HomeMy WebLinkAboutBuilding Permit #674 - 1401 GREAT POND ROAD 6/8/2009 BUILDING PERMIT NORTH ►
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TOWN OF NORTH ANDOVER c� ., o�
APPLICATION FOR PLAN EXAMINATION ~ _ 70
Permit NO: DY
ate Received s, 9'44reo
,TS US
Date Issued: "
IMPORTANT: Applicant must complete all items on this page
LOCATION 1 '10 r ea
Print
PROPERTY OWNER '2�L hA 2�.N 6 tN I'J
Print
MAP NO: 017(- PARCEL:9'-E5 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: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Sy c�� m +�yv ` w n. Phone:
Address:
CONTRACTOR Name: n A Voek . Phone:
Address: T? LOC 0 S
Supervisor's Construction License:<f :5 '7 ;7 0 Exp. Date: '
Home Improvement License: Exp. Date:
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: $ , 0ae�/(D U FEE: $11X 2- 2S'O- .•--
Check No.: 7� Receipt No.: A- 3 61 1
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
signature of Agent/Owner Signature of contractor
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
All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
NOTEp
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/of Contract 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 CompEnn
❑ Engineering Affidavits fo gveered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
sione
from the Board of
In all cases if a variance or special permit was required the Town Clerks office must
isstamp fth edeclone copy and proof of recording
peals
that the appeal period is over. The applicant must then get this recorded at the g Y
must be submitted with the building application
Doc:INSPECTIONAL SERVICES DEPARTMENTMFORM07
Revised 2.2008
1
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 - Date
..... ............__.._....._._..................--- .................................-----._..................._....__..._..------......................._......................_.............._..._ _.._._._._....__._._.................---.... — .._...............
Doc.Building Permit Revised 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
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
c
Zonin j 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 -Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Location 1elol G' r 7w /<Iw * Cf-_
No. Date
TOWN OF NORTH ANDOVER
•roc
` Certificate of Occupancy $ `
} " = Z ZZ-
�',s'•"'
Nut<� Building/Frame Permit Fee $ X Z s
x
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
J�
Check #
22U > s
Building Inspector
MC-Construction
198 Locust ST.
Danvers.MA.O1923
978-777-2577
4/21/09
TO:Judy Manjan
1401 Great Pond RD,Vnit#8
N.Andover MA.
978-989-0843
EST:On water Damage at above address
I
Main bedroom-
-To replace closet light switch with new switch -
-To fix ceiling fan light,poweusupply-at outlet box
-To strip existing wall paper on walls and prep for paint
-To strap existing ceiling were needed
-To insulate bedroom ceiling with kraft faced R-25 insulation
-To blue board and plastejr bedroom ceiling and walls
-To trim out existing }-window and 2-doors to match existing and install baseboard
-To prep walls and ceiling and trim and stain block were needed,and prime 1-coat and paint 2-coats w/Ben Moor
ceiling white and egg shell for walls and semi for trim,at bedroom and closet and doors:color of choice
-To install pad and carpet-on-existing bedroom floor,color of choice
-To install remote control fan at existing ceiling fixture box
-To shave bedroom entrance door to work properly and paint
-To hang window shade or blinds supplied to me if desired
Interior Hallway-
-To remove water damaged ceiling were needed
-To blue board and plaster ceiling were needed
-To stain block ceiling or walls were needed
-To prep prime and paint the entire hall ceiling and existing walls and trim
-To replace light fixtures and smokes with existing
Exterior common hallway-
-To remove water damaged areas were needed
-To blue board and plaster-were needed
-To stain block,prime,and paint walls and ceiling to match existing as discussed
To clean and haul all above debris away
Total Labor and material to complete above itemized job-$9,285.00
Respectfully submitted by Jon Cahill per JMC-Construction
SWORN STATEMENT IN PROOF OF LOSS
and Subrogation Agreement
$2,662,800.00(Building) BP17044105
Amount of policy at time of loss. Policy Number
6/1/2008 BOP35615
Date Issued Co.File Number
6/1/2009 DeAngelis Insurance Agency, Inc.
Date Expired Agent
To the Vermont Mutual Insurance Company
By the above policy you insured Colonnade Condominium Association
against loss by BP 00 02 (12/99) to the property described under Schedule"A".
1. . Time and Origin: A Ice Dam/Water Seepage loss occurred about the hour of O'clock _ M
on 01/11/09 The cause and origin of the said loss were:
Water seepage through a bedroom ceiling due to the build up of ice and snow on the roof.
2. Occupancy: The building described,or containing the property described, was occupied at the time of the loss
as follows,and for no other purpose whatever: Residential Condominium
3. Title and interest: At the time of the loss,the interest of your insured in the property described therein was
Owner No other person or persons had any interest therein
or encumbrance thereon, except: None
4. Changes: Since the said policy was issued there has been no assigmnent thereof, or change of interest,use,
occupancy,possession, location or exposure of the property described, except: None
5. Total Insurance: The total amount of insurance upon the property described by this policy was, at the time of
the loss, $2,662,800.00 as more particularly specified in the apportionment attached under Schedule
"C"besides which there was no policy or other contract of insurance,written or oral,valid or invalid.
(Full Replacement Cost figures to be inserted only when
considered in the adjustment) Full Replacement Cost Actual Cash Value
6. The value of said property at the time of loss was . . . . . . . $ $
7. The whole loss and damage was . . . . . . . . . . . . . . . .
Less: Direct Payment to ServiceMaster. . . ... . $2,436.38
8. The amount(less Deductible of $1,000.00 )claimed under this policy is $11,187.68
9. The said loss did not originate by any act, design or procurement on the part of your Insured, or this affiant:
nothing has been done by or with the privity or consent of your Insured or this affiant,to violate the conditions
of the policy, or render it void;no articles are mentioned herein or in annexed schedules but such as were
destroyed or damaged at the time of said loss;no property saved has in any manner been concealed,and no
attempt to deceive the said company,as to the extent of said loss,has in any manner been made. Any other
information that may be required will be furnished and considered a part of this proof.
10. The Insured hereby assigns,transfers, and sets over to the Insurer any and all claims or causes of action of
whatsoever kind and nature which the Insured now has, or may hereafter have,to recover against any person or
persons as the result of said occurrence and loss above described,to the extent of the payment above made;the
Insured agrees that the Insurer may enforce the same in such mailer as shall be necessary or appropriate for the
use and benefit of the Insurer, either in its own name or in the name of the Insured;that the Insured will furnish
such papers, information,or evidence as shall be within the Insured's possession or control for the purpose of
enforcing such claim,demand,or cause of action. The Insured covenants that no release or settlement of any
such claim, demand,or cause of action has been made.
11. The furnishing of this blank or the preparation of proofs by a representative of the above insurance company is
not a waiver of any of its rights.
12. THIS STATEMENT IS MADE UNDER THE PENALTY OF PERJURY.
State r
of i �� t � A A+
County of l �� e a- r-- Insured
Subscribed and sworn to before me this day of 2, 2009 ' itness
64i
STATEMENT OF LOSS
IMPORTANT NOTICE: This adjustment is-subject to the review and approval of your insurance company
I. Value VALUE LOSS CLAIM
Dwelling Replacement Cost Value(See attached
Insurance to Value Worksheet) 2,527,000.00
II Loss&Claim
Dwelling Loss&Claim
1.) Repairs Per Consultant's Estimate 9,301.32
2.) Repairs Per Consultant's Supplemental Estimate 2,670.79
3.) Emergency Repairs&Protection: 2m/16hrs @ 40. 1,280.00
4.) Emergency Temporary Roof Repair:
L(2 m/6 hrs @ 40.)=480./M,100. 580.00
Additional Coverage
5.) Moisture&Mold Testing -Per Ricker Associates 750.00
6.) Restoration Per ServiceMaster Invoice 2,436.38
Dwelling RCV Loss: 17,018.49
Less Estimate Depreciation(20%): (2,394.43)
Dwelling ACV Loss: 14,624.06 14,624.06
Less Deductible: (1,000.00)
Dwelling Claim,As Adjusted: 13,624.06 13,624.06
*DWELLING POLICY LIMIT: 2,662,800.00
*Complies w/80%I2V Requirement
III VALUE,LOSS& CLAIM 2,527,000.00 14,624.06 13,624.06
Less: Direct Payment to ServiceMaster (2,436.38)
11,187.68
Page 8
COST OF REPAIR:
Unit 8
Rear bedroom
Replacement of ceiling insulation
144 s.f. @$1.80 s.f. $0,259.20
Replacement of ceiling
144 s.f. @$2.80 s.f. $0,403.20
Paint walls, faux finish
467 s.f. @$2.90 s.f. $1,354.30
Paint ceiling
144 s.f. @$.90 s.f. $0,129.60
Remove and replacement of wallpaper boarder
571.f. @$2.40 I..f $0,136.80
Reset bedroom entry door
Labor—2 hrs. @$65 hr. $0,130.00
Paint doors
3 @$75 per $0,225.00
Clean and seal sub-floor
Materials and labor $0,075.00
Replacement of carpet and pad
16 s.yds. @$32.00 s.yd. $0,512.00
Remove and reset electrical devices
2 trips—minimum electrical charge $0,400.00
Bedroom closet
Repair walls—minimum charge $0,150.00
Paint ceiling and walls
286 s.f. @$.90 s.f. $0,257.40
Replacement of carpet
5 s.yds. @$32 s.yd. $0,160.00
Hallway outside bedroom
Removal of ceiling
Labor—2 hrs. @ $65 hr. $0,130.00
Page 9
Replacement of ceiling
60 s.f. @$2.80 s.f. $0,168.00
Paint walls and ceiling
349 s.f. @$.90 s.f. $0,314.10
Remove and reset ceiling light and heat sensor
2 @$75 per $0,150.00
Common stairwell
Removal of two ceiling sections
Labor—2 hrs. @$65 hr. $0,130.00
Replacement of two ceiling sections
Materials and labor $0,250.00
Repair one wall section
Labor and materials $0,150.00
Paint walls and ceiling entire stairwell
885 s.f. @$.90 s.£ $0,796.50
Staging to paint stairwell—set up and dismantle
3 sections @$75 per $0,225.00
Protect carpeting $0,075.00
Remove and reset ceiling fixture and heat sensor
Within affected portions of ceiling—2 @$75 per $0,150.00
General
Permits $0,300.00
Clean up on daily basis—6 hrs. @$45 hr. $0,270.00
Trucking and hauling equipment and materials $0,150.00
Trash removal $0,300.00
Sub-total $7,751.10
Overhead and Profit $1,550.22
TotalCost................................................ $9,301.32
N>cCio�?.�el,�Qnfo
Nicholas DelSanto
NORTEy
Town of
No. -
�`Y ti = dover, Mass.,
T LAKE
11, COCMICNEWICKAr
7� 0RATED PPS` ��
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT........ ... . �!`!...��t. . ............ ........................................................................... Foundation
has permission to erect........... buildings on..... I �.......��..� .......(. ...... Rough
to be occupied as......� ..�... �... ..3................................................. Chimney
... .. ............ ......,
provided that the person accepting this ermit sh In eve res ect c form to the terms of the application on file in
P P P g P rY P PP Final
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
2z2 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU STAR Rough
....... Service
BUILDING INSI'OR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.
Boar ow ung egu atio s an anar.s
w t
Construction Supervispr License
r 144 tr �a
Licese: CS 66770
7•�` ;� ��i
Expiration:_.12/14/2009 Tr# 20373
77
Restriction :-:AG'`s
'4+ r - 3F I_ �
JON M CAHILL
198 L':CUST ST
DANVERS,MA 01923` '�� Commissioner