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Home My WebLink AboutCORRIDOR WORK PER PLANS %AORTH BUILDING PERMIT .'#"6 16 TOWN OF NORTH ANDOVER 0 ; APPLICATION FOR PLAN EXAMINATION ri Date Received ArED Permit No#%:L� C U te,sued: Imust Co J* MPORTNT Applicant all items on this_p 9_ �e vp LCAT I 'O NW Print PROPERTY OWNER Print 100 Year Structure e no MAP PARCEL: C1, ZONING DISTRICT:,.--,—Historic District no Machine Shop Village no TYPE 0F1 IMPROVEMENTPROPOSED USE Residential Non- Residential New Building 1i one family E Industrial Li Addition [I Two or more family 0 Alteration No. of units: D Commercial ri Repair, replacement [I Assessory Bldg [I Others: Cl Demolition El Other DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly Phone: b ( OWNER: Name: v, )e ELF 1 K&2—6--m S�;- L Address- U I qliL�tt6jLx � L) 1)118-1.1 D J16 `Z7 Contractor Name: , K 'L't LP h o n e: Email: J_CiCL:j� CP, a 0 - Email: a Contractor cto' Address: Sv --c-6 ( 0 47 Supervisor's Construction License:`�—' l 6 6 C ? Li- Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER A I!-Ctm 1 1 ' Phone: Address: 6,(e-1V/,�[ . ....._Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000-00 OF THE TOTAL ESTIMATED COST BASED ON.$125.00 PER S.F. Total Project Cost: $ —FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund own o _ 6Andover o .:.. 0 No. iL ? - rQ U.K. h ver, Mass, 09 14 zo a /J4. U BOARD OF HEALTH Food/Kitchen Septic System _ PERMIT T LD THIS CERTIFIES THAT ..... ..441W........gzr .A/ ............... ...................... BUILDING INSPECTOR Foundation has permission to erect ..... buildings on./op:...., ,r. . ,7..;..., ►...� ........ Rough to be occupied as ®. . 10.10W... .....W ... .. ° ................................................. Chimney provided that the person accepting this permit shall in eve 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 2 �. UNLESS CO ION Rough Service gg....... BUILDING I BCTO Final , >' GAS INSPECTOR aC Occupancy Permit Rgguired to Occupy Buitdin Rough s �t Display in a Conspicuous Place on the Premises - Do Not Remove Final z No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner y � Street No. r, Smoke Det. �- E ift Sy�; Plans Submitted ❑ Plans Waived ❑ Certified Piot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sever ❑ Tanning/Massage/Body Art ❑ Swbm ing Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Pxivate(septic tank, etc. ❑ Permanent Du pster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ,i PLANNING & DEVELOPMENT Reviewed On H N SignatureJk il\ COMMENTS �I rM6r [A)t - 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 Dato Driveway Permit DPW Town Engineer: Signature: Located 384'Osgoori Street FIRE DEPAR?TMENT Ternp Dumpster onsite yes no Located at_=124 Main Street - -` Fire Deparfmnt�ignaturelda#e COMMENTS. JK Contracting LLC Proposal 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Proposal Date: 9/13/2016 Proposal##: 203-56 Project: 10 High St, Bldg 5... Bill To: Ship To RCG West Mill NA LLC 10 High St,Bldg 5 David Steinbergh 17 Ivaloo Street Egress Corridor Somerville, MA 02143 North Andover, MA 01845 Description Est. Hours/Qty. Rate Total Project Description/Location 10 High Street, Bldg#5, Egress Corridor, North Andover, MA 01845,' Building Permits 242.00 242.00 General Conditions 500.00 500.00 Wall Framing . . . 3,000.00 3,000.00 Interior Walls 4,000.00 4,000.00 Insulation 1,000.00 1,000.00 Interior Walls, Tape, Compound & Sand 3,000.00 3,000.00 Painting. 3,000.00 3,000.00. Floor Coverings (Vinyl Plank) 3,000.00 3,000.00 Cleanup& Restoration 200.00 200.00 Supervision 1,794.20 1,794.20 Insurance 179.42 179.42 Estimate for your review and approval . Total $19,915.62 Approved:__.__ ([nitiais) SIGNATURE Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 0 edition of the Massachusetts State Building Code,780 CMR,Section 107 Project Title: West Mill - Building 5 Egress Corridor Date: Property Address, _ 10 High Street, North Andover, MA Project: Check one.or both as applicable: n New construction X Existing Construction Project description: Common space egress corridor Linda S. Smiley 1008 3 08-31-17 I MtS.Registration Number: Expit�tion date: ,art a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: X Architectural ' [ J stra0wral [ ] Mechanical [ ) Fire Protection [ ] Electrical [ ] Other_for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project, l understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. .Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2, Perform the duties for registeacd design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and duality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility retarding the provisions of 780 CMR 107. When required by the building official,l shall summit e / regress reports(see item 3.)together with pertinent comments,in a form acceptable to the building � Cl'lnon completion of the work,I shad subrni din `Final Construction Control Document'. No.low Enter in the space to the right a"wet"or o � electronic signature and seal: MAW Phone number: 978-515-9939 Email: Buda r@saarrl-arch.com -- Building Official Use Only Building Official Name: --- Permit No.: __ ___ t7ate:.— Wi sion 06 11 2013 JKCON-1 OP ID:CCD ./A .....Y YYI CERTIFICA,rE OF LIABILITY INSURANCE TEIMMI =07i26 201Y6 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, T141S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 1 REPRESE14TATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: MPO—RTAN-r '—: lf 5`ie c--o`Wtif,—iC—at—e 710-1deris ai"i—ADDIT-1—ONA-1-—INSURED,—Owpolicy—(ios) t=rust bo--endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorspment. A statement on this certificate does riot confer rJghtsto the certificate holder in lieu of such ondorsemarit(s). CONTACT I PRODUCER NAME� DeSanctis Insurance Agcy,Inc, FAY, 6ioNr. 1100 Unicorn Park Drive IA,C,W3,Exf): Woburn,MA 01801 k•MAIL INSURFri(S)AFFORDING COVERAGE NAIC INSORER A StarIfISLWar1C0 Company INSURLD JK Contracting, LI-C, ANSURERB:Seloctive Insurance Company, 19259 4 High Street Suite 108 North Andover, MA 01845 INSURER D INSURER E: INSUIRIER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THI,S IS TO CERTIFY THAT THE POLICIES OF INSURANCIF LISTED BELOW TO THE INSURE D'NAIy1r 0 AF30VE FOR THE POLICY PERIOD JNDfGATED. NOTVVITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTFIER DOCUMENT 14VITH "FO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE M IS SUBJC04 JO ALL. IHE IERMS, FX('t,(.I-SION3AND CONDITIONS OF SNY"l-I P0LI(',IF&LIMiT"SS-4O [` VJN -AAY HAVE:BE'.1EN RED(jt,,E0BYPAID CLAPV15 INt ADDL SUOR POLICY EFF 0micY rXI, an TYPE OF INSURANCL yyLei LIMIT$ B X COMMERCIAL GENERAL LIABILITY LACH 0(X,UfMFNCE 1,000,000 `rA0,-r3IAA-jF X OCCUR 82205113 02/10/2016 02110/20,17 ("Ar A 100,000 10,000 MED LX11 YAriy xioperson) S PFRSONAI i.ADV NJURY 1,000,000 ---------- CENT AGGRE(,AT.UNIP I APPI lf�S PER ,:,FN,NAI.AG3RI.GATF 3,000,000 Ro- ,000,000 x a'oucy LOC PROI)JCJS-COCOMPIOP AGX� S, ifc I 01iffoR, .......... ',''OMWNED SINGLE LINIff AUTOMOBILE LIABILITY S �Faa�c owtl ANY rG ALL OV'n4ED r,HF JJJLfeD NOD Ly accdwv) AUTOS AIA 011-1 -0 __I,*ipf Y DAMAGE H�REDA00S ----------- UNIBRELLA LIADOCM)R FACH OCCURNF.NCE EXCESS LIAO CLAWS-NIAD,- AG(AV7GATE WORKERS GOtAPENSATION j 41 ANC)EMPLOYIERS'LIAWLiTY Y i lArVIT r.R...... ... A ANYWC0853742 02117/2016 0211712017 FI. FAGHACCII'��Nq' 100,000 � N NIA Iman(Jalory 40m) MA If tq,� U 11),SCROTION OF OPF�RATIQIIIS,00r�yS 500,000 DESCRIPTION OF OPERATIONS I LOGATION8 d VEHICLES IACORD 101,ACIOINWIal way lie roquired) "ADDITIONAL INSURED LIMITS ARE NO GREATER THAN THOSE REQUIRED BY WRITTEN CONTRACT" Illustration of Coverage; Town of North Andover is acid'i ins'd as respects spects to the G1.policy, CERTIFICATE HOLDER CANCELLATION I NORTFIA. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tris: THEREOF, NOTICE WILL BE � EXPIRATION DATE DELIVERED IN vif North Andover ACCORDANCE WI1[I THE POLICY PROVISIONS, 43 HII10 1h Street— N.Andovc!r, MA 01845 1 AIJTHOM�P,? I MSMATlVF. Cca -2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD If The Commonwealth qfM, assachuseIts Department ofInrlustriglAccikn' is IBM Office of Investigations 600 Washington Street Boston,MA 02111 www.mass govIdia Workers' Compensation Insurance Affidavit: Builders/ContractorsfEiectricians/Plumbers Applicant Information Please Print Legibly, Name (Business/Organization/individual): W C\ o Address: E L4.— Cs ' City/State/Zip: 00 tf r-- N fft Phone M b 'T=f`1� A,rre you an employer?Check the appropriate box: Type of project(required): 1.(* 1 am a employer with^S 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.T �� , temodelixig ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g wilding addition [No workers'comp.insurance 5. El We are a corporation and its 10.F1 Electrical repairs or additions required.] offtcors have exercised their 3.❑ I am a homeowner.doing all work right of exemption per MOL I LEI plumbing repairs or additions myself. [No workers'comp. c. 152,§1(A),and-we have no 12,Q Roof repairs insurance �uired.re�. v employees.[No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#I must also fill out the section below showing their workors'compensation policy information. T Homeowners who submit this affidavit indicating they a'te doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I arra an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site information. Insurance Company Name:. t5 t t! 57 �v� Policy#or Self-ins.Lic.M — �� t' L - -- Expiration Date: ' 2 t")It "T... �y Job Site Address; t G-H 4�+�+��''-- City/statemp: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredundor Section 25A of MGL o. 1.52 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. X iia Izereby cert! under thepains and penalties ofperjury drat the infirtnation provided above is true and correct. Z Si Date; r afore: Phone#: Official use only. Do not write in this area,to he completed by city or town official: City or Town: Permit/Mcense# Issuing Authority(circle cine): I.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I� r Massachusetts Department of public Safety Board of Building Regulations and Standards License: CS-066334 1 ConStf L1Cho r3 Si"p a ervis r i KIERAN T WHELAN ." I 31 RICHMOND STREET WEYMOUTH MA,02188 it `, -713::1?'.f_ .• . �M CA ; c:omm,issioner Expiration: ��— 0912612017 . a �� ('fnllullrvtil Yr��/�r/f�'"((rL1d<rr�ILirffl ,r: bffRgrtr� icc of Cnosumer Affairs&Business Regulation --HOME IMPROVEMENT CONTRACTOR ISs Registration -.171393 Type: ( v57,prExpiration. 3/1512018 Individual KIERAN WHELAN KIERAN WHELAN 31 RICHMOND ST WEYMOUTH, €VIA 02188 Undersecretary License or registration valid for iatdiviti,aal zase only `.before the.expiration date. If found return 0. Office of Consumer Affairs and Business Regulation " 16 Park Plaza-Suite 5I70 B681ton,NFA 02116 I Not valid without sigrla#erre C��e�oilrllzolrar?rr�(�a��r?/l�a.rrac�<iaef�d Office off 6-Nz lsmi tr Affairs&Business Regulation f a HOME I{Y1PROVEIVIENT CONTRACTOR R:?gistratlon 171393 TYPe: Exp rrat.iarr: 3/15tt&} 8 Corpara#ioh }. JK CONTRACTING LLC KIERAN WHELAN 31 RICHMOND ST WEYMOUTH,MA 02188 Undersecretary i.