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HomeMy WebLinkAboutBuilding Permit #423-2011 - 131 OSGOOD STREET 11/17/2010 ttORTFI BUILDING PERMIT TOWN OF NORTH ANDOVER V6 0 APPLICATION FOR PLAN EXAMINATION Permit NO: 23� Date Received .0"ArMD �SSACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page N L�qq 9 7, P, 66yPROPERT - -Y- ER MAP-P �:n& 21`O =PARCEL_ "Tw R' c'T Y no achTp �-brup Hq TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial tXepair, repla" cement Assessory Bldg Others: Demolition Other eptic e Floodplain' -- " I ids Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 6116J'67- t J Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Address Su enisorss xp....'Date d"6 -r' Ho Exp- :Imprqyp.rqen't,Lic'ense-- 16- - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDWG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ f4f?. s-6 FEE: $ Z Check No.: 6 rAl Receipt No.: �2S NOTE: Persons contracting with unregistered contractors do not haveaccess to the guff ant_vfund Signature ofr-t(O .' �*A " I 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 Siqnature 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 rTemp Dumpster on site yes no Y Located - - .•. _- L� ..:..-- ._ ... I at'12��Mam Street COMMS _ 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 E f 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 I-nterior 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 Per 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 f DO a( 5�- No. y�3 ",:20// Date 1/i�L NORTq TOWN OF NORTH ANDOVER O 0 4L * r Certificate of Occupancy $ MUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 237 G9 Building Inspector ORT1y Town of L M o = A K o dover, Mass., //z z L10 COCHICHEwICK ` ADRATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT A''�/ 6�ei /9� BUILDING INSPECTOR © Foundation has permission to erect...............:.:...................... buildings on .... 1..���,'.0....0. 5 ......................................... Rough ,,f ��, CA to be occupied as G' 7..�1���1��. `� .....�4 -/ "J..:. GG!'Y....... ......CA-15e74..... Chimney . . ........ .... provided that the person accepting this permit shall in everyaspect conform to the terms of tu;pplication 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough .......... .......... .. !' GTt j................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place. on the Premises — Do Not Remove Rough nal al No Lathing or Dry Wall To Be Done Until Inspected and Approved b the Building Inspector. FIRE DEPARTMENT p p p y g p earner I Street No: SEE REVERSE SIDE Smoke Det. Office ofomerrsiness egu a on HOME IMPROVEMENT CONTRACTOR Registration: X108383 Type: ; Expiration: ;81x812012 DBA K CONSTRUCTCO Kenn Keen eth K 21 Hewitt Ave No.Andover,MA 011145,- Undersecretary Ntassachusetts- Department of Public Safrth Board of Building Re,mlations and St;uidards Construction Supervisor License License: CS 58245 Restricted to: 00 KENNETH13 KEEN 21 HEWITT AVE Z . N ANDOVER, MA 01845 o-- J"� Expiration: 3/24/2012 ( uuni.�i mw' Tr#: 20523 Massachusetts- Department of Public SafetN Board of Buildin.- Re.-ulations and Standards Construction Supervisor License License: CS 76691 Restricted to: 00 ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 --� -� Expiration: 8/16/2011 ( uumiaiuncr Tr#: 1690 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1u4p 600 Washington Street Boston,MA 02111 www massg ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 2iw COtyL�1 Address: „ ! 41 Lo k9 0&1 a City/State/Zip: l" . A NAat/3dt /y�A 6!S'� hone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[]Tam a employer with 2�: _ 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. F-1Weare a corporation and its required.] officers have exercised their 10.❑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' 13.0 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: &2 t9 t- Policy#or Self-ins. Lic.M LU C 00 C37/ 3 71 Expiration Date: CA Job Site Address: City/State/Zip:P/ A e/T r(,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. 1 do hereby certify under the p . s andpenalties ofperjury that the information provided above is true and correct Simature: Q Date:z 6 Phone#: C ?X75 ' [�9 • Sao 1 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 M 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,shallwithhold 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 contactyou 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 Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia 8/30/2010 11:02 AM FROM: Gilbert Gilbert Insurance Agency, Inc. TO: +1 (978) 682-3231 PAGE: 001 OF 002 ACOR M CERTIFICATE OF LIABILITTINSURANCE L 0830/20 0 PRODUCER (781)942-2225 FAX (781)942-2226THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gilbert Insurance Agency, Inca 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 01841S 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,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 TYPEOFINSURANCE POLICYNUMBER POLICYEFFECTIVE POLICY EXPIRATIONLTR INSR DATE(MMIDDNVI LIMBS GENERAL LIABILITY ND-P-010078/000 03/13/2010 03/13/2011 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED. $ 50,00( CLAIMS FADE a OCCUR MED EXP(Any one person) $ 5,00( PREMISES(FA A PERSONAL 3 ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,600,00C GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY M JPERCOT- LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea acciderd) ALL OWNED AUTOS H BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per acciderd) PROPERTY DAMAGE $ (Per ecadent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN FA ACC :$ AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY - EACH-OCCURRENCE $ OCCUR ❑CLAIMS FADE AGGREGATE $ $ DEDUCTIBLE $. RETENTION $ $ WORKERS COMPENSATION AND W0006371378 08/03/2010 08/03/2011 WO$TATTI 0TH EMPLOYERS'LIABILm ORIGINAL TO BE.MAILED VIAS' 100,000- ER B ANY PROPRIETOR/PARTNERJEXECUrIVE;' : E.L.EACH ACCIDENT $ . OFFICER(MEMBEREXCLUDED? MASS WORK COMP BUREAU E.L.DISFAS.E-EA EMPLOYEE $ 100,00 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 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 ORREPRESENTATIVES. Evidence of Coverage AUTHORIZEDREPRESENTATIVE Mark Gilbert CIC ACORD 25(2001108) ©ACORD CORPORATION 1988 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N.ANDOVER, IVDA 01845 978-691-5201 Greenwood,.Pam 131 Osgood St. N.Andover,ma 01845 978-725-0122 Contract#5027;Appendix A Date: 11/7/2010 Remodel Pantry and Add Laundry Closet • Remove and dispose of"newer"cabinets in pantry • Supply&install customer selected cabinets from Dracut Kitchen& Bath(white MDF beadboard door, 1'l" overlay, particle board box,42" top cabinets)with all trim,fillers and crown • Supply&install 30"wide cabinet above range to match,.with shelving units on both sides • Supply& install granite counter as selected by customer($1800.00 installed allowance) • Frame walls in kitchen to create laundry closet(approx.30"x 8') • Supply&install blue board on both sides of closet,skimcoat plaster to smooth finish exterior and textured finish interior • Supply&install one six panel hollow core door unit(approx. 6'0"x 6'8" unit pair) • Supply&install trim on closet to match existing Plumbing: • Supply&install plumbing drains and feeds for pantry sink • Supply&install faucet,sink,garbage disposal and soap dispenser in pantry • Supply& install waterline to refrigerator • Supply&install gas line,water lines and drains to laundry closet Electrical: • Upgrade electrical to code in pantry • Supply&install outlet and lighting in laundry closet • Supply&install switching for garbage disposal and lighting above sink • Total electrical allowance$1200.00 Total Price:$15,549.50(fifteen thousand five hundred forty nine and 50/100 dollars) Total Price does not include cost of permits,painting or changes required by inspectors. Page I of 2 SEEN CONSTRUCTION CO. 21 HEWITT AVE. N.ANDOVER, MA 01845 978-691-5201 Payment schedule:$300€3.00 due upon signing contract(Pd Check#124)✓ $2000.00 due the first day of work(plus permit fees)✓ 52500.00 due when laundry closet is framed and plumbing rough-in is complete $1500.00 due when cabinets are installed $2000.00 due when granite is installer` $.3000.00 due when laundry closet is plastered $1549.50 due upon completion of contracted work �11 f r Customer Kenn th B. Keen 0 4� Date Date Page 2 of 2 :G 2. KEEN CONSTRUCTION CO. GP rmew a 21 HEWITT AVENUE PROPOSAL *410 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 /11" Chapter 142A of the general laws,must be registered with Submitted PGS i r �.� the Commonwealth of Massachusetts. Inquiries about To: -- --- - registration and status should be made to the Director, t �G`� .�"�, Home Improvement Contract Registration,One Ashburton _.,.____.._..._....-................... Place, Room 1301, Boston, MA 02108 (617) 727-8598. 2 -• 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. ONE DATE REGISTRATION NO. EIN N0. n Ft ` '� '~ �� I ` �� 0 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: _ k -`- - _... ... _.. _._. .-_._......... 1 p...__. ((( __..... . ..........__. — — ----...-.. > Construc_tion 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 ropOSe hereby to furnish material and labor-complete in accordant with above specific do s,for the sum of: F'fl[eenC� i V .�� e f t r'l I'' C ' r' �` t`t 'V ?. :r. f t ! f dollars($ f Payment to be made as follows: r )' y % ($ ) upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN I Name of Contractor/Designated Registrant ($ )yup niqp eto of ; 21 HEWITT AVE. Street Address ° ($ 4 ) upon completion of ANDOVER, 114k 845 N City/State shall be made forthwith upon (978) 691-5201 (978) 682-3231 ($ ) completion of work under this contract. Phone Fax I' 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 Authorized Signature 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:(NQT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature "- Date Signature Date IMPORTANT.INFORMATION ON BACK 1111111-