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HomeMy WebLinkAboutBuilding Permit # 2/24/2016 i BUILDING PERMIT taoRra� q- O��.�LED !b�•YO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION n r , °°R w, • „ �. Permit No#: Date Received '�,y A�RATEO SS�CHUS� Date Issued: INd ORTANT: Applicant must complete all items on this page LOCATION ^1 n 1, Print PROPERTY OWNER I t-9— i-6)C.�-)v� Print 100 Year Structure yes no MAP '-13 PARCEL: ZONING DISTRICT: Historic District yes no Q Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other A ! s,.e d r 1I ,F.,f,!,1`,X/' iN;,T•�. t�,�Z r ;7 - a!'' .ar L �' 7d. ..";�f,..,,�z”,'r'"'lk, '..,�cf.�" } r,• Zvi t x ,F11948 ��. � r �� x �� � ���,�. �,� � ❑� lootl lain ��y❑.:Wetlantls���f����, ���� ❑ A1Natershe : tnct15 "1 d r�� r Ell. DESCRIPTION OF WORK TO BE PERFORMED: / �� G+t� ��,'(����4� (�t': 4''Vl� �� e�tt;)'-�` �a I"�%C`:`�\ ez �.�C iv`� ( j/1 ��1 � � �L✓��' Identification- Please Type or Print Clearly OWNER: Name: e J V-11c._..� ( % ;6 Phone: e �( -� '19 11> Address: ` I fi )" c 1— 6 1 g" Contractor Name: ee5eo (vJ,c'v( Cc= Phone: 9)Z-6/— 5 I Email: S6 If -5 6 C ..i C— e,v, ce),,L-A Address: PC, tic x 93� ' AJ9 Supervisor's Construction License: 1 Exp. Date: z h& hl 7 Home Improvement License: I Exp, Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.-$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � �� . C)0 FEE: $ Check No.: � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the gu r my and T . �. _ NORTFHI irown o2 ndover -N . 6 ver, MassC24 CO[NICNEWKK V 7 pD0ATED I''? �5 '9S U BOARD OF HEALTH Food/Kitchen PER D Septic System M17 BUILDING INSPECTOR THIS CERTIFIES THAT . ••• • '•'•• ••'••"""""' ............... ................................................... •'•"•"""""""' .• Foundation ..... buildings on .. .. . ...•.............. has permission to erect .. •• " '• Rough ... . Chimney to be occupied as ... . "' """" Final provided that the person accepting this permit s I in eve respect confoJMs of theapplication and on file in this office, and to the provisions of the Codes and,By-Laws relating to the Inspection, PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final ELECTRICAL INSPECTOR PERMIT EXPIRES 16 MONTHS gh LES S SSTR CTIO .ART_ Service •.....•••.•..• Servisce .... ... . ti......... Final ••••• •••••^ BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Islay in a Conspicuous Place on the Premises �- Do Not Remove FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Until Inspects and Approved y the Building Inspector® StreetrNo. Smoke Det. N� � ♦J KEEN CONSTRUCTION CO. PROPOSA7L E 1175 TURNPIKE STREET NORTH ANDOVER,MA 01845 All home improvement contractors and subcontractors kko 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 _ with the Commonwealth of Massachusetts- Inquiries Submitted `) F _ ( `(,C/V-) about registration and status should be made to the To: /Jn Director,Home Improvement Contract Registration,10 (,� C, r Park Plaza, Room 5170, Boston, MA 02116 617-973- 8787 Owners who secure their own construction `rl n cictVY I-t � related permits or deal with unregistered contractors l l / will be excluded from the Guaranty Fund Provision of MGL c.142A. DATE / REGISTRATION NO. EIN No. PHONE nryp,. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install l� See Attached Appendix A. We hereby submit specifications and estimates for work to be performed and materials to be used: !� pP=LIA6C�� X Construction related permits: .__._. _...._.._..._......... WORK S HEDU E (date).The Owner hereby Contra or tl_ I b i the(work or order t delay he materials aused before the third da follows g the signing of this l,Age Agworreement, be completed byed ere-an ti g_ o tractor will begin the work on or beyon about - acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall.n\be considered(—as completion and shall WARRANTY ra The Contractor warrants that the work furnished hereunder shall be tree lin w defects in materials and workmanship for a period of amply with the requirements of this Agreement. In the event any detect in workmanship or materials,or damage caused by the Contracto,his subcontractors,employees or agents,is discovered within one year atter completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,it cause re d remedied, repaired,d replaced,such damage or such detect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum Of � t U� ()�) —dollars($ ). Paymeo to be made as follows: ROBERT A. KEEN ($ ) upon signing Contract; Name ul Contractor/Designated Registrant 1175 TURNPIKE ST. ($ ) upon�i{�letlq�n of Street Address YI� f_ N. _ANDOVER, MA 01845 % ($_ N�sh on completion of City r State (978)691-5201 (978)682-3231 all be made forthwith upon Fax completion of work under this contract. Pho Notice: No agreement for home improvement contracting work shall require a Name nl salesma _i >down payment(advance deposit)of more than one-third of the total contract price , 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 AuthNote:red Signature Thsproposalmaybewthdrawnbyusitnolacceptedwdhin days equipment,whichever amount is greater. "bo the Acceptancehat of signing,on P opo prat-I have read becomes a binding onlris dt.Y You are auon nt umethorized fed to do tall attached he worktas spec f ed accepts and Payment willlbe mans on de as ouionsardtl:onn, fl' ted.You,the Buyer, may cancel this transaction at any time prior to midnight of the third business day after of this transaction.Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THEME ARE ANY BLANK SPACES. Dale Dala— Signature Signature -�'- IMPORTANT INFORMATION ON BACK 6 AR t Rd 090 Brown,Terry 344 Main St. N.Andover, MA 01845 Contract#5573; Appendix A February 23, 2016 Repair water damage in garage and library: • Supply& install 22'of fire-blocking (2"x 4"'s) at bottom of rear wall • Supply& install Borate loosefill cellulose insulation in ceiling of garage and in walls of library where it was removed • Insulate walls of garage with Borate loosefill cellulose • Supply& install approx. 96 sq ft of%Z" blueboard in library and skimcoat plaster to smooth finish, blending into existing wall • Supply& install approx. 671 sq ft of 5/8" blueboard in garage where it was removed and skimcoat plaster to a textured finish • Supply& install base trim to match existing • Supply& install 32' of sheetmetal heat enclosure • Paint walls and trim in library Total Price:$8,648 (eight thousand six hundred forty eight dollars) Price does not include cost of permits,flooring or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this quote. Payment Schedule: $1500 due upon signing contract $2500 due when insulation is complete (plus permit fee) $2500 due when plaster is complete $2148 due at completion of contracted work 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 GSL #076691 Sales@KeenGonstructionGo.com HIG #108383 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 a •.r ; d Boston,MA 02114-2017 www.mass.gov/dia compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. Workers Comp TO BE FILED WITH THE pEg�T'TING AUTFIOIiIT please Print LVdbl A licant Information Name(Business/organization/Individual): VI Address: ��_ (�} Pone#: City/state/Zip: Type of project(required): Check the appropriate box: Are you an employer? �, [�New construction 1.1Z I am a employer with_ employees(full and/or part-time).* 8 Remodeling 2.❑I am a sole proprietor or partnership and have no employees working for m.in 9 Demolition any capacity.[No workers'comp.insurance required.] self. No workers'comp.insurance required.]t 10❑Building addition g.❑I am a homeowner doing all work my L I will 11.❑Electrical repairs or additions 4.❑I am a homeowner and will be hiring contractors to conduct all work on my Property' Plumbing repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12. proprietors with no employees. 13 ❑hoof repairs 5,❑I am a general contractor and I have hired the sub contractors listed ur the attached sheet. 14 ❑Other These sub-contractors have employees and have workers'comp.insurance insurance required.] (•❑We are a corporation and its officers have exercised their right of exemption per MG c• 152,§1(4),and we have no employees.[No workers'comp. g s c ensation policy information. *Any applicant that checks box#1 must also fill out the section below showand then ing their hire o sub contractors and state whether w not those entities have ho submit this affidavit indicating they are doing all l work the name of the tside contractors must submit a new affidavit indicating such. Homeowners w p,policy number. $Contractors that check this box must attached an additional sheet employees. If the sub-contractors have employees,they must provide their workers'com p yent to ees. Below is the policy and job site I am an employer that is providingworlcers'compensation insurartce for my 1� Y information. y Vr?.1e r5 ' 5 Insurance Company Name: � Expiration Date: � .� 1-I� 3 999 M � ., Policy#or Self-ins.Lic.#' ficl C j � oaa L City/State/Zip: I t a(showing the policy number and expiration date). Job Site Address: compensation policy declaration page to$1,500-00 Attach a copy of the workers' comp required under MGL c. 152,§25A is a criminal violation punishable 2DERlandya fine of up to$250.00 a Failure to secure coverage aa fine up s req and/or one-y be forwarded to the Office of Investigations of the DIA for insurance ear imprisonment,as well as civil penalties in the form of a STOP g day against the violator.A copy of this statement may coverage verification. "ns artd penalties of petcert • that the information provided above is true and correct. I do hereby certify,y l l n er z'e p� IillY � Date: Z`f Si nature: 55 Z Phone#: '' � 'r � official use only. Do not write in this area,to be completed by city or town official. • Permit/License# City or Town: e): bing Inspector Issuing Authority(circle on 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plum 6.other Phone#: Contact Person: DATE(M"-DrcY") 10/23/2015 CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE 7HEDE.TES ACORN® g AUTHORIZED CONTRACT BETWEEN THE ISSUING INSURER( �'ED subject to EGATIVELY AMEND,EXATEND OR ALTER THE COVERAGE AFFORDED BY V SUED AS A MATTER OF INFO ONLTE AND CONFERS NO RIGHTS UPO ql THIS CERTIFICATE IS LOT AFFIRMATIVELY C RDOES NOT CONSTR. hts to the CERTIFICATE SOCERT FICATE OF INSURAN CERTIFICATE HOLDER• lic les)must be endorsed. i SUBROGATION n BELOW• ODUCER,AND THE SURED,the P° y( A statement on this at does not confer rig REPRESENTATIVE OR PR holder Is an ADDlolic as may require an endorsement. Policy certain P C TACT McDonough FAX (781)942-2226 IMPORTANT: If the certificate Barbara 2225 rdC No. the terms and conditions of the p NA E, 701)942- PHONE (.781)942-2 h@ j,1bertinsurance.com NAICH Certificate holder in lieu of such endorsements• ErAAIL •bmcdonoug 4 PRODUCER eneY, Inc. ADDRESS. 23965 insurance AQ INSURERS AFFORDING COVERAG Gilbert & Dedham insurance 39454 131 Main Street INSURERANorfolk an 0031 3922 INSURERS-safet Insurance Com MA 01867- Ina. Co. Reading iNSURER0-.Travelers INSURED Company INSURERD: Keen INSURER INSURER E: 483 Chickering Road REVISION NUMBER: INSURERF: ICH THIS MA 01845 CL1552101779 North Andover CERTIFICATE NUMBER. NY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH CRiBED HEREIN IS SUBJECT 70 ALL THE TERMS, LISTED BELOW HAVE BEE ISSUED TO THE ISNSURED NAMED ABOVE FOR THE POLICY PERIOD COVERAGES REQUIREMENT,TERM OR CONDITION OF LIMITS THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE 7HSTANDING ANY PphlL�lpm P $ 11000,000 OR MAY PERTAIN, MAY HAVE BEEN REDUCED BY PAID CLAIMS. THE INSURANCE AFFORDED BY THE POLICI INDICATED. N07\M0E ISSUED M°MrLDlofrrYY 100,000 SUCH POLICIES.LIMITS SHOWN EACH OCCURRENCE $ CERTIFICATE M y B iTIONSOF p e POLICY NUMBER 7O a urren°e 5,000 EXCLUSIONS AND PREMISES n rson) S ILSR TYPE OF INSURANCE 3/13/2016 MED EXP AnY°e $ 1 000,000 X COMMERCIAL GENERAL LIABILITY 3/13/2015 PERSOtNAI-�ADV INJURY 2,000,000 OCCUR RD-p-010070/000 AGGREGATE $ A IS DE a GENERAL 2,000,000 PRODUCTS-COMPfOP AGG $ BINED SING ELI IT $ 1,000,000 OEtrL AGGREGATE LIMIT APPLIES PER: a oaWenl ❑ or son) $ X POI-ICY❑JECOT� LOC BODILY INJURY(P P° OTHER: 5/23/2016 BODILY INJURY('°r H0.1denl) 3 5/23/2015 PROPERTY DAMAGE AUTOMOBILE LIABILITY reccid 0ANY s 100,000 AUTO 6228807 COM O1 B OWNED X SCHEDULED Underinsured notorlst $ AUTOS ED URRENCE AUTOS NON-OWN EACH OCC 3 X HIRED AUTOS X AUTOS AGGREGATE $ ER UMBRELLA LU\B OCCUR S TOTE 100 000 CLAIMS.MADE S EXCESS LIAR E.L.EACH ACCIDENT 100 000 DED RETENTION EA EMPLOYE s 500 000 WORKERS COMPENSATION YIN 10/8/2015 10/8/2016 E.l.-S ASE" LILY IT 5 CUTIVE a NIA 99911458-2-15 E.L.DISEASE-PO AND EMPLOYERSPPRLIABILITYE 6BUB- ANY PR�EIET EEXCLUDED? OFFII t, In NHI C (Mandatory under It es,descnba OF OPERATIONS bebw DESCRIPTION TIONS 1 LOCA710N3 f VEHICLES IACORD t01,Adddional Remarks Schedule,may be attached I(more apace Is required) DEScFU n u of OPERA CANCELIATION DELIVERED IN E EXPIRATION DATE THEREOF, NOTICE WILL BE FICATE HOLDER SHOULD ANY OF THE ABOVE DCV PR VIS ONS'CIES BE CANCELLED BEFORE CERT► TH (978)623-8320 ACCORDANCEW Town of NorITH7HE th Andover AUTHORIZED REPRESENTATNE M Gilbert, CIC/BAR CORPORATION.All right reserved. ©1988_2014 ACORD The ACORD name and logo are registered marks of ACORD ACORD 25(2014101) INS025 r2ma0n Massachusetts -Department of Public Safety Board of Building Regulations and Standards Su„e�ViSOF License: CS-076691 ROBERT A KEEN 12 E WATER STf° _ North Andover AA 0 Expiration 08/16/2017 commissioner �lt.e (�oNr/lzn7Lcoe<F�f�a��U(�G[td9lcc�clJG'�� ice of Consumer Affairs&Business Regulation r E IMPROVEMENT CONTRACTOR egistrat,on: 108383 Type: :> Expiratwn:. g/18/2016 Supplement Car KEEN CONSTRUCTION-CO.•, ROBERT KEEN 1175 TURNPIKE ST NO.ANDOVER, MA 01845 Undersecretary