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Home My WebLink AboutBuilding Permit #216-15 - 64 CAMPION ROAD 8/28/2014 (2) i 1< Q� �l BUILDING PERMIT «``�. ` °'.'.• °nz TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMIN PON a Permit N0: 19j)( Date Received Date Issued: _._ IMPORTANT:Applicant must complete all items on this page LOCATION &-AXA-Pt K) R00 P. PROPERTY OWNER C l tf;�l t Prin MAP NO:( „PARCEL ZONING DISTRICT: Historic District ye no Machine Shap Village y no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑k1teration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well 0 Floodplain 0 Wetlands ❑ Watershed District ❑Water/Sewer I CW ffA Won IC4- Z& �0 d0nQ*e- Identification Please Type or Print Clearly) OWNER: Name: T-H 1 Phone: q aq(0- Address: u 1O CONTRACTOR Name: ne: � i Address: ��_((}} ��tt //��kk Wq P-5w duet V 1 Supervisor's Construction License: �_ --� ' Date: ,d° 1. o Home Improvement License: — --� Exp. Date: (40 31 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: $ ( 5T0 FEE: $ Check No.: 041100_ Receipt No.: k. NOTE: Persons contracting with unregistered contractors do not have access to the anty fund - ignature of Agent/Owner Signature of contractor __„_ ---- 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 i DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) 4-, 6e M 11 Notified for pickup Call Email Date Time Contact Name 3 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H:I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) L3 Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include.Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of s E : ., ndover 0 j- _n No. .Ilk* Doh ver, Mass, coc NICHT WICK SR�TEO PX' '(5 U BOARD OF HEALTH Food/Kitchen PERMI.T T LD Septic System THIS CERTIFIES THAT ........ orl.k.1. 1^„�................... .... BUILDING INSPECTOR . ........ ........... .. ...... . .................... Foundation has permission to erect .......................... buildings on ...0 . ....... Iw ....1 ......... • Rough to be occupied as .... .......... . .......rshall . . . ..Q.'. ..1......... �lh!!'! !... 1.'.�':' r........... Chimney �� '�...... e provided that the person accepting this perm in a ery respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONT S ELECTRICAL INSPECTOR a` UNLESS CONSTRUCTI S TS Rough Service ............... .. .... ... ................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and `Approved by the Building Inspector. Burner Street No. Smoke Det. FAIRWAY10 o o 00000000 000��oC� o � Vinyl Systems www.fairwayvinyl.com Description Unit Qty o A-RAIL OPTIONS 900058 White 2"x 3-1/2"x 16'Vinyl Sleeve 132 { 900062 White 2"x 6"x 16'Vinyl Sleeve 77 900088 White 2"x8"x 16'Vinyl Sleeve 55 --- E no B- FLAT CAP OPTIONS for"A"Rails 900246 White 2"x 3-1/2"Flat Cap 56 a. 900250 White 2"x 6"Flat Cap 110 900256 White 2"x 8"Flat Cap 240 C- SCALLOPED PERGOLA CAP OPTIONS for"A" Rails 900295 White 2"x 3-1/2"Pergola Cap 24 900296 White 2"x 6"Pergola Cap 24 (DZ� 900297 White 2"x 8"Pergola Cap 12 D- MOUNTING CLIPS for"A"Rails \\ 900298 White 2"Pergola Rail Clip 150 a E- SLATS 900332 1-3/8"x 1-3/8"x 16'Vinyl Picket 224 „ F- SLAT END CAPS for"E"Slats G \ 900344 1-3/8"Pyramid Cap 200 j G- VERTICAL SUPPORT OPTIONS 401010A White 4"x4"x 108"Post Sleeve(bagged) 40 900026 White 5"x 5"x 108"Post Sleeve(bagged) 40 ____.____.___._____............................_..........._____._.____.....__...._. 407040 White 6-1/2"x 6-1/2"x 108"Post Sleeve(bagged) 28 400203A 4"Square Porch Post 60 400215A 5"Square Porch Post 40 Ask About White Vinyl Round Column Options H- POST CAP OPTIONS for"G"Vertical Support " 901203 White 4"External Pyramid Cap 80 901201 White 5"External Pyramid Cap 70 900308 White 6-1/2"External Pyramid Cap 30 Ask About Other Stylish Vinyl Cap Options VINYL ADHESIVE 401087 White Vinyl Adhesive 1.5 oz ACCESSORIES FOR CUSTOM MODIFICATIONS E ' 901238 White 4"to 5"Transition Adapter 16 t , 901232 White 4"Decorative Knuckle 24 901236 White 4"Decorative Knuckle with Spacer 8 901234 White 5"Decorative Knuckle 18 { 7-7/8" 200mm O 10-3/8" 263.5mm it I 108" 7-3/4" 2,743mm 196.9mm i i I fft- e8"x 9'Straight Vinyl Round Column is Ne popedyAIRWAY VINYL SYSTEMS yolNisdraMWayMberurranrnlnnd—mages=fanedWUm—y P.O.Box 37 Mount Joy,Pa 17552 A dinpubli fwiomar er,PPRC400120PI I • • • • • • - • •• 1 '• • • • en wnsenlWFainvey Vnyf Sys[ems. u ynwbems are. I of I 'F7`" 7-25-08 8/25/2014° PERGOLA((Fairway Building Products Fan-way Building Products Search... ii L_.,i ® ® to N ® _ FAIR'VAY&RAILING Fx?RAILING LINDMARKI:WULING RAILING COMPONENTS VINYLFENCE BU\'FAIRWAY8 I I I PERGOLA Home—>RAILING COMPONENTS PERGOLA 3, t+ ,��N. i ��#�• 'i" uxu ti';+amu.. a��9�smwwaum� ,� '.iro', A � m+ ��'�� >isl+arex �im"��Sxaw:.•,;aatiw 31 VINYL PERGOLACOMPONENT Y TEM All The Low Maintenance components to Create any Pergola system you can dream UP A • 16' VINYL SLEEVE - Sleeve over Pressure Treated Lumber! 2" x 3-1/2" • 2" x 6" • 2" x 8" B • Flat end Cap for Sleeves 2" x 3-1/2" • 2" x 6" • 2" x 8" C • Scalloped Cap for Sleeves http://fai rwaybp.comlrai l i ng-components/pergola/ 1/4 8/25/201+ PERGOLA«Fairway Building Products 2" x 3- 1/2 . 2" x 6" • 2" x 8" D • 2" Mounting Clips Keep Sleeves Secure E • 1- 3/8" Slats 1- 3/8" x 1-3/8" x 16' Vinyl Slat F • Pyramid End Cap for Slats 1-3/8" Pyramid Cap G • 5/8" Vinyl Plug i Conceal Recessed Hardware Heads H • Rail mounts 2" x 3-1/2" • 2" x 8" 4 S s ^ ' i 1t t i I� I t I I http://fairwaybp.conVraiIing-components/pergola/ 2/4 8/25/201 PERGOLA<(Fairway Building Products I I i D E f { F 3 i H i I ALL PRODUCTS • New Products • Fairwayt Vinyl.Railing • FY—) Composite Railing • LandMarke Vinyl Railing • LED LV Railing Lighting • Porch Posts&Cokirnns • Post Sleeves&Wraps • Vbyl Fence • The DeckMate • Railing Accessories i PRODUCT SUPPORT • Installation Guides • Product Specs • WaiTanty LITERATURE • FAIRWAYO List Price Book • Product Highhlight Book • Brochures • FanwayE Cleannig&Care • MSDS SALES SUPPORT • Architect • AIA CES Trainer • Sales SURnort Progam CONTACT FAIRWAY • Contact Us • Request Product InfoiTnation • Feedback i http://fairvvaybp.com/railing-components/pergola/ 3/4 q c� CE RTIFICATE OF LIABILITY INSURANCE "°°^ Tm CERTIFICATE IS ISSUED ASA MATTER OF INTION ONLY AND 2/14/2014 0 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIIMIATIVELY OR NEGATIVELY AMEND, EXTEND OR NFEALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW lM9'IM�SENTATFFE OR PRODUCER,AND THE CERTIFICATE HOLIER. ETWEEN THE ISSUING INSURE R(S), AUTHORIZED I ORTANT: ff the 00100816holder is an ADDRIONAL MIRED the the farms and conditions of the Policy,certain policies m P�IcY( )must be endorsed. ff SUBROGATION IS WANED,subject to oertlfleMe holder In lieu of such aY require an endorsement. A statement on this certificate does not confer rights to the PRODUCER gift Mackintire Insurance Agency IncI- ' Kelissa Pflug 11 West maim Street PHONE EL-008)366-6161 FAX .(508)366-S202 pams:melissapftackintire. Tieatborough DIA 01581-1931 INS AFFORDING00VERAGE NAIcs t n UMPEMA:Selective Ins. CO. of America 2572 ML Restoration Inc. INSURERBARockhill Insurance Co 69 Fisher Street INSURERC. INSURER D IIIA 01581 tNsuRER E: WSURER F CERTIFICATE NIMABER:14 - 15 Master REVISION NUMBER: TOC FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY Y BE ISSUED OR MAY PERTAIN,AI TERM RNCE AFFORDED BY ON OF ANYHE POLICIES DESCRIBED HEREINTRACT OR OTHER DOCUMENT SUBJECT TO ALL THEWITH RESPECT To TERMS, CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER Eff POLICY EXP L LIMITS_ 3C COMMERCIAL GENERAL L1ASLITy EACH OCCURRENCE $ 1,000,00 LAGE A E ®oL�CUR 1968123 /1/2ola /1/2o1s $ 100,000 ^ate EXP WAny«m Wm $ 10,000 PERSONAL&ADV INJURY $ 11000,000 GENT AGATE Larry APPLIES PER: GENERAL AGGREGATE $ 3,000,00o XPOLICY PRODUCTS-COMP/OPAGG $ 3,000,000 LOC AOrONOBIL9 LMBBJIY $ NED M ANY AUTO A1 000 000 r—IBODILY INJURY(Per Peron) $ gAUU11pgOD x AlTOSin 9096607 /1/2014 HIRED AUTOS /1/2015 BODILY INJURY(Per w*" $ PROPERTY DAMAGE $ X LIANNELLA NA5 $ OCCUR PtP-ease $ 81000 A EXCIIIII8 LIAR cLAIAA$/RADE EACH OCCURRENCE $ 11000,000 AGGREGATE $ 11000,000 A CO ATr)NN 1968123 /1/2014 /1/2015 $ AND BNN&MW LLML fY Y!N X IMS C STATU �fH ANY IRTINERIE)MORM O we EXCLUDED? N/A E.L.EACH ACCIDENT $ 11000.000 7939780 /1/2014 /1/2015 EL.DISEASE-EA EMPLO $ 1 000 000 OF OPERATIONS below E L.DISEASE-POLICYuMrr $ 1 000 000 H. am Pollution Liability (CPL) 003568 1/1/2013 1/1/2014 Claims Kads PER udcIDENT uMrr $1,000,000 DEDUCTIBLE $51,0001 oeacwvrroN of oP�AaDr18!LocATIONs!vEHia eAelaa+ACORD IDI,Aadaoml Raft Schedule,it more ap_is reqs i moum CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - AUTHOMNED REPRESENrarnE William Wence/NARIM ACORD 25(20104M m 198&2010 ACORD CORPORATION. All rights reserved.. 1100�� The ACORD name and.logo are registered marks of ACORD .I Casia�aasaapnn i,ggW dW`HE)nO8081S3M 13381S a3HSl3 69 NOSNHOf MVIN NOI1t2l01S321'`d'W 0ge�od OO alenud 9 Zf#f£= :uol;eild :ad�(1 LL88 1 :uol;eilsOe H013"INOO 1N3W3A01ldW13 W j n014aln2ag ssanlsng v �oxuru awnsuo)o aaujo Massachusetts-Department of Public Safety Board of Building Regulations and Standards jConstruction Supervisor µ _ License: CS-067612 :t.c r.ti MARK A JOHNS9N I � 69 Tuber Street � • Westberoagb MAF 6 Expiration 1 Commissioner I I j i j i • i M.A.Restoration Inc. 69 Fisher Street Westborough,MA 01581 (508)366-4104 Mass.License Number.##067612—Mark A.Johnson Home Improvement Contractor Registration #158877—M.A. Restoration Inc./Mark A.Johnson Proposal This proposal,upon acceptance,shall become a binding agreement between M.A. Restoration Inc.("the contractor") and the undersigned homeowner(s). As a home improvement contract,this agreement is governed by Massachusetts General Laws,Chapter 142A. The homeowner is referred to that statute for a list of rights,responsibilities,and remedies under applicable law. THE HOMEOWNER(S)SHOULD NOTE THAT THIS CONTRACT CONTAINS AN AGREEMENT TO ARBITRATE ANY AND ALL DISPUTES ARISING FROM THIS CONTRACT. Date of this contract 8/6/2014 Date work is to commence Week of 8/25/2014 Date when work is to be substantially completed(barring circumstances beyond the contractor's control) Week of 9/22/2014 Contractor's full name M.A.RESTORATION INC Contractor's street address G9 Fisher St. Westborougly�MA 01581 Contractor's registration number Expiration Date: 158877 Mark Johnson March 11 2016 NOTE: ALL HOME IMPROVEMENT CONTRACTORS AND SUBCONTRACTORS ARE REQUIRED TO.REGISTER WITH THE DIRECTOR OF THE BOARD OF BUILDING REGULATIONS AND STANDARDS. ANY INQUIRIES ABOUT A CONTRACTOR OR SUBCONTRACTOR RELATING TO A REGISTRATION SHOULD BE DIRECTED TO THE DIRECTOR. Detailed description of work to be performed&materials to be used(attach additional sheets if necessary): SEE ESTIMATE ATTACHED HERE TO AND INCLUDING HERE IN BY REFERENCE EXPRESS.WARRANTIES,GUARANTEES,AND DISCLAIMER OF IMPLIED WARRANTIES Except as expressly warranted herein,the contractor,to the extent permitted by law,hereby disclaims all warranties, including,but not limited to,any implied warranty of merchantability or fitness for a particular purpose. Any express warranty offered by the contractor is in lieu of and not in addition to any other warranty,whether express or implied,and such express warranty shall be limited to replacement of.defe4etive-wateriels;4t-shall-act-cflver-any- special or consequential damages. A copy of any and all such warranties must be attached to this contract. BUILDING PERMITS The contractor shall obtain all necessary building permits except as described below(attach additional sheets if necessary). NOTE: OWNERS WHO SECURE THEIR OWN PERMITS WILL BE EXCLUDED FROM THE GUARANTY FUND PROVISIONS OF MGL CHAPTER 142A. Homeowners Name,Address&Phone Number: Greg Titteri Won 64 Champion Road N.Andover,MA 01645 Phone:97$-296-6202 Address where work is to commence: Same i j i TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE Total price for all labor and materials for this job,including all finance charges.if any:S17.553.50 I Payment schedule: Under Massachusetts law,the deposit required cannot exceed 1/3 of the total contract price unless said deposit is for the actual cost of special equipment or custom made material which must be contract ordered in advance of the commencement of work in order to meet the completion schedule. Progress payments may be due on specific dates,or upon completion of a specified portion of the job. Payments Type Amount When Due Deposit $5,718.73 At sign of contract deductible& insurance check. Progress Payment $6,000.00 At start of job or as released by insurance company. Final Payment $5,834.77 Balance due upon.completion of work or as released by insurance Com an . Attach schedule of payments if more than three progress payments will be required. The law prohibits demanding full payment until the contract is completed to both parries'satisfaction. AGREEMENT TO ARBITRATE; EXCLUSIVE REMEDY The parties hereby agree that any and all disputes arising out of this contract which they are unable to resolve themselves shall be resolved'6y binding arbitration in accordance with the appropriate provisions of Massachusetts General Laws Ch. 142A. The parties expressly declare their intent and hereby agree to be bound by the decision of the.arbitrator. The parties expressly declare their intent and hereby agree that arbitration shall be the sole means of resolving such disputes,and that neither of them shall institute legal proceedings against the other regarding any disputes arising from this contract without first obtaining a decision from the assigned arbitrator. They also agree that the arbitration fee shall be borne equally between them,but that each party shall bear his own expenses to prepare for arbitration. ARBITRATION VENUE;SELECTION ON ARBITRATOR Said arbitration shall be conducted in the Greater Boston area unless the parties by mutual written agreement designate another venue. The arbitrator shall be selected according to the rules or guidelines of the American Arbitration Association which administers the Home Improvement Contractor Arbitration Program. Said rules and guidelines are incorporated herein by reference except as such rules or guidelines conflict with this contract,or with additions or modifications hereto,or with subsequent contracts for additional work at the same job site which reference this contract,if said work is to be started within sixty days of the completion of the work specified in this contract. SUFFICIENCY OF NOTICE All notices required for initiating,conducting,and/or enforcing the arbitration,or required or deemed expedient for any other purpose arising from this contract,shall be sufficient if timely mailed,postage prepaid via first class mail or better,to the homeowner at the job site or such other address as the homeowner has designated in this space N/A and to the contractor'at the address printed on the first page of this contract. DATE OF HEARING;DISCOVERY;EVIDENCE;FAILURE TO ATTEND The parties shall attempt to set a date for the arbitration which is satisfactory to both of them and to the arbitrator. In the,event that the parties are unable to agree upon a satisfactory date by mutual written consent,the arbitrator shall have the discretion to set the date of the arbitration hearing. Each party is entitled to submit relevant written or recorded evidence or other relevant information in addition to relevant witness testimony at the arbitration hearing. Thom shall be no formal discovery,but the contractor shall be entitled to reasonable access to the job site as necessary to prepare for arbitration. The failure of either party to attend the arbitration hearing will not invalidate the i arbitrator's decision;the decision shall be binding on each party regardless of whether or not that party appeared at the hearing or presented any evidence at the hearing,provided the party had appropriate notice of the hearing as stated in the preceding paragraph. A breach of the agreement to arbitrate shall be deemed a material breach of this contract regardless of the amount of harm.suffered or damages incurred as a result of said breach. ENFORCING THE ARBITRATION DECISION;CONSENT TO JURISDICTION;COSTS The arbitrator shall issue a written decision and mail a copy of that decision to each party within twenty-one days of the arbitration hearing. Should either party find it necessary to have a court of competent jurisdiction confirm the arbitration decision,the party failing to comply with the arbitration decision shall be liable and responsible for all damages and expenses proximately caused by his failure,including.but not limited to,interest,attorney's fees,court costs,and litigation expenses. The parties hereby consent to the jurisdiction of any court within the Commonwealth of Massachusetts his co petent to exercise jurisdiction over this subject matter. We hereby the p ions above regarding arbitration of any disputes arising under this contract. Greg Titte gt date Mark A.J son date i i i [REQUIRED DISCLOSURES MGL ch 142Aj DISCLOSURE OF HOMEOWNER RIGHTS A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection Iaws may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a timely and workmanlike manner. Homeowners may be entitled to specific other legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree, including,but not limited to,a mutual agreement to arbitrate disputes,may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. Furthermore,Massachusetts General Laws ch.93 sec.48,ch.255D sec. 14 and ch. 140D sec. 10 give you the right to cancel certain contracts within three business days. If you choose to exercise this right,follow the instructions on the attached"NOTICE OF CANCELLATION"which is incorporated by reference as a part of this contract. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical originals of this contract must be completed and signed,one to be retained by the contractor and one _ T to be retained by the homeo r(s). 41 g/- Greg Titterm date P 6 Mark A.Jo n date Y M.A.Restoration Inc. 69 Fisher St Westboro,MA 01581 I.I.C.R.C.&A.D.I.Certified Insured P 508-366-2669 Lic.#067612 Reg.# 158877 F 508-366-4106 2014-07-07-1003 Main Level DESCRIPTION 1. Haul debris-per pickup truck load-including dump fees QTY 2. Taxes,insurance,permits&fees(Bid item) 1.00 EA 3'. Two ladders with jacks and plank(per day) 1.00 EA 4. R&R Siding-beveled-cedar(clapboard) 2.00 DA Damaged from falling pergola. 40.00 SF 5. Siding Installer-per hour Make up time to cut back and tooth in damaged siding. 4'00 HR 6. Clean siding-wood 7. Seal&paint wood siding 1,100.00 SF 8. Caulking-silicone 1,100.00 SF 9. R&R Pergola-Pre-manufactured Kit-Vinyl 100.00 LF 10. (Material Only)2"x 8"hunber-treated(1.33 BF per LF) 252.00 SF Supports for structural pcs of kit. 72.00 LF 11. (Material Only)2"x 6"lumber(1 BF per LF) 240.00 LF Supports for structural pcs of kit. 12. Base anchors and fasteners needed for site specific installation. 13. Exterior Structure Installer-per hour l.00 EA Labor to rework fastening system to work with existing patio.Install supports in sleeves and fasten to house. 32.00 HR 14. Heat,Vent,&Air Conditioning(Bid Item) 1.00 EA AC unit was dented It is unclear if we can get another housing or if we need to replace the unit.We will provide an estimate for the work needed when we receive it. Grand Total 17,553.50 Mark Jo hnso i I 2014-07-07-1003 8!6/2014 Page: 2 1 r r � c 0 � t t . - a t.4 t. a m w .y Thank you, Kimberlee Stone M.A. Restoration Inc. www.marestoration.com Bus: 508-366-4104 Fax:508-366-4106 We're on facebook! Like Us: hqp://www.facebook.com/pages/Northborough-MA/MA-Restoration- Inc/100714566649166 4 IV � .,a V z y,4 �j? i �..-, `� �� ;� , �` � �� .. -�� i {, y '�' iti �I'ji ��,�, �, �=� ij �~ �., s � �� z �., .;�F., �" �_ N � � � �� { ' %�= -a^�iir� t lr I i� �,� 5 �� 7 ��, ��, I� ', i r= "'� _. _.. I • f Deems, Maura • From: Kim Stone <kim@marestoration.com> Sent: Friday, August 22, 201411:03 AM To: Deems, Maura Subject: pergola pics, 64 Campoin Road. i The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations ' I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): M H �i2 -t�Cv�Gv) I I c Address: \Oq 5�� r11 City/State/Zip: M R Phone #: "` O- u 0` Are ou an employer?Check thea opriate box: Type of project(required): 1. Are am a employer with _ 4. ❑ I am a general contractor and I * have hired the sub-contractors 6 ❑New construction employees(full and/or part-time). ! listed on the attached sheet. 7. ❑ Remodeling 2.E, I am a sole proprietor or partner- i ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P n'• 9. E] Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. F-] We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.EJ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.] c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other f comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. f 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. pp��-IL I Insurance Company Name: k;H f r A ( — Policy#or Self-ins.Lic.#: ' —t C —I Expiration Date: '^l I N ��Q q,5 Job Site Address: �/`� I�� 1 V. U11l.�ity/State/Zip: I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certif u er t e Rains and penalties of perjury that the information provided above 's true and correct. Signature: — -- ------- --- _____ ___-___ ___. Date: Phone#: 509 -AID- y IC H 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#: