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HomeMy WebLinkAboutBuilding Permit #676-2017 - 92 BRIDGES LANE 1/3/2017_-vr-,_ 1 � BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ` Date Received ��SSACHUSE��� Date Issued: IMPORTANT: Applicant must complete all items on this pane TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building .One family Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition 0 Other Septic � Well � :r =y�-�`. < , �� ❑ Floodplain = �❑ Wetlands ;" 1� t r, Y {❑ :Watershed Dlstnct `y,r� ?.❑.Water/Sewer�� <�*�r"t a.':.��jt# :,;�����. 'r�`'�. ".'•.i?'�r'�..:.'��9'"s�'S: �y�� �. '��ifJ��� ��'+�� .-,y...J�53�:'" �-Y �,_�. � w '. D $CRIPTION OF WORO BF PREFO�MED' �Z' X ZO A4 I can o7 iec&v ->��- /�,� ,�, V;1/1V eX(l JJ i /ZV11 Ps OWNER: Name: Please Type or Print Clearly) �p 5060 r).52C W- 6'o;/ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $$1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ q , ��� 9� FEE: $ 9757 Check No.: I� Receipt No.: . NOTE: Persons, contracting with unregistered contractors do not have access to the guayanfwd I Location A No. Ii�CG1 Date . - :TOWN OF NORTH ANDOVER Check # # i Certificate of Occupancy $ Building/Frame Permit Fee $ d� Foundation Permit Fee T $_.-N Other Permit Fee $ TOTAL $ Zp // Ll Building Inspector Michael Livingston Production Department Manager mlivingston@blackdogbuilders.com Plans Submitted ❑ Plan ph: 603.898.0868 c: 603.234.0594 fx: 603.898.0821 TYPE OF SEWERAGE DISPOSAL ❑ 7 Red Roof Lane, Unit 1 Public Sewer Salem, NH 03079 Well I www.blackdogbuilders.com Private (septic tank, etc. Am �__ Permanent Dumpster ori Side CI— Plans ❑ In THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF.- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ Z9 61 COMMENTS K CONSERVATION COMMENTS X HEALTH Reviewed o Reviewed o 13 1- CDe ` QJ 2 d t ( Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comme Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Plans Submitted 11 Plans Waived 11Certified Plot Plan F1 Stamped Plans El TYPE OF SEWERAGE DISPOSALF] Swimming pools El Public Sewer 11Tanning/Massage/Body Art Well ❑ Tobacco Sales El Food Packaging/Sales El Private (septic tank, etc. Permanent Dumpster on Site F THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF U FOR DATE REJECTED DATE APPROVED 11 ElPLANNING & DEVELOPMENT U� COMMENTS K. CONSERVATION COMMENTS Y HEALTH COMMENTS Reviewed on Si nature Reviewed on Si nature oning Decision/receipt submitted yes Zoning Board of Appeals: Variance, Petition No: Z ents Planning Board Decision: Comm . Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Straat 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.$10041000 fine IVV I G.7 uuu-- CM z 2 V c e.,j I -i i V� ✓h ® Notified for pickup - Date i Doc.Building Permit Revised 2008 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 'tea Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑. Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) - ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 a CD .0 Z D O Cr Q �. � O 0v CD C� a CD o LWJ O R c n 0 CD cn y O O CD 0 CD 0 0 " 0 __ N — < CD .a CA CCL D CD -%n n n. 0 3 m o _s � -0 N CD TI 00r.n m W nO cn y O U) OEL 2 7 O O � C7 CL O N D) _, 0 O n O CD CY r ► =r S O CD CD -0 OO O' < t4 uw O to� o � ozo CD ?0. a CL r: D `D U) =n CL O Q CDCD CD ` CD CL :11� U) '0 �'0 CD N 0 m � 0 CC 3 O O S rt C O S CD 3 CD ID9 � ~ O N D CD :r y 0 2) 0 o � rCL • Ln � rD M N rD Z z O co C =3m Z MT O s d m ,O O ac s m T cu m oma s Cl)� T °—' r) :3 rD cn- T a- sv b N n N < T a n C7 v o y mO z m G) z �+ 11 x Z a cn Z O M m �m 3 :3 C= cn � Z cn O Cl) ao c F z c) 0 " 0 __ N — < CD .a CA CCL D CD -%n n n. 0 3 m o _s � -0 N CD TI 00r.n m W nO cn y O U) OEL 2 7 O O � C7 CL O N D) _, 0 O n O CD CY r ► =r S O CD CD -0 OO O' < t4 uw O to� o � ozo CD ?0. a CL r: D `D U) =n CL O Q CDCD CD ` CD CL :11� U) '0 �'0 CD N 0 m � 0 CC 3 O O S rt C O S CD 3 CD ID9 � ~ O N D CD :r y 0 2) 0 o � rCL • Ln � rD M N rD Z z O co C =3m T O MT O s d In O � fD n ,O O ac s T cu m oma s T °—' r) :3 rD .TJ u�o S T a- sv b N n N < T a n v o y mO z G) z �+ 11 m mc a Vf m Z O M m C ccl M n 3 :3 W c O m rD- s ,qw ow-, 0 c The Commonwealth ofMassachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street s Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors)EIectricians/Plumbers )pficant Ynfnrmn inn Name (Business/Organization&dividual): Address: g e l Roof 1-4nt City/State/Zip:_ sf^ljy 0 f7 D Phone #:7105)791-0944 Are you an employer? Check the appropriate box: 1..tM I am a em to er with ' p � 4. ❑ I Y am a general contractor and I employees (full an part-time).* 2. ❑ I am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing .officers have exercised their all work right of exemption per MGL myself. [No workers' comp, c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp, insurance rewired Type of project (required): 6. ❑ New construction 7. ® Remodeling 8. El Demolition 9. ,4 Building addition 10-ElElectricalrepairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs q ] Homeowners 13.❑ Other musI Any applicant that checks box #1 t also fill out the section below showing their workers' compensation policy information. 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 their workers' comp, policy information. I am an employer that is providing workers' compensation insurance for my em information. ployees Below is the policy and job site Insurance Company Name: Policy # or Self -ins. Lie. #:_ }� I�i% jrj�/J5 /y . 0 j Expiration Date: � 1 Job Site Address:_ "l� 6(i LJG� lAnt )4a It,,�Qr �✓%/� City/State/Zip: , Attach a copy of the workers' compensation policy declaration page (showing the y �����U �� r�J� yf ( g policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL 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 maybe forwarded to the Office of Wvestigations of the DIA for insurance coverage verification. r do hereby certifJ ysnder tl1e pain. ,' n�penalties ofperjury that the information provided above is true and correct. Official use only. City or Town: Do not write in this area, to be completed by city or town official. Permit/License Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electric 6. Other al Inspector 5. Plumbing Inspector Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,_ an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartinents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance -or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers', compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy; please call the Department at the number listed below. Self-insured companies should enter their self-insurance Iicense 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 permithicense number which will be used 2s a reference number. In addition, that must submit multiple pernut/hcense applications in angiven ear, ion, is applicant Y g y , need only submit o Policy ,� Y one affidavit indicating current me info p y nnatmon (if necessary) and under Job Site Addie ' Address" the applicant should write all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address telephone and fax p number: The ConumonwaRth- oa Massaciausetts Department of Industrial Accidents Office of Investigatious. 600 Washington Street Boston; MA, 02111 TQ1. # 61.7•-727-4900 ext 4406 ox 1-877-MASSAFE Revised 5-9.6_ns Fax # 61.7-727-•7749 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(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 Phone: 603-424-9901 Brown 8, Brown (Merrimack) F 8668481223 309 Daniel Webster Highway Fax: - - Merrimack, NH 03054 Chris McPhail TACT NAME: PHONE FAX A/c No Ext): A/c No); E-MAIL ADDRESS: LIMITS INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Peerless Indemnity Ins Co 18333 INSURED Blackdog Builders, Inc, INSURER B: Peerless Indemnity Ins Co 18333 Blackdog Builders Investment Holdings, LLC INSURER C INSURER D: Total Bsmnt Finishing Systems 7 Red Roof Lane Unit #1 Salem, NH 03079-2984 INSURER E BKS55511514 07/01/2016 INSURERF: 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. INSIRLTR LTR TYPE OF INSURANCE ADDL SWVD UER POLICY NUMBER MM/DDNYYY LICY EFF MM DD/YYLI Y YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY BKS55511514 07/01/2016 07/01/2017 AMAGE TO PREMISES Ea occurrence) $ 300,000 MED EXP (Any one person) S 15,00 CLAIMS -MADE FXI OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICY PRO LOC AUTOMOBILE LIABILITY (CEO OMBINED SINGLE LIMIT accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO BAS55511614 07/01/2016 07/01/2017 BODILY INJURY (Per accident) $ ALL OWNEDSCHEDULED X AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS PadnDAMAGE $X (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ B EXCESS LIAB CLAIMS -MADE US055511514 07/01/2016 07/01/2017 DED I X I RETENTION $ 10000 $ B WORKERS COMPENSATIONWCSTATU- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Fy] (Mandatory in NH) NIA XWO55511514 07/0112016 07/01/2017 OTH- RY LI E E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 1 $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Property Coverage BKS55511514 07/01/2016 07/01/2017 Property 272,041 Deductibl 2,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) *David Bryan is excluded from Worker's Compensation coverage. The Town of North Andover 120 Main Street North Andover, MA 01845 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 (Y,RP/�& ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD BLACK -1 OP ID: BB CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 07107/2016 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 Phone: 60324-9901 Brown & Brown (Merrimack)Fax: 8668481223 309 Daniel Webster Highway - - Merrimack, NH 03054 Chris McPhail CONTACT NAME: PHONE FAX AIC No ExtI: A/C, No): E-MAIL ADDRESS: BKS55511514 07/01/2016 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Peerless Indemnity Ins Co 18333 DAMAGE ( RENTED PREMISES Ea occurrence) $ 300,000 INSURED Blackdog Builders, Inc, INSURER B: Peerless Indemnity Ins Co 18333 Blackdog Builders Investment Holdings, LLC INSURER C: INSURER D Total Bsmnt Finishing Systems 7 Red Roof Lane Unit #1 $ Salem, NH 03079-2984 INSURER E: LIABILITY ANY AUTO SCHEDULED AUTOS AUTOS ALL OWNEDIx HIRED AUTOS NON -OWNED AUTOS 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 LTR TYPE OF INSURANCE ADDL S BR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR BKS55511514 07/01/2016 07/01/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE ( RENTED PREMISES Ea occurrence) $ 300,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO SCHEDULED AUTOS AUTOS ALL OWNEDIx HIRED AUTOS NON -OWNED AUTOS BAS55511514 07/01/2016 07/01/2017 COMBINED SINGLE LIMIT 1,000,000 Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE US055511514 07/01/2016 07/01/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ DED I X I RETENTION $ 10000 $ B WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1A XWO55511514 07/01/2016 07/01/2017 STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) *David Bryan is excluded from Worker's Compensation coverage. CERTIFICATEAetDf - CANCELLATION ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Informational Purposes Only +� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PC C 1� +�+ 5> N o 0 4 ►� Q% 0 IN N Q! N C ' y rA L �? 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Z00 00 a Z W Q 00 N U) z z E >��n LL h C C o c CL - F- z I\ O W W p 'S o W y M J W CD d 0'm a D Z M m w SR' W m Q LL O N 0 J> O= o F- a z CO y O Q Q 1 U 11.1 PC LANE oti , r h'J r i C-)r , to r r r r J� 0) ZQc PZ o Z 1 i cp SOW by ;j ; � I N N Z:,°. ti °p o" ►-------J t 30.0' a �. a ^I m v a 34.1' .9'9ti CID CN O 04 W � Z A a Q p0LQW Nm 0�(r)o 25 Lu Z) IAJ Qo° OC)L Z W WJW � � r -j Q Oo O o0 �f- Gw � hP M s 0� 0 Section of the Business Conditions 08/16/2016 Contract Proposal — Page 3 of 29 BUSINESS CONDITIONS TO THIS CONSTRUCTION CONTRACT This Contract, dated 08/13/2016 is by and between: Ted Lewis and Susan Sabia 92 Bridges Lane North Andover, MA 01845 Blackdog project code LEWIS-16731 (Hereafter referred to as OWNER), and Blackdog Builders, Inc. 7 Redroof Lane, Unit #1 Salem, NH 03079 (603) 898-0868 (Hereafter referred to as CONTRACTOR). Work will be performed at: 92 Bridges Lane, North Andover, MA 01845 (Hereafter referred to as PROPERTY) 1. GENERAL This CONTRACT is for the following work and materials to be performed by the CONTRACTOR on the PROPERTY address shown above. The project is generally described as follows: Whole house renovation (Hereafter referred to as WORK) The CONTRACT consists of this document, any plans, the specifications, the Blackdog client package and the Construction Contract. (Hereafter collectively referred to as the "CONTRACT') Q. PRICE - The total price for the WORK agreed upon is $229,745.59. Payment terms are set out below in Paragraph 6. This proposal may be withdrawn by us if not accepted within thirty (30) days. 3. STARTING AND SUBSTANTIAL COMPLETION PROVISIONS The WORK will begin on approximately 9/2016 and will be substantially completed, on 1/2017, absent unusual or unforeseen circumstances beyond the control of the CONTRACTOR, and providing this CONTRACT and any related CONTRACT documents are accepted when presented. Projects requiring two contracts (one for construction work and one for bath or kitchen product) will not be slotted into the schedule until both agreements have been executed. The aforementioned dates reflect our present workload. Projects are assigned a slot in our work schedule as they are accepted, on a first come first served basis. These dates may move based on the completion time of the project that immediately preceded yours. 4. PERMITS AND APPLICABLE CODES; COMPLIANCE WITH LOCAL LAW All work to be done under this CONTRACT will be in accordance with local, state and county building code. The CONTRACTOR shall obtain all necessary permits and pay all required permit and plan fees from the CONTRACT sum, unless otherwise agreed. The CONTRACT price does not include any fees, which may be incurred to obtain a variance, if required. The CONTRACT price does not include any unbid items required by any local building official to bring the project into compliance with any relevant local, state and county building code. 5. SPECIFIC REQUIREMENTS FOR MATERIALS AND WORKMANSHIP 08/16/2016 Contract Proposal — Page 4 of 29 M a. This CONTRACT will be completed by the CONTRACTOR in a good and workmanlike manner, using quality materials. b. If applicable, the CONTRACT price includes the following allowances: See allowances under specifications. 6. PAYMENT a. Timely payment by the OWNER of all sums due under this CONTRACT is of the essence to this CONTRACT. The parties agree to the following schedule of payments: Deposit with this contract: $34,461.84 b. Payment Schedule Start of footings $22,285.00 Start of framing $22,285.00 Start of window installation $22,285.00 Start of electrical or plumbing trim $22,285.00 Start of electrical rough -in $22,285.00 Start of drywall hanging $22,285.00 Start of trim $22,285.00 Start of floor covering $22,285.00 Substantial Completion $9,689.00 Completion of Punch List $5,814.75 c. Allowances for Owner Selected Components Closet Systems $2,570.00 Carpet $3,075.00 d. The CONTRACTOR may cease operations. if any payment is not made by the OWNER as required herein, and proceed to collect any balance due through any remedy provided by law. Payments are due when the aforementioned progress milestones have been reached. It is understood that minor adjustments to the payments schedule may be necessary due to the flow of work or delays beyond the control of the CONTRACTOR. e. Delays in payment in excess of thirty (30) days shall be subject to interest charges of 18% per annum, and no event higher than the maximum interest rate provided by law. If the CONTRACTOR is required to engage the services of a collection agency or an attorney, the OWNER agrees to reimburse the CONTRACTOR for any reasonable attorney's fees and expenses expended in order to collect the unpaid balance. f. DEFINITIONS Substantially complete - The space or project is substantially complete when the space or project can be used for its intended purpose and only punch list items remain. Punch list - Work or product that has not been performed or provided. Warranty item - A product or service that has been provided or performed that does not meet or exceed industry standards. THESE CONDITIONS MUST BE ACCOMPANIED BY THE CONSTRUCTION CONTRACT 08/16/2016 Contract Proposal — Page 5 of 29 Section I I ..A. Gonstruction Contract 08/16/2016 of the Contract Proposal — Page 6 of 29 CONSTRUCTION CONTRACT This Contract is by and between: Ted Lewis and Susan Sabia hereafter referred to as "OWNER", and Blackdog Builders, Inc hereafter referred to as "CONTRACTOR" for work at 92 Bridges Lane, North Andover, MA 01845 dated 08/13/2016. This CONTRACT consists of this document, any plans, the Specifications and Business Terms that are enclosed and the Blackdog Builders Client Package. (Hereafter collectively referred to as the "CONTRACT") 'I. CONTRACTOR'S DUTIES -- GENERAL a. To direct and control the work contracted for in accordance with the terms of this CONTRACT and all applicable codes, laws, and regulations, and as the building permits issued for this project, if any, require. b. To inspect the site, examine the plans and specifications, if any, and supervise all of CONTRACTOR's employees, and to direct the work of all subcontractors selected by CONTRACTOR. c. To maintain the work site in a safe and clean condition, to the extent consistent with the CONTRACT. d. To advise the OWNER promptly if concealed conditions are ascertained which require additional or different work, and to proceed in such event in accordance with ,this CONTRACT. e. To provide locked storage for any equipment, tools, or other PROPERTY used in the performance of this CONTRACT, unless otherwise agreed in writing. 2. OWNER'S DUTIES -- GENERAL a. To provide adequate utilities for the work agreed upon. b. To advise the CONTRACTOR of any condition of the PROPERTY which affects CONTRACTOR's ability to perform. c. To provide secure storage areas for materials delivered to the work site d. OWNER shall be entitled to make periodic inspections of the work site, provided such inspections do not interfere with the work and can, in the judgment of the CONTRACTOR, be made safely. Any other entry onto the construction site shall be at OWNER's risk. e. OWNER shall notify his insurance agent of the execution of this agreement and obtain any necessary riders to his current coverage or any locally customary forms of coverage, such as builders risk, to cover OWNER's interests and liabilities during the construction process. f. To perform no work on the project without a written agreement with the CONTRACTOR. g. To make no agreements with any trades person, subcontractor, or CONTRACTOR'S employees outside the scope of this CONTRACT without the written consent of the CONTRACTOR. 3. MATERIAL SUBSTITUTION CONTRACTOR reserves the right to substitute other materials, products and/or labor of equal or superior quality, utility, or similar color. 4. DELAY CONTRACTOR shall not be responsible for delays caused by events beyond the control of the CONTRACTOR, including but not limited to: strikes, war, acts of God, riots, governmental regulations and restrictions. Delays caused by OWNER's failure to make allowance materials selections or caused by the performance by CONTRACTOR of extras or necessary work (as described in Paragraph 6) shall likewise be excusable delays. 5. INSURANCE CONTRACTOR agrees to maintain all necessary forms of insurance to protect the OWNER from liability for any occurrence arising from the performance of this Contract. CONTRACTOR agrees that he shall cover his own employees for worker's compensation and carry general liability insurance, and that all forms of insurance referenced herein shall be with reputable companies licensed to do business in the state where the project is located. 6. HIDDEN CONCEALED and UNFORESEEN CONDITIONS 08/16/2016 Contract Proposal — Page 7 of 29 a. The parties agree that in the event CONTRACTOR discovers a hidden, concealed or unforeseen condition requiring an extra cost that they shall proceed as follows: The CONTRACTOR shall notify the OWNER verbally to expedite agreement as to any charge necessary to correct or cure such condition, and provide a written Work Order (as described in paragraph 7a) as soon as practicable. The parties must agree to such extra charges, or agree to a resolution method, or this CONTRACT may be cancelled by either of them. b. For purposes of this section, a "hidden, concealed and unforeseeable condition" shall mean a condition not readily observable to a prudent CONTRACTOR inspecting the subject PROPERTY for the purpose of performing this Contract. Examples of such conditions can include, but are not limited to; rot under siding; ledge below grade; pre-existing plumbing or electrical work not performed to code and pre-existing mold. c. Any change in the WORK required by building officials assigned to this project, including structural and/or any environmental hazards will be billed as an EXTRA charge to this CONTRACT and paid for by the OWNER as a Work Order. CONTRACTOR may cease operations if OWNER refuses to pay. 7. EXTRAS a. Any extra work or materials desired by the OWNER shall be agreed upon in writing and such extras shall become a part of this CONTRACT as if fully set forth herein. Unless otherwise agreed, extra work shall be paid for as performed. Failure of the OWNER to sign a Work Order shall not preclude recovery for any work performed by CONTRACTOR, and acceptance of said extra work or materials shall be presumed, unless there is written notice to the contrary. b. CONTRACTOR shall advise OWNER, at the time of agreement on an extra, as to any additional time required to perform this CONTRACT. CONTRACTOR may cease operations if OWNER refuses to pay. 8. ESCALATION CONTRACTOR reserves the right to pass on additional costs to OWNER resulting from the escalation of the cost of lumber or lumber byproducts. This cost may be passed on only, if after the CONTRACT is signed but before the construction commences, an increase in lumber costs is experienced. The CONTRACTOR must substantiate the change with evidence of the difference between lumber costs at the time of the CONTRACT and lumber costs at the time of construction. Only direct cost differences may be passed on, no allowances for overhead and profit shall be included. Any additional costs will be collected per Work Order (as described in paragraph 7a.). 9. EXCESS MATERIALS ON SITE CONTRACTOR routinely stores extra materials on site to improve efficiency and reduce the likelihood of running out of stock in the middle of a task. Unless otherwise specified in writing all excess materials on site at the end of the project are the PROPERTY of CONTRACTOR. 10. SUBCONTRACTORS a. CONTRACTOR shall select subcontractors as required to complete this CONTRACT. OWNER acknowledges that subcontractors will do various portions of the work. Any subcontractor selected by the CONTRACTOR shall have all requisite licenses for the work to be done by such subcontractor. b. It shall be the duty of the CONTRACTOR to use reasonable care in the selection of subcontractors. Absent objectionable performance by any subcontractor, the selection of subcontractors shall be an exclusive right of the CONTRACTOR. The CONTRACTOR shall require all subcontractors to have workman's compensation and liability insurance in force. c. CONTRACTOR agrees to be solely responsible for the completion of the work described herein regardless of the actions of any third party/subcontractor utilized by the CONTRACTOR. The CONTRACTOR further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. 11. TERMINATION AND CANCELLATION The CONTRACTOR may terminate and cancel this CONTRACT if any payment called for hereunder is not received as scheduled, provided that notice is given to the OWNER as provided below. Upon such termination, the CONTRACTOR shall have all remedies provided by law, including such lien rights as then apply. The OWNER may terminate this CONTRACT upon the following conditions: a. Failure of the CONTRACTOR, or his subcontractors, to pursue the work contracted for, absent excusable delay, as provided in Paragraph 4 above, for a continuous period of fourteen(14)days, without a written agreement permitting same, such agreement may be satisfied by a single notation to this CONTRACT. b. Failure of the CONTRACTOR to rectify any condition for which building code enforcement authority has issued a citation of violation notice, within fourteen(14)days' notice of such violation, unless OWNER and 08/16/2016 Contract Proposal — Page 8 of 29 CONTRACTOR otherwise agree. c. Any other failure to perform this CONTRACT required by the terms of this CONTRACT d. No termination shall be effective unless 10 days written notice of OWNER'S intent is given as required below, during which time the default may be cured by the CONTRACTOR. e. Deposit monies - Cancellation of this CONTRACT prior to the commencement of work shall result in the forfeiture of any and all deposit monies collected. All deposits are non-refundable. The parties hereby agree that upon such cancellation, the CONTRACTOR shall suffer damages including but not limited to the cost associated with designing and preparing the project for commencement. f. You may cancel this agreement by observing the requirements of The Notice of Cancellation attached hereto 12. DISPUTE RESOLUTION If a dispute arises out of or is related to this Contract, or the breach thereof, the parties shall endeavor to settle the dispute first through direct discussions. If the dispute cannot be settled through direct discussions, the parties agree the dispute shall be settled by arbitration as follows: New Hampshire Consumers: If the dispute with a New Hampshire customer cannot be settled through direct discussions, the parties agree the dispute shall be settled by arbitration administered by the American Arbitration Association under its Construction Industry Arbitration Rules. In the event that arbitration is necessary, the parties agree that arbitration proceedings shall be conducted by a mutually agreed upon arbitrator in Rockingham County, New Hampshire. If the parties cannot agree on an arbitrator, either party may file a written demand for arbitration in accordance with the rules of the American Arbitration Association. The arbitration award shall be final and judgment on the award may be entered in any court having jurisdiction thereof. This CONTRACT shall be governed and interpreted in accordance with the laws of the State of New Hampshire. The parties acknowledge that this agreement to arbitrate shall be governed by Chapter 542 of the New Hampshire Revised Statutes Annotated. Either party may, without waiving any remedy under this CONTRACT, seek from any court having jurisdiction any interim or provisional relief that is necessary to protect the rights or PROPERTY of that party, including but not limited to the right to seek liens or attachment. The prevailing party in any dispute arising out of or relating to this CONTRACT or its breach that is resolved by a binding dispute resolution process shall be entitled to recover from the other party reasonable attorneys' fees, costs and expenses incurred by the prevailing party in connection with such dispute resolution process. Massachusetts Consumers: If a dispute with a Massachusetts customer cannot be settled through direct discussions, the parties agree the dispute shall be settled by arbitration administered by the Massachusetts Home Improvement Contractor Law (MGL.c142A). This law provides homeowners with the right to initiate an arbitration action (as an alternative :to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a contractor. The contractor would have to resolve any dispute it has with a homeowner in court unless both parties agree to the following optional provision. This provision gives the contractor the same rights to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. 'The CONTRACTOR and OWNER, residing in Massachusetts, hereby mutually agree in advance that in the event the CONTRACTOR has a dispute concerning this CONTRACT, the CONTRACTOR may submit the dispute to a private arbitration firm approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the OWNER shall be required to submit to such arbitration as provided in Massachusetts Laws, chapter, 142A. Either party may, without waiving any remedy under this CONTRACT, seek from any court having jurisdiction any interim or provisional relief that is necessary to protect the rights or PROPERTY of that party, including but not limited to the right to seek liens or attachment. The prevailing party in any dispute arising out of or relating to this CONTRACT or its breach that is resolved by a binding dispute resolution process shall be entitled to recover from the other party reasonable attorneys' fees, costs and expenses incurred by the prevailing party in connection with such dispute resolution process. Consumers in Massachusetts shall be required to submit to such arbitration as provided in MGL c. 142A. 08/16/2016 Contract Proposal — Page 9 of 29 v , Ted Lewis abina S lig nn Design Susan Sabia Blackdog Builders, Inc. Notice: The signature of the parties above constitutes an acknowledgement of the agreement between the parties to alternative dispute resolution. Massachusetts consumers may have the right to initiate alternative dispute resolution even where this section is not signed by the parties. g. Unless otherwise agreed in writing, CONTRACTOR shall continue the WORK and maintain the agreed work schedule during any dispute resolution proceedings. CONTRACTOR's obligation to continue to perform is conditioned upon OWNER's timely payments ih accordance with terms of this Contract. 13. ENVIRONMENTAL HAZARDS a. The CONTRACTOR is NOT responsible for the inspection, discovery, abatement or removal of any environmental hazard including, but not limited to: asbestos; mold; lead; radon; ground water or environmental pollution at the work site, unless specifically covered in the specifications. b. In the event that any hazardous material is discovered during the course of construction, the testing, abatement and/or removal shall be the sole responsibility of the OWNER. c. Any additional costs incurred on account of suspension of the construction or changes to the specifications due to a hazard or its removal are the responsibility of the OWNER and will be handled by a Work Order. d. In the event that work does not resume within 30 days of the stoppage, OWNER agrees to immediately pay the CONTRACTOR the pro -rated amount of the CONTRACT price applicable to work done up to that point pursuant to the Contract. WARRANTY OWNER warrants that as of the date of this CONTRACT: (1) the PROPERTY (including the land, surface water, ground water, and improvements to the land) is, and will continue to be, free of all contamination, including (a) "oil, petroleum products, and their by-products" (b) any "hazardous waste" as defined by the Resource Conservation and Recovery Act of 1976, as amended from time to time, and regulations promulgated thereunder; (c) any "hazardous substance" as defined by the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as amended from time to time, and regulations promulgated thereunder, specifically including asbestos and mold; and (d) any other "hazardous substance" (2) the PROPERTY is in compliance with all environmental laws and regulations; and (3) there are no underground tanks on the PROPERTY I,1111DIViRlIlI 7 OWNER expressly acknowledges and agrees that it will reimburse, defend, indemnify and hold harmless CONTRACTOR, all Sub -contractors, their successors, assigns and employees from and against any and all liabilities, claims, damages, penalties, expenditures, losses or charges (including, but not limited to, all costs of investigation, monitoring, legal fees, remedial response, removal, restoration or permit acquisition) which may, now or in the future, be undertaken, suffered, paid, awarded, assessed, or otherwise incurred as the result of: (a) any contamination, existing in, on, above or under the PROPERTY (including, but not limited to, contaminated soil, mold, buildings, facilities and/or ground water); (b) any investigation, monitoring, clean up, removal, restoration, remedial response or remedial work undertaken on the PROPERTY; and (c) OWNER'S breach of any warranty given herein. 14. ,WARRANTIES a. The work of the CONTRACTOR, including materials and labor, shall be warranteed for a period of three (3) years, during which period CONTRACTOR shall at its own expense correct any defect arising from its work unless it is a non -warrantable condition as set out in the Blackdog Builders Client Package. That package shall become a part of this CONTRACT as if fully set forth herein. b. Any and all warranties for appliances or mechanical systems shall be delivered to OWNER as the CONTRACTOR receives them. Owner agrees to hold manufacturers solely responsible for all warranties for appliances or mechanical systems and agrees that no action may be brought against the CONTRACTOR on this Contract as a result of manufactures warranties. 08/16/2016 1 Contract Proposal — Page 10 of 29 c. The quality of any work in question will be held to the standards issued in the Residential Construction Performance Guidelines — Fourth Edition published by the NAHB. 15. SEVERABILITY If any portion of this agreement is found invalid or unenforceable by any court, the remaining provisions shall remain in force between the parties. 16. ENTIRE AGREEMENT Upon signing this document becomes a binding CONTRACT under law. Unless otherwise noted within this document, this contract shall not imply that any lien or other security interest has been placed on the residence. This CONTRACT consists of the documents defined herein, and constitutes the entire agreement of the parties. It can be modified only by a written document. OWNER acknowledges that he has read and received a legible copy of this agreement signed by CONTRACTOR, before any work was done, and that he has read and received a legible copy of every other document that OWNER has signed during the negotiation of this Contract.. 17. THREE DAY RIGHT TO CANCEL THIS CONTRACT You may cancel this agreement if it has been signed at a place other that the CONTRACTOR'S normal place of business, provided you notify the CONTRACTOR in writing by not later than midnight of the third business day following your signing of this agreement. See the notice of cancellation form attached hereto for an explanation of this right. 18 Massachusetts Home Improvement Contractor Law ( MGL.c142A) All home improvement contractors/subcontractors working in the Commonwealth of Massachusetts must be licensed and registered by the Office of Consumer Affairs and Business Regulations. All inquiries concerning the CONTRACTOR should be transmitted to those offices. In Massachusetts Blackdog Builders, Inc. operates under License number CSO48847 and Registration number 106877. Federal Tax ID. Number 02-0477778. a. Massachusetts homeowners securing their own permits will be excluded from the Guaranty Fund provisions of MGL c. 142A. b. In Massachusetts the deposit shall not exceed 1/3 of the total contract price, or the cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule, whichever is greater. PLEASE DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Two identical copies of this contract must be completed and signed. One copy shall go to the OWNER with the second copy being retained by the CONTRACTOR. NO WORK shall commence until this contract is fully executed. SUBMITTED: abina Seli n �Designe Blackdog Builders, Inc. ACCEPTED: DATE 0814/ DATE: zb : Cp Ted Lewi DATE: a Susan Sabia 08/16/2016 Contract Proposal — Page 11 of 29 A Blackdog Builders, Inc. Notice of Cancellation Received on this day: 08/13/2016 Ted Lewis and Susan Sabia You may cancel this transaction, without any penalty or obligation, within three business days of the aforementioned transaction date. If you cancel any property traded in, any payments made by you under the agreement, and any negotiable instruments executed by you will be returned within 10 business days following receipt by the CONTRACTOR of your cancellation notice. Any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the CONTRACTOR, at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement. Alternatively you may comply with the instructions of the CONTRACTOR regarding the return shipment of goods at the CONTRACTOR's expense and risk. If you do make the goods available to the CONTRACTOR and the CONTRACTOR does not pick them up within twenty (20) days of your notice of cancellation, you may retain or dispose of the goods without further obligation. 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