Z=� Page 1 of 4 TYPE OF SEWERAGE DISPOSAL ❑ ❑ Tanning/Massage/Body Art E] Swimming Pools Public Sewer ❑ Tobacco Sales Food Packaging/Sales ❑ Well ❑ 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 guaran fu Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plan 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 FIRE DEPARTMENT - Temp Dumpster on site yes a no Fire Department signature/date 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 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required 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 DEPARTMENTMFORM05 Created 1MC..Ian.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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o 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 o 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 DEPARTMENT:BPFORM05 Page 4 of 4 Location No. lO Date �oRTN TOWN OF NORTH ANDOVER .�: � •SOL F141 D Certificate of Occupancy $ �'�S'••°^Eta' Building/Frame Permit Fee $ 2r) SACMUS Foundation Permit Fee $ _ Other Permit Fee $ n+' TOTAL Check # �dya"° G rr�� Q V r, Building Inspector./ NORTH own of 1over No. %464 C% over, Mass., 0 'A 1. C CHICHEWICK rE D Pk*' WARD OF HEALTH Food/Kitchen PERMIT T D Septic System •THIS CERTIFIES THAT Jim 00, BUILDING INSPECTOR W.W............ .............................................................................. Foundation has permission to ere: ....................................... buildings on ...A/ Rough Chimney .... ..................................................................... .......... . to be occupied as iw a...O.W.4-0....... provided that the person accepting this 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 LIE CAL INSPECTOR UNLESS CONSTRUCTION- STARTS Rough ............ ...!......... ................ S;Mce BzDNG INSPECTOR Foal Occupancy Permit Required to Omipy 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. d N011TN,y ♦ s CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 586 Date: March 9, 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON ' 400 Osgood Street MAY BE OCCUPIED AS Commercial Office Fit Up IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: William Bannister 400400 Osgood Street North Andover.MA 0 5 ,v-,,4a. Building Inspector NORTH Town of over No. 66 F" W RP06.. t-4 over, Mass.,- .3-r% to 2 0 LA COCHICHEWICK 7,9 0 ATED WARD OF HEALTH Food/Kitchen PERMIT T Septic System 08jam BUILDING INSPECTOR THIS CERTIFIES THAT.......Wr;e... ......... .............................................................................. Foundation has permission to ereL.................................... buildings on... ........ .......... Rough ............ to be occupied as.% ........ ..................................................................... Chimney provided that the person accepting this 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 '-ALECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ..... .. Service B -ILDING L FiU Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Uf 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): dX_WAd ,4D r/M7dyNl f/NS Z 70,ows Ivaw-20 -.01Address: !�✓� City/State/Zip: Ala, Zleod /Ls/� 067/ Phone#: Are you an employer?Check the ppropriate bog: Type of project(required):. 1.�am a employer with 4. E] I am a general contractor and I employees(full and/or part-tune). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. Buildingaddition [No workers'comp.insurance comp.insurance.$ required.] 5. E] We are a corporation and its ME] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.El Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether 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 and job site information. Insurance Company Name: /,;Al �wj )v5 Policy#or Self-ins.Lic.#: 701870601 ZOZ)7 Expiration Date: 31,04 Job Site Address: 4� ar� aiy vim- City/State/Zip:/ /,. dV470V-,K ✓('�� 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 certifyunde a pa' s nd penal ' s of perjury that the information provided above is true a d correct =��Si ature: Date: T-e � Q 11 _ Phone#: i'79' 9,55 ' G 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 M 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 or more 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 numbers)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 bum 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-$77-MASSAFE Fax#6l7427-7749------ Revised 11-22-06 www.mass.gov/dia w a�n-Ft�ro„� L- Ca a - C-7 61C. Ow ugjy dd 1,M0 dw 'VOW31118 OZZn-W3w LSH08le I 00 :131W31JIsea 91.0L8 :ou LOOZ/90/60:sandx3 L96I./90/60•:eWP4lj18 t� 91,0L80 So :jegwnN 2iQSIAN3dfiS MO11Onu.LSNOD :esueol� SNOI:L�t"Tf}J3a JNialin8�O 02)VO8 �fce -�am�na�eule� o��/�aac�usaek$ Board of Building Regulations and Standards D` HOME IMPROVEMENT CONTRACTOR y Registration: 139072 Expiration; 6/10/2007 Type: DBA CONCORD ROAD CONTRACTING THOMAS MERLUZZO 4 BIRCH ST. BILLERICA,MA 01821 Administrator