HomeMy WebLinkAboutBuilding Permit #895-15 - 103 FARRWOOD AVENUE 5/6/2015 qA6BUILDING PERMITf4 �C NORrH NO
TOWN OF NORTH ANDOVER o?
APPLICATION FOR PLAN EXAMINATION
95-%S
Permit No#: Date Received
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s
Date Issued:
IMPORTANT:Applicant must complete all items on this page
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LOCATIONxm* f er((Vcoa,
n_-Pri�nt
PROPERTY OWNER �a Q C2&0� &.dh,'I k/M5
10? Print 100 Year Structure yes no
j MAP PARCEL ZONING DISTRICT: Historic District yes no
` � • � �p5 Machine Shop Village yes.
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
El Addition KTwo or more family El Industrial
❑Alteration No. of units: ,Commercial
.Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑',.Septic „O'Well ElFloodplain 0 Wetlands [T WateYshed District.
=.:E]Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
RQD���p
(war (,,Lyme)\ Jee�(S
Identi tion- ease Type or Pri t Clearly
Name: h cmIV w� �e U'� Phone:Q�� 615 5-�y3
OWNER: Nam �A
Address:
Contractor Name: v (U Q? Phone: 76( Ll e, ")SI�
Email << c
Address: e)
Supervisor's Construction License: CS 00153 y O Exp. Date: O/
Home Improvement License: I 036(5 Exp. Date:
ARCHITECT/ENGINEER IAa Phone: 61-7 773 6 I SU
Address: 50 146ok(-o CV / t� 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: $ - ,t7= FEE: $ ns2—�R
Check No.: `I 22-- ReceipNo.: 2-% 1 �O
NOTE: Persons contracting with unregistered contractor do o have access to the guaranty fund
Rnature
---
Location �U hqe'C'<'`'du`' AL
No. 0 5 �5
Date
. • TOWN OF NORTH ANDOVER
• LED 1, ..
•
Certificate of Occupancy $
Building/Frame Permit Fee $ a"
Foundation Permit Fee ,
Other Permit Fee
TOTAL
LIL
Check#
2 '� t' Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming pools ❑71
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on -�
/5 Signature
COMMENTS ci� o ��
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Wates,& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
1{F� RI E DEPARTMENT Dumpst 'tet e - -
Located 384 Osgood Street
Temp
1;L c tedatr1�24tIVlain¢Street
1Fire De _
gnafu ds ate¢
pmentsi Yre/Y
C®MMENTtS'
I
Dimension
Number of Stories: 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.$10o-$1000 fine
NOTES and DATA-- (For department use)
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Pennit Revised 2014
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
4. Quilding Permit Application
4. W&kefrl-C-OMP AfF davit"
C.S.L. Licenses
laatca-Eap�y�0 ___—
I.00r""Plan Or Proposed-.Interior Wor
Engine-, ing-Affidavits-for'Engineered product
OTE: All du, ps p_Ponds r quire sign_off fr-or-r�-Fire�Department prior to issuance of Bldg Permlt
Addition Or Decks
Building Permit Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
• Building Permit Application
• Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:Building Permit Revised 2014
NORT1i
own of . � ndover
O .0 .1 .! ".. .-
n0LAKE
In ver, Mass,
COC MIC Nl ws
s U
BOARD OF HEALTH
Food/Kitchen
PERM D Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
............... L!!....... . ......... .. .. ..........lam.......................
has permission to erect buildings n ../.M...&.....'. #%" Ap Foundation
.......................... ..............
... Rough
to be occupied as ..... . . . ......�.......C� a%.'C........................................................ Chimney
provided that the per n 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 TA Rough
Service
............. .. .... .......................................... 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.
SPS
Proposal for Services (PFS)
Project:
Heritage Green Condominiums
39R Farrwood Ave
North Andover, MA 01845
Prepared For:
Rosann Ciofolo
Affinity Realty& Property Management, LLC
63 Atlantic Avenue
Boston, MA 02110
(978) 685 4434
Prepared By:
Chuck Huntley
Schernecker Property Services, Inc.
283 Second Ave,Waltham, MA 02451
(781) 487-2516
chuck.huntley a@spsinconline.com
www.spsinconline,com
SPS HIC#: 123615
Expiration Date: July 1, 2015
Date Submitted: April 7, 2015
Proposal #: 5439739
Deck Replacement and Associated Masonry Repair Heritage Green Condominiums I Proposal#:5439739
Scope of Work
General Description:
SPS,Inc.will provide the necessary supervision,labor,and materials to perform the work specified in this PFS in a good and workmanlike
manner and in compliance with applicable laws and codes.The pricing provided in this PFS encompasses,in general,the following:
Deck Replacement to include removal and disposal of existing steel and wood deck frame. Removal of
specified exterior brick wall, and interior GWB to expose header and joists for repair as described in the
drawing package. New concrete footings,stair landings to be installed followed by new pressure treated
deck frame and stair assembly asshown In the drawing package.The rail system will be a cable system
"Raileasy" by Atlantis.The deck boards will be a capped PUC board from Fiberon's Advantage product
line.All brick masonry will be repaired as described in the drawing package.
The drawing package referred to above was created by Wessling Architects of Quincy,MA dated
02/18/14.
Included Areas:
• Demolition and disposal of existing steel and wood deck
• Interior repair to GWB removed to expose header will be to a"paint ready"finish
• Temporary shoring,as required,and protection of tenant areas during renovation
• Building Permits
Excluded Areas:
• Architect inspections,fees,drawings,or other documents
• Performance or payment bonding
• Painting.
• Interior floor joist,sub floor,and finished floor
• Steel lintel/replacement
Total Price for work as specified in the Scope of Work: $2921900.00
Additional Items, Alternate Items and Unit Prices
Pricing provided on Page 4 is for specific items not included in the contracted Scope of Work.Please note that these items are
additional to the "Total Price".
Schedule of Work
(determined at proposal signing)The work heretofore described is scheduled to commence on with an expected duration
of approximately days.Substantial completion is expected by
Acceptance of Proposal
The undersigned,as authorized representative(s)of the property listed,have read the terms stated herein and accept the terms as r
written.
04/07/15
SIGNATURE DATE SIGNATURE DATE
Chuck Huntley Vice President Rosann Ciofolo
Schemecker Property Services 1 283 Second Avenue,Waltham MA 02451 1800.424.2468 1 spsinconline.com Page 2 of 8
Deck Replacement and Associated Masonry Repair Heritage Green Condominiums Proposal#;5439739
NAME TITLE NAME
TITLE
Schernecker Property Services 283 Second Avenue,Waltham MA 02451 800.424.2468 spsinconline.com Page 3 of 8
Deck Replacement and Associated Masonry Repair Heritage Green Condominiums I Proposalt 5439739
Total Price for work as specified in the Scope of Work
Type of Price/Type
Item Description Quantity Quantity of Quantity Extended Price
1. Deck Replacement and Associated Masonry Repair at 25/27 1.00 Building $129,150.00 $129,150.00
Farrwood Drive
2. Deck Replacement and Associated Mason Repair at 103/105 1.00 Building $129,150.00 $129,150.00
Farrwood Drive
3. Atlantis Raileasy Cable System 2.00 Buildings $6,050.00 $12,100.00
4. CertainTeed Undershield deck protection 2.00 Buildings $3,750.00 $7,500.00
5. Composite Decking Fiberon Advantage capped decking 2.00 Buildings $7,500.00 $15,000.00
Total: $2927900.00
Additional Items, Alternate Items and Unit Prices
Type of Price/Type
Item Description Quantity Quantity of Quantity Extended Price
1. Alternate#1:Composite Decking (additional cost per building) 1.00 Building $7,500,00 $7,500.00
2. Alternate 42:Atlantis Raileasy Cable System (additional cost per 1.00 Building $6,050.00 $6,050.00
building)
3. Alternate#3: PVC trim posts,stringers,and deck frame 1.00 Building $11,850.00 $11,850.00
(additional cost per building)
4. Alternate#4: Dry-Snap underdeck protection (additional cost 1.00 Building $3,750.00 $3,750.00
per building)
5. Alternate#5:Remove-Flash-Reinstall 8 doors(additional cost 1.00 Building $5,500.00 $5,500.00
per building)
Schernecker Property Services 1 283 Second Avenue,Waltham MA 02451 1800.424.2468 1 spsinconline.com Page 4 of 8
Deck Replacement and Associated Masonry Repair Heritage Green Condominiums I Proposal#:5439739
Property Notes & Present Job Conditions
The following conditions were identified during the visual analysis of the property.These notes are not meant to be,nor to replace,an
engineering report.Additional historical information and/or an invasive analysis would be likely to provide further information.
Pricing Notes
EPA RRP / Lead paint
The pricing provided assumes that the property was built after 1978 or that the work being performed will not require SPS,Inc.to follow
the EPA guidelines for renovation,repair and painting (EPA RRP rule).If the work is subject to the guidelines of the EPA RRP rule or any
DEP or local rule regarding lead paint,then the pricing will be re-evaluated and will likely increase.
Permit
SPS,Inc,acting as the Owner's agent,will apply for and obtain any necessary construction-related permits.The cost of any such permits
will be paid by SPS,Inc.and shall be included in the pricing provided,unless specifically excluded.The Owner or its agent shall assist SPS,
Inc.,with any required signatures,documents,or other cooperation necessary to obtain such permits.Construction control by a licensed
engineer or architect,if required by the permitting authority or if elected by Owner,is not included in the pricing provided and is to be
contracted directly by the Owner.
Unforeseen Conditions/Change Orders
Renovation work involves removal of existing materials to expose hidden surfaces.By its nature,renovation work is likeI to result in
uncovering conditions that were not foreseen.It is likely that unforeseen conditions will be uncovered when existing materials are removed.
Unforeseen conditions usually necessitate changes in the scope of work and an increase in the total price of services.Changes to the
scope of work as a result of unforeseen conditions will be presented to the Owner or managing agent in the form of a written Change
Order.All Change Orders,regardless of the reason for the Change Order,must be documented and approved in writing by SPS,Inc.and
Owner or Owner's agent.Change Orders may be approved by email.
Additional Pricing Notes
• Drawing package provided by Wessling Architects was used to complete the deck replacement bid.
• The interior ceiling repair is limited to installation of GWB to a"paint-ready"finish
• The stairwell handrail included in this proposal is pressure treated with black hardware.
• All deck frame posts will be made from 6x6 PT stock as required in the current 2012 IRC.
Schernecker Property Services 1 283 Second Avenue,Waltham MA 02451 1800.424.2468 1 spsinconline.com Page 5 of 8
Deck Replacement and Associated Masonry Repair Heritage Green Condominiums I Proposal#:5439739
Proposal Terms
Proposal: This proposal is valid until July 1, 2015. If this proposal has not been accepted by said date, then this proposal is deemed
withdrawn by SPS.
Acceptance of Proposal:The signature of the Owner or Owner's authorized agent shall constitute Owner's agreement to the terms and
conditions contain herein.
Owner's Managing Agent:If Owner has engaged the services of a property management company("managing agent")to act on its behalf
with regard to the subject matter of this agreement,the managing agent and its representatives shall be considered authorized agents of the
Owner.With regard to the subject matter of this agreement,Owner shall be bound by and SPS,Inc.shall be entitled to rely upon statements
and actions of the managing agent.
Entire Agreement:This proposal and any documents specifically listed under Contract Documents or incorporated by reference constitute
the entire agreement between SPS, Inc. and Owner. Both parties warrant that there have been no promises, obligations or undertakings,
oral or written, other than those herein set forth.No material modification of the terms of this Agreement shall be effective unless approved
in writing by SPS,Inc. and Owner or Owner's agent.Modifications may be approved by email.
Work Progression:Start dates,amount of time needed to complete the work,and completion dates will be estimated at the time of signing
of the PFS, prior to the commencement of the work. The schedule may be modified by mutual agreement for any reason. Changes in the
Scope of Work are likely to impact the schedule.Inclement weather and other circumstances beyond SPS,Inc.'s control are also likely to cause
changes in the work progression. Delays caused by Owner,its managing agent or their representatives,may result in additional charges.
Representations:SPS,Inc,is in the business of providing maintenance and capital improvement services to real property.The PFS contained
herein has been prepared on the basis of a visual inspection of the property.SPS makes no warranties or representations about the physical
condition of the property at the time of this proposal.
Materials Storage and Inspection:SPS,Inc.requires that it be allowed to store the materials and equipment necessary for the performance
of the specified work on the property in a mutually agreeable location. Such materials and equipment shall be subject to inspection and
approval by the property agent.
Protection of Work Areas:The work areas are to be secured and protected during the performance of the work.Unless otherwise noted,
SPS Inc.will be responsible for damages to the Owner's property caused SPS Inc,during the performance of the work.
Rubbish Clean Up and Removal:SPS,Inc.will dispose of rubbish,trash and debris resulting from the performance of the work in a manner
approved by the Owner or authorized agent.Such disposal will be in compliance with applicable laws and regulations.SPS,Inc.shall maintain
the job site in reasonably neat and clean condition during the performance of the work.
Completion and Acceptance:The work will be deemed to be complete when the conditions as described in the PFS have been performed
by SPS,Inc. Upon completion,SPS,Inc.will provide notice to the Owner that the entire work or an agreed portion thereof is complete.Upon
such notification,the Owner or Owner's agent will promptly inspect the work and will notify SPS,Inc.of any incomplete or defective work.SPS,
Inc.shall take such measures as are reasonably necessary to complete such work or remedy such deficiencies.
Insurance:SPS,Inc.maintains Worker's Compensation Insurance,General Liability Insurance and Automobile Insurance.Upon request,SPS,
Inc.will facilitate the delivery of a Certificate of Insurance from its insurance agent naming the property Owner as an"Additional Insured."
Warranty: Unless otherwise noted, SPS, Inc.warrants the work performed under this PFS.against defective workmanship for a period of
two (2)years from the date of completion and acceptance.This warranty is expressly conditioned upon the Owner's full performance of its
--__-_--payment obligations-hereunder.-Any holdback or_.non payment.byOwner_will-invalidate.this-warranty..-----.-—----——————--.-.------.
Schemecker Property Services 1 283 Second Avenue,Waltham MA 02451 1800.424.2468 1 spsinconline.com Page 6 of 8
Deck Replacement and Associated Masonry Repair Heritage Green Condominiums I Proposal#:5439739
Owner shall also have the right to terminate the agreement for convenience.Owner shall give SPS,Inc.ten(10)days advance written notice.
Owner shall be responsible for paying SPS for all work performed to the date of termination plus SPS reasonable costs of demobilizing plus
twenty percent(20%)of the value of the work remaining to be performed under the agreement.
Nominal versus actual dimensions:The actual dimension of a 2x4 is approximately 1.5"x 3.5"."2x4"is the nominal dimension.The actual
dimensions of many materials differ from their advertised nominal dimensions.Nominal dimensions are used in proposals and specifications.
SPS does not assume responsibility or liability for the discrepancy between any nominal versus actual measuremerits.
Indemnity: To the fullest extent permitted by law, the Owner shall indemnify, defend, and hold harmless SPS, Inc. and its agents and
employees of and from any claims by third parties or unit owners arising out of SPS,Inc.'s performance hereunder unless it is finally adjudicated
that such damages,loss or expense was due to gross negligence,willful misconduct or material breach by SPS, Inc. Owner shall indemnify
SPS,Inc.,for any and all damages,losses,and expenses arising therefrom including but not limited to attorney's fees and expenses.
Termination: SPS, Inc.'s termination for cause. Should (1) the work be stopped b any public authority for a period of thirty (30) days
or more,through no fault of SPS, Inc.; (2)the Owner fail to make any payment properly due hereunder in a timely manner; (3) the Owner
cause or fail to prevent a condition that results in an unreasonable delay in SPS,Inc.'s ability to perform hereunder;or(4)the Owner fail to
comply with other material terms of this agreement,then SPS,Inc.,shall give written notice by certified mail or by hand to Owner or Owner's
authorized agent specifying the grounds for termination.Owner shall have seven (7) days to correct the condition giving rise to the notice.
If the Owner fails to cure within seven (7) days after receipt of the notice,then SPS, Inc. may stop work or terminate the Contract. SPS,
Inc. shall be entitled to recover from Owner payment for all work executed plus twenty percent (2076) of the value of the work remaining
to be performed under the agreement.
Owner's termination for cause.Should SPS,Inc.(1)abandon the work;(2)fail to diligently prosecute its obligations under this agreement;
(3) or blatantly disregard applicable laws and codes; then the Owner shall give written notice by certified mail or by hand to SPS, Inc.,
specifying the grounds for termination.SPS,Inc.,shall have seven (7)days to correct the condition giving rise to the notice.If SPS,Inc.,fails
to cure within seven (7) days after receipt of the notice,then the Owner may terminate the Contract.SPS,Inc.shall be entitled to recover
from Owner payment for all work performed to the date of termination.
Safety: SPS, Inc.will maintain a safe work zone.Anyone entering the work zone should wear appropriate Personal Protective Equipment
(PPE).At a minimum this includes hard hat and safety glasses.Other PPE may be required depending on the work being performed. Once
inside the work zone,any outside party including inspectors shall comply with SPS,Inc.and OSHA safety guidelines.Inspectors and/or outside
parties should be escorted by an SPS,Inc.employee inside the work zone.
Governing LawNenue/Dispute Resolution:This agreement is governed by and subject to the law of the Commonwealth of Massachusetts.
In the event of a breach of this agreement,the non-breaching party shall be entitled to recover its reasonable attorney's fees and expenses.
Any issue,claim,or dispute related to this agreement,itsperformance or a breach thereof shall be shall be decided by an independent single
arbitrator in or within 25 miles of the city of Boston using American Arbitration Association,JAMS, or another similar mutually acceptable
arbitration service. The arbitration shall be conducted in accordance with the Construction Industry Arbitration Rules of the American
Arbitration Association currently in effect. The award rendered by the arbitrator or arbitrators shall be final,and judgment may be entered
upon it in accordance with applicable law in any court having jurisdiction thereof.The finding shall be binding with no other recourse.The
parties shall share equally the cost of arbitration and arbitrator's fees.The prevailing party shall be entitled to recover its attorney's fees
and expenses including its share of the cost of arbitration and arbitrator's fee.
No Consequential or Delay Damages:SPS,Inc,and Owner waive claims against each other for consequential damages arising out of this
agreement.This mutual waiver includes damages incurred by Owner for delay,rental expenses, loss of use,income,profit,and the like.This
mutual waiver includes damages incurred by SPS, Inc.for office expenses,office personnel, business and reputation,and for loss of profit
except anticipated profit arising directly from the work,as specifically provided for herein.
No Third Party Beneficiaries: This Agreement will not confer any rights or remedies upon any person other than SPS, Inc. and Owner.
Specific ally,_this is not an agreement with any individual unit owner_of_a-condominium-association_when_the_Owner_is_a_condominium___._____
association. No unit owner has the right to expect or demand any work or performance by SPS, Inc.
Schernecker Property Services 1 283 Second Avenue,Waltham MA 02451 1800.424.2468 1 spsinconline.com Page 7 of 8
Deck Replacement and Associated Masonry Repair Heritage Green Condominiums I Proposal#:5439739
Hidden building components:Fasteners are required to penetrate the sheathing in order to achieve the material manufacturer's installation
guidelines.Any mechanical lines, electrical lines,pipes,ducts, other means of conveyance,or equipment located directly behind /beneath
the sheathing may be subject to harm.SPS is not liable for any damage to items in this zone.
Schemecker Property Services 1 283 Second Avenue,Waltham MA 02451 1 800.424.2468 1 spsinconline.com Page 8 of 8
attment of Public Safety `
Massachusetts -Dep ulations and Standards
Board of Building Reg
Construction SuPercisor
License: CS-095348
GgAyD,ON LATW _ ~;
9 DOLE IML I.A�vE a
Dogford%A 01911
Expiration
jQA 0310412016 I
Commissioner _
05/07/2015 07:42 7814872505 SPS INC PAGE 03
Client#:1025557 SCHERPRO
ACORDTM, CERTIFICATE OF LIABILITY INSURANCE15
°ATE(MM/DDlYYYY)
.`HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
CERTkACATE 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 pollcy(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(e),
PRODUCER
USI Insurance Solutions LLC NAME: Kathy Wagner
No,Fit:4I3-750-4222
123 Interstate Drive E-MAIL 610-537-4670
West Springfield, MA 01098 ADD E�S; kathy.Wagner(# usl.biz
855 874-0123 INISURER S AFFORDING COVERAGE NAIL i
INSURED INSURER A:ABC Masa Workers Comp SIG 99999
Schernecker Property Services,Inc. INSURER B
283 Second Avenue INSURER C:
Waltham,MA 02451 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 ON 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 SUWECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR
LTR TYPE OF INSURANCE �_INSR US POLICY NUMBER POLICY E POLICY
PENERAL LIABILITY MWD0NYYY MM/DD - LIMITS
EACH OCCURRENCE -$
COMMERCIAL GENERAL LIABILITY DA ETO R!NTEb
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J CLAIMS-MADE El OCCUR
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PERSONAL&ADV INJURY 5- ~
GENE14ALAGQREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO. PRODUCTS-COMP/OPAGG $
POLICY LOC
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AUTOMOBILE LlA91LITY
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WNED BODILY INJURY(Per person) S
SCHEDULED
S AUTOS BODILYRINJURY(Por scddent) $
AUTQg NON-OWNED
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ELLA LU1B OCCUREACH OCCURRENCE $
S LIAR CLAIM$-MADEAGGREQATE $
RETENTION$COMPENSATION $
YERS'71Lrty ABCMA12000115 1/01/2015 01/01/201 X WC STATU- OTH-
IETOR1FARTNER/ExECUTIV[Y/N
EMMDEREXCLUDEI)? �NJ N/A E.L.EACH ACCIDENT $1x000,000
(Mandatory In NH) -
It yes,describe under E.L.DISEASE-FA EMPLQYEE $19000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s1 000 OOO
DESCRIPTION OF OPERATIONS/LOCATIONSIV@HIOLES(Attach ACOAD 101,Additlm
onpl Remarks Schedu:e,II more 6pncu ly required)
Proof of MA Workers'Compensation Coverage
i
CERTIFICATE HOLDER CANCELLATION
Heritage Green Condominium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
30 Farrwood Ave. ACCORDANCE WITH THE POLICY PROVISIONS.
North Andover,MA 01945
AUTHORIZED REPRESENTATIVE
®1900-2010 ACORD CORPORATION.All rights reserved,
ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#915057231/M13920367 I
05/07/2015 07:42 7814872505 SPS INC PAGE 02
ACERTIFICATE OF LIABILITY INSUR OATE(MMWD/YYYY)
ANCE
_ 5/6/2015
S L..ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTWFICATE 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 pollcy(lea) 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 N Claire Soutilier
Cleary Insurance Inc PHONE (617)723-0700 A7( .4617)723-7279
226 Causeway Street .cboutilier@clearyinsurance.com
INSURERS AFFORDING COVERAGE NAIL!
Boston MA 02114-2155 INSURER A 4Continental Western Insurance 10804
INSURED INSURER B;Union Insurance Com"pany 25844
Schernecker Property Services, Inc. INSURERCAcadia Insurance CoMRany 31325
283 Second Avenue INSURER D
INSURER E
Waltham MA 02451 INSURER F:
COVERAGES CERTIFICATE NUMBER:2014-15 Liability REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T'0 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
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVEBEEN REDUCEDBY
DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
BY PAID CLAIMS.
INSR I ADDLISUBP P ICY EFF POLI Y EXP
LTR TYPE OF INSURANCE POLICY NUMBER QNYYY MMMLIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE
Pom`enaa _$ 300,000
A CLAIMS-MADE 1 7X OCCUR UPA 0183614-18 12/31/2014 12/31/2015 -MED EXPAn
EXP(Any ono person) $ S'000
PERSONAL d ADV INJURY $ 1,000,000
GENERAL 4GGREGATE 8 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,-000
POLICYFX PRO- LOC $
AUTOMOBILE LIABILITY COMBI SINGLELIMIT
000 000
B ANY AUTO BODILY INJURY(Per person) $
ALL OVvNEO SCHEDULED 0183615-
1 AUTOS x AUTOS 18 12/31/sola 12/31/2015 BODILY INJURY )(Per $
X HIRED AUTOS R NON-OWNED PPROPER AMA S
AUTOS
$
X UMBRELLA LIAB 1( OCCUR
EACH OCCURRENCE $ 5,000,000
C EXC886 LIAB ICLAIMS-MADE AGGREGATE $ 5,000,000
DED RETENTION UA 0193616-18 12/31/2014 12/32/2015 $
C WORKERS COMPENSATION X WC STATU- OTH
AND RMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE 1/N /
OFFICERIMEMStR EXCLUDED? FN-] N/A E.L.EACH ACCIDENT S Z-0001 000
(Mandatory in NH) 5074780-12 12/31/2014 32/31/2015 E.L.DISEASE•EA EMPLOYELS 1 000 000
D as,deacrlge Unger (iSxclttdes �L)
DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT S 1'000,00
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Romgrka Schedule,II more apaco Is required)
The TOWn of Nortb Andover and Heritage Green Condominiums are included as additional insureds for general
liability per insurance coverage form CLCG0492 (02/12) as required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Heritage Green Condominiums ACCORDANCE WITH THE POLICY PROVISIONS.
39 Farrwood Avenue
North Andover, MA 01845 AUTHORIZED REPRESENTATIVE
Claire BOutiliar/CTB e4 -
ACORD 25(2010/05) ®1988-2010ACURD CORPORATION. All rights reserved.
IN.�/)95 f9Atmc1 M The Air NnR 1 norma anA Inns aria ranlglarftA ms*rllm of dr`^gn
The Commonwealth of Massachusetts
Department of Industrial Accidents
,.. I Congress Street,Suite 100
Boston,MA 02114-2017
5�.
�.` www.mass.gov/dia
Affidavit:Builders/Contractors/Electricians/Plumbers.
Workers'Compensation Insurance Af
TO BE FILED WITH THE PERMITTING AUTHORITY.
PI se Print Le 'bl
Applicant Information (�
Name(Business/Organization/Individual): >e i e e U
Address: sc(04 -*
Ci /State/Zi .�A, G M 17� Phone
' p.
Are you an employer?Check the appropriate box: Type of project(required):
1 I am a employer with(� employees(full and/or part-time).* 7. F1 New construction
2.F1 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'comp,insurance required.] 9, ❑Demolition
3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole
11.[J Electrical repairs or additions
proprietors with no employees. 12.[]Plumbing repairs or additions
5.F1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs
These sub-contractors have employees and have workers'comp.insurance.f 14.Q Other
6.❑We are a corporation and its,officers have exercised their right of exemption per MGL C.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submita new
affidavit those entities have such.indicting
Contractors that check this box must attached an additional sheet showing the name of the sub co
ntractors and state
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
li andjob site
Below
is thepolicy 1
ees. cy
X am an employer that is providing workers'compensation insurance for my employ p
information. �
Insurance Company Name:
Expiration Date:
Policy#or Self-ins.Lic.
4
Job Site Address:
//w : —City/State/Zip �J
Attach a copy of the workers' compensation policy declaration page(s39howing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,5
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy o his to ment may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ido hereby certify under tlz pa' s a d enalties of perjury that the information provided ab is tTrrectDate:
Si ature:
Phone#: /
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
6.Other
Contact Person: Phone#:
_Department of Public Safety `
Massachusetts Regulations or Standards
Board of Building Regulator
Construction SupervisA-
License: G :-V95348 I'S
GgAyDON IATA;
9 DOLE HII�L LAS
Boxford MA 0191 € �`
S Expiration 1
t �1 141` -I
03104J20'16
commissioner