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HomeMy WebLinkAboutBuilding Permit #099-14;100-14 - 47 ROYAL CREST DRIVE 7/30/2013 L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received v l Date Issued: v IMPORTANT: Applicant must complete all items on this page LOCATION ocuea rint PROPERTY OW NER M �'�Zv� Print 100 Year Old Structure yes no MAP NO: ` PARCEL ZONING DISTRICT: Historic District. yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Vt_W1.00 family 0 Addition or more family 0 Industrial ❑AI ration No. of units: 0 Commercial 31Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition 0 Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Id �ification Please Type or Print Clearly) OWNER: Name: / n Phone: Address: CONTRACTOR Name: +� Phone:G/ 1 — Z Address: > Uezhh.e,, Supervisor's Construction License: G S Exp. Date: Home Improvement License: Exp. Date: Z i 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: $ �� dGd' c FEE: $ ��� •� Check No.: Receipt No.:2((10 (o(o-7 NOTE: Persons contracting with unregistered contractors do not have access to gu fund Signature of Agent/Owner Siggature of contractor ��'—�. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ .. 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 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 Tovv;. Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster onsite yes. no Located at 124 Mair, Street Fire Departmerit 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 El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fol".)wing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application u Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract Li Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application u Certified Surveyed Plot Plan a Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) u Building Permit Application o Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li Mass check Energy Compliance Report La 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.Buhding Permit Revised 2012 I Location No. V — Date �U i . • TOWN OF NORTH ANDOVER • . • Certificate of Occupancy $ Building/Frame Permit Fee $ 11y�•� Foundation Permit Fee $ Other Permit Fee $ i TOTAL $ Check# 2667 C1 Building Inspector f .. I "� l S Pe Location eoIV,) K ! No. Date . - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $11'+� � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 4-- Check bl!2 2,6679 Building Inspector �� � bA �.� NORTH Town of s E �� Andover o 0 No. 019- 413 h , ver, Mass, v/- 14 3012 o L' .. 01. coc NIc"FWICK 7.9 a°RATED s U BOARD OF HEALTH Food/Kitchen PERMITww L D Septic System THIS CERTIFIES THAT 4.9.... Q.4.................. .... BUILDING INSPECTOR .................... .. .... .......................................... ♦ .. has permission to erect .......................... buildings on ...20 .4�....Cv- � Foundation ...... ....�. ;�` Rough to be occupied as ...�ox� .. ! %&... %...........M.. . ...• .......................... Chimney provided that the person accepting thIS' ermit shall in every respect conform to the terms f 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 s Service ................. ..... .Gyri:.�t..�,.�rC.Grs�..._.......�.................. 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. SEE REVERSE SIDE t%O R TH Town of _ ? E : . Andover Q " - 0 No. — - �` h , ver, Mass, 0 �� � o coc«ic«ew�cw �1' S V BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT �ea....CQ.,...... ,,,,,,,,,,,,,,,, BUILDING INSPECTOR ..... ..... ............ . ............. ........... has permission to erect . ................. buildings on �� r��` .0' Foundation .... .... ......... .... .......................... .. .V.. . �t , Rough tobe occupied as . ........... ...............................4........Pat. ...... ................... Chimney in ermit shall in eve res ect conformto the terms oapplication provided that the person accept g p every pFinal 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 ................ ...... ................... 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. SEE REVERSE SIDE Y The Commonwealth of Massachusetts Department o f lndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/ContractorstEIectricians/Plumbers Applicant Information Please Print Legib Name(Business/Organization4ndividual): r Address: XoSivm City/State/Zip: Pt S S Phone#:_ 61 Are you an employer?Check the appropriate box: Type of project(required): C L I 1 am a employer with 4. ❑ I am a general contractor and I ` 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2111 am a sole proprietor or partner- listed on the attached sheet,T 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurance required.)t employees.[No workers' comp,insurance required.] 1311 other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they a'e 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 efnpI es. Below is the policy and job site information. Insurance Company Name:. .0 q h d Cv {-1•� rr.�r Policy#or Self-ins.Lic.4: 2.2.25 2 ExpirationDate: /L/ Job Site Address: - / (�� City/State/Zip: Attach a.copy of the workers'compensate policy cleclaration page(showing the policy number and expiration date). Failure to secure coverage as requireclunder 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. 3e advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cerci n r the ins a enalties ofperjury tliat the informationprovidedabo e is tr anti correct. - Signature: r� Date: 2Z Phone#: L'/ `— 2 Z f � L7 [[0fJfZc1a1 use only. Do notwrite in this area,to he completed by city or town official.ity or Town: Permit/Lecense# ssuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town CIerk 4.EIectrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: A� CERTIFICATE OF LIABILITY INSURANCE 3/14/2013DATE ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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 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 NAME: jean Sullivan, CIC, AIS Burgin, Platner, Hurley Insurance Agency, LLC PHONE (617)472-3000 FAX (617)472-7248 14 Franklin St. " L jas@bphins.com ,ADRESS INSURERS AFFORDING COVERAGE NAIC A Quincy MA 02169 INSURERA:Hanover Insurance Company 2292 INSURED INSURER B:Safety indemnity Insurance CO 33618 B & M Restoration & Contracting, Inc. INSURERCAcadia Insurance Company 107 Orleans Street INSURER D: INSURER E: East Boston MA 02128 INSURER F: COVERAGES CERTIFICATE NUMBER:2013-14CertUmbupdate 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 MAY 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. IL R TYPE OF INSURANCE Ama POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY y 7dditional 7647 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY Insured p 1 q c g 100,000 A CLAIMS MADE ®OCCUR y by Written /17/2013 /17/2014MED EXP A one son S 5,000 ct PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 R POLICY PRO- LOC $ AUTOMOBILE LIABILITY y y 208157 COMBINED c' 11000,000 B ANY AUTO ditional Insured BODILY INJURY(Per person) $ ALL OWNED SCHEDULED er Written Contract 1/6/2012 11/6/2013 BODILY INJURY Per accident AUTOS AUTOS ( ) $ X HIRED AUTOS NON-OWNED aiver of Subrogation PR PERTY(PertDAMAGE $ PIP-Basic $ 8,000 X UMBRELLA LIAO OCCUR Y N URN905512100 EACH OCCURRENCE $ 5,000,000 A EXCESS LWB CLAIMS-MADE rollow Form AGGREGATE $ 5,000,000 DED I X .RETENTION /17/2013 /17/2014 $ C WORKERS COMPENSATION N X I WC STATU- 1011- AND EMPLOYERS'LIABILITYLIM ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) C-20-20-003740-00 /10/2012 /10/2013 E.L.DISEASE-EA EMPLOYEEI$ 1 000,000 H es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1.000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space la required) Project: Royal Crest Estates(North Andover) Contract# 15519-422094-CP-00003; AIMCO North Andover LLC is additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Aimco North Andover LLC ACCORDANCE WITH THE POLICY PROVISIONS. 50 Royal Crest Drive North Andover, MA 01845 AUTHORIZED REPRESENTATIVE R Besse, CIC CISR CPI ACORD 25(2010/05) ©1986-2010 ACORD CORPORATION. All rights reserved. ( rdivd9tdRd with pdfFactory triargieff25i R oymnt'p 1ff=m dZ#w, 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: 47 and 49 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 47: $145,000.00 Building 49: $145,000.00 We hereby propose to furnish all labor and material complete in accordance with the above specifications for the sums stated above. AUTHORIZED SIGNATURE ATE: 7-16-2013 Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You arYj utho •ized to do work as specified. AUTHORIZED SIGNAT ATE:_7-/8'20/3 l.i41 �i�nstr;c:tr(�rt.�,ii�ervisor License:: : LicenS4-.:.CS 65281 / PAUL BRUNO 184 1/2 SUMNER ST E BOSTON,.MA 02128 3017 l ,