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HomeMy WebLinkAboutBuilding Permit # 1/14/2016 t%ORTH BUILDING PERMIT 3��`-Y'`eD ��G TOWN OF NORTH ANDOVER ° f aw APPLICATION FOR PLAN EXAMINATION Permit NO: ° Date Received Date Issued: T' "... „ m CHU$E� IMPORTANT:A licant must complete all items on this page LOCATION :Paint PRbPERTY'OWNER , .1) t"t - �nw rint MAP NO; R0 E-, ��� �Z,6NIN6blSTRIt✓T;����� Histo1C,lDistrict� 'yes r(61% Machine Shop,V llage yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential D New Building ❑One family Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: Li Demolition ❑Other 17 Septic '0 Well 0 Floodplain Ei Wetlands 0 Watershed District ❑Water/Sewer Hl Identification Please Type or Print Clearly) OWNER: Name:) Phone: �_ % ftl d Address: 2\ CONTRACTOR Name: -_ � Phone; i` m 1 � .Address. 'Sepervisor!,8 Construction License: Exp 'Date- - i Horne imprpvemen#License: Exp: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$123.00 PER S.F. Check No,: ° � ���� ��� Receipt No.: Total Project Cost NOTE: Persons contr cting with unregistered contractors do not have acc ss to tie guaranty fisnd Signature of Agent/Owner signature of contractor 4e �" 'Town of �1®RTH ndover ZC31v - LAK9 h ver, Mass, COCNIC Hl WICK L! BOARD OF HEALTH Food/Kitchen L Nor Septic System THIS CERTIFIES THAT .................. .. .. t BUILDING INSPECTOR ...... ... .. ..................................... has permission to erect ......... buildings on Foundation .......... . .. Rough tobe occupied as ..... .. ..... ..................... .. :.............. ............................................................. Chimney provided that the person accepting this permit shall In every resile conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final Construction of Buildings in the Town of North Andover. g PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final ® PERMIT EXPIRES IN 6 ®LATHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI A Rough Service .................... .. ............ ' Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Puildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final o Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. "A Full Service Remodeling Company" January 13, 2016 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 The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work Scheduled to Begin: ;2ti 4 y,) Expected Date of Completion c2 7)`1-:k 51 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 $2,500.00 Upon completion ClieSignature Si nature Date Contractor's Signature � n.�,� ., �� Date �:� NOTE: All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration shall be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston Ma 02108 617-727-8598 Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on this residence. ARBITRATION The contractor and homeowner hereby mutually agree in advance that in an event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit such arbitration as provided M.G.L c. 142A. n Client Signature -�J�i� Date < <�J Contractor's Signature Date 0� NOTICE:THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NO SEPARATELY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity: A Contactor may not demand payment in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. Contractor's Financial Insecurity: In instances where a Contractor deems his him/herself to be financially insecure,the Contractor may require that the balance to funds not yet due be placed in a joint escrow account as a prerequisite to continuing contracted work. Withdrawal from said account would require the signature of both parties. ESTIMATE 97$-476-4450 kccontracting@comcast.net DATE ESTIMATE# lil 1/13/2016 3472 KFC Contracting, Inc 7 Marvin Street Methuen MA 01844 David Livingston 34 Unity Ave North Andover Ma 01844 i Description Total _. ._.... . ........ ..._.........w.. .. ._......._ _.m ._...... . ...... ........._. ... ..... ... _... ........_. Remove and dispose of existing shingles Install ice and water shield to entire roof Install drip edge to entire perimeter Install ridge vent j Frame cricket,plywood,install lead 7,400.00 Total $7,400.00 � � � ` /o/2»/2no � PRODUcr INFORMATION SHEii-r — � Timberline HDO Shingles Made ToProtect Your Home. Your Story.And � Those 0fOver J0Million 0Your Fellow North Americans! � PRODUCT INFORMATION "Value and performance inagenuine wood-shake look" Timberline HOO Shingles Provide These Unique Benefits: ° Dimensional Look... Features GAF's ° Stays In Place... Dural Ghp~Adhosive proprietary color blends and enhanced aeu|u each shingle tightly and reduces the shadow effect for agenuine wood-shake risk ufshingle b|ow'nff.Shingles warranted look Nwithstand winds upm1nnmph(2ns ° Highest Fire Rating... Class Afire rating km/h)./ from Underwriters Laboratories " Peace Of Mind... Lifetime ltd.transferable ° High Performance... Designed with warranty with Smart Choi000Protection Advanced ProtemivnoShingle Technology, (non'pnonatudmaterial and installation labor which reduces the use ufnatural resources coverage)for the first ten yoarS" while providing excellent protection for your " Perfect Finishing Touch... Use home(visit 0af.00m/apvmlearn more) TimbvrtoePremium Ridge Cap Shingles or RiUg|aon*Premium Ridge Cap Shingles' 'This wind speed coverage requires special installation;see GAF Shingle xAccessory Ltd.Warranty for details. 2 See GAF Shingle&Accessoty Ltd.Warranty for complete coverage and restrictions.The word'Lifetime"refers to the length of coverage provided by o x°x m � o m=GAF oomo�ux==�mrLmwwmm*and means uvlong xsmuvno/nu/mmwouwmma�*m"single-familyo�om° °o=�o/ onvoon owm°x")mcertain circumstances)owns the property where the shingles are installed.For mw"ommtmm"Te"not meeting the above criteria,Lifetime coverage is not applicable. 3Tho"°products are not available mall areas.See for details. ' COLORS/AVAILABILITY " COLORS:8arkwovu.oipmumnd.Biscayne o|uo.Canadian Dhftwood,Chanmo|,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 'aoo m,m/vrmmoam/�mvomom" � The Commonwealth of Massachusetts =- ..==- Department o ialAccidents P fIndustr = Office of Investigations wM I Congress Street, Suite 100 Boston,MA 02114-2017 •�° wwm inass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C Address: f )\ 1 City/State/Zip: Y `�-- n r (A% {Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 F1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have $• ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance mp. insuranceJ required.] 5. ewe are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions [ p•No workers12.. Roof re myself. ' com right of exemption per MGL repairs airs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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 ane an employer that is providing workers'couepensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: t,tr e Gy w , Policy#or Self-ins.Lic.#: U C)10 Expiration Date: Job Site Address: t�,.r N U e, City/State/Zip: jdueel „d,,A 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 provid d above is true and correct, Signature: •d...'­.. Date: h Phone#: a 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other r, Contact Person: Phone#: K&CCO-1 OP ID:SR E(MM/D CERTIFICATE OF LIABILITY INSURANCE DATE 0 016 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 CONTANAME: Michaud, Rowe&Ruscak Michaud,Rowe And Ruscak Ins. PHONE 978 688 8829 FAX No): 978 557 2130 P.O BOX 188 AIC No Ext :North Andover,MA 01845 A DRIESS: Michaud,Rowe&Ruscak 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 ADDLITYPE OF INSURANCE IVSD SUER POLICY NUMBER POLICY MM/DDEFF YIYYYY LIMITS EXP LTR NSD WVD A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 11 OCCUR BOP0100721827 12/19/2015 12/19/2016 PREM SES(Ea occur AMAGE TO RENTED ) $ X Business Owners MED EXP(Any one person) $ 10,000 I PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ( GENERAL AGGREGATE ;$ 2,000,000 POLICY❑ PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY (Ea SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED _iAUTOS AUTOS t BODILY INJURY(Per accident) $ I I NON-OWNED ) (PROPERTY DAMAGE HIRED AUTOS AUTOS r Per accident $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,00C A EXCESS LIAB CLAIMS-MADE UC0100608971 12/19/2015 12/19/2016 AGGREGATE $ 1,000,000 DED X I RETENTION$ 10000 1 $ WORKERS COMPENSATION PER OTH- i iAND EMPLOYERS'LIABILITY STATUTE YIN ER l ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ '.. OFFICERIMEMBER EXCLUDED? ❑ IIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ PROPERTY 2,500 r r 7 j DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) '.. Carpentry E CERTIFICATE HOLDER CANCELLATION NORTH13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St Bldg 20 Suite 2035 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 �fc ( r.nrul,Nuav,ll�iYs& Reg u{atic�i s Offic�of ronsumcr AffaI3usin�c'TO� {�ME IMPROVEMENT CbN1 Type 160272 private Co►pr fwegistration:71712016 : r� � expiration: `4��. K$o-C ontraeting Inc, Kevin Kondrat 7 M»f�in St. Methuen,MA 01844 assac-Ir 4 ..:i . se- CS-099457 Kevin E Kondrat - 7 Marvin Street ; Methuen MA 01844 04/27/2016 Ccrni�?�ss;o,?e�