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HomeMy WebLinkAboutBuilding Permit #434 - 11 OXFORD STREET 12/18/2007 BUILDING PERMIT o`NORT1i t�bo "tio TOWN OF NORTH ANDOVER C? 6.,.�. `..,r., 6 OA APPLICATION FOR PLAN EXAMINATION * 4 Permit NO: Date Received 7 A�gATD pPP��f�� �SSACNU Date Issued: off'/ IMPORTANT: Applicant must complete all items on this page LOCATION Prim `^. PROPERTY OWNER :s... r Print P .: ZON MAP NO: ING DISTRICT. HISTQRIC ClISTRICT yes no J . � ARC - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial C�epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic Ullellx- loodplai: ©Wetla1lll nds at� shed Dista jet ater/Sewer > Y . DESCRIPTION OF WORK TO BE PREFORMED: 62 �MoLL t s� ���• lZ i�� �-l^ Identif744 on Please Type or Print Clearly) OWNER: Name: L£ o -I 1- �T_o /L-Nom' Phone2ZF- 6,9 r, - 7194/ Address: lJe- CONTRA t,y Phar e. A dress: 1 r J v +► C � t1 . 41" 10 Su pervisorV�onstructi r oense� ' Expo ate ' 73 —4o.4 Hcsme Improvement t:i file: AP" 4 ,1 xp #Date: 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: $ 7�,� � � FEE: $__ 7 © �S _�,_° — CNo.: Receipt No.: 02 J J' C-4- NOTE: Persons contracting with unregistered contractors do not have access tathe guar ty fund _ - Sid ature ofNAgentl0:br - _. Signature of co "tracto 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 ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HE41-TH Fl— COMMENTS 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 Located at 384 Osgood Street Flk .DEPARTMENT; .Temp Dumps&on site yes no Located at 124 Main Street Fire Department signature/date 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 ................ .................................. ................................ ............................................................................... ....................................................................... ............................... Doc.Building Permit Revised 2007 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 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 o 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) ❑ 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 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location// No. g3V- Date 2 `d- N0",rh TOWN OF NORTH ANDOVER o�....o ,.�1 16. Certificate of Occupancy $ s''^"Eta' Building/Frame Permit Fee $- 1 ACNUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # _ 20 6 68 Building Inspector NORTH Town of Andover No. 413 dower, Mass.,0 0 LAK COCHICHEWICK S OOATED P? C:) BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....64....... ....................................................................................................... Foundation has permission to ere ....................................... buildings on ... ................................................. Rough to be occupied as... ....... Chimney .....�WW-4�.......74.17 ............................................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 UNLESS CONSTP 0 TARTS Rough ............................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. VU/i7/LVV I 11.00 rfVA 101 On iiiV Vaa+u J—. .r;,vvr I � y "PRODUCEkM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ernsuanoe Agency Inc HOLDER_ THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 137 Main St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Reading,MA 01867-3922 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Kenneth Keen 8 Robert Keen 21 Hewitt Ave North Andover, MA 01845-0000 gem IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR -THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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 AFFORDEDTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY NAVE BEEN REDUCED BY P+CLAIMS, 00 LTR TYPE OFNSURANCE POLWYMUMD POLICYEFFECTivQDA7E POLICYEXPIRATIONDA7E A RK OM TDN EMPLOYERS LPSILITY LIIYUT$ PROPRETOFV PARTNERSlEXECUT(YE FFICERS ARE: NCL a EXCL o 6360668 8/03/2007 9/03/2006 ATUTORYLIMITS mER elope APM 1681 o MA rtlm OPas Or* AccmENT S 100A0 I 1SEASE POLICY LIMIT S 500.00 I ISEASE-EACH EMPLOYEE $ 100.00 ESCMPTION OF OPERAT10N,7d7 C GAL ITEMS ROBERT KEEN IS COVERED 13Y THE WORKERS COMPENSATION POLICY AND KENNETH B KEEN IS NOT COVERED BY THE i WORKERS COMPENSATION PRICY. ,!CERTIFICATE HOLDER CANCELLATION DOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH8 EXPIRATION DATE THEREOF,THE ISSUNG COMPANY WLL ENDEAVOR TO MAC 19 :'18D0 OSGOOD ST DAYS WRRTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT NORTH ANDOVER,MA 01845 FAILURE TO MAR SUCH NOTICE SHALL WPOSE NO OBLIGATION OR LMBILIY OF ANYKND UPON THE COWANY,rM AGENTS OR REPREBENTATNES, AUTHORIZED REPRESENTATIVE e vo,av, rvv• ay.is anu ,va ver rrry va uuua.a a•.v�a�o•.vu �vvv I DATE(NMIDPIYYYY) �gC 1M CERTIFICATE OF LIABILITY INSURANCE 09/13/2007 PRODUCER (781)942-2225 . FAX (781)942-2226 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Gilbert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 137 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Reading, MA 01867-3922 INSURERS AFFORDING COVERAGE NAIC# INSURED Kenneth 9. Keen--& Keen INSURERA; NORFOLK & DEDHAM INSURANCE 2396S DBA: Keen Construction Company INSURER B: • 21 Hewitt Ave. INSURERC: North Andover, MA 018,15 INSURER13 INSURER E: OYERAGES THE POLICIES OF INSURANCE LISTED 9ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN ANY REQUIREMENT,TERM OR CONon bDN 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.AGGREGATE LIMITS SHOWN:MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR ADOIL TYPE Of INSURANCE POLICY NUMBER POLICY E CTIVE POLICY tRA E%PT10N LIMITS GENERAL LIABILITY ND-P-010078/000 03/13/2007 03/13/2008 EACH OCCURRENCE 11 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAO@ TO RENTED S SO,0O DHFWISGC(Fa n CLAIMS MADE a OCCL R MED EXP(Any one person) $ 5 00 A PERSONAL&ADV INJURY 5 11000,000 GENERALAGGREOATE S 21000,000 GEN'L AGGREGATE LIMITAPPLIES FER; PRODUCTS-COMP/OP AGG S 2,000.000 POLICY JpECT LIN, AUTOMOBILE LIABILITY COMBINED SINGLE UMIY ANY AUTO (EB accident) ALL OWNED AUTOS BODILY INJURY 6 SCNEOULED AUTOS (Per pe(aon) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS , (Per accident) S PROPERTY DAMAGE S (Per aalderd) GARAGE LIABILITY AUTO ONLY.FA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGO S EXCESSIUMBRELLALtABIUTY EACH OCCURRENCE S OCCUR F]CLAIMS MATE AGGREGATE S s DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND NEA OTH- EMPLOYERS'LIABILITY , E.L.EACH ACCIDENT S ANY PROPRIETOMPARTNERIEXECUTIVE OFFICERIMEMBER CXCLUOED1 E.L.DISEASE•EA EMPLOYEE S K YCs,describe under SPEGAL PROVISIONS below E.L.DISEASE•POLICY LIMB 5 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS 1 vI:ucus I EXCLUSIONS ADDED BY ENDORSEMEW 1 SPECIAL PROVMAONS CERTIFICATE"OLDCANCELLATIQN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE GANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of North Andover,' BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR LIABILITY 1600 Osgood Street OF ANY KIND UPON THE INSURER S AGENTS OR REPRESENTATIVES. North Andover, MA 02f:45 AUTHORIZED REPRESENTATVE Dawn Cram A'r�! ACORO 25(2001/08) FAX: (9711;)682-3231 ®ACORD CORPORATION 1988 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registr*g9,0,, 108383 Ezp anon-;::818/2008 ,TYP.e A i KEEN-CONSTROCTIU.N Qp, Kenneth Keen 21 Hewitt Ave ,,, i No Arfdovef, MA 01845 Deputy Administrator j 'C�o?runwr�e�eciC�r��/eac�ucuel! ` BOARD OF BUILDIN IRE-ibih IONS leen'.se• CONSTRUCTION SUPERVISOR h Number°CS 058245 f t.,. irthiate 03/24/1943 !' Ex �ae �372473Q08 Tr;rao 135r W 436 _ The Commonwealth of Massachusetts 47) Department of Industrial Accidents 1-11 Office of Investigations ' d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): J� Q C Q Address: 2 l Ld City/State/Zip: 16 , lq OC(60 )411, InIt Phone.#: 1? '7 5i - 66q / " 5 Z O l Are you an employer?Check the appropriate box: Type of project(required): 1.[55-I am a employer with `Z- 4. [] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ElNew construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. employees and have workers' insurance. 9• ❑Building addition comp.[No workers' comp. insurance required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.E]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.Q Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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. TContractors 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: 2 �,. 1,6- Policy#or Self-ins. Lic.#:_(p 73 6 b$ Expiration Date: d 3 ^ Job Site Address: l/ ©) �9 2 a4 t.1 c City/State/Zip: Af. 14 N 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u the pai an pen�alties ofperjury that the information provided above is true and correct. Si nature: Date: 'Q Phone#: G 6 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 InspecEflumbing]Insp]ector 6.Other Contact Person: Phone#: KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978) 691-5201. Turner,Leo&Pat 11 Oxford Ave. N. Andover, MA 01845 (978)682-7194 Contract# 1694: Appendix A Date:12/12/07 Remodel first floor bath: •. .Demo bath to studs, ceiling joists and sub floor_ • Update electric to code Update plumbing as necessary • Insulate walls with R-13 insulation.. • Supply& install blue board and skim coat plaster to smooth finish Install customer,supplied ceramic tile floor • Supply&install.Harvey Majesty replacement window a. rF,M,a • Supply&install-trim to match existing • Install customer supplied vanity,top&faucet • Install existing toilet • Install customer supplied vanity light Total Price:$7450.00(seven thousand four hundred fifty dollars). Price does not include cost of permits,plumbing fixtures, lighting, ceramic tile,painting, staining µ or.light in basement stairs. Payment schedule:$1500.00 due upon.signing contract $2000.00 due when demo is complete $1000.00 due when tough electric&plumbing.is complete $1500.00 due when plaster is complete $1000.00 due when tile and trim is installed ` $450.00 due upon completion of contracted work usto er Ke! KT3. een Date Date x t y 5 KEEN CONSTRUCTION CO. j1694 ° 21 HEWITT AVENUE P ROPOSAL NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 All home improvement contractors and subcontractors 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 with Submitted ! �. ?�t{ --,r) i�` the Commonwealth of Massachusetts. Inquiries about To: '� t, t t C registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. a v Owners who secure their own construction related / permits or deal with unregistered contractors will ry be excluded from the Guaranty Fund Provision of PHONEMGL c. 142A. �.. 4 DATE REGISTRATION NO. F.I.D.NO. IE l q� MA. H.I.C. 108383 0 :325=8452 > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: ,r . . ci Construction related permits. _ .__.---.__________._ ....... .................................................................. .....................,......... .............................................. WORK SCHEDULE ....................................................... ...................................................................................................................................................... .......... _........................................................... Contractor will not b in 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 < /y> — r7 't (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 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 Tabor-complete in accordance with above specifications, for the sum of Payment to be made as follows: dollars ($ ($ ) upon signing Contract; yi'� KENNETH B. KEEN j Name of Contractor/Designated Registrant r { ($ ) upo^^n�f rn�l fi n�f� 21 HEWITT AVE. S � �i'� Street Address ($ NOO City completion of N. ANDOVER, MA 01845 ,� :Co// t � /State d shall be made forthwith upon (978) 691-5201 (978) 682-3231 /���� ) i-J completion of work under this contract. Phone Fax Notice: No agreement for:home improvement:contracting work shall require a ;1 down payment(advance deposit) of more than one-third of the total contract price Name n!Satt aC or the total amount of all deposits or payments which the contractor must make, advance, to order and/or otherwise obtain delivery of special order materials and Aulhortzed". ignature equipment,whichever amount is greater. -� Note: This proposal maybe withdrawn by us if 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 �.%i.fi /' yG... --.. /��t Date �+�•r � Signature Date' IMPORTANT INFORMATION ON BACK ►