HomeMy WebLinkAboutBuilding Permit #58 - 70 PEMBROOK ROAD 7/13/2010 BUILDING PERMITcF NORTy
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TOWN OF NORTH ANDOVER oL
APPLICATION FOR PLAN EXAMINATION ° ' y
Permit NO:
e
Date Received
3y �RAreo F,
Date Issued: SSACHu`�E�
IMPORTANT A plicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Ad n Two or more family Industrial
Alt 'tioeration No. of units:_ I Commercial
Re air replacement Assessory Bldg Others:
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DESCRIPTION OF WORK�TO BE PREFORMED:
Dem 1I /P a��� . pmee /A / i�, Rt,Fo%s�ce
or 9A) & Lh ira-ll evew BOIL,
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I entification Please Type or Print Clearly)
OWNER: Name: I��L y rn n Phone 97s
Address:
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ARCHITECT/ENGINEER Phone:
Address: '
Reg. No.
FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $- FEE: $
Check No.: Recei t No.:
NOTE: Persons contracting with unregistered contractors do not ve access.. the guaranty.fund
Signature of Agent/0u✓ner
7,71
ng
gnaturesof
Ir
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
ublic 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 Si-gnature
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
jf �= ET1ET �erpDurpser or� �te x .ono
n ;
<Li�cated at � laua street M fi
�eartrert �s� ae/ a r
wu
F
tCfJ,11�JI�lE�ITS w � {,- }
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
i
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.$100-$1000 fine
NOTES and DATA— For department use)
❑ Notified for pickup - Date
Doc.Building Permit Revised 2010
Y
I /�
�I
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
❑ BuildingPermit Application
pp atlon
❑ 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 Piot 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:Building Permit Revised 2008
it
1
Location �� T fir'► N ��-
No. 56Date / v
&ORT" TOWN OF NORTH ANDOVER
� y
Certificate of Occupancy $
�Oo•�•o•�•� Yf�
'ssncMust` Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ `
TOTAL $
Check # I/
230 9,
Building Inspector
ORTH
Town ofAndover
_
0 w.
L.
.....
No.
OSS' X01W, -_
A K E O clover, Mass., •
COCHICHEWICK
7�AORATED
`SS BOARD OF HEALTH
Food/Kitchen
Septic System
BUILDING INSPECTOR
T
�
THISCERTIFIES THAT........... . .�.. .. ...�.........................................�.I L**,Mw.. ............................................................. Foundation
has permission to ere ..............:......... .. ........... buildings on .......1.0....... ....G..!!�... ..... .. ..,. ..� Rough
9 to be occupied as... ..1,...... .. .. ...... � ...�........ ��. ..go......�.......... Chimney
provided that the son accepting this permit shall in eve respect conform to the s of the lic tion n file in
P P P g P P PP Final
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
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUC O t�TS ELECTRICAL INSPECTOR
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.
✓lee PorrerAff Affairs / egul.tio. a
Office of Consumer Affairs&B siness Regulation
HOME IMPROVEMENT CONTRACTOR
Registration: :f 160272 Type:
Expiration: :.777/20,12 Private Corporation
K& Contracting
_ 1
Kevin Kondrat
64 Chadwick Street
Bradford, MA 01835
Undersecretary
LA
'do,trd,o Builtlfint Rbiz►utatians .and St intl.►rds
ConstructionGpe �sot 1.License Qt,
44,.: f Y' ia6 7
':wLacene: CS;t 9945 ,
8 Restrictedtto` OW7'*
KEVIN KONDRAT;
19 RACHEL RD
t;*.'METHLIEN, MA 01844 . y .
.4/22012 ^.
t ':"L.+ymmJcgilr�nct ?°�r Trr 9845T' -
The Commonwealth of Massachusetts
Department o f Industrial_accidents
Office Oflnveskolations
600 Washing ton Street
Boston, M4 62111
Workers' Com ensafion Insurance��$ assoov/dig
P vii: Builders/Contractors/Electricians/plumbers
Ao lieant Information
PIease Print Leaibiv
Name(Business/Otganization/1r dividual):
Address: C�4dL,,c
City/State/Zip:_ y �,,
Are you an employer?Check the appropriate box:
1•trJ 1 am a employer with� 4. [] I am a o Type of project r
general contractor and I (required)-
-__S
tion
employees(full and/or part-time).* have hired 6. 0 Nevi,construction
2.0 I am a sole proprietor or partner- listed on the sub-contractors
ship and have no employees the attached sheet x ?• [�RemodAling
These sub`contmctors have
working for me in any capacity. workers' 8• Erbemol.
[No workers' comp. compo.insurance.
required] insurance 5. [] a cOIp ration and its 9. []Building addition
3.0.I am a homeowner doing all work n t Officers
have exercised their I Q❑Electrical repairs or additions
Myself [No workers'co � eXemptaon per MGL 1 l.❑Plumb'
romp. c. 152,§1(4),and we have no repaus or additions
insurance required] t employees. [No workers, 12•�oof repairs
comp.insurance re 13.0 Other
`-nZ =aalicaut that k�Ys box#1 mus!also Wired]
IM opt fhc secfia_below•ahoy=n"th_
Homeowners who submit This afbdavit indicating the„a._doing aI.'work-and a'ori:cs'
+•Contractors that che;k this box mart attae Eben hire outside con
an additional sheet showing, u=tors must submit a new affidavit indicating such.
'�'�the acme of the sub-^�u-A
I am an em e P and their workers cow Po
Ph'j'�that is psovidino workers'con ensalion irLsurance for my e ����
information. / mPloyee� Below is the policy and job site
Insurance Company Name: L
Policy#or Self-ins.Lic.#: S' 3 7�
Expiration Dater ,
Sob Site Address: O `P, A0(,
Attach a copy of the workers'compensation policy declaration aQ City/Stats/Zip j/,4n-/yc,-eP,
Failure to secure coverage as required und„Qr Section 25A ofM Pte(shown the polacy number and e
GL c. 152 can lead to the imposition of Liminal trafion date).
fine up to$I,SOQ.00 and/or One-year imprisonment, as well as civil
Of up to$250.00 a da a Penalties in the form of a STOP W pees of a
Y gainst the violator. Be advised that a copy of statement maybe forwarded to the ORDER and a fine
Investigations of the DIA for insurance coverage verification
Office of
Ido hereby certify under the
Pa"s penalties of perjur thQr the or in f nation provided ab
Sinnatuove is true and correct
re:
Phone#: C
�- 7G -
Off--id use only. Do not write in this area, to be completedc ,
bJ itj or tonm official
City or Tovvm:
Issuing AuthorityI ermit/License#
(circle.one);
L Board of Healtj 2. Building Department .3. Ci /To
6. Other ' Clerk 4. Electrical Inspector 5.PIumbinR
b Inspector
Contact Person:
Phone#:
Information an - d In.strueflons
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 pe=rson 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 ox-other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartnz eats and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintemmce,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not be:cause 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 cammpFmce 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 u�u�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-contractors)name(s),addresses)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC) or Limited L;abilityPartnerships
(LLP)with no employees other than the
members or partners,.are not required to carry workers'comp enation insurance. If an LLC or LLP does have
employees,apolicy is required. Be advised that this affidavit may be submitted to the Department of ludustrial
Accidents for confirmation of insurance coverage. .Also be dare to sign and date the affidavit. The affidavit should
be.retu'ned to the or town that,the application for the pmt or license is beim requested,not the.Department.of
Industrial Accidents. Should you have any questions regardi mg the law or if you are
required to obtain a workers'
compensation policy,piease call the Deparmuent at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
Cite or Town Officials
Please be sun 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/lice e.number which will be used as a-reference number. In addition,an applicant
that must submit multiple pmmnVlicense 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 peiznits 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 ofInvestigations would like to thank you in advaace for your cooperation and should you have any questions,
please do not hesitate to give us a call-
The
allThe Department's address,telephone.and,faxmumb=- .
The CaMmonwmalth cif M&-, chusetts
Departmetnt of Industrial Accidents
Office of Investigmons
640 Washkg-ton Street
Boston,M..A 0.2111
Tel. # 617-727-4900 eaft 406 or 1-577-MAS.SAFE
Rei,ised r-26-OS Fay: 4 6.17-72.7-7749
VMM'.mass._.aov/dia.
K & C Contracting, Inc.
"A IEull Service Remodeling Company"
July 7, 2010
CUSTOMER INFORMATION
Kathy McGonigle
70 Pembroke Rd
North Andover, Ma
CONTRACTOR INFORMATION
K& C Contracting, Inc.
Kevin Kondrat
64 Chadwick Street
Bradford, Ma 01835
978-476-4450
FID#261729246
Construction Supervisor#99457
WORK TO BE PERFORMED
Contractor Agrees To Do The Following Work For Homeowner:
See attached proposal# 2201 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: $23,450.00
PAYMENTS will be made according to the following SCHEDULE:
$ 7,700.00 deposit i
$7,500.00 demo complete, roof complete
$4,125.00 tile complete
$4,125.00 upon completion of contract
O NOT SIGN THIS ONTRACT IF THERE ARE ANY BLANKS
Homeowner's signature
Contractor's signature �17eA Date
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.
n
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.
Homeowner's signature Date
Contractor's signature A& 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.
{
Q..
& Proposal
^�l 'n
K & C Contracting DATE Proposal#
64 Chadwick St.
l Bradford, Ma 01835 7/7/2010 2201
978-476-4450
Kathy McGonigle
70 Pembrook Rd
No. Andover, Ma 01845
DESCRIPTION AMOUNT
Remove and dispose of two skylights
Frame in using 2x8s
Install joist hangers
Install sheathing to roof
700.00
Remove flashing around chimney and grind out old flashing
Install new lead flashing and repoint new flashing
450.00
Remove existing bow window
Install new Anderson vinyl bow window with two crank out windows
Repair siding to make straight and insulate around window
Install trim to match
Paint to match
2,600.00
Remove and dispose of three doors in the basement
Install three 6 panel solid pine doors with doorknobs
Stain to match
850.00
e
Insurance certificate to be given upon acceptance of contract. TOTAL
Pagel
& Proposal
IN
K & C Contracting
1f16,`
64 Chadwick St. DATE Proposal#
l Bradford, Ma 01835 7/7/2010 2201
( F 978-476-4450
Kathy McGonigle
70 Pembrook Rd
No. Andover, Ma 01845
DESCRIPTION AMOUNT
Demo first floor half bath
Frame in opening to den
Install,moisture resistant drywall
Tape seams,apply joint compound, sand,prime and paint
Install concrete backer board to shower walls to accept the
Install tile to shower walls and floors
Grout and seal
Install pocket door using 6 panel solid pine door
Upgrade electrical for vent,GFI,vanity lights and floor heat
Upgrade plumbingfor new shower,vanity and toilet and remove baseboard heat
P�'
7,250.00
Cut out new finish opening going into den
Install trim and paint to match
500.00
Install crown mouldings in 12x12 room
Prep and paint to match
450.00
Insulate where skylights were
Install new pine boards and stain new boards only
550.00
Insurance certificate to be given upon acceptance of contract. TOTAL
Page 2
& Proposal
K & C Contracting DATE Proposal# '
64 Chadwick St.
l Bradford, Ma 01835 7/7/2010 2201
978-476-4450
Kathy McGonigle
70 Pembrook Rd
No. Andover,Ma 01845
DESCRIPTION AMOUNT
Dig out approximately 20' in rear of house down to house footing
Clean and fill any cracks in foundation with hydraulic cement
Apply water proofing to foundation and footing
Back fill and compact every 1-2'
2,100.00
Permit fees 200.00
*Homeowner to supply tile, shower base,pedestal or vanity, glass door for shower and
vanity mirror.K&C Contracting,Inc will deliver items listed above.
Remove existing shingles and dispose of
Install new drip edge to entire perimeter of house
Install ice and water shield to first three feet of roof and to entire slope roofs on rear of
house
Install 151b felt paper to remainder of roof
Install 30yr architectural shingles(color chosen by customer)
Install new ridge vent
Quote includes shed
Cover shrubs and clean yard using a magnet to remove loose nails
7,800.00
i
Insurance certificate to be given upon acceptance of contract. TOTAL
$23,450.0
Page 3