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HomeMy WebLinkAboutBuilding Permit # 12/2/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 0R�TE� 9SSA CHUS��i Date Issued: I �/ ORTANT:Applicant must complete all items on this page LOCATION .. M.. .. ,..., rm# PROPERTY OWNER .,.,._, j .j Pnn# 100 Year Structure yes o MAP PARCEL ZONING,DISTRICTHrstonc District yes 5�op Village, yes Machine o 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: CI Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands ❑'Vllatershed District El Water/Sewer. DE CRIPTION OF WORK TO BE PERFORMED: ge Identification- Please T pe or Print Clearly OWNER: Name: fy�- 1 c:lc�Y� Phone: Address: 2- i �' �2 A), All 41. Contractor Name. ;� ph ne2 Address ' . ! ` Su ervisor's Construction License ::n. Exp. Date: Horne lrnpravenient License Exp Date._ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINC PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASE ON$125,00 PER S.F. Total Project Cost: $ 7 `�� FEE: $ Check No.: V - _ _ Receipt No.: I NOTE: Persons contracting with unregistered contractors do not have.access to the guar %iu d r: Signature of Agent/OWner Signature of contractor, ` ' 'T NORTH own of zAndover . O ,� 0 No. 541- ch 17 oh ver, Mass, COC MIC IiE WICK x �AO'SATED .�C2 U BOARD OF HEALTH Food/Kitchen PERMIT ' Septic System. THIS CERTIFIES THAT .ZT41.&..... � BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .. �.,............ m.�... ..........+.......... a Fla 4..�., Rough to be OCCUpled as ......,0"A .2-rr !!.. .............................................. Chimney provided that the person accepting this permit shalt 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 CONSTRUCTSTA Rough "" Service .......... .. zt.. .. ........................ Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. ee" Cansruolian:Co. KI?IMC)UIi1.INC; SI'IiCa J4LIR'1"S KeenConstiructionCo.com Joe Trickett 21 Norman Rd. N.Andover, MA 01845 Contract#6048;Appendix A October 30, 2016 New Door:$2200 • Remove and dispose of existing side door and storm door • Supply& install fiberglass 9-lite door unit(new door,jamb and casing) • Supply& install new Harvey steel storm door to match existing • Supply& install new lockset Stair work:$1375 • Remove and dispose of existing stair treads and v-groove pine on sides • Supply&install new pressure treated wood treads and pine sides to match, including building a new door within the side Patch siding as needed from bird damage: $200 Total Price:$3775 (three thousand seven hundred seventy-five 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 quote. Payment Schedule: $1000 due upon signing contract $1000 due when door is installed $1000 due when stairs are repaired $775 due at completion of contracted work Cus mer Robert A Keen 12- /z- 12- A Date Date PO Box 935 Page 1 of 1 P: 978-691-5201 N. Andover, MA 01845 I`: 978-682-3231 CSL#076691 Sales@ KeenConstructionCo.com HIC#108383 6048 KEEN CONSTRUCTION CO. PROPOSAL PO sox 935 NORTH ANDOVER, MA 01845 @�:.�97g� X91-5�fl1 All home improvement contractors and subcontractors 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 Submittedto: Tr C_k- with the Commonwealtfi. of Massachusetts. Inquiries 1f about registration and Status should be made to the F� f ,Director, Home Improvement Contract Registration, ��,'tI y" 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-6787 CSCIIJC �, !!� 'I � Owners who secure their own construction related permits or deaf with unregistered contractors will be excluded from The Guaranty Fund Provision of MGL C.142A. PHONE 1 - DATE REGISTRATION N . - MA.H.I.C. 10.8383 EIN NO.49—3783401 > CIS=Customer Supplied S+I=Supply+ Install. ] See Attached Appendix A We hereby submit specifications and estimates for work to be per1prmed end materials to be used: 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 Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in assa setts neral Laws,chapter 142A. Homeowner'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. - Construction Related Permits: - - WORK SCHEDULE Contractor will not begin the work or order the materials before the third day iollowing the sTgning 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 dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY i The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period 0f___ �'"r�`t "—following completion and shall comply with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caus4d by the Contractor,his sub- contractors,employees or agents Is discovered within one year after completion of any jab,-intluding 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 la or-complete in accordance with above specifications,for the sum of i"t Li x1 j .t.✓t +._C-IV-1?,1 (U 1-1C44-1 1 C.� 1_�;lL?.!Lt f 1IL` T dollars'(b Payment to be made as follows: % (# }upon signmgContract; ROBERT A, KEEN Name of Contractor!Designated Registrant l a/o (E �2 r}',t�fi1poncQ r p}jtian of PO BOX 935 r Street Address - it N. ANDOVER, MA 01845 ($ }upon completion of City/State - J % (S shall be made forthwith upon (978) 691-5201 (97$)6$2-3231 Completion of work under this contract. Phone,/) 1 fax Notice;No agreement for.home improvement contracting work shall require a >downa ment(advance deposit)of more than one-third of the total contract Name of Sal m P Y p price 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 Authorized signature materials and equipment,whichever amount Is car r. Nate:This proposal may be withdrawn by us if 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 s[gning,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. DONOTSIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. STgnature ? ;..r., •i,r ..fr Date Signature Date f IMPORTANT INFORMATION ON BACK ► The Commonwealth of Massachusetts Department of Industrial Accidents . ._ Office of Investigations 600 Washington Street ` Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApplicantInformation Please Print Le ibl Name (Business/Organization/Individual): 60 roL J (C Y) C 0 , _ Address: ® B6 Y, City/State/Zip: r ` t� �)K one Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with_2-- 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' insurance. 9• ❑ Building addition [No workers comp.comp, insurance p• 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E:] 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#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 showhig 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 for my employees. Below is the policy and job site 0 information. e Insurance Company Name: —�-+ �e J � S 0 Policy# or Self-ins. Lic. #: {> (� 1 1 "1 t�j ,2- � Expiration Date: (0 Job Site Address: 2 we e cfy c�� �� � City/State/Zip: /k dL?t/ef' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 1 5 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,l er he i s and enalties ofperjury that the information provided above is true and correct. Sig nature: Date: Phone Official use only. Do not 3vrite in this area, to be completed by city or tows: 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#: DATE(MMIODIYYYY) ACo CERTIFICATE OF LIABILITY INSURANCE 41.� 1 10117/2016 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) mast he 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 NAME: Barbara McDonough _ GILBERT INSURANCE AGENCY INC. PHONE xtS: (781)942-2225 nIc ND: a DD AlEss:^bmodonough@gilbertinsurance.Com 137 MAIN ST, INSURERS AFFORDING COVERAGE NAIL# READING MA 01887 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: KEEN CONSTRUCTION CO INSURERC: _ 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. ILTR TYPE OF INSURANCE APDL sUBR POLICY NUMBER POLICY EFF MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE D OCCUR PREMISES Ea Dcourre ce $ MED EXP(Anyone person) $ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO LOC JECT PRODUCTS-COMP/OP AGO $ OTHER: I $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ Ea accident ANY AUTO BODILY INJURY(Per persou) $ ALL OWNED SCHEDULED AUTOS AUTOS NIA BODILY INJURY(Per aWdent) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE Per acc�leat $ AUTOS d $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X PERTUTE ER AND EMPLOYERS'LIABILITY A OFFFI ERIMEM ER EXCLUDED?ESTIVE YIN NIA NIA NIA 6HUB9991 M58216 10/0812016 10/08/2017 E.L.EACH ACCIDENT $ 10p,000 (Mandatory In NH) E.L,DISEASE-EA EMPLOYEE $ 100,000 (fps describe ander — OESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It 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/lwd/workers-compensation/investigations/, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Norah Andover ACCORDANCE WITH THE POLICY PROVISIONS, 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M.Crq y, CPCU,VicePresident—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Publiq,,Safety Board of-Building Regulations and Standards _ , Cfl risti'i7 Eiifiii r,�Lillei'Y'i.`iii License: CS-076691 �,1 T 1 S "� � N ROBERT A KEEL,= 12 E WATER ST � F r North Andover MA 0 r .y J.+�.•w� .�r� "� Expiration Commissioner 08116/2647 ....................... ... .. �, �e�pomvr�aarzusetr.�fi�m�U�ilurc�utaef.�a office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR ;y tApp: Supplement Card til Q, 3 08/17/2018 Keen Gonstru Robert Keen 1175 Turnpike .t �;;: �; ,Q �C No.Andover, '' Undersecretary