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HomeMy WebLinkAboutBuilding Permit # 9/10/2015 t%0RTfj BUILDING PERMIT .06 C TOWN OF NORTH ANDOVER 10 , APPLICATION FOR PLAN EXAMINATION "2 Permit No#:,, Date Received . us Date Issued: MPO TA l®TT:Applicant must complete all items on this page LOCATION H l, &N Print PROPERTY OWNER Q-, Print 100 Year Structure yes no PARCEL: ZONING DISTRICT: Historic District s no MAP P �ft W Machine Shop Village lames no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 11 New Building 11 One family 11 Addition 11 Two or more family 11 Industrial W,Alteration No. of units: 11 Commercial 11 Repair, replacement 11 Assessory Bldg 11 Others: 0 Demolition El Other lrf"V Milli, 0110,11 'W8 J �ox/0 DESCRIPTION OF WORK TO BE PERFORMED: rJ-t ylf4'i Identification- Please Type or Print Clearly OWNER: Name: \,Cv�V<J --rs w 0 Phone: Address: Contractor Name: Yc�-6 V�k� 1tUv— Phone: Email: V;;L W�k�S v-i- a (,—ib (:7,- vyNQV , (-owl Address: Sj t-L6- L s U- rJ P4 N o Supervisor's Construction License: 633 Exp. Date:_ L'b I t?-0 I Home Improvement License: Exp. Date: ARCHITECT/ENGINEER J 1 on: Phone: Le-q? - 2-1 z-� 0 ft 6)%"V," C- -�'�;- Address: rV 5-w 9 drl-Y e 0 Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASE ONift-91PER S.F. Y, Total Project Cost: $ FEE: Check No.: T?; Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund t4ORTH Town of ndover 0% j- 1� ® ti, 3 JID, LAKE h ver, ass, COC KI CKEWICK �®A�R�iTED l'Pp��S S U BOARD OF HEALTH rERM T D Food/Kitchen Septic System 0 THIS CERTIFIES THAT BUILDING INSPECTOR ............ .®.k.. ... .......... ........!.�....�'�... ... SR............. ... ... Foundation has permission to erect .................. ildings on ... ........ .. ..... /1l1. �l: ....®....... Rough to be occupied as ...I......?!!r.5. .dL. ......e.... .. .......... .................................................... Chimney provided that the person acce tl this permit shal e e res ect conform to the terms of the application P p p g p ry p pp Final on file in this office, and to the provisions of the Co es 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 I 6 MONTHS ELECTRICAL INSPECTOR LESS 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 Proposal Date: 8/19/2015 Proposal#: 167 Project: Bill To: David Steinbergh, Sales Lobby,West Mill N.Andover, MA 01845 Description Est. Hours/Qty. Rate Total Plans and Permits 850.00 850.00 Demo, including gym seats, dumpster cost„ removal 5,200.00 5,200.00 and replacement of glass window,Temporary weather protection during demo. Wall Framing, Including soffits and blocking at 8ft 3,200.00 3,200.00 where glass panels will be installed,M&L Windows&Trim, Glass removal and reinstall, Glass 5,000.00 5,000.00 door install, Using all existing doors and glass from Basement space[Estimate] Electrical &Lighting, Demo of existing fixtures ,wiring, 5,000.00 5,000.00 etc[Estimate] Tel-data. {Estimate] 2,000.00 2,000.00 Heating &Cooling 0.00 0.00 Insulation 200.00 200.00 Interior Walls, Board and Tape,walls, soffits. 5,000.00 5,000.00 .Carpet install in lobby, Sand and refinish Pine floors 7,500.00 7,500.00 Painting, Including ductwork 5,000.00 5,000.00 Cabinets &Vanities 0.00 0.00 2,500.00 2,500.00 Supervision 4,145.00 4,145.00 Thank you for the opportunity to bid this work. Total $45,595.00 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL bciclnfi PROJECT NUMBER: 14-0682 A PROJECT TITLE: West Mill Leasing and Sales Center PROJECT LOCATION: 1 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Lobby improvement/fit out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, 'DD.-��� vel- Wk<_--on� REGISTRATION NO. �tS3�Q 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 materials. 3. Be present at intervals appropriate to the stage of construction to become, generally fami A& with6the progress and quality of the work and to determine, in general, if the work is be' ERED performed in a manner consistent with the construction documents. o,j�o PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS RE No.95 TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING ® EC1 J6► UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANC of M s �� ,91GNATURE SUBSCRIBED AND SWORM TO BEFORE ME THIS DAY OF 6L20 I CHERYL L. BURKINSHAW SA tl_� W Notary Public NOTAR UBLIC MY COMMISSION E �ommonwealth of Massachusetts My xpires March 7, 2019 The Commonwealth of1Mlasscrchusetts Department oflndustrialAccidents a _ r d 1 Congress Street, Suite 100 Boston,MA 02114-2017 yet www mass.gov/dia s. Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FMED WITH THE PERAUTTING AUTHORITY. Applicant Information ��++ Please Print Leisibly Name (Business/Organization/Individual): `� a o� c--a-t of L- A ,C �— Address: _f (i t � � ()��_ 2- 1 i�l G-rr l" 4WD - dt6 City/State/Zip: N- d� 1J O Vim— i ►c� Phone#: "Jr1 L (' � Areyou an employer?Checkthe appropriate box: Type of project(required): 1.[!�I am.a.employer with _employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. KRemodelirig any capacity.[No workers'comp.insurance required.] 9. El Demolition 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.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.El Other 6.Q We are a corporation and its off,rcers have exercised their right of exemption per MGL c. 152,§1(4),and we have no,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. !Contractors 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 have employees,'Iiey must provide their workers'comp.policy number. I am an employer that ispi oviding workers'compensation insurance for•my employees.'Below is the policy and job site information. 1 Insurance Company Name: l rsy,� 01 ) — Policy#or Self-ins.Lie.#: W Expiration Date: 2- t 7 Job Site Address: t&-M &7, rJ- jV V-L-- 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 WORD 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 cern y under thepains andpenalties ofpeijury that the information provided bove 's true and correct. Signature: W Date: (f l Phone#• � t Z S q Z — 6 -- 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: CORDe GATE(MMMDVYYYY) A CERTIFICATE F LIABILITY INSURANCE 3 2 15 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 endorsemen s. PRODUCER NAME: Maria Dupont Insurance Agency, Inc. PHONE617 376-0795 ; (617) 479-9121 18 Copeland Street E ADzbss: me@dupontinsuranceagency.com Quincy, MA 02169 INSURE RSI AFFORDING COVERAGE NAICN INSURERA:Main Street America INSURED INSURERS: JK Contracting, LLC INSUREiC: 31 Richmond Street INSURERD: Weymouth, MA 02188 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. LTR TYPE OF INSURANCE WVD POLICY NUMBER Alm MY►1D�dYYYY LIMITS A GENERALLIABttJTY MPT7794M 2/10/15 2/10/16 EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED tc ERCIAL GE NERALLIABILITY !� S 50O 000 LAIMS-MADE OCCUR MED EXP ryonepemcn) a 10,000 PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2.000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-cc)MP/OPAGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILELLABIUTY r,?INGLE LIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALTOS NED AUTOS LED BODILY INJURY(Par accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS —AUTOS eremdent a LI BRELLALIAB OCCUR EACH OCCURRENCE S EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION WC5iATU- OTH- AND EMPLOYERS'I ABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTNE NIA E.L.EACH ACO DE NT OFRCERIMEMBER EXCLUDED? pAandabry in NH) E.L.DISEASE-EA EMPLOYEE If yyeea describe under DESbRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AtfachACORD 101,AdditlonalReim rksSette",Ifmoms pace Isrequilred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE .._„ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Bridget McGowan ©1988,2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: apedranti@crowninshield.com ``3/3/2015 7:22:03 AM PST (GMT-8) FROM: 100005-TO: 76174799121 Page: 2 of 2 DATE MWIMIYYYY) ® CERTIFICATE OF LIADILITY INSURANCE 3WO15 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: N the certificate holler is an ADDITIONAL INSURED,the policy(ise)must be endorsed. If SUBROGATION IS WANED,subject to the terms and condidorb of the policy,certain policies may require an endorsement. A statement on this cartltlats does not confer rights to the c ardfieats holder in lieu of such endameme s. PRODUCER DUPONT INSURANCE AGENCY INC 18 COPELAND ST F"IL Nc QUINCY,MA 02169 WoUgMS)AFFORDING COVERAGE NAIC e aEURERA: Liberty Mutual Fire Insurance 23035 INSURED JK CONTRACTING LLC 31 RICHMOND STREET rmuw�IRc: WEYMOUTH MA 02188 URERD: eIeURER 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. LTR TYPE OF DANCE POLICY NUMBER ADM 01.15HEFF EXP L elITB COMMERCIAL GENERAL LIABLRY EACH OCCURRENCE $ 91unpum IV Mw CLAIMS•MADE EIOCCUR $ MED EXP one enson S PERSONAL&ADVINJURY S GEN%AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑,gCT 7 LOC PRODUCTS-coMP/oPAGG $ S OTHER: AUTOMDeiLE LLIBMRTY OwlS ANY AUTO BODILY INJURY(Per peeon) S AL ALLOS 3SCC� q LED BODILYINJURY(PersoddenS HIRED AUTOS $ IINBRELiJ1LJAS OCCUR EACH OCCURRENCE S EXCESS LIIAB CLAW MA .E AGGREGATE 1090 RETENTION S— A wom am COIMPE4BATION WC2-31 S•60169M15 2/1712015 01712016 AND EMPLOYEia'LIABILI TY ANY PROPRIETORIPARTNEREXECUTNE YIN N/A E.L.EACH ACCIDENT $ 100000 OFFICERIMEMEEREXCLUDED? ❑Y yMeess�emy bt NH) E.L.DISEASE•EA EMPLOYE $ 100000 DESORPTION under O RATIONS bebw E.L.DISEASE POLICY LIMIT S 500000 DESORPTION OF OPERATIONS/LOCATIONS/VENOM(ACORD 101,Addleonal RemarM eehsdMa,Ary be smscimd Ir more ups"Is rwmd) Workers compensation insurance caverna applies only to the workers Compensation laws of the stets of MA. This certi irate cancels and supersedes ell previously Issued cerdficabes,only as they relate to workers Compensation covareee. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VMLL BE DELIVERED IN MEMO ACCORDANCE WrrH THE POLICY PROVISIONS. :',r- .:!h+�+4 •• AUT14OR72>:D REPRESENTATIVE Uberly Mutual Fire Insurance 0IBMM14 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 23677622 CLIENT CODE: 1644469 Lucy Oacfield 3/3/2015 10:19:07 AN (EST) Page 1 of 1 i assaci•,usetts -Dep artment Of aubi:;=safety ions and Standards Board of Building Regulat �s (',Instruction Sttper.,icor License: CS-066334 ` 31 ICM M OND ST _ ww-yMOUTR MA c �� �� �,�.�• Expiration Jam- - 09/2612015 Cortlnlissioner _