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HomeMy WebLinkAboutBuilding Permit # 4/13/2016BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIO Permit No#: C ( tk 7(6 (w Date Received r Date Issued: � 1' IMPORTANT: Applicant must complete all items P on this page LOCATION (,� I -I 6-1-1 PROPERTY OWNER f L c • Print 11/141.771( . Phone: ct7 -_ L- Y yc%e ut (4, Total Project Cost: $ 4~i L� 'U,7/ MAP Print 100 Year Structure yes PARCEL: C, i ZONING DISTRICT: Historic District Machine Shop Village TYPE OF IMPROVEMENT ❑ New Building ❑ Addition Alteration ❑ Repair, replacement ❑ Demolition PROPOSED USE Residential ❑ One family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other Non- Residential ❑ Industrial ❑ Commercial ❑ Others: DESCRIPTION OF WORK TO BE PERFORMED: F --i Lu u i r , ' 1. 0„40- no no no acHUS Identification - Please Type or Print Clearly OWNER: Name 4:3 S I/ ',:.fir-i Address:. u ,Ll. l (7 d I ' c1— �1 .1(2 Phone: t i 7 ' (? ..2_ �'s J Contractor Name: J -0 2 P4 ,yr,/. zT i✓v t- L"Phone: Email: tri rvkis iJ c . �� , l� , �a; I V t l-c 1Z y y 6- LC- c_ Address: Z vq>c t t°trI -- (-i N . -y , iti r'7,t00VL P� t l6 Supervisor's Construction License: S J Exp. Date: ct (7-6/ i 7 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER .� vr.,4' ID 0 Plc Address: /hA t-14PLi-y Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 9r! FEE: $ .-� Check No.: L-/ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund lVHI 911I12133 SIHI CJ U) .O c � r-F 0 -c: 0 CD Z (� p O O D CQ. N O ® CD m� 0 O. Cr cu = CD CD 0 % CO W Q. O CD O CD 0 O 7a 7 2 O CD nod° o; pa gn t10133dSNI ONI03If18 1 z cn cn 0 m Z cn —im c cn 0 0 cn SHINOW 9 N VIOLATION of the Zoning or Building Regulations Voids this Permit. cr O 41.1000 N a- CO = P N JK Contracting LLC 31 Richmond Street Weymouth, MA 02188 617-592-6775 (Kieran) 781-254-2862 (Judy) Bill To: David Streinbergh Suite 14, 50 High St N. Andover, MA 01845 Description Est. Hours/Qty. Proposal Date: 4/10/2016 Proposal #: 203-8 Project: Rate Total Permit, C of 0 740.00 740.00 General Conditions 1,500.00 1,500.00 Demo 2,500.00 2,500.00 Doors & Trim 3,300.00 3,300.00 Wall Framing 2,400.00 2,400.00 Heating & Cooling[Estimate] 7,500.00 7,500.00 Electrical & Lighting[Estimate] 4,500.00 4,500.00 Tele/Data [Estimate] 2,000.00 2,000.00 Insulation 800.00 800.00 Interior Walls, Board, tape, sand 6,200.00 6,200.00 Floor Coverings 4,850.00 4,850.00 Painting 5,600.00 5,600.00 Cleanup & Restoration 300.00 300.00 Sprinkler Work 900.00 900.00 Supervision 4,309.00 4,309.00 Insurance 430.90 430.90 Estimate for your review and approval Total $47,829.90 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 15-0718 PROJECT TITLE: West Mill - SUITE 14 �, ��• FRED AR her. \ c. 0 M. „l, M. v . 0 No.9536 �.1i 4 0 SCITUATE. , tz 2 MA G �j, L A PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant demising and tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I ', ��, REGISTRATION NO. 153 G 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 STRUCTURAL ® MECHANICAL FIRE PROTECTION ' ELECTRICAL e 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 PERMIT AND SHALL BE RESPONSIBLE FORAPPROVED THE FOLLOWING AS IN SECTION 116 0BUILDING 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. present ro tressintervals and appropriate the work and to determine,constructionge become,rhe work is be nfamiliar with6the progress 4' performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 I 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 'N SUBSCRIBED AND SWORM TO BEFORE ME THIS -- DAY OF G / NOTARY P�BL1C MY COMMISSION EX Vi LI(itiRKINSHAW Notary Public mmonwealth of Massachusetts My Commission Expires March 7, 2019 Are you an employer? Check the appr I I am a employer with employees (full and/or part-time).* 2. 0 I am a sole proprietor or partner- ship andhave no employees working for me in any capacity. [No workers' comp. insurance required.] 3. El am a homeowner doing all work myself. [No workers' comp. insurance required.] The Commonwealth of Massachusetts . _ Department of Industr�ialAccidents Office of Investigations 600 Washington Street Boston, MA. 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orgathation/lndividual): +� �rJ 06c 1 i % .. Cr C (-- Address: - � 1 0 t fii�H N -11N.0 0u. t'`- 11 0 1 & City/State/Zip: i�i - i4 r� c dv 6Y- 1 {� Ir9 d 1 e 1Phone #: b b —� rt 1 - - 6 g • ropriate box: 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.0 Other !Any applicant that checks box#I must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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 formy employees. Below is the policy and job site information. Insurance Company Name:.:1 tl (%� 1 i riJ tom` t ._- i'yv AlC- Policy # or Self -ins. Lic. #: Expiration Date: `)o. i 7- I rob Site Address: 1 v P'�� I1 .'C t . P'ai p d (-• City/State/Zip: 11 r d I C r J Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required -under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fin e up to $1,500.00 and/or one --year imprisonm ent, 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. I do hereby certi under the pains and penalties of perjury that the information provided above is true ndcorrect. Signature: Date: ® • Phone #: —I-Ten-- 7 — T Of cial use only. .Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - Contact Person: Phone #: JKCON-1 OP ID: HS - CERTIFICATE F LIABILITY INSURANCE DATE (MM/DD/YYYY) 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(ies) 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 DeSanctis Insurance Agcy, Inc. 100 Unicorn Park Drive Woburn, MA 01801 CONTACT NAME: PHONE FAX (A/c, No, Ext): (NC, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Star Insurance Company 012245 INSURED JK Contracting, LLC. 4 High Street Suite 108 North Andover, MA 01845 INSURER B: Selective Insurance Company 19259 INSURER C INSURER D : INSURER E : INSURER F : REVISION NUMBER: vTHIS 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DDIYYYY) LIMITS B X COMMERCIAL GENERAL CLAIMS -MADE LIABILITY X OCCUR S2205113 02/10/2016 02/10/2017 EACH OCCURRENCE $ 1,000,000 $ 100,000 DAMAGE TOEa RENTEDoccurrence) PREMISES ( MED EXP (Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PER: JECT PRO- !, LOC '. PRODUCTS - COMP/OP AGG $ 3,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE (Per accident) $ $ i UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N NIA WC0853742 MA 02/17/2016 02/17/2017 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 100,000 $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of coverage. CERTIFICATE HOLDER CANCELLATION TO WHOM TO WHOM IT MAY CONCERN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 Construction Supervisor • KIERAN T WHELAN 31 RICHIVIOND STRE_ .-.. VVEYMOUTH MAT; 021: 1,:!, , IT., " -.A.A. Commissioner Expi ration: 09126/2017