HomeMy WebLinkAboutBuilding Permit #664-2017 - 50 HIGH STREET 12/22/2016z-"�ORTH
�l R� BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION A.
./ �A w y myh Y�
Permit No#: Date Received �,RarED "Q-.4
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
Alteration
No. of units:
ALCommercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Se tic D Weld y'
i E0 Flood n ®.UVetlands `gyp
r}(® tW rsfie'd Dist c
N RaMr
DESCRIPTION OF WORK TO BE PERFORMED:
c( �d c9 k1 G� � /� i9 c.� 11.6a^•- SC70e•(;¢ �D /i ' r � �YI.i% �� (N' o"�i'
Identification - Please T3
OWNER: Name:
or Print. Clearly
. LL-- C- _ Phone: dt"7-0ZS =83 /S
Confir� aall N. a _ ,Kc�-�Pho.rie.
Email: J�S_r_ R►z }
Su � e�i�sor s C.on �ucfi'®n�(Lensei2._ �t' .,� �Exp� ®atef_ .1_
pnj str ._
Home Imp.r�;,o�vementL�icense.y„dxp�,
ARCH ITECT/ENGI NEERZ rt—Phone: Y78-4-79 —2$Tef
K dE g1ro
Address:'2-16 p 1161 q a►9 0497 AJ'rPJgV&'Y e 0 AG- Reg. No. 1 3 t�
FEE SCHEDULE. BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ r t� '�'" �-' FEE: $ j 2 f A0 M- ?
Check No.: Receipt No.: 3
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
•c, �Sianaturebof,
Plans Submitted ❑ Plans Waived,❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
well ❑
Private (septic tank, etc. ❑
Tanning/Mas sageBody Art ❑
Tobacco Sales ❑
Permanent Dumpster on Site ❑
Swimming Pools ❑
Food Packaging/Sales ❑
THE -FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m U FORM
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On Signature
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
Conservation Decision: Comments
r
Water & Sewer Cohnec$idn/signature & Date Driveway Permit �
DPW Town Engineer: Signa
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.$1oo-$1000 fine
NOTES and DATA — (For department rase)
❑ Notified for pickup Call Email I
f
Date Time Contact Name I
Doc.Building Pennit 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
o 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
❑ CertifiedProposed 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
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 Clerics 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 4jr
No. Date
Check # 054z—
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $--
TOTAL $
rs
Ot MOiiti .t
O ►
`'�' err.. r�.i�(�i•
a�IC111P'
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 664-2017 on 12/23/2016 Date: March 24, 2017
THIS CERTIFIES THAT
THE BUILDING LOCATED at 50 High Street — Suite 41
MAY BE OCCUPIED AS a tenant fit up — Northern Capital 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
50 High Street
North Andover, MA 01845
Building Inspector
Fee: PrePaid $100.00
Receipt: 31370
Check: 2572
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CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 664-2017 on 12/23/2016 Date: March 24, 2017
THIS CERTIFIES THAT
THE BUILDING LOCATED at 50 High Street — Suite 41
MAY BE OCCUPIED AS a tenant fit up — Northern Capital 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
50 High Street
North Andover, MA 01845
Building Inspector
Fee: PrePaid $100.00
Receipt: 31370
Check: 2572
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 664-2017 on 12/23/2016 Date: March 24, 2017
THIS CERTIFIES THAT
THE BUILDING LOCATED at 50 High Street — Suite 41
MAY BE OCCUPIED AS a tenant fit up — Northern Capital 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
50 High Street
North Andover, MA 01845
Building Inspector
Fee: PrePaid $100.00
Receipt: 31370
Check: 2572
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 101,697.00
m
$ -
$
1,220.36
Plumbing Fee
$
152.55
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
152.55
Total fees collected
$
1,625.46
50 High Street
Tenant Fit Up Suite 43 Northen Capital
664-2017 on 12/22/2016
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OFFICE OF BUILDING INSPECTOR
TOWN OF NORTH ANDOVER
..�.. CONSTRUCTION CONTROL
PROJECT NUMBER: 15-0718
PROJECT TITLE: West Mill - 50 High St. 4th Floor
PROJECT LOCATION: 50 High Street, N. Andover, MA
NAME OF BUILDING: West Mlii
NATURE OF PROJECT: Teriant demising and tenant fit out.
IN ACCORDANCE WI ; H ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,
I, REGISTRATION NO.
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 0
FIRE PROTECTION
RCHITECTURAL STRUCTURAL ' MECHANICAL '
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 1 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 m
3. Be present at intervals appropriate to the stage of construction to become, generally fa iar
with6the progress and quality of the work and to determine, in general, if the work is be g9 Nog 6
cn
performed in a manner consistent with the construction documents. SLIT A E.
J
PURSUANT TO SECTION 1 "16.2.2 1 SHALL SUBM
WEEKLY, A PROGRESS REPORT
TOGETHER WITH PERTINENT COMMENTS TO HIE NORTH ANDOVER BUILDING NSP
UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE
SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY.
��� SIGNATURE
SUBSCRI ED AND SWORM €O BEFORE ME THIS�DAY OF �B
URKINSHAW
+ Notary P41�iit
Commonwealth of MG.S50rliusef
NOTA P BLIG MY COMMISSION EXPI n Expires
March 7, 2019
X Contracting LLC
4 High Street, Suite 108
North Andover, MA 01845
617-592-6775 (Kieran)
781-254-2862 (Judy)
Bill To:
RCG West Mill NA LLC
Daviid Steinbergh
17 Ivaloo Street
Somerville, MA 02143
Proposal
Proposal Date: 12/14/2016
Proposal #: 203-73
Ship To
Northern Capital
4th Floor, Suite 43
North Andover, MA 01845
Approved: (Initials)
SIGNATURE
rroject: ou reign, 4tn H, N...
Rate Total
1,204.00
1,204.00
4,500.00
4,500.00
300.00
300.00
7,500.00
7,500.00
6,000.00
6,000.00
10,000:00
10,000m
4,500.00
4,500.00
'15,900.00
15,900:00
10,000.00
10,000.00
5,000.00
'
5;00000
1,500.001:500"00
2,500.00
2,500 00
4,500.00
4,500.00
4,000.00
4,000.00
300.00
300.00
8,500.00
8,500.00
6,000.00
6,000.00
500.00.
500.00
9,270.40
9,270.40
927.04-
927.04 '.
Total $102,901.44
The Commonwealth bfMassachusetts . - -
De, partment of Industriacl Accidents
Qf ice oflnvestigations
600 Washington Street
.Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information p Please PrintLeiribly
Name (Business/organizaationgnlividual):L—
Address:_ -S V Mr tr►t •
City/State/Zip: /v . }Y� 0 �% -�--- 'e �Pnone# '-7 'r9
Are you an employer? Check the appropriate Ibox:
I. I am a employer with 1?— 4. E] I am a general contractor and T
Type of project (required):
employees (full and/or part-time).*
[]
have hired the sub -contractors .
6 El New construction
Tg Remodeling
2. I am a sole proprietor or partner-
listed on the attached sheet.
7.
ship and'have no employees
These sub -contractors have
8. ❑ Demolition
working forme in any capacity,
[No workers' comp. insurance
workers' comp. insurance.
5. We are a corporation and its
9. ❑Building addition
required.]
officers have exercised their
10.0 EIectrical repairs or additions
3.E1 I am a homeowner'r doing all work
right of exemption per MGL
I L ❑ Plumbing repairs or additions
myself. [No workers' comp,
c.152, §1(4), andwehaveno
12.QRoofrepairs
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.
I 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 checkthis box must attached an additional shaet showing the name of the sub -contractors and their workers' comp, policy information.
I am an employer that is providing workers' compensadon insuranceformy employees Below is thepolicy andjob site
information.
Insurance Company Name:: i- ,(� �'h� 5^, Cz- � M B jn✓J Y
Policy # or Self -ins. Lie. #: w d Lt— Expiration Date: 2 i -7 6 i
��
(�-, `�-' kq
Yob Site Address: -5 � �( �+ �v i ��d d� , � � qty/State/Zip: 1V r I�Jn � � ��
Attach a copy of the workers' compensation Polley declaration page (showing the policy number -and expiration date).
Failure to secure coverage as requiredunder Section 25 . of MGL c.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 cony of this statement may be forwarded to the Office of
Cnvestigations of the DIA for insurance coverage verif eztion.
t' do hereby cera under fli itis and penalties of perjury flirt rise information provided abovf is trueland correct
L�_/IT /I6
?hone #•
Official use only. Do not write in flits area, fo he rornpleted by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5, PIumbing Inspector
6. Other
Contact Person: _ Phone #:
JKCON-1 OP ID: CD
.ACOR®A CERTIFICATE OF LIABILITY INSURANCE
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 POLICYPEAIW
DATE 07/261201 YY)
07/26/Z016
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
DeSanctis Insurance Agcy, Inc.
100 Unicorn Park DriveAI(
Woburn, MA 01801
CONTACT
NAME:
PHONE- --- --- i FAX
C. No Exc : A/( C, Noj_
E-MAIL
ADDRESS:
_ INSURES AFFORDING COVERAGE NAIC #
DA AGE ToRENTED
PREMISES CE. occurrence $ 100,00
INSURER A:Star Insurance Company 012245
INSURED JK Contracting, LLC. _ —
INSURER 8: Selective Insurance Company 19259
4 High Street Suite 108
North Andover, MA 01845
INSURER C
GEN'L AGGREGATE LIMIT APPLIES PER. _ ! i
POLICY,7 PE0 LOC I i
�Q
INSURER D :
INSURER E:
i-- $
INSURER F:
OTHER:
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 POLICYPEAIW
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 POL.IC;ES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRw6Z"�tJtiR
LTR
TYPE OF INSURANCE INSD
— --I POLICY EFF
WV POLICY NUMBER MM/DD/YYYY)
POLICY EXP
(MM/DDIYYYYI
LIMITS
B
X COMMERCIAL GENERAL LIABILITY j
CLAIMS -MADE I A I OCCUR IS2205113 02/10/2016
02/10/2017
EACH OCCURRENCE $ 1,000,00
DA AGE ToRENTED
PREMISES CE. occurrence $ 100,00
MED EXP (Any one person) $ 10,00
1UT11Vj PRESENTATIVE
PERSONAL & ADV INJURY $ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER. _ ! i
POLICY,7 PE0 LOC I i
�Q
GENERAL ERAL AGGREGATE $ 3,000,00
I —_ --
PRODUCTS -COMP/OP AGG $ 3,000,00
i-- $
OTHER:
AUTOMOBILE
LIABILITY i !
COMBINED SINGLE LIMIT $
Ea accident
I� BODILY. INJURY (Per person) $
BODILY INJURY (Per accident) $
ANY AUTO
ALL OWNED SCHEDULED
AUTOS (AUTOS I
!
PROPERTY DAMAGE
LjPer accident) $
NON -OWNED
HIRED AUTOS AUTOS I
$
UMBRELLA LIAR OCCUR
EACH OCCURRENCE $
I AGGREGATE $
EXCESS LIARCLAIMS-MADE
$
DED RETENTION $
A
WORKERS COMPENSATION ! I
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE r�{N/Af
OFFICER/MEMBER EXCLUDED? L!`—f
(Mandatory In NH)
iW�+O6537�12
IMA
O2M7I2O16I
I
02/17/2017
X STATUTE ER H
E.L. EACH ACCIDENT $ 100,00
— — -
E.L. DISEASE - EA EMPLOYEE $ 100,00
If yes, describe under
DESCRIPTIUN OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 500100
I
!
i
i
i
DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If 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 CANCELLATION
C 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
NORTHA-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
43 High Street
ACCORDANCE WITH THE POLICY
PROVISIONS.
N. Andover, MA 01845
1UT11Vj PRESENTATIVE
�Q
C 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
I
' Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS -066334
Construction Supervisor
KIERAN T WHELAN,
31 RICHMOND STRF
WEYMOUTH MA 024 rj !
J
Y�
CommissExpiration:
ioner
_ 09/26/2017 .
cviemriiiowrS, r� r l z.t.irr�ic.rrl%i
s Office of Consumer Affairs & Business Regulation
,':f, HOME IMPROVEMENT CONTRACTOR
h,:i Registration: 7:1393 Type:
Expiration:,: 3/1.5/2918 Individual
KIERAN WHELAN
KIERAN WHELAN
31 RICHMOND ST
WEYMOUTH, MA 02188
Undersecretary
i
t License or registration valid for individual iise only
efore the expiration date. If found return toc
6 -trice of Consumer Affairs and Business Regulation
k i, Parti Plaza - Suite 5170
Boston, MA 02116
F
ori
Not valid without signature
Cf�Le �arrrnaorrraecrlf�e 4�C��LL9Jacfl' LC66f�J
Office of Col giiiiier Affairs & Business Regulation
HOME IMPROV,EMENT.•CONTRACTOR
R¢gistrmon I.71393 Tyle
Expiratio L-_3L151PA18 Corporation {
t JK CONTRACTING LLr=r`
KIERAN WHELAN
31.: RICHMOND ST
WEYMOUTH, MA 02188 Undersecretary