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Home My WebLink AboutBuilding Permit #907-14 - 661 OSGOOD STREET 5/1/2018 BUILDING PERMIT °��t,ED p10 R TF/ TOWN OF NORTH ANDOVER 0 2 APPLICATION FOR PLAN EXAMINATIO Permit No#: I ' Date Received 2 Sys RATED SgCHus Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Pnnt PROPERTY OWNER. �Jt�.d�j.,✓1� � - ---- -- Pnnt 100 Year Structure yes. no s MAP- PARCELa ZONING'DISTRICT`.___ _ 3. Historic District yes no _-_- Machme Shop Village yes trio TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family k ddition [ITwo or more family 11Industrial lteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p Septic El W6 ❑ FCoodplain ❑Wetlands. 0 -WatershedrDistrict Wa#er/Sewer __ DESCRIPTION OF WORK TO BE PERFORMED: I Identific tion- Please Type or Print Clearly . OWNER: Name: 0- I -,ePA0 Phone: 3/44 —0131 Address: 64101 Oss 57"_ Al, eS e�✓�U - Contractor Name: ___.___Ph one A,ddre99 _ r S'upervisor's Construction License: -� J^ -_ Exp. :Date: _ _- YTY a ,R .T�-_k T _ Home Irnprovemenf License.—_/6- 31,ZZ._�_ T Exp: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ c2,COO FEE: $ 04(D•tro Check No.: 532 Receipt No.: 21 tp1 J NOTE: Persons contracting with unregistered contractors do not have access to the guaranty nd Signature of,Agent70wne Signature of"contractoi __� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swumning 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 8 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 AFIRE DEPARTMENT - t_iernp+Dum;pster on site yes ., .__ nom = . -_ -- Located,at 124 Main Sheet a Fire Department:signature/date COMMENTS r . r I i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. it 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 i NOTES and DATA— (For department use) I , ❑ Notified for pickup Call Email i Date Time Contact Name I 3 Doc.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 Li Building Permit Application X� Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses CopY of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) L, Building Permit Application i o Certified Proposed Plot Plan I o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) L, Copy of Contract o Mass check Energy Compliance Report o 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:Building Permit Revised 2014 LU os o us Location LIj t2. �Lj Date � o - TOWN OF NORTH ANDOVER iv • eCertificate of'Occupancy $ Building/Frame Permit Fee $� �' Foundation Permit Fee $ <r Other Permit Fee $ TOTAL $ III Check# , 27673 46ilclinInspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $� 2�0410�0).,0,0) m $ - $ 240.00 Plumbing Fee $ 30.00 Gas Fee 100 comm. 1$3 110:0).00) Electrical Fee $ 30.00 Total fees collected $ 400.00 661 Osgood Street 907-14 on 6/13/14 Finished Room in Basement � NORTfy Town2 E ...'.1,. nc"[nover No. o h y ver Mass J U de. 121 COC "'C"tWIC.t U BOARD OF HEALTH Food/Kitchen ERMI�^ T LD Septic System THIS CERTIFIES THAT ^� Jr e 2 mo BUILDING INSPECTOR .............. ............................................................................................................ .QS 1 O OCA Foundation has permission to erec ......................... buildings on .... ......................... ........................................ � Rough to be occupied as ......... r �v'�' 'r p� ........................................�................................................................................. 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 y c �A Final PERMIT EXPIRES 6 IN MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION 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. 63�-5'16° eTecrr-pa 3 ca erege 17 9 i �1Gy rouvn new fT ished room � < I 4 furnace i I unfinished i unfinished =$ _ m i Y i I - i i 41445' YI•-876° JAMES NEWCOMB 151 SHAWSHEEN ROAD ANDOVER, MA 01810 (978) 479-6577 DATE: June 10, 2014 . OWNERS: John Ferro ADDRESS: 661 Osgood St N. Andover Ma CONTRACTOR: James Newcomb, MA Construction Supervisor License CS 14717 MA Home Improvement Contractor License Reg. 101311 REMODELING CONTRACT DESCRIPTION OF PROJECT: Finish room in basement per plan. 550 square feet. Framing. Electrical including six recessed lights. HVAC from existing system. R-15 insulation in walls. Blueboard and skimcoat plaster. Five interior doors, baseboard. Two coats paint. Drop ceiling. Carpet by others. CHANGES IN THE WORK: Any changes or modifications which Owners want to make shall by done by written Change Order and any costs shall be adjusted accordingly. PAYMENT TERMS: Owners agree to pay Contractor a total cash price of $20,000.00 upon the following payment schedule: $10,000.00 Upon completion of framing $10,000.00 Upon completion of project CONTRACTOR OWNER i D AIE DATE DATE(MM/DD/YYYY) ACORH CERTIFICATE OF LIABILITY INSURANCE 6/10/2014 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 NAME: Sandi Munroe M P ROBERTS INS AGCY INC PHONE (g78) 683-8073 aC No:(978) 683-3147 A/C No. o Ext 1060 Osgood Street ADDRESS:sandi@mprobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAICN INSURER A:ASSOCIATED EMPLOYERS INS CO INSURED JAMES NEWCOMB INSURER B: 151 SHAWSHEEN ROAD INSURER C: ANDOVER, MA 01810 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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. (NSR TYPE OF INSURANCE D s P LI EF Y P LIMITS LTR (NSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FXI OCCUR PREMISES Ea occurrence $ 100,000 3DL8770 06/26/13 06/26/14 MED EXP(Any one person) $ 5,000 B 06/26/14 06/26/15 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F—]JEo 7 LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITYEa accident) $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNEDPROPERAM $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE RIH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 06/27/13 06/27/14E.L.EACH ACCIDENT $ A (Mandatory in NH) EXCLUDED? N/A WCC-500-5012206-2013 06/27/14 06/27/15 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 OSGOOD STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATJVEA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards,:. Construction Supervisor License: CS-014717 JAMES J NEWCO 151 SHAWSHEEN RQ- 0181 ANDOVER MA U S r I Expiratior Commissioner 08/26/201: i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 101311 Type: Individual Expiration: 6/25/2014 Tr# 225530 JAMES J. NEWCOMB James Newcomb 151 SHAWSHEEN RD Andover, MA 01810 Update Address and return card.Mark reason for change. SCA 1 20M-05/11 F-] Address F-] Renewal7 Employment 7 Lost Card t: �6 The Commonwealth of Massachusetts _ Department oflndustrialAccidenis Office oflnvesttgations 600 Washington Street .Boston,NIA 02111 www mass.gov/clia Workers,COMP emationInsurance Affidavit:BuRders/Cony°actors)EIectx clans/PlUmbers Applicant Information Please PrintLegibly Name(Business/OrgadzationlTndividual): y Cr lir,2 S A e'- X Address:_ City/StatelZip: ��G�,�., Phone#: ,,r4 Are you an employer?Check the appropriate box: Type of project(required): _I.,0_I am a employer with C,�2— 4. ❑ I am a general contractor and l g []Now construction employees(full and/or part-time).* have nedth.e sub-contractors 2,111 am a sole proprietor or partner listed on the attached shoot. 7. Remodeling ship and`haveno.employees These sub-contractors have S. E]Demolition working forme in any capacity. workers'comp.insurance. g, []Building addition [No workers'comp.insurance 5. F1 We area corporation audits 10.❑Electrical repairs or additions required.] officers have exercised.their 3.01 am.a homeowner doing all work right of exemption per MGL 11.[1 Plumbing repairs or additions myself:Flo Workers,comp. c.152,§I(4),and wehaveno 12.Q Roof repairs insuraacere ed. employees.[Nb workers' ] 13.0 Other comp.insurance required.] xAny applicantthat checks box#S must also fill outthe section bel6w showingtheir workers'compensation policy information. 'catin the'kedging all work and then hire outside contractors must submit anew affidavit indicating such. ►Homeowners whosubmitthisaffidavitmd� g y g r ed additional sheet showin the name of the sub.-contractors and their workers comp.policy information. •Contractors that cheokthis box must attach an showing the an employer that isproviding workers'compensation insurance for my employees Below is the policy antijoh site information. n : /� � c.'c.�� m e ��1. —� •�S. o. Insurance Company Name —S c�— a'o Policy#or Self-Ins.Lic.#: tcJ�- ��a:� Exptr tz u Date' lob Site Address. ��✓X5 7' fCity/State/tip: /�/�v, rho, Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration.date). Failure to secure coverage as mquiredunder Section 25A ofMGL o.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 WORD ORDER.and a fine ofup to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of investigations of the DIA.for insurance coverage verification. X do hereby cert!y under tiiepains and hies ofper•/ury that thein formation,providecl above is true and correct. _-20/Date• O/ Signature: Phone#• /f ��T� / ��A II Ofjy-eial use Daly. 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.Electricalxuspector 5.Plumbinglnspector 6.Other ContactPerson: Phone i#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an.er,',Ployee is defined as``...every person tri the service of another under any contract ofhire,- express orimpH4 oral ovwxztten.,, An erm ploydis defined as"an individual,partnership,association.,corporation or other legal entity,or any two or moxe 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 xesides therein,or the occupant of the dwolling house of another who employs persons to do maintenance,construction or repair wont 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 1.52,§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 ofpublie work until acceptable evidence of compliance with the insurance requirements of this chapter have beenpresented to the contracting authority.." Applicants Please ftIl out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if n6cegsary,supply sub-contractors)name(s),address(es)and phonenumber(s)along with their cer0cate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other thau the members or partners,are notrequired to carry workers'compensation insurance. If au LLC or LLP does have employees,apolicyis required. Be advised thatthis affidavit maybe 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 retumed to the city or town that the application for the permit or license is being requested,xtot 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 companiesshouldenteri7ieir self-insurance license number on the appropriate line. City or Town Officials Please be sure thatthe affidavit is complete and printed legibly. The Department has provided a space at the bottom of the afftdavitfoxyou 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/Hcense number which will be used as a reference number. In addition,an applicant that must submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessmy)and under"Job Site Address"the applicant shouldwrite"all locations in (city or towh.)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as pxoofthat a valid affidavit-ii on file for future pemsits or licenses. Anew affidavit must be felled out each year.'Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves eta.)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 aind fax number: Tho GoxnMow.ealthofIibSa a(6l,usetta - Depart exit Q£WwWal Accident Office of7nmUgA- 0)n 6bG Washljg-f on S re l TQJ,#617,72,749-00 0A 406 Q.r 1-87MASSM'E Revised 5-26-05 Fal 617-727-7749 WWW-MuS,gQvfdia