Loading...
HomeMy WebLinkAboutBuilding Permit #807-16 - 34 UNITY AVENUE 1/14/2016t Permit NO: J ' Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Date Received ANT: Annlicant must complete all items on this LOCATION�"- Print PROPERTY OWNER nu.,) 1t'I/^q,f rint MAP NO�PARCEL:—Z�ZONING DISTRICT: Historic District yes (noMachine Shop Villaqe ves � TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑. Watershed District ❑ Water/Sewer. . OWNER: Name: r \ Ck Address: �l'` ��y 11 CONTRACTOR Name: ./ Identification n Type or Print Clearly) e: 999- 375-- S tl A hone: Address: Supervisor's Construction License: —1 Exp: Dater Home Improvement License: Exp. Date: A 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: $ �) �� FEE: $ Check No.: Receipt No..Q6W NOTE: Pero contr cting with unregistered contractors do not have acc ss to t e guaranty fund Signature of Agent/Owner (�--!`-- 6ig�iature of contractor 1b' r 0 n O t6 O V CL cc Z y (D I E * ® o .� c N m r <u W O u Q� E 0) .i TQC O N J i CL L � 00 T C.1 >_ co Cc w C = 4) W O a> > � = I- _ 'mo q N a Z -a U) °' Q a o .c .c o W Ec V o F•- H cn OC '> 3 L W '> O c W J ^- c o � a. Z CL " V (D In A, • c L ♦ � o .cn a� F- v O C O C CD c • CLm"� N y0, N d V mcc d V_ W O �+ O O LL. ' N R U) •-1.- t_n O O H � � L~ O Z V " V 0 U.1 Ea) O O F- • co CL U) . 0CLo O cc C 0 H 0-00 > ES 9 0 w H � Ch O O Q. CL CpQ C C —J 'a O Z Q) CLN C Y L L _ J Q W _ LL O D Q m C u T 0 LLI H Z Z m O O O W a Z (g Z D a O W0 Z -•� cQJ W J W W H Z IA Q W C G � Q W a W I=v LL Y \ _6tto_ O O LL N U O_ N N a u 7 O LL t 7 O �' T C t U f0 C LL L to O d' C LL d0 O O K 41 U i N C LL UA '� LL i m p Z v N N Y C N n O t6 O V CL cc Z y (D I E * ® o .� c N m r <u W O u Q� E 0) .i TQC O N J i CL L � 00 T C.1 >_ co Cc w C = 4) W O a> > � = I- _ 'mo q N a Z -a U) °' Q a o .c .c o W Ec V o F•- H cn OC '> 3 L W '> O c W J ^- c o � a. Z CL " V (D In A, • c L ♦ � o .cn a� F- v O C O C CD c • CLm"� N y0, N d V mcc d V_ W O �+ O O LL. ' N R U) •-1.- t_n O O H � � L~ O Z V " V 0 U.1 Ea) O O F- • co CL U) . 0CLo O cc C 0 H 0-00 > ES 9 0 w H � Ch O O Q. CL CpQ C C —J 'a O Z Q) CLN C Y L K & C Contracting, Inc. "A Full Service Remodeling Company" CUSTOMER INFORMATION David Livingston 34 Unity Ave North Andover Ma 01845 CONTRACTOR INFORMATION K&C Contracting, Inc Kevin Kondrat 7 Marvin St Methuen Ma 01844 978-476-4450 FID# 261729246 CS# 99457 WORK TO BE PERFORMED Contractor Agrees To Do The Following Work For Homeowner: See attached proposal January 13, 2016 The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work Scheduled to Begin: P -e,.4 4 Sul&*,,Q.) Expected Date of Completion c2 ,bfys brow pe`"``L TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The contractor agrees to perform work, furnish materials and labor specified for the SUM OF: $7.400.00 PAYMENTS will be made according the following SCHEDULE: $2,450.00 Deposit $2,450.00 Half complete $2,500.00 Upon completion Client's Si nature �/ Date I, g Contractor's Signature Date 10 f n4 NOTE: All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration shall be directed to: 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 The contractor and homeowner hereby mutually agree in advance that in an event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit such arbitration as provided .G.L c. 142A. Client Signatures Contractor's Signature Date Date NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE 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 dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. Contractor's Financial Insecurity: In instances where a Contractor deems his him/herself to be financially insecure, the Contractor may require that the balance to funds not yet due be placed in a joint escrow account as a prerequisite to continuing contracted work. Withdrawal from said account would require the signature of both parties. 978-476-4450 kccontracting@comcast.net KFC Contracting, Inc 7 Marvin Street Methuen ALL 01844 David Livingston 34 Unity Ave North Andover Ma 01844 ESTIMATE DATE ESTIMATE # 1/13/2016 3472 Description Total Remove and dispose of existing shingles Install ice and water shield to entire roof Install drip edge to entire perimeter Install ridge vent Frame cricket, plywood, install lead 7,400.00 Total $7,400.00 PRODUCT INFORMATION SHEET Timberline HD® Shingles Made To Protect Your Home. Your Story. And Those Of Over 50 Million Of Your Fellow North Americans! PRODUCT INFORMATION "Value and performance in a genuine wood -shake look" Timberline HD® Shingles Provide These Unique Benefits: • Dimensional Look ... Features GAF's proprietary color blends and enhanced shadow effect for a genuine wood -shake look • Highest Fire Rating ... Class A fire rating from Underwriters Laboratories • High Performance ... Designed with Advanced Protection Shingle Technology, which reduces the use of natural resources while providing excellent protection for your home (visit gaf.com/aps to learn more) 10/26/2015 V Stays In Place ... Dura Grip'" Adhesive seals each shingle tightly and reduces the risk of shingle blow -off. Shingles warranted to withstand winds up to 130 mph (209 km/h).' Peace Of Mind ... Lifetime ltd. transferable warranty with Smart Choice Protection (non -prorated material and installation labor coverage) for the first ten yearS2 Perfect Finishing Touch ... Use Timbertez Premium Ridge Cap Shingles or Ridglass Premium Ridge Cap Shingles3 'This wind speed coverage requires special installation; see GAF Shingle & Accessory Ltd. Warranty for details. ZSee GAF Shingle & Accessory Ltd. Warranty for complete coverage and restrictions. The word "Lifetime" refers to the length of coverage provided by the GAF Shingle & Accessory Ltd. Warranty and means as long as the original individual owner(s) of a single-family detached residence [or the second owner(s) in certain circumstances] owns the property where the shingles are installed. For owners/structures not meeting the above criteria, Lifetime coverage is not applicable. 3rhese products are not available in all areas. See www.gaf.com/Hdoecapavailability for details. COLORS/AVAILABILITY COLORS: Barkwood, Birchwood, Biscayne Blue, Canadian Driftwood, Charcoal, Copper Canyon, Driftwood, Fox Hollow Gray, Golden Amber, Hickory, Hunter Green, Mission Brown, Oyster Gray, Patriot Red, Pewter Gray, Shakewood, Slate, Sunset Brick, Weathered Wood, White, and Williamsburg Slate REGIONAL AVAILABILITY: Northeast, Southeast, Southwest, West, and Central Areas .See htto://www.gaf.com/Roofing/Residential/Products/Shingles[Timbertine/High Definition for color availability in your area The Commonwealth of Massachusetts Department of Industrial Accidents } Dice of Investigations d I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): V,( _ Address: �f U k City/State/Zip: MU ­Cn M y''1' lZiV VPhone #: O�Z-k-_ (A-� Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ 1 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- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance insurance.$ required.] emp. 5. We are a corporation and its 3. ❑ 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL insurance required.] t 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. F1 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.B'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 thepolicy and job site information. / Insurance Company Name: i`,rT_P V fe J bjj,,a ( _ Policy # or Self -ins. Laic. #: A P O j d Z) -) a 17 a Expiration Date: l -19-is - > d Job Site Address: S c/ on t 64 N U Lei City/State/Zip: M 10 V MC)d0&9 le,4 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 under the pains and penalties of perjury that the information provided above is true and correct. 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 #: K&CCO-1 OP ID: SR CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/14/2016 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 Michaud, Rowe And Ruscak Ins.PHONE P.O. Box 188 CONTACT NAME: Michaud, Rowe & Ruscak FAX JA No Ftl: 978 688 8829 ac Nc :978 557 2130 o : ADDRESS: North Andover, MA 01845 Michaud, Rowe & Ruscak COMMERCIAL GENERAL LIABILITY INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Preferred Mutual Insurance Co. 15024 INSURED K & C Contracting Inc. Kevin Kondrat 7 Marvin St INSURER B: INSURER C CLAIMS -MADE FIOCCUR Methuen, MA 01844 1 INSURER D: INSURER E 12/19/2015 INSURER F: DAMA E TO RENTED PREMISES Ea occurrence) $ COVERAGES CERTIFICATE NUMBER: 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. 1NSR LTR OF INSURANCE ADDLTYPE JMV_ SUER POLICY NUMBER EFF MM/DDY /YYYY POLICY EXP MMIDD/YYYY LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FIOCCUR BOP0100721827 12/19/2015 12/19/2016 DAMA E TO RENTED PREMISES Ea occurrence) $ MED EXP (Any one person) $ 10,000 X Business Owners PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PE� D LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO - 9AUTOS ALL OWNED SCHEDULED' AUTOS I BODILY INJURY (Per accident) $ NON-OWNEDPROPERTY HIRED AUTOS AUTOS DAMAGE $ Pera.d.nt X UMBRELLA LIAB [TCLAIMS-MADE CCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,000 LA EXCESS UAB UC0100608971 12/19/2015 12/19/2016 DED I X I RETENTION $ 10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N 1 A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ PROPERTY 2,500 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached H more space is required) Carpentry CERTIFICATE HOLDER CANCELLATION NORTHI3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St Bldg 20 Suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE <-=�`' 4 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD p(fcce or cr p0airs & i+i� -- = f)Mrr, IMPROVEMENT rv�N � registration. ;166272 Privete CQ } . - piretion: 7/112016 K$�Gpntraetsng Inc..` � °�:� r Kontiiret -.Kevin �, �'- -r;-• g fin SU �+ 716tV Undersecretary 1 Methuen, NIA 01844 G - Massachusetts-�2�%a`tiTiE'ilt Of public rJ1ff � � Sward of Bu-ilding Regulations and Sit tndar* Con'triict on Supen`isvti License: CS-OSM7 Kevin E Kondrat 7 Marvin street.• f- MetEbuen MA 0444 J �6 )i 14t i Expiration ®4)27J20if Commissioner "`i,