HomeMy WebLinkAboutBuilding Permit #992-15 - 344 MAIN STREET 6/1/2015Permit No#:
Date Issued:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
!I
'6
0
OArep 0,
I 'IMPORTANT: A-DDlicant must com-olete all items on this vage I
LOCATJON -C/Lf t (I J-1111
Pdnt
PROPERTY OWNER —ierr B -0 C1.0 P")
Print lob Year Strudure yes
U PARCEL:
MAP ZONING DISTRICT: Historic District yes
Machine Shop Village _,yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
El One family
11 Addition
El Two or more family
El Industrial
Alteration
No. of units:
0 Commercial
Repair, replacement
El Assessory Bldg
El Others:
El Demolition
El Other
El Sepjic El Well
n Ploodplain El Wetlands
0 Watershed,bistrict
El Water/Sewer
OWNER: Name
Address:
DESCRIPTION OF WORK TO BE PERFORMED:
b ce> (0 M 4 In 5-0 ra4p -) I n54-ct In r9r- b cq�: M
V V
'i +WC) doo�-5 o vi �, -Fc)
V
Identification - Please Type or Print Clearly
T—e- RTzL.-) n Phone:
a
Contractor Name: 40)
Address: ID 1� 71-L.� r i
f 0fi
(0 91 -
kn,9( Exp. -, I
S -visor's Construction License,: C�-70
,upe.r
Home, Im pf nt License: Exp. �Date:
wernp
ARCH ITECT/ENGI NEER LrA cri Phone: C) 93 1
Address: �9Z ��fofgLc\vf\ 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: $ LA �<z 40 Ic 0 YEE: $ rb
Check No.: t Receipt No.:
NOTE: Persons contracting wi& unkegistered contractors do not have access to tfteXui#ant0und
X
Plans Submitted 11
Plans Waived El Certified Plot Plan 11 Stamped Plans [I
TYPE'0F SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art El
Sw'mming Pools
Well
Tobacco Sales
Food Packaging/Sales [I
Private (septic tank, etc. El
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On
Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comme
Conservation Decision: Comme
Water & Sewer Connection/signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp 'Dumpster on site yes no
Located 6t 124 Main Street
Fire -Department signature/date
MMENTS
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.$100-$1000 fine
NU I t5 ana IJA I A — (t -or clepartment use
U Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
No
k -
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
Li Building Permit Application
Lj Workers Comp Affidavit
ci 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
ci Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Lj Mass check Energy Compliance Report (if Applicable)
D 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
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
Doc: Building Permit Revised 2014
Location
No. 99-�-
Check # tq3�
28858
Date Ap *0
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Building Inspector
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RIEAft"DELING
%_KeenConstructiOnCo.corn
Brown, Terry
344 Main St.
N. Andover, MA 01845
Contract #5531; Appendix A
Garage remodel:
May 23, 2015
• Frame center beam as drawn by Larry Ogden on 4/20/15, supplying all materials as shown,
substituting the 16" LVL for 18" LVL
• Remove and dispose of existing beam
• Remove and dispose of existing garage doors
• Frame front wall of garage as drawn by Larry Ogden on 4/20/15, supplying all materials as
shown, substituting 16" LVL for 18" LVL
• Supply & install PVC trim on outside of garage doors and siding on front of garage to match
existing
• Supply & install one electrical outlet for opener
• Patch wallboard and plaster as needed
• Create 36" x 36" landing and stairs outside of kitchen door
Total Price: $14,840.00 (fourteen thousand eight hundred forty dollars)
Price does not include cost of permits, painting, garage door or repairs to any unsafe, unusual or non -
code compliant existing conditions.
J,K
;4coo I -(,-
Payment Schedule: $11YUM e upon signing contract
Wo I
AW.00 due the first day of work (plus permit fee)
$4000.00 due when center beam is installed
$4000.00 due when front wall is framed
$2840.00 due at completion of contracted work 17
Customer Robert A. Kee
Date
1175 Turnpike St.
N. Andover, MA 01845
CSL #076691
5 17� 3,
Date
Page 1 of I
Sales@KeenConstructionCo.com
P: 978-691-5201
F 978-682-3231
HIC #108383
5 5
KEEN CONSTRUCTION CO. r"'ROPOSAL
1175 TURNPIKE STREET r
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
Submitted Chapter 142A of the general laws, must be registered
TO: D Q) CAJ 1'-) with the Commonwealth of Massachusetts. Inquiries
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
L of MGL c. 142A.
I'MUNt: rGISTRATION NO. EIN NO.
9 1 Z - 3 12-c. rp MA. H.I.C. 108383 46- 3783401
> C/S = Customer Supplied S + I = Supply + Install �Y see Attached Appendix A
We hereby submit specifications and estimates for work to be performed and materials to be used*
Ck
> Construction related permits:
. ............... ................... ........................................................ . . . . ........... ........................ ............ ...... ....... . ..........
. ..... ...... . . . .............. . . . ........... . . ........... ............................................. ........... . ............ ............................. . ..........................................
WORKSCHEDULE .................. . .. ............ ............ _ ........ . ... . ... ......... . ....... ..... ....... ..... ............. ..
Contract r I i a work or order the materials before the third day following the signing of this Agreement, unless specified he g. ctor will begin the work on or
Z71 t lin (date). Barring delay caused by circumstances beyond Contrac(of'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 ec, r 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 Contract , 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 Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of
- e- d F-6 r � �, —
E, dollars ($
V) �4 L] c' c a
Payment to be made as follows:
upon signin Contract; ROBERT A. KEEN
q Name of contractor / Designated Registrant
oov� i
% f 1175 TURNPIKE ST.
on f
Street Address
p7r,'9( completion of N. ANDOVER, MA 01846
City / S ate
shall be made forthwith. upon (978) 691-5201 (978) 682-3231
($ completion of work under this contract. Pho Fa,
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 .1
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 mateiial� onu AUmoreea bignature
equipment, whichever amount is greater. Note: This proposal may be withdrawn by us if not aocepled within days.
Acceptance of Proposal - I have read both sides of this docu I ment and all attached documents and accept the prices, specifications and conditions stated,
I understand that upon signing, this proposal becomes a binding contract. Yo I u 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 diay after the date of
this transaction. Cancellation MUSt be done in writing.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature Data
signature Date � / ) -?/ 2 " 1
IMPORTANT INFORMATION ON BACK DO-
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198 EAST- MXN-ST�ET
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Massachusetts - Department of Pub4ic Safe-ty
Board of Building Regulations and 8tandards
Construction SuperNisor
License: CS -076691
ROBERT A KEEN-�
12 E WATER ST
North Andover AA 0
W Expiration
Commissioner 08116/2045,
(D�T
-L,\ Off-.,, of Consumer Affairs & Business Regulation
ME IMPROVEMENT CONTRACTOR
9'elgistration: A383
Type:
xpiration: _ 8tz� DBA
KEEN CONSTRUCTITON_-� ,0
Kenneth Keen !PY
1175 TURNPIKE ST
01
NO. ANDOVER, MA Undersecretary
The Commonwe alth ofMassachusetts
Department ofhdustriqlAcc!6�ts
Office of Investigations
600 Washington Street
Boston, MA 02111
W www-mass.govIdla
Workers' Compensation Insurance Affidavit: Builders/Contractors[ElectriciansIPlumbers
Applicant Information Please Print Legib
Name (Business/Organizationgndividual): r\ -e -e V) C UVI �) f ru
0 r
'A 61 'J�6 Pho
City/State/Zip: 6\tFlv
Are you an employer? Check the appropriate box:
1. [X I am a employer with -1—
4. F1 I am a general contractor and I
employees (fall . and/or part-time).*
have hired the sub -contractors
2. El I am a sole, proprietor or partner-
listed on the attached shoot. 1
ship and'haveno employees
These sub-contiactors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3. El I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.]
employees. [No workers'
comp. insurancerequired.]
Type of project (required):
6. []New con * struction,
7. n RemodeRng
8. E] Demolition
9. El Building addition
10.[] Electrical repairs or additions
ILEI Plumbing repairs or additions
12.Q Roof'repairs
13.0 other
*Any applicant that checks box#1 must also fill outthe section below showing their workers' compensation policy information.
T -Homeowners who submit this affidavit indicating they P�e doing all work and then hire outside contractors must submit anew affidavit indicating such.
TContractors that checkthis box must attached an additional sheet showing thename, of thasub-contractors and their workers' comp. policy information.
am an employer that isproviding workers' compensation insurancefor my em
ployees. Below is theyolicy andjob site
information.
Insurance Company
Y� ) L) Fc" n
Policy# or Solf-im. Lie. #: G \�Q Q� — ')99 A, Date:
J+xpiration
Job Site Address: City/State/Zip:
r � -
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 o. 152 can lead to the imposition of criminal penalties of a
flue up to $1,500.00 and/or one --year imprisonment, a's well as civil penalties in the form of a STOP. WORK ORDER and a fine
of -up to $250.00 a day against the wolator. Be advised that a copy of this statement maybe forwarded to the Office -of
Investigations of the DIA for insurance coverage verification.
I do hereby certo under thepains andpenattles ofperjury Mat the information provided above is true and correct.
Signature: Date -
Phone#:
Official use only. Do not write in this area, to be completedly city or town official
City or Town: Permit/License 9
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact.Person: Phone#:
RightFax C3-1 3/24/2015 9:51:03 AM PAGE 2/002
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Fax Server
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I I n.9 412(7115
1=9NIF1 C'ATE IS ISSUED AS A MATTER OF INFORMA71ON 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 CERTIMATE HOLDERR-
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 and endorsement A statement on this certificate does not confer rights to the
certificate holder In Ileu of such endorsement(s).
PRODUCER
CONTACT
NAME:
GILBERT INS AGCY INC
137 MAIN STREET
PHONE
(A/C, No, Ext):
FAX
(A/C, No) -
I
READING, MA 01867
E -MAIL
ADDRESS:
246WY
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED
INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA
KEEN CONSTRUCTION CO
INSURER 8:
INSURER C:
1175 TURNPIKE STREET
INSURER D:
NORTH ANDOVER, MA 01845
INSURER E:
INSURER F:
COVERAGES CER11FICATE NUMBER: REVISION NUMBER:
THIS 19 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 CONDIT IONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
INSIR
LTR TYPE OF INSURANCE
ADD
L
SUR
R
POLICY NUMBER
POLICY EFF DATE
(MDDXYYYY)
POLICY EXP DATE
(MLWD\YYYY)
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
ZACH OCCURRENCE $
)AMAGE TO RENTED $
CLAIMS MADE F-1 OCCUR.
�REMISES (Ea occurrence)
AED EXP (Any one person) $
:)ERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:
3ENERAL AGGREGATE $
�jPOLICY [:]PROJECT LOC
I
I
3RODUCTS - COMP/OP AGG $
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEAUTOS
COMBINED SINGLE $
LIMIT (Ea accident)
BODILY INJURY $
(Per person)
HIRED AUTOS
BODILY INJURY $
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAB
EXCESS LIAB
[71
Ll
OCCUR
CLAIMS -MADE
EACH OCCURRENCE Is
AGGREGATE Is
DEDUCTIBLE
$
RETENTION $
$
WORKEITS COMPENSATION AND
EMPLOYER'S LIABILITY Y/N
ANY PROPERITOR/PARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED? MN
(Mandatory In NH) L i
If yes, describe under
N/A
UB-999IM582-14
10/08/2014
1 OfOW2015
1EI
X I WC STATUTOR I Y OTHER
LIMITS
E. L. EACH ACCIDENT 100,000
is
E.L. DISEASE - EA_,EMPLOYEE 1 $ ID0,000
DISEASE- POLICY LIMIT Is 500,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERA'nONSILOCA'nONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER LLATION -----------
%J yy IN Vr IN UN I ri PILIN IJU V MK
1600 OSGOOD STREET
NORTH ANDOVER, MA 01845
ACORD25(2010/05) TheACORDname;-n
tiMUULU ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
are registered marks of ACORD iomnio