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HomeMy WebLinkAboutBuilding Permit #734 - 60 HERRICK ROAD 5/10/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Issued: <Xt 0 IMPORTANT: Date Received must complete all items on this TYPE OF IMPROVEMENT PROPOSED USE , (zI NEW W dows Co) iicxQ moan; Residential Non- Residential ❑ New Building UOne family W -5 -PA ;4L ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial impair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ' ❑ Other [ Septl it /ell b'Flod la ' Wet ands - p. d ll latershed .prstrict 0aterlSewer DESCRIPTION OF WORK TO BE PREFORMED: 145- 01in61-L lUIfchiN , (zI NEW W dows Co) iicxQ moan; W -5 -PA ;4L /P1 i SC tf S- J —F& r /*I . Identification Please Type or Print Clearly) � 0 OWNER: Name:_& T -, 'D�c�� �,�},� Phone97d -G2Z-3,%l Address: &)C f't t R iZ %G I C 1/,a , 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: $ Z Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guar my fund Signature of Agent/Owner v Signature of contract __ Y Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools Well ❑ Tobacco Sales ❑ • ., a Food PackaginolSe1ds 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS ' DATE REJECTED,. DATE APPROVED HEALTH ❑ ❑ j COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: 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 2007 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 o 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 2.2007 Location No. Date f �� _. A -._ TOWN OF NORTH ANDOVER Check # 20 5`1 1 T16 . Building Inspector .. p Certificate of Occupancy $ M�i.-.... 4 s'""° �MU5 Et 4C Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20 5`1 1 T16 . Building Inspector KEEN CONSTRUCTION CO. c 21 HEWITT AVENUE Nb`RTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978)682-3231 Submitted ..................................... �k To:.............. ....._..................._.... ..-----._... __ .}ck._..._.-.___. . t ,. ,59 PROPOSAL All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION N0. F.LD. N0. �`- �: % r - --t MA. H.I.C. 108383 04-325-8052 > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: > Construction related permits: . .. . . ............ _...................._....._....,...,;_....._.....,.,............_............ ._.......,,.._............................ ........ ...... ,............... .................... ....................._......... ......... .:......:....:......:,....,................... ............................... ........,.................. ............. .... . .......:._,........,....... WUHKSCHEDULE .................................................................................................................................. Contractor wi lgot begi he work or order the materials before the third day following the signing of this Agreement, unless specifi ere 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 L 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 Contra tor, 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 accordance with above specifications, for the sum of F60 t—I U (ICY G X l Y ►'1 dollars ($ Z 11 Payment to be made ag follows % ($ ) upon signing Contract; KENNETH B. KEEN Name of Contractor / Designated Registrant ($ ) upon c o.o 21 HEWITT AVE. �(1� � Street Address % (, �) u�F],�)_n completion of . N. ANDOVER, MA 01845 -, �'»f . City /State ($ ) shall. be made forthwith upon (978) 691-5201 (978) 682-3231 _w ,y completion of.work under this contract., - .,..... .<.,�:� ...._:__,.:..- .P.hone.,.,,,_,,,,•.,_r _r -.Fax_ Notice: No agreement for horn. a improvementcontractingwork shall require a >down payment (advance deposit); of more than one-third of the total contract price Namesale.man or the total amount of all deposits or. payments; which the contractor must make, in advance, to order and/or otherw,i'se obtain delivery of special order materials and Autripr ed ig u ✓ equipment, whichever amount is'greater. NThis proposal may be withdrawn by us it not acceptedwithin days. Acceptance of Proposal ,=haveread,both sides of this document and all attached documents and accept the prices, specifications and conditions stated. I understand that upon signing, this proposal becomesa 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 I Ldone in writing. DO NOT PI I GN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Date .S / Signature �' .*'.(// f i%/ Date IMPORTANT INFORMATION ON BACK ► Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR RegistraGpn 108383 Etttt©►` 818/2008 KEEWCONSTRQtTM`f 1 Kenneth Keen 21 Hewitt Ave No Andover, MA 01845 Deputy Admustrato.r j i i� �ii�<"[�anvrrcanc4ea�C� �ckci,auv�ltd �s , a BOARD:OF BUILDINIRM II ATIONS, ic:.CONSTRUCTION, SIJPERVIS.OR R0 nber tS 058245 u#hclate 03/24/943 xp I�AS ?.08 Tr: no 13435 tri r ! { �mmissioner " The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ^ a j ' d 600 Washington Street Boston, MA 02111 7 'v �w s•v www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly i `� Name (Business/Organization/Individual): �1. / e -G /j Lo o:dau.GT)ow 0, Address: Z 1 t -I E'lA i 77" AV E City/State/Zip: . R N de I/ Zn— fS Phone. #: 9 7 8' 6 Are you an employer? Check the appropriate box: 1.0 I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 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. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] .1 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required):. 6. ❑ New construction 7. RRemodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. El Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other 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. 1 �y + Insurance Company Name: fl. A N i +E- S A f Z0 $ , (- " ,o Policy # or Self -ins. Lic. #: Expiration Date: l ^ p 9 ^ B Job Site Address: 6o /7 E R (Z %cLc Q A City/State/Zip: t Ra► C( 6 t/ I A - 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 Investieations of the DIA for insurance coverage verification. I do hereby certify under the painond penalties ofperjury that the information provided above is true and correct" Phone #: !9! 7 Official use only. Do not write in this area, to be completed by city or town official. City or Town: I 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 #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers 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 including 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 to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of 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 until 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 completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required 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 confirmation 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 the 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 number listed below. Self-insured companies should enter their 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 has 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 applicant. Please be sure to fill in the permit/license number which will 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 of the 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. Where 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 like 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 Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext.406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 wwvv.mass.gov/dia Hpr -io u uu;a is Proposal Dracut Kitchen & Bath 1633 Bridge 8t. Dracut, Ma 01826 (978) 453-3869 To: Dick & Pat Cain Hewitt Drive No .Andover, N.H. Re: Kitchen project Specifications: As per layout provided Counters: Cabico cabinetry Maple wood species (Cinmrnon with) Particle -board construction Watural maple interiors Full W shelving Maple dovetail drawer boxes Blum tandem Full extension glides Slab "E" drawer heads Roman arch walls (720/1 /H) Square raised panel bases (00/140 39" high wall cabinets Medium crown molding ceiling 14" deep wall cabinets Date: 5-3-07 Customer: Keen Phone: 978-682-3571 Site: Same Cabinetry total: $13,800.00 Avonite Solid surface counters per plan A.S.A.P> special Color (To be determined) ( ) Choice of standard edge profiles (To be determined) No backsplash Prep for Free D Shaped Promotional sink under -mount Sink and faucet to be supplied by customer (must be on -sit for template) Template, fabrication, installation Counter Total: $ 4,085.00 May 04 07 09:00a Hardware Job Totals Amerock 1950-G10 Totals as above p.2 (Brushed finish) Hardware Total: No Charge Deposit required for order $17,885.00 $5,900.00 I �. KEEN CONSTRUCTION CO. 21 HEWITT AVE. NORTH ANDOVER, MA 01845 t' (978)691-5201 Payment schedule:$1000.00 due upon signing contract } $4000.00 due the l" day of work (plus permit fees) of electrical work $3000.00 due the first day a $1500.00 due the first day of plumbing work J;. _ $5000.00 due when .windows are installed - $500.00 due when front storm door is installed and threshold repaired $3000.00 due when old -cabinets areremoved $2000.00 due when rear entry door is installed $4000.00 due when cabinets are installed }146 $.9.00 due whencontracted work is complete "us omer » Ke B. Keen. ,r } Date Date t z "I KEEN CONSTRUCTION CO. 21 HEWITT AVE. NORTH.ANDOVER, MA 01845 . (978)691-5201 Cain; Dick.& Pat 60'herrick Rd. N. Andover, MA 01845 (978),682-3571, I } Contract # 1659• Appendix A pP Date: 5/6/07 'Remodel Kitchen: l Remove existing kitchen cabinets & :counters - • Remove new plaster ceiling Remove existing flooring to original'sub floor and install underlayment as required;by. Tashijian Floor) • Supply:& install Pella new construction double casement window ( architect series, with wood snap in grids) • Supply & install Pella replacement double hung widow (architect series, with wood snap in grids) Supply & install blueboard on original ceiling and skim coat plaster to smooth fmish Patch plaster walls as necessary (more:than normal patching will be done at an additional cost) • Install customer supplied cabinets as per drawings by Dracut Kitchen & Bath dated 5/3%07 Supply & install trim to match existing (as close as possible with commercially available molding) • Supply &install rear entry door.(9 lite Thermatru Smoothstar with plastic grids and. double bore) Supply & install. Schlage locksetand deadbolt with brushed nickel interior and brass exterior • Supply & install two Harvey lifetime storm doors "(front- full lite with brass hardware) .(rear Classic with standard hardware) Repair front door oak threshold (standard repair as per conversations) • Install customer supplied 4 x 4 ceramic tilebacksplash diagonally Repair Plaster ceiling in garage ($275.00 allowance) i Electrical: ' Electrical work as per conversations with Larry Rice including new sub -panel in garage Supply & install five recessed light .fixtures in kitchen Upgradeoutlets in kitchen to code Supply .& install, one cable .outlet in kitchen . • Supply & install switch and box for future light pole i Repair unsafe wiring garage in ara e Plumbing: • Plumbing work as perconversations with Bob Salemme Supply .& install toe kick heater in kitchen (replace heat pipes with monoflow tees andball valves) • Supply & install new sheet metal on baseboard heat in kitchen ( including removing molding behind it) • Connect new faucet, dishwasher and garbage disposal • Fill existing heat system with antifreeze Price; doe not include cost of permits, changes required by inspectors, gas line for new range, water line for new refrigerator, painting, .ceramic tile,. and vinyl floor, excess repair of ceiling in garage or kitchen walls. Total Price: $25,469.00 (twenty five thousand four hundred sixty nine dollars) i 1, 0) M m 4 M N M y v M C2 y aCc 10 o m M O p CD CL � O Q CD Wei Z �n n O z C/) sin I/• C/) 2 o-1 K 0 Cn C O O Z 0. m ccl m 0 n m m o H O E COD N CT I?= o m a mail d< m av y —• O I C Ca m C � y v O o Z � � m N CD = m CO) Oa y ..► i IE m� 0-0 Wei Z �n n O z C/) sin I/• C/) 2 o-1 K 0 Cn C O O Z 0. m ccl m 0 n m m o H O E COD N CT I?= o m m N = d< m ca ti D m � m !9 Ca m C �. .� m � m N CL m m = m CO) Oa y ..► = IE m� 0-0 mm a0. oC.) CL z g, =rIs 7d ca ql m Go CL Er ff: so m � m N ti CL z g, CD 7d ca ql m Go Cc m � m N ti m rA Cy ED m o oC.) a� ..i CO) 0 Ml 9 j w O z g, -x T ;oz 7d "I pd -op ql rA • V w ♦` v OM 0 c