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HomeMy WebLinkAboutBuilding Permit #1090-2016 - 1 Royal Crest 4/19/2016 OORTH 0.4 '0 16 � ,�I ���Q BUILDING PERMIT a. y�.;,�, ;:ah,;6 �` `'`� TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION y 2 my ` /r> Date Received '�Rp°j+areo ?o/ Permit No#: AC US Date Issued: EVIPORTANT:Applicant must complete all items on this page OL I nn LOCATION 12o `'J�l Ll P p Print PROPERTY OWNER �'' ' �� PROP Print 100.Year Structure yea no / o ICT: Historic District yes n MAP PARCEL: 25—ZONING DISTR — Machine Shop Village yes, no . FEI PE OF IMPROVEMENT PROPOSED USE Residential �N�on- Residential New Building ❑ One family ❑Two or more family ❑ Industrial Addition ❑ Commercial ❑Alteration No. of units: ❑Assesso Bldg ❑ Others: epair, replacement rY ❑ Demolition ❑ Other _ p EM! - i�, �to a Ne O R M E D: E DESCRIPTIONOOF.WORK TO BE PERF j2e I I.v N dentifiication- Please Type o riot Clearly OWNER: Name: dnn tL D• Phone: Address: 3Csf Contractor Name: /wu P one: - ? � Email: a" ', a 'n�' v r� Address: - v License: Supervisor's Construction C �f��-��Exp. Date: L. Home Improvement License: l 7�� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDIN G PERMIT;$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. U d l9 0 , c� -FEE: $ Total Project Cost: $____ Check No.: 6 �-ey y Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the a a ty fund --.� - - — - - — i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWER-AGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ good Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On _ Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 'Planning Board Decision: Comments Conservation Decision: Comments Wtler& Sewer Connection/sr' nature&®ate Driveway Permit DPW Town Engineer: Signature: FIRE DE_Pgl`�TM`""EN Temp ®umpster on site yes Located 384 Osgood Street Fire ©epartmen sign tune/date � ';:�g#' u.WPM,' COIVIMENT�S7 1 r nr i .ern .. .e+ • .a . 9 Dimension Number of Stories: Total square feet of floor area, based-on_Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter location, rust or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA-- (For department apse) I Ef II l I ® Notified for pickup Call Email j z � Date Time Contact Name Doc.Building Penxiit 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 C®py of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products ®TE: All dumpster permits require sign off from Fire Department prior to is 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 (IfApplicable) Engineering Affidavits for Engineered products OTE: 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 �6 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuathe nce of Bldg. Permit ppeals ][inall cases if a variance or special permit was required t he Town Clerks office must stamp that the appeal period is over. The applicant must then get this recorded at the Regist y of DeedsciOne copy and proof of sion from the Board of Arecording must be submitted with the building application Doc:Building Permit Revised 2014 Location No. �T�J /h Date I • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ C,06 /30 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �e Check# / Building Inspector NORTH own of ver � z , h , ver, Mass, __11111411, coc"Icntwicw 1' �i9s R�1TE0 ►.P ,�'�y U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System f THIS CERTIFIES THAT / BUILDING INSPECTOR .............. ........ �........................................................................................ Foundation has permission to erect buildings on5-7 ..�. d . .Cf,. ... d...... ........................ .... . C� 13CJ Rough to be occupied as ................................................ ........................... ....................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final oli 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 ' Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ....,....... Service ........... .... .i '�'`""'�T'' .�. _....,....... ( 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. -- S py Office of Consumer Affairs&B sines s Regulation _ HOME IMPROVEMENT CONTRACTOR I = Registration. 153188 Type ,t :,EX 'ration: ;C 1/6/2016 Private Corporation B& RESTORAT ON'AND C —N,tBACTING INC � i I., PAUL BRUNO � '', ' 218 PARIS STREET AST BOSTON, MA 02128 r . " Underseeretary' Massachusetts Department of Public Safety Board'of Building Regulations and Standards License: CS-065281 Construction Supervisor I Is PAUL BRUNO 109 CHESTNUT SfiIE T `` LYNNFIELD MA;0194b Expiration: '+ Commissioner 09/28/2017 B&M RESTORATIONAND CONTRACTING, INC. 218 PARIS STREET EAST BOSTON AIA. 02128 (617) 561-9998 (781) 342-5178 fax (617) 293-1722 cell PROPOSAL AIMCO 2 Greenwood Square 3331 Street Road, Ste 450 Bensalem, PA. 19020 JOB LOCATION: Royal Crest Estates, 19 Royal Crest Drive,N.Andover,MA. WE PROPOSE THE FOLLOWING: Work to be performed on Buildings: 1 Set up protection around the work area. Install safety fence around perimeter of work. Replace brick as needed. After flashing is completed,cut and point building 100%. Building 1: $50,000.00 We hereby propose to furnish all labor and material complete in accordance with the above specifications for the sums stated above. AUTHORIZED SIGNATURE O DATE: 4-11-2016 Acceptance of Proposal: The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified. AUTHORIZED SIGNATURE_22=__X.,j/ DATE: ILI 6 The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,PM 02114-2017 www mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl Nalne(Business/Organization/Individual): ut7 Addlress: City/State/Zip: ® �j a y4v&-r 4 Phone#: Are you an employer?Check the appropriate box: Type of project(required: If]I am.a.employer with employees(full and/or part-time).* 7. ❑New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 []Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I l.. Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.0 Roof repairs • These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers.have exercised their right of exemption per MGL c. 14.®-6lher 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 mustattached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors fiaye employees,'tiiey must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self--ins.Lie.#: D� %'7 G z 7 Expiration Date: /7 Job Site Address: ( City/State/Zip: /Vo, � A H 1 LYi[it Attach a copy of the worker 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 DIA for insurance coverage verification. I do hereby cer5"ndep the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: eth 4 Phone#• 02 Of 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#: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract'(hire, express or implied,oral or written." ' An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment bd deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited,Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi•confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if yon'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their ' self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: f The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia