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Home My WebLink AboutBuilding Permit #641-12 - 11 FOXHILL ROAD 3/7/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: rL21 Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Z/ /!�OX ll/ez— zo Y O Z-1-7f 14 Tiayi!�,r— 14A Print PROPERTY OWNER 14e-c-oc..v 4iryeiecv� ,1-�ft1yE ?Os6z�C Unit# Print MAP NO: _PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village ye no 100 year-old structure ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ,0'Alteration No. of units: ❑ Commercial ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ® 375 elle1111;® oodplain ®Wetlands e� iWat�rshes 'ct ®1Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) 76 OWNER: Name: Ak-c.,--c„a, 4/24>GIy hia-m - 19691Y1614-- Phone: Address: /ZA(-4 /7A /6 o I j CONTRACTOR Name: /W16 P0%6 GC�� Phone: Address: 114e-- (ZP Nd�I ✓ Supervisor's Construction License: Exp. Date: Home Improvement License: F, Exp. Date.- ARCH ITECT/ENGI NEER ate.ARCHITECT/ENGINEER Phone: i Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2 Z7��! FEE: $ i I Check No.: � (� Receipt No.:;)� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 1,5nature_of'Agent/Qvvner ;,..:. ' Sigriature_ofcontractor I d 1 Location No. f0 Zi Date L TOWN OF NORTH ANDOVER e. `. Certificate of Occupancy $ Building/Frame Permit Fee $_ 7 F � ` - Foundation Permit Fee $ Other Permit Fee $ t TOTAL $ Check#� ' t� 25075 Building Inspector 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer El' Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ 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 DATE REJECTED DATE APPROVED i PLANNING & DEVELOPMENT ❑ ❑ I COMMENTS CONSERVATION Reviewed on Signature COMMENTS- HEALTH OMMENTSHEADTH Reviewed on Signature COMMENTS i 1 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 FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department'signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i iy on, mast or service drop requires approval of ELECTRICAL: Movement of Meter locati Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine Fo NOTES and DATA— department use r i Notified for pickup - Date Doc:."ui1ding Permit Revised 2011 June/mi 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 '4 ❑ 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/Crossection/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: Doc.Building Permit Revised 2008mi xAORT1i ToVM Of Andover . . "' N �z1/ l2 - �, o , dover, Mass., � '� • � Z• Q C LAKE COC MIC ME WICK �t RATED BOARD OF HEALTH Food/Kitchen rERMIT . T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...................... .. .. .... ....... ......fat. -.0.............................. Foundation buildi son ^ .� Rough has permission to erect..................... ........... ...........�.�........ax... �..... ................ g to be occupied as......... ... .. Chimney r!..... .......... .............................mfiii�4�i��ationon provided that the person accepting this permit shall in every respect conform to the termin Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC N TS Rough ................... ...... ..................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough . Display in a Conspicuous Place on the Premises — Do- Not Remove Final No Lathing or Dry Wall To Be Done FIR_E-DEPARTMENT Until Inspected and Approved. by the Building Inspector. Burner -- Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth ofMassachusetts Department oflndustrialAccidents Office oflnvestigations' 600 Washington Street Boston,MA 0211.1 yJ www.massgov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information 'lease Print Lg ibl Name(Businessiorganization/Individual): 2 �� Address: GG .City/State/Zip: -/"�/ A�Pdvt-t 01 Phone#: as Z_ ------------------- Are you an employer?Check the appropriate box: 1,❑I am a employer with 4: ❑I am a general contr]a,,,dand I 6;Pe of project(required): 2�employees(full and/or part-time), have hired the sub-ctors ❑New construction I am a sole proprietor or partner- listed on the attachet.1 7•,remodeling ship and have no employees These sub-contractoe working for me in any capacity, workers'comp,insu . 8' ❑Demolition [No workers'comp,insurance 5. ❑ We are a corporationts 9• ❑Building addition required.] .officers have exercisir 10•❑Electrical repairs or additions3,❑ I am a homeownerdoing all work right of exemption peL 11.❑Plumbingrepairs or additionsmyself.[No workers'comp. c. 152, §1(4),and wenoinsurance required,]r employees.[No work12•❑Roofrepairs comp,insurance requ13,[]Other *Any applicant that checks box#1 must also fill out the section below showing their workers' t'Homeowners who submit this affidavit indicating they are doing all work and then hire outsidcompensation policy information,e 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 their workers'comp,policy information. -ram an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob life information. Insurance Company Name: Policy#or Self-ins.Lie. Expiration Date: L' y Sob Site Address: �•o,Y ��.(iL. Attach a copy of the workers'compensation policy declaration page City/State/Zip: � �_ _&,�d . w U (showing p g ing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to$250.00 a day against the violator. Be' that a copy of this statement may be forwarded to the Office of Investigations of the DIA,for insurance coverage verification. Ido hereby certify u cler fhe pains and penalties o per' that the information rovided abo ` i P ve is true and correct. Si ature- • -- Date: 7d ff/ Official use OH&- DO not write in this area,to be completed by city or town official. City or Town; Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5Plumbing - 6.Other - . g Inspector Contact Person: Phone M 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 ofthe 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 be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall'4ilihold 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-contractors)name(s),address(es)and phone m nber(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 Industrial Accidents for 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 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 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. PIease be sure to fill in the permibUcense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/liceuse applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in jcity or town)."A copyof 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 homeowner 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 Office of Investigations would like to thank you iu advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: 10 Co��zonweE&h of AfLassachl?setts Department of ladwtrial Accidents Office of Investigations _ 600 Washington Street Boston;MA 02111 _ Tol.#617-727-4904 ext 406 or 7-877 M,SS FE - Revised 5-26-05 Fax#617,727-7749 WWW mass.govjdia ItAORT� T o ® Andover over, Mass., o o � '� • � L coC MIC HE WICK 1 RATED p,?�\��5 '9S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........................ . .. .. ... ....... ...... !... .............................. Foundation has permission to erect...................a.,****,*,*....... buildi s on ........... ........RX...rlb�W.... .s................ Rough himn y to be occupied asC eAJ......... .....................................Z_i�k�ation provided that the person accepting this permit shall in every respect conform to the terms of on i e in Final 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 .VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTS Rough ................... ...... ..................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough . Display in a Conspicuous Place on the Premises — Do- Not Remove Final No Lathing or Dry Miall To Be Done FIR_E-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner - Street No. SEE REVERSE SIDE Smoke Det. �lassachusctts- Dcpartincnt of Public.SafctN Board of Building Regulations and Standards Construction Supervisor License License: CS 105086 I THEODORE KELLEY 214 SUTTON HILL RD NORTH ANDOVER, MA 01845 c Expiration: 10/8/2013 Commissioner Tr#: 105086 i Ofticeot�oasOc r' '�a airs mess egu anon HOME IMPROVEMENT CONTRgCTOR Registration: 165 c�.� 887 Type: Expiration: 4/b/2012 Individual T '`EMODELING =1 THEODORE KELLEY=- �WI 214 SUTTON HILL'R NORTHANDOVER,'"'' MA 0'1:84'5 ' 1-- Undersecretary i t TMK Remodeling CS# 105086,HIC Lie# 165887,RRP#LR000106 214 Sutton Hill Rd North Andover MA 01845 978 852-4491 CONTRACTOR AGREEMENT THIS AGREEMENT made this 2 20/Zbq and between Theodore Kelley dba TMK Remodeling, Construction Supervisor License 105086,214 Sutton Hill Rd,North Andover MA 01845 hereinafter called the Contractor,and Malcolm Winfield and Helaine Posnick,hereinafter called the Owner. WITNESSETH,that the Contractor and the Owner 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,as annexed hereto as it pertains to work to be performed on property located at: 11 Fox Hill Rd,North Andover MA 01845. ARTICLE 2. TIME OF COMPLETION The work to be performed under this Contract shall be commenced on or before March 5,2012 and shall be substantially completed on or before March 30.2012. ARTICLE 3. THE CONTRACT PRICE The owner shall pay the Contractor for the labor and materials to be performed and supplied under the Contract the sum of Twenty Two Thousand Seven Hundred Twenty Five Dollars($22,725),subject to additions and deductions pursuant to authorized change orders. The contract price includes Four Thousand Seven Hundred Seventy Five Dollars($4,775)in allowances for certain materials and fixtures.The final invoice will reflect actual and approved costs for the following materials and fixtures: 1. $1275 for vanity counter(approx 12 SF),shower curb top(approx 3 SF)and shower shelves(1 SF) 2. $700 for Medicine cabinets/mirrors(2 @$350/ea) 3. $2200 for shower glass enclosure,door and hardware 4. $600 for 3 wall sconces3 ( @$200/ea) ARTICLE 4. PROGRESS PAYMENTS Payments of the Contract price shall be paid in the following manner from the Owner to the Contractor: 33%upon contract acceptance and signature 33%upon completion and installation of shower area tile walls and floor 33%upon.final completion and 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. www.tmkremodeling.com 978 852-4491 Page 2 ' TMK Remodeling CS# 105086,MC Lic# 165887,RRP#LR000106 214 Sutton Hill Rd North Andover MA 01845 978 852-4491 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 Contract. 4.Contractor shall furnish Owner 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 Owner and Contractor. 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 Owner 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 Owner hereby mutually agree in advance that in the event that the Contractor and Owner 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 Contractor and Owner shall be required to submit to such arbitration as provided in MGL c 142A. 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(18x24")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 Park Plaza,Suite 5170 Boston,MA 02116 Phone:(617)973-8700 ARTICLE 6. OTHER TERMS www.tmkremodeling.com 978 852-4491 Page 3 TMK Remodeling CS# 105086,HIC Lic# 165887,RRP#LR000106 214 Sutton Hill Rd North Andover MA 01845 978 852-4491 ARTICLE 7. ACCEPTANCE Signed this day of 20LL ti Owner ontractor NOTICE: The signatures of the par 'es above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner 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 i i www.tmkremodeling.com 978 852-4491 Page 4 TMK Remodeling CS# 105086,IHC Lic# 165887,RRP#LR000106 214 Sutton Hill Rd North Andover MA 01845 978 852-4491 Exhibit A - Statement of Work Project Scope: Remodel master bath room on second floor. 1. Demolition a. Remove existing fixtures: 6' vanity,counter, 2 sinks;toilet, 5' medicine cabinet and light fixture over vanity b. Remove 24"x75" soffit and drywall over sink area c. Remove existing fiberglass shower unit and door, and wallboard in shower area d. Remove existing floor and subfloor(approx 48 SF) e. Remove window and door trim f. Remove existing wallboard for access to plumbing and electrical as needed 2. Construction a. Frame 36"x36" shower area with 5" curb and 12 x 18" shelf as shown on construction drawings b. Install 1/2" cement board in shower area up to finished ceiling,tape and mortar all joints c. Install 1/4" cement board sub floor mortared and fastened to sub floor(approx 40 SF) d. Frame out wall for medicine cabinets in sink area e. Install Y2"moisture resistant drywall,tape and fill all joints with joint compound, sand and prime(approx 24 SF) f. Schedule Rough Inspection 3. Plumbing a. Rough in: i. Disconnect and remove 6' radiated baseboard. Reconnect heating loop ii. Install new Symmons Allura shower setup;main valve,2 control valves, drain,2 spray heads iii. Verify and relocate supply and waste lines for new sink locations if needed iv. Verify and relocate supply toilet supply line if needed v. Schedule Rough Inspection b. Finish: i. Install Symmons Allura shower trim and fittings, connect to supply lines lines; Finish: Satin Nickel ii. Install Icera Riose one piece toilet, connect to supply and waste lines iii. Install Symmons Allura faucets, connect to supply and waste lines; 1. Finish: Satin Nickel iv. Schedule Final Inspection www.tmkremodeling.com 978 852-4491 Page 5 TNM Remodeling CS# 105086,HIC Lic# 165887,RRP#LR0O0106 214 Sutton Hill Rd North Andover MA 01845 978 852-4491 4. Electrical a. Rough in: i. Install 3 new light fixtures over sink on existing switch ii. Replace recessed fixture with 5"recessed fixture in shower on existing switch iii. Install 15 amp dedicated circuit for radiant floor system and thermostat iv. Install new GFI outlet left sink area v. Replace fan/light combo with Panasonic FV-I IVQL5 WhisperLite® 110 CFM Ceiling Mounted Fan/Light Combination on existing switch .Add new switch for night light. vi. Schedule Rough Inspection b. Finish: i. Replace existing switches and outlets with new switches and outlets of color TBD ii. Install 3 new light fixtures over sink(to be specified)and shower(5" recessed fixture) iii. Connect floor heat mat to thermostat iv. Schedule Final Inspection 5. Finishes a. Install window and door trim (to be specified) (approx 30 LF) b. Paint: Prime and paint ceiling,walls and trim. Wall and trim color to be specified. c. Floor Tile: i. Install Nuheat custom fabricated radiant heat floor mat mortared to cement board subfloor(approx 30 SF) ii. Install 12x12 porcelain tile,grout and seal joints (approx 40 SF)over custom radiant floor electrical mat(approx 30 SF) d. Shower Tile: i.. Install 12x6 and 6x6 glass tiles on walls in pattern to be determined, grout and seal joints (approx 42 SF) ii. Install mosaic tiles in 12 x 18" shelf area and accent stripe on wall(size jand location to be determined)if directed by Owner&Contractor iii. Install two shelves consisting of counter materials (to be specified) e. Shower Floor Tile &Curb: i. Install rubber membrane in shower area floor over %2" cement board ii. Build up shower floor with a mortar bed,pitched to drain iii. Install river rock 12x12 tile over mortar, grout and seal joints (approx 8 SF) iv. Install tile on curb walls, grout and seal joints v. Install cap stones(to be specified)on curb f. Accessories: Install Symmons Allura TP holder,towel road and towel ring as specified in field www.tmkremodeling.com 978 852-4491 Page 6 • TMK Remodeling CS# 105086,HIC Lic# 165887,RRP#LR000106 214 Sutton Hill Rd North Andover MA 01845 978 852-4491 g. Vanity: Install Bertch Linea series Insignia Macassar vanity as specified by manufacturer; two 24" sink base cabinets,one 24" 3 drawer base cabinet h. Countertop: Template and install 75 x 21"counter and 2 18x12"undermount sinks Counter to be specified i. Tile: Install 4"mosiac tile backsplash and side splash over counter, grout& seal joints j. Install 2 recessed 18 x 30"medicine cabinet/mirrors k. Install %2"tempered safety glass shower panels and door(to be specified) 1. Schedule Final Inspection All construction debris to be placed in dumpster on site. www.tmkremodeling.com 978 852-4491 Page 7 J V DAC IinRTFonn WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S60UB-41 84P88-A-11 ) RENEWAL OF (6S60UB-4184P88-A-10) INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY 1. NCCI CO CODE: 80411 INSURED: PRODUCER: KELLEY, THEODORE DBA JOHN H FERNEKEES TMK REMODELING 95 MAIN ST 214 SUTTON HILL RD READING MA 01867 NORTH ANDOVER MA 01845 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 04-02-11 to 04-02-12 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA a a 'des B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in a, item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee ��— C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: 0 COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A o-- D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 03-18-11 WC ST ASSIGN: MA OFFICE: ORLANDO DA HTFD 05G PRODUCER: JOHN H FERNEKEES 77RCB 004142 PREFERRED MUTUAL INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS RENEWAL BUSINESS DIRECT BILL Policy Number: CPP 0110 60 04 09 Named.Insured: THEODORE KELLY DBA TMK REMODELING Address: 214 SUTTON HILL ROAD NORTH ANDOVER MA 01845 Replacement or Renewal Number of CPP 0100600409 Agent: JOHN H FERNEKEES INSURANCE AGY 20 12700 Address: READING MA 01867 Policy Period: From 03/29/11 to 03/29/12 12:01 A.M. standard time at the mailing address of the named insured as stated herein. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. LIMITS OF INSURANCE GENERAL AGGREGATE LIMIT (Other than Products-Completed Operations) $ 2,000 ,000 PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT S 2,0 0 0,0 0 0 PERSONAL AND ADVERTISING INJURY LIMIT S 11000,000 EACH OCCURRENCE LIMIT S 11000,000 DAMAGE TO PREMISES RENTED TO YOU LIMIT (Any One Premises) 4 100,'000 MEDICAL EXPENSE LIMIT (Any One Person) 51000 The Named Insured is: INDIVIDUAL Business of the Named Insured is: REMODELINGIHOME IMPROVEMENTS Audit Period: ANNUAL FORMS & ENDORSEMENTS ATTACHED TO THIS POLICY CG2404(0509) CG2503(0509) CG9501(0101) CG9502(0101) CG2151(0989)' CG2147(1207) CG9506 0709 CG0068(0509) CG2132(0509) IL0003(0908) IL0021(0908) CG2171(0608) CG0203(0308) CG2187(0107) CG2167(1204) CG2186(1204) CG2426(0704) CG9505(0104) CG2160(0998) CG2161(0498) CG0001(1207) TOTAL ADVANCE PREMIUM $ 1,046.00 THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. PMD1 (06-10) Includes copyrighted material of Insurance Services Office, Inc.,with permission_Copyright, Insurance Services office, Inc., 1983, 1984. 03/11111 BSH wi INSURED COPY CPP GLO 0110600409 954414002 00460 NOTICE N NOTICE TO a TO EMPLOYEES EMPLOYEES 0,1M 5NIS The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152,Sections 21,22&30,this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: HARTFORD UNDERWRITERS INSURANCE COMPANY NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY. (GS60UB-4184P88-A-ii ) 04-02-11 TO. 04-02-12 POLICY NUMBER EFFECTIVE DATES JOHN .H FERNEKEES 95 MAIN ST READING MA 01867 NAME OF INSURANCE AGENT ADDRESS PHONE# a_ KELLEY, THEODORE DBA 214 SUTTON HILL ROAD .�� TMK REMODELING °s NORTH ANDOVER MA 01845 EMPLOYER ADDRESS �s s °= EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE N� MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS ova's, W20P1G02 TO BE POSTED BY EMPLOYER Remove toilet Remove existing floor and subfloor(approx 48 SF) Remove existing fiberglass shower unit and door, and wallboard in shower area II �I IZ Remove window and door trim j IIP 1 i t � III1 .�a I Remove 24"x75"soffit and drywall over sink area Remove existing wallboard for access to plumbing and 1= L electrical as needed ----------------- II Remove existing fixtures:6'vanity,counter,2 sinks,5' medicine cabinet and light fixture over vanity �I- II I I II I i I II I LII �I. Master Bathroom Demolition Plan 11 Fox Hill Rd SIZE FSCM NO DWG NO REV North Andover MA 01845 TMK Remodeling 214 Sutton Hill Rd DRAWN TKELLEY D_1 3 North Andover MA 01845 978 852-4491 ISSUED Mar 3,2012 SCALE 1/2"=1'-0" SHEET 1 OF 6 CSL#105086 Frame 36"x36"shower area with 5"curb and 12 x 18"shelf.Shelf centered on wall, and 56"AFF.Location to be field verified.d. —1075 S Ar ShowerArea r area t 0 / cement board in howe a e 2 .` InstallP M n mortar all joints finished ceiling,tape and 1 9. P A2 Install/z moisture resistant drywall on wall and ceiling,tape a nd fill II joints with - joint compound,sand and Prime(aPP rox ih 24 SF) g Cl) � „ Install/, cement board sub floor over M :N mortar bed fastened to subfloor O (approx 40 SF) N Frame out wall for recessed medicine cabinets in sink area.Typ of 2 8'-0" 1 A2 Master Bathroom Construction.Plan 11 Fox Hill Rd SIZE FSCM NO DWG NO REV TMK Remodeling North Andover MA 01845 • A-1 3 214 Sutton Hill Rd DRAWN TKELLEY North Andover MA 01845 978 852-4491 ISSUED Mar 3,2012 SCALE 1/2"=1'-0" SHEET 2 OF 6 CSL#105086 Plumbing Rough in: Disconnect and remove 6'radiated baseboard. Reconnect heating loop ---------------------------- Plumbing Rough in: Verify and relocate supply toilet supply line if needed Plumbing Final: Install Icera Riose one piece toilet,connect to i supply and waste lines Plumbing Rough in: Verify and relocate supply and waste lines for new sink C? locations if needed.Typ of 2 io Plumbing Final: Danze faucets,connect to supply and waste lines Typ M of 2 M Plumbing Rough in: -I- Install new Danze shower setup;main valve,2 1'-3 3/4" control valves,drain,2 spray heads Rough in new waste line for shower Location of valves and spray heads to be approved _ in field by Contractor 8'0" Plumbing Final: Install Danze shower trim and fittings, connect to supply lines lines Master Bathroom Plumbing Plan I 11 Fox Hill Rd SIZE FSCM NO DWG NO REV North Andover MA 01845 TMK Remodeling P-1 3 214 Sutton Hill Rd DRAWN TKELLEY North Andover MA 01845 ISSUED Mar 3,2012 SCALE 1/2"=1'-0" SHEET 30176 - 978 852-4491 CSL#105086 Electrical Rough&Final Replace fan/light with new Panasonic fan/light combo on existing switches.Add new switches for light and night light Nuheat custom radiant floor mat(approx 30 SF) Electrical Rough&Final: Install new GFI outlet left of vanity _ Electrical Rough in: Install 4 new light fixtures over sink on existing FI switch on either side of mirror/medicine cabinet Verify location in field with Contractor Electrical Final: �o F Install 4 new surface mounted wall fixtures over sink area co #7' on existing switch N' I t , I 2'! Electrical Rough&Final: ih po [� Replace 5"recessed shower light on existing CID #4:5 0'r switch Electrical Final:Replace existing switches and 4 j outlets with new switches and outlets of color TBD R 8'-0., Electrical Final:Install new Harmony Thermostat for radiant floor on new 15 amp circuit.Connect to mat. Electrical Rough: Install new 15 amp dedicated circuit and junction box for radiant floor mat Master Bathroom Electrical Plan 11 Fox Hill Rd SIZE FSCM NO DWG NO REV North Andover MA 01845 TMK Remodeling DRAWN TKELLEY E 1 3 North Andover MA 0214 Sutton Hill 1845 ISSUED Mar 3,2012 SCALE 1/2"=1'-0" SHEET 4 OF 6 978 852-4491 CSL#105086 Prime and paint ceiling, Shower Tile: Shower Floor Tile&Curb: walls and trim.Wall and 12x6 and 6x6'Rain Gloss'glass tiles on walls Rubber membrane in shower area floor over 1/2"cement board trim color to be specified in pattern to be determined,grout and seal Mortar bed,pitched to drain joints(approx 42 SF) River rock 12x12 tile over mortar,grout and seal joints "Vihara Jade Gloss'mosaic tiles in 12 x 18" (approx 8 SF) shelf area tile on curb exterior wall,grout and seal joints 1 '/d'cap stones of counter material on curb (to be specified) co Danze Accessories(Towel Ring,Towel Rod and - TP Holder)to be field located Vanity:Bertch Linea series Insignia Macassar vanity;two 30"sink base cabinets,one 12"3 drawer base cabinet _ O + 1 Y2"Filler panels on each end _ I + Vanity Counter:75 x 22"solid surface materials with two Kholer 18x12"undermount sinks.Edge:Half Bullnose Material to be specified o EbbBacksplash:4"Vihara Jade Gloss mosiac the backsplash and side splash over counter,grout&seal joints + Recessed 18 x 30"medicine cabinet with mirror. 904 I + Typ of 2 -- ''/2"tempered safety glass shower panels and door 8'-0" New window and door trim(to be specified)(approx 30 LF) Floor Tile: Two tiered recessed shelf and one stand alone shelf consisting of IS-1013 12x12 porcelain tile,grout and seal counter materials(to be specified) joints(approx 48 SF)over custom radiant floor electrical mat(approx 30 SF) Master Bathroom Finish Plan 11 Fox Hill Rd SIZE FSCM NO DWG NO REV T North Andover MA 01845 21 Remodeling F-1 3 214 Sutton Hill Rd i DRAWN TKELLEY North Andover MA 01845 978 852-4491 ISSUED Mar 3,2012 SCALE 1/2"=1'-0" SHEET 5 OF 6 CSL#105086 Floor tile on mortar bed,grouted and sealed NuHeat Radiant Floor Mat '/"Cement Board mortared and fastened to V-2 1/2" sub floor ''/_"Tempered Safety Glass Shower Enclosure 1'0" 1 %"Stone Cap FO '/"Cement Board Vihara Jade Gloss mosiac the on mortar bed,joints grouted and 2x4 Wood Frame sealed 1 %"Stone shelves Typ of 2 Rubber Membrane Tile on mortar bed,grouted and sealed OLL '/1'cement board,joints , /2'Cement Board,mortared and taped and mortared fastened to sub floor and wood frame plywood blocking 2 3/4° Mortar bed,pitched to drain 2x4 wood framing Sub Floor 6" 2" LL LL CID LO IV 4k 1'- 0" in : : : : ..: : .Shower Shelf Detail € iil r A `�_ M fV Third Shelf Edge:Pencil Radius. N 2 Shower Curb Detail Top Shelf A2 Edge:Pencil Radius Bottom Shelf Edge:Pencil Radius Ln N M Master Bath Construction Details 11 Fox Hill Rd SIZE FSCM NO DWG NO REV TI North Andover MA 01845 214 Sutton Remodeling Rd lg DRAWN TKELLEY A-2 3 North Andover MA 011845 ISSUED Mar 3,2012 SCALE 1 1/2"=1'-0" SHEET 6 OF 6 - 978 852-4491