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HomeMy WebLinkAboutMiscellaneous - Stacy Drive0 ®0 o CL •� 3 s Z bit C: V) o o L cd r a C1 d ON (A O LL E 0 U a 0 `v Q N U � N U N L� x C E cc Q U z a x W x r 7 O 0 0 0 00 69 tn 00 O O b 66 N N r n 0 N CL O N O O rn 0 0 N ro 0 M d' � N v b O NO p! 00 � O R 0.1 � y O Q c`�tl .D N � b O � 3o o � � 0 c 5M9 W � � U M O b y Qx 0 a� Q G. vi O a x W O o C; M WO tn 00 O O b 66 N N r n 0 N CL O N O O rn 0 0 N ro 0 F OW U w a ti zF z� z� w OW�° W 0 o o N 000 7 N 6H D1 � Q O z o o U Qo o aG o U Nn Q U W Q U DO W W ami � W F � W W H Ln z QW W W oa H o ° zZ w F- x x E.. o oN Q. o o o Q N cz .� rLnD W W W G O .O w w A ON o N ry O ti N Q N N O O N O O O O O O O\ O C O O y N N N 7 M u Ow Ow rQ U W W a W a a n d O N C CN M O 00 W aCD z a a d � °n� b' z rA z� 0 a °x 0 0 0 c N Wa vwi U voi Q A U i cd Q: W M uC G�i O O d d C O .0 d ctl � cC L lu bD G �Ui d b Y CC � w ti p ice- � LL �� V) C o d W a CG � x W E O o a o i � Z 0 W � H d o, o W o O V) N z o b U b U 'a 'a W W w bD C a� O 7 A N y 17" M 7 r.4 (� H t CL N GL m M U O O O O h QO z O O O O d �a o = a U O O L d Q M pa N W O a 3 o TU O O O C O O O p.i 0.1 N N N 7 M rQ C o W a n d O N C CN M O 00 W aCD z qq a b' z rA 0 0 oN U U i cd Q: W M G�i O O d d d ctl � cC lu G b w d V) CG W o a o V) b U b U 'a 'a W W w a� A 17" M 7 r.4 (� H t N m M O O O O O O O O In W 0 7 ca P. 0 0 a .•a y N Q 0 N 00 N z 0 � o aGOS M W 0 0 r F (20 . rr V) 6n j U E� H ¢ C O L ¢ .O a� a U C) N a� z z v W N O O O 65 7 M Y3 b v � W W CG A 0.i r- A �^ o A A O o`n'o �' � o N 0.1 N O 0 o 5 W O N W c M. ti Location /�P- )-3- // No. 14 �1,3 V Date TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ `'eOe�ne ✓��'� Building/Frame Permit Fee $ Check # /�o `T Foundation Permit Fee $ Other Permit Fee $ e� TOTAL $� 2L -- building Inspector v TOWN OF NORTH ANDOVER BUILDING DEPARTMENT v A"LICATI0N TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING ,Y w rY This Section for Official Use Onl BUILDING PERNUT NUMBER:r DATE ISSUED:/ t SIGNATURE: BuildinCommissioner or of BuildingsDate 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 0.23 Stucv.Drive Nnrfh Andnver, MA Ois5.5 Map✓ Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public - ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ District: Yes No _ Y'. ErHistoric 2.1 Owner of Record Name (Print) Address for Service: Signature Telephone 2.2 Authorized Agent Name Print Address for. Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ David n ns on ,. TOhn5foil Address ons ru inn� rnr C5 n21 0t. License Number I Ret lRnud PeobnJv. MA a14(o Licensed Construction Su r. y Expiration Date Signature zTelephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone v n M O M D z O z M 90 0 F v M r r_ z G) SECTI. 4 0410M _.-- .,,_ '_; { .,. •.. F t � r�... 1. �. ?�.: Workers Compensation Insurance affidavit must be completed and submitted with this application. issuance of the building permit. Failure to provide this affidavit will result in the denial of the Si ned affidavit Attached Yea .......® No ....... ❑ sEcol�l s�i�><rnCs l s+ars svt^�rr c©xs�sllrcat�t><� Co�►L�� +� ��. ��;��n`�►��,�E��risl�n s�� �:` 5.1 Registered Architect: Name: Address SignatureTelephone Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Company Name: Not Applicable ❑ Responsible in Charge of Construction New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition 0 Other 0 Specify Brief Description of Proposed Work: Re - tea; +he h� aT Unis 15.7-3 a+ Prescntl Villuar hlense' revieva rj�tacherlTra,oasal iar delads A Assembly ❑ A-1 0 A=2 0 A-3 0 A4 ❑ A-5 0 1, as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A=2 0 A-3 0 A4 ❑ A-5 0 IA 1B ❑ 0 B Business 0 2A 2B 2C 0 ❑ ❑ C Educational ❑ F Factory ❑ F-1 ❑ F-2 0 H High Hazard 0 3A 3B ❑ 0 IInstitutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ M Mercantile 0 4 0 R residential 0 R-1 0 R-2 0 R-3 ❑ 5A 5B 0 ❑ S Storage 0 S-1 ❑ S-2 0 U Utility 0 M Mixed Use ❑ S Special Use ❑ Specify: Specify: Specify: COMPLETE THIS SECTION W EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: ,, . - BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft M Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT R CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date NOW," I, as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Naam��e M /Tv Signature of Owner/Agent Date Item Estimated Cost (Dollars) to be Completed by permit applicant f >' LL 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number �i � yy ! i :✓ � :3-,t � d rt 4 Zki t �� it t ? h5 `S� .�:�? � S Al 1}{ +� t d 7'i� � im�Y .t� .• 1 �. �r �k: h . J s'l � t G5 1 t Yl 1 $ S 4. C4 I t 7 hµ?fAMi }Za t'-: 7r .Cts i�A N�� .� �, s3:�-s�a. '.. �u`?a , u .'�z,?'. � me� Y�kj.;. �'� � a�4`�'�, ,,-r�ks�k2� ��;� Y, r`��1 �, a��`,�`� t, 2'��;�dnr�. � �A ' `fit � f � •„� :;�E ��f�., ;,� NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMERS iST 2ND 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS 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 +'�,,s�,,wp�+.YT"+ 1� 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: 19 2 3 5 t�r.r i5 vF is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I 0A. The debris will be disposed of in: Trann,�cr Station - Peabody MAyt9t n (Location of Facility) Sig ture of Permit Applicant Fire Department Sign off:��-r: Dumpster Permit Date October 18, 2005 Prescott Village Association C/O John McGravey 14 Stacy Drive North Andover, MA 01845 Town of North Andover Building Permit Department 400 Osgood Street North Andover, MA 01845 Dear Building Inspector, This is to inform you of our desire to have roof replacement work completed at Prescott Village, which will be performed by Johnston Construction Co., Inc. Thank you in advance for your attention to this request, it is greatly appreciated. Best Regards, W.V"t' IR ( =.. John McGravey President Prescott Village Association JOHNSTON CONSTRUCTION CO., INC. Two Reo Road W. Peabody, Massachusetts 01960 (978) 535-3228 Prescott Village c/o John McGravey 14 Stacy Drive North Andover, MA 01845 Description of work: Re -roofing of building 19 -23 at Prescott Village. Units 19-23 Remove all existing shingles and tar paper from roof. Inspect and re -nail plywood; new plywood extra. Install 151b. felt underiayment paper. Install 5' wide Iceshield barrier at drip edges and chimney areas Install new 8" Brown aluminum drip edge and rake edges. Install new GAF three tab Solvant 30 -year asphalt shingles. Use of ridge vents to be determined. Disposal of all roof material off premises included. Work areas will be cleaned to unit owner's satisfaction. Labor & Material per Unit:........ Sub -Total: .......................................... August 25, 2005 .............................$ 4,510.00 ..........................$22,550.00 Note: This pricing based on the previously approved completed July 2002. Deduct $230.00 per front door overhang which has been completed. Total w/ Deduction: ................................................................50.00 $21 3 David E. John on ate Johnston Construction Co., Inc. Great North Property Mgmt. Date Note: Fully insured with liability insurance and workman's compensation coverage. Certificates will be provided upon request. t ✓fie 'C?anvnzanr��na`� a�.���,alsa�u6e%� BOARD OF BUILDING REGULATIONS H License: CONSTRUCTION SUPERVISOR Number: CS 021906 Birthdate., .09130/1940 L " Expires: 09/30/2007 Tr. no: 5551.0 Restricted: 00 .. i DAVID E JOHNSTON 2 REO RD PEABODY, MA 01960 /J Commissioner 71w e _ - Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 123124 Ezpirationr 12!12/2006 Type: Private Corporation JOHNSTON CONST CO, INC; DAVID JOHNSTON 2 REO RDS, PEABODY, MA 01960 Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 t Not val' ithout signature ./:111�1..j CERTIFICATE��OF�'INSURANCE . `... DATE(MWDDIYY) 4 k✓' PRODUCER — ` THIS CERTIFICATE IS ISSUED AS A MATTER OF INF ON THE DOUGLAS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR LYNNFIfLD WOODS OFFICE PARK ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 220 •BROADWY SUITE # #301 COMPANIES AFFORDING COVERAGE LYNNFIELD, NMA. 01940 j COMPANY INURED COMPANY JOHNSTON CONSTRUCTION CO., INC. eZUR ICH-AME.MAN_l_N_S_U_RAN.CE_CO_ PEABODY, MA. 01960 C COMPANY D COVERAGES'' 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i ---- CO LTR TYPE OF INSURANCE POLICY NUMBER EFFEPOUCY�CTIVE DATE (MWOONY) POLICY EXPIRATION DATE (TIMI NY) 1 UMTS GENERAL X LIABILITY COMMERCIAL GENERAL LIABatTY J N 912 5 8/ 2 0/ 0 5 8,120/06 GENERAL AGGREGATE PRODUCTS COMP/OP AGG 1$300 $ 6'Q 0� B I�`0. _ 00 0 $ B CLAIMS MADE n OCCUR . .6ZZUB-673X905-1-01 ( ( 9/20/04 i 9/20/05 PERSONAL & ADV INJURY 1$300,-000 EACH ACCIDENT I $ 5 QQ,. 0.0.0 OWNERSSCONIPROT � DISEASE •EACH EMPLOYEE ( I I EACH OCCURRENCE _-_1$300,000 f FIRE DAMAGE (Any one fire) $'_ 50 Q 00 __ (— ----- re MED EXP (Any aperson) $ 5 ANY AUTO )( ALL OWNED ALTOS 00MMTT16128 1 /1 /05 1 /1 /06 BODILY INJURY $1 A SCHEDULED AUTOS (Per ) —` OO, 00 HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (PerU $300 000 PROPERTY DAMAGE $ CONSTRUCTION WORK AT VARIOUS LOCATIONS CERTIFICATE HOLDER CANCELLATION _ . TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN HALL EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAR: NORTH ANDOVER , M A . 3k_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLD ED TO THE LEFT, A T T N : BUILDING INSPECTOR BUT. FAILURE TO MAIL SUCH NOTICE LL IMPOSE OB LIABILITY OF ANY KIND ::-7` A R ENTATIYES MEI! I _ + t'I'MR E. DOUGLA GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT I $ r AGGREGATE '$ --y-� i EXCESS LIABIJTY UMBRELLA FORM (— OTHER THAN UMBRELLA FORM EACH OCCURRENCE t $ AGGREGATE $ $ B WORKERS COMPENSATION AND EMPLOYERS7 LIABILITY { THE PROPRIETOR/ iNcx PARTNEtCUTIVE OFFICERS ARE: EXCL . .6ZZUB-673X905-1-01 ( ( 9/20/04 i 9/20/05 STATUTORY LIMRS— EACH ACCIDENT I $ 5 QQ,. 0.0.0 DISEASE-POLICYUMR $500_,QAU___ " DISEASE •EACH EMPLOYEE $ CONSTRUCTION WORK AT VARIOUS LOCATIONS CERTIFICATE HOLDER CANCELLATION _ . TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN HALL EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAR: NORTH ANDOVER , M A . 3k_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLD ED TO THE LEFT, A T T N : BUILDING INSPECTOR BUT. FAILURE TO MAIL SUCH NOTICE LL IMPOSE OB LIABILITY OF ANY KIND ::-7` A R ENTATIYES MEI! I _ + t'I'MR E. DOUGLA rl D O b 1 h O 11 � A � o w2 v' a cin o ww �'W w° U w a A. n°' m w w W a w a a�' ro w cA x z cn o cn ui z E z h O N co m CD C m 0 CD c �C N m z 0 Z O ON J CD WE a U O O W N W W 19 W N o .cam o 0 :cam O ti CL C :tam CD C •Z O 0 L Ea CF 0 0 z o a coE E� c O O `mo' c CIA ` O o Z' 3 c Cc N m H E m o S m O Q ` O Z 0 Q O C = o F- 0-1 o W 0 •N c +r ~ CL=m C O r"' ID cm a 0 o.2 y m� S W N 0 `p �=.a�m E z h O N co m CD C m 0 CD c �C N m z 0 Z O ON J CD WE a U O O W N W W 19 W N Location. No. l Date TOWN OF NORTH ANDOVER TOTAL Check # .2%U 1809 $ yy lq-n, .2, Building InCpector M : Certificate Occupancy ; of $ Building/Frame Permit Fee $ ` Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # .2%U 1809 $ yy lq-n, .2, Building InCpector ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREP RENOVAT E, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: ®� DATE ISSUED: (/c) SIGNATURE: ,,40 &"— Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: i5 Stacy Drive North An Inv.r 1.2 Assessors Map and Parcel Number: Map Number Parcel Number C9 5 2_ !� Dave North Andover 1.3 Zoning Information: Zonin Distrid Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Leg±ed Provided 1.7 Water Supply M.G L.C.40. 54) Public 0 Private 0 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record Name (Print) Address for Service Signature Telephone 2.2 (,owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: I rvid E_Tohnston-J"ohnsl-nn Licdised Construction Supervisor. • 2 igen Road West Peabody Address ature Construe+ion Co..T_nc. MA. 019(,0 9 7 8 5 3 5 2 8 Telephone Not Applicable ❑ C 5 02-190(. License Number 9-30-c�5 Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Registration Number SEP 19 zo Company Name Address Expiration Date BUILDING Signature Telephone 0 'T. T M X 3 Z O i v M SECTION 4 - WORKERS COMPENSATION (RG.L C 152 § 25c(6) I ' 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 building permit. Signed affidavit Attached Yes ...... *.D No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: (Remove dawaned decks -From Und IS and Unil 21; Replace exisHno rleckc w'dh new pressured tr ret d mafer.j al I SECTION 6 - F.STl MATFD CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant u OMCIAL'USE ONLY 1. Building -/1 0.- (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee sal X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> as Owner/Authorized Agent of subject property Hereby authorize_ to h a s +o n C o n stru ction C o. T n e to act on My behalf, in all matters relative to work authorized by this building permit application. Sep+ember 12 ,2005 Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlVIBERS 1 ST 2 No 3 RD SPAN DIN ENSIONS OF SILLS DIMENSIONS OF POSTS DIN ENSIONS 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 t r 'I ne �airinw�uuea o�✓�iaaaac�uaelta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 021906 Birthdate: 09/30/1940 Expires: 09/30/2005 Tr. no: 4081 Restricted: 00 DAVID'E JOHNSTON 2 REO RD26�!� PEABODY, MA 01960 Administrator F. DATE (MMIDD/YY) 11/.1/1.11.CERTIFICATE OF INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION THE DOUGLAS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR LY N N F I E L D WOODS OFFICE PARK ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 220 BROADWY SUITE # #301 COMPANIES AFFORDING COVERAGE LYNNFIELD, NIA. 01940 COMPANY A CONINE-R-CE INSURANC-F-_L4M� _ INSURED JOHNSTON CONSTRUCTION CO., INC. COMPANY B ZURICH-AM __RICAN INSUR®_NC.E 2 REOROAD PEABODY, MA. 01960 COMPANY C COMPANY D COVERAGES . 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YY) POLICY EXPIRATION DATE (MMIDD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 690.1-000 PRODUCTS-COMP/OP AGG $ 0,000 COMMERCIAL GENERAL LIABILITY J N 912 5 8/ 2 0/ 0 5 8/ 2 0/ 0 6 PERSONAL & ADV INJURY $300,000 CLAIMS MADE [:] OCCUR EACH OCCURRENCE OWNER'S & CONT PROT _$300,000 FIRE DAMAGE (Any one fire) $ 50 000 MED EXP (Any one person) $ 5.000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY $ X ALLOWNED AUTOS OOMMTT16128 1/1/05 1/1/06 A SCHEDULED AUTOS (Per person) 100 000 HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) 300.000 PROPERTY DAMAGE $ 100.000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM WORKS CATION AND STATUTORY LIMITS EACH ACCIDENT $500,00 EMPLOYERS' LIABILITY DISEASE - POLICY LIMIT $ two oflo B THE PROPRIETOR/ INCL 6ZZUB-673X905-1-01 9/20/04 9/20/05 DISEASE - EACH EMPLOYEE $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL OTHER DESCRIPTION OF OPERATMS/LOCATIONSIVEIOCLESWECML ITEMS CONSTRUCTION WORK AT VARIOUS LOCATIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF NORTH ANDOVER TOWN HALL EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL NORTH ANDOVER , VtA . 3.(L_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLD MED TO THE LEFT, A T T N : BUILDING INSPECTOR BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE OB ATI LIABILITY OF ANY KIND ! A NTS R SENTATIVES. AUTHORIZED BY• ACORD 25-S (3/93) R E. DOUG % AC06 CORPORATION i 3 -- September 15, 2005 Prescott Village Association C/O John McGravey 14 Stacy Drive North Andover, MA 01845 Town of North Andover Building Permit Department 400 Osgood Street North Andover, MA 01845 Dear Building Inspector, This is to inform you of our desire to have deck replacement work completed at Prescott Village, which will be performed by Johnston Construction Co., Inc. Thank you in advance for your attention to this request, it is greatly appreciated. Best Regards, John McGravey President Prescott Village Association 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: , s Stacy -Drive! 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: ram zrfrmu : . (Location of Fac, Signature of Permit Applicant Fire Department Sign off: Dumpster Permit SerL�mber 1Z, 2005 Date U) m m m X m N v m v H d � d CO2 CM) � O CD c� Z vs CCD C C d c -• y CD o p CDCL o =� �dIF CD o C CD y� dp y �■ O cc C I S v CO) O 1CD Z C.) �► o CD CD C c?�Om S o - •v,oc 2L �CL m y EDS O C2 m H m CL C-) Z =r -C H ^. o o. ? � m m p y 64 Orm m S a C2 O � �0 0 O Z Le• C07 b ;to CD C =r CLtoa C/)m my m O 7 0 CD � n � a; d 0 l,J .rt N � O p� H O.M.^ Fey fz^^tmff�? _CA C7 0. �•y C y ;\ • 1111) rF O co CT CD 0N. jb a r z � T m cn z '`cn rA t� o 7 m 1 c C=' s `C I tri tri 110 Mt7l w d o CO x z I Location T— I&— /% - l8 S I.? C/ �2 No. 2� a f Date J a 0_0 NORTH TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $' ,s'•"°' Eta Building/Frame Permit Fee $ s�cwus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 6 0 Check # /0 ,i `f 31Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING �S ;M. �j`^S S'"i 9 v.- .?% }� 'iF';. } i-� w'1 Gt% ryuST Section for Official Use Ond .3� 'ST6. SLg'�}'- »3�"`'' .fes' fi'•-[ 'h£ fL,.T':. BUILDING PERMIT NUMBER:w) DATE ISSUED: %V4?_ t A A4 SIGNATURE: BuildiN Commissioner/Inspector of Buildings Date 1.1 Property Address:' 1.2 Assessors Map and Parcel Number: 5 +8 StAcy br. Pb,l(ndcve✓ MA / � /Numbed Rq,�p� . C21, l �Parcel / Map Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required— Provided RqqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record IPreSCcf+ V. ilage. _ 1 7 to e--rkcvare"M 4 1-, * gTtr-R 1 ACV l i' No.A n d a t! t r, M A &11q!5 Name (Print) Address for Serv1 513 638- 0573 Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor �y Not Not Applicable ❑ jo—il4r S ( G jY 1, /-1, 5 f /cn � Address r aeo VA License Number S sor Lice�(:7P S 02 t �'' U G 17? 15,17 S^ > 2 V Expiration Date Sign re Telephone (7/30 2 UG) 3.2 Registered Ho/me Im rovemment ContractorrJ Not Applicable ❑ /YS/ �g Company Name Registration Number r23r2`/ Ad e 9 ?C/ ? 5'S z 216 Expiration Date 4 2// 'Z Z f) o Z Si re Telephone v n M O Tm N D Z O z M 90 O n r v r r 0 SECT16N'4 4 Wtl�R C14SATIE;tN G.« }Z 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 building permit. Signed affidavit Attached Yea .......0 No ....... ❑ sEcrrorl 5 = MOYMPNAL i51fR C IpNER' MS FUR; $1Gli%ttIl�1+ S AND sT tlC€ + 3 CUlYS 1 B)fR113CTI€l LY31TIt4L PUMA' TCl► CR 31#:(++Dl!1 Mfg „t!#i9 F.: OE )TC1511;D Si'A 5.1 Registered AAhitect: Name: Address Signature Telephone It$tiCt P! FtYCS�1 'Cti�S - Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone 7 Area of Responsibility Registration Number Expiration Date Name S' Address Signature Telephone J J k� Y `•� Jahrnyinc. Not Applicable ❑ Company Name: Responsible in Charge of Construction ........... ; �!3'!1`TO+!iF PRiPt;ip'�V {elk.11 appiexzble New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: i2eY%Qvd yid Shy IeS GKd re.OIACe wdk +hrte tab asifkaIf shim les A-2 A-5 ❑ A-3 ❑ ❑ Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 ❑ A-3 ❑ ❑ IA 1 B ❑ ❑ B Business ❑ 2A 2B 2C 0 0 ❑ C Educational ❑ F Factory n, ❑• F-1 ❑ F-2 ❑ H High Hazaid .. s ° 0� , 3A 3B ❑ ❑ I Institutional , '� I-1 0 I-2 ❑ 1-3 ❑ M Mercantile ❑4 4 0 R residential ❑ R-1 R-2 ❑ R-3 0 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Utility 0 Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date ow 1, as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Agent Date zrt Item Estimated Cost (Dollars) to be Completed by applicant permit ; 7 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) e%�0 3 Plumbing Building Permit fee t,l X (t) 0 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number t i� A•� xi -} �� S� tta Ott.1 3'`i7 •a tf qS '"'i_< y t J::� r11x,Cf+j, `� iMa r �' Z ;:ti t t �az y:k5 �'kM1 4` ,. '..ei aS .... .. �:; .i• 4„r...f „vk _.... .x. i�. .�,..+'.K4.7,,,3 C; ,., }:, # :• .., m i .�, rFilj2 i4 i b NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 D 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS 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 wkF aw $,i7 #-w eYt� }Y, <` y?'^� E ? ow t B 3 rJfj '(&', jmaniv*alffr 4 �.. ' 7-fZd3Cl 2(l6EFi3 ✓1 BOARD OF BUILDING REGULATIONS _ License: CONSTRUCTION SUPERVISOR Number: CS 021906 Birthdate: 09/30/1940 Expires: 09/30/200 Tr. no: 4561 Restricted: 00 DAVID E JOHNSTON 2 REO RD PEABODY, MA 01960 Administrator ,>O �e �amrnanrve�l%t o��l��.fjssrxrirrile� � ate-\ Board of Building Regulation-- and Standards 140NIS IMPRMTMENT Ct)NTRACTOR j Registration: 123124 Expiration: 12t1 ?J2002 Type: PRIVATE CORP ORA1'ON -JOHNSTON CONST CO, !NC. DAVID JOHNSTON 2 REO RD PEABODY, MA 01960 i f Adnrim�iratar FA DATE (MWDD/YY) ,aI:ILId11. CERTIFICATE OF INSURANCE 10/07/02 PRODUCER THIS CERTIACATE IS ISSUED AS A MATTER OF INFORMATION The Douglas insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE L n n f i e I d Woods Office f! ce Park HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 220 Broadway Suite #301 COMPANIES AFFORDING COVERAGE Lynnfieid, MA 01940 COMPANY A Commerce Insurance Co j INSURED COMPANY B Zurich -American Insurance Co Johnston Construction Co., Inc. COMPANY - - 2 Reo Road C Peabody, MA 01960 COMPANY COVERAGES TH!S IS To CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD .NDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 ' POLICY KWIC"" i POLICY V011RATION CO TYPE OF INSURANCE POLICY NUMBER UIIRS � LTR � ' DATE (MIIMIDWYY) j DATE (IHIIOOlY1r) y GENERAL UASILM X COMMERCIAL OENEAAL LIABILITY A CLAIMS MADE OCCUR; OWNER'S A CONT PROT AUT061MLE LIABILftY ANY AUTO A X ALL OWNED AUTOS SCHEDULED AUTOS MIRED AUTOS ! NON OWNED AUTOS GARAGE LIABILITY ANY AUTO JN9125 GENERAL AGGREGATE _> 300,000 PRODU�P AGO s 300,000 8/201-02 8/201,03 ;. PEASOMAL. & ADV DUURY 1 300,000 EACH c Oma ENCE 1 300,000 FIRE DA1M0E V4q am 100) $ 50,000 MED EXP V"wopow) - $ 5-,_000 CCMSIIIEOSINMA LIMIT S OOMMT16128 1/1/02 111/03SCIM t oiwrnR'iRr s 100,000 (600Il, o� jRY s 300,000 i PIIONNITY DAMAGE $ 100,000 ; AUTOOKY • EA AOCCENT S i OTHER TIIAN AUTO ONLY. ---- EACH ACCIDENT S OTHER — i ; f i DESCRIPTION OF OPERATION&LOCArOON&VOOCLELIPECIAL fTBIS Construction work at various locations CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AsOYE mcpaED POums BE CANCELLED BEFORE THE Tow N IH a I I EXPIRATION DATE THEIIEOF, TW ISSUWO COMPANY WILL ENDEAVOR TO MAIL North A n d o v t r, MA O I i Y.V 30 DAYS WMrM 00 Ce TO THE CERTIPICATE HOLDER NAMED TO TWE LEFT SUT FAILUR[ TO MAIL SUCH NOTMCE SNAIL IMPOSE NO OGUGATION OR LIASILCTY OF ANY ON TIP CONY, ITS AGENTS OR REPRESENTATIVES ACORD 25-S (3/93) 1 f i. � /Q /TI'>>1 I0 CORPORATION 199 AGGREGATE S - "EXCESS LUISIUT/ EACH OCCURRENCE- UMSAEL�AFORM AOOREOATE S OTHER THAN UMBRELLA FORM. — - t WORKERS COWEATION Alb STATUTORY LIMITS B EMPLOYERS'uAnITY ; 6ZZUB-673X905-1-01 9120/02 9120/03 IAS NT s 100,000 THE PROPRIETOR/ INCL I DIBFFASE . POLICY LIMIT S 500,000 PARTNERSIEXECUTIVE OFFICERS ARE. EXCL j DISEJISE • EACH EMPLOYEE S 100.940 OTHER — i ; f i DESCRIPTION OF OPERATION&LOCArOON&VOOCLELIPECIAL fTBIS Construction work at various locations CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AsOYE mcpaED POums BE CANCELLED BEFORE THE Tow N IH a I I EXPIRATION DATE THEIIEOF, TW ISSUWO COMPANY WILL ENDEAVOR TO MAIL North A n d o v t r, MA O I i Y.V 30 DAYS WMrM 00 Ce TO THE CERTIPICATE HOLDER NAMED TO TWE LEFT SUT FAILUR[ TO MAIL SUCH NOTMCE SNAIL IMPOSE NO OGUGATION OR LIASILCTY OF ANY ON TIP CONY, ITS AGENTS OR REPRESENTATIVES ACORD 25-S (3/93) 1 f i. � /Q /TI'>>1 I0 CORPORATION 199 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: pcabedw Trahsie✓ Sial ,,,yi (Location of Facility) Signatu 4 of Permit Applicant 2v/2 C.702 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Johnston Construction Co., Inc. Two Reo Road W. Peabody, MA 01960 978 535-3228 August �6, 2002 Prescott Village Condominiums C/0 Great North Property Mgmt. 199 Newbury Street Suite 108 Danvers, MA 01923 Job Description: Install new roofs on Units 15-18 at Prescott Village. Units 15-18 Remove old asphalt shingles. Install 3' of Ice Shield and 151b felt paper. Instaay,8" brown drip edge. dashing will be inspected and addressed appropriately. tall new 30 year G.A.F. Black three tab shingles. Entry roofs over front door are included. Disposing of all roof materials off premises. Work areas will be cleaned to unit owner's satisfaction. Labor & Material:......................................................... $16,000.00 Total:....................................................................................... 16 $ 0 00.00 Note: Fully insured with liability insurance and workman's compensation. Certificates provided upon request. Payment methods are negotiable. D� jGZ Johnston Construct' Co., Inc. —D —, -We—,/ tt KMt. � oNorth Prope Date ed V1 �� O z 0� x w A CD uCf) ° o w 1Q," U)w o w z z o o w v U w 0 w a4 P-4 o w ro G w a o w w bo o w cn u. a p U z z � to o rx G w I z w a w w w G zi w z •� cn Q C/)— n O L C O : � � •dam WC ea ` m C� .�. cc CDO co Ea �+ N L r: m c t a;r E a r CD m N 4:p. .0 m y C C pp O O 'a V 4• m c 5 cm CLS CD �'. LA = ' cc .: D Of ,�'� c L :L �C3 ymLr O H O O Z O.� cn ++ : D. 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