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HomeMy WebLinkAboutBuilding Permit #519 - 761 DALE STREET 2/19/2010Permit NO: 511 Date TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received .- t o IMPORTANT: Applicant must complete all items on this paize LOCATION f ri Print MAP NO: 00 PARCE4/6 14 ZONING DISTRICT: Historic District yes Machine Shop Village ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial c— t8pair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TOB PERFORMED: �-4; •4 L c2 S. rn vimZ) f L "'P Y=*,/rz k_ -5A -t L Identification Please Type or Print Clearly) OWNER: Name: ,R 0 9J i- ,/Y,4&;r' .4 WA41 g2iStaM•4✓ Phone:g' Address: t co i `? 4/ c J/ CONTRACTOR 'Name:__REAP (C rA S i R u c'f '► cJ L Phone:'/ 71. 6 Address: H l m E" iJ , 0�, 0— Supervisor's Construction Licenser Exp. Date: f D Home Improvement Licenser / o 3 �' 3 Exp. Date: 'lam 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 7 6 t' FEE: $ o? © 3 Check No.: e2 ;2 °i Receipt No.: Z' NOTE: Persons contracting with unregistered contractors do not have access to the zua4nty fund signature of Agent/Owner Signature of c Location ,_/ No. Date Check #/ Z TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ lz� Foundation Permit Fee $ Other Permit Fee $ 's TOTAL $ 2GUV9 Building Inspector 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 Sianature COMMENTS HEALTH Reviewed on - Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Com 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 ❑ 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: Doc.Building Permit Revised 2008 z s•: 2 aJ I �i v .TIT P i.J 'Pd Co O CD L _O O s Z o d O H � O co Q! i O O 0 y O O �E m m CD 0 CD in - G3 ~ G3 o .a Co O O e_ov oca a � o�Q o vccc t0 J .� a. o ,CD C Z CD u co R 3 �. C C c CLCO2 0 LLI UA U) W W 19 W u o L UU A W 0- a v E a tcz ao' w a W U w W '�°° ao' CA m a � 'oto Cc O z W A w w ° cn Q o cn 2 aJ I �i v .TIT P i.J 'Pd Co O CD L _O O s Z o d O H � O co Q! i O O 0 y O O �E m m CD 0 CD in - G3 ~ G3 o .a Co O O e_ov oca a � o�Q o vccc t0 J .� a. o ,CD C Z CD u co R 3 �. C C c CLCO2 0 LLI UA U) W W 19 W c v ; o � O N Cc O cii V d� CL c D oc � o o 'D c o 0 o c z 1 EE 0 0 o V $ �S1 cm r �O rQ SUR E mm a O CO2 y v ' O v J cmo y � m. := C y n y A c O :a�` 75 m N o C�oa � W oc,ct :mom E m COi y O Z O V00 A p CL Of c Q 2 co = o .`mc :oto N .- o. CD y o t 'r o •_.. •N ... c .. O •C2 cc C C=•oE o .y Z O V `D ca 0 0 C N� CL h o� O� . O y O az e-6 2 aJ I �i v .TIT P i.J 'Pd Co O CD L _O O s Z o d O H � O co Q! i O O 0 y O O �E m m CD 0 CD in - G3 ~ G3 o .a Co O O e_ov oca a � o�Q o vccc t0 J .� a. o ,CD C Z CD u co R 3 �. C C c CLCO2 0 LLI UA U) W W 19 W KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 Submitted To: % NN 6^MArL,'6_ }�tk-... ......... o i ;?Y� PHONE DATE I g9 -J v 5'266 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. REGISTRATION NO. EIN NO. MA. H.I.C. 108383 1 26-0462904 C/S = Customer Supplied S + I = Supply + Install Pt79ee Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: > Construction related permits: WORK SCHEDULE Contra or w not be to 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 " � Q_ (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by �=1,�-I (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 Contra r, 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 : >�tf�� �hoysRa�c�► �F.��fi ,�n�� it to be made as follows: % ($ ) upon signing Contract; % ($ ) upon completion of % ($ ) upon completion of shall be made forthwith upon ($ ) completion of work under this contract. 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 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 equipment, whichever amount is greater. dollars ($ Z& 25 26 e ° ). KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor / Designated Registrant 21 HEWITT AVE. Street Address N. ANDOVER, SAA 01845 City / State (978) 691-5201 (978) 682-3231 Phone Fax Name/!( al n A gnature ote: 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. 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. Cancel lati must be done in writing. 0 DO KOr SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature ��f Date45;Lf —0 Signature Date IMPORTANT INFORMATION ON BACK Keen Construction Co.. 21 Hewitt. Ave. North Andover, MA 01845 978-691-5201 Brightman, Mark & Anne Marie Date: 1/28/2010 761 Dale St. N. Andover, MA 01845 508-243-1093 Contract # 5266; Appendix A Remodel 2"d floor bath:' • Remove existing bath tub/ shower stall • Remove existing vanity and sink • Remove toilet. • Remove existing flooring + : Remove wallboarde i b h nd; vanity. and three shiver wails • Frame -shower wall to accept new tub and create wall under tub for the Repair walls • Supply & install plumbing fixture selected at Peabody Supply (quote # 187226, .updated 1/23/10) excluding light fixture and apron • Supply & install vanity selected at Jackson Kitchen (order # 131455) • Supply & install ceramic tile in tub/shower area.and'floor selected at rational Tile (tile # 10385 ). • Paint walls, ceiling and trim (neutral colors) • Patch hallway wall and touch up paint with customer supplied -paint • - Supply customer selected fart/ light combination Electrical allowance an a $4(30.:00 Relocate switches from .hall'to bath • Install customer supplied vanity light - - Remove all debris Total Price: $16,876.00 (sixteen thousand eight hundred seventy six dollars) Price does not include cost of permits, problems found in walls or floor {rotor damage), non-compliant plumbing, vanity light, shower door, installing new fan /light combo or reframing floor joists to accept larger tub. Page 1 of 2 Keen Construction Co. ORI? QCCERTIFICATE OF LIABILITY INSURANCE o �ii2a 9 PROBUCER (781)942-2225 FAX (781)942-2226 Gilbert Insurance Agency, Inc. 137 Main Street Reading, MA 01867-3922 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # ImuRm Kenneth B. Keen DBA: Keen Construction Company 21 Hewitt Ave. North Andover, MA 0184S INSURERA: NORFOLK & DEDHAM INSURANCE 23965 INSURERS: Granite State Ins. Co. 0077 INSURER C: INSURER O: 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, TERRA 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. 1 RINSFIN DO, yVPE OF WSURANCE POLICY NUMBER POLICY EFFECTIYE POLICY EXPIRATION LIMITS GENERAL LIABILITY ND -P-010078/000 03/13/2009 03/13/2010 FACH OCCURRENCE s 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR OAMAGETO RENTED S 50.000 MED EXP (Any one person) S 51000 PERSONAL 6 ADV INJURY s 1,000,000 GENERAL AOCREGATE S 2 , 0001000 GEWL AGGREGATE LIMIT APPLIES PER: x POLICY j� LOC PRODUCTS . COMPIOP AGG S 21000,000 AUTOMOBILE LIABILITY ANYAUTO COMSINCO SINGLE LIMIT (Eq eaadenl) ! ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY S (Per person) HIRED AUTOS NON•OWNEDAUTOS BODILY INJURY (Peraccldenl) S PROPERTY DAMAGE S (Par acziftn1) GARAGE UABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC E AUTO ONLY:AGG S EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE S 5 DEDUCTIBLE S RETENTION i S wOMWIU COMPENSATION AND EMPLOYERS' LIABILITY 6371378 08/03/2009 08/03/2010 X I WcSTATLL I OTH- E.L. EACH ACCIDENT 3 100,000 B ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? e t, 0"CrIbe under SPECIAL PROVISIONS below E.L. DISEASE • EA EMPLOYE S 100, 000 E. L. DISEASE -POLICY LIMIT I $ 500. 000 CTNER DESCRIPTION OF OPERATIONS I LOCA71OKS I VEHICLES I EXCLUSIONS ADDED BY ENDOR6EMENT I SPECIAL PROVISIONS ti 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. Town of North Andover 120 Main Street North Andover, MA OIA45 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR YO 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 kINO UPON THE INSURER ITS AO ENYS OR REPRESENTATIVES. AWHOPRED REPRESENTATIVE Mark Gilbert, CIC ACORD 25 (2001/08) ©ACORD CORPORATION 1988 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR "t' RegistRmLQVI, 108383 Elb 18/2010 Tr# 272473 KEEN CONSTRPp GQ Kenneth Keen 21 Hewitt Ave No. Andover, MA 01845 Administrator Depm-turient ()I'Public Board ot'BuiI(jijj,� Re-UIjjti()11S and st-1111(jar(js Construction Supervisor License License: CS 76691 Restricted to: 00 ROBERT A KEEN 12 E WATER ST N ANDOVER; MA 01845 Expiration: 8/16/2011 Tr#: 1690 The Commonwaa&k of Massachusetts Department oflndustrialAccidents Office of Investigations 600 I fashington Street V b Boston, MA 02111 www_rnassgov/din . Workers' Compensation insurance Atmdavit: Builders/Contractors/Eieatriciaas/Piambers Applicant InfoMation rn. Please Print LeQibl Name (Business/Organization/Individual) 11'O N IM Address: E' City/state/ZiP:1(3.1Q tN o ; s� ✓Y%QA�cS Phone A. g 7 v FE3 n employer? Cheek.the appropriate box: a employer with _�_ 4. ❑ I am a general contractor andI Type of project (required): loyees (full and/or part-time).* have hired the sub -contractors 6 ❑New construction .a.sole proprietor or partner -listed on the attached sheet 3 �• ❑ Remodeling and have no employees These sub -contractors have ing for me .tri any capacity. workers' comp. insurance. 8'Q Demolition wod=., comp, insurance . 5. ❑ We are a corporation and its 9. Q Building addition red..] officers have exercised their 1Q•❑ Electrical repairs aradditions a homeowner doing ail work right of exam onI£ Ph P� MGL 1 I.Q PIumbing rcpaira or add{tions [Now.arkers' comp. c, I52, § 1(4), and we have no insurance required.] t employees. [No workers' 12•❑' Roof repairs COMP. insurancc required.] I3.❑.Other 'Any applicant that checks boz# I must also fill out the section below showing their.workerc' compensstioe policy information t Homeowners who submit this affidavit indjerting they are.tlain all g work end then hila onside contractors mast submit anew affidavit indicating such Contractors that check this box mustetlPchd an edcrifioasl.shestshowirr� the name of the sub -cop r tractors and their workers' cam.._2_ . _......... a�.{Ncuyer rant rs rovrdin worke . p g rs' cornperrsadon i.`nsurancejor my employee Below is the o ' information p kcy and job site . Insurance Company Name: ' G 2r9 iU �- E A tp --T—N S Policy # or Self. -ins. Lic. #:_ ,� 'r 3 7 q Expiration Date: Job Site Address: 7 i' 77A I E _ 4tiach a copy of the workers' cont Cit'/S*z1zip' ' 6 ©� $ 4( S pensaiion policy declaration page (showing the policy number and expiration date). . Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to. the i fine up to $1,500,00 and/or one-year imprisonment; as well mposition of criminal penalties of a 8s civil penalties in the forth of a STOP WORK ORDER and a Of Lip to $250.00 a day against the violator. Be advised that a copy of this statement may f forwarded to the Office of fine Investigations of the DIA for insurance coverage verification. ae hereby certify under the pains arraides of perjury, thar the informationp cdrnv' ed above is true and correct X9.10 ficial use only. Do not write in this area, to be conFlete ! by city or town. o ciaL City or Town: # Issuing Authority (circle one): Permit/License I. Board of Health 2. Building Department 3. City -Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: