Loading...
HomeMy WebLinkAboutBuilding Permit # 10/26/2016 �,ORTy BUILDING PERMIT of %OR , 4,, a TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION r m � Permit No#: Date Received Date Issued: w � V IMPORTANT:Applicant p scant nzu5t complete all items on this page i/' ,r/ /��%ri/ //i ✓/ r r r r r r / /,//o,,.:// ///,,,./ / /�/„ �,fie,., rrr/// /ro��, ///i/ ,/, „,/ ,rr,//,�, ,,,, „/:. / ✓.,. /ii „i� r r r!,r„ / s� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family --__ ❑Addition ❑ Two or more family ❑ Industrial —J Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg El Others: ❑ Demolition ❑ Other _ ❑ Septic ❑Well ❑ Flw odplain " 0 Wetlands Wate�shed'Distrxct " 0, Weer/Sevrier, rr , DESCRIPTIONOF WORK TO BE PERFORMED: ... ., - Identification - Please Type or Print Clearly OWNER: Dame: a Irv,; Phone: � Address: Co�tract�r, Nariier Ph©rie: . �„ Address " / Supervisor s Construction LNcense �� � // ��� 0 Exp / Date & r/ % Hc�rne'Irnprovernent License r Exp =0ate ARCHITECT/ENGINEER Phone. Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92,00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. 11 Total Project Cost: $ FEE: $ Check No.: t 03 Receipt No.: 0'1.9 NOTE: .Persons contracting with unregi ere rc tractors do not have access to the guaranty f and Signature of Agent/Owner "ignature of contractor NORTH own of s �� bAndover 0 Im No. �„�s h ver, Mass, COC NICNEW1CK 41' �.p 4��RTEp A44,�'i�7 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........ ........ PA... /010 BUILDING INSPECTOR has permission to erect .......................... buildings on .............. ........ ... m ®,w, p Foundation "'C. Af ..... � .. Rough to be occupied as ...... ........................ ......,.... ...... 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 LESS C® STRCTI® STARTS Rough Service ........... . . . ........................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit required to Occupy Building 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. ' The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P.Q.Box 1025 State Roarl,Stow,MA 01773 PERMIT Date: Permit N© Dig Safe Number (City of`I`own] (�-Applicable] In accordance with tha provisions of KG L. Chapter 1 Oas provided in section�2 7 CMR 34 StartDate 01 This Pe=it is granted to: it•d . PuR nano of person,firm or Corporation Permission.to locate dumpster .for construction/renovation/demolition of structure Comments: dun seer be 25 ' from structure or covered with tarp or plywood RZstdOdOns: a t e n d of workday at (Give location try street acid no.,or descn"be in such manner a to prowled adequate idemcation oflocation) Fee Paid$ _ s�� � �C � tlll Tbis-Pormit Vii.expire (Signatrne of ofHoal grantEgpemnit) Offical grantingpermit (Titl TWI_ra �F 2ktl1EY I lil[-fiT i=ts C`E71V PEC`1 tf111CI Y P(� T�l'i l IRnfa1 TI-[F pR ltfliCi~fi 400m 1$8" 3 � 5 i '�n 29" G I n � tf L " a3G ff k 18"--/--� �'t � I 3 � F34 L� UF342 - - EIFI;42 _ 2 w W213SR I j 2718 W3036BD j F[ CV1273[iL a PC3024XI� .� —DtSHW B21L---B11 D-- D1NR6_8$ ? 3 --EXTRA-MAT AlLANG �- -- f7 Nk 36 3—— 2)TOUCH UP KITS DC� GIE� ARVAL 2)SCRIBE=BAT1S DOOR BTL34 BTL34 IEm w 1)FILLER=UF342 POST=3'112"x 31P2" �� I= w � IU CROWN MOLDING PiLT .irk CUT PANEUFILLER A a 4 1r2"WIDE 6)FURNITURE BASE -DING=ASBB T)SMALL COVE CRt3 =SMCC8 ` HARWARE INSTALL PANEL(V WES1542) 1-11 w CA CUP PULL ON DRA BP53010-FB - d ON RIGHT SIDE K p KNOB ON DOORS= -FBy OF STACKED WALL ' % CABINETS TO HIDE SEAM z t� m 2m3 CD p M € 1 i -4 f to® C; _ E E33t16E}€}ST2 r S M 40 TlE f5 DB3fl 24R-BOPJDG s� i x E FI i I Z I N VV303690 ; VU3036BD I JWDE36 j ------------ 3(r ----------3(r " 73 I= cai --40. 'a t rpF ♦43 3fl"— 3E'i" ' 33 ff_______s ff n it t75 82" Jit �7C7 24- C 102-21" ' e" if i 3 2 All dimensions-size designations20 This is an original design and mast ;Designed: 10/13/2016i . given are subject to verification on 1=�� �� , s not be released or copied unless ;Printed: 10113I2C}16 job site and adjustment to fit job applicable fee has been paid or job conditions. £order p laced_ ; 3 1 i \o S Drawing E p Crumrine Beth and Mike !All �. cale_ I l - 3 i I THIS 1S A FINAL LAYOUT }'�;�'�« ' Designed: 10/13/2016Approval below constitutes Nate:This drawing is an artistic , ���,� a, Printed: on�rzO l interpretation of the general recalloLOG]ks , your acceptance and understanding appearance of the design.It is Of this layout not meant to be an exact rendition. . . I PJB'Cnnnrine Seth and Mike All Drawing#: l D�GG�T(U� 990000 __ _,.- _._ 00 OD �711r-l - 100o a o ❑B � a 00 s lif - O b ❑ ❑ 71 0 o e I E :�5UIA.J 41 4 Rate BAs THIS(SA FINAL LAYOUT Approval below consbtutes Note:This drawing is an artistic � 71. Designed: 10/13/2016 your acceptance and understanding interpretation of the general Printed: 10/13/2016 $ this layout, appearance of the design.It is ;€ not meant to be an exact rendition. x PJF Crurnrine Beth and Mike A11 Drawing#: 1 _ 1 I a o s s ff I IF ---------i- i CSDT TQDQD loop {Note:This drawing is an artistic ��� �,s;� Designed: 15f13/2016 Approval WOW y, interpretation of the general ECNNOLQGIES Printed: 10/13/2016 T k"T O T �ptan + and understanding appearance of the design.It is of this layout. not meant to be an exact rendition. i I .__ PJfi Crumrine Beth and Mike All Drawing 9_ 1 ' cLEA?" ----------- ------- -------- a s a e e a I M CAt irn THIS(SA FINAL LAYOUT ��2 � Approval below constitutes 4 " Note:This drawing is an artistic20 Printed Designed: 10/7/2016/ 006 ��ptance and understanding interpretation of the general TECHNOLOGIES 2�' ��] appearance of the design. It is of this layout. not meant to be an exact rendition. X F'1F CrLTrnrine Beth and Mike All Drawing#: 1 nl / yf4 e.'modc➢m'I Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 North Andover, MA 01845 LLC 978-479-1526 9/8/16 adambrico@gmail Contract vwmww�nuwwwwoioiouuomonuwouuuuumumwiwowuwwmwwu avium uwwwwawrww�wwuwwuwuw uwwuwwuwnuw,wwmwwu'juuwnlli inrinlwlmmwwwmuHIMa!alguwwwwwwwiwu bumi"MI MwwwoPpigpppwMuwwww wauuo upiwiyuiuwmwwmgmwivugmpipiam�!iwnwumuuouwomnuuwnuuuuwmuwwwwmpuiowuwwwmw�a .,,.,..y Mike and Beth Crumrine 35 Meadowview rd N. Andover MA 01845 i 978 886 3509 Exhibit A: Job Description: Kitchen remodel with removal of wall I • Demolition of kitchen including 2 walls (Sheetrock only) ceiling and floor. All debris to be demoed and disposed. Wall between dining room and kitchen to be removed. 15 Yard dumpster will be placed on site for debris • Dining room hardwood floor removed. Transition strip to be installed at dinning room if necessary • At the removal of wall between dining room and kitchen. Structural beam installed to support attic ceiling above. Engineered beam size to be calculated. If it is determined and the wall is not structural a credit will be given. • New kitchen casement window installed, window location tbd. Area to be framed • All exterior walls that are opened to be insulated. All demoed areas to be blue-board and plastered. • New 3 '/a" hardwood floor installed, sanded, stained and polyurethane. Stain color to be determined • Electrical layout to coincide with kitchen design. Including, led recessed lights, under cabinet lights, 3 pendant location (pendants supplied by owner). Cable location, all outlets to code. • Installation of cabinets an allowance of $12,000.00 is included for cabinetry purchase. di p /fnor( i Vlckitcl,�ietridb tl�i.c rri Handles or knobs install but purchased and supplied by owner. Kitchen layout designed by a professional cabinet company and to include 3D designs. Permit will not be granted until design is finalized • Granite counter tops supplied and installed and allowance of $4,000.00 is included. Stainless steel sink included with granite purchase. If farmers sink is desired, customer is responsible for purchase. Faucet and disposal supplied by owner and installed by plumber. • New trim work installed to match remaining house. • Entry floor area to receive tile and underlayment. An allowance of$400.00 is included for purchasing of the and grout. • New entry door Therma tru http-//t.hermatru.q Orta I entry door install with new exterior trim to be PVC, interior trim to match remaining house. An allowance of$1500.00 is included for purchasing of the door. Knob supplied by owner installed by BriCo Supply and install new sliding patio door. 0 Remove and dispose existing door system and all trim work. 0 Install new white vinyl Harvey Sliding Patio door with grids (only grid patterns are 151-ite and Praire ) a All new interior and exterior trim. • White handle locking mechanism included Painting not included. • Permit fee included. Allowance Total $17,900.00 Total combined Estimated Cost $53,470.00 Job Description 2 Bathroom remodel. • Demo and remove existing tub shower tile. New fiberglass tub unit installed. An allowance of$600.00 is included for the purchase of the tub.(curved) New shower valve installed. An allowance of$500.00 is included for new showerhead and tub finishes. Walls to be tiled one niche installed in wall. An allowance of$300.00 • Installation of recessed light over shower and switching. • Exhaust fan supplied, installed and vented • Floor to be demoed and receive new tile and underlayment. An allowance of $300.00 is included for purchasing of the and grout. • Baseboard Heat to be cut back and shortened. • Bead board blended in • Painting not included Allowance total $1700.00 Total combined estimated cost $5900.00 Grand Total including all allowance is $56,490.00 The Owner agrees to pay BriCo Building and Remodeling $56,590.00, for doing the work outlined above. The following payments will be paid to the contractor in the following manner: • First Payment is of$1,500.00 is due once contract is signed. Secure permit fees, kitchen design appointments, dumpster, window order and product organization. Deposit of cabinet total will be due prior to construction beginning. Cabinet balance will be due at shipping date. This cost is not included in the payment schedule because it is an allowance. • Second Payment of 12,000.00 is due permit has been obtained and construction is scheduled to begin. • Third Payment $10,000.00 Once walls are sheet rocked and plastered. • Fourth payment of 8,000.00 is once flooring is complete and finish's are beginning • Final payment at completion of project. Allowance totals to be calculated and credit or extra cost will be presented. Purchasing of products with an Allowance may cause payment schedule to change. An "Allowance" is an average cost for products that need to be purchased and are based on style. The cost is calculated to the dimensions of your project. If your item exceeds the allowance cost you are responsible for the difference. If the item is lower then the allowance E cost a credit for the difference is applied. i a All subcontractors that are hired by BriCo or the homeowner must carry the appropriate license and insurance to perform work in the state of Massachusetts. The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices, and all work performed shall be subject to final approval by Owner. All work to be done incompliance with Massachusetts building code. BriCo takes on full responsibility of all necessary inspections. All craftsmanship is warrantied for one full year from completion of construction. Warranty is voided if repairs are necessary due to a natural disaster. All glass installed meets state energy code for performance and efficiency. Each glass unit will contain its own energy certificate. Any unforeseen work or necessary repairs found during this project to be brought to the owners attention as soon as possible. Any extra work resulting from unforeseen problems will be priced accordingly on site and be done with written approval. BriCo is not responsible for anything that occurs on site that is not directly involved with the construction of this project. BriCo Building and Remodeling is a fully licensed and insured LLC company. License numbers are provided in the header above and current insurance documentation upon request. BriCo is a full service general contracting company. We take pride in our work look forward to the opportunity to work with you. Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 North Andover, MA 01845 LLC 978-479-1526 9/1/16 adambrico@gmail �wirm�mwiW ...... aimgimwwwuwuHrmirumu!wmiwiu,w,uwwiii�muwmmmpummw,mmwuuiaugmi w!wwwiww�wuuNpwSmn,,NiWiwunwmu�womouu�uu�uuu�,uyiuuui�wummmmmuumwouqumuoouumouuuuumpw!uu�!�wmmm!w!wiWgw..,_...iiianmim�m�mmwuwmuuiuiwwoi,,youuumuiHmimuiuiu�pmuwunamVumiru�mmmmumwwwuwpi;w, CONSTRUCTION CONTRACT This Construction contract dated as of 9/1/2016 By and between Mike and Beth Crumrine_of 35 Meadowview rd North Andover MA 01845 Owner and contractor in consideration of the mutual covenants hereinafter set forth, agree as follows I Article 1 Contractor shall construct the items in Exhibit A in accordance with contract documents, as identified in this contract on property which is located at 35 Meadowview rd North Andover MA Article 2 Contract Price The Owner agrees to pay BriCo Building and Remodeling $56,590.00, for doing the work outlined above. See exhibit A for payment Schedule details. Article 3 Change Orders Both parties shall agree any unforeseen work or changes requested during this project to be granted with written approval. Any extra work resulting from unforeseen problems will be priced accordingly on site and be done with written approval Article 4: Contractor's Representation Contactor has familiarized itself with the nature and extent of the contract documents, work site, and all local conditions and regulations that in any manner affect cost, progress and performance of the work. Contractor is duly licensed to perform the work as required by laws and regulations. Article 6: Contractors Responsibilities The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices, and all work performed shall be subject to final approval by Owner. All work to be done incompliance with Massachusetts building code. All materials and equipment shall be of good quality and new. All materials and equipment shall be installed in accordance with manufactured specs. Contractor shall be fully responsible to owner for all acts and omissions of its subcontractors, suppliers and other persons performing or furnishing any work under contract with contractor. Contractor shall be responsible for initiating maintaining and supervising all safety precautions in connections with work. Contractor shall comply with all applicable laws and regulations relating to the safety of persons on the property Contractor shall repair or replace at Contractors sole expense every portion of the work that is damaged or destroyed before final completion. Contractor warrants and guarantees to Owner that all work will be in accordance with the contract documents and will not be defective. If within one year after the date of the final completion or such longer periods of time as may be described by laws or regulations or by the terms of any specific provisions or applicable special guarantee in the contract documents and work is found to be defective. Contractor shall promptly without cost to owner and in accordance with written approval correct such defective work. Article 7. insurance Contractor shall maintain general liability and work-mans comp insurance for the work being performed at 35 Meadowview rd North Andover MA. Contractor shall deliver to Owner certificates of proof. Owner shall be responsible for purchasing and maintaining Owners Liability insurance and or other reasonably appropriate insurance. Article 8 Termination Termination by Owner. if Contractor breaches any obligations under this agreement then owner may give Contractor written notification identifying such breach. If Owner has not cured such breach within 7 days from written receipt or if breach cannot be cured or Contractor does not begin to cure or fails to 8 diligently prosecuted cure to completion Owner may terminate contract and take possession of work. Termination by Contractor. If Owner breaches any obligations under this agreement then Contractor may give the Owner written notification identifying such breach. If breach is not cured in 7 days or Owner has not agreed to resolve such breach then contract may be terminated. Exhibit 9 Owner and Contractor each bind itself, its partners, successors, assigns legal representatives, to the party hereto, its partners successors, assigns and legal representatives in respect to all covenants, agreements and obligations contained in the Contract Documents. This contract and all issues disputes and matters arising out of it shall be governed by and construed in accordance with the laws of the state in which the Property is located, exclusive of the body of the law governing conflicts of laws. IN WiTNESS WHERE OF, Owner and Contractor have signed this Contract This Contact will be eff a on September 8, 2016 Owner. Address of Property.-35 Meadowview rd N. Andover MA Contractor.-Ada-m Brien BriCO BuiC�ng and�Remod---ing Address:417 Waverley Rd North Andover MA 01845 Title: Owner Operator The Commonwealth of'Massachusetts Department of Industrial Accidents Off ice of Investigations 600 Washington Street Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busijless/Organization/Individtial): Acmo f3cici\.) 1:-VIce) Address: City/State/Zip;0A#yboA4_ i�1895 Phone 4: �e ----—--------- Are you an employer?Check the appropriate box: Type of project(required): IR I am a employer with 4. F1 I am a general contractor and 1 6. �New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet. Remodeling 7 ff ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. workers' comp.insurance. 9. F1 Building addition [No workers' comp. insurance 5. F-1 We are a corporation and its 10.F-1 Electrical repairs or additions required.] officers have exercised their 3.El I am a homeowner doing all work right of exemption per MGI.. I L EJ Plumbing repairs or additions myself, [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] r employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'corrip.policy information. I am an employer that is providing workers'compensation insurance, or my employees. Below is the policy and job site information. Insurance Company Name: --------------- Policy gorSelf ins.Lic.#: ­710% f�„ TM71 6_12,1111, Expiration Date: Job Site Address:5�,,; i� K,0 City/State/Zip: _A),A�,, cmit o Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MG1,c. 152 can lead to the imposition of criminal penalties of a fine Lip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a sToi)WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true rind correct. Si*nature: . d, � -, Date: U Phone 4: -7 tll-7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector G.Other Contact Person: Phone M DATE(MMIDDIYYYY) ACS L� CERTIFICATE 4F LIABILITY INSURANCE 7/11/16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 thi s certificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER CONTACT Tricia Sabuli3 Armand P. Michaud Insurance Ag PHONE (g78) 685-2549 FAx Na; (978) 794-0822 105 Haverhill Street ADDRESS: trici-asabulis@michaudinsurance.com Methuen, MA 01844 INSURE S AFFORDING COVERAGE INSURER A:Green Mountain Insurance Co. INSURED INSURER 13:Norfolk & Dedham MA BRICO Building & Remodeling LL INSURERC: Adam J Brien INSURER D: 417 Waverley Rd INSURER E: N Andover, MA 01845 INSURERF: 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 HERE=IN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPEOFINSURANCE ADOLSUSR POIJCYNUNBER...�^..^^.....^. ..pM1IDDDYPOLICY EXP NYY MrMIDBTYYY LIMITS p, GENERAL LIABILITY 20009201 4/13/16 4/13/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES E (Ea occ rT $ CLAIMS-MADE OCCUR MED EXP(Ary one person) $ 5 000 PERSONAL&PDVINJURY $ GENFRALAGGREGATE $ 2,000,000 GEN'LAGGREGA7ELWITAPPLIESPER PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY PRO- LOG $ B AUTOMOBILE LIABILITY 91561617A 6/18/16 6/18/17 COaNB9NEEDNSINGLE LIMIT $ ANYAUTO SOOILYINJURY{Per parson) $ 100.000 ALLOWNEO x SCHEDULED BODILY INJURYIPeraccident) $ 300,000 AUTOS AUTOS HIREOAUTOS NON-OAUTOSWNED P era- iiddentD OE $ 100,000 $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSLIAs CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION WC STATU- I 10TH- AND EMPLOYERS'LIABILITY Y I N TORY I IMITS FR. ANY PROPRIETORIPARTNERIEXECUTIVE NIA E.L.EACHACCIDENT $ OFFICER/MEMBEREXCLUDED? _f (Mandatory In NH) E.L.DISEASE-EA EMPLOYE Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L.DIS EASE-POLICY L IMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more since Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Tricia Sabulis ©1988-20110 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: (978) 685-2549 Fax: (978) 794-0822 E-Mail: triciasabulis@michaudinsurance.com AC a� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDmYY) 07/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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: Trudy Lawler MICHAUD INSURANCE AGENCY PHONEFAK AIC No,Ext): 978( ) �6$5-2549 AfG No}: ADDRESS: trudylawler@michaudinsurance.com 105 HAVERHILL ST. INSURER($)AFFORDINGCOVERAGE NAIC# METHUEN MA 01844 INSURERA: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER e BRICO BUILDING & REMODELING LLC INSURERC: 417 WAVERLEY RD INSURER E: NANDOVER MA 01845 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 67853 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 GONDITION 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. LTR TYPEOFINSURANCE W ADD€SUER POLICYEFF PI EXP POLIGYNUMBER MMIDDIYYY MWMlDDDD1YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OGCURRENCE S DAMAGE RENTED CLAIMS-MADE OCCUR PREMISES-(E�aOccurrence) SY ... ...,_, MED EXP(Anyone person) $ _-.. NIA PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGHFGATE S POLICY L-]PRO- 1E11 D LOG PRODUCTS-COMPlOP AGG $ OTHER: g AU€OMOBILELIAeILtTY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOSAUTOS NIA BODILY INJURY(Per accident) S HIRED AUTOS L NON-OWNEDAUTPROPERTY DAMAGE Per accitlent UMBRELLALIA13 OCCUR EACHOCCURRENCE $ EXCESS LIAB _,- CLAIMS-MADE NIA AGGREGATE S DED RETENTION$ -..^ .$ T. WORKERS COMPENSATION -X PER OTH. YIN AND EMPLOYERS'LIABILITY !� STATUTE_- ER ---....,..._ _.. , ANYPROPRIETORIPARTNEPJCXECUTSVE E.L.EACH ACCIDENT S 100,000 A OFFICEWMEMBEREXCLUDED? NFA NIA NIA 7PJUB4618P50716 04/19/2016 04/19/2017 ----_ - - (Mandatary In NN) 1t yes,describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 -- - DESCRiPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 N/A DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additlonat Remarks Schedule,maybe attached if mere space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www,mass.govllwdlworkerf-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M.Gro ey,CPCU,Vice President—Residual Market—WCRIBMA O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks ofACORD F Massachusetts Department of Public Safety t Board of Building Regulations and Standards License: CS-104428 Construct'rovt Supervisor ADAM J BRJEN 417 WAVERLY ROAD, NORTH ANDOVER MA,:018 iii r , CA Commissioner 05/12/2018 to tlaoup flan X Sooty and Wdallfu d� . AdminlaRreffon This card acknowledges that the recipient has successfully completed a 10-hour Occupational Safety and Health Training Course in Construction Safety and Health i Adam Brien _..-..... . ..._ .._..... Marcus Nerino 1 /19/10 (Trainer narne—print or type) Course end data); 1 _. . ami^erwtm�e.,eb ._ ' t d C c ti`r,r�n rzrr�rcie rzfler r fC` %/11JJtr /Ie jeCta ..,,; Office of Consunier Affairs etc f3usino.ss';ftegutatitin i OMB IMPROVEMENT CONTRACTOR Typo' , egistraticn: 168512 Expiration. 3/1/2017 LLC BRICO BUILDING AND REMODELING LLC ADAM BRIEN � 417 WAVERLY RD WORTH ANDOVER;MA 01845 Undersecretary