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HomeMy WebLinkAboutBuilding Permit #1227-16 - 25 ROYAL CREST DRIVE 5/24/2016 _6 0:1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPO TANT:Applicant must complete all items on this page LOCATION Z� (Za�g( C-225-r A21✓.e AJ, t+N0 u�1 ,x f • eDt.9 11,5— Print PROPERTY OWNER Wo R rH Rm oweP_ 90JA I Ca-e5-r LL G Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 0 Addition P?JFwo or more family ❑ Industrial 0 Alteration No. of units: 1 Z 0 Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ s ,c�" f" "..x' „` c+ h( p ®�WatershedlDis 1C -r ` w-0 ep ®W,ell Nt,; o ®Floodplaui� �t�Wetlands 4 { � ., r.�d n, ®Wa_ -,:-ter_ _.�3=�` of a ..�:,:._.,-,.a,+,� z St._�.*�.�R-, ` _'�..�."A'�_�+.�k....,..�sa,- "•} DESCRIPTION OF WORK TO BE PERFORMED:M rR 7b -e(ec�,c c_ i'U �M � Identification Please Type or Print Clearly) OWNER: Name: I A4 Co 1?&y4 L C R.t2St` 5r#7x1-1 5 Phone: 9`77 fQ T 9'z 2. Address: a /0sfilt- C40-5 r-/J21 )U ' I-aooy t' . EI F ts' CONTRACTOR Name: �h°i�'' S �' '��� Phone: F79-36,6— Address: 79`36d—Address: a g tv B 12 AdJ.uA-q /'14 b 1 8 3 2— Supervisor's Construction License: GIS 05 27`f7 Exp. Date: Home Improvement License: Exp. Date: eoo,at"4-n,e ARCHITECT/ENGINEER k>Yi✓4 coaScc 1 '5 Phone: q75 835- 0/ 02 Address:&3144IA�5r• 1A.AA-46, A4 Reg. No. FEE SCHEDULE:BULDING PERMIT,$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 4 t 7Z O FEE: $ / Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfun F--="— " i nature of.contractors:' =,:: Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ TanArt ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ` Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on 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 EI Notified for pickup - Date Doc:.Building Permit Revised 2008 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/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 ❑ 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 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals 'gat the appeal period PP p is over. The applicant must then et this recorded a o recording g t the Registry of Deeds. One copy and proof f g lust be submitted with the building application, Doc: Doc.Building permit Revised 2008mi NORT1� F Town of o :. No. a? I.., 2A * t - � Z o64h , ver, Mass, �� COC NIC Hl WICN 1' 7 R•�TEO I.P ,C�S s U BOARD OF HEALTH PERMIT T LD Food/Kitchen o �� r Septic System THIS CERTIFIES THAT - 4d r BUILDING INSPECTOR I �� Foundation has permission to erect .......................... buildings on ................. .(�`,r�....p... ..G�. ....:� .................... Rough to be occupied as ............... ......Iro..4axt ......... .............. '.................. 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTSRough Service A .. 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. East Coast General Contracting BUILDING RESTORATION PROFESSIONALS 286 Broadway Haverhill, Ma. 01832 Phone 1-978-360-0051 Fax 1-978-372-4215 4/28/2016 North Andover Bldg 25 electrical room wall Remove existing doorframe. Remove existing block wall to accommodate new wall. Remove existing concrete lintel. Provide and construct new wooden 2x4 wall with header as necessary to meet existing sub floor above. New wall shall be framed to accept a new 6 0 x 6 8 steel fire rated door unit. Interior ceiling and new framed wall shall be have a double layed of 5/8 inch fire coded drywall installed. Exterior wall to hallway shall be a single layer of 5/8 fire code sheetrock. All new drywall to be seamed, sanded smooth,primed and painted to match existing. New steel fire rated door shall be provided and installed in new opening. Door unit includes self closing hinges. Transfer existing door lock set to new door unit. Door shall be painted to match existing. Wooden baseboard shall be provided and installed to match in dimension and color. Newly exposed Boor shall be free of defects and painted to match existing. Provide 1 new shallow hallway light fixture to match existing and allow door to swing open. Project shall be completed to meet Aimco standards. Clean up of all job related debris. Project includes necessary permits and inspections. II Total Labor and Materials For the Sum of Six Thousand Seven Hundred Twenty Dollars. $6,720.00 Sincerely; Tom Kinnal J J = c REMOVE EXISTING SINGLE DOOR AND DEMO INSTALL 72"X 80"1-1/2" CONCRETE WALL TO TO FIRE RATED DOUBLE 4'-10" ALLOW FOR CLOSET DOOR UNIT F- EXPANSIONS w cn INTERIOR WALLS OF O UTILITY CLOSET INSTALL M q 2 LAYERS OF 5/8"FC DRYWALL J } F= EXTERIOR WALLS OF 4 UTILITY CLOSET INSTALL a 1 LAYER OF 5/8"FC s EXISTING WALL TO REMAIN DRYWALL 0 2'-2" EXISTING WALL TO DEMO T-0" PROPOSED 2"X 4"WOOD FRAME WALL Utility Closet Expansion Detail SCALE: 1/4"=1 FOOT _. CORNERSTONE NAND ��u��a! !S DevlopgLd Plann(ng•Gener.1c l Contratig 61 Main St.•P.O.Box 657•Pepperell,MA 01463•978-433-8100 } J J a x _ REMOVE EXISTING SINGLE DOOR AND DEMO INSTALL 72"X 80"1.1/2" CONCRETE WALL TO TO FIRE RATED DOUBLE 4'-10" ALLOW FOR CLOSET DOOR UNIT f- EXPANSIONS w INTERIOR WALLS OF O UTILITY CLOSET INSTALLzo 2 LAYERS OF 5/8"FC DRYWALL a � EXTERIOR WALLS OF 4 UTILITY CLOSET INSTALL -j 1 LAYER OF 5/8"FC = _ �� EXISTING WALL TO REMAIN DRYWALL c- 2'-2" P EXISTING WALL TO DEMO PROPOSED 2"X 4"WOOD FRAME WALL Utility Closet Expansion Detail SCALE: 1/4"=1 FOOT ®n�ul�a�ts � De�el�pe>�s ��Civil Engineering•Land Planning•General Contracting 61 Main St,•P.O.Box 657•Pepperell,MA 01463•978-433-8100 i FInvestigations 600 Washington Street -ton, MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers i / Applicant Information Please Print Legibly Name: (Business/Organization/Individual):�gSrc-04st-6,,,,W4A4C Address: 285- 3nb4dw l'( City/State/Zip: H4,)a4 , M+- o to 3 2 Phone#: q75 - 3<. v -aos 1. R I am a employer with 4.❑I am a general contractor and 1 6. ❑New Construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet.These sub- 7• E]Remodeling 2.❑ I am a sole proprietor or contractors have employees and 8. ❑Demo►ition partnership and have no employees have workers'comp. insurance. working for me in any capacity. 9. ❑Building addition [No workers'comp. insurance 5.❑We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their right of exemption per MGL c. 152,§1(4), 11.E]Plumbing Repairs 3.❑I am a homeowner doing all work and we have no employees. [No 12.F1Roof Repairs Myself, [No workers'comp. insurance workers'comp. insurance required.] required] t 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit 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-contractors have employees,they 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 /,r�� Mu_/ D`'it Name: Policy#or Self-ins.Lic.#: Expiration Date: / z g t O)7 Job Site Address:?SR rt42, V,4,vOOLA4 f A(4 o t$y5- City/State/Zip: e, P y 6 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certnder the i d penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: 3 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Existing Building Checklist IFEBC 2009 W i MA Amendments ACORO DATE(ImM/DOmvY) v CERTIFICATE OF LIABILITY INSURANCE02/17/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER.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 NCONTACT AME: Kathleen Marchitelli Fred C.Church,Inc. PHONE No.go: 978 3227172 FAX 41 Wellman Street (978)4541885 Lowell AIC No (800)225 10865 1 Wwchitalli@ftWcehunh.com ADDRESS: INSURE S AFFORDING COVERAGE NAIC N INSURER A: Peerless Insurance Company 24198 INSURED INSURER B: LM Insurance Corporation Thomas H Kinnal DBA Enst Coast General Contracting INSURER C: 286 Broadway Haverhill,MA 01832-2903 INSURER D: INSURERE: 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 WtY 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. /NSR ADDLSUBR POLICY NUMBER POLICY EFF MPOLICY EXP LIMITS TYPf::OFINSURANCE GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY AMAG O RENTED 100,000 PREMISES Ea occurrence $ CLAIM::-MADE a OCCUR MED EXP(Any one person) $ 5•000 A CBP8384091 2/152016 2/75/2017 PERSONAL&ADV INJURY $ 1.000.000 GENERAL AGGREGATE $ 2,000,0DO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2'0130'000 POLICY PRO LOC S AUTOMOBILE LUOILITY Ea BINEe�DdSINGLE LIMIT $ 1,00D.000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED A AUTOS X AUTOS BA8382891 2/732016 2/132017 BODILY INJURY(Per accident) $ X HIRED AUTOS X PROPERTY DAMAGE $ AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAR CLAIMS-MADE CU8979279 211512016 2!152017 AGGREGATE $ 2,000,000 DED X F2ETENTION$10'000 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS"LIABILITY Y/N I TORY LIMITS B ANY PROPRIETORIPARTNEWEXECUTIVE❑ E.L.EACH ACCIDENT $ '� OFFICER/MEMNH:,EXCLUDED? N/A WC531S353816036 12812018 128/2017 (Mandatory In BER E.L.DISEASE-EA EMPLOYE $ If gas,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Apartment Investment and Management Co.(AIMCO)and any AIMCO subsidiaries and affiliates that may directly or indirectly own or manage any property or properties at or for which the vendor performs any work are named as Additional Insured on the general liability,auto liatAity and umbrella liability policies H required by written contract IIS CERTIFICATE HOLDER CANCELLATION AIMCO Properties LP 5Jo c 51744 McGinnis SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE nrris Ferry Roar:Suite 133 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Alpharetta,GA 30005 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CiZi,a Msbi Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i Massachusetts-Department of t= k�{ic Sa`et, Board Of Building Regulations and Standarc!s Construction Supen-isor License: CS-082747 THOMAS H m1a 286 BROADWAY, HaverhiQ MA 01$32 A-10 1 EXP)r_ Commissioner 06/20/2016 i I I T- Location t No. f' ;t _ Date `•- /�/r_ 1 / • • TOWN OF NORTH ANDOVER ,k Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ;* c:. Building Inspector