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HomeMy WebLinkAboutBuilding Permit #703-15 - 14 High Street 3/6/2015<-JAk BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this"page LOCATION -- _ P it PROPERTY OWNER- � �I Print 100 Year Structure MAP L.i�. _ , PARCEL. ZONING DISTRICT: Historic=District Tr)(1A 0711 01 Machine Shop Villaqe yes no Cys no Oes) no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family - ❑ Addition ❑ Two or more family ❑ Industrial ,gAlteration No. of units: `Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Rz 0- V N 4-zy-7w VT Q ar V- Identification - Please Type or Print Clearly OWNER: Name: Phone: Sk'l -k'O --k�, 4 Address: . �A�v V%�5 ��`� D Contractor Name: 'Phone: or Address:, -',I\ Ut*tav V4 4 Supervisor's Construction License: L- - Exp. Date:"t Z Home Improvement ARCHITECT/ENGINEER �.5� . 1 Sova,-c��S t A,. Phone: V+9 -\a �8 Address: JLrlo Nr%vs SZ,—, . 0 _ I-ArJOD\)S P- Reg. No`.. FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMAITED COST BASED ON $125.00 PER S.F. Total Project Cost: $ a 2K, FEE: $ . ".:: 1 I ,S' 0 -(\-2, Check No.: 2--z 3 Receipt, No.. NOTE: Persons contracting with unregistered contractors do.not h4vi e_access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPF'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art E] Swimming Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS CONSERVATION COMMENTS HEALTH t t COMMENTS Signature_ Reviewed on Signature Reviewed on -3/1/ v Sian Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments e Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Usgood 5tre t FIRE DEPARTMENT - Temp Durripster)mfi) site yes no Located. at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service 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 use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe: Building Permit Revised 2014 Location No. 763 c2,62r Check # 2 G 5 4 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ /9 Building/Frame Permit Fee Foundation Permit Fee $ • Other Permit Fee $ TOTAL $ Building Inspector o�,.O °*N'�h a o r •�49 ACH�`'Et CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 703-15 on 3/6/2015 Date: April 28, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 14 High Street MAY BE OCCUPIED AS a tenant fit up "Taste Buds" in ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG NA West Mills LLC 14 High Street North Andover, MA 01845 �, &A,— Building Ins ector Fee: PrePaid $100.00 Receipt: 28545 Cheek: 2038 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 703-15 on 3/6/2015 Date: April 28, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 14 High Street MAY BE OCCUPIED AS a tenant fit up "Taste Buds" in ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG NA West Mills LLC 14 High Street North Andover, MA 01845 Building Ins ector Fee: PrePaid $100.00 Receipt: 28545 Check: 2038 A O n O Z -h CD N O O� co O ID 0 O 2. cn 5 cn -9 CD o20-,�r 1D � 2 <u� MU n CD 0 _rt rt = C9 fl7 O S 'a=i O Vl ,�f cn CD 'r1 O O� .-r QO R1 S rt N -0 VJ O CD 2 S03) N (DD > O O n (Q O' �+ N O � rt COD .� S (D CD CD p < ca �N=. 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[� c.� �W lCl z cin Z v m m m D Z O � a ` 6 M o x TO A I k B -4a)r) 22E`=2;W-a, m»,cn _®$�';I;f&\�;,«tea§;! o G e = 7 ! /( ! ®---®----®-®--------- E §■§t/$§$k))kk/$$k§k$) i �l;m;2;@sEzskeE @EE a: ................ £ ..............��� ..................... £ ff7} - (({ [ (}IE / \�) o \%k§ ■ ƒ ( � -E ■ ( � \ ] Initial Construction Control Document f To be submitted with the building permit application by a Registered Design Professional d for work per the 8th edition of the \ Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: Tastebuds Kitchen Property Address: 14 High Street North Andover, MA Project: Check (x) one or both as applicable 01845 [ ] New construction Date: 03/05/2015 [X ] Existing Construction Project description: Tenant fit -up into existing space. Projects consists of demo of existing interior tenant space and construction of New walls, doors, kitchen area and fixtures, new ceiling in some areas, new lighting and finished throughout. New plumbing and reconfiguration of existing HVAC. I Gregory P Smith MA Registration Number: #8688 (Architect) Expiration date: August 31, 2015, am a registered design professional, and hereby certify to the best of my knowledge, information and belief, that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerningi: [ ] Entire Project [X] Architectural [] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other: for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services in accordance with the Professional Standard of Care, and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. The contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means, methods, sequences and procedures, and for construction safety. The performance of the services shall not require any special testing or inspections unless specifically stated in the Code. When required by the building official, I shall submit field/progress r comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a "wet" or electronic signature and seal: Phone number: Cell: 978-204-4770, office 978-688-5422 x2( Building Official Name: Building Official Use Only AIA MA & Insurance ADnroved Version. Initial Construction Control Doc Permit No.: L _ .Com Date: 0Z Cr 2) CL �. O v CL aA) CD O CL L . CQCD 7 .O O U) �a 0 r_ N CD CD _s U) CD N v O O 70 CD O CD O 10 9 Z m cn O cn N m m cn O h CD co O ap E. CL co CD c= 0 U) 0 N cn o="° � __Mo U) ~' < CD y N n 0 f7 = 0 m o ? �- N ° FD -n 0 0 •ACL 0 m S a) rt � W 'a y O CD CD CD 2 (O O' O rt U) O fl1 r.3M _ 0 CD -0-0 o 0 0• N T - O ocn CD 0, Cr CD rt Q.> y Q. 0 �G r.L Otu c= O CL — y CD y O 7 O C ° CD C CLy SU 'CD CD o ° O CD sem: C CD: U) C 1 -a 3 CD y O -h D �D rt � MR 0 ci : ft � rt L11 O � 7 Q VI 3 O 0 Y V1 1 (D z O W O O M m ° T 7 .o O cm S D '^ N T 7 � N O � 0 : O a S r- m Q n 0 T 7 L O m S M C 9 00 MLA 0 T 7 d n S � 7 M SCI O aq S T = O Q rr O W C r ° z m 0 V1 o ,� n Ln H m 3 T O Q n S rD 3 W O nm r x Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 129,998.00 m $ - n/c Plumbing Fee $ 195.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 195.00 Total fees collected $ 489.99 14 High Street 703-15 on 3/6/15 Taste Buds 0— > jen xz 17, La ` � / \ / � 2 - ® 2 2 /! co C, CZ) 4 � �{ � 70 0-1 (D m if I■'D OD A D® CERTIFICATE OF LIABILITY INSURANCE�'�(MM ;/9/)14 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 Dupont Insurance Agency, Inc. 18 Copeland Street Quincy, MA 02169 CONACT -NAME., Valerie PHONE FAX I.E-MAIL 617 376-0795 N : (617) 479-9121 ADDRESS: valerie@du ontinsurancea en . COm INSURE 5 AFFORDING COVERAGE NAIC# INWRERA:Main Street America 2/10/15 INSURED INSURER B JK Contracting, LLC 31 Richmond Street Weymouth, MA 02188 INSURERC: INSURER D: INSURER E: INSURER F: f;UVtMAUtb CERTIFICATE NUMBER: wCVIQInhl 1101RIIDC10. 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 ADDL SUBR POUCY NUMBER POUCY EFF MIDDIY POLICY EXP MM/DQ'YYW LIMITS A GENERALLIABILITf MPT7794M 2/10/14 2/10/15 EACH OCCURRENCE $ 1,000,0_00 X COMMERCIAL GENERALLIABILMLSES_tDoccurrenITYDA_fflMAGETORENTED CLAIMS -MADE a OCCUR ce $ 500,000 MED EXP (Any one person) $ 100,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,0 0 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOPAGG S 2,000,000 7X POLICY PR0 El LOC $ AUTOMOBILE LIABILITY COMB INED SINGLE LR a accident $ BODILY INJURY (Per person) $ ANYAUTO ALLOWPED SCHEDULED AUTOS AUTOS accident Per BODILY INJURY ( ) $ NON -OWNED HIRED AUTOS _ AUTOS I PROPERTY DAMAGE eraaJdent $ $ UbBRELLALIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE ( AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION LU181L1TY YIN ANY PROPRIETORIPARTNER/EXECUTNE OFFICE WMEMBER EXCLUDED? (Mandatory in NH) Ifyyes desaibeunder N / A i I t I WC STATU- TH- ORY E.L.EACHACgCENT $ ------ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICYLIMR I S DESG�RIPTIONOFOPERATIONS below jf DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(AnachACORD 101. Additional Reni3dmSchedtde,Ifmore spaceIsregttred) 16 Chauncy #43, RCG LLC, Sixteen Chauncy Street Condo Trust and Crowninshield Management Corp are listed as Additionally Insured in respect to GL by means of BPM 3105 12-07 when required by written contract. Waiver of Subrogation applies by means of BP 0497 01-06. l..tK IIFICA I1- 146Lu1-K r`AhIt%=I 1 ATInW 9 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: kwhelanl23@gmail.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RCG LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M ACCORDANCE WITH THE POLICY PROVISIONS. 17 Ivaloo Street AUTHORIZED REPRESENTATIVE Suite 100 Somerville, MA 02143 BRIDGET MCGOWAN 9 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: kwhelanl23@gmail.com ACQRO CERTIFICATE OF LIABILITY INSURANCE �1....�� DATE(MMIDONYYY) 7/10/2014 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(fes) 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 DUPONT INSURANCE AGENCY INC 18 COPELAND ST QUINCY, MA 02169 CONTACT PHONE FAx E-MAIL:.-_,-__. AODRESS: INSURERS) AFFORDING COVERAGE MAIC A INSURER A : Libe_fty_Mutual Fire Insurance i 23035 ..� INSURED JK CONTRACTING LLC INSURER 8__ 31 RICHMOND STREET INSURERc:. INSURER D: WEYMOUTH MA 02188 INSURER E : OTHER: INSURER F; i,uvrrcuc�r� GFKlI}![C0.1}lUIIMR}K• OInDC04n4 NI /Rack=. 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. IHSii. `--�u tADDL-"',SSUBRt LTR TYPE OF INSURANCE POLICY NUMBERLIMITS POLICY EFF POIJCY EXP i-----_�.................._.. MMlDDtYVYY MMlDDMIYY COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE ' 3 CLAIMS -MADE OCCURI ? I !PREMISE . S ...... .._...... g Ea _ ED EXP r n — ..� PERSONAL & ADV INJURY_ S GEN'L AGGREGATE LIMIT APPLIES PER: { GENERAL AGGREGATE PRO- POLICY POLICY JECT L € ---i { PRODUCTS - COMPIOP AG — 5 — OTHER: AUTOMOBILE UABIUTY ... j - �.. I - - ' - .. P O SINGLE LIMITMa mcident! 5 ANY AUTO i i BODILY INJURY (Per ALL OWNED SCHEDULED _i AUTOS _ AUTOS I ; v YBODILY INJURY (Peratctdent) —" e ' NON•OWNEO i HIRED AUTOS AUTOS i 3 PROPERTY DAMAGE (Per acddent} UMBREUA UAB i OCCUR. i ( EACH OCCURRENCE 5 EXCESS UAB- ' 3 I CLAIMS -MADE' i AGGREGATE DED € RETENTION 5 5 A WORKERS COMPENSATION, IWC2-3/S-601698-014 2/17/2014 211712095 I I PER ; OTH AND EMPLOYERS' LIABILITYt Y / N A.IVY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT S 100000 OFFICERIMEMBER EXCLUDED? .MN ! A i ;---------- i 100000 (Mandatoryin NN} ' E.L. DISEASE -EA EMPLOYE ' i yyees. describe under pESCRiP'; ION OF OPERATIONS below ? t..—,...._...._...._.-._....--....___ ? E.L. DISEASE -POLICY LIMIT .�.._..___._....____......._-. S 500000 { j I I 3 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached R more spate is required) Workers compensation insurance coverage. applies only to the workers compensation taws of the state of MA. This certificate cancels and supersedes all previously issued certificates, only as they relate to workers compensation coverage. L:tK i 11-I9:A I t KULUtK UANL:t_LLA I IUN RCG LLC JOB REF#16 CHAUNCY STREET #43 CAMBRIDGE MA 021 17 IVALOO STREET, SUITE 100 SOMERVILLE MA 02143 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 Liberty Mutual Fire Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) -The ACORD name and logo are registered marks of ACORD CERT EIC.: 20S8191 CLS&I:: Coz)s; 1644469 rn_Cy Garfield -71,'!(I/'!o14 2.1?;44 W4 (FDV Page 1 of 1 r