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HomeMy WebLinkAboutBuilding Permit #175 - 777 JOHNSON STREET 9/4/2007 BUILDING PERMIT TOWN OF NORTH ANDOVER 0 4 APPLICATION FOR PLAN EXAMINATION Date Received Permit NO: / �ssACHuse i Date Issued: IMPORTANT Applicant must complete all items on this page r " rekfR' � x. s: e� - x e.ae,,�` nr& yt �� .. &��. ,. 3rF ..�hAU�z 'n" r ,- . Tis `e� :. NeR 6.1-5 V MAIC'M*' E1, 1�R:E . � OIIt� lT� :TT� 4� ©�Sr1 des ' nc� � «.u. .� .. .max_ a�-s...,,,,,- �•.. , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial "Iteration No. of uriits: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg Others: ❑ Demolition ❑ Other �. �& h- 1 ^' &" d e�' Ja DESCRIPTION OF WORK TO BE PREFORMED: c.cc, r\oo6-t- Identification Please Type or Print Clearly) OWNER: Name:s'1a._�I � � Aro Phone: 47� Address P CS o 0 1 7 2Z-- g 3 ° a '.✓ r - iL` L '%�. '' a 3^ HM � �j� CtC LNar� dhore , x a .., r xv g r " ark n . % a A. ^a = � ice° k �' � x r 4E aprvi '� ttn �c�ra '� Of a d zt � g ARCHITECT/ENGINEER PC--J CA19 e&\- x Phone: q��� x/ 3-92.3 0 Address: /ow Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.Q0 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 451;o'�o �i���600 FEE: $ 5 y Check No.: M-3 Receipt No.:n?lJ,�-& f NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 77. Sgnatt7re© AgenOwner , gnature ofc�ar�tractor ,,�, - i 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 ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS S Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature & )ate Located at 384 Osgood Street Driveway Permit FIRS�3E}PA TMENT �Temp D�rra pster o� s, d 24 M �n S+ ayes `oto Locate a 1 a Street a �� u � F arraen s�g�naturelriate � ' 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 Pen-nit Revised 2007 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 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 ❑ Building Permit Application L3 Certified Surveyed Plot Plan L3 Workers Comp Affidavit o 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) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ 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 o 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 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 DEPARTMENT:BPFORM07 Revised 2.2007 Location /� eU� a ' No. «J Date NORTh TOWN OF NORTH ANDOVER L • , ; Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # _ 20561 Building Inspector Huy co Ui Uy:00p Ki uunree Vfb-4b;e-UbW) p.2 Construction Payout Schedule item Pa ygmt Interior Framed 10000 Windows and exterior doors hung7504 Outside Finished 2500 Rough plu-mbing completed 8550 Septic system-complete 1500 'Rough heating 5800 Rough wiring installed 6000 , Insulation installed 4300 Lathed ready for Plaster NA Plastered induding skim cat 12450 i Outsidepaint/stain com late 4000 Standing finish installed 1300 1stf2nd coat interior painfistain 5600 Kitchen cabinets and appliances 15300 Heating completed 7200 Plumbing com ted 2850 Wirin oo eted 9000 Hardwood,ca andfor ceramic the com kAed 13000 Lan dsca ' 2000 walks and drive completed 20� Garage Door 2200 StePs and decks co-n eted 3000 Floors finished tdA Retainage 7250 f YS-10061 Buifder: — Date: 2�- p� owner: Date: D G A V I N & S U L L I V A IV A R C H 0 T E C T S 128 Warren Street(rear) Lowell, MA 01852 Voice: 978-452-3061 gavin.sullivan@verizon.net Fax: 978-452-4713 John F. Sullivan, Jr. AIA Mark D.Wilcox, ASID Daniel J. Donahue, CSI August 22, 2007 Mr. Gerald Brown North Andover Building Department 1600 Osgood Street North Andover,Ma. 0.1545 RE: 777 Johnson Street North Andover, Ma. Dear Mr. Brown . On August 22,2007 I made a site visit to the above mentioned property to evaluate the Fire damaged floor joists. In my professional opinion replacing the damaged 2"x 10"floor joists with new 2"x 10"floor joists having the same span will be structurally sufficient. If you have any further questions or if I can be of any further assistance please call. Sincerely, §ULLINo.9754 �q r�c� John F. S Jr_A.I.A- $ LOWELI.LL . � o MASS. OF NORTH Town of No. Co , �` dover, Mass., • o OLAKE � COCMICEWICK �oRATE D BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System C.U.C. f%j BUILDING INSPECTOR THIS CERTIFIES THAT...... 1........ .............. .. .. ......................................................................... Foundation has permission to erect........................................ buildings on ... N! ................................. Rough to be occupied asAers fit♦ s Chimney provided that then acce tin this ermlt shall i eh ve res pct conform to the terms of thea lication on file inPP 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 ( � PERMIT EXPIRES IN. 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC !� Rough Service BUILDING INSPECTOR 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. Contract 777 Jonnson st. N. A NDOVER MA PRICE $7500 Donovan homes LLC 60 TENNEY RD WESTFORD MA 01886 INCLUDES . OBTAIN ALL NECESSARY PERMITS .To hire all subs . All subs to have insurance all bills to be made out to Clarity Johnson LLC ALL work design to be ok by owners. To general contract all work up to occupancy permit. ALL PAYMENTS FOR WORK BEING DONE WILL BE BY CLARITY JOHNSON LLC payment terms $4000.00 DOWN MADE OUT TO DONOVAN HOMES 2000.00 after inside paint is done. 1.500.00 when occupancy permits is granted David Donovan DBA DONOVAN HOMES LLC-- ar 1 CLARITY JOHNSON LLC -- - ----- --_-------- -------_-------------------------_----- The Commonwealth of Massachusetts I I Department of Industrial Accidents Office of Investigations N '' 600 Washington Street Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): M/40/G 0 d rt t.C, Address: 6'0 7�c o 7 e/ 'I City/State/Zip: Phone #: `�Z�� (� 6 — Y? V I Are u an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New onstruction mployees(full and/or part-time).* have hired the sub-contractors 1_01!1hip am a sole proprietor or partner- listed on the attached sheet. 1 7. modeling je�and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 0.❑ Electrical repairs or additions 3.❑ 1 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.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks boz#1 must also fill out the section below showing their workers'compensation policy information. t 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 and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. C Insurance Company Name: C� �C f- I�f f'!'r ,/f dg �. Policy#or Self-ins. Lie.#: fN 6jZ, "51 Z,6 Z./"o ZAExpiration Date: %l- 2—U i Job Site Address: 72t 7 .,y vg o-: cs City/State/Zip:(l •q-1�)y J ,-,n 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 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. 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 cert' • e.under the pain nd penalties of perjury that the information provided above is true and correct Signature: Dat " Z Phone#: fZ � 91G C 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#: i i 7) "n. f © � N ✓ 1 �r � j 2 I x 9 i �t roe solea/(!/r;r,:_ lf uac/useGr {{(„ Hoard of I3ui� ng�tegaiahons andtanriards Construction Supervisor License License: CS 76045 x Birthdate: 4/1711957 Expiration: 4/17/2009 Tr# 13721 Restriction: 00 DAVID G DONOVAN 60 TENNEY RD WESTFORD,MA 01886 Commissioner t�mrvnxa�+u�c a, o Re nlatioas. and Standards : Board of i;uildinl, i; CONTRACTOR HOMPROVEME EIM Registration: 151691 ��� Expiration: 612112008 Type; individual DAVID G DONOVAN DAVID DONOVAN DA .--�' Tato 60-rFNNEY ROAD Poll pdm nes i t WESTFORD,MA 01886 Liberty Mutual Group Liberty PO Box 7202 mutui1" Portsmouth,NH 03802-7202 Telephone(800)653-7893 Fax(603)X131-5693 March 19. 2007 - RE: Certificate of Workers Compensation Insurance Insured: DAVID DONOVAN DBA JEDM REALTY 60 TENNEY RD WESTFORD,MA 01.886 Polic_vNumber: WC2-31S-352621-026 Effective: 11/2/2006 Expiration: 11/2/2007 Coverage afforded under Workers Compensation Law of the following state(s): MA Em to �xs Liability: Bodily Ii>jury By Accident: $ 100,000 Each Accident Bodily Injury b_v Disease: $ 100,000 Each Person Bodily Injury by Disease: $ 500,000 Policy Limits As of this date;the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms, exclusions and conditions, and is not altered by any requirement,term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as ttcr-off in-formafoi-,-only and confers-a-0Tightupoii you,the cenificateliolder. — - This certificate is not an insurance policy and does not amend, extend; or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date, Liberty Mutual will endeavor to notify you of'such cancellation. . AUTHORIZED REPRESENTATIVE LIBERTY'MUTU L INSLiR. \TCE GROUP "This Certificate is executed by LTBrR"r)'NJ1J UAL IN$1JJB kNCE GROUP as respects such insurance Is is uliorded bv those compmties. cc: Insured: Producer oi'Record: DAVID DONOVAN.DBA JEDM REALTY PANTANO INSURANCE AGENCY INC 60 TENNEY RD 220 BROADWAY SUITE 202 WEST.FORD, MA 01886 LYNN.FIELD. MA 01940