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Home My WebLink AboutBuilding Permit #372 - 86 FOREST STREET 12/2/2008 BUILDING PERMITof"°DT bgti TOWN OF NORTH ANDOVER F °� APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received / 9SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION_ 05 (o 45n&EST 1'4' PROPERTY OWNERS�✓ r /J Print Print MAP NO: PARCEL: ( ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial impair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREMMED: �O�Ac F (I ) �} L;�E T�oOw i s✓ 2A2 f fz of ' 0-,j o w 3 Shy I �A ;p&6(J Identification Please Type or Print Clearly) .,C OWNER: Name: �'„fl N ,► : I l L Fyd�N Phone: /b' 9; Sr-aGo?3 Address: sS T ,�-r - , A CONTRACTOR Name:1�2-5-N 06to S 7`1Z J C-41 , J Phoneq 4?f o ?" Address: A Supervisor's Construction License: Z- "4S- Exp. Date:- :; /o Home Improvement License: /_..O $ 3 3 Exp. "Date: S b 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: $ ` � q o� 9,SO FEE: $ Check No.: Receipt No.: ��d11-4 NOTE: Persons contracting with unregistered contractors do not have access to the gu anty fund ignature of Agent/Owner Signature of contract r 4 Location �� &,F-7 4 T .ST- No. Date /;-,3 _!�e— ' MORTN TOWN OF NORTH ANDOVER i 3 •. _ . OOL i y / Certificate of Occupancy $ Building/Frame Permit Fee $ I Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check ! i 2l % � 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 I I CONSERVATION Reviewed on Signature COMMENTS. , `'\ ''' ••Ida 1 .. " . ... -' •i i � `ti• HEALTH s •1 Reviewed on Signature - COMMENTS Zoning Board'of Appeals:,Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation 'Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit I 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 it t%ORT'H Andover , ;M of 2 - o. 3 - - dower, Mass. Q LAKE T ' ' COCMICHEWICK D'r�ATED Pvio01% BOARD OF HEALTH Food/Kitchen Septic System PtHMIT .................................................................................................. BUILDING INSPECTOR -Foundation THIS CERTIFIES THAT.................A//........ .....�� tion has permission to erect........................................ buildings on ... rA......... .�......* .................... _< Rough to.be occupied as.......... ..'. . .....AQ. ..... 4,tn�.u....1....... ..... �!.. .�✓iaad�P... ..... Chimney provided that the person accepting this permit hall eve res respect conform t6 the terms of We' a application on file in p p g p every pPP 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 6� PERM.tT EXPIRES IN 6 MMONTHS..�, _ ELECTRICAL INSPECTOR UNLESS CONS t.J STARTS Rough ......... .... ...................................................... - Service BUILDING INSPECTOR 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 EIRE DEPARTMENT Until Inspected and Approved by the Building Inspector, Burner Street No. �� ISE SIDE Smoke Det. I KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE PROPOSAL ***0 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 Chapter 142A of the general laws,must be registered with Submitted the Commonwealth of Massachusetts. Inquiries about To: registration�. - ..- -- 1---------- 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 k Ce I... "`� permits or deal with unregistered contractors will } be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. EIN NO. - ;/ n 5 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: X _ ___ _ ..._... ...-..-......_..............._.........-_.... __.. _ - _ ._.............-._......__.___ _. _ _.-.... _ ......-...._..._............. ...._..........—-- I .......... _........__ _.�_. _.�_ .__.._.............. __... _ ._.._... ............. .- ........._.......__- __-_-.__..................................-...-..__.-._--_------ _ .............................._.___ _______......._........._....-.......................... ._.__---------.--__ _ ...........:_.__--__ I > Construction related permits: I Ali _..........._....._....._._...................................._............................................................................................................................................................................................................................................................ 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 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. i We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of ) 7 , Pa�rment to b m de as follows: r ,� dollars($ -,�°--f4- `te�,, l ). % ($ ) upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor/Designated Registrant ($ ) upon corptid. 21 HEWITT AVE. A) ) N. ANDOVER A, +t, Street Address _�-°� (. u on completion of , MA 01845 � City/State °�° ($ ) 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 >down payment(advance deposit) of more than one-third of the total contract price Name of/Salesman or the total amount of all deposits or payments which the contractor must make, in Z-_/ advance, to order and/or otherwise obtain delivery of special order materials and Authorized tionalure? equipment,whichever amount is greater. Note.. ni -- is 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. Cancellation must be done in writing. !n F% DO NOT-SIGN!HIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature Ix l "'f +` Date ' ? Signature Date IMPORTANT INFORMATION ON BACK i KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978) 691-5201 Leyden,Joan,*Bill 86 Forest St. A N. Andover-,MA 01845 (97$)975-2623 i Contract#5002: Appendix dix A Date.11/5/200'8' Replace windows and doors: Supply& install 9 lite fiberglass door on rear of garage • Supply&install 2 stationary vinyl windows in shed Supply:&install Andersen bay window in dining room Approx. 8' x,4'6" Center picture window with double hung fank er s Snap;in wood grilles • White hardware and screens Roofing to match house as close as,possible Supply Su 1 & install PVC exterior trim.on door and bay window • Supply& installinterior trim to match existing(bay window) •'t Supply&install new lockset on door • Replace too-kick under front entry door : • Dispose-of all debris } } Total`Price: $5429:50.(fifty four hundred twenty nine.and 50/100.dollars) Price does not include cost of permits,painting or staining,or changes required by inspectors. + ` 1. Not responsible for any rot found that is not visible at this time. Payment schedule: $1000.00 due upon signing contract $2000.00 due when doorand shed.windows are installed $2429.50 due upon completion of contracted work fl Cus�to`" erl.F Y '..E K e -B. Keen W r " Date. y. �.f~, Date L! J /� �1 e �ananrw7uuea �✓ aac`uceeCa <L\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR _ Registration, 108383 Expiration 8118/2010 Tr# 272473 ` TYPe DBA- KEEN CONSTRl1CTJON Kenneth Keen Iz, 21 Hewitt Ave .;,%f ` No.Andover,MA 01845`" Administrator ;a t.' ✓die -�anvnzo�uuea�,l ao�,'✓ ac�tude�b i � ,r 4 Board of Building Regulati ins and Standards Construction Supervisor License License: CS 58245 Expirifflon ;3/24/2010 Tr# 17840 I Restriction 0'01 j KENNETH B KEEN s. 21 HEWITT AVE � — �`� N ANDOVER,MA 01.84`5 Commissioner .� �IZ� V/02YV79Z092L(1P.CLGGfL ��/YGCLO:SC7Cd2lI.�iGC4 Board of Building Regulations and-Standards Construction Supervisor License Licens'ec CS- 76-691 Birthdate 8/16/1968 xExpiration `8/i 6/2'009 Tr# 3859 b •�te�trictioiti 0�': RQBERT A KE•-EN_; 12 E MATIER1ST N ANDOVER,MA 01'845 Commissioner 8/11/2008 12:18 PH FROM: Gilbert Insurance Ag Gilbert Insurance Ag TO: +1 (978) 682-3231 PAGE: 002 OF 003 AOS, CERTIFICATE OF LIABILITY INSURANCE DATE 088/11/11/z?oos008 (D 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# INSURED Kenneth B. Keen INSURERA: NORFOLK & DEDHAM INSURANCE 23965 DBA: Keen Construction Company RJSURERB1 Granite State Ins. Co. 0077 21 Hewitt Ave. INSURER C: North Andover, MA 01845 INSURER D: INSURER E: VERAGES 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. INBR D TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE 1MMIDDtM LIMITS GENERAL LIABILITY ND-P-010078/000 03/13/2008 03/13/2009 EACH OCCURRENCE $ 1-1000,000, X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 5O,OO CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5 100 A PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00, GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY .P1ECT r OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY ALTO (Ee accident) 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 EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC7431477 08/03/2008 08/03/2009X WCSTATU- on+ EMPLOYERS'LIABIUTY fER B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? If s,describe under E.L.DISEASE-IEA EMPLOYEd$ 100.000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 5QQ QQ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT(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 MAI.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 `.s The Commonwealth of Massachttsetts Department of Indttstrial Accidents Office of Investigations Sh ^k 600 Washington Street Boston, MA 02111 k' www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): M J eQ N Sf1Z V G J;0 vJ Address: k-�U City/State/Zip: � . NCS©yfit, A Phone 69'( -S oP a � Are you an employer? Check the appropriate box: Type of project(required): 1.02-1`6 a employer with 1 _ 4• ❑ I am a general contractor and I ' employees(hill 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.'n Demolition working for me in any capacity. employees and have workers' comp. insurance.$ 9. ❑ Building addition [No workers' comp. insurance P• 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 employees. [No workers' 13.L-6'ther PA;►2S 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. n 11 ,[ Insurance Company Name: (e 2A 1.7 r l" 1T H+C Policy#or Self-ins. Lic.#: LU C 7 113/#77 Expiration Date: `0 of Job Site Address: L(� �Dn-`z�� S'f: City/State/Zip: Nd 1�`e&- Q / a�Jr 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 tinder the ins nd penalties ofperjury that the information provided above is true and correct. Signature:- Date: Phone#: r Q ) 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#: