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HomeMy WebLinkAboutBuilding Permit #599-12 - 40 HITCHING POST ROAD 2/14/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � I L�) ii Permit NO: I� Date Received '?,--- Date Issued: r�/IMPORTANT:Applicant must complete all items on this page LOCATION `!U i Tc 4 P0 37 /2 CJ( Pint PROPERTY OWNER ,+2 a C,iu Print MAP NO:Q(P S PARCELA,�-7? 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 Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other q'Septic D Well ❑Floodplain ITWetland`s 'D Water`sledfDstrict . Water/Sewer DESCRIPTION OF FOrK TO BE PEIVORMED: 12►� - Identification Pleas ype or rint Clearly) 4 7 Wrt OWNER: Name: l %J L' i [� � Is- PSS i i S Phone: W1y Address: o !r tc L, i a CONTRACTOR Name: tz P 7 � Phone: 6>02*1'� zO l Address: a k 11 A , t Y , P4 Supervisor's Construction License: 5 Q; Exp. Date: Home Improvement License: /a 7:57 Exp. Date: '! ARCHITECT/ENGINEER Phone: Address: Reg. No. { FEE SCHEDULE.BULDINGP RMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED$925.00 PER S.F. J Total Project Cost: $ ct So O FEE: 013 If o0- $ Check No.: Receipt Receipt No.: _ , �,6bl,4 NOTE: Persons contracting with unregistered contractors do not have access to the guara�p fund Signature_of Agent/Owner.. F. . Signature ofcontraeto 1 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 ❑ Flo or/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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i 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: Doc.Building Permit Revised 2008mi 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 servicedroprequires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use i ® Notified for pickup - Date Doc:.Building Permit Revised 2008 -- - ` -- r. 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS ' HEALTH Reviewed on Signature — COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning, Board Decision: Comments y Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit _ DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date i COMMENTS Location No. I 1 7i Date ' TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 4W6 25024 Building Inspector NORTH Tovm of 0 o o , dover, Mass., . ;0: L A K E COCHICHEWICK ��t RATED p' -\y BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR �l v C SS i oU,s THIS CERTIFIES THAT.........'`.0 ............YY....................................................................................................................................... Foundation yU /�'fes i �o has permission to erect........................................ buildings on -�� ... .. . Rough T- �f' // ...... G !? A✓r" l�G l" Chimney to be occupied as.. . . . . . -� `?` . . :.. .................... . . . . . .. . . . . . . . . ..............:.............. provided that the person accepting this permit shall in eve, respect coi6rm to the terms of the application on file in Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STATS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises - Do- Not Remove Final No Lathing or Dry Wall To BeDone FIRE,DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDESmoke Det. - o -• Vlassachusetts - Department of Public Safeo / Board of Building Regulations and Standards Construction Supervisor License License: CS 76691 ROBERT A KEEN , 12 E WATER ST N•ANDOVER, MA 01845 C Expiration: 8/16/2013 ( nimisciuncr Tr#: 3772 'ulassachusctts- Departnurit of Public Safet\ _ Board of Building Regulations anti Standard; Construction Supervisor License License: CS 58245 Restricted to: 00 KENNETH B KEEN 21 HEWITT AVE '." N ANDOVER, MA 01845krt"' Expiration: 3/24/2012 ( u��uui>siunc�' irk 20523 Offic fi!,o su°m rt rs dsiness egu a o HOME IMPROVEMENT CONTRACTOR R W Registration: X108383f Type:. I Expiration: :811_8/2012 DBA K CONSTRUC1101� U Kenneth Keen 21 Hewitt Avet No.Andover,MA 01845` Undersecretary i Michael Hovnanian<michael@michaeljamesdesign.com>(�9 Proposal and Layout for Permit February 14, 2012 7:35 AM Michael 234B Pleasant Street Methuen,MA 01844 James KITCHEN AND BATH DESIGN PHONE:978.689.4724 FAX:978.945.8808 EMAIL: michael@michaeljamesdesign.com Design, Inc. WEBSITE: www.Tnichaeljamesdesign.com PROPOSAL Customer: Cindy and Karl Pessinis Phone: 1-978-686-5349 Date: February 14,2012 Pages: 1 of 2 Job site: 40 Hitching Post Rd No.Andover,MA #1 Medallion brand wet bar cabinetry $ 7,689.00 #2 Granite countertop $ 3,456.00 #3 Handles and knobs $ 150.00 #4 Sales Tax $ 705.94 #5 Total $ 12,000.94 #6 The prices above include: #7 The design as represented on the floor plan provided with this proposal #8 liberty Maple cabinetry with the Onyx black stain #9 Medallion Silverline construction features #10 Solid wood dovetailed drawers #11 Wall cabinets to 84"A.F.E(32"upper cabinets) #12 12"plywood end panels for all exposed cabinet ends #13 Classic crown moldings #14 Solid maple solid stock moldings #15 3/4"light rail moldings #16 Furniture base moldings for the back of the bar area #17 Matching toe kick moldings #18 Scribe moldings #19 One factory touch up kit #20 Three clear glass doors #21 Two small wine cubes #22 One trash bin pullout cabinet #23 Solid maple wainscot panels for the back and ends of the bar #24 Delivery #25 Terms:50%deposit due at order time;balance of the materials payable prior to delivery of the cabinets to the jobsite. #26 Signature: Date: i CUSTOMER: SHIP TO: DOOR STYLE: COUNTERS: TOP LIBERTY MOLDINGS: CINDY AND KARL 40 HITCHING SOLID 2-CCM8 PESSINIS POST RD WOOD GRANITE 2-PSSG386 1-978-686-5349 NO ANDOVER,MA SPECIES: MAPLE BASEMENT BOTTOM WET BAR COLOR:ONYX MOLDINGS: NONE TOE KICKS: 2-TK96 FURNITURE BASE: 3-PSSG696 92'" SCRIBE: 4-MLDB TOUCH UPS: 1 -RKPG W1832-1- W1818-L, W3618 W1832-R 624E 3D636 BAR REFR BAR AREA PARTS: 2-PNL344896 6-1DBP40 2-BSOC640 1 -DEP3W DW SB30B B15WB rn Design by: Michael James Design, Inc. 1-978-689-4724 8/22/2011 1:36 PM FROM: Gilbert Gilbert Insurance Agency, Inc. TO: +1 (978) 682-3231 PAGE: 001 OF 002 ACORDM CERTIFICATE OF LIABILITY INSURANCE 05jz/2011 PRODUCER (781)942-2225 FAX (781)942-2226 THIS CERTIFICATE IS ISSUED AS AMATTER OF INFORMATION Gilbert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 137 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Reading, MA 01867-3922 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Kenneth Keen & Robert .Keen - -INSURERA: NORFOLK & -DEDHAM INSURANCE .23965 DBA: DBA Keen Construction Company INSURERB: Granite State Ins. Co, 0077 . 21 Hewitt Ave. INSURER C: North Andover, MA 01845 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERMOR 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD TYPE OF INSURANCE POLICY NUMBER POA EY EEXPIRATION POLICY ETION LIMITS GENERAL LIABILITY ND-P-010078/000 03/13/2011 03/13/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDnce) $ 50 OO CLAIMS MADE a OCCUR PREMISF MED EXP(Any one person) $ 100,00( A - - PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GENL AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG. $ 2,000,00( X POLICY - LOC , PRO AUTOMOBILE UABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS - (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGELIABILITY AUTO ONLY-EA ACCIDENT .$ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLALIABILITY EACH OCCURRENCE $ OCCUR 7 CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC009646942 08/03/2011. 08/03/2012WCSTATL1 OTT+ EMPLOYERS'LIABILITY WC CERT TO BE MAILED B ANY PROPRIETOR/PARTNER/ECECUTIVE E.L.EACH ACCIDENT $ 100 OO OFFICER/MEMBERE(CLUDED? DI ECTLY VIA INS CARRIER It yes,describe under E.L.DISEASE-EAEMPLOYE $ 100,00 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(EXCLUSIONS ADDED BYENDORSEMENTI SPECIAL PROVISIONS vidence of Coverage ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Evidence of Coverage AUTHORIZED REPRESENTATIVE Mark Gilbert CIC ACORD 25(2001108) ©ACORD CORPORATION 1998 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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 1./�6 m 5"t(L V Ci J a k �p Address: 0 E w IT e City/State/Zip: N a d J 10, 14 Phone#: 7$ &q l _,Spjb1 Are you an employer?Check the appropriate box: Type of project(required): 1.CYam a employer with_r 4. ❑ I am a general contractor and I 6. gZmode:g onruction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7• ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their ME]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' 13.❑Other comp.insurance required.] *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: G tZf_) N• _'c ! 'tA+,C! Policy#or Self-ins.Lic.#: Li.3 C o0 9'L q(7 I q:p. Expiration Date: ? Job Site Address: 40 /7t cf k;,n&'L2p T A� City/State/Zip: tU . fq 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 cern der the pain and enalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: `y 7� • �,� ( `,� pZQ t 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#: 5038 KEEN CONSTRUCTION CO. GP EMIL Emillilk A*1W& A` L a 21 HEWITT AVENUE FKUrUSA 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 with Submitted Y�IJ d Ni S the Commonwealth of Massachusetts. Inquiries about To: ___/_`__,__ __ ! �`'......._ .._. ... FSS ` _ registration and status should be made to the Director, Home(mprovement Contract Room 1301, Boston, M 02108to n,One Ashburton Place , (6117) 727-8598. _______. ......................_..........__._ 't` �'�....��.1.____.____._..._.__._._._.._. n f� Owners who secure their own. construction related �.._ A � uC�-- - ._.0�_g _._ __ permits or deal with unregistered contractors will — t.._. be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. EIN'NO. 5349 2 1 f 2 MA. H.I.C. 108383 26-0462904 > 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: _---- ...... — -- -- • 9\00> y 1 l v fM b t `n�-- . 0;,.1 d. T Vl S 1. ._... S.._ +u r1.j _. ......._..._.......__. .......... _-....... ---_-_- d.2 C v cowl c�- ........ p > Construction related permits: ............._...__...........,..__...................._._.__......................_,...............,....._...........,......................,.........,.,.,.,........................,...............,............................................,..,..........,..,........,............................ ....,..........,.....,.........,.,............,..........................,......._.... _.........._................._.,........................ ........................ ..............,.............,.......... ........... ........ ........................... ........ .... ................... ...... ....... .......... .................... ................. .......... ................... ......... ................. -......... .................... ........................... _.............. ........................ ......... ........................ WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor 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 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,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. WeProposehereby to furnish material and labor-complete ingordance with above specifications, for the sum of Zqe, mill � O dollars($ 60 •d6 Payment to be ma as follows: ) ,3Z— % ($25601 ' ) upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN rName of Contractor/Designated Registrant 33— % ($ �DO ) upon completion of- "e_ b roe . e[ 21 HEWITT AVE. I - II Street Address Z1 % ($ a d00 ) upon completion of 1otndr,4cd A P 1cc5 l (ta,. N. ANDOVER, NIA 01845 City i Slate shall% ($ �� ) completion of work under this contract.e made forthwith upon (978) 691-5201 (978) 682-3231 one 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 Name of Sale 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 Auth ignature equipment,whichever amount is greater. Note: This proposal maybe 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. Signature Date Signature Date IMPORTANT INFORMATION ON BACK