HomeMy WebLinkAboutBuilding Permit #444-2017 - 10 High Street 10/25/2016 11�
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BUILDING PERMIT of N,F.D b;�tio
TOWN OF NORTH ANDOVER o
I �p APPLICATION FOR PLAN EXAMINATION,
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Permit No#: Date Received
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Date Issued: Z� �nO
IM,,PIIORTANT: Applicant must complete all items on this page I LOCATION 0 C1lG-H �-i , �9Al>N 1+J %A\-t1,�U-41P,(O /
PROPERTY OWNER e-G— Prin t `t
Print 100 Year Structure es no
MAP PARCEL: 61 ZONING DISTRICT: Historic District a no
i Machine Shop Village no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
:& 4lteration No. of units: commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
uc ( � a r—r-ic- ' s p tee- CjVotvi I,- Uri,,(� x
rev k rk s N P of {4 i GKttXI cS t P P �i6®he•( o
Identification- Please Type or Print Clearly
OWNER: Name: ) Atim 'f-rimame-ti Phone: l"1 6 L S 8 3/
Address: 90 iqa X'oSdc be 1) L i 4.2
fW3j t4 6ivo--
Contractor Name:' . CA r47-vwsc-.w U Phone: 1-7 C- t
Em a 1: 14 1 (9 s dr. (U m cyvi4 c-qu R-
Address:.S v qv- 1 0 Rt f . r 4a U L 8 �-(S-
Supervisor's Construction License: LS f; Exp. Date: 2-b /1 -7
-Home Improvement License: Exp. Date:
r,J
ARCHITECT/ENGINEER 1� ,AAs F � +'��`��� Phone: �'(�
Address: �SC S U nt~q�- 1a 4,4 Tb N Reg. No. I L (�
FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ® FEE: $
Check No.: Receipt No.: �®�
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
u
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL =
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning Pools ❑
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
,FIRE DEPAR�TMENIT TeemDumpster�gonisite5y�es,_
E�Located at 12f,4 MainiStr.eet
TFir-4i ar`trrientsignature/date
"CAMMENTS _
I1
i
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANCER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
1
NOTES and DATA— (For department use)
i
I1
I
I Ll Notified for pickup Call Email
I -
Date Time Contact Name
Doc.Building Permit Revised 2014
4
Building Department E
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
r�
Roofing, Siding, Interior Rehabilitation Permits
4, Building Permit Application
,4. Workers Comp Affidavit
• Photo Copy Of H.I.C. And/Or C.S.L. Licenses
• Copy of Contract
• Floor Plan Or Proposed Interior Work
•. Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Permit Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And '
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
i
4� Building Permit Application
Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
4 Workers Comp Affidavit
Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
4. Copy of Contract
2012 I ECC Energy code
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:Building Permit Revised 2014
Location A-411,41
No. `� L{.L�"'p?C. Date
• • TOWN OF NORTH ANDOVER
` •
e Certificate of Occupancy $ �v
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#2('Oo
building Inspector
Location
No. Date /67 Z; Z�6
• • TOWN OF NORTH ANDOVER
• ,% Certificate of Occupancy $
Building/Frame Permit Fee $
` Foundation Permit Fee $
Other Permit Fee $
TOTAL $ _
j Check# 7-5 3
i
Building Inspect
Enter construction cost for fee cal- North Andover Fee Calculation
Construction Cost
$ 40,323.00 m
$ - $ 483.88
Plumbing Fee $ 60.48
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 60.48
Total fees collected $ 704.85
10 High Street
444-2017 on 10/25/2016
Tenant Fit Up Suite 108
NORTH q
Town of _ sAndover
No. �� -
° S h ver, Mass, &
,f ZW6
C ac NIC 449 WICK y�•
°RATED �Pp� •(5
BOARD OF HEALTH
Food/Kitchen
P E Septic System
THIS CERTIFIES THAT
MIT
..... �/. BUILDING INSPECTOR
oundation
has permission to erect .......................... buildings on .��.:. �� . . ..Y.W00 T...
_ �� Rough
to be occupied .7 +14►."Vr... ..���...... .. ........... ... .. . .... ..
C ney
provided that ton accepting this permit shall in every respec conform to the terms of the applicati
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration an
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR.:-
UNLESS
NSPECTOR :-
UNLESS CONS TIO Rough
Service
'
BUILDING INSP OR Final
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
JK Contracting LLC Proposal
4 High Street, Suite 108
North Andover, MA 01845
617-592-6775 (Kieran)
781-254-2862 (Judy) Proposal Date: 9/12/2016
Proposal#: 203-54
Project: 10 High St, Painti...
Bill To:
Attn: David Steinbergh
RCG LLC
17 Ivaloo Street
Somerville, MA 02143
Description Est.Hours/Qty. Rate Tota
Building Permits,and C of O. 580.00 580.00
Demo 1,500.00 1,500.00
Masonry 1,000.00 1,000.00
Wall Framing 2,500.00 2,500.00
Doors &Trim, Includes glass store front entry 5,200.00 5,200.00
Plumbing 6,000.00 6,000.00
Heating &Cooling, Ductwork only. 2,500.00 2,500.00
Electrical&Lighting 4,000.00 4,000.00
Tele/Data [Estimate 1,500.00] 1,500.00 1,500.00
Insulation 300.00 300.00
Interior Walls, Board. 800.00 800.00
Interior Walls, Tape ,Compound ,sand 1,000.00 1,000.00
Millwork&Trim 0.00 0.00
Cabinets&Vanities 0.00 0.00
Floor Coverings,[Ceramic tile on bath floor, subway tile 4,200.00 4,200.00
on walls]
Painting, Including ductwork, pipes. 4,500:00 4,500.00
Cleanup & Restoration 300.00 300.00
General Conditions 1,000.00 1,000.00
Supervision 3,630.00 3,630.00
Insurance 393.00 393.00
Total $40,903.00
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Initial Construction Control Document
To be milb-mitted with the building permit application by a
Registered Design Professional
for work per the 8'h edition of the
Massachusetts State Building Code,780 CMR,Section 107
Project Tide: West Mill - Studio#306 - Painting With a Twist Date: 09-12-16
Property Address: 10 High Street, North Andover, MA
Project: Check one or both as applicable: 0 New conshuction X Existing Construction
Project description: Tenant fit-out
Linda S. Smiley a
MA Registration Number. 10080 Expiration date: 08-31-17 am
registered design pi-ofe=ional, and T have prepared or dirmfly supervised the pr", ration of all design plans,
computations and specifications onacerning:
X Architectural - [ J Structural Mechanical
[ ] .Fire Protection [ ] Electrical Other
for the above named project and that 10 the beat of my knowledge,infbrination,and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Bui iding Code,(780 CMR),and accepted
engineering practices for the proposed project, I understand and agree that I(or my designee)shall perform the necessary
profmional services and be present on the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
L. 'Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit fie o mss reports(see item 3.)together with pertinent
comments,in a form acceptable to the building
Upon completion of the work,I shad submit t S.0 incl Construction Control Documenf.
NO.low
Enter in the space to the right a"wet"or
tratstt
electronic signature and seal:
Phone numbeF 978-518-9939 Email: finda@saam-ardh,com
Building Official'Jsc Only
Building Official Name. Pix it No Date-
Version 06 11 2013
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please print Legibly
Name(Business/Organization/Individual): C` `J'K & U�
Address:yLHt CSK
�
City/State/Zip: 0a JsI-- . 6 fe Phone#: L L-7 b lff'b
Are you an employer?Check the appropriate box: Type of project(required):
1.I*1 am a employer with_ _ 4• ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t 7•Memodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9, Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 1011 Electrical repairs or additions
11. Plumb' repairs or additions
3. 'I am a homeowner Join all work right of exemption per MGL ❑ � P
❑ . g
c. 152 1 4 and we have no
kers comp. �� ( )� 12. Roofre airs
myself. o wor ❑ P
LN P
insurance required.],t employees.[No workers' 1311 Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they a're doing all work and then hire 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 their workers'comp,policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the,policy and job site
information. (''� I
Insurance Company Name: \v 14 C-17-6 V.S ` VY jyl'�✓dv�C
Policy#or Self-ins.Lic. 0 L Expiration Date:' 2-- 0
Job Site Address- Ar C G•N i4mooye-t--- City/State/Zip: N (4rwa UPq 019
Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL e.152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
'Investigations of the DIA for insurance coverage verification.
Ido hereby cero under thepainsf andp�enlalties ofperjury that the information providedaboveis true and correct.
Signature: ✓tom `'' Date:
Phone#: b L-1 — Q I Z _ b-74i—
Official use only. Do not write in flits 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.PIumbing Inspector
6.Other - - -
Contact Person: Phone#:
JKCON-1 OP ID:CD
AC R CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DONYYY)
07126/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF IN:4)RMATiON 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).
!CONTACT
'PRODUCER NAME ....... ....._........
DeSanctis Insurance Agcy,Inc. PHONE... FAX
100 Unicorn Park Drive !EMAIL
.................. .......... .................. ... . ..
Woburn,MA 01801 �._Auutsess;
INSURER S)AFFORDING COVERAGE ..,,;. NAIC 6
{ I ..... ....
INSURER A:
. ........ ........
Star Insurance Company. 012245
INSURED JK Contracting,LLC, INSURERS;Selective Insurance Company 19259
I 4 High Street Suite 108 INSURER C �—
North Andover, MA 01845 .. _--
INSURER D _ _...
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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
1 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
I CERTIFICATE MAY P2 ISSUED OR MAY PERTAIN. THE. INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES L.hAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIIMS.
.,....... ..................
..............POLICY cFF PULICY EXP
I!LTR TYPE OF INSURANCE
LTR IVSD�VVO POLICY NUMBER IMM.JJ.fY��(MMDDIYYYY) LIMITS
B X COMMERCIAL GENERAL UASI-ITY EACH OCCURRENCE $ 1,000,00
__. CAM11A 1 1C RT4T'S _. .
CLAIMS-MAOF X OCCUR P�t,CNI�>E'4.rfapixuance`, 5 ,--_------_
522051 i 3 02110/2016 02/1012017 - 100,00
_D EXP(Any ane person) S..___...................._. 10,00
N
PERSONALBAOVNJURY S 1,000,00
_.... .._.. .. ...._.. _.... ... ., ....,,.. _
GEN'L nUvREL P.; T I r..IES t'EH GENERAL AGGREGATE 3,000,00
PRO Pi207J(TS CUM'!OP 1GC 3+0
X ,POLICY JECT Jr'
OTHER,
AUTOMOBILE LIABILITY
COA9BINED SINGLE: .IL91T
....................-----_.._._._............
___.._-----
ANY AUf BCW NJURY Pe cersor c
..._.......;AL O.NNE.D SCHEDULED
j AUTOS :. -:AUTOS Pf?ERTY tS.Gc ............ ............_......................
--
NOWCWN;r, <5
1 tiIR=O AUTOS ! AUTOS ;Per2cr_.:d2nt......................_. ........ ....................._...__.._.--
i :.....
UMBRELLA LIAa OCG:iR EACH OCCIJR_,W____.— £ -.--
4 ( EXCESS LIAR - AGGREGATE OCCURRENCE
II CLAIMS-MAD-71 ..... ----------
: RCD ( RETCNT ONSS
i WORKERS COMPENSATION X : ER T+
AND EMPLOYERS'LIABILITY T TL:T(?„ .,E R. ..,,,.._..
A YIN .. 100,00
RNYPRO?RIETDR::-;RTNERiE><ECJT•,, -- WCQ853742 . 02/1712016,0211712017 F,i. E . t.�,cac=N��._.__.... .' ............... _.
. N NIA. .... _
:OFFICERIMEMEER EXC;J-ED 'MA
(Mandatory in NH) — :. ... •- .. _ ...............-r.....-.............__..._.............................
I'L DIS�ASr:-::..A Edd°t.C!'fPE.S +
(Nye&.dsscrlbo under .!_DISEASE-POLICY LIIAII''3 500+00
DEBCR)P i ION OF OPERATIONS be f;w
DESCRIPTION OF OPERATIONS t LOCATIONS 1 VEHICLES (ACORO 101,Additional Remarks Schedule,rr.ay be attached I'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'i ins'd as
respects to the GL policy:
I
i
1
CERTIFICATE HOLDER CANCELLATION
NORTHA- !
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN
Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS.
s*High Street
N.Andover, MA 01845 (AUTHORIZ PRESENTATIVE
iArk1Gx4
lol—
t 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
M Massachusetts Department
Board'of Buildingartmeri_t of Public Safety
Regulations and Standards f
License: CS-066334
Construction Supervisor
R`til•.I ` rt ��..: , :
KIERAN T WHELAhf
31 RICHMOND STREET `'-9
WEYMOUTH MA 02'I38 y,#
�Ii�
J f
�C
ic"irnissioJn�er— 'Expiration:
09/26/2417 .
� ���e�auuuar!iue�rlf�o/C'/lln.�arir,�rr:ref��
_Office of Consumer Affairs&Business Regulation
,,HOME IMPROVEMENT CONTRACTOR
( .,__ Re istratio
9 n.
,171393 Type:
Expiration— 3/1.5/20:18 Individual
In dual i
j KIERAN WHELAN
F KIERAN WHELAN I
31 RICHMOND ST
WEYMOUTH, MA 02188
Undersecretary
License or registration valid for jgdividual►ase only
before the expiration date. If found return toi
(;);ffice of Consumer Affairs and Business Regulation.
:1 Park Plaza-Suite
5170
Boston,MA 02116
} Not valid without signature
, �lZe ((Jar7bn2a71 crJeCG�{!l-R�U(��C(jdClCfLLldP,f�J
OrriceoflbdF9&i er Affairs&Business Regulatiop.. j
HOME IMPROVEMENT CONTRACTOR
1UwV
Registrat<on 171393
TYpe
Expiration:-_311618 Corporation
1 JK CONTRACTING LLQ
KIERAN WHELAN 4�
31 RICHMOND ST _
WEYMOUTH,MA 02188 Undersecretary