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Home My WebLink AboutBuilding Permit # 7/10/2015 t%ORTH BUILDING PERMIT 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Date Received Permit Noir: 0 A PR 5 gsSAC 5 Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print , m, J R PROPERTY OWNER 5iI cv-\ -,o Print TOO Year Structure yes 0 MAP PARCEL: 5(0 ZONING DISTRICT: Historic District yes 0 Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building El One family El Addition 11 Two or more family 0 Industrial El Alteration No. of units: El Commercial 16Repair, replacement 0 Assessory Bldg 0 Others: El Demolition 11 Other Fe""',f,',fld" DESCRIPTION OF WORK TO BE PERFORMED: V % Identi ication- PieapTy, e Print learly [ o OWNER: Name: r+ Phone: c. Address: Contractor Name: VC �eyl ( �+4 ��( -L)c� tcA (c) Phone: Email: (65 V aeAn 6-fru cA oe�c� c,o�VN Address: 1,1 '?5 t\� , A"Je,-cr— Supervisor's Construction License: CS — 0:1 94 Exp. Date: Home Improvement License: Exp. Date: /� / C - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDINGPERMiT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ '4 05 --- FEE: $ 6m 1 Check No.: Receipt No.: 11�T- NOTE: Persons contracting with unregistered contractors do not have access tot e u an f nd o fAgenVDwne ttORTH Town '� � _� �'' ®ver i ® '� "' 0 _ y h ver, Mass T O LAKE ' ' COCKIC"f WICK( ' AOf?ATEO u BOARD OF HEALTH PERM T T D Food/Kitchen (� ,,1 Septic System THIS CERTIFIES THAT ®N 0114A La��T BUILDING INSPECTOR ..........`............................. ......................... .. ................. ........ ........ ... .. .. . .. .... has permission to erect .......................... buildings on �.. ... , , ,, ,,, ....... Foundation .. ....... .... ... ..... ........................................ Rough to be occupied as ........................�........ Qr .... .. .... a ... Chimney provided that the person accepting this permit shall in eve 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 MONTHSELECTRICAL INSPECTOR UNLESS CTI® TARTS Rough ...,......'. Service ...... ... r .e... ........... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final • o Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedy the Building Inspector. Burner Street No. Smoke Det. 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 Chapter 142A of the general laws,must be registered Submitted �} with the Commonwealth of Massachusetts. Inquiries To: "f ►\� " ��£1 U rt about registration and status should be made to the Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617-973- `1 ^ n 8767 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 ND. EIN NO. 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: > Construction related permits: WORK SCHEDULE ConlfaGgr ill of a her ",he work or order the materials before the third day following the signing of this Agreement,unless specified her iti ntraclor will begin the work on or about / (date). Barring delay caused by circumstances beyond Contractors control,the work will be completed by (date).The Owner hereby acknowfedges an 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 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-complete in accordance with above specifications,for the sum of: -------dollars($—/ y(,,5,6In ). Payment to be made as follows: /e ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant ($ q co mtlpletion of pip n ofStreet Address u O 1175 TURNPIKE ST. N. ANDOVER, MA 01845 u co - oo -( City/Slate x shall be made forthwith upon (978)691-5201 (978)682-3231----- $ ) completion of work under this contract. PhanFax 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 "a na n. at sm i 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 Aat w6 ad s.ha area equipment,whichever amount is greater. Note:This V 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. 1 r DO NOT SIGN THIS CONTRACT4 IF THERE ARE ANY BLANK SPACES. Signature 11. 71 /— `)- �,f i Date `' Signature Dale 6 IMPORTANT INFORMATION ON BACK eNmouF_rnc sNt;c�nus-rs 9�'8-69"i-528'® Keen Cons truction Co.corn Burt, Mikel &Winston 1580 Salem St. N.Andover, MA 01845 Contract#5539,Appendix A June 23, 2015 Water Damage Repair Replace missing gutter on back of house Repair damaged downdraft vent hood Kitchen: • Remove casing on window and door • Remove affected wallboard and insulation • Patch wallboard to smooth finish • Re-install casing • Paint affected walls Sunroom: • Remove water stained ceiling"panel" and section of wall behind desk • Install new wallboard and plaster to smooth finish • Caulk around all beams • Paint walls and ceiling in room Living Room: • Caulk around front beam • Paint two front ceiling"panels" Foyer: • Apply stain block primer and paint ceiling Powder Room: • Apply stain block and paint ceiling Dining Room: • Apply stain block and paint ceiling 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 -& REMoueL1/YC SPED 1/_�LIS"TS 978-69-1-520'9 KeenConstructionCo.com Baby Bedroom: • Remove closet shelf and brackets • Remove wallboard and insulation on outside wall in closet • Install new insulation and wallboard • Plaster to smooth finish • Paint affected walls • Re-install closet shelf and brackets Guest Room: • Apply stain block and touch up paint as needed Air conditioner repair: • Remove and dispose of wall air conditioner in sunroom • Patch interior wallboard • Patch exterior siding • Paint siding to match Front drainage: • Supply and install underground drainage pipe away from house, approx 20' away Total Price: $7405.00(seven thousand four hundred five dollars) Prices do not include cost of permits or repairs of any unsafe,unusual or non-compliant existing conditions not addressed in this quote. Payment Schedule:$1000.00 due upon signing contract $2000.00 due the first day of work (plus permit fees) $2500.00 due when plaster is complete $1905 due at completion of contracted work �UL 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 The Commonwealth of Massachusetts - -' Department of InclustrlglAcelkl is Offree of Investigations 600 Washington Street Boston,MA 02111 Uf www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/ElectriciansfPlulmbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): G (),A J +ru C±1,,, Address: _T—D r n k e- - 6i_ - Cxty/State/Zip: 4A t) F 6 61 'Y�6 Phone M 20 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with_ 4• ❑ 1 am.a general contractor and I 6. []New construction. employees(full and/or part-time).* have Hired the sub-contractors 2.❑ I am a solo proprietor orpartner-• listed on the attached sheet. 7 F1 Remodeling ship and'have no employees These sub-contractors have 8. (l Demolition working for me in any capacity. workers'comp.insurance. 9. (]Building addition [No workers' comp.insurance 5. ❑ We area corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.El am a homeowner doing all work right of exemption per MGL ILEI Plumbingrepairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12,Q Roof repairs insurance re uired. employees.[No workers' q ]� 13.[]Other comp.insurance required.] 'Any applicant that checks box*l must also fill outthe section below showingtheir workers'compensationpolicy information. t-Homeowners who submit this affidavit indicatingthey tire doing all worleand 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. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolley and jolt site information. insurance Company Name% `if ' r S t 6L)F C:_I .Policy#or Self ins.Lie. 2- ExpirationDate: Job Site Address-, ,r cJ,l e_0l ' � 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 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 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 ins ance coverage verification. I do liereby cert n er th ains a nalties ofperjury that the information provided above is true and correct. - Si ature• Date: 7 �� Phone# ✓ 7 q- L9— 2zbo J Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License 0 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - J Contact Person: Phone 9: RightFax C3-1 3/24/2015 9:51 : 03 AM PAGE 2/002 Fax Server CERTIFICATE 4F LIABILITY INSURANCE DATE(MWDD/YYYY) [THIS `1'IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE PRODU R D 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): (A1C,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: THIS IS 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 (WDDIYYYY) (MMMMYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE E]OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ H� PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY F]PROJECT OLOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINEDSINGLE $ 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 LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X I WC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-9991M582-14 10/08/2014 10/08/2015 LIMITS ANY PROPERITOR/PARTNER/EXECUIIVE OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe 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 REPRESENTAY NORTH ANDOVER,MA 01845 - +w r.. _ 54 ". ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Y' Massachusetts - Department of PUb�ic Safety Board of Building Regulations and Standards Construction Supers icor t. License: CS-076691 ROBERT A KEEN 12 E WATER ST _' North Andover Na 01$ t� Expiration Commissioner 08/16/2015 �ie tpan��uuea�a�C �ac�cuaeC� Office of Consumer Affairs&Business Regulation rxME IMPROVEMENT CONTRACTOR egistration: 18383 Type: piration: lfi8f0 k6 DBA KEEN CONSTRUCTI,'O�1 UQ i P� F tt Kenneth Keen 47 1175 TURNPIKE ST 4 � NO.ANDOVER,MA 01845 Undersecretary