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HomeMy WebLinkAboutBuilding Permit # 1/29/2016 of %AORTH BUILDING PERMIT TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION o Permit No#: 1 Date Received �y AERATED IN �,�f Ss•aceaus`` Date Issued: I PORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes nod MAP PARCEL r` ZONING DISTRICT:_ Historic District yesnn Machine Shop Village yesi0F) 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 F C(Floodplain ❑Wetlantls ❑ Watershed Distrtct i� l�a ❑U1/aferlSewer, , ,, r. ,,.h ,,,': ,, w. DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type;or Print Clearly OWNER: Name: 'Lr Phone: Address: Contractor Name: "� �� "�(z r �0 Phone Email: ,. _ y a '�ra,- '=; rzj C, Address: � �. ,�< �.� �� ., �_ � t f _ Supervisor's Construction License: -> ` 07 _Exp. Date: Home Improvement License: I +� ' 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: $ -1 ' Check No.: Receipt No.: NOTE: Persons contracting with acnregistered contractors do not have access to t g/uara fund tAORT,ago � Town of Andover L�9 ® �..cE h ver' ass, i �t coc KIc KIWACK RATE® U BOARD OF HEALTH LD Food/Kitchen P Fm; R T T Septic System ® BUILDING INSPECTOR THIS CERTIFIES THAT ........... "� ...... .0 .. .. ..... ........... .... ® .... . ... ............... . . . . .. ........... Foundation has permission to erect .......................... buildings on .................. ......VV . . 1C.. . .............. Rough tobe occupied as ............IrCAM. ... .. ......... .............. ....... ......................................................... 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 Final PERMITI IN 6 MONTHSELECTRICAL INSPECTOR UNLESS TTT 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. - Constr^ue on Co, NGMC)UGLIWG %VC-CIALISTS 4SP7143—4sp 4_93�`1—.S`a®-1 KeenConstructionCo.com Buchta, Mark&Caroline 111 Campbell Rd N. Andover, MA 01845 Contract#5757;Appendix A November 24, 2015 Remodel kitchen: • Remove and dispose of existing cabinets,wallboard on both cabinet walls and ceiling • Frame rear wall;supply& install Andersen CN235 double wide casement window.Approx. size 40 3/"x 40 W,with flat casing • Upgrade electrical as needed. Install seven recessed lights & under-cabinet lighting($3000 electrical allowance) • Remove and install new plumbing fixtures supplied by customer, including new water box for refrigerator($1500 plumbing allowance) • Insulate to code • Supply& install%" blueboard on walls and ceiling and skimcoat plaster to smooth finish • Paint walls, ceiling and trim in kitchen and living room(including corner built-in unit) • Install customer supplied cabinets and related trim • Supply& install tile backsplash (standard installation, $300 tile allowance) Total Price:$22,600 (twenty two thousand six hundred dollars) Price does not include cost of permits, cabinets, counters or repairs to unusual, unsafe or non-code compliant existing conditions not addressed in this quote. Payment Schedule: $5000 due the first day of work(plus permit fee) $4000 due when rough plumbing and electrical is complete $4000 due when plaster is complete $5000 due when cabinets are installed $4600 due at completion of contracted work �I Customer Robert A. Keen Date Date PO Box 935 Page 1 of 1 P: 978-691-5201 N.Andover, MA 01845 F: 978-682-3231 G5L #076691 Sales@KeenGonstructionGo.com HIG #108383 I KEEN CONSTRUCTION CO. 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 ((q��q� f .Chapter 142A of the general laws, must be registered Submitted 11 1`l(� t, CG!'G t V� I»��4 Ct with the Commonwealth of Massachusetts. Inquiries To: Ir V about registration and status should be made to the I 1 P Director,Home Improvement Contract Registration,10 �� I r Park Plaza, Room 5170, Boston, MA 02116 617-973- �j' 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 REGISTRATION NO. EIN NO. �t /?_4 115 MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install 10 See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: — 50e F�n G�t�4 x P _ > Construction related permits: WORK SCHEDULE -_-_-.-- .-----_--------._ __. Contractor ill n t gin the work or order the materials before the third day following the signing of this Agreement,unless specified herq i ilt C nuactor will begin the work on or about L (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 n t be con idered as violations of this Agreement. '.. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from detects in materials and workmanship for a period of it 620 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 Propose hereby furnish rmaterial and labor-complete int accordance with above specifications,for the sum of: T�-Cv1+ `J ! t-om. � G"C-U)c. 112 S� �1�wleJ __. dollars($ 1-22, ( 0 O ), Payment to be madb as follows: % ($ ) upon signing Contract; ROBERT A. KEEN Name of Contraclor/Designated Registrant '.. ($ ) upor�co �ile'n of 1175 TURNPIKE ST. �V IN. ANDOVER MA 01845 —7 Street Address % $ on completion of_ s n e City/Slate ($ ) shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Phe Pax 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 n!Sal n 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 Authe red 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 slated. 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. / Signatul�-t'��l �� (/I/ f6 t /�-- Dat 4 Signature Dale IMPORTANT INFORMATION ON BACK The Commonwealth of Massachusetts Department of Industrial Accidents a i d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. _A licant Information Please Print Letsibly Name (Business/Organization/Individual): 10—eve Address: 1 C-)X 9 5 i �1 �-Ir G OP-hone#: 97Z—(1,9-1 —57ZQ City/State/Zip: � �1 �'v Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 2- employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp,insurance required.] 9. Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I 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 11.0 Electrical repairs or additions proprietors with no employees. 12,0 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.insuranceJ 14.Q Other 6.❑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. Jain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ ry v� 5 I S Policy#or Self-ins.Lie.#:(a /4 U IJ 9 9 9 I M JS 2' "-� Expiration Date: e. City/State/Zip: Ul �C�l`�i�` ►'�l�' U I L � Job Site Address: c"PA ' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 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 r er lie p i s and penalties of peJury that the information provided a ove is true and correct. Si nature:` Date: Phone#: f 'L only. Do not write in this area,to be completed by city or toipn official. n: Permit/License#hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: ACO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM DDIYYYY) 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 NAMEACT : Barbara McDonough Gilbert Insurance Agency, Inc. PHONE E., (781)942-2225 qC No:(781)942-2226 137 Main Street EMAIL ADDRESS:bmadonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERA Norfolk & Dedham Insurance 23965 INSURED INSURERB:Safety Insurance Company 39454 Keen Construction Company INSURER C:'Travelers Ins. Co. 0031 483 Chickering Road INSURER D: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER-CLI552101779 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 OD B POLICYNUMBER POLICY EFF POLICY EXP P LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR PREM SESO a occurrence $ 100,000 ND-P-010078/000 3/13/2015 3/13/2016 MED EXP Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECTPRI �LOC PRODUCTS AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITYa BBINMEeD ril)SINGLE I IT $ 1,000,000 B ANY AUTO BODILY INJURY(Par person) $ ALL OWNED MAANUUOTTNOOOSMED SCHEDULED 6228807 COM 01 5/23/2015 5/23/2016 BODILY INJURY eraccklenl $ AUTOS S (P ) X HIREDAUTCS PROPERTY DAMAGE $ ent Underinsured motorist $ 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION O AND EMPLOYERS'LUIBILITY YIN STA TE ER ANY PROPRIETORMARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 C OFFICER/MEIABER EXCLUDED? O NIA (Mandatory in NH) GRUB-9997M50-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYEE$ 100,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULD ANY OF THE ABOVE 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(2014/01) The ACORD name and logo are registered marks of ACORD INS02512014011 Massachusetts -Department of Public Safety Board of Building Regulations and Standards 1.1/ltltl UlLl1111 sup--- Ll I,i'mI License: CS-076691 ROBERT A KEEN-` ' 12 E WATER ST North Andover MA- 0 r Expiration Commissioner 08/16/2017 p ��ie�pana��zrnzcoea o/bAlaacccluJel Office of Consumer Affairs&Business Regulation WxME IMPROVEMENT CONTRACTOR gistration: 1083,83 Type: piration: 8[18[2016.- ,, DBA KEEN CONSTRUCTION CO.. f Kenneth Keen 1175 TURNPIKE ST NO.ANDOVER, MA 01845 Undersecretary