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HomeMy WebLinkAboutMiscellaneous - 182 MIDDLESEX STREET 4/30/2018Location 'NO. Date 12 NORTN TOWN OF NORTH ANDOVER • s 40 Certificate of Occupancy $ ,SSACNUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i Check # - Building Inspectolk- TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH ONE OR TWO FAMILY DWELLING •A 01( BUILDING PERMIT NUMBER: DATE IS D: / dt SIGNATURE:IR Buildingtommissioner/lEs for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: o i"-,) ©d® l Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft ` Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record / LU f Ll CAM R, f 11x1 AC-ARCT S Vh (%h/0p2 /' I" � to J e)c<S t �e 7— Name Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Namt Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: S % Plle-) ,fie c s 1. -i � Licensed Construction Supervisor: 61Q 1) rL /I/oOve Address • �C �I[� ��'2'zCi?Z SignatuA Telephone Not Applicable ❑ License Number 7-16 � 200Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ �d C Company Name fT PV Registration Number G—Z9-oZ Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.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 .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ T Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: g2e"e-C gft- T1 4004, N@ de,PIQ til (2)#A�U C ,-e ft(,V /NS7A`1 /z ,x ' %E-WAJIN l,'l©0 XV0 7 e . Ades-T4t s,AJx -7--,W-774 OUPfZ �vQ w,44,Lr SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to bet)FCiAL Completed by permit applicant ISE �tiNLY 1. Building o o G r/ri '1O. (a) Building Permit Fee Multiplier . 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical FIVAC 5 Fire Protection 6 Total 1+2+3+4+5) ( Q,00Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, S f t P 9e aJ M_ Ke t S Ll ,) 6 as Owner uthorized Age of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief SYTeP9Q,0 M- �CetSL��1 , PriO&I n ature o Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 sr 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMIENSIONS 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 m m m 0 m CO) CD-o ax CD O CL r d m 0. nc= .o 0 OdcCDp C. c � d CD o C CCD d O CD CO) 10 CD a O CO) 10 CA! Cl) CO) 10. C7 0 C CO) d Cl) CD O CD CD P. COD CD CO2 O O CCD O CCD cn E 0 �, C7 CD cn R a w � z C c = -, p m = 171 cn �, ;u O o✓ r O �• N p CS d MC Co N x p eL n p- d ;d o x 1n o CL M Gy z o E =R m C) w O O C yesao CD m 2 1-0 CD ? CD asd = y CD -40 N p p = N =r CD = O N CD CD Co O o oy.�: W_ � CD ?=,_ m: CL ,..... so o ? =r(n N dc CDCD b C/) cc n CD ,1J d N O N CL d C cn o a CA rCD 91C ...► � : :E CD H • cnr/ ^� N � "� CD cn O o m a ►--� cn a CD o d r: CD _ CL's. 0: n C*,rt . n3 'ort• O CD cn E 0 �, C7 CD cn R a w � z :n Z 2L Pi o a- G) W y 171 cn �, ;u O o✓ r -x RL 7i O a- r GO)CA � CJ x p eL n p- d ;d o x 1n o CL M Gy z cn n 10 cn -e O 0 x rb w O O 9 FORM — U — LOT RELEASE FORM TNSTRUCTTONS: This form is used to verify that all -necessary approval /permits from Boards and Departments having jurisdiction have been obtained. This. does not relieve the applicant and or landowner from compliance with any ap0 0.0plicable requirements. APPLICANT OLCL( rw, F. 4 AkA-ghAtf S'ry ITA PHONE 9,7P-- e.d'a- ,P3,,'/ ASSESSORS MAP NUMBER O 1.6' LOT NUMBER _ O 0 U I SUBDIVISION LOT NUMBER STREET th �44Le S-e?C Z'i�e-r STREET NUMBER 0'2— ,as so0r ow -me ■ r■ a Names ... ■■ .. ■■ ......assume....... r 0 0 0 0 .. ■ 0 0 0 0. r 0 0 0 0 .....imam a OFFICIAL USE ONLY Ia....aaa■■0aaa a 0 a . a 00 as 0a aa.O's a0 -■a aa0..aaa0■■ a 0 a a 0 a 0 ME a 00 a 0 a 0 a a a a 0 a a 0 a a a a■■ RECONevffiNDATIONS OF TOWN AGENTS .. ........................................ 0a0a0.►0a000am 'sa7 .0.0..00... S� DATE APPROVED 3/o/ C NSER VATION ADMINISTRATOR \ COMMENTS w c tW DATE REJECTED DATE APPROVED TOWN PLANNER DATE REJECTED CONO ENTS DATE APPROVED FOOD INSPECTOR -'HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR proposal Page No. STEPHEN M. KEISLING Building & Remodeling 68 Glencrest Drive NORTH ANDOVER, MASSACHUSETTS 01845 MA Lic. 027489 Home Impv. 101846 Phone 682-2072 of Pages PROPOSAL TTEp TO PHONE DATE JJ involving extra costs will be executed only upon written orders, and will become an extra r%Gy STREET JOB NAME or o / �] I /00 '7 /!�f ¢� �l� ) L�l/f� (� e " CITY, STATE and ZIP CODE JOB LOCATION /??C) 9-ne— ARCHITECT DATE OF PLANS JOB PHONE P proPOSP 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 Signature �_ involving extra costs will be executed only upon written orders, and will become an extra 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 Acceptance of Proposal —The above prices, specifications and conditions are satisfactory and are h reby accepted. You are authorized Signature to do the work as specified. Pad ent will e made as outlined above. Date of Acceptance: ��+ L Signature days. ✓/re �.o�rNrton[[reall/r O��-'r�aurc�ir[sella HONE INPROVENENT CONTRACTOR Registration: 101846 Expiration: 6/29/02 Type: Individupl + STEPHEN M. KEISLING • Stephen Keisling 7!� tal 68 Glenncrest Or. AOM R. N. Andover NA 01845 . p �� ...' ✓/ze �amr�no�wre� o�✓�iaaaac%uaelt LL M ' BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 027489 Birthdate:r.07/16/1953 , ! Expires: 07/16/2001 Tr. no: 11352 •�� Restricted To: 00 I j STEPHEN M KEISLING, _ 68 GLENCREST DR L•i.-. r �%�i! N ANDOVER, MA 01845 Administrator ' (j .. .. ... _... .. ............� .i . .. rw..wfn nri•�;, i'nMfY:.U,... neer•MTnn..,�,,,ny�µ.Gi.r...�._ Farm DL•;CLARATIONS CONTRACTORS ADVANTAGE SPECIAL Family Casualty Insurance Company POLICY NO. 2005XO431 ® Glenmoni, New't'ork NAME OF INSURED AND I1AILING ADDRESS: AGENT NO. 2591 OFFICE NO. 2591 STEPHEN KEISLING JAMES W UGONE 68 GLENCREST DR FARM FAMILY INSURANCE N ANDOVER MA 01845-.315 10 S MAIN ST STE 208 TOPSFIELD MA 01983-1832 978-887-8304 RENEWAL TRANSACTION EFFECTIVE 03/21/01 POLICY PERIOD FROM 03/21/OL TO 03/21/02 12:01 A.M., STANDAaD TIiiE AT THE LOCATION OF THE DESC-:IBED PREMISES THE NAMED INSURED IS: INIIVIDUAL , BUSINESS OF THE NAMED INSUED: CARPENTRY-NOC ',OCATION OF DESCRIBED ; (3 GLENCREST DRIVE PREMISES NO. 01: N ANDOVER MA 01845 PREMISES 0 BLDG 01 BUILiING MATERIALS / EQUIPMENT STORA3E BUSINESS PROPERTY COVERAGE BUILDING BUSINESS PERSONAL PI.OPERI' 3USINESS INCOME AND EXTRA EXPENSE LIMITS OF INSURANCE 0 5,000 PAGE 1 PI.OTECTION CLASS IS: 04 CONSTRUCTION IS: FRAME TERM ADDL/h.TN PREMIUMS PREMIUMS 0 0 46 46 ACTUAL LOSS SUSTAINED N�f EXCEEDING 12 MONTHS INCLUDED INCLUDED TUSINESS LIABILITY COVERAGE: BUSINESS LIABILITY - PREMIUM IS SUBJECT TO AUDIT BODILY INJURY/PRO:'ERTY DAMAGE 500,000 PER OCCURRENCE 1,000,000 AGGREGATE 500,000 AGGREGATE FOR PRODUCTS - COMPLITED OPERATIONS HAZARD MEDICAL EXPENSE 5,000 PER PERSON FIRE LEGAL LIABIL':TY 50,000 PER 6CCURRENCE CODE DESCRIPT';.ON PAYROLL TERM PREM ADDL/RTN 91342AA CARPENTR"-NOC 20,000 379 379 THE LIMIT OF INSURAIICE FOR THIS BUILDING SHALL BE AUTOMATICALLY INCREASED BY 5 ON AN ANNUAL BASIS DURING THE POLICY PERIOD. ACTUAL CASH VALUE (..CV) - BUILDING OPTION DOES NOT APPLY. DEDUCTIBLE: $250 DE)jUCTIBLE APPLIES EXCEPT WHERE NOTED IN THE POLICY OR ENDORSEMENTS. COUNTERSIGNED BY: BF 30 05 01 013 INSURED COPY PROCESSED DATE: 02/13/01