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HomeMy WebLinkAboutBuilding Permit #1065-2016 - 50 BLUEBERRY HILL LANE 4/12/2016 0ORT►1 q BUILDING PERMIT a• ~�� ~oo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINA ON ^o Permit NO: ' /�/9 Date Received Date Issued: SSACHusE IMPORTANT:Applicant must complete all items on this page LOCATION v 1?�- tP "Print PROPERTY OWNER ai 9 Abbo�t Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Re.Mo�P,I Vy1 a �� roo iv\ Identification Please Type or Print Clearly) OWNER: Name: U� `b P-P--6� hb. OL Phone: Address: AJ, /to d CONTRACTOR Name: 40' C0451&dW �o- Phone: 977-6 9/— Address: pQ Box 35 ,v ' r7 d o"11`o /vt 61 F4,5 Supervisor's Construction License: Exp. Date: b 41 Home Improvement License: 3 Exp. Date: 2-A /I 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: $ 20 96 I O—J FEE: $ ,zk� " Check No.: ( Receipt No.: �232 r NOTE: Persons contracting with unregistered contractors do not have access to the g ra fund Signature of Agent/Owner Signature of contracto Ftrz10�eRoY1 BUILDING PERMIT O 6v9�0 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 74A°RATE gSSAC HUS�t Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 0 Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District 0 Water/Sewer____ DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signatur . of Agent/Owner- - Location- 'l'� ;2 'P �Y,4� ,' i No. 51 2--O\�- Date ` • - TOWN OF NORTH ANDOVER °u= Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# i 2 , Building Inspector Plans Submitted Plans Waived ❑ Certified PId 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 Duimpster on Site I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS a e 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: 4 IF, DEPARTMENT Tem Durnpsterc�o - w Located Osgood Street �Located�at��124MamtStreetest ni#site° y . R artmen� n {Dep, �s tsignature/d `COMMENT iS: 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 ruse) ® Notified for pickup Call Email 3 _ Date Time Contact Name Doc.Bnilding Permit Revised 2014 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 r OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application 6 Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract 4. 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 4 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 2012 IECC Energy code Engineering Affidavits for Engineered products 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 I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost s 201680.©'0) m $ - $ 248.28 Plumbing Fee $ 31.04 Gas Fee 100 comm. $; 110:01-0,0) Electrical Fee $ 31.04 Total fees collected $ 410.35 50 Blueberry Hill Lane 1065-2016 on 4/28/2016 Remodel main bathroom - ,..o.�:.x:�.x, :- w..e4S%tr,,... ,:i:-'., :i.�s.s'::�„.a,. ..:.tc R.4-�"'..,�e..ti,: <s. ... ?�-�#:�:.P""e'�,`*',--..�.Y,..,....i.c e�..ti --•.....� '"=��+rr.. �'" ,,,x� -c-.s.k. s� NoRT �.awn o : Andover No ver, Mass 2 oLA19,,, QA coc"K.,✓QQi ,�cj �.95 q'�TED r II BOARD OF HEALTH F) ERMIT T LD Food/Kitchen Septic System � R THIS CERTIFIES THAT �• .. ....Qty ......6 ' BUILDING INSPECTOR .. . ..., has Oerillission to erect ... Foundation .......... ...... ........ buildings on , Rough Occupied as .....of,*0.Jet......r.�n+�►�l!to b ..... ...��r.".'•..... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file i Inspection, Alteration and 0"file i this office, and to the provisions of the Codes and By-Laws relating to the Comtction 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 INSPECTQR UNLESS CONSTRUCTI TARTS Rough Service •' BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildln Rough Display in a Conspicuous Place on the Premises — 0° 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. Constucr`ian Co;, ttEMOUf3LIPt C: SPtCa/_�LISTS 978-69'�-520'! KeenConstructionCo.com Abbott, Rebecca 50 Blueberry Hill Rd. N.Andover, MA 01845 Contract#5579;Appendix A April 8, 2016 Remodel main bath: • Remove and dispose of existing fixtures, wallboard and flooring in main bath • Frame closet in hallway • Update plumbing as needed, installing customer supplied fixtures • Update electrical to code, including installing customer supplied vanity light • Supply& install 110 cfm fan/light combination vented to outside • Relocate vacuum outlet as needed • Supply& install insulation to code • Supply& install blueboard on walls and ceiling and skimcoat piaster to smooth finish • Install customer supplied vanity • Supply& install linen closet door and trim to match existing • Supply& install melamine shelves in closet • Supply& install one Andersen wood interior replacement window with similar grid pattern • Install customer supplied the as described in design dated 5/16/15, 6/12/15& 6/22/15, except for mirror area • Paint walls,ceiling and trim of bathroom and linen closet Total Price: $20,690 (twenty thousand six hundred ninety dollars) Price does not include cost of plumbing fixtures,vanity,the or repairs to any unsafe, unusual or non- code compliant conditions not addressed in this contract. PO Box 935 Page 1 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com H I C #108383 REMC�UIiJ_ING SPECl/ALMYS 975-697-520`1 KeenConstructionCo.com Payment Schedule:$1000 due upon signing contract $4000 due the first day of work $4000 due when rough electrical and rough plumbing is complete $4000 due when plaster is complete $4000 due when tile is complete $3690 due at completion of contracted work Customer Robert A Keen q1s Date Date I I PO Box 935 Page 2 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC #108383 i I C J" KEEN CONSTRUCTION CO. PROPOSAL�®�O CJ� 1175 TURNPIKE STREET No 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 R�C)e i , h� i-� with the Commonwealth of Massachusetts. Inquiries To: ��,JJJ yX 1 about registration and status should be made to the I- Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617.973- 8787 Owners who secure their own construction /�y !P\ r t fes( (� j rr((rrYYll//I 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.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install I See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: 1 n'110 I > Construction related permits: WOR . _-_-----.......-....--._. .. .. . . .................._.. ................... .._ .. ....,...... .__...............-.----...._................................_. 12R.KcKS..,....i 1ED not a�Em the work or order the materials before the third day following the signing of this Agreement,unless specified here in ng_ ntractor 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 des_.nSlgFees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not a con i ered 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 Contractorl 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 oPropose hereb to furnish material and labor-complete in accordance with above specifications,for the sum of I t moi -9 61)sot d S " N AJ"0.J K�i ry I �---- dollars($ " Payment to be rhadp as follows: % ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant ($ ) upon co �le� Of 1175 TURNPIKE ST. ((( + Street Address .% ($ qsh completion of. N. ANDOVER, MA 01845 City/Stale be made forthwith upon (978)691-5201 (978)682-3231 J completion of work under this contract. Phr) Fax Notice: No agreement for home improvement contracting work shall require a JL1C1 a >down payment(advance deposit)of more than one-third of the total contract price rfiJ°f 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 Aut 'rize st equipment,whichever amount is greater. Note:This proposal may be withdrawn by us if not accepted within days. I 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. /�� (DeONOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature t„" ' � Date C Signature L' Date IMPORTANT INFORMATION ON BACK ► The Commonwealth of Massachusetts j Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia bv'V Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AAp licant Information Please Print Legibly i Name (Business/Organization/Individual): �0-6yl LA 5i1--L)Cid 0J) � Address: Ci /State/Zi �� Iqn )'�,'� ►r G�$P one ty P• Are you an employer?Check the appropriate box: Type of project(required): am a employer with 2- employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. Wemodeling 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 11.0 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.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14. Other 6.Q 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 41 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. (-c, rS f Pl 5Insurance Company Name: / Policy#or Self-ins.Lic.#:6- 14 0 1J "9 9/ I �N`J<Z2 — )S Expiration Date: i G�ZS' /I CG Job Site Address: 5 O City/State/Zip: Attach a copy of the workers' compensatiod policy declaration page(showing the policy number and expiration date). 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 copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. i I do hereby certify u e the ins and penalties of perjury that the information provided above is rue and correct. Si ature: Date: j Phone#: 9 7'Y— —5 20 E[Other 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 J rson: Phone#: i ACO ® CERTIFICATE OF LIABILITY INSURANCE °ATE(MMIDI Y-) �� 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 Ileu of such endorsement(s). PRODUCER Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 FAC n:(781)942-2226 IA 137 Main Street ADD RIEss:bmcdonough@gilbertinsurance.com ---INSURER(S)AFFORDING COVERAGE NAIC N Reading MA 01867-3922 INSURER AWorfolk 6 Dedham Insurance 23965 INSURED lNSURERB:Safetv Insurance Company 39454 Keen Construction Company INSURER C.Travelers Ina. Co. 0031 483 Chickering Road INSURER D: INSURER E: North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBERCL1552101779 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 I TYPE OF INSURANCE POLICY EFF POLICY EXP LTRPOLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PREMISES Ea occur encs $ 100,000 ND-P-010078/000 3/13/2015- 3/13/2016 MED EXP(Any one laon $ 5,000 PERSONAL 6 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECTT LOC PRODUCTS-CCMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITYC' asect Em I $ 1,000,000 B ANY AUTO BODILY INJURY(Per Person) $ AU OS X SCHEDULED 6228807 COM 02 5 23/2015 5/23/2016 BODILY INJURY Per accident $ AUTOS AUTOS / ( ) X HIRED AUTOS X AUN-OWER �ED PROPTYDAMAOE $ Underinsured motorial $ 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CWMS�1ADE AGGREGATE g DED RETENTION$_ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNERGXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A C (Mandatory In NH) 6HUB-999IM58-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schsduls,may be attathod H more apace Is required) 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 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025=14o11 Massachusetts-Department of Public Safety Board of Building Regulations and Standards r owstr uc lo11 J11 ICI YI\111 �� License: CS-076691 ROBERT A KEEN? 12 E WATER ST R North Andover M-A 0 % r v, Expiration commissioner 08/16/2017 dJ7-X1'�nrr an2ue�l� amJccc�iuteC i ice of Consumer Affairs&Business Regulation E IMPROVEMENT CONTRACTOR egistration 10&383 ._= Type: Expiration��$l18�2p1S, Supplement Car KEEN CONSTRUCTION t, ROBERT KEEN v , 1175 TURNPIKE ST GC NO.ANDOVER, MA 01845 Undersecretary