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HomeMy WebLinkAboutBuilding Permit #681 - 6 LAVENDER CIRCLE 4/17/2013Permit NO: Date Issued: 01 " LOCATI TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page PROPERTY OWNER -,IW Inc5 9� 1114.2 A,6 /,t-/ -Z Print'. 1oo'Year OId.Structure yes no. . MAP NO PARCEL:./ ONING DISTRICT: . Historic District yes no `/ " T Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ ElTwo or more family ElIndustrial rtion ation No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic: ❑ Well ❑ Floodplain. ❑ Wetlands ❑ Watershed -District, . El Water/Sewer DESCRIPTION OF WUKK I U tat 1-tK1-UK1v1tU: _-----Jdentification Ple se Type or Print Clearly) OWNER: Name: Qwznex. Phone: q/T`-69KZ7- Address: A CONTRACTOR Name: o QEt/ / Phone: 025 .c Address: /L4 � ST Supervisor's Construction Licenser ell'q --z9 `-- Exp. Date: Home. Improvement License; ARCHITECT/ENGINEER Phone: Address: 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: $ FEE: $ Check No.: Receipt No.: I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Slgnature�ofAgentlOwner Signature of_eontractor, Plane .qi ihmittPd F1 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ .. Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM - PLANNING & DEVELOPMENT COMMENT CONSERVATION COMMENTS C'. HEALTH COMMENTS DATE REJECTED 0 DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Com Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW '� owp_ Engineer: Signature: Located 384 Osgood Street FIRE DEPAIRTMFNT - Temp Dumpster on site yes no Located at 124 Mair Street Fire Departiner t-signatureldate 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 El Notified for pickup - Date E Doc.Building Permit Revised 2010 Building Department The folowing 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 app; -al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm;4ted with the building application Doc: Doc.Bui!ding Permit Revised 2012 09894 Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING V, This certifies that ... .............. ..),at -1) ............. has permission to perform.. ........ plumbing in the buildings of ...I�".1 U I'�.� ..................... . at. . LcA.Q O.t ✓. ...... North Andover,ass. Fee . Lic. No.1----z-j4q.k . . MD ................. b.-.. PLUMBING INSPECTOR Check I S M t n MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _.ate MA DATE L [ PERMIT# 0 i JPBSITEADDRESSi��/ �,� /C�'aG _ 110WNER'SNAME PGINNER ADDRESS Ff TEL �_� �� FAX _ TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL © RESIDENTIAL ©-- PRINT CLEARLY NEW: El RENOVATION: R' REPLACEMENT: Q PLANS SUBMITTED: YES EQ NO FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN f ___..._; 1 J € 1 I. J _.._._ (.--.-_...I _...... FOOD DISPOSER FLOOR /AREA DRAIN I J _J __.1 _..__ I _..._-,_. I J I .__.-__._l INTERCEPTOR (INTERIOR) € 1 .___.._I � _...___! (� _.._.__ € —_._i _----- _J KITCHEN SINK LAVATORY _..___i ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL-€ ..-.._._J ..--__..E __.._.J __._.J __.--.._.J ...._._--J--..---� WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER _ _ _ _ . J i _€ ..._.__..! � I [ _._.._.__I _.-_.....J ......_.__[ -.._._J .._._.__._i J INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES P–NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D BOND Q OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT rJ SIGNATURE OF OWNER OR AGENT ` 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will bei ance 'th all P Jil vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ..� ! _r1s LICENSE # SIG ATURE MPJP Q CORPORATION RI #=PARTNERSHIP 0#=LLC j COMPANY NAME 111 J/,(sem ,ry/! ADDRESS CITY/ _. I STATEi ZIP I /i(�' i 5� —i TEL FAX CELL MAIL &_ S M t n l The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: City/State/Zip: `1,1 Phone #: �5 A_ Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. EUJ-A'm��a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. E] Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Al Homeowners who submit this affidavit indicating they aie 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 a, Py7 information. Insurance Company Name:. t 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 requiredunder 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 certlfy-uhMy thepains)andpeA*tj ifperjury that the information provided above is true and correct Phone #: 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 #: IL. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' ompensation policy, please call the Department at the number listed below. Self-insured companies should enter their �f-insurance license number on the appropriate line. { ty or Town Officials lease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill m the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations 6.00 Washington Street Boston, MA. 02111 Tel, # 61.7-72.7-4900 ext 406 or 1.-877-MASSAFB Revised 5-26-05 Fay, # 617-727-7749 wWwanass,gov/dia ' ' Lu Lev co tutb uAt U) 00 z CD 0 GOO E Ln Lij LU ul 10 ' ' —\ co 00 0 GOO E Ln Lij LU 10 —\ This certifies that Chas permission for gas installation .. � P n,l � ............ in the buildings of ....h� ' at ... L..�,�c�.,�f'.� , ,North Andover, Mass. Fee Lic. No./ dell . -M& ................ ... GASINSPECTOR Check # f r. Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that Chas permission for gas installation .. � P n,l � ............ in the buildings of ....h� ' at ... L..�,�c�.,�f'.� , ,North Andover, Mass. Fee Lic. No./ dell . -M& ................ ... GASINSPECTOR Check # f r. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK fy CITY 4 MA DATE J PERMIT # JOBSITE ADDRESS __ ­��L _ ,_ _ _ OWNER'S NAME t�`d1� f .n GOWNER ADDRESS - -W FAX • TYPE OR OCCUPANCY TYPE COMMERCIAL[]_ II EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: P--� RENOVATION: EJ1 REPLACEMENT: 0 PLANS SUBMITTED: YES []_f NQG- APPLIANCES Z FLOORS— BSM 1 2 3 4 5 1 6 1 7 8 9 10 11 12 13 14 BOILER _! _ , _: . _� __.� L—_j =11—i BOOSTER —J== r CONVERSION BURNER1 COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR zi J �= I I. - -- I FURNACE GENERATOR GRILLE INFRARED HEATER . -�_�I. LABORATORY COCKS{T_ ___i(-� -� (_-tl �.1-.-.-f �_—i .,—.. j ,�� --- �;__ i -�,- . � �.�.J ,..-.- . 1I –A-1 MAKEUP AIR UNIT --------- - OVEN POOL HEATER - ( _t.1 ROOM I SPACE HEATER ROOF TOP UNIT z TEST UNIT HEATER LAVENTED ROOM HEATER WATER HEATER _ __ I S I __ i -- -�.. __..__-------_-..-._-__ ----- -_.-- INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES la IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAG Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Ej BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENTE SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the be of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli e i I Pe ' n vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME - X1332 LICENSE # -....._ SIG ATURE MP a MGF El JP D JGF [__I LPGI L:CORPORATION J# PARTNERSHIP 0#= LLC D#= COMPANY NAME: _ 'ADDRESS CITY STATE /T ZIP d''. TEL FAX CELL)#,,� EMAIL--- W�W Fi O z 0 H U W a w of a z O )LJ >- W W 0 a z LU Q W 5 o co m> w W co z a a a U J a Q co tii x w � O z v 0 H U W C�7 1 � i The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations kvi . 600 Washington Street Boston, MA. 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name uw Address: ,6, Ile -f s7C City/State/Zip: /j/$10•�X/W/7 A/�J Phone #: '�qZeP- ��4'2,077 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I eir ployees (full and/or part-time).* have hired the sub -contractors _ 2. am a sole proprietor or partner- listed on the attached sheet. # ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 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 N 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. Ido hereby cert fun the and�pp^enaltie f perjury that the information provided above is true and correct. Phone #• C/ �7� C�GD7 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 - - - 11 Contact Person: Phone #: II Information and Instructi®ns Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confumation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial .Accidents Office of Investigations 600 Washington Street Boston? h!I.,A, 02111 Tei, # 617-727-4900 ext 406 or 1-877-MASSAFB Revised 5-26-05 Fax # 617-727-7749 vrrww.mass,8oV1d1a Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 325642.00 m $ - $ 391.70 Plumbing Fee $ 48.96 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 48.96 Total fees collected $ 589.63 6 Lavender Circle 681-13 on 4/17/2013 Master Bath Remodel �I Z MI l� = J Q uj 6=L O m s y Y \ 0 O LL E (V ? N U CL 4) 'N O 1JJ Z l7 Z D J mJ m "O O LL t =3w O W v C s U O LL 0 u W Z l7 ZtA cLU C a L O d' LL 0 Ucc W Z Q V J LU L O K v U VI LL O d Z _ _ d' LL z W Q a wC 6L m O Z QJ { w cu Y O ' N n V1 .a 0 5 � � o �•r .CL a�Li G� cc �• E CL d C d iv 04. N IZ (uW y�-r ate+ .t ,V Q' = u L E ,NGS � C1 L (O CD Q Cc E W J1-15 L L m d en 0 N — o 'a > 3 ._ ca U) ya E ccc o CL W cm N 0 L _NN Q Q. Vd.+= L W CD Co cc 0 o = _ Q L i RS •Q C Qa•:cccD N co o vs m m W_ LIU P C � ' N = o F- N .+�+ ' yam—, Z W O E o _ G v Q 0�as N Q N>= = = J y -= o O H � Q. o v > 2 z G cfl z W w x LU LU CL L7 SIV W O � O .0 Z CL CMa W Q N 0.— E m m a � i d m O > v o O `cc o C- a CL c Q O V J •a .CL O 0 CL V v/ cc r_ cc Q r Bonenfant Construction Co. 1806 Salem St. North Andover MAO 1845 978-689-2066/978-807-8925 Home Improvement Contractor # 157687 Job Name Job Location James and Kristen Mullin 6 Lavender Cir. 6 Lavender Cir. North Andover Ma North Andover Ma 978-682-6524 508-878-5350 Scope of Work The work will be the remodeling of the master bathroom which will include. 1. The removal of existing fixtures, lighting, tile from floors and walls as well as underlayment, and sheetrock. 2. Rebuilding of shower stall and installation of new fixtures (supplied by the home owners) 3. The rebuilding of the tub area and installation of new soaker tub and fixtures (supplied by home owners) 4. Blue boarding and plastering the walls and the ceiling. 5. Installation of electric heat mats under the the floor. 6. Tiling of shower stall and floor (supplied by home owner) 7. Installation of a Panasonic or similar ventilation system. 8. Priming and painting of ceiling and walls. 9. Installation of new cabinetry (supplied by owners) 10. Installation of new lighting fixtures (supplied by owners) 11. Possibly install new insulation, this will be determined when walls are opened and inspected. There would be an additional charge for the new insulation. The contractor will be directly involved with the supervision of all subcontractors during the duration of the project. All will be required leave the work area clean and orderly at the end of each work day. 4,P11 James and Kristen Mullin HIC#157687 Page 2 of 4 Permits are required. It is the obligation of the contractor to secure such permits as the homeowner's agent: NOTE: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGI_c.142A Work to begin during week of April 8, 2013 Expected Completion Date: The first week of May Bonenfant Const agrees to perform the work, furnish the material and labor specified above for the sum of $32,642 to be paid as follows: $10,880. upon the completion of demo work $10,880 upon the completion of tile work $10,882 upon completion of entire job. NERS: CONTRACTOR: or Kristen Mullin Robert Bonenfant Date Date You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later that midnight of the third business day following the signing to the agreement. See attached notice of cancellation for an explanation of this right. 9 James and Kristen Mullin Page 3 of 4 HIC#157687 Note: All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place — Room 1301 Boston MA 02108 617-727-8598 Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the property. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer sha a equired to submit to such arbitration as provided in M.G.L. c. 142 Contractor: Homeowner: Date: Date: aIf77 ACCELERATION OF PAYMENT Homeowner's Financial Insecurity -Contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. Contractor's Financial Insecurity -In instances where a contractor deems him/herself to be financially insecure, the contractor my require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal from said account would require signatures of both parties. James and Kristen Mullin Page 4 of 4 HIC#157687 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE TO: Robert A Bonenfant, Bonenfant Construction, 1806 Salem Street, North Andover MA 01845 NOT LATER THAN MIDNIGHT OF APRIL 5,201 Date: NO WORK WILL BEGIN UNTIL THIS TIMS EXPIRES X Jarrie!,6r Kristen Mullin JOHNAWE-01 CANDREWS 'akl._ o CERTIFICATE OF LIABILITY INSURANCE DAT116/2D/YYYY) 4/16/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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 North Andover Harrington Insurance Agency, Inc. 483 ChickeringRoad North Ando ve, MA 1845 CONTACT NAME: North Andover Office PHONE (978 682-7203 FAX ( ) A/c No Ext): ) ac, No : 978 682-7752 E-MAIL thdhin tonsaves.com ADDRESS: noranover �arr9 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Norfolk & Dedham Mutual Fire Ins Co INSURED John A Weir 39 Brightwood Avenue North Andover, MA 01845 INSURER B: Hartford Underwriters Ins Co INSURER C : INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADL INSR BR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx� OCCUR R0402473A 8/112012 811/2013 EACH OCCURRENCE $ 300,000 PREMISES Ea oaxuED $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT PRODUCTS - COMP/OP AGG $ 600,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS ED NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPAGE PER ROPEN DAM $ ACCID UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) K yes, describe under DESCRIPTION OF OPERATIONS below N / A 6S60UB9775M79311 6/9/2012 6/9/2013 I WC STATU- OTH- TORY LIMITSJ ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000' E.L. DISEASE - POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) This Worker Compensation policy does not provide coverage for John Weir or Robert Bonenfant. CERTIFICATE HULUEK CANCELLAIJUN Town of North Andover Building Department Town Hall North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHO RIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD -rr ' ✓A, �aieonan r�ece�l� n 2'iaaoacivaelta 1 office of Consumer �, fair Fc nJsieess 1tcg+.':tion t HOiv E lNil"ROVItME ?'�= i:"TRACTOR Eyre: i !� Registration: fi:157687, i ' `Indivic ai s� Expiration: <,10/2912013 i ROS RT A BONE,N.FAN, y°iFr_ ROBERT BONENEANTt'g 1806 SALEM ST NORTH ANDOVER, MA;Cl8S5:Undersecrei; y \\ 1 I License o: registration valid for individul use only before t'ie r;;.p r 4.ion date. If found return to: ntiice of Con�_cruer Affairs and Business Regulation 10 Park Plaza - Suite 51.70 Boston, MA 021.16 I Not valid without signature I Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -042212 . ROBERT A BONE$FANT 1806 SALEM ST N ANDOVER MR 018 5 Expiration Commissioner 04/29/201,4 '' Location l�! �!/L+�Q�� C/sle No. Date e TOWN OF NORTH ANDOVER 4�ltrut.l� r q . e Certificate of Occupancy $� Building/Frame Permit Fee $,va-- -j CyV Foundation Permit Fee $' Other Permit Fee $ TOTAL $ Check #� r 26298 Building Inspector