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Home My WebLink AboutBuilding Permit # 4/12/2016 %SORTfq BUILDING PERMIT ., TOWN OF (NORTH ANDOVER APPLICATION FOR PLAIN EXAMINA ON Permit NO: "� "" Date Received 6 41 Date Issued: IMPORTANT:Applicant must conafete all items on this page LOCATION nt PROPERTY OWNER___0rxgJi ZONING DISTRICT: Historic District yes nn� Print MAP NO �' PARCEL: "� o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family f:1 Addition ❑Two or more family n Industrial " Alteration No. of units: IJ Commercial ❑ Repair, replacement I I Assessory Bldg II Others: CJ Demolition ❑ Other _ 1.1 Septic 11 Well D Floodplain IJ Wetlands Ll Watershed District Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: fid' ' .,. '. 'w: , = .)° ..°:. Phone: �, �� gym.. V . Address: : ..� . r�cI k - meq d CONTRACTOR Name: Phone: Address: d O ( - A) , 6 Supervisors Construction License: °� , EXp. Date Home Improvement License: � Exp. Date: p ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000,00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. "fatal Project Cost: $ " A"= � t.,;I - -FEE: $ Check No.: u Receipt No.: TOTE: Persons contraciing wid unregistered contractors do not have access to the 1,#ara .fund Signature of Agent/Owner Signature of contractor--'A-,, " y�?I t%ORTdg*%, verTown oilN 0 . �. 1 ver, Mass, a 20 �A C 0 NIC Kl N" .9 OR^TED `S LJ BOARD OF HEATH Food/Kitchen Septic System THIS C BUILDING INSPECTOR IZTIFIES THAT ..7 .... ... .. . .......... ................. has permission to erect �. • •••.•.•Ut Foundation .......................... buildings on . ® � � � ,,,/� Rough Prov Occupied as .....to bo .... ; . ... ►..... . . �, terms of the application Chimney on file that the person accepting this permit shall in every respect conform to tnelnspection,Alteration and Final Copse 'rt this office, and to the provisions of the Codes and By-Laws relating to the truction 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TARTS Rough Service BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy By'ldtn Rough Display in a Conspicuous Place on the Premises — 0° 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. - Construe ion Go, REMOUEI_ING SI'ECI/_\LISTS KeenConstructionCo.com Abbott, Rebecca 50 Blueberry Hill Rd. N.Andover, MA 01845 Contract#5579;Appendix A April 8, 2016 Remodel main bath: • Remove and dispose of existing fixtures,wallboard and flooring in main bath • Frame closet in hallway • Update plumbing as needed, installing customer supplied fixtures • Update electrical to code, including installing customer supplied vanity light • Supply& install 110 cfm fan/light combination vented to outside • Relocate vacuum outlet as needed • Supply& install insulation to code • Supply& install blueboard on walls and ceiling and skimcoat plaster to smooth finish • Install customer supplied vanity • Supply& install linen closet door and trim to match existing • Supply& install melamine shelves in closet • Supply& install one Andersen wood interior replacement window with similar grid pattern • Install customer supplied tile as described in design dated 5/16/15, 6/12/15& 6/22/15, except for mirror area • Paint walls,ceiling and trim of bathroom and linen closet Total Price: $20,690 (twenty thousand six hundred ninety dollars) Price does not include cost of plumbing fixtures,vanity,tile or repairs to any unsafe, unusual or non- code compliant conditions not addressed in this contract. PO Box 935 Page 1 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 R[MC)UELINC: SPECT/\LISTS Keen Construction Co.com Payment Schedule: $1000 due upon signing contract{ ,J $4000 due the first day of work $4000 due when rough electrical and rough plumbing is complete $4000 due when plaster is complete $4000 due when tile is complete $3690 due at completion of contracted work Customer Robert A Keen 2z �`�l� Date Date PO Box 935 Page 2 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC #108383 J r 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 - (J'1 —1 J with the Commonwealth of Massachusetts. Inquiries To: /�.oJ/ / / f about registration and status should be made to the I I( Director,Home Improvement Contract Registration,10 r-I u l Park Plaza, Room 5170, Boston, MA 02116 617-973- 8 787 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, I G MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install [ See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: i�coo t L A_�I Qd�C I V I > Construction related permits: _.._................. .____...._. .._.__... ._ .._.._... .._.....__.... _. ._.__...... ._. ._.... '___..____.. _.._ ----' -----'—'-- WORK SC ED LE Contrac I I not a m the work or order the materials before the third day following the signing of this Agreement,unless specified here in f`ng. ntractor will begin the work on or about (date). Barring data caused by circumstances beyond Contractor's control,the work will be completed by (date).The Owner hereby acknowl d es an g ees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not he con i ered 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 or f f 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 Contractod 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 hereb to furnish material and labor-complete in accordance with above specifications,for the sum of -PIS"01 `2 V- J )i X [If N]C1 hPj �J f a- V �---~ dollars($ � � 0 ). Payment to be rhadp as follows: ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant ($ ) upon corr)pleAj>of 1175 TURNPIKE ST. v�(( I CCU��tt Street Address ($ mpletion of N. ANDOVER, MA 01845 _ City/State �shiIlbl madeforthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Phe Fax Notice: No agreement for home improvement contracting work shall require a —IL1G) >down payment(advance deposit)of more than one-third of the total contract price m ale a j 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 Aeo nze s+ equipment,whichever amount is greater. Note:This proposal may be 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 staled. 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 S/IIGN��THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature Data IMPORTANT INFORMATION ON BACK DO- The Commonwealth of Massachusetts Z Department of Industrial Accidents 1 Congress Street, Suite 100 Poston,MA 02114--2017 4< www.mass.gov/dia 4A y4 Workers' Compensation Insurance Affidavit:Builders/Contractors/ElectricianslPlumbers. TO BE TILED WITH THE PERNIITTING AUTHORITY. Please Print Legibly AimlicantInfoxmation Co Name(Business/Organization/Individual): '��V1 (_ C� �'�� Address: i City/State/Zi 11)V'1 �)" -Ir i f P one#:-9-23— Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with �— employees(full and/or part-time).* 7. F1 New Construction 2.Q 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 Q Building addition 4.❑I am a homeowner and will be luring contractors to conduct all work on my property. I will 11.FJ Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12,Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repair's These sub-contractors have employees and have workers'comp.insurance.t 14.Q 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. 1 am an employer that is providing wor Icer"s'compensation in for"niy employees. Below is the policy and job site inf0r"rrlat101i. Insurance Company Name: (^��y� J 2- - Expiration Date: Policy#or Self-ins.Lic #: ) City/State/Zip: � (.. .� alt ` �;��• � Job Site Address: Attach a copy of the workers' compensatio 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. j pe l abgve is r•ue acid correct. L-1 A/ It Dat Y do Iiereb y cert zle the in s andperialties ofperyzzry That the zn orraza zorz rovit e iy Si nature: Phone#: w .r C) LLOther only. Do not 1prite in this area,to be completed by city or town official. n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE IMhVDD YYYY) 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(les)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 CONTACTBarbara McDonough HAME: 4 Gilbert Insurance Agency, Inc. PHONE (781)942-2225 uc,c,,(781)942-2226 137 Main Street ADDRESs:bmedonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURER STorfolk & Dedham Insurance 23965 INSURED INSURERB:Safety Insurance Company 39454 Keen Construction Company INSURER c.'rravelers Ins. Co. 0031 483 Chickering Road INSURER D: INSURER E: North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER:CI.1552101779 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 INSURANCEADDL POLICY EFF POLICY EXP LT POLICY NUMBER MWDDM I D LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OX OCCUR PREMISES Ee occurrence $ 100,000 ND-P-010078/000 3/13/2015 3/13/2016 'MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY g 1,000,000 GENL AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECOT. LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY B NED SI G E MI $ 1,000,000 a exHenl B ANY AUTO BODILY INJURY(Porperson) $ ALL OWNED X SCHEDULED 6228607 COM 01 5/23/2015 5/23/2016 BODILY INJURY(Per accklen0 S AUTOS AUTOS X H R D AUTOS X AUTOS NON-OWNED PROPER V DAMAGE11 $ Underinsured molodd $ 100,000 UMBRELLA LIA OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADEAGGREGATE $ DED RETE N770N $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN (ER"'- ''. AMY PROPRIErORIPARTNER/EXECUTNE E.L.EACH ACCIDENT $ 100 000 C OFFICER"EMBER EXCLUDED? NIA ',,....... (Mandatory In NH) 6RUB-9991M58-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYE S 100,000 Ir yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is feclulredl 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(2014101) The ACORD name and logo are registered marks of ACORD INS025120140fl Massachusetts -Department of Public Safety Board of Building Regulations and Standards ln.,l/ll�tl lJl llllll JUS/CI Vlli'/l -fir License: CS-076691 r.r i s ROBERT A KEEN-` ' 12EWATER ST North Andover MA- 0 r -ArIV Expiration Commissioner 08/16/2017 �,, �?�/e�o-r�rr�ra�zcrleccl��a��C�/f�calac�cWe�Gi O' Expiratig,'q.ce of Consumer Affairs&Business Regulation E IMPROVEMENT CONTRACTOR Type: `=$11Mo Supplement Ca; KEEN CONSTRUCTIQNCO ROBERT KEEN 1175 TURNPIKE ST NO.ANDOVER, MA 01845 Undersecretary