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HomeMy WebLinkAboutBuilding Permit #84-15 - 41 HERRICK ROAD 7/24/2014BUILDING PERMIT 3� 4•R:�_ :a°�'\ TOWN OF NORTH ANDOVER r APPLICATION FOR PLAN EXAMINATION Permit NO:�( J Date Received °AATlO '� Date Issued: (i4 9`SSACMU`��� ORTANT: Applicant must complete all items on this pate LOCATION 1A n` e l�) Print PROPERTY OWNER V -J `�� t 1141 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaqe ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Aolition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer Identification Please Type or Print Clearly) U OWNER: Name: Sr \A,,\. \ to ►<.,` Phone: Address: )-4P c- S T' CONTRACTOR Name: Phone: 3 / / 3 Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 13��1� 'I1r�ll� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED N $125.00 PER S.F. Total Project Cost: $ b 0 0 FEE: $ Check No.: Receipt No.: NOTE: Persons%,coft7a-c41hg W unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor M b� Location No.—(.) Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check #_1194)� 1''I \c 2i %) 12 Building Inspector ( _J4 i' 1- -1 4d: p 0>> Warr Zz== z D -� C), Q 00 C) x oCD' 'aur CL Q O w 17 •..�� R A Q. En -319 00 L1 U Ul yy O jtj a a F co a�3 I CD a oo 0 o b. �(D + CD CD CD 01 cn f CD CD I O• � 0 m O. c V Q 0 N Q O_ Z W N W 00 � t f 'aur CL Q O w 17 •..�� R A Q. En -319 00 L1 U Ul yy O jtj a a F co a�3 I - - The Commonwealth ofMassaghuseiffs Deparrtm ntofXndi fstrirclAccic en% Offee of.Investigaleons 6`00 Washington Street Bostog, MA 02111 -www.massgovIdId ` ' Qr ex' Compensatjo;ahsuxanceAffidavit: But dergiCont°actors/Eieetre cxanslTX*bero TPilean0 dormaton Please 'rin e _ xbX� Name(Busiaossforganizaiion&(Rvidllal) _\ � � �V 1 �-\l-'� h S c� 6- C Address: 517" My/Siaie[Zip: `..vt, K On g sr o Phone 4:_ I — (, a Ir Aray9klanemployer?Ctiecktlzoappropriatebox: Type of project(reored): 1. I am a employer with � _ 4. ❑ x � a general contractor and I 6. New Onsirucizon. F employees (fan and(oxpart time) * havelikedtho ffo. -contractors 2. [] I am. a sole proprietor or partnez listed on the attached sheet T 7• � Remodeling ship and`Iiavena employees These suh-contractors have S. ] Demolition worldng forme in. any capacity. workers' comp. insurance. 9. C( EOding addition [No workers' comp. insurance 5. ❑ We axe a corporation and its 10.[( Electricalrepairs or additions required.] officers have exercised their 3. [] Z am a homeowner doing all work Wight of exemption per MaL 11.[] PlumbIgrepairs or additions myself [No workers' comp. c. 152, §I(d•), andwehaveno 12,P Roofrepairs insurance.recluixed.� employees. [No workers, 13.0 Otlier coma. insurance required.] "Anyappiicantthat checksbox#Imustalsofxiioutthesertionbei6wshowingtheirwbrkers'compensationpo]icyinfomiation. i Homeowners who sabmitthis afgdavitindioatingtheY fire doing allworkandthenhire outside contractors must snbniR anent afddavitindicating sVoc . tCostractorsthat cheokthis bozmust attached an addifional sheetshowingihename ofthe suh-contractors andtheirworkers' comp, poRoyWormation. t cru an ernpToye titaiisp ovidIng workers' cornpe asation insurar2ce formy er�tployees Bel'oly isthepolley imd job site information. Insurance Company Name;. L ku .s Policy #k or Semis. LIG. Expitation.Da%: lob Site Address: L� \ \A -t qL WA OL XZ N py/Siateop: {Q w q),j .�-�� : t4- S j Attach a cope of the workers' coxmp ensation-policy tion page (showing tAe policy number and ex aizwi date). Failure to secure, coverage as xequireclunder Section 25A. of MGL o.152 can lead to the imposition of criminalpenaliies of a fmo -ap to $1,500,00 and/or one-year impriso�vnent., as well as civilpenalties in the form of a STOP W ORS ORDER and a fine, of up to $250.00 a day against iho violator. Be advised that a copy of this statement ma�be forwarded to the Office -,Of- investigations £investigations of &a DIA. for insurance coverage verification. xdo hareby certun der ate vaiiris and penalties gf ver ny &attlie information provided above fs/true and eorreet �yn,,.,fiwo. � � /� � - Dale• ��l � L/ offiezai rise o nly. Do not write in this area, to be completed by CO of towxt ofelid City or Town: Permlfffilceuse # Issuing Authority (circle (Ine): 1.)3oardoi:Health 2.130dingJDepartm.ent 3.CitylTowaaClerk 4.Electrical Inspector 5.Plumbinghspector 6. Other - r Infoxmation an Instructions Massachusetfs General Laws chapter 152 requires all employers to provide workers' compensation for iheix employees. Parsuant to this statute, an ergpfoyee is defined as " ...every person:h the service of another under any contract ofhire,• express orhaplied, oral orwxitteel An. , ye is defined as "an. individual, partnership, association, corporation or other legal entity, or anytwo ormoxe of the Foregoing engaged in a joint enterprise, and kcludingthe legal xepxesentatives of wdeceased empipgr . or the receiver o ftzisfee of an individual, partnership, association ox other legal entity, employing employees. However the owner of a dwelling House having notmoxe than three aparim enfs and who resides therein, or the o ccupant to dwelling house of another who employs persons to do maintenauco constructioxt or repair work on such dwelling house or on the grounds or building appurtenant thereto slialinot because of such employment be deemed to be an employer " MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance Or renewal of a license or permit to-operatoa business or to construct buildings in the commonwealth. for any applicant who has not pro duced.acceptable evidezice of compliance with the jahraaic;e coverage required:' Additionally, MC7L chapter 152, §25C(7) states "Neither the commonwealth nox any of its political subdivisions shall enter into any contract for the performance ofpublic workuntil accepfable evidence of compliance with the insurance requirements of this chapter have beenpresentted to the coufracting authority." Applicants Please fill out the workers' coinpens -Von affidavit completely, by checking the boxes that apply to your situation. and, if egsary, supply sub -contractors) name(s), addxess(es) andphononumbex(s) along with their cerecate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other that, the members oxpartuers, arenotrequireclto canyworkers' compensationinsurame. IfanLL C orLLP doeshave employees,apoiicyisxequired. De advised thatthisaffidavitmaybesubmitted tothe Department of Industrial Accidents for confnmagon ofinsuraneo coverage. Also be sure to sign and date -theaffidavit. The affidavit should be xefumedto the city ar town ihattha application forthepem:11t Or license is being requested, xtotthe Department of IudustrW Accidents. Shouldyou have any questions regarding the law or if you are xecluired to obtain a *orkexs' comp ensatioupollay, please can the Department at the number listed below Seri insured companies should enter their self iusuxauce Incense number on the appxopriafe line. City or Town Officials Pleasebesurethattheafffdavitiscompleteaudpxktedlegibly. The Department has providedaspaceatthe bottom of the atxdavit for you to fill out in the event the Office of Investigations has to contact you regarding t�.e applicant. Please be -sure to f11 inthe pezmit/1{cemo number whichwill be used as a refexenre number. N addition, -an applicant thatrnust submitmulfiple permit/license applications in any givenyear, need only submit one Adavi� indicating current p alncy information (if necessary) and under "Yob ,Site Address" the applicant should write "afflocations in[ ' (city or town);' A copy ofthe affidavit ihathas been of oially stamped or marked byth.e city ertownmaybeprovided to the applicant as proof that avalidaff�zdavit."cufiiefoxfutarepermitsorlicenses. Anew azfxdavitmustbefilledouteach year. 'Where a home owner or citizen. is obtaining a license oxpermit not related to any business or commercial venture (i.e. a dog license orliexmit to burn leaves eta.) said person is NOT required to complete this affidavit. The Office of fnvestigations would like to thank you in advance for your cooperation and should you have any.questions, please do not: hesifaie to give us a call. The Depattmenf's address, telephone and fax number: ThQ Cm-Molll�GaWl [fcooftm... fr a 4 .B0.9on., MA 02111 Qx- Revised 5 26,05 a � 1.1 SHORT -FORM FIXED PRICE AGREEMENT CONTRACTOR'S NAME: PMA BUILDERS INC ADDRESS: 11 GRANT ST WOBURN MA 01801 PHONE: 781-608-3113 FAX: 781-305-3441 E-MAIL: PMABUILDERSI@GMAIL.COM LIC #:040162 O -el t�- 13 431 3 DATE: 7/6/14 OWNER'S NAME: KEN ST HILLAIRE ADDRESS: 41 HERRICK RD NORTH ANDOVER PROJECT ADDRESS: 41 HERRICK RD NORTH ANDOVER I. PARTIES This contract (hereinafter referred to as `Agreement") is made and entered into on this 7 day of _JULY , 2014 , by and between _KEN ST HILLAIRE (hereinafter referred to as 'Owner"); and _PMA BUILDERS INC , (hereinafter referred to as "Contractor"'). In consideration of the mutual promises contained herein, Contractor agrees to perform the following work, subject to the terms and conditions below: II. GENERAL SCOPE OF WORK DESCRIPTION AS STATED IN ESTIMATE (Additional Scope of Work page(s) attached: _X Yes No) A. LUMP SUM PRICE FOR ALL WORK ABOVE* $ _12,000.00 * This Agreement will expire 15 days after the date at the top of page one of this Agreement if not accepted in writing by Owner and returned to Contractor within that time. B. NOTES AND CLARIFICATIONS If any conflict should arise between the plans, specifications, addenda to plans, and this Agreement, then the terms and conditions of this Contractor Owner Owner t'3�_I Agreement shall be controlling and binding upon the parties to this Agreement. III. GENERAL CONDITIONS FOR THE AGREEMENT ABOVE A. EXCLUSIONS This Agreement does not include labor or materials for the following work: ' 1. PROJECT -SPECIFIC EXCLUSIONS: LABOR ONLY 2. STANDARD EXCLUSIONS: Unless specifically included in the ""General Scope of Work" section above, this Agreement does not include labor or materials for the following work: Plans, engineering fees, or governmental permits and fees of any kind. Additional work required by governmental plan checkers on final "Red Lined" Job copy of plans that are yet to be issued. Testing, removal and disposal of any materials containing asbestos (or any other hazardous material as defined by the EPA). Custom milling of any wood for use in project. Moving Owner's property around the site. Labor or materials required to repair or replace any Owner -supplied materials. Repair of concealed underground utilities not located on prints or physically staked out by Owner which are damaged during construction. Surveying that may be required to establish accurate property boundaries for setback purposes (fences and old stakes may not be located on actual property lines). Final construction cleaning (Contractor will leave site in "broom swept" condition). Landscaping and irrigation work of any kind. Temporary sanitation, power, or fencing. Removal of soils under house in order to obtain 18 inches (or code -required height) of clear space between bottom�of joists and soil. Removal of filled ground or rock or any other materials not removable by ordinary hand tools (unless heavy equipment is specified in Scope of Work section above), correction of existing out - of -plumb or out -of -level conditions in existing structure. Correction of concealed substandard framing. Rerouting/removal of vents, pipes, ducts, structural members, wiring or conduits, steel mesh which may be discovered in the removal of walls or the cutting of openings in walls. Removal and replacement of existing rot or insect infestation. Failure of surrounding part of existing structure, despite Contractor's good faith efforts to minimize damage, such as plaster or drywall cracking and popped nails in adjacent rooms or blockage of pipes or plumbing fixtures caused by loosened rust within pipes. Construction of a continuously level foundation around structure (if lot is sloped more than 6 inches Contractor Owner Owner 1C3'k-9, from front to back or side to side, Contractor will step the foundation in accordance with the slope of the lot). Exact matching of existing finishes. Public or private utility connection fees. Repair of damage to roadways, driveways, or sidewalks that could occur when construction equipment and vehicles are being used in the normal course of construction. Cost of correcting errors and omissions by the Owner's design professionals and separate contractors. Cost of correcting/testing/remediating mold/fungus/mildew and organic pathogens unless caused by the sole and active negligence of Contractor as a direct result of a construction defect that caused sudden and significant water infiltration into a part of the structure. Cost of removing ponding ground water or other unusual concealed site conditions during excavation. Extra costs associated with refusal of caisson drilling, cave-ins, etc. Cost to modify and/or remanufacture custom brackets and other custom -fabricated materials that are manufactured per plans and/or specifications but do not fit properly into the structure. B. DATE OF WORK COMMENCEMENT AND SUBSTANTIAL COMPLETION Commence work: _ASAP . Construction time through substantial completion: Approximately _3 to _4 weeks/, not including delays and adjustments for delays caused by: holidays; inclement weather; accidents; shortage of labor or materials; additional time required for Change Order and additional work; delays caused by Owner, Owner's design professionals, agents, and separate contractors; and other delays unavoidable or beyond the control of the Contractor. C. CHARGES FOR ADDITIONAL WORK: CONCEALED CONDITIONS, DEVIATION FROM SCOPE OF WORK, AND CHANGES IN THE WORK 1. CONCEALED CONDITIONS: This Agreement is based solely on the observations Contractor was able to make with the project in its condition at the time the work of this Agreement was bid. If additional concealed conditions are discovered once work has commenced or after this Agreement is executed which were not visible at the time this Agreement was bid, Contractor will point out these concealed conditions to Owner, and these concealed conditions will be treated as Additional Work under this Agreement. Contractor and Owner may execute a Change Order for this Additional Work. Contractor is released, held harmless, and indemnified by Owner from all pre-existing mold, fungus, mildew,. and organic pathogen problems and is not responsible for costs or damages associated with correcting, containing, testing, or remediating the same. Contractor Owner Owner 2. DEVIATION FROM SCOPE OF WORK: Any alteration or deviation from the Scope of Work referred to in this Agreement involving extra costs of materials or labor (including any overage on ALLOWANCE work and any changes in the Scope of Work required by Owner, Owner's design professional, Owner's agent, or governmental plan checkers or field building inspectors) will be treated as Additional Work under this Agreement resulting in an additional charge to Owner as set forth herein. Contractor and Owner may execute a Change Order for this Additional Work. Contractor to supervise, coordinate, and charge % profit and overhead on the following: all Additional Work under this Agreement, Additional Work caused by concealed conditions, all overages on ALLOWANCE work, all Owner -furnished materials, and all work of Owner's separate contractors who are working on site at same time as Contractor (any -time in between when Contractor has commenced work and when the work is 100% complete by Contractor). The amount of the Additional Work will be reasonably determined by the Contractor. 2a. Exceptions to the Contractor charging profit and overhead on Owner - supplied materials and Owner's separate contractors are strictly limited to the following: 2b. Contractor's profit and overhead and any supervisory labor will not be credited back to Owner with any deductive Change Orders (work deleted from Agreement by Owner). 3. RATES CHARGED FOR ALLOWANCE -ONLY AND TIME -AND - MATERIALS WORK: Journeyman Carpenter: $_65.00 per hour; Apprentice Carpenter: $_50.00 per hour; Laborer: $_35.00 . per hour; Contractor: $ per hour; .Subcontractor: Amount charged by Subcontractor. Note: Contractor will charge for profit and overhead at the rate of 15 % on all work performed on a Time -and -Materials basis (on both materials and labor rates set forth in Section III.C. of this Agreement) and on all costs that exceed specifically stated ALLOWANCE estimate's in the Agreement. D. PAYMENT SCHEDULE AND PAYMENT TERMS 1. PAYMENT SCHEDULE: * First Payment: $1,000 or 10% of contract amount (whichever is less) due when Agreement is signed and returned to Contractor: $ Contractor ' Owner Owner * Final Payment: Balance of contract amount due upon Substantial Completion of all work under contract: $_ * Interest in the amount of 1% per month will be charged on all late payments under this Agreement. 2. PAYMENT OF CHANGE ORDERS/ADDITIONAL WORK: Payment for Additional Work is due upon completion of either all or part of the Additional Work and submittal of invoice by Contractor. 3. ADDITIONAL PAYMENTS FOR ALLOWANCE WORK AND RELATED CREDITS: Payment for work designated in the Agreement as ALLOWANCE work has been initially factored into the Lump Sum Price and Payment Schedule set forth in this Agreement. If the final amount of the ALLOWANCE work exceeds the line item ALLOWANCE amount in the Agreement, -the difference between the final amount and the line item ALLOWANCE amount stated in the Agreement will be treated as Additional Work and is subject to Contractor's profit and overhead at the rate of, 15 %. If the final amount of the ALLOWANCE work is less than the ALLOWANCE line item amount listed in the Agreement, a credit will be, issued to Owner after all billings related to this particular line item ALLOWANCE work have been received by Contractor. This credit will be applied toward the final payment owing under the Agreement. Contractor profit and overhead and any supervisory labor will not be credited back to Owner for ALLOWANCE work. E. WARRANTY Thank you for choosing our company to perform this work for you. Your satisfaction with our work is a high priority for us, however, not all possible complaints are covered by our warranty. Contractor does provides a limited warranty against material defects on all Contractor - and subcontractor -supplied labor and materials used in this project for a period of one year following substantial completion of all work. This warranty covers normal usage only. You must contact the Contractor at the address on page one of this Agreement in writing for warranty service immediately upon discovering an item in need of warranty service., If the matter is urgent, you must also call the Contractor and send written notice of the need for warranty service. Failure to notify the Contractor of the need for warranty service within ten days of discovery of a warranty item may void this warranty. Additionally, Owner's hiring of others or direct actions by Owner or Owner's separate contractors to repair a'warranty item are not covered by this warranty and will not be reimbursed by Contractor. No warranty is provided by Contractor on any Contractor, Owner Owner ,�-- 0fi_9 materials furnished by the Owner for installation. No warranty is provided on any existing materials that are moved and/or reinstalled by the Contractor within the dwelling or the property (including any warralnty that existing/used materials will not be damaged during the removal and reinstallation process). One year after substantial completion of the project, the Owner's sole remedy (for materials and labor), on all materials that are covered by a manufacturer's warranty is strictly with the manufacturer, not with the Contractor. Repair of the following items and related damages of every kind are specifically excluded from Contractor's warranty: problems caused by lack of Owner maintenance; problems caused by Owner abuse, Owner misuse, vandalism, Owner modification, or alteration; and ordinary wear and tear. Damages resulting from mold, fungus, and other organic pathogens are excluded from this warranty unless caused by the sole and active negligence of contractor as a direct result of a construction defect which caused sudden and significant amounts of water infiltration into a part of the structure. Deviations that arise such as the minor cracking of concrete, stucco, and plaster; minor stress fractures in drywall due to the curing of lumber; warping and deflection of wood; shrinking/cracking of grouts and caulking; fading of paints and finishes exposed to sunlight are all typical (not material) defects in construction, and are strictly excluded from Contractor's warranty. THE EXPRESS WARRANTIES CONTAINED HEREIN ARE IN LIEU OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED, INCLUDING ANY WARRANTIES OF MERCHANTABILITY, HABITABILITY, OR FITNESS FOR A PARTICULAR USE OR PURPOSE. THIS LIMITED WARRANTY EXCLUDES CONSEQUENTIAL, INCIDENTAL, AND SPECIAL DAMAGES AND LIMITS THE DURATION OF IMPLIED WARRANTIES TO THE FULLEST EXTENT PERMISSIBLE UNDER STATE AND FEDERAL LAW. SOME STATES RESTRICT LIMITATIONS ON VARIOUS WARRANTIES, AND SO A CONSUMER'S RIGHTS UNDER THIS WARRANTY MAY VARY. THIS LIMITED WARRANTY MAY NOT BE VERBALLY MODIFIED BY ANY PERSON. THIS LIMITED WARRANTY IS GOVERNED BY THE LAWS OF THE 'STATE WHERE THE WORK WAS PERFORMED. F. WORK STOPPAGE AND TERMINATION OF CONTRACT FOR DEFAULT Contractor shall have the right to stop all work on the project and keep the job idle if payments are not made to Contractor strictly in accordance with the Payment Schedule in this Agreement, or if Owner repeatedly fails or refuses to furnish Contractor with access to the job site and/or Contractor Owner Owner G 0-C-9 product selections or information necessary for the advancement of Contractor's work. Simultaneous with stopping work on the project, the Contractor must give Owner written notice of the nature of Owner's material breach of this Agreement and must also give the Owner a 14 - day period in which to cure this breach of contract. Owner to follow this same notice procedure with Contractor if Owner alleges Contractor is in material breach of this Agreement. If work is stopped due to any of the above reasons (or for any other material breach of contract by Owner) for a period of 14 days, and the Owner has failed to take significant steps to cure his default, then Contractor may, without prejudicing any other remedies Contractor may have, give written notice of termination of the Agreement to Owner and demand payment for all completed work and materials ordered through the date of work stoppage, and any other reasonable loss sustained by Contractor, including Contractor's Profit and Overhead at the rate of % on the balance of the incomplete work under the Agreement. Thereafter, Contractor is relieved from all other contractual duties, including all Punch List and warranty work. G. DISPUTE RESOLUTION AND ATTORNEY'S FEES Any controversy or claim arising out of or related to this Agreement involving an amount less than $5,000 (or the maximum limit of the Small Claims court) must be heard in the Small Claims Division of the Municipal Court in the county where the Contractor's office is located. Any dispute over the dollar limit of the Small Claims Court arising out of this Agreement shall be submitted to an experienced private construction arbitrator that shall be mutually selected by the parties to conduct a binding arbitration in accordance with the arbitration laws of the state where the project is located. The arbitrator shall be either a licensed attorneyi or retired judge who is familiar with construction law. If the parties can not mutually agree on an arbitrator within 30 days of written demand' for arbitration, then either of the parties shall submit the dispute to binding arbitration before the American Arbitration Association in accordance with the Construction Industry Rules of the American Arbitration Association then in effect. Judgment upon the award may be entered in any Court having jurisdiction thereof. The prevailing party in any legal proceeding related to this Agreement shall be entitled to payment of reasonable attorney's fees, costs, and post -judgment interest at the legal rate. H. ENTIRE AGREEMENT, SEVERABILITY, AND MODIFICATION This Agreement represents and contains the entire agreement and understanding between the parties. Prior discussions or verbal Contractor Owner Owner ') t9 representations by Contractor or Owner that are not contained in this Agreement are not a part of this Agreement. In the event that any provision of this Agreement is at any time held by a Court to be invalid or unenforceable, the parties agree that all other provisions of this Agreement will remain in full force and effect. Any future modification of this Agreement should be made in writing and executed by Owner and Contractor. I. ADDITIONAL LEGAL NOTICES REQUIRED BY STATE OR FEDERAL LAW See page(s) attached: Yes No J. ADDITIONAL TERMS AND CONDITIONS See page(s) attached: Yes No I have read and understood, and I agree to, all the terms and conditions contained in the Agreement above. Y"" -&� DATE' CQ;NTRACTOR'S SIGNATU E DATE' OWNER'S SIGNATURE DATE Contractor OWNER'S SIGNATURE Owner Owner © -C q PMA BUILDERS INC. 11 GRANT ST WOBURN MA 01801 Name / Address Estimate Date Estimate # 7/7/2014 394 Project KEN ST HILLAIRE Fax # E-mail 781-608-3113 41 HERRICK RD pmabuildersl@gmail.com NORTH ANDOVER, MA 01845 Item Description Qty Total PULL NECESSARY PERMITS TO COMPLETE JOB STRIP OFF OLD DECKING AND RAILINGS STRIP OFF OLD SIDING INSTALL OWNER SUPPLIED REPLACEMENT WINDOWS INSTALL NEW WINDOWS AND DOOR IN PORCH INSTALL NEW SLIDER INSTALL OWNER SUPPLIED DECKING AND RAILINGS INSTALL OWNER SUPPLIED SIDING, ALL VINYL WITH ALUMINUM TRIM INSTALL VINYL BELT/WATERTABLE AROUND BOTTOM OF HOUSE INSTALL SHEET AZEK UNDER ALL PORCHES 1 TOTAL COST OF LABOR ONLY 12,000.00 MUST HAVE SIGNED CONTRACT TO SCHEDULE SITE CLEANED DAILY PAYMENT SCHEDULE: 1/2 AFTER TRIM WORK/ DECKS 1/4 START OF SIDING REST UPON COMPLETION Total $12,000.00 Phone # Fax # E-mail 781-608-3113 781-305-3441 pmabuildersl@gmail.com q a .vt c ACOOR O& CERTIFICATE OF LIABILITY INSURANCE) 5/21/2014 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 INS44ED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Saltmarsh Insurance Agency 751 Main Street P.O. BOX 458 Winchester MA 01890 CONTACT Susan Rubin NAME: PHONE (781) 729-4615 FAX o . (781) 729-3756 EMAIL .susan@saltmarshinsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:Western World INSURED I PMA Builders Inc. 11 Grant Street Woburn MA 01801 INSURERB:Arbella Indemnity Insurance Co. 10017 INSURER C :ACE Group INSURER D: INSURER E: INSURER F: COVERAGES I CERTIFICATE NUMBER:CL142302268 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF M/D Y POLICY EXP MM/DD Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR NPP1350257 7/31/2013 /31/2014 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN*LA GGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED AUTOS AUTOS 1020010674 12/21/2013 12/21/2014 BODILY INJURY (Per accident) $ XHIRED 11SCHEDULED AUTOSNON-OWNED AUTOS PROPERTY DAMAGE $ Per accident Underinsured motorist BI split $ 20,000 UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ C WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS' LIABILITY' Y / N ANY PROPRIETOR/PARTNER/EXECU ME L OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N / A 336B139903 8/1/2013 8/1/2014 E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Re: 43 Crocker St., Edgartown, Ma. Fred Walters Evidence of Insurance ACORD 25 (2010/05) INS025 (201005).01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE S Saltmarsh, Jr./SUSA nava ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD U n Z D o CLr C >to .� O 0 `3v Cr 0 W CD CD O A� 0 F 0 N CD C O C O co)• CD U) b v o 0 CD 3 C (D O =R 6 O =_ O <1) CDN �. 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U) OO++ - S D CD rt� CD 0 v °: a) o CL O Op C�) %4A y 0 Vf O ;7S D CD (A z O co O j M m v vN m Zi TC) S. O O aq A p T 7 N (n I 5 N x O aq S m m H m p T 7q O aqq S •p c C z �' N n O T! 7 n ? 3 fOD w , S T _ N O 0 O C v z V n (D 'O N � O 3 O O CL \Eli S O W v m _ 0 c The ComruonweaZth of.Massachusetts - De,�a�t�neatof.��td�cs�ic�l.Accic�e�ifs Office o, flfivestigaflons 644Washington Street Boston, MA 02111 Vww.MassgovIdliz Wo rkexs' Compensation InswanceAffidavit: Buffder olContraetoxo/ElecticiezansiPliimbexs Name(Busi�iesdorgauizaiionJ�ndz`vidual): Ca ylStaEel pPhone 4: Are your an. employer? Check the appropriate TO OX'- Type of project (rcegmlred): I.E] I am a employer with __ 4, d x am a general contractor and I 6. � New cOnsizuction y e ayees (full an Voxpart fime� have Wredfhe sub -contractors listed on the attached sheet: � 7• ❑ Eemodeling 2. am! a sole'proprietor Orpartner s7zip and`have na•employees These sub -contractors have 8. Demolition working forme in any capacity. workers' comp. insurance, 5• ❑ We are a corporation and its % E] Bull fg addition [Nb workOra, comp. insurance officers have exerelsed.their 10.p Electrical repairs or additions . xecluired..] 3. [] X am a homeowner doing all work right of exemption per MGL II] Plumbingxepairs or additions myself [go workers, comp. c.152, §1(4), andwehaveno 12,Q Roofxepairs insurancereuixed.� employees.. [N'oworkers' 13.❑ Other comp. insurance required.] — Any applicantthai checks boxOf wMtalso fill outthe section bd6w showing their worxers' compenswonpoucy u¢omianon. 730meowners who subiriitihis affidavit fadicatingthey go, dping allworlg aadthen hire outside contractors must' suhnait anew affidavit indicating stub. TCoutractors'ihat cheektws bcxmust attached aii additional sheet showingthename ofthe sub -contractors and their workers' comp. policyinformation. Man employer tftat is.providlvg worirers' eomue isation insurance foxnay erqI gees Burow as thepaliey ancijo i site information. Insurance Company •/ ' ExrirationDate, Policy #k ox Selz 7ns.�ic. #: � IAV 7 Yob Site Address f P41s"111314p, OR, Attach a copy oMeworkexs' compensaiion-poRcytleclaration page (showing•the policy number and eviration. date). Failure to secure covexage as xegalredunder Section 25A of MGL o.152 can lead to the imposition of crimin al P onalties of a &0 up to $1,500.00 andfox one=yeat zmprisonmextt, as well.as civil penalties in fhe forta of a STOP -WORK ORDER. and a fhe ofup to $250.00 a day against the vloXafor. Be advised that a copy ofthis statementmay be foxwaxdedto the Office o£ Investigations of fhe DT& for insurance coverage verification. x do liereby cert" uriVjrajainZvenaftles of perntry Dat tree infomadonprovidedabove is true andeorxeet /---� i -' /i' /�V /= r-/. — Oficial use a.uly. Do not write in 0is area, to he coftwTeted by city or town of elid Ci Town Permit/License - Issuing Authority (circle 6ne): 1. Board of Health 2. BuildingDepartxaent 3. CityfTown Clerk 4. Electrical Inspector 5. Plumbing l uspector f. Other I- - - Information and Instructi ons Massachusetts General Laws chapter 152 requires all employers to providewoxkers' compensation for their employees. Parsuant to this statute, an employee is defined as "...every person k the service of another under any contract ofhire; ~ express oximpRed, oral orwxiiten!, An employe N defined as "an individual, partnership, association, corporation or other legal entity, or anytwo gxmcre Of the, Foregoing engaged in a joint enterprise, and koludingthe legalrepxesentatives ofa'deceased empl4dex,.or the receiver or iriisiee ofan individual, partnership, as§a dation or other legal entity, employing employees. owevex the owner of a dwelling house having notnt ore than three apartments and who resides therein, or the occupant ofthe, dweliiug house of another who employs persons to do maintenance, construction or repair work on such dwelling house or onthe grounds orbuilding appurtenant therefo shailnot because of such employment be deemedto be an employe:" MGL chapter 152, §25C(6) also states that "every state or Ideal limnsing agency shall withhold the issuance or renewal of a license or permit to operate a Business or to construct buildings iu 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 p erforman.ce ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have b eenpresented to the contracting authority" Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if iiecessary', supply sub-contractor(,)name.(s), address(es) andphonenumber(s) along with theircertificate(,) Of Insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with. no employees other thatt the members orpartuers, are notxequiredto carry workers' compensation insurance. IfmLL C orLLP doeshave employees,apolicyisxeq-*ed. BeadvisedthatthisaffidavitmaybesubmittedtotheDepartmentof Industrial Acoidenfs fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be xetumedtc lhe city ar town thatthe application fox thepermit or license is being xegae Eed, not the Department of Industrial Accidents. Shouldyou have any questions regarding the law or if you ate required to obtain, a workers' compensatfonpolicy,pleamcall the Department atthenumberMod below. ScIf-nsuredcompanies should enter !heir self- insurance license number on the appropriate line. City or Town Officials Pleasebe sure thatthe of zdavi�L is complete andpxiuted legibly. The, Departmenthas provided a space atthe bottom of the affidavit fox you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be -sura to fdl iathe permit/license number whichwill be used as a reference number, In• addition, m applicant thatmust submitmultiple permit/license applications in any givenyear, need only submit one afixdavit indicating current policyinformafion(ifuecessa�y)anduuder"JobSite.A.ddress"theapplicantshouldwxite"aliloca6onsin (city or tow:n)" .A. copy ottRo affidavit that has been officially stamped ox marked by th e city ox town may be provided fo the applicanttasptbofthatavalid ailzdavit•isonfdaIoxfuiurepexmitsorlicenses. Anew affidavitmustbefiltedouieach year. Where a ltome owner or citizen b obtaining a license ox petit not related to any business or commercial venture Q.e. a dog license orpermit to burn leaves eta.) said person is NOT required to complete this affidavit. The Office of Xnves9gations would like to thank you in advance for your cooperation and shquld you have any questions, please do not hesitate to give us a call. The Department's address, telephone andd faxnumber: p y �# .1,`ko.Cw: ouw.Gaftl1ofY-ow.9ac,�C�u,�P-ECa�, Ofro OVIRv fcgattaxt,% ' 6,00 Waft gton Stce�i: 0AG11, 02111 TOL # 617-7-2,74900 W-, 406 ox Revised 5-26-05 Fax# 617"727-7749 ' w�•zxta��,g�•v�cxi�