HomeMy WebLinkAboutBuilding Permit #913-2016 - 344 MAIN STREET 2/24/2016`CD BUILDING PERMIT of NORTy q
"t LED �6 N
TOWN OF NORTH ANDOVER �� ry r'`- ° '°
APPLICATION FOR PLAN EXAMINATION :A
Permit No#.' l/n Date Received
I 7 p�R.17eo
RSSACHUS��
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION L Mn S h
Print
PROPERTY OWNER_ re) Cw r1
Print 100 Year Structure yes n
MAP '-43 PARCEL:_ ZONING DISTRICT: Historic District yes 0
Machine Shop Village yes n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑'Commercial
,WRepair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑tS,eptic ❑Well
❑`Floodplan_�Wetlantls
Q WatershedllDstnct;�g� µ._�
�1"EW,ater/Sewer
r
,
DESCRIPTION OF WORK TO BE PERFORMED:
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Identific:
OWNER: Name:
Address:
Contractor Name:
Email: SG le s
Address: Dn
- Please Type or Print Clearly
Is•1”
Phone: 'J j2s -
r1
nom Cc Phone: 9)0--(,91—
� S •-f `rV � i c:.�.+ CCS � r0 c'I'�
4,1 Uv -e -r' , h19 6 / Tq
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Supervisor's Construction License: 6J5 -0-766 9 J Exp. Date:
Home Improvement License: f 61Z 3'F 3 _ Exp. Date: S �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: $ cls 4'3 , 0 U FEE: $
� Oq ----
Check No.: I " Receipt No.: 5bb�z
NOTE: Persons contracting with unregistered contractors do not have access to the g4rffqiy1yd
-tel ini £i �ro„ri�+�i+?a n-Vr- r_'ti-r
_,
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
Conservation Decision: Comments
Water & Sewer ConnectionlSignature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osg o Street
Y FIREDEP�RTMENT Temp Dumpster4onxsitey�es
Locatetl at 124 Main Street" ' '" f ; ---71-P,tz
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COMMENTShn_�, y+� f ;:'e� :w� y� �.
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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
MGL Chapter 166 Section 21A —F and G min.$10041000 fine
NOTES and DATA -- (For department use
® Notified for pickup Call Email
Date Time Contact Name,
Doc.Bnilding Permit Revised 2014
No
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
4. Building Permit Application
4. Workers Comp Affidavit
4- 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
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
46 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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
� Building Permit Application
4 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: 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
I oc-Qtion
--21-
Date, 2L4��
No. C1
Check# ) �- 63
U
'42
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
Buildin 'Inspector
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55,r
KEEN CONSTRUCTION CO.01"OSL
n
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 P {-� I ��((JV—) with the Commonwealth of Massachusetts. Inquiries
To: about registration and status should be made to the
J`� L/ L) Director, Home Improvement Contract Registration, 10
LJ ' Y' (
Park Plaza, Room 5170, Boston, MA 02116 617-973-
n 8787 Owners who secure their own construction
`//'1 e/l �Jf��.
`I n C cW ,' 6,17,Y5
related permits or deal with unregistered contractors
7 will be excluded from the Guaranty Fund Provision
of MGL c. 142A.
PHONE DATE REGISTRATION NO. EIN N0.
9 9 MA. H.I.C. 108383
46 —3783401
> C/S = Customer Supplied S + I = Supply + Install [,E See Attached Appendix A
We hereby submit specifications and estimates for work to be performed and materials to be used:
C]� x
> Construction related permits:
1__.__._"_'....................._.._._.........___.............................._.._..........._......_............_........................,................................................-............................................_.:................_................................_........_._....._....................................................._......__............_.......
WORKS 'HED"E
Contra )ri the work or order the materials before the third day following the signing of this Agreement, unless specified her 'n �l( 'ting. o tractor will begin the work on or
Barring delay
about (date). 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 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.
Propose hereby to furnishmaterialand labor -/complete inaccordanceaccordance with above specifications, for the sum of
I(W—e
1 1
I ~/ )Ciel Jd! `JI II(JVl[',Yfr� Fcy— % E��/ f �. dollars C �J 1
($ ).
Paymebi to be made as follows: .
% ($ ) upon signing Contract;,n ROBERT A. KEEN
Iver Name of Contractor / Designated Registrant
upoflt�leti, rt of 1175 TURNPIKE ST.
V\ Street Address
/e. ($- oa completion of- N. _ANDOVER, MA 01845
t City /Stale
t)
1 shall be made forthwith upon (978) 691-5201 (978) 682-3231
completion of work under this contract. Fax
Notice:No agreement for home improvement contracting work shall require a
Zwam
> down payment (advance deposit) of more than one-third of the total contract price sale ma /
or the total amount of all deposits or payments which the contractor must make, in1%
advance, to order and/or otherwise obtain delivery of special order materials and Author' ed Signature
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 allached 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 THEME ARE ANY BLANK SPACES.
Signature Data" Signature Data
IMPORTANT INFORMATION ON BACK
*yen.
__ 0- Cq�sfucfion;Co;.
eFmonrt.�nc srec�nt_�srs
9715-69-9-520`!
Keen ConstructionCo.com i
Brown, Terry
344 Main St.
N. Andover, MA 01845
Contract #5573; Appendix A
February 23, 2016
Repair water damage in garage and library:
• Supply & install 22' of fire -blocking (2" x 4"'s) at bottom of rear wall
• Supply & install Borate loosefill cellulose insulation in ceiling of garage and in walls of library
where it was removed
• Insulate walls of garage with Borate loosefill cellulose
• Supply & install approx. 96 sq ft of %" blueboard in library and skimcoat plaster to smooth finish,
blending into existing wall
• Supply & install approx. 671 sq ft of 5/8" blueboard in garage where it was removed and
skimcoat plaster to a textured finish
• Supply & install base trim to match existing
• Supply & install 32' of sheetmetal heat enclosure
• Paint walls and trim in library
Total Price: $8,648 (eight thousand six hundred forty eight dollars)
Price does not include cost of permits, flooring or repairs to any unusual, unsafe or non -code compliant
existing conditions not addressed in this quote.
Payment Schedule: $1500 due upon signing contract
$2500 due when insulation is complete (plus permit fee)
$2500 due when plaster is complete
$2148 due at completion of contracted work
Customer `y
Date
PO Box 935
N. Andover, MA 01845
G5L #07(5691
Robert A. Keen
Z_ 2_ 3 �/
Date
Page 1 of 1
5oles@KeenGonstructionCo.com
P: 978-691-5201
F: 978-682-3231
HIG #108383
-\ The Commonwealth of Massachusetts
Department of Industrial Accidents
-_- 1 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. Legibly
Name (Business/Organization/Individual): i(� n(_Sj f -y C t7
Address: OX
city/State/Zin: k) • lqn cu- °Q`er Gf
Are you an employer? Check the appropriate box:
#: 9?3 (fr 4-I - 572c)1
1.M I am a employer with 2- 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.] I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
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
proprietors with no employees.
5.F-1 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.t
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
11.❑ Electrical repairs or additions
12. (] Plumbing repairs or additions
13. [] Roof repairs
14. ❑ Other
*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: �(�� t' �5 I �l -5
Policy # or Self -ins. Lic. #:6/4L) 1J 9251 K-- Z Expiration Date:iz
L / O/
Job Site Address: �+ 1 ' � i to 5 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
coverage verification.
I do hereby certify�11ties of perjury that the information provided above is
is t�ru/e and correct.
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 #:
Aco OR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
�� 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(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 endorsemengs).
PRODUCER
Gilbert Insurance .Agency, Inc.
137 Main Street
Reading MA 01867-3922
C0U"PC Barbara McDonough
PHONE . (781) 942-2225 FALX No: (781)942-2226
ADDRESS:bmcdonough@gilbertinsurance.com
INSURER(S) AFFORDING COVERAGE NAIC 0
INSURERA Norfolk S Dedham Insurance 23965
INSURED
Keen Construction Company
483 Chickering Road
North Andover MA 01845
!NSURERB:Safety Insurance CompanV 39454
INSURER CMravelers Ina. Co. 0031
INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBERCL1552101779 RFVISIAN NIIMRFR-
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
Im
TYPE OF INSURANCEADDLSUBR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS1dADE ❑X OCCUR
M Gilbert, CIC/BARBAR
ND -P-010078/000
3/13/2015
3/13/2016
EACH OCCURRENCE $ 1,000,000
PREMISES aoccurrenca $ 100,000
MED EXP (Any onePerson) $ 5,000
PERSONAL 6 ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY Jr LOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
2,000,000ECTT
$
B
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNEDX SCHEDULED
AUTOS AUTOS
X X NON -OWNED
HIRED AUTOS AUTOS
6228807 COM 01
5/23/2015
5/23/2016
COMBINED SINGLE LIMIT $ 1,000,000
a..idenl
BODILY INJURY (Per Person) $
BODILY INJURY (Per accident) $
PROPERTY DAM AGE, $
Underinsured motorist $ 100,000
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED I I RETENTION
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, desWbe under
DESCRIPTION OF OPERATIONS below
NIA
6eUB-9991M58-2-15
10/8/2015
10/8/2016
TIr I IE
E.L. EACH ACCIDENT $ 100,000
E.L. DISEASE-EAEMPLOYE $ 100,000
E.L. DISEASE - POLICY LIMIT 1 $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additlonal Remarks Schedule, may be attached If more space Is required)
GCK I1rlUA I C Hut urK nA MCLI 1 ATInM
(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
v IV50-ZU14AGOKU COHPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS02512014011
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
r1constr uc lllll Surferv:-0i,
License: CS -076691
ROBERT A KEMN z :.
12 E WATER ST IMF
North Andover W* 0
r
Expiration
commis�sionneer' 08116/2017
,� n��e �oo�unaa��ueal(� a��ir��ac�uaeG/d
v
ice of Consumer Affairs & Business Regulation
E IMPROVEMENT CONTRACTOR
r _ ,e istration:..
9 ]fl8383 Type:
Expiration,-;%/7�2pj6r ;r Supplement Ca;
KEEN CONSTRUCTION
ROBERT KEEN
1175 TURNPIKE ST:,t
NO. ANDOVER, MA 01845
Undersecretary