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HomeMy WebLinkAboutMiscellaneous - 1025 OSGOOD STREET 4/30/2018 (2)C) N • S srat.. + CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 713 5/3/07) Date: August 13, 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1025 Osgood Street MAY BE OCCUPIED AS Mad Magpie's Tenant Fit up IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: creat Pond crossing zic. 865 Turnpike Street North Andover Ma 01845 Building inspector wu�m • CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 713 (5/3/07) Date: Auger 13, 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1025 Qsgood Street MAY BE OCCUPIED AS Mad Maggie's Tenant Fit up IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Great Pond crossing LLc.. 865 Turnpike Street North Andover Ma 01845 r Building Inspector 1% r h ' x �j a a ; ow ` � u U w a W �i O URw° a°' tw w' cn cn ' �j a ` C H p, C CL -ID o o Olt CD -dy nr `NGo=o o cm 0 h y m o m (� iA os %.; o � _ �a m � C o = N m mo (� aC.3 c0oo � a W = O �Z W � CL vii at o c W E CJ IO _. Is CL= m E COD N zip Go C O CO _ m 0 cm N Z 0 Z 0 g 0 zip a O L O � v Z O 0. O H O O O Om CO2 p� H m m � H Z .00 O � 3� G3 CD O i CL CD CL CL. amQ c cc ca CD CL C Z V y � � C C c Cos O r APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Buildina Permit # 713 ADDRESS/LOCATION OF PROPERTY: Map_ Parcel Lot Number SUBDIVISION M Ab KA &r.ic- S 10x2f 4Srro®n SQ' DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: 6(?IXA T- PO Al --�) CPASS j Aj G ki-, C, Address Ir" "—I(jaalg� i ek"o, 19 ROUTING CONSERVATION PLANNING D Co) j131°� DPW - WATER METER ® 7(0-419-7 SEWERIWATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATIdR METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYlINSPECTION REQUEST DPW Signature File: Application for OC form revised Jan 2007 This certifies that .... 9.�.... . tJ r f kn9 ....... ........ . has permission to perform ....4.11-,"-X-r plumbing in the buildings of.. r at ... ., ........, rth ndover, Mass. Fee. �� `sV.. Lic. No........ .. .. ... PLUMBING IN ECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I MA DATE[ PERMIT # - CITY JOBSITE ADDRESS OWNER'S NAME��y POWNER ADDRESS TEL 911 Ess' -a 8-/Y __ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Q RESIDENTIAL 01 PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: ® PLANS SUBMITTED: YES © NO FIXTURES 1 FLOOR-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I_ I I f_ ll==== I CROSS CONNECTION DEVICE F=J I _ I 1=== I DEDICATED SPECIAL WASTE SYSTEM I 1 I ___.l __._J __ _f �J _ ___ I I DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM 11= DEDICATED WATER RECYCLE SYSTEM I I __-) _1 _rl _____ ___J _.__J �� _.__-_I _ I _.-) DISHWASHER ! 1 _I I _____I __ __.__1 _ _, _J ___I __�I I ___-._i DRINKING FOUNTAIN _ I FOOD DISPOSER FLOOR/ AREA DRAIN ! 1 __._ I __—I INTERCEPTOR INTERIOR I —_J I __j KITCHEN SINK I _.___1 ______I .-_._J LAVATORY ROOF DRAIN I __J __I _�1 _—I __ _-_ I SHOWER STALL SERVICE / MOP SINK TOILET ! r1 _ I ! _ _! _J __J ___) i URINAL J ___.._f __J WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ( ( f i l 1 ___�l _.._._J ____J I ._ _J I i WATER PIPING OTHER _Ss r INSURANCE COVERAGE: I have a current liabilily insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO M IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY QI 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: OWNER M AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complice all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LSA ( LICENSE # �{ SIGNATURE MP M, JPQ CORPORATIONFI#PARTNERSHIP E -1i # LLC E L 9 COMPANY NAME ��_t: (,�,,i�j, ADDRESS I 0"o doe 6 CITYi �-�''`� . _..._.._..-_-_.__ STATE 4-T2 ( ZIP �� t1 il TEL l S a l FAX £ CELL EMAIL CD. :� H O z z 0 H U W Pr Fza N } p W O z LU 3 W °'co Q W co a LU ® > Fy W �Q V J a a a � co w ; s w rA W � z 0 � U W a rAz C9 b a a o x The Commonwealth of Massachusetts - Department of Industritcl Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): S;) I C ✓Ll�t� V Address: Q 0 x City/State/Zip: m CIJAL,"J 'M Y�j n t8 Y - Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1111 am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2.9 I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. # ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10. ❑Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11. OR Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.[]Roof repairs insurance required.] t employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners 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 must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy.information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lic. #: / Expiration Date: Job Site Address: /0 CSS e-20 d S'U 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 requiredunder 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. Y do hereby cert under Chep ins and penalties of perjury that the information provided above is true and correct. Official use only. 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. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Phone 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 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." MGL chapter 152, §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 politicalsubdivisions 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-contractor(s) 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, 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, 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 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, arsapplicant 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 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. 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 Coxnmoawealth of Massachusetts Department of Industrial .Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 Tel. # 61.7-727-4900 ext 406 or 1-877rMASS.AFB Revised 5-26-05 Fax # 617-727-7749 v wwmass.govfdia 00� qy Date.7- .... -a 7 ....................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... ............................................... has permission to performg- — .............................................................................. wiring in the building of ..................... ....... .................................. at .... ......... ....... ............ . North Andover, Mass. 4Z Fee ..................... Lic. No; -°nlhl . ... ......... ( . ............. PECTO LEMICAL Check # 1411-3 7623 Commonwealth of Massachusetts UVMOM Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [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), 5 7 C 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: __ Z 7 Q City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) j ei a.S Q ('s I)A <% Owner or Tenant Owner's Address Telephone No. POO L P!t _ Is this permit in conjunction with a building permit? Yes ET No ❑ (Check Avvroariate Box) Purpose of Building Existing Service New Service Utility Authorization No. Amps / Volts Overhead ❑ Undgrd ❑ Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity and Nature of Proposed Electrical Work: v No: of Meters No. of Meters fele G r"`A 1r1 Arracn aaartional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 exhi ted proof of same to a permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER [(Specify:) I certify, under the pains and penalties of perjury, the information on this application is tr� and complete. FIRM NAME: /V% ,(�� ,` LIC. NO.: a Oa Licensee: Signature !y1/} LIC. NO.: (If applicable, enter "exem t' in the license. number line) _ Bus. Tel. No. C Address: _ / 7 `7 I/>4i'4ZIJ/]n A/ L � �(J� ,l/� /n,4 'O'ki- % Alt. Tel. No.: *Per M.G.L c. 147, s. 7-61, 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 Iiability 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: $ .-«urr U IrW uuumn raole ma oe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires SwimmingAbove In- Pool ❑ ❑ o. o mergency ig g rnd. d. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection an Initiatin Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers HeatPump _umber o. of e-Containe Totals: -ons Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local unicipa ❑ ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices E No. of Water Heaters KW o. of o. of or uivalent Data a Wiring: Signs Ballasts . Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunications icing: No. of Devices or Equivalent OTHER: Arracn aaartional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 exhi ted proof of same to a permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER [(Specify:) I certify, under the pains and penalties of perjury, the information on this application is tr� and complete. FIRM NAME: /V% ,(�� ,` LIC. NO.: a Oa Licensee: Signature !y1/} LIC. NO.: (If applicable, enter "exem t' in the license. number line) _ Bus. Tel. No. C Address: _ / 7 `7 I/>4i'4ZIJ/]n A/ L � �(J� ,l/� /n,4 'O'ki- % Alt. Tel. No.: *Per M.G.L c. 147, s. 7-61, 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 Iiability 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: $ It The Commonwedlih-of Massachusetts >Aj 1 Department of Industrial Accidents Office of Investigations . till 600 Washington Street ' Boston, MA 02111 T; . • ' tz www.nzassgov/dia Wo rkers'.Compensation 1witrance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information - ploq�o n_...4 T ..�L._ Name (Business Address: •ganization/Individual): '�ey City/State/Zip: L: O l/ /7474: Phone % Areyou an employer?,Check the appropriate box:-'. 1. [] I• am a employer with 4. ❑ I am a general contractor and I employees (full and/or par -time).* - have hired the'sub-contractors 2.am 1.a.solele proprietoror partner- _ listed on the attached sheet 2. ship and have no employees These sub -contractors have working for mein any capacity, workers' comp. insurance. [NO workers' comp, insurance ` 5:.0 We are a corporation and its ' required_] officers have exercised their ' 3. ❑ I am a homeowner doing all work r "right of eke mptionper'MGL myself. [No workers' comp. c. 1.52; § 1(4),' and we have no insurance required.].t i .employees. [No'workers' + - comp. insurance required..] Type of project (required): 6. ❑ New construction . 7. Q Remodeling r _ 8. Q Demolition.- ED emolition "ED Building addition 10.[5 Electrical repairs or additions I LE3 Plumbing repairs or additions 12.Q Roof repairs ..13.0.Other -v-rr••— �. O --w --A rt i must also nu out Inc section Delow showing their workers' norhpen6atinTi pol icy information.- t homeowners who submit this affidavit indicating they are doing all work and then hili outside'i:ontractors must submit a new affidavit indicating such. ntr =Coactors that check this box mustattaehed an additional sheet showing the name of the sub- contractors and their workers' comp. policy intonnadon. I am.an eng;loyer that is providing:workers' compensation snsuriUWe for', my enlFloyelm- Below is the policy and job site information. - - Insurance Company Name: ' Policy # or Self= -ins. Lica#:, 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 wellas 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 acopy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby c ify under the at' and pen ' s of �rjury that the information provided above is true and coma, Si iature: 1T; Date:- , Phone Official use only. Do not write in this area, to be completed by city or town of iciaL City or Town: I 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 employees. 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 tcustee-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, §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 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 cavy 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.. Aliso 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 dine. 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 permit1license 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 flog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit i 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 € .2111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia i ,�