HomeMy WebLinkAboutBuilding Permit # 11/3/2016 BUILDING PERMIT of No orH"�o
TOWN OF NORTH ANDOVER
02
APPLICATION FOR PLAN EXAMINATIONy� A
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Permit No#: 41)f- '_ Date Received 4(
�SSACHr15E�
Date Issued: c r a a
LTPOT2TA YT:Applicant must complete all items on this page
LOCATION7 t
Print
PROPERTY OWNER atl = J=tc
Print 100 Year Structure yes _
MRF PARCEL: Z ZONING DISTRICT: Historic District yes o `
Machine Shop Village yes no '
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
El New Building C One family j
Addition ❑Two or more family u Industrial
E Alteration No.of units: i L Commercial I
MiRepair,replacement ❑Assessory Bldg ❑ Others: j
❑Demolition L Other
DESCRIPTION OF WORK TO BE PERFORMED_
J ? J
f
{ G 1 Q t y a r it ice`fl rV7i t"t
Identili trop Please Type or Print Clearly
OWNER: Name: J_0sie- 1 Phone:
Address: 117 #
Contractor ara - f{e: Cc-r? t 1c 6Phone: X7,-6 c r
Email: . o,h Ke - -7 (IX-ti c C', : Q-a1A
Address: ex 6 ;q5
r 3
Supervisor's Construction License: Exp. Date: / r
d
Home Improvement License: /,-Z_73Exp. Date: Il
ARCHITECT/ENGINEER Phone:
Address: Reg.No.
FEE SCHEDULE:&ULDING PERMIT:31200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
.
Total Project Cost:$ S-5 57 c, z C;o FEE:$ 1,,iku
Check No.: �ql Z-3, Receipt No.: tl.3 `
NOTE: Persons contracting with unregistered contractors do not have access to thq alt tad
Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/MassagetHodyArt ❑ Sw—'ng D
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
f PLANNING&DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed en1�3 b 1, Signature 't
COMMENTS oo'
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance,Petition No: Zoning Decisionlreceipt submitted yes
Planning Board.Decision: Comments
Conservation Decision:. Comments
Wates'&Sewer ConnectlOnlSignatUre&Date Driveufay Permit
DPW Town Engineer:Signature:
Located 384 Osgood Street
FIFtEQEPAR+TMENT Temp Dumpstr on site yes no-
Lacafed at 124tam Street
Ftre Department signafiure/date
r cnnnnFniTs r ,
Town of "OR7" Andover
Al °
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h ver,Mass, a 0 611►
7„�s ,TED
U BOARD OF HEALTH
Food/Kitchen
PERMIT
t Septic System
THIS CERTIFIES THAT 4s.Fi+ 4 i N. ........l/�q.!0 BUILDING INSPECTOR
+JJ�� Foundation
has permission to erect..........................buildings on........r 37..........0#% CC.. o........5.+/,.
Q Rough
to be occupied as.....Reoupv :......, ....... ........ 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCA
TART Rough
Service
............ .. ..... Final
BUILDING NSPECTOR
GASINSPECTOR
OccupuncT Permit Recurred to Occupy Buildin 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.
_ —_.rvonrfrirchan Co;
et¢moust enc s tctsrs
978-691-520`i
Ke¢nConstt�ctian Cocom
Josh Moughan
137 Barker St.
N.Andover,MA 01845
Contract#6005;Appendix A October 30,2016
Rebuild rear steps:
• Remove and dispose of existing steps on back of sunroom
• Excavate and pour 12"concrete,4'deep
• Build 4'x 10'deck,with 4'stairs centered,leading to patio
• Supply&install pressure treated S/4"x 6"deck boards,2"x 4"railings and 2"x 2"balusters
Total Price:$5550(five thousand five hundred fifty dollars)
Price does not include cost of permits,problems found during excavation or repairs to any unusual,
unsafe or non-code compliant existing conditions not addressed in this quote.
Payment Schedule: $1000 due upon signing contract
$2000 due the first day of work(plus permit fee)
$1500 due when deck and stairs are framed
$1050 due when contracted work is complete
Customjr Robert Keen
Date Date
PO Box 935 Page 1 of 9 P:978-691-5201
N.Andover,MA 01845 F:978-682-3231
CSL#076691 Sales@KeenConstructionCo.com Hl#108383
6005
KEEN CONSTRUCTION CO.
PO BOX 935 PROPOSAL
NORTH ANDOVER,MA 01845 An home imprav meat cpntractor, and subcontractors
Tel:(978)691-5201 engaged i:; name imps+'amen' contracting, unit,:
Fax:(978)1682-3231 specifically a empt from registration by Provisions of
1 i-1'..�[ \ \r1 Chapter 142A of the general touts,must be registered
! 1
Submitted to: �L •"� C' with the Commonwealth of Massachusetts. Inquiries
about registration and status should be made to the
Otre,le, Home Improvement Contract Registration,
i�
10 Park(`! Plaza,Room 111%Roston,MA 02116 111-911-8787
'Owo r who secure ihtir own construction related permits
or dealwith unregistered contractors will be excluded from
the Guaranty Fund Proviz.a n of MGL c 142A.
PHONE DATf REGISTRATION NO, EiN No.
�Gj3G\ MA,W.C.108383 46-3783401
> C/5=Customer Supplied S+I=Supply+Install See Attached Appendix A
:Ya herebysubmrt specifications and estimates fo,work to be performed and mat-1,w be.
1j,
sed:
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,he contractor and the homeowner hereby mutually agree that in the event the mntracmr has a dispute concerning this contract,the contractor
may submit the depute to a priva'e arbitration firm which has been approved by the Secretary of the Execativttzffice of Consumer Atfair,and
Business
Regulation and the consumer shall be reAu red to submit to such arbitration as provided in Mara,huicuts General laws,chapter 142A.
/�J
`vv\C.. _
H Signature c or's S=.g
NOTiCjThe Sync*ures of the parties above apply only to the aq,eemort of the parties to alternative dispute resolution sellemel by the contractor.The homeowner
may initiate alterna!ive dispute resolution even where this section is not sep i-ely signed by the pardes.
WORK sogpdIE
Cat [beg h work ar ord F1—oadb t he thirdday f WI.we,he samirs,1 Im,Ag i ospa if dhe,,u—ting Centel—will hegh,
thewwker.,d ,e (dot)Rarnng debyca ed by nr[umftancet bey.dC ra[., ca tial the wok will becampt 1odby hdatef TF.e
nor hereby ackrwwiedges xd agreezthat the scheduling dates are aRp=oximate and that arch delays that are no[a+oidable by the Contractor shall not bs o,,gdrm l as
WARRwARRens of ih's Agreement.
ANTY
The Contratorwanants that[M1e[me eo rimmehereull'Aq,nitbefree ftheowmctsinmatenalsandwmhlanihlpbuis, ,die / •-�ey In ftm,hling
ampztian and sha4i comply wVch rite reAuirtmen:s of this Agreement.In the client any deter,in wrorkmanship ar materials.or damage caused by the Gonttatior,his sub-
rem, tors,employees ar agents ii discaserad w!thin one year agermmpietipp of any job,inciutling deanap,the Contractor shall,ai his awn expeme,foritrv+Rh remedy,
repair replace,cr cause ttber¢metlietl,repaired,ar reF'.aced,zN<h damage or such defect In rrateria4 orwwkmamlNp.The teregoln9w'rraniesshail surviveany
inspection performed in connxtbn wi:hthe wgreetlupon work.
We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of:
r �
f n�ilr-•1
Parment to be made az fehl z
es is 7tiPonsigningContracf; ROBERTA.KEEN
Name of Contra<te,r Designated Registrant
ea ti 3.p.� orf PO BOX 935
(�1 Street Address
¢$� � Ip.r camplege..f N.ANDOVER,MA 01845 ctyrs:ata
%is },hat:be made forthwith upon (978)691-5201 (978)682-3231
completion of work under this contract. prynn� Fax
NoticeNa agreement for home mprovement contracting work zhatl requ're a .303 5a� .i r�
>down payment(advance deposit)of more than one-third of the total contract
prcecrthehualamodnt.fali deposits.,payments which the contractor,most
make,in adeance,to order and/or otherwise obtain delivery of special order Authorized Signature
materials and equipment, h"hg_e [ t' rgatgr te:Thsµ sal mwy beeithdr by Is if not accepwd fithin_tlaf
Acceptance of Proposal-!nave read both sides of his document and alt attached documents and accept the prices,specit cations 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 outline above.You,the Buyer,maycancel 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.
Sig -:\•..�Wc,o,ll S,,,mtre Date
IMPORTANT INFORMATION ON BACK li-
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The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
600 Washington Street
vBoston,MA 02111
f www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information / Please Print Legibly
Name(Business/Organization/Individual): LoQ�(I 6�zn1 (�C (CN1
Address: ?o B6 X x`2)5
City/State/Zip: Olone 2?— (p91 -15720/
Are you an employer?Checkthe appropriate box: Type of project(required):
L I am a employer with Z 4. ❑I am a general contractor and I
6, ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
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
working for me in any capacity. employees and have workers' 4. F-1Buildingaddition
[No workers'comp.insurance comp.insurance.t
required.] 5.❑ We are a corporation and its 10.[__J Electrical repairs or additions
officers have exercised their II.❑Plumbing 3.❑ I am a homeowner doing all work g 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' 13.0 Other
comp.insurance required.]
*Any applicant that checks box#1 most 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 most provide their workers'eomp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information. �!
Insurance Company Name:_[_� ,��e r5
1� �`U F 7
Policy#or Self-ins.7Lic.#: ( I � 995..�.1`,5�Z..�.�v Expiration Date:�( �fJ / J ,j/�
Job Site Address: 1137 7 &�K 2 C t5f City/State/Zip:/1J ({R(/D �N o 1915
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
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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify urp�r Fte f s an enalties ofperjnry that the information provided above is true and correct.
Signature: 1Date:
Phone# 9
7<3 94 iJZQ p
Official use only. Do not write in this area,to he completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2,Building Department 3.City/Tovvn Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone##:
A1o/1n7/2016C C!ZP CERTIFICATE OF LIABILITY INSURANCE DATE7/z61s
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(les)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 ME T Barbara McDonough
GILBERT INSURANCE AGENCY INC. PHONE 1 1781)942-2225 FA No:
ADDRESS: bmcdonough@gilbertinsurance.com
137 MAIN ST. INSURERS AFFORDING COVERAGE NAICM
READWGMA 01867 1NSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666
INSURED INSURERS:
KEEN CONSTRUCTION CO NSURER C:
INSURER D:
PO BOX 935 INSURERS:
NORTH ANDOVER MA 01845 INSURERF:
COVERAGES CERTIFICATE NUMBER:94268 REVISION NUMBER:
THIS 15 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 RY PAID CLAIMS.
ICT. TYPE OF INSURANCE .ADDL SUS POLICY NUMS£R MMI ICDDY MOLICY EXP LIMITS
COMMERCtALGENERALLIABILnY ( EACH OCCURRENCE §
CLAIMS-MADE O OCCUR ; P ISE&E acrarrence §
i MED EXP(Am ore P—) §
III$ NIA PERSONAL&ADVIN.YURY $
GEN'LAGGREGATELIMITAPPLIES PER: GENERAL AGGREGATE $
POLICY❑J., 11 LOC iI PRODUCTS-COMP/OP AGO $
OTHER: $
COMBI INdEeDISINGLE LIMIT
AUTOMOBiCELWBWTV Saco $
ANY AUTO
SORLYINJURY(Perp—) $
AOED
AUUTOS SCHEDULED N/A BODRY INJURY(Perewidenl) $
NON-OWNED ? PROPERTY DAMAGE $
HIREDAL AUTOS ! accNen1 P, _
$
UMBRELLA LIAa OCCUR EACH OCCURRENCE $
EXCESS DAB CLAIMSAIADE NIA AGGREGATE $
QED RETENTION$ $
1WORXERS COMPENSATION j X sTATVTE ER
A �ANOEMPLOYERS'DABAITY
ANt'PaOPRiETOR/PART, RFcxEGUTIVE Y/NI E.LEACHACCIDENT s
OFFICERIMEMBEREXCLUDED? NIA MA WA 16HUB9991 M58216 10108/2016(1010812017 16009
(Mandatory in NMI I E.LOISEASE-EAEMPLOYEE§ 160,000
If yes,descabe under
DESCRIPTION
OF OPERATION56elaw 4 £.L.DISEASE-PCi1CY LIMIT § 500,000
NIA
DESCRIPTIONOFCPERATt MtWCATION$IVEHICLES{ACORDtet,Addtllonal Remarks Scaedele,may 6e attached Irmaro space iz reRWred}
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of Insurance shows the policy in force on the date that this Certificate was issued(unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at WWW.mass.gov/W/mrkers-compensation/`lnvestigationsf.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of North Andover ACCORDANCEWITH THE POLICY PROVISIONS.
1600 Osgood St AUTHORIZEOR£PRESENTATiVE
'LUQ
North Andover MA 01845 Daniel M.Cro
y,CPCU,Vice President—Residual Market—WCRtBMA
O 1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
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Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Cnnatrucnnn Salle"".,'
License:CS-076681
se.ro a
ROBERT AkEEI �.
12EWATER5T
d
North Anover l!�0
r
�rY
e.�a Expiration
commissioner 08/1612017
�iomoitoricrea o�Caaaacluwellh
ice of Consumer Affairs&Business Regulation -
EIMPROVEM17@N,TCONTRACTOR
X.
gistratlon Type:
Expirati fi
Supplement Cat
KEEN CONSTRUCT4>i3 �i
ROBERT KEEN ;,r.
1175 TURNPIKE ST
NO.ANDOVER,MA 01845
Undersecretary
ZONING TABLE:
ZONING DISTRICT.• R2 REQUIRED PROVIDED
MAX HEIGHT 35 FEET < 35 FEET
MIN, LOT FRONTAGE.- 150 FT 150.00 FT
MIM LOT AREA: 43,560 S,F. 46,119 S.F.
MIN. FRONT SETBACK 30 FT 101.2 FT
MIN. SIDE SETBACK (L) 30 FT 52.3 FT
MIN. SIDE SETBACK (R) 30 FT 32.1 FT
MIN. REAR SETBACK 30 FT 159.2 FT
OWNER IS SEEKING ZBA,APPROVAL TO CON VE
BASEMENT AREA TO INLAW APARTMENT. NO
FOOTPRINT CHANGE TO EXISTING STRUCTURE.
S54*03'23"W
150.37' FOR REGISTRY OF DEEDS USE ONLY
UTILITY EASEMENT
ZONING INFORMATION.
146.53'
ZONING DISTRICT.• R2 _ "W
S48*53'54
ASSESSOR INFORMATION:
MAP 35 LOT 99
OWNER INFORMATION,
JOSHUA & ELIZABETH MOUGHAN LOT AREA
137 BARKER STREET 46,119 S.F.± 159,2'
NORTH ANDOVER, MA 01845
DEED REFERENCE.-
BOOK: 13531 PAGE. 326
-A
NORTH ANDOVER ZONING
BOA W OF APPEALS
,A- Roofed d
porch
Story
tC
"od
structufe
0-1
k cr
%Nor
OA (,A
APPROVED -, 20
�.A-A
-IQ -
lo-is 101.2' 102.5'
GRAPHIC SCALE
SCALE.•1"--40'
FEET4020 40
94.68' FND
55.32' N53*35'15"E
"I HEREBY CERTIFY THAT THE PROPERTY LINES N53'4.3'05"E
SHOWN ON THIS PLAN ARE THE LINES DIVIDING
EXISTING OWNERSHIPS, AND THE LINES OF THE BARKER STREET
STREETS AND WAYS SHOWN ARE THOSE OF PUBLIC
OR PRIVATE STREETS OR WAYS ALREADY 137 .BARKER STREET
ESTABLISHED, AND THAT NO NEW LINES FOR
DIVISION OF EXISTING OWNERSHIP OR FOR NEW
WAYS ARE SHOWN AND THIS PLAN CONFORMS To THE PLOT A" OF LAND
RULES AND REGULATIONS OF THE REGISTRY OF DEEDS," LOCATED IN
I DECLARE, TO THE BEST OF MY PROFESSIONAL NORTH ANDOVER, MASS.
KNOWLEDGE, INFORMARON, AND BELIEF, THAT F
THIS PLAN WAS PREPARED IN ACCORDANCE (ESSEX COUNTY)
WITH THE RULES AND REGULATIONS OF THE
REGISTERS OF DEEDS. PREPARED FOR
oFk" JOSHUA MOUGHAN
P . SCALE: I"= 40' DATE- NOV 7, 2013
PREPARED BY
SULLIVAN ENGINEERING GROUP, LLC
22 MOUNT VERNON ROAD
BOXFORD, MA 01921
PAUL FINOCCHIO, PLS DATE (978) 352-7871