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HomeMy WebLinkAboutBuilding Permit # 10/29/2015 T&ORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ » 1 of c Poo oc :�ew•Pw�` Permit IVo#: '�. 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Jr"'{...rr,:.t�;✓rr ✓y„S,e'.�.rf f{`�r'r}1.,rfaa xr.rr.�r``.. :== r ,l�.r»'�`. ;„'r-{rF :}7x sr ri....�`f r i' }:-. ,y „. r :„,r ✓.r xvr ..,,y.�P f :,: �� �;�� „�� r r���� f„ ; � , , �✓��� �r� ,{ r � :j r f� Machine Sho Uilla e{� �' es F + no rJ ����r✓�:., �.�� �,�,. .,,,, �e, :. r�.,,��.r,:,.: . ,.,�,�r ,�,,,,w,,: �r� r ,r,..w1 , ,,��,.� r„ ,, p{ ,:Y � �.� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial $Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Se tick §1/1/ell jr r r r{' Cif FloFod rlain Y ❑Wetlands ❑r Watershed strict % r r r .:F`. r " �'pJ ✓ „xr r f: r r:.. r� hr rr.n:� -'�'��1! J..J,.�Y,Nrl r r..:�...s ,� r„fi,��rz�.r,;U” r`' J: �'f �'/l f'?' > rJ..2'� y;.rz. J =`` r > F'-. � r �1. er; . " ..r r r' r x,,m �✓fir r r' �,::.a .r�..r „:'rrrr ✓u. x' �..-, x"r :s'fi'%`rr'.r trv,/e''r r.-. r v' ,f r J:. � f'r"." vdt"tr�r'..:.,"'r'J�'i` r::- r�w.,a rrJ r r.rrr.. .,: r fry r .,t r{rr r xr ".I a rra'rrs z.:r `"r r' ✓„u: fit„ s:o rr d-; �7mrr *r r {,w._.J � �?' t rY¢i.. :r1 r r?rs,j fie' r,{,: rz`,r�rWaterl$eWer,� r ✓l r � i... / pr'r � r.. rz,/J'ftzP.,:rr,'fr;,,l.�rt kr,',,.. r,,.f§1, r". a>>f�, fir.. 1 r ! .;fir,". DESCRIPTION OF WORK TO BE PERFORMED: rep [c- e-e -, o w, r c1cuJ , do I- --b be d dcC"�' �5 -2 Identification- Please Type or Print Clearly OWNER: Name: )C)CkVt_ J3 + Ie Y-c Phone: Address: ✓ c�c� ' S c �E MA �1 r C ✓- ,r J !u £ ✓ r✓Y,J.f r'ff yf t r f / r' / ✓f G r 'j"'r. Y � r-.fr Nr"r f ,✓ ('g L rrfr r f9� � I `r/�,( 5 f r ,r r :' 1 F✓ ! 4 Y /f.: r Y r� ¢f i✓ 'Contractor Name „ �f >�� r F ✓c��r � rJf � 'Phones r � ` �� ��_ � �� '� � f� /r .h� T'�.�,:9"�'s•=�f ,r.. ?yrr rf r r r,,,./:. 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No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ G 9 FEE: $ ' � Check No.: 16 / Receipt No.;, NOTE: Persons contracting with unregistered contractors do not have access to th ua Ginty:'icnd „ Signature of -7 wner �,;• Signa urebf contractor" , ; %AORTH fir0evwn of2 E ..If' nduver ® �( �O LAI(E h " ver, ass, /o g Js' COC NICHEwICK A00ATED � fJ BOARD OF HEALTH Food/Kitchen rvERMIT T Septic System U� �� BUILDING INSPECTOR THIS CERTIFIES THAT .........Art............................................................................................................. has permission to erect .......................... buildings on . .... !� �.�C`.. ................................. Foundation . Rough to be occupied as l p ....... u�. ............... ... ,.. .��...C�. ..� G.�O..: ................................. Chimney provided that the person accepting thi ermit 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 MONTHS Final PERMIT EXPIRES I 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION TARTS Rough Service ...... .......... . . .......... .... . . ................................. Final BUILDING 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. 55 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: �)C- R 1�(l I u about registration and status should be made to the 2Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617-973- �� 8787 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 NO, NO. IQj MA. H.I.C. 1083837q1N —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: c�cc-) C Q�o A( X > Construction related permits: WORK SCH Contractor-, n 1 b gi he work or order the materials before the third day following the signing of this Agreement,unless specified here irl w A)ng. C ntr afor 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 acknowledg s 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 I l &,t r 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 Contractorf,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 b1ove specifications,for the sum of ��Y\ f)t)X'�0A �1 ��l.�J 1Pd 1N �I � I (1� dollars($ D�99 c c) ), Payment to be made as follows: (— % ($ ) upon signjn Contract, ROBERT A. KEEN Name of Contractor I Designated Registrant /° ($ ) upon( tiT1175 TURNPIKE ST. /` Street Address /° ( )a completion of N. ANDOVER, MA 01845 Z 1iJ� City/Slate ($ ) s all be made forthwith upon (978)6 1 52 1 (978)682-3231 completion of work under this contract. Pnone 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 Namonl salesma 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 Authorized Signature equipment,whichever amount is greater. Note:This proposal may be withdrawn by os if not aaepled 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.gancejlation must be done in writing. PO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signalur '� -` "�� Dale /� Signature Date ` IMPORTANT INFORMATION ON BACK a "0.J f,action.Ck REMC�OEI_ING SPEC:1/_�LISTS 9TS-697-5207 Ke enConstructionCo.com QUOTE Spitalere, Dave& Sofia 230 Andover St. N.Andover, MA 01845 Contract#5558;Appendix A October 1, 2015 Replace front door:$3665 • Remove and dispose of front door and storm door • Supply& install Masonite BLS-215-06E-2 fiberglass door(two panel door with six lite glass) and two BLS-152-010-X sidelites • Supply& install new lock and dead bolt • Supply& install new Andersen storm door Bedroom window:$2351 • Remove and dispose of existing window • Supply& install same size Harvey Classic vinyl window(two-wide double hung) • Supply& install trim to match New front window: $988 • Remove and dispose of existing center dead-lite window on front of living room • Supply& install Harvey dead-lite window • Supply& install new exterior trim if needed Install new gutters and downspouts:$1695 Total Price:$8699 (eight thousand six hundred ninety nine dollars) Prices do not include cost of permits, painting or repairs of any unsafe, unusual or non-code compliant existing conditions not addressed in this quote. Payment Schedule:$2500 due upon signing contract $2000 due when gutters are installed $2500 due when door is installed $1699 due at completion of contracted rk fd/15 Customer Date Robert A Keen Date 1175 Turnpike St. Page 1 of 1 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 Industrial Accidents I Congress Street, Suite 100 a tl Boston,MA 02114-2017 www.mass.gov/dia SJ Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print—Legibly Name (Business/Organization/Individual): 06V1 Address: 1 9-75,5 City/State/Zip: �gFlione#: — Are you an employer?Check the appropriate box: Type of project(required): 1.JM I am a employer with 2— employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.0 I am a homeowner doing all work myself,[No workers'comp.insurance required.]t 10 []Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 1.❑ proprietors with no employees. 12.I Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 14.0 Other, 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing worker's'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: __Cc, ter 5 In-5 Policy#or Self-ins.Lic.#:6 /40 B 9951 MSS 2- Expiration DaY I Job Site Address: 3C) 1 '✓ City/State/Zip: �i�(� 'l�'�1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify urn r the pai, s and p nalties of perjury that the information provided above is true and correct. • _ Date: /0 Z 911 Signature: C. Phone#: 977- L91 57—U21 LEContaetPerson:_ only. Do not write in this area,to be completed by city or town official. n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: ,7coR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM DDIYYYY) L.� 10/23/2015 THIS CERTIFICATE 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 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 an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER COUTAc Barbara McDonough NAME: g Gilbert Insurance Agency, Inc. PHONE (781)942-2225 A1CFAXNo:(761)942-2226 137 Main Street ADDRIESS:bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC 0 Reading MA 01867-3922 INSURERA Norfolk & Dedham Insurance 23965 INSURED INSURERB:Safety Insurance CompanV 39454 Keen Construction Company INSURER O'Travelers Ins. Co. 0031 483 Chickering Road INSURERD: INSURER E: North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1552101779 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 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. ILSR TYPE OF INSURANCE DD B POLICY NUMBER POLICY EFF 13/13,/2016 LIMITS X COMMERCIAL GENERAL LIABILITY CCURRENCE $ 1,000,000 A CLAIMS MADE X❑OCCUR PREMISES .occurrence $ 100,000 LID-P-010078/000 3/13/2015 P Any one person) $ 5,000 AL S ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: L AGGREGATE $ 2,000,000 X POLICYO JECT F-1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY C81NE SINGLE IT $ 1,000,000 e accident) BANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 6228807 COM 01 5/23/2015 5/23/2016 BODILY INJURY(Paracclden0 $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERNDAMAGE $ AUTOS era "e 1 Underinsured motorist $ 100,000 UMBRELLA LIAR OCCUR EACHOCCURRENCE $ , EXCESS LIAB CLAIMS-MADE AGGREGATE $ '.. DED I RETENTION $ WORKERS COMPENSATION IPER 10 AND EMPLOYERS'LIABILITY YIN �TATUTE ANY PROPRIETORrPARTNERLEXECUTIVE 0 E.L.EACH ACCIDENT $ 100,000 C OFFICEW/MEMBER EXCLUDED? NIA (Mandatory In NH) .RUB-9991M58-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space is required) CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE '.. Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN '.. ACCORDANCE WITH THE POLICY PROVISIONS. '.. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) Massachusetts -Department of Public Safety Board of Building Regulations and Standards ._-_- -"__ 1.1/11.1 Ll 11 l Lll/ll JVIICI Yll1'll License: CS-076691 ROBERT A KEEN.-` 12 E WATER STI North Andover NFA 0 y. Expiration Commissioner 08/16/2017 U1ee�pari��ea�iurea��o����utocze�uae�i Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: (1.08383 Type: xpiration: .:_8/18%2016..; DBA KEEN CONSTRUCTION CD t: a Kenneth Keen 1175 TURNPIKE ST 2 2 NO.ANDOVER, MA 01845 Undersecretary