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HomeMy WebLinkAboutBuilding Permit #579-13 - 40 Great Lake Street 2/27/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION I Permit NO: ( � Date Received ' c Date Issued: ' IMPORTANT:Applicant must complete all items on this page >LOC-ATIONa -(�lL.l, - -.T �— i , .. y rint1 -tet g $ r iItR®PERTII!'®WN,-JR i tJ 1 N - �r Pnnt, 100�YearOltl Structured yes n0- i MAPNO a o� PARGE ZONINGDISTRICT HlstorlclDlst"rlicfr ye`s new , y ac Ine�Shop ages y off, ; TYPE OF IMPROVEMENT PROPOSED USE Resiclential Non- Residential ' ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Nteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other F. ❑Sep�tic ❑}Welly y i -IFloodplalnt ❑1Netlands Watershed Dlstrictt ,ater/Sewer X � " DESCRIPTION OF WORK TO BE PERFJC�R ED: l lC " I Pi 4J Cw 7iLKV!V&4, i Identification Please Type or Print Clearly) OWNER: Name: �1>14 tJ rjL`G�,N I Phone: 61-11 -J/9' ,3 Address: � 6 2f -4T D RIG SO.NTR,A�C _Phone � _-G�'/ , I T F S` '''f/ f c� �' —�F +G"ti-r •--•c.y yI. (5Ad'd re - - , l Sup�e�nn'sorCorstrucfionLlcense TS g 4EX`� F hHorn�'Irn rovement�Llcense_�� �D 8343 3- . � 'Ex^�_�Date} ZS /y w _�- ARCHITECT/ENGINEER Phone: I Address: Reg. No. $ FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. it Total Project Cost: $ S r5 i 710 FEE: $ 70 Check No.: �Z Receipt No.: ( ��-- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I r^+-.earagrkw,"4'F'...` "— r"» °'9"�r"�"'L... "z'° ^a.`�°"' sirs` ."m+ep.w...s-•+a...�:*^..--.+r """*"y}." " s"'"R r w wstsc-"F ��ignature�,of,�Agent/1®wner���r�,M :-�.r .� .r.=_,,�,v_Y�.�Si nature of�contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans .-'�'...tip e _ -''" -'^-:'•r. =*•`Frw,.}.r`+'14'n.--�.'`p�•b .,y_- .. .;-�Y t__, L, a _ �. .� ,- . .. Location No. —� Date lJ' 4 - e # TOWN OF NORTH ANDOVER � Certificate of Occupancy $ Building/Frame Permit Fee $ - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ d! Check#� 26177 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales I ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM BATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature ' COMMENTS HEALTH Reviewed on Signature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments x Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit a DPW Town Engineer: Signature: Located 384 Os ood Street FikE DEPARTMENT -.Temp Dumpster on site yes, no Located at 124 Mairi Fire Depai-�ment signatureldate " '{ COMMENTS : ;_ I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Totai 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.$10041000 fine I , I NOTES and DATA— For department use I h i El Notified for pickup - Date Doc.Building Permit Revised 2010 I I Building Department The folowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract u Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I i Addition Or Decks o Building Permit Application a Certified Surveyed Plot Plan u Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And I Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract u Mass check Energy Compliance Report o 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 appy al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building permit Revised 2012 Enter construction cost for fee cal - Not h Andover Fee Calculation Construction Cost $ 58,770.00 m $ - $ 705.24 Plumbing Fee $ 88.16 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 88.16 Total fees collected $ 981.55 40 Great Oak Street 579-13 on 2/27/13 Bath and Kitchen Remodel Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost 5.181,770.00 m $ - $ 705.24 Plumbing Fee $ 88.16 Gas Fee 100 comm. $' 1'00.00. Electrical Fee $ 88.16 Total fees collected $ 981.55 40 Great Oak Road 579-13 on 2/27/13 Bath and Kitchen remodel r ,_ NORTIi . )wver 0 No. f t - h ver, Mass, CoCNICMl WICIC 01- 0, ►Pa�,�S S V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System . THIS CERTIFIES THAT ...............�-T. .Qh�..:.... ..... 1.��............................................................. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ....yQ........ 04 .4....Q& •.•..............••• _ 1 Rough to be occupied as .....Kt y Q, T' '' y .. ............. ..... �.. �1..... ........,..... . ........ .........f......................... Chimne 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 CONSTRU ST TS a Rough MJ ML Service ............ ..... 1� ............. Final ....................... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SEE REVERSE SIDE KEEN CONSTRUCTION CO. GP ��� 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978)691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax:(978)682-3231 specifically exempt from registration by Provisions of - 1 Chapter 142A of the general laws,must be registered with Submitted `I(D f� Y.) �/. (JI"� the Commonwealth of Massachusetts. Inquiries about To: __—___ -.._— registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02108 (617) 727-8598. Owners who secure their own construction related v;I Li { ) permits or deal with unregistered contractors will -- be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATE / REGISTRATION NO. EIN NO. MA. H.I.C._1.0088383 26-0462904 > CIS=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, �P1� It raCl n� I .. -- All -- -- ----- - ------ ------- onstruction-- .related. permits: ..._.........-.._.._..........................._....._-_,_____.._._.......__...._........................................._._.............................__............................................................................................................................... WORK SCHEDULE Contractpr u t jg'n the work or order the materials before the third day following the signing of this Agreement,unless specified her r Ing.Cont!ractor will begin the work on or about .( (date). Barring delay caused by circumstances beyond contractor's control,the work will be completed by �� / 5 (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 Contractor, Is 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 PlOpose hereby to fur�ish material and labor-complete in accordance with above specifications,for the sum of I U(11 1 PP.. f ,� V61 ;/ ?�ttf�'t'1 "-dollars($ �> G" j27. J0) Payment to be madeWs follows: )• —% ($ ) upon signing ontract; i KENNETH B. KEEN/ROBERT A. KEEN r ^ , Name of cOtraclor/Designated Registrant —% y�)�ue �hg%n lekron f 21 HEWIITT AVE ..._ .. - -. .....a.St eel Address ol N _ $�.�-j) u�on completion N. ANDOVER,, MA 01845 �'S City/State % ($ ) shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Phone Fax 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 Nae of Salesman / i m 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 Amhonzed'Slgnamre y. equipment,whichever amount is greater. .. Note:This proposal Maybe withdrawn by us it not accepted within days. Acceptance Of PCOpOSBl -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. � Date Signature Dale IMPORTANT INFORMATION ON BACK KFEN CONSTRUCTION CO. 21 HEWI r7"X111 , - . iaav2, 0184-1 978-691 -5201 Ke�nCo� utrux,ttC.-C110 V;V John.R. Allen 40 Great Oak St. N.Andover, IVIA 01845 Contract#5051; Appendix A bate: February 21, 2013 Kitchen: Remove and dispose of all cabinets.and counters Remove:and dispose of waI1b, rd anti insulation Remove and dispose of file floor(1 day allowance} Upgrade electrical to-code Supply& instal[six recessed light fixtures and switching Update pvents lumbing drains; nts and faeds`as;needed (k Supply&install insulation to.code Supply&instal{ blueboa'rd and skimcoat plaster to smooth finish ® Supply&install flooring underlayment i ® Install cabinets;.related trim,granite counters and sink(supplied by Plaistow Cabinet) Supply&i=nstall trim on base;door and window,to match existing a Supply&install'kitchen faucet($600 Mmaterial`allowance) ®. install customer supplied:(or existing)appliances Supply& install vinyl sheet flooring jkitchen and,bath,$1000 installed,allowance) Bathroom: _ ® Remove and dispose of existing:bathroom fixtures and.cabinets . Remove.and dispose of wallboard and insulation e Supply&install Sterling fiberglass tub/shower unit ® Supply&,install insulation to code - Supply.&, blueboard.and skimcoat plaster to smooth'finish e Supply Sc.install new toilet, sink faucet;shower valve,twotowel:bars and one TP holder($1350 material'allowance) Supply&instal! linen cabinet,.vansty.and sink top(suppliers b}t Rlaistov kabinet} 'Supply&`install medicine cabinet andht g ($light 200 material allowance) Page l of 2 KEEN CONS7'2uC7'ION CO. 21 YEW17r AVE. N. ANDOVER, Mit 01845 978---691 -52.01 ]Ce�.v�Co-�tvuc��,owLCo-:co-vw Basement: • Remove and.dispose of all water damaged debris.in basement • Remove-electrical outlets per conversation with.customer • Upgrade switching to code • Supply& install 30 position 100 amp breaker panel • Supply& install circuit and-outlet for sump pump; • Supply& install.new sump pump with"back'up • Paint floor and walls in "fireplace"%of:basernent Misc.: • Supply& install new fiberglass.front door(six panel,two lite)"unitper conversation with customer, including new lockset&dead bolt • ;.Supply:& install Harvey full=lite Lifetime storm door on front door Supply.& install six new interior six panel hollow-core smooth "slab" doors, per conversation with customer • Paint all wails,trim and ceiling in house(incl.uding breezeway) Total Price:$58,777(fifty eight thousand seven hundred sevent seven . .dollars). Price:does not include cost of permits; upgrading of electrical outlets and"switches, new attic stairs, changes requited by inspectors, kitchen appliances.or repairs due to inadequate,unsafe or unusual existing conditions. Pa " yrrient schedule:$1000 due`upon signing contract $20,000 due by February 27, 2013 $10,000 due by March.1, 20137 $10;000 due by March-21,2013 $10,000 due by.April 4,2013 $7,777 due at completion of contracted work CustgKer Date 31 Kenneth B. Keen . Date Rage 2 of 2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Uf 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant.Information Please Print Legibly Name(Business/Organization/Individual): K E N (p W LYE v Address: l l^tN I ` ✓C Ci /State/Zi O $ r tY p _Iu• "dJ c� c7 J£2, ✓� Phone#: Are you an employer?Check the appropriate box: Type of project yp p o�ect(required): 1.[t]'1'am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. o workers' comp.insurance 5. 9. ❑Building addition � p. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL . 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' comp,insurance required.] 13.0 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �12,.o f I I.A s S N S , Policy#or Self-ins. Lic.#: (y 1'e- U S 3 f-6 7,2 6 ' /a Expiration Date: Job Site Address:_ 1'�7� t'ZL�A T le— S City/State/Zip:_ iq , !0 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 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. I do hereby certi un er the pains penalties ofperjury that the information provided above is true and correct Si nature: �y Date: Q� .-1 3 Phone#: ! 7 2 & ! / Official use only. Do not write in this area, to be completed by city or town official City or Town: Pernut/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#: 8/15/201.2 12,SB P.f: FROM:' Gilbert;,Gilbert Insurance Ag'e.ncy ,Inc:, T0: +,1' (978)..682-323,1 PAGE:::001,OF-002 PRODUC� M:- CERTIFICATE OF L;IAB[LITY INS:U ' "NCE o8/is/ioiz (.781)942-2225 ;. FAX ;(781)942 22;,2.6 THIS,CERTIFICATE IS ISSUED AS A MATTER,OFINF-6k IQN Gilbert Insuw.ance Agency; Inc. ONLY AND CONFERS NO RIGHTS U,RON THE:CERTIFICATE HOLDER THIS CERTIFICATE DOES:NOT AMEND,EXTEND ORi i37 Main Street ALTER THE COVE RA GEAFFOROED;'BYTHEPOLICIES-BELOW: Reading,, MA 01867-3922 INSURERS AFFORDING COVERAGE NAIL# iNsuRED .Kenneth.'Keen &' Robert Keen INSURERA NORFOLK & DEDHAM. INSURANCE 23.965 DBA DBA. Keen ;Construet:ion'Company INsuRER,3 T,rayelers Insurance. 21 -Hewitt Ave, INsu�t c "North A"Tidover., MA 018.4.5 INsuRERD: THE POgICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLIGY PERIOD INDICATED NOTWITHSTAND'IN� ANY REQUIREMENT TERM QR CONDITION OF ANY CONTRACT OR.`OTHER DOCUMENT:WITH'RESPECTTOWHICHITHISCERTIFICATE,M.AY BE iSSUEq OR MAY PERTAIN THEINSURANCEAFFORDED BY THE POLICIES DESCRIBED HERE IN IS SUBJECTT:OALL''THE'tERMS-EXCLUSIONS AND;CONDiTIONS OF•SUCH POLICIESi AGGREGATE LIMITS SHOWN MAY HAVE BEEN;REDUCED.BY PAID C[AIMS INSR NS rDD POLICYEF;FECTTVE POLICY;EXPIRATION ` TYPE OF INSURANCE POLICY NUMBER,, LIMBS cENERALLIAeaITY ND=P 0100'78/000'_03/13%2012 03/13/2013 EACH OCCURRENCE $ 1 000 00 X COMMERCIALGENEFbV LIABILITY DAMAGETORENTED' loo ` CIAIMS MADE}�OGCIht MED F�(P(Ariy one person) $ 'S,OO A' PERSONAL&.^ADV INJURY $ 1, OOO OO' GENERAL AGGREGATE: GEM AGGREGATE LIMITjAF PLIES PER PRODUCTS 'APG _p X f OUCY? 'PRO JECT,, LOC AUTO MOBILE LIABILITY ANY AUTO (EeMec dent)INCL E LIMIT A 9 LLr bVMD AUTOS' SCHEDIAEDAUT05 B"ODILY INJ(1RY- $ (P„er.personp HIRED;AUTOS NOtJ-0WNE0 AUTOS {Pere aldentj Y $ r (iReOr PERMCA GE $ GARAGE LIABILITY AUiO ONLY=:FA ACCIDENT $ THE ANY AULO , '• FA ACC $ ALI 0o AGG $ EXCESSAIMBRQLALIABILITY ;EACHOCCURRENCE $: ,OCCUR: ❑.CLAIMS'MADE : AGGREGATE` $ DEDUCTIBLE: $ .`RETEPfIION $ .. - WORKERSCOMPENSATI0NAN0 6KU8 5B4Q726 A 12O3/2012 .08/O3,/2013 WCSTATII QTH EMPLOYERS LIABILITY ANY'PICER/MEMBERROPRIETOR/PARTNEf2rEXECUTIVE -i Ea,EACH ACCIDENT $ LOO OO ; OFF ;D(CLUDED?' I(ye5„i3eScnbe under; 9 NS below, _ ,OISfASE:-FAEAq�LOYE S lOQ,OO SPEEIAL'PROVISI E:L-DISEASE-POLICYGIMIT V•lGIenC2o0f COVera9eAnONS/VEHICLESIEXGLUSIONSADDEDBYEN DORSEMENTISPEgAL'PROVISIONS - - 'CEkTiol 6-'A 0 SHOULD AMf OF THE ABOVE DESCRIBED•P,OL'ICIES;BE CANCELLED,BEFORE-THE E O..IRATION DATE THEREOF,THE ISSUING INSURER)WILL,ENDEAVOR.TQiMAIL lO DAYS WRRTEN NOTICE TO THE,CERTIFICATE r.Lr.DENM HOR L.AED TO THE,L'EFT; BUTFAILURE TO'(MAIL 3UCH NOTICESHALL IMPOSE NO OI;IIGATION ORILIABILRV:�' OF ANY KIND UPON THE INSURER,RS:AGENTS OR!REPRESENTATTVES EK'l CIe�Ce•. Oi COYerage; AUTHORIZED REPRESEfYTATiVE' Mal^k Gilbert CICa , -: - ACO RD.254,2001/08) ©ACORD CORPORAT.ION19;88 Board of Building Romlations and St o dar(ls Construction Supervisor License License: CS 76691 z ROBERT A KEEN , 12 EWATER ST N ANDOVER, MA 01845 - Expiration: 8/16/2013 ('i0nuuissiuner Tr#: 3772 Massachusetts -Department of Public Safety . Board of Building Regulations and Standards Construction Supers icor License: CS-058245 KENNETH B t&EN 1 21 HEWITT AVE N ANDOVER MA,„01845 "7lrl Expiration Commissioner 03/24/2014 �efie�pomvrzo.u�Pa// o�C �adw4e,, Office of Consumer Affairs&.Busibess Regulation OME IMPROVEMENT CONTRACTOR egistration: A"08383 Type: zpiration:..8/18i�014 DBA KEEN CONSTRUCT10Ff C0 r Kenneth Keen } 21.Hewitt Ave No.Andover, MA 01845 Undersecretary i