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Home My WebLink AboutBuilding Permit #014-15 - 4 HIGH STREET 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: — Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION - Ft1 (i--M � Prin' PROPERTY OWNER R-C_Cr- U:'%�- �(t a 1 •- �L/� a Print 100 Year Old Structure yes no MAP NO: PARCEL: 6.9 ZONING DISTRICT: Histonc.District (�a no Machine Shop Village s) 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 ❑ Septic ❑Well � Floodplain ❑Wet lei nds ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORME tq Z C) l,C i-r L4.k v-.s C 74C—C P sY— 59-49–h P 00 P L;�-1 Identification Please Type or Print Clearly) OWNER: Named A v+ O 9'q- ')► aey ri Phone: I-7_ 2- s s� � � V 1IT �le 0� Address: -� �J o .��' got,� I CONTRACTOR Name: Phone: _t 71. AddressLHnJvour �l,ct�y { , _ Supervisor's Construction License: ,� (� tt'- _ . Exp. Date: 0 7 s� Home Improve.menf.License; _ Exp. Date: ARCHITECT/ENGINEER ftMi'td��'I' �-i�; Phone: ur rt<1— �� aa�uv"J QLZI()Re No. 7 t) C� L Address:�j t � � ~ � � g• f FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. q, Total Project Cost: $ Ge 0 - FEE: $ v? dot a Check No.: / 7 7 Receipt No.: �2 7 —7z/ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si nature of-A ent/OwneLi- - C�z-� gnature of contractor. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 'K Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ 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 !later& Sewer Connection/Signature& Date Driveway Permit M•.I'W Town]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on siteyes no Located at-124 Main Street: Fire Departmentsignatureldate ' r ./ COMMENTS f ' 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 use II El Notified for pickup - Date Doc.Building Permit Revised 2010 - 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 NOTE: 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/Crossection/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 NOTE: 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 ❑ 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 NOTE: 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: Doc.Building Permit Revised 2012 Location No. Date 71;: Al o - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee - Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ 7 Check# / X71 =: 2 136ilding Inspector o`H°ATM 1 H° 3? Vit•' ` °t ti a + _ r X73 AC•NUSES4y CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 014-15 on 7/2/2014 Date: August 8, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 4 High Street MAY BE OCCUPIED AS Common Areas - IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill,NA LLC 4 High Street North Andover, MA 01845 Building Inspector Fee: $100.00 Receipt: 27872 Check : 1801 Location L/ No. Date U .. • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ r Building/Frame Permit Fee $ Foundation Permit Fee $ * Other Permit Fee $ 4 TOTAL $ / t (yet y Check# 4 V f l l i' r/.� / i 2 Building Inspector f Nei oTH I o H i ro `r 'rSACNUS' CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 014-15 on 7/2/2014 Date: August 8, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 4 High Street MAY BE OCCUPIED AS Common Areas - IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill,NA LLC 4 High Street North Andover, MA 01845 a Building Inspector Fee: $100.00 Receipt: 27872 Check : 1801 t I a� NORTH own of t E : 1� ndover O - 0 No. � � I T - _ � T - n ver, Mass, i coc"Ic Ml WICK ��• Are en) ►PP,`'(5 S tl BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT R .......................................................... BUILDING INSPECTOR has permission to erect .......................... buildings on ......... j :` Foundations / ... ........................................ .................. ough (: V / - /J to be occupied as ..� ?� .. ..��.i`� ;t^ �. .. ..F':. .... S c n� provided that the person accepting this permit shall in every respect conform to the terms of the application F na 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 CONSTRUCTION RT � 7 z l �� S .... :........................... Service .................... .� BUILDING INSPECTOR ;nab 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. Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 2 ,'0'j,,G :0.0 �m $ - $ 240.00 Plumbing Fee $ 30.00 Gas Fee 100 comm. $5 1--O-W,00) Electrical Fee $ 30.00 Total fees collected $ 400.00 4 high Street 013-15 Tenant Fit Up NORTH Town of t ndover No. C) h over, Mass, 7 i COCNIc"t WICM �1' T� �qS R�reo rPP��S U BOARD OF HEALTH Food/Kitchen PERMIT T L D Septic System /� may, THIS CERTIFIES THAT v'�v �C �! N � BUILDING INSPECTOR ....................... ................�.:�� Foundation ' has permission to erect .......................... buildings on . ........................................................ .r-- Rough to be occupied as ( iJ''��Zf 0 dr-t q ��`.�yl !:'P :S........ `� � 5 y r^ ................................................ ...... ....................... Chimney 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 CONSTRUCTION RTS Rough Service ................... .6 �5..................................... Final BUILDING INSPECTOR 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. OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 1406002.04 PROJECT TITLE: 4 High Street PROJECT LOCATION: _4High Street, North Andover NAME OF BUILDING: West Mill NATURE OF PROJECT:_S,nant_Fit Out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1,, Linda S. 03iley REGISTRATION NO. 1 tt0RQ BEING A REGISTERED PROFESSIONAL ENGINEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL 2 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 T. �EREO Aq� THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE B PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 Ita 10080 1. Review,for conformance to the design concept,shop drawings,samples and other submi which are submitted by the contractor in accordance with the requirements of the constru MAG& documents. 2. Review and approval of the quality control procedures for all code-required controlled materia Q 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 116.2.2 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 OCC IPANCY. L IANATURE t7� RN TO BEFORE ME THIS_J4 DAY OF NO R YY PUEff MY COMMISSION EXPIRES #k Zll-), f NOTICE. NOTICE TO d TO EMPLOYEES EMPLOYEES S. The Commonwealth of Massach-dsetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114-201.7 617-727-4900 - http://www.state'.ma.us/dia t As required by Massachusetts General Law,Chapter 152, Sections 21,22&30,this will give you notice that I(we)have provided for payment to our injured employees under the above-mentioned chapter by insuring with: LIBERTY MUTUAL FIRE INSURANCE COMPANY NAME OF INSURANCE COMPANY 175 BERKELEY STREET,BOSTON,MA 02116 (617)357-9500 ADDRESS OF INSURANCE COMPANY WC2-31 S-601698-014 2/17/2014-2/17/2015 POLICY NUMBER EFFECTIVE DATES NAME OF INSURANCE AGENT ADDRESS PHONE# 31 RICHMONT STREET JK CONTRACTING LLC WEYMOUTH MA 02188 EMPLOYER ADDRESS EMPLOYER'S WORKERS' COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her o«q physician. The reasonable cost of the ser- vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-066334 w .� i IQERAN'T WHET N 31 RICHMOND ST WEYMOUTH MA U, JL ,i ,tip `A • ��,`,,,,.� Expiration Commissioner 09/26/2015 . 3 rte_