HomeMy WebLinkAboutBuilding Permit # 5/17/2016 -----
BUILDING PERMIT 01'%OR H
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
PermitNc,4- Date Received
v
Date us
—----------- .....------
MPORTANT:Applicant must complete all item, ontfiisagc___
-- ---- ------- ----------- ........... _�
LOCATION 1,21 P J
rint
PROPERTY OWNER L nrw, ept
Int 100 Year Structure yes
MAP 0 PARCEL: ZONING DI STRICT:—Historic District yes
Machine Shop Village yes C;Tnd„sr
TYPE OF IMPROVEMENT PRdPOSED USE-----------
ResidentialNon-Residential
......... ..I
.. ........ ...................
El New Building 0 One family
F1 Addition 0 Two or more family [I Industrial
F-1 Alteration No.of units: El Commercial
�4 Repair,replacement Fi Assessory Bldg u Others:
-1 Demolition [I Other
Se tYc 6J t.j"p-g
at6r -0—dp e--tiaid
0
s, ,, IJ Watershed District
nl
SCRIPT ION OF WORK TO BE PERFORMED:
4......A'g?1-r yr
4 V1 C
--
Identification- Please,Type or Print Clearly
OWNER: Name: (el) Phone:
Address:
Contractotl
Name- co Phone: 9?'2691-527�6�9
Email: G
Address: 1.)C 1�31 ' 4,1,6111.1clut-1-- 414r't
Supervisor's Construction License: f)Nc,L Exp, Date: 211.1,- L:z
Home Improvement License: 16 'z� 'r , Exp. /'Z 16,
...............
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:SULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost:$ 3d 5 FEE: 7,
Check No.: Receipt No.: 63sl
NOTE: Persons contracting with unregistered Contractors do not have access to theu hin. fund
..............Si(
gent/Qwaer._............................ qnaWre-of-co
Town of �r � NORTy Lend®ver
O p+
No.
iRh ver, Mass,
�q DAA TED
S V
BOARD OF HEALTH
Food/Kitchen
PERkJIT ILD Septic System
THIS CERTIFIES THAT...................... . ...tOfr........ `^ BUILDING INSPECTOR
...
has permission to erect....... Foundation
buildin on............�......... .�.{ .,...............:.
��`` �o . Rough
to be occupied BE .. �V►•�...5...... ........ �.. �... ....1 .................... Chimney
provided that the person fecepting this permit shall in every respect c , rm to the terms of the application Final
on file in this office,and to the provisions of the Codes and By-Laws r lating 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 INSPECTOR Final
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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.
KEEN CONSTRUCTION O.
PROPOSAL
NORTH ANDOVER,MA 01845
All home improvement contractors and subcontractors-
Tel:
ubcontractorsTel: (978)691-5201 engaged in home improvement contracting, unless
Fax:(978)682-3231 specifically exempt from registration by Provisions
Chapter 142A of the general laws,must be registered Submitted with the Commonwealth of Massachusetts. Inquiries-
To It i
about registration and status should be made to the
err, n_�
Director,Home Improvement Contract Registration 10
Park Plaza, Room 5170, Boston, MA 02116 617-973-
8787 Owners who secure their own Construction
'o,J 27 il-1,15 related permits or deal with unregistered contractors
W,11 be excluded from the Guaranty Fund Provision
of MOL C.142A.
PHONE 11111 1 1 REGISTRATION No. ElN NO
2—15Z o d j MA.H.I.C.108383 46—3783401
CIS=Customer Supplied S+I=Supply+Install El See Attached Appendix A
We hereby submit Specifications and estimates for work to be performed and materials to be used:
—--—-------------
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—------——------
.........—------
>Construction related permits:
..............
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 dated are approximate and that such delays that are not avoidable by file Contractor Shall not be considered as violations of this Agreement,
WARRANTY
Th.Contractor warrants bar the war,furnish.leisure.,11.11 be live from Season mausnals and workmanship for a period of............—-------—following completion and Shall
comply hantdiremerld of this Agreement,in the event any eclectic workmanship or materials.or damage caused by the Contractor,his subcontractors, or agents,is
witsubcontractors,employees
discovered within'be year after completion of any lob,including cleanup.the Contractor Shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,
police,or replaced,such damage or such defectm materials orworkmanship.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
dollar,($
Payment to be made as follows:
—% ($ upon Signing Contract, ROBERT A.KEEN
—% ($ upon completion N [C,ntriet,r i De,,g,,t.d Regsisrt
4 l Z—dr _ Po 3 5
Sir
up—on Zzwmwhm _.___ _=�- N. A
POVER,MA 01846
City�Sba,
shall be made forthwith upon (978)691-5201 (978)682-3231
($ completion of work under this Contract- Ph.
Notice: No agreement for home improvement contracting work Shall require a Vll_t^L
u
-down payment(advance deposit)of more than one-third of the total contract'ric'. .e S in
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 Aulloin,q Si r.lc
equipment,whichever amount is greater. N.I. Th..pco,l may is,withdrawn by1 not.1cbpl.111 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 trartsactgon.
Cancellation Must be done in writing.
DO NOT§IGN TH S CONTRACT IF 7HERE ARE ANY BLANK SPACES.
all I�Lrsue [)are
IMPORTANT INFORMATION ON BACK 00�
f*APT
TL"CONSULTING, LLC
Structural Engineering
505 Middlesex Turnpike Unit 14
Billerica,MA 01821
(978)362-1804
March 14,2016
Robert A.Keen
Keen Construction Co.
21 Hewitt Ave
N.Andover,MA 01845
Re: Existing Damaged Beam and Damaged Sill
121 derrick Rd,North Andover,MA 01845
TLlJC Project/!160512
Dear Bob:
TI,H Consulting,LLC(TLI IC)recently visited the site referenced above.The purpose ofthe
visit was to observe a damaged portion ofone of the existing main beams and a damaged portion
of an existing sill plate.
We observed the damaged portion of the main beam first. The damage appears to be
concentrated at the last three feet of the end of the beam closest to the basement stairs. We
recommend removing approximately 5'-0"of the beam and replacing it with at least a two ply
1 3l"x 7 Y"[,VL. For your convenience,we are including a sketch with this letter;the sketch
depicts the repair.
Next we observed the damaged sill. Based on our observations,the sill in question supports a
very small portion of kitchen floor load. In addition,the damage we observed appeared to be
minimal. In our opinion the sill is in acceptable condition,but to put perspective buyers at ease
we recommend installing neva blocking over the damaged portion of the sill
]'hanks for the opportunity to provide our services to you.If you have any questions,please feel
free to call us at(978)362-1804.
Sincerely, TODD -
,..: - -
flEDLY
Todd Hedly,P.E. bio-41833
Enclosure `StQflAl it1G
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xa"a fNv.s�.ux az TLH CONSULTING-(978)302-180 c=aw-�vvMv
The Commonwealth of Massachusetts
Department of Industrial Aecidents
1 Congress Street,Suite 100
Boston,AM 02114-2017
wwminass.govtdia
'.'Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers-
TO BE FILED WITH THE PER,-HTTING AUTHORITY.
PlessePrint Le ibl
Applicant Informati
Name(Business/Organizat[oollndividual):
Address:
1 i O l� Beo #: 97z-
CityiStatefZip: '� � ��'��r- P
Areyou an employer?Check the appropriate box: Type of project(required):
1.[f I am a employer wkh 2- employ—(full and/or part-tare).* 7.'E]New construction
2,F] m I aa sole proprietor or partnership and have no employees working for me in 8.V]Remodeling
any capacity.[Nowor]cers'comp.insurance required.] 9. El Demolition
3.�Iam ahomeowner doing alt work myself[howorkers'comp.inamearerequtred.]t 10 E]Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.I will
11.❑Electrical repairs or additions
ensure that all contractors Dither have workers'coo pensa r ton insurance or are sole
proprietors with no employees. 12.Q Plumbing repairs or additions
5.❑I am a general e bnote,and I have hired the sub-contractors Listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workera'comp.insurance.t 14❑Other
6.Q We are a corporation and its officers have exercised their right of exemption per NIGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information.
I Iloneorames who submit this affidavit indicating they are doing all work and thea hire outside contractors must submit a new affidavit indicating such.
#Comractors that check this box must attached an additional sheet showing the name of the sub- mraeens and state whether or not those entities have
employees.If the sub-contractors have employees,they must provide their workers'comp.policy number
I ant an employer that is providing workers'cornpeneatiott insurance for lily enzptoyees. Belmp is the policy and jab site
information. r
Insurance Company Name:
P
olicy
II�N-5
Policy#or Self-i ' '4 C.)`J A!/f I `-,�� 2 _��Expiration Date:--LCI � Q
r�� _ -`: ��� Cityl3tatJob Site Address: `iAttach a copy ofrs'compensation policy declaration page(showing the pFailure to secure required under MGL c.152,§ZSA is a crinunal violation pand/or one-year it,as well as civil penalties in the form of a STOP WORI{Oday against the vpy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify un4kr toe pa"s and penalties of perjury that the Information prouided above is true and correct.
t IFjr f"
--
Signature: Date:_
phone#: -^'7- 6 91— _`"'
official use only.Do not raphe 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 Clerlc 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person:
Phone#•
�e _
4`OKO CERTIFICATE OF LIABILITY INSURANCE iotz3/zolsi
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 cardflcata holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to
the terms and wndlBons of the policy,certaln policies may require an eSd.—RnmL A statement on this cartifioate does not confer rights to the
cedirlwte haidef In IIeU of such enaorsement(s.
0 Barbaza McDonough
Gilbert Znsuranoe Agenoy, lna. .(781)942-2225 p,{'rel
137 Main Street o yy.bmodonoughOgilbaztineurance Acom
VPACE
Reading MA 01867-3922 rtq 3Soz£olk 6 Dedham---o.urance 23965 s
WSURERe:sa£et Zneurance compau 39454
K...C notruoti"Company Wsunanc Travelers Ins. ca. 0031
483 Chickering Road
North Andover HA 01845
COVERAGES CERTIFICATE NUMBER:cD155210177S REVISION NUMBER:
THIS IS TOCERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NORM.THSTANDING ANY REOUIREMENT,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,
HSER
L X C HM RLNL E LUABILITY cYN POUCYEPf POLICYE%I U 3
A Oj LWMstWOEOCCUR I _x-010 NGOaURR nems MlTS 000,000
PL S " lS 3 100,000
OTs/o00 3(13(2015 3/1aJ2016 MEO EXP An onv w0 S 5,000
{— I PERSCNh6ADVIN y S 1,Doo,000
OERL AG9RE(OIAT�E LMSTAPPUES PER: GENERALAG FINUE S 2,000,000
X —VYD,ZCT ❑Lw FROENCTA GG $ 2,0001000
exE tueNTY S 1,000,000
g _ NRY(Perpvcwy
OX aUroS f __my 0a 5lxsfx016 5/xa/x016 RT IPareaueml y
X NuxEOAvr X A T, EO S
00,000
REttq � OCCUR S
CWLM6�— GGREGATE RE s
CE. SeTERS—
COs1PENSATION
C I �NERm«EueI LEX�.1U4M TI{¢L]IN! �_y99.N58-x-15 1aJBJ2015S 300 000
scR i0/e(2016
EL 11 IE100 000
S00 000
RiPTaNaR OPERATiaNYILDCAibnsIVFNKSEa IAwRO tat.AaaXio,ul Remens ul,eaW, y �na<hW Hm p><It q real
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.
TNORmo,REPRESENTATIVE
M Gilbert, CZC(BARBAR
07988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INSD25n0u."
IM Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
C—st rucnon S pe r.--
'
License:CS-076691
a.rrs i
ROBERT A KEEW
12 F W ATER ST R rf
North Andover WA 0
954,,,, '1 Expiration
Commissioner
0811612017
_ -ice of Cmisnmer Affairs$Business Regulation
ra _ AE IMPROVEMENT CONTRACTOR
egistrati.n 108383
5
Expiration _ Type:
KEEN CONSTRSupplement Car -
UCTION_GO
ROBERT KEEN
1175 TURNPIKE ST _
NO.ANDOVER,MA 01845
Undersecretary