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Home My WebLink AboutBuilding Permit #683-2017 - 25 ROYAL CREST DRIVE 1/3/2017A, lo�n 0AaAj'L'f Date Issued: ' BUILDING PERMIT TOWN OF NORTH .ANDOVER APPLICATION FOR PLAN EXAMINATION 1 Date Received 1 Lo 'tloffr to - Jf- DR/ITED ^pF �SSAChiU TYPE OF IMPROVEMENT PROPOSED USE Residential Non= Residential 0 New Building ❑ One family 0 Addition ❑ Two or more family ❑ Industrial 0 Alteration. No. of units: 0 Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic p`1lVell---� - v i7 F(oi dpM I i .. UVet(ands` .T 91 Watershed Dtstpict- : DUSWIPTION OF WORK TO HL F1=K1-UK1V1tu: eek CY10 Z l,�G OWNER: Name: Address: 6-0 -Contractor Nar Idgnt �ation - Please Tie (� /C C- 171 Superviso '-`Construction License:= .G Home. Improvement- L• icense..�. .. ARCHITECT/ENGINES AW-=..�1= 4 hone: vas, oZip.o.. K _ Phone: Address: Reg. No. FEE SCHEDULE. B ULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COSTBASED ON $925.00 PER S.F. ___,Total Project Cost: $ �L. FEE: $ Check No.: Receipt Na,; NOTE: Peyso ac n itunregistered contractoFs do not have. access tot e guaranty fund 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C. S. L. ' Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Ei Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products U®TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) • Copy o CContr act o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products 10TE: All dumpster permits require sign off from Fire Department prior to issuance of BIdg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeal that the a `eal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording must be s17 with the building application Doc: Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TWE -OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art Elg STS immin Pools ' ❑ well ❑ Tobacco Sales ❑ ' ' Food Packagiug/Saies ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SINN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature, CONSERVATION Reviewed on Signature COMMENTS F HEALTH Reviewed on Signature COMMENTS �+ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_ P tinning Board Decision: Comments Conservation Decision: Comments Wager & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osc FIRE DEPARTMENT: -.Temp Dumpster on site yes no Located at 124 Main Street Fire Departmefit signatureldate ` s , ��n rtn nr'1.ITl� Street -Mmension 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.$10041 000 fine Doc.Building Pen -nit 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 o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products N®TE: All dumpsfer 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) o Engineering Affidavits for Engineered products 40TE: All dumpsfer permits require sign off from Fire Department prior to issuance of BIdg 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 o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products 10TE: All dumpsfer permits require sign off from Fire Department prior to issuance of BIdg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appel 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 s` Doc: Building Permit Revised 2014 V1110h 0Aa44,.LF Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 1 Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building [I One family 0 Addition [I Two or more family [I Industrial 0 Alteration No. of units: El Commercial Repair, replacement Ej Assessory Bldg [I Others: 0 Demolition El Other [I septicY p 1Nell [I Floodplain n Wetlands" UVaterslied ewer,,,- tp DWWIPTION OF WORK TO 61= FtKrL)K1V1t1J: Address: '5 0 occoyo 6 Ck-?0'51 ktion - Please Type or 'Clearly 77 GINNER: Name: e "]ff P _ e - lab on _5 A --x a e;...' Al S - �c -f E uberviset��-�� §t( t u 0 10 14� 7 -- Home prpKeMQntLicense '. 'Date ARCHITECT/ENGINEER Phone: Address: Req, MD. FEE SCHEDULE. BULDjNG PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 7 -00 -___,Total ProjeGt Cost: $ 112f 5FEE: $ /` Check No.: Receipt No., 11 �I T tot NOTE: Persac 1 nave: o ih unregistered contractors do riot h avaccess to guaranty fund 7c Location -7 ' Edi-'iL,-,-s 1 r r No. 6R �- 01Date o, O/ Check # �9� 31 X96 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL !,�` Building Inspector (�14(9mtmo MWiGrt .. 55 Main St Saugus MA 01906 Fax 781-605-1017 Cell 781-962-99801 Sidnei Eleoterio 12/30/2016 Royal Crest Estates 50 Royal Crest Dr North Andover MA 018045 Bldg 7 unit 5 contract * Abate -Demo bathroom walls and ceiling *Install new drywall *compound, sand,prime & painting *install new plumbing fixture *install new electrical fixture Manager Total $12,500 Contractor Sincerely, Sidnei Eleoterio CELL#781-962-9801 FAX# 781-605-1017 Golden Gates Services Inc. ACL # 000793 ASL # 900973 CSL # 097988 HIC #167403 1213012016 12:01 Prescott & Son Insurance Agency OAX)7813333278 P.0011002 DATE IMMODNY �o CERTIFICATE OF LIABILITY INSURANCE 12/30/2016 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 pollcy(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 Preeaott and Son Insurance Agenoy,Inc. 963 Eastern Avenue Malden MA 02148 INSURED Golden Gate Sarvicaa, Ino 55 Main Street Commercial Linea (781)322-2350 Saugus MA6 01906 I INSURER P t I PnVCOAnca (tPRTIPIrATR NI IMRFRrCL16123024505 REVISION NUMBER: 4 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. Nw LTR TYPE; OF INSURANCE POLICY NUMB2R POLICY EFF POLICY EXP LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 p ENTED nce ® '..500,000 A CLAIM&MADE a OCCUR MED EXP (Any one penin) 9 51000 793-00-38-10-0001 9/25/2016 9/25/2017 PERSONAL 8 ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS. COMP/OP AGO $ 2,000,000 X POLICY 1:1 JPECT ❑ LOC $ OTHER: AUTOMOBILE LIABIUTY COMBINEDSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per pwson) 9 H ANY AUTO AUTOS % SCHEDULED NON -OWNED X HIRED AUTOSS AUTOS 10200054e5 9/21/2016 9/21/2017 BODILY INJURY (Per eccldenU PROPERTY DAMA $ (Per accident) COMBI $ UMBRELLA UABOCCUR HCLAIMS-MADE EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 C EXCESS UAB DED RETENTIONS S AN031601 9/21/2016 9/21/2017 WORKERS COMPENSATION AND EMPLOYERS* LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y❑ ETM - STAT E E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE S D (IA ndawry In NN) EXCLUDED NIA A Realuetsed from the Company 10/28/2016 10/2B/2Di7 EL, DISEASE - POLICY LIMIT $ If yes, desodbe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VeH10LE6 (AWRO lel, AaalaenBi wamaraa acoeaura, m -Y uv acmenva n men vyacv,v rvqu,roul (978)688-9542 Town of North Andover Attn: Paul Hutchings 120 Main St North Andover, MA 01845 ACORD 25 (2014101) INS025 (201401) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORISID REPRESENTATIVE lJ S Seholnxck/PJR ;7�� ®'1988-2014ACORD CORPORATION, The ACORD name and logo are registered marks of ACORD All rights reserved. 1213012016 12:01 Prescott & Son Insurance Agency II)FAX)7813333278 P.0021002 CERTIFICATE OF LIABILITY INSURANCE DATE(NIMMD/YYM 12/3012016 THIS CERTIFICATE 1S 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 18SUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed, If SUBROGATION 18 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 PRESCOTT & SON INS. AGENCY INC. CONTACT NAME: Paul Racki PHONE 81 322-2350 a ss: paul resoottandson.00m COMMERCIAL GENERAL LIABILITY 963 EASTERN AVENUE INeuRER a AFFORDING COVERAGE NAIC a INeuRER A : TRAVELERS INDEMNITY CO OF AMERICA 25668 MALDEN MA 02148 INSURED INSURERS: GOLDEN GATES SERVICES INC INSURERC: INSURER 0! 55 MAIN ST INSURER E: SAUGUS MA 01906 INSURER F: COVEKAGEs CERTIFICATE NUMBER: 114786 REVISION N1tIMRTzR- 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 POLICY NUMBER ia=�) PcUCY ExP (MMIDP�= LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PREMISES E $ CLAIMS MADE a OCCUR MED EXP one parwn $ PERSONAL & ADV INJURY $ N/A GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRL O• JECT M LOC GENERAL AGOREGATE $ PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINE M11 $ ANY AUTO BODILY INJURY (Per peraw) $ ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS N/A BODILY INJURY Per eaidenl $ ( ) PROPERTY DAMAGE $ Per ecdd n1 S UMBRELLA LIAe OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE N/A AOOREOATE $ DED RE NTION $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN OFFICER/MEMS REXCLUDED?Ar4YPROPRIETOPJPARTNERIEXECS NIA (Mandatory In NMI If es describe under SLtRIPTIONOFOPERATIONSbal. NIA NIA 6HUB4898P83816 10/28/2016 10/28/2017 X PER OTH OT . E.L,EACHACCIOENT $ 500,000 E.L. DISEASE -EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached If more *paw le required) Workers' Compensation benefits Will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authodzatlon Is given to pay claims for benefits to employees In states other than Massachusetts if the Insured hires, or hes hired those employees outside of Massachusetts. This certificate of Insurance shows the policy in force on the date that this Certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored dally by accessing the Proof of Coverage - Coverage Verification Search tool at www-mass.gov/iwd/workem-Compensationrinvestigations/. 1 lum SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WrrH THE POLICY PROVISIONS. 120 Main Street AUTHORIZED REPRESENTATIVE North Andover MA 01845 �/_- Daniel M. C y, CPCU, Vice President — Residual Markel — WCRISMA W IVI O-ZU14 ACUKU CUKPOKATION. AH rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD NOTICE TO EMPLOYEES NOTICE EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017 617-7274900 — http://www.state.ma.us/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (6HUB-4898P83-8-16) 10-28-16 TO 10-28-17 POLICY NUMBER EFFECTIVE DATES PRESCOTT & SON INS AGCY 963 EASTERN AVE t MALDEN - MA 02148 NAME OF INSURANCE AGENT ADDRESS PHONE # GOLDEN GATES SERVICES INC EMPLOYER 74 SPRINGVALE AVE UNIT 8 CHELSEA MA 02150 ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the. First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 001402 W20PIGIS TO BE POSTED BY EMPLOYER of Public Safe{Y . me husegs QeO rt a and Standards �lhassac- Mations Reg Board ofi Building asor p `^ Con.triicdon Supe sem. License: �• r Sidnei Eleote D vj'6 I�nnedy _ 244 V2148 gulden Expirations 0211512017 i �a-Iiewtoaerueall�:afC�/�o - a�ac ur1eQ Office of Consumer Affairs.& Business Regulartior. — , OME IMPROVEMENT CONTRACTOR _ egistrationc_ `'-167403 'Expiration— — Type . - 9721 Corpora GOLDEN GATES tion. SER\[(jCE50l`clrt SIDNEI ELEOTERIOl Z44 KENNEDY DR. 402" 1'ALDEN, MA 02948 . Alnderseoretary