HomeMy WebLinkAboutBuilding Permit #1249-16 - 486 OSGOOD STREET 5/1/2018 I `
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BUILDING PERMIT O* N0RTy
3'2 y�Stf�eo.F64aN�
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Li 'l�oP �0
Permit No#: 7 / Date Received TEOfQP`�5
gSSHCHUS�t
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
T' Print o
PROPERTY OWNER r` c Ck 6r4di/1ez
Print 100 Year Structure yes no
MAP�`(' Z PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑ Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
i -Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
0 Water/Sewer_
DESCRIPTION OF WORK TO BE PERFO
c, ce Fre43cer- ei �� r� ED: s
Identification- Please Type or Print Clearly
OWNER: Name: JJC�c;V -b (�S vv t 6 , ))0-0 l/ Phone:
Address:
ContractorName: r.
( i c 6 Phone: - d
Email: �A 1e5 & Vee&,- rVr-4c c� GU . <-
Address: X70 13vx 935
Supervisor's Construction License: 65- 076691 Exp. Date: g (o
Home Improvement License: LO '3 3'93 _Exp. Date: O J
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: $ , Z- FEE: $ / 7 01,
r
Check No.: Receipt No.: 509'y/ ,,-7j`
NOTE: Persons contracting with unregistered contractors do not have access to theVaty, and
1
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanuing/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑
I
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
t
COMMENTS
I
HEALTH
Reviewed on
Signature
COMMENTS
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:
"FIRE DEP - - - Gated 4 .. ...e.,
,� _ C - AM.- WENT iK V-4 ster�ontsif s
n
Located Osgood S et
o tLocatediat•�124MainfStreet rnp� -Y
n
fFreDeparfinentsignatu�e%dater t
_ _._
---------- ---
COMIVIENTiS `
Dimension
Number of Stories: Total square feet of floor area, based dn_Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Hueter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: lies No
MGL Chapter 166 Section 21A—F and G min.$10o-$10oo fine
NOTES and DATA— (For department use)
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Bnilding Pennit 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
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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Permit Application
4; 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
OTE: 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
4. Photo of H.I.C. And C.S.L. Licenses
,4� Workers Comp Affidavit
4 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Affidavits for Engineered Engineering Affld products
g
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:Building Permit Revised 2014
NORTI-�
Town of �.. _ Andover
Q
h ver, Mass, / j C.
Q
COCMIC"t WILA T
CK o ��.
�•9 RATED r'P�',`,�5
s U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ......CC'"�` °�:�!v . BUILDING INSPECTOR
....................... ........................................ .......
L Foundation
has.permission to erect .............. buildings on ..� ........1!!!1 .4?.:��l..�j
_ Rough
to be occupied as .............. F�,7..���.�. .... r�.�...................f P. °:... :.� ...........� .:::!. ............ 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO STARTS Rough
e
Service
........r:..... . . ........................................ 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.
v;
REMC�UEL11'1 C: SPECGI/_�LISTS
4.
0.
978-697-5207
KeenConstructionCo.com
O'Donnell, Brian &Carol
486 Osgood St.
N.Andover, MA 01845
Contract#5582;Appendix A May 5, 2016
Replace front palladium window and door:
• Remove and dispose of existing 65"x 75"circle top fixed window and front door unit
• Install customer supplied Pella Architect series window
• Install customer Pella fiberglass smooth door unit with sidelites
• Re-install existing storm door
Replace front triple double-hung and single window:
• Remove and dispose of existing window unit
• Install customer supplied Pella Architect series window
Replace rear quad double-hung unit&two single double-hung units:
• Remove and dispose of existing windows
• Install Pella quad double-hung unit two single double hung units
Replace double double-hung in kitchen:
• Remove and dispose of existing window unit
• Install customer supplied Pella window unit
Replace master bathroom window:
• Remove and dispose of existing window
• Install customer supplied Pella window
On all windows and doors:
• Supply& install new clear casing to match existing
• Spray foam around windows
• Patch siding as needed
• Re-create panelized trim between palladium window and front door
Total Price: $11,362 (eleven thousand three hundred sixty-two dollars)
We are not responsible to repair lawn in the event it is damaged from equipment.All work will try to be
scheduled when the ground is firm, but the equipment may still make depressions on the front yard.
PO Box 935 Page 1 of 2 P: 978-691-5201
N. Andover, MA 01845 F: 978-682-3231
CSL#076691 Sales@KeenConstructionCo.com HIC #108383
i
REMC9OELIIV C: SPECIALISTS
978-691-520`1
KeenConstructionCo.com
Payment Schedule: $1000 due upon signing contract
$5000 due when the front door and window above is done
$2500 due when the quad window unit is installed
$2862 due when the remainder of the windows are installed
i
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Price does not include cost of windows, door, permits, painting or repairs to any unusual, unsafe or non-
code compliant existing conditions not addressed in this quote.
3
f
Customer Robert Keen
I
z.4
L2-6, ZI,�
Date Date
PO Box 935 Page 2 of 2 P: 978-691-5201
N. Andover, MA 01845 F: 978-682-3231 j
CSL#076691 Sales@KeenConstructionCo.com HIC#108383
55r
KEEN CONSTRUCTION O. PROPOSAL
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
Submitted,ed b �c, Ir��� / ' lC Vf o ) with the Commonwealth of Massachusetts. Inquiries
l l 41 / about registration and status should be made to the
l,r C^ Director,Home Improvement Contract Registration,10
Park Plaza, Room 5170, Boston, MA 02116 617-973-
/ 8787 Owners who secure their own construction
('l y IU�j 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.
5� (� Il H.I.C. 108383 46—3783401
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.
X
Construction related permits:
........
_..__....._....__.._..._._.._. ....___.__..............................................._.........._........................................._................,_..................................................__.._....._..................._._.__..__.
WORK SCHEDULE
Contra or�ILn ?e in the work or order the materials before the third day following the signing of this Agreement,unless specified herein rit+ o tractor 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
acknowl ges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not a con dere 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,rep it,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
_ I�VEb1 kc%l�J�°l L I Inr^� . j�lN�12'(1 �r 1<� 7 �L(1n dollars($ 2 ,00
Payment to be made es fol ows: )•
—% ($ ) upon signing Contract; ROBERT A. KEEN
Name of Contractor/Designated Registrant
—% ($ upon ComRlejtJ r ofd 1175 TURNPIKE ST.
I ,J��t Street mdress
—% ($ 1� completion of N. ANDOVER, MA 01845
(�� `� ��� qty/Stale
-4 $ ) shall be made forthwith upon (978)691-5201 (978)682-3231
completion of work under this contract. phjNamen�!
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 as a
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 91onzea signaur
equipment,whichever amount Is greater. Note:This proposal may be withdrawn by us it ml 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,ca cel this transaction at any time prior to midnight of the third business day after the date of
this transa tion.Cance ation must be done in writing.
�,r Q�JHIS CONTRACT IF THERE ARE ANY BLANK SPACES.
signature ,' f Jiv/ Signature Date
IMPORTANT INFORMATION ON BACK ►
The Commonwealth of Massachusetts
Department of Industrial Accidents
.- 1 Congress Street,Suite 100
Boston,MA 02114-2017
�•`~ www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): wo—e', 6&1 « C7
Address: 1 1X 93
City/State/Zip: k) Jq n '��e r M � 61$P one#: ��— ��r 9'� P SZc
Are you an employer?Check the appropriate box: Type of project(required):
LM I am a employer with 2-r employees(full and/or part-time).* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.] 9, ❑Demolition
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12..❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
14.E]Other
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c.
152,§1(4),and we have no employees.[No workers'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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. --�-^ /
Insurance Company Name: I (��� I�.'�S Iy1 S —
Policy#or Self-ins.Lie.#:6; 140 i� —99/ I M!5?'2 V�S Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' comp sation policy declaration page(showing the policy number and expiration ate).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A ckhisent may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.I do hereby certif de Izlties of perjury that the information provided above is tri a and correct.
Signature: Date: _ Z
Phone#:
E[ :
only. Do not write in this area,to be completed by city or town official
n: Permit/License#
hority(circle one):Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
son: Phone#:
DATE(MIWDD(Y
k- o CERTIFICATE OF LIABILITY INSURANCE 10/23/20 Y5
`� 10/23/2015
THIS CERTIFICATE 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 policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER C Barbara McDonough
Gilbert Insurance.Agency, Inc. PHONE (781)942-2225 FA% o:(781)942-2228
137 Main Street E-MAILDR :bmcdonough@gilbertinsurance.com
INSURER(S)AFFORDING COVERAGE RAIC S
Reading MA 01867-3922 INSURERA Norfolk 6 Dedham Insurance 23965
INSURED INSURERB:SafetY Insurance Company 39454
Keen Construction Company INSURER C Mravelers Ins. Co. 0031
483 Chickering Road INSURER D:
INSURER E:
North Andover MA 01845 INSURERF:
COVERAGES CERTIFICATE NUMBER�L1552101779 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 - TYPE OF INSURANCE POLICY EFF POLICY EXP
LTRPOLICY NUMBER LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO R —
A CLAIMS-MADE Fx-1 OCCUR PREMISES n e $ 100,000
LID-P-010078/000 3/13/2015- 3/13/2016 'MED EXP(Any one non $ 5,000
PERSONAL b ADV INJURY $ 1,000,000
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY JECT O LOC PRODUCTS-COMP/OP AGO $ 2,000,000
'
OTHER: $ I
AUTOMOBILE LIABILITY � LIMIT S 1,000,000
B ANY AUTO BODILY INJURY(Per person) $ _
ALLOUNEOSCHEOULED
AUTOS X AUTOS 6228807 COM 01 5/23/2015 5/29/2016 BODILY INJURY(Pereakler� $
X HIRED AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE $
Underhmumd motodmw $ 100,000
UMBRELLA LIAR HOCCUR EACH OCCURRENCE $
EXCESS UAB
MS-MADE AGGREGATE $
OED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS'LIABIUTY Y I N
ANY PROPRIETORMARTNMMXECUTIVE E.L.EACH ACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED? N/A
C (Mandatory In NH) 6HUB-9991458-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000
8 yes,desatbe undet
DESCRIPTION OF OPERATIONS be$ow E.L.DISEASE-POLICY LIMIT 500,000
DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES.(ACORD 101,AddhkNul Ramatka Schedule,may be attached K mora space is required)
II
CERTIFICATE HOLDER CANCELLATION
(978)623-8320
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
M Gilbert, CIC/BARBAR
01988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025 nolson
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Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Lllllltl Ulllllll JVICI VI\111 •
License: CS-076691
-T]'ti.ti GrN
ROBERT A KEEN"
12 E WATER ST< IMP
North Andover WA 0
Expiration
Commissioner 08/16/2017
��e�a-rnintoratueu.�l�o��caaac��teGti
ice of Consumer Affairs&Business Regulation
E IMPROVEMENT CONTRACTOR
;�
egistration:,. Ifl883-:_ Type:
Expiratrgn ; ;', Supplement Car
KEEN CONSTRUCTI'pN 6%de4
ROBERT KEEN
1175 TURNPIKE ST P
. -
NO.ANDOVER, MA 01845 IN
Undersecretary
Location
No. ; �� ` , Date -
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
- Foundation Permit Fee $
Other Permit Fee $
TOTAL $�_
Check#
;] !Building Inspector