HomeMy WebLinkAboutBuilding Permit #1047-15 - 135 RALEIGH TAVERN LANE 5/1/2018 NORTH q
BUILDING PERMIT o? � "O
TOWN OF NORTH ANDOVER �o
4 APPLICATION FOR PLAN EXAMINATION
Permit NO: v /7–� Date Received
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Date Issued: 9SSACHUS
IMPORTANT: Applicant must complete all items on this page
LOCATIONS 12111-6-16 ,4-t �✓1✓d /`� � 6�
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PROPERTY OWNER ` 1,–t3L7=A 91-- ! 1G._JtJL/
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MAP NO: 1�� F-°PARCEL012-- ZONING DISTRICT: Historic District yes <1
!Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Resioential Non- Residential 11 M1
❑ New Building One family
❑ ddition ❑ Two or more family ❑ Industrial
Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic o Well _0 Floodplain p Wetlands _a Watershed District____ J1
11 Water/Sewer
26-,-A0 d Ai-t5r_ Ur w �- >-� u 1---)i A3 6: A-t—
D 61 Oran n ov A-c_ 12E 4TrLU c-Tu Ai*(_ W AticJ E.0 11) c ry 5 cY}zLc n�Cr
P--1 t;Ny c t2s� crF�r✓�' �-3v v 6) cv-) w,ry 6ow � �b jnmti es (_3 A-C cL
i Identification Please Type or Print Clearly)
OWNER: Name: --/Zl iL t Z)6-13r-'1JF k JuLr/'J Phone:
Address: !3S 12Az_s-,61+ `7—v`h/6y2-,i-i L4"6—
CONTRACTOR
6—
CONTRACTOR F-Name: Phone: 6/7-7/ L�
Address:
me
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
12w-�-
/00143317- 6 Lz`f zz0
ARCHITECT/ENGINEER AT/i61, J65,E Phone: 7-9 77/-1330
Address: -70 i Reg. No. S�
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$$�125.00 PER S.F.
Total Project Cost: $ 1_1 . 00 FEE: $ l 5-cv-
Check No.: Receipt No.: �Vq2 0
NOTE: Persons contracting with un istered contractors No not have access tot e g ran
Signature of Agent/Owner 4 Signatureof contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF e U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
I
COMMENTS
{
1 CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
1
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
r
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
1
DPV�Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT` Temp D mu p e onsite y��e's ONE
Located at 1®24 Main Street �' '`1 1 �
sr 2 ,5 " is <.s �,� tit } '✓�fi?�`ty4�t#y ,' aa' .• A
Fire Department�ignafure/date J4 r -
�iF�`iY'�
s ? '' R tg x "�s x' 'f trt x,, f •,,,,±., Y }r$7 ,'+' i s tid Cr7t i •' c4h y, Fs: 2`"' x g.TTS'
��� tia". t` rM+ �s. ��yE"#+� ,�a" "Yt'_.*i'3.!'°�? d.M�i,i., R��1 �',e-„�I�++ � $i• � 'e'+ -�.�".. z �z3:i:..' R,°'L4 '..:A*' '..
C('�OMMETS x . �_., # A Nyjat sa a4a # yew , sL '} Y �n n� # xr_ yi ft •7. +r
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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 q pp 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 Permit Revised 2014
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
Building Permit Application
Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Permit Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And, C.S.L. Licenses
Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
4, Building Permit Application
4 Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
4, Workers Comp Affidavit
• Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Copy of Contract
6 2012 I ECC Energy code
4� 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
Location
No. L 7 /� ' Date f�
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $ r
Other Permit Fee $
TOTAL $ `
Check# 3�
_ r
- uil>ing Inspector
Final Construction Control Document
N W To be submitted at completion of construction by a
' d Registered Design Professional
h
est for work per the 81h edition of the
�7M SJOv�
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: 135 Raleigh Tavern Lane Date: 07/14/15 Permit No.
Property Address: 135 Raleigh Tavern Lane
Project: Check one or both as applicable: ❑New construction X Existing Construction
Project description: Renovation of a single family dwelling
I Daniel Webb MA Registration Number: 40752 Expiration date: 06/30/16 , am a
registered design professional, and I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning:
[ ] Architectural Structural [ ] Mechanical
[ ] Fire Protection [ ] Electrical [ ] Other:
for the above named project. I,or my designee,have performed the necessary professional services and was present at the
construction site on a regular and periodic basis. To the best of my knowledge,information,and belief the work
proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building
permit and that I or my designee:
1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals
by the contractor in accordance with the requirements of the construction documents.
2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work was performed in a manner consistent with the
construction documents and this code.
Nothing in this document relieves the contractor i r ponsibility regarding the provisions of 780 CMR 107.
�P"";OF t�gssq
Enter in the space to the right a"wet"or. DANIELVJ.
s
electronic signature and seal: STT RAi.
0752
Ff
Phone number: 781 779 13305 MAt �'
Email: dan@webbss.net
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
$ 1073740.00 m
$ - $ 1,292.88
Plumbing Fee $ 161.61
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 161.61
Total fees collected $ 1,716.10
135 Raleigh Tavern Road
Kitchen Remodel
144645 on 6/11/2015
NORTH
own o EAndover
0 -
No. ®� -
�` h ver, Mass
O K@
COG"IC.RWIC" y1.
s L1
BOARD OF HEALTH
Food/Kitchen
PERM17
T LD Septic System
`,CC,�/�� �/ BUILDING INSPECTOR
THISCERTIFIES THAT ..... .................................................................................. .................................
has permission to erect .......................... buildings on ..: :'... " .. .o:S.F.!. .�j..../. .�/F..!: ..`,� ...�:.... Foundation
Rough
j moi`
4R e' Q c�G LJ�/V to be occupied as ...................................................... .......................................................................... 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 CONSTRUCTIO ARTS Rough
Service
..............
........ ....... .... .. . . ... ............ Final
v 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.
This contract is made between The Company, Lee Kimball Kitchens, Inc.:
d/b/a
P,
LEE KIMBALL
DESIGN • BUILD w CELEBRATE
PO Box 617,Reading,MA 01867 781-838-6100
Federal Employer ID#043039027
Account Executive: Bruce D.Johnson Contractor Registration#100837
.....................................................................................................................:.................................................................................................
And The Client: This contract is subject to the provisions of MGL C142A which
regulates home improvement. For inquiries regarding
Erik and Debra Julin ' Contractor Registration please contact:
135 Raleigh Tavern Lane Administrator, Home Improvement Contractor Registration
North Andover, MA 01845 One Ashburton Place, Room 1301, Boston, MA 02108
978-258-0931 617.727.8598
:................................................................................................................................................................................................
_....................
;
1. Contract Documents--the contract documents include the terms of this remodeling contract and, by
reference, the provisions of the other documents listed below: (Copies of these documents are attached to this
contract.) The contract, plans, and specifications are intended to supplement each other. If these documents
conflict, however, the specifications shall control the plans, and the contract shall control both.
Contract documents:
No.of
Title Date Pages Signed
A. Plans by Lee Kimball numbered 141113, Pages A101-
A103, SC101 &E101 6/3/15 5 tw—
The
B. Specifications by Lee Kimball numbered 141113 6/3/15 3
C. Owner Supplied Material Disclaimer 6/3/15 1
D. Notice of Cancellation 6/3/15 1
E. Pre-renovation Lead Form 1 following schedule will be adhered to unless circumstances beyond The Company's control arise:
Work Scheduled to Begin: June 22,2015 Expected Date of Completion: September 10, 2015
2. Description of Work—The Company will furnish all labor in accordance with the NAHB Residential
Construction Performance Guidelines, materials, construction equipment and machinery necessary to complete
certain alterations and improvements in accordance with the plans and specifications upon the following
described property: 135 Ralei h r ane, North Andover, MA 01845. Client acknowledges receipt of
aforementioned guidelines
This contract does not include the following tasks:
A. Changing electrical service or any other electrical equipment that is in violation of applicable electrical or
building codes.
B. The identification, detection, abatement, encapsulation, handling, or removal of any hazardous material as
defined by the Environmental Protection Agency (EPA) that is present on the site prior to the time of
commencement of the work described in this contract. The Company reserves the right to stop work until
such materials are properly removed.
3. Contract Price—In consideration for the work to be performed by The Company, The Client shall pay
The Company the sum of One Hundred Seven Thousand Seven Hundred Forty Dollars ($ 107,740.00) (subject to
additions and deductions by written change order). This contract price is based on the cost of the work as defined
by the plans and specifications. The cost of the work not specifically defined by the plans and specifications has
been added into the contract price by budgeting an allowance for each item. A list of these allowances is attached
to this contract and is incorporated into it by reference. If The Client' selections and/or actual construction costs
result in costs exceeding the budget allowances, The Client agrees to pay The Company such additional costs. If
The Client's selections and/or actual costs result in costs less than the allowances, The Company agrees to credit
The Client for the difference. The contract price shall be payable as follows:
$ 17,000.00 Deposit due at contract signing
$ 20,000.00 Due to start construction
$ 20,000.00 Due upon rough inspections
$ 20,000.00 Due to install wood flooring
$ 20,000.00 Due upon installation of counter tops
$ 10,740.00 Due upon substantial completion (Substantial completion occurs when the work is suitable for its
intended use)
4. Cancellation of Contract— The Client understands that the products described are specially designed
and custom built and that The Company takes immediate steps upon execution of this Agreement to design, order
and construct those items set forth herein; therefore should the contract terminate for any reason, The Client
understands they are responsible to make payment for all custom materials
5. Final Payment and Inspections—Upon notification by The Company of substantial completion of the
work, The Client and The Company shall inspect the work performed and at that time The Client and The
Company shall prepare a Remaining Items List that identifies any deficiencies in workmanship or materials. The
Client may retain the value of the Remaining Items List work from the final payment until the Remaining Items
List items are complete.
6. Application for Payment—The Company shall prepare and present invoices for The Client when payments
are due under the provisions of paragraph 3 above, payable upon receipt. Payments due and unpaid shall bear
interest at the rate of one and one half percent(1.5 %)per month. The parties agree that this late charge represents
a fair and reasonable estimate of the costs The Company will incur by reason of the late payment by The Client. If
any payment is not paid when due, and if The Company has provided a written demand to The Client for
payment, The Company may suspend the work until such time as all payments due have been paid without The
Company being in breech of contract . Demobilization of the contract for nonpayment shall toll the schedule
pending receipt of payment.
7. Time of Performance and Financial Arrangements—The Company shall commence work under the
provisions of Paragraph 1 after signing this contract,but not until The Client has made financial arrangements that
are satisfactory to The Company. The Company shall substantially complete all work under this contract under
the provisions of Paragraph 1, subject to the following delays: failure to obtain all necessary building permits and
other approvals within a reasonable length of time, acts of God, weather, strikes, owners' change orders, acts of
neglect or omission by owner, changes caused by inspectors of governmental agencies, or other causes beyond
The Company's control.
If The Company is delayed at any time in the progress of the work as described above, the completion
schedule for the work or the affected parts of the work shall be extended by the same amount of the time caused F
by the delay plus remobilization time.
i
i
8. Owners' Responsibilities—The Client shall secure and pay for any easements, variances, zone changes,
necessary modifications of restrictive covenants, or other actions. The Client will indicate the property lines to
The Company and will provide boundary stakes by a licensed land surveyor if The Client is in doubt about the
property boundaries. The Client assumes all responsibility for the accuracy of the boundary markers. The Client
agrees to make drinking water and toilet facilities available to The Company, The Company's employees, and
subcontractors or to pay The Company for the cost of rented units. The Client shall pay for assessments, hook-up
charges, connection or tapping fees required by public bodies or utilities and for electricity, water, gas, sewers,
and other utilities required for the work to be performed.
9. Acceptance of Deliveries—The Client agrees to accept delivery of the product or products when ready.
The risk of loss, as to damage or destruction, shall be upon the Purchaser upon the delivery and receipt of the
product.
10. Permits,Licenses and Other Approvals—The Company shall obtain and pay for all local building
And construction permits, licenses, governmental charges and inspection fees, and all other approvals necessary
for the work, occupancy of permitted of permanent structures, or changes in existing structures that are applicable
when the contract is signed, except as provided otherwise in this contract.
11. Change Orders= During the course of the project, The Client, without invalidating the contract, may
order changes in the work consisting of additions, deletions, and modifications. (The contract sum and the
contract time will be adjusted accordingly.) All such changes in the work shall be authorized by a written change
order signed by the parties. If the property is owned by more than one party, then all interested parties must sign
all change orders over $500.00. The Client agrees that changes resulting in the furnishing of additional labor or
materials shall be paid for prior to commencement of the extra work. If the change is required for work to
proceed, the Company shall not be obligated to continue performance until all orders are properly executed and
signed. ,The Company will not be liable for delay costs in this circumstance. The Client shall be responsible for
out of pocket costs, including lost ogFQF4*144ies and su isory costs as a result of delays during pendancy of
change order execution.
V
12. Access—The owner sh 1 grant free access to work areas for workers-and vehicles and shall allow areas
for storage of materials and debris. Driveways shall be kept clear and available for movement of vehicles during
the scheduled working hours, which will be 7 a.m. to 4 p.m., Monday through Friday. The Company and The
Company's workers shall make reasonable efforts to protect driveways, lawns, shrubs, or other vegetation.
However they shall not be responsible for damage to any of the items listed above unless the damage results from
their gross negligence. If off-street parking is not available, The Client agrees that The Company will secure E
parking, and the cost of the parking will be included in the final contract price.
13. Matching Materials— The Company calls attention to The Client to the limitations of plaster, stucco,
concrete, and so on, and while The Company will make every effort to blend existing textures, colors, and planes,
exact duplication is not guaranteed. Roofing materials and/or the color of the roofing material may not match
existing roofing because the manufacturer discontinued the color or product, shading difference of product, age,
or changes in the product's manufacturing process.
14. Differing Site Conditions— The Company stipulates that it has visited the home site, and it has
familiarized itself with the local conditions under which the work is to be performed. However lient
q
acknowledge that this contract is based solely on observations that The Company was able to make with the
structure in its current condition at the time the work was bid, and that The Company shall not be responsible for
differing site conditions that were not visible when this contract was made unless stated otherwise in the
specifications.
Differing site conditions may include, but are not limited to, damage caused by termites or dry rot, rock not
removable by ordinary hand tool, hidden pipes, and code violations that must be repaired, corrected, replaced, or
overcome. Before disturbing any such differing site condition, The Company shall give notice to The Client of
such a condition requiring repair, and The Company will with work to correct such condition in accordance with
Paragraph 11.
15. Insurance and Risk of Loss— During the term of this contract, The Client shall maintain insurance
covering the full replacement cost of the improvement under contract, including theft of materials on site, and any
damage to persons or property arising out of the work. The insurance shall be on an all-risk policy form and shall
include interest of The Client,The Company, and Sub-subcontractors in the improvement under contract and shall
insure against the perils of any accident, casualty, disaster, or calamity, including, but not limited to, fire, storm,
flood, or earthquake. A loss insured under The Client's property insurance shall be adjusted with The Client and
made payable to the Client as fiduciary for the insured's, as their interest may appear, subject to any requirements
of any applicable mortgage clause.
The Company shall purchase and maintain such insurance as is necessary to protect The Client from claims under
workers compensation and from liability to others for damages because of bodily injury, including death, and
from liability for damages to
property other than damage to the work.
16. Warranty—The standard form of warranty shall apply to the service and equipment pment furnished (except
where other warranties of purchased products apply). The warranty shall become effective when signed by the
Company and delivered to the Purchaser. The warranty is for one year materials and labor. The warranty is not
transferable.
17. Clean-Up—The Company will leave the work site orderly at the end of each day. Upon completion of
the work, all of The Company's construction debris and equipment shall be removed by The Company and the
premises left in neat,broom-clean condition,unless the parties make some other arrangement.
18. Dispute Resolution— The Client and The Company will cooperate with one another in avoiding g a nd
informally resolving disputes between them. However all claims or disputes arising gout of, or relating to this
contract that are not informally resolved shall be resolved by mediation or arbitration provided by American
Arbitration Association, under their rules and procedures, and the decision by the arbitrator shall be final and
binding on the parties
19. Entire Agreement—This contract (including the documents incorporated by reference) constitutes the
entire agreement between the parties and supersedes all prior or contemporaneous agreements and understandings
between the parties whether oral or written. This contract shall not be assigned without the written consent of all
parties.
This contract has no force or effect and will not be binding upon The Company until it is accepted and signed by
The Client and countersigned by The Company.
We the undersigned, have read, understand, and agree to each of the provisions of this contract and hereby
acknowledge receipt of a copy of this contract.
DO NOT SIGN HIS CONTRACT IF THERE ARE ANY BLANK SPACES
By � J /S
16rLieball Kitchens, Inc. Date
By , Owner Date
B
D r Julin, Owner Date
You may cancel this agreement if it has been signed b a art t
Company, g Y party hereto at a place other than an address
p y, which may be his main office or branch thereof, provided sof the
p vided ou notify the e Com an
office or brant Y Company writing at his mai
h by ordinary mail posted,by telegram or delivery, g n
following the signing of the agreement. g Y IY�not later than midnight of the third business day
See attached notice of cancellation for an explanation of this right.
r
LEE KIMBALL
DESIGN w BUILD w CELEBRATE
Contract Specifications& Pricing
Debra and Erik Julin Plans Numbered: 141113
135 Raleigh Tavern Lane Plans by: Lee Kimball
North Andover, MA 01845 Dated: 06/03/2015
Kitchen Renovation
GENERAL CONDITIONS $ 14,768.00
Provide project management and site supervision throughout the duration of the project
Provide building permit and oversee necessary inspections
Provide delivery of materials into the jobsite
Site protection and cleaning
Provide engineering of structural work
Site preparation labor and material
SITE CONSTRUCTION $ 7,800.00 .
Demolition of existing walls and ceilings as follows: exterior wall of kitchen &playroom;
load bearing wall between kitchen and playroom;wall adjacent the first floor bath;
partition wall between the kitchen and office; ceilings throughout the kitchen, playroom
and office
Furnish dumpster for job related debris
CONCRETE $ 840.00
Cut slab and dig new footing for steel lally in basement
Furnish new concrete footing to support new steel lally
CARPENTRY&BUILDING MATERIALS $ 28,087.00
Furnish new rough carpentry and framing
Install new structural beam &post to support load above
Furnish new finish carpentry
Furnish new framing material
Furnish new structural W 8 x 28 steel beam to support load above
Furnish new interior trim
THERMAL& MOISTURE PROTECTION $ 375.00
Furnish and install new fiberglass batt insulation with vapor barrier
DOORS&WINDOWS $ 6,297.00
Furnish three new interior doors with an allowance of$750.
Furnish new Thermatru exterior full-light exterior door and hardware including an
allowance of 1,000.
Furnish new interior door hardware including an allowance of$250.00
Furnish new Pella triple double hung window as specified on plan
FINISHES $ 23,278.00
Furnish and install new blue board and skim coat of smooth plaster on the following:
exterior wall of kitchen;wall adjacent the first floor bathroom; ceiling throughout the new
kitchen; new partition walls between kitchen and pantry
Furnish and new tile for backsplash. Includes$1,000 allowance for tile material
Install new tile on walls
1
Provide grout and setting materials
Furnish and install new 5"White Oak wood flooring throughout new kitchen, pantry and
foyer and apply one coat of stain and three coats of polyurethane.
Prep, prime and apply two finish coat of paint on walls, ceiling and woodwork
throughout kitchen. Prep, prime and paint exterior where window and door was
changed.
MECHANICAL $ 14,775.00
Furnish new rough and finish plumbing including installation of new fixtures with new
shut off valves
Relocate existing drain/stacks (2)from wall to be removed -NOTE.Re-plumbing&
setting of second floor bathroom fixtures is not included
Furnish and install new Slant-Fin baseboard heat in three locations throughout
renovated space (one next to back entry door; one along stairway wall; one on front wall
of home/Furnish and install one new toe kick space heater in kitchen
Provide plumbing permit, oversee inspections and furnish new rough plumbing
materials
Furnish and install new ductwork from new hood to exterior of the home and relocate
HVAC registers as necessary
ELECTRICAL $ 11,520.00
Furnish and install new rough and finish electrical including connections to new fixtures,
appliances&devices
Provide electrical permit, oversee inspections and provide electrical materials
Furnish and install 18 new recessed lights and switching
Furnish and install 8 under cabinet lights and switching
Decorative fixture for desk area and AN is not included
TOTAL PRICE $ 107,740.00
2
Z.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
IF
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): �CIt►?;�f¢ZL /j G{ �,c. 1h/L
Address: PC) —&)X [9 �-
City/State/Zip: l 6.1- Phone #:
Are you an employer?Check th appropriate box: Type of project(required):
1 I am a employer with 4. EJ I am a general contractor and I
employees (full and/or part-rime).
* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9. E] Building addition
[No workers' comp. insurance comp. insurance.
1
required.] 5. We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
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 workers'compensation insurance for my employees. Below is the policy and job site
information. /
Insurance Company Name: LZ6 LGaG -1 l�lv�c 162�'!xl� Co"efilr1
Policy#or Self-ins.Lic.#: C-3 Y602 OS Expiration Dater
Job Site Address: 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 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 of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify u r th ains and penalties of perjury that the information provided above is true and correct.
Si ature: Date: Id//
//,r
Phone M
Official use only. Do not write in this area, to be completed by city or town offwiaL
City or Town: PermWLicense#
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#:
iblassachusetts-Department of Public Safety
Board of Building Regulations and Standards
CoilslrtiltiUrt Supervisor
License: CS-045257
Gregory D Johnsog=
PO Bog 617
Reading MA 01897 ,.
f
Expiration
Commissioner 04/01/2017
t�fie Tvam�noouaecr�o�C�liGad�,crde/�iJ
ffice of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
gistration: 1100837 Type:
5 Private Corporatior
xpiration: -6/24/201
LEE KIMBALL KITCHENS,lNC F
h
Gregory Johnson
2 LOWELL AVE. � -
WINCHESTER.MA 01890 Undersecretary
r ' CERTIFICATE OF LIABILITY INSURANCE 03/23/2015D/YYYr)
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 certff)cate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT Paychex Insurance Agency Inc
PAYCHEX INSURANCE AGENCY,INC. NAM
PHONE
150 SAWGRASS DRIVE . 877-266-6850 FAX 585 389-7426
ROCHESTER,NY 14620 E-MAIL Certs@paychex.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: Technology Insurance Company 42376
LEE KIMBALL KITCHENS,INC.
PO BOX 617 INSURER e:
READING,MA 01867-0402 INSURER C:
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.
LIAR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
GENERAL LIABILITY NSR D (MM/DDNYYY) (MMIDD/YYYY)
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
�LAIMS MADE�CCUR PREMI MED EXP(Any one person)
PERSONAL&ADV INJURY $
ENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY pROJECT�LOC PRODUCTS-COMP/OP AGG $
$
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANYAUTO (Ea accident) $
ALL OWNED SCHEDULED BODILY INJURY
AUTOS
A�UpTN�O.ppS (Per person) $
HIRED AUTOS O AUTOSWNED BODILY INJURY
(Per accident) $
PROPERTY DAMAGE
(Per accident) $
UMBRELLA Llae O OCCUR EACH OCCURRENCE $
EXCESS LIAR =CLAIMS-MADE AGGREGATE $
DED I I RETENT ICN$ $
WORKERS COMPENSATION AND )(I WC STATU• OTH-
A EMPLOYEFW LIABILITY TWC3460985 03/06/2015 03/06/2016
ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000.00
OFF ICER/MEMBER EXCLUDED? ! E.L.DISEASE-EA EMPLOYEE $ 100,000.00
(Manciarory In NH) Y N/A E.L.DISEASE-POLICY LIMIT
X yes,desvibe under $ 500,000.00
CRIPTION OF OPERATIONSbolow T1 I - T- 1
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,11 more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY
PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AUTHOR IEyDy REPR�tES}}ENTATIVEj.,
.
V tr
ti.
ACORD 25(2010/05) @198&2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
GENERAL CONDITIONS U
1. G. C. MUST BUILD EXACTLY WHAT IS SHOWN ON STRUCTURAL DRAWINGS. Z
ANY PROPOSED DEPARTURES FROM WHAT IS INDICATED MUST BE REVIEWED 1--1
WITH THE ENGINEER PRIOR TO CONSTRUCTION. ALL UNAUTHORIZED
CHANGES TO THE APPROVED DRAWINGS MUST BE REMOVED AND REPLACED (n
AT THE CONTRACTOR'S EXPENSE. Lu
2. THE CONTRACTOR SHALL CAREFULLY VERIFY ALL DIMENSIONS AND u
CONDITIONS SHOWN ON DRAWINGS PRIOR TO COMMENCEMENT OF THE WORK, 1--1
AND SHALL NOTIFY THE ENGINEER IMMEDIATELY OF ANY DISCREPANCIES
7
' Lu BETWEEN ENGINEERING AND ARCHITECTURAL DOCUMENTS. LY LLI 'o O
c 1 1 '—✓" 1 1 -O" 3. THE CONTRACTOR IS RESPONSIBLE FOR ALL MEANS AND METHODS OF N 00
TEMPORARY SHORING, BRACING, OR OTHERWISE PROTECTING ANY PORTION OF d N '~ M '
>> HE STRUCTURE, SITE AND UTILITIES FROM DAMAGE DURING CONSTRUCTION. Ln n +�
THE ENGINEER IS SPECIFYING THE FINISHED CONDITION ONLY, WITHOUT J Q
(E) BEARING (E) BEARING I ASSUMING KNOWLEDGE NOR RESPONSIBILITY FOR HOW THE CONTRACTOR WILL >� C 2 n
zc,
ACHIEVE THIS RESULT. > woLINE LINE 4. FORRENOVATION WORK STRUCTURAL DRAWINGS PRODUCED WITH
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ASSUMPTIONS MADE REGARDING EXISTING CONDITIONS. IF CONTRACTORD CoFINDS EXISTING CONDITIONS NOT AS ASSUMED CONTACT ENGINEER n2—7/4"LVL sz IMMEDIATELY. REVISIONS TO THE STRUCTURAL FRAMING MAY BE REQUIRED. = 0 tD
FOUNDATIONS
o Q o ED
RO R FTE S 1 ASSUMING FOUNDATIONS ARE. WHERE FOUNDATIONS ARE EXISUI ASLEESTONSUPPORTHAS EPROPOS DT RENOVATION.
CONTRACTOR RESPONSIBLE FOR VERIFYING THAT THE EXISTING FOUNDATION
5' 6—" WALL TO E (T D OOF CONFORMS TO BUILDING CODE REQUIREMENTS AND REPORT FOOTING m
CONDITIONS TO ENGINEER FOR VERIFICATION. m
2. CONCRETE SHALL ACHIEVE A MINIMUM 28 DAY DESIGN STRENGTH AS OF Lu
It fv7 LoI 3000 PSI. SOIL BEARING CAPACITY. FOOTINGS MUST BE PLACED ON SOIL
WITH A MINIMUM BEARING CAPACITY OF 4000 POUNDS PER SQUARE FOOT.
L I ROUGH CARPENTRY OF L`
' 1. ALL ROUGH CARPENTRY WORK SHALL BE EXECUTED IN CONFORMANCE WITH „'IHSS
HANGERS—l", THE 8TH EDITION OF THE MASSACHUSETTS BUILDING CODE FOR ONE AND TWO 9
ATTIC (STORAGE) FAMILY DWELLINGS (MBC 1&2)AND THE INTERNATIONAL RESIDENTIAL CODE FOR DAMELW: O
L ONE AND TWO FAMILY DWELLINGS (IRC 1&2).
2. REFER i0 THE MBC 1&2 AND IRC 1&2 FOR FRAMING COMPONENTS NOT
SPECIFIED IN PLANS AND SECTIONS. NOTIFY THE ENGINEER OF ANY (n
COMPONENT NOT DEFINED IN EITHER THE MBC 1&2 AND IRC 1&2 OR IN ST RA- -4
THESE DRAWINGS. ti
Oi 3. REFER TO THE IRC 1&2 FASTENER SCHEDULE FOR STRUCTURAL MEMBERS 072 O
TABLE 602.3 FOR CONNECTION FASTENING NOT IDENTIFIED IN THESE PLANS OR
DETAILS.
4. ENGINEER MAKES NO CLAIMS TOWARDS EXISTING CONDITIONS. G
5. WHEN NOT OTHERWISE IDENTIFIED, ALL W000 BEAMS, JOISTS, RAFTERS,
HEADERS, STRINGERS, PLATES, AND SILLS SHALL BE SPRUCE PINE FIR 12 OR
p BETTER, WITH A MINIMUM Fb = 875 PSI (SINGLE USE)AND Fb = 1000 PSI ��- 015
(E) BEARING (REPETITIVE USE), AND E SHALL BE 1,4000,000 PSI OR BETTER.
�J J 6. WOOD STUDS MAY BE EASTERN HEMLOCK, EASTERN SPRUCE, OR HEM-FIR,
WALL GRADED "STUD"GRADE, J2 OR BETTER. LJJ N
7. LVL BEAMS, AS NOTED ON PLANS, SHALL HAVE A MINIMUM Fb = 3100 PSI, E V Z W
p, ur = 2,000,000 PSI, AND Fv = 285 PSI. LVL BEAMS SHALL BE "VERSALAM" BY W
I I BOISE CASCADE. NO SUBSTITUTIONS WILL BE ACCEPTED, UNLESS THE Z
NC". J ENGINEER SPECIFICALLY APPROVES ANOTHER PRODUCT SUBMITTED BY THE W LU '
"trCONTRACTOR.
L 8. ENGINEERED WOOD POSTS(VERSA COLUMNS). AS NOTED ON PLANS, SHALL BE 0 Q 0
V L VERSA-LAM 1.7 2650. 00
LL 0 V) 9. ALL METAL CONNECTORS INCLUDING JOIST AND BEAM HANGERS AND COLUMN
J L CAP AND BASES SHALL BE BY SIMPSON STRONG-TIE CORP. THE CONTRACTOR LTJ
* W 0 �° 2ND FLOOR 0 R SHALL STRICTLY ADHERE TO MANUFACTURER'S FASTENING REQUIREMENTS.
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ORDERING. z
@) f0. CONTRACTOR SHALL CAREFULLY COORDINATE THE WORK OF ALL TRADES TO W W G
L ^ MINIMIZE THE NEED FOR CUT, BORED OR NOTCHED IN FRAMING LUMBER. J
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N AND JOIST WRITTEN APPROVAL FROM THE ENGINEER. LL Z
11. AT WOOD POSTS LANDING ON FLOOR DECK, PROVIDE SOLID VERTICAL WOOD
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V Zli LJ 12. MINIMUM BEAM BEARING TO BE 2 INCHES UNLESS NOTED OTHERWISE ON PLAN. r
Q (E) BEARING Rev.: Date: Remarks:
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Date: MAV 7,2015
Scale: AS NOTED
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GENERAL CONDITIONS U
1. G. C. MUST BUILD EXACTLY WHAT IS SHOWN ON STRUCTURAL DRAWINGS. Z
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r 7�� BETWEEN ENGINEERING AND ARCHITECTURAL DOCUMENTS. LLJ ,�, l^p
'Sy 1 1 —J 1 —O 3. THE CONTRACTOR IS RESPONSIBLE FOR ALL MEANS AND METHODS OF W a CO 1.-1
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lz RAFTERS ASSUMING FOUNDATIONS ARE WHERE FOUNDATIONS ARE ISUI ABLDESTONSUPPORTHAS EPROPOSEDTRENOVATION. Ln
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V WALL TO E (TM-D OOF CONFORMS TO BUILDING CODE REQUIREMENTS AND REPORT FOOTING co
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HANGERS-1I ATTIC (STORAGE) AMITHE�Y DWELLION OF INGS(MBC 1&2)SACHUSETTS AND THE INTERILDING CODE FOR NATIONALL RESIDENNE AND TWO
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DANIELW.
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IL 8. ENGINEERED WOOD POSTS(VERSA COLUMNS), AS NOTED ON PLANS, SHALL BE Q O e}
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Lu Q (/j 9. ALL METAL CONNECTORS INCLUDING JOIST AND BEAM HANGERS AND COLUMN Z
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NEW WS BEAM STRUCTURAL FLOOR MEMBERS SHALL NOT BE CUT, BORED OR NOTCHED IN J O
X x EXCESS OF THE LIMITATIONS SPECIFIED IN THE BUILDING CODE WITHOUT
N AND JOIST WRITTEN APPROVAL FROM THE ENGINEER. Z
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