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HomeMy WebLinkAboutBuilding Permit # 4/19/2016BUIL 1 G l'ERMIT TOWN OF ORT1 A DOVER APPLICATION FOR PLAN EXAMINATION i 6 l' m ' Permit No#: Date Received oRTH ,.. • -.tn..- '94TED AICHL1 4 1 Date Issued: IMPORTANT: Applicant ust complete all items on this page 00 LOCATION , ;1--.1Lt ("- no no no Print PROPERTY OWNER CC:3m ZONING DISTRICT: -i 00 Year MAP PARCEL: tz,,,°^'C2( ,--- Print Historic Structure District yes e Shop Village ' Machine TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 Addition gAlteration 0 One family 0 Two or more family No. of units: 0 Industrial 0 Commercial 0 Repair, replacement 0 Demolition 4 0 Assessory Bldg 0 Others: ° - 1 0 Other ' ' f , e / t 6. ,, /p '; Floodplain Wetlands , 'i/ ' 1 ,' i Watershed',/,- istrict /,,,ar4',///4 Y 4 tei, , , Vice 1:1'M DESCRIPTION OF WORK TO BE PERFORMED: ''' V-0V-t4 Q °F t,72-N,LS cs ‘s 1/41/4.,;" 6 S73-- e 5,4" ak-WN ,f1 Identification - Please Type or Print Clearly OWNER: Name: xivi.to VT t,,,;,"'- t p‘i g.s-A.ci-i Phone: b cl ,, 2 i Address: * 3 t,,,,,) AA oc.,) ,..7-- ,,,J 11, V; L Ou - ''' ti 1,17 IC (Jill S Ho t9 LA K; ' W itt=3L44604 Contractor Name: , ) otk-Atm, eat 6.1 l' -Phone: ii I- "1 - ‘ ' Email: VI. te-pav1/41 62_ -T, K. Address: S:',:- ‘76, I agst Li- ti, i teil ,SG- ti , (4 IJ 0 0 Li 1/4,1-14- kt V) 6 le 1/) I ( Supervisor's Construction License: Home Improvement License: CL 0 ir:3(z' :? :2 Lt-' Exp. Date: (.1 1E4 It Exp. Date: ARCHITECT/ENGINEER ^, 'L.; et lij 14 trim/ ilr 0-- Phone:cr7- - tecect -L,c1 c? Li. 0 Address: IV a 10,4, Li A, ,i p 0 1,171 ifi 1,4: 0 t ce cb Reg. No. 1 s FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST Total Project Cost: $ 5 Lr i 0 ,3 FEE: '- BASED ON $ 25.00 PER S.F. ' tr45 ti Receipt No.: -47 -'' "; r",)/ Check No.: 2 4-2 (2 , :2 ( NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 1:innatiirp nf Anprd/Ownre, Sinnature of contractor; O 0 O CD C ® m N `< O co CO CO E. v� O 13 CD O O CD 0 cp m Cocn 0 C7 0 cn Cn SH1NOIN 9 NI S32IIdX31IVt l2d VIOLATION of the Zoning or Building Regulations Voids this Permit. 0 0 O 0 = CD oCO U) C. Ig Q CI) y . O CO = = O ow CD �CD- CD.0r Ca = y 2. O 0 N ..t, cn .a o Oy, Q o 04 CL • gu 0. 03 r- rt CD CO 0 CD cn -a CD rt O CD t s CD 0. 73. • CL m O a CD O n C pan o; uolsslwied seq JK Contracting LLC 31 Richmond Street Weymouth, MA 02188 617-592-6775 (Kieran) 781-254-2862 (Judy) Bill To: David Streinbergh Schylling, 21 High St, N. Andover, MA 01845 Description Est. Hours/Qty. Proposal Date: 4/4/2016 Proposal #: 203-3 Project: Rate Total Permit and C of 0 1,100.00 1,100.00 Demo 2,500.00 2,500.00 General Conditions 2,000.00 2,000.00 Wall Framing 1,500.00 1,500.00 Roofing, Remove all glass in skylite and install new insulated glass, seal . 5,000.00 5,000.00 Doors & Trim, Includes adding film to 2 doors,adding security locks to 2 bathroom doors,adding locks to 20 offices, one server room: 3,800.00 3,800.00 Remove plywood from window in new office on 4 th floor beside server room and re -open 130.00 130.00 Heating & Cooling; Re -configure Server room. Re -feed corner conference room 6,500.00 6,500.00 Electrical & Lighting; Add lights on 5 th floor. Re wire corner conference room, and new office. Re wire storage/showroom. [Estimate] 6,000.00 6,000.00 Tele/Data; Re -feed data to all new cubicles. Tie in other spaces [NEIS and HELMS} data into server room,[Estimate] 5,000.00 5,000.00 Insulation 300.00 300.00 Interior Walls, Board, tape ,sand. 3,000.00 3,000.00 Ceilings & Coverings, Repair damaged ceiling by skylite 300.00 300.00 Plumbing, Check all fixtures, 150.00 150.00 Cabinets & Vanities 0.00 0.00 Floor Coverings; Use NETS carpet to patch by new conference room.carpet one or two offices in NEIS space with new,similar carpet. Patch area where transition occurs [Estimate] 3,000.00 3,000.00 Sprinkler Work; Cover heads in 5 th floor offices with cages. 500.00 500.00 Specialties; Add furring and sound board to show room wall for noise reduction. Seal all penetrations, Insulate around all window areas.Tape, compound, sand . 3,000.00 3,000.00 Estimate for your review and approval . Total Page 1 JK Contracting LLC 31 Richmond Street Weymouth, MA 02188 617-592-6775 (Kieran) 781-254-2862 (Judy) Bill To: David Streinbergh Schylling, 21 High St, N. Andover, MA 01845 Description Est. Hours/Qty. Proposal Date: 4/4/2016 Proposal #: 203-3 Project: Rate Total Specialties; Install slat wall on showroom wall,[supplied by tenant] Estimate $950.00. Carpenter rate -$65.00 per hour, Laborer $40.00 per hour. Painting; New walls, ceiling in showroom only {$3,500.00] Entire space ,including 5 th floor, $25, 000.00 950.00 3,500.00 950.00 3,500.00 Cleanup ,Final Clean 1,500.00 1,500.00 Supervision 4,973.00 4,973.00 Insurances 1% 497.30 497.30 Estimate for your review and approval . Total $55,200.30 Page 2 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 14-0683 PROJECT TITLE: East Mill - Schylling Space PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: East Mill P. o` 0 No.9536 u,', SCITUATE. ',_:; j AMA � , id> ,C., A ��rH OF M{*r44sSA wvirt NATURE OF PROJECT: Tenant demising and tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, bK/ALO M. t,JpA,1 JL— REGISTRATION NO. g5,xe 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 familiar with6the 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. PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY , A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPA fri SUBSCRIBED AND SWORM TO BEFORE ME THIS -I ✓ DAY OF NOTARY P IC MY•COMMISSIO L. BURKINSHAW Notary Public onwealth of Massachusetts L, f—Goifim6sion Expires March 7, 2019 The Commonwealth of Massachusetts Department oflndustriulAccidents 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/Organization/Individual): `�l r c '' 1 i IV , � Address: ITC 0 g � 116 O 1& t-J City/State/Zip: 61 (4 rs v a - i ti 1,9 0 le it lPhone #: b - S zt 1-- 6 ..7 q • Are you an employer? Check the appropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- ship and'have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. t 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 11.0 Plumbing repairs or additions 12.111 Roof repairs 13.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they hie 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 for my employees. Below is the policy and job site information. Insurance Company Name:.Z £ ,Sf9 N %7•1 S IS." d Lu A 0— L' - l t e- Policy # or Self -ins. Lie. #: W d _,i L Expiration Date: 7—,17 ft Job Site Address: 1 v� �� ��' ('t- T ►" f311/4To4,,d oi_ Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requireclunder Section 25A of MGL o. 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. City/State/Zip: H I 4® J I do hereby certi wider the pains and penalties of perjury that the information provided above is true nd correct. Sig -nature: r Date: Li— Date: l 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): 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 OF 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 CONTACTNAME: PHONE FAX JA/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # 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: 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIODIYYYY) POLICY EXP (MM/DDIYYYY) LIMITS B X COMMERCIAL GENERAL CLAIMS -MADE LIABILITY X j OCCUR S2205113 02/10/2016 02/10/2017 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PER: PRO- I IPRODUCTS JECT I LOC - COMP/OP AGG $ 3,000,000 $ AUTOMOBILE LIABILITY AUTO ALL OWNED SCHEDULED CO aBcid Dt, SINGLE LIMIT (EaANY $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION A.ND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N N I A WC0853742 MA 02/17/2016 02/1712017 X PER OTH- STATUTE �, ER E.L. EACH ACCIDENT $ 100,000 EL.. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 1 O0,000 $ 500,000 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 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 • • " c,) > a) Ce o 'z c co 0.. .m csi , 9 ' cr )—,.., — it22 cA ow s Qc on o o x _c CII RS 4 0 2 Y8 co 0 LLJ (-) E g