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Home My WebLink AboutBuilding Permit #152-15 - 46 ROYAL CREST DRIVE 8/12/2014 t%ORTH BUILDING PERMIT o�t,eo 102. .6 0� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: ( Date Received °R..TEo'ea�5 gSSAc►+US Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION (6, e< ^ � PROPERTY OWNER A c pm C o Print 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 G�fwo or more family ❑ Industrial ❑Alteration No. of units: /I, ❑ Commercial R epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 11 Water/Sewer DESC• IPTIO OF 7JRK TO BE PERF )RMED: t G .D Identification- Please Type or Print Clearly OWNER: Name: i rh C-0, Phone: /' Address: 2 �1-een woo Contractor Name:. Phone: Address: all- Supervisor's ll-Supervisor's Construction License: 5 --O %;xe) Exp. Date: . r Home Improvement License: -`5 3 /klo, Exp. Date: 1 1( 6//q ARCHITECT/ENGINEER Phone: f . 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: $ 40, 00iD vu FEE: $ '� �� " , Check No.: ®0 G Receipt No.: NOTE: Persons contrac na g with unregistered contractors do not have access tot g ran fund Sig re of Agent/Owner Signature of contractor f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ti 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 RE`DEPAR aM EetNT - Temp Dumpster on site yes no LI 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) ❑ Notified for pickup Call Email 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 � uilding 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 pp 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 - - I pORTh Town oM . _ , . ndover 0 No. * T.� iL C,, h ver, Mass, c0c.41c t..C. 1. �q0 Pay TE O 1►P ,`'�5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT Z'� .��'� BUILDING INSPECTOR ...... .... .. ...... .................................................................................................. has permission to erect ............. buildings on .. GRA ��.. 1'! ........................ Foundation ............. .. ......... ....... oRough to be occupied as ........ ............................... Chimney provided that the person accepting this permit shall in every respect confgtm to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final 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 CONSTRUCTIONS ARTS Rough Service ........ ........ .................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. The Co mmonwearth of M'assachusells -- Depa�€xnen�aflnc��s�rc�r.Acci�'e�� • . Office of.Investigatioas 604 Washington Street Boston,.ltd 02111 www.mass gov1d a Workeys'Compensation bsurance Affidavit:BuiSders/CodtractorsfElectxexansTl**be�� .A. lzcant-bforntatto>I Please,Flrkt Le w Name(Businessl0rganization/ln&iduaD: 64� k41 .Address: Z.14C YJa l••i S S"0! _ Ciity/State/.dip: 45sg' .� j`�as t d'}I Phone : Are you[an employer?Ckteck the appropriate box: Type of project(required): 1. employer with t 4. 111 am a general contractor and 1 6. New constractiol, f employees(fulland/oxpart=time).* haveliiredthe sub-contractors listed o 2.Q I am.a sole proprietor or pattxter n.tho attached sheet:t 7. ❑R.emodaling ship aud'haveno•em to ees These sub-contractors have, 8. ]Demolition w xl�ing forme in any capacity, workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. El We area corporation and its 10.p Electricalxepairs or additions xeciuixed.] off'teers have exercised.theit� ' 3.[I X am a homeowner doing all work right of exemption per MGL 11,.�[S'lumbingxepairs or additions myself LEOwprkers'comp. c.152,§1(4),andwehaveno 1.2.n Roofxepairs insurancerecluixed.]7 employees.[No workers' 13.0 other comp,insurance required.] Airy applicautthat checks box#I mustalso M outthe section bel6w sfiowingtheir workers'compensat[onpolicy information. Homeowners who submitthis of davitindicatingthey e doing aLl worlcandthenRe outside contractors must submit anew af�davitindicating s'aoh. xContracfors that cheokthis boy-must attached as additional sheetshowingthe name ofthe sub-contractors andtheirworkers'comp.policy information. X am are errzproyieN that isproviding 1Vorker.s'compeination insurance for my employees Below is tfie pokey aniilab l ife information. Tnsuxance Company Name; 110 tl>Policy#or Selz 10.Lic.#' ,=,.y2g2 ExpirationDate: I7 lob Site Address: ZI City/State/Zip: Attach a copy of t�a wox'kers'co pensationjpolicy declaration page(showing-the policy limber and expiration.crate). Iiailur,to secure coverage as regmixedimder Section 25A-ofMOL o.152 can lead to the imposition.of eriminalpenaltiesof a Erne up to$1,500.00 and/or one�ycar'imprisop ent,as well as civil penalties i a the form.of a STOP WORD ORDER_and a fmo ofup to$250.00 a day against the violator. Be advised that a copy of this statementmay be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. X do liexeby cert or the pains ar�cl penalties ofpey,jury t7w Me information provided above is true and correct, Si afore: Data: di 7� Phone# to P1 Offlcia,use®rtly. Do not write b,tlais area,to be conWieted by city or tort official. City or Town: PeranitfLicense# Issuing Authority(circle one): 1.Board of llealth 2.BuildinglDepartmeut 3.CityfTown Clerk 4.Electrical Thgector 5.NuznbingJfuspector 6.Other - - - Information and Instruction Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an eraployee is defined as",..every person tri the service of another under any contract ofbire,• express orhaplied,oral ovwzxtten." An enWfoye�is defined as"an individual,partnership,association,corporation or other legal entity,or any two Or More ofthe foregoing engaged in a joint enterprise,and includingthe legal representatives ofa-deceased employex,.or the receiver or'- u ee of'an fudividual,partnership,association or other legal entity,employing employees. Hiiwe r rho owner of a dwelling house having notmore than.three apartments and Who resides therein,or the occupant ofthe dwelling liouse of another who employs persons fo do maintenance,construction ox 19p' air work on such dwelling house or onthe grounds oxbuilding appurtenant&ereto shallnot because of such emp1gymentba deemedto be an employer.,, MOL chapter 152,§25C(6)also states that"every state or local llc�usiug agelicy shall withhold,she issuance ox renewal of a.license'C permip to operate a business or to eonstrM buildings in tftW commonwealth fora'Vy applicant who has tot produced.aeceptable evidezice of compliance nth the insitrnaxic�cover aga re:�uired:' .A-ddiiionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions sliall enter into any contract fox the performance ofpublic workuntil acoeptable evidence of coxnplianquwith the insurance requirements oftMs chaptexhave beenpresentedto the contracting authority," Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,it 9le0e9saty,supply sub-contractors)name(s),address(es)andphonenumber(s)along with their certi6cate(s)of :insurance. Limited Liability Companies(LLC)or LimitedUabilityPartnerships(LLP)with no employees other thattthe members oxpartners,arenotrega1redto can7workers'compensationinsurance, 7fan2�C orLLP ctoeshave employees,apolicyzs required. Be,advised thatthis af(1davitmaybe,submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should b e xetumed to the city or town that the application for the permit or license is being requested,not the Department of 1n.dustrial Accidents. Shouldyou have any questions regarding the law or if you are required to obtain,a workers' compensation policy,please call the Department atft number lhtedbelow. Selfinsuredcompanies shouldenter their self insurance Incense number on the appropriate line. City or Town 00cials Pleasobe sure thatthe affidavit is complete audprinted legibly: The Department has provided a space atthe bottom of the affidavitfor you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be-sure to Min.-the peaxnit/Iicense number wluchwill be used as a refexence numbe , tn,addition,an applicant ihatrnust submitmultiple permit/.lxcunse applications in any givenyear,need only submit one affidavit indicating current Policy information(ifnecessmy)and under"fob,Site Address"the applicant shouldwrite"all locations in�, Coity or tov )".A copy of•&e affidavit that has been officially stamped or marked by the city ox town may be provided to the applicantasproofthat avaEdafidavit•isonfdoe orfnturepemvtsorlicenses. Anew affidavitmusthef ed out each year.'Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture Q.o.a dog license erliermit to burn leaves eta.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance fox your cooperation and should yota have any questions, Please do not hesitate to give us a call. The Department's address,telephone a Afaxnumber: 600 WaIn g(onxeQ B0904,MA 02111 TO 617n72,t,4900 Qxt 406 ax x•-g77-M.aSAFE - Revised 5-26-OS Fay,#617"727"774'9 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: 46 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 46: $60,000.00 We hereby propose to furnish all labor and material complete in accordance with the above specifications for the sums stated above. AUTHORIZED SIGNATURE ATE: 7-22-2014 Acceptance of Proposal: The above prices,specifications and conditions are satisfactory and are hereby accepted. You are autho ' to work as specified. AUTHORIZED SIGNATU ATE: Per your request Jean '' CERTIFICATE OF LIABILITY INSURANCE 6ArepuwDOYYr17 V19/2014 THIS CERTIFICATE IS ISSUED ASA 1MATTEA OF INFORiXATI[OR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF tNSURANC'E DOES NOT CONSTITUTE A CONTRACT'BETWEEN T#IE ISSIONG INSURER(S), AVTHORtXEO REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the eertillcate holder Is an ADDITIONAL INSURED.the policy(les)nwst be endorsed. M SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,oMain policies may require din endorsement. A sisteanent on this certificate does not confer rights to the corriflcate holdor In lieu of such wWommont s. P"000c" naw: Jean ,Sullivan., CIC, AES Burgin, Platner, Hurley insurance Agency, LLC IrhoKewal JIM IG17 i72-3000 cAx t6LTT471-I14l 14 Franklin St, C-MAIL ,'nsSb bins.com # IKS1PCtEPIFI AFFOPANG COVERJ,i,f f NAIL i Quincy MA 02169 _ lu$i;M 1Kanover Insurance CSM PAftY_j�7 IKEur+[o asuans:Safety Indemnity insurance Co 33618 B & M Restoration & Contracting, Inc. rKs)wRc,ACadia insurance Company 107 Orleans Street rNeumol tKsufitPi e:: -- - least Boston IIA 02128 1491)= -- COVERAGES CERTIFICATE NUMBE11:2013-13Hasterc ertU ate REViSION NUMBER: THIS 15 TO CERTIFY THAI THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 10 THE Ir,0JRED NA%IED ABOVE FOR THE POLICY PERIOD iN7%CA.7ED NOTW1TI-iSTANDING ANY REOVIREit1ENT,TERM OR CO"DITION OF ANY CONTRACT OR OTHER DOCUMENT VATH RESPECT TO WHICH THIS CERTIFICATE%tAY BE ISSUED OR MAY PERTAIN,THE IrmRAANCE AFFORDED BY THE POLOCIES DESCRIBED HERt:N IS SUBJECT TO ALL THE TERMS. EXyCLUSIONS AND CONDITION OF SUCH POLICIES.LIMITS SHOW74MAY RP09 SEEN REDUCED BY FAMCLAiA1S. 1irn"Ri TYPE6FIReWhNCf OL - !N & AIR 41CYW LAWS CMUMALUA61IJ y p 11IR6997647 L.ACHCIt:T:JPI"CE s 2,000,000 I GfRMEItCu1?EtiE}IALLALITITw dit►ortA1 Iaaarad DAuer:-TOREtTED PREWI sS iia asma+msct 3 100,000 A .—S. to J OCCO% Prainery by Written111712013 311712614 t w Exf'(m,—Pk' 1 gtr*et PBNSUN LL IS 41W IIILRY S 2,bob,DdO V*NHW.Ao U(AEUOE s 3,000,000 L*N1.A-UCALGArE UItiT M-PiS:S PER PRODU-Ifs•towpulr.Atr. 1 4,000,000 11 ftmy M '"U Luc I Al 0wed.e LIAMUIT y y O. 3 CU iri:7 SNULc1PA.: dit irml 1 Io a oT nd F-1k ac atrll I 1,000,000 ® ArlY AU TO aeOA.v lrkc lAv rPM xrnr..�+s a AIJ4C7A�En .Au Ly uLt11 r wry AU rltt.n omtrllct 3Ilf/To13 11/412916 9noltjuj;;Y rPsr 1w(4rli 6 X H4REi A4Tt?.5 11 N04-LYAUM Yaer of .Sitbragatiori rNUPLtti Y Z4KALit 5 .AuTo.'. IPCI KC42ril aaF r I VVISACLLA LULSf $ KUR y p 10,90SI21e0 EA:H ucOJR>¢rt:E 1 S,ODd1,600 "crta UA CLAIM-W ME 11PY Form d A r,Grri>=raTE 1 s,OtID,00D 77-1X7 F011WIONS r 3117120L3 /17/2614 C aDwcelaseearrmsATlon N x tittis'Al e� t RAID CAPLD1tn:LtA81uTY Y.,S IC)ftY LP,IIs Lit Arvt�rlPa�T cut3t ExECJn�E Rr EL LAL"AZOLENY S 1,000,000 CCFT,.EIW9%-PEF plcao-I r, „4O_y6-603746=61 '110!2613 i6/1@1201< Iwrniexry«n'KNt EL LISLA21L-Ln l: %xi S 1,000,000 r ars,dY/.Ah!aTw?3r Gf' '+F*JotaGSC.cERAnOYgtet,* - - - --_ - - EL.tx-EASE-KX.:YLA11 S 1,000,000 Descavto"or CICnAn6Y2 WXATIDNS5 TEMCt.ES IASa h AC0kV 101,AddlMn]PhS.SAS SChf&40,.*."OF.-u.t kl dl Contracts I611-322093-CP-00001 ;A1XCO North Andover LLCis additional insured CERTIFICATE HOLDER CANCELLATiOPI SHOULD ANY OF TT,&ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T*4 CXPIAAn*N DATE THERIOP, NOTICt WILL OE OELrv'AAD IN AIMCO North Andover LLC ACCORDANCE YATM THE POLICY PROVISIONS- 50 ROVISIONS50 Royal Crest Drive AUTHatsunwmrAtrscKTATrve North Andover, KA 01845 t AeLit'Qi< s��.z 9 Besse, CIC CISIt CPI Location �-/ �O V/ / ore:- c No. 2 — Date /2 ! . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ `U•00 e ] W Foundation Permit Fee $ I Other Permit Fee $ �` TOTAL $ Check# 006 Building Inspector