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HomeMy WebLinkAboutBuilding Permit # 2/29/2016 %AORTH BUILDING PERMIT 1.6,6 1, 6 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Are Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION & Print PROPERTY OWNER Print 100 Year structure yes no MAP PARCEL: ZONING DISTRICT: Historic District Ano Machine Shop Villageno S" TYPE OF IMPROVEMENT _ PROPOSED U E Re_�idenf�ial Non- Residential El New Building Li One family [I Industrial 0 Addition [I Two or more family [I Commercial Np(,Alteration No. of units: [I Repair, replacement 11 Assessory Bldg 0 Others: [I Demolition 11 Other d''I­.... ....... Eig, a r ed Districte ❑ Flooain ,x DESCRIPTION OF WORK TO BE PERFORMED: 6�V6 �Avq (1-5 (LIM Identification- Please Type or Print Clearly 17 OWNER: Name: ,DAUi .0 '17717,1N 11, C� C H Phone: (,/�104( U 3 Address: S"; (7 J­ _ 9 Contractor Name: ...Sa "ie.fjA v,4 & Phone: '711 i'L (L'A 1QS)AA,4)0PN VIL r-J Email: K� ,Ltt�,J_ C-L! Address: °"u ierG . I Oe I&-k 4( 7 Supervisor's Construction License: 6 6'Z"? Exp. Date: -_It Home Improvement License: Exp. Date ARCHITECT/ENGINEER Ottk, 6)t-t I Tilts-K.- Phone: < _74 Address: o-mj c J^."i P �t(_J Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 2Lrt> Total Project Cost: $ FEE: $ Check No.: —Receipt No.: NOTE: Persons4contractin ivith unregistered contractors do not have access to the guarantyfund ............ ---------- -—--------- Slq,­n­aiiij�6-_-_�i­ Flans Submitted ❑ Flans Waived ❑ Certified Plot Flan ❑ Stamped Flans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tarming/Massagc[Body A-t ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ F oocl Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dwupster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF ® U FORM PLANNING & DEVELOPMENT Revie W-ed On � —7'7(/( Signature_ ��-/1� COMMENTSU . .� .Rl. f(a .. O CAjA,CA6 f. i .. � tod" ... iA) .PIz-i( ' I CONSERVATION Reviewed on Signature ure COMMENTS . f m LTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& @dale Driveway Permit JDPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPART NT - Temp Dumpster on site yes no Located at 124 Main Street - '�k Fire Depaftrngnt signatue/date COMMENTS I,10RTF/ A ,own ot Andover i hver ass 9 9 coc..M..cu 1' �,95 RATED t] BOARD OF HEALTH Food/Kitchen '- PERMIT T Septic System DONEftL mxd THIS GERTIFIES THAT ....�Y ... . ....... ......... ....... .................................................... BUILDING INSPECTOR Foundation '. has permission to erect.......................... buildings on .s ....., ...... ........ .,,..... Rough to be occupied as `. Chimney provided that the person accepting s 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 LES TI tTS Rough Service .............. ........ ....... .................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. JK Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 Proposal Date: 2/29/2016 Proposal M 208 Project: Bill To: David Steinbergh, Suites 16,26[27&28]. 50 High St N.Andover, MA 01845 Description Est.Hours/Qty. Rate Total Plans and Permits 1,896.00 1,896.00 Demo 11,000.00 11,000.00 Wall Framing 9,500.00 9,500.00 Doors &Trim 7,500.00 7,500.00 Plumbing 4,700.00 4,700.00 Heating &Cooling 23,500.00 23,500.00 Electrical&,L,ighting 17,500.00 17,500`,00 Insulation 5,500.00 5,500.00 Interior Walls 13,500.00 13,500.00 Cabinets &Vanities 4,000.00 4,000.00 Floor Coverings 23,400.00 23,400.00 Sprinkler Work 4,000.00 4,000.00 Specialties, Glass. 3,000.00 3,000.00 Painting 16,500.00 16,500.00 Plumbing 14,300.00 14,300.00 Total $159,796.00 commonwealth off'_ orssachusetts .Deet t��tent gfindiustriralAccidenis x S't�eet,Suite 100 X Congress Sosto ,MPJ O2T1�2017 _... "ww.mass.gov/dia wovkers'compensaflonbs'uraAce WX�lda b uildeTO BE F"DTINa AUM OPJTY.t zcxazts/�'Xumbexs. 7'lease Print-Le2h A Meant Inform ation Name(BtXsinesslOxgasvzationac'Rvidual): 1 .�c�c�ress: ,��td� � �� l� ��c� / y -77 City/Statelzip: Phone#: Are you an employer?checktbe appiopriafebox: Type Of project(eequired): to ees(full andlor part tune) 7. [�Now Construction T am a employer with em p Y 2 Q T am a sole proprietor or partnership and have no employees working for me in $. Relxlo delirig any capacity.(No wozkers'comp_insurance required.] 9. []Demolition. T am ahomeowner doing allworkmysel (No wozkers'comp.nrswaucerequired.]t 10 E]Building addition ¢0Tamahomeowner andwillbahiring contracforstoconductallworkonmypropezty. Twill ���Eleot3[calxepa7Tsoxadditions ensurethat all contractors either have workers'compensation insurance or are sole } -- 12:Ep-lum�bing repays o additions _ —.—_pro�ie orswiiflzno empxoye _ _---�-.�—.�--r—.. — 5•[]Tama general contractor andl hagelvredthe sub-coiitractozs listed enthe attached sheet. 13•[]Roof repairs Z°hesa silo-conixactor'sliave einplayees andhaveworkers'comp.insurance- 14 El Other 6.[jWe are a corporation audits officers have exerclsedtheir right o£exemptionperMM c. 152,§1(4),and-We have no emplgyees.(No workers'comp.insurance required.] FAny applicantthat checks box#Z must also fill outthe sectionbelowshowingtheirworkers'compensationpolicyinfozmation i Homeowners wlzo suliriittthis affidavit mdicahng they are doing all work andthenhire outside con{racfozs must submit anew affidavit indicating such. xContraotozs that check this box must attached an additional sheet showing the name o£tue sub contractors and state whefhez or not those entities have employees. If the sub contracfozs fiave employees,they must provide their workers'comp.policy number. am an employer that isp oYzdir�g tvorkers'compensation insr� ancefor my employees' 8eroty is t�iepolicy androV site information. �- Tnsurance Company Name: -C'71 t�� Policy'#or 8 elf-ins,Lie.#: Expiration Date: p: Ci /State/Zi ' V fob Site Addxess- � ` � � � Attach a copy of the workers' coxnpepsation policy declaration.page(showing the policy dumber and e7cpiratioxa date). Failure to Some coverage as required under MGL G.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 hm o K ORDER and a sof f ho ofup to for msux50.00 a day against the violator.A copy of this statement May aye fowatclto the Office ance coverage verification. do rL 'eby c t ancler<triepains andpenaltles ofpeijurn,�that the informationpr�ovided ab pe�z�ru an�orrect. Date: Si nature' - . Phone Official use only. Vo notwrite in this area,to be completed by city or•town official. City or Town: Perxnit/X,icexise#i Zssuing.A.uthority(circle orae): i 1.Board.ofIfealth 2.Building Department 3.City/Town Clerk 4.]Electrical Impector 5.Plumbing Inspector 6.Other Phone#: Contact Person: JKCON-1 OP ID: HS DATE(MMIDD/YYYY) 'macA CERTIFICATE OF LIABILITY INSURANCE 02/17/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: DeSanctis Insurance Agcy,Inc. PHONE FAX 100 Unicorn Park Drive A/C No Ext): A1C No): Woburn,MA 01801 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Star Insurance Company 012245 INSURED JK Contracting,LLC. INSURER B:Selective Insurance Company 19259 4 High Street Suite 108 INSURER C: North Andover,MA 01845 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 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 BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE IN SUB POLICY NUMBER POLICY M DD/YYYY MMIDD� LIMITS LTR IN B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A—MAGF TENTED CLAIMS-MADE rx]OCCUR 52206113 02/10/2016 02/10/2017 PREM SESOE! occurrence) $ 100,00 MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 '....., X POLICYF—]PRO JECT ❑LOC PRODUCTS-COMP/OP AGG $ 3,000,00 '.. PRO- OTHER: ED AUTOMOBILE LIABILITY COMBINSINGLE LIMIT $ '.. Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ '.. AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ Per accident HIRED AUTOS AUTOS $ '.. UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $F '.. DED RETENTION$ $ WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N WC0863742 02/1712016 02117/2017 E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? N❑ N/A (Mandatory In NH) MA E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of coverage. CERTIFICATE HOLDER CANCELLATION TO WHOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TO WHOM IT MAY CONCERN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD OFFICE OF BUILDING INSPECTOR c��RED ARS y TOWN OF NORTH ANDOVER "w CONSTRUCTION CONTROL 'wirtW.1 .Q N 953 4 o SCITUATE MA PROJECT NUMBER: 15-0718 ® E West Mill - SUIT16 26, 27 & 28 � PROJECT TITLE: � PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant der111SIng and tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, REGISTRATION NO. q 5 3l� BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH 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,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 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 stage of construction to become, generally famili with6the progress and quality of the work and to determine, in general, if the work is bein performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPOR TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INS CTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANC Ni� SI NATU Ib SUBSCRIBED AND SWORM TO BEFORE ME THIS DAY OF 32 Ade. � YL—L:f�tlR4�QfySHAW Notary Pi,,,clic Commonwealth of Massachusetts NOTARY P LIC MY COMMISSION EX My Comic iWQn Expires March 7, 2019 4 " Massachusetts Department of Public Safety IrF Board of Building Regulations and Standards License: CS-066334 f Construction Supervisor KIERAN T WHELAN €` 31 RICHMOND STR WEYMOUTH MA-02 E r.=/lExpiration: } Commissioner 09/26/2017