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Home My WebLink AboutBuilding Permit # 6/10/2016 BUILDING PERMIT ®� ea'r�ED � �tD S. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ® ', _ Z m $ 7 o Permit No#: I V Date Received 016 zo 2PJ,& �5 + caaus``t Date Issued: l I IMP TANT: Applicant must complete all items on this page LOCATION 5 A Q Print PROPERTY OWNER SG�' I i` S Print 100 Year Structure yes MAP 7—Z PARCEL: %( ',' ZONING DISTRICT: Historic District yes 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 KRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑LSeptic ❑Well ❑ Floodplain ❑Wetlands D Watershed District ❑;Water/Sewer � �� ° P DESCRIPTION OF WORK TO DE PERFORMED: �e- I ciC e- t56 J r) r + 't5 )-,f p c ;r- Identification- Please'Type or Print Clearly OWNER: Name: Phone: Address: G Cee,, oLoyer- Contractor Name: epeo 6m*rUcq i',�0 Co Phone: 978-69/.05 % Email: lei C rv� ccs c--oiLA Address: PQ Go 0 , ckle,- 31 Supervisor's Construction License: CS-0 -7 Exp. Date: if // '7 "7 Home Improvement License. /0 3 d 3 Exp. Date: /t a ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 5 13 FEE: $ �- Check No.: 1011-b Receipt No.: o,4 NOTE: Persons contracting with unregistered contractors do not havq access to thq u n and SicinaftlrP of AaPnt%Owner; " i SORTH Town ofe ", ndover ® T `�� ver, ass, cocti�cwewocx y1. SATE® BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System 0 E THIS CERTIFIES THAT ........................ ............................... I. ....................... ...... . ....... ... .. ..... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ... .:..:.. ..................................... . .................... Rough to be occupied as ....... ...... .. .. .. .. .... ... . ......... ...... o&44...... ......... ....... ........... ...... .......... Chimney th provided that the person accepting this permit shall in every respect conform to e 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST Rough Service ..... .... ........ ........ ........ ....... Final BUILDI IN PE : OR GAS INSPECTOR ccueancy Permit Required to Occupy BuRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 5 / , F, 1 KEEN CONSTRUCTION CO. 14 -75fE�REf �-(: Lac= 935 NORTH ANDOVER; MA 01845 All home improvement contractors and subcontractors Tel: (978)691-5201 engaged in home improvement contracting, unless Fax:(978)682-3231 ;w- 'specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered Submitted j with the Commonwealth of Massachusetts. Inquiries To: f about registration and status should be made to the Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617-973- t` 8787 Owners who secure their own construction lk CN Lc h C ( � related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATEREGISTRATION NO. EIN NO. /L�� MA. H.I.C. 108383 46—3783401 > CIS=Customer Supplied S+I=Supply+Install E�T'See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: > Construction related permits: WORK SCHEDULE Contract 'll not begin the work or order the materials bbfore the third day following the signing of this Agreement,unless specified here in writing.Contractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dales are approximate and that such delays that are not avoidable by the Contractor shall not be 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 v- G 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,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 laborf-complete in accordance with above specifications,for the sum of: F 1 11 �I'-J.�C'✓i J C rls �-yN �'1 v^F'C:I I I 1 i t F Fr --'e --dollars($ Sy Payment to be made as follows: % ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant ($ ` a�75-11 ��CPX9:3`^ % 6n y Street Address ($ `) u� N. ANDOVER, MA 01845 �or1 completion of ` City/Slate shall be made forthwith upon (978)691-5201 (978)682-3231 ° ($ ) completion of work under this contract. Ph o Fax + r Notice: No agreement for home improvement contracting work shall require a �>t)E r I t _ :-) >down payment(advance deposit)of more than one-third of the total contract price Name n!Sales— 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 maierials and Aulnenzed signa5u're equipment,whichever amount is greater. Note:This proposal may be withdrawn by us it not accepted within days. Acceptance of Proposal-1 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 SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature I// ` Dale - ))16 Signature Dale IMPORTANT INFORMATION ON BACK ► Consti°act`ron Co, REMC313ELING %PECGIALISTS 497$-4597�'Jr2®_9 Keen ConstructionCo.com Scott Ellis 5 Green Hill Ave. N. Andover, MA 01845 Contract#5782; Appendix A May 24, 2016 Replace shower: • Remove and dispose of existing tub and shower walls • Supply& install Sterling shower unit,with full tub and three-piece walls • Supply&install Symmons shower valve • Patch plaster around shower • Paint walls and trim in bathroom Total Price: $5135 (five thousand one hundred thirty-five dollars) Price does not include cost of permits 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 tub is removed (plus permit fee) $1500 due when new shower is installed , $1135 due when contracted work is complete f Customer Robert Keen �. /' 9 b, /9 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 Massachusetts-Department of Public Safety Board of Building Regulations and Standards �onstiucfilon SupeiviSi�� License: CS-076691 ROBERT AKEEPj^ ��• 12 E WATER ST f� North Andover lV1[31 0 WWI Expiration Commissioner 08/16/2017 ��e�arrr�iza�raset��t�a�C/�aaaac�uaeC�i. OrExpiratiq'0 ce of Consumer Affairs&Business Regulation E IMPROVEMENT CONTRACTOR gistration:<-108 Type: ,4� p 0� Supplement Car KEEN CONSTRUCTION' ROBERT KEEN 1175 TURNPIKE ST NO.ANDOVER,MA 01845 Undersecretary Aco OR ® CERTIFICATE OF LIABILITY INSURANCE °ATE`MI�°°"""' 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 Ileu of such endorsement(s). PRODUCER C E.0 B8rbara McDonough Gilbert Insurance.Agency, Inc. PHONE (781)942-2225INC,Nc, FAX o:(781)992-2226 137 Main Street EDDDRIEs:bmcdonough@gilbertinsurance.corn INSURERS AFFORDING COVERAGE NAICB Reading MA 01867-3922 INSURER AYiorfolk 6 Dedham Insurance 23965 INSURED INSURERB:Safety Insurance Company 39454 Keen Construction Company INSURER C.TraveleKs Ina. 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 7ypE OF INSURANCEADDL POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ; 1,000,000 A CLAIMSMADE XO OCCUR P E ES aoccu ante ; 100,000 LID-P-010078/000 3/13/2015 3/13/2016 'MED EXP(Any one ; 5,000 PERSONAL S ADV INJURY ; 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY a JECT LOC PRODUCTS-COMPMP AGO ; 2,000,000 OTHER: ; AUTOMOBILE LIABILITY BeB_,d.,,,S I ; 1,000,000 ,B ANY AUTO BODILY INJURY(Per person) ; ALL OS EO X AUUTTOODULED 6228607 COM 01 5/23/2015 5/23/2016 BODILY INJURY(Peraccklen0 ; X HIRED AUTOS X ADNOS ED PROPERLY DAMAGE $ riUnderimumd motodd ; 100,000 LdUMBRELLA LIAR OCCUR EACH OCCURRENCE ; EXCESS LIAR CLAIMS-MADE AGGREGATE ; DED RETENTION ; WORKERS COMPENSATION '.. AND EMPLOYERS'LIABILITY Y/N rR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT ; 100 000 C OFFICEP/LIEMSER EXCLUDED? EIN I A (Mandatory In NH) 6HUB-99911458-2-15 10/8/2015 10/11/2016 E.L.DISEASE-EA EMPLOYEI ; 100.000 11 es,desaibe undor DESCRIPTION OF OPERATIONSbebw E.L.DISEASE-PO'MY-MIT ; 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES(ACORD 101,AddlUonal Remarks Schadute,maybe attached If mors space is requlrad) CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULDANY 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 ©1888-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS02512014011 The Commonwealth of Massachusetts Department of Industrial Accidents ,.r 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 Leaibly Name (Business/Organization/Individual): �,qev\ C_C CA cv� n 93 Address: — o• City/State/Zip: lqv) P one#: Are you an employer?Check the appropriate box: Type of project(required): 1.Rl I am a employer with--?n--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. [gRemodeling any capacity.[No workers'comp.insurance required.] 9• ❑Demolition 3.❑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.❑Electrical repairs or additions proprietors with no employees. 12.n 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 repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.Q Other 6.Q We are a corporation and its officers have exercised their right of exemption per MGL a. 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. l T-r�,�� I �5 o 5 Insurance Company Name: 1 Policy#or Self-ins.Lic.#: NIJ 9 9/ I r?, 2 Expiration Date: 5c� �� • Aoe- City/State/Zip: ,~1 Job Site Address: ��eve t 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 er rep i and penalties of peijuty that the information provided above is true and correct. Signature: Date: i 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: