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Home My WebLink AboutBuilding Permit # 3/1/2017Permit No#: Date Issued: IMPORTANT: Applicant st complete all items on this page t BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '02 Date Received LOCATION S PROPERTY OWNER MAP PARCEL: Print ZONING DISTRICT: 100 Year Structure Historic District Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential D New Building D Addition : I oration Li One family LI Two or more family No. of units: 0 Industrial MLCommercial 0 Repair, replacement 0 Demolition 0 Assessory Bldg 0 Others: 0 Other DESCRIPTION OF WORK TO BE PERFORMED: c07.) j)f WJ6- Identification - Please Type or Print Clearly OWNER: Name.__flv a, -7, Phone:f1 1-7-6 2_ i , Address:Li a-iit;,. 1 6 0 1- vrt9toe a 1 Contractor Name: ,S Email: l< Address::' t 617: (-Phone: ) 2_ —6 7-773 61-/41 c L. Supervisor's Construction License: C;." •C 36,61,2 (1--- Exp. Date: Home Improve ent License: Exp, Date: ARCHITECT/ENGINEER i) N Add ress : 4 Livt—V ork-) Reg. No. ?,Y" ,„„ FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER, S.F. FEE: $ b4-6 k,6(' t Phone: 7 Total Project Cost: $ —7 Check No.: Receipt No.: ) NOTE: Persons contracts ig with unregistered contractors do not have access to the guaranty fund Signature__a=mtra ent/Owner 'CS OCD p O '•O • =. C • O - h' O ® C CD 0- C) O CD co W 2 c N CO (D I � ® �. CD 0 O r� CD &r) as p of palm -11 m cn co VIOLATION of the Zoning or Building Regulations Voids this Permit. -a CD 0. c, 0 0 0 CD 2 0 0 0 CD 0 C, -0. a. w PROJECT NUMBER: 15-0718 PROJECT TITLE: SONEXIS OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant improvement/fit out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, 9bNA,LA's N , t„) lk i REGISTRATION NO. S,63 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 m 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 familiar: with6the progress and quality of the work and to determine, in general, if the work is be'Iit= L performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY , A PROGRESS R TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDIN 4 UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO T SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPA SUBSCRIBED AND SWORM TO BEFORE ME THIS ottoi /40 DAY OF MY COMMISSION Ei-1 CHERYL L. BURKINSHAW Notary Public mmotiwealth of Massachusetts My Commission Expires March 7, 2019 JK Contracting Inc. 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 Proposal Proposal Date: 2/20/2017 Proposal #: 203-89 Project: 50 High St, Sonex... Ship To Sonexis North Andover, MA 01845 Project Location/Description: 50 High St, 2nd Floor, Sonexis, North Andover, MA Permit and C of 0 Demo General Conditions, Dumpsters, floor protection, Wall Framing Doors & Trim Plumbing,[Estimate] 868.00 2,500.00 3,500.00 3,800,00 3,700.00 5,500.00 868.00. 2,500.00 3,500.00 3,800.00 3,700.00 5,500.00 Heating & Cooling [Estimate] Ductwork only 2,500.00 2,500,00 >. Electrical & Lighting, [Estimate] 10,000.00 10,000.00 Tele/Data [Estimate] 5,000.00 5000,00 Insulation 750.00 750.00 Interior Walls, Board, interior Walls, Tape, Compound, sand, 1,800.00 3,600,00 1,800,00 3,600.00 Cabinets & Vanities, including Formica tops. 4,300.00 4,300.00 Floor Coverings, [Estimate] 7,500.00 7,500.00 Painting, Including ductwork, 6,500.00 6,500,00 Sprinkler Work 1,300.00 1,300.00 Glass ,Windows. 800.00 800.00 Cleanup & Final Clean 500.00 500.00 Supervision 6,441.80 6,441.80 Insurance 644.18 644.18 Estimate for your review and approval . Approved:_ __ _ (Initials) Total $71,503.98 SIGNATURE The Commonwealth of Massachusetts Department ofIndustrialAecidents 1 Congress Street, Suite 100 Boston, MA 02114 2017 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plunzbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information 11�� 9 Name (Business/Organization/Individual): �] Ce J p ` µ. ' i ✓V ' Please Print Legibly Address: cJ t G 10 S 1: ( 6 r/ 4t Ncc City/State/Zip:0 . /°mil atD J V 0 1(0-1-) Phone #: t l' 'J Are you an employer? Check the appropriate box: 1. I am a employer with. 6. employees (full and/or part-time).* 2. El I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3 ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGI, c, 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction S. Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.0 Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14.❑Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. I' Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that cheek this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, fliey must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy # or Self ins. Lie. #: /I a) Job Site Address: NC 0 M t611. • i, i ITO PLC j *..1 City/State/Zip: „ 3 Af Q d ei 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 c. 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 WORD. 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. gWerpt-- I Al-r 0/14K3 v\J Expiration Date: 1" do hereby cer ' y under the pains and penalties ofper jury that the information provided boys is t we and correct. Signature: Date: ` I Phone #: t ? 1-Ct L y� `7 J Official use only. Do 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 Contact Person: Phone #: CERTIFICATE OF Ll THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the the terms and conditions of the policy, certain policies may require an certificate holder in lieu of such endorserrtent(sl, PRODUCER DeSanctis Insurance Agcy, Inc. 100 Unicorn Park Drive Woburn, MA 01001 INSURED JK Contracting, Inc. 4 High Street Suite 108 North Andover, MA 01845 JKCON•1 OP ID: LK 1B!UTY INSURANCE DATE{MMIDDIYYYYj 02/17/2017 Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES TE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to ndorsement. A statement on this certificate does not confer rights to the CONTACT NAME; PHOimg,rr. kr,, 781.935-8480 C, ol. 781 -933-5ii4�a N [ E-MAIL ADDRESS: INSURERISj AFFORDING COVERAGE NAIL # INSURER A ; Star insurance Company 092245 INSURER E ;Selective Insurance Company 19259 INSURER C ; INSURER 0 ; INSURER E ; INSURER F : COVERAGES CERTIFICATE NUMBER: REVISIOsN NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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. INTR TYPE OF INSURANCE TAoni.i SUER; INV) S X I COMMERCIAL GENERAL LIABILITY I CLAIMS.MADE LX I OCCUR IS2205113 --i POLICY NUMBER GER'L AGGREGATE LIMIT APPLIES PER: X POLICY I JEtj LOG OTHER: AUTOMOBILE LIABILITY r ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS UMBRELLA LAB OCCUR EXCESS LIAR CLAIMS-MADE�II DED [ RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY A ANY PROPRIETCRIPARTNE /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, cloacae under DESCRIPTION OF OPERATIONS be; w T I {HHOIUDD L4 (MM DDIYYYPY) LIMITS EACH OCCURRENCE 02/1012017 02/10/2018 PREM SE$ lEe ocarrrencol MED EXP (Any one person) PERSONAL & AOV INJURY GENERAL AGGREGATE s 9,000,000 S 100,00 s 10,000 $ 1,000,000 3,000,000 PRODUCTS-COMP}OPAGG S 3,000,000 WC0853742 MA COMBINED SINGLE LIMIT P sc_ridant) BODILY INJURY (Per person) S BODILY INJURY (Per accident) PROPERTY DAMAGE per accident) $ S $ EACH OCCURRENCE AGGREGATE S W I PsR T" OTH• I STATUTE I ER 02/17/2017 02/17/2018 EL. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE DISEASE - POLICY LIMIT I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES {ACORD 1U1, ACditicnai kam iri; Salreduk, may Lo ettachsd if more specs is required} I"ADDITIONAL INSURED LIMITS ARE NO GREATER THAN THOSE REQUIRED BY WRITTEN ICONTRACT" Illustration of Coverage; Town of North Andover is add'I ins'd as respects to the OL poky. CERTIFICATE HOLDER CANCELLATION Town of North Andover 43 High Street N. Andover, MA 01845 NORTH A- S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AI)TIIORI2E0 REPRESENTATIVE ACORD 25 (2014109)., O 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 - I License: CS-066334 1 Construction SUpervisor • KIERAN T WHELAN , 31 RICHMOND STREt WEYMOUTH MA. 021 Commissioner Expiration: 09/28/2617 (71":1;(., Yir in ille),+(ie.,errld 6-1/ 4,.. Office of Consumer Affairs & Business Regulation - - - - - -- i -.,,;-.— .• • . - IMPROVEMENT CONTRACTOR eg Risraron. ' t • i'-.1.-71393 • Type: 'F.......7 -'44.0„A,,z.:-_-., . . '...':<•`',.il.' Expiration: 3/1512018 Individual ,., ...„, . . . . • . KIERAN WHELAN FUERAN WHELAN 31 RICHMOND ST WEYMOUTH, MA 02188 Undersecretary License or registration 'Valid for individual use only '.before the expiration date. If found return tot Office of ConSurner Affairs and Business Regulation 16 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature `6,0i,,moileueaS oitC2/1/awricietiierta Office of _-a,:asi.1titer Affair's 4 Ousiness Regulation HOME iMPlkoyEMP,1!1TiONTRACTOR Registration 171393 Type: ", • Expiratio04044:18 Corporatioh JK CONTRACTING K1ERAN WHELAN 31 irchiMaND ST WEYMCiUTH, MA 02188 • - Undersecretary