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HomeMy WebLinkAboutBuilding Permit #402-13 - 120 WEYLAND CIRCLE 11/14/2012 L BUILDING PERMIT NORrk q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION • T � Permit NO: . by ^ �� °4 <o.....,�. �> Date Received '� 4°R�reD. 5 gSSACHUSE� Date Issued: I RTANT:Applicant must complete all items on this page s-. ... /.•/�:47' ..��� �-`ter S •- - t� �y tl'&CATIONt_ ,)� �. `� 4PRa©PTY ER ®1Y. T Mnt � 7 lir MT 3=MAPtNO% P�ARCEL= Is _ ZQNlNG1DISTRICT"` HistorctDistrct; +yes, nog � , M Whop Village= yes' :no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Ateration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ DemolitionElOther Dept c"�t❑W IIS _4 :"� Floodplam3 , Wetlandsi µ '0 WatersMe'd,nct DESCRIPTION OF WORK TO BE PREFORMED: +� Ce,- LA3 t4 ij i' Identification Please Type or Print Clearly) 7 OWNER: Name: 2ic1L Schw.�tf-2- hone: 73396,'3 Address: C®N: RA'CTOR{,+NameC15)-I Su "ervisor'sConstructiokho nLcenset ExpoDate p � L Y ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. d� Total Project Cost: $ �J q;2 FEE: Check No.: 7jy Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran u _ 4v. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer 11Tanning/Massage/Body Art E] Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ ElPermanent 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 r o Planning Board Decision: Comments r Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 3.84 Os ood Street F,IREDEE PARTMENT�' TempDumpstegon IVocated�at�124,�MainSt�eet� �- FireiDepartmerit spnatureldate ---h 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 i I i i ❑ 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 VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o 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) a 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 MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals 4 that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording i must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:13PFORM07 Revised 2.2008 I Location Fz-) Date No. � • • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ 03 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check# 7540 25952 Building Inspector ttORTH own -o t E . I, ndover �O LANE h " ver, Mass, CoCKICNEWICK y1. S U BOARD OF HEALTH Food/Kitchen PERM -,IT T Septic System THIS CERTIFIES THAT �t lam./. ........ G�Lh��.�Z.11 BUILDING INSPECTOR . has permission to erect ........................... buildings on ....l Q...W.4.��.. .�r� ...lr..!... �t`................. Foundation Rough g tobe occupied as ................. .................................................. Chimney 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 i VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STA T Rough Service ........................G.... ...�6�..S_0 �................... 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 Board of Buildin�� Rc��ulutions and Stand,a-ds Construction Supervisor License License: CS 76691 ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 �. I Expiration: 8/16/2013 ('umniisiuncr Tr#: 3772 Massachusetts -Department of Public Safety Board bf Building Regulations and Standards Construction Supervisor License: CS-058245 J' r r.5 0 KENNETH B IdEN 21 HEWITT AVE 0 N AND -- OVE MA'01845 Expiration Commissioner 03/24/2014 Office of Consumer Affairs&Busi ess Regulation OME IMPROVEMENT CONTRACTOR egistration: ,,ItP8383 Type: xpiration:,._>:8/_1°8120.14; DBA KEEN CONSTR UCTION - -G.Q. :::.. = � - Kenneth Keen ..t' 21 Hewitt Ave No.Andover, MA 01845 Undersecretary 8/15/2012 1.2,:,58.PM FROM:I Gilbert Gilbert Insurance Agency, Inc. TO: +1 (978).`68273231 PAGE: 001 OF 002 DATE(MMIDDIYYy1" AC W. CERTIFICATE OF LIABILITY INSURANCE 08/1s/2012 PRODUCER (781)942-2225` FAX (781)942-2226 'THIt,CERTIFICATE IS ISSUED'AS A MATTER OF'INFORMATION Gilbert Insurance Agency, Inc. ONLYANDCONFERS N6 RIGHTS UPON THE'CERTIFICATE 137 Main Street HOLDER.THI&CERTIFICATEDOES NOT AMEND,'EXTENO'OR ALTER THE:GOVERAGEAFFORDED BY THE POLICIES BELOW. Reading, MA 018. 67-3922 INSURERS AFFORDING COVERAGE MAIC# INSURED'Kenneth Keen &' Robert Keen INSURER .NORFOLK & DEDHAM INSURANCE 23965 DBA: DBA Keen Construction Company iINSURERB: Travelers Insurance 21 Hewitt, Ave. INSURERC: North Andover, MA 01845 INSURER D: INSURER E`. OVERAGES,, THE POLICIES OF INSURANCE LISTED BELOW:HAVE.BEEN ISSUED"TO-THE INURED NAMED ABOVE FORTHE POLICY PERIOD:INDICATED:.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF.ANY CONTRACT. OTHER DOCUMENTYVITH-RESPECTTO WHICH THIS;CERTIFICATE MAYBE ISSUEq OR- MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES.DESCRIBEUKREIN IS-SUWECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS:OF SUCH POLICIES.AGGREGATE'tIMITS'SHOWN MAY HAVE$EI=N'REDUCED BY-PAID CLAIMS: ILTR IN'NSRDD TYPEOFINSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS GENERAL LIABILITY ND=P-010078%000 03/13/2012 03'/13/2013 EACH OCCURRENCE $ 1 .000 00 X COMMERCIAL GENERAL LIABILITY DAMAGE T0:RENTEDwej $ TOO,OO:' CLAIMS MADE OCCUR MED EXP(Any one person) $ S 0.0 A PERSONAL&ADV INJURY S L 000,00. GENERAL AGGREGATE $ 2,000,00C GENLAGGREGATE LIMIT APPLIES PER: " - PRODUCTS-COMP/OP'AGG $ 2;.000,,00 X `POLICY PPROO-- LOG JE AUTOMOBILE LIABILITY COMBINED"SINGLE LIMIT $ ANY AUTO (Ea accident) 'ALL OWNED.AUiOS 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 $ EXCESSIUMBRELLA LIABILITY EACH.00C(1RRENCE $ OCCUR a CLAIMS MADE AGGREGATE. $ S DEDUCTIBLE $ RETENTION $ ; WORKERS COMPENSATION'AND 6013-SB40726-A-12 O8/03/2012 08/03/2013 WC"STATIN" Dig: EMPLOYERS'LIABILITY B: ANY-PROPRIETOR/PARTNER/EXECLRIVE E.L.EACH ACCIDENT $ LOO O0 OFFICEWMEMBEREXCLUDED7 It yes.describe under E.L.DISEASE-EAEMPLOYE $ 100,00 SPECIAL PROVISIONS below E.L.DISEASE-POLICY.LIMIT $ 500,00 "OTHER DESCRIPTION OF OPERATIONS$LOCATIONS,I VEHICLES'I EXCLUSIONS ADDED BYENDORSEMENT I SPECIALPROVISIONS vidence of Coverage CANCELLATIONCERTIFICATEr HOLDER SHOULD ANY OF 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 T0`THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES Evidence of Coverage AUTHORREDREPRESENTATIVE iMark- Gilbert, CIC ACORD 25(2001/08) ©ACORD CORPORATION 1988 . i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street b Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electri ' clans/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):. N S Address: City/State/Zip: ,�) . t� N�, �( q., 0 e Y U' Phone 7, _b?I` 5�2,6 Are you an employer?Check the appropriate box: ❑/ Type of project(required): 1. I am a employer with ' _ 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. 1 7. [0,R-dmodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9 Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] f employees. [No workers' comp.insurance required.] 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: _ :7rlt d U i t erg S Policy#or Self-ins. Lic.#:19 V'Q "S V� L10-7,710 Expiration Date: Zj Job Site Address:_ 2 W �. � � �'K/'d � 'A. City/State/Zip: �/J 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify u der the pains an penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official i City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector j 6.Other Contact Person: Phone#- i K�:'�" ;.�c$Z � °''�.ir 1` _'.,�iU p...:,,..� .�+,;,, �"'� ,„:., `;3�":: � , �[•:.,.� v��ttr".ro�r�" \N'�" � r. � q,1 t 7�y.H_. P t,mvr, r; t �.v� -�g�, ti .r""'',�";y' ti r.•d4. 47 KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE PROPOSAL 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 ( the Commonwealth of Massachusetts. Inquiries about To: �( i (� N ��` ~ .... .-C_.r i �� registration and status should be made t t he Director, Home Improvement Contract Registration,One Ashburton Loiicl.__...._.._...�. ._._..._._.__....._.....__._.. Place, Room 1301, Boston, MA 02108 (617) 727-8598. J i Owners who secure their own construction related IQ c_) c� t;r < yi u�J /a 6 ✓�' �,� permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE ( x; I DATE REGISTRATION NO. EIN N0. 6 17- '7 '7 .a " L� 5r Y% / �" l l 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 mat�'als to be used: ( N ! f r� 0't�w fi 5 e'' (t (` `-)C r v J 2(/L, u�hS �`� Fi F9 i i'� j�1 l ___._____.. .... . ... .. ..... .... ._____ _ __.____.__._.___._.-._.... _ --- h� SL,L,�k1i��� a I� 1raf Logi flV� ( �c r ,�J �vN ��� � ! �-+ f' 10 4 r! a✓L _ _................. _ �._.,__._ _.� _ . _ _ ...5. _ __- _ .._— -�.- _ -- _._........._-_.._- .- .........._-_--------__—.__ _._. _. . > Construction related permits: __......_..._..............-'',. .... .._.... __...... ...... _.................................... ............ ..._...... _................ .................... .......... ........................ ............................................................. ........... ............. ..,....................... ..................... .................. _. ..,......................... ...................... WORK SCHEDULLE..... Contra or i I not bs in the work or order the materials before the third day following the signing of this Agreement,unless specified her i wn Contr ctor will begin the work on or about �' 3 (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by -� I (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 Contrac or,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 t O� U dollars($ Payment to be made as follows: OD 0($ 1 ' C' upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor/Designated Registrant upon d� I ' , 1� com completion of w 2 ay 2HEWITT AVE. I Street Address ($/ ) upon completion of 4'fes`' ( .r 1. �tJ . ' f N. ANDOVER, MA'01845 i/ fO fs City/State ($ 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 alesm >down payment(advance deposit)of more than one-third of the total contract price Name 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 Autho' gnature `- equipment,whichever amount is greater.9 Note: This proposal maybe withdrawn by us if not accepted within days. II y Acceptance Of Proposal -I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. 1 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 .Signature Date IMPORTANT INFORMATION ON BACK{ 00