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HomeMy WebLinkAboutBuilding Permit # 12/22/2016 (2)BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION "TA Permit No#: Date Issued: IMP4TANT: Applicant must complete all items on this page Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 Addition ,gLAlteration 0 One family 0 Two or more family No. of units: 0 Industrial >0:Commercial El Repair, replacement Li Demolition D Assessory Bldg u Others: ill Other Li e , : , 'F'-'4dpir— etlarl . Y:' 40cIfr.e' --t DESCRIPTION OF WORK TO BE PERFORMED: rne-r (4, 0 ct p ti— P A IdentiVeation - Please Type or Print Clearly OWNER: Name: ?CC- WW A L-.1, C. Address: u n-6 m rovem ens Phone: ARCHITECT/ENGINEER3 Phone: crze 2-761 fteq 0 tclro Address: 'Lb. 6 14 614410e:1C._ N 5 qq(..Z4emf att.) Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER vocmoo OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 'Li 0 FEE: $ k C Check No.: Receipt No.: -3 31 I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Oignature of Agent/Owner— Signature of contractor 4.0.0 H zotlt TIRES THAT 1 0 U) 01 cu co z C O C QO,a� w�+ co 2 C) O c c 1.2 0 cu U �m 0 -a 0 4-0 a c C2. 0 0 13a) — o .0 c h C C O as CMG C om O '� 4.1 U CD cl)a 0 co U E Q • C a)0 a) W o E 0a Ucn L.- -0 a c .__ -0 0 -Fcsv C o VIOLATION of the Zoning or Building Regulations Voids this Per C.) LU - J co CO uired to Occu JK Contracting LLC 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Bill To: Genians, Suite 45, 50 High St. N.Andover, Ma.01845 Descriptio Proposal Proposal Date: 11/3/2016 Proposal #: 203-62 Project: 50 High St, Genie... Ship To Genians 4th Floor, Suite 45 North Andover, MA 01845 Permit C of O. Demo General Conditions, including dumpsters. Wall Framing Doors and Trim Heating &`Cooling, includes new a or unit and all ductwork [estimate] 478.00 2,000.00 2,000.00 1,200.00 1,500.00 15,900.00 478.00 2,000.00 2,000.00 1,200.00 1,500.00 15,900.00 Electrical & Lighting [estimate) 3,000.00 3,000.00 Floor Coverings[estimate] 3,200.00 3,200.00 Interior Walls, Board, 2,000.00 2,000.00 Interior Walls, Tape, sand 2,500.00 2,500,00 Painting 3,000.00 3,000.00 Tele/Data [not priced] 0.00 0.00 Insulation 400.00 400.00 Cleanup & Restoration 200.00 200.00``. Sprinkler Work 900.00 900.00 Supervision 3,827,80 3,827.80'..' Insurance 382.78 382.78 Estimate for your review and approvai Approved: (Initials) Total $42,488.58 SIGNATURE OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 1 5"0 11 8 PROJECT TITLE: West Mill - 50 High St. 4th Floor PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Miil NATURE OF PROJECT: I enant demising and tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH 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 PROCEEEDIN ' 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 m 3. Be present at intervals appropriate to the stage of construction to become, generally fa lie with6the progress and quality of the work and to determine, in general, if the work is beiffip performed in a manner consistent with the construction documents. PURSUANT TO SECTION '1 '16.2 .2 I SHALL SUBMIT WEEKLY , A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSP 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 SWO R'.M TO BEFORE ME THIS `DAY OF I SIGNATURE NOTA ! P . BLIC MY COMMISSION EXPI A URKIINSHAW Notary Pubii Commonwealth cif Mc5sachuseil n Expires March 7, 2019 1. Il I am a employer with Li -- employees (full and/or part-time),* 2, D I am a sole proprietor or partner- ship and'have no employees working for me in any capacity. [No workers' comp. insurance required. 3. ❑ lam a homeowner doing all work myself. [No workers' comp. insurance required.] The Commoniveriltia OfMassachusetts Departrnimt of Industrie A. ccirients fti .,2: of ivestigations 60 1y Washington Street Boston, .JL4 02111 www.tnass.gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/PIumbers Applicant Information Name usiness/orga_i.�on zation/ln):dividual Address: S U f ►_ 6-11 Please Print LegThl* City/State/zip: I I�-14-0 b Cl 'e . 0p FY it-- # 6 ' ( Are you an employer? Check the appropriate box: 4. 11 I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These; sub -contractors have workers' comp, insurance. 5. L I We are a co:rporatien 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 e(rnstruction 7.1�'4 Remodeling 8. ❑ Demolition 9. 0 Building addition 10.0 ElectricaI repairs or additions 11. ❑ Plumbing repairs or additions 12.0Roof repairs 13.0 Other 4Any applicant that checks box WI must also fill out the section below showing their workers' compensation policy information. f Homeowners who submit this affidavit indicating they ore doing all work and then hire outside contractors must submit a new affidavit Indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. 1 am an employer that is providing workers' compensation iasaar meefor my employees. Below is the policy and job site information. Insurance Company Name:. Et-.{` k`Y'9 .r 1.1 /11: Policy # or Self ins. Lie. #: W �' (� �� Lf—" Expiration Date: Z 711 9-3 Yob Site Address: - NI Gn i I —I d 'c," , 1'' City/StatelZip: Attach a copy of the workers' compensation policy declaration page (showing t'he policy number and expiration date). Failure to secure coverage as required. under Section 25A of.I1'.IG% o. 152 can lead to the imposition of criminal penalties of a fate up to $1,500.00 and/or one-year imprisonment, as well tls 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. i do hereby cer iA under the at and penalties ofpea rat; that ; rye information providers ahoy is true and correct. signature: , Date: l l�1 J / ?hone #: I 1 " Z — b Official use only. Do not write in IMs area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board ofHealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5, Plumbing Inspector 6. Other Contact Person: Phone #: "eiCCoRi=ia' CERTIFICATE OF LIABILITY INSURANCE JKCON-1 OP ID: CD DATE (MMIDDJYYYY) 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 OI1 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 endorser ii&nt{s). PRODUCER DeSanctis Insurance Agcy, Inc, 100 Unicorn Park Drive Woburn, MA 01801 INSURED JK Contracting, LLC, 4 High Street Suite 106 North Andover, MA 01845 I�e.�x , :m• CONTACT NAME: PHONE FAX _..IA/0, No Extk: L INC, Noti EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A: Star Insurance Company INSURER B: Selective Insurance Company INSURER C INSURER D : NAIC # 012245 19259 INSURER E INSURER F N NUMBER: %.vrrnn�1-0 THIS IS TO CERTIFY THAT THE INDICATED. NOTWITHSTANDING CERTIFICATE MAY BE ISSUED EXCLUSIONS AND CONDITIONS ..,a>. ..,m.,n POLICIES OF €NSURANCE ANY RF_QUIREME1.1T, OR MAY PER 3 AIN, OF SUCH POLICIES, DDi',5U3fii, t�IV j1N5 'i', ,U; ...d�... _ LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEROD-- TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS THE IE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I. EMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE I POLICY EFF POLICY NUMBER I (MM/DDIYYYY POLICY EXP IMMIDD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY OCCUR 4 :52205113 1 I 0211012018 02/10'2017 i EACH OCCURRENCE $ 1,000,000 PPREES (Es occurrence)$ 100,000 1 CLAIMS -MADE X MED EXP (Any one person) $ 10,000 I PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES__PER I i LOC i PRODUCTS - COMP/OP AGG $ 3,000,000 X_I POLICY U JE 9 OTHER: $ AUTOMOBILE LIABILITY ANY AUTO i — -OWNED COMBINED SINGLE OMIT accide_r $ i_(E. BODILY. INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED AUTOS _ H $ UMBRELLA LIAB EXCESS LIAB OCCUR I j CLAIMS -MADE j EACH OCCURRENCE $ AGGREGATE $ — DED RETENTION $ i $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OE OPERATIONS i Y ! N ;' =W00135:3742 MA I 02117/2016 02/17/2017 XPEPERTUTE , ER H E.L. EACH ACCIDENT $ dQ Q00 , 1'� iii I''. K I A below E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 l i a DESCRIPTION "ADDITIONAL CONTRACT" respects OF OPERATIONS! LOCATIONS! VEHICLES (ACORD in Additional Remarks Schedule, may be attached IT more space Is required) INSURED LIMITS ARE NO GREATER THAN THOSE REQUIRED BY WRITTEN Illustration of Coverage; Town of North Andover is add'I ins'd as 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 .l` PRESENTATIVE 60141114,.. ACORD 25 (2014/01) ©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 sTR4g; WEYMOUTH MA- 021 - .7; CA_L_ Commissioner Ex p ration: 09/26/2017 t r//e1,1oif (7. fe;1All.h-11.; 4!- Office of Consumer Affairs & Business ItCgulation LHOME IMPROVEMENT CONTRACTOR Registration. .171393 • Type: 1-4k'_a--•;g Expiration: 3/15/.2018 Individual KIERAN WHELAN KIERAN WHELAN 31 RICHMOND ST WEYMOUTH, MA 02188 Undersecretary License or registration Valid for Individual use only efore the expiration date. If found return to: Office of Consumer Affairs and Business Regulation :10 Park Plaza - Suite 5170 8oston, MA 02116 Not valid without signature rt-Tim'ic;inmeoirtiv.erld orgi(laiareckiiein Office of cOnspMer Affairs 4 Ousiness Regulation HOME IMPROVEMENT CONTRACTOR Registration:--:Z.i72§3 Type: ' • ExpiratiorRigitgi 8 Corporation JK CONTRACTING tfr," r • LLC- KIERAN WHELAN 3'1 RICHMOND ST WEYMOUTH. MA 02188 Undersecretary