HomeMy WebLinkAboutBuilding Permit #148 - 498 OSGOOD STREET 8/21/2006 i
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BUILDING PERMIT No DT b�ti
TOWN OF NORTH ANDOVER
0 y M
APPLICATION FOR PLAN EXAMINATION
L � eti
Permit NO: I r�
Date Received '� °4 p - •'
�, 44rap
�,
Date Issued: SSACHUSE�
IMPORTANT:Applicant must complete all items on this page
LOCATION _
Print,
PROPERTY OWNER � fL�o V FSG 0A i0o*MA ..1
Print
MAP NO _�?,_PARCEL:Q0o'oLZONING DISTRICT: Historic District yes no
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
r Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
emolition Other
Septic Well Floodplain Wetlands Watershed District
ater/Se
DESCRIPTION OF WORK TO BE PREFORMED:
£ moliL �iDFig &AI L, R.50*,1
Identification Please Type or Print Clearly)
OWNER: Name: G 2 ,4
A o L/ c 23A, bI:MFt r V�� P.1ne:- LS'�• 77.e-34
A
Address: y 9 q 0 .5,200& Sf . A
CONTRACTOR Name:
�E4AJ Phone'4zg- &W•Sd-c1
Address: of L 14E71"_; 1T rQ vac= A r-►d a a£r- r r.� • / '�.s"
1
Supervisor's Construction License: ,"Y;Z f Z� Exp. Date: 3 —,/o
Home Improvement License: A9 '3 5 Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No. k
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. I
Total Project Cost: $ �, �� �- FEE: $ I
Check No.: 0 /0 Receipt No.: �Z 3
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor`/
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 F6RM
Y
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
Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT -Temp Dumpster oil site yes no
Located at 124 Main Street
Fire Department signature/date �- --d
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
r
❑ Notified for pickup - Date
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................-...............__.—_-.................................._..-............_—_._..................._.....-_..._-.._..............--.... _.......................----.......__..........--........................__.....
—_.....................— - .._..---- ..._.........................
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
o Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
. 0 Copy of Contract
o Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products z
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o 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
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o. Copy of Contract
E3 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 the_n get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
'Revised 2.2008
tAORTH
Andoveirown of
INTO. - 94 al
0 dover, Mass.,
ry` Q = LAKE A•
COC HICHEMCK
ADRATED PPp\
S BOARD OF HEALTH
a y Food/Kitchen
T
Septic System
PERMIT . ... ..
BUILDING INSPECTOR
THIS CERTIFIES THAT..... 0-1......................... O...d``..'�■.•. ...................................................��.................. Foundation
has permission to erect........................................ buildings on ....'i..�.. ......... .® ..... ..l.................... Rough
to be occupied as !!1�..... do...... ......... ...... 1�.. ... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on ile 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
tELECTRICAL INSPECTOR
UNLESS CONSTRU TARTS
Rough
Service
BUILDING I CTOR
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 Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
The C' Pmmonwealth of Massachusefs
Department of Fire Serviees
Office of the State Fire Marshal .
P.0.Box lOZd SGite Road,Stow,MA 0I775 i
PERMIT Date: O -01
North Andover JPermitNo
(City of Town) ('If Applicable) Dig Safe NUM er
In accordance with the provisions of M G.I 14 8.chapter__as provided in section 5 7 7 ('Mg 34
Start Date
This Permit is granted to:. j��„
Full name of person,Firm or Corporation
Pennissionto locate dumpster for Construction/renovation/demolition of building.
C°`nments: dumpster must be . 25 ' from structure if unable tolace with re uired
� Restrictions:
clearance dumpster must be covered with 1 wood or tar end of work -day
I at
(Give location by street and no.,or descn-be in such manner as to provied adequate identification of location)
Fee P aid$ 50.00
7� • Fire Chief
This Permit will expire' �'�d a (Signature o (Title)
L 5262
KEEN CONSTRUCTION CO. GP
1 a 21 HEWITTAVENUE ®� L
� NORTH ANDOVER. MA 01845
;I
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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
Submitted j ( Chapter 142A of the general laws,must be registered with
i To: ft t") F�JLZ(� "`+' ` f� i(�`'"�. the Commonwealth of Massachusetts. Inquiries about
1.._.,
-- — registration and status should be made to the Director,
=� - Home Improvement Contract Registration,One Ashburton
` C' _ ) Place, Room 1301, Boston, MA 02108 (617) 727-8598.
Owners who secure their own construction related
__...... ` � I,.n 1 t;' permits or deal with unregistered contractors will
be excluded from the Guaranty. Fund Provision of
MGL c. 142A.
i PH NE DATE REGISTRATION N0, EIN N0.
f � MA. H.I.C. 108383 26-0462904
j > C/S = Customer Supplied S+ I = Supply + Install 6-9 a S See Attached Appendix A
We hereby submit specifications and estimates for work to be performed and materials to be used:
f
_............._w _ _.
,
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i _............� _ ___..__.._....._.................._....-....._.._.1-1...._....._________'_'1'___.......... -_- -
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._...
--------
.
.-._._.
......................_.__ _ _ _ _--_--
__ ---
> Construction related permits: __.._.._.. ..,. _..__.----__-----
I
i _....._.__. ,.„,,.._...,.,_..._....._............._........_.....,.....__..........................,....,_.,............._..........,....,.._.
....._.._.........._.................................._.............._.........................._..................................................,.........................................................................................................................................,...,........................................................................_............._..................._....._........._..................
WORK SCHEDULE
Contrail r y Il,.�tot begs the work or order the materials before the third day following the signing of this Agreement,unless specified heredi,.wri i C ntra for 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.
ILII WARRANTY
The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of .f r~-- following completion and shall
comply with the requirements of this Agreement. In the event any defect in workmanshipior materials,or damage caused by the Contra or,his subcontractors,employees or agents,is
discovered within one year after completion of any job,including cleanup,the Contrac6r 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 fur ish material and labor 'Com
i accordance wi h above s ecI _I.fications,for the sum of
I -- ”
I 1 1 f t� 9 t � _F dour 1
Payment to be made as follows:
— dollars ,, .
($ ) upon signin Contract; KENNETH B. KEEN_/ ROBERT A. KEEN
\ Name of Contractor/Designated Registrant
$ u- n �` ti �Df \\\YYY 21 HEWITT AVE.
i ( ° ' , s
Street Address
po completion of N. 'ANDOVER, MA 01845
City/State
=" % $ shall be made forthwith upon (978) 691-6201 (978) 682-3231
l
( ) completion of work under this contract. 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 IIZdsi
an— ` C'
jor 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°fi .4t g
e -------_..-
equipment,whichever amount is reater. Note: Tis proposal may be 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.
j 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.
NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature Date �/'fir •�,
Signature - Date.
ANT -O C
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IMPORT INFORMATION NBA K
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•.;.� Z: G#�:��., �clY�aSr"t+s,Z'i�,?S�Fx��l. .4�r'kJ%i<�wrMM+�'.Ls '`�sc
777-7'777
U6/11/LUUa U8:41 YAA 101 V4L LLL0 b1LVLAI 11VJU1tAAkZ I(IJUUJ
AAC,ORQ CERTIFICATE OF LIABILITY INSURANCE 08/11/2ro 091
PRODUCER (781)942-2225 FAX (781)942-2226 THIS CERTIFICATE IS ISSUED AS A MATTER 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
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Reading, MA 01867-3922
INSURERS AFFORDING COVERAGE NAIC#
IIsuRED Kenneth B. Keen INSURERA: NORFOLK & DEDHAM INSURANCE 23965
DBA: Keen Construction Company INSURERS: Granite State Ins. Co. 0077
21 Hewitt Ave. INSURERC:
North Andover, MA 0184S INSURER O:
INSURER E:
GO-VEMQES
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.
1 R D ' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE r0LjCY EXPIRATION LIMITS
DATE IMMID131111D
GENERAL LIABILITY ND-P-010078/000 03/13/2009 03/13/2010 EACh occuRRENcE S 1,000,000
X COMMERCIALGENERAL LwBRITY DAMAGE TORENTED S S0,000
CLAIMS MADE a OCCUR MED E](P(Any one parson) S 51000
A PERSONAL A ADV INJURY S 1,000,000
GENERAL AGeREGATE It 2,000,000
GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO S 21000,000
X POLICY jEC7 7LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT f
ANY AUTO Me scadero)
ALL OWNED AUTOS BODILY INJURY S
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
14ON-OWNEOAUTOS (Per accident) 5
PROPERTY DAMAGE 5
(Por amidrnl)
GARAGE LIABILITY AUTO ONLY-FA ACCIDENT S
ANY AUTO OTHERTHAN EAACC S
AUTO ONLY: AGG S
EXC9551UPABIWLLA LIABILITY EACH OCCURRENCE S
OCCUR FICLAIMS MADE - AGGREGATE f
DEDUCTIBLE g
RETENTION i S
WORKERS COMPENSATION AND 6371378 08/03/2009 08/03/2010 xwcsTATU%nrr
huT- orH-
EMPLOYERS'LIASILITY Fft
EACH E.L. S 100,000
B ANY PROPRIETOP PARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED? - EI.-DISEASE•EA EMPLOYEE S 100,000
SIQ AL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500.000
OTHER
OESCRIPnON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSKNI9 AD09D BT);NDORbEMENT I SPECIAL PROVISIONS
riginal workers compensation certificates to be issued by company forthcoming.
ertificate holder is included as additional insured on the general liability with respect to
Aerations of the Named Insured.
ERTIFICATE HQLRLR CANCELLAMN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE YHEREOF,TI4E ISSUING INSURER WILL ENDEAVOR TO MNL
30 DAYS WRITTEN NOTICE YO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Town of North Andover BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
120 Matin Street OF ANY RIND UPON THE INSURER ITS AOENYS OR REPRESENTATIVES.
North Andover, MA 01845 AVTNORUEDREPRESENTATNE
Mark Gilbert, CIC
ACORD 25(2001108) CACORD CORPORATION 1988
. 14u,G
The Commonwealth ofMassachitsetts
Department of Indttstrial Accidents
:. Office of Investigations
600 Washington Street
Boston, MA 02111
ax www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information / Please Print Legibly
Name (Business/Organization/Individual):
Address: gZ L 1'FE.4i ; TC i4 J E
City/State/Zip: O JLC- A4 4 0/ qS Phone #: 0Z 7'F . A 9 1
Are you an employer?Check the appropriate box: Type of project(required):
1.❑"1 am a employer with a 4. ❑ I am a general contractor and I
employees (full and/orpart-time).
* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [L—
modeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in'any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.$ 9. E] Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.]t c. 152, §1(4),and we have no
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.
tContractors 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: G t2 6 1'1 �-tr
Policy#or Self-ins.Lic.#: 66 3 713 7 9 Expiration Date:
Job Site Address: n :5900City/State/Zip:�1, ltd . Q / Y,
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 tip 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 certify under thepAndpenallies ofperjury that the information provided above is true and correct.
Signature: Date: / O
Phone#:
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#:
ii
---.— lee"�ory�rw�uueali o�✓�uza°ac�uc6el �f •.,
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
.x-.
_ Registration 108383
– Exp�rtion 8118/2010 Tr# 272473
r
Type DBA
KEEN CONSTRUCTION CO
Kenneth Keen
21 Hewitt Ave `
No.Andover,MA 01845 Administrator r>
✓lie I069YUI➢"/.Oi�2[lle2GU2 o�✓l�Ga�Jdcacf�ucJe�i
Board of Building Regfilatiobs and Standards
Construction Supervisor License
License: CS 58245
Expires#lora 3/24/2010 Tr# 17,840
Restnc#ion 0'0 �
s
KENNETH.B KEEN
21 HEWITT AVE � -
N ANDOVER,MA 0184'5 Commissioner
- "�. ✓lie �anz�reaiacaecz�li o�,;C�,czaouclu�,aedzi
Boar-d:of l ilding..Regulafions and=Standards
Construction Supervisor License.
License: C"S 76691
;Birthdate;.,8/16/1;9118
Expirawn w 8{16/2009 Tr# 3859
Restkict�on'; 60
ROBERT A KEEN:::
12.E WATER ST
N ANDOVER,MA.01'845 Commissioner
i
I
KEEN CONSTRUCTION CO.
21 HEWITT AVE.
N. ANDOVER,MA 01845
(978) 69.1-5201
Graovac, Dan & Barbara
498 Osgood St.
N.Andover, MA 01845
(978)258-77.64
Contract#5262 ,Appendix A Date: 8/21/2009
Remode12nd floor bath:
• Remove all existing fixtures in 2nd floor bath
• Remove wallboard to studs and tile floor to subfloor
• Frame walls to accept built-in medicine cabinet and pocket door(using existing door)
• Supply& install-blue boardand skimcoat plaster to smooth finish
• Supply& install fiber board in shower area
• Supply&install u'nderlayment on floor
• Supply&install trim to match existing
• Install customer supplied ceramic the on floor and shower area (5' high) (standard installation)
Paint walls, ceiling&trim (walls&trim 2 neutral colors)(2 coat finish)
• Supply& install..shower door
• Install customer supplied vanity and medicine cabinet (top to be installed by Jackson Kitchen)
Plumbing:
• Supply& install all bath fixtures per quote from Peabody Supply#179512 dated 8/1/2009
• Supply& install pipe&fittings to complete job
• Relocating drains or vents will be extra
Electrical:
• Relocate switching for pocket door
• Supply& install Panasonic fan/light combination in ceiling
Total Price:$15,350.00 (fifteen thousand three hundred fifty dollars)
Price does not include cost of permits, tile,vanity, medicine cabinet,vanity top, moving of vents and
drains or any unforeseen problems.::
Page 1 of 2
KEEN CONSTRUCTION CO.
21 HEWITT AVE.
N. ANDOVER, MA 01845
(9718) 691=5201 I
Payment schedule: $1000.00 due upon signing contract
$5000:00 due the V'day of work(plus permit fees)
$3000.00 due when demo is complete
$3000:00 due when plaster is complete
$2000.00 due when complete except vanity and top
$1350.00 due at co.mpleti`on of contracted work
l
Customer Kennth B. Keen
i
Date 1 ,.
Date
Page 2 of 2
Location Ile
No. Z Date 0t
NORTH TOWN OF NORTH ANDOVER
O
F AL
w
9 r
Certificate of Occupancy $ '--
"'°'At� Building/Frame Permit Fee $
s�CNust �—
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
Building Inspector