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HomeMy WebLinkAboutBuilding Permit #597-2017 - 21 NORMAN ROAD 12/2/2016 NORT/y BUILDING PERMIT TOWoF,t..Eo ,6'�ti N OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION • � 2 P-0. Permit No#: �� 7 Received t Date Rived !�V � lie CHl1Date Issued: JM�PO'RTANT:Applicant must complete all items on this page , �tj ,R®PERiTY OWNER Priht - 10DkYearStruct a yesK o _ _ __ MAP iPARCEL -_-(--� ZQNING DISTRIC,T ._ HistoribAistnct yes _ Macho; TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial -Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - -_--.- - - - ---- _. __ — _ 0 Septic 0 Well ❑ Floodplain - 0 Wetlands b• WatershediDisct. []WaterfSewer DE CRIPTION OF WORK TO BE PERFORMED: PeIs6 �r ev PMi se- <J Identification- Please Tp or Print Clearly OWNER: Name: A�e fir i L�2 Phone: Address: 2 f �mr-IVla n RC/ I Contractor Name: reef! '011 n/USe:_ 69,9/7 52-OJ Adtlress: _ �� .�C3>C-___Jc3,J ._: /V � ��1C�'�1/`Q✓.�, Supefvisor's�Constructiorn License,.. 5--_ (� .__ .Exp. Date: -7 sZ - - Hometlinprovernent�License:. �.$�3_ 3 Exp: `Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASE11LON$125.00 PER S.F. Total Project Cost: $ 3 7 25 FEE: $ � Check No.: (eo Receipt No,- Z �� NOTE: Persons contracting with unregistered contractors do not have:access to the guWud Signature of Agent/Owhe"( Signature of contractor, Plans Submitted ❑ Plans Waived 01 Certified Plot Plan ❑ Stamped Plans ❑ TyP-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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 1 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 OsgopckStreet FIRE DEPARTMENT - Temp Dumpster on site yes no Located,at 124MainStreet Fire,Department signature/date is COMMENT limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I ELECTRICAL: Movement of Meter location, mast or service drop.requires approval of Electrical Inspector fres No DANGER ZONE LITERATURE: fres No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i i I - ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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/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 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 40TE: 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 No. _> �` ~ Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $moi . TOTAL $ Check# Building Inspector NORTf� own of o - 0 No. 5 — 1 * t - 91 as 1 � oh ver, Mass, LAKI Coc"ICK.wICK ��• U BOARD OF HEALTH Food/Kitchen PERMIT Septic System. THIS CERTIFIES THAT .ZDC.7%1. . . .. .... .................. . BUILDING INSPECTOR has permission to erect .......................... buildings on ... .I..............�PMA.I`Wrl... ..........!k......... Foundation Rough tobe occupied as ........ .... .. ... .... ........ ... .... ...to a �. . ................................................ Chimney provided that the person accepting this permit shall in every 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 CONSTRUCTft STA 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. 7�en Cons€radion Co. KtMC»ELINC; SPEC.11AL,S -S 978-697-520-1 KeenConstructionCo.com Joe Trickett 21 Norman Rd. N. Andover, MA 01845 Contract#6048;Appendix A October 30, 2016 New Door: $2200 • Remove and dispose of existing side door and storm door • Supply& install fiberglass 9-lite door unit(new door,jamb and casing) • Supply& install new Harvey steel storm door to match existing • Supply& install new lockset Stair work: $1375 • Remove and dispose of existing stair treads and v-groove pine on sides • Supply& install new pressure treated wood treads and pine sides to match, including building a new door within the side Patch siding as needed from bird damage:$200 Total Price:$3775 (three thousand seven hundred seventy-five dollars) Price does not include cost of permits, painting or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this quote. Payment Schedule: $1000 due upon signing contract $1000 due when door is installed $1000 due when stairs are repaired $775 due at completion of contracted work Cus9mer Robert A Keen I L I L L2_ Date Date PO Box 935 Page 1 of 1 P: 978-691-5201 N.Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 6048 KEEN CONSTRUCTION CO. PROPOSAL PO BOX.935 NORTH ANDOVER, MA 01845 Tel: (978) 691-5201 All home improvement contractors and subcontractors engagedin 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 to: Joe t�-�I,�-� with the Commonwealth, of Massachusetts. Inquiries about registration and status should be made to the 21 N o<X11 C-k Director, Home Improvement Contract Registration, t 4 (/ 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787 ` '�C� r YI� i I —�I'I ? � 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 / c DATE REGISTRATION NO. EIN NO. Z0 ! /30 /� b MA. H.LC. 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 pnd materials to be used: The contractor and the homeowner hereby mutually agree that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a_private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in assa setts' neral Laws,chapter.142A. -�=2 7- . Homeowner's Signature Contractor's Signature G._.._ NOTICE:The Signatures of the parties above apply only to the agreement of the parties to.alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. - > Construction 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 k.",`- « following completion and shall comply with the requirementsof this Agreement.In the event any defect in workmanship or materials,or damage caus4d by the Contractor,his sub- contractors,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 la or-complete in accordance with above specifications,for the sum of: i G"n . ,c' :✓1 _'y Ci'1 '`r'i LJ7/�C �r 11l�' `_ dollars Payment to be made as follows: - - % ($ )upon signing Contract; - ROBERT A. KEEN' � Name of Contractor/Designated Registrant % ($ )y(P4njcgmp�tion of f PO BOX 935 ( Street Address _ 1 ($ )upon completion of N. ANDOVER, MA 01845 . City/State JJJ oda ($ )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 Name of Sal rice or the total amount of all de a which the contractor must P deposits or menti P payments make,in advance,to order and/or otherwise obtain delivery of special order Authorized Signature materials and 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 outline 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 CONTRACT IF THERE ARE ANY BLANK SPACES. Signature z: •.Q.:-�"� ~=��� Date Signature Date IMPORTANT INFORMATION ON BACK► :t 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): J,0e(,J C ��5 1 YuL� (cam C'v Address: 'UCS X 5 City/State/Zip: rA �l�one Are you an employer? Check the appropriate box: Type of project(required): 1.� I am a employer with 2. 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [?Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' insurance. 9. ❑ Building addition comp.[No workers' comp. insurance p• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. officers have exercised their I am a homeowner doing all work 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 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. 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: u-p— L r 5 17 Policy#or Self-ins.Lic. #: U i� 99911 M 1, Expiration Date: r J Job Site Address: 21 I V ti 1n C, City/State/Zip: 0\L'I cver 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. Ido hereby certify urs er hep i s and enalties of perjury that the information provided above is true and correct. r Sipjnature: Date: Phone#: / D J lJ /q 1 -2—o I 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#: DATE(MMIDD/YYYY) A�Rte® CERTIFICATE OF LIABILITY INSURANCE 10/17/2016 THIS CERTIFICATE 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,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER -NAME:CONTABarbara McDonough GILBERT INSURANCE AGENCY INC. P"O"E (761)942-2225 (A/C No: ADDRESS: bmcdonough@gilbertinsurance.com 137 MAIN ST. INSURER(S)AFFORDING COVERAGE NAIC# READING MA 01867 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: KEEN CONSTRUCTION CO INSURER C: INSURER D: PO BOX 935 INSURER E: NORTH ANDOVER MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 94268 REVISION NUMBER: THIS IS 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR DD/Y POLICY NUMBER MM/ YYY MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE FIOCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY❑JET F LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY URY AUTOS AUTOS (Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident 1 f 1 $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIEfOR/PARTNER/EXECUTiVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? N/A WA NIA 6HUB9991M58216 10/08/2016 10/08/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M.Crq y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public.Safety Board of Building Regulations and Standards License: CS-076691 Tl:% AN ROBERT A KEEN4' 12 E WATER ST IMP North Andover 0 r W Expiration Commissioner 08/16/2047 ,.,... Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR ! e: Supplement Card -xittration Expiration 08/17/2018 Keen Construi Robert Keenra wr' 1175 Tumpike No.Andover,MA` 1 SAH Undersecretary