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Home My WebLink AboutMiscellaneous - 110 FOREST STREET 4/30/2018 110 FOREST STREET 1 210/106.A-0135-0000.0 �.1 1 A I I k Date. r f r' ,AORT#4 �"c TOWN F NORTH ANDOVER a PERMIT-FOR PLUMBING �V CMUSE� This certifies that . . . . . . . . . . . . . . . . . . . . . . . . d. ... . . . . f� : . .� 5 � ..'W, has permission to perform . . . . . . . . . . . . . . . . . plumbing in the buildings of . l,s0 U << at. . .i.i. . . . . . �..' . . .` . . . . . . . . . . . . . . . , North 'Andover, Mass. Fee �'. �Lic. No.. �. . . . . . . . . ?-�. . ./l . .:r'y ,�,1 /PLUMBING INSPECTOR Check # 7631 I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location A0 Owners Name l s� 0 Permit# ' Amount Type of Occupancy ,� �� New rl Renovation ReplacementC- Plans Submitted Yes ❑ No ❑ FIXTURES w a w x a � x a y p 0 Cv� 9MESM . RAWVEVT M HIDCR: ! t M H aR 34 H.DM 4IR H-00R 51H RaR 6M HIDO[Z ' . - 7]H FLOCK SIIi HID(�2 (Print or type) Check one: Certificate Installing Company Name 2-� 1 5�� / ytc�(,c �. 4_ /7 ri Corp. Address D X a>n-� vt Partner. usmess elephone [D 0 -20 [jFirm/Ca. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and inst tions pro rmed under Pe Issued for this application will be in compliance with all pertinent provisions of the Massach a Stat lu bing C e and a ter 2 of the General Laws. By: igna ure.o icense um er Titley Ty e of Plumbing License / City/Town icense um�oer Master ni Journeyman ❑ APPROVED(OFFICE USE ONLY 1_I PERMIT NO. ��-� C� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE i I MAP NO. LOT NO. 12 RECORD OF OWNERSHIP iDATE (BOOK PAGE Iy ZONE I SUB DIV. LOT NO. r - 1 LOCATIONaf PURPOSE OF BUILDINGi.y-' oo J� NO. O STORIES ,v SIZE F I OWNER'S NAME yam'„ � A` �y /u 7— BASEMENT OR SLAB OWNER'S ADDRESS ' (T''v I ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS DISTANCE FROM LOT LINES —SIDES RE " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS + IS BUILDING NEW N SIZE OF FOOTING IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION A IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO RE IRE✓MiENTS OF CODE 7,fIS BUILDING CONNECTED TO TOWN WATER } BOARD OF APPEALS ACTION, IF ANY X IS BUILDING CONNECTED TO TOWN SEWER �j aV 0 IS BUILDING CONNECTED TO NATURAL GAS LINE 1 INSTRUCTIONS 3 PROPERTY INFORMATION i LAND COST i SEE BOTH SIDES EST. BLDG. COST 1 EST. BLDG. COST PER SQ. FT. PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER ROO PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. i i ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED _ BOARD OF HEALTH SIGNATURE OF NER OR AUTI90RIZED AGENT F E E PLANNING BOARD PERMIT GRANTED . 9 BOARD OF SELECTMEN v BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM APARTMENTS MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B il2I= CONCRETE BL'K. PINEBRICKOR STONE HARDW'D PIERS PLASTER� DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ '/. 1/1 1/. FIN. ATTIC AREA _ NO BMT NO FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMON _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME - BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. _ STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I__] POOR I_ ' ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.1 _ GAMBREL � MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET - ASPHALT SHINGLES LAVATORY v WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN, TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING ' RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC 1st 13rd I NO HEATING Location m) 17 No. t�5'i Date `0 07--- NORTN TOWN OF NORTH ANDOVER 3,+ •. _ OL Certificate of Occupancy $ CMUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ .3a Check # JZ y„p '� 565 Building Inspect TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: j DATE ISSUED: . y ic SIGNATURE: L -- Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number ` 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record SRC.k-+ (JRANCleISCo Lt lld �d,2e�/ d7" Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 6a? V P 9 O 6 JO llt.,/CReC7 Ivo License Number "nAddr `7� / 6A 2uy 3 � 97P 6,P2'2U72 Expiration Date fignatulk Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name /O/tQ V4 M 6S A Byu` Registration Number r r Address (o 2-.9 02 Z Expiration Date G) Signature Telephone Y/ N S SECTION 4-WORKERS COMPENSATION(NLG.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) X Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �e �v t4/pia Bw'-�,eg,&\ - Ck#+,ug e- w t>✓dow ?o 4 A-w�JcN4 J SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building do (a) Building Permit Fee 7 o;/s, Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, S'T Pd e,y Ae SLS v as Owner uthorized Agent f subject property Hereby authorize to act on 1 My=t1pxj telat;ve to,",ohk authorized by this building permit application. Si nature o Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Page No. of Pages Proposal STEPHEN M. KEISLING s Building & Remodeling 68 Glencrest Drive NORTH ANDOVER, MASSACHUSETTS 01845 MA Lic. 027489 Home Impv. 101846 Phone 682-2072 PROPOSAL SUBMITTED TO PHONE DATE - I /.� X3 ® z STR JOB NAME //o pori -f` 1-� CITY,STATE and ZIP CODE JOB LOCATION 1 0 ARCHITECT. DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: .............................................. ........................................................ -fie �zr- -c<, ..... . ........................ ............... ..................... y �. .......:.................. J...................................................................................... ....................................................................................... �.....Q-.... �a.�.� cam_ 1 ... . . .... ... ..... ........... .......................... .................................................................z... e r._' ............................G. +ell ...................p........ ..................................y....... .....................� ............... ..... e ............ ..........................-..............C.. ................. . ................ GC 4t..c.... ........................................................ ............................................................ ..............................° ... - '............ ................ ........................................ ..................................... .... ........................ .............................. ..............Ga ..................................................................... J.J Qe�ce�C J iv�t,�-�v`�. ,e.� . e .e .............................................................................................. ..............................................................-��-'-'Q-��.............................._.......................................................................................... 3..........11&4 :. e ....................................................................................................................................�1............_lam,..........-...................................... ......................... .......................................................................................................-....................................................................................................................................................................................................................................................................................................................................... We proPUSP hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: dollars($ )_ Payment to be made as follows: 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. Acceptance ofroposal —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. Date of Acceptance: Signature ® To Reorder: I Farm DECLARATIONS PAGE 1 CONTRACTORS ADVANTAGE SPECIAL Family Casualty Insurance Company POLICY NO. 20051X0431 ® Glenmont,New York NAME OF INSURED AND MAILING ADDRESS: AGENT NO. 2591 OFFICE NO. 2591 STEPHEN KEISLING JAMES W UGO � NE 68 G LENCRE ST DR FARM FAMILY INSURANCE N ANDOVER MA 01845-1315 10 S MAIN ST STE 208 TOPSFIELD MA 01983-1832 978-887-8304 RENEWAL TRANSACTION EFFECTIVE 03/21/02 POLICY PERIOD FROM 03/21/02 TO 03/21/03 12:01 A.M. STANDARD TIME AT THE LOCATION OF THE DESCRIBED PREMISES THE NAMED INSURED IS:- INDIVIDUAL BUSINESS OF THE NAMED INSURED: , CARPENTRY-NOC LOCATION, OF DESCRIBED 68 GLENCREST DRIVE PROTECTION CLASS IS: 04 PREMISES NO. 01: N ANDOVER MA 01845 CONSTRUCTION IS: FRAME PREMISES' 01 BLDG 01 BUILDING MATERIALS / EQUIPMENT STORAGE BUSINESS PROPERTY COVERAGE: LIMITS OF TERM ADDL/RTN INSURANCE PREMIUMS PREMIUMS BUILDING 0 0 0 BUSINESS PERSONAL PROPERTY 5,000 46 46 BUSINESS INCOME AND EXTRA ACTUAL LOSS SUSTAINED NOT EXI�ENSE EXCEEDING 12 MONTHS INCLUDED INCLUDED BUSINESS LIABILITY COVERAGE: BUSINESS LIABILITY - PREMIUM IS SUBJECT' TO AUDIT BODILY INJURY/PROPERTY DAMAGE 500,000 PER OCCURRENCE 1,000,000 AGGREGATE 500,000 AGGREGATE FOR PRODUCTS - COMPLETED OPERATIONS HAZARD MEDICAL EXPENSE 5,000 PER PERSON FIRE LEGAL LIABILITY 50,000 PER OCCURRENCE CODE DESCRIPTION PAYROLL TERM PREM ADDL/RTN 91342AA CARPENTRY-NOC 20,000 379 379 THE LIMIT OF INSURANCE FOR THIS BUILDING SHALL BE AUTOMATICALLY INCREASED BY 5% ON AN ANNUAL BASIS DURING THE POLICY PERIOD. ACTUAL CASH VALUE (ACV) — BUILDING OPTION DOES NOT APPLY. DEDUCTIBLE:" $250 DEDUCTIBLE APPLIES EXCEPT WHERE NOTED IN THE POLICY OR ENDORSEMENTS. COUNTERSIGNED BY: BF 30 05 01 98 INSURED COPY PROC&SSED DATE: 02/15/02 S • I i • f • i .. r , �/ce�omoxonetealA�o�./�liiaam,�,.:oe%la .JJ7ggq HONE INPROVENENT CONTRflt IOf Registration 101846 Expiration: 6/29/02 Type: Individual STEPHEN N. KEISLING y Stephen' Keisling �tg' 68 Glenncrest Or. ADMINISTRATOR N. Andover HA 01845 1 I � I L ATI O NS BOARD OF BUILDING REGU License: CONSTRUCTION SUPERVISOR ! , Number':.CS.. 027489 1 )7/1611953 Expinss.07/1612603 Tr.no: 12035 } ,. Restricted To: 00_ STEPHEN M KEISLING' —/ /�r'" 68 GLENCREST DR 1•� ; p 'OKTH 01%?M , Of1 RAndover No. 6 9 1 P17 LAE 0 dower, MassQoL6�. COCHICHEWICK ORATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THISCERTIFIES THAT............ ........................................................ . ..................................................................... Foundation .has permission to erect........................................ buildingsWX 0 on .// .................................................. Rough to be occupied as......... ... ... ....... . ....................................................................... 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 PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION S T ELECTRICAL INSPECTOR 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE Smoke Det. REVERSE SIDE DaW,<.-? L Of,NORT:��o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,sSACMUS� This certifies that . . . .,�. . . _ /�,�-f ;�.t.�l?: t. . . . . . . . . . . . . . . has permission to perform . . .f. plumbing in the buildings of . . '. . . . . : .`. . . . . . . . . . . . . . . . . . . . . . . at. . .//.G . . .`.�. . . . . . . . . . . . . . North Andover, Mass. Fee. . . . . .Lie. No— A . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # '�- 5282 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS �) Date ' 2- Building Location t/ Permit# Amount Owner New Renovation Replacement �/ Plans Submitted Yes 0 No ❑ FIXTURES 7 Cr Cr Crw x as RASffvf 1T MILOCR 3�A)HIDCit �)HIOCgt, 41H]H jOCIR 51H FLOCIR 6HI KOOR 7Hi H i" 8M HIDM (Print or type) )� Check one: Certificate Installing Company Name t �/ G? Gj.N � ❑ Corp. d vL Address � Partner. Business Telephone []--Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and informatiRins ubmitte or entered)in above applicatio aret rue and accurate to the best of my knowledge and that all plumbing work ations ormed under rmit Issued f s applicati ill be in compliance with all pertinent provisions of the Mas St ing Code nd Chapter 1 of the Gene BY ignature or Licenseaum er Type of Plumbing License Title City/Town kens um er Master Journeyman ❑ APPROVED(OSCE USE ONLY , I _ Commonwealth of Massachusetts City/Town of No andover System Pumping Record r` Form 4 DEP has provided this form for use by local Beards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, use only the tab key to move your Addr�� ^ cursor-do';ut No Andover _Ma key. _ use the return City/Town ------ --_.,_.._--`- State Zip Code 2. System Owner: Name reo� Address(if different from location) 4 City/Town d State Zip Code 4 Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Mons 3. Type of system: ❑ Cesspool(s). Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of SyAemr KI- 6. System Pu Name j` Veil'icle L cense Number Stewart a tic Service , �=catfion 7, where contents were disposed: art sere-tre tment Plant 20 So. Mill Bradford Ma 0183 - Stew r 5 Signature of ul r Date Signature o �Re eiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 TOWN OF v SYSTEM PUMPING RECORD DATE: RUG Z 9 � SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example:left front of house) d �4 �J l r DATE OF PUMPING: �oZ > QUANTTTY PUMPED : C7 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: I J CONTENTS TRANSFERRED TO: J