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Building Permit #061-2017 - 100 UNION STREET 7/20/2016
4W BUILDING PERMIT o� NORTH q ST LEU I6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7D Permit No#: Date Received©� gSSAC HLIS Date Issued: Wl� IMPORTANT: Applicant must complete all items on this page r A �' LOCATION (� — I U� ti /� C Sf ' Print PROPERTY OWNER M a Vl 9i1� Q::0 �1 Q/✓ Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition 9Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial kRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO ¢E PERFO MED: L4.9 GU JU(/t 1 WIUWL W k-OL'a red 1-c9y tdi D tALN-Ak If Lv _ e� Identification- Please Type or Print Clearly OWNER: Name: 1�414l?u &L -7—fiV l&-< Phone: $— sq0— I in- Address: t — 1 D,�. UA-vJt9M Al, fvw� 0 Contractor Name: ,o2_C-bS Phone: Email: _1 c&11_t.~D Address: / 6 0_b00NP Supervisor's Construction License: q`_0S—C Exp. Date: I0 Home Improvement License: /0 16 6 98 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. A95. 5 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.�� Total Project Cost: $ u�- FEE: $�_ Check No.: I®/1 Receipt No.: NOTE: Persons contracting with unre is eyed contractors do not have acces t aran 5_ - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ FI SEWERAGE DISPOSAL gown. ]5-Sew, ❑ Tanning/Massage/Body Art ❑ Swimming Pools ll ❑ 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 Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit t+ DPW Town Engineer: Signature: Located 384 Osgood Street FIRE+DEPARiTMENiT = Tenip�Dumpster onIsite .yes _ nog_ lbcated at 1241MainrStreet Fi'reiDepartinent�signature/date COMMENTS 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 for pickup Call Email 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 t,4 Building Permit Application \_X 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) . 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) 4, Building Permit Application 4, 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 I ECC 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 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 Doe:Building Permit Revised 2014 Location /00 102- V/vJII No.6 f — Date ©;t gz�7 ze�/b • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ° " Foundation Permit Fee $ Other Permit Fee $ TOTAL $ _ P"TEfl 192 - Check# Mff.. / r Building Inspector RO)VIA,;5:� M En$jine -erina Steven Mansaray 385 Gorham St,Suite 2 Civil Engineer Lowell,MA 01852 Business Development e'`�G� 79718-7228-7351 smansaray(a)romasm.com w ww.romasm.coin TOWN OF NORTH ANDOVER FORTH BUILDING DEPARTMENT °��*�`° '6.q't'o 1600 Osgood Street, Suite 2-36, North Andover Ma 01845 0 NOTICE OF VIOLATIONATED SS US zle Date: 42;7� Address: — N` e'j✓ s Building ❑ Zoning Bylaw IKStop Work Order ❑ Certificate of Inspections Electrical 0 Plumbing ❑Gas , ,r Violation observed: Lill Ui6 /i!/ 4 — �/ � � N Fail re on your part to comply with this notice within 10 days may subject you to penalties prescribed by Massachusetts Law 0 r rt A ver's Zonin By law. Please contact the Building Department for further information at 978-688-9545 Inspector Home Owner Contractor h TOWN OF NORTH ANDOVER NORTH BUILDING DEPARTMENT ' ` D�Sq LEO qyO 1600 Osgood Street, Suite 2-36, North Andover Ma 01845 C _ NOTICE OF VIOLATION `h � SSACHUS� y Date: (/JJ r-- Address: UN e'er J!7 • - ❑ Building ❑ Zoning Bylaw Stop Work Order ❑ Certificate of inspections Electrical Plumbing Gas Violation observed: LAJ& U�r` � �UII-pi t,� 9-1f—,P4f�"� Failure on your part to comply with this notice within 10 days may subject you to penalties prescribed by Massachusetts Law ,780.CMR, rfNorth.An ver's Zonin By law. Please contact the Building Department for further information at 978-688-9545 !!Inspector J` Home Owner Contractor NORTH own of ndover p to No. 2 �o h ver, Mass, 04- a W/ 6 �lqs R�rEo rPa��S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..... .... . J. U..J6lt..�...�+� � BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ... Rough to be occupied as �•� �.Aispe .. �.. ..�r.. i.....4#01 .... Chimney provided that the person accepting trmishall 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, Alterati nd Construction of Buildings in the Town of North Andover. / 0 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRTIONS T Rough '�jService ' Final BUILDING INSPE R GAS INSPECTOR Occupancy Permit Required 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. REMODELING CONTRACT I. Parties This AGREEMENT is made this day of July in the year Two Thousand Sixteen between the owner(s) of 100-102 Union Street North Andover MA hereinafter called the Owner, and MA hereinafter called the Contractor. II. The Scope of the Work The remodeling contractorwillfurnish all the labor and equipment,butte homeownerwillfi.mishall mate ria ls neoessaryto complete the alterations and improvements described in the contract documents.The work does not include the attic and the basement.The Owner intends to remodel the first and second floor with a scope consisting of: 102 Union Unit Cost Quantity Unit Total Cost Street, N. Andover MA FIRST FLOOR Replace Ceiling $200.00 1 Lot $200 Tiles Demo $1,000.00 1 Lot $1,000 Reframe Wall $2,000.00 1 Lot $2,000 to restore 2 bedrooms Sand, Stain $5.00 200 SF $1,000 Floor& Polish Floor Replace $2,750.00 1 Lot $2,750 Kitchen Cabinets Countertop $42.00 50 SF $2,100 Sink $200.00 1 Lot $200 Sink Faucet $175.00 1 Lot $175 Install Ceramic $3.00 50 SF $150 tiles-kitchen floor Back Splash $5.50 50 SF $275 Hardware $4.00 40 Each $160 Paint walls $150.00 2 Lot $300 Labor $2,800.00 1 Lot $2,800 M isc $500.00 1 Lot $500 First Floor Total $13,610 SECOND FLOOR Paint the walls $150.00 2 SF $300 Page 1 of 4 BUILDING PERMIT of NORTy q '(SLED 6 H TOWN OF NORTH ANDOVER o ti A APPLICATION FOR PLAN EXAMINATIONVL * ,� (r I • `� ` ` 1 Date Received �G �C/ ��° � Permit No#. � 4�- � , gSSAC HUSEt Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ti s+ 1 Print PROPERTY OWNER M A Vl. Il.P 2 z: 01 &y Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition NTwo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial )kRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ yTOther 9 3 - 1 R 0 R E' ii$-Y`Y'e {:-. _ ...0 �•.,-.t( 'r DESCRIPTION OF WORK TO RE PERFORMED: , PAA i VL Identification- Please Type or Print Clearly ice✓ �.F.Oi, OWNER: Name: M14iV u &L - PTV t Phone: �( '�-- S�tC�_ 8i p Address: t -- 1001. avv,'OAA —q� Al ���'i�C-Py �i'� Q:J�S— Contractor Name: "'e2r-05 � tzt Phone: -2 Email: �-c.�r:�� o Y_-v 2. Address: / 6 0,b00 N_p -5;—. t,_�rz-r--y4c-E: Supervisor's Construction License: 6�pasz Exp. Date:- Home ate:Home Improvement License: yg 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.076c Total Project Cost: $ Uw,-�FEE: $_� Check No.: /'®// Receipt No.: NOTE: Persons contracting with unre * ered contractors do not have acces t aranty Replace some $200.00 1 Lot $200 ceiling tiles Install Ceramic $3.00 50 Lot $150 tiles-kitchen floor Sand,Stain $5.00 200 Lot $1,000 Floor& Polish Floor Second Floor Total $1,650 First+Second Floor $15,260 Profit&Overhead 8% $1,220.80 Total Cost $16,481 Owner and Contractor agree to the following: A. The contractor will perform all the work that is required by this agreement. B. this agreement and will complete work within 30 days after work begins. I. Change Orders All change orders must be in writing and signed by all the parties. The owners agree that changes resulting in the furnishing of additional labor or materials will be paid for prior to the commencement of the extra work. The owners agree that either of them may sign a change order, and that signature will be binding on both. H. Permits, Licenses,and Approvals The remodeling contractor will obtain and pay for local building and construction permits. The owners will obtain and pay the fees for the governmental inspections that are necessary for the construction and occupancy of the finished structure, except as otherwise provided in this contract. III. Insurance.and Risk of Loss The owners agree to maintain insurance covering the replacement cost of the improvement under contract in the event of loss through fire, casualty, storm or other disasters, and theft of materials from the site. The remodeling contractor agrees to maintain workers' compensation insurance and liability insurance to protectthe owners from liability claims for damages because of bodily injury, including death, and from liability for damages to property. IV. Access Page 2 of 4 Y The property owner will allow free access to work areas for workers during scheduled work hours agreed upon by both parties. V. Site Conditions The property owners acknowledge that this contract is based upon the remodeling contractor's observation of conditions.Conditionswhich could not be known by a reasonable inspection,such as termite damage, hidden water damage, hidden code violations, or other concealed conditions, may require extra labor or materials,which are not part of this contract. If such hidden conditions are discovered, the remodeling contractor will notify the property owner and will attempt to reach an agreement for a change order to this contract that addresses those problems. VI. Payment The owner will pay the cost of all materials used in construction plus delivery and handling costs, the wages of all carpenters and other workers for the actual time spent on the job, and the cost of all subcontractors.The owner will also pay 8%percent of those costs to the contractor's overhead and profit. Payment Schedule VII. Final Inspections and approval Upon notification by the contractor of substantial completion of the work, the owners and the remodeling contractor will inspect the work performed, and at that time the owners will prepare a punch list that identifies any incomplete work or deficiencies in workmanship or materials. The owners may retain the value of the punch list work from the final payment until the punch list items are complete. Completion of the punch list items must be made within 24 hours from the date of the punch list preparation. When the punch list items are completed,the owners will pay the contractor the balance of the contract price within 3 days of the demand. At that time,the contractor will deliver to the property owners a release of all approval. VIII. Warranties The contractor guarantees the work will meet trade standards of good workmanship. The contractor will make every effort to blend existing textures, colors, and planes, but exact duplication is not guaranteed.The remodeling contractor warrants that materials of good quality will be selected. The contractor will maintain all manufacturers' warranties. The customer is limited to the manufacturers' warranties for defects in the manufacture of materials. All contractors' warranties are limited to a period of no more than 30 days. The remodeling contractor's warranties are limited to the cost of labor and materials only, and exclude ordinary wear and tear or abuse by others. Page 3 of 4 IX. Dispute Resolution All the parties will cooperate with each other to resolve conflicts informally. In the event that is not possible,conflicts between the parties will be resolved by a mutually agreed mediator with similar work experience. The conflict will be decided according to the Construction Industry Rules of the American Arbitration Association, and the laws of the state where the project is located. The arbitrator will award reasonable costs and expenses, including attorney fees, to the prevailing party. X. Signatures We,the undersigned,have read and understood this entire contract,including documents attached by reference.We acknowledge that this document constitutes the entire agreement between the parties.This contract is not binding upon the co r to or the property owners until it is signed by all parties. Dated: Signed: Contractor: Dated: Signed: Owner: 100-102 Union Street, North Andover Massachusetts Dated: �4 Signed: rAaV,-Jau"� Owner Contract documents: Drawings: Space drawing showing finished work Page 4 of 4 i o -- c © 2 - U�� 0-jA s J. n( � dot AAA- MERIDIAN ASSOCIATES, INC. JOB � 1 500 Cummings Center 69 Milk Street SHEET NO. OF Suite 5950 Suite 302 Beverly, MA 01915 Westborough, MA 01581 CALCULATED BY DATE (978) 299-0447 (508) 871-7030 CHECKED BY DATE SCALE 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 2 3 4 5 6 7 8 1 2 3_ I_ 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 m m� 3 IsfJ6 � , �dny 3.3 2 ....... �l 3 ..........-...... 41 2� 3 _. r!t7 fes✓ , m .. ... .. .... /. ...��,. ... _ _....., .. _._ .. _... .,.......... .... .... .... ... g. b : .. L J 7P, f celypt N1/1j .. ... ..................... . ...... ............ .... ... .... ......... ... ..g Y" 7 2 m .//.... _... ._....... ..... .,... a. ... ... ..I...,. ..., ......... ...... ... .. ........ 8 ....,.. .. .... - �A [77 ti 1 7 w ......... \. .: ... ©.... ... 5 4 n panni lrT 9n7 (:g Qlfb MERIDIA ASSO ES, IN JOB 500 Cummin Center 69 Milk eet SHEET NO. OF IV Suit 950 Suit 02 Bever , MA 019 Westboro , MA 01581 CALCULATED BY DATE (9 299-0 47 (50 871-7030 CHECKED BY DATE SCALE t 2 3 4 5 6 1 2 3 4 5 66 7�a 5 6 1 8 - 2 I S�'{riyC 6 f, J,11 /i1'q 2 3 <� 6 7 g I ) 3 4 5 6 7 g I 2 3 4 5 6 7 g t 2 3 .. .. :.. .....{. ... :..... ... .. .. :. ... .: 7 Y .1!� F► I` m slay .._. ............. -. ...._._ .... ... ... ......... .... .... ......................... .. ... ............ �n� 1 m ............ .. - - -.. ',..- .. ... .... ....,... -. .. .......... ......., i. ..... ..... .... .... _.._...... g m .. 3 e .. ..... ..... :. ........... .. : ... .. -... .. 6 m ........... .. .......... .: ..........: .. ..:... .. :..._ .......... ........ ................... ............. ., ........ .. .............. ..g i m ............. .._...._........ .. ... ...,_... ....... ....... ....................................... ._.. ..... __.-. g n Poew IrT onT Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement!'before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name1 Company Name Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name IDFI�1 p� m rivvS Cityrrown State Zip Code Business Address(must includ astreetaddressl N� M 190 1 l 6 Dame Phone EvetvngPhone City/rown State Zip Code Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number Home lmpro—A Conlmctor Reg.Number Expiration date /. Low idregisth"rmost —benhome0 Improvement contmeton bove (_yjil 6 a valid rcgislnlion numher The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sV�ets if necessary. �wvr,.�;�, t a' .,I.e ,��► �.t�.d' -P.►--e c:� Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be // excluded from the Guaranty Fund provisions of o J��- (Date when contractor will begin contracted work. MGL chapter 142A.) / (?Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of. (*) Payments will be made according to the following schedule: $ upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ /6 4?f by PIZOd or upon completion of $ by_/ / or upon completion of $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(") $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty rs an express warranty being provided by the contractors RNa Yes(all terms of the warranty must be attached to the couLmtl Subcontractors-The contractor agrees to be solely responsible for completio of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor fiuther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT N THIS CONTRACT IF THERE ARE NTZ Cp !!! Two identical copi f th contract must be completed and si&ped.One copy should go to d, r. otl should be kept by can r r. I owner's Sin ure Cont t ' Sr a e at Date Contractor Arbitration The Horne Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The salve right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the evelh the contractor has a dispute concerning this contract,the contractor may submit the dispute to a priv bi t' which has been approved by the Secretary of the Executive Office of Consumer Affairs and Busine Re erlsmne quired to submit to such. *ration as provided In Massachusetts General L s,c 4 Homeowner's Signature tractors Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative u e resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfiully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your conswner/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Horne Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http://www.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homeimprovement/licenseetist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/22/2010 s rrvrn IUnry r I 17 .luI LV10 Lvi Loixt mei LUI rays L UI L CERTIFICATE OF INABILITY INSURANCE DATH(MMIDDIY" 07/15/2016 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 NAME: Elisabeth Rich ALBERT J, TONRY $ CO., INC. PHONE�A/C No 617 773-9900 ► C Nn: MAIL r ri[;tI c y ADDRESS: (ail)nr .ocun 300 CONGRESS ST. INSURER(S)AFFORDING COVERAGE NAIC 0 QUINCY MA 02169INsuRERA: CONTINENTAL CASUALTY CO 20443 ...................................................................................................................................................................................................................................................................................................................................................i.................................. INSURED INSURER 6 MDJ INC INSURER C: INSURER D 10 WOODLAND STRI:.F.T INBUR6RE. .....................................................................................................................................................................I..................... LAWRENCE MA 01d41 INSURERF: COVERAGES CERTIFICATE NUMBER; 69223 REVISION NUMBER: THIS IS TO CEWIFY THAT THE POLICIE:$ OF INSURANCE I.,I$'rFD BELOW HAVE BEEN ISSUED'1'O T'HF: INSURED NAMED ABOVE FOR THF:.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. INBR 'I'YPt OF :AODI.:SUBR PULICYL►► i POLICY t:)<P LlMlfb LTR: POLICY NUMBER MM DDIYYYY NlMIOD/YVVY j COMMERCIAL GENERAL LIADILrrY EACH OCCURRENCES I................ CfnTrIAGLTO R: CN rED............... .............................................. CLAIMS-MADE. I 1 01;UUN err,[MISF..S IEs 6ewirem e1 $ i ? rA6U_XP(nn7 ona t rrwn) $ ......................... N/A r ER90NAL&ADV INJURI' $ 9EN'I.AC•CaREOAIk l!MI'r A11111,IFS PER: C,FNF'.RAL AGO RE�ATF. S PRO i I POLICY 1 d47iI LUL' i [ Pf;UUUC'IS CUMF/OF'M9G $ I OTHF.'K: i $ AUIOMOSILL LIAOILf 1'Y COMBINEDSINGLELIMIT ANY nU'I'0 BODILY INJURY(Per f areon) $ ALL OWNED SCHEDULED N/A riOrul Y wJIIRY(Por or�JApm) AUTOS AUTOS .......... ............................................ Nr,>N(1WNFn t���bPERTYDAWC—E HIFFUAu'I't>S9 ......... AUTOS i `..DK:5ccpdern%................................ ........................................ UMBRELLA UAe OCCUR ; EACI I OCCURRENCE $ I..... .................................................................................................. CxCC33 LIAR ClA1M3PAADtI N/A AGGREGATE S ............�.................. ..............................I .......................................................... .. .. .................... D[D 'RETrATION $ IWORKER$COMPENSATION AND EMPLOYERSUABIUTY ...................... lI. ... .............................................. VIN �)a (F ANI'PHUPHSL•:I UH/VAhINI:NA::kL:Cl111V1:: i E.L.EACH ACCIDENT $ Cs00,D00 A OrnCERVEMDEREXCLUDEW wA:NIA NIA 6S59U65B75967015 11/20/2015; 11/2012016 i"'' ' (Mandatory in NII) f.•l..013tA3F-F'.A FtAPI.OYF,f S SOO,000 Ifyo dcccnbo under UE9CRIF?ION OF OPErWSIONS Lulu r f.L.bI:;EA:If•Ftit.li;V LIMIT $ 500,000 N/A ...................................................................................._....._..................................................................................._......_......_......_......_......-......_.................................................................................................... DE$GRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Addldonal Remarks Schedule.may bo atfacned K more Space Ig required) Workers'CompensaUon benelits will be paid Lo Massacllusetle employees only.Nursuanl to tndursemenl WC 20 U3 06 d,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows[lie policy in force on the date that t111s certificate was issued(unless the expiraton date on the above policy prewdes the issue dale of this nertificRIP of insmanrP). ThP sRHtu;of Ihia c nvPrtlrle can be mnnitorPd dtlily by annr'ssinrl the Prnnf of CnverarlP-t nvf'rHOe VPrifiralinn Searcn tool at www-inass.gov/lwd/workers-compoi)eavon/li)vostiganons/. CERTIFICATE HOLDER CANCELLATION 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 TIIE POLICY PROVISIONS. 1000 Osgood Street AUTHORIZED REPRESENTATNE MA 01845 North Andover `'� "��' C 11yts6yl ill,t;tr3W*I,I,CPCU,Vice President Residual Market WCRIBMA 01988-2014•ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD FIVIII IVIIIY r l " JNI LVJ.V LV J.C.J't MIVI LVI rawc L V1 L CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD/Yvrv)7/15/2o1s 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 ONTCT Duana Biggins-Amari ............................................................................................................................................................................................ Tonry Insurance Group, Inc. PHONE (617)(617)773-9200 jA1C,No): (ciY>rI�-yyzu 300 Congress street ADDRESS,certs@tonry.com ........................................................................................................................................................................................... INSURERS)AFFORDING COVERAGE NAIL d . ....................................................................................................................... Quincy MA 02169 INSURER A Endurance American Specialty 41718 INSURED. INSURER B:Llo d 8 Of Lyndon 1-1-57-9-2 MDJ, Incorporated INSURER C ........................................................................................................................................................;.................................. 16 Woodland street INSURER D INSURER E. .......................................................................................................................................................:.................................. Lawrence MA 01841 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1632312820 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: TYPF OF INSIIRANC.F '§ POI ICV FFF Pnl ICY FXP : I�� LTR POLICY NUMBER i MINODfYYYY MNIMOIYYYY X COMMERCIAL GENERAL LIABILITY .........................FACOI:C;I;'RRFNC:F f 1,000,000 ........i.......... N .................... .............................................. A C)LAIM6-MAW: X UC;(,UH 'PREMISES a ocleurrencc� i 10 0 ..... ....... .......(.. .................... ,000 CBC10001403803 '12/22/201512/22/2016 MFIIFXN(Any nnr.linr-.rm) 5,000 F'FHSf)NAI fi N)V IN,Il1H'f 1,000,000 ........ ............................................................................... i i :..........................................................:................................................... r.,EN'L.AGI�RECATE LlM:T ArrL1E9 rER. GENERAL AGGREGATE :5 2,000,000 ........................................................:................................................... X ! PIT1<11Y i-cl ICY,: 2,000,000 OTHER. E AErlmi oral In:a u•an HWnxut S AU I01VIUEdIL6 LIAIIIU I r COMB'NED GIN" L41v11T y- (Fn nrrlctcnta... ..... ............................................ AW nil I•:) DOCIILY INJURY(Per veiwn) .4, A I C)W'NI-I) SC:HFI30I 1-11 BpDILY INJUR'i(rer9a'1.1eni)'S i AIII I)5 AUI(Xi NON OWNCO PROPERTY DAMAGE 3 ........ HIHFI)AI!IUFi ......... AUTO;; ..IF!.�s arr�nrCnr:............................ ............................................. W UITiBRELLRLIAB ICCrUR FAr.H c,l:ruHHf NGF $ EXCESS LIAR ?CLAIMS NIAOC'. AGGZCGATC IIFII Hf-TENT RIN1, 1 S WORKERS COMPENSATION gEgTIJTC i CRH :AND EMPLOYERS'LIABILITY Y1 N ::ANY PR:,PRIFTC)R:PARTNFR/FXFCIITIVF ;; i C.L.GSCI I ACCIDE14T u i UFFIC.tK.lultMkltH tXC:LUUhU'i ::N/A: ..........................................................:................................................... (Mandutory in NI I) [ f E.L.DI9EA9E•EA EMf'LC)'fEF,5 If ry dc:cribc undcr I ........................................................ UCc i RIPTIuN ur OPCNATIONS brlvn E.L.D19EA9E-POLICY LNIT`•5 B ;DESIGN PROFE33IGNAI;/ PGIARK0357002 2/1B/2016 2/18/2017 :CACTI CLAIM $1,000,000 i Vul,l.l l'1'ION I,IAFtl1.1'I•V mmnnrmTAT.R: 85,nOD Af,C:HFf:A 11,- S'I ,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101.Additional Remarks Schedule.may be attached if more space Is required) ProjPat:102 union Street. Operations usual to a residential general contractor. when required by written contract executed prior to loss, the certificate holder and othor parties are included as additional insured(s) for work performed by the named insured. CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover, MA 01845 AUTHORIZED REPRESENTATNE L Torry Jr./DONNAFi Q 19BB-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS07A rmlana The Commonwealth ofMassachusetts z. Department of IndustirialAccidents V 1 Congress Sheet,Suite 100 Boston,MA.02114-2017 www.mass.gov/dia yY� Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/individuai): M b-T l d ti cl8 ojz-� Address: City/State/Zip: kZh..,�'u Ut Phone#: Are you an employer?Check the appiroprlate box: Type of project(required): 1. ,m a employerwith-.._employees(full and/or part-time).* 7. q Now construction 2.E]I ama sole proprietor or partnership and have no employees working for me in $,&emodeliiig any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.Q I am a homeowner doing all work myself[No workers'comp..nisurance required.]t 10 FJ Building addition 4.F1I 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 proprietors with no employees. 12;h Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no.,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. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 airs an employer that is providing workers'compensation insurance for my employees'Below is the policy acid job site information. Insurance Company Name: CQl7`�/V -/uTi9 �c,�.g _i / Policy#or S elf-ins.Lic.#: 4Xpation Date: Job Site Address: /Z")0—fd Z ��1�'iJ �f City/State/Zip: 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 criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce ;;enaldes ofpetjury that the informationprovided above is true and correct Si ature: Date:Phone#: -7 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.Electrical Inspector 5.Plumbing Inspector 6.Other 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 hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or 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 another who 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 b6 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 commonvyealth 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-contractoi(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 carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Iv.dustrial Accidents foi-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 Accidents. Should you have any questions regarding the law ox 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 Town 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 Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-•727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia �I ��f7.8 V,.IJ-972?7.7P7t1/1G'ClGtf2.O/-UI-7CYJJCIC�lI21C�3 -o— Massachusetts Department of Public Safety Office of Consumer Affairs&Business Regulation is= Board of Building Regulations and Standards $OME IMPROVEMENT CONTRACTOR egistration: r,5,f06698 Type: License: CS-047056 Expiration'=--:74/2016; Private Corporatioa,.1 Construction Supervisor 17 MDJ INC. � � � MARCOS A DEVERS 16 WOODLAND ST r,FaT LAWRENCE MA-01841 Marcos Devers 61 WOOD LAND STREET ja LAWRENCE,MA 01841 Undersecretary >I 1N h Expiration: Commissioner 10/2512017 ;y r' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT of N°oT 6 qti 1600 Osgood Street, Suite 2-36, North Andover Ma 01845 F? ~° o NOTICE OF VIOLATIONATS g. Date: �9SSACNUSE��� — T o Address: ❑ Building ❑ Zoning Bylaw Stop Work Order ❑ Certificate of Inspections Electrical Plumbing Gas Violation observed: Fail re on your part to comply with this notice within 10 days may subject you to penalties prescribed by Massachusetts Law 0 or rt An bver's Zonin By law. Please contact the Building Department for further information at 978-688-9545 Inspector Home Owner Contractor