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HomeMy WebLinkAboutBuilding Permit # 9/26/2016 OORTti BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � - - ermit AMP " Date Received RTA_NT. A . licant must corn lete all items on this .are Crate Issued: LOCATION Print PROPERTY OWNER , Print MAP NO; ', � P EL: ,ZONING DISTRICT: _ Historic District es no Machine Show Village, no TYPE OF IMPROVEMENT PROPOSED USE i__. Residential Nan- Residential U New Building J One family Addition I 1 Two or more family I:1 Industrial 1 Alteration No. of units: Commercial U Repair, replacement IJAssessory Bldg _I thers: 1.1 Demolition .:J Other iii Septic D'U"Well 0 Floodplain D Wetlands D Watershed District F]Water/Sewer d / �f Identification Please Type or Print Clearly) OWNER: Name: 4 s"'q 7rc L" Phone: Address: CONTRACTOR Name: i Address: Supervisor's Construction License: � � � Exp. Date: � _70-1ya% Horne Improvement License: Exp., Date ARCHITECT/ENGINEER1 l 1 Phone: 0:3 `� Address:-4L!_ 4-10-2"44 1-11. Reg. No. ' ? FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total ProjectCost: tC°� d FEE. w Check No.: C Receipt No. c11, NOTE: Persons contracting with unregistered contractors dna not have access to the ;raanty�rn u Signature of Agent/Owner Signature of contractor " is Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL. Public Sewer ❑ Tannin Swim in fools ❑ glMassage/Body Art ❑ � weft ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed OnJ&�! 6 Signature_ �4I'ail l COMMENTS ��+�t ti 1��� �li is <f H5 v" CONSERVATION Reviewed on Signature COMMENT'S (IFALTH Reviewed on'_q12 �-SiEgnature COMMENTS r toning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water ewer Connection/Sr nature& pate Drivewa Permit ]DPW Town Engi.nee3r: Signature: Located 384 Osgood Street FiRE;DEPARTNiENT Temp DumpstiLr an site ;yss no Located at 124 Main Street p g FireDe a ent sr ratureldae COMMENTS t%aRTH '4 own of t ndover O '- - 0 �„�E h ver, Mass, /49 COC MICAM.ICK Y S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT LJ":!?.Pf ... 5�44.L.vl.... BUILDING INSPECTOR .3,.. . Foundation has permission to erect .......................... buildings on ..., ��t \ .. .. ... ...... .t. . ... � ! Rough to be occupied as ... .... ...x..."........ M14...... ....et"..... . �... ..., chimney provided that the person acceptin this permit shall in every respect conform to the ter f the applicatlo�l Final p p g 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 16MONTHS ELECTRICAL INSPECTOR LESS CONS1RiJfkTI Rough Service .,... .` .. Final BUILDING 1 PECT0R GAS INSPECTOR Occuizancy Permit Required t® Occupy Builciin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No_ Smoke Det. t4ORTh 4,0 Town of North Andover Machine Shop Village Neighborhood Conservation District Commission V 16000sgnod So-ect NorthAndover, NIA 01915 CH Certificate to Alter Date! Contact Name&� ddress: Pr -D u m SX- I"A Y kVt'r'V r-O a Gk Project Address� Project Description (attach additnioal pages,if needed): nn +f ;K, Ic '4 1 YU') LO y A- '2- a V & Commission Vole: Voled to to grant deny Certfflif-[rte to A tier oil Comments (attach additional pages,if needed): ncM Aftichine Shop Vilhige Neighbor/rood Coll serwition District Commission MSV NCIX Page I Scanned by CarnScanner f } �SyORTry� ° ��E9 is ti0 Town of North Andover * Machine Shop Village Neighborhood Conservation District Com nissiozx 1600 Osgood Street: North Aiidnver,MA 01845 ssAcseSe A lication For EXCLUSION From Certificate to Alter t Certain alterations are excluded from review by the Machine Shop Village Neighborhood a Conservation District Commission in accordance with the Bylaw. Applicants far exempt projects must fill out the form below and submit to the Commission Chairperson(contact info below). Date: !P / Contact Name&Address: PF�Qa ►���� � dipa G Project Address: S{ Project Description(attach additional pages,if needed): �j ooq 7e [ dIC r�l1Fs.• �' vw.eieatG /i oTallX u,ce*VP P f Gw+s3i.0(ne: /7a to l +� s Ae t$1rbf#15 Exclusion From Review Requested For- © 1.Interior Alterations existing conditions including materials, design and dimensions. ❑ Z Stoma windows and doors,screen windows and doors. ❑ 9. Replacement of existing substitute doors,substitute siding or substitute ❑ 3.Removal,replacement or installation of windows with new materials that are substantially similar to the existing gutters and downspouts. condition. ❑ 4.Removal,replacement or installation of window and door shutters. LJ10.Replacement of original fabric windows or doors with substitute ❑ 5.Accessory buildings of less than.100 windows or doors that maintain the square feet of floor area. architectural integrity with respect to form,fit and function of the original ❑ 6.Removal of substitute siding. windows or doors. ❑ 7,Alterations not visible from a public LI11.Reconstruction,substantially similar in way. exter:iot design,of a building,damaged or destroyed by fite,storm or other disaster, ❑ 8. Ordinary maintenance and repair of provided such reconstruction is begun architectural features that match the within one year thereafter. MSV NCBC Page 1 Current Chair:Liz Fennessy,77 Elm Street,[izettafeuncssyq g oo.com,978-688-2915 SILVERWATCH ARCHITECTS. LLC ArchitectLire Engineering Land Planning Design Friday, September 23, 2016 Inspector Donald Belanger Town of North Andover, Massachusetts Building Department 1600 Osgood Street North Andover, Massachusetts 01845 RE: John Breen Memorial Funeral Home Addition Code Review Inspector Belanger, Folowing is our code review for a minor addition to the existing John Breen Memorial Funeral Home located at 35 Merrimack Street. Project Narrative: The project consists of a 180 SF addition to the rear of an existing funeral home facility. The addition will be used as a workroom for the preparation and embalming of human remains. The existing preparation room that is currently located in the basement of this ancient building does not meet the current standards set by the Commonwealth of Massachusetts nor does it provide for easy access for transport and handling of remains. The State of Massachusetts has ordered the facility to upgrade the current conditions to meet current standards required for licensing by the Commonwealth. There are no modifications made to this existing building's construction type, occupancy type, occupant load calculations or affecting any required egress routes. Space is simply being relocated from the basement to the main level. The existing facility would fall under an A-3 Funeral Parlor Occupancy Type. The construction type will be continued as Type 513 Combustible—Unprotected. Allowable area, story and heights for this occupant and construction type is as follows: 40 Feet High, One story and 6000 SF per floor. The proposed addition adds 180 SIF to an existing 2100 SF facility. 2280 SF is well below the allowable 6000 SIF allowed per code. The addition is on the same single level and is 8 feet high at the wall plate and well below the the existing building,height. This concludes our review. A cerely, R Joel Pavid verwatch Architect"AIA 155 Londonderry Road Windham,New Hampshire 03079 603.894.4450 Licensed: New Hampshire, Maine, Massachusetts Associate Member Massachusetts ffililding Commissioners and Inspectors Association, Inc. 1391 e HAMMERTIME CONSTRUCTION HOME IMPROVEMENT CONTRACT HOMEOWNER INFORMATION CONTRACTOR INFORMATION NAME; COMPANY NAME: Lisa Breen, Breen funeral Home HAMMERTIME CONSTRUCTION STREET ADDRESS: OWNER NAME: 35 Merrimack St. JAMES GODFROY CITY/TOW STATE ZIP BUISINESS ADDRESS: N.Andover Ma 1845 382 PRIMROSE HILL RD DAYTIME PHONE; CITYITOWN STATE ZIP DRACUT MA 01826 EVENING PHONE: EMAIL: PHONE #: �Ic. LM Q0MCAS1.::..gEj 978-995-1898 MAILING ADDRESS 1F DIFFERENT): CONTRACTOR W.C. REG. # (EXPIRATION): 139503 (7/21/2017) EMAIL: CONST, SUPERVISOR LIC. # EXPIRATION CS92065 3/28/2017 HAMMERTIME CONSTRUCTION AGREES TO DO THE FOLLOWING WORK FOR THE HOMEOWNER: The following work to be completed at the above address. Build custom addition to the existing building per plans prepared by Silverwatch Architects to include Dig foundation hole to provide for concrete foundation Supply labor and materials for poured concrete footing and walls to grade. Backfill exterior of foundation to grade and patch pavement as necessary and loam and seed. Frame walls and roof per plans including tie into existing roof. Install vapor barrier and vinyl siding to match existing structure. Install shingles to match as close as possible. Supply and install all plumbing supply and drain lines. Supply and install new electrical circuits including outlets,switches and lights Supply and install insulation to code. Supply and install concrete slab floor with provisions for floor drain Supply and install ductless mini split and ERV system per drawings. Supply and install drywall with plaster and finish to smooth texture Supply and install FRP around entire new room four feet up wall. Paint walls and ceiling color of choice. Provide all necessary permits and inspections. Dispose of all demo debris and trash daily off site.. REQUIRED PERMITS (REQUIRED AND PROPOSED START AND COMPLETION SCHEDULE SECURED BY HAMMERTIME CONSTRUCTION (THE FOLLOWING SCHEDULE WILL BE ADHERED TO ACTING AS THE PROPERTY AGENT): UNLESS CIRCUMSTANCES BEYOND THE CONTRACTORS CONTROL ARISE): DATE WHEN CONTRACTED WORK WILL BEGIN: 8/22/2016 DATE WHEN CONTRACTED WORK WILL BE SUBSTANTIALLY COMPLETED: 9 HAMMERTIME CONSTRUCTION HOME IMPROVEMENT CONTRACT 9/30/2016 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE: HAMMERTIME CONSTRUCTION AGREES TO PERFORM THE WORK, FURNISH ALL MATERIALS AND LABOR SPECIFIED ABOVE FOR THE SUM OF: $ (*} $54,475.00 PAYMENTS WILL BE MADE ACCORDING TO THE FOLLOWING SCHEDULE: $ 15,000.00 upon signing contract(not exceeding 113 of the total price OR the cost of special order items, whichever is greater) $ 15,000.00 by 1_I or upon completion of Complete dry in and rough sign ofl $ 15,000.00 by�1 / or upon completion of Electrical, Plumbing and HVAC Finish sign off $ 9,475.00 upon completion of the contract. The following material/equipment $ to be paid for must be special ordered before the contracted work begins in order $ to be paid for to meet the completion schedule{**) NOTES: (*) Including all finance charges (**) Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(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. EXPRESS WARRANTY- YES NO (All warranty terms will be attached if needed) SUBCONTRACTORS-HAMMERTIME CONSTRUCTION agrees to be solely responsible for the completion of the work described regardless of the actions of any third party/subcontractor utilized by HAMMERTIME CONSTRUCTION. HAMMERTIME CONSTRUCTION further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. CONTRACT ACCEPTANCE - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. 1. Don't be pressured into signing the contract. Take time to read and fully understand it. 2. Make sure the contractor has a valid Home Contractor Registration. 3. Ask the contractor for insurance information so you can confirm coverage. 4. Know your rights and responsibilities. Get a copy of the Consumer Guide to the Horne Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram HAMMERTIME CONSTRUCTION HOME IMPROVEMENT CONTRACT sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESIIII HOMEOWNERS SIGNATURE: CONT RS SIG URE: DATE: DAT 81 1120'16 CONTRACTOR ARBITRATION -The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an alternative to court action) if they have a dispute with a contractor. The same right is NOT automatically afforded to a contractor, however. The contractor would have to resolve any disputes he/she has with a homeowner in court unless both parties agree to the OPTIONAL clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in Massachusetts General Laws, chapter 142A. HOMEOWNERS SIGNATURE: CONT. TO NATURE: HOMEOWNER'S RIGHTS -A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A) and other consumer protection laws(i.e. MGL chapter 93A) may not be waived in any way, even by agreement. However, homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the workas described, in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provide by the contractor, all goods sold in Massachusetts carried an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic rights. If you have questions about your consumerlhomeowner rights, contact the Consumer Information Hotline (listed below). EXECUTION OF CONTRACT-The contract must be executed in DUPLICATE and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as voided, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract, and HAMMERTIME CONSTRUCTION HOME IMPROVEMENT CONTRACT the three day rescission period has expired. ACCELERATED PAYMENTS -A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/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 of funds from said account would require the signatures of both parties. ADDITIONAL INFORMATION -If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or if you with to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement"contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at: If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the HIC website at: LittPA Go online to view the status of a Home Improvement Contractor's Registration* http:L/d��? cE� .�iyjicenseelist.asp qirnr�( yf) .............— Q ,Mg For assistance with informal mediation of disputes or to register formal complaints against a business call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800, 508-755-2548 or 413-734-3114 a HAMMERTIME CONSTRUCTION HOME IMPROVEMENT CONTRACT NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE 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 BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER 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 SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLERS EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY 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 SELLER 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 JAMES GODFROY (HAMMERTIME CONSTRUCTION), AT 382 PRIMROSE HILL RD, DRACUT, MA 01826, NOT LATER THAN MIDNIGHT OF (DATE). HEREBY CANCEL THIS TRANSACTION. DATE: BUYER'S SIGNATURE: y'hp, Commonwealth Of'Hassacliusetls Department of fidUstrial Accidents Congre's`s Street,suite,700 gosion,.ISA 02114-2017 www.mass.govldia Wo3:kexs'Caanpe)asatiEon.InsuranceAffidavit:)Buzlders/Conti'actoxs)RI gtyzcians/PitYmbexs, TO BE FMKD V MR TI R)?ERMITT1NC-A-UT-UoR'dry' Applicant Iixfaxmatio BieasePxint Le ' X loe I� Namc- (BiT.siness/organizatioz>tfndividual):Ad&ess 2� city/state/zip: ✓a� f Phone v E4 Areynu an employer?Cheekda approprlatebox: Type of project(�equixed): I am a employerwith employees PH andlorpart part-time)-* 7. �New co�sti�3ctzo� 2. I am a sole proprietor or partnership and have no erarploye'as Vorking forme in $. Rentodelitig - any capacity.No wnrkers'COMP.insurance required.] 9 Demolition 3_❑ram a homeowner doing allwozkmyseli [No workers'comp..insurauceregnired.]' 1.0 E]Builcyng addition 4.E]I=a homeowner and wilt be hiring contractors to conduct all work on my property. I will iQ 1. Electrical xepahs or additions ensure that ail contractors either have wozlcers'compensation insurance or are sole I !—I proprietors withno employees. 12 Q plumbing repairs or additions 5.❑Iamaganezalcontractor and Ihayelvredthe sub-contractors listed on the attaohodsheet- Raafr-epairs 'These soh-contractnrsliaY�einpinyees aadhavewnrkars'camp.ins�rraucet 14.El O-Eher ` 6.0 We are acozporation andifs of vers have axerdsedthoi€right o£'exemption perMGL c. aa4wehave n0.�Ppl6yees.rNpworkers'camp.insurance required.] 'Ary applicantthat checksbckM must alsoffil outthe secfionbelowshowitngtheirworkers'campensationpoliOyin£ormation T Homeowners pwlio snlimit# afizdavitizrdicatingthey are doing allworkanditrildra outside contractors mustsahnritane33raf affidavit indicating such Contractors that check tbisbox rnTt-gttacf ed an additional sheet showing the name ofthe,sub-contractors andstate whether arnotthose entities haus p.p y empIoyeos.Iftha sub cnriirs c Ors liana employees,f ey must pzOoide their workers'Com otic nurubez.' I ain an erhyIoyertliatisTxovzaingwoPhr•scornpensadon itis urancefoV my emprayees'Below is epolicy andjob site ir2�`or�'natiorz. - insurance Company Name; Paliay#or Self-ins.I ic.#: d Exphatzor€Da#e.^ T'ob Site Address: City/State/Zip; W ✓`�-'�/`�` Dl Sys Attach a copy of the workers' cb.mpensation�poRey declaration page(showing tbepalzc�rn�zxubex and esprxat%on[late). Failure to sec ut a coverage as requixerl under MGL c. I S2, §25A is a criminal violation punishable by a fine up to$1,500-00 and/or one-year izrnprisonment,as well as civil penalties in the form.of a S`TO'P WORK ORDER and a ane ofup to$254.00 a day against the violator.A.copy of this statement may be forwarded to the ORic a oflnvestigations of the DI:A.for insuxance coverage veriftoatiou. Ido hereby cer•ttfy Uri Mie pains and enalties 0 perytrry that the information,r oviderl above is true and correct. Date: Si afore. Off eIal ,use only. Do not-write in this area,to he completed by city or town offacia4. City or Town' Perma/Meense# Issuing A nthori W(circle one): l..Board of l$ealffi 2.Bnffdi-ngDepartmettt 3.City/Town Clerk �.Electrical�nspecfor �.Plmnbingxnspector- S.Other Contact Persoix t. i. I. Aco CERTIFICATE OF LIABILITY INSURANCE DATE D1-2018 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 NAME: FRANCIS E PROVENCHER INS PHONE FAX 530 ROGERS ST AIC No Ext): A1C No): LOWELL,MA 01852 E-MAIL u INSURER(S)AFFORDING COVERAGE NAIC a pI INSURER A;HARTFORD UNDERWRITERS INSURANCE COMPAN 9 INSURED INSURER B: GODFROY JAMES DBA INSURERC: HAMMERTIME CONSTRUCTION 382 PRIMROSE HILL ROAD INSURER D: DRACUT, MA 01826 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. INSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MMIDDIYYYY POLICY FFF POLICY EXP LIMITS LTR INSR WVp ( 1 MMIDp1YYYY GENERAL LIABILITY EACH OCCURRENCE $ CLAWS-MAGE L LIABILITY AMRE $ COMMERCIAL GENERA D71 PREAGE NTED MISESTO Ea occurrence -- OCCUR MED EXP{Anyone person) $ PERSONAL.&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ CT POLICY PRO LOC $ JE AUTOMOBILE LIABILITY OMBINED SINGLE LIMIT $ Ea acc dent ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED OPE TY AMAGE $ AUTOS ! r crden! $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X WC S7gTU- OTH- pNp EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOWPARTNERIEXECUTIVE�__ N 1 A E.L.EACH ACCIDENT $100,000 OFFICERIMEMBER EXCLUDED? LJ 6S60UB 07-22-2016 07-22-2017 (Mandatory is4305P306 E.L.DISEASE-EA EMPLOYEE $100,000 un Ii-yes.describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD t!]t,Additional Remarks Schedule,If more space Is required) THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR GODFROY JAMES CERTIE14DIATE HOLDER CANCELLATION LISA BREEN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE / 35 MERRIMACK ST. CANCELLED BEFORE THE EXPIRATION DATE THEREOF, N ANDOVER,MA 01845 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. s AUTHORIZED REPRESENTATIVE / ©1986-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD G0DFJA1 OP ID:BW ,d►corrc�° CERTIFICATE 4F LIABILITY INSURANCE DATE 071219/20/YY) 07/29/2076 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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). CONTACT PRODUCER NAME: Francis Provencher Insurance PHONE FAX Agency,Inc. Arc No Ext: A/C No: E-MAIL 530 Rogers Street ADDRESS: Lowell,MA 01852 Mike Provencher INSURERS AFFORDING COVERAGE NAIC11 INSURER A:Preferred Mutual Insurance Co. 15024 INSURED James Godfroy dba INSURER 8: w Hammertime Construction INSURER C 382 Primrose Hill Road Dracut, MA 01826 INSURER D. INSURER E: s ENSURER 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. INSR TYPE OF INSURANCE ADDL SU POLICY NUMBER MMIDDIYYYY NIM1DDIYYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 500,00 A X COMMERCIAL GENERAL LIABILITY BOP0100719540 0911312015 09/13/2016 DAMAGE O REED50,00© PREMISES Ea occurtence $ _ CLAIMS-MADE OCCUR MED EXP(Any one Berson) $ 5,40 PERSONAL RADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000 POLICY PRP- LOC $ Jr =CTCOMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea.accident ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ HIRED AUTOS AUTOS PER AGGIDENT _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- ANA EMPLOYERS'COMPENSATION TORY LIMITS ER YIN ANY PROPRIETORlPARTNERIEXECUTIVE ❑ N!A E.L.EACH ACCIDENT $ OFFICERIMEMBFR EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 104,Additional Remarks Schedule,if more space is required) **CERTIFICATE FOR WORKERS' COMP COVERAGE WILL BE ISSUED DIRECTLY FROM THE COMPANY WITHIN 2 BUSINESS DAYS** CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ' ACCORDANCE WITH THE POLICY PROVISIONS. ,� isC Breen ..�_ _..._.y 35 Merrimack St. AUTHORIZED REPRESENTATIVE N.Andover, MA 01845 ©1986.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i�T4�Nam1` ii lavld �i" if r i OSHA � .�.,., ww 1X �,�w"dC4Pk'ri.tl'kH,&,Mi YatSe4',.. CL,x'aapaa89aeaaW Safely aaW Haiapi,Wa Adnftstration James Godfroy Was sm"Ca as luffy aorrurintwf as 10baaaaa S faW�,2 AM Heal"I T00ning(Xxiree in CoWsk a sod is m i naxaaeri (Date) 6'✓�a° "�r�rtaaa�anrrsaa�ff a�x�'''�fra.,rfc�r�ae/L:� Office of Consumer Affairs&Business Regulation License or registration valid for individui use only j ,IWME IMPROVEMENT CJNTRACTOR before the expiration date. If found return to: r~ registration: 138503 Type: Office of Consumer Affairs and Business Regulation 8xpirat=on: 7121/2017 DBA 10 Park Plaza-Suite 5170 NAMMERTIME CONSTRUCTION&REMODELING Boston,MA 0211.6 JAMES GODFROY 382 PRIMROSE MILL RD T DRAGUT,MA 011326 5 s"'�--- 4 Undersec'retary Not valid without signature Massachusetts-Department of Public Safety Beard of Building Regulations and Standards Unrestricted-Buildings of any use group which t'a a� t:�� tiakaa uj n-i1sor contain less than 35,000 Cubic feet(991nn)of License: CS-092065 enclosed space, JAMES K GODF Y 382,PRI[AMOSE Dracut MA 01825 Failure to possess a current edition of the Massachusetts Expiration State Building Code is cause for revocation of this license. Commissioner 03/2812017 For DPS Licensing information visit: www,Mass,Gov/DPS IAMMEOTIME CONSTRUCTION HIC#134503&MA CSL#42065 HAMMEOTINiE Licensed and Insured General COntrOChn���+4''111QG1ef� a /?'�,f.�' �yf��f i i �woinff Vinyl Siding,Wtndo4vs $� ,//r o /Of i of C0MCA,5T NET Primrose Mill Rd (97,p f