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HomeMy WebLinkAboutBuilding Permit # 11/2/2016 12 ci7 2- 3 — 7 of NOeoTJJ 6�'b0 BUILDING PERMIT = y : , ^.,,,_;6 TOWN OF` NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION * _T - W7f °moo to Date Received � 3,� °R,��° Permit No#: a ,.� ul �SpcH05 Date Issued: JjVJPORTANT: Applicant must complete all items on this page LOCATION ' A167 P . t PROPERTY OWNER 100 Year Structure yes no Print MAP PARCEL: ZONING DISTRICT: Historic`District yes` no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ ew Building One family (/Addition ❑Two or more family [I Industrial Ll Alteration No. of units: ❑ Commercial Ll Repair, replacement ElAssessory Bldg ❑ Others: ❑ Demolition Li Other l� �. ct aoc ^ h N OF WORK TO BE PERFORM' Y 6 DESCRIPTIO '/I '&p 'JAI Y .-- Identification�- Please Type or Print Clearly ��— OWNER: Name: Phone: `� �` ��` Address: /�'1 � 7 AA h5vro L, Contractor Name:_TGli Phone.: � f Email: Z7#.- .� en L� +< /1 ' /19'} Address: C� Ex Dater . Supervisor`s Construction License. .Wit' p �� Ex Home Improvement License:.. P Date: ARCH '� Phone: '~ � " � 3 7 / -° y-S Address: /� �``� �d�lr ,� Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_�lcr 70 FEE: $ Check No.: Receipt No.. NOTE: Persons contracting with unregistered contractors do not have access to th r nd Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE=DISPOSALPublic Swimmui Pools Cjg Massage/&ody lrt ❑ gWellbacco Sales ❑ Food Packagingt3ales Q Private manentDumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM PLANNING&DEVELOPMENT Reviewed Onq V10 Signature UA--� \t COMMENTS I CONSERVATION Reviewed on )4't� 1 i Ca Sianature � v COMMENTS HEALTH Reviewed on Signature COMMENTS_ Zoning Board of Appeals:variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments r Conservation Decision: Comments Water&Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer:Signature: ted 384 Osgood Street FIRE DEPARtTMENT Ternp Dumpster onsite ,yes toca�ed at 124 Mam Sfreet J� FlreDepartment slgnatureldate I COMMMTS f rf?e a ,��a 4/a F Dimension Number of Stories: I Total square feet of floor area,based on Exterior dimensions. Total land area,sq.ft.: ELECTRICAL:Movement of Meter location,mast or service drop requires approval of Electrical Inspector Yes ' No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 tine NOTES and DATA—(ror department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 �O Town of 5 "°RT" .6 Andover 0 No. h ver,Mass, BOARD OF HEALTH ILD Food/Kitchen PERMIT TSeptic System THIS CERTIFIES THAT of...._40194.16......................... BUILDING INSPECTOR 4 Foundation has permission to erect...... ..........................buildings on......M. ....00 rs00 .................. R ough to be occupied as... x. . ........ o ....eAA........... Ch 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 CONSTRUCTI TA RRough 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. s — _:,F "Couldn't your home use a late TLC?" HIC#136779 87 Belmont Street Phone:{978}685-7447 North Andover MA 0184 Fax:(978)685-7446 EXHIBIT B Pr2posal/Sl2ecification 912312016 Homeowner: Contractor: Chris Lembo Twomey&Legare Contracting,Inc. 470 Main Street 87 Belmont Street N.Andover MA 02810 N.Andover MA 01845 The following is a description of the kitchen addition and new bathroom per plan provided by customer. Denio: • Remove and dispose existing siding as needed to build new kitchen addition. Foundation Work: • Dig holes necessary to provide footings to be big-foot bases with 12"sonar tubes poured with concrete. • Contractor to back-fill with existing materials and level off grading. Framing&Rough: • Frame addition with 2X10 floor joist,'la Advantee Plywood flooring • 2x6 wall construction • 1"OSB plywood,2x8 ceiling joist,2x8 rafters,518 CDX plywood on roof • Roof shingles to be IKO Architectural shingles of owner's choice • Siding to be primed Red Cedar shingles. • Provide and install one Harvey classic window in bath and one in sitting area. • Provide and install one Triple Mulled Harvey Classic white double-hung window over the sink. Customer Initial �f— Interior Specifications: • R38 batt insulation in floors,R21 batt insulation in walls,R41 batt insulation in ceiling • `la"blueboard on walls,smooth wall finish,sand finish on ceilings • Provide 4 panel Masonite interior doors per plan • Finish carpentry to be 2 V Colonial casing and 3`Is baseboard trim • Kitchen floor to be tile with cement board subflooring. • Bathroom flooring to be the with cement board sub-flooring. • Provide I Therma-tru exterior door to deck(see allowance page) • Provide and install cabinetry in new kitchen area.Contractor to work with home owner creating the design. • Remove hardwood flooring in existing dining room area,install the with cement board subfloon Exterior Deck Specification: • Provide 6x30 p.t.deck at addition area • Provide 12xI3 p.t.deck at new door location off dining room. • Contractor to install pressure treated rails and one set of stairs. Electrical: • Provide I Nutone ceiling fanllight on switch. • I GFI outlets at bathroom sink location. • Provide 1 vanity light on switch at bathroom sink. • Provide and install I-4'florescent light in closet mudroom closet. • Install necessary outlets to code in kitchen addition. • Provide and install 8 recessed lights in kitchen on 2 switch locations. • Provide wiring to new appliances. • At back door in kitchen addition provide exterior light with switch. • Surface mounted light fixtures provided by owner. • Kitchen appliances provided by owner. Plumbing: • Provide plumbing for new toilet and sink. • Provide baseboard heat in bathroom as needed off existing zone. • Provide 2 Toe-kick heaters in kitchen area off existing zone. • Connect sink and dishwasher as needed. • Provide water-line for ice maker on refrigerator. • Cut up existing basement floor,run 3"drain line&repair floor. Job-Related Costs: • Contractor to supply dumpster that will be located in driveway. • Contractor to pay for building permit fee. • Contractor to meet inspector. • Contractor will work with owner on final plan. Customer Initial Allowances Kitchen Addition Allowances Kitchen Cabinet Material Allowance: $6,000.00 Granite Countertop Allowance: $4,700.00 Therma-Tru Door with Hardware: $400.00 Bathroom Fixture Allowance: $1,400.00 Kitchen Sink&Faucet Allowance: $400.00 Tile Allowance bath,kitchen,dining. $2500.00 Architectural Plans Allowance: $2,000.00 Customer Initial �� O E Y I ter'- ,I -\_ - .- �1 _ tt r., "Couldn't your�home use a little TLC Y"� HIC#136779 87 Belmont Street Phone:(978)685-7447 North Andover MA 01845 Fax:(978)685-7446 EXHIBIT B Proposal/Specification 9/23/2016 I lomeowner: Contractor: Chris Lembo Twomey&Legare Contracting,Inc. 470 Main Street 87 Belmont Street N.Andover MA 02810 N.Andover MA 01845 The following is a description of the first floor remodeling,removal of bathroom,remodel of nmdroom,new fire door to garage,add new beam in center of kitchen. First Floor Remodeling: I. Demo existing bathroom down to studs. 2. Floor height in mudroom to remain as is existing. 3. Remove existing beam in kitchen and extend new beam 3'to main house wall. 4. Existing exterior mud room door to remain. 5. Replace existing door from mudroom to garage with fire-rated door. 6. Remove door into kitchen and frame in. 7. Frame new mudroom wall to plan and install new interior door. 8. Move switches for relocated door from mudroom into kitchen. 9. Install hardwood flooring in sunroom—2 W'Red Oak,sanded 3 coats poly. 10.Remove closet next to existing front door,patch walls and flooring. 11.Shim-up sunroom addition as needed for leveling with cedar shims.Allowance$300.00 12.Install new 6'-0"sliding or French door to back wall,where new deck will be located. 13. Install Harvey Classic Window in back wall of sunroom,size tbd. 14.Create pass through in existing window opening at location of sunroom area. 15. Install Y connector in basement for future bathroom. 16. Remove closet and 2 foot wall next to front door,repair floor. 17. hi existing living room,repair floor as needed where walls removed,sand and finish floor with 3 coats of poly. Customer Initial ��L 18.In dining room and existing living room ceilings,overlay new V"blueboard over existing ceiling,plaster and sand finish so there will be no drywall patches on ceiling. 19.Contractor to install 518"blueboard and skim coat 2 walls in garage adjacent to living area. 20.Contractor to insulate 2 walls in garage adjacent to living area to be R 13. 21. Build new closet in mudroom as discussed on September 20,2016. 22.Frame up new doorway into kitchen from mudroom as discussed. 23.Repair areas of baseboard trim in areas of walls removed. Main House Roof: 1. Main house roof to remain,strip and install new shingles on back of garage where new addition lay over is to be water tight. 2. Head off roof line and ceiling joists where needed to create head room as discussed with Chris in mudroom area.Ceiling area in step up to be flush with addition ceiling. Job-Related Costs: • Contractor to supply dumpster that will be located in driveway. • Contractor to pay for building permit fee. • Contractor to meet inspector. • Contractor will work with owner on final plan. Costs Not Associated With Contract: • Painting. • New Exterior Garage Door. • Cost for removing wall at interior stairway. • Central Air Conditioning. Potential Credits Requested by Owner: • Credits if demo work done by owner: Demo existing deck$400 Demo First floor bath walls,floor&ceiling$600 Demo existing kitchen walls to studs and demo floor$750 Customer initial ��L Allowances New Fire Door to Garage with Hardware $500 New Slider or French Door $1800 Customer Initial W L Project Total and Payment Schedule Job Total $118,700.00 t-A Start of construction drawings deposit $ 1,500.00 PP '4' I" Signing of contract. $8,500.00 2nd Completion of Architectural Plans $10,000.00 3`d Completion of contractor obtaining building permit $ 10,000.00 4th Completion of footings for kitchen addition $ 10,000.00 5th Completion of roofing on kitchen addition $15,000.00 6"'Completion of plumbing and electrical rough-in $16,000.00 7"'Completion of insulation in kitchen $12,000.00 81h Completion of beam work in main house $ 9,000.00 91h Completion of drywall and plaster $10,000.00 10th Install of hardwood floors, 1 coat of poly. $5,000.00 111h Completion of installation of cabinetry $ 5,000.00 12"'Completion of installation of granite and appliances $ 4,000.00 13th Substantial completion of project $ 2,700.00 Customer Signature Date t 2` lip Contractor Signature Date c1 Z! !d l — 4 *This contract dated September 23,2016 supersedes any other proposals submitted*** O E.F t i G IsL L. tai—. € 'UN . - "Couldn't your home use a little TLC?" ladifftionsf HIC#136779 87 Belmont Street Phone:(978)685-7447 North Andover MA 01845 FAX:(978)685-7446 CONTRACT:9/2312016 1. Date of Contract Signing: �L-e 2. List of Documents/Counterparts of this agreement: A. Contract B.` Specifications/Proposal(See Exhibit B attached) C. Drawing/Plan(see Exhibit C attached) D. Payment Schedule(see Exhibit D attached) E. Limited Warranty(see Exhibit E attached) F. General Notes(See Exhibit F attached) 3. Parties to Contract: A. Contractor: Twomey&Legare Contracting,Inc. Shaun Twomey/Doug Legare Federal ID#20-3436110 Address:87 Belmont Street,No.Andover MA 01845 Contractor Registration No.:136779 B. Homeowner: Chris Lembo 470 Main Street North Andover MA 01845 781-856-4951 4. Description of work to be done and the materials to be used:See Specifications (Exhibit B) 5. Total amount agreed to be paid for work to be performed under the contract: $118,700.00 Owner Initials: CQL Contract Contractor Initials: 1, Page I of 4 6. Time schedule of payment to be made under the contract;finance charges for late fees(if any)*: See Payment Schedule(Exhibit D) *Any deposit required to be paid in advance of the start of the work shall not exceed one third of the total contract price or actual cost of any material or equipment of a specific or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. 7. A. Date work is scheduled to begin:(see No.14 below) B. Date work is scheduled to be substantially completed:tsee No.14 below) &. Notice: A. All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor and/or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation 10 Park Plaza,Suite 5170 Boston,MA 02116 (617)973-8700 B. For contractor's registration number,see first page. C. Homeowners have a three(3)day cancellation right under MGL Ch.43§ 48;MGL Ch.140D§10;or MGL Ch.255D§14 as may be applicable. See attached Notice of Cancellation. D. For homeowner's warranty rights,see 780 CMR R6 and MGL Ch.142A. 9. There is no lien or security interest on the residence as a consequence of this contract. 10. Permit Notice: A. The following permits will be required in connection with the work to be performed on your property: Building—Electrical—Plumbing B. It is the obligation of the contractor to obtain these permits as the Homeowner's agent. Owner Initials: C9L— Contract Contractor Initials: ' Page 2 of 4 C. Any homeowner who secures their own construction-related permits or deals with unregistered contractors shall be excluded from access to the guarantee fund. 11. Contractor reserves the right,if he deems himself to be insecure,to require,as a prerequisite to continue work,that the balance of funds due under the terms of the contract,which are in possession of the owner,be placed in a joint escrow account requiring the signatures of the contractor and the homeowner,for withdrawal. 12. The parties agree that no work shall begin prior to the signing of the contract, transmittal to the owner a copy of the contract and the expiration of any applicable rescission period. 13. Arbitration Clause: 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 Regulations and the consumer shall be required to submit to such arbitration as provided in MGL Ch.142A. 14. Other Provisions: A. Commencement and Completion of Work-Contractor agrees to proceed diligently with the agreed upon work,commencing promptly,following: o Issuance of a building permit by the town. B. Final payment shall be upon the satisfaction of the homeowner. The parties agree that the issuance of a certificate of occupancy and/or final inspection shall be the objective standard that the contract has been complete and the parties satisfied. Any final punch list items shall be reduced to writing,with an estimated date for completion. The parties agree that no escrow will be held for punch list items. C. Insurance—Contractor agrees to provide evidence of liability,workers compensation and other risk insurance. Owner agrees to provide copy of hazard insurance as is required by contractor to coordinate policies. Owner Initials: t— Contract Contractor Initials: Page 3 of 4 Notice:The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner 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 Ow0- "2e Owner Date Contractor Date Contractor Date Owner Initials: CDL Contract Contractor Initials: Page 4 of 4 -Y Cop LH-C A N� ON7P'A "Couldn't your home use a little TLC?` HIC#136779 87 Belmont Street Phone:(978)685-7446 North Andover MA 01845 FAX:(978)685-7447 EXHIBIT F General Notes Unforeseen Changes&Extras I Existing,unforeseen code violations are not included in this contract and will be priced at time and material. 2. Any unforeseen frame or sheathing-rot is not included in this price. 3. All subcontractors are in contract with Twomey&Legare Conti-acting,Inc.and are not available for direct hire by homeowner for a time of six(6)months after completion of project. 4. Contractor will keep home and site as neat as possible. At end of job,the homeowner is responsible for final cleaning and window washing. 5. Any plumbing,electrical or miscellaneous material purchased by homeowner is homeowner's responsibility to get product to site in a reasonable time for installation. Contractor does not hold warranty on these items. 6. If contractor is needed to pick up project,homeowner will incur a trip charge of$50.00 per hour,with one hour minimum. 7. Any additional work beyond contract will only be done with a signed and agreed to price change order sheet. Said payment is due in full on next progress payment. 8. Please review all items on Specification pages. Verbal additions and wants,if not in writing,are not included in the project, 9. Due to large trucks,equipment,dumpsters,etc,driveway may crack,create divots,etc. Also during construction,lawn may be damaged.Conti-actor is not responsible for same. 10. During excavation,any ledge or boulders over 20 inches will be an extra priced on site. 11. Please review plans when received to ensure design is correct. 12. Any changes made when customer is with architect will not be included if not on original Specification pages. It will only be included if a change order sheet is created and executed. Owner Initials: CIPL- General Notes Contractor Initials: Page 1 of 1 �—NTP "Couldn't your home use a little TLC?" y, HIC#13 6779 87 Belmont Street Phone:(978)685-7447 North Andover MA 01845 Fax: (978)685-7446 NOTICE OF CANCELLATION Date You may wish to cancel this transaction,without any penalty or obligation,within three (3)business days from the above date. If you cancel,any Property traded in,any payments made by you under the Contract,and any negotiable instrument executed by you will be returned within ten(10)business days following received by the Contractor of your cancellation notice,and any security interest arising out of the transaction will be cancelled. If you cancel,You must make available to the Contractor at your residence,in substantially as good condition as when received,any goods delivered to you under the Contract; or you may,if you wish,comply with the instructions of the seller regarding the return shipment of these goods at the Contractor's expense and risk. If you do make the goods available to the Conti-actor and the Contractor does not pick them up within twenty(20)days of your Notice of Cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the contractor,or if you agree to return the goods to the contractor and fail to do so,they you may remain liable for performance of all obligations under the contract. To cancel this notification,mail or deliver a signed and dated copy of this Cancellation Notice or any other written notice,or send a telegram to Twomey&Legare Contracting,Inc at 87 Belmont Street,North Andover,MA 01845 no later than midnight of I hereby cancel this transaction. Date: Signature of-Owner Owner Initials: eve- Notice of Cancellation Contractor Initials: Page I of 1 Client#:13298 TW0MEY6 A�'PR—A. CERTIFICATE OF LIABILITY INSURANCE 07/06/20 s"""' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION '.. Doherty Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.Q.Box 1985 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 21 Elm Street Andover,MA 01810 INSURERS AFFORDING COVERAGE NAIC# INSURED _ INSURER A Arbella Protection Ins Company Twomey&Legere Contracting,Inc. INSURER B 87 Belmont Street INSURER c North Andover,MA 01845 NS INS.. INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDpj EANBUREDNAMEDABOV€FQ£{THE PQLICYPERiQQ1NDICATEO.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT Of(b ER 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NS TYPE-OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPtRAT1ON LIMITS A GENERAL LIABILITY 9520040230 05!22116 06122/17 EACHOCCUARENCE $1 000 OLIO +DAMAGE TORENT D -- COMMERCIAL GENERAL LIABILITY $100,000 CLAIMS MADE®OCCUR MEDEXP(MymoPerson} 55.000 PERSONAL&ADV INJURY $1.000.000 GENERAL AGGREGATE S2 OOO= GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO s2,000,000 X POLICY PRO ECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO IE. acpden+} S ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS tPprpe—) S HIRED AUTOS BODILY INJURY S NONO'WNED AUTOS {Per_cft,-t) PROPERTY DAMAGE S (Per pcod.0 GARAGE LIABILITY AUTO ONLY a EAACCIDENT S ANY AUTO OTHER THAN EAACC S AUTO ONLY AGO S EXCESSAIMBRELLA LIABILITY EACHOCCURRENCE _ S OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION 5 Is WORKERS COMPENSATION AND TWO STATU OTH- EMPLOVERS'LIABILITY E.L.EACH ACCIDENT S, ANY PROPRIETORIPARTNEWEXECUTIVE OFFICE"tEMSER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S IIYas.dcscnhp uncle+ SPEGIALPROVISIONSOp1p E.L.DISEASE�POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS t LOCATIONS t VEHICLES t EXCLUSIONS ADDED BY ENCORSEMENT1 SPECIAL PROVISIONS Covering operations usual to Twomey&Legere Contracting,Inc... CERTIFICATE HOLDER CANCELLATION 10 Da s for Non-Pa meet SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _l n DAYS VBUTFEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SNALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REP= ACORD 25(2001!08)1 o12 #S33888tM33740 DML A RD CORPORATION 1988 '` T'e DATE{MMRNNYYYY1 A b: CERTIFICATE OF LIABILITY INSURANCE 10/1312016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS '... CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES '... BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. '.. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME:. Diana LeBlanc DOHERTY INSURANCE AGENCY IMGPH"�Ee e. (976)475-o260 EMAIL ADDRESS: dieblanc dohert insurance.co_m @ Y _ P.O BOX 1985 _ INSURER(S}AFFORDING COVERAGE __ _MAIC. ANDOVER MA 01810 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA A _ T_25666 INSURED INSURER 8: TWOMEY&LEGARE CONTRACTING INC INSURERC: INSURER 0: 87 BELMONT STREET INSURERS: NORTH ANDOVER MA 01845 1 INSURERF: COVERAGES CERTIFICATE NUMBER:93248 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A RUSH TYPEOFINSURANCE POLICY NUMBER MWOOYEfF MOMUUD EXP LIMITS tR COMMERCIAL GENERAL LIABRTTY EACHOCCURRENCE ; CLA ISAIAGE 1:1 OCCUR PREMSE,ES Ea­) E _ MED EXP inn,---,I S NIA PERSONAL&ADV INJURY ¢ GEN'L AGGREGATE LIMIT APPLIES PER; {GE NERAL AGGREGATE S POLICY.JEECCT []LOC PRODUCTS-COMROP AGO S OTHER I IS '.. AUTOMOBILELIABILRY ( EOAB�nDIJSINGLE LIMIT S ANYAUTO BODILY INJURY(Pparson) S AOS AUTOSSCHE LED NIA BODILY INJURY{Pix auAem} S OPE AUTOS AUTOS _ NON.OWNED ( PRRTVDAMAGE E HIRED AUTOS AUTOS P n,a_J______. S UMBRELLA 13 OCCUR ;�., EACH OCCURRENCE__ E EXCESS LIAR, CLAMS-hUmE WA `��`�t#�fA[E ¢ T DED RETENTIONS S --- W{f#JKV_RSCOMPENSATION ( PE '`.OH. AND EMPLOYERS'LIABILITY X STATUTE YIN ANYPROPRIETORIPARTNERiEXECLRNE EL EACH ACCIDENT S 500,000 A OFFICERIMEMBEREXCLUDED! NIA WA NIA 6HU80290M99416 69/18/2016 09/18/2017 (Mandatory In NHJ EL DISEAS SEA EMPLOYEE¢ 500.000 It yycc daxn0N under DESCRIPTION OF ORE RATIONS M4mv t.. t.OiSEASEPOUCY LIMIT S 566,060 7 NIA DESCRIPTION OF OPERATIONS t LOCATIONS IVEHICLES(ACORD 101.Addieon.I Rom,II.SCInnIN'.m.y bo.-InnIUmory opaco i. Q.Ind) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 0306 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.govAwd/workers-compensationrinvestiga6onsi. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel Ct M.Dropsy,GPCU,Vice President-Residual Market-WGRIBMA ©1988.2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD '.. TheCornaronurealth ofiVassachusetts w Department oflndustrialAceidents Offlce oflrrvestigations t' 600 Washington Street n l Boston,MA 02111 mous nassgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le tg'bly Name(Business/Organizationttndividujal): Address: !� r 112rt✓�f 1 ' City/State/Zip: fv r / O"`�1' Phone#: 715 -- Are an employer?Check the appropriate box: Type of project(required): i. I am a employer with v 4. I am a general contractor and 1 employees(full andlor part-time).* have hired the sub-contractors G. ❑New construction 2.❑I am a sole proprietor or partner- listed on die attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have &. []Demolition workingfor me in an capacity. employees and have workers' y P iY 9. [(�Building addition [No workers'comp,insurance comp.insurance.+ required.] 5.Q We area corporation and its 10.❑Electrical repairs or additions ;.El officers have exercised their I am a homeowner doing all work 11.0 Plumbing repairs or additions myself.[No worker'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]` c.152,§1(4),and we have no employees.[No workers' 1311 Other COMP.insurance required.] ,arty applicant tha[checks box rl must also fill out the section beton•showing he wnrkers'compensation policy info mn[ioa. t Hovheawnens who submit this affidavit indicating they me doing all work and thea hire outside commemrs..at submit.new rdod.eit indicating such. =Comtactars that check this box must aueehed an addhiaoal sheet showing the name of the rob.—orehax end.mte whether cram those entities have employees.If the sun-covwe[or have employees,ttcy must provida their n•orkers'camp,policy mhmirer. I am an employer that is providing ivorkers'compensation insurance for my employees.Befout is thepoGca,mat job site information. f ,, Insurance Company Name: Policy#or Self-ins.Lic-4: b Z Expiration Date: Job Site Address: 0 City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(ate). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500-00 and/or onc-q imp n eat,as well as civil penalties in the form of a STOP WORK ORDER and a fate ofup to$250.40 a day a� ' v o or_ e advised it al a copy of th s statement may be forwarded to the Office of Tnwest gations oEthe r' ce verage verificat on. I do berehy cer ,an tl 's an enalties of perjra.v that the iaforinatioir protdrle/d above is true and carr-eeel. Sienature: (/ Date: /4 /Y Y Phone ?/J' ( t 2 Official use only. Do not write in this area,to be completed by city or tome official City or Town: PermitlLicense m Issuing Authority(circle one): 1.Board of health 2.Building Department 3,Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector h.Other Contact Person: Phone#: Office of consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR — Registration: 136779 Type: Expiration; 8/26/2018 Partnership TWOMEY+LEGARE CONTRACTING INC. SHAWN TWOMEY 87 BELMONT ST. __N.ANDOVER,MA01845 Undersceretary Massachusetts Department of public Safety Board of Building Regulations and Standards License:CS-055108 DOUGLAS LEGARE 79 GARY AVE \\j HAVERHILL MA 01930 l'—JZ{ " `A`--- Expiration: Commissioner 0910212018 \\Xz II LOT 1 AREA=12,747 S.F. =0.2926 AC. ei- 20.29'� 15.67' l PROP. DECK 36 15.34' co PROP. ADDITION -------7 — —7 2' & G # ARA(,E 4 # 70 L4 co tc, F 145.00' N48*18'00"W MAIN STREET NOTES t SEE TOWN OF NORTH ANDOVER ASSESSORS MAP PLAN OF LAND #57 LOT #8 AND DEED BOOK #6176 PAGE #93 IN E.N.D.R.D. FOR SITE. NORTH ANDOVER, MASSACHUSETTS 2. ZONING DISTRICT IS RESIDENCE 4 DRAWN FOR CHRISTOPHER LEMBO 9 470 MAIN STREET NORTH ANDOVER, MASSACHUSETTS 01845 O SCALE: 1"=20' DATE: OCTOBER 26, 2016 0 10 20 40 60 o MERRIMACK ENGINEERING SERVICES 10/26/16 '66 PARK STREET STEPHEN SKI, R.L.S. DATE IIANDOVER, MASSACHUSETTS 01810