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HomeMy WebLinkAboutBuilding Permit # 2/22/2017 BUILDING PERMIT V%ORTHI% ,E D TOWN OF NORTH ANDOVER 0 APPLICATION FOR. PLAN EXAMINATION '. q Permit No#: Date Received AC US Date Issued: LN4PORTANT:Applicant must complete all items on this page LOCATION_ 17 Print PROPERTY OW Print 100 Year Structure yes MAP PARCEL:`11'a­ >V/ Z'ONING"DISTRICT: Historrc District- yes nod Machine Shop Village yep 171 0��, .............. TYPE OF IMPROVEMENT PROPOSED USE ----------- Residential l46`n_-­Residential 0 New Building F1 One family 0 Addition 11 Two or more family D Industrial NI)Alteration No. of units: 0 Commercial 0 Repair, replacement 11 Assessory Bldg 0 Others: 1i Demolition 11 Other F Septic 0 Well E Floodplain 0 Wetlands 0 Watershed District D Water/Sewer I DESCRIPTION OF WORK TO BE PERFORMED: V% ............ I entification- Please T'3ype oi-Print Clearly OWNER: Name: vi m_ Phone: Address: ----------- cvj 9 ? Contractor ract or_ . N- _ am_e . Phone, Address. v Supervisor's Construction License: Exp. Date: P Exp. �Home Im ARCHITECT/ENGINEER Phone: Address:-- - Reg. No. FEE SCHEDULE.BULDINGPERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00PER,,§�F. ........... rotas Project Cost: $ 2- Z' ---FEE: $ (;Y Receipt No., :S-`>,,, 6 Check No.: NOTE: Persons con traefing witli unregistered contractors do not h ave�access to tz 'kua I tv Spgnature Ac f ient/Owner Signature of contractor— ' ]rown of 11dover 4 N®RTF -9 o ver, Mass, Aso MMMIT 1 " Adpmqa _qM s` LD BOARD OF HEALTH No Am E M in Food/Kitchen 17 ® Septic System THIS CERTIFIES THAT .........k.9!A.�......49A.f./ ....`/(d AY .. . ...... . . . BUILDING INSPECTOR has permission to erect .......................... buildings on .......A.. .......... .160!!! ......b;.&.'.`...X./s Foundation to be occupied as ......... Rough ............ ...............Aov....................................� . .....................,. ... 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 EXPIRESIN 6 MONTHS ELECTRICAL INSPECTORUNLESS . CONSTRUCTION TS Rough Service ............... ._. ...•...... BiJIL©hNG.IN$PECTOR' Final GAS INSPECTOR OccupancyPermit RLquired t® OceM 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. 6007 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 .� Chapter. 142A of the general laws, must be registered Submittedto: with the Commonwealth of Massachusetts. Inquiries f about registration and status should be made to the _ r� I r t 4''`'� c I Director, Home Improvement Contract Registration, 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787 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` / REGISTRATION NO. EIN NO. __5 l MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+ Install [See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: f ,r 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 Exec rive Office of Consumer Affafrs and Busine}ss Regulation and the consumer shall be required to submit to such arbitration as provided.in Massachusetts General Laws,chapter 142A. Homew/her'sX nature 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 to work corder the materials before the third day following the signing of this Agreement,unless spedfied here In i mg.C actor will begin the work an 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 The Contractor warrants that the work furnished hereunder shall be free from defects In materials and workmanship for a period of 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 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 iL v.Jc-s' _ t�` �..,IIJIS 1C G 1r I, 'dorlars($ t f Payment to be mad as follows: ($ )upon signing Contract; ROBERT A. KEEN Name of Contractor!Designated Registrant ($ )upon completion off- PO SOX 935 J� Street Address upon ompletion of . N, ANDOVER, MA 01845 City IState % ($ y shall be made forthwith upon (978.) 691-5201 (978)682-3231 completion of work under this contract. PhgFax Notice:No agreement for home improvement contracting work shall require >down payment(advance deposit)of more than one-third of the total contract Name of,5algsm3n'- } price or the total amount.of all deposits or payments which the contractor must ' make,in advance,to order and/or otherwise obtain de3ivery of special order Aut rix dSignature materials and equipment,whichever amount is gf,Qat.re. - Note:This proposal may be withdrawn by us if not accepted Wthin_--days. Acceptance Of Propo5af -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. 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. %' DD.• )NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature Date. Date Signature Date ��— IMPORTANT INFORMATION ON BACK ► wn— rx�iir►c�usHi_Rrac: sNec�ni�s'rs 97'8-69-t—S 2 f►� Keen ConstructionCo.cam Lynne& Bill Gillen 54 Spring Hill Rd. I N. Andover, MA 01845 Contract#6007;Appendix A February 3, 2017 Main Bath Remodel: • Remove and dispose of existing fixtures, flooring and wallboard to studs and sub-floor • Remove laundry area and closet • Frame shower area per drawings from Kohler Signature Store • Install customer supplied plumbing fixtures, except glass shower door ($4000 plumbing parts & labor allowance) • Supply& install new fan/light unit,shower recessed light and customer supplied sconces.Supply and install wiring for outlets and switching to code. ($2500 electrical parts and labor allowance) • Insulate walls to code • Supply& install wallboard and skimcoat plaster to smooth finish • Supply& install tempered glass window sashes for the existing Pella window • Install customer supplied cabinetry and related trim, and base,window and door trim to match existing • Install customer supplied the on floor and shower walls. • Paint walls,ceiling and trim Total Price: $27,285 (twenty-seven thousand two hundred eighty-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 quote. PO Box 935 Page 1 of 2 P: 978-691-5201 N.Andover, MA 01845 F. 978-582-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 s i 7 .,Onj°Y'tfC15f1Y]CO,, H�_mcant.i_tnc; SNECGnL1"�"S X378—Er'�ly-5X1"1 Keen ConstructionCo.com s i Payment Schedule:$2000 due upon signing contract $5000 due the first day of work(plus permit fee) $5000 due when rough electrical and plumbing is complete $5000 due when tile is complete $5000 due when painting is complete $5285 clue when contracted work is complete 1.4 ustom r Robert A Keen Date Date P4 Box 935 Page 2 of 2 P: 978-691-5201 N.Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com H IC#108383 0 I 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 Applicant Information Please Print Legibly % J Name (Business/Organization/Individual): I e6�,51 rU� ('C>✓) C� Address: ® BCS X City/State/Zip: +(� 1hone #: Are you an employer? Check the appropriate box: Type of project(required): 1,0 1 am a employer with 1 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. F] New construction 2.❑ 1 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.I 9• ❑ Building addition [No workers comp.comp. insurance p. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGI., 12.❑ 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 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: rr, V'E le r � ►� S. _._ Policy# or Self-ins. L �, �' Ul� 9 1 J "1 � z Expiration Date: ic. #: f Job Site Address: l n c' City/State/Zip: kl at,cl, ✓ , N►� L Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration daQ� 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 an enatties of perjury that the information provided above is true and correct. r Si ature: Date: 9 Phone#: 97 ? J L J 5 Z Q Official use only. Do not write in this area, to be completed by city or totun official. City or Town: Permit/License 4 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#: 7 BATE(MMIDDIYYYY) A�a 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Barbara McDonough NAME: GILBERT INSURANCE AGENCY INC. PHONE (781)942-2225 arc No: fEss: bMlcdonoijgh@gllbertinsurance.com 137 MAIN ST. INSURERS AFFORDING COVERAGE MAIC# READING MA 01867 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER a; KEEN CONSTRUCTION CO INSURERC: INSURER D: PO BOX 935 INSURERE: NORTH ANDOVER MA 01845 INSURER P: COVERAGES CERTIFICATE NUMBER: 94268 REVISION NUMBE=R: THIS 15 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 TYPEOFIN$URANCE ADDL9UBR POLICYNUMBER MMlDDYIYYYI MMA]DYIY YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 1-1 OCCUR PREMISES Ea occurs ca $ MED EXP(Any one person) $ _ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY❑ PROJECT- ❑LOC PRODUCTS-COMPlOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident ANYAUTO BODILY INJURY(Parperson) $ ALL OWNEDSCHEDULED NIA EODILY INJURY{Per accident) $ 0 $ AUTOS AUTOS NON-OWNE0 PROPERTY DAMAGE $ HIRE)AUTOS AUTOS er accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE NIA AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE EOR YIN ANYPROPRIETORIPARTNRIEX(wCUTiVE EE.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED7 NIA NIA NIA 6HUB9991M58216 10108/2016 10/08/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPER01ONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000 NIA r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addittonat Remarks Schedute,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 0613, no authorization is given to pay p 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 j 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 atwww.mass.gov/twd/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.Cry,CPCU,Vice President—Residual Market--WCRIBMA j ©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 BUding Regulation's and Standards �owstrucfiorl SUrpel-visOr License: GS-076691 ROBERT A XEEN-1- 12 E WATER ST� two Nortb Andover WA 0 A, 9,21 -)j-I iA Expiration Commissioner 08/16/2017 office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Reg lstration:.,,-.'Y,"l Q8383 Type: Expiratlow,—,.8 lid2-0-18 DBA off'g— KEEN CONSTRUCTI., -�—. �,--,i���1.1 Kenneth Kee 1175 TURNPIKE ST NO.ANDOVER,MA 0184 �Undersecretary