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HomeMy WebLinkAboutBuilding Permit #457 - 46 FOSTER STREET 12/8/2006 L TOWN OF NORTH ANDOVER pORTh APPLICATION FOR PLAN EXAMINATION 01 <t�•' #6q't'o t° p ♦ t +f 1 Permit NO: �' Date Received � 0 Date Issued: SSACNus IMPORTANT: Applicant must complete all items on this page . . . LOCATION 4w -- Print PROPERTY OWNER ��r �.� O GZ Print MAP NO.1 0 (A PARCEL: S—C' ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building >(One family ❑ Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: Repair, replacement ❑ Assessory Bldg ❑Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DE,S,CRIPTION OF WQRK TO BE PREFORMED ,e-aZ) Identification Please Type or Print Clearly) OWNER: Name: C Phone: X17 �g g Address: r CONTRACTOR Name: ��� '` ��4� '�'` o Phone Address: ]JtL J 44 ©t `0 Supervisor's Construction License: Exp. Date: /0 D 7 Home Improvement License: Exp. Date: I 27 v ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost 1 000 FEE:$ r 16 V2 43Z— Check No.: ? Receipt No.: Page I of 4 � --R-- Location - / No. Date NORTq TOWN OF NORTH ANDOVER MF a s Certificate of Occupancy $ �Ss+cMust<� Building/Frame Permit Fee $ �^''" { Foundation Permit Fee $ c Other Permit Fee $ TOTAL $ Check # 19865 `~? Building Inspector TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ F1 Tobacco Art ❑ g Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project j NOTE: Persons contracting with unregistered contractors do not have access to th;Stamped guarantyfu Signature of Agent/Owner Signature of contract Plans Submitted El Plans Waived ❑ Certified Plot Plan ❑ Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION" 411 COMMENTS � c (,U����,( '� . DATE REJECTED DATE APPROVED HEALTH ❑ ❑ N COMMENTS 'I FIRE DEPARTMENT - Temp Dumpster on site yes Fire Department signature/date 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 Drivewav Permit Building Setback ( Front Yard Side Yard Rear Yard Required Provided Re uired Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use IN6 YL i i i Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2000 {v I 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 Addition Or Decks ❑ Building Permit Application ❑ 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) New Construction (Single and Two Family) ❑ Building PP 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 1 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 i I i Page 4 of 4 NORTH T C-M own of Andover No. C% ver, Mas 0 0 S40P Cc, HEWICK IT Of#ATED Pk%l WARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR !... ......... .. .............................................. Foundation has permission to erej....................................... buildings on.....fRough 'A...........f� !1 .... ... ................. to be occupied as..Xe.... -4044AR...W.. 41 i . i...........1..* ......4W 4 "Uney I : every .. .. ...&."� provided that the person accepting tWperm shall respect conform to 'the terms of the application on file in Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 43LOOM PERINvff EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU00 TS Rough T . Service BUILDING-INSPECTORFinal Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE" Smoke Det. 9 7 ` abbitt esign TAVIS R.BABBITT 60 BREED STREET LYNN,MA 01902 781-592-9201 LEGEND Dumc WA_ \=W WA•_ STORAGE FAMILY 17.2'X V.9' I MUDROOM I KITCHEN 7-6 x 12-0• WALL O O ❑ REV15IONS WEN O O N0. DATE s GARAGE ur71 r7 M BREAKFA57 PROJECT: FOYER- � 14'Tx77 MARGOLYGZHOUSE DINING 46 FOSTER STREET ,r 4.6x3'-r NORTH ANDOVER,MA L � SHEET TITLE: ---- , PROPOSED FIRST FLOOR PLAN SCALE: 1/6=1'-0•• PROJECT#: X162 DATE: NOVEIMBER 27,2006 DRAWING#: : .� A - 1 3 Y abbitt esign TAVI5 R.BABBITT 60 BREED 5TREET LYNN,MA 01902 781-592-9201 LEGEND - -Ww N_1VWA._ - Fm - EllLU FM ❑❑ ❑❑ ❑❑ a a a ❑❑ ❑❑ ❑❑ ❑❑ FRONT ELEVATION REVI510N5 [� NO. DATE PROJECT: MARGOLYGZ HOUSE 46 FOSTER STREET NORTH ANDOVER,MA SHEET TITLE: FRONT ELEVATIONS � = LWFFH ® B ® ® ® E10T-1 ❑❑ ❑❑ SCALE: 7/8"26162 PROJECT#: 26162 ❑❑ EI❑ ❑❑ FTI DATE: NUVEMBER27,2006 DRAWING#: FRONT ELEVATION A - 2 Myy G� abbitt esign TAVIS R.BABBITT 60 BREED 5TREET LYNN,MA 01902 781.592-9201 LEGEND NSTAG WA- ':w W0._ r REVISIONS NO. NO. DATE pr UP PROJECT: MARGOLYGZ HOUSE 4455 FOSTER STREET NORTH ANDOVER.MA 5HEET TITLE: EXISTING FIRST FLOOR PLAN SCALE: 1/8"=T-0 PROJECT d: 26162 DATE: NOVEMBER 27,2006 DRAWING : A _ 3 �tl e ene�-ter+ The Commonwealth of Massachusefts Department of Fire Services Office of the State Fire Marshal P.O.Box 1025 State Road,Stow,MA,01775 PERMIT Date: North Andover Permit No Dig Safe Num er (City of Town) (Lf Applicable) In accordance with the provisions of M.G_L.14 g Chapter 10 as provided in sections�7 CMR 34 Smrt Date � /J This Permit is granted to: Full name of person,Firm or Corporation Permissionto locate dumpster for construction/renovation/demolition of-building. - Comments: f building.Comments: dumpster must be . 25 ' from structure if unable to place with required Restrictions: tions: clearance / dumpster must be covered with plywood or tarp end of work -day at J (O /ewS 77 (Give location by street and no.,or describe in such manner as to provied adequate identification of location) Fee Paid$ 50.00 Fire Chief This Permit will expire Signature of offical granting permit) Offical granting permit (Title) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name(Business/Organization/Individual): F:Z "e—y Address: 325 Me,,,-) 2o:s -on 24, #4- City/State/Zip: W off,,,r r\ Mme, Phone.#: (178) 4Z3- CZ3Z3 Are y u an employer?Check the appropriate box: Type of project(required):. 1. I am a employer with W 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• $ 9. E]Building addition [No workers' comp. insurance comp. insurance. ME] Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *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. ;Contractors 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: fRe..n CA�S S 0.r\CQ, T—,r1A V Y'CW1 C-Q_ Policy#or Self-ins. Lic.#: V °C_OCA Z4 Z3 Expiration Date: Job Site Address: City/State/Zip: 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 g q �P 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 //ceify u der the pa' and penalties of perjury that the information provided above ' true and correct Si nature: L✓C 2 7 _ Date: Phone#: V ' -/ °2 3 — 0 3 .2 3 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#: Information and 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 be an employer." MGL chapter 152, §25C(6)also states that"every state 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 any applicant who has not produced acceptable evidence of compliance with the insurance 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 of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented 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),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be 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 for the permit or license is being requested,not the Department of Industrial 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 and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.govfdia A.�M CERTIFICATE OF LIABILITY INSURANCE �DATE(MMIDD YY) PRODUCER 6 (781)447-5531 FAX (7$3)447-7230 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mason & Masan Insurance Agency. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 458 South Ave. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Whitman, MA 023$2 ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. Gwen Vosburgh INSURE)RS AFFORDING COVERAGE NAIC# INSURED Devereux Enterprises IAC INSURERA; National Grange Mutual 14788 325 New Boston St INSURERS: Charter Oak Fire Insurance Co 25615 Unit 4 INSURERC: Savers Property & Casualty Ins 000203 Woburn, MA 01801 INSURER D; INSURER Er COVER THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEM 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 DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFPI°CTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY MSS26807 07/26/2006 07/26/2007 EACH OCCURRENCE $ X COMMERCIAL GENERAL LIABILITY 11000,00 DAMAGE Tq RENTED $ 50,000 CLAIMS MADE ®OCCUR MED EXP(Any one person) $ �0,000 A PERSONAL&ADV INJURY $ 1,000,oa GENERAL AGGREGATE $ 2,000 000 GENTAGGREdATE L(MITAPPuES PER: POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00( AUTOMOBILE LIABILITY BA1943AO3205SEL 12/14/2005 12/14/2006 COMBINED SINGLE LIMIT $ ANY AUTO (Ea�ccldenq 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS g (Per person) $ X HIRED AUTOS NOBODILY INJURY $ ){ NOWOWNED AUTOS (Per accidont) PROPERTY DAMAGE (Por accidenl) GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER TITAN EAAgC $ AUTO ONLY; AGG S EXCES"MDRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ OeoucnBLE RETENTION $ - $ WORKERS COM PENSATIONAND W0002423 0/29/2006 08/29/2007 WC STATU- OTH- ENIPLOYERS'LIASIUTY .C ANY PROPRIETORIPARTNER/EXECU'I'IVE E.L EACH ACCIDENT $ 500 00 OFFICERIMEMBER EXCLUDED? 11p 6 deSCtlbe Lindor E.L.DISEASE,EA EMPLOYE $ 500100 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $ 500100 DESCRIPTION OF OPERATIONS Ir�OCATION$I VEHICLE$I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS operations: remodeling contractor TIFIC HOLDER C L N 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, Essex Restoration BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 325 New Boston St. Unit #4 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, Woburn, MA 01801 AUTHORIZEOREPRESI:NTle,TIV ACORD 2s(2001/08) FAX. (781)569-6296 CACORD CORPORATION 1988 TO 39Vd NOSVW NOSVW ZE8ZLbbT8L 8Z:ET 90OZ/90/60 ______ ✓lie �arrunraruuea,�� o�./aGaaaac`euael7a ; -_` �'/ie -�oavrr�aouuea�C� o�./G�.aaa�ulucaeCza Board of Building Regulations and Standards a 'a BOARD OF BUILDING REGULATIONS License CONSTRUCTION SUPERVISOR HOME IMPROVEMENT CONTRACTOR Number CS-, 067041 Registration: 123313 Birthdate X10/1$11:963 Expiration: 1/27/2007 - Type: Private Corporation I i Ekpires+10/18/2A07 Tr.no: 7538.0 ESSEX RESTORATION/DEVEREAUX ENTERP. I Restt�cte S00 WALTER BEEBE-CENTER WALTER D BEEBE CENTER 17 KONDELIN RD#7 / �—G GLOUCESTER, MA 61"43'0 � 17 KONDELIN RD.7 GLOUCESTER,MA 01930 Commissioner Administrator 3 `NORTIy L BUILDING PERMIT o Ss�Eo "40 TOWN OF NORTH ANDOVER o p APPLICATION(CATION FOR PLAN EXAMINATION * ,� � o - e Permit NO:Jl� Date Received .y .� s ss ACHU Date Issued: y i IMPORTANT Applicant must complete all items on this page M. � �h��` TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: Q Commercial �8 Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other DESCRIPTIOr� OF WORK TO BE PREFORMEp. Ce% 0 Identification Please Type Print Cilearly) G OWNER: Name: e�'(' -b sG e o Phone, Address )IS IR-AfMay' ON- A, I 4^r 5 ,t� ! � �,� � " �., � � � s .� �- ���3,� s ,da ✓ �,�� int' .a A, r}e g �� 2-1 ARC HITECT/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: $ ('C�' /(0 5113 5 FEE: Check No.: 5-1116 Receipt No.: red contractors do not have access to i ar fund NOTE: Persons contracting with unregistered tJ' contractor, - 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 a Building Permit Application ❑ Workers Comp Affidavit ■ �h�t� 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 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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 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) :: O Notified for pickup - Date _......._ ................. ....................... . . Doc.Building Permit Revised 2007 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ . ❑ COMMENTS ` •.DATE REJECTED DATE APPROVED HEALTH ❑ sEl COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoriing Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/signature & Date Driveway Permit Located at 384 Osgood Street 1R� DEPARTMENTS Temp DamPste-cin slte�yesrio � LOca#ed mg at124 Malr1 StreetW y FIre�l epar men s>tgnatbrelda e } Location No. Date )v ,T NORTH TOWN OF NORTH ANDOVER F R 9 ' Certificate of Occupancy $ 'ss^cMusEtc'� Building/Frame Permit Fee $ JIV Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # n + G I Building Inspector FORTH c Town of And 'SVT O M,>.m�M-" lel.`•',F'• '���.., .0 o. 7 /7 o dover, Mass., T Q LAKE !� COC HIC HE WICK V 1, A�RATE0 PPS` �5 S E 0 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System P BUILDING.INSPECTOR THIS CERTIFIES THAT...................... ........ .........1...............................J.......... ................................................................ Foundation has permission to erect........................................ buildings on.................. .......................................................................... Rough to be occupied as A.)/.:vAcJS. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit, Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS Rough ... Service ..................... ...... .... .... BUILDING IN ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. KEEN CONSTRUCTION CO: 2,1 HEWI ,. r TT AVE. ANDOVER,MA 01845, 97$ 691-5 r _ A S ^ Margolycz,7ackie&Jerry' 46.Foster.S.t: N Andover,MA 01845 (978)683 7&88 Contract #4,67S Appe-n i-.A D°ate 5/27/08 Garls bedroom and:entry ceiling Remove ceihng;in entry(app`r'ox 41%' x 8 jend girls bedroom • Supply&install;blue board where ceiling was removed . • Skun coat plaster to a smooth finish Remove 1�arge window unit(picture with flarikers)m girlsbedroon • . Reframe window openmg_to accept new windows - J Supply&mstatl three Andersen Tilt=Wash windows with snap n grille's • S,upply&:mstall<tnm lo,rnatcl existing Total Price $,696,5;85 sixly,nine hundred=sixty five and 85/101 o: ars, Pace.does not include cost of perrrirts,"insulation in ceilmg;.:rotten wood found, or.replacing s'din°. g; !'Payment scfiedule $1000.00 due upon signing contract $2000 00 due the first day of,work $2000 00 due when windows;are,installed Pd $1000:OQ due when ceilings are removed $965 85"due at completion of'contracted work .. VT Guster Robert``A Keen Date ::Date KEEN CONSTRUCTION CO. 1678'OPOSAL a,, 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 All home improvement contractors and subcontractors Tel: (978)691-5201 engaged in home improvement contracting, unless Fax: (978)682-3231 specifically exempt from registration by Provisions of !� Chapter 142A of the general laws,must be registered with 1 ' - the Commonwealth of Massachusetts. Inquiries about Submitted � '� � 'ter G: ��. �_ To - --- - —-- -- registration and status should be made to the Director, ,�. Home Improvement Contract Registration,One Ashburton _ Place, Room 1301, Boston, MA 02108. (617) 727-8598. pp , n L4 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. MA. H.I.C. 1083, 04-325-8052 > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: - __ .... I _ CeI 11t ) , ......... ...... _----________-_.___-_ __----._-__ ._.__- ... - _______ _._._.__ > Construction related permits ....................................................................................................................................._...._.................................................... WORK SCHEDULE Contract r will of begi2-the work or order the materials before the third day following the signing of this Agreement,unless specified heryn wCS rit C� C_o�trBCtor will begin the work on or about CC�� (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by C `•(date_The Owner herebv�— acknowledges and agrees that the schedulinq dates_are_aooroximate and that c„rh r4.1----------1--- -° it Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 108383 ; Expiration: 8%18/2008 r: Type:_DBA ?. KEEN CONSTRUCTION CO. Kenneth Keen 21 Hewitt Ave -No.Andover MA 018 Deputy 45 Administrator P h' Board of Building Reg'ulatio'ns and Standards 1 Construction Supervisor License 4 License. CS 582.4.5 1Expiation.".3/24/2010 Ti# 17840 j 02 Restmtc i 00x` 7 i KENNETH B KEEN Com. 21 HEWITT AVE k^ N ANDOVER,MA 01845 Commissioner i, '✓jie 1D0!)7/I�Z0076lIC�GGlL o�,���,aaarxc�uael�"a i Board of Building Regulations and'Standards j J i Construction Supervisor-License r. a License: CS 76691 ` � �Birtliidate =8%16/1968 E i�Expia ion 8/16%2009 Tr# 3859 Restnct�on 0.0. ROBERT A KEEN' , 12.E WATER ST N ANDOVER,MA 01845 commissioner # VotCI/GVV1 11,Jv AILA 1vl Qn& GLGv V1LYLiau 1114VA\ 11— W--J PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Gilbert Insurance Agency Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 137 Main St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Reading,MA 01967-3922 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Kenneth Keen&Robert Keen 21 Hewitt Ave North Andover, MA 01845-0000 go' 011111 rTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,IVOT WITHSTANDING 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 THE POLICIES DESCRIBED HEREIN IS!iIIUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY P)v D CLAIMS, 00I LTR TYPE OF INSURANCE POW-J' ! MDE POLICYEFFECTTW IIATE POLICYEXPMATION DATE A RKE OM TON EMPLOYERS'LMB IL TTY LIMITS PROPRETOW PARTNERSIEXECUTIVE OFFICERS ARE: NCL 1 6360688 1 6/03/2007 8/03/2008 ATUTORY LIMBS mER erago Applies Io TAA Opwallms Only. ;ACH ACCIDENT S 100.0011 ISEASE POLICY LIMB $ 500100 ISEASE-EACH]EMPLOYEE $ 100100 ESCRIPHON OF OPERATION.NV CL CIAL inns ROBERT KEEN IS COVERED BY THE WORKERS COMPENSATION POLICY AND KENNETH B KEEN IS NOT COVERED BY THE c.. WORKERS COMPENSATION P=OLICY. CERTIFICATE HOLDER CANCELLATION JOW'N OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCR®ED POLICIES BE CANCELLED BEFORE THE EXPRATON DATE THEREOF.THE ISSUING COMPANY WILL ENDEAVOR TO MAL 14 '16d0 OSGOOD ST DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT `NORTH ANDOVER,MA 01845 FAILURE TO MAIL SUCH NOTICE SHALL WOSE NO OBLIGATION OR LNBILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRE8ENTATWES. AUTHORIZED REPRESENTATIVE I ,