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HomeMy WebLinkAboutBuilding Permit #613-15 - 281 MAIN STREET 1/20/2015BUILDING PERMIT Eo TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION /^J 2J —G)/ � Y C 1 ®~ �J c � 04 Permit No#• Date Received 3q Argo SSACH Date Issued: IMPORTANT: ADDlicant must complete all items on this page L-:OCATION _ ___;. �S f _ 1 ko,.- � ��t�� Pir�nt �PROPERTY'OWNER 1eJ^ec- t�?PS'S'- i Pnnt 100'Year Structure MAP --�� _ PARCEL:' ZONING DISTRICT:: _Historic District a no Machine Shop Village a no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial KRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p Septic O Well ❑Floodplain ❑ Wetlands ❑ Watershed -:District ❑,Water/SOwe r DESCRIPTION OF WORK TO BE PERFORMED: rek-o ;�_ \,-._..,~i ;�%o ww- rao M — Type or Print OWNER: Name: ` o Address: 02RI mc� ffiffz�_16A_ Contractor Name:: ►died uS 5e0 e:._ _'_?d _2034 Address ..23 ie►�o�a�i.e . �'�viP_ I _'P onve-Y MA,,- O_l' Supervisor's Construction License.CS -___073 RM [ _ Exp •Date:..... ._ Home Improvement License p.. Date: z- Ll_ � � _�... _.. Ex ARCH ITECT/ENGINEER i_1( /1 /j Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ -73, %SD �^ FEE: $ Check No.: C� Receipt No.: 2'32 - NOTE: Persons contra n witlAunre istered coniractors _ '�►e�'li -�FLA r'� _ --mss%/� Plans Submitted ❑ Plans Waived 0 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 PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature_ CONSERVATION Reviewed on Signature COMMENTS HEALTH A 'b COMMENTS Reviewed on Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Signature Zoning Decision/receipt submitted yes Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pen -nit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) o 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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: Building Permit Revised 2014 Location No. Date C) Check # 4�� 28432 ff, TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL Wk, b—Olic-f—ing Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 739750.00 m $ - $ 885.00 Plumbing Fee $ 110.63 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 110.63 Total fees collected $ 1,206.25 281 Main Street 613-15 on 1/20/2015 Basement Repairs O 0 N CD CD CD U) I O O rmllL CCD O CD V to orh Z m Cl) O cn 0 -q m 70 X �o cn z 0 cn < 0= B � --IN ="' O I N N lD o IrD (') • EL on m O O F Rt FD- N "n Oh O "L Q' 0 m N WOE N CD 2 0 CD C e n �• y Q O O CO's M CD S. cD -0 L O :� U2 �• CD O v, C c o, s > CD :., � C-, =r Q O � H O O C Ob Q <D N o v,,2) m CL CD nIP � �a S.0 yea^� 3 > ° CCD =r: C ' ^. CD f I� N 'Ai CDd a r CD C'> rp �s O '� I 0 rt '• DCD CD fu o 0) o A� CL vl N co T x T W = T w T (7 70 T VI T 3 C O 3 (D O j O 5' O O CD O N Di _3 �. d X- O 000 W 00 0 0'00 fD �* M(D O_ n M Ln v OZ O - V fD 3 r W (D m C C 3 ' 00 °D m D W v_ v in � n 2rnz N � G7 O IA M m m p n rn m D z 0 0 0 0 '�1 Page 1 of 8 Nexus II Carpentry and Construction Design P.O. Box 2823 Woburn, MA 01888 781 760 203.1 Fax 978 9751263 markAnexuscarpentry.com www.nexusearventry.com CS # - 073991 HIC # 129177 Contract This is a contract between Derek Wessel and Kim Reinert of 281 Main Street, North Andover MA 01845 (Hereafter referred to as the "owners" or "owner") and Nexus II Services (hereafter referred to as "Nexus") dated January 5 t 2015. GENERAL SCOPE OF WORK DESCRIPTION WE HEREBY SUBMIT SPECIFICATIONS AND CONTRACT FOR: work as stated below for water repairs and upgrades to existing basement Scope of work: General details ♦ Meet with local building official and apply for permits ♦ All work will be in accordance with local building code regulations and will be inspected by local officials prior to continuing with the next phase — Nexus will be responsible for arranging and being available for all inspections - ♦ All work will be coordinated directly between "owners", architect if required and Nexus ♦ Nexus confirms that it is licensed, insured as required and ensures any sub -contractors utilized on this site will have the appropriate insurance coverage ♦ Nexus will be responsible for the safe storage of all its property and any materials to be used on the site. Any items left on site will be covered under Nexus insurances ♦ Owner is responsible for removal and return where necessary of all items within the work area and their safe storage prior to our work commencing ♦ Owner will then be responsible for returning all items to the area after completion of the scope of work SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 2 of 8 ♦ Nexus will. remove all trash associated with this project into a Nexus supplied dumpster and arrange for safe disposal in to a registered site — if required ♦ Nexus will contact Dig Safe" and confirm all utilities location — if required Scone of work; Insurance/damaged items - proposed cost is - $39, 590.00 Demolition ♦ Dumpster cost— remove from site all debris associated with this project ♦ Remove and trash the existing bar in the main living area ♦ Remove and trash the partition wall outside the bathroom ♦ Remove and trash the existing ceiling in the living area, hallways and the salon area ♦ Remove and trash the existing flooring in the living area, hallways and salon area (NOTE: this is something we may want to consider leaving it in place and installing tile over the top of it, if that is an option - I can ask the tile installer to check!!) ♦ Remove and trash the tile on the 2 existing staircases and prepping for installation of treads and risers ♦ Cost above is - $5, 500.00 % bathroom; ♦ Demolish bathroom to studs ♦ Remove and trash the existing door and frame ♦ Treat all the exposed framing with a mold -X ♦ Furnish and install electrics to code inclusive of GFI outlets, l Panasonic ceiling fan with light (on 2 separate switches) and 1 wall sconce (supplied by you), over new sink ♦ Furnish and install plumbing for new sink/faucet and update existing toilet gasket (fixtures supplied by you) ♦ Furnish and install new baseboard heater supplied by Nexus ♦ Furnish and install insulation to exterior wall ♦ Furnish and install sheetrock with smooth plaster finish to walls ♦ Furnish and install sheetrock with smooth plaster finish to ceiling ♦ Install tile and grout (supplied by you) to floor of bathroom only ♦ Install toilet, sink, vanity and faucet supplied by you ♦ Furnish and install a new door (to same specifications as current door), with frame, ♦ Furnish and install paint grade trim to new door and baseboard ♦ Furnish and paint walls, ceiling and trim ♦ Total repair cost is $12, 000.00 - NOTE: I have reduced the cost of this item by removing the allowance for the basic toilet, vanity, sink, faucet, tile and grout, so you can now chose fixtures that you want, rather than ones the insurance company would have included!! 1 x closet doors and frames 4' x 6' 6" (located at bottom of stairs to 1st floor); ♦ Remove and trash existing doors and frames x 1 closet ♦ Furnish and install new doors and frames x 1 closet ♦ Furnish and install stain grade trim to new doors and frames x 1 closet SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 3 of 8 2 x closet doors and frames 4' 8" x 6' 6" (cedar closets); ♦ Remove and trash existing doors and frames x 2 closets ♦ Furnish and install new doors and frames x 2 closets ♦ Furnish and install stain grade trim to new doors and frames x 2 closets ♦ Materials and labor cost is $1, 920.00 1 x entry doors and frames 32" x 6' 6" (door to Sauna area); ♦ Remove and trash existing doors and frames x 1 entry ♦ Furnish and install new doors and frames x I entry ♦ Furnish and install stain grade trim to new doors and frames x 1 entry ♦ Materials and labor cost is $800.00 1 x framed opening (a) 32" x 6' 6" (entry to cedar closet area); ♦ Remove and trash existing trim ♦ Furnish and install stain grade trim to 2 x openings ♦ Materials and labor cost is $300.00 1 x entry door and frame 32" x 6' 6" — wood panel lower with 9 lite glass upper - NOTE: I would question if this is the right door in this location - you may want to go to a door that matches the others in the basement; ♦ Remove and trash existing door and frame ♦ Furnish and install new door and frame ♦ Furnish and install stain grade trim to new door and frame ♦ Materials and labor cost is $1,150.00 Remove and trash remaining wood panel ♦ Remove and trash remaining wood panel in affected area ♦ Treat area with a mold -X solution. ♦ Total repair cost including materials and labor is $360.00 ♦ NOTE: I do not have anything in for the cost of an exterminator if required Cill plate and studs ♦ Remove and trash existing damaged cill plate ♦ Remove and trash existing lower 18" of vertical studs in this area ♦ Furnish and install new PT cill plates ♦ Furnish and install lower 18" of vertical studs and sister in to the existing upper sections ♦ Total repair cost including materials and labor is $1, 980.00 SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 4 of 8 Jack studs set ups in doorways ♦ Remove and trash existing damaged Jack studs in 12 doorways ♦ Furnish and install new jack studs x 12 doorways ♦ Total repair cost including materials and labor is $1, 480.00 Wood panel change to sheetrock on walls in hallways!stairs ♦ Furnish and install new wood panel sheets to exposed framing ♦ Total repair cost including materials and labor is $4, 650.00 Paint grade baseboard ♦ Furnish and install new paint grade baseboards ♦ Total cost including materials and labor is $900.00 lx regular closets located at bottom of stairs ♦ Remove and trash existing closet ♦ Furnish and install new materials to re-create closet ♦ Total repair cost including materials and labor is1$ , 300.00 Plumbing work ♦ Furnish a plumber to disconnect fixtures and baseboard items to allow the scope of work above ♦ Total cost including materials and labor is $1, 200.00 Electrical work ♦ Furnish an electrician to disconnect/reconnect items to allow the scope of work above ♦ Total cost including materials and labor is $1, 200.00 Painting and staining work ♦ Furnish and paint or stain items associated with the scope of work above ♦ Furnish and paint the new sheetrock walls ♦ Total cost including materials and labor is $3, 600.00 Staircase skirt trim ♦ Remove and trash existing skirt trim from staircase ♦ Furnish and install new skirt trim to staircase ♦ Total cost including materials and labor is $450.00 SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 5of8 New Work - proposed cost is $34,160.00 ♦ Furnish and install outlets to code to the living area and the salon area ♦ Furnish and install 16 recessed lights on various switches to the living area, salon and the hallways ♦ Install 1 ceiling mounted fixture (supplied by you) to the cedar closet area ♦ Furnish and install sheetrock to the l wall in the existing salon area (the back of the separating wall to the living area) ♦ Furnish and install floor leveler as needed to prepare the existing concrete pad for the tile installation ♦ Install tile and grout supplied by you to the floor of the living area, hallway (including closets) and salon area ♦ Furnish and install a new 2'x 4' suspended ceiling grid to the hallways, living area and salon area ♦ Furnish and install a new 2'x 4' ceiling tile to this new grid NOTE: assumes a basic grade Armstrong tile similar to the following; http•//www.homedepot.com/p/Armstrong-Fine- Fissured.�2-ft-x-4-ft-Square-Edge-Panel-8-Pack-922A/202562692?N=5vclvZc581- as you will see there are hundreds of different ceiling tile options, and if there is something else you would like me to price, just let me know! ! ♦ Furnish and paint the existing doors and frames of the cabinets in the salon area - "White". NOTE: it is not the intention to paint the insides of these cabinets NOTE 2: this assumes the doors and exteriors of the cabinets are wood - if they are a laminate, they may not be paintable (I'll double check later in the week when I stop by!!) ♦ Furnish and paint the walls, doors and trim in the living area, staircases, hallway and the salon area ♦ Furnish and install Oak treads to 2 staircases ♦ Furnish and install white painted risers to 2 staircases ♦ Furnish and polyurethane new stair treads ♦ Broom clean the area covered in the scope of work The above quotation does not include the cost of any of the following and in some cases where stated allowances have been given to assist you in selection. If requested, we would be happy to provide any costs on items listed below, if not here stated; Permit fees Unseen conditions Light fixtures as noted Painting or staining or prep work beyond specifically noted in the scope of work above Tile and grout for the floor Bathroom fixtures (sink, faucet, vanity, towel rail, toilet roll holder and toilet) Sauna room work, shower room work Any other items previously listed on insurance document if you decide to reintroduce them Asbestos pipe removal in the living area (I would budget $1, 500.00-$2, 000.00) but we'll get a certified company to come out, once the pipe is exposed so they can give us their best price!! All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control owner to carry fire tornado and other necessary insurance Our workers are fully covered by Workman's Compensation Insurance. SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 6 of 8 f� PERMITS "Nexus" has accepted the responsibility to obtain the necessary building permits. "Nexus" will act as a GC and work in accordance with fair and reasonable practices, and cooperate fully and under the guidance of the "Owners" and authorized parties. Standard Exclusions: Unless specifically included in the "General Scope of Work" section above, this agreement does not include labor or materials for the following work (any Exclusions in this paragraph which have been lined out and initialed by the parties do not: apply to this Agreement): Removal and disposal of any materials containing asbestos or any other hazardous material as defined by the EPA. Custom milling of any wood for use in project. Moving "Owners" property around the site. Labor or materials required repairing or replacing any "Owners" - supplied materials. Repair of concealed underground utilities not located on prints or physically staked out by "Owners", which are damaged during construction. Surveying that may be required to establish accurate property boundaries for setback purposes (fences and old stakes may not be located on actual property lines). Final construction cleaning ("Nexus" wi11 leave site in "broom swept" condition). Landscaping and irrigation work of any kind. Temporary sanitation, power, or fencing. Removal of soils under house in order to obtain 18 inches (or code -required height) of clear space between bottom of joists and soil. Removal of filled ground or rock or any other materials not removable by ordinary hand tools (unless heavy equipment is specified in scope of work section above), correction of existing out -of -plumb or out -of -level conditions in existing structure. Correction of concealed substandard framing. Removal and replacement of existing rot or insect infestation. Construction of a continuously level foundation around structure (if lot is sloped more than 6 inches from front to back or side to side, "Nexus" step the foundation in accordance with the slope of the lot). Exact matching of existing finishes. Repair of damage to roadways, sidewalks, or driveways that could occur when construction equipment and vehicles are being used in the normal course of construction. The "Owner" is to enter into contracts for all of the above-mentioned services and provide direct payment to "Nexus" for all of the services we are to provide. "Nexus" will be responsible for removing all components and all construction materials relevant to the "scope of work" in this contract. The "Owners" have received a copy of the lead hazard information pamphlet informing them of the potential risk of the lead hazard exposure from renovation activity to be performed in the dwelling unit. This was received before the work began and the "owners" are responsible for informing their tenants of all potential hazards. Dumpsters, trailers and signs "Nexus" will provide as included in the cost of this project, a dumpster for the sole purpose of the removal of trash associated with this project. This dumpster should not be used by any persons for any other waste items or for any purpose outside of the specific use under the scope of work, unless authorization is received from "Nexus". Nexus may have on site for part, or the whole of the project, a trailer containing materials and tools belonging to "Nexus". This trailer will be parked in a position agreed to in coordination with the "Owners" and will be covered under the insurances of "Nexus" at all times. "Nexus" will have on site, a sign, with our contact details, in the event that anyone, including your neighbors, has a need to contact us directly. Photographs "Nexus" reserves the right to, from time to time, take photographs of the contracted work for use in its general marketing or for production on its web site. At no time will "Nexus" share any personal contact details of the "owner" for any photographs that it may use without seeking authorization from the "owner". Warranties All the components supplied by "Nexus" as part of the original order are covered under the warranty exercised by "Nexus" and supported by the vendors or sub -contractors. All labor and materials purchased from other suppliers to achieve completion of contracture warranted (1) one year from completion of the construction. Owner appointed sub contractors From time to time an "owner" may request that we incorporate a sub -contractor of the "owners" choosing on a project. "Nexus" will facilitate this request provided the assigned sub -contractor is connected directly with "Nexus" for all scheduling requirements and "nexus" will manage this sub -contractor in a fashion comparable with any other sub- contractor. All sub -contractors must be licensed and insured in accordance with State law. "Nexus" will meet with these sub -contractors and will ask them to submit a written proposal of all the work that will be included which "Nexus" will then confirm with the "owner'. "Nexus' will oversee this scope of work and ensure that it is completed in a professional manner but the sub -contractor will be responsible for any future warranty issues directly with the "owners". All sub -contractors are responsible for the safe and clean upkeep of the working environment and will be responsible to remove their associated trash on a daily basis. SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND — PROJECT MANAGEMENT Page 7 of 8 Deliveries "Nexus" will be responsible for the safe arrival to site of all materials required for construction purposes for items contained within the scope of work. The "owners" shall be responsible for the safe arrival to site of other items outside of construction materials, however, should "owners" require "Nexus" to collect and bring to site, any of these items, "Nexus" will accommodate as able and add a minimal cost to cover time and fuel to a change order. . Allowances with the contract cost Within the cost structure of this contract, certain cost allowances may have been given for the "owners" to purchase items chosen by them —these allowances will be noted above with the amount allowed clearly noted. If the "owners" do not spend the full allowance in an area, this amount will be credited back to the customer and not included in the final contracted amount. If the "owners" spend beyond the allowance noted, then the "owners" shall be responsible for this balance and a payment made to cover this amount either to the vendor, the sub -contractor or to "Nexus" Expiration of this Agreement: This Agreement will expire 30 days after the date at the top of page one of this agreement if not accepted in writing by "Owners" and returned to "Nexus" along with the necessary deposits within that time frame. People Authorized to Sign Change Orders: The following people are authorized to sign Change Orders: "Nexus": Ma Gotobed qPr\Ged White "Owner/Owners": Derek Wessel or Kim Reinert Concealed Conditions: This Agreement is based solely on the observations "Nexus" was able to make with the area in its current condition at the time this Agreement was bid. If additional Concealed Conditions are discovered once work has commenced which were not visible at the time this proposal was bid, "Nexus" will stop work and point out these unforeseen Concealed Conditions to "Owners" so that "Owners" and "Nexus" can execute a Change Order for any Additional Work. Changes in the Work: During the course of the project, "Owners" may order changes in the work (both additions and deletions). "Nexus" will determine the cost of these changes and the cost of this additional work will be added to "Nexus" profit and overhead. Schedule of work It is agreed by both parties that this work will be coordinated with the "Owners" and "Nexus" to be undertaken in various stages to avoid complete disruption of the home environment. "Nexus" will give "Owners" no less than 2 days notice prior to arriving on site for commencement of any of the SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 8 of 8 agreed stages of work to allow "Owners" to prepare. "Owners" commits to have sites identified for construction work available for start at the beginning of the scheduled day so as to avoid any unnecessary delays. Contract Cost and Payment Schedule: Total cost of work description and materials included in the proposal (except materials/work stated) - $73, 750.00 (Seventy Three thousand, seven hundred and fifty dollars and zero cents) Amount due upon signing this contract is $25, 000.00 I have read and understand, and I agree to, all the terms and conditions contained in the proposal above. Date.... ...!..................... . I............ "Nexus" Authorization ...................` '° Date.... .......... "Owner/Owners" Authorization..... AND/OR Date ................................ "Owner/Owners" Authorization ................................................ SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT PAYMENT SCHEDULE Ist Payment due upon signing this contract TOTAL $25, 000.00 2nd Payment due upon completion of rough framing TOTAL $15, 000.00 3rd Payment due upon completion of tile floor installation TOTAL $15, 000.00 4th Payment due upon completion of painting TOTAL $15, 000.00 Final payment due upon final inspection TOTAL $3, 750.00 Amount due upon signing this contract is $25, 000.00 I have read and understand, and I agree to, all the terms and conditions contained in the proposal above. Date.... ...!..................... . I............ "Nexus" Authorization ...................` '° Date.... .......... "Owner/Owners" Authorization..... AND/OR Date ................................ "Owner/Owners" Authorization ................................................ SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT - The Commonwealth of Massachtsl etts Department of IndustriglAccidents Office of InvestIgatIons 600 Washington Street Boston, MA 02111 -www mass gov/dia Workers' Compensation Insurance Affidavit: Buffders/Contractors/Electir icianslPlumbers ,Applicant Information Please Paint Legibly Name (Business/0rgmizaRon.&dividual): oCJUm Address• Ci /State/Zi : k D� n 6 I $c Phone #: 76o 2 6 3 6 tY P Are you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 4• RI am a general contractor and I 6. ❑ New constriction employees (filll and/or parE time).* .ave liiredthe sub -contractors 7• ❑Remodeling 2111 am a sole proprietor or partner- listed on the attached sheet.' These sub -contractors have 8. ElDemolition ship and: have, no employees working for me in any capacity. workers' comp. insurance. g. E] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.[] Electrical repairs or additions required.] 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11.[] Plumbing repairs or additions myself. [No workers' comp. c.152, §1(4), andwehave no 12.QRoofrepairs insurance required.] ; employees. PTo workers' 13. ❑ Other comp. insurance required.] xAny applicant that checks box 41 must also fill out the section below showingtheir workers' compensation policy information. -Homeowners who submit this affidavit indicatingthey Are doing all work and igen hire outside contractors must submit anew affidavit indicating such. ?Contractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. X am an employer that is providing workers' compensation insurance for my employees: Below is thepolicy and job site information. Insurance Company Policy # or Self -ins. Lic. #. Expiration Date:, 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a time 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 ofup 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 verffiication. X do hereby cert uncle and penalties ofperjury Mat Me information provided above is tr a and correct. na+P• � � ► . 4 � i 5 r 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. Pltunbing Inspector 6. Other - Contact Person• Phone . III. 0 CERTIFICATE OF LIABILITY INSURANCEF1215120DATE(MM/DD/YYII! `� 141 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.'THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Cross Insurance -Peabody CONTACT Lauren Goldman pHONE . (978)532-5445 A/CNo:(978)532-2217 139 Lynnfield Street E-MAIL 1 oldman@crossa en ADDRESS: g g Cy . COm INSURER(S) AFFORDING COVERAGE NAIC # Peabody MA 01960 INSURER AWestern World Ins. Co. INSURED INSURERB:Safety Indemnity 33618 Nexus II Services LLC INSURERC: P.O. BOX 2823 INSURER D: INSURER E: NPP8236669 Woburn MA 01888 INSURER F: GOVEKAGES CERTIFICATE NUMBER-CL1491619237 RFVISION NIIMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR, SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR NPP8236669 8/12/2014 /12/2015 PREMDAMAGE T RENT ED ISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,0-0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 XPOLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ .500 000 B ANY AUTO ALLOWNED X SCHEDULED AUTOS AUTOS 116632 ) BODILY INJURY (Per accident) $ 500,000 X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ 100,000 Medical payments $ 5,000 UMBRELLA LIABOCCUR HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A LM,, E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Refer to policy for exclusionary endorsements and special provisions. Derek Wessel and Kim Reinert 281 Main Street North Andover, MA 01845 AL;UKU -Zb (ZU1UIUb) INSn25 r?ntnnsl m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Timothy Tramonte/ND1 Yt.' ' (; . ©1988-2010 ACORD CORPORATION. All rights reserved. Tho ArfNiOn n- -4 Innn pro rnniefo rl morlre of Arf1Rr1 1/5/2015 Re: Basement projects consolidated and streamlined From: migtb <migtb@aol.com> To: derekwessel <derekwessel@comcast.net>; kimreinert <kimreinert@comcast.net> Subject: Re: Basement projects consolidated and streamlined Date: Mon, Jan 5, 2015 2:38 pm Attachments: Basement insurance_repair contract.doc (115K) Kim and Derek, Please find attached the contract for the basement project for your review - it is basically a "cut. and paste" of the email confirmation you sent, entered into our standard contract, but do let me know if you have any questions. If everything looks in order, I'd like to set some time aside to come and do the paperwork this week, with a view to starting the work possibly next week, if that is good for your schedule. Let me know if you have a few minutes over the next few days to connect, and do the permit application/contract etc. Mark —Original Message ---- From: Derek Wessel <derekwesselO)comcast.net> To: migtb <migtbtc�_aol.com>; kimreinert <kimreinertecomcast.net> Sent: Mon, Dec 22, 2014 9:00 pm Subject: RE: Basement projects consolidated and streamlined We will move forward with the basement based on this. Derek Wessel (978) 809-1616 From: migtbCaD-aol.com [mailto:migtbe-aol.coml Sent: Wednesday, December 17, 2014 3:39 PM To: derekwessel@comcast.net; kimreinerticDcomcast.net Subject: Basement projects consolidated and streamlined Derek and Kim; The following "overview" takes the items from both basement scopes of work and creates 1 scope of work that includes all of the list issued last week, then adds in those "insurance" items that are deemed as most necessary. Please note, the items I have chosen are based upon those that received the most damage from the sewer back up - if there are other items that you would like to see included, then please let me know and we can include!! Basement overview scone of work - includes all of the work listed from the email dated 12/10/2014 and then includes selected items from the insurance list NOTE: NO work is listed below or intended for the existing shower room, nor the room where the Sauna/HVAC unit is located - those are planned to remain "as is" The following is a list of the work we reviewed with Ged (beyond the initial insurance work that is already approved) - NOTE: as I put this together, and also read through the document we prepared for the insurance folks, there are definitely some "crossover" items on the insurance list, that I don't think you need to do any more (saving you dollars) which we should review together. Here is the list of new things you wanted to consider, Demolition; - proposed cost $5, 500.00 1 - Dumpster cost Remove and trash the existing bar in the main living area Remove and trash the wall outside the bathroom 1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards.. Con+tructiun Supervisor License: C"73991 , GERALD WEM ,- 23 GLENDALE DR r• �A �. DANVERSMA 61923r�1 Expiration 04/07/2016 commissioner .A.. ,i.-- 3tlice=o 1Cor4stRip'er Al#iiirsI usin�ss Regulation OME imAnvEMENTCONTRACTOR ' .' h egistration: 129177 hype: .&xpiration: 7/19/2015 • Individual Gerald White Gerald White 23 Glendale Dr a Danvers, MA 01923_ Undersecretary f I e%se,or'regi trafbn�v�alid+%r �t«d vsdu use only.. ..exp date, date.alIf%ugd'ret�`rn to Office of Con mer Affairs and Business Regulafion 10 Park Plaza - Suite 5170 `Boston, MA 02116 Not valid without signature