HomeMy WebLinkAboutBuilding Permit # 2/16/2016 <.
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TOWN OF NORTH ANDOVER
^, APPLICATION FOR PLAN EXAMINATION q
Permit N®: Date Received
Date Issued.
AC91195��
IMPORTANT:Applicant must complete all items on this page
PFZOPE(�TYOWNER: ��Cr �. Pant �'ci�;`
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I�r�P NfJ PARCEL ZQNING b1�TRICT H,rstoric l�rskrrct yes no
M�ch�rt�shop Village yes na
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:
❑ Demolition ❑ Other
€ ;Sepfiic ❑1lllell [ Floodpfam ❑Wetlertds ❑f Vllatershed [�istnct
❑�Wa�erf5e�ra�` ,
Identification Please'Type or Print Clearly)
OWNER: Name: Phone:
Address:
CaNTRACTC3R Name
77
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Acdress
Cter�rrsor's Construan Llcrrrse
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Home Irnpro�er>rtenf l.rcens rat
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBAS D ON$125.00 PER S.F.
Total Project Cost: $ 1/4 6700 FEE: $
Check No.: 2� � Receipt No."'
NOTE: Persons ontracting with unregistered contractors do not have ace s the guarani fund
Sigre of Agenf/Owner< �gnattare of contractor r
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Quote # 02012016
Campaniello Kitchen Replacement
Scope of work:
* Dema/ Removal
a Tile Floors in Kitchen, bathroom, & hallway
o Counters and Cabinets
* Electrical
o Wire & install up to 6 light fixtures/ Recessed lights in Kitchen
o Wire appliances
® Micro wave
® Dishwasher
Wine Fridge
a Install Fixtures devices (switches & outlets)
Plumbing
o Run gas line for stove
o Install appliances, and fixtures
Frame Window opening into Livingroom
o Approximately 7ftx4ft
o Cased opening w/2 h colonial casing
Cabinetry& Countertops
a Nang Semi Custom cabinets to desired Layout. Includin 2 piece Crown moldin
o Install all new hardware
o Install desired Countertops
Install Subway Backsplash Tile
Flooring, install and finish 3 coats of Polyurethane, to match existing flooring
« Paint
a Ceiling&walls in kitchen
a All new trim work
i
o Touch up in hallway and bathroom as needed.
® Dispose of all debris
Key Notes :( prices based on)
• This quote is an estimate of the total project as written in the scope of work, and any
hidden issues such as rot, or insufficient framing, plumbing or electrical will result in
extra cost,to customer
• Electrical budget is based of REMODEL not REWIRE.
• Includes no appliance or Fixture budget.
• Includes Standard backsplash tile and installation included $5 PER SQ ft included
• All materials purchased by and work subcontracted by I.H.S. with include 15%
Contractor fee.
• Dumpster will be onsite throughout duration of project
• Innovative Home Solutions will work with as little disruption to home owner as possible
Project Totals
47 OOO
3
Break Downs (®
Demo/Prep $2,500 $150
Plumbing/appliances $1,500 $200
Gas $800
Electrical 3,300
Cabinetry/Carpentry $17,3
Quartz Countertops ,500 l
Farm House Sink 900 $250
Window Into Livingroom (includes framing,
drywall,trim, paint) $1,500 $500
Flooring $5,000
Tile Backsplash $1,150 $300
Final Clean Up. $300
Paint $1,250 $350
Disposal $525
Permit fee $300
Total Kitchen Replacement $47,0001
Contractual Agreement
This contract is between (The "Home Owner") and
Innovative Home Solutions, L.L.C. (The "Contractor"), who is licensed in the State of
Massachusetts under H.I.C. license number 172639. Innovative Home Solutions
warrants that they currently hold a valid license under the laws and statutes of the State
of Massachusetts. Innovative Home Solutions LLC is working as General Contractor to
the Home Owner, and takes Responsibility for sub-contractors involved in the remodel,
Signature of this contract confirms customers understanding and agreement to
contract, as written in "scope of work" and "key notes" section of Quote#02012016.
Estimated Project Totals: $47,000, based of scope of work.
Project Address: 456 Salem Street, North Andover
4
Project Description: Kitchen Remodel
Payment: Payment shall be made in installments, on the agreed schedule benchmarks
to Innovative Home Solutions, L.L.C. with the final installment upon completion &
home owners full satisfaction of the services described in this contract. Extra worked
needed, upon discovery will be billed upon work completion
1. 25% Upon Contractural Agreement. (To place Cabinet Order)
2. 25%After start of Project
3. 25% Upon Delivery of Cabinetry
4. Balance Due upon completion and Satisfaction
Terms and Conditions
Time for Performance
Innovative home solutions will commence work, on February 21st 2016, will continue
work until completion with as little disruption in schedule as possible
IN WITNESS WHEREOF, this Contract has been executed with the intent to be legally bound.
OWNER
Date
CONTRACTOR
5
Date
Innovative Home Solutions, L.L.C.
4 Birch st Billerica Ma 01803
1-(978)833 1120
www.lo,,tiiovativehoryiesoli,,j,tionsmass.,cog,n
-'fie commoftweaft of.1 USSO-018effs
Depart dent ofYr�dr�siF �aZ�cczc�e cs
M _ Congress Street,Suite 100
,MA 021142017 t
rvww.mass gov/dza
orkexs'Comp en,r0 BE T'T1BD SVS H TM RET xT M A.UTHORX'I':Sr.tr�icianslPlumb exs.
7'leasePx�int I,e 'bl
Applicant Information
Namc)(B,tsiness/Oxganization/ln.dividual): T outs^ i'liku c C ro
Address:
�� �t ,�� �lv'Z� �'hoxie#: !/Zc
City/State&ip:= .
Are you an employer?Checktlie appropriate box: Type of project(Veguixed):
employees full,andlor,part-time)."' '7. [�New consfxuGtIOR
1�Z ant a employer withT_ p Yees
2,Q I am.'a sole proprietor or partnership and have no employees working forme in 84�1 R,mo d,,Ug
any capacity.[Nowozkers'comp.insurance required.] 9. El Demolition
3,Q I am ahomeowner doing allworkmysel£[No workers'comp.insuraucexequired.]t 10 ElBuilding addition.
4.E]I am a homeowner and-will bD hiring contractors to conduct&I work OXIMY PrOPOAY- I-w"' 1E]E,lectricalrepai7:soxadditions
ensure that all contractors either have workers'compensation insurance or are sole j i
[�=PIt}nrtbng repairs-o7radditiolts._....��
5.�I am a general contractor and I have hired the sub-coittractors listed onthe attached sheet. 1S Roof repairs
'These sub-contractorshaveeinplayeesandhave workers'comp.iusurance. 14. ether
6.❑We are a corporation and ifs ofitgers have exercised their right of exemption per MGIC c.
152,§1(4),and we have na emplciyees.[No workers'comp.in
required.]
r;.
kAny applicantthat checks Box#1 must also til]outthe sectionbelow showingtheirworkers'compensationpolioy information
i Homeowners who sn$riut this affidavit indicating they are doing all work andthea hire outside contractors must submit anew affidavit indicating such.
zContractors that check this box must attached an additional sheet showing the name ot:the sub contractors and state whether or not those ettflties have .
employees. 7fthe sub contractors have employees, tiey innst provide their workers'comp.policy number.
X erriployer tlaatisp ovidir�gworkers'compensation insurancefor'my employees'Below is thepolicy andjob site
am an
information. `
Insilrance CompanyName;
Policy#or S elf-ins,Lic.#:
I�i(1l 1 DO k)G l 1 2_.L� 1 S Expiration.Date: 7? 23
Jt
fob Site AAdxess: City/State/Zip: I*r4 ��Kdovel- /64
A,ttaclt a copy of the vvoxkexs'compensation.p olicy declaration page(showing the policy)Ruznber and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the and d to the 0 h e f a STOP O' K ORDER
and a of theme DIA.for insurance ofuP to e a
day against the violator.A copy of this statement may b f
coverage verification.
X do lherehy cert under thepains audp� atttes ofpeijoPr t7iat the information provided above is true and correct.
Date: 7J 1
Signature.
Phone#: 6Z Z
Official use only. Vo notwrite in this area,to be completed by city or'town off cial.
City or Town: JPexxnit/>Gzcense#
IssuingA.uthority(circle one):
1.Board of Ifealth 2-Building DePariment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Phone#:
Contact Persozx•
0211612016 13:41 LTB Insurance Agency (FAX)7812210031 P.0021002
.4coR[a►� CERTIFICATE OF LIABILITY INSURANCE oATU' '°°""'"'
2116/16
--THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUrHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTS the certificate holder to an ADDITIONAL INSURED,the pollcy(lee) must be endorsed. If SUBROGATION ,subject to
the terms and conditions of the policy,certain policies may require in endorsement. A statement on this cardficate does not confer rights to the
certificate holder In lieu of such endorsemen s.
PRODUCER RUEACT
L'I'B Insurance Agency PHONE FAX(7 01) - (781) 221-0031
85 Wilmington Road
Wlksa; lima ltbinmurance.00m
Burlington, MA 01803 INfiUFWR($)AFFORVfN3 COVERAGE Nana
INAURERA.Preforred Mutual
INSURED INsuRERs:Commerce In9urance
Innovative Home Solutions LLC IN3URER0;
9 Porter Ave INSURER D:
Burlington, MA 01803 INSURER E:
INSURER R:
COVERAGE$ 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.
TYPE OFINaURANCE POLICY MMID LINTS
A GENERALLIAOILITY BOP0100713051 2/15/16 2/15/17 EACH OCCURRENCE 6 000 000
X COMERCIALGENERALLIABILITY MI RENTEDMweel 0 300,000
CLAIMS-MADE Fx—]OCCUR MED E)F one Y14n6 104000
PERSONAL&ADVINJURY $ 1
GENERALAGGREOAYE S 2.090,000
GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP10PAGG 6 2 000 000
POLICY PR Loc 3
H AUTOM0e1L.RUADIUTY BBJD41 11/21/15 11/21/16 9=S1NQLF1.Niv
6
ANYAUTO BODILY INJURY(Per person) 8 250,000
ALTOS�D X SCHEDULED BODILY INJURY(Peraccident) 0 500,000
X HIREDAVTOs X
AUT09ED era I MAW t 100,000
S
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
EXCESOLIAO CLAIMS-MADE AGGREGATE 6
DED RETENTION
VIORKERO COMPENSATION wC STATU-
AND EMPLOYERS'uABIu-N
ANY PROPRIEHWUPARTNERIEXECU7WN/A E.L.EACH ACCIOENr
Q_FFICERM)EMBER 2XCLLIDED9
.naabry In NH) E.L.DISEA13E-EA ENPLOYE5 6
[fro dacribv under
DEB RIPTIQM JOEPPE RATIONS balaw E.L.DISEASE-POLICY LIMIT 6
MSCRI"ONOPOPERATION0/LOCATiONSIVEHICLEB (AthtohACORD 101,AddldanWRarmem3cb Wa,HMore SpnowtarvgUred)
Job Desaription:Kitchen Ramodel
Job Location: 456 Salam Street
Phe Workers Compensation certificate has been ordered and will be merit to you directly from
the carrier.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THG ABOVE DESCRIBED POLICIES BE CANCF[I,L,ED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS.
120 Main Street
North Andover, MA 01845 - AUTHORIZED REPR90&NT .
Lisa Tuokor
®1988 MAD CORPORATION. All rights reserved.
ACORD 26(2010/06) The ACORD name and logo are registered marks of ACORD
'hone: Fax: (978) 688-9542 E-Mail,
scald 04 S"l!aing Pcg,:iwt ansal Standards
L;ccnse:CS-102824
DOUGLAS M MERLUZZOk
4 BIRCH STREET.
BILLERICA MA 01821
B: ;raiic^::
Commissioner 06/1812017
Office of Consumer trfters&@u incss 1
-- Zc nl;etiott
HOME IMPROVEMENT CONTRACTOR
-Registration: 172639 Type:
Expiration: 7f1272015 LLC
INNOVA—i IVE HOME SOLUTIONS,LLC.
DOUGLAS MERLUZ70
4 B64CH ST
',!L ER.'CA.MA0182i
ImtrcrsecrMary
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