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HomeMy WebLinkAboutBuilding Permit #823 - 498 OSGOOD STREET 6/22/2010Permit NO: -. � 2-s Date Issued: t n " TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received - IMPORTANT: Applicant must complete all items on this naLye LOCATION q9'8 d Sq (nc,,4 S T mm V MAP NO: OZ/© PARCEL:Le)Z ZONING DISTRICT: Historic District yes Machine Shot) Villaae ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building x One family Addition Two or more family Industrial Alteration No. of units: Commercial Others: ,X,Repair, replacement Assessory Bldg Demolition Other Septic Well Floodplain Wetlands Watershed District ater/Sewe UtbUKIF i 1UN OF WORK TO BE PERFORMED: Z rn o d z Z L 6 7' 0 -'-lo 4D eL iTl R si F f. -1J q t LIZ (0,0 n--, Identification Please Type or Print Clearly) OWNER: Name: 4LbffaIQ 1 DAN G0,fi0VAC Phone'McZSg- 776 Address:_ Y q� OS9©ed S�'• CONTRACTOR Name: K2 L N Cp rj .S 't. Phone'?°7 bt l ' S�o�4� Address: 9 l Iq C w ; TZ -,�Y-4!!` 1� . )9N Je' Jar /f�4 Supervisor's Construction License: _ ..SSS oZ Exp. Date: -3 -.;. q - f Home Improvement License: /b S 3Y'3 ARCHITECT/ENGINEER Date: q -/2-/6 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: $ 36%6,51 O 6'�' FEE: $ Check No.: �� �j Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund co 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 CONSERVATION COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature 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: Located 3 Os ood Street FIRE DEPARTMENT - Temp Dumpster on site yes C no Located at 124 Main Street Fire Department signaturefdate COMMENTS 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 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 ❑ 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 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 2008 Q W V, 9 9 6 z payo b w° cn O q ►�, w° Ema U cd w as to cC O w u w W U ' c� a o d C7 W w �, H co o cn Q cn a N 'O .o N C O cc cmW C: CD C _ m O cm C .0 N CD Z O Z 0 g 0 F. ii, U 0 O f - P4 .� 2 4446 0 I cm c o � CO2 h O O .g m m co L eov o a E: cma CO.) O +_- O cCc Q3 v vs R C C cc h LU 0 LU cn 19 W W w W c o m c c o ` :.0 H O V V : C. C A O O ;L O A ca Q Ea CD CF CD C a N �i E m o "r m c N ca L 01 � m C __ '' _ m ' N A A N m CD o CL C.) N m ; y- /' C Q (A 7 dC= �•�I . y O Y: 0 '� Z C O C �- Q : 2 m C = m m: 30 � �N � A W H cc N �E Im ca cm,) N v m c®mac a m�Os N•= = A = .0 g .4-CL�m a N 'O .o N C O cc cmW C: CD C _ m O cm C .0 N CD Z O Z 0 g 0 F. ii, U 0 O f - P4 .� 2 4446 0 I cm c o � CO2 h O O .g m m co L eov o a E: cma CO.) O +_- O cCc Q3 v vs R C C cc h LU 0 LU cn 19 W W w W r l �piL /t r The Commonwe¢1th of Massachusetts Department of Industrial Accidents Office of Investigations 600 TTlashington Street Boston, MA 02111 www mass.gov/dia . Workers' Compensation Insurance Affidavit. Builders/Contractors/El 1plicant Information Nave (Business/Organization/Individual):_ d E y �OINsT2u Address: oZ f F•t� A City/ State/Zip:JC3-, �i d uF� ✓i�R �!$iFS Phone #:. g 751 - V 21 •S ao � Are you as employer? Cheek.the appropriate box: I. UI`am a employer aired_ with __ 4. ❑ I am a general contractor and I employees (full and/or Part-time).* 2. E I am .a.sole proprietor or have .hired the sub -contractors partner- ship and have no employees' listed on the attached sheet. # These stub -contractors have working for me in any capacity, [No workers' comp. insurance workers, comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ 1 am s homeowner doing all work officers have exercised their right of exemption per MOL myself [No•workers' comp. c. 152, § I(4),'and we have no insurance required.j t .employees. [No workers' comp insurance Type of project (required): 6. ❑ New construction 7. Q1Eemodeiing 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 PIumbing repairss or additions 12.❑ Roof repairs ] I3.❑.Other I "Any applicant that checks boz l must also fill out the section below Showing their workers' bompensation policy mforrrmahon. t Homeowner¢ who submit this affidavit indi=ting they am doing all work and than hire outside contractors must submit a new affidavit indi 4coaftctors that check this box Must rttEchrd an additional sheet shave', ostia¢ such. rag. the name of the sub -contractors and their workers' cam. petic,, irfonnation. ! ant an einEdoyer than is protri�g:workers' compensation insurance or information f m1' eniP�Ye�: Below is Me Policy and job site . Insurance Company Name: ' G NS Policy # or Self -ins. Lic. #:_ G 7 3 I . rr Expiration Date: Job Site Address:__ �1 Attach a copy of the workers'_ cant nsaiion tic Cid/5�� n I • �lg�J Pe 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 t$ $1,500,00 and/or one-year imprisonment, as well as civil penalties in the fortis 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 certify under the en pains aLdw o e ' 1 P r!f'rY Mat the information provided above is true and corned / 41 _[& Off,ici& use only. do not write in 6"1 area, to be completed b or town. o y city ffcia[ City or Town:Permit/License # Issuing. Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Cierk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person• Phone #-. 3/30/2010 9:30 AM FROM: Gilbert Insurance Gilbert insurance Anenrv_ Tnr_ TO! +1 IQ7A1 rA?_1911 Pars:• not ow nn7 ACORDN CERTIFICATE OF LIABILITY INSURANCE o3/3izo 0 PRODUCER (781)942-2225 FAX (781)942-2226 Gilbert Insurance Agency, Inc. 137 Main Street Reading, MA 01867-3922 THIS CERTIFICATE_ IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Kenneth Keen & Robert Keen DBA: DBA Keen Construction Company 21 Hewitt Ave. North Andover, MA 01845 INSURERA: NORFOLK & DEDHAM INSURANCE 23965 INSURER B: Granite State Ins. Co. 0077 INSURER C: INSURER D: INSURER E: ftltlH �'AfNY' 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SRgR TYPE OF INSURANCE POLICYNUMBER POLICYEFFECTIVE DATE IMMIDDNYI POLICY EXPIRATIONLTR DATE M LIMITS GENERAL LIABILITY ND -P-010078/000. 03/13/2010 03/13/2011 EACH OCCURRENCE $ 1 000 ,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY PRO- JECT LOC ' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ " ANY AUTO (Ee accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLALIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND WCO06371378 08/03/2009 08/03/2010 wcsrATu- OTH- Pp B EMPLOYERS'LIABILITY ORIGINAL ANY PROPRIETOR/PARTNER/EXECUTIVE TO BE MAILED VIA E.L. EACH ACCIDENT $ 100,000 OFF ICER/MEMBER EXCLUDED? MASS WORK COMP BUREAU E.L. DISEASE - EA EMPLOYEE $ 100,00 If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES 1 EXCLUSIONS ADDED SY ENDORSEMENT I SPECIAL PROVISIONS Evidence of Coverage 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. AUTHORIZED REPRESENTATIVE Mark Gilbert CIC ACORD25(2001108) rKA: kVf*)0c3-6scu ©ACORDCORPORATION 1988 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Regist[atjpr:, 108383 - E :i[e ton gf18/2010 Tr# 272473 TYPe ASA . KEEN CONSTRI'C Kenneth Keen �• 21 Hewitt Ave No. Andover, MA 01845 Administrator 1 MaSsachusek-s - Department of Public'SACO Board of Building Regulations and StAII&Wds Construction Supervisor License License: CS 58245 Restricted to: 00 KENNETH B KEEN 21 HEWITT AVE -Jos—. '+ - ! N ANDOVER, MA 01845 Expiration: 3/24/2012 (' unmi.ci may Tr#: 20523 Massachusetts - Department of Public Safe.t� Board of Building Regulations and Standlieds Construction Supervisor License License: CS 76691 Restricted to: 00 4� d: ROBERT A KEEN 12 E WATER ST -N ANDOVER; MA 01845 Expiration: 8/16/2011` j ( ummissiuner Tr#: 1690 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 978-691-5201 Graovac, [fan & Barbara 498 Osgood St. N. Andover, MA 01845 978-258-7764 Contract ## 5026; Appendix A [late: 6/14/2010 Remodel master bath: Demo master bath to studs Remove existing.flo:or tile in bath and adjacent closet ® Reframe shower to approximately 42" x48" o Reframe door and install pocket door kit 6 Reframe opening from bath to closet to a larger size. a Supply & install two Pella Architect series awning windows with Azek exterior trim ® - Supply :& install: door to: match mai n. 2"d floor bath - - - ®. Supply & install blueboard and skimcoatto-a smooth finish f. Supply & install trim on base, Windows and door to match existing - - - - ® Supply & install customer supplied tile in -shower area and, on floor in bath and -closet ($2500.00 allowance) Paint walls, ceiling and trim (walls and .trim; 2 neutral colors, 2:coat finish).(ceiling;2 coat finish. of flat white) ($1500:00 allowance) Install customer supplied vanity Plumbing: 0 - Relocate toilet next to vanity a Relocate pipes as needed for new fixtures o Supply & install new fixtures selected by customer o Relocate oil lines in basement if necessary($500.00 credit if not needed) 0 Total plumbing allowance $9100.00 Electrical: Upgrade electrical to code as needed, ® Supply _& install approx. 30 sq. ft. of supplemental heat pad under the floor in bath controlled by a. programmable thermostat • Supply & install six recessed fixtures light fixtures and switch to code Total Price: $30,650.00 (thirty thousand six hundred fifty dollars) Page 1 of 2 KEEN CONSTRUCTION CO. GP eVAP 21 H;EWITT AVENUE 0 NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 Submitted(I �" To: I r r� C 1s J C PHONE DATE r4 2,10 b .., 2 0 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. REGISTRATION NO. EIN N0, 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: III > Construction related permits: t~., j q as (- fl( Y ^ flLY i ...,..,_..._.................._..._.... ........... _...... ...... .... _... ........... ..... ....... .._.......... ..__....... ....,,........................... ...... ................... .......... ........................ .................. .......... ................... ..................... ...... ........ ......._.........,......,..........,........_.........,.,.........._................_...._..._.................. WORK SCHEDULE Contra or wll 4t be in the work or order the materials before the third day following the signing of this Agreement, unless specified here i writing. Contractor will begin the work on or about s (date). Barring delay caused by circumstances beyond Contractor's control, the work will be. completed by = p= j.!� (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 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 he) v.5r it to be ade as follows: i -1` 4 1/ 6 .1 for the sum of : dollars ($. _4� ) ), % ($ ) upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor / Designated Registrant ($-.),10 pl ion of 21 HEWITT AVE. t Street Address �_. N. ANDbVERi MA 0`i845 _ f % ($ upon completion of � J ,y;o ($ i) shall be made forthwith upon completion of work under this contract. 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 o: -sap or the total amount of all deposits or payments which the contractor must make, in G/ j advance, to order and/or otherwise obtain delivery of special order materials and A riz -amre __- equipment, whichever amount is greater. _ Note: This proposal maybe withdrawn by us if 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 tra/�saction. Can ellation must be done in writing. t (; _;Z NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. f t•'"""`� (� I /y- t /c' Signature Date i Signature Date IMPORTANT INFORMATION ON'.BAC,K:IDm- ,..kX�W_a�­, .. ,«. 4: a... ....,.� a.,..�. ... r,...,.. '.. x s 0..... �... .hi.w,.,. _...s� ,, ... Location �2 l! SJ No. Date 40RTN TOWN OF NORTH ANDOVER . 0 ` 9 Certificate of Occupancy $ '�S ""•t<�' Building/Frame Permit Fee $ 129F s�CHus Foundation Permit Fee $ Other Permit Fee $ f TOTAL $ Check # co 23015`" Building Inspector