No preview available
HomeMy WebLinkAboutBuilding Permit #194 - 57 HEWITT AVENUE 9/10/2009 BUILDING PERMITo "°oTFi qti TOWN OF NORTH ANDOVER �? 4�tt oL APPLICATION FOR PLAN EXAMINATION nO� eb T Permit NO: Date Received 4q y7. Ar ��SSACHUS Date Issued: r IMPORTANT: Applicant must complete all items on this page LOCATION n PROPERTY OWNER_SUr f}roc.�1 -r obPrint/Gytog tj Print MAP NO: CEL: ZONING DISTR+CT: Historic District yes Machine Shop Village yes PnoT TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair,teplace Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sew DESCRIPT ON OF WORK TO BE PREFORMED: fI e- t .� �� E !`moo o zy til 7- Identification Please Type or Print Clearly) OWNER: Name: AlArq-f I h fZ}/RPhone:afi- 07• /a7Y I!, Address: 4 cl e CONTRACTOR Name: -� ;-.Lod C4 tj S"T Phone:4 7 �b` 4 • ,S az) t Address: 42 E HILL tr ur Supervisor's Construction License: S`�c t ,S Exp. Date: "/ o Home Improvement License: 7 D S6 3 "3 Exp. Date: 2 - -/0 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 6 J'- Cni FEE: $ � Check No.: v 3,q Receipt No.: NOTE: Persons co tracting with unregistered contractors do not have access to the guara fund 5i9nature of A eng(?wner - � __9 _ . 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 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 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 on site yes no Located at 124 Main Street Fire Department signature/date 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 II ❑ 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 PP Permit Application cation ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 I Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 LocationCID) 0 J' Gc,✓, .S'1�� No. 6 Date ' MORTM TOWN OF NORTH ANDOVER,, F AL A A } ° Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s+CHU 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �/d 2 < Building Inspector F NORTF� own of Andover 0 ", No. CN == A K E dover, Mass., d ' 1 co HIC HE WICK V ORATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System q BUILDING INSPECTOR V THIS CERTIFIES THAT....... . �. ....t....J.......O�K�!'`.. ..... .......................... .......................................... Foundation has permission to erect........................................ buildings on ..........S.T.........I.. ... .. .................. ........ Rough to be occupied as.........�-r k „��{,�.... Chimney provided.that the person accepting this permit shall in every respect conform to the terms of the application on file 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 3bd ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service BUILDING 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. . . it -------- Gflee toamnnoozurea.� ��/�aaoczc`ucaeC>t6 � ,�K Board of Building Regulations and Standards — HOME IMPROVEMENT CONTRACTOR Registratl�or�, 108383 } E -p 'hon m8 18/2010 Tr# 272473 KEEN CONSTRP.9110N CO Kenneth Keen a 21 Hewitt Ave No.Andover,MA 01845 Administrator TLie �anvrrcanusea�,� a�„�ao�czc�ivaeltct Board of Mitding Re'g-utatid-s and Standa'r&* Construction Supervisor Licen's'e Licemse: CS 58245 Expiration _3/2412010 Tr# 1784.0 KEtVNETH B KEEN'> 21 HEWITTAVE �� — N ANDOVER,MA 0145 Commissioner �, ✓�ie yr m�zmo�iu�iea� o'',:'��,adouc/zccaeG� Board of Bujl'dmg Reg.u'Iations:rand'Standards C:onstructid.h Superrvisnr l cense Lwense CS: 766:91 Brrthdafe y8�1611,96:8 � Tt#E j63859 t tin00• ROBERT A KEEN; 12 E WATER STS— Nt ANDOVER MAc.0184:5 Comin'issioner ACORP CERTIFICATE OF LIABILITY INSURANCEoa tMMIOW 9) 11/2 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 Reading, MA 01867-3922 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# IN9umm Kenneth B. Keen INSURER A: NORFOLK & DEDHAM INSURANCE 23965 DBA: Keen ConStruCtion Company INSURER B; Granite State Ins. Co. 0077 21 Hewitt Ave. INsuaERc: North Andover, MA 0184S INSURER D: INSURER E; COV THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDIIT ION 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 LIMIT$SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 R OWL TYPE OF WSURANCE POLICY NUMBERPOLICY EFFECTIVE rOuCY EXPIRATION LIMfi3 GENERAL LIABILITY NO-P-010078/000 03/13/2009 03/13/2010 EACH OCCURRENCE s 1'000 000 )( COMMERCIAL GENERAL LIABILITY DAMAGETO RENTED S 50,000 CLAIMS MADE a OCCUR MED EXP(Any one person) S 5,OOO A PERSONAL 6 ADV INJURY S 1,000,000 GENERAL AOCnEGATE f 2,000,000 FP_ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 21000,000 X POUCY j� LOC AUTOMOBILE UMLITY COMBINEO SINGLE LIMIT s ANY AUTO Me occident) ALL OWNED AUTOS BODILY NJURY S SCHEOULED AUTOS (Per person) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE 5 (Por accident) OARAOe LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EACESS/UMBRELW IABILRY EACH OCCURRENCE 5 OCCUR FICLAIMS MADE AGGREGATE t S DEDUCTIBLE S RETENTION S S WOAKERSCOMPENSATION AND 6371378 08/03/2009 08/03/2010 X I WCSTATU OTH- EMPLOYERS'.LULBB.ITY TORY LIMITS ANY B OFFICER/MEMBER PPARTND£0 XECUTIVE E.L.EACH ACCIDENT S 100,000 e yes,descnbe under EL.DISEASE-EA EMPLOYE S 100,000 SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT S 500.000 OTHER DESCM"*N OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BT ENDORSEMENT 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. R IFICATE fjoi DER CANCELLAT11ON SHOULD ANY OF THE ABOVE DESCRIBED POLICIE5 BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 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 Main Street OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 AUTOO IM REPRESENTATIVE Mark Gilbert CIC ACORD 2S(2001/08) ©ACORD CORPORATION 1988 The Commonwealth of Massachusetts kf j! Departmenf of Industrial Accidents • ! Office of Investigations p6� 600 f rashington Street Boston, Mg #2111 {1 Www-mass .go v/dnaWorkers' CamPensation Ineranee Affidavit: . ALcantInforaation ectricia ns/Plambers Please Print LeQibl Name(Business/Ot'wization/Individual): i t F N Address:city/State/zip .1Q,� 0 t�f.L ✓y1 RS Phone#: . g 7 ' v Are you an employer?Check-the appropriate box: 1.LI"am a employer with�_ 4. ❑ I am a T ypeject(r��7 general contractor and I employees(full and/or part-time).* have hired the sub- constru 2. cotrtractors ❑ I am.aso le proprietor.or partner- listed PmP parte sted on the attached sheetdeiing ship and have no employees These su&contractors have working forme in any capacity. workers' comp,insurance. lition [No workers'comp. insurance 5. W i addition e P ❑ are a co oration � on rp and its 3.❑ required) officeas have exercised their ical repairs or additions 1 am a homeowner da' all work right of exemption per MGL myself, ing repairs or additions Y [No•w.orkers comp. c, 152, §I(4),'snd we have no insurance uired. .t 12.[]Roof repairs � l .employees.[No workers' camp. insurancx wired_ 13-❑-'Cfther Poo 2. `Any applicant that checks hoz'#I mast also fnl out the section below showing their worker'oompensation policy information. t homeowners who submit this affidavit indicsting they ars doing an work and than hire outside contractors must submit a new affidavit indicating such ;Coetracton;that check this box mustrltPcttrd an afttional shear show ing the name of the sub-contractors and t hetr workers 'ecru^. p !ici;.Emnsdon.I7 an amPioyerthaisrovidingworkrs1 infarmaton. comPensatoninsurancefor iy amP!oYe� Below is the pulley aoa',job site . Insurance Company Name: ' G rz�q N �-E �N S tF Policy#or Self-ins.Lie. Expiration Date: Job Site Address: ' ��� E tit/ iTfJel City/State-Zip, i o r . ty�tat:.,/Z� AttachrP �! a copy of the workers' compensation poli declaration c3 on page(showin the oil Failure to secure covers a as g P c3 number and expiration dafe� g required under Section 25A of MGL c. 152 can lead to the imposition of criminal fine up to $1,500.00 and/or one- ear' penalties Y imprisonment;as well P es of i Of up to$250.00 a against 8s civic penalties in the form of a STOP WORK ORDER �3' ga nst the violator. Be advised that a copy of this statement may be forwarded to the Office of a fine investigations of the DIA for insurance coverage verification. I do hereby certify under the pains enaltieecc o e .rP dury that the information provided above is true and correct Si tom: Phone#: Q Ofj`Iciat use only. Do not write in this area,to be completed by city or town octal City or Town: Permit/License# Issuing Authori{y(circle doe): 1. Board ofFiealt6 L Building lding Department 3.City/Town Clerk 4. Electrical Inspector 5. Piunrbing Inspector 6.Other Contact Person• Phone#: Information and Igstructions Massachusetts General Laws chapter 152 requires all emp I oyers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, - express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and includir tg the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association►or other legal entity,employing employees.'However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such-employment be.deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or-local licensing agency.shall withhold the issuance or renewal of a license or permit to operate a business or ite construct buildings in the commonwealth for any applicant who has riot produced acceptable evidence.oir compliance with the insurance coverage required" Additionally, MGL chapter 152,§25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work utrtil acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation•affidavit compimtely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es)mind phone number(s)along with their oertificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not requiredt to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirnriation of insurance coverage.. Also'be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the.application for.tfire permit or license is being requested,not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the nurnber.listed below, Self-insured companies should entertheir self insurance license number on the'appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hes provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the appli= Please be sure to fill in the permit/license number which%-ill be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating-current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy ofthe affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit:must be filled out each year. When a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would lilm to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of 13ndustrial Accidents Office of Envsstie atians 600 Washington Street Boston, MA 02111 TeL # 617-7274900 6Xt 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia X161 I KEEN CONSTRUCTION CO. GP A 21 HEWITT AVENUE PROPOSAL 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 iChapter 142A of the general laws,must be registered with Submitted _ the Commonwealth of Massachusetts. Inquiries about To: ......-......._.....__.._....C�.....Y - registration and status should be made to the Director, j Home Improvement Contract Registration,One Ashburton I � � V Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related L .. permits or deal with unregistered contractors will _.�.__ _.__._.--..............._.-..--- --....._..._ ........_............_..-._...__......_.... ____._._... __. be excluded from the Guaranty Fund Provision of I � MGL c. 142A. P ONE(" \ DATE REGISTRATION NO. EIN NO. ' � ` — - MA. H.I.C. 108383 26-0462904 i > C/S= Customer Supplied S + I = Supply + Install ❑ See Attached Appendix A i We hereby submit specifications and estimates for work to be performed and materials to be used: -.b „ _ - I t _ (J............. CL I cled .-.._.............. . . -- - — - --- ..----------------------__ ._...------._.___. > Construction related permits: - ----- I i _...,..__..-._____....___..,__..........._„_...................... t I 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 i 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. I 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 Contractof,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. i I i We Propose hereby to furnish mated I and labor-complete in accordance with abo s cifications, for the sum of Payment to be made as follows: dollars($ 1y` 9 ), % ($ upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN iName of Contractor/Designated Registrant "�'j upon completion of 21 HEWITT AVE. (, Street Address iN. ANDOVER ($ upon completion of-"-"'"�'"""5' ANDOVER, 018+ 5 City/State -- % ($� j,(� shall be made forthwith upon (978) 691-5201 (978) 682-3231 completion of work under this contract. Ph^ Fax f INotice: No agreement for home improvement contracting work shall require a kSignature l� >down payment(advance deposit) of more than one-third of the total contract price ",,,!I i or the total amount of all deposits or payments which the contractor must make, in i advance, to order and/or otherwise obtain delivery of special order materials and Auth r Iequipment,whichever amount is greater. Note: This proposal may be withdrawn by us it not accepted within days. J 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. I DO,IOT SIGN THIS CONTR�CT)F THERE ARE ANY BLANK SPACES. Signature Date Signature Date rP IMPORTANT INFORMATION ON BACK,►