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HomeMy WebLinkAboutBuilding Permit #610-14 - 34 ROYAL CREST DRIVE 2/26/2014_ ' TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page L®CATiIONzo- P. rint PRORERTV ®WNER � � M C 0 Pnnt 1:00 Year Old Strutt MAP NO: PARCEL °� ZONING DISHistonc District yes, o yes roof TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: t -L- ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Septic D 1Nelt Floodplain♦ ❑'Weflands Vllatershed�®istrlct El (YV er/:Sewer DESCRIPTION U1- V11UKK I U bl= rtKrUKIVltu: iv IGi c 47 1 %, bis +i P ." / & cn /2 Ln Identification Please Type or Print Clearly) OWNER: Name: 4,� i C < Phone: Address: 'a 6r 1 ch L&Z2 7 c� G 3�Z - -- _ r - - - Address: /c? S"upervlsorrspCosnstruction rLlcense C)GS�C ► _ Exp Date: _ _ _ Home Irnpr-ovementF License Vi=i (,--.� ._ � -k p Date' --JL 6 J -1q ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. C) FEE: Total Project Cost: $ V ---- Check No.: VT 601 Receipt No.: NOTE: Persons contracting 4ith unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Pians ❑ i` Plans Submitted ❑ PlansWaived-11 :.Certified Plot Plan ❑ Stamped Plans ❑ TI'PE.OF..SI WEMGEDiSi'OSAL Public Sewer ❑ Tanning/1b4assageBodyArt ❑ .. .Swimming Pools ❑ Well ❑ -Tobacco-Sales ❑ -Food Packaging/Sales ❑ Private.(septic tank, etc..:❑ Permanent Diimpster ori -Site THE- FOLLOWING SECTIONS FOROFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM :_ DATE REJECTED: PLANNING & DEVELOPMENT' ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE: APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments :Comments Water & Sewer Connectio111Signature Date Driveway Permit DPW Towo Engineer: Signature: Located 384 Osgood Street F)kE DEPARTNi NT Temp Dumpster on sit eyes no Located at 124;Mair Street- .1. 'Fire Depatme►it signature/date { MMENTS a -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. ®NE LITERATURE: Yes No MGL -.Chapter 166 Section. 21 A= F and G min.$100-$1000 fine NOTES and DATA — (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 ~ Building Department -The follawing is a-li'st of -the required.forms to be filled out for the appropriate. permit to .be obtained. Roofivg, Siding, Interior Rehabilitation Permits o' Building Permit Application ❑ Workers Comp Affidavit LiPhoto 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 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.+.ted with the building application Doc: Doc.Building Permit Revised 2012 The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): S,411-1 //Z0� AddressS City/State/Zip: Phone #• e, Are you an employer? Check the appropriate box: 1. EJ 'Iam a employer with �_ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. i 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 must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy andjob site information. n 1 /, Insurance Company Name:. . &-7 Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: v s City/State/Zip: Attach a copy of the workers' compens ion policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or oneyear 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 DTA for insurance coverage verification. X do hereby cert Jeriepains nd penalties ofperjury that the information provided abov7/'V andcorrect. Cia-nnfirrP- /� 7 Date: 2— h 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 B&M RESTOR,4TIONAND CONTRACTING , INC. 107 ORLEANS STREET EAST BOSTON, MA. 02128 (617) 561-9998 (781) 342-5178 fax (617) 293-1722 cell PROPOSAL �I 1 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: 23 Set up protection around the work area. Install safety fence around perimeter of work. Remove 4 courses of brick on top foundation and install new 16oz. copper flashing with thru wall membrane. Fasten with termination bar and set in mastic. After prep work is completed, close in cavity. After flashing is completed, cut and point buildings. Building 23: $60,000.00 We hereby propose to furnish all labor and material complete in accordance with the above specifications for the sums stated abov . AUTHORIZED SIGNAT DATE: 2-5-2014 Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are eaauthorized o do work as specified. AUTHORIZED SIGNATURE DATE: I! 1 B&M RESTORATIONAND CONTRACTING , INC. 107 ORLEANS STREET EAST BOSTON, MA. 02128 (617) 561-9998 (781) 342-5178 fax (617) 293-1722 cell PROPOSAL eDC 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: 34 Set up protection around the work area. Install safety fence around perimeter of work. Remove 4 courses of brick on top foundation and install new 16oz. copper flashing with thru wall membrane. Fasten with termination bar and set in mastic. After prep work is completed, close in cavity. After flashing is completed, cut and point buildings. Building 34: $60,000.00 We hereby propose to furnish all labor and material complete in accordance with the above specifications for the sums stated above. /-4'-'EDATE: AUTHORIZED SIGNATURE 2-5-2014 Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified. AUTHORIZED SIGNATUREI.— DATE: � � �,✓ �` CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYY1t) 2/19/2014 TI{I� CERTIFICATE IS ISSUED AS Q MATTER OF IN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CEFMMFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL -40W- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REFw!SESENTATWE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMV4C:)RTANT.- If the certificate holder Is an ADDITIONAL INSURED, the polloy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the Berms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the catt"icate holder In lieu of such endorsement(s). PRODuGaR cT Jean Sullivan, CSC, AIS Bur zn, Platner, Hurley insurance Agency, LLC PNNAo g y r ( 617) 472-3000)2-7288 ADDRESS. FAX (617 47 14 r �ankl in St. E-MAIL ' as@b hins .Com Quiet dT —y MA 02169 INSURER & AFFORDING COVERAGE NAI iNSURERA:Hanover insurance Com an 229: tNSUREt7 INSURER B:Safet Indenmit Insurance Co 361E B & 164 Restoration & Contracting, inc.INSURERC:Acadia Insurance Com an 107 4arleans Street INSURER D: INSURER E : East Boston - MA 02128 -•-_-- S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE""ORM NUI DGNAMED ABOVE FOR: THISITHE POLICY PERIOD INDICATED. NOTWITHSTANDINd ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH 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, EXCLJJSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCEsu POLICY EFF POLICY EXP TR POLICY NUMBER LIMITS O�£:RAL LUtBILfTY y NrM0647EACH OCCURRENCE%2 , 000� COMMERCIAL GENERAL LIABILITY nal insured PREMI 9 a occuA CLAIMS MADE ®OCCUR by Written /17!2013 /17/2014 MED EXP ( one t PERSONAL &ADV IN, OOO, OI GENERAL AGGREGA, 000, 0( GEN`L AGGREGATE LIMITAPPLIESPER- PRODUCTS - COMP/ v POLICY I ► Pe Q I f inn DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addit(onaf Remarks Schedule, It Moro is required) Contract# 1611 -422094 -CP -00001 ;AIMCO North Andover LLC is additional insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN A19CO North Andover LLC ACCORDANCE WITH THE POLICY PROVISIONS. 50 Royal Crest Drive North Andover, NA 01845 AUTHORIZED REPRESEIITATIVE 1K Besse, CFC CiSR CPI �' ACORD 25 (201 OMS II ©t9E18-2010 ACORD CORPORATION. All rights reserved. i i'� tLtf withpdfFactory triali'O�fsiftWWn3' ff�tjt A�MOBILE LIABILITY y y 208157 $ ANY AUTO - ditioaal Insured Ea -a iideDtl i NG L 1 1, 0010 B AUL ED $ SCHEDULED er Written Contract 1/6/2013 1/6/2014 BODILY INJURY (Per person) S '-" NON -OWNED 2 HIRED AUTOS AUTOS diver of Subrogation BODILY INJURY (Per accident) $ PROPERDAMgGE S X UMBRELLA LIA6 g OCCUR Y N 905512100 PIP -Basic $ B A EXCESS U" CLAIMS MADE Follow Forth EACH OCCURRENCE S 5, 000 pED y RETENTION /17/2013 /17/2014 AGGREGATE $ 51000 WOR>FCERS COMPENSATION N S AND EMPLOYERS' LIABtLITY Y/ N r I WC TATO- OTH- TORY I ANY pROPRIETORtPARTNER/EXECUTivE WITS ryiinNIEOR EXCLUDED? O N/A -20-20-003740-OZ /10/2013 /10/2014 E.L.EACH ACCIDENT 4L --1--0-0O 11 -000 E.L. DISEASE - EA EMPLOYE $ 1 000 if yam, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE . Pnl Iry a marc m nnw DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addit(onaf Remarks Schedule, It Moro is required) Contract# 1611 -422094 -CP -00001 ;AIMCO North Andover LLC is additional insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN A19CO North Andover LLC ACCORDANCE WITH THE POLICY PROVISIONS. 50 Royal Crest Drive North Andover, NA 01845 AUTHORIZED REPRESEIITATIVE 1K Besse, CFC CiSR CPI �' ACORD 25 (201 OMS II ©t9E18-2010 ACORD CORPORATION. All rights reserved. i i'� tLtf withpdfFactory triali'O�fsiftWWn3' ff�tjt QaLU = LL O o O m C u Y \ LL v N U VI u Z C7 Z m C LL L YN w N C u _ LL O a aLLJ 2 c7 Z 7 d L 7 c _ (O LL O0 a0 ? a u V W L j CC N U Ln f6 LL w z H Cal L 3 w _ t0 LL ~ Z LU a a c ui 5 LL ` N i CO z -0 ++ N N V1 aj QJ U Y O to uj am _ _ Cc 0 Q 4+ �a y- o N o. N °= _ �s o 40 E vm L = 0 i v N d Cc Q' J L m wr > N i °' (n a) 0- °' C c a.: U -a O 0 N �a =ss E c 00 z y O O �.to 3 L Q d d CD 0 d+ _ m 0 .N c� co 4)c = a L L = 0 I— p N 0 v m cc li N R N = F- N .0 W - C.) V a> 0 -a as ,_• N C. d U) N O 1- _ 0 Q O V V. CO Z L CD Z COW w x LUH LU 0- ti N 2 W O Q� L o Z O y I O N � � W � O �+ win O O CL a CL �a O J0 •�O,a; Z O v cn C CL Cl y N W W 19 W U) "�4 - Location "YL ( I No. Date f Check # 1.2,7320 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee . $- Other Permit Fee TOTAL $ Buildihg Inspector J-� 1 1: ,