Loading...
HomeMy WebLinkAboutBuilding Permit #173-2016 - 119 GRANVILLE LANE 8/6/2015 6-III 1 AIU'CX N LI �� ` �` � pORtFf 9 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINA I N Permit NO: 1-115 �1�' Date Received Date Issued: �9SSACHUS IMPORTANT: Applicant must complete all items on this page LOCATION 6=,,�,) V I ll e C._-4 y�Print PROPERTY OWNER �/r'V)� l�e 4e 1 Print MAP NO: I� PARCEL: _ZONING DISTRICT: Historic District yes o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ^ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial `Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other I ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer 4A6W a� 0(i pOki � Identification Please Type or Print Clearly) OWNER: Name: NJ�J� l '! l+C- Phone: / 7- 7� <��0 Address: CONTRACTOR Name: 5or 1 5 2E1/y)E1 Phone: Address: T 0, Supervisor's Construction License: Exp. Date: 0)-J-00 Home Improvement License: Exp. Date: 13 �Ll1� a3— c16 ARCHITECT/ENGINEER Phone: J Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 00 Total Project Cost: $ , /00 FEE: $ 3 Check No.: -7�a Y Receipt No.: a 9 f 75 NOTE: Persons contracting with unregistered contractors do not have access to a gua and ignature of Agent/owner Signature of contractor � . , Location No. 17 3 L c/�- Date • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � Check ilding Inspector 29175 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS 1 CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature COMMENTS i 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 DPW Town Engineer: Signature: _ Located 384 Osgood Street ,�FIREDEPAR�TMENT - tTiffm�®umpstOTonIslte,.}yes� �no� R,Locatetl ath124!LMainrfSt�eet �" �r�e;�De artment�si�nature/dafe �� ' ��,. � 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) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pen-nit 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 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) 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 2012 IECC 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 Doc:Building Permit Revised 2014 NAT-54091-1 B.Z. Painting & Remodeling Co. Boris Zemel P.O Box 165 Lynnfield,MA 01940 Telephone 781-342-5326 Scope of work agreement Property: 119 Granville Ln North Andover REO #P150173 July 30, 2015 Replace 20 windows $6,100 Painting interior $4,930 FANNIE MAE"PAIR VENDOR AGREEMENT#LEG-MSA-000230 This Fannie Mae Repair Vendor Agreement#LEG-MSA-000230 (hereinafter"Agreement"),made and entered into this I l m day of September, 2009(the`Effective Date'l,by and between B.Z.Painting and Remodeling("Vendor"),a Massachusetts sole proprietor, having its principal place of business at P.O.Box 222,Marblehead,MA 01945,and Fannie Mae,a Congressionally chartered corporation ("Fannie Mae'),having a place of business located at 14221 Dallas Parkway,Suite 1000,Dallas,Texas 75254. RECITALS WHEREAS,Fannie Mae is the owner of residential real property acquired through foreclosure and deed in lieu of foreclosure,located throughout the United States(the"Properties'); WHEREAS,Vendor is in the business of providing residential property repair services and other related professional services;and WHEREAS,Fannie Mae is in need of such services in relation to Fannie Mae's ownership of the Properties. NOW,THEREFORE,in consideration of the foregoing and for other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties hereto agree as follows: AGREEMENT 1. SERVICES PROVIDED BY VENDOR From time to time,as requested by Fannie Mae,Vendor shall provide Fannie Mae with property repair services and service levels as set forth in Exhibit A,which is attached hereto and incorporated by reference herein (collectively,the"Services")and which may be amended from time to time. 2. PRICING. Fannie Mae agrees to compensate Vendor for services rendered in accordance with pricing that is customary in the industry. Vendor acknowledges receipt of the Fannie Mae Repair Cost Guidelines which are incorporated hereto by reference and understands that all pricing for services will be reviewed by Fannie Mae from the perspective of the Guidelines. 3. TERM.This Agreement shall commence upon the Effective Date and shall continue in effect until terminated pursuant to paragraph 4- 4. TERMINATION. (a) Fannie Mae may,in its sole discretion,terminate this Agreement with or without cause by providing written notice of termination to Vendor,which termination shall be effective as of the date specified in such notice of termination. (b) Vendor shall have the right to terminate this Agreement or a Work Order upon written notice to Fannie Mae if Fannie Mae fails to pay Vendor according to the terms of this Agreement or otherwise materially defaults in fulfilling its obligations under this Agreement and does not cure such default within thirty(30)days following receipt of written notice of default. (c)The termination of any particular Work Order shall not affect the parties'respective duties and obligations under any other Work Orders then in effect.Unless otherwise speed in a termination notice,the termination of this Agreement shall terminate all Work Orders in effect on the date of such termination.if a termination notice provides that specified Work Orders are not terminated or affected by the termination ofthis Agreement,then such Work Orders shall be performed until completed as provided in such Work Orders or until the Work Orders are terminated in accordance with this Section,in each case subject to the terms of this Agreement,which will remain in effect for such Work Orders until completion or termination. (d) If this Agreement or a Work Order is terminated prior to completion of the Services,Fannie Mae will pay Vendor only for those authorized Services rendered to Fannie Mads,reasonable satisfaction prior to termination. Within five(5)days of termination of this Agreement or a Work Order,Vendor shall deliver to Fannie Mae,to the extent relevant to the Work Orders affected by such termination,all:(i)work in progress;(ii)Fannie Mae property;and(iii)materials containing or embodying Fannie Mae Confidential Information or Work Products. Vendor shall not make or retain any partial or entire copies ofany of the foregoing and will destroy all computer files containing such data or information. The parties will continue to be bound by those sections of this Agreement that survive termination. (e) The parties will continue to be bound by those sections of this Agreement that survive termination. Any provisions of this Agreement that contemplate their continuing effectiveness,including,without limitation,Sections 7-9,11-18,20 and 21(a),and(e),shall survive termination of this Agreement. l AGREEMENT#LEG-MSA-000230 ECLJTED this 11' day of September,2009. N7DNAM BZ PAINTI AND REMO_ E�Gs AND,, /w^ BY: ��1� �Kathy HintonPRINTL AME•JE_ /., TLE:vp i`oroorete Procurement TITLE: 'L`�►� � s EXMITS :xhibit A -Services ,Aibit B -Fannie Mae Insurance Requirements :xhibit C- Supplier Diversity 9 r ,v NAT-54091-t B.Z. Painting & Remodeling Co. Boris Zemel P.O Box 165 Lyn nfield,MA 01940 Telephone 781-342-5326 Scope of work agreement Property: 119 Granville Ln North Andover REO #P150173 July 30, 2015 Replace 20 windows $6,100 Painting interior $4,930 AGREEMENT ALEG-MSA-000230 ECUTED this I I' day of September,2009- 71D)NAME BZ PAIN AND REMODELING: BY:111Kathv Hintan PRI4 NAME: 1 TITLE: ,TLE:VP Co orate Proc ment ��'tL`�►f 1V ?r EXHIBITS ;xhibit A -Services Exhibit R -Fmnie Mae Insurance Requirements Exhibit C- Supplier Diversity 9 FANNIE MAE REPAIR VENDOR AGREEiVitENF#LEG-MSA-000230 This Fannie Mae Repair Vendor Agreement#LEG-MSA-000230 (hereinafter"Agreement"),made and entered into this i ld'day of September, 2009(the"Effective Date'l,by and between B.Z.Painting and Remodeling("Vendor"),a Massachusetts sole proprietor, having its principal place of business at P.O.Box 222,Marblehead,MA 01945,and Fannie Mae,a Congressionally chartered corporation ("Fannie Mae ,having a place of business located at 14221 Dallas Parkway,Suite 1000,Dallas,Texas 75254. RECITALS WHEREAS,Fannie Mae is the owner of residential real property acquired through foreclosure and deed in lieu of foreclosure,located throughout the United States(the"Properties"); WHEREAS,Vendor is in the business of providing residential property repair services and other related professional services;and WHEREAS,Fannie Mae is in need of such services in relation to Fannie Mae's ownership ofthe Properties. NOW,THEREFORE,in consideration of the foregoing and for other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties hereto agree as follows: AGREEMENT 1. SERVICES PROVIDED BY VENDOR. From time to time,as requested by Fannie Mae,Vendor shall provide Fannie Mae with property repair services and service levels as set forth in Exhibit A,which is attached hereto and incorporated by reference herein (collectively,the"Services")and which may be amended from time to time. 2. PRICING. Fannie Mae agrees to compensate Vendor for services rendered in accordance with pricing that is customary in the industry. Vendor acknowledges receipt of the Fannie Mae Repair Cost Guidelines which are incorporated hereto by reference and understands that all pricing for services will be reviewed by Fannie Mae from the perspective ofthe Guidelines. 3. TERM.This Agreement shall commence upon the Effective Date and shall continue in effect until terminated pursuant to paragraph 4. 4. TERMINATION. (a) Fannie Mae may,in its sole discretion,terminate this Agreement with or without cause by providing written notice of termination to Vendor,which termination shall be effective as ofthe date specified in such notice of termination. (b) Vendor shall have the right to terminate this Agreement or a Work Order upon written notice to Fannie Mae if Fannie Mae fails to pay Vendor according to the terms of this Agreement or otherwise materially defaults in fulfilling its obligations under this Agreement and does not cure such default within thirty(30)days following receipt of written notice of default. (c)The termination of any particular Work Order shall not affect the parties'respective duties and obligations under any other Work Orders then in effect.Unless otherwise specified in a termination notice,the termination of this Agreement shall terminate all Work Orders in effect on the date of such termination.If a termination notice provides that specified Work Orders are not terminated or affected by the termination ofthis Agreement,then such Work Orders shall be performed until completed as provided in such Work Orders or until the Work Orders are terminated in accordance with this Section,in each case subject to the terms of this Agreement,which will remain in effect for such Work Orders until completion or termination. (d) If this Agreement or a Work Order is terminated prior to completion of the Services,Fannie Mae will pay Vendor only for those authorized Services rendered to Fannie Mads reasonable satisfaction prior to termination. Within five(5)days of termination of this Agreement or a Work Order,Vendor shall deliver to Fannie Mae,to the extent relevant to the Work Orders affected by such termination,all:(i)work in progress;(ii)Fannie Nfae property;and(iii)materials containing or embodying Fannie Mae Confidential Information or Work Products. Vendor shall not make or retain any partial or entire copies ofany of the foregoing and will destroy all computer files containing such data or information. The parties will continue to be bound by those sections of this Agreement that survive termination. (e) The parties will continue to be bound by those sections of this Agreement that survive termination. Any provisions of this Agreement that contemplate their continuing effectiveness,including,without limitation,Sections 7-9,11-18,20 and 21(a),and(e),shall survive termination of this Agreement. Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): LII), -21 all R- Address: P+ 0 , O'k ° q, -,3`7/ City/State/Zip: /� �� � � Phone 7#: � / r Are you an employer?CI eck the appropriate box: Type of project(required): 1.0 I am a employer with _employees(full and/or part-time).* 7. ❑New construction 2.Fj I am a sole proprietor or partnership and have no employees working for me in 8.JR Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition <1 I 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.E]Plumbing repairs or additions 5.n I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 14.F1 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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 am an employer tl:at is pf oviding ivorlcers'compensation insurmtce for n:y employees. Below is the policy and job site information. f,, Insurance Company Name: — �'!e q� rib(, Policy#or Self-ins.Lic.#: 65 ,6 0B -(hi�X4q"A -13 Expiration Date: Job Site Address: I l l V t uV 1 1(t t L- 1 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify rthe pains an Ities of perjufy that the information provided above is true and correct Signature: ! Data: -7.3 Phone#: 37Mf� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH THE PERMITTING AUTHORITY. Avylicant Information Please Print Legibly Name (Business/Organization/Individual): i ,• r, �- q� If Address: Pi 0 , F)o,)( 1 City/State/Zip: AJ /2 1° Phone#: 7- -1 _ Are you an employer?Clieck the appropriate box: Type of project(required): 1. I am a employer with _employees(M and/or part-time).* 7. ❑New construction 2/.❑]I am a sole proprietor or partnership and have no employees working for me in 8.JR Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10❑Building addition 4Q am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub contractors have employees and have workerscomp..insurance.$ ❑ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors 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 am an employer that is providing worlcers'compensation insurance for'nzy employees. Belofv is the policy and job site information. be- •, �Insurance Company Name: 7 'j(�IJ - Policy#or Self-ins.Lic.#: V��ip0�� -(d �J6 "'T) �1 Expiration Date: Job Site Address: [ 0i V I nu y( 1(t t L' _AJ City/State/Zip: /), t ` it l 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 certify r the pains an Ides of perjury that the information provided above is trite and correct. -7 0Si nature: Date: _3 �-�� Phone#: Ga 1,2- -7141,321D Official use only. Do not sprite in this area,to be completed by city or tolvn Official City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ZEMEB01 OP ID:LR CERTIFICATE OF LIABILITY INSURANCE DATE(M 07/001/11/1 YYI� 5 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 Phone:781-593-9393 NAAONACT MME: Soderberg Insurance Services 200 Broadway Fax:781-599-7338 PHONE N Ext): AI No): Lynnfield,MA 01940 E-MAILOR Kathryn M.Soderberg INSURERS AFFORDING COVERAGE NAIC# INSURER A:Merchants.Supplies INSURED BZ Painting&Remodeling INSURER B:Hanover Insurance Company P.O.Box 165 Lynnfield,MA 01940 INSURER c-Hartford Insurance Company INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE InL DDL B POLICY NUMBER MML DY EFF MMIDD POLICY EXP LIMITS GENERAL LIABILITY 1 EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY SCO060025001299 08/27/14 08/27/15 DAMA E O R NTED PREMISES Ea occurrence $ 100,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,00 POLICY PRO-IECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident C ANY AUTO ADN 6087454-13 02/04/15 02/04116 . BODILY INJURY(Per person) $ 100,00 X ALLOWNED SCHEDULED BODILY INJURY(Peraccident) $ 300,00 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ 100,00 HIREDAUTOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY �,/N TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE 6S60UB-0645N69-A-13 04/16/15 04116/16 E.L.EACH ACCIDENT 100,00 OFFICERIMEMBER EXCLUDED? � N/A $ (Mandatory in NH) E.L'DISEASE-EA EMPLOYEd$ 100,00 DESCRes escribe under IPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 Commercial Applica DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Painting and Remodelling CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fannie Mae THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14221 Dallas Parkway Dallas,TX 75254 AUTHORIZED REPRESENTATIVE Kathryn M.Soderberg ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD �IZ4, Office or Consumer Affairs&Bcvciness Read!x" License or registration valid for individul use only ME IMPROVEMENT CONTRACfvR before the expiration date. If found return to: registration: 136417 Type: Office of Consumer Affairs and Business Regulation ,V xpiratio.. 7/23!2016 DBA 10 Park Plaza-Suite 51,70 Boston,MA 02116 f B.Z.PAINTING&REMODELING CO. BORIS ZEMEL j 20 EVERETT PAINE BLVD fr9f,RBLHEAD,MA Oi945 undersecretary Not valid without signature If Public Safety nd Standards Y ,.r n. The Commonwealth of Massachusetts Department of IndustrialAceidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aimlicant Information Please Print Le ibl Name (Business/Organization/Individual): 2 , /� r(I� Address: P. 0 , G l rs__ ` 71 City/State/Zip: hl ��E1/� rn Phone#: / 7- -7 1 -3 Are you an employer?C eck the appropriate box: Type of project(required): 1. I am a employer with__employees(full and/or part-time).* 7. ❑New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in 8.J'Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.❑I 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. 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.# 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors 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 ant air employer t/:at isproviding workers'compensation insurance for my employees. Below is thepolicy and job site infOrrlrallorl. /,, � f Insurance Company Name: / A I r o Policy#or Self-ins.Lie.#: 656o e -Vh'I / -13 Expiration Date: Job Site Address: I V t u y( 1(4-9-e City/State/Zip: /`�• fes '/ 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 certify r the pains an !ties of perjury that the information provided above is tare and correct Signature: � Date: 0 Phone#: 17- 71 -X!/y 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#: I I ZEMEB01 OP ID: LR ,a�oRo° CERTIFICATE OF LIABILITY INSURANCE DATE(M 07/001/1111YY1� 5 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(les)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). CONTACT PRODUCER Phone:781-593-9393 NAME: Soderberg Insurance Services 200 Broadway Fax:781-599-7338 A/CC ,N Extl: (A/C,No): Lynnfield,MA 01940 E-MAIL Kathryn M.Soderberg ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Merchants.Supplies INSURED BZ Painting&Remodeling INSURER B:Hanover Insurance Company P.O.Box 165 Lynnfield,MA 01940 INSURER C:Hartford Insurance Company INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY SC0060025001299 08/27/14 06/27/15 PREMISESEa occurrence $ 100,00 CLAIMS-MADE Fx�OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,00 POLICYF_IJECT PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident C ANY AUTO ADN 6087454-13 02/04/15 02/04/16 BODILY INJURY(Per person) $ 100,00 X ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ 300,000 NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Peraccident $ 100,00 $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N 6S60UB-0645N69-A-13 04/16/15 04/16/16 E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 Commercial Applica DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Painting and Remodelling CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fannie Mae THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14221 Dallas Parkway Dallas,TX 75254 AUTHORIZED REPRESENTATIVE Kathryn M.Soderberg ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I i I �l l7r l:tt)ll)n+wH/tu(if�1C! rl[/%S.i�A'fldf(,9t1�' Offire of Consumer Affairs&uesins Regdlatiors License or registration valid for individul use only " DME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: FXegistratiom 136817 Type: Office of Consumer Affairs and Business Regulation Expiration: 7/23/2016 DBA 11 14 Park Plaza-Suite 5170 i L Boston,MA 02116 B.Z.PAINTING&REMODELING CO. 9 ' SORTS ZEMEL 20 EVERETT PAINE BLVD 1v1ARBLHEAD,MA 01945 -`""-`�`""- - Undersecretary Not valid without signature #Public Safety _ ad Standards i I � I 1 i II � I ' •�yEPA v NAT-54091-1 B.Z. Painting & Remodeling Co. Boris Zemel P.O Box 165 Lynnfield,MA 01940 Telephone 781-342-5326 Scope of work agreement Property: 119 Granville Ln North Andover REO #P150173 July 30, 2015 Replace 20 windows $6,100 Painting interior $4,930 i FANNIE MAE 7PAIR VENDOR AGREEMENT#LEG-MSA-000230 1 i This Fannie Mae Repair Vendor Agreement#LEG-MSA-000230 (hereinafter"Agreement"),made and entered into this I 1 d'day of September, 2009(the"Effective Date'l,by and between B.Z.Painting and Remodeling("Vendor"),a Massachusetts sole proprietor, having its principal place of business at P.O.Box 222,Marblehead,MA 01945,and Fannie Mae,a Congressionally chartered corporation ("Fannie Mae'),having a place of business located at 14221 Dallas Parkway,Suite 1000,Dallas,Texas 75254. RECITALS WHEREAS,Fannie Mae is the owner of residential real property acquired through foreclosure and deed in lieu of foreclosure,located throughout the United States(the"Properties"); WHEREAS,Vendor is in the business of providing residential property repair services and other related professional services;and WHEREAS,Fannie Mae is in need of such services in relation to Fannie Mae's ownership of the Properties. NOW,THEREFORE,in consideration of the foregoing and for other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties hereto agree as follows: AGREEMENT 1. SERVICES PROVIDED BY VENDOR From time to time,as requested by Fannie Mae,Vendor shall provide Fannie Mae with property repair services and service levels as set forth in Exhibit A,which is attached hereto and incorporated by reference herein (collectively,the"Services'l and which may be amended from time to time. 2. PRICING. Fannie Mae agrees to compensate Vendor for services rendered in accordance with pricing that is customary in the industry. Vendor acknowledges receipt of the Fannie Mae Repair Cost Guidelines which are incorporated hereto by reference and understands that all pricing for services will be reviewed by Fannie Mae from the perspective of the Guidelines. 3. TERM.This Agreement shall commence upon the Effective Date and shall continue in effect until terminated pursuant to paragraph 4. 4. TERMINATION. (a) Fannie Mae may,in its sole discretion,terminate this Agreement with or without cause by providing written notice of termination to Vendor,which termination shall be effective as of the date specified in such notice of termination. (b) Vendor shall have the right to terminate this Agreement or a Work Order upon written notice to Fannie Mae if Fannie Mae fails to pay Vendor according to the terms of this Agreement or otherwise materially defaults in fulfilling its obligations under this Agreement and does not cure such default within thirty(30)days following receipt of written notice of default. (c)The termination of any particular Work Order shall not affect the parties'respective duties and obligations under any other Work Orders then in effect.Unless otherwise specified in a termination notice,the termination of this Agreement shall terminate all Work Orders in effect on the date of such termination.If a termination notice provides that specified Work Orders are not terminated or affected by the termination of this Agreement,then such Work Orders shall be performed until completed as provided in such Work Orders or until the Work Orders are terminated in accordance with this Section,in each case subject to the terms of this Agreement,which will remain in effect for such Work Orders until completion or termination. (d) If this Agreement or a Work Order is terminated prior to completion of the Services,Fannie Mae will pay Vendor only for those authorized Services rendered to Fannie Mads reasonable satisfaction prior to termination. Within five(5)days of termination of this Agreement or a Work Order,Vendor shall deliver to Fannie Mae,to the extent relevant to the Work Orders affected by such termination,all:(i)work in progress;(ii)Fannie Mae property;and(iii)materials containing or embodying Fannie Mae Confidential Information or Work Products. Vendor shall not make or retain any partial or entire copies ofany of the foregoing and will destroy all computer files containing such data or information. The parties will continue to be bound by those sections of this Agreement that survive termination. (e) The parties will continue to be bound by those sections of this Agreement that survive termination. Any provisions of this Agreement that contemplate their continuing effectiveness,including,without limitation,Sections 7-9,11-18.20 and 21(a),and(e),shall survive termination of this Agreement. l I I # AGREEMENT#LEG-MSA-000230 I EXECUTED this II'' day of September,2009- FAN7DNAMIE' BZ PAIN, AND REMODELING: lBY:BY PRIN4 NAME:PRIKathv Hinton►_____ __— ( 1�`'�►�1V�'?r TITLE-.vITLE:'CoComarate Procurement EXHIBITS Exhibit A -Services Exhibit B -Fwmie Mae Inmrxnce Requirements Exhibit C- Supplier Diversity Y 9 t I I I r' i NORTH Town of E �� Andover To }� �h ver, Mass, i Y O LANE 4 a 7AK COC NIC Nl WICK � S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........ �,l.�� Ok& BUILDING INSPECTOR .............................. ..... ............. ....... ................... ...... .... .... Foundation has permission to erect .................:.:...... buildings on ...11 �� rl �N • ................. ' Rough J24— to be occupied as ......... �. . ?►• ....IIS A.^.o 4.h!.%......................................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough Service ....................... ..... .. ................................ Final BUILDING INSPECTOR 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.