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HomeMy WebLinkAboutBuilding Permit #472 - 196 COTUIT STREET 1/6/2010Permit NO: V12, BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: IMPORTANT: Applicant must complete all items on this Daae LOCATION Co A U i t) 'iiOaPrin A WPROPERTY OWNER � DSV �4 Print MAP NO: Lzjc PARCEL: Z ) ZONING DISTRICT: Historic District Machine Shop yes a`r 7 - 46 t ti TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One fami y Addition -Z=family Industrial Alteration No. of units: Commercial Repair, rep aceme Assessory Bldg Others: Other Septic Well Floodplain Wetlands Watershed District Water/Sewer n S,FD RIPTION OF WORK TO BE PREFORMED: dor b�� h Identificati Plea Type or Print Clearly) OWNER: Name: 4 rb aMnA a o, I &ff Phone97$'6S�o� �5 Address: 9 (o co 0, 1\CIO q .f l'1 CONTRACTOR Name: ��'e n G>nsATuc,+(cyn Phone: 9-) 91- 51c) Address: 2..\ "e -v-)14 A0, V ali og ; f rf f Supervisor's Construction License: 7% �o 9 l Exp. Date: (z l d % Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12x00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. "2,Total Project Cost: $ \ , / ^7 6 , 0 O FEE: $ I � 6 Check No.: � I k(or Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th gu ran fund signature of Agent/Owner Signature of contractor Location �/b L Q ' f No. Date TOWN OF NORTH ANDOVER A Certificate of Occupancy $ '� s',••° • E�� Building/Frame Permit Fee $�� AG MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # (D 10 2ri:�:.f Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL , ublic 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 COMMENTS CONSERVATION COMMENTS HEA'LTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Sianature 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: Locates 364 uS ooa 5tre FIRE DEPARTMENT' -'Temp Dumpster on site yes no Located at 124 Main Street 3 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 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: Building Permit Revised 2008 0-- E w O O E004 0 w O d x °o w v in cn v cn a O w z C7 ,5v or- b r. o w x° o a ^c U c w �a O E-4 w Aw U 00IX o a G x O w a U a W o r2 U) G tw a 0 a d o cG c w w w w w v cra ° z cn Q ° cn W �a� c O Cc O O V V •dam cA a c m c 0 Ea Q :co co Y= Q Q = O QV W '~ ' o c. Q°0 CD f, 0 Q- * s CD fti .` WE ca cc mm a 0 Cos H L � CD 0 3 H CA O�0+ N W Amo75 4 CL o - �.► y m m oC O O m es vi o �. Im z O r cO C N Q o y m c o = o : cc, N m o o Lu = W m CD •C,LU .- a.Z C Z Gw m om c g z ya _ 0 H O H t aim d, Z I 4 0 2 O O CD O O v Z O a O H � C O C O■� CO) H O �O ' m m CD 3.0 cm O O i e—Qv a �a c O Q 'O EL Z CD ts c CD 0 CL V H cc d C c — y LU N C9 W W U) __F7 ACORD CERTIFICATE OF LIABILITY INSURANCE os,l /2 PRODUCER (781)942-2225 FAX (781)942-2226 Gilbert Insurance Agency, Inc. 137 Main Street Reading, MA 01867-3922 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # swumm Kenneth 8. Keen DBA: Keen ConStruCtion Company 21 Hewitt Ave. North Andover, MA 0184S INSURERA: NORFOLK & DEDHAM INSURANCE 23965 INSURERS: Granite State Ins. Co. 0077 INSURERC: INSURER O: INSURER E: 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. 19 ADVI TYPE OF INSURANCE POLICY NUMBERPOLICY EFFECTIVE rOLICY EXPIRATION LIMITS GENERAL LIABILITY NO -P-010078/000 03/13/2009 03/13/2010 EACH occuRRENce s 1,000,0001 X COMMERCIAL GENERAL LIABILITY CLAIMS MADEa OCCUR DAMAGETO RENTED S SO, OOO MED EXP (Any one person) f 5 , 000 A PERSONAL A ADV INJURY S 1,000,000 GENERAL AGeREGATE S 21000,000 GEML AGGREGATE LIMIT APPLIES PER: x POLICY ;� M LOC PRODUCTS - COMPIOP AGG S 21000,000 AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Es eaadenq S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (PerpeTeon) s HIRED AUTOS NON-OWNEDAUTOS BODILY INJURY (Per&cclasm) 5 PROPERTY DAMAGE S (Por aWdenl) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANYAUTO OTHER THAN EAACC S AUTO ONLY: AGG S EXCE55tUMBRELLA LIABILITY OCCUR FICLAIMS MADE EACH OCCURRENCE S AGGREGATE S 5 DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION ANO 6371378 08/03/2009 08/03/2010 X WCLL OTH- LIMITS pig EMPLOYERS' LIAlMYTORY E.L. EACH ACCIDENT S 100,000 B ANY PROPRIETOR/PARTNER(EXECUTIVE OFFICERIMEMBER EXCLUDED? Itye s, descnee under SPECIAL PROVISIONS balm EL. DISEASE • EA EMPLOYEE S 100 ,000 E.L. DISEASE - POLICY LIMIT $ 500.000 OTHER DEYCWPTION OF OPERATIONS $ LOCATIONS I VEMXLES I EXCLUSIONS ADOEO BY rzNDORBEMENT I SPECIAL PROVISIONS riginal workers compensation certificates to be issued by company forthcoming. ertificate holder is included as additional insured on the general liability with respect to Aerations of the Named Insured. Town of North Andover 120 Main Street North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE YHEREOF, THE ISSUING INSURER WILL ENDEAVOR YO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AOEHYS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Mark Gilbert, CIC ACORD 25 (2001/08) ©ACORD CORPORATION 1986 The Cotnmorrwealth of Massachusetts Department of Industrial Accidents Ofce of Investigatiotts 600 Washington Street Boston, MA 02111 www n=s gov/die . Workers' Compensation Insµrance Affidavit: Builders/Con spiicant Information tractors/Electricians/Plumbers Name (Business/prgaBiza6ordlndividual): 16 Address., N eoNS!2ucInt-0-A/ 6 - City/ ' city'State/Zip:�(3 ..1A d 0 tlf•z ✓l'l R / $ �S Phone #.. 7 V C ' Are you an employer? Check.the appropriate box: 1 • uirn a employer with _L_ 4. ❑ 1 am a general contractor and I employees (fol] and/or part-time).* 2. ❑ I am .a.sole proprietor or have hired the sorb -contractors listed partner- ship and have no employees . on the attached sheet. _ These sub -contractors have working for me in any capacity. [No workers' comp, insnr•ance workers' comp. insurance. 5. ❑ Weare a corporation and its required.] 3. ❑ 1 ain a homeowner doing officers have exercised their all work Myself • [No -workers' comp. right of exemption per MGL c, 152, § 1(4),'and we have no insurance required.] t .employees. [No workers' comp. insurance uired_ Type of Project (required): — 4. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ PIumbing repairs or additions 12.n Roof repairs req ] 13.❑.Other 'Any applicant tiler checks botC a I most also fill out the section below showing their workers' oompensatioe po[tcy mformahon t ontrac wntirs who submit this affidavit indicating they are doing all work and then him oaaide contractors must submit anew affidavit indioatias suer ;Contractors that check this box mustatteolmd an additional sher,show' . Showing the name of the sub -contractors and their workers' corj „ r:..• ! am ar envloyer Phar is m ' r A^..., In tion. information. vng workers comperrsatron crasurance f or nty. employees: Below is the o ' P lCJ' ane' lob sit, Insurance Company Name: ' C TNS Policy # or Self -ins. Lie. Expiration Date: 12— /0 Job Site Address: . . City/State/Zrp. Attach $copy of the worlters' compensation policy declaration page (showing the policy somber and ezpira6oa dale Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal fine up to $1,500,00 and/or one-year imprisonment; as well las civil penalties in the form ofa STOP WORK ORDER 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 pains eaalties o e ' fP dory that the information Provided above la true and coned Si tore: `/ L Date: —?—of 0 PhnnP it- '7 r, O}f ficial use Only. Do not write in this area, to be completed by cii}, or town official City or Town: Permit/I.iccase # Issuing. Authority (circle one): I. Board of Health 2. Building Department 3. City/Town •Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person- Phone #: — ✓/e t�om�rco�uuea� ���aaaciu,�ae%ta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR .,. _ Registrg o -. 108383 – Eg i[at►on 18/2010 Tr# 272473 r � Type SBP KEEN CONSTRUCTIA, r✓L� Kenneth Keen r s I, 21 Hewitt Ave No. Andover, MA 01845 Administrator ���ie lJo�nr�nareurea:� py ✓ac�aueei�s Board of B"wilding Regulatidns and Standards Construction Supervisor License - Liednse: CS 58245 Exiratio�a „3/24/2090 Tr# 17840 KENNETH B KEEM,.- 21 HEWITT AVE N ANDOVER, MA 04$45- Commissioner Nlxss�tchusetts - Departmentof Public Safety Board of Buildin!a Re�,,ulations and Stxndar'ds Construction Supervisor License License: CS 76691 Restricted to: 00 ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2011 <ununi�siuncr Tr#: 1690 KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 Submitted TI,-, PHONE _ DATE C/S = Customer Supplied We hereby and estimates for work to be e oc ­­1­.'­­­'­-._...........�-_ Construction related permits: S + I = Supply + Install � ;J tro-1 0011A A -k � I All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about 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. REGISTRATION NO. EIN NO. MA. H.I.C. 108383 26-0462904 med and materials to be used: _f_.._..-..............__.........__.._............-------- --- See Attached Appendix A WORK SCHEDULE Contracto will,no begin}dhe work or order the materials before the third day following the signing of this Agreement, unless specified here�ir�wfjt`. CQnttractor will begin the work on or about —' `3 (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 L( �� 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 - sand A)t`nj� Payment to be made as follows: % ($ ) upon si ing Contra t� ($)b completion of jj f% Ab ) upon completion of _ in accordance with above specifications, for the sum of / fir 'f'1 7 ly �v .a, .�_ 7dollars ($ KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor / Designated Registrant 21 HEWITT AVE. Street Address N. ANDOVER, MA 01845 City / State MGL c. 142A. PHONE DATE REGISTRATION NO. EIN NO. !)7 - -" i 7 --� Z- � � ��-- ��� �(�� MA. H.I.C. 108383 26-0462904 C/S = Customer Supplied and estimates > Construction related permits: S + I = Supply + Install x work to be performed and materials to be used: 11 5 r 0o tc) 0 r See Attached Appendix A WORK SCHEDULE Contracto will Po beg. a work or order the materials before the third day following the signing of this Agreement, unless specified here in wp jr »Contractor will begin the work on or about r (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by " J (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(I omTple a in%accordance with above specifications, for the sum of : ^� f 't -v I Ut f !'1 C, U SiC,� /1 J At II ("' f 1f t17 �►� �� �y l�1 V'() dollars 2 5 +' (S ) Payment to be made as follows: % ($ ) upon sighting Contra ($ ) t ti pletion of ; %I) upon completion of C shall be made forthwith on u ( p % $ ) completion of work under this contract. 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 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 Equipment, whichever amount is greater. KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor / Designated Registrant 21 HEWITT AVE. Street Address N. ANDOVER, MA 01845 City / State (978) 691-5201 (978) 682-3231 PhojrO�6Jj/ �^— J / Fax Name of ateman Autfforize ignature Note: This proposal maybe 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. 1 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. r� ADO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Datet t ? = f `�_ Signature Date J } IMPORTANT INFORMATION ON BACK l► KEEN CONSTRUCTION CO. 21 HEWIM AVE. N. ANDOVER, MA 01845 978-691-5201 Waldrep, Dave &.Martha 196 Cotuit St. N. Andover, MA 01845 978-686-4895 Contract # 5022; Appendix A Date: 12/30/2009 *Customer will be demolishing entire bathroom to studs, insulating, hanging wallboard, plastering and painting. Remodel 1" floor bath: • Supply & install strapping on ceiling • Remove rotted studs and plates as needed per conversation with customer • Reframe floor joists as needed to accept new shower drains • Supply & install new underlayment • Install customer supplied vanity • Supply & install new trim on door, window and base to match existing • Install customer supplied tile floor (diagonal pattern) • Install customer supplied towel bars, toilet paper holder, etc. Plumbing: • Relocate feeds, drains or vents as needed • Supply & install new neo -angle shower, toilet, vanity top and faucet as selected by customer Electrical: • Remove existing baseboard heat • Supply & install fan/ light/ heat combination in ceiling • Supply & install GFI outlet • Supply & install switching. and thermostat to code • Install customer supplied vanity light and switching Total Price: $12,975.00 (twelve thousand nine hundred seventy five dollars) Price does not include cost of permits, demo, insulation, wallboard, plastering, painting, vanity, tile material, or painting. Page 1 of 2 V KEEN CONSTRUCTION CO. 21 HEWITTT AVE. N. ANDOVER, MA 01845 978-691-5201 Payment schedule: $6000.00 due when plumbing fixtures are delivered $2000.00 due when framing is complete $3000.00 due when rough plumbing & electrical is complete $1975.00 due at completion of contracted work Customer Robert A. Keen t17`3t'o5 Date Date Page 2 of 2