Loading...
HomeMy WebLinkAboutBuilding Permit #74-11 - 43 LISA LANE 7/20/2010TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Issued: !� Date Received IMPORTANT: Applicant must complete all items on this pa,2e LOCATION__ d'2 L 1 r9 Z N PROPERTY OWNER I r► �� �.?in// / 1 k t 77 A f C YL. Print MAP NO: 10 PARCEL: ZONING DISTRICT: Historic District yes ti on Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE -Residential Non- Residential New Building L--O-ne family Addition Two or more family Industrial Alteration No. of units: Commercial Others: repair, replacement Assessory Bldg Demolition Other Septic Well Floodplain Wetlands Watershed District vWater/Sewer DESCRIPTION OF ORK TO BE PERFORMED: fZ rn o c L (At+ s fig,• Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: i/1�2 rj NLf�J Phone: C/7 69 t 'S a(Z l Address: .:vq { 1+ -w -k in vqUE 1. 4 r cf, , N ff Supervisor's Construction License: q S- Exp. Date: 3 `/a Home Improvement License: ! b 3 Exp. Date: 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: $ LQ )'—" FEE: $ I �Jb Check No.:Receipt No.:� 1 Z NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED 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 & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 MainStreet 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 2008 Location 40 Z^ No. 2� Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ? Other Permit Fee $ TOTAL $� 23 0 ilding inspector m m m m X CO) m CO) .p CD aZ CD O CL r =? CL.��. n� CD � O o p C� Q CD CD a: p S.O tC = CD w O CO2 .p n c 0 C CO2 CDd O _ rt CD CD a CO2 CD CO2 C2 O CCD O CD cn O to t O 0 Z O CD 0 t0 O W C to co coC "Ort. O N C 0 a N N cn o a y N y ®C.:, d � Cos C d C n m =r= N H 2iO m a�� CO) .p CD aZ CD O CL r =? CL.��. n� CD � O o p C� Q CD CD a: p S.O tC = CD w O CO2 .p n c 0 C CO2 CDd O _ rt CD CD a CO2 CD CO2 C2 O CCD O CD cn O to t O 0 Z O CD 0 t0 O W C to co coC "Ort. O N C 0 a N N O y, C09 � • =r =7F LO H CL .....+ O m H o mO CL N9/ : d H 1�� o a: a me 0o a CD H � t d CA co -�- U2 = , �- 0 0 . CS co, � CO CD CD a� H : CD SU C n � Co O .: O . � O O �w cn d rD cn o a aN �.CD N y ®C.:, m c-) Cos C d C n m =r= N H 2iO m a�� z T m CD OCD C,* c y -0:--I� o�o: O CD a c : � � O O y, C09 � • =r =7F LO H CL .....+ O m H o mO CL N9/ : d H 1�� o a: a me 0o a CD H � t d CA co -�- U2 = , �- 0 0 . CS co, � CO CD CD a� H : CD SU C n � Co O .: O . � O O �w cn d rD cn o a Oil 7d tz tz IV �z CEi OQ O c W0. n r b 2iO n rD ` z 03x O c � OC �- 9O O ozy z O 4 1 0 I� rA rA n cr 0 c KEEN CONSTRUCTION CO. CP 21 HEWITT AVE. N. ANDOVER, MA 01845 978-685-0641 Whittaker, Steve & Cindy 62 Lisa Ln. N. Andover, MA 01845 978-683-8004 Contract ## 5265; Appendix A Date: 7/15/2010 Remodel master bath: • Reframe door & install pocket door kit (if possible, $250.00 credit if not) • Install blocking for shower seat '.grab rail & soap cubby in shower area • Supply & install insulation in exterior wall • Upgrade electrical to code ($1200.00 allowance) • Supply & install blueboard and skimcoat plaster walls and ceiling to smooth finish • Install customer supplied Swanstone shower wall kit (including corner seat and soap cubby) • Install customer supplied ceramic the on floor (standard installation) • Supply & install trim to match existing • Repair front entry halfway ceiling on first floor below tub area Price: $7300.00 Price does not include cost of permits, plumbing or plumbing fixtures, paint, demo, electrical fixtures, or ceramic tile. Main bath: • Supply & install blueboard in shower area and skimcoat plaster to smooth finish • Install customer supplied shower surround Price: $950.00 Price does not include demo, plumbing, the work, shower surround or paint. Total Price: $8250 00 (eighty two hundred fifty dollars) ,fir Payment schedule: $1000.00 due upon signing contracts $1000.00 due the 15'day of work w- $3000.00 due when insulation and blueboard is instaffed $1000.00 due when floor the and trim is installed $1000.00 due when shower walls in master bath are installed $1250.00 due w n contracted work is complete A � � r Custo er Kenn th f3. Keen 71liv/-zoIo 2-1,5 _f0. ---------- ii. -e �i o7rvnwauuea�li o�✓�aaaacivaeG�a ` `? Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Regist( h4, 108383 E ixati�n $118/2010 Tr# 272473 Tpe IJ6A KEEN CONSTRl160'i G ' Kenneth Keen - '• 21 Hewitt Aver No, Andover, MA 01845`'' Administrator I 3-1— Malsachusetts - Department of Public SafetN — Board of Building Regulations and Standards Construction Supervisor License License: CS 58245 Restricted to: 00 KENNETH B KEEN y 21 HEWITT AVE N ANDOVER, MA 01845 Expiration: 3/24/2012 ( unmi.�i mcg Tr#: 20523 J WIL Massachusetts - Depai-tment of Public S!fet�: Board of Building Re,�ulations and Standards Construction Supervisor License License: CS 76691 Restricted to: 00 ROBERT A KEEN 12 E WATER ST N ANDOVER; MA 01845 Expiration: 8/16/2011' 1 ( ununisxfuner Tr#: 1690 3/3n/2mn Q!30 AM FROM- Gilh—t Tn—ran— GilhPrt Tnsnrnn— Anon— Tnr_ Tn• al rQ7A1 r.A9_7921 Dace nn1 nr nn? ACORDM CERTIFICATE OF LIABILITY INSURANCE TE (MWDDNY" 03/30/20 0 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 ONLYAND 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 Keen & Robert Keen DBA: DBA Keen Construction Company 21 Hewitt Ave. North Andover, MA 01845 INSURERA: NORFOLK & DEDHAM INSURANCE 23965 INSURERB: Granite State Ins. Co. 0077 INSURER C: INSURER D: INSURER E: fInkIPGAr CC 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. INTR DDR' TY PE OF INSURANCE POLICYNUMBER PDOLICYATE M�DCTIVE POLIffYI CY E,XPI TION LIMITS GENERAL LIABILITY ND -P-010078/000 03/13/2010 03/13/2011 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED $ 50,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5,000 AT-- PERSONAL & ADV INJURY $ 1-10-0-0-1000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRG -LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ee accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO E OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR a CLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMP LOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE ORI OFF ICER/MEMBER EXCLUDED? If yes, describe under W0006371378 INAL TO BE MAILED VIA MASS WORK COMP BUREAU 08/03/2009 08/03/2010 WC STATU- OTH- TORY IS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEd $ 100,00 E.L. DISEASE - POLICY LIMIT 1 $ 500,000 SPECIAL PROVISIONS below - OTHER DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Evidence of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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 KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Mark Gilbert, CIC ACORD 25 (2001108) FAX: (978)b13 -831U ©ACORD CORPORATION 1989 The Commonwealth of Massachusetts i DePartment of Industrial Accidents I Office of Investigations 'F� 600 Washington Street Boston, MA 02111 www m=s you/dia . Workers' Compensation Iasitrance Affidavit: Builders/C Alicant nformation oatsctors/Eiecfricians/Piumbers I Please Print LeQibl Name (Business/orgmization/individoal): d t; E N u c 1,C) -1/ Address: oZ City/,State/Zig:�(3 -, 0 / $ �S Phone #:. g 7 ' y employer? Check the appropriate box: employer with 4. Type of Project (required): ❑ I am a general contractor and I ees (full and/or part-time).* have hired the sub -contractors 6. ❑ New construction FO -171 ole proprietor or partner_ listed on the attached sheet Remodeli ship and have no employees These suti-contraetors have ng working for mem any capacity, workers' comp. insurance, 8' ❑ Demolition (No workers' comp. insurance 5. We are a corporation and its 9• ❑ Building addition 3. required.) officers have exercised their 10.0 Electrical repairs or additions �] I am a homeowner doing all work right of exemption per MGL I I .�] Plumbing repairs or additions myself. (No•warkers' comp, a insurance required.1t 2, § I(. [No wor have no 12.❑ Roof repairs �1 � ��PloYees. [No workers' COMP- it Musanc a require&] I3 •❑ Othtr Any applicant that checks boZ 1f t mutt also fill out the section below showing their workers' bompettsetiori policy information Homeowner¢ who submit this afft'davit indicating they sm.doin all Contractors that check this box roust g work and then him outside contractors must submit a new affidavk indicating ra sdrFitiarrsl ehe show Phe narne of the sub -contractors and their workers' ce °smn such I anr.an er�rployer that is ro ' mF• pcti3• irtnmration. f p radirrg workers contpe2s n cizsu-,=ce for IM employees; Below is the o in arnrafio2 /� P &J' and yob site . Insurance Company Name: Li /2q N -+- E .0q �N S Policy # or Self -ins. Lie. #: 3' Expiration Date: Q Job Site Address: Attach a copy of the workers' cotrtpensa#ion I' d Ci"tate2rp. Policy oration page (showing the policy number and expiration daie� . Failure to secure coverage as required under Section 25A of MGL C. 152 can lead to the imposition of criminal fine up to $1,500,00 as one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and of a" 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 a fine Investigations of the DIA for insurance coverage verification. •yy unser Eftepamr�kdeaaltiea of Perjury '*at the irrf"Matian provided above is true and correct Official use only.Do not write in (his area, to be completed by c� or town. o �i a4 City or Town: Issuing Authority (circPermit/License #le one): I. Board of Hesltb 6. Other 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Piumbin Inspector pector Contact Person: Phone #: KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 Submitted t( I{ t ^) PHONE DATE 5 2 t., luffo7luowm 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. I EIN NO. MA. H.I.C. 108383 26-0462904 > C/S = Customer Supplied S + I = Supply + Install B~"See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: > Construction related permits: ...,....._..._..,.._,.....__......----_..._......................_..........................,.........lf,`... ,'"�: I t� €.-1 + .�-' f..t ......_i�'."..� � .,..., ,.,.....,......_tJ.......� ...� ff_)..�....,..._�n...�6.._:..%�.i...',.�...1... �.. ...............................,..................... /..'';.. t WORK SCHEDULE 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 that 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 +: !L 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: it r C )n v' iy C�,)) d Tl U ii,)( Payment tol6e made as follows: y ` / dollars ($ > ) _ % ($ ) upon signing -Contract; f % ($ mon completion of _ %' upon completion of .. / shall be made forthwith upon % ($ ) completion of work under this contract. KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor / Designated Registrant 21 HEWITT AVE. Street Address N...ANOOVER, MA 01845 - City / State (978) 691-5201 (978) 682-3231 Phone Fax Notice: No agreement for home improvement contracting work shall require a >down payment (advance deposit) of more than one-third of the total contract price Named$ Dynan j 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 Aut' tgnature equipment, whichever amount Is greater. Note: This proposal 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 myst be done in writing. C ,l j DO/NOT SI1;N THIS CONTRACT IF THERE ARE ANY .BLANK SPACES. signatere ^ .f .r F ri v i v. Date % "/ g Q Si nature Date' r IMPORTANT INFORMATION ON,$ACK I _..,.--_ - ----. _- _ —_