Loading...
HomeMy WebLinkAboutBuilding Permit #519-12 - 20 JOHNSON CIRCLE 1/4/2012M TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 1J--/ Z Date Issued:—Ar—/A z ANT: Date Received must complete all items on this LOCATION o�C' �� 1�S©✓ i XC 1 E Print PROPERTY OWNER Print MAP NO:®? % PARCEL: S. -ZONING DISTRICT: Historic District yes Machine Shop Village yes no no TYPE OF IMPROVEMENT --fesidential PROPOSED USE Non- Residential ❑ New Building gene family El Addition El Two or more family El Industrial ❑ Alteration No. of units: ❑ Commercial Rl�epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other q Septic 0 `Well Flood lain Q Wetlands 0 WaterShed�DiStnct Later/S.ewer L TION OF WORK TO BE PERFORIVIE : iN Identification OWNER: Name: �b12 R +c d Type or Print Clearly) C/ 7'9 q;? 2A tie 14 Phone i G 'q 7 q ;�- Address: a 6 t Q ri CONTRACTOR Name: �� �v S .'f f3 i, iS Phe: Address: iI H4t-V. if /4VE ud, dVl,4. Supervisor's Construction License: 7 02 Lf ,S Exp. Date: Home Improvement License: % D'J -"i `5Exp. Date: S5 -1 ;L ARCM Phone: Ad RET. -Na, FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ _3 6 33 6 FEE: $ 4-31. Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guara9VUnd Signature of!Agent/Owner Signature of contractor -- M Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE APPROVED El Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature 8� 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 Doc: Doc.Building Permit Revised 2008mi Location No. Date �L N0RTM TOWN OF NORTH ANDOVER F � R A si Certificate of Occupancy $ a scMust Buildin /Frame Permit Fee 9 $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 4 92 R " 04 fig Inspector 0 0 z W z O p u z 0 u C/) a pi W Qi ■ L Z CL. O y p C I Ctm � p� .- M E m m CL ~_ � 3 CD Cm o R O d 0. c Q ca o .1-a � Rcc o G3 ca C Z CD C) CO) to C C— �— C c COD E G v oco w co a A w w vQ U w" x o —co w a 0 � a U w .� u: Cl) w" a x a: w z w A 0-4 z.. cn v v ° cn z O p u z 0 u C/) a pi W Qi ■ L Z CL. O y p C I Ctm � p� .- M E m m CL ~_ � 3 CD Cm o R O d 0. c Q ca o .1-a � Rcc o G3 ca C Z CD C) CO) to C C— �— C c COD E c O L C y O C V V d C O A y C v� E a L m c r s :.. CLCD VJ E5 0 C c 0 cm V me E CD � a L z o a Cm ' t C C y O O E vs m v =cj y m m o o, CD C: os c0Q :o O C V V C3.0 O. L V�Z' O O. m m e o Q = m m= 0 N H aO. y O w H O CO2 YJ CO ev " *: C .y •_.+ .� CLj Z CD ® o® g. COD d O� O32S 0 �= m.m� z O p u z 0 u C/) a pi W Qi ■ L Z CL. O y p C I Ctm � p� .- M E m m CL ~_ � 3 CD Cm o R O d 0. c Q ca o .1-a � Rcc o G3 ca C Z CD C) CO) to C C— �— C c COD E KEEN CONSTRUCTION CO. GP e 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 Submitted _– -- — DATE 1 f 1 k2—/1 S > C/S =Customer Supplied + I = Supply + Install for work to be performed and materials to be used: We hereby submit specifications and estimates -.__.-._-----._.. ___..__..._--------- Construction related permits: All home improvement contractors and subcontractors engaged in home improvement contracting, unless of specifically exempt from registration by Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, 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. EIN NO. REGISTRATION NO. MA. H.I.C. 10838326-0462904 [ r See Attached Appendix A •loajagl MOO e 10 aaurn0 9141 01 lelllwsu'" pue luawaaa6d aul 10 6ulu6ls aql of gaud ul6aq Ileus luawaaj6V aul aapun �Jom ON uoilnoaxe }o owll ay; le aaumO ay} 01 uan16 }oaaay Adoo pau61s `leul6lao ue PUL,`aleo!ldnp ui palnoaxe aq isnw 11 -sllasngoesseW }o sm1e aul lCq pauaana6 sl luawa916y sly1 83N MO Ol N3AI9 38 011N3W33)jOV d0 Ad00 •o;away payoe>}e aae ulaaay pa}eaodjooui aje 3ey1 sjuawn -oop paouaaal.aa ao pate!aa pue sllq!yxa Ile 11iun pue `algeo1ldde jou ao pata!ap `Plop se PO)VUw Jo u1 pa11ll uaaq an84 suolloes )IUelq Ila 11xun pue sselun tuaweeft slyJ u6!s fou pinoys ay leyx pas!npe Agaaay st aauMp 041 N0an03X3 »Od 1N3W33HOV -10 SS3N313id"00 U01lellaoup-10 90110KI at)t KEEN CONMUCTION CO. 21 A I/E. N- ANDOVER, MA 018,45 978-691-5201 Payment schedule: 52000.001 due upon signing cQntr&ct $3000OOdue the first day 8fwork $4DO(lODdue when the window i6install and framing /scomplete $Z0OO.ODdue when b/ueboa[disinstalled $20DO.0Dwhen floor isinstalled . $2O0O.00due when cabinets are installed $ZQ0}.DOdue atcompletion ofcontractedwork Customer KeWnethB.Keen � / Date Date KEEN CONS71MC710N Co. 21 If-EW1T"T AVE. N. ANDOVER, MA 01845 978-691-5201 Kee,nC&n0ra t Co -w tw Branca, Steve & Carrie 20 Johnson Circle N. Andover, MA 01845 078-886-4.742 Contract # 5048; Appendix A Date; December 19, 2011 Remodel Kitchen: o Reconfigure framing of existing walls between kitchen and dining room to make opening as large as possible a Frame new step between kitchen and family room a Supply & install. Harvey Classic twin double -hung window unit over kitchen sink, approx. 53" x 40" a Insulate exterior wall to code a Supply & install blueboard a Supply & install 2 M" unfinished Oak flooring in kitchen a Install customer supplied cabinets and associated trim a Supply & install trim on windows, door openings and base to match existing (paint grade) Electrical: a Supply & install recessed light fixtures, outlets and switching to code as per conversation with Steve Juba a Electrical allowance ($4500.00) Plumbing: a Install customer supplied plumbing fixtures (dishwasher, sink, faucet, gas range, and refrigerator) a Remove portion of heat in family room for step enlargement a Plumbing allowance ($2800.00) Total Price: $17,800.00 (seventeen thousand eight hundred dollars) Price does not include cost of permits, painting, demo, floor finishing, plastering or unforeseen problems that may arise. P agy, 1 of 2 ITnTI Jackson iL11 KITCHEN DESIGNS 1093 Osgood Str-::et, North Andover, MA 01845 Phone: (978) 685.7770 Fay:: (978) 685-7771 MAIL TO: Jackson Lumber & Millwork Co. Inc. PO Box 449, Lawrence, MA 01642 CARRIE AND STEVE BRANCA ** CASH ACCOUNT — 20 JOHNSON CIRCLE (978)886-4742 NORTH ANDOVER, MA 01845 Billing Fax: 978.687-5841 Order SAME ** CASH. ACCOUNT ** 20 JOHNSON CIRCLE NORTH ANDOVER, MA 01645 45438 1 430515 j 12/19/2011 L073 CASH D1R SHIP •. - . 1 SOSCHROCK 1 SCHROCKTRADEMARK EA 13,676.00 13676.00 PLEASANT HILL MAPLE WITH COCONUT FINISH PER KITCHEN PLAN 2 SOGRANITE 1 SILESTONE COUNTER IN CAMBRIAN EA 3,770.00 3770.00 BLACK WITH BAC:KSPLASH AND STANDARD EDGE PRICE INCLUDES TEMPLATING AND INSTALLATION J Amount:17,446:00 Special order and immufactured merchandise is' non -returnable. Customer agrees that any amount not paid within 30 days of invoice date will ca:::ry interest at the rats of 1.5% per monthaid: 0.00 and further agrees to pay all costs incurred in collet -ion, includ_rLg reasonable attorney's fees. Due98,536.38 Page 1 of 1 12/30/2011 11:32:59AM c.d i i i icoaoia enin1e=1n n1=1u1'% i iv nines^Nr (Inn -71 71 on IRdr t w - 15" -f. -2129a — 9"----51 75:" --9 ---38---------------- �-24" 1 ''U2136L W3018 to - N • A 4 .. S 123 -t i ...... ...............---._............... N i v.�20 66 r ------------------------ �! 1 Ci SCHROCKTRADEMARK TEP24 PLEASANT HILL MAPLE t- - WITH U - 4SS- U 9024 I? I o COCONUT FINISH -- t f i F 1 CEILING HEIGHT 95" :._.............- ............... ._............ .... ........:__... HANGING HEIGHT 90" i H CLOSED SOFFIT `! cc VV96 FOR FASCIA FI U� SWTCRM8 FOR CROWN MOLDING i ' CAPM FOR LIGHT VALANCE + m g 1 -SINK CABINET WITH TILT DOWN FRONT i Q, 1 m 2 -BASE CABINET WITH n i _ _;� _ TOP DRAWER AND DOUBLE - � I �I ROLLOUTS INSIDE � N + 1 co 3-BASE FULL HEIGHT DOOR CABINET ? } '' k WITH TRAY DIVIDER INSIDE �! fl I i 1 4 -TALL PANTRY CABINET.WITHto SLIDING SHELVES INSIDE -- 1j�/ ---- -- ?J m 5 -TALL PANTRY CABINET WITH SLIDING SHELVES INSIDE 'e I ..._............... 6 -BASE DOUBLE TRASH CABINET 7 -WALL CABINET CUT FOR GLASS WITH MATCHING INTERIOR CUSTOMER TO PURCHASE GLASS ON THEIR OWN 8 -BASE PULLOUT PANTRY UNIT 9 -RANGE GE'MODEL # JG8820DEP TOTAL DEPTH "TH HANDLE 297/811 10 -TALL FILLER AND TALL END PANEL WILL BE PROVIDED 96" HIGH CONTRACTOR DOWN ON SITE TO THE HEIGHT HE NEEDS. All dimensions _sue d:slgnatiorns given are subjectto verification on job site and adjustmer.. t to fit job conditions. KEEN BRANCA d JESSICA ZAPPALA-SYKORA IThis Is an original design and must JACKSON not be released or copied unless KITCHEN applicable fee has been paid or job DESIGNS order placed. Qmc)iQ::in mziwn I iv mnevnHr Designed: 11/16/2011 Printed: 1/3.'2012 All ' Drawing it: 1 dnn:71 71 on u2r •%�, Massachusetts - Department of Public Saf'et% Board of Buildin!g Regulations and Standards Construction Supervisor License License: CS 76691 ROBERT A KEEN 12 E WATER ST N ANDOVER,, MA 01845 Expiration: 8/1612013 ( mmINS i4lite r J- Tr#: 3772 -� Massachusetts - Department of Public Safets Board of Building Re„ulations an(1 Standards Construction Supervisor License License: CS 58245 Restricted to: 00 KENNETH B KEEN 21 HEWITT AVE N ANDOVER, MA 01845 #2 Expiration: 3/24/2012 ( u�uui w m'r i r#. 20523 f 0Mce�t"Comer rs ifsiness egu a �o jjjj HOME IMPROVEMENT CONTRACTOR Registration: _4A,08383 Type: Expiration: $/8012 DBA K CONSTRUC�L�tJ Kenneth Keen { 21 Hewitt Ave No. Andover, MA 01845 -- Undersecretary i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kip 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):N �g} N 5' f 't2 V ��' 00 , Address: 9 City/State/Zip: 1i, R N a p cl ;_ V., 14 q 0 Phone #: 017 2 6 a/ t - S ;? a Are you an employer? Check the appropriate box: 1. NEl am a employer with 1 _ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other ."Uy applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t 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 their 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. Insurance Company Name: G t26 N ", +-' Policy # or Self -ins. Lic. #: ki C oo 9' 6 i4 6 9 qa Expiration Date: S — 3 Job Site Address: O � t, lit a_Ieo 0i Rc(e City/State/Zip: �• �N�1 , �� e! 865 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 cer A ruder the painfandnenalties of perjury that the information provided above is true and correct Phone #: t",q 7n .69 ( ac t 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 #: A19212091 .1.4F DM F"- r.;lh.lff ri.I.hu..-* T-. ..., AC .RD. CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDOIYYYY) 05/23/2011 PRODUCER (781)942-2225 FAX (781)542-22.26 Gilbert Insurance: Agency, Inc.. 137 Main Street Reading, MA 018:67=3922 THIS CERTIFICATE IS ISSUED AS A. _MATTER OF:INFORMATION ON LY AND CONFERS wNO:RIGHTS ;UPONTHECE.RTIFICATE HOLDER: THIS,CERTIFICATE DOES NOT AMEND; EXTEND OR ALTER:THE `COVERAGE AFFORDED,BYTHE�POLICIES BELOW: ]NSURERS;=AF.FORDING COVERAGE NAic.# INSURED Kenneth Keen & Robert Keen` . DBA: DBA Keen Construction-Cbmipany 21 Hewitt Ave, North Andover, MA 01845 INstRERa NO FOLK & DEDHAM:INSURANGf 23.965 INStIRERe: Granite Stat'e.Ins. Co. 0077' INSURER C INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE.BEEN ISSUED TO, THE INSURED NAMED:ABOVEFOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF..ANY.CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR. MAY:PERTAIN, TOE INSURANCE AFFORDED'BYTHE POLICIES eDESCRIkbHkkEIN. IS:SUBJECTTO.ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN.MAYNAVE.'BEENREDUttl[)' "PAID. CLAIMS. ILTR DD' TYPE OF INSURANCE POLICYNUMBER POLICY.EFTE FECTIVE:.POLICKEXPIRATION LIMIT&. GENERAL LIABILITY NDP 01.0.07.8/000 03/13/_2011 ` 03/13/2012 EACHOCCURRENCE $ 1 OOO :OO X 'COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $• 5O , OO CLAIMS MADE. aOCCUR MED,EXP (Any one person) 3 lOO,OQ. A PERSONAL-.8ADV INJURY :f' 1,, OOO .. .. GENERAL AGGREGATE S 2 60O •OO GENL,AGGREGATEIIMITAPPLIES PER: , PRODUCTS -COMP/OPAGG .'$.; 2,x:000,00.. X POLICY ER LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $. ANY AUTO (Ea accident) ALL .OWNED AUTOS- SCHEDULEO AUTOS BODILY -INJURY $ (Per>.person) :HIRED AUTOS NON OWNED AUTOS. BODILY INJURY (Per accident). $ PROPERTY DAMAGE $. (Rer: accident) GARAGELIABILITY AUTO ONLY -FJ{ACCIDENT :S ANY AUTO OTHER THAN tAACC $ . AUTO`ONLY: AGG:$ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE ; DEDUCTIBLE RETENTION $ WORKERS CQMPENSATIONAND 46 009694`2 O8/03/2O1.1 03/03'/2012' TFi WCSTATU ',OER ENYPRO Rs TORI We CERT TO $BE MAILED. E.L. EACH ACCIDENT` $. 100 0O B AR ANYPROPRETOR/PARTNER/O(ECUIIVE OFFIGER/MEMBEREXCLUOED7 DI ECTLY VIA INS CARRIER , If:ye% describeunder. E.L. DISEASE -EAEMFLOYE $ lOO,,OO'' SPECIAL'PROVISIONS below E.L. DISEASE - POLICY.LIMIT $ SQO, QO' OTHER -DESCRIPTION OFOPERATIONS I LOCATIONS IVEHICIIEXCLUSIONSADDEDBY.ENDORSEMENTISPECIAL PROMS16NS - - v1dence of Coverage Evidence of Coverage 25 12001108) - w SHOULD ANY. OF THE'ABOVEDESCBIBED POLICIES BE.CANCELLED'BEFORE THE EXPIRATION•DATE:THEREOF, THEISSUING INSURER WILL ENDEAVOR �TO MAIL SO DAYS WRITTEN NOTICE TO THE CERTIFICATE. HOLDER NAMED TO THE LEFT, BUT -FAILURE TO MAIL:SUCH NOTICE SHALL IMPOSE .NC�OBLIGATION 'OR LIABILITY m A/`f1D r% /^Nn nnn A. T1^k i»Ann.