Loading...
HomeMy WebLinkAboutBuilding Permit #153-15 - 44 ROYAL CREST DRIVE 8/12/2014 NORTH BUILDING PERMIT o` qti TOWN OF NORTH ANDOVER o� 0 APPLICATION FOR PLAN EXAMINATION * z YY Permit No#: J / Date Received k1 Z)/L/ Ar �gSSACHUs���y Date Issued: l zh IMPORTANT:Applicant must complete all items on this page LOCATION ` Print PROPERTY OWNER .; - I 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: )'L ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer n DESCRIPTION OF ORK O BE PERFOTED: Gv� ti �X OdA G r' Id tification- Please Type or Print Clearly OWNER: Name: vn C a Phone: Z Address: c e P% wig o d 544444W ��l Njtiaa Contractor Name: r Phone: G! S6 ^ 5 *h- Address: _- d`1_� _. Avf.SJars Supervisor's Construction License: L " (� 4 a,8'I Exp. Date: Home Improvement License: 1 S 31_.8 ' Exp. Date: // 6 /z1 b ARCHITECT/ENGINEER Phone: 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: $ 66. 000 FEE: $ 2 U Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund S g tture 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. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS I i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes f 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 i 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 9 pp 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) i i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i 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 Doc:Building Permit Revised 2014 I B&M RESTORA TIONAND 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: 44 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 44: $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 E: 7-22-2014 Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. Youare auth *zed to do work as specified. AUTHORIZED SIGNAT ATE: 2 NORTH Town of Andover Z. No. 3• I KE so L^Kah .� ver, Mass, Y coc..M.'C.. A_ \ 7,95 R47Eto) nPP�gS 11 BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT ......... ... ... CO BUILDING INSPECTOR has permission to erect �/-( ��f"ES� Foundation p .......................... buildings on ....... ..........�.:�.�.�........................................... c / Rough to be occupied as .......... .. :... .... . :. .... x"1. ...f /..{... .................................... Chimney provided that the person accepting this permit shall in every respect conform to therms 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 TARTS Rough Service ..................................... ... ... ... ..................... _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. alae Commonwealth qfHassachusetts - Departm nt of nditsft!iTl Aceldiints • Office ofluvestigateons 600 Washington.Street Boston,.tt1A 02111 www.mass.govtciza Wo rkexcs'Compengaton)fnsurance A-Mdavit:SuRder-I/Contrcac ox /E+lec iczansl'Xiiinbe ' A,. cant-Wo natio Please Print Le •Name(Businessl0rganizationLCnctivzdual):. .Address: -2-12"' Ab4l; Yd': CAy'/State,Mp: lX. &,Jv-, HAS OP;,k Phone# G A S 41— f f g Are yo an employer?CheckthO appropriatebox: Type of project(requires!): J. S am a employer with^ 4• ❑1 am a general.contractor and 1 6• New construction. f employees(`fulland/oxpar�time).* haveliiiredthesuls-contractors 2.C7 T am a sole proprietor ox partner listed on the attached sheet T `7• ❑Remodeling Alp and`havena.employees These sols-contractors brave 8. [�Demolition working forme in.any capacity. workers'comp.insurance. 9. Building addition [No workCrS'comp.insurauCe, 5. ❑We are a corporation and its 10.0 Electricalrepairs or additions xequired.] officers have exercisedtheir 3.[] I am a homeowner doing all work right of exemption.per MGL 11.E Plumbing repairs or additions myself:PTOworkexs'comp. c.152,§1(4),andwehaven.o 12.p Roofxepairs insurancere ed. 7 employees.[No workers' 13•❑Other comp.insurance required.] Any applicant that checks box#1 must also M.dut the section bele wshowingtheirwbrkers'compensation policy information. Homeowners who submitthisaMdavitiadicatingtheyai'edoingallworkandthen hireoutside contractors mustsubmit anewaftidayitindicatingsuch, TContractors that checkthis box must attached an,additional sheet showing the name ofthe sub-contractors and their workers'comp,policy Woanation. policyarTjobmite41WOefs'comnormYmployees Bolowishe Wamaxemployerthat i p o9pxzrf in,fv�mation. tt �� • Insurance Company Name; �-+,►C�Y� Oyp� 17 Policy#or Selz ins..T zc.#: `��•-`�� Expiration Date: lob Site Address: '�' City/State/zip: .» J.L Attacha copy ofthaworkers'e pensatioxt•poIleydeclaration page(showing.thepolicy number and expiration!date) . I Failure to secure coverage as regr6edunder Section 25A.of MOL a.152 can lead to the imposition of eriminalpenalties of a flue up to$1,500.00 and/or one-year imprison ent,as well as civilpenalties in the fours.of a STOP WORTS ORDER and a tine ofup to$250.00 a day against the violator. B e advised that a copy of this statement may be forwarded to the Office of fnvestigations of'the DTA.for insurance coverage verification. X do bereby eext f thepain and yenanies o,�•,perjary tJiat trie irg or natzoxt pYovidecT a7 oYe 2s ue and eon eet. Si afore• Date: f Phone# �l 7•,�'G /"g g g,•� O cciaT�cse©xtTY, Do not write in ON area,to be eoxnpTeferT Tiy e%ty ox'totvt o�ezaT. .ff City or Town: PermitlLiceuse# Issuing Authority(circle ene): 1.Board of Health 2.13uildingJDepartment 3. City/Town Clark 4.Electrical Inspector 5.Rlumbing Inspector f.ether - - - Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for fheix employees. Pursuant to this statute e " • ,au rn•�Tayeeisdei7nedas •.•everypexson,7 the service of mother uader . express orhaphed,oral or written.." r any contract of hire, An employes is defined as"an.individual,partnership,association,corporation.or other legal entity,or anytwo oxmoxe ofthe Foregoing engaged in a joint enterprise,and includingthe legal representatives ofa•deceased empioyer,.or tile, xedeiver or ftt stee ofan individual,partctership,association or other legal entity,employing employees. Sowe,vex the owner of a dwelling house having notmore,than three apartments and who xesides iltereiu,or the occupant ofthe dwelling house of another who employs persons.to do maintenance;constractio'n lox repair work on such dwelling house or on the grounds or building appurtenant thereto shall nof because Of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every sfate or local licensing agency shall" z'fhlfolry•l.Elie xssi4ance ox'' renewal of a license or pexknit.to,op erste a bgsiness orto constmet,buildings irz the,commanwealfli fdz aTay applicant who has xtot fro ditce'd.accepfalile evidezlace of compliance pvzth'te imstanc�covdxagexeuz Additlonally;MGL chaptex 152,§25C(')states"Neither the commo e nw althmox an of oli'c enter into . y p tt al subdzv�szons shall xn o an con . y fractfoxthe,perfoxmanceofpublicworkunt�lacceptableevidence ofcoxnplianceiththe insurance ' requirements of this chaptexhave beenpresentedta the contracting authority.." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if iiecessaxy,supply sub-contxacfox(s}name(s),addresses}andphonentunbex(s) along wig,their cerMcafe(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)vdthno employees othexthattthe members orPartuers,arenotrequiredto carry workers'compensation insurance, ffanIT CorLLl?doesbave em ployees,apolzcyismquired. Do advised thatthisaffidavit maybe,submittedtothe Department of l dustrial Accidents for confvmation of insurance coverage. Also be sure to sign and date the aidavit ifte affidavit should b e retumed to the city or town that the application for the permit or license is being requested,not the D4arttnent of Industrial Accidents. Shouldyou have,any questions regarding the law or if you are required to obtain,a workers' compensationpoRoy,please call the Department at the number listed below. Self insured companies should enter their self-insurance license number on the appropriate lice. City or'1':'oYm Offfelals Please be sure thatfhe affidavit is complete andpriated legibly. The Department has provided a spaee.altho hottom of the affidavit fox yotl to fill out in the event the Office,of rttvestigations has to contact you zegardirig the applicant Please be-sue to fl1 trithe permit/license number whichwill be used as a reference number, l'n,additiop,an applicant thatmust submitmul pleernut%lxcense applications m any given year,need only submit one,affidavit indicating current polYcy infonmation Qfnecess*);amd under"Yob Site Address"the applicant shouldwxlfe"all locations in „,(catty or towit)" copy of the aftidavif:thathasbeenofficiallystampedormarkedbythe'cityoxtownmaybepxovidedtothe applicant aspxbofthat avalid af davit•isonfele oxfuture pemsztsorlicenses. Anew affidavitmustbefiledouteach, year.Where a.homo owner or citizen is obtaining a license ox.peruutnotxelatedto any business or commercial venture (i.e.a dog license orpermit to burn leaves eta.)said p erson is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and shquld you have any questions, please do not hesitate to give us a call. The Department's address,telephone aztd faxnumber. ••• '• �Si�G�►:tQ�.w�ax�o�`Xt�'�s�a chv,���s . ,," ' y , .. 6,00W @,ft. &n _t 13Mon,MA 02111 Td.#617.727-4. 00 a 406 w 1-877-MAU. F _ Revised 5-26-05 NX#617-727-7749 Per your request Jean CERTIFICATE OF LIABILITY INSURANCE 2/19/2014 INS CUMFICATE IS ISWW AS A MATTER OF IRFOFUAATMN ONLY AND CONFERS NO 010FITS UPON THE CER'ITFICATE HOLOem THIS CERTIFICATE DOES NOT.AFMR'illATfVELY OR NEGATIVELY AMEND EXTEND OR ALTER'THE COvemu AFFORDED BY THE POUCHES SELGW, TM CERTIFICATE CF RMIRANCE FSS NOT COWITrI 4a'I'E A t ONTRAGT Skny H life ISSVWO INSCfFMAE , At171'fAf rAM REPRESENTATIVE OR PRODUC€R,AND THE CERTIFICATE HOLDER. t;PORTANT. III the ee"Mcsto ho}dor is at7 A00ITtONAL INSURED.04 0I7110 44)MSt 00 Ondor"d, 11$00ROGATION IS WAIVEO> I - to the terms and catkIlions SIH the poaityr cadasim poiir may slqulre n endorsenvnf. A staxtwnw on ws certidcAte does,not aorher regtltd to the colirl"W laotdsr In Ueti 9t 6wh wwwwl79n # pacotraa Yaaa2A .Scan sallivan, CIC, AES Burgin, Piatner, Hurley Insurance Agency, LLC vHoae 86111472-1000 ± id:T?a::a-1244 14 Franklin St. .'as84� h3ns=com 7I4F?rIE?t}FS EF3:K3e2GHG�C.Gi+F,Rd{+E_ NMI;t. quinsy slat 02169 Iia ffaAeaver II sllraa�e ersug ss ee.Iaa�n&:Safety Indemnity insurance Cry ;33618 . 8 & H Restcar.atieti Cofttraeting, lat. wwv_,maclttsadia Ins?lranice Company , I07 Orleans Street t East Britten IFA 02128 e COVERAGES - CEFMRCATE NUMBER-.2 X13-i4m stercert atc iRalil'IS3t1A8 NUMBER: MIS i5"0 CERTIFY?iRT THE.P,7LIti£S CF-@153JR,:.NG£.L{St 4 BELOW HA;e t.BEEN IS- C a0?" IrCcurm!3 li Mb ARM'S F;9'IM POCK.?'PEItm If is ATE!1 NOTV6TK5'A11011IC A4;Y REO�jotE,%egT.i tRli OR'CCNIDI'TION OF AW COWRA-C i OR OTHER Da3`.:S��tE�iT s'lt}?t ftF"'4� F TO t� }C14 TNt`} % IiTii3 P.xE.'.SAY B.t-Sa:IAD OR PJA`t'PERfi€�IK THE Ir+.StAA CE AF-t CICO BY T` .POC.;;+ES EI€�S"kIMO HI REW I5 yI.tF1, T��A11.THE�E&yl�,. t=XCLUI IOWSAND CONDIk-4115 Cr-SUCH POLICIES.LIMITS"(YAW-MA.Y HAVE SSEN REDUCED BY MV CL+>A, . TYPE OF IN814SiAatt£ " '.'� v^�'+-�"�` 004 QMMAL u utror Y 'a::. .awA4oT€'ti ; f�setu c�ttlt=ro E �' r}i:?0 S c�alltYe�Lwc���L Lest.ity aIa taoatai ilasasw3 a�,F,g,+t,.5 4.,*ve�-mr ra 13 E40 i 00D 117£2618f17/20i4 A ,�rwLII:.Ia�t kB ;c_LI=. axaaxg 1,g WsiR.Leca �.scs«E Ings act al'su s ant r71 e*r 3 2,000,000 acck ,are.uff.oq 1e; Ni <» ; r q tr - its ul'str § Sr4,,000,00(3cj I r I:v #*Dt .40iE nos 3 sra see gnat ru± g GdO,060 AL a61sd.8 tAa$GJ3'e Y g ° kza F6#jr1m 5 uli AUTO tlAt ivnAl .aaEaxed 3f(6 s to a}5 a am r, b atx.t.ANEO %j 7 t't0Z4LtJJ �-r Written Contract �Yl5F7n13 7.'w'29A4 .. �:`{t9„Y lRp IFrS dm's#Si7tfv;' $ AJl±C$S Aka^R; ktLt)i..F9Y bWdai: K;4 pkf±'[A'� $ KLtt:^(Siit�.Cl i4xax 4 5ahraat.atsst I fr , Y* ro - A;ITL'C: .E tWRU ALun !$ Y 3a c9Sslzat#� ,� ccx azcacs rc 2 Ts ±400,000 A, UcM.-LIM a41*w Tor 3 sd +1.tE s 5.{000,000 i.sPllSrtr�iu"'£ s $"'",-7- ' r±rFv 117/1611 1�71712614 g C ,s�a+tt=ts:as.�;aere 11 � r.It�rtYaS I.a AM tMLOTER LIADW lY Y i Y °A1 F1:x':�)Er;Ae+.�;'±teM.£x_v^3n5r' •"� s` xlCrt.�:::a[¢tt` 3. IF400a04.. ffi a#!a _.6-2fl-64334E-.efi 118/1611 *110/3614 cL Ix.5t,n- EA�A€^:c5-�.�3 30000,,040 y�tx 0.. wa 0. ;a.g!'r b j „1.vv'araaEciF£R>;:lus�c�.xir �.- a. t L'*.sClstLF:#t j� 2(000,000 DE5C1FLa'1larA D.*VMPt.A11417IS ILOCATIGNSY?Yt4t US IAM*-h ACLShiT 3Cl_4d3umw R.n U 5ct d-AK 4'mss;sgie'e n,ms�r�d,I coutractlt 1611-4,224$4-CF-00001 IAZXC0 morth Andover LLC is additicaal insured CERTIFICATE HOLDER CANCELLATI01 3HOXA.3i ANY OF rfe ABOVE DESCRM ED FhoUCIES at CANCELLED BEFORE TH€ 6%pmAnom QATc THEM*r,. NOTm WU Of OEUKRED IN A-CCORDAME VATIA THE POLICY FROVI530HS. AINCO North Andover LLC 54 Royal Crest Drive AMNON=l4Ls'ALM'rAYNE North Andover, k:A 01845 Besse, CIC CISR Cp'1 — Location 1141 No. / Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ IVBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ u TOTAL $ ' t Check# deo G � IUUts Building Inspector