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HomeMy WebLinkAboutMiscellaneous - 182 MIDDLESEX STREET 4/30/2018 (2)N° G U Date. -../7.. G / TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. �.. �! ... ,� . �� :: .......).? .. /-/— . . has permission to perform ....?.... / C L `: �.`. `..! plumbing in the buildings of .. J .;.i ..... f .. . ................ . at .. /k.? .� .......... , North Andover, Mass. Fee. , G.. Lic. No... '.. ......... ...... PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer N Building MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING New M Renovation M of i Replacement �� Plans Submitted Yes T FIXTURES Date/0©/- Permit # Amount No ID (Print type) r � �` ` Check one:Certificate Installing �'` � g Company Name V f�� 7 ❑ Corp. Address _,,�� 6 by U /L Partner. Business laFiim/Co. Name of.Licensed Plumber. I D 6 0 5 )ell' -I,- Insurance I, -Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy � Other type of indemnity r_1 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 Q 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 inFtio;performed der Permit issued for this application will be in compliance with all pertinent provisions of the Mass u P umbingt�ode and Chapt 42 of General Laws. JJJJJJ������ o City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License a&�- License um er Master Ell" Joumeyman Nj 4, 7 7 <".�•� :'� TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that ........................................... has permission to perform ............ ....... ..l .............. plumbing in the buildings of ........... ................. . at .................................... e , North Andover, Mass. Fee., ! =...:.. Lic. No..... ... ....... '- .............. . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location e iers Name 01 G /-- c UMBING , Date L G Permit #fit Amount Type of Occupancy Replacement �� Plans Submitted Yes ❑ No New 13 Renovation (Print or type) ,1� Check one: Certificate Installing Company Name �.l _( � "� (� / '� 11 Corp. S U `�'' %t r- U f2 f� r1 Partner. Address —lam) . /� �/�i d ✓-L •2 _ —1-L- -1 , v Business Telephone (G X (q p 9-1-0 7 Firm/Co. Name ofLicensed Plumber 1 J� U✓ ��9� �'r `-� 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 ignature Owner F� Agent F 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 installations pert ed under Permit Issued f(F this application will be in compliance with all pertinent provisions of the Massachus to P mbin ode,�d Chapter of the eral Laws. Title City/Town APPROVED (OFFICE USE ONLY T e ofPlumbing License 6 icense Numoer Master Journeyman ❑ • (Print or type) ,1� Check one: Certificate Installing Company Name �.l _( � "� (� / '� 11 Corp. S U `�'' %t r- U f2 f� r1 Partner. Address —lam) . /� �/�i d ✓-L •2 _ —1-L- -1 , v Business Telephone (G X (q p 9-1-0 7 Firm/Co. Name ofLicensed Plumber 1 J� U✓ ��9� �'r `-� 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 ignature Owner F� Agent F 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 installations pert ed under Permit Issued f(F this application will be in compliance with all pertinent provisions of the Massachus to P mbin ode,�d Chapter of the eral Laws. Title City/Town APPROVED (OFFICE USE ONLY T e ofPlumbing License 6 icense Numoer Master Journeyman ❑ Location No. Date NORTH TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ �— y sJACXUs Building/Frame Permit Fee $ i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ l Check # i �f 1! / 0 Building Inspector r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: c6o�� Building Commissionerff for, of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 0 / 5J Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided RcTured Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record R/ c 114,e d G e S.� , % AP2 4ff /zi aid �c rem s'T Name (Print) Address for Service Sig( Telephone 72.2 OwnKr of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Vnstruction Supervisor: sT ��P� ,C�e.sL.,✓ G Licensed ConstVtction Supervisor: Address z" 2O7 '§iinatA Aelephone Not Applicable ❑ Q Z 2 S/p9 License Number Expiration Date 3.2 Registered Home Improvement Contractor S�hs c �s �,6o vG Not Applicable ❑ /0/F y/i Company Name Registration Number a Address Expiration Date Signature Telephone ils 0 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) X Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ,Qe1>,,, J eL�i¢T/ 1.vsT LL I�/�/-li/z ew'V14 40"A"dlay '&r ky %i Le nLus ci�.�.voe .L,T/��.� Cov.J%ie. Tyr SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pern-dt applicant OFFICL. USE E?NLY 1. Building %UO. (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) L� 4 Mechanical HVAC 5 Fire Protection I 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, 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 ��� �P i J ���J aster/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 S'% e 9/,�P.J ,fie s L •� Print a, Si attire ofer/Agent Date MEW - NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 SPAN DINIENSIONS OF SILLS D[NIENSIONS 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 Farm DECLARATIONS PAGE 1 Jf4CONTRACTORS ADVANTAGE SPECIAL rFamily Casualty Insurance Company POLICY NO. 2005XO431 ® Glenmont, New York NAME OF INSURED AND MAILING ADDRESS: AGENT NO. 2591 OFFICE NO. 2591 STEPHEN KEISLING JAMES W UGONE 68 GLENCREST 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 03/21/00 POLICY PERIOD FROM.03/21/00 TO 03/21/01 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 PREMISES NO. 01: N ANDOVER MA 01845 PREMISES 01 BLDG 01 BUILDING MATERIALS / EQUIPMENT STORAGE BUSINESS PROPERTY COVERAGE: BUILDING BUSINESS PERSONAL PROPERTY BUSINESS INCOME AND EXTRA EXPENSE LIMITS OF INSURANCE 0 5,000 PROTECTION CLASS IS: 04 CONSTRUCTION IS: FRAME TERM ADDL/RTN PREMIUMS PREMIUMS 0 0 74 74 ACTUAL LOSS SUSTAINED NOT 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 91342AA CARPENTRY-NOC PAYROLL TERM PREM ADDL/RTN 15,600 276 276 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: $250 DEDUCTIBLE APPLIES EXCEPT WHERE NOTED IN THE POLICY OR ENDORSEMENTS. COUNTERSIGNED BY: BF 30 05 01 98 INS.:°ED CCPV PROCESSED DATE: 02/14/00 + tie Toamxnxa�acuea�bi a�✓�/iavaacfivael�.6 '. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR s Number CS027489 Birthdate 07Ft6l1953 6g-'07/ -kob1 Tr. no: 11352 — -M Restricted To: 00 STEPHEN M KEISLING _ 68 GLENCREST DR N ANDOVER, MA 01845 Administrator °T HONE INPROVENENT CONTRACTOR EVE Registration: 101846 ' Expiration: 6/29/02 Type: Individual STEPHEN N. KEISLING Stephen Keisling tall 68 Glenncrest Or. �\ ADMINISTRATOR N. Andover NA 01845 I Proposal STEPHEN M. KEISLING Building & Remodeling 68 Glencrest Drive NORTH ANDOVER, MASSACHUSETTS 01845 MA Lic. 027489 Home.lmpv. 101846 Phone 682-2072 PHONE STREET JOB NAME /fie/ '?'y'i j te,� CITY, STATE and ZIP CODE JOB LOCATION ARCHITECT We hereby submit specifications and estimates for: DATE OF PLANS �sra..z.�" a►mq. cc.a�� a-�Y.�e�v Page No. of Pages DATE 17ay -�2,q vU JOB PHONE .................................................................................................................................................................................................................................................................. Cie . A'04 -r :. off.&. �..... .........._........:............_�-.�... _�-, - - ...� . .... .............. ?zrf .fir-�o. "° ............................... .............................�.1................................................................................. ............................. ......................................... ............................................... .............................................. ........................................ ...................................................... ................. ` / zje ale, PTOpi00P hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: Payment to be made as follows: dollars ($ ). 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 ArreptauCr of proposal1— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Pay l�ient will be ma a as outlined above. Date of Acceptance: C' � \\� C, -1K C-1 C9 Signature vo/l days. Cl) 7) m Cl) U m CZ o to CD CD H 'L7 co 0 7 O CA -p 0 c 0 C CA C7 CD 0 co NJ' CD CO) O co 0 G CD dC41 cr CA C :5.0 'o H ��mo m C7 C H n a� m Z =-c y =r m =r y W O m N 'a: O m mCA n n C C- - O , c � N R r� a to 3 - <� .i► a '� V I 1 N o m _ ca1 m CD W N cn Na � y :EZ c c �o t dCD z `�? � � o mo C. o m .ED :♦ CD o ?: d „d: CL a h �o Y b: c O '• CD o LW d o w M� °� 0 °� x 0 oda Crf r7l m Co z 0 OQ .� r rAtz -x °= n D 0 wG �n 0 o � m a! 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