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Miscellaneous - 1600 OSGOOD STREET 4/30/2018
BUILDING Locationco No. 3,:5-el Date OiNORTH TOWN OF NORTH ANDOVER �•n ,•,1•C i • Certificate of Occupancy $ Qrl • Must<�' Building/Frame Permit Fee $ G Foundation Permit Fee $ Other Permit Fee $ f r TOTAL $ l Check # �— t87 Qf `, Building Inspoptdr i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SCCt10R for Official Use BUILDING PERNUT NUMBER: 3 fG DATE ISSUED: SIGNATURE: �-h Yom " Bwlch2g Commissioner or of BwIchngS Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number. ©o ©, s/ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: v Zoning District Proposed Use Lot Area Fronts ft m 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Requimd Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zane Outside Flood Zane ❑ Municipal On Site Disposal System ❑ 9 93 N Historic District: Yes No 2.1 Owner of Record �o C' 33 p Name(Print) A�ress orService: I � m Signature Telephone 2.2 Authorize)Agent Name riot Address for Service: Signature Telephone ' Z m 90 3 1 Licensed Construction Supervisor f Not Applicable ❑ G Agdress License Number O J Licensed Construction Supervisor. Z--�p -eExprrationDate T 3 i re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number M r Address r Expiration Date /z Signature Telephone L Workers^Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea.......11 No.......❑ SECTfQAT 5-kR© #QI ; 1 � fi+lA1$� . II± L 5.1 Registered Architect: Name: I'Qur_ Address Signature Telephone MIT IRE= Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address Signature Telephone Expiration Date z Name Area of Responsibility Address Registration Number Sio ture Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date fieS Not Applicable ❑ Company Name: Responsible in Charge of Construction New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Pro osed Work: -( USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 0 A-3 ❑ ]A 0 A4 0 A-5 0 IB ❑ B Business ❑ 2A 0 C Educational 0 2B 0 F Factory ❑ F-1 0 F-2 ❑ 2C 0 H High Hazard ❑ 3A 0 IInstitutional 0 I-1 ❑ I-2 0 I-3 ❑ 3B ❑ M Mercantile ❑ 4 0 R residential 0 R-1 ❑ R-2 0 R-3 ❑ 5A ❑ S Storage 0 S-1 ❑ S-2 0 5B 0 U Utility 0 Specify: M Mixed Use ❑ Specify: S Special Use 0 Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: s: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT 09 CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property Hereby authorize to act on My behalf; in all matters relative two work authorized by this building permit application Signature of Owner Date I as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury 7:::�/�� 2 41 Print Name gnature of Owner/Agent Da Item Estimated Cost(Dollars)to be Completed by permit applicant � 'y 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a)x(b) 4 Mechanical(HVAC) 5 Fire Protection M64iviSP, Q. 6 Total (1+2+3+4+5) Check Number gn�1 ?�..'L t,' 4:: / 5il'Z�. ,�_ �, �' F'',�� y h. -�a �' ,.� 'aa.`a°td "� J.>.�4' `»4< .ui 1„.: 41 �F rig:.. + °. .t A'1: x: t.�:.t ri. se c r 3�'. �,�..^.> �>�`� +h.;a.;,.�+, ... t ��ti i 7;v,' dlyW. u..�>e§�**t,' ..... fF3� a:. x�'z..-.r� �.''3,.e',fi�f_.:��t-'�.,. �'�.,;�s:"`��;s���N--:U����a P a,-.,.• ,+�'�E �✓r,Ar ;.�,z �SAS :-*'. � ..kyoh' �,x�_t. 7y ,,4„¢#�1 a1`.�e.f rSN ,.� a nt i� ,�,.� ��:•.���^fn�:�” ti�' riv�i. t. s�:r� F�.��Z'3w.,tt q, �� za.� �F C � A,��.�,{�'�:T�:. :a- >, .��`�'s 1r d,c.��` x,• t �r:''� .T,�.4 n.='� :8:'u i.. _.dr Y3, ,Ui, ,.+,,�.;9 NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS Isr2 ND 3 SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CBRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t TOWN OF NORTH ANDOVER Construction Control Affidavit ` Project Number: 0508092— First Choice Project Title: First Choice Project Location: Bldg 20, 2nd floor south wing at 1600 Osgood Street, N. Andover, MA Name of Building: 1600 Osgood St. Building #20 Nature of Project: Tenant Fit-up in existing building. In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory P Smith, Registration No. 8688 being a Registered PFefessional EflgineeF/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural _)= 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 AND READINESS OF THE PROJECT FOR OCCUPANCY. Signature and Stamp (no facsimile) �0z). REDARcy,T Q ��GORY .8 88 ti o NORTH ANDOVER, o MA. �J 9T8 OF MPSSPG SUBSCRIBED D SW R ORE ME THIS DAY OFUwh 20015, MY COMMISSION EXPIRES NOTARY PU LIC (p �� rUKm U - LU 1 KCLCAQC rvRm INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT PRONE LOCATION: Assessors Map Number PARCEL SUBDPASION LOT (S) STREET -e g ST. NUMBER OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT All XQbr/ ?ECEIVED BY BUILDING INSPECTOR DATE R�vts�d 9W1 JM Nov 08 05 09: 30a 6038900192 P. 1 FROM :ROBERTS INSURANCE, FAX NO. :9786833147 Nov. 08 2005 10:44FIM P2ii CERTIFICATE OF LIABILITY INSURANCE 11/812005 ER TINS CERTIFICATE IS ISSUED AS A MATTER OF DEFORMATION K-P. ROBERTS IN8. AGSNCY, INC. ONLY AND CONFERS NO RIGNTS UPON THE CERTIFICATE OR 1060 OSGOOD STREET �RHE THIS AATE am FFFORDED mar THE POUCH LOW. NOM ANDOR/>rR, 10 01845 978-683-8x73 UGURERS AFFOROING COVERAGE NAICN INSURED DON rxRT CONSTRUCTION 03WMZ INC. *13URERk ESSE7C CE COMANT- MviuRF.R 175 lwwT AVL N URER C: - SAI.BN, US 03079 WS(IRER Q. MMM-INSURANCE WsuREH E COVERAGES THE POLICIES OF INSURANCE USTEO BELOW HAVE BEEN ISSUED TO 711E M=RED NWE.D ABOVE FOR THE POLICY PERK1a INDICATED.NOTWTTHSTANOING ANY REOUM3&NT.TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH"THIS CERTiFN:ATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONMWNS OF SUCH POLICIES,AGGREGATE LOM SHOWN MAY HAVE OWN REDUCED BY PAM CLAIMS. -- -----OR Wm POUpYMUh�tR -.IfO rE"'$" T I Liana GMRAL L1°"TM EACH OCCURRENCE t 000 000 E OOMMERCPILGENERAL LIAMLmr PRErISEs(E.om. .Z_._ f 50,000 CwaISMADE [0 OCCUR MEOExPpmya.rPm" l--=L=ED A 3CP3616 10/26/05 10/26/06 rEASONAL49MNKAM i 1. L"1000 _ GUMPAL Aacae:GATE s -000,000 GEML AGGREGATE LMT APPLES PER; PRODUCTS-COMV/OPAGG S 1,000,000 POLICY AGI pno' Lae AUTOMODUUAercm COMMNEDSINGLeuIn i ANVAUTO (EoKridw) ALLOWKDAUT09 BONLYINJURY SCHEDULEAAUTOS (Pvpwamh s NIRED AUTOS SODI .. NON-0WMiEDAUTO8 La*CCftfd) i — .• --- PROPERTY DAMAGE i (Pwreddwg) GARAGE LIAWLRY AUTOONLV-EAACCIDENT t ANYMITO OTHERTHAN EAACC s AUTOONLY. AGO i EXCESSWORELLA LAMITY EACM OCCURRENCE s OCCUR �_ CIASMIBMADE AGGREGATE s DEDUCTIBLE -- i RTe7iNTION i i EMPLOYERS LV`ITY 14ATWNANO TORY}/YIITB_ a AW PROPIKETUPWARMEAWNCLMWE DONCSOO548 10/26/05 10/26/06 ELEACNACCNDENT s _ 5fl0 000 arncD 1 aacuFm? EL DISEASE-EA EIPLOMi 50Q 000 a. LoM�u�ao. °' s— OTHER 000 b" E.L.EL D18EASF.POLUCY I aulrr i N3T„ER DEICRIPTM(W OPERATIONSTLOCATIONSI VOnCLMt EXCLUSIONS ADDEDBY ENDORSEMENT t SPECYILPROVISIDNS '- 603-890-0192 CERTIFICATE HOLDER CANCELLATION 088Y PROPERTIES, LLC. WOULD ANY OF THE ADOK DESCRISED POLICIES BE UANMLL&O INXQAE THC OMATION � 8�tlU�UN�DZE PARK DATE THEREOF.?HE&MMIG WSMER VALL ENDEAVOR TO MAL 10 DAYS WRITTEN ANDOVER 1R 01810 NOTICE TO THE CERTIFICATE HOLDER MANED TO THE LWT.BUT FAILUNk w UOSO StW.L IMPOSE NO OBLIGATION OR LIAWLITY OF ANY NOND UPON THE WAMFt I'TS AGENTS OR ATIVE TA7 ACORD 25(2MMO) V ACOM CORPORATION ISU NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: %f 0S� 0 "41 !� 4'-is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL :. 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: z ' s . (Location of Facility) Signature of Permit Applicant Fire Department Sign off: 6� Dumpster Permit Date �•�\ _..-- -. -•----•----------- Deportment of IMUS&W Accidents 4JIe of Inv+&*inions 600 Wig Ainaton Smut Boston,MA 02111 wwmmassaoWdin Workers'Compensation Insurance Affidavit: BundeTs/Contractors/Electridx=Mlomben A licant Inf rmati Please Print L&Ab Name(3usinea8/0rPWz3hOtVln iMdnai)• ' Address: City/StateMp:_c =� ` Phone M. r c` Arey_ oaemployer?Check the'appropriate box: R 1. am as employer with,S — 4. ❑ I am a general ooutraclor and I 'ry"of project(regdred): ra employees(fall and/or part-time).* have hired the sub-con"= 6• ❑New cougMw ion 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑ Remodelig ship and have no employees These sub-contra com working for me in any cap workers' have 8. El Demolition [No workers'comp.insarsnce 5. ❑ We we a corporation cad it@ 9. ❑ Buming addition ❑ rgUhomeow►ner doing.] Officers a exercised their 10•0 Ekcwwg npaira or additions 3. 1 am a all work emption Per MGL I I.❑ �>� myself (No workers comp. c. 152,11(41 and we have no 12, � or additions required-] employees. [No workers, ❑ repairs _ cep.=nraaoe ) 13.[] O&w tAnY Honnoow nen Am MAMA an dM cbnb box#1 num dio ii8deva ®out w wesecdo below a an VM it t�nw�tan wo*end'bowngs Meme e°ao'ide p° 'irdoeaadod mcti tContraebis telt ebecR Pois bare�t d Bonet�� new+I am an employer �P �,�rnrow olicy tim thjorhrtatlar. di�,r is pr°'�ldlwa w +kers'corrrpwrsrrtloh 6rsrrnace for cry Below b dlrepeaw Andiob sine Insurance Company Name: Poli # Policy or Self-ins.Lie.#: i 61 t, -G Expiration Date: Job Site Address: Attach a copy of the workers'com City/Statca*: pen on pollry deciarstlon pa fie(showing the policy number and Fa>7ure m sewn coverage as requir under Section 25A of MGL C. 152 can lead m the• e:pIMUO,date). fine up m S 1,500.00 and/or one-year nnposition of criminal penattics of a of up m$250.00 a day against�e violator Be ed gat a opy IS Penalties m the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification, d*of titin statement may be lotwarded to the Office of I do hereby ten*uorler the pr =Rhd peha&,W 000] Y&W d w lx S, F----- fwm&looPmvl*d old b ma &M l nrnesat e#:At 7 ' Q,dlcid use on&. Do no write-IN Ah eua,to be completed by ebb►or town sfflcw City or Town: Issui Authorityr�ttlUce°se (circle one): 1.Board of Health 2.Building Department 3.Chy/ own Clerk 4. Eecckl I motor S.Plumbing Inspector Contact Pe OUR: phone N: ✓lie-�orrvnra�zu!ecz/,Clt o�,/l�s�ivaelta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR 40 , Number:.CS 048040 Birthdate: 10/2911955 Expires: 10/2972007 Tr.no: 8053.0 Restricted: 00 TADEUSZ DOWGIEERT 175 BRADY AVE SALEM, NH 03079 Commissioner NORTH 0 0 over _ 0 No. 3ST ;.F.. .;. 'i" .. z dower, Mass. T O LA 1 1 COCMICMEWICK V RATED PPS\ BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............. ....... .. ....... 44 Foundation .. ........... .. has permission to erect........................................ buildings on 14.00............... ... 4V Rough to be occupied as........ .... . .. . . . . .. . . . Chimney provided that the person accepting this permit shall in every r pact conform to a tfirms of the application on file in Final this office, and to the provisions of the Cod s and By-Laws relating to the Insp tion, Alteration and Construction of Buildings in the Town of North Andover. x�.0s t 0)" PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N START Rough ....... ............ Service G INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. do 3/10 " SEE REVERSE SIDE Smoke Det. NORTH Twn 0 of 4Andover No. 3ST d......... over, Mass., l A �. I� ADCOCMICMEWICK RATE D PPS\ ACO �`s E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..................... ....... ........... ................................. ..... ................................................ � Foundation has permission to erect........................................ buildings on 14.00..... .. ....... .. ........ .......... � Rough to be occupied as........ . ....................................... . ... .. Chimney provided that the person accepting this permit shall in every r pest conform to a tbrms of the application on file in Final this office, and to the provisions of the Cods and By-laws relating to the Insp tion, Alteration and Construction of Buildings in the Town of North Andover. %s-ps to S)G PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI N START ELECTRICAL INSPECTOR Rough },r:......:. Service G INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. *3/10 " SEE REVERSE SIDE Smoke Det. ` NORTiy '9 TO" Of 2Andover No. o o dower, Mass., 'S� COCMICKEWICK ADRATED PPS` �C5 i '9S ti BOARD OF HEALTH T T Food/Kitchen Septic System PERMI D BUILDING INSPECTOR THISCERTIFIES THAT..... ....... .... .... ....... ......... .................................................................................................... Foundation has permission to erect......................... ............ buildings on ��G.. ....�......................... ...... ........... Rough ' to be occupied a Chimney . ... ... ......... ..... ........ ....y.... ................................................. provided that the person accepting this permit shall in every r pest conform the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, ANoration and Construction of Buildings in the Town of North Andover. 7'o W n ���C s PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 1 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough ................................................................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry !Nall To Be Done ?FIRE DEPARTMENT � Until Inspected and Approved by the Building Inspector. Burner e Street No. j SEE REVERSE SIDE Smoke Det. Commonwealth of Massachusetts (41111,111 Se )111\ Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 9;'05 Ileaveblankl APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All \\ork to be performed in accordance\Nith the iklassachusetts Electrical Code(\IEC). 527(AIR 12.00 (PLEISE PRINT IN INK OR TYPEALL INF( RLI TION) Date: City or Town of: _41(9—ij a mei � � To the h7speclor of [Vire.~': By this application the undersigned gives notice or his or hertion to perform th electrical work described be Location(Street& Number) /6dDcO 0S oo n:nter > A ",44) Zee_-,0CZ_ Telephone elephone No. Owner's Address s 2P JIM Is this permit in conjunction with a build'ng p -mit? Ye Fq--'198Ft� 4AU9,Yppropriate Box) Purpose of Building 64, b,_-J, (��tility Authorization No. Existing Service all Amps Jolts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps Volts Overhead❑ UndgrdEj No.of Meters Number of Feeders and Ampacity -7 az) X ol 0 Location and Nature of Proposed Electrical Workr—/-7,--- J_ / ;)Z c gL Completion(?1*the fi)11oiring ruble ina.v he wetived by the Inspector ofil"ires. No.of Recessed LuminairesNo.of Ceil.-Susp.(Paddle) Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above Ei In- No. of Emergency Lighting grnd. ❑ grnd. E3 Battery Units No.of Receptacle Outlets ,20 No.of Oil Burners FIRE ALARMS INo. of Zones No. of SwitchesNo.of Cas Burners No.of Detection and li -2) Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices KW "eat Pump I.Nq!pber Tons No.of Self-Contained No.of Waste Disposers Totals: : ....,I. .......... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW LocalMunicipal [] Connection0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Nevices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wing. No. Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: 111CIL-17 aeldiliMhll derail lesired, or as required h.1 /he Inspector of Wilvs. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with ~IEC Rule 10.and upon completion. INSURANCE COVERAGE: Unless NNaived by the owner, no permit for the performance of electrical work may iSSLle unless the licensee provides proof of liability 111SUranCe including*'coillpictcd operation"coverage or its Substantial equivalent. The Undersigned certifies that Such coverage is in force, and has�:xhibited proof of same to the permit issuing of lice. CHECK ONE: INSURANCE 0 BOND El UTI-IER D (Specify:) I eertifjy, under the pains anilpenuffieS oj,'perjt(rjp,that the infimmation on this application is trite and complete. FIRM NANIE: LIC. NO.: L6.Ac—I Licensee: I.///I? , 'al.Ld Signature Iv LIC. NO.: g2cC�e_ t�z 111A, 'exculpt"',"the I / _ns e i 1b Bus. Tel. No.f, Address: LX -& Aft. Tel. No.: `Security System Contractor Lice I-CqUirccl for this work: if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I ani aware that the Licensee does not havc the liability insurance cov�.rage normally required by law. By my signature below, I hereby waive this requirement. I ani the(check one)El owner El owners agent. Owner/Agent Signature Telephone No. PERMIT rEE: S f_� �c�� � � 3 �- 3 -� � � �, � � �� ; � � � � Commonwealth of Massachusetts =ti -rnit No. 6 Pei Department of Fire Services Checked Occupancy and Fee Ch c L t BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9.'05] deaNeblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK \ii xsork- to be performed in accordance with the%1L1SSZlChLlSCttS nectrical Code(.%U-C). 527(A. IR 12-0(1 PLE,ISE PRINT IN INK OR TYPEA LL INF()`RAL-1 Tlo�v) Date: City or Town of: V"- To the Inspeclor ol'Wires: S undersigned [on to the dectrica By this application the Undersigned gives notice of his or her intent- I work.described below. Location(Street& Number) /6 V 6 Owner or Tenant o lephone No. 2z Owner's Address e- z 4� -c-, Is this permit in e I onjunction with a building permit? Ye 0 (tVeNo.ck Appropriate Box) t Purpose of Building r)V, i t r n kt� I tl�4 vee-elr�ih e6�#�o Undgrd ❑ No. of Meters Existing Service Ams J: "let V o New Service Amps Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity "ew Location and Nature of Proposed Electrical Work: Ille- OV 9 6/ &2_�_ Ir— Completion ty the 1611oit ing table mal;he waivcd by the hispector OfIVI/VS. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. o Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA ,2 Above E] In- r-1 No. of Emergency Lighting No.of Luminaires swimming Pool gr-A 0 0 o o f f Recessed e Luminaire m ess in e 0* No. 0 of m i 2 q Lu n Swimming of c Pt. No.of Oil Burners FIRE ALARMS J,No.of Zones No.rofReceptacle Outlets -) c) — 11 No.of Detection and N of Switches tc I No.of Gas Burners No. of Switches Initiating Devices Total I 1,40 of a n g s No.of Air Cond. No.of Alerting Devices No. of Ranges Tons Heat Pump I Number, Tons K.W. No.of Self-C-Gi________ No. of Waste Disposers Totals: Detection/Alerting Devices -1 Municipal E] Other No. of Dishwashers Space/Area Heating KW Local 0 Connection Heating Appliances KW Security Systems` No. of Dryers No.of Cices or Equivalent No. of Water No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.of Motors Total HP Telecommunications Wiring: No. Hydromassage Bathtubs No.of Devices or Equivalent OTHER: i1,lesired. or as requil-I'd by the 111spector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 4 /t,> Inspections to be requested in accordance with NIEC Rule 10, and upon completion. INSL RANCE COVERAGE: Unless%aiv ed by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability il1SLll_dllCC including"completed operation"coverage or its substantial equivalent. The undersigned certifies that SLICII CO\ICI',,i,,e is in force, ,uld has exhibited proof of same to the Permit issuill',11 office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER n (Specify:) I certifj%under the pains and penalties qJ'peq rp, 1hal 1he infimmottion on thisapplicalion is true and Complete. FIRM NAME: LIC. NO.: /47 Licensee- v It',Fv, t C Signature(W t)l ki %a t 11;2,= LIC. NO.:__; ,%4," CJISVII. IhO'linc.) F Bus.Tel. Address: Ait. Tel. No.: 'Security System Contractor License required for this work: if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability illSLlrallCe coverage normally required by law. By irly signature below. I hereby waive this requirement. I arri the(check one)[] owner [:] owner sagent. Owner/AgentPERMI T ff,E: I Signature Telephone No. S �J 3- e' G � OR , Date.................. ........ RT" TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMU This certifies that ...... ...........I'& .......... ................................ has permission to perform .... ............................. wiring in the building of. 4 ...o......... ................. ......... ......... . at...A�................ - ....... .North Andover,Mass. / � Y& Fee . . ... Lic. o. ..... .. ......... .. .... ELECTRICAL INSPW ..#............ Check # 1 t-_---tip Commonwealth of Massachusetts Official tIse Only Permit No. Department of Fire Services f = Occupancy and Fee Checked ` BOARD OF FIRE PREVENTION REGULATIONS i[Rev. 9,%05] (leak blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All«ork to be performed in accordance NNith the Massachusetts Electrical Code(OEC). 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL LVF( RA1A TION) Date: City or Town d: Qom' f To the hispeclor ol'YVires: By this application the undersigned gives notice of his or her intention to perform the lectrical work described below. Location (Street& Number) 6,00 Owner or Tenant -C - r nlephone No. Owner's Address l sage �� ✓ �� r Is this permit in conjunction with a building permit? Yee No ❑ (Check Appropriate Box) Purpose of Building ,0c, iJ— Utility Authorization No. rt�C Existing Service Amps oItC4 verhe�';a '❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity 6 .-4, 9-N L Location and Nature of Proposed Electrical Work: Q,- A leC 9 61 v . ('om letion n the following table may be waived by the Inspector of li'ires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- omergency Lighting No.of Luminaires Swimming Pool rnd. ❑ .o rnd. ❑ Batter Units _ No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No. of Detection-and No.of Switches Initiating Devices Total No.of Ranges No.of Air Cond. Tons 11 No.of Alerting Devices 2— No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other n Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: e Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:No.of Devices or Equivalent OTHER: 11tach additional detail if desired, or cis required by the hispeNor of 1671-es. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: ` p Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COV EAGE: 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. CFIECK ONE: INSURANCE E] BOND F1OTHER ❑ (Specify:) certify,under the pains and penalties of per' ry,thal the information on this application is Imre and complete. FIRM NAME: . r C, - LIC. NO.: 16SQ'3 Z-47 Licensee: Signature fv LIC. NO.:�� 125;..9' /1/crhplicuble, enter ecem 1"m the�lf,ense nt nb(Ir line.) Bus.Tel. No.:17h9Ys-Z 9 z Address: / 7 _Ty L��le S �.�- />' Alt.Tel. No.: *Security System Contractor License required for this work. if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee sloes 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 ❑ owners agent. Owner/Agent PER�ti11T FEE: f ` Signature Telephone No. Date.../..`;.2V..C) ....... .o , �^ TOWN OF NORTH ANDOVER i► i PERMIT FOR WIRING 41 • + SS�cHusf� This certifies that f '? a........ ................... ................................ has permission to perform,. ': -.,.: .:::� * --............................. wiring in the building of..� � .....r.....wA, ... ' ... ':-?..e7 j�FYl � '. � at... ........... ..a'.........:............. .North Andover,Mass. Fee!r ........... Lic Nom... 1. .......................... ELECTRICALINSPECTOR Check # �a31 G I fid i Commonwealth of Massachusetts official use only Permit No. Department of Fire Services ���-- ��•. _ __ Occupancy and Fee Checked �— ` '05 BOARD OF FIRE PREVENTION REGULATIONS [Rev.9• ] r� (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All,\ork to be performed in accordance NNith the massachusctts[aectrical Code('NIEC).51-7 CMR 12.00 (PLEASE PRINT IN L'VK OR TYPE ALL AflqRAIA TION) Date: City or Town of.• .Z�� mei P To the h7q)eaor ol• Vire,v: By this application the undersigned gives notice of his or her inter tion to perform the electrical work describe�belo„w. Location (Street& Number) /6CPc0 Oq �?a Owner or Tenant 0 0 0 oG 7� Z Telephone No.�{}j Owner's Address , 'oc° Is this permit in conjunction with a building p mit? Yes No ❑ (Check Appropriate Box) Purpose of BuildingQ LyUtility Authorization No. r Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Zip /1 c-� 1 t v"� al•o I- Location and Nature of Proposed Electrical Work. Completion OJ'the Jnllowing table nary be waived by the Ins)ector of ll'ires. No.of Total No.of Recessed Luminaires l No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o mergency ,g ing No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets 12--Lo No.of Oil Burners FIRE ALARMS No. of Zones No.of Gas Burners No.of Detection and No.of Switches InitiatingDevices No.of Ranges Tons No.of Air Cond. Total No.of Alerting Devices Heat Pump Number Tons KW No. of Self-Contained No.of Waste Disposers Totals: Detect ion/Alertin Devices No.of Dishwashers Space/Area Heating KW Local ElMunicipalConnection ❑ Other Heating Appliances Kit Security Systems:* No.of Dryers No.of Devices or Equivalent No.of WaterKms, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent �y Telecommunications Wiring: No. Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: .Itlueh additional detail iJ desired, or«s required h,•the Inspector o/!b'ire.r. 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 exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penuries of ry,that the info,•,►uni„n on this application is true and complete. n FIRM NAME: �I'� LIC. NO.:��� 93 h� nature Sy C. . Licensee: (� r,�� �i. s� t Signature LICNO: �— (1/'applic•able• catu eXenrpt nr the h, msec iber line Bus.Tel. No.f1ZU XYZ 22 Address: Alt.Tel. No.: *Security System Contractor Lice .e required for this work, if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I an,aware that the Licensee sloes 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 PER,IIIT FEE: .�� ' / Signature Telephone No. Date.. ............................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING I o U This certifies that ...... ......... ..............4 . ............... ... ..... has permission to perform .......... (................................................................ �4' - wiring in the building of VV�ro Y�.... -. ell ........................ I.............................. ............... ,North Andover,Mass. ,rFee................. Lic.No. ELECTRICAL INSPECTOR/ Check # 6/ 3 Commonwealth of Massachusetts t)nccial use t>n1y Permit No. 6 Department of Fire Services Occupancy and Fee Checked REGULATIONS� ' BOARD OF FIRE PREVENTION Rev. 9•05•� - � 1 (leak blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance NNith the Massachusetts riectrical Code(MEC). 527 CMR 13.00 (PLE,4S'E PRINT IN INK OR TYPE)LL LVFO Al-1 TION) Date: City or Town d: To the hiyeelor ttf YVire.v: By this application the undersigned gives notice of his or her intent n to perform t4-T trical work described belo - Location (Street& Number) Q Q CO o Owner or Tenant Q Telephone No. off(� Owner's Address 5 Is this permit in conjunc i n with a buil 'ng p rmit? Yes �''�o ❑ (Check Appropriate Box) Purpose of Building ` Utility Authorization No. Existing Service X Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Zc`,4) Amps Volts Overhead❑ Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,p✓ fy Completion o the 1611otirinq Table muv be waived by the Ins)eetor of•ff'ires. No.of Total No.of Recessed Luminaires D No.of Ceil.-Susp.(Paddle) Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of oil Burners FIRE ALARMS No. of Zones LO No.-of Detection and No.of Switches No. of Gas Burners InitiatingDevices No.of Ranges Tons 2- No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump I.N. Tons KW No.of Self-Contained P Totals: ..... Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW" Local❑ Connection El Other Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or Equivalent No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalent OTHER: Touch additional delail if'desired or as required by the Inspector of fl'ires. Estimated Value of Electrical Work: (When required by municipal policy.) o Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COV RAG ,: 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:) !certify,under the pains and pe�tllies of erjury,thattheinf minittietn on this application is true and complete. FIRM NAME: /�( . / /— -r � LIC. No.: /6.5 3 J-)L �p,�� �C !�� �, Si nature_ � �0.�/ LIC. N0.: 7Qc4,4t l� Licensee: S g � (ll'applicable• c atel c.eem�t' n1 the h Ouse number line.) Bus.Tel. No.:?z1-! /f24?'F Address: i` 3 _ ye_- Alt.Tel. No.: *Security System Contractor Licen.e required for this work, if applicable,enter the license number here: 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 a17ent. Owner/Agent PERMIT FEE: Signature Telephone No. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLIC ION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING yip 37 ..s Section for Official Use Onl � - BUILDING PERNUT NUMBER: DATE ISSUED: SIGNATURE: Buildig Commissioner or of Building Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ®® 6) 9p � 73 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: v Zonin District Proposed Use Lot Area Frontage(ft) 1.6 BUR DING SETBACKS ft m Front Yard Side Yard Rear Yard R red Provide R Provided R •red Provided 1.7 Water Supply UQL.C.40.§54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zana Outside Flood Zone ❑ Municipal On Site Disposal System ❑ islo 1C District: Yes i O 4 /Y 2.1 Owner of Record 1 D Name(Print) Address for Service m Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Z Signature Telephone m 90 3.1 Licensed Construction Supervisor Not Applicable ❑ Address �' License Number 0' Licensed Construction Supervisor. YT— j® J � Expirati n Date r Signature CTelephone r< 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number M r Address Expiration Date ^Z Signature Telephone G YLILL"% . . -., Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea.......❑ No.......❑ $ECT14 S- iib I[l L f1� I' 1� rjC T� �/8V1��S #1�U tY S� "t'= 0 co Ct�t)L l' ls#Tid ± r�+b31 SIE ' FFACTE1► ' ,. z. s 5.1 Registered Architect: Name: Address Signature Telephone Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date NA Not Applicable ❑ Company Name: Responsible in Charge of Construction New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ [Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: 1 USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 ❑ A-3 ❑ 1A ❑ A4 ❑ A-5 0 1 B ❑ B Business ❑ 2A ❑ C Educational ❑ 213 ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ IInstitutional ❑ I-1 ❑ I-2 0 I-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R residential 0 R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage 0 S-1 0 S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use 0 Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: I Y' BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stones Include Basement levels Floor Area per Floor s Total Area s Total Height ft I:. Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject property Hereby authorize to act on My behalf,in all matters relative two work authorized by this building permit application Signature of Owner Date f f as Owner/Authorized Agent _,7 Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury ::, :1 D_.A C"��c 0 Pri t Nam igr6ture of Owner/Agent Dat Item Estimated Cost(Dollars)to be Completed b applicant F Y permit PP ,���,..`�,rye. , z,� � � �;. . �' =>✓c; 1. Building (a) Building Permit Fee j Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a)x(n) 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) ®Q �?r Check N $fib J 4Yy43lPn$ �� .;$. j �1�fS.`G r✓4{l `s"�3Vi``.$2 :.�e^A"r+'^ r 2' .. V,.+ y4 :u y -'r- a"GSV`;x3"3 �LFtt tx ;,�u„rY =t f. ��, ?r...,F`N��. ,. t,i r G a.,s ?s'�.•zu' t : v �`2 t,3r F� 7., r.�«+.L a '`` .., &`,,,. yy t s.,F a �k k a ;e x ➢t 3 r a}..' � r ,t hx�rcz.;,ISO �, �. :5;S'�r ;Y, ;i'v xsuhs. t3 3•p:�yg!,e.,4 �., �( ��.. ..' �K� , ..:i NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS OT 2 No3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL.GAS LINE , a. rUKm U - LU 1 KGLCAQc rvr%m INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS §�UTTHIS SECTION APPLICANT PHONE LOCATION: Assessors Map Number PARCEL SUBDIVISION LOT (S) STREET Irn, © AAST. NUMBER OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT All faun t+ a /'D/e , a,�,G �.. L��1 ?ECEIVED BY BUILDING INSPECTOR DATE RSOW 907Im 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 Date 11/8/2005 Address 1600 Osgood St Job Loc City North andover State ma ZIP Job Name First Choice Phone Qty Description Unit Price TOTAL Supply necessary material and labor including necessary permits and build out approximately 1,226 sq ft. as per preliminary plan by GSD on 9/26/05. Price includes building of walls as per lay out, installation of electrical service, necessary meters, including two electrical panels. Install parabolic lighting and electrical outlets as per Ozzy standard. Modify duct work and registers as per new lay out. Install oak doors in metal frames, Install windows as per plan. Install 2x4 suspended ceiling as per Ozzy standard. Adjust sprinkler heads as per new lay out. Install emergency lighting and horn strobes per new lay out. Paint new walls and woodwork, colors to be picked by others. Install carpet and cove base Ozzy allowance$12 per sq yard installed. TOTAL CONTRACT PRICE $30,884.92 SubTotai $0.00 Price does not include arcitectural or engineering Shipping & Handling costs, data, telephone wiring, equipment or furniture installation TOTAL $30,884.92 Office Use Only Nov 08 05 09: 30a 6038900192 P. 1 FROM :ROBERTS INSURANCE F* NO. :9786833147 Nov. 08 2005 10:44AM P1/1 AC��>. CERTIFICATE OF LIABILITY INSURANCE �1`8 2 5 PRDOUClR TWS CERFWICATE IS MED AS A MATTER of piFORMATION H.P. PasaT8 rue. Amcy, ASC. ONLY AMD CONFERS NO PJGW6 UPON THE CERTIFICATE 1060 os0000 STREM M�COVERAGEIS CERTIFICATE DOES BY NOT�'C� BELOW. IIORTB XCVIirR, NA 01848 978-683-8073 _ INSURERS AFFORDING COVERAGE NAICN BLsuRED DONSISIXT CONSTRUCTION C@ITMX INC. ilt A k PSS — --�-' IN�IRSR B: 175 SMD? AVL f ablim C: _ SALM, MH 03079 "SURER D: Guam IliSVMN• i INSURER E: CO'VERAGF.IS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISBUED TO TK V=RED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWRMTANDMG ANY REQUIREMENT,TER1Y1 OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC"TMIS COMFICATE MAY BE ISSUED OR MAY PERTAIN,THE INS(1RANCE AFFOROEA BY THE POLICIES OESCRIBED HEREIN(S SUBJECT TO ALL THE TERMS.EXCLUSONSANO CONOf WM OF SuCM POLOES.AGGREGATE LOM SHOWNMAY"AVE BEEN REDUCEDBY PAIDCIAMAS. 2WOMMIA r T w LINRE -J•-- GGNOW WARM EACH OCCURRENCE B -1,000,000 MMMEW f GENERAL LIAMLITY PRE1119FS LFAoeorr�p_. i 50.00 CtANSMADE ®OCCUR MEDELtP(AAYarrPsrtory iZmCmmm A3CP3616 10/26/05 10/26/06 raw0NAL49ADVBIJ<W i 1 0 .���000 .._ GENGRAL ADUREGAM X-2-000,000 G M. AR 1TELifTAPPLM9 � PRODUCTS-CORt-- AGG S 1.000,000 POLICY m LDC AUTOMD�ICRP COOMOP"SINGLELM i ALL OHR/EDAUTOO BODILYKJURY SMOUMAUTOS (P-PwJ i MIREDAUTOS eoDMylvjw NON�NINEDAUTOe (Prttalanp i _.-.._. .-_� PROPlRTrDAINACE i (Ps�odJ�M) OARAGELOSLaY ^VrODNLV-EAACCWU l ANVAVTO OYNERTHAN EAACC S AUTO ONLY. . AGO i EXCESLIUMBRGUA LwKrTY EA*fOCCURRENCE i OCCUR CI.AMMADE AG(.REGiCt! i — DEOUCTELE i R rwKVON B i W ORRERS COM PENSAATM AND EMPLOYERS MAMIYTortY X DAM PROPMETOWAW0031010MMM DOIIC600549 10/26/05 10/26/06 E.LEACH AWDENT s 500 000 s�o E1 DISEASE-EA BP% i� 5000 00 ° tsT►rElt 'b` E.L.DISFASS•POtaCV UNIT I s 00000 OElCRiT1ONOF OPERAl10NStlOGATiONStVF]IKX.E8/EftCLUSIONs AODEDeY ENODRSFA(EMr SPECtALPROtrISIDNS 2 CERTIFICATE L!OLDER CANCELLATION 08&Y PROPERTIES, LLC. "ULD ANY OF THE ADOVE DESCRIBEDTOUCEU BE UANMUAM j1hFo F TR%frJwIRATION e DUNDIZ PAM DATE TMNIEDF,THE tutimo LAsuItER YALL ENDEAVOR To IAS L 20 DAYS WRITTEN ANDOVER 1R 01810 NOTICE TO THE CER WICATE NOL OER NAMED TO THE LHR.BUT FALUM!IO V0 SO*A I IMME ND OBLIGATION OR UAALM OF ANY LOBOUPDN na mmmFt I'r$AOEW&OR ATIVE REM AT ACOR025(ZMMB) ®ACOAD CORPORATION1988 TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: 0510105 Project Title: Town of North Andover Project Location: Bldg 20, 2nd floor south wing at 1600 Osgood Street, N. Andover, MA Name of Building: 1600 Osgood St. Building #20 Nature of Project: Tenant Fit-up in existing building. In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory P Smith, Registration No. 8688 being a Registered Prefcss^~a! E gine~/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural _)00( 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 AND READINESS OF THE PROJECT FOR OCCUPANCY. Signature and Stamp (no facsimile) �RED AR�y/T �<t,�Q�GOM P.sF01 ti No.8688 CS' NORTH ANDOVER, 0 MA. J� �9�TH Of MPSSPG� SUBSCRIBED D SW N 0 RE ME THIS DAY OF _200F MY COMMISSION EXPIRES NOTARY PU LIC NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORINT In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: /X OL--o,,c:, is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: Z a (Location of Facility) Signature of Permit Applicant Fire Department Sign off: 6��, /'/G�_ Dumpster Permit Date Department of Industri d Accidents Office of InvesdZedons 600 Washington Street Boston,MA 02111 www.massgov/d1i Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Pluinbers Applicant Information Please Print Legibly Name (Business orpnizatiowb ivi&w): TD 9 Address: F City/State,/Zip: .� ,�«� s/jam Phone#•_ CF ,sr/s� -7" Are you W employer?Check the appropriate box: Type of project(required): 1. am a employer with-5 —/CO 4. ❑ I am a general contractor and I New 6. employees(full and/or part-tune).• have hired the sub- racmrs ❑ c°nstrucd°n wa 2.❑ I am a sole proprietor or partner- listed on the attached sheet._ ?• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' coup. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9' C] Building addition ur required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ l am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,$1(4�and we have no 12,❑ Roof repairs insurance required.]t employees. [No worker' comp. insurance required.] 13.❑ Other 'Any appHWM dM cheeks box#1 mint deo 811 ori the scrim below rho �their wrorhee PoHY i<aivm»ion t Homeowners who submit Pots affidavit tndicattoa they we d %all work sod gm hire outside eonhactors must submit a new affidavit is�l such tConiracton iM check this beat mart atteclsed=additional sheet drowtiq the nors of the sub-oormaetors and their work='CoIg •pow,W fol� I an an employer that It provldlna workers'coeur wwadon Inswranee for my employes aglow Is the pe ft and fob site informadwL Insurance Company Name: —6&R-- 17 Policy#or Self-ins.Lic.#: / cC7 rC) Expiration Date:_/&5) Job Site Address: i` c L�-- City/Statetzip: Attach a copy of the workers' compen on policy declar�rtlon page(showing the policy number and expiration date). Failure to secure coverage as requiref under Section 25A of MGL c. 152 can lead to the imposition of erkninal penalties of a fine up to$1,500.00 and/or one-year Imprisonment,as wen 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 vCrification. NIMMONS I do hereby certify vender the pains and penahlea of perjury that dire information pmvikd&bow is&w and correct Si Phone M Oddie/use only. Do not write In this area,to be coal pleted by clq,or�0- c City or Town: Permitlucense 0 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrl'own Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact lemon: Pkone N: NONE 1111Va aunt attiVaa All.%& iilvai •av�av v Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their euployexa. 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,ParmersbiP,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 empluYM However the owner of a dwelling house having not more than three aparanemts 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 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 untd acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants e Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractol(s)name(s),addresses)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLCM 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 affidavitshould be returned m the city or town that the application for the permit or license is being requested,next the Departrn ent 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-imsuranee license member on the appropriate lice. City or Town Officials Please be sure that the affidavit is complete and printed lee ly. 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 of the affidavit been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid afl�is on file for future permits or licenses. A new affidavit must be fined out each year.Where a borne 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 aff'idav'it. 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 can. 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 wwwmm.gov/dia J/L6 -6.....w4LLC L 0 - LLld6 ,? BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 048040 Birthdate: 10129/1955 -^ Expires: 10/2912007 Tr.no: 8053.0 .Restricted- 00 TADEUSZ DOWGIEERT F� 175 BRADY AVE SALEM, NH 03079 Commissioner