HomeMy WebLinkAboutBuilding Permit # 11/23/2016 BUILDING PERMIT a "O°T
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received
�Ssact+us��{y
Date Issued: 1
IMPORTANT: Applicant must complete all items on this page
LOCATION ��� s t
PROPERTY OWNER e-a`'t ' 'n t
rr �� C f� Print 100 Year Structure yes o
!
MAP P Li PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Nan- Residential
❑ New Building ❑ One family
❑Addition ❑ Two or more family ❑ Industrial
Alteration No, of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
e del � no plies 1 � Z irer�
m
IP ION OF WORK TO O BE PERFORMED:
Identification.- Pte,�se ype or Print Clearly
OWNER: Name: =71e_a a� r � C� P Phone:
Address:
Contractor arae: KPeO C605FQC ('c" Phone: 0-27— ( 21
Email: e- e-OVLA
Address: PC 5 A ivt f
Supervisor's Construction License: C,"" 61 0:�-,C)i Exp. Date: <ElI& { f 7
Home Improvement License: J ® T Exp. Date: �1`7 A
ARCH ITECTIENGINEER 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: $ � CD FEE: $
Check No.: � q i Receipt No.: �-
NOTE: Persons contracting with unregistered contractors do not have access to th u r 'ty nd
AIRE-
nab 26
f,
r .,
- � RT1.p
own of � s ndover
No. 545
h ver Mass
Q cocHcNewcM 4-
�,4 pdaRTER P'PP�,`�(5
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT Djj Septic System
THIS CERTIFIES THAT ...... �i►„N,,,i �... d, V�,!! r . yk ,, CMr►S`.11..... ► BUILDING INSPECTOR
has permission to erect .... ....... buildings on . �.......... kL.. +............. Foundation
p ... ..mvA*,A. � . ............ Rough
to be occupied aS ,..... .. ......................................... 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
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS C®NSTRU 10 STA Rough
Service
.. ................. .......... BUI ....LDING INSPECTOR........................ Final
GAS INSPECTOR
Occupagey Permit lie oared to Qccupv Pualdan Rough
Display in a Conspicuous Place on the Premises — Do 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.
911"
x-21" 90
I
233x'
24" 12", 44=,"
80x" 107,"
1�, !
36" 30" 20" 431x'
I [[
7
_ W1 L W3012 W203012R W3630 [W1> PL M630
L 30-RANGE.
` B363415
2 3424
ro
E � vc� ; BEP
8G�06;� CABICO UNIQUE FRAMELESS
LJ _ DOOR 50011/K
Ln MAPLE WITH WHITEWASH FINISH
CEILING HEIGHT 90"
HANGING HEIGHT 84"
N N ap m � N r m _Q EPO1SP2484/51a --- CLOSED SOFFlT
N N ,L to r - 7w. DM/SHA01 S6/5 FOR FASCIA
'I ail DM/CRW21Ss FOR CROWN
DMITOB01 SWK FOR TOEKICK
s� —7:
�� w' +r4
E N ° 0) m 1-SINK CABINET"TH TILT DOWN FRONT
EP01SP24841578 �Gl3O6 E
i
F273412 SF01S3X30 2-WOROWAVE ABOVE RANGE
8
? V
r E � 6j-
S = i
01 S3X3O N -P 1 3-BASE CABINET WITH TOP DRAWER
] I P263 a - N AND DOUBLE TRASH BELOW
2r' ' ! m
4-BASE CUBBY DRAWER CABINET
j „_"ES
127, l 4
53- 5-REFRIGERATOR SPACE LEFT 33 X 72
a
- 6-12"DEEP CABINET WITH FULL
HEIGHT DOORS AND SHELF INSIDE
7-WALT.CABINETS PREPPED FOR GLASS
WITH MATCHING INTERIOR
CASICO DOES NOT PROVIDE GLASS
All dimensions_size designations7f 1 This is an original design and must Designed: 9/7/2016 j
given are subject to verification on TECHNOLOGIES not be released or copied unless Printed: 11/16/2016
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed. j
i
MANTNE CABICO FINAL FOR APPROVAL IAII Drawing#: 1 Na Scale.
�� ;�h 6 � ewnon:
, 0;
HIiM[?171z I.t♦r[: S1'�CJIJ11_t ti'1'S
KeenConstr"ctionCo.com
Jeanine McEvoy
20 Hemlock St.
N. Andover, MA 01845
Contract#6041;Appendix A October 30, 2016
Remodel kitchen:
• Remove and dispose of existing cabinets,counters and wallboard in kitchen
• Update electrical to code ($4000 parts and labor allowance)
• Disconnect plumbing fixtures, update drains,vents and feeds as needed, and connect new
fixtures. Reconfigure heat and add one toe-kick heater($3000 parts and labor allowance)
• Frame wall between kitchen and dining room to create approx. 69" opening, install one )ally
column in the basement
• Supply& install new, larger Andersen 400 series casement window over kitchen sink. Size TBD,
but approx.36"x 39"
• Insulate exterior wall to code
• Supply& install blueboard and skimcoat plaster to smooth finish
• Supply& install trim on window, doorway and base to match existing
• Supply& install 3 5/8" crown in dining room (extra $850 to install cabinet crown and living
room
• Paint walls,trim and ceiling in kitchen and dining room (areas associated with project)
• Install customer supplied cabinets and related trim
• Install customer supplied appliances
• Supply& install vinyl sheet flooring in kitchen ($30 sq yd allowance)
Upstairs repair:
• Remove wallboard in water damaged area upstirs, investigate for mold
• Repair wallboard
• Paint affected areas
First floor powder room:
• Remove and dispose of existing window and flooring
• Frame exterior wall to accept new window
• Supply& install Andersen double casement to match kitchen
• Patch wails and trim
• Install customer supplied tile floor
• Paint affected areas
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
=_ Cons'truc6 CO,
KEiMC]INiLIN[: tiPECJ/ALIS"1"S
K@@I1COIlSYE'lEC(Itl llCtl.Ctlm
Total Price: $31,600 (thirty-one thousand six hundred dollars)
Price does not include cost of permits,flooring, cabinets, counters,appliances,fixtures or repairs to any
unusual, unsafe or non-code compliant existing conditions not addressed in this contract.
Payment Schedule: $1000 due upon signing contract
$4500 due the first day of work(plus permit fee)
$4000 due when windows are installed
$4500 due when rough electrical and plumbing is complete
$4500 due when plaster is complete
$4500 due when cabinets are installed
$4500 due when paint is complete (except touch ups)
$4100 due at completion of contracted work
Customer
Robert A Keen
Date Date
PO Box 935 Page 2 of 2 P: 978-691-5201
M. Andover, MA 01845 F: 978-682-3231
CSL#076691 Sales@KeenConstructionCo.com HIC#108383
604'1
KEEN CONSTRUCTION CO. PROPOSAL
PO BOX 935
!NORTH ANDOVER, MA 01845
Tel: (978) 691-5201' All home improvement contractors and subcontractors
engaged in home improvement contracting, unless
Fax: (978) 682-3231 specifically exempt from registration by Provisions of
C Chapter 142A of the general laws, must be registered
Submitted to: ��,ti ' �.Q_ C3 with the Commonwealth of Massachusetts. Inquiries
`t,} �t C �\ about registration and status should be made to the
Director, Home Improvement Contract Registration,
I f `_
TI
C� 10 Park Plaza, Room 5170, Boston, MA 02116 697.973-8787
1 1 f 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 L
l
REGISTRATION NO. EIN NO.
MA.H.I.C. 108383 46—3783401
a CIS=Customer Supplied S+I Supply+ Install [ ,;See Attached Appendix A
We hereby submit specifications and estimates for work to be performed and material to he use :
The contractor and the homeowner hereby mutually agree that in the event the contractor has a dispute concerning this contract,the contractor
may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Ex�tive O Vice of Consumer Affairs and
Business Regulation and the consumer shall be required to submit to such arbitration as provided7//�--7
'General Laws,chapter 142A,
omeowner's signature �! - Contractor's Signature ` --
NOTICE:The Signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution Initiated by the contractor.The homeowner
may initiate alternative dispute resolution even where this section is not separately signed by the parties.
,tet Construct ion Related Permits:
roc (,k
WORK SCHEDULE
Contractor w1€I not bei t w r or order the matefials before the third day foiiowmg the signing of this Agreement,unless specified here in�'rilSt�rlyq C t 55 or wil€begin
the work on or about ate},Barring delay caused by circumstances beyond Contractor's control,the work wilt be completed by {yfate},The -
Owner hereby acknowle gas an agrees that the schedu€ing dates are approximate and that such delays that are not avoidable by the Contracto shag not be considered as
violations of this Agreement.
WARRANTY
The Contractor warrants that the work furnished hereunder shall be free from defects in material;and workmanship for a period of�L "r following
completion and shall comply with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage ca sed by the Contractor,his sub-
contractors,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,correU,replace,or cause to be remedied,repaired,or replaced,such damage or such defect In materials or workmanship.The foregoing warranties shat€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:
10' J. X
Payment to be madg as follows:
($ }upon signing Contract; t ROBERT A. KEEN
I I Name of Contractor 1 Designated Registrant
% ($ p�t brisdleLi if i PO BOX 935
' �.
t Street Address
1
)1. .on completion of N. ANDOVER, MA 0184!5
/ (# )up
/ IC City/State
shall be made forthwith upon (978) 691-5201 (978)682-3231
completion of work under this contract. Phople j , Fax
Notice:No agreement for home'improvement contracting work shall require a 9
>down payment(advance deposit)of more than one-third of the total contract Name of sates n
price of the total amount of all deposits or payments which the contractor must
make, in advance,to order andlor otherwise obtain delivery of special order Autho rfzed39natur
materials and equipment,yy ,j.+F o rrrggpj is prgp.er., Note:This proposal may be withdrawn by us if not accepted within�,...days.
Acceptance of Proposal -I have read both sides of this document and ali 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 outline 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)GN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
signature ^'.-: <�--��..r�-� (`� -"�^� Date �/"/y.,-,�? /L. Signature nate
61 IMPORTANT INFORMATION ON BACK O�
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
wwfv.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant InformationPlea
se Print Legibly
,,,, _,•,.., ,,.
Name (Business/Organization/Individual):
en Y-UC (cV)
Address: �D
City/State/Zip: t� 6fZone #: 9-2a-. (p 9l - 5 ZQ l
Are you an employer? Check the appropriate box: Type of project(required):
1. I am a employer with „„ 7� 4. ❑ I am a general contractor and I
* have hired the sub-contractors 6. ❑ New construction
employees(full and/or part-tune).
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. VkRornodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.t 9• ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGI
12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information.
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.
I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information. {
Insurance Company Name: V`e, 1� C�
f;
Policy#or Self-ins. I,ic. #: � � M Expiration Date: G
Job Site Address: 2,0 Ole City/State/Zip: g, Rfi
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification,
I do hereby certify u er he p i s angWenallies of perjury that the information provided above is true and correct.
SigLiature: �j ( J Date:
Phone#: /�}7 U r G, 91
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#:
' 3 DATE(MMIDDIYYYY)
ACC)R fl CERTIFICATE OF LIABILITY INSURANCE
1a/17Iza16
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(ies) 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 CNAMT0 CT Barbara McDonough
GILBERT INSURANCE AGENCY INC. PHONE . (781)942-2225 ac No:
MAIL
ADDRESS: bmedonough@gilbertinsuranGe.com
137 MAIN ST. INSURERS AFFORDING COVERAGE NAIC#
READING MA 01867 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666
INSURED INSURER B
KEEN CONSTRUCTION CO INSURER C:
INSURER D.,
PO BOX 935 INSURER E:
NORTH ANDOVER MA 01845 INSURER F:
COVERAGES CERTIFICATE NUMBER: 94268 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.
14�R ADDL SUER POLICY EFF POLICY EXP
TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDDIYYYY MMIDDIYYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE OCCUR PREMISES Ee occurrence $
MED EXP Any one person) $
NIA PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $
POLICY PROELOC PRODUCTS-COMPIOPAGG $
JCT
OTHER: $
AUTOMOBILE LIABILITY GOMBINEDSINGLE LIMIT $
En accident
ANY AUTO BODILY INJURY(Per poison) $
ALL OWNED SCHEDULED
AUTOS AUTOS NIA BODILY INJURY{Per axidenl} $
HIRED AUTOS NON-OWNED PROPERTYDAMAGE $
AUTOS Per accidanl
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LU1BC€AIMS-MADE NIA AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION X STATUTE ER
AND EMPLOYERS'LIABILITY Y!N
ANYPROPR€ETOR/PARTNERIEXECUTfVE E.L.EACH ACCIDENT $ 100,000
A OFFICERIMEMBEREXCLUDED? NIA NIA NIA 6HUB9991M58216 10/08/2016 10/08/2017
(Mandatory in NH) E.L.DISEASE-EAEMPLOYEE $ 100,000
It yes,describe under
DESCRIPTIONOFOPERATIONS below E.L.DISEASE-POLI CYLfMIT $ 500,000
NIA
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the
issue date of this certificate of insurance), The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at www.mass.gov/Iwd/workers-compensationlinvestigations/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN
Town Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS.
1600 Osgood St
AUTHORIZED REPRESENTATIVE
North Andover MA 01845 rte""X 4�y,
Daniel M. CPCU,Vice President—Residual Market—WCRIBMA
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
a",,,"]Titl'i3CtifMi,ulei viCoi -
License: CS-076691
:,r•:rr.�
� UFn
ROBERT A I EEI! ��
��.
12 E WATER ST
North Andover Na0
. r
wis Expiration
Commissioner 08/16/2047
�� cT,/e tPa�r���zarrusect�a��cra:lae�iuvetCa^ ,
Office of Consumer Affairs&Business Regulation
HOMEIMPROVEMENT CONTRACTOR
gip$: Supplement Card
E' '-Midi tration Expiration
W 0 3F 3 06/17/2018
Keen Constru
Robert Keen
1175 TurnpikeNo.Andover,
Andover,
:.t Undersecretary