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Home My WebLink AboutBuilding Permit #237 - 83 ACADEMY ROAD 9/26/2007 I p►ORTH I BUILDING PERMIT oFs1"D ? 9�; d .,,.."•.t6 O TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION I e G—O o « Permit NO: Date Received 2 �9Ssnc►+us�`�� Date Issued: --C6-o IMPORTANT: Applicant must complete all items on this page kd17, s, "v LOCATION ` j a Print17 I? -OPERTY OWNI f� Tfx s�'"` i - ... t1: �� : RAE .; MAP N, L WING DISTRI HIS R}C DISTFtI 't , e I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial XRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Sepia E Well [ �Jn dplatr � Wetlands ' Waterei ,isrict WaterlSewer; _ { DESCRIPTION OF WORK TO BE PREFORMED: C 1 ft 4a+-k d F,@ Afr &-P 3 e-VI-,e*1e Tp J'rc fo,y. ,Pery vke d/ Zo SS iPMAV1.s �ATE,�,clZxed S/�4v,4 o,y Side �r ff, 4 2-o �"'� lCla�e Ov.ld n?aCy s,dP �u /end ek,`1P2S o+�� s T.¢�ew� S,,~'�,� LF s�a�/��c�v-�' ,� e ls� Bo>4,es0 as L�- Identification Please Type or Print Clearly) OWNER: Name: 46� 7?9/3,/ S'Tc°*vyS Phone: ?Y Address: ONTRACTdR� lame i � ��. '. Pe 9d' s"`7 hon i Address, ` ' Supervisor's Construe-fi,_ l�i`cer►se � Dater �, Horne` mprovemert �Ecense: R2&e' ,. :, exp - Dater � ., ` G�B' ARCHITECT/ENGINEER Phone: Address: Reg. No. I FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /4 FEE: $ jo2G � Check No.: [�c� Receipt,No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor. Location No. ��/� G Date /r MOR7h TOWN OF NORTH ANDOVER } s t Certificate of Occupancy $ cMustt� Building/Frame Permit Fee $ �- Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check # r 20660 i �- -� Building Inspector 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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 FIR bPARTMEN emp�l�ttmpste'an site dyes na w Looted int 124 Mai Stref� Fire,Department srghatureldat$ _ r CC�Nli�IENTS V L Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i 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 { 1 ' NOTES and DATA— For department use I k i i I ❑ Notified for pickup - Date ..... ..... .... . ... . . _. ........ _ ......... .. ...... Doc.Building Permit Revised 2007 _ - 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 ❑ 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 I ❑ Building Permit Application ❑ Certified Surveyed Plot Plan Li 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) o 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 a 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) o 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 I I NORTH Town of 0 V" No. 37 111- __ c , . 4 y C� `AK o dover, Mass., 1 2 L o� T 0 �. GOCMICMEWICK 7�p ADRATE D `s BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...................... ....................................... .................... ........... Foundation has permission to erect........................................ buildings on......�..�........ ................................,... ....................... Rough tobe occupied a ........... .... ...... ...................................... •... ............................................. Chimney provided that the person cepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the pro isions 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 CONSTRU T T Rough ......... Service BUILDING TOR 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 SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lehibly Name (Business/Organization/Individual): S'TP/f��P� ��t i k2 (r Address: 3 m 2 City/State/Zip: A-Do Phone #: Q7 fi 3/Y-R YS ') Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and 1 6. New construction employees(full and/or part-time).* have hired the sub-contractors 11 2 I am a sole proprietor or partner- listed on the attached sheet. 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.❑ 1 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 12.0 Roof repairs insurance required.]t 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. 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. Ido hereby certify nder the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: 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. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other i Contact Person: Phone#: TOWN OF NORTH ANDOVER MASSACHUSETTS NORTH ANDOVER OLDE CENTER HISTORIC DISTRICT COMMISSION VIA FACSIMILE 978 6889542 Building Inspection Town of North Andover North Andover,MA 01845 TO WHOM IT MIGHT CONCERN: Please be advised that renovations at 83 Academy Road do not need approval of the Historical District Commission. The renovations are in the rear of the property and therefore do not need approval from the Olde Center Historical District Commission. Any questions please call me at 978 685 5000. Sincerely, !&- �'�J'6�4z George H. Schruender, Jr. Chairman North Andover Historical District Commission Copy: Kathy Stevens �ro�oStti Page No. of Pages STEPHEN M. KEISLING Building & Remodeling 68 Glencrest Drive NORTH ANDOVER, MASSACHUSETTS 01845 MA Lic. 027489 Home lmpv. 101846 Phone 682-2072 PROPOSAL SUBMITTED TO PHONE DATE s' q224 //, ,o STREET JOB NAME �J CJ'LNa CITY,STATE and ZIP CODE JOB LOCATION 6 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: . .. . ... .............. ... .... t . ........... ...................... � _. ......................... _ _ ............................. .............................................................................................................................................................. ?.............................. . .................................... ............................ _...................................... ........................... hl 39�, a' .............................................................................................................................................................................................................................................................................................................................................................. _. ............................................................................................................................................................................................................................................................................................................................................................................................... ............ .............._ . ............... „, ,, ............................... . . ............................. ... ....... ............ ...................... ........................................................... .... ..... .... . .... ._............. .................................. ................................................................................................................................................................................................................................................................................................................................................................................................................................................. ...................................................................................................................................................................................................... ...._.................................................................................... ............................. ................................................. ..._............ ................................................ ................... ....... .................................... ......................................................................................................._....................................................................................._................................................................ .......................................................................................... We PrOPOsr hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: ). Payment to be made as follows: dollars($ 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 Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. S- - F ArrP,ptance of Proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work a+secifZied.pPmen I be made as ou r ed above. If Date of Acceptanc Signature Page No. of Pages Z STEPHEN M. KEISLING Building & Remodeling 68 Glencrest Drive NORTH ANDOVER, MASSACHUSETTS 01845 MA Lie. 027489 Home Impv. 101846 Phone 682.2072 PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME CITY,STATE and ZIP CODE JOB LOCATION /Ua 4AIZ awe 1w,44 cac4'. ave, ARCHITECT DATE OF PLANS JOB PHOIAF We hereby submit specifications and estimates for: ...........��c r Me........... ...... ................... .................paw Pw...Z 7 e..._ a .................................... .....�v a '`� � ............. �� . ..... ......................... �u....... .. x„fa.... ... .. �`......�.y... ....�.�.. .. - °-,__ .... ..................... . -, ..... .. .......... .... _ .. ............... ......... .................... . ---, , .. .. . .......... ..... . . ........ ...................................... ............................................. ............._........ .................... ..................... ................ � � �� ?Z------0- 0 .................... .. .. ............. . ..... .................. ................ .. . ................. ._........._ ..................... . . ....... . ........ ........... ....._......................................... . . ......... .... . ...... .... . ......._...... ........ ............................. ........................................................................................_............................................... .................... .................................................................................................................... . .1-1................................................................ ................................ ................................................................................................................................................................................................................................................................................................................................................................................................................................................. .............................. .......................................................... .............................. Mr propoSr hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: ). Payment to be made as follows: dollars($ Ord All material is guaranteed to be as specified. AlIleork 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 Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. ArrePtttnre of Proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. ayment will be made as outlined above. _ Date of Acceptance: Signature i I I • I III ✓tae l�arnir�aara�rea,�,� a�.,�aaa�.`uwaelt6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR RegistrLion: 101846 Ex pi,•ation: 6/29/2008 Type: Individual STEPHEN M.KEISLING Stephen Keisling 68 Glenncrest Dr. -` N.Andover,MA 01845 Deputy Administrator �fze �a»vnzonuiea� a�✓�aaaae�waella Board of Building Regulations and Standards Construction Supervisor License Liceri'se:,CS 27489 Birthdate:"7/16/1953 Expiration 7/1-6/2009 Tr# 17077 Restrictiori: W STEPHEN M KEISLING-"' 68 GLENCREST DR N ANDOVER,MA 01845 Commissioner I II I I I,I � i � i FARM FAMILY CASUALTY INSURANCE COMPANY Issuing Office - P.O. Box 656 • Albany, New York 12201-0656 i CONTRACTORS ADVANTAGE BOP000916902 o DECLARATION PAGE Policy Number: 2005X0431 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 01 845-1 31 5 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 BPO5140103 BP07010197 BP10040498 BF30061103 BF40380902 BF40390303 BF41090204 F199020107 Countersigned By Page: 1 of 2 Authorized Representative aNx-31 so INSURED COPY Processed Date: 01/31/2007 1 i I I Brockway-Smith Company ' www.brosco.Com TM T7,) I 4. t i C i }} I } l t { 1 { I : I i tea I t t i , ' x -4_ � s _ r 1 f i EE t , ANDOVER, MA 01810 COXSACKIE, NY 12051 HATFIELD, MA 01038 PORTLAND, ME 04103 146 Dascomb Road Hudson Valley Commercial Park 125 Chestnut Street 203 Read Street 1-800-222-7981 1-800-222-7303 1-800-922-0191 1-800-442-6734 Fax: 1-800-242-4533 Fax: 1-800-222-7304 Fax: 1-800-922-0296 Fax: 1-800-443-0331