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HomeMy WebLinkAboutBuilding Permit #841 - Stacy Drive 6/20/2007Permit NO: S -q ( Date Issued: i7 6 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I f h TYPE OF IMPROVEMENT PROPOSED USE Ir6A QW11 5 Ucfran Residential Non- Residential ❑ New Building ® One family ❑ Addition ❑ Two or more family [I Industrial ❑ Alteration No. of units: ❑ Commercial Y Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 1 Septic ©hell ?-�4I] Floodplain 0 Wetlands-, d watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFOKMtu: 'Remove old s1on4les and regince w'dh +hrte. +ab shin41e Identification Please Type or Print Clearly) OWNER: Name: bo►v i el To h n s�n n ?r Phone: Address: 8 S CONTRACTOR Name. - M Supervisor's Construdfon L-' lq oexp. b 7,,. 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: $ 7000.- FEE: $ '1 OF Check No.: 1SIC ? Receipt No.: 2 0 3 -Z o NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of AgentfOwner0 Signature G�J' Ir6A QW11 5 Ucfran lq oexp. b 7,,. 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: $ 7000.- FEE: $ '1 OF Check No.: 1SIC ? Receipt No.: 2 0 3 -Z o NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of AgentfOwner0 Signature G�J' 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Conn Located at 384 Osgood 9tr FIREDEPARTMENT - Temp Dumpster on site y s no Located at 124 Main Street, " Fire Department signature/date- 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use No 6 vq -P) �� (4k, 4'-�-d ❑ Notified for pickup - Date Doc.Building Permit 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 ❑ 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 ❑ 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) ❑ 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 Li 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 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 P —I - - — No. Date TOWN OF NORTH ANDOVER Certificate of occupancy $ Building/Frame Permit Fee $ CMU Foundation Permit Fee $ Other Permit Fee $,, TOTAL $ Check # 2 0 ') 4 VBuilding inspector JOHNSTON CONSTRUCTION CO., INC. Two Reo Road W. Peabody, Massachusetts 01960 (978) 535-3228 www.johnstonconstructioninc.com October 10, 2006 Great North Property Management c/o Prescott Village Association 95 Brewery Lane Suite 210 Portsmouth, NH 03801 Description of work: Install new roofs on Unit5-ile- o IUnits 5-9, 24-25 Remove old asphalt shingles. Install 3' Ice Shield and 151b felt paper. Install 8" Brown drip edge. Flashing will be inspected and addressed appropriately. Install new 25 year G.A.F. Black three tab shingles. Entry roof over front door are included. Dispose of all roof materials from the premises. Work areas will be cleaned to unit owner's satisfaction. Labor & Material: ......................................................... $31,500.00 Total: ............................................................................................... $31,500.00 Note: Fully insured with liability insurance and workman's compensation. Certificates provided upon request. Payment Schedule: 1/3 to start, 1/3 halfway and 1/3 upon completion. Johnston Cons crion Co. Inc. at Great North Property Mgmt. Date P' 0 NQ W W L3:1 "_♦ * ,rl%, S 0 z c o a •; : ;m g a a C r� O C V U c U -� w w x w w w x o � w x w a cn' cn .0 o cn "_♦ * ,rl%, S 0 z E a- ct N C ch m Cas C M ._ m O Cas C !V O Z 0 Z O g O F. O ai • L co Z p, O y G. C cms I C C C.— ca M E m m CD 0 CD �3 O di p i a CL cMa Co a Cc CJ ca Z C CD V h C CLc — C40 is LLI W W W LLIW N c o •; : ;m g O ` C r� O C V CLC A O O C o � y = E cc O yIr m : : r -. 1: O d E c .co co s o, tJ: m c y O O �.: y 0 3 J C co _ 'o aye w. owl N m 1 CLC� y O m w � C � y Q :•�m0'L" ca .y C� W Z F=— O CL r 0 W CO C •ca O C •ui CZZ ' r 0. H C. m p m '.0 C_ COD CL m� O� 210 m N �O _ A ` E a- ct N C ch m Cas C M ._ m O Cas C !V O Z 0 Z O g O F. O ai • L co Z p, O y G. C cms I C C C.— ca M E m m CD 0 CD �3 O di p i a CL cMa Co a Cc CJ ca Z C CD V h C CLc — C40 is LLI W W W LLIW N Type: Private Corporation JOHNSTON CONST CO, INC. DAVID JOHNSTON - 2 REO RD Q.(.«+��� PEABODY, MA 01960 Administrator looston, Ina. Ulu1Uo Not valid with signature PRODUCER The Douglas Insurance Agency Lynnfield Woods Office Park 220 Broadway Suite f301 Lynnfield, MA 01940 INSURED Johnston Construction Co., Inc. 2 Reo Road Peabody, MA 01940 N"IP, DATE (MM/DD/YY) ' 3/19/07 THIS CERTIFICATE IS ISSUED AS -M OF -INFORMATION 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 C(;MPANY I## A Commerce Insurance Co COMPANY B Airich-American Insurance Co. COMPANY C COVERAGESD - --------------- . . ..... ..... . .. .. .. .... .... =5 51 LI -W-10 Or 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 POL CO ICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION GENERAL LIABILITY DATE (MWDD" DATE (MM/DO I fMI UWS X COMMERCIAL GENERAL LIABILITY I GENERAL AGGREGATE -30-0,. 0_09 CLAIMS MADE El OCCUR I PRODUCTS-COMP/OP AGG -3.00..kQQ OWNER'S & CONT PROT PERSONAL & ADV INJURY A 000 JN9125 8/20/06 8120107 I LEACH OCCURRENCE1 '300, 000 AUTOMOBILE UABILrrY ANY AUTO X ALL OWNED AUTOS A SCHEDULED AUTOS OOMMT16128 HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILTTY ANY AUTO EXCESS LIABurry UMBRELLA'FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY B THE PROPRIETORi 6ZZUB-673X905-1-01 PARTNERSIEXECuTiVE INCL I OFFICERS ARE EXCLI 9/20106 9/20/07 DESCRIPTION ---R-IIVRb/LMA"ONS/VEHICLES/SPEEAL ff�EMS__-------- Construction work at various locations CER'n*Fl6A- fk'jf6_L_DgR`_--- Town of North Andover Town Hall North Andover, MA Attn: Building Inspector ACORD 25-S (3/93) STATUTORY LIMITS EACH ACCIDENT 4 00, 000 DISEASE • POLICYIT U - M S00,000 DISEASE • EACH EMPLOYEE !10 '10-0 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POIU0ES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL T�DAYS MVrTFN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 8 FAIL E TO MAIL SUCH mo-nCE SHALL IMPOSE NO OBLIGATION OR LIAsIL[n O�Fy KIND UPON THE ..-�PAInTs AGENTS OR REPRESEINTATTVIES. kuTHO ED ryRESEKTAT­TiE7_. i A : '-7 M I FIRE DAMAGE (Any one fire) i .50, 000 'MED EXP (Any one person) f -'000 COMBINED SINGLE LIMIT $ 1/1/06 1/1/07 ; 'BODILY —INJURY - - (Per Pwwn) 1100,000 BODILY INJURY (Per ao6dem) '300, 000 PROPERTY DAMAGE 1100,000 AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ��H ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE 9/20106 9/20/07 DESCRIPTION ---R-IIVRb/LMA"ONS/VEHICLES/SPEEAL ff�EMS__-------- Construction work at various locations CER'n*Fl6A- fk'jf6_L_DgR`_--- Town of North Andover Town Hall North Andover, MA Attn: Building Inspector ACORD 25-S (3/93) STATUTORY LIMITS EACH ACCIDENT 4 00, 000 DISEASE • POLICYIT U - M S00,000 DISEASE • EACH EMPLOYEE !10 '10-0 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POIU0ES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL T�DAYS MVrTFN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 8 FAIL E TO MAIL SUCH mo-nCE SHALL IMPOSE NO OBLIGATION OR LIAsIL[n O�Fy KIND UPON THE ..-�PAInTs AGENTS OR REPRESEINTATTVIES. kuTHO ED ryRESEKTAT­TiE7_. i A : '-7 M .� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 r Workers' Compensation Insurance Affidavit: Bu des/Conti A !leant Information actors/Electricians/Plumbers Please Print Le 'bl Name (Business/Organization/Individual): � t Address: City/State/Zip: Phone #: 35 - Are you an employer? Check the a pproprrate box: 1 • ®I am a employer with -�_ 4. ❑ I am a general contractor 2. ❑employees (full and/or part-time).* 1 am a sole proprietor or and I have hired the sub -contractors partner- ship and have no employees listed on the at#ached sheet. I These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp, insurance. 5. ❑ We are a corporation 3. ❑required.] 1 am a homeowner doing all and its officers have exercised their work myself. [No workers' comp, right of exemption per MGL c. 152, , 1(4), and we have insurance required.] t no employees. [ [No workers cora Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12•0 Roof repairs p. msurauce required.] 13•❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy mformatron. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indican 'Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers' comp. policyinforms ng such. I am an employer thRt is providin /te � information. g wor rs compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: T1, Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip;—L110 ,q r+ d a v tit P7 A Attach a copy of the workers' compensation policy declaration page and (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 )• fine up to $1,500.00 and/or one-year imprisonment, as well as civil peWOE{ ORnalties in the form of a STOP ER aa of up to $250.00 a day against the violator. Be advised that a copy a fine Investigations of the DIA for insurance coverage verification of this statement may be forwarded to the Office a Ida baro/n....w:e -��� ••l r •••.wrr me pains andpenaldes of pe jury that the information provided above is true and correct P• / )i.... _I C 0- / OffIcial use only. Do not write in this area, to be completed by city or town gJ)9ciaL City or Town: Issuing Authority (circle one): Permit/License # 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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: e vj i a e 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 laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Fire Department Sign off: Dumpster Permit Sioiature of rmit Applicant Date