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HomeMy WebLinkAboutBuilding Permit #023-12 - 134 BEACON HILL BOULEVARD 7/11/2012 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION. Permit NODL,3` �- Date Received ij !� 4-no Date Issued: IMPORTANT:Applicant must complete all items on this page s —ere"•E�nt,t�tiA}.+�}.r»�.-:mss, "tiM"'i ,'Ty #.. '`-,}, `. T"'�. a'g ':"S``"� w.ar '" y"F"i ,,.,y ,a..«c. ...x=py. W ��!"'f a rG 1 �.'7+'^v" -+�.4. +u w....�_.....�`... #. ;.- in jPR©PERiTi�Y®WNER ` � � " 'C� _:z �. MAP, N®� PP,RCE OZ®NING ®ISTRIC¢T � i. `JHistoriDistrctr � , • , ;Kr 'tg'�s lAacFii e ShopRVillage� TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building S-erne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial R'kepair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑ Other ❑_ tic,, MWell �k❑ Flootlplain ❑{Wetlands f i�'Watershed?District +i < .s� , DESCRIPTION OF WORK TO BE PREFORMED: I✓1 CE 61d #4,L n C� C S d n1 L k' FT Ca r46(F C. ,u f� C H-0rlC Identifica�p n Please Type or Print Clearly) �7 g OWNER: Name: ��c/ d 16far d l �"; rn S Phone: I - (0,5-S6 Address: f' �J A Va P ,sl ` ' } iJ C®N 'RA'C�T®RlNam`e � Cl�9 ,- , c one 7 .i2".,,,.E:i.' Address�_ � u1 , <L., V ..�s _ .1 Y ; SupenisOfis Constraction License w ¢ a2 � $ ' jExp,'�Date J }} y � i r+ ,x S s$ ,r `� iS ✓ -`M� fila '< ., .. F , s Home lmpro'vemen Lic-nse � � 1Date ARCHITECT/ENGINEER Phone: Address: eg. No. FEE SCHEDULE:BULDING PERMIT.'$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1 D 10 FEE: $ Check No.: 7,42 Oy Receipt No.: a?,S'�i NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund --- - - Si naturesofA r.: Slgnature offco ntracto,a h"' Location 134 3PG o n,�; 11 No. Date A11117, e - TOWN OF NORTH ANDOVER tit;b tr4�` • e Certificate of Occupancy $ T Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# (�0� is 25497 Bui ding Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ SwunmmgPools ❑ 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 Sign ature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 7 Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street ..�, vv>+ -� :. "i s2s2'.► C a,7:: .st xiy .+,t 9;} "'r 1 `'?' + •.. ., ,'P'=.�,q ..7 ''° {'a�, 1p t,- ,y�.. 9 IRE�DEPARTMENT ,Temp Dumpster �� � T F ""+..t' `3; x�,.s` ��_� fit.. "r��, � a �'""""'�"��"«"°yw_'"u`°��"c }✓ "[�"'"°�y" �_.A+w^�w .a Located;at 124 Main Streetsv tU t M Firel]epartmeri`t=signature/dated ., _ t y r r `� ,,. . `�}� t�': 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 LJ 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 j ❑. 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 o 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 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 DEPARTMENTMFORM07 Revised 2.2008 t%ORTH own of s Ra ndover 0 . 10 1 No. - C% LAK. h ver, Mass, C t� 2 COCHIC"tWIC« S U BOARD OF HEALTH - T T D Food/Kitchen PERMI Septic System THIS CERTIFIES THAT k � �.�+. .... BUILDING INSPECTOR ............ .............. .... .... ........................ has permission to erect ....0eeppting g �, '5e6-c-qb,�1--� �1' Foundation Rough ............... build' son ... ..... ..... .. ....... .. �. .. • to be occupied as ,�� . ... .�. ,� ' ... �.. ,..�. iw. w Chimney provided that the person athis permit shall in every rest 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final �O PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR OkiUNLESS CONSTRUCTION STARTS Rough Service ....... ..... . ........... :`:'::: ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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 The Commonwealth of1{?assachusetts Department of--ndustrial lcczrlents Office oflnvestigations' 600 Washirzgtpn&reet Boston,MA 02.1X1 IVWWyY yWorkerw COMP ensationTnsur4nceAfxA IicantTxfoxn davit:Bui erslContractors/�Iectxicians/ 'Zumbersmat • pleaseP.rinttX,e ibZ Name(Business/organizationadividual): . N ( O� S b Address: w t Cxty/State/Zip: - Ni L) t rn. q ./� Phone Areyou an employer?Check the appropriate box: 1•LRI am a employer With z ' . 4. E]7 am a general contractox and Z Type of proj ect(required): employees(full and/orpart-tune), have hired the sub contractors6. LJ New 2• X am a sole proprietor orpartner_ listed on the attached sheet.1 7 ❑Remodeling coon ship andhaveno employees These sub-contractorshve working for me in any capacity, workers'comp,insurance. 8. d Demblition [No Workers'comp,insurance 5. ❑yore e a corpoxInsuation and its 9. ❑Building addition required,] .officershave exercised their 10•ElElectricalrepairsoradditions 3•❑I am a homeowner doing an work right of exemption perMGL 11.1]1'lumbingxepairs or 2dditions myself [I�]o workers'comp, c.152,§1(4),and�vehaveno insurance required,]'i employees.1( 12•C]Roofrepairs [No workers' comp,insurancerequixed.] 13•1�'Other ��PiQr2 �` AnyappIicantthatchecksbox#Imustalsofill Out the sectionbelow showingtheirworkers,compensationpolicyinformefion, $omeowners who submitthis affidavitindigatingthey are doing all work and then outside contractors mustsubmit anew aifidavitindic tContractors the}check this box attached an additional sheet showing tfie name ofthe sub-contractors and(heir workers'comp. olio Inform ' atmg such. dam an employerThai zspraviding workers'compensation rnsuTflnce,for•yny employees Below is tliepolicy and J'ob site reformation, , assurance Company Name: blicy#or Self-ins.Lic.#:_ W C D 9(9 6 of c f Expiration Date: � ' (•� ' )b Site Address:I ; tq q fo c n u u ( a J d Citylstate/Zip: P IN a. ttach a copy of the workers'compensation policy declaration page(shoWingthepolicy number and expiration date). •ilura to secure coverage as required Wider Section 25A ofMGLc.152 care Lead to the imposition of criminalpenalties of a Le up to$1,500.00 and/or one-year imprisonment,as Well as civil penalties in the form of a ST'op WORKORDERORDER and a fine up to$250.00 a day against the violator. Be advised that a copy of this statementmay be forwarded to the Office �estigations of theDLt forinsurance coverage verification. ok �Iiere70,cerci •r thepains a na ie ury that the informattonp lature: jovidedabove istrue and correct. ase#: �0'zcfal use only. Do not wrife an fins area,to Le completed by city or town official icy or Town; Permit/Eicense# • wing Authority(circle one): Board of Health I BuildingDeparfinent 3.City1T9WR Cleric 4.Mectricall(nsnertnr nt>;P, Nl tssachu',etts- Departments of Public Safety Board of Building- Re�'Uliltions itild Standards Construction Supervisor License License: CS 76691. ROBERT A KEEN 12 E WATER ST N.ANDOVE R,:MA 01845 �-'4- ��j� Expiration: 8/16/2013 (1.MIDisiuncr - .:Tr#: 3772 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supersisor = License: CS-058245 KENNETH B K4EN 21 HEWITT Ag. •- N ANDOVER MA01845^ r Pis"J Expiration Commissioner 03/24/2014 Office ot`. mer eairs usincssegn a{on HOME IMPROVEMENT CONTRACTOR Registration 108383 Type:. Expiration: 8Y�12012 DBA K CONSTRUQ- Kenneth Keen xr A 21 Hewitt Ave 1-V =� _ s ,z� No.Andover,MA 0185, � = Undersecretary 4/25/2012 9.55'AM FROM: Gilliert Gilbert Insurance Agency,-Inc, TO: +1'`(978) "2-323.1 P.AGE:. 001 OF 002 DATE(MMIDOM M A QTM. CERTIFICATE OF LIABILITY INSURANCE oa 25�zou. PRODUCER, FAX (783)942-2226 THIS'CERTIFICAT.E IS ISSUED:AS AWMATTER OF INFORMATION: (781)942.-2225 Gilbert. InsuranceAgencyj Inca ONLYAND,CONFERS NO RIGHTS UPON THEtERTIFICATE. 137 Main Street HOLDER.THIS CERTIFICATE DOES NOT-AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED:-BY THE'POLICIESs BELOW: Reading, MA 01867-3922 INSURERS AFFORDING COVERAGE. NAIL# INSURED Kenneth Keen & Robert Keen INSMERA :NORFOLK .&.OEDHAM INSURANCE -23965 DBA: DBA. Keen Construction Company wsuRERa. Granite State Ins. Co: 0077. 23 Hewitt Ave. trasllaER s: North Andover, MA:'01845_ InsuR�ri'o: INSURER E. THE.POLICIES OF INSURANCE-LISTED BEL01N HAVE 6.EEN ISSUED TO THE'1NSURED NAMED ABOVE•FOR THE POLICY,:PERIOD.:INDICATMAOTWITHSTANDING ANY REQUIREM ENT,.TERM OR CONDITION OF ANY CQNTRACTOR 07HER-DOCUMENT.WITH RESPECT TO WHICH THIS-CERTIFICATE'MAY'BE ISSUED OR MAY PERTAIN;THE INSURANCE AFFORDED BY'THE POLICIESOESCRIBED HEREIN IS SUBJECT TO ALL.THE TERMS;.EXCLUSIONS;AND CONDITIONS OF SLI POLICIES:AGGREGATE'LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS.: ILTR NSR -SDL TYPE OFINSURAyCE.• POLICYNUMBER POLICY EFFECTIVE:'�P.OLICYEXPIRATION - LIMITS - 9ENERALLIA81LRl! 'ND P 0110078/000 G3/13/2012 -0/13/2013EACHGCCIlRRENCE $ ;'1,000 QO- X COMMERCIAL GENERAL LVAILITY DAMAGE TO,RENiEO $ 30;,00 as inns iE 'r7X ora m MED F�(P'(Arry one person) $ 100,;.00_ A _ PERSONAL'&.AUVINJURY ,000:,;0'O - GENERAL AGGREGATEOOO;:OO - GEN'L AGGREGATE UMITAPPL�ES PER - PRODUCTS CO- MP/OP�AGG; $ 2,000,00 �;- X: POLICY. JPERCOT LOC AUTOMOBILE LIABILITY - - - - .COMBINED SINGLE LIMIT $ ANY AUTO.. - - (Ea acadent) :ALL OWNED AUTOS 80DILYINJURY $ .. SCHEDULEDAUi05 (Psrperson) - .. HIREDAUiOS BODILY INJURY $ -NON-OWNED AUTOS, (Per acciderd) . �PROPERTY,DAMAGE (Per accident)` <GARAGELIABILITY. AUTO ONLY--_EAACCIDENT '. $ .-ANY AUTO OTHER THAN EXACC. $ - - ALRO ONLY: AGG.Fg .EXCESSIIMBRELLALIABILRY - - - - EACHO(xURREfJCE $ OCCUR CLAIMSMADE AGGREGATE $- DEDUCTIBLE - RETErrrX)N .$. V WORKERS COMPENSATIONAND PY0009646942 0$�O3�2o11 08�03�2012 WCSTATLI 'CTI+ Eg EMPLOYERS'i[MILITY yy[ CERT TO 'BE MAILED. B ANY PROPRIETOR/pARTTJER/D(ECUTIVE - �., E L,;-EACH ACCIDENT $ lOO,OO _ OFFICER/MEMBEREXCLUDED4 DI ECFLY VIA INS CARRIER' _ - E.L.oISEASE•EAEMPLOYEE s 100;,00 - II yes,describe.wMec saECIAL.PaovlsoNs.5elow EL.DISEASE-POLICY uniT 8- 500 00 OTHER` _ . -DESCRIPTIONOFOPERATIONSILOCATIONS IVEHICLES JEXCLUSIONS-AODEDBYENDORSEMENTfSPECM PROVISIONS vi Bence of Coverage CERTIFICATE HOLDER CANCELLATION. . SHOULD ANY'OFTHE ABOVE DESCRIBED PC LICIES BE CANtfLLED BEFORE THE 'EXPIRATION DATE THEREOF;THE ISSUING INSURER`WILL-ENDEAVOR TO-MAIL - 10 DAYS YVRITTEN NOTICE TO THE-CERTIFICATE HDLDER-NAMEO TO THE LEFT; 'BUT.FAILURE TO MAIL.SUCH'No nCE:$HALL IMPOSE NO OBLIGATION OWLIABILITY -OFANY KIND:UP.ON THE INSURER;ITS�:AGE,NT9 OR REPRESENTATIVES. - Evi`dence of.Coverage AlmioRrzEDREPRESENrATrve Mark Gil bert,;,CIC ACORD 25'(2001108) OACORD`CORPORATION 1988 KEEN CONSTRUCTION CO. 21 REWI rr AVE. N. ANDOVER, MA 01845 978-691 -5201 Kee��.Cav�tlruct►,o-l�.Co:co-wv Sims, Peggy&Randy 134 Beacon Hill Blvd N.Andover, MA 01845 978-681-0550 Contract#5074;Appendix A Date: 7/1/12 Replace siding: o Remove and dispose of existing siding on left gable end of house ® Supply&install house wrap and new R&R pre-primed 'A or better' siding to match existing • Seal around windows with 4"Grace ice&water shield ® Replace corner boards as needed with clear pine to be stained e All damaged wood under the siding will be repaired and charged separately in a 'time plus materials' manner Total Price: $8100.00(eighty one hundred dollars) Total Price does not include cost of permits, unforeseen damage or finishing(paint and stain). Payment Schedule: $1000.00 due upon signing contract C.L<, $2000.00 due the first day of work $2500.00 due when siding is removed $2600.00 due at completion of contracted work Cu er K "eth B. Keen Date Date KEENN CO STRUCTION CO. GP a 21 HEWITT AVENUEP,0"i S A PRO U AL 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 Chapter 142A of the general laws,must be registered with Submittedp^ the Commonwealth of Massachusetts. Inquiries about __ .. ---- � I To: _..... ............. ----- registration and status should be made to the Director, 1 j Home Improvement Contract Registration,One Ashburton Place,Room 1301, Boston,MA 02108 (617) 727-8598. i Owners who secure their own construction related permits,or deal with unregistered contractors_will I -- ( - be excluded from the Guaranty Fund Provision of MGL c.142A. ONE C" =E / REGISTRATION NO. EIN N0. iF ]Z— �.0 a -_ b V, �� __11 MA. H.I.C. 108383 26-0462904 > C/S =Customer Supplied S+I=Supply+ Install ❑ See Attached Appendix A I We hereby submit specifications and estimates for work to be performed and materials to be used: ------------- .......... i t i i I ........... ............ -—— .__ . _-..ai t — -.............. -----....------ __ _._....._........-....................__.. i > Constrciorlated pemits: � �� ' "- utn er ----'�--- .,,.,....._......_.......,..,-_....._._.._.,...._................................................................................................_.......................................... f ...............___..__.._.........-,....__........._.......__..................---..._-.._,.,_....................................................................................................... t WORK SCHEDULE Contractor w-II n t b gin the work or order the materials before the third day following the signing of this Agreement,unless specified here in w'ti .,- o Stractor 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 tree 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 Contracto,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, I 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. i. l We Propose hereby to furnish material and labor-co plete in accordance with above specifications,for the sum of l�C:f �, Q C� dollars($ 1 ). Payment made as follows. i % ($ ) upon si ining Contract; KENNETH B. KEEN / ROBERT A. KEEN I Name of Contractor/Designated Registrant ($ r - a `°�phetion Of. 21 HEWiTT AVE. Street Address ($ \ L) + ) upon completion of N. ANDOVER, MA 01845 City/State` ° shall be made forthwith upon (978) 6�1-5201 (978)682-3231 ($ ) completion of work under this contract. Phone Fax i Notice:. ,No.agreement.for home improvement contracting work shall require_a. down pa'gment(advance deposit)of more than one=third of the focal contract puce Name M Sale4man or the total amount of all deposits or payments which the contractor must make,in i advance, to order and/or otherwise obtain delivery of special order materials and Authorized`signature `�' equipment,whichever amount is greater. Note:Tis proposal may be withdrawn by us if not accepted within days. a 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. i DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. rFrtJ r `, . Signature Date Signature` � Date _S IMPORTANT INFORMATION ON.BACIG,