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HomeMy WebLinkAboutBuilding Permit # 1/6/2017( Permit No#: (-1 Date Issued: BUILDING PE IT TOWN OF NOTH ANDO ER APPLICATION FOR PLAN EXAMINATION / IMPORTANT: Applica li;e1r//0 II //0,4(41.A gr/0 OATIONI) /10111V) ?PR PARTyi 44 ) '1441 j Irditr— Date Receive it must complete all items on this page m/1 /O2t Kidj2d ij11/4§17A, , yofq f V,T6,7\ Yqi MachineShor» TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building D Addition Alteration Li One family El Two or more family No, of units: Li Industrial RZommercia cgRepair, replacement 0 Demolition D Assessory Bldg 0 Others: D Other Wetlands , /, /A ,/iiloN/Yatershe' s D istna/,,,,z/z, , / ' DESCplpTION OF WORK TO BE PERFORMED: 71-1- ercrimtcv.€13 uP Identification - Please Type or Print Clearly OWNER: Name) 64‘ Z7611,1 42.6N0L-C1 Address: '' ir2102;74 "iP ARCHITECT/ENGINEER (- 6'ct Address: 1- 6 0 rtd itttt rtr" C Phone: 14 Phone. A,„„ , ete,&04," "I;r,,' '$ e,,611AWZYATA ' Phone: a64.6,ht..-110.osReg. No. CS 2 D. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. x Total Project Cost: $ 14. Lt- 4-a FEE: $ Check No.: /.1 12)1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund rturef Agent/Owner gngure of CorytrOpfoT„, Plans Submitted L] Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOS Public Sewer Well rivate (septic tank, etc. Li LII anni 11 g/Massage/B ody Art Tobacco Sales Permanent Dumpster on Site Li Li Tri.g PooJs LI Food Packaging/Sales Li THE FOLLOWING SECTIONS FOR OFFICE: USE 9 INTERDEPARTMENTAL SIGN OFF U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS \ Ex\co ii)),c6or LY CONSERVATION COMMENTS Reviewed on Signature HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Zoning Decision/receipt submitted yes Comments Comments Water & Sewer ConneetiOWSignature & Date Driveway Permit DPW Town. Engineer: Signature: L.ocated 384 Osgood Street FIRE DEPARTMENT - -romp Dumpster on site yes 1-00p.ted at '124 Main Sheet Fire'tthpetrri4nt signature/date COMMENTS • Cn *. Cl) 0 O -o O Fir "5 su am.. O o v rt. = m m 0 CO w n an cc' vI O cn ZCD 'a 0O O .71 CD 3 O CD LATION of the Zoning or Building Regulations Voids this Permit. m o 5. a CD ^" ro o 0- 0."4 o _<cc C N• o 0 o co o. ."15r�+ a, -a cn 0 0 E 0 N 1VH1 S3Iflla3 SIHI w CM CA "MOMMOONDIMMIM Whol 50High Street North Andover N1A � lvenix is a medical device company that provides infusion pumps to hospitals and clinics for the Cdelivery offluids and medications topatients. SUHigh Street will bethe primary office space for the com�~any that will support Management, Sales, Marketing, Customer Service, Finance, Genera|Adminis1ra -tion, and Research & Development, The company does not noaoufactureany product onsite. All prodvo, otsane manufactured and tested by external vendors. The, various "laboratory" spaces designated for tN e 5"' and is' floor of High Street will be built to support produadevelopment of new products and clu a|ity control of existing products. There will be no biological or chernically hazardous materials used a --,t the The following is a description of each lab area and its inteiided use: Flow Lab — The main flow lab is used by engineering and quality teams to develop new products --and verify the performance of existing products. The lvenix infusion pump is designed to accurately 0�,eliver fluids toapatient inatypical hospital setting. The pump accuracy and performance iscontinuours|y tested using sterile water mrstandard saline. These fluids are measured using highly accurate sonles.This space is also used to support product development activities and therefore may contain typical adhesives and household cleaners. EE Lab (Electrical Engineering) —The Ivenix infusion pump is a highly sophisticated electronic devire that has a large color touch screen and wireless connectivity. The electrical engineering lab area supp«zrtsthe design, evaluation, testing, and prntotypingofsmall, mobile electronic devices. This space will be mostly occupied with electronic test equipment including small prok/typings0|dehng stations. QA Lab —The QA lab on the S'f'floor is dedicated for final product software testing. This room will be populated with standard desktop computers. Field Support Lab -- A dedicated work space for customer service and field support engineers to diagnose issues found in the field.This room will be occupied by Ivenix products and software running on PCs simulating a user environment. Usability Lab ' The |venixpump is medical device that could heuse by nurses and care givers in several high risk health care settings such as emergency roorns, operating rooms and intensive care units in a hospital. Human factor and user interaction design is critical to avoid cornnonn medical errors. This room and its adjacent observation room is set up to simulate a hospital environment so representative users can be observed interacting with Lhe product, This i-,, a simulation environment only. No hazardous materials other than typical cleaning prodoC1sare used inthis setting. t Floor: Machine shop — The machine shop is used by engineering for prototyping of new product concepts. It is not used in any way for production or finished product manufacturing. It will have basic manual shop tools used intermittently as needed. Typical cleaning products, solvents, lubricants, adhesives will be stored in appropriately controlled cabinets. Set Assembly - The Ivenix pump system utilizes a disposable, sterile component that is used only once for a given patient. This assembly is produced by an external contract manufacturer in very high volumes. This room is designed to support engineering and quality teams working on external manufacturing process development and quality control of existing processes. This is an R&D function only, no product is manufactured on site. Clean room — Any medical device requires validation of cleanliness and sterility. This space is a controlled area for sampling of finished product as well as verify cleanliness of any product that may be returned from the field for failure analysis. Only typical household and healthcare cleaners are used and no special handling is required. OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER. CONSTRUCTION CONTROL PROJECT NUMBER: 15-0718 PROJECT TITLE: West Mill - 50 High St. Ivenix - 5th Floor PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 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 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 familia 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. I PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY , A PROGRESS REPOR TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INS 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 DAY OF MASS] SIGNATURE NOTARY PUBLIC MY COMMISSION EXPIRE A f3t1RKINSHAW Public Irh of Massachusetts; rnrnission Expires •ch 7, 2019 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 lvaloo Street Somerville, MA 02143 Proposal Proposal Date: 12/20/2016 Proposal #: 203-76 Project: 50 High, 5th Fl, lv... Ship To 5th Floor Ivenix North Andover, MA 01845 Dust Containment Wall Framing Roofing, Flashing Doors & Trim Windows & Glass. Plumbing Heating & Cooling Insulation Interior Walls, Board Interior Walls, Tape, sand Millwork & Trim, Front desk.,distressed wood walls Electrical & Lighting Floor Coverings Cabinets & Vanities Painting Supervision insurance 8,908.00 1,000,00. 45,000.00 1,000,00 40,000.00 40,000.00. 15,000.00 125, 00A..00 20,000.00 50,000.00 60,000.00 15,000.00 100,000.00 105,000.00 10,000.00 42,00000. 66,200.00 6,620.00 8,908.00 1,000.00 45,000.00 1,000.00 40, 000.00 40, 000.00 15, 000.00 125,000.00 20,000.00 50,000.00 60, 000.00 15,000.00 100, 000.00 105, 000.00 10,000.00 42,000.00 66,200.00 6,620.00 Thank you for your business. Approved: (Initials) Total $750,728.00 SIGNATURE JKCON-1 OP ID: CD ACORO" 41611/111 CERTIFICATE OF LIABILITY INSURANCE DATE (MMfDDIYYYY) 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 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 JK Contracting, LLC. 4 High Street Suite 108 North Andover, MA 01845 CONTACT NAME: PHONE FAX 1AIC, No EeQ: I (A/C, No): E-MAIL ADDRESS: INSURERIS) AFFORDING COVERAGE INSURER A: Star Insurance Company INSURER B: Selective Insurance Company INSURER C : INSURER D : NAIL # 012245 19259 INSURER E : INSURER F : • REVISION NUMBER: 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 REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR -IADDL SUER; POLICY EFF TPOLICY EXP TYPE OF INSURANCE INSD WVD 1 POLICY NUMBER (MM/DDIYYYY) IMM/DD!YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY', i X OCCUR I 52205113 02/10/2016 02/10/2017 EACH OCCURRENCE r $ 1,000,000 J CLAIMS -MADE II I DAMAGE TGRENTED PREMISEjEa occurrence) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 FGENT X AGGREGATE LIMIT APPLIES PER', rGENERAL AGGREGATE $ 3,000,000 POLICY y JE � I LOC I OTHER: PRODUCTS - COMP/OP AGO $ 3,000,000 • $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT i5e accident} $ BODILY INJURY (Per person) INJURY BODILY INJURY {Per accident ) $ I $ ALL OWNED I SCHEDULED AUTOS L ,_I AUTOS NON -OWNED 1 HIRED AUTOS I AUTOS 1 I PROPERTY DAMAGE _(Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR I CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ $ A WORHERS COMPENSATIONI AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIP? ION OF OPERATIONS Y! N N 1 A WC0853742 MA 02/1712016 02/17/2017 X STATUTE I �R H E,L. EACH ACCIDENT $ 100,000 N --- E.L. DISEASE - EA EMPLOYEE $ 100,000 below E.L. DISEASE - POLICY LIMIT $ 500 000 , DESCRIPTION OF OPERATIONS f LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) "ADDITIONAL INSURED LIMITS ARE NO GREATER THAN THOSE REQUIRED BY WRITTEN CONTRACT" Illustration of Coverage; Town of North Andover is add] ins`d as respects to the GL policy, CELLATION 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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 , www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Name (Business/Organization/Individual): --Z"—• K • e-o ikt5 /to c- Address:S tits- tOdl ( 6-H City/State/Zip: ins ro v. .f Phone #: Arc you an employer? Check the apPi:opriate box: ijj1aina employer with .r; _employees (full and/or part-time).* 2.0 1 am a solo proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3, n a homeowner doing all work myself. [No workers' comp. insurance required.] t 44J I am a homeowner and will be hiring contractors to conduct all work on my property. Twill ensure that all contractors either have workers' compensation insurance or are sole propiietors with no employees. 5.0 am a general contractor and I have hired the sub -contractors listed on the attached sheet. `these sub -contractors hale employees and have workers' comp. insurance.1 6.[] We are a corporation and its officers have exercised their right of 'exemption per MGT, c. 152, §1(4), and we have no..emplOyees. [No workers' comp. insurance required.] Please Print Legibly L C-- Type of project (reciuired): 7. 0 New construction 8. modeling 9. El Demolition 10 I j Building addition i1.i1 Electrical repairs or additions 12.0 Plumbing repairs or additions 13. El Roof repairs 14.0 Other 'I'Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. • t Homeowners who submit affidavit indicating they are 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 state whether or not those entities have . employees. If tho sub-cOniracters have employees, they nndt provide their workers' comp. policy number. l am an eniployer that is proViding workers' compensation insurance for my employees.Below is the policy and job site Insurance Company Name: '...,- iS (t5. ( (/.5.- I 0 4 (1 0 information. (7 Policy # or Self -ins, Lie. ---C__:: --74—Lr:1--- Expiration Date: i .16. . 7...._ Job Site Address: .s- 1) 14 ( A pi SG- City/State/Zip: 0 0 r,t--J k Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of pedury that the information provided above is true and correct. Signature: Phone #: q Date: Official use only. o 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 Phone #: Contact Person: Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 Supervisor KiERAN T t HELAN 31 RICUMOND STREET, WEYMOU7lf MA O218B `1 .: Corn ssian Expiration: 09/26/2017