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HomeMy WebLinkAboutBuilding Permit #854 - 115 HILLSIDE ROAD 6/30/2006 01 NORT1{ . g ..... .. n O 3 0� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION SS"CH Perin it NO: Date' Received: �S�/ Date Issued: IMPORTANT:'Applicant must complete all items on this page it .r•�'�.... ti, k'• ^ nn t 1 LOCXTION fZc,! IJP' ' �� � ick E _a, Print PROPERTY O'W'NER �f iNE -t' �L S.J O S�erza Print NIAP NO.: C PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT ' PROPOSED USE Residential Non-Residential New Building XOne family i Addition C Two or more family Industrial Alteration No. of units: kRepair, replacement r Assessory Bldg L. Commercial C Demolition Moving(relocation) r' Other i_; Others: Foundation onlv i DESCRIPTION OF WORK TO BE PREFORMED © � ,vI 4. -- Identification Please Type or Print Clearly) .OWNER: Name: - Phone: 4227 6C/a Signature Address: CONTRACTOR Name: 90 7F �11�S N Nr¢k et2. ���'c,.! Phone: 691 2O) C Address: _Z- I L%,.1 : IT �' ✓c 1� . Supervisor's Construction License: `J Z, 4AS Exp. Date: i Home Improvement License:_ zo(734--s Exp. Date: ARC I-II•IEC'T,FNGINFL;R Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDLVG PERMIT:$10.00 PER$1000.00,61FTHE TOTAL ESTIMATED COST BASED ON 5125.00 PER S.F. Total Project Cost :S g�'7 8 �-� x10.00-==FEE:S Check No.: Receipt No.: 'TYPE OF SEWARGE DISPOSAL a ; S�•imnun Pools -. TannmQJ�Massa7�e;Body Art _- Public Sewer Tobacco Sales -- Food Packaging;Sales . � Well - Permanent Dumpster on Site Private(septic tank,etc. NOTE: _ Persons contracting; with unregistered contrnc•tors do not hnve uccess to the l;uartuntl7 fitn(I Signature of kgenti0wner sS griat tre of Contractor Plans Submitted ❑ Plans Waived ❑ . ,Certified ,Plot Plait ❑' tamped Plans �.� ... : .: .p THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ , . ❑ ❑Water Shed-Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION :❑ A` " COMMENTS DATE REJECTED DATE APPROVED HEALTH. CO, MENTS ► b;. "tonin`_Board of Appeals: Variance, Petition No: 'jtoning Decision,'receipt submitted yes F Plannims. Board Decision: Continents Conservation. Decision:_ Comments , Water Sewer connection signature&date Temp- 111pster on site yes _no)6_ Fire Department sibnature.:date 13Utlding Permit ,approved and Issued by: (J; I I - I Building Setback (ft.) Front Yard Side Yard Rear Yard. Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area, based on Exterior dimensions. '1 Total land area, sq. ft.: NOTES and DATA—(For department use) I ;1 i t _ i i 'al:1:1lcls 1'C.I':.1.1,.11 "i I 11 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 o Building Permit Application a Debris Removal Form a Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract a Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application a Form U a Surveyed Plot Plan ❑ Debris Removal Fortn a . Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And .Hydraulic Calculations (If Applicable) o' Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Pen-nit Application a Form U a Certified Proposed Plot Plan ❑ 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 Hydrauli' Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report to all cases if a variance or special permit was required the Town Clerks oft-ice 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 cope and proof of recording must be submitted with the building application Doc:INSPECT ZONAL SER%ICES DEPARTMENT:1311FORM05 Location No. � Date NOR,h TOWN OF NORTH ANDOVER Of •.rc ,•,�C F 9 s Certificate of Occupancy $ ssACMustt� Building/Frame Permit Fee $ , Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # . '"' Building Inspector � 0.10RTIy � Town of S - '> R Andover C% AKE dover, Mass., •. � d(O COC.".e"'IC. s RATE D 1 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System - ........... e THIS CERTIFIES THAT,...... BUILDING INSPECTOR Foundation has permission to erect.. ........ buildings n ......... �. .. .......... StC �....... .1��........... Rough to be occupied as �&"� Chimney provided that the perso accepting this permit shall in every respect conform to he arms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final 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 UNLESS-CONSTRU TATS ELECTRICAL INSPECTOR " Rough ' .................... ... .................Alk-riviiWA1211ServiceUILD VECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. rt 1 KEEN CONSTRUCTION CO:. 1:63:5 21 HEV111TT AVENUE .yOSIM% L NORTH ANDOVER. MA 01$45 Tel: (978)691-5201 All home improvement contractors and subcontractors Fax: (978) 682-3231 engaged..in home improvement contracting, unless Specifically exempt from-registration. b'y. Provisions of Submitted Chapter 142A of the general laws,muregistered istered with To: --_.__ _lr� - �_ N ` L —�� fthe Commonwealth of 'Massachusetts. 'Inquiries about registration'.and status,'should be made to the bisector, H mty=C ome Impro`veenontract Registration,One Ashburton Place, Room 1301,'Boston;MA,I)21U8 (617) 727=8598. �y Owners ..who secure their own>:construction related -. .•. .__ . ...... /!.. ,_ .._„ �;? /h�l Permits or deal with un[eg.isteretl<contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO d -- �,: EG 0 v MA H I C 108383 �, 7F�IDO. 325-8052 C/S =Customer Supplied,S+ I =Supply + Install We hereby submit specifications and estimates for work to be performed and materials to b&used. (� Q:/�l.. r , s �- �- 1 ` f .......L�� Q� � ... 74 _....... ............_... ,.,......,.... ...._. ...._ ...:._... 1 4 t � ......_. ._ w - --— _._ - c vs } , ---- � Construction related permits: ....,.. .. ,. ► _.. ::_................................... ........ ....... WORK SCHEDULE ................................................................................................................................ ............... Contractor will nyt begin the work or order the materials before the third:day following the-sighing of this Agreement,unless specified herg.tn writing. Co tr ctor will begin the work on or about -�j�(date). Barring delay caused by circumstances beyond Contractor's.control,the work will completed b /��, P Y ` (date). The Owner hereby acknowledges and agrees that scheduling dates are approximate and:that suchdelays.that.are not avoidable.by the Contractor shall not be considered as violations of this Agreement. WARRANTY ° The Contractor warrants that the work furnished hereunder,shall be free from defects inmatenals;and workmanship for a period of Z followingorsmployee tion and encs,ishall comply with the requirements of this Agreement: In the event.any defect in workmanship or materials,or damage causedbythe Contractor,; is subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense;forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. i We Propose hereby to furnish material and.labor-complete in accordance with above specifications,for the sum of: IBJ . ,z < XI �yS rc� dollars / .?%C Payment to be made as follow ), upon-sighingContract;O 00- /(-3c, KENNETH B. KEEN Name of Contractor/Designated Registrant ($ ).. upon completion of 21 HEWLTT AVE..,x Address - % ($ ) upon completion of N. ANDOVER,-MA 01845 City/State -- % ($ -shall be made forthwith upon (978).,691-5201 (978)-682-3231 completion of work under this contract. Phone-. Fax Notice: No agreement for home`improvement contracting'work shall-require a down payment(advance deposit)of more than one-third of the total contract:price Name of saa esma e or the total amount of all deposits or payments which the contractor must make,in rr�r advance, to Order and/or otherwise obtain delivery,of special order materials and. Authorize n ure equipment,whichever amount is greater. Note: P�i s proposal may be withdrawn by us if not accepted within days. Acceptance 0f Proposal I have-read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this,proposal 6ec'omes a binding contract. You are authorized to do the work as-specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. DO NOT SIGN THIS:CONTRACT IF THERE ARE ANY BLANK SPACES. I � / Signatures Signature Date IMPORTANT INFORMATION ON BACK . ,. k .�.:.r ;. .,._m.x u.: fkil!`e�k .tel+c:.�rn!.V'T.S!°W+,..•. _ ._rr 4. .. µr ��+ I 1 - T--- _----------- ex- Board ._,.,.�1Board of Building Regulations and Standards — HOME IMPROVEMENT CONTRACTOR Registration; 108383 Expiratwn &118/2008 ' Type DSA KEEN-CONSTRUCTION CO Kenneth Keen 21 Hewitt Ave Q oma_ No.Andover, MA 01845' s' Deputy Administrator j o.xE.. pp �` ✓�ie vimniirwrzus O ac�iuGe�t6.: BbARD OF BUILDIN'REGULATIONS ? icense: GONSl RUCTION:SUPERVISOR ! " . � Number SCS 058245 Birthdate 03/24/1943 Expires 03/24/2008 Tr.m 1-3P Restricte'd 00---� KENNETH>VjKEEN 3 .� 21hHEWITTAVE "rr j I N ANDOV`FER� IIA .0145 y' ° - Commissloner 'i The Commonwealth of Massachusetts I (V Department o Industrial Accidents Office of Investigations ;k 600 Washington Street, 7'l'Floor t G; 4a, Boston,Mass. 02111 Workers' Compensation Insurance Affidavit Building/Plumbing/Electrical Contractors Applicant in'f/oi rsiation': Plea se!Py , name: address: Z., L 14 e w ; city un(Ll N de f)Ix state: 1 iV zip7O/2YJ phone#9e 3'L----,:7SZ.O( work site location(frill address): ❑ 1 am a homeowner performing all work myself. Project Type: ❑New Constniction[]Remodel �1 mn a sole proprietor and have no one working in any capacity. E]Building Addition ❑ I am an employer providing workers' compensation for my employees working on this fob. company name: address ci phone#• insurance co. ohc # '. .. �':: �-!}...r: lu..s'k..yi�'``'r..r��, r4-_....: �. .wri�ti:.,;: � .4�� i �I.���.qx!�( LL^':,;,� �:r�.sfr,x;... i ✓t-ti .-'� .:�`;� § 'll.l, ' � .t�t,i' ❑ l,atn a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation polices: company name: address: city' phone#• insurance co: ohc # ..:.itis7 79-77-7 company name:,- address: city. phone M insurance co 10111 1-v# Attach ad:dthonal:sfteet ttnecessary y t r i Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and afine of$100:00 q day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cerci r the pains a d r 'es ofpeijmy that the information proviiled above is true and correct. Signature Date 6) — 2 / Q (� Print name ! Z N I5 Phone# ?� �7 r ,.:'T '�. c,.e_,�.k�ir 5.;'£;.t'+A3.e.r..?i=wX.Yse':' h fa,?:t..i7in,.�2wi t:y✓ :v T' "'1. official use only do not write in this area to be completed by city or town official x city or town: V permit/license# ❑Building Department Elcheck if immediate response is required ❑Licensing Board a! ❑Selectmen's Office s, contact person: h ❑Health Department one li; ,,.v: (revised Sep.2001) p ❑Other tr4e.r .� ., -.... � •:..�.._. .,n:t',i.;�rl �G�.^es:,::,riS�„��5;<i:n:ic` Tt