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HomeMy WebLinkAboutBuilding Permit #192-13 - 50 ROYAL CREST DRIVE 5/1/2018 BUILDING PERMIT OFNoRrH ,�tL� TOWN OF NORTH ANDOVER 32 h - w: °� o � APPLICATION FOR PLAN EXAMINATION _ 70 Permit NO: Date Received ��e°RtTfD rP"'yq9 �SSACHU Date Issued: ENIPORTANT:Applicant must complete all items on this page �., '�' F e6' .-r. t: R•, s ,'1 .q'r 4 - ,c _Lffi C ' # LOCATION�MA tis :.. `� .rI2Sdz �� � �. �` � '+�.,tEW, ZhH at k --. �• rpt e �a q ,RROPERT#Y4.O.WNERI f�'r:ls 1. .'.•lJ,, � U a. , � L%�- � * r �,.� �> �, . #`rr' . ..�'t `,{••. r�-' ..'°'y. ry.,nwrs+� Pfl�l =t.�'°""..� t q.".` '.."��."t . +}t✓�q''=., T'' rr�.. i •� 2�}� �:� 1P 1+.:�?r..-,-d r.,i...,x. •�t Z—�r.. ,�--- s �w _,�"��4h�•n'_aa � �:.fT ,�'�(' ! ,i#4'S• MAP NO PARCEL "ZONING�DISTRICT Historic Distnct��� '`'L yes no •: Y+u � k+�ie�i!� p y ,�'.� R R'�! •.., x`c, t�s�.�,a�w-.pa'�t � �7":.s r� �ri'� �..�,s '.�' tt,_`.r « ,�w .^ Y r 'SSS- t � t ,�,-,r,�� t; ,� ,_ ,� �� �= kms} 'Machine Sho Villa e` ; es' •no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other r "� :;Floodplain Wetlands Watershed"D�sfrict W- an} r `+' t a t-'I. Pi ' Ct•J ' .. "y4' •fyi. 'r�' -``. " .,,rr-�,'-vr r��w4' 'g."'•'a�q'! �,{c k e t ,rxVllaterlSewerr *" i �3� ;, `r`����" DESCRIPTION OF WORK TO BE PREFORMED: k. W G , ��F• ,1�� I �)v .2- zz Identi cation Please Type or Print Clearly) OWNER: Name: 4s�0 Q ,P'-V1wUeVt Ll Phone: Address: rR0 4\ ( ��- �• �``�c� DI ��,,d .,.,�. f 't )ti s.-�?- t p '�J '1.'"' r.• 5.. R � ; -,. "�1. »t., •.rF 1 .L}'st.4�.lshfY' J`^5:'f'R�o-. ARIA;: � err{ 'Ptd`r t .".l� t., < ..{^ �r�r * ,}'� L',.' >CONTRACT®RName �R.Lc�c��S {_� SZu.ec _ Phone , �t, �t� ;?�' M1""��y ff•�3'�•�^•r w .s f r � � �M � � � 'z�'' rsr rr r�r +'C^'.9,»^°� � ,g e: x a�F' t T � "tt4z t t s _ • "�'r�'"`fi rs+. ,� v= L -.. .� ;.��..i ..,�_° �r t- baa k, w Rf,Y t _ .,`�'"'as.;..1 �,C ,i��:��' k�sc ,7i��rr"' �, r.t� `e ... &j��."a ERP `Supervisor«s Constructio'"n License r� '- .�. ERP Date }•, -P ,. ` `. _ '•s �.J-;4 [ f s••. �,+:v. f'a•� -rz sy:: .. +err v a i �17.c �X� ti 3T�{�v �S.i W+t �'aa •t T '��'., "� �'�. .T., t i� '9 € r s .�, }j`T��a j 4n �i � �t �1 � ' � Yy '1 n.Ott L ty t t Home Improvement License .F:, w t��. Exp Dater ARCHITECT/ENGINEER C 1�2C lGtN0 llnsul hone:q-7%7 —yiB—'b 06 Address: (A MO%h'o4-' Q©%X&g? PvppaLt ejl MC. Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 'i I� , `��� • ®© FEE: $ Qi`11 . 00 Check No.: a Receipt No.: NOTE: Persons contracting with ung• istered contractors do not have ac he gua.PM ty fun Signature of A erit/OvVne :. nature of contrac 9,. 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 MOTE: 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) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products MOTE: '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 a - 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:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 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 r' THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE.REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on - — Signature COMMENTSpEy ZJ4L Lid) 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 FIRE DEPARTMENT;-:.'4,j emp Dumpsterbn site yes ♦r<Ke . { - '.i1L�. -e`e-d r�O�ated'Oat 4 M6i treet Fire Department signature/date r r ` i4 � f: . k ` A C IVIII%IENTS { -r .�},�.� -��_ � t; +�` • � ,ba.,, ,�; � , , ,_{ � -,��r rte► �. ;p7�, . r r... ,t ;f.y-a ti� fi`.�:, :� Y►...� .h:,+.> R,.t.Cd?, tt...:...y �^wZ- .,. ,.c �..� .� i 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 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 . 11 I I� I, Notified for pickup - Date Doc.Building Permit Revised 2008 it i Location .S 0 A) No. '� Date TOWN OF NORTH ANDOVER 0 e Certificate of Occupancy $ Building/Frame Permit Fee bz) Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �i Check# 25689 Building Inspector Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 414,238.00 m $ - $ 4,970.86 Plumbing Fee $ 621.36 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 621.36 Total fees collected $ 6,313.57 50 Royal Crest Dr 192-13 on 9/7/12 New Sub Drains waterproofing buildings 8,20,21, 22 25, 29, 31, 38 t r NORTFI rr`own of Andoveir 0 NO. t - 0C, iAK, h ver, Mass, �-- cocNic S U ^ 8 BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT ... �l.:� .. /�. �1� ,h. ................ BUILDING INSPECTOR .. — Foundation has permission to erect .......................... buildings on .. ... G2. " .G..4 �.................... Rough to be occupied as ...... ....:,..<..!..�1.�....... ,�:..............�!1�..........................�.�.�............��... Chimney provided that the person accepting thisyermit shall in every respect conform to the terms 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 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 !Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SDDE ACORD 7/17/2012 CERTIFICATE OF LIABILITY INSURANCE DAT>2D/YYYY' 012 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(ies)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). CONTACT PRODUCER NAME: The Driscoll Agency, Inc. PHONE mo).781-681-6686 93 Longwater Circle E-MAIL P.O. BOX 9120 ADDRESS Norwell MA 02061 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A.-Old Republic General Ins Co[p 24139 INSURED 3767 INSURER B The Hanover Insurance Company- 2292 G. Lopes Construction, Inc. INSURER C:Fmreman's Fund Insurance Co. New England Recycling Co., Inc. INSURER D:Starr Future Fuel, LLC 490 Winthrop Street INSURER E Taunton MA 02780-2166 INSURER F: COVERAGES CERTIFICATE NUMBER:512601856 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. LTR TYPE OF IADDL NSURANCE UBR POLICY NUMBER NIDD EFF MMMIIDD EXP LIMITS A GENERAL LIABILITY A2CG98001202 /30/2012 /30/2013 EACH OCCURRENCE $1,000,000 DAMAGETOR qCOM MERCIAL GENERAL LIABILITY PREMI ES Ea ED $100,000 CLAIMS-MADE �OCCUR MED EXP one rson) $5,000 nc XCU PERSONAL 8 ADV INJURY $1,000,000 I X Inc Contractural GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO-JECT X LOC $ A AUTOMOBILE LIABILITY A2CA98141202 /30/2012 /30/2013 Es ac6d,n)tJ9 $1.000,G00 ANY AUTO BODILY INJURY(Per person) $ x ALL OWNEDX SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident X Ind MCS90 $ D UMBRELLA LMB X OCCUR SISCCCLO1823812 /30/2012 /30/2013 EACH OCCURRENCE $30,000,000 C X EXCESS LIABSHX00057595829 30/2012 /30/2013 - CLAIMS-MADE AGGREGATE $30,000,000 DED I IRETENTION$0 $ A WORKERS COMPENSATION CW98001202 30/2012 /30/2013 X STATU- OTH AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N❑ N I A (Mandatory M NH) E.L.DISEASE-EA EMPLOYE $500,000 Hr describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500.000 B Property and Inland Marine RHN9597532DO 30/2012 /30/2013 Leased or rented $500,000 Installation Floater $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Rerrarka Schedule,N more space Ia required) RE: Royal Crest Estates, North Andover,MA Contract No. 13651-403528-CP-00003 AIMCO North Andover, LLC is included as an Additional Insured for Automobile Liability on a Primary and Non-Contributory Basis for the conduct of the(Named)Insured, but only to the extent of that liability,as required by a signed written contractor or agreement with the Named Insured. See Attached... CERTIFICATE HOLDER CANCELLATION 30 days,exce t 10 for nonpayment 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 drt� ! SPd ©1988-2010 ACORD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: 3767 LOC#: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED The Driscoll Agency,Inc. G. Lopes Construction, Inc. POUCYNUMBER New England Recycling Co., Inc. Future Fuel, LLC 490 Winthrop Street CARRIER NAIC CODE Taunton MA 02780-2166 EFFECTIVE DATE: ADDITIONAL REMARKS 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE AIMCO North Andover, LLC is included as Additional Insureds for General Liability and Excess(Umbrella)Liability on a primary, non-contributory basis as required by a signed written contract or agreement with the Named Insured. The General Liability,Excess(Umbrella)Liability,Automobile Liability,and Workers Compensation/Employers Liability Policies include a Waiver of Subrogation in favor of on whose behalf the Named Insured is required to obtain this Waiver under a written contract or agreement executed prior to a loss. General Liability policy includes coverage for"X, C, U"(hazards,collapse of building, blasting and damage to underground property). Completed Operations,and Contractual Liability Notice of cancellation provision is 30 days,except 10 days applies for non-payment of premium. I I I I ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. I��II01Il�e IIIV0IIIDV III00111�01110�III��IIII I��I ape a0d3 �� 1001 III I I91110�1119�II 110111�BIII�01I I SIIII001101 1%0RTFl BUILDING PERMIT oFt-JLAo 't.,; ° TOWN OF NORTH ANDOVER a �`,�== ' 6 APPLICATION FOR PLAN EXAMINATION Date e � X04 : Permit NO: DtReceived ® �RSS9CHU5� Date Issued: ' f ORTANT:Applicant must complete all items on this page 4 LOCATION' PROPERTY=OWNER` - MAP NO� _ PARCEL: . ZONIN&DISTRICT: .: Historic.Aisfn".ct es - -- _ Y •' Machine:Sliop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential New Building One family Addition Two or more family Industrial No. of units: Commercial ZR6pi eplacement Assessory Bldg Others: olition Other Septic. Vllell Floodplain 'Vj/etl-an ds Wafesled-District �Wate_r/Sew_e_r DESCRIPTION OF WO K TO BE P FORMED: W lj -FgeA 1 K 1 t Z-0 Iden ' ca on Please l`ype or Print arly) OWNER: Name: n Phone: I Address: �� � , Q,e 5h eue- L MC, 0) &w CONTRACTOR Name: L -S tib 'Phone: Sa3�. . Address' •.rygy . fk - .i +'• C'"+'R,-~I••- ^a '4 -- ...�y..'+9'sf F_ - - - - _N:�t=RY 1..'.: ).tl: .N .t - Superyiisor~s°Con`str[acfion License:.. b,•�. :Exp:.°Date , Home=lmpFovement License::.:: -Eacq: Date: ARCHITECT/ENGINEER 00QA0LSt(Y\t, k,G0ejASkone: �-7a' V33 -�l ; Address: %' n �.D I�C3 S-7eiftt1 Reg. No. 4 w1 FEE SCHEDULE.BULDING PERMIT_$9200 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $_ o 3 S5a . LoO FEE: $ ev_3• a If Check No.: L' �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ftAORTH BUILDING PERMIT " TOWN OF NORTH ANDOVER h• 6 00 APPLICATION FOR PLAN EXAMINATION -T. <ocrlc Permit NO: Date Received Arm ACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page -I--v LOCATION�N,�4 f,oi 11� 5a. .k . 'i�iP�ROP,�--RT.Y��OWNER-,.+"���O'j�--.��L:��--1 �1*1 7 Me N no. TYPE OF IMPROVEMENT PROPOSED USE Residential ----Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other V. M,-�rp- DESCRIPTION OF WORM TO BE FrItt-UKIVIED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: T7 Z"A .4 4�4 N 0`0 N T R�A ,,Q ,TiQRName" -.,-4x ol�i- d.. T 7� -,yr n;s .� 4--'k,-4-tA4 I? J1, Supe_tv I�§off's poristrootr n License: oli J,tie rH me lm htiLticense* ,.-�.--.-.-.,L,!",;.f ARCHITECT/ENGI NEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1ZOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 7_7 Signature 1 _ f Agent/0 Signature OT contractor cto r 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 o Copy of Contract o 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 o Building Permit Application o 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) 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) ❑ 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 o 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:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 I Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL � Public Sewer Tanning/Massage/Body Art Swimming Pools ` } lWell 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT p COMMENTS N CONSERVATION Reviewed on I Signature" i nature" 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 a FIRE DEPARTMENT' Temp Dumpster oh:-ii te yes 'nom r:4 }. r *�- ` 7 Ak s --, `Fire Department is gnatu`re,date ti�fs`' r� . y .. °.< st� .v T 3 }• #.t J. i A1Z 4 a tf ! 4,,,,,}-� W ' � � � " •�f-�.. r� �. �I h 4..a.5 k. ...�,i�nS 1�.`.a 1 x ' ; �'r car' �l�r tr { � I♦� , Cie,. ! Lc a•�3} ,. 4 �,.s 4 1 COMMENTS,` f 'ter ...t t, f ,:t;' . . . ,`.. � •�p3 �¢'t"- Y'"..� r.'s- 3_��' r i, {�c��.a.?.alt �:< st'i ¢L...�.�"F? i Dimension i G Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 4 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.$10041000 fine NOTES and DATA— (For department use y i i i I ® Notified for pickup - Date Doc.Building Permit Revised 2008 I � I r 4 Location 0 No. Date 1 " o - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $1 '00 f ' Foundation Permit Fee $� Other Permit Fee $ TOTAL $ Check# (5v n 1 �a 25570 Buil'ding Inspector xAORTy F-awn Of Andoveir O to No. h ver, Mass, COC MIC h!WIC I/ 1' D ID 1 V BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT �/���0 �©°'.��..... � BUILDING INSPECTOR .......... .... ................................................................ has permission to erect ... buildings on � ,9111 Foundation /ice Rough to be occupied as `... ..................... ............................................................................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms 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 ARTS 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. IFSEE REVERSE SIDE Smoke Det. 1 E DATE(MMIDDIYYYY) Alf H CERTIFICATE OF LIABILITY INSURANCE 7/19/2012 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). i N PRODUCER �ME. The Driscoll Agency, Inc. PHONE FAX Ne 93 Longwater Circle EMAIL P.O. Box 9120 ADDRESS: Norwell MA 02061 INSURERS AFFORDING COVERAGE NAIC 11 INSURER A:Old Republic General Ins Colp 24139 INSURED 3767 INSURER S-The Hanover Insuranm Company Z2292- G. Lopes Construction,Inc. INSURER C:Fireman's Fund Insurance Co. ii New England Recycling Co., Inc. INSURER Starr Inden"111fty&Liability Company Future Fuel,LLC 490 Winthrop Street INsuRERE: Taunton MA 02780-2166 INSURER F: COVERAGES CERTIFICATE NUMBER:1040366464. 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 I 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. INSR ADDLSUBR POLICY EFF POLICY EXP 1 LTR TYPE OF INSURANCE NSR WVn PO(JCY NUMBER MMIDD MMMD LIMITS A GENERAL LIABILITY A2CG98001202 /2012 130@013 EACH OCCURRENCE $1,000,000 AMAGTO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea oc urrence $100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $5,000 X Inc XCU PERSONAL&ADV INJURY $1,000,000 X Inc Contractural I GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY X PRO I^ I LOC $ A ,AUTOMOBILE UABIUTY A2CA98141202 /30/2012 /2013 Ea acdderd $1 000 000 ANY AUTO BODILY INJURY(Per person) $ X ALL OWNEDX SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-010MED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ X Incl MCS90 $ D UMBRELLA UAB X OCCUR SISCCCLO1823812 613012012 /30/2013 EACH OCCURRENCE $30,000,000 C X EXCESS LIABSHX00057595829 /30/2012 /30/2013 CLAIMSadADE AGGREGATE $30,000.000 I DED RETENTIONSO $ A WORKERS COMPENSATION A2CW98001202 W3012012 513012013 X WC STATU- DTH- AND EMPLOYERS'LIABILITY Y I N TORY LIMITS ANY PROPRIErOR/PARTNERIEXECUTIVENIA E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? MN (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 B Property and Inland Marine RHN959753200 /2012 /2013 Leased or rented $500,000 ( Installation Floater $100,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additionat Remarks Schedule,H more space is required) RE: Royal Crest Estates, North Andover,MA Contract No. 13651-403528-CP-00003 New England Helical&Excavation,Inc.is included as an Additional Insured for Automobile Liability on a Primary and Non-Contributory Basis for the conduct of the(Named)Insured,but only to the extent of that liability,as required by a signed written contractor or agreement with the Named Insured. See Attached... I { CERTIFICATE HOLDER CANCELLATION 30 days,except 10 for nonpayment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN New England Helical&Excavation,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 35 Briarbrook Drive Seekonk MA 02771 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD