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HomeMy WebLinkAboutBuilding Permit # 11/10/2016 BUILDING PERMIT t%CRTN TOWN OF NORTH ANDOVER yy APPLICATION FOR PLAN EXAMINATION Date Received—a-1 it 1—U Permit No#: ED Date Issued: IMPOR,rANT: Applicant must_comp� �te all items on this page LOCATION Print PROPERTY OWNERS Print 100 Year Structure yes (n o PARCEL: ZONING DISTRICT: MAP 5 Historic District yes no - - Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 1:1 New Building El ne family Ll Addition W?Iwo or more family,, Li Industrial Q,4teration No".--of units: Ll Comm­ercial F1 Repair, replacement,- 0 Assessory Bldg 11 Others: Ll Demolition El Other El Septic 0 Well 0 Floodplain Li Wetlands 0 Watershed District n Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED, L�n '-1ird-C.1 LEL(- -1i. 9 )L. L f) --learly Identification- Please 1�ype or Print C OWNER.- Name: Phone: ­111� Address: LY ZY Contractor Name: i ((,f)ij J' cf)t-(Phone: 3 Email: e�L) r y � e 7 F 1-T FTF /Ay Address: Supervisor's Construction License: Exp. Date: Home Improvement License: I I(I at f�45 Exp. Date., 7Z.1-C) ARCHITECT/ENGINEER Phorle: Address: Reg. No. FEE SCHEDULE:BULDINGPERMIT'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost.- $ FEE: $ Check No.: -Receipt No.:_ NOTE:. Persons contriteting ;vith unregistered contractors do neat h ve access to tie guaranty fund ---------------- ­--------------- - gnaWre­of-4g- ... ..... . .... .... t%O R TH own of ; 2Andover 0 No. - y h ver, Klass, I/—® ® T 0 LAKE -__. 0®^ COC MI CHl WICK V �•9 A�RRTEO s L) BOARD OF HEALTH Food/Kitchen PER T T LD ff Septic System THIS CERTIFIES THAT � ... BUILDING INSPECTOR ........... ...... .,.... ... .......... . ............,... .... ....... . . ...... ..,......... has permission to erect ........................ buildings on ...... ....�,�. .........�f .....46................... Foundation ..Y Rough to be occupied as ......�Cmbd.eA....... .......��.... . :.�! ... .. .................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT STA TS Rough Service i� J.......�..................... ............. ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit„Required to Occupy_ Buildinz 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. ���p®fes q{�/�pp q�q',�fq�., V V dYJs�YJ�'�y 1L..CONS UOd Ss fl-nit+ is ACA�FWY AVENUE Akd lllAV1:Sa9 01835 PROPOSAL 11/2/16 E , i ' Project name: Matt Cote;, 116 High Street North �ndc ver, MA 01845 SCOPE: PERMIT: $ 750.00 DEMO • After acceptance o new floor plan by homegwner, remove all walls and floors on interior tl fit new layout. • Removal of existing kitchen and bathroom. • Strip wallpaper. • Disposal of all debris toa wMC supplied du 6 pster. Labor: $ 21800.00 Materials: $ 1,438.00 i FRAMING: I ' ® Supply and install �'Il framing for new opening at living room, new bathroom and nein, window in kitchen. ® Install LVL beams in 'new Living room opening and provide engineer for stamp for building department. Frame new bathro6rn walls. Engineer: $ 500.00 Labor: $ 2,100 Materials: $ 1,661.00 'i . r 3 q° INSULATION V • Fill all wall cavities with cellulose insulation bl wn in from the outside. ELECTRICAL • Update all existing outlets and switches. • Install new fixtures in each room, kitchen, dini ig room, living room and a bath/fan light combo'!inthe bathroom. PLUMBING e • Disconnect all existing plumbing to kitchen an, bathroom. • Supply and install all' rough plumbing for new kitchen layout and new bathroom layout. • Supply and install toilet; vanity and shower en Iosure. • Install all fixtures. Toilet, bath, sink faucet, sh wer valve and head, kitchen sink, garbage dispos i and dishwasher. J Of SHEETROCK j ® Apply %" blue board onall ceilings and plaste . Labor: $ 2,500.00 Materials: $ 750.00 i �3 KITCHEN j • Supply and install kitchen cabinets and count rtops of client's choosing. Labor: $ 2,520.00 Materials: $ 8,438.00 ! !. FLOORING E • Install %Z" underlayn�ent in kitchen and dining room. • Install 12x12 self-adhesive linoleum tiles. Labor: $ 1,120.00 Materials: $ 1,250.00 DOORS m Supply and install insulated entry doors and h Il entry and basement. Labor: $ 575.00 j Materials: $ 551.00 ! R 1 i 4� A N 1,3 (:: � I assaehuset>ts Home Ion rovement Sa Ie Contract ' � p but fines not Include standard person tannin Dome imp vcmcnts should first obtain a copy of"A This Eorm satisfies all basic requiremcnss Oft he tatic's faina Impro.'Cmcnt Contraetar Cary h 4GL ski ter lA2 b 1 ailing the Language to protect homeowners. Seek legal dvice if necessary- Any P planning Massachusetts Consumer Guide to Rome impro'e vent"before agreeing to any ivark on your reside�e.You may obraiu a free coon' Y ' Office ofconsumet Affairs and Business Rce-'ul Lion's Consumer Infamtation Hotline a[C617"tea to Irtfor$g tion or on our tvehsite. Irl CON In r Info a o C MQ V - Conipm Name Name P Ci Cantr3Ctor/$alespersord owncrt`tlllrllc I Street Aid trss E n use a post Offiec Box address � h. e) e Stat7ipCoe Business Address(nitutire luden t fires) o! CityfTmvn � 1r I ti ;e Zip Code Evening S hone P City own Y p; paytime Phone Federal Empl Business Phone oyer 1D ar S.S.Number F, 'clion fine Mailing Address lit different from above) Ilum:lRr,n.,,..m co�u,acw`Rrs-�wm`nr i t.an.rQciscs Ihst mos160mc � �/ im-uanrn�irn 'Cite Contractor agrees to do the Following I utk for the Homeowner: }� �,brand,and grade of materials to 6`used,Tse a d'tional shy•ts-f ncu�-sary-} {Describe in detail the pork to completed,speci€yidg;he ty�. ing schedule Required Permits-The followingo building o ovyn sagarereqes 6e adhered to unlcssred Proposed Start and Cucmuptnst noes beyond the contracitOes colt"'arisen and will be secured by the contra 6Yi11 bE (Owners who secure their own pe t urs E IT ©a1e cV3ten en traclor will begin contracted work. excluded from the Guaranty Fun Provisions of MGL chapter 142A.} 9--Oate tt'h£u ca traded work will be substantially complctal. Total Contract Price and Payment Schedule. I # The Contractor agrees to perform the wort,jfumish,the material and lobar specified above for the total sum or, payments will be made according to the fol owing schedule: S ,Jap upon signing con[rul t{n�t to exceed 113 of lige total contract price the cost�Ofspccjal order items,whichever is greeter} or ttpan completion of nip 5 ; 9q. yr_! or tPon completion oe 1 „113p�ompletiun of the comrael (Law forbids demanding full payment until antract is completed to both party's satis€3c[ion) �"— ro be pals for Tire foliowitss matcriallcgnipmeslt mus be Svwial S ordcrM before the coatmcted trork beg"in order S to he paid For to Mee,the cumplelion schedule.( ) :-d by the cantImetor j orU work NOTES't`)Including ail finance eha-s l.*'1 taw r�}u[res that any deposit or don iN'J any special cquspmcnt for custom made material not exceed ate greater of(a)onc`diird of the total co=tton`[price or(b}he actual cast which must be special ordered i�ar<ivancc to meet the completion schedule. L'intess Warran '-1.an ex ress wan ants ben r�ovided try the enntrecto ' 0 No©Yes atE terms grin`oar t'.au e n c carr r Subcontractors- The contractor agrees[ be sulcly responsible for completion of the:work del cribed regardless of the actions ofany third Subcontractors utilized by the contra ter. The contructur further agrees to be soiely respal�sible for all payments 10 all subcontractors for t[aterials and labor un er ibis a rccmcnt C.mr.-„ct Acceptance-ilpon Qictrinn.thr document becomes a binding contract under law, !+{3nloss otherwise not tvllhin this document,the eonmret Shall nut imply that any lion or other security interest has been placed on the residenla.. [ccvrcw me rormwlnb cA„rrons and�ode�. carefully before signing this contract. : e Don't be pressured it signing the contract:Takc time to read and fully understand it. E k questions ifsomething is unclear. make stirs the et)mraclor Eta`a valr Home improvement Cgrltmctor Registration. The Ila requires most home improvemcul contractors and subcontractors to be registered withe piriector of Hm oe lmprovcruent Contractor Regis tion. You may Inquire about contractorde - - registratioby writing to the Dircetgr hit 1©:Park Plaza,Room 5170,Boston,MA 021 lG r by catlins 6t?-973-9787 or SSB-?A3-3757. n Dues the contractor have insunrnce?i Ask the Contactor for his insurance company info nation so drat you can confirm coverage,or ask to see a copy ofa"proof of insurance"documcni. Know your rights and responsibilities.;:Reud the Important In€ornration on the reverse sitst re a ofthis form get a copy of the Consumer Guide to the}Some Improvement C'ntractorLaw- You may cancel this agreement if it bas 'ecu sighed at a place other than the conwactoet;noro al place ot'business,provided you notify the contractor in writing at hisiltar main offic c or branch office by ordinary mail posted,by Act 'in sent or by delivery,not later than midnight of the third business day following the signing (this agreement. See the attached notice of canetitgtion form for an explanation of this right. DO NOT SIGN HIS CONTRACT IF THERE ARE.ANY BLANK SPACESM r+ r.1h.ouerr N d—ld W[:cps by dw senSrsebr. Tura idenTical copies of[h,:runxr cn cksr be wmplcc�I nn�E bys�.Once cups'a�u13 go m rho ima,xro�nl. P5' 1lomeotvner's Silntatnrc :Con S Signidut 7 e7 Date Date c !E Contractor Arbitration � The Home Improvement Contractor Law provides homeowners with the right to' bate an arbitration action(as an alternative to court action)i f they have Ea dispute with a contractor. The same righ is not automatically afforded to a contractor,however. The contractor wbtild 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 he contractor the same right to arbitration as is afforded to the homeo,vner by.the Home improvement Contractor Law- The contractor and the homeowner her 6p mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contracL0J may submit the dispute to a private ar6itra ion firm which has been approved by the Secretary of the Executive office of Constimcr Affairs and Business Regulati n and the consumer shall be required to submit to uch arbitration as providt d to Massachusetts General Laws,chap r 1142A4Romeowrier's Signat reCont NOTICE:"Che signatures of the parties Aboveapply only to the agreement o the ative dispute resolution initiated by the contractor. 1Che homeowner may initiate alternative di Aute resolution even where this section is not separately signed by the;parties. Homeowner's Rights A homeowner's rights under the Horn Improvement Contractor Law(MGL chap er 142A)and other consumer protection laws(i.e.MGL chapter 931 L)''nlay not be waived in any way,even by greemcnt. However,liomeownem may be excluded from certain rights i the contractor they choose is not properly gistered as prescribed by law, Homeowners who secure their own bLilding permits are automatically excluded,;rom all Guaranty Fund provisions of the Home Improvement Contractor L,w. The contractor is responsible for comp eting the work as described,in a timely and workmanlike manner. Ho ooNvhers may be entitled to other specific [egal rights if the contractor guarantees or provides an express wa anty.for workmanship or materials. In ad ition to guarantees or warranties provided by the contractor,all goods tild in Massachusetts carry an implied war,anty of merchantability and fitness for a particular purpose. An enumeratica of other matters on which the homeowner and contractor lawfully agree may be added to the terms of tile contract as 110Rig as they do not restrict a homeowner'sbasic:consumer rights, if you have questions about your consumerlhomebvvner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must he executed in�dulicate and should not be signed until a cop of all exhibits and referenced documents have been attached. Ps`arc<also advised not to sign rbc documen until all blank sections have been filled in or marked as void,deleted,o'r not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other pt 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 ave received a fully executed copy of the contract,and the three day rescis ion period has expired. Accelerated Payments A contractor may not demand paym nt.s in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to befinancially insecure. However,in instances where a contractor deems him herself to be financially insecure,the contra tgr nay require that the balance of funds Dot yet due be placed in a joint escrow account as a prerequisite to continuing the;.contracted work. Withdrawal of fun is from said account would require the signatures of both parties. I Additional Information Ifyou have general questions or necil additional information about the Holne It,tPrOvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Con umer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business ire lation 10 Park Plaza,Room 5170,Boston,IvlA 0 116 617-973-8787,888-183-3757 Or visit the OCABR website at hu t:Ytr•, tJ.F tas,.:;it�":uc;tttr on have questions or need additional information specifically you want to verify the registratiori of a contractor or if y about the contractor registration cottpaneni of the Hanle Improvement Contractor Lav,contact: Dirbctor.af Home Improvement Contractor Re is ration O� ce of Consumer Affairs and Business Re lation 1.0 Park Plaza,Room 5170,Boston,MAO 116 617-973-8787,88k-283.'3757 or visit the RIC website at ltti��'��t+�,'•lu t i't'`'t `"'` t Go online to view the status of a Hme lilnprovement Contractor's Registratio h _�it>. 4ut�.m:i.uslttntcitnnr # ,n€'irt.ntieeiiM..i;n For assistance with informal mediation of:disputes or to register formal comp/ ints against a business,call: Consamer complaint Section office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 5WO52-1800,508-755-2548 or 413-734 3114 Vc+ston 2i-I tl? 2tt10 The CoMr ORWeallh of'.Itljassachusefts - DeVartagent vf"xPastrialAcchlenty M 1 C!Ongrress Xvtt eet,suite 100 gostor , 7i 9 02114 2017 www niass.gov1di'a 'G�T'orkers'ConxpeaasatialaXlisur mice Affidavit-}waders/Contractor:s/�lqctxxcians//�'lnobexs. TO 73E FILE))VIIHTHE pR1:tIVfJ.7CT]NG.ATJT)107EtdTY Please f`rint Le bl �ppjieapt In oor enation � ..b . .mm. ,p ..... . Name(13nsiness/Orgari!7,atioi3&dividual): M. .Address: " � � o .p city/state/zip:� �. Are you,u employe,.?C&,clt the pliiropriato bei: Type of project(l'equxred}: " " r arttun). 7. D Now construction 1. am a employervithemployees G£zil andf4 ,d X am a sole proprietor or partnership and havo no employees worldrfg for me in $. Ii emodelirlg any capacity.(Noworkers'comp.insurance required.] Demolition 3 1ant ahomeowner doing all workmysclf[l;loworkere comp,uasurancerequired.i t 10 E]Building add tlori 4.E]I am.a homeowner andwiill be hiring contractors to conduct all work on my property. l will 11.11 1J Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12.[]Plumbing repairs or additions proprictors with no employees. 5.FJ X am a general contractor and 1have hiredthe sub-contractors listed on the attached sheet. 13,F!E,00 fiepairs ,fhesa siib-contractor's fiade employees and have workers'comp.irasuran4o 19 El Othixr 6.❑We are a corporation and its gff gers have crrequired.] right insurance rired MGG,c, 152,§l(4),and wo have nq earr 11" , ple workers' o Any applicautthat chects UoXA must also fill out the section below showing their workers'compensation policy information. davit indicating �if Ibis affidavit ktall work andthert ono h 1Tomeawrs whosl ataeashowing the name f the subcontractors and state whether or hose entiti have tCoutraetors th k boxmuthna employees. If the sub-calraolors Taava employ ees,ley must provido their workers'comp.policy number. X am an employer that is pf'cividirrg-World rs'compensation insurance for my employees.'.below is thepolicy arta johs ite information. µ . �° _ - Iusurance Company Nama: - ' � „ " Expiration Policy 9-or Sem ins,Lir,. „ .� ...,, „ l f-w ,.. ,. _ C%t�I/State%zap i„.. . N fob Site Address. �-� Attach a copy olFtlxe vvorlcers' �npexzsation policy declaration page(slio tying e policy number and expiration date). Failure to secure coverage as required under MGL o. 152,§25A is a criminal violation punishable by a dine uIi to$1,500.00 of a STOP WORK ORDER and a fine of lip to$250-00 and/or ono-year imprisonment,epi this statement ins Well as GiVil lties in the formay be forwarded to the Olft e of It�`ves a ns oG`the DTA..£or insurance d clay against the violator.A copy coverage verffloation. ” lr da hereby cert fy a P the i s andpenaftles ofper;/ury treat the informatlon provided alcove is trace and car s ect. Si nature: ` r C� Phone It: official. Official use only. Do not write in this area,to be completed by city or fawn a fl City ar'I awn: PerrnitUcense# Issuing Authority(circle one): i L Board of gealth 2.);wilding Department 3.City/`pa'vvix Clerk 4.Electrical Inspector 5.plumbing Inspector 6.other ---- Phone Contact persont: - ~1 WILLI-6 OP ID: LANK �C®R® DATE(MMIDDIYYYY) CIERTIFICAT F LIABILITY IN URANCE 1110712016 THIS CERTIFICATE IS ISSUED AS A MATTER OF�INF,ORMATION ONLY AND CONFERS 140 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AL `ER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DdES NOT CONSTITUTE A CONTRACTETWEEN 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 b endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A sta ement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). j PRODUCER j CONTACT Macdonald&Pangione Insurance NAME: Kim Landry 104 Main Street AONE!C 978-6 $-6921 978-688.5350 North Andover,MA 01845a -MAIL klm@in in5.net Lisa Ross ADDREss INS RER[S)AFFORDING COVERAGE MAIC q INSURER A:Guard insurance Group INSURED W Mckay Construction, LLC Billy INSURER B 18 Academy Avenue INSURER C: Haverhill, MA 01832 1 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THISIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERK 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 POLI�LIM SHOWN MAY HAVE BEEN REDUCED SY AID CLAIMS. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE f?OLICY NUMBER MM1DD YYY MMfDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 6 COMMERCIAL GENERAL LIABILITY ! PREMISES Ea occurrence S CLAIMS-MADE 11 OCCUR MED EXP(Any one person) $ i PERSONAL&ADV INJURY 5 E GENERAL AGGREGATE 5 GEN'L AGGREGATE LIMITAPPLIES PER: I PRODUCTS-COMPlOP AGG 5 17 POLICY PRO LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident)S ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS j BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED I I PROPERTY DAMAGE $ PER ACCIDEN S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DED RETENTION 5 S WORKERS COMPENSATION ! { X SLIMIUS PER AND EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNERIEXECUTIVE Y!N WM``., 6760002 0312912016 03129!2017 E.L.EACH ACCIDENT S 500,000 OFFICERIMEMBEREXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-to EMPLOYE~ S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 I I : i DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES{Attach ACOfiD 101,Additional Remarks Schedule,it more space Is requifed) i I e F CERTIFICATE HOLDER s CANCELLATION I j SHOULD ANY OF ZE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOM1 DATE THEREOF, NOTICE WILL BE DELIVERED IN i ACCORDANCE WI H THE POLICY PROVISIONS. 1 - AUTHORIZED REPRESS ITATIVE r � . O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORIJ name and logo are registered marks of ACORD ® DATE(MMiD€YYYYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME_...__--...-_Sand. miunroe M.P. Roberts Insurance Agency PHONE (978) 683-6073 ArX Na: (978) 683--3147 1060 Osgood Street ADDRESS: sandi@mprobertsinsurance.com North Andover, MA 01845 _ INSURER4S)AFFOROING COVERAGE ___—___ NAICB INSURERA:Merchants Mutual Insurance Ca INSURED INSURER B __ --.---- ....................................---------._..._........._...._-.._.__. W MCKAX CONSTRUCTION LLC INSURER C: ATTN: BILL MCiCAY -- --- _ ------------ - INSURER D 18 ACADEMY AVENUE INSURER E: BRADFORD, MA 01835 ._._.....R..___._..._ _ 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 CONTRACTOR 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIIDDIYYYY i MMIDUYYYY 1 LIMITS A GENERAL LIABILITY BOP9097489 8/14/16 8/14/17 EACH OCCURRENCE S 1,000,000 RENTED X COMMERCIALGENEPALLIABILITY I DAMAGETO _PREMLSEx_ aa_owrr c $ 500,000 CLAIMS-MADE LK1 OCCUR MED EXP(Any ore persen) _$_.._...--_151.000._-.. PERSONAL&ADV4NJURY S 1,0 0 0 OOQ GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIESPER PRODUCTS-00mPlOP AGO S 2,000,000 _. POLICY 0 PRIT LOCIEQS AUTOMOBILE LIABILITY 8 6/16 8/6/].7 W ED INE ELWIT A MCAI002126 / � S.-_--1..e_000_r.00D._.. ANYAUTO BODILY INJURY(Per person) £ ALLOWNEO SCHEDULED BODILY INJURY(Per accMent) S AUTOS X AUTOS - — NON-OWNED PROPERTY o1iNEAGE X HIRED AUTOS X AUTOS Peraccidenl A X UTABRELLALIAB X OCCUR CUP9147266 8/14/16 8/14/17 EACH OCCURRENCE S 1,000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 1,000,000 OED X RETENTION$ 10,000 S V40RKERS COMPENSATION , WC STATU- OTH- AND EMPLOYERS'LIABILITY iOpKL3hALT ANY PROPRIETOWPARTNER!EXECUTIVE Y� EL_EACH ACCIDENT OFFICER „5 fMEMBEREXCLUDED? NIA ..___.___..�....... ......... {Mandatory In NH] E.L.D_ISEASE-EA EMPLOYEE„ -3_W,-.,_W.._,,,-,,....._.________.,,_...... It yes.describe under DESCRIPTION OF OPERATIONS hetow FL.DISEASE-POLICY LIMIT S I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Atiacli ACORD 101,Addltional Rerrnrks Schodule,if more space ie rerIti red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SEFORI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS_ NORTH ANDOVER, MA 01845 AUTHORIZED)E PRESENTATIVE O 0-88-20110 0 A ORD CORPORATI 6N. All rights reserved. ACOR0 25(2090105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: i Office of Consumer,Affairs&Business Reguiation!! License or.registration valid for individual use only before the , ,,• HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Registration: 179265 Type: Office of Consumer Affairs and Business Regulation ;.; Expiration: 7110/2018 LLC 10 Park Plaza-Suite 5170 Boston,NIA 02116 W.MCKAY CONSTRUCTION LLC. WILLIAM MCKAY 18 ACADEMY AVE. HAVERHILL,MA 01835 Undersecretary Not v lid t iut signature 81,021801£U JauOis53uJu}00 i gr8i o VW l-IIHl13AVH 3nN3AV AW3avov n 41;y,: ">low wVII1IM Josiraad:�� uOs13nJ1suo�. l££690-SD :asua3i i spJUpu,015 pue suo1jujni5aZj 6ujpjinq io pJeoa A1aie5 ojlclnd do 1uaw:pedap s4lasny3vsseV4