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Building Permit #473-15 - 44 CASTLEMERE PLACE 11/17/2014
BUILDING PERMIT oFst,eD,s�ti` TOWN OF NORTH ANDOVER 3� z'``•- . a�..6 0 APPLICATION FOR PLAN EXAMINATION T b Permit No#: LILIS Date Received Ac US Date Issued: V P IMPORTANT: Applicant must complete all items on this page LOCATION 7D, Print PROPERTY OWNER ,c / Print 100 Year Structure yes n MAP ©37 PARCEL. Z _ ZONING DISTRICT-stPA Historic District yes no. Machine Sho1. 1p Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial KAlteration No. of units: ❑ Commercial ,Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic p Well ❑ Floodplain ❑ Wetlands ❑ Watershed District [Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Aemeale /cii Identification - Please Type or Print Clearly OWNER: Name: Phone: V 8-7C/-SyC/ Address: VCa s/lei dJ Contractor Name: 1' ` Q,l�'"Y'P one Address: 33 Nm ���'�� G/t�^1�., Y ,//,? a Date: Supervisor's Construction License: 7_6)!?L32 Y Exp Home Improvement License:,, Exp Date: ARCHITECT/ENGINEER `'l / Cg Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ ' 2 . 3 Z e9 FEE: $ Check No.: ')*"? 3 Receipt No.: eg-`� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner 21 Location +5 (2aSJ(e WLR¢" No.A y 3 — it; Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check # ' 2 1 (2 2'U'2 I Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public SewerTanning/Massage/Body Art ❑ Swimming Pools 11 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH t COMMENTS Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: ., Conservation Decision: Comments omments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street - Fire Department signature/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.$100-$1000 fine wu 1 CJ ana UA I A - (1 -or department use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pen -nit Revised 2014 r 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 o 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 ❑ 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 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 ❑ 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 ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Cakulat/on Construction Cost $ 72,320.00 m $ - $ 867.84 Plumbing Fee $ 108.48 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 108.48 Total fees collected $ 1,184.80 Foundation 100 45 Castlemere Road 473-15 on 11/17/14 Remodel Kitchen v C O U) n -0 O CD ZU) CD o� A) CL �• N � O � < vCD CD O CL cr CD CD O � co ou CD EL O CD (. C � v N O CD n VEIRLO O CD O CD � n c r m m in n 0 Z in m x � ;u /cam m C!� A `, Z D O Z 0i, S CD N to 0 �o CD co c 0 U) 0 Q N N 0 o = c 0 -q IlL C CD' CD n CL � m o �� FD 0 O. TI O •� Q 0 m W a v, cn0 CD CD 2 00 m D F = o c0 0• .-. N o 0 S 0 CD CD y. rt 0 0 y --h CD O 0, S CD no n Q y CD 0 C CL 0 : W � C r C * * N .+ A. 0 _ w_ w CD S •v '■ CD p � CD S s 0 U) 0 �. 0 CD '0 0 o � rt 2) o m CL 0 N '0 W T.Z7 T N � T A cn c (1 x T N T C z !DS. Z: cn : ,a: M: ° Do °—' O °—' °—' D O Z 0i, S CD N to 0 �o CD co c 0 U) 0 Q N N 0 o = c 0 -q IlL C CD' CD n CL � m o �� FD 0 O. TI O •� Q 0 m W a v, cn0 CD CD 2 00 m D F = o c0 0• .-. N o 0 S 0 CD CD y. rt 0 0 y --h CD O 0, S CD no n Q y CD 0 C CL 0 : W � C r C * * N .+ A. 0 _ w_ w CD S •v '■ CD p � CD S s 0 U) 0 �. 0 CD '0 0 o � rt 2) o m CL 0 N W T.Z7 T N � T A T (1 x T N T C !DS. ° Do °—' °—' °—' °—' � �. n. rf opo m ago 3 aq ( n SS :3S CL n \ � °+ 0 Z n r+ 0 s m m m W 3 C C3 O 7o G1 H '° ° e A Z ° M Z a c) O �_ A Vf N y m O m m m D n O 0 O = z z �` 0 c = __*'EtWAW CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD) 10/9/201414 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 FICATE HOLDER. 0 DER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(los) must be endorsed. If SUBROGATION IS WAIVED to subject 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). j� VRODUCER CONTNAMEACT Sarah Cullen, AINS, ACSR GROSS INSURANCE - LACONIA PHONE (603)524-2425 FAX A/C No (603)524-3666 155 Court Street E-MAIL gss:scullen@crossagericy.com INSURERS AFFORDING COVERAGE NAIC p yNH 03246 INSURERA:Fireman Is Ins. CO. of DAMAGE TO RENTEDPREMISE Ea occurrence $ URED /NSURED OCCUR PA5095073-11 6/10/2014 6/10/2015 JDL BUILDING & REMODELING OF NEW ENGLAND LLC INSURER 8: 33 PALM DRIVE INSURER C: INSURER D RSONAL & ADV INJURY $ INSURER E: GREENLAND NH 03840 GENERAL AGGREGATE $ =OVFROr;FS f%MDT101f%AT0 wu ur_r.-nr n �� INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED KtVISIVN NUMBER: NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DOCUMENT WITH RESPECT TO WHICH THIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR ILTR TYPE OF INSURANCE TD—DL SUER POLICY NUMBER MM/DCDY� MMIDD� GENERAL LIABILITY LIMITS EACH OCCURRENCE $ 1,000,000 ERCIAL GENERAL LIABILITY p!.LAIMS-MADE a DAMAGE TO RENTEDPREMISE Ea occurrence $ 250,000 OCCUR PA5095073-11 6/10/2014 6/10/2015 MED EXP (Any one person) $ 5,000 RSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 ELIMITAPPLIESPC PRO- PRODUCTS-COMP/OPAGG $ 2,000,000 YF_ Y LOC $ LLAADE ILE LIABILITY COMBINED SINGLE LIMITEa accident 1 000 000 AUTO WNED X SCHEDULED AA5095643-11 6/10/2014 6/10/2015 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ AUTOS X NON -OWNED PROPERTY DAMAGE$ AUTOS AUTOS Per accidentELLA Uninsured motorist ro ert$25 000 LIAB OCCUR EACH OCCURRENCE $ 2,000,000 S LIAB CLAIMS -MADE AGGREGATE $ 2,000,000 X 0 UA5099323-11 /10/2014 015DED A WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY Y/N „IILY X WC STATU•JOTR ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F N/A E.L. EACH ACCIDENT $ 500 000 (Mandatory In NH) A5095646-11 6/10/2014 6/10/2015 If yes, describe under E.L. DISEASE - EA EMPLOYE $ 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Jason Lajeunesse is excluded from workers compensation coverage. rCQTIFIRaTF Wn1 11C0 Town of North Andover MA 1600 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building 20, Suite 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Jessica Hildreth/JH5 ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r7mnnsi m Tho arnRn nama onrl Inn^ OrA ranlafarart marlrc of ArnRn Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supentisor License: CS-094379 `,� r•. rlI-S JAMES C MATTf�U 1 GARRISON ROAD SALEM NH 0307-9 Expiration Commissioner 01/31/2016 e 0 0 CL — c o o � = I- 73 0 o en ti- 1.0 of o V J W =�a 7 7 y V (,..: . ?7 y a> y L �OwO C �.. OC -0 � yy Ri (n (l _ y y L O ai W N E!otf Cm 'C. U` E oww 7 C W ~ g og t ED Q W a W J (n Q M Q' cQ 'O es 'C C O N «. Z L „ULL� � c 0 ,.a � O .• Ca � o a y U 0 CL — = I- 73 0 N Z ti- 1.0 of o V J W ui V (,..: . �.. uJ ° d C c (n (l _ ai W N E!otf Cm 'C. U` E oww Z Z D °z z � J g og Z ED Q W a W J (n Q M Q' The Commonwealth of Massachusetts - Department oflndifstriglAccidents Office of Invesfigations 600 Washington Street Boston, MA 02111 UT www mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep-ibly Name �fpL RU%l Gi/hat., �,' Address: .3 3 f hs l r)'ve 6-e?<h1 chaff 4. El am a general contractor and I City/State/Zip: /y ",./ A! 03 ry 0 Phone Are you an employer? Check the appropriate box: Type of project (required): 1. !—X am a employer with % 4. El am a general contractor and I 6. ❑ New construction F employees (fall and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. T 7. ®Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. El Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. C. 152, §1(4), and we have no 12.❑ Roofrepairs insurance required.] q ] employees. [No workers' 13.❑.Other comp. insurance required.] *Any applicant that checks box41 must also fill outthe section below showing their workers' compensation policy information. i -Homeowners who submit this affidavit indicatingthey P' a doing all work and then hire outside contractors must submit anew affidavit indicating such. ?Contractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lam an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:. 1�c 't d/ Policy # or Self -ins. Lie. #: w ©//1'Expiration Date: (o�/��Z o / Job Site Address: �%(� Ca I f �� u G -r City/State/Zip: �5" °� cr `-f ✓ �l�. Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required -under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil -penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby certto under the pains and penalties of perjury that the information provided above is true and correct. Sim ature: Date: 11h -2 `/ Phone #• 141— �/ Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, - express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a j oint enterprise, and including the legal representatives of a -deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct 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 subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If au LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Con=onwoalth of Massachusetts Department of Zndusirial .Accidents OfSpe offnvestigatiom 6Q0 Washingtoza Street Boston} MA, 021.1.1. Tol, # 61.7-727-4900 at 406 ox 1-877.:MASSAFE Revised 5-26-05 Fax 0 617-727-7749 www-mass,govfdia J -Db -Building & Remodeling 33 Palm Drive Greenland, NH 03 840 Name / Address Bob and Donna Cuomo 45 Castlemere Place North Andover, MA Estimate Date Estimate # 11/17/2014 1039 Project Item Description Total 01 Plans & Permits 1. Plans & Permits - Permit fee not included, to be billed to owner at cost 0.00 Rental Equipement 2. Dumpster Toilet - Use existing dumpster toilet 0.00 Demoltion 3. Cabinetry removed for repurposing by others 0.00 Kitchen Remodeling 4. Cabinetry / Counter Allowance $47,000 53,000.00 5. Kitchen Installation/ Oversite $6,000 Electrical Service 6. Base Elcectrical - Assumes all items are ok, with some minor provision for basic 2,020.00 electrical tbd $720 allowance 7. Fan in Can For range hood/ boiler room make up air - Provideintake fan to exterior in boiler room to turn on when range hood turned- to prevent CO2 issues $1300 14 Plumbing 7. Plumbing 4,300.00 a. Prvoision of Fixtures $2100 Allowance b. Install new Kitchen Faucet/sink, Install New wet Bar Faucet/sink c. connect new dishwashers Appliances 8. Appliance for new kitchen $13,000 allowance 13,000.00 Total $72,320.00 ..A MASSACHUSETTS CONTRACT FOR CONSTRUCTION SERVICES This agreement made this & day of October 2014, by and between JDL BUILDING & REMODELING OF NEW ENGLAND LLC (HIC # 153003), herein called the "contractor", and Bob & Donna Cuomo, herein called the "Grantee". The location of the project is 45 Castlemere Place, North Andover, MA The Contractor and Grantee mutually agree: The contractor, having visited the site, is satisfied that all costs included with this project are included in this bid. The contractor shall furnish, all labor, materials, equpment, and services to complete all tasks associated with the Scope of Work specified within the proposal and/or other documents. Documents specifying scope of work: - Proposal #1015 — dated 10/2/2094 Contract Amounts and Payments: The Grantee shall pay the contractor for the performance of work in accordance with the terms and conditions of this Contract for the sum of $25,050 Twenty Five Thousand Fifty Dollars. A down payment of $0 is required, rendering a balance of $25,050 which shall be paid per payment schedule: 'note- the contract amount does not reflect possible cost plus modifications to proposal Scope of time and warranty The work shall start on October of 2014. The contractor shall correct any defects due to faulty materials or workmanship within three hundred sixty-five (365) days of Contract completion. Default The Grantee may declare the contractor in default for any of the reasons listed below and may terminate in whole or part any portion of this Contract. • Failure to begin work within a time frame that correlates to the start date specified • Farfure to provide adequate labor, equipment, or materials to ensure work is completed as specified • Failure to remove and replace any work rejected by the Grantee as unsatisfactory .e,Unsatisfactory performance Permit Notice: It shall be the obligation of the contractor'to obtain the required permits as the owner' ' agent. Owners who secure their own construction -related permits or deal with unregistered contractors slIl be excluded from access to the Guarantee Fund. Permit(s) required: Building Pe"it, Plumbing Permit, and Electrical Permit Contractor Signature /Date C Grantee Signature/ Date Page 1 of 2 I MASSACHUSETTS CONTRACT FOR CONSTRUCTION SERVICES Disputes The contractor and the grantee hereby mutually agree in advance that in the event that 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 Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. Contractor Signature: Grantee Signature: J1y The signatures of the parties above applies only to the agreemen f the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties." Notices: The grantee by law is entitled to cancel this contract within three days as specified under MGL c 93 s 48; warranty rights under the provisions of 780 CMR R6 and MGL c 142A. MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. In addition, the grantee is also entitled to Be advised that all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to; Registration Division, Program Coordinator One Ashburton Place Room 1301 Boston, Ma 02108 Tel: (617) 727-3200 ext. 25239 Activation of Contract: This instrument, together with all above articles is the contract. The parties hereto cause this instrument to become active as of the day and year specified above and by signing below. Contractor of Record JDL BUILDING & REMODELING OF NEW ENGLAND LLC Employer Federal ID Number 43-2111165 Address 33 Palm Drive, Greenland, NH 03840 Contractor Name and Title Jason Lajeunesse Owner Contractor Signature / Date DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Grantee Name / Title Bob Cuomo & Donna Cuomo Grantee Signature / Date Page 2 of 2 r+ • ih& e ,tel w 33 Palm Drive, Greenland NH 03840 office: 1-(603)-418-8644 fax 1-(603)418-8992 CHANGE ORDER Job: Cuomo Change Order for: Kitchen Remodeling Date: 11/17/14 Change Order Number: 1 Total for Items below $73,320 This Change Order modifies Proposal 1015 dated 10/2/14 and makes provision for remodeling kichen. Agreement Sign Off: Both the contractor and homeowner have reviewed the change order. By signing below, both parties accept the alterations made to the original scope of work, including details of work to be completed and payment terms Contractor JDL Building & Remodeling Contractor Name Jason Lajeunesse / Owner Contractor Signature/Date '/= ,,4s.1,-- Homeowner Name Robert or Donna Cuomo fiY Homeowner Signature/Date �:- RQA /\ , i .y£L 4241. © Q 0 b N 0 WU 04 L i� Q< b0 C 'a � bU OJ � 0 e V O w 0 :Q �Z M 04 V . Q Z j27,' CA .0 ~oab M F' C cc 0 0£.F,J oEEj z Q zz�hh `n N 1S�CF7S cPv � F1 LZH 7*" ; 2h N 6E /F i9Ef� ti ,7R . ....... --- - - 9Ef.� W3036 OW362 h L Cc, z� 3 !I w M Wm ° ® o ;, d 0 C m Qwo oW g Clto -15 CC RW ¢ LL �p 'iaZ + b C * y 0 3N .Ni U � 0,0 >O ¢g° °w Z¢ �-' a hz cam, W WN W m�C > ak- Op 2°N ¢❑m 8-�Q LL a w� W J= H ❑ O Q� J m0- n0 LL Z❑ a u.Z O" :J O? N 4 ®O ¢¢ ❑ LL J Om w oBwW8LLW ¢ - F h ' wol.owNa ❑�°x❑�w O J Up m=w LL¢ yr ¢w❑NP, 50 Nt 3.r�<_J •- �3W QQ� h y i O - N p j O m - ° S)i 0MO6roZd 31 �t"� � � v`�, •T O t7t9A49 _ I i 1' .y£L 4241. © 0 b N 0 04 b0 C 'a � bU � 0 v w 0 M 04 V CA .0 ~oab M F' C cc 0 Q zz�hh `n N N ,,,I• N Qv+�)F"A 1�1 z� !I ih M N ;, d 0 C 0 O ys ^ Clto 0 b C * y 0 .Ni U � 0,0 U cC C m j z 0 y C W WN W m�C > w�� H rLn `� � •nom V 00 ¢vhi Z� w C..h Q LLxN O O O� °° ¢¢ ❑ LL J Om w oBwW8LLW Oay°Iz 3= .r ' wol.owNa ❑�°x❑�w Q L t " r10RTh q p �t�ao BUILDING PERMIT �� 4� TOWN OF NORTH ANDOVER ° " APPLICATION FOR PLAN EXAMINATION ey Permit NO: j/ Date Received Date Issued: 1 i1 1 �SSgCHUs�� IMPORTANT: Applicant must complete all items on this page LOCATION Ca4 ki.9- Meee fa 1. Print :PROPERTY OWNER �o� �-- l�u►� � � �v o v" � Print MAP NO: q-��;IPARCEL: ZONING DISTRICT: Historic District yesnn /47 17,"a s. yI ° Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Zl One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial -Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic -0, Well - - ❑ Floodplain a Wetlands.. ❑ Watershed `District ' Water/Sewer' �Repal n 4- IMk II pea10e r Tn4ti-►,ar a ---C hoyte.. �aeplac,; "F'i fe Haplzr'ncy i`n 10�1ud �ar,. fence Eye; o -i y, M t r2 �4 h S 6�u w P h k4 ` r� ," Identification Please Type or Print Clearly) / OWNER: Name: u : � C ✓B m D Phone" 78-76/— f9v,1 - Address: �lerk eP1,4C e ,�o✓��i ��►�o V cr P/n ARCHITECT/ENGINEER r1 ! Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ j(S, 0 ,.5-0 FEE: $ Check No.: 1193 Receipt No.: L.$ l S a -- NOTE: Persons contracting with unregistered contractors do not have acces he guaranty fund `Slgnafure af. Agent/Owner Signat of co tra or a . M Location 415 No. nor I� ccxs-� I,- w eL Check #J 23162 Date t 011-1 1 1 e,,-4 -, )-a-- TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page 1% e, /0'�SLeD 16 to to LOCATION Print PROPERTY OWNER ✓ Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic El Well ❑ Floodplain ❑ Wetlands ❑ Watershed District 11 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Address - Contractor Name: _ Phone:. Address: _ Phone: Supervisor's Construction License: Exp. Date: Home Improvement License: Date: - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT.'$12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund nature of ' nent,!Owner atu re of co 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 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 ❑ 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 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 ❑ 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Q p 9 Q ' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer 6-- Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT ❑ COMENTS CONSERVATION COMMENTS r HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ ■❑ DATE REJECTED DATE APPROVED Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments . Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site ;res no Located at 124 Main Street Fire Department signature/date Y COMMENTS_ Aga Plans Submitted ❑ Plans'Waived' ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'bF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Commen Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: - - - - Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes Located 384 4 Located at 124 Main Street - no Fire Department signature/date COMMENTS i I 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 re Electrical Inspector Yes quires approval of No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.s1oo-s1o00 fine No AIP1Tr-n _ . - _ _ _ Lvc.nuuamg rermit Revised 2014 id L r O 'Z rA y = 0 0 w 0 f- LU0 Z LU wWa a z CA Z Z W LL Z D W Z Z V W a O co kA C7 m E m N d d W +U_+ \ ? N •0 � O +.r z 0 -0 U a L C c_ E L 7 _ L v _ 7 f9 L _ OJ N Y i O O CL 7 C CO Z C 3 (0 C 2 LL In LL �' LL LL' LL 2' !n LL �- LL m N Ln u O 2 O .aw �� 10 Q ,► O , E cL { : D i Q 7 " Q • O Z 2. J i0 m C i;.' 1 C y = d 1 O = O > = -0 o =.�.�A �r' E c c aCL X00 t > o E- o ��[[ Q � as V: (D � - 0 cni F- C� Q i cu 'a •i I=•• w N N .V m CO) W_ O 'a w O O " M LL- M N C H N •CLt t c ml Ix W L V i F V Q 0-0 y N d3= fq 2 N O o L = 0 H t 0-00 9 2 w .aco CERTIFICATE OF LIABILITY INSURANCE ¢- DADD/YYYY) 10//9/29/2014 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 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). PRODUCER CROSS INSURANCE - LACONIA 155 Court Street CONTACT Sarah Cullen, AINS, ACSR PHONE ,03)524-2425 'VAC. o•(603)524-3666 EMAILADDRESS:scullen@crossagency.com INSURERS AFFORDING COVERAGE NAIC A Laconia NH 03246 INSURER A:Fireman Is Ins. Co. of INSURED INSURER B: JDL BUILDING & REMODELING OF NEW ENGLAND LLC 33 PALM DRIVE INSURER C : INSURER D: INSURER E: GREENLAND NH 03840 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1461311668 DEVISiON NI IMRCD• 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 I TYPE OF INSURANCE ADDL INAR SUER V1AJn POLICY NUMBER POLICY EFF MM/DDfYYYYI POLICY EXP (MMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR PAS095073-11 6/10/2014 6/10/2015 DAMAGE T RENTED PREMISE Ea occurrence $ 250,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICYPRO LOC $ AUTOMOBILE LIABILITY Ee aBINEDtSINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO ALLOSNED X SCHEDULED AA5095643-11 6/10/2014 6/10/2015 BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ Uninsured motorist property $ 25,000 X UMBRELLA LIABOCCUR HCLAIMS-MADE EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB �UA5099_323-11 AGGREGATE $ 2,000,000 DED I x I RETENTION $ 10,00 $ 6/10/2014 6/10/2015 AWORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED7 [IY] (Mandatory In NH) If yes, describe under N/A A5095646-11 6/10/2014 6/10/2015 x WC STATU- OTH- TORY I IMITS _R E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Jason Lajeunesse is excluded from workers compensation coverage. Town of North Andover MA 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 nvWrw &U tw IvrvUl INS025 mmnnsi m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ica Hildreth/JH5 U 1988-2010 ACORD CORPORATION. All rights reserved. Tho Ar:r1Rr1 nnmo anri Innn nro ronicforori m2rlrc of Arnpi1 u Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -094.379 JAMES C MAT TIp :', 1 GARRISON ROAD9k SALEM NH 030'19 '` = S)I'1111c am'"" —1'� Expiration Commissioner 01/31/2016 »K^ � ; } * E , \ 2 j . \o \ / ■L ] . � j $ 7®0 ,:.,. I.. \ �n�<py� » «K IC'(\\ {§A\W\� c \ ' ;=o.§§: . \lax k k�f \ \ 3 k % E 0 4) k LU 0 o W § \ \ j z § Z i . -iq w § @ « Q s R his a9re ~cyUSF�'T 8 p ;oQaFZ NG t made S c0i{ijR'gC The locationc�o�op he eF G day o rFoR c�Ns The °f the prOiect; in �a//ed he 0 Zz Oct, ber?0' TR�/crpN. The c0 Cobk ntraCtora s 4SCastfehierGrantee,C 16300, c7/7c/b,,,,,,, nd be as F. rhes actor ha�� nd Grantee QP�ace, �ya� herejn een ✓Di .. OOcurnentsd wi,h the S ha// f4 na the si�4t4a// a ree. hAn°�°i s e s Cont specif in9 sc pe of �O�k sp-c°r asaticed that The ractAnt ov a Of work. red within fh e9u. osts inc/ Gr nto epr anent ude q onditi°ns tee lv,th saiipay t and pa �he eht . ArOpOsa� ,orf posy/ana, c SchedU epakrn o fCOntra t ent for hkctOr fo S� ys, ydtec, the 14 note the contract $O �s re9vioed r u� °f�2Pen; Oormanc Sco actarnount d°es ender�n9 a ba/an wehfYFf e°'60 n acco T e oftirne nOt retlect ce °f Sys o4sana�nce he wOr and pOss;b/e s� whch h!'� O workman hipaw;t tact on arrant cost �o sha//beT QfaO/t hin threOCfOber diff ati c I w he "ante a hundr d S 14 Th °ns to pr°pO h e ore 1 xtY--rive a Con s Fa//ur pan aY de (36s actor FaaUrre to p o9 Y oorlon o a cOn days o fCo�nCorrect un to re v'de a k with; this C tractor tract c anY def, sfact pr ee anae9uate �a Aon tract in de favi, f rnplet1017. - ects doe t ry perryti nor�nanceace am e9uipe that c oranY of, ° fau/, st shad/ tNot'ce' Y wook relec ed� a era t° the a reasons list, score be he.theOblj Y the G� to ens date d b%wSp a Ae cc�ss to Ir he Gn Co On °f,h antes Oreas un atsf e f, nd,nayte/ rM"(s) Ieq,,, grantee FU n e/aetl.d qo too actory /eted as sp Confraclo,.s, pernl1,s o in tdea��, �e4uireof ecife� Gryfee S�9ns end tU�e eui/d;n9 Asir,, if IV, unre9is e els as the P/uthb'n9 perMi , cOntracta s s pent t and Flectrica/ be e*c, dr'neswho 106%, M pager oft A The Commonwealth of Massachusetts Print Formf Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): S -UL �� j �d lh ✓ [ l�Jy T Address: 33 Al `r, 4r-1 1¢x City/State/Zip: 9{ f,4 /a.- J IVY 07 YY 0 Phone #: �6—p Are you an employer? Check the appropriate box: 1. [am a employer with /S 4. E]I am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance required.] comp. insurance. $ 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 1 I.[] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.0 Other 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. :Contractors 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 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Acakot'Si Policy # or Self -ins. Lic. #: r 4 P f- �_ o ? 5-6 q (, — Expiration Date:((�?_-o/,!5— Job Site Address: F (4.S -et"Aer �`kGf City/State/Zip: y2r/-ti A lar r�t2 !tii Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cEqi& under the pains qnd penalties of perjury that the information provided above is true and correct. Phone #: IOG 1? 7/0 — FL 7V s Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: