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HomeMy WebLinkAboutBuilding Permit # 11/10/2015 NORTH BUILDING PERMIT TOWN OF NORTHA V �� ''_ `"' 4d °0 APPLICATION FOR PLAN EXAMINATION Permit No#: `° � � " Date Received ^/RADRg7 ED rP�`y�� �Ssgcsaus�� Date Issued: �/ b /� IMPORTANT:Applicant must complete all items on this page 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 7fflf `+ ff y1,. / / Oftio/ lJ /.. d / l //// 1111011�11l V/J, i�(.% r�. dG JON, / Y'/" '/ "! I / ,J 11,.rtl //� / .lr./rr'i�/i//C% ,/ / I/ ,/iffJY/J f,f II.�C.lal / / / G'//.Nlllf,IU,l..,d„C/ry/ // . r; �,,� L/.///,/f/ %/1 /.„ /r,(/I,,,Y/,(�f f ( .c 1I ru f ilr �/% /%,� 11a ,i l//, r d / t ,Pf, ates ,e y ,„ Wel,�9) �� /,� / ur ood a /�dWe4lan s// r� W Istn, f ��j �� 1 ll �f�� 1�� ///r/l r�l',!li f ff / /l� � y r/r, y a ,e;r f 0 / I'1� / / j �, f/ + ,f ��� �� E SCRIPTION OF WORK TO BE PERFORMED: .( �, �. 1, ac7r lar. �l'oo P , f 6u,% I K- (n f/ - Identification- Please Type or Print Clearly OWNER: Name: , ; b 'rh � Phone: Address: ", p° d 6 `-..g 17 o " ' 1 � � f , d I rd"u ��� ��u A Ni VnE n✓u�au u�a"alp ro 4=�ro�n� �„r i (vi lro�errrnYvi�l 1, _ � � � � �� II /rwrrani�ewfv��ovuerr,»f�ii,��wi/rroniii��,.� � l I I':� ��'l rr Ill ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ "r )0 FEE: $ 1._ Check No.: ` > Receipt No.: elp, NOTE Persons with unregistered contractors do not have access to the u n and t%oRTH Town of ( E .''''. 1-ftido'ver p to No. % h ver, Mass,0 LAKE is COCNICKl WICK y1' A04ATED PIPE`�,�5 S U BOARD OF HEALTH Food/Kitchen PERMIT T L �D Septic System G G ' THIS CERTIFIES THAT !:!.5.�.... �..,.. Ge�� Fn`s .......................................... BUILDING INSPECTOR ..............• •• ...................moi... •A. •. �G�/ES Foundation has permission to erect .......................... buildings on ........................................... Y......:5�................. � Rough to be occupied as `�7�!!? .�X� ..... ..�( ` oa,� �Til.............................................. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION T RTS Rough Service ............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay 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. 5561, KEEN CONSTRUCTION CO. 1175 TURNPIKE STREET PROPOSAL 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 ,� 1(��� with the Commonwealth of Massachusetts. Inquiries To: 11 j p t 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 �f�/J f \ 8787 Owners who secure their own construction t Ac V � 0 C, S related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DA7E REGISTRATION NO. EIN NO. MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install CV See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: > Construction related permits: about SCH Conlrac or w 1 e n the work or order the maledafs before the third day following the signing of this Agreement,unless specified here i w't� o tractor 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 acknowfedg s and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall nil be cons; eyed as violations of this Agreement. WARRANTY p The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of l l_Ck 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 Contractor,I is 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($ Payment to be made a4 follows: /e ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant /e ($ o on\of� 1175 TURNPIKE ST. Street Address D A N. ANDOVER, MA 01845 ($'_ ) `p n completion of N , - � City/State $ shall be made forthwith upon (978)691-5201 (978)682-3231 ( ) completion of work under this contract. Fax Notice: No agreement for home improvement contracting work shall require a S C E� Ph Y 1 >down payment(advance deposit)of more than one-third of the total contract price Name of S as an 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 us if not accepted wdhin days Acceptance Of Proposal-I have read both sides of this document and all allached 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Si azure !✓:,.. (` -'�`�. _ _ ;:) 9^ Dale Signature Dale IMPORTANT INFORMATION ON BACK I® -7 Wn Const uafion Co, e�mc�or_�_�nc sPrctnt_ts-rs 975-69'�-520` Keenconstructionco.com McSweeney,Trish& Mike Middlesex St. N.Andover, MA 01845 Contract#5564;Appendix A October 30,2015 Master closet: $5,900 • Remove and dispose of wall in back of existing closet and existing door • Frame walls to create approx. 8' x 10' closet,frame doorway for standard door • Insulate to code • Supply& install blueboard and skimcoat plaster to smooth finish • Supply& install door,trim and shelving • Paint walls,ceiling and trim • Supply& install one ceiling light fixture • Supply& install carpet($30/sq.yd. allowance) Main Bath:$17,372 • Remove and dispose of all tile, wallboard,fixtures and ceiling in main bath • Update electrical as needed, installing new vent($1500 total electrical allowance) • Supply& install new plumbing fixtures as per quote S016884357 from Peabody supply (Plumbing allowance$3500) • Frame linen closet • Supply& install blueboard and skimcoat plaster to smooth finish • Supply& install underlayment, closet door and trim • Supply& install tile on floor as selected in Peabody quote • Paint walls,ceiling and trim Prices do not include cost of permits,or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this quote. Total Price: 23,272 (twenty three thousand two hundred seventy two dollars) PO Box 935 Page 1 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 - een, Consts^w on Co, etewoot_�_�nc st't:c�nr�s-rs 978-69"�—S2Q 1 KeenConstructionCo.com Payment Schedule:$4000 due upon signing contract $4000 due the first day of work $4000 due when framing is complete $4000 due when plaster is complete $4000 due when tile is installed $3272 due at completion of contracted work Cusltomer �. ,. Robert Keen 0131 _ 10/ 31/5 Date Date PO Box 935 Page 2 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 ,k. o CERTIFICATE OF LIABILITY INSURANCE ATE 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 H EAC Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 FAX CNo:(781)992-2226 137 Main Street E-MAIL bmedonou h ADDRESS: g 9gilbertinsurance.core INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERA Norfolk 6 Dedham Insurance 23965 INSURED INSURERB:Safetv Insurance Company 39454 Keen Construction Company INSURER C.-Travelers Ins. Co. 0031 483 Chickering Road INSURER D: INSURER E: North Andover MA 01845 INSURER F: 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. 'LTR TYPEOFINSURANCE DD POLICY NUMBER POLICY EFF P�OVLIICYE P DDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR PREMISES .occurrence $ 100,000 ND-P-010078/000 3/13/2015 3/13/2016 MED EXP(An on.person) $ 5,000 PERSONAL d ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JEST r LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY C OMBINEDSINGLE MIT $ 1,000,000 B ANY AUTO INJURY person) $ ALL OS X SCHEDULED 6228807 COM 01 5/23/2015 5/23/2016RY AUTOS AUTOS (Per accident) $ X HIRED AUTOS X NON-OWNEDUTODAMAGE $ 1 molodsl $ 100,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ '.. EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEC) I I RETENTION $ WORKERS COMPENSATION p JOTH­ AND EMPLOYERS'LIABILITY YIN S E R ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 C OFFICER/MEMBER EXCLUDED? ❑N/A (Mandatory In NH) 6HU13-9991M58-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If 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(2014/01) The ACORD name and logo are registered marks of ACORD INS025120140n The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia bV• Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERImTTING AUTHORITY. Apl' nt Information Please Print Le�ibiy Name (Business/Organization/individual): Wp—ey1 Address: 9,35' ­­ 11' 5 City/State/Zip: f`�,� `�'� °�,' 't�Ir one#: 9?3` �f,�'+ Zn Are you an employer?Check the appropriate box: Type of project(required): 1.[Z I am a employer with �— employees(full and/or part-time).* 7. ❑New construction 2.Q 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.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.FJ Electrical repairs or additions proprietors with no employees. 12,.. J Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.❑Other, 6.Q 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. showing contractors and state whether or not those entities have the name of the sub-contractors that check this box must attached an additional sheet g employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Y am an employer that is providing workers'compensation insurancefol-my employees. Below is the policy and job site information. Insurance Company Name: Cc vet e o 'o, Policy#or Self-ins.Lie.#:6 No ,J —925 1 N�5?—2' � �� Expiration Date: / f1 �" y� Job Site Address: `" t � 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 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 WORD 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. 1 do hereby certi ''u der ie p s and penalties of perjury that the information provided ab ov is it a and correct. Signature: Date: .. Phone#• LLleonly, 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/TownClerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: Massachusetts -Department of Public Safety Board of Building Regulations and Standards 1.1/11\ Conn neLl 11 ltll/ll Jl111C1 V1s1'/l ® - License: CS-076691 ROBERT A KEEN.-` 12 E WATER ST North Andover AfA 0 r I 1 � / `� Expiration Commissioner 08/16/2017 ��ie�pam�nearaurea�o�C%/iLadeae�uJe�i1 Office of Consumer Affairs&Business Regulation W'ME IMPROVEMENT CONTRACTOR gistration: 108383 Type: piration 8[1$12016__; DBA s= KEEN CONSTRUCTION Cq." r Kenneth Keen Er ; 1175 TURNPIKE ST g r NO.ANDOVER,MA 01845 Undersecretary