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Home My WebLink AboutBuilding Permit #380-14 - 110 RUSSETT LANE 10/23/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: r113 IMP ANT:Applicant must complete all items on thisage / 1 _ LOCATION I I R-0 5 52 !_ Lr - � Print. PROPERTY OWNER Ac H Print 100 Year Old Structure yesno MAP NO:LQ ARCEL: ZONING DISTRICT: Historic District ye nc 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 0 Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer r2 �� DESCRIPTION OF WORK TO BE PERFORMED: k r-aody\,5- , re-P1c,ce ' ^dQV./5 � 1 i I I Identification Pleas9116AC ype or Print Clearly) ,I, .Sesta ? OWNER: Name: k 1rr-ck P4vi� rn Phone: 97� —?9y" 7989- Address: �0 (�o-Y, Nor+ tla►dever' MA o i 2v5 CONTRACTOR Name: een (-LY15+7UC+1et1 CC Phone: 97Z-L91'5'2-01 Address: 117 5 -T-q rri pi- Ve Aq o 1 Z 5 Supervisor's Construction License: GJ - 0-7 (c9 I Exp. Date:_ 2/16 //5 5 Home Improvement License: 1 () 3 3 Exp. Date: z 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. � I Total Project Cost: $ (o y 11595100 FEE: $ Check No.: Receipt No.: o NOTE: Persons contract* with unregistered contractors do not have access 1b e u *!anty fund _gnature,of Agent/Owner SigilaLunt of contractor f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted'[] Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ .-TYPE_OF=SEW-ERAGEDISPOSAL - 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.APPR-OVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS -CONSERVATION Reviewed on Signature COMMENTS s HEALTH _ Reviewed on Signature COMMENTS I i 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'�'o��_ Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMf_NT Ten-ip Dumpster on site yes no Located-at 124 Mair Street -Fire Department signature/date COMMENTS L 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 I El Notified for pickup - Date Doc.Building Permit Revised 2010 J Building Department The fol(owing i6-a list of the required forms to be filled out for the appropriatepermit to.be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application Li Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) Li 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 o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cascs if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building permit Revised 2012 i Location 1�0yls�-tel 1 I No. f Date • - TOWN OF NPRTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 64,595.00 m $ - $ 775.14 Plumbing Fee $ 96.89 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 96.89 Total fees collected $ 1,068.93 110 Russett Lane 380-14 on 10/23/2013 Reno Kitchen, 2 Baths, 24 windows replaced NORTH own of E ndover. O - 0 No. 3b— ' y ,� o h , ver, Mass, �� COCHIC MIWICN y1. �ds RATED pP��,��j 1 V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ............. �!(.......6'."4........ BUILDING INSPECTOR .0..................................... has permission to erect buildings on ........ � ..� . .��............... Foundation f<.41�. ^ Rough to be occupied as ... ... a. ..` ... r. ..".1!!1 �...)...p�l..9.+4 f&$40�Q Chimney provided that the person accepting this permit shall in every respect conform to the ter'Fns of the application Final on file in 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCT T Rough Service ............... ..... .......... ........................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE ,7 �'V A71 'ITT-, 0 184 5 I C.-O-COITL North Birch Properties, LLC Paul & Unda Swartz PO Box 881. N. Andover, MA(:184!) 978-794-7988 Contract ft 5282;Appendix A October 21, 201.3 Remodel 110 Russet Ln.. Remodel kitchen Rem.aclef two bathroonels Supply&install 24 windows Supply& install interior doors Supply& install new base trim increase size of garage door openings 4 Rer-flove partition walls in basement Repair rotted exte'rior tF."irn Supply durnp.ster All labor andmaterf-ats vvi'll be billed on a weekly basis, Projectedcost(including C t A. Keen u 'artier - 0 Robe, ft-111 f��e5 Date Date Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuperAisor . License: CS-076691 ROBERT A KEEN-` 12 E WATER ST= U11 ,North Andover NFA Oi Expiration Commissioner 08/16/2015 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction SuperN is(',- License: surLicense: CS-058245 KENNETH B IGEN 21 HE TT �1 N ANDOVER MA401845' Expiration Commissioner 03/24/2014 C�1e-� � � 4aac�uael,�a, ;.. ie�parnirno�ruuec� r I Office of Consumer Affairs&Busi ess.Regulatiom 1 OME IMPROVEMENT CONTRACTOR egistration:• 108383 Type: xpiration 8/18/2014, DBA KEEN CONSTRUCTION C0! Kenneth Keen 21 Hewitt Ave g , Q�— a No.Andover, MA 01845 Undersecretary 09/27/2013 U9:00 FAX 781 942 2226 GILBERT io001 0 DATE(MWDDIYYYY) A�a CERTIFICATE OF LIABILITY INSURANCE j 4/18/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE,OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsernent(a). PRODUCER NAME CT Barbara McDonough I Gilbert Insurance Agency, Inc. IAf PHONE (781)942-2225 F I,(791)942-2226 C-No E361, 137 Main Street ADDRESS:bmedionough0gilbertinsurance-com! INSURERS AFFORDING COVERAGE I NAIC 4 Reading MA 01867-3922 INSURERA'JTORVOLK & DEDHAM INSURANCE 23965 INSURED INSURERE:TraveleL9 Xna. Co. 0031 Keen Construction Company INSURERC: 21 Hewitt Avenue INSURER 0: INSU RER E: North Andover MA 01945 1 INSURER F. COVERAGES CERTIFICATE NUMBER:CL1341800232 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDLSUBK POLICY UMBER MM/DDY EFF POLICY EXP LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 -DAMAGE TO RENTED X COMMERCIAL.GENERAL LIABILITY PREMI E�I�o(,cuttnncel S 100,000 A CLMMS•MADE rx-1 OCCUR -P-010070/000 /13/2013 /13/2014 MED EXP(Any ono arson) S 5,()00 PERSONAL hADV INJURY S 1,000,-000 OEdERAL AGGREGATE 1 S 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO 5 2,000,000 X POLICY PRO.. LOC ( S AUTOMOBILELIABILITYCOMBINED BINDLE LIMIT ccklent ANY AUTO BODILY INJURY(P&oemon)j S ALL OWNED SCHEDULED BODILY INJURY(Par amidenq S AUTOS AUTOS NON-OWNED PRaOP��e DAMAGE s HIRED AUTOS AUTOS - I 3 -UMBRELLA UAaOCCUR EACH OCCURRENCE S EXCESS L1A8 HCLARAS4AADE AGGREGATE I S DED I i RETENTION I E $ WORKERS COMPENSATION VNC STATU- OTy- AND EMPLOYERS'LIABILITY YIN PROPRIETORJPARTNERNXECUTIVE YEN C.L.EACH ACCIDENT i $ 100,000 OFFICERIMEMBER EXCLUDE07 MIA GLUM-SB0726-A-13 /3/2013 /3/2014 (MonaatoryU NH) E.L.DISEASE-EA EMPLOYE 3 100 000 li yes describeun06r DESCRIPTION OF OPERATIONS Delon E.L-DISEASE-POLICY LIMB 3 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS!-VEHICLES)A(tach ACORD 101,Adalloml Remarks Schaduls,if mon space Is ruqul►e1) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEICANCELLEO BEFORE THE EXPIRATION GATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Coverage ACCORDANCF WITH THE POLICY PROVISIONS.. AUTHORIZED REPRESENTATNE M Gilbart, CIC/BARSAR i ACORD 25(2010105) (D1988-2010 ACORD CORPORATION! A11 rights reserved. INS025(2alOON-01 The ACORD name and logo are registered marks of ACORD The Commonwealth q fMassachusetts -Department of fndustria[Accidents Office of.Investigatdong 600 ffiashington,S'tyeet Boston,AM 02.111 Y 7i�1p AIMISS,gOv/dIa Workers' Compensation XusurAnce Affidavit:BuildersiCmntractors/.,!Iectrxcians/plumbers A Iicanf xintfoxxnation ) l&asePrintLe 'bI Name(Business/Organization/kclividual): we e r, Address: rfj �i ✓� D ► �n `J f .Coity/State%Zip: IV d I�C�G (°(� l,� 0 i g�1 ' Phone Are you an employerY Check the appropriate box: 1.W I am a employerwith 4. TTYpe of Project(required): �_ ❑I am a general contractor and I 2.❑ employees(full and/orpart-time).' have hired the sub-contragtors 6, ❑New construction I am a sole proprietor or partner listed on the attached sheet.1 7. ❑Remodeling ship and haveno employees These sub-contractors k$ve wort ng forme in any capacity. workers'comp,insurance, $ ❑llemblition [Noorkers'comp,insurance 5. El We are a corporation and its 9' ❑Building addition required.] officers have exercised their 10•❑Electrical repairs or additions 3. I am a homeowner doing all Wbrjc right of exemption per 11.[]Plumbing repairs or additions F7 [No workers' comp. c.152, §1(4),and wehaveno insurance required]i employees.[No workers' 12.[]Roofrepairs comp.insurancerequired.) 13-El Other . ' Any applicant that checks box#1 must also fill out the section below showing their workers'compensationpolicyinformation. Homeowners who submit this affidavitindigatingthey are doing all work and then hire outside contractors mus cyinfb t anew affidavit indicating such. 'tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policyin sting such. tam an employer flint is providing workers'compensation insurancefor yny employee's Below is tlzepolicy and'ob site .formation. I' J insurance Company Name: r G'kJ G(n ' 'olicy#or Self-ins.Lic.#: (p KU a _• O� 'f !3 xpirationDate: )b Site Address._ r] R 15 j - LY City/State/Zip: 1 direr. /1/I ft v ► Y4. 5 dlure to secure a copy e the workers'compensation policy declaration page(showing the policy number and expiration date). lure coverage as required under Section 25A ofM'GL c.152 can lead to the imposition of criminal penalties of a Le up to$1,500.00 and/or One-year imprisonment,as we as civil penalties in the form of a STOP WORK ORDER and o fine UP to$250.00 a day against the violator. Be advised that a copy of this statementmay be forwardedto the Office of Testigations of the DIA for insurance coverage verification. �Herebycertifyunderf epai andpenaltiesofperjuryfhatilzeinfornzationpsovidedaboveistru7afic, cbrrect. ` nature: r' �- Date- U Z 3 3 Yfrcial use ol* Do not Write in this area,to be completed,by city or town official ity or Town: PermitMeense# Ming Authority(circle one): , Board of Health 2.BuildingDeparfinent 3,Cify/To ntl,P,- WnClerk 4.Electrical Tnsneetnr q � ry a KEEN CONSTRUCTION CO. GP PROPOSAL a 21 HEWITT AVENUE 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 Chapter 142A of the general laws,must be registered with Submitted } �r �` ��.,� C the Commonwealth of Massachusetts. Inquiries about To: _ <- __..�. ........ ...t4 -- - registration and status should be made to the Director, / Home Improvement Contract Registration,One Ashburton G c r.Izi_._.......__,__.._.._...-..... Place, Room 1301, Boston, MA 02108 (617) 727-8598. p Owners who secure their own construction related permits or deal with unregistered contractors will t — be excluded from the Guaranty Fund Provision of �^ I (I�n MGL c. 142A. PHONE DATE REGISTRATION NO. EIN NO. L r f3 MA. H.I.C. 108383 26-0462904 > C/S= Customer Supplied S + I = Supply + Install ( " See Attached Appendix A We hereby submit specifications and estimates for work to be performed,and materials to be used: . . .. ., -... .. _.___--.__— _,.. .. _ _ .......... e_,-le ..._.. � ... -....._--� r� � -_. _ _... .......... ................ -------.........--------------- ----------- .......... ........... ................. ........ ............- ............. ...................... ............... ........... ........... ----------- __ .... - - --- ...................----------- _....__.................___ ._.._.-.. ______ > Construction related permits: � -""� "-------- "--�-"-�--^ .___ . .....,.__....0...LE..._...................._....................._...............,....,,...,,.......,............................,.....................................,.,,.......,...,........................,..........................................-,.................,....,...........,,......,.............,............_...................._.._.__- .._...._..,.........._._.....__.........._...__.. WORK........ SC__...._..HED _