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HomeMy WebLinkAboutBuilding Permit #030-13 - 43 MAGNOLIA DRIVE 7/17/2012 BUILDING PERMIT °* pORTH q �ttyeo 6• �O TOWN OF NORTH ANDOVER �? �.. ° _ , .. � APPLICATION FOR PLAN EXAMINATION 41 Permit N0: l� � Date Received gSSAC HU`��� Date Issued: 7 /y IMPORTANT:Applicant must complete all items on this page LOCATION S'_ ,c>dL�sa__ 14 Print PROPERTY OWNER-- C14Ie-1S Print MAP NO-::&J,� PARCEL'.: � ONING DISTRICT: . : Historic District yes... no . ` 'Machine-Shop Village yes, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacementx Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed;District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: re^o+.e -i- leap L.9c e /y . IiRN ITy 7a lE Ti 1 e .a S I o1v&,P A.p4tt 00 �L®olz AleQ e��,A1L PLss 2 Identification Please Type or Print Clearly) OWNER: Name: CPhone: ?7P G�S-S�Go7 Address: CONTRACTOR. ;Name. e Ale- ( Phone: Q2cP 3/S-cPfr_7 :Address: __ � _� .. 4 91-2ee/ Supervisors Construction.License. _ _CP_7 yp9y- _.Exp. Date: 7--16^2cci� . a - - Home Improvement.License.; p; Date 232 / Ex 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: $ /:k� o?®. FEE: $ II' Check No.: 0 -� Receipt No.: ���� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund _----- - --•-ter i Signature;of Agent/Owner r . _ Signature of contractor. 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 2.2008 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 CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments w Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIR_E DEPARTMENT Tamp swmpster on site` .yes,- +_ .no. - Located at-124'Main.Sheet Fire. Department signature/date. . COMMENTS 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) r ❑ Notified for pickup - Date i I Doc.Building Permit Revised 2008 Location 7'—� / llC"i 4 AID 1,'dI'c)„x *t No. Date I • - TOWN OF NORTH ANDOVER � arra f. p Certificate of Occupancy $ Building/Frame Permit Fee $_7Af Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 7 " Check# 25507 13iai`dfng inspector t%ORTf own of t s ndover 0 �. - No. LAN! h ver, Mass, 77 / 7 i?- A_ COC NIC Nl WICK y1. 7�A0" �ATEC S U RM - T LDBOARD OF HEALTH Food/Kitchen PE I T Septic System THIS CERTIFIES THAT /17./ .. .. .. °. ... 7� .... BUILDING INSPECTOR has permission to erect .. .. .D�,,,,,,N."0'r..................... Foundation p .......................... buildings on /U� BOV/1. Rough tobe occupied as ........ ........ ....................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION RTS Rough Service ...................... . . .... .. ..: ---T............... final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. F_�SEREVERSE SIDE The Commonwealth of Massachusetts Department of Industrial_fccidents Offiee ofInvestigations ..600 Washington Street Boston, AM 02.711 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�;<biy• ' Name(Business/Organization/Individual): -� Af e— - - - - . Address: -- — City/State/Zip:_. �i� .S Eva y ,azo, Phone#: P2dP F2. 1 employer?Check the appropriate box: employer with 4. FOuiltd ect(required):' ❑ I am a general contractor and I yees(full and/or part-time).*, have hired the sub-contractorsonstruction sole proprietor or partner- listed on the attached sheet 1deling d have no employees Thesesub=contractors haveg for me in any capacity. workers' comp.insurance. litionrkers comp.insurance 5. g additionp ❑ We aze a corporation and itsrequired.] officers have exercised their cal repairs or additions 3.El.I 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 in required.] t 12•❑Roof repairs q ] employees. [No workers' comp,insurance required.] 13.❑Other *rya'akglicant t yt ehec`�s box rl must also fill out E e se At _ __ ction belou sheer W. ���:, _ _ T Homeowners who submit this affidavit indicating they are doing all work and then Lure 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(heir workers'comp.policy information. infoormation. I an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site 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 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. Ido hereby certify under the 'ns and pen¢Ities of perjuU that the information provided above is true and correct: Signature: Date.- Phone ate.Phone#: 2. sS/V PP'S'7 F[6.Other only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: i 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,•§35C(6)also states that"every state or local Ticensing*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 certificates)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 LL•C 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 t w .t r town that the appliG ton L , �Sb:r�tl-'s!u�r� 4 the city o; r a e '£rir the e�14.Or 1'�gs^�Sy 2S bA,,,n request-.d,4P F e j`o a Ar f .� p vs_g _ a Se,.4,�� t9.- -�=i�—rtmv2:4_ 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(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 GfMassachusetts Department of Industrial Accidents \ Office of Invesfibatlons 600 Washington Street Boston,MA 02111 Tel. #617-72.7-4900 ext 40.6 or 1-8.77MASSAFE Fax#617-72.7-7749 Revised 5-26-05 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 03/21/2012 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 $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 Up Your Complete Policy: 8P00021299 SP00060197 SP00090197 SP04170196 SP04190689 BP04961001 BP05140103 SP07010197 BP10040498 BF30061103 BF40380902 SF40390303 SF40861010 BF40910708 SF40921010 SF40940510 BF41090204 BF41321008 F199020108 Countersigned By Authorized Representative Ulze ipa�zzmz¢1z[ucrrlf�o�Vl�[9:iac�u6c Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR legistration: 101846 Type: iration: --6/29/2014- Individual STEPHEN M.KEISLING Stephen Keisling 9 NINTH STREET SALISBURY,MA 01952 - Undersecretary - Massachusetts- Department of Public Sakti Board of Building Re!grulations and Standards Construction Supervisor License License: CS 27489 STEPHEN M KEISLING y 9 9TH STREET WEST SALISBURY, MA 01952 -- ——��� Expiration: 7/1912013 Commismoner Tr#: 19624 J; , Page No. y of Pages Proposal ^� STEPHEN M. KEISLING Building &s Remodeling 9 9th Street West ' Salisbury, MASSACHUSETTS 01952 MA Uc, 027489 Home lmpv. 101846 Phone (978) 682-2072 Cell (978) 314-8457 "`PROPOSAL SURTO PHONE DAT STREET JOB NAME CITY,STATE and ZIP C DE JOB LOCATION t 3-4 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: '1 . _ � "�G<-C'�C (.� t7�� /�,g� • /c.e'>r�ov2 J /[1�=,Go�[a-,/ lc,Jz�'� L�2 � 04-, L-)Ia a a �o ?' / crk,, 1 04� 941 a C� AA- toe CIIpOSP hereby to furnish material and labor—complete in c fordance with av�specificaiAns, fofhe sum of f � dollars�� Payment to be made as follows: �y All material-is guaranteed to be as specified. All work to be completed in a workmanlike t 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 Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. Arreplaure of proposttl — t The above prices, specifications • f 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. e Date of Acceptance: Signature �� aD 6� uf0se�lrHe�e �ert� _ m Smkb@d8ffdMff Mmut+ t ai as t :ED8out8 '� ��s�cc�lYoa Risirr *== �J'aa�caeoeF9gY � "P- �rib29r373.8?giarl-0��.375Tca� e �S foc k - s�an��o��ot�sasoKt�� Mm '444ampie A,4 t E sPmm UMTMR 7� ��'S—S/60 Tpcadt t�t� � a�arSstt� P.rnoke epOfce j4,!3 ht4l0 I=�2 New t �t6vA `P� mpmd aadrmbvFmma� �� - tet �st�netR�rsr�a eft!� � ��sammoi� � ► �� t�e�ae�mrsat$ WA.) begiaao»ffi� MwWmmvcft=gWmMr. de�ana�trasm�s�n� s � g�a(naa�amoer;t/3af0a;et�ic __ �(Jl✓GhGS.� P rcta�fo+bt�� cis �,� mderedt�e�am�arsd� - oomatthe { moal� - S 6obepadfa aaao�ma�af tvl�eaaa�emr,� bresm�tr���@Ie�s�y � m beams l63 ens a�amabctpes3o�ia>�ewaaet Speed��taraammasdt� �•^^sdS,..n,es__isaem+..���m„z�c; rA©upL3yeslen[a�a� . �eaoet�ee�sstotxafOterm �cftstesrou4am� e>msrabi6�eo '� af�effiF�edr�y0� — ���� �e�StobtsatdYaa�r� toaS ;nr _ 08sdoemse� avnftambmmfthm UnIm 0 sdoa 0<e comil9esgffi�ot9iatete�tu<s�emOad� @sefnBowEeg �¢ 0 DorANtciioatilteaustra�t'f�efm�tozaals�fuAy�d3.�cQaa�iFs � . x oomtracertts�6e a OBD � aiudttosee a sod . as . i5*�tD t Dkaa"IOP Roam Y��n esbaata tRHaa�a,t+fA�itbat 6t bgr�g 7-37343787a: � '�a������A�i4Q�a�£�Insaomprapisut�3�aa�o�mYa�et��t6o K=waafl I�tketm � s�aft�'afmmad a �tei�s �I+o�ov�Cuatrac�lawc Yca¢egraecet�'stR'itL�6ems�edgar�n� ���� ��� m � a�ar�affss�a�9a� ,�pastyaatt>��ata � Ota' after see#= daoboeafe fmm furan x:18 N(YrSdGi TM(J[TiNMC.REF LARgAtV SpAC: Twi�da�xcet ��gc.3ier7 zr� --7-;G r. se - ride a�... ✓ ira marc tIDpmvemem c onuaaor navy p ruVM s thourcottmers with the d&to imitate an arbitration action(as an alternative to court action)iftheyhave adispute with a contractor. The MIKE d&is notspy afforded to a r contractor,however: The oonh=W vvmtld have too resolve arty&qMcWsk has with a homeowner m arnat unless both patties agree to the"coat clause provided below This clause would give the contrsctarthe same right to arbitration as is db*d to the hmw mer by the Home Improvement Contract Law The color and the homeowner hereby mom*agree in advance that in the event the eontraarhas a dispute concerning @his contra,the contrackw may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Comma Affairs and Basiness Regulatien and the consumer Mall be requited to submit to such arbitration as provided TO AlassuchusUft General Laws,CbaLftr 142A.- Honeoanee's signature Conhtncts s- nable NOTICE:The signatures ofthe prattles above apply only to the W00110A of the parties to*Motive&prae resolution initiated by the contactor_ The hamteowm may initia'be altet1111tive dispare tesolutirm even where this section is not shy signed by the parties. Homeowners Rights A homeowner's rights under the Honore Improvenhent Contractor Law(MGL dupter.142A)and other,comer protection laws fm MGL cox 93A)may not be waived in any way,even by agretmeaL HowevM horocowners may be excluded fry certain rights ifthe contractor they choose is not prape dy rimed as prescribed by law Homeowners who Beane their nam buildingpermits are aulmnatic*excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law MM contractor is resPOnSrble for cxrmpleM9ffie work as descrW in a tun*and woikrmhoh'lo manner Homeowners may be entitled to other specific legal rights ifthe contractor guarantees Or provides an express warranty for worlomanship or materials, in addition to gds or warranties provided by the mor,all goods sold m Massachusetts nary an implied warranty of maclatltabildy and Shnesa for a particilar ptupom An mom of effier m$I t oa which the homeowner and eonhacW hmfimlly agree maybe added to the teams of the eoahset as long as they dorrot restrict a houreawnes basic consanrerrW ts. gyon}ate questions about ym a Ax n wwoce rights,cmtad the Coils Inforrrmtion Hotline below Execution of Contract The contract must be executed in 62500 and should not be signed until a copy of alt exhibits and referee documents have been atinbed. Parties are also advised not to sign the dwoutcat until all black sections have 6Iled in onmatimd as void,deleted,ornmt applicAle. OrreuriginalsigmdaWofthecontmetwith its k m be given to the owM and the other kept by the contractor. Any modification to the original contact most be in writing and agreed to by both pattics.Contac wok may not begin until both patties have received a fully Uec ted copy of the contract,and the three day rescission period has expired. Amdetated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/haselfto be financially insecure. Hovtever,in instances where a coutmew deems hirotherself to he financially kwchoe,the contractor may require that the balance of fila&not yet due be planed in a joint escrow account as a prerequisite to continuing the contacted.wark, Withdrawal of funds from saidwould reac quur a the signatures of both parties countAdditional Information Ifyou bove general questions or need additional infinarm ion about the Home Improvement Contractor.Law or other consumer rights,or if you wish to obtain a free copy of°A Massachusetts Consumer Guide to Home Improvement" contact Cons<nnea Inf nmation Hotline Office of Consumer Affairs and Business itegulation 10 Patio Plaza,Room 5170,Boston,MA 02116 617-9734rM,88$.283-3757 or visit the OCABR website at Into:li�c�;tti_i,1as5 20,10cahr/ Ifyou want to vm*the registration of a contractor or if you have questions or need additional information specifically about the contrary registration component of the Home Improvement Contactor Law,co s Director of Home lmptov est Coonaror Registration Office of Consumer Affairs and&Wness Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973.8787,SM283-3757 or visit the MC website at Iran.jhi* .ma.;s.eoe/ocahr/ Go online to view the status of a Home Improvement Contractor s Registratiow thin://db.state r:ra u�ihameirrrnro�•err°nt IieznSeetist•Lr For assistance with infurand mediation of dimtes or to tiglate formal-Mlaid,against aImsi.,call: Consumer Complaint Section Office of the Attorney General 617 7274KW AND/OR Better Business Bmeam 508-652-4800,508-755-?548 or 413-734-3114 Veisipn 21-h hl2Tl�10