HomeMy WebLinkAboutBuilding Permit # 3/1/2015 i
BUILDING PERMIT of No oT" �a
TOWN OF NORTH ANDOVER
02 9�•,'r` ` 1' x6 O IV
APPLICATION FOR PLAN EXAMINATION
Permit No#: I Date Received
Date Issued:
—"
IMPORTANT: Applicant must complete all items on this page
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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:
❑ Demolition ❑ Other
❑ S�e�t�c / ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
D SCRIPTION O • WORK T
ell O BE PERFORMED:
hAe V n J-f dg� � el r te r; 61 J 16, lr PC I)//-C1,01ao
Identification- Please Type or Print Clearly
OWNER: Name: ) C�Q i & hI[x ; My Phone: 92
Address: Kei rt", LJ i IV ti 0 deve k
Contractor Name`r ' ,, Phorie `�
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$92A0 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ 3 90 FEE: $
41
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guar4n. and
Signature of Agent/Owner Signature of contractor
t,ORTH
Town of2 . :� a ,_..�,;'
ndover
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No.
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ver, ass
COC NIC c"t NL'WtCK V
sRATED ilk?
7 U BOARD OF HEALTH
PE MIT T LD Food/Kitchen
Septic System
�� BUILDING INSPECTOR
...4 ....�r*A....
THISCERTIFIES THAT ................. ................................... ...........................
••. ..••• Foundation
has permission to ect ...... .................. buildings on ..49.....k1�A••7VW .. . ..`
t Rough
to be occupied as .......�. .�.�...�',. �. . ♦•• V •• •••••• •• •• 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
s
UNLESS CONSTRUCTST TS Rough
Service
.............. ..................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy 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.
� J- Const�uctian Ca,
REMC7UELINC: SPED UALI STS
978-69'1-520'!
Keen ConstructionCo.com
Alaimo, David & Missy
49 Kara Dr.
N.Andover, MA 01845
978-975-2405
Contract#5517;Appendix A March 9, 2015
Basement Door:
• Remove and dispose of existing 36"x 78" door between basement and garage
• Supply& install similarly sized 20 minute fired-rated, 6 panel wood door unit, including
aluminum threshold, new lockset and casing to match existing
Attic Staircase:
• Remove and dispose of existing house fan
• Re-frame ceiling joists
• Supply& install new wood pull-down staircase (MFS Excel with Thermogard insulation)
• Patch ceiling as needed
• Patch existing scuttle hole
• Supply& install trim on staircase to match existing
Bathroom Fans:
• Remove and dispose of existing bath exhaust vents
• Supply& install two Delta Breez 110 cfm bathroom exhaust fan/light combination units on
existing switches
• Supply& install two eave vent kits
• Supply& install insulated 4"vent hose
Total Price: $3680.00(three thousand six hundred eighty dollars)
Price does not include cost of permits, painting or repairs to any unusual, unsafe or non-code compliant
existing conditions.
1175 Turnpike St. Page 1 of 2 P: 978-691-5201
N. Andover, MA 01845 F: 978-682-3231
CSL#076691 Sales@KeenConstructionCo.com HIC #108383
ee .
b COnylr^aclion.Co,
RFN1y17FIAMC %VFCILALISI'S
978-691-52"'i
Keenconstructionco.com
Payment schedule:$1000 due upon signing contract
$1300 due when attic stairs is installed (plus permit fees)
$1380 due upon completion of contracted work
Customer Robert A. Keen
'3liv iS
Date. Date
1175 Turnpike St. Page 2 of 2 P: 978-691-5201
N. Andover, MA 01845 F: 978-682-3231
CSL#076691 Sales@KeenConstructionCo.com HIC#108383
5 5
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KEEN CONSTRUCTION CO.
° 1175 TURNPIKE STREET
NORTH ANDOVER, MA 01845 All home improvement contractors and subcontractors
Tel: (978)691-5201 engaged in home improvement contracting, unless
Fax:(978)682-3231 specifically exempt from registration by Provisions of
r
.Chapter 142A of the general laws, must be registered
Submitted D ,fes �t with the Commonwealth of Massachusetts. Inquiries
To: —�)tP ry ��t��_f et r'!�L) about registration and status should be made to the
Director,Home Improvement Contract Registration,10
rc D Park Plaza, Room 5170, Boston, MA 02116 617-973-
( f 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.
�7 9-)5—2 q 6155 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:
iConstruction related permits:
1 _..._.__. ..---._...---._—._.___.._---------______.--__-------.......__.___....._._._._........
_ _......_----------------_.._._..._.._.-------.._.._..___..__.__._____..._..._-------_......---.............._..._._.__:._.._....---_._.__._.....--.._._____...__._.____.....___......__...._..----......_____.
WORK SCHEDULE
Contrae o ip no egm the work or order the materials before the third day following the signing of this Agreement,unless specified her in tin on actor will begin the work on or
about ((� J (date). Barring delay caused by circumstances beyond Contractors 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 no be con idered 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 subcontractors,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
X rc � b�-t — -- dollars($ �(rIn,OG
Payment to be made as follows: )
% ($ ) upon signing Contract; ROBERT A. KEEN
Name of Contractor I Designated Registrant
% ($ upon o ids�I
1175 TURNPIKE ST.
�y `` Slreet Address
completion of N. ANDOVER, MA 01845
city(Stale
shall be made forthwith upon (978)691-5201 (978)682-3231
($ ) completion of work under this contract. Phe ( Fax
Notice: No agreement for home improvement contracting work shall require a
>down payment(advance deposit)of more than one-third of the total contract price Name n!sales an
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 materials and Authorized signature
equipment,whichever amount Is 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. Payment will be made as outlined above.
You,the Buyer, ay c cel this transaction at any time prior to midnight of the third business day after the date of
this transacts n. anc lotion must be done in writing.
OT G '�LiIS CONTRACT IF THERE ANY BLANKSPACES.
/ 1�'r � f
Signature v/ /'� // ri Dale sign alu� "--§C . �I�-W"C Date 1O
IXfI IMPORTANT INFORMATION ON BACK 111111-
The Commonwealth of Massachusetts -
- Department of Indtfstrig1 Aeczclents
Office of Investigations
600 Washington Street
Boston,MA 02111
w w w.m ass.go v1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/FXectrxciansIplumbers
Applicant Information Pleaas'e Print Le�ibiy
NaMo(Business/Organization/individual): V) Vy ` `J ru C± i e-- . ,
Address: =y C n e-
'
City/State/Zip: V1(�cam`, E� Phone#: �7` ' (o I rj Z-y l
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with �- 4• El am a general contractor and I 6. El Now construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sola proprietor orpartner-
listed on the attached sheet. 8 Remodeling
ship and'have.no employees These sub-contractors have 8. Demolition
working for me in any capacity. workers'comp.insurance. 9. El Building addition
[No workers' comp.insurance 5. El We area corporation and its 10.❑Electrical repairs or additions
required.] officers have exercised their
3.E1 I am a homeowner doing all work right of exemption per MGL 11.[]Plumbingrepairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12.QRoofrepairs
insurance ]ired.re q uemployees.[No workers'
13.❑Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information,
i Homeowners who submitthis affidavit indicatingthey Are doing all work and then hire outside contractors must submit a new affidavit indicating such.
TContractors that cheekthis box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information.
lam are employer that isproviding workers'compensation insuranceformy employees. Below is thepolley andjob site
information. i
Insurance Company Name:. V'e.' (-S
Policy#or Self-ins.Lic./#: L 1*xpiration Date:
Job Site Address: ��c; rc1 r, City/State/Zip: Al go do ve r) /l l/7- e)
r
Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL o.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 civilpenalties 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 ofthis statement maybe forwarded to the Ofco of
Investigations of the DIA for insurance coverage verification. '
I do Hereby certo un the pa' s and enalties of perjury tliat the information providedve is true and correct.
Si afore: " - Date: 37/ C
Phone# 7 ` � �� -Z—C) j
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License 0
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk. 4.EIectrical Inspector 5.Plumbing Inspector
6.Other -
Contact Person: Phone#:
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-058245
`j..I.
KENNETH B KEEN ,.
21 HEWITT AW-
N ANDOVER MR 01k4
Expiration
Commissioner 03/24/2016
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-076.691
ROBERT A KEEN"
�: -
12 E WATER ST
North Andover MA 01'8 ,
i
Expiration
Commissioner 08/16/2015
,pa �e tpomUr�za�zus�o�CiaCczaeacluveG�i
` \ Office of Consumer Affairs&Business Regulation I'
ME IMPROVEMENT CONTRACTOR
egistration: A 8383 Type:
xpiration:,,811866,S-; DBA
KEEN CONSTRUCTION CO
Kenneth Keen
1175 TURNPIKE ST
NO.ANDOVER, MA 01845"
Undersecretary
11/13/g014 10:00 FAX 781 942 2226 GILBERT 0001/001
DATE(MM/DD/YYYY)
A CERTIFICATE OF LIABILITY INSURANCE .11/13/2014
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 �Y THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR17ED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certlflcate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION l5 WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement, A statement on this cartlficate does not confer rights to the
certificate holder In lieu of such endorsemen0a).
PRODUCER 0NAI
0 ECT Barbara McDonough !
Gilbert TrnsuraAca Ageriay, InO. PHo a (781)942-2225 P •I(9111)F42-2226
137 blain Street ELI .bmcdonougblgilbortinaurance,com '
INSURER AFFORD NG CqERA06 i NAIC
ReaLcUng MA 01867-3022 INS R R :NOPLFOLK & DEDHO INS IDE
INSURED INSUMBIHartford Fire Inausanoe Com
Keen Construction COMPOL iy INa RERolTrav&lers Insurance DIS 2
117.5 Turnpike Street INAURER P I
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INSURER E:
North Andover MA 01845 IN R F:
COVERAGES CERTIFICATE NUMBER:CL3.441500922 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TSE 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.
I R TYPE OF INSURANCE, L 9 POLICY MEER MMILI ICY LIMITS
GENERALLIAWLITY SAMA URREN06 'j-
tris
6 1,000,000
X COMMERCIAL GENERAL LIABILITY D I FTOE RE 4rrcnce1 S 100,000
A CLAWS-MADE Y OCCUR -P-010078/000 /13/3014 /13/2015 MED GXP(Any,ww eon) 6,000
PERSONAL&ADV INJURY 1,000,000
GENERAL AGG E TE I 5 2,GOO,000
fiE 'LAGGREGATE LIMIT APPLIESPER: PROD CTS-
COMP/OPAGGI 9 2,000,000
X POLICY PRD- LOC % S
AUTOMOBILE LIABILITY RI ED GLe IT
000
end ,.
ANY AUTO BODILY INJURY(Per person)I S
B ALLo aD X 60HEDULE0 OVECAA6432 2/3/2013 2/3/7014 SODILYINJURY(PeraWden1) $
NON-OWNED ROP TYAMAGE S
X HIRED AUTOS X AUTOS
Undarinelrtedmo(orlet 5 00 000
UMBRELLA UAB OCCUR EACH 0cCVRRENGE ! S
EXCESS LIAR CLAIMS-MADE AGGREO YE E
S `
ED I I RETENTION TH'
C WORKERSCOMFCNSA71ON To 'ae Peavided directlyAND EMPLOYERS*LIAEILnYis the carrier, CHAOOIDENT 0 000
ANY PROPRIGTOR/PARTNERIEXECUTIVE(r NIA A
OeFFFiCdi�EMPIREXCLUDEO? �J 0/9/z014 0/®/ 015 E.L,DISEASE-EA EMPLOYE S 100,000
Itye*,pasaim UM1ar E.L.In NHI DISEASE-POLI Y LIMIT i 500,000
DESCRIPTI N OF OFt!RATIONSlo
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(A11aeh AOORD 161,Additional RemuRs Schedule,K mere apace le required)
Evidences of a0varage
CERTIFICATE HOLDER CANCELLATION
(978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEI CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS. i
Town of North Andover
1600 Osgood Street AUTHORIZPD REPRESENTATIVE
North Andover, MA 01845
I
M Gilbart, CIC/BARMR
ACORD 25(2010/05) ®1989-2010 ACORD CORPORATION. All rights reserved.
:e:on,sx; ,,., Tha ACORD name and logo are registered marks of ACORD I ,