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HomeMy WebLinkAboutBuilding Permit # 4/27/2015 'i NORTH BUILDING PERMIT Ott�ED ,6gtio �! TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received ��°4ArEDW'P �5* Ss US Date Issued: IMP RTANT: Applicant must complete all items on this page 6 r i,.r�r� :,sr r r ryr r r r ;/ 1 t .f r r f- �ir'` x fr`✓i / r rr/J ..r „_ r d �'' 1 .k frf .✓+Xfd l r..,�/ l ff Wr Xl / / r'`I��rrP„`rYr�^r k --`i� rtfrr tp fYr.l ::r'r rx / � r ✓x rr .! S r :r t:; r r t xM +rr1Ffxr uI l rY"xt JI�x r :r�.�,tl ,,, r eW ii r ',x r r✓t�.r.l�rr„'�rr.' ,"rj,_ 3 ,,,j y,? r Ll r,flr rrtt IN,- :r r,' f r,s r f ? �,rr ss✓ r r; .Ir r �s/,,r. it /1 x s r:,a 1 t r r r j r�,,,,f .,r,%+PARCEL"� ��a�f�r,,'� `ZONING�DISTRI�CT r „�,�Histo'rtc Distnct'r yyes o MAP r r7 r r: r, � x achene Shop Village yes o i 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 ❑ Floo'dplam ❑Wetlands ','e `6 Distract . ❑1Nater/Seviier � � s x DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: C-yl A-, KezA� -41 �� �"C,� Phone:WX- r7 2-66 Address: z� 1°� A�rL r Contractor Name = .. ,, .,; „ Phone r r ! Address � � p 1 St�peruisorfs Construction License j `� �� `� Exp r Datxe ,� ,Home Impra�ement License , , � ,�, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ti. Total Project Cost: $ �� ��' FEE: $ Check No.: Receipt No.: NOTE: Persons contracting wit i unregistered contractors do not have access to 1/1guar ty rad ;Signature of Agent/Owner Signature of contractor rim 11 own ol' 2 e 1j' Andover ® o t Z b O LAKE VeYY aSS' COCKIC"R W'CK �® RATED 7S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THATr. R .. .!: IF T L �D ............................................................ BUILDING INSPECTOR has permission to erect .......................... buildings on .... . ........ .. .... ............ ................................... Foundation �► Rough tobe occupied as ........ . .................... ....... .. .....�s...........:............................................. Chimney provided that the persona epting this permit sha I 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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR a T S Rough Service ................ . ..... ........ ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. 5VA.-i 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 f Chapter 142A of the general laws, must be registered Submitted 1� 'C t G ,`; {; Kr:,'�'�� HCI ' C_ ) with the Commonwealth of Massachusetts. Inquiries To: III about registration and status should be made to the 1 / Director,Home Improvement Contract Registration,10/ rG Park Plaza, Room 5170, Boston, MA 02116 617-973- /1 ) OI �� 8787 Owners who secure their own construction C (� V e V- Y I related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. P ONE DATE TION NO. EIN NO. g'� (�— 7 Z 67 V / REGISTRATION l5 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: � r b If(1�; c . > Construction related permits: _........ -____....___........ __...... _ ____._._ ._.---_................... ._............ ... WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about (dale). 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 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 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 thereby to furnish material and labor-compl to in accordance witch above specifications,for the sum of dee l �CySCtM3 11 `� 1�<V1�t�� JEV��1 JI X dollars($3576,00 ). Payment to be made as follows: /e ($ ) upon sign)rrr111g Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant /e ($ R; i Ion of 1175 TURNPIKE ST. Street Address ) up _ fp a n completion of N. ANDOVER, MA 01845 a; City/Slate - %(�"`/// ( shall be made forthwith upon (978)691-5201 (978)682-3231 $ ) completion of work under this contract. J!o Fax Notice: No agreement for home improvement contracting work shall require a P ti 1 >down payment(advance deposit)of more than one-third of the total contract price 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 gnal— 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 thittrnsaction.Cancellation must be done in writing. DON T SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signal - `� `v �Dele �` ( F / Signature Dale IMPORTANT INFORMATION ON BACK e" - Comifraehon Co, REMVOELInc SPECUALISTS 978-69'1-520"9 Keenconstructionco.com Halbach, Rick& Kathy 79 Gray St. N.Andover, MA 01845 Contract#5529;Appendix A April 15, 2015 Office tile floor: $550 • Cut existing floor in office adjacent to rear door(approx. 12 sq.ft.) • Supply& install underlayment and install customer supplied ceramic tile Office roof:$1066 • Remove top 2' of roof and bottom 1' of siding • Supply& install one layer of Grace Ice& Water Shield on roof and wall sheathing • Re-install siding • Supply&install new roofing where removed Master bedroom:$680 • Paint walls and ceiling Mid front bedroom:$640 • Paint walls and ceiling Rear bedroom:$640 • Paint walls and ceiling All prices include disposal of all construction related debris, but do not include cost of permits or repairs to any unusual, unsafe or non-code compliant existing conditions that have not been addressed in this contract. Total Price: $3576.00 (three thousand five hundred seventy six dollars) 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 ConstrUc6on Ca, RFMC�UFI_IMC: SPEC:1/�LISTS 978-697-5201 KeenCon structionCo.com Payment Schedule: $1600.00 due when office roof and tile floor is complete (plus permit fees) $1976.00 due at completion of contract work OU9-Q-�c""t'14� !,, Customer Robert A. Keen �5 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 The Commonwealth of Massachusetts iLL Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 4 www.mass gov/dia Workers'Compensation Insurance Affidavit: General Businesses, TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: FUCA— i, Address: n o� k cc City/State/Zip: k, 68 Y- d)Zq_ Phone#: 7 _(0Q t_5 Are you an employer?Check the appropriate box: Business Type(required): employees(full and/ 5. ❑Retail 1.[ I am a employer with , or part-time).* 6. Restaurant/Bar/Eating Establishment 2.® I am a sole proprietor or partnership and have no 7. Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. g Non-profit [No workers' comp. insurance required] 3.El We are a corporation and its officers have exercised 9. ®Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]* 11.0 Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.;n Other CGV1 NCJ. 1 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Beloip is the policy information. Insurance Company Name: Insurer's Address: V b �o`7< '3T55)6-) City/State/Zip: 0,<—\ e) F 7 o �- Policy#or Self-ins.Lic.# G-9991 K 5 Z 2- L' Expiration Date: '10/;x-/I 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. 11 I do hereby certify,ut r the p is and tallies of perjury that the information provided above is true and correct. Signature: "."-. Date: !ib_ -7 Phone#: 7 S 2- 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): L Board of Health 2,Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia 03/29/2015 08:56 FAX 781 942 2226 GILBERT 0001/001 ACCORDDATE OF LIABILITY INSURANCE 4/15/26 4 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UpbN THE CERTIFICATE HOLDER-THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEDIBY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT DETWEEN THE 1$$UING INSURED($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. c Barbara McDonough PRODUCER NDMT. Gilbert Insurance Agency, Inc. PONE (781)942-2225 Pn� (70l)9a2-2226 137 Main Street �oAll .bmadonough@giIbex tinsuranca,cotn INS R( R$ {{FF0RDIN0 C VERAOE I NAIC 0 Reading MA 01$67-3922 INSURERA:NORF'OT,K &, DEDHAM INSURANCE _23965 INSURED INSURER A•$�fOt Y71Sural'100, Keen O4nst uctipz7 Company INSURERC:Travel.ers Insurance 0022 1175 Turnpike Street INSURER D I INSURER E! North Andover MA 0184.5 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1441500922 REVISION NUMBER:I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR FHE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION QF 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 CLAIM$. NSR TYPE OP INSURANCE A OUEXP EEB�F POLICCY LTR POLICYNUMBER MMI0C0= M 7D0 LIMITS GENERALLfA01LITY EACH OCCURRENCE I S 1,000,000 X COMMERCIAL GENERAL LIABILITY OAMA E 10 REN A CLAIM9-MADE ©OCCUR —P-010076/000 / /2016 rtanca I S 100,000 /13J2015 13 M0 EXP(Any one ersan 3 5,000 PERSONAL d ADV INJUft7 I 31000,000 GENERAL AGGREGATE S 2,000,000 GEN'l,AGGREGATELIMRAPP44$PER: PROD CTS-COMP/OPAGG S 2,000,000 X POLIOY PIlf("T 71 RO, OC 9 AUTOMOBILE LIABILITY COM�aB�INNEU IN L LIMIT 11000,000 BANY AUTO pp 6gGILY INJURY(Pnr Person) S ALLOVMED X AUT06ULEO 6226607 05/23/2014 5/23/2015 BOOILYINJURY(Peracadant) S H 5{ NON-OWNED PR PER bAMA E HIRED AUTO$ AUTOS g $ Undav'ioruredmetoFisl I S 100,00 UMBRELLA LIAe HOCCUR EACH OCCURRENCE I $ EXCE56 UAE CLAIM •MADE AGGREGATE S DED RETENTigN3 I g G AND KERSEMPLCOMPIIEUA IION o Be Provided directly WC STAT - DTH- ANY PROPRICTORIPARTNERIEXECUTIVE YIN 14 tno tnrri*r. E,L EACH ACCIDENT 3 100,000 OFFIOERRIMEMSER EXCLUDED? N/A (MandatoryIii NH) 10/0/201a 0/8/2015 E,LDISEASE-EAEMPLOYE 9 100,000 if 0yea,desonbe under RIPTION OF OPERATIONS balbalmE,l,pl$EA$6.POLICY LIMIT S 50Q,000 DESC DESCRIPTION OF OPERA71ONS I LOCATIONS I VEHICLES(Alleoll ACORD 101,Addlllonal Remarks Sohedwte,If more spaeo Is roqulrod) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ESE 9ANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR17ED REPRESENTATIVE I I M Gilbert, CIC/SAPBAR ACORD 25(2010105) Q 1988-2010 ACORD CORPORATION.I All rights reserved. INS026(nioos).01 The ACORD name and logo are registered marks of ACORD Massachusetts - Department of PUbiic Safe,,y Board of Building Regulations and Standards Constriction Supervisor License: CS-076691 ROBERT A KEEN--- 12 E WATER ST North Andover MA 0181;5 ,f Expiration Commissioner 08/16/2015 �e epao���aaaacueccLL�a�C�/�ccoaac�uoelta Office of Consumer Affairs&Business Regulation frME IMPROVEMENT CONTRACTOR epgistration: "08383 Type: iration: 8/18(2016;, DBA KEEN CONSTRUCTION CO. .'- Kenneth Keen 1175 TURNPIKE ST g �o NO.ANDOVER, MA 01845 Undersecretary