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Home My WebLink AboutBuilding Permit #831-14 - 410 GREAT POND ROAD 5/15/2014TOWN OF NORfH-*M0VER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Datelssued: IMP6RTA �4T: �kpplicant must complete all items on this page ... . .. ... �OCATION pzl� PROPERTY OVVNER__ 4, k1rit 1-06ye�af'610 Stfu MAP NO: PARCEL ZONING DISTRICT: Historic District Wqchine SNOP yes rf6' yes ( no TYPE OF IMPROVEMENT. PROPOSED USE Re�dential Non- Residential ew Building Vone family V0 Addition 0 Two or more family 11 Industrial El Alteration No. of units: 11 Commercial 11 Repair, replacement 11 Assessory Bldg 11 Others: El Demolition 0 Other 11 Septic El Weli 0 Floodplain El Wetlands 0 Watershed, District 11 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: I/ Y-�` A dJ') -k- o--,11 �2 Print Clearly) OWNER: Name: OUIV6, Address: Ll (0 CONTRACTOR Name: 0 Phone: 4�0 3 ne: .54 Ive- L( Add resslo iqt S upervisor's Construc tion License 621 Exp. Date: ctllq b 6 �5- 0 /JS- 57q57 - Home Improvement License -E:xp. Date: of ARCH ITECTIENGI NEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000X6 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. Total Proiect Cost: $ FEE: $ Check No. - Receipt NO.' co"IlkwRIMEMS c9 7 v NOTE: Persons contracting with unregistered contractors do not hae ac gua��und I Lcss i t t r I g ty 6,of A re of, contract rw .6q6tiNvne gnotu Plans Submitted Lj Plans Waived / , =e�ified Plot Plan El Stamped Plans(/El Building Department :---The foL.'-ow - ingJ94-1ist. of -the e6juited.forms to be filled out-for.the appropriate. permit tob.e obtained. Roofivg, Siding, Interior Rehabilitation Permits Q B,uilding Permit Application o Workers Comp Affidavit h * P Copy Of -�.:-Licenses oto H.I.C. AndlOr C.S.L. Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products NOTE: All dumpster. permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application z, Certified Surveyed Plot Plan L3 Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) zi Mass check Energy Compliance Report (if Applicable) u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) • Building Permit Application • Certified Proposed Plot Plan c3 Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract Mass check Energy Compliance Report Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cas,�s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Builffing Pennit Revised 2012 ----aived ET-777-TCertified Plot Plan Stamped Plans Plans Submitted -.Plans W ,W- -P -..-SEWE TEDIS G -OF RAC ROSAL Public Sewer V Tanning/Mas'sageffiody Art Swinuning Pools Well El Tobacco.Sales Tood Pack�ging/Sales El Private (septic tank, etc..-- Pe'm'* adent Diunpster on'Site THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATEAPPROVED ._:..'DATE REJECTED P PLAN N IN G'&'DEVELOPM ENT LI MMENTS 01,C13 'O'F 6enerCA) zplle- CONSERVATION COMMENTS Reviewed ,-,- . � ) "A V- C>z�, , �' HEALTH Reviewed on Signature C MENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes-.. Planning Board Decision: Conservation Decision: 10 1=1 ff :Comments Water & Sewer ConnectionlSignature & Date Driveway Permit DPW To-vv;2 EnRineer: Signature: FIRE -DE0ARTM1.E`-NT - Temp Dump'ster on site yes. Lbcated-bt 124,Mair, Street -Fire DL-pattiney'itsiigriatu'feidate.-1 COMMENTS to �, L - LOcateci j�4 usgooa oireei -no -Dim-ension -- - - Number of Stories: .Tota.1--land area; sq. ft.* Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement -of. Meter location-,, mast -6 r service drop requires approval of Electrical Inspector Yes No DANGER ZONELITERATURE: -Yes No MGL -Chapter 166.section 21&�.F and G min.$100-$1000 fine NOTES and DATA — (For do artment use (-"7 / El Notified for pickup - Date Doc.Building Permit Revised 20 10 Location 4110 e�)- -(--4 — No. ?S /— / 41 Check ltl,�9- Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 2119500.00 m $ - $ 2,538.00 Fee $ 317.25 -Plumbing -Gas Fee 100 comm. $ 100.00 Fee $ 317.25 -Electrical fees collected $ 3,272.50 -Total 410 Great Pond Road 831-14 on 5/15/2014 _22x32 Addition ENO tn LL 0 0 co C: u 0 LL E Q) >. V) u -Z CL ai Ln 0 LLI IL tA z z co .2 0 Ll- w :3 0 0 Ma LL 0 IA z < bn 0 cr > Ln Ll- LU CL fA Ln < to o CC L� z < CL LU 10 ui LL CO 6 z a) Ln CL (D E (D CL 0 0 o E CD CL M ca -0 E COL CO .0 > .0 (D CL IM CL in -04- 0.0 2 (D =:E.2 Lu E 0 0 -0 (D CL (D U) -0 0 am C13 o Z.- 0 0 M Z CL 0 (-) E U) 0 tM 0 ?14 0 :o LLJ w CL x LLJ LLI CL 0 U) Cl) M 0 C-) CO) U) ui -j z M I 2 '0 M 0 CL 0 4) 0 .2 CL U) M 0 ICU "a cn rMse 10 CL U) 0) IM co 0 , IM CD 00 - I- 0 'CL CL co 0 'CL C'O top iv\ A e. LAWRENCE H. OGDEN, P.E. 198 EAST MAIN STREET GEORGETOWN, MA 01833 978-352-8318 fax 978 —352-2858 cell: 978-502-5921 July 14, 2014 Mr. Andrew Taylor 10 Fieldstone Way North Reading, Ma. 0 1846 RE: 410 Great Pond Rd. North Andover Dear Mr.Taylor As you requested I conducted a site visit 7/14/14 to review the installation of the Engineered Materials consisting of LVLs,beams utilized in the framing of the above project.. The Lvls are shown on plans prepared by you with the framing plans sheets certified by me 5/14/14. Based on the above site visit and based on what I could visibly see. I can certify that to the best of my knowledge the LVLs members and details utilized in the framing as shown on the drawings are installed properly and meet the loading conditions of the 8th Edition of the Massachusetts State Building Code for 1 &2 Family Residences, provided the following work is performed. All other framing requirements of the drawings and code, including but not limited to materials, nailing schedules, blocking, connections, manufacturers installation requirements and other details are the responsibility of the licensed construction supervisor responsible for the project. It was pleasure working with you on this project, your professional approach resulted in a well executed project resulting in compliance with the plans. Should you have any questions please do not hesitate to call. Yours truly, 4t0 enK E. Structural 27765 e CRESc eck Software Version 4.5.0 �J( Compliance Certificate Project YOUNG PARK Energy Code: 2012 IIECC Location: North Andover, Massachusetts Construction Type: Single-family Project Type: New Construction Conditioned Floor Area: 500 ft2 Glazing Area 14% Climate Zone: 5 (6322 HDD) Permit Date: Permit Number: Construction Site: Owner/Agent: 410 GREAT POND ROAD NORTH ANDOVER, MA Designer/Contractor: 55-iffiff-5WHEIR Compliance: 10.2% Better Than Code Maximum UA: 588 Your UA: 528 The % Better or worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum -code home. Envelope Assemblies Floor 1: Sl a b -On -Grade: U In heated Insulation depth: 3.5' Wall 1: Wood Frame, 16" o.c. Window 1: Wood Frame:Double Pane with Low -E Door 1: Solid Ceiling 1: Flat Ceiling or Scissor Truss Compliance Statement: The proposed building design des( calculations submitted with the permit application. The pro RESgDeckyersion 4.5.0 and to.comply with the mandatory 500 18.0 0.659 330 1,960 22.0 0.0 0.056 93 272 0.300 82 21 0.290 6 564 38.0 0.0 0.030 17 is consistentwth the building plans, specifications, and other ing has In designed to meet the 2012 IECC requirements in 11 ts I ist i the R Scheck Inspection Checklist. - UZ e Date Project Title: YOUNG PARK Report date: 05/15/14 Data filenarne: Untitled.rck Page 1 of 8 1ZRE c eck Software Version 4.5.0 Inspection Checklist Energy Code: 2012 IECC Requirements: 0.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. section # Pre-inspection/Plan Review Plans Verified Value Field Verified Complies? CommentslAssumptions & Req.1D 103.1, ;Construction drawings and ElComplies 103.2 documentation demonstrate E]Does Not [PR111 energy code compliance for the E]Not Observable 0 :building envelope. E]Not Applicable 103.1, Construction drawings and ElComplies 103.2, docurnentation demonstrate E]Does Not 403.7 :energy code compliance for E]Not Observable [PR311 Jighting and mechanical systems. E]Not Applicable 4 :Systems serving multiple dwelling units must demonstrate compliance with the IECC ,Commercial Provisions. 302.1, Heating and cooling equipment is Heating: Heating: ;E]Complies 403.6 !sized per ACCA Manual S based Btu/hr Btu/hr UlDoes Not [PR2]2 ;on loads calculated per ACCA Cooling: Cooling: :F�Not Observable Manual J or other methods 1 Btu/hr Btu/hr :E]Not Applicable !approved by the code official. Additional Comments/Assumptions: 11 High Impact (Tier 1) 2 1 Medium Impact (Tier 2) 3 1 Low Imp.z. Project Title: YOUNG PARK Report date: 05/15/14 Data filename: Untitled.rck Page 2 of 8 Section # Foundation Inspection Plans Verified Val Field Verified Value Complies? Comments/Assumptions & Req .11) 402.1.1 ;,Slab edge insulation R -value. R-R- ;E]Complies :See the Envelope Assemblies [FO111 Unheated E] Unheated :E]Does Not table for values. E] Heated Heated :E]Not Observable :E]Not Applicable 1: 303.2, Slab edge insulation installed per ElComplies 402.2.9 'manufacturer's instructions. E]Does Not [F0211 E]Not Observable E]Not Applicable 402.1.1 ',Slab edge insulation ft ft :0Complies See the Envelope Assemblies [F0311 depth/length. :E]Does Not ;table for values. :[-]Not Observable :F -]Not Applicable 303.2.1 !A protective covering is installed ElComplies [FO1112 !to protect exposed exterior E]Does Not ;insulation and extends a E]Not Observable iE]Not minimum of 6 in. below grade. Applicable 403.8 ;Snow- and ice -melting system ElComplies [FO12]2 :controls installed. IE]Does Not []Not Observable E]Not Applicable Additional Comments/Assumptions: 111 High Impact (Tier 1) 12 1 Medium Impact (Tier 2) 13 1 Low impact (Tier 3) 1 Project Title: YOUNG PARK Report date: 05/15/14 Data filename: Untitled.rck Page 3 of 8 Section # Framing / Rough -in Inspection I Plans Verified Value Field Verified value 1 Complies? Comments/Assumptions 1 & Req.ID 402.1.1, Door U -factor. U_ U_ : See the Envelope Assemblies :E]Complies I 402.3.4 :E]Does Not table for values. [FR111 i0l\lot Observable :E]Not Applicable 402.1.1, ',Glazing U -factor (area -weighted U- U_ ':F—]Complies ;See the Envelope Assemblies 402.3.1, average). :table for values. :E]Does Not 402.3.3, 402.3.6, :E]Not Observable 402.5 :E]Not Applicable [FR211 303.1.3 U -factors of fenestration products []Complies [FR413 !are determined in accordance E]Does Not � with the NFRC test procedure or :taken E]Not observaDle from the default table. E]Not Applicable 402.4.1.1 ;Air barrier and thermal barrier ElComplies (FR2311 ;installed per manufacturer's E]Does Not instructions. ONot Observable E]Not Applicable 402.4.3 Fenestration that is not site built E]Complies [FR20]1 ;is listed and labeled as meeting E]Does Not AAMA /WDMA/CSA 101/l.S.2/A440 E]Not Observable :or has infiltration rates per NFRC E]Not Applicable �400 that do not exceed code limits. 402.4.4 1 IC -rated recessed lighting fixtures ElComplies [FR16]2 � sealed at housing/interior finish E]Does Not 0-1 land labeled to indicate :52.0 cfm []Not Observable leakage at 75 Pa. E]Not Applicable 403.2.1 Supply ducts in attics are R- R- :E]Complies [FR1211 insulated to -�-R-8. All other ducts :E]Does Not R- R- in unconditioned spaces or 4 :E]Not Observable outside the building envelope are :E]Not Applicable insulated to aR-6. 403.2.2 All joints and seams of air ducts, ElComplies [FR1311 !air handlers, and filter boxes are E]Does Not sealed. ONot Observable []Not Applicable 403.2.3 Building cavities are not used as ElComplies (FR15]3 'ducts or plenums. E]Does Not E]Not Observable []Not Applicable 403.3 �HVAC piping conveying fluids R- R- [FR17]2 ;above 105 QF or chilled fluids :[]Does Not below 55 QF are insulated to aR- �0) :E]Not Observable 3. :E)Not Applicable 403.3.1 Protection of insulation on HVAC �Elcompiies [FR24]2 piping. E]Does Not E]Not Observable IE]Not Applicable 403.4.2 Hot water pipes are insulated to R-_ R- iElcomplies [FR18]2 —R-3. :E]Does Not ENot Observable �01\lot Applicable 11 JHigh Impact (Tier 1) 12 1 Medium Impact (Tier 2) ict (Tier 3) Project Title: YOUNG PARK Report date: 05/15/14 Data filenarne: Untitled.rck Page 4 of 8 Section # Framing / Rough -in Inspection Plans Verified Val Field Verified Value Complies? Comments/Assumptions & Req . ID� 403.5 ,Automatic or gravity dampers are OComplies (FR19]2 installed on all outdoor air MDoes Not intakes and exhausts. E)Not Observable IE]Not Applicable Additional Comments/Assumptions: 111 High Impact (Tier 1) npact (Tier 2) 1 3 JLow Impz Project Title: YOUNG PARK Report date: 05/15/14 Data filename: Untitled.rck Page 5 of 8 Section # Insulation Inspection Plans Verified Value Field Verified Value Complies? Comments/Assumptions & Req. ID 303.1 !All installed insulation is labeled ElComplies [IN13]2 or the installed R -values E]Does Not provided. E]Not Observable I E]Not Applicable 402.1.1, :Wall insulation R -value. If this is a; R- R- ;E]Complies See the Envelope Assemblies 402.2.5, : mass wall with at least 1/2 of the E] Wood [-] Wood :E]Does Not table for values. 402.2.6 :wall insulation on the wall 0 mass E] mass :[]Not Observable [IN311 :exterior, the exterior insulation requirement applies (FR10). El Steel F1 Steel :RNot Applicable 303.2 :Wall insulation is installed per E]Complies [IN411 !manufacturer's instructions. E]Does Not E]Not Observable ONot Applicable Additional Comments/Assumptions: 111 High Impact (Tier 1) 12 1 Medium Impact (Tier 2) 13 1 Low Impact (Tier 3) 1 Project Title: YOUNG PARK Report date: 05/15/14 Data filenarne: Untitled.rck Page 6 of 8 Section # Final Inspection Provisions I Plans Verified Value Field Verified Value Complies? Comments/Assumptions & Req.113 402.1.1, ;Ceiling insulation R -value. R- R- :DComplies See the Envelope Assemblies 402.2.1, Jable for values. E] Wood Wood ElDoes Not 402.2.2, Steel Steel :E]Not Observable 402.2.6 [F1111 :E]Not Applicable 303.1.1.1, ;,Ceiling insulation installed per ElComplies 303.2 :manufacturer's instructions. E]Does Not [F1211 4own insulation marked every E]Not Observable i 300 ft�. E]Not Applicable 402.2.3 Vented attics with air permeable ElComplies [F122]2 insulation include baffle adjacent IONot E)Does Not to soffit and eave vents that E]Not Observable extends over insulation. I Applicable 402.2.4 !Attic access hatch and door R-_ R- ;TIComplies [F1311 insulation -aR-value of the :E]Does Not :adjacent assembly. :E]Not Observable :E]Not Applicable 402.4.1.2 Blower door test @ 50 Pa. <=5 ACH 50 ACH 50 11E]Complies (FI17]1 :ach in Climate Zones 1-2, and :E]Does Not <=3 ach in Climate Zones 3-8. :[--]Not Observable tlNot Applicable 40 2.4.2 lWood-burning fireplaces have _1EINot ElComplies ]2 [F18 litight fitting flue dampers and E]Does Not outdoor air for combustion. -]Not Observable Applicable 403.2.2 Duct tightness test result of <=4 cfm/100 cfm/1 [F1411 �cfm/100 ft2 across the system or ft2 ft2 :E]Does Not <=3 cfm/100 ft2 without air :E]Not Observable handler @ 25 Pa. For rough -in ;E]Not Applicable 'tests, verification may need to :occur during Framing Inspection. 403.2.2.1 Air handler leakage designated ElComplies [F12411 :by manufacturer at <=2% of I E]Does Not :design air flow. ONot Observable E]Not Applicable 403.1.1 1 Programmable thermostats ElComplies [Flg]2 ;installed on forced air furnaces. E]Does Not E]Not Observable E]Not Applicable 1� 403.1.2 Heat pump thermostat installed ElComplies [F110]2 ion heat pumps. E]Does Not IE]Not 14-41 []Not Observable Applicable 403.4.1 Circulating service hot water E]Complies [Flll]2 :,systems have automatic or E]Does Not !accessible manual controls. []Not Observable []Not Applicable 403.5.1 �All mechanical ventilation system OComplies [F12512 i fans not part of tested and listed []Does Not HVAC equipment meet efficacy EJNot Observable :and air flow limits. E]Not Applicable 111 High Impact (Tier 1) 2 1 Medium Impact (Tier 2) 3 1 Low Impact (Tier 3) .1 Project Title: YOUNG PARK Report date: 05/15/14 Data filenarne: Untitled.rck Page 7 of 8 Section # Final Inspection Provisions I Plans Verifle value ield Verified Value Complies =Co M M ents/Assumptions & Req .11) 403.9.1 Readily accessible switch on ElComplies [FI12]3 heaters for swimming pools or E]Does Not permanent in -ground spas. 19) E]Not Observable ONot Applicable 403.9.2 ;Jimer switches on heaters and DComplies [FI19]3 !pumps serving pools and []Does Not permanent spas. E]Not Observable E]Not Applicable 403.9.3 �Heatecl pools and permanent ElComplies [F120]3 'spas have a vapor retardant 0Does Not cover. 10) []Not Observable E]Not Applicable 404.1 75% of lamps in permanent OComplies [F1611 'fixtures or 75% of permanent E]Does Not I �fixtures have high efficacy lamps. 0 E]Not Observable Does not apply to low -voltage E]Not Applicab le lighting. . 404.1.1 Fuel gas lighting systems have IE]Complies (F12313 no continuous pilot light. E]Does Not IE]Not Observable JE]Not Applicable 401.3 ;Compliance certificate posted. OComplies [F17]2 E]Dot2b PJUL E]Not Observable ONot Applicable 303.3 Manufacturer manuals for OComplies [Fil8]3 mechanical and water heating []Does Not �systems have been provided. E]Not Observable FINot Applicable Additional Comments/Assumptions: 111 High Impact (Tier 1) npact (Tier 2) 1 3 1 Low Impa Project Title: YOUNG PARK Report date: 05/15/14 Data filenarne: Untitled.rck Page 8 of 8 fz2012 IECC Energy Efficiency Certificate Wall 22.00 Floor 18.00 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): Window 0.30 Door 0.29 Heating System: Cooling System: Water Heater: Name: Date: Comments Massachusetts - Department of Public Safety -Board of Building Regulations' ndStandards a Construction Supemiwr License: CS -048010 ANDREW V TAYOR 10'FIEEILDSTONE:* NREADINGMA�-018 Expiration Cornmissi6ner 09/10/2015 Office of Consumer Affairs s4 License or registration valid for individul use only M 0 E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: st egi ration: �125545 Type: Office of Consumer Affairs and Business Regulation k'VJE,pi "tion ----1/2 12016 Individual 10 Park Plaza - Suite 5170 Boston, MA 02116 TAYLOR MADE VICTOR TAYLOR 101 RESERV61R ST CHERRY VALLEY, MA 1-61-1 Und,rs-6cretary Not �alid'witho'ut)dgnature Taylor Made Construction 10 Fieldstone Way, North Reading MA 01864 (508) 243-5254 "Ic ja��S�q5 To: Mr. Young Park 4 10 Great Pond Rd North Andover, MA April 11, 2014 Proposal : construction of a 22x22' addition. Permitting with structural plans by Andrew (not full detailed design plans.) Demo and disposal as required. Relocate irrigation. Excavation: and backfill for addition. A 6" base of 1/4" stone will be provided in the cellar area. Gravel removed for excavation will be stored on site and any excess will be hauled away. Site work beyond the building envelope and ledge removal would be additional. Cut key ways, reglets, and install water stop into existing foundation where new foundation will meet. Concrete Foundation: 3000 psi concrete footings and walls according to plan. Concrete floors at cellar, 400OPSI, 4" thick, 4 mil poly, with 5x5 wire mesh and 2" rigid foam beneath. Frame: L & M according to plan Roof. New roofing to match existing as close as possible. Exterior Trim and Siding: to match existing. Exterior paint: 2 coats Exterior Windows: Anderson 200 series pre -finished interior sash with grills: Size to match existing. 17 new double hung, 3 units re -used from existing house. I ThermaTru 3068 nine lite smooth fiberglass. HVAC: Extend into addition from existing RVAC Electric: Outlets to code. Lighting budget $2,000.00. Add smoke detectors where needed. Interior Finish Trim: Baseboard and casing to match existing. 2668 left hand Fritz glass 15 lite door into walk-in closet. Cased openings from dining room. Insulation: I inch of closed cell spray foam plus fiberglass batts to meet Mass Code. Blueboard and Plaster: Smooth walls smooth ceilings. Interior Paint: 2 Coats to all surfaces. Flooring: approximately 1,100 s.f.@ $10.00 per SF Total $146,900.00 Payment terms; Receipt of permit $5,000.00 plus permit fee Excavation of cellar hole $9,000.00 Foundation footings and walls $9,000.00 Delivery of frame, first and second floor $9,000.00 Completion of second floor deck $9,000.00 Delivery of roof trusses and roof framing $9,000.00 Completion of fi-ame $9,000.00 Roof shingles complete $9,000.00 Delivery of windows and door $9,000.00 Installation of windows and door $9,000.00 Trim and siding 50% complete $9,000.00 Trim and siding complete $9,000.00 Hvac and electrical rough $9,000.00 insulation and blueboard $9,000.00 Plaster $9,000.00 Finish trim and paint $9,000.00 Flooring $6,900.00 Total $146,900.00 plus permits Acceptance of Proposal: Buyer Signature Date: Contractor Signatural-ai Date: We propose hereby to ftimish all labor, materials, accessories, equipment and supplies necessary as per the above requirements and specifications. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. C 0� Apppoy"(0)4�� jL.'gA(J'v' n PSTATE AUTW Wr- �) I A Y L U�'H � H 2ULINN0078230 001864 f Insurance Companies INSURED COPY BOP 2730624 01 BUSINESSOWNERS POLICY COMMON DECLARATIONS NAMED INSURED AND MAILING ADDRESS: AGENT NAME AND ADDRESS: First Named insured Is Specified To Be: LINNANE INS AGENCY INC ANDREW TAYLOR 280 MAIN ST STE 101 10 FIELDSTONE WAY NORTH READING, MA 01864 N READING, MA 01864 BUSINESS DESCRIPTION: Carpentry - Residential POLICY PERIOD: AGENT TELEPHONE NUMBER: AGT. NO. — From: 04/03/2014 TO: 04/03/2015 (978) 664-2000 0078230 COVERAGE PROVIDED BY: A STATE AUTO INSURED SINCE: Patrons Mutual Insurance Company of Connecticut 2011 AUDITABLE POLICY: � POLICY STATUS: AFTER-HOURS CLAIMS SERVICE. Yes Renewal - Standard 800-766-1853 or www.stateauto.com i ne coverage ana tnese declarations are effective 12:01 AM Standard Time on 04/03/2014 at the above mailing address. BUSINESS ENTITY TYPE: BILLING ACCOUNT NUMBER: BILLING QUESTIONS? Individual CB00582169 Call 800-444-9950 X5118 Direct Bill Insured 4 -Pay BUSINESS DESCRIPTION: Carpentry - Residential Upon valid payment of premium when due, these renewal declarations continue your policy for the period indicated. In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide the irisurance as stated in this policy. PREMIUM SUMMARY BY COVERAGE PARTS AND POLICIES This policy consists of the following coverage parts or policies for which a premium is indicated. This premium may be subject to adjustment. COVERAGE PARTS PREMIUMS Businessowners Special Property Coverages $29.00 Commercial General Liability Coverage Part $605.00 Businessowners Extra Coverage $27.00 Comn�ercial Inland Marine - See IM Declarations SM 50 00 $78.00 Terrorism (included in total below) $7.00 POLICY TOTAL AT INCEPTION $739.00 If terminated at your request, this policy is subject to a minimum retained premium of These declarations together with the Common Policy Conditions and coverage form(s) and any enclorsement(s) identified on these declarations and attached to your policy complete the above numbered policy. Countersigned (Date) By 350.00 (Authorized Representative) Issue Date 0112012014 10.'41-.03 AM BP 60 00 (01/08) Page 001 of 002 �IIIZI TRAVELERS40P TYPE AR RKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (GHUB-5B31898-1-14) RENEWAL OF (6HUB-5B31898-1-13) INSURER: THE TRAVELERS INDEMNITY COMPANY OF AMERICA 1 INSURED: TAYLOR, ANDREW 10 FIELDSTONE WAY NORTH READING MA 01864 Insured IS AN INDIVIDUAL NCCI CO CODE: 13439 PRODUCER: LINNANE INSURANCE AGENCY 280 MAIN STREET NORTH READING MA 01864 Other work places and identification numbers are shown in the schedule(s) attached. - 2. The policy period is from 04-11 -14 to 04-11 -15 12:01 A,M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE:'Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 500000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 OGA D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All.required Information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 03-31-14 JA . OFFICE: ORLANDO INDUS AFF 161 PRODUCER: LINNANE INSURANCE AGENCY 000559 77TGX ST ASSIGN: MA The Commonwealth ofMassachusetts Departme-ntoflndustrialAceldi�ts Office Of Ifivesfigaflons 600 Washington Street Boston, MA 02111 www.mass-govIdia wo 01 Compensation Insurance Affidavit: BuildersIContractors/FIectricians/.Pliimberq Name CBusin�ss/Organi-zationgudividual): City/;Statc_/Zp:. A Phone#: rl"q Z;zt /I/ Are Vd an employer? Check the appropriate box: Type of project (required): 1. UI am a employer 4. 0 1 am a general contractor and 1 6. El New construction qith V employees (fall an rpart-time). have hired the sub -contractors listed on the attached sheet. T 7. 0 Remodeling or or.0 2111 am a SOID pr riot r orp or- ship and'lavano.employees These sub -contractors have S. El Demolition ' working for me, in any capacity. workers' comp. insurance. 5. El We are a corporagon, and its 9." uilding addition PTo workars' comp. insurance, required.] officers have oxercised.their 10.E] Electrical repairs or additions 3.E] I am a homeowner 40ng all work right of exemption per MOL ILE] Plumbing repairs or additions myself. LWo workers' comp. c. 152, §1(4), and we have no 12.QRoofrepairs insurancarequireq.] T employe6s. [No workers' 13F] Other comp. insurance required.] NAnyapplicant that diecks box #I must also fill out the sectionbeldwsho-wing their Workers' compensation polipyinfoirnation. i Homeowners who submit !his affidavit fndicltini the� Ai� d9ing all. work and then hire outside contractors must submit a now affidavit indloatifig such. tContractors that che A this b ox must attache d an gdditional sheet showing the name of the sub -c ontractors and their workers' comp. p olicy infon-nation . I am an employer that isproviding workers' compensation insurancefor my employees. Below is thepolley andjob site information. Insurance Company Name% JeAT)w 3 Expiration Date: ' q/6 P011GY #Or S ON illS. UG. M: — f Job Site Address Pity/S tate/Zip.,O& AA,9 (Xt _q10 CACA+ L-OAIJ P Attach a copy oftlte workers' compensation-polley declaration page (showing the policy number and expiration date). Failure to secure coverage'as requiredunder Section 25A ofMGL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one�year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine ofup to $250.00 a day against the, Violator. Be advised that a copy of this statement may be, forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do h ere b! Yy e. r1t u A Jer thei4tfandpenaftles ofperjury that the informationVrovided ahoy r is true and correct. h kl,.l Ofil-cial use oply. Do not write in Mis area, to he conVietedby cli�y or town official CityorTown: Permit/License it Issuing Authority (circle 6ne): 1. Board of Health 2. Building Department 3. Cltyffown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other ContactPerson: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for thek employees. Pursuarit to this statute, an employee is defined, as every person hi the service of another under any contract ofhiray express orimplI4 oral orwritten:' An employWis defined as "an hadividual, partnership, association, corporation or other legal entlty� or any two ormore of the B6r�joliuj engaged in ajohit enterprise, and inclading the legal representatives of xdeceased empjOya4 or the receiver or. trustee of an individual, partnership, askolation or other legal entity, employing employees. 06varthe owner of a dwelling house having notmore than three apartments and who resides therein, or the occupant of the dwellinghousa of another who employs persons to do maintenance, construction orrepair workon such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be, deemed to bean employer." MGL chapter 152, §25C(6) also states that "everY State Or lo'cal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constiruct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political sub6isions shall enter into any contract for the performance of til acceptable evidence of complipce with the ins public work un ' urance requirements of this chapter have beenpresented ta the contracting authority." Applicants Pleas.offl out the workers, com fidavit completely, by checking ffie, boxes that apply to your situation and, if ponsailon, af n6cegsarY, supply sub-contractor(s) name(s), aftess(es) andphonanumber(s) alongwiththeir cortificate(s) of insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the members orpartners, are not required to carryworkers, compensation insurance. If anL—TC orLLP doeshave, employees, apolleyis required. B a advised thatthi� affidavit maybe submitted to the Department of Industrial Accidents for confirmationof insurance coverage. Also be sure to sign and date the affidavit. !he affidavit should be retumddto the city or town thattlib application for thapermit or license is being requested, not the Dep,artmont of Industrial Accidents. Shouldyou have any questions regarding the law orif you are required to obtain a *orkers' coinponsation policy, please call the Department at the number listed below. Self-lu=ed companies should enter their self-insurance license number on the appropriate Eno. City or Town Officials Please, be sure that the af ff davit is complete. and printed legibly. The, Department has provided a space attho bottom of the affidavit foryou to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be-suro to fdl in the permifflicenso number which will be used as a reference number. In addition, an applicant that r�ust submit multiple permit/license applications in any given year, need only submit one, affidavit indicating cutr6nt p olicy i0ormation (if necess my) and under "lob Site Addross'� the applicant should write "all lo c'ations in or tovm).:) A: 6opy of the affidavit that has been offloially st ' edormarkedbythecifyortownmaybe amp provided to the, applicant as proof that avalld affidavit -ii onfilc�brfatmaPemlits orlicenses. A -now affidavit must be flffqd out each year.'Where, a home, owner or citizen is obtaining a license oi�ermit not related to any business or commercial venture (i.e. a dog license orljermit to burn leaves etc.) said person is NOT required to complete this affidavit. The, Office of Investigations I would like to thank you in advance for your cooperation and should yqu have any questions, please do not hesitate to give us a call. The D, epartment' s address, telephone. and fax number: The CQM .0ajttL OfM q ,q MQRW Dqparftueut offad-uMal Accidonta ofte OURVIPStiga-amm - 6 0 wasbivawa SfXQI�t Boston,M-A02111 iel,#617�727-4900QY,t4Q6o.r-1-877�WAS,� I Revised 5-26-05 FaY, 0 617-727-7749 0 0 C) IT14 C-1 CY) 0) C\� Q) (T5 LLI 0 a_ ;., -W Q) LLI C.) 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