Loading...
HomeMy WebLinkAboutBuilding Permit #793-2017 - 54 SPRING HILL ROAD 2/22/2017TYPE OF IMPROVEMENT PROPOSED USE Identification - Please Type o Print Clearly Residential Non- Residential ❑ New Building ❑ One family r ❑ Addition ❑ Two or more family ❑ Industrial sOAlteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg 0 Others: ❑ Demolition 0 Other '.�.:-:=dam -_ •'-'•#. Y�- ©;Septics '❑�1Nell Y-i--iY-- .{^... _..r "1�,�#-." _�`.. v ®Floodplain''1t ❑,�,UVatershedibistnct ,Wetlantls , r DESCRIPTION OF W RK TO BE PERFORMED: v e to a ,.V'\ )9A k e -d n �✓` f �Superviso�'s�Construction�'License Hoeflr07v. mh1- 6hVb icense IExp:.19 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S -�7 T 2 �otal Project Cost: $ � 5 y FEE: $ � Check No.: ' Receipt No.: 3-1 S S S NOTE: Persons contracting with unregistered contractors do not have access to t un iy, d Signature_of Agent/Owner Signature of contractor I Identification - Please Type o Print Clearly OWNER: Name: -b yi A -c r Phone: Address: 0 -A 5 (' I e H Q r— p �Corit fetor' Name�I/PO7Vh0n/y)e: "7 o 'X f �Superviso�'s�Construction�'License Hoeflr07v. mh1- 6hVb icense IExp:.19 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S -�7 T 2 �otal Project Cost: $ � 5 y FEE: $ � Check No.: ' Receipt No.: 3-1 S S S NOTE: Persons contracting with unregistered contractors do not have access to t un iy, d Signature_of Agent/Owner Signature of contractor I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ J WpB'bF SEWERAGE DISPOSAL Public Sewer ❑ . Tanning/MassageBody Art ❑ swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: r iAl rrPlanning Board Decision: 1 Conservation Decision: Comments Comments ning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Usgooq Street FIRE DEPARTMENT -,Temp Dumpster on site yes no Locatedat 124—Main Street Fire,Departrnent sigriatur' date COMMENT µ limension 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 droprequires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doe.Building Permit Revised 2014 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 o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H. I. C. And C. S. L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 275285.00 m $ - $ 327.42 Plumbing Fee $ 40.93 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 40.93 Total fees collected $ 509.28 54 Spring Hill Road 793-2017 on 2/22/2017 main bathroom remodel x J 2 6L 0 O O m u t Y \ 0 O LL v >. N u ++ CL UJ V) 0 V Val Z Z m c O .2 m -O C :DE O LL L O CL > N C L U LL O W N Z z J a L d0 O 2 — C LL Q W 0 Z J u V J W L CD p U v N — C LL 0 u W V) Z a 0 L Op p of — C LL W G W LU LU LL a) m 6 N l% +3 N N Y O E -5.1 V O w E d L z o N 0 cc MM MM •� W W O �+ d 0L. O Q CL Q os ca ca V J 'a �CL o 4) �z 0 C -)v cu a CL U) is _ _ C W v a0 J: cc co CL d CD O • E I Q m +) _ cn •: O d z 0 1!z 7 �• _ cc Z J; a: �• Q N J LW m a zLLJ N� x > a = O d > '0 VJ Cl) E `~ O O z Q ® a= = 0 N O, O a o V O c = = d Q d •7 m CO = d .v - O O _W 'a uj m D N = CL 7 0 LU v co ;,_ _ H y c .� -w CL -5.1 V O w E d L z o N 0 cc MM MM •� W W O �+ d 0L. O Q CL Q os ca ca V J 'a �CL o 4) �z 0 C -)v cu a CL U) is W co z CD m cn i z 0 1!z O Z , 1 LW a zLLJ x '0 Cl) W J a= -5.1 V O w E d L z o N 0 cc MM MM •� W W O �+ d 0L. O Q CL Q os ca ca V J 'a �CL o 4) �z 0 C -)v cu a CL U) is 6007 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 .� Chapter 142A of the general laws, must be registered r1' Submitted to: o �' (� f I �' ���°� with the Commonwealth of Massachusetts. Inquiries SI �(� about registration and status should be made to the C.� ;� i I J Director, 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. ``7 �' REGISTRATION NO. EIN NO. 2-/ MA. H.I.C. 108383 46— 37834.01 > C/S = Customer Supplied S + I = Supply + Install l See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: Al (�Y h 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 Exec five Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit io such arbitration as provided in Massathusetts General Laws, chapter 142A. Homeoyfner's�,)nature - Contractor's Signature `-- NOTICE: The Signaturesofthe parties above apply only to the agreement ofthe 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 work rgQder the materials before the third day following the signing of this Agreement, -unless specified here in riliiing�. CC nth/,actor will begin the work on or about ��_. (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by, 4 f'4 -`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 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 Contractor, his sub- contractors, employees or agents is discovered within one year after completion ofany 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 ._I ollars ($ <` /' � � Li ✓ r �)'L ). . Payment to be mad as follows: d ($ ) upon signing Contract;. ROBERT A. KEEN Name of Contractor / Designated Registrant % ($ ) upon completion of 4 PO BOX 935 cq�( _ Street Address upon ompletlon of . N. ANDOVER, MA 01845 D, _ _ City/State % �$ ) shall be made forthwith upon (978.) 691-5201 (978)682-3231 completion of work under this contract. Phohe) ) f / Fax Notice: No agreement for home improvement contracting work shall require a ILI >down payment (advance deposit) of more than one-third of the total contract Name.ot,S`aIJesm1W price or the total amount of all deposits or payments which the contractor must Q make, in advance, to order and/or otherwise obtain delivery of special order 17th6riz d Signature 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 time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature ��G-/ �.%�'�c '••`-�"�� Date L-- Signature '7Date IMPORTANT INFORMATION ON BACK Ill RFmnuF�_inc srt:c_tnt�s-rs 97569-1-520'7 Keen ConstructionCo.com i Lynne & Bill Gillen 54 Spring Hill Rd. N. Andover, MA 01845 Contract #6007; Appendix A February 3, 2017 Main Bath Remodel: • Remove and dispose of existing fixtures, flooring and wallboard to studs and sub -floor • Remove laundry area and closet • Frame shower area per drawings from Kohler Signature Store • Install customer supplied plumbing fixtures, except glass shower door ($4000 plumbing parts & labor allowance) • Supply & install new fan/light unit, shower recessed light and customer supplied sconces. Supply and install wiring for outlets and switching to code. ($2500 electrical parts and labor allowance) • Insulate walls to code • Supply & install wallboard and skimcoat plaster to smooth finish • Supply & install tempered glass window sashes for the existing Pella window • Install customer supplied cabinetry and related trim, and base, window and door trim to match existing • Install customer supplied the on floor and shower walls. • Paint walls, ceiling and trim Total Price: $27,285 (twenty-seven thousand two hundred eighty-five dollars) Price does not include cost of permits or repairs to any unusual, unsafe or non -code compliant existing conditions not addressed in this quote. PO Box 935 N. Andover, MA 01845 CSL#076691 Page 1 of 2 Sales@KeenConstructionCo.com P: 978-691-5201 F: 978-682-3231 HIC #108383 Ken CCo,, REMC�DEL1/'IG SPECl/aLISTS 978=69"2-520-7 %,,KeenConstructioinCo.com� Payment Schedule: $2000 due upon signing contract $5000 due the first day of work (plus permit fee) $5000 due when rough electrical and plumbing is complete $5000 due when the is complete $5000 due when painting is complete g57R5 rliia whan rnntrnrted work is Com P late Date PO Box 935 N. Andover, MA 01845 CSL#076691 Robert A Keen -2--- /&' //'7 Date Page 2 of 2 Sales@KeenConstructionCo.com P: 978-691-5201 F: 978-682-3231 HIC #108383 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 Applicant lntormatlon Please Name (Business/Organization/Individual): � eerl C�51 Y-Ud ( C)✓) C Address: 0 /State/ Ah'd'ne#: 9 -2 9/ - 5726 Are you an employer? Check the appropriate box: ( I am a employer with 2 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- 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 listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.T 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' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions I L ❑ 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 iob site information. Insurance Company Name: r S Policy # or Self -ins. Lic. #:—L _H U 1� 9 91) ' Expiration Date: % /i Job Site Address: �5 p r f naL City/State/Zip: f n' �t_�Au/ c Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration daQ) � J 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 u de�he p#s anoenalties of perjury that the information provided above is true and correct. -2-12-2-11 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 #: ACOR 7 a CO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 10117r2016 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 NAME CT Barbara McDonough GILBERT INSURANCE AGENCY INC. PHONE . (781) 942-2225 ac No: IL Ilbertinsurance.com ADDRESS: bmodonough@gilbertinsurance.com INSURER(S) AFFORDING COVERAGE NAIC# 137 MAIN ST. INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 READING MA 01867 INSURED INSURER B: INSURER C: KEEN CONSTRUCTION CO INSURER D: INSURER E: PO BOX 935 INSURER F: NORTH ANDOVER MA 01845 COVERAGES CERTIFICATE NUMBER: 94268 REVISION NUMBER: THIS 1S 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. I TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY DY/YEFF YYY M�D� LIMITS MERCIALGENERALLIABILITY EACH OCCURRENCE $DAMAGE 70, TO RENT U PREMISES Ea occurrence $ CLAIMS -MADE FIOCCUR 4— MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ N/A GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ e accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY (Per accident) $ NON -OWNED HIREDAUTOSAUTOS PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR I CLAIMS -MADE N/A DED I I RETENTION $ $ A WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA N/A 6HUB9991M58216 10/08/2016 10/08/2017 X STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS / LOCATIONS / 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, n0 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/twdtworkers-compensation/investigations/. It1Y7 a�1I1 �1Pfi\ta a.1 A.17C '1A fig AI " 0r�l\ W T'JS$-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover MA 01845 �-''"'� Daniel M. Croy, CPCU, Vice President —Residual Market — WCRIBMA W T'JS$-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of. Public Safety Board of Building Regulations and Standards l^.11ljstt LIt LI II11 JI�IICI `'151'll License: CS -076691 T FS .. ROBERT A KEEP]-` 12 E WATER ST � � ¢ North Andover WA 0 Expiration Commissioner 08/16/2047 Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Registration:,;?108383 Type: Expiration. —;`8&6/201,8 DBA f 1 � KEEN CONSTRUCTj;'..' Kenneth Keen :i 1175 TURNPIKE ST �� L NO. ANDOVER, MA 0184"^ Undersecretary Location `i 5� ' ✓� '7 No. -767 � - gil r? Check # g �L &7 2' �--v Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $-2 if, Foundation Permit Fee $ t Other Permit Fee $ TOTAL $ lj4, j Building Inspector