Loading...
HomeMy WebLinkAboutBuilding Permit #453 - 100 Forest Street 1/11/2008 VAO BUILDING PERMIT o� ,Oto q TOWN OF NORTH ANDOVER Jo. b �"..6 � 3 ° � APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received p�RilTtD/'Pay.�J �SSACHUs�t Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION /Cc - .ST ee Print PROPERTY OWNER Z!�I ,J + /j1`I~A k)l Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village' yes no 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 4ernotom. + eele14(-em QTc .(�,y N,�6� �vQ7S 4- cyd.lTP Identification Please Typor Print Clearly) OWNER: Name: + /JA,uc� ' �Eld'cp Z', Phone: Address:_ //o CONTRACTOR Name: She pl4e&3 Kt tse ivC Phone: 97P 31 Y-c'Vs 7 �a Address: 6P ct&4?" '`b4 is e 3d A Ald V e N .— Supervisor's Construction License:: 62 '7 YP 9 Exp. Date: 7- /6-0 9 Home Improvement License: �O ' V6 Exp. Date: 6 ' a y'" O ARCHITECT/ENGINEER Phone: Address: Reg. No. i FEE SCHEDULE;BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ CPCP of . FEE: Check No.: Y03 Receipt No.:;2 v�� NOTE: Persons contracting with unregistered contractors do not have access to tile guaranty fund ignature of Agent/Owner Signature of contractor ��� Location //0 1--PAG47—`s7— No. / S Date MORTM TOWN OF NORTH ANDOVER + .. o F � A Certificate of Occupancy $ Building/Frame Permit Fee � — Foundation Permit Fee $ Other Permit Fee 11 TOTAL $ Check # ©3 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 I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED i CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS �s Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning,Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS 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 2007 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 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ 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) ❑ 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 ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of BuildingPlans One To Be Returned to Include Sprinkler Plan And ( ) P Hydraulic Calculations (If Applicable) ❑ 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 I Revised 2.2007 otr/can was 104"rt now/can 111" rt new window center 48"rt - ---- - -102z" 12': —21" 30"— —24" ,' 48"— .P 24" 4.. I36" 27"v ! J - - - 102 12 21"— --30' 9,.E_2y.. 36 9� .44" 4 .. I PGa � switches I ;44 "w mdgw wrt h s � 123 WSR2130LI W3012 W2430 I �r � DW302424R IT 41t BTC12 B21SSLD9 24 DISHW SI <' �A I I '.m • N - roi c C Co -nA - m N I -d .� 6P �N u+ I I BTC R U308424SS j 46618 618 L 'C12RL II WTC1230LR i -. .. c6 . — 4 J II IJ W3630 EC123QL jf �— 31" 231 77 1 >6 t "— { I /4" --101" ----- —: 12" 8"/�—24" --- 18"—f—18"—' 12"-,,---404" 4„ L f4 36" 12"-.'- 40i'----.'' `-- -- -119"— All dimensions_size designations given are2020 ....::�x�. This is an original design and must not be Designed: 6/20/2007 subject to verification on job site and TECHNOLOGIES a released or copied unless applicable fee has Printed: 6/20/2007 adjustment to fit job conditions. been paid or job order placed. FISHER PAYKLE I All Drawin¢ 0. 1 NORTH T0VM of No. �3 o .over, Mass., ' ......illie COCHICHE WICK ADRATED Ile `S BOARD OF HEALTH i PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..374 .�....K.......�� �.�....��...�.�......... .... ............................................................. ..................... Foundation ' has permission to erect.. ...... buildings on - 0.....� .... TRough .. .. .. .... 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 VOW PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU �G TS 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 REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 6� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): S`/et/e, /C e/..r i✓(� Address: to P t/- r—i4/-• City/State/Zip: A)Q 44�O O/L, 0/40X 5_ Phone #: 47dl-1 31Y—A's-7 Areou an employer? Check theappropriate box: YType 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.X I am a sole proprietor or partner- listed on the attached sheet. $ E] Remodeling ship and have no employees These sub-contractors have 8. F] Demolition working for 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.El 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.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. fi 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.1 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 tinder 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: tri Date: O Phone#: 3 o YS :Z 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#: FARM FAMILY CASUALTY INSURANCE COMPANY Issuing Office - P.O. Box 656 • Albany, New York 12201-0656 CONTRACTORS ADVANTAGE BOP000916902 © DECLARATION PAGE Policy Number: 2005XO431 Agent No: 3485 Agent Phone: 978-887-8304 UGONE -JOHNSON INSURANCE AGENCY, IN 10 S MAIN ST STE 208 TOPSFIELD MA 01983-1834 Name and Mailing Address of First Named Insured: STEPHEN KEISLING 68 GLENCREST DR I N ANDOVER MA 01845-1315 i The Insured is: INDIVIDUAL Transaction Type:, RENEWAL Transaction Effective: 03/2112007 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 1 Business Income and Extra Expense Actual Loss. -Sustained Not Exceeding X12 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 BP05140103 I BP07010197 BP16040498 BF30061103 BF40380902 BF40390303 BF41090204 F199020107 Countersign6d By Page: 1 of 2 Authorized Representative Proposal Page No. of Pages STEPHEN M. KEISLING Building & Remodeling 68 Glencrest Drive NORTH ANDOVER, MASSACHUSETTS 01845 MA Lic. 027489 Home Impv. 101846 Phone 682-2072 PROPOSAL SUBMITTEDTO PHONE DATE STR JOB NAME CITY,STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: � �� .......................................................................................................................................... ..................................................................................................................... : ....................................................................... .. ......._�� ....�... � - ........ ... . ...... ..................... .. .................. ._ ,w .... ..� ........: .......... u,............ ................... ..... ...... .- a�- ...._�1 . ................ ti;sf� �fce .._u, a- , c� ......% r ............. J ...................... .............,•........... ...c oy,- ti- .... .........................'v..✓. 7, ............................. ��. �2 l. 9Q ,..................................... .�....................................... K.t� ............................ .._ +C!.........c% < ..........................................,....................,...........................,.,........................................................... ....................................................................................... ` ...,. ` Y..............................................................................................._ 1�Ik t ce y......./ .0G�1................................................................................................................... ,�-�'».. `L... ......................................................................................................................................................................................................................................................................................................................................................... .. ........................................................................................................................................... .A�� .,� ........................... ............................. ..................... ................................... ......................... ..................................... ......................... ................ ................ Hit propml 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 ,24 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. ArrPptttrirP of Proposal —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: Z Signature I Z t —