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Home My WebLink AboutBuilding Permit #696 - Exception 5/3/2006Ot HORTH 1ti O TOWN OF NORTH ANDOVER '= o APPLICATION FOR PLAN EXAMINATION ,SSA MUSE Permit NO: Date Received: r� Date Issued:61,3,bc, IMPORTANT: ApUlicant must complete all items on this page LOCATION l 0 �/`�'S T ��4f�n- S-1 ,,n Print�� PROPERTY OWNER -44n1% 1 kc 1 t 11i �-�`c �•- - Nrint MAP NO.: PARCEL: ZONING DISTRICT: TVPT ANn 11QF (11V R1T11.111N(- HKTORIC nlgTRICT VF4 Fl TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building `1 Addition &Aiteration E One family L-T'wo or more family No. of units: 7- Industrial t-Kepair, replacement C� Demolition C Assessory Bldg i-: Commercial C Moving (relocation) Other F; Others: _! Foundation only DESCRIPTION OF WORK TO BE PREFORMED V`czp OWNER: Name: Address: 1GT- �d6�'L VNi Identification Please Type or Print Clearly) Signature Phon Ve o'�S CONTRACTOR Name: Phone: 6 9'1 J 201 Address: Z I q i w: -n- R J l? , I-V C(6 V F Ad A - Supervisor's Construction License: S Z`i-s Exp. Date: Home Improvement License: l6 Exp. Date: , RCI-[ITECT+NGINF1:R Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDLVG PERMIT. .510.00 PER $1000.00 OF THE TOTAL ESTIMATED COST RASED ON 512.5.00 PER S.F.B 2 Total Project Cost :$I j� xI0.00-FEE:$ Check No.: 3,oqc3_ Receipt No.: --VW& , Location 8 e � No. (,-�5 (,;, Date 513 1 o C., TOWN OF NORTH ANDOVER S �o Certificate of Occupancy $ Building/Frame Permit Fee $"� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 39�_ i 69 Building Inspector TYPE OF SEWARGE DISPOSAL I _ Tanning/ _., Massage;Body Art Swimming Pools Public Sewer — -Tobacco Sales -- Food Packa,, -iSales Well Private (septic tank, etc. i _ Pernianent Dempster on Site NOTE: Persons contracting with unregistered contmelors do htot hh►ve access to the guarantp_fhutd Si(nature. of Agent Owner Signature of Contractor Plans Submitted ❑ Plans Waived L_I Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ LI El Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS e CONSERVATION z COMMENTS HEALTH - COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED Zonis`,, Board of Appcals: Variance, Petition No: Zoning Decision.'receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments ater fs Scwer connection signature &, date Temp Dempster on site yes__no__ Fire Department signature.;date Building, Permit Approved and Issued by: DATE APPROVED I Building Setback (ft) Front Yard Side Yard Rear Yard ReqUired Provided Required Provides Require Provided ^,"IT""uIII nu~v�� NumhcrofSkniro:__ Total land area, sq. ft.: Total mluar«feet of floor area, based on Exterior dinnenoious`______�___ 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 ❑ Debris Removal Form ❑ 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 ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Form ❑ 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 Pen -nit Application ❑ Form U ❑ 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 Hydrauli Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report 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 cop), and proof of recording must be submitted with the building application Doc: I\SPE(" I'IONAL SER\ ICES DEPARTNIE\T:RPFOR\105 CA m m X CO) m O Q C/) C 0 c-O�CD m Ic- C. gOElmH 0' CC EF- H wIm RLm ti o aim = IF m CS hip. ;&O m ac O MCO CL 0o w :4 V-2 00,00, m Cos C. CL Q gym: col o mcir: ao � CD i GO CD cn �C. m co, dd � CL's O Cos n T m rnC042 _ cn c C/) W C ro � a c � � ro z H 0 4 I P- W U C w � a c � Pelletier, Phil & Many 18 East Water St. N. Andover, MA 01.845 (978) 685-2081 Contract # 1629; Appendix A Date:3/14/06 • Supply & install. three Thermatru Smoothstar exterior door units (one 2'6" x 66 5-1112, two 2'6" x 6'6" S-1122) • Supply & install'threesets of Schlage entrance lock and deadbolt • Supply &'install four Harvey solid core storm doors: ( two Classic series, two Victorian series) grz. , • Supply & instaff two Harvey vinyl transom -lites above front doors • Supply & install steel bulkhead door on existing basement access Total Price:$7500.00 (seventy five hundred dollars) Price does not include cost of permits; painting or_problerns found when existing doors are removed (e.g. rotor insect damage, unusual framing, etc.). Payment schedule13750.00 due upon signing contract (pd.. Check 42834) $3750:00 due when contracted work is complete 4stomerr� ' RobeA A Keen Date Date � f ✓�e �pmv�rwizu�ea�i d�✓l�C�aciu.�.Ge�l`4 t = Board of Building Regulations and Standards ins HOME IMPROVEMENT.CONTRACTOR I Re'gistr fbn'�, 108383 . E {'SSP• KEEN CONSTRUC QP Kenneth Keene 21 Hewitt Ave No. Andover, MA 01845 Administrator { �V/ry7/I7204 i BOARDI7OF BUeCG/.G1LILDINeREGULATIONS icense: CONSTRUCTION SUPERVISOR Number:3CS 058245 31rthdate.703/24/a 943 Expires 03/24/2008 Tr f ea no: nricM w-4inw _ r`C . _ Restricted 00 KENNETH B KEEN 21 HEINITT AVE - NANDOVER, MA 01$45 r ✓ C /�` i i Commlasioner " I am a homeowner performing all work myself. Project Type: ❑ New Construction ❑Remodel 21 Tarn a sole proprietor and have no one working in any capacity. ❑ Building Addition ❑ I am an employer providing workers compensation for my employees working on this job. company name: IL S [[ t t5- ei C' c� o ,� 1 H address: Z( i t4i t A V C, city: NZ f- 6 0 C, I^ tl t »AC phone 4:9 75 I am a sole proprietor, general contractor, or homeowner- (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city. phone #• insurance co. Voliev # COntpany name` city: phone #• insurance co. ohc # Attach.additional sheet tfti.ecessary Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby ce tit the pains # ppyt8(ties ojpetjuty that the information provided above is trite and correct. .S Print name'Phone # � �C� official use only do not write in this area to be completed by city or town official la city or town: permit/license # ❑Building Department i.. ❑Licensing Board ❑ check if immediate response is required ❑Selectmen's Office ❑Health Department v; contact person: phone #; ❑Other (revised Sept. 2007) 4 , - - The Commonwealth of Massachusetts Department ofbidustrial Accidents , Office of investigations 600 Washi'n ton Street 7l' g `Floor Boston Mass. 02111 Workers' Compensation Insurance Affidavit Building/Plumbing/Electrical Contractors Applicant m ffiation: 1?lease:PRINT leoiblV x_11—o s1 k ILi-r,- t address: Z 17 ( L t (t T7A ti E city l`-' 6 ti n -0 [9 L (r. state: • /' ( A ZiP7 In 44 phone # % a U'�i ` Z� work site location (frill address): /9 Eq " r LO 4 +S nt. " I am a homeowner performing all work myself. Project Type: ❑ New Construction ❑Remodel 21 Tarn a sole proprietor and have no one working in any capacity. ❑ Building Addition ❑ I am an employer providing workers compensation for my employees working on this job. company name: IL S [[ t t5- ei C' c� o ,� 1 H address: Z( i t4i t A V C, city: NZ f- 6 0 C, I^ tl t »AC phone 4:9 75 I am a sole proprietor, general contractor, or homeowner- (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city. phone #• insurance co. Voliev # COntpany name` city: phone #• insurance co. ohc # Attach.additional sheet tfti.ecessary Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby ce tit the pains # ppyt8(ties ojpetjuty that the information provided above is trite and correct. .S Print name'Phone # � �C� official use only do not write in this area to be completed by city or town official la city or town: permit/license # ❑Building Department i.. ❑Licensing Board ❑ check if immediate response is required ❑Selectmen's Office ❑Health Department v; contact person: phone #; ❑Other (revised Sept. 2007) 4 , >t c E KEEN CONSTRUCTION CO. ° 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 r Submitted yp PHONE DATE r > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: Construction related permits: 169 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 Ashburtori Place, Room 1301, Boston, MA 021.08 (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. F.I.D. N0. MA. H.I.C. 108383 04-325-8052 _ ..........4'�rGr.. ` �5,. f C_) �rl��..�C .f�.._ •..,...-�: �.L._ ` ?.;- (� £ �! Li ! ^ t__..__......................................'_....................... CJ ContractorOwiHED ll pot begin the work or order the materials before the third da following the signing nin of this g Y 9 9 9 is Agreement, unless specified here in wri to Contractor will begin the work on or about _ (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed b �S g acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall considered as viola(dattions of this Agreement. WARRANTY notbe The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of i '-• 6 G "•.. comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, temployeesng compllor aand sha gents, 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 Payment to be made as ollows - dollars ($ % ($ ) upon signin Contract; % ($`� 'uponcoimletibn of If u�on completion of �t�✓.1 �$ ) shall be made forthwith upon completion of work under this contract. i Votice: No. agreement for home improvement contracting work shall require a Town payment (advance deposit) of more than one-third of the total contract price it the total amount of all deposits or payments which the contractor must make, in idvance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is greater. KENNETH B. KEEN Name of Contractor /-Designated Registrant 21 HEWITT AVE. Street Address N. ,ANDOVER, MA 01845 City / State (978) 691-5201 (978) 682-3231 Phone Fax ttr Name nf,S'alman 1 Aute oozed S natu e Note: This proposal may be withdrawn by ns it nm uays. 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. rr (^ Signatu a ✓`- f _.•-/ .Date/` Signature Date IMPORTANT INFORMATION ON BACK ►