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HomeMy WebLinkAboutBuilding Permit #654 - 214 OSGOOD STREET 5/29/2009Permit N0: 0 Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IIMPORTANT: Applicant must complete all items on this pate LOCATION 3 i• / v Stte 16\ - Print PROPERTY OWNER me4 &h ;�9 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaqe ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne ami Addition Two—or more family Industrial Iteratio No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer OWNER: Name:_ Address: 339 CONTRACTOR N Address: D S RIPTIONWOjjRK TO BE PREF RM D: F %% Please Type or Print Clearly) Ds�ad� S� s V# 4�230 i 09-g7la� Supervisor's Construction License: CS �" Ug Exp. Date: � 5 –// Home Improvement License: /00 Date: 7 IC ARCHITECT/ENGINEER rIA Phone: Address: Reg. No FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 31, X33, 00 FEE: $�� c T Check No.: Receipt No.: 22 NOTE: Persons contracting with unregistered contractors do not have access to the gu ranty fund Signature of Agent/Owner Signature of contractor C 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 3134 Us ood Street FIRE DEPARTMENT - Temp Dumpster on pite yes no Located at 124 Main Street Fire Department signaturefdate VdL;� 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU I t5 and UAI A — (For deuartment use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 No 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 a Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location fl— No. Date 5-1�2q X� f TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 2- U A Building Inspector 0 Project Proposal to Theresa Mendel 339 Osgood Street North Andover, MA 01845 7 RED ROOF LANE, UNIT 1 SALEM, NH 03079 PH: 603.898.0868 FX: 603.898.0821 BLACKDOGBUILDERS.COM Blackdog project code: MENDE-8575 (978)688-4727 for Kitchen Remodel 05/19/2009 Contract Proposal — Page 1 of 22 Theresa Mendel 339 Osgood Street North Andover, MA 01845 Dear Theresa We are pleased to offer for your consideration the following proposal for the construction of your project. For ease of reference, this proposal is divided into the following sections: Section I Contract/Proposal Business conditions Section II Contract/Proposal Construction Contract Section III Attached Booklet I Specifications of the job The description of the proposed project contains precise, but understandable specifications (Section III) of the items which are included in your project. The specifications form the heart of any construction CONTRACT and we ask that you review them carefully. IF IT IS NOT SPECIFIED IT IS NOT INCLUDED IN THE SCOPE OF THIS PROPOSAL. The business section gives you the general conditions of the work and site, the anticipated start and completion dates, the price of the project with the payment schedule as well as any allowances. The legal section expresses the general conditions of the CONTRACT and specifies the responsibilities of the contractor and the owner. The item identifier i.e. GN01001, is shown in the specifications for ease of identification of each and every item we have included in this proposal. Remodeling work can be confusing and complex; however, hopefully this format will facilitate your review of our proposal to insure we have included all your wishes. We are pleased to have the opportunity to prepare this proposal for your consideration. I will be happy to answer any questions you might have on any aspect of this CONTRACT proposal at your convenience. Blackdog Builders, Inc. is a Corporation run by a dedicated team of employees and prides itself on maintaining the highest level of customer service in the industry. Our list of satisfied clients is our most valuable asset. We look forward to adding your name to that list. Sincerely, Amee McNamara, CKD Design Division Manager Enclosures/Attachments 05/19/2009 Contract Proposal — Page 2 of 22 Section of the Contract/Proposal for Theresa Mendel Business Conditions 05/19/2009 Contract Proposal — Page 3 of 22 BUSINESS CONDITIONS TO THIS CONSTRUCTION CONTRACT This Contract, dated 04/17/2009 is by and between: Theresa Mendel 339 Osgood Street North Andover, MA 01845 Blackdog project code MENDE-8575 (Hereafter referred to as OWNER), and Blackdog Builders, Inc. 7 Redroof Lane, Unit #1 Salem, NH 03079 (603) 898-0868 (Hereafter referred to as CONTRACTOR). Work will be performed at: 339 Osgood Street, North Andover, MA 01845 (Hereafter referred to as PROPERTY) 1. GENERAL This CONTRACT is for the following work and materials to be performed by the CONTRACTOR on the PROPERTY address shown above. The project is generally described as follows: Kitchen Remodel (Hereafter referred to as WORK) The CONTRACT consists of this document, any plans, the specifications, the Blackdog client package and the Construction Contract. (Hereafter collectively referred to as the "CONTRACT") 2. PRICE The total price for the WORK agreed upon is $31,632.96. Payment terms are set out below in Paragraph 6. This proposal may be withdrawn by us if not accepted within thirty (30) days. 3. STARTING AND COMPLETION PROVISIONS The WORK will begin on approximately 6/2009 and will be completed, absent unusual or unforeseen circumstances, on 7/2009 providing this CONTRACT and any related CONTRACT documents are accepted when presented. Projects requiring two contracts (one for construction work and one for bath or kitchen product) will not be slotted into the schedule until both agreements have been executed. The aforementioned dates reflect our present workload. Projects are assigned a slot in our work schedule as they are accepted, on a first come first served basis. These dates may move based on the completion time of the project that immediately preceded yours. 4. PERMITS AND APPLICABLE CODES: COMPLIANCE WITH LOCAL LAW a. All work to be done under this CONTRACT will be in accordance with local, state and county building code. The CONTRACTOR shall obtain all necessary permits and pay all required permit and plan fees from the CONTRACT sum, unless otherwise agreed. The CONTRACT price does not include any fees, which may be incurred to obtain a variance, if required. The CONTRACT price does not include any unbid items required by any local building official to bring the project into compliance with any relevant local, state and county building code. 05/19/2009 Contract Proposal — Page 4 of 22 t k b. All home improvement contractors/subcontractors working in the state of Massachusetts must be licensed and registered by the Bureau of Building Regulations and Standards. All inquiries concerning the CONTRACTOR should be transmitted to that office. In Massachusetts Blackdog Builders, Inc. operates under License number CS048847 and Registration number 106877. 5. SPECIFIC REQUIREMENTS FOR MATERIALS AND WORKMANSHIP a. This CONTRACT will be completed by the CONTRACTOR in a good and workmanlike manner, using quality materials. b. If applicable, the CONTRACT price includes the following allowances: See allowances under specifications. 6. PAYMENT a. Timely payment by the OWNER of all sums due under this CONTRACT is of the essence to this CONTRACT. The parties agree to the following schedule of payments: Deposit with this contract: $1,581.65 Payment Schedule amounts reflect a Partner Plan credit of $500.00 b. Payment Schedule Start of project $5,437.44 Start of plumbing rough -in $5,437.44 Start of drywall hanging $5,437.44 Start of countertops $5,437.44 Start of painting $5,437.44 Substantial Completion $1,477.57 Completion of Punch List $886.54 c. Allowances for Owner Selected Components d. The CONTRACTOR may cease operations if any payment is not made by the OWNER as required herein, and proceed to collect any balance due through any remedy provided by law. Payments are due when the aforementioned progress milestones have been reached. It is understood that minor adjustments to the payments schedule may be necessary due to the flow of work or delays beyond the control of the CONTRACTOR. e. DEFINITIONS Substantially complete - The space or project is substantially complete when the space or project can be used for its intended purpose and only punch list items remain. Punch list - Work or product that has not been performed or provided. Warranty item - A product or service that has been provided or performed that does not meet or exceed industry standards. THESE CONDITIONS MUST BE ACCOMPANIED BY THE CONSTRUCTION CONTRACT 05/19/2009 Contract Proposal — Page 5 of 22 Section I I Construction Contract of the Contract/Proposal for Theresa Mendel 05/19/2009 Contract Proposal — Page 6 of 22 x CONSTRUCTION CONTRACT This Contract is by and between: Theresa Mendel hereafter referred to as "OWNER", and Blackdog Builders, Inc hereafter referred to as "CONTRACTOR" for work at 339 Osgood Street, North Andover, MA 01845 dated 04/17/2009. This CONTRACT consists of this document, any plans, the Specifications and Business Terms that are enclosed and the Blackdog Builders Client Package. (Hereafter collectively referred to as the "CONTRACT") 1. CONTRACTOR'S DUTIES -- GENERAL a. To direct and control the work contracted for in accordance with the terms of this CONTRACT and all applicable codes, laws, and regulations, and as the building permits issued for this project, if any, require. b. To inspect the site, examine the plans and specifications, if any, and supervise all of CONTRACTOR's employees, and to direct the work of all subcontractors selected by CONTRACTOR. c. To maintain the work site in a safe and clean condition, to the extent consistent with the CONTRACT. d. To advise the OWNER promptly if concealed conditions are ascertained which require additional or different work, and to proceed in such event in accordance with this CONTRACT. e. To provide locked storage for any equipment, tools, or other PROPERTY used in the performance of this CONTRACT, unless otherwise agreed in writing. 2. OWNER'S DUTIES -- GENERAL a. To provide adequate utilities for the work agreed upon. b. To advise the CONTRACTOR of any condition of the PROPERTY which affects CONTRACTOR's ability to perform. c. To provide secure storage areas for materials delivered to the work site. d. OWNER shall be entitled to make periodic inspections of the work site, provided such inspections do not interfere with the work and can, in the judgment of the CONTRACTOR, be made safely. Any other entry onto the construction site shall be at OWNER's risk. e. OWNER shall notify his insurance agent of the execution of this agreement and obtain any necessary riders to his current coverage or any locally customary forms of coverage, such as builders risk, to cover OWNER's interests and liabilities during the construction process. f. To perform no work on the project without a written agreement with the CONTRACTOR. g. To make no agreements with any trades person, subcontractor, or CONTRACTOR'S employees outside the scope of this CONTRACT without the written consent of the CONTRACTOR. 05/19/2009 Contract Proposal — Page 7 of 22 4- A. 3. MATERIAL SUBSTITUTION CONTRACTOR reserves the right to substitute other materials, products and/or labor of equal or superior quality, utility, or similar color. 4. DELAY CONTRACTOR shall not be responsible for delays caused by events beyond the control of the CONTRACTOR, including but not limited to: strikes, war, acts of God, riots, governmental regulations and restrictions. Delays caused by OWNER's failure to make allowance materials selections or caused by the performance by CONTRACTOR of extras or necessary work (as described in Paragraph 6) shall likewise be excusable delays. 5. INSURANCE CONTRACTOR agrees to maintain all necessary forms of insurance to protect the OWNER from liability for any occurrence arising from the performance of this Contract. CONTRACTOR agrees that he shall cover his own employees for worker's compensation and carry general liability insurance, and that all forms of insurance referenced herein shall be with reputable companies licensed to do business in the state where the project is located. 6. HIDDEN, CONCEALED and UNFORESEEN CONDITIONS a. The parties agree that in the event CONTRACTOR discovers a hidden, concealed or unforeseen condition requiring an extra cost that they shall proceed as follows: The CONTRACTOR shall notify the OWNER verbally to expedite agreement as to any charge necessary to correct or cure such condition, and provide a written Work Order (as described in paragraph 7a) as soon as practicable. The parties must agree to such extra charges, or agree to a resolution method, or this CONTRACT may be cancelled by either of them. b. For purposes of this section, a "hidden, concealed and unforeseeable condition" shall mean a condition not readily observable to a prudent CONTRACTOR inspecting the subject PROPERTY for the purpose of performing this Contract. Examples of such conditions can include, but are not limited to; rot under siding; ledge below grade; pre-existing plumbing or electrical work not performed to code and pre-existing mold. c. Any change in the WORK required by building officials assigned to this project, including structural and/or any environmental hazards will be billed as an EXTRA charge to this CONTRACT and paid for by the OWNER as a Work Order. CONTRACTOR may cease operations if OWNER refuses to pay 7. EXTRAS a. Any extra work or materials desired by the OWNER shall be agreed upon in writing and such extras shall become a part of this CONTRACT as if fully set forth herein. Unless otherwise agreed, extra work shall be paid for as performed. Failure of the OWNER to sign a change order shall not preclude recovery for any work performed by CONTRACTOR, and acceptance of said extra work or materials shall be presumed, unless there is written notice to the contrary. b. CONTRACTOR shall advise OWNER, at the time of agreement on an extra, as to any additional time required to perform this CONTRACT. 05/19/2009 Contract Proposal — Page 8 of 22 8. ESCALATION CONTRACTOR reserves the right to pass on additional costs to OWNER resulting from the escalation of the cost of lumber or lumber byproducts. This cost may be passed on only, if after the CONTRACT is signed but before the construction commences, an increase in lumber costs is experienced. The CONTRACTOR must substantiate the change with evidence of the difference between lumber costs at the time of the CONTRACT and lumber costs at the time of construction. Only direct cost differences may be passed on, no allowances for overhead and profit shall be included. Any additional costs will be collected per Work Order (as described in paragraph 7a.). 9. EXCESS MATERIALS ON SITE CONTRACTOR routinely stores extra materials on site to improve efficiency and reduce the likelihood of running out of stock in the middle of a task. Unless otherwise specified in writing all excess materials on site at the end of the project are the PROPERTY of CONTRACTOR. 10. SUBCONTRACTORS a. CONTRACTOR shall select subcontractors as required to complete this CONTRACT. OWNER acknowledges that subcontractors will do various portions of the work. Any subcontractor selected by the CONTRACTOR shall have all requisite licenses for the work to be done by such subcontractor. b. It shall be the duty of the CONTRACTOR to use reasonable care in the selection of subcontractors. Absent objectionable performance by any subcontractor, the selection of subcontractors shall be an exclusive right of the CONTRACTOR. The CONTRACTOR shall require all subcontractors to have workmans compensation and liability insurance in force. c. CONTRACTOR shall pay subcontractors in a timely manner and obtain from subcontractors any necessary documentation required to release their liens, if any, as the work proceeds.. 11. TERMINATION AND CANCELLATION The CONTRACTOR may terminate and cancel this CONTRACT if any payment called for hereunder is not received as scheduled, provided that notice is given to the OWNER as provided below. Upon such termination, the CONTRACTOR shall have all remedies provided by law, including such lien rights as then apply. The OWNER may terminate this CONTRACT upon the following conditions: a. Failure of the CONTRACTOR, or his subcontractors, to pursue the work contracted for, absent excusable delay, as provided in Paragraph 4 above, for a continuous period of fourteen (14) days, without a written agreement permitting same, such agreement may be satisfied by a single notation to this CONTRACT. b. Failure of the CONTRACTOR to rectify any condition for which building code enforcement authority has issued a citation of violation notice, within fourteen (14) days notice of such violation, unless OWNER and CONTRACTOR otherwise agree. c. Any other failure to perform this CONTRACT required by the terms of this CONTRACT. 05/19/2009 Contract Proposal — Page 9 of 22 d. No termination shall be effective unless 10 days notice of OWNER's intent is given as required below, during which time the default may be cured by the CONTRACTOR. e. Deposit monies - Cancellation of this CONTRACT prior to the commencement of work shall result in the forfeiture of any and all deposit monies collected. All deposits are non-refundable. The parties hereby agree that upon such cancellation, the CONTRACTOR shall suffer damages including but not limited to the cost associated with designing and preparing the project for commencement. f. You may cancel this agreement by observing the requirements of The Notice of cancellation you have received. g. If a dispute arises out of or is related to this Contract, or the breach thereof, the parties shall endeavor to settle the dispute first through direct discussions. If the dispute cannot be settled though direct discussions, the parties agree the dispute shall be settled by arbitration administered by the American Arbitration Association under its Construction Industry Arbitration Rules. In the event that arbitration is necessary, the parties agree that arbitration proceedings shall be conducted by a mutually agreed on arbitrator in Rockingham County, New Hampshire. If the parties cannot agree on an arbitrator, either party may file a written demand for arbitration in accordance with the rules of the American Arbitration Association. The arbitration award shall be final and judgment on the award may be entered in any court having jurisdiction thereof. This CONTRACT shall be governed and interpreted in accordance with the laws of the State of New Hampshire. The parties acknowledge that this agreement to arbitrate shall be governed by Chapter 542 of the New Hampshire Revised Statutes Annotated. Either party may, without waiving any remedy under this CONTRACT, seek from any court having jurisdiction any interim or provisional relief that is necessary to protect the rights or PROPERTY of that party, including but not limited to the right to seek liens or attachment. The prevailing party in any dispute arising out of or relating to this CONTRACT or its breach that is resolved by a binding dispute resolution process shall be entitled to recover from other party reasonable attorneys' fees, costs and expenses incurred by the prevailing party in connection with such dispute resolution process. Consumers in Massachusetts shall be required to submit to such arbitration as provided in MGL c. 142A. Theresa Mendel Amee McNamara, CKD Design Division Manager Blackdog Builders, Inc. Notice: The signature of the parties above constitutes an acknowledgement of the agreement between the parties to alternative dispute resolution. Massachusetts consumers may have the right to initiate alternative dispute resolution even where this section is not signed by the parties. h. Unless otherwise agreed in writing, CONTRACTOR shall continue the WORK and maintain the agreed work schedule during any dispute resolution proceedings. If CONTRACTOR continues to perform, Owner shall continue to make payments in accordance with this Contract. 12. ENVIRONMENTAL HAZARDS 05/19/2009 Contract Proposal — Page 10 of 22 a. The CONTRACTOR is NOT responsible for the inspection, discovery, abatement or removal of any environmental hazard including, but not limited to: asbestos; mold; lead; radon; ground water or environmental pollution at the work site, unless specifically covered in the specifications. b. In the event that any hazardous material is discovered during the course of construction, the testing, abatement and/or removal shall be the sole responsibility of the OWNER. c. Any additional costs incurred on account of suspension of the construction or changes to the specifications due to a hazard or its removal are the responsibility of the OWNER and will be handled by a Work Order. d. In the event that work does not resume within 30 days of the stoppage, OWNER agrees to immediately pay the CONTRACTOR the pro rated amount of the CONTRACT price applicable to work done up to that point pursuant to the Contract. WARRANTY OWNER warrants that as of the date of this CONTRACT: (1) the PROPERTY (including the land, surface water, ground water, and improvements to the land) is, and will continue to be, free of all contamination, including (a) "oil, petroleum products, and their by-products" (b) any "hazardous waste" as defined by the Resource Conservation and Recovery Act of 1976, as amended from time to time, and regulations promulgated thereunder; (c) any "hazardous substance" as defined by the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as amended from time to time, and regulations promulgated thereunder, specifically including asbestos and mold; and (d) any other "hazardous substance" (2) the PROPERTY is in compliance with all environmental laws and regulations; and (3) there are no underground tanks on the PROPERTY INDEMNITY OWNER expressly acknowledges and agrees that it will reimburse, defend, indemnify and hold harmless CONTRACTOR, all Sub -contractors, their successors, assigns and employees from and against any and all liabilities, claims, damages, penalties, expenditures, losses or charges (including, but not limited to, all costs of investigation, monitoring, legal fees, remedial response, removal, restoration or permit acquisition) which may, now or in the future, be undertaken, suffered, paid, awarded, assessed, or otherwise incurred as the result of: (a) any contamination, existing in, on, above or under the PROPERTY (including, but not limited to, contaminated soil, mold, buildings, facilities and/or ground water); (b) any investigation, monitoring, clean up, removal, restoration, remedial response or remedial work undertaken on the PROPERTY; and (c) OWNER'S breach of any warranty given herein. 13. WARRANTIES a. The work of the CONTRACTOR, including materials and labor, shall be warranteed for a period of three (3) years, during which period CONTRACTOR shall at its own expense correct any defect arising from its work unless it is a non -warrantable condition as set out in the Blackdog Builders Client Package. That package shall become a part of this CONTRACT as if fully set forth herein. b. Any and all warranties for appliances or mechanical systems shall be delivered to OWNER as the CONTRACTOR receives them. 05/19/2009 Contract Proposal — Page 11 of 22 r c. Notwithstanding any manufacturer's warranty of any component, appliance, or system, no action may be brought against the CONTRACTOR on this CONTRACT for the performance of this work, except as provided above. d. The quality of any work in question will be held to the standards issued in the Residential Construction Performance Guidelines — Third Edition published by the NAHB. 14. SEVERABILITY If any portion of this agreement is found invalid or unenforceable by any court, the remaining provisions shall remain in force between the parties. 15. ENTIRE AGREEMENT This CONTRACT consists of the documents defined herein, and constitutes the entire agreement of the parties. It can be modified only by a written document. OWNER acknowledges that he has read and received a legible copy of this agreement signed by CONTRACTOR, before any work was done, and that he has read and received a legible copy of every other document that OWNER has signed during the negotiation of this Contract.. Am ' - N ara, CKD Design 'v ion Manager Blackdog uilders, Inc. DATE : •O 04/W2009 ACCEPTED: -41"--_ DATE: — T sa Men rel DATE: 04/28/2009 Contract Proposal — Page 12 of 22 ,► 05/19/2009 Section III Attached Booklet i to the Contract/Proposal for Theresa Mendel Job Specifications Contract Proposal — Page 13 of 22 The following paragraphs show the breakdown of the individual phases (rooms, areas, or activities such as site preparation) of the project detailing each principle task. Each phase of the project is defined by a phase heading. The project the specifications have been consolidated and are listed in the order of the work. These specifications outline your entire project as priced in this proposal. If there is work that you want performed and it is not listed in this proposal it is not included and you have not paid for it in the contract price. Please review these specifications carefully. Client initials Client initials GENERAL CONDITIONS ------------------ 01.002. - Pre construction conference - 1 EA Pre -construction conference with client to review plans, discuss schedule, storage and project access. Approve existing conditions with final approval of plans by owner as well as introducing project manager and lead carpenter. 01.003. - Administrative fee for small projects - 1 EA This fee address the initial set up of your project as well as labor associated with permitting. This item relates to small projects. 01.006. - Roll off container permit -1 EA Provide permits from the fire and board of health departments to allow a roll off container to be located on a property. 01.009. - Building Permit Fee Based on $ per 1,000 -1 $M This item is the component driven by the cost of the project and adjust the price based on a fee per $1,000 of construction. Base permit fee should also be included in the proposal. 01.009.04 - Daily set up and breakdown - 40 HR This item addresses the time for carpentry related set up as well as breakdown at the beginning and ending of each day. CLEAN-UP 25.000. - Clean Up interior job, Set up costs - 1 EA Clean up interior of project to include the removal of all debris generated by the construction process. Grounds shall be swept and/or raked as appropriate. Debris will be loaded into roll -off container if included in proposal. If roll -off container is not in the general conditions section of the proposal, the client is responsible for debris removal from site. This item reflects a base fee for interior clean up. 25.000.01 -Cleanup interior job - 20 DY This item addresses the daily interior clean-up work associated with the project. 25.002.01 - Dust protection - no access -1 EA Set up plastic to be secured for the duration of the project in an area that will not need to be accessed during the construction. Plastic may be secured with staples and strapping. Any holes in trim will be filled with color match putty at completion. 05/19/2009 Contract Proposal — Page 14 of 22 r s. 25.002.02 - Dust protection with Access - 2 EA Provide plastic and adhesive zippers to create a re -sealable enclosure between areas of the house. This is typically used in one area on the project where regular access between the work area and the rest of the house is needed. 25.007.02 - Floor protection-WoodNinyl/Tile-basic -150 SF Provide and install Red Rosin paper to be secured with masking tape. This material will be installed in the areas of the house that will receive foot traffic from the trades. 25.013.02 - 30 cuyd roll off container for debris -1 EA Provide 30 cubic yard capacity roll off container for construction debris. This container is for construction debris only. Precautions will be taken to protect the area beneath the container by using blocks to distribute the weight. However, Blackdog is not responsible for damage or depressions in the ground or driveway cause by the container. As with all items in the proposal, please note the quantity of containers included with the proposal. Due to the difficulty in estimating debris volume, you will be charged or credited based on the actual number of roll off containers used. KITCHEN SITE PREPARATION 02.106. - Cedar shingle siding removal - 40 SF Remove siding from existing exterior wall 02.220. - Wood window removal - 1 EA Remove wood window that has been nailed to frame. 02.300. - Remove nailed hardwood flooring - 100 SF Remove nailed hardwood flooring. Standard strip flooring that has been nailed in place. 02.315. - Plaster & wood lath ceiling tear -out - 100 SF Remove ceiling covering from ceiling joists 02.320. - Ceiling tile removal, stapled - 100 SF 12" x 12" composition tile 02.322. - Insulation removal, loose - 364.5 SF Remove loose insulation from open wall or ceiling 02.341. - Wall gypsum lath & plaster tear -out - 364.5 SF Tear out wall covering from studs. Either one or both sides of studs based on design and sqft in estimate. 02.400. - Kitchen sink removal -1 EA Disconnect, remove and cap 02.505. - Kitchen cabinets removal -17 LF Remove wood or steel kitchen cabinets base, wall or island. This item covers running feet of wall and base cabinets counted independently. 05/19/2009 Contract Proposal — Page 15 of 22 Mr & 02.506. - Countertop removal -17 LF Remove countertop from base cabinet (NOT including disconnect of appliances or fixtures) SIDING 11.104. - Exterior siding - 40 SF Weave in exterior siding around new window - match as closely as possible to existing. WINDOWS AND TRIM 13.075 - Install composite window -1 EA Additional carpentry or general labor required, not previously covered in any other specs. IE. Blocking or framing for drywall installation, additional demolition labor, appliance relocation or trouble shooting existing conditions. INCLUDES PELLA PROLINE ARCH HEAD WINDOW AS PER DRAWING BELOW. PLUMBING 14.000.03 - Plumbing permit -renovation -base fee -1 EA Base permit fee for any work we do in an existing bathroom/kitchen involving plumbing work. See a sep. spec. for per fixture fee 14.000.04 - Plumbing permit -renovation -per fixture - 3 EA Per fixture plumbing permit cost. Must include base fee spec. 14.000.07 - Gas permit- renovation -base fee - 1 EA Base fee for permit for renovation related gas work. 14.000.08 - Gas permit -renovation -per fixture -1 EA per fixture permit charge. This spec must also have a base fee in the proposal 14.104.03 - Kitchen sink,dw,ice maker, disposal >5' - 1 EA Replumb new kitchen sink with disposal further than 5' of the original location. Tie in and install dishwasher and water line for refrigerator. Proper venting is assumed. If the existing fixture is improperly vented there will be an additional cost to bring the plumbing up to code. In most cases this cannot be determined until the demolition is completed. Fixtures and appliances are not included in this item. 14.110. - Misc. Plumbing Labor - VENT - 8 EA This item address labor only and is used in areas where standard pricing does not apply. These could be but are not limited to difficult access, existing conditions that do not meet code and unusual configurations. 14.115.07 - Gas line to Range w/tie-in -1 EA Run gas line from source to range and tie-in appliance. See separate spec for permit. ELECTRICAL 16.000.01 - Electrical permit - Medium project -1 EA This item covers the cost of an electrical permit and inspections for a medium size project. Some typical examples include but are not limited to; basic kitchen remodels, complex bath remodels, additional bathrooms, finished basements and small additions. 05/19/2009 Contract Proposal — Page 16 of 22 16.001. - General electrical information -1 EA The electrical portion of this proposal is an approximation of the work your project will require. Due to the nature of electrical work and unknown existing conditions on every project the electrical portion of your project will be reconciled and confirmed after the walk through but before any electrical work actually occurs. If there is a credit or debit a work order will be provided prior to work commencing. Electrical work for all appliances of any type are to be verified by the electrician as to amperage requirements. The amperage for the circuits included in this agreement are approximation based on typical installation. If a specified device has a larger amperage draw than was assumed there will be additional electrical costs in the reconciliation. 2008 code change note: A new modification to the electrical code that will be enforced starting in 2008 is the need for all new breakers regardless of location to be upgraded to a "heliarc" breaker. The actual interpertation of when existing breakers will need to be upgraded will rest in the code enforcement officers hands. Your proposal reflects our best estimate as to what is required but does not assume existing breakers will get changed to new Heliarc breakers. 16.100.01 - Electric Duplex outlet, old work - 2 EA Install duplex outlets in old work. Installation to include wire and device. This item addresses work where the wall finish is still in place and work has to be done by fishing.This reflects a tamper -proof device. 16.100.03 - Electrical Duplex outlet -dedicated, old work - 2 EA Install dedicated duplex receptacle in old work conditions. This items allows a receptacle to be serviced by a "home run" line back to the panel. These outlets are often used for computers and other sensitive equipment to ensure more consistent power.This reflects a tamper -proof device. 16.106. - Hood, microhood, downdraft - outlet - 1 EA Install outlet for hood, microwave/vent or downdraft unit. Installation to include 15 or 20 amp circuit as required. This item does not include installation of vent work. 16.108.01 - Ground fault outlet - old work - 2 EA Install ground fault circuit interrupt outlet on existing 15 or 20 amp circuit . Installation to include wiring and device and to be under old work conditions. This reflects a tamper -proof device. 16.111. - Basement/1 st floor 220 volt outlet, 30amp -1 EA Install in the basement or 1 st floor, install a 220 -volt, 30 amp outlet for an air conditioning unit, clothes dryer, range or oven. Installation to include necessary labor and material to install outlet receptacle and necessary wiring to existing panel breaker. 16.115.01 - Single -pole switch - old work - 3 EA Wire for and install single pole switch under old work conditions. To include box, device and labor. A single pole switch will control one or more fixtures from one location. 16.116.01 - Three-way switch, set - old work -1 EA Install 3 -Way Switch set in existing circuit under old work conditions. Installation to include mounting boxes, devices and labor. A three way switch is a switch that will control one or more devices from two locations. A three way switch set is comprised of two switches. 16.116.04 - Set back timer switch - new work -1 EA 05/19/2009 Contract Proposal — Page 17 of 22 MOTION SENSOR OR TIMER TO BE CONNECTED TO GENERAL LIGHTING PATH 16.122. - Recessed light, old work - 6 EA Provide, install and wire recessed light with step baffle trim and flood lamp. This item includes wire to power source under old work conditions. See separate spec for switches. Electrician to provide fixture. 16.124 - Disposal circuit -1 EA Hardwire disposal unit in new or old sink base. If disposal has a plug and outlet will be installed. 16.125. - Dishwasher circuit -1 EA Hard wire new or existing dishwasher. If dishwasher has a plug and outlet will be installed. 16.126. - Refrigerator outlet -1 EA Provide duplex outlet wired to a 20amp circuit to service refrigerator. 16.127. - Peninsula or Island outlet -1 EA Install a duplex receptacle in the end or side of a peninsula or island cabinet layout. Note: A minimum of one receptacle must be installed to meet code. The device color will be Ivory, Brown or White. Additionally, very often the design requires that the device be cut into a finished cabinet end or a raised panel. In some designs, plug strips may be used under the edge of the counter, at additional expense. 16.143 - Low profile undercabinet light, old work - 5 EA Under new work conditions, wire and install a 21" low profile fluorescent fixture under a wall cabinet. This item includes materials, labor, fixture and lamp. Electrician to provide fixture. 16.225 - Rework as needed - 4 EA This item address miscellaneous electrical labor required on all jobs. Specifically, these labor hours will be used in omitting or reworking existing electrical to allow for wall or ceiling removal as well as reframing walls to add or increase openings. Electrical labor may also be used in unusual conditions where standard unit pricing does not address the actual labor required for the work INSULATION 17.000.01 - Unfaced R-13 3 1/2" insulation - 243 SF Stapled to open framing or laid flat between ceiling joists on installed drywall. 17.321. - Exterior wall vapor barrier -180 SF 6 mil plastic installed at inside of frame wall, over existing unfaced insulation. INTERIOR WALLS 18.010. - Drywall work, base fee -1 EA This item reflects a minimum charged assessed for small drywall jobs such as bathrooms or small kitchen bumpouts. 18.012. - Gypsum Drywall, 481-800 sf - 364.5 SF Install 1/2" gypsum drywall on existing framing. Drywall to be secured with approved, coated drywall screws. Any nails used will be driven to a dimple. All joints to be taped with paper tape embedded in pre -manufactured drywall mud with three coats of joint compound to be applied over the tape. Edges to be feathered and sanded and ready for 05/19/2009 Contract Proposal — Page 18 of 22 01I, " Nf- paint. This item covers walls. CEILING COVERING 19.014. - Gypsum Drywall, 481-800sf - 100 SF Install 1/2" gypsum drywall on existing framing. Drywall to be secured with approved, coated drywall screws. Any nails used will be driven to a dimple. All joints to be taped with paper tape embedded in pre -manufactured drywall mud with three coats of joint compound to be applied over the tape. Edges to be feathered and sanded and ready for paint. This item covers ceilings. MILLWORK AND TRIM 20.003.01 - Base trim, 4-1/4" OG profile, FJ primed - 10 LF Install 41/4" finger jointed primed pine OG (Colonial) base. Install base with coped inside and mitered outside joints. All finish nails to be set, ready for spackling. 20.125.03 - Trim large unit - Bay/Bow or picture win -1 EA Trim interior of existing window with 2 1/2" window trim. Window to be Bay/Bow or Picture Window and is to be trimmed picture frame or traditional sill style. Window to be ready for paint or other finish. KITCHEN CABINETS 21.010.01 - Install cabinets, grade 1 -1 EA Install factory built cabinets per designers approved plans. Installation includes all accessories, trim work, knob installation and subsequent "tuning" call back. See separate spec for laminate counter installation. If counter is to be solid surface or stone, the installation is included in the cost of the counter. The grade of the installation is driven by the complexity of the design and trim work. This is a labor only item, see cabinet contract for materials. 21.010.15 - Vent work for microwave/hood -1 EA Provide materials and labor to install duct work to allow hood or venting microwave to vent to the exterior. This spec includes exterior cap in a mill (silver) finish. This spec also assumes unit is within 5' from the exterior. If the horizontal run is longer than 5' see spec 21.010.16 for additional cost. 21.010.19 - Install venting microwave - 1 EA 21.010.21 - Misc. appliance labor - 4 HR FLOOR COVERING 23.002.01 - Install Oak Threshold -1 EA Using matching material (Oak) install threshold with eased edges to bridge the gap between two floors or room transitions. 23.100.01 -Floor underlayment, 1/4" -112 SF Install 1/4" voidless luan plywood under-layment as a base for resilient floor. Underlayment to be nailed or stapled over existing floor and ready for floor covering. 05/19/2009 Contract Proposal — Page 19 of 22 k IA - 23.125. - Premium grade sheet vinyl floor -168 SF Lay premium grade resilient vinyl flooring in adhesive over a smooth prepared subsurface. This is an allowance item covering materials and labor. Please see allowances as outlined in the contract. THIS INCLUDES 12" X 12" VCT IN CLIENT'S CHOICE OF BLACK AND WHITE SOLID OR BLACK AND WHITE WITH FLECKS. FINAL CHOICE TO BE DECIDED WHEN SAMPLES ARE SUPPLIED. SQUARES TO BE LAID ON THE DIAGONAL. PAINTING 24.118. - Paint cedar shingles, Prime and 2 coat - 40 SF Cedar shingles, paint with brush 24.202. - Paint exterior trim, Prime and 2 coats - 20 LF Door or window moulding or trim with brush 24.604. - Paint window, Prime and 2 coats -1 EA Paint one side only, wood or metal double hung, sliding, casement, awning or picture window, including all trim, one side. 24.702. - Prime and paint 2 coats on interior wall - 364.5 SF Smooth finish plaster or plasterboard, with roller 24.717. - Paint interior moulding, Prime & 2 coats - 10 LF Base, ceiling moulding, chair rail or door or window trim up to 6". 24.726. - Paint ceiling, Prime and 2 coats -100 SF Smooth finish plaster or plasterboard, with roller DINING ROOM CEILING COVERING 19.014. - Gypsum Drywall, 481-800sf - 200 SF Install 1/2" gypsum drywall on existing framing. Drywall to be secured with approved, coated drywall screws. Any nails used will be driven to a dimple. All joints to be taped with paper tape embedded in pre -manufactured drywall mud with three coats of joint compound to be applied over the tape. Edges to be feathered and sanded and ready for paint. This item covers ceilings. MILLWORK AND TRIM 20.058 - Special curved molding - 1 HR FOR DINING ROOM SIDE OF ARCHED OPENING 20.100. - Special wood mouldings - 1 EA Custom moulding milled to order in small quantities. Material costs include setting up and shaping in shop, & labor costs for installation on job. See sep. item for cutter charge PAINTING 05/19/2009 Contract Proposal — Page 20 of 22 24.524. - Paint interior door 1 coat - 4 EA Paint one side of flush or panel door including casing & jamb, with brush. 24.600. - Paint window 1 coat - 3 EA Paint one side only, wood or metal double hung, sliding, casement, awning or picture window, including all trim, one side. 24.700. - Paint 1 coat on interior wall (WAINSCOAT) -170 SF PAINT WAINSCOAT 24.715. - Paint interior moulding 1 coat - 60 LF Base, ceiling moulding, chair rail or door or window trim up to 6". PAINT CROWN MOLDING 24.715. - Paint interior moulding 1 coat (BASEBOARD) - 60 LF Base, ceiling moulding, chair rail or door or window trim up to 6". BASEBOARD MOLDING 24.717. - Paint interior moulding, Prime & 2 coats - 20 LF Base, ceiling moulding, chair rail or door or window trim up to 6". NEW ARCHED OPENING TRIM 24.726. - Paint ceiling, Prime and 2 coats - 200 SF Smooth finish plaster or plasterboard, with roller 05/19/2009 Contract Proposal — Page 21 of 22 .r #1 Received on this day: 04/17/2009 Blackdog Builders, Inc. Notice of Cancellation Theresa Mendel You may cancel this transaction, without any penalty or obligation, within three business days of the aforementioned transaction date. If you cancel any property traded in, any payments made by you under the agreement, and any negotiable instruments executed by you will be returned within 10 business days following receipt by the CONTRACTOR of your cancellation notice. Any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the CONTRACTOR, at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement. Alternatively you may comply with the instructions of the CONTRACTOR regarding the return shipment of goods at the CONTRACTOR's expense and risk. If you do make the goods available to the CONTRACTOR and the CONTRACTOR does not pick them up within twenty (20) days of your notice of cancellation, you may retain or dispose of the goods without further obligation. If you fail to make the goods available to the CONTRACTOR or you agree to return the goods to the CONTRACTOR and fail to do so, then you remain liable for performance of all obligations under the agreement. To cancel this transaction, mail or deliver a signed and dated copy of this Notice of Cancellation or any other written notice or send a telegram to: Not later than midnight of date. I hereby cancel this transaction. Theresa Mendel 05/19/2009 Blackdog Builders, Inc. 7 Redroof Lane, Unit #1 Salem, NH 03079 603 898-0868 which will be the third day after the aforementioned transaction Date Contract Proposal — Page 22 of 22 01 �X Board of Building kt gi lations and Standards HOI1hE. IMPROVEMENT CONTRACTOR Re91etr-a i0 q 106877 Expirabo 8/2010 f T pe _5 dement Card BLACK -DOG BUI'O€R : I,' MIKE LIVINGSTQ a - 7 RED ROOF LN Salem, NH 03079 T Administrator Massachusetts - Department of Public Safet) Board of Building Regulations and Standards UV aGgc l s -r� t:tjp , : Supervisor License Ocense: CS 75668r Re ricted,, MICHAEL : LIVI N .57 Ho6K R©' AUBURN, NROAQ32 1 Commissioner iN .n Expiration: 4/29/2011 Tr#: 14442 ACORD W. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 1 07131/2008 PRODUCER Phone: (978) 562-5652 Fax: 978-562-7120 WELSH & PARKER INSURANCE AGENCY, INC. 131 COOLIDGE STREET, SUITE 100 HUDSON MA 01749 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AF gpEp By THE p IES BEL W. POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MMIDD INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Merchants Insurance Group CMP9149773 BLACKDOG BUILDERS, INC. BLACKDOG BUILDERS INVESTMENT HOLDINGS LLC 7 RED ROOF LANE #1 INSURER B: EACH OCCURRENCE $ 1,000,000 INSURER C: INSURER D: SALEM NH 03079 INSURER E: MED. EXP (Any one person) $ 10,000 VVVCIWVC.J 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MMIDD LIMITS AUTHORIZED REPRESENTATIVE GENERAL LIABILITY CMP9149773 07/01/08 07101/09 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADEa OCCUR DAMAGE TO RENTED PREMISES (Ea occurence) $ 100,000 MED. EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT PRODUCTS-COMPIOP AGG. $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO CAP9265878 07/01/08 07/01/09 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ALL OWNED AUTOS BODILY INJURY A SCHEDULED AUTOS (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ _ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS UMBRELLA LIABILITY CUP9139768 07/01/08 07101/09 EACH OCCURRENCE $ 1,000,000 OCCUR ❑ CLAIMS MADE AGGREGATE $ 1,000,000 A $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WCA9095570 07101/08 07/01/09 VIC ST TORY uMITs OTHER E.L. EACH ACCIDENT $ 100,000 A ANY PROPRIETORIPARTNERIEXECUTNE OFFICER/MEMBER EXCLUDED? E.L. DISEASE -EA EMPLOYEE $ 100,000 U yea, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION BLACKDOG BUILDERS, INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BLACKDOG BUILDERS INVESTMENT HOLDINGS LLC EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 7 RED ROOF LANE #1 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS SALEM NH 03079 AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE *r-06- Y*; )Cmc Attention: Nicole M. McMeekin ACORD 25 (2001/08) Certificate # 28658 © ACORD CORPORATION 1988 k, rr stlsL .� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Mashington Street Boston, MA 02111 t i www_mass.gov/dia . Workers' Compensation Insurance Affidavit: Biuilders/Contractors/Electricians/Plumbers APPlicant Information Please Print Le-gibly Name (Business/Organization/individual):--B Address: ane, City/State/Zig: gal All 03019 Phone 03)17�� . og�� Ares you an employer? Check -the appropriate box: 1.--I lima employer with ZO 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am.a:sole proprietor or have hired the sub -contractors listed 2 partner. on the attached sheet ship and have no employees These sub -contractors have working for me .in any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [Nonworkers' cornp. c. 1.52, § 1(4), and we have no insurance required.] t employees. [No workers' tl d.. ..tet: comp. insurance required_] Type of project (required): 6. []New construction . 7. Q Remodeling 8. Q Demolition 9. Q Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.❑.Other t rr••--••• �W M. ��x n t must e�so nu out the section below showing their worker;' oompensation policy information, Homeowners who submit this affidavit indicating they ale doing all work and then hire outside cont actor: must submit a new affidavit indicating such. 4comatctors that check this box must a_ffacl-A an additional sheet showing. the name of the sub -contractors and their workers' comp, polis; irfnmation. lam an employer that is-providtng workers' compensatuin insurance for m y employees: Below is the r3d job site information. , policy c Insurance Company Policy # or Self -ins. Lic. #: Wc 4 q o tj 5; Expiration Date: Job Site Address: 339 Qsgo o� s City/state/Zip: N �n r+d✓a� /v%/� 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. 1 do hereby cert un,4eer the ns penalties of perjury that the information provided above is true and correct Signature: //' / Date: Phone #: 603 0 ( —0$6 1 F 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 Cierk 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 emplayer is defined as "an individual., partnership, assadiation, 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 tntstee 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 t1he 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 compie;tely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) acid 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 reguiredto 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 nurnberlisted below. Self-insured companies should enter their self-insurance license number on the appropriate fine. 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 permittlicense number which NvilI be used as a reference number. In addition, an applicant that must submit multiple permiMicense 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 firture 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 bum 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-5.77-MASSAFE Revised 5-26-05 Fax # 617-727-7744 www.mass.gov/dia 6 z W W Cd w O a � O G x w° C/) z A L � v U w a O v C7 w � O w U U w a n u. x�o WPW O w w w A w rA ° z cn Q cn g 0 F. 91 4.4 O Co ■ O Z Co O y � C O Cm iO-0 Co G _ .CO3 O ■O F Co m CL CD imp, CD CD L O d � Q�Q C O O V J "FL Cm 'fl O C Z CD CL �..� y R C ■ C _cc �. COD D LLI U) 19 W 19 LUW N Note: 'Phis drawing is an artistic interpretation ofthe general appearance of the design. h is 20 20 1EC1114010GIES Designed: 03/05/2009 Printed: 03/10/2009 not meant to be an exact rendition. Mendcl - Layout #+ Presentation Plan Drawing #: I All dimensions _size designations given are subject to verification on job site and adjustment to fit jab conditions. 202011 This is an original design and must TECHNotOGIE$ not be released or copied unless applicable fee has been paid or job order placed. Designed: 03/31/2009 Printed: 04/28/2009 " N\ Mendel - Layout #4 Presentation Plan I Drawing #: 1 Scale : 0 3/8" = V VESTIBULE (no changes) DOWN Remove existing window. Install new, larger window. Will require all new froming including header. (Z) 2,10 w►���61� jc��►s 0 0 E �_: �_� � - 1 6*DINING AREA Re -surface ceiling w/ 1/4" sheetrock. "Create arched trim/casing for opening between Dining Area & Kitchen *Re -point all trim in Dining Area (crown, doors, door & window casings, bead -board wainscoat, chair -rail & baseboard molding) Remove MENDEL RESIDENCE closet KITCHEN & DINING AREA STRUCTURAL CHANGES a CH = 107" All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. Mcndel - Layout tt 4 20 20 This is an original design and must IFCHN010GIES not be released or copied unless applicable ree has been paid or job order placed. As Built/Struct. Changes I Drawing th I Designed: 03/05/20091 Printed: 03/10/2009 1�& Scale : 0 3/8" = V All dimensions _size designations given are subject to verification on job site and adjustment to fit job 2U 2("�� IECIINOIOGIES This is an original design and must not be released or copied unless applicable fee has been paid or job Designed: 02/02/2009 Prinlml: 0_3/10/2009 conditions. order placed. Mendel - As-Built As Built/Struct. Changes J.Drawing #: 1 Scale : 0 3/8" = 1'