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HomeMy WebLinkAboutBuilding Permit #498-15 - 995 OSGOOD STREET 11/24/2014BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION O',�t�eo cb�'ry0\ i y/" nQ � 4 Permit No#: Date Received gSSACH' Date Issued �w__ I ORTANT: Applicant must complete all items on this page LOCATION �� �S�S OO D �5 Print PROPERTY OWNER i C r 0 0 h Pro I Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building ❑ One family ❑ Addition & ►Lt) o ❑ Two or more family ❑ Industrial ❑ Alteration OF S (A C No. of units: gCommercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands 0 Watershed District X Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Add rPq-,- Phone: r, Contractor Name: Ca a s -t em- otl4 1A)KI Y 29498'WY Address: �y�N �l E Si -j D A AINQI) ),` a MA Dr8¢,S Supervisor's Construction License: G J f 7 Exp. Date: c� 3 Home Improvement Lice . Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BIASED ON $125.00 PER S.F. Total Project Cost: $ ' 6 LfJ FEE: $^�- Check No.: �� Receipt No.:���r NOTE: Persons cont acting with unregistered contractors do not have accfss to the guaranty fund nature of contractor 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 Reviewed On Signature, COMMENTS CONSERVATION Reviewed on Signature COMMENTS C HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osqood Street IRE 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) _ZT55 IV ❑ Notified for pickup Call Email Date Time Contact Name 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o 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 Doc: Building Permit Revised 2014 � � S Location No. Date Check #7 u TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ r Other Permit Fee $ TOTAL $� Building Inspector ANNINO INCORPORATED ARCHITECTS • PLANNERS DOUGLAS R. ANNINO, NCARB PRINCIPAL RICHARD PAUL PETERSON, NCARB ARCHITECT ERIK L. IMMONEN, NCARB ARCHITECT, LEED G.A. November 26, 2014 Mr. Brian Leathe Building Inspector Town of North Andover Building Department 1600 Osgood Street Building 20 Suite 2035 North Andover, MA 01845 Re: Rough Framing Inspection Associated Home Care I#995 Osgood Street=s North Andover, MA Dear Mr. Leathe: This letter is to verify that the framing of non -load bearing partitions in the Associated Home Care space in the lower level at 995 Osgood Street conforms to the plans developed and submitted to the building department and the contractor should be allowed to proceed with the work. Framing work has been done in a neat and workmanlike manner. If you have any questions or comments please feel free to call me at 508-643-4551. Thank you for your consideration in this matter. Sincerely, • t4o Douglas R. Annino, NCARB -,� . iii$ S R•,q "•,F; o � Q No. 5496 ° MANSFIELD, M ivOMA 4t jH OF to ARCHITECTS & PLANNERS • 125 NORTH WASHINGTON STREET • NORTH ATTLEBORO • MASSACHUSETTS • 02760 508.643.4551 • FAX 508.643.4622 Eq* IN a 0 W U o R O W cc °j z — c z o o M E L N :m f 0 o oF— ` cccZ H o V i VCD 3 lC f: N J w i �+ CL Z Go N U O ) cc (A LLI O ww -0 O N O ~ . 0-0 > ) Q = x Z U) y.+ mm G /� W O C C V r.L 0 �co ■- y = O as N W a,'> o c W J H CL Z CL ' y m V Z C L O .:�Q o O C C -0 0 Q i O .O = d 4) 6= N ~ N O V m d N w W .•�ROC o O y.N C LLJ w QJo rL�O . 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J -a O ..(D Z rmL U) CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 498-15 on 11/24/2014 Date: January 7, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 995 Osgood Street MAY BE OCCUPIED AS tenant fit up — Associated Home Care IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: PrePaid $100.00 Receipt: 28297 Check: 1576 Osgood Properties, LLC 995 Osgood Street North Andover, MA 01845 21,61=- Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 612.00 Plumbing Fee $ 76.50 Gas Fee 100 comm. Electrical Fee $ 76.50 Total fees collected $ 865.00 995 Osgood Street 498-15 on 12/2/14 Tenant Fit Up A ANNINO INCORPORATED ARCHITECTS s PLANNERS DOUGLAS R. ANNINO, NCARB PRINCIPAL RICHARD PAUL PETERSON, NCARB ARCHITECT ERIK L. IMM6NEN, NCARB ARCHITECT, LEED G.A. November 26, 2014 Mr. Brian Leathe Building Inspector Town of North Andover Building Department 1600 Osgood Street Building 20 Suite 2035 North Andover, MA 01845 Re: Rough Framing, Inspection Associated Home Care 995 Osgood Street North Andover, MA Dear fair. Leathe: This letter is to verify that the framing of non -load bearing partitions in the Associated Home Care space in the lower levelat .995 Osgood Street confirms to the plans developed and submitted .to the building department and the contractor should be allowed to proceed with the work. Framing work has been done in a neat and workmanlike manner. If you have any questions or comments please feel free to call me at 508=643-4551. Thank you for your consideration in this .matter. Sincerely,n`SttiR�D�AP,��hj�/ j IG. . 4. t5.1f oI� 5496 � �tZ Douglas R. Annino, NCARB ril OC ARCHITECTS & PLANNERS • 125 NORTH WASHINGTON STREET • NORTH ATTLEBORO * MASSACHUSETTS a 02760 508 a 643.4551 s FAX 508 0 643.4622 O C O O Cc V :a+ cc .Q d �_ o U� E Q. i y w C N d � r � • 0 � E O C A O v i �N 0 3 aLCa Q' J CD C m > C O t: C •� N O O = N > cm cc N O C to CD 4 n E� o m � z — N G O c0 1.O L Q d Q aw o CD V R 0co y O C C L cu:a ~ 0 O O v m ujh W = :5 O O LL y d W C •� O v 0 w E U 4) i V O O -a d cn n >z _ N =O F— .0 $ 0.O 0 W O W :a c� 0 9., W i Z Z V W I.f. x Z wCOv H W CL Z ( 0, O U °C 0 u ocz Q W CL W d O W W x d z z z a LL D z z U Z Q W O �_ co U CA O 95 m C EJ N 4J m C n W W LL Y Y VTI \ U -z' N "O L C _ L _ O L V L _ L z N ++ N Y O . 0 (ULL N 7 O LL w U LL O d' LL O d' N LL O K LL O m 0 (n O C O O Cc V :a+ cc .Q d �_ o U� E Q. i y w C N d � r � • 0 � E O C A O v i �N 0 3 aLCa Q' J CD C m > C O t: C •� N O O = N > cm cc N O C to CD 4 n E� o m � z — N G O c0 1.O L Q d Q aw o CD V R 0co y O C C L cu:a ~ 0 O O v m ujh W = :5 O O LL y d W C •� O v 0 w E U 4) i V O O -a d cn n >z _ N =O F— .0 $ 0.O 0 W O W :a c� 0 9., W i Z Z V W I.f. x Z wCOv H W CL Z ( E o z CL ti O 0 I CD •E � m m O 0 a s 0 , W �_ ` a �^ nw W }� • 0 D O L CCL O N = O Cc Cc 0.0}4A) "Z2 O W CL V V U) cc r— c The Commonwealth of Massachusetts Department of Iaiclushigl Accidents Office of Investigations 19 600 Washington Street Boston, MA 0211.1 www.massgov/dia Workers' Compensation TwuranceAffi davit: BuildersfContractors/Elecfricians]Plumbers AnMUcant Information Please Print I;e ibly Name (Business/Orgmization/individual.):(t- �(� � t7 ��7 /� G��U C-1% ,� 11V G Address: 556 City/State/Zip: IVO 8 A) D O U M Mi9 Phone #' A,re'u an employer? Check the appropriate box: 1. I a employer with 4. I ?m a general contractor and I Lv! am _ employees (full and/or Part-time)-* have Hired the sub -contractors listed on the attached sheet. x 2. ElI am a sole proprietor or partner- ship and'have no employees These sub -contractors have working forme in any capacity. workers' comp. insurance. 5. ❑ We area corporation and its [No workers' comp. insurance officers have, exercised their required.] 3. ❑ i am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §I(4), and we have no insurance required.] i employees. PTo workers' comp. insurance required.] Type of project (required): 6. [] New construction 7. [] Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing.repairs or additions 12.Q Roof repairs 13.[] Other -Any applicant that checks box4l must also fill outthe section below showing their workers' compensation policy information. ?'Homeowners who submit this affidavit indicating theY sire 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 sub -contractors and their workers' comp, policy information. jam an employer that is providing Workers' compensation insurance for my employees: Re%w is thepolicy ancijob site information. Insurance Company Name% I, Pelicy # or Self ins. LicA (Ai t S 3 L4 a tl 01 5eP 39 Job Site Address Q 9s © r-oo City/State/Zip: 4)0 IQ' NO 0 a 6 �f � Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one7-year imprisonment, as wallas civil penalties in.the form of a STOP -WORK 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 molder tliepains and penalties ofperjury tilat the ir2formation provided above zs� true and correct. 6 Official use only. Do not write in this area, to be completed by city or town official City or Town: PermMicense # 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 0: 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 ofhire,. 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 wdeceased 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 bean employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shalt 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 tiie boxes that apply to your situation and, if necessary, supply sub -contractors) 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 required to carry workers' compensation insurance. If an LLC or LLP does have employees, apolicy 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 Departmenthas 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 (ifnecessary) 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. Anew affidavitmust be filled out each year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn 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 acid fax number: Tho Commonwealth of Ml ssa. dh_weott4 Departmon ; offaduOdal .Aceldentt office ofInvestigatim X00 washrtCtg a fleet Boston, MA. 021 It Tel # 617-72,7-400 at 406 ox 1-8,77-MASSAFE Revised 5-26-05 Fax 4 617-727-7749 www-mass,gov/clla 5 gyp., ���J/.(: �(/%77i/7%(i%%IIi('.!/4�� (�/��l�Id1(If4lfld('✓�1 Office of Consumer Affairs &Business Regulation p ME IMPROVEMENT CONTRACTOR - registration: 113130 Type: i xpiration: 5/18/2015 Private Corporatici, GRASSO CONSTRUCTION CO., INC. JOHN GRASSO 865 TURNPIKE ST N. ANDOVER, MA 01845 Undersecretary Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supen-i+or ,. License: CS -022988 JOHN GRASSO 865 TURNPIIM Si ' s NO ANDOVER NIA Ol5 d ' p Expiration . 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