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Home My WebLink AboutBuilding Permit #691-13 - 19 HOLLY RIDGE ROAD 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7 Permit NO: �� I Date Received + 2.2II i Date Issued: i IMPORTANT:Applicant must complete all items on this page LOCATION. � � � x { F � 77 s$ycaama-.r-4-r^a-'- � �r Pnrit 4 T 10OYeartOldStructureo yes <noj: MAPN0:IPARCEL Z:J ..ZONINGDISTIRICTFfiistonctDistncti yes nod .�� T MachineSho 3Villa el es no T- -_- P. 9._- 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 _ r- - n�� ❑,�Septics D�Wefl ❑ Floodplam� ❑1Netlands , D Watersheds®istrict DESCRIPTION OF WORK TO BE PERFORMED: Identification Please type or Print early) I OWNER: Name: Phone: Address: I :CONTRACST,ORt Pone n .•Ad'dress -.°� �_.1 _Tt fr�t�.� �- .R�_�. �r_��7U_ �✓t�� r� �:.� _ Supe;rvlsor- CorstructionLleense' 6 6�_t Expo ®ate _ #Horned lmpro�ement'License ' n J 3 _� Expi Qate z� 7� __ l o-� ARCHITECT/ENGINEER Phone: j I Address: Reg. No. i FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.` ®d t Total Project Cost: $ S �d�, �J 6O FEE: $ ro Check No.: �V Receipt No.: 2(0 NOTE: Persons contracting with unregistered contractors do not have access to the gu anty fund T ef�."�.,tr .^"..� - -`"�•-•+r+�.?.»s +s—........-,'.'�."�x"r"""'.`r"".,�"""t�5lszo`,�'%i�.'�' ;i?�"'1r."t r �" ,h ."- ''fi i ySignature�of Agent/®wner�3 '�� , ;r�> t�_;��:r,_=�:Signature�of�contracto � a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ tamped Plans ❑ i 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 I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature � 4 COMMENTS 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 i DPW Town! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -.Temp Dumpster on site yes no :Located at:124,Mairl'Street:.: Fire Departmerit signature/date ' COMMENTS i 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 E Doc.Building Permit Revised 2010 A Building Department The foliowing 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 o 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks a Building Permit Application , a Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (if Applicable) o 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 o 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) 1 o Copy of Contract o 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 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 subm_Ated with the building application Doc: Doc.Bui!ding Permit Revised 2012 J Location O �. �-- QC No. ,' �� Date ZZ �7j • C •" TOWN OF NORTH ANDOVER e_ . Certificate of Occupancy $ 4Building/Frame Permit Fee $ �0 Foundation Permit Fee $ ' ` Other Permit Fee $ TOTAL $ Check#71 26308�: / uilding Inspector ,k,,, NORTH own ol o - . .. No. 6c, C% h ver, Mass, � I as X013 A- AcocHicHeweccc N1' 7,9 0RATED ►`M TPER I T LD PP,`�(� S U BOARD OF HEALTH Food/Kitchen Septic System � ' ► 1 THIS CERTIFIES THAT V .......... ,.,,,,,,,.,.....,........,..........,.,,,,,,,,,,.,,,,,,, BUILDING INSPECTOR �,. iWU� has permission to erect .......................... buildings on o Foundation Rough tobe occupied as ..............................��....Z..7n.............a........................................................................... 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 CONSTRUC I N STARTS8 Rough Service ..... ..... ..��.. ..................,...................... i.• Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place. on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT i Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE 04/18/2013 09:26 FAX 781 942 2226 GILBERT INSURANCE Z001 V CERTIFICATE OF LIABILITY INSURANCE 4/1ei2013 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 AD131TIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,Certain policies may raqulm an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER nC Barbara McDonough Gilbert Insurance Agency, Inc. PHONE , (781)942-2225 FAA No-1781)942-2226 137 Main Street = ,bmcdonough@gilbertinsurance.cam INSURERS AFFORDING COVERAGE NAIL Reading MA 01867-3922 INSURERA:NORFOLK & DEDHAM INSURANCE 23965 INSURED INsuuER a:Travelers Ins. Co. 0031 Keen Construction Company INSuPARC: 21 Hewitt Avenue INSURER D INSURER E: North Andover MA 01845 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, INSR TYPE OF INSURANCE AOOL SUBRI POLICY NUMBER 7WID POLICY E7rP LIMITS LTRim GENERAL LIABILITY EACH OCCURRENCE S 11000,000 X COMMERCIAL GENERAL LIABILITY RENTED n n $ 100,000 A CLA1M5-MADE ❑X OCCUR -P-010078/000 /13/2014 MEDEXP(ArvV one meson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LI Mrr APPLIES PER: PRODUCTS-COMP/OP AGC S 2,000,000 X POLICY PRO-JEU LOC g AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accWnh S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE 3 HIRED AUTOS AUTOS Par accident 8 UMBRELLA UAB HOCCUR EACH OCCURRENCE 15 EXCESS LIAB CLAMS-MADE AGGREGATE S OEO RETENTION $ $ WORKERS COMPENSATIONWC 5TATU- OTH- AND EMPLOYERS'LIABILITY ' ANT PROPRIETORMARTNER&XECUTIVE YIN E.L EACH ACCIDENT $ 100,000 OFFIGERIMEMBEREXCLUDED7 r-1 N/A BRDB-520726-A-12 /3/2012 /3/2013 (Mandatary 1n NH) E,L DISEASE.EA EMPLOYEE S 100,000 It yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 3 500,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,AddltIMMI Remarks Schedule,If more space Is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE X Gilbert, CIC/BARBAR ACORD 25(2010105) ®1988-2010 ACORD CORPORATION. All rights reserved. INS025(niao5pi The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Appheant.Information Please Print Legibly Name(Business/Organization/Individual): K E N L o w �n �1 C��d Address: l 1^tN . ✓F City/State/ZipIV• irl d JFIZ. r : !�!� �� _ Phone#: �7 d - (�g t - a Q Are you an employer?Check the appropriate box: Type of project(required): 1.[ am a employer with�_ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I 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' comp.insurance required.] 13.0 Other *Any applicant that checks box#1 must also fill out the section below show' m the' fi g their workers'compensation policy information. , 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 then 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. 1�. Insurance Company Name: (2 y �S �–N S Policy#or Self-ins.Lie.#: U -S 3 f o7,Z 6 Ex iration D Z p ate: Job Site Address: f'"[ rlF��./ R;�d —Ttr C City/State/Zip: Pt 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 1 enalties fine u to$1 500.0 P of a p 0 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 cerci un er the pains i pe allies of perjury that the information provided above is true and correct. Si nature: Date: / Phone#: 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# Board of Buildin.- Regulations and.Standards` Construction Supervisor License License: CS 76691 ROBERT A .KEEN 12 E WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2013 Commissioner Tr#: 3772 Massachusetts -Department of Public Safety Boardof Building Regulations and Standards Construction Super%isor License: CS-058245 T Us U, KENNETH B I&EN .._. •''r.:" 21 HEWITT AVEa� N ANDOVER MA701845 iAae Expiration Commissioner 03/2412014 -', ��>lie rparnirrzoauuecr,�(�o�C?�a.�ciaeCta Office of Consumer Affairs&Business Regulation Y'e0gME IMPROVEMENT CONTRACTOR tratiow. .�p8383 Type: is piration: DBA KEEN CONSTRUCT, T-66' c= r' Kenneth Keen 21.Hewitt Ave No.Andover,MA 01845 " :,' e Undersecretary , KEEN CONSTRUCTION CO. GP PROPOSAL e 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 r Chapter 142A of the general laws,must be registered with Submitted �} y�'1r !I the Commonwealth of Massachusetts. Inquiries about Toe1a.C.__— registration and status should be made to the Director, - 9_ � i C� y� (�.-+f Home Improvement Contract Registration,One Ashburton _. _' �C`�+ _ f 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. EIN N0. 3) ' (�� - c 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: --—..._.. ....._.-..- . --- — - -- _.------------ - -- ......._....... --------- > Construction related permits: -_........_..........._---_................_-._—._.._._........._.._............................. ... WORKSCHEDULE _.,._..._.................__..._..._..........._..............................-_..............................................................,,... Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing: Contractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date).The Owner hereby acknowledges and agrees that the scheduling dates are approximate and(hal such delays 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 in materials and workmanship for a period of - 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 f' j44 .�PUPv) 11{{160Sc i; i TON! CO N. ANDOVER, IVIA 01845 078...r°Y..a v 4.c fvlello,.ling & maary 19 Holly Ridge Rd. N, Andover-, MA 0184; Cont-ract Appendix A Dane.3j/2'.0/20I3 ! n }6 2 Remove all carpet, paid and tasckless in all rooms (-fie--nail subfioor 0 Supply& install 2 .1./4" Oak pre[inisi"3ed flooring !satin fii lisp) 0 Supply&install new base rn olding in all E€corns to snatch 1.'-f cior Q Supply&install crown rrlolding (3 5/89' standard)inal; roorrI (except r:-Josetsjl 0 Replace all single doors wins "slab" rnachined doors to match Ist flock Replace all double doors with Unit pair sti^ding doors(including iamb and casing,) Replace all door hardware with satin nickel finish Replace .11 double hung windl€w s to ma3lc.'t ISS floor { Build closet ir�maste dressing room to match rearCloy'.'.'!.. 0 Supply&install two shelves above Boor in nnaster dressing room Faint all walls, ceilings and tt.;rn on 2"'floor * Replace all outlets and switches with decor style Replace ceiling fan in rna te`-'r'Fries ng room, sre 9:( r;txr alis `�' ,e. * Supply&install two recessec< LED celirig lights sote?c'at: _-ufef eaover vS5iEE bedc r,.. Replace sr oke deter ors with S"-C smoke Comt o-`_ '3 t 3`L3i4{,3C�d:tiPrgal ph t.oelectn'-units are 50 ea ch) install customer supplied center ceiling iigr3`_in master bedroom Suppiy&-ir':.r-ta l outlet?i-I€fali.,a Total Price: $357,360.00 (;-iffy seven thousand three hundred sixty dollars' i Price does not:include cost of pcn"rnnits; master bath rer`odel or-i'ii In hath ireriodei, additional recessed light fixtures or any pref:'xistirk;i-rsane or unusual a 3nd'rttfln5. I Page I of | TR /-�)_ A I �- � N. ,4NO CtTPI, PlA /l183/f-�7A: 78-6 91 -.52[)1 nWc�� PayrnenL�chedu<e� �7'�D0due atsi�n�nQ cnmtrac1/Smrvv�ndmw/order) �15- I830 duethe 0pt day ofvvork /for haroilwood order) $5, ,OODdue w/han�rsttwo hednnnnnsare done(exoapt-mdndoxw3) $7,SU0due when third bedroom andhallway isdone (except windows) $7,5UQduewhen vx}ndovvsare installed $5.00Odue m/hencloset/sconnplete $5,0OOclue vvhenmaster bedroonnfloor isinstalled "-4,850 due- at.cornp|ednnofcnnVzctedyvork ' ' c mer Kenneth 8. Keen / ' Date Date � Page 2of2