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HomeMy WebLinkAboutBuilding Permit #511 - 29 NORMAN ROAD 2/16/2010Permit NO _J 1 Date Issued: v & —/D TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this vaQe LOCATION�i `�' ®,e. �9N Rel Print PROPERTY OWNER Print MAP NO: alo PARCEL: /oZ ZONING DISTRICT: Historic District yes Machine Shop Villaae ves �no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building t.One family Addition Two or more family Industrial Iteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District ater/Sewer DESCRIPTION OF WORK TO BEP RFORMED: ��-- ' �l 5 /� PPP -Ox 3(00 -F'tZ ©f IdentificationPlease Type or Print Clearly) OWNER: Name: skfaY 6,ZJ:e SGr,EA Phone: 1V k-alU Zapf/ Address: Q I r)oa.rna u CONTRACTOR N C°n ,i zu,l t1'T i-9vE x.1, O - J Supervisor's Construction Licenser ,F o'Z `f S Exp. Date: 0 Home Improvement License: /0'7317-5 Exo. Date: '�x -/ 7 "/ Cl 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. Total Project Cost: $ `, ed FEE: $ Check No.: &;2.14 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of Agent/Owner Signature of contract r1 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 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 Connection/Signature & 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 NOTE5 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 =o --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) 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 ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit a 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 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 2008 Location 2� 'v 0rt-MR k4 No. Date 7 -- Check # 11 TOWN OF NORTH ANDOVER Certificate of Occupancy $ t Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �'- 3uilding Inspector KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 979-691.-5201. Total Price: $16,328.00 (sixteen thousand three hundred twenty eight dollars) i Price does not include cost of permits, electrical sub -panel, changes required by inspectors, or venting of boiler room (more than louvered door). Payment schedule: $1000.00 due upon signing contract $2000.00 due the 1t day of work (plus permit fees) $2000.00 due when framing is complete $2000.00 due when rough electrical is complete $2000.00 due when insulation is installed $2000.00 due when blueboard is hung $2000.00 due when entry doors are installed $2000.00 due when work is complete except flooring $1328.00 due at completion of contracted work tr to e f Ke rth B. been Date Date Page 2 of 2 cri � " cn U F^.1 ogP-W w° �D0 w2 m U v� 0� r -W ono co x W SEI W C2 u Cf) � w U � w W G r� �i cf) O cn >;� v .• y � 1It. O���I `NG O F=4 O z c c ® c c w O ` c h : O C O : C. v .0 O_ C R R m p �+ m o m y CA a D C _ ts �: ys V CD Q • O O. N �O 43= cO u c CD all E om a C3 3 N r cm m N �mCD zoo y Cc ER o CD w C3 cm . y m m � -=Z O cm C O a dC= m f1 :11o.3O O O O Z Cf hc �O C_ _ ® m (V O. COD N m rO-. CD � m LU!:!LLS CO : �~GC O I.- •N -d= R Z •� V -O 4WD •N O CLCOD O. m = cyo a `=m O CL 0- zip 91 0 dftp 4w �.d 2 O CD 0 C L 0 Z a3 CL O y o c CD CM co CA m m CD C2 CD H t CL _ -1.•• CD C2 co G3 m LO _Q o a CL CMQ c Cc o Cc V C G3 :..i y Cc i _cc 0. ca is KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 578-691-5201 Shea, Greg & Ashley 29 Norman Rd. N. Andover, MA 01845 978-273-7041 Contract # 5023; Appendix A Elate: 2/10/2010 Remodel Basement: G z ti i *tP_.60r. partition walls to create approx. 300 sq. ft. of finished area Create shelf area where foundation is jogged Acid middle stringer to existing stairs a Replace treads and risers on stairs e Supply & install C-6010 handrail on one side of stairs • Create j, wall on both sides of stairs to finished areas e Supply & install R-13 insulation in all exterior walls ® Supply & install l" blueboard on all walls & stairway to be finished a Skimcoat pilaster walls to smooth finish o Supply & install 3'0" x 6'8" 5262 9 -lite Thermatru Smooth Star fiberglass door unit with.clear glass & fixed grilles to replace existing egress to outside ® Supply & install new Harvey Lifetime "full lite" -vinyl -skinned door ® Supply & install 2'6" x 6'6" 6 -panel wood 20 minute fire -rated door unit to replace existing into garage Supply & install two Harvey vinyl hopper windows to replace existing o Supply & install two interior hollow core doors and one louvered unit pair door unit * Create soffits around pipes that will be exposed Supply & install 2 %" colonial casing on all doors and 5 W base molding in finished area ® Supply & install 2'x 2' revealed edge suspended ceiling (Armstrong Cortega series) a Supply & install approx. 35 sq. ft. of ceramic We at exterior doors ($3.00/ sq. ft. material allowance) Supply & install 38 sq. yd, carpet in remaining finished area including stairs ($1216.00 installed allowance) ($30.00/ sq. yd.) Electrical: • Supply & install eight recessed ceiling light fixtures • Supply &install switching to code R Supply & install outlets to code • Supply & instalf two cable outlets ® Supply & install one zone of electric baseboard heat on programmable thermostat Page I of 2 The Commonwealth of Massachusetts i Department o, f Industrial Accidents 1 Office of Investigations 600 %frashingion Street «r Boston, M�4 02111 r\� www rnassgov/dia . 'Workers' Compensation Insurance Affidavit: S.uilderslContractors/Eieatricians/Piambers A • licant Information . Mease Print LeQibl Name (Business/Organizationlindividual) � � E' " ter Address: oZCity/State/Zip 1U tA tN ci d �1 f �z ✓yl R O t $ YS Phone #:. 971' 6 I 'S ao i FE]T employer? Check -the appropriate box: a em to er with 4 Type of project (r utP y ,�❑ I am a general contractor and I � �'yees (full and/or part-time).* have hired the sub -contractors New constructionOle proprietor or partner_ listed on the attached sheet. 2Remond have no employeesThese sub -contractors haveng for me in any capacity. workers' comp. insurance.g'❑ Demolrtton orlcets' comp. insurance 5. ❑ We are a corporation and its 9.❑ Building additionA j officers have exercised their 10•❑ Electrical repairs oradditions homeowner doing all work right of exemption per MGL 11.❑ Plumbing myself [No -workers' comp. c. 152, § 1(4),'and-we have no grepairsoradditions insurance required.] .t employees. [No workers? 12•❑ Roof repairs comp. t isurance required.] 13 ❑.Other Any applicant that checks boil * 1 mutt also fill out the section below showing their workers' oompensation Policy informaEion t Homeowners who submit this affidavit indicatin th g ey az Lining all work and then hire outside contractors must submit anew affidavit indicating such. ;Contractors that check this box mustL�ch-d an adtritioasJ shactshowing the name ofthe sub cop haetons and their workers' comp. paiiry irformation. --m an ersployer that is pT"ng workers' compensatroa nsurance orm1' mp a to �—" informahorL if yam% Below it the po&cv and inh e;f. Insurance Company Name: Li fz,N i + e - N S Policy # or Self. -ins. Lic. #: .. �y 'j [ 3' Expiration Date: AA Q /Q Job Site Address:_ Attach a copy of the workers' camisensation policy declaration page (showing ttthe Policy number and a D' & �S Failure to secure coverage as required under Section 25A of MGL C. 152 can lead to the imposition of criminal penajti io,d of a.. fine up to $1,50000 and/or one-year imprisonment., as well as civil penalties in the farm of a STOP WORK ORDER and a fine Of up to 5250.00 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. ------------------- 1 do hereby cert under the pairu d erralties o e `; L fp rlury that the information provided above is true and correct Si tore:. Date: a? - / 6 LLI-Bo2rd use only. Do not write in this area, be completed by ctlj, or town. n ciaL Town Permit/License # Authority (circle one): of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbin Ins g pector Person• Phone #: 08/11/2009 09:47 FAX 781 942 2226 GILBERT INSURANCE 14003 A JM CERTIFICATE OF LIABILITY INSURANCE oail1/2o 0 PRODUCER (781)942-2225 FAX (781)942-2226 Gilbert Insurance Agency, Inc. 137 Main Street Reading, MA 01867-3922 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Kenneth B. Keen DBA: Keen ConStruCtion Company 21 Hewitt Ave. North Andover, MA 01845 INSURERA: NORFOLK & DEDHAM INSURANCE 23965 INSURERS: Granite State Ins. Co. 0077 INSURERC: INSURER D: INSURER E: vcb w/]PC v 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ME AQVI.POLICY EFFECTIVE POLICY EXPIRATIONINSIRE LIMITS GENERAL LIABILITY ND -P-010078/000 03/13/2009 03/13/2010 EACH OCCURRENCE s 1,000,000 DAMAGE TO RENTED S 501000 )( COMMERCIAL GENERAL LIABILITY CLAIMS MADE ff] OCCUR �PJ3�4 MED EXP (Any one person) S 5, 000 PERSONAL A ADV INJURY S 1, 000 , 000 A GENERAL AGGREGATE S 2,000,000 �GEN`L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO S 2.000,00POLICY MJIECOT f7 LAC AUTOIBORII F LIABILITY COMBINEO SINGLE LINdT (Es Rcademl S BODILY NJURY (Per person) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) S IANYAUTO HIRED AUTOS -0 NONWNED AUTOS PROPERTY DAMAGE 5 (Por accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHERTHAN EA ACC S AUTO ONLY: AGO 5 ANYAUTO EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR FICLAIMS MADE AGGREGATE S s S DEDUCTIBLE S RETENTION S wORKERSCOMPENSATIONAND 6371378 08/03/2009 08/03/2010 X wC3TATU- OrH- B EMPLOYERS' LIABILITY ANY OFFICERWEMBER EXCLUDED? ECUTIVE E.L. EACH ACCIDENT S 100, 000 ELL• DISEASE - EA EMPLOYE i 100, 000 ye gPECIAALL PROVbe ISIONS Wo* E.L. DISEASE - POLICY LIMIT I $ 500.000 OTNER OeSCIQ"*N OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS riginal workers compensation certificates to be issued by company forthcoming. ertificate holder is included as additional insured on the general liability with respect to Aerations of the Named Insured. Town of North Andover 120 Main Street North Andover, MA 011145 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RATE THEREOF, 714E ISSUING INSURER WILL ENDEAVOR YO MNL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE 14OL.DER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INS AU WORIM REPRESENTATIVE Mark Gilbert. CIC ACORD 25 (2001108) ©ACORD CORPORATION 1998 ✓le Vaa�wouuec�CLi �✓�dda�luaetla Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrar.', 108383 E-bifdtto i= 8f18/2010 Tr# 272473 KE i tc�r Kenneth Keen 21 Hewitt Ave No. Andover, MA 01 �,G7.Administrator �a....-�. ✓iie �oavriaoouuea a(./�aaoac�iJ Board of Building Regdlatid-s and StandivaeCards Construe -tion Supervisor License License: CS 5824.5 EE-_xprration 3/24/204.0 Tr# 17,840 RestFiclion OQ', KENNETH.B KEEN" 21 HEWITT AVE N ANDOVER, MA 01845 Commissioner IPylassachusetts - Del)u-tntent of Ptlt)IiC Safet% Boar d of Building Re<aulations and Standards Construction Supervisor License License: Cs 76691 Restricted to: 00 f,. ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2011 ('ummissiuner Tr#: 1690 Submit KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 PHONE DATE . .5.0 2 3 All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by Provisions of 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. REGISTRATION NO. EIN NO. 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: �y Construction related permits: It