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Building Permit #787-13 - 870 GREAT POND ROAD 5/17/2014
Permit NO: 7E7 — 1-3 Date Issued: 7A BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATI N Date Received RTANT: Applicant must complete all items on this LOCATION ?0,+9 9-c9-. Print PROPERTY OWNER Kov, cw. Koxy.v, dVlrC luskrt„ Print MAPNO:-M PARCEL01 12— ZONING DISTRICT: Historic District yes Machine ShoD Villaae ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ).One family ❑ Addition ❑ Two or more family ❑ Industrial kAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well ❑ Floodplain a Wetlands ❑ Watershed District Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: v4Ac..Clusice Phone: Address: i? -?C) C -"O, Q i�, CONTRACTOR Name: PP Phga one: 9-22 -Rgq- 9 q q I �ccSn�1 a1�.�rY�nCk tis -,Ick''' Address: Supervisor's Construction License �� L Exp, M� 0`��3 p 3CofJ ►� �` �p, Date: c-iJ60,2a3a ,, a 1/q 3 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: $ �, O y 0 a� Check No.: A of L11 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to Oe ,,gua�rnty fund Sianature of - Q, i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: PROPOSED USE Date Received Date Issued: Non- Residential 11 New Building [I One family IMPORTANT: Applicant must complete all items on this page El Two or more family El Industrial ----,-- No. of units: [I Commercial El Repair, replacement D Assessory Bldg El Others: L D Other El Floodplain 'Ot arfft 4m_ _�7 at A 0 q� 10 T P�int� OXY y no;. �'P�s ff R IGstb ri thdr" :ZONING Q, c -0 -is. 'Y n,6Machine�Sho, _01 �qT p,VV I I yes nog TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 11 New Building [I One family 11 Addition El Two or more family El Industrial El Alteration No. of units: [I Commercial El Repair, replacement D Assessory Bldg El Others: El Demolition D Other El Floodplain 'Ot arfft y T 0 r_sQTW at DESCRIPTIUN Ur VVUMK I u tat i-r-mrummau. Identification Please Type or Print Clearly) OWNER: Name: Phone: A-1 A __ - - ARCH ITECT/ENGI NEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $_ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund gh, a ohtr.a. i j —A SI natureof!A Plans Submitted ❑ Plans Waived D Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ S "' Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 11. TYPE OF SEWERAGE.DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ .. .Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS 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: _ Comments -Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow;! ]Engineer: Signature: FIRE DEPARfIWi-- t - Temp Dumpster on site yes Located at 124 Main Street Fire Departlme it -S ignaiture/date COMMENTS Located 384 Osgood Street no Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service Top 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 Doe.Building Permit Revised 2010 A 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 ❑ WorkersComp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o 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 app; -al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.BuNing permit Revised 2012 or r' Locattion No. ---I -te7 Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL 26416 Building Inspector Enter construction'cost for fee cal - North Andover Fee Calculation Construction Cost $ 86,668.00 m $ - $ 1,040.02 Plumbing Fee $ 130.00 Gas Fee 100 comm. $ 1!00.00 Electrical Fee $ 130.00 Total fees collected $ 1,400.02 870 Great Pond Road 787-13 on 5/17/2013 new Balcony off of Master Bedroom Reno Laundry Room Oa 7- Q x LL O OG m C cu X O LLL. N y CL 1 j G a z Z m cu c mon 7 LLL tZ,- N U _ LL O to 7 K _ LL 0 Z Q U J m :3O O' N _ " to _ L.L ,n W to d' y � Q W LU 5 _ LL 1 v E CO Oa 7- Q x LL O OG m C cu X O LLL. N y CL 1 j G a z Z m cu c mon 7 LLL :3E d' N U _ LL HH Z C7 Zco -i to 7 K _ LL 0 Z Q U J m :3O O' N _ " to _ L.L a Z LA a C7 to d' t_ LL � Q W LU 5 _ LL 1 v E CO z v 0 D to Y O Ln Z m CD z W w X LUH uj .S A' w f 0 cc 9 o ® ' V Z55 •�L - Q, a) M= c o 0 J- U' d CD E cm o c a' c O CD CD CL N J d' CL> i "Y.+ C o dN d =c0 N 0 V G: C 0 z CD o w �( •y 3 cm CD - H C C CE L a 2 L d cc•o : Q. m '� N = ca LUli W Nm -a -- o o H e .=��*N O •E Z o a W V L -o r- V 0 m ._ i O y Q u cn C-) 2 o oor- O0. C L) > Z m CD z W w X LUH uj .S A' w f CONSTRUCTION SERVICES AGREEMENT Contractor: Owner: Date: Howell Custom Building Group, Inc. Ron & Karen McCluskey 13`h, 2013 360 Merrimack St. Bldg 5 ..May 870 Great Pond Rd. Lawrence, MA 01843 North Andover, MA 01845 Phone: 978-989-9440 Project: C.S.L. #068232 Additions & Renovations II H.I.C. #L24-25`7 I I. PARTIES & DATE OF AGREEMENT This contract (hereinafter referred to as "Agreement") is made and entered into on this 13`h day of May, 2013, by and between Ron & Karen McCluskey, (hereinafter referred to as "Owner"); and Howell Custom Building Group, Inc., (hereinafter referred to as "Contractor") II. SCOPE OF WORK DESCRIPTION & CONTRACT SUM In consideration of the mutual promises contained herein, Contractor agrees to perform the "Work" on the structures and grounds at the project address per the following Scope of Work: General Notes • All Work includes labor and materials unless otherwise noted Owner Responsibilities • Owner to attend bi-monthly project meetings on-site with Contractor. Meetings to be scheduled at a mutually agreed upon time on a weekday between the hours of 7:30am-4:00pm. • Owner to coordinate with Contractor on planning the detailed sequence of work. • Owner to provide information, selections and decisions to Contractor as requested by Contractor in a timely manner so as not to delay progress of the Work. • Owner to remove all personal items and furniture from the following Work areas: • Laundry Room • Garage (wall adjacent to Laundry) • Ron's Master Closet • Karen's Sewing Room • *Note: Contractor to move & cover Owner's furniture as needed for new flooring in the following Work areas: • Master Bedroom Permits & Inspections • Contractor to prepare building permit application, file application, and post permit on-site. • Town of North Andover Building Permit Fee. • Plumbing & Gas Permit to be obtained, and the fee paid, by Contractor's Plumbing Subcontractor. • Electrical Permit to be obtained, and the fee paid, by Contractor's Electrical Subcontractor. • Except for permits and fees noted above, the Owner shall secure and pay for other necessary approvals, easements, assessments and charges required for construction, use or occupancy of permanent structures or for permanent changes in existing facilities. • Contractor to schedule and coordinate the various inspections required to complete the Work as described in this Scope of Work. Site Prep General Notes: Page 1 of 14 Initials:/ • Contractor to provide and maintain a Portajohn on site during construction. • Contractor to seal off existing rooms adjacent to the areas affected by demolition and construction during the project with plastic sheeting. • Contractor to protect existing finishes in affected areas, if those finishes are to remain. Existing finishes to be protected with plastic sheeting, cardboard or other padding. • Supply and Install Site Protection per the following notes: • Protect hardwood floors in kitchen, front hallway & LR • Protect carpet runner on Main Stairs Demolition General Notes: • Contractor to disconnect electrical, cable, phone and plumbing as required in affected areas prior to demolition. • Where Contractor is removing and saving an item, he will use his best efforts to remove that item with minimal damage. Storing & protecting the saved items is the responsibility of the Owner. Re -installation of the saved items is not included unless otherwise specified. • Where Contractor is removing existing tile, assume tile is laid on plywood or gypsum wall board. Removal of cement board underlayment or a mud base would be extra. • Existing baseboard trim in Master Bedroom/Ron's Closet/2nd Fl Landing/Sewing Rm is to remain (see Interior Trim, Doors & Millwork for shoe moulding to cover edges of new flooring) • See Plumbing for modifications to existing baseboard radiators in Master Bedroom • The abbreviations R/S = remove & save, R/DNS = remove and do not save. • Contractor to perform demolition work per the following notes: • Laundry Room: o R/S: ■ Washer/Dryer (to be relocated/reinstalled) o R/DNS: ■ Plumbing & electrical fixtures ■ Baseboard heat (to be replaced with toe kick heater under sink) ■ Countertops (including backsplash) ■ Base & upper cabinets ■ Interior/exterior window trim ■ Interior door casings & baseboard trim ■ Laundry Room door including jambs ■ Ceramic floor tile including underlayment ■ Wall & ceiling plaster down to bare studs in the following areas: • Laundry Room — all walls & ceiling (insulation in ceiling & one exterior wall to remain) • Stub wall on kitchen side next to garage door (for new pocket door wall) • (1) garage wall as needed for Laundry Room bump out ■ Wall framing as needed for Laundry Rm extension & pocket door ■ Dryer vent & ductwork (to be relocated) ■ Laundry Room window • Garage: o R/S: • Modular wall storage panels (to be reinstalled on new wall) • Master Bedroom/2nd Floor Landing/Karen's Dressing Room: o R/S: o R/DNS: Interior doors (slabs only) to Master Bedroom & Ron's closet (to be re -installed after flooring) (1) pair of exterior window shutters (save for future replacement parts) (1) double DH window unit (save for donation) Carpet & pad on 2"d floor areas • *Note: Carpet in Karen's closet & runner on main stairs to remain Wall plaster & insulation on (1) exterior wall in Master Bedroom Subfloor in Master Bedroom as needed for cantilevering balcony joists Page 2 of 14 Initials:/ ! i ■ Clapboard siding & exterior wall sheathing as needed for new 10' wide door opening in Master Bedroom Floor Framing General Notes & Specifications: • Floor Joists: KD 2x10 @ 16" o.c. • Subfloor: 3/" T&G Advantech Subfloor Balcony Cantilevered Floor System: • PT 2x8 floor joists sistered to both sides of existing bedroom floor joists Supply and install Floor Framing per plans in the following areas: • Laundry Room: C Frame laundry room floor extension into Garage space ■ Notes: • New floor to extend into garage so washer/dryer are cabinet depth • See Wall Framing for support walls under floor extension o Modify existing floor framing as needed for relocating plumbing Master Bedroom Balcony: o Remove existing plywood Subfloor to install cantilevered joists o Frame 5'x12' cantilevered floor system for balcony deck per Plans & Structural Engineer's design. o Patch existing subfloor in Master Bedroom as needed Wall Framing General Notes & Specifications: • Ext Wall Studs: 2x6 @ 16" OC; (1) bottom and (2) top plates • Ext Wall Sheathing: 7/16" Advantech • Support Wall: 2x4 @ 16" with (1) PT2x4 bottom plate • Interior Wall Studs: 2x4 @ 16" OC; (1) bottom and (1) top plate • Beams and Engineered Headers: (listed by area, see below) • Pocket Door Kit: Johnson HD 2868 with rollers & tracks • Supply and install Wall Framing per plans in the following areas: • Laundry Room: o Frame exterior wall & 30"h support wall for laundry room extension into garage o Frame -in existing window opening o Frame wall partition with pocket door frame kit for new laundry rm pocket door ■ *Note: existing wall between kitchen & laundry to remain in same location • Master Bedroom Balcony: o Cut & frame new 10'w x 6-8"'h opening with (3) 1 3/" x 9 %z" LVL header for new patio sliders Roof Framing General Notes & Specifications: • Framing lumber to be kiln -dried #2 SPF unless otherwise noted. • Ceiling Joists: 2x8 @ 16" OC • Rafters: 2x10 @ 16"o.c. • Ceiling Strapping: 1x3 furring • Beams and Engineered Headers: (listed by area, see below) • Supply and install Roof Framing per plans in the following areas: • Laundry Room: o Frame ceiling bumpout for laundry room extension o Cut & frame skylight opening in roof above laundry room ■ Add single 2x10 rafter sistered to existing rafters on either side of new skylight opening ■ (2) 9 %4" LVL headers hung off of sistered rafter pairs i Page 3 of 14 Initials:5w/ o Cut & frame skylight shaft in laundry room ceiling o Install ceiling strapping for new plaster Roofing General Notes & Specifications: • Asphalt Roof Shingles: Iko 30 yr architectural (match existing) • Flashing: Velux EDL flashing kit installed over aluminum step flashing woven into roof shingles • Supply and install Roofing per plans in the following areas: • Laundry Room: o Install new aluminum step flashing & patch roofing around new skylight o. Install skylight flashing kit Exterior Trim General Notes & Specifications: • Door Casings: 1x4 PVC • Door Kick board: 1x4 PVC • Light Blocks: 1x8 PVC with aluminum drip cap • Supply and install Exterior Trim per plans in the following areas: • Laundry Room: o None • Master Bedroom Balcony: o Door casings .& kick board on new sliders o (1) light block for exterior sconce Siding General Notes & Specifications: • Tyvek Housewrap, taped seams • % x6 VG FJ primed smooth WRC Clapboards • 4" exposure, face -nailed with stainless steel nails • Prime all end cuts in the field during installation. • Supply and install Siding per plans in the following areas: • Laundry Room: o Patch clapboard siding at removed window location • Master Bedroom Balcony: o Patch clapboard siding around new patio sliders Exterior Doors & Windows General Notes & Specifications: • Laundry Room Skylight: • Manufacturer: Velux • Model: VSE M04 deck mounted skylight, electric venting • R.O. 30"x 38" • Exterior: Bronze aluminum with matching EDL flashing kit • Glazing: Low "E" II insulated glass, tempered • Window Hardware: (1) wall mounted remote control (supplied by Owner) • Master Bedroom Door: • Manufacturer: Neuma • Model: DGP 10068 4 -Panel Gliding Patio Doors with (2) active center panels & (2) fixed outer panels • Features: Mini -Blinds Between the Glass • R.O. 9'10"x 6'8" •. Exterior: White • Interior Finish: Painted • Muntins: none Page 4 of 14 Initials: V, • Jambs: 6-9/16" • Screen Door: White aluminum sliding screen door with charcoal fiberglass mesh • Door Hardware: Standard handle set, bright brass; gold -tone adjustable hinges • Door Sill: standard • Supply and install Exterior Doors & Windows per plans in the following areas: • Laundry Room: o (1) venting skylight with flashing kit • Master Bedroom: o (1) Gliding Patio Door with Sliding Screen Door Porch & Deck Finishes General Notes & Specifications: • Decking: o Manufacturer: TimberTech o Product Line/Color: XLM Composite Decking/Mt. Cedar o Fasteners: Ebty hidden fastening system (except perimeter boards to be face screwed with stainless steel screws) • Railings: • Manufacturer: Feeney • Model: Cable Rail System • Railing Sections: (11) 3/16" stainless cables, end termination & tensioning hardware • Posts: o Main Posts: 3x3 painted aluminum posts bolted to framing (Owner to select color) o Intermediate Posts: 3/8" flat painted aluminum (cable supports) • Top Rail: profile & material TBD • Bands: 1x10 PVC • Supply and install Porch & Deck Finishes per plans in the following areas: • Balcony Deck: 0 60sf of TimberTech composite decking on 5'x12' deck area of balcony, picture -framed around perimeter with mitered corners o (4) cable railing sections with continuous cables, (5) main posts, (2) intermediate posts & handrail; handrail to be installed above posts Plumbing, Gas & Heating General Notes & Specifications: • Pex/Type L Copper water lines. • PVC Drains & Vents. • PVC Plumbing vents through the roof. • Baseboard Radiators: Slantfin (match existing) • Allotment Item: Plumbing Fixtures to be selected by Owner and supplied by Plumbing Subcontractor. • Supply and install Plumbing Work per plans in the following areas: • Laundry Room: o Farmer's Sink & faucet in new location ■ Allotment Item: Laundry Faucet Amount Carried: $500 • *Note: Farmer's Sink part of Countertops o Relocate w/d hookups including gas line to dryer o Relocate radon remediation stack in garage o Install new toe -kick heater • Master Bedroom: o Modify existing baseboard radiators as needed for new patio doors to balcony Electrical General Notes & Specifications: • Allotment Item: Decorative Electrical Fixtures. Selected by Owner. L ''ll Page 5 of 14 Initials:50/ V Fixtures supplied by Electrical Subcontractor: o Low voltage under -cabinet lights 0 5" recessed ceiling fixtures & trim kits • Outlets to code • Outlets and switch plates to match existing • Dimmer switches to be toggle style • Supply and install Electrical Work per plans in the following areas: • Laundry Room: o Relocate existing switches & outlets as needed o (4) GFI outlets, 20A, interior o (2) appliance outlets, 110V o (2) recessed ceiling fixtures with single pole switch on dimmer o (6) under cabinet lights: low voltage, T track, transformer & switch on dimmer o Wire for skylight • Master Bedroom/Balcony: o Relocate (1) existing wall outlet o (1) GFI exterior wall outlet, 20A o (1) exterior wall mounted light fixture (above new doors) with single pole switch ■ Allotmentltem: Wall Fixture Amount Carried: $100 • Cupola: Repair cupola light (timer not working) Insulation General Notes & Specifications: • Walls: 5-1/2" R-19 unfaced fiberglass batts with poly vapor barrier. • Ceilings: 9-1/4" R-30 kraft -faced fiberglass batts • Draft stop caulking in framing as required by code • Supply and install Insulation Work per plans in the following areas: • Laundry Room: o Fiberglass insulation in new exterior wall, floor & ceiling of laundry room extension o Patch insulation at framed -in window & new skylight locations as needed • Master Bedroom: o Patch insulation as needed around new patio doors Plaster General Notes & Specifications: • Walls: %z" gypsum blueboard screwed to studs; smooth skim -coat plaster finish. • Garage Wall: 5/8" fire -rated gypsum blueboard screwed to studs, textured skim -coat plaster finish. • Ceilings: %z" gypsum blueboard screwed to strapping; smooth skim -coat plaster finish • Supply and install Plaster Work per plans in the following areas: Tile Laundry Room: o New smooth plaster on laundry room walls, ceiling (including walls of skylight shaft) & kitchen side of pocket door wall Garage: o New textured plaster on new garage wall o Patch new to existing wall & ceiling tie-ins Master Bedroom: o Patch existing plaster wall around new patio doors to balcony • None (backsplash in Laundry Room part of Countertops) Interior Doors, Trim & Millwork General Notes & Specifications: '1 v Page 6 of 14 Initials: • Pocket Door: Custom 2668 half -lite French Door with frosted glass & "Laundry" lettering, 1-3/8" thick, primed, standard bore • Pocket Door Hardware: Quikset pocket door hardware with recessed cups & jamb pull, polished brass (works with standard bore; see allotment below) • Door Casing: match existing • Baseboards: match existing • Shoe Moulding: %z" quarter round fjp pine • Supply and install Interior Trim & Millwork -per plans in the following areas: • Laundry Room: o (1) pocket door slab with door hardware ■ Allotment Item: Pocket Door Hardware Amount Carried: $100 o Door Trim: ■ Jambs & casings on (1) pocket door o Baseboard trim on (4) walls in laundry o Patch baseboard trim on kitchen side of pocket door wall • Master Bedroom/Ron's Closet/2❑d Floor Landing/Karen's Sewing Rm: o Door casings on new patio doors to balcony o Patch baseboard trim on (1) wall o Install new shoe moulding along bottom edge of new & existing baseboard trim to cover edge of new flooring (after flooring installation) o Re -install existing bedroom & closet door slabs (after flooring installation) Cabinets General Notes & Specifications: • Manufacturer: Espresso • Wood Species: Hard Maple • Color: Latte (painted finish) • Style: Shaker • Doors: Full overlay w/ concealed hinges • Drawers: Dovetailed boxes with full extension glides • Cabinet Boxes: 5/8" plywood • Supply and install Cabinets per plans in the following areas: • Laundry Room: o Painted Wood Cabinetry in Laundry Room per B&G Cabinetry plans dated 4/18/13 ■ Allotmentltem: Cabinet Hardware Amount Carried: $250 o Paint grade shelf with small crown per SDH sketch dated 4/30/18 Countertops General Notes & Specifications: • Material: 1 1/8" thick Nordic Black granite with textured finish • Edge Profile: 1/8" round over ("pencil" edge) • Supply and install Countertops, Backsplashes & Farmer's Sink per plans in the following areas: • Laundry Room: o New countertops on base cabinets in laundry (backsplash details to be discussed with and approved by Owner at time of templating) o (1) Farmer's Sink fabricated from matching granite (integral with countertop) Appliances • Install Appliances per plans in the following areas: • Laundry Room: o Relocate dryer vent and ductwork with new exterior wall cap o Re -install existing washer/dryer in new location Specialties Page 7 of 14 Initials: Il Supply and install Specialty items in the following areas: • Garage: o Reinstall modular wall storage panels on new walls in garage Floor Coverings General Notes & Specifications • Hardwo Floorior): • M rer: Bruce • escription: 4 - mished "Hand -Scraped Maple Spice" flooring — PF6311 • 5Des' 262 (Home D ot) • Cork Flodry): • ome Legend • n: 11. 1.75 Cork Mocha Flooring TilesHL9319 83 (Home De t) • Supply and install Floor Coverings per plans in the following areas: • Laundry Room: o Ultraply underlayment over exposed laundry room floor areas o Allotment Item: Cork Flooring Amount Carried: $ 900 (includes installation labor) • Master Bedroom/Ron's Closet/2°d Floor Landing/Karen's Sewing Rm: o Pre -finished hardwood flooring not to exceed 575sf Painting General Notes & Specifications: • Owner to select colors; Contractor to supply materials and labor • All paints to be Benjamin Moore, Latex unless otherwise specified below • Colors & Sheens: o Ceilings: flat, white; other colors or sheens would be extra. o Walls: flat or eggshell; (1) color per room,�bau�•rnwriraddihianai-coats-t�•covnai W4ftkl.40-"" LAk -13-t3 o Trim, Doors & Windows: satin or semigloss; (1) color per room different than walls; dark colors or dramatic contrast to wall color may be extra. o Exterior Trim: satin or semigloss; (1) color different than siding; dark colors or dramatic contrast to siding color may be extra o Siding: flat or eggshell; (1) color different than the trim; some colors may require additional coats to cover, which would be extra. o Cedar Bleed: the natural tannin extracts in cedar may bleed through light colors; there is no guarantee against cedar bleed. • Unless otherwise noted below, interior painting of existing rooms if included, shall generally include, prep plus (1) finish coat of paint on ceilings, walls, trim, windows and doors. • Supply and install Painting in the following areas: • Laundry Room: o Interior painting of new trim, wall & ceiling plaster o Exterior painting of patched siding on (1) wall of laundry • Kitchen: o Interior painting of patched trim & wall plaster on kitchen side of pocket door wall Garage: o None (textured wall & ceiling plaster to match existing unfinished plaster) Master Bedroom/Ron's Closet/2nd Floor Landing/Karen's Sewing Rm: o Interior painting of new trim & wall plaster on (1) wall of master bedroom o Master bedroom baseboard and shoe molding o Exterior painting of new deck trim & patio door trim Clean-up General Clean-up notes: • Contractor to provide on-site dumpster during demolition and construction. Owner and Contractor to agree on Page 8 of 14 Initials: dumpster location prior to delivery. • Jobsite to be cleaned up daily. • All construction debris to be removed from site. • At completion of the Work, the Contractor shall remove construction equipment, tools, machinery and surplus materials from site. • The house shall be left "broom clean" upon completion. (Additional page(s) attached: X Yes No) • (2) pages of plans titled "McCluskey Residence" dated March 11`h, 2013 by Howell Custom Building Group • (4) pages of plans titled "McCluskey Laundry Room" dated April 18`h, 2013 by B&G Cabinetry • (1) page List of Contract Allotments dated May 13`h, 2013 • (1) page Substantial Completion Agreement CONTRACT SUM (lump sum price for all Work described above): $ 86,668 TOTAL ALLOTMENTS (included in Contract Sum): $ 1,850 (Listed above in Scope of Work Description) III. GENERAL CONDITIONS FOR THE AGREEMENT ABOVE A. DATE OF WORK COMMENCEMENT AND SUBSTANTIAL COMPLETION Commence Work on or about May 20`h, 2013. Contractor to achieve substantial completion of all Work in this Agreement on or about July 12`h, 2013 not including delays and adjustments for delays caused by: inclement weather, accidents, additional time required for performance of Change Order Work (as specified in each Change Order), delays caused by Owner, and other delays unavoidable or beyond the control of the Contractor. B. EXCLUSIONS Unless specifically included in the Scope of Work described above, this Agreement does not include labor or materials for the following Work: b 2. Surveying that may be required to establish accurate property boundaries for setback purposes 3. Temporary sanitation; power, or fencing 4. Moving Owner's property around the site 5. Repair or replacement of Owner -supplied materials 6. Public or private utility connection and usage fees 7. Repair of unforeseen and concealed conditions including, but not limited to, repair of concealed underground utilities not located on prints or physically staked out by Owner which are damaged during, construction 8. Testing, removal and disposal of any materials containing asbestos (or any other hazardous material as defined by the EPA) 9. Removal of filled ground or- reek or any other materials not removable by or-dinafy hand tools or othe l,eaN-, equipment .heady , 4te 10. Any di do below , the .ion L.,....., the laps i the o ..t that soils unsuitable f �,,sxbgiiib v� ciccu`v'aaon ocxo`v`v cxxc-graac� �xxv-wzrvircnc� !I. Oe water-ing of exeavatiens 12. Frost pr-ateet: ., for ..pe e ..bons eenditions 14. Correction of existing out -of -plumb or out -of -level conditions in existing structure 15. Correction of concealed substandard framing. 16. Removal and replacement of existing rot or insect infestation Initials:SJPA/ 1l/ zj�� Page 9 of 14 17. Re-routing/removal of vents, pipes, ducts, wiring, conduits, structural members, or steel mesh which may be discovered in the removal or cutting of openings in the existing structure. 18. Failure of surrounding part of existing structure, despite Contractor's good faith efforts to minimize damage such as plaster or drywall cracking and popped nails in adjacent rooms. 19. Repair of damage to existing roadways, driveways, sidewalks, or grass areas that could occur when construction equipment and vehicles are being used in the normal course of construction 20. Exact matching of existing finishes. Where Contractor's Work involves the "matching of existing finishes or materials," Contractor will use his best efforts to match existing finishes and materials. However, an exact match is not guaranteed due to such factors as discoloration due to the aging process, difference in dye lots, and difficulty of exactly matching certain finishes, colors, and planes. 21. Final construction cleaning (Contractor will leave site in "broom swept" condition) 22. Landscaping and irrigation work of any kind. 23. Any item on the Plans marked "Not in the Contract" or "NIC". C. CHANGE ORDERS CONCEALED CONDITIONS: If conditions are encountered at the site which are (1) subsurface or otherwise concealed physical conditions which differ from those indicated in the Contract Documents or (2) unknown physical conditions which differ from those ordinarily found to exist and generally recognized as inherent in construction activities of the character provided for in the Contract Documents, then the contract price shall be equitably adjusted in accordance with the change order provisions set forth herein for such concealed or unknown conditions upon claim by the Contractor. 2. CHANGES IN THE WORK: Any change from the Scope of Work referred to in the Contract Documents involving extra costs of materials or labor (including any overage on ALLOTMENT Work and any changes in the Scope of Work required by governmental plan checkers or field building inspectors) will be performed upon a written CCO (Contract Change Order) issued by Contractor and signed by Contractor and Owner prior to the commencement of Additional Work by Contractor. Contractor's profit and overhead, and any supervisory labor will not be credited back to Owner with any deductive Change Orders (Work deleted from Agreement by Owner). D. PROGRESS PAYMENTS AND PAYMENT TERMS 1. APPLICATIONS FOR PAYMENT: Based upon Applications for Payment (Invoices) submitted to Owner by Contractor, Owner shall make progress payments on account of the Contract Sum to Contractor as provided in the Contract Documents. Applications for Payment (Invoices) shall be prepared by Contractor approximately every two (2) weeks and submitted to Owner. Payment is due within three (3) business days after receipt of the Application for Payment by Owner. 2. CALCULATION OF PAYMENT AMOUNT: Applications for Payment (Invoices) shall itemize the amounts due thru the Invoice Date for completion or partial completion of the Work and/or project milestones as shown on the Schedule of Values below and any Change Order Work added to the Schedule of Values. The Schedule of Values, which allocates the Contract Sum to the various portions of the Work and project milestones, shall be used as a basis for Contractor's Applications for Payment, but shall not be used as a basis for the value of Work added to or deleted from the Agreement. SCHEDULE OF VALUES: 1 Initial Deposit due when Agreement is signed and returned to Contractor $ 5,000 2 Demolition $ 8,000 Ai Page 10 of 14 Initials:S�i1�► / �' / / 3 Framing $ 10,000 4 Rough mechanicals $ 8,000 5 Fixtures Ordered $ 3,000 6 Cabinets Ordered $ 3,000 7 Countertops Ordered $ 2,000 8 Exterior Doors & Windows $ 9,000 9 Insulation & Plaster $ 3,000 10 Exterior Finishes $ 5,000 11 Cabinets $ 4,000 12 Countertops $ 6,000 13 Finish Mechanicals $ 3,500 13 Trim & Millwork $ 4,500 14 Appliances & Specialties $ 2,000 15 Flooring $ 8,000 Final Payment: Balance of contract sum due upon Substantial Completion of all Work under contract: $ 2,668 Total of Payments $ 86,668 3. PAYMENT OF CHANGE ORDERS: Payment for each Change Order is due upon completion of the Change Order Work, and submittal of invoice by Contractor. 4. FAILURE OF PAYMENT: If the Owner does not pay the Contractor within three (3) days of the Invoice Date, then the Contractor may, upon seven (7) additional days' written notice to the Owner, stop the Work until payment of the amount owing has been received. The Contract Time shall be extended appropriately and the Contract Sum shall be increased by the amount of the Contractor's reasonable costs of shutdown, delay and start-up, plus interest as provided for in the Contract Documents. 5. PAYMENTS/CREDITS FOR ALLOTMENT OVERAGES/UNDERAGES: The cost of items designated in the Agreement as Allotments and Contractor's associated overhead and profit have been initially factored into the Contract Sum and Payment Schedule. If the actual cost of an item exceeds the Allotment amount, the difference between the actual cost including taxes and delivery charges and the Allotment amount will be added to the Contract Sum via Change Order. Contractor overhead and profit will not be added to material only Allotment overages as long as the scope of work to receive, handle, install, and warrant such materials has not increased. For Allotment items that include materials and installation labor, ten percent (10%) overhead and eight percent (8%) profit will be added to the labor portion of an Allotment overage. If the actual cost of an item is less than the Allotment amount, a credit will be issued to Owner after all billings related to this particular Allotment have been received by Contractor. This credit will be issued via Change Order prior to calculating the final payment owing under the Agreement. The amount of the credit will be the difference between the Allotment and the actual cost of the item including taxes and delivery charges. Contractor overhead and profit will not be credited back to owner on Allotment underages. 6. INTEREST ON OVERDUE PAYMENTS AND ATTORNEY'S FEES: Payments due and unpaid under the Contract Documents shall bear interest from the date payment is due at the rate of one percent (1%) per month.The Owner shall be responsible for reasonable attorney's fees incurred by Contractor in collecting any sums due hereunder. F. WARRANTY 1. Upon final payment by Owner of the entire contract sum including all change orders and allotment overages (if any) due to Contractor, Contractor warrants to the Owner that the Work performed under the Page 11 of 14 Initials: S* 1 ' I Agreement is free from defects, not inherent in the quality used, in materials, equipment and workmanship for a period of two (2) years after the date of substantial completion as described in the Agreement. THIS LIMITED WARRANTY CONTAINS ALL EXPRESS WARRANTIES OF CONTRACTOR, ALL OTHER WARRANTIES EXPRESS OR IMPLIED ARE EXCLUDED AND HEREBY DISCLAIMED, INCLUDING WITHOUT LIMITATION, ALL WARRANTIES OF MERCHANTABILITY, HABITABILITY AND FITNESS FOR A PARTICULAR PURPOSE. Except for any warranties implied by law and not subject to exclusion, there are no warranties that extend beyond the express warranties set forth herein. The term of any warranties implied by law and not subject to exclusion shall end upon the termination of this Limited Warranty. In the event of breach by Contractor, the Owner's recovery shall be limited to the actual cost to repair any defect or deficiency covered by this Limited Warranty. The Owner waives any and all claims for incidental, consequential, special and consumer protection damages. The parties agree that Massachusetts law shall control this Limited Warranty and jurisdiction is proper in the Massachusetts Superior Court. The Owner shall notify the Contractor in writing, within 30 days after the discovery of any failure, defect or damage, otherwise the claim shall be deemed waived. In the event of an emergency failure (i.e. roof or plumbing leak), Owner should contact Contractor immediately by telephone or fax at the numbers listed above. If Owner gives Contractor proper notification and if the condition is covered by this Limited Warranty, Contractor or subcontractors chosen by Contractor will replace or repair the defect (the decision to repair or replace is Contractor's sole decision) at no charge or cost to Owner within a reasonable time, not to exceed sixty days, unless weather conditions, labor problems or shortages causes delays. Any steps taken by Contractor to correct defects under this Limited Warranty shall not extend the time of this Limited Warranty. 4. Owner acknowledges that the following, as applicable, are EXCLUDED from this Limited Warranty: A. Defects which are the result of characteristics common to materials used, such as, but not limited to, warping or deflection of wood; fading, chalking and/or checking of paint due to sunlight; cracks in concrete, plaster, brick, masonry, grouts and caulking due to drying and/or curing. B. Hairline cracks and seams in plaster and drywall other than those caused by structural defects, provided that joints are properly located to minimize cracking. Any repair of plaster or wallboard, caused by structural defects, may not completely blend with surrounding materials. C. Shrinkage, swelling, or leakage of doors and windows attributable to weather conditions. D. Occasional dents of interior woodwork and twisting, and hairline checking of wood framing, plywood, exterior siding and wood trim. E. Shrinkage or separation of hardwood flooring. F. Damage to roofs caused by snow or ice backing up under shingles or damage, if any, caused by windblown rain or snow through roof, gable or soffit vents, or louvers into attic space, unless caused by negligent workmanship or defective material. It is Owner's obligation to insure free passage in gutters and downspouts at all times. G. Fading or darkening of paints, stains and other finishes exposed to sunlight. H. Defects in items supplied or installed by Owner, or anyone other than Contractor or its subcontractors acting at the Contractor's order. I. Defects in materials or equipment that are covered by manufacturer's warranties including labor to repair same, even if such labor cost is not warranted by manufacturer. The Contractor, at the Owner's written request and at no expense to the Owner, shall act as the Owner's agent in pursuing the manufacturer for any defects in materials supplied and installed by Contractor. J. Damage due to abuse, improper or insufficient maintenance, improper operation, alteration, modification or normal wear and tear under normal usage. K. Contractor assumes no liability for damages to personal property of Owner. L. Loss or damage which the Owner has not taken timely action to minimize. Page 12 of 14 Initials: SDS/ 1 / a M. The presence or development of radon and mold are products of environmental conditions that are beyond the control of Contractor, therefore Contractor does not warrant and expressly disclaims any responsibility for the presence or development of radon or mold. G. OWNER'S SEPARATE SUBCONTRACTORS Owner shall not hire separate Subcontractors to work on the site at same time as Contractor without prior written consent from Contractor. Contractor reserves the right to not allow uninsured, unlicensed or unqualified subcontractors to work on the site at the same time as Contractor. Owner may hire separate Subcontractors to work on the site either before Contractor's date of Work Commencement or after final completion of the Work. H. WORK STOPPAGE, TERMINATION OF CONTRACT BY CONTRACTOR Contractor shall have the right to stop all Work on the project and keep the job idle if (1) payments are not made to Contractor in accordance with the Payment Terms in this Agreement, or if (2) Owner repeatedly fails or refuses to furnish Contractor with access to the job site and /or product selections or information necessary for the advancement of Contractor's Work. Simultaneous with stopping Work on the project, the Contractor must give Owner written notice of the nature of Owner's default and must also give the Owner a fourteen (14) day period in which to cure this default. If Work is stopped due to any of the above reasons (or for any other material breach of contract by Owner) for a period of 14 days, and the Owner has failed to take significant steps to cure his default, then Contractor may, without prejudicing any other remedies Contractor may have, give written notice of termination of the Agreement to Owner and demand payment for all completed Work and materials ordered through the date of Work Stoppage, and any other loss sustained by Contractor, including Contractor's overhead and profit at the rate of 18% on the balance of the incomplete Work under the Agreement. Payment for this final invoice is due within 7 days of submittal of invoice by Contractor. Thereafter, Contractor is relieved from all other contractual duties, including all Punch List and Warranty Work. If the contract is terminated and Owner pays all outstanding balances owed to Contractor, then materials ordered through the date of Work Stoppage become the property of Owner. I. TERMINATION OF CONTRACT BY OWNER The Owner shall have the right to initiate termination this Agreement if (1) the job remains idle for longer than fourteen (14) consecutive days after the Work has been started without reasonable written notification of the cause of the Work Stoppage by Contractor to Owner, or if (2) the Contractor repeatedly fails to perform the Work according to the Contract Documents. The Owner must give the Contractor written notice of the nature of the Contractor's default and must also give the Contractor a 14 -day period in which to cure this default. If the . Contractor fails to take significant steps to cure his default within the 14 -day period, the Owner may give written notice to Contractor of Owner's desire to terminate this Agreement. Upon receipt of the Owner's written notice of desire to terminate this Agreement, the Contractor has 14 days to respond with an invoice for payment for all Work completed and materials ordered through the date of Work Stoppage. Payment for this final invoice is due within 7 days of submittal of invoice by Contractor. After payment of final invoice Owner may terminate this Agreement and Contractor is relieved from all other contractual duties, including all Punch List and Warranty Work. If the contract is terminated and Owner pays all outstanding balances owed to Contractor, then materials ordered through the date of Work Stoppage become the property of Owner. The Contractor shall not be responsible for any incidental or consequential damages incurred by Owner as a result of such termination. J. DISPUTE RESOLUTION The parties agree that Massachusetts law shall control this Agreement and jurisdiction is proper in the Massachusetts Superior Court. Any controversy or claim arising out of or related to this Agreement involving an amount of less than the maximum limit of the small claims court must be heard in the Small Claims Division of the district where the Contractor's office is located. Any controversy or claim arising out of or related to this Agreement which is over the dollar limit of the Small Claims Court shall be settled by binding arbitration administered by the American Arbitration Association in accordance with the Construction Industry Arbitration Rules. The parties agree that mediation administered by the American Arbitration Association in accordance with the Construction Industry Page 13 of 14 Initials: Arbitration Rules shall be a condition precedent to arbitration. Judgment upon the award may be entered in any Court having jurisdiction thereof. K. ENTIRE AGREEMENT, SEVERABILITY, AND MODIFICATION This Agreement represents and contains the entire agreement between the parties. Prior discussions or verbal representations by the parties that are not contained in this Agreement are not a part of this Agreement. In the event that any provision of this Agreement is at any time held by a Court to be invalid or unenforceable, the parties agree that all other provisions of this Agreement will remain in full force and effect. Any future modification of this Agreement must be executed in writing in order to be valid and binding upon the parties. M. 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 Owner and returned to Contractor within that time. O. OWNER'S 3 -DAY RIGHT OF RECISION The Owner may cancel this agreement with no further obligations by notifying the Contractor in writing that they wish to cancel the agreement within 3 business days of the date they signed the agreement. I have read and understood, and I agree to, all the terms and conditions contained in the Agreement above. '5 14q�h XW. P -o& -f at tephen D. Howell ' owe 1, President Howell Custom Building Group, Inc. Date at3. e ate Page 14 of 14 Initials$�R/P' " ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD)YYYY) WHICH THIS 06/21/2012 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 CONTACT NAME: NORTH ANDOVER INSURANCE AGENCY, INC. PHONE FAX Exp, (978) 686-2266 �n//c -No). (978) 6e6a4io— M. J. FOSTER INSURANCE SERVICES ADDRESS: cfernandez@nafins. com 163 MAIN STREET PRODUCER CUSTOMER ID #HOWELL CUSTOM BUILDING GROUP INC ---- ----- ------------ NORTH ANDOVER MA 01845-2508 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A MAIN STREET AMERICA ASSURANCE '2_9.939 HOWELL CUSTOM BUILDING GROUP INC _ INSURER B :NATIONAL GRALQG MUTUAL INS. 360 MERRIMACK ST BLDG 5 2,000,000 INSURER :GUARD INSURANCE - Ste 4N -- -- ----- X POLICY , ---I PE T RO- LOC EPLI — --------i — ii PLI $ INSURER B AUTOMOBILE LIABILITYNIT7781E I ESSEX 1,000,000 INSURER E LAWRENCE MA 01843-1740 INSURER F COVERAGES CFRTIFICATF Nl1MRFR- RFVISION NIJMRFR- 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- ------ADOL SUER' -- � LTR TYPE OF INSURANCE ' INSR i WVD 1 POLICY - � POLICY EFF ' POLICY EXP NUMBER (MM)DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY i Y MPT7773E 06/01/2012 6/01/2013 EACH OCCURRENCE 1 , 000 , 000 _$ — / / / / �DACI%E TO RENTED X COMMERCIAL GENERAL LIABILITY _ ! ! I PREMISES_LEa ocwrr."C. $ 500 , 000 _ _ CLAIMS -MADE X- �. OCCUR i ! / / / / I MED EXP (Any one person) �. $ — 10,000 PERSONAL 8 ADV INJURY is 1,000,000 GENERAL AGGREGATE $ ---- 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS _COMP/OP AGG is 2,000,000 X POLICY , ---I PE T RO- LOC EPLI — --------i — ii PLI $ - 100,000 B AUTOMOBILE LIABILITYNIT7781E I 06/01/2012 06/01/2013 COMBINED SINGLE LIMIT $ � 1,000,000 (Ea accident) ANY AUTO ' ! BODILY INJURY (Per person) � $_ ALL OWNED AUTOS BODILY INJURY (Per accident) $ —_ X SCHEDULED AUTOS/- -- PROPERTY DAMAGE HIRED AUTOS / / / / (Per accident) $- .. NON -OWNED AUTOS I---------------------- / $ -- B X UMBRELLA LAB X :OCCUR ! CUT7773E 06/01/2012 06/01/2013 EACH OCCURRENCE S 3,000,000 EXCESS LIAR/ _ ' CLAIMS -MADE, 1 / / / AGGREGATE $ 3,000,000 DEDUCTIBLE , $ RETENTION S ! / / / / i I $ C. WORKERSCOMPENSATION �HOWC321401 06/01/2012 06/01/2013 WC STATU- i iOTH- X AND EMPLOYERS' LIABILITY Y / NI I TORY LIMITS___1 ER—L—__ ! _. ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N /A! --------� - —-- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below -- '— - — / / / / E.L. DISEASE - POLICY LIMIT $ -- — 500,000 A BOPPR - MPT7773E :06/01/2012 06/01/2013 !, INSTL 50,000 i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) li Mllrl�mlC r1VL.LJCR VANI:tLLA11V1V ( ) - (978) 887-1236 ATTN: BUILDING DE TOWN OF BOXPy IRD 7A SPOFFORd ROAD ACORD 25 (2009/09) INS025 (200909) 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 MA 01887- ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ' Office of Consumer Affairs and Business Regulation ,, 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Dome Improvement Contra_etor Registration Registration: 175166 Type: Corporation Expiration: 4/29/2015 Tr# 239150 HOWELL CUSTOM BUILDING STEPHEN HOWELL 360 MERRIMACK ST LAWRENCE, MA 01843 r Y Update Address and return card. Mark reason for change. '--' SCA 1 e; 20M-05/11 Address E] Renewal [] Employment Lost Card \ Office of Cousumer Affairs & Business Regulation License or registration valid for individul use only nt,F� OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ¢registration 175166 Type: Office of Consumer Affairs and Business Regulation expiration: ---4/9015;. Corporation 10 Park Plaza -Suite 5170 Boston, MA 02116 HOWELL CUSTOM BUILDING GROUP STEPHEN HOWELL-� / 15 MT VERNON RD BOXFORD, MA 01921 Undersecretary Not vafib without Signature L� W. Q � �M�3•` cww 'F+1 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 Print Form www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): t k0O -7Q -1 V g,,. ; \3 � Address: SOC-) Ci Phone #: 4-2k -9%q - 9 yV Are you an employer? Check the appropriate box: Type of project (required): 1. 54_ 1 am a employer with � 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 6. E] New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have employees and have workers' comp. insurance.+ 5. ❑ 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 reauired.l 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: &S,4,a� ��Scs c� nLp Policy # or Self -ins. Lic. #: IAOWCC 3Q \ `-i 0 k Expiration Date: Job Site Address: �70 &rJ2,cx k— Po,c_� 9S . City/State/Zip: A)o-AAAA J Jer r V1 -1A (DI�y� 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 certify under the pains and penalties of perjury that the information provided above is true and correct. S-/13/adI Phone #: Qi _'t" — 9�g — 9 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 #: ORESSER 40"x2O*' 83A3lLiNVO .0-,G C,e) C) Ln LLJ N w aa< cn C, u;) I s z) N A;) �j s n I D:) W of J'UOIIvaoud ORESSER 40"x2O*' 83A3lLiNVO .0-,G C,e) C) Ln LLJ N w aa< cn C, ORESSER 40"x2O*' 83A3lLiNVO .0-,G i u 7k o C; .0 C Yu 00 z 53uapjs3-H aN.[sni:):)W o ) rH^ V 01 SU04Yl OUd- r aaa W O o �w U� xoz woo O a O N q w U iv .U. cC1 (/1 D U C 4 p O � V a o a v z 53uapjs3-H aN.[sni:):)W o ) rH^ V 01 SU04Yl OUd- r aaa p F F- L CV 0 3 0 Z V) X W O (n W W ck� 0_ > w F— r' 0 z M Q U 0 F- W W V) V) W O o �w U� xoz woo O O N q U p F F- L CV 0 3 0 Z V) X W O (n W W ck� 0_ > w F— r' 0 z M Q U 0 F- W W V) V) W i cooO � cu y.60 aauap�sax a�snj�ay� o N V� z 'E 01 S'UOIIVaOUd-a s IL f 7 W cn d Li mmm I mS • „d —,9� 11d�J 13H l'I�M�.� !(�'?;'` 0 Am N U r 0- II < d O J ,< A y G O w C., t0 z zi O <om(/) it < CD ..,..Nz`�QNI�.o �N � G7 CL C tV L V C.2 N N rte+ a v o 0 7 s (-Dw Z V W J D co W cn d Li mmm I mS • „d —,9� 11d�J 13H l'I�M�.� !(�'?;'` � Am N U r 0- II < d O J ,< < O z zi <om(/) it < CD ..,..Nz`�QNI�.o �N CL s (-Dw Z V W J D co ad -899Z \La I .P,Z N W � n vzi o- �•J I�I W cn d Li �„ �. � V)d 0 • „d —,9� 11d�J 13H l'I�M�.� !(�'?;'` � ad -899Z \La I .P,Z N W � n vzi o- �•J I�I NNIS ; ,.l< N f �„ �. l9GJ\ • „d —,9� 11d�J 13H l'I�M�.� !(�'?;'` qm -0'2J d0 d01 JNnH :i 8anoa N 00 - M kn 107" 89" --18" 3011 ---� 3 6" 41 it 26" as LO C) I (N CY) (Y) j I.tl6 N 00 LO T - C'7 C� m a f� d �n a+ � 0 r N U O C [rico o. UD CD m co MCD 7 E W u, 1 xp O N cn ^' a 3 o- �l T s a !� I[ Ll c ; D.7 suoll1%aoud N <1 I G { CD ac 0 (N L Y a �� ` ' H 0 Q� M 0 01 SUOIlvaoud I �-Q Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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) T -A ❑ Notified for pickup - Date Doc.Building Permit Revised 2012