HomeMy WebLinkAboutBuilding Permit #1011-15 - 146 MAIN STREET 6/5/2015 BUILDING PERMIT No DT b�tip
4TOWN OF NORTH ANDOVER Lrz
P APPLICATION FOR PLAN EXAMINATION 0 ~
Permit No#: Date Received 74A0Rgreo 01fcy
�SSACHUS��
Date Issued: 1
IMPORTANT: Applicant must complete all items on this page
LOCATION l Yb //U Ste' /� 611- vfoaElL
Print
PROPERTY OWNER
Print 100 Year Structure yes no
MAP (� PARCEL: ZONING DISTRICT: Historic District no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
ration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic []Well ❑ Floodplain 0'Wetlands E Watershed District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: �,� ��'�,rry Phone: �? - 98-15�ZZ_
Address:• - AJ p. Xvr.>oV�4L ^P- D/S <S�
Contractor Name: one: 6
Email: Z r
Address: �'oult�. �tir_c �S� VNi7- /ni 4•vr>o11)Z!f-
Supervisor's Construction License: �c5— D �l 2�9 Exp. Date: 08'Z9 zy/37-
Home Improvement License: ZRO Exp. Date:
ARCHITECT/ENGINEER 4�Sy ��,��G` Phone:
Address: /�� �Nsi Am- ,C Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $JZ,3: 7.-.- Z, CC) FEE: $ 9() -3
Check No.: ?� Receipt No.: c�0
NOTE
• Persons co cting with unregistered contractors do not have access to the guaranty fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Taming/Massage/Body 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 m U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Siqnature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
"swanning Board Decision: Comments
,Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRES„DEPAR4TMENT -- Teinp�®umpster o'isite byes _Ino
iLocatetl_lat E124tMairi�Street: � -
yg � =
Fireibepartment_signature/date
`COMMENTS-
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$10041000 fine
NOTES and DATA,— (For department use)
�r
/L
❑ 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
I,
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
Copy Of Contract
4 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 I ECC Energy code
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:Building Permit Revised 2014
Location
No. Date G
D
• - TOWN OF NORTH ANDOVER,
Certificate of Occupancy $
Building/Frame Permit Feed
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# r
Building Inspector
Enter construction cost for fee cal- North Andover Fee Cakulat%011
Construction Cost
$ 25'5,232.00 m
$ - $ 302.78
Plumbing Fee $ 37.85
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 37.85
Total fees collected $ 478.48
146 Main Street
1011-15 on 6/5/2015
Remove Stairs and Cosmetic Improvements
NORTH
own of . � E ndover
O - y to
No.
K2 ver, Mass, I&.je' �/s
COCHIC"IWICK �A-
�,p A0RATE O I`P�,`�y
$ U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT �
/Y1 ► BUILDING INSPECTOR
Foundation
has permission to erect .......................... buildings on .. ... ........ t........... . ............. ...............
Rough
to be occupied as ..... f!!: . ..... .... ......... .................0011 .. .� ...5. ►.t.f Chimney
provided that the person accepting this a shall in eve" respect conform to the terms of the application
p p p g p every p pp 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 CONSTRUCTI T RS Rough
Service
............. .......................................................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildin�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.
Initial Construction Control Document
�
Z f To be submitted with the building permit application by a
M Registered Design Professional
' b for work per the 8th edition of the
w
Massachusetts State Building Code, 780 CMR, Section 107.6.2
Project Title: 2ND FLOOR OFFICE RENOVATIONS Date: 05/29/2015
Property Address: 146 MAIN ST. NORTH ANDOVER, MA
Project: Check(x)one or both as applicable: [] New construction [X] Existing Construction
Project description: SCOPE OF WORK FOR THE SECOND FLOOR IS TO REMOVE THE EXISTING STAIR FROM THE SECOND FLOOR
J
TO THE FIRST FLOOR. INFILL EXISTING OPENING TO MATCH EXISTING FLOOR,AND RENOVATE THE INTERIOR FINISHES ON
THE SECOND FLOOR INCLUDING NEW CARPET AND BASE PAINTED WALLS NEW WOODEN CEILINGS IN PORTIONS OF THE
EXITING SPACE,AND PREPARE FOR NEW OFFICE PARTITION LAYOUTINCLUDING ELECTRICAL SWITCHES AND OUTLETS AND
DATA AND NEW LED LIGHTFIXTURES. THE EXISTING FIRE ALARM IS INTENDED TO REMAIN. THE EXISTING SPRINKLER SYSTEM
WILL BE REQUIRED TO BE MODIFIED.
THE 2ND STAIR/EXIT IS NOT REQUIRED IN AN B- BUSINESS USE WHERE THE COMMON TRAVEL DISTANCE IS LESS THAN 100'-0"
IN OCCUPANCIES WITH LESS THAN 30 PEOPLE,OR THAT ARE FULLY SPRINKLERED AND HAVE LESS THAN 50 PEOPLE. SEE
SECTIONS 1014.3,TABLE 1015.1, AND SECTION 1021.2 AND TABLE 1021.2 IN THE 8TH EDITION OF THE MASS CODE 780 CMR.
I Gregory P Smith MA Registration Number: #8688 (Architect) Expiration date: August 31, 2015, am a
registered design professional, and hereby certify to the best of my knowledge, information and belief,that I have
prepared or directly supervised the preparation of all design plans, computations and specifications concerningi:
[X] Entire Project [X] Architectural [ ] Structural [] Mechanical
[ ] Fire Protection [] Electrical [ ] Other:
for the above named project and that such plans, computations and specifications meet the applicable provisions of the
Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I
understand and agree that I(or my designee) shall perform the necessary professional services in accordance with the
Professional Standard of Care, and be present on the construction site on a regular and periodic basis to:
1. Review, 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. Such review shall not diminish or
relieve the Contractor of its submittal and other responsibilities.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Be 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 is being performed in a manner consistent with the approved
construction documents and this code. The contractor shall be responsible for performing the work in accordance
with the contract documents and shall be exclusively responsible for its construction means, methods, sequences
and procedures, and for construction safety. The performance of the services shall not require any special testing or
inspections unless specifically stated in the Code. When required by the building official, I shall submit
field/progress reports (see item 3.)together with pertinent comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final ontrol Document'.
Enter in the space to the right a"wet"or Q�,�Q�60RYP,
electronic signature and seal: a.8688 s
KORTH AND
?i MA.
Phone number: cell: 978-204-4770, office 978-688-5422 x203 ma . smith@gsd-assoc.com
Building Official Use Only
Building Official Name: Permit No.: Date:
AIA MA&Insurance ADDroved Version. Initial Construction Control Doc
Initial Construction Control Document
M
f To be submitted with the building permit application by a
Z W
Registered Design Professional
d for work per the 8th edition of the
W
Massachusetts State Building Code, 780 CMR, Section 107.6.2
,ems
Project Title: 2ND FLOOR OFFICE RENOVATIONS Date: 05/29/2015
Property Address: 146 MAIN ST. NORTH ANDOVER, MA
Project: Check(x) one or both as applicable: [ ] New construction [X] Existing Construction
Project description: SCOPE OF WORK FOR THE SECOND FLOOR IS TO REMOVE THE EXISTING STAIR FROM THE SECOND FLOOR
TO THE FIRST FLOOR. INFILL EXISTING OPENING TO MATCH EXISTING FLOOR,AND RENOVATE THE INTERIOR FINISHES ON
THE SECOND FLOOR INCLUDING NEW CARPET AND BASE, PAINTED WALLS, NEW WOODEN CEILINGS IN PORTIONS OF THE
EXITING SPACE, AND PREPARE FOR NEW OFFICE PARTITION LAYOUTINCLUDING ELECTRICAL SWITCHES AND OUTLETS AND
DATA AND NEW LED LIGHTFIXTURES. THE EXISTING FIRE ALARM IS INTENDED TO REMAIN. THE EXISTING SPRINKLER SYSTEM
WILL BE REQUIRED TO BE MODIFIED.
THE 2ND STAIR/EXIT IS NOT REQUIRED IN AN B- BUSINESS USE WHERE THE COMMON TRAVEL DISTANCE IS LESS THAN 100'-0"
IN OCCUPANCIES WITH LESS THAN 30 PEOPLE, OR THAT ARE FULLY SPRINKLERED AND HAVE LESS THAN 50 PEOPLE. SEE
SECTIONS 1014.3,TABLE 1015.1,AND SECTION 1021.2 AND TABLE 1021.2 IN THE 8TH EDITION OF THE MASS CODE 780 CMR.
I Gregory P Smith MA Registration Number: #8688 (Architect) Expiration date: August 31, 2015, am a
registered design professional, and hereby certify to the best of my knowledge, information and belief,that I have
prepared or directly supervised the preparation of all design plans, computations and specifications concerningl:
[X] Entire Project [X] Architectural [] Structural [] Mechanical
[] Fire Protection [] Electrical [] Other:
for the above named project and that such plans, computations and specifications meet the applicable provisions of the
Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I
understand and agree that I(or my designee) shall perform the necessary professional services in accordance with the
Professional Standard of Care, and be present on the construction site on a regular and periodic basis to:
I. Review, 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. Such review shall not diminish or
relieve the Contractor of its submittal and other responsibilities.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Be 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 is being performed in a manner consistent with the approved
construction documents and this code. The contractor shall be responsible for performing the work in accordance
with the contract documents and shall be exclusively responsible for its construction means,methods, sequences
and procedures, and for construction safety. The performance of the services shall not require any special testing or
inspections unless specifically stated in the Code. When required by the building official, I shall submit
field/progress reports(see item 3.) together with pertinent comments; in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Constru_ - S ocument'.
Q�4 60AY P.S F�
Enter in the space to the right a"wet"or
electronic signature and seal: K°•8688
r�TH a"�o1�fR,
z�
OF
Phone number: Cell: 978-204-4770, office 978-688-5422 x203 Em a . SMI gsd-assoc.com
Building Official Use Only
Building Official Name: Permit No.: Date:
AIA MA&Insurance Avoroved Version. Initial Construction Control Doc
https://doc-08-00-apps-vievver.googieuser...
Constnmtton Management Agreement
THIS CONSTRUCTION MANAGEMENT AGREEMENT is entered into on June 01,2015,by and between Gregory
Smith, 146 Main St, North Andover, Massachusetts 01845(hereinafter referred as the Owner),and William McKay
Construction Management,4 Powdermili Square,Andover,Massachusetts 01810(hereinafter referred as the
Manager).
RECITALS:
WHEREAS,Owner intends to construct 2nd Floor Office Renovations- 146 Main St. (herein after referred as the
Project)and desires to engage Manager to render general management services with respect thereto;and
WHEREAS,Manager has significant expertise and knowledge in connection with the management of construction
projects and desires to manage the Project,
NOW,THEREFORE, in consideration of the mutual covenants and promises hereinafter contained,the parties
agree as follows:
MANAGEMENT OF PR03ECL In connection with the remodeling of the 2nd Floor Office Renovations- 146
Main St.located at 146 Main St.,North Andover,Massachusetts 01845,Owner hereby employs Manager and
Manager does hereby agree to undertake all construction management obligations and services with respect to
the project.
DUTIES OF THE MANAGER.Manager's duties shall include,without limitation,the following:
a. Consult and advise Owner on all aspects of the Project including the alternatives proposed by the
architect in the design phase,
b. Consult with Owner in connection with the preparation of budgets,reports,scheduling,evaluations,
cost estimates, in connection with the selection of subcontractors,materials,and issuance of permits,
DUTIES OF THE OWNER.Owners duties shall include,without limitation,the following:
a. Direct Payment of all Consultants,Contractors,and Subcontractors to be employed on this project.
Ib. Direct payment of all costs of the materials and labor. All work will be paid directly by the Owner.
The Manager shall have no financial responsibility in the implementation and day to day management
of the project.
C. Coordination and implementation of the scope of work shown on the construction drawings.
WORKING HOURS. The parties acknowledge that Manager will devote a maximum of 4 hours per week during
the construction and renovation phase.
COMPENSATION.Owner agrees to pay Manager for the sum of$300.00 per week. Manager shall keep track of,
and account to Owner for,the number of hours which he works directly for the Project
TERM.This Contract will terminate automatically upon completion of the work and the Services required by this
Contract
TERMINATION OF CONTRACT.This Contract will terminate upon completion of the work and the Services
required by this Contract,or upon 7 days written notice of either party to this contract.
TRANSFER AND ASSIGNMENT OF CONTRACT.This Contract cannot be transferred or assigned to another
party not on the signature page. Any transfer or assignment will terminate this agreement immediately; 7 days
written notice to either party is not required upon transfer or assignment.
INDEMNITY.To the fullest extent permitted by law,Manager shad and Owner shall mutually indemnify,and
hold harmless Owner and Owners agents and employees,and Manager and Manager's agents and employees,
from and against all claims,damages,losses and expenses,including,but not limited to,attarneys'fees arising
out of or resulting from the performance or non-performance of his duties hereunder.
2nd Floor Renovations— 146 Main St. North Andover,MA
Page 1 of 3 2015-06-05 07:22
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t
DEBRIS.Owner shall be responsible to keep the premises free from accumulation of waste materials or rubbish
caused by any subcontractor's operations.
DEFAULT.the occurrence of any of the following shall constitute a material default under this Agreement
a. the failure to make a required payment when due.
b. The insolvency or bankruptcy of either party.
C. the subjection of any of either party's property to any levy,seizure,general assignment for the
benefit of creditors,application or sale for or by any creditor or government agency.
d. The failure to make available or deliver the Services in the time and manner provided for in this
Contract.
REMEDIES.In addition to any and ail other rights a party may have available according to law,if a party
defaults by failing to substantially perform any provision,term or oardr`tion of this Agreement(inducting without
limitation the failure to make a monetary payment when due),the other party may terminate the Agreement by
providing written notice to the defaulting party.This notice shall describe with sufficient detail the nature of the
default.The party receiving such notice shall have 14 days from the effective date of such notice to cure the
default(s). Unless waived by a parry providing notice,the failure to cure the default(s)within such time period
shall result in the automatic termination of this Agreement.
FORCE MAIEtURE. If performance of this CAgreement or any obligation under this Agreement is prevented,
restricted,or interfered with by causes beyond either party's reasonable control("Force Majeure"),and if the
party unable to carry out its obligations gives the other party prompt written notice of such event,then the
obligations of the party invoking Oils provision shall be suspended to the extent necessary by such event The
term Force Majeure shall include,without limitation,acts of God,fire,explosion,vandalism,storm or other similar
occurrence,orders or acts of military or civil authority,or by national emergencies,insurrections,riots,or wars,
or strikes,lock-outs,work stoppages,or other labor disputes,or supplier failures.The excused party shall use
reasonable efforts under the circumstances to avoid or remove such causes of non-performance and shall
proceed to perform with reasonable dispatch whenever such causes are removed or ceased.An act or omission
shall be deemed within the reasonable control of a party if committed,omitted,or caused by such party,or its
employees,officers,agents,or affiliates.
ARBITRATION.Any controversies or disputes arising out of or relating to this Agreement shall be resolved by
binding arbitration in accordance with the then-current Commercial Arbitration Rules of the American Arbitration
Association.The parties shall select a mutually acceptable arbitrator knowledgeable about issues relating to the
subject matter of this Agreement. In the event the parties are unable to agree to such a selection,each party will
select an arbitrator and the two arbitrators in turn shall select a third arbitrator, all three of whom shall preside
jointly over the matter.The arbitration shall take place at a location that is reasonably centrally located between
the parties,or otherwise mutually agreed upon by the parties.All documents,materials,and information in the
possession of each party that are in any way relevant to the dispute shall be made available to the other party for
review and copying no later than 30 days after the notice of arbitration is served. The arbitrators)shall not have
the authority to modify any provision of this Agreement or to award punitive damages.The arbitrator(s)shall
have the power to issue mandatory orders and restraint orders in connection with the arbitration.The decision
rendered by the arbitrators)shall be final and binding on the parties,and judgment may be entered in
conformity with the decision in any court having jurisdiction.The agreement to arbitration shall be specifically
enforceable under the prevailing arbitration law. During the continuance of any arbitration proceeding,the parties
shall continue to perform their respective obligations under this Agreement.
GOVERNING LAW.This Agreement shall be construed in accordance with the laws of the State of
Massachusetts.
WAIVER OF CONTRACIMAL RIGHT.The failure of either party to enforce any provision of this Agreement
shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict
compliance with every provision of this Agreement.
NOTICE.Any notice or communication required or permitted under this Agreement shall be sufficiently given if
delivered in person or by certified mail,return receipt requested,to the address set forth in the opening
paragraph or to such other address as one party may have fumished to the other in writing.
2nd Floor Renovations—146 Main St.North Andover,MA
Page 2 of 3 2015-06-05 07:22
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SEVERABILITY.If any provision of this Agreement will be heli to be invalid or unenforceable for any reason,
the remaining provisions will continue to be valid and enforceable.If a court finds that any provision of this
Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable,
then such provision will be deemed to be written,construed,and enforced as so limited.
AMENDMENT.This Agreement may be modified or amended in writing, if the writing is signed by the party
obligated under the amendment
The parties have hereunto set their hands the day and year first above written.
SIGNATURES.This Agreement shall be signed on behalf of Gregory Smith by Gregory Smith,its Owner,and on
behalf of William McKay Construction Management by William McKay,its Owner.
OWNER--
Gregory
WNER:Gregory Smith
By. Gregory Smith,Owner
MANAGER.
William McKay Construction Management
By: William McKayOwner
2nd boor Renovations—146 Main St. North Andover, MA
Page 3 of 3 2015-06-05 07:22
2nd floor office renovation 146 Main St N. Andover
Demolish portion of ceiling $1,170.00 $0
Remove ceiling&soffit in open areas and stair 2 MAN $100.00 $200.00 $0.00
Dumpster Rental 1 EA $650.00 $650.00 $0.00
Remove Suspended tile in Offices 1 MAN $100.00 $100.00 $0.00
Demo clg on 1st floor 40 sf $0.50 $20.00 $0.00
Remove Carpet 2 MAN $100.00 $200.00 $0.00
Demolish Stair framing and walls on 2nd floor
$455.00 $0
Demolish stair framing,handrails and trim 0.5 MAN $100.00 ,$50.00 $0.00
.. .........
Demolish walls above 2nd floor to ceiling 1 MAN $100.00 $100.00, $0.00'
make safe opening 0.25 MAN $100.00 $25.00
Demolish lower walls on 1st floor 0.5 MAN $100.00 $50.00. $0.00
Remove Oak Doors 0.2 MAN $100.00 $20.00: $0.00
Demo door in 2nd floor 0.1 MAN $100.00 $10.00: $0.00
Demo and clean up around perimeter of walls in office 1 MAN $100.00 $100.00 $0.00
... ..............
General Clean up and fill Dumpster 1 MAN $100.00 $100.00 $0.00
............... .......
Frame in floor at stair $459.30 $0
Joist Hangers 20 EA $1.60 $32.00: $0.00
New 2x 12 Framing 10 EA $10.00 $100.00 $0.00
3/4"Plywood/OCB subfloor 3 EA $14.10 $42.30 $0.00
LW Concrete topping slab 8.75 CF $4.00 $35.00 $0.00
Labor for Above 2.5 MAN $100.00: $250.00 $0.00
Demolish reception counter $20.00 $0
Remove countertop and low wall 0.2 MAN $100.00 $20.00 $0.00
$0.00, $0.00
.
........ . ... . ..... . ... ... ......
Build soffit walls&Beams $800.36 $0
Build Soffit along exterior for HVAC;pipes 10 EA $2.10 $21
Build soffit along suspended ceiling 4 EA $2.34 $9
repair gwb around perimeter of offices where ceiling is 25 EA $10.00 $250,
raised
Buckets of Taping Mud 2 EA $10.00 $20.
Labor for tape and samd and install GWB 5 MAN $100.00 $500
Build Box Beams at open ceiling area $799.80 $0
Trim edge 120 LF $0.69 $83:
1x12 bottom 60 LF $2.15 $129'
1x6 sides 120 LF $138
$1.15
Fix 1st floor ceiling trim 10 LF $5.00 $50
labor to build and install beams 4 MAN $100.00 $400
W.:
- ... }�1 ,r`" "a"L. sw``" Py, g„�`..;.. "�w •,_
Build Box Beams at open ceiling area $465.75 $0
2x3 stud frurring 50 EA $2.10 $105'
2x3 box beam/soffits 10 EA $2.10 $21
1x3 furring 25 EA $1.59 $40;
labor for framing furring 3 MAN $100.00 $300'
-'. Install new light fixtures $2,346.27 $1,353
Ordered New LED recessed fixtures 42 EA $19.47 $818' $825
Ordered New housings 7 EA $35.47 $248' $248
Ordered New dimmable Switches 9 EA $18.26 $164: $164
Ordered New Outlets 10 EA $11.59 $116: $116
New wiring 2 MAN $500.00 $1,000!
-i install toilet rm Base Cabinet $200.00 $192
New Cabinets&Faucets 2 EA $100.00 $2001 $192
_._. ................................... _....!..... _.
Install cabinets 1 MAN $0.00 $0'
.... ......... ....... _...._..
Install wood ceilings $2,893.00' $0
Wood Ceiling 1200 SF $1.89 $2,268,
Nails 1 EA $25.00' $25
Installation of wood ceilings 6 MAN $100.00 $600
Stain for ceiling 5 qts $7.77 $39'
rags 1 EA $22.00 $22
spray Stain on clg&wipe 1 MAN $100.00 $100
Tung oil clg 1 MAN $100.00 $100'
Sprinkler repair $2,750.00 $0
Retrofit heads for new ceiling plan 1 EA $1,750.00 $1,750
Add drain and extension line so access into pit is not 1 EA $500.00 $500
required
..........
1st floor sprinklers at stair 1 EA $500.00 $500
$0.
Flooring $2,725.16 $0
Existing Carpet to be installed in Office/s(verify Qty) 1 EA $25.00 $25
New Carpet tile 864 sf $1.69 $1,460
New Vinyl cove Base 5 EA $80.00 $400
Adhesive 1 EA $100.00 $100
New resilient Flooring at Kitchen 120 sf $2.00 $240
labor for Carpet&Base 5 MAN $100.00 $500'.
Other Items $8,685.00 $0
French doors to replace solid OAk 3 EA $225.00 $675
Paint for walls 12 ga $35.00 $4201
Painting all walls 5 MAN $100.00 $500;
7M.2
v >$� t;. ,`� a zwa - � ,t .r,LR ,+,�,..•: i { a r.. �m ''1
metal mesh guards around perimeter 4 MAN $100.00 $400:
spray foam 5 EA $6.00' $30:
Window repair of sills 20 EA $48.00 $960
Labor for Window repair of sills 10 MAN $100.00 $1,000.
Paint exterior 4 MAN $100.00 $400'
Paint for exterior 1 EA $350.00 $350'
Repair/Rebuild Front entrance 1 EA $1,500.00 $1,500'.
Replace Rear Exterior door 1 EA $167.00 $167,
Rebuild Door trim at exterior rear 1 EA $500.00 $5001
Labor for door and trim 4 MAN $100.00 $400.
Repair trim 1 MAN $100.00 $100:
A&M Hardware Brackets 21 EA $23.00 $483
countertops 2 MAN $100.00 $200:
Frame low walls 2 MAN $100.00 $200'
Oak trim MAN $100.00 $0i
......... ............. . ..... ...
low walls,GWB&Finish 3 MAN $100.00 $300'
.. .. __ ...,... ... .. .... ... ... —
Outlets on walls 1 MAN $100.00 $100
$0
Subtotal $24,030 $23,770
Contingency 5%' $1,2021
Budget $25,232
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
07M S��V
' Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERIVIITTTNG AUTHORITY. Please Print Le 'bl
A licant Information G
Name(Business/Organization/Individual): G L1.4X4Nm
Address:
5 City/State/Zip: O�
Type of project(required):
Phone#:
Are you an employer?Check the appropriate box:
to full anP
and/or art-time).* 7. ❑New'c6nstruotion
1.❑I am a employer with em P yees(
2.FJ I am a sole proprietor or partnership and have no employees working for me in 8. remodeling
any capacity.[No workers'comp.insurance required.] 9. ❑Demolition
3.FJ 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
11.❑Electrical repairs or additions
ensure that all contractors either have workers'compensation insurance or are sole
proprietors with no employees. 12.0 Plumbing repairs or additions
5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q R66f repairs
These sub-contractors have employees and have workers'comp.insurance J 14.Q Other
• 6•9-6e are a corporation and its.officers have exercised their right of exemption per MGL c.
152,§1(4),and we haven'employees.[No workers'comp.insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
i 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.
ensation insurance for my employees. Below is the policy and job site
X am an employer that is providing workers'comp
information.
Insurance Company Name:
Expiration Date:.
Policy#or Self-ins.Lic.#:
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 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.
Ido hereby certify under the pain�and
lues of perjury that the information provided above is true and correct.
Date:
Si ature:
Phone#:
official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person:
Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defiuied 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 carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be 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 permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-NUSSAFE
Fax#617-727-7749
Revised 02-23-15 wwwmass.gov/dia
A��® DATE(MIIpDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE1 6/2/2015
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,ANO 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 Lisa London
MTM Insurance Associates DEA
PHONE (9'76)691-5700 FAX
1320 Osgood Street A/C No•(9713)681-5777
ADD .ileal@mtminaure.com
INSURER S AFFORDING COVERAGE
North Andover MA 01845 NAIC pINSURERAR9aeX insurance Com an
INSURED
INSURE18:
William McKay Construction MMagement LLC
4 Powder Mill Sq. Suits 101 INSURIERC:
INSURER D
Andover MA 01810 INSURER E'
INSURER
COVERAGES CERTIFICATE N5MBER:15-16 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 INSUNCE DDL
RAPOLICY EFF PM/DD P
POLICY NUMBER LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE PS ,
11000,000 E10000
A
CLAIMS-MADE OCCUR P MISES rtence
2CU2341 5/31/2015 5/31/2016 MED EXP(An one pMon)
PERSONAL&ADV INJURY 1010
OEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
R POLICY %T 7 LOC
OTHER:
PRODUCTS-COMPlOPAGG 00,000
Wankel addlOcrel mowed Is
AUTOMOBILE LIABILITY
4 1AG-GRE-GATE
IS E LIMIT S
JA
SCHEDULED N URY(Per person) S
AUTOS NJURY(Paracck(en() f NON-OWNEDAUT08 TY DAMASf
A6, OCCUA
CLAIMS-MADECURRENCE S
ETENTI
WORMPRS COMPENSATION f
AND EMPLOYERS'LIABILITY SCAT Oq .
ANY PROPRIETOWPARTNER/EXECUTIVE YIN _
OFFICERIMEMSCA EXCLUDED? NIA E.L.EACH AOCIDENT f
(Mandatory In NN) C.L.DISEASE-EA EMPLOYD S
dE5 deP11QN OF OPERATIONS bolov
EL.DISEASE-POLICY LIMIT f
A Equipment Floater 2CU2341 5/31/2015 5/31/2016 ContfaccreEquomeM 010,000
Deduehbla $500
DESCRIPTION OF OPERATIONS!LOCATIONS I VENICL96(ACORD 191,AddRional R9lnarke SohaOIde,May be attached if mora apace Is rogUlred)
Re Job: 146 Main St. North Andover, MA 014845. 2nd Floor Office
This certificate of insurance represents coverage currently in effect and may or may not be in compliance
with any written contract.
CERTIFICATE HOLDER CANCELLATION
Town of North Andover THE UEXPIRATIION DATE ANY OF THE ABO
THEREOF, NOTICE DESCRIBEDPOLICI ES WILL BENCDELIVEREO N
384 Osgood St, ACCORDANCE W"THE POLICY PROVISIONS.
North Andover, MA 01845 !
AUTHOR17.Q0 REPRESENTATIVE
M Laorenza/SAMANT -�
C 1988-2014 ACORD CORPORATION, All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS0251z 011
i FYI epi .J 4a.chusetts " DepartITt'e:1t Of 1�iVi"AC
' Boalyd of Building peguiations -Ind Stan& ds-
Ov R
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License: CS-046789
W LLIAM L MC"-' Y
5 KATHY DR
HA.VERHILL MA 01832
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08129120/5
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