The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #561 - 1 Stacy Drive U-1 4/28/2009 OORTFH BUILDING PERMIT o`<t�E° 'bgtio TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION * � Permit NO: Date Received �9ssAc►+us��y Date Issued: � IMPORTANT:Applicant must complete all items on this page �r r LOCATION Pant `° PROPERTY OWNER Pmt MAP NO: PARCEL: NI IG I IS I [C3. „ HISTORIC PPI -yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family [I Addition [I Two or more family 11 Industrial ❑ Alteration No. of units: ❑ Commercial X Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .k. Septic ❑Well Q Ffoodplgin p Wetlands"*".' Watershed District a v Water/Sewer n DESCRIPTION OF WORK TO BE PREFORMED: Rmnre aid e.xisfino deck and repic►ce iudh new deck Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: �a CONTRACTOR' Name: �- . �s Phoe w. Address: - , 1 . Supervisor's Construction Lrce se r 2119�._ Exp'",Date Home improvement License'. _ w Exp .:'1D at 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: $ 7sj5r- —FEE: $ D Check No.: la� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agentlowner Signature of contractor b 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 Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE,DEPARTMENT Temp D mps,t ori site eyes ^ nc Located at 124 Main Street , „ Fire Department sign"atureMat M r x, n COMMENTS w 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-$1 000 fine NOTES and DATA— For department use IUo CL 0 11 11, 6—V( ot' . L3 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 - — -------- ❑ pert te--d Surveyed Plot Plan pp _ ❑ Workers Comp Affidavit _Photo Copy-of H.I.C. And C.S.L. Licenses (2). Copy Of Contract ❑ Ekxo G�ection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hy4ratflfa Calculations (If Applicable) ❑ 'Mam-CMck Energy Compliance Report (If Applicable) ® 4 g' davits 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 Aa /� s �L9 072 No. Date r NpRTy TOWN OF NORTH ANDOVER 3:41 �. • p Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 1 i `/ L} Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 0 ashington Street ' Boston, MA 02111 www_mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information Please Print Legibly N$Ine(Business/Drganization/individual): Address:_ 2 ire p City/State/Zip:_ pea b Art,,e M A Phone#: . cl ,s S ; -321& Are you an employer?Check-the appropriate box: -- 1.9 I am a employer with 4. ❑ 1 am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am.a.sole proprietor or partner. listed on the attached sheet,x 7. ❑Remodeling ship and have no employees These sub-.contractors have 8. [J Demoiition working forme.in any capacity. workers' comp.insurance. g, ❑ Building addition [No workers'comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[1 Electrics)repairs or additions 3.❑ I am it homeowner doing all work right of exemption per MGL 11.❑ 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' comp. insurance required.] 13.®Others *Arty applicant that checks ba#t 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 conuactars must submtt a new affidavit indicating such. ;Comtntctors that check this box_must thick ed an additional s`esr showirl the name of the sub-contractors and their workers`ecmp.r�?ick irfoziation. lam an employer that is promding workers'compensation insurance for my employees: Below is the information. policy m1d job site Insurance Company Name: i h O n u c t ct s i n g t_.r o n c e Policy#or Self-ins.Lic.#: 1 7 7„ .016 4 rn r n 9 Expiration Date: 9 2 v .c Job Site Address: Stae y nA City/State/Zip: y_A o tx v 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is race and correct Signature: L o, 7W Q �„r f Date: y Z g Phone#: 9 7 Q 12 EOtb&r only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health Z Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector son: 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 remiver or trxrstm 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 Eicensing 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 coritracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)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,notthe 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 numberlisted below. Self-s+w�!red crmnanies sho�,ld enter t"eir self-insurance license number on the appropriate fine. City or Town Officiais 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 Investigation 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 permits 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 42111 TeL#617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax 4 617-727-7744 www.mass.gov/dia JOHNSTON CONSTRUCTION CO., INC. Two Reo Road W. Peabody, Massachusetts 01960 (978) 535-3228 www.iohnstonconstructioninc.com April 27, 2009 Great North Property Management c/o Prescott Village Association 95 Brewery Lane Suite 210 Portsmouth,NH 03801 Description of work: Building New Desks New decks installed on Units; 16, 17,20, 22,24,25 Decks to be framed with pressure treated wood. Install Trex decking for the surface of the deck. Install new pressure treated wood railings. Remove all rubbish from the premise;Allowance: If needed; carpentry repair rate$85.00 per hour. Labor&Material: .................................................$21,000.00 Total: ...............................................................................$21,000.00 rq'�L ' Johnston Constructi o. Inc. Date tomer Si a Date WORTH Town of :_� RAndover . Ol „;.4:, 'may". �,i... V No. - __ dover, Mass., 'o LAKE COCKICKEMCK V RATED P-' �5 `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 1 BUILDING INSPECTOR THIS CERTIFIES THAT.....elr4am.4.......ult(N—VC...... !................................................................. Foundation has permission to erect........................................ buildings on lfwt... za..,...2, .r...� .�..� ..... Rough to be occupied as Chimney . . . . . .. . . .9944.).C.5.1?............................................................................................................ provided that the person ac piing this permit shall in every respect conform 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 a PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRU S;6ARTS 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. i • 3oar�'�"af"l�u��i�iug'{fegu`ia�io�i6s�e Gonstruction Supervisor License License: CS 219M Birthdate:_9W1940 Ekpiration: 9/30/2009 Tr# 3336 Resbiction: 00 DAVID E JOHNSTON r` 2 REORD - - i` PEABODY,MA 01960 Commissioner Bo ril AnUng Qufat4io°s A tan�ar License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _=- Registration- 123124 Board of Building Regulations and Standards Expiration7.=12/1212010 Tr# 278545 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 JOHNSTON CONST CO,INC. } DAVID JOHNSTON 2 REO RD PEABODY,MA 01960 Administrator Not valid without signature re'mutj1,IYYiUI.7VV