The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 6/9/2016 RTH BUILDING PERMIT t%OF D TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Arko CHUS Date Issued: ei I IVI Pq i RTANT: Applicant must complete all items on this page LOCATION _A Q 0 C�, pn -C'i I Print PROPERTY OWNER &)) ,'s (6 rq Print 100 Year Structure yes MAP CO> J.. PARCEL: ZONING DISTRICT: Historic District qis') n o Machine Shop Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Li New Building 11 One family [I Addition ;,Two or more family 11 Industrial 'PIteration No. of units:- 11 Commercial ❑ Repair, replacement 11 Assessory Bldg 11 Others: Demolition El Other DESCRIPTION OF WORK TO BE PERFORM 1� 45, Identificdtion- Please Type or Print Clearly V, VC\k moi- OWNER: Name:,4-)e1vj -e) Phone: I 1--6 L j- -- 7 Address-Su c7-i:S? ly tLv 0 zi 'e-IJ J Contractor Name: Email: k,-k,5 M Phone: Address:_:.; Q Tliq_ Supervisor's Construction License: —Exp. Date: > Home Improvement License: T, —Exp. Date: ARCHITECT/ENGI NEER— RM Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$1Z00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED 011/$125,OOPE Total Project Cost: $ 1 2- FEE: $ 5 7 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund A, io ft6tu re of A Plans Submitted ❑ flans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming P001s ❑ 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 Signature_ COMMENTS CONSERVATION Reviewed on Si nature COMMENTS �� HEALTH 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 Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMENT - Temp Dumpster onsite yes no , Located,af 124 Main.Street t ,, Fire Department signature date COMMENTS,�� N®RTH Okwn oiE � Andoveri} 0 ® (?O(� 441 ZT � O LAN. h ver, ass, vrj& �I COC HICHEWNCH 1• x,95 TE ED) �Q Ll BOARD OF HEALTH LD Food/Kitchen PE I Septic System I Q� BUILDING INSPECTOR THIS CERTIFIES THAT ............. .. ................ ....... .. .................................................................. has permission to erect.......................... buildings on ...�,06..el ........ . .�......................:.......... Foundation Rough . .......` �� ..d. .. ............................... Chimney to be occupied as ............. . .......... .. .... .. ..... .... �. . ............... �- 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final EXPIRESPERMIT ELECTRICAL INSPECTOR UNLESS CONS TI Rough Service ........ . ..... ........................ Final UILD NG 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 617-592-6775 (Kieran) 781-254-2862 (Judy) Proposal Date: 5/23/2016 Proposal#: 203-15 Project: Bill To: David Streinbergh 100 Elm St, N.Andover, Mass 01845 Description Est. Hours/Oty. Rate Total cc- — 1,660.00 1,660.00 Demo, remove interior walls on 1 st and 2nd floors andeeetoo— ceiling of 2 nd floor kitchen to create cathedral ceiling. 0 0 Dumpster fees.[Figure 3dumpsters] 2,250.00 2,250.00 Doors&Trim, Includes 4 new entry rated doors. [Allow 3,200.00 3,200.00 $2,000.00 for entry doors] Doors &Trim, Interior doors, Supply/Install 5,000.00 5,000.00 Plumbing, Includes 3 new bathrooms, plumb 2 18,000.00 18,000.00 kitchens, 2 laundries. Heating & Cooling, Vent bathrooms and laundries 2,000.00 2,000.00 Electrical & Lighting, includes upgrade of panels where 16,000.00 16,000.00 necessary Insulation 5,000.00 5,000.00 Millwork &Trim 4,000.00 4,000,00 Cabinets&Vanities 10,000.00 10,000.00 Painting 16,000.00 16,000.00 Floor Coverings 13,000.00 13,000.00 Ceilings & Coverings, Board and plaster 10,000.00 10,000m Cleanup & Restoration 1,000.00 1,000.00 Supervision 11,705.00 11,705.00 Insurance 1,170.50 1,170.50 Total $129,985.50 The Commonwealth qfMassachuseus Departinint of1Adush*1Acc1dinfs Office of Investigadons 600 Washington Street Boston.,MA 02111 vwW.znass.gov1dia Workers' Compensation Insurance Affidavit:BuildersfContractorsfFle,ctldcimfPlumbers A Please PrintLe piftant Information Name(Busineworganizationftdividial): C0 W7 It! Address: �,,Irrc log City/State/Zip: N 0 CJ 4V 0- V9 0 I 'phone#: b Are you an employer?Check the appropriate box: Typo of project(required) 1.9 1 am a employer with ? 6. El Now construction 4. 0 1 am a general contractor and I employees(fall and/or part-time).* have hired the sub-oofitractorp 2.0 1 am a sole proprietor or partner- listed on the attached sheet 7. W.Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. Building addition [No workers' comp,insurance 5. El We are a corporation and its 1011 Electrical repairs or additions required.) officers have exercised their 3.0 1 am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),andwehaveno 12.ElRoof repAn insurance required.]t employees.[No workers' aEl.other comp.insurance required.] J *Any applicant that checks bDx#1 must also fill out the section below showingtheir workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such. tODntraotors that obeckthis box must attached an additional sheet showing the name ofthesub-wntractors and their workers'comp.policy information. laman employer that is providing workers'compensation insurance for my employees. Below Is fliepolley and job site Information. Insurance Company Name:.Z C5 .J,4 p C—,7 4 J.-44 11 noW ,y /(I C— Policy#or Self-ins.Lie.M 099 1 -7Lw— -L— Expiration Date: lob Site Address-.—I it. 14 a o 6 d pity/state/zip: 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 ofMGL 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 copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under M epains an dp en affies ofperjury that the information provided above is true nd correct Si afore` Date: Phone#: Official use only. Do not write in this area,to he completed by city or town official City or Town: PermitfLlcmse 0 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: JKCON-1 OP ID:HS DATE(MMIDDIYYYY) CERTIFICATE F LIABILITY I INSURANCEONLY AND CONFERS NO RIGHTS UPON THE 02117/2016 CATE THISCERTIFICATE CERTIFICATE ICA ES NOT AFFIRMATIVELYOROR NEGATIVELYR OF AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLILDER CIES CERTIFICATE DO BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. SUBROGATIONpoliolgles)must be endorsed. If to IMPORTANT: H the certificate holder is an ADDITIONAL INSURED,the re an a dorsa ant A statement on this certificate doss n color rights to the the terms and conditions of the pollcY,certain Policies may req certificate holder in lieu of such endonsemo s. PRODUCER r ctis Insurance Agcy,Inc. PHONE iuc Noicom Park Drive rn,MA 01801 NAICY NSu a AFFORDNG covEwu+E p12245 MURER A:Star Insurance Cc n 19258 NsuREO JK Contracting,LLC. eISURERa:Selective Insurance Com n 4 High Street Suite 108 INSURER C: North Andover,MA 01845 Net D: MURER E: eIiURER 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 HE POLICY PERIOD CERTIFICATE MAY ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY OR CONDITION OF ANY HE POUF ES DESCRIBED HEREIN IS SUBJEECTCT OR OTHER DOCUMENT WITH PTO ALL HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS TYPE OF NSURANCE POLICY NUMBER 1,000,00 L EACH OCCURRENCE $ B X cOMMERCLAL GENERAL I•IAUNY 02110/2018 02/10/2017 � s 100, CLAIMS-MADE T OCCUR 2205113 MED EXP 10,00 ot» �) S PERSONAL 3 ADV INJURY S 1,000,00 GENERAL AGGREGATE $ 5,000,00 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 3,000,00 X POLICY❑PRF7 LOC $ OTHER NED 8I MIT S AUTOMOBILE LIABILITY BODILY INJURY(Pet Psrwn) S ANY AUTO BODILY INJURY(Per wddent) $ ALL AUTOS OWNED SW� M SCHEDULED I' $ HIRED AUTOS OS AOT $ EACH OCCURRENCE $ UMBRELLA UAB OCCUR AGGREGATE S EXCESS UAB CLAIMS-MADE g DED RETENTION s X AT ER Wor"CcePENSATION100,00 AND EMPLOYEW UABLI TY YIN C0853742 0211712018 OV1712017 E.L.EACH ACCIDENT S 100,00 A ANY PROPRIETORIPARTNEROMMITNE ®NIA MA E.L.DISEASE-EA EMPLO $ OFFICERIMEMI�EXCLUDED? 500 00 If aro atony I e under E.L.DISEASE-POLICY LIMIT S � DESCRIPTION OF OPERATIONS below LOCATSQNS 1 VENX L�( 101,AddWwW Rwmwiw Sdwdu3e,way be stbebed If mmeP N required) DEiCR1P TION OF OPERATIONS 1 Evidence of coverage. CANCELLATION CERTIFICATE HOLDER TO WHOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TO WHOM IT MAY CONCERN ACCORDANCE CYYITH THE POLICY PROVISIONN DATE THEREOF, S. VYIU. BE DELIVERED IN AUTHORIZED REPRESENTATIVE ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD a Office of Consumer Affairs and Business Regulation - 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171393 Type: Individual Expiration: 3/15/2018 Tr# 288589 KIERAN WHELAN KIERAN WHELAN 31 RICHMOND ST WEYMOUTH, MA 02188 Update Address and return card.Mark reason for change Address 0 Renewal n Employment [] Lost Ct SCA 1 0 20M-05/11 ��roD!)xnillu�ill/l n ('ll�lJJnCflnJe//J License or registration valid for individual use only :Q\ Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 171393 Type: 10 Park Plaza-Suite'5170 Expiration: 3/15/2018 Individual Boston,MA 02116 KIERAN WHELAN KIERAN WHELAN 31 RICHMOND ST --- WEYMOUTH,MA 02188 Undersecretary Not valid without signature Massachusetts Department of Public Safety E, Board of Building Regulations and Standards License: CS-066334 Construction Supervisor KIERAN T WHELAN 31 RICHMOND STR WEYMOUTH MA-02jL - r�'-JZCK l- Expiration: Commissioner 09/26/2017 North Andover MIMAP June 9, 2016 r„off/i�i/�rr� r yU �ffr, j fr�ff „i; a54.a-aaai j i rirr�� r i I f,r u Illlluf y'M r'ui,NN I ri rr t, Il,r ' VI ru ru' �7 r v 6. ll � ' I / r T � r r I 4 r � a r i%; ; , /r'�fr/�� ,”�� rr,✓d J �- VI� Y f! �''�I��P1�'6�q1� /f�i,, y,br // ,�' 'rr ' qa � t /r r rr, a54.a-aaa3 J/i/r' �; ffjr %i , r y Fr r a41.a-aaa2 J � ' ' I�I,Il4r�� I � ' � 055.a-aaa'1 a41.a-aa46 �r1r� f a4�2.a-aaa� 8 �LWr 5T � 'soh) a� f a55.a-aaa9 0 MVPC Bo Interstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, I ._„SR Meters Data Sources:The data for this map was produced by Merrimack N0RTH Valley Planning Commission(MVPC)using data provided by the Two of Roads pQ' 4`o p� North Andover.Additional data provided by the Executive Office of o Easements ,4. S++t+ .y+a OQ Environmental Aflalrs/MassGIS.The information depicted on this map is Parcels L for planning purposes only.It may not be adequate for legal boundary 0 — definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING {t r1 THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY +1 i ^ * OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT 09 < < �° • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 9SSACHUS�� 1" 39 ft �.