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HomeMy WebLinkAboutBuilding Permit # 11/28/2016Permit No#: Date Issued: .77c, # / , e / e 401 GATI. N a/74/ 11 "Ts P ER* N E /t711#1/0tW tf,y,f7/e/y (f,[1 eread* 4 MA4 ee BUILDING PERMIT TOWN OF NOTH A D VER APPLICATION FOR PLAN EXAMINATION Date Received /1 ,,C.70 7 IMPORTANT: Applicant must complete all items on this page /;/// oPUUU5nwlimEr•07 o Varygir Itireisro: nox ; '00r11101) r room ,7'1W/ e /n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 Addition 14Afteration lil One family Cl Two or more family No. of units: Cl Industrial il Commercial v f Cl Repair, replacement LI Demolition U Assessory Bldg t I Others: Li Other , eOtic 2, 'e i, 44 7EiFJeodpIain— PWetlands i e e 4 4 ' z ° e irezfr '4 /4/;t,/'/4 ' e " Watershed 'i' 66t 10, / iee/ lieW6 4 zee /4v e zee/ ,' ..., ; f„ /// , ;ater/6e _ 4 / fr17 p „ TO BE PERFORMED: Etii 0 c/G-- Pr.6-16_11 f Identification - Please Type or Print Clearly OWNER: Name:4 /4v( (77-. zd7t. 0,4 ecs---", Address: Phone: OF( ri-vt (ST 0 Li (-fr A,%11':'''' 41f.J7M.4: ,,a/,;,.,,,e//&„://gAA,,,,,,,z: P, f'Y r '' /w 4 - Y. atee,. ARCHITECT/ENGINEERJ, (Jai- Phone: (1"c17 k.4,—pe4e—q 0,4 c_ (do 7, Address: N',..rou ci,4- y e o Hij 0 vt SO 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: / 2- 0 FEE:S 6 \be Check No.: Receipt No.: ,n5) LF7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Oignature of Agent/Owner Signature of contractor C a) 0) N n C3 z o -a CL St O Q� N "D 13 15 o 1.5 CU O 0 CD CD CL m --I" CD Wc. O N co cc) = v 0 "a m 0 C) m 0 CD I Hoop o.? pagn 0 0 0 vt to c c m 0 ca 0 110133dSNI SV9 CD ✓ 0 0 0 b0133dSNI 1VD11313313 0 v o-to o o F„ C CD [07 = O [9 -I. . o 0" -0 = FA" g. m O 0 • a) 0 • CO p CD tto 0 CM � it'soCl) o nCD 03 ▪ a. O O O 110133dSNI 9NI2 W fl1d pen o; uo!sslwiad se t Clciat CD v 3 co -tG cr O • MED 0 0 T J.VHI S31dlisao 8I1-I1 0 Q. 0 a01D3dSNe 9NIo1Ifl8 HIIV31-I 30 axvo ;,; Old fv• kr '111 Plans Submitted ❑ Plans Waived.❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tantc, etc. ❑ Certified Plot Plan Stamped Plans E. Tanning/Massage/Body Art ❑ Tobacco Sales ❑ Permanent D17npster on Site ❑ Swimming Pools ❑ Food Packaging/Sales ❑ THE -FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING & DEVELOPMENT COMMENTSX.A62,ri\V\ eNCicoo/A 7\?ei eto Reviewed On ))n11,.o ? Signatura 1 0 CONSERVATION Reviewed on COMMENTS Signature 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: TIRE DEPARTMENT Leeatec1 at r1;24 Main Street Tire Department signa COMMENTS.'' Driveway Permit Located 384 Osgood Street Dumpsthr.on site Yes ® `; Number of Sfories: Total square feet of floor area, based on Exterior dimensions.-__ - Total land area, sq. ft.: ELECTRICAL: Movement of Meter l tion, mast or servicerop requires approval of Electrical Inspector DANGER ZONE LITERATURE; 1(es �O MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department us Time Contact Name Doc.Building Permit Revised 2014 OF5 9CE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL 14-0718 PROJECT NUMBER: 4 _____ _ .___"_.. PROJECT TITLE: American Contracting PROJECT LOCATION: -- treet,.N. Andover, MA NAME OF BUILDING: A BSt MITI NATURE OF PROJECT: Tenant improvement/fitut WITH ARTICLE 11C OFT ASSACI�USETTS STATE BUILDING CODE, ACCORDANCEREGISTRATION NO.� ���-- BEINGBY HAVE A EPA REGISTERED PROFESSIONAL ENGINEER/ARCHITECH PREPARATION OFE ALL CERTIFY THAT I SED THE COMPUTATIONSAVE DOR DIRECTLY AND SPECIFICATIONS CONCERNING: �RC;HITECTURAL STRUCTURAL " MECHANICAL ENTIRE PROJECT � ��„�._-R FIRE PROTECTION ''' ELECTRICAL RICAL OTHER (SPECIFY) BEST PROVISION THE MASSAGHUSETTS FOR THE ABOVE NAMED PROJECT AND TETHE APPLICABLE TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. YAND B I FURTHER CERTIFY THAT I SHALL NSITPERFORMTHE NEAND DOCUMENTS APPROVED TO FOR RMI ETHAT BUILDING THE WONT ON THE CONSTRUCTION SITE ON A REGULARTHE NDPERIODIC BASIS TO DETERMINE E THAT T N IS E.EDING IN ACCORDANCE WITH PERMIT AND SHALL BE FtESPONS103LF. FOR THE FOLLOWING AS SPECIFIED IN SECTION dCO other submittals 1. Review, for conformance to the design concept, shop drawings, samples a which are submitted by the contractor in accordance with the requirements of the construction documents. Review and approval of the quality control procedures for all code -required controlled meter 2. Revgeneraily famili to the stage of construction to general, become, the work istfamiiliii 3. with6theBpresent at Tess vals appropriate progress and quality of the work and to determine, in g performed in a manner consistent with the construction documents. s A ES PURSUAN T TO SECTION 116.2 .2 I SHALL S O CIT EEKL , AO O RUI[� TOGETHER WITH PERTINENT t`��! 4 COE�f ALL SUBMIT A FINAL REPORT AS 1 TS UPON COMPLETION OF THE WORK, I SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OIA SUBSCRIB NOTARY P 'L C D AND SWORM TO .FORE ME THIS 0.0 DAY OF MY COMMISSION EXPI URK1' Notary Puk Commonwealth of M' My Commission arc , 21 JK Contracting LLC 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Bill To: RCG West Mill NA LLC Daviid Steinbergh 17 Ivaloo Street Somerville, MA 02143 Description Permit, includes C of 0, Demo Wall Framing Doors & Glass Panels installed General Conditions Cabinets & Granite tops Heating & Cooling Electrical & Lighting Insulation Tele/Data sand Interior Walls, Board, tape, Painting plumbing Sprinkler Work Floor Coverings Supervision insurance Approved:____ (Initials) Proposal Proposal Date: 11/15/2016 Proposal #: 203-65 Project: 50 High St, Amer ... Ship To American Contracting 4th Floor, Suite 46 North Andover, MA 01845 Est. Hours/Qty. SIGNATURE Rate Total 1,612.00 1,500.00 4,000.00 3,200,00 3,500.00 2,500.00 6,500.00 15,000.00 18,000.00 1,500.00 8,000.00 8,500.00 15,000.00 4,500.00 4,500.00 17,500.00 11,220.00 1,122.00 1,612.00 1,500.00 4,000.00 3,200.00 3,500.00 2,500.00 6,500.00 15,000.00 18,000.00 1,500.00 8,000.00 8,500.00 15,000.00 4,500.00 4,500.00 17,500.00 11,220.00 1,122.00 Total $127 ,654.00 I am a employer with employees (full and/or part -tune).', 2. ❑ l am a sole proprietor or partner- ship andhave no employees working for me in any capacity. [No workers' comp. insurance required.] 3.0 I am a homeowner doing all work myself. [No workers' comp. insurance required.] The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 W1vay.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electritcians/Plumbers Please Print Le 'Tali A 1icant Ifu%rmation r� t l C.� Name(33usiness/Orgaaizagon/Tndiividuai): A.dcl7cess• v ti ► �� - City/State/Zip: s.0.1.!?�j Phone #• Are you an employer? Check the appropriate box: 4. 0 I am a general contractor and) have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. [1 We are a corporation and its officers have exercised their right of exemption per MGL e. 152, §1(4), and we have no employees. [No 'workers' Type of project (required): 6. D New construction 7, [] Remodeling 8. ❑ Demolition 9. D Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.Q Roof repairs 13.D Otherr._.____�_ — -- camp. insurance required nfrmaton actors that cbecked ail m *Anyapplicantat shecks box i mustalsoflli cut section workers' olico— i Homeowners whosubmit this affidavit ieating*ye doingailwork and then e outside contractors must submit anew affidavit tContrthis box mat_s:ttael ad ditionaE sheet showing the name of the sub -contractors and their workers' comp. Pi n. I am an employer that is providing workers' compensation insurance far my employees. Below is the policy and job site information. k 4.�tviPs�; t,u wP Insurance Company 1`Fame:, . + �1 r "7J RxniratiofDate: !i 1n. Policy �# or o erg-1us. ,r.v. �.e� ._-,,�_ —� -- O q J �'�--=__ CitylStatelZip: � . a-----14.. expiration date). Job Site Address:�� -- slowing the policy nuxnbcr and eicp' Attach a copy of the workers' compensation they declaration page Failure to secure coverage as required.under Scotian 25A oell ancivilenalties in the form of a STOP WORK ORDERd a fineiAGL op.152 can lead to the imposition of criminal penalties ofa fine up to $1,500.00 and/or ono -year imprisonment, a. �x of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office twestigations of the DIA. for insurance coverage verification. Ida hereby cert j under the pains and penalties of per, wy that the information provided hove is ue and correct. Date: i l Si ature: Official use only. Do not write he this area, to be completed by city or town official, Permit/License tt 0J"M tog d(��' City or Town: 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Issuing Authority (circle one): 6. Other Piiolne �:_,_�-- Contact Tiers �._- �= - —one -�---- CERTIFICATE OF LIABILITY INSURANCE AC -CPR i0 TE HOLDER. THIS THIS CE RTIFICATE E OE IS NOTLrD AFFIRMATIVELY A IVifaTCOF DATIVE Yl0 ONLY AND CONFERS NO RIGHTS UPON THE MEND, EXTEND OR ALT R THE COVERAGE AP ORDEDABY THE POLICIES BELOWCATEDOES OFiU ORDOES NOT Y A BELOW. THIS CERTIFICATE O�RINA t� 7 NE C � ��GA�E HOLDER. CONSTITUTE A CONTRACT BETWEEN THE ISSUING SUBROGATION ISR(S), AUTHORIZED WAIVED, subject to REPRESENTATIVE certificate PROl3U IM • uiro an endorsement. A t be endorsed. ®nt e . If certlitcate does not confer rights Lotto the to ms an If the is holder is rtn ADDITIONAL INSURED, the endorsement. must be on orse terms and conditions of the policy, certain policies may require he .a•... ..._ CONTACT I NAME: ,'FWf.... rAJQ No, gulf...,,. E-I1Alt I INSURER. AFFORDING COVERAGE „ i W--^_ 012246 INSURER A;Star Insurance Company. ..... 119259 INSURER E: Selective Insurance Company_ .. .- -_.,, _..,.-i.- ; INSURER C • ...,.. .. _.,.,,...... INSURER D : _. 1 INSURER E' I INSURER f : REVISION NilI�BER: CERTIFICATE NUMBER: LADING ANY NEQIJIREMENT, TERM OR CONDITION OF SAN TCO TRACT OR OTHER DESCRIBED DOCUMENT SUBJECT HSPECTATO WHICH TERHIS THIS IS TO CERTIFY THAT THE POL101E5 OF ENSUF:ANCi: LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD CERTIFICATE INDICATED. NOTWITHSTANDING BE ISSUED A HE ECiFICRTE OR PERTAIN, THE S S INSURANCE y . .'.-...--"oULIGY EFF POLICY EXP EXCLUSIONS AND CONDITIONS OF SUCH PQLIt IFS t rJ�l °� SHOWN atAY HAVE BEEN REDUCED BY PAIDCLANSs (MIT —___--_ -_—A I- WWHL"YUBR rPOLIC EFF POLICY Yvvs 1,000�DOi ILTR POLICY NUIn_...,—• BER g _._�».._ TYPE OF INSURANCE .CI � _._.....------ EA�k OCCURRENCE — — — raa+A� ro aNT�c 100,00( I g )( COMMERCIAL GENERAL LIABILITY Sj21}5i'S3 021101701$' 02�10�2017 p iEMI;'FS IE•e a'.c4 —ram- -$ ---• 1�'D�1 CL IM5 OE ' X DCCIJA • MED ESSF Al e,person} ...,',.$.__.._ ._... 1,000,001 PERSONAL E. ACV INJURY .-- 3,000,001 GENERAL AGGRr9A E_...:5__ ..............�..3!{70O,OD PRODUCTS • COMP/OP AGO:`.... _., .._-._.,�-0 5 JKCON-1 OP ID; CD rhea eortlfinate holder in Ilea of such endorsement s). (PRODUCER Inc. jDeSanctis Insurance Agcy, 1100 Unicorn Park Drive Woburn, MA 01801 !K Contracting, LLC, 4 High Street Suite 108 North Andover, MA 01845 CEN'L AGGREGATE LIMTAI'FLIES PER PRO-•LOC • POLICY • OTHER AUTOMOBILE LIABILITY ANY AU'C .. _..-` ALL DINED SCHEJULEC AUTOS ... AUTOS NON-OAl'E[ HIRED ALTOS AUTOS UMBRELLALIAS • - OCCUR . EXCESS LIAR CLAIMS -MAD. ' CEO 1 I RETENTION C ;WORKERS COMPENSATION !: AMC EMPLOYERS' LIABILITY A ANY!PROPRIETOR+RARTNERrEXECIr"I'fE `DFFICERl..EMEER EXCL'.JOEO'' Mandatory In NA) II vee. (je6Cribe order ' DESCRIPTION OF OP__RA.TIONS co,ew Y Is N NON 's/11C�t 5 3742 MA COMBINED SINGLr.'_IMIT , $ ,Ea accid=nti....... ........... 6O01LY INJURY (Re' oerser.I , S • BODILY 'NJURY,,d aclO. 'a , yrgdanlj; $ ' PROPLRTY DAMAGE IPormedal.% S EACH OCCURRENCE. §§ ..AGGREGATE ..-.-• a .____.....,,.._.�._....--.-- �.._--.�—�^^^-_a'..'.. X TATUTE ER 1 oa,a 021171201E 02117/2017 E.I. EACH AccIDENr s 100,0 E I. DISEASE CA EMPLOYEE' $ E I,. DISEASE - POLICY LBW ' S 500,0 __�._..C_.E..___:.._.- OE$CRIPTEON Of OPERATIONS! LOCATIONS 1 VEHiCI.�S (ACORD `iU1, Adnit,vn. I Rema rho Schntluka, may be attached It more space i5 roqutretlj CONTRACT" IIllusttrat Illustration of LIMITS Coverage; Town of North Andover NO GREATER. THAN s add REQUIRas ED BY WRITTEN respects to the GL policy, Town of North Andover 43 High Street N. Andover, MA 01845 NORTFlA- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOF THE ACCORDANCEIWITH THE POLICY PROVISIONS. E ALL BE DELIVERED AUTHOR(2 © 1988.2014 ACORD CORPORATION, Ali rights reserver ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 Colts Suaervisor KIERAN `1 WHELAN 31 RICHMOND STREET':;': WEYMOUTH MA 021E E,; NiC-orninissioner Expiration: 09/26/2017