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HomeMy WebLinkAboutBuilding Permit # 5/16/2016 BUILDING PERMIT �PERMIT TH a,n � � TOWN OF NORTH ANDOVER Permit N®. ... APPLICATION FOR PLAN EXAMINATION Date Received CH Date Issued: Z. IM CDRTANT:Applicant must complete all items on this 2ag.e ri t PROIIRT( NiR MAS NO PA '05 'V/STRICT,RJCTw Fllstori District yes ° Machine Shop Village, yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial _ r eRepair, replacement Assessory Bldg Others: Demolition Other 4'4pptio ;}Well LI=la odplain Cl wetlands Watershed District ,.., . Identification Please Type or Print Clearly) OWNER: Name: Q.;rt._. t:::4 Phone: ' . Address: Qi . ... c ONT`RA «Tt � e ikon ' t". �� Na 'tipftcr' tantrttiot=i ink Exp. Date,, w . � r ^ x � Home irn ravenient is es Exp, Dat . , 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. Total Project Cost: $ ;; ,11e-(,-,J ,J FEE: $ (' m ,, Check Na.; Y z Receipt No.: r` NOTE: Parsons contractingwith nnregistei d contractors s Flo not have access to the gear antp fiend Signature of Agent/Owner Signature of contractor 0 t%ORTH Andover L. Town of ® t /C Very SSS' %6 ®Q coc"Ic"t-cn �� ® ®RATED BOARD OF HEALTH LD Food/Kitchen Septic System PERMIT T BUILDING INSPECTOR THIS CERTIFIES THAT .l. ............................................................................. Foundation d t ion ... buildings on ....�.�D....�U �:.............................................�:: has permission to erect .....................�,. Rough G` Ocv Chimney tobe occupied as ................5................................................................................................................. 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS IO,STARTS Rough . Service ................... ........ ... ...................... Final BUILDING INSPECTOR GAS INSPECTOR _cc pa cy Permit Required t® Oceupy Buildi Rough Final Displayi a Conspicuous lace a Premises — ® Remove r all a Done FIRE DEPARTMENT Lathing Until Inspected a Approvedt e ili Inspector. Burner • Street No. Smoke Det. A Full Service Remodeling Companv May 2, 2010 CUSTOMER INFORMATION Tony RoyaI 80 Court St North Andover Ma 01845 CONTRACTOR INFORMATION It&C Contracting, Inc i<evin Kondrat 7 Marvin St Methuen Ma 01844 978-476-44SO FID#261729246 CS#99457 WORK TO BE PERFORMED Contractor Agrees To Do The Following Work For Homeowner: See attached proposal#3760. Anything else is excluded The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work Scheduled to Begin: Expected Date of Completion TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The contractor agrees to perform work,furnish materials and labor specified for the SUM OF: $8,800.00 PAYMENTS will be made according the following SCHEDULE: $ 4,400.00 Deposit for materials $ 4,400.00 Upon Completion �. /4 r Client's Signature G'l �'rJ Dater j Contractor's Signature Date �; S be registered and any NOTE: All home improvement contractors and subcontractors egist ation shall be directed to: inquiries about a contractor or subcontractor relatingo a Director, Home improvement Contractor Registration One Ashburton Place, Room 1301 Boston Ma 02108 617-727-8598 Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on this residence. ARBITRATION Thcontractor and homeowner hereby mcitually agree in advance e t at in a ventcl spate to the To contractor has a dispute concerning this contracr4�d by the Secretary of the Executive office uch a private arbitration service which has been app of Consumer Affairs and Business Regulations and the consumer shall be required to submit such arbitration as provided M.G.L c. 142A. Date Client Signature jDate Contractor's Signature LY TO THE AGREEMENT OF THE NOTICE: SIGNATURES OF THE PARTIES ABOVE APPLY OR ACTOR.THE OWNER MAY INITIATE PARTIES TO ALTERNATIVE DISPUTE INITIATED BY THE C ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NO SEPARATELY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT Homeowner's Financial insecurity: A Contactor may not demand payment in advance of the Homeowner'snee'specified on the payment schedule in cases where the homeowner deems him/herself to dates be financially insecure. Contractor's Financial insecurity: in instances`Nthat the balance to funds nere a Contractor deems 'ot yet due ble plaf to ced financially insecure,the Contractor may require "Dint escrow account as a prerequisite to continuing contracted work. Withdrawal from said mai account would require the signature of both parties. 1O" The Carnrnorrwettltlr of Massachusetts Department of lndustrialAccidents 1 Con�r•ess Street,Suite 100 Boston,MA 02114-2017 w� Ivlvw.mass.govA1ia Workers'Compensation Insurance Affidavit:General Businesses. To BE FILED WITH THE PERMITTING AUTHORITY. Please Print Le ibl licant Information �» Business/Organization Mame; Address: 1 1 C• Phone#: . w .. City/State/Zip: - FBusiness Type(required): Are you an employer`?Check the appropriate box: . �Retail employees(hull and/ 1 am a employer with,_.___,_._._._._._ 6. ®RestaurandBar/Eating Establishment or part-time).* ® T am a sole proprietor or partnership and have no 7. 0 Office and/or Sales(incl real.estate,auto,etc,) 2, employees working for me in any capacity, g. 0 Non-profit E [No workers'comp•insurance required] sed 9 ®Entertainment 3.Ej---�are a corporation and its officers 1 av their right of exemption per c. 152, Os"e dtwe have 1.0.®Mamtfactur7ng § no employees.[No workers'comp.insurance required]** 11.®Health Care 4.n We are a non-profit organization,staffed by volunteers, 12.0 Other with no employees.It workers'comp.insurance req.] *pay applicant that checks box#1 must also fill out the section below strewing their workers'compensation policy mtarnrati°n' *An the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. [ant ori employer that is pravidilig workers'contpensation insurance for my employees. Below is the policy r"►rforrrtatrora. insurance Company Name: Insurer's Address: City/State/Gip: her Expiration Date: policy#or Self-ins.Lie,# Attach a copy of the workers'compensation policy declaration page g52(showing lead to�tlxeolinposumn of criminal rpenaltiesration aof a Failure to secure coverage as required under Section 25A of MGL meet may be forwarded to the Office a to u to$1,500.00 and/or one-year imprisonment,as well act civil penalties a cies i the form of a STOP WORD ORDER and a fine fit p of up to$250.00 a day against the violator. Be advise t 1 Investigations of the DTA for insurance coverage verification I do hereby certify,ander the pains ani/penalties ofperlrrry that the infarrnatiott provided above is ri`t a and correct. Date: 2_A Signature: Phone#: o fficiallY. Da not write in this arca,to be completed by city or town official Pernrit/License# : rity(circle one): ealth 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Off' ice 6.Other Phone#: Contact :Person:* ------- K&CCO-1 OP ID:KM DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0511212016 ES NEGATIVELY AMEND, EXTEND OR ALTER THE CO H R SSUINGFORDED By NSURER(S),rHE AUTHORIZIED THIS THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NO RIGH N UPON THE CERTIFICATE HOLDER. CI CERTIFICATE DOES NOT AFFIRMATIVELY OR BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE subject to REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. olicy(ies)must be endorsed. If SUBROGATION IS WAIVED, IMPORTANT: If the certificate holder i an nDITIONAL INSURED,the p terms and conditions of the policy, policies may require an endorsement. A statement on this certificate does not confer rights to e the CONTACT certificate holder in lieu of such endorsements. NAME: Michaud,Rowe&Rusca FAX 978 557 2130 PHONEg7g 688 8829 A1C No PRODUCER A1C No Ext Michaud,Rowe And Ruscak Ins. E-MAIL P.O BOX 188 ADDRESS: NAIC# North Andover,MA 01845 INSURERS AFFORDING COVERAGE 15024 Michaud,Rowe&Ruscak INSURER A:Preferred Mutual Insurance CO. INSURER 8 INSURED K&C ContraCling lnC• INSURER C: Kevin Kondrat INSURER D: 7 Marvin St Methuen,MA 01844 INSURER E: INSURER F REVISION NUMBER: COVERAGES CERIOD RTIFICATE NUMBER: POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, UIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PE INDICATED. NOTWITHSTANDING ANY REQ CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICY EFF POLICY EXP LIMITS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. sue LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1,000,000 POLICY NUMBER EACH OCCURRENCE $ INSR TYPE OF INSURANCE INSD WVD DAMAGE TO RENTED LTR $ A COMMERCIAL GENERAL LIABILITY BOP0100721827 12/19/2015 1211912016 pREMISEs Ea occurrence 10,000 CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $ 1,000,000 X Business Owners PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: $ PRO- 0 LOC POLICY[_1JECT COMBINED SINGLE LIMIT $ OTHER: Eaacadent BODILY INJURY(Per person) $ AUTOMOBILE LIABILITY BODILY INJURY(Per accident) $ ANY AUTO PROPERTY DAMAGE $ ALL OW NED SCHEDULED Per accident AUTOS AUTOS $ NON-OWNED HIRED AUTOS AUTOS 3,000,000 EACH OCCURRENCE $ 3,000,000 xUMBRELLA LIAR OCCUR UC0100608971 12/1912015 1211912016 AGGREGATE $ 10000 ER A EXCESS UAB CLAIMS-MADE PER OTH- STATUTE DED X RETENTION$ $ WORKERS COMPENSATION E.L.EACH ACCIDENT AND EMPLOYERS'LIABILITY YINE.L.DISEASE-EA EMPLOYEE $ ANY PROPRIETORIPARTNER/EXECUTIVE [:] N 1 A OFFICERIMEMBER EXCLUDED? E.L.DISEASE-POLICY LIMIT $ (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below may be attached if more space is required) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule, Interior Carpentry CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DE OF, NICE POLICIES WILL CBECDELIVERED ELLED BEFORE THE EXPIRATION DATE THEREOF, ACCORDANCE WITH THE POLICY PROVISIONS. Tony Royal 80 Court Street AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-0994.`'sor Construction Supe KEVIN E KONDRAT 7 MARVIN sTR ET METHUEN MA Expiration: .� on` 04127/2018 mmis Cosionerr ae' arz�uoaicuea�C�a o�C�f�aJJac%uv6lc., Business Regulation Qifiict or consnmet Affairs&Bu C fop, ODIIE IMQRpVFMENT oratic egi •stratlon: private CsrP. - 160272 xpiiation: ..7/712016 onttEting Inc. KontlrAt. ,� • (Vin St:' Uiiderseci etni'Y' MA 01844 Methuen,