The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #562-2016 - 71 PINE RIDGE ROAD 5/1/2018 NORTH BUILDING PERMIT O�SquED '91.0 TOWN OF NORTH ANDOVER O APPLICATION FOR PLAN EXAMINATION PJ(, Date Received Permit No#� �RADRATED �SSgCHUs�� Date Issued: IMPORTANT:Applicant must complete all items on this page .LOCATION - Print PROPERTY OWNER - C'_ �'" Rn 100 Year Stfuctureeyes, MAP_ 7 PARCEL: ZONING DISTRICT: .-Historic-District yes. - Machine SRhop Village 4 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 Eldg ❑ Others: Demolition ❑ Other El Sep p Well. El Floodplain p Wetlands ❑ Watershed District ❑Water/Sewer . DESC PTION OF WORD TO BE PERFORM D: r- o �e �o �l - u� �b le- � aL Identification- -,ase Type or Print Clearly OWNER: Name: eo r PQ �TAr.2 4h Phone: Ir Address: 7 >� ✓l.2 /2C+ f � r- Contractor arae: __ 1 t r' .0---Phone: 977--691..-54Q / - Email: Address: O Supervisor's Construction License: �.�T_fj ` , g. Exp. Date:. Home Improvement License LLJ_0—!z-L319 3 ExpR :Date: Ti /ig 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: $ 2 S'O FEE: $ 39.00 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th u n nd g,nature of Agent/Qwner __ _ -_ _ _ Signature�of 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 ❑ 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 Li Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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 VOTE: 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 2014 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 Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS a �r 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: �-.- it �o_ca�aa, _ sgo Street Te �IREI RAMT umpstorse +Loeatetli;atfl 24Mam'Sheet mm � F'rrre Department signature/d1a#e COMM ENTiS:_ - --gym k 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 ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 Location No. !, - 2G/�; Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ r r Building/Frame Permit Fee $ . Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 29633 Building Inspector NORTH Town of s E ndover O 0 No. h ver, Mass, COC HIC Hl WICK 1' A04A TE D S BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System ��1/ , THIS CERTIFIES THAT ........ � lGf �[7� BUILDING INSPECTOR .... `�....... ............. .G,�t�............................... ............................ P��. .p �/ Foundation has permission to erect .......................... buildings on ... `................... .. 1.G�t..�!� ............................... Rough to be occupied as ...............&11 /'O�............... .......f:.I... ...p��.. .�: 1��.. '�'. ....... Chimney provided that the person accepting this permit shall in every respect 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough .................................... Service ........... ....... L>�/Cry':"/.. . .... 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. a MOREL REMC)OEt_IlI C: SPEGIAILISTS. 978-69'1.-5:z -1 Kee nConstructionCo.coin . Toolan, Mary Jane&George 71 Pine Ridge Rd. N.Andover, MA 01845 Contract#5568;Appendix A October 30, 2015 Repair wall in great room: • Remove existing wallboard and replace rotted studs under window • Pull back carpet and replace rotted subfloor _ • Re-install carpet • Install new insulation and wallboard and skimcoat plaster • Install new trim to match • Repair small water damaged area above fireplace • Paint affected walls and trim Misc. repairs: • Jack base of outside deck stairs and install new footing • Replace short rake board near chimney • Supply& install new landscape timber • Re-secure electrical meter box by licensed electrician $3250.00.00(three thousand two hundred fifty dollars) Price does not include cost of permits,window replacement or and repairs to unusual, unsafe or non- code compliant existing conditions not addressed in this quote. Payment ment Schedule: 1000 due upon signing contract $1000 due when framing is repaired $1250 due when contracted work is complete Customer Robert A. Keen ,// ,S / [ /,5 // -5 Date Date 1175 Turnpike St. Page 1 of 1 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 556E KEEN CONSTRUCTION CO. '( ,35 PROPOSAL NORTH ANDOVER, MA 01845 All home improvement contractors and subcontractors T61: .(978)691-520.1 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 SubmittedU with the Commonwealth of Massachusetts. Inquiries To: ()edr,:l� �L r(n about registration and status should be made to the �f P' Park Plaza, Room 5170, Boston, MA 02116 617.973- Director,Home Improvement Contract Registration,10 8787 Owners who secure their own construction M C'g t related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATEREGISTRATION NO. EIN N0. �CbcI(15 MA. H.I.C. 108383 46-.3783401 > 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: Re0(6c IV,tj G 5Qe 00eAd ( {� > Construction related permits: ._.______v._—__._._........................---.__...._.._....._._.._......________....._____........._...................._......................._..................................................................._................................................................................._....._.........__.._....._._........_.___..__...__.. ._._...__ _...__...................___......._._......................................................._._.........................................................................................._......_............................................................................................................................................................_.............. .__.,......'--'- WORK SCHEDULE Contra t r i not Q 'R the work or order the materials before the third day following the signing of this Agreement,unless specified her in tin o actor 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 consi ered 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 + 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. �W'e� Propose hh{ereby to furnish material and and labor-complete in accordance(with above specifications,for the sum of I y f`'e Q 1 i�C,).�c ✓1 (J 1 V c) M C��C1 t-'� 't--"Lf dollars($�5 z,150.o c) ). Payment to be made as follows: /° ($ j upon signing Contract; n ROBERT A. KEEN Name of Contractor/Designated Registrant ($ ) upon co pie ign2�f 1175 TURNPIKE ST. Street Address qO77n.completion-of. N. ANDOVER, MA 01845 /7 qty/State' ($ ) shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Pn9 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 a"mensal m 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 Auth zed i tur equipment,whichever amount IS greater. Note:This proposal may be withdrawn by us it 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.Ca cellation must be done in writing. O O ^SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature / Dale/J % Signature Dale IMPORTANT INFORMATION ON BACK ► AcoRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `./ 10/23/2015 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(iss)must be endorsed. If SUBROGATION IS WAIVED,subject to 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 CONTACT Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 FAX, o:(781)942-2226 IL 137 Main Street ADORE:bmedonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERANorfolk S Dedham Insurance 23965 INSURED INSURERB:Safety Insurance Company 39454 Keen Construction Company INSURER C:Travelers Ins. Co. 0031 483 Chickering Road INSURER D: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1552101779 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 BY PAID CLAIMS. INSR TYPE OF INSURANCEADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER M LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PREMISES Ea=._) ccurrence $ 100,000 ND-P-010078/000 3/13/2015 3/13/2016 MED EXP(Arvy one rson) $ 5,000 PERSONAL 6 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY E]JECT F7LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY BINEDINGI $ 1,000,000 e eccideMS B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X AUTOOSSULED 6228807 COM 01 5/23/2015 5/23/2016 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWN 0 PROPERTY DAMAGEAUTOS (Per $ Underimured motorist $ 100,000 UMBRELLA LULB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN S TU ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100.000 C OFFICER/MEMBER EXCLUDED? �N I A (Mandatory in NH) 6HUB-99911458-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additlonal Remarks Schedule,my be aftached If more space Is required) CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 t2ouon The Commonwealth of Massachusetts Department of Industrial Accidents a d I Congress Street,Suite 100 Boston,ALL 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Wo-en t' SA no c j� G/1 Address: - 1 City/State/Zip: �{ I��1 C '`;e t'-Ir I G f$P one#: �z— (,94 572,0) 1 Are you an employer?Check the appropriate box: Type of project(required): 1.Z I am a employer with 2- emp]oyees(full and/or part-time).* 7. El New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12-1-1 Plumbing repairs or additions 5.❑I am ageneral contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insuranceJ 14. Other 6:❑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.] *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. Com Name: rc,vt°..�e 5 /P7_5Insurance Company y Policy#or Self ins.Lic.#:(� 14 V "9/ 9 I N5<9Z — �5 Expiration Date: 1 G 3 1 Job Site Address: ?/ , 1 #`c- i Qr (�. City/State/Zip �' p 0j gq5 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify d r the sins an penalties ofperjury that the information provided abov is true and correct. r� Signature: Date: Phone#: Z O 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Massachusetts -Department of Public Safety Board of Building Regulations and Standards - - —: 11111\tl U1 L11111 Ju11C1 V1N1/1 License: CS-076691 Pte' ROBERT A KEEN- 12 E WATER ST: North Andover AA 0 -Ii,0 Expiration Commission 08/16/2017 Officeof Consumer Affairs&Business Regulation W'ME IMPROVEMENT CONTRACTOR gistration: ;:108383 Type: piration:�_8%f /201&, DBA KEEN CONSTRUCT1!1N Kenneth Keen r 1175 TURNPIKE ST _ NO.ANDOVER,MA 01845` Undersecretary