The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #584 - 151 SANDRA LANE 3/8/2007 pO R TH BUILDING PERMIT oFtt�.o "tio F F 0- TOWNOF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION s y � Permit NO: ✓ Date Received �R"�R,7eo c5 9SSAC HUS�� Date Issued: - o IMPORTANT: Applicant must complete all items on this page LOCATION 7,7" Affrin't PRQP RTY fl11VNE'R r% - ..,i?°tso fl,M 40" . ffi �, � �. rt(tt MA NtJ. < PARCEL;R Z ;NING DISTRIOT. HSCRICnDISTRICT ° eyes n� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial 'I Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition [I Other tea. 1 .Sptic 1lllell Flocadplairl �ands A � lae�h� Cssrrct,y 1later;/Sewer f . ! DESCRIPTION OF WORK TO BE PREFORMED: +� fCPl7v0 ale L A:: 7Z ,ld�~ Ss'iyc.��.o-LG I f IdentificationPease Type or Print Clearly) OWNER: Name: � ZyL Phone: Address: / S—� -SH-N CONTR4CT4R Name i Phone 3 --�' r g. ddesvn cf' c,cP sf� c • �; R '., X cul brvisofs Construc �� L cI s ' ' Date . 1 `: 41,61 1, Herne.Improrrement L�c� se ARCHITECT/ENGINEER Phone: r Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Ile Total Project Cost: FEE: Check No.: 1/ Receipt No.: D Z� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ti COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS I DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 4 L 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 ❑ t 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 FIRS DEPARTIUIEIVT Temp Dumpster`o� site ye no ' " Lovated a�1' 4pMan Stre Flee Department slgnatureldai .r, x -x C9419NTF . 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 ❑ Notified for pickup - Date ..........................................................................................................................................._.................................................................................._._._.................................._...................................._.............._.......................................................... .... i 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 9' i ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products 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 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 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 ropostti Page No. of Pages I � ST[-:EHEM M. KEISLENG j Building & Remodeling 68 Glencrest Drive (NORTH ANDOVER, MASSACHUSETTS 01845 MA l-ic. 027489 Home lmpv,' 101846 Phone 682-2072 PROPOSAL SUBMITTED TO PHONE DATE STREET .I JOB NAME /5l .3&,6a V � CITY,STATE and ZIP CODE JOB LOCATION ArrCHITECT DATE OF PLANS JOB PHONE is 4� I We hereby submit specifications and estimates for: #4,al16� '7 ,X � .' ,I GW�C�L�G C.1�Yt�0(� Vjl'•�'�J �-�j.Q- '� �T / /"'i-'.F"S„ '/rte .�.U► �. �C �'GO ,. J J �7 We prapgSr hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: I ). Payment to be made as follows: dollars($-�t� -moo yc� ka�..E�Cc C' +1 7�'Gertc-�--�tr. � �. _ 1 2— All All material is guaranteed to be as specified. All work to be completed•in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra -Signature / charge over and above the estimate. All agreements contingent upon strikes, accidents ' or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be 1 Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. i Arreptanre of proposal — The above prices,specifications ( / and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. s �V — V Date of Acceptance: � Signature i 40 tAl J - BROOKHAVEN FRAMELESS COLONY DOORSTYLE SIERRA FINISH ON MAPLE WOOD CEILING HEIGHT 93 1/2 HANG AT 90 QSS 54 SOLID STOCK W/OET EDGE CROWN MTT803 FASCIA BOARD QSS54 SOLID STOCK W/OET EDGE LIGHT RAIL MSU805 TOEKICK COVER NO DECORATIVE FRONT PANELS REF&DW ELITE BAR HARDWARE P10 DOORS AND P09 DRAWERS BRACKETS FOR OVER ANGINCLUDED ----156"------- --- -234" --106'0" L --- - y ,-30"— f ---36„ T- W2436 W3636 WbbC7 W3636 H 830153 n B1 363 RN33343634 �g Q 1-TWO ROLLOUT TRAYS 3 U 2-OVEN N a 3-TWO ROLLOUT TRAYS i 3 rn 4-TILT FRONT p TOWEL RACK RIGHT Z SOAP RACK LEFT 5-CUTLERY DIVIDER Q Z DOUBLE TRASH ROLLOUT N a m 5UB 42 v 24 b15HW BS634LL B3D2734 �' 18 4R 24"--1`---36" / 42"----�-----------------107 i"--__------ r , All dimensions_size designations given are This is an original design and must not be Designed: 1/2/2007 released or copied unless applicable fee has Printed: 1/9/2007 subject to verification on job site and r' t;�a�.scc•I�� been paid or job order placed. adjustment to fit job conditions. All Drawing#: 1 AMYTURK2REV -- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /,-V, �J ,C01,S A,-L Address: /S/ Sf9.tol.QiSt ,vim City/State/Zip: N0 1,9-kko IP719� Phone.#: 92d' -319`603`s 7 Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. Q New construction 2 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' co insurance.$ 9• ❑Building addition [No workers'comp.insurance comp. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.Q Other employees.[No workers' comp.insurance required.] *Any applicant that checks box#1 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. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: 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 thepains andpenaides ofperjury that the information provided above is true and correct SiMature: Date: B 7 _ Phone#: 7 3/f/ PIPS 7 Offlcial use only. Do not write in this area,to be completed by city or town offlcial, 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-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,not the Department of Accidents. Should you have an questions regarding the law or if you are required to obtain a workers Industrial Accrde y Y compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the ro riate 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 permittlicense 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 02111 Tel. #617-727-4900 ext-406 or 1-877-MASSAFE _.._ .. _.. Fax#617-727-i-7749--- Revised 17=727-7749--Revised 11-22-06 www.mass.gov/dia ✓�e 1�a��na�reu�e�. a�/G'ltra:s�u�iuvP� Board of Building Regulations and Slandards HOME IMPROVEMENT CONTRACTOR Registration: 101846 Exp;;ation: 6/29/2008 Type: Individual STEPHEN M. KEISLING Stephen Keisling 68 Glenncrest Dr. C. ,.�CL e-•.� N:Andover,MA 01845 Deputy Adminisli:alor ✓/zeomeniwoariea a�✓f�aaarrelu�ael�a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR �v'sem Number: CS 027489 Birthdate: 07/16/1953 Expires: 07/16/2007 Tr.no: 14847 Restricted: 00 STEPHEN M KEISLING R DR N N ANDOVER, MA 01845 /_/��` Commissioner FARM FAMILY CASUALTY INSURANCE COMPANY Issuing Office - P.O. Box 656 • Albany, New York 12201-0656 CONTRACTORS ADVANTAGE BOP000916902 ® DECLARATION PAGE Policy Number: 2005XO431 Agent No: 3485 Agent Phone: 978-887-8304 UGONE -JOHNSON INSURANCE AGENCY, IN 10 S MAIN ST STE 208 Name and Mailing Address of First Named Insured: TOPSFIELD MA 01983-1834 STEPHEN KEISLING 68 GLENCREST DR N ANDOVER MA 01845-1315 The Insured is: INDIVIDUAL Transaction Type: RENEWAL Transaction Effective: 03/21/2007 Policy Period: From 03/21/2007 To 03/21/2008 12:01 A.M. Standard Time Business Description: CARPENTRY Total Limit of Liability Term ADDL/RTN Business Property Coverages Premium Premium Buildings Business Personal Property $5,000 $25.00 Business Income and Extra Expense Actual Loss Sustained Not Exceeding 12 Months Other Endorsements SEE SCHEDULE BUSINESSOWNERS LIABILITY Except for Fire Legal Liability, each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period. Business Liability Limits of Insurance Bodily Injury/Property Damage $500,000 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 AGGREGATE FOR PRODUCTS/COMPLETED OPERATIONS HAZARD Medical Expenses $5,000 EACH PERSON Fire Legal Liability $50,000 ANY ONE FIRE OR EXPLOSION Other Endorsements SEE SCHEDULE TOTAL PREMIUM I POLICY SUBJECT TO ANNUAL AUDIT: YES The Declarations, Schedules and These Forms and Endorsements Make Up Your Complete Policy: BP00021299 BP00060197 BP00090197 BPO1080398 BP04170196 BP04190689 BP04961001 BP05140103 BP07010197 BP10040498 BF30061103 BF40380902 BF40390303 BF41090204 F199020107 Countersigned By Page: 1 of 2 Authorized Representative ANX 3190 INSURED COPY Processed Date: '61/31/2007 t,%ORTH Town of over No. 8 _ over, Mass., 3 .1 01�ow 0 LA E COCHICHEwic o C7 RATE #kV BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................ ...........to....ib*4L.................................................... ........ Foundation 4Pj J* has permission to erect .............. ... %A� buildings on .......................... Rough to be occupied as........,4*.'.14'�a........A*f'WW4-*4011r1.11!l16&............................................................................................. Chimney provided that the person accepting 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 qqq%W0W PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough ............ Service ....................... ......... ...................................................... 40 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 SIDEJI Smoke Det. Location S�4"IGI,,ZGZ1`�7 k-� No. Date MORTM TOWN OF NORTH ANDOVER /0 9 Certificate of Occupancy $ 'IS t Building/Frame Permit Fee $ tH CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 206 �. � Building Inspector