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HomeMy WebLinkAboutBuilding Permit #707-14 - 11 OXFORD STREET 4/14/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION AI Permit NO: r Date Received Date Issued: MPORTANT: Applicant must complete all items on this page LOCATIONPOnt I t JX TLS PROPERTY OWNER �4fi�t G i c+- .- Print 100 Year Old Structure yes MAP NO: PARCEL: rJ ZONING DISTRICT: Historic District yes Machine Shop Village yes J TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family ❑ Industrial Alteration No. of units: El Commercial ' ❑ Repair, replacement ElAssessory Bldg El Others: ❑ Demolition ❑ Other El Septic El Well ❑ Floodplain El Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTI N OF WORK TO BE PERPRMED:j Identification Please Type or Print Clearly) OWNER: Name: �'� e,� �:- -T—L) rn e- Phone: 97 Z- Address: t nJ _h r CONTRACTOR Name: fUCJ lc-%A (g.'Phone: �7�� �� 52,61 I Address: � l 7 5 � �� D� S fi lt1 lqn �' , in 0 t 0415 Supervisor's Construction License: C 5 " d X �? � _Exp. Date: I(a / 5 Home Improvement License: ri), 3 Exp. Date: ��/ /`y ARCHITECT/ENGINEER Phone: j Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ y 2-0 — FEE: $ sip Check No.: !� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the g ra and Signature of Agerit�Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF`.SEWERAGEbISPOSAL 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS .CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 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 Tow Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT =Temp Dumpster on site yes. no Located at 124 Mair, Street Fire Department signature/date r COMMENTS 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 - Date s Doe.Building Permit Revised 2010 Building Department The foliovving is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, 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 NOTE: 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 ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) j ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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 apv,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submated with the building application Doc: Doc.Building Permit Revised 2012 Location No. 61 ` Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy r ' Building/Frame Permit Fee o Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 411 J 1.7 Building Inspector NORTH Town of 2 E ndover No. - 1 � s . � y 1 h ver Mass a1 14, 2oaN o GOC NIC Nt WICK y1. 40 R�TEO U BOARD OF HEALTH Food/Kitchen PER T L D Septic System THIS CERTIFIES THAT T%1r 04 f� BUILDING INSPECTOR .. ....... .... *has permission to erect .......................... buildings on ... D.A..Q...... .... .... ............. Foundation -ne Rough � ..... .� � ,... ... Chimneyto be occupied as ...... provided that the person accepting A erlrall Mineterespect conform to 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.MONT S ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO) TS Rough i Service r ................. ............................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Occupancy Permit Required to Occupy Building 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. 55�i 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 SubmittedG I (� Y�e� with the Commonwealth of Massachusetts. Inquiries To: 1 about registration and status should be made to the L Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617-973- ( \� 8787 Owners who secure their own construction Il ( M J related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. RHONE �. DATE / REGISTRATION NO. EN NO. y y 3/, Z /;61 MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install [ See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: ff c\ c�cr>� e� 1 c��< - 4. zee > 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 Contractors 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 C !' 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 Contras r,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 'o/f �� t6 el'i dollars($ '-!-27c);y0 ). Payment to bel made as follows: _% ($ ) upon signing Cont r ct; �11 ROBERT A. KEEN �{ Name of Contractor/Designated Registrant ($ O do 11 1175 TURNPIKE ST. Street Address ($ - ) n repletion of N. ANDOVER, MA 01845. _.... City/Slate shall be made forthwith upon (978)691-5201 (978)682-3231 —� ($ ) completion of work under this contract. Ph 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 Nam I sal man 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 Aulhorized Signature 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 Dale Signature Date IMPORTANT INFORMATION ON BACK I► - Consts^ucfion,Co. ItEMOUELING SPEC:IALIS"fS 978-69'1-520'1 KeenConstructionCo.com Turner, Pat 11 Oxford St. N.Andover, MA 01845 978-682-7194 March 12, 2014 Contract#5503; Appendix A Garage door enlargement: • Remove and dispose of existing garage door • Re-frame opening to accept 12'x 7'door • Trim to match existing • Supply& install Raynor Traditions Showcase 12'x 7'door with Liftmaster belt drive opener Total Price:$4720.00(forty seven hundred twenty dollars) Price does not include cost of permit, painting or repairs any unusual, unsafe or non-code complaint conditions. Payment Schedule: $1000.00 due upon signing contract $2000.00 due when opening is complete $1720.00 due when contracted work is complete Customer Robert A. Keen Sjj-72, /) q Date Date 1175 Turnpike St. P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 Sales@KeenConstructionCo.com Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuperN icor License: CS-076691 ROBERT A KEEN 12 E WATER ST -� North Andover WA 013 ` Expiration commissioner 08/16/2015 Massachusetts -Department of Public Safety Board'of Building Regulations and Standards Construction SuperNisur License: CS-05.8245 KENNETH B IdEN 21 HEWITT AVU.,ft �� N ANDOVER MA 01845 tj Expiration commissioner 03/24/2014 �rze�pdrnnnarzcuea& o�C%�La�aac�u�eGla '. I Office of Consumer Affairs&Busi ess.Regulation- lrOME IMPROVEMENT CONTRACTOR egistration:• 108383 Type:xpiration:.--8/18%2014..: DBA KEEN CONSTRUCTION�CO. Kenneth Keen 21 Hewitt Ave g –, — No.Andover, MA 01845 Undersecretary The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations y. 600 Washington Street ' ,� Boston, MA 02111 F µ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Lo,, Please Print Legibly Name (Business/Organization/Individual): ��?o len `ZI (yc-, f C� �,...o Address: 1175 TU t'f1 p; k_p `j± , t City/State/Zip: k , A1JM,,r_ 9§ 6I7Y5 Phone #: 9.2,2-6- 91—S2,0 / Are you an employer? Check the appropriate box: Type of project(required): 1. I ain a employer with Z- 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 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' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing 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 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must 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 must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. . Insurance Company Name: {' I'i S i.I Policy#or Self-ins.Lic. y'L� 2 — i 3 Expiration Date: G' %t- Job Site Address: l �ox y-d 6k1l City/State/Zip: ► A1,14-)Ve 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 fonn 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 coverage verification. I do hereby certify er t e pai nd penalties of perjury that the information provided above is true and correct. Signature: -"` Date: / `7 Phone#: D ' l,:' 9 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#: A� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD 10/29/2013013 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(ies)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 CONTNAME, -ACT Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 FAX -(791)942-2226 137 Main Street EMAILADDRESS.bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERA:NORFOLK & DEDHAM INSURANCE 23965 INSURED INSURERB:TravelerS Insurance 0022 Keen Construction Company INSURER C: 1175 Turnpike Street INSURER D: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:CL13102900618 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 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. INSR I ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP MMIDD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 10 0,0 0 0 A CLAIMS-MADE F0OCCUR -P-0I0078/0003/13/2013 /13/2014 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED HIRED AUTOS Per accident PROPERTY DAMAGE $ $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION To be provided directlyWC TRYSTATU- OTH- AND EMPLOYERS'LIABILITYLIMITS I FR ANY PROPRIETORIPARTNER/EXECUTIVE YIN is the Travelers Ins. OFFICER/MEMBER EXCLUDED? ❑ N I A E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) 0/8/2013 0/8/2014 E.LDISEASE-EAEMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,ifmore space is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 360 Bartlett Street AUTHORIZED REPRESENTATIVE Andover, MA 01810 M Gilbert, CIC/BARBAR ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).Ot The ACORD name and logo are registered marks of ACORD