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HomeMy WebLinkAboutBuilding Permit # 11/10/2015 IAORTH BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: 2.o i P5- Date Received 0 Arep1V �ssgcwUS Date lssued:4,to IMPORTANT: Applicant must complete all items on this page TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building [I One family [I Addition El Two or more family El Industrial El Alteration No. of units: El Commercial XRepair, replacement 11 Assessory Bldg El Others: El Demolition El Other � �� !, Jf � r�l, ��! / ! �! � �,� � � � 1, ,1�, Irl, h .. � ��)��� ,,o DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: To, � 3 e ,, Ie---/ Phone: Address: fedA 7 V '3 t10 c1bvV1- 04 C) 5 _5:�o� e g, 12/01 ar- IN IN, 1 11 M", J/19111N,�SIN A ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2-Q1 01 FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the, a n and igh t%ORTH Didover Town of O ® r T7 yg �. O h ver, ass, Y LAKE COCKICKL'WICK S U BOARD OF HEALTH tiERMIT T LD Food/Kitchen Septic System wow THIS CERTIFIES THAT „ , ,,, BUILDING INSPECTOR L'3 has permission to erect buildings on .. . . .................. Foundation pp Rough to be occupied as .....Z.1 ....... . %. ®..10.4h.O...UA .......................................................................... 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 I IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION RTS Rough I,yService Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. - � _ :�GanSty�uC�t0Y1 CD; REMCIUELING SPEC 1/ALI STS 978-69'/-520' Keenconstructionco.com Beasley,Tom 53 Cedar Ln. N.Andover, MA 01845 Contract#5561;Appendix A October 15, 2015 New windows: • Supply& install twelve standard sized double hung windows, eight over-sized double hung windows and one double wide casement window • All windows to be new construction Harvey Classic vinyl windows with six over six grid pattern (grids between the glass, larger windows will be different but proportional grid pattern), energy star rated glass,with half screens on second floor,full screens on first floor • Supply& install new interior and exterior casing(integrated with window, 908 brick mold style) to match existing • Dispose of all construction related debris '..... Total Prices do not include cost of permits, painting or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this quote. Total Price: $18,240(eighteen thousand two hundred forty dollars) Payment Schedule:$1000 due upon signing contract $4000 due when windows are ordered (approx. November 2) $4000 due the first day of work(plus permit fee) $4500 due when nine windows are installed $4740 due at completion of contracted work Customer Robert A. Keen /0)2- Date Date PO Box 935 Page 1 of'I P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 556 ,i KEEN CONSTRUCTION CO. 1 PC ad< X35 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: �Ei '� f?rt a I l about registration and status should be made to the Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617-973- 8787 Owners who secure their own construction G 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. MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install [y�l See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used. I\ t > Construction related permits: RK SCHEDULE - Contractor wi not gin the work or order the materials before the third day following the signing of this Agreement,unless specified here M wr'ng. C ntractor will begin the work on or about (date). earring delay caused by circumstances beyond Contraclofs control,the work will be completed by (date).The Owner hereby acknowled s an agr s(hat the scheduling dales are approximate and that such delays[hal are not avoidable by the Contractor shall not be consid re s 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 Cont act 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 accordance with above specifications,for the sum of c c ' �ERTA_ dollars($ ` , / Payment--be made as follows: "f 0,00) /° ($ ) upon signing Contract; Name of Contractor/Designated Registrant % ($ ) upon completion 'f 1175 TURNPIKE ST. Street Address Q l ($ . p. Til�ion of N. ANDOVER,MA 01845 Z � City/State - °/� ) sh II p made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Phone 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 Name n. fes an _ or the total amount of all deposits or payments which the contractor must make,in ; ti /2 advance,to order and/or otherwise obtain delivery of special order materials and Author ign ure equipment,whichever amount is greater. Note:Thisr p oposal may be withdrawn by us it 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 transaction.Cancellation must be done in writing. 1DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature >- Date V d` Signature Date IMPORTANT INFORMATION ON BACK TE DN , `6 o CERTIFICATE OF LIABILITY INSURANCE D 0/23ID20M15) �� 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 NAMEAC Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 1 ac o:(711)942-2226 137 Main Street ADORIESs:bmcdonough@gilbertinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERA Norfolk 3 Dedham Insurance 23965 INSURED INSURERB:Safety Insurance Comloany 39454 Keen Construction Company INSURER C..Travelers Iris. Co. 0031 483 Chickering Road INSURERD: INSURER E: North Andover MA 01845 1INSURER 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. INSR LTR TYPE OF INSURANCE DD POLICY NUMBER POLICY EFF PWDIDfYCY Y LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑ REMISE OCCUR ORE 7E 100,000 PS eexurrence $ _ ND-P-010078/000 3/13/2015 3/13/2016 MED EXP(Anyoneperson) $ 5,000 PERSONAL d ADV INJURY $ 1,000,000 '.. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICYO JET FILOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ POMOS(LELIABIUTY COMBINED SINGE I IT $ 1,000,000 e eoddenlBANY AUTO BODILY INJURY(Per person) $ ALL UTOS ED X AUTOSULED6228807 COM 01 5/23/2015 5/23/2016 BODILY INJURY(Per accident) $ HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTO ereocident $ Underinsured motorist $ 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ E%CESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABWTY YIN S E E ANY PROPRIETORPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? NIA C (Mandatory In NH) 6HUB-9991MSB-2-15 10/8/2015 10/8/2016 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 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(2014/01) The ACORD name and logo are registered marks of ACORD INS02512outiii The Commonwealth of Massachusetts Department of IndustrialAccidents u 1 Congress Street,Suite 100 a ; Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / Please Print Lesibly Name (Business/Organization/Individual): Vp—en LC•�5 �'y 1 Ca/1 C7 5 Address: n City/State/Zip: I�v l �J``".� G f$P one#: 9 2� �`� �� Are you an employer?Check the appropriate box: Type of project(required): 1.LZ I am a employer with 2 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 $, rel Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will Electrical repairs or additions❑ ensure that all contractors either have workers'compensation insurance or are sole 11.• proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.Q Other, 6.Q We are a corporation and its officers have exercised their right ofexemption 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. lam an employer that is providing worlcers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: f �/� t e r 5 I q-5 Policy#or Self ins.Lic.#:6; /40 9 9 9 rj� 2 V� Expiration Date: I Job Site Address: �� Ce- k G-( (,yl City/State/Zip: 1 l7d,�,, U''�'d�, 'l D l 7J 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. 1 do hereby certify and r th,pains and penalties of perjury that the information provided above is true and correct. Date: 1L) 12-911 Si ature: f C Phone#: 7 Official use only. Do not write in this area,to be completed 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 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Massachusetts -Department of Public Safety Board of Building Regulations and Standards c---- �.I/II1L1 Ll l/11 JI111G1 V'111/1 License: CS-076691 ROBERT A KEEN-` 12 E WATER ST IF North Andover NF1 0 Expiration Commissioner 08/16/2017 /ie�rnwr�ioaacuecc�i a��/�curaacficcaeC�s Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: 1'8383 Type: xpiration 8/1.8f2016_; DBA KEEN CONSTRUCTION CC? Kenneth Keen 1175 TURNPIKE ST g� Bdp NO.ANDOVER, MA 01846 Undersecretary