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Home My WebLink AboutBuilding Permit #373 - 25 HERRICK ROAD 12/2/2008 BUILDING PERMITo� "°RT" q `tt�ec 16* TOWN OF NORTH ANDOVER `" ' APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received " 11 9SSACHUS�t Date Issue — IMPORTANT:Applicant must complete all items on this page LOCATION 9 S7 14O R fti c � Qct A Pri tS � PROPERTY OWNER- tA tJ •e' d -! A2 Z Print MAP NO.: 6_PARCEL:ppb°►'ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building c Gne family Addition Two or more family Industrial Alteration No. of units: Commercial vl�epair, replacement Assessory.Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District ater/Sewer DESCRIPTION OF WOr C TO BE PREFORMED: E ,.� Identification Please Type or Tyint Clearly) II OWNER: Name: 0 R z!v FT Phone. - W -VgSoZ Address: a SIVE R 4;c fL 12& CONTRACTOR Name: X-4 1i 0&,V S7/2 0 c i i D AJ Phone:q!b ' Address: Al ��i 17 fie- ,9)1 ., Supervisor's Construction License: d? A VS Exp. Date: �! Home Improvement License: _ 1 D Exp. Date: /U ARCHITECT/ENGINEER Phone: Address: Reg. No. 4 FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $L$ !a,,13 D• 6 a FEE: 1 Check No.: r—,q ( )o Receipt No.: oZ� - NOTE: Persons contracting with unregistered contractors do not have access to the gifarantyfund i ignature of Agent/Owner Signature of contract Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerSwimming Pools Tanning/MassageBody Art 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH. �, Reviewed•on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: - Zoning Decision/receipt submitted yes Planning Board Decision: . - Comments y Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osciood Street FIRE DEPARTMENT - Temp Dumpster on site yes no _ Located at 124 Main Street Fire Department signature/date COMMENTS y 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 - Date Doc.Building Permit Revised 2008 A Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. II 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 t 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) t ❑ 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 f Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 11 Revised 2.2008 Location �r 11 ��e No. Date MO�,M TOWN OF NORTH ANDOVER O � � s + • , Certificate of Occupancy $ �r ti'�n• Building/Frame Permit Fee $ Foundation Permit Fee $ ► Other Permit Fee $ TOTAL $ Check #t �d 2179 - Building Inspector j i NORTH Town of Andover •c`► „ No. 72 LAKEo lover, Mass., • � COC HIC NE WICK \ V R'q T E AD P�D O' 10 M_ '9S ti� BOARD OF HEALTH h, Food/BOARD F�' . Septic System i BUILDING INSPECTOR THIS CERTIFIES THAT.................. . .............. 2` :(..v. .'..�F ..........._.............................................................. i Foundation has permission to erect........................................ buildings on ... ....... . .. .16.X...... ........................... Rough to be occupied as..............49*0 444400.m`^.....�.... Chimney ......................................................................................... provided that the person accepting this permit shall'in 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 EV1 ES IN. 6 MONTHS ELECTRICAL INSPECTOR' V.i, LESS CONSTR STNS Rough ............ . ..................................................::........................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises -- Do Not Remove RoughFinal No Lathing or Dry !ball To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE S Smoke Det. 44 x at � , 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):--I<,,2 g N O ",7 ' A_V OU''' Address: of ! E L1,-i TF V E .City/State/Zip: fitJ 4 D d Sw D A 4S- Phone #: 9-71 � �j of ( -7j�o t Are you an employer? Check the appropriate box: Type of project(required): 1.[K��am a employer with / 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 8. ❑ Demolition working for me in any capacity, employees and have workers' insurance.t 9. E] Building addition comp.[No workers' comp, insurance . P• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 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.�ther 122, /2S 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. lContractors 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: /2 r) V'1 i r Policy#or Self-ins.Lic.#: W C 7 V.311-177 Expiration Date: 56' A g, Job Site Address: 02.� r 22 C ItG� City/State/Zip:7V. R/V AQ t9 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 certify under the pains e alties ofperjury that the information provided above is true and correct. Signature: V1 c4m Date: 'Q Phone#: 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#: 8/11/2008 12:18 PM FROM: Gilbert Insurance Aq Gilbert Insurance Aq TO: +1 (978) 682-3231 PAGE: 002 OF 003 AD�. CERTIFICATE OF LIABILITY INSURANCE 08/iizo 8 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 B. Keen RJSURERA: NORFOLK & DEDHAM INSURANCE 23965 DBA: Keen Construction Company RJSURERB: Granite State Ins. Co. 0077 21 Hewitt Ave. INSURER C: North Andover, MA 01845 INSURER D: 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. INSR ID TYPE OF INSURANCE POLICY NUMBER POLICYEFfECTNE POLICY EXPIRATIONDATE(MMIDDNY) LIMITS GENERAL LIABILITY ND-P-010078/000 03/13/2008 03/13/2009 EACH OCCURRENCE $ 1,000,0001 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,00 CLAIMS MADE XI OCCUR MED EXP(Any one person) $ 5100 A PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 ' GEN'LAGGREGATELIMIT APPLIESPER* PRODUCTS-COMP/OPAGG $ 2,000,00 X POLICY JEa LOC AUTOMOBILE LIABILITY 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-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE - AGGREGATE $ DEDUCTIBLE S RETENTION $ - $ WORKERS COMPENSATION AND WC7431477 08/03/2008 08/03/2009 X I WCsLTATU- I I on+ EMPLOYERS'LIABILITY ER 8 ANY PROPRIETOWPARTNER/EXECUTIVE E.L.EACH ACCIDENT g 100.00 OFFICERIMEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA Etv1PL0YE $ 100,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 OTHER LI DESCRIPTION OF OPERATIONS I LOCATIONS$VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS riginal workers compensation certificates to be issued by company. Evidence of Insurance only. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 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 AUTHORIZED REPRESENTATIVE Mark Gilbert CIC ACORD 25(2001108) OACORD CORPORATION 1988 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR L Registrations 108383 = Expiration 8Y18/2010 Tr# 272473 z z Type DBA KEEN CONSTRUCTION,CO Kenneth Keen ' �5 21 Hewitt Ave No.Andover,MA 01845` Administrator 4 = r ✓l- -1�04J Board 0111111 Badding Regulati sand Standards Construction Supervisor License License: CS 58245 Expiration u3'/24/2010 Tr# 17840 - Restrtction._00'- _.. �- KENNETH B 21 HEWITT AVE " �� { N ANDOVER,MA 01845 Commissioner j Boa rd:of Building Regulations and:Standards ConstructibmSuperv'i-sor License J. License: CS 76691 -Birthdate,�8/16%1968 �=E pira�tion 8%x16/2"0:09 Tr# 3859 N itestnction ROBERT A KEEN:; 12.E WATER ST N ANDOVER MAO 1-845 Commissioner KEEN CONSTRUCTION CO. 21 HEWITT AVE. N.ANDOVER,MA 01845 (978) 691-5201 Marzluft, Siobhan&Jeffery. 25 Herrick Rd. N.Andover,MA 01845 (978)794-4852 Contract#.5003: Appendix A Date:11/5/2008 Update bathroom: 'Replace tub toilet&faucetsc ets with customer selected items from Peabody Supply Repairceiling.and walls + Supply& install Harvey Classic vinyl�replacement window • Supply& install exhaust fan/light combination . • Suppjy&installtrim to match existing • Rllair'e)dsting bank of drawers as best possible •.!Supply&install,Merillat vanity and medicine cabinet and granite vanity top per customer seleoton-.at;Jackson Lumber • Electrical allowance$800.00 Total Price:.$12,130.60(twelve thousand one hundred thirty and 60/100 dollars) Price does not:include cost of permits or flooring. Payment schedule: $1000.00 due upon signing.contract $3000.0.0 due the first day.:of work(plus permit fees) y' $2000.00 due when demo is complete $2000:00 due when tub is installed $2000.00 due when plaster is comlete p $2130.60 due when contracted work is complete Customer i( Keetb- . Keen Date Date 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 specifically exempt from Fax: (978)682-3231 pec y p registration by Provisions of • t Chapter 142A of the general laws,must be registered with Submitted (� �° the Commonwealth of Massachusetts. Inquiries about -- registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton -` — - 1 =�` \ ' '� Place, Room 1301, Boston, MA 02108 (617) 727-8598. Y � 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 DATE s _ REGISTRATION NO. EIN N0. _ � �;;� '' �` 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: _. ...........-. _ ....................... -_--- __ _._. ._....-......... ----- __................_ ._..........._--__-------__._______._.. ..............__.._............_-__ ....._............._....... -------_ > 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 following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused t)y 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 workmanshi .The foregoing warranties shall survive an inspection P 9 9 y pect on 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 Paymentw to be made as follos: d011arS($ ,�f� � i + > ), % ($ ) upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN r Name of Contractor/Designated Registrant ($ ) upon corntit�o ! ; 21 HEWITT AVE. Street Address % 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°:/SXes -- ,�_-•,, or the total amount of all deposits or payments which the contractor must make,in 6-11 r I advance, to order and/or otherwise obtain delivery of special order materials and Aulhori 9dsg_r)ai re 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 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. O NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature Date Signature Date IMPORTANT INFORMATION,ON BACK 111111o,-