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HomeMy WebLinkAboutFINISH BASEMENT (2) i _ NORTH-J BUILDING PERMIT _q• TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ', Permit Nv#: 7�t 4 0 .7 ©ate Received SACµII$� [Date Issued: ORTANT:Applicant must complete all items on this page L QCATI O N . . ._- — _ _ os - Print Pn t 1 t}�Year Sfruct�re.' yeg �. Hrstonc Distnct es o MAPPARCEL ZONING DISTRICT: Y -:: Macape ShowV�lla e Y - - - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building )4 One family E Addition ❑Two or more family ❑ Industrial Alteration No_ of units: ❑ Commercial ❑ Repair, replacement 11Assessory Bldg ❑ Others: ❑Demolition ❑ Other Septic �A1Ne1 (]MI.` aodpfairi 1111et[ands L7 111Jatershed la�strict•- . p WaterlS�vtiier ._.. DESCRIPTION F WO�,-TO BE PERFO Zdentificati.o lease Type or Print Clearly' OVVNER: Name: v cr. Phone: Address: 5 - -t Conr>afior Name: .fid,- Phare; :Address:- 1.., C..- 5upervisars CDI=Ordctlari License Home irnprovemerlt License Exp Date . . Zia 4 ARCHITECTIENGINEER Phone: Address: leg. leo. FEE SCHEDULE.,BLILDING PERWIT.$12.00 PER$1000.00 OFTHE TOTAL ESTIMATED COST BASED ON$125x0 PER S.F. notal Projeot Cost: $ 3 I C FEE: $ Check No.: V Receipt Na-,. NOTE: Persons contracting-with unregistered contras ars do not ave.asses the g aranty fund €nr fr, ,`r r A�iPnfil(7�nir�ar Ira: afr�re cohtractor j Plans Submitted K-1 Plans Waived F1 Certified Plot Plan ❑ Stamped Plans ❑ -—-------- TyPj3-0F SEWERAGE DISPOSAL Public Sewer ❑ Tan-ning/Massage/BodyAxt 0 Swimaling Pools Wel FIl, F-1 Tobacco Sales 11 Food Packaging/Sales 0 Private.(septic tank etc. ❑ Pennanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On .COMMENTS--.- CONSERVATION Reviewed on L tre COMMENTS )a------1076 H EALTReviewed on e,,H COMMENTS z 4- _�� Yv In tv'o /I�na Zoning Board of Appeals: Variance, Petition Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Cornrnents Water & Sewer Con nection/,Sjgntark [jq _ Driveway Permit DPW Town Ei ngijaeer: Signatare:­ --------- ------- Located 384 0s.9ood Street FIRE DEPARTMENT - Temp DLImpster on site no Located at 124 Main Street Fire Department signatureldate COMMENTS Vft L_ 00RT#y own of : T ndover . 0 js�awii�X ��:MMNLVM No. ;6q 41W77*_W_ '_W. , ��. h , ver, Mass, O CDC ICHE-CK 400 44��. V BOARD OF HEALTH ERMIT T LD Food/Kitchen P : Septic System THIS CERTIFIES THAT � BUILDING INSPECTOR KEN,... .o.. s .......... 1.C.. has permission to erect .......................... buildings on ...V4 .....FOAL. ..S.. .......4.t Foundation p' . t 40set"tw"Imp lCoigneto be occu led as ......... ......... ............ ............ Rough y provided that the person accepting this permit shall in every respect conform to t 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 CONSTRUCTAR Rauh Service ......... ............................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. t 9 y V i �J VVV 1 t , \ � i d i I Enter construction cost for fee cal - North Andover Fee Calculation � Construction Cost $ 31 ,000.00 m $ - $ 372.00 Plumbing Fee 46.50 f Gas Fee 100 comm. $ 100.00 Electrical Fee $ 46.50 Total fees collected $ 565.00 495 Forest Street 686-2017 on 1/3/2017 basement remodel AGREEMENT FOR SERVICES This CONTRACT satisfies all basic requirements of the State's Home Improvement Contractor Law(M.G.L.c. 142A),but does not preclude parties from adding language to protect their specific interests. Seek legal advice if necessary. Before agreeing to any home improvement work on your residence you should obtain a free copy of"Consumer Guide to Home Improvement Contractor Law"by calling the Office of Consumer Affairs and Business Regulation's Information Hotline at 617-973-8787. You may cancel this Agreement if is has been signed by a party thereto at a place other than an address of K&R Contractors, Inc.,which may be its main office or branch thereof,provided you notify K &R Contractors,Inc., in writing at its main office or branch by ordinary mail posted,by Telegram sent or by delivery,not later than midnight of the third business day following the signing of the Agreement. See Attached Notice Of Cancellation For An Explanation Of This Right. Homeowner Information Kenneth Roy,President Business Street Address Josh Haley K&R Contractors, Inc. 495 Forest St I Campbell Road North Andover,MA North Andover, MA 01845 Business Phone: 978, 726.5062 Federal Employer ID: 000961723 Salesperson(s): Kenneth Roy,President Contractor Registration: 80721 Exp. Date:4129117 Contractor/Owner Name: MA Sup. License: 137557 WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor Agrees To Do The Following Work For Homeowner:Fully gut existing finish basement and rebuild to same layout except kitchenette will be removed and space added to bathroom for laundry Work description: Finish basement Includes permit, framing 2x4 walls,moving water heater,electrical(consisting of 16 recessed light,outlets, cable drop and switches),insulate walls to r-13,plastered walls,paint and painting,trim(around windows, doors and baseboard),move central vac unit,tile entry(allowance of$3/SF for tile purchase),carpet remainder of finished area with mid grade carpet,and suspended ceiling with Sahara tile The following schedule will be adhered to unless circumstances beyond the contractor's control arise* Work Scheduled To Begin: 112117 Expected Date Of Completion : 311117 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work, furnish the material and labor specified above for the SUM OF$31000 Payments will be made to the following SCHEDULE: $10000 due upon signing this contract $14000 due upon completion of rough plumbing and electrical $7000 due upon completion of this project 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* )No final payment shall be demanded until the contract is completed to the satisfaction of the parties thereto. OTHER IMPORTANT PROVISIONS You are dealing with a Registered Home Improvement Contractor and are entitled to certain rights under the provisions of 780 CMR Rb and M.G.L.c. 142A. Payments: If payment is not received as per the Contract,then the Owner shall be responsible for all attorneys' fees,court costs, and other costs incurred by the Contractor and enforcing Contractor's rights hereunder. Pets: Homeowner agrees to keep all pets out of the work area and take whatever steps are necessary to safeguard them from any harm that may come to them as a result of the work being performed under this Contract, including but not limited to injury on or outside the Premises or ingestion or inhalation of,or contact with,hazardous substances. Company assumes no responsibility for any harm to the pets as a result of the work performed under this Contract. Further, Homeowner shall take all steps necessary to protect Contractor, its agents,servants, contractors and employees, fi•om any harm as a result of contact with said pets. Characteristics of wood: Wood is a hygroscopic material. Wood swells and/or shrinks in relation to the humidity,temperature and environmental conditions of its surrounding. Generally, wood flooring is expected to shrink in any conditions and expand when exposed to moist conditions. Natural wood also contains variations of graining,texture,hardness and/or knots,depending on the wood chosen. Contractor cannot be responsible for the natural features of the wood chosen. Contractor is not responsible for shrinkage,checking,swelling,or other conditions which are the normal condition of wood or the result of household or environmental humidity,beat,cold,or other conditions. Colors: You may choose colors and finishes for the parts being used in your remodeling project. It is important to remember that a color or finish you see at the store or in a showroom may not look the same in your home,especially after all of the different colors and finishes are brought together upon the completion of a project. In addition,one manufacturer's named color is not the same as another manufacturer's named color.The Contractor cannot be responsible for the appearance or lack of coverage from Homeowner/chosen paints and/or stains and finishes. Building Officials: Any additional costs incurred by Contractor as a result of decisions made by Building Officials will be the responsibility of the Homeowner.The costs of additional work will be calculated as follows:cost of materials plus an hourly rate of$45 per man hour. Liens: In the event of non justifiable non-payment,Homeowner's residence or property may be subject to a Mechanic's Lien as a consequence of signing this Contract. Utilities: The Contractor will use reasonable efforts to notify the Homeowner in advance of any interruption of utility services. However,there may be instances where the Contractor must shut down these services without advanced notice. Homeowner must arrange for emergency backup service for any utility critical equipment such as medical devices and computers. The Homeowner must also notify the Contractor at the start of the work day if you will be engaged in any utility critical activities in that the Contractor makes a notification in writing in the daily log book or otherwise. Additional work: Any additional work requested by the Homeowner which is beyond the scope of the work to be performed as set forth in this Agreement,shall be the subject of a separate agreement,and/or if not,subject to the same terms and conditions as set forth in this Agreement and billed on a time plus cost of materials basis at Contractor's normal hourly rate. Contractor's normal hourly rate per man hour is$45. In the event that additional work is to be performed on an hourly plus cost of materials basis,the Homeowner shall be required to execute a Change Order which shall include Contractor's best estimate as to the time required,together with the cost of labor as well as the type and cost of materials necessary. Delays: Contractor is not responsible for delays attributable to Homeowner initiated modifications or additions,or for delays incurred due to the actions or inactions of city/town officials,strikes,acts of God, unfulfilled customer obligations,vendor delays, interference by other tradespersons,customer supplied items or other delays beyond Contractor's reasonable control. Contractor will use reasonable efforts to stay on each job until substantial completion by allotting specific time periods to each Homeowner to complete each job in as timely a manner as possible. In the event that Homeowner does not allow Contractor and/or his employees or sub-contractors access to the residence or property so as to allow Contractor to perform his obligations and/or to complete the scope of work in as timely a manner as possible,other than for reasons of safety or other reasons mutually agreed to between Homeowner and Contractor,then the Homeowner shall be responsible to pay Contractor the sum of $500.00 per day,on a pro rata basis,to cover the costs of delay. Contractor reserves the right to suspend work and/or delivery of materials in the event of unjustified non-payment. In such event,the Contractor shall have no liability to the Homeowner for alleged delays or damages due to said suspension. Punch-list Items: The Homeowner agrees that routine"punch-list"or repair items after substantial completion are outside the agreed scope of services,and covered by Contractor's warranty obligation and will be completed as soon as practicable and according to Contractor's and Homeowner's mutual availability. Homeowner agrees that it shall use his/her best efforts to make himself/herself available to observe and/or sign off on the completion of any such punch-list Items,and that the approval of one Homeowner regarding the completion of any such punch-list items,as well as change orders shall be binding upon all Homeowners. Unforeseen Conditions/Circumstances: Contractor shall not be responsible for any changes at the request of the Building Inspector. Contractor shall also not be responsible for any unforeseen bedrock/ledge or latent defects such as structural and/or dry rot or insect damage to the existing structure,or for preexisting faulty or inadequate wiring or plumbing. Contractor shall also not be responsible for any pre-existing code violations or responsible for correcting contiguous work completed by others not under the Contractor's authority. Insurance: Homeowner agrees to carry fire,theft,vandalism, liability and all other necessary insurances to protect their personal property while construction is in progress. Contractor will carry all required and necessary insurances including worker's compensation insurance. Contractor will ensure that all personnel including sub-contractors will be covered by all required and necessary insurance including worker's compensation insurance. Homeowner's Cancellation Rights: in addition to the rights the Homeowner has,as set forth in the attached Notice of Cancellation,the Homeowner may have rights under other Massachusetts Statutes, including M.G.L.c. 93 §48,M.G.L.c. 140D, § 10 and M.G.L.c.255D § M. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies of the contract should go to the homeowner and the contrar,or. Homeowner's Signature: -sem" t�' J C Date: /z ' -> � I Contract is Signar1K& ontractors, Inc.: Date: By: Kenneth Ro Its: president You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. NO WORK WILL BEGIN UNTIL,BOTH PARTIES SIGN THE CONTRACT AND THE OWNER RECEIVES A COPY REQUIRED PERMITS The following building permits are required. It is the obligation of the contractor to secure such as the homeowners agent: Electrical rough and finish Plumbing rough and finish Insulation Framing insp. Finish and occupancy NOTE:Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. EXPRESS WARRANTY All workmanship and materials to be free of material defect for a period of one(1)year. During the Warranty period,the Company may,at its option,either repair or replace products or workmanship which prove to be defective. This Warranty shall not apply to defects or damage arising from improper or inadequate maintenance by the customer,customer's applied products,unauthorized modification or misuse, damage incurred as a result of acts of God or civil strife,or normal characteristics of the materials such as wood shrinking,expanding and otherwise reacting to moisture or environmental conditions. The Company's liability is limited to the repair or replacement,at its option, set forth herein and Company shall not be liable for any consequential,sequential,incidental or other damages not set forth herein.The Warranty set forth herein is exclusive, and no other Warranty, whether written or oral,is expressed or implied. Company specifically disclaims the implied Warranties of Merchantability and Fitness for a Particular Purpose. NOTE: All home improvement contractors and subcontractors shall be registered and any inquires about a contractor subcontractor relating to a registration should he directed to: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,MA 02108 617-727-8598 Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence, DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies of the contract should go to the homeowner and the contrae or. Homeowner's Signature:_ r ' , < Date: v Contract is Signature IC& antractors, Inc.: Date: Z l By: Kenneth Ro Its: President You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery,not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. NO WORK WILL BEGIN UNTIL BOTH PARTIES SIGN THE CONTRACT AND THE OWNER RECEIVES A COPY REQUIRED PERMITS The following building permits are required. It is the obligation of the contractor to secure such as the homeowners agent: Electrical rough and finish Plumbing rough and finish Insulation Framing insp. Finish and occupancy NOTE: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty bund provisions of MGL c. 142A. EXPRESS WARRANTY All workmanship and materials to be fi•ee of material defect for a period of one(1)year. During the Warranty period,the Company may,at its option,either repair or replace products or workmanship which prove to be defective. This Warranty shall not apply to defects or damage arising from improper or inadequate maintenance by the customer,customer's applied products,unauthorized modification or misuse,damage incurred as a result of acts of God or civil strife,or normal characteristics of the materials such as wood shrinking,expanding and otherwise reacting to moisture or environmental conditions. The Company's liability is limited to the repair or replacement,at its option,set forth herein and Company shall not be liable for any consequential,sequential, incidental or other damages not set forth herein.The Warranty set forth herein is exclusive,and no other Warranty,whether written or oral, is expressed or implied. Company specifically disclaims the implied Warranties of Merchantability and Fitness for a Particular Purpose. NOTE: All home improvement contractors and subcontractors shall be registered and any inquires about a contractor subcontractor relating to a registration should he directed to: Director, Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,MA 02108 617-727-8598 Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence, ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the even 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 Secretary of the Executive Office of Consumer Affairs and Business Regulations and the c nsumer sh ll he required to submit to such arbitrati+-o�n as provided in M,G,L. c.I42A. Contractor: IDate, Homeowner: �� Date: -Z `l- NOTICE:THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETFLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOTSEPARATELY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity-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. Contractor's Financial Insecurity-In instances where a contractor deems himself/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 from said account would require the signatures of both parties. Homeowner agrees to allow reasonable access to allow Contractor to reasonably attempt to remedy any outstanding uncompleted,disputed or non-satisfactory item. If you have general questions or need additional information about The Home Improvement Contractor Law,contact: Consumer Information Hotline Commonwealth of Massachusetts Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170 Boston,MA 02116 617-973-8787 If you have questions about Contractor Registration,contact: Director of Home Improvement Contractor Registration Board of Building Regulations and Standards One Ashburton Place,Room 1301 Boston, MA 02108 617-727-3700,x25205 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT 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 OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN (10)BUSINESS DAYS FOLLOWING RECEIPT BY THE CONTRACTOR I I I 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 THIS CONTRACT;OR YOU MAY, IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE CONTRACTOR REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE CONTRACTOR AND THE CONTRACTOR DOES NOT PICK THEM UP WITHIN TWENTY(20)DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE CONTRACTOR AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT, TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO K&R Contractors,Inc. I Campbell Road,North Andover,MA 01845 NOT LATER THAN MIDNIGHT OF TBD. I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: Received: lie commonwealth ofHassachusefs _ De ax hent of_rndustdal Accadezats deet ,S`O� 100 A o2114-2017 .T C`o�gf'es�S` rnasg o fdia q W�WYV- g ationTx�Saraned A.fda-vit:PnilderslCoxxia�actorsl Xectrzciaxxsl'Inmtaexs. .A'LT�'HO��- ToBF,Ma-U�4UHTJ3E:, �Gj? ,lease �. '-licant�fnx•ma-�an. Name(BusSnessl(zg aiiovfln&VICI Y Adcxess: C lhonc) 7_z 5 v 2 Cxfty Latex - Type of project(Teciva�red) Ax lyoIx an empXoyer?C ee tkie appropzia#e box: } - -7. Ll Nei;#`cansttvcti0n employees(roll audlar parrtime)- 1,E]I am aempioyer wi#h,._.,.�.._ o ees orldug for mein 8. '�R.emodoNg 2 Iamasoleproprktarorpartnm-jipangha W,,Upl Y MY capani,�y. Workers'comp.iramwaaer IeTmrd-j 9. I)almoti94 3.Q I am alzn veowaer do9ng all wozlu 'seli~ o Workers'camp.instuancerecluired,7 i 10❑Building addition _nIamnhameovrneraz�dt Jlbchin€3gco actoss#cconduc�all�varkonmYi op Y Iva 1�.QETecttlCalpepp.7„ , a.ddit1_ov.S eitherhaYamarkers'CompensatioaMa¢aucaoracesole ` (�` g re aixsoxadc�io7ass ensnxetiaat all contxacftrs , , 1.2..�:PbU— _xng p proprie#ozswitb.na enapioyees. 5_L�I=a general contractor and Ilaaye hfred.the sub-co»f€aetors listed nnthe attached sheet. �.�PiOpT� alxS Thesasrab-coniractorsbave employees andhavavr�kers carxtp.9nstuanee 14,Q.Other R 5-��e are a coxporaiion.and s nffiCers have exercisedtheiz light ofbXODIptionperivIGZ G. I52,§I(4),and'weiayzrro employees_lNowolkers'comp.ivsutancerecpured� �r rapplicancthatchecks o>£s l nstalsd o e doing aFlvlorkandth(nhireo1[tside�on actorsmoustsabmitanew ffldaTAindicamgWe'l i HnmeoWsrers v1ao sr mi,B-d a�datnt the S Y retractors that checlthis liiiX fnusE attaolied an addiaCnel sheetshetheir Workers'cemp.policumberd state Whether ozot#hasa,entes IsaYe �`� exnpleyees. Ifthesub confaactarshaveelaployees,they #pxovt Zo e t�zcitisp�ovic7ing rvo rce�s'co�epensadon tnsurar2cef0P MY el -P 8sXo7t�is ttiepaliey air ja site .I am an emv y irzf©rrnation. . Txt=ance ComparxyNama RpirafioUDato, City/State/zip: rob S`iteAddress_ sho( WjmgtbePolity numb or asxcle�pzrat5tozx data). A.ttaeh a copy Ofthe�vaxk-ers' campensa oxxpoliey c[eclarat[onpage coves e as required�ndezMGL o. 2, 25A is a exsm?ualvzalatiaR pOR]�ER attd a$ne ofuiito $250.00 a Failure to a0emo e alt[es iu&a form.of a S'I P NORM and/or one yearprisonrnex�t�as~mall as civil p an a sane-theimri'violator.A copy ofthis sfatement xray he forwoxded to the DfFioa of Snvestigations afthe DTA fox irasuraxtcs y g COW -vex�tcatioll- p da 1xc e cexttfy r r e� zepair�s ar�d es afperju y t7�at the jnformation pvo-vided abo e s t o a correct y Date• f 2 Si at11T0. l�hoxte#: C ' G Z Dot-write in tlsiv area,to 75e CoP�p e eL by city ar to pfficictl use orgy. rv�i ofl. fteia D,9 ro Per:m�tlLcense# City or Tom.' fssning.A-rx*oi ity(circle 0x16): pactor I.Board of'�eal-�Iz �,33nYldzng papaa:tm.ent 3.C:ityl'JCo�t clerk �.�Yect�r3cal xxxs ecto�r 5.PInmT�'zxg Sxtsp 6.©they Phone#. Con-La e't 1'ersar3 r OP 10,IRS ,d►co o� CERTIFICATE 4F LIABILITY INSURANCE pATE'M3/201�"' ol�oaizol7 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 [NSURER(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). CONT PRODUCER NAMEACT Pete Sullivan Foster Sullivan Insurance PHONE 978-686-2266 (Ac No:978-686-6410 163 Main St. Alc No.ExtI: North Andover,MA 01845 E-MAIL p suvan ersuvan rollcom llifostlli ADDRESS: @ N _ Stephen Sullivan PRODUCER K&RCO»1 CUSTO ER ID#: INSURER(S)AFFORDING COVERAGE _ NAIC#_ INSURED K&R Contractors,Inc. INSURER A:MERCHANTS INSURANCE GROUP 12775 Ken Roy 1 Campbell Road INSURER B: North Andover,MA 01845 INSURER C: INSURER D INSURER E: INSURER 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 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. p POLICY EFF POLICY E%P !LTR TYPE OF INSURANCE POLICY NUMBER IMM[DDNYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA AGE T014ENTED A X COMMERCIAL GENERAL LIABILITY BOP1062559 12/09/2016 12/09/2017 PREMISES Ea occurrencel $ 500,000 CLAIMS-MADE D OCCUR MEG EXP(Anyone person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accldernq ANY AUTO BODILY€NJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accidenl) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (PER ACCIDENT) NON-OWNED AUTOS UMBRELLA L1AB OCCUR EACH OCCURRENCE $ EXCBSS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION TORY LIATT ER AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN N!A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (Attach ACORD 101,Additlonal Remarks Schedule,If more space is required) mdeems@northandoverma.gov e u **INSURANCE EVIDENCE** CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E=XPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. fax#978-688-9542 MAURA DEEMS AUTHORIZED REPRESENTATIVE 120 MAIN STREET NORTH ANDOVER,MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 1 B. e R 71. TJan�n�zootttrea ay /� Dac�ul6e 'i F. Office of Consumer Affairs&Bi(siness Regulation NOME NPhOVEMENT CONTRACTOR Registration: ?.162123 Type: s Expiration: 1]20/2017 Private Corporatio K& CONTRACTORS INC,. KENNETH ROY 1 CAMPBELL RD. N.ANDOVER, MA 01645 Undersecretary dcise er Massachusetts -Department of Public Safety Board of Building Regulations and Standards Z License: CS-08021 1.7 j.ti KENNETH R ROY-` 1 CAMPULLRI North Andover AffA 0 n r J.+i21 JI'14i�` Expiration Commissioner 0412912017