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HomeMy WebLinkAboutBuilding Permit #437-15 - 94 SHERWOOD DRIVE 11/4/2015 BUILDING PERMIT o` t10RTH,Eo 16,06 TOWN OF NORTH ANDOVER c? h�yt b,b o APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received SSACHU`��� Date Issued: I; IMPORTANT: Applicant must complete all items on this page j LOCATION �/� m Sf �/C�a �P�nnt PROPERTY OWNER .�i•4.y__=G�fcJ �` _ _D _ Print 100 Year Structure yes no MAP __PARCEL ZONING DISTRICT Histori.epistrict yes no. i 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 ❑ Septic ❑Well O�Floodplain ❑'Wetlands ' �f UVatershed�Distnct 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 13(a as:� riti/ Identification- Please Type or Print Clearly OWNER: Name: o, tn GJ Phone: 97 Address: ^a o t^I-J` Contractor Name 9?'SZ s� j 44 F Address =._ S D t Supervisor's Construction License CS'. z o_.S7o.� (o Exp Date: Ho me Improvement License: . _l_G_. ''7 �. 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: $ f 000 d FEE: $ Check No.: --J Receipt No.: � NOTE: Persons contr cting with unregistered contractors do not have access to the guaranty fund Signature ofof Agent/Qwner -t�-- Signature of contractor I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ _T_Y_P-E_OESE_W-ERAGE-DZS P_OS.AL— Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiimning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS v' on HEALTH Reviewed Signature j COMMENTS H 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 b DPW Town Engineer: Signature: Located 384 Osgood Street 1FIR,E DEPARTMENT - Temp Dumpster on site' yes no. Located at,124.MainiStreet Fire'De -artmentsignature/date t-OMMENITS_ Qiman.slan Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i Building Department The following is a list of the required ed forms to be fill g q ed 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 ❑ 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 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan Li Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) D 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 ❑ 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 Location / No. Date J o - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �. — Foundation Permit Fee $ Other Permit Fee $ TOTAL i Check Building Inspector Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost 40,10,00.00 m $ - $ 480.00 Plumbing Fee $ 60.00 Gas Fee 100 comm. 1$3 110:0100 Electrical Fee $ 60.00 Total fees collected $ 700.00 94 Sherwood Road 437-15 on 11/4/2015 Master Bath Remodel 1-- '1M'jW1 OP ID:J A��� CERTIFICATE OF LIABILITY INSURANCE 711105/14 T1 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 endomemen s. PRODUCER 978-975-1300 CONCT NAME! Soreve&Hall Insur.Assoc-Inc 978-91'5-7598 PHONE FAX 306 North Main St. No' e Ext): AIC No): Andover,MA 01810 Lawrence J.Hall ADDRESS: °u ER .TMKRE- INSURERS AFFORDING COVERAGE MAIC 4 INSURED TMK Remodeling INSURERA:Arballa Protection Ins.Co. 41360 214 Sutton Hill Rd INSURER 13:AEIC 11104 North Andover,MA 01845 INSURER c: INSURER D: INSURER E: INSURER F: COVERAGES - 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. :LTR TYPE OF INSURANCE POLICY NUMBER POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENF RAL LIABILITY 8500058513 03108/13 03108/14 PREMISES Ea occurrence S 100,00 CLAIMS-MADE ❑ OCCUR MED EXP(Any one person S 6,00 8500058513 03/08/14 03/08/15 PERSONAL&ADV INJURY $ 1,000,00 _ GENERA..AGGREGATE $ 2,000,00 GEN'LAGGREGATE LIMIT APPLIESPER PRODUCTS-COMP/OPAGO S 2,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea gccidant) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per ateident) $ SCHEDULED AUTOS PROPERTYDAMAOE S HIRED AUTOB (Per accident) NON-OWNED AUTOS $ UMBRELLALIARFCL OCCUR EACH OCCURRENCE $ EXCESS LIAR JIVIEWADE AGGREGATE $ DEDUCTIBLE $ RETENTION S 8 WORKERS COMPENSATION WC STATU- I JOTH- AND EMPLOYFW LIABILITY TORY LIMIT B ANY PROPRIETOWPARTNER/EXECUTIVE Y/❑N NIA 5005011872 03/11/13 03/11/14 E.LEACH ACCIDENT D $ OFFICER/MEMBER EXCLUDE (Mandatory In NH) 5005011872 03/11/14 03/11/15 E.L.DISEASE-EA EMPLOYEF $ If yea,Gescrlbe Under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATION81 LOCATIONS/VEHICLES (AttAoh AOORD 901,AddiNonAl Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS- 1600 Osgood Street North Andover,MA 01845 AUTHORI=D REPRESf'NTATIVF ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009109) The ACORD name and logo are registered marks of ACORD NORTH own o y. : : Andover No. - ��`! V L AA! h ver, Mass, 110Vecx-,�6cA, T O L [OC MCA.". , S U BOARD OF�,HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAZ.1A.R.v.......C-tze„g--t............................................................ BUILDING INSPECTOR Foundation has permission to erect ... ............. buildings on ......��. ....�i��.�T . ..,............................ Rough to be occupied as .......... .. ..... ..... ..P................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION A S Rough Service ........................10.. "',.... ...................................... 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. i TMK Remodeling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 Wen—MB—Contract—R5 HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com CONTRACTOR AGREEMENT THIS AGREEMENT made this 20i#by and between Theodore Kelley dba TMK Remodeling, Construction Supervisorlicense#105086,214 Sutton Hill Rd, North Andover MA 01845 hereinafter called the Contractor, and Jian Wen&Judy Hou hereinafter called the Owner. WITNESSETH,that the Contractor and the Owner for the consideration named herein agree as follows: ARTICLE 1. SCOPE OF THE WORK The Contractor shall perform all of the work described in the specifications entitled Exhibit A—Statement of Work, as annexed hereto as it pertains to work to be performed on property located at 94 Sherwood Rd North Andover MA 01845. ARTICLE 2.TIME OF COMPLETION The work to be performed under this Contract shall be commenced on or before October,.66'2014 and shall be substantially completed on or before NovemberDr,2014 i ARTICLE 3.THE CONTRACT PRICE The owner shall pay the Contractor for the labor and materials to be performed and supplied under the Contract the estimated sum of Forty Thousand Dollars and No Cents($40,000.00),subject to additions and deductions pursuant to authorized change orders. The contract price includes two components; Fixed cost of Twenty Three Thousand Three Hundred Thirty Dollars and No Cents($23,330.00)for the building materials and construction labor as specked in Exhibit A. Variable cost of SixteenThousand Six Hundred Seventy Dollars and No Cents($16,670.00)for the allowance items in Exhibit A Allowances and will be 110%of the actual invoice price paid by the Contractor to his suppliers. Exhibit A lists the allowance items and budget costs the Contractor will purchase for the Owner. Contractor will furnish and install all building materials,fixtures and finish items unless noted otherwise. ARTICLE 4. PROGRESS PAYMENTS Payments of the Contract price shall be paid in the following manner from the Owner to the Contractor: 33%upon contract execution; $13,333.33 33%upon rough building inspection;$13,333.33 34% upon final building inspection and owner sign-off; ($3,336.67)plus the actual contract price for allowance items as defined in Article 3. The contract cost for mutually agreed to change orders will be paid 50%at time of change order signature and 50%after completion and owner sign-off. ARTICLE 5. GENERAL PROVISIONS 1.All work shall be completed in a workmanship like manner and in compliance with all building codes and other applicable laws. 2.To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 3. Contractor may at its discretion engage subcontractors to perform work hereunder, provided Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this Contract. Copyright TMK Remodeling 2014 Initials/ �� All Rights Reserved Page 1 r TMK Remodeling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 Wen-MB-Contract-R5 HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com 4. Contractor shall furnish Owner appropriate releases or waivers of lien for all work performed or materials provided at the time the next periodic payment shall be due. 5.All change orders shall be in writing and signed by both Owner and Contractor. The cost for mutually agreed to additional work, required due to unknown conditions or substantive change orders,will based on the current bill rates for the actual time used.Additional materials will be billed at contractor cost.All change orders subject to 10%markup for overhead. 6. Contractor warrants it is adequately insured for injury to its employees and others incurring loss or injury as a result of the acts of Contractor or its employees and subcontractors. 7. Contractor shall at its own expense obtain all permits necessary for the work to be performed. 8.Contractor agrees to place all debris in an on-site trash receptacle(dumpster)and leave the premises in broom clean condition. 9. In the event Owner shall fail to pay any periodic or installment payment due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 10.The Contractor and the Owner hereby mutually agree in advance that in the event that the Contractor and Owner has a dispute concerning this contract,the Contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the Contractor and Owner shall be required to submit to such arbitration as provided in MGL c 142A. 11. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials, or inclement weather. 12. Contractor warrants all work for a period of 12 months following completion. The contractor warranties the shower pan and floor from any defects for a period of 60 months following completion and the finish tile installation for a period of 36 months following completion. 13. Contractor may post small signage(18x24") on property advertising services during the duration of the project. 14.The Contractor and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: (617)973-8700 Copyright TMK Remodeling 2014 Initials l All Rights Reserved Page 2 S�'6f1� TUK Remodeling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 Wen MB Contract R5 HIC 165887 978 852-4491 — — — RRP LR000106 www.tmkremodeling.com ARTICLE 6.OTHER TERMS The Contractor will reimburse the Owner or repair any damage or breakage caused by Contractor or sub contractors to the residence during the project period. The Owner must document the damage or breakage and show proof it was done by the Contractor. Normal wear and tear will not be considered damage. Contractor will prepare site survey with photo and video documentation to record existing conditions prior to work. ARTICLE 7.ACCEPTANCE Signed this "6 day of A!44 Y Owner Contractor NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Copyright ri ht TMK Remodeling2014 Initials All Rights Reserved Page 3 TMK Remodeling 214 Sutton Hill Rd Exhibit A - Statement of Work CSL 105086 North Andover MA 01845 Wen—MB—Contract—R5 HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com To: Jian Wen &Judy Hou lian wen(a)yahoo.com, iudyhou(o)yahoo.com 94 Sherwood Rd North Andover MA 01845 978 973-9074 Estimate Date: 8/12/2014 Revision: 5 Exhibit A=Statement of Work;` Scope: Complete.,remodel of master bathroom approx. 136 SF in existing footprint as shown on..layout.SK-1; Revision 3 dated May 27;2014.. Remove all fixtures and finishes. Install new custom tub/shower and.new fixtures and finishes. 1.00 Planning&Design 1.01 Construction Drawings for building permit application. 1.02 D-1 Demolition Plan 1.03 A-1 Construction Plan 1.04 F-1 Finish Plan 1.05 E-1 Electrical Plan 1.06 P-1 Plumbing Plan 2.00 Demolition 2.01 Disconnect and remove walk-in shower fixtures, enclosure and plumbing. 2.02 Disconnect and remove vanity cabinets,fixtures, and plumbing. 2.03 Disconnect and remove toilet. 2.04 Disconnect and remove electrical fixtures over vanity. J 7 2.05 Remove finished floor and wall finishes down to framing on plumbing walls. Leave finish on exterior walls by /J 'a^ 2.06 Remove dividing partition between shower/toilet and main bathroom 2.07 Disconnect and remove soak tub and partition 2.08 3.00 Construction 3.01 Construction Rough In 3.02 Frame out custom walk-in shower approx. 5'-0"x 4'-0"per plan SK-1. 3.03 Frame tub surround partition approx. 20"in height. 3.04 Provide blocking in walls for vanity and fixtures. 3.05 Install ducting and vent cap,vented to exterior. 3.06 Construct half wall at toilet stall approx.42x30" 3.07 Rough Building Inspection. ? Copyright TMK Remodeling 2014 Initials " ` All Rights Reserved Page 4 TMK Remodeling 214 Sutton Hill Rd Exhibit A - Statement of Work CSL 105086 North Andover MA 01845 Wen MB Contract R5 HIC 165887 978 8524491 - - - RRP LR000106 www.tmkremodeling.com 3.08 Construction Finish 3.09 Shower pan: Install rubber membrane shower pan, mortar mud pack on shower floor, pitched to drain. 3.10 Walls: Install 1/2"plaster board drywall on walls.Tape and fill joints.Apply plaster skim coat (approx. 150 SF). 3.11 Floor: Install 1/4"cement board sub floor, mortared and fastened to sub floor. Install plank style floor tile over radiant heat mat. Grout and seal joints(approx. 100 SF). 3.12 Shower: Install 1/2"cement board substrate in shower walls, tub walls and deck. Install tile on shower walls, floor and tub surround as specified. Fabricate& install access panel for tub equipment. Grout and seal joints 3.13 Granite: Fabricate and install 1 1/4"thick granite countertop, capstones, curbs, bench and niches as noted on plans(approx.46 SF). Shower Door: Fabricate and install 1/2"tempered glass shower door, panel and 3.14 Vanity: Install vanity, cabinetry, and mirrors/medicine cabinets as noted on plans. 3.15 Accent tile: Install tile on wet space walls up to 42"AFF over plaster base. Grout and seal joints(approx.40 SF)_ 3.16 Trim: Install wood base board to match existing. Install door and window case molding. Prime and paint, ceiling,walls and trim. 3.17 Final Building Inspection. 4.00 HVAC 4.01 HVAC Rough In 4.02 N/A. 4.03 4.04 HVAC Finish 4.05 N/A. 4.06 5.00 Electrical 5.01 Electrical Rough In 5.02 Install boxes&wires for new light fixtures as shown on plan. 5.03 Install new circuit, boxes and wires for bathroom radiant floor. 5.04 Install boxes and wires for fan exhaust on huff+dietal:/timer. 5.05 RQU944 4e +.:,..,i i.,�._r �t�nn 5.06 Rough Electrical Inspection 5.07 Electrical Finish 5.08 Install all fixtures, devices and trims. 5.09 Final Electrical Inspection. 6.00 Plumbing 6.01 Plumbing Rough In I _r 6.02 Install venting, supply and waste lines for custom shower s shown on plans. Install drain for tile floor. 6.03 Install supply and waste lines for 2 sinks&toilet. 6.04 Install new soak tub. Connect to supply and waste lines 6.05 Plumbing Finish 6.06 Install finish trims and fixtures in shower. g Tu�� 6.07 Install 2 faucets and drains in sink. Connect to supply and waste lines with new shut-off valves. 6.08 Install new toilet. Connect to supply and waste lines with new shut-off valve. 6.091 Final Plumbing Inspection. Copyright TMK Remodeling 2014 Initials ; G' All Rights Reserved Page 5 TMK, Remodeling 214 Sutton Hill Rd Exhibit A - Statement of Work CSL 105086 North Andover MA 01845 Wen-MB-Contract-R5 HIC 165887 978 852-4491 RRP LR0O0106 www.tmkremodeling.com 7.00 Allowances 7.01 Tile 1 -wet space wall 40 SF@$7/SFS,, 280 7.02 Tile 2-Floor 100 SFS @$7/SF 700 7.03 Tile 3-Shower walls 100 SF @$7/SF 700 J 7.04 Tile 4-Shower floor 20 SF @$10/SF 200 7.05 Tile 5-Shower Bullnose 30 Pcs @$3/EA x-9,0 7.06 Cabinetry 2 sink bases @ 33wx32t 1,1500 7.07 1/2" Frameless Glass Shower Enclosure 2250 x.7.08 Undermo., Sinks-2 350 7.09 F a $75/SF 3450 ,46S�T�<.. �.10 Plumbing-Shower valves,2 sprays, union, hose,trims 850 A-12 1.1..Plumbing-Sink Faucets-2 300, Sconces-4 - (J � 3 Toilet - - 0650 .14 Soak Tub 3500. 7.15 Tub Filler _ ,.450. 7,16 Mirrors/Medicine Cabinets-3 ,. 5 i�`� 900 7.17 7.18 Allowances Total 16670 8.00 Permits&Inspections 8.01 Building 554 8.02 Electrical 75 8.03 Plumbing 75 8.04 8.05 9.00 Pricing: 9.01 Planning &Design $ 360 9.02 Demolition $ 1,800 9.03 Construction $ 9,270 9.04 HVAC $ - 9.05 Electrical $ 1,900 9.06 Plumbing $ 2,875 9.07 Allowances $ 16,670 9.08 Building Materials $ 2,340 9.09 Standard Costs $ - 9.10 Permits&Inspections $ 704 9.11 Dumpster/Disposal $ 490 9.12 Overhead $ 3,592 9.131 Total $ 40,000 F Owner Approval: Date: i Contractor Approval: Date: Copyright TMK Remodeling 2014 Initials All Rights Reserved Page 6 S r f , Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-105086 THEODORE M Yk''LLEY;t- 214 SUTTON HR;L RDS s NORTH ANDOVER M,'0184 Yf )rW 1A Expiration Commissioner 10/08/2015 - �Le�poa�zmaaracueczll/z of C �ac/u�eC t ffice of Consumer Affairs&Business Regulation i t ME IMPROVEMENT CONTRACTOR i istration: 165887 Type: i V,! iration: 4/5/2016 DBA TMK REMODELING THEODORE KELLEY,, 214 SUTTON HILL RD. `',,4ry'F:;.•:% 4 �„�__ NORTHANDOVER,MA 01845` Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 j Not valid without signature 4 , Access panel in adjacent closet New the floor over radiant 4'-0" heat mat 1 3 r—y t+> New soak tub w/granite and tIle tub surround Master New sink base vanity w/3 drawers, Bath countertop,undermount sink, 136 SF i faucet,mirror and wall lighting iv �,` fixture2. Type of 2 New grooming station with pencil drawer,mirror, s countertop top @ 30"AFF. fV R b New 48x57"walk in shower N with bench seating,wall niche, i� overhead spray,hand held spray.Y2"frameless glass shower door and enclosure N N Wall removed,partial wall at _ + toilet stall 42"AFF w/granite N j capstone. New toilet i b' 4'-6" Wall the up to 42"AFF on 3 0 --( F}— walls O R O Q .ti iV ,1 y.i I 4'-9.. 5..7.E First Floor Partial Plan TMK Remodeling 94 Sherwood Rd SIZE FSCM NO DWG NO REV North Andover MA 01845 SK-1 214 Sutton Hill Rd 3 North Andover MA 01845 DRAWN TMK Master Bath Layout 1 978 852-4491 ISSUED May 27,2014 SCALE 1/2"=1'-0" @ Copyright TMK Remodeling SHEET 2 OF 2 CS LIC#105086 0 Copyright TMK Remodefing All Rights Reserved Unlawful to distribute without permission 13'- ' Master Bath 136 SF o + ` I } o N N N o + 2'-7" . I i O � Q First Floor Partial Pian TN4K Remodeling 94 Sherwood Rd SIZE FSCM NO DWG NO REV North Andover MA 01845 214 Sutton Hill Rd Existing Conditions DRAWN TMK E-1 2 North Andover MA 01845 978 852-4491 ISSUED March 30,2014 SCALE 1/2"=1'-0" ©Copyright TMK Remodeling SHEET 1 OF 2 CS LIC#105086 ®Copyright TMK Remodeling All Rights Reserved Unlawful to distribute without permission The Commonwealth of Massachusetts - Department oflndustrirrlAccikks Office of Investigations 600 Washington Street Boston,MA.02111 UV.- www.mass govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applican> Information PIease Print Legibly Name(Business/Organization/Individual): %7f�U Q Address: IV /SGC e4Q City/StatPhone M !7 7 -9 rz Are you an employer?Check the appropriate box: Type of project(required): J/O I am a with employer 4. ❑ I am a general contractor and I ❑ - _—�. 6. New construction employees(full and/or part-time).* have Hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. y, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l 1.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]i employees.[No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i-Homeowners who submit this affidavit indicating they ore doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. �� l Policy#or Self-ins.Lie. O 7 Z_ Expiration Date:��// Job Site Address: i�L S/Y4, l W o oto oo City/State/Zip:_.�U A, PV✓�_AM rte/cJ�''� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of-up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains and penalties of rjury eat the information provided above is true and correct. Signature: Date: zz Phone#: S_ 7— Z 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,• express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for theperformance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. the affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwalth of M-assachvsetts De-partmat of I.dustdal Accident.- Office of Intyestigalion,% 6.00 Washiza&a Stzeet Boston,MA.021.1.1 Tel,#617-227-4900 at 406 or 1-877-MA&SAFB Revised 5-26-05 Fax#617-727-7749 _www.mass,gov1d1a