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Home My WebLink AboutBuilding Permit # 8/1/2016 BUILDING PERMIT OORT TOWN OF NORTHA D V 0 APPLICATION FOR PLAN EXAMINATION c am, IL PernnitNo# Date Received—_ Date Issued: IMPORTANT: Ap must complete all items m this page LOCATION rint PROPERTY OWNER Print 100 Year Structure yesno MAP .&Le PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye no F—TYPE OF IMPROVEMENT PR OSED USE Residential Non- Residential FJ New Building Li One family X'Addition ri Two or more family 0 Industrial F PROP eside J L] O� U Tw kAlteration No. of units: 1i Commercial ri Repair, replacement 11 Assessory Bldg El Others: E3 0 Demolition El Other p c g a ers e 6/z/ 6d n" 777-777 lalsv DESCRi� Lit, Identification Please Type or Print Clearly OWNER- Name-. Address: Contractor Name:L e.r Email: 2k,ro0ti T441,-1 "2 Address: 44 1,-1 \A)A F,1,r, Supervisor's Construction License.*..,::::> Ex p. D a t e m mpr Supervisor's Improvement License: Exp. Date: ARCHITECT/ENGINEER "LLPhone:9,18 Lzfd Address: t2-rL�W A Reg. No. FEE SCHEDULE. BULDING PERMIT, $12.00 PER$1000.00 OF THE TOTAL ES A TED COST BASED ON$125-00 PER S.F. Total Project Cost: FEE: $$ 3 Check No.: 0 92b, - Receipt No.: "'3112a,� NOTE: Persons contrac a* , regiWered contractors t10 not' have access to the g"arantyfund gnaWre-oLcont=tor Mans Submitted Plans Waived ❑ Certified Plot Plan 'X, Stamped Plans ❑ FTE OFSEWERAGE WSPOSAL lic Sewer LlTanningWassage/Body Art ❑ SwI mm ing Pools El ll ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM �/LANNING DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on 2tf Signature r COMMENTSSI-06c a 5 L , \ C` (L c� v��V�e�J [c10isjp -G� EARTH Reviewed on Sig.nature COMMENTS G (k) C� 1.2 L� Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/signature& Dato Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMENT - Temp .DUMDster an site. .yes rho , L"orated at 124;Main street Fire Dnt signature/date LCOMMENTS Town of Andover 0 No. * x - . h ver, Mass, ��K 'QA COC LAK WFcx\V�• S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...... .. ...M ..... ,, �.... BUILDING INSPECTOR has permission to erect .......................... buildings on =......Aw.W........ Foundation Slow Rough to be occupied as .. . .,. . ............ .,, .............. chimney provided that the person accepting this permit shaflin every respect conform to the ter s 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST CTION Rough Service .. ... . . .... . . .. ... .... Fina BUILDING PE OR GAS INSPECTOR QccupanEE Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fina` YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. North Andover MIMAP 66 Cedar Lane July 20�, 2016 Afi °%•105:0-00�1�6;(, HFy � MM ( 0M / /, l ru 9r✓� �� i�i / 9i o 7"7 r /g�i M i � / p > �1� 106 A 0142 ' , a f Fn 3 I a J // `. � / �! T� 4 i t j %ldr u u t DAM L.11 n >y ,, ✓ Vt� i r .,.P f r !' D U 6 l# (]MVPC Ba co v Interstates Heters'al Datum:MAS he data or this nap System,Datum Merrimack Meters'Dam Sources:The data far This map Was produced by MarrimaGc Roads ,� wpRrh Valley Planning Commission(MVPC)using data provided by the Town of 61 p 't p x a^,,y North Andover.Additional data provided by Ilia Executive Office of Co Easements � . ? blit *p A0 Environmental AffalrslMassGtS.The information depicted on this map is Parcatsq� " t for planning purposes only,It may not he adequate for legal boundary ® definition orragulatory Interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING it THE ACCURACY,COMPLETENESS,RELIABILITY.OR SUITABIt.ITY 4L 's OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 10 ft ft.ua'i��Poa , Q �� u�aa �P4 1iui4,P Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 North Andover, MA 01845 LLC 978-4791526 7/12/16 adambrico@gmail CONTRACT mmimmu'Imimmmllmmuumimiimmmmau��m¢moumimmommmmmmuommmmmiwwumimmoumrmm mH�mmmm.mwmimumommummimumumnuuuumimuuumuuum�ummuumw;,mumwum'Mm',mmmmuuwiom�niowummiommwmuu m'm�wm�mmmnummrmmuumimuumum'lummmimoiM.rm'mmuuommwmmummimimwmommimullmmmwuuuoiowmooiououmuuumoimiouuouomomouuuuuuuuuumouuuuuuuuuuuuuumuilgigigiiiqpoupiqipmm Nick Kline 6 Cedar Lane North Andover MA EXHIBIT A Job Description. Master Suite addition including bathroom over existing garage • All construction built to stamped plans provided. • Demolition of existing roof over living room. Demolition of ceiling in a living room, removal of wall paneling and insulation in living room. Permitted Dumpster will be placed on site for debris. • Finished floor to be covered with plywood for protection of existing living room floor. • All framing constructed to plan. Exterior plywood to be "Zip System" All partition movement and structural elements built to plan. All exterior trim work to be PVC material. All structural beams and columns to be approved by engineer • 24"x24" footing cut into garage floor for new concrete footing and column. Location and sizes per plan • Roof of new addition to receive architectural shingles, color and brand to be matched. Backside of house shingle to be blended into existing. Due to age and dye lot, shingle may not match 100% • New addition to receive vinyl siding. Siding to be blended in back of house. Due to age and dye lot, siding panels may not match 100% • New Harvey windows installed where dictated on plan, glass to meet energy rating and style to match existing windows. Two windows to be removed and installed at new location. • All exterior walls, ceilings and floors to be insulated to meet energy code. • All new walls and ceilings to receive blue board and plaster, garage ceiling to receive 5/8" fire code blue board and plaster, small closets and garage ceiling to receive texture finish • Master bedroom, closet and hallway to receive new 3 '/4" red oak flooring sanded, sealed and polyurethane (2). Carpet to be cut in around new closet that are created in existing bedroom. • Electrical scope to consist of the following. Plugged and switched to code. Led Recessed lights in master bedroom, master closet and hallway. 1 ceiling fan, an allowance of$400.00 is included for ceiling fan, one cable location. Bathroom to be wired to code, exhaust fan light combo vented to outside, recessed light over shower, recessed light in toilet room, vanity lights, an allowance of$300.00 is included for vanity lights. Ceiling in existing living room to receive LED recessed lights. Recessed cans to be on dimmers. New closet on second floor to receive light and switch. Bedroom to receive new hardwired smoke detector. • Bathroom to be built to plan. Walls and ceiling to receive blue board and plaster. Floors to receive Hardi-backer underlayment prepped for tile installation. An allowance of$300.00 is included for the purchase of tile and grout. • Shower walls to receive cement board underlayment prepped for tile installation. A $400.00 allowance is included for the purchasing of tile and grout. (Tile pattern and design may reflect a price increase in labor.) An allowance of$200.00 is included for shower head and trim kit • Soaking Tub to be installed. An $800 allowance is included for tub and faucet. (If tub requires specialty plumbing design price may increase due to labor. Jacuzzi tub will require a price increase based on electrical feed necessary for pump controls) • An allowance of$300.00 allowance is included for the purchasing of toilet and seat. • An Allowance of$800.00 is included for vanity, an allowance of$800.00 is included for granite top, white under mount sinks included with purchase of granite. If different style is desired homeowner is responsible for purchasing and delivering to site. An allowance of$300.00 is included for the purchasing of 2 faucets. Toiletries and mirrors not included but BriC4 will install at no expense. Glass shower enclosure not included (estimate $1200.00) • All new doors to be solid core Masonite, all existing second floor doors to be removed and new solid core primed Masonite doors installed including jams and casing • Master closet to receive 1 "MDF" wrap around shelf with pole • Per plan option, closet to be removed and new window installed over front entrance, walls to be patched and plaster to blend. • Painting not included • Permit fee included Total Allowance figure $4600.00 Grand Total $58,750.00 The Owner agrees to pay BriCo Building and Remodeling $58,750.00, for doing the work outlined above. The following payments will be paid to the contractor in the following manner: • First Payment is of$20,000.00 is due once contract is signed. This payment will be for permit fees, window order(generally 3 week manufacturing), lumber and dumpster fees. • Second Payment of 15,000.00 is due once structure is weather tight, glass is installed, roof is complete, mechanical rough begins and exterior siding. • Third Payment $10,000.00 is due at completion plaster and interior millwork has begun. • Fourth payment of $10,000.00 is due at completion of flooring. • Final payment is due at completion of project All subcontractors that are hired by BriCo or the homeowner must carry the appropriate license and insurance to perform work in the state of Massachusetts. The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices, and all work performed shall be subject to final approval by Owner. All work to be done incompliance with Massachusetts building code. BriCo takes on full responsibility of all necessary inspections. All craftsmanship is warrantied for one full year from completion of construction. Warranty is voided if repairs are necessary due to a natural disaster. All glass installed meets state energy code for performance and efficiency. Each glass unit will contain its own energy certificate. Any unforeseen work or necessary repairs found during this project to be brought to the owners attention as soon as possible. Any extra work resulting from unforeseen problems will be priced accordingly on site and be done with written approval. BriCo is not responsible for anything that occurs on site that is not directly involved with the construction of this project. BriCo Building and Remodeling is a fully licensed and insured LLC company. License numbers are provided in the header above and current insurance documentation upon request. BriCo is a full service general contracting company. We take pride in our work look forward to the opportunity to work with you. V 1 Customer Signature Date Contractor Signature Date �"vm t. Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 North Andover, MA 01845 LLC 978-479-1526 7/12/16 adambrico@gmail wuumm'awwwwwm'awmw ommiwimmoiommuwwmwmwwwumiommwmuommllimuuummomwwwumwwwwmwwwwummmmnwwmwwwoumw,w, uuummmoi000umnumomommuuuuuuuuuuuoumooumuuuuuuuuuuuuumimmmmumuuwimwmwwmummumumwuwumtwmuwwmum'mmm'mwwwmimmtiimmimmwwuaw!mv. Nmoowmm!opmummuomwmv7numummimmumimmmiouwwmumigwowmmmwuw. awnmmououmouuoiougogpppiommomouuuuuumuuuuuunumognpm CONSTRUCTION CONTRACT This Construction contract dated as of 7/12/2016 By and between Nick Kline of 66 Cedar Lane._No,rth__An_dover MA, and BriCo Building and Remodeling Owner and contractor in consideration of the mutual covenants hereinafter set forth, agree as follows Article 1 Contractor shall construct the items in Exhibit A in accordance with contract documents, as identified in this contract on property which is located at 66 Cedar Lane. Article 2 Contract Price The Owner agrees to pay BriCo Building and Remodeling $58,750.00, for doing the work outlined above. The following payments will be paid to the contractor in the following manner: • First Payment is of$20,000.00 is due once contract is signed. This payment will be for permit fees, window order (generally 3 week manufacturing), lumber and dumpster fees. • Second Payment of 15,000.00 is due once structure is weather tight, glass is installed, roof is complete, mechanical rough begins and exterior siding. • Third Payment $10,000.00 is due at completion plaster and interior millwork has begun. • Fourth payment of$10,000.00 is due at completion of flooring. • Final payment is due at completion of project Article 4 Change Orders Both parties shall agree any unforeseen work or changes requested during this project to be granted with written approval. Any extra work resulting from unforeseen problems will be priced accordingly on site and be done with written approval Article 5: Contractor's Representation Contactor has familiarized itself with the nature and extent of the contract documents, work site, and all local conditions and regulations that in any manner affect cost, progress and performance of the work. Contractor is duly licensed to perform the work as required by laws and regulations. Article 6: Contractors Responsibilities The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices, and all work performed shall be subject to final approval by Owner. All work to be done incompliance with Massachusetts building code. All materials and equipment shall be of good quality and new. All materials and equipment shall be installed in accordance with manufactured specs. Contractor shall be fully responsible to owner for all acts and omissions of its subcontractors, suppliers and other persons performing or furnishing any work under contract with contractor. Contractor shall be responsible for initiating maintaining and supervising all safety precautions in connections with work. Contractor shall comply with all applicable laws and regulations relating to the safety of persons on the property Contractor shall repair or replace at Contractors sole expense every portion of the work that is damaged or destroyed before final completion. Contractor warrants and guarantees to Owner that all work will be in accordance with the contract documents and will not be defective. If within one year after the date of the final completion or such longer periods of time as may be described by laws or regulations or by the terms of any specific provisions or applicable special guarantee in the contract documents and work is found to be defective. Contractor shall promptly without cost to owner and in accordance with written approval correct such defective work. Article 7.- Insurance Contractor shall maintain general liability and work-mans comp insurance for the work being performed at 66 Cedar Lane North Andover MA. Contractor shall deliver to Owner certificates of proof. Owner shall be responsible for purchasing and maintaining Owners Liability insurance and or other reasonably appropriate insurance. Article 8 Termination Termination by Owner. If Contractor breaches any obligations under this agreement then owner may give Contractor written notification identifying such breach. If Owner has not cured such breach within 7 days from written receipt or if breach cannot be cured or Contractor does not begin to cure or fails to diligently prosecuted cure to completion Owner may terminate contract and take possession of work. Termination by Contractor. If Owner breaches any obligations under this agreement then Contractor may give the Owner written notification identifying such breach. If breach is not cured in 7 days or Owner has not agreed to resolve such breach then contract may be terminated. Exhibit 9 Owner and Contractor each bind itself, its partners, successors, assigns legal representatives, to the party hereto, its partners successors, assigns and legal representatives in respect to all covenants, agreements and obligations contained in the Contract Documents. This contract and all issues disputes and matters arising out of it shall be governed by and construed in accordance with the laws of the state in which the Property is located, exclusive of the body of the law governing conflicts of laws. IN WITNESS WHERE OF, Owner and Contractor have signed this Contract This Co be effective on July 7, 2016 Owner t4boq�-? 0 Address'of`Paperty.-6�-�- At, AA Contractor.,-Adam BrienBriCO Buifd.fiy and-Reinodel'ing Address:417 Waverley Rd North Andover MA 01845 Title: Owner Operator The Commonwealth of Massachiovetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 JV;VW.inass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busiiiess/Organization/Individiial): ("o V,-2) t jSC, Address: �JAA� f< City/State/Zip:0, - 0 1� Phone 4: Are you an employer?Check the appropriate box: Type of project(required): I JQ I am a employer with 1 4. n I am a general contractor and 1 6. n New construction employees(full and/or part-time).* have hired the sub-contractors 7. Remodeling 2.0 1 am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub-contractors have 8. Ej Demolition working Im me in any capacity. workers' comp. insurance. 9. R1 Building addition [No workers' comp.insurance 5. n We are a corporation and its 10.n Electrical repairs or additions required.] officers have exercised their 3.0 I am a homeowner doing all work right of exemption per MGL I Ln Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.n Roof repairs insurance required.] t employees. [No workers' 13.n Other comp, insurance required.] *Any applicant that checks box fl 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ltit)iatiemployer titati.vproviding ovorl(ers'coinpeti,vtitioiiiiisul-tiiieef6i-mY employees. Below is the policy and job site information. Insurance Company Name: ............ Policy 11 or Self-ins. Lic. U-1)tl b I�F 1_6 ............. Expiration Date: Job Site Address:— C,Ej-)kw City/State/Zip:_N,%-j_f) y�,i� __j �,)j _�4�) 01W(i.T Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains ail penalties of perjury that the information provided above is true and correct Sig ature: 2 Date: Phone If: 9 -)8 Official use only. 1)o not write in this area,to be completed by city or town official. City or Town: Permit/Liceuse# 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 M AC0l`Rf> CERTIFICATE OF LIABILITY INSURANCE DATE{MMlO❑/YYYY} 07111/2016 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 CONTACT NAME: Trudy Lawler MICHAUD INSURANCE AGENCY a1CCcNiJ Ext: (978)685-2549 (FAX E-MAIL di i drulawler mchaunsurance.com ADDRESS: tY � ,.. 105 HAVERHILL ST. INSURERSAFFORDINGCOVERAGE METHUEN MA 01844 INSURERA: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: BRICO BUILDING & REMODELING LLC INSURER C: INSURER D: 417 WAVERLEY RD INSURER E:^T NANDOVER MA 01845 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 67853 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. _, _. 1LTR TYPEOFINSURANCE ADDLBUBR POLICY NUMBER MWD�01�YY MMIDD1YYYV LIMITS LTRINSD V1/VD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DA __ CLAIMS-MADE 1:1 OCCUR PREM SES Ea occur encs $ MED EXP(Any one person) $ NIA PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ POLICY❑PRO EILOC PRODUCTS-COMPIOP AGG $ SECT OTHER: .. .S. AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) S AUTOS NON-OWNED PROPERTYDAMAGE $ HRED AUTOS AUTOS Per accident),,,,_ _..- S UMBRELLA LIAB OCCUR EACHOCCURRENCE S EXCESS LfAB CLAIMS-MADE NIA AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION V PER OTH- ANYIN DEMPLOYERS'LIABILITY /1 STATUTE ER ANYPROPRIETORIPARTNER)EXECUTIVE E.L.EACH ACCIDENT $ idd,OdO A OFFICERIMEMBEREXCLUDED7 I NIA1 NIA NIA 7PJUB4618P50716 04119/2016 04/19/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I s 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I 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/[wd/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 The Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHORIZED REPRESENTATIVE rD I North Andover MA 01845 D Daniel M.G�y,CPCU,Vice President—Residual Market—WCRIBMA 01988 2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD � CERTIFICATE OF LIABILITY INSURANCE DATE`MM�%1 16 ACORO 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 ADDI'T'IONAL INSURED,the pollcy(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). PROWLER NAMEt Tricia Sabulis Armand P. Michaud Insurance Ag PHONE (9713? 685_2549 FAx wu: (978) 799-0e22 105 Haverhill Street ADDRESS: triciasabulis@michaudinsurance.com Methuen, MA 01844 INSURE S AFFORDING COYE_RAGE. NAlC# INSURERA:Green Mountain Insurance Co. INSURED INSURER B:Norfolk & Dedham MA BRICO Building & Remodeling LL INSURERC: Adam J Brien INSURER D: 417 Waverley ltd INSURER E: N Andover, MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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. !NSR DO TYPE OF INSURMCE JOR SL1[) _ POLICY NUMBER PMIDDffYLICY EFF POLICYDYYY..W LIMITS LTR A GENERAL LIABILITY 20009201 4/13/16 4/13/17 EACH OCCURRENCE $ 1,000,000 DAMALX COMMERCIAL GENERALLtAMILITY PREMISES E ocuunencul n $ CLAIMS MADE OCCUR MED EXP(Any one person) $ 5.000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMITAPPLIESPEI2 PRODUCTS-cowtoPAGO $ 2,000,000 POLICY P O- LOG $ B AUTOMOBILE LIABILITY 91561617A 6/18/16 6/18/17 Caada'SINGLELIMlT $ ANYAUTO BODILY INJURY(Per person) $ 100.000 ALLOWNED XSCHEDULED BODILY INJURY(Pat accident) $ 300,000 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRLDAUTOS �....AUTOS eraccident $ 100 000 $ UMBRELLA LlA9 OOCUR EACH OCCURRENCE $ EXCESS LlAB CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION WC STATO- OTH- AND EMPLOYERS'LIABILITY Y I N TORY I IMITS FR. ANY PROPRIETORIPARTNEWIEXECUTiVE NIA E.L.EACHACCIDENT $ _..... OFFICERMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE H yes, describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LtMrr DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (Allach ACORD 101,Additional Rerm*s Schedule,if more space Is regal red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Tricia Sabulis O 1988 2010 ACO RD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD Phone: (978) 685-2549 Fax: (978) 794-0822 E-Mail. triciasabulis@michaudinsurance.com ACNI The Commonwealth_ alth af Massachusetts , Department of Fire Services 0 Office of the ,Mare Fire Makshal P.Q.Box 1025 State Road,Stow,MA 01775 Permit No PERMIT bate: (City of Town) (1f Applicable) Dig Safe Number In accordance v;ith the provisions of MGL. Chapter 1 Oas provided in section 5 2 7 CMR 34 This Perxait is granted to, 6d � 1 cf � �" . Mart Date pull name of Person,Film or Corpor ' Permission to .locate dumpster for construction/renovation/demolition of structure Comments. dum ster be 25 ' from structure or covered with tarp or plywood Restrictions: at end of workday at Z- C K-� b 1. (Give location by street and no.,or describe in such,manger as tovied adequate identification of location) Fee Paid 62— G/t�- an' _ This Pernnit will expire /-16 {Signature of off cal granting permit) O-Mcal granting (Title) TWIG PPP"IT MI IAT"PIP CMI-RPlrl IrIl LqI V P f)-QTPn i IPnM THF PPPAfiICi=fi The Commonwealth of Massachusetts y �. Department of Fire Services C?ffl'ce of the Stage Fire Matshai P.0.Box 1025 State Roan,Staw,MA 01775 Permit No PERMIT hate: Gity of Tawe � (If pplicable) Dig Sale Number In accordance with the provisions of MG.L. Chapter OOas provided in section S 2 7 CMR 34 This Permit is granted to: zz6 v! L f� � �' Start Date TO name ofpmson,Firm or Corpor . Permission to locate dumpster for construction/renovation/demolition of Structure Comments: ' _ men.deof�of structure or covered with or plywood Restrictions: at at Z, G �z (Give location by street and no.,or desonbe in such manner as to pr adequate idem cation of location) Fee Paid$ s'b fneee � This Pemait mill expire �6 (5rgnatf7rE O offiGai�FaTt�Ing peI2rlit Offical granting permit (Title} �' TI-1-Q PRRMIT MI I_CT"14P r'.E hj_gPIC'1 IClI I_CI V PARTI✓1'] I IP[" 1 TI-IP PRFMfCI'G "�� Massachusetts Department of Putaiic Safety Board of Building e_. B0 R eauiatiorrs and Standards "> License: CS-104428 Cori strUction Supervisor ADAM J BRIEN ' 417 WAVERLY ROAD NORTH ANDOVER MA i "' -- Expiratia n- missraner 05112/2018 4. Office of ConsumerAffairs. Busiue`ss Iteuiauon `s w�OMEIMPROVEMEN7CONTRACTOR TYPs � i egistration: 168512 Expiration:, 3/1/2017 LLC BRICO BUILDING AND REMODELING LLC; - t ADAM BRIEN 417 WAVERLY RD NORTH ANDOVER,MA 01845 UndersecreWy