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HomeMy WebLinkAboutBuilding Permit #827-16 - 35 JOHNNY CAKE STREET 1/21/2016BUILDING PERMIT 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#:R9_�__--/4Date Received Date Issued: ' IM ORTANT: Applicant -must all items on this page LOCATION �J c �1► i� Pri t PROPERTY OWNER T6- �fiJ �rbI Print 100 Year Structure yes o MAP _PARCEL: [ 9 ZONING DISTRICT: Historic District yes o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building [I Addition ❑ One family [I Two or more family 11 Industrial [I Alteration No. of units: ❑Commercial ri Repair, replacement ❑ Assessory Bldg ❑Others: ❑ Demolition ❑ Other _ ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: bed I bo r- —J -e i A 6 0 1 S4I cw\ i "' r0Vet1 Identification - Please j Type or Print Clearly 9i g y OWNER: Name: J0 "'- �' ' ' Phi Address: , , �c0) Contractor ame: Email 6 A le, L L -K-9 Address: PO Box 93 ✓" ��- m 54- /V o45LM-J, ('GV7 c,✓1 S +tUC-f l'Ckl one: 9) 0-6 9! - 5 6_,1 /LA Supervisor's Construction License: C - S' _ U -7 6 (o g j Exp. Date: 1I J( /l 2 Home Improvement License: /,OS NZ). Exp. Date: ?5 b g /1(0 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: $ 2-,9 ( 15, d C FEE: $ Check No.: /�}'�� Receipt Nor26i V�� 1�_A access to NOTE: Persons contracting with unregistered contractors do not have ty d Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanningwassage/Sody Art ❑ Swiuuning 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 o U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes L :`Manning Board Decision: t,onservation Decision: Comments Comm Wafter & Sewer Connection/Signature & Date Drivewav Permit DPW Town Engineer: Signature: —�- �.� _� Located 384 Osgoo Street FIRE:DEPAR1TMENiT - TempfDumpster onsite ,y'es Locatedlat ,124tiMaineStteet Fire D:epart>ient.signature/date r_ _ COMMENTS 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 ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine No Doc.Building Pennit Revised 2014 0 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 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 )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 ;k 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 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) ;rP Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 V No. Dater—�� Check # �� 3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee 06!—,� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector z a W, rA rA 5� F-1 J 2 LL 0' Q O m N U \ 'O O O LL N U Y Q 67 LA 0 LI CL LnU Z z J O O "p C 7 O LL L w =37 O cr C E L U LL 0 u iy z z m J d t LD O w !0 LL 0 u Ly z U u W J W S U.0 :3 O K V i N N N C LL a O a N Q C7 L CA .7' O W — C LL z W °c Q W L=I 5 LL N C i 7 m Zcu N N N v p Y O E N ml O W :a z Z 0 m `2 ■ OTZ: E � O N Z t O W I.L CL z 0 wO C0 c W J CL Z_ m L O _ •0 N d s O z O 04 E � O O Z YI M •M E + .AW W W CL M O 4) V 0 0 O CL a. CL Q O c .QO� = Z 4) O U cU to � CLN 0 O O V CL CD �a o U)C E a L C- .0 L cn = _Q .r aL 3 M U J i m , _ • _ 0) O cn -a O O =mom CD o z CL _ � o 0 . 3 ao0 L Q C m ) as v -4W .N am t- a 16- N== O 0 dl Q. v m +r � as -- W = +�-' O O LL 'y D N = 'a t o •� LU U Q t� d i O (D N N � O F=- CL 0U O W :a z Z 0 m `2 ■ OTZ: E � O N Z t O W I.L CL z 0 wO C0 c W J CL Z_ m L O _ •0 N d s O z O 04 E � O O Z YI M •M E + .AW W W CL M O 4) V 0 0 O CL a. CL Q O c .QO� = Z 4) O U cU to � CLN 0 *-0--ir",Corst�^ucfion;o, HEMC3DFLIMC: SPEGI/JILISTS 978-697-520 t KeenConstructionco.com i Trombly, Joseph & Elaine 35 Johnny Cake St. N. Andover, MA 01845 Contract #5570; Appendix A Replace wallboard in bedroom: January 16, 2016 • Remove casing on three windows and three doors • Remove base cap • Remove and dispose of wallboard, sheetmetal enclosure on heat and insulation in room, cutting wallboard above base molding • Supply & install R-15 kraft -faced insulation • Supply & install %" blueboard and skimcoat to smooth finish • Re -install casing that is deemed usable by customer. All other trim will be installed in the spring. Total Price: $2965 (two thousand nine hundred sixty five dollars) Install new trim in spring: ($915) • Supply & install pre -stained casing, base cap and crown molding • Supply & install new sheetmetal on baseboard heat Price does not include cost of permits or repairs to any unusual, unsafe or non -code compliant existing conditions not addressed in this quote. Payment Schedule: $1000.00 due upon signing contract $1000.00 due when plaster is complete $965.00 due at completion of contracted work E� L.CJstome Date PO Box 935 N. Andover, MA 01845 CSL #076691 f 117. Robert A. Keen Date Page 1 of 1 Sales@KeenConstructionCo.com P: 978-691-5201 F: 978-682-3231 HIC #108383 5 5 i G 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 Submitted1 — T with the Commonwealth of Massachusetts. Inquiries To:�� �G 1� Lr�t1Y11 �i about registration and status should be made to the 7 Director, Home Improvement Contract Registration, 10 �-��d- Y— (}��cr `- J f Park Plaza, Room 5170, Boston, MA 02116 617-973- �� ��j i (�/� `� f r 8787 Owners who secure their own construction G�s-�/ � 'V 1 fJ�C � S4. 1 related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. EIN N0. %% I - �;,3- 2_(�. �j U �j ��-` � l / 201 MA. H.I.C. 108383 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)�G S -e C ORQ,nJ >c > Construction related permits: .._._..___._...._......__...._.............._...._.........___.._..................._. _. WORK SCHEDULE _ ................................__... .... .............._................ ........................... ........... .......... ....... Contractor will notegin the work or order the materials before the third day following the signing of this Agreement, unless specified here in In C ntraclor 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 a 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 n ✓� 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 r, 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 "P'ropose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of : / �^ id,, J S K f I,7 r7111°.—' --:!--dollars 2-9b ) C� Payment to be made as follows: i($)' % ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/ Designated Registrant % ($ ) upon completion �f /c 1175 TURNPIKE ST. r,C � 1 Street Address Nha etion-of-_ N. ANDOVER, MA 01845 �City /State e�J b� made forthwith upon (978) 691-5201 (978) 682-3231 completion of work under this contract. Phe Fax Notice: No agreement for home improvement contracting work shall require a 20 >Name nt S s an down payment (advance deposit) of more than one-third of the total contract price 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 Aulhe zee gignaILTrE 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. 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 THERE ARE ANY BLANK SPACES. Si nat re ' g Date t /� Signature Date IMPORTANT INFORMATION ON BACK ► The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street, Suite 100 Boston, MA 02114-2017 �•• www.mass.gov/dia 5 t' Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Workers Compensa ion TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information _Please Print Legibly Name (Business/Organization/Individual):t(�&_V1 Si ry L . 1 cv� o Address: M,:1 \—)Q X M,)-) rite/CtAtP./Zin. M . 1q t) cu- "36i—IPS Are you an employer? Check the appropriate box: #: 973— (7r 9 r 520 1 1.M I am a employer with 9 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 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.❑ 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. insuranceJ 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. MRemodeling 9. n 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: `�r� �5 la -5 — Policy # or Self -ins. Lic. 14 U 3 " 9 9 / 1 N1'Z - 2 — 6 Expiration Date: IG A37..Z f Job Site Address: 5 Z n n o �Ko 5 t City/State/Zip: fividoerin-01Xq5 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration ate). 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 covverfication. Idoy certify un de th ai and penalties of perjury that the information provided above is true and correct, nate. 112-1 116 Phone# 9% C- / Ems% 1, 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 DATE , 6.- R CERTIFICATE OF LIABILITY INSURANCE in/gMDDIYYYY) �/ 1n/�q/5-nta 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(iss) 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 !Silbert insurance Agency, Inc. 137 Main Street Reading MA 01867-3922 CNA E C Barbara McDonough PHONE Ek, (781) 942-2225 ac No: (781)942-2226 ADORIESS:bmcdonough@gilbertinsurance.com INSURER(S) AFFORDING COVERAGE NAIC K INSURERA Norfolk 6 Dedham Insurance 23965 INSURED Keen Construction Company 483 Chickering Road North Andover MA 01845 INSURERB:Safety Insurance Company 39454 INSURER C'Travelers Ins. Co. 0031 INSURERD: INSURER E: INSURER F; COVERAGES CERTIFICATE NUMRFRCL1552101779 RPVISIAN MI IMRPR- THIS IS TOCERTIFY 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 la TYPE OF INSURANCE 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 CLAIMS -MADE ❑X OCCUR M Gilbert, CIC/BARBAR LID -P-010078/000 3/13/2015 3/13/2016 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence S 100,000 MED EXP (Any onePerson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: X POLICY 0 J CT FI LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG S 2,000,000 $ BANY AUTOMOBILE LIABILITY AUTO CHEDULED ALL UTOS OS X SAUTOS AU X HIRED AUTOS X NON -OWNED AUTOS 6228807 COM 01 5/23/2015 5/23/2016 COM ae kemI ISMG— $ 1,000,000 BODILY INJURY (Per person) $ (Per BODILY INJURYaccident) $ PROPERTY DAMAGE $ m Underinsured motorist $ 100,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ Q WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXE­'—E.L. OFFICERIMEMBER EXCLUDED? (Mandatory in NH) y es, describe under DESCRIPTION OF OPERATIONS below N I A 6HUB-9991MSS-2-15 10/8/2015 10/8/2016 EACH ACCIDENT $ 100.000 E.L. DISEASE - EA EMPLOYE $ 100 000 E.L. DISEASE -POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) UFKI WICA IF HEM IlFN CARD `ul I A'nnKI (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 ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 2512014/01) The ACORD name and logo are registered marks of ACORD INS025 /2014011 Massachusetts - Department of Public Safety Board of Building Regulations and Standards wusu ucirfrir, Surfer vriur License: CS -076691 ROBERT A KEEN.- 12 E WATER ST 11IF North Andover WA O�j �:r® Y ,L 9.4- "w-" Expiration Commissioner 08/16/2017 Office of Consumer Affairs & Business Regulation WxME IMPROVEMENT CONTRACTOR gistration 4083x83 Type: piration:.; 8/f8 ?61.6.; DBA N_-- KEEN CONSTRUCTI::N G� ; Kenneth Keen 1175 TURNPIKE ST NO. ANDOVER, MA 018464--- - Undersecretary