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HomeMy WebLinkAboutBuilding Permit #559-2017 - 21 HIGH STREET 11/16/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER 1. oL PLICATION FOR PLAN EXAMINATION �j p� .�¢ r1! Cp o -7 Date Received �i A R'� (Permit No#:5✓ V 9 RATED IP eeJ '4gS4CHU`��R Date Issued: di(Alv- IMPORTA.NT: Applicant must complete all items on this page LOCATION �-�� p Pr'ntt e Cs LAW f EPROPER4TItY ©` 4ER �u ► Prnn: X100 Yea Strut ore `e - no r�. s Z®KING DMITI I� Historic Dis rich e no fM � Pf��RCEL' L Machine Sho> Villa e e no ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial .Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other =["F-1flTTSSq're-0 © 11Vell ® Floo� dpla_in ®Wetlands a ® Watersfhed Distr ctr s e DESCRIPTION OF WORK TO BE PERFORMED: i ( tt \\ �_) 3 Vk1QS W 'A \ _S M-111 Q U_A 1&J �as d C_P1\S- V<\ Liv N Identification- Please Type or Print Clearly OWNER: Name:z,Ay\'0 Phone: 6 Q-4z1� _ 1� Address:!�>v \T6 n •- r ' ' Et --� r Contractor N mJry�NGd . w Erair l �� S pee is or's Construc'ioniL cR se Exp @54R-e& Home Imp-rovement Llicensef,� �ate:y ARCHITECT/ENGINEER Address: �� Syt-vN,S`ti '�`�,� -Reg. No. - (, 0 FEE SCHEDULE.BULDING PERMIT.,$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. SC° �oC� �C� = �Zo2 Total Project Cost: $ 3 8 1 b l �' FEE: $ PZ Check No.: oa55_7r_ Receipt No.: '3 I -3 <7 NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund r _ nattare of,contractor " '`-_- '- Plans Submitted ❑ Plans Waived.[] Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Sody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE-FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature s 1 COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Plf,nnin?i Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: _ Located 384 Osgood Street s•^t * 4:s:�s" 1L<'%1r r rt M;�x y. .rr :'1 ;� """"' "'A'�"Rf•' M—T— F EP�R�TMENTTempDumpsterF ornsite yesmu &Locat d a ,� %..ffi finfStreeti -- ►tFire D p rtment�ignatur�e"{'�/add�e;,"zJ _.���' _ 4' ' '' � '_• ,�.�% L -- y� '�2`k- ',=Vin'..► � .4r 7 � t` i ;t„t;,� .t. ".�.. re � �.�,.°},,. 'G�. ..,'`�.r "t`FM •.. _ i u.L'L�.�.+ t1{7} r •�a_Piit��" �ir54� y a G; ��'} �y '{� Yh. ti. i COMMENT'S. '� �;�1 ,,a; � :.�j t ��,x�4,�s���`,•' i ',�a}.+a�*��r� � w, ;;,h ,� _ t ;+.,T,1,s !��..x! t 1, ;`t..t"ti±'�7, ' �+ " '►"sA....a cldi��`r 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 DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department ease) Ll Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ 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 DTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products ATE: 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 19 / V 57 /C 6 No. �U/ 7 Date • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $f46 Building/Frame Permit Fee $4�0 Foundation Permit Fee $ Other Permit Fee $—IS TOTAL $�• U Check# "✓r/� <__�^ , / / �. \� '� 2 3 3 Building Inspector tf Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 383462.00 m $ - $ 461.54 Plumbing Fee $ 57.69 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 57.69 Total fees collected $ 676.93 21 High Street 559-2017 on 11/16/2016 conference room and IT room DSA Expansion and WCG Laaw Group Suite 2086 � c10RT1y Town of xAndover 0 No. % h ver, Mass, ®® COCKICl/l WICK 7' A- 7.9s RATED V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT NTA � �. ��' N BUILDING INSPECTOR ......... .... .. ............................ ......`. .... ... .�..,, � ... has permission to erect .......................... buildings on ....o�.l.......1.� ..¢,I!.�......,,,�! .�'i. l oundation w �t� r� � * �!� ough to be occupied as .�-.. �. . W 1o............ne.1 44 ney .................... provided that the person accepting this permit shall in every respect 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TI Rough l� Service ........ ... Final BUILDING I PECTOR 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: 11/15/2016 Proposal#: 203-63 Project: 21 High, Suite 21... Bill To: Ship To RCG North Andover Mills LLC David Steinbergh 17 Ivaloo Street Somerville, MA 02143 Description Est. Hours/Qty. Rate Total Permits and C of O. 566.00 566.00 Demo, Remove curtain rail ,steel angles , steel,beams, 3,400.00 3,400.00 kitchenette, carpet,etc. Bring to dumpsters. Dumpsites[2] 1,400.00 1,400.00 Wall Framing, infill.door, cut out entry door in another 1,500.00 1,500.00 location, frame conference room ,kitchen and it closet walls. Doors&Trim. Supply and install one new double door 1,600.00 1,600.00 to it closet. Re-use other doors on site, provide new locks for offices and IT room. Plumbing. Install new plumbing for kitchen using old 1,200.00 1,200.OQ ; sink and fixtures. Heating &Cooling. Install vent into new conference 350.00 350.00 room. Electrical&Lighting 9,300.00 :'x,9,.300:001 Tele/Data 4,900.00 4,900.00 Insulation 100.00 100.00 Interior Walls, Board ,patch wall, tape ,sand 2,800.00 2,800.00 Cabinets;&Vanities ,Remove and re-install - 500.00 500.00 Painting, includes ductwork, and outside hallway walls 4,200.00 4,200.00 affected by construction. Sprinkler Work, Install head in IT closet 450.00 450.00 Cleanup & Restoration 150.00 150.00 Floor Coverings 2,800.00 21800.00 Supervision 3,465.00 3,465.00 Insurance - 346.50 346.50 Total $39,027.50 Approved: (Initials) "L-y'V ✓�/ SIGNATURE Initial Construction Control Document To he subivitte'with the building jxrtnit application by a Registered Design Prafessional for-xork per the e edition of the W Massiclrusats.State Building cAx1c,7go CMR,Section 107 Project, Title: East Mill -D.S3A Expansion 11-15-16 Property Address.. 21 High ,Street, North Andover, MA Project: Check one or both A New construction X FA-isting Construction Project description: _ Tenant fli-nut for DSA Suite 210 &WCG Law Grow ri Suite 2088 ----------- ------------ Linda S. Smiley MA Re.gasrrabon Nninber. 10080 Expirationdate: 08-31-17 'ant.a registered design profesvioiled, ind I have prepared or(1ireetly Supervised the carnputations and specifications ounteming: Preparation of all design plans, X Architcduml structural Mechanical [ ] Firc-Protection 13kctrical 1 Other for the above named project and that to the best ofmy kuDwledge,information,and beliersuch plans,Computations and specifications meet the appliable,provisions Of the State Building Code,(780 MR),and accepted engineering practices for tli6 proposed project. I understand and agree that I(or my designee)"I perform the nemsury professional services and he present on the cortstruWon site on a regular and periodic basis to: 1. Review,for conformance to Ns code and the design conceptstamp drawings,sainples and other sahmittals by the contractor in accordance with Ov,requircincats of the construction documents, I Perforat the duties for registered design professionals,in 780 MR Chapter 17,as applicable. I Be present at ink-mals app,,upriate to tile';tkge,of Construction to become generally familiar ividi 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 ctQc-. Nothing in this document relieves the contractor of its responsibility regarding the provisions of Iso CiNtp, 107. When requit-ed by the building official, F shall sultan" oras(see item 3.)together with pertinent connuents,in as turn]acceptahle to the building n Upon completion(if the work,r sEan jy:t wit tjz , I Constracdon(:Wjtrol Ncuntent,,, Enter in ft space to the right a'we,."or electronic sigmatre and scat. Phone number., lindasaarn-arch, om ------- E@c mail: 140di-kg Official Use 0,01Y BuUdingOfficiA Naaw. Daw, Versioi 06112013 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UqF 600 Washington Street .Boston,MA 02111 rvww.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/fndividual):- �—rlid co, j\P Address: ,�tJ I rs 1 109, 44- City/State/Zip: J. 14m,p oy ry., d A g 6:N Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. FJ I am a.general contractor and I ' 6. E]New construction employees(full and/or part-time).* have lured the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t ?• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑DemoIition working for me in any capacity. workers'comp.insurance. g, Building addition [No workers'comp.insurance 5. 0 We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions I myself.[No workers'comp. c, 152,§1(4),and we have no 12.❑Roof repairs insurance required.]f employees.[No workers' ME]Other comp.insurance required.] !Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they ire 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. Insurance Company Name.:. _�,T l Gi c–?l 1®s (�(Ly,�r �� �l7 H(raw {y Policy#or S elf-ins.Lie.#: W 6 f tf'Z Expiration Date: 1- , Yob Site Address: 16M City/State/Zip: T � .Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a foie up to$1,500.00 and/or one-year imprisonment,as yell 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 DTA for insurance coverage verificatiom t do hereby certio under the pains andpenalties ofpeva y flint the information provided above is true and correct. Signature: _ Date: /L/! r/f ?hone#: 6 t CL L— Official use only. Do not write in this area,to le completed ltl)city or town official. City or Town: _– __ Permit/Liceiise 0 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityf f'own Clork 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: ,•� „ - JKCON-1 OP ID:CD CERTIFICATE OF LIABILITY INSURANCE DATE(MM2016Y) _ o7r2s12o�s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLt 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 INSURANCEDOES 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 -;CONTACT NAME: DeSanctisInsurance Agcy,Inc, L_PNON.E............._.................._.............._......................................._......._..,......L.FAX......_.__._..............___.._._.._ 1100 Unicorn Park Drive _..... No; E-MAILWoburn,MA 01601 L..............L...................._.........._........ GE _•...._• . ........_............_....._............. NAICX INSURER S)AFFaROlNG COVERA•• I..._.........._.'........ ...... .. ............... ...... ...... ....._... IhsuRERA Star insurance Company 1012245 INSURED JK Contracting, LLC. INSURERS:Selective insurance Company 119259 i 4 High Street Suite 108 INSURER c North Andover, MA 01845 _._._ INSURER D: }.. .. . .......... ............................................................................................................... ..,....._.._.._. i INSURER E I 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION 0=ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT10 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 i.IPOITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMIS. INSR TYPE OF INSURANCEPOLICY O1dcY EFF PEXP LIMITS LTR rPOLfCY NUMBER MMlOD;YYYY MMID1D0'YYYY) B X COMMERCIAL GENERAL UABI:.ITY EACH OCCURRENCE $ 1,000,00 "CAF•IAuI2TC`R IVTED0", „ S2205113 02/1012018 02!1012017 aEMISFS,tfa,occurrpnce. S CLAIMS-MADE ! OCCUR p _ . MED EXP(Any Pr+.e person) S 1Q,OQ ..............._........................_....,......................................._................ ............ ... ......... .......... PERSONAL 8 ADV INJURY __`S 1,000,Q 01 j ._......: ....._..._.__._.._...._.._...................................................._.... ............................................_....................._ ._................._._._...___ GENYL AGGREGATE LIMO'APPLIES PER GENERAL AGGREGATE 3 3,000,00 ............ ........ .............._............_......................_....�..._,._ PRO- X X .POLICY' ., �jEC'It-OC PROD'UCT'S•COM?/OP AGG S 3,000,00 OTHER —_ 5 AUTOM06ILE UABIUTy COMBINE SINGLE LIMIT S Ea,Act;dent' . . ANY, C BODILY!NJURY:Per Person) 8 j ......... ... ...................... _....._....__ ALL CANNED SCHEDULED .�BP OODILEvRYNYJ•..U...O'Y.A.Y.M...;.A.P...G.e._r�.a.._.c......d�.........d.....e...n...;..)...:...S5 AUTOS � .........».........._... HIRED Au'0c AUT OS Peacc�aent. ....................... .....:...................... ._.--- .. UMBRELLA UAB OCCUR EACH OCCURRENCE $ _ ....'_._.. I EXCESS LIAR CLAIMS-WADE AGGREGATF. _— S OLD RETENT!ON$ ''$ WORKERS COMPENSATION H X uTATUTF ...........i ER..................... AND EMPLOYERS'LIABILITY Y:N """' ""` ..........- A 'ANYPROPRIETOR/PARTNERiEXECUT!v% --- WC0853742 0211712016 02/1712017 E.I. E•Ac};ACCICEN*,_,_._.._._......_................._._.__....__.1QO,QO OFFICERrMEMEER EXCLUDED' N N:n MA ... IMandatorg in NH) E; DISEASE•Eh E+,PLOYEE:S 100,00 M as.da=ibe under ._............. ................._.................................._.. DESCRIPTION OF OPERATIONS avow E.L.CISEASE•POLICYLIMIT 'S 500100 DESCRIPTION Of OPERATIONS I LOCATIONS}VEHICLES (ACORD 105,Additional Remarks Schedule,tray be attached it 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, CERTIFICATE HOLDER r CANCELLATION —� NORTHA- i 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, 43 High Street i N.Andover, MA 01845 ' AU?HORI�RESENTAnVE j w Cc 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 KIERAN T WHELAN 31 RICHMOND STREP; ,. WEYMOUTH MA 02111% € t k. Expiration: Commissioner 09/26/2017