The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #141 - 60 HERRICK ROAD 8/26/2008 BUILDING PERMIT NORTH q ? Ett�eO 6• �O TOWN OF NORTH ANDOVER 0 F . APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Received 11 ID ` "`•� 4t �gsSACHUs��y Date Issued: MPORTANT:Applicant must complete all items on this page LOCATIONC o .<'"� Gk Pint PROPERTY OWNER_ r�>Ocv 1 i C-V, Co a Print MAP NO: 0!$' PARCEL: o76 ZONING DISTRICT: Historic District yes Li Maclaine Shop Village yes 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: emo i ion Other Septic Well Floodplain Wetlands Watershed District Water/Sewer R \ DESCRIPTION WORK TO BE PREFORMED: e `a cp. W i n tk Identifc tion Please T e or Print Clearly) OWNER: Name: C, Ph �b Q one: l 'n nn 7 (,o Z Address: (Ct:,O e f-r l ck r 1 CONTRACTOR Name: VPPO Phone:97e 01 "5Zo Address 2W i�. �-��tee, �� A(\J&-�er M P- Supervisor's Construction License: CS 5 T5 Z`\\ S Exp Date: c-A— O Home Improvement License: O �J Exp. 'Date: ARCHITECT/ENGINEER Phone: i 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: $ yy�O FEE: $ i .Check No.': ST,70 Receipt No.: 21 NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund lgnature_of Agent/Owner Signature of contractor 4 �_ _. 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 r i COMMENTS i HEALTH. r ' Reviewed on Signature- i t • 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.s100-s1000 fine NOTES and DATA— For department use i ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 J r i Building Department The following is a list of the required forms to be filled ed 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 ❑ Workersl 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 f 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 DEPARTMENTMFORM07 Revised 2.2008 I Location �dFfl� No. y� Date NORTH TOWN OF NORTH ANDOVER i Certificate of Occupancy $ �,,� a ;.•, �'ss�cMusE<l� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 44L Building Inspector NORTIy TO" of _ Andover - - - - - �` - o.- '� dover, Mass., � o COCHICHEWICK V 7 ADRA-rED �`s �� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System . BUILDING INSPECTOR THIS CERTIFIES THAT .. . .e4q. ........ ...... ... ...... .. Foundation ....... buildings on J'�.Q....,le'i'C . ... has permission to erect...............................:. .... ... . . .................................... Rough to be occupied as........................ f/-� .��` , ��i.�v0c.>r........ � ' 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS Rough :.�..... ... ...................:................. Service BUILDING INSPEC R 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations = 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): �Qen Ccs S-Vr U C, Address: 2 City/State/Zip: fid( � Ili - 01S45Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.[ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ lam a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' insurance.$ .9. ❑ Building addition comp.[No workers' comp. insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 13. Other W i 8O t.J 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. tContractors 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:_.c rc,n i h'e 5 ACGN lo, `{1 C6 Policy#or Self-ins.Lic.#: W G �� —] Expiration Date: (Z9 Job Site Address: of n t✓�< Rd City/State/Zip: h), �7� � M ��'tz) 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 certify under the pain nd e It' o perjury that the information provided above is true and correct. Signature: Date: �1_ i6tz ^Q _ Phone#: 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#: 0 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration y 108383 — Expiration 8118/2010 Tr# 272473 Yp OBA t\ KEEN CONSTRUCTION,Cii O I t Y Y5 r Y Kenneth Keen I, 21 Hewitt Ave No.Andover,MA 01845'' Administrator �\...._.�--mar---. 'n {;+y�x,•—?.--— .. _ - F r ,u ��e �animomwgea� �� cfivaell4 Board of Building Regulations and Standards Construction Supervisor License License: CS 58245 Expiration _3/24/2010 Tr# 17840 Restr��ctWi 0 " KENNETH B KEEN ! 1 21 HEWITT AVE N ANDOVER,MA 01845-= Commissioner ; 1 i � ✓ire �anvnzarzsuea�c ��,G .�uaetGs Board of Building Regulations and`Standards Construction-,Supervisor License License: C-S 76691 i8irthtlate_g/1611'968' Expiratwn 8/I1G120:09 Tr# 3859 '`Restnctwn:00: ROBERT A KEEN.= 12.E WATER ST N•ANDOVE.R MX01'8.45 Commissioner �I r 8/11/2008 12:18 PM FROM: Gilbert Insurance Ag Gilbert Insurance Ag TO: +1 (978) 682-3231 PAGE: 002 OF 003 AC ORQ CERTIFICATE OF LIABILITY INSURANCE 08/11/?0 8 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Reading., MA 01867-3922 INSURERS AFFORDING COVERAGE NAIC It INSURED Kenneth B. Keen INSURER& NORFOLK & DEDHAM INSURANCE 23965 DBA: Keen Construction Company INSURERS: Granite State Ins. Co. 0077 21 Hewitt Ave. INSURER C: North Andover, MA 01845 INSURER O: 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERALLIABILIIY ND-P-010078/000 03/13/2008 03/13/2009 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED rx�e $ 50,00 PR (Fa occure CLAIMS MADE a OCCUR MED EXP(Any one person) $ S I OO A - - - PERSONAL&ADV INJURY $ 1.000.00 GENERAL AGGREGATE S 2,000,00 GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000.0 0 7X POLICY JEC7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT AALTO (Ea accident) $ NY 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 T}1AId EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR a CLAIMS MADE AGGREGATE $ S DEDUCTIBLE S RETENTION $ $ WORKERS COMPENSATION AND WC7431477 08/03/2008 08/03/2009 X I WCSTATU- I OTH- EMPLOYERS'LIABILITY ER B ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEd$ 100,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS riginal workers compensation certificates to be issued by company. Evidence of Insurance only. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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,ITS AGENTS OR REPRESENTATIVES. evidence AUTHORIZED REPRESENTATIVE Mark Gilbert CIC ACORD 25(2001108) OACORD CORPORATION 1980 5.9 5 l KEEN CONSTRUCTION CO. GP Aft 21 HEWITT AVENUE PROPOSAL ' "'4ko 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 with Submitted ,?, `1 the Commonwealth of Massachusetts. Inquiries about To: r ^ -- - t-► — -- 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 — .C,, , �� __ permits or deal with unregistered, contractors will be excluded from the Guaranty und Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. EIN NO. MA. H.I.C. 108383 26-0462904 > C/S= Customer Supplied S+ I = Supply + Install 0 See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: ff s j ...... _I.i s._d� If C i _...........-.___..._._._____ r roc J �I ...................___..._..__ ........... _.__......_......_...__.._..---_—_--- ._... .............._"_._..__._...__._-- -.____......._.......... ._...___-___. _._.........._.._.:..._.__... _ _..........................__._-_- - -_-_- ._..._...... ......................................_f................_ ..__.....-..................................... > Construction related permits: _: .. .._ .._......, .....jw.......... :._ . _.1.._ ... ...C=..............44_2.a.- ....... ............ ...z_... .:.. ...j.......r....r�..�...,.1�...f..:._ c... ., .a......,._ ......r :. ::a.... :.. :J..... _......_.......J_!1_z._..0,...1.1.........._................._............................................................................................................................................................................................................................................................. 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 r 'date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by�' - :: - G- (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 nob corisidered 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 11 x1_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,fh'is 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 Tc .a (1 1_ � '-� 41 7lv ! � / dollars $ 41a-1` Payment to be made as follows: f ( ) % (s -,--f,-upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor/Designated Registrant % ($ C�0a" uor� orip6O90,Ti'gt 21 HEWITT AVE. Street Address ( _ _.r..._ �.�.._ X. ANDOVER MA 01'845 % $ ) upon com letion of �P _..,... ... City('State'.... — )Oshall 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 S lesman I or the total amount of all deposits or payments which the contractor must make, in 'f advance, to order and/or otherwise obtain delivery of special order materials and Authorize i a ure v equipment,whichever amount is greater. Note: rRs proposal maybe 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. 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. --- DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature iii !'! �`� 1 - r /��` �•� Date ' Signature Date 1 IMPORTANT INFORMATION ON BACK 10