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Home My WebLink AboutBuilding Permit #99-11 - 24 STACY DRIVE 8/2/2010Permit NA q f BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 4L i 4 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family V Addition Two or more family Industrial Alteration No. of units: Commercial Others: Repair, replacement Assessory Bldg Demolition Other e,A 00�, DESCRIPTI N OF WORK TO BE PREFORMED: Replace. old sidi'nQ '(And insfall new cedar scd.jnQ Apply lun enats df Identification Please Type or Print Clearly) OWNER: Name: Prr5coi-+ VillnQr_ Assnt. Phone:' ARCHITECT/ENGI NEER 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: $ g 1,4 1), - —FEE: $ Check No.: - & Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access �Iothe �bquaranofiund Plans Submitted Plans'Waived Certified Plot Plan 'Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Poo I I.s 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 DATEAPPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENT -0 fit HEALTH Reviewed on Sionature 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 Drivewav Permit DPW Town Engineer: Signature: 0 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 21 A —F and G min.$100-$1 000 fine Doc.Building Permit Revised 2010 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 ii Floor Plan Or Proposed Interior Work. D 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 a Certified Surveyed Plot Plan u Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u 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) L3 Building Permit Application -Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses E3 Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) 13 Copy of Contract .a 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. el Doc: Building Permit Revised 2008 '_ Locatio No. Date jORTot TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 3 CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 232 �,6 "-�uilding Inspector M rA co C2 CL m Rco C2 ca E 4C CD co ccaL E E z cf) Cb CD CD 0 a CL C* COD Ma C42 Cf) cm CO) co) A-. ca E CD CD 0 CLL..) I.: CD La C D 4:D, cm 0 cm" C'a C2 CIO S.— CD CD cm cc, CD 40:5 0 COD cc cob — = 4- G� uj E C3 C2 C* CD ce C3 CL..— pa >0 rm 0 S I C E CD Q CL CD cm CO) co CO2 0 CD CD Q CM. CL CO2 Cc Cc I t.4 ca co co) CA w LLI U) 19 LLI LLI 19 LLI LLI U) Cu) co C� x o" R. U �2 cz Cf) v cf) M rA co C2 CL m Rco C2 ca E 4C CD co ccaL E E z cf) Cb CD CD 0 a CL C* COD Ma C42 Cf) cm CO) co) A-. ca E CD CD 0 CLL..) I.: CD La C D 4:D, cm 0 cm" C'a C2 CIO S.— CD CD cm cc, CD 40:5 0 COD cc cob — = 4- G� uj E C3 C2 C* CD ce C3 CL..— pa >0 rm 0 S I C E CD Q CL CD cm CO) co CO2 0 CD CD Q CM. CL CO2 Cc Cc I t.4 ca co co) CA w LLI U) 19 LLI LLI 19 LLI LLI U) NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: — is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention I aws Chapter 148 Section 10A. The debris will be disposed of in: &'cibad.v Tran�en, sfa4ion (Location of Facility) 7) uz&�l f "�tt4je-"t Signaturg'of Permit Applicant Date JOHNSTON CONSTRUCTION CO., INC. Two Reo Road W. Peabody, Massachusetts 0 1960 (979) 535-3228 www.johiistonconstructioninc.com July 12, 2010 Great North Property Management c/o Prescott Village Association 95 Brewery Lane Suite 2 10 Portsmouth, NH 03801 Description of work: Carpentry & Painting on Units 24 & 25. Remove old clap boards and replace with 6" Cedar Clapboard. Replace comer boards on the left and right fronts of Units 24 & 25. Apply two coats of paint on the front of Unit 24 & 25. Install Tyvex house wrap on the front,of Lmit 24 & 25. Rubbish Fee -Included - Labor & Material: ........................................................................ $8,740.00 Permit Allowance: .................................... ...................................... $ 250.00 Carpentry repair work will be performed at a rate. $85.00 per hour for two men on necessary work pertaining to trim and window sill where needed. 9 1 o i��i in, Note: Fully insured with Liability and Workman's Compensation. Certificates are on file and can be provided upon request. Per our,previous arrangement, the payment. schedule is a third to start the project, a third halfway through the project and the final payment upon the completion. C) Customer Signature bavid E. johnst IYateT Date Johnston Co=Ction Co., Inc. MORI). PRODUCER The Douglas Insurance Agency Lynnfield Woods Office Park 220 Broadway Suite #301 Lynnfield, NIA 01940 NSURED Johnston Construction Co. 2 Reo Road Peabody, MA 01960 DATE (UWDOfM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A Commerce Insurance Co. COMPANY B Travelers Insurance COMPANY C COMPANY D COVERAGES:'-' THIS IS TO CERTIFY THAT THE POLICIES' O'F INS ABO'V'� F 0' 1 R THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRE T WITH RESPECT TO WHICH THiS CERTIFICATE MAY BE ISSUED OR MAY PERTAII IS SU&JECT rO ALL r1HE TERmS EXCLUSIONS AND CONDITIONS OF SUCH POLICI CO L rR TYPE OF INSU ANCE UCYNUMBER DATE (MM001M.. DATE (UMMOD ULNTS GENERAL LIABILITY ENERAL LIABILITY _X..CO MERCIAL r A CLAIMS MADE E OCCUR JN9125 8/20/09 8/20/10 OWNER*S & CONT PROT L AVTOMOOILE UABiLrry ANY AUTO X ACL OWNED AUTOS A X SCHEDULED AUTOS OOMMT16128 1/1/09 1/1/11 HIRED AUTOS NON -OWNED AUTOS GARAGE UABILITY ANY AUTO EXCESS IJABIU`TY UMBRELLA'FORM OTHER �HANI UMBRELLA FORM WORKERS COMPENSATION AND EA�PILOYERS' UABIU-rY 1 THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE I � �FFICERS A�9�_., EXCL I OTHER XHUB-3307T43-4-09 GENERAL AGGREGATE 1,000,000 PRODUCTS-COMP/OP AGG L1091000 PERSONAL & ACV INJURY 1_Q_0 0 0 0 0 EACH OCCURREt�E i"000,000 FIRE DAMAGE (AAy one hre) 50,000 MED EXP (My " p -son) - ()00,-.-- 7 COMBINED SINGLE LIMIT $ BOOILY INJURY (Po(wxn) '250,000 ;I---. BODILY INJURY (Pw socident) 1500,000 PROPERTY DAMAGE 1100.000 I AU`TO ONLY - EA ACCIDENT OTHER THM AU"TO ONLY: EACHACCIOEW AGGREGATE s EACH OCCURRENCE AGGREGATE EACH ACCIDENT 9/20/091 9/20/10 1 500,000 - 0 . I . SEASE_- POLICY LIMIT 1500,000 --- — ------ DISEASE - EA4H EMPLOYEE $500,000 N OF OPERAnONSILC>CAT)OHM-ELMICLEStSPECIAL ITEMS D RI Construction work at various locations Snow Plowing at various locations CEWhFICATE HOLDER -CANCELLATION, City of Peabody SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE Lowell Street EXF4RATION DATIE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Peabody, MA 01960 30 DAYS ivRrrrEN NOTICE To THE CEFmF)CATE HOLDER KAMED TO T)IE LEFT, BUT FAILURE TO "L SUCH NOTICE SKALL OAPOSE NO 06UGAT)ON OR UABILJT-Y PPON THE COMPANY, ITY'19ENTS OR REPRESENTATTYES AVTHORIZ ATTVE ACORD 25-S (3/93) BY: Ic e ou as 4 . .......... a ACORD COR AT10N 1993 41 N The Commonwealth of Massachusetts 4. 1-1 1 am a general contractor and I Department of Industrial Accidents have hired the sub -contractors Office of Investigations listed on the attached sheet. 600 Washington Street These sub -contractors have Boston, MA 02111 WWW.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contrac.tors/Electricians/Plumbers Applicant Information Please Print Legib Name (Business/Organization/In.dividual): Johr%5+on eonsfruc+ion Co.. T-ne, .. Address: 2 gea g,5c,,j City/State/Zip: ftcAb a r_1 V - MA t)1q(,n Phone#: 918S35-3229 Are you an employer? Check the appropriate box: 1. Z . I am a employer with 4. 1-1 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. 0 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5.0 We are a corporation and its required.] officers have exercised their 3. El I am a homeowner doing all work right of exemption per MGL myself [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required-] Type of project (required): 6. F1 New construction 7. Remodeling 8. Demolition 9. E] Building addition 10.0 Electrical repairs or additions 11.[:] Plumbing repairs or additions 12.E] Roof repairs 1311 Other *Any Applicant that checks box# 1 must also fill out the section below showing their workers' compensation policy information. � Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors afid their workers' comp. policy information. I am an employer that is providing workers' compensation insurancefor my employees. Below is the policy andjoh, site information. Insurance Company Name: Commercc InstAran r, e - Policy # or Self -ins. Lic. 9: X H U J1 _ 3 3 07 T 4 - .3 r. -1 _ a q Expiration Date: q - 20- it Job Site Address: 1,4 - ZS Slapy 'by. City/State/Zip: No. An-daver, mA Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crirninal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the forin of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofpeiYury that the information pro vided above is true and correct. Signature: D&Utd— 1 (41XJbX Date: 8 -2 -lb a Phone#: 9 7 9 5 3 5 - 312 9 Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deerned to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuanee or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) narne(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employe es, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confin-nation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application. for the permit or license is being requested, not the Department of .Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please, call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is.comp , lete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license nurnber which will be used as a reference number. In addition, an applicant that must submit multiple pen-nit/license applications in any given year, need only submit one affidavit indicating current policy inforination (if necessary) and under "Jo ' b SiteAddress" the applicant should write "all locations in _(city I or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen -nit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 1 www.mass.gov/dia Massachusetts - Department of Public S11fety Board of Building Regulations and Standards Construction� Supervisor License License: CS MW Restricted to: 00 DAVID E JOHNSTOk 2 REO RD PEABODY, MA 01960 L� Expiration: 9/3012011 Commissioner Tr#: 3095 .. wte. -7 K7. 1 .1-14 oe. -.- dndm M HOME IMPROVEMENT CONTRACTOR Registration: 123124 N�'- Expirakio-n�- 1-2/12/2010 Tr# 278545 �,Type: Private Corporation JOHNSTON CONST CO,'INC.. DAVID JOHNSTOW, 2 REO RD — PEABODY, MA 01960 Administrator 4 License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and -Standards One Ashburton Place Rut 1301 Boston, Ma. 02108 4 Not valid witLs�i- 07/29/2002 11:4@ FAX 17815965412 CANON 12 002/0)2 CATE (wicDO I I CERTIFICATE OF -INSURANCE, A 1 THIS CERMEX-Mif-1-3SUED AS A FORMAT!'6'N__' DOUGLAS INSURANCE AGENC-Y I 1 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE f Lynnfield Woods Office Park HOLDSIR. THIS CERTIFICATE DOES NOT AMEND, EMIND OA I 220 Groadw,�y - 301 ALTER THE COVERAGIE'iFFORIDEE) BY THU; POLICIES BEL�, COMPANIES AFFOADING COVERAGE Lynnflield, JVA 01940 COMPANY A Commerce Insurance COM PA NY Johnston Construction Co., Inc. 1 9 Travelers Indemnity Company of Ameri C� 2 Reo Road COMPANY Peabody, MA 01960 C COMPANY D COVERAGES TMIS IS TO CFRTIFY THAT THE POLICIES OP INSURANCE LISTED BELOW HAVE 9EEN ISSUED T'Q' THE INSURED NAMED ABOVE FOR '1*hE POUCY PER100 INDICAIED. NorWITHSTANDINrA ANY REOUIRISMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W!TH RF;$PEC1 70 OI(HICH THIS 65 ISSVED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCAiBI-0 mEFEIN IS �QELJECT TO ILL �HE TERII�', EXCLUSIONS AND CONDITIONS OF SUCH POOCIES. LIWS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTF "PE OF INWANCE POLICY NVIIIIIII19A POUCY eppenyc OATS (W*V9iYV1, POLICY EX�PIFILAT`10W: DATE (W�Dofry) LAWT 5 GE91AAL LIA4;LjTY 7 LGENEFAL 11,00REGATE $1,000,000 X Of NERA4 "AllLn I 'Z_0UC17b___ -_ -COA4POOP AGG A CLAIMS MADE WCU141 --- JN9125 8/20/09 PERSONoU a ADV iNJUFkY 8/20 11 --- - - - . $1,000,60Q 0,ANEA'S & CONT Frq0T j�E; 00 L; ME C6 $1,000,000 1W F E . 1A . hrel 1 50,000 MEG EXP (Any -0 pPrMA I I 0 — ISAR . COMBINED SINOLE 6IMr 6 ANY AV70 X ALL OWNED ALTO$ A *5C-(D-AE0 AUTOS 00MMT1 6128 BODILY IWURY Ipse waw� I Z50,000 m+IED AUTOS NON -OWKO AVY09 DOPIt Y NJURV (Per wcp6anl; 500,000 PPOPIERYY OAMAGE 1 100,000 rARAQ9 LIABILF-- AUYOCINLY EAACCIDENI --�NT AUTO OTHEP T�4M AUTO ONLY EACH ACCIDENT 4ZLGILlk!�� T E_ UCF53 UADiLRN EACH 00CURPIENCE UM84ELLAFOAM OrHE A THAN UWBAELLA FOFIW *OOOAERS COmMOAT110," mo STATUTOR�'Lluffs b"%OYCOM, 6LABItm EACH ACCIDENT 1500,000 TH.( II-AQPRjE,OFV PAFITNER&ifXECUT;vE INC, XHUB-3307T43-4-09 9/20/09 9/20111 11151EASE - POILICY LIMIT 1500 000 OFFICEAS AAtf .QrH.6'A - 013FAM - EACH EMPLOYEE s S(I � d' coo __ _ — "'PSCIALMIEW Construction work at various Imations CERTIF16ATE'HOLDE'A ... .. ...... . ' CANCELLXT116� Town of North Andover SHOULD ANY Of THE ABOVE 15F&CAiAeO P"ir'L$ 09 CAPOCILLLLI) ULI'0W. fi,L Town Hall W4111ATIOM DATE rHEAEOF, i)I& msuigG coupAmy m�I, &HOEAVOIII TC WA)L North Andover, MA 01845 -AL DAVIS WRffWX NOr-Cf. YO rMF CERTIFICATE WLJ)f.A "WEV TQ T,46 4E,". 11"AMURE TO 1WL WCi4 NOT)CE ILL. MPME NO 00LOQAT)O91 OR LIAWLI711f MU' IIJ ANY OUND UPON YNC rrg AGEWM M kIAPAC3EN7AT1Vk5. A p0it -'iI t ACORD 25-5 (3193) X�' iA OV� R �PR AT) 0 N 19 9 3 By. Michae R D`ou�jlas