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HomeMy WebLinkAboutBuilding Permit #885-2016 - 4 High Street Suite 302 2/16/2016�21 o�,l� BUILDING PERMIT NORTH �* TLED 16 qhC TOWN OF NORTH ANDOVER`'• - APPLICATION FOR PLAN EXAMINATION~ y _ T N K 1. Permit No#: � Date Received gSSACHUS Date Issued: 1 IMPORTANT: Applicant must complete all items on this page 71 LOCATION —�U r -r-57 C L �-�'' t'l ti Cr K Ste' 1 Print PROPERTY OWNER fL A, W S1q-rW( 5 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District <236� no Machine Shop Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other O Septic ❑ WellFlootlplainWetlantls ❑ UVatershedlgDrsirnct Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: V V OWNER: Name n - Please Type or Print Clearly ✓5,i W QdII-Cs H Address:,fuITC (03, 14-�"✓�1ddS-r -�0tiovwt11,5, H & VZ b2 5 -K3 Contractor Name: Phone: Email: tWi cs gA416C 3 L,3r►-q7K4 C --r,3 A- , i s r N o Address: Soj trs k 15 t+- NvCrW S; O , ar►ooveYL-, tiA Supervisor's Construction License: �� c���,33 Exp. Date: R 2,6 14L Home Improvement License: Exp. Date: 11 ARCH ITECT/ENGINEER-�:i'� (� /� �+'I-I ��'`r u Phone:11 Address: gull :ry- �iJJ ®, 'd YJ • 0124 () Reg. No. t 0 0 80 Azo FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. X-* I n Ca Total Project Cost: $ q 3 ? 0 © FEE: $ I, ( — Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund It s Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming 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 COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes iy Planning Board Decision: Comments --^onservation Decision: Comments —.a Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: :rirejugep,ar[menj�pignaturEe/dale COMMENTSv� uocatea jo4 usgooa Street 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 MGL Chapter 166 Section 21A —F and G min.$10041000 fine MOTES and DATA. -- (For department use Notified for pickup Call Emai Date Time Contact Name Doc.Building Permit Revised 2014 M 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 a. 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4. Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products TE: 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 -le, No. Date Mn -2/7//r Check.. ,:— - TOWN OF NORTH ANDOVER Certificate of Occupancy $ pe $ 7Q,0 Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector o�,,o°TM fro Y + •"19 �,SSACINSEi CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 885-2016 on 2/16/16 Date: March 29, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 4 High Street — Suite 302 MAY BE OCCUPIED AS a tenant fit up — Technical Training Foundation IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG, LLC 4 High Street North Andover, MA 01845 Building Inspector Fee: PrePaid $100.00 Receipt: 30008 Check: 2418 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 885-2016 on 2/16/16 Date: March 29, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 4 High Street — Suite 302 MAY BE OCCUPIED AS a tenant fit up — Technical Training Foundation IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG, LLC 4 High Street North Andover, MA 01845 Building Inspector Fee: PrePaid $100.00 Receipt: 30008 Check: 2418 �r��n� O O. O11, O 2 O y < MU acap N r p,CD,n 0 O rt rt Q- o �_ ; Z p _? �� N ='I O O N rt cp' N rte► O O r+ Q Ill ON p'a CCD = O S=u O lD co N Q O W CD CDCD Q. 0 p O c :\ S. � .04� 7 O. O o c o0 �, a - c o =� n N 3 0 <m Q � 5,— o < : Q; ID �� O U CDJ _C cA CD cD r y O cD CCA cD O saw Nr, r CD C CD CD D :P:v: o CO CL =N N N W '� C O N O 't T xT 3 O 00 3' v O O OOq n S (D T A O' O OOU m _ C7qT SO 7Q(DD 7Q V1 T O O n \ z m C - (D w \jam W C N 7C (D s 3 W vH A W O z 70 v m y O m - m mD A O r, O O \ 0 x 0 oft CL0 c Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost 34990:3.00 m $ - $ 418.84 Plumbing Fee $ 52.35 Gas Fee 100 comm. $ 10.0.00 Electrical Fee $ 52.35 Total fees collected $ 623.55 4 High Street Suite 302 885-2016 on 2/16/2016 Tenant Fit Up _v C @ n 'a 0 CD n Z N CD 0' -0 CL �• y o CD <Q CD CD 0 CL 0 CD 0 N. �• C ' � v 0 0z CD 0 0. o CD CD O n e� Z m Cl)� cn n ZX cn C Cn Z 0 cn m O C25 o : C _ N < CD � � O > m. C 0 CD n 0 rt rt 0-0 ;o Z o _= �� N O O vi s - 'f1 rt O O r+ Q i71 -w CD ON C. SD 'a M C 2 CD O 3 a) O CD � rt to N 1 O O� CO's W 3cD CD 3 C CD ,a '� O 0 cm CQ U) ^" CD o� N to -� cn pC z CD tti o0, a Sr `CD 0 a 0 o < mo — cn n.-:� Q. N O O cn O CD OCD N Q -0 W CD `; �D 9 � CD cD o , j,� oNS.+I S. O y ODS DJ CQ n Er O COD rr v CDCD CD �s =r c (D o CL L OC 0 (D 0z O''' N (D - O W (D T O N xT O C. j 0) N (D Z7 O C T j N :p O G T O' DJ n S x O C T O C Q N N 'a n N T O O T m D m N vZi O m T f1 rD- 0 V C +) M 0 W C C Z Z viT m 0 - 3 S O W O m D r 2 'IM 0 c "°"":�• OFFICE OF BUILDING INSPECTOR !? � TOWN OF NORTH ANDOVER iiCNY54 CONSTRUCTION CONTROL PROJECT NUMBER: 1406002.41 PROJECT TITLE: 41-lighStreet Suite 302 Technical Training Foundation PROJECT LOCATION: _ 4 High Street, North Andover NAME OF BUILDING: West Mill NATURE OF PROJECT: IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1,_Linda S. Smiley EGISTRATION NO. 10080 BEING A REGISTERED PROFESSIONAL ENGWEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL 0 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 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 being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 118.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OC9PPANCY.1 r s 'FFA URE-'. SUBSCRIB AND SWORN TO BEFORE ME THIS DAY OF -�cJaIL S PATRICIA E. BARKER bNotary Public NOTARY PUBLIC MY COMMISSION COMMONWEALTH OF MASSACHUSETTS My Commission Expires A iso, i i.;t 24, 2018 JK Contracting LLC 31 Richmond Street Weymouth, MA 02188 Bill To: David Steinbergh, Suite 302, 4 High St, N.Andover, MA 01845 Proposal Proposal Date: 2/14/2016 Proposal #: 203 Project: Description Est. Hours/Qty. Rate Total Plans and Permits, Includes C of O, 700.00 700.00 Demo 500.00 _ 500.00 General Conditions, 1,000.00 1,000.00 Floor Coverings, Includes extensive floor prep. Carpet` "... 2,030.00 2,030.00 already stored on site. Wall Framing, Materials and Labor 2,900.00 2,900.00 Doors & Trim, M&L,[Newdoors,4 with glass,one solid' 4,800.00 4,800,00 keyed to tenant master]. If doors can be salvaged from building and painted , deduct $2300.00 from this , number] Heating & Cooling 4,350.00 4,350.00 Electrical & Lighting[ estimate until have marked up set 3,000`.00 3,000.00 of drawings indicating locations for outlets ,etc] Tel -data,[ estimate until marked up set of drawings] 1,500.00 1,500.00 Insulation r: 40000 400.00 Interior Walls,Supply and Install whiteboard. 2,900.00 2,900.00 Tape, sand, make paint ready 3,000.00 3,000.00 Painting, No ductwork, paint old doors or stain/varnish 4,200.00 4,200.00 new doors, paint frames.[Sealing of brick an extra]. cleanup & Restoration 150.00 150.00 Insurance ,[1%] 300.00 300.00 Supervision [100/6]... 3,173'.00 _ 3,173.00 Thank you for the opportunity to bid this work. 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(p D °° D n i \\1 U) m D n Q o m D o m U) � 0 z C (_n °'= U) C z 0 C �' C 4-7/8" o cn n z r O 4-7/8" m r m CsJ m !E ci °' m z m 9 O Xzx = C/) m OCmMDmD C z= O 0 z m O n z zr�n�>� m m O 0 °0 ;oz o m z o v < Z n- zDz�� O r m Xz.r-�0m mo-DOZX 7< Z -ymozimD C/) z ,"D < Ex �r-03m-j-,K 0 0 0 0 -u n O�mDom-ml w N m = CuZT 2.ZDl r -Mmm>or- z z z z D?T 0 C y m-1 ocnzr�00 zmm,c�x O O O O -{m ��� -u m m m m G) m r0 M Z D -rC-m xx—r5 -um m_ -u m -urn z 90 m<zzm DOD• 0-A <m Z.ZDI cn-i � m O--1-1 <m O� m rmzcnm 0 z 0o =� m— z o z mo cn z mz u w� ,O oz O� O cm,7� ;O o 3m 'o m Nm 9FG'i -Az nm z Xz rtrtyy��.. F G 0 CO O= co 0 07 o UD1 m N �_ Q OOdd p 00< �0 O< O<O a CD m in CA m CL 'ry r'' z c 00 m O z c uzi r � DC cn C r 0 D Cl) z f z3 fG 3 O K'7+TER STREET BLDG 7-4 HIGH ST ' cn BLDG 6 C BLDG m a $ m N O , no7 go 8 D i z A N p m The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UT. 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual):CTX Kd¢ tea ej P N GL AN 1 C nr� cm r G Address: _� U ITS a 4- 41 ti -K SG' IV, lq City/State/Zip: Apoy n j 6ft d I8�-S Phone #:.61'i - 5' ` -L, Arean employer? Check the appropriate box: 1. am a employer with 4_ 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. # ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance reauired.l Type of project (required): 6. ❑ New construction 7. t4 Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. r Homeowners who submit this affidavit indicating they are 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. l am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site `reformation. ! nsurance Company Name: rl VTU1+ 'olicy # or Self -ins. Lic. #: Expiration Date: 7, 1 t —7 ob Site Address: iiUk Z _�-H lC�tl ,�-- N A r -DV amt,/State/Zip: r- � a li �(`u ,.� attach a copy of e the workers' compensation policy declaration page (showing the policy number and expiration date). 'ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of svestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 1 ..0--- , i _ 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 6. Other Contact Person: Z'11s-/t6 4. Electrical Inspector 5. Plumbing Inspector Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and .phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 61.7-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.govfdia Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -066334 Construction Supervisor F Nr KIERAN T WHELAN`\ 31 RICHMOND STREAET�-1 --1 WEYMOUTH MA'02 88 r �` 1 CAlS11\ Expiration; Commissioner 09/26/2017,