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Home My WebLink AboutBuilding Permit #859-13 - 60 ROSEMONT DRIVE 6/11/2013C .A 1 n BUILDING PERMIT -r °\ TOWN OF NORTH ANDOVER ° o --� — i APPLICATION FOR PLAN EXAMINATION Permit NO:0 V Date Received ^o Date Issued: //` 12 IMPORTANT: Applicant must complete all items on this LOCATION (60 bcfi `rte' �� p C, PROPERTY OWNER VN(& V-Q11'b Print CC ctx pck Print MAP NOPARCEL ZONING DISTRICT: Historic District yesrno Machine Shop Villaqe Yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building AOne family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer -'rovw-), Identification Please Type or Print Clearly) OWNER: Name: �`n�i' S �octru Ht�A'i Ph( Address: f U i 16-A r-Qovl e. 97'�-,54 - 4065 -- CONTRACTOR Name: �{Phone: q7" X33 ?3i? Address: ( -7 ` l \9'A `Y Supervisor's Construction License: Exp. Date: Home Improvement License: 1 Exp. Date: / ARCHITECT/ENGINEER Phone:_ Address: Reg. No._ FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED CO: Total Project Cost: $d& d FEE: $ dg Check No.: I f Receipt No.: .4 NOTE: Persons tWactlng wit"nregi#ered contractors do not have acA Signature of Agent/OwnerC)�JC XQ Signature of contractor, BASED ON $125.00 PER S.F. fund's Permit N0: Date Issued: .. L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this pate LOCATION _ Print PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic []Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: ArlrlrPcc- CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING 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.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Qgent/Owner Plans Submitted ❑ Plans Waived ❑ Signature of contractor. Certified Plot Plan ❑ Stamped Plans ❑ y a ra d Plans Submitted ❑ b 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 PLANNING & DEVELOPMENT ❑ COMMENTS DATE APPROVED .❑ a 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: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW 'I owo Engineer: Signature: FIRE tEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Departiner-it signatureldate COMMENTS Located 384 Osgood Street no 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 Doc.Building Permit Revised 2010 Building Department The folipwing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, 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 apn,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:tted with the building application Doc: Doc.Buiiding Permit Revised 2012 Location I zw) 6pv,-,, Pq No. P5� Date A111 /�//,z / I - ---w Check q3 �- / TOWN OF NORTH ANDOVERj. Certificate of Occupancy $ Building/Frame Permit Fee $Z—, -- Foundation Permit Fee $— Other Permit Fee $ TOTAL $ Building Inspector I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 58,000.00 m $ - $ 696.00 Plumbing Fee $ 87.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 87.00 Total fees collected $ 970.00 Foundation 100 60 Rosemont Drive 859-13 on 6/11/13 Finish Basement Jun 11 2013 9:19 P.01 CERTIFICATE OF LIABILITY( INSURANCE 6�1i�2onYM 13 nIS 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, eubipti: to the terns 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 ' INSURANCE SOLUTIONS CORPORATION 60 Westville Rd Plai. tow NH 03865 NTA Nathleen Miller,' CISR, CPIW• PHONE (603) 352-4600 1. FAX , '. (609)982-2094 E -MAL ,kmiller@iac-insuranCa.com'' INSURERS AFFORDING COVERAGE NAIL R INSURER New England Excess Exchange INSURED M R Norman LLC dba M R Norman Builders 63 Peaslee Crossing Road Newton NH 03.858 INSURER R ; INSURERC: INSURERD: INSURER R ; INE RER F COVERAGES CERTIFICATE NUMB ER:CL1361111423 REVISION'NUMBER:_ THIS.IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR SHE NOLICY FERIW .INDICATED_ NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 07HER 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 TEkM_ t, EXCLUSIONS AND CONDITIONS OF. SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _TR TYPE OF INSURANCE 'POLICY NUMBER AQDLSUBK MMIDQ EFF POLICY EXP • LIMITS GENERAL LABILITY EACH OCCURRENCE S 11000-100 X COMMERCIAL GENERA), LIABILITY MI E5 Ea O RENTED IOO OO urcence $ A CLAIMS -MADE OCCUR 8175148 /20/2013 /20/2014 MED �p An 'axme; ereon g 5,00 PERSONAL•&ADV:INJUFiY S 1,000,00 2 000 00 DESCRIPTION OF OPERATIONS / LOCATIONS /.VEHICLES (Attach ACORD 101, Addlllonal Remarks $chedufe, If moro space is required) tThe insured has purchased'Workera' Compensation coverage through the NA Workar's Compensation Assigned Risk Pool. We have requested the servicing carrier issue a Certificate of insurance on your behalf. Agente•..ara not permitted .to. issue Certificates of Insurance for Workars' C.Qmpensation coverage on policies iesued.through tha MA Worker's Compensation Assigned Risk Pool. (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of.North Andover 1600 Osgood St AUTHORIZED REPRESENTATIVE: No Andover r'MA 01845-1048 K Miller, C=SR, CPIW/ ACORD 26 (201,0105) ®1988-2010•ACORD CORPORATION. All rights reserved. TLP ACORn name and loan are resiiskred marks. of ACORD ' GENERALAGGREGATE $ , , PRODUCTS-COMP/OP AGG $ 2,000,00 GEN.L AGGREGATE LIMrr'APPLIES PER: E SINGLE LIMIT X POLICY PRO -LOC CT F$ jF AUTOMOBILE LIABILITY (Per person) S ' BODILY INJURY (P ANY AUTO BODILY INJURY (Par aoddenl) S ALL OWNED' SCHEDULED, AUTOS ON -0 - HIRED AUTOS AUTOS PERTY DAMAGE $ Per eccl UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE AGGREGATE $ � $ . WC STAYU-• 777 DED •RETENTION WORKERS COMPENSATION E.L. EACH ACCIDENT $' AN6FMPL0YERS' LIABILITY' ANY PROPRIE-TOR/PARTNERIPJ(ECUTIVE YD OFFICERIMEMBER EXCLUD8D9 U (Mandatory in NH) NSA [.L DISEASE _ EA EMPLOYE $ E.L.DISEASE -POLICY LIMIT $ It;yea desarbe under DEBDRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS /.VEHICLES (Attach ACORD 101, Addlllonal Remarks $chedufe, If moro space is required) tThe insured has purchased'Workera' Compensation coverage through the NA Workar's Compensation Assigned Risk Pool. We have requested the servicing carrier issue a Certificate of insurance on your behalf. Agente•..ara not permitted .to. issue Certificates of Insurance for Workars' C.Qmpensation coverage on policies iesued.through tha MA Worker's Compensation Assigned Risk Pool. (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of.North Andover 1600 Osgood St AUTHORIZED REPRESENTATIVE: No Andover r'MA 01845-1048 K Miller, C=SR, CPIW/ ACORD 26 (201,0105) ®1988-2010•ACORD CORPORATION. All rights reserved. TLP ACORn name and loan are resiiskred marks. of ACORD ' Jun 11 2013 9:19 P.02 -� .CERTIFICATE OF LIABILITY INSURANCE Fr. I/..A.CO�L7 11/aa13 . THISFICATE IS •ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DO ES N OT AFFIRMATIVELY 0 R N EGATIVELY AM END, EXTEND O R ALTER THE C OVERAGE AFFORDED B YT HE P OLICIES BELOW. THIS. C E.RTIFICATE• 0 F I NSURANCE, D OES N OT CONSTITUTE A CONTRACT BETWEEN THE ISSUING I NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions, of the.ppllcy, certain Ponces may require an endorsement, A statement on this certificate doer not confer rights to the certificate holder. In Ileu of such endarsement s . PRODUCER NAME:c! 'Barkley Ansi ned Risk Services Tneurance,'Solutiorip Corp PHUNt FAX 60 Westville RD c.No Fal: (800) 634-4589 (fVC, No : 866 215-8116 Plaistow, NH 03865-2941 INaU ER A: M R Norman LLC INSURER B: d": M R Norman Builders INSURER C: 63 Peaslee. Crooeing Road INSURER D: INSURER E: Newton NH 03858 1 INSURER 1NDICAT6. NOTWITHSTANDING' ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER PC CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED DY PAID CLAIM ism TR TYPEOF INSURANCEINBR WVD SUFJR POLICY NUMBER MMIDD/YYYv MMIDD/YYYY GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ' ❑ CLAIMS -MADS ❑ OCCUR ❑ ❑ GEN -L AGGREGATE LIMIT APPLIES PER; PRO POLICY JEOT Loc AUTOMOBILE LIABILITY ANY AUTO ALL•OWNED(� SCHEDULED AUTOS AUTOS lJ MIRED Au7os .11 NON -OWNED AUTOS UMBRELLA LIAR- 1:10CCUIR EXCES6 I,IAB • ❑ CLAIMS -MADE DEP RETENTION 5 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YEN wc-20-20-004689-0 4/20/2013 4/20/2014 ANY PROP RIETO RrPARTNERJEXECUTNE a _ ❑ A OFFICEIMEMBER'EXCLUDED7' NIA (M%n4atoryIn NN) If ye e. 4esodbe under, DESCRIPTION OF OPERATIONS below ❑ ❑ DESC IPTION OF o ERATIONE I LO AT15NB I VEMICLE6 (Attach ACORD 101. Addhlonal Ramarks Schedule, if more space is rvquua Election Category Election. Statue Name ,All Entities/Insureds: Farm -Wife Exclude M Ryan Norman M R Norman LLC NAMED ABOVE FOR THE POLICY PERIOD CUMENT WITH RESPECT TO WHICH THIS 1EREIN IS SUBJECT TO ALL THE TERM$, s• LIMITS EACH OCCURRENCE $ DAMAGE RENTED $ EMISES Ea oar rranea MED EXP An one eraon $ PERSONAL& ADV INJURY $ GENERALAGOREciATE $ PRODUCTS - COMP/OP AGO S N o acc3denl $ BODILY INJURY For e $ BODILY INJURY PeAccident)$ PROPERTY DAMAGE $ Pe r 4celdenl S ' EACH OCCURRENCE $ AGGREGATEt—W$ c I TATO• YY --'11 OTH- TO LIMITS • u E C.LEACH ACCIDENT $ 7.00000.00 E.L.•DISEA&E-EA EMPLOYEE $ 100000,00 E.L. DISEASE • POLICY LIMIT S 500000,00 ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVF DESCRIBED POLICIES BE -CANCELLED BEFORE THE Town Of North Andover EXPIRATION DATE THEREOF. -NOTICE WILL BE DELIVERED. IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHOWtO REPRESENTATIVE No Andover kA 01945-1048 � NORMAN PROPERTIES & DEVELOPMENT �xa ARTICLE 5. PROGRESS PAYMENTS 5.1 The Owner will make payments to the contractor pursuant to the attached construction draw schedule as work required by said schedule is satisfactorily completed. Owner shall make draw payments to contractor within 3 days after request by contractor. Should the owner fail to make payment, contractor may charge a penalty of 5% annually upon the unpaid amount until paid. 51 If payment is not received by the Contractor within 5 days after delivery of payment demand for work satisfactorily completed, contractor shall have the right to stop work or terminate the contract at his option. Termination by Contractor under the provisions of this paragraph shall not relieve the Owner of the obligations of payments to Contractor for that part of the work performed prior to such termination. Termination by Owner under the provisions of this paragraph shall not relieve the Owner of the obligations of payments to Contractor for that part of the work performed prior to such termination. 5.3 Payment Schedule and Amounts 1. Signing of Contract: $3,000 2. Start Date: $15,000 — September 9", 2013 3. Rough Ins Inspected: $20,000 — September 27", 2013 4. Insulation and Wallboard Complete: $5,000 — October I lb, 2013 5. Tile & Finish Work Complete (before plumbing fixtures installed): $10,000 — November 1 �`, 2013 6. Project Complete: $5,000—November 15`x, 2013 ARTICLE 6. DUTIES OF THE CONTRACTOR 6.1 All work shall be in accordance to the provisions of the plans and specifications. All systems shall be in good working order. 6.2 All work shall be completed in a workman like manner, and shall comply with all applicable national, state and local building codes and laws. 6.3 All work shall be performed by licensed individuals to perform their said work, as outlined by law. 6.4 Contractor shall obtain all permits necessary for the work to be completed 6.5 Contractor shall remove all construction debris and leave the project in a broom clean condition. . 6.6 Upon satisfactory payment being made for any portion of the work performed, Contractor shall furnish a full and unconditional release from any claim or mechanics' lien for that portion of the work for which payment has been made. ARTICLE 7. OWNER 7.1 The Owner shall communicate with subcontractors only through the Contractor. 7.2 The Owner will not assume any liability or responsibility, nor have control over or charge of construction means, methods, techniques, sequences, procedures, or for safety precautions and programs in connection with the project, since these are solely the Contractor's responsibility. 7.3 All persons working on this, i.e. sub -contractors, foremen or laborers will be notified that no payments will be made by owners of property to them, that only Norman Builders is responsible for payments to them. All contractors shall be insured to the minimums provided as described by Norman Builders and not the responsibility of the owner. I ARTICLE 8. CHANGE ORDERS AND FINISH SCHEDULES 8.1 A Change Order is any change to the original pians and/or specifications. All change orders need to be agreed upon in writing, including cost, additional time considerations, approximate dates when the work will begin and be completed, a legal description of the location where the work will be done and signed by both parties. 50% of the cost of each change order will be paid prior to the change, with the final 50% paid upon completion of the change order. A 0% fee shall be added to all change orders and overages in excess of initial allowances. Additional time needed to complete change orders shall be taken into consideration in the project completion date. 8.2 Any delays or changes in finish selection schedules will delay the projected completion date. ARTICLE 9. INSURANCE 9.1 The Owner will purchase and maintain property insurance to the full and insurable value of the project, in case of a fire, vandalism, malicious mischief or other instances that may occur. 9.2 All Workers will be covered by Workman's Compensation and Liability insurance coverage as needed and required by law. ARTICLE 10. GENERAL PROVISIONS 10.1 If conditions are encountered at the construction site which are subsurface or otherwise concealed physical conditions or unknown physical conditions of an unusual nature, which differ naturally from those ordinarily found to exist and generally recognized as inherent in construction activities, the Owner will promptly investigate such conditions and, if they differ materially and cause an increase or decrease in the Contractor's cost of, and/or time required for, performance of any part of the work, will negotiate with the Contractor an equitable adjustment in the contract sum, contract time or both. ARTICLE 11. HAZARDOUS MATERIALS, WASTE AND ASBESTOS 11.1 Both parties agree that dealing with hazardous materials, waste or asbestos requires specialized training, processes, precautions and licenses. Therefore, unless the scope of this agreement includes the specific handling, disturbance, removal or transportation of hazardous materials, waste or asbestos, upon discovery of such hazardous materials the Contractor shall notify the Owner immediately and allow the Owner/Contractor to contract with a properly licensed and qualified hazardous material contractor. Any such work shall be treated as a Change Order resulting in additional costs and time considerations. ARTICLE 12. ARBITRATION OF DISPUTES 12.1 Any controversy or claim arising out of or relating to this contract, or the breach thereof, shall be settled by arbitration administered by the American Arbitration Association under its Construction Industry Arbitration Rules, and judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. ARTICLE 13. WARRANTY 13.1 At the completion of this project, Contractor shall execute an instrument to Owner warranting the project for 1 year against defects in workmanship or materials utilized. The manufacturer's warranty will rr ' prevail. No legal action of any kind relating to the project, project performance or this contract shall be initiated by either party against the other party after 1 year beyond the completion of the project. ARTICLE 14. TERMINATION OF THE CONTRACT 14.1 Should the Owner or Contractor fail to carry out this contract, with all of its provisions, the following options and stipulations shall apply: 14.1.1 If the Owner or the Contractor shall default on the contract, the non -defaulting party may declare the contract is in default and proceed against the defaulting party for the recovery of all damages incurred as a result of said breach of contract, including a reasonable attorney's fee. In the case of a defaulting Owner, the Earnest money herein mentioned shall be applied to the legally ascertained damages. 14.1.2 In the event of a default by the Owner or Contractor, the non -defaulting party may state his intention to comply with the contract and proceed for specific performance. 14.1.3 In the case of a defaulting Owner, the Contractor may accept, at his option the earnest money as shown herein as liquidated damages, should earnest money not cover the expenses to date, the Contractor may make claim to the Owner for all work executed and for proven loss with respect to equipment, materials, tools, construction equipment and machinery, including reasonable overhead, profit and damages applicable to the property less the earnest money. ARTICLE 15. ATTORNEY FEES 15.1 In the event of any arbitration or litigation relating to the project, project performance or this contract, the prevailing party shall be entitled to reasonable attorney fees, costs and expenses. ARTICLE 16. ACCEPTANCE AND OCCUPANCY 16.1 Upon completion, the project shall be inspected by the Owner and the Contractor, and any repairs necessary to comply with the contract documents shall be made by the Contractor. 16.2 Building inspector of North Andover, MA must sign off on final inspection prior to final payment by owners to Norman Builders, for completed work at 60 Rosemont Drive. ARTICLE 17. CONTRACT LANGUAGE REQUIRED BY THE COMMONWEALTH OF MASSACHUSETTS 17.1 All home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 0211.6 Phone: (617) 973-8700 17.2 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 17.3 PERMIT NOTICE 1. ANY AND ALL NECESSARY CONSTRUCTION RELATED PERMITS SHALL BE THE OBLIGATION OF THE CONTRACTOR TO OBTAIN SUCH PERMITS 2. IF ANY ADDITIONAL APPROVALS OR PERMITS ARE REQUIRED OTHER THAN THE BUILDING PERMIT TO START CONSTRUCTION, THERE WILL BE ADDITIONAL DELAYS AND FEES INCURRED THAT WILL BE THE RESPONSIBILITY OF THE HOME OWNER 3. OWNERS WHO SECURE THEIR OWN CONSTRUCTION RELATED FERIVIITS OR DEAL WITH UNREGISTERED CONTRACTORS SHALL BE EXCLUDED ACCESS TO THE GUARANTEE FUND 17.4 The contractor and the homeowner herby mutually agree in advance that in the event that 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 Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. Witness Contractor , ure Owner Signature Witne Owner ' nature Owner Signature a'J JO =N LL O CE O ca c L Y —p U V) 'u Ul Z Z 0 m c l m c C LL to LL' ? U co C LL O y Z Z a toX0,0 w co c LL N CLO Z ~ W W 2' U > v N to C LL 0: a Z C7 tto O CC — m c LL Z 4: o. W LU U. aj c m p Z N ,� V) �' v O Y O Vl I ,,wwn V/ �'•'o m �• � o oTI:� a w � L 0 u 0. O 4) • v t�� C C - Q h �' c • a �s CL M �y J L >= w O O O y C y .� O O -a 0 t/! V; O O Q C 'a y cu Z/ 0 O ® o - N = o ce e _' r(A 0) CM O r c Q i L •O d N y � m 4 W =_ O O y O O y C O •V Z. V O Lu • V t:. 0-0 N H s 4),5; U) -p"- OO $o> Q C > O a . z O J m r z F' O� �z z Cl) Lu a. x Z L LJ O U U) Cl) a. z V ti Z L" - El W D YI U) W W 12 W The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ,. 600 Washington Street 776w— Boston, MA 02111 `' www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: (9 -Z-) I�� c�.S 1 e C �cUSS� e4 2 t !) ( � G %5t Phone #: Are you an employer? Check the appropriate bog: I X 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. ❑ I 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. employees and have workers' [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] 7�6-t33--?33 Type of project (required): 6. ❑ New construction 7. 'ORemodeling 8. ❑ Demolition 9. ❑ Building addition 10. EJ 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. t 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 state whether or not those entities have employees. if the sub -contractors have employees,_ they must provide their workers' comp_ policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: W 1. A) -:) V -0G11i M1 0() Expiration Date: `i Job Site 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 DLA for insurance coverage verification. I do hereby certify of perjwy that the information provided above is tnre and correct. Phone 4: 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 #: C-'J/7C[EO)It)I(C7((P(,p(�110��/FZgJJIIf�(IJPI�J Office of Consumer Affairs & Bosihess Regulation OME IMPROVEMENT CONTRACTOR egistration: 160921 Type: xpiration: 9/10/2014 DBA M.R. NORMAN PROPERTIES & DEVELOPMENT MICHAEL NORMAN 63 PEASLEE CROSSING RD go NEWTON, NH 03858 Undersecretary Massachusetts - Department of Public Safet% Board of Buildim, Re-,rulation% and Standar(" �f Construction Supervisor License License: CS 87851 MICHAEL R NORMAN I 63 PEASLEE CROSSING RD 4y NEWTON, NH 03858 �i Expiration: 912312013 ( mnmi .i ner Tr»: 3508 .4 AD ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ODIYYYY) 212612013 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 INSURANCE SOLUTIONS CORPORATION PO BOX 1079 ATKINSON, NH 03811 CONTACT NAME: PHONE A/C No GENERAL LIABILITY EMAIL ADDRESS; INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: LIBERTY MUTUALINSURANCE EACH OCCURRENCE $ DAMAGE 7 REN PREMISES Ea occurTEDrence $ INSURED DALE NORMAN INSURER B: 9 QUAKER STREET INSURER C: INSURER D: NEWTON NH 03858 INSURER E: CLAIMS -MADE FIOCCUR INSURER F: !1l1VC0Ar_CQ f`CRTICICATE IdItMRER• 49ao0Q19 REVISION NUMBER: vTHIS,'IS_TO CERTIFY THAT THE POLICIES OF INSOftANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORT 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 ADDL SUBR POLICY NUMBER MMIDIDYtt'EYY�Y MMIDDY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE 7 REN PREMISES Ea occurTEDrence $ COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ CLAIMS -MADE FIOCCUR PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ V $ POLICY PRO LOC ECjANY AUTOMOBILE LIABILITY Ea acddeDtSINGLE LIMIT $ BODILY INJURY (Per person) $ AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ S UMBRELLALIAB EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR HOCCUR CLAIMS -MADE DED RETENTIONS $ $ $ A _ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PJ3. PRIFTOR[PARTNER/EXECUTIVE Y f N OFFICERIMEMBEREXCLUDED? ❑Y (Mandatory in NH) N/A _ __ WC5-31S-375921-013 _ 1/19/2013 1/19/2014 - - - o STATU- OET�I- TOR LIMITS .E.L. EACH.P.CCIDENT -.- - - - $ - 'I DD000 E.L. DISEASE- EA EMPLOYEE $ 100000 E.L. DISEASE- POLICY LIMIT $ 5000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR DALE NORMAN Workers compensation insurance coverage applies only to the workers compensation laws of the state MA. CERTIFICATE HOLDER CANCELLATION NORMAN PROPERTIES .63 PEASLEE CROSSING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NEWTON NH 03858 AUTHORIZED REPRESENTATIVE Jeff Eldridge O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD am No.: ltssatz33s Deb Derochemon[ 2/26//2013 4y8g0$,a areviousl issued certificates. 1S Cer 1 lcate cancels an SU erse eS Y