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Home My WebLink AboutBuilding Permit # 9/22/2015 ......... BUILDING PERMIT 0osary q� TOWN OF NORTHA VE APPLICATION FOR PLAN EXAMINATION Permit No#: f Date Received �r�'DRArED craus��c Date Issued: ✓ IMPORTANT: Applicant must complete all items on this page LOCATION --) & r`A � Print PROPERTY OWNER c �.` e- V cC,\ Print 100 Year Structure yes MAP ( PARCEL: It ZONING DISTRICT: Historic District yes nog Machine Shop Village yes nod TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial gCRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r rrr ,r r i�i✓n ., /i,. / a. o. r. it„/i/ r / r /. , /r, „, ,,. lr f r/ / ,,, ,� s, r i/ ,❑ rWa ershed�DI t I ,/ ❑Wetand / / / O al I / / / 1 / / r �� .� � DESCR � r 10, Location �� ,: '"� e, No � ry Bm Date d_ Identific� OWNER: Name: TOWN OF NORTH ANDOVER Address: 3-)` o x Foy-cj r; i Certificate of Occupancy $ Contractor N me: VQ,evv Building/Frame Permit Fee Email: �-2cx le,5 r, 160,01" Foundation Permit Fee $ Address: I I ) -To f-p p 4 Va Other Permit Fee $ Supervisor's Construction Licer' TOTAL $ Home Improvement License: i check# ARCHITECT/ENGINEER Buildin6 Irispector Address: FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OFT HE TOTAL ESTIMATED COST BASED ON mm 9 Total Project Cost: $ ) T- FEE: $ g Check No.: I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to then” at hty ,wind ,.r � r r-mr"q tkORTH -indover Town of 0 No. h LAEver, ass, � COCNICKIWIC K.��• ORATED S V BOARD OF HEALTH Now Food/Kitchen ERMIT T Septic System THIS CERTIFIES THAT ......... � ...(�. .. !:�`l BUILDING INSPECTOR .. .............................................................................. has permission to erect .......................... buildings on � .��>.. .................../.............................. Foundation p L/ Rough tobe occupied as ................................................................................................................................... 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 IMONTHS ELECTRICAL INSPECTOR UNLESS C CTIO TARTS Rough Service ... . ....................................... Final DING INSPECTOR -- GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 Approved by the Building Inspector. Burner Street No. Smoke Det. 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 '/ 1 with the Commonwealth of Massachusetts. Inquiries Submitted dl C 'e k Alk T !VI G 1 To: '\ � about registration and status should be made to the Director,Home Improvement Contract Registration,10 1J O XCi C J T Park Plaza, Room 5170, Bostori ,,MA 02116 617.973- GI'r 8787 Owners who secure their own construction ,f\ `c�'�� (� O f" l related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATE flEOISTRATION NO. EIN No. q/1 Z / 1 5 MA. H.I.C. 108383 46-3783401 > C/S=Customer Supplied S+I=Supply+Install [W See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: 1 ReAAC)cI-J Por-��der- 906IAt i I i Construction related permits: ._... _..._.__....._.___..............__._..___.___....__.__........... WORK SC DU E Contra c wi he work or order the materials before the third day following the signing of this Agreement,unless specified her i rte tractor will begin the work on or about (date). earring delay caused by circumstances beyond Contractors control,the work will be completed by (dale). The Owner hereby acknowledg s and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no a 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 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 accordanancc(e"with above specifications,for the sum of �IPye�- __ Iia USc�ti A �12QQWN \�O-AA PI{ �—_—dollars($�1 �0). Payment to be made as follows: I `U ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant ($ hupon�.pletb'on m 1175 TURNPIKE ST. Street Address ($ 'Vof N. ANDOVER, MA 01845 city/State shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. PhoPa. 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 salearpa 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 Aut ar eas n re equipment,whichever amount is greater. Note:This proposal may be 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 trans ction.21Cacellation must be done in writing. i' O OT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature Date I D Signature Date IMPORTANT INFORMATION ON BACK ,W.N1 'SConsfruc6on Co, 6040 � Lynch, Katie & Matt 379 Boxford St. N. Andover, MA 01845 Contract#5526; Appendix A August 12, 2015 Remodel powder room: $8450 • Remove and dispose of ceiling,tile floor(8 man-hour allowance) and existing plumbing fixtures • Supply& install new fan/light combo, upgrade electrical as needed • Supply& install new laundry valve, install customer supplied plumbing fixtures • Supply&install%" blueboard on ceiling and skimcoat plaster to smooth finish • Supply& install trim to match existing • Supply& install underlayment and tile on floor($5/sq. ft. tile allowance) • Paint walls, ceiling and trim • Install customer supplied cabinetry Front foyer: $3308 • Remove and dispose of existing floor in foyer(8 man-hour allowance) • Supply& install underlayment and tile in a herringbone pattern ($6/sq. ft. tile allowance) Prices do not include cost of permits, cabinetry, plumbing fixtures or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this quote. Total Price: $11,758.00 (eleven thousand seven hundred fifty eight dollars) Payment Schedule: $1000.00 due upon signing contract $2000.00 due the first day of work(plus permit fees) $3000.00 due when demo is complete $3000.00 due when plaster is complete $2,758.00 due at completion of contracted work Cusomer Robert A. Keen _La :5-1- 5 //5. Date t Date 1175 Turnpike 5t. page 1 of 1 P: 978-691-5201 N.Andover, MA 01845 F:978-682-3231 G5L#076691 Sales@KeenGonstructionGo.com HIG #108383 The Commonwealth of Massachusetts - Department oflnrlusfrigl Acclkl is Office of Investigations 600 Washington Street Boston,NIA 02111 UT www.mass gov/dia Workers' Compensation Insurance.Affidavit:Builders/Contrcactoxs/Flectricians/Plumbers Applicant Information. Please Print;Legibly Name (Business/Organization/Lidividual): G{'-0—V1 (N1 J +ro�� Address: City/State/Zip: V1 d 6\tF6, � 617 Phone#: 97 Y 2- Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with -!- 4• El am a general contractor and 1 6. El Now construction employees(fall and/or part-time).* have hired the sub-contractors 2,01 am a sole proprietor orpartner- listed on the attached sheet. 7• Remodeling ship and'have no employees 'these sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. E]Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption por MGL 11.❑Plumbing repairs or additions myself.[No workers' comp, c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] employees.Wo workers' 1311 Other comp,insurance xequired.] 'Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information. i-Homeowners who submit this affidavit indicatingthey 2'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. I am an employer that isproviding workers'compensation insurance formy employees. Below is thepolicy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.##: (� u `� 9xpirationDate: 1.J Job Site Address: City/State/Zip: A), 'l v�dd tie e- Attach a copy of the workers'compensation Polley 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.WORD 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 insurance coverage verification. I do hereby cert r til gins d penalties of perjury that the information provider)above is fru and correct. Simafore: Date: / Phone#• 1 7 tea—/ 2'Q Official use only. Do not write in this area,to be completer)by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk d.EIectrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone#: RightFax C3-1 3/24/2015 9:51 : 03 AM PAGE 2/002 Fax Server `? DATE(MWDD� CERTIFICATE OF LIABILITY INSURANCE T_ TIFICATE 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 BELO\ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIV, OR PRODUCER. 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 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: THIS 19 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 (MM\DD\YYYY) (MKDD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F__1 OCCUR. PREMISES(Ea occurrence) ff--:: ED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY D PROJECT E]LOC 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 $ 71 (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIARILI CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X ,WC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-9991M5B2-14 10/06/2014 10/08/2015 LIMITS i ANY PROPERITOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? WA E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS CONIP 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/,)AIVE ' NORTH ANDOVER,MA 01845 m n t� 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 1.I111�L1 UlLlllll JUI/GI Vill'/l License: CS-076691 ROBERT A KEEN- -` 12 E WATER ST� I North Andover AR 0 r Expiration Commissioner 08/16/2017 ��ie�paiwnaoauuea��2 o�G%l�GuazttrlacLu�eC7a Office of Consumer Affairs&Business Regulation ftME IMPROVEMENT CONTRACTOR epgistration: j08383 Type: iration 8/18/2016. DBA KEEN CONSTRUCTION CO , Kenneth Keen , 1175 TURNPIKE ST NO.ANDOVER, MA 01845 s Undersecretary