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HomeMy WebLinkAboutBuilding Permit # 8/28/2015 BUILDING PERMIT 01%tORo ,bq�o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7° Permit No#: 74) Date Received �il RATE o,'Pp,c'(5 '� J SSACHU50 Date Issued: E1°� IMPORTANT: Applicant must complete all items on this page p �A LOCATION /"6 t l�° . So , 2-L) 1 2.0 c( z-ti m 1_i I Pri t PROPERTY OWNER � � i I� , •I� . C,_L_ Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village no 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 ❑O Septic ❑Well ❑ Flaodpla�n ❑Wetlands Wat h 1Nate/sew„er f' „ f „ ed fD str►c ers i t DESCRIPTION OF WORK TO BE PERFORMED: Z c1 . 2- Identification Identification- Please Type or Print Clearly -- OWNER: Name-:N30v0%N �z Phone: Addres : :� en 00 (0 © ��� N ow d- Contractor Name: � '�� Phone: �� `�`Z Email: Address:_ L�ti �” 1� 2 l Lc �, 1�' �' JUS � e, 1, e'er 7 Supervisor's Construction License:C Exp. Date: L d -Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: ` 7 � � ��� 2- L��LL C L1 Address:_ _. K U i_krt� �� Uwn'�`�-F 'IJVX Reg. No. I �' C FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. x > Total Project Cost: $ FEE: $ h Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Flans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped flans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ i Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m D FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS 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 Drivewav Permit ]DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -,Temp.Dumps r on,,sitq yes no. Located„at,124 Main.Street; Fire Department signature/date COMMENTS ' i N®R1' AIL To' *wn of Hdover ® .�••. 0 As- P 1-5 LA K2 h ver, ass, COCNICMQW.CK �. I AOA?ATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System TB-IlS CERTIFIES THAT BUILDING INSPECTOR .......R.C.6. ....® ...... .. .. .......... .................................... . ..... . . .. .. .. . . .. . Foundation has permission to ere .......................... buildi gs o;441*410 .... ... .....'. ....... ........ % .... Rough to be occupied asLFac .. .. ........ .......... ........ ........ ...... Chimney . ...................... provided that thecepting this permits all in every respectonfor 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 PERMITI ELECTRICAL INSPECTOR 30 ® 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 r Dry Wall To e Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. JK Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 Proposal Date: 8/28/2015 Proposal#: 173 Project: Bill To: David Steinbergh, Suites 207,209,211,213.West Mill N.Andover, MA 01845 Description Est. Hours/Qty. Rate Total Plans and Permits 360.00 360.00 Demo, includes plenum wall and carpet 2,000.00 2,000.00 Masonry, Seal Brick, 2 coats 500.00 500.00 Wall Framing 2,500.00 2,500.00 Doors &Trim 2,000.00 2,000.00 Heating &Cooling 700.00 700.00 Electrical, 2,000.00 2,000.00 Interior Walls,Sheetrock, Tape ,sand, 5,000.00 5,000.00 Insulation 500.00 500.00 Floor Coverings 5,000.00 5,000.00 Painting, Includes hallway outside,ductwork, piping. 5,000.00 5,000.00 General Conditions 1,500.00 1,500.00 Cleanup-final clean 300.00 300.00 Supervision 2,542.00 2,542.00 Total $29,902.00 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL C c c C PROJECT NUMBER: 1406002,34 4, PROJECT TITLEk '" [''] or 2 Suites 204, 207, 209, 211,213, 216 : Hgh Street ­ o PROJECT LOCATION: 4. 1-figh Street, Suite 201, North Andover NAME OF BUILDING: West MM NATURE OF PROJECT: 'I U[12111 U LUt IN ACCORDANCE WITH ARTICLE 1,16 OF THE MASSACHUSETTS STATE BUILDING CODE, 1, Lbdia S. SnAev REGISTRATION NO. 1 Q080 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 F] ARCHITECTURAL E STRUCTURAL R MECHANICAL ❑ FIRE PROTECTION P ELECTRICAL El 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 with6the 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 OCCUPANCY. SUBSCRIEB14ANIDSWORN TO BEFORE METHIS Q2jLDAY OF Ao'lf'f 1 NOTARY PUBLIC MY COMMISSION KL 7C A PAI kiCIP', E. BARKER Notary PUblic 'S,ACH U SETTS GOWI"'NWEALT OF Mv�SSACHUSETTS My Commission Expires 1,2018 The Commonwealth of Massa chusetts Department of IndustrialAceldents 1 Congress Street, Suite 100 Boston,MA.02114-2017 § www mass.gov/dia sJ• Workers'Compensation Insurance Affidavit:Builders/Contractors/ETectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project()required): . I am a employer with :_employees(full and/or part-time).* 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in $, emodeling any capacity.[No workers'comp.insurance required.] ' 9. Memolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 (]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.F]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.t • 14.[]Other 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have na employees.[No workers'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. tContractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors fiave employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: �'n e y `t t r)V Pa Policy#or Self-ins,Lic.#: W L-Z 3 S , ( L Z Expiration Date: t fob Site Address: `f- �'`( x-19 �J� + O 4' 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 required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. Ido Hereby certify under the painslandpenalties of pet jury that the infofmation provided ab ve is true and correct. Si nature: Date: ` J Phone# 6 1-2 � 7 (^ Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: ` 3/3/2015 7:22:03 AM PST (GMT-8) FROM: 100005—TO: 2'61?',799121 Page: 2 of 2 ACC>R CERTIFICATE OF LIABILITY INSURANCE DATE3 " /312oi 5 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: H the aartificute holder is an ADDITIONAL INSURED,the policy(isa)must be endorsed. H SUBROGATION IS WAIVED,oubject to the teems and conditions of the policy,certain policies may require an andorsement. A statement on this certificate does not confer rights to the certMoste holder In lieu of such endorsems s. PRODUCER DUPONT INSURANCE AGENCY INC CONTACT 18 COPELAND ST MM.,10 1 1F"Ii Rm QUINCY,MA 02169 DOURENS)AFFORDING COVERAGE MAIC e MURERA: Liberty Mutual Fire Insurance 23035 IN JK CONTRACTING LLC Neter`®' 31 RICHMOND STREET WEYMOUTH MA 02188 uRRD INLUM E: COVERAGES CERTIFICATE NUMBER: 23677622 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. rHSi! TYPE OF INSURANCE ADDL POLCYNUNM EFP EXP LIMns CMVJ3tCAL GENERAL LABLCY EACH OCCURRENCE $ CLAW84AADE E-1 OCCUR l S ACED W one enran 5 MISONAL&AN INJURY i GENtAGGREGATELIMIT APPLIES PER: GENSIMAGGREGATE $ POLICY❑.�ECT 7Lac PRODUCTS-COMPlOPAGG S OTHER: s AUTOMOBILE LIIABL" $ ANY AUTO BODILY INJURY(Per person) s SWIIED SCHEDULED BODILY INJURY(Pereeddert) $ AUTAUTOS HIRED ALTOS AAUUTNOS wo PROPEKrY s s UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIM m.E AGGREGATE A wORIEQ7R8 COMPEtsATM C2-31:-601696-015 2/17/2015 2/17/2016 AND EMPLOYE II'LIAMAM ANY PROPRIETORIFARTNERIE)ECLTNE Y 1 N E.L.EACH ACCIDENT s 100000 OFFICERAEMBEREXCLUDED7 Q NIA (Manddw In NH) El.DISEASE.EA EMPLOY $ 100000 M dow under DE LIRe� IPT10N OF OPERATIONS bobw E.L.DISEASE POLICY UMIT $ 500000 DESORPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddNorri RmnuM SehdLds,rosy be sescftd If rom spew Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancele and supersedes all previously Issued caMostes,only as they relate to workers Compensation Coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEABdVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VALL BE DELIVERED IN IMIEW ` ACCORDANCE WITH THE POLICY PROMt51CNe. »sr«- :d1++M'� .. AtrTIW1O2fD REPREafItTAT1YE Hj't�UO� Liberty Mittal Fire Insurance ®1988.2014 ACORD CORPORATION. All Rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 23677622 CLIENT CODE: 1641469 Lucy Gas£ield 3/3/2015 10:19:07 AM (EST) Paga 1 of 1 Massachusetts -Department of Publ,l:Safety Board of Building Regulations and Standards C'on%truction superN icor License: CS-066334 / xwmy AN 31 RICHMOND ST WF,YMOUT11 MA A Expiration 9 � 0912612015 Cor,missionQ1