Loading...
HomeMy WebLinkAboutBuilding Permit #053-2016 - 1580 SALEM STREET 7/10/2015 r' 'j NORTH (! I f BUILDING PERMIT 2O9 tt LED_06 q�O TOWN OF NORTH ANDOVER a - - APPLICATION FOR PLAN EXAMINATION _ 76 Permit No#: Date Received oq " 1 SSACHUS� Date Issued: 1 10 IMPORTAANTI: Applicant must complete all items on this page LOCATION 1 D Jam`l'� ►n'1 [ Print,�n �! PROPERTY OWNER ''� 5 1 CVN � Uy l 1 U�2,t 1 Print TOO Year Structure yes zo MAP C. 4 PARCEL: 5(0 ZONING DISTRICT: Historic District yes o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ipRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ®.SeI - ❑Wd istnptcetlanct� ®Water/Sewer - . s DESCRIPTION OF WORK TO BE PERFORMED: Identification- Plea Type o Print learly OWNER: Name: n!by -)o 1,� (Syr+ Phone: Address: 60e- 1 5t �Q1ACVCr— p Contractor Name: VeFO rc-w1S+,FL)cL4 Ccs Phone: 9'7'Z- (o9! Email: -Fruc., Jcg/1 GU , cc Al Address: lt '7 -yrv1 i V---e. k1a ojgq5 I Supervisor's Construction License: 94 Exp. Date: Home Improvement License: i o ,9393 Exp. Date: g7 f ARCHITECT/ENGINEER Phone: I^ y Address: Reg. No. i FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 6 7 H 0 -5 FEE: $ b Check No.: �� � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tote u an f nd 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENT'S 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 AFIRE DEPAMEAIT Tem-R D r �- r Y s, , V kms'' __ rnp uposte w t �no r=on situ L sated at 124 Main Street``4 '; •��` ��' h� ,z� ts��y v ,fir '� < i* Fire De mennature /date 4 ' , y :� x '� �, - •,` ��, ' I� KirtY:i �*4.ti,,..Ns ,r.P1 t.• '- '� '.`.' A s. + 4. i a .. .gyp 1x k-t. ? t• . i 0 s {�, s r- X-.. ( `v c n r' ♦! Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of deter 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) LI Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 4. Building Permit Application 4. 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 OTE: 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/Cross Section/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 . OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 2014 Location 1 C J CXR t'1 No. © � Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ � ^ Other Permit Fee $ ,, TOTAL $ i / 441 Check# �Z Building Inspector NORTH own of �.. 1 E ndover O 0 h ver, Mass COCHICH.WICK ��• A�RATED I,P��.(5 S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System P'.T4 � ��l«il Bah BUILDING INSPECTOR THISCERTIFIES THAT ... ....................... ............................ ........................... ......................... ..� .. . . Foundation has permission to erect .......................... uildings on ....... .... ..... ... ....................... Rough tobe occupied as ........................�........ .... .. .. �.... ww ...................................... Chimney provided that the person accepting this permit shall in eve 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service ............ ...... .... r.xn .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough g 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. KEEN CONSTRUCTION CO. PROPOSAL 1175 TURNPIKE STREET 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 Submitted /,qr/(� /� ,{/JI c � —t with the Commonwealth of Massachusetts. Inquiries To: "11 �C I /v��J��R1 t�Ur 1 about registration and status should be made to the q �\' Director,Home Improvement Contract Registration,10 �J f UPark Plaza, Room 5170, Boston, MA 02116 617-973- 8787 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. MA. H.I.C. 108383 46—3783401 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: �\J C, c,'v1c c Construction related permits: ..._....__.._..........___.__—_........-.............................................................._.................................._..........._.._.........,....-_...............................................................,................._...................._......I'll.........._.._....................................................._...._.._.............. ........_. WORK SCHEDULE ConlracWr ill of a he work or order the materials before the third day following the signing of this Agreement,unless specified her Ili Mractor will begin the work on or about / (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (dale).The Owner hereby acknowledges an 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 Contract ,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: lP lQ� tOJ>��G� �7kX 1'1 , ,dv�ecl t—t ie dollars($ ��65•n� ). Payment to be made as follows: % ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor I Designated Registrant ($ {{{���///��`���111 cc e(i rr�n oil 1175 TURNPIKE ST. Street Address .0 completion,of. DT \ N. ANDOVER, MA 01845 — 9 .. ° City/State , ( shall be made forthwith upon (978)691-5201 (978)682-323Tf completion'of work under this contract. Phon 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 n,sal m 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 ed si h prd equipment,whichever amount Is greater. Note:This proposal may be withdrawn by us it 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 CONTRACTG IF THERE ARE ANY BLANK SPACES. Signature Date Signature Date IMPORTANT INFORMATION ON BACK lill Canstvuc�ion Co; eemoue. nc sNee�n��s-rs 978-69'1-520'1 KeenConstructionCo.com - Burt, Mikel &Winston 1580 Salem St. N.Andover, MA 01845 Contract#5539,Appendix A June 23, 2015 Water Damage Repair Replace missing gutter on back of house Repair damaged downdraft vent hood Kitchen: • Remove casing on window and door • Remove affected wallboard and insulation • Patch wallboard to smooth finish • Re-install casing • Paint affected walls Sunroom: • Remove water stained ceiling "panel' and section of wall behind desk • Install new wallboard and plaster to smooth finish • Caulk around all beams • Paint walls and ceiling in room Living Room: • Caulk around front beam • Paint two front ceiling"panels" Foyer: • Apply stain block primer and paint ceiling Powder Room: • Apply stain block and paint ceiling Dining Room: • Apply stain block and paint ceiling 1175 Turnpike St. Page 1 of 2 P: 978-691-5201 N.Andover, MA 01845 F:978-682-3231 CSL#076691 Sales@ KeenConstructionCo.com HIC#108383 REMC7bFLIPIG SI'EGI/aLISTS 9T8-697-5207 KeenConstructionCo.com Baby Bedroom: • Remove closet shelf and brackets • Remove wallboard and insulation on outside wall in closet • Install new insulation and wallboard • Plaster to smooth finish • Paint affected walls • Re-install closet shelf and brackets I Guest Room: • Apply stain block and touch up paint as needed Air conditioner repair: • Remove and dispose of wall air conditioner in sunroom • Patch interior wallboard • Patch exterior siding • Paint siding to match Front drainage: • Supply and install underground drainage pipe away from house,approx 20'away Total Price: $7405.00(seven thousand four hundred five dollars) Prices do not include cost of permits or repairs of any unsafe,unusual or non-compliant existing conditions not addressed in this quote. Payment Schedule: $1000.00 due upon signing contract $2000.00 due the first day of work (plus permit fees) $2500.00 due when plaster is complete $1905 due at completion of contracted work Customer Robert A. Keen 2, Date Date 1175 Turnpike St. Page 2 of 2 P:978-691-5201 N.Andover, MA 01845 F:978-682-3231 CSL#076691 Sales@ KeenConstructionCo.com HIC#108383 The Commonwealth of Massachusetts - -' Department oflndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly GName(Business/Organi'zation/Xndividual): Address: O t"s'1 ik e - City/State/Zip: �t�1 , F�A o i �J Phone#: 7 2 U 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 I 6. ❑New construction employees(full.and/or part-time).* have Hired the sub-contractors 7• ❑Remodelin g 2.❑ I am a sole proprietor orpartner�- listed on the attached sheet.I ship and'have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.E]Electrical repairs or additions required.] officers have exercised their 3.01 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.]i 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. i Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. fain an employer that isproviding workers'compensation insurance formy employees. Below is thepolicy and job site information. Insurance Company Name: i Policy#or Self-ins.Lie.#:� /(� L MS2S-2_- *xpirationDate: 10 1 Job Site Address:, City/State/Zip: N V'21—, Attach a copy of the workers'compensation policy ileclaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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 civilpenalties 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 maybe forwarded to the Office of Investigations of the DIA for ins ance coverage verification. I do Hereby certify n er th ains a nalties ofpei'jury that the information provided above is true and correct. - Signature: Date: 7 .15 Phone# ✓ 7'K- 4 7 9— 9M5 official use only. Do not write in this area,to he completer)by city or town offzcial. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: i RightFax C3-1 3/24/2015 9:51 :03 AM PAGE 2/002 Fax Server DATE(MM/D DIYYYY) CERTIFICATE OF LIABILITY INSURANCE T IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER. E HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: GILBERT INS AGCY INC PHONE FAX 137 MAIN STREET (A/C,No,Ext): (A/C,No): E-MAIL READING,MA 01867 ADDRESS: 246WY INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNTTY COMPANY OF AMERICA KEEN CONSTRUCTION CO INSURER B: INSURER C: INSURER D: 1175 TURNPIKE STREET INSURER E: NORTH ANDOVER,MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 6 TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMtDmYYYY) (MLWD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F-1 OCCUR. IREMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY [D PROJECT[:]LOC IRODUCTS-COMP/OP AGG $ AUTOMOBILE UABILITY COMBINEDSINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YM US-999IM582-14 10/08/2014 10/08/2015 LIMITS j ANY PROPERITOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? Q WA E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,de6ae under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTA%31VE g� NORTH ANDOVER,MA 018451 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Massachusetts - Department of Puntic Safety Board of Building Regulations and Standards Construction SuperNisor t License: CS-076691 ROBERT A KEEN-` 12 E WATER ST _ North Andover NFA 0 c^' Expiration Commissioner 08/16/2015' cls Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR WIeigistration: A 8383 Type: iration: -VLi`8l106_,, DBA KEEN CONSTRUCTi..O(V.GO, Kenneth Keen 1175 TURNPIKE ST NO.ANDOVER, MA 01845 f—' Undersecretary I I i