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HomeMy WebLinkAboutBuilding Permit # 9/29/2016 BUILDING PERMITx*�� �cp'°6' 0 TOWN OF NORTH ANDOVER ® i j APPLICATION FOR PLAN EXAMINM Permit NO: / r � Date Received ... .... ' SS�+C 61tk�'£'t Date Issued: >I ORT NT:Applicant must complete all items on this page 4 / , I � CAIO�G � �Tem G N �p l d�� �, Mi 6 / r ! ✓ / / ✓ / ✓ ✓ r r r ✓ (� a TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential p New Building 7 W—One family F1 Addition El Two or more family l Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: E Demolition ❑ Other l ft w/ Replace Deck 14x16.5 : Remove existing deck boards, railings, posts, stair, deck framing approx. 262 SF. Excavate and pour concrete footings wl bottorn of tooting below grade. Frame new single level deck w12x10 PT joists on 4x10 LVL carrier beam, through bolted to house framing. Install Azeck Cypress deck boards with hidden fasteners on frame for deck and stair treads. Install Fortress metal posts, rails and Identification Please Type or Print Clearly) OWNER: Name: David & Leslie Wondowlowski Phone: 978 886-4853 Address: 100 Ralei h Tavern Lane North Andover MA 01845 / l V ! l � �y g / 'h ��� � � ��� �`e �+"�` P� �� / ,- � E mow` 4� ,✓ � r ARCHITECTIENGINEER Benjamin Osgood Phone: 978 435-1324 Address: 15Z BluffSalem tAH03079- Reg. No. 45Rn'l FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 28,921 FEE: $ "CI� Check No.: Receipt No.: --:ay'A-1 NOTE: Persons eontractdn Wirth unregistered contractors do not have access to the guaranty fund o ✓r T, odtre 74dt III <�s S� natlrre of Aenn , . I V1. grYre ofot € r Plans Submitted 0 Plans Waived 0 Certified Plot Plan ❑ Stamped Plans 0 TYPE OF SEWERAGE DISPOSAL AL Sewer rPubhic-Sewer 7EO] Tanning/Massage/Dody Art ❑ Swimming�POIJI L1 Tobacco well El Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. Permanent Dumpster on Site L1 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - UTORM PLANNING LANNING & DEVELOPMENT Reviewed On Zul� Siqnatur6 COMMENTS ON 0 ONSERVATION Reviewed on Si nater , COMMENTS /HEALTH Reviewed on nater COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Sic -Inature & Date Driveway Permit DPW Town Engineer: Signature: FARE EA FI I E N T' rfle ffi Located 384 Osgood Street I f t'rg -X1, F 1 W Q e p a m o-n't-, sw"i "_0 z i S COMMENTS 'f... ........................ . ........... Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft..- ELECTRICAL: t.:ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGI.Chapter 156 Section 21A--F and G rnin.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name n Doc.Buildiug Pemit Revised 2014 NoRT1 Town S of :� "'* 6 over 0 0 No. ver, Mass, 02� cacN,c«ew,cK 1' 4a �ti. �RwrEv S U BOARD OF HEALTH Food/Kitchen PERMIT .. T LD '_:D _ /� Septic System THIS CERTIFIES THAT ............4. ...�"�.....k. �te.. M.�...��wrjl!'i........... ....... . ,., BUILDING INSPECTOR q�b � Foundation has permission to erect .......................... buildings an .... . av ..............,. . .. .... .I. � .......,.....bow�:...... 0-l . Q� Rough to be occupied as ...zqA'au4....,......,1�.....r........ .�:�,!�.. �.........................�.�.'�r4�`1.:................,.. Chimney provided that the person accepting this permit.shall in eve respect conform to the terms of the application p p p � g p every p 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT p+EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR-:: UNLESS CONST 10 T Rough Service ......... . .......... ................. Final B DING NSPECTOR GAS INSPECTOR Occupancy Permit Regurred to Occupy Fugldan 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. Sales: 800.448.3636 A Phone: 804.271.2363 CN,]F NEX'J'I GENERATION Fax: 804.743.7779 ]EEMMi acfenvironmental.com LETS ET 11DONE s,r(',)RM'WA,I'ER MANAG'EMENT LI IONS ' G " Site Development and Retrofit e Low Impact Development e Green Infrastructure FOCALPOIN"I'(Iiighfiowbiofilti,atioii) R-'rANI((waic)dLilal'sul)sLtrface storage) PAVE DRAIN(paving,drai i iage,storage) FABCO(decentralized treatment) -Ij d 4............ 01, ........ .......... V7J 1. EXISTING CONOITiONS INFORMATION FROM AN ON THE GROUND SURVEY PERFORMED BY NEW ENGLAND ENGINEERING SERVICES IN S:TE 2004 AND VERIFIED BY BENJAMIN C. OSGCOD,3R., PE IN APRIL 20;6 2. THE PURPOSE OF THIS PLAN IS T4 DEPICT PROPOSED y'fi MAINTENANCE ITEMS REOUIRED TO REPAIR EXISTING DECKS AND =Y" Fgrau�sr STAIRS AND TO SHOW THE OQ ' ACCEPT WATER FROM THE STAIRWELL1 TO THE EASEMON OF A DRY ENT TO T N/F McEHTE€ 10G RALEIGH TAVERN LANE ASSESSORS MAP 107A, PARCEL 109 LOCUS MAP NOT TO SCALE 44,824 SQ.FT. 0 aEiL.anPS LR1€T-- FRgc PiFA5 PF RECG� o � � 4 W£UNDS UlK Al TO AY�—W �s�t7. 4 r sEr�Iaaae c asv.ai ow Haat 2.:0x5 1I m��v tt sEmn:n exsm:G WALKO i su sum wus a, z E E«aNP F�nAL W PNRa PRY WG t CNb'iRUCi a X x'i.WCe9P ANP ST4R5 FDR cwtXWT PRAIR II � � - !vTA1G!'E Alv:RELDGTE EY.S,RNP SLr'� r � REtk?t�AHP eEPtACE A.aOSRtsC PECK -- - -----;----- - - ^g`aq � � PRdRPSEP kElk SIM@ tGGTkX:`l ol &u,D'COME l �w MR LEGEND �. R!P RAP SDP@ � _ � @6XtGP4 MPUSE GiRAGE ,. .. l 96 — — __ 6`\ (f i�6 •-_ �\ $TM W+ADDU1SGT GF WPAI( --_._—..--__..--___-- _ - .�_ K- --gg-_ --__ _ it hE X'.STNG GRADE A3 --- _-_ _ WETLANDS UNE MIA s a �� F5' NO DIST LEACH aM A '.1RB ZONE \ , W I Q � t COQQO 50' NO BUILD ZONE o 4 Q 70O' SUFFER ZONE LIMITOF CONTROL f LIMIT OF WORT( I S41'S8'00"E t - RE"A,N1NG WALL ___��3.19' EXISTING SPOT GRADES 98'49 1u'ik:Frca ZC"+€' r PRES$WS r WNER scR SEGdENTkL acaGK j \ f \ t :`�:, SITE PLAN RETwMwG WAu- a., f` \ TO' s$.57 Eac�� 100 RALEIGH TAVERN LANE, NORTH ANDOVER, MA ...\ !� L-,5Eh`CYR4LPoL U:Fr cPa of _ /' PPTrau Faayr r.EP.Euv.,�.co ta��a earani 5G," IJ,s�q, a� ASSESSORS MAP 107A, PARCEL 109 1 ~—u RALEIGH TAVERN LANE ANE SCALE; 1" = 20' DATE: APRIL 11, 201$ r,X BENJAMIN C. OSGOOD, JR., PE 157 BLIIFF STREET 20' 0 20 40 60' SALEM, NH 03079 (978) 435-1324 i 2016-01 sY: H.C.O.. JR:9Y: S.C.Q.in 214 Sutton Hill Rd ON Contract North Andover MA 01845 Wondolowski_2016-076.8-Deck 9788524491 TMK www.TMKremodeling.com REMODELING CONTRACTOR AGREEMENT THIS AGREEMENT made this 20X by and between TMK Remodeling, LLC Construction Supervisor License#105086, 214 Sutton Hill Rd, North Andover MA 01845 hereinafter called the Contractor, and Leslie&David Wondolowski hereinafter called the Homeowner. WITNESSETH, that the Contractor and the Homeowner for the consideration named herein agree as follows: ARTICLE 1. SCOPE OF THE WORK The Contractor shall perform all of the work described in the specifications entitled Exhibit A--Statement of Work, as annexed hereto as it pertains to work to be performed on property located at 100 Raleigh Tavern Lane North Andover MA 01845. Work Scope Summary:Replace Deck 1416.5': Remove existing deck boards, railings, posts, stair, deck framing approx.262 SF. Excavate and pour 3 12"concrete footings wl bottom of footing 48" below grade. Frame new single level deck wl 2x10 PT joists on 410 LVL carrier beam,through bolted to house framing. Install Azeck Cypress deck boards with hidden fasteners on frame for deck and stair treads. Install Fortress metal posts, rails and wire balusters on deck perimeter and stairway. Install Azeck PVC trim board at deck rim joist and stair risers. Install lattice under deck at frame. Replace entry door landing and railing at garage. Remove existing railing and landing. Excavate and pour 2 4'x1'concrete footings. Build 4x4'PT frame. Finish wl Azeck Cypress decking and Fortress railing. ARTICLE 2.TIME OF COMPLETION The work to be performed under this Contract shall be commenced on or before September 06, 2016 and shall be substantially completed on or before September 17, 2016 ARTICLE 3.THE CONTRACT PRICE The Homeowner shall pay the Contractor for the labor and materials to be performed and supplied under the Contract the estimated sum of Twenty Eight Thousand Nine Hundred Twenty One Dollars and No Cents ($28,921.00), subject to additions and deductions pursuant to authorized change orders. Contractor will furnish and install all building materials, fixtures and finish items unless noted otherwise. Any Homeowner supplied materials will be charged a 15% handling and coordination fee based on actual invoice. ARTICLE 4. PROGRESS PAYMENTS Payments of the Contract price shall be paid in the following manner from the Homeowner to the Contractor: Payment 1: 33% upon contract acceptance and signature; $9,640.33 Payment 2: 33% upon foundation and frame inspection;$9,640.33 Payment 3: 33% upon final building inspection and completion of finish; $9,640.33 The contract cost for mutually agreed to change orders will be paid 50% at time of change order signature and 50% after completion and Homeowner sign-off. ARTICLE 5.GENERAL PROVISIONS 1.All work shall be completed in a workmanship like manner and in compliance with all building codes and other applicable laws. 2. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 3. Contractor may at its discretion engage subcontractors to perform work hereunder,,provided Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this Copyright TMK Remodeling, LLC Initials All Rights Reserved Page 1 /i A, 214 Sutton Hill Rd On Contract North Andover MA 01845 Wondolowski 2016-076.8-Deck 9788524491 TAK www.TMKremodeling.com RE,MODELING 4. Contractor shall furnish Homeowner appropriate releases or waivers of lien for all work performed or materials provided at the time the next periodic payment shall be due. 5.All change orders shall be in writing and signed by both Homeowner and Contractor. The cost for mutually agreed to additional work, required due to unknown conditions or substantive change orders, will based on the current bill rates for the actual time used.Additional materials will be billed at contractor cost. All change orders subject to 15% markup for overhead. 6. Contractor warrants it is adequately insured for injury to its employees and others incurring loss or injury as a result of the acts of Contractor or its employees and subcontractors. 7. Contractor shall at its own expense obtain all permits necessary for the work to be performed. 8. Contractor agrees to place all debris in an on-site trash receptacle (dumpster) and leave the premises in broom clean condition. 9. In the event Homeowner shall fail to pay any periodic or installment payment due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 10. The Contractor and the Homeowner hereby mutually agree in advance that in the event that 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 Office of Consumer Affairs and Business Regulation and the Homeowner shrequired to submit to such arbitration as provided in MGL c 142A. all b - - M Homeown Date: _ f Cont for Date: Notice: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the Contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed by the parties. 11. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials, or inclement weather. 12. Contractor warrants all work for a period of 12 months following completion. 13. Contractor may post small signage (36x36") on property advertising services during the duration of the project. 14. The Contractor and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: (617) 973-8700 Alvd, Copyright TMK Remodeling, LLC Initials Y _ All Rights Reserved Page 2 i 214 Sutton Hill Rd Contract North Andover MA 01845 Wondolowski-2016-076.8-Deck 978 852-4491 TTW wwuv.TMKremodeling.corn REMODELING 15. The Contractor or Homeowner may terminate this contract at any time for any reason by giving 3 days notice in writing to the other party. If either party terminates the contract as provided herein, then the contractor will be paid for work (labor and materials)completed as of the date of termination plus any materials or equipment that are backordered and not delivered. Payment is defined as actual job costs for the project plus 15% overhead charge. The contractor will provide a written report detailing actual job costs plus overhead for payment. The Contractor will refund any funds paid by the Homeowner that are a remaining balance for the labor and materials used as of the date of termination, plus any materials or equipment that are backordered and not delivered, plus 15% overhead charge. The Contractor will make arrangements for the backordered items to be delivered to the Homeowner. 16. The Homeowner is responsible for maintaining adequate access to the property including snow removal, personal property storage, and working doorways, stairways and walkways. In the event the contractor is required to provide access or repair to the doorways, stairways and walkways, then the Contractor will bill the Homeowner at the hourly bili rate for same. ARTICLE 6.OTHER TERMS ARTICLE 7.ACCEPTANCE Signed this faday of 20./_�a Homeowner C ntractor NOTICE: The signatures of the ies above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES V Copyright TMK Remodeling, LLC Initials All Rlghts Reserved Page 3 /IT/A 214 Sutton Hill Rd ON. Exhibit A-Statement of Work North Andover MA 01845 Wondolowski_2016-076.8-Deck 978 852-4491 TOC www.TMKremodeling.com REMODELING A B I C D E F G I 7 Owner; 2 Leslie Z;<David Wondolawski Estimate: 2416-076.8 Estimate valid for 30 days 3 lesliewondogdhotmail.com Estimate Date: 07/29116 Expiration Date:0812812016 4 100 Raleigh Tavern Lane 5 Forth Andover MA 01845 6 978 886-4853 7 8 Scope of Work Replace Deck 14x16.5':Remove existing deck boards,railings,posts,stair,deck framing approx.262 SF.Excavate and pour 3 12"concrete footings wl bottom of footing 48"below grade.Frame new single level deck w12x10 PT joists on 4x10 LVL carrier beam,through bolted to house framing.Install Azeck Cypress deck boards with hidden fasteners on frame for deck and stair treads.Instal[Fortress metal posts,rails and wire balusters on deck perimeter and stairway. Install Azeck PVC trim board at deck rim joist and stair risers. Install lattice under deck at frame.Replace entry door landing and railing at garage.,Remove 9 existing.railing and landing.Excavate and pour 2 4'x1'concrete footings.Build 4x4'PT frame.Finish wl Azeck Cypress decking and f=ortress railing. 10 Mates: 11 Pricing includes labor and materials to install finished item+allowances. EA=Each LF=Lineal Feet SF=Square Feet 12 EA LF SF Total Cost 13 Quantity Cost Quantity. Cost QuantityCost 14 `7.0 Administration 1 $_3,650 m. .. _. _ _._._. _. $3 650 __.. _ _._. _ __.. .. __ ___.__._- .... ._ _ _ _,�._._ .. 15 3i Overhead&Expenses 1 $3,650 - 3,650 16 Overhead and project administration . $3,650 $3,650 17Deck-230 SF1. 20 $2,229 138 $12,214 1218 $8,315 $22,757 18 01 Plans and Permits:01.2 Building Permits 1 $204 $204 19 01.0 Permit-Building 1 $204 $204 20 01 Plans and Permlts:01.3 Building Inspections 2 $130 $130 21 11.6 Final Inspection-Building 1 $65 $65 22 Foundation Inspection 1 $65 $65 23 02 Site Work 1 $605 $605 -74—.20 led Dumpster 1 $605 .$605 25 02 Site Work:02.10 Remo 460 $1,242 $1,242 26 Removedeckfloor 230 $670 $610 27 Remove deck rails,posts,stair and framing 230 $633 $633 28 03 Excavation 3 $371 $371 29 Excavation for 4'deep 12"wide footing 3 $371 $371 30 04 Concrete3 $450 a $92 $542 31 Concrete 3000 PSI for 4'x 12"Concrete Footing 3 $450 $450 32 Concrete 3000 PSI for 4"structural slab 8 $92 $92 33 10 Exterior Trim&Decks 10 $469 138 $12,214 750 $6,981 $19,663 34 Furnish and install 2x12PT stair stringer 12 $448 $448 35 Furnish and install Azeck Cypress 1 x5 finished decking materials 262 $4,533 $4,53$ 36 Furnish and install Fortress rail,post,wire kit,blocked and fastened into deck frame 62 $10,525 $10,525 37 Furnish and install hidden fastener clips in deck grooves 246 $726 $726 38 Furnish and install PT 2x10jois%galvanized hangers and fasteners 230 $1,274 $1,274 39 Furnish and instal[PVC trim board 62 $572 $572 40 Furnish and install treated 8x4'lattice 10. ..$469 .$469 41 Install 14'4x10 LVL Carrier Beam&Posts 14 $1,117 $1,117 424 GarageEntDoorLandirig y_ $547 20 $1.468 �. _.._$499 $2,515 43 02 Site Work:02.10 Demo 32 $86 $86 44 Remove deck floor 16 $42 $42 OO Copyright TMK Remodeling LLC All Rights Reserved Page-4 Unlawful to distribute without permission 214 Sutton Hill Rd Exhibit A-Statement of Work North Andover MA 01845 7 Wondolowski_2016-076.8-Deck 978 852-4491 Tm www.TMKremodeling.com RF,bI(}I3.ELM, A S C D E F G I 45 Remove deck rails,posts,stair and framing 16 $44 $44 46 03 Excavation 2 $247 $247 47 Excavation for 4`deep 12"wide footing 2 $247 $247 48 04 Concrete 2 $300 $300 49 Concrete 3000 PSI for 4'x 12"Concrete Footing 2 $300 $30o 50 10 Exterior Trim&Decks 20 $1,469 48 $413 $1,881 51 Furnish and install Azeck Cypress 1x5 finished decking materials 16 $277 $277 52 Furnish and install Fortress rail,post,wire kit,blocked and fastened into deck frame 8 $1,358 $1,358 53 Furnish and install hidden fastener clips in deck grooves 16 $47 $47 54 Furnish and install.PT 2x10 joists,galvanized hangers and fasteners 16 $8g $a9 55 Furnish and install PVC trim board 12 $11_1 $111 56 Grand Total - 25 $6,425..... ... 168 $13,682 - 1298 $8,814 $2i k ©Copyright TMK Remodeling LLC All Rights Reserved Page-5 Unlawful to distribute without permission il�1�1116 The Commonwealth of.Massachusetts Department ofrndustrialAcerd'ent F `zte 100 . M ° Boston,Mfg.a2114 20.17 www mass.gov/dia -WOVI< ere CosnpensationTaasura)neeAff.dadt:Bui�dexslCan ac4oxslL+,7Ectrzcia sl��t bexs. Tp-BBYMFD WITHTHE�EliM1L7CT7LNG A1(]T [O�t?1'SC- Fiease 'rant Le. 'bi A ''licant�n£ormationt Name(B'usiness/Cj:Rgoi7 atia dividual): Da 2� Address: A4 oL"rl� Ota`( City/state/Zip: . .:.... : ���., '`. _Are you an employez? Type o ChecIt�ie alipxoprlafe box: fpx'o1e cet{j�etizzred): /� einpIoyees(dill andlorpart time).* 7. ❑Nd- 'co"n structlo% 1, I am a employor with ✓: -- 2,u Iern ssole proprle#or nrpartnership and have no employees working£Deme in 8. Reim o deliiig i owarkers any caty. 'comp.insurance required. 9. gDemolition pac 3.QIa€nahotneuwmrd0ingAworkmysel£INoworkera'comp.insurance xequrredl 10❑Building addition ¢❑I am a hameowner and will bo hiring contractors to aenduct all work on my property. I will ll.[�$lecfticaleairs or additions ensure that all contractais either hate workers'compensation insurance or arc sole ,. . :�?l,i�'r mg-repay or aclditzbn� proprietors with'q'-5 $.❑I am a general cont Facto�d I�&�'e Iv,edthe sub-confractoxs listed onthe attached sheet. re 13.[]Rea£ pairs These sub-con".Ors hate empIoyees andhaveworkers'camp.iusuranco t � r j Other g.❑Weareacorporafiq'i�atrdits,ope�.havo xercisedtheirrightotexemptionperMGLa. ! Ise rd a c and'wehave iio em to ees'. oyrorkers'comp.insurance re uired. *Auyapplicantthatcheck§`hox ;1l ',rilloutthesectionbelowshowingtheirworkers'compensationpolicylzafarmation: i Ilorneaw mn who submit Chits affidavit indicating they are doing all work andthenhire autside contractees must submit a new affidavit indicating Snob' �Cordractors that checklE iq boxmusf attached'an additional.sheet showing the name ofthe sub contractors and state whether o�not those en#ities have employees. Ifthe sub eontractgrs have omployees;they must provide their workers'comp.policy number. lam an ernploye�t7iatisprovirling-woplrers'compensation insrarancefor my errtployees. eroly is thsporicy and�otasite information. htsutance Company Hama: Policy#ox Self is3s.Lic.#: 4k GG 5� 871 Z�lS f pixationDate; lob Site Address: +fid �G� City/Stata/Zip: �t..f-'o rim J F' oli cy declaration.page(showing tl�e policy nulrar and ep atYozi date). Attach a copy of the Wotrltvers' compensation p Failuxo to Secure coverage as xegtaired uIldex MGeLalties intoe f rm oda TOf'-Violation -WORK c)"E Z.land �n£up to $250.00 a andlor one-year impxisonmentfl as-well as ci-vil p day against the violator.A copy of this statement may be,-forwarded to the Mae Of)S vestigatlons of the DJAA f. r esu rance covexage verification. 7 coo lice eliy cer•tl under tlae pains and penalties o Per Haat rile information provideve is t correct Date: Si aturo: Official use only. Do not-Wp tc in tries area,to lie completed liy city or•town offtcial. perjnitt/License# City or TOVn• ZssuiugAntlaoriity(Circle one): ' C �.Board of Health .2.Build�ung pepartno.ent 3. itty/'I`own Clexl�. d•.EYECtxXCaIxTISpECtOr 5.Plt'IIlz�IIIl9XT15peCtOx 6.Other Phone#: Contact I'ersox;;t DATs{MraIoommrl , CERTIFICATE OF LIABILITY INSURANCE 09519/2016 THIS CPRTIFICATI= IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE G1=RTIFICATE HOLDER. THIS HE POLICIES BELO V, THIS CERT F CATEOES NOT FOFMINTIVELY OR NF.GATIVELY AMEND. EXTEND SURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE SUNG NSURER 5)R ALTER THE COVERAOE AFPORDED 13Y TAUTHOR ZED D6l.QW. THIS C REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. es} must be endorsed. If SUB IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,tha POIIcy(iROGATION IS WAIVED, subject to the terms and conditions of tho policy,certain policies may requ{ro an ehdorsement. A stafament on this certificate floss not confer rights to the certificate holder in lleu o€such endorsamen#S . CONTA Or PRODUCER N E: AX Segreve&Hall Insur.Mgoc.In0 PHONgEI-1 E AIG NO L 305 North Main St. AIC Andover, MA 01810 nDDRe6 Lawrence J.Hail >z. ToMER n:TMKRE-1 INSURERS) AFFORDING COVERAGE NA1C$ INSURED TMK Remodeling LLC LNBURERA IArbella Protection Ins.Cn, 41360 214 Sutton Hill Rd INSURfRB;AEIC 11104 North Andover, MA 018455' INSURER o= INSURER 0: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER'THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTI"D BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH Ri=SPECT To WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY-f HE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AMMM IF CY EF POLI LIMITS INSR TYPE OF INSURANCE POLICY NEIMBER M DDrfYYY MM1DDlYYTY 000,00 GENERAL LIABILITY EACH OCGURttI;NCE $ r R � 140,OQ A COMMERCIAL GENERAL LIA$ILnY PRE PS Es rrence MED EXP Any one ereon) 5,4C CLAIMS-MADE OCCUR g0(}r0( PERSONAL A ADV INJURY 5 9520007133 03/1812016 03MB12017 GFNPRA6AGGREGATE 2,000,0( PRODUCTS-COMP/OP AGG B 25040,0( GEN`L AGGREGAYI:4,IMIT APPLIES PER: $ POLICY F1 PRO LDC COMBINED SINGLE=UMIT 3 AUTONIOBILV LIABILITY {Es accident} ANY AUTO DODILY INJURY(per parson} S ALL OWNED AUTOS BODILY INJURY(Per Occident) s SCHEDULED AUTO$ PROP-RTV DAMAOF» S (PER ACCIDENT} HIRED AUTOS g NON-OWNED AUTOS § EACH OCCURRENCE & UM1311r; LA LIAS =000UREXCUS LIAB AGGISEI^sATE 5 09DUC-PBLE s RETENTION S WC STAT - OT'H- WORHERS COMPENSATION [J,M T AND SMPLOYERB'LIABILITYYWCC:-500 5011872 04/01/2016 4410112011 E{.,EACH ACCIDENT' 3 600'4 B ANY PROPRIETORIPARTNERIEXECUTIVE � NIA6600 0 OFFiCEtIMEdBER EXGLUDED? Y EL,pl&EASE-EA EMPLOYEE $ µ (MOndatory In NH} 5001C IFyae daxonba under F.L.D49EASE POLICY LIMIT fi DENIP-O ON OF OPE ATIONB bQlow DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Ameeh ACORO 1011 A—CID11al Ramerka Schedule,If marc=Paco Ie requlred) CERTIFICATE HOLD E CANCELLATION SHOULD ANY OF THE ABOVE:ZIESGR15ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED It Town of North Andover ACCORDANOF WITH THE POLICY PROVISIONS. Maura Dean 1600 Osgood Street AUTRORIZrW REPRESENTATIVE North Andover, MA 01845 ®1988-20-09 ACORD CORPORATIOW All rights reserved, ACORU 25(2001 09) The ACORD name and logo are registered marks of ACORN s� Massachusetts Department of Public Safety Y Board of Building Regulations and Standards License: CS-•105086 / Construction SupervisorI TN . THEODORE M KELLEY f;, 214 SUTTON HILL FDS NORTH ANDOVER M ) ' I Expiration: Commissioner 1010812017 Ufte�po��z�Jza�z<uecr���a�C�2rcava11teVe&,J. Ofgce of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: :165887 Type: Office of Consumer Affairs and Business Regulation Expiration:._415/201:8; DSA 10 Park Plaza-Suite 5170 Boston,MA 02116 TMK REMODELING THEODORE KELLEY, 214 SUTTON HILL RD.`' �— NORTH ANDOVER, MA 01845 Undersecretary Not valid without signature