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Building Permit #209-16 - 337 PLEASANT STREET 8/18/2015
O� %40RTh q BUILDING PERMIT °��� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * - Permit NO: ^ J Date Received r ,I1 �9SS�cHu`S���� y Date Issue w IMPORTANT:Applicant must complete all items on this page LOCATION 337 FL.EA5A"T Pri crtzrT- PROPERTY OWNER_ALA.44 'frPtt�#�IyIAA.! � _n4W.0 6 Pe*, QA, Print MAP NO: PARCELM ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 1,4<ne family 0 Addition ❑ Two or more family ❑ Industrial 10<teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water//Sewer -�,,-i� vwt� r /�-�-.,�-%-e ✓,r�—�z � /U,,.�� ' ,,�eft � ' Y1 ► g>--J `u Vi1.4� S xz icnc Identification Please Type or Print Clearly) OWNER: Name: A.LAxl M— &Q0tA&0 Phone: -M-(.83.4g45 Address: CONTRACTOR Name: Phone: l003.980. 37GI _C�M.4�eiTk 'D65tyt,.,1 �,6�nODC�LIt.1 V Address: 1 Z t-Aup AA r Mws �A-SHuI�. N o3otoZ Supervisor's Construction License: Exp. Date: GS-0399(�.� 2•Z 3•ZaI So Home Improvement License: Exp. Date: 09 9 -Ito•Lcx�a �. ARCHITECT/ENGINEER Phone: Address: Reg. No. 4 FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMAT D COST BASED ON$125.00 PER S.F. Total Project Cost: $ T 3 pp FEE: $ •n Check No.: 1' IX4(; Receipt No.: 4 d=2dL NOTE: Persons contracting with unregistered contractors do not have a cess e g rand" Signature of Agent/Owner Signature of contract 1 � Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ a TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ J Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 3 Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit _ DPW Town Engineer: Signature: F RIF E�bEP�1R�TMENIT, ._: . . _ . . _ 40 Tempi®u Located 38 Osgood Street m'stet onxsite,: eyes ;nog Fire�D'epartmentsgnature/date; COMMENTS, Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL,: Movement of Meter location, mast or service drop requires approval of Electrical Inspector yes No DANGER ZONE LITERATURE: yes No MGL Chapter 166 Section 21A—F and G min.$1o0-$1000 fine NOTES and DATA— (For department use) LOW— Ll Notified for pickup Call Email Date — ^y _ Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor P p Ian Or Proposed Interior Work � . Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan �. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) .� Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) • Building Permit Application • Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 I ECC Energy code 4. Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 i Location tT `6x"o, ' 'Ir No.001 Date 1 �� . - TOWN OF NORTH ANDOVER rLED�64a • Certificate of Occupancy $ — Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �a Check# _ r 1Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 44,434.00 m $ - $ 533.21 Plumbing Fee $ 66.65 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 66.65 Total fees collected $ 766.51 337 Pleasant Street 209-2016 on 8/19/2015 Two Bathroom Remodels * TNORTH Town o tEAndover O 9 No. 0.60 , �h ver, Mass, I I cocM�c»ewick 1' RpDRATED ►P�`��(y 9S U � BOARD OF HEALTH RM LPE I T T D Food/Kitchen Septic System THIS CERTIFIES THAT , /1!L '� � ..... ,, ,, 0 �- BUILDING INSPECTOR �� Foundation has permission to erect .......................... buildin s on ..�..570..��.....,,,,... ,�, , ,,,, ,,, , Rough tobe occupied as ..L[�(4 .....:. . .. ........... ...........................:P........................................................... Chimney provided that the person-accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 3 UNLESS CONSTRUCTION Rough — Service .....................M................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 40 4 i DESIGN REMODELING � /� id f� Dreams Delivered. ( l Project Proposal Alan Freedman &Therese Honda Project Name: Freedman/Honda Main Bath 337 Pleasant Street Telephone: 978-683-4949 North Andover MA 01845 Date: 7/16/2015 We hereby submit specifications and estimates for: Remodel Main and Master Bathrooms to the enclosed Preliminary Plans, Specifications,and Terms and Conditions Agreement. All workmanship is guaranteed for three years upon completion and all supplies, materials, and equipment to be covered by manufacturers warranties. The following is not included in this proposal: Permit fees, Excavation, Concrete, Masonry, Floor Framing, Roof Framing, Roofing, Gutters, Exterior Trim, Decks, Porches, Siding, Shutters, Exterior Doors,Windows, s#moe Moia ;js, Insulation, Drywall Ceilings, Closet Shelving, Appliances,Tub and Shower Doors, Fireplaces, Hardwood Flooring,Tile Flooring,Carpeting, Exterior Priming&Painting,Wallpapering, Landscaping and Walkways, Driveway Paving and Preparation,and anything else not specified here in. G.M. Roth Design Remodeling,Inc.is fully covered by liability and workers compensation insurance. Massachusetts Construction Supervisors License#056336 Massachusetts Home Improvement Registration#109467 Thank you for your consideration! We Propose to furnish material and labor-complete in accordance with these specifications,for the sum of: Payable as follows: Refer to Terms and Conditions Afireement G.M.Roth Design Remodeling Inc.Authorized Signature: -Date: . lyh �S Note: This proposal may be withdrawn if not accepted, in 14 days Acceptance of this Proposal -The pricesispecifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature: Date: ` / Signature: Dater 12 Murphy Drive, Nashua, NH 03062 / p 603.880.3761 / 866.446.7684 / f 603.880.8991 / www.gmroth.com • • i o DESIGN REMODELING F�� O/d w-6 Dreams Delivered. /` Project Proposal Alan Freedman &Therese Honda Project Name: Freedman/Honda Main Bath 337 Pleasant Street Telephone: 978-683-4949 North Andover MA 01845 Date: 7/16/2015 We hereby submit specifications and estimates for: Remodel Main and Master Bathrooms to the enclosed Preliminary Plans,Specifications,and Terms and Conditions Agreement. All workmanship is guaranteed for three years upon completion and all supplies, materials, and equipment to be covered by manufacturers warranties. The following is not included in this proposal: Permit fees, Excavation, Concrete, Masonry, Floor Framing, Roof Framing, Roofing, Gutters, Exterior Trim, Decks, Porches, Siding, Shutters, Exterior Doors,Windows, , Mtx�t # ' r Insulation, Drywall Ceilings, Closet Shelving, Appliances, Tub and Shower Doors, Fireplaces; Hardwood Flooring,Tile Flooring,Carpeting, Exterior Priming& Painting,Wallpapering, Landscaping and Walkways, Driveway Paving and Preparation, and anything else not specified here in. G.M. Roth Design Remodeling,Inc.is fully covered by liability and workers compensation insurance. Massachusetts Construction Supervisors License#.056336 J)� X I T /3r / S Massachusetts Home Improvement Registration#109467 '/y�•y�j,�( /o y�j Thank you for your consideration) /- �' We Propose to furnish material and labor-complete in accordance with these specifications,for the sum of: Payable as follows: Refer to Terms and ConditionLreement G.M.Roth Design Remodeling Inc.Authorized Signature: 1Note. This proposal may be withdrawn if not acceptedFwi+thin 14 dai Acceptance of this Proposal --rhe pricesApecifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature: Date: (L/ Signature: / l `'r►�-" Date: 12 Murphy Drive, Nashua, NH 03062 / p 603.880.3761 / 866.446.7684 / f 603.880.8991 / www.gmroth.com 0 ' 4 . . I T I • t Freedman-Honda Main Bath 7.15.15 Terms and Conditions MA 7/16/2015 BUILDING PLANS,INSPECTIONS,AND PERMITS r` I. Contractor will furnish all necessary plans for the completion of this job. These plans will supplement the specifications as an attachment to this contract. C 2. Contractor will schedule all necessary inspections for this job in a timely manner,and will comply immediately with any correction notices posted in order to keep the job schedule. 3. Contractor will obtain any and all necessary construction-related permits as the owner's agent;owners who secure their own construction—related permits or deal with unregistered contractors shall be excluded from access to the Guaranty Fund; all permit fees for permits obtained by Contractor or its representatives shall be reimbursed by owner. INSECT/WATER DAMAGE 4. Contractor will provide a progressive wet rot inspection of the work being completed(as described in the enclosed specifications)and furnish a written report and cost estimate of the necessary repairs.The report and estimate will list all infected areas and suggest the method of repair. 5. Insect infestation and damage will be noted in the report if evident,but neither an insect inspection nor insect damage repairs will be included in the report or estimate. ENVIRONMENTAL HAZARDS 6. Contractor's scope of work shall not include the identification,detection,abatement,encapsulation or removal of asbestos,mold,lead,radon,ground water or environmental hazard,or products or materials containing asbestos or other hazardous substances from the home. 7. In the event that Contractor encounters any such products or materials in the course of performing his work, Contractor shall have the right to discontinue his work and remove his employees from the project until such products or materials and any hazards connected therewith are abated,encapsulated or removed,or it is determined that no hazards exists(as the case may require). Contractor shall receive an extension of time to complete his work and will also receive fair compensation for any additional costs resulting from delays encountered as a result of such situation and correction of it. Owner understands that costs incurred for removal will be over and above the contract 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. DEMO/TEAR OUT g. If any of the existing building materials removed from this home are to be reinstalled,Contractor will notify Owner at the time of removal if the item or any of its parts need replacement. If so,Contractor will write an additional work order at that time and give Owner a firm price quotation on the cost of replacement as needed. 9. This contract is subject to owner obtaining suitable financing. Owner must apply for financing within ten(10)days of the signing of this contract, and shall notify contractor in writing within thirty(30)days of his inability to obtain financing or this contingency shall lapse. In the event that financing cannot be obtained by owner and the contractor r� has been notified,owner agrees to reimburse contractor for all costs,expenses,and labor incurred by contractor to date. G.M. Roth Design Remodeling Inc. ,, 11�of/5� Freedman-Honda Main Bath 7.15.15 Terms and Conditions MA 7/16/2015 10. Owner shall be responsible for,and pay to obtain any variances or zone changes required,unless specified otherwise -1 in this agreement. 11. Owner warrants that he owns the real property upon which the work is to be performed. 12. Without invalidating this agreement,Owner may order extra work by the use of a change work order,providing the document is signed by both Owner and Contractor. 13. Owner understands and agrees not to engage in any side arrangements or separate contracts with any of the employees,vendors,or sub-contractors performing work on this job. 14. Owner has read,understands,and agrees with the total payment schedule as shown on this agreement. Owner will pay the Contractor the down payment,progress payments,and the final payment,as per this agreement. Final payment is due on the day of substantial completion of this job. 15. Owner agrees that if Contractor has not been paid in full within 30 days after substantial completion of his work, Owner will pay Contractor 1.5%per month,(18%annual percentage rate)of unpaid balance as a late charge. CONTRACTOR TERMS AND CONDITIONS 16. Contractor will be responsible for,and will at his own expense,obtain qualified and efficient workmen to complete this job. All contractors and subcontractors shall be registered,and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumers Affairs and Business Regulation Ten park Plaza,Suite 5170 Boston,MA 02116 Tel: (617)973-8700 Contractor will pay all workmen's compensation and other employment costs required for the performance and completion of this job. Contractor shall carry bodily injury liability insurance relating to the work in an amount not less than$1,000,000.00 for bodily injury including accidental death. Contractor shall carry property damage liability insurance in an amount no less than$1,000,000.00,or Contractor shall carry a combined single limit of liability not less than$1,000,000.00. JOB SITE AND PRODUCTION ,.�— 17. Contractor will start this jol�6n or aboutN,x� 2di�,and will complete this job on or about ��= � .��"� Start date shown is contingent upon product selection being completed by 2015. Above start and completion date is contingent upon office approval and receiving a minimum of a 10%deposit. Contractor will diligently pursue this job through to its completion,but shall not be responsible for delays caused by the following: Timely receipt of payments as described here in or on future change orders. Issuance of job permits within a G.M. Roth Design Remodeling Inc. V2of5 A-r- N Freedman-Honda Main Bath 7.15.15 Terms and Conditions MA 7/16/2015 reasonable length of time,receipt of a certified plot plan,loan approval and funding,loan disbursement act of God, weather,strikes,lockouts,boycotts,or other labor union activities,job change ordered by Owner,inability to secure materials,delays caused by inspection,changes caused by inspectors of governmental agencies,or any other cause �1 beyond Contractors control. 1U No penalties will be assessed to Contractor for job completion beyond the date shown above. 18. Owner understands and agrees that if at owners request a key is not furnished to contractor prior to job start,owner will provide access to the residence from 7:30 am to 5:30 PM Monday through Friday during the duration of this job. If at any time access to the work area is not available to Contractors crew for any reason,owner agrees to reimburse Contractor for expenses incurred for travel and lost time at the rate of$105.00 per man-hour lost, and.38 cents per mile per vehicle. 19. Owner understands and agrees to provide Contractor,Contractor's employees and Sub-Contractors,free use of all utilities to complete this job. Utility use will include electricity,water, telephone,a washbasin,and toilet at the job site. Contractor agrees to maintain those facilities in"maid clean"condition at all times.Contractor agrees to reimburse Owner for all long distance telephone charges incurred by Contractor,Contractor's employees,and/or Sub-Contractors. 20. All workmanship as outlined in this agreement is guaranteed for a period of 3 years from the date of substantial completion of this work,and all materials,supplies,and equipment are to be covered by their manufacturers warranties(subject to normal use and care and provided Owner has complied in full with terms and payments and other conditions of this contract). While quality is a relative term and standards of quality vary,the Contractor subscribes to the National Association of Home Builders(NAHB)set of quality standards applicable to residential construction and residential remodeling developed by the NAHB Remodelers Council and the NAHB Single Family Small Volume Builders Committee and set forth in the manual entitled Residential Construction Performance Guidelines for Professional Builders& Remodelers(2005). All unused materials shall remain the property of Contractor. Owner understands and agrees that this Contract is for the purchase of the job(s)as stated herein,and is not a purchase agreement for the individual parts or materials that comprise this project. 21. Owner understands and agrees to the limitations of patching plaster or drywall,and while Contractor shall make every effort to match existing textures,finishes,and planes,an exact match cannot be guaranteed. 22. Change of the electrical service, (meter and base,or panel),or any other electrical equipment that is in violation of applicable electrical or building codes,is not included in this job unless stated otherwise in the specifications. In the event the Electrical Inspector requires any change in the existing electrical equipment to perform the electrical work as outlined in this contract,Owner agrees to pay for such work. 23. Contractor is not responsible for nominal damage caused to lawn and landscaping by workmen and machines. 24. Owner will assume responsibility to remove from any and all work areas,all household and personal items,and store those items away from the work areas during the entire duration of this job. Contractor will not be held liable for any damage to any owner items not removed from the work area. The Contractor will move any and all items left in the work area,will be moved on the day of job start,and owner will be subject to a charge of$105.00 per man hour for moving those items. Contractor will not be liable for any damage to those items caused by the moving process. 25. Owner authorizes Contractor to use photographs taken at job site for display,promotion and advertising,without G.M. Roth Design Remodeling Inc. 3 of 5 Freedman-Honda Main Bath 7.15.15 Terms and Conditions MA 7/16/2015 compensation to Owner. LEGAL 26. Owner understands and agrees that the final price quotation for this job has been figured at present labor and material rates,and that Contractor,at his option,may increase the Contract price if any increases in said costs develop prior to job start(increase not to exceed 5%of the total agreement). It is also agreed that if any additional work is added to the plans and specifications by any governmental agency,city or county for their approval,the cost of the additional work will be added to the agreement price. 27. If any provision of this agreement is declared invalid by any tribunal,the remaining provisions of the agreement shall not be affected thereby. 28. It is understood and agreed between all parties to this agreement that this contract replaces and'voids,any and all previous agreements between the parties to the agreement,either written or verbal. 29. Contractor will keep said premises free from all mechanics and other liens by reason of any materials or labor to be furnished to him by others. Nothing stated herein or in said note shall prevent Contractor from timely filing a mechanic's lien on his own behalf to secure payment of the money to become due under this agreement should he deem it necessary unless otherwise agreed. 30. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulatio s and the consufner shall be required to submit to such arbitration as provided in MGL.C. Owner � ,.. Contractor Owner � � CRJ ✓� � v NOTICE: The signatures of the parties above apply only to the agreemen of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative-ispute resolution even where this section is not signed separately by the parties. 31. Owner will pay Contractor's cost of collection,including reasonable attorney's fees,if Contractor has to resort to litigation or arbitration to collect any monies owed by Owner to Contractor. 32. This written contract constitutes the complete integration of all statements,agreements,and discussions relating to the work and contract,and there are no representations,guarantees,or warranties other than those expressly incorporated herein,nor are there any agreements collateral hereto,nor is this contract dependent upon or subject to any conditions or approvals,precedent or subsequent,not herein stated. No subsequent agreement relating hereto shall be binding upon Owner or Contractor unless in writing and signed by the party being bound. Faxed,PDFed, and/or scanned documents have the force of an original document. C- is ontract,an t e 33. This construction contract is entered into on the__k�& _day of _ 3&4 2015 by and between G.M..Roth Design Remodeling Inc.,herein called Contractor,and the party or parties signing below,herein called Owner. The above specifications,conditions,and job material selection sheets are satisfactory and are hereby accepted. You are authorized to purchase materials and proceed with this job as specified in this proposal. G.M. Roth Design Remodeling Inc. � 4 of 5 eedman-Honda Main Bath 7.15.15 Terms and Conditions MA //16/2015 Contractor shall furnish all labor and materials to do the work described in the above specifications and Owner agrees to pay Contractor as follows: ea-t�itio L �§ `� iu i r �fAC_ rIvy CONTRACT PRICE.......................................... DOWNPAYMENT.............................................. START OF JOB PAYMENT............................... Progress Payment: / �' �'� ile/ - Progr�s�.y�tea���-- COMPLETION OF THIS JOB..,/:s4:1. ?�:.�.�.:V ATTENTION: Contractor will do only that work which is written in the above specifications for the above-agreed amount. The Terms and Conditions as stated are part of this contract. This contract is subject to office approval. You,the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See attached Notice of Cancellation form for an explanation of this right. FORFEIT OF DEPOSIT: Under this Contract,we have asked you to pay a deposit. The deposit may be used by us to pay for materials,labor and other costs involved in your project,and to cover preliminary costs of starting your project. Either party, (you or we)may cancel this Contract within three days for any reason or no reason and we will promptly return your deposit in full,no questions asked. However,if you cancel this Contract after this three day rescission period,you agree that we may apply the deposit or a portion of the deposit to cover our costs and losses resulting from the cancellation. These costs include not only labor and materials of your project,but also other losses to us,including overhead and estimating costs that may be incurred before the work at your project begins. Because these costs and losses are difficult and burdensome to calculate on a case-by-case basis,you agree that G.M.Roth Design Remodeling Inc.may apply an amount of your deposit equal to 20%of the total job value if you cancel the project after the three day rescission period. Both you and G.M.Roth Design Remodeling Inc.reserve other rights to applicable remedies in the event this contract is breached. For example,if significant work has been completed on your project,our damages may exceed 20%of the total job value,in which case we reserve the right to recover the additional damages, including lost profits as applicable. We will always work with you to avoid cancellation and application of your deposit in any way possible,because we would rather deliver on our promise of excellent work,and complete your project within the terms or our agreement. ISO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLAND SPACES; (Owner's Signature) (Date) i= { (Owner's Signature) (Date) Owner acknhwledges recti/)t of a copy of this contract. J/� (Contri&Authorized Sign4tu e) (Date) if G.M. Roth Design Remodeling Inc. ?�' 5 of 5 •j Freedman-Honda Main Bath 7.15.15 Terms and Conditions MA 7/16/2015 Contractor shall furnish all labor and materials to do the work described in the above specifications and Owner agrees to pay Contractor as follows: CONTRACT PRICE.............................................. 6'.3 DOWN PAYMENT.............................................. START OF JOB PAYMENT............................... `�j"'�(��'� / Progress Payment: / vt ®f- r�� Pr ` lw°rr COMPLETION OF THIS JOB............................. y� ATTENTION: Contractor will do only that work which is written in the above specifications for the above-agreed amount. The Terms and Conditions as stated are part of this contract. This contract is subject to office approval. You,the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See attached Notice of Cancellation form for an explanation of this right. FORFEIT OF DEPOSIT: Under this Contract,we have asked you to pay a deposit. The deposit may be used by us to pay for materials,labor and other costs involved in your project,and to cover preliminary costs of starting your project. Either party, (you or we)may cancel this Contract within three days for any reason or no reason and we will promptly return your deposit in full, no questions asked. However,if you cancel this Contract after this three day rescission period,you agree that we may apply the deposit or a portion of the deposit to cover our costs and losses resulting from the cancellation. These costs include not only labor and materials of your project,but also other losses to us,including overhead and estimating costs that may be incurred before the work at your project begins. Because these costs and losses are difficult and burdensome to calculate on a case-by-case basis,you agree that G.M.Roth Design Remodeling Inc. may apply an amount of your deposit equal to 20%of the total job value if you cancel the project after the three day rescission period. Both you and G.M. Roth Design Remodeling Inc.reserve other rights to applicable remedies in the event this contract is breached.For example,if significant work has been completed on your project,our damages may exceed 20%of the total job value,in which case we reserve the right to recover the additional damages,including lost profits as applicable. We will always work with you to avoid cancellation and application of your deposit in any way possible,because we would rather deliver on our promise of excellent work,and complete your project within the terms or our agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE jANY BLANK SPACES (Owner's Signature) (Date)kaw) —� 14-- " o /�t,I (Owner's Signature) (Date) Owner ack �bwledges rec t of yco y of this contract. , (Contracyi/uthorized Sign to e) (Date G.M. Roth Design Remodeling Inc. 5 of 5 Freedman-Honda, Master Bath, 7.16.15, Specifications Page 1 of 3 Description Qty Unit Remodel Master Bathroom to the following specifications: 1 Plans & Permits 1 Project Mobilization 1 Project Mobilization for a standard remove and replace bath remodel, includes pre-construction meetings,project set-up, and includes minimum debris removal up to a 1/2 dump truck load. Permits and plans are not included, assumes in conjunction with "main bath". 1 EA 1 Tear-Out 1 Remove and dispose in dumpster or truck the following: 1 EA Complete systems Tear-Out 1 Standard three piece bathroom remodel demolition(bathrooms up to 64 SF) -includes removal of one vanity cabinet and counter top,bath sink and faucet,bath tub/shower,toilet,baseboard trim, mirror or medicine cabinet,bath accessories, flooring and up to 300 SF of wall and ceiling drywall. Door and window removal, electrical removal,tile wall removal, and anything else not stated are not included. 1 EA Wall Framing Tear-Out 1 Wall removal set-up 1 EA Remove Interior walls -non-bearing, studs with drywall on 2 sides,4LF minimum -to remove wall between shower and "closet' 4 LF Electrical Tear-Out 1 Electrical Tear Out for outlet and light fixture. 1 EA 1 Wall framing 1 Wood Stud Walls 1 Frame for bench in shower 1 EA Interior wall, 2x4 16" on center, average number of headers for doors and windows-to frame new shower wall 40 SF 1 Plumbing 1 Bathroom Plumbing: 1 Furnish and install the following bathroom plumbing(plumbing fixtures are not included unless noted otherwise).Note: it is assumed that existing plumbing in home is to code. Any existing plumbing upgrades needed are not included. Concrete cutting if needed is not included. I Standard three piece bathroom fixture installation(toilet, sink,tub/shower)in same location, no fixtures included,tie into existing rough plumbing 1 EA Furnish the following showers 1 Sterling Ensemble 36" Alcove Shower Receptor,model#72161100-96, 36"x36" single threshold acrylic receptor with molded-in floor pattern,center rear drai ,Biscuit, with Kohler K- 9132 chrome shower drain 1 EA Furnish the following Bath Lavatories/Pedestal sinks 1 Kohler Archer Pedestal Sink 23-154TL x 20-7/8"W x 35-1/4"H K-2359-8-47 (8" Wide Spread Faucet Holes),Almond o�Bi� 1 EA Furnish the following Toilets 1 / G. M. Roth Design Remodeling, Inc. 7/16/2015 3:37 PM Freedman-Honda, Master Bath, 7.16.15, Specifications Page 2 of 3 Description Qty Unit Kohler K-3949-UR-0 Highline Comfort Height Elongated Toilet, 1.28 GPF, l4_"1k0.,includes 1 a K-4774 Brevia Q2 Quick Release solid plastic seat with cover,Almond or iscuit, ChromeTrip Lever included 1 EA Furnish the following Lavatory Faucets: �U�z.-� �' 1 1 Kohler4C- ^ � wi spread lav faucet with metal lever handles with pop up drain 1-1/4" tailpiece. Chrome 1 EA Furnish the following Tub and Shower Valves/Heads n� �(� U kf e 1 Kohler f)CVn rshiire - ,rite temp pressure balancing shower faucet trim with lever handle Chrome, w/a K-304-K balancing valve. 1 EA 1 Electrical 1 Electrical Permit Fee is not included,owner will be responsible for fee. 1 EA Furnish and install the following(Take off existing electrical in home.Light fixtures and service upgrades are not included unless noted) Electrical Work Minimum,for very small projects. : 1 EA Electrical Outlets 1 Dedicated 110 duplex outlet-bathroom GFI 1 EA Dedicated outlet on second floor add-on 1 EA Switches 1 Timer Switch, 60 min Push Button 1 EA Lighting 1 Light outlet for wall or ceiling mounted light fixture(fixture is not included unless specified otherwise)for new fixture over sink 1 EA Recessed lights, waterproof,Halo or equivalent, 75par30fl bulbs-over shower 1 EA Exhaust Fans &Hoods 1 Install 4", 30 gauge galvanized bath fan ductwork with R-8 foil faced insulation sleeve,up to 12' lineal feet, vent to exterior with one aluminum roof or wall cap (exhaust fan not included). 1 EA Bath fan,Nutone QTRN080, Ultra-Quiet Test, 80 cfm, 1.0 sones or equivalent(for bathrooms up to 75 sq.ft.) 1 EA Fish wiring for outlets or switches in closed walls or ceilings 2 EA 1 Interior Walls & Ceilings 1 Furnish and install the following gypsum board. Tape,apply 3 coats of joint compound and sand(ready for paint). Priming and painting is not included.All areas where drywall is removed and new walls and/or ceilings. 1 EA Drywall 1/2" for UNDER 750 SQ.FT., 1/2" gypsum board, installed with drywall screws. Moisture resistant board will be used on all bathroom walls if applicable. 128 SF minimum 128 SF Wall and Ceiling Tile &Backer 1 Tile backer board,per 3'x5'sheet 6 EA Wall tiles,Campogaliano TEOS Almond(CGBBTA) -6" x 6" Diagonal pattern 84 SF 1 Interior Doors, & Interior Millwork & Trim 1 Baseboard Moldings-Furnish and install the following: 1 Baseboards, 3.5 colonial pine OG base(finger jointed and primed), mitered outside corners and coped inside corners 14 LF 1 (� G. M. Roth Design Remodeling, Inc. 7/16/2015 3:37 PM N� e Freedman-Honda, Master Bath, 7.16.15, Specifications Page 3 of 3 Description Qty Unit Cabinets, Counters & Appliances 1 ,. Bath Cabinets 1 Furnish the following vanity cabinetry: Diamond Vibe, Rensi,Maple or Purestyle Laminate, Brie 1 EA Bath cabinetry labor,per cabinet and panels 1 EA Install bath cabinet knobs and/or handles,$6 each material allowance 2 EA Specialties Bath.Accessories 1 Furnish &install the following bath accessories: 1 Kohler K-10551-CP 24" Towel Bar Chrome1 EA Kohler K-10557-CP Oe Towel Ring Chrornefiwo� 1 EA Kohler K-10554-CP Hev®nsl4e Toilet Paper Holder Horizontal Chrome 1 EA Mirrors & Medicine Cabinets 1 Furnish and install the following Mirrors: 1 EA 1/4"beveled edge mirror, 16"x24", 24"00" or 24"x36" 1 EA Tub & Shower Enclosures � +� 1 Furnish and install the following: 1 EA Signature Hardware 36" chrome straight shower rod 1 EA Floor Covering 1 Flooring Preparation/Add-Ons 1 Floor transitions for tile, vinyl, &/or carpeting-Install metal strips (includes aluminum Schluter strip),tack strips, etc. (doorways etc.),4'min. 3 LF Floor Underlayment-Furnish and install the following : 1 EA Install 1/4" lauan underlayment, (min 1Sheet 32 SF) 2 EA Install vinyl flooring, $35 per sq. yard material and labor allowance. g Sy 1 Painting 1 Furnish and install the following painting: 1 EA Material and labor paint allowance(includes all painting prep required)for : 500 $ ' 1 Clean up 1 Project final clean-up, dispose of all debris in dumpster or dump truck on site and broom/vacuum clean area remodeled,per job 1 EA G. M. Roth Design Remodeling, Inc. 7/16/2015 3:37 PM k )o'( Freedman-Honda Main Bath 7.15.15, Specifications Page 1 of 3 Description Qty Unit Remodel Main Bathroom to the following specifications: 1 Plans & Permits 1 Project Mobilization 1 Project Mobilization for a standard remove and replace bath remodel, includes pre-construction meetings,project set-up, and includes minimum debris removal up to a 1/2 dump truck load. Permits and plans are not included 1 EA 1 Tear-Out 1 Remove and dispose in dumpster or truck the following: 1 EA Plumbing Tear-Out 1 Remove Sink&faucet 2 EA Remove Toilet 1 EA Heating,Ventilation &Air Conditioning Tear-Out 1 Remove FHA ceiling register 1 EA Electrical Tear-Out 1 Electrical Tear Out, light fixture over vanity and duplex outlet and switch over vanity. 1 EA Interior Trim/Millwork Tear-Out(10 LF minimum) 1 Remove Baseboard moldings,one-piece, (up to 20LF), min. IOLF 10 LF Cabinet and Counter Top Tear-Out 1 Remove Vanity cabinets ,LF 6 LF Remove Wall mirror,EA 1 EA Remove Laminate counters (when removing cabinets) 6 LF Remove wall mount toilet paper holder 1 EA �..1 Flooring Tear-Out 1 �.J Remove underlayment nailed or stapled 45 SF Remove Ceramic Tile flooring,Mortar base(under 100 SF) 45 SF 1 Plumbing 1 Bathroom Plumbing: 1 Furnish and install the following bathroom plumbing(plumbing fixtures are not included unless noted otherwise).Note: it is assumed that existing plumbing in home is to code. Any existing plumbing upgrades needed are not included. Concrete cutting if needed is not included. 1 Standard sink installation in same location,no fixtures included,tie into existing rough plumbing,new PVC trap and shut-offs included,center new sink on cabinet where there was two sinks before. 1 EA plumbing 1 EA Furnish the following Bath Lavatories/Pedestal sinks 1 Kohler Archer K-2355-47 Porcelain Lavatory Rectanglular Bowl, 15-5/16"x 19-7/8" x 7-1/2" deep-inside dimensions, Rectangle shape, almond o ' ism 1 EA Furnish the following Toilets 1 Kohler K-3949-UR-0 Highline Comfort Height Elongated Toilet, 1.28 GPF, 14" R.O., includes a K-4774 Brevia Q2 Quick Release solid plastic seat with cover,Almond orq,--J—lscuit ChromeTrip Lever included 1 EA C1 G. M. Roth Design Remodeling, Inc. 7/16/2015 3:36 PM ,V( g c` Freedman-Honda Main Bath 7.15.15, Specifications Page 2 of 3 Description Qty Unit Furnish the following Lavatory Faucets: 1 Kohler K-10272-4 Forte Wide Spread lavatory faucet with pop-up drain and 1-1/4" tailpiece Chrome 1 EA ,rte 1 Heating,Ventilation and Cooling 1 Furnish and install the following: 1 EA Install a FHA ceiling register(ductwork not included) 1 EA 1 Electrical 1 Furnish and install the following(Take off existing electrical in home.Light fixtures and service upgrades are not included unless noted) Electrical Work Minimum,for very small projects. : 1 EA Electrical Outlets 1 Dedicated 110 duplex outlet-bathroom GFI 1 EA Dedicated outlet on second floor add-on 1 EA Switches 1 Switches, single-for light over vanity 1 EA Timer Switch, 60 min Push Button-for new fan 1 EA Lighting I Light outlet for wall or ceiling mounted light fixture(fixture is not included unless specified otherwise) -for new sconces over vanity 2 EA Exhaust Fans & Hoods 1 Install 4", 30 gauge galvanized bath fan ductwork with R-8 foil faced insulation sleeve,up to 12' lineal feet, vent to exterior with one aluminum roof or wall cap(exhaust fan not included). 1 EA Bath fan,Nutone QTRN110, Ultra-Quiet Test, 110 cfm, 1.5 sones or equivalent(for bathrooms up to 1.00 sq. ft.) 1 EA Miscellaneous Electrical 1 Fish wiring for outlets or switches in closed walls or ceilings 2 EA 1 Interior Walls & Ceilings 1 Furnish and install the following gypsum board. Tape,apply 3 coats of joint compound and sand(ready for paint). Priming and painting is not included.All areas where drywall is removed and new walls and/or ceilings. 1 EA Drywall patch or small area projects under 128SF,per sheet, 32 SF ea-to patch wall where existing light fixture is over vanity-Assumes fan can be installed from attic access without having to disturb the sheetrock. 1 EA 1 Interior Doors, & Interior Millwork & Trim 1 Baseboard Moldings- Furnish and install the following: 1 Baseboards, 3.5 colonial pine OG base(finger jointed and primed), mitered outside corners and coped inside corners 10 LF 1 Cabinets, Counters & Appliances 1 Bath Cabinets 1 Furnish the following vanity cabinetry(includes wood dovetail drawers): Manufacturer: Diamond Vibe, Species: Oak, Door Style:, Drawer Style:AVgRE39 ,Finish: Dark Ale 1 EA G. M. Roth Design Remodeling, Inc. 7/16/2015 3:36 PM W' � Freedman-Honda Main Bath 7.15.15, Specifications Page 3 of 3 Description Qty Unit Bath cabinetry labor,per cabinet and panels 5 EA Install bath cabinet knobs and/or handles, $6 each material allowance 8 EA Granite Counter Tops I Custom Stock Remnant Granite Vanity Counter top,up to 86" W and 25-1/2" D,eased edge, with 4" back splash and one sink cut-out-includes "banjo" over toilet 1 EA 1 Specialties I Bath Accessories I Furnish &install the followingbath accessories: 1 Kohler K-11371 Forte Sculpted 24" Towel Bar Chrome 1 EA Kohler K-11377 Forte Sculpted Towel Ring Chrome 1 EA Kohler K-11374 Forte Sculpted Toilet Paper Holder Horizontal Chrome 1 EA Mirrors & Medicine Cabinets Af I Furnish and install the following Mirrors: 1 EA 1/4" beveled edge mirror, 30"x48", 36"x48", or 30"x60" 1 EA Floor Covering I Flooring Preparation/Add-Ons I Floor transitions for tile, vinyl, &/or carpeting-Install metal strips (includes aluminum Schluter strip),tack strips,etc. (doorways etc.),4'min. 3 LF Floor Underlayment-Furnish and install the following : 1 EA Install 1/4" lauan underlayment, (min ISheet 32 SF) 2 EA Install vinyl flooring, $35 per sq. yard material and labor allowance. 8 Sy 1 �1 Painting 1 �✓✓ Material and labor paint allowance(includes all painting prep required)for : 500 $ 1 Clean up I Small sized project(basic bath etc.)clean-up,dispose of all debris in dumpster or dump truck on site and broom/rake clean area remodeled,per job 1 EA 1 G. M. Roth Design Remodeling, Inc. 7/16/2015 3:36 PM Investment Schedule Complete Main Bathroom Remodel as specified: $18,359.43 Complete Master Bathroom Remodel as specified $26,934.00 Subtotal: $45,293.43 Optional: Use-Ren-sizhtndm—wer ron s Ins -pe-in-Mai -Bath ,duct-----4--44-5-G0 Switch to eith r Wzstburke-door style (slab drawers) in Main Deduct $525.009 .4 Bath ,Switch-t6WFilte Ixtf uses Use same vinyl flooring selection in both bathrooms �.( Deduct )'-695.00 Use 12x12 tiles instead of 6x6 in a straight lay pattern V �� Deduct V* -1"0. 0 - `� ' Total Investment with options: �3� 3 (yo, CHOOSE: 6.99%5 YEAR,7 YEAR,or 10 YEAR LOANS Loan Amount 10,000 $20,000 $45,000 Estimated Monthly Payment for a 5 year Loan Q 6.99% $198.00 $396.0-0- -- $891.00 Estimated Monthly Payment for a 7 year Loan @ 6.99% $151.00 $302.00 $679.50 Estimated Monthly Payment for a 10 year Loan @ 6.99% $116.00 $232.00 $522.00 Note: These are only examples,actual rates and payments will be based on your loan loans provided by Enerbank USA(1245 E.Brickyard Rd.,Suite 600,Salt Lake City,UT 8416)on approved credit, for a limited time. Repayment term is 60,84,or 120 months.6.99%APR,effective as of February 2013,subject to change.The first monthly payment will be due 30 days after the loan closes. * 100%UNSECURED LOAN FROM$3,500-$45,000(NO CREDIT CARDS INVOLVED) OR O IF YOU PREFER... ONE YEAR NO INTEREST NO PAYMENTS... NO PAWENTS i Loans provided by Enerbank USA(1245 E.Brickyard Rd.Suite 640,Salt Lake City,UT 84106)on approved credit,for a limited time.Rrepayment terms vary from 24 t0 132 months.Interest waived if repaid in 365 days.16.75%fixed APR, effective February 2013,subject to change. We accept Visa& MasterCard($10,000 maximum per project) r' c� -- - - - 1074111 --- _- -- -- � I J' -34 4" ---- � � I I - � mem L M i I � V�2 All dimensions-size designations ' This is an original design and must Designed: 7/8/2015 given are subject to verification on `O�OW not be released or copied unless Printed: 7/17/2015 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Freedman-Honda main bath All Drawing#: 1 e : 0 1/2" = 1' 11611 W24306 J _ I TOIL.STD j I �N -YD�`3Cp LO ZD m WALAV All dimensions-size designations20,�,`� This is an original design and must Designed: 7/15/2015 given are subject to verification on TECHNOLOGIES not be released or copied unless Printed: 7/17/2015 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. __ Freedman-Honda master bath -pedesta All Drawing#: 1 Scale : 0 1/2" = 1' S ,F Note: This drawing is an artistic20 � Designed: 7/10/2015 interpretation of the eneral 0�" g TECHNOLOGIES, Printed: 7/16/2015 appearance of the design. It is not meant to be an exact rendition. Freedman-Honda main bath DV All Drawing#: 1 BEPFVDB213421 N I VDB21 BEPF D All dimensions-size designations20 20 bj r This is an original design and must Designed: 7/10/2015 given are subject to verification on TECHNOLOGIES 1 not be released or copied unless Printed: 7/16/2015 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Freedman-Honda main bath DV All Drawing#: 1 No Scale. r I & r I' 1 r , t . f 4 ah r;b" Note: This drawing is an artistic 20 'Y r :J: Designed: 7/15/2015 interpretation of the general TECHNOLOGIES Printed: 7/16/2015 appearance of the design. It is not meant to be an exact rendition. Freedman-Honda master bath -pedesta All Drawing#: 1 s, r- h Note: This drawing is an artistic �O �" " Designed: 7/15/2015 interpretation of the general TECHNOLOGIES Printed: 7/16/2015 appearance of the design. It is not meant to be an exact rendition. Freedman-Honda master bath-pedesta All Drawing#: 1 The Commonwealth of Massachusetts Department of Industrial Accidents y 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): .1 l• rE''�� G��^�'MG9 Address: Z, MURpN-Yyoya City/State/Zip: NAs�AuQ 0306Z Phone#: BO'S• 95430• 3Z(01 Are you an employer?Check the appropriate box: Type of project(required): l.[eTam a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in $. D4rVmodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition In I am a homeowner doing all work myself.(No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance., 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer t/tat is providing workers'compensation insurance for my employees. Below is the policy and job site information. �•. Insurance Company Name: �.�rT01•-1j�'� � ��517Q. (N Policy#or Self-ins.Lic.#: FodL ( PM4 (tXDC;G O. r5ZSA Expiration Date: Job Site Address: ? _ Ci /State/Zi ty p:N.AM0WAMArb1�4s Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do he�•t�� is and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 4GC73• $�� • 37So� 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/'1'own Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ,eco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 1/5/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CT PRODUCER NAO MEA Cathy Beauregard Eaton&Berube Insurance Agency, Inc. PHONE FAX 11 Concord St IA,Co Ext: - - 7 6 AIC N-):603-886-4230 Nashua NH 03064 AoM Ress: aur r b r be. INSURERS AFFORDING COVERAGE NAIC# INSURER A: j INSURED GMROT INSURERB:AIM Mutual Insurance man G.M. Roth Design Remodeling Inc. INSURERC: 12 Murphy Drive INSURER D: Nashua NH 03062 INSURER E: INSURER F: ' COVERAGES CERTIFICATE NUMBER:308828032 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ICY EXP LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER MMIDIIY DYYY MMIEFF -DDIIYYYY LIMITS A GENERAL LIABILITY BKS55825281 1/1/2015 /1/2016 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $300,000 CLAIMS-MADE JA I OCCUR MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO X LOC $ A AUTOMOBILE LIABILITY BAS55825281 1/1/2015 /1/2016INULE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident A X UMBRELLA LIAB X OCCUR US055825281 1/1/2015 /1/2016 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED X I RETENTION$10,000 B WORKERS COMPENSATION N ECC60040005992015A 1/1/2015 /1/2016 X WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/N TQPY S E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? Y❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Compensation Information: Gerald Roth Excluded;coverage for NH &MA. Additional Insured status applies if required by written contract per Liberty Mutual General Llability Extension Endorsement#CG8810(04/13). i CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. C/o GM Roth 12 Murphy Drive AUTHORIZED REPRESENTATIVE Nashua NH 03062 i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD li Massachusetts Department of Public Safety Unrestricted-Buildings of any use group which `" Board of Building Regulations and Standards contain less s ----, than 35,000 cubic feet(991m )of enclosed space. y _cense GS-089916 WILLYAIW P DO1-IL,RTY ` 62 COLI)SPRING RD s WLSTI+ORD MA 01886 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. �% � Expiration Commissioner 02/23/2016 For DPS Licensing information visit: www.Mass.Gov/DPS '�flr 1i r Ill/71ri'l.rt/ti/���C�!-,�'{,Cr:13Crr'�r61U.l, 'lice of Consumer Affairs&Business Regulation i;i' a• , E IMPROVEMENT CONTRACTOR License or registration valid for individul use only I before the expiration date. If found return to: egistration: 109467 Type: Office of Consumer Affairs and Business Regulation Expiration: 9/16/2016 Supplement Carr, 10 Park Plaza-Suite 5170 G M ROTH DESIGN REMODELING, INC. Boston,MA 02116 WILLIAM DOHERTY 12 MURPHY DRIVE UNIT G LNASHUA,NH 03062 Undersecretary Not valid wi ut signature COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OiF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF iNVIRONMENTAL PROTECTION 5V� RECEIVED JUL 16 2004 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOT TS SUBSURFACE SEWAGE DISPOSAU-ZIU51-hivi RM PART A CERTIFICATION Property Address: 337 Pleasant Street North Andover_ Owner's Name: William Stratton_ Owner's Address: 337 Pleasant Street , _North Andover,Ma 01845_ Date of Inspection:7/9/2004_ Name of Inspector: Neil J.Bateson Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ Andover,Ma.01810_ Telephone Number: (978)475-4786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes T Conditionally Passes Needs Further Evaluation by the Local Approving Authority �j Fails p Inspector's Signature: ' Date: _7/9/2004_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ` Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 337 Pleasant Street_ _North Andover — Owner:_Stratton Date of Inspection:_7/9/2004_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 337 Pleasant Street_ _North Andover— Owner:_Stratton Date of Inspection:_7/9/2004_ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment. _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or 1 tributaryto a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance__ "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 337 Pleasant Street_ _North Andover— Owner:_Stratton Date of Inspection: 7/9/2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: Yes No No Backup of sewage into facility or Ustem qomponent due to overloaded or clogged SAS or cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _No_Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6"below invert or available volume is'/2 day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form,] No_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or`no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 337 Pleasant Street _North Andover— Owner:_Stratton Date of Inspection: 7/9/2004_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes _ Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks? _Yes_ _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes _ Were as built plans of the system obtained and examined?(If they were not available note as NIA) Yes_ _ Was the facility or dwelling inspected for signs of sewage back up? Yes _ Was the site inspected for signs of break out? Yes _ Were all system components,excluding the SAS,located on site? _Yes_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _Yes_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _Yes_ _ Existing information. Owner had as built plan,town didn't No Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 337 Pleasant Street _North Andover— Owner:_Stratton_ Date of Inspection: 7/9/2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): N/A Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_N/A Number of current residents:_2_ Does residence have a garbage grinder(yes or no): No_ Is laundry on a separate sewage system(yes or no):_No Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings: Yes_ Sump pump(yes or no):_No Last date of occupancy: Current COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped two years ago,owner_ Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500_fflllons—How was quantity pumped determined? Measured tank Reason for pumping: Inspect took_ TYPE OF SYSTEM _X Septic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe):_ Approximate age of all components,date installed(if known)and source of information: 23 years old,6/9,1981,as built plan._ Were sewage odors detected when arriving at the site(yes or no):_No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 337 Pleasant Street _North Andover Owner.—Stratton— Date trattonDate of Inspection: 7/9/2004_ BUILDING SEWER_X_ (locate on site plan) Depth below grade:_22"_ Materials of construction: X cast iron 40 PVC other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):_4"Cast iron thra wall, 3"PVC in house, no leaks SEPTIC TANK: X Depth below grade:_10" Material of construction: X concrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:_10'x 5'x 4'_ Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 25"_ Scum thickness:_2" Distance from top of scum to top of outlet tee or baffle:_8"_ Distance from bottom of scum to bottom of outlet tee or baffle:_19" How were dimensions determined:_Difference between tee length&scum&sludge depths_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.)_Pumped septic tank.Inlet tee ok.Outlet tee eroded on top.Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction: concrete_metal_fiberglass_polyethylene Tother (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 337 Pleasant Street_ _North Andover — Owner:_Stratton Date of Inspection: 7/9/2004_ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass ,polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: —0 — Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):_D-box level&distribution equal. D-box cover broken,replaced same.No evidence of leakage.Evidence of carryover,pumped d-box to clean._ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no): Alarm in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 337 Pleasant Street _North Andover — Owner:_Stratton Date of Inspection: 7/9/2004_ SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type — leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length:_ X leaching fields,number,dimensions: 32'x 38'Field overflow cesspool,number: innovative/altcmative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil ok.Vegetation ok.No sign of ponding to surface._ CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): r Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 337 Pleasant Street_ _North Andover — Owner:_Stratton Date of Inspection: 7/9/2004_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. SepticTank A GarageDriveway D- B Water Meter Bos 38' A to Tank=13'3" A to D-Bos=29' 32' B to Tank=24' B to D-Bos=39'10" i Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 337 Pleasant Street _North Andover_ Owner:_Stratton_ Date of Inspection: 7/9/2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water —>61— Please 6'_Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain: Essex County Soil map— You apYou must describe how you established the high ground water elevation:_Essex County Soil Map,Sheet##30, Paxton Soil,Water>6'Deep_ .reLLJ ts x .' 1A O ^ yam.. 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HNM�•NtdC�000•m,rINMCNtaL�ODW ulOff � �F Tel: (978) 475-4786 3 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover,Mass. 01810 _Title 5 Inspection Report Property Address: 337 Pleasant Street, North Andover Owner: Stratton Date of Inspection: 7/9/2004 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. NqJ. Bes Bateson Enterprises,Inc. Commonwealth of Massachusetts City/Town of System Pumping Record --� i - Form 4 ED DEP has provided this form for use by local Boards of Health. Othe former` 4y b �� but t e information must be substantially the same as that provided here. fore using this form, the k with your local Board of Health to determine the form they use.The System tTIR4�Qrc rs�ut bmitted to the local Board of Health or other approving authority. ATH DEPARTMENT A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of hous a ri ht a of hou a eft/ Y 9 9 9 Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address City/Town State Zip Code 2. System Owner: VIA C�LVA Name Address(if different from location) Cityrrown State Zip Code Telephone Number B. Pumping Record c� 1. Date of Pumping ` -<< Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. 7G. tion wh ntents were disposed: L S. Lowell Waste Water Sign toe qt Haule Date `T � t5form4.doc•06/03 System Pumping Record•Page 1 of 1