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HomeMy WebLinkAboutBuilding Permit #833-14 - 35 EQUESTRIAN DRIVE 5/10/2014L Permit NO: Date Issued: LOCATION -62- TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page 5% I not PROPERTY OWNER—J,4\ j "b 5�-� �c, �Jl o1IV r- Print 100 Year Old Structure yes MAP NO: 105 PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes 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 . ❑ Water/Sewer UtbUKIF I ION OF WORK TO BE PERFORMED: Dck+;, cluvi�S OWNER: Name: L--60 b Address: -f.�. CONTRACTOR Name:- Address:. 1 l t1 ren or Print Clearly) Phone: 9 'tlV\ C I-) Phnm-- V/ D Supervisor's Construction License:_ j> ( Exp. Date: Home Improvement License: T D Exp. Date: / I/ q 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: $ 9 9'75 FEE: $ /20,04' Check No.: It -7 Z Receipt No.: X7,51.6 NOTE: Persons contracting with unregistered contractors do not have access tZtgtara fund Signature of Agent/Owner- Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location No. <f --S -.5 - / 9 Date Check# A/ -7 r jjj TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ 1,?o-- Foundation Permit Fee $- Other Permit Fee $ TOTAL $ 'e� C- Building Inspector J 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 & DEVELOPMENTEl COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Siqnature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Ic Comm Conservation Decision: Comments f Water & Sewer Connection/Signature & Date Driveway Permit DPW Towz Engineer: Signature: Located :364 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at'124 Main°Street Fire Departinent•signature/date ` COMMENTS Street 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 - Doc.Building Permit Revised 2010 Building Department The foEowing 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 ❑ 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 N TE: 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 ❑ 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 N TE: 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 o Engineering Affidavits for Engineered products N TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals it the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording est be subm,tted with the building application Doc: Doc.Building permit Revised 2012 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supers icor License: CS -058245 KENNETH B KEEJ4 , 21 HEWITT AVE= N ANDOVER Mk 01;4g' i t-7,2,,, Expiration Commissioner 03/24/2016 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -076691 _� I I , ROBERT A KEEN-` 12 E WATER ST ; North Andover 018 y ; ,P �jL 11-Itl \\ Expiration Commissioner 08/16/2015 d�, !/(,G•iJ.1IX�`� Offce..of Consumer Affairs & Busibess Regiflil8ap OME IMPROVEMENT CONTRACTOR egistration: Td8383 Type: Xpiration: , BMB/2054, DBA KEEN CONS FRUCTIO Cts Kenneth Keen 21 Hewitt Ave g �� No. Andover, MA 01'845 Undersecretary < 0 o ¢ CD �' N 0 d c �D, m 0 CD n O 0 CL 0 � M Z o �- � -o y' p� f/1 � CD O T C o o •,Fn `C WCD y o N NCDm m 2 a a)CD N y �.�o N n n cn o o O o �, �D W = m CD Z N C �. CD N O r' OX Day � Z <0 —CL 0 CD cD� o �m rt ��CD CL =1c Cl) 5 QCD co a =r00 ,� C7 Z D CD CD CD cD O cD O Z " cn � WM� Z coo yCL—ova' su 0 CD —�� to ky U) o o cQ CD v N CD CD O �: N CD Z c CD CD F: �' 0v = o G) � O rt 0 � y CD z CD -0 O m y': < rn o tu� CD � = O a) o C y 0 Ln O T. fD 0 Y Ln N rD O `�' z O OD C O rD m 0 y m -I TZ7 3 O 3 D (A07 Z v+ m O T >' N (n � � n m :;o O OCG S m D r� Z n 00 T O' E A O OOC 7" Z Z fmi 00 T j n _S 7 rD < .Z7 O OCG 7' T O 7 O_ 0 GI _ Z m 0 N (D n N K T O L Q 7C > O O T _ 0 The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations rl 600 Washington Street ' Boston, MA 02111 Y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers pplicant Information_ Please Print Legibl, Name (Business/Organization/Individual): %� (?,�� C 'Ul , ' Nom. ► cy Address: 1175 5ts City/State/ 617V,') Phone #: Are you an employer? Check the appropriate box: . [P I am a employer with Z 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship 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 have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 5. ❑ 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.] —6-91— Type (L9I— Type of project (required): 6. ❑ New construction 7. ( Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 1 LEI Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I 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�i i I e r5 I n u icy l'1 &e, Policy # or Self -ins. Lic. #: 3 Expiration Date: Job Site Address:��.2 �uc6 �r � c l �`(, City/State/Zip: Al, &ddver, of g15, Attach a copy of the worker's' 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. Ido hereby certifyIpTler t/ e pai nd penalties of perjury that the information provided above is true and correct. Sienature: / ,*� �"""Date: , / `1 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 #: AC"Rb® v CERTIFICATE OF LIABILITY INSURANCE l DATE (MM/DDIYYYY) 4/15/2014 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 G�lbert Insurance Agency, Inc. 137 Main Street Reading MA 01867-3922 CONTACT Barbara McDonough NAME: g PHONE (781) 942-2225 FaX o: (781)942-2226 EMAIL ADDRESgg bmcdonou h@ ilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:NORFOLK & DEDHAM INSURANCE 23965 INSURED Keen Construction Company 1175 Turnpike Street North Andover MA 01845 INSURER B :Hartford Fire Insurance Com an INSURERC:Travelers Insurance 0022 INSURER D: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER:CL1441500922 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 PEQUIREMENT, -TERM OR. CONALTION_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. INSRPOLICY LTR TYPE OF INSURANCE INSg WVp SUER POLICY NUMBER EFF MM/DD/YYYYI POLICY EXP (MM/DDfYYYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR D -P-010078/000 /13/2014 3/13/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE PREMISE a occur ence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F7 PRO JFCTLOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS X AUTOS OBUECAA6432 12/3/2013 12/3/2014 COMSINGLE LIMIT BINED Ea accident 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Underinsured motorist $ 100,000 UMBRELLA LIAR EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROP RIETOR/PARTNER/EXEC UTIVEE.L. OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 6HUB-9991M58-2-13 10/8/2013 10/8/2014 WC STATU- OTH- rRY EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INS025 (201005).01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR ACORD 25 (2010/05) INS025 (201005).01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r r bb L KEEN CONSTRUCTION CO. PROPOSAL �0 POS�'1 L ° 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 ) ,r Chapter 142A of the general laws, must be registered Submitted GV Cj� d U L i rl r with the Commonwealth of Massachusetts. Inquiries To: Ej about registration and status should be made to the 32— C9 Llys r 1 Dr Director, Home Improvement Contract Registration, 10 Park Plaza, Room 5170, Boston, MA 02116 617-973- t h C r'/ 8787 Owners who secure their own construction �Y I related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE L1 REGISTRATION NO. EIN NO. MA. H.I.C. 10838346 —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: r(c,r 5 ice > Construction related permits: ._./,_...__/_....____.__.._.__.._....._....._. _. . __r .................... ....................I..........._. WORKS HEDkJLE -- .% ............................... _._ ........_ _. Contractp vyily-o in 'e work or order the materials before the third day following the signing of this Agreement, unless specified here id ritip p ctor will begin the work on or about —f i� 1 Barring t (date). delay caused by circumstances beyond Contractor's control, the work will be completed by f, L(d / (date). The Owner hereby acknowledges and agrees that the scheduling dales are approximate and that such delays that are not avoidable by the Contractor shall of 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 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 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 too 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. WPropose hereby to furnismaterial an� labor - complete in ac ordance with above specifications, for the sum off�:QQ /� 1 dollars ($ Payment to be m e as follows: ) % ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor / Designated Registrant ($ upr pt tii oP` 1175 TURNPIKE ST. Street Address �$ ) PP completion of N. ANDOVER, MA 01845 qty /Slate shall be made forthwith upon -5201 ($ ) 1 ) _ (978) 682-3231 completion of work under this contract. Fax Ko /'(/ ,rt 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 nl le ,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 A on: Signalure equipment, whichever amount Is greater. Note This proposal may be withdrawn b y y us it not accepted within days Acceptance OT Proposal - 1 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. 90 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature' �� Data Signature Date IMPORTANT INFORMATION ON BACK ► `u Corn'trac(ion Co, R1:MC71)1=LING tiP/=C:1 /�i.l1Tt � Keenco-1—tioneo.com Wagner, Lou & Linda 32 Equestrian Dr. N. Andover, MA 01845 February 15, 2014 Contract # 5501; Appendix A Replace rear sliding doors:. • Remove two existing sliding door units on rear of house. • Supply & install two Eagle hinged patio factory finished door units as quoted by Jackson Lumber to customer on 12/27/2013 • Supply & install PVC flat casing with scotia molding, similar to existing single door unit • Supply & install new interior trim if necessary (staining trim to match existing) • Dispose of all debris Price does not include cost of permit or repair to damaged flooring or framing, which will be billed separately. Total Price: $9985.00 (nine thousand nine hundred eighty five dollars) Payment Schedule: $3000.00 due when contract is signed $3500.00 due when doors are delivered $3485.00 due at completion of contracted work Customer Date / 1175 Turnpike St. N. Andover, NIA 01845 Sales@KeenConstructionCo.com Robert A. Keen IZI ! Date P: 978-691-5201 F: 978-682-3231