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HomeMy WebLinkAboutBuilding Permit # 1/21/2016 0.1 OORTH I BD UILDING PERMIT .,LE '6 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION f�_ 0 Permit No#: Date Received ArE, I�11 sSAcl lase Date Issued: IMPORTANT: Applicant must complete all items on this page TC LOCATION 5 Pri"t • PROPERTY OWNER T6 (VI V) Print 1 100 Year Structure yes 0 r MAP J o PARCEL: ZONING DISTRICT:_ Historic District yes 0 Machine Shop Village yes nQ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Ll New Building 0 One family Ll Addition 0 Two or more family Li Industrial Li Alteration No. of units: Li Commercial [M Repair, replacement Li Assessory Bldg ri Others: Li Demolition El Other DESCRIPTION OF WORK TO BE PERFORMED: I �,u s bo(7 Identification- Please Type or Print Clearly ae , ,h , V—ro "o, k 1 Phone- OWNER: Name: �4 �J, P ti do\16� N Address: /I Con-tractor Name: one: 9) b"Le 4 Ph img� ❑ Floodplain Address: 'PC Box 2351 k L140 e Supervisor's Construction License: Exp. Date: Home Improvement License: I 6Y ,Yil) Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT. $12.00PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1 ;9-(4 5 .c)t FEE: $ Check No.: Receipt No NOTE: Persons contracting with unregistered contractors do not have access tot to a d 7 1 of"Cont en'f/QwnL-r ------ 'Town NORTH 2 L ofndover O ti 0 ZOLAKE h L ver, G@�SS' COC HICKIWICK y1. �.95 RATE0 U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR . .... .. . .. ....... . . . . .... .... . .. .... Foundation has permission to erect ... ..................... buildings on .. ........ _.......... ....� '. ............ Rough usaw tobe occupied as ........ ............. ........ .~�w ..................................................... Chimney provided that the person accepting this permit shall in every respect conform to the 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 r3 ff Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIOTA 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. -` ,,_;_GanJtrueliayr Co, NI?MCSUE!_I W C: 51'EG I/_�I_ISTS 978-69-/-520`d Kee nconstructionco_com Trombly,Joseph & Elaine 35 Johnny Cake St. N.Andover, MA 01845 Contract#5570;Appendix A January 16, 2016 Replace wallboard in bedroom: • Remove casing on three windows and three doors • Remove base cap • Remove and dispose of wallboard,sheetmetal enclosure on heat and insulation in room,cutting wallboard above base molding • Supply& install R-15 kraft-faced insulation • Supply&install %" blueboard and skimcoat to smooth finish • Re-install casing that is deemed usable by customer.All other trim will be installed in the spring. Total Price: $2965 (two thousand nine hundred sixty five dollars) Install new trim in spring: ($915) • Supply&install pre-stained casing, base cap and crown molding • Supply& install new sheetmetal on baseboard heat Price does not include cost of permits or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this quote. Payment Schedule: $1000.00 due upon signing contract $1000.00 due when plaster is complete $965.00 due at completion of contracted work i .','-7 C stome Robert A. Keen Date Date PO Box 935 Page 1 of 1 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC #108383 KEEN CONSTRUCTION CO. ° 1175 TURNPIKE STREET PROPOSAL 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 ( �- L v with the Commonwealth of Massachusetts. Inquiries To: Tr-X )Il c L(G'c 1 l / about registration and status should be made to the i/ S Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617-973- ` 8787 Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATE REGISTRATIO14 NO. EIN NO. :;�01)_N �(„ / 2-01 (- MA. H.I.C. 108383 46—3783401 C/S=Customer Supplied S+I=Supply+Install Lid See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: L Construction related permits: WORK SCHEDULE Contractor ill not egin the work or order the materials before the third day following the signing of this Agreement,unless specified here_in in C ntractor will begin the work on or about {�.�,(date). Baring delay caused by circumstances beyond Contraclor'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 Contractors not a 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 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 Contract r,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 yPropose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: —rUc> I nC)Ln"'N F\) f1�n ( �tanr�r('Si )� K� �° _�.�_=dollars($ -9�n b) OC) ). Payment to be made as follows: ($ ) upon signing Contract; ROBERT A. KEEN r (, Name of C.mmr tar/Designated Registrant ($ ) upon completion f �1/� '(�(1 1175 TURNPIKE ST. �h2 �� (())V SlheeAddrss($ ) -rietion of_ y 01845 N. ANDOVER, MACrt /Stale b made forthwith upon (978)691-5201 (978)682-3231 J completion of work under this contract. Phe Notice: No agreement for home improvement contracting work shall require a ) `O2.Ya down payment(advance deposit)of more than one-third of the total contract price Namenl �s an _ or the total amount of all deposits or payments which the contractor must make,in - J_- advance,to order and/or otherwise obtain delivery of special order materials and Aut wdzed ignature equipment,whichever amount is greater. Note:This proposal may be withdrawn b y y us if not accepted wuhin days. Acceptance Of Proposal-I have read both sides of this document and all attached documents and accept the prices,specifications and conditions staled. 1 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. Sign tY a�f Dale ' Signature Dale IMPORTANT INFORMATION ON BACK DO- The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia SJ•V` Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A_pplicant Information /� Please Print Legibly Name(Business/Organizationdividual): �n 6[Vt /In Address: 5 City/State/Zip: ��'n °v°��'p G f$P one Are you an employer?Check the appropriate box: Type of project(required): 1.[Z I am a employer with 2r employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working forme in 8. Memolition emodeling any capacity.[No workers'comp.insurance required.] 9, 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.[]Other 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'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. $Contractors 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. Insurance Company Name: -T7(jc, i e r5 I q-5 Policy#or Self-ins.Lie.#:Cts 14 U 1J " 9 9 91 r'1 S 2- — W� Expiration Date: j 22 C City/State/Zip: nClt;\l }.(� G f) Job Site Address:3 J �C i1!,~1 ��� -� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify uncle th ,pai !and penalties ofpeijury that the information provided above is true and correct. Sinature: N- Date: L2— l Phone#: 9 9 E use only. Do not write in this area,to be completed by city or town official. Town• Permit/License# Authority(circle one):of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Person: Phone#: AC4ORa CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD YYYY) 141� 10/23/2015 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 BY 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(ies)must be endorsed. If SUBROGATION IS WAIVED,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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME, Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)992-2225 AIC O;(781)942-2226 137 Main street ADDRIEss:bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERA Norfolk S Dedham Insurance 23965 INSURED INSURERB:Safety Insurance Company 39454 Keen Construction Company INSURER C'Travelers Ins. Co. 0031 483 Chickering Road INSURER D: INSURERE: North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER CL1552101779 REVISION NUMBER: THIS IS 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 TYPE OF INSURANCE ADOL B POLICY EFF POLICY EXP T POLICY NUMBER MWDDIYYYY) (MWDDrrYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PREMISES ,occurrence $ 100,000 ND-P-010078/000 3/13/2015 3/13/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY O JET n LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ce eBNED SINGLE LIMIT $ 1,000,000 CE w1denl ANY AUTO BODILY INJURY(Perperson) $ B ALL OWNED SCHEDULED AUTOS X AUTOS 6228807 COM 01 5/23/2015 5/23/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS eramidenl $ Underinsured motorist $ 100,000 UMBRELLA a OCCUR EACH OCCURRENCE $ EXCES9 LIAR CLAIMS-MADE AGGREGATE $ DED RETE I$ WORKERS COMPENSATION IFER E AND EMPLOYERS'LIABILITY YIN OFFICEROlMMEMBEOR EXCLUDED? CU7IVE NIA E.L.EACH ACCIDENT $ 100,000 C (Mandatory In NH) 6RUB-9991M5B-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedu(e,may be attached If more space Is required) '.. CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULDANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS02512014011 Massachusetts -Department of Public Safety Board of Building Regulations and Standards I/11 ._-- .- 1. J L111l Lll'/ll r aurfel_Y111/1 License: CS-076691 ROBERT A KEEN— 12 E WATER ST IMMMV North Andover NE4 0 r J.•�,.� � ."'"`� Expiration Commissioner 08/16/2017 &tie W."111tauueal a�C eracfcare Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Wepgistration: 168383 Type: iration: 8L18t016 DBA KEEN CONSTRUCTION CO Kenneth Keen 1175 TURNPIKE ST NO.ANDOVER, MA 01845 Undersecretary