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HomeMy WebLinkAboutMiscellaneous - 6 KATHLEEN DRIVE 4/30/2018 � ��--- 1 6 KATHLEEN DRIVE 2101025.0-0059-0000,0 1 r-7-7 k Date..................................-0 7 "Y NORTH 4, TOWN TOWN OF NORTH ANDOVER -a PERMIT FOR WIRING 5 �,ss^CNUS� i t This certifies that 0.4,4LEcT2� has permission to perform kTG yE� wiring in the building of.................7............P�........................................... iP ............... North Andover,Mass. Fee-��..©©.... Lic.No. 7/S�E............�!r,/� �Gj I ELECTRICAL INSPECTOR / Check 7876 Commonwealth of Massachusetts Official Use Only MEWPermit No. 7 MCI Department of Fire Services �7Z,, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: ?- City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) (® kAAi e,(N Owner or Tenant �eyer�e,ii !?&!:0gD t. Telephone No. Owner's Address fQ )<G*ke,e i1 , Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Boz) Purpose of Building �S�G�C�1�1�C.�1 Utility Authorization No. Ezisting Service 100 Amps (20 /ZLID Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity f Location and Nature of Proposed Electrical Work: ( Completion of the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Off Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges Z No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number I Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances. KW Security Systems:* No.of Devices or E uivalent No.of Water , No.of No.of Data Wiring: Heaters Si ns' Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: c No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: /a—/L/ Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 93 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: D(Z LIC.NO.: Licensee: ac c��s Signature LIC.NO.:371S- (Ifapplicable, enter"ez t to the license tuber line.) (� � Bus.Tel.No.: Address: J 7 1.1 VdCS Clic�Q ,u. c6ol j� h) 'f U3,�-j q Alt.Tel.No.: 1l(,'76(Z. *Per M.G.L c. 147,s. 57- 1,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ /I p, lo�' r •.—.��...��.W _ __ ,p� ✓� mew ���r t of Puhlic S<Ifc[N~ Office of Consumer Affairs&Business Regulation ` iYiassuchusctts - Delr.�►-tnjmen Board of Buildin�� OME IMPROVEMENT CONTRACTOR Re�r,tyulations and Standar Construction Sup ervisor License Registration X4.1,%23 Type: License: CS 94372 w Expirat�q[� 8/6/ f71,1 Supplement Restricted to: 00 Dube Constructior��l3tinc -i LORIANN J LANGAN ' 7 CREST ROAD LORIANN LANGAs[+h E_ 10 Bricketts Mill Road; KINGSTON, NH 03848 ��P Hampstead, NH 0384''t _ Undersecretary Expiration: 7/31/2011 (ummiai ner Tr#: 19319 i e ACORQM CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDNYYY) 10/13/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Lakeside Insurance Agency, Inc. PHONEFAX AIC No Ext: .(603)432-3666 AIC No: (603)432-6076 Three Wall Street E-MAIL ADDRESS: Windham, NH 03087 PRODUCER CUSTOMER IDR: INSURERIS AFFORDING COVERAGE NAIC R INSURED INSURERA: Peerless Insurance 124198 Thomas A. Dube Construction-Plus, Inc. INSURER B: _ Dube Plus & Dirt Pro; Watertown Village, LLC INSURERC: µv^ 10 Bricketts Mill Rd, Suite C INSURER D: Hampstead, NH 03841 -INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:Dube Construction 2010 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 ADDL SUER MMlLIDDiYYYFY MMILIODIWYY LTR INSR WVDI POLICYNUMBER I LIMITS GENERAL LIABILITY I CBP827351 0412612010 0412612019 EACH OCCURRENCE s 1,000,000, X COMMERCIAL GENERAL LIABILITY JI DAMAGE TO,RENTED PREMISEE o S 100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) S 5,000 A � PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: j PRODUCTS-COMP/0P AGG S 2,000,000 POLICY X JECT F�LOC S AUTOMOBILE LIABILITY i BA827842 0412612010 04126/2011 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 ANY AUTO # ALL OWNED AUTOSi BODILY INJURY(Per person) S BODILY INJURY(Per accident) S A X SCHEDULEDAUTOS PROPERTY DAMAGE S X HIRED AUTOS (Per accident) X NONAWNEDAUTOS i S 5 UMBRELLA UAB X OCCUR CUB270418 0412612010 04126/20111 EACH OCCURRENCE S 1,000,000 At1ESS UAB CLAIMS-MADE AGGREGATE s 1,000,000 CTIBLE i ^� S NTION s 10,000I S WORKERS COMPENSATION WC8279020 0412612010 0412612011 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N LI ANY PROPRIETORIPARTNERIEXECUTIVEf—I i E.L.EACH ACCIDENT S 500,000 A OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yyes,desvibe under DESCRIPTIONOFOPERATIONS below E.I_DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES 'fAttach ACORD 101,Additional Remarks Schedule,if mom space Is required) overing work performed by the ZJamed Insured during the policy period for Anita & Leveret Zompa Worker's Compensation statutory coverage is provided for New Hampshire and Massachusetts. No Executive fficers are included under Worker's Compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover AUTHORIZED REPRESENTATIVE 1600 Osgood Street d z,.,. North Andover, MA 01845 Edwin Duvall/LYNN ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD r 10 Bricketts Mill Road Hampstead,NH 03841 Phone: (603)329.50.77 Fax: (603)329.7026 ACCEPTANCE/PROPOSAL LETTER Revision#1 September 22,2010 Client Name: Anita&Leveret Zompa Home Telephone: (978) 475-5722/978-376-2748 Job Location: 6 Kathleen Drive,Andover,MA 01810 Job Description: Front Window Replacement General work scope—New Construction Window 1. Client will be removing wallpaper at a later date. 2. Window dimensions to be confirmed prior to order placement. 3. Provide building permit for window replacement. (Allowance included in' this estimate for permit fees is$50.00) 4.. Remove existing interior and exterior window trim 5. Existing siding is brick 6. Remove and dispose of existing (1) picture window units, and (2) flanking double hung windows. 7. Supply and install new vinyl construction Harvey white classic flanking double hung windows (Double Hung R.O. size 31 '/4") with Low-E glass with Argon, grills between the glass, 6/6 full screen,white hardware, and (1) center White Classic Picture Window (Picture R.O. size 76 '/a"),Low-E glass with Argon, grills between the glass 16/16 white hardware.Two double hung units will need to be mulled on site, due to length. 8. Supply and install new insulation,ice and water shield, and caulking as required 9. Supply and install new interior 2 '/a" primed colonial trim. 10. Supply and install new window sill, and primed apron trim. 11. Supply and install new primed 908 casing exterior trim. 12. No drywall patch required. 13. No priming,painting or staining has been included in this estimate. Debris removal/Clean up- www.dubeplus.com 1. Clean-up and remove all construction debris from site and dispose of in our off-site dumpster. Grand Total Installation ofNew Construction Windows$3,360.0 TERMS OF PAYMENT- $1,680.00 To be paid at signing of this contract. $1,680.00 To be paid upon completion of job. Substantial completion-Area in which work has been performed is functional, or occupancy can occur, and only punch list items remain to be addressed. Completion-When job has been completed as described in scope of work. Warranty- (3) year warranty begins upon completion of contracted work. Warranty covers: - Defective workmanship,performed by Dube-Plus Construction. - All products are covered under manufacturer's warranties. - Items purchased by the client for install are not covered by the Dube-Plus warranty. Proposal price is valid for 30 days from receipt of contract. No rot repair has been included in this estimate,unless otherwise noted above. If rot is discovered, ,.. ti 1 repair cost will be discussed with the client at time of discovery. initial Unless otherwise noted above all construction debris is to be disposed of in a dumpster that is to be located in a mutually acceptable location on the client's property. It is common for a dumpster and/or the truck servicing the dumpster, to leave marks and /or damage the lawn and/or driveway. Repairing the lawn and/ or the driveway is not included in this agreement; it is the total responsibility of the HOMEOWNER.The dumpster company is not t h Id responsible: this is a standard term of their agreement and policy. initial The homeowner is responsible to remove any and all furniture,pictures and fixtures in or around the work area prior to the installation process.All cabinetry must be emptied and appliances removed from the countertops.All pictures and valuable items should be removed from the vicinity of the work area as the installation process �, • Iii often creates small vibrations that may cause these items to fall from the walls or shelves.While our workers take the utmost care to prevent incidental damage,we cannot be held onsible for damage to items that the homeowner neglected to remove. i initial l Out of Networ mate ' or Sub Contractors—Although not preferred,Dube will allow the use of materials from an approved out of network supplier or use of approved subcontractors that are not Dube Subcontractors; However,Dube can not guarantee the quality of the materials / installation or prevent delays that may occur. Dube reserves the right to apply additional charges in the form of a"change order" if ar ' carred to Dube while using"out of network"materials or subcontractors. initial i SERVICE CHARGE: A service charge on past due accounts will be computed at "Periodic Rate" of 2% per month, which is an "Annual Percentage Rate" of 24%. Customers shall be and are responsible for all costs of collection, including reasonable attorney's fees, arising from any breech of this agreement or failure to pay any amount due and owing. Changes to the above specifications will be accepted only if a written request is made. We will then complete a "Change Order" to supply you with the additional charges or credits. No work can be changed, altered, or cancelled without an authorized"Change Order". Payment of"Change Order" is as follows: Full Payment will be due Upon Signature of Change Order. ACCEPTANCE:the price(s),specifications and conditions above are satisfactory and are hereby accepted. You are hereby authorized to proceed with the work as specified. I/We agree to make payment as detailed above. My/our(the customer's signature below onstitutes full agreemen�` / >z: Leveret mp Date Mrs. Zompa Date V-22 d Lori]Langan Date Dube-Plus Construction,Inc. PLEASE INITIAL THE BOTTOM OF EACH PAGE BEFORE SIGNING NORTH TONM of _. _ 6Andover No- t -o dover, Mass., • COCMICMEWICK 7�S RATED P �C� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT � !!' �' ......................................................4................... ....� ...... ........................................ Foundation has permission to erect. buildings on ...... ..............1c.44 .. . Rough to be occupied as.........�... �........ �Ntow..........677.7.......................... Chimney 6666 ... ......6666... 6666... provided that the person acce ing this permit hall in every respect conform to the terms of the application on file in Final 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 MO THS ELECTRICAL INSPECTOR UNLESS CONSTR O TS Rough 6666. ... ................................................................................... .......... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. NQRTH TO" of : Andover No. 0 6 .3 CA O dover, Mass. • If, COC MIC MEWICK ADRATED PPa��S S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....A.�Ammw. ............ ... . .. ........................ .. ............................. ................ Foundation has permission to erect........ ...................... buildings onRough to be occupied as �.... .�. ........................................ Chimney . . . . . ............ .. . . . . . . . ...... provided that the pe on accepting this per d shall in every respec form to the terms of the application on file in Final 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 CONSTR ARTS Rough ....... .............wu.. .... ........ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. east coast lumber Route 111•East Hampstead;New Hampshire www.eastcoastlumbennet 603=329-5322•1-800-682-6006 PROPOSAL/ACCEPTANCE LETTER Revision#1 October 16, 2007 Client Name: Anita& Leverett Zompa Home Telephone: (978) 475-5722 Job Location: 6 Kathleen Drive, Andover, MA Job Summary: Kitchen Remodel Job Number: 896606 Work to be performed Kitchen—(tear out) 1. Client to remove floor tile. 2. Client wishes to paint around area where wall cabinetry will be installed prior to installation.-Coordinate agreeable time frame for this to occur. 3. Coordinate with tile floor installer, when installation of flooring to occur, and where tile border is to be placed around new island location. 4. Client to have floor extended out further into family room area(at step down),new underlayment, floor tile and handrail to be installed by others. 5. Wallpaper on dining room walls is to remain, use care when framing for new swing door. 6. Note- basement is finished-dry walled ceiling. 7. Remove and dispose of existing cabinetry. 8. Remove and dispose of existing kitchen countertop and backsplash. 9. Remove and dispose of existing kitchen sink and faucet, and garbage disposal. 10. Dube installer to remove existing dishwasher, electric range,hood, and refrigerator. Client to dispose of existing appliances. 11. Remove and dispose of existing colonial baseboard trim, and window trim as required. 12. Remove and dispose of existing door into dining room area, including door trim, and j amb. 13. Remove and dispose of existing closet, including bi-fold doors,jamb, trim and studs. 14. At foyer/kitchen cased opening, remove section on of wall (back to bathroom partition � wall)to create larger 4'l 0opening. 15. Remove and dispose of existing drywall on walls and ceiling area. 16. Remove and dispose of existing lighting fixtures. 17. Plumber to cut back and remove FHW baseboard heat at peninsula area. Initial E== 1 Kitchen—(install) 1. Supply materials for and frame new 4'10" cased opening at foyer/kitchen location, as per drawing. 2. Fame and install new client provided 2/6 x 6/8 LH in-swing door at dining room/kitchen location. Door to be installed at previous door location, door to swing into dining room area. Existing wallpaper at dining room wall is to remain. 3. Remove and supply and install insulation at exterior wall if required 4. Supply and install drywall on walls, and ceiling,tape and sand. Ceiling to have sand textured finish. Drywall on ceiling to be applied to existing strapping, no additional leveling of ceiling has been included in this estimate. 5. Patch drywall at basement ceiling area, and at larger cased opening area's if required, Tape, and sand. 6. Provide materials as necessary to shim cabinets as necessary to accommodate new tile floor height. 7. Install new base and wall cabinetry,panels, '/2 posts at island, and tall cabinets as per ECL layout. Note-Some wall cabinets are set at different heights. (See ECL materials quote) 8. Install (1)piece crown molding at tops of cabinets, as per ECL layout. (See ECL materials quote) 9. Install (1)piece under cabinet molding as per ECL layout. (See ECL materials quote) 10. Install all required hardware and toe kick molding. (See ECL materials quote) 11. Coordinate-template and installation of new countertop. (See ECL materials quote) 12. Install customer supplied appliances,refrigerator, electric cook top,hood(hood to be vented to exterior), oven,warming drawer, microwave and dishwasher. 13. Client to have tiled backsplash done at a later date. 14. Supply and install new primed colonial base, door/cased openings and at window molding at kitchen area. Kitchen window—trim to be picture framed 15. No priming, painting or staining is included in this estimate Plumbinst& Heating- 1. Cut back and cap FHW baseboard heat at previous peninsula area. 2. Install kitchen sink and faucet, and make final connections to same (Se ECL materials quote) 3. Install client provided garbage disposal. 4. Install and connect dishwasher at new location. 5. Provide materials for and install ice line to refrigerator. Initial 2 Electrical 1. Existing panel is 100 amps, 20 circuits, no available circuits. 2. Provide rewiring as needed. 3. Supply materials for and install new electrical sub panel. 4. Supply materials for, and install custom hood outlet. Hood to be recirculating 5. Supply materials for, and install electric cook top outlet. 6. Supply materials for, and install microwave outlet, (in tall cabinet). 7. Supply materials for, and install oven outlet, (in tall cabinet). 8. Supply materials for, and install warming drawer out, (in tall cabinet). 9. Refrigerator outlet will remain at existing location. 10. Supply materials for and hardwire dishwasher. 11. Supply materials for and wire garbage disposal to existing switch. 12. Provide materials for, supply and install GFCI outlets where required, by code 13. Supply materials for and install (1) outlet at island location. Outlet location is to be at 3"filler, in-between two base cabinets, outlet is to face towards kitchen sink. 14. Supply and install (8) recessed lights, with appropriate switching. 15. No decorative light fixtures are to be installed. Flooring 1. Flooring and underlayment to be installed by client. 2. Coordinate- with tile installer placement of island, for tile border installation. Debris removal and disposal 1. Remove all construction debris from site and dispose of in our off-site dumpster Kitchen Remodel Labor Total$ 14,060.00 Initial 3 Estimated Costs: This estimate includes allowances that are based on our experience performing similar jobs. Any additional costs incurred due to unforeseen circumstances or conditions will be reviewed with the customer and approved in writing by signing a Change Order. A deposit for 50% of the Change Order is due before work begins, with the balance due upon completion. Warranties: There is a ninety- (90) day warranty that applies to all labor performed. All products are covered under manufacturer warranties and any inquiries should be made directly with the manufacturer. East Coast Lumber does not warranty any of the manufacturer products. Homeowner Responsibilities: The homeowner is responsible to contact all local authorities, such as the building inspector's office, for remodeling guidelines and regulations. The homeowner is also responsible to obtain all building and other legal permits necessary for construction before work begins. The painting and staining of all products is the responsibility of the homeowner. The homeowner is responsible to remove any and all furniture,pictures and fixtures in or around the work area prior to the installation process. All cabinetry must be emptied and appliances removed from the countertops. All pictures and valuable items should be removed from the vicinity of the work area as the installation process often creates small vibrations that may cause these items to fall from the walls or shelves. While our workers take the utmost care to prevent incidental damage, we cannot be held responsible for damage to items that the homeowner neglected to remove. Initial —� 4 INSTALLATION PAYMENT TERMS Client Name: Anita& Leverett Zompa Home Telephone: (978) 475-5722 Job Location: 6 Kathleen Drive, Andover, MA Payment Schedule: Labor A 50% deposit is due at the time of acceptance with the remaining balance of the original labor bill to be paid in full upon completion of services provided. Any change orders agreed to in writing by the customer will require an additional 50% deposit of the amount quoted on said change order before work begins, with the balance due upon completion. Material All materials must be paid in full on or before the date of delivery to the job site. Guarantee of payment: 1. The undersigned, in consideration of East Coast Lumber and Building Supply Co.,Inc. extending credit to the applicant,jointly and/or individually, unconditionally guarantees prompt payment of any and all obligations and indebtedness, which the applicant incurs,to East Coast Lumber and Building Supply Co., Inc. during this project. 2. Applicant also agrees to pay all reasonable attorney's fees and other collection costs in the event of default of payment. 3. In the event any unpaid balance is not paid within a timely manner, East Coast Lumber and Building Supply Company, Inc. has the right to claim any lien it may be entitled to under NHRSA 447.5 Total price on this labor proposal (as written) $ 14,060.00 Customer Acceptance: Date: Sales Consultant: Date: This proposal is valid for 30 days from the above date. Initial 5 COUNTER TOP TO BE CAESARSTONE MAHAVE SUNSET O G EDGE 4"BS 1814" 82" 38" • 21" 15" 27" 42i" 37' 8}" c 37}• 30" 33" S LL W2130L 1530 W361224 TTM. TEP2 B30 '"' .� .-.. m m ______________ of . pr ELECT.OUTLET �b m STAINLESS STEEL H OD BY OTHER 5 Im o � w at at fm0 l� ' rya ygVVYY,((', A y m a NEED PANELS 3 ------------------------- 32* _______________________32" 2 58" -------------- r; u ATTENTIONI This quote Is for estimating purposes only. All sizes, specifications,and quantities must be checked and confirmed by the archltecttwntractor/homeowner before ordering. East Coast Lumbar accepts NO RESPONSIBILITY for errors in extension. All dimensions_size designations given are Designer This is an original design and must not be Designed: 9/21/2007 subject to verification on job site and Jerry Buananno released or copied unless applicable fee has Printed: 10/25/2007 adjustment to fit job conditions. been paid or job order placed. ZOMPA All Drawing#: 1 0 C� L U-- 151 ao Note: This drawing is an artistic Designer Designed: 9/21/2007 interpretation of the general appearance of Jerry Buananno Printed: 10/25/2007 the design. It is not meant to be an exact rendition. i i ZOMPA I All Drawing#: 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street p Boston,MA 02111 M Sv www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name(Business/Organization/Individual): Address: ID r I IRL, tr'l 11r�� City/State/Zip: Phone#: QJ�—� Are you an employer?Check the appropriate box: Type of project(required)`:,, 1.❑ I am a employer with ' 4. ZI 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. JE'kemodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y p t3'• 9. ❑ Building addition , [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ",5 Policy#or Self-ins. Lic.#: �qd�� xpiration Date: -R0 Job Site Address: I°��(� � 0 l'1 pY—( u_Q _ City/State/Zip: 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 cerci under the pains a d penalties of perjury that the information provided above is true and correct. Si natur Date: [67 Phone#: Offfcial.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#: _ I 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 employgr 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.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-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 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 license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext.406 or 1-877-MASSAFE Revised 1122-06 Fax## 617-727-7749 www.mass.govldia Jk � e BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR .mow 4Lumbec rCS 094372 Birth&ite 07/31/.1969 Exp!res 07/31/2009 Tr. no: 94372 E:2esYricked .,00 , LORIANN! LANGAN. -: 7 C!2S S ROAD K!NGSTON, Nib 03848 Commissioner Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 119623 Tr# 132911 Expiration: 816/2009 lug TWO: 'Private Corporation Dube Construction-Plus,Inc. THOMAS DUBEP,„iQm...� 10 Bricketts Mill Road;Suite"C" Aaminlstrator Hampstead,NH 03841