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HomeMy WebLinkAboutBuilding Permit #328-15 - 54 LONG PASTURE ROAD 10/1/2014 y pORTH BUILDING PERMIT O�etLED TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION y h T Permit No#: �' Date Received �,R"�R`"" gSSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ." 9 4�yry4, RS� -a m...._ -- Print PROPERTY OWNER -PA , 7/ VZ'/4 A Rep,-r&w- ee ll - Print 100,Year Structure yes MAP'_ _Q PARCEL: . ZONING DISTRICT: -- Historic District yes Machine ShopVillage yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ,X One family 'A Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition 0 Other 0 Septic 0 Well ❑ Floodplain ❑1Netlands El Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: e t L � 1`'L G" X k 3' �cdpi ��raw a o f P C-Ac,lv Identification- Please Type or Print Clearly OWNER: Name: A'L Vlav a P;4 X, 6;,e12A Phone: Address: K taly G k,,� Contractor Name:. i Phone: �.SL-�3 - _ Address: t,O� 13 cu A c5, 053 4� 246 /6, Supervisor's Construction License: ___ _ ,Exp. Date:_ Home. Improvement License: I ___ ____-_ Exp. Date: t I �5_/._ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON ON$125.00 PER S.F. t Total Project Cost: $ 15-1 P& FEE: $ (o ASv r Check No.: i Receipt No.: ` � 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund $ignature of Agent/Owner Signature of contractor - 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 J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF 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 Reviewed OnSignature_ COMMENTS �� �,,1 r fi w( �� CONSERVATION Reviewed on ' 3 - Si nature COMMENTS t� - HEALTH Reviewed on Signature COMMENTS -7" 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 Ilk 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.$1oo-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email 5 Date Time Contact Name i-----^............... Doc.Building Permit Revised 2014 Location Lo No. X28 15- Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $1 ( �{ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t Check# 28090 Building Inspector NORTH Town of s ndover Tpo I 261q h ver, Mass, �— COCHICNlWICK S U BOARD OF HEALTH Food/Kitchen PERM T D Septic System 1 � � THIS CERTIFIES THAT ..` - BUILDING INSPECTOR ..................... .. .................. ..........:......�i ........................................ .. �5 �� Foundation has.permission to erect .......................... buildings on .�,�.... ... .. .. ..... ...................... law Rough to be occupied as a- )(l� scmftAit� y .. ..... .................................................. ..rt.��4..... ..�/�--!�-..................... Chimney provided that the person accepting this permit shall in every respect conform to�he terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU A Rough Service ........... .......... . ...... .. .... ................. ................ ..... Final BUILD. I.NG.INSPECTOR.. GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT. Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. i i GENERAL CONTRACTOR/HOME OWNER AGREEMENT THIS AGREEMENT is entered into this day of July,2014,by and between Elvin M. da Silveira and.LaSalete C.da Silveira, (hereinafter"Home Owner") of 54 Long Pasture Road,N.Andover MA; and Hinckley Brothers Inc. (hereinafter"General Contractor') of P.O. Box 623 Tewksbury Ma 01826. PROJECT PREMISES: 54 Long'Pasture Road,N.Andover MA. Title Reference: Deed recorded with the Essex North Registry of Deeds in Book 13636 Page 39. .'DES:CRIPTION 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; 0 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; a Supervise work in progress; • Coordinate subcontractorsand suppliers and inspections a Review all invoices and payments; e 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: I"Installment of$7,500.00 is to be made prior to commencement of work on the Project, "d `h. Installment of$7,500.00 to be paid on August ,15 2 3rd Installment of$5;000.00 is to b.e made within five(5)business days of completion of the Project. If any payment is not made when duel 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. 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. TERMSAND CONDITIONS The Terms and Conditions appended hereto and incorporated herein are expressly incorporated into this Agreement. This appended, t-constitutes the entire understanding of the parties. No other understanding or representations, verbal or otherwise, shall be binding unless in writing g 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. 2 �� � Signature Page. HOME OWNER: Elvin M�ra, DATE �611 f� �.�..mac-:.- t HOMt&WNER: LaSalete C.da Silveira T'DATE Home Owner contact infonmtion: j Elvino PH: 1 (978)807-5594 Elvino Email: elvino(izaol.com La-Salete PH: 1 (978)482-5498' La-Salete Email: 1das.ilve1ral3@gmail.com GENEP >4 CONTRACTOR DATE Hin ' ey Brothers.Inc. Stephen P. Hinckley,Treasurer MA Builder's.License# PH:978-852-6364 Email:hinckicybrosinc(a)gmail.com r 3 Scope of Work and Coordination Specifications 54 Long Pasture Road .North Andover,MA 01845 PROP.A.NE 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 system e) Future range-top,oven&other small appliance allowance f) Need to confirm iocation o f: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 locations to be run underground-Verify what is included from Pool Co. d) Trenches and digging for above WATER MAICN. 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 a. Itis critical t o coordinate with water department to shut down main n 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 eastern 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. 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 Garneau a. Confirm Height of new driveway retaining wall including new pool required fence heights b Confirmheightof 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 locationanddesign .e. confirm final square;footage of pation. STRUCTURES a) Shed-l0 x 12 to house pool equipment and landscape tools a. Will;also act as corner frame for new gate entry for new fencing b. Concrete slab provided by?Size 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.vvalpolevvoodworkers.coin 1. Walpole to quote fencing as well l FENCING & GATES a) Need local 2'quote for fence detail-Lattice privacy&decorative fence,and post&uire along rear property line REPAIR & LANDSCAPE b) Install;gutters c) Painting' I Quotes still needed; • Water line and pipe fittings • Electrical for landscape and other structures. • Propane gas.lines and connections for other than pool(confirm w/Tony) j • Rear porch(if approved) • 1 a quote for fencing • Obtain Apdated Earth Creation quote to reflect changes • 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 AV 6 i TERMS AND CONDITIONS HAZARDOUS MATERIALS Home Owner represents that the property does not contain 'hazardous materials. This contract does not contemplate.the testing for or removal of hazardous materials. GENERAL CONTRACTOWiS R1GIITS.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 datethat 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 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 further Iiability. 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 foul payment amount, 2. General Contractor,. at General Contractor's option, inay 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 saidmork. 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 further that: �� 7 ` (1)the specified work will comply w th.all applicable building codes and regulations. (2) the labor and materialsprovided as part of the specified work will be free from defects for a period of one(l)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 anissue 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,O rner's property free of valid labor, material or mechanic's liens: I ITEMS NOT THE RESPONSIBILITY OF GENERAL CONTRACTOR I. EXISTING VIOLATIONS AND CONDITIONS. General Contractor shall not be held responsible 'for any existing violations ofapplicable 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, roofing. 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 OWNERS RESPONSIBILITIES UTILITIES: The Home Owner is responsible for water, gas, sewer and electric utilities, from the appropriate agency to the metering devices servicing the Project Premises. It is 8 I i 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-contractorsworking 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 represents Home Ownership of the property 1.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 wag 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, reportsorcalculations 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 M1 9 `:J 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: MATERIAL 'REMOVED AND DEBRIS It shall be the responsibility of each Sub- contractor to remove construction debris at endof their' job b 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 issigned or initialed by General Contractor and Home Owner,,shall be deemed a pain 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. I' 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 i i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-053268 ,:.r 1.1,STEPHEN HINCK EY " ' 4 50 Fox Avenue OU Dracut MA 01826 S' )I'W 0 Expiration Commissioner 12/06/2015 Office of Consumer Affairs&Business Regulation-Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation a Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints Registration# 174237 Home Improvement Contractor Registrant HINCKLEY BROTHERS INC. Registration Home Page Name STEPHEN HINCKLEY Address P.O. BOX 623 City, State Zip TEWKSBURY, MA 01876 Expiration Date 01/15/2015 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. I i http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=76126 9/25/2014 De Co mmompealik afMassaeh.usetts0.1 *.� Offlea O fAvestzgaiYORS 00 Wasfthfm Street . Waytoa.,AM 02111 mwlp.mass go-Pfciia ' •ork,ex,gi Coxnpengatioubsurance x�avit:S c erg /�o ac orc 1 1e� re ezan l'Z berg A� Aant oma-Ro PX asp x u �G . idixatj: UC S IVB, Rama( usiness(Organ aationlPvo . Address3SOIK gid'- 951- 04� Ax•e yolxan employer?Checkffto appropxzatebox: Type of project(re *ed): 1.a 1 mu a employer with 4. El x ata a general contractox and x 6, ew cbnstmo-Hoa f employees("Maud(oxpattime}T haveliitedthesub-contzact '1 remodeling 2.❑ S am a sale pxopxietox or paxinex- listed on the atiached sheet- ship and`havena.employees These contractowhavo 8. El Demolition woxkixag foxxue In any calracity. woxkexs'comp.Insurance. 9, -t. wilding addition PTO workers'comp.insurance S. We axe a avo oDragon crods affieIr . Electrzcalxepairs or additions � < e . � ofxcexs have exexcised.thelr mgafr d or add 1.. 21 mbingxe airs itions 3.El am.a h�meawxtex doing all work rig7xt of exemption pexX�G�.� � .p myso .Ulowoxkers°comp. G.152,§1(4),andwehave o 1 ,QRao xe azrs Insnxancexerlulred.�; employees.LNb woxkexs' 13,�OtTiex comp.Insurance xecluixed.] Ivyasoillouitbeseetionbel6vrsho�vin$theirWorkers'eompensat!OaVOJicyWOnnation. pplicanttfiascheckshox ZmnsEal ihomeownerswhosabmitthisatf%daYitind�catingihey�i(;dpingatlworltandtbennaoutsidecontractorsmvstsn7iznifaneF1afddagitindica ngsizch. TContracfors that cbeckthis botimtistatEached artadditionalsheetshowingthenameotthe suT-eouEraetors andft eom�.policyuifomiaiion. Iaz exnax2 ploy4P tNd 19pravIding w0fjXOFS eornpe�i�atxan z�s�c�ar�ce fog�r�y ex�royees; ��row%�z�ie�a7icy artt��a�,��e i�z,�namatiorz. . hsam=Company dame; A, 1, i /elm—,w— INC, Policy#ox Selma vis.Vc.#: AWC7d2y 9 7,2 ' -701M ExpixatzoaDate: 7abSite Address; AV (A�. IF-� City6State/.dip: ttaeb a cogy a tTzo woxXZers'eompensatroxtTolzey declax•ation page(S]`Owing•the poNcy nmuber and eUkatzorx date). Paliilxe to seemo oovexage as xag*odundex Section 25-A.ofmof,0.152 caa leadto'tb e Impositian of enkdhalpenaXties of a :be-up to$1,500.00 xmpxisopmeut,,as well-as civilpenalties Ian the form.of SWOP-Gt+ORX ORDER.MCI a fmo ofvp to$250.00 a day against the vtolat r. Be advised that a copy offt statementmay'he oxwaxdedto the Off too flz investigations of ffio DxA.fox 1Lwance coverage YeTWOEWDn. Xtlo Xtemby Curdy a ae jains amYFertalttes ofxe&. ..I-'V trtatAfe infarmation provided 0ve ii �t/rue wd eorreet. Si afore• Data: 9v/ Ofeial usa mly, Do not write ft,AIN area,t0 be corqfeW ry clip or tarn 0felax pity or Town: EexznztlDzcez�se# fssufng.A-athoxity(circleone: Z.Board of uealf ).BufdhagDepar'tmeea, 3.Cityf'7Coym Clerk 4.Electxicalfaspeetor S.RX-ambinginspector 6.Otlier - r t information and Instruction Massachusetts General saws Chapter 152 xe ires x .� yu all e mployexstaprovzdewoxkexs co14ensationi'oxtiiekempZoyees. -Pursuant to GIs statuto,an ergployee is d0fmcd as"...OYMYPOlsonk lbservica of mother undor any c6fract hire; express ox implied,oral ox written:' ' raz c{y zs ei7nedas anzt�dzviduai, ariuexs soczai.0 Go o otherl�egaXex�tzty,o�a�ytwooxmoxe ofthe foxegong engaged in a joint enterprise,andinaludingthe le galxepxesentatives ofa'deoeased enPlQyex,.oxtTze receiver ottcistee o andxvzduaT, axfxtexshi ,associatioxz ox ofi7sexlegal entity,employuzg employees, Sowevexihe ownexofarlweliinghousehavivgnotzztoxethan�xeeaParEmentsaudwhoxesidest exek,oxth000mpaatof'tte dweft!ouse ofanothex wRo employs persons to do maintenance,constraction oxxepaix wOrk on suolz dwaffighouse OrMthegroumsoxbuildin a urLenwt g thexetoshallnotbec pp ause ofsucR employe sl n ntbe deemedtabe an employe: MGI.chaptex 152,§25C(6)also states that"evexy state or to Cal jleensing agency shau withhold the ksuanc4 ox renewal of a license or permit to operate,a business or to constrict builc'tixtgs in the commonwealth for any applicaxtt who has riot pxaduced•acceptalrle evidence of compliance wztl�.the insurance covsxage required;' .Additionally;MCxI,cha�tex 152,§25C(7)states`�1'eithexthe common ea • d w Itltnor any ofzts political subdzv�szons shall enter into any contract ft the performance oipublzc work-until acceptable evidence of compliance with,the ijmwance xoquirementsozthis chaptexhavebeextpresentedtothecantractiagauthority z' .Applicants , Please fail out the workers'compensation affida&completely,by checking the boxes that apply to your situation and,if iiecessaty,supplysub-coniractox{s)nanae(s),addresses)andphonenumbex(s)along witlttheir cex'z eate(s)of :insizz'ance. 1,imitedLiabi1V Companies(LLC)orUm&dL1abilit rPattnexships(fU)withno employees othexthmthe me bexs oxpartnexs,arenotragairedto carrywoxkem,compensatioxzinsuxance, anLLC oxLLP daesbave OM ployees,apoliey xsxeciuixerl. $e advzsedthattbis afdavitmaybo mbmitioato fhaDepartment of Industrial Accident for contixtnation of insurance coverage. Also be sure to sign,and date the afidavz. !1ie afc"tdavit should b e xetumed to the city Ox tom thatthe application fox tiieperngt or license is being requeded,xtof the Deattment of kdustrialAccidents. Shouldyeuhaveany+luesdonsxegaxdin thelawoxif ou oxe . t g y ar lied�o obta" compensation,PORGY,please call thaDeparfzaeutattlt u mbexlistedbelow: Selfinsuxerloompavies outdenextheir self~insuxance license numb ex on the appxcpxiate line. +City or TOM Qllxcials Pleasebesuretb.attheaf�"zdavitiscompleteandpxiatedlegibly. TheDepax,�n.enthaspxovicledaspaceatthebotcom of tRea�davitfoxyoutotsllolxtin.theeventtheOfCeeaflnvestigationshastacontactyozxxagard�gttteap�lieant: - 'leasebesuxetaz"i7lintbepexmit/licensenumbex�vl�zclawillbeusedasaxeiexencenamber, Inaddttion,anapplicant thatnius E submitznultiple pennitllicex e applications iu any gi euyeax,need only submit one affzdaviG iudica&g cun'ent policy information(ffnecessmy)and under"Jab Site Address"the applicant shouldwdte"all locat%oxis in (city or towzt):'A copyo tlieaifidavi4thathasbeenofficiallystampedoxmarkedbythecity ortowumaybepxovidedtothe applicant aspxoo thatavalidaf tdavitison le o-rttuxepon tsoxlicenses, A.-aawaffidaemustbef-tlled'outeach year.'Where ah.ome ower or citizen is Obtaining alicense oxpexmitnot xelatedto anybusinms or commercial ventuxe, (z.e.a dog JiGonse orjarmitto bum leaves etc)said person is NOT xec*alto complete the affidavit. The Office 6ffnMdga&-un wauld like to thank you in advance fox your cooperation and sb guid yo-a have aay questions, please do xmt hesitate to give us a cart. Via Depaxtm.ent's address,telephone aizd faxnumber: This CQM—Mo waam OrM-QwSaVAwk,-t AtTaximutt OfTnd-Wal Acoldoi a (.exec dfAVQWgAAo.1l% �Y Revised 5-26-05 FOX#617-W7"7749, From: <978-922-2731> To: 19786889542 Page: 2/2 Date: 7/23/2014 3:55:30 PM CERTIFICATE OF LIABILITY INSURANCE DA0TE 7(MM/DD/YYYY) 07123/2014 o CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO. RIGHTS UPON THE CERTIFICATE HOLDER. THIS cRTIFICATE 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. s. - 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). &4 PRODUCER 02047-001 NAMCT E: Appleby&Wyman Ins Agency Inc AI o.Ext): (800)528-2288 FAAic.No.: (978)236-3711 152 Conant Street EMAIL .4 Beverly,MA 01915 ADDRESS: IIINISURERI'S1 AFFORDING COVERAGE NAIC INSURER A: A.1 M.Mutual Insurance Company 26158 INSURED INSURER B: Hinckley Brothers Inc INSURER C P O BOX 823 � INSURERD: Tewksbury,MA 01876 INSURER E: 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 TYPEOF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DDIYYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES'Ea occurrence CLAIMS-MADE n OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY I EO� OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMSMADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X WO STATU- O AND EMPLOYERS'LIABILITY TORY LIMITS ER R ANyy PROPRIETORiPARTTNEER'EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000.00 A OFFICER.,MEMBEREXCLCD ED? u NIA AWC-400-7023972-2014A 1013/2014 101312015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 If es.describe under E.L.DISEASE-POLICY LIMIT $ 500,0013.00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS!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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover, MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010!05) The ACORD name and logo are registered marks of ACORD Gutter 2 5/12 roof pitch 5eptember 18, 2014 C'u �ru: _ 97 9901 - - - 6x6 WOOF HOMING 5ee Facie 2 - -- -- — - FINISH PA110 TILE M2 5 -216ii - - 2x6 TTAtP MU2511-I, i FII PM5H CONCPgTr 5LA3 4, SILL 5MEP, - i VApop PApr EV �"CVIUSN1�P STONE __ —_ - - CAST-IN-PLACE MCHOP, — - - \ - 601T COMPPCTEG 5011 �_ ----- --. - P.51NFOP\CING 5tEl,AS _ - �xistinq __-__-- - - Handrail p�auli�o ^f - 8X16 CMU WALL All L VAPOR PMEP,TO CWAOE co inish-Grade „ i - - �} slab patio deck 8,25 risers Bx16 F0OMC, Concrete sfab - N CMU FOUNJAfloN _ I2" tread depth i ra e ead -- CONCTE I " trs -- _ e exterior - -- FOOTING Cinder block to be Veneered:with Not to scale matching patio stone builder Foorinol- 8'' below frost 8x16 poured/ 12'-6 concrete Footing b ns out -12 -6 . drain e Tl3b 2.25 I?00F PIfCH rubber roof-Membrane - I r — — — — — — — — — — — Finish 11312 bAYU�NfRF p00F 12' -61 1 F rami A5PHALf 1200ING I I New 8" x 16'' Block Wall 5/811 FU 5H�ATI-IING- \ , - ( I & 811d x 16"w concrete Footing clutter--- ti 2t2z6 eciingr'1,YWoOn rim-- Fill & 4" F ibei-Me5h slab FASCIA r3eadboard Ceiling I I I I'-1011x I2'-4i i s 50FFIf-- Finish Ht. 96'' ri c� FINISH VIM & a2Y,6 2x6 Framed 16"oe 51 f�ATNING - III NNI\ cei,i at 99" Not to Scale X 8''-16''OC \ iHu � I --� I :-�: I ba5ilv� ira �esid�nc� - 2x101?idge 8d=4 ----'� I 5lmp5on Hurricane Ties HCP Nip Corner fie L%210 Joist Hanclers North Ah J oV e r, MA 01845? September 18, 2014 - ru „��,�co -.. Note; Al exterior framing hardware, ties, handers, etc. 6x6 porch s shall be non-corrosive material- ., 3-2x6 dba .k I No galvanized finished or exposed hardware jExterior Trim & Moldings - Azek or equal a s. .-� N L8t8/ jrt"Fj 9 o Triple.20 Header tiy" �- - �PC66-16 �" post to-Header Strap 5imp5on Concealed post Tie 12'-6 ' Model# CP66z-for 6x6 post Porch Panels will be 5ereeneol with removable storm 5ingle glaze clear glass $ 4x9 Post Triple 2x8 Pins;CJTPS) N TOP Vll?.W OF PORCH P. KIEL ASSEMBLY CEDAR POST `H"Asl ao INTERIOR – \ I Existing Exterior x8 Hear� Triple 2 de \ I wall w/slider i— C 1-\ PORCH PORCH \ I I I'ANEI, ` PAINT-I, INTERIOR na5ilveira residence \ r' $,ceps(As„xb.il Cali B11-as5 Screws Proxidea Stops 5� bong Pasture P J Nad On FF North Andover, MA 01845