Loading...
HomeMy WebLinkAboutBuilding Permit #4-13 - 52 MIFFLIN DRIVE 7/2/2012 NORTF/ BUILDING PERMIT O� TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION h T Date Received � Permit N0: °RwrE° ` '� gSSACHU5E4 Date Issued: IMPORTANT:Applicant must complete all items on this page J , LOCATIONl / Print PROPERTY OWNER Seen g y-e,SSX&O Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yesrho 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 Repair, replacement Assessory Bldg Others: Demolition Other Septic 1 Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: R, li' /Per 45h10/es Idtification Please Type or Print Clearly) OWNER: Name:Sen � ess,r,� S/l�� Phone: Address: CONTRACTOR Name: Ire,)(A oG►�d "� Phone: Address: �/lev7S Supervisor's Construction License: S Exp. Date:. Home Improvement License: / �'� Exp. Date: 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: $ �6yd0 FEE: $ o� Check No.: U Receipt No.: NOTE: Persons contracting w-th un istered contractors do not have access to the guaranty fund -— -- -- --- - -- --- - - - - - - - -- Si nature of A ent/Owner Signature of contractor g- _ g. _ Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ 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 ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT = Temp Dumpster on site. yes no - Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: ! Total square feet of floor area, based on Exterior dimensions.j�-6 — Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.s100-s1000 fine NOTES and DATA– (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location 5za No. OLS "' Date ® • TOWN OF NORTH ANDOVER AILED I e � Certificate of Occupancy $ Buildin 9/Frame Permit Fee }. . t Foundation Permit Fee $ IKG 4 1 Other Permit Fee $ TOTAL Check#�_�raL 25473 Building Inspector Technical Data Sheet CertainTeed LANDMARK TM Premium Shingles *SAINT-GOBAIN LANDMARK TM Pro Shingles LANDMARKT"' Shingles LANDMARK Premium/ArchitectTm 80 Shingles (NW Region only) PRODUCT INFORMATION LandmarkTm shingles reflect the same high manufacturing standards and superior warranty protection as the rest of CertainTeed's line of roofing !! c �:i; `•:.;?':; ':'` ,w1,w,J;'a1,:'.,.•u::.:,i�•q��h:.;.lr.,:.i.r,•%%•.��:is::. products, Landmark Premium (and Algae Resistant-AR), Landmark Pro (and AR)and Landmark(and AR)are built with the industry's toughest fiber glass mat base,and their strict dimensional tolerance assures consistency.Complex granule color blends and subtle shadow lines produce a distinctive color selection. Landmark is produced with the unique NailTrakTm nailing feature. Please see the installation instruction section below for important information regarding hlailTrakT"'. In the Northwest(NW) Region Landmark Premium(AR)is double-branded as Landmark Premium/Architect 80(AR). Landmark algae-resistant(AR)shingles have the additional attribute of resisting the growth of algae especially in damp regions. AR shingles are not available in all regions Colors: Please refer to the product brochure or CertainTeed website for the colors available in your region. Limitations: Use on roofs with slopes greater than 2 per foot_ Low-slope applications(2"to 4"per foot) require additional underlayment. In areas where icing along eaves can cause the back-up of water, apply CertainTeed WinterGuardTM Waterproofing Shingle Underlayment,or its equivalent,according to application instructions provided with the product and on the shingle package. Product Composition: Landmark series shingles are composed of a fiber glass mat base. Ceramic- coated mineral granules are tightly embedded in carefully refined,water-resistant asphalt.Two pieces of the shingle are firmly laminated together in a special tough asphaltic cement. All Landmark shingles have self-sealing adhesive strips. Applicable Standards UL 997 Wind Resistance ASTM D3018 Type I ICC Evaluation Report ESR-1389 ASTM D3462 NYC-MEA-120-79-M(Regional) ASTM E108 Fire Resistance: Class A CSA Standard A123.5-98(&-05)(Regional) ASTM D3161 Class F Wind Resistance Ontario BMEC Auth.97-10-219(Regional) ASTM D7158 Class H Wind Resistance Miami-Dade Product Control Approved UL 2390/ASTM D6381 Class H Wind Resistance Florida Product Approval#FL5444(Regional) UL 790 Fire Resistance:Class A TDI Windstorm Resistance(Regional) Technical Data: Landmark Landmark Pro Landmark Premium* (and AR) (and AR) (and AR) Weight/Square(approx.) 240 Ib 250-270 Ib 300 Ib Dimensions(overall) 131/4"x 38 3/4" 131/4"x 38 3/4" 131/4"x 38 3/4" Shingles/Square(approx.) 64 66 66 Weather Exposure 56/81, 5 5/8" 5 5/8" "Includes"Landmark Premium AR/Architect 80" TOOO SH"M SHOMI'idav VMCM09 XVA OZ:60 ZT0Z/Z0/L0 Technical Data Sheet(Continued) Landmark Shingles Page 3 of 3 Application:The recommended application method is the'Five-Course, Diagonal Method'found on each bundle of shingles. In this method, shingle course offsets are 6"and 11". Instructions also may be obtained from CertainTeed.These shingles may be used for new construction or for reroofing over existing Metric-sized shingles. Flashing: Use corrosion-resistant metal flashing. Hips and Ridges: For capping hip and ridge apply CertainTeed Shadow RidgeTM, Cedar CrestTm or Mountain RidgeTm shingles of a like color. MAINTENANCE These shingles do not require maintenance when installed according to manufacturer's application instructions. However, to protect the investment, any roof should be routinely inspected at least once a year. Older roofs should be looked at more frequently. WARRANTY Landmark Premium (and AR), Landmark Premium/Architect 80, Landmark Pro(and AR),and Landmark (and AR)shingles carry a lifetime limited,transferable warranty to the consumer against manufacturing defects. In addition, Landmark Premium (and AR), Landmark Premium/Architect 80, Landmark Pro(and AR), and Landmark(and AR)carry 10-years of SureStartT" Protection. For specific warranty details and limitations, refer to the warranty itself(available from the local supplier, roofing contractor or on-line at www.certainteed_com). FOR MORE INFORMATION Sales Support Group: 800-233-8990 Web site:www.cert$inteed.com See us at our on-line specification writing tool, CertaSpec, at www.cortaintized.com/certest)ec. CertainTeed Roofing P.O. Box 860 Valley Forge, PA 19482 CertainTeed ®Copyright CertainTeed Corporation, 2011. SAINT C08AIN All rights reserved. Updated: 1212011 c000 SHIVS SHO.Milidav b9VLC69C09 YVA TZ:60 ZTOZ/ZO/LO Technical Data Sheet(Continued) Landmark Shingles Page 2 of 3 INSTALLATION The following is a general summary of the installation methods. Detailed installation instructions are supplied on each bundle of Landmark shingles and must be followed. Separate application sheets may also be obtained from CertainTeed. Roof Deck Requirements: Apply shingles to minimum 3/8"thick plywood, minimum 7/16"thick non- veneer(e.g_OSB),or minimum 1"thick(nominal)wood decks.The plywood or non-veneer decks must comply with the specifications of APA-The Engineered Wood Association. Ventilation: Provisions for ventilation should meet or exceed current HUD Standards.To best insure adequate ventilation, use a combination of continuous ridge ventilation (using Ridge FilterVent or Ridge Filter ShingleVent II, manufactured by Air Vent Inc, or a comparable product with an external baffle)and balanced soffit venting. Valleys: Valley liner must be applied before shingles. The Closed-Cut valley application method is recommended, using CertainTeed WinterGuard Waterproofing Shingle Underlayment or its equivalent to line the valley prior to being fully covered by the shingles. Underlayment: On slopes 4"per foot or greater, CertainTeed recommends one layer of DiamondDeck TM Synthetic Underlayment,or Roofers' SelectTTM High-Performance shingle underlayment,or shingle underlayment meeting ASTM D226, D4869 or ASTM D6767.Always ensure sufficient deck ventilation, and take particular care when DiamondDeck or other synthetic underlayment is installed. For UL fire rating, underlayment may be required. Corrosion-resistant drip edge is recommended and should be placed over the underlayment at the rake and beneath the underlayment at the eaves. Follow manufacturer's application instructions. On low slopes(2"up to 4"per foot),one layer of CertainTeed's WinterGuard Waterproofing Shingle Underlayment(or equivalent meeting ASTM D1970)or two layers of 36"wide felt shingle underlayment (Roofers'Select High-Performance Underlayment or product meeting ASTM D226, 04869 or ASTM D6767)lapped 19"must be applied over the entire roof, ensure sufficient deck ventilation.When DiamondDeck or other synthetic underlayment is installed,weather-lap at least 20"and ensure sufficient deck ventilation.When WinterGuard is applied to the rake area,the drip edge may be installed under or over WinterGuard. At the eave,when WinterGuard does not overlap the gutter or fascia,the drip edge should be installed under WinterGuard.When WinterGuard overlaps the fascia or gutter,the drip edge or other metal must be installed over it. Follow manufacturer's application instructions. Fastening (NailTrakr"'): Low&Standard Slopes: On low and standard slopes,four nails are required per shingle.There are three nail lines on NailTrak shingles. Position nails vertically between the upper and lower nailing-guide lines. It is acceptable to nail between either the middle and lower lines or between the upper and middle lines. Nails must be of sufficient length to penetrate into the deck 314"or through the thickness of the decking, whichever is less. They are to be located 1"and 12"in from each side of the shingle(see instructions on product wraps.) Nails are to be 11 or 12 gauge,corrosion-resistant rooting nails with 3/8"heads. Steep Slopes:On slopes greater than 21"per foot,fasten each shingle with six nails and four spots of roofing cement placed under each shingle according to application instructions provided on the shingle package. Fasteners must penetrate the two-layer common bond area that is indicated by the middle and lower NailTrak lines, also illustrated on the shingle package. z0oz S3IVS SH01.v0I'IddV 168i9LMC09 YVd TZ:60 ZTOZ/ZO/LO NORTH Town of t E 1, Andover No. I nh ver, Mass, CO LNT • 1� COC MIc Nl MACK V AERATED S U BOARD OF HEALTH PERM Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR �`• •.. �*. Foundation has permission to erect .......................... buildings on . ...... .... ••.•.••••••••••••••••••• Rough tobe occupied as ........�.. ...... .. ............................. ... rt�.l�. .............................................. Chimney provided that the person accepting this per shall in every respect confor 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 Rough L VIOLATION of the Zoning or Building Regulations Voids this Permit. LD Final S' PERMIT EXPIRES IN 6 MONTHS Rough ELECTRICAL INSPECTOR ,a TS UNLESS CONSTRUCTI T Service --— ................ .. ... ... .... . ....... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE 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 Fax# 617-727-7749 Revised 5-26-05 www.mass.gov/dia 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 Information JJ Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip:y'�e��"'en ro, Y V Phone#: 4176— Y y.5-6 Are you an employer?Check the appropriate box: Type of project(required): 1.[9 I am a employer with ? _ 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors � 2.E] E I am a sole proprietor or partner- listed on the attached sheet. $ 7. Kemodeling 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 10.❑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.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other eb c comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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: Policy#or Self-ins.Lic.#: �✓C' '" 3 IcJ —.�7 Expiration Date: �—J3'13 Job Site Address: Fob In I Eli's V City/State/Zip:,,(/• 'Q0d 0 y e 1` 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. Sienature• 2�lse Date: Phone 9: �1 Z17 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 & C Contracting, Inc. "A Full Service Remodeling Company" July 2, 2012 CUSTOMER INFORMATION Sean&Jessica Slipp 52 Mifflin Dr North Andover Ma 01845 CONTRACTOR INFORMATION K&C Contracting, Inc. Kevin Kondrat 7 Marvin St Methuen, Ma 01844 9784764450 FID#261729246 Construction Supervisor#99457 WORK TO BE PERFORMED Contractor Agrees To Do The Following Work For Homeowner: See attached proposal# 2468 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 the materials and labor specified for the SUM OF: $10,400.00 PAYMENTS will be made according to the following SCHEDULE: Roof Payments $5,000.00-Deposit $5,400.00-Upon completion DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANKS Client's signature Date _ Date Contractor's signature 1 You may cancel this agreement if it has been signed by a party thereto at a place other than and address of the seller,which may be his main office or a branch thereof, provided you notify the seller in writing at his main branch by ordinary mail posted or by delivery, not later than midnight of the third business day following the signing of the agreement.See attached notice of cancellation for an explanation of this right. NOTE: All home improvement contractors and subcontrators shall be registered and any inquires about a contractor or subcontractor relating to a registration shall be directed to: Director, Home Inprovement 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 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 to such arbitration as provided by M.G.L c. 142A. Client's signature Date 7 0� 1 Contractor's signature Date NOTICE: THE SIGNATURES OF THE PARITES 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 IN NOT SEPERATELY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity: A Contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems his/herself to be financially insecure. Contractor's Financial Insecurity: In instances where a Contractor deems him/herself to be financially insecure, the Contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal from said account would require the signature of both parties. 2 PROPOSAL K & C Contracting DATE Proposal# 7 Marvin St. Methuen Ma 01844 6/25/2012 2468 978-476-4450 Sean&Jessica Slipp 52 Mifflin Dr No. Andover Ma 01845 DESCRIPTION AMOUNT Remove existing lead and install new,repoint lead on two chimneys Remove and dispose of existing shingles down to roof deck Renail sheathing as needed Install 6'of ice and water shield Install ice and water to all valleys Install 151b felt paper to remainder of roof Install 8"drip edge to entire perimeter of roof Cut back ridge for venting Install new architectural shingles Flat roof or low sloped roof to be covered in 1/2"high density board, install .060 rubber membrane roofing fully adhered,install seam tape to all seams,install cover tape to drip edge Does not include any rotted sheathing Strip siding and stucco to sheathing of house and dispose of Repair as needed Install house wrap and a min if 3/8 foam board to entire house Install Certainteed siding with.046 thickness Wrap all trim,fascia and rakes as needed with white aluminum metal- .019 gauge 10,400.00 Any framing,installing windows etc will be billed out as time and material Workman's Comp WC1-31S-373718-011 GL-BOP9096009 Federal Tax ID#26-1729246 TOTAL $10,400.00 Page 1 of 1 Details r� Licensee Details Demographic Information KEVIN E KONDRAT Full Name: Gender: Owner Name: License Address Information ddress: 7 MARVIN ST ddress 2: ity: Methuen tate: MA ipcode: 01844 ount United States License Information License Type: Construction Supervisor Foing : CS-099457 : Building Licenses Date of Last Renewal: 47/2014—' 5/30/2008 Expiration Date: 7/1/2012 : Active Today's Date: atus: License: iness As: 18 n e: prer it a Information ► F matron NO rrere u►an �� a ���r���� Disci line No Disci line Information Documentum http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=288306& 7/1/2012 THE COMMONWEALTH OF MASSACHUSETTS Department of Public Safety One Ashburton Place, Room 1301 Boston, MA 02108-1618 APPLICATION FOR LICENSE RENEWAL KEVIN E KONDRAT � - 64 CHADWICK ST BRADFORD MA 01835 Please note changes to marltitg address. License Type: Construction Supervisor Restricted to: License No: CS-099457 Expiration. 04/27/2012 Please refer to the Department of Public Safety website,www.mass.gov/dps for continuing education requirements. Licenses not renewed by the expiration date shall become void,and shall after one year be reinstated only by a new application and re-examination of the licensee if required.An future renewal notices will be sent by E-MaiL Please specify the E-Mail address you want your renewal notice to be sent to: c} d CSC`� 0- Please review information on your license on the DPS website at. www mass.Qov/dpS I hereby certify,under the pains and penalties of perjury,that I am unable to access a-mail notifications and therefore request U.S.mail notifications of renewals. Date Signature of Applicant Mail the com leted renewal form with Please enclose a check or money order made payable to the p Commonwealth of Massachusetts for the required non refundable paymenttopa:Department of Public Safety processing renewal fee of$10(1.00- CSL Renewal DO NOT MAIL CASH. P.O.Box 414376 Write the license number on the front of the check or money order. Boston,MA 02241-4376 AUTHORIZE DPS TO USE MY RMV PHOTO INFORMA'T'ION (Pkwe chi baz the left). Massachusetts Ibis option authorizes the Department of Public Safety to electronically access mY photograph froReaishy of Motor Vehicles database solely for use on this licceschegistmt►on If You do not authorize use of your MA RMV photo or do not have a MA RMV license,Please submit Photo Submission Form for License Renewal available at www.mass-gov/dps. Failure to follow DPS license photo procedure will result in your renewal status being changed to . °Incomplete"until a proper photo is received. ability penal please check here if English is not your primary language AND your ty to 0 J NGUAGE ACCESS PLAN (Op ) e is: read,write,speak,or understand English is li�pited. Please indicate what your primaryS� that to the best of my Rowledge and belief the I hereby certify under the pains and penalties of perjury information above is correct and that I have filed all s a the�wreturns turnsand ng and all state of child suplm� y law and complied with all laws of the Commonwealth relative Date Signature of Applicant Rev: 1000-3000 Amt: $100.00 RenID• 84050 LicID: 288306 Submit by Email Print Form '—"' THE COMMONWEALTH OF MASSACHUSETTS Department of Public Safety One Ashburton Place, Room 1301 Boston, MA 02108-1618 REQUEST FOR DUPLICATE RENEWAL FORM PLEASE COMPLETE THIS FORM AND MAIL TO THE ADDRESS ABOVE ATTN: REQUEST FOR DUPLICATE RENEWAL FORM OR FOR IMMEDIATE ASSISTANCE,PLEASE EMAIL THIS COMPLETED FORM OR THE REQUESTED INFORMATION TO ?SINFOr,STATE.MA.US WITH THE SUBJECT LINE"REQUEST FOR DUPLICATE RENEWAL FORM" Failure to do so will result in your license renewal being delayed and/or expiring until the proper documentation is provided. Licenses not renewed by the expiration date shall become void, and shall after one year be reinstated only by a new application and re-examination of the licensee if required. Name: Kevin Kondrat License Number: 99457 License Type: CS Expiration Date: 4/27/2012 Would you like to have your renewal form e-mailed to you? 0 YES ❑ NO If so, please specify the E-mail Address you want your renewal notice to be sent to: kandccontracting@verizon.net DO NOT ATTA CHA FEE AS THIS IS NOT A RENEWAL FORM. LICENSES WILL NOT BE RENEWED UNTIL THE PROPER RENEWAL FORM IS SUBMITTED. Check Images Page 1 of 1 Bank America's Most Convenient 8❑,F Check Images Account: x9904 - BUSINESS CONVENIENCE CHECKING I Check Number: 2665 1 Date Posted: 5/25/2012 1 Amount: $100.00 Zoom InQ Zoom OuA Print -K ANDc 60WMCTlti%!MC - 2fi6b- - 7 MARVIN 8T METHUEN MA01844 _ 05- Pay to the - 1: - - - $-� Ca~ 1 __Q.fdier o Dollars "�- Oq�N M Mkt. ©-:Saik 24 13705451: 8 24? 0i 9041' g6 t�:evct 1Ccc, to CD 1 _ Z N WOFAOD Idw. ONtl1 -:7 Qtil QwUtN OD - _ - - txiH0A ,p . C1 H ON 1-888-751-9000-Live customer Service 24/7 1 Terms of Use ©20127D Bank,N.A.All Rights Reserved. https://businessonline.tdbank.com/CorporateBankingWeb/Core/CustomerService/Checklma... 7/1/2012 if 4` Board o1 BviiililiA H,,u0iws.-,aid 5tapd.lyd Cr elriton Suqeezxl:3or- .License Ict n.a: C 5 99457 . t 00 KEVIN KONDRAT 19 RACHEL RD METHUEN, MA 01844 --�— =xpiration: 4/27/2012 . •° .C uun:ui'..t�nrt 'Tiff• 99457 - ��ze "(oomi�novcuse¢�i o�✓�Zaaaac�iuu(>x4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 160272 Type: -' � Expiration: 7/7/2012 Private Corporati K&Contracting Inc. Kevin Kondrat 64 Chadwick Street Bradford,MA 01835 Undersecretary F F,! 1/ r