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Home My WebLink AboutMiscellaneous - 17 KIERAN ROAD 4/30/2018 (2) / 17 KIERAN ROAD J 210/098_ '"0000.0 NORTH Town of Andover . o , �` dower, Mass., (V ' 0 RATED P'Pa CI BOARD OF HEALTH Food/Kitchen Septic System PERMI ' TO 1.L mu% rBUILDING INSPECTOR THIS CERTIFIES THAT �/1 .............. )�.(G.�./.........................Q....IIR.A.^. .................................. Foundation has permission to ere ...........:...........................buildings on Pt.............. _. p.. .......................... Rough @I i to be occupied as..... ............. .. .. . !!!...........RA%A :.-�.......:.(..O..r� Chimney ... .. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office,and to the previsions 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 C 1 PERMrT EXPIRES IN 6 MONTHS HS ELECTRICAL INSPECTOR 6 l ' UNLESS CONSTRUCTI TS Rough ............................ ............................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. PROPOSAL PROPOSAL NO. J sons 6,�5NGZAZ SHEET NO. 44k-AJ � �� DATE A 6,14-1.1 . PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME ADDRESS ADDRESS LZ AriclGuee, / vitic DATE OF PLANS PHONE NO. ARCHITECT i We hereby propose to furnish the materials and perform the labor necessary for the completion of 13L-rj2A1b-_ ZAJ017-4 —7 et Gx4d Z jj I J » r93 44il-AL >'. All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of �l Dollars ($ ("kx � ) with pa ments to be made as follows. Respectfully submitted 7:�� E"_ Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per >C.L;10 Wti Lely--'-4' over and above the estimate. All agreements contingent upon strikes, ac- cidents,or delays beyond our control. Note—This proposal may be withdrawn by us if not accepted within days.' ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. r Signature Date Signature a�ld— NC 3818-50 PROPOSAL I. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV. wwwanass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): }San s I;"EAA5ZAL �iYYf "V4 Aa LLL Address: i J S / #1.1.e u • City/State/Zip: Z/LL EJz J C A Phone#: 3�2 03 Are you an employer?Check the appropriate box: Type of project(required): 1.I� l am a employer with / 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. $ E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Ro if repairs insurance required.]i employees. [No workers' 13. Othe comr / C 4_- .insurance required.] � P q ] *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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /hS co Policy#or Self-ins.Lic. #: s dee ,[� —9 L.7 V— —12 Expiration Date: /—I^S- /J Job Site Address: 12 /�)G J-Gt XJ I�D City/State/Zip: JV0- 14)-112,1 lrer 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 cert' under theT,14MAAtt_�_ . andpenalties ofperjury that the information provided above is true and correct. Signature: �� Date: Phone 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia I: I I Msu •hr+retts-Depurttnent of fammic sit" i�IIY (if guiWing ReplYtkrrs RM Sandiards truction Supervisor License I i I RICHAR OCONNELL 153 ALL RD BILLERI AAAA 01871 E 1 / 12 t� T i \ ce of Consumer Affairs&Bi siness Regulation EIAAPRO CONTRACTOR iatration 54017 Type. Ira6n, 14013 Ltd Liability Corpo? DO &60h GEI}iC7ORS LLC. RICHARD ONI�tLI. 153 ALLEN BILLERICAJ 01Undersecretary i 9