HomeMy WebLinkAboutBuilding Permit #732 - 43 LISA LANE 6/25/2009Permit NO: v
Date Issued:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
LOCATION b Sa. _ Lq
Print
PROPERTY OWNER Y"vo--�o t' ct0 rl '1 MG -
Print
MAP NO 69 9S PARCEL:50 ZONING DISTRICT�Historic District
Machine Shoe
yes
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
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please
OWNER: Name: E.p- G -6 L.,a V r -i e
Address: 4-6 Li -�)g Ln
CONTRACTOR Name: ire CC5nf
or Print Clearly)
e:979-69236q'I
p
Address: 2- \ \te.W -kt N . ARdaye - , 011-
Supervisor's Construction License: C 2-`A J Exp. Date: %-'+12-o 10
Home Improvement License: t C) 95S �!) Exp. Date 12 zo/ 0
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: $ -Z t , O �J�• �O FEE: $ 2C
Check No.: 5 2 J Receipt No.: ad
NOTE: Persons contracting with unregistered contractors do not have acce4toa ar myfund
,-_,__. _..-q_ _.___t,_ --o ._ ._ignature ofAgent/Owner Signatureofcontractor
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
XOMMENTS
14
Zoning Board of Appeals: Variance, Petition No: - Zoning Decision/receipt submitted yes
Planning Board Decisiori:
Conservation Decision:
Comments
Comme
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes,
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Located 384
no
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: Building Permit Revised 2008
Location
No. -7-32, Dated
NGRTN
TOWN OF NORTH ANDOVER
1
Certificate of Occupancy
$
�� s'•^°' ESQ'
�CMUS
Building/Frame Permit Fee
$ -'
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check #
22►%1�4
V
Building Inspector
CA
m
m
m
YI
m
y
m
y
'v
C �
d
CO) Cl)
10 0
CD
MZ y
CLO n.
r
C2. = y
� o �
O v CD
�� O
cr
Id ED
CD CD
w w _3,
C CD rA
av y
a C
CD I
� v
y O
CD CD Z
oCD
cmdcCD
CrT]
cn
n
O
Cn
C
0
C O
d
H
S
N e O
??
y
m a ®n
N m d C
��'-
P11
o
asn
�-
r
b
?r
o
oda
x
ca
z��o
w
c?d
=
m
CD
CD
^
y
y
� o
O
G
S
=rco
m
CD
CA
BOO:
Z�.n
O N O
a
= o,m
CL
O
CD
,o0
c
CD k
m�
N
to y
CL d f
:
cr
,W
�CD
m
C O
CA
N
O
m mcol
:a
=10:
_I
3
CCD
oo:
CD o
CA
CD_
—CD
n,h
� O
a3�
.� co)
CD
o CD
d
C -)C:
C* SO
rA
�m
CD
\�
r0
rA
9
0
4�
^
It
??
o�
�
�-
��'-
o
asn
�-
r
b
?r
o
oda
x
"�
�
Q�
z��o
w
z
CD
ok
x
a
o•
w
�
�
0
^
y
o
A.
^
C
H
0
9
0
H
KEEN CONSTRUCTION CO
21 HEWITT AVE.
N. ANDOVER, MA 01845
(978) 691-5201.
Neyman, Eric & Laurie
43 Lisa Lane
N. Andover, MA 01845
(978) 682-3544
Contract # 5015; Appendix A Date: 6/13/2009
Remodel existing 3 season room:
• Remove existing sliding doors
• Remove existing cedar shakes from wall abutting house
• Remove ceiling and ceiling joists
• Remove flooring down to the deck boards
• Cut overhang of deck boards where knee wall will be framed
• Move one 4" x 4" support column to accept 6' sliding door
• Frame knee walls approximately 26" from floor to accept windows
• Install collar ties in ceiling to create vault (as high as possible)
• Supply & install one Pella Impervia 6' sliding door
• Supply & install five Pella Impervia sliding windows
• Supply & install 1" x 6" v -groove primed pine on ceiling
• Supply & install 1" x 6" bead board primed pine on all walls
• Supply & install 1" x 4" primed pine trim on base, doors and windows (interior and exterior)
• Supply &install vinyl siding below windows to match existing
• Paint all walls, ceiling & trim (interior and exterior trim) with two neutral colors, two coat finish
• Supply & install Homer 5 %" Country Hickory engineered hardwood flooring
Electrical:
• Supply & install four recessed ceiling light fixtures
• Supply & install one fan safe
• Install customer supplied paddle fan and control
• Supply & install outlets in knee wall
• Supply & install switching for lights
Total Price: $21,056.00 (twenty one thousand fifty six dollars)
Price does not include cost of permits, rotten wood found, paddle fan & control or changes required by
inspectors.
The windows selected by the customer will not meet federal standards for the tax incentive program.
Page 1 of 2
KEEN CONSTRUCTION CO
21 HEWITT AVE.
N. ANDOVER, MA 01845
(978) 691-5201.
Payment schedule: $4000.00 due upon signing contract
$3000.00 due on 1s' day of work
$3000.00 due when rough framing is complete
$2000.00 due when rough electrical is complete
;,'$3000.00 due when pine on ceiling and walls is installed
3000.00 due when job is complete except flooring
$3056.00 due when contracted work is complete
/4�
Customer Ken
teth B. Keen ' ✓
1 L
Date Date
Page 2 of 2
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration; 108383
— Exptration A't18/2010 Tr# 272473
DBA 6
:�•\ Type,
KEEN CONSTRf1CTION CO
Keen `
Kenneth
r
21 Hewitt Ave
?: No. Andover, MA 01845
Administrator
✓iie -l�Jana/rna�uvea� o�../l/l�aaaac�u�aP,ll` k
Y� Board of Building Regulations and Standards
Construction Supervisor License
License: CS 58245
Expiration 3/24/2010 Tr# 17840
Restr0ion: 00
KENNETH B KEEN
21 HEWITT AVE
N ANDOVER, MA 01845 Commissioner '
E. ✓ J?� U/ O'iJ7/IItO'I9.UJP,CLLGfL � i �,CLOOZ7.CaZLIOC�i1
Board of Building. Regulations and Standards
Construction Supervisor License
License: CS 76691
Birthdate '-8/16/1968
Expiration 4',8/16/2009 Tr# 3859
Rest i' UA -bb
ROBERT A KEEN
12 E` WATER ST
N ANDOVER, MA 01845 Commissioner
KEEN CONSTRUCTION CO. GP
a 21 HEWITT AVENUE
NORTH ANDOVER. MA 01845
Tel: (978) 691-5201
Fax: (978) 682-3231
Submitted /
........ ... _�/./_....:Z�
PROPOSAL
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.
PHONE DATE REGISTRATION NO. EIN NO.
_9-73- 62) _ 35q476--/3 — 9 MA. H.I.C. 108383 26-0462904
C/S = Customer Supplied S + I = Supply + Install M/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
Contra or will of 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 that such delays that are not avoidable by the Contractor shall n t be considere 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 T following completion and shall
comply with the requiremehts of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor is 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 :
�
dollars ($ rte% i 12 _ � � --1
C( C
to be made as follows:
% ($ ) upon signing Contra t;
upon I
-m ption of
% ($ i ' pon completion of _
KENNETH B. KEEN / ROBERT A. KEEN
Name of Contractor / Designated Registrant
21 HEWITT AVE.
Street Address
N. ANDOVER, MA 01845
City / State
i shall be made forthwith upon (978) 691-5201 (978) 682-3231
° ) completion of work under this contract.
Phone
Fax
Notice: No agreement for home improvement contracting work shall require a _
Name nl Sa
te r"
>down payment (advance deposit) of more than one-third of the total contract price 1�
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 Authoriz Si t e
equipment, whichever amount is greater. Note: h' proposet may be withdrawn by us if 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 ANY BLANK SPACES.
Signature ` � Date ` I ` U Signature Date
IMPORTANT INFORMATION ON BACK W-
L4
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
mpensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
n
Name (Business/Organization/Individual):
G
Please
Address: -21 ReLi i-(+ Ave,
City/State/Zip:h, PAdNk!7- AW -6/1s'!'5 Phone #: 9%,31 69J -520
Are you an employer? Check the appropriate box:
1.0 I am a employer with
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.
employees and have workers'
[No workers' comp. insurance
comp. insurance.T
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp,
insurance required.] t
5. ❑ 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
10.0 Electrical repairs or additions
11. El Plumbing repairs or additions
12.❑ Roof. repairs
13. ❑ Other
*Any 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.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. _
Insurance Company Name: 574,*
Policy # or Self -ins. Lic. #: WC 7L%3 JL/77 Expiration Date: 9/ /0 J
Job Site Address: q,3 L, i,5ct U J r City/State/Zip:"all �i, !'/t t/ ole / 5
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 ipsurancjr coverage verification.
I do hereby certify r thpain nd penalties ofperjury that the information provide//d above is true and correct.
Si nature: rintp. 612 V� 16 9
Phone #: 9) 0 —(0.91 ' 17,
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 S. Plumbing Inspector
6. Other
Contact Person: Phone #:
a/S/2009 4:15 PM FROM: Gilbert Insurance Aa Gilbert Insurance Aq TO: +1 (918) 682-3231 PAGE: 002 OF 003
AC- R ,, CERTIFICATE OF LIABILITY INSURANCE
DATE (MMODYYYY)
04/09/2009
PRODUCER (781)942-2225 FAX (781)942-2226
Gilbert Insurance Agency, Inc.
137 Main Street
Reading, MA 01867-3922
THIS CERTIFICATE IS 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 NAI: #
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:
COVERAGES
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.
INSR
ADDI
Ibm
TYPE OF INSURANCE
POLICY NUMBER
POLICYEFFECTNE
POLICYEXPI2ATION1I&
)ATE (MMIDDIM
LIMITS
AUTHORIZED REPRESENTATIVE
GENERAL LIABILITY
ND -P-010078/000
03/13/2009
03/13/2010
EACH OCCURRENCE $ 1,000,00(
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED g S0
CLAIMS MADE ® OCCUR
MED EXP (Any one person) $ 5,00(
A
PERSONAL & ADV INJURY $ 1 000 00
GENERAL AGGREGATE $ 2:000:00(
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,00
X POLICY PE LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
(Es accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
BODILY INJURY
NON -OWNED AUTOS
(Per accident) S
PROPERTY DAMAGE $
(Per accident)
GARAGE UAHILfTY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ADC S
ANY AUTO
AUTO ONLY: AGG $
EXCESSAIMBRELLA LIABILITY
EACH OCCURRENCE $
OCCUR ❑ CLAIMS MADE
AGGREGATE $
g
S
DEDUCTIBLE
$
RETENTION S
WORKERS COMPENSATION AND
WC7431477
08/03/2008
08/03/2009
X I WC STATU- OTH-
TORY LIMITS FIR
EMPLOYERS'LIABLITY
E.L. EACH ACCIDENT $ LOQ QO
B
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYEE $ 100,00
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - POLICY LIMIT $ 500,00
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
riginal workers compensation certificates to be issued by company. Evidence of Insurance only.
CERTIFICATE HOLDER [_ANI FI I ATIAN
ACORD 25 (2001108) OACORD CORPORATION 1988
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MNL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY W ND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
NONE - EVIDENCE ONLY
AUTHORIZED REPRESENTATIVE
Mark Gilbert CIC
ACORD 25 (2001108) OACORD CORPORATION 1988