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Home My WebLink AboutBuilding Permit #063-13 - 114 SPRING HILL ROAD 7/25/2012 ttORT11 BUILDING PERMIT o " TOWN OF NORTH ANDOVER 32 '5 -0, 16 0 2t. APPLICATION FOR PLAN EXAMINATION Permit 4:uj Date Received RATED F'V csS Date Issued: AcHUS IMPORTANT:Applicant must complete all items on this page t4 tu ION;-- �-P-RZVRERTYMWNE yesA PAP MAR DIRIC ST � no MachirieSh ill 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 SL I Others: Demolition Other " -ti-, Vllell, knFl.'__ la: oo p 6il'qnds.� qin Ne ae-Sew DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) 1q -8 OWNER: Name: X01 L-2 1e Phone Address: Name-, 'QNTRA TQR e qppry �Qdh dso�- s- trUct.i6h,Ltide'm§ 'j 4� -M P 6 t 1216e6Sb: 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: $ FEE: $ o2- Check No.: Receipt No.�� NOTE: Persons contraci14 with unregistered contractors do not have access to the gurntyfund sigaqtureof ---6_6466_,E�6�._ gqn Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL i 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 Siqnature COMMENTS HEALTH Reviewed on Signature r h 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 Osgood Street 'F-IREDEPARTMENT =Temp Dumpster on site yes r _ �no� w ;- ..� •*�- y, Located;at�124 Main®Street Fire Department'signature/date.• Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I 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 Doe.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 ConstructionSin le and Two Family) Construction ( Single Y) ❑ 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 / sa,` i � No. &2 Date ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ f Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee A TOTAL $ Check# 25542 Building Inspector NORTH own o : � 1� Andover O ». - 0 No. - h ver, Mass, CoCKICAWICK p�RAT E D P, S V BOARD OF HEALTH PER T LD Food/Kitchen Septic System • THIS CERTIFIES THAT BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ............. Rough �.�. ..... . ... .. ... .............• ........................... ........................................ Chimneto be occupied as ....... �r.........nowkllk ... y provided that the person accepting this permit shall 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 I - - NTHS ELECTRICAL INSPECTOR Ia UNLESS CONSTRUC I Rough Service ................................................. ................ Final BUILDING INSPECTOR GAS INSPECTOR 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. SEE REVERSE SIDE i KEEN CONSVIZU01ON co. 21HEW,I7'7"AV-E.., .. N: �tNDOOVE2, MA 01&45 -691-5,201 Dolben,Sumi 114 Spring Hill Rd. N..Andover,,MA,01845 978-682-1456 Contract##5075;Appendix A Date;luly 24:201.2 Build pool cabana: Pour concrete slab on grade approx. 10'x 12' ® Build walls(approx.8')and erect roof truss system Supply&install two Harvey vinyl.Classicsingle hung windows, o Supply&install-one 5'0"x-6'8" 6-panel fiberglass door unit ` • Supply&'instal[ropfing and siding to match house Price does not include cost.of permits,painting or interior finish. Total Price: $10,724.00.(ten thousand seven hundred twenty four dollars) Payment schedule: $1000.00 due upon signing contract $3pW.00 due when the cement:pad'is poured $3006.00 due the first day of framing $20MIDO duawhen Widing is framed $1724.00 due at completion of contracted work Customer Ken eth B..Keen Date Date •. vlassachusetts- Departinent•of Public SafetN Board of Building Regulations ;in(] Standards Cons#ru.ction Supervisor License License: CS 76691. ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2013 ( Huai si nuv - Tr#: 3772 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Super%isor License: CS-058245 TTS KENNETH B 19EN 21 HE WITT.AVE N ANDOVER MA�01845 (i Expiration Commissioner 03/24/2014 0Mce�f6`o> mer airsiness e g u anon HOME IMPROVEMENT CONTRACTOR Registration:--,Al 08383 TYP e:, Expiration: `8I1j8 2,012 DBA K CONSTR{JC �� E—A Kenneth Keen 21 Hewitt Ave 4F 115- N o. No.Andover, MA 018x , Undersecretary 4/25/2012 9:55 AM FROM: Gilbert Gilbert Insurance Agency, Inc, TO: +1 (978) 682-3231 PAGE: 001 OF 002 AC—MnA CERTIFICATE OF LIABILITY INSURANCE 04/z X2012. PRODUCER (781)942-2225 FAX (781)942-2226 THIS CERTIFICATE IS ISSUED AS A'-MATTER OFINFORMATION 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. Keen & Robert Keen INSURER A NORFOLK :& DEDHAM INSURANCE 23965 DBA; DBA Keen Construction Company INSURERB: Granite State Ins. Co. 0077 21 Hewitt Ave. INSURER C: North Andover, MA 01845 INSURER'D: INSURER E - OVERAGES 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. INSRDD'L -TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE- POLICY EXPIRATION LIMITS GENERAL LIABILITY ND-P-010078/000 03/13/2012 03/13/2013 EACH OCCURRENCE $ 1,000 00 X COMMERCIAL GENERAL LIABILITY- - . - - DAMAGE TO RENTED - $ SO,OO CLAIMS MADEOCCUR PREMIMEO EXP(Any one person) $ 100,00( A PERSONAL 6 ADV-INJURY $ 1,'000:,00( GENERAL AGGREGATE $ 2,000,06( GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,,00 X POLICY JECT PRO LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANY AUTO (Es accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY - NON-OWNED AUTOS (Per accident) $ - PROPERTY DAMAGE 3 (Per accident) GARAGE LIABILITY - AUTO OWY-EA ACCIDENT $ ANY AUTO OTHER THAN FA ACC ,$ AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $ OCCUR F]CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION - $ WORKERS COMPENSATIONAND WC009646942 08/03/2011 EMPLOYERS'LIABILITY .08/03/2012 WCSTATU- OTIi- - - I B ANY PROPRIETOWARTNEWEXECUTIVE VC CERT TO BE, MAILED E.L.EACH ACCIDENT 1 100,00 OFFICER/MEMBER EXCLUDED? DIRECTLY VIA INS CARRIER If yes,describe under E.L.DISEASE-EA EMPLOYEE.S 100,000 SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BYENDORSEMENTI SPECIAL PROVISIONS vidence of Coverage SHOULD.ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING.INSURER WILL ENDEAVOR TO MAIL. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE T04MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITSAGENTS OR REPRESENTATIVES. Evidence of Coverage AUTHORQEOREPRESENTATIVE Mark Gilbert CIC ACORD 25(2001108) OACORD CORPORATION 1980 z The Commonwealth of.Massachusetts Department oflndust,&I Acczder is Office oflnrestigations 600 WashingtQn;S&eet .Boston,MA 021-YI Workers' C0311Pw satlionlmsuxgnceAffidavit:Budde s/Contxac A licantlafoT'zmtion tors/.,G.tectxxciansiplumbers • �''ZeasePrintl,e 'bX Name(Businessforgauizationtlndividual): Address: E W 't to V. city/State/zip: Phone#: • � 1� ' 6 �'� - j a O Are you an employer?Check the appropriate box: 1•[`f j am a employer with=T 4. ❑T am a general contractor and T �I'a of project(required): 2•❑ employees(full aud(orpart dime). havehiredthe sub-contractors I am a sole proprietor or partner listed on the attached sheet.1 7. ❑Remodeling construction ship and have no employees These sub-contractorskaye working forme in any capacity, workers'comp. ' 8. 0 Demblition [No workers com .insurance 5. p Insurance. g• (l Building addition p ❑ We are a corporation and its required,] �ofCcers hake exercised their ZO•❑Electrical repairs or additions 3. T am a homeowner doing all woriC right of exemption perNlGL T 1.[j plumbin repairs or myself.[No workers' comp, c.152, §T(4),anon rMGLhave g p E•dditions insurance required.]i c.employees,1( 12•[]Roofrepairs [No workers comp,insurance required.] T3�Cther� [' IAny applicant that checks box#I must also fill out the section below showing their workers'compensation policy information, Homeowners who submitthis afiidavitindi�atingthey are doing all work and then hire outside contractors mOIicY f Contractors that check this box must attached an additional sheet showing the name of the sub-o contractors ors and their workers'com . clic ' mr anew affidavitindicating such. tI am an employer that fsproviding workers'corrtpensation insurar2cefo'•yny eYnpzoyees below is f7ae OIIc y' e anon. nformatio�t, p y andj'ob site nsurauce Company Name: C.-> /'L A ps; S-f A�E 'olicy#or Self-ins.Lir.#: W C ''609 q � 4 ExpirationDate; q rb Site Address: a 2 pity/State/Zip: '�,� l$ J'— trach a copy of the workers'compensation policy declaration page(showing the policy number and ex irati-on date). �ilure to secure coverage as required under Section 25A ofMGL c.152 e p L(3 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 Gan lead to the imposition of criminalpenalfies of a UP to$250.00 a day against the violator. Be advised that a copy ofthis statement may be fors op W to the Office a 'estigations of the D9 for insurance coverage verification. :hlierehyy cerithepains a na iezcry flint theinformationpjovidedabove is true andcorrect.l ae 4: Date: fzcial use only, Do not Write in Otis area,to be completed by city or town of�ciaj ity or Town: MingAutho;rity(circle one): Permit/License# Board of Health 2.Building Department 3.OtylTown Clerk 4.Electrical rnsnectnr, 'q 'Pr�,rn ntl,Pr Uig KEEN CONSTRUCTION CO. GP L A 21 HEWITT AVENUE *4ko 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 - i,,t ( ��lll/// the Commonwealth of Massachusetts. Inquiries about To: registration and status should be made to the Director, L Home Improvement Contract Registration,One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. ,/p n Owners who secure their own construction related ri 61 ` 5 permits or deal with unregistered contractors will ______--.-_._..._.. be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONEDATE REGISTRATION NO. EIN NO. 97 _ C F 7L2-(4 /11 MA. H.I.C. 108383 26-0462904 > 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: le > Construction related permits: ....................._.._.........__.....,..,............._,...._.._......_....._....,.........._......,...,...........................,,.,,...........................................,,,..............................................,...._................,,.,,........,....,...,.,........,,.......................,.,..............,.._.......................,............._.....,.............. ..........._..K ... .......ED_.............ULE..................,.,............. ...... ........ ..... _....... .. ._......_.,,................",................................ .....,............................ .... .............. ............ ............................ .................. ...................................................... .. .......................... .................... . .. ......................._............. ............... WOR._..._SCH..... 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 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 labor-complete in accordance with above specifications,for the sum of _ tt t�Y �`CO� FC4-'Tdollars ($ f 0-, 72 7 r 0 0 Payment to be made as follows: i )' % ($ ) upon signing Contract; if'/ptx KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor/Designated Registrant % ($ ) u onn pf h I 21 HEWITT AVE. Street Address %1($ n completion of N. ANDOVER, MA 01845 City i State C-- 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 o!Salesman 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 Authorized 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. _--D7T T SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature Date Signature Date IMPORTANT INFORMATION ON BACK Do-