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HomeMy WebLinkAboutBuilding Permit # 9/14/2016 V%OF?TH BUILDING PERMIT 01 ,,*,a TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION d Permit No#: Date Receive ACHUS Date Issued: Applicant must co�iete all-item.s on t,is­ h pa e IMPORTANT: 7 It LOCATION ID Print PROPERTY OWNER 4.111 Ho M a ''. es no Print 100 Year Structure y MAP PARCEL: `/ ZONING DISTRICT Historic District yes no 2 Machine Shop Village yes no TYPE OF IMPROVEMENT -PROPOSED USE Residential Non- Residential E New—Building 7 [I One family n Industrial n Addition E Two or more family ri Commercial Alteration No. of units, Repair, replacement In Assessory Bldg Others: (k F1 Demolition c3 Other ❑ T p Floodplain rlWetland. s ­ DESCRIPTION OF WORK TO BE PERFORMED: x _ay - -SL K %I CAIC ) LAL)h ti Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: T A t,,i I LN r�obp1zz>t:-x �Z Al>pw 1`� -7 Id I L 52 6 Contractor NameEmail: „: 9C i E Phone: Contractor tt�tL 0 'k r N�, MA , Address:L4.I'l, Address: Supervisor's u p rvisor's Construction License-._�:_ 15 ..—Exp. Date: upervis 0 Exp. Date: '12(11-7 Home_Improvement License. ........ ARCHITECT/ENGINEER f Phone'. IV LI-75 52Q,:>L WA Htqz(.� ,�2,M_5_5 0 C 06,M A i LCD 01� Address: 0VER, 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: $V T, DO —FEE. $ Check Receipt No.:— No.: NOTE: Persons contracting with unregiste d contractors (Jo not have access to the guarantvfund ' ontra_rAo __,.__81gnatUreg.er*0 _wn 6r"f'c- - ----- �oRT" Town of 4 ndover O No.0114 .16 Z h �y rih ver• Mass T O LArcE � / 7 COC MICKE WICK ApOATED S U BOARD OF HEALTH Food/Kitchen PER T LD ML Septic System 4a THIS CERTIFIES THATAA BUILDING INSPECTOR ..� .... .... Foundation has permission to erect .......................... buildings on %. . . 7.rn.. � .. ... ...... Rough to be occupied as 1 . ..................... Chimney provided that the person accepting this permit shall in every respect confo!#n to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to th inspection,Alteration and Construction of Buildings in the Town of North Andover. N IA A6*,..n PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS C ST TIO Rough Service .. ... . ... ....... ........... Final BUILD INSPECTOR GAS INSPECTOR Occupancy Permit Required to ®ccu Puildin Rough 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. Burner Street No. Smoke Det. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OFSEDISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swilmning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private{septic tank, etc. ❑ Pen aoentDumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - D FORD PLANNING & DEVELOPMFNT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on.__ „Signature COMMENTS Zoning Board of Appeals: Variance, Petition No., Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: ' Comments Water & Sewer Connectionlsigna�ure& pate __ Drivewa Permit Y . ._ DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT; Temp Pump ster on site :yes Locat ed at;1.24,Ma.in.Stfea " Fire Department signafureldate. 1 . Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 966 Section 21A—F and G rnin.$100-$9000 fine NOTES and DATA-- (ror department use) Q Notified for pickup Cali Email Date Time Contact Name i 'r Doc.Bui1ding Permit Revised 2014 The Commonwealth of Nass. Department of Fire Services Q Office of the State Fire Ma°arsh; P.0.Box 1025 State Road,Stow,MA 01775 PERMIT (City of Town) Permit NO - if 2Ep&cable) In accordance with theprovisions ofMG.L. Chapter 10as provided in section 5 2 7 CMR This Permit is grantedto: Fn3lname ofperson,Firm or Corporation Permissiouto locate dumpster for construction/renovat.ic Comments: dumpsite-r- be 25 '. from structure or covered wi Restrictions: -- .. ._._,.......,.,.,...__..,...._,,.,_. _ at end of workday at (Give location by street and no.,or describe in such m r as to rovied adequ Fee Paid$ C3 _ This P MR expire .(Signature of ofEw granting permit) Wal grant'] TWIC PPRMIT MI f'qT'9tP r..r)NCWIr'_I InI ICI V Or)CTPn I IF i I i i r y i 1 1 W-0 pw ra be end \JgowE:;) C Wells Fargo Home Mortgage, Inc,-) AUb hS'MU xMRM MORTGAGE INSPECTION PLAN I r�T MY 1HAT THs FNRDRttti+� ICO t 1 nb MAIM IN ��4FRz>Nr, er REAR 01%"DO Yj Nar over NORTH ANDOVER t€►i ORAitA»ETOIIPT FKCKA NOLATRAi ACrA4 UWM Ws&�6t. T=W.CHAFM 40A.sEUnGN 1. ane X C u U I t URTF1k3L IRAT THS PRPER OTY IS not LOOAM IN THE Es rim HAZARo OOMMUNIaYPANELNo.: 250098 00b3C DATE: 6.2-93 DEED TM COMPANY`18 HOT FOR MY1NOENT M MADE SUNEWJU#f TO JK RECpF w um DATE OF WE LATWr nM W RECOM PACE WMEMM @Ui.MM ARE WAOMd LESS TNAN ONE FWY MOM THE PiLOP£ATY LANE IT W AOYtOE`O CERT.Rm 'f�1{t�AT�A V"REtp�9t3RVA'1f�ItA�7b Y 7HES@' Thi'—ER7IfTCATft?N is BA 91 tlN'tFEE Lt7oAA'Ra!OF S1/RV�°Y Rri1" PLAN RK. PAW A PstOPEttTT'tarpvEl YF1tIFICATtON Cfi SUgVEY M ONN IAA TR�R ApCL9 D qRY RY AH ACl 1RAT� IASIRL D,T Y5 Ic7m � r CATFYFI/ °t' THIS zT1F,Cg71oN Tn aE USED Fot: IApRTCiA 4 March 26, 2003 orrs�Ts As sNo� ARE e'ror USE'S/ FOR TETE ESTABlISFiMENT' Of PR g sCALe t. � BRADFORD NGINEERING CO. 3AUEs W. RbUMOUKAw^ RLS. d8"�2 !AvMI S HA Ot®-3t TOTRL P.02 u lB i Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 Borth Andover, MA 01845 LLC 978-479-1526 8/22/16 adambricoQgmail oiwuwwuwummouoioiowomouuumoioiouuuuuuuuuumomououuuuuuuuuuuumumumuwuwwuwawwouuuumwwuwww iomoiouomu u�uu+uuuu�uuuupuwwwuupuuuuuuuuuuuuuuuwwwwwwwww _ ,�w� ..... uuomuummwwuwwww,�mmmummwiwmmooiwouuuuuwwwmiwwwwwwwwwwwwwwwunuuuuouuuuuuuuuuuum¢ CON CTION CONTRACT This Construction contract dated as of 8/22/2016 By and between Andy Van Horn of 149 Middlesex st North Andover 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 $57,900.00, for doing the work outlined above. The following payments will be paid to the contractor in the following manner: • First Payment is of $10,000.00 is due once contract is signed. Secure permit fees, dumpster, window order and product organization with extensive lee times.(3 weeks prior to the beginning of construction) • Second Payment of 15,000.00 is due once construction has begun, lumber and materials on site. • Third Payment $15,000.00 Once structure is weather tight this will also coincide with allowance orders Fourth payment of $10,000.00 is due at completion of Sheetrock and plaster. I i • Fifth payment of$6000.00 is due at completion of flooring finishes. • Final payment at completion of project. Allowance totals to be calculated and credit or extra cost will be presented. 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 i specs. V 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. 'o. 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 at66 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 Contact will be effective on August 22, 2016 Owner: —CIM Address of Pr erty:_1 9 Middlesex st N. Andover MA Contractor:_Adam Brien BriCO Bufl�ng and-Remode-ing Address:417 Waverley Rd North Andover MA 01845 Title: Owner Operator Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 North Andover, MA 01845 LLC 978-479-1526 8/16/16 adambrico@gmail CONTRACT wwuuuuwwwwwwmow auwuw'w'wwwwwwwwwnuo wwwwww.wwwuwwiomiwo iwuunnwuwwunuwwwwwwwwwswwwwuoiwwwmwwwww.muw�vwwwwwwwwwoowwiwiwiuwiwouwwwwwwwwmowwiwwww'wvwwwuwpwwwrwmwo�mopppiuuwwwuuuuuuuuuuuwouowouuouuuumuuuuuuuuuuuuuuuuuuuuuuuuuuuu�uwwwwwuwwwwwuianwmmmmgim Andy Van Horn 149 Middlesex st North Andover MA EXHIBIT A Job Description: Addition over existing Kitchen, with bathroom remodel. • All construction built to plans provided. • Demolition of existing roof over kitchen. Demolition in existing bathroom to plan. Permitted Dumpster will be placed on site for debris. Temporary protection and dust control installed during construction. • All framing constructed to plan. Exterior plywood to be "Zip System" All partition movement and structural elements built to plan. All structural beams and columns to be approved by engineer. • Roof of new addition to receive architectural shingles, color and brand to be matched. Shingle to be blended into existing. Due to age and dye lot, shingle may not match 100% • New addition to receive cedar shake siding primed. All exterior trim to PVC and pine material • New Harvey windows installed where dictated on plan, glass to meet energy rating and style to match existing windows. (If existing windows can be re-used credit will granted) • All exterior walls, ceilings and floors to be insulated to meet energy code. • All new walls and ceilings and patching to receive blue board and plaster with smooth finish • Flooring o Master Bedroom floor, to be sanded and refinished, master closet to receive flooring that matches the bedroom. o 2 Bathroom floors and Laundry room floor to receive Hardi-backer underlayment prepped for the installation. An allowance of $900.00 is included for the purchase of tile and grout. • Master Bathroom o Shower walls to receive cement board underlayment prepped for tile installation. Custom shower pan supplied and installed. A $600.00 allowance is included for the purchasing of the and grout. Wall niche and seat incorporated into design. (Tile pattern and design may reflect a price increase in labor.) An allowance of $200.00 is included for shower head and trim kit. An Allowance of $600.00 is included for vanity, top, sink and faucet A An allowance of$300.00 allowance is included for the purchasing of toilet and seat. Toiletries and mirrors not included but BriCO will install at no expense. Glass shower enclosure not included (NIC estimate $ 800.00) • Remodeled Bathroom. o Tub and toilet location to remain. Tub walls to receive cement board underlayment prepped for tile installation. A $300.00 allowance is included for the purchasing of tile and grout. Wall niche incorporated into design. (Tile pattern and design may reflect a price increase in labor.) An allowance of$200.00 is included for shower head and trim kit. An Allowance of$800.00 is included for vanity, top, sinks and faucets. An allowance of$300.00 allowance is included for the purchasing of toilet and seat. Toiletries and mirrors not included but BriCO will install at no expense. Glass shower enclosure not included_ (NIC estimate $ 800.00) • Laundry Room o Washer dryer hookups built in wall. Dryer vent hard piped outside for venting o Cabinet and counter top installed an allowance of$1000.00 is included for products (extensive design may result in price increase) • Electrical scope to consist of the following. Plugged and switched to code. o Master Bedroom, to remain the same electric layout o Master closet to receive surface mount fixture, plugged to code. o Master Bathroom to be wired to code, exhaust fan light combo vented to outside, recessed light over shower, vanity lights fixture e i o Remodeled bathroom to receive exhaust fan light combo vented to outside. Surface mount light (fixture supplied by owner), vanity light (fixture supplied by owner) • All new doors to be primed solid core Masonite, all trim work installed to. reflect the style of the remaining house finishes (old doors attempted to be installed frames to be provided, price adjustment TBD) • Master closet to receive no shelving Bathroom closet to receive 3 shelves • Permit fee included Not Included • Interior and exterior Painting • Washer Machine and Dryer • Light Fixtures • Desk Area Design? Total Allowance figure $5,400.00 Grand Total $57,900.00 The Owner agrees to pay BriCo Building and Remodeling $57,900.00, for doing the work outlined above. The following payments will be paid to the contractor in the following manner: • First Payment is of $10,000.00 is due once contract is signed. Secure permit fees, dumpster, window order and product organization with extensive lee times.(3 weeks prior to the beginning of construction) • Second Payment of 15,000.00 is due once construction has begun, lumber and materials on site. • Third Payment $15,000.00 Once structure is weather tight this will also coincide with allowance orders • Fourth payment of $10,000.00 is due at completion of Sheetrock and plaster. • Fifth payment of$6000.00 is due at completion of flooring finishes. • Final payment at completion of project. Allowance totals to be calculated and credit or extra cost will be presented. 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 fl B 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 jvivw.nuiss.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractot-s/Tilectricians/Plumbers Applicant Information Please Print Legibly Name(13tisiness/organization/indivi(lual):-]�; Address: City/State/Zij : N Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0�1 am a employer with 4. El I am a general contractor and 1 6. New construction employees(full and/or part-tirne).* have hired the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet. 1 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for ine in any capacity. workers' comp, insurance. 9. Building addition [No workers' comp. insurance 5. D We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.El I am a homeowner doing all work right of exemption per MGL 11. Plumbing repairs or additions myself. [No workers' comp. c, 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.n Other camp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers"compensation policy information. t I fomeowners 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, ltitticin ettil)loyertlit,tti,vprovitlitigivorl(ers'conipeits(itionitisur(incefar nth employees. Below is the policy rind job site information. Insurance Company Narne:—_ Policy#or Self-ins.Lic. ..... Expiration Date: I ....... Job Site Address:11A nt)PLC- 5z,:X -,z;-y City/State/Zip: o )VtiS 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 MG1,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 azul penalties of perjury that the information provided above is true and correct —2 0 SSMPWMLDate: Phone 11: 4-71 Official use only. Do not write in this area,to be completed by cite 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 Pei-son: Phone Ac o0 CERTIFICATE OF LIABILITY INSURANCE DaTE(MMmomvv) 07/11/2016 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(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). pRooucER CONNAME CT Trudy Lawler MICHAUD INSURANCE AGENCY IPA N Ext; (976)6B5-2549 ac NoL. EMAIL y AODREss: trud lawler michaudinsurance.com — 105 HAVERHILL ST. INSURER S)AFFORDING COVERAGE NAtC# METHUEN MA 01844 INSuRERA: TRAVELERS PROPERTY_CASCO OF AM 25674 INSURED INSURER B: BRICO BUILDING & REMODELING LLC INSURER C: INSURER D: 417 WAVERLEY RD INSURER E: N ANDOVER MA 01645 INSURER F COVERAGES CERTIFICATE NUMBER: 67653 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. ILTR TYPEOFINSURANCE I16DINSDLSUBR IWVD POLICY NUMBER MMDDIYYY MMDDIYYYP LIMITS �Y COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DR AG 'P�i�T�'Cl CLAIMS-MAOF 71 OCCUR PREMI6ESaoccurrence)„ $ MED FXP{Any one person) £ NIA PERSONAL&ADV INJURY S GEN'LAGGREGATE UWTAPPLIES PER: GENERALAGGRI;GATE $ POLICY 3ECT M LOC PRODUCTS-COMP/OP AGG S _ OTHER: $ AUTOMOBILE LIABILITY COM9INEDS€NGLEUMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTYDAMAGE $ HIREDAUTOS AUTOS Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB GLAIMS-MADE NIA AGGREGATE S OED RETENTIONS ..�......._,. _._, WORKERS COMPENSATION N11. PER 1-12TH H- AND EMPLOYERS`LIABILITY ,/,._„,,,STATUTE,,., ,,, ,, ER ANYPROPRIETORIPARTNERIEXECUTiVE YIN: E.L.EACH ACCIDENT S 100,000 A OFFICERIMEMBEREXCLUDED7 I NIA N/A NIA 7PJUB4618P50716 04/19/2016 04/19/2017 "-"-"--�-'--"-'-"—'---"-" (Mandatory In NH) F.L.DISEASE-EA rMPLOYEEI$ 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 IVEHICLES IACORD 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 certiflcate 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/iwd/workers-compensationtinvestigations/. 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 North Andover MA 01845 Daniel M.Cro ey,CPCU,Vice President Residual Market—WCRIBMA O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD A CERTIFICATE 4F LIABILITY INSURANCE °AT�'M"7;x;'16 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 endorsemen s. PRODUCER CONTACT NAME: Tricia Sabulis Armand P. Michaud Insurance Ag PHONEg7$1 685-2549 Fax N : (978) 794-0822 105 Haverhill Street -ADDRESS: triciasabulis@michaudinsurance.aom Methuen, MA 01844INSURER($)AFFORDING COVERAGE NAIL# INSURERA:Green Mountain Insurance Co. INSURED INsuRER B:Norfolk & Dedham MA BRICO Building & Remodeling LL INSURER C: Adam J Brien INSURER D: 417 Waverley Rd INSURER E: N Andover, MA 01845 INSURFRF: 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. INSR - ADDL SUBIR POLICY EFFmPOUCY EXP W LTR TYPE OF INSURANCE POUCY NUMBER M1DDry MMIDDIYYYY LIIATS A GENERALUABILITY 20009201 4/13/16 4/13/17 EACH OCCURRENCE $ 1 000 000 X COMMERCIAL GENERALL€.4BIL€TY DAM4GETORENTEDPREMISES tEa_QxummD4_ $ CLAIMS-MADE I—XI OCCUR MED EXP ryone person) $ 5,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMa APPLIES PE Ft PRODUCTS-COMP/OPAGG S 2,000,000 POLICY PRO- LOC $ B AUTOMOBILELIABIUTY 91561617A 6/18/16 6/18/17 MINED SINGLE LIMIT $ ANYAUTO BODILY INJURY(Per person) $ 100,000 ALLOWAUTOS NED X SCHEDULED AUTOSBODILY INJURY(Per accident) $ 300 000 HIREDAUTOS NON-pWNEO PROPERTY DAM4GE $ AUTOS er accident 100,000 $ UMBRELLALFAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ -- DEO RETENTION $ WORKERS COMPENSATION WC STATU- I IOTH- ANDEMPLOYERS'LIABILITY YIN TORY I m ANY PROPRIETORIPARTNERIEXECUTpIE NIA E.L.EACH ACCIDENT $ OFFICERMEMBER EXCLUDED? ..— (Mandatory In NH) E.L.DISEASE-EA E7JPLOYEE Ifyes,describe under DESCRIPTION OF OPE RA TI ONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 161,Additional Rerreft Schedule,it more space Is required) 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: (978) 685-2549 Fax: (978) 794-0822 E-Mail: triciasabulis@michaudinsurance.com Massachusetts Department of Public Safety Board of Building Regulations and Standards License: C5-104428 Constructi()y° upervisor ADAM J BRIEN 417 WAVERLY ROADir NORTH ANDOVER MAI-'1' '1�0 r1j, �� y I COmmi sioner Expiration: 06/12/2018 r iT � �rn�itxoz iuunir�/ cr'�/Zrrl�ur✓r�rrcrC�,� G OPficenf Consumer Affairs T3nsdne"ss Regulation, a (3ME IMPROVEMENT CONTRACTOR egistration: 168512 Type a Expiration: ''3111201.7 ` LLC aKr� BRICO BUILDING AND REMODELING LLC ADAM BRIEN 417 WAVERLY RD NORTH ANDOVER,MA 01845 Undersecretary