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Home My WebLink AboutBuilding Permit #744 - 114 SPRING HILL ROAD 6/16/2008 BUILDING PERMIT of Noer 6�a TOWN OF NORTH ANDOVER 0 , APPLICATION FOR PLAN EXAMINATION '' 70 Permit NO: Date Received �SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 50rine, A` not n PROPERTY OWNER c�UM I !)5,>_\ q Print MAP NO: d� PARCEL:z3/ ZONING DISTRICT: Historic District yes o Machine Shop Village yes 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: Demo i ion Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF W RK TO BE PREFORMED: Identificati Ple se Type or Print Clearly) // c1 / OWNER: Name: 4SL3M ,% ofi )Ne Phone:97TS 'b92- yTL)(0 Address: '�l� ver 1 1 1 CONTRACTOR Names eeY_1 Phone 7$"'b 9j` 2-01 Address: Supervisor's Construction License: I�,b� j Exp. Date: '3_ 1("09 Horne Improvement License: � 01 319 Exp. Date: ARCHITECT/ENGINEER Phone: 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: $ �3) 03S . 90 FEE: Check No.: 5Y3 d Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to ar fund - _�-- _. -t.w. , S - Signature of A-gg-ent/-O-wner .Sgnatur.,_ e_o_f—_con, trac. to, 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS ,1.;HEALTH, 1 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 Town Engineer: Signature: Located 384.Os ood Street FIRE DEPARTMENT -Temp Dumpster 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 2008 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 ❑ 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 2.2008 Location 11V fel h 4 -// No. VC/ Date f/ NORTH TOWN OF NORTH ANDOVER f 9 a Certificate of Occupancy $ �ss•►CMust Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r O Building Inspector �ORTIy Town of _ Andover No. :741 _-_ 10 dover, Mass., �i •�G ' d y O COCMIC e".CK V 7�ADRATED Py S BOARD OF HEALTH Food/Kitchen PERMIT T D - Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT...........SuV1,1A.0...........'•, ...a.. .. •.................... ...... ........... .................. .............. Foundation II has permission to erect........................................ buildings on ....1..�.... .......3 .. ... ........ ......... ..1�......... ...,.......... Rough to be occupied as........ 'l.O!!VL!...................�IR..'....r ....! ... �..�.r.............................................. Chimney 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 CONSTN CZICL START.So Rough ........... .................................................................................................. Service BUILDING INSPECTOR Final �- Occupancy Permit Required to Occupy wilding 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. KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978) 691-5201 Dolben, Sumi 114 Spring Hill Rd. . N.Andover,MA 01845; (978)682-1456 Contract# 1.679;Appendix A Date:5/28/08 New front windows and door: • Remove existing six windows Supply& install six Pella architect series double hung windows(white clad exterior;:9/9 grids.between the glass) Trim'interior to match existing(exterior Azec custom.trim) Remove front door • Supply&install-Thermatru smooth star fiberglass door-unit-with two.12 sidelites • Repair front door trim as necessary • Remove all debris Total.Price:.$13,038.90(th rteen thousand thirty eight and 90/100 dollars)' . Price does not include cost of permit fees,siding repair or rot found in framing or sheathing: Payment schedule:$5000.00 due upon signing contract $3000.00 due when front.entry door is installed(plus permit fees) $3500.00 when windows are delivered $1538.90 when contracted`work is complete C tomer Kv4meth B.Keen Date Date 1679 KEEN CONSTRUCTION CO. a 21 HEWITT AVENUE PROPOSAL Nko 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 ` 't 1�G 1 E 1 the Commonwealth of Massachusetts. Inquiries about To: ..-.... <........ ......_. _...._...._.)__._ ___� _ __ �._ registration and status should be made to the Director, 1 �j` ��,, 1 t Home Improvement Contract Registration,One Ashburton j `1 1 _�..._�_ ___.. . Place, Room 1301, Boston, MA 02108 (617) 727-8598. _-. . _ ..__-._ 11__11 \ _ ��_ _ . Owners who secure their own construction related � C r^ I f� 1� ~ t �y permits or deal with unregistered contractors will ...............11_11.-.__.-_._._.,.t.�._...... _..�....._.... ... ...._......1... .. . ..._._._..... __...,_..._....._�.�....�._.__ be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. F.I.D. 10, C_7 �� `-I ( - C4-325-8052 -?`�' ! MA. H.I.C.H.LC. 108383 > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: - _._ _.._.....__ 1111...-_.. _ _. .......... . .....................................-....._..- -- _........ .. ............._.....__.... I ... _ --_ __.. _ 1.111.. > Construction related permits: _...._.....,._............_......................................................................................................................................................................................................................................................._........................................................................................................,.....,.....,......................... W ......:.O....RK.........S......C H E D U L......................................... ....................... ._.......................................................................................... .............,,....,...........................,......,..........,...............................:...............,...,.,.................................................................,.................. ..............1...11..1 E 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 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 ` C� C /_, 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 �1 dollars($ Payment to be made as follows: / % ($ ) upon signing Contract; r I KENNETH B. KEEN Name of Contractor/Designated Registrant % ($ ) upon coFp tion Z 21 HEWITT AVE. rQQ Street Address 6 % ($ jib tarf -ompletion of N. ANDOVER, MA 01845 t City/State a, ) sF�all 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 Nament at sman 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 Autnord Signature equipment,whichever amount is greater. Note: This proposal may be 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 Date Signature Date IMPORTANT INFORMATION ON BACK 6/16/2008 11:13 AM FROM: Gilbert Insurance Ag Gilbert Insurance Ag TO: +1 (978) 682-3231 PAGE: 002 OF 003 DATE(MMODfYYY11 CERTIFICATE OF LIABILITY INSURANCE 1 06/16/2008 PRODUCER (781)942-2225 FAX (781)942-2226 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gilbert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 137 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Reading, MA 01867-3922 INSURERS AFFORDING COVERAGE NAIC# INSURED Kenneth B. Keen & Robert Keen INSURERA: NORFOLK & DEDHAM INSURANCE 23965 DBA: Keen Construction Company INSURERB: Granite State (A I G) 21 Hewitt Ave. INSURERC: North Andover, MA 01845 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDI JZ&him TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPRATION fmwDDAIYI L8NfT3 GENERAL LIABILITY ND-P-010078/000 03/13/2008 03/13/2009 EACH OCCURRENCE $ 1,000.00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED T $ 50,00 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,00 AW-- PERSONAL A ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICYF—j JEa LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ee accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY, AGG S EXCESSAIM13RE-LLA LIABILITY EACH OCCURRENCE $ OCCUR F7 CLAMS'MADE _ - AGGREGATE $ DEDUCTIBLE - RETENTION $ $ WORKERS COMPENSATION AND �( WC STATU- 0TH- EMPLOYERS'LIABILITY Y I I B ANY PROPRIETORIPARTNEWEXECUTIVE WC6380698 08/03/2007 08/03/2008 E.L.EACH ACCIDENT S 100 00 OFFICER/MEMBER EXCLUDED? If es,describe under E.L.DISEASE-EA EMPLOYE $ 100 00 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500100C OTHER DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS riginal Workers Compensation coverage certificate to be forthcoming from .Granite State Insurance. vidence of Insurance CERTIMCATE-HOLDER----.------------..- CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Suzanne L. Cedor ACORD 25(2001108) OACORD CORPORATION 1988 ... .. .. �, �fze V�rn7iIY40a'lLlla.2lG�L O' ./�,aiJ.1c[G12�cde�d �� \ Board of Building Regulations and Standards ' 11-4 tr= HOME IMPROVEMENT CONTRACTOR E•. � Registration: 108383 f. �) Expiration: 8/18/2008 Type: DBA t KEEN CONSTRUCTION CO. Kenneth Keen �` 21 Hewitt Ave � � r -No.Andover, MA 01845 Deputy Administrator I. . k �' ✓lie "COanv�reoizcuea oy ac�ticde6 Board of Building Regulati s and Standards J ' Construction Supervisor License License: CS 58245 I Expiration 3/24/2010 Tr# 17840 �.Rastnc#ion 09P , iNA a Rill mI} f I KENNETH B KEEN F 21 HEWITT AVE N AND-OVER,MAO Commissioner �,�' �� ✓lie '�i'o7.v�naurea�i o�,��,aaecrc,�.,caeka I Board of Building Regulations and Standards Construction Supervisor License License: CS 76691 " Birthdate: ,8/16/1968 ! Expiration 8/16/2009 Tr# 3859 j Restriction:- 00 ROBERT A KEEN:' 12 E WATER ST N ANDOVER,MA 01845 Commissioner The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street eW Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /1 Please Print Legibly Name (Business/Organization/Individual): Address: z, ! 7 lig C', City/State/Zip:,LJp lL7'� T`P des V CN 111A Phone.#: 7 6 9/ Z O I Are you an employer?Check the appropriate box: T project(required j':',am a general contractor and I 6.Type of p �ect(re 4 ) ' 1.® 1 am a employer with Z '— ❑ I g E]New construction employees(full and/or part-time).*` 4. have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-con-tractors have g ❑ Demolition working for me in any capacity. employees and have workers' 9. [No workers' comp.insurance comp. insurance. ❑Building addition ` required.] 5. ❑ We are a corporation and its 10..0 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 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. Icontractors 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: Policy#or Self-ins. Lic.#:' (15 3 6 a eo Expiration Date: d Job Site Address: LA f t oq i �' City/State/Zip: kUV � 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 certi u er the in a penalties of perjury that the information provided above is true and correct Si ature: q �7 p Date: Phone#: / d �C` 6 / V -LS Zn 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#: