HomeMy WebLinkAboutBuilding Permit #531-2016 - 230 ANDOVER STREET 10/29/2015w cSCJ13/L''w� D ll - y- /S
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: �� Date Received
Date Issued:
v'ttLeo ib�•ND
32 h�::� • a 0�
o p
IMPORTANT: Applicant must complete all items on this page
4
LOCATION 3d /t ✓I d e g_r 5 fi
Print - _ -
t PROPERTY OWNER bc,,te—
Print 100 Year Structure yes no
MAP 7 PARCEL: Z`"� ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
r
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 ❑ Wetlands
❑ Watershed'District
El Water/Sewer _
DESCRIPTION
—2 D 1 G G e -F;z t+ W' ✓t
I i 'k e -5 T -2-r-
Identification - Ple
OWNER: Name: Uo.VtS �P
Address: 2-36
Contractor `N
WORK TO BE PERFORMED:
� , Lor -t bed w da"l LA.
Type or Print Clearly
;re Phone:
Aoer-, MA o/F�f-5
Supervisor's Construction License: 5 - U 7 �� Exp. Date: /(G 7
Home Improvement License: Exp. Date: gni . Ll
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: $ 'ZG 99 FEE: $
Check No.: A 4/ Receipt
NOTE: Persons contracting with unregistered contractors do not have access to ua my
ignature of Agent/Owner Signature of contractor
c2 Oe -,4 dolve, J4,u�
Location
No. 53 / 2a /�
Check #
Date A 2 9
TOWN OF NORTH ANDOVER
ertificate of Occupancy $ 11
uilding/Frame Permit Fee
oundation Permit Fee $
Ither Permit Fee $�
OTAL $
t
J
Building Inspector
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 0
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
HEALTH
COMMENTS
r.
Reviewed On
Signature
Reviewed on Signature
Reviewed on Signature
u
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located
FIR�iDEP'ARTMENT Ternp'Dumpster onsite yes -� 4 _ ln.Q,
_ 384 Osgood Street
L_ ocated,at' 124?"Main .Street _ — -
F:re Department signature/date :_
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
NU I t5 and UAl A — (For department use
❑ Notified for pickup Call Emai
I Date 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.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
o Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ 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
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
a 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
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
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55`,,
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 with the. Commonwealth of Massachusetts. Inquiries
To: V�C AN[l about registration and status should be made to the
!� Director, Home Improvement Contract Registration, 10
Park 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. EIIT N.
MA. H.I.C. 108383 1 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:
- �`� I tU
4�wcVf x A
> Construction related permits:
_-...--- ............. _..._._....._.._._._._.._........... _..
WORK SCHEDU
Co tract r w n t b gi a work or order the materials before the third day following the signing of this Agreement, unless specified here i w i�n C ryr for 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
acknowledg s 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 Nt? 1- 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,
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 ProposeI'�h-erreby to fumish material and labor - complete in accordance with bove specifications, for the sum of :/ <� (�
Y�<)r)� 1✓11� ��( �1 � \ V �c ( I t`Q. dollars ($ D 1. ! 9 , U 0 ):
Payment to be made as follows: —�
% ($ ) upon sign' Contract; ROBERT A. KEEN
Name of Contractor / Designated Registrant
($ )upon co p1 ti(�rlf 1175 TURNPIKE ST.
4 / ` Street Address
)� completion of N. ANDOVER, MA 01845
Zcity / Slate
�o ($ ) s all be made forthwith upon (978) 6 52 1 (978) 682-3231
completion of work under this contract. ,none 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 of salesma
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 sgnalure
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.
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.
D6 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
r' /
Signal',, - �� Date /G
Date
IMPORTANT INFORMATION ON BACK ►
Construction; CN,
NEM(�l)EI_IPtG SPECIALISTS
975-69'1-520'1
KeenConstructionCo.com
QUOTE
Spitalere, Dave & Sofia
230 Andover St.
N. Andover, MA 01845
Contract #5558; Appendix A
Replace front door: $3665
October 1, 2015
• Remove and dispose of front door and storm door
• Supply & install Masonite BLS -215-06E-2 fiberglass door (two panel door with six lite glass) and
two BLS -152-010-X sidelites
• Supply & install new lock and dead bolt
• Supply & install new Andersen storm door
Bedroom window: $2351
• Remove and dispose of existing window
• Supply & install same size Harvey Classic vinyl window (two -wide double hung)
• Supply & install trim to match
New front window: $988
• Remove and dispose of existing center dead -lite window on front of living room
• Supply & install Harvey dead -lite window
• Supply & install new exterior trim if needed
Install new gutters and downspouts: $1695
Total Price: $8699 (eight thousand six hundred ninety nine dollars)
Prices do not include cost of permits, painting or repairs of any unsafe, unusual or non -code compliant
existing conditions not addressed in this quote.
Payment Schedule: $2500 due upon signing contract
$2000 due when gutters are installed
$2500 due when door is installed
$1699 due at completion of contracted k
Customer Date Robert A Keen Date
1175 Turnpike St. Page 1 of 1 P: 978-691-5201
N. Andover, MA 01845 F: 978-682-3231
CSL #076691 Sales@KeenConstructionCo.com HIC #108383
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 d I Congress Street, Suite 100
Boston, MA 02114-2017
•� www.mass.gov/dia
SJ•v Workers' Compensation Insurance Affidavit: Builders/Contractors/E lectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Name (Business/Organization/Individual):
Address:
City/State/Zip:
k) , lq n dr
Are you an employer? Check the appropriate box:
i—M
7'
#: 9?z Cir 94 — 57w
1.W I am a employer with Z employees (full and/or part-time).*
2. ❑ I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3. Q I am a homeowner doing a]l work myself. [No workers' comp. insurance required.] t
4.1 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
proprietors with no employees.
5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.:
6:❑ 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.]
Type of project (required):
7. ❑ New construction
8. Remodeling
9. Demolition
10 ❑ Building addition
l 1.0 Electrical repairs or additions
12. Plumbing repairs or additions
13.0 Roof repairs
14. ❑ Other
*Any applicant that checks box 41 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 workerscompensation insurance for my employees. Below is the policy and job site
information. —�—• •
Insurance Company Name: I �'� �' f �s / 0-5 —
Policy # or Self -ins. Lic. #:6/4L) 3 -- 99 91 M 5S J 2- — � 'Expiration Date: 'Z7Job Site Address: 2-30 1 r City/State/Zip: ] Z �� �' 1 / q5
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
coveraae verification.
I do hereby certify under the pas and
Phone #:
9.77- L,,41- 'F5 7-0
of perjury that the information provided above is true and correct
1012- 9�
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): i
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
,acoRU® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDIYYYY)
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
CONT nc Barbara McDonough
Gilbert Insurance Agency, Inc.
PHONE (781) 942-2225 F 0,.. (781)942-2226
WC, No.
ADDIRES;bmcdonough@gilbertinsurance.com
137 Main Street
INSURER(S) AFFORDING COVERAGE NAICN
M Gilbert, CIC/BARBAR
Reading MA 01867-3922
INSURERA Norfolk 6 Dedham Insurance 23965
INSURED
!NSURERB:Safety Insurance Company 39454
INSURER CTravelers Ina. Co. 0031
Keen Construction Company
483 Chickering Road
INSURERD:
INSURER E:
North Andover MA 01845
INSURER F:
VV1EMAVG.7 U= wIWit.-A IF NIIMKPWR L1hY"l1[I71"I"I9 DC\NCIl,ar art IaaOCo.
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
LTR
TYPE OF INSURANCEADIX
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover
POLICY NUMBER
POLICY EFF
POLICY EXP
D
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OOCUR
M Gilbert, CIC/BARBAR
EACH OCCURRENCE $ 1,000,000
PREMISES Ea occurrence $ 100,000
MED EXP AnyonePerson) $ 5,000
YID -P-010078/000 -
3/13/2015
3/13/2016
PERSONAL d ADV INJURY $ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
X POLICY ❑ TECT M LOC
GENERAL AGGREGATE $ 2,000,000
PRODUCTS -CCMP/OP AGG $ 2,000,000
$
OTHER:
I
I
AUTOMOBILE LIABIUTYa
e8L D SING I $ 1,000,000
BODILY INJURY (Per person) $
B
ANY AUTO
ALL OWNED X SCHEDULED
AUTOS AUTOS
6228807 CCM 01
5 2015
23
/ /
5/23/2016
BODILY INJURY (Paraxloenq $
1t HIRED AUTOS X NON -OWNED
AUTOS
PROPERTY DAMAGE
er$
Underinsured motodst $ 100,000
UMBRELLA LU18
OOCUR
EACH OCCURRENCE $
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
DED I I RETENTION
$
WORKERS COMPENSATION
C
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED7 ❑
(Mandatory In NH)
8 yes, describe under
N I A
6HUB-9991M58-2-15
10/8/2015
10/8/2016
E.L. EACH ACCIDENT $ 100.000
E.L. DISEASE -EA EMPLOYEE $ 100,000
E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORO 101, AdditbrW Remarks Schedule, my be attached I more space le required)
(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.
AUTHORED REPRESENTATNE
M Gilbert, CIC/BARBAR
W 1955-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 also,)
Massachusetts ' Department oyPublic Safety
Board of Building Regulations and Standards
onstm��8u�nimr
License: CS -076691
10.1,
ANIC-S-TTS
12 E WATER ST
North Andover Na 0
"
Expiration
Commissioner
08/16/2017 '
Office of Consumer Affairs & Business Regulation
ME IMPROVEMENT CONTRACTOR
Konnem noa �
1175TURNP|KEST '
NO. ANDOVER, MA[n
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nuo,m,retar,