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HomeMy WebLinkAboutMiscellaneous - 50 HIGH STREET 4/30/2018 (10) 3 71, 7N)" NQS J CflWPE'b ✓ PERMIT �063Yp�p -JUIL®ING 1 ERIP711T O��t LED ,6��y� h 46 OG TOWN ®F NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION iii y � �•� Permit No#• Date Received �s0,TED E4�5 Date Issued: l l L 6 IMPORTANT:Applicant must complete all items on this page L ?0%ON nt7YL�Y Ig fF'R®.�.,,�,P,tEgg RT1YlOr' �E C. r - - p„ 100 Yea Str: cur_, no M�gP� A�RCE �Z®N, I,N�G(DIS�TF21�TMm: ;� �Hi,� s. !cDistrict44Pf _ Maehf Shop Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ti ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: emolition ❑ Other Septic q 1N:ellt Oil! Iain f®Wetlands, ® Vllaters, hed ®`istr�ct [11, Water/ we ere -- — __��n a D SCRIPTION OF WORK TO BE PERFORMED: j '5 rL iqf C_/160 DiStio �l P� �L t► Identification- Please Type or Print Clearly OWNER: Name:`oigvr o Phone: Address:.�� �'7'` l V c7 `�' 1.�aA �� y��Wi�F_ ,.:....�..-�.. �d.�,'�-r..--•---"-•' Contractor N, ameaK �i'"��` -(—'4 Phone Y? ErnailR �� v Sup ruti—sod's Coraf_Wc on Lice e:,C A___ _ �._ LExp, Dates � 2--� l ' ,_._e� �_�_� _ _ .,� Ex, ®ate. Home Improvement�Lcense _ ,,, - .�___-�__w. N ARCHITECT/ENGINEER D 6 Ft lel Qt­ Phone: 0 (JL4--rVUK05L 1 © r3 3 Address: is � �•rr�Y � PF-1HA6� E � �t J_C7 . No.-Reg. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ X X FEE: $ Check No.: gs'S-­� Receipt No.: L1�� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �Sgnature'of'Agent/Owne Si nafiure'ofcontracto"r 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 e 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 r > Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street Located�at.1�2�IVlain�Street�'. � '�•°���:':� `�.,��•� �,�3r►=»� �-,�;.�',�- -.. �-�...-wa., • dire D partment Signe%da�e� �� -� � 'J� ` �S• i�/��'�r�� ,f.,11' �•i�i�: i�,�'•t�'y+iS L 1 � �4 ;� 1 r�r,, ..cj r i9r'S'r v.0. .r a.:�t.+. �pfd t � � .�3 },♦ � .. ry t it ��L • - '' l +! F n ea C©MMENTS,� frts 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 rnin.$1oo-$loon 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 a Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit a Photo Copy of H.I.C.C. And C.S.L. Licenses L, 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) o Engineering Affidavits for Engineered products ®TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) E o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit 1 s ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report C) E I gineering Affidavits for Engineered products ATE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit fn 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 i _ I Location 92 �� S ' No. �a �0 • Date ;201 k 1 I i . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ i Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ f TOTAL $ Check# S 0 ' f � J Building Inspector i Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 299208.00 m $ - $ 350.50 Plumbing Fee $ 43.81 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 43.81 Total fees collected $ 538.12 50 High Street 525-2017 on 11/16./2016 Demo walls for lusnix � pORTiiy own of � _ : Andover O y� 0 No. h ver, Mass, • COCHICNl WICK 1• ZJ.9S R�re1) U `BOARD OF HEALTH PERMIT .T LD Food/Kitchen Septic System THIS CERTIFIES THAT C k......can,,,,r^h„ , .......................................................011t BUILDING INSPECTOR has permission to erect ...buildings on ....... Wtowtv .ar Foundation .,A to be occupied as ...,D.�!.N..!�.0..............W.#k.44.S......... !�..........�.��.� Rough ...... 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 CONSTRUCSTARTS Rough Service ...... .. .. .. .. .. .... ............. Final 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. i JK Contracting LLC Proposal 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Proposal Date: 11/15/2016 Proposal#: 203-66 Project: 50 High, 5th FI, Iv... Bill To: Ship To RCG West Mill NA LLC 5th Floor Daviid Steinbergh Ivenix 17 Ivaloo Street North Andover,MA 01845 Somerville, MA 02143 Description est Hourslaw. Rate> 4 Tota! k, Demo Permit 348.00 348.00 Demo aIIrWi1fs.and flooring per submittea demo plans 22 d00 0 I ,22;(3Q .(01; Dumpster fees 4,000 00 4,000.00 Supervision - 26Q0 On: Insurance 260.00 260.00 i Total $29,208.00 Approved: (Initials) SIGNATURE i The CoMMOnI ea th q►fMassachufetts Depa fie..' 3'i-dui trigl Accidiky :a ves igations ay ois Md, 021I.I wwrti.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrieians/PIumbers Applicant Information Please Print Le ibIy Name(Business/OrganPzation/Individual): S Address:_S�c (��' u i t a_ `{ �". n�6�0(21,sv� City/State/Zip: NA © � �' � k'hone#: ^� L— Are you an employer?Chee"A the appropriate bax: ,Type of project(required): 3.01 am a employer with_��_ 4. ' ! ��9 1��LL�t o,g�.asp��c:�r,.tractor and I s employees full and/or a� r ' ,t 5. 0 New construction ( 13 t=time).'°` slav✓h"xod 1 sx&contractors .2.El I am a sole proprietor or partner- lists d e:t'uc atiached sheet.x 1 i. E]Remodeling ship and'have no employees f <ece•.;.6-coni actors have 8. Demolition working forme in any,capacity. 'tori en`com"-in.suxance. 9. Building addition [No workers'comp.insurance 'i17e arcs u cor for Ron an its required.] e;.L.Ecvrs havo exercised their 10.E Electrical repairs or additions �• I am a homeowner doing all work .b b rt p r MGL l Numbing repairs or additions myself.[No workers'comp. •, .:�..s, );aadwehavenr' 11FIRoofrepairs insurance required.)ie:xn0'!Vee� %+Nv:i workers' irys..,ur�;:Graquared.j 1.3.[]Othex {'.Aw applicant That checks box#1 must also fill out the section hdow, sb.011;7kcz e;u:sr zozkers'compensation policyinfommatio;2. Homeowners who submit this affidavit indicating they ale doing all user c.irid then hue outside contractors must submit anew affidavit indicating such. -Contractors that checkthis box must attached an additional sheets::a:';N;g he^a u„ofthe sub-contractors.Paid their workers'comp.policy information. ===V_ __ _ ' pan employerthht isprovi(7ing workers'cora:efz,�adon ins"o at?ce formy emplgyees, Below is thepolicy antijob site f��irfztatton. /' p is,aance Company Name: Lc_;i S cy#or Self-ins.fic.#.—W (5 E)wli a`ion bate: :'L:j Site Address K d -- � �.�� � G ._�f_�.._l�'rvb. �--�i:•ViS$ t.��ip:_ Yd � t< Attach a co of the workers'com ensation .« 1.,- 'cdu'z-a �.,: ,y PY p �-3 tr�,� a�., t cF� �ctra,vrzr:g lx"-)Iicy number and expiration date). Failure to secure coverage as required.under Section 2M c t i,,40 s v, '1,2 can lead to the imposition of criminal penalties of a fume up to$1,500.00 and/or one-year imprisonment,as well as�_,, 1' alties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day againstthe violator. Be advised 1ha.t a. .ppy of;his statement may be forwarded to the Office of investigations of the DIA for insurance covert e;rrfic+atic3r,> t do hereby c�errt6 under t iepatns andpenaf igN a�urmatioizppovided above is true and correct. _ 'hone##: t �- Ff 1I Viccial use only. Do not write in fiefs a?,w,ra ief lei t.,ezyz,�� oar a'Uwn c%+�rct4�� City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Departrmenit.3 C144011 n O' - Elect.-Icel hispecter S.Plumbing inspector 6o Other - - Contact Person: Shone#r: JKCON-1 OP ID:CD A�f..�/�C)RD DATE(MMMONYYY) CERTIFICATE OF LIABILITY INSURANCE F07/26/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLt: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. I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to I 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 endorsements, PRODUCER' (CONTACT DeSanctis Insurance Agcy,Inc, 1..PHO ktl Ext''r•........................._............._..........,..................._............._........_.......,..FAX,................_.................... _...- NAM E: 1100 Unicorn Park DriveArc,Nod L,.._...:.:........._. ....._........._..._._.._. Woburn,MA 01801 E MAIL l INSURERS)AFFORDING COVERAGE..._.___............... ............. NWC S ..INSURER A:Star Insurance Corn.Pa. X12245 ..._._..__...................._._._..........._........................................................................................................ ......_........................................ Y........................................._......_.......................,... INSURED JK Contracting,LLC. ;INSURER B:Selective Insurance Company 1,19259 4 High Street Suite 108 North Andover, MA 01845 ; FNsuRt.Rc'. ... ...... ......... INSURER D: F.. .. ......._ ..................................................................................................._........_........,.._.—. I INSURER E I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLiC:ES 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, FNS EXCLUSIONS AND CONDITIONS OF SUCH AO��SuBRt.IrAITS 510!^JN MAY HAVE BEEN REDUCED o cr E BY PAID poicYEZP ..._................................_._.........._ LTR! TYPE OF INSURANCE NSp POLICY NUMBER MWDD;YYYY MMFDD'YYYY) LIMITS B X COMMERCIAL GENERAL UABI%-ITY '_._...:.._...... ___. EACH OCCURRENCE �$ 11000,00 ^ X 'OCCUR S220S113 02/1012016 02110/2017 --T—_ LAIMS MPwf ! p tEMISfS tfa,x�currenee) S 100,00 N_D EXP SAnl one person) S 10,00 PERSONAL a ADV INJURYS 1,00010 ._.....: ............... ................................ . ..........................._.........__._......._......_ _..............__.._....__ X ? UES F7£F't GENERAL AGGREGATE 'S 3,000,00 GEh'L A,GRE�A PRO- POLICY: APF..... ................................ ............_..._........_................-... ....__ : OLICY JECT ........... LOC PRODUCTS COMPIOPAGG •S 3,000,00 ................................._._.__.....__... OTHER' S AUTOMOBILE LIABILITY ^OM INED SINGLE LIMITS .............. 'Eaaccaentt y ANY AUTO? BOU!LY INJURv;Per person! 5 _._�_ ALL OWNED SCHEDULED _ AU?O5 AUTOS _.—.... ................... BODILY 4JURY(Pe a...... t)...5. I NON•CN.�NEC � PROPERTY OAMAG�� !S HIRED AUTOSAUTOS Peracc)dent'......................................... _.......__-_. ._._. j j i5 !UMBRELLA UAB OCCUR EACH OCCURRENCE !$ j EXCESS UAB CLAIMS-VIAD- AGGREGATE I-$ —..._..................... DED I 1 RETC•NT!ON$ S i WORKERS COMPENSATION X !PER H• ;AND EMPLOYERS'LIABILITY Y F N uTP.TUTf........,........_E R,„,„,,,„_,,_................._........ _.._. A 'ANY PROPRIETORr',:IARTNEIiEXECUTIVE '— WC0853742 02/17/2016 02/17/2017 E.I. FA0 ACCICENT S 100/00 OFFFCERFMEMSER EXCLUQED'1 N :.'NIR ..__....._.... ..................._......._.._.......__..._ (Mandatory in NH) MA `L DISEASE.EA ENA.PIAYEE 8 100.100 !M yyes.dascnbe under _..._..,.._......................... ._ 1 ID ESCRIPTION OF OPERATIONS cb:cw El.DISEASE-POLICY LIMIT' '� 50010d( DESCRIPTION OF OPERATIONS I LOCATIONS F VEHICLES (ACORC 10t:Additional Remarks Schadule,may be attached it more space is roquired) "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 4 CERTIFICATE HOLDER CANCELLATION NORTHA. I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ( THE EXPIRATION DATE THEREOF: NOTICE WILL BE DELIVERED IN Town of North Andover i ACCORDANCE WITH THE POLICY PROVISIONS. 143 High Street I N.Andover,MA 01845 I gUTHORF2 PRESENTA?1VE C 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: OS-066334 Constru:tion Supervisor ' KIERAN T WHELAN 31 RICHMOND STRE9� ����,:�, WEYMOUTH MA 0211 i ZCK- CJA - Expiration: Commissioner 09/26/2017 i i � I . � I I i