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HomeMy WebLinkAboutBuilding Permit #929-16 - 66 PALOMINO DRIVE 5/1/2018 00 T, BUILDING PERMIT q"o I TOWN 4F NORTH ANDOVER J p APPLICATION FOR PLAN EXAMINAT! N Permit NO: Date Received / / •" �` Date Issued: ss�caust� IMPORTANT Applicant must co fete all items on this page 5 s,rpt o 0L✓I'1i0� J i qlY` C. � MQ�TIII�pa<�h W-�: •+ K 7.1 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑Two or more family ❑ Industrial teration No. of units: ❑ Commercial X,Repair, replacement ❑Assessory Bldg ❑ Others: Y .Demolition ❑Other el o,r�_yy��`" 0�f �t ••���l��ir,��i{ � �'yr,�t`,�E�f w r; x s }, y, t f y a Identification Please Type or Print Clearly) OWNER: Name: �c r-►� g 4o l/k Phone Address: 77 r{{��.jj�� /�a.'wxp ; W VR \i/ 4'R e 1 t1•�l l f 5:. s+ , i R SS A f j i T N IRA ns-t r", Qnstt r 64,_JCe.•seg r y.'ygat,� a Y ✓ LtcettSe "v.' 1 f y ` '-Da . r a1 r. i j r . i ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULD/NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 13 g 3 P) v 7 FEE: $ 214 �- Check No.: _ �/el,5`t;F Receipt No.: �J6 0 6 6 NOTE: Persons con tr with unregistered contractors do not have access to the guaranty fund Bt ria# r ® A ; g::.. rltfQwtie . Srgna#ur ,of`con#qac#4r r t NORTH, BUILDING PERMIT *",LED 16"ro TOWN OF NORTH ANDOVER ` APPLICATION FOR PLAN EXAMINATION * _ Date Received �RA°RAreD ^y Permit No#: q CH Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family j ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other >]a:Septie Well ❑ Floodplain --D-Wetlands ❑ 1Natershed District. Water/Sewer ' :s E h�• DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: i Address: I Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. 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 Si ature of Agent/Owner Signature of .on tactor _ Plans Subrnitted'�] 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature'— i COMMENTS i I I CONSERVATION Reviewed on Signature j COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments r Conservation Decision: Comments J Water& Sewer Connection/signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street RE R IMENTrT;ern_ D�umpster�onsite : yes ;:.. r . ELo`cated'at124iMai Fine DeparitmeintsignatureLdate# 'COMME�.N,,TS �. , F 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.$1oo-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doe.Building Permit Revised 2014 r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I Roofing, Siding, Interior Rehabilitation Permits Building Permit Application ;rA 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 OTE: 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 4. Workers Comp Affidavit � Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/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 . . OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application aCertified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code 4. Engineering Affidavits for Engineered products OTE: 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 Location 'v No. > i _ Date • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t Check# oe Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 321:838.00 m $ - $ 394.06 Plumbing Fee $ 49.26 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 49.26 Total fees collected $ 592.57 66 Palomino Drive 929-2016 on 3/1/2016 Bathroom remodel N0RT1y Town of 0 No. % h ver, Mass,0 LAKI /A , COCN1c"t WI[.l 7 RArED Joke s V BOARD OF HEALTH PE. RMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .... .�.�! � � .! BUILDING INSPECTOR ................................. Foundation has permission to erect .......................... buildings on ....................................... Rough C 6�— / . to be occupied as ..... .. C°�?:!..��.� k�..1.:(?. .. ... .. .? .... .................................................................. Chimney provided that the person accepting this permit shall in every 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 Reg"Ulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ........... ... r.Y.............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 WILLIAM POGOR as GENERAL CONTRACTOR Representing Hub City Builders, LLC MA CSL License No.083917 MA HIC License No.180234 Inquiries may be made to: Contractor Registration One Ashburton Place Boston,MA 02108 (617)727-8598 CONTRACT Customer: Jonathan&Michelle Hurtig 66 Palomino Drive North Andover,Ma 01845 Project Location: Same as above Nature of Work: X Design/Layout/Concept Bid Services,Permit Acquisitions X General Contracting Services This Contract relates to the above checked services Hub City Builders, LLC shall provide to Customer. The services being provided are spelled out in the next section. The Customer's Payment Schedule is provided for in the section following that. This is a written binding contract: Do not sign if there are any sections or spaces remaining blank, If the contract is not understood, please have it reviewed by an attorney of your own choice. Customer imivals Contractor Initials 1 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 Services to be performed: I. General Description of Work 1. PERMIT ACQUISITIONS 1.1. Building Permit. 1.2. Waste Removal Permit. (If required)as determined by Hub City Builders,LLC. 1.3. Electrical Permit. 1.4. Plumbing Permit. 1.5. Forms and Filings necessary. 1.6. Meetings On/Off-site as required. (Owners agent) 1.7. Pertaining to permits, any extra permits beyond the scope of this contract,if required,the financial burden shall be subsequent to this contract and shall be billed on a time and materials basis and stated in the change of work order. Note: Design Professionals or other professionals engaged for consultation, (energy envelope, Structural engineer,ect)if required,the financial burden shall be subsequent to this contract and shall be billed on a time and materials basis and stated in the change of work order. *NOTE: If applicable all working drawings were prepared as an instrument of services for the two fold purposes of making these designs available scrutiny (client services, design professionals and contractors) for the securing of construction material and trade bid costs for the project secured herein. Although they have fulfilled their purpose when such is accomplished, they are complete set of documents from which the project may be constructed provided they conform to all local and state building requirements. Since these drawings are artistic and conceptual in nature ALL DIMENSIONS SHOULD BE FIELD VERIFIED. At no time should these drawings be considered or mistaken as Architectural or Structurally Verified drawings unless the corresponding seals have been placed appropriately upon these documents by registered licensed professionals. I. CLIENT LOGISTICS Remove all items in the Entry, Hallway, 2"d floor master bedroom and master bath,to inter-house storage areas designate by client, (as needed). Note*Limited liability to use a"best care scenario'is expressed, and is not a replacement liability when moving Personal Affects or furniture. All personal affects of any value (jewelry,paintings, sculptures,ect.)should be removed to a secure environment by the owner project start date. No liability is expressed or implied. Gomm"hnitials contractor initials 2 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 2. Demolition 2.1. Remove flooring to sub-floor in master bath and master toilet area. 2.2. Remove exterior second floor master bathroom walls and flooring, (sheetrock for insulation and floor assessment).If water penetration has occurred in either walls or floor area due to either exterior or interior element/H2O penetration that is unforeseen by either the homeowner or contractor. A time and materials scenario will be used for separate billing and repair of this work to existing Massachusetts Building Code Levels. 2.3. Remove 2„d floor master bathroom,soaking tub,bath shower surround,toilet, minor,vanity drawers, vanity top,and all plumbing and electrical fixtures as needed to complete demolition as determined by Hub City Builders,LLC. 2.4. All Debri is to be removed off site or to an on site dumpster daily. 2.5. Remove and secure bathroom plumbing outlets(sanitary&feeds lines). 2.6.All demolition&disposal necessary to accommodate 2nd floor master bath remodeling,as needed,and determined by contractor.Hazardous waste removal as required by Federal, State or local authorities is based on separate disposal fees and not enclosed as a cost herein.All hazardous waste generated by normal house remodeling. (Note: lead based products/debris generated herein are designated Under 40 CFR 261.4(b)(1)house hold wastes)and not subject to special disposal conditions. 3. Framing 3.1. All framing necessary to accommodate second floor entrance bath remodeling. To include flooring to accommodate new plumbing fixtures, shower walls, shower surround and blocking. As needed,determined by Hub City Builders, LLC. 4. Plumbing Remove existing and re-plumb new Bath Tub (Giagni LH2 Hawthorne 60"Free Standing Soaking Tub Package -Includes Tub,Tub Feet, Floor Mounted Tub Filler Faucet,and Drain Assembly). 4.1. Remove existing and re-plumb new shower valve (Kohler K-T396-4-BN-K- 304-K-NA). 4.2. Install "KERDI-SHOWER KIT"by Schluter Systems 36 X 60"with one 16" wide seat. 43. Install shower drain,no extra body sprays. 4.4. Remove toilet and reinstall.(Toilet upgrade is cost plus of$500 approximately depending on unit requested by client). 4.5. Remove Sink Basins,faucets&vanity drawers and tops. 4.6. Vanity Faucet replacement allowance($250)per unit. 5. Finish Plumbing 5.1. Finish Trims- Install all finish surface trims guest bathroom and kitchen. �� (0 Customer Initials Contractor Initials 3 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 11.2. Install 10 X 12' (approximate floor area including water closet). Bianco Carrere marble 1"hexagonal tiles sheets,no patterns, with sanded grout(color match by client). $11/sgft(on-line order)allowance. 12. Walls 12.1.Bath walls and any wall tile areas will have '/2" cement board installed as sub- wall area, with fiberglass tape at all seams and corners covered with a skim coat of thinset for bonding. 12.2.Apply white subway style"soft"tle surrounding bath tub area with a matching four foot high border around the exposed bathroom walls, toilet area,and vanity area$2.00/sqft. Bull nose($7.00/Lnft)areas determined by Hub City Builders, LLC and presented in wail elevations.Base board tile to match(white only). 12.3. Grout wall tiles with non-sanded grout(White match). 12.4.Patch,repair or replace as required.As needed and determined by Hub City Builders,LLC. 12.5.Finish sand all affected areas. 12.6.This does not include shower shelving,corner ceramic or porcelain shelving, recessed soap areas. This is a time and materials extra. 13. Tile 13.1.Prepare Floor and place tile with 1/8 "grout lines in a bed, "Versa bond Thinset" mortar SKU: YFY1077 or comparable. 13.2.Prepare Wall and place file with 1/16"grout lines in a bed, "Versa bond Thinset"mortar SKU: YFY1077 or comparable. 13.3. Grout Floor tile with client's choice accu-color sanded grout. 13.4.Grout Wall tile with client's choice accu-color non-sanded grout 13.5. Finish Tile Seal tile with satin sealer before grouting. 14. Carpentry 14.1.Paint Vanity with Sherwin Williams epoxy coat paint(color match by client) or acquire new vanity(client's choice$800.00 allowance). 14.2. Reinstall Vanity,Vanity Top,and Back splash as required. 14.3. Remove doors and drawers.Acquire new doors and drawer fronts paint to match Vanity. 14.4. Install two mirrors (as provided by Peabody glass, $280.00 allowance for both). 14.5.Install Blum slow close slides drawers. 14.6.Install Blum slow close European style hinges. 15. Hardware 15.1.Install towel bars,Towel rings,toilet roll holder, new knob or hinges interior to bath remodel. ($250)Allowance 15.2. One Shower Surround-36 X 60""Tempered-3/8" (32" x 67")3/8" Clear Tempered$491:83 20; Polish-3/8" 2W 2L- Polished Edge, Shower Door-3/8" Hinge/Handle Cutout, Tempered-3/8" (30" x 67") 3/8", Polish-3/8" 2W 1L Polished I Customer Initials Contractor Initials 5 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 Edge,Miter-3/8" OW 1L (30" x 67")45°Miter,Notch-3/8" Notch Cut-out, Tempered-1/811 (19"x 32")3/8"Clear Tempered,Polish-3/8" 1 W 2L Polished Edge, Miter-3/8" 1 W OL(19"x 32")45°,BM6X6CH 6" C-Pull(Chrome), GEN037CH Geneva Wall Mount Hinge(Chrome), SDCD38BA 3/8" U-Channel (Chrome), P880WS Seal w/wipe,P99OWS Drip Rail,PCC 10 H-Jamb Soft Leg". IncIusive 15.3.Door&Drawer Hardware allowance$1 O/Knob 16. Paint 16.1.Prep-one coat mold resistant Primer/sealer all affected areas. 16.2. Finish-Two coats finish(color match by client) Sherwin Williams Interior Grade. 17. Communications(Cable,Phone, Internet, Security, House speaker system)-None 18. Substantial Completion-950/opoint of any milestone,as notified by contractor, defined here-in. 19. Clean up-all affected areas as determined by contractor. 20. Communications-None 21.Vanity Cabinets Tops 21.1.Natural Stone for 24 X 72"two sink cut out will be acquired by Hub City Builders,LLC. Client is obligated to pick out the stone at Napolitano's Marble and Granite 448 Andover St Lawrence,MA 01843 Phone(978)688-2225 htty://www.napolitanoura dte com with-in seven days of notification by Hub City Builders,LLC. 21.2.Natural stone shower seat 16 X 36"max. 21.3.Both nose details round over detail(sanded edge). 22. Substantial Completion-as notified by contractor as defined here in. 23. Clean up-Construction clean, all surfaced wiped clean and vacuumed if required. 24. Return all items moved in Item#1,#2 in a"best case scenario"to the same locations as pictorially documented. 11. Dates of Performance: Commencement Date: As Soon as Deposit for services is received and within two weeks after the rescission date as stated herein. Substantial Completion Date: A.S.A.P—target date,as indicated herein. (60 Days) Cbstomer Initials Cz�Initials 6 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 Note: Definitions 1. As defined herein the phrase"owners argent"refers to the ability of William Pogor through Hub City Builders Owner's or Representative designation as used in the construction industry to describe an individual tasked with controlling the design and development and process while protecting the best interests of the owner, in the contracting individuals, local, State and Federal authorities. This Authority is limited to the project scope contained herein. 2. As defined herein the phrase"substantial completion"refers to 95%point where work on a specific requirement is complete,as defined by contract herein, and or a point designated by the contractor. 3. As defined herein the phrase"Preparedness only"refers the state where the next action can be taken by the owner or a separateldifferent contractor. But a previous action/paper work will be filled out and completed. 4. As defined herein the phrase "on oink designs"refers the state where daily as build's drawings are required by either the building dept,design professionals, or building contractors as the General Contractor(Hub City Builder's or their designated agents) determines necessary to proceed expediously to a specific tasks conclusion. 5. As defined herein the phrase"mar fixture allowance"refers the state where a allowance for a single fixture,materials or services is specified on a line item contained herein. Example, "max fixture allowance ($40.00)". This means in the context of this contract that you can spend up to$40.00 per fixture type indicated by the line item where the amount is listed. If allowance in question does not reach the example amount,there is no eredit implied or realized. If the amount exceeds the per fixture allowance a change of work order would be required,signed by all parties and the allowance amounts will be predetermined. 6. As defined herein the phrase"best case scenario"refers to the state where workers are doing the best they can overall to perform the task assigned. Through no fault or malicious behavior a fault occurs,(breakage,scratch, dent,misplacement, ect.)of objects furniture, appliances, artwork,jewelry,dishes, rugs, walls, doors, rails, floors, granite,sinks, ect.) Other Particularly Agreed Dates 1. Target Date 03/01/2016 Commencement,or as soon as permitted by the North Andover Building Department. 1.1. Item#I Agreed Date: 03/01/2016 Commencement Contractor Int: Date: Owner Int: Date: Customer Initials Contractor Initials 7 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 III.Dates of Performance: Commencement Date: As Soon as Deposit for services is received and within two weeks after the rescission date as stated herein building permit application is applied for. Substantial Cornnletion Date: A.S.A.P—target date,as indicated herein. Other Particularly Agreed Dates 2. Target Date 2.1. Item#1 Agreed Date: 05/15/2016 Contractor Int: Date: Owner Int: Date: I No-work on weekends, (unless constrained by completion date), no work Thanksgiving and Christmas and recognized holidays. IV. Work Changes Any changes to this contract must be mutually agreeable and put in writing under a Change Order Form. A blank Change Order Form is attached after the signature lines below and shall be the form used for any changes to this contract. It shall be the obligation of both parties to adhere to this provision. aA custoim It did Cnntracmr Mi iah 8 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 Contractor's Conditions of Performance All dates of performance are subject to reasonable extension(s), at the Contractor's request, if request .is made due to inclement weather, labor disputes, issues involving acquisition of materials or permits from appropriate authorities, mutual dissolution of contract by the parties, stop work order(s) by state or local municipalities, or act(s) of God Approval of such request(s) shall not be unreasonably withheld. No acceptance of liability is expressed, assumed or implied due to any of these circumstances. Work may be stopped, interrupted or ceased at the sole discretion of Contractor if payment(s) under the terms of this contract, or any written amendment thereto, is not made by Customer as agreed herein. Work shall be performed in an ordinary standard. It is understood that certain portions of Contractor's consulting and drafting work is deemed artistic and/or subjective in nature, and therefore, disputes related to subjective portions of Contractor's work shall never be grounds for non-payment by the Customer. Permits for Work The type(s) of permits that will be required for the Contractor's work herein shall include: 1. North Andover Building Permit. 2. North Andover Electrical Permit. 3. North Andover Plumbing Permit. 4. North Andover Rubbish Removal(Dumpster Permit)as Needed. Owners Agent44� Customer Ad, Unless otherwise requ ted by the Customer, the Contractor shall act as the OWNERS AGENT with regard to Andover Building Department for the sole purpose of obtaining all necessary permits required to undertake and complete the project. If the Customer undertakes to obtain their own permit(s)the Customer will be excluded from the guaranty fund provisions of M.G.L. c. 142A. �A n'vy. Customer initials Contractor tnitia6 9 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 Special Conditions of Services: (If this section is intended to be left blank,state"none"): 1. None. Customer Payment Schedule: This Contract is: X Agreed Fee ❑ Time and Materials Invoiced ❑ Combination Agreed Fee and Time and Materials Invoiced Agreed Fee(If applicable): Contract Base Price Total $32,838.25 Remainder due: *Time and Materials billed on weekly basis (see below) 1"Payment/Deposit $10,946.08 Special orders UN.A $15446.08 2"�Payment oil eompletion of item#3.1 as referred to herein $5,797.39 3rd Payment on completion of item#13.5 as referred to herein $5,797.39 4a'Payment upon substantial completion as defined herein and notified. $5,297.39 Final Payment, due upon submission as invoiced. $500.00 *Time and Materials billed on weekly basis(see below) custoum InitialsContractor Initials 10 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 i *Time and Materials/Labor Invoiced as needed (If Applicable): Contractor shall be paid at a rate of$60.00/per man hour for (Design Bidding services only). Building contract requires $120.44/per two men per hour. Both rates are subject to the addition of all materials and out of pocket expenses, including, but not limited to invoiced subcontractors, consultants and.materials suppliers. Contractor shall provide an itemized entry of his time billed as part of his invoice together with incurred expense invoices. Invoices shall be issued weekly. Payments due under invoice shall be made within seven(7)days of receipt of invoice. Receipt shall be upon delivery to Customer's address, email or in person. Contractor may suspend or cease work under this contract if payment is more than seven(7)days overdue. Special materials,or materials of a special order or custom made nature,shall be separately invoiced and require advance payment by Customer prior to order. Description of Combination Agreed Fee and Time and Materials: 1. As specified by any extra work orders Payment terms may not be altered Unless expressly agreed by the parties in writing. Deposit Terms If there is an initial deposit, it shall be refundable only after a full accounting of incurred cost by the contractor. Incurred costs shall be considered non-refundable inclusive of the Contractors time. The Customer acknowledges and agrees that the Contractor shall commence work in good faith upon receipt of said deposit, utilize his time and that of contractors and/or consultants he may work with, and that the Contractor shall be fairly compensated for such commencement of work and dedication of time to this Customer that might otherwise be devoted to other projects. The parties agree there is valid consideration for the non-refundable deposit: Customer Initials Contractor Initials 11 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 DEFAULT OF CUSTOMER If the Customer defaults for any reason, the Contractor shall be entitled to immediate payment of all monies owed as of the date the Contractor notifies the Customer in writing that he deems the Customer to be in default. The Contractor's Notification shall state all sums deemed to be owed and due from the Customer. Said sums shall be due and payable within seven(7)days of delivery of said notice. Any sums due after such notice of default shall be assessed an interest charge of 1 1/z% per month, or 18%per year until all sums are paid in full. If the Customer defaults, and does not tender payment of all sums due within said seven (7) days, the Contractor may record this contract in the registry of deeds and seek alien on the property for the enforcement of payment. The Customer shall be responsible and owe the Contractor all costs and expenses incurred in the collection of monies owed under this contract,including,but not limited to reasonable attorney fees. ALTERNATIVE DISPUTE RESOLUTION The Customer and the Contractor mutually agree that in the event the Contractor has a dispute with the Customer, the Contractor may submit such dispute to a private arbitration service, of the Contractor's sole choosing; provided however, such private arbitration service shall have been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and which shall have been in business for more than five (5) years, and shall be staffed with at least one retired justice of the Massachusetts Court System. This provision is an election at the sole discretion of the Contractor. This provision is in addition to any rights afforded the Customer under M.G.L. c. 142A. The arbitration, if elected by the Contractor, shall follow the rules and regulations of the American Arbitration Association. Nothing in this provision shall prohibit the Contractor from initiating a civil action for any such defaults. The Contractor may have the right to institute a civil action to obtain and enforce any statutory liens rights the Contractor may have, while contemporaneously seeking arbitration of the underlying disputed claims, which determination shall be conclusive as to the amount,if any the Contractor may enforce through such civil action lien. 4 Customer Initials Contractor"Initials 12 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 This Contract shall be construed in accordance with the laws of Massachusetts. This Contract may be executed in duplicate. Customer acknowledges receipt of copy by signing below. THIS IS A BINDING LEGAL DOCUMENT. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES OR YOU DO NOT UNDERSTAND ANY TERMS HEREIN. /6 ' ��ur I cDCOVKCAA-5� v�6, C tomer a e ail ��` - ��/d�f�e ���t�ef�.e.Imo► � ,mc�c.� .c,�y� Customer Date Email X billgwilliampo or.com Date Email Hub City Builders,LLC 4V Customer Initials Contractor Initials 13 Hub City Builders, LLC 10 Lacy Street North Andover,MA 01845 WORK CHANGE ORDER FORM Owner Jonathan&Michelle Hurtig 66 Palomino Drive North Andover,Massachusetts 01845 Project Location Same Original Contract Date: Time and Materials Billing: Description of Change(s): This Work Change Order changes only those items specifically addressed herein. Nothing in this Change Order shall be construed to change any other term or condition of the Original Contract. CagamaInitials Conuacter Initials 14 '• T'he Commonwealth of Massachusetts Department of IndustrialAeeidents I Congress Street,Suite 100 'Boston,MA.02114-2017 - F www.mass.gov/dia T"DSM Sy'V� Workers,Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Le 'b1 A ' licant Xnformation nn r L Name(Business/Orgai&ation/lndividual): Address: G Phone#: 7 z 7 City/State/Zip: .. ... .. : ...2�,., .. , . . • mpCheck the appropriate box: Type of project Qequired): Are you an eloyer? hill and/or part-time).* 7. ❑Nevv'constriictlon 1. I am a employer wit ���mployecs 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. emo deliiig any capacity.[No workers'comp.insurance required] 9. DemolitioR 3.❑I am a homeowner doing all work myself:[No workers'comp.insurance required.]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.0 Electrical xepavrs or additioiis ensure that all contractors either have workers'compensation insurance or are sole ��'x9 Plllmblllg repairs or additions 4•,, proprietors with no en'iplbyees. 5.❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13;0 Rbof reliairs These sub-contractors have employees and have workers'comp.insurance.t 14.n Other 6.[]We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and'we have no employees:[No workers'comp.insurance required.] applicant that checks box#1 must also fill out the section below showing their workers'compensation policyinfornation PP Homeowners who submitbb-k affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suc tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not(hose entitles ave 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. Pelow is the policy and job site information. Insurance Company Name: 81 M C• " -2016PftirationD0eY ) '/��� ��� 13 3 Policy#or Self-ins.Lie.#: 10 IO�� G�?�✓®���'S l Ci /State/Zi Job Site Address: �� / /L ,�� ,ter/v p Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration.date). lation punishable by a fiiie up to$1,500.00 Failure to secure coverage as required under MGL c.152,§25A is a criminal vio and/or one-year imprisonment,as vre11 as civil penalties forwarded to the ffin the form of a STOP eo0RK£InvOestigat ons of the DIA for ER and a fine of up to insur5anc0 a day against the violator.A copy of this statement may coverage verification. I do hereby ertify un tli pains and penalties of perjury that the information provided above is true and correct : _ Date: Si afore: Phone#: official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): LLIBI�oardHealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Phone#• son• 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 hlre, 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 receiv&'or trusted d 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 b6 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 certificates)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 anLLC 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 IndustrialAccidents. 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"fob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia WILLIA OP ID:JF CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDmvY) 02119/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 CONTACT Jeff C.Manna Michaud,Rowe And Ruscak Ins. A/c No):978 557 2130 P.U.BOX 188 AIC.N Ext):978 688 8829 FAX North Andover,MA 01845 E-MAIL Lawrence R.Michaud,CIC ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Preferred Mutual Insurance Co. 15024 INSURED Hub City Builders LLC INSURER B: William Pogor INSURER C: 10 Lacy St North Andover, MA 01810 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBN POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM1DD1 MMIDDIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE r-1 OCCUR BOP0100721169 10/2412015 10/2412016 DAMAGE TO RENT D X Business Owners PREMISES Ea occurrence $ MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 JECOT ]LOC PRODUCTS-COMP/OP AGG $ POLICY❑ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peraccident $ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAR H.CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I IER _ ANY PROPRIETORIPARTNERfEXECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCE.L.DISEASE-POI LIMIT $ RIPTION OF OPERATIONS below BUILDING PROPERTY 1,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Carpenter Office/Home CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jonathan&Michelle Hurtii THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 66 Palomino Drive North Andover,MA 01845 AUTHORIZED REPRESENTATIVE 2 /� �/s;iF.fl�lt/•l�' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY DATE(MM/DD/YYYY) - INSURANCE 02/19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poky(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Jeffrey Manna CDN Insurance Brokerage PHONE (978)851-3436 FAX Eft AIC No: (978)455-2601 P.O.Box 121 Equal JCJM@aol.com Tewksbury,MA 01876 INSURERS AFFORDING COVERAGE NAIC# Phone (978)851-3436 Fax (978)455-2601 INSURER A: A.I.M.Mutual Insurance Co. 33758 INSURED INSURER 6: Hub City Builder LLC INSURER C: 10 Lacy St INSURER D: North Andover ("1A 01845- INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE B POLICY EFF POLICY EXP ._.__.. , N R WVD POLICY NUMBER MMIDDIYYYY MM/D LIMITS ❑ COMMERCIAL GENERAL LABILITY _ _. EACH OCCURRENCE $ ❑ CLAIMS-MADE ❑ OCCUR DAMAGE TO RENTED ❑ PREMISES Ea occurrence $ MED EXP(Any one person) $ ❑ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ E] POLICYElJET ❑ LOC PRODUCTS-COMP/OP AGG $ ❑ OTHER a AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED ❑ AUTOS ❑ AUTOS BODILY INJURY(Per accident) $ ❑ HIRED AUTOS E] AUU O WNED PROPERTY DAMAGE Per accident $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS UAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ©PER1:1OTH- AND EMPLOYERS'LIABILITY Y/N STA z. ER ANY PROPRIETOR/PARTNER/EXECUTN E.L.EACH ACCIDENT $ 100,000.00 A OFFICER/MEMBER EXCLUDED? N/A VWC-100-6021323-2016A 02/18/2016 02/18/2017 (Mandatory In NH) N yes,desalts under E.L.DISEASE-EA EMPLOYE $ 100,000.00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,U more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jonathan&Michelle Hurtig THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 66 Palomino Drive ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)QF The ACORD name and logo are registered marks of ACORD r�i C��e` amma�uucalfi�a�'C�i��ijra��ulell,t �\ Office of Consumer Affairs&BuslacsYRi,:.tion i Li¢ensear registration valid for individul use only ME IMPROVEMENT CONTRACTOR bet'ore the expiration date. Vfound return to: egistration: 280234Type." Office of Consumer Affairs and Business Regulation xpiration: '0/27/2025 Individ42f 10 Park Plaza-Suite 5170 WILLIAM N.POGOR Ba(tft AJA 12116 WILLIAM POGOR �+ : 20 LACY ST NORTF+ANDOVER,MA 02845 — Undersecretary `.N4t valid ithout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards C,imtruction $uperi i%or, L:ccnso- CS-083917 WILLIAM H POG©�R 10 LACY ST NO ANDOVER MA 01845 ; �- -—� Exp rattan Co:rrrnssiorer 06/28/2016