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Home My WebLink AboutBuilding Permit # 9/14/2015 Y: l BUILDING PERMIT O� ,AoRrr� gypp"� �,(,�L@D ibp'YO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ Permit No#: Date Received �SSac HusE��S Date Issued: I PORTANT: Applicant must complete all items on this page LOCATION 6() 16 Print PROPERTY OWNER � � �� e4� '—r i vl Print 100 Year Structure yes to MAP / ()- PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial WRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other d�Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed Distract ❑1Nater/Sewer r c 1 r DESCRIPTION OF WORK TO BE PERFORMED: l v , Identification- Please Te or Print Clearly OWNER: Name: �c�:7 ` 't L-io °i n Is Phone: ,'f —9Z9 ®k 5c; rV� Address: ® �r � � t� , NIL, ck_�1"0` lVCi 2,q5 Contractor Name: h�C' 3�U icNr (o Phone: 9-2 (� j Email le,5 <k vee , e�ow,- Address: Supervisor's Construction License: (6 Exp. Date: d < l 7 Home Improvement License: I CJ<27t� 3 _Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� s G�' FEE: $ Check No.: Recei t No.: f � p NOTE: Persons contracting with unregistered contractors do not have access to th n ffind AM V%oRTH own of nclover 0 :. OA No. Xj Alft , �AKe h ver, ass, rw 7�A�RATIC coc"Ic"ew CK EO S U Nor— BOARD OF HEALTH Food/Kitchen PER D Septic System THIS CERTIFIES THAT ................ ..... . .Im..........f4j>. .. ..U.I.0% ............................................. BUILDING INSPECTOR Foundation has permission to erect ........................ buildin son ... . ......... ... ...... ..... ..... ............... . ..................... Rough to be occupied as ..... ... .. ........ .... ... .. ............... ..... .... .. .... chimney provided that the person accepting this permit s all 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 EI E IN 6 MONTHS ELECTRICAL INSPECTOR ® UNLESS CONSTRUCT ST Rough Service ................. ... ..... .......... .......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit required to Occupy PuildinRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry !Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. po 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 SubmittedI with the Commonwealth of Massachusetts. Inquiries ' To: J 1 t' �. 0 F C- l �P �-1 t� 7 about registration and status should be made to the 'f Director,Home Improvement Contract Registration,10 I t f 5 fi Park Plaza, Room 5170, Boston, MA 02116 617-973- 8787 Owners who secure their own construction I\ GUS h i l7 related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATE REGISTRATION NO. EIN NO. 7b',"' ��5 - 6S 3 E' �� /r5 MA. H.I.C. 10831 46—3783401 C/S=Customer Supplied S+I=Supply+Install CX See Attached Appendix A We hereby submit specifications and estimates for work to jbe performed and materials to be used: w \�ie7 S 1 i _FrGV1+ �df'C_ ,'1 L c— A a fr O I x > Construction related permits: ..........._..............__.........---_-._..._._...._....___.__.._--_..__..__.---..._...._.__...__._____:_....._._.....__..._.....-._....___.............__...........____.._._.........__...__-.---.._..__..____- WORK SC EDUL Contra o 42ft b he work or order the materials before the third day following the signing of this Agreement,unless specified here in wri i . nlractor will begin the work on or about LI (dale).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (dale). The Owner hereby ackno"led es 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 - 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.,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. WJP PI OpOSf3 hereby to furnish material and labor-complete in accordance with above specifications,for the sum of �1 , 1 j , �S C3 X iccc dollars($ t 901 / ). Payment to be made as follows: % ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant ($ un of � 1 ��\ 1175 TURNPIKE ST. PYt�95iyDr' Street Address %�$ upon completion of N._ANDOVER, MA 01845 City/State shall be made forthwith upon (978)691-5201 (978)682-3231 % ($ ) completion of work under this contract. Ph en Fax Notice: No agreement for home improvement contracting work shall require a I�U y! I '') >down payment(advance deposit)of more than one-third of the total contract price Name of sal / or the total amount of all deposits or payments which the contractor must make,in -- n ;i —C;" advance,to order and/or otherwise obtain delivery of special order materials and Autlwnled'Slgna 6o, equipment,whichever amount Is greater. Note:This proposal may be withdrawn by us Hoof 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 staled. 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 �cX / Date"(" a�',r',r Signature Date IMPORTANT INFORMATION ON BACK NO- CO w6on.Co, REMC�OEI_INC: SPECILILIS7% 978-69"�-5207 Kee nConstructionCo.com Berzins, Paul & Laura 1080 Turnpike St. N.Andover, MA 01845 Contract#5552;Appendix A August 26, 2015 Remodel front porch: • Install temporary beam to support existing roof • Remove and dispose of existing deck and roof support • Rebuild deck using 2"x 10"framing to current code specifications on existing footings • Deck and stairs will be similar size as existing • Supply& install Azek XLM decking in RiverRock(grey)with color matched screw plugs • Supply& install PVC lattice around bottom of deck • Supply& install PVC trim on deck and stairs Total Price: $6,690.00 (six thousand six hundred ninety dollars) Price does not include cost of permits, railings, decorative columns, painting or repairs to any unusual, unsafe, or non-code compliant existing conditions not addressed in this appendix. Payment Schedule: $1000.00 due upon signing contract $2000.00 due when demo is complete (plus permit fee) $2000.00 due when deck and stairs are framed $1690.00 due at completion of contracted work Customer Robert A Keen Date Date 1175 Turnpike St. Page I of 1 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 The Commonwealth ofMassachusetts - -' Department of Xndi(striglAccWt is Office of.Investigations 600 Washington Street Boston,MA 02111 -www.mass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please PrinE Ise ibXv Name(Business/Organization/Individual): k-e—n (f(M J (^u_� i� Address: y City/State/Zip: UnF, IV A 61916 Phone#: 92 Z_ 6 9 l-52.6 I Are you an employer?Check the appropriate box: Type of project(required): 1.[� I am a employer with 4. ❑ I am a general contractor and I 6. []New construction employees(full and/or part-time).* have Hired the sub-contractors 2.❑ I am a sole proprietor orpariner- listed on the attached sheet. 7. [VRemodeling ship and'have no employees [(These sub-contractors have 8. Demolition working forme in any capacity. workers' comp.insurance. 9, []BuiIding addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.E]Electrical repairs or additions required.] officers have exercised their 3.El Z 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.QR.00frepairs insurance j ired.re q uemployees.[No workers' Un Other comp.insurance required.] *Any applicant that checks box#1 mustalso fill outthe section below showing their workers'compensation policy information. i-Homeowners who submit this affidavit indicatingthey A're 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 of the sub-contractors and their workers'comp.policy information. X am an employer that isproviding workers'compensation insurance for my employees: Below is thepolley and joh site information. Insurance Company Name:. vt,' c t n 6 o Ff.: n +xpirationDato: 9 /111) k Job Site Address: !� ` � �`'rn p 1 �_-2 cit .City/State/zip: C, o r Old 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 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 Offico of Investigations of the DIA for i�surance overage verification. 'Ido Hereby eert n er th ains cdpenalties ofperjury that the informationprovided above is true and correct. Si afore: Date: 7 / Phone# 71— (n 2 — VE_21-6 1 Official use only. Do not write in this area,to he completed by city or town official. City or Town: PermitlLicense 0 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone 4: RightFax C3-1 3/24/2015 9:51 :03 AM PAGE 2/002 Fax Server DATE(MM/DD/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 d 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): E-MAIL READING,MA 01867 ADDRESS: 246WY INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNTT'Y 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 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 (MM\DD\YYYY) (MKDD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMPREMISES GENERAL LIABILITY CLAIMS MADE OCCUR. REMI EES S( RENTED $ (Ea occurrence) ED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ 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 LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X 1 WC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-9991M582-14 10/08/2014 10/08/2015 LIMITS ANY PROPERITOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 It 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 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1600 OSGOOD STREET IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT VE t NORTH ANDOVER,MA 01845 �1�? ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Massachusetts -Department of Public Safety Board of Building Regulations and Standards -f - �.I/ll.l Ll Ul.Ll It/1 JUpul vi.-ml �® License: CS-076691 ROBERT A KEEN-` 12 E WATER ST t$ ¢ North Andover NfA 0 r ?yl S JI"141 ` Expiration Commissioner 08/16/2017 �e�parn��aoauuecc�o��accc�cwe�t Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Wegistration: ;-1.08383 Type: piration: 81.16%20-16-;; DBA KEEN CONSTRUCTION a� Kenneth Keen 1175 TURNPIKE ST NO.ANDOVER, MA 01845 Undersecretary