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HomeMy WebLinkAboutBuilding Permit #569-15 - 92 COLONIAL AVENUE 12/22/2014 O�,t�ao 6'�•p BUILDING PERMIT °off TOWN OF NORTH ANDOVER A APPLICATION FOR PLAN EXAMI I Permit NO: Date Received * � AS Date Issued: �i� CHU IMPORTANT:Applicant must complete all items on this page LOCATION___JZ C-6 10 n t at AVIL Print PROPERTY OWNER 4.LAtAxw__.7,Al Print MAP NO: PARCEL:_ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non-Residential D New Building **One family D Addition D Two or more family D Industrial D Al ration No. of units: D Commercial VlRepair, replacement D Assessory Bldg D Others: D Demolition D Other Septic '7 Well G Floodplain Wetlands ❑ Watershed District Water/Sewer •n CA iccorja VIC& 4n 161A M", 6".5 C a sa- 6e idt" W,iA n ejz Identification Please Type or Print Clearly) OWNER: Name: M i kl/_ Cw1A 1 Phone: IT79. 317. 9 /q Address: CONTRACTOR Name: WiW A✓Kb�I Phone: q4 376'tWT Address: J B0 Supervisor's Const ction Li nse: ��I � Exp. Dater Home Improvement License: Exp. Date: , /Z7J&16 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 100 _FEE: $ Check No.: Receipt No.: 0 tar' C /OwNOTE: Persons c ntracti with ?=ignature contractors do not have access to the guaranty fund Signature of Agentner of contractor b �- t � •, r,�� � S R 1 � t f S L a {' . i Y � ' � �• S r ^t �I" � F x t M • ! F4 a ' j .. t � A w t f � � ��, l e • {`��/ V +t- r L V P V y P r + f � 1 � i t M J,� a � �� i i F '•4,'„1e ~. R ' •i 4F y r P 4 e .. i � � '�� f.s R !ZJ 6 < a Y. i, .. •, M \ • .+.� Y •P wn• � I y,' .. �..` 1u./war • °� > i • t • `R � , . - � I �, � ��" � � J > w. i, i �" s tT tiORTIi BUILDING PERMIT °F�t,Eo "moo TOWN OF NORTH ANDOVER �2zh '' APPLICATION FOR PLAN EXAMINATION e Permit No#: Date Received '1s�4�AATEo �SSACHus�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print 1 PROPERTY OWNER. - Print 100 Year Structure yes no MAP ...PARCEL: _ ZONING DISTRICT:`Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic El Well ❑ Floodplain El Wetlands El Watershed Distract ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: . ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons cantracting with unregistered contractors do not have access to the guaranty fund _10— SS g ture of Agent/Owner Signature of contractor I 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Pians Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well P Tobacco Sales ❑ Food Packaging/Sales El Private(septic tank,etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORTY! i DATE REJECTED DATEAPPROVED PLANNING &DEVELOPMENT ❑ ]� COMENTS TMO _ : c.a a r�k��`tit.. ne,,,f h6v'1A- Eiec�c-i VG* �.I�n�s�r,�,y� Dear "Co iu��kallt-lE:e.n .s�ry�e�) M►.�cn��lt.s CONSERVATION ❑ ❑ hJ51 C, c� { COMMENTS P4-61-t 0- (o i DATE REJECTED DATE APP OVE HEALTH ❑ COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connectiorvsignature&Date Driveway Permit Located at 384 Osgood Street DIRE DEPARTMENT. Tem ,E)um Oster on site es P O y. nd Located at 92, Main.Street dire DepartMent:signah reldate ,/ ,./ OMMENT a . S Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use) i ❑ Notified for pickup Call Email i Date Time Contact Name Doc.Building Pen-nit Revised 2014 Location IAL �� t 0,44 No. t Date 2 2z I . = TOWN OF NORTH ANDOVER �n Certificate of Occupancy Q$ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check# ' Building Inspector 3/15/2016 Town of North Andover Mail-Building permit for 92 Colonial Avenue deck 24.5 feet by 12.5 feet NOR : AN :OVER Massachu s Maura Deems <mdeem s@northandoverma.gov> Building permit for 92 Colonial Avenue deck 24.5 feet by 12.5 feet 1 message mikeziehl@comcast.net<mikeziehl@comcast.net> Mon, Mar 14, 2016 at 11:17 PM To: mdeems@northandoverma.gov Maura, Thanks for the discussion today. As requested this email should serve as notice that our contractor, William Pogor, abandoned our deck project and that I have finished the project myself and that I am the homeowner. checked the building permit this evening, permit # 569-15 issued 12/22 2014 and there are no signatures other than the building inspector's from the permit issuance. There is a number 333 in light blue also on the permit. I do remember during construction that the sono tubes for the footings were left open for some time - perhaps the inspector did check them, but did not sign the permit as it was inside the house so it was not exposed to the winter weather at the time and the contractor would not have had access to our house. Mr. Pogor's name does not appear on the permit, by the way, even though he procured the permit. will call tomorrow, but may not be able to call before 10 AM. Best Regards, Mike Ziehl hUps://m ai l.googl e.com/m ai I/ca/u/0/?ui=2&i k=aeO2b3b5c4&view=pt&search=i nbox&th=1537847476be6616&s i m l=1537847476be6616 1/1 CERTIFIED PLOT PLAN PREPARED FOR: MICHAEL & LAUREL ZIEHL AT 92 COLONIAL AVENUE NORTH ANDOVER. MA. NORTH ESSEX REGISTRY OF DEEDS.• BK. 4931 PG 12 ASSESSOR'S MAP. 107B, MAP 140 ZONING: R2 SCALE. 1`30' DATE. AUGUST 04, 2014 NOTE.• EXIS77NG BUILDING DIMENSIONS TAKEN TO CORNERBOARD. WE7LANDS FLAGGED BY NORSE ENVIRONMENTAL SERVICES ON 07-29-14. N STONE N O 2 z Q J R30.00' BOUND A L6 39.3 ' FOUND Q STONE S QQ FOUND COL 014 R1$ 96 LOT 20 \ 25,59J SF. '54,.E STONE .43154,'E 43 + BOUND \ ' 85.2' ?7'6 FOUND \\\91 SAG �� 9 o \ �O \ FLAG 2A 58.8' 1 FLAG 3A 4 ,COQ 20.2' 15.9� -i/ EXISTINq �� FLAG / WE�IiN� �P4A " g2 Q D a 7.1 - wopD 29' D NQ. Z cd U3 a pEGK / FLAG O rTl C 0''� A5. 5A _ --A 2'O 2.5' / �P O Z Z 0.3' / / pF FLAG FLAG LA 5/ Q� OR BAG S�Q BUFFER 5 25' 2 FLAG �s 9A O FLAG FLAG 10A FLAG LA 12A FLAG IRON 13A ROD FLAG FOUND FLAG 14A 15A �lH OF SSS o� N0. 35773 Fss L LAND PREPARED BY JOHN ABAGIS & ASSOCIATES, PROFESSIONAL LAND SURVEYORS 9 BAR7LETT STREET, NO. 252, ANDOVER, MA. (978)-688-4899 JOB NO. 6092 OORTH own of 2 ndover O - 0 No. h ver, Mass, cocMicKewic« 1' S V BOARD OF HEALTH Food/Kitchen PERMI T LD Septic System THIS CERTIFIES THAT ....... N 1 ' z I I � BUILDING INSPECTOR ..................... ........................................................... ................................. .. Foundation has permission to erect .......................... buildings on .... ..... .Q.to" .................... .. q 17..!.� � �............................................ Rough to be occupied as .... .... ............ ........ .......... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIP5..k� A Rough Service .................... .... ....................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/ln(fividual): LAIlikA Pow, Address: City/State/Zip: \`fl &"� Phone#A le.3 ;1q1T5 Are you an employer?Check the appropriate oz: Type of project(required): 1.K I am a employer with 4. E] 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 These sub-contractors have g, E]Demolition working for me in any capacity. employees and have workers' insurance.$ 9. ❑Building addition coinP• [No workers' comp. insurance required.] 5. E].We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.�'Other employees. [No workers' comp.insurance required.] _ *Any applicant that checks box#1 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. Qntractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have lwoyees. 1f 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:_ LA.Q�IVIGL4V4VICC , Policy#or Self-ins.Lic.#: 2 Is IWC-52U-92- Expiration Dater /5 Job Site Address:�2-,Q nlal hoe City/State/Zip: j/ Vl J 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 cern under the 'ns and enakies o er'u that the information provided above is true and correct. Si ature: �^ -Date � Od Phone#: q 78 (o • ;1 J 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#: �1 '.a.ti ! r „�T, o pati' ,, �, ., �1. � , � � i a gyp? C� 8 ,�, + ,.• t a—� • a • C � � cc � N'N �i .. C...n r +.. �..a1•_ � ...., i r,s,,..M1 l M4, -1 J� �r1 . M .a r -JF ••y�`,� a „}'" �'� '�sa``�ri.�{' !1�'r a� : � � i .f- wYe �. v .. �,.. Y #. � J w r�. •�� � _ .,_..� a r f 1 �J WILLIA OP ID:JF ACORD° DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/24114 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 terns 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). CONTACT PRODUCER Phone: 978 688 8829 NAME: Michaud,Rowe And Ruscak Ins. Fax:978 557 2130 PHONE FO.Box 188 AIC No Ext: INC,AINo North Andover,MA 01845 ADDRESS: Jeff C.Manna INSURERS AFFORDING COVERAGE NAIC f! INSURER A.Preferred Mutual Insurance Co. 15024 INSURED William Pogor INSURER B: Bill INSURER C: 10 Lacy St North Andover,MA 01810 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AD DL B POLICY NUMBER MMIbONYYY CY EFF MMIDO/YYYY Y EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO A COMMERCIAL GENERAL LIABILITY BOP0100721169 10I24M4 10/24/15 PREMISES EaEoccurrencel $ 100,00 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 10,00 X Business Owners PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE I$ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO M LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATU- OTH. AND EMPLOYERS'LIABILITY YIN Y E.L.EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE __1N NIA OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ (Mandatory in NH) --- If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ BUILDING PROPERTY 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Carpenter CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mike&Lori Zeihi ACCORDANCE WITH THE POLICY PROVISIONS. 92 Colonial Ave North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD BERKSHIRE HATHAWAY Berkshire Hathaway GUARD UARDCOMPANIES INSURANCE P.O. Box A-H • 16 S. Rarer Street Wilkes-Barre, PA 18703-0020 570-825-9900 (Toll-Free 800-673-2465) FAX 570-823-2059 www.guard.com November 04, 2014 WILLIAM POGOR WILLIAM POGOR Agent: CDN INSURANCE BROKERAGE 10 LACY ST P O BOX 121 NORTH ANDOVER, MA 01845 Tewksbury, MA 01876 Phone: 978-851-3436; Fax: 000-000-0000 Binder#: 1049639 Note: A binder from the National Council on Policy #: R2WC522232 Compensation Insurance (NCCI), which Policy Period: 10/31/2014 - 10/31/2015 you may have already received or will be receiving shortly, serves as your proof of coverage until cancelled or your policy is issued. WELCOME TO Berkshire Hathaway GUARD! As the servicing carrier selected by the state to handle your policy, Berkshire Hathaway GUARD Insurance Companies (specifically, our subsidiary, AmGUARD Insurance Company) is pleased to have the opportunity to provide you with the superior customer services you deserve. If you have a question about your Workers' Compensation coverage or have a particular need, our professional staff and automated resources will be available to assist you. Our Customer Service Department is available by phone at 1-800-673-2465 Monday through Friday, 8:00 AM to 5:00 PM EST. After hours,you can leave a voice mail,send an e-mail (csr@guardcom), FAX us (1-570-823-2059), or complete an on-line form (accessible from the Customer Service section of our Policyholder Service Center at www.guard.com). Our mailing address is listed in the upper right corner. To report a claim or loss: 0 Call us immediately at 1-888-NEW-CLMS(1-888-639-2567) — 24 hours a day, seven days a week. 0 0 To report fraud: Call our Fraud Special Investigative Unit via our Fraud Hotline at 1-800-673-2465, ext. TIPS — 24 0 hours a day, seven days a week. 0 a To request Certificates of Insurance: If you are represented by an agency, they can provide you with the certificates you need. Otherwise, you can either fax us at 1-570-823-2059 or call our Customer Service Department at 1-800-673-2465. Either way, be prepared to provide the company name, address, fax number, and contact person of the entity requesting the certificate. To obtain service from a specific discipline: You can feel free to address your issue to the attention of the following individuals. Department Contact Name Email Address Extension Fax Number Billing Lori Decker csr@guard.com 1300 570-825-6211 Audit Dawn Aigeldinger csr@guard.com 1300 570-829-4587 Loss Prevention John Bohn csr@guard.com 1300 570-825-2990 Underwriting Dawn Aigeldinger csr@guard.com 1300 570-820-7968 Claims Lisa Krzywicki csr@guard.com 1300 570-825-0611 We look forward to having this opportunity to serve your insurance needs. Please keep a copy of this letter with your Berkshire Hathaway GUARD Insurance Companies policy for future reference. HQ: MA/WC Your Business is Our Business sm DECTO I NOTICE OF ASSIGNMENT VUR EMPLOYER: COMBO I.D. STATUS OF EMPLOYER WILLIAM POGOR 000326373 Individual 10 LACY ST NORTH ANDOVER, MA 01845 COVERAGE GROUP 0326373 Coverage under this assignment The Waiver of Our Right to applies to Massachusetts Recover from Others Endorsement operations only. For coverage is available on Pool policies. outside of Massachusetts, contact Contact your agent for details. the appropriate Pool or Pian for that state. INSURANCE COMPANY: AGENT CDN INSURANCE BROKERAGE AMGUARD INSURANCE CO PRODUCER: p O BOXX JEFFER121 MANNA INSURANCE AND SUPPORT SERVICES PR TEWKSBURY, MA 01876 16 S. RIVER STREETP 0 BOX AH WILKES-BARRE, PA 18703 AGENCYFEIN: 025384314 (800) 673-2465 CLASSIFICATION OF OPERATION CLASS ESTIMATED RATE ESTIMATED CODE TOTAL ANNUAL PREMIUM REMUNERATION -------------------------------------------- ----- -------------- ---------- ---------- CARPENTRY-DWELLINGS - THREE STORIES OR LESS 5651 $0 8.06 $0 CARPENTRY-DETACHED ONE OR TWO FAMILY DWELLINGS 5645 $0 8.06 $0 CARPENTRY NOC 5403 $0 9.86 $0 ROOFING NOC & YARD EMP, DRIVERS 5545 $0 31 .79 $0 EMPLOYERS LIABILITY 100/100/500 9845 STANDARD PREMIUM $0 LOSS CONSTANT 0032 $50 EXPENSE CONSTANT 0900 $159 TERRORISM CHARGE 9740 $0 RISK MINIMUM PREMIUM 0990 $500 TOTAL POLICY MINIMUM PREMIUM $500 TOTAL ESTIMATED PREMIUM $500 DIA ASSESS. 5.8% $0 TQTAL EST. PREMIUM PLUS ASSESSMENT $500 INSTALLMENT BASIS: Annual DEPOSIT PREMIUM: $500 THIS IS NOT A BILL/ c COMMENTS Coverage effective 12:01 AM on 10/31/14. DATE OF NOTICE: 10/31/14 PREPARED BY: Evelyn Cobb EXT 522 * * SERVICING CARRIER ASSIGNMENT LETTER ID: 4268990 The Workers'Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street• Boston, MA 02110 (617)439-9030• FAX(617)439-6055•www.wcribma.org Office of Consumer Affairs and Business Regulation Jr 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration �.... v . Registration: 180234 _ Type: individual _` Expiration: 10/27/2016 Tr# 259345 WILLIAM H. POGOR � WILLIAM POGOR 10 LACY ST of 4r�`° `t NORTH ANDOVER, MA 01845 - Update Address and return card.Mark reason for change. sca i 2OM•05/11 ['i Address [] Renewal ❑ Employment E] Lost Card (92. anvrrzo�rcuenlCl oC�/t/f raoac/z"uaetlr #Iegistration: ice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 180234 Type: Office of Consumer Affairs and Business Regulation piration:,::10%27!2016 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 WILLIAM H.POGOR`" , s WILLIAM POGOR 10 LACY ST NORTH ANDOVER,MA 01845 Undersecretary I Abt valid iithont signature t Massachusetts - Department of Public safety Unrestricted-Buildings of any use group which Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m)of Construction Supenlsor endosed space. License: CS-083917 WILLIAM H PO"R 10 LACY ST , NO ANDOVER MA 01845 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Expiration For DPS Licensing information visit: www.Mass.Gov/DPS Commissioner 06/28/2016 6 WILLIAM POGOR GENERAL CONTRACTING 10 Lacy Street North Andover,MA 01845 MA CSL License No.083917 Inquiries may he made to: Contractor Registration One Ashburton Place Boston,MA 02108 (617)727-8598 CONTRACT Customer: Wednesday, October 08,2014 Mike and Laurie Ziehl 92 Colonial Avenue North Andover,Massachusetts 01845 Project Location: Same as above Nature of Work: Design/Layout/Concept Bid Services,Permit Acquisitions X General Contracting Services This Contract relates to the above checked services that William Pogor in General Contracting shall provide to Customer. The services being provided are spelled out in the next section. The Customer's Payment Schedule is provided for in the section following that. This is a written binding contract. Do not sign if there are any sections or spaces remaining blank. If the contract is not understood, please have it reviewed by an attorney of your own choice. 1 Cusforfier Initials Contractor Initials Services to be performed: I. General Description of Work 1. Permit Acquisitions 1.1. Building Permit. 1.2. Waste Removal Permit. 1.3. Forms and Filings necessary. 1.4. Meetings On/Off-site as required. (Owners agent) 2. Demolition (CMR 3313.0) 2.1. Acquire appropriate size dumpster, and temporarily placed in drive,aligned with the left bay of garage as facing the house from street. 2.2. Remove Concrete impediments(pads or existing sono-tubes that do not meet existing CMR 1806.1) 2.3. Remove any existing decking not re-useable and or not compliant with new design plan. 2.4. Remove siding appropriate to removal and re-installation of deck support system and flashing for deck and replacement sliding patio door, compliance (CMR 3407.2, 3609.9.1-.2). 3. Foundation tubes 3.1. Required footings appropriate to foundation design plan in support of deck and pergola overhead. Sono tubes 4. Framing 4.1. Pressure treated support framing and support members to meet(CMR 2311, 3603.22)used in all support mechanisms as framing, sub-support, or super structural aspects corresponding to new deck design, framing section S 1. 4.2. Fasteners and fastener Systems shall meet or exceed(CMR 3603.22.3.4&AFPA TR 7 Appendix A) 5. Decking 5.1. Exterior Flooring-Choice of flooring color and style chosen along Zuri Manufactured samples provided to the client. 5.2. Decking will be applied with hidden fasteners systems in the main field and where applicable. 6. Patio Sliding Door- 6.1. Remove existing sliding door 6.2. Replace with new Pella sliding door. 6.3. Replace siding with new material or reuse as appropriate. 7. Structural support columns— 7.1. All Pressure treated columns will be covered with a synthetic(Boral exterior finish)(CMR Appendix A). 2 Custcbbr Initials Contractor Initials 8. Newel post- Newel post in support of rail system and stair case will be made of a natural pest water resistance material,no finish will be applied and material will be allowed to naturally grey. 9. Exterior trim- 9.1. All exterior trim is to be covered with a synthetic (Boral exterior finish)(CMR Appendix A). 10.Railing system- 10.1. Stainless steel cable rail system(CMR 3603.13) 11. Exterior stairs-(CMR 3603.13) 11.1. Tread material will be consistent with Decking material. 11.2. Risers' material will be consistent with column finish material. 12. Landings-(CMR 3606.12) 12.1. All landings will be consistent design for decking and rail system requirements. 13. Lattice- 13.1. All open areas below decking and stairs trim exposed to line of site and above grade level shall be covered by horizontal and perpendicular vertical lattice per design specifications. In accordance with(CMR Appendix A). 14. Paint- 14.1. One coat exterior acrylic sealer. 14.2. Except on pressure treated wood areas, and areas defined to allow for natural graying(intermediary newel posts). 15. Substantial completion- 15.L Homeowner inspection 15.2. Generation of a mutually agreed to punch list if any. 16. Clean up- 16.1. All debris and remaining materials to be remover and grade to be rake smooth and to existing grade. 11. Dates of Performance: Commencement Date: As Soon as Deposit for services is received and permit issued. Substantial Completion Date: A.S.A.P–target date, is six weeks from date of permit issuance. Note: as defined herein the phrase"substantial completion"refers to 95%point where work on a specific requirement is complete, as defined by the herein and by the contractor. Other Particularly Agreed Dates (if any): no-work weekends, (unless constrained by completion date),no work Thanksgiving and Christmas. 3 V? — iffust6kr Initials Contractor Initials III.Work Changes Any changes to this contract must be mutually agreeable and put in writing under a Change Order Form. A blank Change Order Form is attached after the signature lines below and shall be the form used for any changes to this contract. It shall be the obligation of both parties to adhere to this provision. IV. Contractor's Conditions of Performance All dates of performance are subject to reasonable extension(s), at the Contractor's request, if request is made due to inclement weather, labor disputes, issues involving acquisition of materials or permits from appropriate authorities, mutual dissolution of contract by the parties, stop work order(s) by state or local municipalities, or act(s) of God. Approval of such request(s) shall.not be unreasonably withheld. No acceptance of liability is expressed, assumed or implied due to any of these circumstances. Work may be stopped, interrupted or ceased at the sole discretion of Contractor if payment(s) under the terms of this contract, or any written amendment thereto, is not made by Customer as agreed herein. Work shall be performed in an ordinary standard. It is understood that certain portions of Contractor's consulting and drafting work is deemed artistic and/or subjective in nature, and therefore, disputes related to subjective portions of Contractor's work shall never be grounds for non-payment by the Customer. Permits for Work The type(s) of permits that will be required for the Contractor's work herein shall include: 1. North Andover town building Permit. 2. Dumpster Permit Owners A ent Unless otherwise requested by the Customer, the Contractor shall act as the owNExs AGENT with regard to North Andover Building Department for the sole purpose of obtain all necessary permits required to undertake and complete the project. If the Customer undertakes to obtain their own permit(s)the Customer will be excluded from the guaranty fund provisions of M.G.L. c. 142A. 4 i Custo r Initials Contractor Initials Special Conditions of Services: (If this section is intended to be left blank,state"none"): None Customer Payment Schedule: This Contract is: X Agreed Fee ❑ Time and Materials Invoiced ❑ Combination Agreed Fee and Time and Materials Invoiced Agreed Fee(If applicable): Special materials, or materials of a special order or custom made nature,shall be separately invoiced and require advance payment by Customer prior to order. Contract Price $27,742.00 Initial Deposit: $19,700.00 Remainder due: $ 8,842.00 1 StPayment (due floor decking substantial completion) $4021.00 Final Payment (due upon substantial completion $4021.00 As notified by contractor and Defined/noted herein on page 3). 5 —W-3' Custocr Initials Contractor Initials C Time and Materials/Labor Invoiced(If Applicable): Contractor shall be paid at a rate of$120.00/per two men per hour, plus all materials and out of pocket expenses, including, but not limited to invoiced subcontractors, consultants and materials suppliers. Contractor shall provide an itemized entry of his time billed as part of his invoice together with copies of expense invoices. Invoices shall be issued weekly. Payments due under invoice shall be made within seven (7) days of receipt of invoice. Receipt shall be upon delivery to Customer's address. Contractor may suspend or cease work under this contract if payment is more than seven(7)days overdue. Special materials, or materials of a special order or custom made nature,shall be separately invoiced and require advance payment by Customer prior to order. Description of Combination Agreed Fee and Time and Materials: As specified by any extra work orders. Payment terms may not be altered Unless expressly agreed by the parties in writing. Deposit Terms If there is an initial deposit, it shall be non-refundable. The Customer acknowledges and agrees that the Contractor shall commence work in good faith upon receipt of said deposit, utilize his time and that of contractors and/or consultants he may work with, and that the Contractor shall be fairly compensated for such commencement of work and dedication of time to this Customer that might otherwise be devoted to other projects. The parties agree there is valid consideration for the non-refundable deposit. 6 —k-?- Custo a Anitials Contractor Initials DEFAULT OF CUSTOMER If the Customer defaults for any reason, the Contractor shall be entitled to immediate payment of all monies owed as of the date the Contractor notifies the Customer in writing that he deems the Customer to be in default. The Contractor's Notification shall state all sums deemed to be owed and due from the Customer. Said sums shall be due and payable within seven (7) days of delivery of said notice. Any sums due after such notice of default shall be assessed an interest charge of 1 '/2 %per month, or 18%per year until all sums are paid in full. If the Customer defaults, and does not tender payment of all sums due within said seven (7) days, the Contractor may record this contract in the registry of deeds and seek a lien on the property for the enforcement of payment. The Customer shall be responsible and owe the Contractor all costs and expenses incurred in the collection of monies owed under this contract, including,but not limited to reasonable attorney fees. ALTERNATIVE DISPUTE RESOLUTION The Customer and the Contractor mutually agree that in the event the Contractor has a dispute with the Customer, the Contractor may submit such dispute to a private arbitration service, of the Contractor's sole choosing; provided however, such private arbitration service shall have been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and which shall have been in business for more than five (5) years, and shall be staffed with at least one retired justice of the Massachusetts Court System. This provision is an election at the sole discretion of the Contractor. This provision is in addition to any rights afforded the Customer under M.G.L. c. 142A. The arbitration, if elected by the Contractor, shall follow the rules and regulations of the American Arbitration Association. Nothing in this provision shall prohibit the Contractor from initiating a civil action for any such defaults. The Contractor may have the right to institute a civil action to obtain and enforce any statutory liens rights the Contractor may have, while contemporaneously seeking arbitration of the underlying disputed claims, which determination shall be conclusive as to the amount, if any the Contractor may enforce through such civil action lien. i 7 Cu Initials Contractor Initials CUSTOMER RIGHT OF CANCELLATION YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE CONTRACTOR, WHICH MAY BE HIS MAIN OFFICE OR BRANCH THEREOF, PROVIDED YOU NOTIFY THE CONTRACTOR IN WRITING AT HIS MAIN OFFICE OR BRANCH BY ORDINARY MAIL AIL POSTED BY TELEGRAM SENT OR BY DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS AGREEMENT. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. This Contract shall be construed in accordance with the laws of Massachusetts. This Contract may be executed in duplicate. Customer acknowledges receipt of copy by signing below. THIS IS A BINDING LEGAL DOCUMENT. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES OR YOU DO NOT UNDERSTAND ANY TERMS HEREIN. Executed as a sealed instrument this day of X _ X Custer / William Pogor General Contracting C� Cusco er 8 Custc&r Initials Contractor Initials NOTICE OF CANCELLATION FORM Date of Contract You may cancel this contract,without any penalty or obligation,within three(3)business days from the date entered on the first page of this contract. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten (10) business days following receipt by the Contractor of your cancellation notice, and any security interest arising out of the contract 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 contract; or you may if you wish, comply with the instructions of the Contractor regarding the return shipment of the 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 the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Contractor, or if you agree to return the goods to the Contractor and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this contract,mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to William Pogor General Contracting, at 10 Lacy Street,North Andover, MA, 01845,not later than midnight of: (Date of 3rd business day.) I hereby cancel this Contract. Customer(s) Signature (Date) 9 Customer Initials Contractor Initials