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Building Permit # 2/8/2016
/F" .,rrrriwi'<ty pp pp .1 OOR!H BUILDING PERMIT ��I �p l�� -y0 o 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � ��� Date Received * Date Issued: 1-Ml?ORTAIr T: Applicant must complete all items on this page / ;J/ ,7777 t, rf,/ r , ✓ f r✓; r �� � �/ /,r. /„ r / /r 1. ✓ l/ 3N / c- r/ /'/ /r r l /, ✓r f r , r/r 1, /i / / fr ✓, r, r,r, 1 � � / / // r rrr, ,/, „/, / d ,✓ ,,, // r r,.. ,i, fi / rrrrrl ✓./ � ,,✓ ,/, /,/ ,/, /.,,,,,, ,,•/, /„/ r ,�./ ✓ r. I'rr Jr f fr' l "tty� rr� £ /// / /„ / � / / 1. ✓ 5 �/ �, r✓ / /. fr / ,//, f r r /�r 7777, rl Y ,f✓ /��/ .1.ro v. ', r, / ✓, // ,�,,. r �, 7,J ,� 1,,"c r r r, /„ � L' r r r / / r r / /71177 ✓ e, / r ,/ r /r✓ / ',, ,,, r r, �,r r rrr� J ,f �r� 1 1 r , /1,17 /, rrr, r, a. l r /fi rr, ✓ 1, /, / ✓.rr l.. /.. /r rr f r ��/,/77.77 / r. ,r/ �fr .r,yyr ,,/1 ?/^,",M-- t� r -rl f�r, rrf a /,. ., �. ,,/ / ' f/. 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No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED OM$125.00 PER S.F. Total Project Cost: $ e 00 FEE: $ Check No.: Receipt No.: � NOTE: Persons con ra t' � th unreg,stered contractors do not have arc 'to h ranty fund t%OR H Town of ndover 0 ti to No. �' - Lk - L Ver' .3 Z.0 O LAKE COC RICHE WICH V A A•9 S U BOARD OF HEALTH IMF rw F. RMI . L D Food/Kitchen Septic System THIS CERTIFIES THAT ,,,1 ...... BUILDING INSPECTOR ............. . . . ... . ....... .... .. . .. ������ ... Foundation has permission to erect .......................... buil ' gs on ............. . ....... .. .... A 000 Rough to be occupied as .(L 1 0. ... ............ ® ....�.I1...d ..... Chimney . . .....604%............ provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North'Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS S' ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T Rough Service ................ ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy By Rough Display in s Conspicuous Place on the Premises — ® Not Remove Final No Lathing all To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Ratte' Construction Co., Inc. 33 Walker Road North Andover, MA 01845 Tel. 978-682-4982 February 5, 2016 Charles and Susan Papalia 61 Coachman's Lane North Andover, MA 01845 The following are specifications to remodel your master bath and main bath. Permit- Obtain necessary Town of North Andover building permit. Demo- Remove and dispose of existing vanity/top, shower,tub, tile floor, hamper and linen closet. Remove drop down ceilings above shower and tub. Framing- Frame for shower and close in (2) bifolds to single doors. Blocking for future grab bars. Plastering- Install blue board and skim coat plaster on new walls and ceiling finished smooth. Wedi shower system- Supply and install a Wedi shower system for shower floor, walls and ceiling. Electric floor heat- Supply and install Schluter Ditra floor heat all floor except closet. Plumbing- An allowance of$3,500.00 to disconnect and cap existing tub and shower and vanity. Relocate drains as necessary. Supply and install new shower valve with personal shower. Supply and install new tub valve. Pull and reset existing toilet. Replace shut offs for vanity. Plumbing fixtures- An allowance of$3,000.00 to supply a 5-6 Maxx acrylic soaking tub, (2)undermounted sinks, (2) lavatory faucets, shower trim and tub faucet. PLEASE INMAL YW� s.� Electrical- An allowance of$2,500.00 to rewire master bath to include (4)recessed lights, Panasonic fan, night light,updated vanity lighting and switching as necessary. Interior trim- Supply and install (2) 2-6 x 6-71/2" custom door units for entry to bath and closet. Swap toilet room door to match existing. Install crown moulding in vanity area. Patch base as necessary. Floor tile- Supply and install the floor TBD. Shower tile- Supply and install the on shower walls and ceiling TBD. Tub tile- Supply and install tile on tub walls and area between shower and tub to ceiling. Tile TBD. Cabinetry- Supply and install a Wellborn vanity with pencil drawer in Glacier paint. Supply and install a tower in Glacier paint. Vanity top- Supply and install a custom Quartz top TBD with (2)undermounted sinks and 4"back and side splashes. Shower door jamb, seat and niches- Supply and install Quartz parts as follow. (1) Shower corner seat with round front. (1)Jamb and threshold set for shower door opening. Niche parts as necessary. Painting- Paint bathroom walls, ceiling and trim complete. Touch up wall and baseboard in master bedroom after wall patching. Mirrors- TBD Hardware- Install owner supplied towel bars,robe hook and toilet paper dispenser. Lighting- PLEASE INS i L"I Install (3) owner supplied vanity lights, cabinet knobs and (1) owner supplied ceiling fixture. Main bath- Demo by others. Supply and install Wellborn vanity in Glacier paint. Supply and install a custom quartz double bowl vanity top. Supply and install a new tile floor over new underlayment TBD. Remove and reset toilet. Remove and reinstall existing lavatory faucets. All work is covered under our workman's compensation liability and contractor's public liability insurance policies. PLEASE E!, goods carry an implied warranty of merchantability and fitness for a particular purpose. XII. COMPLETENESS OF AGREEMENT FOR EXECUTION The owner is hereby advised that he should not sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits or referenced documents that are incorporated herein are attached hereto. XIII. COPY OF AGREEMENT TO BE GIVEN TO OWNER This Agreement is governed by the Laws of Massachusetts. It must be executed in duplicate, and an original signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal. RIGHTS TO CANCEL The Owner may cancel this agreement if it has been signed by the Owner at a place other than an address of the Contractor which may be his main office or branch thereof, provided that the Owner notifies the Contractor in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. See attached Notice of Cancellation. Note: This proposal may be withdrawn by us if not accepted within 30 days. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. -1 ! Owner's Signature �1 �� v Date Signed Owner's Signature _ Date Signed Contractor's Signature Date Signed ZI5 J IX. CONSTRUCTION-RELATED PERMITS The following construction-related permits will be necessary in order to complete the scope of work included in this Agreement: Town of North Andover building permit. The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction-related permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies, authorities or individuals. Notice: If the homeowner obtains his own construction-related permits for the work described under this Agreement, the homeowner is hereby advised that in the event of a dispute,judgment and nonpayment of the contractor, the homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A, M.G.L. X. MODIFICATION This Agreement, including the provisions relating to Price (Section III) and Payment Schedule (Section IV), cannot be changed except by written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation(annexed). XI. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 Year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy,repair, correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such equipment,which shall be and are hereby passed through directly to the Owner. Under such manufacturers' warranties, the Owner may be required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentation,which failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such equipment. This warranty gives the owner specific legal rights, and owner may also have other rights which vary from state to state under Massachusetts law, sales of PLEASE INITIAL riM2 Ratte' Construction Co., Inc. 33 Walker Road North Andover, MA 01845 Tel. 978-682-4982 RESIDENTIAL CONTRACT AGREEMENT Read this Agreement and make sure you understand it before signing it. This Agreement has legal force and effect and binds those who sign it. Note: All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration provisions of Chapter 142a of the General Laws, must be registered with The Commonwealth of Massachusetts. Inquires about registration and status should be made to the Director,Home Improvement Contract Registration, One Ashburton Place,Room 1301,Boston,MA 02108. This Agreement is made on 2/5/16 between Ratte' Construction Co., Inc. of 33 Walker Road,North Andover, MA 01845 (978) 682-4982,hereinafter called "Contractor" and Charles and Susan Papalia, 61 Coachman's Lane,North Andover, MA 01845 (978) 685-0916,hereinafter called"Owner". I. DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following: See attached specifications. II. DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be used in performing the above described work consist of the following: See attached specifications. III. PRICE Contractor agrees to do all work described on a cost-plus basis. Materials at contractor's cost. Subcontractor's at contractor's cost. Carpenter's labor at$54.00/hr. Total of all above plus 21% overhead and fee. Projected cost approximately$61,432.00. HIDDEN CONDITIONS AND NECESSARY ADDITIONAL WORK Hidden conditions may require adjustments to the contract price. In such a case the contractor will inform the homeowner of such condition forthwith PLEASE INITIAL and where necessary a written amendment of this contract will be negotiated and executed by the parties. IV. PAYMENT Payment will be made as follows: $15,000.00 deposit upon signing contract; Deposit will be credited as job nears completion. Job to be billed weekly with copies of all backup invoices and an updated job cost report. Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit) of more than one-third total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special delivery materials, and equipment,whichever amount is greater. V. COMMENCEMENT AND COMPLETION OF WORK Contractor will not being the work or order the materials used before the third day following the signing of the Agreement,unless specified here in writing. Contractor will begin work on or about February 8,2016. Barring delay caused by circumstances beyond Contractor's control,the work will be completed by March 25,2016. The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. VI. NO ACCELERATION OF PAYMENTS BY ESCROWING ALLOWED The Contractor may not require payments to be made in advance of times specified in Section IV (Payment) above for reason that he deems himself or the payments to be insecure. If however,he deems himself to be insecure, he may require as a prerequisite to continuing the work described herein,that the balance of the payments under this Contract that are in the control of the Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor and the Owner for withdrawal. VII. INSURANCE Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself, his employees or his subcontractors in the performance of, or as a result of, the work under this Agreement. Contractor agrees to carry insurance to cover such damage or injury. VIII. SUBCONTRACTING Contractor agrees that, notwithstanding any agreement for materials and/or labor between Contractor and a third parry, Contractor is responsible to Owner for completion of all work described in a timely and workmanlike manner. PLEASE INITIAL vN92 s� Raft Construction, Inc. 2/5/2016 Charles and Sue Papalia Coachmans Lane North Andover Master bath remodel Permit building 61 $13.00 1 $54.00 $793.00 $847.00 Dump trailer $450.00 $0.00 $0.00 $450.00 Dust and floor protection 4 $75.00 $216.00 $0.00 $291.00 Supervisory 12 $648.00 $0.00 $648.00 Cleanups 8 $432.00 $0.00 $432.00 Master bath $0.00 $0.001 $0.00 Demolition 40 $50.00 $2,160.00 $0.001 $2,210.00 Framing 16 $150.00 $864.00 $0.001 $1,014.00 Heated floor material 1 $542.60 $54.00 $0.001 $596.60 Heated floor install $240.00 $0.00 $0.001 $240.00 Heated floor electrical $250.00 $0.00 $0.001 $250.00 Interior trim 32 $4,500.00 $1,728.00 $0.001 $6,228.00 Cabinetry 6 $4,081.85 $324.00 $0.001 $4,405.85 Vanity top custom 1 $1,200.00 $0.00 $0.00 $1,200.00 Shower parts $500.00 $0.00 $0.00 $500.00 Insulation $250.00 $0.00 $0.00 $250.00 Plastering $800.00 $0.00 $0.00 $800.00 Wedi System materials 2 $800.00 $108.00 $0.00 $908.00 Floor tile labor 200 $6.50 $0.00 $1,300.00 $1,300.00 Floor tile material 200 $5.50 1 $25.00 $54.00 $1,100.001 $1,179.00 shower floor material 20 $10.00 $0.00 $200.00 $200.00 shower floor labor 20 $10.00 $0.00 $200.00 $200.00 Wall tile install 380 $10.00 $0.00 $3,800.00 $3,800.00 Wall tile material 3801 $5.00 $0.00 $1,900.00 $1,900.00 shower niches $100.00 $150.00 $0.00 $0.00 $250.00 Painting $1,500.00 $0.00 $0.00 $1,500.00 Mirrors 2 $700.00 $108.00 $0.001 $808.00 Bath accessories install only 4 $216.00 $0.001 $216.00 Plumbing $3,500.00 $0.00 $0.001 $3,500.00 Plumbing fixture allowance $3,000.00 $0.00 $0.001 $3,000.00 Venting 4 $40.00 $216.00 $0.001 $256.00 Electrical $2,500.00 $0.00 $0.001 $2,500.00 HVAC $500.00 $0.00 $0.00 $500.00 Bath accessories install only 3 $162.00 $0.00 $162.00 Cabinet knobs not included 3 $162.00 $0.00 $162.00 Vanity light fixtures not included $0.00 $0.00 $0.00 Main bath $0.00 $0.00 $0.00 Demo by others $0.00 $0.00 $0.00 Vanity 10 $900.00 $540.00 $0.00 $1,440.00 Vanity top custom $1,200.00 $0.00 $0.00 $1,200.00 Plumbing 10 $80.00 $100.00 $0.00 $800.00 $900.00 underla ment 5 $50.00 $0.00 $250.00 $250.00 tile floor material 80 $5.00 2 $25.00 $108.00 $400.00 $533.00 tile floor labor 1 80 $6.50 $0.00 $520.00 $520.00 Cabinet knobs not included 3 $162.00 $0.00 $162.00 tax on materials $644.23 cost of mark u $2,299.88 $3,742.59 $1,746.36 $2,365.23 `r _ cost with mark HE cost of contingency $2,925.34 labor rate per hour $54.00 FINAL COST mat'[&unit cost mark up 21% tax on materials 6.25% subcont.mark u 21% contingency E5% PLEASE UNITIAL MSR:2/5/2016 Page 1 Papalia master bath 1 \ tt " JOB `-4 � Construction . Ince SHEET NO. I OF ' 33 Walker Rd CALCULATED BY ,` DATE North Andover, MA 01545 CHECKED BY DATE lot/SCALE ,►o , , v 4 41-10-4-4-- ++++A--1 ±+-i- f 1 1 t 1- P 4-4-4-1 -t--t 4-4 44 1- T- FIT i k-1 f...... ...........:........ .. 4-4-1-1 1 ++-f -:11TI:'[9--14-1 1 A t "IttJr 14-4-4 —T—; t [ i i i ..... ..... ...... .._. ..... ... .. ..... ..... ...... ...... .._ , is ....:.... .._:.... ....:... : it .......... ....:.... ....:.... i ..... ...... ..... ... �........... .... .... ..... ..... ..... P6 .. ... u ...... ...... ..... .... i ' ` ... ... _....... .... .... 77— i i , i . i i t .......... ........:.... ! ; : i ! i ....:..... i i ; i ............:..........:.i...............,.....,......;............. : ..... ..... , : i i I i f i j i ...... ..... ... ........ ..... ..... ......Jr I ... I ............ ' O i ! ! i i ... ... ...... ..... .... .... ! i • ............:............................e..............,....,........a.............e.............<........,.... ...... ...... ...... ...... ... , 14-4-4 .... .. ..._�� ..... ........:...........:......__ .... .:... .. ....... ... ..... ...... ll FORM 204 Available from INC Townsend,Mass 01469 The Commonwealth of Massachusetts Department oflndusfrialAccidents 0 I Congress Street,Suite 100 Boston,MA 02119-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Conti•actors/Electricians/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / �, Please Print Letlibly Name (Business/Organization/Individual): R C61V,(`12l 1T(_ (SAV Address: ? muu�f a&a� City/State/Zip: Phone#: (IM �62_W y? Are you an employer?Check the appropriate box: Type of project(required): 1.41 am a employer with Ll employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $• [ERemodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself,[No workers'comp,insurance required.]t 9. EJ Demolition 10 [—]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.[—]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.F-1Weare a corporation and its officers have exercised their right of'exemption per MGL e 14,Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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 arrz art employer•iliat is providing ivorlrers'compensation insurance for•nzy employees. Below is the policy and job site information. ^ Insurance Company Name; A)d v,�I r Policy#or Self-ins.Lic.#; y VV e—1,00-600 I550 ?0S A Expiration Date: 04 Job Site Address: �� <�Jae"�I � City/State/Zip: /� � / ,�a'f ©l U Q Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c, 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 day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify funder thepainsndpenaldes ofpeijury that the information provided above is tare and correct. Signature: /nature: "4 Date: 2I S II- Phone#: >0cd?_ �Z Official use only. Do not 1vr•ite 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#: A��® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/05/2016 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 NAME:CONTACT Charles Kurkjian MTM INSURANCE ASSOCIATES LLC fPAICHONE No. o Ext): (978)681-5700 a/c No): nDDRESS: charliek@mtminsure.com 1320 OSGOOD ST INSURER(S)AFFORDING COVERAGE NAIC# NORTH ANDOVER MA 01845 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: RATTE CONSTRUCTION CO INSURERC: RATTE CONSTRUCTION CO INC INSURERD: 33 WALKER ROAD UNIT 2E INSURER E: NORTH ANDOVER MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 29313 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGECLAIMS-MADE E] OCCUR PREM SESOo Ea Nccur ante $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 7 PRO JECT E LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY PEcitl Y DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ER H AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICER/M EMBER EXCLUDED? N/A N/A N/A VWC10060045502015A 10/06/2015 10/06/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St Building 20 Suite 2035 AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M.Cro r�v ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i rtment of Public Safety Massachusetts -Depa Board of Building Regulations and Standards a� w� 7 y License: CS-043865 , 7 r + I MARK S RATTE:'` •.r 20 CRAIMMRAAI M, _ I ANDOVER MA 0181 �c I UV !',s -)I'l',A ` Expiration 914— X1.9" 05/08/2017 Commissioner G-; ��e tpd��z��za�uaea��a�P/f�aeaac�ate� ,� Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 117532 ' Type: FExpiration:' 10/16/2016 Private Corporatit RATTE CONST CO INC. MARK RATTE i f 33 WALKER RD NORTH ANDOVER,MA 01845 Undersecretary i e