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HomeMy WebLinkAboutBuilding Permit #568-2017 - 50 HIGH STREET 11/28/2016 BUILDING PERMIT � ®��Ao T H�`�o TOWN OF NORTH ANDOVER ® APPLICATION FOR PLAN EXAMINATION _ _. 0yq Permit No#• � Date Received��1�/ � °Rp<���"��<�°�` � °RATE°PQM ,c5 • r gSs9CHUS�( Date Issued: ORTANT:Applicant must complete all items on this page\ L®CA ION ° G 1�-Lel'y'I'9 (_j-, / OFFERW"141,011111—f3i P t._� �,.rL C- 1 P 1, Str cur no _ ' r-- M � PP�RCELL-L� Z NING ®ISRLCTf fHf, stork Dsfri�t} e tno Machine Sho Villa e �es no ,. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial V.Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septics I©1N 'r � © Flo,� in ,pWe lands ® �Wate s ed D'istret '" "` _ �� _..n�.�...�� DESCRIPTION OF v�gRK TO BE PERFORMED: CL 3 ✓� Ick n cC opcs-rL -<ai& c e lsu :f ,I Identification- Please Type or Print Clearly OWNER: Name: vcrn-&)l Phone: f7 Address: Su rrg 0 0 Vr9 I v o -qL,3 ft t2v1 �L5-- Li-� Contr�act,.orrN.arne�. ct INl: _KL 3 '3 ty�.�r. r �5." ' ►'✓� - - - - ' , Ves Sup,,e"rui or's Cons r�uct. ®n LL�icense < � t- tExp ®ate 2,6 1 Home Imp.rouem ntLicense ,(Ex�% Date= - - ` 1 t,�i2— ARCHITECT/ENGINEER c91'l.S' 't'IJ�. 7J Phone:�� Z 0 '? t� rpt (9- C- W— e(CJq 7. ACU 0 vL L- p Address: Akrw Q Lao- Y n o M I ck. 0'L cc J-C) , Reg. No. FEE SCHEDULE:BULDING PERMIT:MOO PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2 (� . 04-4' FEE: $ ' 1� kb,o = -7 Check No.: Receipt No.: 3 (2-+ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund f �Sr natureof`A' ent/Owier" - -- - --- - — �g _ __ g --- 2: �z;: Signattare of�coritractor :, l Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swfinming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pexlnanent DumP ste r on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY I INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed,On Signature6g4jAi_ COMMENTS Y4 AW le I 1>� I - t��lv — CONSERVATION Reviewed on Signature COMMENTS a HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation,Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street AFIRE DEP`AR a MENT ti. - ,,� �T;�em�©umpsterrornsite��ye��., L►5cateMt 124�Main�treet« °� .� '�a;���S� {4x +#` ,�.W"`i Fire Depart�Iw nt'sQ'g ure/elate tt N— w Y �" � :• f'1�,Y5�L ,� 'CO,MMEIVT}St.>, �``�;;�`�..:,'���r,��t�h�°��'�; •�'_��. �;. • � ��• ,,r���,�����r .�:j>�; �, � �'� 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.$1oo-$1000 fine NOTES and DATA— (For department use) if zz N ❑ 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 it ❑ 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products C`I'E: 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 Locati5on No. � ' G�7 .. Date • - TOWN OF NORTH ANDOVER • v Certificate of Occupancy $ i" Building/Frame Permit Fee $�5j3 a Foundation Permit Fee $ Other Permit Fee $ TOTAL $lkY.3 Check r� Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 1263044.00 m $ - $ 1,512.53 Plumbing Fee $ 189.07 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 189.07 Total fees collected $ 1,990.66 I 50 High Street 568-2017 on 11/28/2016 tenant fit up Suite 46 � NORTI� own Of n over A-- No. �� �, - tow". Q _ * t , h ver, Mass &Iemlw COCN1CNIWICN �qs gArE101��.�y V BOARD OF HEALTH Food/Kitchen PERMIT Septic System • THIS CERTIFIES THAT RCS�� BUILDING INSPECTOR .... Foundation has permission to erect ........................ buildi s on �......... ....... . ........ . ...... . Rough to be occupied as ......... .fir. ......� �.... ...,.. ..... ...T.......... .........� �............................... Chimney provided that the person accepting this per hall in ev 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 nd Construction of Buildings in the Town of North Andover. & PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST O Rough Service .. ..... .... ...... . . ...... ...... Final BUILDING I PEC OR 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. �;°"•' y OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER. 14-0715 i PROJECT TITLE: American Contracting PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant improvement/fit out IN ACCORDANCE WITH ARTICL 116 OF THE MASSACHUSETTS STATE BUILDING CODE, �1 REGISTRATION NO. r' 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 ° ARCHITECTURAL 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 mater' s. 3. Be present at intervals appropriate to the stage of construction to become, generally famili with6the progress and quality of the work and to determine, in general, if the work is be' performed in a manner consistent with the construction documents. ���� D qRc, Q� PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY , A PROGRES TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILD li�J p TUAT f� � UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OC Y. p r `� p `7.1 OF _g N T � � SUBSCRIB D AND SWORM TO FORE ME THIS DAY OFL. BURKINSHAW Notary Public Commonwealth of Massachuseh NOTARY P L C MY COMMISSION EXPI My Commission Expires C , 2019 A Contracting LLC PrQpQS1� 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Proposal Date: 11/15/2016 Proposal#: 203-65 Project: 50 High St, Amer... Bill To: Ship To RCG West Mill NA LLC American Contracting Daviid Steinbergh 4th Floor,Suite 46 17 Ivaloo Street i Somerville, MA 02143 North Andover,MA 01845 Description Est. Hours/Qty. Rate Total Permit, includes C of O. 1,612.00 1,612.00 ,Demo 1,500.00 1 500.00 Wall Framing 4,000.00 4,000.00 Doars-&Trim 3,20Q.00 3,200.00 Glass Panels Installed 3,500.00 3,500.00 General Conditions 2,500.00 2,500.00 Cabinets& Granite tops 6,500.00 6,500.00 Heating &Cooling 15,000.00 15,000.00 Electrical & Lighting 18,000.00 18,000.00 Insulation _ 1500.00' 1,500.00 Tele/Data 8,000.00 8,000.00 Interior Walls, Board, tape, sand 8,500.00 8,500.00 Painting 15,000.00 15,000.00 Plumbing 4,500.00 4,500.00 Sprinkler.Work 1 4,500.00 4,500.00 Floor,Coverings 17,500.00 17,500.00 Supervision 11,220.00 11,220.00 Insurance 1,122.00 22.00 1,122.00 Total $127,654.00 Approved: (Initials) SIGNATURE i The Commonwealth of Massachusetts - De artmint o IndustrialAccidents Offace oflnvestigations 600 Washington Street Poston,MA.02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/lndividual)' � �. W n`t CIA eG l 1-.1 6— t,_ 1I L_ Address: �z y ►6 I�GM City/State/Zip:_ Afi fl a v sy kE A.13l \ Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.R I am a employer with 3 4• Q I am a general contractor and I ' 6. E]New construction =k have hired the sub-contractors employproprietor or p employees(full and/or part-time). 2.❑ I am a sole pro partner- listed on the attached sheet# 7. Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9, [�Building addition [No workers'comp.insurance 5. We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3. 1 am a homeowner,doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.El Roof repairs insurance required.]f employees.[No workers' 13.0 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 ace doing all workand 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. lam an employer that is providing workers'compensation insurance for my employees Below is thep oliey and job site information. Insurance CompanyName:.�a Its c'1 Udw)-f4 �-� � tie" �y . Policy#or Self;ins.Lia#:, '+4-r ti Expiration Date: 2 17111-7 , Job Site Address._r(p I ,0 d 61'`— City/State/Zip: N• O 0%/d,^ Attach a copy of the workers'compensation policy declaration page(showing the policy number and ek'piration date). Failure to secure coverage as requiredunder Section 25th,ofMGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,a3 well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certio under the pains andpenalties of p.etjuru that Elie information provided Bove is ue and correci Si ature: Date 1 Phone#• Official use only. Do not write in this area,to he eoanpleted by City or town official. i City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: - - . JKCON-1 OP ID:CD Aft o I ► CERTIFICATE OF LIABILITY INSURANCE FD0712ATE 10/Y16 �+--�''' , 071261201$ IFTHIS 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 11PIPLOW. 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 ._ NAME:........................................................................................_........._._......._............ ....._.................._....•.........__.._...._ iDeSanctis Insurance Agcy,Inc. PHONE FAX :100 Upicorn Park Drive ac kd �xci........ ................._....................................................._.....:_._......._.......L4 N4L Woburn,MA 01801 I E MAIL AUUNESS.;,,, TNSURER(SIAFFORDING,COVERAGE.._.................................._... NAICft `INSURER Aar Insurance C .pan ..__..,.. ;012245 ................................................_...................................._,........................ .._.......... , ..._....... .......... m ._.....__............ ........... 'INSURED JK Contracting,LLC. INSURERS Selective Insurance Company !19259 4'High Street Suite 108 INSURER C North Andover, MA 01845 ........ ... ......... ._ INSURER 0: i L.. ... . .. .._. ........... ...........................................................................;................. __....._.._._.._. 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 OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE'MAY BE ISSUED OR MAY PERTAIN, THE iNSURANCE AFFORDED BY THE FOUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. _�. ....._........ ......_........._ INSR; 0 L UBR; POLICY EFF POLICY EXP LTR TYPE OF INSURANCE w yPOLICY NUMBER MM:OO;YYYY MM1DD,TYYY) LIMITS JB i X !COMMERCIAL GENERAL UA&LITV EACH OCCURRENCE $ 11000,00 _.. ArNrE CLAIMS•MADE ( X OCCUR S2205113 02/1012016 02/10/2017 p;,E. fS 10fe ocdu andel 5 10Q,OQ V-0 EXP'Any r e person) S 1Q,OQ PERSONAL ADV iNJURY S 1100010 :_......i .............._..........._........_.._............I.............................. ................................._......_.__...._........_ _.........._.___._...—•— i GEN'L A3GREGAT':'LIM141T'APPLIES PEFi GENERAL AGGREGATE 5 31000,00 ......... .......,.. PRO• _...........................__ ..._ X^POLICY........_.i,IECT .,,,•,•„ LOC PROD'UCT'S•COMPtOPAGG S 3,000,00 ................................................__......_. OTHER• AUTOMOBILE LIABILITY ^CMBINE SINGLE LIMIT S Ea,xcrd?nl ANY AUT C BODILY AJURY(Per persor; S ..,.'............._....................... ALL OWNED SCHEDULED BODILY NJUR T AUTOS Y Mer acctidentj 6 �_.._.; AUTOS ._._...... N WN"C PCU?ERYY...DAMSG._..........___. ...5.._..... i HIRED AUTOSAU 0„ 'Par,ax�denti................_......r -- j UMBRELLA LIAS OCCUR EACH OCCURRENCE !S EXCESS LIAR CLAIMS-MADEAGGREGATE S RETENTION$ s »..Y.. I WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X ! . _uS TU:TE.._:............ER............L..................._. ... .._ ...._. A ANY PROPRIETORi7ARTNERiEXECJT,I" �'N VVCC853742 02/17/2016 02/17/2017 FA FACt ACCIDENT 1QO,O0 0FFICERIMEM8ER EXCLUOED'7 N 't;r A S I(Mandotory in NH) MA E L DISEASE•EA[MPl.OYEE.S 100,00 I It Yea.describe under .. .. ._......._...........,..................._...........__....•_. ':DESCRIPTION OF OPERATIONS ce!ow E 1..0ISEASE•POLICY LIMIT:S 500100 DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (ACORD 101,Additional Remarks SChadula,may 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, I CERTIFICATE HOLDER ` CANCELLATION NORTHA- ( SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 43 High Street I N.Andover, MA 01845 j AUTHORi2 PRESENTATIVE 7 t 1988.2014 ACORD CORPORATION, All rights reserved. ACORD 26(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 Corstru ;inn Supervisor KIERAN T WHELAN 31 RICHMOND STREET WEYMOUTH MA 0218$ Expiration: Commissioner 09/26/2017 Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ i 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 e U FORM PLANNING DEVELOPMENT Reviewed On 5�►1 �I' Signature_ COMMENTS Yl� AW IlC i 1�� - ULU 1 � . 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 Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: FIF2E DEP Located 384 Osgood Street 4 p , �,p` yeS . , 4 ARaTMENT Teem Dum stet onsite• j' afeclaf 1241IVIa njSfreeta y :.k+..4; " �w .:.az ,;►f'T nod._ .- - � �'' Ftr�e De arfinenfs .. ,p �, �.� gnatureldateY, 1 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) if z - i i El Notified for pickup Call Email Date Time Contact Name i Doc.Building Penuit Revised 2014