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Home My WebLink AboutBuilding Permit #574-13 - 130 MEETINGHOUSE ROAD 2/26/2013 BUILDING PERMIT pTH 0, do TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ^/� Date Received �A"`""` : - ��SSACHUS�� Date Issued IMPORTANT:Applicant must complete all items on this page LOCATI©N �� E�C i n � C9y_�c _f G� (rf t a PROP EReTkY�{®UVNER _ MAPN®d �P.ARCED �7rG.: ZON41tri qL, NGlDISTRICT µHistorrc ©istnet; :yes; t \ Mhin' hopl acVillage ;yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ebne family (Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑4Se tic .t©Welk _ ©xFloodplam Wetlands _. ' ` [7 'WatershedkDistr ct, r DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: �C®IV RA"C�T,OR 4Name � i NIJ �i � tcJ-� Phone 11.� . kv - �. p - .. . .. - -v- ?Add�ess __ �1. ..CW .TT __rt I'SupervlsorA #Construction#License . a? � :.__ _L"M t - Home Im rovement Licenser 1.D_. 3.�_� p ._ .� z - 'Exp ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ��I �' ' 0 FEE: $ a Check No.: + k� ' Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to theg ranty fund Signatureof�Agent/Owner� Signature of,contractor { 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 HEALTH Reviewed on Signature COMMENTS t 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: FIREDEPAR " Dumte"r Y Locya,t.ed 384 Osgood Street ptTMENT Tempser on sies ., 3no dw�k u ',Located�at�124�Mair,�Street+ o4 i s Fire�Depa`rtment=signature/date _ 77 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.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date I 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 ❑ 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 o 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 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 m�� -1TAy)-AM . No. Dat - 3 • ' TOWN OF NORTH ANDOVER • y�;�•rtrn t�q�,� • Certificate of Occupancy $ oo— f Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 14 Check# 1 26172 Building Inspector / Enter construction cost for fee cal- North Andover Fee Cakulatlon Construction Cost $ 189184.00 m $ - $ 218.21 Plumbing Fee $ 27.28 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 27.28 Total fees collected $ 372.76 130 Meetinghouse Road 574-13 on 2/26/13 Finish existing Room on Second Floor i .. _ F NORTit•� Town oover ver, Mass, 19L `gI&AD • 3 coc"Ic Nlwlc. y1. BOARD OF HEALTH PERMIT --T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ...........�i.�i. ........ .�.... ./*.11.�R .................................... Foundation has permission to erect . .................. buildings on ....'. ..... .�i�r.. .. .. . ..... . ..... ... e .... sRough to be occupied as ..... ......r...�. h......' •� .....F ........... ...... .. W.qp............... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 .MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU N S Rough ....................... Service ......... ...... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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 CONSTRUCTION CO. GP a 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 Submitted t)I C I^ Chapter 142A of the general laws,must be registered with j _ / -t / the Commonwealth of Massachusetts. Inquiries about To: —1-4- registration—) I(I' C_��I G/6 C (/l t r I i 'r 4 C' J - - -- registration and status should be made to the Director, % Home Improvement Contract f C' �' P Registration,One Ashburton Place --�- -- ( ~-` ! ` ,Room 1301,Boston,MA 02108 (617) 727-8598. Owners who secure their own construction related —__-_ _,,._-f=1�iLrc( � I-�!!! //1 ;'� permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE _ DATE p REGISTRATION NO. EIN NO. MA. H.I.C. 10838326-0462904 C/S=Customer Supplied S+I=Supply+Install ❑ See Attached Appendix A We hereby submit specifications enn,estimates for work to be performed and materials to be used: ---.....----- -----. ----- .. _- ......_. ------ � Construction related permits: _._.._......-------------.._ ........ WORK SCHEDULE..._._.. - __............ _._....................._.._-.............................................................................._._ ...................................................... ........... ..... ........ ................._...... ........_...............__............. ....... ........ _---.._. Contractof will not beg, tt)e work or order the materials before the third day following the signing of this Agreement,unless specified hem-n w jti g Contactor will begin the work on or about r (date). Barring delay caused by circumstances beyond Contractors control,the work will be completed by ) -1 / .2(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 Payment to be made as follows: dollars($ ), ($ ) upon signing Contract; KENNETH B. KEEN/ROBERT A. KEEN Name of Contractor/Designated Registrarit % ($ ) upon completion of 21 HEWITT AVE. Street Address —% ($ ) upon completion of N. ANDOVER, MA 01845 City/Slate % ($ ) 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 n5 S�lesman 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 AmnSr:ed Sign— equipment,whichever amount is greater- Note:This proposal may be withdrawn by us if not accepled 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. Signarure Date . Signature Dale IMPORTANT INFORMATION ON BACK ► KEEN CONSTRUCTION CC. i 21 HEWI7 �k *8-691-520-1,, Ke - C&'structumCo.cotm Dick& Maggie Moynihan 130 Meetinghouse Rd. N. Andover, MA 01.845 978-685-2232 Contract#5052;Appendix A Date: February 21, 2013 Finish 2"d floor room: • Frame interior partition walls to create room and two closets totally approx. 380 sq.ft. of habitable space • Create panels in closets for access to unfinished areas • Supply& install six recessed light fixtures • Supply&install.electrical outlets to code - • Supply&install 'leg`of heat from existing HVAC zone • Supply&install sprinkler head to code - • Insulate exterior walls to code • Supply&install blueboard and skimcoat plaster to match existing • Supply&install one unit pair door and two single door units to match existing • Supply&install hardwood flooring to match existing • Supply&install trim on doors,windows and base to match existing - f Total Price: $18184.06.00(plus sprinkler) Price does not include cost of permits,painting or changes required by inspectors. Payment schedule: $4000.00 due upon signing contract(paid check#1924) $4000.00 due when framing is complete $4000.00 rough electrical, insulation complete $4000.00 plaster complete $2184.06 when Job is completed,plus permit fees Customer Date 97 c2 s- .� Xenneth B. Keen Date a paq'el 1 of 1 ANNOL .i Board of Building Regulations and Standards' Construction Supervisor License License: CS 76691 ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2013 ( ununissiuner Tr#: 3772 Massachusetts -Department of Public Safety Board of BuildingRegulations and Standards Construction Supers isor ' A License: CS-058245 �. I's KENNE TH B IGEN •��r. ;. 21 HEWITT AVE, U845�j N ANDOVEAM .,0 71 Expiration Commissioner 03/24/2014 ��ie�parnmaoouaecc�o�C�aacluae� Office of Consumer Affairs&Busibess Regulation OME IMPROVEMENT CONTRACTOR egistration: fb8,383 Type: xpiration:._.8 J.- D.]4:. DBA KEEN CONSTRUCT10N�0 c' Kenneth Keen Y 21 Hewitt Ave No.Andover, MA 01845 Undersecretary 8/15/2012 12:58 PM FROM:' Gilbert Gilbert Insurance:Agency, 'Inc. T0: +I.(97.8.)`. 682-3231 PAGE: 00:1;OF 002 AICOR 4, CERTIFICATE OF LIABILITY IN:SURANC°E gATE(MMIDDIYYYY) TRODUCER U8/15/2;012 Gilbert Insurance Agency, Inc, O,NLYAND'CONFERS•NO,RIGHTSUMATTER'OFINFQ_RMATION 781 '942 2225' FAX 781 942-2226 THIS CERT:IFICATEIS ISSUED AS A PON THE CERTIFICATE 137 MainStreet HOLDER.THIS CERTIFICATE DOE5-NOT AMEND,EXTEND Ott ALTER THE COVERAGE AFFORDED BY THE POLICIES$EL01N: Reading, MA 01867-3922 INSURERSAFF COVERAGE . NAIC:4. INSURED"Kenneth'Keen :& Robert Keen INsiIaERA NQRFOLK & "DEDHAM INSURANCE 23965 PBA: DBA Keen:Construcfi"on C an " INs1iaERB' OW . y T.rav6lers Insurance: 21 Hewitt Ave: INsiiiiERc. North Andover, MA ol$,,45: iNs( ER D: INSl1RER E: VERAGES THE POLICIES OF INSURANCE LISTED;BELOW HAVE BEEN ISSUED 70 THE INSURE,D,NAMED ABOVE FOR-THE POLICY PERIOd INDICATED NOTV1lITHSTANDING" " ANY REQUIREMENT TERM OR CONDITION OF"ANY CONTRACTOR?OTHEWDOCUMENT WITH RESPECT TO WHICH`TyIS;CERTI"FICATE MAY"BE:I$SUE4 OR<: MAY PERTAIN THE INSURANCE AFFO-11. THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE<TERMS';'EXGLUSIONS AND`CONDITIONS OF'SUCH POLICIES.AGGREGATE•t`IINITS SHOWN MAY HAVE BEEN REDUCEpBY PAID:CLAIMSi; INSR DD' TYPE OF INSURANCE - POLIEYNUMBER�• POLICY.4EF:FECTNE" POLICY.EXPIRATION - LIMITS cE"Ew(L�nBILITM ND The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Uf 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant.Information Please Print Leg><bly Name(Business/Organization/Individual): K lc E N 0p ------------ Address: ( 1^tA1 "� .�✓C City/State/Zip: $ Iy d d J£2 ✓� - Ph r- �ne�: �� Are you an employer?Check the appropriate box: 1.�am a employer with 1 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2. ❑ I am a sole or proprietor partner- listed on the attached sheet. $ 7• El Remodeling shipd have anno employees These sub-contractors have 8. E]Demolition working for me in any capacity. workers' comp.insurance. [No workers' comp. insurance 5. 9• E]Building addition P ❑ 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 insurance required.] t 12.❑Roof repairs q ] employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and :Contractors that cthen hire outside contractors must submit anew affidavit indicating such. heck 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:--I(2 4 y Policy#or Self-ins.Licc.#: (fl U U—S 3 f-67.26 » iR - /9 Expiration Date: Job Site Address: 30 /o cce A (`, City/State/Zip: �S YJ 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 cern un er the pains pe allies of perjury that the information provided above is true and correct Si1nature: Date: ^ Phone#: 7 & Official use only. Do not write in this area,to be completed p 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#: