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HomeMy WebLinkAboutBuilding Permit #86 - Exception 8/8/2006Permit NO: Date Issued: ' LOCATI PROPERTY TOWN F DOVER APPLICA6� ORUP�,L�ANN EXAMINATION Date Received eJ1:21101� v St"v �6\� f' 6 T N 1• IMPORTANT: Applicant must complete all items on this page I MAP NO.: PARCEL: TVV1V A1%T" 1TQ1V nV RITII DYN(_ Print ZONING DISTRICT: WNT(1RIr DISTRICT VES fl TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition tC_Altertion ❑ One family ❑ Two or more family No. of units: ❑ Industrial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED t Identification Please Type or Print Clearly) OWNER: Name: CONTRACTOR Name: Address: Supervisor's Construction License: -O L-12ic2 q1Q Exp. Date: Home Improvement License: _ Exp. Date: ARCHITECT/ENGINEER �?� Name: Phone: ro�- Address: qcCL _elf S ��-meg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST-BASEP ON $� PER S. F. Total Project Cost :$- 7 ® x12.00=FEE:$ Check No.: j Receipt No.: I g 3 2 p - Page l of 4 TYPE OF SEWERAGE DISPOSAL Art ❑ Swimming ❑ g Pools Public Sewer 11Tanning/Massage/Body Well F1Tobacco Sales ❑ Food Packaging/Sales El Private ❑ Permanent Dumpster on Site ❑ (septic tank, etc. Electric Meter location to project iN U i r: rersons contractcnunregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �Q— Signature of contractor i Plans Submitted ❑ Plan awed ❑ Certified Plot Plan ElStamped Plans El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation DE Water & Sewer Temp Dumpster Building Setback (ft.) Front Yard Side Yard Rear Yard Re uired Provided Required Provides Required Provided Dimension Number of Stories: Total land area, sq. ft.: INV 1 L,) ana UA I A — (I" or Doc: INSPECTIONAL SERVICES DEP Created JMC. Jan.2006 Total square feet of floor area, based on Exterior dimensions. 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 ❑ Copy of Contract ❑ 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 ❑ 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 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 Noe 4 ni'4 Location 16"),1) �0 3 .. No. S C.- Date Check# �!q �—V— Building Inspector TOWN OF NORTH ANDOVER Certificate of Occupancy $ HU Building/Frame Permit Fee $ Foundation Permit Fee $1 Other Permit Fee $ TOTAL $ Check# �!q �—V— Building Inspector TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: 0603028 Project Title: South Hallway Bathrooms Project — Building 20 Project Location: 1600 Osgood Street, Building 20, Second Floor South Hallway Extension Name of Building: Osgood Landing Nature of Project: Renovation and Upgrade of Existing Bathrooms. In accordance with Section 116.0 Registered Architectural and Professional Engineering Services -Construction Control of the Massachusetts State Building Code, I, Gregory P. Smith, AIA Registration No. 8688 being a Registered Prefessiena' Ef ineeF/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural _XXXX_ Structural Mechanical Fire Protection Electrical Other (specify) FOR THE ABOVE-NAMED PROJECT AND THAT SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE 780 CMR MASSACHUSETTS STATE BUILDING CODE. ALL ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the state of construction to become, generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. UNDER SECTION 116.4, I SHALL PERIODICALLY SUBMIT A PROGRESS REPORT, TOGETHER WITH PERTINENT COMMENTS, TO THE BUILDING INSPECTOR UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY_ _ k1AND READINESS OF THE PROJECT FOR OCCUPANCY. Signature and Stamp (no facsimil IVa. 8688 )71 P OF SS ME THIS 26thY OF 3 D V 2006 ''� MY COMMISSION EXPIRES Twb I m m m m CA m 2 y d CCie CM) CD 'C O a Z y CD d O �• d C2. y o v CD CDCL O Q d CD CD o CD C CD y� O CDy to CD I S v y O � Z CD � o CD C CD n-, N cn cn n O ` _ ? m = �O =w < m N — =i O mO m n CD CO) man 3, Z •" �� N -� I O r" x y N oho: m 2 IE GQ T 7 O N m y O H tG � p O � .-► o � W O C =n' a o � �m CL m N v CD m in c a m H O =t y N W Q G o , c• �_ F CL CA r07 m Cg ? _' m H co)H E 1 .Ort oma: d: =r CD CD � o cooO O O ;wy d� CCD C o CL gym. cn rD cn w o a' ; T r" x b o :v n GQ T o a 0 C37 � o � W 4 O h'! CL M O o CD DOWGIERT CONSTRUCTION CO. INC. 40 616 ESSEX STREET LAWRENCE, MA 01840 978 685-0306 fax 978 685-1290 CONTRACT Customer Name 1600 Osgood St. LLC Ozzy Property Mgmt Address 1600 Osgood Street City North andover State MA ZIP 01845 Phone Supply necessary material and labor for southside bathrooms as per plan by GSD. Remove and dispose of existing walls. Build new walls as per plan for new bathr000ms. Install new plumbing fixtures including toilets, urinals and sinks. Install drywall and ceiling. Install lighting and horn strobes as per plan. Install tiles. Install oak doors in metal frames. Install bathroom partitions. Install mirrors and soap dispensers. Paint walls and woodwork. AL CONTRACT PRICE Date 7/31/2006 Job Loc Job Name southside bathrooms Unit Price I TOTAL $27,530.00 SubTotal Shipping & Handling TOTAL 1 $27 Office Use Only 530.00 $0.00 AQWA Department of Indu*Wd Accbk is Office ojlnv=*&*fts 600 w.stl hbq"n shret Bosley MA 02111 www.menzovIdle Workers' Compensation Insurance Affidavit: Builders/ContractorsMectridanWPlnmbers Nasse Address: Phone #-.'? 72 - )*:'��j cam �- Are yqwtni employer? Check the appropriate box: I. I am a employer with 1� 4. ❑ I am a general contractor ad 1 6. of prom ( i � New ooa:h�rction employees (fon and/or pan -limn).• have hfrod the silo-oaatragats �• 2. ❑ 1 am a sole pmprietor or patter- listed on the attached sleet. t ?• ❑ Remodding ship and have no employees These sub-coutracm have S. ❑ Dewfition working for me in any capacity workers' comp. max. 9. 0 Building addition 5. Weare$ [Nreq� o � 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGI, 11.0 P4nnbipg repsirs or additions myself (No w(rkers' comp. C. 152, #1(4), and we have so 12.0 Roof repaim insurance required.] t eanpbyeea. [No workers' 13.❑ QtLer COUP. h0 ranee required.] -Any RWMWM a UMV056" MM si UMM MUPU nu UM MC asrnoa oerosr MDW nkat Matoas' tobry t Homeowners Mho s AN& No adiatit any an doW9 as Mat aid dies telae OE i& GUMMdas mint submit • env aMrit barn g sock tconvramm that cheek ars boat mot attached sn eddido W meet dmw* fibs � of tie sotroosmaWn Md their MoAoats• coulL ppft bftwnvdaL I an an employer tluat b p vvldbg mors' con'pensatbn bsrrTance for dry rNtployees Bdow b d w palw and, job stns Insurance Company Policy #i or Self -ins. Lie, Job Site _ 'Expiration Date: (-0 4 lz _City/StaldZip• Attach a copy of tine workers' compeandi a posey dedarsdon page (shorisg the pdky number and eaphuflos date). Failure ID secure Coverage as req imder Section 25A of MGL a 152 can lend b the imposition of cr&* al penalties of a fine up to $1,500.00 and/or one-year soament, as well as civil paahiea 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 dopy of this gat== may be forwarded to the Office of Invadgations of the DIA far insurance coverage vgificadm I do l mby cen* under Ike pabs d"penabies of perjury titer *e b arm Wen pnrvilsr shore b trsre art eirs�t. O,Sleld use onb. Do not write in this area, to be completed by eAW or town a j9efiL City or Tows: PU%dM.lctme g Issuing Authority (drde one): 1. Board of Health 2. Building Department 3. Cky/rown Clerk 4. Eledrkd Inspector S. Plumbing Inspector C Other Contact Person: Phone *, � T Nov 08 05 09:30a FROM I : ROHE2TS I NSL#a*CE FAX No : 9786833147 AODM- CERTIFICATE of LIABILITY INSUI WWM ms cm x. p. roomma INs. ]Ltim=, iNC. ONLY ER 1060 09000D STMEW A{,T NORTH MWOIVA, NA 01845 6038'100192 p. 1 — Nov. as 2085 1a:44AM pl,,ll 978-683-8073 _ INaURERS AFp MUM OWED DomizR4 i—miiwc- OW amom C ownrtk ESSiSs Ili EV8INRR tc 175 wam AVa touRER c 8lli , Nii 03079 wmm" W. RUED A3 A RRIATTEi OF 01FORWAYM No Hm" UPON THE tou*16ATiE Wa Om NOT ASM. OR AFFOROW BY T!x Pouc1Ea eEtow. MN:N WE #NAICM w�xCL coup .. THE POLMS OF O MOWACE U IED BELOW H WE BEEN =UEO TO THE W=RED NANEDABOW FOR THE POUCV POWD NWATW NDTVYfrWANtl1NG ANY REQUUU@MENT. MW OR WHOMOIV OF ANY CONTRACT OR OTHER DOCUMENT VM RESPECT TO VOWH THIS CERTEICA'M IMAM BE 15. w OR MAY PERTAIN. THE NOWIANCE AFFORDED BY THE PODS OECD HEREIN t4 SUBJECT TO ALL THE TERNS. EXCLUSIONSANO ©ONOiT W OF SUCH PDLIGIE.S. AOCMiEGIRTE tollTSS'siew�tSur uivc wecu metuu�ne.. e........... CANCELLATION 083:2 PROP1eM82, I=. &MLO ANY OF THE NMVt DR&M EOPoUCE6 BE CANCWJ" KFOAC TUC GMnAToft 8 DUNDIM PAaZ MATE TKEAEOF- THE 4MMO VmxWR ram HmE.wow To Wx 10 ours wr ntu ANt>iiM 34A 01810 NOTE TO TM CERrWXATE NOLOFA HAMM TO THE LEFT, NUT FAILNU! 10 UOSO SW WL MIOSE NO O XCATION OR LW W Y OF ANY XLW VIM THE W11RER IM AOENTS OR 3CP3616 10/26/05 10/26/06 UNITS ]; aN6RAL LMlLRY CNMRIFmuftG&MgLUABlttlr CANTlMAW OCCUR to" Rt ! 1,000,000, srssyrsEsOm,1.: ! 00 MEoupwAlsrpswo i BXCZAMW PswoNAL*AOVlLARRY s -1.000.0 GDERAL A0091t6 W s 2 000 000 C4W AamrATt LaW APPLIESnn P " pR, cOe PRMoucrS-cOMigPAW :1-200,0 O iwToMolaeuArn.m AWPAM IFa S tkGlEt�ar ! ALLOWNWAUMS SCHEOUM AUTOS B pLYNJURY ! NLUDAUTM NOtF4NH1FOAUTo! BODLYPUtm s PRWE(nv DAMP= QARAWLMBRtEY AVMDNLV-rAACCIOENT t OTWA" mi EAJwo _ AurcoNLY. App i MC£ilR LVR7.lA LW1 uw OCCUR C AMMME FJ1ClR OCC1AtllENCE ! EV AG6RE{iA/F i oElu�r►NrLE Rk iNYMN s ! i EMPLOYLuwuyv TWNAND -AMt ,.,d..EL OTIiER DONCS00549 10/26/45 10/26/06 z eA sv+Aoowm t 50D 00 oxFASE - FA esFL s . 50 000 F.L owEAsc.POuGYUMrr : 500 000 OEICRPTgNOPpPERATIOl151tOGT�ORSl11EEpCtEglE%Cl1�lONSA00lUYYFNOORSEAIEI�fT�SPECNLPI�ONs101Dt 2 CERTIFECI►TE ENOLOER CANCELLATION 083:2 PROP1eM82, I=. &MLO ANY OF THE NMVt DR&M EOPoUCE6 BE CANCWJ" KFOAC TUC GMnAToft 8 DUNDIM PAaZ MATE TKEAEOF- THE 4MMO VmxWR ram HmE.wow To Wx 10 ours wr ntu ANt>iiM 34A 01810 NOTE TO TM CERrWXATE NOLOFA HAMM TO THE LEFT, NUT FAILNU! 10 UOSO SW WL MIOSE NO O XCATION OR LW W Y OF ANY XLW VIM THE W11RER IM AOENTS OR The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P. O. Box 1025 State Road, Stow, MA 01775 PERMIT Date: s �d North Andover permit No Dig Safe Number ( City of Town) ( If Applicable) In accordance with the provisions of M.G-L 1/4 8 Chapter_LO_ 0 as provided in section 9 *2 7 GMR 3 4 Stut Date This Permit is granted to: Full name of person, Firm or Corporation Permission to locate dumpster for construction/renovation/demolition of building Comments: dumpster must be 25' from structure if unable to place with reaui,red Restrictions: clearance dumpster must be covered with plywood or tarp end of work day at S ( Give location by street and no., or describe in such manner as to provied adequate identification of location ) EeePaid$. 50.00 4YZ, Fire Chief This Permit will expire(Signature of oflical granting permit) Offical granting permit ( Title ) �� TNIC PERMIT MI ICT RF Inj I_CI v D(1CTFr) I IPtIAI TNF Pt?GMICFC ♦tt�1 ��,znrzarzrr' TIONS NG BuiLDI BOAR ONSTRUC�ION SUPERVISOR license. C 018040 p Number: CS 6-dhdate:10t2911955 8053.0 gyres: 1012912001 Tr. nO: -Exp . Restricted: 00 TADEUSZ DOWGIEERT� 175 BRADY AVE issianeT ' SALEM. NH 03079 Comm