Loading...
HomeMy WebLinkAboutBuilding Permit #904-11 - 562 TURNPIKE STREET 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: v / Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION r Print /� PROPERTY OWNER I� io(' �` OV40VIely' nO.C-cyorJS /N-Unit# Print MAP NO: 9'JK PARCEL: 0/ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial B�Iteration No. of units: Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑Floodplain ❑ Wetlands ❑ Watershed District Y�Vater/Sewer DESCRIPTION OF WORK� T�ws ERFORME / W CO F✓ �- (identification Please Ty a or Print Clea ly) OWNER: Name:k/c9r '� v�va�a�' �rYr� )s 4 � ' Phone: Address: 7) 6_0 v vie llc>rk � AK, V Name: 2eA ' Y\ LA 0) �� s Phone: CONTRACTOR Na Address: oC A o/ 9¢¢ Supervisor's Construction License: �� ��9r� Exp. Dater Home Improvement License: Exp. Date: ARCHITECT/ENGINEER cA A A 1'. ��w Phone: 64o 3 �� 3'5 Address: j �I rA I'» Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ d'0 FEE: $ �4 Z d 713,3 Receipt No.: y Check No.: p NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ., __- •.. . __ _ , _ _. - nature of Agent/Owner Signature of,contractor _ 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 DATE REJECTED DATE PPR VED LANNING & DEVELOPMENT ❑ C MMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS: Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 DATE REJECTED DATE PPR VED LANNING & DEVELOPMENT ❑ 1 C MMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 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 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/Crossection/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: Doc.Building Permit Revised 2008mi Location .5--�-� / vl /tit 16 No. C� — Date NORTN TOWN OF NORTH ANDOVER 0 � a i � C + Certificate of Occupancy $ MUSEta' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # X33 - 24 � � 5 � Building Inspector NORTH Tovm Of Andover . 0 No. LAKE o , dover, Mass., COCMICKEWICK AORATE0 PPP���S `s BOARD OF HEALTH Food/Kitchen rERMIT T Septic System > BUILDING INSPECTOR THIS CERTIFIES THAT................................................................. °� < ................... . . .............................. ..................... Foundation has permission to erect........................................ buildings on ...... ...r ✓'1�� �s.: !�:... f............................... Rough to be occupied as f ` J. ...:.. / .' � Chimney p .............. ��.............................._ ...., ..... ........ ...........,/ ��, :�..... provided that the person accepting this permit shall in every respect conform to the terms of th application on file in 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION/STARTS Rough .............. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. 1 21 Eile List Management Help 025.0 0001 562 TURNPIKE STREET Details People Inspections Certificates Conddions A pro�als Documents ��-e Permit No. BP-2011-0967 Work Category Commercial Alteration Tracking No BP-2011-904 Construction Class .., h ....... Work Location 562 TURNPIKE STREET s Estimated Cost $160,000.00 +; , J Status OPENIl Tax Id. Inspector �I'' Zoning Date Submitted 06F28t2011 ±tt Use Group _ - Approved On _x�a a. Water _ I APProved By - Sewer , Dig Amended On . �.I.. D� Safe# s 121812011 s Expires 4n °�A Fire Grading Date Issued 0602812011:��, Live Load i Date of Occ Occupancy Load I a Alk.Tracking No i Comment Desc.of Work BUILD 2 WALLS AND 4 HANDICAPPED BATHR4OMS . Fees Edit Preview Permit Preview Merge GIS Map New Notification fz1ose !� g, - � 4 , Start �v Buildin Eleckrical&Mec... 2.05 PM Wednesday,Aug 10, 2011 02:05 PM J >> CONSTRUCTION CONTRACT (Lump Sum) Contractor: New England Builders & Contractors 290 Broadway, Suite 137 Methuen, MA 01844 Owner: North Andover Crossroads, LP Property Address: 550 Turnpike Street,North Andover, MA Date: I. THE WORK 1.1 Contractor's Duties. Contractor shall furnish the material, labor, equipment, tools, and supervision (the "Work") necessary to Change the existing Blockbuster store into three separate stores. The work includes 2 additional bathrooms, lights, HVAC, ceiling, sprinkler heads, fire alarm. Fire rated walls between stores front doors and emergency egress in the rear of every store. (the "Project")for Owner on the Property in compliance with the plans and specifications supplied by Owner (the "Plans"). The Plans are attached as Exhibit A. This Contract and all of its Exhibits, and all Change Orders after execution, are the "Contract Documents." Contractor agrees to immediately inform Owner in writing of any discrepancies, errors, or omissions in the Plans or materially changed or unanticipated conditions and not to proceed with any work affected by such discrepancy until Owner directs Contractor to do so. 1.2 Permits. Contractor shall obtain the governmental approvals of the Plans and all permits for construction of the Project. The cost of the building permit and any other necessary permits is not included in the lump sum amount. Owner is responsible for cost of the building permit and other necessary permits. II. LUMP SUM PRICE AND PAYMENT 21 Lump Sum Amount. Contractor shall perform the Work for the Lump Sum Price of One Hundred Sixty Thousand Dollars ($160,000.00) ("Contract Price") The Contract Price is detailed by scope and trades in the Schedule of Values at Exhibit B. 2.2 Down Payment. Owner shall pay Contractor a down payment of Zero dollars ($0.00) prior to commencement of the Work. The down payment shall be credited against the Contract Price beginning with Contractor's first Progress Payment. Owner has sufficient funds, either personal or through lender financing, in an amount equal to the Contract Price. 2.3 Progress Payments. On the first business day of every month, Contractor shall present to Owner an Application for Payment to Owner. Each Application for Payment shall be based on the Schedule of Values at Exhibit B. The Schedule of Values shall allocate the entire Contract Price among the various portions of the Work. The Schedule of Values shall be prepared in such form and supported by such data to substantiate its accuracy as the Owner may require.The Schedule of Values shall be used as a basis for reviewing Contractor's Applications for Payment.Contractor's Applications for Payment shall show the percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment. Owner shall make payment to Contractor based on the percentage of the Work completed for the period covered by the Application for Payment date plus sales tax,less previous payments and less retainage specified in Section 2.4. Owner shall make payment no later than ( ) (Twenty-Five if not filled in) calendar days from the date of receipt of each Application for Payment.With each Application for Payment,the Owner shall have the right to require Contractor to provide documentation to support the claimed percentage of the Work completed. Contractor shall apply Owner's payment only to the costs and fees of this Project. 2.4 Retainage. Owner shall withhold five percent(5%) as retainage from each progress payment(the "Retainage"). Retainage shall be released to Contractor at the time of Final Payment. The Retainage is a fund for the protection of the Owner(i)from incomplete or defective work by Contractor; (ii)for the payment of persons who supplied materials or who worked on the Project and were not paid by Contractor; and (iii) damages incurred due to other breaches of the Contract. 2.5 Lien Release. Owner shall not be required to make any payment to Contractor unless and until Contractor provides Owner with an unconditional waiver and lien release form signed by Contractor and by each subcontractor and supplier who is claiming Two Thousand Five Hundred Dollars($2,500.00)or more in payment,verifying payment in full, less any retainage,from Owner's prior month's payment to Contractor.A form lien release is attached as Exhibit C-1. 2.6 Final Payment. Within ten(10) days after Contractor notifies Owner that the Work is Substantially Complete, Owner shall inspect the Work with Contractor and deliver to Contractor a comprehensive list of items to be completed or corrected prior to Final Payment(the "Punch List"). The Punch List and other Work shall be finished by Contractor within ) [Twenty-One if not filled in] days of Contractor's receipt of the Punch List. Final Payment shall be due fourteen(14)days after Contractor(1)completes the Work in accordance with the Contract Documents; (2)provides Owner with final lien releases from Contractor and all subcontractors and suppliers,conditioned only on receipt of Final Payment attached as Exhibit C-2; "Substantially Complete" or"Substantial Completion" means the stage in the progress of the Work when Owner has received an occupancy permit for the Project with only minor incidental work or correction or repair remaining to be performed by Contractor. 2.7 Failure of Payment. If Owner fails to pay Contractor amounts due within fourteen (14) days of the time required by Section 2.3, Contractor may, upon providing seven(7) days written notice to Owner, suspend the Work until the amounts due have been received. If the failure 2 of payment remains uncured for fourteen(14) days after the first written notice, Contractor may terminate the Contract.Payments due and unpaid under the Contract Documents shall bear interest at the rate of twelve percent(12%)per annum from the date payment was due until paid. III. CHANGES 31 Nature of Change. If Owner or Contractor requests, or one of the parties believes that a change is necessary, (a "Change"), then the parties shall comply with the following procedure to reflect a Change in the Work: The Party requesting or noting the Change shall write a description of the Change and give the other Party that writing (the"Change Notice"); Before proceeding with the changed work, unless excused by an emergency involving safety or property damage,the Contractor shall provide Owner with a fixed-price written estimate of the cost and time impact of the requested Change; Owner and Contractor shall execute a Change Order confirming their agreement with the Change, the fixed-price cost, and the extension of the Substantial Completion date, if any. If the Change cannot be performed on a fixed-price basis,the Change Order shall identify the agreed method of compensation. 3.2 Change Order Format. A blank Change Order form is included in this Contract as Exhibit E. IV. SCHEDULE 41 Commencement and Completion of the Work. Contractor shall commence the Work within ten(10) calendar days of receipt of a building permit. Subject to the permitted extensions and delays provided herein, Contractor shall Substantially Complete the Work within ( ) calendar days after the commencement date. With its first Application for Payment, Contractor shall provide a schedule indicating proposed subcontractors' activity sequences and durations,deadlines for Owner's decisions on material selections,and milestones for delivery of materials.The schedule is included in this Contract as Exhibit F. 42 Construction Time and Liquidated Damages. Contractor agrees that the time in Section 4.1 to reach. Substantial Completion, as reflected by Contractor's schedule, provides sufficient time for the expeditious and practical execution of the Work. If Contractor fails to achieve Substantial Completion of the Work by the date set forth in Section 4.1,Owner will suffer substantial damages that are both extremely difficult and impractical to determine. Owner and Contractor agree that if Contractor fails to meet the Substantial Completion date,then Contractor shall pay Owner liquidated damages at a daily rate of Five Hundred Dollars($500.00). The parties agree that liquidated damages are not a penalty,but rather a reasonable estimate of the amount of damages Owner will suffer in the event of delay. Owner shall have the right to withhold the amount of liquidated damages from any sums due to Contractor. 43 Delay. If the Project is delayed by the act, neglect or default of Owner, Owner's 33 z agent, Owner's design professional, Owner's lender, governmental action or inaction, any contractor employed by Owner,any materials supplier acting for Owner,or any other reason or reasons beyond Contractor's reasonable control, including without limitation damage caused by fire or other casualty, strikes, force majeure, shortage of materials or labor,transportation delays, weather conditions,change orders,or deficiencies in the Contract Documents(the "Excusable Delay"),then the Substantial Completion date shall be extended for a period reasonably equivalent to the time lost by reason of such delay. V. INSURANCE Before commencing the Work and as a condition of payment,and as part of the Lump Sum Amount, Contractor shall purchase and maintain insurance as described below from an insurer admitted to do business in Massachusetts with an A.M. Best financial strength rating of Al or better,that will protect it from bodily injury or property damage claims arising out of its operations under this Contract,whether the operations are by Contractor, Contractor's consultants or subcontractors, anyone directly or indirectly employed by any of them, or by anyone for whose acts any of them may be liable. Commercial General Liability (CGL)insurance providing bodily injury liability and property damage liability with combined single limits of not less than$1,000,000 per occurrence,and $2,000,000 general aggregate limits,and Products/Completed Operations aggregate limits of $2,000,000, written on an occurrence form. If the Owner requires that Contractor's general liability policy be endorsed so that the aggregate limits of insurance apply on this job,both parties must check the appropriate box: Owner [ ] Contractor [ ]. Owner shall be included as an additional insured under the CGL policy. Prior to starting work,Contractor shall provide a copy of the actual additional insured endorsement or blanket additional insured policy wording to the CGL policy that documents the Owner's additional insured status. Owner and Contractor hereby waive their rights of subrogation against one another for any losses covered by the required insurance policies except that Contractor shall be liable for the property insurance deductible if a claim is made against such property insurance and that claim arises out of Contractor's negligence. VI. CONTRACTOR'S WARRANTY 61 Contractor's Warranty. Contractor warrants that the Work shall be in accordance with the Contract Documents and free from material structural defects and shall return and repair any Work not in accordance with the Contract Documents for a period of one (1)year from the date of Substantial Completion of the Work(the"Warranty Period").All product warranties,if any,are deemed assigned from Contractor to Owner. 4 62 Cure of Defect. If a defect is discovered within the Warranty Period, then Owner must promptly notify Contractor in writing following the discovery of that defect(the "Warranty Defect Notice") and must provide Contractor with an opportunity to inspect and an opportunity to either cure the defect in a manner customary in the industry or to pay to Owner the cost of repair or replacement of the defect as estimated by Contractor.This Warranty Defect Notice shall serve as the written notice of claim described in the following paragraph.In no event shall Contractor's liability exceed the fair and reasonable cost of repair or replacement of the warranted defect. Contractor shall not be liable for any cost or expense incurred by Owner in remedying any warranted defects unless Contractor has been notified in writing and has been afforded the opportunity to cure the claimed defect or to pay the sums specified herein.Nothing contained in this section shall be construed to establish a period of limitation with respect to Contractor's other obligations under the Contract Documents. 63 Limitation of Damages. Contractor and Owner waive claims against each other for consequential damages. This mutual waiver includes, but is not limited to: damages incurred by Owner for loss of income,profit, financing, business, and reputation; and damages incurred by Contractor for losses of financing,business and reputation, and for loss of profit except anticipated profit arising directly from the Work. This mutual waiver is applicable,without limitation,to all consequential damages due to either party's termination in accordance with Section 9.Nothing contained in this Section 6.4 shall be deemed to preclude an award of liquidated damages, when applicable, in accordance with Section 6.4 If any court determines that this section or its application to any person or circumstance is,to any extent, invalid or unenforceable,the remainder of this Contract shall not be affected thereby and each other term, covenant or condition of this Contract shall be valid and be enforced to the fullest extent permitted by law. VII. SAFETY Contractor and its subcontractors shall take all reasonably necessary safety precautions,including compliance with applicable laws, ordinances, regulations, and orders issued by a public authority, whether federal,state,or local. Contractor shall at all times be responsible for providing a safe job site and be responsible for the work performance and safety of all employees, personnel, equipment, and materials within the care, custody, or control of Contractor or its subcontractors of any tier. Contractor and its subcontractors shall furnish all required safety equipment and ensure all of its employees and lower-tier subcontractors' employees have and wear personal protective equipment in compliance with applicable safety requirements. Contractor shall promptly provide Owner with written notice of safety hazard(s) or violation(s)found on the job site or of any injury to its or its subcontractors'workers incurred on the job site. VIII. INDEMNITY Contractor agrees to defend, indemnify, and hold harmless (the "Indemnity Duty") Owner and 5 its agents from and against claims,damages, losses and expenses,including but not limited to attorneys' fees and costs and expenses, arising out of or resulting from performance of the;'fork, provided that such claim, damage, loss, or expense is attributable to bodily injury, sickness,disease or death,or to injury to or destruction of tangible property (other than the Work itself)(the "Harm"), provided,however,that the Contractor owes no Indemnity Duty if the Harm was caused by or results from the sole negligence of the Owner or its agents or both, and provided further that in the event of concurrent negligence(i)by Contractor or the Contractor's subcontractors agents or employees, or both and (ii) by the Owner or its agents, or both, then the Contractor's Indemnity Duty is valid and enforceable only to the extent of the negligence of Contractor,its agents,and its employees. Contractor further agrees to defend, indemnify, and hold Owner harmless from all OSHA or other related claims, demands,proceedings,violations,penalties, assessments, or fines that arise out of or relate to Contractor's failure to comply with any safety-related laws,ordinances,rules, regulations,orders,or its obligations hereunder. IX. TERMINATION 91 Termination by Owner for Cause. Owner may, after giving Contractor seven(7) days written notice and an opportunity to commence and continue to cure the alleged cause, terminate the Contract if Contractor violates any material provision of this Contract or: refuses or fails to supply enough properly skilled workers or proper materials; or fails to make payment to subcontractors for materials or labor in accordance with the respective agreements between Contractor and the subcontractors; or persistently disregards laws,ordinances,rules,regulations or orders of public authorities having jurisdiction;or fails to provide Owner, upon request, reasonable evidence that the Work will be completed by the date of Substantial Completion. When termination based on any of the above reasons occurs,Owner may,without prejudice to any other rights or remedies; take possession of the site and of all materials, equipment,and machinery thereon owned by Contractor; accept assignment of subcontracts; finish the Work using reasonable methods. Upon Contractor's request, Owner shall furnish to Contractor a detailed accounting of the costs Owner incurs in finishing the Work;and charge Contractor the costs of completion in excess of the amounts due to Contractor. 9.2 Intentionally deleted 93 Termination by Contractor for Cause. In addition to Contractor's right to terminate the Contract pursuant to Section 2.7,the Contractor may terminate the Contract for cause if the Owner breaches any material provision of the Contract Documents.Prior to terminating the Contract for cause under this Section,Contractor shall first provide Owner seven(7)days written notice of the alleged breach.If Owner fails to cure the breach within seven(7)days of receipt of such notice,or fails to commence and diligently continue with cure efforts if the breach cannot reasonably 6 S be cured within seven(7)days,the Contractor may terminate the Contract. X. ARBITRATION Any controversy or claim arising out of or relating to this contract, or the breach thereof, shall be settled by arbitration in accordance with the Rules of the American Arbitration Association, and judgment upon the award may be entered in any Court having jurisdiction thereof. XL GENERAL 11.1 Survival.In the event any clause or provision of this Contract shall be held to be invalid,then the remaining clauses and provisions shall nevertheless be and remain in full force and effect. 11.2 Entire Agreement. The Contract Documents contain the entire agreement between the parties with respect to construction of the Project.All other agreements, oral or written,are hereby merged into and superseded by this Contract.There are no other agreements which modify or affect the terms hereof.No amendment hereto shall be binding unless the terms thereof are in writing and signed by both parties.No verbal or other agreements modify or affect this Contract. 11.3 Binding Effect. This Contract shall be binding upon the parties hereto, and their heirs, successors,executors,administrators and assigns. 11.4 Assignment.Neither party shall assign nor transfer this Contract or any rights hereunder without the prior written consent of the other. 11.5 Notices.All notices which may be required under this Contract are to be in writing and delivered(a)to the attention of the party at the address listed on the signature page;or(b)by email to the email address on the signature page;or(c)by fax to the fax number on the signature page,or(d) mailed by certified mail,postage prepaid,to the address listed on the signature page.All notices shall be deemed served upon delivery, successful transmission, or two (2) days following deposit of the notice in the U.S.mail as required herein. 11.6 Governing Law,Venue. The performance and interpretation of this Contract shall be governed in accordance with the laws of the State of Massachusetts.Any litigation arising out of or in connection with this Contract shall be conducted in the Rockingham County. CONTRACTOR OWNER: By: By: Printe d Name: Printed Name: Title: Title: E-Mail: E-Mail: Fax: Fax: Address: Address: g Contractor Registration No.: Exhibits: A—Plans B—Schedule of Values C-1 —Unconditional Lien Release Form C-2—Conditional Lien Release On Final Payment Form D—Disclosure Statement/Notice to Customer E—Change Order Form F—Project Schedule 9 EXHIBIT B PLANS List of Plans provided by Owner: 10 EXHIBIT B SCHEDULE OF VALUES (To be provided by Contractor) 11 EXHIBIT C-1 CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT The undersigned has been paid and has received a progress payment in the sum of$ for labor, services, equipment, or material furnished to on the job of (Maker of Check) located at (Owner) (Job Description) and when the check has been properly endorsed and has been paid by the bank upon which it is drawn,the undersigned does hereby release any mechanic's lien, stop notice, or bond right that the undersigned has on the above referenced job to the following extent. This release covers a progress payment for labor, services,equipment,or materials furnished to through only and does not cover any retentions retained before or after the release date;extras furnished before the release date for which payment has not been received; or extras or items furnished after the release date. Rights based upon work performed or items furnished under a written change order which has been fully executed by the parties prior to the release date are covered by this release unless specifically reserved by the claimant in this release. This release of any mechanic's lien, stop notice, or bond right shall not otherwise affect the contract rights, including rights between parties to the contract based upon a rescission, abandonment, or breach of the contract, or the right of the undersigned to recover compensation for furnished labor, services, equipment, or material covered by this release if that furnished labor, services, equipment, or material was not compensated by the progress payment. Dated: (Contractor) By (Print Name) (Title) 12 EXHIBIT C-2 CONDITIONAL WAIVER AND RELEASE UPON FINAL PAYMENT Upon receipt by the undersigned of a check from in the (Maker of Check) sum of$ payable to and when the check (Payee) has been properly endorsed and has been paid by the bank upon which it is drawn,this document shall become effective to release any mechanic's lien, stop notice,or bond right the undersigned has on the job located at (Owner) (Job Description& Address) This release covers the fmal payment to undersigned for all labor, services, equipment, or material furnished on the job. Before any recipient of this document relies on it,the party should verify evidence of payment to the undersigned. Dated: (Contractor) By (Print Name) (Title) 13 EXHIBIT E CHANGE ORDER Number: Date: Contractor: Address: Job Description: Property Address or Legal Description: Contractor: Contractor hereby agrees to make the change(s)specified below: See Attachment"A" Fixed Price of Change(s): Add: Deduct: Previous Change Orders: Reason for Change: See Attachment"A" Contract Time Extension: New Completion Date: ACCEPTANCE: The terms of this change order are satisfactory and are hereby accepted: OWNER APPROVAL: CONTRACTOR APPROVAL: DATE: 14 EXHIBIT F PROJECT SCHEDULE 15 Attachment"A" Change Order No. 16 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YY1301YY) DDUCER 603.224.2562 FAX 603.224.8012 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFOORMATIONl ie Rowley Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 39 Loudon Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR .li. Box 511 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. oncord, NH 03302-0511 INSURERS AFFORDING COVERAGE DRED -- -- __._... --- I NAIL New England—Builders ders & Contractors, 11 Inc. — ------------ ---- ----- INSURER A: Union Insurance Company ! - 290 Broadway, Suite 137 -- __INSURERB: Acadia Ins. Co. _ j00371 Methuen, MA 01844 INSURERc_Acadia Insurance Company 131325 NSURER 0: INSURER E )VERAGES 'HF POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ,NY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR BAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INFRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE EXPIRATION T� DATE MM/DD/YYYY 1 I DATE MM/DD/YYYY I LIMITS ! GENERAL LIABILITY CPP002835524 10/13/2010 10/13/2011 EACH OCCURRENCE I S 1,000000X j COMMERCIAL GENERAL LIABILITY i DAMAGE TO RENTED- - -----'--- r PREMISES Eaoccurrence S 250,00(, CLAIMS MADE X ! OCCUR I --- ----_._.__-.---' MED EXP(Any one person) S 5,0001 _.__:.--------.----___--- I PERSONAL&ADV INJURY S - 1_._... ,- 0 r DO ODO r--`--1 '---- ------ ------ i GENERAL AGGREGATE IS 2 DODr OOO GEN'L AGGREGATE LIMIT APPLIES PER: - ------------ i POLICY 1-X1 JERO-CT F-1 LOC j PRODUCTS_COMPIOP AGG I S- I - - AUTOMOBILE LIABILITY i CAA003249424 10/13/2010 1 10/13/2011 i I ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S ------ ---- - -I _ 1,000,0001 ALL OWNED AUTOS _X_! SCHEDULED AUTOS BODILY INJURY i S -� I (Per person) X HIRED AUTOS I --BODILY INJURY--._..-- --- -L j I X J NON-OWNED AUTOS (Per accident S j ) PROPERTY DAMAGE S ---i' ---------------- I � I (Per accident) j GARAGE LIABILITY i —_ __--_.--__-._---------jl AUTO ONLY-EA ACCIDENT S ' I ANY AUTO -------'--------- OTHER THAN EA ACC j $ AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY CUA008438318 10/13/2010 1D/13/2011 EACH OCCURRENCE X-I OCCUR J CLAIMS MADE -- — S .__-_10,000,0001 AGGREGATE -- --I 5 10,000.DDD' DEDUCTIBLE -XJ (� -- ----- ------ -' - -- - - RETENTION S j S .WORKERS YERS'LIAILIT WCA0355905-11 10 W TAru- TH-' A. )EMPLOYERS'LIABILITY I /13/2010 1D/13/2011 X I ! I !ANY PROPRIETOR/PARTNER/EXECUTIVE 3A: NH MA LTORY LIMITS I ER OFFICER/MEMBER EXCLUDED? E L.EACH ACCIDENTS 5OO OOO (Mandatory in NH) EXCLUDED: NONE -�-� ----- i If yes,describe under i E L.DISEASE-EA EMPLOYEE S_______ 5O_D,D_O_O SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER I CPP00283 S S 24 ,10 500,000 :Leased/Rented Equip /13/2010 10/13/2011 $150,000 Installation Floater j I $300,000 I j I :RIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I I I :e t 10 days for nonpayment of premium ZTIrICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30'° DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Danielle Rice/DJR I )RD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CONSTRUCTION CONTROL AFFIDAVIT NATURE OF PROJECT GI-(C L L9 iJ i LO 0 1- Date PROJECT TITLE b C V,G U S j 4 {-k PROJECT LOCATION J GeC TUI_"'P r V_C- NAME OF BUILDING OR ADDRESS CQoSS&o-A-QS Q CHARACTERISTIC OF SITE }Z 01.,Q ARCHITECTURAL CHARACTERISTICS OF NEIGHBORHOOD IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUILDING CODE, I, =Aj2_M N ME _ (.I.G it l`t1Ac1�DDtESS _�lFJtdf.1�/��{Po3$ UMBER BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECT HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPERATION OF ALL DESIGN PLANS, COMPUTATION AND SPECIFICATIONS CONCERNING ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL OTHER(SPECIFY) FOR THE ABOVE PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS, AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THEN ECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A WEEKLY BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCOR ANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT A D SHALL B ESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2. 1. Review o shMudding pler,and other submittals of the contractor as required by the construction documents as submitt ,and approval for conformance to the design concept. 2. Review and approval of the quality control procedure for all code-required controlled material. 3. Special architectural or engineering professional Inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards. PURSUANT TO SECTION 116.2.3 AND CHAPTER 17, 1 SHALL SUBMIT WEEKLY,A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE CITY OF WALTHAM BUILDING COMMISSIONER/INSPECTOR OF BUILDINGS. UPON COMPLETION OF WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND REASINESS OF THE PROJECT FOR OCCUPANCY: kal HENRY SA KI8 SUBSCRIBE AND S ORN 0 EFORE THIS DAY S J L Notary f obn� LAM ission Expires MY COMMISSION E I my Comm I ST4''F#rel d:A40