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HomeMy WebLinkAboutBuilding Permit # 5/10/2016 BUILDING PERMIT t% T TOWN OF NORTH ANDOVER .:,,: . . :__. APPLICATION FOR PLAN EXAMINATION Permit No#: . ��� Date Received �reD CHU���C Date Issued: J,/ IMPORTANT: Applicant must complete all items on this page _ LOCATION % all". Aa ;;�` &-7- r -eq LP-9-25--,- Print " Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL. ZONING DISTRICT: Historic District yes Machine Shop Village yes Fioa TYPE OF IMPROVEMENT PROPOSED USE _ Residential _ Non- Residential ❑ New Building eone family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration _ No. of units: 11Commercial *- 'Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other llai r / ❑ ,Waters ed D�st1 � .❑Wetlands„/ , � /od a� hYl i/ � ,/r°rM ...DESCRIPTION OF WORK TO DE PERFORMED: 5 ✓ ss.. Id ntification- Please Type or Print Clearly OWNER: Name: Jr c � a � _ Phone: Address: / � l�ilS — Contractor Name: Phone: Email: t�c c b Address: 10-2— Supervisor's P Supervisor's Construction License: -OS ( Epp. Date:_ Home Improvement License: ,�', Epp. Date. ARCHITECT/ENGINEER Phone-: Address: Reg. No., ' FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ES TIMA TE&.,COS7-ffASEEk ON$125.00 PER S.F. Total Project Cost: $ �'� „ FEE: $ 2 Check No.: Receipt 'No . � NOTE: Persons contracting with unregistered contractors do not have reccess,4o the guazraapty fund _— .t na it-3 of:.A 1 R.S. HEBERT Construction & Remodeling Inc. 102 Adams Ave. No. Andover Mass. 01845 (97 8) 686-0786 Phone / Fax Lic. #:058241 Reg. #:153811 DATE: 4/16/16 OWNER'S NAME: MR. & Mrs. Steinberg 132 Pleasant St. No. Andover Mass.01845 JOB. Front Porch Windows & Paint House I. PARTIES This contract (hereinafter referred to as "Agreement") is made and entered into on this 16th day of April by and between Mr.& Mrs. Steinberg (hereinafter referred to as "Owner"); and R.S.Hebert Construction & Remodeling Inc., (hereinafter referred to as "Contractor"). In consideration of the mutual promises contained herein, Contractor agrees to perform the following work, subject to the terms and conditions below: 11. GENERAL SCOPE OF WORK DESCRIPTION 1. Remove existing casement windows and door from front porch. 2. Supply and install 4 new Harvey classic casement windows. 3. Supply and install a new 15 lite door unit. 4. Install new light fixture supplied by owner. S. Sand and refinish porch floor. 6. Replace water damaged shingles on sides of dormers and porch roof line and replace missing shingles. 7. Paint entire house exterior including trim two coats color by owner. Contractor Owner (.dcaner B. DATE OF WORK COMMENCEMENT AND SUBSTANTIAL COMPLETION Commence work:5/16/16 Construction time through substantial completion: Approximately,5/31/16 not including delays and adjustments for delays caused by: holidays; inclement weather; accidents; shortage of labor or materials; additional time required for Change Order and additional work; delays caused by Owner, Owner's design professionals, agents, and separate contractors; and other delays unavoidable or beyond the control of the Contractor. C. CHARGES FOR ADDITIONAL WORK: CONCEALED CONDTTI ONSi, DEVIATION FROM SCOPE OF WORK, AND CHANGES IN THE WORK 1. CONCEALED CONDITIONS: This Agreement is based solely on the observations Contractor was able to make with the project in its condition at the time the work of this Agreement was bid. If additional concealed conditions are discovered once work has commenced or after this Agreement is executed which were not visible at the time this Agreement was bid, Contractor will point out these concealed conditions to Owner, and these concealed conditions will be treated as Additional Work under this Agreement. Contractor and Owner may execute a Change Order for this Additional Work. Contractor is released, held harmless, and indemnified by Owner from all pre-existing mold, fungus, mildew, and organic pathogen problems and is not responsible for costs or damages associated with correcting, containing, testing, or remediating the same. . DEVIATION FROM SCOPE OF WORK: Any alteration or deviation from the Scope of Work referred to in this Agreement involving extra costs of materials or labor (including any overage on ALLOWANCE work and any changes in the Scope of Work required by Owner, Owner's design professional, Owner's agent, or building inspectors) will be treated as Additional Work under this Agreement resulting in an additional charge to Owner. Contractor and Owner may execute a Change Order for this Additional Work. Contractor Owner weer D. PAYMENT SCHEDULE AND PAYMENT TERMS 1. PAYMENT SCHEDULE: *1st payment: due when Agreement is signed and returned to 2nd Contractor. $ 3,000.00 ( Deposit on windows) Payment when work starts. $ 10,000.00 Final Payment: Balance of contract amount $4,600.00 when work is complete. 2. PAYMENT OF CHANGE ORDERS/ADDITIONAL WORK: Payment for Additional Work is due upon completion of either all or part of the Additional Work and submittal of invoice by Contractor. E. WARRANTY Thank you for choosing our company to perform this work for you. Your satisfaction with our work is a high priority for us, however, not all possible complaints are covered by our warranty. Contractor does provides a limited warranty against material defects on all Contractor- and subcontractor-supplied labor and materials used in this project for a period of one year following substantial completion of all work. This warranty covers normal usage only. You must contact the Contractor upon discovering an item in need of warranty service. Additionally, Owner's hiring of others or direct actions by Owner or Owner's separate contractors to repair a warranty item are not covered by this warranty and will not be reimbursed by Contractor. No warranty is provided by Contractor on any materials furnished by the Owner for installation. No warranty is provided on any existing materials that are moved and/or reinstalled by the Contractor within the dwelling or the property (including any warranty that existing/used materials will not be damaged during the removal and reinstallation process). One year after substantial completion of the project, the Owner's sole remedy (for materials and labor) on all materials that are covered by a manufacturer's warranty is strictly with the manufacturer, not with the Contractor. Repair of the following items and related damages of every kind are specifically excluded from Contractor's warranty: problems caused by lack of Owner maintenance; problems caused by Owner abuse, Owner misuse, vandalism, Owner modification, or alteration; and ordinary wear Contractor Owner weer and tear. Damages resulting from mold, fungus, and other organic pathogens are excluded from this warranty unless caused by the sole and active negligence of contractor as a direct result of a construction defect which caused sudden and significant amounts of water infiltration into a part of the structure. Deviations that arise such as the minor cracking of concrete, stucco, and plaster; minor stress fractures in drywall due to the curing of lumber; warping and deflection of wood; shrinking/cracking of grouts and caulking; fading of paints and finishes exposed to sunlight are all typical (not material) defects in construction, and are strictly excluded from Contractor's warranty. F. WORK STOPPAGE AND TERMINATION OF CONTRACT FOR DEFAULT Contractor shall have the right to stop all work on the project and keep the job idle if payments are not made to Contractor strictly in accordance with the Payment Schedule in this Agreement, G. DISPUTE RESOLUTION AND ATTORNEY'S FEES Any controversy or claim arising out of or related to this Agreement involving an amount less than $5,000 (or the maximum limit of the Small Claims court) must be heard in the Small Claims Division of the Municipal Court in the county where the Contractor's office is located. Any dispute over the dollar limit of the Small Claims Court arising out of this Agreement shall be submitted to an experienced private construction arbitrator that shall be mutually selected by the parties to conduct a binding arbitration in accordance with the arbitration laws of the state where the project is located. The arbitrator shall be either a licensed attorney or retired judge who is familiar with construction law. If the parties can not mutually agree on an arbitrator within 30 days of written demand for arbitration, then either of the parties shall submit the dispute to binding arbitration before the American Arbitration Association in accordance with the Construction Industry Rules of the American Arbitration Association then in effect. Judgment upon the award may be entered in any Court having jurisdiction thereof. H. ENTIRE AGREEMENT, SEVERABILITY, AND MODIFICATION This Agreement represents and contains the entire agreement and understanding between the parties. Prior discussions or verbal representations by Contractor or Owner that are not contained in this Agreement are not a part of this Agreement. In the event that any provision of this Agreement is at any time held by a Court to be invalid or unenforceable, the parties agree that all other provisions of this Agreement will remain in full force and effect. Any future modification of Contractor Owner qlWner this Agreement should be made in writing and executed by Owner and Contractor. I have read and understood, and I agree to, all the terms and conditions contained in the Agreement above. DATE CONTRACTOR' �,.,SIGNATURE DAT OWNER'S SIGNATURE I I-VI 7 DATE JN!EiS SIGNATUE/ Contractor Owner ner The Commonwealth ofAfassochusetts z ' , department ofIndlustr al.Accidents " 1 Congress Street,Suite 100 Boston,MA 02114-2017 ywww mass.,gov/dza Workers'Compensation insurance Affidavit:Builders/Contractors/EXee,tricians/Plumbers. TO BE FILED WITH THE PEI2.MlT`l'ING AUTHORITY. , Applicant Information Please Print Legibly N•aMe (Business/OrganizationAndividual): r �^,✓" ( s "aazk '� j `C _-- A.ddress: City/State/Zip: ,o I Vez /, Phone#: : Are you an employer?Chef O ie appropriate box: Type of project(required); 1. am aemployerwith employees(full and/orpart-time).* 7• 0 eW construction 2.Q I am a sole proprietor or partnership and have no employees Working for me in $, emodeling any capacity.[No workers'comp.insurance required.] • 9. El Demolition 3..Q I am a homeowner doing all work myself.[No workers'compAnsarance required.]t 10 ❑Building addition 4Q am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11,❑Electrical repairs or additions propr.1 torswithno employees. { 12.d Plumbing repairs or additions 5.n I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.❑We are a corporation and its officers have exercised their right of exemption per MGL G. 1d•0 Other 152,§1(4),and we have na.employees.[No workers'comp,insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information, fi Homeowners who s0af this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whother or not those entities have employees, If the sub-contrhe ors have employees,%hey must provide their workers'comp,policy number.' fain are employer•that ispr'dvidzrzg wormers'compensailorz insrrr•ancefor•my employees.'Pelow is tlzepolicy andjob site information. Insurance Company Name; Policy#or Self-ins,Lie.##: 9/'Z Expiration Date; .fob Site Address: � � •wp a^� f City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration elate). 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 foxim of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby eer•ti fy u der th eppilins and penalties ofperjary that the infibrinallon Provided above 's true and correct. Sign 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): L]Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.dither Contact Person: Phone#: 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 lire, express or implied,oral or written." ` An employer is defined as"an individual,partnership,association,corporation or other legal entity,of 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 anotherwho 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=contiactox(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 cavy 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 fok 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 Acaidenis. 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 To-wn 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Tndustrial Accidents 1 Congress Street, Suite 1.00 Boston,MA 02114-201.7 Tel.# 617•-727-4900 ext. 7406 or 1-877-NMSSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia RSHEB-1 OP ID: KM CERTIFICATE OF LIABILITY INSURANCE [:!01510412016 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 �TE`T Lawrence R.Michaud,CIC Michaud,Rowe And Ruscak Ins. PHONE97$688$829 ac No):978 357 2130 P.O.Box 188 North Andover,MA 01845 AASS;lmichaud@,mrrinsurance.com Lawrence R.Michaud,CIC INSU s AFFORDING COVERAGE NaC# INSURER A:Commerce Insurance Company 34754 INSURED R S Hebert Const 8t Remod,Inc. INSURER B;NorGuard 102 Adams Avenue INSURER c:AmGuard N Andover,MA 01845 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. ILTR TYPE OF IADDL NSURANCE IND WVD POLICY NUMBER MMMIUDCU EFF POLICY EXP LIMITS C COMMERCIAL.GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 ffW--KG"T REIT CLAIMS-BADE ❑ occurrence) OCCUR RSBP611273 05111/2016 05/11/2017 PREMIS S Ea $ 50,00 X Business Owners MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000100 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY❑PR LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY CFOMa81cd rrtSINGLE LIMIT $ 1,000,00 A ANY AUTO BSCM08 12/19/2015 12119/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) S AUTOS OS NON--OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccideni $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETORIPARTNER/EXECUTIVE YINN!A RSWC759421 01/01/2016 01/01/2017 EL.EACH ACCIDENT $ 100,00 OFRCERIMFMBER EXCLUDED. � El (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 100,00 If DESGkRIscribe P'T10N OF undOPERATIONS below EL DISEASE-POLICY LIMIT $ 500,00 PROPERTY 5,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Jennifer Scott Steinburg ACCORDANCE WITH THE POLICY PROVISIONS. 132 Pleasant Street North Andover,MA 01845 AUTHORIZED REPRFSEENNTATIVE ©1988-2014 ACORD CORPORATION. All fights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD !✓�� '�`�ra�rP„�szc+a®�r�rrrll� rr�;. �'Cxrrs�er.��cC Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 153811 Type: Expiration: 1/9/2017 Private Carporatio R S.'HEBERT CO.&REMODELING INC. RONALD HEBERT 102 ADAMS AVE. �ae� NO ANDOVER,MA 01845 Undersecretary ass ach yetis Department of Pu,rbhc Safety Board of Be,aaWhig RegW t ons arrest Standards i or ei s CS-058241 RONALD S HEBERT - 102 ADAMS AVE N ANDOVER MA 01845 yorn iT)Gssiu~uner° 01/08/2018