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HomeMy WebLinkAboutBuilding Permit #1098-16 - 47 HIGH STREET 4/20/2014 1 A`^/'v4 Y V LI NORTH BUILDING PERMIT Q��ttED ,bq'�•O TOWN OF NORTH ANDOVER 3 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received ArEo gSSACHUS�� Date Issued: IMPORTA1NT:Applicant must complete all ite�m�s on this page LOCATION u \ `-r T ��Cst� r, . li- (1IV Pry /t ��� Print PROPERTY OWNER R. C Cr K%,th �� L Print 100 Year Structure yes no MAP �1 — PARCEL:61 ZONING DISTRICT: Historic District a no Machine Shop Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 1Nell Flood Iain Wetlands 0 UVate" hed 'District S,eptie p- • DESCRIPTION OF XVOc O BE PERFORMED: �` ,rw 6piL 1 KIpo N I XPLv c- 9,177.S Identifica on- Please Type or Print Clearly OWNER: Name: Phone:( lZ (32 Address: l �rx\Xvwt It es � =3 - C.0 r.c e'n'" Contractor Name: Phone: 6 n - sci Email: tS --Z-rt 3 e-01— COM Address;S'v iqV- 16 Ag 4- tv- /yD 3yz^-- (/d too Supervisor's Construction License:G4 L9 Exp. Date: Ct Z / 1 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER.0 " - t Vv. C. Phone: `] Address:260 d6f4x,rf^.c-- AJ57WgL1r- *2v1na Reg. No. `�3� b FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ A -0 Check Check No.: `�/ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Ili r-� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL r Public Sewer ❑ Tanning/Mass ageBody 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS I CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes .Planning Board Decision: Comments "onservation Decision: Comments Water& Sewer Connection/s►gnature Bate Driveway Permit DPW Town Engineer: Signature: Il- Loca ed ;4r , Ep2A, +y'ya. t3_ - Osgood Street ; TDmpumno loc �tlat 14M5i SSFie Deamt r /date � r COMMENTS 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 ® Notified for pickup - Date Doc:.Building Permit Revised 2008 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 4. Building Permit Application 4. Workers Comp Affidavit ik. Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4. 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) 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 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 u No. Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee TOTAL Check#,/ r" / Building Inspector IJ - 1 aF HoaiN 9y i o ,{, 1 V Ar ICHUSEt49 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 1098-2016 on 4/20/2016 Date: May 31, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 47 High Street— Suite 101 MAY BE OCCUPIED AS a tenant fit up —New England Inpatient Specialists IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG NA Mills LLC 47 High Street North Andover, MA 01845 Building Ins�ector Fee: PrePaid$100.00 Receipt: 30268 Cheek : 2471 r 7 NO w: 1 . RTH _ A­.. .c . . ve . O . • Y^• r h ver, Mass � 1. COCMICNtw.c" y1. / AERATED S U BOARD OF HEALTH Food/KitchenPERMIT T LD 4 Septic System THIS CERTIFIES THAT ...� .G .. 1:G.:��':7,. ..... .�::................................... ................ .. BUILDING INSPECTOR .. . ....... ... ... ..... -.,Foundation gS 0" has permission to erect . .�........` f� s ',yl, Sfr�T -'.. on ...................... buildin ,r :-:...... .. . ................... -� Rough•< to be occupied as ...:: '$:; - /' c. ................ .......... ....... ..:..................... b;Fi ey! ..................... .r.................. , ' provided that the erso`n acce tin this ermit shall in eve respect conform to the terms of the application , /� p p p g p every p pp G}�L . _ `(� 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. PLU BING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final �� l PERMIT EXPIRES IN 6 MONTHSCTRICAL INS TOR ®, UNLESS CONSTRUCTIO �� (n�kTARTS dM$®/® Service - / i ............ .... ...... ....................n.�.......................... Final �t BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. j� OS~O olN'1N ysswciu5E4g CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 1098-2016 on 4/20/2016 Date: May 31, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 47 High Street— Suite 101 MAY BE OCCUPIED AS a tenant fit up —New England Inpatient Specialists IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG NA Mills LLC 47 High Street North Andover, MA 01845 i Building Ins,ector Fee: PrePaid$100.00 Receipt: 30268 Check : 2471 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $; 96,4"O, 'LOG) m $ - $ 1,181.87 Plumbing Fee $ 147.73 Gas Fee 100 comm. f S 100}.00i Electrical Fee $ 147.73 Total fees collected $ 1,577.34 47 High Street 1098-2016 on 4/20/2016 Suite 101 - NE Inpatient Specialists r -i NORTH _ : w: 1 _ c . . ve. . p :. �' �► 1(41."h ver Mass CCKNICNlWKIK y1. p0R�TED S V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ................................ .. .. .. ... ... ...G::!���.�✓.�:..:..�1. ................................................................ has permission to erect ... T - < oundation ..................... buildin o.. .. ..............: ................ ..................... .. to be occupied as 0 ' L r�.� .:...... . .(��/� �k��N„ �ac. �"S Chimney �.. �..................... S„ u ..... .......... ........ .... .............. provided that the per accepting this permit shaii`n 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 CON STRUCTIO TARTS Rough Service ............ ............. .......... .........�...� 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 a TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL N0.9536 0, o SCITUATE, 14-0682 MA PROJECT NUMBER: yo PROJECT TITLE: New England Inpatient Specialists TM OF PROJECT LOCATION: 120 Water Street, N. Andover, MA NAME OF BUS DING: East MITI NATURE OF PROJECT: Tenant improvement/fit out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, A t-A E 2 REGISTRATION NO. S 3l0 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 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 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 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 RE RT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING 11, SPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO T,..Eq SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR )CCU CY. SUBSCRIBED AND SWORM TO BEFORE ME THIS 7W. sig=DAY OF 20 <Z4, CHERYL L. BURKINSHAW Notary Public NOTAR BLIC MY COMMISSION EXPI Commonwealth of Massachusetts �+ My Commission Expires March 7, 2019 The Commonwealth of Massachusetts Department of.&dus&&jAccidents Office oflnva*a&ns 600 Washington Street Boston,MA 02111 •www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le>sitbly Name(Business organization4adividuat): - 1��- �1� �i tl !r G - Address: .1 moi' I ® � s H I�N fl ayy'' Vq 01 City/State/Zipa 11�rlPhone Are you an employer?Check the appropriate box: - 'Type of project(required): 1.® I am a employer with a 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part time)."` have hiredthe sub-contractors 7. gLRemodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet.: ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. El Building addition [No workers'comp.insurance 5. ❑We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their t of exemption per MGL 11.❑Plumbing repairs or additions 3.El am a homeowner doing all work � � p myself.[No workers'comp. c.152,§1(4),andwehaveno 12.❑Roof repairs k [No employees.[ o worers' insurance required.] 13.❑Other comp.insurance required.] `Any applicant that chodim box#1 must also fill out the section below showingtheir workers'compensation policy information t Homeowners who submit this affidavit indicating they ace doing all work and then hire outside contractors must submit a new affidavit indicating sucb. #Contractors that che&this box must attached an additional sheet showing the name ofthe 90)-contractors and their woriaers'comp.policy infomlation. lam an employer that is providing workers'compensation insurance for my employee$ Below is the policy and fob site Information. Insurance Company Name:Z'ss .96 N C741 a r4,4 a 0-00N Policy#or Self-ins.Lie.#: �` 0 Bxpiraiioa Date: ti i Z i -7 Job Site Addressyo EL�t5 tL �Q JJ0 3 d SIS City/State/Zip: M r 6 1 4" 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 o.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 tine 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. X do hereby cerci under the paW andpenaltces ofperjury that the information provided above' true. d correcif �. Date• � � Si tore: _ one#: Official use only. Do not write hi'this area,to be completed by city or town qf,ficra.I City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/fown CIerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• JKCON-1 OP ID:HS ACORL7" i`„r� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 02117/2016 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, 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). PRODUCER CONTACT DeSanctis Insurance NAME: Agcy,IAC. PHONE FAX 100 Unicom Park Drive A/C No Ext: AIC,No): Woburn,MA 01801 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL S INSURER A:Star Insurance Company 012245 INSURED JK Contracting,LLC. INSURERS:Selective Insurance Company 19259 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOLSUTYPE OF INSURANCE B POLICY NUMBER PSD EFF POLICY EXP OI D LIMITS LTR B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED CLAIMS-MADE FKOCCUR S2205113 02/10/2016 02/10/2017 PREMISES Ea occurrence $ 100,00 MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 X POLICY E JECTPRO- LOC PRODUCTS-COMP/OP AGG $ 3,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accdent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE Per as dent $ AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YSTATUTE ER A ANY OFFICER/MEMBER EXO EXCLUDED? ® NIA A WC0853742 02/17/2016 02/17/2017 E.L.EACH ACCIDENT $ 100,00 (Mandatory In NH) MA E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE--POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ACORD 101,Addttlonal Remarks Schedule,m be attached H more eek required) ( may Pa re4 ) Evidence of coverage. CERTIFICATE HOLDER CANCELLATION TO WHOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TO WHOM IT MAY CONCERN THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Departmerst of Public Safety Board of Building Regulations and Standards License: CS-066334 Construction Supervisor KIERAN T WHELAW 31 RICHMOND S WEYMOUTH MA-02 = Expiration: Commissioner 09/2612017