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Home My WebLink AboutBuilding Permit #457 - 65 MEADOWOOD ROAD 4/10/2013Permit N0: Date Issued -4-P-0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 4 10 1 ( -� /IMPORTANT: Applicant must complete all items on this page LOCATION. 66" mEAt?oW-rAD_ Print PROPERTY OWNER MAJ� 1 to! D Un1 t_6A f Print; 100`. -ear-Old structure PARCEL: f ZONL,NG DISTRICT: Historic District+ MAPNO: , _ � al �� _ r Y Machine. Stop Villa __yesno: yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building N One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ W61F 0 Floodplain ❑ Wetlands: ❑ Watershed,District .. _ ij Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: �&Avve d- .2 X i o CIL PL -141-e r\��aYt kXls f4GSu01CR QtQt.Ac,� �J NI Iy W Identification Please Type or Print Clearly) OWNER: Name: M j_)d bVWL-EA Phone: A(lriracc• 7 CONTRACTOR Name Address: 3 GED N rF - Nr xis DkIVIE,� , IS ^ c 7 - )-03 -D a_�J2da�,JP,hone: �g - �65 A MA '51.°lZ 3 Supervisor's Construction License: CS �' 07 39g l Exp. Date: 0 4 Home Improvement License: - 12,911"74 p.Date:. _1lei- 13 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: $ Gg `�,- Check No.: Zion Receipt No.: �4®p' NOTE: Persons contracting with unregistered contractors do not have access to ityla. guar and Signature of Agent/Qvvner Signature of contractor'_ :__9.1_______-- ss�__.__s._._ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application Li Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract u 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 u Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/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) o Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract u Mass check Energy Compliance Report Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Bui!ding Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ElTanning/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 COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ CONSERVATION Reviewed on Siqnature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Com Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW 'g owp- ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMIE-Nit Temp Dumpster on site yes no Located at'U4.Mein'Street_ Fire Departmer'it-signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No, MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (for department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of fleeter 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 t E Doe.Building Permit Revised 2010 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools -• D• . 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 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 Com Water & Sewer C®nnection/Signature & Date Driveway Permit DPW Tows Engineer: Sign FIRE DEPARTM�-NT Temp Dumpster on site yes Located at'124 MainStreet Fire Deparftinen"t signature/date COMMENTS Located 384 Osgood Street no Building Department The foliowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm;tted with the building application Doc: Doc.Bui!ding Permit Revised 2012 Permit Date I LOCATI O. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION / Date Received " I 1 WgILZ IMPORTANT: Applicant must complete all items on this 5 MEADow'za D oAb Pant: PROPERTY OWNER MAR I t4 L6A tt Print, 100 Year 01d'Structure yes no, . MAP N,O: �PARCEL:.6I ZONING DISTRICT: Historic District yes no Machine Shop Village yes. 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 ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑.Floodplain ❑ Wetlands: ❑ Watershed'0istrict -. El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: � >+ rJ-- °�► o �� 2 x D Crit_ PLA7G i EHBYt XIS 1'F�{�r SLID{Q RtPI..,oc,� Wli 4 IVitW Identification Please Type or Print Clearly) OWNER: Name: MW) -)r/ b%4L-EA Phone: CONTRACTOR- Name:._ W p"Nr xis Address: 23 i s1�9G Plione: 79 i 61 " 203 D — Supervisor's Construction License.: C5 "' a7 3 gel IExp: Date: O 4 -- 0'7 ! Home Improvement License: 2,9 Exp. -Date:: 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.: 67/4-5- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t guar and Signature of Agent/Owner s _ �_w Signature of contractor. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Location�/� ��1t�f/f'1�m&y /CLQ 40 No Date / Check 26268 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations vy 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): GED VfH 11 6 "" f�Fx us Cor" (lLW1 for✓ Address: 23 GLE-0,q ct 'PJdt City/State/Zip: Dn1YiEKs. MA O 1� 23 Phone #: _JS J P -760— 2030 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2E I am 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. ❑ 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. E] Plumbing repairs or additions 12 E] Roof repairs 13. Other CIu REPAIR *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they ace 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 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 certify ynder AelaM13�n enalties ofperjury that the information provided above is true and correct. Phone #: —781— 7 6 O 2 o 3 o 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. PIumbing Inspector 6. Other - - Contact Person: Phone #: 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-contractor(s) 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' 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 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 TO, # 617-727-4900 ext 406 or 1-877,7MASS.AFE Revised 5-26-05 Faze # 617-727-7749 'S'S'wwmass,govfdia 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. De advised that this affidavit maybe 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' 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 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 600 Washington Street Boston, MA 02111 TO, # 617-727-4900 ext 406 or 1-877.7MASSAFB Revised 5-26-05 Fax # 617-727-7749 www-mass.govkdia The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, MA 02111 VV www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): G617 H tl 6 "- NFX US C-pr4 IYZVC t tor/ Address: 23 Gc.c.,oAcF_ .UAivt City/State/Zip: DA4 ViEgs. MA O 1823 Phone #: -IS, — %6 O r 203o Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. # ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp, insurance t c. 152, § 1(4), and we have no employees. [No workers' 12. ❑ Roof repairs REPA/JZ required.] 13. Other CAL comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 Name; 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 77�= of perjury that the information provided above is true and correct. e Date: 4 ' 1,E) / 3 Si afar . Phone#: -7s/— 76o — 2 o30 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 #: PC d u4i J W = LL Q 0 m N L'A O LL v Q Ln s d Z Z D m C O 41U cu Ctxo 7 Ll- p Eto u _ (6 iT cc O d Z Z C DW i -C 7 p w Cp LL cc 0 d Z J V b W L bo 7 U 2 co C ~ a N Z N Q L to 7 t9 CLn WC G Q W C W LL N C i Z N v Y 0 Ln Q,Q vj J: c aca .r+ y 0.1 �' Q (� L4- U) 4y d o __ m o U) �... — 'a � Vi; -ca 0 32 y+ t . O o z CL =o �0 -> o �- c o CL Q" CD CC%r V 0 C � - O � .y • r � V O 47; C raw F- O y CD m 0 2 m co W_ C 'a O O LL 'y 2Dujc N C y O � w v m o� C5 Cl) 0. 0 >- U) = O4 c 0 FM o LU U) z L m Cl) r C) Cl) Z U c Lu CLL '^ XUJ 0 v� Cl) az cz 0 E O O d Z N O = CD to 01- E .- E m m Q s t � � t• � . O �+ > U D L- 0 0C a Q 0 Q o s c bla V J .CL 10 +� r Z 0 CL V Vi Q. Ch ul D LLI W W 19 W C O O r - o CDa c o.2 rn V E Q r IV y d N .0 O Q,Q vj J: c aca .r+ y 0.1 �' Q (� L4- U) 4y d o __ m o U) �... — 'a � Vi; -ca 0 32 y+ t . O o z CL =o �0 -> o �- c o CL Q" CD CC%r V 0 C � - O � .y • r � V O 47; C raw F- O y CD m 0 2 m co W_ C 'a O O LL 'y 2Dujc N C y O � w v m o� C5 Cl) 0. 0 >- U) = O4 c 0 FM o LU U) z L m Cl) r C) Cl) Z U c Lu CLL '^ XUJ 0 v� Cl) az cz 0 E O O d Z N O = CD to 01- E .- E m m Q s t � � t• � . O �+ > U D L- 0 0C a Q 0 Q o s c bla V J .CL 10 +� r Z 0 CL V Vi Q. Ch ul D LLI W W 19 W ® A� v CERTIFICATE OF LIABILITY INSURANCE YI'Y DATE (MMIDDIY) 8/13/2012 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 -Peabody CONTACT Lauren Goldman NAMECross PHONE . (978)532-5445 F No): (978)532-2217 nDnResS:lgoldman@crossagency.com 139 Lynnfield Street INSURER(S) AFFORDING COVERAGE NAIC # INSURER Western World Ins. Co. Peabody MA 01960 INSURED INSURERB:Safety Indemnity 33618 INSURERCNational Grange Ins Co Nexus II Services LLC INSURER D: P.O. Box 2823 INSURER E: INSURERF: Woburn MA 01888 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 I LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FIOCCUR NPP8113510 8/12/2012 8/12/2013 EACH OCCURRENCE S 1,000,000 DAMAGE T RENTED PREMISES Ea occurrence S MED EXP (Any one person) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG S 1,000,000 S EOa am eDISINGLE LIMIT S LICY PRO ,IFCTLOC AU TOM ILE LIABILITY BODILY INJURY (Per person) S 250,000 B A UTO ALL [XX] SCHEDULED XDAMAGE X AUTOS NON -OWNED AUTOS HIRED AUTOS AUTOS 116632 1/10/2011 1/10/2012 BODILYINJURY(Peraccident) S 500 000 Perraccident $ 100 000 Medical payments S 5,000 UMBRELLA LIABOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE S DED RETENTIONS STATU- OTH- WCLIM WORKERS COMPENSATION TOR ER E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE E.L. DISEASE • EA EMPLOYE 5 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA if yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C 47109 /27/2012 /27/2013 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if morespace Is required) Refer to policy for exclusionary endorsements and special provisions. 113 For Insureds Purpose SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Tramonte/NIDI I+nnn nnnnno ATIAAI All AM,#c -MICH ACORD 25 (2010105) INS025 r7ninnsi nt The Ar`r1R11 nnmc nnrl Innn arc runictcrarl marlrc of At npn Massachusetts - Department of Public Safety Board of Building Regulations and Standards � onst; uction Supers isoi ! Q License: CS -073991 GERALD WHITE -- 23 GLENDALE DR ^ s DANVERS MA 61923 f Expiration Commissioner 04/07/2014 U uRe of Cb A a' '& smess bQ a HOIIft JM'PROVEM TCONTR+4G,1" egis rat+on X1,291 .1;.: ' , 0 iype: d Ex iiI on: 7]19[20,3' t k,gal - p Individual Ge a d White - r, ' t kCL'f 47`r 2 1 « -7 Gerald White `r ix 23141 ndale Dr n5 ` Danvers, MA 01923 Undersecretary -77 S i i i 4/9!13 Installation of Sliding Door Tue 4/3/20131:17 PM From: BMDunlea To: mark@nexuscarpentry.com Dear Building Inspector of North Andover, Inbox(5) - mAiscarpentrycorn - SmarterMai) I, James Martin Dunlea, being the owner of record at 65 Meadowood Road, North Andover MA 01845, can confirm that I have authorized Ged White of Nexus II Services (also DBA Nexus li Carpentry and Construction Design) to install a sliding door to my property. Thank you for your assistance with this matter. Regards, James Martin Dunlea 9-d £9Z[ 9L6 9L6 swimeS 11 snxeN d9b:60 £l 60 AV Page 1 of 5 Nexus II Carpentry and Construction Design P.O. Box 2823 Wobum, MA 01888 781 7602031 Fax 978 9751263 nexusca rpent rvna,,aol.com www.nexuscarpentrY.com CS # - 073991 HIC # 129177 Contract This is a contract between James Martin Dunlea of 65 Meadowood Road, North Andover, MA 01845 (Hereafter referred to as the "owners" or "owmer") and Nexus II Services (hereafter referred to as "Nexus") dated April 9th 2013. GENERAL SCOPE OF WORK DESCRIPTION WE HEREBY SUBMIT SPECIFICATIONS AND CONTRACT FOR: work as stated below Scope of work: General details Meet with local building official and apply for permits ♦ All work will be in accordance with local building code regulations and will be inspected by local officials prior to continuing with the next phase — Nexus will be responsible for arranging and being available for all inspections ♦ All work will be coordinated directly between "owners", architect if required and Nexus 4 Nexus confirms that it is licensed, insured as required and ensures any sub- contractors utilized on this site will have the appropriate insurance coverage ♦ Nexus will be responsible for the safe storage of all its property and any materials to be used on the site. Any items left on site will be covered under Nexus insurances ♦ Owner is responsible for removal and return where necessary of all items within the house and their safe storage prior to our work commencing SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT L -d £9ZL 9L6 9L6 swimeS 11 snxaN d9b:60 £L 60 adV V Page 2 of 5 ♦ Owner will then be responsible for returning all items to the home after completion 70f the scope of work • Nexus will remove all trash associated with this project into a Nexus supplied dumpster and arrange for safe disposal in to a registered site — if required • Nexus will contact Dig Safe" and confirm all utilities location — if required Scope of work Rear Slider replacement with trim repair; • Remove and trash the existing Trim and slider • Furnish and install new framing and sheathing, around door to accept new slider • Furnish and install new slider • Furnish and install new flashing details ♦ Furnish and install new hardware • Furnish and install new Azek trim to exterior • Install existing trim to interior The above quotation does not include the cost of any of the following and in some cases where stated allowances have been given to assist you in selection. If requested, we would be happy to provide any costs on items listed below, if not here stated; Permit costs, unseen conditions, and architect or engineering costs Painting or staining or prep work -- Electrical or plumbing work All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control owner to carry fire, tomado and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance PERMITS "Nexus" has accepted the responsibility to obtain the necessary building permits. "Nexus" will act as a GC and work in accordance with fair and reasonable practices, and cooperate fully and under the guidance of the "Owners" and authorized parties. Standard Exclusions: Unless specifically included in the "General Scope of work" section above, this agreement does not include labor or materials for the following work (any Exclusions in this paragraph which have been lined out and initialed by the parties do not apply to this Agreement): Removal and disposal of any materials containing asbestos or any other hazardous material as defined by the EPA. Custom milling of any wood for use in project. Moving "Owners" property around the site. Labor or materials required repairing or replacing any `Owners" -supplied materials. Repair of concealed underground utilities not located on prints or physically staked out by "Owners", which are damaged during construction. Surveying that may be required to establish accurate property boundaries for setback purposes (fences and old stakes may not be located on actual property lines). Final construction cleaning ("Nexus" will leave site in "broom swept" condition). Landscaping and irrigation work of any kind. Temporary sanitation, power, or fencing. Removal of soils under house in order to obtain 18 inches (or code -required height) of SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Z -d £9Z1, 9L6 9L6 seointsS 11 snxaN d9t,:60 Cl, 60 ady Page 3 of 5 clear space between bottom of joists and soil. Removal of filled ground or rock or any other materials not removable by ordinary hand tools (unless heavy equipment is specified in scope of work section above), correction of existing out -of -plumb or out -of -level conditions in existing structure. Correction of concealed substandard framing. Removal and replacement of existing rot or insect infestation. Construction of a continuously level foundation around structure (if lot is sloped more than 6 inches from front to back or side to side, "Nexus" step the foundation in accordance with the slope of the lot). Exact matching of existing finishes. Repair of damage to roadways, sidewalks, or driveways that could occur when construction equipment and vehicles are being used in the normal course of construction. The "Owner" is to enter into contracts for all of the above-mentioned services and provide direct payment to "plexus" for all of the services we are to provide. "Nexus" will be responsible for removing all components and all construction materials relevant to the "scope of work" in this contract. Dumpsters, trailers and signs "Nexus" will provide as included in the cost of this project, a dumpster for the sole purpose of the removal of trash associated with this project. This dumpster should not be used by any persons for any other waste items or for any purpose outside of the specific use under the scope of work, unless authorization is received from "Nexus". Nexus may have on site for part, or the whole of the project, a trailer containing materials and tools belonging to "Nexus". This trailer will be parked in a position agreed to in coordination with the "Owners" and will be covered under the insurances of "Nexus" at all times. "Nexus" will have on site, a sign, with our contact details, in the event that anyone, including your neighbors, has a need to contact us directly. Photographs "Nexus" reserves the right to, from time to time, take photographs of the contracted work for use in its general marketing or for production on its web site. At no time will "Nexus" share any personal contact details of the "owner" for any photographs that it may use without seeking authorization from the "owner". Warranties All the components supplied by "Nexus" as part of the original order are covered under the warranh, exercised by "Nexus" and supported by the vendors or sub -contractors. All labor and materials purchased from other suppliers to achieve completion of contract are warranted (1) one year from completion of the construction. Owner appointed sub contractors From time to time an "owner" may request that we incorporate a sub -contractor of the "owners" choosing on a project. "Nexus" will facilitate this request provided the assigned sub -contractor is connected directly with "Nexus" for all scheduling requirements and "nexus" will manage this sub -contractor in a fashion comparable with any other sub -contractor. All sub -contractors must be licensed and insured in accordance with State law. "Nexus" will meet with these sub -contractors and will ask them to submit a written proposal of all the work that will be included which "Nexus" will then confirm with the "owner". "Nexus" will oversee this scope of work and ensure that it is completed in a professional manner but the sub- contractor will be responsible for any future warranty issues directly with the "owners". All sub -contractors are responsible for the safe and clean upkeep of the working environment and will be responsible to remove their associated trash on a daily basis. Deliveries "Nexus" will be responsible for the safe arrival to site of all materials required for construction purposes for items contained within the scope of work. The `owners" shall be responsible for the safe arrival to site of other items outside of construction materials, however, should "owners" require "Nexus" to collect and bring to site, any of these items, "Nexus" will accommodate as able and add a minimal cost to cover time and fuel to a change order. Allowances with the contract cost Within the cost structure of this contract, certain cost allowances may have been given for the "owners" to purchase items chosen by them — these allowances will be noted above with the amount allowed clearly noted. If the "owners" do not spend the full allowance in an area, this amount will be credited back to the SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT £'d £9Z1. SM 9L6 seoimeS 11 snxeN d9b:60 Cl, 60 ady Page 4 of 5 customer and not included in the final contracted amount. If the "owners" spend beyond the allowance noted, then the "owners" shall be responsible for this balance and a payment made to cover this amount either to the vendor, the sub -contractor or to "Nexus" Expiration of this Agreement: This Agreement will expire 30 days after the date at the top of page one of this agreement if not accepted in writing by "Owners" and returned to "Nexus" along with the necessary deposits within that time frame. People Authorized to Sign Change Orders: The following people are authorized to sign Change Orders: . —4e -- "Nexus": Mad Gotobed or Ged White SEE ATTACHED EMAIL "Owner/Owners": James Martin Dunlea Concealed Conditions: This Agreement is based solely on the observations "Nexus" was able to make with the area in its current condition at the time this Agreement was bid. If additional Concealed Conditions are discovered once work has commenced which were not visible at the time this proposal was bid, "Nexus" will stop work and point out these unforeseen Concealed Conditions to "Owners" so that "Owners" and "Nexus" can execute a Change Order for any Additional Work. Changes in the Work: During the course of the project, "Owners" may order changes in the work (both additions and deletions). "Nexus' will determine the cost of these changes and the cost of this additional work will be added to "Nexus" profit and overhead. Schedule of work It is agreed by both parties that this work will be coordinated with the "Ovrners" and "Nexus" to be undertaken in various stages to avoid complete disruption of the home environment. "Nexus" will give "Owners" no less than 2 days notice prior to arriving on site for commencement of any of the agreed stages of work to allow "Owners" to prepare. "Owners" commits to have sites identified for construction work available for start at the beginning of the scheduled day so as to avoid any unnecessary delays. SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT b'd £9Z l 9L6 9L6 seoimeS 11 snxaN d9t,:60 £ l 60 add Page 5 of 5 Contract Cost and Payment Schedule• Total cost of work description and materials included in the Prol2osal exce t materials/work stated - $4,390.00 (Four thousand three hundred and ninety dollars and zero cents) PAYMENT SCHEDULE 1st Payment due upon signing this contract Final payment due upon completion of scope of work TOTAL $2, 390.00 TOTAL $2, 000.00 Amount due upon signing this contract is $2 390.00 [ have read and understand, and I agree to, all the terms and conditions contained in the proposal above. Date..' �� 3,,, „ "Nexus" Authorization. ........ .......... (�54 ..................................... Date .............................. :`Owner/Owners" Authorization................ AND/OR y Date.... :... (. �........... " `Owner; Owners" Authorization.......SEE ....... ATTACHED EMAIL ..................... SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT 9•d £9ZL 9L6 9L6 swimeS 11 snXeN d9b:60 £L 60 ady