Loading...
HomeMy WebLinkAboutBuilding Permit #262-12 - 20 FULLER MEADOW ROAD 9/27/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 4�j Date Received Date Issued: EMORTANT:Applicant must complete all items on this page LOCATION o �y l �- I I 1(z- 0 JCDw Print PROPERTY OWNER C'h 2 i S �+ a`1R/L • E �oo q ,N S Print MAP NO 10 PARCEL-_/a ZONING DISTRICT: Historic District yes o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other . w 11�'" .t i© ; '�l Watershe'clkDstrict g t(jFiloo'dplainhWetlandsl �, � C�Septic =[7k � 1 �P t..._'D�Water/Sewer; :--� -;_--_- -- --•S=- -�----_--�•---' -_ .:_. _.- -�--- ..: ..___---- -..�w��.:�...`.�._,,3._..::.' i�.��"r__�.:----�M. � DESCRIPTION OF WORK TO BE PERFORMED: (Z L fJ Identifiicati n Please Type or Print Clearly) OWNER: Name: A ap.i E Dcq - S Phone: Address: �4 0 ru << S� l�wd�o"✓ R-d ?7 CONTRACTOR Name: x :j- tj C'6 ^l ST- Phone: a b Address: 9t 4 f W i v e . lR ` Supervisor's Construction License: c51 2 4 S Exp. Date: 3 - 17, Home Improvement License: a 4 25 % > Exp. Date: C4 –12 ARCHIT'c�E"�r =R Pl one: Ad ess: �— R-e�. No• FEE SCHEDULE:BULDIN G PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125 00 PER S.F. Total Project Cost: $ 1 z Is '60 6b FEE: $ X74 Check No.: Receipt No.: SL NOTE: Persons contrac ng with unregistered contractors do not have access to the guar my fund - ature of contracfoU s.� Location0 A oe,4010,w /e'll, No. � Date —rvo— "S.0 TOWN OF NORTH ANDOVER 3 °c � w M 41 Certificate of Occupancy $ s�CMUs<� Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24661 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ E WERAGE DISPOSAL ❑ Tanning/Massage/Body Art ❑ Swimming Pools❑ Tobacco Sales ❑ Food Packaging/Sales ❑c 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 I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. IIS 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.$10041000 fine NOTES and DATA— For department use ® 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 Q . 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit a all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals tat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording Lust be submitted with the building application Doe: Doc.Building permit Revised 2008mi �yORTH Town of And O1- r • �FV�``:`r• 0 No. �y o , '� dower, Mass.., /fesCOCHICHEWICK s RATED F' �Cl 7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • • BUILDING INSPECTOR THIS CERTIFIES THAT.................''. .t....Si........... Foundation ALL 11L has permission to erect........................................ buildings on*1 ...... .. `1.... ... ., Rough to be occupied as.................... �.. .. Chimney provided that the person accepting this permit shail ri every respect conform to the terms 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 CONSTRUC STS Rough ....................... ..... ............. Service 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 FIREE_DEPARTMENT Until Inspected and Approved by the Building Inspector. Burnet Street No. SEE REVERSE SIDE Smoke Det. Massachusetts - Department of Puhlic Safeth Board of Building Regulations and Standards Construction Supervisor License License: CS 76691 ROBERT A KEEN IT,12 E WATER STN ANDOVER, MA 01845 Expiration: 8/16/2013 ( ununissiuncr Tr#: 3772 A-- 'VI assachusetts- Dcf►artmcnt of Public SafetN Board of Building Regulations and Standards 1 Construction Supervisor License License: CS 58245 Restricted to: 00 KENNETH B KEEN 21 HEWITT AVE ., , N ANDOVER, MA 01845 Expiration: 3/24/2012 ( „iaimism,off cI i r#. 20523 Office of'co> mer �rs t iness egu a o -- HOME IMPROVEMENT CONTRACTOR I . Registration: 0108383 Type:. Expiration: $IY012 DBA K CONSTRUTOft ,•, Kenneth Keen 21 Hewitt Ave � E- y --+ w' No.Andover,MA 01$4 •r` Undersecretary i 'Tim slo�_ �v Quote 11MERKITCHEN DESIGNS Billing Fax:978- 7-5841 Transaction 66 1093 Osgood Street, North Andover,MA 01845 378123 Phone: (978)685-7770 Price Date Pcd Fax: (978)685-7771 8/8/11 A/0 Location LAWRENCE MAIL TO: Jackson Lumber&Millwork Co. Inc. Sales Representative PO Box 449, Lawrence,MA 01842 LUCY ROSS . . CHRIS GOOGINS SAME *CASH ACCOUNT *CASH ACCOUNT* 20 FULLER MEADOW ROAD 20 FULLER MEADOW ROAD (978)689-8360 NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 OrderCustomer# Date Oper Purchase Order Terms Ship Via 35980 378123 08/08/2011 169 F CASH DELIVERY LN# Item Number Ordered Description Um Price/Unit Extension 1 SOSCHROCK 1 HENRICKSON DOOR STYLE EA 11,000.00 11000.00 PARTIAL RAISED PANEL SQUARE MAPLE ALABASTER WITH BARN WOOD PER PLAN 2 SOGRANITE 1 PROMO COLOR/BUTTERFLY EA 3,850.00 3850.00 PER PLAN WITH 3/8"RADIUS EDGE 3 SOTOPKNOB 20 M1226KNOB(20)TOTOAL EA 5.67 113.40 4 SOTOPKNOB 21 M1205 PULLS(21)TOTAL EA 7.74 162.54 *, �- Special order and manufactured merchandise is non-returnable.Customer agrees that any amount not paid within 30 days of •invoice date will carry interest at the rate of 1.5% per month . and further agrees to pay all costs incurred in collection, Due: �— 16,071.31 including reasonable attorneys fees. Page 1 of 1 8/8/2011 12:02:02PM KEEN CONST tRUMON CO. 21 f(EW1r7AVE. N. ANDOVER, MA 01845 978-691-5201 Keen constru'di'OnCo-com Googins, Carrie&Chris 20 Fuller Meadow Rd. N. Andover, MA 01845 978-689-8360 Contract#5031;Appendix A late:9/7/2011 Remodel Kitchen: • Update electrical to code as needed and install nine recessed lights($3000.00 allowance) • Update plumbing as needed ($1500.00 allowance) • Reconfigure framing at pantry and refrigerator(as per drawings)and fire block as needed(including studs shoes and reinforcing straps as needed)and nail subfloor • Insulate exterior wall to code • Supply&install wallboard on walls and ceiling and plaster to smooth finish • Supply& install trim on windows and doors to match existing • Install customer supplied cabinets and trim • Paint walls and trim (2 coat finish,2 neutral colors)and ceiling(ceiling white)($2000.00 allowance) • Install customer supplied appliances Price does not include cost of permits,cabinets, counters,appliances,flooring,demo, debris removal, changes required by inspectors or problems found when room is demoed. Total Price:$16,500.00(sixteen thousand five hundred dollars) Page,1 of KEEN CONsMUMON CO. 21 ftEWITT AVE. N. ANDOVER, lit 01845 978-691-5201 Kee 11COnStrU4CrLO tC&COnV Payment schedule: $1000.00 due upon signing contract/' $3000.00 due the first day of work(plus permit fees) $2000.00 due when rough electrical is complete $2000.00 due when rough plumbing is complete $3000.00 due when wall board is installed $3000.00 due when cabinets and trim are installed $2500.00 due at completion of contracted work r stomer �__.. r�l Ken4th B Keen Date Date PaV,e,2 of 2 r r 8/22/2011 1:36 PM FROM: Gilbert Gilbert Insurance Agency, Inc. TO: +1 (978) 682-3231 PAGE: 001 OF 002 A DM. CERTIFICATE OF LIABILITY INSURANCE o5/zi2011 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 INSURERS: 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,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED'BYTHE 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 ADD TYPE OF INSURANCE POLICY NUMBER POALICY EFFECTIVE POLICY.EXPIRATIONTE IMMIDONYI DATE LTR LIMITS NYI GENERAL LIABILITY ND-P-010078/000 03/13/2011 03/13/2012 EACH OCCURRENCE $ 1,000,00( X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,00( CLAIMS MADE Fq Oram MED EXP(Any ona person) $ 100,00( A PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN' L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,006,00 M X POLICY P�RCOT LOC AUTOMOBILE UABILITY 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-FA ACCIDENT j ANY AUTO EAACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR a CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND Yk009646942 08/03/2011, 08/03/2012 WcsTATLI OTH- EMPLOYERIETORjILrrY FIR B ANY PROPRItZORlPARTNERlD(ECUTIVE WIC CERT TO BE MAILED E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBERDLCLUDED7 DI ECTLY VIA INS CARRIER E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - Evidence 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 wRTTTEN 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 OR REPRESENTATIVES. Evidence Of Coverage [AUTHORIZED REPRESENTATIVE ark Gilbert CIC ACORD 25(2001108) OACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents 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 Name(Business/Organization/Individual): k O» N S�(Z uCi t a A� 06 , Address:__9 i H EW ,' Tr U�' p! City/State/Zip: N J p cJ �w /Y1!} g Phone#: 1� 7$ &q Are you an employer?Check the appropriate box: Type of project(required): 1.CE- I am a employer with 1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hued the sub-contractors �� 2.El am a sole proprietor or partner- listed on the attached sheet. $ 7. j R/emodeling 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.❑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. �o workers' comp.insurance required.] 13.❑Other *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 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:_(S rZO N't f i Policy#or Self-ins.Lic.#: UJ C O,D)q 6 q 6 9 ga Expiration Date: g ^3 Job Site Address:_y �J �C /���z 0416 La City/State/Zip:_ 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 Signature: C Date: Phone#: g 7 O 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#: OU31 I KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE PROPOSAL 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 i I Chapter 142A of the general laws,must be registered with Submitted the Commonwealth of Massachusetts.(� sa usetts. Inquiries about To: �—�:.__l..L}_f....,i...�........._..._._.6.0`C? .sn� - registration and status should be made to the Director, t Home Improvement Contract Registration,One Ashburton ._.._.0 ' �.._ ..1... 3��C) �(.h- �_._._ _._.. Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related j 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 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: 1 ____ __.,._---- .. _._._.._._.._._ ......_ ._.._�_. ___ _ ........ . . i ............. _ ....a...._._............................_ ...._............_......_._.._........._......._.._. ! ............ ............... _.--.---_____. _..___. . -.__� _ ___.__..__..........................._ __......... ._... ........__-__ ______....... .... .. ..... . .—.--.--._-. ___ _. ___.____.__...-----_....._ ._.................. .....................................__............... __... - ---- -__.._ .._....-_-_............. .......... _.........._ --___.. _._____.._............. ---__-__- _.__ __.__.__ _ ............... ___..__._ ................... ........... ................ ---------- ............ ! ------------- ........... ................ ! ------.._......._..__ _ _.....-... - ....-._. ---- _ > Construction related permits: -` ___..._......._...........................—E................._. ........................,,............,..............,..................................,...............................................................................................................,.................................................... WORK SCHEDULE ..... .................. .......................... _..................................................._.,_..,_._ ! I 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 i The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of I &4g2C —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, j 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 PYO ose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of ---dollars Payment to be made as follows: ($ ) upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor/Designated Registrant j ($ ) u o OTMII°tiof 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 or Splespn �- 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 Autnoriz da=- equipment,whichever amount is rester. % i g NoleeThis 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 ttais transaction at any time prior to midnight of the third business day after the date of i this transaction. Cancellation'must be done in writing. / DO OJT 10 THIS CONTRACT IF THERE ARE ANY BLANK SPACES. r IV 1i SignatuFe + % �r Date Signature Date IMPORTANT INFORMATION ON BACK.► e-..4J�-;u:»wN�1,..F'-m. .�.,."t4'^ '�� yine.�. '""�.n.�wi,wk+..�u'S�S�r:�re3,i w.a�•.,n +4 e. �.,. :S'. ;s:k:w.�.:�'Sua.wdC}ii�t'�,.£�'c;..: