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HomeMy WebLinkAboutBuilding Permit # 8/13/2015 FORTH BUILDING PERMIT of�t�en 16 5 ::<._ ,,•:6 TOWN OF NORTH ,ANDOVER 0 APPLICATION FOR PLAN EXAMINATION - - Permit Iqr�#: Date Received �Q"�R�TEo �SSACHV`��� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER (� Print 100 Year Structure yes no MAP " PARCEL0 I� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial [IRepair, replacement [IAssessory Bldg 11 Others: ❑ Demolition ❑ Other ..�,^�,,wFu',,�(rr...._✓rr;fs t" J�,,..,.. r.��st.Wf:,'Grr=,te:.�`,:.llrrrt „" �,r.ra r:I:,":-.J-...,ry1 ri^lrr..�.".'..f/b..r❑,tJ,Fr xlr lJ`"o.t,:ao:�;crcr'°t.i1p r�l " rL11111,111110❑ar 'ar.�,rxl.m�d;-F.<:.t�:,�cj��rxr 1..",s fdr❑f..r.:d,.�1`'-F1�Uk eHrit.rlaJYc n.s....:"r-dr7'sc r .tri^lt'r'`rS.".,..Jr/r.r tt�r„`„'rFW'r,'l`s.�, ".Fdt:.Y.f.rJ..s.k��”Vi.�r..,.i�-;.�.av,W:r�J�..v^�.a,r�,'x.rd rfi�,re1=d>vz,`�.r.�r s.�°�l.?l.,Tr..J.s e.',�.r,d ct;i�<'`.x,,YXDomst�',.i...",,-s.::u..:J...�i.,t4:t.L >rr 5 f ..:.-.::..r?.: ,�r.,�gNr � �? r ?`_'.,�r �"r-.J�.J^✓�r J^'xr� ti ✓'` .:,ate � / .� ::.' J rrxiP�;;,u?, ,:.!',J' .�. r�Water/Sewe,r t� , f,J„� i t'`t� ,.���� ' %✓�r�f�' {.rr�'�t.t?.fix J`�/� ,r . �r/z'�,,., r �`�� ,r_ yJ r,-�1 DE CRIPTION OF WORK TO BE PERFO ED' c� 1 ld&6effication- Pleasee or Print Clearly OWNER: Name: � �c © 'Y ,- !-(�- I .� Phone: Address . G f Contractor Name: r- ,. 'hone: Email: Address s � Supervisor's Construction License: CV Exp. Date: ' Home Improvement License: Exp. Date: ARCH ITECT/ENGINEER--� �� ! _ Phone: Address: / �jr7 Reg. No. FEE SCHEDULE:BOLDING PERMIT $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Projec t. �' _ 0- FEE: $ Check No.. ` Receipt No.: C� NOTE: Pers s co tracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSI L Public Sewer ElTanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On 70 � Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes manning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT, Temp Dum 'r,on.sit yes nou Located at 124 Main Street Fire,Department signature/date &a— "'Cps n r COMMENTS �� �"� t4ORT11 Town of ; ndover No. Y_llsl':2�0 LAKE h Ver, ass, 0 COC"I CHH WICK �. A®4ATED �e �C BOARD OF HEALTH Food/Kitchen PER-.MIT T LD Septic System �j �� " BUILDING INSPECTOR THISCERTIFIES THAT .......4f.' 7. ..... .............��................................................. ............................. � has permission to erect .......................... buildings on ...A-7. .................��.........7................. ... ....... Foundation ®.. ......... ............... L Q / ) Rough Chimney y ........................................................................................to be occupied a . 5 . . provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMITI ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N TARTS Rough Service ...,........ ........ t/... .... .a.................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 4bDOWGIERT CONSTRUCTION CO. INC. 616 ESSEX STREET LAWRENCE, MA 01840 978 685-0306 fax 603 458-1090 Customer CONTRACT Name _1600 Osgood St- LLC Ozzy Property Mgmt --- Date .8/11/2015---- Address /11/2015 —Address 1600 Osgood St_— City North Andover State MA_— ZIP 01845 -- Job Name GSA space Phone demo walkway -- Description-- --.-------------— - T Unit Price TOTAL qty --- --- --- ---—-- — —- --O —- Remove and dispose of existing interior walls and flooring and ceilings. Save ceiling stock and lights to be reused later. Cut an opening in exterior wall for new entry. Install new concrete walkway to new entry with bollards. Total Contract Price $66,861.50 I *Price does not include architectural or engineering costs andis based on plans dated 7/9/15. If changes are made, pricing will be adjusted accordingly. SubTotal _ $66,861.50 Shipping & Handling $0.00 TOTAL $66,861.50 — Office Use Only Initial Construction Control Document x To be submitted with the building permit application by a N p1 d Registered Design Professional for work per the 8t' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: OOM� Date: Property Address: Project: Check one or both as applicable: ❑New construction xisting Construction. Project description: 66W amexz kA� I ee MA Registration Number: °" Expiration date: am a registered design professional, and I have prepared or directly supervised the preparation of all design plfins, computations and specifications concerning: P "irchitectural [ ] Structural [ ] Mechanical ] Fire Protection [ ] Electrical [ ] Other for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 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 if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the buil ' al Construction Control Document'. u Enter in the space to the right a"wet"or electronic signature and seal: Phone number: Buildin O al Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 The Commonwealth ofMass�chusetts Department oflndustrialAccidents ;, r a 1 Congress Street,Suite 100 Boston,MA 02114-2017 :yWt www.mass.govtdia 5�. Worl(ers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE k'IGED wJTH THE PERMITTING AUTRORITY. Aplilicant Information A Please Print Legib Nagle (Business/Orgamzationffndividual): c .A.ddxess: 2 ✓ � 'hone##: c ..11-5 City/state/Zip: c °' s . Are you an employer?Check the appropriate box: Type of project(Tgquired): I I am.a employer witbL_ employees(full and/or part-time).* 7. ❑Now construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. [ �K-ernodelhig any capacity.[No workers'comp.insurance required.] 9, El Demolition IE]I am a homeowner doing all work myself,[No workers'comp.insurance required.]t 10 ❑Building addition 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will. ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. J.Z,[:J Plumbing repairs or additions 5.F1 I am ag eneral contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors havo employecs and have workers'comp,msurance.! 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.F1 Other 152,§1(4),and we have nq emplayees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit#his 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 state whether or not those entities have employees. If the sub-c6n6cf6rs have employees,they rimst provide their workers'comp.policy number. I am an employer that ispiaviding workers'compensation insurance for my employees'Below is the policy and job site information. y r Insurance Company Name: � ":�..0-, Y Policy#or Self-ins.Lic.#: , ' ,,° Expiration Date: 1 &" City State/Zi Job Site Address: -°, " � � y / p: �,r �,� . -. _ �^.......�.�.. Attach a copy of the workers' compensation'policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, Ido hereby certify ander tree pains and penalties ofpetjuiy that the infoFt! Vid0d above is true a11d correct. ww Sign c: .. ,... Date: .. Phone 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): i 1,Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.:Plumbing Inspector 6,Other Contact Person: Phone#: Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: GS-048040 TADEUSZ DOWGfERTgs, 175 BRADY AVE. SALEM NH 03019 J,2,,,,. Expiration Commissioner 10/29/2015