Loading...
HomeMy WebLinkAboutBuilding Permit #578-2016 - 23 MIDDLESEX STREET 11/10/2015 BUILDING PERMIT of "ORT" qti 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: '?0�� Date Received _ 'Tf,9 A°a�reo�ea,�49 SSACHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWN11-k- {r ,�-� _I r7 S byMl 17e - wPrint 100 Y _ r Structure yes o MAP `(3 PARCEL: _ 2r ZONING DISTRICT: Historic District yes Machine Shop Village, yes o 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 ❑Septic ❑Well ❑ Floodplain El Wetlands ❑ Watershed District El Water/Sewer rr _ n _ d�� 2 d .DESCRIPTION OF WORK TO BEI PERFORMED: // I'`,th 0 , /'7�/'00 � , tfY T 2 ty a be- f n c !0 5t,,L Identification- Please Type or Print Clearly OWNER: Name: c - ,e00e u Phone: dd( sxAddress: Contractor Name: l eo CV75�ru= {rc-A ed _Phone: 9_�F-691-5zo Email: :5c, Address: o Supervisor's Construction License: G S_" _0 ?&_(a .9_t Exp. Date; O 1 i 7 Home Improvement:License /-_d 3 _'� Exp. Date. yb Srl,_l - - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2 3 , 2? Z e X70 FEE: $ AV- Check No.: &(Z Receipt No.: CO 9as� NOTE: Persons contracting with unregistered contractors do not have access tot u 'end of Agent/Owner __ __ _ Signature of contractor_ 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application Li Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products VOTE: 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 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_ 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 r Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: ilFIRE iDEPARrTME;NT Tern Durn �ter�on�sit Lyes T ono Located Osgood Street ps e, _ rLocated�at 124�Mam�St�eet - `� ' �' Fire Departtion" isjgnatureldate. c COMMENa 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) ❑ Notified for pickup Call Email Date Time Contact Name i Doc.Building Permit Revised 2014 Location No. ���7 Date w: TOWN OF NORTH ANDOVER Certificate of Occupancy $ was' Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ �` TOTAL $ Check#/b�w I 296.53 Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 23,272.00 m $ - $ 279.26 Plumbing Fee $ 34.91 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 34.91 Total fees collected $ 449.08 23 Middlesex Road 578-2016 on 11/18/2015 Second Floor Bathroom A. .. .c ve. No. - 2 IZ ,� oh ver, Mass, " CHICHI-ICK s LU) BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System /'�:5� , �Gl��ENF- BUILDING INSPECTOR THIS CERTIFIES THAT ................./... . .............G.......................:76w"�' Foundation has permission to erect buildings on �3 ��.. . .FS.FY......:5�................. .......................... ... •Qor ... ....... Rough to be occupied as ............ .�X.. .... ..�Y.. ........(..........T�..7' ,.'l.............................................. 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 CONSTRUCTION T RTS Rough 'A� Service ............... ... .. . ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. 5 5 6 KEEN CONSTRUCTION CO. ° 1175 TURNPIKE STREET PROPOSAL POSA L 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 Submittedtll } �e�f� with the Commonwealth of Massachusetts. Inquiries To: 1 i 'j t 1 e`� about registration and status should be made to the S Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston,.MA 02116 617-973- l 8787 Owners who secure their own construction �i related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATE REGISTRATION NO. EIN N0. MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install I !See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: X > Construction related permits: ..._.... _......-.-. __. ....__......._...._......._._..�_._.................... ..... ........ ...._............................._..........................................................................:......................................_.._._.._............._......_................_..................__................................__........ WORKK SCH.___._.._...._._.__._ ED LE Contrac or wl t the work or order the materials before the third day following the signing of this Agreement,unless specified here i w 1 o ctor 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 acknowled s and agrees that the scheduling dales are approximate and that such delays That are not avoidable by the Contractor shall n t be consi ered as violations of this Agreement. WARRANTY p F 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, is 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 -I rep � \U0 ---- dollars($ Z�)r�7Z1UC� Payment to be made aA follows: % ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant ($ on,Of 1175 TURNPIKE ST. { Street Address ) VIn-complefion of N. ANDOVER,MA 01845 _ 1` City/Stale ($ ) shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. PhFax Notice: No agreement for home improvement contracting work shall require a on,, >down payment(advance deposit)of more than one-third of the total contract price Name nt s es an 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 Authorized an 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 CONTRACT IF THERE ARE ANY BLANK SPACES. {/ Signature 's"-- 1 , ✓'! /S 9 l '�'� Dale !'� Signature Date IMPORTANT INFORMATION ON BACK ► 7 r;,Cans�ruc�iarr Co;. REMVOEI_I►iC: SPEC:ILaLISTS KeenConstructionCo.com McSweeney,Trish& Mike Middlesex St. N.Andover, MA 01845 Contract#5564;Appendix A October 30, 2015 Master closet:$5,900 • Remove and dispose of wall in back of existing closet and existing door • Frame walls to create approx.8'x 10' closet,frame doorway for standard door • Insulate to code • Supply&install blueboard and skimcoat plaster to smooth finish • Supply& install door,trim and shelving • Paint walls,ceiling and trim • Supply& install one ceiling light fixture • Supply&install carpet($30/sq.yd. allowance) Main Bath:$17,372 • Remove and dispose of all tile,wallboard,fixtures and ceiling in main bath • Update electrical as needed, installing new vent($1500 total electrical allowance) • Supply& install new plumbing fixtures as per quote S016884357 from Peabody Supply (Plumbing allowance$3500) • Frame linen closet • Supply& install blueboard and skimcoat plaster to smooth finish • Supply& install underlayment, closet door and trim • Supply& install the on floor as selected in Peabody quote • Paint walls,ceiling and trim Prices do not include cost of permits,or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this quote. Total Price: 23,272 (twenty three thousand two hundred seventy two dollars) PO Box 935 Page 1 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 �onruefion,Ca;, ttrsnooet_tnc: srt:ctn�ts-rs 978-697-520'1 KeenConstructionCo.com Payment Schedule:$4000 due upon signing contract $4000 due the first day of work $4000 due when framing is complete $4000 due when plaster is complete $4000 due when the is installed $3272 due at completion of contracted work Cusltomer (_.... Robert Keen 115 lO/ 5f Date Date PO Box 935 Page 2 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 ik.- v CERTIFICATE OF LIABILITY INSURANCE FDATE 23/2015 �� 10/23/2015 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(les)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 A TAC Barbara McDonough D ME Gilbert Insurance.Agency, Inc. PHONE . (781)942-2225 PAX No:(781)942-2226 137 Main Street ADDRESS:bmcdonough@gilbertinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERA Norfolk 6 Dedham Insurance 23965 INSURED INSURERS:Safety Insurance Company 39454 Keen Construction Company INSURER Travelers Ins. Co. 0031 483 Chickering Road INSURERD: INSURER E: North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER-.CL1552101779 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER M M D LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR PREMISES(Ea occurrence) $ 100,000 DAMAGE TO REN IID-P-010078/000 3/13/2015 3/13/2016 MED EXP(Any onePawn) $ 5,000 PERSONAL d ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PO- JET r-1 LOC PRODUCTS-CCMP/OP AOG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGL OMIT(Ea $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 6228807 COM O1 5/23/2015 5/23/2016 BODILY INJURY(Per $ AUTOS AUTOS (� ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS t Underinsured motorist $ 100,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN OR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 C OFFICER(MEMBER EXCLUDED? N I A (Mandatory in NH) 68UB-9991M58-2-15 10/8/2015 10/8/2016 E.L.DISEASE-FA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 -F DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR ©1988-2014ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS02512o14011 - The Commonwealth of Massachusetts Department of IndustrialAccidents a a. I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information .Please Print. Le ibl Name(Business/Organization/Individual): LIgeV1 cy/ C� Address: 1 City/State/Zip: I��1 �C)��e�'r I G one#: �3— (r_1 Are you an employer?Check the appropriate box: Type of project(required): 1.&1 I am a employer with 2-- employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.F]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.0 Other, 6Q We are a corporation and its officers,have exercised their right of'exemption per MGL c. 152,§1(4),and we have no employees.[No workers'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, provide their workers'comp.policy number. pto yees theY must P Y I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: cc,ve-Je f 5 In-5 Policy#or Self-ins.Lic. 14L) i3 99 91 M5SExpiration Date: Over. t 01016, JobSiteAddress: IeS2 /` J 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance II overage verification. do hereby certi u der top sand penalties of perjury that the information provided abov is tr a and correct Date: Il 15 i ature: q Phone# ;7 7 /�� 52-0 j 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#: Massachusetts -Department of Public Safety Board of Building Regui'ations and Standards �.II11�L1 Illtlllll Jll 11C1 V1\111 License: CS-076691 ROBERT A KEE11�-` 12 E WATER ST North Andover WA 0 81 Expiration Commissioner 08/16/2017 _.._._.. -��e�paminaoruuea,�o�Ci�activaeC� Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Wxegistration: 108383 Type: piration: 8/1$12Q16 DBA s"% ` t KEEN CONSTRUCTIONCOr r' Kenneth Keens 1175 TURNPIKE ST NO.ANDOVER,MA 01845` Undersecretary