HomeMy WebLinkAboutMiscellaneous - 796 CHICKERING ROAD 8/3/2015 V%ORTH
BUILDING PERMIT 0, K,,ED
TOWN OF NORTH ANDOVER
0
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received )-5- ATep
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION 9(� C A
PROPERTY OWNER
Print 10OYear Strcture yes
MAP PARCEL: ZONING DISTRICT:-Historic District yes
Machine Shop Village P10)
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
[I New Building D One family
11 Addition 11 Two or more family 11 Industrial
[I Alteration No. of units: 11 Commercial
[Repair, replacement El Assessory Bldg El Others:
El Demolition 0 Other
W
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"DID
Id 11,
i11letlat
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DE�CRIPTION OF WORK TO BEP qRFORMED:
L' bnek e0A e�
e c�k
.4 .fification- Please Type or Pr' Tarl
OWNER: Name
ce, k. c Phone:
i
Address: Chic- e r-,V) 0
POJ
Contractor Nqme: teerl (005-fiv&:h" (0 Phone:
Email: 5 (--, J�"e?e%t� e6-7 5 J-(Ix-1 C 0, 5-0
Address: i,-
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE;BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTqASED ON$125.00 PER S.F.
Total Project Cost: $
c) ro C C FEE:
1�11
Check No.: Receipt No.: , I
NOTE: Persons contracting with unregistered contractors do not have access to i gua n and
J- 7
r
ja
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer 11 Tanning/Massage/Body Art F1 Sw"mn'ng Pools 11
well El Tobacco Sales 11 Food Packaging/Sales El
Private(septic tank,etc. El permanent Durapster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENT'S
CONSERVATION Reviewed on. ignatu
COMMENTS --6
n S-C� A Acym,ak
L
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/s�anature� nate Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
Fj R EwDEPARTMENT; Temp Dumpster o,n siteyes no,.
L66 t' ain Street
Firs hi ent,signature/date
COMMENTS
tAORTH
F11 own ofE over
0
;... .
o `ANE. ..
ANE h ver, Mass,
�Q COCHIG Kl W.CK
q°ftAT ®
BOARD OF HEALTH
P E Food/Kitchen
RM ' T1[ . LD
Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
............ ....... :.{.,,, ►...............................................
Foundation
has permission to erect .......................... buildings on ....._A0...... 4. IT......1�/�.
Rough
to be occupied as ......... ....... ..�. ........ ..........�.4 *Corm.....j......0". s.......... Chimney
provided that the person accepti�lg this permit shall In eve res ect to the terms of thea licationppp 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 6MTHS ELECTRICAL INSPECTOR
LESS C® ST CTIORough
Service
.. mW00.00........................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy .Permit Required to Occupy Building Rough
Islay 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.
Cons c6on Co.
IZfiMOU@LING: tiPHC1ALIS'1'S
KeenConstructtonCo.com
Rollins,Jeffery&Stacey
796 Chickering Rd.
N. Andover, MA 01845
Contract#5540;Appendix A. July 28, 2015
Remodel existing deck:
• Remove and dispose of existing deck surface, railings and roof structure from existing 10'x 10'
deck
• Supply& install three 4"x 4" posts, standard pressure treated 2" x 2" baluster rail system and
TimberTech Reliaboard Grey 5/4"x 6" decking
• Install customer supplied SunSetter awning
Total Price:$3,810(three thousand eight hundred ten dollars
If an electric awning model is chosen, electrical work will be an additional cost.
Prices do not include cost of permits, or repairs to any unsafe, unusual or non-code compliant existing
conditions not addressed in this quote.
Payment Schedule: $1000.00 due upon signing contract (paid)
$1000.00 due the first day of work(plus permit fee)
$1000.00 due when deck is done
$810.00 due at completion of contracted work
Customer Robert A. Keen
y/ l�
Date Date
1175 Turnpike St. Page 1 of 1 P: 978-691-5201
N.Andover, MA 01845 F:978-6682-3231
GSL #076691 Sales@KeenGonstructlonGO.com HIG #108383
KEEN CONSTRUCTION CO.
a 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
Chapter 142A of the general laws, must be registered
Submitted e r_,C e `, d ; N with the Commonwealth of Massachusetts. Inquiries
To: about registration and status should be made to the
(p Gll.'r C_�r �i d Director,Home Improvement Contract Registration,10
Park Plaza, Room 5170, Boston, MA 02116 617-973-
{�/� ` 8787 Owners who secure their own construction
tl}yl 86 V e r / Ur t Q I '95 1 related permits or deal with unregistered contractors
will be excluded from the Guaranty Fund Provision
of MGL c.142A.
PHONE DATE REGISTRATION NO. EIN N0.
MA. H.I.C. 108383 46—3783401
CIS=Customer Supplied S+I=Supply+Install Cl See Attached Appendix A
We hereby submit specifications and estimates for work to be performed and materials to be used:
OF
> 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 (dale). 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(his 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.
We ropose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of:
�� � SID I O
---dollars($ �- � o
Payment )-
to be made as follows: `
% ($ ) upon slgning'ontract ROBERT A. KEEN
✓\ �, Name of Contractor/Designated Registrant
/e ($ r ( u�p\n completion of 1175 TURNPIKE ST.
\ Street Address
upon completion of N. ANDOVER, MA 01845
J City/State
($ ) shall be made forthwith upon (978)691-5201 (978)682-3231
completion of work under this contract. Ph Fax
I
Notice: No agreement for home improvement contracting work shall require a 4&
>down payment(advance deposit)of more than one-third of the total contract price Name M salsm
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 Aulhod ed Signature
equipment,whichever amount is greater.
Note:This proposal maybe 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 traIn action.Cancellation must be done in writing.
DO NOT IGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature�t � Dale
Signature Date
IMPORTANT INFORMATION ON BACK NO-
•
•
CONSERVATION DEPARTMENT
Community Development Division
July 28, 2015
Ms. Stacey Burritt
796 Chickering Road
North Andover, MA 01845
RE: VIOLATION of the Massachusetts Wetland Protection Act (M.G.L. 0.131 § 40) and the North
Andover Wetland Protection Bylaw (C. 178 of the Code of North Andover) at 796 Chickering
Road
Dear Ms. Burritt,
During a site inspection to review the wetland resource area related to the building permit submitted for deck
reconstruction at the above referenced property, I observed unauthorized dumping of brush, yard waste and
debris within the 100' Buffer Zone to jurisdictional wetland resource area. Yard waste observed included
grass clippings, tree debris, a mailbox, bricks and other items (see photos attached). According to C. 178.2 of
the Bylaw, "No person shall engage in the following activities: removal, filling, dredging, discharging into,
building upon, or otherwise altering or degrading the wetland resource areas..."including any 100-foot buffer
zone.
As such, The North Andover Conservation Department is hereby issuing this Violation Notice requiring that
you cease the aforementioned activities within the jurisdictional resource area, remove all stockpiled materials
by August 15, 2015 and relocate them to an area outside the 100-foot buffer zone or properly dispose of them
off site in an appropriate location (transfer station, Cyr Recycling Center, etc). All yard waste and debris
should be temoved by hand(no machinery). Please inform this department when clean up is complete.
The deck work is located within 100 feet of the wetland resource area but the revised building permit
application received 7/30/15 shows the proposed work is limited to replacement of the decking, railings and
posts and will utilize the existing footings with no ground disturbance proposed so that a permit should not be
required. The NACC has the authority to undertake additional enforcement action including the levying of
fines. The NACC does not feel such action is necessary at this time and looks forward to your immediate
cooperation in this matter. Please do not hesitate to contact me should you have any further questions or
concerns in this regard.
Sincerely,
ORTH AND VER CO SERVATION DEPARTMENT
e ifer Hugh
servation dministrator
y��
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542 Web www.townofnorthandover.com
The Commonwealth of Massachusetts -
- Department of Indust lglAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
-www mass gov/dza •
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciaus]Plumbers
;Applicant Information Please Prim Legibly
Name(Business/Organization/fndividual): G-e—y) (N1 ,) +I�l�
Address: 'lk e-
Ci.ty/State/Zip: VI 6�.tF E, Phone#: 7 — 6 91 6 2�
Are you an employer?Check the appropriate box: Type of project(required):
1. 1 am a employer with �- 4• Q I am a general contractor and 1 6. Q New construction
employees(full and/or part-time).* have hired the sub-contractors
2.F1 am a solepropxietor orpaxfnex-•
listed on the attached sheet.•X /• [ Remodeling
ship and'have no employees These sub-contractors have S. [(Demolition
working for me in any capacity. workers'comp.insurance. 9• []Building addition
[No workers' comp.insurance 5. Q We are a corporation and its 10.Q Electrical repairs or additions
required.] officers have exercised their
3.[] I am a homeowner doing all work light of exemption per MOL 11.Q Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12.Q Roof repairs
insurance required.]T employees.[No workers' 13.[]Other
comp.insurance required.]
'Any applicant that checks box 4l must also fill out the section below showing their workers'compensation policy information.
t-Homeowners who submit this affidavit indicatingthey iiia doing all work and then hire outside contractors must submit anew affidavit indicating such.
TContractors that eheekthis boat 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 worlrers'compensation insurance for my employees. Below is the policy and job site
information.
insurance Company Name:. V� ' F-j 6
Policy#or Self ins.Lic.#:� U L) ����=2- *xPirationDate: 1 7
Job Site Address: ►flP r�i r C+� City/State/tip: i klG�yl�
Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requixeclunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/ox 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 cert" u r the ains dpenalties ofperjury that the information provided above is tr e and correct. -
Si ature: Date:
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.Electrical Inspector 5.Plumbing Inspector
6.Other - -
Contact Person: Phone#:
RightFax C3-1 3/24/2015 9:51 : 03 AM PAGE 2/002 Fax Server
- DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
rTC0,11R
RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE
PRODUCER AND THE CERTIFICATE HOLDER.
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): (A/C,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 19 TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
INSR ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DDIYYYY) (Mt&DD\YYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $
CLAIMS MADE ED OCCUR. PREMISES(Ea occurrence)
ED EXP(Any one person) $
PERSONAL 8 ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $
POLICY a PROJECT FLOC RODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
(Per accident)
NON-OWNED AUTOS PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
A WORKER'S COMPENSATION AND ` WC STATUTORY OTHER
EMPLOYER'S LIABILITY YM UB-9991M5B2-14 10/08/2014 101013/2015 LIMITS
ANY PROPERITORIPARTNER/EXECUTIVE
MN OFFICER/MEMBER EXCLUDED? N/A E.L EACH ACCIDENT $ 100,000
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
ftyes,describe Older ELDISEASE POLICY LIMIT $ 500,000
DESCRIPTION
RIPTIOIPTIO . . -
N OF OPERATIONS below '.
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 R
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 REPRESENTAdVE 4
NORTH ANDOVER,MA 01845
ACORD 25(2010105) 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
�.111t.1 L141'Ll 1111 JU IIGI 1/
Y111
License: CS-076691
ROBERT AKEENz
12 E WATER ST,;� ¢
North Andover AA 0
)1,1fA ` Expiration
Commissioner
08/16/2017
�fe W11.109zureaN,o/cAcure�cc�ivaeCl
Office of Consumer Affairs&Business Regulation
VxPg
ME IMPROVEMENT CONTRACTOR
istration: ,;108383 Type:
iration 8L18L2016.; DBA
KEEN CONSTRUCTION CO
Kenneth Keen
1175 TURNPIKE ST
NO.ANDOVER, MA 01845' Undersecretary
9ii t Massachusetts - Department of PUbfic Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-076691
ROBERT A KEEN
12 E WATER STw v-
North Andover NFA O1sxi� ;
'A Expiration
Commissioner 08/16/2015
' �ie Ipo�nvmaouoec���o��?'�aaacce�ivaeC7a
Office of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
egistration: -T 8383 Type:
xpiration: _8LT8%206.,, DBA
KEEN CONSTRUCTI' CO
t
Kenneth Keen t Fel Y
a ikc
1175 TURNPIKE ST 4 ��
NO.ANDOVER,MA 01845" -' Undersecretary