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Home My WebLink AboutBuilding Permit #892 - 157 HIGH STREET 6/12/2012 BUILDING PERMIT li TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION Permit NO: Date ReceivedUS�� °R.T.° j �`SSACH Date Issued: ' �g IMPORTANT Applicant must complete all items on this page E 'I' S �,,dq�„/�~'A �;', 'ki.4 C t i T}1•� A4 .X haM S. F`2-1L y 1 IkJ' _+,+i�$'1.4}; �OCATIDI�I.I� T- 'y-� - tia,- 't,. F -� s n 3;i i .-�.: Knrnt�-: ti 3-. *�: 1?'`}. y .3! ✓ .} .TY, j.x-+ 1 PROPERTY�01/1fNER,� ��n y X15. 5�r ,f l��74f� .`N��`' sf i�.r �C .5 S'R S,ti�xs -res r P��tr�4 t T�^r id'ry-+.- F9 �'xi�BmtH�K � '�+ rY ¢ „r' � � ''•�. I �, � „� �.a 7 ti' v .,-tts' �:+ � i x � _F y - C4 f, ,.t� e yt a' rt .ya•a 5 r , t ». 1 .i„S•.`TV l „(• r1 + )'"'`J ex� k t Fl}.�', 'l MAP4D FP�F:CEL O�iING DISTR1G ,tnFiisttorc Distinct, S��Y 4 '` `; �- s � Machine Shop 17illage y�� rto+ 1 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family . ❑ Industrial ❑Alteration No. of units: U Commercial y(Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other {p OSeptEc ❑'llVell�t� C7�Floodplam' , `DlNetlan'ds k fl 11Vatersfled`Distriot C� • ater�Sewe�.�: ; �...4fi�'.,.ri ,, � , . .. :�: � . .:...-. .,,�.. ;._. 3�. ,.r;_,5_._ . _ DESCRIPTION OF WORK TO BE PREFORMED �'�.�e v� �ec� �.r•��S f 2,��L.✓�syvs it'll �e� ��k� ,oma�l`�isr e I i Identification Please Type or Print Clearly) OWNER: Name: ea.v.¢-x—d Phone: Address: I , ) r r r 5 ... Phone CONTRACTOR 4 A3ddressf I C Supervisor's Construction L�cerisp e �»- , at f � Exp e dat ' F r � _Horne°lrnprflvement�L�cense `'4 '' � ' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ �•��' FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature_�f`Agent/Ovvner .Si .nature of�ontracor 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning 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 j DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance,, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Si nature&Date Driveway Permit Connection/signature v Located at 384 Osgood Street F;IRS DEPARTMENT Temp.Dumpster on site yes' no Located at`124 Mam Stree# k ' Fire Depa�rfinent signature/date y t ♦ t 5 i 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 � p ) ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Location 17 No.—�sv Date * TOWN OF NORTH ANDOVER Certificate of Occupancy $ A Building/Frame Permit Fee $ Foundation Permit Fee �$ Other Permit Fee $ TOTAL $ Check# � 25405 Building Inspector AORTFI ® of :. � Andover. . N o. Vr& o o , dover, Mass., tt-- LAKE COCMICHEWICK 7��oRAT E D 1�7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......................................................................Py... ...................................... Foundation has permission toe Pt.............o................... buildings on .....I.�.`... . .............. 5.�. .R.......... Rough to be occupied as............... .....:.1 .C......... r .. *............. Chime y �. e 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 i 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 LESS CONSTRUC ST 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 FIR_E-DEPARTMENT Until Inspected and Approved by the Building .Inspector. Burner - Street No. SEE REVERSE SIDE Smoke Det. Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR - jegistration: _101846 Type: xpiration: 6/29!2014. Individual STEPHEN M.KEISLING Stephen Keisling 9 NINTH STREET SALISBURY,MA 01952 Undersecretary --------------- Massachusetts- Department of Public Safety Board of Building Re!-Mations and Standards Construction Supervisor License License: CS 27489 - - - STEPHEN M KEISLING ;' 9 9TH'STREET WEST SALISBURY, MA 01952 Expiration: 7/16/2013 ('unnnissionc•r Tr#: 19624 FARM FAMILY CASUALTY INSURANCE COMPANY Issuing Office - P.O. Box 656 • Albany, New York 12201-0656 CONTRACTORS ADVANTAGE BOP000916907 ® DECLARATION PAGE Policy Number: 2005XO431 Agent No: 3485 Agent Phone: 978-887-8304 UGONE JOHNSON INSURANCE AGENCY , IN 7 GROVE ST STE 201 TOPSFIELD MA 01983-1862 Name and Mailing Address of First Named Insured: STEPHEN KEISLING 9 9TH ST W SALISBURY MA 01952-1702 The Insured is: INDIVIDUAL Transaction.Type: RENEWAL Transaction Effective: 03/21/2012 Policy Period: From 03/2112012 To 03/21/2013 12:01 A.M. Standard Time Business Description: CARPENTRY Total Limit of Liability Term ADDL/RTN Premium Premium Business Property Coverages Buildings Business Personal Property $5,000 $22.00 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 1 $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 POLICY SUBJECT TO ANNUAL AUDIT: YES TOTAL PREMIUM ___ The Declarations, Schedules and These Forms and Endorsements Make U Your m Up Co tete Policy: Y BP00021299 8P00060197 BP00090197 BP04170196 BP04190689 8PO4961001 BPO5140103 BP07010197 BP10040498 BF30061103 SF40380902 BF40390303 BF40861010 BF40910708 BF40921010 BF40940510 BF41090204 BF41321008 F199020108 Countersigned By Page: 1 of 2 Authorized Representative Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the states Home lmprovanmt Contractor lav(MGI.chapter 142A),but does not include standard bagmage to protect bomeowaem Sem legal advice B'necessary.Any person planning home improvements should first obtain a copy of"A Massachursdts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-9734rM7 or 1-U-283 3757 or on our websft Homeowner Information Contractor Information Name ® Company Note Le�,,v�-.mol ,p��arfvs% Stred Address(do not use a Post Office Sox address) Contraetod Salesposod Owner Naam /j? ffr A K%/xeejS'Ted eeAfJ, - Cityrr— U State Zip Code Badness Addrs(naat include astnse address) Apo/—f4 9 9/ J%e,le Daytime phone Evening Phone .Cityffawn State Tap Code 92S 790-05.s'7 Mailing Address(h different fimm above) Business Phone Federal Emptoya 113 or S.S.Number Hea�mmaRea.r=b. Esymcadae i•rnyatcmam cant tins ,o acumber°"" f�/tytD �p--a9 X20�y The Contractor agrees to do the following wait for the Homeowner. (Describe in detail the work to etmtpleted,speci4ing the type,brand,and grade of materials to be used,ase additional sheds if M) /�.rrove dee e 8o rA-c1t 9A U_ ,e,4fLat�t y.t,.IT�LL xG ooeP.V.�'ee RequirW Permits-The following holding permits we required Proposed Start and Completion Schedule-The following schedule vill ted will be std by the contractor as the homeownexs agent: be adhered to unless Vices beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of d-20-12- nate vdmn contractor will begin contracted work MGL chapter 142A.) d-2 2 Date when contracted wodt will be substantially compldc. Total Contract Price and Payar nt Schedule pp The Commdor agrees to perform the wink,famish the material and labor specified abmve for the total son of ��65, (•) Payments will be made according to the following schedule: $ upon signing contract(not to exceed 113 ofthe total contract price 9L the cosi ofspecial order items,whichever is greater). $ •'S44 by..4•/E_2//.i? or uponcompldionof ��%A�� o 'S $ by I I - .or upon completion of $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to loth party's satisfaction) The following rameriallequipment must be special S to be paid for ordered before thecart- , I work begins in order to meet the completion schedule.(**) S to be paid for NOTES:(•)hichalingallfinanceBerges(••)lowrequiresthatanydepositordmm-payment.e* bydecamcacmrbefore work begmsmay not oweed the greater of(a)one4hird of the total commet price or(b)the—A cost ofany special equipment or custom made material which must be special ordered in advance to meet the completion schedule. l ticorsas warranty-Is nmaoress wnrrsaiv bene movidad nv the auutrmeior? 13 No❑Yes tab tams of thewarrsaty most be attached to the niStMct) Subcontractors-The contractor agrees to be solely responsible for completion ofthe work described regardless of the actions of any third party/snbcmtmctor atilt nd by the wnbactor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this atseeauan Contract Acceptance-Upon signing,this document becomes a binding contract arras law. Unless otherwise noted within this went,the c ontrad shall not impb rdW any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract • Don't be pressured into signing the contract.Take time to read and fully undersand it.Ask questions if something is unclear. • Make see the contractor has a valid Home hnorovernent Contractor Reeistration.The law requites most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may require about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm toveragc,or ask to see a copy of a"proof of insurance"document. • Know your rights and responsibilities.Read the Important Information on the reverse side of this farm and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a pine other than the contractor's normal place of business,provided you notify the contractor in writing at hisilm main office or branch office by ordinary mail posted,by telegre n seat or by delivery,not Iater than tpidnight of the third business day following the signing of this agreement See the attachal notice ofcancellation form for an explanation of this tight DO NOT S N NTRACT IF THERE ARE ANY BLANK SPACES!'.'. Tnoideet�tmpies mastbeconpktedandsigaed ibeothweopysbooldtickpibythemrmmcmc Is Contcador' igmatare 12- Date zDate Date Page No. of Pages Proposal STEPHEN M. KEISLING Building & Remodeling 9 9th Street West Salisbury, MASSACHUSETTS 01952 MA Lic, 027489 Home Imp. 101846 Rhone (978) 682-2072 Cell (978) 314-8457 PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME CITY,STATE and ZIP CODE JOB LOCATION ;l o"Z-a ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: �-^ 1 CL�-74�tI�Z ��. G,�i-��c,,.,.�a•`-� 1 41 f ;i We pro)pm hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: Payment to be made as follows: dollars($ I/ V All material is guaranteed to be as specified. All work to be completed in a workmanlike f 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 Y 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 Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. I Amptaurr of proposay—The above prices, specifications ��f / and conditions are satisfactory and are/hereby accepted. You are authorized Signature to do the work as specified Pay ,entill be ad outlined above. Date of Acceptance: / < +J Signature U(/ The Commonwealth of Massachusetts - Department oflndustriglAccidents Office ofInvestigations 600 Washington Street .Foston,MA 02111 www.mass govIdia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /�!/� ,�elS L<�✓ �r Address: City/State/Zip: Phone#: 1'7 P 3 iY J1Ys7 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 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.x 7• 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 required.] officers have exercised their 10.0 Electrical repairs or additions 3111 am a 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.❑Roofrepairs insurance required.]i employees.[No workers' .13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they Lire doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam 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 requiredunder Section 25A ofMGL 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. X do hereby certlo under the pains and penalties ofperjury that the information provided above is true and correct. Signature: / ( Date: 10,-12 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.CitylTown 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 ofhire, 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 ofpublic 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 cant'workers'compensation insurance. r p I,.an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 on for the permit or license is beim requested,not the g De artment 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(ifnecessary)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 bum 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: Tho Got Aonwealth of Massaehv..sPtts Dopaztment of Industrial Aceidonts Offwe ofIuvestigations 604 WashVon Street Boston,MA0211,1, TO.#617-727,4900 ext 406 or 1-877,:MASSAB.F Revised 5-26-05 Bax#61T,727-7749 wwwanass,govaa