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HomeMy WebLinkAboutBuilding Permit #1206-2015 - 121 HERRICK ROAD 5/17/2014 BUILDING PERMIT of NORTH q �, LED a 6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION - _ Permit No#: I Date Received �SSgcHas��� Date Issued: 'TM-PORTANT: Applicant must complete all items on this page LOCATION /Z I gery-i c k 9d Print PROPERTY OWNER iny - I�'✓1 Print 100 Year Structure yes o MAP PARCEL:ZONING DISTRICT: Historic District yes o Machine Shop Village yes rYo TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial JV Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District o Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: of Ca rr_11 ,1 vl b_ .-,e,tAee14 pE Identification- Please Type or Print Clearly OWNER: Name: �y n rW- Phone: Address: 121 OfrrIc,� Contractor Name:k/ee n6w.5I ryc�i,oA Ca Phone: 97 S�-6 9/-52_o / Email: Sri Te 5 � ,-, G 5 �' G icvr G0, C O AA Address: PO r3_ b , iqi cteu.,eF' dl�l9 Supervisor's Construction License: C5 X 6 9 ( Exp. Date: ��/ 7 Home Improvement License: l0 Exp. Date: t 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: $ 2 75 FEE: $ �7,vo Check No.: �� �� Receipt No.: ail NOTE: Persons contracting with unregistered contractors do not have access to the u an ;:fund i i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL � Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY I INTERDEPARTMENTAL SIGN OFF m U FORM f PLANNING & DEVELOPMENT Reviewed On Signature_ i COMMENTS i I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 1 Conservation Decision: Comments Water& SeWer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: _ .. 84 ' FIREIDEPYARTMENtT _aemppurnpsteonsite� eyes ._.___ no __ ___` _�_ Located3Osgood Street F; tocated at r1�24tMaintStreet - = - - ---- — = - -•---_. Ff F i re `D` l t- e�part�.m_ent��signature/date; s COMMENITS: 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.$1o0-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks � Building Permit Application 4 Certified Surveyed Plot Plan 4 Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract 4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. Mass check Energy Compliance Report (If Applicable) Q. ErIgineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit l 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 Location L e L- S No. 1-2 ok — 2 b k� Date • TOWN OF NORTH ANDOVER v Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ;_ ; Other Permit Fee $ TOTAL Check A 13 - Building Inspector NORTH own of ndover No. Q—* ver, Mass � 1 - - 'ls,9CocMICMEWI[/t s RATED U BOARD OF HEALTH Food/Kitchen PERM' IT LD Septic System THIS CERTIFIES THAT . ....!!fi r......... .. BUILDING INSPECTOR . ....�. Foundation has permission to erect ....... .................. buildin on ....... ........ ... t...............:: � Rough to be occupied as .. ,...�...... ... ...... r.. �... .......4.Y. .....1.�r'!.................... Chimney provided that the person cepting this permit shall in every respecrm to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws r lating 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 CONSTRUCTIO ARTS Rough Service ............ ...... ... . ..... ............................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. TLH CONSULTING, LLC Structural Engineering 505 Middlesex Turnpike Unit 14 Billerica, MA 01821 (978) 362-1804 March 14,2016 Robert A. Keen Keen Construction Co. 21 Hewitt Ave N.Andover, MA 01845 Re: Existing Damaged Beam and Damaged Sill 121 Herrick Rd,North Andover, MA 01845 TLHC Project# 160512 Dear Bob: TLH Consulting, LLC(TLHC)recently visited the site referenced above. The purpose of the visit was to observe a damaged portion of of the existing main beams and a damaged portion g p g g of an existing sill plate. We observed the damaged portion of the main beam first. The damage appears to be concentrated at the last three feet of the end of the beam closest to the basement stairs. We recommend removing approximately 5'-0"of the beam and replacing it with at least a two ply I %"x 7 '/4"LVL. For your convenience,we are including a sketch with this letter;the sketch depicts the repair. Next we observed the damaged sill. Based on our observations, n the sill iquestion supports a g Pp verysmall portion of kitchen floor 1 1 p load. n addition,the damage we observed appeared to be minimal. In our opinion the sill is in acceptable condition,but to put perspective buyers at ease we recommend installing new blocking over the damaged portion of the sill. Thanks for the opportunity to provide our services to you.If you have any questions,please feet free to call us at(978)362-1804. Sincerely, "OF MAS � s9� To L. EDLY STRUCTURAL Todd Hedly,P.E. No.41433 Enclosure IsT�R``G��`�� ` �01dAL cc: file TP411 EACH SIDE OF BEAM SKS-1 USING(6)-16d. OTHER (E)BEAM METHODS TO TIE BEAM 1/8"(+h) OW0.N�. SECTIONS TOGETHER ARE -- ACCEPTABLE (E)POST - (2)1 3/4 X 7 1/4 LVL NEW POST DOWN PORTION - LL_ (MIN). REPLACES DAMAGED OF BEAM TYPICAL LALLY (E)STONE 14Z + f� (2)1 3f4 X 7 1/4 LVL BEAM (E)POST TO REMAIN PLATE IF LALLY FOUNDATION WALL �$ O _ COLUMN,(2)10d m - NAILS THREE FACES IF 4x4 31/2"O LALLY POST w - COLUMN OR 04 i POST i (E)WALL PARTIAL IST FLOOR FRAMING PLAN IF LALLY COLUMN INSTALLLALLY PLATE WITH R a 1'-O" CONNECT TO CONCRIETE WITH(4)114"TAPCONS. o USE 1 112"EMBED. IF 4x4 USE 2x6 ro P.T.PLATE AT BASE OF POST. N CONNECT 2x6 TO M I SLAB W1(4) �.____._ _______._�1.t_ . .. RAMSETS �^ L@V@I1� 0' 2 EON VIEW z 3/8 -1"-0" I- w z U m $z U m O tN OF o� TO D x DL `k saw UCTURAL ' 68 S o No.41433 TI Tr o lONAI EZa 3 8 The Commonwealth of Massachusetts Department of Industrial Accidents l tl 1 Congress Street, Suite 100 A Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information 6/ i Please Print Legibly Name (Business/Organization/Individual): � _ n e -vt C-T� cy) c) Address: 1 City/State/Zip: �$P one#: 9?3— 9'+ —572,0 1 Are you an employer?Check the appropriate box: Type of project(required); 1.M I am a employer with ? employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. '0I Remodeling any capacity.[No workers'comp.insurance required.] 9, �❑`'Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole ME]Electrical repairs or additions proprietors with no employees. 12..❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance-$ 14.❑Other 6.❑We are a corporation and its officers have exercised their right of'exemption per MGL c. 152,§1(4),and we have no employees.[No workers'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. $Contractors 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(-c,\e- i lv r5 P75 — Policy#or Self-ins.Lic.#:6 14 V 1J "9 9,9 1 N5S 2 ' Expiration Date: Job Site Address: /")-f &CE 1 C, City/State/Zip: r o��`�✓ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 r epa' s andpenalties ofperjury that the information provided above is true and correct Si ature: Date: 7 / 6 Phone#: 9-2Z– 6 91 5 2 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: Aco O® CERTIFICATE OF LIABILITY INSURANCE DATE(MNYDD/YYYY( 10/23/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCERA CONTACTBarbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)94(781)942-2225 0:(781)942-2226 137 Main Street ADDRIESS:bmcdonough@gilbertinsurance.com INSURER(S)AFFORDING COVERAGE NAIC M Reading MA 01867-3922 INSURERA Norfolk S Dedham Insurance 23965 INSURED INSURFRB:Safety Insurance Company 39454 Keen Construction Company INSURERCTravelers Ins. Co. 0031 483 Chickering Road INSURERD: INSURER E North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER-,CL1552101779 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR TYPE OF INSURANCEAVOLSUBR POLICY EFF POLICY EXP POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADEX❑OCCUR PREMISES Ea occurrence $ 100,000 AID-P-010078/000 3/13/2015. 3/13/2016 'MED EXP(Any onePerson) f 5,000 PERSONAL B ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY O PRO- JECT F]LOC PRODUCTS-CCMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COWNG I Me 0, $ 1,000,000 1 BIx ANY AUTO BODILY INJURY(Per person) $ ALLONMED SCHEDULED AUTOS EX]AUTOS 6228807 COM 01 5/23/2015 5/23/2016 BODILY INJURY(Per accident) S HIRED AUTOS X NON-01MNED PROPERTY DAM(Par accident) AGE AUTOS $ Underinsured motodd $ 100,000 UMBRELLA LIA OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTION $ WORKERS COMPENSATION TER AND EMPLOYERS'LIABILITY Y/N T ANY PROPRIETOR/PARTNER/FXECUTIVE E.L.OFFICER/MEMBER EXCLUDED? ❑NIA EACH ACCIDENT $ 100,000 C (Mandatory In NH) 6RUB-9991MSS-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYE $ 100,000 N yes,descdbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mora space Is required) CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025/2owo I Massachusetts-Department of Public Safety Board of Building Regulations and Standards License: CS-076691 ROBERT A KEEI�� ' 12 E WATER ST North Andover WA 0 Expiration Commissioner 08/16/2017 :.c.` cJ1ie�o-�n�nsa�rrue�alt���ceaa�tateGY� ice of Consumer Affairs&Business Regulation E IMPROVEMENT CONTRACTOR egistration 10-"-- T Expiration g/3A Supplement Car` KEEN CONSTRUCT ION##O ROBERT KEEN 1175 TURNPIKE ST NO.ANDOVER, MA 01845 Undersecretary IyJ KEEN CONSTRUCTION CO.BG K 5315 PROPOSAL 1'1�0 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 P 9 9 Submitted with the Commonwealth of Massachusetts. Inquiries To: +f — about registration and status should be made to the Director, Home Improvement Contract Registration, 10 IP—J, Park Plaza, Room 5170, Boston, MA 02116 617-973- 8787 Owners who secure their own construction )M related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATE REGISTRATION NO. EIN N0. 5-7 —� �zQ ( ,4 MA. H.I.C. 108383 46—3783401 > CIS = 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: ctrl J dmrr tm t � oM j'e.r (o �Vpr - r e-r eln f G5 ;ncw if �r / � ee � c+ o f Nth � G (� k �vi hd � Re IGS G afid dc,r oY7 ► + �r tie (eiclo ie5 4MO&5� 67 &1 rneer, byf e/ec.f rjcr, , (UM bff7 �. c � uOC. Luor will k bifleJ ggepgre;Ile-I, > Construction related permits: ..........................-........._...............................,....... ........................................,..........................................................................................................................................,........................................................._..........................._............._..................._....................................... ... ........................................................................_....................,......-.............................................................................................................................................................. WORK SCHEDULE . 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: T�tce Th U c- n i �I T CM d v`I? 5-evpotwNQ --"___"'. dollars($ Payment to be made as follows: k..4 �— % ($ I0 00 ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant p c�2 % ($f�'`o) upon completion of �S I htF(L �4175 ILURNRIKIP- STa X l J 5 Street Address upon co N. ANDOVER, MA 01845 City/State Bio ($f 2 ) shall be made forthwith upon (978) 691-5201 (978) 682-3231 completion of work under this contract. TPh Fax Notice: No agreement for home improvement contracting work shall require a 4f.>down payment (advance deposit)of more than one-third of the total contract price r Sales 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 Authoriz `Si atu equipment,whichever amount is greater. Note: This proposal may be withdrawn by us it 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 t7 n. Cancellation must be done in writing. DO NO IG THP CONTRA T IF XHERE ARE ANY BLANK SPACES. Signature ate Signature Date IMPORTANT INFORMATION ON BACK ►