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HomeMy WebLinkAboutBuilding Permit #550-13 - 51 MOODY STREET 2/1/2013 BUILDING PERMIT ",-D b'�ti TOWN OF NORTH ANDOVER 21�~`r APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �4A°HATED �5 �SSACHU`��� Date Issued: 2 �� IMPORTANT:Applicant must complete all items on this page 4., ,+ .r r ..'� N'*s;r. l•'r. xY*-t. •- �t S��wc -ti i � �r y t s� s o w• _ t� -,^ rin PRQPERTwY`OWNER? N© rLt �.`c MAP NO . Q 1.. PARCEL; 1 `ZONING,DISTRICT �jHstonc District: ` yes, .no �,- •„ 'Machine:ShoPVillage yyes no p 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 kSeptict Well �`' ;yFloodpla`m`_, Wetlands. 'f: ; �'. WatershedkDil isfrict >' Nate(/Sewer " DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: COIVTRACTOR Name �&A41-fk f� Fc !✓. Phone Address 1 z �U .✓`. r7_i ►d� _ ,. Su P ervisor�s�Coristrucfion License: � - TExp �Home�lmprovement►License L z. t= ARCHITECT/ENGINEER Phone: ' Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. m Total Project Cost: $ � }t�oo FEE: $ Check No.: ��'a 7 Receipt No.: '?g�-3f` NOTE: Persons contracting with unregistered contractors do not have access to the g anty fund Signature of Agent/Qwner Signature of contractor' _- A I 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 COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes t" Planning Board Decision: Comments F f ' Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT °=,Temp Dumpster`on site` yes ,Loc ated;at�124iMaih Street r. lam. Fire Department°sjgnature/elate;: 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No. Date -? • ' TOWN OF NORTH ANDOVER • VVL h�n • . . Certificate of Occupancy $ Building/Frame Permit Fee � Foundation Permit Fee $ Other Permit Fee $ TOTALVA $ I E G Check#?W 7 1 26134 Buil-mg Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 51940.00 m $ - $ 71.28 Plumbing Fee $ 8.91 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 8.91 Total fees collected $ 189.10 51 Moody Street 550-13 on 2/1/2013 Misc Repairs-See Detail in B Permit File NORTH own- of t E : ., 6 ndover O y' to No. 55000V C, h ver, Mass, �,eCOCHIC«e WICK y�• ADR�TED �'PP��S s � BOARD OF HEALTH Food/Kitchen PER. MIT T D Septic System THIS CERTIFIES THAT .....�dr��I..��!:�r.....G.a��::�.�,.s...!��G.................................................. BUILDING INSPECTOR Foundation has permission to erect ........................... buildings on y.. ..................................... / Rough to be occupied as .. / �l,�c-GJ�..; fL/��"' . rr..,... 0 r�.1:. !;:!�C.�•-!J. ...................... Chimney ........ ........ .... ..:. ..., f.............. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service ................. .. .. ................ .r+:tr: s/....:.7.::`.• . ...............: 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. SEE REVERSE SIDE K-EEN COND-RUC710N CO. 2-1 ftrr-r AVE IV. ANDOVER, MA 01845 978-691-5201 Ka�'r�uct'io- Cv�.C�:cavv� Linda&Paul Swartz January 31,2013 North Birch Properties,LLC P.O. Box 881 N. Andover, MA 01845 Contract##5054;Appendix A Plaster/ceiling repair:$2240.00 • Hang blueboard and skimcoat plaster to a smooth finish in both V floor bathrooms,addition, rear room(old 2'id kitchen)and halfway • Repair walls in rear room • Repair ceiling in 2"d floor bath • Does not include kitchen plaster repairs Doors and windows:$855.00 • Supply&install vinyl dead lite in basement window • Supply& install door slab in front corner bedroom • Supply& install door unit in opening between house and addition • Install customer supplied door at basement doorway Miscellaneous:$285.00 • Supply&install three bathroom vents • Remove old caulk and re-caulk V floor bath tub - • Supply&.install missing base molding in rear room Kitchen:$2560.00 • Remove existing cabinets and counters • Remove one rear window and patch interior and exterior . • Install customer supplied cabinets(1/2"overlay,full frame)as per drawings from Plaistow Cabinet Co. dated Jan. 25, 2013 with related trim Total Price:$5940.00(fifty nine hundred forty dollars) Price does not include cost of permits or piaster repairs in kitchen.. Page,1 of 2 i KEEN COj1 S /(may U(^�Ky ON CO. 21 9EWI7 r AVE. N. ANDOVER, MA 01845 978-691-5201 KeevtC&n0rcccri xnC&-ccs Payment schedule: $2000.00 due upon signing contract $2500.00 due when ceilings are complete $1000.00 due when door in addition and bath vents are installed and cabinets removed $440.00 due at completion of contracted work stbmer { r1 Keizeth B. Keen. Date. Date Pagel 2 2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kip 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): K E N op w !n v C��d Address: ( 1^w 17— ,q v C N• d o �£tZ. orgy r City/State/Zip: ✓� _ Phone Are you an employer?Check the appropriate box: Type of project(required): 1.[ am a employer with-- 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 F-1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. o workers' comp.insurance 5. 9• ❑Building addition [N p. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]f employees. [No workers' comp.insurance required.] 13.[1 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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 is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: 112 r.V 6 21.15 , Policy#or Self-ins.Lic.#: (o ��(, U U-5 3 f-87.2 6 A - /a Expiration Date: Job Site Address:_ 5t I Y l p,0 City/State/Zip:, 'A d 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. Ido hereby certi un er the pains pe alties of perjury that the information provi above is true and correct Si nature: .. Date: ^- Phone#: [Official use only. Do not write in this area, to be completed by city or town official, ty or Town: Permit/License# uing 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#: Board of Building Regulations and Standards. ` Constructiom Supervisor License License: CS 76691 ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2013 (ununissi mcr Tr#: 3772 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058245 KENNETH B IdEN 21 HEWITT AVE" N ANDOVEtiR MA 01845' z •fir•+ 14"�� Expiration Commissioner 03/24/2014 ��fie�a�n��rr�uuecc�l�o�C �crelta Office of Consumer Affairs&Busibess Regulation OME IMPROVEMENT CONTRACTOR egistration: 468383 Type: xpiration: _;-81_l'8%2014, DBA KEEN CONSTRUCTIO1% Kenneth Keen 21 Hewitt Ave No.Andover,MA 01845 Undersecretary 8/15/2012 12:58 PM FROM:' Gilbert Gilbert Insurance Agency; Inc. TO: +1 (978) 682-3231 PAGE: .001 OF 002 ACR CERTIFICATE OF LIABILITY INSURANCE 08/15/2012, PRODUCER (781)942-2225 - FAX (781)942-2226 - - -THIS CERTIFICATE IS ISSUED AS AMATTER'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 Reading, MA 01867-3922 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . INSURERS AFFORDING COVERAGE NAIL# INSURED Kenneth Keen & Robert Keen INSURERA: NORFOLK & DEDHAM INSURANCE 23965 DBA: DBA Keen Construction Company INSURER 8: Travelers Insurance 21 Hewitt Ave. INSURER C: North Andover, MA 0184S INSURER D: INSURER E: OVERAGES 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THE TERMS,EXCLUSIONS AND CONDITIONS.OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY-HAVE BEENREDUCED BY PAID CLAIMS. ILTR DD TYPEOFINSURANCE POLICYNUMBER- POLICY EFFECTIVE POLICY EXPIRATION DATE fMMIDDI'M DATE(MMIDO" .LIMBS - GENERAL LIABILm ND=P-010078'/000 03/13%2012 03/13/2013 EACH OCCURRENCE $ 1 000,00 0. X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ LOO,OO: CLAIMS MADE.❑X .00CUR MED EXP(Any.one person) . A - PERSONAL&ADV INJURY $ 1 000,OO GENERAL AGGREGATE $ 2,000,00C - GENL AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ .2,.00O OO X POLICY P LOC AUTOMOBILE LIABILITY - - - ANY AUTO COMBINED SINGLE LIMIT $ _ ) ALL OWNED AUTOS BODILY INJURY - - $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NOWOWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGELUIBILITY - - - AUTO ONLY-EAACCIDENT .-$ - ANY AUTO - OTHER THAN EAACC� $ AUTO ONLY. AGG $ EXCESSIUMBRELLALIABILITY EACH.OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE " $ RETENTION $ - $ WORKERS COMPENSATION AND 6KUB-5640726-A-.12 08/03/2012 08/03'/2013 wcsrATu OTH- EMPLOYERS'LIABILITY - ER - B ANY PROPRIETOR/PARTNER/ExECUTIVE E.L.EACH ACCIDENT $ 100.000 OFFfCER/MEMBERIXCLUDED? E.L.DISEASE-EAEMPLOYE $ 100'0Q0 If E.L.- SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,00. " OTHER - - - - DESCRIPTIONOFOPERATIONSILOCATIONSIVEHICLES"(EXCLUSIONSADDEDBYENDORSEMENTISPECIALPROVISIONS - vidence of Coverage ERTIFICATE HOLDERO - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRTITEN NOTICE TO THE CERTIFICATE HOLDER.NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH-NOTICE SHALL IMPOSE No,OBLIGATION OK LIABILITY - OF ANY KIND UPON THE INSURER;ITS AGENTS OR.REPRESENTATIVES. Evidence of Coverage AUTHORM, REPRESENTATIVIE Mark Gilbert CIC ACORD 25(2001108) ©ACORD CORPORATION 1989 `1`�k,Z;.;"• :r �;;�'�^G.A,7 �Y"'-`� �. � �-.S. t,;`�' ;*�,^..�'�'- ...�i�-�:�;r"},u, .,..:3 ;�...�,�"" 7 ....`';T��-;c7a` ,,.... 'yyyy��€µµ����.e "'.kc.L;•� , .. KEEN CONSTRUCTION CO. GP ��®��J�L e 21 HEWITT AVENUE NORTH ANDOVER, MA 01845 Tel: (978)691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax:(978)682-3231 specifically exempt from registration by Provisions of r� Chapter 142A of the general laws,must be registered with Submitted ?. �� j / ( the Commonwealth of Massachusetts. Inquiries about To: - p {1 �.�I f C r} G� 'f );F .) _ registration and status should be made to the Director, ------ - I 1t Home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02108 (617) 727-8598. D Owners who secure their own construction related X j.— — - -—-- permits or deal with unregistered contractors will ---1� _ be excluded from the Guaranty Fund Provision of N Odd d V e � I V( � 6 f ��f�� MGL c.142A. PHONE 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: L Cruel ..........--------- .--------- --- I� 1 �c. - ---- --------------------- t 1 l } { tr ------- ---- --- ---.....---- > 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 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 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. 1 We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of I p'I dollars($ �) to ). Payment to b6 made as follows: % ($ ) upon signing Contract; KENNETH B. KEEN/ROBERT A. KEEN i % , I Name of Contractor/Designated Registrant % ($ "�,0 al i o 21 HEWITT AVE. '^ t ` Street Address —1 @ ($ ).uDncompletionof N. ANDOVER, MA 01845 G-� City/State shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Phone Fax i Notice: No agreement for home improvement contracting work shall require a >down payment(advance deposit)of more than one-third of the total contractprice Name of sal 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 Aulhon;?d t equipment,whichever amount is greater. Note This proposal may be 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. 1 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. v SSignature ,� f��`"'�-- °'t Date z 1115 Signature Date IMPORTANT INFORMATION ON BACK