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Home My WebLink AboutBuilding Permit # 10/28/2015 ------------- BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO. Date Received .0 "@ CaeWuakwNfw Arlo OX Date Issued: � �Ss�cwus � IMP TAN T A licant must eom lets all items on this 2age / I / i / / f � / r i r / / r / / 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 / � �,� ,,✓ �%%/iii ,.r / e // % / ! / r,,,/, ,� ,r„i «ir,,a/ ,,,, ! / / rS W1, ,�,� "'gip �"'P�� „, �t ... Identification Please Type or Print Clearly) OWNER: Name: Phon • e � cn`; _ �1 Address: ( f,. ✓I F (J I U�y J Ir., ``l� � � �� /��✓ /� /%,. 1/O/%/%////�// ,�/i,/� // '' a /i//i/ /i/ij/r/ Vii' ,,,i r r / / 1 „ / 11 Ill I / / r I � I / i � 1 I i i , r 4 � , 1 , gg ARCHITECT/ENGINEER �� c� I �. �»:, � �� -��„ .��- Phone: IN �w �� ,"� ,y Address: d f Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ i4fT, o o FEE: $ t°��” Or Check No.: Receipt No.: NOTE: Persons ontracti g wit uistered contractors do not have acR§v iJ tke gua anty fund Signature of Agent/OWner'� r� Signature of contractor "" -- I,0RTTown of � a ` EAndover No. 2b QA �0 LAKE h ver ass46W 400"%F' CoCKICKE.,CK x.95 RATED 11BOARD OF HEALTH PERM Food/Kitchen 1) Septic System THIS CERTIFIES THAT ......... .q.. . „ ....... .............. ,.,.,. ... BUILDING INSPECTOR has permission to erect.......................... buildings on ...FS.1.5. �� 1, ....... • Foundation ... .............. 10 Rough to be occupied as ..... .. ... .�1�lR.....r�s-ha �.. ..� SC ..0 .�.�;,�......�..�.�• Chimney provided that the person ac pting this permll in every respect Mform to the terms of thea application pp 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 LESS CONSTRUCT ST S Rough Service .............. ........... ... ..... ................................ BUILDING INSPECTOR Final 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. PURC14ASE MOM [BILL TO: WattsWater@OnlineCaptureCenter.com FAX: 978-6824561 PURCHASE ORDER NUMBER REVISION PAGE : Watts Water Technologies CA728865 0 1 of 1 PO Box 4929 CA 09468>r f a c�,-:-rdec p�allncrwl dgmsiiG�,p it Portland, OR 97208-4929 t ^��e- YY1X? mtik►� yeepa'sil USAnl�a. ACCT NO ISSUED Knollmeyer Building SHIP TO WATTS REGULATOR COMPANY TO: Corporation 815 CHESTNUT ST 60 Jonspin Rd NORTH ANDOVER, MA 01845-6009 Willington, MA 01887-1019 USA USA <31'It=1tMCt I t3ktY8R $ #1 ?k No, A666 �U>► , VAM tF . INCOTERMSlF.O.B.POINT SHIP VIA CREL:: DIT TERMS ATI' NET 30 DAYS .ICCE CiVU LINE ITEM NUMBER/DESCRIPTION ° Ii10 DUE DATE COM AE QUANTITY UNIT UNIT PRICE EXTENDED T NTS Please Confirm Price&Delivery Within 48 Hou To Fax#978-687-7873 Invoice Price Must Match PO Price ATTENTION: Box weight MUST be 40 lbs maxi um PROJECT BASED ON GALE ENGINEERING D AWINGS DATED 8/21/15,SPECIFICATIONS DATED 8/21 15 AND ADDENDUM#1 DATED 9/4/15. 1 BASE BID 10/15/15 1.0 EA 180,650.00 180,650,00 N Site: A00 Type: Memo Item Not In Inventory 2 ALTERNATE#1 10/15/15 1.0 EA 15,950.00 15,950.00 N Site: A00 Type: Memo Item Not In Inventory 3 ALTERNATE#2 10/15/15 1.0 EA 3,985.00 3,985.00 N Site: A00 Type: Memo Item Not In Inventory WATTS WATER TECHNOLOGIES 815 CHESTNUT ST. NORTH ANDOVER, MA 01845 Net Total 200,585.00 BUYER: Comiskey, J UTax 0.00 SD Grand Total 2Q0,585.00 Terms&Condlticns of Purchase-Rev.11/25/14-Apply Here-in By Reference l/.•...�-..CEJ tt-�L,.-Ii-/.t..-�lL-Jt---t IST�.. -A- - -A-4- A X44"AA0 w 1 LAOL11V00 11-v6U1C111V11®1V1GlA0.%JUV rage 1 01 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) % Consumer Affairs and Business Regulation =h Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints Registration# 110104 Home Improvement Contractor Registrant KNOLLMEYER DESIGN &BUILDING CORP Registration Home Pape Name CHRISTOPHER KNOLLMEYER Address 60 JONSPIN RD t t City, State Zip WILMINGTON, MA 01887 1 Expiration Date 10/06/2016 i _ _ _ Complaints Details 4 4 No complaints found for this registrant. s 4 You can also view arbitration and Guaranty Fund history. Back To Search i ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=10070 1/29/2015 CERTIFICATE OF LIABILITY INSURANCE DATEIMMIbD/YYYY) TW 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: EASTERN INSURANCE GROUP PHONE FAX 233 W CENTRAL STREET (AIC,No,Ext): (A1C,No): E-MAIL NATICK,MA 01760 ADDRESS: 22LRD INSURER(S)AFFORDING COVERAGE NAIC 11 INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA KNOLLMEYER BUILDING CORP INSURER B: INSURER C: INSURER D: 60 JONSPIN ROAD INSURER E: WILMINGTON,MA 01887 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. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE CLAIMS MADE OCCUR. REMISES S RENTED $ ( PREMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: 3ENERAL AGGREGATE $ POLICY [::]PROJECT LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) _ ALL OWNED AUTOS,' BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND UB -14 x WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN ANY PROPERITORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Dyes, e under DESCRIPTION OF OPERATIONS below �E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSfVEHICLESIRESTRICTtONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. 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 REPRESENT VE I ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. ACC>" CERTIFICATE OF LIABILITY INSURANCE 16-.� F9/DATE[M5D/YYYY) 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 endorsement(s). PRODUCER NAMEACT Kelly Seip The Driscoll Agency, Inc. PHONE 781 421 2490 FAX 781 421 2491 93 Longwater Circle E-MAIL MA 02061 .kseip@driscollagency.com .com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Geminl Ins CO 10833 INSURED 216073 INSURERB:Merchants Mutual Ins Co 23329 Knollmeyer Building Corporation INSURERC:RSUI Indemnity Company 22314 Wilmington nn INSURER D:Massachusetts Workers Compensation Wilmimingtgt on MA 01887 M INSURER E:Ironshore, Inc. INSURER F: COVERAGES CERTIFICATE NUMBER:287746944 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. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY VCGP080960 10/1/2015 10/1/2016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE E OCCUR DAMAGE TO EN ED PREMISES Ea occurrence $50,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY jEo F LOC PRODUCTS-COMP/OPAGG $1,000,000 OTHER: $ B AUTOMOBILE LIABILITY MCA0000119 10/1/2015 10/1/2016 Ea accident $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL DXUTSULEDUTAOBODILY INJURY(Per accident) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident C UMBRELLA LIAB X OCCUR NHA073114 10/1/2015 10/1/2016 EACH OCCURRENCE $10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X I RETENTION$none $ D WORKERS COMPENSATION To be issued 10/1/2015 10/1/2016 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Contractors Pollution Liability 00738005 10/1/2015 10/1/2016 Each occurrence $2,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION 30 Days except 10 Days for Non-Paymt 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 /©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents b 1 Congress Street,Suite 100 Boston,MA 02.114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THF.PERMITTING AUTHORITY. A licant Information Please Print Le ibl Name(Business/Organization/Individual): C Address:lc City/State/Zip: (*-Phone#: Are you an employer?Check the appropriate b .: Type of project(required): 1.0 I am a employer with employees(fill and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. In I am a homeowner doing all work myself,[No workers'comp.insurrurce required.]t 10 F1 Demolition 1 (] g addition 4,❑I am a homeowner and will be hiring contractors to conduct nll 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.n I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.x 13. Roof repairs 6.0 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 now 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 have employees,they must provide their workers'comp.policy number. I a»r an employer'iliat is providing workers'eornpertsation lusurauce for my employees. Below is the policy and job site information. _ Insurance Company Name; 1:4(,c J e i- ` Policy#or Self-ins.Lic.1#; l�J ��?�: toi �-�, 7�® �`� Expiration Date: _(0 Job Site Address:(~IL11`a ' � r ` I'" City/State/Zip: h I' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration ate). Failm•e 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$250.00 a day against the violator•.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify tder'-tl e paha an rrOil so ijuiy that the information provided above is true and correct. Si nature: zz�'"r� /' "¢ Date: Phone# Z it a Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 �P li t f {Massachusetts -Department of Public Safety i Board of Building Regulations and Standards' Cumtruction Supervisor License: CS-108884 j 41� MICHAEL DEIWC 2 LYNN STREET-'- Maiden TREET Malden MA 0214$ 954- }c ,� Expiration Commissioner 10/15/2018 j Unrestricted-Buildings of any use groupwhich contain less than 35,000 cubic feet (99 to of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revoratinn of thio ur•anaa !