HomeMy WebLinkAboutBuilding Permit # 10/14/2016 OF
BUILDING PERMIT
3= 4�T�LMa 'a� OG
TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION
Permit NO: I Date Received /4�• /Y p -o
Date Issued: I L( " �ssACrws��
LWORTANT:A com Applicant must lete all items on this age
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
` ew Building ne family
Addition Etwo or more family Ondustrial
F.:
►Iteration No. of units: nommercial
epair, replacement ssessory Bldg LJOthers:
Ebemolition Ether
ell Ioddpla►rt � etlartds 13s
atrlerr
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Identification Please Type or Print Clearly)
OWNER: Name: RC^�,ff,1 Phone: f7�
Address: i► 0i ,,
C I�ITR C b Name 17,
Address w.
FlrC k d '
BMOM,-
I'Mair`s Ga ss tta aan tcense. 77,777,77,
Home 1> rer�ere rcet Epp Date
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000,00 OF THE TOTAL ESTIMA TED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �� ' FEE: $ S 11: 0 4.
Check No.: _ Receipt No.: 2i 6 cf,s
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of, gk on/C3 nlner Signature of cor�tractcrr �`
T
own o a. 6 ndover
No. 4o so,, i6a
C �.K. h ver, Mass,
coc.4c..ewacw '�'
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BOARD OF HEALTH
PERMIT T Food/Kitchen
LD Septic System
THIS CERTIFIES THAT .........
.........�•• ,. .�i�. ,.,. .� ,' L. BUILDING INSPECTOR
has permission to erect ............. buildings on . ... LAZ Foundation
.,.
. Rough
to be occupied as ....L.14 o!w..... ,f"a. I..,/.. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final
Construction of Buildings in the Town of North Andover. L
PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR
UNLESS C®NSTRUCTI® T RTS Rough
AV
-Service
.........., y � .....
BUILDING INSPECTOR.
Final
GAS INSPECTOR
Occupancy .,Permit required to Occupy Buildintr 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.
F
OEM
BUILDING & REMODELING
CONTRACTOR
MASSACHUSETTS HOME IMPROVEMENTS CONTRACT
This form satisfies all basic requirements of the states Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to
protect homeowners.Seek legal advice if necessary.Any person planning home improvements should first obtain,a copy of"A Massachusetts Consumer
Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business
Regulation's Consumer Information Hotline at 617-973-8787 or 1.888-283.3757 or on our website.
Homeowner Information Contractor Information
Name Company Name
Mr.&Mrs.Harrison
Joscon Ov1unugement,Ecru
Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name
110 Olympic Lane Jonathan O'CdWan
City[Town State Zip Code Business Address(must include a street address)
North Andover,MA 01845 185 Atlantic Avenue
Daytime Phone Evening Phone 978.655.1784 City/Town State Zip Code
Email:robandlizh@yahoo.com Sal isb ur7,MA 01352
Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number
603 TS5.1568 51.1432121
Home Improvement Contractor Reg.Number 159444
Expiration date 4.12018
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the work to complete;specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.)
The following Scope of Work has been figured on remodeling the existing kitchen by expanding it into the dining room per Jackson Kitchen Design plan dated 6-
21-16.
Building permits per the Town of N Andover,MA
Temporary protection and daily cleanup throughout the remodeled areas.
Demolition work to include the following: Removal of the cabinets,countertops,appliances,flooring,bay window and walls for the new layout.Tile
j flooring in the foyer!hall to be removed. Disposal of all construction related debris. Unforeseen mechanical items may be exposed at the wall
removal area. Relocation work of any unforeseen item will be considered additional work.
Temporary support the second floor joists at the wall removal area for preparation of a new beam.
Install a flush mount steel beam at the wall removal area approx.16'wide. Steel beam to be a A36 W8x24 span of 16',
4 Re work the existing window opening for the new kitchen sink window unit.
• Install a new kitchen window similar to the existing replacement units. Further details needed on the manufacturer of the windows. Window unit
Allowance listed below.
Siding and exterior trim to be installed at the new window location similar to the existing.
Insulation as needed around the new window.
• Install new%drywall on all disturbed walls including the new window area. Install new 318"drywall over the entire ceiling area and finish smooth,
Ceiling area to include the kitchen,foyer and hallway.
Installation of the kitchen cabinets per layout. Includes all moldings and hardware.
• Plumbing work throughout the kitchen area to include the removal of the existing kitchen sink and appliances. Rough in and finish the new sink,
faucet,dishwasher and ice maker. Rework the baseboard heat at the now cabinet area along the wall by adding a toe kick heater under the
cabinet. Venting of the new sink,location through the roof. Relocate the gas line for the new location.
Electrical work has been figured on code upgrades throughout the kitchen area,re work existing electrical per the new layout,install 8(5°)recessed
lights.Install circuits to code for the gas range,hood fan,microwave,refrigerator,dishwasher,wire refrigerator and countertop plugs.Install
homeowners purchased surface mounted lights. Rework the electrical at the wall removal areas. Install under cabinet lighting. Install wiring and
switching for hanging light in the new dining room area and LED under cabinet light for desk area. Install 60 AMP 8 circuit sub panel to
accommodate the new circuits.
Carpentry work to include baseboard moldings throughout the remodeled area as needed and new trim at the window, Install new baseboard
throughout the hallway at the new hardwood flooring area.
• Install homeowners purchased appliances. Hood vent to be vented to the exterior.
• Painting by others unless agreed upon.
Install new 2-114 red oak hardwood flooring throughout the foyer and hallway. Sand and finish clear with 3 coats. Re finish the existing family room
hardwood flooring,
Install homeowners purchased cabinet hardware.
• Install tile backer board throughout the kitchen area and prepare for the new tile.
• Install tile throughout the kitchen area. Tile install has been figured on a square pattern and 12"x 12'square tile. Final layout and sizing TBD.Tile
material allowance listed below.
• Install a tile backsplash. Further details needed and area confirmed.
• Final post construction cleaning throughout the project area.
Allowances:
+ Building permit @$700.00
• Plumbing furfures(Sink and faucet) @$800.00
Appliances by others
+ Window unit @$800.00
+ Tile flooring materials @$2,000.00
Tile backsplash materials @$500.00
Total for the above scope of work including the Allowance amounts: $42,875.00
Required Permits— Building permit Proposed Start and Completion Schedule-The following
schedule will be adhered to unless circumstances beyond the contractor's
control arise.
(Owners who secure their own permits will be
excluded from the Guarantee Fund provisions of 10-10-16 Date when contractor will begin contracted work,
MGL chapter 142A.) Actual start date TBD once cabinets are ordered
11.18.16 Date when contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of:$42,875.00(')
/Payments will be made according to the following schedule:
$4,287.50 10%Deposit Upon signing contract, (not to exceed 113 of the total contract price or the cast of special order items,whichever is greater)
$8,575.00 20%Upon the starl of the project
$12,862.50 30%Upon the of the completion of demolition and rough in sign A.
$12,862.50 30%Upon the start of the cabinet install and drywall completed
$ 4,287.50 10%Upon substantial completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following material/equipment must be spectral$0 to be paid for N/A
ordered before the contracted work begins in order to meet the completion schedule.(*)$0 to be paid for NIA
i
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-Is an express warranty being provided by the contractor? tNo n Yes(all terms of the warranty must be attached to the contract)
Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor
utilized by the contractor.The contractor 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 that any lien or other security interest has been placed on the residence,Review the following cautions and notices
carefully before signing this contract.
nDon't be pressured into signing the contract.Take time to read and fully understand it,Ask questions if something is unclear,
Make sure the contractor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor
registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757.
Moes the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to
see a copy of a'proof of insurance"document,
(now your rights and responsibilities,Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractors normal place of business,provided you notify the
contractor in writing at his1her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the
third business day following the signing of this agreement,See the attached notice of cancellation form for an explanation of this right,
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESIII
Two identical copies of the contract must be completed and signed.One7should 0 to the homeowner.The other copy should be kept by the
'contractor.
10" 114,11411L L j -
Ho6ebwrie racoes Signature
�s Signature
te
date Xa
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 dispute 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.
......................
1-167e&nieiSignature" ontractors Signature
ent of the
NOTICE:The signatures of the parties above apply only to thea elm parties to alternative dispute resolution initiated by the
contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties.
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 work as 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 provided by the contractor,all goods sold in Massachusetts carry
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 homeowners basic consumer rights.If you
have questions about your consumerihomeowner 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 void,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 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
wish 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 httpJ1www,m ass,gov/ocabrl
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 http:#Ymw mass,govlocab[l
Go online to view the status of a Home Improvement Contractor's Registration:hUp:f/rlb.state.ms.us/hrameirrMproveme�`WUlir
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
Project:Harrison Beam Joel Silve►watch
Location:Harrison Residence 110 OlympicAvenue North Andover,MA ' tl SilverwatchArchitects,LLC /
Uniformly Loaded Floor Beam ,,„w j 155 Londonderry Road
[2009 International Building Code(AISC 13th Ed ASD)] Windham,New Hamphire 03087
A36 W8x24 x 16.0 FT
Section Adequate By:10.1% StruCaic Version 8.0.113.0 7/12!2016 8:39:49 PM
Controlling Factor Moment LOADING DIAGRAM
DEFLECTIONS Center
Live Load 0.46 1N U420
Dead Load 0.27 in
Total Load 0.72 IN U265
Live Load Deflection Criteria:U360 Total Load Deflection Criteria:U240
REACTIONS A g
Live Load 5950 Ib 5950 Ib
Dead Load 3472 Ib 3472 Ib
Total Load 9422 lb 9422 lb
Bearing Length 0.79 in 0.79 in
BEAM DATA Center r
Span Length 16 ft _.._.._.._
Unbraced Length-Top 0 ft
STEEL PROPE#aIES
W8x24-A36 FLOORO D� ING
m 1 Side
Properties: Floor Live Load FLL= 60 psf 60 psf
Yield Stress: Fy= 36 ksi Floor Dead Load FDL= 30 psf 30 psf
Modulus of Elasticity: E= 29000 ksi Floor Tributary Width FTW= 6.5 ft 6.5 ft
Depth: d= 7.93 in Wall Load WALL= 20 pff
Web Thickness: tw= 0.25 in LIVE LOAD REDUCTION
Flange Width: bf= 6.5 in Average Uniform Load: LL Ave= 60 psf
Flange Thickness: tf= 0-4 in Floor Loaded Area: FLA= 208 sf
Distance to Web Toe of Fillet: k- 0.79 in Reduction Based on Total Area: R1= 0.05
Moment of Inertia About X-X Axis: Ix= 82.7 in4 Max.Reduction Based On DULL Ratio: R2= 0.35
Section Modulus About X-X Axis: Sx= 20.9 in3 Max.Reduction Based On Total Area: R3= 0.4
Plastic Section Modulus About X-X Axis: ZX= 23.1 in3 Controlling Reduction Factor: R= 0.05
Design Properties per AiSC 13th Edition Steel Manual: Design Live Load With Reduction: LL= 57.2 psf
Flange Buckling Ratio: FBR= 8.13
Allowable Flange Buckling Ratio: AFBR= 10.79 BEAM LOADING,
Web Buckling Ratio: WBR= 25.89 Beam Total Live Load: wL= 744 pif
Allowable Web Buckling Ratio: AWBR= 106.72 Beam Total Dead Load: wD= 410 pif
Controlling Unbraced Length: Lb= 0 ft Beare Self Weight: BSW= 24 pif
Limiting Unbraced Length- Total Maximum Load: WT= 1178 pif
for lateral-torsional buckling: Lp= 6.7 ft
Nominal Flexural Strength w/safety factor: Mn= 41497 ft-1b
Controlling Equation: F2-1
Web height to thickness ratio: h/tw= 25.89
Limiting height to thickness ratio for eqn.G2-2:h/tw-limit= 63.58 j
Cv Factor: Cv= 1 .. --
Controlling Controlling Equation: G2-2 0' V--O An,L,X/
Nominal Shear Strength wl safety factor. Vn= 27977 lb ,w �q'SIL V ,�C"
c C
r
Controlling Moment: 37690 ft-Ib o
8.0 ft from left support NNFI "
Created by combining all dead and live loads. f c5
Controlling Shear: 94221b
At support. / OF t
AW
Created by combining all dead and five loads.
I
Comparisons with required sections: Beg' PLo_yided
Moment of Inertia(deflection): 74.85 in4 82.7 in4
Moment: 37690 ft-Ib 41497 ft-lb
Shear: 94221b 279771b
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146;" 10" 12;: f - 25; 15' 82` 23" 3.
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ROOKHA<EN i FRAMELESS CABINETRY
i a 33® '.S" 23" 18' 35' 24" 24' � DOOR STYLEEOGERAONT RAJSE-SQUARE
CAB€N'TS§4AP-E b ITA NORDIC WHITE FINISH
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ISLAND:�APL`E W!IF–'BALTIC SEA RNISH W4 M INTERIOR
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NGHsMOULDINGS:-S S :
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KICK RAIL R#O..csA :BALL
�gS 3'382 BkD2".�i426 3 SSC9 34 9VRM7,E GRIL" ARD/YESC'tiC SIDE AN BACK 4 ISLAND:4#85845
.7 a ice_ aDOOP,S:KN-BS ..,2 AND DRAWERS AY,.D-UBL_:.�'.A..-,.RUL_;ESS
±-DOUBLE OV EN CABINET:BOSCH MODEL€HBL55s1 LC
- LEFT AND RIGHT SIDES EXTENDED 2"FOR 26'TOTAL
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, QA BAR, T :�6'C �S`CP;6OSC'T GAS`vX3CE w sei,'.£SSS;.-'€,"
HOOD MODEL!FABER.-36SSS3'.S4 CHIMNEY STYLE
In P I n4 7 e END PANELS - I
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5=D'RAVVERS FORTJ SEP.WARE 1 POTS PANS
DRAWER
:t2 WALL 18E BUILT EOR 8EVEPAGE ENG PANE!5 °",.SSS LOCATION�BREAD in v.. Oxo-DRAWER€ CENTER F.ECTRl.:AL PY153r3:i17
SS02 X84 2.4_WOF - 6-LIQUOR S709LAGE.CNE ADJUST ABLE ROLL Cis"
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SaDa^£,34 '!5 6-KDS=LASTIG UP-S PLA—.–S
BBD 696
vim.., ' ,." - Et D2434 ,4� P - 9-1VVC RILL OUT—MAYS,STORAGE
OF BREAD CIP T1 ESERWARE
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V�.�3s3o
TRAYS
STORAGE OF CAN GOODS.AND APPLIANCES
LEFT AND FIGHT EX–ENDED< OR A TOTAL 26"
o'
24. -38'–
i 7-S'ANDARC SHELF
30" 24'
A� 12MA.'L.K:DS PAPERWORK s BILLS
33-PULL CABNET TO DEPTH OF REF PANEL
EXISTING REF TO BE USED:WHIRLPOOL
6976,H TO TOP OF HINGE X.:,c W X 28'DEEP WITH CST-DOOR
sT 1;<'DEEP WITH DOOR
54-c ECTRiC TO BEV CTR TO BE FLUS.WITH H BACK WALL
NOT Lu s>.TE0 IN AGJACES T CABINETS
SILHOUETTE SAXON"24':DBC05604_C4PR
All dimensions size designations This is an original design and must Designed: 6/22/2016
given are subject to verification on I not be released or copied unless Printed: 8/26/2016 j
job site and adjustment to fit job i20applicable fee has been paid or job
conditions. _ order placed.
I
HARRISON,LIZ AND ROB FINAL Al Drawing#: 1 Scale : 0 5/16" ® 1'
The Cini ntonivealth of Massachusetts
Departrnent of Irulustrial Acchlents
I Congress Street,Suite 100
Boston,MA 0.2.1.14-2017
lvwtt inass.gov/dia
Workers'Compensation insurance Affidavit: Builders/Conti•actorslElectricians/Plumbers.
TO BE FILER WITU THE PERHII`I"PII1'G AUTHORITY.
A ilicant Information Please Print Le ibl
Name (Business/Organization/ltt(lividual):M y tJ Gt`� M e<nt k pia T c
.Address: -`7,N- PI-ev,O.e n t'e 411 Rd _
City/State/Ziac: Ctr'r.5t5^ N� UPhone#:
Are you art employer?Check the appropriate box- Type of project(required):
l.�I am a cmployerwith )_ employees(full and/or part-time).* 7, ❑New construction
2.[11 am a solo proprietor or partnership and have no employees working for me in 8. 16'Itemodeling
any capacity.1110 workers'comp.insurance required.]
9. Ef Demolition,
3.F11 am a homeowner doing all work myself,[No workers'comp.insurance required.]t
10❑Building addition
4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workcrs'compensntion insurance or are sole 1 I.❑Electrical repairs or additions
proprietors with no employees.
12.[]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the subcontractors listed on the attached sheet. 13.❑Roof repairs
"These sub-conlractors have employees and have workcrs'comp.insurance.t
6,❑We arc a corporation and its officers have exercised their right of exemption per MG1,c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant thnt checks box fill must also fill out tho section below showing their workcrs'compensation policy inrormation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1Conitactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the subcontractors have employees,they roust provide their workers'comp.policy number.
T am an employer that is providing Ivor kers'contpensatiou iusturance for my employees. Below is the policy and joh site
information. t
Insurance Company Name: t e Qr C 1-e c.+ c i-
Policy fl or Self-ins.Lic.#;�1._.a_.a. (p�(J _ ..,..__---- Expiration Date:
Job Site Address: to 0 Lcv-c City/Statel7ip:_._V. �rfayrl
Attach a copy of the woticers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required tinder MGI,c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statctnent may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cer11 under the pains and penalflev ofperjtrry that the Infarrrrniinrt prowled alcove is it-tic and correct.
s
Si;enatttre: Date:
Photic#i: boa- �c' i's 6 e
u
Offici rise only. Do not tprite in this area,to be completed by city or town offciaL
City or Town: Perrnil/License#
Issuing Authority(circle one): i
1.Board of Health 2.Building Department 3.CityPTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: _ Phone it:
u
6
i
Oct.14.20 6 08:06 AM Advantage Insurance Agenc 978 794 4933 PAGE. 2/ 2
CERTIFICATE OF LIABILITY INSURANCEDATEIMMADDIYMI
10/05/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THF 13ERTIFICATP HOLDER. THIS
CERTIFICATE DOES NOT A1-FIRMATTVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CEK"FICATE OF 14 RANCB DOES NOT CONSTiTVrE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IM15011TANT: If ffi7ertffibato hD du► la. an ADOITIONAL INSURED, the pD11ny(les) must w ndo►eed. if §rj-o-R64A—irjoN--jl; WAl1/Iwv. euBiect to
the toFmg an(! DDndltlons of the policy, certain pollcles may require an endorsement. A statement nn MID cartiticata docs riot confor 1191ft to tho
Derllfigpte holder In lieu of such endoraemerrt(a).
PRODUCER
NAMGAUL DEVIN
E:
ADVANTAGE INS, AWNCT INC, PHONKE _.__.._.._...._• .._.. FAK
. 979-681-1655 tArc,Na1978-794-4833
184 PLEASANT VALL&Y STREET _ .__---.__..._......
ADrXrEBB!
MEiTHUEN, MA 01844 ivauR�Rls ___..
IA810RD€NG CpYeR_Ad_E_ xAlc u
_ INSURERAIA"ZLYA PROTECTION INS. CO.
40SO N MANAGEWWT INC, mauRSRC
72 PRQVIDENCE HILL ROAD
MSURSRD:
A,TI TIISON N H 03811 -,-
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INUIRRR F;
COVERAGaE$ CERTIFICATE NUMBER! REVISION NUMBER:
THi$ IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMFD AFapVe !"qR THE POLICY PERIOD
INDICATED. NQTVNTHSTANDING ANY REQUIREMENT, TERM OR CONUITION OF ANY CONTRACT OR DYHER DOCUMENT MTH RESPECT TO 1AIMICH THIS
r,ERTIFIGATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCts AFFORDFO BY THE POLICIES DESCRIHEO HCREIN 13 'SUBJECT TO ALL THE: TEPoM8,
EXCLUSIONS AND CONI)ITIONS OF SUCH POL(CIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
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TYP!DP INSURANCE AUPL VpNSD rroLIGY.N._t.M_aers IMM10nYYY) 1MNDNYYYYI LMn3LTR
IMER
A, OENERALLUMUTY 8500055694 45/34/201 05/30/2017 EACNOCCLlRrsENCE S 1,000,000
R 4XWMER0IALGENERALLDIB1LrrY 100,000
CLAedS.MADE &D OCCUR UtOk:4P
IAryaneparsarl s 5,D00
FERepNALAAOY1kJUFTY ; 1,DTID,O00_
GENERALA40RFPATE It 2,000,004. ..
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AND ENPLOYER&'LIAWLITY YIN TORY LR,IIYB
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DESCRIPTION OF 4PEIIRTIONe/LODATIONE I VEHICL90(AMA ACOAD 101,M011kv"I RKM A4 Adladws.If mora apnea to ls4u4ad)
RUIMINQ & R141013ZLINC CONTRACTOR
CERTIFICATE HOLDER CANCELLATION
TOGPia 4$' NORTH AMOVatt
SHOULD ANY OF THE ABOVE DESCRIBED POLICI96 6E OANOELLED OEFpRE
BUILDING bxpT. THE ir7lr MATION DATE THEREOF, HOTIGE VALL BE 0WVi Rt0 IN
1600 08WOO STREET ACOORDAROE WITH YNB POUOY PAOOS1pN&
BUILDING 20, SUITE 2035 AUTHORIZED REPRESEHTA'"VE
NQRTH AND VER MA 01845
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ID1480-2010ACOROCORPORATION. All righty:wowvad.
ACORD 25(2611=5) The ACORO name and logo Idro r9glsterad marks of ACORD
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_office of Consumer Affairs&Business Regulation
P a HOME IMPROVEMENT CONTRACTOR
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7Registration: 159444 Type.
Expiration: 43012018 Private Corporation
JOSCON MANAGEMENT INC.
JONATHAN.O'S11 LL•I VAN
72 PROVIDENCE HILL RD.
ATKINSON,NH 03811 Undersecretary
Massachusetts Department of Public Satety
Board of Building Regulations and Standards
License: CS-070043
:"Onst-ruction s::n:wervr.sor
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JONATHAN O'SULLIVAN
185 ATLANTIC AVENUE#4
SALISBURY MA 01862
.ten l./ Expiration:
commissioner 0812612018
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