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Home My WebLink AboutBuilding Permit #94-15 - 54 LONG PASTURE ROAD 7/28/2014t%ORTH BUILDING PERMIT 0 TOWN OF NORTH ANDOVER J? APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received r o Date Issued: VS US 4MPOhT�NT: Applicant must complete all items on this page LOCATION,i Print PROPERTY OWNER 6�e Print 100 Year S tructure MAP --PARCEL: -2 0 ZO—ZONINGOISTRICT: --,Ristoric bist.rict yeg - 7 �Machine Shop Village, --- - ----- -yes ejRn- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building XOne family /KAddition 11 Two or more family 11 Industrial 11 Alteration No. of units: 0 Commercial 0 Repair, replacement 0 Assessory Bldg 0 Others: [I D olition -em - El Septic El Well" ,[.]Other Oflood-pla-i n- [I �' Wet, la n d's 11 Watershed-I)istrict El Water/8ewer,-.---.'- DESCRIPTION OF WORK TO BE PERFORMED: �DD(/Y4 70 44m- a)m ar 4g Identification - Please Type or Print Clearly OWNER: Name: 'LA S41-&7?f :P JQ J/4 Vd-lf&4 Phone: Address:_9 L-wi. 615vw PZP one: h- Contrac rN'me�.�- --L--_2b�C C - r Address: V—S Supervis&s Construction License: -45- -J5.3;-76,9 p. Date: /Z Ex Date:--, ARCH ITECT/ENG IN EER Phone: Address: Reg. No. oa FEE SCHEDULE. BULDINGPERMIT.- $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 5 ez '� ()0 1 ..' 1� Total Project Cost: $ FEE: $ A ---I -7:�- � Check No.: I (�5 Receipt No - a, NOTE: Persons contracting with unregistered contractors do not have access.to the guyrantyfund ure otAaenVUwner bianature ot contractor 1\ 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 2( Building Permit Application ia�' Workers Comp Affidavit ;al Photo Copy Of H.I.C. And/Or C.S.L. Licenses a/ Copy of Contract M,A Floor Plan Or Proposed Interior Work glA Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application Ej Certified Surveyed Plot Plan Ei Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract Ei 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) D Building Permit Application Ei Certified Proposed Plot Plan Ei 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 Plans Submitted 11 Plans Waived D Certified Plot Plan D Stamped Plans [I TYPE OF SEWERAGE DISPOSAL Public Sewer El Tanning/Massage/Body Art El Swimming Pool.s well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on. Signature V COMMENTS �,2 A HEALTH Reviewed on Siqnature COMMENTSOAa'loitfa I t2 �Aks!�' SA)n " ::� , U Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments A Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Sigpahire: Locatea 3M USgood -3treet FIRt-`DEPAR,TMtNiT. - Tempf)pm ster-on tit e yes: ,no--,, Located,,at 124 Main street Fire'lDepartment sionaturo/date 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 21 A —F and G min.$100-$1000 fine NU I t5 ana UA I A — wor aeoartment use LJ Notified for pickup Call Email Date Time Contact Name Doc.Building Perinit Revised 2014 Location Ion No. Date Check #4 27822 TOWN OF NORTH ANDOVEP Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL $ Nk Building Inspector 7/22/2014 9:54:06 AM PST (GMT -8) FROM: 100005 -TO: 19786889542 Page: 2 of 2 0 AC�-"R" CERTIFICATE OF LIABILITY INSURANCE `IiIk� DATE (MM/DDNYYY) r 7/22/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE "OLDER. 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 Liberty Mutual Insurance PO Box 188065 Fairfield, OH 45018 CONTACT NAME: PHONE I - ,./C. .. Exil, 800-962-7132 T (2. Noi: 800-845-3666 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 9 8/29/2013 INSURERA: Peerless Insurance Company 24198 EACH OCCURRENCE $ 1,000,000 INSURED Hinckley Brothers Inc PO Box 623 INSURERB: INSURERC: INSURERD: Tewksbury MA 01876 INSURER E $ INSURERF: AUTOMOBILE COVFRAGFR rr-12TIFIrATF- KIIIIVIRP12- onQrnJQ7r IZF-VI-qIr)KI KIIIMRF-P- 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 ADDLSUBR INSD WVD POLICY NUMBER POLIC (MMIDD= POLICY EXP (MMIDDfYYYY) LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F-,/ ]OCCUR Businessowners CCP9840561 8/29/2013 8/29/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE T-5 RENTED PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- F71 LOC OTHER: �21ENERAL AGGREGATE $ 2,000,000 PRODUCTS - CCMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED H I RED AUTOS AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPER' ZIDAMAGE (P.r.ccid $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LlABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes. describe under .DESCRIPTION OF OPERATIONS below NIA PE'RT OTH- ST UTE ER_ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ rEL. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Job: 54 Long Pasture Road �"F% Q r1%JL-9JQM %,AI[4%..rLLA I IUN 0001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St., Bldg 20 ACCORDANCE WITH THE POLICY PROVISIONS. Suite 2035 N Andover MA 01845 AUTHORIZED REPRESENTATIVE Tajwana Tj Swalef ID 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 20960875 CLIENT CODE: G00703530 Tajwana Tj Swalef 7/22/2014 12:50:33 PM (EDr) Page I of 1 From: <978-922-2731> To:19786889542 Page: 2/2 Date: 7/23/2014 3:5530 PM CERTIFICATE OF LIABILIW INSURANCE DATE (MMIDDNYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 0712312014 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. �lf 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 enclorsement(s). N PRODUCER 02047 - 001 CONTACT NAME� Appleby & Wyman Ins Agency Inc H E X I OM. FkC No.: -3711 IPA C El): (800)928-2289 (978)236 152 Conant Street EMAIL Beverly, MA 01915 ADDRESS: INSURERfS) AFFORDING COVERAGE NAIC # INSURER A � A.I.M. Mutual Insurance Company 26168 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—] OCCUR INSURED Hinckley Brothers Inc INSURER B: INSURER C: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER D: MED EXP (Any one person) P 0 Box 623 Tewksbury, MA 01876 INSURER E: [INSURER F, COVERAGES CERTIFICATE NUMBER: 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 ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDD(YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—] OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) S PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ SEN'L AGGREGATE LIMIT APPLIES PER' PRODUCTS - COMRiOPAGG S 1POLICY I ffRCO;� I �OC AUTOMOBILE LIABILITY CO, 1.1NED SINGLE LIMIT E.I�c i'an'l $ BODILY INJURY (Per person) $ ANYAUTO ALL OV%NED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) S HIREDAUTOS NON-OVMED AUTOS PROPERTY DAMAGE (Per accident) $ UMBREILA LIAII J OCCUR EACH OCCURRENCE S __7DED AGGREGATE $ EXCESS LIAB CLAIMS MADE I I RETENTION 3 S WORK5RSCOW,ENSATION AND E PLOY 'LIABILITY FATIY� H- X TVO'CR LIM 9TR A AN� PRRPRIE'rOR,'PARTNER,EXF-CUTIVrIY I N OF IC rMEMBER EXCLUDE ? Y I NIA AWC400-7023972-2014A 101312014 101312015 E.L_ EACH ACCIDENT $ 1 00,OOD.DO E.L. DISEASE - EA EMPLOYEE $ 1 150,00D.00 (Mandatory in NH) lf6es So dpirribe under D ION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Job: 54 Long Pasture Rd CERTIFICATE HOLDER CANCELLATION Town of North Andover 1600 Osgood Street Building 20 Ste 2035 North Andover, MA 01846 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 TION. All riahts ACORD 26 (2010ID5) The ACORD name and logo are registered marks of ACORD 0 -4 m n m cn m P_ 4( A b 0 0 9 201 0 0 41 21L CA (A 03 -n ;o < 0 0 -0 =r ;;o M n ;u -n 0 0, B con -n 3 0 X, (D rD — z 0 m =r (on IOD CD - fD 1 . < F; fD 0 c - 0 c m =r :3 oj =r , j = (D ID .L C C.) r 0 C 0 (D 'a — F, Ln 0 0 O_ -_ z > (A m r, m Q m 0 0 0 w C F 2 z m 0 (D 3 rD 0 > 0 m > 0 0 CL =r CD a) ID Cn 0 SD -0 ID CD _% 0) 0 CD U) 0 2) 0 0 -.0 CD 0 Z :3 'z S. rr CD CD fm-lpk CD o z rL CD r— M co 0 m o Cf) ch jC CD 0 , U) z CD 0 0 Cr > cc 0 M a 0 o X > CMD CUn) a z cl) - (1) 0 ==r rL 0 2) (.0 cn 0 CD 0 0 = CD 0 CD 0 M (0) (<D U) CD CL Cl) 2: CD Cr 0— Z (n CD CD CD j;> m _uo) �4 0 CD 0 CD CD 0 W Go cn o CD z = U) CL 0 CD cn CC CD cn =Dr CD U) o U) CD '0 -0 Z E_ : CD cn CD 0 F: 0 = o 0 —h 0 Z C) CD > CD Z =a) CD -0 0 < m 0 CD --I: 0 2) 0 -4 m n m cn m P_ 4( A b 0 0 9 201 0 0 41 21L CA (A 03 -n ;o LA ;;o ;;o M n ;u -n Ln -n 3 0 X, (D rD — z 0 m =r fD 1 . < F; fD 0 c - 0 c m =r :3 oj =r , j = (D 0 c aq =r 0 C 0 (D 'a — F, Ln 0 0 O_ -_ m a m > m z > (A m r, m Q m 0 c m 0 w C F 2 z m 0 (D 3 rD 0 > 0 m > ,4w 0 EX. PROPANE TANK ,,&lbafe E WATER EAS 32 .3' N 41 *2 9 "W Ex. S ptic- Tank 10 X0 EN fl I 04x6 30.0' 71-- 162.76' N41'29'27"W 139.89' w L'y 3,6.8' Ah /1/0 ,7 19 1110 ob/ PROP. 3' HIGH NDSCAPE WALL o 0,6 70. 104x4 ls�l 4i 01 47.8' A) 4 BIT. CONC. DRIVEWAY 99X4 10OX3 x5 A4 94x9 5 'tK IL A3 LL— c� CA cx� Cn 4x2 17.60' -400- ra-o/- 0 PROP. 3' HIGH 5' HIGH FENCE OF THE WALL STONE RET. Wi Office of Consumer Affairs & Business Regulation - Mass.Gov The Official Website of the Office of Consumer Affairs & Business Regulation (OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints Registration # 174237 Registrant HINCKLEY BROTHERS INC. Name STEPHEN HINCKLEY Address -P.O. BOX 623 City,StateZip TEWKSBURY, MA01876 Expiration Date 01/15/2015 Complaints Details No complaints found for this registrant.', You can also view arbitration and Guaran!y Fund history. Back To Search 2012 Commonwealth of Massachusetts. Mass.GovG is a registered service mark of the Commonwealth of Massachusetts. Page I of I z Home Improvement Contractor Registration Home Page http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=76126 7/24/2014 Massachusetts - Department of Public Safety Board of Building Regulations and Standards bnstruction Supervisor License: CS -053268 - 's, -I'. I -, I ,, I. /� 1-1, STFPHENHNCOF- Y 50 Fox Avenue Dmcut MA 01826 Expiration J21061205 Commissioner The CommonvealtIz ofMaswhuse'lts Deparfinentofrnitlfsfti(tideeidii�ts Office Of Ifivest1gations 600 Washington Street Boston., MA 02111 vmmass.govIdla Workeis' Com-pengation Insurance Affidavit: BuflderolCo)atractor$)FIectri.clans�?I*ber.0 Address: cityfs,,ate,fzip:'t,,;Eoj"tzjL-�i A Phone, Are you an employer? Check the appropriate box- T�pe of project (reqm1red): 1. F1 I am a employer with 4. 1 am a general contractor and 1 6. New cOnsf raction employees (fullandlorput-tinia).* 2.E1 I am a sole, proprietor or partner- have filred the sub -contractors listed on the attached shoot. I 7. Remodeling ship aud'lavano-employeG� These sub -contractors have 8. Demolition I worMug forma inmy capacity. Jnsuranco -workers' comp. insurance. 5. We ate a corp ora#on and its 9. Building addition [No workers' comp. officers have exercised.their air. 1 10.[] Electricalrep - or additions required.] 3. El I am a homeowner dQing all work right of exemption p or MOL 1111 Plumbingrepairs or additions myself. [Eb workaya' �omp- c. 152, § 1 (4), and we have no UP Roofrapairs insuraacareqairzc�] employe6s. [No workeys, 13.[] Other comp. insurance required.] Bnsaqn U wimatin applicant that checks boxal must also fill duttho section boldw showing1heir wor ers comp o po GY 0 0 - f-Horneownerswfio siibinit�ilgaffldavitfndirat�iffieygo' doing A worKand then hire outside contractors must subm"t a now affidavit ludicatifig sdoh. TContractors that cheacthis box must attached �a gddidonal shoot showing the nama of the sub�-contraotors andtheir -workers' comp.polloyfifonnation. aftz an em F eW eev But W is th ep 11 ofoyer that bprovid1119 117,9?kers'compellsat!OB!nsuTanc fO MY 70Y - 0 o ey andjoh sYe information. Insurance Company Name% Policy # or Self las. LIG. ff: lo 2, '3 6 n- EXPIMODIX)MG.- Y lob Site Address -,!!d 4e�q!�c Ankdc pityistatc/zip: N, 4vg>,,v* Attach a copy offteworkers, eoruponsation-po&�,declaratlon page (showing -the policYnMber and e�*at!Oa date). Failure to secure asre ; dundar Section 25A ofMGL o. 152 can lead to the, impositiort of orh3halponalffes of a coverage. TWO fine, up to $1,500.00 and/ar oneyear M.PrI904MOnt, a� wellas cK penalties in the form of a STOP-WORY, ORDER a -ad a ffn a of -up to $250.00 a day against the -violator. Da advised that a copy of this statementmay be forwarded to the Office -of. investigations ofthe DIA for ibsurance, coverage veriffoation. top- - sand . enaftles ofperjary Mat Me informationprovided above is trae and eorrect, v 2,2.,-Iy offyclaluseoply. Do not 1prile in this area, to he eoiqletedby e!V or town official City or Tow -u: Permit/License# fssulng Authority (eirele 031e): 1.)3oard of Health 2.BuildingDepartment 3.0tylTow)i Clerk 4. Electrical Inspector 5. Plumbingluspector 6. Other M, — . 444 Information and Instructions Massachasetts General Laws chapter 152repires all employers toprovida, workers' compensation for fhei� employees. Pursna�t to this statute, an employee is defined as ".. ..every person k the service of another undur any contract ofhira,- express orimplied, oral arwritten!' AM employeils deffned as "an individual, partnership, association, corporation or other legal entity, or anytwo qxmoro of the f&6�6lqj engaged in ajolut enterprise, and includingthe, legal representatives of wdeceased epiplq pA .-or the red 'I elver or. tt*dsteo'ofaa individualpartnership, askolation or other legal entity, employing oniployees. 0�fh.6 Owner of a dwalling housohavingnotmore than tbxeo apartments and who resides thorelu� or tko occupant ofthe, dwelling house of another who employs persons to do maintenance, construction orrepair workon su6h dwelling house or ontho grounds or building appurtenant thereto shall not because of such employment be, doomed to bean employer." MQL chapter 152, §25C(6) also states that "every State or Ideal lie-enslug agency shall withhold the issuance or renewal of a license or p ermit to op erate a business or to construct buildings in the commonwealth for any applicant Who has not produced.acceptable evidence of compliance with the insurance coverage requireV Additionally, MOL chap�ter 1A §25C(7) states "Noither the commonwealth nor any of its political sub (6hom Shan enter into any contact for Me performance ofpublic; work until �cceptablo evidence of complipco with the insuranco requirements of this chapter have been presented ta thb cotractlug authority." Applicants Pleas,o,M out the workers, compensailon, affidavit completely, by checking the boxes that apply to your situation and necessary, supply sub-contractor(s) Rame(s), addross(es) and phononumbor(s) along -with their cortfficate(s) of Insurance. LfmitedUabifftyCompanias (LLQ orLimitedLiabilityPartnarships (Lid?)vdthno employees otherthantho members oxpqrfnars, aronotrequkedto can7workers, compensation insurance. I-E&UL_TC orLLp doeshavo employops,apoFGy1sxeqy1red. Be advised thatthii affidavit maybe submitted to the Department of Industdal Accidents for conffimationof insurance coverage. Also be sureto sign and date the affidavit. ilia affidavit should be, retumod, to the �ity or town that th.6 aPpEcation for thaparmit or licanse is baiqgreqwte�)iot the Dep'artmont of fadustrial Accidents. Shouldyou. have. any questions regaxdhig the law or if you are Yevired, to obtain a*orkors' cor�pensatfonpolic;y-, please call the Department at themunber listed below. Self -Insured companies should enter their self-insurance licenso number on the appropriate lino. City or Town Offf cials Please be, sure, that the affidavit is complete andprintedlegibly. The Department has provided a space at the, bottom Ofthe, afff davitfatyou to fill out in the event the Office of hvestigations has to contact you regaxdffig &a appRcant. Please be -sure to JM inthc Potmit/Ecensa number whichwill be used as a reference number, In addition., ail applicant that Y�Cust submitnultiple, pormit/licetse applications !a any givenyo . ar, need only submit ono, afff davit indicathig cjm6nt policy Infonnation (if nocessaty) and under "Yob Site Address' the applicant shouldwrite "afflocations in '(City or towt)-" A: �Opy dtho aff Wavit that has b so'n, officially stamped or marked by to city or town may be pxo-vldpl to the applicant as Proofthat a valid affidavit is' on file for f[iture permits or licenses. Anew affidavit ma'st be Mqd out each year.'Whero a home owner or citizen is obtafitijug a license oibermit: not -related to any busines or commercial Youture (i.e. a dog license oriermit to butu leaves otc.) said pexsoiiis NOTxoquired to complete, this afsUdavit. The Office of Investigation.- . wouldlike to thankyouin advance for your cooperation cand shQuIdygilhave any questions, please do not hasitito to give us a call. Tfao Department's address, telephone and fax numben The CQm- mon -w, tmfth of Musia chwat 6bQ Waftgtm . � - B oston, U. & 02111 TQ1, # 617-72,Z_49-00 W406 Q -r- 1-87MASSAFF, Revised 5-26-05 F40 GENERAL CONTRACTOR/HOME OWNER AGREEMENT THIS AGREEMENT is entered into this 16'4 day of July, 2014, by and between Elvino M. da Silveira and LaSalete C. da Silveira, (hereinafter "Home Owner") of 54 Long Pasture Road, N. Andover MA; and I Hinckley Brothers Inc. (hereinafter "General Contractor") of P. 0. Box 623 Tewksbury Ma 0 1826. PROJECT PREMISES: 54 Long Pasture Road, N. Andover MA. Title Reference: Deed recorded with th:e Essex North Registry of Deeds in Book 13636 Page 39. DESCRIPTION OF GENERAL CONTRACTING SERVICES: The General Contractor shall provide the Home Owner with the contracting services detailed in the Scope of Work and Coordination Specifications appended hereto and incorporated herein and in general shall include the following: • Overseeing the project; • Review existing quotes and obtain quotes for remaining work; • Help Owner to acquire and review all contracts with subcontractors and suppliers; • Help Owner to come up with a total project budget; • Supervise work in progress; • Coordinate subcontractors and suppliers and inspections; • Review all invoices and payments; • Permitting and Construction costs to be paid by Owner TIME FOR STARTING AND COMPLETING PROJECT: WORK SHALL COMMENCE UPON SIGNING OF CONTRACT GENERAL CONTRACTOR'S PAYMENT: Home Owner agrees to pay General Contractor a total cash price of Twenty Thousand Dollars ($20,000.00). Payment of the General Contractor's fee shall be in installments as follows: /,1 0 I" Installment of $7,500.00 is to be made prior to commencement of work on the Project; 2 nd h Installment of $7,500.00 to be paid on August 15 3rd Installment of $5,000.00 is to be made within five (5) business days of completion of the Project. If any payment is not made when due, General Contractor may keep the job idle until such time as all payments due have been made. A failure of payment without written justification of cause for a period in. excess of said five (5) business days shall be considered a breach of contract. I . The funds will be paid directly by the Home Owner to the General Contractor as well as to all Sub -contractors. NOTICE TO THE HOME OWNER (1) Do not sign this Agreement before you read it or if it contains any blank spaces. (2) You are entitled to a completely filled in copy of this Agreement. Home Owner acknowledges that he/she has read and received a legible copy of this Agreement signed by General Contractor, including all Terms and Conditions herein included, before any work was done. If Home Owner cancels this Agreement after the right of recession has expired, and before commencement of construction, Home Owner shall pay General Contractor the amount of any expenses incurred to that date. TERMS AND CONDITIONS The Terms and Conditions appended hereto and incorporated herein are expressly incorporated into this Agreement. This Agreement constitutes the entire understanding of the parties. No other understanding or representations, verbal or otherwise, shall be binding unless in writing and signed by both parties. This Agreement shall not become effective or binding upon General Contractor until signed by General Contractor. By Home Owner's signature below, Home Owner acknowledges receipt of a fully completed copy of the Agreement. J /�� 2 M F 1��) IN" &-1 0 - aignature Page HOME 6WA R: Elvino M. da Silveira DATE HOMt USalete C. da Silveira Home Owner contact information: Elvino PH: 1 (978)807-5594 Elvino Email: elvino@aol.com La-Salete PH: 1 (978)482-5498 La-Salete Email: Idasilveiral3@gmail.com GENEML CONTRACTOR HinqKey Brothers Inc. Stephen P. Hinckley, Treasurer MA Builder's License # PH: 978-852-6364 Email: hinckleybrosinc@gmail.com t7 - /,y q V bATE DATE Scope of Work and Coordination Specifications 54 Long Pasture Road . I North Andover, MA 01845 PROPANE GAS TANK AND LINES Size new tank & main gas line to foundation- options for type of tank? Underground? Own or lease? a) New exterior appliances b) New pool equipment c) New generator d) New Furnace s tem YS e) Future range -top, oven & other small appliance allowance f) Need to confirm location of gas line to be run for all of the above- where, how, visual, etc g) Removal of existing oil tanks ELECTRICAL SERVICE Work with Pool Company to see if resizing pool width is viable option to avoid relocation of the existing meter. Otherwise: a) Relocation of existing Meter a' Repairs needed after main electrical is moved- driveway, walkway b) Need to verify electrical services included with Environmental Pool and locations c) Need to design and verify any new electrical requirements for porch, pergola/kitchen area, shed, and landscaping. And it's locations to be run underground- Verify what is included from Pool Co. d) Trenches and digging for above WATER MAIN a) Water department has been notified of pool project and will mark existing water line and valves a. Mike- field marker, Tim- water dept. operations, 400 Osgood Street b. They have plan dated 6-9-14 b) Run new water lines for hot tub and pool- What is included in Environmental Pool quote EXCAVATION a) Pool & patio 4 e6f A a. It is critical to coordinate with water department to shut down main and confirm location of line to house and how new line will be laid b. Pipe fitter- TBD b) Proposed rear stair entrance. Explore bulkhead or covered stair if possible basement entrance c) Proposed underground propane tank? a. Confirm with . eastem propane or owner choice of utility supplier d) Order of conditions to be followed- see separate documents Site Preperation a) Coordinate demo of existing deck and slab as required b) Coordinate cutting of two trees shading the pool area. I POOL- order of conditions to be followed- see separate documents c) Timetable for pulling permit for pool project d) Excavation and grading questions 1. How much grading will be done? 2. Review all aspects of work to be performed and any overlapping PATIO & WALLS a) Earth Creations- Dennis Gameau a. Confirm Height of new driveway retaining wall including new pool required fence heights b. Confirm height of continuous wall and water feature - i. Coordinate water feature and pool details c. Need to review all inclusive concrete footings, slabs, etc. for all structure bases d. Review outdoor kitchen location and design e. confmn final square footage of pation STRUCTURES a) Shed- 10 x 12 to house pool equipment and landscape tools a. Will also act as comer frame for new gate entry for new fencing b. Concrete slab provided by9 Sizc specified by shed builder b) Pergola c) Pergola Footings a. Supplied by Earth Creations- Post details to be wrapped stone at base per design b. Supplier of pergola and roof detail TBD- quoting i. www.gazebocreations.coin ii. www.walpolewoodworkers.com 1. Walpole to quote fencing as well 5 FENCING & GATES a) Need local 2 "d quote for fence detail- Lattice pr ivacy & decorative fence, and post & wire along rear property line REPAIR & LANDSCAPE b) Install gutters c) Painting Quotes still needed; a Water line and pipe fittings I 0 Electrical for landscape and other structures 0 Propane gas lines and connections for other than pool (confirm w/Tony) 0 Rear porch (if approved) 0 2 nd quote for fencing 0 Obtain updated Earth Creation quote to reflect changes 0 Second quote for patio work Notes: All updated plans with structures, generator, landscape alterations, fencing, etc. all must also be sent via Pdf TO Heidi at Conservation TERMS AND CONDITIONS HAZARDOUS MATERIALS Home Owner represents that the pro' erty does not contain hazardous materials. This p contract does not contemplate the testin for or removal of hazardous materials. ,9 GENERAL CONTRACTOR'S RIGHTS AND RESPONSIBILITIES 1. General Contractor shall have the right to stop work and keep the job idle if subcontractors' payments are not made when due. Failure to make payment within five (5) business days of the date that payment is due will be considered a material breach of this Agreement. If the work shall be stopped for reasons where the Home Owner elected to do so or failed to meet it obligations as per the contract, for a period of sixty (60) days, then General Contractor may, at General Contractor's option, upon five (5) business day's written notice, demand and receive payment for the General Contractor's fee based upon the contract price. Thereafter, General Contractor is relieved from any fiu-ther liability. In the event of work stoppage for reasons where the Home Owner elected to do so or failed to meet it obligations as per the contract, Home Owner, shall provide for protection of and be responsible for, any damage, warpage, racking, or loss of material on the premises. If the work is stopped for a period greater than (6) months for reasons outside the Home Owners control General Contractor is relieved of his obligation and both parties shall negotiate in good faith a final payment amount, 2. General Contractor, at General Contractor's option, may alter construction specifications but only so as to comply with requirements of governmental agencies having jurisdiction over same. 3. All work shall be completed in a workmanship like manner and in compliance with all building codes and other applicable laws. 4. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 5. General Contractor agrees to assist Home Owner in procuring all materials necessary to complete the Project and to oversee completion of the Project in a professional manner. 6. LIMITED WARRANTIES: General Contractor will require all Sub -contractors as part of their contracts with the Home Owner to certify that the specified work being contracted for will be performed in a substantial and workmanlike manner according to standard practices prevalent in their trade and finiher that: 04 (1) the specified work will comply with all applicable building codes and regulations (2) the labor and materials provided as part of the specified work will be free from defects for a period,of one (1) year from the date of completion. This limited warranty extends to the Home Owner from the Sub -contractors only. There is no implied warranty either expressed or implied, nor any implied warranty of fitness for any particular purpose to be granted to the Home Owner by the General Contractor. In the event an issue arises with a subcontractor warranty, the General Contractor will help pursue and coordinate a corrective action. All equipment, assemblies, or units purchased by the Home Owner, are sold and installed subject to the manufacturer's or processor's guarantee or warranties, and not that of the General Contractor's. To the extent permitted by applicable law,, all warranties given by manufacturers pertaining to materials used by General Contractor in connection with the Project will be passed through and inure to the benefit of Home Owner. 3. The Home Owner shall pay all sub -contractors, laborers and material suppliers in a timely manner so as to keep Home Owner's property free of valid labor, material or mechanic's liens. ITEMS NOT THE RESPONSIBILITY OF GENERAL CONTRACTOR 1. EXISTING VIOLATIONS AND CONDITIONS. General Contractor shall not be held responsible for any existing violations of applicable building regulations or ordinances, whether cited by the appropriate authority or not. General Contractor is not responsible for any abnormal or unusual preexisting conditions or any unusual or abnormal concrete footings, foundations, retaining walls, framing, roofmg or other components of the Project Premises. Correction of such violations or abnormal conditions which may need to be corrected by the General Contractor shall be considered additional work and shall be dealt with as herein provided for under "Extra Work". 2. DELAYS. General Contractor agrees to start and diligently pursue work through to completion, but shall not be responsible for delays for any of the following reasons; (a) failure of the issuance of all necessary permits within a reasonable length of time, construction funding or disbursement of construction funds by the Home Owner or Home Owner's employees or Home Owner's agent, acts of God, stormy or inclement weather, strikes, lockouts boycotts, or other labor union activities, extra work ordered by Home Owner, acts of public enemy, riots or civil commotion, inability to secure material through regular recognized channels, imposition of government priority or allocation of materials, failure of Home Owner to make payments when due, or delays caused by inspection or changes ordered by the inspectors of authorized governmental bodies, or for acts of independent sub -contractors, or holidays, or other causes beyond General Contractor's reasonable control. HOME OWNER'S RESPONSIBILITIES UTILITIES: The Home Owner is r�sponsible for water, gas, sewer and electric utilities, from the appropriate agency to the metering devices servicing the Project Premises. It is 8 /7 the Home Owner's responsibility, at Home Owner's expense, to provide toilet facilities, electricity and water to the site as needed by the Sub -contractors working on the Project. FINANCING: The Home Owner is responsible for having sufficient funds to comply with this Agreement. This is a cash transaction. INSURANCE: Home Owner will purchase insurance at Home Owner's expense before any work begins. Such insurance will have course of construction, fire, vandalism, malicious mischief and other perils, clauses attached. The insurance must be in an amount at least equal to the estimated completion value of the premises being constructed. If the Home Owner does not purchase such insurance, the General Contractor, as agent for the Home Owner may purchase it and charge such cost to the Home Owner. The General Contractor shall verify that all Sub -contractors retained to perform any work on the Project Premises have the required workman's compensation insurance for themselves and their employees or agents. DAMAGE OR DESTRUCTION: If the Project or any portion of it is destroyed or damaged by fire, storm, flood, landslide, earthquake, theft, or other disaster or accidents, any work done by the General Contractor to rebuild, etc., shall be paid for by Home Owner as an Extra and dealt with as herein provided for under "Extra Work". BOUNDRY LINES: The Home Owner repre I sents Home Ownership of the property where construction is to occur. It is the Home Owner's duty to confirm the location of boundary lines of the property and Home Owner is responsible for the accuracy of such lines and how they are represented on drawings. If required, the Home Owner will pay for a survey to chart boundary lines. EASEMENTS, ETC.: Prior to construction the Home Owner is to give the General Contractor a copy of any easements, restrictions or rights of way relating to the property. If Home Owner does not do so, General Contractor will assume that none exist. ENGINEERING AND GEOLOGY: Unless specifically agreed upon in writing between Home Owner and General Contractor, and made a part of this Agreement under "Description of Materials", "Specifications" or "Plans", this Agreement does not include any engineering or geology surveys, drawings, studies, reports or calculations as may be required by a public body or building authority as a condition for issuance of a building permit or as a condition to securing final building inspection. The cost of any such required professional services shall be paid by Home Owner. DRAWINGS AND SPECIFICATIONS: The Project will be constructed according to drawings and specifications that have been examined by Home Owner and that have been or may be signed by the parties to this contract. Unless otherwise specifically provided the Home Owner will obtain and pay for all required building permits. Home Owner will pay any assessments and charges required by public bodies and utilities for financing or repaying the cost of sewers, storm drains, water service, or other utilities including sewer � 6z� /1 9 � t and storm drain reimbursement charges, use fees, revolving fund charges, hookup charges and the like. MEASUREMENTS: Measurements, -sizes and shapes in plans and specifications are approximate and subject to field verification. Unless otherwise specified, all dimensions are exterior dimensions. In the event of a conflict between the plans, specifications, etc., and the Agreement, this Agreement is. controlling. General Contractor is not responsible for any existing illegal conditions. I MATERIAL REMOVED AND DEBRIS: It shall be the responsibility of each Sub- contractor to remove construction debris at end of their job and to leave premises in a neat broom -clean condition. ADDITIONAL REQUIREMENTS FOR COMPLETION: General Contractor shall promptly notify Home Owner of any additional requirements necessary to facilitate the Project's completion. Any subsequent amendment, modification or agreement, which operates to alter this contract, and which is signed or initialed by General Contractor and Home Owner, shall be deemed a part of this contract and shall be controlling in case of conflict, to the extent that it alters this contract. EXTRA WORK: The Home Owner and General Contractor must agree in writing to any modification or addition to the work covered by this contract. The General Contractor shall do no extra work without the written authorization of the Home Owner. Any written agreement shall list the agreed terms and be signed by both parties. DISPUTE RESOLUTION: All disputes hereunder shall be resolved by binding arbitration in accordance with the rules of the American Arbitration Association. The decision of the arbitrator shall be final. Disputes shall be settled according to the laws of the state that apply to this agreement. Any costs and fees (other than attorney fees) associated with mediation and arbitration shall be shared equally by the parties. Each party shall pay his or her own attorney fees associated with arbitration or litigation. � GENERAL: This contract, including incorporated documents, constitutes the entire agreement of the parties. No other oral or written agreements between General Contractor and Home Owner, regarding construction to be performed exist. This agreement shall be construed in accordance with, and governed by, the laws of the Commonwealth of Massachusetts. NOTICE: Any notice required or permitted under this contract may be given by ordinary mail sent to the address of either the Home Owner or General Contractor as listed in this contract, but the address may be changed by written notice from one party to the other. Notice is considered received five (5) days after deposited in the mail, postage paid. 10