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HomeMy WebLinkAboutBuilding Permit # 6/10/2016 UILDING PERMIT ®f %aoRrm� TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION Permit N®#: �f® Date Received s�reaus���y Date Issued: 1 III ORTANT: Applicant must complete all items on this page LOCATION , . �,<� ,� 5<' ��� Lb �_ - Print PROPERTY OWNER c r� e + Print 100 Year Structure yeso MAP PARCEL: ZONING DISTRICT: Historic District yesno Machine Shop Village yes 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 ��� ❑ Floodplain ❑Wetlands ❑ Watershed District ❑,Ul/ater"/Sewer } DESCRIPTION OF WORK TO BE PERFORMED: k.�-\' i._ �}C �' °,..•y{6 fil, i 1 VO {�; ,F a Identificatign- Please Type or Print Clearly OWNER: Name: Phone: Address: f1`?1:2) jf .'5 o;-� e Contractor Name: ' ' _, i Phone. Email ', . 5 t I 'AJ Address: �, �._, wi. � Supervisor's Construction License: .,T,�; Exp. Dater Home Improvement License: �G� = � 'a 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: $��t�-, �) `" FEE: $ '+5 Check No.: 1 / Receipt No.: �U I NOTE: Persons contracting with unregistered contractors do not havelaccess to the ar I ty d %A®RTH Town of0Andover , � _ L PW ver, Mass, LAIJG LAKE COC MICMI WICK "I. RYE® BOARD OF HEALTH Food/Kitchen PER T T LD Septic System THIS CERTIFIES THAT ........ .. ............... .. ...... ... ..... BUILDING INSPECTOR ........................ ............ ............... . has permission to erect .. buildings on Foundation ........................ .... . ... ....... . ................................................ ® Rough to be occupied as ... .... . .... . ............. Chimney provided that the person accepting this permit shall in eve 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS-CONST TIO T Rough Service ................ Final BUILDIN N PELTO. R GAS INSPECTOR Occupancy Permit Required to Occupy Bu Rough Display in a Conspicuous Place on thePremises — D® Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. µConjilme on Co, ttr_nnous:t_ nc sPrc:tnusrs 978-697-520`i Keen ConstructionCo.com Calzetta, Paul 559 Johnson St. N.Andover, MA 01845 978-686-3520 Contract#5780;Appendix A May 15, 2016 Kitchen work: • Remove existing range hood, trim,counter back splash and cabinet valance • Supply& install%" blueboard and skimcoat plaster to smooth finish on all walls in kitchen • Re-install range hood • Remove and replace baseboard heat enclosures • Supply& install trim on crown, doors,windows and base in kitchen • Supply& install new cabinet hardware Front window trim: • Remove and dispose of existing window trim of living room front window • Supply&install new trim to match existing Total Price:$3610 (three thousand six hundred ten dollars) Price does not include cost of permits, painting or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this contract. Payment Schedule:$1000 due upon signing contract $1500 due when plaster is complete $1110 due at completion of work Cus Robert Keen � 13 � � _ 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 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 ToSubmitted IJ J ' a.��_. C-, with the Commonwealth of Massachusetts. Inquiries : f about registration and status should be made to the I C L~ c _ Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617.973- ` u 8787 Owners who secure their own construction t I',0 C \!-t( �� A j{ I related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE_ ,.7 F DATE REGISTRATION NO. EIN NO. y_L`�,`& __ J'D2-Ci `j/��j ' 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: > Construction related permits: _................._...__...___._--....___.__........___.__.......__....__...___.____..._..._._....._ WORK SCHEDU E / Contraclpr VA not gin the work or order the materials before the third day following the signing of this Agreement,unless specified he Vn prtgl qn}ra_�ter will begin the work on or about `1(2 (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by / K (date).The Owner hereby ackno 1e ges an agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall 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 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 to furnish material and labor-complete in accordance with above specifications,for the sum of Payment to be made as follows: -dollars($ ), ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant '.. % ($ ) upon completion of 1175 TURNPIKE ST. `` Street Address %. ($ upon, N. ANDOVER, MA 0184.5 City/Slate { ` II be Made forthwith upon (978 ) 691-5201 (978 682-3231 } $�) bci pletion of work under this contract. Phone Fax Notice: No agreement for home improvement contracting work shall require a JL t' >clown payment(advance deposit)of more than one-third of the total contract price Namen!Salesmg or the total amount of all deposits or payments which the contractor must make,in advance,to order and/or otherwise obtain delivery of special order materials and Awn :ea 4ignalul.1 equipment,whichever amount is greater. Note:This proposal may be withdrawn by us it not accepted within days. Acceptance Of Proposal-I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.Cancellation must be done in writing. DO NOT,SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. ) signature Signature nate _J IMPORTANT INFORMATION ON BACK ► i -\ The Commonwealth of Massachusetts Department of Industrial Accidents } 1 Congress Street,Suite 100 Boston,MA 02119-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): �� CCS f­o Address: 5 City/State/Zip in '� r 'r f G�$P one#: �3— Lir 9"+ —�2,C� I Are you an employer?Check the appropriate box: Type of project(required): 1.R]I am a employer with L- employees(full and/or part-time).* 7. ❑New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in 8. E]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 hiring contractors to conduct all work on my property. I will airs or additions re ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electricalp proprietors with no employees. 12.[J 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.FJ 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. Yam an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. i Insurance Company Name: (���V� �5 15 — Policy#or Self-ins.Lie.#:6 14 L) i. /9! i M 5g'—2� Expiration Date: c-~ �, Job Site Address: ���£j V\a\jUt'� City/State/Zip: r r � 1� � 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 in er 1 e p i s and penalties of per jury that the information provideed above is true and correct. Signature:' Phone#: t_ — '`' (i Official use only. Do not►vrite 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ,acoRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) L.� 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 CO EC : Barbara McDonough Gilbert Insurance.Agency, Inc. PHONE (781)942-2225 FAC No:(781)942-2226 137 Main Street ADDRIESS:bmcdonough@gilbertinsuranee.com INSURERS AFFORDING COVERAGE NAIC q Reading MA 01867-3922 INSURERA Norfolk & Dedham Insurance 23965 INSURED INSURER B: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 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 ADD B POLICY EFF POLICY EXP LT POLICY NUMBER MIND D LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OX OCCUR tG PREMISES(E. 100,000 occurrence $ ND-P-010078/000 3/13/2015 3/13/2016 -MED EXP(Any one erson)_ $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEHL AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY O JET F-1 LOC PRODUCTS-COMPIOP AGO S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY C e exidenlS NG E I S 1,000,000 B ANY AUTO BODILY INJURY(Per person) S ALL OWNEDX SCHEDULED 6228807 COM 01 5/23/2015 5/23/2016 BODILY INJURY AUTOS AUTOS (Per eccklanq $ X HIRED AUTOS X AUTOS PR PROPERTY DAMAGE $ Underinsured mo(odd $ 100,000 '.. UMBRELLA LIAR HCCUR EACH OCCURRENCE ; EXCESS UAB CLAIMS-MADE AGGREGATE S DED I I RETENTION ; '.. WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN TU ER ANY PROPRIETOR/PARTNERJEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICE"EMBER EXCLUDED? NIA C (Mandatory In NH) 6HUB-9991M58-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under DESCRIPTION OF OPERATIONS b.1— E.L.DISEASE-PODGY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remark.Schedule,may be attached if more space le 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 COiutPiiCiH-i Ti ourlEi viSfiT License: CS-076691 CS,r i,s ROBERT A KEEI!�� 12 E WATER ST North Andover Nh 0 ,yy`•S J � `J11ti.,` Expiration commissioner 08/16/2017 �.n,�iarna��ruueall�a��caaac�itateC�i *egIstratIon:c=.j e of`Consumer Affairs&Business Regulation E IMPROVE ENT CONTRACTOR Type: xpirati4r2 ._ ,: .._ Supplement. le -:: pP ment Car KEEN CONSTRUCTIO ROBERT KEENi ` z 1175 TURNPIKE ST NO.ANDOVER,MA 01845 Undersecretary