HomeMy WebLinkAboutBuilding Permit #533-13 - 51 MOODY STREET 1/25/2013BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: o Date Received
/3l :moi}'•_'. �i„�`
Date Issued:
2
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
Imine family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑,Septic �t❑ Well } `
` p`FloodpCain?~ ,Wetlands
.q WatershedD sfnet;
DESCRIPTION OF WORK TO BE PREFORMED:
VY1 t5C. 22- Pqio,S
Identification Please Ty or Print Clearly) 017?)
OWNER: Name: itr--/i * k _ Oil R.cG� �&e) PLdL fi: FS GLCPhone: 79'x' 79'fi
Address:
1CQNTRACT,OR Name -�1�✓_ Nk� K Ec _ P,hone�g
F W r Zt� U �
SupervISO �s�ConstructionLcense:�,. �'o�._Sr .._- Expo
}..
�Hnrrie�lmnro'vement?Licerise:-. >.�_`�3��3-,-..�•= �:�.._`Exp�kDate:w®�Sl/��:�.a_. ._ � �:`
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT.' $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ aQ9' O 00 FEE: $
Check No.: U Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access Fo Ne gu ranty fund
Si nature�of�Agent/Qwner `': ` Signature of�contract _. __ _ : , .:'i
h
_)
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
e
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
---
FIRExDEPARTMENT, Temp,Dumpsterspn'site dyes _ � _ Mo
;Loc atedat,124!MalnSt�eet
{Fire3Department=�ig:nature/clate�� _ _
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.$10041000 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
o 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
VOTE: 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Location
No.
W63
Check #
Date 613
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $�
Foundation Permit Fee $ t
Other Permit Fee $
TOTAL $
26115 Building Inspector
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Linda & Paul Swartz
North Birch Properties, LLC
P.O. Box 881
North Andover, MA 01845
Contract # 5062; Appendix A
KEEN CONST"t2Z.�C7" ON CC,-
21 ��Irr AII-E,
N. ANDOVER. MA 01845
978-691-5201
Xe 4'LC0n&trU,Ct'Lw-h.00-COM
January 24, 2013
Remodel 51 Moody St.:
Misc. repairs: $1€160.00'
• Exterior window trim on family room
• Garage window sill
! New walk-in garage door (9 -lite steel)
Old (larger) kitchen area: $600.00
• Remove'existing cabinets and approx. 8' of wall
Back family roam: $1130.00
• Remove sheetrock (approx. 17') and install new insulation and blueboard
• Skimcoat plaster to smooth finish
Debris: $200.00
• Dispose of debris from above listed work
Total Price: $2990.00 (twenty nine hundred ninety dollars)
Price does not include cost of permits, repairs due to inadequate, unsafe or unusualexisting conditions,
changes required by inspectors or any work discussed, by not specifically listed, in this contract.
Payment schedule: $1000.00 due upon signing contrfet 11`7
$1000.00 due when family room wall, old kitchen and wall is demoed (plus permit)
$500.00 when family room wall is repaired
$480.00 due when contracted work is complete
Customer p r,.5 ! IVernh B. Keen
Date Date
;aU()2
KEEN CONSTRUCTION CO. GP PR®�®���
A 21 HEWITT AVENUE
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
1 Chapter 142A of the general laws, must be registered with
Submitted-� �� I n. ! : j L_1! the Commonwealth of Massachusetts. Inquiries about
To: r r__. _ - ' trC_'���. ' J registration and status should be made to the Director,
1 i) f t Home Improvement Contract Registration, One Ashburton
_ t1 I' + : G ( Place, Room 1301, Boston, MA 02108 (617) 727-8598.
'1
(� Owners who secure their own construction related
C X permits or deal with unregistered contractors will
---- ry" ""}" "---n- —� be excluded from the Guaranty Fund Provision of
Cie r MGL c. 142A.
kl0 E _ DATE REGISTRATION NO. EIN No.
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:
> 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 dales 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 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, 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 accordan a with above specifications, for the sum of
AU I ✓).' `� (t11�t Uo/UCS _— _dollars ($ �l //6),C<1
Payment to be made a follows: )
/o ($ ) upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN
Name of Contractor / Designated Registrant
/o ($ )�Jcp com 11tiPnr1 t 21 HEMTT AVE.
} ! i' !'\`Street Address
/o i($ _T`comp�letion of N. ANDOVER; MA 01845
` �i, ` City / State
,� $ shall be made forthwith upon (978) 691-5201 (978) 682-3231
( ) 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 of sa
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 Authdn@ed s,gnature '
equipment, whichever amount is greater.
Note: This 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.
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.
1 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
i"
Signature r �r 6'� °' " Date t l "^ Signature Date
IMPORTANT INFORMATION ON BACK ►
ti.,, �..M.w.huY>,err,r'.x.`it .s.w�a..eC `x' ..,. �: s, r.;', .A , a.c_};:.,, ,, svw..,x.:�z.:c,,�„�.a,:>te�,tie.irr.,.`..•�.�Yii�.Lr> +.,,. �.:&z,%¢ac..id'wL a., �n.� .M...��,s�:V wo, >::,.0 ,., .a a xva.:rtnm..ar, ru....:,'iu'.�, ,..xsw..:..�..L..�d>r6'vi
Board o[Q"iNin�Ro-"|*iooyand Standards'
CoostnucfiomSupervi,or License
License: cs 7e6e1
`
ROBERTA KEEN
12EWATER QT
Expiration: 8/16120 13
T,#: 3772
Massachusetts - Department of Public Safety
Board bf Building Regulations and Standards
License: CS -058245
KENNETH B EN
21 HEWITT AVE
Expiration
Commissioner 03/24/2014
Office of Consumer Affairs & Busifess eguZla�t4io`u
.°"C.=~
Type:"""Xpir""' Dun
U
-
---------
KennethKeen
z1Hewitt Ave
No. Andover, mmmm45 =��~
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):-K 6- E to (p
Address:__ 1 H E: W; I l 4 V C
�%Ji C
Ot%43 .
City/State/Zip: iN d 55 t/' f 97F-
!L �/ �� . Phone #: ` Z F " 6 c' L - S�2 O
Are you an employer? Check the appropriate box:
1. �am a employer with --
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. ❑ I
have hired the sub -contractors
am a sole proprietor or partner-
listed on the attached sheet. #
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No,workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11..❑ Plumbing repairs or additions
12. ❑ Roof repairs
13. ❑ Other
r. -- �• R...wasv qui out me 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 their workers' comp. policy information.
I am an employer that isproviding workers' compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name:�j c t4 V C 11.4s . r.1 S ,
Policy # or Self -ins. Lic. #: (p (�(. U Q - S 9 *67,Z Expiration Date:
Job Site Address:YY ! Q [`( �/ JC f, City/State/Zip: tit
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 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. 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 cern un er the pains�lndp (ties of perjury that the information provided above is true and correct.
- - - - v p, Date: ^
Phone M ! 7 & /
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
6. Other
4. Electrical Inspector 5. Plumbing Inspector
Contact Person: Phone
R/1S/�ni� 17•SA DM F'aror. r: lho.♦ r_: lh.�., .. --- ------
CERTIFICATE
..
CERTIFICATE OF LIABILITY INSURANCE
osnSMjzoi
PRODUCER (781)'942-2225 - FAX (781)942-2226 -
Gilbert Insurance Agency, Inc.
137 Maim Street
Reading, MA 01867-3922
THIS CERTIFICATE IS'ISSUED AS AMATTER OF INFORMATION
ONLY AND 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
INSURER A: NORFOLK &:DEDHAM INSURANCE 23965
INSURER 8: Travelers Insurance
-INSURER C: -
INSURER D:
INSURER E`
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDNAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM .OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH -RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJACTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR
DD
TYPEOFINSURANCE
POLICYNUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
ND-P-01OO7H�000
03/13%2012
03/13/2013
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO: RENTED j lOOyOO. 01
CLAIMS MADE OCCUR
-
- -
MED EXP (Any. one person) $ - 5:100(
A
PERSONAL & ADV INJURY $ 1 OOO OO
.
GENERAL AGGREGATE $ 2j000,00
GEM. AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OP AGG S 2,.000 :OO
X POLICY P0. LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
(Ea 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 EAACC. $
AUTO.ONLY, AGG $
EXCESSIUMBRELLA LIABILITY
EACH. OCCURRENCE $
OCCUR CLAIMS MADE
AGGREGATE $
$
DEDUCTIBLE
$
RETENTION
WORKERS COMPENSATION AND
6KUB-5B40726-A-12
08/03.2012
08/03/2013
WCSTATLL OTH-
FR
EMPLOYERS' LIABILITY -
E.L. EACH ACCIDENT $ 100,000
B
ANY PROPRIETOR/PARTNEWEXECUTIVE
- OFFICER/MEMBER EXCLUDED?
£.L" DISEASE - EA EMPLOYE $ 100 ,000
.If yes. describe under
-
-
-
E.L. DISEASE - POLICY LIMIT $ 500,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES /EXCLUSIONS ADDED SY ENDORSEMENTI SPECIAL PROVISIONS -
vidence 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, RS AGENTS OR REPRESENTATIVES.
Evidence of Coverage AUTHORIZED REPRESENTATIVE
ACUKU 20 (2UO1IUH) OACORD CORPORATION 1988