HomeMy WebLinkAboutBuilding Permit # 8/31/2015 FORTH
BUILDING PERMIT OF�t�eD .bgtio
TOWN OF NORTH ANDOVER
_APPLICATION FOR PLAN EXAMINATION 70
Permit No#: t °� Date Received �4oDRA7ED ^`�
gSSACHUS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
677
LOCATION � �j � � � � � � C2t S:�
Print
PROPERTY OWNER �� rLL C
Print 00 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: �c�., storic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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,
DESCRIPTION OF ORK TO BE PERFORMED:
e— I' 2l �e Ei C
.2 f r r
Y Identification- Pleaseype or Print Clearly
OWNER: Name: ' ` G � Phone:
Address: C-,9
Contractor Name.,-, -9f , Cz �1 , - 'Phone: -7 �� j C �2 C/ '2
Email:
Address: r-G- C�) e— ZL
Supervisor's Construction License: C�,I �2 x� Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEERPhone:
Address: ��,,.� Reg. No.
FEE SCHEDULE:BULDING PERMIT.•$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project t: $ FEE: $
Check No.: � Receipt No.: �2 �,2
NOTE: Pers ns c tracting with unregistered contractors do not have access to the guaranty fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF:SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/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 - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT- ❑ ❑ - a/,
a
COMMENTS
ONSERVATION Reviewed on - Si nature�k
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
1 .
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Tow;; Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Mair Street
Fire Departmerit signature/date _
COMMENTS
i
®RT
AL
utiver
No.
^K. h Ver, Mass, 'F �Si P0/s---,
COCHICHEWICK 1'
�ADRATED PQ
U BOARD OF HEALTH
Pt: RMIT
LD Food/Kitchen
Septic System
THIS CERTIFIES THAT .......� ... 5 ; ,1�'��,� ......: ,• � �%�+� , ,f�.C,� , ,, , , BUILDING INSPECTOR
...
Foundation
has permission to erect .......................... buildings on l'.6 '(. ... �, ........��...: ......���,f.................
Rough
to be occupied as ..........Veptin
��'� �"........................................................................................... Chimney
provided that the personthis 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
LESS CONSTRUCTIO ARTS Rough
..........................
.: Service
............ ..... ...�:: ...� �—.. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildin-e 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.
Smoke Det.
Initial Construction Control Document
x
To be submitted with the building permit application by a
d Registered Design Professional
�< for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: " 0*# Date: o
Property Address:
Project: Check one or both as applicable: ❑ New construction Existing Construction
Project description: Jvl"6�z i2m�
MA Registration Number: x w Expiration date: "�� am a
regis eyed design professional, and I have prepared or directly supervised the preparation of all design pl s,
computations and specifications concerning:
� chitectural [ ] Structural [ ] Mechanical
]�Fiie 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'.
. 0 .
Enter in the space to the right a` vet"or a
electronic signature and seal:
PA ,
Phone number: W17) 114yv
a 4( 4
Buildin Off al Use Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
GIERT CONSTRUCTION
INC
V 1/ . .
616 ESSEX STREET
LAWRENCE, MA 01840
978 685-0306 fax 603 458-1090
CONTRACT
Customer
Name 1600 Osgood St- LLC Ozzy Property Mgmt — Date 8/11/2015 —
Address
City North Andover State MA— ZIP 01845 _— Job Name GSA space
Phone interior build out
- - --- - -------Description TOTAL
Qty
_ _ ------- — —— �- ----- --- -
Supply_necessary material and labor to build out appoximatel
4,600 sf of space as per plan by Rumpf Associates.
Price includes :
Framing of new walls, wire mesh installation, drywall and
taping. Reinstall lighting, install new electrical outlets as per
plan. Reinstall ceiling using as much existing material as
possible. Install 1 VAV and redo heat registers as needed.
Clean duct work in GSA space. Rework sprinklers as per
new layout. Install kitchen and sink. Rework fire alarm and
emergency lighting as per new layout. Install flooring and
cove space as per specs. Paint walls, trim and woodwork as
needed.
Install cameras, security alarms and piping for data wiring.
Install 2 Mitsubishi AC units.
1 Total contract price $552,510.00 $552,510.00
1/3 to be paid at start of work
1/3 to be paid within 10 days after rough inspections
Final balace to be paid upon substantial completion.
*See attached cost breakdown
*Price does not include architectural or engineering costs
and is based on plans dated 7/9/15. If changes are made,
(pricing will be adjusted accordingly.
SubTotal _$5_52,510.00
Shipping & Handling
TOTAt- $552,510.00
- �,--- ------- Office
The Commonwealth ofMassachusetts
Department of XndustruclAccWnts
Office of Investigations
to 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legib
Name(Business/OrganizatiorAndividual): - • ,„ �w s .
Address: '
� Phone#•City/State/Zip .
__.._...._.
Areyou an em
y employer?Check the appropriate box: Type of project(required):
1.❑ I am a em to er with c.' 4. ❑ I 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. Remodeling
2.0
ship and'have no employees These sub-contractors have 8. ❑Demolition
working forme 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.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers'camp. c. 152,§1(4),and we have no 12,0 Roofrepairs
insurance required.]t employees,[No workers' 13.❑Other
comp.insurance required.]
!Any applicant that checks boxmi must also fill out the section below showing their workers'compensation policy information.
T Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information.
.i am 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:
a
Job Site Address: .> °° City/State/Zip m
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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
fy pains ancdpe �fperjury that the information provided above is true and correct. -
Ido Hereby certr under telae nalties o
Signature. ��. ..,;���,�,-• ..,._ �"�w Date:
Phone#: „Y�._ -.... ..
Official use only. Do not write in this area,to he completed by city or town official,
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
DATE(JS/MM/DDNn15YY tJ
jEORLUT...CERTIFICATE OF LUf 5
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOM NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER T14F COVERAGE AFFORDED SY THE POLICIES
BELOW. THIS MIRTIFICATE OF INSURANCE DOEa NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT': If the CortifleatO MaleIS drI ADDITIONAL,INSURED, pall"i )mug b* . If SU19ROGATION M WAIVED,sublad to
tho terms Bow0"dwons of pa ollay,Dedoln polloles wire an and&ftfflaft A abihImerd sn Oft IUfl Int aDLltr dghts to the
oorUflcgin holder In Vou of sues ardor g}.
PRODUGgR
NAME:
F ROBERTS IN3 AWY ONE
1p150 Ocr�c� ��t Ntt): {97S} 0 -ib'7 �,��;(97S) 653-3.47
0145 i7 assn � 111brtwirasr�ra�i c►rL�
North or, � I Arr olNo oaY�Ac� NAI�M
IN&UMR A:NERCHAWS INS_ P
INSURED DOMIERT CONSTRUCTION CCR02M INCINSURER LI MOM
175 EMADIC AVEINSURER c:PRMIDENCR HDTUAL
SALMI, NH 03079 MMMERD: N�
' INKMER E;
INS RIR F: u
COVERAGES CER'IFIGATE NUMBER REMSION NUMBER:
THIS IS TO CERTIFY I'MAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABS FOR THE POLICY PERF
INDICATED, NOTWITIiSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE HiWE0 OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE DEEN REDUCED BY PAID CLAIMS.
ADDL 8111311
LM TYPE OF INSURANCE I POLICYlfummmmw LIMITS ~„
X COMMMIAL @@NERAL LIABIMY EACH OOO MENCE $ 1,000,000
aLAIMs 1oDE �ccul: PREMISES(En waurrenpj � �00 000
BOPOO86'768 03/23/1s 03/25/16 ME "P(Arr ;;;erHoit) $ stoop
C. _ KROONAL&ADV INJURY $ 2,000,000
GEN'L AWRGOATE LIMIT APPLIES PER; GENERAL AGGREGATE 1__24000,000
P411I0Y nJERL1Qt LOC PRODUCTS•COMPlQP AM s2,'u-00'000
UTHER, $
AUTOMOBILE LIARNITY Srx $ 1,000 000
ANYAUTO BDOILY INJURY(Par pmt) $
ALL,OWNED =18CHEDULE0 005151000 03/23/15 03/23/16 —
– -
A AUTOS AUTOS SODILY INJURY(Per acmes) $
• HIRED AUTOS NQN.WMED rr ur s`"® 0
Per aal�
• UMSRGIAA LIAR IX OCCUR 00ZX00 03/23/15 03/23/5,6 EACH OCCURRENCE S 1 r 000,OOa
C T QXCESS LIAR CLANS{V E AGGREGATE ffi
pll� RETENTION a $
WORKERS COMPENSATION ST TIJTE ER
AND EMPLOYERS'LVW1LITY
ANY PROPREU R7PAIITN® OUIIVE vrW DONCSS7177 16/26/14 x.0/96/15 Ek.EACH ACCIDENT $ 1, foo
�En NH) eXCLUbEO7 �NIA ILLfir .DISEASE.EA EMPLOYE 9 1,CRIT qw OF! ERATIONS below S.L.a1SEASE-POLICY L Icr $ 1,0
)E5CRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACOPb 101,AddlMml ,may tie affadvd x mom opm is )
CERTIPICATZ RO ER IS NAMED AS ADDITIONALINSURED AS PER THE TERM OP THE
MITTEN CONTRACT AND A$ PER THEIR IST 114 THE INSUMIS OPERATIONS ON A PRDMY
WN—CONTRIBUTORY BASIS
603-458-109D
'EIRTIFICATE HOLDER CANCEL LAMON
0ZZY PROPERTIES INC 1.600 0SQ0OD SHOULD ANY OF THE ABOVE OEORMED POLICIES BE CANCELLED 9EFORe
ST 4W DUNDEE OVrICE PARK LLC THE EXPIRATION DATE THEREOF, NOTME WILL SE DELIVERED IN
$ 4)t ST�STATION LLC 0 ACCORDANCE,WITH THE POLICY PROVISIONS.
MMSPRING T4t4C HERITAGEOE LLC FO REASENTAM
21, HOWE ST Lp ZOROON IAP C/o OZ21t
,PROPERTIES 1600 OSGOOD ST
01980-2014ACOADCORPOP.ATION, All rights reserved,
IGORD25(2014101) The ACORD name and logo am registered merge of ACORD
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-048040
TADEUSZ DOWGART
175 BRADY AVE-
SALEM NH 030179
Expiration
Commissioner 10/29/2015
