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Home My WebLink AboutBuilding Permit # 7/26/2016Total Project Cost: $ Permit No#: b Date Issued: LOCATION PROPERTY OWNER MAP BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 211 , Date Received PORTANT: Applicant must complete all items on this page PARCEL: Print Print ZONING DISTRICT: L IIf Or IrCta-h-- 100 Year Structure Historic District Machine Shop Village yes no z-V1 no no ORTH TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential E New Building LI Addition '1' A Iteration LI One family 0 Two or more family No. of units: 0 Industrial LI Commercial 0 Repair, replacement Li Demolition El Assessory Bldg LI Others. E Other '* i /17 / /''' / 7, , ''''' "6M1514.14''' ,' ' ' -Ii ' gel."6 le7'. , "''' DESCRIPTION OF WORK TO BE PERFORMED: OWNER: Name: Address: S et7" 6:7 () il'71771t Identificat'on - Pleas (I, C., C7IA) ri - Contractor Name:L1 Address: 'ype or Print Clearly () 0 Phone: L 7- 6 it 6 Nr711443 thri, &n. Phone: F7 - A-91 - 7-zicS Supervisor's Construction Construction License:C-S 3 -2 Home Improvement License: ARCHITECT/ENGINEER Address:Z., % Exp. Date: Exp. Date: sevkitoi- I/ H. irriC Phone: - - Reg. No. 7.ot$ FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. "7 C 3 FEE: $ V:c) Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 4 'stoat ire_ entilawnef6, gnature of contractor_ Plans Submitted Plans Waived Certified Plot Plan C Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art I Tobacco Sales C Permanent Dumpster on. Site ❑ Swimming Pools ❑ Food Packaging/Sales ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING & DEVELOPMENT COMMENTS 'Tm4r Ce�cGioti— Reviewed On Signature CONSERVATION Reviewed on Signature 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 DPW Town Engineer: Signature: Driveway Permit Located 384 Osgood Street FIRE DEPARTMENT Temp Dempster on site yes no Located at'924aMain Street, Fire Department: signature/date COMMENTS v (; = ,. i. ' - a 0 p 0 ZC D45 N -0 - su 3 ▪ v� cv o O. mop COCA ww.IM CAM ' 0 N �C � v � 0 o a 0 tD 113d0 of pdvipl ti. SNOO ss31Nn m -v VIOLATION of the Zoning or Building Regulations Voids this Per cn • CD Q O ='a0 Q =-a U) O_0 rtQ W = 0 CD • sa Ca 0. Cst m cu D .-. its N' 3 • -. - Cl)N 0 co 0- _ ci) co <CO Ca py13 CD 00 ^�o W th O 0 ss CDca �m Mt O �. >0 a)13 5. a) o a pan o uoisspuled seq git.) et 4 JK Contracting LLC 31 Richmond Street Weymouth, MA 02188 617-592-6775 (Kieran) 781-254-2862 (Judy) Bill To: David Streinbergh, Suite 12, Maker Mill, 50 High St N.Andover, Mass 01845 Description Est. Hours/Qty. Proposal Proposal Date: 6/13/2016 Proposal #: 203-21 Project: Rate Total General Conditions 2,000.00 2,000,00 Permit and C of 0 920.00 920.00 Demo, Walls, remove doors. 3,000.00 3,000.00 Wall Frame ,Includes materials. 3,500.00 3,500.00 Doors & Trim 2,500.00 2,500.00 Electrical & Lighting[Estimatej 8,000.00 8,000.00 Tel/Data[estimate) 3,500.00 3,500.00 Heating & Cooling, [Estimate without plan] 5,000.00 5,000.00 Insulation 1,500.00 1,500.00 Interior Walls, Board. 2,400.00 2,400.00 Millwork & Trim, oak cap 450.00 450.00 Cabinets & Vanities 0.00 0.00 Painting 5,000.00 5,000.00 Cleanup & Restoration 300.00 300.00 Sprinkler Work 900.00 900.00 Supervision 3,897.00 3,897.00 Insurance 389.70 389.70 ----- CHANGE ORDER. July 14, 2016 > Removed 1 24 Paint. (-$10,500.00) > Removed 1 29 Supervision. (-$4,447.00) > Removed 1 30 - Insurance. (-$444.70) > Added 1 24 Paint. (+$5,000.00) > Added 1 29 Supervision. (+$3,897.00) > Added 1 30 - Insurance. (+$389.70) Total change to estimate -$6,105.00 Total $43,256.70 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 15-0718 PROJECT TITLE: West Mill - Maker Mill Suite 12 PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant demising and tenant tit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ENGINEERJARCHITECH 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 OCCUPANCY. SUBSCRIBED AND SWORM TO BEFORE ME THIS LU LIC NATURE DAY OF I MY COMMISSION EXPI 20 CHERYL L. BURKINSHAV Notary :Public Commonwealth of Massachus 141-y Commission Expires March 7, 2019 Are you an employer? Check the appro I am a employer with , employees (full and/or part-time).* 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.] f The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street Boston, M4 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricinnslPlumbers Applicant Information Please Print Legibly Name (Business/Organizaiion/fndividual): . it & LIT (t c fir- , ti C_ Address: �� (T$ � 0 g f I i N. 4 Nfl au •, I t 6 o 1 g t'S City/State/Zip: • 1 rs ri c►v s� ti kg)d I d�SrlPhone #: 6 iq--5S ( g • apriate box: 4. 0 I am a general contractor and I have hired the sub -contractors 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 censtruction 7. Remodeling 8. 0 Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roofrepairs 13.0 Other *Any applicant that checks box#1 must also fill outthe sodden below showingtheir workers' compensation policy information. t Homeowners who submit this affidavit indicating they ale doing all workand then hire outside contractors must submit a new affidavit indicating such. tContractars 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.:.6 NCD I w t..15- A cy-+ Policy # or S ell ins. Lic. ##: lip+ es 0 1 Z. Expiration Date: /17 f I i Job Site Address: 'Ls° Win, t It- � F t 1 V• Rao 4416-1"" ,City/State/Zip: H I 6 1 e 4- i 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 o. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or ore -year imprisonment, as wallas 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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi, Signature: Phone #: q i-�7 4' raider the pains and penalties of per, jury that the information ormation provided above is true. ndl1correct. Date: it- (I O Official use onIy. 13o 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 ACOR,17" THISCERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE AFFIRMATIVELYNEGATIVELY AMEND, COVERAGEAFFORDED BELOW. CERTIFICATE OINSURANCE DOES NO CONSTITUTE EXTEND ONTRACT BETWEEN THE ISSUINGINRER(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 INSURED CERTIFICATE OF LIABILITY INSURANCE JK Contracting, LLC. 4 High Street Suite 108 North Andover, MA 01845 CONTACT NAME: DATE(MMIDDIYYYY) 0211712016 PHONE EAISS. No. Exit: ADDRESS:. INSURER(E) AFFORDING COVERAGE INSURER A : Star insurance Company INSURER B: Selective insurance Company INSURER C : FAX Not: RAW S 012245 19259 INSURER 0 : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP (MMIDDIYYYYI (MM13DIYYYY1 LTRR TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR ADDL .JNSD GEM- AGGREGATE LIMIT APPLIES PER; iC I POLICY u JECT LOC i} OTHER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS " NON -OWNED AUTOS A UMBRELLA LIAR EXCESS LAB OCCUR CLAIMS•MADE DED 1 I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y!N � PROPRIETOREJ(R NE E CU (Mandatory In NH) If describe under DESCRIPTION OF OPERATIONS below N SUER WVD„, NIA POLICY NUMBER S2205113 WC0853742 MA 02J1012016 02/1712016 02110i2017 0211712017 DESORPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It morn apace le requ Evidence of coverage. CERTIFICATE HOLDER TO WHOM IT MAY CONCERN ACORD 25 (2014101) TO WHOM CANCELLATION EO NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS D HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,ODO PREMISES (Ea occurrence) 5 MED EXP (Any one person) $ 10,000 PERSONAL S AOV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 3,000,000 $ C�OpeecddenUMBINED SINGLE LIMIT $ (E BODILY INJURY (Per person) S BODILY INJURY (Per ecddant) $ PROPERTY DAMAGE $ (Per accident) $ EACH OCCURRENCE $ AGGREGATE S. X ST� ii i $ ATUTE ER HOT EACH ACCIDENT $ 100,000 E,L.DISEASE -EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 Ind) 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 (01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 (01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD *Pr Massachusetts Department of Public Safety Board of Building Regulations Standards License: CS-066334 and Construction Supervisor - KIERAN T WHE• . , . 31 RICHMONDLAN STREE' WEYMOUTVH MA 02/* - Coklmissioner • Expiration: 09/26/2017