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HomeMy WebLinkAboutBuilding Permit #349-11 - 129 OSGOOD STREET 10/26/2010 BUILDING PERMITO "ORT" q . WN OF NORTH ANDOVER 011 APPLICATION FOR PLAN EXAMINATION Permit NO: 3W_11 Date Received 4 • ' � Date Issued: d ��SSACHus���y IMPORTANT:Applicant must complete all items on this page LOCAT104'Yo Pnnt PROPERTY(„WNER C&f' i /p �2 L wom cx Pnnt MAP 210 ,, PARCEL; ZONING DISTRICT :lHistonc Distract yes no _. Machine Shop Village : yes_ no , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building k-0-n-e family Addition Two or more family Industrial cAlteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Flood'p Iain Wetlands Watershed District motet/Sewer DESCRIPTION OF WO K TO BE PREFORMED: � 1 s l1,41 OWNER: Name: (fiIdentification Please Type or Print Clearly) r}M.£ /.1 r t-1 t 'v *)oa PhongJ v Address: 1 3 45 5Q 0 ,n zT LHe CTOR 'Name: S ( P,hone.q 7�- 6� ! . 4-w��_�-7 tu or's Construction License:. Ex Date,: P provement License" Exp. Date:. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ l 3, R'5 a . :1 1 FEE: $ Check No.: Ce !Z35 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaraty fund t&7 Signature of Agent/Owner .. Signature of contractor_ Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody 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 HEALTH 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 Osgood Street F1RE DEPARTMENT TempburnDster on site yes no _ i Located:at 124,ain Sfrreet Fire Departmentsignafureldate COMMErNTS` __ 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 2010 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:Building Permit Revised 2008 Location, , No. Date A/5 i. MORTN TOWN OF NORTH ANDOVER • O F � }si + r o 4 , ' Certificate of Occupancy $ sa Building/Frame Permit Fee $ s,+cNu Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # O J' 236Ui Building Inspector ORTH ovm Of And * — - - _- T �O _ LAKE `O dover, Mass.,&_4249 COCMICMEWICK ��tG Ad RATED P9F`�,�5 SS BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System c_.-;: � BUILDING INSPECTOR THIS CERTIFIES THAT.......... .... �. ..lnr- '�l!! U«" ......... '"-1 .a..c................:................................... Foundation has permission to erect. ..................................... buildings on .......12. ........... aE 6. . Rough �.t.. . .....S'...... t0 be occupied as......... ...............o � S d0� lg^ Chimney pi ................ t'......... 1....................................................................................... 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 �2_- Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUC O ST ELECTRICAL INSPECTOR O Rough ......................................................................................:.......................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Office ak,er rs lines egu a o,M HOME IMPROVEMENT CONTRACTOR - Registration: .od,08383 Type: Expiration: X81812012 DBA K C0NSTRUQ-%f0t-,6 Kenneth Keen 21 Hewitt Ave 0, vi No.Andover, MA 0184 Undersecretary -•� Massachusetts - Department of Public Safeh �. Board of Building Re�uulations and Standards Construction Supervisor License License: CS 58245 Restricted to: 00 KENNETH B KEEN 21 HEWITT AVE N ANDOVER, MA 01845 Expiration: 3/24/2012 ( npmi. iuncr Tr#: 20523 Massachusetts- Depai-tinent of Public Safety Board of Buildim- Re�-ulations and Stiindards Construction Supervisor License License: CS 76691 Restricted to: 00 ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 �--G— Expiration: 8/16/2011 ( unmissiuncr Tr#: 1690 8/30/2010 11:02 AM FROM: Gilbert Gilbert Insurance Agency, Inc. TO: +1 (978) 682-3231 PAGE: 001 OF 002 A DRflTM CERTIFICATE OF LIABILITY INSURANCE 08/30//20 0 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 Keen & Robert Keen INSURERA: NORFOLK & DEDHAM INSURANCE 23965 DBA: DBA Keen Construction Company INSURER& Granite State Ins. Co. 0077 21 Hewitt Ave. INSURER c: North Andover, MA 01845 INSURER D: INSURER E: CO E AGES 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 DD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS LTR NSR TE MID ATE MMIDD GENERAL LIABILITY ND-P-010078/000 03/13/2010 03/13/2011 EACH OCCURRENCE $ 1,000 00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED nce $ 50,00( CLAIMS MADE 1XI OCCUR MED EXP(Any one person) $ S'00( AIf-- PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PEO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per acciderd) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSNMBRELLALIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND W0006371378 08/03/2010 08/03/2011 WT 0TH- EMPLOYERS'LIABILITY TORRYY LIMITS I IMII B ANY PROPRIETORIPARTNERIEXECUTIVE ORI INAL TO BE MAILED VIA E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBEREXCLUDED? MASS WORK COMP BUREAU E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS Evidence of Coverage. CERTIFICATE HOLDER CANCELLATION 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 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. Evidence of Coverage AUTHORIZED REPRESENTATIVE Mark Gilbert, CIC ACORD 25(2001108) ©ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ky 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): ['L /J (,Q /U 5 Address:--s_1 14 E w in[ ,+9 U e City/State/Zip: }r JO1J6-.,t4 1Q1 N-C Phone#: 9''71 G 4 l - S_o7 0 ) 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 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. : (]t-Rcinodeling 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 10.❑Electrical repairs or additions required.] officers have exercised their 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.] t 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. #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: /Z A r j4 i; U(/A � C^ Policy#or Self-ins.Lic.#: LL) C D 3 7 Expiration Date: l Job Site Address: 1-✓ 1 0 SQ©o Q S City/State/Zip: J . 1q Nd S' 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 nd penalties of perjury that the information provided above is true and correct Si ature: Date: V Phone#: 1 -71 ' 6q " 5 a a 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#: 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-contractor(s)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 be 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 Office of Investigations 600 Washington Street Boston,MA 02111. Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia l KEEN CONSTRUCTION CO. 21 HEWITT AVE. N.ANDOVER, MA 01845 C 978-691.-5201 i i Greenwood, Pam 131 Osgood St. I N.Andover, NSA 01845 978-725-0122 Contract#5257;Appendix A Date: 10/12/10 Remodel first floor bath: • All demo to be completed by homeowner ® Reframe for recessed medicine cabinet if possible Upgrade electrical to code ($1000.00 allowance) Supply&install fixtures selected from Peabody Supply quote#214135 Supply&install insulation on exterior wail to code(possibly fatten wall to accept R-21 insulation) Supply&install blueboard and skimcoat plaster to smooth finish Supply&install n6w underlayment on floor o Supply&installri nse board on shower walls I t Supply&install c ramic the as selected from National Tile on shower walls,ceiling&.bath floor Supply&install panel door toilet topper cabinet If Replumb dishwasher in kitchen& replace drum traps in basement We may have to reframe a lower ceiling to accept the exhaust fan piping at an additional cost. Total Price:$13,952.22(thirteen thousand nine hundred fifty two and 22/100 dollars) Price does not include cost of permits,demo, paint,changes required by inspectors,or damaged framing: Payment schedule:$3000.00 due upon signing contract-r $2000.00 due the 15t day of work(plus permit fees) $2000.00 due when rough plumbing is complete $2000.00 due,,64n rough electrical is complete $1500.00 due when insulation&blueboard is installed $2000.00 due when file is complete I $1452.22 due at completion of contracted work Customer Ke10 Xeth7B. een Date Date a 5257 KEEN CONSTRUCTION CO. GP e 21 HEWITT AVENUE PROPOSAL 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 r� Chapter 142A of the general laws,must be registered with Submitted + ( r a t the Commonwealth of Massachusetts. Inquiries about To: _ �.,�_ -.......:__�-_'`.'�._�.._` __. ..........._ __.............-- _ registration and status should be made t the Director, II 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 c. 142A. PHONE _ _ DATE REGISTRATION NO. EIN NO. f / �) 7 ( f U�/� /J MA. H.I.C. 108383 26-0462904 > C/S= Customer Supplied S+ I =Supply + Install 19 See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: ........... -6......... .......... -----u- ..... . -- - > Construction related permits: .................................._............................................................................................................................................................................................................................................................... ..__..,......_............._..........._.._. _...._............._.._........_...........................--,............_...............................................,...........,,....................,,............................................................................................................................................................................................................._. _......_._.._........_._....__...__..w....._.......... WORK SCHEDULE Contractor wit of a 'n the work or order the materials before the third day following the signing of this Agreement,unless specified her i7 w fC tractor will begin the work on or about ' (date) acknowledges and dgrees 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 e G 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 Contract r,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: U i rt een 77�r'U 5n od /tJ r ric I by1 drPd r Toe) ('747 lr rQUdollars($ 13 i 9 5 2 Z2 ). Payment to be made as follows: % ($ ) upon signing ontract; '1 KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor/Designated Registrant ($ ) up n, Illy f�o 21 HEWITT AVE. (� Street Address .($ u`p n completion of i N. ANDOVER; MA 01845 1 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 >down payment(advance deposit)of more than one-third of the total contract price Name of 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 Authoja i nature ( �.- 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 Y 11• 'i.�..f.... 6�1 ,r �t"�..L,b.�-� Date f 4!l l0 Signature - Date IMPORTANT INFORMATION ON BACK; ,a,.w..ae,u'3�n+.rrsa.:s,.:!..ut• ' � :amu:.,*..��SetS�;:: _,:��...v�.weu�is,.a-:��tllw.®."= f r:�--�tx ,mr°;'�,-i-�.....��.ih��so.�.;�1 ., �,.:-.f.,, �a��:"'. .�c.+>a ..,:?,....tt' +a.,�'; 4 g+,+la+t-�� �F�.ar..€� s ,,.• -