HomeMy WebLinkAboutBuilding Permit #Exception - 105 CARLTON LANE 5/1/2018 (10) BUILDING PERMIT NORTH ,
1 TOWN OF NORTH ANDOVER -�
APPLICATION FOR PLAN EXAMINATION
Permit No#: 7 l Date Received ��Ssgc►+usti���
Date Issued: 26t I�
IMPORTANT:Applicant must complete all items on this page
LOCATION a r 1 Tom'` L v-)
nn Print r
PROPERTY OWNER r M ir'd�ro
Prins 1 100 Year Structure yes
MAP 1 PARCEL: ZONING DISTRICT: Historic District yes o
Machine Shop Village yes o
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
WRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other w
Septic Well �'Flootlplain 1Netland�`s D Watershe--_00istrrcif.
p 1Nater/Sewe -, -----DESCRIPTION OF WORK TO BEP RFORMED:
e 1 a G -33 w A � r - G Ie- cva -�-
�N `��� �1 1Grg, r— wivxJdW cA D 06e QT Qd�b � d�' C1✓J► �
Identification- Please Type or Print Clearly -7— 2 J 3 5-( 765^( 7vs
OWNER: Name: Euu i �6 Pele� Co►'nn ''ars Phone.
Address: J CS 5 �' �U-, Z_ Iv in
Contractor Name: ��(1 COn5-641cyi Phone: 923
Email: a le 3 frv� ' q-) Cc "fcvxA
Address: _ f' Ye47 H
/
Supervisor's Construction License: C 5 —O�(4 0 ( Exp. Date: /I Co /17
Home Improvement License: 10� 3 �J Exp. Date: �1 ! 1
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: $�-T 7 - 0 C� FEE: $ 24(e.EYD
Check No.: > � Receipt No.:'
NOTE: Persons contracting with unregistered contractors do not have ccess o th u 'an fund
[ � �. 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
4. 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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Application
Permit A lication
Certified Surveyed Plot Plan
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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New ConstructionSin le and Two Family)
( g Y)
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
2012 IECC Energy code
Engineering Affidavits for Engineered products
IN OTE: 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
Doe: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 m U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
:Tanning Board Decision: Comments
4Conservation Decision: Comments
Water&Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
^ Located 384 Osgood Street
�—r_ Ey'7 Y ePa=
,Fy�IRE DEPAR<TMEIVTTernn DumDste� on;situ,
t"� rj„ � aj�-�,� N- -4y+W141.;�'r x p,� ,rt b} ��,�,iti��!�i2 4- ,51 � rho J7 '�,,� J �,,ry►�
e1L•ocateci at 1P24 MainStree ` , '` '� �' *�,
..�+..Q. � .' Ya+nt� �1 ° r •�
?,Fire Department signature/date�,,,�:..�
^ x'' _y_ -+4 .��.ezca...,-„
!'.'+F3 �*w'✓.34A�:a �V t,f .• el ��.�'"s�,,. -r s x.', «1 � s i r ���,# �.'t t„• y �. � r.t;T T �{c i # '��
•COMNIENT�S4 f X.
m
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 ease)
Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
_ F
Location
No. c? - o� 0 {� Date
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $C?
; - Foundation Permit Fee $ a'
E„«
Other Permit Fee $
? TOTAL $
Check#
Building Inspector
2 1 2 4 O
r -I - - 7 NORTH -
. W. tver
O -
No. �— *
h ver, Mass4&_'C.03:
O1
CoCNIc"t WICK y1.
p04ATED P�,��(y
S V ,
BOARD OF HEALTH
Food/Kitchen
P E
Septic System
THIS CERTIFIES THAT ... MIT
ilC. .... �' �� �0 BUILDING INSPECTOR
........ . .... ...... ... ........................... ............................
Foundation
has permission to erect .......................... buildings on 4 ........ •
4.4® Rough
to be occupied as .... �� .... ..w�!.: �..r .' r! '1'IIR.... 1�.... ... chimney
provided that the person accepting this permit shall in every respect conform to the terms V the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Ins ection, Iteration and
Construction of Buildings in the Town of North Andover. i' /� 4� Cry PLUMBING INSPECTOR
• "'�� Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU RTS . Rough
Service
........... ..................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final T
NO Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
- 5 I
KEEN CONSTRUCTION CO.
° 1175 TURNPIKE STREET PROPOSAL
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
Submitted (\ `� C� (`tr 0 with the Commonwealth of Massachusetts. Inquiries
To: about registration and status should be made to the
Director,Home Improvement Contract Registration,10
A,,,) Y1 Park Plaza, Room 5170, Boston, MA 02116 617-973-
8787 Owners who secure their own construction
N CV e r f �� I I o I ���� related permits or deal with unregistered contractors
will be excluded from the Guaranty Fund Provision
of MGL c.142A.
PHONE DATE REGISTRATION NO. EIN NO.
MA. H.I.C. 108383 46—3783401
> CIS=Customer Supplied S+I=Supply+Install PrSee Attached Appendix A
We hereby submit specifications and estimates for work to be performed and materials to be used:
> Conslmction related permits:
..__....._..._.......__....
WORKS,HEpULE
Conto.vll rN t1n the work or order the materials before the third day following the signing of this Agreement,unless specified her n t ia-.jcrr will begin the work on or
about y r I / (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 considered 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 V e- f 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.
We Propose hereby
to furnish material and labor-'complete in accordance with above specifications,for the sum of
l tL ) � `1 `{ VI d')SCA V13 t c'U r L W Ci i ')-e+n� l I If . `dollars($
Payment to be made his follows: —
% ($ ) upon signing Contr ct; ROBERT A. KEEN
Name"1 Contractor/Designatetl Registrant
($ ilu
p
pen o I ti f 1175 TURNPIKE ST.
sneer aatlresa
° ($ ,p om letion of N. ANDOVER,MA 01845
T. City/State
le% shall be made forthwith upon (978)691.-5201 (978):682-3231
completion of work under this contract. Phon Fax
Notice:°No agreement for home improvement contracting work shall'require a � 1l �t
>down payment(advance deposit)of more than one-third of the total contract price Namenf 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 Autn ed Sigirawre
equipment,whichever amount is greater. Note This Proposal may be withdrawn b
y y us it not accepted w,thin Bays.
Acceptance of Proposal-I have read both sides of this document and all attached documents and accept the prices,specifications and conditions slated.
I understand that upon sig 'ng,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above.
You,the Bu er,m ca el this transaction at any time prior to midnight of the third business day after the date of
this trap c o C cel a ion must be done in writing.
N T SIGN THIS CONTR CT IF THERE ARE ANY BLANK SPACES.
Signature I Data �i I` Signature Dale
IMPORTANT INFORMATION ON BACK 1111111-
_ �:Construe an CO.
ttcmc�ur�.tnc srec�u��srs
975-69`1-520'1
Kee nConstruction Co.com
Cordaro,Emily
105 Carlton Ln.
N.Andover, MA 01845
Contract#5751;Appendix A July 28, 2015
Window Replacement:
• Supply& install thirty Harvey Classic double hung replacement windows
• Supply&install one Harvey Classic replacement picture window
• Supply&install two Harvey Classic hopper(basement)windows
• Remove doors and deck on front garage, re-frame and supply&install one Harvey Classic new
construction unit with double hung window flankers and picture window center(approx.96"x
51"),patch interior wall and install trim to match existing
• Remove existing quad casement in kitchen,supply&install Harvey Classic new construction
triple casement and trim to match existing
• Remove existing double casement in kitchen,supply&install Harvey Classic double casement
and trim to match existing
Total Price:$20,475.00(twenty thousand four hundred seventy five dollars)
All windows will have white 5/8"contoured grids between the glass,%screens on the double-hungs,full
screens on hopper and casements.We will insulate around new windows with spray foam and remove
all construction related debris.This quote does not include permits,painting,windows in master bath or
repairs to any unusual,unsafe or n nn-
code compliant existing conditions not addressed in this quote.
/oj
Payment Schedule:$4990-.Q"ue upon signing contract
Ip
CC $50DB�08 due when windows are delivered
$4500.00 due when replacement windows are installed
$3975.00 due at completion of contracted work
I
j
Cust er Robert A. Keen
1 ?Z2, 5) 115
Date Date
1175 Turnpike 5t. Page 1 of 1 P:978-691-5201
N.Andover, MA 01845 F:978-682-3231
GSL#076691 Sales@KeenGonstructlonGO.com HIG #108383
The Commonwealth of Massachusetts
Department of IndifstriglAccidents
Office of Investigations
VP 600 Washington Street
Boston,MA 02111
www mass gov/dza
Workers' Compensation Insurance AfAdavit:BuilderslContractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): -0-V1 CL" rl�L+ i o, C-"2
Ad&ess• 01IAC -�-
City/State/Zip: VI L)�trIV ( I f 5 Phone#: 92 2— (9 J'5 2.C) l
Are you an employer?Check the appropriate box: Type of project(required):
1.(M I am a employer with 4. ❑I am a general contractor and I 6. ❑New construction
employees(fulland/or parttime).* have hired thesub-contractors
2.El am a sola proprietor or partner- listed on the attached sheet. 7. [Remodeling
ship anThave no employees These sub-contractors have 8. ❑Demolition
working forme in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.Insurance 5. ❑We are a corporation and its 10.❑Electrical repairs or additions
required.] officers have exercised their
3.El am a homeowner doing all work right of exemption per MGL 1 LEI Plumbing repairs or additions
myself.[No workers'comp. c.152,§1(4),and we have no 12.[]Roofrepairs
insurance required.] employees.[No workers' 13.❑Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill outthe section below shov>heir Workers'wmperrsationpolicy 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.
TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site
information. `
Insurance Company Name:. V 1 5 1x'16 f)+-C,,_Dq
Policy#or Self-ins.Lic. 9 SZ'2_-J+xpirationDate: i A
Job Site Address:� C'r l isio, L n) City/state(Zip: &,)d0teclQ /D
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 o.152 can lead to the imposition of criminal penalties of a
ane 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 rine
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 certb un.er ae pat and aloes ofperjury that the information provided above is true and correct
Si afore: Data:
Phone#
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#:
RightFax C3-1 3/24/2015 9:51:03 AM PAGE 2/002 Fax Server
CERTIFICATE OF LIABILITY INSURANCE DATE(MRNDD/YYYY)
T44240WIFICATE 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. E E
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 and endorsement A statement on this certificate does not confer rights to the
certificate holder in Ileu of such endorsemen s.
PRODUCER CONTACT
NAME:
GILBERT INS AGCY INC PHONE FAX
137 MAIN STREET (A/C,No,Ext): (A/C,No):
E-MAIL
READING,MA 01867 ADDRESS:
246WY INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA
KEEN CONSTRUCTION CO INSURER B:
INSURER C:
INSURER D:
1175 TURNPIKE STREET
i INSURER E:
NORTH ANDOVER,MA 01845 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS 6 TO CERTIFY THAT THE POLICES 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 MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE
AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EKCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
INSR ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (LWDMYYYY) (MIADDNYYYY) LIMITS
GENERAL LIABILITY CH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $
CLAIMS MADE CDOCCUR. DREMISES(Ea occurrence)
ED EXP(Anyone person) $
ERSONAL 8 ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:
ENERALAGGREGATE $
POLICY PROJECT F]LOG RODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
A WORKER'S COMPENSATION AND WC STATUTORY OTHER
EMPLOYER'S LIABILITY YM UB-999IM582-14 10/08/2014 10/06/2015 X LIMITS
ANY PROPECERIME BER EXCLUDED? CUTIVE WA E.L.EACH ACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED?
(Mandatory M NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes, er
DESCRIPTIO OFtinO E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS glow 500,000
DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
1600 OSGOOD STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENT VE
NORTH ANDOVER,MA 01845 :
......
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved.
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
LI/11\tl ul llllll auDel Y11111
License: CS-076691
ROBERT A KEEfV
12 E WATER ST:
North Andover 1VA 0
Expiration
Commissioner 08/16/2017
lie�paa�murru�iea�a�G/�aac`u�aetta
Office of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
egistration: 1'8383 Type:
xpiration: DBA
KEEN CONSTRUCTION CO ~'
Kenneth Keen ?
1175 TURNPIKE ST
NO.ANDOVER,MA 01845` =' Undersecretary