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HomeMy WebLinkAboutBuilding Permit #877 - 486 OSGOOD STREET 6/7/2012TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑gip❑'❑ Welly -` r❑Flood I n 0 Wetlands' ,4pF In L b i0 WatershedDistrict �CiVVater/Sewert L' 1 o `r rw ri. �y . �_ DESCRIPTION OF WORK TO BE PREFORMED: Q2YnoJ-kf L -x i 15 1)'t -Li —5 5,F oq s6 tj 9 oA OWNER: Name: 0 Address: Adcires _ - S prvis64$7fc�11 st�`ui tificat'on Please Type or Print Clearly) 479 L% f4 ay ©,%n w ri L R Phone: 0 s � nQicens_e71 I?hone7� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT.• $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No. -/7 � e �/ Receipt No.: . �. _r. Persons contracting with unregistered contractors do not have access to theguarantyfund _ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT.• $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No. -/7 � e �/ Receipt No.: . �. _r. Persons contracting with unregistered contractors do not have access to theguarantyfund _ 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 COMMENTS DATE REJECTED El DATE APPROVED El CONSERVATION Reviewed on Signature COMMENTS HEALTH a COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_ Planning Board Decision: Comments Conservation Decision: __Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street -,.;..... .+. '^�..;,3f C.+. "'S„E b.�}' -n.. i t t:f5;°_Y `r,:j • r ;.. '°�`°"' �< ' .7'rP,�/''y,.2a.FIREDEPARTMENT3•�TempDumpsteon site;.yes� _. t ono �� ��• �LMtetl�;at 241105innj,Streetl , u '� t �- 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 NOTES and DATA — For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 40TE: 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/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 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 N OTE: 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: INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 rA rA Cd c O c s W O C a V� O_ C rG • r.+ O C c M O O ra L r m C vn/ ��• ts m CL ca N 71 ,^ 4• �E C O o -,� 2 CD cm i Jcc E a. m� a • L � mac .mac- co ' 11 _ I y Cc 0 E GO -CD m o o C-/) N m �= o c w 40-. tu 5 �c�0? saOC . �•N�cO W'4 ON OL cm m0 0a m Z COD CO F- N SGL Z O w.. m •N C.3 0,011 co 0.5 = R - NCO O •A ON,. CD C CD ■ 0 V Z CD CL O y � C W CM I/ O G3■� y � � CD 0 CD m m CD � .a CD CD L m o a E: ra y C O� .0- C CCc vo CD J •fl co C Z co 0 CL C.3 h c C ■w d 0 LU 0 U) LLI U) W W W U) O O O O ca U) vn O w w z OO E w w LL. cp n W. 04 cn cn c O c s W O C a V� O_ C rG • r.+ O C c M O O ra L r m C vn/ ��• ts m CL ca N 71 ,^ 4• �E C O o -,� 2 CD cm i Jcc E a. m� a • L � mac .mac- co ' 11 _ I y Cc 0 E GO -CD m o o C-/) N m �= o c w 40-. tu 5 �c�0? saOC . �•N�cO W'4 ON OL cm m0 0a m Z COD CO F- N SGL Z O w.. m •N C.3 0,011 co 0.5 = R - NCO O •A ON,. CD C CD ■ 0 V Z CD CL O y � C W CM I/ O G3■� y � � CD 0 CD m m CD � .a CD CD L m o a E: ra y C O� .0- C CCc vo CD J •fl co C Z co 0 CL C.3 h c C ■w d 0 LU 0 U) LLI U) W W W U) KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 Submitted To: I U+ 1 0 e ._....... ... All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about 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 permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONEr C _ DTE / REGISTRATION NO. EIN NO. " J `" D 9 �� l 3 /.2 c 1 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: ._.__.............. r-1 (I\ 6-10 .trn ) 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 . G' !� 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 Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: F$ i� �� t��i �l�t-�e tl ..�t t pyle�j t t to :. m 1 �G. I �J � } Y`C� s t' C +alt C t dollars ($ � t Z Payment to be made as follows: )• % ($ ) upon sign in Contract; ($ ) ► ion 41 —�. / op- u�on completion of J° ($ ) shall be made forthwith upon completion of work under this contract. KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor / Designated Registrant 21 HEWITT AVE. Street Address N. ANDOVER, MA 01845 City / State (978) 691-5201 (978) 682-3231 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 Name of sales . 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%deidrg ature equipment, whichever amount is reater. J Note: This proposal may be withdrawn by us if not accented within na 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. . �PO NOT SIGN THIS CONTRACT 1,F THERE ARE ANY BLANK SPACES. Signature r Date G Gi Signature Dale IMPORTANT INF TION ON BACK ► 4/2S/2012 9-S.5 AM FROM--fGi lha'rt Gi•lhart TA—rm—b AA -111 . Tnr. Tr%- it f07R1 IDA—. nM — nm ACO T,' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIrr" - 04/15/2012 PRODUCER (781)942-.2225 FAX (781),94272226 Gilbert Insurance. Agency, Inc. 137 Main Street Reading, MA 01867=3922 `THISCERTIFICATE IS ISSUED AS A MATTER OE INFORMATION ONLY AND:CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE: DOES_ NOT AM.END,EXTEND.OR . ALTER THE COVERAGE AFFORDED:BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL# INSURED Kenneth Keen & RobertKeen DBA;: DBA. Keen Construction Company 21 Hewitt Ave.. North Andover, MA 01845 IN SURERA NORFOL•K_& DEDHAM INSURANCE 23965 INSURER a:, .Granite State Ins. Co. 0077 - INSURER c: INSURER G:. . INSURER E: _ THE POLICIES OFINSURANCE LISTED. BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERMOR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH'AESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED"HEREIN IS.SUBJECT TO ALL THE'TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEENAEDUCED BY PAID CLAIMS. ILTR NSR R TYPEOF INSURANCE POLICYNUMBER . POLICYEFFECTIVE'> DATE IMMODAIVI `POLICY EXPIRATION DATE (MMODIM LIMITS cENEfiAAL WaBILITY ND -P-010078/000 03/13/2012 `03/13/2013 EACH OceuRRENCE ` $ 10.0001 00 .-X COMMERCIAL GENERAL LIABILITY CLAIMS McDE. X� .oCcuR .. . ,DAMAGE TO RENTED PREMISRS (FA o ren $ 50,06( hIED F)rn (my one person) -s 106,00( A PERSONAL & ADViNJURY $ 1,•000 "0"0( GENERAL AGGREGATE $ 2,000, OD GENI. AGGREGATE LIMIT APPLIES PER: X, POLICY:� LOC PROOl1CTS-.COMPlOPAGG $ 2,000.0 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE OMIT (Es accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON -OWNED 'AUTOS BODILY..INJURY $ . (Per accident) . PROPERTY DAMAGE $. (Per accident) GARAGE LIABILITY AUTO 9NI Y - FAACC.IDENi 3 . .ANY AUTOOTHER TfirW. :EA ACC : $ - AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY OCCUR Q CLAIMS MADE: EACH OCCURRENCE _ $ / AGGREGATE $ $ DEDUCTIBLE RETENTION WORKERS COMPENSAnON:AND _ WC009646942-_°08/03/2011 08/03/2012 WCSTATU- BOTH- TOPY�MI TS FIR B EMPPGYERs•uABILm ANY ANYPROPRIETOR%PARTNER/D(ECUfIVE OFFICEH/MEMBEREXCLUDED? -; DI If yes, describe under. - - W CERT TO BE MAILED.. .ECT LY' VIA INS CARRIER-. - ". -- E.L. EACH: ACCIDENT $ 10;0,OQ Ea. DISEASE-EAEMPLOYEE `4' 100, 0U E_L DISEASE:- POLICY LIMIT .$, 500,000 SPECIAL PROVISIONS below - - .. - OTHER DESCRIPTION OF OPERATIONS I LOCATIONS.I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS Evidence of.Coverage GERTIFICATE-HOL121EIR 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 AUTHORREDREPRESENTATIVE Mark Gilbert CIC ACORD 25 (2001108) WORD CORPORATION 1988 Yl tssachuutts -Dep artment of Pit I)Iic Sitfeth Board of Building Regulations and Standards C nstr-uctibn Supervisor License License: CS 76691. ROBERT A KEEN 1 12 E WATER ST HANDOVER,, MA 01845 Expiration: 8/16/2013 ( nunissi ncr �- :Tr#: 3772 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -058245 KENNETH B 19EN 21 HEWITT-AW N ANDOVER MA. 0.184y�5}? .- 1 ,il1+J Tt4c`�s Expiration Commissioner 03/24/2014 Office*onsumer airs 7V�sffi-e&sse-g.6�6. HOME tMPROVEMENTCONTACTOR Registration:.108383 Type: Expiration: $Y8J 012 DBA K CONSTRUCT4f� 3 Kenneth Keen ` 21 Hewitt Ave No. Andover, 'MA 01885 Undersecretary The Commonwealth of Massachusetts De partment oflnd'ustYialAccidents Office oflnvestigatioug 600 Washington Street Boston, MA 02111 U - Workers' Comp ensationxnsurgnceAffidavit: JBuf dens/Contractors/.l�+lectxicians �izcani lufoxznation /.Plumbers Name (Business/Organization/1'iidividual) Address: IIp 0 #AV -city/state/zip:�- Na Oy L in. M A Phone #: • a�O ) Are you an i emp oyer? Check the appropriate box: 1 • am a employer with 4. z ❑ I am a general contractor 2• ❑employees (full and(ox pari •time).* l am a sole proprietor and x have hired the sub -contractors or partner- ship and have no employees listed on the attached sheet. t These sub -contractors bt ve working ,for me in any capacity. [No workers' comp. insurance workers' comp. p insurance. 5. ❑ We are a corporation required.] 3• Y am a homeowner doing and its �of$cers hake exercised their all work myself. [No workers' comp. right of exemption per MGL c. 152, §1(4), and wehaveno insurancerequired.] i employees. emP to Y [No workers' comp, insurancerequired j Type aprolect (required): 6. ❑ New construction 7. remodeling 8. d Demblition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.[] 1'lumbingrepairs or g.dditions 12.[] Roofrepairs 13.[] Other , •Any applicant that checks box#1 must also frll out the section below showing their workers' compensationpolicywformation. i Homeowners who check this bo affidavit cheda n add ti are doing all work and then hire outside contractors must submit a new affidavit indicating suc Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policyinformation. ' g h. Z am an employer flint isproviding workers`compensation insuranceformy emproyees: I3e1ow is tltepolicy and 'ab site `nforynation, //�� nsurance Company Name: V X A 4 [ SIA �' E 'olicy # or Self -ins. Lic. #: W C `O q 6 c f QExpirationDate: 1{(� )b Site Address:_ Q Cjr r` S -1 ` . Oity/State/Zip: r., D �j J'— ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). tilure to secure coverage o required under Section 25A ofMGL c.152 can lead to the imposition of criminalpenalties of a �e 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 up to $250.00 a day against the violator. De advised that a copy ofthis stateme0 form of forwarded to the Office of restigations of the DIS. for insurance coverage verifiication. — - ••�•«��.� p�uP"'Iaaoveistrueandcorrect. ficial use only. Do not Write in this area, to be completed hyclo, or town official. �- PermitLL,fcense # I umg Authority (circle one): Board of Health 2. BuildingDeparfinent 3. City/Town Clerk 4. Electricalrnsnne.mr (lfhor Location Date /v4 - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee TOTAL Check#+ 25386 Building Inspector