Loading...
HomeMy WebLinkAboutBuilding Permit #738 - 114 SPRING HILL ROAD 5/14/2007 %40RTH BUILDING PERMIT Ot�� ED ,bgy0 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION e Permit NO: I30 Date Received �9 o„ATED SSACHUSE Date Issued:,.`) �'JJ IMPORTANT: Applicant must complete all items on this page LOCATI(* PROPERTY OWNER_, i MAP NO: PARCE>� t3N1NG DISTRICT ,,: Y : I�IS £ R1�01STRICT yesnc� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building -One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial §,Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septie' ',414.well k� , �� nFloodplain �^ ds ffiterhed district 11Vate �werNO ��; DESCRIPT ON OF WORK TO B REFORMED: m L +� ,� o rwti Ls 14A = L'_/ /BUJ 1,t.�iMC�OWS C1 '.t-4,©eS Identification Please Type or Print Clearly) OWNER: Name: n.1 M i �D 1 b Phone.9'71. 6 8Z- IyEg Address: C1c o< CQNTRAtOR Ne e� ' ` < Address` -> �— ht: L w T AA Supervisor's,Construction ase Exp.; ©ate " Home (mpouement Licerieu fl# xp } 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: $ �? C �' S FEE: $ Check No.: `4/ y 3 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guara and Signature of Agent/Qwner ���: Signature of cont i i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSALL 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Qoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Drivew ermit Located at 384 Osgood Street FIRE DEPARTMENT -Temp Dumpsonx:site yeS gip'' no Located at 124 Main Street .. �< Fire Department.sgnature/date ot h*1-1k 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application Li Certified Surveyed Plot Plan L3 Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) Li 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) Li Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report a 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 ��/ 4// X.-Of ' No. Date MORTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Mus t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ? 2 o 6 ,1 ` Building Inspector tk0RT#j Town OO ver 0 0 No. ? 8 J/ Y . C * 0 dower, Mass., S'- I COCHICHEWICK ORATED 101-h1v BOARD OF HEALTH T Food/Kitchen PERM T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.............. .... . ............... [b * e.................................... .. ...... ........................ Foundation has permission to erect........................................ buildings on .....11Y........3 P. .&f.!.- . .........................................d Rough to be Occupied as..... 4* ................................................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application *'" ** cationonfilein 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 Fikial PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU T S Rough .....c7a......................................................................... Service ............ ................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove FiRough nal No Lathing or Dry Wall To Be Done � FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burne Street No. SEE REVERSE SIDE Smoke Det. ivicay i i yr vcu.v.�a N,i (�/iii Gu>ft L�Zfr .�cJ 8 4-rW ' �Ah - 453-Jv p y urZ v�z7Jos C-A>3 ,(J4-rS C!°d A��cr' ©A-) 1660 KEEN CONSTRUCTION CO. Ad 21 HEWITT AVENUE PROPOSAL **1410 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 with Submitted �J ',I �>4, �� the. Commonwealth of Massachusetts. Inquiries about To. _.._..._..................-........................ _...-__._....____..---------.._...__ _ --_ registration and status should be made to the Director, \ Home Improvement Contract Registration,One Ashburton ............. , Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL a. 142A. PHONE , DATE REGISTRATION NO. F.I.D.N0. MA. H.I.C. 108383 04-325-8052 > C/S = Customer Supplied S + I = Supply+ Install We hereby submit specifications and estimates for work to be performed and materials to be used: . .,... . . .. ____ _-�...._....__-._---- -_ _.........- ..-._. ........ _ -. - _.. _ _ --------- ........... ---------_ --- -- _-- -. - ----- _ _. > Construction'-related permits: ....................._..,........,..........._.._..................._...................:......,,,...,:,.._:........._......._......... r ............. .....t,�l...f ..�.. LzJl. 7....a .................... ?`..........0... ....... '..!: ..� .!.r .. ...... c s WORK SCHEDULE Contra ��e ill not be ' he work or order the materials before the third day following the signing of this Agreement,unless specified here in w'ing. Contractor will begin the work on or abouF� (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 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. We Propose hereby to furnish material and labor-complete in accordance with above specifications, for the sum of D ?( _ �\yk- ilt' '�33 \ 1'k H`1 dollars($ 1 k: i Payment to be ade as follows: % ($ ) upon signing Contract; KENNETH B. KEEN Name of Contractor/Designated Registrant ($ ) up o (e�jf\,�, 21 HEWITT AVE. " Street Address ) p n rftpletionof N ANDOVER; MA 01845 City/State ---- `0 ) shall be made forthwith upon (978) 691-5201 (978) 682-3231 completion of work under this contract. Phone 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-' Authorizes a we equipment,whichever amount is greater. Note: This proposal may be withdrawn by us if not accepted whin days. f. 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 A'NY BLANK SPACES. Signature '" `�—� Date / Signature Date IMPORTANT INFORMATION ON BACK ► KEEN CONSTRUCTION CO. 21 HEW ITT AVE. N.ANDOVER,MA 01845 (978) 691-5201 Dolben, Sumi 114 Spring Hill Rd. N. Andover,MA 018.45 (978)682-1456 Contract# 1660;Appendix A Date: 5/9/07 Remodel Sunroom: • Remove existing sliding doors • Remove carpet • Create knee wall(approx.26"-28"high)to accept five new windows • Supply,& install five Pella Impervia rolling windows with tempered Insulshield glazing (appro . 5'0"x4'6") • Supply&install two Pella Impervia sliding doors(5'0"x.6'8") • Supply& install.exterior siding&trim to match existing • Insulate new walls * Supply&install PVC bead board on knee walls and trim windows to match existing • Flooring, painting and electrical work isnot included is this price Kitchen • Remove existing cabinets and counters • Remove existing ceiling • Remove existing flooring in kitchen,rear hall and powder room • Supply&install new smooth plastered ceiling • Supply&install Pella out swing French door unit • Supply&install trim to match • Supply&install new pre-finishedhardwood floor($3000:00 materialallowance) • Install customer supplied cabinets and trim • Supply&install tile backsplash(standard installation, $740.00 material allowance) • Paint walls and trim(2 coats, 2 neutral colors)and ceiling(2 coats,white) Kitchen electrical: • Upgrade electrical outlets to code • Supply&install ten recessed light fixtures • Re-install existing under-cabinet lighting • Electrical allowance $3600.00 Kitchen plumbing: • Relocate plumbing pipes as required • Install customer supplied fixtures and appliances l KEEN CONSTRUCTION CO. 21 HEW ITT AVE. N. ANDOVER,MA 01845 (978)691-5201 Total Price: $46,530.00(forty six-thousand five hundred thirty dollars) Price dohs not include cost of permits, cabinets,counters, appliances,plumbing fixtures or changes required by inspectors. Price does not include repairs to ceiling in basement caused by relocating plumbing pipes or electrical wiring. Payment schedule: $8000.00 due upon signmg:contract $4000.00 due when_sunroom is framed(and cost of permit) $6000.00 due when sunroom windows and doors are installed $4000:00 due when French door is installed $3000.00 due when trim is installed in sunroom $5000.00'.due when kitchen is demoed $4000:00 due when rough electrical and plumbing is done $4000.00 due when floor is installed $5000:Wdue when cabinets are Installed $3530:00 due upon,completion of this contract ust,mer K th B. Ke n: Date"j i Date. i I 2 ✓fze V�ahzmcarzu�ear� o�,/�,aaatcc,lucae�a � Board UBuilding Regulations and Standards HOME IMPROVEMENT CONTRACTOR Reg istratori;. 108383 E�tpiratCoia f3%18/2008 i; Tjrpe OBP+ . K€EN,CONSTRQ,,, 17 Q0 Kenneth Keen t 21 Hewitt Ave ..,Qrr .` No.Andover,MA 01845 Deputy Administrator j i IQmvrreanu�eall! avnicae BOARD OF BUIL DIN aREGUUITIONS t '`x ieeri $: GONSTRUCTION SUPERVISOR .i Number+bS 058245 irttid to 03124/x;943 a xe @34��408 Tr;no 13436 i-�. N aNQbV 1GI`A 0�` 4 ;;�r r GomrlSlsione� j i j The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): K 6 E,ri Address:—Z I 1-1 E'ls.j i 7T Ave , City/State/Zip: 1(1. R N do U Zn— I,I)VA Phone.#: 978 6(?/ -5-7,0 1 Are you an employer?Check the appropriate box: Type of project(required):. 1.[3 I am a employer with 11V 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6 11 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. D�.Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.$ 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 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 employees. [No workers' 13.0 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. lContractors 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: _-7:70.S Policy#or Self-ins.Lic.M -LUC g s�© $'3 Expiration Date: l ^ Q 9 O Job Site Address: lj 4 >� P2_ t Nj_4 : 1 2 City/State/Zip: 1J. fT Nd Q C8, 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 under the pain ndpenalties ofperjury that the information provided above is true and correct. Signature: Date: / - 07 Phone#: 7 Official use only. Do not write in this area,to be completed by cityor 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Offtce of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia