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Home My WebLink AboutBuilding Permit #741-15 - Exception 3/27/2015�tl X 117 R -ate -+o- w -..........,,. ��..,T Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION -74/r /4' r ,)RTANT: LOCATION l Pr— 5 PROPERTY OWNER M0, r - MAP _PARCEL: Date Received Applicant must complete all items on this page Print 100 Year Structure ZONING DISTRICT:. Historic District Machine Shop Vi yes no yes no es no 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: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WOM TO BE PERFORMED: '/z b �;-l_\ +-o 154- t- I c -o (— , .V 6 rr_c-+e tQU A J r �7 wY— Identification -Please Type or Print Clearly OWNER: Name: M ckf'-i PSI t e,+I e,r Phone:57 S—( 95--2-d I tt nnnn,n Address: 5 W a SAc T m M V� N v�64,Contractor Name: tCQ,� (w� Phone:. - _ 92,7—(,g Address:- � � % �J � +'� � � Inc sf- ajc y � Supervisor's Construction License: If 5-07 (c & 9-1 Exp. Date: Home Improvement License: Exp. Date: Dh g 11I 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: $ 1 90 t O d FEE: $ &) PO Check No.: 15(,/ Receipt No.: (2�F-yy NOTE: Persons contracting with unregistered contractors do not have access to ar ty f nature of of Agent/Owner Signature of contractor i /f ,660- I nratinn No. V— /Si Date -3 2 7116-- TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /� C 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 PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature, CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS joning 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 I' 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.sloo-sl000 fine nu i is ana UA 1 A — (1 -or department use ❑ Notified for pickup Call Email I Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I 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 o 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 ❑ 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 TE: 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 o 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: Building Permit Revised 2014 IC) N. .a C � U) n. O n Z y D o �.�•N - `o 0 O 1p v(D CL t 23 CD o° I CO CD CO � v 0 0 z CD 00 �CD 0 CD co 0 Z C) z cn m O C �m c COM Z X a � rn C Cn n — iM 9;:z CF) 2 O D O m O 0 N 0 R co 0 co CD co c 0 cn2. cn cn CD rt o _ = -a 0 _ U) =' < CD �n C_° 0 CD n m o s �� N vi fu CO) FD -n O 0 .-► Q 0 m WCD � 0 x as N ' o gym D c� Qo �, -i U) -I- fl, �+ D ID CD -0 . 0 CO 0 0 v,CD ..� o0 �, a' rt v CD c C- 0 CL cn CLo2 0 CD U) 0 O < 0 CD Q) -o U)CD O 7N� O O � y o O �tq O 0 CD C CD CD CD �C C� 0h nCD CD r as o n a� O y O O CL N 3 T. (D rD to fD — W c rD ^ m rn vN m T 3 xT 0 Ot1 7- H 0 3' N N ('1 W O 00 S m m AW rte- M � 0 0 T �' E ;;o O3 DO S C 3 0 0 T (� 3 3 rD -<n A O d4 S T O Q � C z m 0 N m f1 LA 3 T O �- ? m W O 0 D S c k AIL We:. Carstsurl�an Ca, REMC 0ELINC: SPECIALISTS 978-697-520-1 KeenConstructionCo_com i Pelletier, Mary 18 East Water St. N. Andover, MA 01845 978-685-2081 Contract #5533; Appendix A March 18, 2015 Create new powder room and laundry closet: • Remove and dispose of existing china cabinet in dining room • Create powder room, approx. 40" x 60", in corner of dining room • Supply & install plumbing drains, vents and feeds for powder room and laundry closet on 2nd floor • Install vent through roof for plumbing system • Supply & install Kolher Cimarron comfort height toilet, Wellworth pedestal sink and Alteo chrome faucet, TP holder and towel ring • Supply & install laundry valve (single valve) in closet • Supply & install new electrical panel in basement • Supply & install wiring for bathroom and laundry to code • Supply & install %" blueboard and skimcoat plaster to smooth finish • Supply & install 80cfm fan, Hampton Bay 2 -light vanity light, Napoli oval mirror and Hampton over -john cabinet in powder room • Supply solid core Masonite door with trim to match • Supply & install base trim to match • Supply & install vinyl sheet flooring • Paint walls, trim and ceiling (two coat finish) Total Price: $15,190.00 (fifteen thousand one hundred ninety dollars) Price does not include cost of repairs to unsafe, unusual or non -code compliant existing conditions. 1175 Turnpike St. N. Andover, MA 01845 CSL #076691 Page 1 of 2 Sales@KeenConstructionCo.com P: 978-691-5201 F: 978-682-3231 HIC #108383 r.. ° KEEN CONSTRUCTION CO. PROPOSAL AP 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 j� Chapter 142A of the general laws, must be registered Submitted ��, i'e f ��r with the Commonwealth of Massachusetts. Inquiries To: I 111 about registration and status should be made to the f C 1 Director, Home Improvement Contract Registration, 10 C,.tf J 1 Park Plaza, Room 5170, Boston, MA 02116 617-973- ' I r f4/ `Y 5 8787 Owners who secure their own construction ,y �V V (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. ?j J 5 MA. H.I.C. 108383 46— 3783401 > C/S = Customer Supplied S + I = Supply + Install C� See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: Cr2 - -fie jew e (,,-/e/e r- rc) v� 4 J ( GY-r4 Gto:2ej Construction related permits: _......__....'_S6--'--....._........... ................_-.... _........ _........-_..__--.......__.--_...�..........--- ........................................................._................ .......... ............ ........................:_............-...................... ._.-_....__._.............._.............................-_.._...__...-...._................._-. WORK SCHEDULE Contra r �I not b i e work or order the materials before the third day following the signing of this Agreement, unless specified here'n r 1 g. n ctor, 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 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 Contracto , 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 Prop se hereb to furnish material and labor - complete in accordance with (above specifications, for the sum hof F; Prop se e � 6 y 5ck A (� C t� ' �00 C1 f*- Y V t NA "4 —r dollars ($ I J � 90 1 U � ) Payment to be made as follows: % ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor / Designated Registrant % ($ upon' e'oI}`Qf%� 1175 TURNPIKE ST. (((�� Street Address %($: n of N. ANDOVER, MA 01845 I - - City/ Stale {� sha I 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 advance, to order and/or otherwise obtain delivery of special order materials and Authorized Signature equipment, whichever amount is greater. Note: This proposal may be withdrawn by us it not a«epted 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 '� r " /' / ./ r Dale - Signature Dale IMPORTANT INFORMATION ON BACK ► _ 7 een Cons tv uc6on, Ca, IiEMC7UF1_IPI C: SI'tSG1AWSTS 978-697-520 1 �_ KeenConstructionCo.com i Payment Schedule: $5000.00 due upon signing contract $5000.00 due the first day of work $5190.00 due at completion of contracted work /- o"tll' 4zo Customer T Robert A. Keen S-a�- /-'5� Date Date 1175 Turnpike St. Page 2 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL #076691 Sales@KeenConstructionCo.com HIC #108383 11/13/.4014 10:00 FAX 781 942 2226 GILBERT 10001/001 .r"'"`RI a►Ta1MuroD CERTIFICATE OF LIABILITY' INSURANCFr ,i1/12/2014oi4 THIS CERTIFICATE 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 8Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be enaOM;d-. if SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the Qeedfleat,e holder in lieu of such endorsemen e). PRaDUcer Barbara McDonou, G13.bert Insuran00 Agency, InC. PHONrt -(781) 9a2gilb 137 Main Street 'M^IL .bmodonoughQilb MA 01867-3922 INSURED Kees Construction Company 1175 Turnpike Street MA 01845 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURI INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM@ GENERAL LIA UTY Xq7CL9UMS4wF- GRCIAL GENERAL LIABILITY A [i] OCCUR 060 1. AGGRE�LI GGAW LIMIT APPLIES PER: X I i oem Iry PAR I I LOC AUTOMOBILE LIABILITY H ANY AUTO ALL OWNED AUTOS X HIRED AUTOS UMBRELLA UAB EXCESS UAS U51 DESCRIPTION OF EYfdenCA I SCHEDULED NON-0WNED AUTOS Occur( CLAIMS -MAD YIN !EXECUTIVE L--.1 07 El N 1 10079/000 Se Provided 4 I the carrier. /3/2013 X12/3/2014 /2015 / LOCA'noNS / VENICLES (Attach ACORO 101, AddWonal RaMWa Schedule, R mora apace It ragWrcd) i m, Not: 1(791) Y42-2226 irtinSuranCe.COM ' 0100 C NNIC TAM IN_CZi _23965 1"urs Comxkin =ance _ 0022 -finnawna, u, uaoco. D NAMED ABOVE FOR THE POLICY PERIOD �OCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, UMITs EACH O URREN09 S 1,000,000 DAMA RE a rn 100,000 MED EXP on s 5 000 PERSONAL & AOV INJURY 3.,000,000 GENERAL AGO TB i S 2 000 t 000 PRODUCTS - COMPIOP AGGI 8 2,000,000 S O B LIMI � O 0 0 BODILY INJURY (perpwsm) S BODILY INJURY (Pel acGdvnl) S OP S nderrnaured iw I S:L00,000 EACH OCCURRENCE s AGGRE 'rE E i B A L. EACHA001 ENT 100,000 El, DISEASE - EA EMPLOYE 100,000 E.L. DISEASE - POLICY LIMB 1 S SQQ 1 000 (978) 688^9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEICANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i Town of North Andover 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 M Gilbert, CTC/RMUMR ACORD 25 (2010/05) 01989.2010 ACORD CORPORATION. All rights reserved. ,a,enns ,,,,,.,ro, n. Thw ACORD name and Joao are registered marks of ACORD Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -058245 KENNETH B IKE" ;. 21 HEWITT AVE: N ANDOVER MR 01,4 Expiration Commissioner 03/24/2016 ---- ..-.._--------------- -. Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -076691 ROBERT A KEEN" 12 E WATER ST ; r. North Andover NfA 01;8 ry Expiration i Commissioner 08/16/2015 �-\ Office ofConsumer Affaiiness Regulation t1ME IMPROVEMENT CONTRACTOR elgistration: . t'8383 Type: iration: c 8/18%2016 , DBA KEEN CONSTRUCT A r t f Kenneth Keen_,0 1175 TURNPIKE ST NO. ANDOVER, MA 01845" Undersecretary The Commonwealth of Massachusetts - Department of Ind ifstrigl Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/El.ectricianslplumbers Applicant Information Please Print Legibly Name (Business/organi'zation/fn.dividual): Ko �v) rU C=± I Address: J f - I City/State/Zip: �V1 d _FIflA 61 9 f 5 Phone #: Are you an employer? Check the appropriate box: 1. [( I am a employer with �- 4. ❑ I am a general contractor and I employees (fall and/or part-time).* have Hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working .for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. LqR.emodeling 8. ❑ Demolition 9. ❑ Building addition 10.[] Electrical repairs or additions 11.[] Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ Other 'Any applicant that checks box#1 must also fill outthe section below showing their workers' compensation policy information. 1' -Homeowners who submit this affidavit indicating they ore doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that cheekthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that isproviding workers' compensation insuranceformy employees. Below is thepolfcy andjob site information. 1 C Insurance Company S M 6 L) rc�_ Policy # or Self -ins. Lie. #: Expiration Date: 5 Job Site Address: City/State/Zip: 90Wed�er A# O I g� 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby Phone #: 927- - S 7-01 of perjury that the information provided above is true and correct. 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 #: