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HomeMy WebLinkAboutBuilding Permit # 12/21/2016Total Project Cost: Check No.: (95(c,-,c' Permit No#: BUILDI G PERMIT TOWN OF NOTH AND ER APPLICATION FOR PLAN EXAMINATION Date Received i Date Issued: IMPORTANT: Applicant must complete al CATI. N AP)3 PERTY7 /41)017 " yr/ AP9 6/, „ PARCE - inyJIW///047 A toR on this page Ii 61,04,4001: 1;'4 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential CI New Building F.] Addition VAlteration L-1 One family L.] Two or more family No. of units: Li Industrial .iigCommercial 0 Repair, replacement 0 Demolition Li Assessory Bldg 0 Others: El Other / / , / Wetlands Or:VA t 7//7 re / ,'% ,,,,, , ,v -/irt 7 ters e DI 'IC .ft ,///, , / 4f/e DESCRIPTION OF WORK TO BE PERFORMED: g I id u cr 6 ‘1,8-- 1 ri,7zr115 C-4 613 Pt,tch&f.f OWNER: Name: Address: Please Type or Print Clearly 1/45"., A Phone: k „PihO'le: „ontI'Ara,4;'eto a'4q . , ie Eba I1 0lc'-V„ Wf ,„',4P..k.g0v7 ? ..,,,,,,,A% erV:tiSbr!;s0bris rifetie , dc,Pri. ,, 9 - " / ',' ' Vv''' 7 r ' / ' / ' d / ,AE , '1,25p 'z' '4%ggig,%%141,"'"/"'"'"Vg,":0 V- , ,, , , .., ,,:f 7 t Exp ARCHITECT/ENGINEER—) (A.I Phone: ef -7 8 - tiv3 o as 0 Address: 2-t 0 Hr fJ7ri Reg. No. et FEB SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAIreESTIMATED COST BASED ON $125.00 PER S.F. 8135-2- FEE: $ Receipt No.: 3 13 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund tif AgenV.Owner Signature of contractdr 0 M 61' MO U) CO -0 0 n Z CL 5w O CL � o O CD a CD CD 17 CD o CO C ▪ v Fri' ▪ 0rn cQ m 1 rn � v z C) ©- o xi CD 0 CD ftZ woo o/ palm 2I0103dSNl owning m z m co c 0z ®a, 0 Cn N of the Zoning or Building Regulations Voids this Permit. o o CD Q • Q �D = cn 0 o sti co 5 m c, C CD 0 as va co o_ cn o a) ca ca o- o _< co C _ g cn. . C 3 c7,^er o o� CD y CD • DI 11) N rca - ccn c;: n fs • 0 ( g oa- st • g / o o, n0 ! n.) it. CD 73 52 a) I5. JP }oaJ8 al uolsslwjad sey JK Contracting LAX 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Bill To: RCG West Miff NA LL.0 Daviid Steinbergh 17 Ivaloo Street Somerville, MA 02143 Description Proposal Proposal Date: 12/14/2016 Proposal #: 203-72 Project: 50 High, 4th Fl, H... Ship To Hoyle & Tanner North Andover, MA 01845 Permits, Cof O. 976.00 976.00 General Conditions 2,500,00 2,500.00 Demo, Includes removing to 'I :,A l or and clurnpster fees 4,000.00 4,000.00 Dust Containment, Sealing holes ,,1,1,:i ;?�rimeter caulking 400.00 400,00 Heating & Cooling 19,790.00 19,790.00 Wall Framing 3,500,00 3,500.00 Doors & Trim 3,000.00 3,000.00 Windows & Trim, Install 1 inch In sr.Ilated glass in large window. 1,300.00 1,300.00 Plumbing [Estimate] 4,500.00 4,500.00 Electrical & Lighting [Estimate] 8,000.00 8,000.00 Tele/Data 3,000.00 3,000.00 Insulation 700.00 700.00 Interior Walls, Board. 2,500.00 2,500.00 Interior Walls, tape,sand 3,500.00 3,500.00 Cabinets & Vanities, Including granite tops 3,500.00 3,500.00 Floor Coverings 6,500.00 6,500.00 Painting 4,000.00 4,000,00 Sprinkler Work, Remove piping in Uo..'t from o€d system. 2,500.00 2,500.00 Supervision 7,416.60 7,416.60 Insurance 741.66 741.66 Estimate for your review and approval . Approved: (Initials) Total $82,324.26 SIGNATURE • FFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: I '-'• ` ` PROJECT TITLE: West Mill 50 High St. 4th Floor PROJECT LOCATION: 50 FIB Street, N. Andover, MA NAME OF BUILDING: West MMHI NATURE OF PROJECT: 1'i:. :tt demising and tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ESSIONAL ENGINEERJARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR D!RE..::: LY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND r=q1::C ,FICATIONS CONCERNING: ENTIRE PROJECT' : RCHITECTURAL STRUCTURAL e MECHANICAL FIRE PROTECTION " ELECTRICAL $ OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPEC= IGATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, Ail L ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND OF )INANGES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONS T F'UCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDi O 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 conformar:ce to the design concept, shop drawings, samples and other submittals which are submitted by tho contractor in accordance with the requirements of the construction documents. 2. Review and approval t}'.o quality control procedures for all code -required controlled m 3. Be present at interval l opriato to the stage of construction to become, generally fa ' i»r' `�' �a ► with6the progress and r u °ity of the work and to determine, in general, if the work is be SC ` i performed in a mann& sr :ic;r :istant with the construction documents. q a PURSUANT TO SECTION 3.2 ,2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPORT TOGETHER WITH PER.TIN'ENT. COMMENTS TO THE NORTH ANDOVER BUILDING INSP UPON COMPLETION OF' .'♦--: WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLEETON AND READINESS OF THE PROJECT FOR OCCUPANCY. SUBSCRIBED AND SV1`;.::C , TO BEFORE ME THIS DAY OF NOTA P BLIC MY COMMISSION EXPI �URKIINSHAW Notary Public Commonwealth of Mcasachusei n Expires March 7, 2019 The Commonwealth. of :Massachusetts Deo ui me rt of.IndustruilAcculenfs t2ffee of Investigations 600 Washington Street onion, )1 A 02111 www.mass.gav/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly c0-1►4 G-. f City/State/Zip: } o t7Pnono # i � -r9 z- —Cl'�— Address: 0 1 F (1- )1 Are you an employer? Check the appropriate box: . 1.14 I am a employer with i-f"' 4. Li I am a general contractor and I .. have hired the sub -contractors listed on the attached sheet $ These sub -contractors have workers' comp. insurance. are a corporation and its officers have exercised their right of exemption per MOL . 152, § 1(4), and eve have no employees. [No workers' omp. insurance required.] *Any applicant that checks box#1 must also fill out the svedon bolorr showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they tire ruing cii work and then hire outside contractors must submit a new affidavit indicating such. tContractors that cheekthis box must attached an additional sire =t slowing the name of the sub -contractors and their workers' comp. policy information. employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and'haveno employees working for me in any capacity. [No workers' comp, insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t Type of project (required): 6. [ New construction 7.Remodeling S. 0 Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.n Roofrepairs 13. ❑ Other I am an employer that is providing workers' compensation insurance for my employees. Below is the policy anti job site information. insurance Company Name:. Crj)G-1-- f` :tC4`1 f f'4✓`t Policy # or Self -ins. Lie. #: Job Site Address: Ht 611 v j '` ` 1 i c1',.`. , Expiration Date: 2 jl i /I —7 City/State/Zip: i V r i 0 0 Attach a copy of the workers' compensation -policy 8.eclaration page (showing the policy number -and expiration date). Failure to secure coverage as required.under Section .2 5A of,GL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonmoui, a3 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 of this statement may be forwarded to the Office of investigations of the DTA for insurance coverage °rcn11 ention. rdo hereby ce under the pains andpenalt ., (..1fpe.Jnyv that Me information provided abov is true and correct. Signature: ,/ `�'- Date: f L� i J /i % )hone #: j —q Z -- Official use only. Do not write in this area, ;er .> c ainpleieri by cify or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3 :`;°::y,/Tawn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - o Contact Person: Phone #: 4WRt1 CERTIFICATE OF LIABILITY INSURANCE JKCON-1 OP )D: CD DATE (MMIDDIYYYY) 07/26/2016 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 ate 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 endorselnentis). PRODUCER DeSanctis Insurance Agcy, inc. 100 Unicorn Park Drive Woburn, MA 01801 INSURED JK Contracting, LLC, 4 High Street Suite 108 North Andover, MA 01845 CONTACT NAME:_._" PHONE (A1C, No, ExtL LOX, No): EMAIL ADDRESS: INSURERIS) AFFORDING COVERAGE INSURER A: Star insurance Company INSURER B: Selective Insurance Company INSURER C : INSURER D : NAIL k 012245 19259 INSURER E : INSURER F N NUMBER: V JVLr1MVk..V va.r.a or .vr..,--..`............. 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 REQ(JIRENil ENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, 'YI-IE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCI-I POLICIES LIMI rS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE IADULe S JaN .ytoc. ivr. POLICY NUMBER POLICY EFF IMMfDDJYYYY) POLICY EXP (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY OCCUR j S2205113 02/10/2016 02/10/2017 EACH OCCURRENCE $ 1,000,0001 CLAIMS -MADE X DAWAGE SESO(Ea RENTED $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER 7 LOC GENERAL AGGREGATE $ 3,000,000 XI POLICY 1 jE O PRODUCTS - COMP/OP AGO $ 3,000,000 I OTHER: $ AUTOMOBILE --I LIABILITY ANY AUTO ALL OWNED T I SCHEDULED AUTOS I Ii AUTOS NON -OWNED H UMBRELLA LIAR EXCESS LIAR OCCUR CLAWS -MADE Il EACH OCCURRENCE $ AGGREGATE $ DEO RETENTION $ 4 $ WORKERS COMPENSATION ! AND EMPLOYERS' LIABILITY r Y 1 N I .'W00853742 OFFICA ANY PERNE ORfPXCLUD lEXECUTI� r~ II IN N l A l [Mandatory InNER EXCLUDED? L --,i itliA (Mandatory NH) If yes, describe under DESCRIPTION OF OPERATIONS below I 02/17/2016 02/17/2017 X ;MUTE I ER H- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 1 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACOID 101, Addltlona€ Remarks Schedule, may be attached It more space Is required) "ADDITIONAL INSURED LIMITS ARE NO GREATER THAN THOSE REQUIRED BY WRITTEN CONTRACT" illustration of Coverage; Tows. of North Andover is add'I ins'd as respects to the GL policy. CERTIFICATE HOLDER CANCELLATION NORTHA- Town of North Andover 43 High Street N. Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZ. PRESENTATIVE ACORD 25 (2014101) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 Construction Supervisor • KIERAN T WHELAN , 31 RICHMOND STRE -;v, WEYMOUTH MA; 021 Commissioner • Expiration; 09/26/2017 %fir• rurmri,parr,/l, r�r`74/.1free/ rzie/f..i Office of Consumer Affairs & Business Regulation !HOME IMPROVEMENT CONTRACTOR Registration: 171393 Type: ," Expiration::. 311512018 Individual KIERAN WHELAN KIERAN WHELAN 31 RICHMOND ST WEYMOUTH, MA 02188 Undersecretary License or registration valid for individual use only before the expiration date. If found return to: Oftiee of Consumer Affairs and Business Regulation. 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature OA tpa/Ir. JIEaYIII ett/fit 0lP/i/cr..lrtek et/i Offiee:of Consumer Affairs & Business Regulation HOME Ii11IPROVEMENT,CONTRACTOR Registration:.:= 14.71393 Type: Expiration_: Corporation lK CONTRACTING LLG KIERAN WHELAN 31. RICHMOND ST WEYMOUTH, MA 02188 Undersecretary