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HomeMy WebLinkAboutBuilding Permit # 4/12/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 41L Permit No#: 4— �,r& Date Received All C US Date Issued: PORTANT: Applicant must complete all items on this page LOCATION �, � P rant PROPERTY OWNER 4 f'`6. �',U Print 100 Year Structure yes (nom" MAP PARCEL:C)ILIJ ZONING DISTRICT: Historic District yes Machine Shop Village yes rK0,7 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Li New Building One family [I Industrial [I Addition [I Two or more family 11 Alteration No. of units: [I Commercial [I ----- Repair, replacement Assessory Bldg [I Others: Repair, 11 Other Sh 6District Identificatiop - P11Type or]Print Clearly OWNER: Name: 0,6xA 7eA,r,(-t,ye,411 t Phone: Address: 6 U Contractor Name: e4�, -i"C5 Phone: 5-04,o 2, - Email: r-, o tcv- Address: I ,tea vve,,( 1� 01? L) Supervisor's Construction License: - Exp. Date: Home Improvement License: 3 Exp. Date: 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: $ l FEE: $ Check No.: Receipt N o.: �2 0 ' NOTE: Persons contracting with unregistered contractors do no /cave access to the guarduty fund Si q natube-DfAgentlOwner— i Wri n at�e� Flans Submitted ❑ Flans Waived ❑ Certified Plot Flan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DIS7SAL — -- Public Sewer ning/Massage/Body Art ❑ Swunming Pools Well Tobacco Sales ❑ Food Packaging/Sales Li (septic tank, etc. Permanent Dinupster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL, SIGN CFF - U FORM PLANNING Ot 11 �PLANNINGDEVELOPMENT Reviewed Oni , � �"� Signature COMMENTS �. -4� CONSERVATION Reviewed on II ) � Si nature` )4 a ��y COMMENTS ` .,. HEALTH Reviewed onSi nature � MMEN C TS �, ,. x ,. `ILLap Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Surer Connection/S.Ignature & Dawe Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street �� RAftRTENT - Temp Durnpster on site yes no Located at,124:Main Street , �ir�.� Parioigariaa /dte , .; COMMENTS AV F ttORTH own oilr9 '" 46 AnduvUF O ��• ; ® Am 4 Z o SAN! h ver, Mass, A COCNIC Nl WICK �• r x.95 RA tE O U BOARD OF HEALTH Food/Kitchen ER ITSeptic System ® Arcot ��! THIS CERTIFIES THAT BUILDING INSPECTOR ......... ... .................... ....... .. ...... .................... ......... ... .. . ...... ........... Foundation has permission to erect .......................... buildingson �* . ...............t+ ••ll a Rough to be occupied as ....7�C. ee .... v.......X. .... .. .... `� ... ....... ................................ Chimney provided that the person accepting this permit shall in every respecfconform to the terms-of the application lication pp 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 EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR STARTS Rough 4 Service ......... .... . ..........................................................'... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — ®o Not Remove-,. . Final No Lathing or Dry Wall To Be ®one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. AGREEMENT FOR SERVICES This CONTRACT satisfies all basic requirements of the State's Home Improvement Contractor Law(M.G.L.c. 142A),but does not preclude parties from adding language to protect their specific interests. Seek legal advice if necessary.Before agreeing to any home improvement work on your residence you should obtain a free copy of"Consumer Guide to Home Improvement Contractor Law"by calling the Office of Consumer Affairs and Business Regulation's Information Hotline at 617-973-8787. You may cancel this Agreement if is has been signed by a party thereto at a place other than an address of K&R Contractors,Inc.,which may be its main office or branch thereof,provided you notify K &R Contractors,Inc.,in writing at its 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 the Agreement. See Attached Notice Of Cancellation For An Explanation Of This Right. Homeowner Information Contractor/Owner Name: Michael Marcinelli Kenneth Roy,President 66 Equestrian Dr. Business Street Address North Andover,Ma K&R Contractors,Inc. 1 Campbell Road North Andover,MA 01845 Business Phone: 978. 726.5062 Federal Employer ID: 000961723 Salesperson(s): Kenneth Roy,President Contractor Registration: 80721 Exp.Date:4/29/17 MA Sup.License: 137557 WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor Agrees To Do The Following Work For Homeowner: Replace rear deck of house with larger one(plan enclosed) Work to include: Demolition of existing deck.Build new deck according to submitted plan entirely out of PT wood.Framing to be 2x1 OPT,decking to be 5/4x6 PT,rails to be PT(2 vertical 2x4s, 1 2x6 cap,posts to be 6x6,balusters to be aluminum in black sand color of Fortress brand model Vintage).Deck and sunroom to be wrapped in PT lattice with an opening under sunroom approx.4'wide.Footing to be screw type steel piers.Includes permit and hauling away debris. Customer to provide post caps The following schedule will be adhered to unless circumstances beyond the contractor's control arise* Work Scheduled To Begin:April 18,2016 Expected Date Of Completion:May 3,2016 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work,furnish the material and labor specified above for the SUM OF$16,300 Payments will be made to the following SCHEDULE: $5000 upon signing contract $6300 due upon finish of framing $5000 due upon completion of project as outlined here Law requires that any deposit or down payment required by the contractor before work begins may not exceed the greater of- (a) £(a)one-third of the total contract price or (b.)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule*)No final payment shall be demanded until the contract is completed to the satisfaction of the parties thereto. OTHER IMPORTANT PROVISIONS You are dealing with a Registered Home Improvement Contractor and are entitled to certain rights under the provisions of 780 CMR R6 and M.G.L.c. 142A. Payments: If payment is not received as per the Contract,then the Owner shall be responsible for all attorneys' fees,court costs,and other costs incurred by the Contractor and enforcing Contractor's rights hereunder. Pets: Homeowner agrees to keep all pets out of the work area and take whatever steps are necessary to safeguard them from any harm that may come to them as a result of the work being performed under this Contract,including but not limited to injury on or outside the Premises or ingestion or inhalation of,or contact with,hazardous substances. Company assumes no responsibility for any harm to the pets as a result of the work performed under this Contract. Further,Homeowner shall take all steps necessary to protect Contractor,its agents,servants,contractors and employees,from any harm as a result of contact with said pets. Characteristics of wood: Wood is a hygroscopic material. Wood swells and/or shrinks in relation to the humidity,temperature and environmental conditions of its surrounding. Generally,wood flooring is expected to shrink in any conditions and expand when exposed to moist conditions. Natural wood also contains variations of graining,texture,hardness and/or knots,depending on the wood chosen. Contractor cannot be responsible for the natural features of the wood chosen. Contractor is not responsible for shrinkage,checking,swelling,or other conditions which are the normal condition of wood or the result of household or environmental humidity,heat,cold,or other conditions. Colors: You may choose colors and finishes for the parts being used in your remodeling project. It is important to remember that a color or finish you see at the store or in a showroom may not look the same in your home,especially after all of the different colors and finishes are brought together upon the completion of a project. In addition,one manufacturer's named color is not the same as another manufacturer's named color.The Contractor cannot be responsible for the appearance or lack of coverage from Homeowner/chosen paints and/or stains and finishes. Building Officials: Any additional costs incurred by Contractor as a result of decisions made by Building Officials will be the responsibility of the Homeowner.The costs of additional work will be calculated as follows: cost of materials plus an hourly rate of$45 per man hour. Liens: In the event of non justifiable non-payment,Homeowner's residence or property may be subject to a Mechanic's Lien as a consequence of signing this Contract. Utilities: The Contractor will use reasonable efforts to notify the Homeowner in advance of any interruption of utility services. However,there may be instances where the Contractor must shut down these services without advanced notice. Homeowner must arrange for emergency backup service for any utility critical equipment such as medical devices and computers. The Homeowner must also notify the Contractor at the start of the work day if you will be engaged in any utility critical activities in that the Contractor makes a notification in writing in the daily log book or otherwise. Additional work: Any additional work requested by the Homeowner which.is beyond the scope of the work to be performed as set forth in this Agreement,shall be the subject of a separate agreement,and/or if not, subject to the same terms and conditions as set forth in this Agreement and billed on a time plus cost of materials basis at Contractor's normal hourly rate. Contractor's normal hourly rate per man hour is$45. In the event that additional work is to be performed on an hourly plus cost of materials basis,the Homeowner shall be required to execute a Change Order which shall include Contractor's best estimate as to the time required,together with the cost of labor as well as the type and cost of materials necessary. Delays: Contractor is not responsible for delays attributable to Homeowner initiated modifications or additions,or for delays incurred due to the actions or inactions of city/town officials,strikes,acts of God,unfulfilled customer obligations,vendor delays,interference by other tradespersons,customer supplied items or other delays beyond Contractor's reasonable control Contractor will use reasonable efforts to stay on each job until substantial completion by allotting specific time periods to each Homeowner to complete each job in as timely a manner as possible. In the event that Homeowner does not allow Contractor and/or his employees or sub-contractors access to the residence or property so as to allow Contractor to perform his obligations and/or to complete the scope of work in as timely a manner as possible,other than for reasons of safety or other reasons mutually agreed to between Homeowner and Contractor,then the Homeowner shall be responsible to pay Contractor the sum of $500.00 per day,on a pro rata basis,to cover the costs of delay. Contractor reserves the right to suspend work and/or delivery of materials in the event of unjustified non-payment. In such event,the Contractor shall have no liability to the Homeowner for alleged delays or damages due to said suspension. Punch-list Items: The Homeowner agrees that routine"punch-list"or repair items after substantial completion are outside the agreed scope of services,and covered by Contractor's warranty obligation and will be completed as soon as practicable and according to Contractor's and Homeowner's mutual availability. Homeowner agrees that it shall use his/her best efforts to make himself/herself available to observe and/or sign off on the completion of any such punch-list Items,and that the approval of one Homeowner regarding the completion of any such punch-list items,as well as change orders shall be binding upon all Homeowners. Unforeseen Conditions/Circumstances: Contractor shall not be responsible for any changes at the request of the Building Inspector. Contractor shall also not be responsible for any unforeseen bedrock/ledge or latent defects such as structural and/or dry rot or insect damage to the existing structure,or for preexisting faulty or inadequate wiring or plumbing. Contractor shall also not be responsible for any pre-existing code violations or responsible for correcting contiguous work completed by others not under the Contractor's authority. Insurance: Homeowner agrees to carry fire,theft,vandalism,liability and all other necessary insurances to protect their personal property while construction is in progress. Contractor will carry all required and necessary insurances including worker's compensation insurance. Contractor will ensure that all personnel including sub-contractors will be covered by all required and necessary insurance including worker's compensation insurance. Homeowner's Cancellation Rights: In addition to the rights the Homeowner has,as set forth in the attached Notice of Cancellation,the Homeowner may have rights under other Massachusetts Statutes, including M.G.L.c.93 §48,M.G.L.c. 140D, § 10 and M.G.L.c.255D § 14. DO NOT SIGN THIS CONTRA IF THERE ARE ANY BLANK SPACES Identical copies of the contract should go to the homeown �and the contractor. Homeowner's Signature: Date: 9� Contractor's ignature K,&R Contractors,Inc.: Date: By: Kenneth Roy Its: President You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you notify the seller 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 the agreement. See attached notice of cancellation for an explanation of this right. NO WORK WILL BEGIN UNTIL BOTH PARTIES SIGN THE CONTRACT AND THE OWNER RECEIVES A COPY REQUIRED PERMITS The following building permits are required.It is the obligation of the contractor to secure such as the homeowners agent: Electrical rough and finish Plumbing rough and finish Insulation Framing insp. Finish and occupancy NOTE: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. EXPRESS WARRANTY All workmanship and materials to be free of material defect for a period of one(1)year. During the Warranty period,the Company may,at its option,either repair or replace products or workmanship which prove to be defective. This Warranty shall not apply to defects or damage arising from improper or inadequate maintenance by the customer,customer's applied products,unauthorized modification or misuse,damage incurred as a result of acts of God or civil strife,or normal characteristics of the materials such as wood shrinking,expanding and otherwise reacting to moisture or environmental conditions. The Company's liability is limited to the repair or replacement,at its option,set forth herein and Company shall not be liable for any consequential,sequential,incidental or other damages not set forth herein.The Warranty set forth herein is exclusive,and no other Warranty,whether written or oral,is expressed or implied. Company specifically disclaims the implied Warranties of Merchantability and Fitness for a Particular Purpose. NOTE:All home improvement contractors and subcontractors shall be registered and any inquires about a contractor subcontractor relating to a registration should he directed to: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,MA 02108 617-727-8598 Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence, ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the even the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the nsumer shall he required to submit to such arbitration as provided in M,G,L. c.142A. Contractor: Date: i 1 Homeown r: Date: NOTICE:THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETFLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOTSEPARATELY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity-A Contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems hint/herself to be financially insecure. Contractor's Financial Insecurity-In instances where a contractor deems himself/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal from said account would require the signatures of both parties. Homeowner agrees to allow reasonable access to allow Contractor to reasonably attempt to remedy any outstanding uncompleted,disputed or non-satisfactory item. If you have general questions or need additional information about The Home Improvement Contractor Law,contact: Consumer Information Hotline Commonwealth of Massachusetts Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170 Boston,MA 02116 617-973-8787 If you have questions about Contractor Registration,contact: Director of Home Improvement Contractor Registration Board of Building Regulations and Standards One Ashburton Place,Room 1301 Boston,MA 02108 617-727-3700,x25205 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR OBLIGATION,WITHIN THREE (3)BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN(10)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 AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT;OR YOU MAY,IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE CONTRACTOR REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE CONTRACTOR AND THE CONTRACTOR DOES NOT PICK THEM UP WITHIN TWENTY(20)DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE CONTRACTOR AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO K&R Contractors,Inc. 1 Campbell Road,North Andover,MA 01845 NOT LATER THAN MIDNIGHT OF TBD. I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: Received: p , c:r PAX r"XV I . t d tc C eel 7 It 7.... LJ �� .�, � " �.. ��.v q .,a�"��w��. aM, � .,, °jib m .. �� �_.G`� 4� w,. c� .�O­t) 6CIC"e ,, y -.�� �• COY , r q-, 1 I 1 S CONSERVATION DEPARTMENT Community Development Division September 11, 2015 Michael Marcinelli 66 Equestrian Drive North Andover, l\t/� 01845 66 Equestrian Drive, North Andover Construction of a deck on Sono-tube Footings Conservation Conditions of Approval, NACC #155 Pursuant to section 4.4.2 (A) of the North Andover Wetlands Protection Regulations,Michael Marcinelli, filed for a small project for work proposed at 66 Equestrian Drive,North Andover. The proposed work includes the construction of a deck (-450 sq. ft. total—less than 100 sq. ft. is within the Buffer Zone) on sono-tube supports. The deck is approximately 90 feet from the edge of Bordering Vegetated Wetland (BVW) as shown on the herein referenced plan. During the September 9,2015 public meeting, the NACC voted unanimously to approve this project.All work shall conform to the following: RECORD DOCUMENTS: Small Project Filing Including: Application Checklist and project narrative, Filing received: 8/31/15. Plan titled "As-built foundation location" original plan date: 8/19/85; revised by The Morin Cameron Group, Inc., revision date: 9/8/15. The following conditions are hereby mandated: CONDITIONS: 1. Prior to the start of construction the applicant shall ensure that the site contractor has reviewed the small project permit and is aware of the wetland resource areas and the limits of the proposed work. 2. No erosion controls are necessaiy. 1600 Osgood Street,Building 20,State 2-36,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 R'eb xv\m.http://N«t-\v.townofnorthandover.com/cotiservel.htm 3. Excess construction material shall be properly disposed of offsite and accepted engineering and construction standards and procedures shall be followed in the completion of the project. 4. Wedand markers shall be installed at the 25' No-Disturbance Zone, and can be placed on existing trees. Conservation Department staff can assist wida wetland marker placement locations if needed. Wedand markers are available at the Conservation office ($2 round/$3 square). 5. Upon completion of the approved project and site stabilization,please contact the Conservation Department for a final inspection. 6. This .permit shall expire six months from the date of issuance. Should you have any question or comments regarding the contents of this letter,please do not hesitate to contact the undersigned at 978.688.9530 at your earliest convenience. Thanking you in advance for your anticipated cooperation with this matter. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT 4J Heidi Gaffney Conservation Field Inspector 1600 Osgood Street,Bad ng 20,Stute 2-36,North.-Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web http:/%-,i-tN,%•.townofnorthandover.com/conservel.htm The Commonwealth of Massachusetts F Department oflndustrialAceldents d 1 Congress Street,Suite 100 4' Boston,MA.02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electrieians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant-Information Please Print Le 'bl Name (Business/Organizationllndividual): S Address: �a City/Mate/Zip: Al /,,N c' J,u� /VAA Phone#: 01 Are you an employer?Checlrthe appropriate box: Type of project()required): 1.❑I am a employer with employees(full and/or part-time).* 7. Q New construction 9. 2.M I ama sole proprietor or partnership and have no employees working for mein 8. Remodeling any capacity.[No workers'comp.insurance required.] �Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]� 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.Q 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.- I3.F1 Roof repairs These sub-contractors have employees and have workers'comp.insurance.) 14. Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGI,c. [� 152,§1(4),and we have na.employees.[No workers'comp.insurance required.] 1 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit:this affidavit indicating they 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-cori`lractors fiave employees,ltiep must provide their workers'comp.policy number.' f am an employer Mat is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Dato: fob Site Address: 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 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 day against the violator.A,c py of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify' er'tliepains an -[ties ofperjury that the information provided above is true and correct. Signature: Date: /' ` Phone Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OP ID: PS A ® CERTIFICATE OF LIABILITY INSURANCE DATE 04//11 11/2//201166 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(les)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 N Foster Sullivan Insurance AME: Pete Sullivan 163 Main St. a/cNr o EM:978-686-2266 A!C No):978-686-6410 North Andover,MA 01845 E-MAIL sullivan ostersullivan rou com Stephen Sullivan ADDRESS:p 9 p• PRODUCER K&RCO-1 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED K 8r R Contractors,Inc. INSURER A:MERCHANTS INSURANCE GROUP 12775 Ken Roy 1 Campbell Road INSURERS: North Andover,MA 01845 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILiRR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF MM/DD� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY BOP1062559 12/09/2015 12/09/2016 PREMISES Ea occurrence $ 500,00 CLAIMS-MADE 1XI OCCUR MED EXP(Anyone person) $ 15,00 '.. PERSONAL BADVINJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: =PRODUCTS COMP/OP AGG $ 2,000,00 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ '.. HIRED AUTOS (PER ACCIDENT) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONWC STATU- TH- AND EMPLOYERS'LIABILITY YIN TORY LIMITSI ER ANY PROPRIETORIPARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) EVIDENCE-bleathe@townofnorthandover.com 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. fax#978-688-9542 BRIAN LEATHE-BLDG.DEPT. AUTHORIZED REPRESENTATIVE 1600 OSGOOD STREET NORTH ANDOVER,MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ' o. ° o Ca Ca ;. L 07 "� ✓l� �CvY�/7ZGLY���2p�LfL `/!?�G�k���%0�( _... vQ ate\ Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Q a = Registration:; 1.62123 Type: Office of Consumer Affairs and Business Regulation o CZ `z<��i;:v�. _ Expiration 1/20!2017 Private Corporation 10 Park Plaza-Suite 5170 ��,.. Boston,MA 02116 o K& CONTRACTORS II�C .I a KENNETH ROYPoe , o y 741-47 _ m` 1 CAMPBELL RD. ',° V �` ° N.ANDOVER, MA 01845 E O � y Undersecretary Not vali ithout signature is 0 P4a > E U p O Ca U) -0 � O� N Ca R O ' j