HomeMy WebLinkAboutBuilding Permit #373-2016 - 379 BOXFORD STREET 9/22/2015 NORTH
BUILDING PERMIT oFttiEo ,b;�tio
TOWN OF NORTH ANDOVER c�
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received �`° P`,y
y Areo �(
I SSACHUSfc
Date Issued: ��
IMPOR+T�ANT: Applicant must complete all items on this page
LOCATION 3 9 Boy, —Fo 1'8 'S-f-
Print
PROPERTY OWNER `Y 1�`�� KC.,:�_ e_ ock
Print 100 Year Structure yes
MAP /,a PARCEL: I 1 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑ Addition 11 Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
JCRepair, replacement 0 Assessory Bldg ❑ Others:
❑ Demolition ❑ Other _
i ❑Septic ❑1Nell ^'g ❑lFrodpli '1%Vetlarids ❑❑WatersheEtDstrifi;
Y Vl/ater/:Sewer{
DESCRIPTION OF WORK T"E PERF MED:
Identification- Please Type or Print Clearly
OWNER: Name:�Kc,++ -b kc f i e- L_ j Phone:
Address: 319 Gox PoY-J 5t k, Ar,C�-'Vt0i Yq5
Contractor N me: Keen C $4�'�; 6 Phone: 7 9- 9j 0
�I
Email: E1 e, ' ,Qer-, Svc i�.�+co , e0,A,-,-
Address: i I 5 To /)
r- 0, V- Sf i J A KCJcVt v . Wry- 0 i
Supervisor's Construction License: G5- O.7 6 9 I Exp. Date: 2h(o �/ 7
Home Improvement License: t Exp. Date: '911 ,F lI
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: $ 1 I 5 FEE: $ 1ql
Check No.: I�� Receipt No.. � t�
NOTE: Persons contracting with unregistered contractors do not have access to they a arty nd
p10RT7�
BUILDING PERMIT oFt�L�o ,6;�tio
TOWN OF NORTH ANDOVER 0h " . .
APPLICATION FOR PLAN EXAMINATION
Permit No#: / Yj � Date Received �qs RATE, e�;�e5
SACH�15
Date Issued: 17-4/1 K-
IMPORTANT: Applicant must complete all items on this page
LOCATION 3 .—A
Print
PROPERTY OWNER Lir Y1C.�1
Print k100 Year Structure yes
MAP 10 PARCEL: 1 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑ Addition p Two or more family ❑ Industrial
❑ Alteration No. of units: ❑ Commercial
giRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other _
Septic UVell T ❑1Floodplain OhWetl'ands r Watersh�edu+®rstnct��
a r_ -
`Water/Sewer _
DESCRIPTION OF WORK T(�-BE PERF MED:
Identification- Please Type or Print Clearly
OWNER: Name: Pa:�+ -b kc,.+i e- vxc." Phone:
Add ress: 3 9 V'3 IA k of r- 0 i YC45
Contractor N me: veev, Cc7..-$4 Phone: — d
Email: e1 - Qe" i CO , evz^--
Address: i ke_ 54 M . A M- eyc r WA-
Supervisor's Construction License: 05- 6-7 w 6 9 Exp. Date: 2��Cv �l 7
Home Improvement License:�,��3 Exp. Date:
ARCHITECT/ENGINEER - Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASTED ON$925.00 PER S.F.
Total Project Cost: $ 1 ( ) 5 b `� FEE: $ 141
Check No.: I Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to th a af�ty end
Location f
X -�
No. Date
. • TOWN OF NORTH ANDOVER
Certificate of Occupancy $
�g
Building/Frame Permit Fee $�L
Foundation Permit Fee $
Other Permit Fee $
A TOTAL $
Check
i
� r
Buildin IrIspector
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 Si nature
HE Sia
nature
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
aFIREiDEPAR+T,dMENYTemD'umpster onsite
;tLocated at 124 Mam'St�e-AV�� Rom
,„ent si naturete Y�< : iki
tFired P g ...-`_.
S}/� ,Zz � �x !°�,�,�-�, ��`t 4y� �xf�', �'
Z`-i'c �j' uY� .x r Y 4"-
'.i...+4-t ..c y .s s c q hjz .a crx"hy t v
Y
COMMENTS k�' b � ;
s`.... .u.,.';.<.>.x....,.c� ...><:.:..:.. s.. L. •:.;s
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, creast or service drop requires approval of
Electrical Inspector Yes No
DANCER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
LJ Notified for pickup Call Email
3
I Date Time Contact Name
Doc.Building Pennit Revised 2014
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
❑ 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 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/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
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
NORTI�
own of
. � ndover
o - .:�.: ,
. .
.No. 3• �G� - h
h ver, Mass, ? ��
COCHIC"R WICK-y�•
A�RATEO r.Pa�,�S
S U BOARD OF HEALTH
PERMIT T LD Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT ......
has permission to erect ,S7/./62Y A-W2P Foundation
.......................... buildings on .... .. ............................
Rough
to be occupied as ......................................
............*.......................
........................
................................. chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION TARTS Rough
Service
... . ....................................... Final
DING INSPECTOR --
GAS INSPECTOR
Occupancy Permit Required to Occupy.Buildin Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
551-6
KEEN CONSTRUCTION CO. PROPOSAL
° R
1175 TURNPIKE STREET
NORTH ANDOVER, MA 01845 All home improvement contractors and subcontractors
Tel: (978)691-5201 engaged in homeimprovement contracting, unless
Fax:(978)682-3231 specifically exempt from registration by Provisions of
'/ I Chapter 142A of the general laws, must be registered
Submitted b!�\I'e �, ,�-�. +L y, G with the Commonwealth,'Of Massachusetts. Inquiries
I\ 111 111 about registration and status should be made to the
Director,Home Improvement Contract Registration,10
/ 1)DX pi' ST Park Plaza, Room 5170, Boston-MA 02116 617-973-
8787 Owners who secure their%wn construction
t 1 V�[,���� �Y{'' Q l (, related permits or deal with unregistered contractors
will be excluded from the Guaranty Fund Provision
of MGL c.142A.
PHONED!/ REGISTRATION ENO.
!Z/1 Z I MA.. H.I.C. 108383 466—3783401
> C/S=Customer Supplied S+I=Supply+Install Yd See Attached Appendix A
We hereby submit specifications and estimates for work to be performed and materials to be used:
�od V11
F� e � + fie
> Construction related permits:
_-.-__......._.....__M_..,..._.,._._.....__._..._.____._.__........_,._....._.............._.._...._....._.....................................................................................,......................................,........................................,......._...............__..................___.,.._.._...............___..................
_.......,..
WOR
C DU E
about S
Contra w' he work or order the materials before the third day following the signing of this Agreement,unless specified her i fill tactor 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
acknowledg s and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no a consi ered 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 — C 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 complelion.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
E7�e�e , lI�ays<,I� �eye1� \���nc� lFIE�,, l���k ($ 1 Un
Payment to be made as follows: I ��T —'�CIIarS ),
/o ($ ) upon signing Contract; 1 \ ROBERT A. KEEN
r \ Name of Contractor/Designated Registrant
($ upon romoletio f 1175 TURNPIKE ST.
SI el Address
ei.
g ANDOVER
( ) u �i c mpletion of N r
MA 01845
(� - City/Stale
) shall be made forthwith upon (978)691-5201 (978)682-3231
completion of work under this contract. PTFax
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 of sales pa
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 Auth ed-Sigintruffire
equipment,whichever amount is greater. Note:This proposals may he 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 trans ction.Ca cessation must be done in writing.
1 O OT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
/ r /
Signature Date SI S Signature Data
IMPORTANT INFORMATION ON BACK ►
'fen
- _ =-- Cons eschion Co,
HEANC3DEL1/VG tiPLC1AL15'1'S
978-697-5207 I
KeenConstructionCo.com
Lynch, Katie& Matt
379 Boxford St.
N. Andover, MA 01845
I
Contract#5526;Appendix A August 12, 2015
Remodel powder room: $8450
• Remove and dispose of ceiling,tile floor(8 man-hour allowance) and existing plumbing fixtures
• Supply& install new fan/light combo, upgrade electrical as needed
• Supply&install new laundry valve, install customer supplied plumbing fixtures
• Supply& install W blueboard on ceiling and skimcoat plaster to smooth finish
• Supply& install trim to match existing
• Supply&install underlayment and the on floor($5/sq. ft. tile allowance)
• Paint walls, ceiling and trim
• Install customer supplied cabinetry
Front foyer:$3308
• Remove and dispose of existing floor in foyer(8 man-hour allowance)
• Supply& install underlayment and tile in a herringbone pattern ($6/sq.ft. the allowance)
Prices do not include cost of permits, cabinetry, plumbing fixtures or repairs to any unusual, unsafe or
non-code compliant existing conditions not addressed in this quote.
Total Price:$11,758.00(eleven thousand seven hundred fifty eight dollars)
Payment Schedule: $1000.00 due upon signing contract
$2000.00 due the first day of work(plus permit fees)
$3000.00 due when demo is complete
$3000.00 due when plaster is complete
$2,758.00 due at completion of contracted work
r
c u'sTKmer Robert A. Keen
La�
Date Date
1175 Turnpike St. Page 1 of 1 P: 978-601-5201
N.Andover, MA 01845 F: .978-062-3231
GSL #076691 Sales@KeenConstructionCo.com HIC #108383
The Commonwealth of Massachusetts -
Department of Industrigl Accidents
Office of Invesfigations
600 Washington Street
Boston,MA 02111
UV vww.mass gov/dia
workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians[Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/lndividual): (),A 5+t'l�
Address: =y r n b', �-+-
City/State/Zip: Phone#: (�
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with �— 4. El am a general contractor and I 6. E]Now construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.XT 7. [�Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. g. E]Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),a-ad we have no 1211Roofrepairs
insurance required.] employees.[No workers' 1311 Other
comp.insurance required.]
*Any applicantthat checks box#I mustalso fill outthe section below showing their workers'compensation policy information.
p"Homeowners who submit this affidavit indicating they t:re doing all workand then hire outside contractors must submit anew affidavit indicating such.
TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
X am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjoh site
information.
Insurance Company Name:. " vf.I r j ' S ll�rf%L��C
Policy#or Self-ins.Lie.#:_LA�u \,'� •v `� � _L � M�1�-2.-'L�xpiration Date: /� /
Job Site Address: 9 �� Ttly C �" City/State/Zip: o "'f to, d vel
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
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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cerf r th gins dpenalties ofperjury that the informationprovided above is tru andcorrect. -
Si ature: / Date: 19
Phone#
Official use only. Do not write in this area,to he 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.EIectrical Inspector 5.Plumbing Inspector
6.Other - - -
Contact Person: Phone#:
RightFax C3-1 3/24/2015 9:51 :03 AM PAGE 2/002 Fax Server
DATE(MM/DD,
CERTIFICATE OF LIABILITY INSURANCE
T. IFICATE 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 BELO\
TOHIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATI{,
R PRODUCER.AND THE CERTI[MATE HOLDER.
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 lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
GILBERT INS AGCY INC PHONE FAX
137 MAIN STREET (A/C,No,Ext): (A/C,No)-
E-MAIL
READING,MA 01867 ADDRESS:
246WY INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA
KEEN CONSTRUCTION CO INSURER B:
INSURER C:
INSURER D:
1175 TURNPIKE STREET INSURER E:
NORTH ANDOVER,MA 01845 INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 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.
INSRADD 3U6 POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (LWDD\YYYY) (MMMD\YYYY) LIMITS
GENERAL LIABILITY =-ACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $
CLAIMS MADE OCCUR. REMISES(Ea occurrence)
ED EXP(Any one person) $
ERSONAL 8 ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $
POLICY Q PROJECT LOC IRODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY COMBINEDSINGLE $
ANY AUTO LIMIT(Ea accident) _
ALL OWNED AUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
(Per accident)
NON-OWNED AUTOS PROPERTY DAMAGE $
71 (Per accident)
UMBRELLA LIAR OCCUR EACH OCCURRENCE_ $
EXCESS LIAB [71 CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
A WORKER'S COMPENSATION AND XWC STATUTORY OTHER
EMPLOYER'S LIABILITY YM UB-999IM582-14 10/08/2014 10/08/2015 LIMITS
ANY PROPERITOR/PARTNER/EXECLMVE N N/A E.L.EACH ACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
1600 OSGOOD STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENT
NORTH ANDOVER,MA 01845
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved.
�`�.
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`,
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
�.IIIIsLI Ul.Llll11 JUIIGI 11 111
License: CS-076691
ct:rr.c ty
ROBERT A KEE4-- r�
12 E WATER ST
North Andover ha 0
r
y ` .
Expiration
Commissioner 08/16/2017
fie�pay�mo�reus o�C��acLur�e�
Office of Consumer Affairs&Business Regulation
rME IMPROVEMENT CONTRACTOR
gistration: x108383 Type:
piration 8/'f01;6, DBA
r M� s `
KEEN CONSTRUCTION CO
V
Kenneth Keen
1175 TURNPIKE ST
N0.ANDOVER,MA 01845 Undersecretary