HomeMy WebLinkAboutBuilding Permit # 6/9/2015 'r
NORTH
BUILDING PERMIT 0.1�t�Eo '6,910
TOWN OF NORTH ANDOVER �_
APPLICATION FOR PLAN EXAMINATION -
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Permit No#: Date Received 00ATEU
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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
[)rRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well , ,, r ❑ Floodplain ❑:Wetlands ❑ Watershed District
DESCRIPTION OF WORK TO BE PERF RM D:
-Floor-, "�-�,d � lel 'vJ `3`!�y►^ S �� r r 1 CIU
`E-x Ce a i a • Y-6C) J,� � ✓tet
Identification- Pleasepe or Print Clearly
OWNER: Name: 14v7 P cA i� 1v�t- 5 Phone: Y? ��� " 1 q17
Address: 46 C�1 J � Je-ve'-
Contractor Name1 rJff,t inr � �. l
Ad
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ ` � ` �� 9 (-)c) FEE: $ Ii
, ,bl
Check No.: 1(4 3 S Receipt No.:
1
NOTE: Persons contracting with unregistered contractors Flo not have access to the g arae fu
Signature of Agent/Owner Signature of contractor
F t%®RT'H
Town of ndover
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2.01's
coc"IC"@WICK 11,
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BOARD OF HEALTH
PE IT LD Food/Kitchen
Septic System
T..
THIS CERTIFIES THAT ... BUILDING INSPECTOR
...... ... ......... ........ .......... ....... ... ..... .......................................
has permission-to erect . ..... buildings on .. ... e. A.% Foundation
................ ..... C ....
Rough
t
to be occupied as ....... .. ..... . ... ..... ........ .......� � n........ .......... 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
EXPIRESPERMIT IN T ELECTRICAL INSPECTOR
_
oUNLESSI STJ Rough
.............. ....... Service
. .....................................................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® Occupy Building Rough
Displayin a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected rove the Building Inspector. Burner
Street No.
Smoke Det.
7 ee
Cons;truefion Co,
REMC�bELlnc; SPECl/_'�LIS'TS
9'75-697-520
Keen ConstructionCo.com
Rogers, Chip &Ann
45 Chestnut St.
N.Andover, MA 01845
May 15, 2015
Contract#5523; Appendix A
Install and re-finish hardwood flooring:
Second floor partial: $8,433
• Remove and dispose of existing carpet in hall and master bedroom, including closets
• Re-nail subfloor and install moisture barrier
• Supply& install 2 %" Oak flooring; sand &seal with three coats of water based urethane
First floor sand &seal: $3,866
• Disconnect gas range, dishwasher and refrigerator
• Sand first floor(except for dining room and formal living room)existing hardwood
flooring, including stairs
• Seal floor with three coats of water based urethane
Total Price: $12,299 (twelve thousand two hundred ninety nine dollars)
Prices do not include cost of permits, moving or storing furniture, or any problems found under carpets.
Payment Schedule: $1,000.00 due upon signing contract
$4,000.00 due the first day of work (plus permit fees)
$3,500.00 due when flooring is installed
$3,799.00 due at completion of contracted work
Customer Robert A. Keen
Date Date
1175 Turnpike St. P: 978-691-5201
N. Andover, MA 01845 F: 978-682-3231
CSL#076691 Sales@KeenConstructionCo.com HIC #108383
551.
KEEN CONSTRUCTION CO.
° 1175 TURNPIKE STREET PROPOSAL
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
Chapter 142A of the general laws, must be registered
Submittedwith the Commonwealth of Massachusetts. Inquiries
To: cl v171 Re�cCC) about registration and status should be made to the
Director,Home Improvement Contract Registration,10
`I\ �\'`}1)��Z� Park Plaza, Room 5170, Boston, MA 02116 617-973-
8787 Owners who secure their own construction
�2� related permits or deal with unregistered contractors
will be excluded from the Guaranty Fund Provision
of MGL c.142A.
PHONE DATE REGISTRATIOtI NO. ERN No.
9-T>— (c � D__ �Lt 11 15 I S f I J MA. H.I.C. 108383 46—3783401
> C/S=Customer Supplied S+I=Supply+Install L1 See Attached Appendix A
We hereby submit specifications and estimates for work to be performed and materials to be used:
nCi���
A
> Construction related permits:
...._...___.___._.--___...._...................._-.................__..___.,----._._..._____....._...._........_._.........____..__........._.........
_.�....____..---
WORK SCHEDULE
Conlracfor ill n b in the work or order the materials before the third day following the signing of this Agreement,unless specified he in riting. tractor 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
ackno Me gas n agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractors not a 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 10 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,a1 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
Tyel� dollars($ �f 299 OO ).
P
in to be made as follows:
% ($ ) upon sze`tickbf
g Contract; ROBERT A. KEEN
Name of Contractor/Designated Registrant
($ p 1175 TURNPIKE ST.
Streel Address
YYcompletion of N. ANDOVER, MA 01845
City i State
shall 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 N me of s' n �"
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 AmhnAiea i'nature
equipment,whichever amount Is greater. Note:This proposal maybe 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.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature DaleSignature Date
= IMPORTANT INFORMATION ON BACK Ill
The Commonwealth of Massachusselts -
-' Department o,f Indgshrigl Acclke fs
Office of Investigations
600 Washington Street
Boston,MA 02111
vww.mass.gov/clia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Prim Le&ibly
Name (Business/Organization/Sndividual): Ke-e vW1 ,J +ru
Address: e-
� -
City/State/Z:ip: 4,A r�e �, E�I'I61 '1� Phone#: 7 —J� 1
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 4• ❑ T am a general contractor and T 6. []New construction F
employees(full and/or part-time).* have hired the sub-contractors
2111 am a sola proprietor or partner-
listed on the attached sheet.I 7• Remodeling
ship and'havena employees These sub-contractors have 8. [l Demolition
working for me in any capacity. workers'comp.insurance. g• E]Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
required.] officers have exercised their
3.❑ I 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,Q Roofrepairs
insurance required.] employees.[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 1fomeowners who submit this affidavit indicatingthey kdoing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information.
lam an employer that is providing workers'compensation insurance fors my employees. Below is the policy and joh site
information.
Insurance Company Name:.
Cx .J
Policy#or Self ins.Lic.#:��u � '�- � � � �����* pixationAate• .
Job Site Address: `I �Ldti� City/State/Zip: Gt fi 61
8rg5
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 civil:penalties in the foam 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 DTA for insurance coverage verification,
X do Hereby cert19 n er ibe ains dpenaltles ofperjury that the information provided above is true and correct. -
Si afore Date: i
Phone
Official use only. Do not write in this area,to he 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 Cleric 4.EIectricaI Inspector 5.Plumbing Inspector
6.Other -
ContactPerson: Phone#:
,1
RightFax C3-1 3/24/2015 9:51 :03 AM PAGE 2/002 Fax Server
DATE(MMlDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
T. 1IFICATE 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. D THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the poilcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the
terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
GILBERT INS AGCY INC PHONE FAX
137 MAIN STREET (A/C,No,Ext): (A/C,No):
E-MAIL
READING,MA 01867 ADDRESS:
246WY INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA
KEEN CONSTRUCTION CO INSURER B:
INSURER C:
INSURER D:
1175 TURNPIKE STREET
INSURER E:
NORTH ANDOVER,MA 01845 INSURER F.
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
IS 19 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 ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MMDD\YYYY) (MMmDIYYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $
CLAIMS MADE F'_1 OCCUR. IREMISES(Ea occurrence)
ED EXP(Anyone person) $
GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $
ENERALAGGREGATE $
POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
71 (Per accident)
UMBRELLA LIAB []OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
A WORKER'S COMPENSATION ANDX I WC STATUTORY I OTHER
EMPLOYER'S LIABILITY YM UB-999IM582-14 10/08/2014 10/01/2015 LIMITS I
ANY PROPERITOR E!XCWDD?R/EXECUTIVE M N/A E.L.EACH ACCIDENT $ 100,000
OFFICERIMEMBER EXCLUDE
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes,desaibe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMP $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER CANCELLATION n�-
TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
1600 OSGOOD STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTItVE $'
NORTH ANDOVER,MA 01845 ? w
ACORD 25(2010!05) The ACORD name and logo are registered marks of ACORD m`��M`1988-2010 ACORD CORPORATION. All rights reserved.
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 MA 01845
Expiration
Commissioner 08/16/2415
/ze�poa�a��za�zwea,%C�a���iurtac/zcutelt�
Office of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
9XI' ',elgistration:
168383 Type:
iration: 8118f2-016 DBA
KEEN CONSTRUCTION CO
Kenneth Keen
1175 TURNPIKE ST
NO.ANDOVER, MA 01845 Undersecretary