HomeMy WebLinkAboutBuilding Permit #991-15 - 45 CHESTNUT STREET 6/1/2015BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received -
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 9 0,
Pr'
PROPERTYOWNER Pucieer—s
Print 100 Year- Structure
MAP 5 -PARCEL.. ZONING DISTRICT: 'Historic District
Machine Shop Vil
yes
yes
'616 '50,
. . . . . . . . . .
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
El New Building
El One family
El Addition
0 Two or more family
0 Industrial
0 Alteration
No. of units:
El Commercial
[JORepair, replacement
El Assessory Bldg
El Others:
El Demolition
El Other
Efseptic I E1W4__
0 11 Floodplain OW , eflands
El Watershed District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERF RM�13:
Re,V1dVC A054r be -d -b 1q, n,5
oor-,, :5-oc
Y-6qVVk_ It,/1-ple,
Identification - Please Rpeor Print Clearly
OWNER: Name: 1qv) /7 _f C-_ � i 12 Phone: Y? 1 L/17
Address: 44 '5' C 6 eS4llJ+ '3f dcvo, Pi &
Contractor Name: !��on Lco�oWoolnle-:6- 9,? 17 - � 9(.- 5'ZC)
Address: 5L JV� HMatef , ff114
Supervisor's Construction License: _Exp. Date:.(i�
'Exp. Date:,
Home Improvement License: S-1,19
ARCH ITECT/ENGI NEER
Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. MOO PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 2=9 9 , C)C) FEE: $ N1 -n
Check No.: IC43S Receipt No.: 2 -MI
NOTE: Persons contracting with unregistered contractors do not have access to thfg?iarai0fi
nature of Aaent/Owner Sianature
L
Locati
No. Cfl)— 15
Check #
26867
Date 4 It ��vf
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ A
TOTAL $�J,
AldirYg Inspector
Plans Submitted El
Plans Waived El. Certified Plot Plan El Stamped Plans El
TYPF'OF SEWERAGE DISPOSAL
Public Sewer 0
Taiming/Massage/Body Art E]
Swimming Pools El
Well El
Tobacco Sales El
Food Packaging/Sales El
Private (septic tank, etc. El
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed On
Signature
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition N
%m'Planning Board Decision:
Conservation Decision:
Comments
Comments
Zoning Decision/receipt submitted yes
Water & Sewer Connection/signature & Date Drivewav Permit
DPW Town Engineer: Signature:
Located 384 Osgoqd Str t
FIRE DEPARTMENT--- Ternp;Dumpster on site yes �no
Located at 124 Main Street N
Fire Departmentsignature/date
COMMENTS
--I—
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 2014
r
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
Lj 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
L3 Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
Li Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
o Mass check Energy Compliance Report (If Applicable)
Li 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
Doe: Building Permit Revised 2014
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Keen,ConstructionCo.com
Rogers, Chip & Ann
45 Chestnut St.
N. Andover, MA 01845
May 15, 2015
Contract #5523; Appendix A
Install and re -finish hardwood flooring:
Second floor partial: $8,433
Remove and dispose of existing carpet in hall and master bedroom, including closets
Re -nail subfloor and install moisture barrier
Supply & install 2 X" Oak flooring; sand & seal with three coats of water based urethane
First floor sand & seal: $3,866
0 Disconnect gas range, dishwasher and refrigerator
Sand first floor (except for dining room and formal living room) existing hardwood
flooring, including stairs
0 Seal floor with three coats of water based urethane
Total Price: $12,299 (twelve thousand two hundred ninety nine dollars)
Prices do not include cost of permits, moving or storing furniture, or any problems found under carpets.
Payment Schedule: $1,000.00 due upon signing contract
$4,000.00 due the first day of work (plus permit fees)
$3,500-00 due when flooring is installed
$3,799.00 due at completion of contracted work
Customer Robert A. Keen
5 13c) //5
Datel Date
1175 Turnpike St. P: 978-691-5201
N. Andover, MA 01845 F 978-682-3231
CSL #076691 Sales@KeenConstructionCo.com H IC #108383
1,
55,_.-S
KEEN CONSTRUCTION CO.
1175 TURNPIKE STREET PROPOSAL
NORTH ANDOVER, MA 01845 All home improvement . contir . actors 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
Submitted C, with the Commonwealth of Massachusetts. Inquiries
To U about registration and status should be made to the
Director, Home Improvement Contract Registration, 10
Park Plaza, Room 5170, Boston, MA 02116 617-973-
8787 Owners who secure their own construction
related 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.1 46 —3783401
9TX - (I- S,
> 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
e -
It
> Construction related permits:
- - - _ - - - __-_ - - - . . ..................... . .. — ------ . . ........ . . . ............................................ ........... ............................. . ........................................... .......... . . . . .............. . . . ... . ........... . . .. . ................... . ... . ......... ........... . ............. . . . . .........
. . ...... . ......... . ...... . ...... . . . ........... ................. ............... .............. ................... I ............. .... . ............... ............... .. . .............
W KS UL
C,2R
ract.,9
, n he work or order the materials before the third day following the signing of this Agreement, unless specified h in riting. tractor will begin the work on or
about -7 8, 1 1 n (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by (d, ite). The Owner hereby
acknowle6gas And agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not e 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 theirequirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractof h�is subcontractors, employees or agents, is
discovered with n one year after completion of any job, including cleanup, the Contractor shall, at his own expense, IT hwith 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
,J
:EC-' �Axi 4 dollars ($ 2 Z 9 9. CJ 0
P T_�LJ_E
ayment to be made as follows:
— % ($ upon Sig�g Contract; ROBERT A. KEEN
Name of Contractor / Designated Registrant
— % I$ e�iibf 1175 TURNPIKE ST.
Street Address
Completion of
N. ANDOVER, MA 01845
cityistate
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 shallrequir� a
>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
equipment, whichever amount is greate .
Note: This proposal may be %mthdrawn by us it not accepled within day�.
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.
Signal- Dalen' Signature Date
IMPORTANT INFORMATION ON BACK ON-
The Commonwealth of Massachusetts
Department oflndustrlqlAcclk�ts
Office of Investigations
600 Washington Street
Boston, MA 02111
v w w. m ass. go v1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors[Electricians/Plumbers
Applicant Information Please Print Lepbly
Name (Busin�ss/Organization/fndividual): G V) GM K1:2,
Address: 15 73) like- 6i
City/State/Zip (�\tF ., 111
Phone#:
Are you an employer? Check the appropriate box:
1. 1 am a employer with 15
4. F1 I am a general contractor and I
employees (fall and/or pErrttitn6).*
have hired the sub -contractors
2,E] I am a sole, proprietor orpartnor-
listed on the attached sheet. I
ship and'have, no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3. 1 am a homeowner doing all work
EJ
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1 (4), and we have no
insurance required.]
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. New construction
7. Remodeling
8. El Demolition
9. E] Building addition
I O.n Electrical repairs or additions
ILE] Plumbing repairs or additions
12.Q Roofrepairs
1311 other
*Any applicant that checks box#1 must also fill out the section below showing their wbrkers' compensation policy ifformation.
f-Homeownerswho submit this affidavit indicating they hire doing all worle and then hire outside contractors must submit anew affidavit indicating such.
lContractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that isproviding workers'compensation insurancefor my em
ployees. Below is theFollcy andjoh site
information.
Insurance Company
S ky� 6 of-C,'n
Policy # or S elf -ins - Lic. #-_L�AL 2 - +xp it ati on D ate: 9
Job Site Address: nl.& <()t Pity/state/Zip: 8V5
Attach a copy of the workers' compensation -policy declaration page (showingthe policy number —1-11DU date).
Failure to secure coverage as requiredunder Section 25A of MOL o. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500M and/or one-year imprisonment, as well as civilpenalties in the form of a STORWORK ORDER and a fine
ofup to $250.00 a day against the violator. Do advised that a copy ofthis statement maybe forwarded to the Office. -of
Investigations offfie DIA for insurance coverage verification.
Jer theJains V Tre
I do hereby certj%4n_1 qddpenaldes ofperjury that the information provided above is h ue and co ct.
1 .4
Phone #: 9 17) - I
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. Cfty/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: — Phone
RightFax C3-1 3/24/2015 9:51:03 AM PAGE 2/002
A I -k . r ; CERTIFICATF OF I 1AR11 1TV IM-ql 1RAW`�
Fax Server
I DATE (MM/DD[YYYY) I
It nw9w9nis
TUS40FTWICATE 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 pollcy(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-
PHONE
FAX
GILBERT INS AGCY INC
137 MAIN STREET
(A/C, No, Ext):
(A/C, No) -
READING, MA 01867
E -MAIL
ADDRESS:
246WY
INSURER(S) AFFORDING COVERAGE NAIC# j
INSURED
-----------
INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA
KEEN CONSTRUCTION CO
INSURER 8:
INSURER C:
1175 TURNPIKE STREET
INSURER 0:
PNSURER 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.
INSR
LTR TYPE OF INSURANCE
ADD
L
SUB
R
P OLICY NUMBER
POLICY EFF DATE
(NMDD\YYYY)
POLICY EXP DATE
(Mmomyyyy)
LIMITS
GENERAL LIABILITY
0'
C COMMERCIAL GENERAL LIABILITY
ZACH OCCURRENCE $
AGE TO RENTED $
IREMISES (Ea occurrence)
CLAIMSMADE f__1OCCUR.
H�
ED EXP (Anyone person) $
— —
�ERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:
3ENERAL AGGREGATE $
POLICY F ] P ROJ ECTE] LOC
3RODUCTS - COMP/OP AGG $
UT
kALJTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE $
LIMIT (Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULEAUTOS
(Per person)
HIRED AUTOS
BODILY INJURY $
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per accident)
UMBRELLA L'1ABF__1OCCUR
EACH OCCURRENCE $
EXCESS LIAB
LL]
CLAIMS -MADE
AGGREGATE $
DEDUCTIBLE
$
RETENTION $
$
A WORKER'S COMPENSATION AND
EMPLOYER'S LIABILITY Y/N
UB-999IM582-14
10/0812014
10/08/2015
WC STATUTORY OTHER
LIMITS
ANY PROPERITORIPARTNERIEXECURVE
OFFICERIMEMBER EXCLUDED? MN
L-8
N/A
E. L. EACH ACCIDENT $ 100,000
(Mandatory In W14)
If yes, desalbe under
E.L. DISEASE - EA EMPLOYEE $ 10(),000
E.L. DISEASE - POLICY LIMIT $ 50o,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERA'nONS/LOCA'nCNSIVEHICLES/RESTRICMONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER
- ----------------- - - ------------------- - - -- ......
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
_VE
- ----------
ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2610 ACORD CORPORATION. Ail rights reserv-e --- d-._
Massachusetts - Department of Pubfic Safety
Ponrrj nf P"ilrjm Q. "I�+i— —4 6+,-r4 A
Construction Supervisor
License: CS -076691
ROBERT A KEEW
12 E WATER ST
North Andover ACA 0145
Expi ration
Commissioner 08116/20,15
Office of Consumer Affairs& Business Regulation
VME IMPROVEMENT CONTRACTOR
legistration: 4^68383 Type:
xpiration: �-811-8/2016-, DBA
KEEN CONSTRUCT(0"-,.'�----.
Kenneth Keen
�' ii ff �1�11'
--- --------
- -4— '1',"
- t!
1175TURNPIKEST
NO. ANDOVER, MA 01845-� Undersecretary