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HomeMy WebLinkAboutBuilding Permit #154-15 - 44 ROYAL CREST DRIVE 8/12/2014 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER 02 h' O� APPLICATION FOR PLAN EXAMINATION '" A 4 � Permit No#: Date Received Z / 7.95 RATE°r`Pa,`'�5 SACHUSE Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION, /� Print PROPERTY OWNER AD,^ C u - Print 100 Year Structure yes no MAP PARCEL: , ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: t ti ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIP 10 OF RK TO BE PERFOR ED: GLk d a /^C! r ' Identification- Please Type or Print Clearly OWNER: Name: C6 Phone:/, 2—;LJ&_02Z Address: -e h Wom Contractor Name: �°""� _ Phone: (v 16 :' S4 f —5gy�r Address: d•.l let!& 55, gap Supervisor's Construction License: 1'C ._U t a I _Exp. Date: Home Improvement License: ,. 1 �, 3 4 Exp. Date: /;/K1�41 _ ARCHITECT/ENGINEER Phone: t Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ (4. 00 d FEE: $ 79 0 . d'© Check No.: 00�; Receipt No.: 9 7cp,�--2 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sig a of Agent/Owner Signature of contractor 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. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY I INTERDEPARTMENTAL SIGN OFF - U FORM ` L i PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments a Conservation Decision: Comments Watwr4 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 i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i i 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) ❑ Notified for pickup Call Email i Date Time Contact Name Doc.Building Permit 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 ❑ 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/Cross Section/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 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 Doe:Building Permit Revised 2014 RT � N� M Town of ndover No. I� E ," ver, Mass, 1. �q COC MIC Ml WICK � - U BOARD OF HEALTH Food/Kitchen PERM. IT T LD Septic System THIS CERTIFIES THAT .......... . .... ..z� q...C62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR has permission to erect ......,................... buildings on ..��'�..�.�'.. ..�,/.�:./„�.C�,r ,,,,,,.,,,,,,,,,,,, Foundation Rough to be occupied as ............. �r..: . . t... .%`.�... �G:, .Qr Yer .. . ....................... Chimney provided that the person accepting this permit shall in every respect conform to thems 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 ..... ............................ fu"lLDI�VG INSPECTOR Final 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. l , rMe Commonwealth gfMassaefiusetts - Department of ntl;'cst�rcclAcciclent . , O•face offnvestigadons 600 Washington Street . Boston,MA 02111 www.massgovIdia Wo rkey$l compensation Insurance Affidavit:BuRdere/Con.�ft°actoo)FIectriciansr?I*Pers ADufficanl hformatzon Please.Print •N'ame(Business/Orgauizationlfn&idual): LOS �Owe..A d&.1 Address: cx (gr-1 114y►t s City/State/ftp: Age Ca�13�, Phone# 0 -�:S Vr- . Ala yoltan employer?Cbecle the appropriate box: Type of project(required.): 1.Lr I am a employer with�� 4• d 1 am a general contractor and 1 6• El New construction f employees(fWland/orpmttime)* have nodthe sub-contractors 2.C] I am a sole proprietor or partner listed on the attached sheet T 7• ❑Remodebing ship and`havena.employees These subs-contractors Have S. [[Demolition working forme in any capacity workers,comp.insurance. g, ❑Building addition [Nb workers'comp.insurance 5. ❑We are a corpoxaiion and its 10.j]Electricalrepairs ox additions re clakad.] officers have exercised.theix 3.E11 am a homeowner doing all work right of exemption per MOL 1111 1 Plumbing repairs or additions myself:[No workers'comp. a 152,§1(�)a andwehaveno 12•�(Roofxepairs insurancerecluixed.�i employees..LN'o workers' 13�Otliex comp.insurance required.] Any applicant checks boxi#1 must also fill outthasection belcm showingtheir workers'compensatioupollay information. �'Homeownerswho submit thisaffidavitindtcatiugiimey2red ping anworlcand then hire outside contractorsmust submit anow affWevitindicafingsuch. xContractors that oheokthis bgF mast attached p additional sheet s-h I the name of the sub-contractors and their workers'comp.policy information. mpensation insurance fopmy employees Balolp is ihepolley antljoh site I a�n an ernproyeN t�iat is providir2g workers'Co infomation. � / Insurance Company Name; �M 4U n v ey Policy#ox Selz ins.11ic.#; '3.�-�`'y Z Expiration Date: I7 To6 Site A ddxest;: 4 ` 1' City/State/Zip: AtEaclx a copy of tete woxlcers'comnpern•policy declaration page(showing�tile policy number and expiiratiora date). Failure to secure ooverage as xegpixecl,under Section 25.A.ofNSGL o.152 can lead to the imposition of eximinalpenalties of a fma up to$1,500.o0 and/ox one-year iinpxiso�ment.,as well as chilpennalties in the foxrn of a STOP-WORK OIt37E12 and a fine ofupto$250.00aday against thay.olator. Be advised that a copy ofthisstatement maybe forwarded tothe Office of- Investigations of the DIA.for insurance coverage veriRcation. X do hereby cert f ert1 epa'rts and venalties ofperjury tliat trio information provided move is true and correct. Si afore- . Date: 2 Official use 0111Y. Do not write in trigs area,to be compYeted by city or town official City or Town: - Permffff icense# fSsuingAuthority(circle(ne): 1.Board of wealth 2.Building Depa�rtmeek I Cityl7Cowa Clerk 4.Electrical inspector 5.Pluznbiug Inspector 6.Other - - - Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for i ieir employees. Parsuant to this statute,au ernployee is defined as"...every person iii the service of another under an express orlmplied,oral Orwxitten." y contract of h7xe,. .Ane lave" defined as"an individual,partnership,association,corporation or other legal entity,or anytwo ormoxe Oftho oxegoingengaged inajointenterprise,andkoludingthe,legalxepresentativesofwdeceasedein to ex.orie, xeceiver outnistee of an individual,partnership,association or other legal entity,employing employees. 4,6vex the owner of a dwelhghousehavingnotmoxe-thanthmo aparknenfs andwho xesides thereina oxthe occupant o£tize dwelling house of another who employs persons to do maintenance;constructio4,6rxep*work on such dwelling house or on the grounds or building appurtenant thereto shsll not be cause of'such emplbyt ignt ba deemed fo be an employer., MGL chapter 152,§25C(6)also states that"every state or local l eusmg agency shaltwithhbld iho issuance ox renewal of a Reensevr permit to-Operate a business or to construct buildingsanthe.com'ponwealth for any applicant•who has not pyo d�xced.accelifable evit�ince of compliance wife tl3.e�nsdraazc�'eb�ieraga xe�uiir�ed;' Additionally;MGL chaptex 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpubllc workuntil acceptable evidence of compliance»with,the insurance xegi:dxemants oftlus chapterhave beenprosentedta the contracting authority." .Applicants Please fill.out the workers'compensallon affidavit completely,by checldng the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)andplionenumbex(s)along with their cer9cafe(s)of insurance. Limited Liability Companies(LLC)oxLfi itedUabilityPartnerships(M)with no employees other tfim the, members orpartners,arenctrequiredto carryworkers'compensationlusurame. If an LLC orLLP doeshave employees,apolicyisrequired. De advised thatthli affidavit maybe submitted to!ho,Department of ladustdal, Accidents for confirmation of insurance coverage. Also be suxe to sign and;date the affidavit: the affidavit should be,returned to the city or town that the application for the lit or license is being requested,)tot the Department of Industrial Accidents. Shouldyou have any questions regarding the law ox if you are xequired to obtain a workexs' eompensadonpolloy,please call the Department atthe nmmhErItedbelo . Selfinsuredcompanies shouldenter their self insurance license number on the appropriate line. City or Town Offtelals Pleasebe sure thatthe affidavit is complete andprinted legibly. ThaDapartmenthas pravjded a.spaco aE,tha bottom ofthe affidavit for you tofill out in the event the Office ofInvesfigationshas to contactyouregarak� the applicant. Please be-sure to fill inthe peimit/,licenm number whichwill be used as a reference number. M additio ,;fin applicant thatrnust submitmultiple permit/ltconse applications in any givenyear,need only submit one affidavit indicating current Poll cy 3nfo�xma��"o ifnecessary)and under"Job,Site Address"the applicant-shouldwx1te"alllocatior�in. r;(city or tow:n)"'A copy of'the affidavit that has been officially sfai aped or marked by th city or town may be provided fo the applicant as proofth.at a valid at�davit•is ou file dor future p exmits ox licenses. A new a fxdavit must b e filled out each year.Where ahome owner or citizen is obtaining alicense oxpexmitnotrelated to anybusiums or commercial venture (i.e,a dog license orpermit to burn leaves eta.)said person is NOTrequired to complete this affidavit. The Office of Investigations would like to thank you is advance for your cooperation and should you haveany esfi0 please do not:hesitate to give us a call. . The Department's address,telephone anal fax number: oIawcalth ofM; PaPaxtMt dZx ftftial AcddeutEt Ofco offmadpooxt 6bQ Wang n xeo logon"MA 02111 Revised 5-26-05 FOR 6 � I C�/c ze�oa�a��vacuaeatl�-o �ccaaac�uanlf Office of Consumer Affairs&Business Regulation -- #OME IMPROVEMENT CONTRACTOR Registration: 153188 Type: xpiration: 11/6/2014 Private Corporati I B&M RESTORATION AND CONTRACTING INC i PAUL BRUNO 107 ORLEANS ST I EAST BOSTON,MA 02128 Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards i Construction Supervisor License: CS-065281 PAUL BRUNO 109 CHESTNUT STREEJ-) Lynnfield MA 01940 Expiration Commissioner 09/28/201: I Per your request Jean Ac CERTIFICATE OF LIABILITY INSURANCE 2f/19/I 2001414 1 �.---- 191 THIS COMM411 Is 16-SUED A5 A MATTER OF INFORMATIO'AI ONLY AND CONFERS NO MOMS UPON THE C'Eit]"CA"TE HOLDEM THIS CERTIRCATE DOES NOT AFFUMAT1VELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORMD BY THE POUCtES BELOW, THIS CEFMFIGAM OF Fti5 PANC'E (DOES NOT C(NiSTiT>}7'E A CONTRACT SEMM"THE IMM IMStt A[%,AUTHOA REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. OPORTANT, tt tha certiiitata holdor t&aro A00ITIONAL INSURED. $olisYClesP moist b0 enow"o, m B 000GATION is wAIVM subsea to the terms and condWons a1 the party,catisin pofick4 may rt;I in an tndorserm-A. A statement on this certificate does not conAtt 69fits to We c*41"te hoidor to ON of Such+�xdG+SetsM A POODUCEA : ' ,lean S%123van, CIC, AIS Burgin, Platner, Burley insurance Agency, LLC to» 6111472-34413 cox" teirlssa_sa�s 14 Franklin St. w"aA add hins:cam tlEcaYl "�3 EFIa71Zk1NG cfivEFJiC.E NaIS r , Quincy MA: 02169 $ . • 81Qovr, IastlranGe Cvnlgpacay,._•.. �Z2292:»..x,� Muiw a tstmrrta•<Safety Indemnity Insurance Co ;33618 B & M Restoration & contracting, Int. IggoF.,c'CAcadia Insurance Company, 4 107 Orleans Street s*4fuFTro;, i } aNzultaw r East Boston MA 02129 cu t COVERAGES CER?9I:ATE NUMSE1T:Z943-14M sterCertU ate REV1S#ON NUMBER; THIS IS TO r-OZTIFY?IRT THE POUC-SES OF INVJRANCE.LIS MC'-BE'.3.t V;t-AVa BEE!!ISSL4 h To T*r ft�13:ic�T fi$�i�ttBD'UE i't%f'I T'f�.PGi.R.Y PE THIS tt rt:.ATE0 uOTJTWMT,5,ANDING AW, REs`WREME14T.Tt-RM OR#*IDITION OF ANY 4`GWRA-CT OR IJMtE d 111}e':MENT WITH RE,'KCT TO VIHIMI THIS CERTIFICATE M6-Y BE ALT OR MAY PERTAII4.THE If<AAA+g F AFFORDM 8Y THE Pfd~g5;,d'E i&ED fiE fu I$SIMC7 TO ALL.THE TEFeM$, EXCLUSIONS AND C#DNDt T MIS OF SUCH POLICIES.LIMITS SRC9hWMAY HAVE SM:N RE'JUCEi}BY't> V CLAiASS46UL POULT em EV . 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C040 �Ff.E+�.N£::Etir --!l£>;C:' N kiA r- 20-20-00374a-01 61. #.'10/2013 .6110/2014 1L 0ttA. tG oE.DYt: S 1,044.,000 ttir,#¢lFiilyet+#IIMF - .. .. :VWGY"�,rY",hf�'( L L..iF$f-rt7L.11eLAi4 : 1,044,444 p.�FiiW"3(;OA GF•,-.t�RhAU�£EKT.0 .. .. .... :. ,. A:..., .:. ... x l7e.CR3eTY3N Ot C'CCAi/'{IQ!l31'L9CAFttfNiSJYE}iC3.G3 IAS,r'h JtGt]AL7 3DI.addtA-mtl ft�ar4x Seh�Arlr..fA»aec aPu�ht�rs4l Corotract#1 '1611-42204E-CF-00601 ,,AIXCO North Andover LLC is additional insured cEf;rnFtCATE HOLDER CANCELLATION SHOULD ANY OF TM ABOVE DESCRIBED POLICIES BE CAM ELLER BEFORE THE Ex$nAAnoxt DATE. THEMOF, NOACE kV%,L 89 DEUV00 w ACCORDVXE WITH THE.POLICY PROVISMUS, ARMCO North Andover LLC 50 Royal Creat Drive s>srrtalatmrvPgsaes�ITArnIs North Andover, MA 01645 K Besse; cYc CISR CPY r i B&M RESTORATIONAND CONTRACTING, INC. 107 ORLEANS STREET EAST BOSTON, MA. 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: 45 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 45: $60,000.00 We hereby propose to furnish all labor and material complete in accordance with the above specifications for the sums stated above. AUTHORIZED SIGNATURE ATE: 7-22-2014 Acceptance of Proposal: The above prices,specifications and conditions are satisfactory and are hereby accepted. You are author' d to work as specified. AUTHORIZED SIGNAT DATE: 1- 241111�1 Location � r No. ��LI— 4j Date A / 41 • - TOWN OF NORTH ANDOVER e Certificate of Occupancy $ 4 "N' . �� Building/Frame Permit Fee $ e7 — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Buijd,�KInspector