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HomeMy WebLinkAboutBuilding Permit #781-2011 - 565 OSGOOD STREET 5/19/2011�6 4 TOWN OF NORTH ANDOVER d / APPLICATION FOR PLAN EXAMINATION s Permit No- Date Received o / Date if ANT: Applicant must complete all items on this - v Print PROPERTY OWNER Print MAP NO: .2 PARCEL:_A 9 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ ❑,Septi_ ' k ®loodplain INtlands: a+i� K'�,��f.+''/y,�l'," `WatershedDistrict , i. ❑Water/Sewerk ' .,t_ k_ _. DESC" IlUN -UP wUK& 1 U bb rr✓r%XUtuvarL: ' gJ�� I a 0 Yrs i� f 1 t� l Yom' i T N `- V .' Ci. ( � 1 . � t �"'t C �C. r Identification Please Type or Print OWNER: Name: Fa vv% 114. � 0 d . r V4 tie P /Y -,P -Y FJr7 Address: CONTRACTOR Name: Py r TO M u, S 2 , T6 Z Ca � fn4-, yphone: R1,t�- Address: 6 � M1 I k S tie.,e-4- - , /U 0 r, A- -ct o v ', W © (-41Y Supervisor's Construction License: 9 -7 ( � 5 Exp. Date: 9 - c,6 - a O a Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925,00 PER S.F. ti Total Project Cost: $ S-7 0 9 . "6 FEE: $ Oz) Check No.: Receipt No.:,9�416 7 NOTE: Perso-ns contracting with unregistered contractor rAot have access to the guarantyfund s -Si `nature_ of-contracto , r 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED El DATE APPROVED Reviewed on Signature Reviewed on Signature c Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments �fllater & 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 COM1ViENTS 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 Doc:.Building Permit Revised 2008 Building Department e following is a list of the required forms to be illee-d-out-or-ihe ap (Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application �❑ Workers Comp Affidavit ❑ Photo Copy O And/Or C.S.L. Licenses u Copy of Contract ❑ Floor Plan Or EMPas�d Interior Work X— F -for Engineered products All dumpster permits require sign off from Fire Department p Adc f Qg Or Decks j/G111114, LV WV aIMLw.r.v— to issuance of Bldg Permit l ❑ Building Permit pA p tca ion ❑ 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 r 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals tai the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording Lust be submitted with the building application Doc: Doc -Building permit Revised 2008mi '...r T -`►---" ...�� _..,.�..� _ - .� ......,,..�,.....,...-, . ^r....., �-• w--•...as-,,.--amu-^-.. �•...,.�. ,..-ivi:�.-..--.-...�.F . _ LocationC/ ' E No. Date TOWN OF NORTHANDOVER ?4411 �. • ,p 9 Certificate of Occupancy $ S C t� Building/Frame Permit Fee $ Foundation Permit Fee $ . Other Permit Fee $ TOTAL $ Check # 24'167 Building Inspector 0 c'r) W Q Z - CLLL E 0 o cEo a Z 3 � LL C g E �c m Ec LL01 O r 4t U�0 J ,. °� r u 0 �V 0 ;W. PQ C7 N �O Q Q v cu CU 'N •^ C t.)U LO k W 41 'a) ami N U a v cz CZ 14-4 cd A �i C1 p .-qo •" *� � N N CD CZ U W y cd rl RI *r+•/ y p O cz Q" N 'd o �I U N ° U 1. t o P.4 Z o� O ~ pcu W ? O c� z o� Q o y•� o o 042 v o O Cd Q ono [� o 4-4 s U Z U U') CIS z O /ri)jN lL !� LO D 1 m 4; Q) •O G% 41 N • � 1 4J .N y, W -0 b. U �Al 0 �N a a, .N _ U h w N r4 a •� y O � asg-, � H •O � a o o °t3 G ro � ;--4 � haw 4-4 m 0)+�+ ;5 U V w ti `r 14A' � a 1U 0., 7-4 �V 0 ;W. PQ C7 i Q\ sa x o w° A cn W IS 0 G w° a°' r U m w 0.' :j W 0 a°' cin o w 900 to - cn � a S W ui- ui y zCL= c c CO CIS G N O ;vV •C.= C. C ca � CD C :Z Q L co, Ea m c :r _ r V O C, N E C CD :oma :mom CL N R y m 3 m C � 'D m �crl N C g) y . E CD ,o CD o C -t. C� y m m .o N cm c �o,ct S �Z • � C � O cc Q O y : O C CD :ago aC+ N m~ C CD .y '_ a C C . 0.0 v y E O ® C C. m- O� CD • Mm - O O as ■ L O V O H � C ICDcm O O ■O 'ff m m L- H *" CD 3� O G O O d CL cm< c o -1- � vO O J •O Q O CD ca C Z CD 0 CL V CO) O C C cc CL CO2 TGR Carpentry 69 Milk Street North Andover, MA 01845 978=689-8599 March 7, 2011 Family Coop 549 Osgood Street North Andover, MA 01845 Attention: Kim Hearst -PROPOSAL- Re: (5) Exterior Doors Four doors enter the building and one door enters the furnace room. The four doors that enter building will be Therma-Tru fiberglass doors with 9 lite glass, grills between tempered Low -E glass. Two doors will be installed with panic hardware. One on the main entrance exiting to the parking lot and one at the other end of the building exiting to the playground. The remaining two doors will have handicap handles. The door for the furnace room will be Therma-Tru fiberglass with no glass and standard hardware. The five doors will be installed with new casing inside and outside. Quotation: $4959.00 Option: Vinyl jams and exterior casings: $150 Accepted by:f �� , i, ( Date: 3- I �— Peter Tomasz Owner MA Lic. No. 97115 05/16/2011 07:07 9786820713 RC LAFOND INSURANCE PAGE ` 03, pav! c (uN"iDDiri" s ApQRDCERTIFICATE OF LIABILITY INSURANCE TGR Q01 PRODUCER MIS CERTIFICATE 18 ISSUED AS A MATTER OF INFOFiMA s 0 s ONLY AND CONFERS NO RIGHTS UPON THE CER11FICA a HOLDER. THIS CERTIFICATE ROES NOT AMEND, EXTEND I ,• TER THE COVERAGE AFFORDED BY THE POLICIES BEL+ o ' R. C. LaEoltxd znsurmnce Agency 396 Andover Street '� North Andover NA 01845 Phone -978-686-3826 Fax:978-682-0713 INSURERSAFFORDIroGCOVERACE NA,�+" INSURED INSURER A- The Norfolk & A7adham E�rC+^:J INSURER B: - - TGR INSURER C Pete T=aoz --� 69 M lk Street INSURER 0: -- North Andover NA 01845 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHUTA` 011"O ANY REQUIREMENt, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITM RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, POLICIES, AGGREGATE INS SHOWN MAY HAVE BE ANC POLICIES REDUCED DESCRIBED PAID HEREIN Is SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH -- — POLICY NUMBER p M DUNA= GENERAL LUI6IUYY COMMERCIALGBNERALLIABILITY R0627666A CLAIMS MADE r—_-1 OCCUR _E_ 'L AGGREGATE LIMIT APPLIES PER: K POLICY 7 TROT Ll LOC AUTOMOKE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE UABILm 7 ANY AUTO EXCESSIUMBRELLA uASILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION i WORKERS COMPENSATION AND EMPLOYERS' LIABLLITY O�FFIOROOP IETERMAAC NE& ECUTIVE ERM ALL OPERATTOI g USUAL TO '1TRAT OF A CARPENTER - HOLDER Family co -Operative Pre School Inc. 549 Osgood Street North Andover MA 01845 ACORD 26 3.2/21/10 1 12/21/11 SHOULD ANY OF THE ARM DESCRIBI D POLICIES pi DATE THFJMOF, THP MUM INSURER WILL ENWEAVOR -10 MAtL NOTICE TO THE CERTIFICATE HOLDER NA74E D e0 THE LBF T, BUT FAAUR-. ;i W Wl. 5HA?;1:•. IMPOSE NO OMJOATION OR UANtLtTY OF ANY KIND UPM 'i r'F INSURER. IT F� At--Eh'i 5 + REPRESENTATIVES. EACH OCCURRENCE PREMISES (FA 00Wren«s) MED EXP (Arty one PBr9Rfl) E 1 a 05 4,_ _, PERSONAL & AUV INJURY 5 h, A 0 (' S ?. ; 0 Q 0 GENERAL AGGRFG/Ci E MODUCTS • COMPIOP AC-G COMBINED SINGLE LIMIT (Ea osxlderry . _-- BODILY INJURY (Per petsen) i JURY 5 (POe°IIwIdwt) tllt PROPERTY D", GE (Per w�dent) AUTO ONLY - EA ACCIDENT OTHER THAN F -A ACC r AUTO ONLY: AGC3 EACH OCCURRENCE AGGREGATE _ TORY LAIN HR-- E.L EACH ACCIDENT i E.L. DISEASS • FA EMPLOY -R. S,Iw DISEASE ^?OLICT UMIT . SHOULD ANY OF THE ARM DESCRIBI D POLICIES pi DATE THFJMOF, THP MUM INSURER WILL ENWEAVOR -10 MAtL NOTICE TO THE CERTIFICATE HOLDER NA74E D e0 THE LBF T, BUT FAAUR-. ;i W Wl. 5HA?;1:•. IMPOSE NO OMJOATION OR UANtLtTY OF ANY KIND UPM 'i r'F INSURER. IT F� At--Eh'i 5 + REPRESENTATIVES. INDOOR SPACE SKETCH In the space below, diagram the Center's layout. When drawing in walls, note the length in feet on each wall (i.e., 116"=1.5 ft). The diagram should designate all space used by the Center including classrooms, kitchens, bathrooms, and administrative areas. Please note all Exits. } , , HI , I j K, Oil" 1 { , D 1 ' i � i I f r ' i 11 , f! 11Vg bquure ff car requi-reu length X width=footage chil- staff dren Room 1 Room 2 Sig tore Room 3 Room 4 Room 5 Position Total square Footage ` �' • /! o GDCDate.-16 3 f �°� O The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 www.mas,. gov/dia Workers' Compensation Insuranee Affidavit: Biiilders/ContractorslElectriciaaasfplu nabelrs Applicant Information Please Print Legibly Naive (Business/Organization/Individual): 1 V" Address: City/State/Zip: ►\�C . %�Ue� �c- G(t(S-Phone#: �-t�� -`� - ��' Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in. any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling . 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box 41 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 isproviding workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins, Lic. M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workerscompensation 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 11ereby certi&znder the pains andpenalties ofpe#ury that the information provided above is true and correct. 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone \ Zm: } mq \ z \ \ O . ` o = K 2 $ / m H N / a 3. @ / o o -. 5 \ \\ v. D 2 ID m ® \\K (D 2 � % \ } \ 00-§�- \ -