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HomeMy WebLinkAboutBuilding Permit # 1/11/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 1 j 64H Date Received Date issued: IMPORTANT:Applicant must complete all items on this page Eli- WE N TYPE OF IMPROVEMENT .PROPOSED USE Residential I Non-Residential New Building One family Addition Two or more family Industrial Alter No.of units: Commercial epav,replacement Assessory Bldg Others: Demolition Other �� Septic�We�tl��- loedFFa Etlands �aY"er�e �31strt �= - DESCRIPTION OF WORK TO BE PREFORM dsti ��'Fw t`:�� i �5 @ Gr.feL*rt+it56.vo �ry-arcs� �e I.0 tC 5-aa✓F �i3r�� 5r^r�.S ' w ` Y"utificafion Please Type or Print'Clearly) OWNER: Name:Riah-;rie ro'.�- #-a �=,. �f-- Phone: Address: 80, (/t-b—,, A-,j,,»— ON�TRAG��Na er �` Hone ' Aets SupeEvi or�sCo�t� Io kens _ '� HameffrfxPr`o�rr{enl�woetgse_ � �'�" �-�E?Pkat.."- ARCHITECT/ENGINEER /;1 Phone:I�/rA t Address: /}A Reg.No.tur� FEE SCHEDULE:BULDING�PRMIT:$1200 PER$9000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost:$"� I G( FEE:$ Check No.: 1`5,, %-% Receipt No.: -a'?9 NOTE: Persons contracting with unregistered contractors do not have access to he guaran +u Signature of-AgenUOw Iter SrgieatPrvv hof con . F ,,oRTPo 2 ; -town ofAndover o � V � h ver,lVia3S, $ uu BOARD OF HEALTH Food/K[then PERMIT T ILD Sept c System THIS CERTIFIES THAT. . ( BUILDING INSPECTOR has permission to erect................. buildings on..a....../.......h +...b ..l�-.✓... Fo�ndaton . .. .... y� Q �j•�• (/(��• • �Ioo to be occupied as.. �l-...1 ! ►/......P® ...!...^...".~..,......IC l.I�.�.o..:..(� t lwR h h mne provided that the person accepting this permit shall in every respect conform to the terms of the application Ftoai 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 CONSTRUCTI T S R-gh sen,�ee ................. .. .. ..... ..................................... Final BUILDING INSPECTOR GASINSPECTOR Occupancy Permit Required to Occupy Puildiup Ruugh 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. B�rn sheet No. Smoke Det. BUSINESS CONDITIONS TO T{'IS COPSSTP.Di:TET?Yd CO'NTi Ar, This Contract,dated 10/26/9015 Is by and between. Roberta and Richard Denault 80 Huckleberry Lane North Andover,MA 01845 Blackdog project code DENAU-13031 (Hereafter referred to as OWNER),and Blackdog Builders,Inc. 7 Redroof Lane.Unit#1 Salem,NH0 3079 (603)898-068 (Hereafter referred to as CONTRACTOR).Work will be performed at_ __ 80 Him,kleberry Lane,North Ando-r,CAA 01845 {Hereafter referred to as PROPER-TY) __._--.- 1_GENERAL Tills CONTRACT is for the following work and materials to be performed by the CONTRACTOR,on the PROPERTY address shown above.The project Is generally described as fellows'. Master Bathroom,Main Bathroom,Living Room,Kitchen (Hereafter referred to as WORK) The CONTRACT consists of this document.any plans,the specifications,the Blackdog coon{package and the Construction Contract.(Hereafter collectively referred to as the"CONTRACT) 2.PRICE The total price for the WORK agreed upon Is 558,018.85_Payment terms are set our below in Paragraph 6 This proposal may be withdrawn by us If not accepted within thirty(30)days- ,. ;i.STARTING AND SUBSTANTIAL C©MPLETIOPS PROUISIOIds The WORK will begin in January 2016 and will be substantially c0l"Plet-i in April2016,absent t ulnar i w- unforeseen circumstances beyond the control of the CONI RLCTOR,and pr—aim?this CONTRACT and any I elated CONTRACT documents are accepted which pressn d.Pir.r.on squ 71-9'no or act bne fa constriction wor`a and one for bath or kitchen product)will n n l-a intc thefadula r III Loth grecs cts have been executed.The aforementioned dates reflect our p s-ut workload F -cc`s ar assigned o�i�,in our work schedule as they are accepted,on a first come first sawed basis.Trose dates may move based on the completion 6—of the project that Immedlately preceded por- p. PERMITS ANDAPPLIGABLE GO_DES'G�:J P't�fFr.NGE_rIV1TH_LGGA1_LCL All work to be done Urrilal this CONTRACT ill be a 11 h -b co,n,v F 'N n ie CONTRACTOR sh..I obtain all neclassa:f Ps'nirits am,pv all ca r ian fe,I sr m. Knees othe-Ae agre.d. C KTRA p e dv r u - r a i-a—,f required.The C TRF.CT price —rc, coir. Lry , o fic.a,to bring tha project Into c m ans=_w 7 a y e.evs 5. SPEC#FRG REQU IREMCNTS FCR 11 A I EP 0.LS h.N6 l bkf rA,,,f=SHi_° 1'0/22212015 a.This CONTRACT will be completed by the CONTRACTOR in a good and voerkn-14te manner,using quality materlale b.If applicable,the CONTRACT price includes the following allowances.See altowancas under specifications. �. PAYMENT, a. Timely payment by the OWNER of all sums due under this CONTRACT Is of the essence to this CONTRACT. The parties agree to the following schedule of payments: Deposit with this contract.$5,061-89 P W ClL t"�4, Payment Schedule amounts reflect a Partner Plan credit of$2,000.00 b.Payment SchodW. 3StartoEri rU r.lY;;e.; t v�jr;'` 06.599.&�. 9 Start of drywall hanging ) S6.599,94 S-Slart of The work 36,599-94 6SYart of floor tile $6,599.94 7 Start of painting $6.599.94 Substantial Completion $2,510.85 `]Completion of Punch List $1,566.53 I Start of project $6,599.94 Start of plumbing rough-in $6,599 oa c.Allowances foe Dvunev Selected Com.{.ionesets d.The CONTRACTOR may cease operations if any payment is not made by the OWNER as required herein, and proceed to collect any balance due through any remedy provided by law. Payments are due mohee the aforementioned progress milestones have been reached. It is understood that minor adl to the payments schedule may be necessary due to the flow of work or delays beyond the control of the - CONTRACTOR. e.Delays in payment in excess of thirty(30)days shall be subject to it ferest charges of t8%1 annum,and ne event higher than the maximum interest rate provided by law.If the CONTRACTOR Is reggired to engage tl lie services of a collection agency of an attorney,the OWNER agrees to reirnburse the CONTRACTOR for any reasonable attomey's fees and expenses expended in order to rglleet the unpaid balance. r`.DEFINITIONS Substantially complete-The space or project is substantially complete when Che space or prosect can be used for its intended purpose and only punch list items remain. Punch[let-VV.,or product that has not been performed or provided. Warranty item-A product u,service that has beei provided rr I e`o:rred e .-,S no r"exs ]ds^l' standards. THESE CONDITIONS MUST 6E F.CCOM[7AIi Cv TN C S'I RO'T c C N–'R/,(:T t0/22/20-i5 -" Construction Contract of the Contract/Proposal for Roberta and Richard Renault CONSTRUG1ION CONTRACT This Contract is by and betuveerc. 'PIDg1.1—ed to Roberta and Richard Denault hereafter referred to as"OW North Andover (dA 20184+5 dot c 10,126/2015 This as 'CONTRACTOR"for work at 80 Huckleberry LaneN , t CONTRACT Bl ocinslas Euilders f iliusent Package document (Hereft Plans c the ecSip ly rlererons to assu'ilei IdTRACTTerms hzt are e c d and dog 1_CONTRACTOR'S®UTIES�GENERAL a. TO direct and control the work contracted for In acco dance with tr e terns of tl- CON T and al applicable codes,laws,and regulations,and as the building p.rmits Issuer)for thie prole e If a,y,idgr e b. To inspect the site,examine the plans and specifications,if any,and supervise all of CONFRACTOR'e employees,and to direct the work cf all subcontractors selected by CONTRACTOR. c.To maintain the work site In a safe and clean condition,to the extent consistent with the CONTRACT. d. To advise the OWNER promptly if co— conditions are ascertained which redr-e additional or di$erent NTRP. work,and to proceed In such event In accordance with this COCT. orrnanco of this e.To provide locked storage for any equipment,tools,or other PROPERTY used In Brt re pe CONTRACT,unless otherwise agreed in writing. 2. OWNER'S OUTIES;.GENERAL a.To provide adequate utilities kor the v o l<agreed upon. b.To advise the CONTRACTOR of any condition of the PROPERTY w h�ffech COM 1 CACTO -bility Po perform. G.To provide secure storage areas for materials delivered to the work sito. ed such llrs.3.,?ions do not d. OWNER shall be entitled to make panodic inspections of the work site,pro�id interfere with the work and can In the judgment of the CONTRACTOR,no ee safe 4 'o,er t n o. the construction site shall be at OWNER's risk. a. OWNER shall notify his Insurance agent of the execution o thisagree art end of tzii -n) roce ary it ars to his current coverage or any locally customary forms of coverage.sin s guilder J,,to co O rINcR's Interests and IlabiGties during the construction process- f. To perform no work on the project without a written agreeme�t wi[r tr CO RACT� - g.To make no agreements with any trades person.subcontractor,a CON PA ATO S e.�ployees aside ilia scope of the CONTRACT without the wriiten consent of the CONTRACTOR. g. MrAl'ERIAL sueS'TITUTION - c al ors .,,uaMy. CONTRACTOR reserves the right to cubsttute othe�maie'ais,produc n utility,or similar color. 4. 6ELAY -I eCC TF1_ rR. COIVTRAGTOR spat ot be e ponsible for o la J.,gas o by e [s hey r Including but r of Thad to.sc?keI wa.,a t of Coo.a acv r me f e .r? n str r � t/ caused by OWNERS failure o make allovd c mat n Is -13c: - 6 GONTP.ACTOR of er.`as or c-ss2J'w i�a ie'�r''bo 'd-a° 5 PNSURAN - _ a. a t CONTP,AC`O< c 0 � 0 1. .�.tr .r - - ..� o ur:en a �'f ""a Cc n - ferem.ed _. - -e ep"a— - located 6HiDDF CO!-CEA.LEb as U4 10'2212015 a. The parties ogres that In the event CONTRACTOR discovers a hidden,concealed or unforeseen condition requiring an extra cost that they shall proceed as follows. The CCN,I RAC FOR shall no if i find ed a wFRl verbart-. lly to exp dire ugreemant as to any charge ecce. y to:o ref r.c s. A dfio 1.Order(as described in paragraph 7a)as soon as practicable The bails rr st agree to srch extra charges,or agree to a resolution method,or this CONTRACT may be cancelled by elther of them. b. For purposes of this section,a"hidden,.concealed and unforeseeabl CO'Mncint sh II mean a could bon not readily observable to a prudent CONTRACTOR inspecting the subject PROPERTY for the purpose or pe forming this Contract.Examples of such conditions can include,but are nor unueo to,iot under siding ledge below grade; pre-existing plumbing or electrical work not performed to code and pre-existing moid. c.Any change in the WORK required by building officials assigned to this projectincluding structural and/or any environmental hazards will be billed as an EXTRA charge to Phis CONTRACT and paid for by free OWNER as a Work Order.CONTRACTOR may cease operations if OWNER refuses to . pay 7AXTRrS . extra or materials desired by the OWNER shall be agreed upon In writing and such extras shall become a part of this CONTRACT as if fully set forth herein. Unless otherwise agreed,extra work shall be paid perras formed{by CONTRACTOR,and the OeNERee of said en a xtra Order rna'eire s s hall bedp esarmedryfor any wOlk unless there a pate written notice to the contrary. b. CONTRACTOR shall advise OWNER,attire time Of agreement on an extra,as to any additional three required to perform this CONTRACT.CONTRACTOR may cease operations If OWNER refuses to pay- 8. ESCALATION CONTRACTOR reserves the right to pass on additional costs to OWNER resulting from the escalation of the cost Of lumber or lumber byproducts.This cost may be passed on only,if after the CONTRACT Is signed but before the construction commences,an increase in lurnber costs is expc,oxo,,d.The CONTRACTOR must suhstanfiate the change with evidence of the difference between lumber costs at the time of toe CONTRACT and lumber costs at the time of construction.Only direct cost differences may be passed on,no allomrences for ovetend and profit shall be included-Any additional costs will be collected per Work Order(as described in paragraph 7a.). 9, EXCESS MATERIALS ON SITE CONTRACTOR routinely stores extra materials on site to improve efficiency and reduoe the likelihood of running out of stock In the middle of a task.Unless otherwise specified In writing all excess materials on site at the and of the IT, are the PROPERTY of CONTRACTOR. 10. SUBCONTRACTORS a. CONTRACTOR shall select subcontractors as required to complete this CONTRACT.OWNEP.acknowledges that subcontractors will do various portions of the work.Any subcontractor selected by the CONTRACTOR shall have all requisite Ilcauses for the work to Jr.done by such subcontractor. b. It shall be the duty of the CONTRACTOR to use reasonable care in the selection of subcontractors. Absent objectionableperformance by any subcontractor rhe selec len or subco a to� Dail b n exclusio roht of t'he CONTRACTOR. The COINTRACTOR shall require all subconteltcrs to I ay.,work-a s comper io red liability insurance in force. c.CONTRACTOR agrees to be solely responsible for the completion of the work described herein regairlless of the actions of any third party/subcontractor utilized by the CONTRACTOR The CONTRACTOR further agrees to be solenerve to a,l .ib ort a�:ors or r '.rials 7-r u-,a ly responsible for all pay Ir agreement 11. TKLIIlNATION AIIi3 CANCGLLATEON Tire CONTRACTOR -r—an Yr and car f fills CORT[ L is a >-h_r n is-of re ar o edited al n otid h t at. 'oe r r OA tl _ ,lo J r� the„Olv RACTr�R li o e nou?s "Vide-`/.a n r =- r = Tua 0'INER Cpl r rl uate t s 301ITRAG -he fo ..„.- a. t o l-e of file O arrRACT i;,or his sIjbret V flias u dclzy as P oat a 'Ic Pa:zg T i- core cd agraello—T uenountra sonesuch ag,ceoent m..y b., __ y - b.Fallu e o.tree CONTRACTOR to rect,v a v cojif - , u o Orr , C v, aaatc _ or - - 0/22/23 t 5 otherwise agree. c.Any other failure to perform this CONTRACT req!tired ey the terms of this CONTRACT. d. No termination shall be effective unless 10 days written notice of OWNER'S Intent is given as required below, during which time the default may be cured by the CONTRACTOR. e. Deposit monies- ag"'s that Cancellatlon of this CONTRACT prior to the commencement of work shall resort In the ,Pon forfeiture Of fcany and all itts p CON TRACT oil shall sulf peposile r da Wages including with not ,ad tlo thhe cost associated with designing and preparing the project for commencement. f. You may cancel this agreement by observing the requirements of Tile Notice of Cancellation attached hereto. 12 DISPUTE 2E50LU14N or the breach the dispute It a dispute frit throughttle fd�ecl discussions,to ifthisContract, hendisputs cannot be settled through dif,the rect des hallr end-," s op sv the pato rties agree the dispute shall be settled by arbitration as follows. New He shire Consumers. g parties are the If the dispute with a New Hampshire customer cannot be settled throw h direct discussions,the p agree dispute shall with settled by arbitration administered by the Hmerican Arbhation Association under lts Construction Industry Arbitration Rules-In the event that arbitration is necessary,the parties agree that arblfratlon proceedings shall Us conducted by a mutually agreed upon arbitrator in Rockingham County,Ivew Hampshire.h the parties cannot agree on an arbitrator,either party may file a written demand for arbitration'm accordanre with the rules of the American Arbitration Associafion.The arbitration award shall be final and judgment on the award entered in any court having jurisdiction thereof. Tills CONTRACT shall be governed and interpreted in accordance with the laws of the State of New Hampshire.The parties acknowledge that this ag a reined under this CONTRACT,seek from any court havung lui sdictlon a ry ii:,rim or arbitrate shall be Teamed by Chapter 542 of the New Hampshire Revi er'3tatuCes An ro'ted EIYh ria y without waiving any Y provse e isional relief that Is necessary ro protect the rights or PROPERTY of that party including but no limited TRACT right to seek liens or attachment The prevailing party In any ar,dispute arishall ing out of o�plat n9�o ectlonw+tl such party breach thle att'eaovorneys''by ariindIstsng d sputa l s infC'urred by the".,a tfihe"'sdYe recover from trio other dispute resolution process. Massachuset ors. If a dispute with a Messachusefls customer cannot be settled through direct discussions,the parties agree the sti -dus dispute shall e s law providers homeownerstwithd the right tossatiat.an orbIlait mate iiy a (as eco as.,I alternative to MGLc,42A). court action)if they have a dispute with a contractor.The same right is not automatically afforded Co ti contractor. The contractor would have to resolve any dispute It has with a haneowner in co�.ut unless both parties agree to the following optional provision.This provision give,the contractor the same rights fo arbitration as is afforded to the homeowner tby o the Home Improvement Contractor Law- in advance that In the event The CONTRACTOR arid OWNER,residing In Massachusetts,hereby mutually'Top, to a the CONTRACTOR has a dispute concerning this CONT FACT,the CON c.or OR nay bnite pu e I erbitratlon fim�approved by the Sec,tory of[e Executive Office, ,c sum r blas s r,1 Business Regulation and the OWNER shall be 2qulred to sniff t is such arbl�r 'or as prod ted Nessa rse:is Law's. chapter.142A, t h u c on pry Party�i g Lut c. Either party may,without waiving any iem�dy under this C'O RP CT seek rroir,snrr1t interim or provisional relief that i=_neves a�y to pro'ecr ,t. o FCR _ g his pr a i ._ty r r' r _ r. mired to the right t seek lin or kacr o a _ CONTRACT cr it.1,11sehtr c cecsaria e c. r 'er s the ocher pa ty reasgrable a err r "`o li,pA'ss 51 such dispute process provided In MGL c.142A. 10i22120'�d RJerta Denault iryn r onsult„q /1 -i^ €la jIdog Builders,Inn Richard Denault Notice.The signature of the parties above constitutes an acknowledgamenC of the agreement between the parties to alternative dispute resolution.Massachusetts consumers may have the right to initiate alternative dispute resolution even where this section is not signed by the parties. g.Unless otherwise agreed in writing,CONTRACTOR shall continue the\NORK and maintain[he agreed work during any dispute resolution proceedings. CONTRACTOR's obligation to continue to perform is conditioned upon OWNER,timely payments in accordance with terms of this Centrad. 13.ENVIRONMENTAL HAZARDS a.The CONTRACTOR is NOT responsible for the inspection,discovery,abatement or removal of any environmental hazard Including,but not limited to'.asbestos;mold;lead,radon,ground water or environmental pollutan at"a work site,unless specifically covered In the specifications. In In the event that any hazardous material is discovered during the course of const,,,rnon,the testing, abatement and/or removal shall be the sole responsibility of the OWNER, c.Any additional costs incurred on account of suspension of the const ruction or cPrenges to the specifications due Co a hazard or its removal are the responsibility of the OWNER and will be handled by a Ill Order s the. CONTRACTORt tl er poo-eatendolamoa,f of rtfrenCClPdITRACThoriceoappgeOWIVEror'ngtlane ro,r;nmebr a[relnrpaY pursuant to the Contract. LNARRAFlTY OWNER warrants that as of fine date of tints CONTRACT:(1)fine PROPERTY(including the Land,surfiaea watar,ground water,and improvements to the land)is,and wil{continue ka 1ac--,free rsf air ca definnaYby including(a)"oil,petroleum products,and their by-products"(b)any"hazardous m�aste"as defined by the Resource Conservation and Recovery Act o3197"as amended from time to time,and regulations promuigated thereunder;{c)any"hazardous substance as defined by the Cornprahensive E-ti aamenta> Response,d theCorhau hcllr n,and Liability Act of 1900,as amended from time to flme.and"gal' promulgated thereunder,specifically including asbestos and mold;and(d)arty other"hazardous substance"(2)the PROPERTY is in compliance with all anvironmoud d favus and regulations;arrd(3)there are no underground tanks on the PROPERTY N4E MNITY OWNER expressly acknowledges and agrees that it will raimburse,defend..indemnify and hold harmless CONTRACTOR,all Sub-contractors,their succassors,assigns and employees from and against any and ali CONTRACTOR claims,damages,penalties,expenditures,losses or charges(including,but not limited to,all costs of Investlgatloq monitoring,legal tees,remedial response,removal,restoration or permit acquisition)which may, nowt In the imonitutui e,be undertaken,suffered.paid,awarded,assessed,or otherwise Incurred as the result oP. (a)any contamination,existing in,on,above or under the PROPER Fy(including,but not hurled to,contaminated soil,mold,buildings,facilities and/or ground water)I (b)any investigation,monitoring,clean up,removal,resl'orat,on,remedial response or remedial work undertaken on the PROPERTY,and (c)OWNER'S breach of any warranty given herein. 14_WARRHNTIES a. The work of the CONTRACTOR.Including ma[enars and -b r "I'll be �-n`e,e�i1 arising do f irv'ork years,during rd,i,h period CONTRACTOR Y II at, yr, ,pal,_ Y, c a L.,t I„o Ytaa r,less it is a non mar ar ..condullon as c outthe 31 d, ,g 31 g became a part li tin O vTRACT as If fully setfo I, ere I e�m. _ Ott-R is b Any apd all a 2' ppl ane o hz 1 be t a',° CONTRACTOR r ce tl�, m Owner sore ,'2 i, fa u,e y n Rr, „ is app/a ices or me h ni,..�st st 7s and agr s hat nv achel o 1 Contact as a result Of­­ufachree warm ti su. - T,e quality of a�' do k q�_stion ill e held t -taa.,a s ."--- Perfo",nance Go delis- Forr h Eeinc,,pGb ,d by the A 3 _v„ sge ro circ 1 012212 0 1 5 15.SEVERABILITY If any portion of this agreement is found invalid or unenforceable by any court,the remaining provisions shall remain In force between the parties. 15. ENTIRE AGREEMENT Upon signing this document becomes a binding CONTRACT under law. Unless otherwise noted within this document,this contract shall not imply that any lien or other security Interest has been placed on the residence. This CONTRACT consists of the documents defined herein,and constitutes the entire agreement of the parties. It can be modified only by a written document.OWNER aclmowledges that he has read and received a legible copy of this agreement signed by CONTRACTOR,before any work was done,and that he has read and received a legible copy of every other document that OWNER has signed during the negotiation of this Contract.. 17.THREE DAY RIGHT TO CANCEL THIS CONTRACT You may cancel this agreement If It has been signed ata place other that the CONTRACTOR'S normal place of business,provided you notify the CONTRACTOR in writing by not later than midnight of the third business day following your signing of this agreement.See the notice of cancellation form attached hereto for an explanation of this right. 18.Massachusetts Home Improvement Contractor Law{tfli ci 142A1 All home improvement contractors/subcontractors working in the Commonwealth of Massachusetts must be licensed and registered by the Office of Consumer Affairs and Business Regulations.All inquiries concerning the CONTRACTOR should be transmitted to those offices.In Massachusetts Blackdog Builders.Inc.operates under License number CSO48847 and Registration number 106877.Federal Tax ID.Number 02-0477RS. a.Massachusetts homeowners securing their own permits will be excluded from the Guaranty Fund provisions of MGL c.142A. b.In Massachusetts the deposit shall not exceed 113 of the total contract price,w the cost of any special equipment or custom made material which must be special ordored!n advance to meet the completion schedule, whichever is greater. PLEASE DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Two identical copies of this contract must be completed and signed.One copy sha[l go to the OWNER with the second copy being retained by the CONTRACTOR.NO WOPUi all commence until this contract is fully executed. SUBMITTED: \ _ _ DATE Jq Nicolson rttf2612Q1a Design Consultant Blackdog Builders,inc, ACCEPTED: t�.cc -- DATE: obetfa Donau@t n Richard Denatu t — _--10122/20'15 C�:i':a�1 Proprsal—Page t'.o'zE The Commonwealth ofMossachasetts Department oflndastrial Accidents office of Investigations »a d 600 Washington Street Boston,MA 02111 www.nmass.gov/dio Workers'Compensation Insurance Affidavit:Builders/Contractors/El Please PriPlumbers nt Le bl Applicant Information �f Name(eualness/orgattieadoo/maiyiaaap: -c�i Address: �ed voet �' �.c,m a3°�y Phone 4. 03"�;ye o f CitylSCate/Zip: Are you an employer?Check the appropriate box: Type of project(required): 4.Q I am a general contractor and 1 6 Fj New construction 1.E?'l am a employer with 35_ have hired the sub-contractors y [.�Remodeling employees(full and/or part-time).* listed on the attached sheet. 2.❑I am a sole proprietor or partner- These sub-contractors have 8.Q Demolition ship and have no employees employees and have workers' 9 0 Building addition working for me in any capacity, cmnp.insurance? 1 p.Q Electrical repairs or additions [No workers'comp.insurance 5 ❑Wm area corporation and its addition, required.] officers have exercised their 1 LQ Plumbing repairs ora 3,❑1 am a homeowner doing all work right of exemption per MGL 12.0 Roof repairs myself.[No workers'comp. c.152,§1(4),and we have an 13❑other__ insurance required.I employees.[No workers' compinsurance required.) *An licantthat checks box#1 moat nlso fill ont the section bgelaow sM1owingtneir woekers'compensatienpoliey inronnation' gsuc. ymeoP s who submit itis affidavit indi.,,,,they are doia r work vnd thea nice wtside conttactors must submit n new affidavit indieanv h t do c of[hc sub-contractors avd state whither or vot moose anomies have tContmcror�s that oneok this box must attached amt vdditional sheet showing the nam p 1 bar. kers'core po icy num cmplvyees.If me eon-eonhaaors have empmrees,tney most pm�iae metr wnr Below is thepoliey and job site I am un employer that is providing workers'compensation insurance for my employees. information. !� ✓ , yr, Insurance Company Name:Teu1"� z Expiration trace /of�/� Policy#or Self-ins.Lic.#'. \"f it city/State/Zip:kl Job Site Address: "o V,iH °u (showingthe I number and expiration date). Attach a copy of the workers'core d under Section 25A of MGL paS 2 can lead to the amp sition of criminal penalties of a Failure to scrum coverage as require Pena fine up to$1,500.00 and/or one-year, as well as civil hies in the fomr o£a STOP e ORK ORDER and a me of up to$250.00 a day against the violator.Be advised that a Dopy of this statement may be forwarded to the Office of Investigations of the DIA for main am a coverage son ticah.c. Pro �hcre �nft_Vlda, Ins a d Pe Ines of Pe Jury that the it fr oon'- nd correct. -- Phone#: Official use only.Do not write in this ares,to be completed by city or town ficial Permit/License# City or Town: Issuing Authority(circle Due): Depamen rtt 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 1.Board of Health 2.Building 6.Other Phone#: Contact Person: Lr 4 PI rll IC r'1 L OF L Lt1\G11 I�y I1=1 t v1'i c ov - t Y 41.. `I3 -T 1 \ 1^ A L 1 n Sy THE A F 1 N T_R I +` _ STI \ F��.,.�a _ T Is ft I C A T _ - vT F� i t[.a h {e c L ..< N r. ry c Jc e 't. 14 05�6b - a a- n Alsr " I S1 d Hy I,,SC *x18733 _ el doge Id N D,,StU ent}{Id g'I,iC Y R d Roo L U '01 S 7 ,PIH 11111-1111 " - -- �_ - COVERAGHS Cf RTLIC "NUMBER REV151O1`I NUMBER -I r T411515 0 CER IFY THAT T PO ICIES OF S RANG L D 6 ON TERMS IOFAVE 9 EN IS UEO IS HE �SU E NA—ED—0 FO HE PO ICY PE nils INDIc TED 0'NITHs-IDPI N!2EOU C - T M 0 GON N OF AP COh-A 0 OT D.CL CERT FIC E MAY 0E I SUE OR NY P RTPI TF E INSU NC FO ED V 1N 0 I IES ESC IB H N I SU J CT 0 A T "EXCLUSIONS AN CONO TIO SOF SUCI OIIC ES.I Ts OW Yf /EB NRC C P I CUI _. �Ta I -� 7oo,6ao A� nTv al<s65n1514 o2lBvzol�oT I ""n �. �� msmnoe[�cccua E ( 10,000 z R — �PRe -)000,00u E 000,100 z 1al,olil i 000,000 a� �� aA56551151C mlav2olsloTlovells I �� _- o o -SCITI�ULFn °F - Lix x BIns., IU5066511510 0]1011RU15 0T101/R016 ca 11010 _ —CH Tory ^ TTY Y/" )(W05501151ry 0]10112015 0]101/2016 EL 600,000 N A rvE1-11Tve ��I 500,000 J" -T-1 „aEe' — _011,060 Es�A,I R�,,,,�o�e T,mo,�•„<.�P rval ana�,aner:ra�T=e e><oivaea c=tom vT skex Csre Compensationk coverage. CANCELLATION CERTIFICATE HOLDER ANY OF THE ABOVE DESCRIBED POLIOIEWILL GBL GELLIVEREBORN OXPIRATION D E THEREOF, N OEL For Insured's Reference ,/ACCORBArvcE wITH THE Paucv PRovlslo"s.L _— ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2 01 010 5) The ACORD name and logo are registered marks of AAGRD FM /C J�aro M<reshcha [t 17 yai'rce P Pp klq SePwYy �i4e l' ,��ry rtammn Horc d of 3. J,f2 gulmt dSt—dards oe Coa�,wu N�r"NN "' m I e:CS-09451) F88P3QOVE98E857 O0Vi'P'R4ICTOR C t nc.tic� 4 I v.rsi "(,t, . r'-..i D08n".. Suloplemenf TIMOTHY S MB 272 CHESTNUTUT HILHILL ROAD �CFOGG frRfluy-frS'"M ROCHESTER NH 03867 p 7 fk"L*D C39ID'r'W Si _ SV,-a fda 3HIDV8 psdervesreamry C.C �.� Expiration'. (, mmissioner 08/28/2817 �, ao•reser Harr vertu tmr ieeairiahi hnr arciy 4D�rees�oe&ea3_ gigs Of anyW6H'91-P 10=ich a➢ns®„pormiiom a®te.�e PI Pao.v ms rAeoialaCiou �caro9aiee 1es^s a'r 35,000_&& fit(99E raa')of ab7Dra sP�®mumer,9(Psirs nu v e s eaac73s�o-3a-a. aor�rg a°aon-shae sP7m , :+au3 40oaanee,lA3A 02HIl6 r Ga5lwre flo P.a eurrsnt¢ditian of the Massacnuset[s ^-” LVae9 vviPpmvt sighaaoas i Scher g�dimg Cade is raosz Sar revocatioh of this Ilcense. f+[W3 kixsarc3in(4 inamrm�hmn eish. www Mass Gor/D?5 a d i+.�au �+ xa mmanawwaw +N wi» nh w.�r�n dgA Mwxa 6rduaMwm wl' rnyWo. `4 w,w.M.+dwrWww+.rsaemaenw ner m {awenw Tanta cBXd adwmww y, y'64mnrr9Cwrrha u+ mmawu+aaNmedsN rw,merva mu(arrom Nuaaeoamnnrvua W0na.4va .gW�71/4Witlae 9oomy _... orJasJattlo r�, WunOgD aceas�la �as I '' ,wuutA*r 4nwureu rmr�rn iew 8n6 W+u wamrornuripµ (natn6e narnn.,paaJuiNllg�rB� .. tenawdWpu➢+giwbNUW�Nn®��NN 6�yeua,.v0u M1m�wtlaw w aS rh NYhfl��lmf an TiN90 ... �i.wi III I � � III � I III ill II��I II III I �� i III II�L.--��� jl 1� III SII-ill 1 III III- I III al_�h I , 24 i IIS Ir - I ILII c ini � � I III it11 II I a� I I I II I l� 9 ill Il III III II � i I III I III �I I _ VIII illl I q _ Il Ili - II i;l VIII I�� IIIL II II III Ill. _ V 1.8., ° ��III L� SII I i y'I l IN 8oLAND HUCK _AO'EA_I ��_. - T ill l_I/41H ri,11,11 1,001 BAI IF 1� f N1�1�1�[ III N W I i,Ovm A [I 001k I 1p— UNI M-P"AYM I N NNW! I 1/2 BATH BATH II I o -UP i :E U.� JL L LIVING F 1.1 o z z'N ACF NO f KITCHEN W-MI(M NU,J.JL�] AND �j �3!)Vli I M'AI�11,11\1 W 'UH... 11� I 1", :1-,0 � Wu,1,(J)UN 11 1, l�, I 'r- fd �(, I f"N � 1, Ad VA"I �j I IT,IN 1 Al 10o- ODI, pt M,�NC Z' �IMOM "PINIRM'I m'm ('k Id Nt; -A a U, UP � I' ONSTALL BLOCKING FOR ALL ORAD EARS (SEE FADE 8,CONFIRM ALL LOCAI SONS WITH CLIENT) ' UP- VEER JOHN NICHOLSON,INSTALL ADDIITIONAL BLOCKING EOR ®EOED EXISTING GRAB RAR LOCATIONS L DOOR ------------ rU EXISTING 2'-8" vu THRESHOLD WINDOW } (2)2x4 HIGH NICHE R O1.2H , O HAI F w ii r} niFl14W � � @48"OFF FLOOR10 31 Iu m 15-314 x 13-3/4 FUH, WALL p IS u I0 84 HIGH w c �. G 1 11 w,; Z w, r U 3AL-i— D I MENSONw T O FRAME Ltl I YC �v Y / ,, j **NOTE ROLL OUT TRAY 18°DEEP. E r IW SONS VANITIES WILL HAVE o v IF PLUMBING SUPPLY AND FAMY �,Y '�, WASTE ROUGH THROUGH � r THE FLOOR THEY NEED TO �nri RE SET BACK TOWARD THE WALL. i CANDLELIGH°U'CABIMETRv ". I _... CHATHAM SHAKER F/O DOOR PAINT GRADE ENG.LIMEN MASON AMT.NO SAND IC.H. . � ,1. VVHDD 1",FINISHED INTERIOR REDUCE DEPTH TO 4-1/2" . 2. VKSBB27 XS 3"RIGHT 'WOOD TOPSROLL OUT TRAY 18"DEEP I --- 13. VKBD184 i i I . VKSBB27 �._ ROLL OUT TRAY 18"DEEP NO TE �6. (1)CM-08 MEDIUM CROWN � 7/. M MT-08 TOE KICK - NO TILE BACKSPLASH ON CHINA CAMNE 'OR®ESPN I � � (3' 0- (5} CH NA pit CAB NET 'C'2 ® SGC - 7/8" h 27' , 18" 27" , 18' 1 CANDLELIGHT CABINETRY WOOD COUNTERTOPS BATHROOM, C.H.901, CABINETS CHERRY,AMERICAN VINTAGE I � °7r �, 1. WCT1248 36W x 25D FINISH FRONT EDGE ONLY 2, WCT1248 48W x 25D -- FINISH FRONTAND RIGHT EDGE - 3/4 3/�" 17" 17" U � i fn 0 m o , .f SlIl'BUILT '" 3 M NEEDF[) Irl 11 1„ 2 7" � I VOTE � BATH PRODUCT INSTALL BLOCKING 1. KOHLER'CIMARRON"TWO PIECE FOR ALL GRAB BARS TOILET,BISCUIT,K-3589-96 (SEE PAGE 8,CONFIRM 2. KOHLER"CACHET"TOILET SEAT ALL LOCATIONS WITH CLIENT) BISCUIT,K-4636-96 3, KOHLER"ARCHER"TP HOLDER ®���GD�®��®Rg G��T�L� POLISHED CHROME K-1 1RAB B m�u PER J4. KOHLER"TRADITIONAL GRAB BAR 36" ADDITIONAL BLOCKING F I POLISHED STAINLESS K 11875-S 5. KOHLER 2 LEVER VALVE,TBD S�ECGEGED Cv) CI�TB®P9AL CLIENT POLISHED CHROME,K--CP GRAB GEAR LOCATIONS _ 6. KOHLER 2 LEVER TRIM,TBD —-- 6 POLISHED CHROME,K--CP i,._ 7. KOHLER"ARTIFACTS"TUB SPOUT POLISHED CHROME,K-72792-CP —._�------- -- � 8. KOHLER"TRADITIONAL"GRAB BAR 9" 4 POLISHED STAINLESS,K-11870-S l,J I 9. KOHLER"PUREFLO"OVERFLOW/DRAIN �yl 9 1 l PVC,K-37383-NA 10. KOHLER"PUREFLO"DRAIN TRIM °J POLISHED CHROME,K-T37391-CP -iw 11. KOHLER"MARIPOSA"JETTED TUB G BISCUIT,K-1239-GLF-96 12� KOHLER "MARI36OSA"TUB APRON a f1 „y„ 4-96 GRANITE COUNTERTOP,SHOWER JAMBS J V AT 13. CAPS,BENCH&SUPPORT,AND NICHE SHELF " "BLANCO PEARL" 14. KOHLER"ARCHER"TOWEL RING POLISHED CHROME,K-11057-CP iu �---r 15. KOHLER"CAXTON"LAVATORY SINK CO �}- --" �., BISCUIT,K-2211-96 16. KOHLER"ARCHER"LAVATORY FAUCET '"''"' POLISHED CHROME,K-11076-4-CP 1 17. KOHLER PRES V SURE BALANCE VALVE K 304 K-NA � uA 1 �-- � �"'" 18 KOHLER 2-OR3-WAY TRANSFER VALVE K-728-K-NA )� � 19. KOHLER"ARCHER"SHOWER TRIM ni i POLISHED CHROME,K-T11078-4-CP Fl it 20. KOHLER"ARCHER"TRANSFER VALVE TRIM ani POLISHED CHROME,K-T45850-4-CP �� fc, 21. KOHLER"FORTE"SUPPLY ELBOW iad,> POLISHED CHROME,K-355-CP 22. KOHLER"AWAKEN"HANDSHOWER KIT FAM II Y POLISHED CHROME, 23. KOHLER"TRADITIONAL"L"GRAB GRAB BAR 18" POLISHED STAINLESS,K-11872-S — 24. CUSTOM GLASS ENCLOSURE I)A rI -� �� CLEAR GLASS,CHROME HARDWARE I Jf01f20 OMM PRODUCT (Y"I l� 1. GRANITE FIREPLACE SURROUND "BLUES IN THE NIGHT" r e _r,i— e POWDER PRODUCT 1. KOHLER"CIMARRON"'TWO PIECE �� 2. TOILET,WHITE K-3589-0 `" ( KOHLER"CACHET" TOILET SEAN WHITE, PC DER ROOM 2nd FLOOR PRODUCT( f1. KOHLER'CAXTON"LAVATORY SINK I ® BISCUIT,K-2211-96 2 SALVAGED MASTER BATH TOILET&SEAT J) ; .3L �. mmN �n KITCHEN211 KITCHEN PRODUCT 1. CHERRY WOOD TOP 0 u r "AMERICAN VINTAGE' z < 2. GRATIINUM'OUNTERTOP IJ P! i err z 3. ESTAINLESS ROTEC' STEEL, WL1 3070 "C' 'WATERLOO"SINK rr�nl 4. KOHLER"SIMPLICE"FAUCET VIBRANT STAINLESS STEEL,K-597-VS 5, 3/8"TEMPERED GLASS SHELVES (3)IN CHINA CABINET 02 (2)EACH IN WALL CABINETSU LEFT/RIGHT OF SINK ��� — :'12102/20 (sol l �_5 _ z , l-1 ""V&IFY ALC L.00ATOON --_.—_._. WITH CLIEN � � — SGtl®NC9f��AGt� �VERW ALL LOCATIONS WITH CLIENT e c� — ,9) �RANS! yA�VE DSHOWER KIT 9"GRAB BAR] �a _�o BAR —� Lo ED El WET WALL UO [SH®wE7 z CWITH Iwql� — VER 'Y A04 OOGATVO� — �.� I IILL_IUI WITHCLIENT Ili fk" Z YV ' I k f) 00 �"ITE BIENCP fICE�TR SUPPORT D9 GiRA� [UB SPOUV] of kl 0) /' m o.. N (POOR UPPORCK 3'T� SHOWER �� ��® � FROMBATH WET WALLFRONT) •� 7 ------- Alm ._ ... r. F r, G Imo, I I XISIJNG'SWITCFi I t h V� w F RDE KI14HT c,ONV Ru i0svvoru� — MI a eaBi€ET LGHTS � II �I�IV � . ��4E��irt4 of I IG�ArII i ca s CKSP ,4h,i'allt4.,w CW\fl`4�JI7I8AS,lPV�i4PP..ITOX I�dl 1)EhXil IVBkIi-. i O II I I,fi:Ii9dlE?i11� C' �N]I,Q!Q i k4fV17P�P"i` r Vh I_ITF)—,X[ I`y4�1 Y�____ I`�!I -E7,LX71.1'�E)LIw' III --- — - ------ P i JU N=w-- I� I --� r triy¢:.c � �-- I 'scorrt�,w': :"�:�' USI,EXIS rIN `6 fl f)A FION UIRtI.. D UB HEA I ER, rr ap IAI"�� 10 0"1 � JET & �1 R,rA r FOR FXISfICRC IAY'., (� I,kl Ilial I ^, l67 fl Y 111 ni 0 < Cr 9