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HomeMy WebLinkAboutBuilding Permit #286-14 - 82 LONGWOOD AVENUE 9/27/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:�' "� �I Date Received j Date Issued:: " I IMPORTANT: Applicant must complete all items on this page LOCATION - not PROPERTY OWNER._ Qn 7 - - .- __ —r 100 Year Old Structure yes: no Print MAP NQ: On -_ PARCEL:dU 1 ZONING DISTiRICT p Village Historic District yes - Machine Sho _ yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family Addition ❑Two or more family ❑ Industrial ❑Addit ElAlteration No. of units: ❑ Commercial %Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ - El Septic ❑Well 0 Floodplain El Wetlands ❑ Watershed District E!Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 0 ,.;i S JC) 1 Identification Please Type or Print Clearly) T7/ OWNER: Name: An� �-�- \�©✓Lk�e n Phone -.7D T �o 0 (1 Address: L.00�c f� w - - _hone: CONTRACTOR -`Name: Address: Z-45=a = 3 iJ� l2 7 -I-: _ Supervisor's Construction License: Exp. Date: (!01_ _ _ /- - ` Home Improvement License:. - -Exp. Date: 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: $_ Check No.: b t Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to e u nty�fundd _ �� "`"�' Si _� ature,of contractor, _ Signature,( f K ent/Ovv§r� _ y Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The following is'a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, 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 t In all cases.if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals r that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Buhding Permit Revised 2012 I Plans Submitted ❑ Plans Waived-0 Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF`,SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodySwimming❑ .. g Pools El Well ❑ ❑ Tobacco.Sales Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ ` I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ti DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS IZoning 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 Tow;: Engineer: Signature: � Located 384 Osgood Street FIRE DEI'AkTMENT =Temp Dumpster on site eyes. Located ano t 124 Maim Street �i Fire Departmer f-signatu'r"eldate`! COMMENTS_ r 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 El Notified for pickup - Date - t Doc.Building Permit Revised 2010 r ' f Location �� L4 Nx1,Zb A ke— No.l�(D—M. L Date 11 s . - TOWN OF NORTH ANDOVER o _ Certificate of Occupancy $ " Building/Frame Permit Fee $ � — �� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 26919 Building Inspector r tko H own of s EAndover 0 10 0A Iq T 2 b O LANE h , ver, Mass, J 21, 2-biS A_ COC"'t"WICK �' s RwTEc) ►`P�,�'L5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT 1':t��.. A BUILDING INSPECTOR .......A. ......................................................................... has permission to erect ..... buildings on .... IZ..... 11. ... �.� Foundation ® � A �Ji . Rough to be occupied as .....1.I�...... .. V"I%. . .�N#►....A..\A rj . !.5. iChimney provided that the person accepting his permit shall in every respect conform to the terms of thpplication 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 CONSTRUCTION S 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. SEE REVERSE SIDE vaiaI^iAvi.l vv;vv raA Iof a4t t«a UU1 .® DATE(MMIDDIYYYY) ACOOR'v CERTIFICATE OF LIABILITY INSURANCE i 4y1e/2013 . _ THIS CERTIFICATE 13 ISSUED ASA MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE"CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAnVELYAMEND, 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,OR PRODUCER,AND THE,CERTIFIGATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pclicy(ies).must be endorsed. If SUBROGATION IS WAIVED,Subject to the farms and-conditions of the policy,certain pollcles may require an endorsement. A statement un this certificate does not bonfer rights to the certificate holderin lieu of such endorserllent(s). .PRODUCER NAME:OONEAc Barbara MC.D6naugh I : IAdc.Na- Gilbert Insurance Agency, Inc. PHONE (781)942-2225 F I,( 01)942-#2,6 137 Main Streat a-,Mal bmcdonough@g lbarti:lsvrance.coml INSURERS AFFORDING COVERAGE I NAIC 4 Reading MA 01867-3922 INSURER A:NORFOLK _& DEDHAM INSURANCE 23965 INSURED INSURERB:Travelers Ins. Co. 0031 Keen Construction Company INSURVAC; 21 Hewitt Avenue INSUR -D: INSURER E North. Andovor HA 01,045 INSURERF:. COVERAGES CERTIFICATE,NUMBER:CL1341000232 REVISION NUMBER: THIS IS'TO,CERTIFY'THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE'SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. .NOTW TMSTANDING ANY REOUIREMENT, TERMOR 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.UMITS'SHOVVN MAY HAVE_1EEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE A POLICY EFF ROUGY EXP. POLICYNUM ER: MMIDD YYy. LIMITS: . OENERA6 LIABOTIF EACH OCCURRENCE' S 1.,000"n 0 X' CONMMERGAL GENERAL LIABILITY PREMIE :IFH 2WNM"-) S 100,,000 A CLAIMS40ADEOCCUR -P=0100767000 /13/2013 /13/2014 ,IVIEDEXP'(Anyone mson) 'I S 5,000 PERSONAL&ADV INJURY„I .i:. i'000,000 GENERAL-AGGREGATE 1`. -a 2,000.,.000 GEN'LAGGREGATE LIMIT APPLIES PEP, PRODUCTS-COMP/Op Aad s 2,000,000 X POLICY PROs LOG ; :S AUTO MOBILE LIABILITY - - 'COMBfloac��DBINOLE.LMIT ANY AUTO BODILY INJURY(Pae.oareoni'l 5 ALL.ovwnSCMEDUCED BODILY:INJURV'(Par xcidiMQ 5 AUTOSAUTOS -NON-0WNED - PRQOPacc�idE"".DAMAGE S - HIRED AUTOS -AUTOS _ - il UMBRELLA LIAO .. OCCUR EACH OCCURRENCE I '4 EXCESS LIAR CLAIMS-MADE AGGREGATE I 3 DED RETENTION )..:5. $, WORKERS_COMPENSATION' WC.STATUr OTM ANo EiePLOVERS'LIABILrrY YIN ANY dROPRIETOA/PARTNERIEXECUnVE F.L.EACII ACCIDENT i S 100,000 OFFICERMNEMBER EXCLIOEOT NIA 6az)s.=5H0726-A-13 /3/20.13 /3/2014 (MinGatory7n;Nry) VE, DISEASE•EA HMPLOYE B 100,000 " n y.as ddscrua und91 DES�.RIPTION OF OPERATIONS below E.L.018EASE•POUCY LIMB -9 $00" 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ANach ACORD 101;AWI oral Romarks Schad ilej It mow space is mqulred) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF 7HE ADOVF DESCRIBED POLICIES BEICANCELLED BEFORE THE EXPIRATION DATE THEREOF;..NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS Evidence of Coverage . AUTHORIZED REPRESENTATIVE M Gilbert, CIC/SARSAR L ACORD 25(2010105) c 9888-2010 ACpRD CORPORATION! All rights reserved. INS025(20100e).01 The ACORD name-and logo are registered marks of ACORD 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 Address: p City/State/Zip: Phone#:_g7 91 - Are you an employer?Check the appropriate box: I am a employer with�_ 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am 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. workers' comp.insurance. 9 ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 L❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 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 their workers'comp.policy information. . I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: V.L le.,zr Policy#or Self-ins.Lic.#:_ (9 K UV SU 0-7 A (o /� .�"3 Expiration Date: Job Site Address: nic sl L O N 4 C 5-3 oO j A t/ City/State/Zip: 6v A I. 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 pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone M 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 In 6.Other Contact Person: Phone#: Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor , License: CS-076691 ROBERT A KEEN-` 12 E WATER STS North Andover NFA ofr5� r ,a Expiration Commissioner 08/16/2015 Massachusetts -Department of Public Safety Board=of Building Regulations and Standards Construction Super• iso" License: CS-058245 rs KENNETH B K-)EEN 21 HE TT afVE,st N ANDOVER MAOf845 K �,•�..� � I 4 `` Expiration commissioner 03/24/2014 L/�12e lQN/�'ur�7,o42t!/eaGGfZ O¢ 4da]ype Office of Consumer Affairs BcBusi ess.RegulOME IMPROVEMENT CONTRACTORegistration 108383Txpiration 8/1'8/2014.; DBA KEEN CONSTRUCTIONKenneth Keen 21.Hewitt AveNo.Andover, MA 01845 Undersecret �II I 1 KEEN CONST RUCT14N.CO. 21 HEW ITfi AVE. N. ANDOVER, MA 01845 978-691 -5201 Ke nCons&acti&nCo c&vw Fionte,Anita 82 Longwood Ave. N. Andover, MA 01845 978-683-4768 Contract#5082; Appendix A Date:9/11/2013 Siding,4 Window Replacement: • Supply& install 18 Harvey Class.ic:white.vi;nyl replacement windows with similar grid patterns as existing windows • Supply& install vinyl.siding(Cetainteed Main Street double 4")over existing siding including the following: g • Buckskin color siding with Light Maple color trim • 3/8"foam-under siding - • Light Maple:color coverage over rake.boards and fascia • Electrical blocks and plumbing.bibs • Paint non-covered areas such as porch windows,columns and trim that can't be covered to match trim Total.Price:$32,310.00(thirty two thousand threehundred ten dollars) Price does not include cost of permits, interior painting, necessary electrical work, or any unusual, unsafe or inadequate existing conditions. Payment Schedule:$5000.00 due upon signing contract $4000.00 due on first day of window installation (plus permit fees) $4000:00 due on the first day of siding;work $4000.00 due when al[the windows are installed $4000.00 when first side is done $4000.00 when second side is done $4000.00 when third side is done $3310.00 when contracted work is complete Customer Ke neth B. Keen Date Date Ub 5 KEEN CONSTRUCTION CO. GP ��®�®��� n 21 H.EWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978)691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax:(978)682-3231 specifically exempt from registration by Provisions of I Chapter 142A of the general laws,must be registered with Submitted ii the Commonwealth of Massachusetts. Inquiries about To: I_( l-_—��' registration and status should be made to the Director, f Home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02108 (617) 727-8598. fl IIII ' _ Owners who secure their own construction related ) I, V 7 permits or deal with unregistered contractors will _ .... >� ----.�.-.- --- be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATEREGISTRATION NO. EIN NO. �,y��_ (� �f �/ _� MA. H.I.C. 108383 26-0462904 C/S=Customer Supplied S+I=Supply+Install ( See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: , - --_._- - ------- > Construction relatedpermits._w ____..._..—_........__—_____ .._...._.._..._........__.._........................................_......._............................................................................................................_._...._...._................ _...._..................... ................. ................................ _.......--____----_..._.._.-...__....... .._.............._...._......_....– � 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 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 f \�� Y 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. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of ,c, ollars $ �uiC� V\CC" �– A 8 -�•_'V –dr 1�1'Q Payment to be madl as follows: y - _ upon signing Contract; n KENNETH B. KEEN/ROBERT A. KEEN `` f ` Name el Contractor/Designated Registrant _% ($ ) upon cc T pletf n of �(` 21 HEWITT AVE. \'\ \ y Street Address ° — n /y�l N: ANDOVER—MAr01-845 ..,,_. �.. mpletion of City/Slate shall 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 > Name Salesman down payment(advance deposit)of more than one-third of the total contract price /NN, Sales— 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 d ature f U equipment,whichever amount is greater. •vote:Thi,proposal may be wandrawn by�,\i net amepled 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 I '7(:/-.,it I_' -� 91.r1, Date. Signature 'Dale IMPORTANT INFORMATION ON BACK 111111- Q Q