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Home My WebLink AboutBuilding Permit # 12/8/2015 OORTH BUILDING PERMIT OF�, Eo (g�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION M1 Cwd � Date Received �Rp��areo Permit 1�03�. SS CHLJS Date Issued: ) z 1/5 imP RTANT: Applicant must complete all items on this page LOCATION S 7 0 Print PROPERTY OWNER fL Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District no Machine Shop Village &i� no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial Alteration No. of units: ❑ Commercial ElRepair, replacement [IAssessory Bldg [I Others: ❑ Demolition ❑ Other ,_., ,,��T r ,': /r n,-, r U/rwcn i Wr,d0lpfi'�l,GC�LGF%rG ll.,�„r,,.; %r ✓/l /riiii r, �, /rpi nP N ��❑/r / ,�/ ❑,Wet ,�/,,, �, „� i, r ,�JJr, ,,l rr /� r ❑ 1,,, /, �� //,I �� ,� f �� ,/i,�//(r)r%rl/ I/��/if r, ,� ✓o rel��r�li�al /�ir/;'rl//� �� ir, RK TO BE PERFORMED: �� W ww '' DESCRIPTION OF W 1 �� z- a, - � Plea e'Type or Print C ear Identification- Y - �,,. ' Phone: (j ... rs OWNER: Name: _ �""a.._ ( �C . G .,. Address: C C t t No o 7-7 Contractor Name: is Phone: ` . ' w . - Email: IN- C�-12.�. Address:. C''�- � C Supervisor's Construction License: C- S (4Exp- Dater Ex ...... ..._ Home Improvement License: p. Date: ARCH ITECT/ENGINEER, ° I �` i C Phone: to �'i t � .2 Address: Address: Reg. No. S FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: -. FEE: $ ” Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ..._ — -r Plans Submitted ❑ Flans Waived ❑ Certified Plot Plan ❑ Stamped Pians ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ElSwimming Pools ElWell ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dulmpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM VL ep ANNING DEVELOPMENT Reviewed On �I 114' Signature MMENTS 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 Connoetion/SDriveway Permit DPW Town Engineer: Signature: I� Located 384 Osgood Street FIREDEPARTMENT Temp Dempster on site yes na LacatedStreet . Fire Departai0pt si jgrtat6 e/date COMMENTS Dimension Number of Stories: Total square feet of floor area, (cased on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL Movement of Meter location, mast or sett®ice drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE. Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA-- (For department ruse) Notified for pickup Call Email Date Time Contact Name Doc.Buildin;Permit Revised 2014 t%ORT i own ot ndover ® hL^Kver, Mass, /,-J, COC IF C"116 WICK ATED U BOARD OF HEALTH Food/Kitchen ER 'M1 I TSeptic-System 6- // t,--? BUILDING INSPECTOR THIS CERTIFIES THAT ..... ......................—I ................................. .............. .. . ........... 7' Foundation has permission to erect .......................... buildings on 57-- ................................................x......................... Rough cam to be occupied as ..... ....................... ...............4...........r....................................i........ 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. 44 P 1-1/7, -7�Z '-_2- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC 10 TARTS Rough Service . .......... ......... ....... . .. ................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy uildin Ro u*gh Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. OFFICE OF BUILDING INSPECTOR | � TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 15-0718 PROJECT TITLE: West Mill FLR 1-3 � PROJECT LOCATION: High Street, NAndover, NAME OFBUILDING: West Mill NATURE OF Tenant demising Fd tenant fit out. IN ACCORDANCE WITH ARTICLE 110 OF THE MASSACHUSETTS STATE BUILDING CODE, | REGISTRATION NO BEING AREGISTERED PROFESSIONAL ENG|NEER64RCH|TECH HEREBY CERTIFY THAT | HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION [)FALL DESIGN PLAN8, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT w STRUCTURAL w 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 PRAT|CES. 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 ASSPECIFIED IN SECTION 118.0 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 ofthe 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 bein performed in a manner consistent with the construction documents. i n-qg \STER ALD PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REP A DING 1 ;0 TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUIL 6 UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE,% SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANC 11�10 ASS�' � >- / SUBSCRIBED AND 8VVORK4TO BEFORE K�ETH| , OF CHERYL LBURKINSHAVV Nota Public NDTAFWPUBL|C MY COMMISSION EXP|R ohusan �� '`^x �°"~,"=wmn Expires March 7/ 2019 � JK Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 Proposal Date: 11/25/2015 Proposal M 195 Project: Bill To: David Steinbergh, Floors1-3, 50 High St, N.Andover, MA 01845 Description Est. Hours/Qty. Rate Total Plans and Permits 7,340.00 7,340.00 Demo 2 w 6- `'7- ° t 45,000.00 45,000.00 Wall Framing 75,000.00 75,000.00 Roofing, Flashing 600.00 600.00 Exterior Trim & Decks 32,000.00 32,000.00 Doors &Trim 30,000.00 30,000.00 Windows &Trim 7,000.00 7,000.00 Plumbing 20,000.00 20,000.00 Heating &Cooling 80,000.00 80,000.00 Electrical 78,000.00 78,000.00 Cabinets &Vanities 8,000.00 8,000.00 tel/data, Demo only. 2,000.00 2,000.00 Insulation 7,500.00 7,500.00 Floor Coverings 72,000.00 72,000.00 Painting 75,000.00 75,000.00 Cleanup& Restoration 2,500.00 2,500.00 Sprinkler Work 3,000.00 3,000.00 Contingency 25,000.00 25,000.00 Supervision 56,994.00 56,994.00 Thank you for the opport Total �$6�E;9-34:-08-_ yhe Commonwealth of Massachusetts Department of IndustrialAceldents 1 Congress Street,Suite.100 =' Boston,IVIA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/PXumbexs. TO BE FILED WITH TEE' PERMITTING ATJTHORITY. Applicant Information TO Print Legibly Name(Business/Organization/Individnal): c l .� � Address: t r , City/StatelZip: Phone Are you an employer?Checl(tlie appropriate box; Type of project )Vequired): 1. am a employer with employees(full and/or part time). 7. Q New construction 2.E]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. Spemolition 3.FJ I am a homeowner doing all work myself-[No workers'comp.insurance required.]t 10 (1 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will Electrical repairs or additions❑ ensure that all contractors either have workers'compensation insurance or are sole 11.• proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.a Roof rep airs These sub-contractors Bade employees and have workerscomp.insurance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGI.G. 14.[1 Other 152,§1(4),and we have no,employees.Wo workers'comp.insurance required.] r:. . . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who subii if this afNavit 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-ci n}raciors have employees,lhoe must provide their works'comp.policy number. X am an employer'that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. / / Insurance Company Name: ✓t + ✓ { l t}.o t 4Policy#or Self-ins.Lie.#: - . /apirationDate: -- r"7 16 fob Site Address: 9( 64, r Cita/State/Zip: 4 e L) Attach a copy of the workers'compepsation 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 DTA-for insurance coverage verification. .t do hereby cert!y under•the alns andpenatties ofperjWy Haat the information provided ab ve is f•ue and correct. • .�."' �---° Date: ftTx I.` / Si nature: Phone#: ("� `T C(-2 .�--- , _ 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): i 1.Board of Idealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other Contact Person: Phone#: 1)Y CERTIFICATE OF LIABILITY INSURANCE to 3 1 1 YYY) 215 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 poilci(iea) =at be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A stat9ment on this certificate does not confer rights to the certificate holder in lieu of such endorssmengs). PRODUCER NAME: Maria Dupont Insurance Agency, Inc. PHONE 18 Copeland Street (617) 376-0795 In Nol: (617) 479-9121 Quincy, M& 02169 151969: me@gupontinsuranceagenML.com INSURE RS)AFFORDING COVERAGE NALCO !INSURERA:MRin Street America INSURED INSURER B: JK Contracting, LLC INSURERC: 31 Richmond Street INSURERD: Weymouth, MA 02188 INSURER E: I 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 TIE 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 AWL SUBIR LTIR TYPEOFINSURANCE POLICY NU ;Wmrm IREPA-1 UMTS A GENERAILLIABILITY MPT7794M 2/10/15 2/10/16 FACHOCCURRENCE $ 1,000,000 O X COMMERCIAL GENERAL LIABIUTY DAMAGE TRENTEDPREMISES fEA $ 500,000 CLAIMS-MADE FX7 OCCUR MED EXP(Ary ono person) $ 10,000 PERSONAL&ADVINJURY_ $ 1,D00,OOO GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LINTAPPUES PER PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY F-1 OR [:] LOC $ AUTOMOBILIEUABIUTY aacdderk__ $ ANYAUTO, BODILY INJURY(Per person) S ALLOWNED SCHEDULED AUTOS AUTOS 130DILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS (p . drt) u'OFELLALL48 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE E DIED RETENTION$ $ WORKERS CONIPENSATION WC AT u crH- AND EMPLOYERS'LMOUITY ANY PROPRIETORIPARTNER/EXECUTNEYNIA E.L.EACH ACO DE Nr $ OFFICERNIEMBER EXCLUDED? Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT $ DESCRIPTION OFOPERA71ONS I LOCATIONS IVEHICLES (AllisMAODRO101,AddItIonalRarratim ScIts",N mom space Is requited) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORCMD REPRESENTATIVE Bridget McGowan 0 1986-2010 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 + ' uum a,uluuAlr��i' PRO== DUPONT INSURANCE AGENCY INC COPELAND ST .._.♦ WEYMOUTH18 QUINCY,MA 02169 JK CONTRACTING LLC 31 RICHMOND STREET 02188 • c JIL._r il IN riX ■ �G; f AI oil.;caa�t� 1 .T1T.l" m N.ml 14 VIA o"NT""ITTRIM. MEMO= -LNI.... • �.."., ,.. +. h. 1 _ice• 6- 6 Massachusetts Department of Public Safety ..w. Board of Building Regulations and Standards License: CS-066334 Construction Supervisor KIERAN T WHELAAi 31 RICHMOND ST j Y WEYMOUTH MA-02'' Expiration: ' Commissioner 09/26/2017