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HomeMy WebLinkAboutBuilding Permit # 10/6/2015 %AORT#q BUILDING PERMIT 16 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 6s,0. z, Permit No#: Date Received ^rrD Ivs CHUS Date Issued: IMPORTANT:Applicant must complete all items on this page 7 7 - LOCATION Print PROPERTY OWNER (L C_- G-, o ✓ Print 100 Year Structure yes no MAP .-J-- PARCEL: n' ok ZONING DISTRICT: Historic District ye no Machine Shop Village We no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building [] One family [I Addition [I Two or more family 11 Industrial �RAlteration No. of units: 11 Commercial [I Repair, replacement 0 Assessory Bldg 11 Others: D Demolition El Other � eTptt , We 4 NNIIIT�i �fi 0014101" WA""wr IN 1 ya KIM r so, fo DESCRIPTION OF WORK TO BE PERFORMED: C3, DESCRIPTION cE- cs,( 1� 0 1 -,�0�_ O 's 0- rt I -J7-6-D 'K 71��e r 6-T L,low S Identification- Please Type or Print Clearly OWNER: Name: jqv( im 0 d-y-&i-( Phone: Address:_g 0 17,6 1, 0 0 Sq- f-t (3 tn CYL-1 To Contractor Name: i Q5-v4*;w 14 Phone: L,_+ ct 1 Email: L o Ku L_ "- -(, C->_ , Address:_', v i c-e 04— 14 '2- 1 14 1 c,;-ti Eid La NIZ4 0 �-,S Supervisor's Construction License: c o 6 6 Exp. Date:- '2-6/17, Home Improvement, License: Exp. Date: ARCHITECT/ENGINEER Phone: OV4 VTT( Z Address: C I Q rt -Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -------- -FEE: $ b 0 fl Check No.: Receipt No.: NOTE: Persons contraetinff with unregistered contractors do not have access to the kuarantv fund 7--------77 t/ fijr 7,77774 "'atufe_b� 77,7,�,,7777, gna tkORTH 1" cu%ve No. 43 7- 2o i h ver, Mass, T O LAKE COCMICMEWIc K- �,4 ADRATED P' �� S 'V BOARD OF HEALTH ERMIT T U Food/Kitchen Septic System kc THIS CERTIFIES THAT ` Q ,,,,,,,!�, ,,,,,LLC BUILDING INSPECTOR ............. ............... ...°�,?... .............................. ... has permission to erect buildings on ..................... Foundation c ........................... Rough to be occupied as .. I ...JIC.. ... . ....... ........ UeAl .z......... ?.¢.P...&� Chimney provided that the person accepting thl ermit s all 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 I MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough Service ........... ..... . ....................c/� ......r...�....,.......... 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. AORT" OFFICE OF BUILDING INSPECTOR o TOWN OF NORTH ANDOVER X CONSTRUCTION CONTROL PROJECT NUMBER:—1 40600Z 36 PROJECT TITLE: 4 i-figh Street Fbor 3 Buiki--Out PROJECT LOCATION: 4 Fligh Street, SOre 201, North Andover NAME OF BUILDING: WE,St MP8 NATURE OF PROJECT: 2­91LIaLlt L-JI SP Ut IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1, inch S. arniiev 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 El 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 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. IGNA URE 1A, f SU R IB WORN TO BEFORE ME THIs qDAY OF 14, f4brRY PU-Sr MY COMMISSION EXPIRES_.:� JK Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 Proposal Date: 10/6/2015 Proposal#: 185 Project: Bill To: David Steinbergh, Suites 301, 306/hallway,West Mill N.Andover, MA 01845 Description Est. Hours/Qty. Rate Total Plans and Permits 2,436.00 2,436.00 Demo 9,000.00 9,000.00 , Seal brick 2,500.00 2,500.00 Roofing, Flashing 500.00 500.00 Doors&Trim 22,000.00 22,000.00 Plumbing 5,000.00 5,000.00 Heating & Cooling 25,000.00 25,000.00 Electrical & Lighting 20,000.00 20,000.00 Insulation 7,000.00 7,000.00 Interior Walls 30,000.00 30,000.00 Floor Coverings 30,000.00 30,000.00 Painting, includes taping 30,000.00 30,000.00 Cleanup& Restoration 2,000.00 2,000.00 Supervision 18,544.00 18,544.00 Thank you for your business. Total $203,980.00 The Commonwealth of Massachusetts Department of IndustrialAccidents " = 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gav/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. ApWicant Information Please Print LeWb Name(Business/Organization/Individual): • z (s1 ' � ,Address: O, City/State/Zip: > ° � Phone#: Are you angmployer?Check the appropriate box: Type of project(required): L® am a employer with® employees(full and/or part-time).* 7. []New Conti action 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Z.Remodelirig any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t �4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. - 12.[]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 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 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. t 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-coniraciors have employees,they must provide their workers'comp.policy number. fain an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. �] Insurance Company Name: �"( �"� +� ► ._ f t �� Policy#or Self-ins,Lie. Expiration Date: '� `( -7 Job Site Address: "�`" r'1� G�-tt �C:1"1 � � �f-d rt" City/State/Zip: / " At K) V1�- � 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 DTA for insurance coverage verification. I do hereby certify under the pains andpenalties ofpeijury that the information provided above is true and correct. f 4 Signature Date l / 6 Phone# L -1 ­ Official use only. Do not write in this area,to he 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#: AeVR& CERTIFICATE OF LIABILITY INSURANCE ='°°"Y""' 3215 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 pollcypes) 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 NAM. Maria Dupont Insurance Agency, Inc. PHONE 617 376-0795 . (617) 479-9121 18 Copeland Street E4 Quincy, MA 02169 ADII�ss: me@du ontinsurancea en .com INSURE S AFFORDING COVERAGE NAIC# INSURERA:Main street America INSURED INSURER B., JK Contracting, LLC INSURERC: 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 101.3UBR LTR TYPE OF INSURANCE AINSR WVQ1 POLICY NUMBER MAn MNmdYYYY LIMITS A GENERA-LIABILITY MPT7794M 2/10/15 2/10/16 EACH OCCURRENCE $ 1 000 000 X COMMERCIAL GE NEPALLNBIUTY DAMAGE TO RENTED $ 500,000 CLAIMS-MADE 7 OCCUR MED E)(P(Anyone person) $ 10,000 PERSOML&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMPAOPAGG S 2,000,000 POLICY PR6 LCX: S AUTOMOBILE LU181UTY a W1INEDdart�INGLE LIMIT $ ANYAUTO BODILY INJURY(Per Person) $ ALTOS PED SCHEAUTODULED BODILY INJURY(Per accident) $ HIREDAUTOS _AUTOS D P eraacddlenDAMAGE S a UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION I WC STATU- I OTH. AND EMPLOYERS'LIABILITY Y/N TOPYLIMITS ANY PROPRIETO IPARTNER/EXECUTNE E.L.EACH ACO DE Nr OFFICERIMEMBER EXCLUDED? N I A QNandafory in NH) E.L.DISEASE-EA EMPLOY If yye8s describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACachACORD 101,AddidonalReno ftSoha",Nmom space Isregdred) 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. AUTHOR=REPRESENTATIVE Bridget McGowan ©1988,2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: apedranti@crowninshield.com rayC: c �3/3/ZU15 7:ZZ:U3 AM PST (GMT-FI) k'ROM: lUUUUS-TO:' lb: l41Y!01Y1 uL c CERTIFICATE OF LIABILITY INSURANCE �`� �' "3Wo16 THIS CERTIFICATE M 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 REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the cut! cats holder Is an ADDITIONAL INSURED,the poibAles)must be endomsd. If SUBROGATION IB WANED,subject to the to and conditions of tM policy,p , Id poNdes may require an endormeam . A ststsrnent on this 6rertifictts does not confer rights to the Certifieste holder in Neu of such endonow s. PROmm DUPONT INSURANCE AGENCY INC NMI 18 COPELAND ST mores QUINCY,MA 02189 BOURMMAff*r4MGCCVBVM • 1.1birly Mutual FIm Insurance 235 e JK CONTRACTING LLC 31 RICHMOND STREET "°""�"`�` WEYMOUTH MA 02188 aleuLmee 112111VIER F.- COVERAGES CERTIFICATE NUMBER: 23V7S22 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 PND CLAIMS. vast pmm WAR TM OF 910UPANCE Lie COMMEIeC1AL Gi3MM L LIASLI Y EACH OLaXlMENCE f CLAW4 M 0 OCCUR7 MED EXP ons S PEl1JlONALLADV INJURY f GMACaMGKrELIMIT APPLIES PER: GENERALAGGREGATE f POLICY❑.SECT ❑LOC PRODUCTS-COMPOOP AGO i wue60aWARM RM ro _ f ANY AU O EMILY INJURY mw paeroel f ALL 01"D SCHEDULED BODILY INJURY(PuAUTOS AUTOS eeddxU f _ HIRED AUTOS A WNID s s UIeI1�SLJAe OOCUR EACH OCCURRENCE f EJCC LW CLADAS41ADE AGGREGATE two RETENTION& I A MOR3031a CDnIBBW►tLDN 1 FOOM15 7/10 5 2M71XI16 ANY LL#�Y YIN EJ..EACH ACCDIKr t 100000 OFFICERAMISEREJCd111DED7 ❑Y NIA Dy„d10fy N app EJ_.DISEASE•EA f 100000 M d—PC Nr EL.Dim POLICY LIMIT 500000 MUM T1 NS D 'E 110MTs311 OF OPERATIONS I LOQAT10Ne!VlsClta(ACOIIO te5,A popes Fmi Ranam aa.ar.,mm b.a6dnd If mora apace b nqurmq Workers comparmilon Insurance coverage Woiss Only to flte wwksm Comae adon laws Of ft State of MA. This oertkflcate canals and Supersedes di previously Issued c afflaates,cn yl ae they relate to workers eOmWodon coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ADM DESCRIBED POLICIES BE CANCELLED BEFORE TILE apstATION DATE THEREOF, WMCE WILL BE DELIVERED IN ACCORDANCEVIRH THE POLICY PRDVIMONS. sdh*�'•. .:;• Au'f1f0a®Le91LleBITwTNE Mutual Fire Insurance 019S&014ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered tmft of ACORD CL&T NO.: 23677622 CLIENT COOP! 1646469 Lucy OaatieLd 3/3/2015 10:19:07 AN (EST) Page 1 of 1 tMassachusetts Department of Public Safety � Board of Building Regulations and Standards License: CS-066334 Construction Supervisor KIERAN T WHELAN I 31 RICHMOND STR- WEYMOUTH MA,02P "- Expiration: Commissioner 09/26/2017 1