HomeMy WebLinkAboutBuilding Permit #013 - 30 VEST WAY 7/13/2006 ' TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAM NATION
,Ss'ACMUs�i
Permit NO: t � Date Received:
Date Issued:—
UNIPORTANT: Applicant must complete all items on this page -
LO.CATION3ove5i VU
Print
PROPERTY OM NER gttt+ K I rodv i4pnozew
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N4AP NO.: PARCEL: ZONING DISTRICT: E
I
TYPE AND USE OF BC ILDENG HISTORIC DISTRICT YES 0
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non--Residential
New Building )(One family
Addition Two or more family Industrial
Alteration No. of units:
- Repair, replacement =Assessory Bldg Commercial
= Demolition
Moving(relocation) Other Others:
Foundation only
DESCRIPTION OF WORK TO BE PREFORMED 'hs roo
Identification Please Type or Print Clearly)
OWNER: Name: &#Z) 07100/W KlemwLiPhone:9 N'�y
Address: 30 VC5 N. I#J d r»A .
CONTRACTOR Name: AL&LklqQn itors Z4c. Phone:L01-A28-O
Address:-'7 Wt`od� Lr') s&4-t m N A 0 30 9
Supervisor's Construction License:.--O#
4M01!j Exp. Dater 8- 30'0
Home Improvement License: I U 6 $ 't Exp. Date: �} ' L8 -o6
,kRCHI"I'ECT. "N'CINEER N/A Virne: E'hcne:
"Oddress: N Reg. No. N /F1
FEF SC'H£DL LE:St LDING?L'8,1�T:510.00 ER Si'?00.00 OF THE TOT.IL EST131-1 TED COST 3ASED OA ,'SJ'5.60 PF-.,R.Y.F.
Total Project Cost :$__^ lav x-L -t�?C-FEE:$
g i3 Receipt No.: 9�s
ti
I
TYPE OF SEWARGE DISPOSAL Swimming Pools —
Tanning'ltassage Body .art
Public Sewer — —
IJTobacco Sales
Well -- Food Packaging Sales
Permanent Dumpster on Site
I` --_
Private(septic tank,etc. 'Electric deter location to
project
NOTE: Persons contracting with unregistered contracto do not have access to the guu'antyv_f and
Signature of Agent Owner Signature of Eontr
Plans Submitted Plans Waived Certified Plot"Plari', Sta ed tans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ -
❑Water Shed Special Permit
❑ Site Plan Special Permit -
Other
COMMENTS - -
'F ., e > ..
DATE REJECTED. DATE APPROVED.
CONSERVATION -L7• � • .• _ ;.
COMMENTS
OATE'REJECTED 'DATE APPROVED
HEALTH
CUMMENTS
Zoning Board of Appeals: Variance, Petition No:
Z-oninG Dec isiem receipt submitted -es _
i :Inning &rlyd Geci,l' it -----------l.mmntcnhs —
+1S1'1'�.ltlCfl Duci.Ion: �_�'Jlttlnl'ntS
uter. S.:vN(.r Cof n0(.—tion l as l'&uatC
imp Dumpster cn site ;es ,'ire Department si�rnatur_ date� 0�
Building Permit .kpprov ed and (ssuud by: s
Building Setback (tI.)
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
DIMENSION
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA—(For department use)
i
�.,.c �'I_Cif,t:".,`L',I.I:�II'fS:�I:I'.'pl' I;- L
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
j Building Permit Application
Workers Comp AffidaN,it
,.a Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
Floor Plan Or Proposed Interior Work
Addition Or Decks
u Building Permit Application
a Surveyed Plot Plan
u Workers Comp Affidavit
zi Photo Copy of H.I.C. And C.S.L. Licenses
a Copy Of Contract
u_ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydrauli
Calculations (If Applicable)
u Mass check Energy Compliance Report (If Applicable)
New Construction (Single and Two Family)
-:3 Building Permit Application
�a Certified Proposed Plot Plan
a Photo of H.I.C. And C.S.L. Licenses
j Workers Comp Affidavit
a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable) -
o Copy of Contract
:j Mass check Energy Compliance Report
In all cases if a variance or special permit was required the Town Clerks uffice 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
::u•:t .SP!•.("3'IU\.11.,til'ai\'f('L':;i�)F;I".R'1'VF. :'!':3Pf!DRFIIS
LocationNo. Date
kORT" TOWN OF NORTH ANDOVER
h 9
Certificate of Occupancy $
�'�s',•'°''<�
Building/Frame/Frame Permit Fee $
a�cMust 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
19251
'�` 'Nilding Inspector
XA®RTH
TO" Of t 19Andover
® ....... ......
-
__
J4 s
r -: E - dover, Mass.,�'1 - ?• O G
COCMICMEWICK
ADRATED P"
`s BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT..............Fro.I.'...I.................�r� .�i. .... .................................................................... Foundation
has permission to erect........................................ buildings on ..,,,? ..........v&..r......I.pe
... .............. Rough
to be occupied as........�A......ge.'l.�... ......�. I. ..T........ �.. ................... Chimney
provided that the person accepting this permit shel in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERM EXPMES I 6 MONTHS
1
ELECTRICAL INSPECTOR
UNLESS-LESS-CONSTRUC 1 iO1 S Rough
......... Service
.. ... ... ... . . .. .......... ........... .........
" D R
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
BUSINESS CONDITIONS TO THIS
CONSTRUCTION CONTRACT
This Contract, dated 5/15/2006 is by and between:
Frank and Judi Kenney
30 Vest Way
North Andover, MA 01845
Blackdog project code KENNE-6452-K
(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:
30 Vest Way, 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:
Master Suite 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 $48,989.74. 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 7/2006 and will be completed, absent unusual or unforeseen
circumstances, on 9/2006 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.
05/18/2006 Contract Proposal—Page 4 of 4
t
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: $2,449"49
Payment Schedule amounts reflect a Partner Plan credit of$2,500.00
b. Payment Schedule
Start of project $6,752.84
Start of plumbing rough-in $6,752.84
Start of electrical rough-in $6,752.84
Start of drywall hanging $6,752.84
Start of floor tile $6,752.84
Start of painting $6,752.84
Substantial Completion $2,202.01
Completion of Punch List $1,321.20
c. Allowances for Owner Selected Components
•A(p.pJlptyanr: "s at this times C�+c�� `�
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
05/18/2006 Contract Proposal—Page 5 of 5
CONSTRUCTION CONTRACT
This Contract is by and between:
Frank and Judi Kenney hereafter referred to as "OWNER", and Blackdog Builders, Inc hereafter referred to as
"CONTRACTOR" for work at 30 Vest Way, North Andover, MA 01845 dated 5/15/2006. 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.
If. 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.
05/18/2006 Contract Proposal—Page 7 of 7
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.
05/18/2006 Contract Proposal—Page 8 of 8
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.
05/18/2006 Contract Proposal-Page 9 of 9
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
subrni -ar-bjtr i ,as rov' ed in MGL c. 142A.
IVA it
Frank and Judi Kenney Shirley Vande ult
Design Consultant
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.
05/18/2006 Contract Proposal—Page 10 of 10
12. ENVIRONMENTAL HAZARDS
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 an "hazardous waste"
as defined by
the Resource Conservation and Recovery Act of 1976, as amended from time to time, and regulations
promulgated thereunder; c an "hazardous substance" as defined b the Comprehensive Environmental
( ) Y Y p
Response, Compensation, and Liability Act of 1980, as amended from time to time and regulations
P p Y ,
9
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.
05/18/2006 Contract Proposal—Page 11 of 11
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.
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..
SUBMITTED:
/ DATE :
Shirley Vandeb It 5115/2006
Design Consultant
Blackdog Builders, Inc.
ACCE7P :
DATE:
Kenney
(DV�CM TE.
Judi Kenney
05/18/2006 Contract Proposal—Page 12 of 12
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subject to verification on job site and released or copied unless applicable fee has Printed: 5/17/2006
adjustment to tit job conditions. been paid or job order placed.
Kenney-As Built Final Layout JDrawing#: 1 Scale
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All dimensions_size designations given are This is an original design and nntst not be Designed: 3/26/2006
sut>_ject to verification on job site and released or copied unless applicable fee has Printed: 5/17/2006
adjustment to tit job conditions. been paid or job order placed.
Kenney-Structural Change Final Layout. Drawing#: 1 Scale: 0 1/4"= I'
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All dimensions_size designations given are ,. This is an original design and must not be resigned: 6/5/2006
subject to verification on job site and released or copied Unless applicable fee has Printed: 6/5/2006
adjustment to ft job conditions. been paid or job order placed.
Kenney-Design 06-05-06 Final Layout J.Drawing#: 1
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N pL, �504-
HALL
0e„HALL _ MASTER
BATH --- - BATH P
(NO REMODEL) I r -- --I CH=91" ,;fir O,,' 501;"
N
s 764,.
12 ,w O Ili,
y rt
loll--
6
oll„6 � U`
.I:
3611-1
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to w
A I
'd C N "i- to I 36" MASTER HALL
N ` - N
mp
N .1, n P
1n
31;,, 19a„ 47e„ 79#.' 1 301;" �I
331„ 303" _ 12-1-7 to w 76,,, 12a,.
N i-
N ^I- �
Iq41s" ;I, i 507"—�L 51„ N moi.
r 0
CLOSET - G
>� 763.'
12 12-"
101;"
All dimensions size designations given are This is au original design and must not be Designed: 3/26/2006
subject to verification on job site and released or copied unless applicable fee has Printed: 5/17/2006
adjustment to fit job conditions. been paid or job order placed.
Kenney-As Built Final Layout Drawing#: 1 Scale: 0 1/4"= l'
�q
l
n window,
sling location
I
1 I
O
center
toilet if I i
I
------
NO STRUCTURAL �- I t---- ---------------------
C AC fyF1.,S �" W�N(T I
CHANGE IN demo original closet to
build new tub WPB._ IQ I create walk-in closet
HALL BATH �-_-- j I
I win wall I I
rove
.
po I switch ,y`QIL�Ce I p umbin
I plumbing demo iforI double
from original
1 winkshower to bathroom I
wall Ito this
tub (location
demo
I shower I build
wing wall 1 I new DEMO CARPET
I closet IN MASTER
I BEDROOM
I
I
I I
I
build new relocate minimize
wall for I 1new at Vic original
new master I p II-down opening
bedroom to 42"
entry door
I i
------------
demo closet space
and create 1/2 close
t/2 alcove space
All dimensions size designations given are This is an original design and_a11 stst not be Designed: 3/26/2006
subject to verification on job site and released or copied unless applicable fee has Printed: 5/17/2006
adjustment to fit job conditions. been paid or job order placed.
Kenney-Structural Change Final Layout Drawing#: I Scale
r1
{ j
102"
22" 35=" 44 v 79 „ v
i
Cf—
------ -------
39"
2s
i
NO STRUCTURAL build up wall to nter
CHANGE IN toilet in space
HALL BATH
Walk-In �
Shower Head:78' AFF N Closet N
O �nalvei 33"AFF
O Master
Shampoo Niche Bathroom
12"x 12" CH=91"
center on wall
42" AFF
66"x 6" x 20' 10
verify w/client i
Mari os Tub
grab bar 33 i" 25i"
36"AFF
i
Iw
: 0 33="-- 25�" O
N
N
79"' FR ME
3OP NI G
– W T�tV mIw
m 7 46 M/tSTE
m a BE RO M
3
46.T" – 33
I N
N
33=,,, N
M - - dee
N N sh =
16,E �V O
/46 R,' 71
All dimensions size designations given are This is an original design and must not be Designed: 6/5/2006
subject to verification on job site and a released or copied unless applicable fee has Printed: 6/5/2006
adjustment to fit job conditions. ,a been paid or job order placed.
!Kenney-Design 06-05-06 Final Layout Drawing#: I.
DESIGN
REMODEL:
. 00-3.5,900 cf:enclosed space ry
✓fte i� ut
BOARD OF BU EMN,s R— UILAMOl�S r 03L G,112 S:6ot)
License: CONSTRUCTION$.UP.ERVIS.OR 1A 'Masonry only;
i 1 G Family Homes
t Number CS 0488,'.47 allure to possess a cuRent edition of the
BirtFtdate s.011E 1964 �VlassachUt6ftState Building Code f
- _
,i is cause forrevocatfon of his license.
a E l rresi Off 1 7 Tr. no: 19930
.$ Restrict d JWN i
DAVID K 14RYAN
7 RED ROOF LN#4
SALEM, NH 03079
Commissigner
bMk%SAFE CALL CENTER: (888)344-7233
- -- --------
✓1e ------
ammeaozule
�\ Board of BuilBing.Regulations and Standards Lkense.or registration valid for.individixfuse only
- --- -- HOME IMPIROVEMENT CONTRACTORbefore:the expiration:date If ft and return tor.
Registratibn 106877 I Board;ofBuildItig:goguigtions and:5tdudards
10-040008/2006.72812006. One-Ashburton Pl'gce-Rtn 1301
�'Jypbz P.Hvate Corporation j Bostony.Ma,02108'
- - i
BLACKDOG BUILDEM INb5.*: '.i
DAVID BRYAN
7 RED ROOF LN #1 � �
Salem,NH 03079 1.
Administrator
Not vali :"iut siginature
ACORD„ CERTIFICATE OF LIABILITY INSURANCE of/11/2006
PRODUCER (603)669-0704 FAX (603)669-6831 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Infantine Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 5125 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Manchester, NH 03108
Joyce Dunlap INSURERS AFFORDING COVERAGE NAIC#
INSURED Blackdog Builders, Inc. INSURER.A: Peerless Insurance 24198
7 Red Roof Lane Unit 1 INSURER B. Acadia Insurance Co. 31325
Salem, NH 03079 INSURER C
INSURER D:
INSURER E'
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAIAED ABCVE 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,
INSR ADUL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY CBP9869957 07/01/2006 07/01/2007 EACH OCCURRENCE $ 1,000,0001
X COMMERCIAL GENERAL LIABILITY DAMAGE Tu^RENTEC $ 100,OO
CLAIMS MADE I I OCCUR MED EXP(Any one person) $ 5,000
A PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGA TE LIMIT APPLIES PER, PRODUCTS-CCMP.IOP.AGG $ 2,000,000
rOLICYF—1?E'DT LOC
AUTOMOBILE LIABILITY BA9860458 07/01/2006 07/01/2007 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) S
1,000,00
ALL OWNED AUTOS BODILY INJURY S
SCHEDULED AUTOS (Per person)
A X HIRED AUTOS BODILY INJURY
X ICM-OWNED AUTOS (Per accident) S
PROPERTY DAMAGE S
(Par accident)
GARAGELIABILITY AUTO ONLY-E.AACCIDENT 1i -
ANY AUT O OTHERT-IAN EA ACC S
AUTOONLY: AGG $
EXCESSIUMBRELLALIABILITY CU81457331 07/01/2006 07/01/2007 EACHocCURRENCE S 1,000,00
X OCCUR ❑CLAIMS MADE AGGREGATE $ 1,000,000
A $
DEDUC-5= S
X RETENTION $ 10,00C5
WORKERS COMPENSATION AND WCA006920415 07/01/2006 07/01/2007 X WCSTATORY LIMTBS U- GTH-
EMPLOYERS'LIABILITY ER
B ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000
OFFICEPJMEMSER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000
IF yes.describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT i SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF.THE ISSUING INSURER'MLL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER." AGENTS OR REPRESENTATIVES.
For Informational Purposes [AUTHOR12ED REPRESENTATIVE 1 , �Jl _
ACORD 25(2001/08) FAX: 898-0821 @ACORD CORPORATION 1988
The Commonwealth of Massachusetts
Department of Industrial Accidents '
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
'davit: Builders/Contractors/]Electricians/Plumbers
Workers' Compensation Insurance Af
Applicant Information Please Print Legibly
Name (Business/Organization/Individual).: V
Address: Rroo
City/State/Zip: 5&.Le,nn N 0309 Phone #: 603 - 876- 06,66
Are you an employer? Check the appropriate box: Type of project(required):
1.% I am a employer with N5 4. ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4), and we have no 12.❑ Roof repairs
insurance required.] # employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information:
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site
information.
Insurance Company Name: 1P.)�N`!. .1��6cx*A)cZ 3
Policy#or Self-ins. Lic. #: 49-A 00 69 ZO N 145 Expiration Dater/0
Job Site Address: 3 0 v 1t- —0044 City/State/Zip:�O.A�c MA O/MN S
Attach a copy of the workers' compen ion policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine.
of up to $250.00 a day against the violator.. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under thepains and penalties of perjury that the information provided above is true and correct-
Si a Date: -O 6
Phone#:
Oficial use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
Information. and Instructions .
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hue,
express or implied,oral or written."
An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives.of a deceased employer, or the
receiver of trustee of an individual,partnership, association or other legalentity,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'mail"iaance, construction or fep u 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 agengy,shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buil`diiigs in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.”
Additionally, MGL chapter 152, §25C(7) states"Neither the.commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance"With the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractors)name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees.other than the
members or partners,Iare not required to carry workers' compensation insurance. If an LLC.or LLP does have
employees, a policy is required..Be advised thatthis affidavit may be submitted to the Department of.Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or.town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies.should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact-you iega`rdiiig the applicant.
Please;;be.-sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
:,.: . 1.
that must subrmt inultiple`pernutflicense applications in any given year, need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address" the applicant should write."all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the.city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(Le.
. a do 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: t�
The Commonwealth of Massachusetts,
R / • 3 '
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax #617-727-7749
Revised 5-26-05 �v
ww .mass.gov/cha