HomeMy WebLinkAboutBuilding Permit #276-15 - 54 SPRING HILL ROAD 9/16/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �� Date Received Date Issued: Id IMPORTANT:Applicant must complete all items on this page r nn LOCATION' PROPPrint ERTY�owNER `� Ll �� Print 1001year Old Structure yes:: MAP'NO: _) 1_.PARCEL:��ZONING DISTRICT: Histbdc,Distnctl yes; n Machine,Shop Village yes. n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ARepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ S.eptic> DWell, ❑ Floodplain ❑Wetlands ❑ Watershed,District . ❑Water/Sewer _ ,( I)ESCRIPTION OFYVO K TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Rt i Phone: '4�Z7 Address: `'i CONTRAC1 OR Name:. V-e�� c�� fUc j cN1�� Phone: - _ y Address rr � iV r ✓�-' _ �M SupervisoCsi Construction License: C 6-7 691 Exp.. Date: Home Improvement'License; �1 � Exp. Dater ARCHITECT/ENGINEER Phone: i Address: Reg. No. s FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $Z ��3 ` dy FEE: Check No.: 1 0�5� Receipt No.: 2_Zb2_-)� NOTE: Persons contracting with unregistered contractors do not have access to the g ran fund Signature of Agent/Owner"_. Signaa LuW Z-'contractor' l Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El 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 ❑ i 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 i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments c Water & Sewer Connection/Signature& Date Driveway Permit DPW TowL Engineer: Signature: Located 384 Osgood Street EIRE DEPARTMENT -.Temp Dumpster on site yes no Located at I24;Main'Street Fire Departinent•signatureldate COMMENTS 1 t 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 i Doc.Building Permit Revised 2010 Building Department The fohowing 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 o 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 appy al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 NORTH Town o . s E ndover 0 ' . ... 1 ...... .. . 0 J.- INo. C w ver, Mass, �cocNIc«ewic A044 TE D S U BOARD OF HEALTH Food/Kitchen PER IT T Septic System THIS CERTIFIES THAT .......... „., BUILDING INSPECTOR .! ......... . ... . ..... ....... .��.�• ��....... Foundation has permission to erect .......................... buildings on .... ... ! ................... 1 Rough to be occupied as Ylr'�t...... . .. cm! ......V...��t... ... .................. Chimney 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T Service TS Rough .......................... 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. r , i C I I I ( I i I � -�� - ' -�- j----,---,-- -�---�--f---�---- ' I - , -fit 3' , -r-I- }-- I ---� -- -� --1--I -- i --•---- � i , , I ' L I , li - I - I , , I , I I , , T -- I , I , , , , i , If , I J { I I ; I i , I i , f , 55 = C KEEN CONSTRUCTION CO. PROPOSAL�0 POSH ° 1175 TURNPIKE STREET L 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: j` �� GI 'Iel� with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director,Home Improvement Contract Registration,10 j Y I ICY Park Plaza, Room 5170, Boston, MA 02116 617.973- kfh\, - /�/J 8787 Owners who secure their own construction I t 0 info r � ''r� 0 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. 2- MA. H.I.C. 108383 46—3783401 > 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: J > Construction related permits: .-..-_._..._..___-D__. E ..._._. WORK SCHEDUL _................. .................._.__................. .............. ..... ,........................._...__....... .................................___._.............. .._............. Contra w I b 'n the work or order the materials before the third day following the signing of this Agreement,unless specified herr actor will begin the work on or about (date). or delay causedby circumstances beyond Contractor's control,the work will be completed by U (date). The Owner hereby acknowledges and agrees[hat the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be consi Mered 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 G 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 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 too 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 specifications,for the sum of: 2 x �euar A I h P 114')AtA �1<k V'1 rifCdonars($ Payment to be made he follows: % ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant ($ ) up r eli0r 6f 18 1175 TURNPIKE ST. Street Address ?/ (� ) pon completion of;: N. ANDOVER, MA 01845 City i Slate % ($ ) shall be made forthwith upon (978)691- 201 (978)682-3231 completion of work under this contract. p pna F�az l 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 salesman 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 Aulhonzed signature equipment,whichever amount is greater. Note:This proposal maybe 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. 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 BuyX, may cancel this transaction at any time prior to midnight of the-third business day after the date of this transa .Cancellati n must be done in writing. DON TSI JTHIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signetu Date44 __ / Signature Date IMPORTANT INFORMATION ON BACK ► —r Canit aobw Co REMC1OEL IMG SPECIALISTS 978-697-520' Keen ConstructionCo.com Gillen, Bill& Lynne 54 Spring Hill Rd. N.Andover, MA 01845 September 15, 2014 Contract#5510;Appendix A Remodel existing deck: • Remove&dispose of walkway on rear and driveway side of sunroom • Remove rotted trim and patch siding to match • Remove& dispose of existing decking and rails • Re-frame deck as needed • Supply& install approx. 375 sq.ft.of Azek PVC(Arbor Acacia) decking with Cortex blind fasteners • Supply&install Timbertech Radiance Rail system on deck • Supply& install six lights on stairs (to be wired by customers electrician) • Supply& install PVC trim around deck and where needed around sunroom • Supply& install Stationary panel of existing Andersen Frenchwood Sliding door Total Price:$26,383.00(twenty six thousand three hundred eighty three dollars) Price does not include cost of permits, painting,electrical work,or repairs of any unusual, unsafe or non- code compl'i'ant existing conditions. Payment Schedule:$5000.00 due upon signing contract 5000.00 due when decking g is delivered $4000.00 due on first day of work(plus permit fee) 4000.00 due whenwalkwa $ Y is demolished $4000.00 due when decking is installed .$4383.00 due at completion of contracted work Jr usto a Robert A. Keen Date Date 1175 Turnpike St. P: 978-691-5201 N.Andover; MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 The Commonwealth of 1tMassachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street r Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual): 6�9.A (C"t'l ,`�(yC� I cv� L CJ Address: �O `fl D, gyp, City/State/Zip: (1 6/7y5 Phone#: 92Y-6 9f"SZO Are you an employer? Check the appropriate box: . Type of project(required): 1.P I am a employer with Z 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling 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. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.El am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insuranc6 required.] t c. 152, §1(4), and we have no 13.0 Other employees. [No workers' 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. *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. Insurance Company Name: f`zi�J`� �'r� ,n 5�i,1 r—r,.n e,-e, Policy# or Self-ins.Lic.#: 6- NUB— 9991 I' ► W- 2 — Expiration Date:Al Job Site Address: City/State/Zip: 6ndL,1&,,C &4()1jq5 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 ascivil 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 er tJ a pai nd penalties of perjury that the information provided above 's true and correct. Si nature: � �''�� Date: 7 Phone#: 5,2,0/ 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#: Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-058245 KENNETH B KEEL\ 21 HEWITT AVE: k4l N ANDOVER Mk 01 Expiration Commissioner 03/24/2016 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-076691 ROBERT A KEEN' 12 E WATER ST 7 North Andover Na Of I° • , Expiration Commissioner 08/16/2015 'Cl1ze ipan7ona�u�sea/�a��aac�iu�C4 Office of Consumer Affairs&Business Regulation 1 f, � ME IMPROVEMENT CONTRACTOR eglistration: 6668i383 Type: S—�. 71 . xpiration: 8!18!2016 DBA KEEN CONSTRUCTI0"aG0 zFt Kenneth Keen 1175 TURNPIKE ST NO.ANDOVER, MA 01845 Undersecretary ti �I i ® DATE(MM/DD/YYYY) AC40RCERTIFICATE OF LIABILITY INSURANCE 4/15/2014 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(ies) 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 lieu of such endorsement(s). PRODUCER CONTACT Barbara McDonough NAME: g Gilbert Insurance Agency, Inc. PHONE (781) 942-2225 A/c No (?81)942A/C -2226 137 Main Street ADDRESS:bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERA:NORFOLK & DEDHAM INSURANCE 23965 INSURED INSURER B:Hartford Fire Insurance Com an Keen Construction Company INSURERC:Travelers Insurance 0022 1175 Turnpike Street INSURER D: INSURER E North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1441500922 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. NOT-WITHSTANDING ANY REQUIRF_MENT_TERM OR COND1TJOf.LOF-AN_Y_.C;ONTRAC_LOR OTHER DOCUMENT WT.H 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 ADDL SUBIR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE T RENTED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE FX OCCUR D-P-010078/000 /13/2014 3/13/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED X SCHEDULED OBUECAA6432 12/3/2013 12/3/2014 AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Underinsured motorist $ 100,000 UMBRELLALAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION WC STATUS OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100 000 ED? OFFICER/MEMBER EXCLUDNIA 6HUB-9991M58-2-13 10/8/2013 10/8/2014 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd $ 100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD Location I ' No. 01(, IL5 l Date n e - TOWN OF NORTH ANDOVER- ,.. Certificate of Occupancy $ a t Fee Building/Frame Permit Fe $ ���•� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 30 Bidding Inspector