No preview available
HomeMy WebLinkAboutBuilding Permit #410 - 131 OSGOOD STREET 11/10/2011 t TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION l J 1 © S 00 c� S 7 Print PROPERTY OWNER l .9 ✓l C� 1-k A✓LA2 o o r Print MAP NO: C6 q PARCEL: Q ZONING DISTRICT: Historic District n Machine Shop Villag e no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition *,I`wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other [7`S�.e trc 11 Well U Floodplain D Wetland`s $ 0 Watershed=District , n DESCRIPTION OF WORK TO BE PERFORMED i �. F— Place,3©,9n.� S a� �tio�T �S Identification Please Type or Print Clearly) rl OWNER: Name: 1?Iq W., C 2 Is,& w ©06 hone: 7.1S -O l;A Address: 1 12 1 19-Q01 CONTRACTOR Name: N &5-t �,�is� Phone: 697• o?ml Address: I i W 111 A UoE— N •ANd ' Supervisor's Construction License: Eq a y Exp. Date: 3 /� Home Improvement License: a i 3 l 3 Exp. Date: 'I ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ '' FEE: $ Check No.: &0S I Receipt No.: T NOTE: Persons contracting with unregistered contractors do not have access to the guar my fund Signature ofrAgent/Ovvner Signature oftontract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F PE OF SEWERAGE DISPOSAL blic SewerElTanning/Massage/Body Art ❑ SwimmingPoolsll ❑ 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 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 Ll 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 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: Doc.Building Permit Revised 2008mi Location � � �I�OCf �� 117— No. /U ' Q/a�. Date NORT1y TOWN OF NORTH ANDOVER 0 F00A 9 Certificate of Occupancy $ CNUS��' Building/Frame Permit Fee $ /4' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 6F5-1 24508 Building Inspector r � NORTH � Town of Q over 0 No. _ z over, Mass., �( o , 'Y• - L A K E .`• COCMICHEWICK I %S�RATE O P� C5 E BOARD OF HEALTH Food/Kitchen PER T T D Septic System BUILDING INSPECTOR ICM. 4/ THIS CERTIFIES THAT.....:......... .... ........................................000�l ...................... Foundation eeL has permission to erect ....... buildings on ...� �............... .................................. Rough n to be occupied as ��✓�-� bd d� �?� `sem �` ,� c im y di;eh' eprovided that the person accepting this permit shall in every respect conform to tms 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTION STARTS Rough ..........���� �f r t_c �........................................ Service 1 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 Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE 11r tw cu1.r. 11.U'� 7f000:lUUUV I,HfCLJUIVICG rHUC G17Gl TO WN OF NORTH ANDOVER MASSACHUSETTS NORTH ANDOVER OLD CENTER HISTORIC DISTRICT COMMISSION VIA FACSIMILE 978 6889542 Building Inspection Town.of North Andover North Andover,MA 01845 TO WHOM IT MIGHT CONCERN: Please be advised that replacing the deck at 129-131 Osgood Street does not need approval of the Historical Commission. Section 6 B l&B 6 exempts ordinary maintenance and repair from the bylaws.. It therefore does not need approval from the Olde Centex Historical District Commission. Any questions please call me at 978 685 5000, Sincerely; George H. Sebruender, Jr. Chairman North Andover Historical District Commission The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 0 ,. �p , '� ESN 1. Fs N5l rLtJCi��^1 Address:­0 H E W ,' rL U e City/State/Zip: N A D cJ ;_tN_ !phone#: 7$ &q j l Are you an employer?Check the appropriate box: Type of project(required): 1.LK 1 am a employer with 1 4. ❑ I am a general contractor and I 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. 7. ❑Remodeling 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 10.0 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.] 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. 1 Insurance Company Name: G t2Fj N rJ_c Policy#or Self-ins.Lic.#: (4(7 9 qa Expiration Date: g 3 Job Site Address: 3/ 6.5!9!OoXf _ $ys 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. I do hereby cern der the pain and enalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: / 7<� -69 ( `,5a0t 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#: 8/22/2011 1:36 PM FROM: Gilbert Gilbert Insurance Agency, Inc. TO: +1 (978) 682-3231 PAGE: 001 OF 002 ACORDN CERTIFICATE OF LIABILITY INSURANCE o5/z/2011 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 INSURERB: Granite State Ins. Co. .0077 21 Hewitt Ave. INSURER C: North Andover, MA 01845 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. ILTRINS �DO TYPEOFINSURANCE POUCYNUMBERPOALICYTE MFFEOCTIVE POLICNyI E EXPIRATION LIMBS GENERAL LIABILITY ND-P-010078/000 03/13/2011 03/13/2012 EACH OCCURRENCE $ 1,000,00( X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDnce� $ 50,00( CLAIMS MADE OCCUR PREMISF MED EXP(Any one person) $ 100,.00 A PERSONAL&ADV IN.RIRY $ 1,000,00t GENERAL AGGREGATE $ 2,000.000 GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/0P AGG $ 2,oOO,OO X POLICY JECT PLOC 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 accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: _ AGG $ EXCESSUMBRELLALIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION WORKERS COMPENSATION AND WC009646942 08/03/2011. 08/03/2012 1 WCSTATu- On+ EMPLOYERS'LIABILITY TORY LIMITS B ANY PROPRIETOWPARTNER/D(ECUTIVE WC CERT TO BE MAILED E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBEREXCLUDED? DI ECTLY VIA INS CARRIER E.L.DISEASE-EAEMPLovE g 100,00 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS vidence of Coverage CERTIFICATE HOLDERCANCELLATION 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 OFA NY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Evidence of Coverage AUTHORIZED REPRESENTATIVE Mark Gilbert CIC ACORD 25(2001108) ©ACORD CORPORATION 1909 Massachusetts - Department of Public SafeTh Board of Buildin!- Re-dations and Standards Co ns'tr.uction Supervisor License License: CS 76691 ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2013 ( nunissiuncr f- Tr#: 3772 Massachusetts- Department of Public Safeo Board of Buildino Regulations and Standal-ds Construction Supervisor License License: CS 58245 Restricted to: 00 KENNETH B KEEN 21 HEWITT AVE ' N ANDOVER, MA 01845 c Expiration: 3/24/2012 uiuuissnm'�' I rtt. 20523 °T P�'' ' i �° ?° Office o onsumer airsTwWsim� egu a on HOME IMPROVEMENT CONTRACTOR Registration: ,108383 Type:. I ; Expiration: ,'$i48�012 DBA K CONSTRUC, lt-- Kenneth Keen xr 21 Hewitt Ave ``y No.Andover,MA 0184 Undersecretary 5U50 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 , j,�� too 6 ol the Commonwealth of Massachusetts. Inquiries about To: ___ _____ .---_-.____ . ........ . ........... .-_... .____..-_._._.__ _- registration and status should be made to the Director, 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. PHONEDATE REGISTRATION NO. EIN NO. l/ 7 f/ 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: ci - 'j IVl cofyP105 PVC OYA rlvo ,- Frovv deck S > 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 o'f: 5LK& Eve �' ISYS �t .+�-� 1 dollars($ (g ��I a O ). Payment to be made as fo ws: % ($ ) upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor/Designated Registrant % ($ ) upon completion of 21 HEWITT AVE. Street Address % ($ ) upon completion of N. ANDOVER, MA 01845 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 Authori gnature 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. Signatu Date Signature Date IMPORTANT INFORMATION ON BACK