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HomeMy WebLinkAboutBuilding Permit #454 - 134 SOUTH BRADFORD STREET 12/5/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: VS Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 1 3 to �o Ln V �4 zCZJAQR! 1 Print PROPERTY OWNER Unit# Print MAP NO:103 PARCEL: 13 ZONING DISTRICT: Historic District yes no Machine Shop Village yes 100 year-old structure yes na TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family ❑Addition ❑Two or more family ❑ Industrial RAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Sept �,W'ell :j Floodpla ®Wetlands s® Watershe D D�W�ater/Sewer _�� ,." �� • k � DESCRIPTTIOON OF WORK TO BE PERFORMED: Te� FQ � 9--, (Identification Please Type or Print Clearly) , OWNER: Name: C A� �1.`,/ �A �� lJ Phone: 91.5• (c��- 4,1-4 Z� Address: V'r &T CONTRACTOR Name:,M\C11 £L 1-\CA ,J C O N S u Phone: �`� _ S90p_ Is,6 Address: C c) \ &90 J Le- s> Supervisor's Construction License: CS (01-71 S Exp. Date: (a ll (o ll Z Home Improvement License: l X01 (00 Exp. Date: I o ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ (� FEE: $ ^-7Pa, 06� Check No.: b-Z 2� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund '#�' �. u 7'� ,,.i�y; \ .r n:atu[e:of�Agent/O,wner ; ; d :�_ _ • ,Signature,�of�contractor� �. .--: �.,��m,�,_ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ; TYPE OF SEWERAGE DISPOSAL Public Sewer TanningfMassage/Body Art ❑ Swunmmg Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY I INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Sianature ACOMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Conner-tion/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 I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of i Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine i NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 20117une/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 o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 u Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 l i Massae usetts Home Improvement Sample Contract it t 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 ISeek 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 callingthe Office of Consumer Affairs and Bt4ainess Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Iiformation Contractor Information Name Company Name CiAT+�v ��- glsaitil �� cl-1A L Imo. -Street Address(do not use a Post Offico Box address , S Contractor/Salesperson/Owner Name •��� � 1MLAO�'p � �T � 14�L. �i3•fJt� • City/Town State II Zip Code Business Address(must include a street address) m':)- aD n A-I &.) St.T Daytime Phone Evening Phone City/Town State Zip Code Mailing Address(It different from above) Business Phones}? _j;W.0 C6 4 1 Federal Employer ID or S.S.Number • Lmvrcquires that most home Home Improvement Contractor Reg.Number Expiration date tors improvement validregistration umbo ave �O 1O a valid registration number ( 1_7 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 sheets if necessary.) C'1 cwt E V.k Tcvr ti 2 E o j E 2CPC -:�C-E 3 w tiv (Jo WS Q.E�� FL��Z,S � I Required Permits-The following1building 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 oevn permits will be excluded from the Guaran ]Fund provisions of � ty 'ZJ�a�I( Date when contractor will begin contracted work. MGL chapter 142A.) : i AILZS&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: $ '7,60 G upon � I • p signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ 7-0by /;; or upon completion of G\'�Q by or upon completion of $ Z-O(on upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) I The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule i('k*) $ to be paid for NOTEE'S:(*)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 I(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 Warran -Is an ex ress warrlanty3eing provided by the contractor. � ❑No El Yes all terms of the warran r must be attached to the contract Subcontractors-The contractor agrees to be solely responsible for completion of the workc'described regardless of the actions of any third patty/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this a eement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contra l befohall retimply that any lieh r other security interest has been placed on the residence. Review the following cautions and notices Y signingthis contract. I � • Don't be pressured into si fining the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has aWalid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registeredlwith 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. � i 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 maim office or branch office by ordinary mail posted,by Telegram sent or by delivery,not 1 ater than midnight of the third business day following the sigziing of this agreement. Seethe attached notice of cancellation form for an explanation of this right. I * NOT SIG'N', THIS CONTRACT IF THERE ARE�y 3 K SPACES!!! Two i opies ofthe contract must be completed and signed. one copy should go to the homeowner. The other copy should be lceptby the contractor. i omeo s Signa re ____ ontracior's Signature Date — Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate aniarbitration action(as an alternative to court action)if they have a dispute with a contractor. The same 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. i ! The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm)which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to sugh arbitration as provided In Massachusetts General Laws chapter 142A. m er's Signature Contractor's Signature NOT CE:The signatures of the parties above apply only to the agreement of the parties tol alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. 1 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.i 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 iwork as described,in a timely and workmanlilce 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 lawfully 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 consumer/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 exlibits 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 receii;ed 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 duel 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 Consuumer Guiae to Home Improvement" contact: I I Consumer Information Hotline Office of Consumer Affairs and Business Regulation j 10 Park Plaza,Room 5170,Boston,MA 02116 j 617-973-8787, 888-283-3757 or visit the OCABR website at lltto://www.rhass.Lov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additii nal information specifically about the contractor registration component of the Home Improvement Contractor Law,clodtact: 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.inass.G:ov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: I h=://db.state.ma.us/homeiMprovement/licenseelist.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 •. ' '.' o ".. ' > Better Business Bureau j 508-652-4800,508-755-2548 or 413-734-3114 j Version 2.1-11/22/2010 NORTH Tovm oAndover . 0 No. x -__ _ dower, 1Vlass., Q �t- CAKE COCMICKEWICK V ORATED P`P���S '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................... ......:........ .41�Si ► ........�....... .. ............................................................ ...... Foundation _r has permission to erect.............................. ...... buildings on ....� ...........5a....lar. 6(6.r.Q........ ...... Rough t to be occupied as a ....... '...: .....w.twdO�J�..... .......... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file 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 1 PERMIT EXPIRES IN 6 MONS ELECTRICAL INSPECTOR 51i 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 Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Massachusetts- Department ol•Public Sufetl Board of Building Regulations and Standards Construction Supervisor License License: CS 62751 MICHAELP SHAW 80 MAIN ST GROVELAND, MA 01834 Expiration: 6/16/2012 ('unun��iuncr Tr#: 29257 Office ofonsr a�u�iness egu a on -'— — HOME IMPROVEMENT CONTRACTOR Registration: ,167605 Type: Expiration: 10/7/2012 DBA Mi�"EL SHAW CONSTRUC Nn MICHAEL SHAW 80 MAIN ST fE GROVELAND,MA 01834 Undersecretary The Commonwealth ofMassachusetts me t e art p n o In�lu ' f strzalAcczdents � Office oflnvestigations 600 Washington Street Boston,MA 02111 SV www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers Applicant Information please Print Le gribl Name(Businesslorganization/Individual):_ 1 -.2 �C 0 • Nom; � C U 1v C`�` Address: � X —� City/State/Zip: 1.� � O ty�j � �- Pone#: Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. Type of project(required): ❑ I am a general contractor and I 2.Nemployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction .I am a sole proprietor or partner- listed on the attached sheget. 1 7• ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers'comp,insurance. 8. ❑Demolition [No workers'comp.insurance 5. ❑ We are a corporation and its 9' ❑Blinding addition 3.❑ required.] officers have exercised their 10.El Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c.152, §1(4),and we have no insurance required.] 12.❑Roofrepairs q ] � employees.[No workers comp,insurance required.] 13•❑Other *Any applicant that checks box#1 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 neve affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lain an employer that inis providing workers'compensation insurance for my employees B formation. elow is the policy and job site Insurance Company Name: Policy#or Self-ins.Lie.#:_ Z-0 Expiration Date-_ 1_J(p• LT__ Job Site Address:_ S City/State/Zip: , J Attach a co � � py of the workers compensation policy declaration page(showing 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 advised that a copy ofthis statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. fP J ry ` Ido Izeteby certify under the pains andpenalties o et•'u that the information provided above is true and correct. Signature- ��-e� Q Date: 'hone#: -l :' .- 6 '. F only. Do not write in this area,to be completed by city or town official.n: Permit/License# ority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M i i t • Y Information and Instructions tions 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 be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance-or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the.commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers''compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cavy workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. B e advised that this affidavit may be 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. Please be sure to fill in the peimit/license number which will be used as a referencd 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 maybe 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 Office of Investigations would like to thank you in 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: The O01--W—aonwea1t1- of.PVf1assa0AL,setts Department of Industrial Accidents Of oe of InVestaigationS 600 Washington Street Boston;MA,02111 Tel.#617-727-4900 ext 4406 or 1.-877-MA.SSAFE Revised 5-26-05 Fax#617-727-774. www.rnass.i;ov/dia. Co v moi, �� GalvinfoNote 1.3 Rev 1.1 Jan 2011 the coating requires a higher reheating temperature and/or a longer soak time. Too high a temperature and/or too low an aluminum will result in high iron and excess powdering. Stabilized IF grades react faster than plain carbon steels. Steels with higher phosphorous levels react slower in the galvannealing furnace than low phosphorous steels. Figure 2 is a schematic representation of the galvannealing process. Figure 2 The Galvannealing Holding furnace to Process hold strip at or below 1050OF[565°C]for up to 10 seconds r r � ® DATE(MM/DD/YYYY) ,4 CERTIFICATE OF LIABILITY INSURANCEF 12/05/2011 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). PRODUCER CONTACT NAME: UGONE-JOHNSON INSURANCE AGENCY INC. PHCN o 1.978-887-8304 AIC N.1:978-887-5517 DALE E.JOHNSON E-MAIL ADDRESS:DALE_JOHNSON@FARMFAMILY.COM 7 GROVE STREET, SUITE 201 INSURER(S)AFFORDING COVERAGE NAIC# TOPSFIELD, MA 01983 INSURERA:FARM FAMILY CASUALTY INSURANCE INSURED INSURERS: MICHAEL SHAW INSURERC: DBA MICHAEL SHAW CONSTRUCTION INSURER D: PO BOX 158 GEORGETOWN, MA 01833 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDIYYYY A GENERAL LIABILITY 2005XO949 07/15/11 07/15/12 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY IRM'IS occ M SEa u ence $ 50,000 CLAIMS-MADE FX-1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY PeOac RdT^DAMAGE $ HIREDAUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 2001W6690 01/06/11 01/06/12 WCSTIMJT I X OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) LIABILITY POLICY INCLUDES CARPENTRY, DWELLINGS 3 STORIES OR LESS MICHAEL SHAW IS EXCLUDED FROM WORKERS COMPENSATION COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDGIN INSPECTOR N.ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE TP DALE JOHNSON ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 2512010/051 The ACORD name and loco are reaistered marks of ACORD G, 2 2 2 2621/2 Cherry kitchen cabinetry ——747/8 -29 , --1583/8 finished with(1/2 cherry 1/2 thinner —443/4 —1 60 i/4 I - 51 --42 1/4 - —64 64 1/4 — stain) 233/4 I -19 -11 —601/4 1I 47 I -- 42 1/4 —i 64 1/4 --- Raised panel doors and drawer fronts —38 i 54 1/8 I-- I —2 - I —37 7/8 — i 46 --- I -18 i --44 1/2 - 3/4"overlay Panels on all exposed ends + -- -- v 12 11 ; 14 S Nr FM 3 4 _'� � � 1� I r M _.. -------i N f� C a U-) - 0 J 0) M 10 00MM- 1 -- j-;--36n-- 11 ti- 44 -- o, 1 M 1 2 Nr -I MCM � 8 7 A5 16 N N 24 — I 40 I —42 3/4 — 6.3/4 3p I 52 C 110 3/4 —�6 3/4 3p I 52 —28 — ( 40 141 1447 38 3/4 Y 107 314 2181/2 71 1/2 I � I 11/2 21/2 VILLAGE WOODWORKING SHOP Dawson, K 9.14.11 Floorplan 55 MAIN STREET PTOPSFIELD 978-887-2893 Fax:978-887-3508 MA Room 11 Current Date:Nov 23,2011 Scale: NTS hone:978- 893 MICHAEL SHAW CONSTRUCTION Estimate PO BOX 158 GEORGETOWN, MA 01833 Date Estimate# 10/28/2011 608 Name/Address Dawson,Cathy 134 S.Bradford N.Andover Ma 01845 Project Description Qty Cost Total 1)Demolition 1,100.00 1,100.00 a)Remove all existing cabinetry,trim,floor covering,drywall and 1 non load bearing partition wall as discussed 2)Frame and Windows 5,400.00 5,400.00 a)Install R-13 insulation in all of the exterior walls b)Frame in openings for a double window in the kitchen and a single in the back hall c)Blueboard and plaster the walls and ceiling d)Install 3 Anderson windows,a double over the sink,one behind the proposed peninsula and one in the bench area(True divided light,tilt wash,vinyl)Trim out the out side with Azek e)Sister all of the joists that need it with 3/4"plywood on each side(Due to the removal of the old plumbing) f)Finish the siding on the back of the house 3)Flooring 2,400.00 2,400.00 a)Refinish the existing hardwood flooring b)Patch in flooring where needed(THIS MAY ONLY BE POSSIBLE IF WE CAN SALVAGE FLOORING FROM ANOTHER PART OF THE KITCHEN) Hope to do business soon Total Page 1 ' .t l MICHAEL SHAW CONSTRUCTION PO BOX 158 Estimate GEORGETOWN, MA 01833 Date Estimate# 10/28/2011 608 Name/Address Dawson,Cathy 134 S.Bradford N.Andover Ma 01845 Project Description Qty Cost 4)Finish Total 525.00 525.00 a)Trim out windows and doors and install baseboard to math the rest of the house Disposal fee 600.00 600.00 5)Paint 1,500.00 1,500.00 a) 1 coat of primer and 2 coats of paint on the walls and the new trim and 2 coats on the ceiling Permits&Fees 135.00 135.00 Hope to do business soon Total $11,660.00 Page 2 I ` Location No. Date NORTIy TOWN OF NORTH ANDOVER O L 9 Certificate of Occupancy $ �sJ+cNus<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ L. Check #4�j 24656 Building Inspector