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HomeMy WebLinkAboutBuilding Permit #252-14 - 56 Royal Crest Building 23 9/19/2013 uvw Jle BUILDING PERMIT �� .•`{ '�• o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: "— ' Gate Received �•'"� Date issued: CAU IMPORTANT:Applicant.must Co lete all items on this age, � f � d nt}.' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential G New Building G One family G Addition X Two or more family E Industrial 0 Alteration No.of units: Varies ®Commercial X Repair, replacement l i Assessory Bldg 0 Others; Li Demolition X Other Waterproofing, Stairs &Rails E'53115a ER, Provide exterior foundation waterproofing and replace stairwells with railings as necessary at .Bldg. #'s 23, 24, 26 &49 Identification Please Type or Print Clearly) Dan Millanazzo OWNER: Name: AIMCO North Andover, LLC Phone (617) 639-6052 Address: 50 Royal Crest Dr.; N. Andover MA a. e° 4 A L S Cornerstone Land Consultants, Inc. ARCHITECT/ENGINEER John A. Visniewski. PE Phone: (978) 433-8100 Address:__61 Main St.: P.O. Box 657: Pepperell MA 01463 Reg. No. _Klass__ PE 2q775 FEE SC14EDULE:BUWINGPERMIP$12.00 PER$1000.00.0F THE TOTAL:ESTIMATE©COST BASED ON$125.00 PER:S.F. Total Project Cost: $ 25,000.00 "b — FEE: $ 300.00 ��(►� Check No.: Receipt No.: Zcp 6 W., NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fiend i, TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on thisage . �. L ;CATION _— - - R_ - _ - - ,3 r . Pnnt. - x PROPERTY OWNER -- - Print Q O e yes 100�Year Id Structur` no MAP NQS _ PARCE � _ ZQNING'DISTRLCT _ :Historic Districtyesr in _ -r - - _ - p4 rMachine Shop Village,. yesE not TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential 0 New Building ❑ One family 0 Addition 0 Two or more family 0 Industrial 0 Alteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other SWdp eptic ❑ ell Flo,olairi Wetlands `°; ❑ 1NatershedrDistnctps _p Waterfsewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR ,Name:: hone �_ Address: , Supervisor's�Constructiori .License - —� _. ;.Exp. Dafe; — -_ j Home 101 em license: r — - - - 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. a. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund S nature�of Agent/Ownerr_., _ Slgatur�of confractorx , � s Plans Submitted ❑ Plays Waived ❑ Certified Plot Plan ❑ Stamped Plari� ❑ t Plans Submitted-[] Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ .'TYPE_0P.SEWERAGEDiSP0SAL Public Sewer ❑ Tanning/MassageBody 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 DATE REJECTED: DATE.APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Si nature I COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments I I Conservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit R DPW To-vvda Engineer: Signature: Located 384 Osgood Street FIRED OARTKENT.`=-Temp Dump'ster on site yes no Located at�124{Mair,`Street Fire-De'pa'rtmeiitsigiiature/date, 4 y '•?rf X �', ,;- ' COMM.ENTSj � ®i�ensi®n Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 1 _ i ELECTRICAL: Movement of Meter location mast or service droprequires Electrical Inspector Yes N® approval of DANGER ZONE LITERATURE: Yes No MGL-Chapter-166.Section 21A-F and G min.$100-$1000.fiine NOTES and DATA— (For department use i EJ Notified for pickup - Date I I Doe.Building Permit Revised 2010 i Plans Submitted N Plans Waived d Certified Plot Plan 11 Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer M Tanning/Massage/Body Art ❑ Swimming Pools L) Well ❑ Tobacco.Sales ❑ FaodPackaging/Sales 0 Private.(septic tank,etc. ❑ Permanent'Dumpster on Site. 0 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF -U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT E COMENTS CONSERVATION El C©MiVIENTS -Q�_�IG� l a�� ' DATE REJECTED DATE APPROVED HEALTH ❑ COMMENTS Zoning Board of Appeals:Variance, Petition No Zoning Decision/recti ptlsub submitted yes es r Planning Board Decision: Comments I Conservation Decision Comments Water& Sewer Connection/signatu're&date Driveway Permit Located at 384 Osgood Street AR 4' t . Building Department •The fol swing 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 i Addition Or Decks i ❑ Building Permit Application 1 ❑ Certified Surveyed Plot Plan 1 ❑ 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) j ❑ Engineering Affidavits for Engineered products i 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 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.Bui?ding Permit Revised 2012 i ' y Location 2—S �2 D el v No. b2 l q Date 4 OF NORTH ANDOVER �I eD . Certificate of Occupancy $ f Building/Frame Permit Fee $ Foundation Permiffee $ Other Permit Fee $ Tilt)� N, TOTAL $ Check# wA Building Inspector NORTH Town of '� Andover No. LAM* h ,� ver, Mass, ZO 13 0 COC "IC"IWIcK �1 '�i,9 A�R�TEO ►`p�,�'��' s U BOARD OF HEALTH Food/Kitchen PERMIT T LD rSeptic System �.`''O ' " BUILDING INSPECTOR THIS CERTIFIES THAT ....... . .... ..... .... OfC y�� Foundation has permission to erect ....... buildings on .. 1 .. .ST :fir !... - �Y w tl. ��/�dEo--- AAW p C �41 Rough to be occupied as ..............................•..ted ...................... ....... .. �.....�i�. Ai. ..... 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 CONSTRUCTION §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. SEE REVERSE SIDE .......... .__. at Np irh TOWN OFNORTH ANDOVER OFFICE OF BUILDING DEPARTMENT a 400 Osgood Street North Andover,Massachusetts.01845 i Telephone 978 688''=95454 D.Robert Nicetta, � ( ) Building Commissioner Fax (978)688=9542 CONTROL CONSTRUCTION—SECTION 11&0 M.&B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 I, John A. Visniewski HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT Bldg. Ws 23, 24, 26 &49 at 50 Royal Crest Dr. DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: Foundation waterproofing and subs", age,piping at the specified �N orMqs� buildings. A. NIEWSKI ; AUTHORIZED SIGNATURE: :2 s ' 11� A„ ,, :September 13, 2013 REGISTRATION: Mass. PE # 29775 j NOTE: ENGINEER"WET STAMP"MUST BE AFFIXED TO THIS FORM COMMI CODAUUction Form revised-1.1.152004 BOARD OF APPEALS 688=9541 CONSF,RVATION"658-9530 HEALTH 688-9540, 'PLANNING 698-9535 Massachusetts -Uepartment of Pumic 5atety Board of Building Regulations and Standards Construction Supen-isor License: CS-017809 `' LAWRENCE V MstWN, - 65 HOWARD BRAINTREE 11 02184 ' )I Ila Expiration Commissioner 07/19/2015 AcoCERTIFICATE OF LIABILITY INSURANCE D /DDIYYY1� �i 9/18//18/2013 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). PRODUCER CONTACT Criatina NAME: T. Edmund Garrity & Co. , Inc. PHONE ,,,. (617)354-4640 FAX (617)354-5828 545 Concord Ave. Nok -MAIL ADDRESS.criatina@garrity-insurance.com INSURER(S) AFFORDING COVERAGE NAIC N Cambridge MA 02138 INSURERAdhio Security Insurance Co INSURED INSURER B L.V.M.J. Corporation INSURERC: 65 Howard Street INSURER D: INSURER E Braintree MA 02184 INSURER F: COVERAGES CERTIFICATE NUMBERVASTER COZ 2013 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. ILSR DDLSUBR TYPE OF INSURANCE POLICY NUMBER MIDD EFF IPS Y EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENT-Eg— X COMMERCIAL GENERAL LIABILITY PREMISET Ea occurrence $ 100,000 A CLAIMS-MADE Fx�OCCUR BLS1455690302 /13/2013 /13/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N EIR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,I more space Is required) Excavation & Hauling. CERTIFICATE HOLDER CANCELLATION lvm46@beld.net SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 120 Main Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 W Garrity/CRISTI ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r7mnn-ii m Tha Oi npn name 2nri Innn aro raniefanarl mark*of ae npn ACC O CERTIFICATE OF LIABILITY INSURANCE 9ii8i2o�' 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 CONTACT NAME: Albert J. Tony & Co. , Inc. PHONE (617)773-9200 FAX (617)7739920 300 Congress Street INSURER 3 AFFORDING COVERAGE MAIC i Quincy MA 02169 INSURER A:Ca®erce Insurance 34754 INSURED INSURER B: L. V. M. J. Corporation INSURER C: 65 Howard Street INSURERD: INSURERE: Braintree MA 02184 INSURERF: COVERAGES CERTIFICATE NUMBER:CL139407107 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP AM POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED- COMMERCIAL GENERAL LIABILITY PREMI ES Ea occurrence $ CLAIMS-MADE FIOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 17 POLICY PRO- LOC $ AUTOMOBILE LIABILITY Ea MANED SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ 8 ALL OWNEDSCHEDULED J1808 /15/2013 /15/2014 AUTOS Ix AUTOS BODILY INJJRY(Per accident) $ X HIREDAUTOSNON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Medical payments $ 5,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION I WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y 1 NER LIMANY PROPRIETORIPARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Any and all jobs performed usual to an Excavation contractor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tawe of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE L Tonry Jr./CDIGRA " ACORD 25(2010105) O 1988-2010 ACORD CORPORATION. All rights reserved. INSn75 r,)mnns)m Tho arnon namo onrt Inn^aro wntc4oro'I marke^f Arnon MASSACHUSETTS ASSIGNED RISK POOL. REQUEST FOR CERTIFICATE OF INSURANCE Use this form to request a'Certificate of Insurance from the Assigned Risk Pool Carrier(A.I.M. .Mutual Insurance`Co.). Please provide all of the requested information, including the facsimile nurnber(s) of the person or persons to whom the. Certificate of Insurance`should be issued. If this form is fullyand accurately completed; the Certificate of Insurance will be, issued and distributed by facsimile,to each fax number provided below, within'two (2) business days of the carrier's receipt. This Form may be mailed or faxed to the.Assigned Risk Pool Carrier. To obtain each carrier's contact information refer to the Certificates of Insurance section located in the Producer Community section of the Bureau's website(www.wcribma.org). j 9. Name,address, telephone number and facsimile number or email address°of the INSURED: Name: _ L. V. M. J. Corporation dba:' Mailing Address: 65 Howard Street Braintree MA 02184-1150 Physical Address: Phone: (781)848-6030Fax or email: Ivm460beld.net 2. Name,address, telephone number and facsimile number or email address of the CERTIFICATE HOLDER. Name;- Town of:North Andover Mailing Address:' 1.20 Main Street North Andover MA 01845 Physical Address Phone: Fax or email': Fax Number 3. Name, address, contact person,telephone number and facsimile number or email address of the PRODUCER. Name: Albert J.Tonry&Co.. Inc.. Mailing Address: 300 Congress Street Quincv. MA 02169 Contact Person: Cheryl A. DiGravio Phone: (61.7)773-920:0 Fax or email: (617)773-9920 or certsOtornnr.com 4 Policy Number, Policy Effective Date and Policy Expiration Date If a Certificate of Insurance is needed for more than one policy term,provide 1he Policy Number, Effective Date and Expiration Date for each policy-term. If the policy has not yet been issued, you must attach a copy-of the Notice of Assignment. Policy Number: VWC10060082462013A Effective Date: 4/6/2013 Expiration Date: 4/6/2, 014., 5. List any special requests for optional coverages l endorsements(see Page.21for listing of coverages available in the,pool and the"conditions of availability)or additional inib rmation;(including changes in exposure not yet reported to the carrier)that will assist the carrier in the:issuance of the Certificate of Insurance. NOTE.An additional insuted(s)shall not be listed on any Certificate:of Insurance unless:such additional insured(s)is a named insured on the policy. None