Loading...
HomeMy WebLinkAboutBuilding Permit # 6/1/2016 1 ®� 0®RrP BUILDING PERMIT �T�ED ,g�+ TOWN OF NORTH ANDOVER �� � :' . pb o ® APPLICATION FOR PLAN EXAMINATION Permit No##• Date Received rEv caaus�R�S Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION e ct V`) Print PROPERTY OWNER Ck J0 Print 100 Year Structure yes no MAP (` PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 ❑rSepfic ❑Well „< P"' Pal _0 61111111111111111 ❑Wetlands ❑ Watershed Distract ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFO ED: Ge ( V) e� � (� Identification- Please Type or Print Clearly OWNER: Name: Bc\c." --b � 17� Phone: Address: G5e J 5t c� Contractor Name:k6by (wa-5dPhone: ci - —.5-2- Email: -2-Email: den 1e5 .. ►� ec cfj2 01 Address: PO f3ox 9, Supervisor's Construction License: ( ) Exp. Date: (e) Home Improvement License: / 'Z M3 Exp. Date: / Fzt 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 FEE: $ _i� 7 06 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not havelaccess to thei ar ty. unci __ 8ignat6re of Anent/Owner riff-I AM FFORTH i own ote I Andover "INt\_ 0 to ® T _ _ ®"L! ver, ass, / f P COCKICKQWICK AOf?ATE0 p.P�\��� U BOARD OF HEALTH T LD Food/Kitchen ER Septic System THIS CERTIFIES THAT .....CCZ.' �or•i/sic BUILDING INSPECTOR .................................................................. . ............................... Foundation has.permission to erect .......................... buildings on ..�..�r...:�'...�,���..�.;�!% / J Rough to be occupied as .............. �/-?/G,G. ....:�.�E.. ..f P.�:::...C .! .T... ............ •�•• •vim y• d ! 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 PERMITIN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service 000 ti- ........r:..... . ............................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy BuRough Islay in a Conspicuous Place on the Premises _ Do Not Remove Final No Lathing Or Dry Wall To Be One FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. r:,Ga�r�tnuctior�Cg; REMC�UtEI_INC: SPEG1!_�LtSTS 978-69"1-520-7 Keen Cons tructionCo.corn O'Donnell, Brian& Carol 486 Osgood St. N. Andover, MA 01845 Contract#5582;Appendix A May 5, 2016 Replace front palladium window and door: • Remove and dispose of existing 65"x 75" circle top fixed window and front door unit • Install customer supplied Pella Architect series window • Install customer Pella fiberglass smooth door unit with sidelites • Re-install existing storm door Replace front triple double-hung and single window: • Remove and dispose of existing window unit • Install customer supplied Pella Architect series window Replace rear quad double-hung unit&two single double-hung units: • Remove and dispose of existing windows • Install Pella quad double-hung unit two single double hung units Replace double double-hung in kitchen: • Remove and dispose of existing window unit • Install customer supplied Pella window unit Replace master bathroom window: • Remove and dispose of existing window • Install customer supplied Pella window On all windows and doors: • Supply& install new clear casing to match existing • Spray foam around windows • Patch siding as needed • Re-create panelized trim between palladium window and front door Total Price:$11,362 (eleven thousand three hundred sixty-two dollars) We are not responsible to repair lawn in the event it is damaged from equipment.All work will try to be scheduled when the ground is firm, but the equipment may still make depressions on the front yard. 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 GOns o6on Co, ehnnooE�_�nc sPrcuar�s'rs 9�s-69-�—s2o-e Keenconstructionco_com Payment Schedule: $1000 due upon signing contract $5000 due when the front door and window above is done $2500 due when the quad window unit is installed $2862 due when the remainder of the windows are installed Price does not include cost of windows,door, permits, painting or repairs to any unusual, unsafe or non- code compliant existing conditions not addressed in this quote. )""jf != customer Robert Keen Z4 A-6 ZIb 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 55 10 KEEN CONSTRUCTION O. ° 476-%RNME-6TRE€-T �+ �jc;X��J . 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 ,CC) I / I I��0 n�Q with the Commonwealth of Massachusetts. Inquiries To: ���SSS l / about registration and status should be made to the Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617.973• Y / 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. 5MA. H.I.C. 108383 46—3783401 C/S=Customer Supplied S+I=Supply+Install EP/See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: 2C ✓( L 'c �e-L _PNC_ X � Construction related permits: '. WORK SCHEDULE Contra or�Ifrl t yegin the work or order the materials before the third day following the signing of this Agreement,unless specified here in nr o tractor will begin the work on or about �� (dale). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowle ges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall noftf WARRANTY a con dere as violations of this Agreement. The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of C 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,ll discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remis edy,rep ir,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 to furnish material and labor-comp ete in accordance with above specifications,for the sum of _ �� V1 I J t l�J�v1 L 111.Int' (�%K fv�'C� ! C. % 1 �CJ�7 --- dollars($ �:2 ,r DCS Payment to be made as lot ows: )• —% ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant ($ upon comrplgtry of-✓ 1175 TURNPIKE ST. T' Slreel Address % ($ �d completion of N. ANDOVER, MA 01845 City/Stale ($ ) shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Ph6Aut) rized Fax ffi Notice: No agreement for home improvement contracting work shall require a i 'o down payment(advance deposit)of more than one-third of the total contract price ea a i 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 Sig' fur equipment,Wt1lCheyer amount IS greater. Note:This proposal may be withdrawn by us it not.—pled 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.capcel this transaction at any time prior to midnight of the third business day after the date of this transa tion.Cancellation must be done in writing. ISD NOT, IGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature - �v/�//� Dale Signature Dale IMPORTANT INFORMATION ON BACK The Commonwealth of Massachusetts F Department of Industrial Accidents h 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia SV•V Workers' Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lesribly Name(Business/Organization/Individual): Oe yl Address:T�1 G X 93 City/State/Zip: f'�.� lqv-) R G) one 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. ❑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 I❑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.insurance? 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. -�•- Insurance Company Name: I (�� 15 I S Policy#or Self-ins.Lic.#: jT() IJ 9 9 —Z Expiration Date: 457Z1 5G Job Site Address: !TL c j'' City/State/Zip: i V t ✓P�� Attach a copy of the workers' comp sation 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 o his statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certif c de the andpenalties ofperjury that the information provided above is tf je ar2d correct. .� Date• Si nature: 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) `-� 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 C E�CT Barbara McDonough Gilbert Insurance.Agency, Inc. PHONE . (781)942-2225 A o:(781)992-2226 137 Main Street ADDREs:bmcdonough@gilbertinsuranoe.com INSURERS AFFORDING COVERAGE MAIC S Reading MA 01867-3922 INSURER Norfolk & Dedham Insurance 23965 INSURED INSURERB:Safety Insurance Company 39454 Keen Construction Company INSURER C'Travelers Ina. Co. 0031 483 Chickering Road INSURER D: INSURER E: North Andover MA 01845 INSURER F: 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 FORTHE 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 POLICY EFF POLICY EXP T POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS47ADE ❑X OCCUR -PDA ITERTEu— E ES a occu enc. 3 100,000 ND-P-010078/000 3/13/2015 3/13/2016 'MED EXP(An onePerson) 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,0001000 X POLICY O JEC TT Q LOC PRODUCTS-C6MPIOP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY e B e 5 0 1 S 1,000,000 BANY AUTO BODILY INJURY(Perp.rson) $ AOWNED SCHEDULED AU 6228807 COM 01 5/23/2015 5/23/2016 BODILY INJURY AUTOS AUTOS (Pcc ereklen) S Ix HIRED AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE $ Underinsured molodd $ 100,000 UMBRELLALU11 OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMSMADE AGGREGATE S DED RETENTION S WORKERS COMPENSATION RTUTE H. AND EMPLOYERS'LIABIUTY YIN ETA OERT ANY PROPRIETOR/PPRTNERIEXECUTIVE E.L.EACH ACCIDENT S 100,000 C OFFICER/MEMSER EXCLUOED? NIA (Mandatory In NH) 6HUB-9991M58-2-15 10/8/2015 10/0/2016 E.L.DISEASE-EA EMPLOYE S 100 000 0 .s,d—ibe under DESCRIPTION OF OPERATIONS b.1— E.L.DISEASE-POLICY LIMIT 500 000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,AddRlonal Remarks Schedule,may be attached If mors 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(2014101) The ACORD name and logo are registered marks of ACORD INS025noi oo Massachusetts -Department of Public Safety Board of Building Regulations and Standards Constr uction 'Uriel Yl�l/l License: CS-076691 ROBERT A KEEPI- 12EWATER ST� IMF North Andover NF1 0 9,•/«1 ^� Expiration Commissioner 08/16/2017 G ��¢�orrtwzo»rrle��lf�a��a�aac�ituteL�i ice of Consumer Affairs&Business Regulation E IMPROVEMENT CONTRACTOR 9 ;egistration:Er,16g 83=====: Type: Expiration Supplement Car KEEN CONSTRUCTIQN }O , i ROBERT KEEN _ f 1175 TURNPIKE ST NO.ANDOVER,MA 01845 Undersecretary