Loading...
HomeMy WebLinkAboutBuilding Permit # 12/6/2016 - t►pRT►-t BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '- P Permit No#: Date Received SSS 4C Fil]`+���y Date Issued: IMPORTANT:Applicant must complete all items on this page PR ... Pr[ t OPERTY GINNER '� ., .. Pnnt 10 Year Structure yes ��� �� SF MAP PARCEL ZONING;pISTR]CT Historic Distr[ct yes 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 P Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑;Septic 0 WeII 11Floodplain q Wetlands ❑;`Watershed District ❑ VVater/Sewer ...... ...... DESCRIPTIO OF WORK TO }3E PERFORMED: 0 v1 _r J 1 cle Ur— P 1.0 )C, �� J Ide tif"ic ion-- Please Type or Print Clearly OWNER: Name: c - �5n.I Phone: Address �ck PcGtRc N ,V-) 11 dd� r 61 Contrac#ar Name: UPh V � Adtlress: Supervisor's Construction License ' Exp Home Irnprovemen# License: a Exp Date:,' ARCHITECT/ENGINEER Phone.- Address.- hone:Address: Reg, Ido, FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$925.00 PER S.F. I"otal Project Cost: $ ( s O o FEE: $ 19 Check No.: e-7 IM Receipt No,. ' NOTE: Persons contracting with unregistered contractors do not have:access to th� ar d 5lgnature of AgentlOnlner Signature of contractor, F �oRrk � oven of ndover 0-- . 0 No. jo 1 � C,o h � ver, Mass:l�!c, .4%( C oc"W..{w.[.. 1' U BOARD OF HEALTH Food/Kitchen PERMIT D Septic System �1�_ BUILDING INSPECTOR THISCERTIFIES THAT . ... .......... ... . . . . .. ,.. ......... ... ............. .,. .1.!Tti.,... Foundation has permission to erect .... #"gathis .... buildings n ..... .. . .. ........ ... t .................. W1N ,�a■� . � ',- Rough tobe occupied as r.. .. .. :.. ..r.........................eu :.. ..... x.x. ..r..... Chimney provided that the person acceptpermit 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 CONSTRUCTI STAR Rough Ir Ar Service ..........dta- . .•A.... ...............................• Final BUILDING INSPECTOR GAS INSPECTOR QceupanCE Permit Required to OL cu 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. Care ruelion Ca; Ai IzMS?1)Iii.ANC: Si'i?Cl/_►LItiTS '. co Kee"Cons tructionCo.com QUOTE Pessinis, Karl & Cindy 40 Hitching Post Rd. N.Andover, MA 01845 Contract##6046; Appendix A October 5, 2016 Replace windows above the garage: • Remove and dispose of existing arch top picture window and two double hung windows on the front of the great room,two double hung units above driveway in great room,two double hung windows in guest bedroom and one double hung in guest bathroom • Supply& install Andersen Tilt-Wash series windows with similar grids patterns • Supply& install trim on interior and exterior to match existing • Paint interior and exterior trim Repair flashing and roofing on roof above side door, Stripping siding and putting bituminous membrane up wall, install new siding. Total Price: $16,000 (sixteen thousand dollars) Prices do not include cost of permits or repairs to any unsafe, unusual or non-code compliant existing conditions not addressed in this quote. Payment Schedule: $5000 due upon signing contract $4000 due when windows are delivered $2000 due when roof is repaired $5000 due at completion of contracted work r Customer Robert A Keen / 0 /7 10L7 Date Date 1175 Turnpike St. Page I of 1 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSI.#076691 Sales@ KeenConstructionCo.com HEC#108383 6046 KEEN CONSTRUCTION CO. PROPOSAL PO BOX 935 NORTH ANDOVER, MA 01845 Te[: (978) 1191-5201 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 Submitted to: with f l I ']i.. ...i 7.) 4 i with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, �1 f L v `1•_ 'r S !.- 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787 7.;�' 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 _ REGISTRAT#ON NO. EIN NO. (�C; ] MA.H.I.C. 108383 46—3783401 > CIS=Customer Supplied S+ I =Supply+Installs] See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: C. The 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 providedin,Massashusept General Laws,chapter 142A. J v 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: > WORKSCHEDULE— -----------------'-----...-----.,------------`--------':----------'-----------'----.,.,__—._—__ Contractor will not beg t e w_or pr order the materials before the third day following the signing of this Agreement,unless specified here in writing.Contractor will begin' the work an or about 1 I' .!'{{tate).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 The Contractor warrants that the work furnished hereunder shall be free from defects In materials and workmanship for a period of— s'"i'�i ; following completion and shalt comply with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused y the Contractor,his sub- contractors,employees or agents is discovered within one year after completion of anyjob,including cleanup,the Contractor shall,at his own expense,forthwith remedy, V repair,correct,replace,Or Cause to be remedled,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: r -------- dollars($ Z / 1 J Payment to be made as fofiows: % ($ )upon sign' contract; ROBERT A. KEEN - Jr1 Name of Contractor!Designated Registrant % ` PO BOX 935 Street Address rupon completion of N. ANDOVER, MA 01845 City l State shall be made forthwith upon (978) 691-5201 (978)682-3231 completion of work under this contract. Phone ! Fax Notice:No agreement for home improvement contracting work shafl require a h >down payment(advance deposit)of more than ono-third of the total contract Name of Safesran price or the total amount of all deposits or payments which the contractor must make, in advance,to order acid/or otherwise obtain delivery of special order Aul�rdrize Sig lure materials and equipment,whichever amount is greater. - Nate:This proposal may he withdrawn by us if not accepted within days. Acceptance of Proposal -I have read both sides of this document and alt 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 SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature , ''tel •� 1�-7"'f? Date �� (y Signature Date IMPORTANT INFORMATION ON BACK ■ The Commonwealth of Massachusetts Department of Industrial Accidents >. .. - Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information - Please Print Legibly Name (Business/Organization/individual): eels 60,51 Y-ocd ('CNS Co , Address: 7l) Be) x t rJ City/State/Zip: , s(1 6) one #; Are you an employer? Check the appropriate box: Type of project(required): 1.[N I am a employer with Z 4• ❑ I am a general contractor and I employees(full and/ax part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. FQ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 Buildingaddition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work 11.E] Plumbing repairs or additions No workers myself. ' cam right of exemption per MGL y � p• I2.❑ Roof repairs insurance required.] c. 152, §1(4), and we have no employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks box 41 must also fall 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. [ Insurance Company Name: V'e.`L- r rI I Policy# or Self-ins. Lie. #: ..1, M 1 Expiration Date: 1 / Job Site Address: I4 t Ic,k i Vt G Y(ZS, " _ Citv/State/Zip:__LLl 4rVer Alk of q5 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 ulder he i s an enalties ofperjury that the information provided above is true and correct, Sijznature: G p C� ` Date: +'-2— Phone#: /7 Q y / 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#: PATE(MMDDlYYYY) A�L]Y CERTIFICATE OF LIABILITY INSURANCE 10/17/2016 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) 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 Tights to the certificate holder in lieu of such endorsement(s). CONTAPRODUCER NAME CT Barbara McDonough GILBERT INSURANCE AGENCY INC. PHONE E (781)942-2225 FAXJAI,N% a DD al ss; bmcdonough ftibertinsurance.com 137 MAIN ST. _ INSURER(S)AFFORDING COVERAGE NA€Cif READING MA 01867 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 INSURERF: 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. fNSR TYPE OF INSURANCE AODL SUER POLICY NUMBER MMfDDYfYYEFF MMI�DIY YY 4W— f.IM{TS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE Ll OCCUR PREMISESRE (Ea occurrence) $ MED EXP(Any one person) $ NIA PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIESPER; GENERAL AGGREGATE $ POLICY❑PRO LOC PRODUCTS•COMPIOP AGG $ _ PRO- rl— OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OVMIED SCHEDULED AUTOS AUTOS NIABOgILY INJURY(Per erxidont) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Perapeldent UMBRELLALIAR OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE NIA AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION X I STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE YIN NE.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED9 NIA NIA MIA 6HUB9991 M58216 10/08/2016 10/0812017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 141,Additional Remarks schedule,may be attached if more space is required) Workers'Compensation benefits wilt 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/Wd/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 North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M.CroGvv y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I Board of Building Regulations and Standards Construction Supervisav License: C5-076691 ROBERT A]KEEN 12 E WATER ST North Andover WA 0 Expiration 92 5e�- Commissioner 08/1612017 .......... ........... ... .............- ............. C-ywl V)?,7 110 9 e I tj e,4,///1,6/)� (d j ct.C/I J"d e//a Office of Consumer Affairs&Susiness Regulation HOME IMPROVEMENT CONTRACTOR Type: Supplement Card oqg .,ation tiarl 08/17/2018 Keen Constructid6-Cp' Robert Keen 1175Turnpike S't No.Andover,MA.. d Undersecretary