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HomeMy WebLinkAboutBuilding Permit # 1/19/2017 �f AOR I I BUILDING PERMIT o��tLEp �1 'q•�.6 �J TOWN OF NORTH ,ANDOVER } �-` ` -°' e APPLICATION FOR PLAN EXAMINATION Permit No#: �'' Date Received I � � �����Arfio wp �4`t Date Issued: IMPORTANT:Applicant must complete all items on flus page LO ATIC7N _ f �x %,:' P in , APROPERTY�C7V1/hJER >� Pnnf ; 'Oo Year Structure MA6' PARCEL. Z'C1NIN' Q DISTRICT:, His Distract, 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: FJ Commercial _ _ -------------------_ ❑ Repair, replacement ❑Assessory Bldg D Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well F.] Floodplain ❑Wetlands ❑ Watershed District Li Water/Sewer _ ORK —- , �fQ—E P EISA )°ED; C)I DESCRIPTION OF V� Identilicatio � PleasType or Print Clearly' OWNER: Name:_ Phone: Address: 1 , _.. Contractor Name: Veeo hone: - �� Address- De� q� Supervisor's Construction License: 6 — 07669 ( Exp. Crate: Home Improvement License: Exp. Date-- -- - :- -- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BA SED ON$125.00 PER S.F. total Project Cast: $ FEE: $ Check No. °" Receipt No.. r q 55" wn 7th� ara tNOTE: Persons contracting witli unregi�s�terectcontractors do not Halle:access tofu Signature of Agent/Owner� Signature of contractor, .............­­­­­........................ .............. ........... .............................................................. ........................ tkORTH Town '� "of ndover 0 . 0 No. p�R h ver, Mass, ATED U BOARD OF HEALTH Food/Kitchen E B PERMIT T L01111111111IF Septic System THIS CERTIFIES THAT ......k!" V....(O.A.SbVo. Pt...4..... .... ... . ............. .... BUILDING INSPECTOR ................. has permission to erect .......................... buildings on .........1.41........ AAAO. 1.C.......S, ,. Foundation Rough to be occupied as ...... ..........W.t%&............. ..........om... OChimney 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 CONSTRUCTFIZART Rough Service ............ .......................................... Final BUILDING INSPECTOR GAS INSPECTOR 0ecy2ancy Permit Required to Occupy Building 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. e -''I„-;; Cnnslrur.�Ciar�Cry. 3F rmc�3iF:F.inc: til'F":[:Fni.lti"1'S Ke uarCnns3 met "CrnCum 0 p i Gene &Teddie Hunt 19 Boxford St. N.Andover, MA 01845 i Contract##6050; Appendix A January 12, 2017 Remodel bedrooms: a Remove and dispose of existing closet walls and carpeting in front two bedrooms Frame closet in first room (closest to front door), including removing and framing door to hallway 0 Relocate wiring as needed" Wire for light in new closet and two ceiling lights ($1500 allowance) , G Patch walls as needed, piaster new closet walls i Supply& install 6'x 6'8” unit pair(two, hinged doors)closet doors and trim to match existing '.... Supply& install scuttle hatch into attic, in closet ceiling ® Supply&install heat enclosure to connect existing heat on front wall Paint walls,ceiling and trim • Supply& install carpet in new room ($30/sq yd installed allowance) Total Price: $8840(eight thousand eight hundred forty dollars) Price does not include cost of permits or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this quote. Payment Schedule:$1000 due upon signing contract $2000 due the first day of work $2000 due when plaster is complete $2000 due when painting is complete $1840 due at completion of contracted work mer Robert A Keen 111,311 I I -_ //51/L7 Date Date PQ Box 935 Page 1 of 1 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSLt#0766.91 Sales@ KeenConstructionCo.c m HIC H108383 i 1 � A 6050 KEEN CONSTRUCTION CO. PROPOSAL PO BOX 935 NORTH ANDOVER, MA 01845 Tel (978) 691-5201 Al home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978) 682-3231 specifically exempt from registration by Provisions of Co r f t chapter 142A of the general laws, must be registered Submittedto: - i1e I -IC'1i( + twith the Commonwealth of Massachusetts. Inquiries C 2 about registration and status should be made to the f l� }�{ i 'fir Director, Home Improvement Contract Registration, I 11 `� >, o r }.1 r :.,r r r__ 1 Park Plaza, Room 5170, Reston, MA 02116 617 473-6787 jJ Hers who secure their own construction related permits o deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE iJAT REGIS RATION NO. E1N NO. • /� i H.I.C. 108383 46—3783401 > C/S=Customer Supplied 5+`I=Supply+Install See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: " �-F�:�,�,�,cls_ I ���^.c!`(7.!>f`l/► e The contractor and the homeowner hereby mutually agree that in the event the contractor has a dispute concerning this contract,the contractor Tay submit Iheic Lte to a private arbitration firm which has been approved by the Secretary of the Executiyg Office of Consumer Affairs and Business f;eg� tto and the consumer shall be required to submit to such arbitration as provided in ssachGsetts General Laws,chapter 142A. I omeower1 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 beg' n y�o of order the materials before the third day following the signing of this Agreement,unless specified here in wr€tE o r�a�tpf will begin She work on or about date).Barring delay caused by circumstances beyond Contractors control,the work will be completed by {05ie).The Owner hereby ackno vie ges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor hall not be considered as violations of this Agreement. WARRANTY n The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of - (�.c- i 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 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,correct,replace,or Cause to be remedied,repaired,or replaced,such damage of such defect In materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose he}r—eby to furnish material an__d labor-complete in accordance with above specifications,for the sum of [El, ✓1l I Y�r%)%.�r111�4 �i'l11 It-51�� �'1�C1 .�"..r[ �y __ dollars($ %CJLI—i ,�C� J. Payment fo be made as l ifowsr V % ($ 3upon signing Contract; ROBERT A. KEEN i! I Name of Contractor l designated Registrant I ($ )upon c p�a� ��' i PO BOX 935 Street Address ,% ($ )Vponcompletion of N. ANDOVER, MA 01845 t City 1 State ,/o ($-),hall be made forthwith upon (978) 691-5201 (978)682-3231 completion of work under this contract. Phone Fax I Notice:No agreement for home improvement contracting work shall require a Name of 5al"e'sman - >down payment(advance deposit)of more than one-third of the total contract 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 Auth 3Tgne materials and equipment,whichever amount i5 greater. 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 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. I 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, the date of this transaction.Cancellation must be done in writing. 'r D.O.NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. u Slgnaturel ”"� --- Date signature Date IMPORTANT INFORMATION ON BACK ► i E _ 3 E 1 � I F { j F S i d Ix bo ,� , Z f a .. I The Commonwealth of Massachusetts Department of Industrial Accidents 6AOffice of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Legibly V Name (Business/Organization/Individual): L (`u/) Address: ?o Bbx City/State/Zip: 0 hone #: Are you an employer? Check the appropriate box: Type of project(required): 1.[A I am a employer with 2- 4. E] 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' comp. insurance.$ 9, Building addition [No workers' comp. insurance p• required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12-El 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. YContractors 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:_ ^ �5 o . Expiration Date: C }Polic # or Self-ins.Lic. /L Job Site Address:_ J Bo 7C-Ey- City/State/Zip:b r 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 forth 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 i s anoplenaltles ofperjury that the information provided bone is trice and correct. 10 Sit-mature: — Date: I Phone#: / I U V 1 — .,Z-0 1 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#: 7 ® DATE(MMIDD1YYYY) ACC)RO 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 HOES 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). ONTAPRODUCER NAME: Barbara McDonough GILBERT INSURANCE AGENCY INC. PHONE (781)942-2225 FAX No: �INS DD RESS: bmcdonou h@gilbertinsurance.com 937 MAIN ST. INSURERS AFFORDING COVERAGE N 10 READING MA 01867 URERA: 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 ADDL 9UBR POLICY NUMBER MWDDYIYYEFF Y MMIDDIYYY LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RFNTEU— CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY 1-1PRO- ❑ LOC PRODUCTS-COMPIOP AGO $ JECT OTHER: $ AUTOMOBILE LIABILITY CO BIIaccED5INGLELIMIT $ (EaANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED NIA BODILY INJURY(Per aceidenl) $ AUTOS NON4YVVNEO PROPERTY DAMAGE $ HIRED AUTOS H AUTOS (per acciden€ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS•MADE NIA AGGREGATE $ DED RETENTION$ $ TH WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X PER ER YIN ANYPROPRIETORIPARTNERr=XECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMaER"CLUDED? NIA NIA N/A 6HUB999IM58216 10/08/2016 10/08/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 Ir yyes,describe under DESCRIPTION OF OPERATIONS Itetaw E.L.DISEASE-POLICY LIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS f LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) a Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay j 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.govl€wdlworkers-compensationlinvestigationsl. 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 r-� North Andover MA 01845 an Daniel Ni.Cra,a ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved, I ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD AC R CERTIFICATE OF LIABILITY INSURANCE DATE(MM 10DlYYYY) 1/9/2017 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 INSURERS), 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 CONTACT Barbara McDonough PHONE Gilbert Insurance Agency, Inc. arc XI); (781)942-2225 Fax (7s1)9d2-zzz6 _ Arc No 137 Main Street EMAIL ADDRE .bmcdonoug h@�ilbert:insurance.com _ � ....._._ INSURER(S)AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURER A:Noxfolk & Dedham Insurance 23965 INSURED W tNSURERB:SafetV Insurance Company _.,., 39454 Keen Construction Company INSURER c:Travelers Ins. Co. 0031 PO Box 935 INSURER D: _ - INSURERE: North Andover MA 01845 INSURRRF: COVERAGES CERTIFICATE NUMBER:16-17 MASTER 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 AODL 5 R POLICY NUMBER MM0 IIDD== EFF P81LDI p EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ A CLAIMS-MADELil OCCUR EREDAMAGE TO RENTED M SES Ea oncurcenceS $� 100,000 ND-B-010075/000 3/13/2016 3/13/2017 MED EXP(Any one person) $ 5,000 PERSONAL& %DV INJURY $ W 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY D JEIT �LOC PRODUCTS-COMPIOP AGG $ 2,000,000 PRO- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 6228807 COM 02 5/23/2016 5/23/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS _ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident ._ Underinsuradmotorist $ 100,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC) RETENTION S $ WORKERS COMPENSATION To he issued directly by STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIva YINN!A the company. E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? 10/5/2015 10/8/2016 E-L.DISEASE-EA EMPLOYE $ 1D0 000 C (Mandatory in NH) . _ Tfes,describe under DESCRIPTION OF OPERATIONS helnw E.L.DISFASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD I at,Additional Remarks Schedule,may he attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover, MPI, ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/LINDSE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1NS025(201401) I Massachusetts -Department of Public 5,afety Board of Bbilding Regulations and Standards ci)n.itructiorl SuDervjior License: CS-076691" T'I'S' ROBERT A I(EE4' 12 F WATER ST< IMF North Andover Na 0 95Expiration 4-� Commissioner 08/16/2017 ............... NO Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Reg istratlon:,,,5!."1 q8383 Type: ExpiratioR.---M-8720118 DBA KEEN C0NSTRUCf,'I)0'N-- Kenneth Keen 1175 TURNPIKE ST NO.ANDOVER, MA Undersecretary