HomeMy WebLinkAboutBuilding Permit # 3/27/2015 I
BUILDING PERMIT of N°eoT 6q.�.o
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION o
Permit No#: 2 Date Received ,ED "`c5
gSSACH�1`���
Date Issued:
IlVI ORTANT: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
❑ Septic:: ❑Well r ❑ Floodplain ❑Wetlands �� ❑ Watershed Di tnct'
Water/Sewer `
. � �
\\DESCRIPTION OF WO, j TO BE PERFORMED: -
Identification- .Please Type or Print Clearly"
OWNER: Name: c�r-i 2e-I "�`i e-C- Phone:57 7—L-T5' 2-601
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Address: , 5'V �( OA V,
Contractor Name6"1
Phone
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Home fmprouernent License
r
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ,, 90 1 Go FEE: $
Check No.: /' Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to tl ar 1ty f
Signature of Agent/Owner Signature of contractor a
V40RTmj
Town 01 ndover
® 0%
.
y 0h ver, Mass, !�
Y' OLAKE .�
COC KICKEWICK V
�®AERATED
S UMilk
BOARD OF HEALTH
Food/Kitchen
rERMIT 111111111IF Septic System
THISCERTIFIES THAT . ...... .. ...OVO] /... .... BUILDING INSPECTOR
.......� � ..... .... ............................... ............
has permission to erec .. buildings on Foundation
Rough
to be occupied as ...� .�.. .......�....... •• • jCW••••• IRIMMYL.. •l..... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the ication 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 I 6&N- S ELECTRICAL INSPECTOR
LESS C SRCTI Rough
Service
.... .................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy .hermit Required t® Occupy Buildinga Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing in or Dryall ToBe ®one FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
—,; Cons., C60n Co,
REMCJUGI_Ui C: SPECILALISYS
978-697-5207
KeenConstructionCo.com
Pelletier, Mary
18 East Water St.
N.Andover, MA 01845
978-685-2081
Contract#5533;Appendix A
March 18, 2015
Create new powder room and laundry closet:
• Remove and dispose of existing china cabinet in dining room
• Create powder room, approx.40"x 60", in corner of dining room
• Supply& install plumbing drains,vents and feeds for powder room and laundry closet on 2nd
floor
• Install vent through roof for plumbing system
• Supply& install Kolher Cimarron comfort height toilet,Wellworth pedestal sink and Alteo
chrome faucet,TP holder and towel ring
• Supply& install laundry valve(single valve) in closet
• Supply& install new electrical panel in basement
• Supply& install wiring for bathroom and laundry to code
• Supply& install%" blueboard and skimcoat plaster to smooth finish
• Supply& install 80cfm fan, Hampton Bay 2-light vanity light, Napoli oval mirror and Hampton
over-john cabinet in powder room
• Supply solid core Masonite door with trim to match
• Supply& install base trim to match
• Supply& install vinyl sheet flooring
• Paint walls,trim and ceiling(two coat finish)
Total Price: $15,190.00 (fifteen thousand one hundred ninety dollars)
Price does not include cost of repairs to unsafe, unusual 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
KEEN CONSTRUCTION CO.
n 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
f'� Chapter 142A of the general laws,must be registered
Submittedl e I fr with the Commonwealth of Massachusetts. Inquiries
To: CA about registration and status should be made to the
s Director,Home Improvement Contract Registration,10
G , -c r J 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.
C)73_G, S— �0 ZI 3/I g /G, MA. H.LC. 108383 46—3783401
> C/S=Customer Supplied S+I=Supply+Install [�r See Attached Appendix A
We hereby submit specifications and estimates for work to be performed and materials to be used:
(c CieCi- e �c� ouu�er- nr_)DtM
1�1 ,17 CL 6i L)J`17 J r4 /_ /0Sp-
Construction related permits:
WORK SCHEDULE
ConlraG r 11 not b i e work or order the materials before the third day following the signing of this Agreement,unless specified her e'n r'i g. n clor 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 considered as violations of this Agreement.
WARRANTY
The Contractor warrants Thal the work furnished hereunder shall be free from defects in materials and workmanship for a period of V 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 Contracto,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
Prop Se hereb tIo furnish material and labor-complete in accordance with above specifications,for the sum of: /l
1 \ 77 eh ) e't)S� l�d1 eU t 1���1 "�_r dollars($
Payment to be made as follows:
/, I$ ) upon signing Contract; n ROBERT A. KEEN
�r k\ Name a,Contractor/Designated Registrant
comple o f ?� 1175 TURNPIKE ST.
_% ($ upon
— Street Address
% {$_- mpletion of N. ANDOVER, MA 01845
alty/State
s 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 shall require a _
>down payment(advance deposit)of more than one-third of the total contract price Name o!Salesman
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 it 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, 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.
\ rrr
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature � r- -� / i -- �� Date - Signature
Date
IMPORTANT INFORMATION ON BACK OP-
= Jr;; Cans�trucfian,Ca.
eemooe�_�nc SNEGI/�t_ISTS"
978-69'/-520`!
Kee nConstructionCo.com
Payment Schedule:$5000.00 due upon signing contract
$5000.00 due the first day of work
$5190.00 due at completion of contracted work
�,�
Customer Robert A. Keen
Date Date
1175 Turnpike St. Page 2 of 2 P: 978-691-5201
N. Andover, MA 01845 F: 978-682-3231
CSL#076691 Sales@KeenConstructionCo.com HIC#108383
11/13/Tp14 101:00 FAX 781 942 2226 GILBERT
[a]001/001
DATE(MWDWYYYY)
cc I?H CERTIFICATE OF LIABILITY' INS
URAN�F !11/1TE H DERDTHiS
S PON THE CERTIFIC
THIS CERTIFI
CATS l5 lSSUS A MATTER OF INFORMATION ONLY AND C J!ERS NO TEND hR ALT R TIG OVERAGE A FORDEDADY THE POLICIES
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX '
BELpyy, THIS CERTIFICATE OF I ANS THECE DOES CERTIFICAOE NOLDER.UTE A CONTRACT BET�►EEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, 6 ;i�idarsed- if SUBROGATION 18
IMPORTANT: If the certificate holder Is an ADDITIONAL may req pan endolrsemenmstatement on this aa�lfi atp does not ConforDngi�ts to the
the terns end conditions of fire policy,aerta P
certificate holder in lieu of such endorsement(s)• ao cT Barbara M❑Donough
(�13�)942-2225 .11991)942-2226
PRODUCER PHO E
Gi7h®rt Tnsurarnce Agency' MAILbmedonaugh@ gilbartinsurance.comnna '
1.37 Main Street MAIC
INSU ER AFFORD c 3965
Reading MA 01867-3922
INS RER A:NC)RFOI+K DEDFIAM INS OB '
suR acRasbfosd 3'ire InaysslnCe Com OO 2
INSURED INS RERclTravel4ar$ Insurance
Keen construction Comp"y INSURER D!
1175 Turnp;-ke Street INSUR E:
1 Q1845 IN RERF:
North Andover REVISION NUMBER:
COVERAGES CERTIFICATE NUMBER:C11441500922
THIS CH THIS
IS TO'CERTIFY THAT TFiE POLICIEEL2UIREM@TER ) 10 IIIE INSURE CT To
M R CONDITION TION OFHAVE EANY CONTRACTS RO cH DOH REN S S B EC ENT WITH RET d ALL 17ERM5,
INDICATED. NOTWTHSTANDING ANY R
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLI uMIT5
EC(CLUSIDNS AND CONDITIONS OF SUCH POLI CIES.LIMITS SHOWN MAY HAVE SEEN REDUCED BY
P10 YAW
POLICY MBER M 1,000,000
1 TYPEOPINSURANCE EACH 0 URRENOE `+
GENEPALLIABILJTY OAMA1858.(E EN knnce 10 000
/18/2014 /33/2015 MED GXP(Any WW San s 5 000
5
$ CpMIWBRCIALGENERALL{A8VLIYY -p_010078/000 3.,000,OOO
A CLANS-MADE a]OCCUR PER OWY.&ADV INJURY
GENERAL AGG E TE I $ 2,000,000
PROD CTS_Cam I,AGGI $ 2,000,0001
GEN'L AGGREGATE:LIMIT APPLIES PER; S
PRO- LOC O B G L IT
x POLICY
AUTOMOBIL.O LIABILITY EODILY INJURY(Per pelma)I S
ANY AUTO 9VEcAA6432 2/3/2013 2/3/2014 gpOILYINJURY(PeteCCl49nl) $
} LLOWNED X SCHEDULED OP •TY DAMAGE S
AUTOS 1
X HIRED AUTOS X AUTOS IJndarinsured>rWlerle S 0 000
FACH OCCURRENCE S
U4IBRELLA LIAR OCCUR AGGREGATE S
EXCESS LIAR CLAIMSAW ! S
0 RETENTION TATO- OT�'
C WO RKERSCOMPENSATION a $e 9revided 3$YQ6tJx ElCH AOOIDENT 0 000
AND EMPLOYERS'VASILITY IN is the carrier. , $
ANY PROPRIETOWPARTNSRIEXECUTNfc NIA 0/9/2014 0/8/201 5 E.L, ISEASH-EA EMPLOYE $ 100 000
OFFICER/MEMBER EXCLUDED? E•L pIgEASE_POLICY LIMB S 500.000
IWwWataY In NHI
If yes,dazaba urwer
OESCRIPTI N OF OP2RATION b
11
p>:aCRIPTION OF OPERATION&1-11-8/VEKICLES(AUathAc RD 1d1,Additional ReM11`0 Schedule,H mora space Is roqulred)
Evidence of aoVerage
CANCELLATION
ERTIFICATE HOLD9R THE
ABOVE
DESCRIBED POLICIES 8cCR
SHOULD
ANY
OWsEDELIVERED IN
(978)688-95x2 HpNDATE
ACCORDANCE WITH THE POLICY PROVISIONS.
Town of North Andover
d1Q45 AUTIEORILEDREPRESENTArne
1600 Osgood Street
North Andover, X& i
X Gilbartl CTC/SAR3AR
1888.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) Tha ACORD name and IOAu are registered marks of ACORID
man,pe,.n.n..e,n
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-058245
KENNETH B REE 7` ~ 1--; '-,.
21 BEWITT AVE=
N ANDOVER MA 014
4,
Expiration
Commissioner 03/24/2016
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-076691
ROBERT A KEEN'
12 E WATER ST
North Andover NSA 018 '
Expiration
Commissioner 08/16/2015
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F:
\ Office of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
egistration. 1.08383 Type:
xpiration: 8/18/2016; DBA
KEEN CONSTRUCTION CO
Kenneth Keen - -
1175 TURNPIKE ST
NO.ANDOVER, MA 01845
Undersecretary
S t
c_.
The Commonwealth of Massachusetts -
- Department o,f`IndifstriglAccWd fs
Office of Investigations
600 Washington Street
Boston,AIA 02111
-www.mass gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant;Information Please Print Legibly
Name(Business/Organizationffn.dividual): Ke-e v) �uo ru c± C *-� ( -)
Address:
City/State/Zip61 <; 5 Phone ? ' 'J f5 2-0 l
Are you an employer?Check the appropriate box: Type of project(required):
1.[ I am a employer with 4. ❑ I am a general contractor and I 6. 0 New construction
employees(full and/or part time).* have liiredthe sub-contractors
2.❑ I am as ola proprietor or partner- listed on the attached sheet.t 7 emodeling
ship and'have no employees These sub-contractors have 8. []Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. E] We are a corporation and its 10.E]Electrical repairs or additions
required.] officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.0Roofrepairs
insurance d.re uireemployees.[No workers'
required.] 1311 Other
comp.insurance required.]
'Any applicant that checks box41 mustalso fill outthe section below showingtheir workers'compensation policy information.
T-Homeowners who submit this affidavit indicating they lire doing all work and then hire outside contractors must submit a new affidavit indicating such.
tCoatractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information,
jam an employer that isproviding workers'compensation insuranceformy employees. Below is thepolicy andjob site
information.
Insurance Company Name Q--e- r 5 5 o►� ►'1 G
Policy#or Self ins.Lic.#: Expiration Date:
Job Site Address: r' City/State/Zip: , go'I'ver
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 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 of this statement may be forwarded to the Office of
Investigations of the DIA for' surance coverage verification.
I do hereby cert! er tl pain d enarties ofperjury that the information provided above is true and correct,
Si afore: Date: 3
12
Phone#• 9) 7 —
Official use only. Do not write in this area,to he completer)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 9:
i