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HomeMy WebLinkAboutMiscellaneous - 1009 OSGOOD STREET 4/30/20180 0 O d H NAMEOFBUILDING IAOut of DentaM Ottices for Dr. Peter Devlin PROJECT NUMB ©5'�o d 2 PROJECT LOCATI N 1009 �C--i car n Rd., Lower Level, North Andover IN ACCORDANC WITH SECTION 116.0 OF THE SSACHUSETTS STATE BUILDING CODE, SEVENTH EDITIO , DA FARMER REGISTRATION NO. 8333 BEING A REGISTERED PROFESSIONAL ARCHITECT HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT x ARCHTTECI'URAL STRUCTURAL MECHANICAL FIRE PkoTECTION ELECTRICAL OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES, AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I HAVE PERFORMED THE NECESSARY PROFESSIONAL SERVICES AND BEEN PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK PROCEEDED IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT, AND THAT I WAS 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 material. 3. Be present at intervals appropriate to the stage 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. I FURTHER CERTIFY THAT THE WORK WAS COMPLETED IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AS PER SECTIONS 116.2.2 and 116.4, SEVENTH EDITION OF THE MASSACHUSETTS STATE BUILDING CODE. DAVID A. FARMER PERSONALLY APPEARED BEFORE ME AND SUBSCRIBED AND SWORN TO BEFORE ME THIS 1 4thDAY OF January, 2009 4 U'arr. 8, 2013 _ ,.. r' f MO oTM s CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 231 (9/30/08) Date: January 9, 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON Great Pond Crossing 1009 Osgood Street MAY OCCUPIED AS Tenan fit Un — Dr. Office DMD IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Great Pond Crossing 1009 Osgood Street North Andover MA 01845 Building Inspector ON 0, r� S. N R A© C t w w P \� awl. i� O A, IOU 47 �t� \Nc,o��Q' • S i cn 3 &Y o`'� ° U w' a i� ° w r� S. C G - m C Q N C O : r c.3 CL =u to - O p � sCD N R p C t w w P \� awl. i� O A, IOU 47 \Nc,o��Q' cn � 4. z o`'� ° U w' a i� ° w W0Gw°C/)a ° Cf) lAii n°' w w� vn cn C G - m C Q N C O : r c.3 CL =u to - O p � sCD O E04 N O C t rna i� A, IOU 47 \Nc,o��Q' O E04 O .TZV as Cm co I o� .y m LC3 mL 0- -P-6 3 .o O CJ cc o a d. C1Q c� C3 cc = . 'C Cj. caC3 CL Z V C.3 V3 � C C� C c H Q O t rna i� cn � 4. H O � z� U � � w -,C/) O .TZV as Cm co I o� .y m LC3 mL 0- -P-6 3 .o O CJ cc o a d. C1Q c� C3 cc = . 'C Cj. caC3 CL Z V C.3 V3 � C C� C c H Q Date... ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... i _.... `.. ' ................ ........................................... has permission to perform,.::'.:.:: : ;.. . "` wiring in the building of ..;'..:F..,......: .:.... ...: ........ :: ................ h at .... ....................... .,.F... ..`..�... .. ........ ,North Andover, ib Mass. Fee... ">a......... Lic. No, .. �..:.: ............. ............j .....r E� EcmJCAL INSPECTO Check # `'``� . A 40 Commonwealth of Massachusetts TNO Department of Fire Services Wn BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked /tP,�50' [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 C 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATIOA9 Date: 0 1.1 7d City or Town of: NORTH ANDOVER To the Inspector o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) /Ql1 j 0 v Z, - `/ <—,,-I— Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building'Kermit? Yes No ❑ (Check Ap ropriate Box) Purpose of Building �,�q e� �j f !� b Utility Authorization No. 7Qq ' . !/ Z Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters 1 New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location. and Nature of Proposed Electrical Work: r�uacn aaamonal detait tJ desired, or as required by the Inspector of Wires. Estimated Value of Electric 1 Work: �liGaO (When required by municipal policy.) Work to Start: 7 Oj Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including 'completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofp/ry� at the information on this application is true and complete FIRM NAME' LIC. NO.: D Licensee: /fo t�a Signature,-4C� LIC. NO.: / (If applicable, enter "exempt " in the license number line) Bus. Tel. No.: �ifg nd 7 Address: Alt. Tel. No.: ZJ F-7,31 *Per M.G-L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ c�.S —.u« Sac Jultum caoie May De waived bV the JE ector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans O. Of Tota Transformers KVA No, of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above - ❑ ❑ o. o mergency ig grn d. d. Batte Units No. of Receptacle Outlets No. of OR Burners FIRE ALARMS N®, of Zones No. of Switches No. of Gas Burners o. etection and I nitiatin Devices vi No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers eat Pump _.,.umber ons No. of Self -Contained Totals: _ '..-'.......-. Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW LOMunicipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Water Heaters ]KW No. of o. of No. of Devices or Equivalent Data a itin Si s Ballasts . Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total Hp Tilecomimmications Wiring: No. of Devices or Equivalent OTHER: r�uacn aaamonal detait tJ desired, or as required by the Inspector of Wires. Estimated Value of Electric 1 Work: �liGaO (When required by municipal policy.) Work to Start: 7 Oj Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including 'completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofp/ry� at the information on this application is true and complete FIRM NAME' LIC. NO.: D Licensee: /fo t�a Signature,-4C� LIC. NO.: / (If applicable, enter "exempt " in the license number line) Bus. Tel. No.: �ifg nd 7 Address: Alt. Tel. No.: ZJ F-7,31 *Per M.G-L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ c�.S 1� ��� a �c. l2 � � G2�, 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 el www.rstass gov/dia . Workers' Compensation Insiitrance Affidavit: Builders/Contractors/Electricians/Piambers Apalicant Information Please Print Legibly Name (Business/Organization/individual): Address: City/State/Zip: Phone #: . Are you an employer? Check the appropriate box: Type of project (requires!): I. ❑ I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am.a.sole proprietor or partner- listed on the attached sheet. t 1. ❑ Remodeling ship and have no employees These sub -contractors have S. [j Demolition working for me in any capacity, workers' comp. insurance. g. Building addition tNo workers' comp. insurance 5.,[3 We are a corporation and its 10.❑ Electrical a required.] officers have exercised their repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL I I .Q Plumbing repairs or additions myself. [No-worke'rs' comp. c. 1.52, § 1(4), and we have no 12. insurance required.] t employees. [No workers' n Roof repairs 13.Q Other comp, insurance required_] `HnY ePPiieam tnat Checks boXtti must also fill out the section below showing their workers' compensation policy infommatioa t Homeowner; 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 mustattaahed an additional sheetshowing the name of the sub -contractors and their workers' comp. policy information. I am ann employer that is prq%"ag:workers I compensation insurance for my employees: Below is the policy and job site information Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/state/Zip. Attach a copy of the workers' compensation 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date. Phone #: Of iciat use only. Do not write in this area, to he completed by city or town offciat City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employee's. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, 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 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." MOL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of 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 the 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 cant' workers' compensation insurance. If an LLC or LLP does have employees, a policy 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, not1he 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 iine. 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 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 (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy ofthe 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 firture 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 bum 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 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 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7744 www.mass.gov/dia f. Date ./. �/ MORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBINC3 CHUSE� This certifies that ...:.. ... . has permission to perform ..... ... ..... .................. . 10 plumbing in the buildings of ...'.'2�`. r v at ..4� ` L. `............... . North Andover, Mass. Fee ......... Lic. No.. / 36 S !� ........ .. PLUMBING INSPECTOR Check # � '? % FIXTI IRF.R MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: f U�,fpa/�► ,. MA. Date: -/z)-3-0 $ Permit# Building Location: /®o,? ( 51,Ia Owners Name: jk>41tl e/za..5 o if Type of Occupancy: Commercial [ja Educational ❑ Industrial ❑ Institutional ❑ Residential ❑ New: ❑ � Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTI IRF.R INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy F Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) reclardinq this aoDlication are true and accurate to the hest of my nnowmage ana that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ❑ Plumber City/Town ® Master APPROVED (OFFICE USE ONLY) ❑Journeyman nature of License Number: I Plumber 136 '? � z U) z O W z Y coJ Q U x I— W to a z z H W N QQ Y 2 W 0 W 0 a�: o rn x a W a o W Q cn z 0 a o v~i W Z rn w rn z °- X v a w xam � p LU Lu 0 am I- N pa O O x -j a a a a X a oa u. Y -j -i X o 0 ��� OnLu SUB BSMT. BASEMENT 1 FLOOR --2 -� 'FLOOR 3RuFLOOR 4 FLOOR --9 'FLOOR -6 'FLOOR 7 FLOOR 8 FLOOR Installing Company Name: 30 �,AA0 Q jc�rh�tN� 1 (� ow�,,,1� Check One Only Certificate. # Address: i? box F X )LO 0 (, Cit /Town: ,M CTi(xr' y State:, pvl %� ❑Corporation Zip Code: Dl Kr ❑Partnership Business Tel:40 �j�S-3(32 Cell: I`�I&SI 9Y9a Fax: 21' Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy F Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) reclardinq this aoDlication are true and accurate to the hest of my nnowmage ana that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ❑ Plumber City/Town ® Master APPROVED (OFFICE USE ONLY) ❑Journeyman nature of License Number: I Plumber 136 '? � King Design Associates, Inc. ARCHITECTURE PLANNING INTERIOR DESIGN 10 HIGH STREET MEDFORD, MA 02155 (781) 393-0400 FAX(781) 393-4228 EMAIL: INTERIORS@KINGDA.NET November 25, 2008 ROUGH INSPECTION LETTER Brian Leathe Local Building Inspector Town of North Andover 1600 Osgood Street North Andover, MA 01845 RE: Buildout of New Dental Offices for Dr. Peter Devlin Andover fo dd Dear Brian: Brian: I inspected the project noted above this morning. The following has been done to date in compliance with our documents: Rough Framing has been Completed. Rough Plumbing has been Completed. Rough Electrical Work has been Completed. Please call me if you have any questions. Thank you. Sincerely, King Design Associates, Inc. David A. Farmer. AIA Architect