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Home My WebLink AboutBuilding Permit #204 - Stacy Drive 9/13/2007 13UILU1IVU r'CMV11 1 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION *y y* T 1 w T Permit N0: Date Received 4SSACHUS�� Date Issued: IMPORTANT Applicant must complete all items on this page i s- -. baa:.. � a,,.,.r .„ •, m e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9 One family El Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: 0 Commercial R Repair, replacement ❑ Assessory Bldg 0 Others: ❑ Demolition ❑ Other DESCRIPTION OF WORK TO BE PREFORMED: I 19+23 Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: 9 + 23 r lki" x rte,+a+� s=.r,;.-...f.��.;<. c,. _ ... .. •:a - - 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: $ 700A.- FEE: $ Check No.: Receipt No.: ess to the guaranty fund NOTE: Persons contracting with unregistered contractors do not have acc mans 6ubmitted U Plans Waived LJ 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 Connection/signature & Date Driv a Permit Located at 384 Osgood Street P1M E �+ 'w �N1°i�ir��'�W7'i�l�lal�iir�•ia7i��'Wei�b`��4."xf �.v',' 4 r �r.;'�.„�f¢�t �'�,..,*.a� ,.:'&�. .' ��f � � ». ,�'�'_.�r��'' f,a�•��7:. e +cx' xa 'Y"`� � a �, (a 2�x`.• as -k'*^F�� '��' ''^T.?"�z � m'rg .� z,er''x3r,.s- �ti" . 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 0 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 ❑ 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 No. Date NORTIy TOWN OF NORTH ANDOVER C •. O� Certificate of Occupancy $ it F P /F i l Buidngrame Permit $' sAcwust —� Foundation Permit Fee $ Other Permit Fee g1 TOTAL $ Check # _I 205 : x, I j• I "') Building Inspectoo' ;IF.ICrATE z WINS DATE(MM'DOn'Y'{ PRODUCER "vylk��F..��t { �'a c,v u+1 ti i',' 9/12/08 A . 9 ......T..,... The Douglas Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OFONLY AND NO RIGHTS INFGi �TlOri - Lynnfield Woods Office Park i HOLDER. TTHSONFERS CERTFICATE DOES OTO AMEND,THECEXT:AD OR 220 Broadway Suite #301 ALTER THE COVERAGE AFFORDED BY THE POLICIES S'ELOW Lynnfield, MA 01940 _-_—_.___—_--COMPANIES AFFORDING COVERAGE_ COMPANY 1 INSURED - "--`- -- A Commerce Insurance Co Johnston Construction Co., Inc. COMPANY 2 Reo Road _e- - Zurich-American Insurance Co. Peabody, MA 01940 COMPANY C COMPANY F D COVERAGES p �:..:rl {�itLil�i �l. �1{+rti -� .4.C:+�tl�.�'i7N t`,�If f 1...ti.�i � 1 !•�� •.� 1 1 i '. .. 7 -. ..____ fR9* Yt'{ 1k'..�'If Yf,.r E-i:�1•+'c�'Stl'➢"j `-r7'��'l'N ii J" ;r�Etfrl(:'{-" t�,. )?;fi i<f;�. ,: ~IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEPiC+_' ,:'CATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VvHiCN % '_ER'!FICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM`; ,S ONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE POUCY EXPIRATION DATE(MM/DD/YY) DATE(M ----'--- UMfTS GENERAL LIABILfTY X COMMERCIAL GENERAL LIABILITY !GENERAL AGGREGATE S 300,000 PRODUCTS-COMP/OP AGG- S 3-00,000 CLAIMS MADE —; OCCUR ---- PERSONAL&ADV IWURY_ S 300,000 A DW.NERsacoNTPROT JN9125 8/20/0 8/20/08 EACH OCCURRENCE - S 300,000 -- — -'- FIRE DAMAGE(Anyone fire) S 50,000 AUTOMOBILE LIABILPY MED EXP(Any one person) S _-5,9.00 ANY AUTO COMBINED SINGLE LIMP S X A. OWNED AUTOS .------ --_. A SC.•EDULEDAUTOS OOMMT16128 1 /1 /07 1/1 /O 8 BODILY INJURY (Per person) $100,000 ,IRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per ecaoent) $300,000 PROPERTY DAMAGE $100,000 GARAGE UABILITY -'--- ANY 4;;.0 AUTOONLY_EAACCIDENT f- - ----- - - OTHER THAN AUTO ONLY _-- EACH ACCIDENT S - ------ AGGREGATE S EXCESS UABILfTY --------^_------ ---------•---- EACH OCCURRENCE S JMBRELLA�fORM . AGGREGATE S JTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERSUABILPY STATUTORY LIMPS B ^E PROPRIETOR,, 6ZZUB-673X905-1-01 9/20/06 9/20/08 EACH ACCIDENT INCL -- __.- '100,000 ARTNER$EXECUTIVE DISEASE POUCYLIMIT rj00,000 - ^ERS ARE c,.. OTHER ------' --------------------,_-- —_-_ DISEASE-EACH EMPLOYEE yL_00,0.0.0.. . DESCRIPTION OF OPERATIONS/LOCATIONS/VEMICLES/SPECIAL ITEMS - Construction work at various locations CERTIFICATE HOLDER CANCELLATION - -- Town of North Andover SHOULD ANY OF Tl1E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town Hall EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO WAIL North Andover, MA 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT B FAI URE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR UABIUTY ATTN: Building Inspector OF ANY KING UPON THE COMPANY, ITS AGE OR REPRESENTATIVES ----.. AUTHORREDR R ENLATTVE ------ -_---- ----"' i ACORD 25-S (3/93) B Ic el R .. m RD 1993 s The Commonwealth of Massachusetts Department of Industrial Accidents I Office of Investigations r 600 Washington Street . W . 11 Boston MA 02111 \ UUp I ` ' ' t' ;N www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): -Lbws cei CogstracLon CodrlL. Address: 2 gpn Rd City/State/Zip: o , Phone#: s . __e_ ahvclT, MA qGa �1$ 53 3228 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. E] Remodeling ship 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 r 10.F] Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL l 1.❑ 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' 131-1 Other comp. insurance required.] Any applicant that checks boz#I 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. lContractors 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. Insurance Company Name: t)ouyas .InSu✓ahcr Policy#or Self-ins. Lic.#: } u A,<1 3 x 9a 5 -1-c;I Expiration Date: 9-2 0-v R Job Site Address: City/State/Zip: 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 certify under the pains andpenalties ofperjury that the information provided above is true and correct. .Signature: Date: Phone#: 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 deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance 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)name(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 employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation 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 complete 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 number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city 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 pen-nits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit 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. # 617-7274100 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7741 www.mass.gov/dia t } ✓ 4��r � loa o a m u a o s an n ar s Construction Supervisor License ' License: CS 219M Birthdate: 9/30/1940 Expiration: 9/30/2009 Tr# 3336 x. Restriction: 00 DAVID E JOHNSTON 2 REO"RD - PEABODY,MA 01960 Commissioner -. ✓!re mann?zusetrllf r. ((.n49aGtu4e�G fn Board of Building Regulations and Standards License or•registratiou valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards `- Registration: 123124 One Ashburton Place Rin 1301 - ' Expiration: 12/12/2008 Tr# 125437 Bion,Ma.02108 Type: Private Corporation JOHNSTON CONST CO,INC. -DAVID JOHNSTON 2 REO RD �"+""� Not valid witho signature PEABODY,MA 01960 Administrator JOHNSTON CONSTRUCTION CO. INC. Two Reo Road W. Peabody, Massachusetts 01960 (978) 535-3228 www.johnstonconstr,uctioninc.com September 5, 2007 Great North Property Mgmt. C/o Prescott Village 95 Brewery Lane Suite 210 Portsmouth,NH 03801 Description of Work: Deck Replacement Replace exterior deck on Unit 23 and Unit 19. Decks to be framed with pressure treated wood material. Trex material will be used for the decking. Railings to be constructed with pressure treated wood. All old material and trashed will be removed from the property. Labor&Material: $3500.00 per deck. Total: ....................................................................................$7,000.00 ;t � David E. Jo Ston ate Customer i ture ate ohnston Construction Co., Inc. NORTH Town of o No. ..;� ;,,. V" y C% dover, Mass.,g_� 3 • O T O LAKE COCMICKEWICK V ADRATED `r BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... .. ........ A........... !C+ o.................................................. .......... Foundation 14�i has permission to erect........................................ buildings on ...V. .'...... . }. ......... ........... ...... ...... !�I Rough to be occupied as ......"s6 i............................ .................................... Chimney . . . .. . . . . . .......... provided that the per n accepting this peconform to the terms of the application on file in 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 CONSTRUCTIO T Rough Service BUILDING IN�PE 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. # p oa ofig�oifs as Wn' ar s t6%Construction Supervisor License - License: CS 21906 Birthdate . 9/30/1940 Expiration :9/30/2009 Tr# 3336 Restriction: 00 DAVID E JOHNSTON 2 REO'RQ L: PEABODY,MA 01960 Commissioner ;�•.. - - J�e omz�rua7rusealt� r.�:�ila�ha�czQef`c - �. Beard of Building Regulations and Standards Luse or'registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the.expiration date. If found return to: Board of Building Regulations and Standards Registration: 123124 One Ashburton Place Rm 1301 r ` Expiration- 12!12/2008 Tri/ 925437 Boston,Ma.02108 Type: €'rWate Corporation JOHNSTON CONST CO,INC. DAVID JOHNSTON 2 REO RD PEABODY,MA 01960 Administrator Not valid witho signature JOHNSTON CONSTRUCTION CO., INC. Two Reo Road W. Peabody, Massachusetts 01960 (978) 535-3228 www.johnstonconstructioninc.com September 5, 2007 Great North Property Mgmt. C/o Prescott Village 95 Brewery Lane Suite 210 Portsmouth, NH 03801 Description of Work: Deck Replacement Replace exterior deck on Unit 23 and Unit 19. Decks to be framed with pressure treated wood material. Trex material will be used for the decking. Railings to be constructed with pressure treated wood. All old material and trashed will be removed from the property. Labor&Material: $3500.00 per deck. Total: ....................................................................................$7,000.00 David E. Jo ston ate Customer i ture ate Johnston Construction Co., Inc.