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Home My WebLink AboutBuilding Permit #285-14 - 35 EQUESTRIAN DRIVE 9/27/2013 L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: U Date Received Date Issued: I PORTANT: Applicant must complete all items on this age LOCATION Print PROPERTY OWNER �4 U `6 ---t'�� y"d" Print 100 Year Old Structure yes o MAP NO: � PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes 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 El'Floodplain ElWetlands ❑ Watershed District ❑Water/Sewer DESCJIPTION OF WOPK Tq BE PERFORMED: Identific tion Jlease UTye or Print Clearly) n�� OWNER: Name: L0(3 -(.1 c^ Phone:7 W Address: 3;z- U� rte �� ► " ' O�J�� LLImproovement Name: �1 - l.olil f Phone97F-691- 2 � 3 �- nstruction License:C5- n71n(�� Exp. Date: q/t G License: l�� 323 Exp. Date: (r� r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.000 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � , /7 1 U6 FEE: $ A'_2�2 , ` Check No.: bo Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the g ra fund Si nature of A ent/Owner Si nature of contracto r_g t- _g-_ _ _ _._.9 - - - - � .� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ LocationNo. 0 Date Z . - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y Check#77-7&� J } u Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE:OF`.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swirling Pools ❑ Well ❑ Tobacco-Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent 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 Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS 1 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 r DPW Tow,. Engineer: Signature: Located 384 Osgood Street ' FIRE DEPARTM�_NT =Temp Dumpster on site yes. Located at 124 Mair, Street no Fire Department signature/date COMMENTS I L 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 LI Notified for pickup - Date E Doc.Building Permit Revised 2010 r Building Department The folt,"o. wing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, 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 Affidavits for Engineered❑ Engineering products g 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 apo-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submated with the building application Doc: Doc.Building Permit Revised 2012 t NORTH own of ndover 0 0 h , ver, Mass, X613 COC MIC Nl WICK y1. S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....... 6-3 .. ....I. ................:............................... ...................... BUILDING INSPECTOR has permission to erect buildings on .. S 4!!!� �............ Foundation .......................... .. Rough to be occupied as ��... . � !?R,!? �. cle y provided that the person accep ng this permit shall in every res ct 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final ` PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T Rough Service ........................ ...................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SEE REVERSE SIDE 09/_2.7+//2�U13 09:00 FAX 781 942 2226 GILBERT 4001 r ' a DATE(MMIDD/YYYY) AC 1 D CERTIFICATE OF LIABILITY INSURANCE 1410/2013 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(les) must be endorsed. If SUBROGATION IS WAIVED,subject t0 the terms 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 NAME C bartema McDonough Gilbert InBurance Agency, Inc. PHONE , (781)942-2225 F I (791)942-2226 137 Main Street E-MAIL ADDRESS.bmcdonoughegilbertinsurance.coml INSURERS AFFORDINO COVERAGE I NAIC S Reading MA 01867-3922 INSURER A:NORSOLK ts DEDHAM INSURANCE 23965 INSURED INSURERB:Travelers Ins. Co. 0031 Keen Construction Company INSURFAC: 21 Hewitt Avenue INSURER P: INSURERE: 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 8Y PAID CLAIMS. INST/PE OF INSURANCE A POLICY EFF POLICY EXP LIMITS LTR wynPOUCYNUM ER MM IDD Y GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 -DAMAOE TO RENTED X CONAIERCIALGENERAL.LIABILITY PREMIE nce 5 100,000 A CLAMS-NIADE OCCUR -P-010078/000 /13/2013 /13/2014 IVIED EXP(Arty one anon) 5,000 PERSONAL 9:ADV INJURY S 11000,000 GENERAL AGGREGATE I .S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS•COMP/OP AGO S 2,000,000 X POLICY PRO. LOC S AUTOMOBILE LIABILITY COMBINED 61NUM L MIT ccldera ANY AUTO BODILY INJURY(Per pereon), 5 ALL OWNED SCHEDULED BODILY INJURV(Par amidMU S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Paratxide 13 UMBRELLA LIAROCCUR EACH OCCURRENCE 4 EXCESS LAS HCLAWAS44ADE AGGREGATE I I DED RETENTION I i B WORK=COMPENSATION SSTATU, OTH- AND EMPLOYMS'LIABILITY ANY PROPRIETOWPARTNEPEXECUTIVE YIN E.L.EAC14ACCIDENT i L 100,000 OFFICERIMEM13ER EXCLUDED NIA (Mandatory In.NMI BTLTTH-580726-A-13 /3/2013 /3/2014 E.L.DISEASE-EA EMPLOYE 3 100,000 It yes describe under DESCRIPTION OF OPERATIONS below E.L 018EASE.POLICY LIMB 9 500 000 DESCRIP71ON OF OPERATIONS I LOCATIONS/VEHICLES IANach ACORD 101,Addltlonal Remarks SehedUls,If mora space Is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEICANCELLEO BEFORE THE ExPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS.. AUTHORRED REPRESENTATIVE M Gilbert, CIC/BARBAR ACORD 26(2010105) 9)1938-2010 ACORD CORPORATION! All rights reserved. INS025(2mon).01 The ACORD name and logo are registered marks of ACORD i The Commonwealth ofMassachusetts Department of Indus'frial.Accidents Office oflnvestigations 600 Washington Street Boston,MA 02111 SY VwI-m6-IssogoyMa Workers' Comp ensationinsurance Affidavit:Builders/Contra ctorsyiectricians/PZumbers A licalnf Information �'leasePrintx,e ibl Name(Business/Organization/Tndividual): eQ� fan Address: Av .City/state/zip: IyUl (� d�� hone Are you an employer?Check the appropriate box: L I am a employer with. 4. D I am a general contractor and I pe ofproject(required): employees(full and/or parttime)• have lured the sub-contractors • ❑New construction 2• I am a sole proprietor orpartner- listed on the attached sheet.t 7. []Remodeling ship and have no employees These sub-coutractorskave working forme in any capacity. workers'comp.insurance. g' Demblition [No workers'comp.insurance 5. ❑ We aic a corp oxation audits 9. 0130dmg addition required.] 'fficers have exercised their 10.[]Electrical repairs or additions 3• I am a homeowner doing all work right of exemption per MGL 11.D Plumbing repairs or additions myself.[No workers' comp, .X52,§1(4),andv'ehaveno insurance required.]i cc- 12.DRoofrepairs employees,[No workers' comp,insurance required.] 13.0 Other . 44 applicant that checks box#1 must also fiII out the section below showing their workers'compensafionpolicy Information. T Homeowners who submit this affidavit indiFafingthey are doink all work and then hire outside contractors must submit a new affidavit indicating such. Confracfors that check this box must attached an additional sheet showing th��n , tsonfracorsand theirkcop.policyinformaZcalo2at isproviding workers'compensation Ince for my eynpZoyees Below is tlaepolicy rznctjob site reformation. assurance Company Name:_ /V/2 fl ,� S 'Olicy#or Self-ins.Lic. (?u - . ! Expiration Date: )b Site Address: — n u r�/2► i1►-- �,� City/State/Zip. ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). tiIure to secure coverage as required under Section 25A of.MGL c.152 can lead to the imposifion of cri Le up to$1,500.00 and/or one-year imprisonmentminalpenalties of a ,as well as civil penalties in the form of a STOP WORK ORDER,and a fine �.P to$250.00 a day against the violator. De advised that a copy ofthis statement may be forwardedto the OffZce of 'estigations of the DTA.for insurance coverage verification. lierehy certYy under thepains andpenarties ofperjury Azatthe infora►aation provided above is true and correct. ` nature: • Rafe: . ae 4: Yfrcial use on&. DO not Write an tills area,to be completed by city or town offciar. ity or Torun: Permit/Gicense# ' Ming Authority(circle one): Eoard of Health 2.Building Department 3.City/To1vx►Clerk' �.Electricalhspector 5,plutnbin Other glnspector Information' anti Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ` of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152,§25C(6)also states that"everystate or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for nny applicant who has not produced acceptable evidence of compliance with the insurancd coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapterhave beenpresented to the contracting authority." Applicants , Please fill out the workers,compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addresses)andphone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)orl imitedLiability partnerships(LLP)with no employees other th.anthe members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. De advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation.of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application fox the permit orlicense is being requested,not the Department of In Accidents. Should you have any questions regarding the law or if you are required to obtain a Workers' compensation policy;please call the Department at the Number listed below. Self-insured companies should enter their self-insurance,license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete andprinted legibly. The Departmenthas providedaspace atthe bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. PIease be sure to fill in the permit/license number which will be used as a reference number. I addition,an applicant that must submit multiplepermit/license applications in any given year;need only submit one affidavit indicating current Policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit thathas been officially stamped or marred by the city or town may be provided to the applicant as pro of that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or permit notrelated to,any business or commercial venture (i.e.a dog license or permit to burn.leaves etc.)said person is NOTrequired to complete this affidavit. The Office of.Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: ` ha ConamowwearLu of Arjauac umtts 13epartmoAt Of ladu4d l.A.celdeats OXce of IUVeMigations 600 Washington Sjree1 BQstQn M�4 02111 T01.#617-727-4900 ext 4Q6 or 1..977MARRAVP . 'IJ KEEN CONSTRUCTION CO. 21 REWITTAVE. N. ANDOVER, MA 01845 978-691 -5201 -- 1CeP�o-v�tv'U.c<t�crvLCcr:cd-vw Wagner,Lou & Linda 32 Equestrian Dr. N.Andover, MA 01845 978-686-9354 Contract#5080;Appendix A Date: 9/8/2013 Remodel existing deck: • Remove and dispose of deck surface, railing and lattice from existing 14'x 40' deck • Relocate 4.' x 4" posts if needed • Supply& install new flashing:under existing siding, deck surface,railing_ s and lattice • Material to be as follows: o Decking-Timbertech,XLM Harvest Bronze PVC decking o Railing:Timbertech Radiance Rail Antique White o Lattice: PVC,square-privacy 4'x 8' panels o Trim: %" PVC trim boards Price does not include cost of permits,framing or any unusual, unsafe or insufficient existing conditions. Total Price:$35,978.00 (Thirty.Five Thousand Nine Hundred Seventy Eight Dollars) Payment Schedule: $10,000.00 due upon signing contract(to cover cost of.decking) $5,000:00 due the first day of work $5,000.0.0 due when old material is removed(plus'permit fee) $5,000.00 due when decking is installed $5;000.00 due when railings are installed $5;978.00 due when contracted work is complete Customer Kenneth B.Keen Date Date *� Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-076691 ROBERT A KEEN 12 E WATER ST; c . North Andover� 01.815J , )I Ok' Expiration Commissioner 08/16/2015 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuperN isur License: CS-058245 I FS KENNETH B I&EN _ r. 21 HEWITT AVE,,jj N ANDOVER MA'019845, ..t.+. N'7rrj4, Expiration Commissioner 03/24/2014 �1ie�aminaoauuecr,�l/i o��aa�uaeGt Office of Consumer Affairs Bc Busi ess.Regulation i OME IMPROVEMENT CONTRACTOR egistration • 108383 Type: 1 xpiration 8/1`8/2014 DBA l KEEN CONSTRUCTION C0 Kenneth Keen 21 Hewitt Ave No.Andover, MA 01845 Undersecretary