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Home My WebLink AboutBuilding Permit # 7/6/2016 t% BUILDING PERMIT OF ORTI-i16 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION PermitNo#: Date Received Date Issued: CHUS MOXTANT:Applicant must complete all items on this page LOCATION ctc, r) rin PROPERTY OWNER bc,\("t k Bep+*,5te-�, Print f 100 Year Structure yes MAP 0 6 PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential F1 New Building ne family [I Addition Two or more family 11 Industrial D Alteration No. of units: 11 Commercial --XRepair, replacement [I Assessory Bldg 11 Others: 0 Demolition 11 Other 51 h -10 ow kwiaz DESCRIPTION OF WORK T-0 BE PERFORMED: j.0rJec r-epc, , �- �-ft�VAJ- Identification- P ase Type oar Pr* t Clegrly OWNER: Name: C',�J'k V I.-5Vc, -i ct vA Phone: Address-- 2-15 ce y- Llv-,\ Contractor Name: Phone:1,ckla- S-2-0 ( 00n ,�-cstoIJ Email '5 c�(e 5 & 12�A, - *�"U C:�0 Address:_A :E�r-v\ 0 lu an a-VLI,- MLt olsq5 Supervisor's Construction LicenseO '(D-] C-, 9 1 Exp. Date: 1 � h Z 3<Z 3 ' / Home Improvement License: Exp. Date: 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. Ck-) Total Project Cost: $ FEE: $ Check No.: 1 1... Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to e uar n nd trn, t al Sianatur C nr,� t%ORTH Town of E �' fludover vL ® 0 ® 2 yy C% hver. Mass, 2-69 5 Y O LAKE / 1 COc Kac"tw.c. �1• A04ATIE® � Rmm= IT T S U BOARD OF HEALTH Food/Kitchen P �E U Septic System THIS CERTIFIES THAT ...... ��^-� 5 . ,, BUILDING INSPECTOR .... ..................... .........................1 has permission to erect buildings on p 5 °'� Foundation .................... ................... ....................... ' '........................ Rough E to be occupied as ............................ ..... .I.:.:� ��( .. ./ eP ...... 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS TIO ARTS Rough Service ..To..,,............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® ccupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. KEEN CONSTRUCTION CO. c 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 Submitted with the Commonwealth of Massachusetts. Inquiries To: FT� I/ about registration and status should be made to the r Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617-973- 8787 Owners who secure their own construction 3a �e E related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATE REGISTRATION NO. EIN N0. I , MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install C See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: > Construction related permits: WORK SCHEDULE Contraclo w ❑t i"e work or order the materials before the third day following the signing of this Agreement,unless specified here t� tractor will begin the work on or about (date). Barnng delay caused by circumstances beyond Contractor's control the work will be completed by (date).The Owner hereby ack cowled s and agrees that the scheduling dales are approximate and that such delays that are not avoidable by the Contractor shall not be consi ered 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 Con racto,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 lab/otr-complete in accordance with above specifications,for the sum of: 1 (3Q �A�L,— ,-VC� !V atb \(,d dollars($ l( , no y Payfnenl to be made aViollows: �I ($ ) upon signing Cont ct; ROBERT A. KEEN Name of Contractor,Designated Registrant ($ �Ipl F�rVI c 1175 TURNPIKE ST. 11'!I/', Street Address om letion ofN. ANDOVER MA 01845 ° ( � �..- P ciryrState r shall be made forthwith upon (978)691-5201 (978)682-3231 lll�� ) completion of work under this contract. Ph°a 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 of sal 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 Authmr a sl ria re I 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:Ca cellation must be done in writing. �DO NOT SIGN THIS CONT R C IF THERE ARE ANY BLANK SPACES. Signature I LL-- Dale /57- Signature Dale IMPORTANT INFORMATION ON BACK ek," Can'ti^ucOn,Ca, REM[7UELINC SPECl/_\LISTS 978-697-5207 KeenConstructionCo_com Pashayan, Betsey& Dave 25 Cedar Ln. N.Andover, MA 01845 Contract#5545;Appendix A July 3, 2015 Water Damage Repairs: • Jack's bedroom: o Remove and dispose of ceiling and investigate mold concerns on insulation o Supply& install new blueboard and skimcoat plaster • Stairway: o Remove and dispose of ceiling and V down wall o Supply&install new blueboard and skimcoat plaster • Living room, dining room &entry: o Remove and dispose of ceiling approx.4'from outside wall o Supply&install new blueboard and skimcoat plaster • Kitchen &family room: o Remove cabinet trim o Remove and dispose of ceiling in kitchen through family room o Supply& install new blueboard and skimcoat plaster o Re-install cabinet trim • Center wall clear openings: o Remove and dispose of casing o Supply& install blueboard and skimcoat plaster o Patch base molding as needed • Living room: o Remove chair rail and prep walls for paint • Supply& install six Harvey double hung replacement windows (white) with Energy Star glass and grids in the top sash. Replace all window trim with 2%"flat casing • Supply& install four recessed light fixtures • Supply& install new Masonite BFT-215-06E-2 (craftsman style,fir texture, 6-lite, exterior grilles) fiberglass entry door, new hardware and new retractable screen door 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 `on Jt; Construe,oln Co �amc�uFL�nc. SI'ECIALtS'IS 978-69"1-520-1 Keen Construction Cocom Total Price: $10,900(ten thousand nine hundred dollars) Price does not include cost of permits, painting or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this contract. Payment Schedule: $1000.00 due upon signing contract $2500.00 due when door is installed (plus permit fee) $2500.00 due when windows are installed $2500.00 due when plaster is complete $2400.00 due at completion of contracted work l Customer Robert A. Keen 7 '?/3 1!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 - -' Department of Industritd Accidents Office of Investigations 600 Washington Street Boston,MA 02111 kvi -www.mass gov/dia Workers' Compensation Insurance Affidavit: B-ailders/Contractors/.El.ectricians/Plumbexs Applicant Information. Please Prim Legibiy Name(Business/Organization/fn.dividual): �' V) C(�/l 5 r lu Address: I � � 7tJ r n b,( e- � - Cxty/Stade/Zip: 11� Vl e- &AF,AF, I�11 . 619� 6 Phone#: �}� ` — — 2-y Are you an employer?Check the appropriate box: Type of project(:required): 1. I am a em 10 ex with ❑ I am a general contractor and I [� p y 6. []New construction employees(full and/or pant-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. C[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.Q Electrical repairs or additions required.] officers have exercised their 3.[[I am a homeowner doing all work right of exemption per MGL II.El Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.Q Roo repairs insurance required.] employees.[No workers' 13.Q Other comp.insurance,required.] 'Any applicant that checks box#1 mustalso fill outthe section below showingtheir workers'compensation policy information. t"Homeowners who submit this affidavit indicatingthey ai'e doing all work and then hire outside contractors must submit anew 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. I am an employer that isproviding workers'compensation insuranceformy employees. Bellow is thepolley and jots site information. Insurance Company Name% �v�I (^� 1�'1 � Ll��'� Policy#or Self ins.Lic. Q� C1 MS,(6`2.- gExpirationDate: � ' Job Site Address: -ZC City/State/Zip: I V IVB Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requlred-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 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 insur e coverage verification. I do Hereby certi der pal andpenadtles ofperjury that the information provided eabove is truce and correct. 7 - Si ature: Date: l AJ Phone 4 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): 1.Board of Health 2.BuildingDepartment 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone M •1 RightFax C3-1 3/24/2015 9;51 : 03 AM PAGE 2/002 Fax Server DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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 CERT TE HOLDER. IMPORTANT:If the certiflcate 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 (Arc,No,Ext): (A/C,No)- E-MAIL o):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: TIS S 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 (MM\DDIYYYY) (MMkDD\YYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F__1 OCCUR. PREMISES(Ea occurrence) ED EXP(Anyone person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ ENERALAGGREGATE $ POLICY PROJECT LOC RODUCTS-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 $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND Y WC STATUTORY I�OTHER EMPLOYER'S LIABILITY YIN UB-9991M5B2-14 10/08/2014 10/06/2015 LIMITS I ANY PROPERITOR/PARTtJER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,desaibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 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 REPRESENTlVE n4` NORTH ANDOVER,MA 01845 ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD __ 1088-2010 ACORD CORPORATION. All rights reserved. 4. 5 Massachusetts - Department of PUb#ic Safety Board of Building Regulations and Standards Construction Supers icor License: CS-076691 ROBERT A KEEN 12 E WATER ST North Andover MA 0184,0 apY . J Expiration Commissioner 08/16/2016 �' �e�panvneaizcue�o�C> acce�uQel�a Office of Consumer Affairs&Business Regulation WXME IMPROVEMENT CONTRACTOR istration:9 6108383 Type: piration:,_ L18%20_k6; DBA KEEN CONSTRUCTI; GO Kenneth Keen �" € 1175 TURNPIKE ST ge Pz NO.ANDOVER, MA 01845` Undersecretary t