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HomeMy WebLinkAboutBuilding Permit # 4/13/2015 %40RT#1 ,.�., .... BUILDING IT a ®� TOWN OF NORTH ANDOVER t 'APPLICATION FOR PLAN EXAMINA N ; Permit NO: ` Date Received °q<or..... . 14 A,rgp Date Issued: SS i� I ORTANT: A22ficant must com Tete all items on this pMe LOCATION14 Pr��t 'R(aF' RTY C7WNER Print' MAP-NQ P.ARCEL., ZONING DISTRICT Hxstor�c District es ria . '` Y Nlaclri Shi0p Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building pd One family ❑Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other o septic 'p We I, p FlOodI)lairs: -❑ W Ind ,,. -C7 Watershed District o lNater/Sewer all.,V Ir 1A J r a Y�11 'k¢ ' , s'�i Ap,A1,211 er Identification Please Type or Print Clearly) OWNER: Name: Phone: a Address: CONTR,ACT(7R Nim P Address i t Suervlsor spnsructlen L�cer►sex Cate rs r Home�Improuernert License77777777777( '�'�� Exp ©ate ' 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: $ qq,qooFEE: $ Check No.: $1,11-1 Receipt No.: -) � 72, NOTE: Persons contracting with u re istered contractors do not have acceW-tharanty fund Signature of Agent/Owner1/)---Signature of contractor AM � %A®RTH --A& dolver� fown of ® :, �► h ver, Mass, 41191 1 i5; COC NICHEWiCK �1• �.95 BOARD OF HEALTH Food/Kitchen PER T T L ummah' Septic System THIS CERTIFIES THAT ... ... .V.L...... .......A ., BUILDING INSPECTOR ffhas permission to erect .......................... buildings on ... � ......... ............................... Foundation •— ............. �,,.. Rough to be occupied as ......... 9 . . . . ............. .........................'.................................................................... 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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONT T Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin:; Rough Display in a Conspicuous Place on the Premises — ®o Not Remove Final No Lathing or Dry all To Be ®one FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Page 1 of 3 00500 CONSTRUCTION AGREEMENT Agreement made between the Owners: Paul J.McGovern&Lorraine A.McGovern 234 Bridges Lane North Andover,MA 01845 and the Contractor: Joppa Design Inc. email: projects@joppadesigninc.com Noel Ochtman,President 35 High Street MA-CS# 069183 Newburyport,MA 01950 MA-MC# 144582 ph/fx: 978.462.1797 FEIN# 20-1434947 1. General Project Description: Renovations to kitchen,family room,dining room,foyer,and hall closet areas. 2. Specific Project Description: The specific work of this agreement shall consist of a. All Work with respect to the referenced Drawings(6c),with the following exceptions and notes. b. All Work is to be at areas of construction only.Cutting/patching/touch-up painting is permissible where complete demolition is not performed. c. Purchasing appliances and decorative light fixtures is not included in the Agreement.Installing them is included. d. Purchasing cabinet door and drawer pulls is not included in the Agreement.Installing them is included. e. All cabinetry is to be Metropolitan or Decora,Prescott door style,non-beaded inset,painted Confection.All finished ends of cabinets to be flush(not paneled).All glass in cabinets to be clear glass. f. An allowance of$9,000 is included for the purchase and installation of all countertops. g. An allowance of$1,800 is included for the purchase of all plumbing fixtures.Installation is included in this agreement. h. An allowance of$750 is included for the purchase of all backsplash tile.Installation is included in the agreement. For all tile installations,mixed media,borders,non-orthogonal installations,epoxy setting materials,etc.,may constitute an additional cost. i. The work to move outdoor&porch switches from left side to right side of slider is not included in the price. j. The work to install new track lighting on beams in family room is not included in the price. 3. Period of Performance: The work shall begin no later than 13 April 2015 and be substantially complete no later than 17 July 2015, subject to adjustments as provided in the General Conditions of the Construction Agreement. 4. Price: The Owner shall pay the Contractor the sum of ninety-four thousand,nine hundred dollars($94,900.00)for the work under this agreement,subject to additions and deductions as stipulated in the General Conditions. 5. Payment: The Owner shall make weekly payments to the Contractor according to the following schedule: Work Performed Amount to be Paid* a. Demo,disposal,permits $ 3,950.00 b. Structural framing,windows,exterior trim and siding $ 5,750.00 C. Insulation,firestopping,board&plaster $ 5,440.00 d. Flooring install,patch,refinishing $ 9,650.00 e. Finish trim,cabinet installation,appliance installation $ 9,960.00 f. Cabinetry $ 34,200.00 g. Countertops allowance $ 9,000.00 h. Plumbing fixture allowance $ 1,800.00 i. Mechanical,electrical,plumbing $ 12,650.00 j. Painting $ 2.500.00 Total $ 94,900.00 Page 2 of 3 Key to payment schedule: * An amount equal to five(5)percent of the payment amount shall be retained by the Owners until the above Work is completed. Payments shall be made within five(5)days of submission of the Application for Payment. Any payments not made within the specified time shall be subject to interest charged at the rate of 1-1/2%per month. 6. Agreement: This Agreement shall consist of the following documents,which are incorporated by reference herein: a. The Construction Agreement(this document)executed between the Owners and Contractor. b. The General Conditions of the Construction Agreement executed and dated 3 April 2015. C. The Drawings as follows: McGovern Residence,A.0-A.6,dated 12 March 2015. d. Any Change Orders executed by the parties in accordance with the General Conditions. e. Other documents as follows:None. 7. Other provisions: None. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. This A eement entered into this third(3`d)day of April 2015. Paul J. overn,Owner �S Lorraine A.Mc I vern,Owner J Noel�OcHttman,Contractor President Joppa Design Inc. Page 3 of 3 NOTICE OF CANCELLATION -sign only to cancel the contract transaction- The Owners,may cancel this transaction,without any penalty or obligation, within three business days from the above referenced date. If you cancel,any property traded in,any payments made by you under the Contract,and any negotiable instrument executed by you will be returned within ten business days following receipt by the Contractor of your cancellation notice,and any security interest arising out of the transaction will be cancelled.If you cancel,you must make available to the Contractor any goods delivered to you under this contract in as good condition as when received.If you do make the goods available to the Contractor,and the Contractor does not pick them up within twenty days of the date of cancellation,you may retain or dispose of the goods without 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 in as good condition as when received within twenty days of the date of cancellation,then you remain liable for the performance of all obligations under the Contract.To cancel this Contract,fax or deliver a signed and dated copy of this cancellation notice to: Joppa Design Inc. Noel Ochtman,President 35 High Street Newburyport,MA 01950 I hereby cancel this transaction. fax#978.462.1797 no later than midnight of 8 April 2015. Paul J.McGovern,Owner Date Lorraine A.McGovern,Owner Date Page 1 of 5 00700 GENERAL CONDITIONS OF THE CONSTRUCTION AGREEMENT 1. General 1.1 The Work of the contract shall consist of all construction materials,labor,equipment and services required by the Drawings and other Contract Documents,or as reasonably inferable from any or all of the Construction Documents as defined in part 6 of the Construction Agreement.The Work shall be for the whole or part of the project as described in the Construction Agreement. 1.2 The Contractor and all home improvement contractors and subcontractors shall be registered. Any inquiries about registration should be directed to: Director,Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170 Boston,MA 02116 Phone#617.973.8787 or 888.283.3757 1.3 The Work of the project shall comply in all respects with applicable federal,state,county and/or city regulations, laws and codes. All required building and other permits shall be obtained before beginning construction.The Work shall require a building permit,as well as some or all of the following permits as applicable: electrical,plumbing,gas fitting. The contractor is obliged to obtain the above referenced permits as the Owners'Agent.An Owner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A) may not be waived in any way,even by agreement.However,Owners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.Additionally,Owners who secure their own construction related permits are automatically excluded from access to the Guaranty Fund provisions of the Home Improvement Contractor law.The Guaranty Fund is a fund out of which an owner,aggrieved by a registrant,may be paid part or all of their damages under rules and regulations promulgated by the secretary of Executive Office of Consumer Affairs and Business Regulation. 1.4 All materials and workmanship shall be done in a professional and workmanlike manner and shall be to the reasonable satisfaction of the Owners,and in accordance with,and to the extent applicable,to the current standards of the American Society of Mechanical Engineers,American Society of Testing Materials,the American Water Works Association,the American Institute of Electrical Engineers,the National Board of Fire Underwriters and the American Society of Heating and Ventilating Engineers that apply. The Contractor warrants all materials and workmanship against defect for a period of one(1)year after substantial completion.Additional manufacturers'warrantees for installed equipment,as applicable,will be provided to the Owners upon completion of the Work. 1.5 Substitution of items will not be permitted unless specifically approved by the Owners. 2. Responsibilities of the Owners 2.1 The Owners shall furnish the Contractor with a survey of the project site if required. 2.2 The Owners shall obtain and pay for the necessary approvals,easements and/or variances required for the construction of the project.The Owner shall be wholly responsible for obtaining approvals from the Zoning Board, Conservation Commission,and the federal and state Environmental Protection Agencies,if applicable. The Owners shall hold the Contractor harmless for any violations of zoning by-laws and all federal and state environmental regulations. The Owners may be charged by the Contractor for damages due to fines or lost time on the job due to zoning or environmental violations. The Owners represent and warrant that they shall obtain any and all zoning and environmental permits prior to the construction work so that Contractor's work shall not be delayed or otherwise impaired by Owners' failure to obtain same. 2.3 If the Contractor fails to complete the Work,or part of the Work of the Agreement in accordance with the Construction Documents,through no fault of the Owners,and fails to correct such discrepancies,the Owners may,by written order,stop work on all or part of the project until the cause has been corrected. Page 2 of 5 2.4 The Owners reserve the right to occupy the building space,or such portions thereof as may be desired,at any time without in any way invalidating this Agreement. An additional fee may be charged to the Owners by the Contractor if the Owners' occupancy interferes in any way with the progress of the project. Additional time for completion of the project may also be required if the Owners'occupancy hampers the Contractor in any way. 2.5 Unless otherwise set forth in this contract specifically,the Owners shall be responsible for(i)all costs associated with the drilling and blasting of ledge,or any other existing undiscovered condition or conditions not set forth in the scope of work attached hereto,(ii)any design plans submitted to Contractor,and(iii)all costs associated with clean-up work or removal of hazardous waste or materials found on the site which were not disclosed and not set forth in the scope of work attached hereto. All extra work as a result of same constitutes Change Orders that may require extra costs for labor and materials if Contractor agrees to do same at its sole discretion. 3. Responsibilities of the Contractor 3.1 The Contractor shall be responsible for the Work described in the Construction Agreement. Unless otherwise agreed upon in writing,the Contractor shall have complete control over construction methods,techniques and procedures and shall supervise such work with his best skill and attention. 3.2 The Contractor shall pay for all labor,equipment,materials, and services required to complete the Work as described in the Construction Agreement as well as building permits,licenses,and inspections necessary for the proper completion of the Work. 3.3 All contractors and subcontractors shall be properly licensed and will coordinate their work with that of other contractors so that all work will be in harmony with the other contractors on the project. 3.4 The Contractor warrants to the Owners that all materials and installed equipment required to complete the work on the project will be of good quality and new,unless otherwise specified and/or approved. 3.5 The Contractor shall take care in working near existing areas to protect them from damage. The Contractor shall be responsible for any damage to existing areas and will repair such damage,at his expense,to the Owners'reasonable satisfaction. 3.6 The Contractor shall keep the project site and surrounding area free from waste materials and rubbish which results from their work on the project Removal,hauling and disposal of rubbish and waste materials shall be the responsibility of the Contractor unless otherwise agreed to in writing between the parties_The Owners shall afford the Contractor a reasonable place for a waste disposal unit,a dumpster,roll-off or what is deemed required by the Contractor for the duration of the Work.This waste receptacle is for the sole use of the Contractor,and Owners'use of it will constitute an extra charge.In no event shall inappropriate or hazardous materials be disposed of in a waste receptacle provided by the Contractor. 3.7 Limitation of Liability (a) IN NO EVENT SHALL EITHER PARTY BE LIABLE TO THE OTHER FOR ANY INDIRECT,INCIDENTIAL, CONSEQUENTIAL,SPECIAL,PUNITIVE OR EXEMPLARY DAMAGES IN CONNECTION WITH THIS AGREEMENT,HOWEVER CAUSED,UNDER ANY THEORY OF LIABILITY,REGARDLESS OF WHETHER THE PARTIES HAVE ADVISED OR BEEN ADVISED OF THE POSSIBILITY OF ANY SUCH LOSS OR DAMAGE. (b) IN NO EVENT SHALL THE AGGREGATE LIABLITY(INCLUDING,BUT NOT LIMITED TO CONTRACT, NEGLIGENCE AND TORT LIABILITY)OF EITHER PARTY OR ITS DIRECTORS,OFFICERS,EMPLOYEES AND AGENTS,UNDER THIS AGREEMENT EXCEED THE TOTAL CONTRACT PRICE. 3.8 The Contractor shall provide the Owners reasonable access to the Work. 4. Subcontractors 4.1 The Contractor shall select the subcontractors,except that he shall not use subcontractors to whom the Owners have a reasonable objection. The Contractor shall not be required to use a subcontractor to whom he has a reasonable objection. Page 3 of 5 5. Disputes 5.1 The parties will attempt to settle any claim or controversy arising out of this Agreement or the subject matter hereof through consultation and negotiation in good faith in a spirit of mutual cooperation. If they fail to resolve the dispute within 15 days after a party notifies the other party of the dispute and do not mutually agree to extend the time for negotiation,then the dispute will be submitted to arbitration in accordance with the procedure set forth in Section 5.2. Pending resolution of any dispute pursuant to this Section 5.1,both parties will continue their performance under this Agreement;Contractor shall proceed in accordance with the interpretation and direction of Owners and prosecute the Work diligently and without delay and Owners will continue payment of all amounts that are not in dispute. If a dispute moves to Section 5.2,the Contractor may stop work pending resolution of the dispute. 5.2 (a) Any claim or controversy that is not resolved pursuant to Section 5.1 will be referred to and finally resolved by arbitration in accordance with the Commercial Arbitration Rules("Rules")of the American Arbitration Association,as such Rules may be modified by this Section 5.2. A party shall initiate arbitration with written notice to the other party that describes the issues for resolution. From the date of such notice and until such time as the dispute has become finally settled,the running of the time periods as to which a party must cure a breach of this Agreement becomes suspended as to the subject matter of the dispute.The arbitration shall be conducted by one arbitrator,who will be agreed upon by the parties and selected from a list of at least five nominees'selected by the AAA.If the parties have not agreed upon an arbitrator and notified the AAA within 5 days following receipt of such list,the AAA shall select the arbitrator within 3 business days of receipt of responses from each party providing a rank order listing of the five nominees(with the most preferred having the lowest rank)provided to the AAA by the parties. (b) Unless the parties agree otherwise,they will be limited in their discovery to directly relevant documents. Responses or objections to a document request will be served 20 days after receipt of the request. The arbitrator(s)will resolve any discovery disputes.Unless otherwise agreed by the parties,all such arbitration proceedings will be held in Boston. The arbitrator(s)will apply the law of Massachusetts. (c) The arbitrator(s)will only have the authority to award actual money damages(with interest on unpaid amounts from the date due)and the arbitrator(s)will not have the authority to award indirect,incidental,consequential,exemplary, special,punitive or any other type of damages not measured by a party's compensatory damages,and the parties expressly waive any claimed right to such damages. Judgment on the award rendered by the arbitrator(s)may be enforced in any court having competent jurisdiction thereof. (d) The costs and expenses of the arbitration,but not the costs and expenses of the parties,will be shared equally by the parties. If a party fails to proceed with arbitration,unsuccessfully challenges the arbitration award,or fails to comply with the arbitration award,the other party is entitled to costs,including reasonable attorneys'fees,for having to compel arbitration or defend or enforce the award. Except as otherwise required by law,the parties and the arbitrator(s)will maintain as confidential all information or documents obtained during the arbitration process,including the resolution of the dispute. 6. Work by Other Contractor(s) 6.1 All contractors and subcontractors shall cooperate with others on the project and the Owners shall provide the Contractor and other subcontractors reasonable opportunity for the storage of materials and equipment. 7. Changes 7.1 Changes,modifications,additions and/or deletions to the Work under this agreement will only be made by written order signed by both the Owners and the Contractor. Any such changes will not invalidate this Agreement. The time for project completion and the project cost will be adjusted accordingly. In the event of a conflict between this Agreement and the terms of an executed Change Order,the executed Change Order shall govern. Page 5 of 5 the Owners may,upon seven(7)days written notice to the Contractor,terminate the contract,and finish the work by whatever reasonable method the Owners determine. 14. Miscellaneous 14.1 Terms of this Agreement which are of a continuing nature shall survive termination hereof. 14.2 If any term or provision of this Agreement should be declared invalid by a court of competent jurisdiction,the remaining terms and provisions of this Agreement shall be unimpaired. 14.3 Failure by either party at any time to require performance by the other or to claim a breach of this Agreement will not be construed as a waiver of any right under this Agreement. 14.4 No modification,waiver or amendment of any term or condition of this Agreement shall be effective unless in writing and signed by both of the parties hereto. 14.5 All notices and other communications hereunder shall be in writing,except as herein specifically provided,and shall be deemed to have been given when either received in person,or mailed by first class mail postage prepaid,or e- mailed and confirmation sent to sender,to the intended recipient hereof at its address shown above. 14.6 This Agreement,together with all exhibits attached hereto,constitutes the entire Agreement between theparties with respect to the subject matter hereof and supersedes in all respects all prior proposals,negotiations,conversations, discussions,and agreements between the parties concerning such subject matter. 14.7 This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective successors and permitted assigns. 14.8 This Agreement shall be governed by,and construed in accordance with,the laws of the Commonwealth of Massachusetts. 14.9 The parties agree(i)to furnish upon request to each other such further informationiito execute and deliver to each other such other documents,and(iii)to do such other acts and things,all as the other party may reasonably request for the purpose of carrying out the intent of this Agreement and the documents referred to in this Agreement. 14.10 Neither party may assign any of its rights under this Agreement without the prior consent of the other party. 14.11 The headings of Articles and Sections in this Agreement are provided for convenience only and will not affect its construction or interpretation. 14.12 This Agreement may be executed in one or more counterparts,each of which will be deemed to be an original copy of this Agreement and all of which,when taken together,will be deemed to constitute one and the same agreement. 15. Other Provisions: None DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Notice: Upon signing this document,it becomes a binding Contract under law. This agreement entered into this third(3'd)day of April 2015. J Paul . cGovern,Owner I/S Lorraine A. overn,Owner N ch an, ontractor President Joppa Design Inc. ClIx The Commonwealth of Massachusetts Department oflndustrialAccidents o X Congress Street,Suite 100 Boston,MA 02119-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/1G lectricians/PIumbers. TO BE FILED WITH THE PERMTTTING AUTHORITY. Artplicant Information Please Print Legibly Name (Business/Organization4ndividual): 0 ', ® ry Address: City/State/Zip: rP I q,5p Phone#: q6Z /797 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).* 7. F1 New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in $. JA Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees,[No workers'comp.insurance required.] *Any applicant that cheeks box#I must also fill out the section below showing their workers'compensation policy information. t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing iporlrers'compensation insurance for nay enzplayees. Belou,is the policy and job site i information. Insurance Company Name: " '0Ce1SQa.4Le (V i rS Policy#or Self-ins.Lic.#: _ C _DQ6 C "' Expiration Date: Job Site Address: d o e s L4AL City/State/Zip: dV e 01 Attach a copy of the workers'compen tion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e, 152,§25A is a criminal violation punishable by 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 j day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificati n. I do hereby certiy nd tI pains and penalties of perjury that the information provided abo is ttzte and correct Sign re: Date: Phone#: Official use only. Do not sprite 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: WORKERS COMPENSATION AND EMPLOYERS LIAq,ILIT4JNSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 40959 POLICY NO. WCC-500-5006180-2015A PRIOR NO. I WCC-500-5006180-2014A ITEM 1. The Insured: Joppa Design Inc DBA: Mailing address: 35 High Street FEIN:**-***4947 Newburyport, MA 01950 Legal Entity Type: Corporation Other workplaces not shown above: See Location 2. The policy period is from 02/03/2015 to 02/03/2016 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 418701 INTER SEE CLASS CODE SCHEDULE Minimum Premium $575 Total Estimated Annual Premium $10,516 GOV GOV Deposit Premium $2,773 STATE CLASS MA 5645 State Assessments/Surcharges $9,933.00 x 5.8000% $576 This policy,including all endorsements,is hereby countersigned by 12/15/2014 Authorized Signature Date Service Office: Boston Insurance Brokerage Inc 54 Third Avenue 24 Federal Street,4th Floor Burlington MA 01803 Boston,MA 02110 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. i' Massachusetts -Department of Public Safety Board of Building Regulations and Standards �.w»u uLtion oupers iior - j License: CS-069183 35OEL S M CHT ' T MWBURYPORT MA 01950 ^ I` Expiration Commissioner 12/16/2016 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only '�'OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 144582 Type: Office of Consumer Affairs and Business Regulation Expiration: 10/1572016 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 JOPPA DESIGN,INb NOEL OCHTMAN 35 HIGH ST � a NEWBURYPORT,MA 01950 Undersecretary f Not Valid without signature