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Home My WebLink AboutBuilding Permit #285-16 - 79 GRAY STREET 9/3/2016 i �aC.0 Zllf BUILDING PERMIT NORTH O��tteo ib 6N0 ol TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION y� • • • 1 Permit No#• o Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 9 nnL Print � G PROPERTY OWNER I�` �C ct Pririt 100 Year Structure yes no MAPPARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition ❑Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial [Repair, replacement ❑Assessory Bldg ❑ Others: El Demolition 11 Other _ 1� Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Li Water/Sewer - - DESCRIPTION OF WORK TO BE PERFORMED: r �edra.re, �p CA Ce S d a 5 oU-� ex -Sj k head, Identification-I Please Type or Print Clearly OWNER: Name: cAc -b Phone: Address: 79 r-ca S-- A,Jo v r Contractor Name: 4em C�vt ►'Uc�t��Co Phone: 972- 69(--57-0 1 Email: 5-1e s k oev, Co,n 5 ✓^Qc-i ccs O , CoW`, �= Address: l - A Supervisor's Construction License: eS_07<o G 51 Exp. Date: ill Home Improvement License: �0 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAS DON$125.00 PER S.F. Total Project Cost: $ �6 (oO . 0 O FEE: $ 41 Check No.: (o 2— Receipt No.: D NOTE: Persons contracting with unregistered contractors do not have access to the ray f Location � T No. S 1 . 4v Date • TOWN OF NORTH ANDOVER TLEb 16g6 . r • 4 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $_ Other Permit Fee $ TOTAL $ Check# t Building Inspector :� ! tJ i '. 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 Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature i COMMENTS a Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/signature Date Drivewav Permit DPW Town Engineer: Signature: *;r LFo"IcR�a`E te dDia,EtP1�2A�RNaT�M Tm p� m. _ r --Located.�3.e84 O sgo `r e�e ®epser�no � og _-:n- 4f 4 MantSt-et, � _. Fire{D'epa�rtments�gnature/date �,C®MIVIENTS m� �_� 1 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land areasq. 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) i ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 r" 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 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/Cross Section/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 OTE: 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) 4. Copy of Contract 4. 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 IAORTH own of . � EAndover 0 0 ver, Mass, all A COC NIC Nl WKN S V BOARD OF HEALTH Food/Kitchen PER T Septic System 00, THIS CERTIFIES THAT ................ .... .�.!(/. .....................4BUILDING INSPECTOR ................................................................... Foundation has permission to ere .......................... buildings on-..J.�....... .. ......... .............. Rough to be occupied as .. .........�?..� .......SA.....I..Oqb�.....:�'.''...... . .Tth�e �....... 4� .. . Chimney provided that the person accepting this permit sll in every respect conform 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 CONSTRUCT S Rough Service ........................................ .......................... 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. KEEN CONSTRUCTION CO. PROPOSAL ° 1175 TURNPIKE STREET 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 f .Chapter 142A of the general laws, must be registered Submitted (- Ct I G`t with the Commonwealth of Massachusetts. Inquiries To: CrC about registration and status should be made to the 9 Director,Home Improvement Contract Registration,10 r� �' J Park Plaza, Room 5170, Boston, MA 02116 617-973- GlLn� Al /� 8787 Owners who secure their own construction C l�iJr `j 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. 9 7 S ��j MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install 17 See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: q J; > Construction related permits: -_..-_....._._....._.....__._.._._......._.._..........._....................._..___.._______............ ........ ...... ....................._._.._.._.�................................................._..._._..._.......:............ ........... ......._........................ ........ _._......_........ ___.....__.......___......_.__.._......... ............... 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 Contractors 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 (' r 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,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 accordancewithabove specifications,for the sum of J L y Y1 G li.`DC,"�� l=l 'l� I�c`1 Gt r�. �l X f -' —� dollars($ ). Payment to be made as follows: ($ ) upon signing Cont r ct; ROBERT A. KEEN Name of Contractor/Designated Registrant ($ )apo c m e i n� 1175 TURNPIKE ST. `\b Street Address °io ($ )`p, ,c ion of N. .ANDOVER,_MA:01845. City/State .. shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. P„o Fax Notice: No agreement for home improvement contracting work shall require a t V�. �1 >down payment(advance deposit)of more than one-third of the total contract price Na a n!sales(an 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 Aethodz dsgn ere equipment,whichever amount is greater. Note:This proposal may be 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. 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. J/o D�O�NOT �SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature (Z16'�// Date Signature Dale r IMPORTANT INFORMATION ON BACK ► . Cons�ru�f�or��ca:, REMC�DEI_INI C: SPECIALISTS 978-697-520" Keen ConstructionCo_com Halbach, Rick& Kathy 79 Gray St. N.Andover, MA 01845 Contract#5551;Appendix A August 25, 2015 Gable end siding:$6240 • Remove existing siding on southern gable end • Supply& install Tyvek house wrap and %"x 6"clear cedar clapboards to be stained • Repair damaged front rake board • Remove& re-secure electrical service and post as needed • Replace mist.siding around house(50 lineal feet allowance) • Replace mist.trim board around house(32 lineal feet allowance) Replace Bulkhead: $1620 • Remove existing top of bulkhead • Create wall with 6"x 6" pressure treated wood • Supply& install Bilco 0 series bulkhead Total Price: $7860.00(seven thousand eight hundred sixty dollars) Payment Schedule: $1000.00 due upon signing contract $2000.00 due the first day of work(plus permit fee) $2000.00 due when siding is done $2860.00 due at completion of contracted work f )- Customer (^ Robert A. Keen Date Date 1175 Turnpike St. Page 1 of 1 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 The Commonwealth of Massachusetts Department of Inilust�zctl Accldents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electriciansfplumbers Applicant Information Please Print Legibly Name(Business/Organization/Xn.dividual): G-0—V) OA C" Address: -7 y s'11 e- -`- - Ci�ty/State/Zip: � 1 48 LgF, ,6 Poon#: 9?Y" C 9 5 2-0 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 6. []New construction f employees(full and/or part-time).* have Hired the sub-contractors 2.❑ I am a sole proprietor orpartner- listed on the attached sheet.It 7. 0 Remodeling ship and'have no employees These sub-contractors have 8. []Demolition working forme in any capacity. workers'comp.insurance. g, E]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its ME]Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing,repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' 1311 Other comp.insurance required.] ?Any applicant that checks box#1 mustalso fill outthe section below showing their workers'compensation policy information. t-Homeowners who submit this affidavit indicating they airs doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. v _, r5 5 V CCA.i�C Policy#or Self ins.Lic.#: (0 M 9 �, 1 \ '25-2.- qE '� xpixationDate: I I Li1 J Job Site Address: J '`r 5 City/State/Zip: a 4 75 Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby cert' de ae p ins andpenalties of perjury that the information providdeed above i true and correct. Si ature• Date: 15 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.EIectrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: ,1 RightFax C3-1 3/24/2015 9:51:03 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE 1M11VDDlYYYY1 0 .44W IFICATE 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 CERTIFICATEOR PRODUCER.AND THE IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: GILBERT INS AGCY INC PHONE FAX 137 MAIN STREET (A/C,No,Ext): (A1C,No)- E-MAIL READING,MA 01867 ADDRESS: 246WY INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA KEEN CONSTRUCTION CO INSURER B: INSURER C: INSURER D: 1175 TURNPIKE STREET INSURER E: NORTH ANDOVER,MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS TFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TEAM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. I INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (N MIDDIYYYY) (MN=wYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F-1 OCCUR. REMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: ENERALAGGREGATE $ POLICY F]PROJECT❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINEDSINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON OWNED AUTOS (Per accident)PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR M CLAIMS-MADE AGGREGATE $ DEDUCTIBLE ----_�_ $ RETENTION $ $ A WORKER'S COMPENSATION AND XWC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-9991M5B2-14 10/08/2014 10/08/2015 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE OFFICERWEMBER EXCLUDED? MN WA E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describeunder DESCRIPTIONON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT VE g:.-. NORTH ANDOVER,MA 01845 ;::. +: ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Massachusetts -Department of Public Safety Board of Building Regulations and Standards %.1/HILI ULllllll JUIICI VI\111 � License: CS-076691 ROBERT A KEErJ7,- ` 12 E WATER ST IMF North Andover ha 0 �c IiA Expiration Commissioner 08/16/2017 Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR oegistration: X8383 Type: xpiration -81f8f21)� DBA KEENCONSTRUC110NGD Kenneth Keenj � r T 'a'r 1175 TURNPIKE STA. NO. a NO.ANDOVER,MA 01845 - 'I Undersecretary