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Home My WebLink AboutBuilding Permit # 8/26/2015 ',, e1 No RTH 5N BUILDING PERMIT TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION Date Received Permit No#: �H 7 a Date issued: v �DSE IMPORTANT*Applicant must complete all items on this page LOCATION Print t Lr�d� .5—�.-�- PROPERTY OWNER IVe1 T� Il+—LAI+ l t'�'�' I ioo vear structure yas Pnnt MAP f SJ PARCEL: ZONING DISTRICT.,_ Historic District yes tho- Machine Shop Village yes 00 TYPE OF IMPROVEMENT IPRCHPOSED USE - 7n" sidentialResidential❑One family❑Two or more family strial No.of units: mercial Repair,replacement ❑Assessory Bldg ❑Others: ❑DemohtiDn ❑Other Tstn -, Se c fl ell",9 F ootl Ian 0 Wetlands tVYers edb ety ,u DESCRIPTION OF WORK TO BE PERFORMED: ! t +OL d �jcr' Identification-Please Type or Print Clearly OWNER: Name: �i. �-I^ B;Eck LSC a I��-^�° Address: P6 Contractor Name: ��EGs' CcilSfe 7ctir Cc Phone: C ,cavti ��S � :eco cw:9' r'�`D-'�+o✓i o _ Address t l�5 T� Supervisor's Construction License: L5—C=��%�:� Exp. Date: Elf it 7 3Exp. Home Improvement License: /C J` — Date: ARCHITECT/ENGINEER Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER 51000.00 OF THE TOTAL ESTIMATED COST,13ASED ON$125.00 PER S.F. Total Project Cost:$ L��3 CC FEE:$ 1 Check No.: Receipt No.: , NOTE: Persons contracting wit unregistered contractors do not have access to th u I infy and �:•Slnnatur" - '� - - �1an ti irP nfrA�n�ant/Ot nPr � _. _ Town of N°RrH , Andover p No. �� *�Th ver,Mass, `S LJ 2,016 BOARD OF HEALTH PER ood/Kitchen Septic System L, `A® 5we-&4 BUILDING INSPECTORTHIS CERTIFIES THAT......... JI T....... .............................................. ........... L d buildings on 51-1....��...... .........`...................... e. at.°n ATA has permission to erect......................... g !tk Rnug 1y_- n �!�r �t.] ...17. .......... Chimney to be occupied as...... ¢ '. ............ 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 relating to the Inspectloy Ittee®t'on nd PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. �M��i Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES I �ONTH ELECTRICAL INSPECTOR UNLESS CONSTRIyA�5............................. .T ... .................. H°ugh �5f. BUILDING INSPECTOR m.] �nai 7DEPARTMENT occupancy Permit Required to Occupy Buildiin Rough Final Display in a Conspicuous Place on the Premises—Do Not Remove No Lathing or Dry Wall To Be Done Burner Until Inspected and Approved by the Building Inspector, Street Nn. Smoke Det. KEEN c®NsTlaucTfON CO. PROPOSAL 1175 TURNPIKE STREET j NORTH ANDOVER,MA 01845 A6 home improvement contactors and subcontractors g - - Tel:(978)691-5201 engaged in home improvement contacting, unleee Fax:(978)682-3231 specifically exempt from registration by Provisions of Chapter 142A of the geneal laws,m st be registered n f T ? V! with the Commonwealth of Massachusetts In - Submineo Iv t•� �f '�-y qu res T: � about reg stmt on Intl status should be made to[he � r> D rector Haome lreprovein,"Centraor:�Reg et"'. ta[on 16 UCr f� Park Plaz Room 5176 Boston MA 02116 617 973 yc-, 8 7 Owners who a their constructign —rlQ IJO } related permits or tlee with orogi—Ild contractors nHONe ReG Sill be .142A.tl from the Guaranty Funtl Provision III I �t of MGL c.1A2A. �v, ��cicv�a ((il� G!3�7 <,ien np eh ne T a MA.H.LC.908383 46-3783401 C/S=Customer Supplied S+I=Supply+Install ❑ See Attached Appendix A >We M1ereby submit specifications Intl estimates for work to be perfgrmetl and hreerhe to be used t�� Conslructio re ed prints: j tat WORK SCHEDULE M1 be ore the tM1rtl tlay to low ng hesgri ng of tris Agreement un a ss spedl'ed M1eEey M�g.G 1 Iib g h 7. 11 - v dbv=ropmatanees beyl.asephiru aeeoa he woraw bco�ma�oetlna na bac sdere spa Dna qn-eor geemem. wletlges Intl agrees that the scnetlu"ng tlates are eppro+mare Intl the suc e.''her are vo ab a by Ne WARRANTY plaraperiodof fallowing completlan entl snail TM1e Coniragor warm at M1e work lurnlsnetl hereuntler shall be Iraq from defects in materials and workmansM1i omply with the requirements qi ihis Agreement In the avant any tlefecl in workma 1,el materiels.ordamage causetl bythe ConUacto actors,employees oragents.is tliscoveretl witM1l'he year atter completion of any job,inclutling cleanup,me Con«actor snail,at his own expense,f.lhwitM1 remedy,repair.correct,replace.or cause to be remedied. repairetl,or replaced,..,damage el such defect In materials or workmanship TM1e Igregoing warranties shall survive any Inspection performed in connection with 1M1e agreed-upon work. We PrOpOse hereby to furnish material and labor-complete In accordance with above specifications,for the sum of: dollars(f aaym ie he be made o tougws. _ -v)COC Upon Signing Contract; ROBERT AoKEEN ($ ) P 9 9 ee n me er no ted aegiet.... `/ ($ )upon completion of 1175 TURNPIKE ST. ($ )upon completion of Na ANDOVER,MA 01845 III shall be made forthwith upon (978)691-$201 (978)682-3235 ($ )completion of work under this contract — Notice No agreement for home improvement contaacbrrg work shall require >down payment(advance deposit)of more than one-third of the total contract pr co s or the total amount of all deposits or payments which the contractor must make,in advanceorder and/or otherw e obtain delivery of special order materials and n......sig.... r tla ent�whohaver amount is creator equipm 9 Acceptance ofPropOSal-lhavereadbothside,ofthisdoet,mentandanchedanadoaumemaoandaoceptthephoes5ape,,fid i-eandeoradion.stated. I understand that upon signing,this proposal becomes a binding contrail.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. SIGN THIS CONTRACT If THERE ARE ANY BLANK SPACES. YI I U1/h f N�/f",. Dale IMPORTANT INFORMATION ON BACK Mi ,The Commonwealth ofMasst chusetts Department of IndustrialAccidenfs �S._e. 5 I Congress Street,Suite 100. Easton,wa 02119 www.massgov/disie Workers'Compeasafion Lsnrsnice Affidavit:Builders/Contractors/Clnet<7cans/Plumbars. TO BFFII.ED WITIITHE kERAUTTJWGAUTffORlTY- Appli,antInfonnation Please Print La bl Name(Eaa;nasa/organbmuonttnaioiaaal): �t/i wr 5- IY/<- (C'1_ Address:/ — City/State/Zip: Areyon an anrpmyar?c6adcthe appi'opriateLox: Type of project(Asplaed): I.�Iam cmployarwitlr ,�. employees(flrllavd/orpart-time)." 7.❑NeW conshvction 2.❑Ism sclepropriatoxorpermexship and Lave va mnployees working formein $.DRemode7idg airy capacity[Nowarkms'comp.vuuranca inquired.] 9,❑Demolition 3.❑I am ahsmeewnor doipg all work myself[No workers'cmnp.insura¢cerequired.l t 10❑Building addition 4.0 I an.h--eudwill belilring confractcrs[o conduct elI workon my property.Iwilt amathaeau nommetorsa;iharhava workers'aomperuationinamanao or aresote 11.❑Electrical repairs or additions proprierora wi;hao employees. _ 12.❑Plumbing repairs or additions - 5.❑I-,agenmalconhncbrandIhayshhedthesub-cPawtomliatcdoathe atlachedsbeet' 13.❑Roofrepaixs These sub-couhacMrs Lade oaptoyees andh—workers'comp.insuauce.- 6.❑Waareacmpomi[onandita gf{Tc haveexercisedtheir right of'exemptim pa,MGL c. ME]Other 152,§1(4),andwebave m.emp1q,.[IQoworkers'comp.insurance reguired.] •'Any applicant that checkstioxAl must'alss fill ouf Iheseclonbelow showingtheirworkere'compensationpolicyivformation. 't Homeowners wfio submit kWs a6idse,ivdiaating they me doing all workandd—hhe opt ads cmr—to,a rzurstsubmitanew affidavitmdicatingsucL. tContractors that checktbis boxmustattaehed?n additional sheetshpwiug tbpname oftbosubcontmcbm andstate wheUrer ornot thossentities Lave employees.Iftha subaovkmprors liavp employees,iliay must providaihek wodceia omp.policy uvmbar. ' Zam an ern pZoyer that ispioviding workers'campensatima dnsarancefor ney empddyees.'BeZmv is tlaepoZd y andjob site $nformati— InsuranceCompanyName: 0. -2-(e(- Pahcy#nrSell ins.Li,#- U11-999 �4-M ZZ-1t-1 _Elplratin.Dat. 5'715'9 5t _ci isazip:� 4't��we '�/i} 0/8 " Job Site Addeess: - Af4 chacopy oftkeworkm's'compensationpo)icy declaration page(ah ovringthepolicy number and expiration date). Failure to secure coverage as requiredundc MQL o.152,§25A is a crvninal violation punish¢ble by a fine up to$1,500.00 and/or one-yearimprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine o£np to$250.00 a day against the violator.A copy ofildr statement may ba forwardedto the Of lice oflnvestigatio ss ofthe DfA for ialoo-ce coverage—Iffeatimr. Id,hereby certijya .e the tnsa penedtter ofperjury that Ase Bnfrmatlonprovidedabove-irremsdc -t. _sx h,,.. _ _ Date Tb 6/i 5 Phone#: 97 Y-01 Off tat use only.Do natwrite in this area,to be completed by city or hewno-ffl W.. City-Town: Peirai"icanse'tl IssningAuthority(circle one): 1.33 oard of Health 2.MldingDepart—A 3.City/Town Clerk 4.Fketadcal Inspector S.PlrwbingI pacts, 6.Other ContactPm'SOIl; Phone#: _ - RightFax (33-1 3/24/2015 9:51:03 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDD/YYYYI TW24BATIFICATE ISISSU EO AS A MATTER OF INFOpMATION 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 INSURERfS),AUTHORIZED REPRESENTATIVE ODU 0 IC TE IMPORTANT:If the certifleale holder Is an ADDITIONAL INSURED,the pollcy(les)must he endorsed.If SUBROGATION IS WAIVED,subject to the terms...Contlltlons of the policy,certain polleles mayregDire and endorsement Astatemenl on ihls certificate does not confer rights to the certificate holder In RBU of such endorsements. PRODUCER CONTACT NAME: III BERT INS AGCY INC PHONE FAX 137 MAIN STREET (A(C,Na,_I: (NC,ND): EMAIL READING,MA 01867 ADDRESS: 246WY NSURERIS)AFFORDINGCOVERAGE NAICN INSURED IN.DR.R A:TR TT COMPNJY OF-R—A KEEN CONSTRUCTION CO INSURER 8: INSURER C: INSURER D: 1175 TURNPIKE STRIT INSUflIR S NORTH ANDO VER,MA 01845 INsuPER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: P RANCElllmn YYY)E P(MsnBD1YYYY)E R GENERAL LIABILITYNT—I � ACH mn OGCUPRENCE $ COMMERCIAL GENERAL LIABILITY AMAGET0 RENTED $ CLAIMSMADE E30CCUR. PEMISES(Eauccu,Neace) ED EXP(Aly one Pe,aae) $ ERSONAL A ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY OPROJEGT[3LOG RODUCTS-COMP/CP AGO $ AUTOMOBILE UABILRYCOMBINED SINGLE $ ANY AUTO MIT(Eae O.i ) All OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per Pe,aen) BODILY INIURV $ HIRED ANTOS accitlam) NON-OWNED AUTOS PH PROPERttDAMAGE $ (PeN accitlent) UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ PETEMION$ A WORKER'S COMPENSATION AND UB--BSm M582-14 10108/2054 INOW2015 X f0 EMPLOYER'S LIABILITY YM c.., VE Ej NIA E.L EACH ACCIDEM $ 100,0(10 (m—,N NH)Ex E.L.DISEASE-EAEMPLOYEE$ 100,000 E.L.DISEASE-POLICYIIMIT $ BOB DESCR—ON OF OPERARONS/LOCARON—EHICLESIRESTRICRONSISPECIAL ITEMS 5RBPLACRSANYI'ttlORCBRTIFICA'12ISSINDTOTf CERRDCATRHOLDBRAFFR GWORRBRSCOMPCO RAGR. CERTIFICATE HOLDER CANCELLATION ...... ............_......,...,............._....,...�....._........ TOWN OF NORTH ANDOVER SHOULD ANY OFTHE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1600 OSGOOD STRE[;I' IN ACCORDANCE WUH THE POLICY PROVISIONS. AUTHORIZED REPRESENT VE NOR I'IT ANDOVER,MA 01845 ^' 'Z ACORD 25(2010105) The AGDRD name and logo are registered marks of ACORD Y988�2010 ACORD CORPORATION.All rights reserved. kWMass ach usetts-Department of Public Safety Board of Building Regulations and Standards C—'iu-d-Sur- .,,. License:CS-076691 ROBERT AKEErI-`" 12EWATERST jlkg +_ North Andover A A 0 '''W° Expiration Connlssioner 08/16/2017 Off f( omc Aff re&0uainess RegulaM1on ' = ME IMPROVEMENT CONTRACTOR g t t : 108383 Type: p t Bft'8/2016 DBA KEEN CONSTRUCTION CO Kenneth Keen 1175TURNPIKEST _ NO.ANDOVER,MA 01845'- U----y