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No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 00 FEE: $- Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access the guaranty fund Signature;of Agent%Owrier ` + Vi,, �gnatiare of"contra , ttORTH Town of Andover 0 ® � ZT7„ 26 O Lq.aE 11 ver, 6A.SS' —r� COCKIC..ew.c« meq. Pk 47 U BOARD OF HEALTH Food/Kitchen P E mR� mmm I �T �T� LIJ Septic System THIS CERTIFIES THAT ........................ UCAAAh ....................... BUILDING INSPECTOR ... ........ ... .................................. 92 has permission to erect .. buildings on Foundation ...... ...�. A.... .. ............. ........ ..... ....®.............. Rough to be occupied as .............. ki."lej....... .... ........................................................................ 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 EXPIRESPERMIT ELECTRICAL INSPECTOR UNLESS Rough Service .............. ..... . ...... .. . ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildin Rough Display in a Conspicuous Place on thePremises — of Remove Final LathingNo or Be® Wall o one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. N KTM Properties,LLC 25 Spaulding Rd Suite 17-2 Fremont,NN 03044 r Phone: (603) 895-0400 Fax: (603) 253-2600 fi Service Providerfor Company Representative: Custolnee•Info: Mark Minasalli Job#: N/A (80409059 Beato) (603) 234-9320 3480 - Beato, Felicia Markni( ktniproperties.coni 9 Fern Wood Street, Job Number: N/A (80409059 Beato) North Andover,MA, 01845 (978) 869-1308 (978) 681-0847-mobile _VERIFICATION ESTIMATE 3/5/16 Description - VERIFICATION ESTIMATE 3/5/16 total: $0.00 DEMOLITION Description Interior Protection Protection of floors,walls and doors, and dust abatement and clean up. Debris Removal Construction debris removal and haul away Removal of Countertopse Remove laminate, solid surface. stone,quartz, or file countertops. Removal of Cabinetry Remove walls, base and tall cabinets. Cardboard Removal Remove cardboard and cabinetry debris. Appliance prep Remove appliances, Hood fan, microwave, sink prep. DEMOLITION total: $1,200.00 CABINETS Description Permits Permits Wall Cabinets Install Wall Cabinets Base Cabinets Install Base Cabinets Tall Cabinets Install Tall Cabinets Wall/Base Fillers Install wall/base fillers Tall Fillers Install Tall Fillers Knobs/Palls Knobs/Pulls Installation CM Crown Molding Toe kick Install toe kicks at bas(, cabinet. Silims Install Shuns as needed Hole and pennitrations Make penetrations as needed Dishwasher panel Install Dishwasher panel includes any blocking COUNTER TOP DOES NOT INCLUDE COUNTER TOP INSTALLATION CARDBOARD DISPOSAL PRICING IN THIS CATERGORYDOES NOT INCLUDE CARDBOARD DISPOSAL.. CUSTOMER IS RESPONSIBLE. KTM CAN PROVIDF,IT FOR ADDITIONAL FEES CORBELLS INstall corbells to support countertop CABINETS total: $2,235.00 ELECTRICAL Description Dishwasher Wire dishwasher with existing power present add cord and box with outlette Microwave-New Circuit Run a new circuit for a dedicated microwave hood (installer provides components) Electrical permit Supply electrical permit and inspections ELECTRICAL total: $900.00 Total for all sections: $4,335.00 Total: $4 335.00 The above signature does not conunit either party to the sale of the above listed items only if this contract states Prelimiiian,Estimate as one s a full understanding of the price and scope of labor Por the categories listed only. prices are subject of the first[roes.The signature represent to chance based on the final design, la}rout of the kitchen and unforeseen conditions. we CANNOT start.the work at your job until the necessary permits have been procured and a signed °What to Expect Sheet"on file, please contact us should you need a copy of this. itEIVt!NPX1,—RS: this installation quote is based on normal working hours 7am-4pm,unless other arrangements have been made prior with KT\t. one rough and one finish; finish will occur atter counr countertops. Code or local inspecto plumbing&Electrical wort:is based on 2 trips- requirements not tuentioned in this estimatewill be an additional cost.Cabinets must be delivered in kitchen area or adjacent space on same level,which must have heat. if cabinets have to be moved by KTivl,additional fees will be charged. Countertop templates require you to be. onsite,no exceptions! a Date -ner Sign, u Date Company Authorized Signature ` 'List ler Signature Date This estimate was last edited by Mark Minasalli ((603) 234-9320,Markm@ktinproperties.com) on March 05, 2016. The estimate may be withdrawn if not accepted within days. c"M.",)1 5"O'de 50�,way Nes k,back slple,�h tEED TO ORDER BACI(SPLIVill TILES AUD ov+ MEASURE AND INSTALL caking copy r'._...-....-------------------- cros ha';",A�,en yd,ml,ed NT Teser a Ice Whyle,4x,l Oal,rs hh.,s yz'-, 471" al #10 526.370 M—w,ed by S/o froln Memla PO W,1522148) hk"k klma�Op na,k,wilasmi,'slyahos,om (Rn 2311'4320 Fm,cua Real. s .................. M a bY3fbagfQ)an�",e ii 15VWi'll W3012BUIT 1VWVF- 0 Legelind 02AL v Nukesl 2 S630HU T w c0ing he�gN go 1 2 !SWO)DO 7 sofM 8:11 W.p3L fr,d,ge 33 70 10 Sink smgde TV dlkO 'MY gas ---------------- BE.P3Q 0 washer, "ange ffi�l If,3 24'd,5b wast", 33 x 70 (BD15 3) 011e.1 MAge Tn"", 'Wd"S am i ange ­eT fange�6,,,ru ........... INMI ca4s"M go W saffit, J I BUB —rI I -74 I istvll,� f7 ,I.ps bWWe black CURREN]KIM PR(WOS 101%Of ik'i feb I T AW)DMSM pani,Y 2�l 7-r�lr -If------------ Ct,^,'Orkv -top unde,w"d.... .............. flusds s���pWmad,�OLPAW03 HD cium NEED TO OREWR SUPPOR� f1s vMh wen door"pen Oeck hvqM js lbego,enmWicxm rjfWewiiiitovd for c Wp and 51 Whahs The Commonwealth ofHasscrchusetts Department of IndustrialAccidents ti= I Con b ress Street, Suite 100 Boston, AM 02114-2017 wlvw.mass.b din �Yfr,,lcers' Compensation Insurance Affidai t: Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH TIM, PERRIIMNG AUTHORITY. t Information Nalne (Business/Organizationrindividual): ' r Address: City/State/Zip: Phone#: � A re you a employer Check the appropriate box: Type of project(required): I l. 1 ani a employer with employees(full and/or part-time).` I 7. ❑New construction I am a sole proprietor or partnership and have no em loy yes working for me in 2.F-] P P P P P l� g � 8. emodeling � any capacity.(No v:orkers'comp.insurance required.] 9. ❑Demolition 3 ❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]' I 10 [_�Building addition t.❑I am a homeownerand 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 ! I LF-1 Electrical repairs or additions proprietors with no employees. tv 12.�Plumbing repairs or additions I am a general contractor and I have hired the sub listed sted on the attached sheet. ❑ 13.F�Roof repairs These sub-contractors have employees and have workers'comp.insurance.t i 6❑we are a corporation and its officers have exercised their right of exemption per MGL c. t4. Other ' 152,§1(4);and we have no employees.(No workers'comp.insurance required.] 'Ariv applicant that checks box d l 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 indicative such. tCgptractors that check this box must attached an Ei ditional sheet showing the name of the sub-ctirttractors and state whether or not those entitieS]have empltlyees. If the sub contractors ha:e employees,they must provide their workers'comp.policy t umber. I am an employer that is providing workers'compensation insurance for mJ+employees. Below is the policy and job site information. p �^ insurance Company Name: Policy#or SeLf-ins.Lic.#: Expiration Date: t Job Site Address: 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 IvIGL 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. I do hereby cer jy it er th airs and penalties of perjury that the information provided a ove is rue and correct. Si nature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: PermitfLicense# -6 _ oarlMmIDorr^rrI � ACORD CERTIFICATE, 'F L I Urf INSU NCS V1812016 � 1 71-f!S CERTIFICATE IS ISSUED AS A MAMR OF INFORWL4,TION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATVELY OR NEGATWELY AMEND, IrtTEND OR ALTER THE COVEP,AGE AFFORDED BY THE POLICIES 7EL0W_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTfi A CONTRACT BE-rPIEEN TIRE ISSUING I4SL7RER(S), A11THDREFD PEPRESENTATIVE OR PPODUCER, AND THE CERTIFICATE HOLDER IMPORTANT! if the certificate holder iED s an ADDITIONAL INSURED, the policy(ies) must be eindorsed, if�UBROGATON IS WAfVED,subject to 1 the terms and conditions of the policy, certain policies may require an andersemerrL A statement on this certificate does not caner rights t0 the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NADA NIAP.SH USA,INC. T'NO ALLIANCE CENTER C PHONE o t � kl No 35M I ENOX ROAD,SUITE 2400 52h SS: ATLANTA,GA 30326 µ0.1c wsuReR AFFORDING covERnce 100492•HDmeD•GAVC-16-17 INSURER A:S��lflW WCampany Z�� INSURED INSURER a.2101d1 Amedcari IfiSInam CO 16535 TWD AT-HOME SERVICES,INC- 23041 DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:Newkamptire Ins Go 2&90 CUMBERLAND PARKWAY,SUITE 300 INSURER 0.Emis National Insurance Company 17 ATLANTA,GA 30339 INSURER E: INSURERF: COVERAGES CER71F1CATE NUMBER: ATLM374fi 644 REVISION NUMBER:O THIS Is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNT-HSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFIGATE 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 REDUCE BY PAID CLAIMS. INSSP TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EI(P LIMITS LTR p POLICYNllMBER p A j X COMMERCIAL GENERAL LIABILITY GL048B7T1445 03mitM16 03/0112017 EACH OCCURRENCE s. s,0oo,4D4 G(�1lMS tnAOE OCCUR OAEdAGE rO RENTED S 1,000,000 (_`_• PR ISIS oaaurelra MITS OF POLICY XS MED�(i"one person) S EXCLODED OF SIR 5141 PER OCC PERSONAL&ADV INJURY 5 9,000,ODD GEid'LAGGREGATE LIMIT APPLIESPER' GENERALAGGREGATE I S 8.004.000 POLICY X ❑PRD- F]LOC I PRODUCTS-COMPIOP AGG -S 9,040,000 JECT I S OiFiCR I I ICOMBINED SINGLF-LIMIT I S 1,OOD,000 8 AUTOMOBILE L[Aa1L.fTY BAP 2930B63-13 03)0112016 0310112017 -�dw X ANY AUTO HOoILY WJURY(Per person) 5 ALL owls SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Paraccidenq S AUTOS AUTOS NON-OWNED PROFERPf DAMAGE S H HIRED AUTOS AUTOS (Por acmden S UMBRELLA LIAR OCCUR EACH OCCURRENCE 3 E%CESS LIPS CLAWS-MADE AGGREGATE S Dim RETENnoN5 S C WORKERS COMPENSAL1tON WC015519215(AOS) 031012016 031012017 X nrTE ETM AND EMPLAYEEW UABItJTY YIN C015519217 KY 0310112(116 03101!2017 1,000,000 G ANY PROPRIETORIPARTNERIEXECUTIVE ❑ lAK NH N�.'R) Ei EACH AccLDENT s D OFFICER/MEMBEREXCLUOED, N NIA WC015519216(FL) 03/012016 03!01!2&17 1,000,000 (MandatnryhrNN) { ELOISEASE•EAEMPLO S ores•des�ros°du Conihtued an Add4ional Page 1,00(1,000 OESCR[PTIONOF0'9RATIONSbelow 9 - EJ_DISEASE-PODCYI.[MIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more spaeo is requfmd) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION TND AT-HOME SERVICFS,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POjUCY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED RORESMATNE of Marsh USA Inc Manashi Mukherjee ©198!3-20.1.4 A,00PD CORPORATION. All rights reserved, i - �'•�3t.'�� GiJJGi. .iJ'v.�J U2 11' �'�orl,� IrrLpr��`v'eL znt•,Co tra�t�r P�eD-E—At}C P is-ration: 126893 - :- T/PP. SupPI" -- - ExQhticn' 8131201 ���IE SERVICES, INC.liiD r.T HO RICHARD FALLON'" - 2090 CUNIH- .LAND PARKVNAY SUIT-E--TR-70 ATLANTA, GA 30339 L; date;address and return card. Mark reason for change, - Nddress — Renetivai 7 Employment J Lost Card re ai _on,lmer Uceuf� Or re; ra.ion`ia id for tnl'iidll a5'- lleior `.h�'aptranon dale• Ii found return Lo: �� ^��1_iti r'a�ITPACIJ°. �s, ` iii t zI£71 I livi-, / Jx i e`)t Consumar�i.a and 3_si2e„ 10Par!c2lazary Sui=e31_70 � =rtptiraiio �8131�r�T� - 5upcte�ar:Car1 yosion �LAO_.Lo IL)?.I Uibl= ] /iVc t� fj� •_ HOvi_DEPOT A t E{Ot41E SE?bIC'c� CHARD FALLOME 3913 cucLi6cp3i lD PAP,KAAY 5 GA 30339 �1 Not rafid wttaout si;naiure Undersecretary / Board of Builth: Re and St Massachusetts Department apt I"���i.i Safety S ��V��:ftns� n n:wi n:d. C gpnstw:� :k�hA: "aair�Iq:�kweo t YR.�b?1.V"4se� C"20261➢ ANTHONY gip I FERST ST p�.y mmri o Y s 06/16/2016 P-'�/!C° ffice of Consumer Affairs&Business Regulation r�ru ME IMPROVEMENT CONTRACTOR "registration: 180139 Type: w " Expiration: 8/28/2018 Supplement KTM PROPERTIES,LLC. ANTHONY PETINO 25 SPAULDING RD SUITE 17-2 � ' -- FREMONT,NH 63044 Undersecretary