HomeMy WebLinkAboutBuilding Permit # 6/9/2015 I
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BUILDING PERMIT OF�iLe° �6`�tio
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received gSsATED
Date Issued: 41
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
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
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❑Water/Sewer.,i r {
DESCRIPTION OF WORK TO BE PERFORMED: j
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Identification- lease Type or Print Clearly"
OWNER: Name:, C, �CJ �n Phone:
Address: CA " t� I v Ip1✓I
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ARCHITECT/ENGINEER LG (—f-I C LA0,1") Phone: 5?9-- 2
Address: / C Ng s` ��fbr -4.��VA , M Reg. No. 7
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ -C� FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to u an fund
Signature of Agent/Owner, Signature of'contractor
tAORiH
Town of aAndover
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h ver, Mass, c
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BOARD OF HEALTH
PEI , MIT TU LD Food/Kitchen
Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
......... ... .. ........ ... .... ........... ..................
. . .... . .. .. .
Foundation
has permission to erect .......................... buildin s on ... .... .. ......... .... . . ........
. .... Rough
tobe occupied as ...................A......... ......... .. . ..... .#........................................... .. 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 EXPIRES IMONTH ELECTRICAL INSPECTOR
UNLESS I Rough
Service
1�
................ ..... ......... ......................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildin z 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.
1 CaTstruction Co,
RrMOUEI_IWG SPECIIALISTS
975-69-9-S2"ti
KeenConstructionCo.com
Brown,Terry
344 Main St.
N.Andover, MA 01845
Contract#5531;Appendix A May 23, 2015
Garage remodel:
• Frame center beam as drawn by Larry Ogden on 4/20/15,supplying all materials as shown,
substituting the 16" LVL for 18" LVL
• Remove and dispose of existing beam
• Remove and dispose of existing garage doors
• Frame front wall of garage as drawn by Larry Ogden on 4/20/15,supplying all materials as
shown,substituting 16" LVL for 18" LVL
• Supply& install PVC trim on outside of garage doors and siding on front of garage to match
existing
• Supply& install one electrical outlet for opener
• Patch wallboard and plaster as needed
• Create 36" x 36" landing and stairs outside of kitchen door
Total Price: $14,840.00(fourteen thousand eight hundred forty dollars)
Price does not include cost of permits, painting,garage door or repairs to any unsafe, unusual or non-
code compliant existing conditions.
;1_1000 �K J
Payment Schedule: $1166-0WOe upon signing contract
$3r&.00 due the first day of work (plus permit fee)
$4000.00 due when center beam is installed
$4000.00 due when front wall is framed
$2840.00 due at completion of contracted w rk
Customer Robert A. Kee
S �i '� l� � ' s 5 z -
Date Date
1175 Turnpike St. Page 1 of I P: 978-691-5201
N. Andover, MA 01845 F: 978-682-3231
CSL#076691 Sales@KeenConstructionCo.com HIC#108383
55-. '
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
Chapter 142A of the general laws,must be registered
Submittedi3 with the Commonwealth of Massachusetts. Inquiries
To: r`1yC'y about registration and status should be made to the
Director,Home Improvement Contract Registration,10
Park Plaza, Room 5170, Boston, MA 02116 617-973-
8787 Owners who secure their own construction
related permits ordeal with unregistered contractors
will be excluded from the Guaranty Fund Provision
of MGL c.142A.
PHONE DATE REGISTRATION NO. EIN NO.
5 2 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:
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Construction related permits: '..
'-__v._..__.____.._—.....__.._.._..__--._...__.___......_._._..._._—...___--_--...,........................_____.._.._..----------.............._.___....___...___._._____..__..-__.._....___._.___......,.______.________---..__.._...—____
WORK SCHEDULE
Contract r ill 1 b the work or order the materials before the third day following the signing of this Agreement.unless specified herei w ti g. pro for will begin the work on or
about (date). Barring delay caused by circumstances beyond Contractors control,the work will be completed by / J (dale).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 e 4 r 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 Contract r,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-completein accordance with above specifications,for the sum of
ecu'--: y)d �����1� C\U��C! ��C, B UY �`� �' dollars($ �Lf
Payment to be made as follows:
($ ) upon signin Contract; ROBERT A. KEEN
Name of Contractor/Designated Registrant
/o ($ ) u �r�it[ e ion df Street Address
1175 TURNPIKE ST.
\/��1 N. ANDOVER, MA 01845
- // (� 8pdn completion of
/.- � City/State
shall be made forthwith upon (978)691-5201 (978)682-3231
YO ($ ) completion of work under this contract. Phon Fax
Notice: No agreement for home improvement contracting work shall require a l,._ f (le.
>down payment(advance deposit)of more than one-third of the total contract price Name of s fes
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 Minor a— d Signatuie
equipment,whichever amount is greater. Note:This proposal maybe 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, 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 Date f r Signature Data
IMPORTANT INFORMATION ON BACK NO-
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„tt LAWRENCE H. OLDEN, P.E.
198 EAST MAN STREET
GEORGETOWN,MA. 01833
A4 tvJ1 978-352-8318, cell 978-502-5921.
9` S Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
COnStrnction SuperNicor
License: CS-076691
ROBERT A KEEN
12 E WATER STS ?
1,g
.
North Andover NFA Of-8-41-
5
Expiration
Commissioner 08116/201.5
�ze epanvnaoaacue�o�Coccc�ivaeCta
Office of Consumer Affairs&Business Regulation
W'ME
IMPROVEMENT CONTRACTOR
gistration: JJ 8383 Type:
piration: BA72Q16- DBA
r
v.-
KEEN CONSTRUCTI,O}VCO
s
Kenneth Keen
1175 TURNPIKE ST g Q�
NO.ANDOVER,MA 01845 Undersecretary
The Commonwealth of tllassachuse'tts -
Department of Xndtfstr!gl Acc16e fs
Office of Investigations
600 Washington Street
Boston,MA.02111
www.mass:gov/cila '
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organizationilndividual): Kt)-ev)
Address' _TT) -
Cxty/State/Zip: ti V1 t) r F� 61 ;� Phone#: 7 )2 t
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with �- 4• F] I am a general,contractor and I 6. ❑New construction
employees(fall and/or pmt-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner
listed on the attached sheet,t 7. ❑Remodeling
ship and'have no employees These sub-contractors have 8. El Demolition
working for me in any capacity. workers'comp.insurance. g, ❑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 out the section below showing their workers'compensation policy information.
t-Homeowners who submit this affidavit indicating they tiio doing 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 o£the sub-contractors and their workers'comp.policy information.
lam an employer that isproviding workers'compensation insurance formy employees. Below is thepolicy and job site
information.
Insurance Company Name:. �Q-e_
Policy#or Self-ins.Lic.#: (� �u \�� 5 2 9 1 MSZ--2=1 irationDate:
Job Site Address: City/State/Zip:
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 e,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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
X do Hereby cert under the pains and penalties ofperjury that the information provided above is true and correct. -
Si aturo: Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Perxnit/License 9-
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Mectrical Inspector 5.Plumbing Inspector
6.Other -
Contact Person: Phone#:
RightFax C3-1 3/24/2015 9:51 : 03 AM PAGE 2/002 Fax Server
"w CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
T. .. IFICATE 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 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):
READING,MA 01867 E-MAIL
ADDRESS:
246WY
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA
KEEN CONSTRUCTION CO INSURER B:
INSURER C:
1175 TURNPIKE STREET INSURER D:
NORTH ANDOVER,MA 01845 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
IS T C TIFY 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 (MWDD\YYYY) (MMiDD\YYYY) LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE �OCCUR. DAMAGE TO RENTED $
REMISES(Ea occurrence)
ED EXP(Any one person) Is
GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $
POLICY �PROJECT�LOC ENERAL AGGREGATE $
RODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY
ANYAUTO COMBINEDSINGLE $
LIMIT(Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS CLAIMS-MADE AGGREGATE $
DEDUCTIBLE BLE $
RETENTION $ $
A WORKER'S COMPENSATION AND WC STATUTORY OTHER
EMPLOYER'SLIABILITY Y/N UB-9991M5B2-14 10/08/2014 10/08/2015 Y LIMITS
ANY PROPERITOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? M N/A E.L.EACH ACCIDENT $ 100,000
Mandatory In NH)
(I yes,desalbe raider E.L.DISEASE-EA EMPLOYEE $ 100,000
I
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 50(,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
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 REPRESENT VE !=<•. <
NORTH ANDOVER,MA 0184 �...
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-20 ACORD CORPORATION.—AII rights reserved.