HomeMy WebLinkAboutBuilding Permit #949-16 - 58 COUNTRY CLUB CIRCLE 3/8/2016Ak% � k y , r)'If w, 4 U�
Permit NO: &
Date Issued
NPOR
LOCATION 5S C(kkn-
PROPERTY OWNER
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION,
Date Received 41
TANT: ADDlicant must cornDlete all items on this
Print 1J
MAP NO: PARCEL:/K-0 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
'k One family
El Addition
11 Two or more family
11 Industrial
�K Alteration
No. of units:
11 Commercial
11 Repair, replacement
11 Assessory Bldg
11 Others:
11 Demolition
11 Other
El Septic 11 Well
0 Floodplain 11 Wetlands
11 Watershed District
0 Water/Sewer
NW)en ccnovahoo , aw cct-binfis., counkE, -hie,
Identification Please Type or Print Clearly)
OWNER: Name:
Address
ELI
CONTRACTOR Name: Phone:
Address: J
Supervisor's Construction-' License: Exp. Date:
S C SA,
Home Improvement License: Exp. Date:
1 6 (1 -t (e 4
ARCH ITECT/ENGI NEER Phone:—
Address: Reg. No.
FEE SCHEDULE. BULDINGIPERMIT: 12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ �66,11 FEE: $ lo 102
Check No.: Receipt No.: 3
fund
NOTE: Persons contractIng with unregistered contractors do not have access to he u
!?4ar �t
v,
Signature of Agent/Owner- Signature of contractor
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#:
Date Issued:
IMPORTANT:
LOCATION
Date Received
must complete all items on Us
Print
01 t%ORTH
,I.ED 16 1>�
16
fo
PROPERTY OWNER
Print 100 Year Structure yes no
MAP —PARCEL:— ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSEDUSE
Non- Residential
Residential
0 New Building
0 One family
0 Industrial
11 Addition
0 Two or more family
[i Commercial
0 Alteration
No. of units:
0 Others:
0 Repair, replacement
0 Assessory Bldg
0 Demolition
0 Other
fp longds
[]�Flbbt Xq�h;
R
-i
W
KI AV IA[nPV Tn RF PFRIFORIVIED:
OWNER: Name: Identification - Please Type or Print Clearly — Phone:
Address:
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
Horne improvement License:
ARCH ITECT/ENGI NEE
Exp. Date:
Phon
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Location 4,42 C1116
No, Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee
TOTAL $
Check#
Building Inspector
I t
Plans Submitted Plans Waived Certified Plot Plan Starnped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
TanningfMassage/Body Art
Swimming Pools El
Well F1
Tobacco Sales 11
Food Packaging/Sales El
Private (septic tmk; etc. El
Permanent Durapster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
I
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On
Signature.
HEALTH
COMMENTS
Reviewed on
Sianature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
W&er & Sewer Connection
DBW Town Engineer: Signature:
Located 3840sgoodStreet
Yq§ 'n
urnpsterpn.�.site;,-, -I A
F�IRE M-WAIN"ENT, Q
if� ignatureldatp�;,;,.
p.�(r
C M M E N T -,$,f
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELEGTRICAL.- Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A —F and G min.$100-$l 000 fine
No
Doc.Building Permit Revised 2014
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
4� Copy of Contract
Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products to issuance of Bldg Permit
10TE: All dumpster permits require sign off from Fire Department prior
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 of Proposed Work With Sprinkler Plan And
Floor/Cross Section/Elevation Plan
Hydraulic Calculations (if Applicable)
Mass check Energy Compliance Report (if Applicable)
- Eng . in eer . i . ng Aff . i . d . av i . ts - for-E-ng-ineere- product's
TE: 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
10TE: 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
Doe: Building Permit Revised 2014
E I -
Enter construction cost for fee cal -
North Andover Fee Cakulation
Construction Cost
$ 90,597.00
m
$ -
$
1,087.16
Plumbing Fee
$
135.90
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
135.90
Total fees collected
$
1,458.96
58 Counry Club Circle
949-2016 on 3/8/2016
Kitchen Reno
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Diwny.s Delivemd,
Project Proposal
Mr. & Mrs. Donald & Debra Stanley
58 Country Club Lane
North Andover MA 01845
We hereby submit specifications and estimates for:
Project Name: Interior remodel - Kitchen
Telephone: 978-857-1957
Date: 11/12/2015
Remodel kitchen, and seating area to the enclosed Preliminary Plans, Specifications, and Terms and
Conditions Agreement.
All workmanship is guaranteed for three years upon completion and all supplies, materials, and equipment to be
covered by manufacturers warranties.
The following is not included in this proposal: Permit fees, Excavation, Concrete, Masonry, Floor Framing, Wall
Framing, Roof Framing, Roofing, Gutters, Exterior Trim, Decks, Porches, Siding, Shutters, Exterior Doors, Windows,
Heating, Air-conditioning, Surface Mount Light Fixtures, Insulation, Drywall Ceilings, Closet Shelving, Appliances, Mirrors,
Tub and Shower Doors, Bath Accessories, Fireplaces, Floor Underlayment, Flooring, Hardwood Flooring, Tile Flooring,
Vinyl/Resilient Flooring, Carpeting, Exterior Priming & Painting, Wallpapering, Landscaping and Walkways, Driveway Paving
and Preparation, and anything else not specified here in.
G.M. Roth Design Remodeling, Inc. is fully covered by liability and workers compen ation insurance.
�71-- - �.
Massachusetts Construction Supervisors License #056336 �?Qll
Massachusetts Home Improvement Registration 4109467
Thank you for your consideration!
We Propose to furnish material and labor - complete In accordance with these specificatio� for the sum of:
Payable as follows: Refer to Terms and Conditions Agreement sq�
'3 0— S"Vtx� bo r
G.M. Roth Design Remodeling Inc. Authorized Signature:
Note: This proposal may be withdrawn if not accepted
7 2 C -I
Acceptance of this Proposal - The prices, specifications and conditions are satisfactory and are hereby accepted. You are author4&Wa--'
do the work as specified. Payment will be made as outlined above.
Signatu
NOV 17 2015
/I /f Z// j,
/14 v-/, I -
12 Murphy Drive, Nashua, NH 03062 / p 603,880.3761 / 866.446�7684 / f 603,880.8991 / www.gmroth.com
Description Qty Unit
to the following specifications:
Plans & Permits
Project Mobilization
Project mobilization for a partial kitchen project, includes pre -construction meetings, project set-
up, build plans, permit procurement (fee not included) and a 15 yard dumpster. Note: Amount
of waste can only be estimated --additional dumpster costs, if needed are not included and will
be additional.
I EA
1
Tear -Out
I
Remove and dispose in dumpster or truck the following:
I EA
Plumbing Tear -Out
I
Remove Sink & faucet (salvage sink and faucet in butler's pantry for re -installation.
2 EA
Remove Kitchen disposal
I EA
Remove Gas line, cap off for relocation.
I EA
Electrical Tear -Out (Assumes all existing is up to code)
I
Electrical Tear Out minimum use when tear out 4 item or less
I EA
Remove light fixture over island
I EA
Interior Wall Covering Tear -Out
I
Wall covering demo set-up
I EA
Remove interior wall covering - tile or thin brick, backsplash.
55 SF
Interior Trim/Millwork Tear -Out (10 LF minimum)
I
Remove Baseboard moldings, one-piece.
8 LF
Cabinet and Counter Top Tear -Out
I
Remove Kitchen Base cabinets
25 LF
Remove Wall cabinets
12 LF
Remove decorative glass upper cabinets, SALVAGE FOR RE -INSTALL
3 EA
Remove dishwasher drawer panel only in butler pantry.
I EA
Remove crown molding from cabinets on wall with the double oven.
12 LF
Remove all knobs and handles
40 EA
Remove granite counters (when not removing cabinets)
120 SQ
Remove appliances, salvage on site (cooktop, dishwasher - drawers ), refrigerator, hood and
trash compactor to be disposed of, each appliance
5 EA
Plumbing
Kitchen Plumbing
Furnish and install the following kitchen plumbing (plumbing fixtures are not included
unless noted otherwise). Note: it is assumed that existing plumbing in home is to code. Any
existing plumbing upgrades needed are not included.
I EA
Install kitchen sink and faucet in same location, includes new PVC trap under sink, take off
existing rough plumbing, includes standard dishwasher install, disposal install is not included
2 EA
Plumbing labor to install disposal (salvaged or owner supplied) while installing sink
1 EA
Furnish the following kitchen sinks-
I
Under mount Kitchen sinks
I
G. M. Roth Design Remodeling, Inc.
11/12/2015 11:58AM,-�o
Electrical
I
Electrical Permit Fee is not included, owner will be responsible for fee.
I EA
Description
Qty Unit
Pither: Majestic M31 8 Under mount Single Bowl Kitchen Sink, 16 gauge, 18-10 Stainless
\Steel 31-1/2"xl8-1/2" utside dimension, 29-1/2"LRx 16-1/8 "FBx I 0"deep inside dimension,
I EA
Center drain waste hol , matte finished bowls, MI 3-1/2" all steel basket strainer included, 33"
0
cabihet recommended.Nottom grids not included.
I EA
�nk,J-6-g-auge,-r8--10-'Stainless Steel, 32-
0
JL4al8" outside dimension, equal bowls,: 14-1/2"LR&L6--1/4-LFBx8l!DP-end-drain waste holes,
I
-matte-f-mi-sh-e7ito--wTs-,-ITI-7-3--l-7T-'all-steeI basket strainers included, 36" sink base is
re1C_0mmeiid@d_.B.otLoz grids not included.
0 EA
Furnish the following Hospitality/Bar Sinks: (re -use existing)
0
Furnish the following Kitchen Faucets:
I
Kohler Single hole kitchen faucet, 16" pull down spout K -99261 -VS.
I EA
Furnish and install the following kitchen disposals
I
Insinkerator Evolution Pro Essential Disposal. Sound Seal Plus - at least 40% quieter, 34.6 -oz
Stainless Steel Grind Chamber and components, 3/4 HP Dura -Drive Induction Motor 8 -year
"We come to you" in-home Warranty
I EA
Furnish and install the following miscellaneous kitchen plumbing
1
Ice Maker water supply line install, new, within 12' of sink, easy basement access
I EA
Electrical
I
Electrical Permit Fee is not included, owner will be responsible for fee.
I EA
Furnish and install the following (Take off existing electrical in home. Light fixtures and
service upgrades are not included unless noted ) Electrical Work Minimum, for very small
projects. :
I EA
Service Wiring/Circuits (assumes existing is up to code).
0
Electrical Outlets (assumes we don't need to add outlets to island and peninsula as would be
required by code).
0
Lighting
I
Light-o-u-tl-el-for-wa,H-or-ee-iliitg-m- ounted�tighrfffxfure (ffx—ture i� 'not i-n-clEud-e-d-ml-ess-gpec-ified
otherwise), for -ever -sink -r—
I EA
Light fixture install, existing box over island.
I EA
Exhaust Fans & Hoods
I
Hood and fan outlet (hood included in cabinet order)
I EA
Interior Walls & Ceilings
Wall and Ceiling Tile & Backer
Furnish and install the following standard installation (diagonals, borders etc.) are
additional:
I EA
Wall tiles, $20/SF material allowance (tile and grout), Add 10% min for waste,
62 SF
Decorative Medallion
I EA
I
Interior Doors, & Interior Millwork & Trim I
Baseboard Moldings - Furnish and install the following: I
Baseboards, 3.5 colonial pine OG base , mitered outside corners and coped inside corners 8 LF
Cabinets, Counters & Appliances
Kitchen Cabinets:
G. M. Roth Design Remodeling, Inc. 11/12/2015 11:58AIVI-Dm�
Description
Qty Unit
Furnish the following kitchen cabinetry:
I EA
Install kitchen cabinets and panels.
17 EA
Install kitchen cabinets and panels, to re -install decorative upper cabinets above desk area.
3 EA
ln-stalk-ustem-eolE m.n-near-sink.
A
Add labor for peninsula back and side panels
8 LF
Glass for glass doors, plain clear 1/8" glass, ea door
Labor for installation
4 EA
of crown or other cabinet moldings (mat. costs in with cab quote).
50 LF
Install cabinet knobs and/or handles, $8 each material allowance
60 EA
Granite Counter Tops
I
Granite counter top with a 3/8" radius edge or equivalent standard edge, furnished and installed
per enclosed plan. Includes kitchen tops with 33" x 22" under mount sink cutout, a cook top or
stove cutout, and a 4" backsplash with eased edge.
I EA
Kitchen Appliances
I
Install the following (appliances, and hook-ups are not included):
I
Standard Dishwasher
I EA
Standard Cook -top
I EA
Undercounter refrigerator
I EA
Sub Zero refrigerator custom hood install
I EA
Microwave (built-in) I/
I EA
Custom hood install (framing and drywall is not included)
I E
I
Floor Covering 0
Painting I
Material and labor paint allowance (includes all painting prep required) for: 0$
Cabinet Painting I
Furnish and install the following painting- I- EA
Material and labor allowance (includes all painting prep required) for: Island only. 750$
Clean up
Project final clean-up, dispose of all debris in dumpster or dump truck on site and
broom/vacuurn clean area remodeled, per job I EA
G. M. Roth Design Remodeling, Inc. 11/12/2015 11:58 AM
Description
Replace ceiling T & G painted with stained to the following specifications:
Plans & Permits
Project Mobilization
Project Mobilization for a small repair job, and includes minimum debris removal (up to a 2
barrels). Permits and plans are not included, assumes being done in conjunction with partial
kitchen remodel.
Tear -Out
Remove and dispose in dumpster or truck the following:
Ceiling Covering Tear -Out
Remove wood tongue and groove ceiling, 50 SF minimum
Interior Trim/Millwork Tear -Out (10 LF minimum)
Remove Ceiling or wall moldings, one-piece, (over 75LF)
Interior Walls & Ceilings
V -joint Solid Wood Wall and Ceiling Boards
Furnish and install the following wall boards:
Douglas fir, 5/8"x6", C& better, vertical grain, edge & center bead
Painting
Furnish and install the following painting:
Material and labor paint allowance (includes all painting prep required) for moldings around
perimiter of sections where ceiling was replaced
Staining
Furnish and install the following painting:
Material and labor stain allowance (includes all painting prep required) for: Stainingand
sealing new T & G ceiling boards.
V"im&
T
-Z'_ , ,
Qty Unit
I
0 EA
I EA
1
27Q SF
1
250 LF
I
270 SF
1 EA
500$
1
1 EA
500$
_Y�'
G. M. Roth Design Remodeling, Inc. 11/12/2015 11:48 AM
Investment Schedule
Complete Home Improvement as specified:
Less design retainer:
Subtotal:
Less Off Season (Jan - Feb) Discount
Sub Total - Investment Amount:
Optional:
Total Investment with options:
CHOOSE: 6.99% 5 YEAR, 7 YEAR, or 10 YEAR LOANS
5%
Loan Amount
$10,000
$20,000
Estimated Monthly Payment for a 5 year Loan @ 6.99%
$198-00
$396.00
Estimated Monthly Payment for a 7 year Loan @ 6.99%
$151.00
$302.00
1
Estimated Monthly Payment for a 10 year Loan @ 6.99%
$116.00
$232.00
Note: These are only examples, actual rates and payments will be based on your loan
loans provided by Enerbank USA (1245 E. Brickyard Rd., Suite 600, Salt Lake City, LIT 8416) on approved credit,
for a limited time. Repayment term is 60,84, or 120 months. 6.99% APR, effective as of February 2013, subject
to change. The first monthly payment will be due 30 days after the loan closes.
* 100% UNSECURED LOAN FROM $3,500- $45,000 (NO CREDIT CARDS INVOLVED)
NO
PAYMENTS
Endank[S4
OR
IF YOU PREFER...
ONE YEAR NO INTEREST NO PAYMENTS...
Loans provided by Enerbank USA (1245 E. Brickyard Rd. Suite 640, Salt Lake City, UT 84106) on approved credit, for a
limited time. Rrepayment terms vary from 24 tO 132 months. Interest waived if repaid in 365 days. 16.75 % fixed APR,
effective February 2013,subject to change.
We accept Visa & MasterCard ($ 10, 000 maximum per project)
$96,366.00
-$1.000.00
$95,366.00
$4,768 ' 30
$90,597 X
YO
$0.00
$0.00
$0.00
$0.00
$45,000
$891.00
$679.50
$522.00
Stanley Partial Kitchen Remodel, 11.12.15 Terms and Conditions MA 11/12/2015
BUILDING PLANS, INSPECTIONS, AND PERMITS
Contractor will furnish all necessary plans for the completion of this job. These plans will supplement the
specifications as an attachment to this contract.
2. Contractor will schedule all necessary inspections for this job in a timely manner, and will comply immediately with
any correction notices posted in order to keep the job schedule.
Contractor will obtain any and all necessary construction -related permits as the owner's agent; owners who secure
their own construction—related permits or deal with unregistered contractors shall be excluded from access to the
Guaranty Fund; all perrr�t fees for permits obtained by Contractor or its representatives shall be reimbursed by
owner.
INSECT/WATER DAMAGE
4. Contractor will provide a progressive wet rot inspection of the work being completed (as described in the enclosed
specifications) and furnish a written report and cost estimate of the necessary repairs. The report and estimate will
list all infected areas and suggest the method of repair.
5. Insect infestation and damage will be noted in the report if evident, but neither an insect inspection nor insect
damage repairs will be included in the report or estimate.
ENVIRONMENTAL HAZARDS
6. Contractor's scope of work shall not include the identification, detection, abatement, encapsulation or removal of
asbestos, mold, lead, radon, ground water or environmental hazard, or products or materials containing asbestos or
other hazardous substances from the home.
In the event that Contractor encounters any such products or materials in the course of performing his work, e*
Contractor shall have the right to discontinue his work and remove his employees from the project until such
products or materials and any hazards connected therewith are abated, encapsulated or removed, or it is determined
that no hazards exists (as the case may require). Contractor shall receive an extension of time to complete his work
and will also receive fair compensation for any additional costs resulting from delays encountered as a result of such
situation and correction of it. Owner understands that costs incurred for removal will be over and above the contract
In the event that work does not resume within 30 days of the stoppage, OWNER agrees to immediately pay the
Contractor the pro rated amount of the contract price applicable to work done up to that point pursuant to the
contract.
DEMO/TEAR OUT
8. If any of the existing building materials removed from this home are to be reinstalled, Contractor will notify Owner
at the time of removal if the item or any of its parts need replacement. If so, Contractor will write an additional
work order at that time and give Owner a firm price quotation on the cost of replacement as needed.
9. This contract is subject to owner obtaining suitable financing. Owner must apply for financing within ten (10) days
of the signing of this contract, and shall notify contractor in writing within thirty (30) days of his inability to obtain
financing or this contingency shall lapse. In the event that financing cannot be obtained by owner and the contractor
has been notified, owner agrees to reimburse contractor for all costs, expenses, and labor incurred by contractor to
date.
G.M. Roth Design Remodeling Inc. 1 of '5v
Stanley Partial Kitchen Remodel, 11.12.15 Terms and Conditions MA
11/12/2015
10. Owner shall be responsible for, and pay to obtain any variances or zone changes required, unless specified otherwise
in this agreement.
11. Owner warrants that he owns the real property upon which the work is to be performed.
12. Without invalidating this agreement, Owner may order extra work by the use of a change work order, providing the
document is signed by both Owner and Contractor.
13. Owner understands and agrees not to engage in any side arrangements or separate contracts with any of the
employees, vendors, or sub -contractors performing work on this job.
14. Owner has read, understands, and agrees with the total payment schedule as shown on this agreement. Owner will
pay the Contractor the down payment, progress payments, and the final payment, as per this agreement. Final
payment is due on the day of substantial completion of this job.
15. Owner agrees that if Contractor has not been paid in full within 30 days after substantial completion of his work,
Owner will pay Contractor 1.5% per month, (18% annual percentage rate) of unpaid balance as a late charge.
CONTRACTOR TERMS AND CONDITIONS
16. Contractor will be responsible for, and will at his own expense, obtain qualified and efficient workmen to complete
this job. All contractors and subcontractors shall be registered, and any inquiries about a contractor or subcontractor
relating to a registration should be directed to:
Office of Consumers Affairs and Business Regulation
Ten park Plaza, Suite 5170
Boston, MA 02116
Tel: (617)973-8700
Contractor will pay all workmen's compensation and other employment costs required for the performance and
completion of this job.
Contractor shall carry bodily injury liability insurance relating to the work in an amount not less than $1,000,000.00
for bodily injury including accidental death. Contractor shall carry property damage liability insurance in an amount
no less than $ 1,000,000.00, or Contractor shall carry a combined single limit of liability not less than $ 1,000,000.00.
JOB SITE AND PRODUCTION
17. Contractor w7l star7thisjob on or about ---,and will complete this job on or
about
Start date shown is contingent upon product selection being completed by 2015.
Above start and completion date is contingent upon office approval and receiving a minimum of a 10% deposit.
Contractor will diligently pursue this job through to its completion, but shall not be responsible for delays caused by
the following:
Timely receipt of payments as described here in or on future change orders. Issuance of job permits within a
G.M. Roth Design Remodeling Inc. 2 of 5
Stanley Partial Kitchen Remodel, 11.12.15 Terms and Conditions MA
11/12/2015
reasonable length of time, receipt of a certified plot plan, loan approval and funding, loan disbursement, act of God,
weather, strikes, lockouts, boycotts, or other labor union activities, job change ordered by Owner, inability to secure
materials, delays caused by inspection, changes caused by inspectors of governmental agencies, or any other cause
beyond Contractors control.
No penalties will be assessed to Contractor for job completion beyond the date shown above.
18. Owner understands and agrees that if at owners request a key is not furnished to contractor prior to job start, owner
will provide access to the residence from 7:30 am to 5:30 PM Monday through Friday during the duration of this
job. If at any time access to the work area is not available to Contractors crew for any reason, owner agrees to
reimburse Contractor for expenses incurred for travel and lost time at the rate of $105.00 per man-hour lost, and .38
cents per mile per vehicle.
19. Owner understands and agrees to provide Contractor, Contractor's employees and Sub -Contractors, free use of all
utilities to complete this job. Utility use will include electricity, water, telephone, a washbasin, and toilet at the job
site. Contractor agrees to maintain those facilities in "maid clean" condition at all times. Contractor agrees to
reimburse Owner for all long distance telephone charges incurred by Contractor, Contractor's employees, and/or
Sub -Contractors.
20. All workmanship as outlined in this agreement is guaranteed for a period of 3 years from the date of substantial
completion of this work, and all materials, supplies, and equipment are to be covered by their manufacturers
warranties (subject to normal use and care and provided Owner has complied in full with terms and payments and
other conditions of this contract).
While quality is a relative term and standards of quality vary, the Contractor subscribes to the National Association
of Home Builders (NAHB) set of quality standards applicable to residential construction and residential remodeling
developed by the NAHB Remodelers Council and the NAHB Single Family Small Volume Builders Committee and
set forth in the manual entitled Residential Construction Performance Guidelinesfor Professional Builders &
Remodelers (2005).
All unused materials shall remain the property of Contractor. Owner understands and agrees that this Contract is for
the purchase of the job(s) as stated herein, and is not a purchase agreement for the individual parts or materials that
comprise this project.
21. Owner understands and agrees to the limitations of patching plaster or drywall, and while Contractor shall make
every effort to match existing textures, finishes, and planes, an exact match cannot be guaranteed.
22. Change of the electrical service, (meter and base, or panel), or any other electrical equipment that is in violation of
applicable electrical or building codes, is not included in this job unless stated otherwise in the specifications. In the
event the Electrical Inspector requires any change in the existing electrical equipment to perform the electrical work
as outlined in this contract, Owner agrees to pay for such work.
23. Contractor is not responsible for nominal damage caused to lawn and landscaping by workmen and machines.
24. Owner will assume responsibility to remove from any and all work areas, all household and personal items, and store
those items away from the work areas during the entire duration of this job. Contractor will not be held liable for
any damage to any owner items not removed from the work area. The Contractor will move any and all items left in
the work area, will be moved on the day of job start, and owner will be subject to a charge of $105.00 per man hour
for moving those items. Contractor will not be liable for any damage to those items caused by the moving process.
G.M. Roth Design Remodeling Inc.
3 :f�5
Stanley Partial Kitchen Remodel, 11.12.15 Terms and Conditions MA
11/12/2015
25. Owner authorizes Contractor to use photographs taken at job site for display, promotion and advertising, without
compensation to Owner.
LEGAL
26. Owner understands and agrees that the final price quotation for this job has been figured at present labor and
material rates, and that Contractor, at his option, may increase the Contract price if any increases in said costs
develop prior to job start (increase not to exceed 5% of the total agreement). It is also agreed that if any additional
work is added to the plans and specifications by any governmental agency, city or county for their approval, the cost
of the additional work will be added to the agreement price.
27. If any provision of this agreement is declared invalid by any tribunal, the remaining provisions of the agreement
shall not be affected thereby.
28. It is understood and agreed between all parties to this agreement that this contract replaces and 'voids, any and all
previous agreements between the parties to the agreement, either written or verbal.
29. Contractor will keep said premises free from all mechanics and other liens by reason of any materials or labor to be
furnished to him by others. Nothing stated herein or in said note shall prevent Contractor from timely filing a
mechanic's lien on his own behalf to secure payment of the money to become due under this agreement should he
deem it necessary unless otherwise agreed.
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a
�d� te concerning this contract, the contractor may submit such dispute to a private arbitration service
w w
h%ichkeen approved by the Office of Consumer Affairs and Business Regulations and the consumer
shall be requir submit to such arbitration as provided in MGL. C. 142A.
Owner Contractor
Owner
NOTICE: The signatures of the parties above apply only to the agreement af�le parties to alternate dispute
resolution initiated by the contractor. The owner may initiate alternative dispute"Nolution even where this section
is not signed separately by the parties.
3 1. Owner will pay Contractor's cost of collection, including reasonable attorney's fees, if Contractor has to resort to
litigation or arbitration to collect any monies owed by Owner to Contractor.
32. This written contract constitutes the complete integration of all statements, agreements, and discussions relating to
the work and contract, and there are no representations, guarantees, or warranties other than those expressly
incorporated herein, nor are there any agreements collateral hereto, nor is this contract dependent upon or subject to
any conditions or approvals, precedent or subsequent, not herein stated. No subsequent agreement relating hereto
shall be binding upon Owner or Contractor unless in writing and signed by the party being bound. Faxed, PDFed,
and/or scanned documents have the force of an original document. Contractor mav assign this Contract, and the
33. This construction contract is entered into on the 1-9'-- — day of—WL—', 2015 by and between
G.M.. Roth Design Remodeling Inc., herein called Contractor, and the party or parties signing below, herein called
Owner.
G.M. Roth Design Remodeling Inc.
4 of 5
Stanley Partial Kitchen Remodel, 11.12.15 Terms and Conditions MA
11/12/2015
The above specifications, conditions, and job material selection sheets are satisfactory and are hereby accepted.
You are authorized to purchase materials and proceed with this job as specified in this proposal.
Contractor shall furnish all labor and materials to do the work described in the above specifications and Owner
agrees to pay Contractor as follows:
CONTRACT PRICE ..............................................
DOWN PAYMENT ..............................................
START OF JOB PAYMENT ...............................
Progress Payment:
Progress Payment:
COMPLETION OF THIS JOB .............................
2aorlo
N 12TK
2 8
ATTENTION: Contractor will do only that work which is written in the above specifications for the above -agreed
amount. The Terms and Conditions as stated are part of this contract. This contract is subject to office approval.
You, the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of
this transaction. See attached Notice of Cancellation form for an explanation of this right.
FORFEIT OF DEPOSIT: Under this Contract, we have asked you to pay a deposit. The deposit may be used by us
to pay for materials, labor and other costs involved in your project, and to cover preliminary costs of starting your
project. Either party, (you or we) may cancel this Contract within three days for any reason or no reason and we will
promptly return your deposit in full, no questions asked. However, if you cancel this Contract after this three day
rescission period, you agree that we may apply the deposit or a portion of the deposit to cover our costs and losses
resulting from the cancellation. These costs include not only labor and materials of your project, but also other
losses to us, including overhead and estimating costs that may be incurred before the work at your project begins.
Because these costs and losses are difficult and burdensome to calculate on a case-by-case basis, you agree that
G.M. Roth Design Remodeling Inc. may apply an amount of your deposit equal to 20% of the total job value if you
cancel the project after the three day rescission period.
Both you and G.M. Roth Design Remodeling Inc. reserve other rights to applicable remedies in the event this
contract is breached. For example, if significant work has been completed on your project, our damages may exceed
20% of the total job value, in which case we reserve the right to recover the additional damages, including lost
profits as applicable. We will always work with you to avoid cancellation and application of your deposit in any
way possible, because we would rather deliver on our promise of excellent work, and complete your project within
the terms or our agreement.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
(Owner's Signature) t 7Date)
(Owner's Signature) (Date)
Owner acknowledges receipt of a copy of this contract.
G.M. Roth Design Remodeling Inc.
5 of 5
0
ACC>RL> CERTIFICATE OF LIABILITY INSURANCE
DATE IMMIDD/YYYY I
1 1/21/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
Eaton & Berube Insurance Agency, Inc.
11 Concord St
Nashua NH 03064
CON
NAM Cathy Beaureaard
PHONE FAX
WC. No. Exti&603-882-2766 IA/C. No):603-886-4230
E'MAIL
ADDREss:cbeau reaa rd deato n be rube, corn
INSURER(S) AFFORDING COVERAGE NAIC #
1/1/2016
INSURER A:Libe[ty Mutual
EACH OCCURRENCE $1,000,000
INSURED GMROT
JNSURER B :AIM Mutual Insurance Company
INSURERC:
G.M. Roth Design Remodeling Inc.
12 Murphy Drive
Nashua NH 03062
INSURER D:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY Oi Fx_1 LOC
F] JPERC
PRODUCTS - COMP/OP AGG $2,000,000
-INSURERE:
INSURER F:
AUTOMOBILE
X
COVERAGES CERTIFICATE NUMBER: 542947712 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
POLICY EFF
IMMIDD/YYYY)
POLICY EXP
(MM/DQNYYY)
LIMITS
A
GENERAL LIABILITY
COM MERCIAL GENERAL LIABILITY
CLAIMS -MADE 1XI OCCUR
BKS55825281
1/1/2016
1/1/2017
EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence) $300,000
MED EXP (Any one person) $15,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY Oi Fx_1 LOC
F] JPERC
PRODUCTS - COMP/OP AGG $2,000,000
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIREDAUTOS AUTOS
I
BAS55825281
1/1/2016
117
I/l/201,
Co GLE LIMIT
(E� $1,000,000
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PRO ER DAMAGE
a d $
P Z t�
$
A
X
UMBRELLA LIAB
EXCESS LIAS
x
OCCUR
CLAIMS -MADE
US055825281
1/1/2016
1/1/2017
EACH OCCURRENCE $2,000,000
AGGREGATE $2,000,000
DED I x I RETENTION $ 10,000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABIL17Y YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE _—]
OFFICER/MEMBER EXCLUDED? [Y
(Mandatory In NH)
Ues, describe under
SCRIPTION OF OPERATIONS below
NIA
N
ECC60040005992016A
1/1/2016
1/1/2017
T7 STATU JOTH-
RY Ll� T� I
I TORY LIMI I ER
E.L. EACH ACCIDENT $500,000
E I DISEASE - POI ICY LIMIT $500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Workers Compensation Information: Gerald Roth Excluded; coverage for NH & MA. Additional Insured status applies if required by written
contract per Liberty Mutual General Liability Extension Endorsement# CG8810 (04/13).
CERTIFICATE HOLDER CANCELLATION
@ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
For Informational Purposes Only
ACCORDANCE WITH THE POLICY PROVISIONS.
c/o GM Roth
12 Murphy Drive
Nashua NH 03062
AUTHORIZED REPRESENTATIVE
@ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD
ts,
The Commonwealth of Massaehusetts
Department of IndustrialAccidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.govldia
Workers' Compensation Insurance Affidavit; Builders/Contractors/FIectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Aimlicant Information Please Print Legibl
Name (Business/Organization/Individual):
JV1
-Ad
1z mulzKy MWEI- CAIIII (I
City/State/Zip: K)NS�kAk AJA Q3()(o7— Phone#: -S7(ol
o03 -�'RQ
Are you an employer? Check the appropriate box:
1. M I am a employer with __ZtQ_employccs (full and/or part-tinie).*
2. 0 1 am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
In I am a homeowner doing all work myself [No workers' comp. insuranedrequired.] t
4.FJ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5. [-J I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insuranceJ
6,F] We are a corporation and its officers have exercised their right of 'exemption per MGL c.
152, § 1(4), and we have no employees. [No workers' comp. insurance required.]
Type of project (required):
7. F1 New construction
8. N[Remodeling
9. El Demolition
10 E] Building addition
11.E] Electrical repairs or additions
12. [] Plumbing repairs or additions
13.E] Roof repairs
14. FJ Other
*Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must allached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees, If the sub -contractors have employees, they must provide their workers' comp. policy number.
Itun an employer that isproviding workers'compensation insurancefor iny employees. Below is thepolicy andjob site
in rination.
00
Insurance Company Name: A � M M of iA&i lrisi.Arante- CamqAnq
J
Policy# or Self -ins. Lic. #: r_LC(0()0J()()0(5qqZ- 0((Ok _Expiration Date:
Job Site Address: (wkM� (hA �2 tlahe- City/State/Zil): N Ondwee- MA
Attach a copy of the workers' compendsation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. 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 Itiq painj'ahi(penaltles ofpeijuiy that the information provided above is true and correct.
.-,w --
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/�own Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
At
IvP 07
0
Fm
Massachusetts Department of Public
Safety
Board of Building Regulations and Standards
License: CS -056336
onstiuchol, supeiv-so,
GERALD M ROTH
10 QUARRY RD
NASHUA NH 03062
COMMissioner
Expiration:
07/14/2017
MEN
Office of Consumer Affairs and Business Regulation
k
10 Park Plaza - Suite 5 170
Boston, Massachusetts 02116
Home Improvement Co-ii-trk,tor Registration
G M ROTH DESIGN REMODELINGJW-Q-�
GERALD ROTH
12 MURPHY DRIVE UNIT G
NASHUA, NH 03062
'-M-05i�
Registration: 109467
Type: Private Corporation
Expiration: 9/16/2016 Tr# 257460
Update Address and return card. Mark reason for change.
[] Address [] Renewal [] Employment [] Lost Card
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