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HomeMy WebLinkAboutBuilding Permit #343-2017 - 100 RALEIGH TAVERN LANE 9/29/2016 �YANS 5'GgNrvED A AI'I _`` BUILDING PERMIT �oo� �Q � T` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMIN h Permit NO: Date Received I 'ZJ9 Dq�reD�eP�,�9 Date Issued: SSACHuse I ORTANT: Applicant must complete all items on this page • LOO>?1TION 100 Raleigh Tavern Lane North Andover MA 01845 Print PROPERTY OWNER" : �Y1 6v� L� Pr rit . MAP NO: PARCEL: _ZONING DISTRICT: Historic District yes no Machine Shop Village yes; no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial i/Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septict' .❑Weil ❑ Floodplain OWetlands ❑ Watershed District ;VWater/Sewer, Replace Deck 14x16.5': Remove existing deck boards, railings, posts, stair, deck framing approx. 262 SF. Excavate and pour concrete tootings w bottom ot tooting below grade. l7rame new single level • deck w/ 2x10 PT joists on 4x10 LVL carrier beam, through bolted to house framing. Install Azeck Cypress deck boards with hidden fasteners on frame for deck and stair treads. Install Fortress metal posts, rails and Wire heli istere an dock pedmeter andstairway a�avwv r Identification Please Type or Print Clearly) OWNER: Name: David &Leslie Wondowlowski Phone: 978 886-4853 Address: 100 Raleigh Tavern Lane North Andover MA 01845 ZTRACTOR Name: Phone: Theodore Kelley 978 852-4491 3Addrass .214..Sutt6h-.HiII Rd North Andover(VIA 01845 supervisor's Construction_,License: Exp. Date: 10/8/2017; . 105086 Home Improvement License: Exp. Date: 165887 4/5/2018 ARCH ITECT/ENGINEER_Beniamin Osgood Phone: 978 435-1324 Address: 157 Bluff St Salem NH 03079 Reg. No. 458nl FEE SCHEDULE.BOLDING PERMIT:MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cos : $ 28,921 FEE: $ Check No.: Receipt No.: -,-2-0c Fi NOTE: Persons contractin ith unregistered contractors do not have access to the guaranty fund Signature.of Agent/Owne gnature of contractors,Thore�`iVl'Kelley E Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Privatex (septic tank, etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM VPL ANNING & DEVELOPMENT Reviewed On 9 Wb Z Il Signature_ COMMENTS JONSERVATION Reviewed on 5 Si natur COMMENTS /(0 i /HEALTH Reviewed on Si natur All i COMMENTS Wor(� dL� �-���� 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: Fi _ Located 384 Osgood Street RE DEPARTMENTF Tem iDumpster,�on�sit )yes{k ILocat tr eta -- ed at«1�24IVIamuSs ,Fire�Dejiartm.ent sgnafure/date, " � - � ,{. .f CO-MMENTS;L � - fj�e H i i i Dimension Number of Stories: Total square feet of floor area, based on 'Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No q pp DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i i, I ❑ Notified for pickup Call Email Date Time Contact Name_ = Doe.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 ❑ 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 ❑ 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) ❑ 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 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 ❑ 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 2014 Location ,/f�6 f\ Z '7 v No.: `P .-, r Date . �lkl� • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $. ` 7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 10, Build ri'Ins' 'or 3 � i � g P NORTk Town of s_ s ndover O soh ver, Mass,LAKI coc»1cMew1c■ �1' ATE 9) S U BOARD OF HEALTH PERMIT . T D Food/Kitchen 1 Septic System THIS CERTIFIES THAT ............4 �^.... ...Is��.L...�J ,.Jo I�`:"s��'!,,,,,,,,,,, „ , ,,, ,, BUILDING INSPECTOR .. . ... .... . . . has permission to erect c- Foundation ........................... buildings on ....���........... .. .l.l ��...................... Rough to be occupied as ...zqAap.....r .. .��?. ..... :K .. ...c� 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 f VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR,. UNLESS CONST 10 T Rough Service ......... .. ......... . ........ .................. Final B DING NSPECTOR 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. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ [Well YPE OF SEWERAGE DISPOSAL blic Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ ❑ 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 PLANNING & DEVELOPMENT Reviewed On -I ILWDISignaturE" _ COMMENTS N VZOLNSEIRVATION Reviewed on Si natur , , COMMENTS HEALTH Reviewed on Si natur n, W 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 �FRaE DEPARTMENT =Te p®u apste���on site y L ocateci�"ate 1�2` - y � �.� 4Ma,n�StreetY A - Fire Departmentsignature/ad tae PG®MMEN 5 4' - •,,tem _ , Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 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) "el ❑ Notified foricku Call Email P P Date Time Contact Name Doc.Building Permit Revised 2014 ACsFSales: 800.448.3636 Phone: 804.271.2363 NEXT GENERATION Fax: 804.743.7779 O LET'S GET IT DONE STORMWATER MANAGEMENT SOLUTIONS acfenvironmental.com s Site Development and Retrofit . Low Impact Development • Green Infrastructure FOCALPOINT(high flow biofiltration) - R-TANK(modular subsurface storage) - PAVE DRAIN(paving,drainage,storage) - FABCO(decentralized treatment) s -41 0 � � 4 l� I � w ---------- - ---------- : 1. EXISTING CONDITIONS INFORMATION FROM AN ON THE GROUND SURVEY PERFORMED BY NEW ENGLAND ENGINEERING SERVICES IN 8 SITE 2004 AND VERIFIED BY BENJAMIN C. OSGOOD,JR., PE IN APRIL 2016 ��w 2. THE PURPOSE OF THIS PLAN IS 70 DEPICT PROPOSED s MAINTESTAIRSNANCE ITEMS REQUIRED TO REPAIR EXISTING DECKS AND FMNDM 9 SDRY loo. 21" ACCEPT WATER FROM T EAND TO SHOWE STAITRWELLI 70 ON OTHEABASEMENTL TO lOp.ey E N/F McENTEE 100 RALEIGH TAVERN LANE ASSESSORS MAP 107A, PARCEL 109 LOCUS MAP NOT TO SCALE 44,824 SQ.FT. w O pl WETLANDS LINE TAKEN FROM PLANS OF RECORD �O ASf C d' WETLANDS LME Al TO A7 DELINEATED BY SIp• GO DENMARK C.OSCOOD,JR ON APRs 2.2016 23� pp. zREBUILD EXISTING W OUT STARS AND WNLS pp• MOVE Ex—NG DECK AND ST." IMSTAAL NEW 3'OWIEIER DRY WEII CONSTRUCT 4'X 4'LANDING ANO STARS FOR WNKOM GRAN REMOVE AND REL TE EXISTINO STARS REMOVE AND REPLACE EXWNO DECK 92\ Al A3 m _ 2a• \ PROPOSED NEW STAR LOCATION \ 05TU,ZONE _ __ \ 94--_ `\ No _ OaSS ""� RN RM SLOPE BEDROOM HOUSE GARAGE � _.._. 1-------- -------- - \ -- ' ' ` ___\ - ---------- _ /--98 /i :::�:!`.!.a•�i.';:Ii:l';.!.iViis�;iil;i!„ \ E ON CONTROLN R OF WORN 96-- STKEDUWN EXISTING GRADE __________________98_________^ __�> Al WETLANDS LINE LEACH BED AREA .. •ijFI'ii"i�ii�I:iiili�?! Q r!%?�I'i 1I - v' 25' NO DISTURB ZONE a vEert / I!li;:!:r!;I:r!nn. iilE>',I III I o •ao-n \ ' O ::: ..::::ij I 15�� 50' NO BUILD ZONE .._..-.._ B O •::::i!!;:,. I!� ! O 1 OFFER ZONE -...—..._..._..._..._..._...—...—..._ I jjfyi'I yi}i I ¢� 00' 8 i �•"' EROSION CONTROL/ � // PUMP NAMBE 00 �.. !i N ,l l, : / LIMIT OF WORK ------------------------------ \ \... PREasuRE )LI ti""+•i, f / RETAINING WALL ....._.._.._......_.._..._..__.._ M FAST SEPTIC TANK_ I! -•— S41°58'00''E /T / EXISTING SPOT GRADES 99.99 100'BUFFER ZONE) \" / \. WATER SERWCE ,I'/ SEGMENTAL BLOCK \.., ,/ / `\ 1, RETANMG WNL \.., / Co aFl-"'\ SITE PLAN TOP ELEV.99.67 \.., \... -� 00LEFTCIXtNER OF +� �+�L 100 RALEIGH TAVERN LANE, NORTH ANDOVER, MA enC \..,` BENCHNNM:FROM .,.` •� BonaM FROM STEP.ELay. aAGin0. '&' ASSESSORS MAP IOTA, PARCEL 109 osDDGo,� �„ RALEIGH TAVERN LANE CIVIL Raaem��' SCALE: 1" = 20' DATE: APRIL 11, 2018 . 'Etala'rac ro)A' �a BENJAMIN C. OSGOOD, JR., PE 157 BLUFF STREET 20' 0 20' 40' 60' SALEM, NH 03079 (978) 435-1324 lk 2016-01 Br: B.C.O., JR:9Y: -B.C.O. jr. 214 Sutton Hill Rd Contract North Andover MA 01845Wondolowski 2016-076.8-Deck 978 852-4491 Tmii6rx www.TMKremodeling.com REMODELING CONTRACTOR AGREEMENT c THIS AGREEMENT made this / 206 by and between TMK Remodeling, LLC Construction Supervisor License#105086, 214 Sutton Hill Rd, North Andover MA 01845 hereinafter called the Contractor, and Leslie&David Wondolowski hereinafter called the Homeowner. WITNESSETH,that the Contractor and the Homeowner for the consideration named herein agree as follows: ARTICLE 1.SCOPE OF THE WORK The Contractor shall perform all of the work described in the specifications entitled Exhibit A—Statement of Work, as annexed hereto as it pertains to work to be performed on property located at 100 Raleigh Tavern Lane North Andover MA 01845. Work Scope Summary:Replace Deck 14x16.5': Remove existing deck boards, railings, posts, stair, deck framing approx.262 SF. Excavate and pour 312"concrete footings w/bottom of footing 48"below grade. Frame new single level deck w/2x10 PT joists on 4x10 LVL carrier beam,through bolted to house framing. Install Azeck Cypress deck boards with hidden fasteners on frame for deck and stair treads. Install Fortress metal posts, rails and wire balusters on deck perimeter and stairway. Install Azeck PVC trim board at deck rim joist and stair risers. Install lattice under deck at frame. Replace entry door landing and railing at garage. Remove existing railing and landing. Excavate and pour 2 4'x1'concrete footings. Build 4x4'PT frame. Finish w/Azeck Cypress decking and Fortress railing. ARTICLE 2.TIME OF COMPLETION The work to be performed under this Contract shall be commenced on or before September 06, 2016 and shall be substantially completed on or before September 17, 2016 ARTICLE 3.THE CONTRACT PRICE The Homeowner shall pay the Contractor for the labor and materials to be performed and supplied under the Contract the estimated sum of Twenty Eight Thousand Nine Hundred Twenty One Dollars and No Cents ($28,921.00), subject to additions and deductions pursuant to authorized change orders. Contractor will furnish and install all building materials, fixtures and finish items unless noted otherwise. Any Homeowner supplied materials will be charged a 15% handling and coordination fee based on actual invoice. ARTICLE 4. PROGRESS PAYMENTS Payments of the Contract price shall be paid in the following manner from the Homeowner to the Contractor: Payment 1: 33% upon contract acceptance and signature; $9,640.33 Payment 2: 33% upon foundation and frame inspection;$9,640.33 Payment 3: 33% upon final building inspection and completion of finish; $9,640.33 The contract cost for mutually agreed to change orders will be paid 50%at time of change order signature and 50% after completion and Homeowner sign-off. ARTICLE 5.GENERAL PROVISIONS 1.All work shall be completed in a workmanship like manner and in compliance with all building codes and other applicable laws. 2. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 3. Contractor may at its discretion engage subcontractors to perform work hereunder,_provided Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this ? Copyright TMK Remodeling, LLC Initials t All Rights Reserved Page 1 g1106 214 Sutton Hill Rd 49-4 Contract North Andover MA 01845 Tm'6r"K Wondolowski_2016-076.8-Deck 978 852-4491 www.TMKremodeling.com REMODELING 4. Contractor shall furnish Homeowner appropriate releases or waivers of lien for all work performed or materials provided at the time the next periodic payment shall be due. 5.All change orders shall be in writing and signed by both Homeowner and Contractor. The cost for mutually agreed to additional work, required due to unknown conditions or substantive change orders, will based on the current bill rates for the actual time used.Additional materials will be billed at contractor cost.All change orders subject to 15% markup for overhead. 6. Contractor warrants it is adequately insured for injury to its employees and others incurring loss or injury as a result of the acts of Contractor or its employees and subcontractors. 7. Contractor shall at its own expense obtain all permits necessary for the work to be performed. 8. Contractor agrees to place all debris in an on-site trash receptacle(dumpster)and leave the premises in broom clean condition. 9. In the event Homeowner shall fail to pay any periodic or installment payment due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 10. The Contractor and the Homeowner hereby mutually agree in advance that in the event that 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 Office of Consumer Affairs and Business Regulation and the Homeowner shalrequired to submit to such arbitration as provided in MGL c 142A. /C_A_�' 1191 Homeown Date: l Cont for Date: Notice: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the Contractor, The Homeowner may initiate alternative dispute resolution even where this section is not signed by the parties. 11. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials, or inclement weather. 12. Contractor warrants all work for a period of 12 months following completion. 13. Contractor may post small signage(36x36") on property advertising services during the duration of the project. 14. The Contractor and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Paris Plaza, Suite 5170 Boston, MA 02116 Phone: (617)973-8700 kV4-) , Copyright TMK Remodeling, LLC 9. Initials All Rights Reserved Page 2 214 Sutton Hill Rd Contract North Andover MA 01845 Wondolowski_2016-076.8-Deck 978 852-4491 TMK www.TMKremodeling.com REMODELING 15. The Contractor or Homeowner may terminate this contract at any time for any reason by giving 3 days notice in writing to the other party. If either party terminates the contract as provided herein,then the contractor will be paid for work(labor and materials)completed as of the date of termination plus any materials or equipment that are backordered and not delivered. Payment is defined as actual job costs for the project plus 15%overhead charge. The contractor will provide a written report detailing actual job costs plus overhead for payment. The Contractor will refund any funds paid by the Homeowner that are a remaining balance for the labor and materials used as of the date of termination, plus any materials or equipment that are backordered and not delivered, plus 15% overhead charge. The Contractor will make arrangements for the backordered items to be delivered to the Homeowner. 16. The Homeowner is responsible for maintaining adequate access to the property including snow removal, personal property storage, and working doorways, stairways and walkways. In the event the contractor is required to provide access or repair to the doorways, stairways and walkways, then the Contractor will bill the Homeowner at the hourly bill rate for same. ARTICLE 6.OTHER TERMS ARTICLE 7.ACCEPTANCE Signed this day of S iVf 20�_. Homeowner contractor NOTICE: The signatures of theies above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES "! Copyright TMK Remodeling, LLC Initials All Rights Reserved Page 3 41«Ili 214 Sutton Hill Rd Qf: Exhibit A-Statement of Work North Andover MA 01845 Wondolowski_2016-076.8-Deck 978 852-4491 www.TMKremodeling.com tiFbODFLING A B C D E F G I 1 Owner: 2 Leslie&David Wondolowski Estimate: 2016-076.8 Estimate valid for 30 days 3 Iesliewondo(a)hotmail.com Estimate Date: 07/29/16 Expiration Date:08/28/2016 4 100 Raleigh Tavern Lane 5 North Andover MA 01845 6 978 886-4853 7 8 iScope of Work Replace Deck 14x15.5':Remove existing deck boards,railings,posts,stair,deck framing approx.262 SF.Excavate and pour 3 12"concrete footings w/bottom of footing 48"below grade.Frame new single level deck w/2x10 PT joists on 4x10 LVL carrier beam,through bolted to house framing.Install Azeck Cypress deck boards with hidden fasteners on frame for deck and stair treads.Install Fortress metal posts,rails and wire balusters on deck perimeter and stairway. Install Azeck PVC trim board at deck rim joist and stair risers. Install lattice under deck at frame.Replace entry door landing and railing at garage. Remove 9 existing railing and landing.Excavate and pour 2 4'x1'concrete footings.Build 4x4'PT frame.Finish w/Azeck Cypress decking and Fortress railing. 10 Notes: 11 Pricing includes labor and materials to install finished item+allowances. EA=Each LF=Lineal Feet SF=Square Feet 12 EA LF SF Total Cost 13 Quantity Cost Quantity Cost Quantity Cost �_ .—�—, 14 1.6'Administration - ��"` 1 $3,650 ' $3,650 15 31 Overhead&Expenses 1 $3,650 $3,650 16 :Overhead>'and project administration 1 .$3 650 $3,650 17 Deck-230 SF 20 $2,229 138 $12,214 1218 $8,315 $22,757 18 O1?Ians,and Permits:01.2 Building Permits. 1 $204' $204 19 01.0 Permit-Building 1 $204 $204 20 01 Plans and Permits-.01.3 Building Inspections 2 $130: $130 21 11.0 Final Inspection-Building 1 $65 $65 22 Foundation'Inspection 1 $65 23 02 Site Work 1 $605 $605 24 20 Yi1.Dumpster 1. $605': - $605 25 02 Site Work:02.10 Demo 460 $1,242 $1,242 26 Removedeck:floor - - 230 $610 $610 27 Remove deck rails,posts,stair and framing 230 $633 $633 28 03 Ezcavatlon 3 - $371 $371 29 Excavation for 4'deep 12"wide footing 3 $371 $371 30 04:Concrete00 3 $450,: 8 $92. $542 31 Concrete 30PSI for 4'x 12"Concrete Footing 3 $4.50 $450 32 Concrete 30W PSI for 4"structural slab 8 $92 $92 33 10 Exterior Trim&Decks 10 $469 138 $12,214 756 $6,981 $191663 34 Furnish:-and install 2x12PT.stair stringer 12 $448 . ,. $448 35 Furnish and install Azeck Cypress 1x5 finished decking materials 262 $4,533 $4,533 36 Furnish and install Fortress rail post;wire kit,blocked and:fastened into deck frame 62 .'$10 525 $10,525 37 Furnish and install hidden fastener clips in deck grooves 246 $726 $726 38 Fuirnsh and'install`PT 2x10;joists,galvanized,hangers.and fasteners _ - 230 .$1;274. $1,274 39 Furnish and Install PVC trim board 62 $572 $572 40 Furnish and:install.treated 8x4'.lattice 10, ;$,469 $469 41 Install 14'4x10 LVL Carrier Beam&Posts 14 $1,117 $1,117 42 Garage EntryDoor,Landing''. 4 x$547 20 $1,469":` 80 ' `$499 $2,615 43 02 Site Work:02.10 Demo 32 $86 $86 44 Remiive'deck:floor" -, 16 $42 $42 ©Copyright TMK Remodeling LLC All Rights Reserved Page-4 Unlawful to distribute without permission 214 Sutton Hill Rd OK Exhibit A-Statement of Work North Andover MA 01845Wondolowski_2016-076.8-Deck 978 852-4491 www.TMKremodeling.com RMODELIiNG A B C D E F G 1 45 Remove deck rails,posts,stair and framing 16 $44 $44 46 .03 Ucavatlon` + _ ;2 $247 . $247 47 Excavation for 4'deep 12"wide footing 2 $247 $247 48 04 Concrete '2 $300 $300 49 Concrete 3000 PSI for 4'x 12"Concrete Footing 2 $300 $300 50 10 Eicterior Trlm&Decks - - 26 $1,469 48 $413' $1,881 51 Furnish and install Azeck 1x Cypress 5 finished decking materials 16 $_277 $277 52 .Furnish and install'Fortress fall,ii6k.wire kit,blocked'and fastened into deck frame 8. $1;358 $1;358 53 Furnish and install hidden fastener clips in deck grooves 16 $47 $47 54 Furnish and install PT WO 161sts,,galvanized hangers..antl-fasfeners 16. $89 $89 55 Furnish and install PVC trim board 12 $111 $111 56 lGrand Total 25 $6,425 158 $13;682 1298 $8,814 $28,921 ©Copyright TMK Remodeling LLC All Rights Reserved Page-5 Unlawful to distribute without permission ��t� The Commonwealth of Massachusetts Department o findustrialAceldents 1 Congt"ess Street,Suite 100 Boston,MA.02114-2017 -- www.massgov/dza G1M - S�j V9 VQ'ar;keo,Compensatiouhmrance Affidavit:Builders/Contractors/Electricians/Plumbexs. TO BE NEED WITH THE TEM&TTIN'G.A.UTHORTx Y- Please Print Le 'bl A ''licantTnfornnatzon ,''. . • , ..... EGG F�1 Nae(BusinesslQrganizatiion/1n-di`riduan: —Iwo, Dc7(L'£ Address: 21 s 9�0 ol✓`l'� Phone 4: �'2 City/State/Zip: r9r✓� ova MA eckttie a to rlatebox: Type of projee (re[�iiii ed); :Are you an employer?Ch PP P ein full and/or Par to ees t time)•* 7. [(NSW eonstriiction 1. X am a employer with � P Y ( 2.U I am a sole proprietor oz partnership and have no employees Working fox mein S. Kkemodel!HP;anca aci [NoworkeIs.comp.insurance required.] 9, Demolition Y P tY 3.0 Tam a homeowner doing all work myseltr[No workers'comp.insurance required.]T 10❑Building addition 4.0 lam a homeowner and will be hiring contractors to conduct all work on my property. I will IL[]Electrical"repairs or additions ensure that all contraddrs either have workers'compensation insurance or are sole tt" `ees. 12. 'Plumbing repairs or additions proprietors with,"'o,employ 0 t. 5.❑I am a general contracto Z and 1•have hiredthe sub-contractors listed onthe attached sheet. 13;E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14. Other (,❑We are a corporatio""nand its,officers have exercised their right of exemption per MGL c. 152,§1(4),and'we have no employees.[No workers'comp.insurance required] :� ;r' . *Any applicant that checks boi#1 musE also till out the section below showing their workers'compensation di information: I Homeowners who submit,this affid?Yit indicating they are doing all workane name of b-contractoren hire outside os and state whether orthosers must submit anew affidavit entitieshave Contractors that check this boxmust attached an additional sheet showing employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providing-wor^kers'compensation insurancefor my ernplayees. 73elow is thepolicy andjoh site information. Insurance Company Name: G AL !/l� Expiration Policy#or Self ins.LIG. !-�/f/G,LI �� l' _City/State/Zip: N•-../�oviOL Job Site Address: /DO Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminalOP WORK ORDER and a fine of up to$200.00 a and/or one-year imprisonment,as well as civil penalties in the form of a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veril7-cation. X do hereby certify under tliepains andpenalties o perju tTiat the information provide above Correct Date: Simature: Phone#• �� official use only. Do not write in this area,to be completed by city ortown official. Permit/License# City or Town: Issuing A.ui-thority(circle one): � ector 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Pluanbing Insp 6.Other Phone#- Contact Berson• OP ID; VVV DATE(MWDDJI'YYY) CERTIFICATE OF LIABILITY INSURANCE 0911912016 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 certlflcate does not confer rights to the Certificate holder in lieu of such endorsement 6 . CONTR CT PRODUCER N E: AX Sagreve&Hall Insur,Assoc.lne PHONEA/C ac No), 305 North Main St Andover, MA 01810 aDDR�s Lawrence J.Hall PR M R �:TMKRE-1 INSUF S AFFORDING COVERAGE NAIC A INSURED TMK Remodeling LLC INSURERA:Arbella ProteCtlon Ins. Co. 41380 214 Sutton Hill Rd INSURER H I AEIC 11104 North Andover, MA 01845 11_- INSURER D INSURER E INSURER F, GOVERAGES CERTIFICATE NUMBER: RFVISION 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. ADDE KIM CY EF POLI LIMITS !LTR TYPE OF INSURANCE POLICY NUMBER M DD MwooffYY 1 000,00 EACH OCCURRENCE $ i GENERAL LIABILITY R T PR ES Ee urrenCO S 140'0(! A X COMMERCIAL GENERAL LIABILITY 5,0� CLAIMS-MADE F OCCUR MEP EXP Any one ereon) $ PERSONAL&ADV INJURY $ 1,000,0( 9520037133 03118/2016 03/18/2017 GENERAL AGGREGATE 2,000,0( PRODUCTS-COMP/OPAGG $ 2,000,0( GEN'L AGGREGATE LIMIT APPLIES PER $ POLICY PRO_ RO LOC COMBINED SINGLE=LIMIT $ AUTOMOBILE;LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Perpgraon) $ ALL OWNED AUTOS BODILY INJURY(Per accident) S SCHEDULED AUTOS PROPERTY DAMAGE $ (PER ACCIDENT) HIRED AUTOS g NON-OWNED AUTOS $ �UMAFPZE�LLALIAB�O�CCUR EACH OCCURRENCECESDE AGGREGATE $ 5 DEDUCTIBLE $ RETENTION $ WC STATU_ 0TH_ WORXERS COMPENSATION 'j,Qg MITI AND EMPLOYERS'LIABILITYYWCC-500-5011872 04/01!2016 04101/2017 E.L.EACH ACCIDENT S 500,0 B ANY PROPRIETORIPARTNER/EXECUTIVE ❑ 500 0 OFFICERIMEMBER EXCLUDED? Y N I A E.L.DISEASE-EA EMPLOYEE $ r (Mandatory In NH) 500,( Ifyeedaswbeunder E.L.DISEASE-POLICY LIMIT $ DESGIRIPTION OF OPE ATIONB boloN DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more spare IB required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANGELLEp BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED II Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Maura Dean 1800 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 011988-20-09 ACORD CORPORATION. All rights reserved, ACORD 26(2009109) The ACORD name and logo are registered marks of ACORD S-\ Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-105086 Construction Supervisor THEODORE M KELLEY 214 SUTTON HILL RDi NORTH ANDOVE-R M. 04 .y Expiration: Commissioner 10/0812017 - J &2e omvr�aoorauseczlG� qac uaeC�s Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ;_165887 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration:—­4 6'11f1& DBA Boston,MA 02116 TMK REMODELING1 u',= THEODORE KELLEY 214 SUTTON HILL RD:` NORTH ANDOVER,MA 01845 Undersecretary Not valid without signature r