HomeMy WebLinkAboutBuilding Permit # 8/6/2015 .... 1
IJIL I PERMIT O��Q oY
TOWN OF NORTH ANDOVER
q APPLICATION FOR PLAN EXAMINATION_. -- -:' ��_
Permit iVo Date Received
Date Issued: ssa
IMPORTANT:Applicant must complete all items on this'page
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TYPE OF IMPROVEMENT PROPOSED USE
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
1jSe t�,c /❑Wel / f / � lood lata /❑UVe ,/ i /, , ,
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DESCRIPTION OF WORK TO DE PERFORMED:
9 33 cr Q 0 mii r
Identifikation- Please Type or Print Clearly TP
OWNER: Name: <M Y'a Phone:
Address: L V 44 L70 Is O t �
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{�}U h Sp, Sl,�r,<u, );$ �'.I,�'r:, -�� o., ,r ar1e��(�•I I'm� 1YiP@I`J�I�GIg �f I JI l��E�X'+,,!, �,� � ,VIj' ��,/�,l>�l //r,
l�rid��i�url��r�r �,(���ilM�innlUyn,�/irle(lmmc�ieum�rrm�totaimHmrr�xll,Otronaanw�- _,,���„rt.,�/.�sr�Ra��,�,a„ �� ���G/%��n�t
ARCHITECT/ENGINEER , .� Phone. '
Address: SReg.. No. C
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$10 0.P0 OF THE TOTAL ESTIMATED'COST BASED ON$125.00 PER S,F.
Total Project Cost: $ , , FEE: $ Y.`
Check No.: Receipt.No:�. /
NOTE: Persons contracting with unregistered contractorsdo,not`11ave,access to the guaranty fund
Signature ” �Agent/Own r Signature.of,.coritractor
F ttORTH
Town of i
Andover
®
® LAKEh ver, Mass,
COC HICNCW.Cx '�
S 11
BOARD OF HEALTH
FERMIT T L �D Food/Kitchen
Septic System
THIS CERTIFIES THAT ....... 4-/�... ........ .14 �, BUILDING INSPECTOR
° .. y Foundation
has permission to erect �a
p .......................... buildings on ... ./...� �1......................................................
Rough
�(aGhl�✓7" T v - JAM to be occupied as .... .................... .............�r.............................................. . :l:Jl.�f:� 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
IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS C T CTI® ARTS Rough
...................... Service
............. ...... .... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® 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
Proposal Date: 6/30/2015
Proposal#: 157
Project:
Bill To:
David Steinbergh,
Suite 206,4 High St,Boston Indemnity
N.Andover,MA 01845
Description Est. Hours/Qty. Rate Total
Plans and Permits 1,100.00 1,100.00
Demo, Carpet removal and disposal, demo and dispose 2,500.00 2,500.00
of ductwork
Wall Framing, Includes hallway demising walls to 5,500.00 5,500.00
space.
Doors &Trim,[Includes glass in all office doors and 6,000.00 6,000.00
conference room,glass in transoms
Window treatment 150.00 150.00
Plumbing 4,500.00 4,500.00
Heating&Cooling 17,800.00 17,800.00
Electrical [No lighting fixtures] Rough Estimate. 3,500.00 3,500.00
tel/data 3,000.00 3,000.00
Insulation 2,000.00 2,000.00
Board/tape, compound, make paint ready, interior. 7,500.00 7,500.00
Cabinets &Vanities [estimate] 3,000.00 3,000.00
Floor Coverings 10,932.32 10,932.32
Includes piping, no ductwork 5,000.00 5,000.00
Clean and Seal exterior brick,2 coats 1,000.00 1,000.00
Final Clean 500.00 500.00
Sprinkler Work, Change out old heads to new,etc 900.00 900.00
General Conditions 3,000.00 3,000.00
Supervision 8,247.23 8,247.23
Specialties, Barn door in conference room 1,696.25 1,696.25
Thank you for the opportunity to bid this work.
Total $87,825.80
a
OFFICE OF BUILDING INSPECTOR
TOWN OF NORTH ANDOVER
CONSTRUCTION CONTROL
PROJECT NUMBER: '1406002M
PROJECT TITLE* 4 High Street I�:bor 2 SuR.e 206 Boston IndernrRy
PROJECT LOCATION: 4 iigh Street, Fbor 2, North Andover
NAME OF BUILDING: West Mill
NATURE OF PROJECT:. Tarjaj"ij Ht-OLIt
IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,
1, Ljnda S. n'iflev REGISTRATION NO, 10080
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 R 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
witWhe 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 REPORT
TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR,
UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE
SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR O7CCANCY.
000
'I'SICNATURE
SU ,/
tt�l)AND SWORN TO BEFORE ME THIS DAY OF (M�1 -J/- to �'6
PUBLIC MY COMMISSION EXPIRE 6
S41 -- U.)
The Commonwealth of yassachusetts
Department of fndustr'ial.A-ccidents
1 Congress Street,Suite 100•
N AfA:021.14-2017
Boston,
WWw.rnass.goV1dia +lectricianslPXumbers.
, ensation Insurance Affr�d PERARTTTR' AUTHORT�Y
Workers Comp please print Le 'bl
TOBEIUXIL T�
A licant Xnform ation v
ation/lndlvidual):
Name(Brtsiness/Organiz � � �
b
Address: JV— phone# aired ;
L`) Type of project(req )
City/Stale/Zip: 7 New construction
Checicflie appropriate box:
�,reyau a employer. art-time)* 8 Remodeling
employees(full and/or or p
with= -- ees working for
me in
l 1 am a employer9 11 D emolition
2,�Y am a sole proprietor or partnership and have eq employ
insurance required.] l0❑Building addition
any capacity.[I`lo workers'comp• insurance required•]t s or additions
all work myself.[No workers'comp• 1 will
eowner doing property, 11,Q Electxical repair
3.❑ am ahom
eowner and will be luring contractors fo conduct all work cc or El Plumbing P
12 re airs or additions
1 am a hom ozkere compensation insurance oz ate sole
4. Roof repairs
ensure that all contractors have 13.0
proprietors with
on emp y 14❑OtheT
hired the sub contractors listed onathe,atttached shee.
5❑1 am a general contractor and I have hs erMGl °•
These sub contractors have employees and have workers'comp• tion p
light of'exemp
d its officers have exercised their ng tnsmance required•] orrnation.
We(e area corporation an °workers'comp. ezvsation policy irrf davit indicating such.
6. to ees•. theirworMs'comp
152,§1(4), haveno.,emp Y
checks box must also fill outthe sere doing°W sh°wing
that chall work and then hire outside contractors must submit a new
applicant davit indlcahng yt showing the name of the"ab'-co
*Any
and state whether or not those entities have
Anyers who subnuti t us affi Polio nllTII ob site
i gomeown ust attached an addeionnau tt p oxide their workers comp•p ole and J
,Contractors that checkthis boxm to ees,tli y or my employees.' Below is the p
employees.
if the sub-conlr oiolshave emp y compensation insurance f
p er that is pj'oviding workers'comp
f am an em loy ld
information. -( rr E,pirationDate:
Insurance Company Name' . ._ "Ci I / G' �-w
policy#or Self-ins.Lic.#: CitylStatelZip: nation date).
the policy number and exp'
l A �)I e showing unishable by a fine up to$1,500.00
Job Site Address: ensationpolicy declarag al violation p to$250.00 a
.Attach a copy
of workers cornp GL c.152, - - is a cximin ORIS ORDER and a fine of up
e as required under M atlons of the DIA-for msmance
Failure to secure coverag as well as civil penalties in
form of a STOP
and/or one-year imprisonment, be forwarded to the Office of Investig
an of this statement may
day against the violator.A Copy that t12e info�'mation pf'ov d a ove i true cor'j'ecf,
coverage verification. enalties of petyuf�
Un the pains and p pate:
X do hereby cert y
{��;
city
l 03'tojVn of`Cial.
Phone#: to be completed by t1'
official use only. Do not IVr•ite in this al-ea) -p rmit/l,icense#
City or Toyvn: i
ector 5.Plumbing""Pector
(circle one): Ci /q'own Clerk 4.Electrical nsp
Issuing Authority( adding Department 3. t3'
1.Board.of health 2•$
6.Other
phone#:
Contact Person:
` 3/3/2015 7:22:03 AM PST (GMT-8) FROM: 100005-TO: J6174799121
Page: 2 of 2 -
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CC OR CERTIFICATE OF LIABILITY INSURANCE 313/zo15
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AN END OR ALTNFERS ER THE COVERAGE AFFORDED BY THOHEDPOLICHEIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E
BELOW. THIS CERTIFICATE OF INSURANCE
D THE CERTIFICATE HOLDER.UTE A CONTRACT BETWEEN THE ISSUING INSURER(S),WAIV=hto
� RIZjeaD
REPRESENTATIVE OR PRODUCER,
IMPORTANT: H the�ertificow holder Is an ADDITIONAL INSURED,the polky(as)must be endorsed• K SUBROGATW
the terms and conditions of the poll;.I
certain poiteiae may require an endorsement. A atstemeM on this certificate does not confe
cerdfxmte holder in lieu of such endam—I.s s
PRODUCER DUPONT INSURANCE AGENCY INC PFIONRAWE PAx
18 COPELAND ST
QUINCY,MA 02169 E Noce
t s AFFORDtNO C0IIERIIG
raA: Ube MUtU8I Fire Insurance 23035
Ir4euR>ae :
K CONTRACTING LLC wur4ec:
31 wEYMOUTTH MA02188 0
l4e4lRERE
COVERAGES CERTIFICATE NUMBER: 23677622
REVISION NUMBER: POLICY
NAMEE
INDICATED.
NDI IS EDD
CERTIFY THAT
ANY REQUIREMENT,TERM LISTED
ER CONDITION OFBEEN ISSUED TO ANY CONTRACT ORE INSUR OTHEREDOCUMENT WITH RESPECT TO WHICH THIS
RMS,
INDICATE
CERTIFICATE
AND CONDITIONS OF SUCH PpORTAIN,THE INSURANCE LIGI 3 LIMITS HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS CYS" P E� LIMITS
TYPE OF INSURANCE NOMStM EACH OCCURRENCE S
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AND BePLOYERe,UABBM YIN E.L.EACH ACCIDENT $ 100000
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This ceRiticsta cancels and supersedes all previously Issued caffliostes,on y as they relate to workers oorrlpansation coverage•
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED LL
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:0.: 23677622 CLIENT CODE: 1644469 Lucy Garfield 3/3/2015 10:19:07 AN (CST) .Pala 1 of 1
DATE(NMIDDIYYYY)
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INSURE S AFFORDING COVERAGE
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31 Richmond Street IlSLJRErtE:
Weymouth, MA 02188 IuReeF: REVISION NUMBER:
CERTIFICATE NUMBEBR�D BELOW��BEEN IgSUED TO THE INSll2)OcUM NT WITH RESPECT TD ABOVF FOR THE OLW WHICY ICH '
COVERAGES
OR CONDITION OF ANY CONTRACT OR OTHER
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INDICATED. NOTWITHS Y PERTAIN,T Y HAVE BEEN PMMIDDIYYY�
CERTIFICATE MAY BE ISSUED OR MA 2/10/16 EACHoccURRENCE $ 1 000 000
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DESCRIPTION OF OPE
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DESCRIPTION OF OPERATIONS DESCRIPTION LOCA
CANCELLATION
CERTIFICATE HOLDER NOTICE WILL BE DELIVERED
SHOULD ANY OF THE p`BO T��OFBEDPOUCIES BE CANCELLED BEFIN
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THE EXPIRATION DATE
ACCORDANCE WITH THE POLICY PROVISIONS-
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ROVISIONS.AUTHOR> REpMSENTATLVE
Brid et McGowan ON. All rights reserved.
p 1988 2010 ACORD CORPORA
The ACpRD name and logo are registered marks of ACORD
E-Mail: apedranti@crowninshield.com
\CORD 25(2010105) Fax:
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Deartment cf aub!' safety E
Massachlusetts - p lations and Standards
Board of Building Regu
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n.truction 5i-0��
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