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Home My WebLink AboutBuilding Permit #744 - 105 BROOKVIEW DRIVE 6/16/2008 00RTly BUILDING PERMIT o` TOWN OF NORTH ANDOVER or 4� -» o° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 0AATl0 PpP` �SSACHUS�� Date Issued: o IMPORTANT: Applicant must complete all items on this page LOCATION AT40LC18a t PROPERTY OWNER t L Pint MAP NO:d PARCEL; ZONING DISTRICT: Historic District yes P" O Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, rep acemen Assessory Bldg Others: emo Other Septic Well Floodplain Wetlands Watershed District W. ater/Sewer eDA aGe DESCRIPTION OF WORK TO BE PREFORMED: I en icatio leas Type or Print Clearly) (�-7 /�� OWNER: Name: tc-m =c.) Phone: 7/9-6 '�g91 Address: a6 &Dbkview Dr. c(dyer- N ' CONTRACTOR Name: Phone ,b1 " 1 Address; i; Supervisor's Construction:License; J(0(109 k Exp. Oahe: , -� Home Improvement License: A 6 S-1-S Exp. Date <7—Z>4 C) ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. G .!� Total Project Cost: $ FEE: $ 3D Check No.: J' T a I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to thea u d icgnature of Agent/Owner a Signature of contractor Location g6- Zle w,e L1, No. Date ' �O�TM TOWN OF NORTH ANDOVER H A # Certificate of Occupancy $ �7s s�cMusU Eta Building/Frame Permit Fee $ qJ Foundation Permit Fee $ r- Other Permit Fee $ TOTAL $ Check # � 2 247 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 CONSERVATION Reviewed on Signature COMMENTS t'J HEALTH . ' Reviewed on Siqnature COMMENTS 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 DPW Town Engineer: Signature: 'Located 384 Osgood Street FIRE DEPARTMENT -Temp:Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 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 2008 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 Building Plans (One To Be Returned) to Include Sprinkler Plan And 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 Dor.INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 I Revised 2.2008 �p1�Tly Andover own 0 . 0 No. o dower, Mass., �. COC MIC ME WICK V S 7��oRATED P'Ppt� _ v ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System � C �� BUILDING INSPECTOR THIS CERTIFIES THAT.................................................................... .............. -4�.J... ........................ .................. • Foundation Q has permission to erect........................................ buildings on .... .:... . la .11/44.................. Rough to be occupied as.......... ....' � Chimney ,: provided that the arson accepting this ermit hall in eve respect conform to the terms of the application on file in P P P g P every P PP 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU ARTS 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. KEEN CONSTRUCTION CO. n 21 HEWITT AVENUE PROPOSAL NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978)682-3231 specifically exempt from registration by Provisions of Submitted Chapter 142A of the general laws, must be registered with !/ / To: the Commonwealth of Massachusetts. Inquiries about � .._[. _l L/'..L E . Li r?c/ �_ z s 1_`.... c .> _. Lr��1 registration and status should be made t he Director, V Home Improvement Contract Registration,One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. / Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE �DATE REGISTRATION NO. 164 I.D.NO. i �% r -�r - < - ` >/ %�� c '�s MA. H.I.C. 108383 35805.2 C/S.= Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: I ....- _.._.._ — _ __... ...... --------- J, --- 1 c tJ r- ( f ry r C` .... -._......_.. .._..._.. _.. _......_. . } // r 1Z j _ .. r . I _... Construction related permits: i i I 6/16/2008 11:13 AM FROM: Gilbert Insurance Ag Gilbert Insurance Ag T0: +1 (978) 682-3231 PAGE: 002 OF 003 ACORN CERTIFICATE OF LIABILITY INSURANCE 06TE(MMODMTY) /16/2008 PRODUCER (781)942-2225 - FAX (781)942-2226 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Gilbert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 137 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Reading, MA 01867-3922 INSURERS AFFORDING COVERAGE NAIC# INSURED Kenneth B. Keen & Robert Keen INS3URERA: NORFOLK & DEDHAM INSURANCE 23965 DBA: Keen Construction Company INSURER8: Granite State (A I G) 21 Hewitt Ave. INSURER C: North Andover, MA 01845 INSURER 0: INSURER E: GE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATIONim IN= DATE(MMIDDtM DATE(MWDD1YY1 LIMITS GENERAL LIABILITY ND-P-010078/000 03/13/2008 03/13/2009 EACH OCCURRENCE $ 1,000.00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,00 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,00 A PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY JE�7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE _ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X WC STATU- OTH- Y I I EMP LOYERS'LIABIUTY rR- B ANY PROPRIETOR/PARTNER/EXECUTIVE WC6380698 08/03/2007 08/03/2008 E.L.EACH ACCIDENT $ 10000 OFFICERJMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500 00 OTHER i I DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS riginal Workers Compensation coverage certificate to be forthcoming from Granite State Insurance. Evidence of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSIANG INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Laura and Chris Bowe BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 12 FOSS Road OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. N. Andover, MA 01845 [AUTHORIZED REPRESENTATIVE uzanne L. Cedor ACORD 25(2001108) OACORD CORPORATION 1988 i I I ' �fe {�on�mwyuuna�G�i o�✓l�l.�a�yucc�uca�Cta �-\ Board of Building Regulations and Standards F e� HOME IMPROVEMENT CONTRACTOR (. Registration: 108383 t; Expiration: 8/18/2008 r, Type: DBA pp' t: KEEN CONSTRUCTION CO:. k, Kenneth Keen 21 Hewitt Aver No.Andover, MA 01845 Deputy Administrator i ✓fie -rian?mwn.�rea� oP.,/�aaac/zuaella j Board of Budding Regulations and Standards I 1 Construction Supervisor License License: CS 58245 i Expiration_3/24/2010 Tr# 17840 I 07Restnction 00f�.4 KENNETH B KEEN----` C- 21 HEWITTAVE N ANDOVER,MA 01845 Commissioner �(_ � 1, '✓fie i�an�nonurecr,LC� o�'✓�',aavrzcluae�/a � i Board of Building Regulations and'Standards j Construction Supervisor License - Lic nse CS 76691 E �Birthidate~ 8/16/1968 Expiration 8/1,6/2009 Tr# 3869 r(Restriction ,AQ ROBERT A KEEN 12 E WATER ST `� w �'�_ ixr N ANDOVER,-.MA 01845 Commissioner J The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations 600 Washington Street Boston, MA 02111 5 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /7 Please Print Legibly Name (Business/Organization/Individual): KEEN) C. N /I CSCr n N� Address: Z � City/State/Zip:�)p a A tJ Cyd U t N MA Phone.#: 2 :?,? - 691 ' 'S Z O 1 Are you an employer?Check the appropriate box: T e of ro ect(required ' 4. I am a general contractor and I yp p J ( q y.., 1.® I am a employer with_Z� ❑ g 6. .❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp.insurance comp. insurance. g required.] 5. ❑ We are a corporation and its 10..❑ Electrical repairs or additions 3.F-1 officers have exercised their I am a homeowner doing all work 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no 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 Homcmvners who submit this of daNrit 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. // Insurance Company Name:_ a A r;t I c S'�- T E mi ti s, Policy#or Self-ins. Lic. Expiration Date: d Job Site Address: O5j Ccokye. City/State/Zip:_.h �6&ktec . 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. I do hereby cern u er thein a penalties of perjury that the information provided above is true and correct. Si atuie: Date: r _ Phone 1#: 279,- 6 c// -LSZ O 1 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 Contact.Person: Phone#: _XXI CDa nv»aoau�ieczlllo o � rav uzcfucde�la Board of Building Regulations and Standards e� HOME IMPROVEMENT CONTRACTOR Registration: 108383 Expiration .8/18/2008 ,Type DBA KEEN CONSTRUCTION CO. Kenneth Keen I 21 Hewitt Ave -� I. -'No.Andover, MA 01845 Deputy Administrator i Tfie CJanUmoo��redLCl ✓ aaaacslivaela :1 Board of Building Regulati sand Standards Construction Supervisor License License: CS 58245 Ex-p ttoq X24/2010 Tr# 17840 1� �,=�Restrtctron fl0'� KENNETH B KEEN 21 HEWITT AVE �,� N ANDOVER,MA-01845=x'"" Commissioner `✓lie TBonvrrcaotr�rnaC�t o�✓�,aoa�.�,uael�s . Board of Building Regulations and Standards d Construction Supervisor License a i. Licens"e: CS 76691 } jffirtbbate 8/16/1968 M 4rExplration 8/1-6/2009 Tr# 3859 t 5° r Restriction -D0 t ` ROBERT KEEN\ • 12 E WATER ST . , N ANDOVER,MA 01845 Commissioner ii