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HomeMy WebLinkAboutBuilding Permit #611-2017 - 40 HITCHING POST ROAD 12/6/2016A31-4 � Q a 4 L�BUILDINGNORPERMIT TOWN OF TH ANDOVER f APPLICATION FOR PLAN EXAMINATION PermitNo#: Date Received Date Issued: CP TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building [] One family [I Addition El Two or more family D Industrial 0 Alteration No. of units: El Commercial PRepair, replacement 0 Assessory Bldg El Others: 0 Demolition 0 Other SepticW611 --b 0 Floodplain -' 0 We an V tergH6dbi i`stribi, @".W6t&/-Sewer,- I DESCRIPTION OF WORK TO )BE PERFqRMED: N Ci- h + I L) I11 c/v J % SCJ rep (a Z""o T— ,51 de OWNER: Narne:--�f Address: Contractor Name: ��PP,'ox� - Please Type or Print Clearly nr;h Address: Supervisor'sQQfi�truetiohi Libens'e,, ale,--. <df 0:7 e-nViLitens -xP HbmedrnDrovern e:- OT,�)'93- --7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. -,--,Tota l Project Cost:$ l 0oo FEE Check No.: cil) Receipt No.,. - NOTE: Persons contracting with unregistered contractors do not have: access to th ar d Signature of Agent/Owner Signature of cohtreibtot, Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 I -Nmension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop.1requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21 A —F and G rnin.$10041000 fine Doe.Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ TYPE`OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Certified Plot Plan ❑ Stamped Plans ❑ Tanning/Massage/Body Art ❑ Tobacco Sales ❑ Permanent Dumpster on Site ❑ Swimming Pools ❑ Food Packaging/Sales ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 FIRE DEPARTMENT - Temp Dumpster on site yes no Located;,at 124_Main Street Fire. Department signature/date COMMENT 3 Location �16 / �c 1� No. �--, // - 'A'17 Check # --� 1 (465— j Date /,"-' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ IV— Foundation Permit Fee Other Permit Fee TOTAL $ T. -Buildin6 ln'�ecfo—F r. O Q SVhf LL p O m aV+ \ O O !t w T > U Q QD VD oc O W Z Z ® J m O OO iJ 70 7 O t.[_ L O d' C L C.D U- U NA ul Z Z m L bo 3 O OC f6 O ti V W W) CL Z cQ7 V WUL L to 7 O cc U —_ i y Dn Lm -W oC O U YJ Z Q L O _ U- Z m LLI W 5 QD c 3 ca z QD �, va Y Y O to ui am O :v LU d 0 ini t0 Z� W CC az w0 ~_ V W JCL z O O Z Q A�` W Q v 'YA/ •E co�M� co W O cc �:2 o �> W c 0 L Q tCc CL Q OM C cts V V J Q W p Z 4) ! ` vV ��►`1 O V�WVAA` `+v, v c ^I = Ccts }a C N O _. r een Consfracfion Co. 978-69'1-5207 KeenConstructionCo.com i QUOTE Pessinis, Karl & Cindy 40 Hitching Post Rd. N. Andover, MA 01845 Contract #6046; Appendix A October 5, 2016 Replace windows above the garage: • Remove and dispose of existing arch top picture window and two double hung windows on the front of the great room, two double hung units above driveway in great room, two double hung windows in guest bedroom and one double hung in guest bathroom • Supply & install Andersen Tilt -Wash series windows with similar grids patterns • Supply & install trim on interior and exterior to match existing • Paint interior and exterior trim Repair flashing and roofing on roof above side door, Stripping siding and putting bituminous membrane up wall, install new siding. Total Price: $16,000 (sixteen thousand dollars) Prices do not include cost of permits or repairs to any unsafe, unusual or non -code compliant existing conditions not addressed in this quote. Payment Schedule: $5000 due upon signing contract $4000 due when windows are delivered $2000 due when roof is repaired $5000 due at completion of contracted work Customer Robert A Keen /'0 /71' , /0/7 //6 Date 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 6046 KEEN CONSTRUCTION CO. PROPOSAL PO BOX 935 NORTH ANDOVER, MA 01845 Tel: (978) 691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978) 682-3231 specifically exempt from registration by Provisions of '/ 11 ' (\ ) � i Chapter 142A of the general laws, must be registered Submitted to: j�Ca f "4. ` (_ = L;.) f ?,. j i I with the Commonwealth of Massachusetts. Inquiries I In i r� about registration and status should be made to the ' V 4 I Director, Home Improvement Contract Registration, 14, �„/ 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787 i" J 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. EIN NO. MA. H.I.C. 108383 46 —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: J�'L. ����t'f/Ir'I X •� r � The contractor and the homeowner hereby mutually agree that in the event the contractor has a dispute concerning this contract, the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive 0 fice of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as providedjn Massa fiusetA General Laws, chapter 142A. Homeowner's Signature Contractor's Signature NOTICE: The Signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed.•by the parties. Construction Related Permits: WORK SCHEDULE----'-----------..._�..'--'-------`—� Contractor will not begin t wpr ppr order the materials before the third day following the signing of this Agreement, unless specified herein writing. Contractor will begin - the work on or about(date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by (date). The Owner hereby acknowledges 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 Contractorwarrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period offollowing completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused y the Contractor, his sub- contractors, 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(/ll / ). Payment to be made as follows: -� - ($ ) upon signin Contract; ROBERT A. KEEN i1 Name of Contractor/ Designated Registrant ^/° ($ �upgp epnfpl tion of PO BOX 935 J�C V Street Address upon completion of N. ANDOVER, MA 01845 City/State shall be made forthwith upon(978) 682-3231 (978)691-5201. completion of work under this contract. Phone ; Fax Notice: No agreement for home improvement contracting work shall require >down payment (advance deposit) of more than one-third of the total contract Name �. of Safesh an price 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 q'rize Sig Lure- materials and 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 outline above. You, -the Buyer, may cancel this transaction at any 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 Date �� (�. Signature - Date IMPORTANT INFORMATION ON BACK ► The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Information Please Print L Name (Business/Organization/Individual): Loen Coto,51 Y-Ud (un C'C) Address: P0 BC] X Citv/Sta QlXLd/n e# Are you an employer? Check the appropriate box: I am a employer with Z 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors '. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t These sub -contractors have employees and have workers' comp. insurance.1 5. ❑ 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' insurance _20- (�91- 5zo l Type of project (required): 6. ❑ New construction 7. [SI Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *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 workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name Policy # or Self -ins. Lic.U � 919 91 J Z , Expiration Date: Job Site Address:_ (4 t t c k i o c, 965-i RA City/State/Zip: r 10 C)lsq 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 c. 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 Office of Investigations of the DIA for insurance coverage verification. I do hereby certify udder hep i s and enalties ofperjury that the information provided above is true and correct. Si ature: �-----~mate- / Z /� / / f_ -(,091 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 #: ACORO0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDnnYY) 10/17/2016 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(ies) 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 CONTACT NAME: Barbara McDonough GILBERT INSURANCE AGENCY INC. PHONE (781)942-2225FAAixc No: ADDRIESS: bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# 137 MAIN ST. INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 READING MA 01867 INSURED INSURER B KEEN CONSTRUCTION CO INSURER C: INSURER D: INSURER E: PO BOX 935 INSURER F: NORTH ANDOVER MA 01845 COVERAGES CERTIFICATE NUMBER: 94268 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 ADDL SUER POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FIOCCUR EACH OCCURRENCE $ PREMISES_�aoccurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ N/A GEN'L AGGREGATE LIMITAPPLIES PER: POLICY PRO- ❑ a JECT LOC IGENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per axklerd $ $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE N/A AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N-- ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) If yes, describe under NIA NIA 6HUB9991M58216 10/0$/2016 10/08/2017 X I STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 I E.L. DISEASE - POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS I LACATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts If the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage -Coverage Verification Search tool at www.mass.gov/iwd/workers-compensation/investigations/. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M. CroSr y, CPCU, Vice President— Residual Market — WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD W Board of Building Regulations and Standards V1711\LTIIItITII J�JTICI YI\111 License: CS -076691 %cF: n :e 4 ROBERT A KEEN= 12 E WATER ST..w North Andover NFA 0 r Expiration Commissioner 08/16/2017 .......... � ��e rnoo�r�r�znncaecc�Gf ...... .....:......._:..., ........... a�P/�a6;ta�ur�elxd Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR ai Type: Supplement Card qw..101-83 Registrationgiration 08/17/2018 Keen Construction. RobertKeen 1175 Turnpike St— No. Andover, MA 01845 -" Undersecretary