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HomeMy WebLinkAboutBuilding Permit #1193-16 - 80 COURT STREET 5/16/2011 V ORT► AA :qBUILDING PERMIT � p TOW N OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:—// Date Y Received '� 4„<�<•• >` + 9 °gATt°•�"`(� Date Issued: 9SSACHus�s M OR_TA`NTT:Applicant must complete all items on this page LOCATION___ _ Q �C �(,��� PROPERTY OWNER C�'�L\ 1 : ,��O Print MAP NO: f� PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building [J One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial LkRepair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑Other Septic ❑Well L± Floodplain ❑Wetlands ❑ Watershed District Water/Sewer G' O/' hdcntification Please'Tvpe or Print Clearly) OWNER: Name: 2 Phone: :W Address: '`�� CONTRACTOR Name: ill 1 qQ�Phone: RD F CM-44 Address: PSC. �j`� �. •� 1 �`����� ���� C�-p�`'� Supervisor's Construction Licenses,} 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: $ �t , FEE: $ d Check No.: eZ-7r% 9 Receipt'No.: NOTE: Persons contracting witli unregister d contractors do not]have access to the guaranty.fund Signature of Agent/Owner Signature of contractor] Location ) No. / � %6 Date • -+ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ �Y Check# ?70, I 3 n J 3 7 r gu(ding Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL l Public Sewer ❑ Tanning/Massage/Body Art ❑ ,11U11n1ng Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ` Private(septic tank, etc. ❑ permanent Dumpster on Site ❑ i I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENT'S CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori Signature COMMENTS C, Zoning Board of Appeals:variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 3onservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit ]DPW Town Engineer: Signature: FIRELocated 384 Osgood Street Y nx _ _ DEPAR�T` .�T ;Temp Dumpsfe�o"nsiteY�eS :�', r{ i;Lo ted as"t12�4�MainSt�eet' G{ - 4Fire De— -a datee ' .r partmenUsignatur�e/�'` -�yi �. r, � �-_ C•'•.r,"� -`;1,.s _ mss. .-tw;-- �-='-aSc.t.r- --- _ COME TSS, Dimension Number of Stories: Total square feet of floor area, basedaBterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service dr®p-momquires 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 Call Email f ' Date Time Contact Name Doc.Building Permit Revised 2014 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 4- Building Permit Application 4. 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 OTE: 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4, Mass check Energy Compliance Report (if Applicable) Engineering Affidavits for Engineered products OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Registry of Deeds. One co and roof of recording that the appeal period is over. The applicant must then get this recorded at theg y PY P must be submitted with the building application Doe:Building Permit Revised 2014 NORTH Town of �� Andover. No. }� h ver, Mass T Q LAK! _ A- COC NIC Nl WICK 7�A0 4'4TED ill, �y S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System S CERTIFIES THAT BUILDING INSPECTOR THI ...................... ........ .a .............................................................................. Foundation has permission to erect ................y............ buildings on .... .......... ...... Rough ........................................ __ / 1/ Xe-- G` 0 tobe occupied as ........................... .........:...................................,..................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service ................... ......... ... ................. ........................ Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. / - CoN K&C Contracting, Inc. A Full Service Remodeling Company May 2, 2016 CUSTOMER INFORMATION Tony Royal 80 Court St North Andover Ma 01845 CONTRACTOR INFORMATION K&C Contracting, Inc Kevin Kondrat 7 Marvin St Methuen Ma 01844 978-476-4450 FID#f 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 Bate 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 Client's Signature_ cti Date Contractor's Signature 1( Date S 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 €32108 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 M.G.L c. 142A. Client SignatureR Date Contractor's Signature Date 1 ��- 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. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 i w www mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. .Applicant Information Please Print Le ibl Business/Organization Name: ` P Address: c) S� City/State/Zip: Com'_ Phone#: Are you an employer?Check the appropriate box: Business Type(required): j 1.❑ I am a employer with employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment i 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) It employees working for me in any capacity. k [No workers'comp.insurance required] 8. ❑Non-profit ( 3.El-Vie are a corporation and its officers have exercised 9. ❑Entertainment ((( their right of exemption per c. 152,§1(4),and we have E- 10.[1 Manufacturing no employees. [No workers'comp.insurance required]* 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers'comp.insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If 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 41. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: Insurer's Address: City/State/Zip: Policy#or Self-ins.Lic.# Expiration Date: 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 andpenalties ofperjury that the information provided above is true and correct. Signature: Date: ` ! A 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia K&CCO-1 OP ID:KM ACORO" DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE F05/1212016 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 CONTACT SME: Michaud,Rowe&Ruscak Michaud,Rowe And Ruscak Ins. PHONE FAX P.O.Box 188 ac No E,):978 688 8829 1 AIC No):978 557 2130 North Andover,MA 01845 E-MAIL Michaud,Rowe&Ruscak ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Preferred Mutual Insurance Co. 15024 INSURED K&C Contracting Inc. INSURER B: Kevin Kondrat 7 Marvin St INSURER C: Methuen,MA 01844 INSURER D: INSURER E: INSURER F 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. INSR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 71 CLAIMS-MADE E1OCCUR BOP0100721827 12/19/2015 12/19/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ X Business Owners MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY D JE� [:]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COEa aMcciBINEDdentSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB HCLAIMS-MADE UC0100608971 12/19/2015 12/19/2016 AGGREGATE $ 3,000,000 DED I X I RETENTION$ 10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Interior Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tony Royal THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y Y ACCORDANCE WITH THE POLICY PROVISIONS. 80 Court Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE / ;M4�3012 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety I � Board of Building,Reg ulations and Standards - License: cS-099457 Construction Supervisor KEVIN E KONDRAT 7 MARVIN STREET. ` F METHUEN MA 01844 7' r i Expiration: � Co mrnissioner 04/27/2018 - ��e`��j�unrc�icUea�L`fz o���cr�Jdac�Lua�G[s, { pffict of. onsnmer Affair's&-Business Regulaho►. . NtE IMPROVEMENT C6N'tliCTE7i; YPe. 6gistration: •16.0272, ... o C ory? ratic 7812016 Private , xpiratiorl t �- , fiC 4tStatfAting Inc` Tkj- ;7 Sevin K694rt' \� gtv2 it 7 iri St: V ---�_ seta* _r ec Y dens Methuen,MA 01844 ?J�! {