Loading...
HomeMy WebLinkAboutBuilding Permit #210-2016 - 110 BLUE RIDGE ROAD 8/19/2015 X iC NORTH VV A�o BUILDING PERMITs TOWN OF NORTH ANDOVER �� y '` `,a 0 APPLICATION FOR PLAN EXAMINATION T h Permit No#: 7 Date Received SSACHUS� Date Issued: --�,Df' RTANT: Applicant must complete all items on this page LOCATION J I D U-2 k6 D< t'. L &fe, /. Print PROPERTY OWNER g0&5 C/ )( , % t, �._ Print 100 Year Structure yes o MAP PARCEL:���ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑Addition ❑Two or more family ❑ Industrial ,Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: 0 Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District El Water/Sewer ` —DF,SCRIP ION OF WORK TO BE PERFORMED: pea )0�emotze c �5 Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: ( Phone: !'2� Email: - G Address: RA 1A A < o Supervisor's Construction License: D�9�j1!� Exp. Date: Home Improvement License: / Exp. Date: Z -- ARCHITECT/ENGINEER Phone: Address: 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: $ 902,� FEE: $ Check No.: (� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund -- I Location lo 61 � No. Dat • - TOWN OF NORTH ANDOVER � TED] � . Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ + Other Permit Fee $� TOTAL $ ! Check#�� � !I CC�� +� r Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swilmning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS H`ALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT �' _ _ _.� _1 _1., = Tempi®ump�ster on�sit& �y�es�, o _t i `t` 124YMain „ . _µ _ Loca ed a _ tS,teet F�i're�Dgpartm,ent�sgnature/date;_._ _ _ CQMMEN� �S._._._.__ 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.$100-$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 Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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) 4 Building Permit Application 4. 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 I ECC 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 I i * CERTIFICATE OF LIABILITY INSURANCE DATE (M141201 YYYI TWL%AERT1FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS rTC0,R ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE 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 terns and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: WELSH&PARKER INS PHONE FAX 131 COOLIDGE STREET STE 100 (AIC,No,Ext): (Arc,No): E-MAIL HUDSON,MA 01749 ADDRESS: 73L2B INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: HARTFORD UNDERWRITERS INSURANCE COMPANY SAGER&SON INC INSURER B: INSURER C: 37A DUNSTABLE ROAD INSURER D:INSURER E: NORTH CHELMSFORD,MA 01863 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. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE DAMAGE TO RENTED $ OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ GENERALAGGREGATE $ POLICY PROJECT❑LOC 0 PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND XWC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-58952586-15 04/02/2015 04/02/2016 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ED NIA E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION RUSS STEVENS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 110 BLUE RIDGE RD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIO AUTHORIZED REPRESENTATIVE NORTH ANDOVER,MA 01845 1 ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORP _ i:SW! R§fits reserved. Massachusetts -�Departm�ent Public Safety . Board of Building Regulation's guiations and Standards COii�ii License: CS-079413 L titiT 1'.L �� • EDMUND L SAG�� * 37 A DUmstable Rod North Chelmsfor& My Expiration Commissioner 05/1812017 `----- �'amnza�arucatt� Office of Consumer Affairs 61CIf/ttlJ[�fJ ME IMPROVECON &Business Regulation 165266 egistration:IMPROVEMENT CONTRACTOR xPiration: .112,7!2016, Type: SAGER&SON INC. Corporation EDMUND S A G , ER *•r' 37 A DUNSTABLE RD. NORTH CHELMSFORD,M'A 61863. E Underseereta� Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 299260.00 m $ - $ 351.12 Plumbing Fee $ 43.89 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 43.89 Total fees collected $ 538.90 i 110BIue Ridge Road 212-2016 on 8/19/2015 Bath Remodel NORTH Town of . t E I� Andover To No. so h ver, Mass, bi 0g COCNICNIWICK . � R^TEO U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System �.,�/THIS CERTIFIES THAT ......... ......!JJ................_............�5....�:�.�`:�'.`^..�......................................... BUILDING INSPECTOR has permission to erect .......................... buildings on .*................. Foundation �Q /� Rough MJ.l�/ to be occupied as .............. .....&A......�.•�•��:. .................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 2 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S TS Rough Service ........................ ....................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. d GER SON1 INCI Remodeling and Development Co. Specializing in Top Quality Kitchen & Bath Remodeling Russell &Marie Stephens 110 Blue Ridge Road March 25 2015 North Andover, Ma Dear Russ &Marie, Thank you for allowing us the opportunity to quote on remodeling the master bathroom at your home. We would like to assure you that the work will be completed in a timely and professional manner. Please review the following factors we discussed with you,that would apply to the work being done. SCOPE OF WORK: Remove and dispose of the vanity, sinks, faucets and toilet. Remove and dispose of the existing tub. Remove and dispose of the existing shower enclosure, valve and trim. Remove and dispose of the existing tile flooring and sub-floor. Remove and dispose of all walls and ceiling as necessary. Remove and save toilet for reuse. Install batt insulation to all exterior walls. Install new cement board sub-floor for tile. Install new floor tile(homeowner). Install new plaster skim coat walls and ceiling (smooth finish). Install cement board in tub area to be tiled. Install vinyl shower pan. Install new cement board to walls in shower area. Install tile on walls in shower area(Homeowner). Install new base and tile floor in the shower area(homeowner). Install new vanity,top, sinks and faucets (Homeowner). Install new free standing tub(homeowner). Install new Toilet(Homeowner). Install new shower mixing valve and trim(homeowner). Install new 3/8" frameless glass shower enclosure with chrome trim. Install new medicine chest or mirror(homeowner). Removal of linen closet for new cabinet will be at extra cost Install new base trim Install new window casing One coat of primer and two coats of premium latex finish paint to be applied to all walls and ceilings (paint supplied by contractor color selected by homeowner). All plumbing work to be done in accordance with local and state building codes. Install new ceiling fan/light vented to the exterior(contractor). Install new wall light or 2 wall sconces at same location(Homeowner). All electrical work to be done in accordance with local and state building codes Any electrical code issues hidden behind existing walls will be addressed at extra cost. Any plumbing code issues hidden behind existing walls will be addressed at extra cost. Any wall framing that is rotted or undersized will be replaced to code at extra cost. PRICING: We propose to provide labor and certain materials to complete this project for: $29,260.00 TERMS: 30% at contract, 30%after plumbing and electric, balance on completion. We are registered, and in compliance with the MA Home Improvement Contractor Law (MGL chapter 142A) our registration number is 292968. Insurance certificates and references are available upon request. If you have any questions feel free to contact us www.sagerandson.com Sincerely, Ed Sager Alan Sager / 4 CUSTOMER NAME: Russel & Marie Stephens DATE 3/16/2015 DESCRIPTION: Master bath remodel 110 Blue Ridge Rd.Andover Planning&Initialization Permit 531.25 Disposal 650.00 Daily Cleaning 312.50 Final Cleaning 525.00 Temporary Protection 312.50 Rough Carpentry/Framing 3,900.00 Demolition 1,300.00 Project Management 3,125.00 Finish Materials Base Molding 125.00 Door Casing 218.75 Window Casing 218.75 Insulation Bats 525.00 Plaster Skim-Coat 937.50 Wall Covering Paint-Latex 130.00 Paint Labor 812.50 Tile 1.25 Tile Labor 937.50 wall prep for tile 562.50 Floor Covering Tile 1.25 Bath Floor Tile Labor 2,000.00 Shower Base 325.00 Shower Floor Tile Labor 618.75 Plumbing Rough 3,500.00 Finish 1,250.00 Glass Enclosure 2,125.00 Linnear Drain 1.25 Electrical Rough 2,125.00 Finish 1,750.00 Bath Fan/Light/Vent 437.50 Hard Surfaces/Countertops Granite 1.25 Total Price: 29,260.00 DELUXE FOR BUSINESS 1-800-888-6327 Hei.No:G 110202000 SAGER SON, INCI Remodeling and Development Co. Specializing in Top Quality Kitchen&Bath Remodeling 37A Dustable Road, North Chelmsford,MA 01863 (978)250-2322 This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A). Any person planning home improvements should first obtain a copy "A Consumer Guide to the Home Improvement Contractor Law" before agreeing to any work on your residence. The guide will inform you of your rights and responsibilities as well as provide you with important information about what to do if a dispute arises. You may obtain a free copy by calling the Executive Office of Consumer Affairs'information Hotline at 617-727-7780. Homeowner Information Contractor Information NameCompany Name USES � e ate �( Street Address (Do not use a Post Office Box Address) Contractor/SalespersoOwner Name 6 N � V t City/Town State Zip Code Business Address(Must Include a street address) Daytime Phone Evening Phone City/rown State Zip Code Mailing Address(if different from above) Business Phone Feder�l,EmpI y�r ID c S.�myerA Law requires that all home Homelmprovement Contractor Reg./N'umbeerr Exppir=aattiionD Improvement contractors have a valid registration number. D J The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to be completed,specifying the type,brand and grade of materials to be used.) ❑ Check this box if additional pages are used for this section. Required Permits - The following building permits are required and Proposed Start and completion schedule The following schedule will be will be secured by the contractor as the homeowner's agent. Owners adhered to unless circumstances beyond the contractor's control arise. who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A. / -Date when contractor will begin work 1) f -Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule /�✓ V The contractor agrees to perform the work,furnish the material and labor specified above for the total sum of:$ Payments will be made according to the following schedule: C ��q T/C cS M t $ / r �v upon signing contract(not exceed 1/3 of the total contract priceoror`t'hhe cost�of special order items,whichever is greater $�br COV . 9W by-/-/ or upon completion of /7/'/G !�(df,C�{ ��L.°/�c 1`r%6 f-) E $ by / / or upon completion of $ •vv upon completion of the contract. (Law forbids demanding final payment until contract is completed to both party's satisfaction.) 1 01 The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.2 $ to be paid for Notes:(1)Including all finance charges (2)Law requires that any depositor 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. Express Warranty-Is an express warranty being provided by the contractor? No ❑ Yes (all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,this contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. Don't be pressured into signing the contract, Take time to read and fully understand it. Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires all home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-8598 or 617-727-3200. Does the contractor have insurance? While not required by law,it is a good idea and an additional protection. Know your rights and responsibilities. Read the important information on the reverse side of this form and get a copy of the Consumer Guide. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day followi igning of this agreement. See attached notice of cancellation form for an explanation of this right. NOT SIGN THIS/CO Cr IF THERE ANY BLANK SPAC .. omeowner's Signature e Contr tor's Signature Da w { oQr i 1 lab ' l� D( ,f.� } The Commonwealth of Massachusetts Department of IndustrialACCidents 1 Congress Street,Suite 100 ` Boston,MA.02114-2017 www mass.gov1dna yy Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMY=G AUTHORITY. Aipplicant Information �+ Please Print Legib Name(Business/Organization/Individual): .J _21411 Me, Address: � (� f �/�-90 City/State/Zip: IV, eye,J1)ZVQV /til- _ Phone Are you an employer?Check&e appropriate box: ' Type of project()required): L Q I am.a.employer with employees(full and/or part time).* 7. [1 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8.�R.emodelirig any capacity.[No workers'comp.insurance required.] in all work myself. o workers'comp.insurance required.] t 9. Demolition 3.. Y am a homeowner doing y [N p q 10 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.❑Electrical repairs or additions proprietors with no employees. 12..0 Plumbing repairs or additions 5.❑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,instuance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have nQ 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. f Homeowners who submit#his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-con6c6s have employees,%oy,must provide their workeis'comp.policy number. X am an employer that is pioviding workers'compensation insurance for my employees'Below is the policy and job site information. Insurance Company Name: 127) f — Policy#or Self-ins.Lie.#: ui3,, �P ;/ ,2s=S �� ' �'s Expiration Date: / ,2� Job Site Address: �/62 /2 e— / /Z4 c 20 City/State/Zip:1��i /1�1�d 1&12— Attach a copy of the workers'compensation-policy declaration page(showing 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$1,500.00 penalties in the form of a STOP WORK ORDER and a fine of u and/or one-year imprisonment,as well as civil p P to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certify under the pains and pen ties ofperjury that the information provided above is true and correct. Signafore: Date: 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#: SAGE&SO-01 BBOYER coR�� CERTIFICATE OF LIABILITY INSURANCE r ATD/YYYI� 8//13/213/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Welsh&Parker Insurance Agency,Inc.I Hudson Office HONE. Ext:(978)562-5652 FAX No: (978)562-7120 131 Coolidge Street,Suite 100 IAIC'EMAIL Hudson,MA 01749 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Merchants Mutual 23329 INSURED INSURER B: Sager&Son Inc INSURER C: 37A Dunstable Road INSURER D: North Chelmsford,MA 01863 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. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAGE TO RENTED- CLAIMS-MADE P(I OCCUR BOP1071262 0311912015 03/19/2016 PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 1 PES [:] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A ANY AUTO MCA0000015 0211712015 02117/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE CUP9145613 03/19/2015 03/19/2016 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYY/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Worker's Compensation Certificate to be sent directly from the company. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Russ Stevens THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 110 Blue Ridge Rd. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE � .4.4.-e- /1• `>n•,.G�et.�� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD