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HomeMy WebLinkAboutBuilding Permit #201-11 - 65 GREENE STREET 9/8/2010 NORr BUILDING-PERMIT of TOWN OF NORTH ANDOVER `ttLeD '6t APPLICATION FOR PLAN EXAMINATION y� Permit N0:492/ Date Received 144TEp 011 Cl �SSgC LIS Date Issued. (/ IMPORTANT:Applicant must complete all items on this page «>;4:++ :tri+•.-a=te- - •:trw' _;.ia:,y,. _ = a:,,.,. - - - - _ ; +rte, ` _ �;{;:�.:<-a z, cam�,r :'z:.. rF' ?'c.°� .V.r„-�':> - :.%,.-.•-' tar. •-.2•,. "mak:;• },'w:. - :si _- - ' _ - •-;-y =-'�.:.a_.. .�-..�:..TtS:�.. _:'•:•Lr., s-:-. �...rte•%C' =r...., �.:a�' '.-r'-,. 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L�n �r-:�e.,, .,.'�"t•,.�_'rf..y„--�:,.n•.�.,.s'�_,._r r� � _ ..1: � :r{-��:,. i �.�,�..'nr �_. .^.I. �.f_ .c„re::+.�- r9L._ r,2:7.- •-.•r,r�M.r��+ _ i ,'�'�- �=' it"m.� �i:; `JS..r .;�:T'v."1._.f�y.srts�4,-.,,�5 .:•�(,�W- .r.•=- r.t_ :•Y� -'7_,P',-^}�; •. �=.7`.4•..-e��,u-. -:>�-�7q, y,s,:a:� rST--^�_,e�.^�_"`�z`�.`U•.•v:: -:a: - 'fes 7ir�• .u. e:1-�>'y ��_�;�_ ,1�!'r:°•k+:�.ruf.'�•u;:•._r.,-��_ _ _.1f J.71'-. _ i....��t-`.ay”-Si'-.'';.._ai1..,.�Cl+.r_ - __ _ ::N�%c:. -c�n� C,rr.J;.a .: ."-�--�'c�_a��;..- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more.family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other '_-rg?:�;'ia,P,?='mac _ - - _ _ - __rr"- - _ ��q.�_, .:.p;. -r�n_�,..u._ r.ow:. .-•�x. _ _ _ _ :�t`�'Fm <•� �`L=±;'„ };�1.;'' 3Y 5'' ;Y''S' e.�=r ��:..s..^5-` '_.F;yY r`-e-3-Y...b�.". - -•-^P.^.h' z Y.-:a-:r:..,.. - r�- �`�.�.�',-''„� ' � _.ri. `�`'ti.. �,--�ri�-a�s.,� y a' _ ..,,e?lc' .r=J .x7P�,...�..+� ..-is�^r� sd�:...r3ak=a=-., - "�'.•�.:., �,,5' +xpvly�; .,�`-' �i. t�,hi-�.._ u;�_ t'r _c 1 � 'y '°"fiF,"`� l�� 3 •.���... 5 � �:a��r.�. :�{�a� � rl �r�_ a �-��;�• fi`sr�„J�,.,'I Mr.�..���.,�-� �,'�•�' �� ,ter �:�3z• ����Ji���f'�'�= 'fe1 ��da��:, ���,rty`✓"•`�,_.�n..- r '� � �� �-x�i�� u •^•S1 ''�� ,'[ :`h.�-''i�'. �••r,-'�-'S y.lL'�l s�� ° �r _e�`��F�scr -x�::-:s�lFa n'ro:�?•j;S-'. 3z.-'0v;r �"� ✓:• �r�� n.4�^ � usL^'"�':vr"'�?•.S'''r-^"" •.,rY"�C+�$�'r�aJTr.Y�!•�i-d>��_n r__�sl;�?.ii�.:�'.�'`��?��:��6+},�r� ,�^'=. Y�k.�G.:•^��.t:!'fi+.�;� `-����:SL-.Y,-`.-cL,'rC,�9.':":-s5:.r�d_ Pmt-•gilt:-�•:'lr�, ��,-r _:i^�•',=i-�lrY�-"`',;'^E "ta, _ ! .�_�=,F:+.�-�=cr�vptc5fm;:��v�5°,�;,x;�P`;ane.$Cil:r=N'ff=r.ec.!t_�._JY_,`;:�i4;a',a:.,�-,'y..rW:...••-nS�J+�'""rrW�4ti•„r.ly':-=-x, C. :u�_y _ -<_4�. ��:L�d:�:�.-•c- �'�;r DESCRIPTIONOFWORK TO BE PREFORMED.' 4-Ald 40,04-10 4l 7 Identification PIease Type orrant CIeariy) OWNER: Name: ,;¢`r,e� ern P alp �� Phone: Address: l S G�PP�✓� i�� /' ` - .Ei�a�-'s'=��:::�y'i _ ...rti•.�� =-i'a-�,i:�'✓: - -•.'.�°:YR's�kccs=::r:,:vi=•�,r_T.^ -=_ ;�- -- -sem••- - -- '-..z-. � 3'== =S'�mw. _�9:�'X Sa'a1'��.-.F..r.ter!._..,.:_tn�-..vf,- ":�:iWs?':?:uhr_-L•••��=„cr5�i�rr".; --r_.-.^•,_'ear.. - .�r� � :�r=n¢a'h '^� l.�.�s-i'E'r�..�:k�a'';..n�.r��1tm-'.g af,��”. v'�`��•:5'h',�-�� +h�•���-a'�>.-'"'. - -��-z�=5+,,�{��-�F_�' S' _ s_`;_? �_. � ,a� r s'-r¢ 3L,�`;'.._ x:�-,••rc�'F �°v�tic��?'v-.ra�.->�,'',,�L-'.-�.�zr,ri n, ��._. ,.Iz�+'+.Y,�'.+'�. 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"Q'�'^�..._..tia '.�n"'�'=:�- ••5-: "aft=:-[s:a ,.e.o-=F_ ✓' .vrr'-:"'_Y''•o:'�"`k•;•J3"'vw'••r r; .;a.•_ -r`+'r-.`�:•'�. - ...�- ;.;,� i� 'r..L :'mT6.,- Y:'..._�':�.��}h�u._ _ :-r'e..,.a3pS,{=;r`s^-•'�4 6 .. ��a � �-k"�'-�r..-Ufa-:• -''}.',:_.r•`'�,`�Y- 1', s3-= bp;_'vT-.,-•�•Y _l•_ of,t L'L,. Lam.... �s,�' x',R'�� - 'L ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$123.00 PER S.F. Tota( Project Cost: $ �. /�� CPO FEE: $ or?asr Check No.: C) - Recei t No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund rip3'?t�"�_y:.f£.t�-.+.ste`y _ _>. .�r:C._..r�=-•-�z.%::s•?i':- -- - ,.':. rrJti",,: - :.< areerifi0anmer :_; - __::, : ar_=S:a 'ra::ure=ogco :`rae: r : 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 j 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 o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ iviass check Energy Compliance Report ()f 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 ❑ Ce1.a'Cr n r: :Cs. n{_cnl an.il{{ : r' 1rvi i o 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 EnergyP P 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:Building Permit Revised 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 Sigriature !\f'\� •\IIS\.[T f� C..Vi�lIIVICIV 1 J HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 'Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signatiire: Located 384 Osgood Street } 7x iEFNA 45.13 _zaaite.-?m.�..•..,d' .�t:'::s.'C...=.a.(,�.....:...g.7rire.�„:ti'l:-'i.t...e.-.�... - - .Y.d+- - _:41`.r�,:..�.: - - :.:. a ... ai - _ - `.^.Y•». - — _ r�. .r- a3L '- - 'Aid:• -'-'T`-' ..4......_. .2__.._I..........._4'.-. .,.. ,ir, - _ .,... -5 .,,: 'k`i '-1' �l> x_j'i t;l� - -- ♦.h. - ^ - �� 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 Doc.Building Permit Revised 2010 Location No. Date &ORTp# TOWN OF NORTH ANDOVER F A 9 �o a' Certificate of Occupancy $ s"cMus t�' Building/Frame Permit Fee $ 0 t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #0—)O—� (?I 234 ,137 Building Inspector NORTH ToNvn of Andover 0 C,0 _ LAK dover, Mass., $ • �� 2 COCMICMEWICK �1. ADRATED P'P�,C�� 7`S BOARD OF HEALTH PER I T D Food/Kitchen Septic System BUILDING'INSPECTOR THIS CERTIFIES THAT...... . ... .. .:...................... ......... .......opwa�... Foundation has permission to erect........................................ buildings on .....� ........ lrrlev.....6+0......�:................... Rough to be occupied as..... � ....................... ........ 4 ii .1. ► 5........................: Chimney provided that the person accepting this perm' 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 aS " PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ON T TS Rough ........... .. ...... ................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occu y 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 S 1 D E Smoke Det. Page No. of Pages proposal M STEPHEN M. KEISLING 3 _ Building& Remodeling 9.9th Street West R fir. Salisbt#y,.MASSAOHUSETTS 01952 ; MA Uc. 02"M89 Home impv. 101846 -Phone (978) W'44 -46�72 "712• (978) 465-4712 PROPOSAL SUBMITTED TO PHONE "x DATE 3 2010 STREET,C/ JOB NAME CITY;STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE a ; We hereby submit specifications and estimates for: 7»- K.�-�•..ar2.,, -�f�„= t' _C,;�v�v.a-.,s ��,;-�►2`�erw4,,,- a.�,,e,�;��.,�`"= ��p �tJ�Gt9u.�c+�-.G+ � .� �'� .�x. ll�yz-,,..;c�C uhf+- .� f�l� �' a��' � —��1��+✓4 �+-a� I, pot /4P 46 of We propuSE hereby to furnish material and labor-complete in accordancewith above specifications; for the sum of: "I dollars($ ) Payment to be made as follows: 40 60.5 Go - OOIJ. 00 cl F r -"All material is guaranteed to be as specified. All work to be completed m a workmanlike. ` manner accordinglo standard practices Any altefailon.or deviatwn from above specrf;cat;ons. "Authorized j +� fZ�involving-extra costs will be executed only.upon written;orders,-and`w;ll become an extra Signature x.- charge.over and above the estimate. Allagreementscontingent upon,strikes;-accidents r Note:This' ro osal may be r I n r' ntr I:Owner to r fir • tornado nd other'ri ins r nc R P Y o delays s beyond d ou co 0 0 a ca e o ado a ecessa u a e t y y carry ry. withdrawn.b us if not accepted within days. � Our workers are fully.covered by Workman's Compensation Insurance. -. y P Y rreptaurP of Propind—Theabove prices,specifications ' and conditions_are.satisfactory.and are hereby accepted. You are authorized Signature Za _ o do the work as specified. Payme twill be made-as outlined above. Date of Acceptance: ���n Signature Milssachusetts- Delmi-tment of Puhlic Sat'cty Board of Building Re- Il Itions and Standards i Construction Supervisor 'License License: CS 27489 _ Restricted to: 00 STEPHEN M KEISLING I 9 9TH STREET WEST SALISBURY, MA 01952 o— �"G– Expiration: 7/16/2011 ('oroer�isio�eer Tr#: 18542 Office ofConsamer Affairs&B siness Regulation qHEN HOME IMPROVEMENT CONTRACTOR Registration: .x:101846 Type: Expiration_ -629/2012 Individual M.KEISQI-N- 1' Stephen Keisling 9 NINTH STREET SALISBURY,MA 01952-, : _ Undersecretary The Commonwealth of Massachusetts I I Department of Industrial Accidents ' I W 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): ye Address: 9 9 %) s-/-X,P 0 City/State/Zip: S`A-Z(T &-� Phone#: 3/Y J-Ys'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 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. t ❑ 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.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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 their workers'comp.policy information. 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 the pains and penalties of perjury that the information provided above is true and correct• Signature: Date: 2e/v Phone#: 97do 3/1�--��5'� 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.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone M 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." A 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 pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the 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 pen-nit 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#617-727-7749 Revised 5-26-05 www.mass.gov/dia FARM FAMILY CASUALTY INSURANCE COMPANY Issuing Office - P.O. Box 656 • Albany, New York 12201-0656 CONTRACTORS ADVANTAGE BOP000916905 ® DECLARATION PAGE Policy Number: 2005XO431 Agent No: 3485 Agent Phone: 978-887-8304 UGONE JOHNSON INSURANCE AGENCY, IN 7 GROVE ST STE 201 Name and Mailing Address of First Named Insured: TOPSFIELD MA 019$3-1862 STEPHEN KEISLING 9 9TH ST W SALISBURY MA 01952-1702 The Insured is: INDIVIDUAL Transaction Type: RENEWAL Transaction Effective: 03/21/2010 Policy Period: From 03/21/2010 To 03/21/2011 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 $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 ComplC« , ,,..;,y: BP00021299 BP00060197 BP00090197 BP04170196 BP04190689 BPO4961001 BPO5140103 BP07010197 BP10040498 BF30061103 BF40380902 SF40390303 BF41090204 BF41321008 F199020109 Countersigned By Page: 1 of 2 Authorized Representative ANX-3190 INSURED COPY Processed Date: 02/15/2010 i "r;.,., ��" div .,a r!'t`' ,tt;�!7►'� .d:: .� :r�',1 r .. . . f;:� i}�.�� ' S :t^-'Fn?_'." ,�;..�tW you, Us "! 1 1 t." } 4. w.J I S�r • F•,( r .t�}L� i� '�� r • f e _. l Y1 r ' F i .. 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