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HomeMy WebLinkAboutBuilding Permit #1066-2016 - 50 HIGH STREET 4/13/2016 i BUILDING PERMIT of No DT"qHo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '' 7D I 1 � �Q ey A- N 1 Perm It No#: 1 Date Received 7 p�RArED gSSACHUs�� Date Issued: IMP RTANT: Applicant must complete all items on this page I LOCATION f► i &H Print PROPERTY OWNER 1 L C (, Fy �_(� 1"l t ( �.S L L� Print 100 Year Structure yes no MAP PARCEL:__ZONING DISTRICT: Historic District a no Machine Shop Village no TYPE OF IMPROVEMENT PROPOSED USE i 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 us ❑11Vell ❑ Floodplain ❑VVetlands ¢` ❑ Watershed ®istnctx Water/Sewer. _ n DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name ,iln �IN�em-eM Phone: i'7 ' k2tJ Address: ?U ,CIT (� d�i1 UaV8- < tc5't"W�,tiltjl4uJ_J.#$A° Contractor Name:J CC o-104,+g_T Ire G LL'Phone: b 1?-'%ff L_ b 717S� Email: id" -C. . Cuew� ) G LL_C__ Address: 3 u Ic6 I D L4- i aN V0 oi!' Supervisor's Construction License:<f. S ® � 122 40' Exp. Date: I 2 /17 4�Home Improvement License: Exp. Date: ARCHITECT/ENGINEER ,.a' µi"11�- Phone: ���" ` �' C? 6 0 M iS Y✓tt,Hc%9 C.r i, &I ti t 2 t-1 a arm Address: x Pte. t Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. c1 51fCp— i 1-jo ~ 1 Total Project Cost: $ it- FEE:" 1 L�'1 $ Check No.: 0`��o Receipt No.. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund N�hAttlrpire of EaE�.J -- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL r Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ e Permanent DumP stex on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM r PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS i CONSERVATION Reviewed on Signature COMMENTS j HEALTH Reviewed on Signature POMMENTS I Zoning Board of Appeals.Variance, Petition No: Zoning Decision/receipt submitted yes Y Planning Board Decision: Comments Conservation Decision: Comments V2ter Sewer Connection/Signature& Date Driveway Permit r DPW Town Engineer: Signature: ocated84 FIRE 3 Osgood Street .,.. DEPgR+T�MENT T:�ernDumpsterg �' to �y 5; }; ' ' iLocated at 1�2'41�Maint"Street Fire De artment�i nature/date 2 Ae'- 'COMMEiVTS� 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.$10041000 fine NOTES and DATA— (For department use) ❑ 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 � p Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks I Building Permit Application Certified Surveyed Plot Plan , ' Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses �I 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 4. Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit 4. 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 l ��� ?.�^ ��_��E �,4 No. �0( Date - (O l • - TOWN OF NORTH ANDOVER � t r Certificate of Occupancy $ "— } Building/Frame Permit Fee $ 5 Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# o =z -_ 'Building Inspector Enter'construction cost for fee cal- North Andover Fee Calculation Construction Cost S W..Zl,,113;0.0,0,' m $ - $ 565.56 Plumbing Fee $ 70.70 Gas Fee 100 comm. $� 1'0:0.:0:0 Electrical Fee $ 70.70 Total fees collected $ 806.95 50 High Street - Suite 14 - Select Patch 1066-2016 on 4/13/2016 Tenant Fit Up Enter construction cost for fee cal - North Andover Fee Cakulat%on Construction Cost $ 47,129.00 m $ - $ 565.55 Plumbing Fee $ 70.69 Gas'Fee 100 comm. $ 100.00 Electrical Fee $ 70.69 Total fees collected $ 806.94 :50 High Street Suite 14 1066-2016 on 1/13/16 Tenant Fit Up i i NORT11 own of � nd over 0 . _ L_ C% h ver Mass GOGNIG MI WKu +re o pxf� S U BOARD OF HEALTH Food/Kitchen PER IT T D G Septic System THIS CERTIFIES THAT ......... ......WA...Wmk...��...,/. .� ....: ........ BUILDING INSPECTOR .. . .... ... has permission to erect ........ buildings on b Foundation Rough to be occupied as .4 aj a 1.... "'� ............. Chimney provided that the person accepting thi it shall i very 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 STARTS 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. JK Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 617-592-6775 (Kieran) I 781-254-2862 (Judy) Proposal Date: 4/10/2016 Proposal M 203-8 Project: Bill To: David Streinbergh Suite 14, 50 High St N.Andover, MA 01845 Description Est. Hours/Qty. Rate Tata/ Permit, C of O 740.00 740.00 general Conditions 1,5QOA0 1,500.00 Demo 2,500.00 2,500.00 Doors&Trim 3,300.00 3,300.00 Wall Framing 2,400.00 2,400.00 ...... .. .. Heating &Cooling[Estimate] 7,500 00 7,500,00 ,Electrical,& Lighting[Estimate] 4,500.00 4,500.00 Tele/Data[Estimate] 2,000A0 Insulation 800.00 800.00 Interior Walls, Board, tape, sand 6;200.00 6,200.00 Floor Coverings 4,850.00 4,850.00 .Painting 5,600.05,600.00 Cleanup & Restoration 300.00 300.00 Sprinkler Work 900.00 900.00 Supervision P 4,309.00 4,309.00 a In ur n s ce 430M 3....80 430.90. Estimate for your review and approval . Total $47,829.90 OFFICE OF BUILDING INSPECTOR �►°°i�''°'��� * \SAFRED A. RS TOWN OF NORTH ANDOVER CONSTRUCTION CONTROLNo 9536 "I ` o SCIT�UAATE. -- �!!® PROJECT NUMBER: 15-0718 PROJECT TITLE: West MITI - SUITE 14 ►��Fq�rH OF ON--o- �s PROJECT LOCATION: 50 High Street, N Andover, MA NAME OF'BUILDING: West Mill NATURE OF PROJECT: Tenant demising and tenant fit out. N ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 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 ' ARCHITECTURAL STRUCTURAL ' MECHANICAL FIRE PROTECTION ' ELECTRICAL ' OTHER(SPECIFY) KN FOR THE ABOVE NAMED PROJECT AND THAT,TO THE MY OWLEGE BEST OF , 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, shopdrawings,s, 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 progress and quality of the work and to determine, in generalJSIGNTU bein with6the ro q ty P 9 performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PRREPO TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVEINS CTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPOHE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT OCCUPANCY. i- U E � ,SUBSCRIBED AND SWORM TO BEFORE ME THIS ` DAY OF �-�!�RKINSWAVNNotary Public mmonwealth of Massachusetts MY COMMISSION EX My Commission Expires NOTARY P BIC arc 7, 2019 The Commonwealth ofMassachusetts Department of IndustrialAccidents Office of Invesfigations IF 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/ContractorsLElectricians/Plumbers A-pplicant Information Please Print Legibly Name(Business/Orgmization/lndividual): .$< ltje-- Address: LLT Nom- 10 i �H - No 4v 4v—. City/State/Zip: N 0 d I�'�iPhone#: b ti x--511- Are L.Are you an employer?Check the appropriate bog: Typo of project(required): 1.® I am a employer with . ❑ I am a general contractd I or an ' � 4 6. E]New construction employees(hilt and/or part-time).* have hired the sub-contractors 2.F1 am a sole proprietor or partner- listed on the attached sheet. �• Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance.nsurance g, uilding addition [No workers'comp.i 5. ❑ We are a corporation and its required.] officers have exercised their 10. Electrical repairs or additions 3.❑ I am a,homeowner,doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),andwehaveno 12.QRoofrepairs insurance required.)t 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 aie doing all workand then hire outside contractors must submit a newaffidavit indicating such. TContraetors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and f ob site information. Insurance CompanyName:.'s -�04N cr,l4 14,10 now tom`" C_ Policy#or self-ins.Lia#: e' 0 Z E 1 -7 L.P- Z- Expiration Date: Job Site Address: � 6-1 tt- 40�J0•-. City/State/Zip: 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 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 copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido Izereby cern under the pains and penalties of perjury that the information provided above is true d correct. Sinature: Date: Phone# '� Z 6 -T+47 - Dffzcial use only. Do not write in this area,to be completed by city or town official City or Town:, Permit/Licease# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: ---MOON IXCON-1 OP ID: HS AlIC"RomCERTIFICATE OF LIABILITY INSURANCE 7OT2/17/2016 E(MM/ Y) 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 NAME: DeSanctis Insurance Agcy,Inc. PHONE FAX 100 Unicorn Park Drive A/C No Ext): A/C No): Woburn,MA 01801 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Star Insurance Company 012245 INSURED JK Contracting,LLC. INSURER B:Selective Insurance Company 19259 4 High Street Suite 108 NSUR North Andover,MA 01845 -ERC — - 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. INSRADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 CLAIMS-MADE OCCUR 52205113 02/10/2016 02/10/2017 DAMAGE To RENTED PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO- JECT I LOC PRODUCTS-COMPIOPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLALIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER A ANY OFFICER/MEMBERIEXC TN ECUTIVE Y/ N❑N NIA WC0853742 02/17/2016 02/17/2017 E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) MA E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 EL DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 artme4t of Public.Safety Massachusetts Dep Board of Building Regulations and Standards License: CS-066334 i. Construction Supervisor j KIERAN T WHELA1 31 RICHMOND STR WEYMOUTH MA-02 ` Expiration: t 09/2612017 Commissioner a I I I I I ' w I I