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Home My WebLink AboutBuilding Permit #365 - 56 WAVERLY ROAD 11/3/2006 TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION o`�t�ao b quo E OL APPROVED Permit N0: Date Received ys + vy Date Issued: l SSACHUSS IMPORTANT: Applicant must complete all items on this page LOCATION LJQV erl-i R4 Print PROPERTY OWNER GUY AA)t>0 Print MAP NO.: Ir PARCEL: f ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building `One family XAddition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only O DESCRIPTION�C t� �g OF WORK TO BE PREFORM" a4 Br"-L�j ADp Z,, 7-11 '< 1� i y; �L� U< 4 Identification Please Type or Print Clearly) OWNER: Name: G u � AAj-pc Phone: Address: SG, cxIrl.. (2J. AV, A�Ajaz>ovv(' "Act 016 3' CONTRACTOR Name: 3 o h n J— Phone: C7–7 Address: SOX l 3a . to. AAjC> lv-ef° V- A- vI M f Supervisor's Construction License: Obbl431 kv Exp. Date: I IU Home Improvement License: l3� S� oZ Exp. Date: I( Z4'I U ca ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.OR$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ FEE:$ aO Check No.: : 1, Receipt No.: l Page I of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ Tanning/Massage/Body Art ❑ g Public Sewer 'A Tobacco Sales ❑• . .'Food Packaging/Sales ❑ Well ❑ '- L 1 ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. Electric Meter location to project NOTE: Persons contra�t'ng with unregistered contractors do not have access to t uaranty fund Signature of Agent/Owne - - __ Signature of contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Sta ed Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS TE REJECTED DATE APPROVED CONSERVATIOl COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date 4�,/', !� COMMENTS 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 Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use) 9 COve 6w I !, Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 I 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 Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit —o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract 'u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Y Page 4 of 4 Location No. Date NORTH TOWN OF NORTH ANDOVER N A Certificate of Occupancy $ Building/Frame Permit Fee $ C U Foundation Permit Fee $ ° Other Permit Fee $ / TOTAL $ / l Check # l ,p 19767 Building Inspector t%ORTH Town of No. o = A o dover, Mass., WOE 0- 10 COCMICMEWICK y�. AORATED P? Cl) S ` BOARD.QF.�` � � PERMIT T D FoodMtchen k Septic System F BUILDING W_ SPECT OR THIS CERTIFIES THAT.......... . .......�. ........ ... ..�.WIP.................... ..... ............................................................. Foundation has permission to erect........................................ buildings on An......i ........... . .......... .................... Rough to be occupied.as. O... ..... .,.. ,�......�r �. .._ Chimney r..... � j/ ..... �h' provided that the person accepting thi ermd shall in every respect form i�the terms of the application on file n Final 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOTS Rough .............. ......... ..... ..... .. Service .. .. . ... . .... ...... DING TOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a ConspicuousPlace on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. r GENERAL CONTRACTOR: 3 y. NABC GENERAL CONTRACTORS PO Box 132 N. Andover, MA 01845 1-978-869-9616 DRAWINGS BY: Designs R Us, LLC 64 Scobie Pond Road Derry, NH 03038 Phone: (603) 432-9974 Fax: (603) 432-9510 Email: Designs rus®comcast.net PROJECT. _ GUY ANPO LL=j Waverly Poad N. Andover, MA DESCRIPTION 1i ! I, - 10, EXISTING —�- HOUSE PLANS SIDE ELEVATION Ao REV: DATE: 9/25/06 DWG. # GENERAL CONTRACTOR: Z. NABC GENERAL CONTRACTORS PO Box 132 N. Andover, MA 01845 1-978-869-9616 DRAWINGS BY. 12 2 RIDGE: Designs R Us, LLC 6"t VERIFY �,-- 64 Scobie Pond Road EXISTING Derry, NH 03038 2" X 6" COLLAR TIES ARCHITECTURAL SHINGLES Phone: (603) 432-9974 1/2" PLYWOOD Fax: (603) 432-9510 Email: ~ 2" X 10" RAFTERS ® 16" O.C. Design srus0comcost.net 2" X 4" WALL 16" O.C. PROJECT: Ix 1/2" OSB PLYWOOD = 1/2 CEDAR CLAPS GUY ANnO U a 3/4" PLYWOOD Waverly goad 2" X 8" @ 16" O.C. 0 N Andover, MA w DESCRIPTION 12" SONOTUBE EXISTING j 13'-8" PLAN5 HOUSE REAR ELEVATION •2 1/4' = 1'-o' 2 SECTION @ GARAGE o Rte: 1.2 1/4• = 1'-o' DATE: 9/25/06 DWG. ip %IpH17PA1Ri610tlR11S19111W1M1fAIlEAHAHE@FIIAABRHI>sAC9114�18E9119AN101mi0919HIfl4L19HINA!`SltGifl".113MIW1l4t�i15GYd�HIM1iA!@01804•.01 +�'AH@R6!RIIDRa9EHU.✓��. GENERAL COPdTRkCTOR: .. OB9�RBAiP700[lIgA004?�9&fA1MIM1Rbb7ANW ilgA!!OHlIRARCA!tl86@H7AOOAS90PRXiliIOEEIaH R111�77�IASiRH®t�'RAHR��OIOtH01AWF.AIARHISRAAR101N1&'H11p1�4B090A®tA1A0511'aildRl�151RiH0lP4l0�lHRAtlIOteWiRHFRFI•HH ^ 1'�A: C rE]'�TI`R.A.L CONTRACTORS PO E3ox 132 N. Andover, MA 01845 - _ 1-978-869-961 EXISTING HOUSE- 1" X 6" EXISTING HGUSE Cq 16" O.C. Z. ... NEW ADDITION 0 0 DRAWINGS BY: Designs R Us, LLC, 64 Scobie Pond Road Derry, NH 03038 ex X 10" BEAD^-\ 432--9974 Phone: (603) _ -- --9510 Fax: (603) 432 Email: Designsrus@comcast.net --— — — rOJECT: - GUY mpo NEW DECK Waverlu, 1o03J Lu Cl w N, h1jover, MA DESCRIPTIO REV: PIAN @ FRAMING DATE: 9/25/06 1 PLAN @NESP ADLITION 1:3 �_- R DWG. { 1.3 mRln1RHA1nA1mHR1nrtlesuH He�wAtHHlaaHaH�HlaweoxaewvlmHmmaawA�Hl�nl�°� aHl�lmorialaHo9RvlsAAURAIasm�°rt�� . p�i0g9RISAHl1®0H�!lilYYl�l0�ie9'9R�HRiAY9l�i0®79H�119HAf11�A9HRl9R�Rl�MtNJHORRAi The Commonwealth of Massachusetts l Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass,g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): AJ A(3 �- Address: Po /30u f a). City/State/Zip: i) A.,jpy\er A A"1 Phone #: q7 A r(Of Are yo employer?Check the appropriate box: Type of project(required): 1.ED,ram a employer with 4' 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ i am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ Remodeling ship and-have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. ' 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: (� / Date: Phone 9: J � �G`_ 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#: INTERNET INSURANCE Fax:9786870149 Sep 29 2006 11 :37 P. 02 ACORD' CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 11111o,�' 1 09/2912006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INTERNET INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 522 CHICKERING ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES SEI-OW. NORTH ANDOVER, MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Norfolk&Dedham JOHN LEEMAN INSURER B, PO BOX 132 INSURFRC: NORTH ANDOVER, MA 01845 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR IN' TYPE OF INSURANCE POLICY NUMBER DA A 7 LIMITS A GENERAL LIABILITY R0618286A 2/17/06 2/17/07 EACH OCCURRENCE $ 1,000,000.00 717 COMMERCIAL GENERAL LIABILITY pAEMISE3 Ea c 15— $ 60.000.00 CLAIMS MADE Z OCCUR MED EXP Any one person) $ 5,000.00 PERSONAL$ADV INJURY $ 1,000,000,00 GENERAL AGGREGATE $2,000,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000,00 POLICY r7 PROJECT LOC AUTOMOBILE LIABILITY COMBIV D SINGLE LIMIT 5 cc ANY AUTO (Ea sent) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per perecn) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (per oeeltlent rPOP RTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTOpTHER THAN EA ACC $ AUTO ONLY; AGO EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE b $ RETENTION WORKOE COMPE�SLTIONAND WEND20155 2/16/06 2/16/07 d T RY 1 Ta EMPL Y S'LIAR 1 100,000.00 A E.L.EACH ACCIDENT S OFFICERJMEMBER EXCLUDED?ECUTNE 100,000.00 El.016EASE•EA EMPLOYEE Is If yyees desulbe under E.L.DISEASE-POLICY LIMI S 500,000.00 SPELLIAL PROVI910NS beiaw OTHER CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A13OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION GUY AN DO DATE THEREOF,THE ISSUING INSURER WILL ENDFAVOR TO MAIL 080 DAYS WRITTEN 55 WAVERLY ROAD NOTICE To THE CERTIFICATE HOLDER NAMED TO THE?LEFT,BUT FAILURE TO DO 30 SHALL NORTH ANDOVER,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTkOR1ZED REPRESENTATIVE ®ACORD CORPORATION 1988 ACORD 2S(2001108) s i BOARD OF:BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS 082816 " ' ` Birthdate 06/16/1958 Expires 06/16/2008 Tr.no: 27672 " Restricted 00 ` I JOHN R.LEEMAN JR i 70 PILLON ROAD ti C/ MILTON, MA 02186 "'- `" commissioner t - 130ai i!of'BlliI Ap;T UCgt iLn and Cra`t� {`� 'HOME I�dlf?RCiVEtSEilT COI.TFi,aI rk 13502 ' .'�xpira on�1-L26/2006- _ Pnvate,CorForaticin NORT!1 A^.UCVER}3U 01ING CGRP. ` M JOfJN:LEEMbN A'; VER eA018x' aG'; CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE.1"=40' DATE.1011212006 Scott L. GilesR.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. THE ZONING IS R4 100'FRONTAGE 30'FRONT SETBACK 8> OR AVE, OF SETBACKS 250'EACH WAY. 15'SIDE SETBACK 30'REAR SETBACK. LOT V L.C. PLAN 19865B MAP 18 PARCEL 69 CI. WOOD GAR. 0 RO10, P PROP. EXIST. a DECK cy 10 E2S 2 STY. o W.F. O 8 V 0o DWELL. W �,� C-9� J o° Lu 84.44' I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING ILS DETERMINATION OF ZONING . 93972 o� BYLAWS OF Fc/S?EREO NORTH ANDOVER CONFORMITY OR NON-CONFORMITY io��t WHEN BUILT WHEN CONSTRUCTED. IANO AIA Document A105 StandardForm of Agreement Between Owner and Contractor for a Small Project where the Basis of Payment is a STIPULATED SUM 1993 SMALL PROJECTS EDITION Because this document has important legal consequences, we encourage you to consult with an attortaey before signing it. Some states nuindate a cancellation period or require other specific disclosures, including warnings for home improvement contracts, when a document such as this will be used,for Work on the owner'spersonal residence. Your attornq))should insert all language required by state or local law to be included in this Agreement. Such statements 7n ay be entered in the space provided below, or if required by law, above the signatures of the parties. i f This AGREEMENT is made: ZS 17-00 ,. (Date) BETWEEN the Owner: Gul DL) . AAjP o.he,r rAci 01b-4f- and (Y-ff- and the Contractor: N A6L Pty box t 3� AJ for the following Project: t-3 )( 10 ,4D0;VZA J `-rcl me 0,;. of ) The Architect is: DCS(o vi 5 A U S LLL 2."' f\) 14 03o30, The Owner and Contractor agree as follows. - ®Copyright 1993 by The American Institute of Architects, 1735 New York Avenue,NAXJ.,Washington,D.C. 20006-5292. Reproduction of the material herein or substantial quotation of its provisions without the written permission of the AIA violates the copyright laws of the United States and will subject the violator 10 legal prosecution. ,r AIA DOCUMENT A105 OWNER-CONTRACTOR AGREEMENT—SMALL PROJECTSYp EDITION•AIA`•01993•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,WASHINGTON,D.C.20006-529.2 WARNING:Unlicensed photocopying vinlatps II.S.convrioht lawsandwill subject the violator to legal prosecution. _ - A1-05._ -g93 " �"' •_. 8'; ARTICLE 1 THE CONTRACT DOCUMENTS The Contractor shall complete the Work described in the Contract Documents for the project.The Contract Documents consist of: .1 this Agreement signed by the Owner and Contractor; .2 AIA Document A205,General Conditions of the Contract for Construction of a Small Project,current edition; .3 the Drawings and Specifications prepared by the Architect,dated and enumerated as follows: r Drawings: ( � l 1 3 1_-)ci RAY) `l I 7-5-)0 Specifications: PL-61,u S J .4 addenda prepared by the Architect as follows: A- .5 written change orders or orders for minor changes in the Work issued after execution of this Agreement;and .6 other documents,if any,identified as follows: P/A AIA DOCUMENT A105 OWNER-CONTRACTOR AGREEMENT—SMALL PROJECTS EDITION•Ale•01993•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW PORK AVENUE,N.W.,WASHINGTON,D.C.20006-5292•WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. A105-1993 2 ARTICLE 2 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION DATE The date of commencement shall be the date of this Agreement unless otherwise indicated below.The Contractor shall substantially complete the Work not later than A5 Soot A 5 r65:51 b L subject to adjustment by Change Order. ptuey the date or number of calendar days after rhe date of contntencenent) f ARTICLE 3 CONTRACT SUM q 4o 3.1 Subject to additions and deductions by Change Order,the Contract Sum is: 3.2 For purposes of payment,the Contract Sum includes the following values related to portions of the Work: Portion of Work Value A K:# 3.3 The Contract Sum shall include all items and services necessary for the proper execution and completion of the Work. AIA DOCUMENT A105 • OWNER-CONTRACTOR AGREEMENT—SMA.11 PROJECTS EDITION•AIA`•Oc 1993•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,WASHINGTON,D.C.20006-5292•WARNING:Unlicensed photocopying A105-1993 3 . . ..- .... __. ...;n ".ki—t tho vinlator to leoai prosecution. ` ARTICLE 4 PAYMENT 4.1 Based on Contractor's Applications for Payment certified by the Architect,the Owner shall pay the Contractor as follows: (Here insert payment procedures and provisionzs for retainage,if a»y) tzo e { "J"'— com 19l,e t-e-A 4.2 Payments due and unpaid under the Contract Documents shall bear interest from the date payment is due at the rate of or in the absence thereof,at the legal rate prevailing at the place of the Project. (Usury laws and requirements under the Federal Truth in Lending Act,sinular state and local consumer credit laws and other regulations at the Owner's and Con- tractor's principal places of business,the location of the Project and elsewhere nary affect the validity of this provision.) ARTICLE 5 INSURANCE 5.1 The Contractor shall provide Contractor's Liability and other Insurance as follows: (huerl specific insurance required by the Owner) 6rt1Che D 5.2 The Owner shall provide Owner's Liability and Owner's Property Insurance as follows: (Insert specific insurance furnished bt the Owner.) 81A (Ll(CP"� �SI �v/ CWfV2 (+� 5.3 The Contractor shall obtain an endorsement to its general liability insurance policy to cover the Contractor's obligations under Paragraph 3.12 of AIA Document A205,General Conditions of the Contract for Construction of Small Projects. 5.4 Certificates of insurance shall be provided by each party showing their respective coverages prior to commencement of the Work. ARTICLE 6 OTHER TERMS AND CONDITIONS Ouse i 1 anp other terms or conditions below.) This Agreement.entered into as of the day and year first written above. (1Jrequired 41,law,insert cancellation period,disclosures or other warning statements above the signatures.) OWNER ;' C TRACTOR (Sigaliature (Sr.'gnat"re G- w A.tir:,o t33 (Panted name,title arzd address) (Printed name,title and address) 40,0,\- l 3�). LICENSE NO. JURISDICTION I ? CAUTION: You should sign an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. See Instruction Sheet for Limited License for Reproduction of this document. AIA DOCUMENT A105 • OWNER-CONTRACTOR AGREEMENT—SMALL PROJECTS EDITION•AIA°•01993`THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,WASHINGTON,D.C.20006-5292•WARNING:Unlicensed photocopying violates U.S.copvriaht laws and will subiect the violator to legal prosecution. A105-1993 5 . � ad's �+:JlLC Z�Jdi)7/I)9bI9.UleR+u/L•'fl�'/I'�'�"^�Zfl � -ARD OF.f3UjLD.ING RE�'ULATIOi�S �« X30 Ltaense: CONSTRUbtION'S#71?ERVISOR X8281:6 �Xpires fl6I9612008 3r.no. 27672 fOHN iz 'LE-EMAN.7()Pil ON ROAD 1R'` / i' iJIL�ON,NA•02186 {Dmmissiorier ,y .�,• � i3oarc:of;3pitd�n��c�l: '�LZii,�ind�ra 't+IMW iCIv1E ilili? OVE;II:NT Reys:�fi3r'tJ3 3 v 5:i2 ira`�o 112612006. - -_ ivale.corpora#ion E— 7yp?- f. CORP. 03'N LEEMA+�1 °� -Y /; � la 1 I IgTERMET I tgSURAIICE Fax:97860707 49 Sep 29 2006 11 :32 P. 04 ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MIAIDD/YYM 09/29/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INTERNET INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 522 CHICKERlNG ROAD HOLLER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTH ANDOVER, MA 01845 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURERAI Norfolk&Dedham JOHN LEEMAN INSURERS! PO BOX 132 INSURaRQ NORTH ANDOVER,MA 01845 INSURERD, INSURER E; COVERAGES 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 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR01 TYPE OF INSURANCE POLICY NUMBER DA M DD ) 61/DD/ LIMITS A GENERAL LIABILITY R061828$A 2/17/06 2/17/07 EACH OCCURRENCE Is 110004000100 �/ COMMERCIAL GENERAL LIABILITY A Nl 50,000,00 PR ISE Es accurence $ CLAIMS MADE Q OCCUR MED EXP(Anyone person) S 6,000.00 PERSONAL&ADV INJURY IS 1,000,000,00 GENERAL AGGREGATE 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PER; PRObUCTS-COMP/OP AGO $ 2,000,000,00 POLICY M PROJECT LOC LAW VOMOSILE LIABILITY COMBINED SINGLE LIMIT 5 ANY AUTO (Ea accidenp ALL OWNED AUTOS SCHEDULED AUTOS (POefDipeYepn)URY g HI RED AUTOS NON-OWNED AUTOS (BPM ac IN Y S PROPERTY DAMAGE S (Pcr acoldcnt) GARAGE UABIL.ITY AUTO ONLY•EA ACCIDENT s ANY AUTO FA ACG S AUT0�NLYN AOG EXCEBB/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE DEDUCTIBLE $ RETENTION 6 g INMpLW ERmQ IAB U AnTION AND �' WEND20155 2/16/06 2/16/07 V TORYLillYB Fj E A ANY PROPRIETOR/PARYNER/EXECUTIVE E.L.EACH ACCIDENT � 100,000,00 OFFICER/MEMBER EXCLUDED? E,L,DlBEARE-EA EMPLOYEE 100,000,00 II yc^ des6ribe under SPS�IAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 6 300,000.00 OTHER CERTIFICATE HO(.b1=I2 CANCELLATION --. SHOULD ANY OF THE ABOVE DEDCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 030 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,OUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGAYION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVF ACORD 25{2001/08) 0)AVRD CORPORATION 1988 guy NABC General Contractors PO Box 132 N Andover,MA 01845 'W' r.�s .� § �a` �Y-n k' }afkr't�' +4 ;"' t`s> fr, �n;ct�' u x� guy,t. r 3 general conditions $ 1,200.00 permit inc plans/engineering inc insurance layout dumpster inc tools equipment heat,light.Power by owner toilet by owner winter conditions demolition $ 400.00 site building sitework $ 300.00 for footings excavation backfill driveway concrete $ 520.00 footings inc foundation waterproofing slab walkways masonry chimney $ - walls steel beams $ - decking rough caraentry $ 7,970.00 framing inc roofing inc rubber roofing siding inc windows 3 inc sky lights fire door exterior doors 1 inc garage doors trim inc i guy NABC General Contractors PO Box 132 N Andover,MA 01845 finish carpentry $ 2,950.00 base/trim doors stairs decks/rails no rails kitchen cabinets bathroom vanity countertops other cabinetry insulation $ - none inc flooring $ - none inc wood carpet tile other finishes $ - none inc drywall plaster paint exterior paint interior wallpaper hvac $ - none inc heat air conditioning plumbing $ - none inc electrical $ - none inc $ 13,340.00 overhead profr $ - total $ 14,940.80 Qualifications no unforeseen conditions . no hazardous materials 10 x 13 addition 10 x 13 deck roof at addition only siding at addition only frame,windows,roof,deck only