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HomeMy WebLinkAboutBuilding Permit #253-14 - 24 ROYAL CREST DRIVE 9/19/2013 i 'i 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received i GG Date Issued: IMPORTANT:Applicant must complete all items on this page -, - t t� LOCATION Ro z A ��R.�s� 6T� 3.5uw` Imo_ _+4�1 �2as� rc . ..N__.tw�OraR _ _ -- _. Print PROPERTY OWNER_-At M co,a i`[a n.1L A"dov art_ Print' , 100 Year Old StrucCure yes 'MAP NO. _ r- PARCEL: d/ ZONING10.ISTRICT Rcl S ,Historic District eyes MachmeShop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition IiKwo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition VOther wow aoeR.t - 5 ACRS ❑ Septic ❑'Well ❑ Flootlplain D Wetlands - 1J Watershed District:, - - _p Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: '?&D,%J& t o R` !-a uw J*+'1 G l WA a A rt,o o r?w. w J t 1 � y /9 (Lp.i l 1 Mt N d ca 5 sAQ /lT Qv�1CL� 44 . .?sSf' Identification Please Ty a or Print Clearly) OWNER: Name: jI e- hl oJL 14 %ra.n L.Lr- Phone: 61 Address: &I ax sl DA-w-e t4ai . j4ajov a R mo CONTRACTOR'N, ame: . {.*w Itc;�i_� M t4WAl_ Phone: 'lit- k� 6o3rQ r Address. 10 4�6WRRcl� ��{ �Q1 , w+R���_ l`✓hA_ d 2194( . -- --- -- - _� Supervis'or's CohW6c-tion License: L'_S O f Off!' _ ZExp_ 'Date:-4 - /S�_2_ D Sri. s-_ - _ Home, mprovemenfL._ice `;Exp Date: CaL&Lat6 ogP L.AMccl Cv #asv -14 141C- li ARCHITECT/ENGINEER 7o LN )9 . 111sus-e wS kl Fe Phone: 71 �--433 - 8/ a a Address: 61 MAiAf S4 P.00J695 P1,pjI`4,.HA Reg. No. H46:5 PE i 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: $ - 4 Check No.: Receipt No.: 21P��7 'l NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �Si_gnature=of�Agent/Owner�;. � _� S�g-�atUre of�contractor� ' �A, �u%iL Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF-:SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ _ Swimming Pools ❑ 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 DATE REJECTED DATE.APPROVED PLANNING & DEVELOPMENT- ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature i COMMENTS 'S-e 8 " DC- A42- - r _tq bf t 5' 4&+ , &Z Pa 04S4A.0j-c.0Fl en-4 J,4 owS �o K,tAl64o HEALTH. Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - ,x Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow;: Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTIIlII}Nt - Temp Dumpster on site yes no Located-at 124 Mair Street Fire Departi' ePit-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 DANGERZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$10041000 fine NOTES and DATA— For department use El Notified for pickup - Date Doc.Building Permit Revised 2010 i Building Department The foli'.3wing is a-list of the required forms to be filled out for the appropriate.permit to be obtained. Roofirg, 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 i i o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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 o 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 o 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 apw•al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must.be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 Location �`� ` G No. � f3 1 Date t � f o - TOWN OF NORTH ANDOVER i o Certificate of Occupancy $ Building/Frame Permit Fee $i ci ` - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � f"� '� x �l Building Inspector NORTH Town of E : ,, Andover O - 0 11 __ S lit C,o : �A�E h ," ver, Mass, alp cocNic.Rw.c.. y1. A0t.P�,`�5 Si U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System ApAe.o `� . LI._.0THIS CERTIFIES THAT ................. BUILDING INSPECTOR ..... .. .. ..... Foundation has permission to erect .......................... buildings on ..:Zq .'�...��e .... L Q Rough to be occupiedas . ;D ................... ..........N.. ~ !�.'� ... ...^ � Chimney provided that the person accepting this permit shall in every respect confor�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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ...... ...... .. . .....1. .... '............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. SEE REVERSE SIDE Massacnusens-uepartment of i-mic aatety Board of Building Regulations and Standards Construction Supervisor License: CS-017809 LAWRENCE V kWN ' 65 HOWARD ST' I BRAINTREE At c 02(1 Expiration Commissioner 07/19/2015 �`� 9//18/18/20113 CERTIFICATE OF LIABILITY INSURANCE D IDD 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 CNAME:ONTACT cristina T. Edmund Garrity & Co. , Inc. PHONE . (617)354-4640 FAX (617)356-5828 JA/C,No: 545 Concord Ave. A DD'DRIESS:cristina@garrity-insurance.com INSURER(S) AFFORDING COVERAGE NAIC# Cambridge MA 02138 INSURERA:Ohio Security Insurance Cc INSURED INSURER B: L.V.M.J. Corporation INSURER C: 65 Howard Street INSURER D: INSURER E: Braintree MA 02184 INSURER F: COVERAGES CERTIFICATE NUMBER*dASTER COI 2013 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD DfYYYYl GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE ❑X OCCUR BLS1455690302 /13/2013 /13/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- RO LOC $ J,CTAUTOMOBILE LIABILITY Ea a�deMSINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB —d CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WC WORKERS COMPENSATION STATU- 0 TH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE❑ E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addiflonal Remarks Schedule,if more space is required) Excavation & Hauling. CERTIFICATE HOLDER CANCELLATION lvm46@beld.net SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover Building Department 120 Main Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 W Garrity/CRISTI ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS02519ninnm n1 Tho arnpi 1 name 7nr1 Innn oro ronic4oror1 marka of A(npn ATE 'ate©® CERTIFICATE OF LIABILITY INSURANCE D/18/IDD 3 9/18/2013 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(les)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 CO NTACT NAME: Albert J. Tonry & Co. , Inc. PHONE (617)773-9200 FAX .(617)773-9920 300 Congress Street EA DRESS: INSURERS AFFORDING COVERAGE MAIC Quincy MA 02169 INSURER A-Commerce Insurance 34754 INSURED INSURER B: L. V. M. J. Corporation INSURER C 65 Howard Street INSURERD: INSURER E: Braintree MA 02184 INSURER F: COVERAGES CERTIFICATE NUMBER:CL139407107 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 ADOL TYPE OF INSURANCE POLICY NUMBER POLID MMO EFF MPOMIDID EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGER TE COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE FIOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY Ee ',d..SINGLE LIMIT 1 000 000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDIx SCHEDULED J1808 /15/2013 /15/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS NOWOX ER HIRED AUTOS AUUTOS�ED PIR eoacdden DAMAGE $ Medical Pavments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATIONWCSTATU- OTH- AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNERIEXECUTIVE 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 $ DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Any and all jobs performed usual to an Excavation contractor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE L Tonry Jr./CDIGRA ' ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS075 onlnnsi ni Tho arnan nnma anti Innn arA ranietarari mance of Arnion MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE Use this form to request a Certificate of Insurance from the Assigned Risk Pool Carrier(A.-I.M. Mutual.Insurance Co.). Please provide all of the requested information, including the facsimile number(s) of the person or persons to whom the Certificate of Insurance should be issued. If this form is fully and accurately completed, the Certificate of Insurance will be issued and distributed by facsimile to each fax number provided below, within two(2) business days of the carrier's receipt. This Form may be mailed or faxed to the Assigned Risk Pool Carrier. To obtain each carrier's contact information refer to the Certificates of Insurance section located in the Producer Community section of the Bureau's website(www.wcribma.ogj 1. Name,address; telephone number and facsimile.nwnber or email address of the INSURED: Name: . L. V. M. J. Corporation dba: Mailing Address: 65 Howard Street .Braintree MA 021 84-1150 Physical Address: Phone: . _(781)848-6030 Fax or email lvm460-beld.net Z. Name,address, telephone number and facsimile number or email address of the CERTIFICATE HOLDER: Name: Town of North Andover Mailing Address: 1.20 Main Street North Andover MA 01845 Physical Address: Phone: Fax or email: Fax Number 3. Name,address, contact person,telephone number and facsimile number or email address of the PRODUCER: Name: Albert J.Tonry&Co.. Inc. Mailing Address: 300 Condress Street Quincy. MA 02169 Contact Person: Cheryl A. DiGravio Phone: _ _(617)773-9200 Fax.or email: (617)773=9920 or certs(cptonrv.com 4. Policy Number, Policy Effective Date and Policy Expiration Date If a Certificate of Insurance is needed for more than one policy term,provide the Policy Number, Effective.Date and Expiration Date for each policy term. If the policy has not yet been issued, you must attach a copy of the Notice of Assignment. Policy Number: VWC1.006.0082462013A Effective Date: 4/6/2013 . Expiration Date: 4/6f2014 . . . . 5 List any special requests for optional coverages/endorsements(see Page 2 for listing of coverages available in the pool and the conditions of availability)or additional information rincluding changes in exposure not yet reported to the carrier)that will assist thecarrierin the issuance of the Certificate of Insurance. NOTE.An additional insured(s)shall not be listed on any Certificate of Insurance unless such additional insured(s)is a named insured on the policy. None o<t►a gra�sti TOWN OF NORTH ANDOVER OFFICE OF n BUILDING DEPARTMENT 400 Osgood Street * 's+;,, ,;• * North Andover,Massachusetts 01.845 D.Robert NiGetta, Telephone(978)688-95454 - Building Commissioner Fax (978)688-9542 CONTROL CONSTRUCTION — SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULD.ING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 I, John A. Visniewski HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT Bldg. Vs 23, 24, 26 &49 at 50 Royal Crest Dr. DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING.: Foundation waterproofing and subs -hi OF ge piping at the specified buildings. x3�N' Ss,� A. V NIFWSKI AUTHORIZED SIGNATURE: t tt 111 DATE:��`',.Se tember 13, 2013 yy3,P t�.�,ti P REGISTRATION., Mass. PE # 29775 NOTE: ENGINEER"WET STAMP"MUST BE AFFIXED TO THIS FORM Control Construction Form revised1.1.15.2004 BOARD OF APPEALS 688.9541 CONSERVATION 688-9539 HEALTH 688-9540 PLANNING 688-9535 4, S