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HomeMy WebLinkAboutMiscellaneous - 1000 JOHNSON STREET 4/30/2018 (2)N O p O O` V D 0 o z w o rn z o m o m f' Location ZM0 :T©h Sy'� St No. Date i NORT1y TOWN OF NORTH ANDOVER F � 9 • Certificate of Occupancy $ cMus CHU E<� Building/Frame Permit Fee $ Z s� Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ Check # 4 % ��vZz N(�V_i",i,_._ r �+ V j u Building Inspector TOWN OF NORTH A NDOVER BUILDING DEPARTMENT APPLICATI®N Tq CONSTRUCT REPAIR, REPioVATE, , OR DERIOLISH, AANE.QR TVYO.FAMILY.DWELLING BUMDING PERMIT NUMI3ER: DATE ISSUED: l / SIGNATURE: Building CommissionerlI ctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: iso 6 ��s�� s� 1.2 Assessors Map and Parcel Number: 0�9A 36 Map Number Parcel Number 1.3 Zoning Iuformafion: Zonin P, District Pt_ 4Sed Use, 1.4 Property Lot.Area- Front i e i% BUILDING SETBACKS ft Front:Yard_ . Side Rear Yard Required Provide R reel Provided _.. . Recluired Provided. 1.7 Water Supply M:GJ—c.40.154) 1.5. Flood lone tuf6.tmn Public , 0 Private ❑ Zone Outside Flood Zone ❑ . - 7.8 Sewerage Drsposal S3 st m Municipal ❑ On Site Disposal System. ❑ SECTION 2 -PROPERTY 2W7ERSI3IPfAiZTHORIZED AGENT " 2.1 Owner 'of Record Name (Print)Address for Service N. Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele ;hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Const ition Supervisor: -rcensed Construction Supervisor: addressX,.1;. la �I v✓ CI 1!✓ [7 1�4a3 (% q9 —7 ( g� 7 2 of nature,. g elephone Not Applicable ❑ C License Number / Expiration Date .2 Registered Home Improvement Contractor rh�✓os l.�v�.l�if ��� , Not Applicable ❑ /0� g ompany Name BRegistration Number ddress 0) Expiration Date nature Telephone SECTION 4 - WORKERS COMPENSATION (HIG L. C f52 $ 0 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildi rmit. Si ned affidavit Attached Yes .....;. Na;._....❑ SECTION 5 1mteri''tioh of Proposed Work- check all a hcable r New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) G Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify P F — P Brief Description of Proposed Work: /�. S fNp Ae- -6e1j� ke-cl dfnce SECTION 6 - ESTIM[ATED CONSTRUCTION•COST5 Item 1. Building Estimated Cost (Dollar) to be£ Completed by permit applicant " •� (a)` Building Pe lViulti"' ler rriit Fee ... ;. , 2 Electrical _. -.(b),, Estimated Total -Cost of Construction 3Building Permit fee (a) x (b) 4` Mechanical HVAC 5. Fire Protection. 6 Total._ 1++3+4+5 Check h7iii4rber ... SECTION 7a OWNER AUTHORIZ-ATPON TO BE COMPLETED WIZEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application.:. Signature of Owner Date AIrL�PI1 LL(:�•.°►KA11ViV 1, . / f'17 ,as Owner/Authorized Agent of subject property T � Hereby declare that the statements and information on the foregoing application are true.and accurate, to the best of my knowledge and belief 9 Print Na . g Si ature o er/A e Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 .P DIMENSIONS OF SILLS DIMENSIONS OF POSTS DRv1ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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 Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: -q,11%4 S/ewe /1 (Location of Facility) 13FI — C'e"94k Signature of Permit Applicant lo��/ol Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massach usetts Department of Industrial Accidents' Olfc.- aIffastigagvos 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit Q I am a homeowner performing all work myself. !['1 I am a sole proprietor and have no one working in L I am an employer providing workers' compensation for my emnloveec 6: :_L ;f - - ��•�_ .�� -s requirea unser section .5A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for Coverage verification. [do hereby certify under theDai :andpe lies of perjury that the information provided above is true and correct Signature _ R14-10U lam / ate Print name R/4-10 / L1vM Phone 9 �� S°1sg - Od4g otLcial use only do not write in this area to be completed by city or town OMCial city or town: permit/license # Mudding Department Cheek if immediate response is required _ ❑Licensing Board ❑Seiectmen's Otiice C ntact person: phone #• OHealth Department Other ('""ft 3/91 PYA) :�aGd e 1 64'�ralbi 0 /�%�aaaciivaelld BOARD OF BUILDING REGULATIONS 00 - 35,000 d enclosed space License: CONSTRUCTION SUPERVISOR (MGL CA 12 S.60L) 1A -Masonry only Number: CS 075668 1G -1 8 2 Family Homes Birthdate: 04/29/1963 Failure to possess a current edition of the ; Massachusetts State Building Code Expires: 04/29/2003 Tr. no: 75668 j is cause for revocation of this license. �! Restricted To: 1G 'I. MICHAEL D LIVINGSTON 57 HOOK RD'�'�'. ± NH 03032 AUBURN, Administrator DIG SAFE CALL CENTER: (888) 344-7233 `faaaar4� ( HOME IMPROVEMENT CONTRACTOR License or registration valid for individual Registration: ^6877 4 e use only before expiration date. If found Expiration: 7/28/02 return to: One Ashburton Place Rm 1301 Type: Private Cor oratio p Boston Ma. 02108 z DI nrvnnc Dun nroc run :�aGd BUSINESS CONDITIONS TO THIS CONSTRUCTION CONTRACT This contract, dated Jul 11, 2001 is by and between: Anthony Fragala 1000 Johnson St. North Andover, MA 01845 Blackdog project code FRAGA-001 (hereafter referred to as OWNER), and Blackdog Builders, Inc. 7 Red Roof Lane, Unit # 1 603 898-0868 (hereafter referred to as CONTRACTOR). Work will be performed at: same 1. GENERAL This contract is for the following work and materials to be performed by the contractor on the property address shown above. The project is generally described as follows: Roofing replacement The contract consists of this document, any plans, the itemized estimate, the specifications, and the Construction Contract. 2. PRICE The total price for the work agreed upon is $16,594.94. Payment terms are set out below in Paragraph 6. We may withdraw this proposal if not accepted within thirty (30) days. 3. STARTING AND COMPLETION PROVISIONS a. The work will begin on approximately 03/11/2002 and will be completed, absent unusual circumstances, on 04/05/2002 providing this proposal and any relevant product related proposals are accepted when presented. Projects requiring two agreements (one for construction work and one for bath or kitchen product) will not be slotted into the schedule until both agreements have been executed. The dates reflect our present workload. Projects are assigned a slot in our work schedule as they are accepted, on a first come first served basis. These dates may move based on the completion time of the project that immediately preceded yours. 4. PERMITS AND APPLICABLE CODES; COMPLIANCE WITH LOCAL LAW a. All work to be done under this contract will be in accordance with the county codes. The contractor shall obtain all necessary permits and pay all required permit and plan fees from the contract sum, unless otherwise agreed. Does not include any fees which may be incurred for a variance if required. Contract price doesn't include any unbid items required by the local building official. 15. ENTIRE AGREEMENT This contract consists of the documents defined above, and constitutes the entire agreement of the parties. It can be modified only by a written document. OWNER acknowledges that he has read and received a legible copy of this agreement signed by CONTRACTOR, before any work was done, and that he has read and received a legible copy of every other document that OWNER has signed during the contract negotiation. SUBMITT DATE: 7'lI-G�l Carl T ll Designer Blackdog Builders, Inc. ACCEPTED: DATE: An ony ra ala ALL INTERESTED PARTIES: DATE: DATE: MAKE SURE ALL INTERESTED PARTIES TO THIS CONTRACT HAVE RECEIVED THEIR COPY OF THE RIGHT OF RECISSION DOCUMENT m m m m 0 m N! C d CO2 Cl) co Ca! Z H CL CD n� r c = c CL _. y � O � 0 CD CDCL O Q CD CD O CD c CCD CD C3. CD O CO)CD CD CO) O 'oCD Z a a CD CD 0 C CD Cc ? O -• N1 oQ H d�OCm y E n m C3 O HC2ao M CD Z N -i CD n CL =r o o• y m o CD .� o m CO) o N=r m CD S rA CD B-1 O C= �0 n o zyC�9 o C2 CD Er o R Cco Cn CD (/) D cry : p t7 o. m n y 0 h �f Vcn H a d C c cn CD f0 H m e -r ` m •�' • Z =r "6 c� cn 0 y 3 I zCD o �0 cn cn C0 :Z O � o o EED: r o a� rZ o �7 C/' � ° ��, ~ d `r 0 x CA 5 `° ; 0 r 5 0 � b r n :11 n o X o CL � a1 rzr- c o � rD on o y 0 O C