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HomeMy WebLinkAboutBuilding Permit #649-14 - 19 HOLLY RIDGE ROAD 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: "'/ Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOGATIONI�_: "PROPERTY OWNER_r - - P —� 100 Y Old S y rent ear tru x es n $ `MAP NQ _ PARCEL �_ ZONIN.G �;ISTRI:CT �� Histor c District _ n- — — ` - er yes �Machne Shop Villag i._ o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial PRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well µ ❑'Floodplain �Wetlands ® V1latershed'®istnct ❑\Nater/Sewer (� ' T"o CRIPTION WORK TO BE PERFORMED: Je, �0 r` kTh rz)o 0/\ Identificatio Please Type o rant Clearly) OWNER: Name: �+ -b �� e�!'Po P hone:979 F Address: ,C T- -NameAeP,�%I L1�1�5T1 t>GTi�,vt 6.O Phone? -1 �t - — N. _ I ' x Add-cess: / (` �(/ }ijr J/� -/- [ Its.\/L i/�.O ) - .. 1. hk = �_Supervisor's Construction.License C 7 w� �' Exp Date. Home Impro�yement L icense /_d . 3 .3 c _ . _ z v . ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2, FEE: $ 2. 0 Check No.: f �Z Receipt No.:--,27-36 i NOTE: Persons contracting with unregistered contractors do not have access to e ta try fundd Signature�of Agent/Ownerft=: _•:-� ..{_ , , S_-.�g�ature of°.contractor...: _� .��..� ;��: •. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted-0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE:OF=SEWERAGE:DiSPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ - 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 & DEVELOPMEN-f ❑ ❑ COMMENTS _CONSERVATION Reviewed on _ Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer ConnectionPermit DPW Tow;: Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTI44iif AT - Temp Dumpster on sit yes no Located at 124;Mair Street: Fire De ..� ' partmenfasignature/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 I 1 ® Notified for pickup - Date f ` Doe.Building Permit Revised 2010 I Building Department The fol;-)wing 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 casts if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apu.,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.Bui!ding permit Revised 2012 Location No. 119— / Date �f TOWN OF NORTH ANDOVER o . Certificate of Occupancy $ 0 0 Building/Frame Permit Fee C? Q Foundation Permit Fee $ ; , Other Permit Fee $ TOTAL $ �a2Check# f� 27369 Building Inspector ` i Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 20,587.00 m $ - $ 247.04 Plumbing Fee $ 30.88 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.88 Total fees collected $ 408.81 19 Holly Ridge Road 649-14 on 3/20/2014 Remodel 2nd Floor Bath Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 203587.00 m $ - $ 247.04 Plumbing Fee $ 30.88 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.88 Total fees collected $ 408.81 19 Holly Ridge Road 649-14 on 3/20/2014 Second Floor Bathroom Remodel NORT11 Town of t E : ndover No. C, h ver, Mass, L COCHICHl WICK �• S V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT �-�� C 1� C��e BUILDING INSPECTOR has permission to erect .. buildings on ..1�... �' �� ...�.!....W4 ..: Foundation �....................... / Rough to be occupied as ... ... . / �v .....V.1'til.V., �G�r.. QY4............................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms 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 CONSTRUCTI STARTS Rough Service ....... ...... . . ......................................... BUILDING INSPECTOFinal GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildiniz 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. 7�, Constuch'an;Ca: HEIACA0I3ELINC SPECIALISTS 978-69'1-520'1 KeenConstructionCo.com Mello,Jim & Mary March 19, 2014 19 Holly Ridge Rd. Contract#5504; Appendix A N. Andover, MA 01845 978-688-1888 Girls Bath: • Remove and dispose of existing fixtures and walls and ceiling to framing • Remove the existing floor to sub-floor(4 hr allowance) • Update electrical as needed ($2000 allowance) • Supply& install insulation to code • Supply& install wallboard and skimcoat plaster to smooth finish • Supply& install plumbing fixtures and accessories as selected at Peabody Supply, substituting Bellwether tub • Install customer supplied vanity&toilet topper • Supply& install granite vanity top • Supply&install trim to match • Supply& install tile floor, shower walls and ceiling as selected at National Tile. D222 field tile with 'Blue Eyes" glass tile border in shower and 2 x 2 dots on floor.This also includes two niches in shower. • Paint walls, ceiling and trim Total Price:$20,587 (twenty thousand five hundred eighty seven dollars) Price does not include cost of permits, cabinets or any unsafe, inadequate or unusual conditions. Payment Schedule: $3000.00 due upon signing contract $4000.00 due the first day of work(plus permit fee) $4000.00 due when plumbing and electrical inspections are complete $4000.00 due when plaster is complete $3000.00 due when tile is installed G — $2587.00 due when contracted work is comple am 7tomer Robert A. Keen Date Date 1175 Turnpike St. P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 Sales@KeenConstructionCo.com KEEN CONSTRUCTION CO. ® O.�OS�® ° 1175 TURNPIKE STREET �" L NORTH ANDOVER,MA 01845 All home improvement contractors and subcontractors Tel: (978)691-5201 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 SubmittedI with the Commonwealth of Massachusetts., Inquiries To: `— t about registration and status should be made to the I \ C Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617-973- 8787 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. EIN N0. 9�2 - L-9 Z -�Q 2 /19 �,y MA. H.LC. 108383 46—3783401 C/S=Customer Supplied S+I=Supply+Install C See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: Construction related permits: ___._...---..._._.._.,_._._......_. ..............._................................................................................._.................................................................................................._.­------- _._.___._._._.-.__._.__._.,_._ WORK SCHEDULE __�......... Contractor w 11 not b gin the work or order the materials before the third day following the signing of this Agreement,unless specified here i w din ont actor will begin the work on or about�—(date). Barring delay caused by circumstances beyond Contractors control,the work will be completed by (date). The Owner hereby acknowledges and agre s that the scheduling dales are approximate and that such delays that are not avoidable by the Contractor shall not b considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of r following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contractor,his 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. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of :EL)2 t 1 .q I (l S Q fI,-� i—ty(J �'I li\U _l� 'il� Z��,1 t� % Payment to be made as f ollars($(lows:II �r 11 % I$ ) upon signing Contr ct; ROBERT A. KEEN Name of Contractor/Designated Registrant u o ; , '' i 1175 TURNPIKE ST. I Street Address upbo_c0m lesion of N. ANDOVER, MA 01845 City/State_... _..... .. _.. .._ .. shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Phgn Fax Notice: No agreement for home improvement contracting work shall require a P� >down payment(advance deposit)of more than one-third of the total contract price Name nl ale an or the total amount of all deposits or payments which the contractor must make,in —� advance,to order and/or otherwise obtain delivery of special order materials and Aethe fn w e equipment,whichever amount IS greater. Note:This proposal maybe withdrawn by us it not accepted within days. Acceptance Of 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 becomes 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 NY BLANK SPACES. Signature — ate `3 Signature Date< U MPORTANT INFORMATION ON BACK • t The Commonwealth of Massachusetts De 0attment oflndustr al,Accidents Ofjrce of-Investigations 600 Washington Street Boston,MA 02.111 Y l�vww,mas.-gov/dia Workers' Compensation Insurance Affidavit:BuildexsiContlractors)Electriciaus/Plumbers -�• licanlL Information please Print.Lr e ibl Name(Business/organization/individual): t Address: -City/State%Zip:_ Phone Are you an employer?Check the appropriate box: 1• lam a employer with I 4. ❑Y am a.general contractor and X '�'pe ofproject ect(required): 2•❑ employees(full and(or part-time). have hired the sub-contractors 6 ❑New construction I am a sole proprietor or partner listed on the attached shget.x 7• `�Remodeling ship and have no employees These sub-contractors leave working forme in any capacity, workers'comp.insurance. 8. 0 Demblition [No workers'comp,insurance 5. ❑ We are a corporation and its 9. 0 Building addition I •officers have exercised their 10•j]Electrical repairs or additions 3. X 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 insurance required.]t employees.[No workers' 12.0 Roofrepairs comp,insurance required.] 13.0 other . 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensationpolicyinformation, 1 Homeowners who submitthis affdavitindicatingthey are doing all work and then hire oufside contractors mnstsubmit anew affidavit indicating such. +Contractors that check this boxmust attached an additional sheet showing the name of the sub-contractors and their workers'comp,affidavit indicating such. poll �trm an employer jilat isproviding Workers'compensation insurance foy yyiy eY�proyee�: Below is thepolic anrZ'ab site reformation, y j assurance Company Name: l e rs 'yl 'olicy#or Self-ins.Lic. M 5-S— r / ExpirationDate; �O �' • `] )b Site Address: I C� �o (( �� i City/State/Zip: +tach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). !O Uputo to secure coverage as required uhdex Section 2SA of1VIGL c.152 can lead to the imposition of criminal Penalties of a �e up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK 0lPenaRDER and a ane up to$250.00 a day against the violator. Be advised that a copy ofthis form be forwardedto the Office of •estigations of the DTA for insurance coverage verification. hereby certify er the aims d enalties o erjury t72at the information provided above is jru and correct. lature: a • � p /I q Date: U Zp � � , ase#: D —`T 7 •/ — ��� l?tial use oreZy. Do not Write an Otis area,to be coin pleteiiby cify or town official ity or Town: Permit/license# ' 3 wing Authority(circle one): , Board of Health 2.Building Department 3,City/T?W-Q Clerk 4.Electrical lusnectnr j:; n har U Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor .•. License: CS-076691 ROBERT A KEEN` 12 E WATER ST; ' North Andover NR Ol?8•I'5�, / 9 Expiration Commissioner 08/16/2015 11 71 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058245 KENNETH B I EN --- 21 HEWITT AVE N ANDOVER NIA 018,5, 92,-. � 1 f Expiration Commissioner 03/24/2014 ,y� `V`^y�G�ie�o�rrunwnwecz��o�C�ac�ivaeGla I , u_ �\ Office of Consumer Affairs&Busi ess.Regulatioir I' OME IMPROVEMENT CONTRACTOR' egistration 108383 Type: xpiration.„-8/1°8/261A_ DBA F KEEN CONSTRUCTION C Kenneth Keen 21 Hewitt Ave No.Andover, MA 01845 '` Undersecretary AC40RVCERTIFICATE OF LIABILITY INSURANCE —DATE 9/200 3'' 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 terns 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 endorsement(s)- PRODUCER CONTANAME.cr Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 FAX (781)942-2226 137 Main Street E-MAIL .bmcdonoughBgilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERA:NORFOLK & DEDHAM INSURANCE 23965 INSURED INSURERB:Travelers Insurance 0022 Keen Construction Company INSURER C: 1175 Turnpike Street INSURER O: INSURER E North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:CL13102900618 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUOR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY HUMBER f M IDD (MM/DDNYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED — PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE OCCUR -P-010078/000 /13/2013 /13/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- F1 LOC $ AUTOMOBILE UABIUTY COs adBIINEeD SINGLE LIMIT E $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Par ,dent $ $ UMBRELLA UABOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION ro be provided directly WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN is the Travelers Ins. E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? F-1NIA (Mandatory in NH) 0/8/2013 0/8/2014 E_L.DISEASE-EA EMPLOYE $ 100F000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION (97 8)623-832 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 360 Bartlett Street AUTHORIZED REPRESENTATIVE Andover, MA 01810 M Gilbert, CIC/BARBAR ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD