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HomeMy WebLinkAboutBuilding Permit # 3/1/2017 (2) g r� BUILDING �,oR�r PERMIT o� �t�@D ,6 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINAT41 ION (late Received : h 1 „ �✓ I �� Permit No#t M >a aRArEn nrr" 9 'C Gate Issued: ' " .....PORTANT: ipplicant must complete all 'items on this page LOCATION ' d v � " Print PROPERTY OWNER -.— Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:———T�...._a.Hisfioric District pe§i no Machine Shop Village no ------------------ TYPE OF IMPROVEMENT T PROPOSED USE Residential Non- Residential F-1 New Building 0 One family ❑Addition Li Two or more family 11 Industrial '� Iteration No. of units: � ommercial Cl Repair, replacement FJ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ,i ,. aI/ ,/ / /.///, //r t/i/ ,,//,/I/,./i,,. ,//�r /, �_ L../r„ r. rr. .� rr .% ,. / ,rr,r.:rr r✓r ..r ✓ lir l� / / � / ///,r�/� r/ / / /� DESCRIPTION OF WORK T BE PERFORMED: _-.-.. ,Pdent4i action- Please Type or Print Clearly _ OWNER: Narne• e, ' Ln Phone: C7- (T' ti -Address: " � � � Contractor Name: jV 1 (-7J 1 Y11 Ll- Phone: 1'-? -A" �_ Email: k C 6 t w° Address: ; - Rio � V ZT � rivq OTTq--T"- Supervisor's Construction License: 62 (-1— Exp. Date: d :. Home Improvement License: Exp. Date: ARCHITECT/ENGINEER d Phone: " Address: r Reg. No. �100o FEE: osrsasEn a $125.00 PER S.F. Total Project C�astFEE SCHEDULE. o$c n�rr.MOO PER .00 o� xE rar,�L Esnm,�rEn c �.. � � �h Check No,: Receipt No.: NOTE: Persons contracting with nnregisterFed contractors civ not have access to the gnarvnty fund JAC)RTth own of ® er . 0 0 No. 'ab 0 OiA " I d„K� ver, Mass, ATEID Ll RMPh I T LD BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT ..... ..................................14!11 N wt BUILDING INSPECTOR has permission to erect ...................... buildings on .. ' . ... . ,,,,,,,,,,,,,,,,,,,,,, ,,,, Foundation ..,. ..,. ®� � Rough tobe occupied as . ` " ....... .. ... ... .. ............... ... ` .....� .........I......................... Chimney provided that the person accepting this ermit shall in every, r apect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. '= t• 2 tke' PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST I Rough Service ., .. .. .... ...... ..... Final BUILDING IN EC R GAS INSPECTOR Occupancy Permit e uired to Occupy Buildin Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector, Burner Street No. Smoke Det. OFFICE CE BUILDING INSPECTOR t TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL �oo Ate PROJECT NUMBER: 15-0718 PROJECT TITLE: Internet & Telephone, LLC. PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: !Nest Dill NATURE OF PROJECT: Tenant improve rrtentlfit out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 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 1 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 fa Ii r with6the progress and quality of the work and to determine, in general, if the work igpfg a performed in a manner consistent with the construction documents. �'�=_F?\� PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGR TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER B L 1j, UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT T uj SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR A CY. SUBSCRIBED AND SWORM TO BEFORE. ME THIS_ _ DAY OF �v I .._�20 a C x 1"RYL, BURKINSHAW Notary Public a NOTARY PUB MY COMMISSIiEfiafawealth_afAfl=sncftuaeils #� My Commission Expires March Y, 2019 JK Contracting Inc. Proposal 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Proposal Date: 2/20/2017 Proposal#: 203-90 Project: 50 Nigh St, IT, LL... i Bill To: Ship To RCG West Mill NA LLC IT,LLC-2nd Floor Daviid Steinbergh Norih Andover,MA 01815 17 lvaloo Street Somerville, MA 02143 Description, Est. HoursiQty Rate Total Project Location/Description 50'High St IT; LLC North Andover;.MA permit &C of O. 2,800.00 2,800:00 Demo 5,000.00 5,000.00 General Conditions.; Dumpsters, protection, dust 4,500.00 4;500 00 containrnent, Floor Framing, Supply, install raised floor[approx 2,200 20,000.00 20,000.00 sq ft] and 3 ramps framed with engineered wood, glued and screwed 314 in ply. Wall Framing 15;000.00 15,000..00 Doors&Trim, excludes glass doors. 600.00 600.00 i?iuribing,[Estimat3] 6;000.00 6,000.00 " Heating &Cooling, [Estimate ,ductwork only] 5,000.00 5,000.00 Electrical &Lighting, [Estimate] 17,500.00 17;50(}.00 Tele/Data, [By others]. 0.00 0.00 Insulation 1,500,001 11500.00 interior Walls, Board. 7,500.00 7,500.00 Tape, compound,sand: 15,000.00 €5,006.00" Cabinets & Granite tops 7,500.00 7,500.00 Specialties,`Garage ©oar - 4,36o.0O 4,350.00 Floor Coverings, [estimate] 25,000.00 25,000.00 Palming; No existing ductwork8,000.00` 8;000.00 Cleanup , Final Clean 500.00 500.00 Sprinkler.Work 1;300:00 1,300.00 Glass Doors [#7]/Panels Instailed,[Approx 180 ft of 65,000.00 65,000.00 glass walls].One storefront entry door. .Supervision 21,205.00 21,2.05.00 Insurance 2,120.50 2,120.50 Estimate for your review and approval . Total $235,375.50 Approved. l Initials} SIGNATURE The Commonwealth of Massachusetts Department oflndustrialAecidents d 1 Congress Street, Suite 100 Boston,MA 021.142017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pluinbers. TO BE FILED WITH THE PERMITTING AUTHORITY. i y Applicant Information Please Print Legib Name (Business/Organization/lndividual): Address: � kt (�h �b ►L ( �'C City/State/Zip: a d #A, 161 4 VPhone Are you an employer?Cheek thappropriate box: Type of project(required): L lam a employer with �.. : employees(full and/or part-time).* 7. ❑New construction 2,Q I am a sole proprietor or partnership and have no employees working for me in S. f4 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.Wo workers'comp.insurance required.]t 10 []Building addition 4.❑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 11.0 Electrical repairs or additions proprietors withno cmployees. 12.❑Plumbing repairs or additions 5. 1 am a general contractor and 7 have hired the sub-contractors listed on the attached sheet. ❑ 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.F-1We are a corporation and its officers have exercised their right of'exemption por MGL c. 14.F1 Other 152,§1(4),and we have no employees.No workers'comp,insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. I Homeowners who subiriff this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. $Contractors 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 the sub-ebniractors Have eirrployees,they must provide their workers'comp.policy number. I am an employer that is providing ivorkers'compensation insurance for•my employees.'Below is the policy and job site information. ��r Insurance Company Name: Policy#or Self ins,Lia.#: �-- '� Expiration Date: Job Site Address: J t`� t �` 4 _ ' " t City/State/Zip: - �4 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 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 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. zdo hereby certify under the pains andpenalties ofperjuiy that the information provided alio a is true and correct. Signature: Date: 2— �— Phone#: l 7 "Sq -1 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: Pbone#: JKCON-1 OP ID: LK .� ERIVIC TE OF LIABILITY I 6J ANC nArB(lAMroD1YYYY, 021171221017 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, EX END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT SETWEEN 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 endomement. A statemem on this certificate sloes not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT DeSanctis Insurance Agcy,Inc. PHgN — W FAX - 100 Unicorn Park Drive 1Alcyo L.Ku�781_935-84&a_ -- — (AIC,Nn): 781-933-5645 Woburn,MA 01801 E-MAIL ADDRESS_.____._.__._.��..m-„____.____.....T..T .___._._._._._ —_ E _ INSURrR(S)AFFORDING COVERAGE MAIC =,S J<ER A;Star Insurance Company-_--_. .�. 012245 INSURED JK Contracting,Inc. INSuNFi,B:Selective Insurance Cotl(iparl 19269 4 High Street Suite 108 INsur,sk c - -- -- North Andover,MA 01645 — ---" ----—- -- INSt1RER D ENSURER L; INSURER F COVERAGES CERTIFICATE NUMBER: Y REVISION NUMBER: I HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATED. NOTWITHSTANDING ANY REQUIREMEN'E, FERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE IvfAY BE ISSl7ED OR MAY PERTAIN, .THE INSURANCE AFi ORDGD BY THF POLICIFS OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIWTS S (OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. r --- lidakT ADDI- URRPDLIr Y FF i POLICY EXP TYPE OF INSURANCE ,� i,Arr POLICY NUMBER 5iti lDDfYYYY fd�taDIYYYY�,�,,, LIRSII'S_ lJJ Y J a I. COMMERCIAL GENERAL�LEABrLirY EACH OCCURRENCE $ 1,000,00 f Oil �� 102 02!10?2p18 pRAI& 56R�oCwrroence S $00,00 € CLAIMS-MADE accuR h2205113 MED EXP(Any one person) $ 10,00 1'FRSONAL&ADV INJURY S 1,000,40 i G���EIIIN'L AGGREGATE L1MI'r APPLIES PER: i i I j GENERAL AGGRFGA_TE $ 3,00(1,00 POLICY PRC- Lpc �-Yy� I Pr�aou�c7s-co nPtop AcG $ 3,000,00 I-1 JEGT r OTHER: AUTOMOBILE!_IAB€LITY �f �i COMBINED 51NGLE LIMIT S --- _ I 'i (Ea accident -_. BODILY INJURY(Per parson) 5 ANY AUTO — ALL OWNED i SCHEDUIF0 i ! BODILY INJURY(E'er accident) 5 AUTOS AUTOS — NON•OWNEO i i PROPERTY DAMAGE -...._-_..._NJUR _E HIRED AUTOS �_,I AUTOS I L(Per accident II S ! , CLAIA7S-MAGE -- _ OCCUR _ _ I UMBRELLA WAB ` � �EACW OCCURRENCE _ S k �EXCESS L#AH _-- � I AGGREGATE E DED RETENTION$ I b -^� WORKERS COMPENSATIONw� STATUU PES l TE !AND EMPLOYERS'LIABILITY YIN I, � A 11 ANY PROPRIETORIPARTNrR;Fxr:LTIVC I— � I IIWC0853742 �''. rJd1�71z017 JI 2111/20181 L.EACH ACCIDENT $ 100,ul 999 'OFFir-FRIMEMBER EXC:t1G::J? I�� N i A I I r - --- I(Mandatory rn NH) t"—" ' I IFMA ! i I E.S_.DISEASE-EA EiJ{PLOYEE $ 100,00 fif yes,Cascri6e under j �'''� 500,000 ''. DESCRIPTION W OFFRATIGNS b0o�:f q E_L.DISEASE-POLICY LIMIT $ t7E5CRIPTiiJN Of OPLRATii3NS!LOCAi"si]PI5!Vf HICL»5 JACOr D 101..add€tionai Raniwrk 4c;budu'.•,may tc attachsd If Snore space Is required) i"ADDITIONAL INSi RED LIMPS ARE NO GREATER THAN THOSE REQUi RED BY WRITTEN ICONTRACT"Illustration of Coverage,Tow,-. of Worth Andov, r is add'l ins;d as respects to the GL policy. CERTIFICATE HOLDER Cf�rtiCE€_LATI(5N OR-N-€A- SHJOULD ANY OP TI-JZ-Ar;!OVE DESCRIBED POLICIES RE CANCELLED BEFORE fHF EXPIRATION DATE THERECIF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS, 43 High Street N.Andover,MA 01845 AU7HOR!zV.D R PREsENTATIVe r' L 1988-2014 ACORD CORPORATION. All rights reserved. .ACORD 25(2014101),- The ACORD name and logo are registered nmrks of ACORD Massachusetts Department of Public Safety .` Board of Building Regulations and Standards License: CS-066334 Construction Supervisor KIERAN T WHELAN ¢ 31 RICHMOND STRf '^" ;t= :. VVE YMOUTH MA;02 ' ...' 1. 1; ��-- Expiration: .l Commissioner 09/26/2017 r4-/!C' 4�(Il/I/!!+/!!C't'CI���C�`.�• [fl.i3C/('l1 CIJF.'�li -� Office of Consumer Affairs&Business Rquiation ',i"HOME IMPROVEMENT CONTRACTOR * � ri Registration Type: Expiration: .311. f2QM$ Individual KIERAN WHELAN KIERAN WHELAN 31 RICHMOND ST WEYMOUTH, MA 02188 Undersecretary License or registration valid far hidividdyal use only before the expiration date. If found reiurn to: Office of Consumer Affairs and Business Regulatton. 10 Park Plaza-mite 51.70 Boston,MA 02116 Not valid without signature . I Once of&tstiiaer Affairs&Busines8 Regulation HOI411:JMPROVEMENT..C6�A&011 Reglstiat{on & 171393 Type: � xpiratlort 3 E &18 Corporafoh X Co NT RACTING LLQ Kjt. AN WHELAN WEYN'OUTH,MA 02188 Undersecretary