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HomeMy WebLinkAboutBuilding Permit #87 - Exception 8/8/2006I 1' (14 Permit NO: Date I Date Issued: A vd 2 4G I IMPORTANT: Applicant must complyall items 0page LOCA PROP] MAP NO.: ) `r PARCEL: r — nr. �T' "TT Ti TTATd' ZONING DISTRICT: LIIC'MVIC "MTRICT VRC ❑ 1 11 L' til\L %-Jk3 vl LvL — TYPE OF IMPROVEMENT --- — — PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family F1 Addition 11 Two or more family 11 Industrial Iteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WOKK TU 13t YKtVUK1V1h1J I GLS _& C -',— Identification Please Type or Print Clearly OWNER: N Address: CONTRACTOR Name:? Supervisor's Construction License: 0 44,62-C Gfd Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: /C ;2! Address: t-1 7�' Z_ZZq No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTA D N 15.00 PER S.F. Total Project Cost x12.00=FEE:$ j Check No.: tp r Receipt No.: > a Page 1 of 4 rA TYPE OF SEWERAGE DISPOSAL Art ❑ n ❑ Swimming Pools Public Sewer 11Tanning/Massage/Body Well Tobacco Sales ❑ Food Packaging/Sales [I❑ Private ❑ Permanent Dumpster on Site ❑ (septic tank, etc. Electric Meter location to project iN u i E: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Own e C� - Signature of contracto Plans Submitted L Pived ❑ 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Water & Sewer Temp Dumpster on site yes DATE REJECTED ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED 11 Comments Fire Department DATE APPROVED Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided RequiredProvides Required Provided Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. NU I ES and DATA — For department use) Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1MC. Jan.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 ❑ 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 Pnov 4 of 4 Locatio No. Date 0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 19.0 Check # 9 3z 9 U Building Inspector CA m m m m C CO) CD.p az Co o d a� nCC2 'o .p O o p CL Q CD O d O W CD _ CO) .O CD 0 CA d O COD O c y d C7 CD O �F CD CSD CO) CD CO) O CD O CD Ewl V J n 0 IO c�c d O fA O Q N a0�m y m an m A O N. m ,t Ces = ri1 Z >•� vi -� O� , ,� .d•► m N ffin 1 =r w o �OmN p O O O a a > > y n .4 OCCO2 'A m .Oy.O O (a ' CL a cc o?� M m CD co) m O m CCDL sc � \ d co) N ` d I I Cr CL •c N O VJ H NC,* ca CD C CD O � N • O MRm: m N m �d O O O co Cn ro Cn o w � '^] O x ?J �' O � O a r• � n Zi T CL r, CJJ cn 9 7C �. tz O 9 v CL 0 v O TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: 0508094 Project Title: North Hallway Project — Building 20 Project Location: 1600 Osgood Street, Building 20, 2A Floor Name of Building: Osgood Landing Nature of Project: Renovation & Construction of New Hallway 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 PFefessienal /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 COMPLETION ApjDNESS OF THE PROJECT FOR OCCUPANCY. Signature and Stamp (no facsimile) \S EFIED Aq�y�� GORY P, � y � No. 8688 NORTH ANDOVER, MA. � SPp SUBSCRI EDA SW RN BEFORE ME THIS DAY OFO 2006 MY COMMISSION EARES NOTARY (� 151S DOWGIERT CONSTRUCTION CO. INC. 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 Date 7/31/2006 Job Loc Job Name North Hallway and bathrooms Qty Description it Price TOTAL Supply necessary material and labor and frame out new hallway and bathrooms as per plan by GSD. Remove existing walls as needed. I Install 5/8" drywall. ! Tape and sand walls to smooth finish. Install ceiling. Install outlets, switches and lighting as per plan. Install plumbing fixtures including partitions and counters. Install fire protection as required including new sprinkler heads, pull stations and horn strobes. Install oak doors in metal frames. Install tiles and carpets. Paint new walls and woodwork. Install kitchenette in lobby. TOTAL CONTRACT PRICE $127,400.00 SubTotal $127,400.00 Shipping & Handling $0.00 TOTAL $127,400.00 Office Use Only Department of Ind>estrdal Aeeddenb Office of Invesdgations kv 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridamfflluxnbers Name(Businesstorpnization/Iadivi&w); Address: Phone #:�- Are yo ->r employer? Check the, appropriate box: 1. ET I am a employer with 4. ❑ I am a general contractor and 1 employee's (full and/or part-time).' have hired the sub-contractm 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t sbip and have no employees These sub -contractors bave 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 borneowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, $1(41 and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repain 13.❑ O&er -Any awns liosn cocaaa Z al muss mm 'cul out tae MMOn DelOw dwwtng their wO&W �tim pommy inmrnrtian t Homeowner who submit this drWkivh =&caft dwY ae &=i an work and thea hire outside -ftwt. mutt submit • new a@'davk "cdina rich tConvw1m that check this bawl most attached an wNhimA sheet showing Ale none of Ale wb•oo� and *–&*- wohets' OMng. Po ft Wmmfti I am on elrtp/oyer flat is providlrra wrlrkers' com, pensedon In armee fe, srty tRIploytea, Below L the pWky and job site Informatlerr. / Insurance Company Name: Policy p or Self -ins. Lic. M Expiration Date: o Job Site Address: 6 - c0 f2ft::City/Statcqip: �,.r�✓ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requir�Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year % as well as civiil 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 dopy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do (hereby cen1fy under the pectus and penaMa of perjury that the Irrfwwsdvx ins provided aboNe is sore and corrr!ex llllvl matavii Ril%s ilavWa Mva1avaav Q q Massachusetts General laws chapter 152 requires all employers b 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 bite, express or implied, oral or written." An employer is defined as "an individual, parmership, 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 152,125C(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 152,125C() 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 10 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 -contractors) uame(s), address(es) and phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability partneisbips (LI.P) with no employees other than the members or powers, are not required to carry workers' compensation insurance. If an LLC or 112 does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of bydustsial 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 nmtber listed below. Self-insured cOmpanies abohm enter their self-insurance Ike= mintier 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 die Office of Investigations has to contact you regarding the applicant please be sure to fill in the permit/ticeme 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 informstion (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit fl� been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid a 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to d mk you in advance for your cooperation and should you have any questions, please do not hesitate to give as a cal 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 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 wwwmass.gov/dia • 4 Nov 08 05 09:30a FROM : R0BE2Ts iNsuRnNcE FAX ND. : 9786933147 A CERTIFICATE OF LIABILITY IHSUE trteoD(ICER MOM eat N.P. RWlH;Rn ZNB. AmCY, INC. HoftyER 1.060 osr,Aw STSUM ALTER T! NOMM Ali MM, !O1 01843 998-683-8073 WoURENS MBURED DONGIER2 %:AQS'lRI3C7I@i CMWANY INC. NISUIER k 8 INSURiR R 17S Owlvs ma c $AUK, = 030-19 SURERd e 6038900192 P.1 a Nov. 08 2005 10:44AN PI/2 PLO- n THE POt.IM OF iMMTRANCE USTED SELDW HAVE BEEN "MCW TO THE WSURED NAMEDAWW FOR TM ANY PMY PERT TAK TME • OR FORRDED 8V TANTE POI TOE, C 0!OER OCUMEPIT MeCT Two ABEL CI ROD Aa A NATTER OF 01FORMAT(ON W RK MT6 UMN THE CH3tTIF'lCATE um DOES NORAte, EXTOHD OR A BY THE POUCiE6 ■ELdiN. NOVAE MAIC# - -- — - — 6ANtOEE,EJ►TlON O88Z PROBNRTZE9, L=. WOULDAWOiTNE1►OOVEDESiAIiEDPOIICEBBEt:ANCILIkiiPCFQAFTNliE7EP1atATM)N s VUNDIM PARK DATE TNM,EOF. THE ISSUMS WouRM Twa evowwwt To wuL 10 DAvs wRRTEN N DM= ma 01810 NOTICE TO Tee CENrw"TE woum NAMED TO THE UWT WrfALUNe to uoso SMALL - WON NO ODUGATION OR UASUrY OF ANT 1OND UPON TW *=mER ITS AGWM OR ACOR025(2M/Os) _.•_- _�.._ POUCYNtiIOER _ 3CP3616 10/26/05 10/26/06 EMITS , _—. tercet cCCURNY cE s 1,000,000 Al GiNum L AeLITY CON%WACWWJ*WALVASfUV CiAMIlMItOL- © OCCUR PRQIISES I I ieI In=)- = 000 MEDEwomrWagwe S 1 PENONALSADVtNt"W s ..aoo�000• -- GZNLAAN ,11TEliETAPPLE9 POLICY ' we rAMMAL Acummm s 000 PltOOUGTS-CO~AGG 6 0 0 0 AUTOMOMLE�WII,OY ANTAUTO OO stNrA uml s AUOWWDAUTM SCHEDUUM AUM s NUtMAUTOS NONOWNEDAUTOS ROD_ . QW pOew e� s (Powdd�Ml OARAOELtLB41iY AUTOON%V-EPIACCIDENT S OTHEATOM EAACC s AUTODNLY. AGO s EMS&KWO SUA LUOL"T OCCUR C AMMAW - EAtOt O.txtRO1ENCE i _ ABGREtilrrE i iiTpff" $ i i D iNONr�CCMIlNSItTtONAND EAPLOYERS UltD m Elent�ear �., oTe+Elt DONCS00548 10/26/05 10/26/06 _ ELSACNACOMW s 5�i 0 00 EL DISEASE - EA OPINTO i� 5Q0"000 E.LOl$EASE.P0UlCV Urr s 500 000 OEICRPrmarOPERA cmitLOCAmHSivenct.ESIEXrU=ONSADDIDYYENOORSEMBafSPBCMPROVISIDNS 602-8-90-0192 CFRTmr-Aw mm r1L"s - -- — - — 6ANtOEE,EJ►TlON O88Z PROBNRTZE9, L=. WOULDAWOiTNE1►OOVEDESiAIiEDPOIICEBBEt:ANCILIkiiPCFQAFTNliE7EP1atATM)N s VUNDIM PARK DATE TNM,EOF. THE ISSUMS WouRM Twa evowwwt To wuL 10 DAvs wRRTEN N DM= ma 01810 NOTICE TO Tee CENrw"TE woum NAMED TO THE UWT WrfALUNe to uoso SMALL - WON NO ODUGATION OR UASUrY OF ANT 1OND UPON TW *=mER ITS AGWM OR ACOR025(2M/Os) '*If 002�mft The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P. o. son 1025 State Road, stow, MA 01775 PERMIT Date: North Andover permit No nig Safe Number ( City of Town) ( If Applicable) In accordance with the provisions of M.G-L 114 $ Chapter__ j_Q_ as provided in section—5 2 7 CMR 34 Stad ate This Permit is granted to: Full name of person, Finn or Corporation Permissionto locate dumpster for construction/renovation/demolition of building Comments: dumpster must be 25' from structure if unable to place with required Restrictions: clearance dumpster must be covered with plywood or tarp end of workday at Fee Paid S ( Give location by street and no., or describe in such manner as to provied adequate identification of location ) 50.00 �� ��•, Fire Chief This Permit will expire Signature of offical granting permit) Offical granting permit ( Title ) MMUN10' TNIC PI=QMIT MI ICT RF r_ntJ-gPIr.i Illi ICI v D(1CTt=n 1 wnti Tw= PRFM1Ct✓C ��