Loading...
HomeMy WebLinkAboutBuilding Permit #317-16 - 1080 TURNPIKE STREET 9/14/2015 J'e,�u1✓r-v t4ORTH BUILDING PERMIT oFst�Eo .s'�tio TOWN OF NORTH ANDOVER 4a APPLICATION FOR PLAN EXAMINATION K 1 Permit No#: Date Received �gsoOArEv5���5 Date Issued: i I PORTANT: Applicant must complete all items on this page LOCATION )D 70 �u ry) p 1 Vo 5 Print PROPERTY OWNER �au `b �—� u Y_Ic�_ r 3 Y).5 Print 100 rear Structure yes no MAP 10 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 ❑ Septic ❑Well ❑ Flogdplain El WetlantlsWatershed D1strict 0 Water/Sewer DEpr RIPTION OF WORK TO BE PERFORMED: -- --� �yo-k-% r � S Identification- Please T Pe or Print Clearly OWNER: Name: �a,, � ", Lsu rc.- Phone:?21 --9Z9 -x-53G Address: 0-bz v rn ,� ke, J A 014- 0 f Contractor Name: kin &,s C© Phone: 970— 0-6Z Email: eS @ GC-e-ea , e ave. Address: A&CL�tar 07 Supervisor's Construction License: CS — 0-?6 6 91 Exp. Date: Home Improvement License: Exp. Date: l'l ! t ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$$112.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ to l9 N FEE: $ Check No.: f �;_(,,0:3 Receipt No.: - NOTE: Pe ns contracting with unregistered contractors do not have access toth a n fund g - - __ - ct r_. 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. ❑ Pennanent 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 r t�AOMMENTS 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: Located 384 Osgood S eat 3667c—ate-1 EPg gflMENTamat124 Nlaintreet, a ,.� )�F e Departmenot Qijature%date U ' .i • t 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) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 OTE: 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 � Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract :rF Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) :r 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 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 2012 IECC Energy code Engineering Affidavits for Engineered products 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 Doc:Building Permit Revised 2014 Location « 1 012N Nom — 1G Date ulcdr TOWN OF NORTH ANDOVE00' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Mw 1}+ TOTAL $ Check# [i B ilding Inspector NORTH own of _� Andover 1' j"f . No. 7—j 4t �_T - �` - h " ver, Mass coC"Ic"NWICI[ S V BOARD OF HEALTH Food/Kitchen PER LD Septic System THIS CERTIFIES THAT . .�.�i�..II.Ar, BUILDING INSPECTOR .....!1E.... ...... ........................................... ,. Foundation has permission to erect AL-1-tA.1A ............. buildin son ... .... . .�. ... .... Rough to be occupied as .... ........ .... ... .............� .... ..................... chimney provided that the person accepting this permit s all 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 6 UNLESS CONSTRUCT ST Rough Service ................. ... ..... .......... Final BUILDING INSPECTOR 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 CO. PROPOSAL 1175 TURNPIKE STREET 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 Submittedb U l')P f t 5 with the Commonwealth of Massachusetts. Inquiries To: -.[ �J about registration and status should be made to the { Director,Home Improvement Contract Registration,10 L � Lt rtn i�1 S 1 Park Plaza, Room 5170, Boston, MA 02116 617-973- ( 8787 Owners who secure their own construction o i,7`T related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATE PEGISTRATION N0. ::[46 IN N0. '7�Qf- �d y - 6S 3 (� �? ( /(5 MA. H.I.C. 108383 -3783401 > C/S=Customer Supplied S+I=Supply+Install LX See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: hep r rz-_o f a c c 1 > Construction related permits: ..._.._...__..._..__..,....._.__....._..._...__.._... _.............. __........ ............. .......................................... ..._......................_...................................................,............................_.._.......... ...... ..............._................._.__....__.__,....__.....__......__._.......__..._ WORK SC EDUL Contra ill.ngt a work or order the materials before the third day following the signing of this Agreement,unless specified here in wri i atractor will begin the work on or about LI (date). Barring delay caused by circumstances beyond Contractors control,the work will be completed by (date). The Owner hereby acknowled es 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 detects in materials and workmanship for a period of i k4dCk 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 Contracto,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 Propose hereby to furnish material and labor-complete inacc rdance with above specifications,for the sum of CA)S61 1^11 �! -� j ./1� L, . dollars($ V ). Payment to be made as follows: e/ ($ ) upon signing Contract; ROBERT A. KEEN f Name of Contractor/Designated Registrant �e ($ u p(T�gr)pt�Rof 1175 TURNPIKE ST. `���""" Street Adtlress % upon completion of. N. ANDOVER, MA 01845 City/State eia ($ ) shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Phu�` 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 Name of Sale n 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 rize ignature 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.Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF (THERE ARE ANY BLANK SPACES. Signature Date 6 1)t/`'}' Signature Date IMPORTANT INFORMATION ON BACK Canstuchan:Ca;. REMC�UFI_ING SPECl/_�LISTS 978-697-5207 Keen ConstructionCo.com Berzins, Paul & Laura 1080 Turnpike St. N.Andover, MA 01845 Contract#5552;Appendix A August 26, 2015 Remodel front porch: • Install temporary beam to support existing roof • Remove and dispose of existing deck and roof support • Rebuild deck using 2"x 10"framing to current code specifications on existing footings • Deck and stairs will be similar size as existing • Supply& install Azek XLM decking in RiverRock(grey)with color matched screw plugs • Supply&install PVC lattice around bottom of deck • Supply& install PVC trim on deck and stairs Total Price:$6,690.00(six thousand six hundred ninety dollars) Price does not include cost of permits, railings, decorative columns, painting or repairs to any unusual, unsafe, or non-code compliant existing conditions not addressed in this appendix. Payment Schedule:$1000.00 due upon signing contract $2000.00 due when demo is complete(plus permit fee) $2000.00 due when deck and stairs are framed $1690.00 due at completion of contracted work Customer Robert A Keen 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 l The Commonwealth of?Massachusetts - Department of IndwtriglAccldiints 49 Office of Invesdgations 600 Washington Street Boston,MA 02111 klip www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmizationffndividual): �� C GNA j+ry Address: y r n _ City/state/Zip-_L, Ltlloff,_ffi''LL9 ' ,6 Phone#: 9?Y` (c9 6 W Are you an employer?Check the appropriate box: Type of project(required): 1.[� I am a employer with i-- 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• [1�Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, (�Building addition [No workers' comp.insurance 5. El We area corporation and its 9. [l Electrical repairs or additions required.] officers have exercised their 10. 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.Q Roof repairs insurance required.] employees.[No workers' �' .j� 1311 Other comp.insurance required.] *Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information. i-Homeowners who submit this affidavit indicating they iiie doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance formy employees. Below is the policy and joh site information. Insurance Company Name% " V e ' �S 1�1�t1 a-GA� Policy#or Self ins.Lie.# (� y `� �) 9 _2-1 xpiration Date: 1 Job Site Address: U r l'1 p k2 5t City/State/Zip: 4J, A7 haw Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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 may be forwarded to the Office of Investigations of the DIA for insurance overage verification. Idolzerelycartify a er th ains d penalties ofperjury that Elie information provided above is true and correct. Signature: Date: 7 Z15 Phone# 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/Town Clerk 4.EIectricaI Inspector 5.Plumbing Inspector 6.Other - ContactPerson: Phone#: i RightFax C3-1 3/24/2015 9:51 :03 AM PAGE 2/002 Fax Server r DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE TU&M11FICATE 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 CERTIFICATEHOLDER. 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 lieu of such endorsement(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 INSURER E: NORTH ANDOVER,MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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,EXCLUSIONS 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 (MIAOMYYYY) (MKM\YYYY) LIMITS GENERAL LIABILITY :ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE �OCCUR. REMISES(Ea occurrence) ED EXP(Anyone person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY PROJECT❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINEDSINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY I OTHER EMPLOYER'S LIABILITY YM UB-999IMS82-14 10/08/2014 10/0&2015 I LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE El OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 100,000 (Mandatory M NH) 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/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 BEFORE THE EXPIRATION DATTHEREOF, 1600 OSGOOD STREET N ACCORDANCE WITH THE POLICY PROVISIIO SCE WILL BE DELIVERED AUTHORIZED REPRESENTVE NORTH ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Massachusetts -UepartmentofPublicSatety Board of Building Regulations and Standards - '3--- --V=--- 1.1111�LI LI1 L11111 JI111C1 V1S111 License: CS-076691 ```cl.fl'.0 UFS ROBERT A KEEN.`' 12 E WATER ST North Andover ha 01V �1J�•J1.1ilExpiration Commissioner 08/16/2017 C���ie�pomrrzoau�iP,cr,�C1 ayOC?��a�rsaeC� Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR oegistration: ;,,08383 Type: xpiration 8118/20469 DBA KEEN CONSTRUCTIONS ; ,-+ i ' Kenneth Keen 1175 TURNPIKE ST NO.ANDOVER,MA 01845`""` Undersecretary