Loading...
HomeMy WebLinkAboutBuilding Permit #498-2017 - 116 HIGH STREET 11/10/2016 of BUILDING PERMIT NORTy qw- �.f LEO 16"`Y - TOWN OF NORTH ANDOVER ~_.h.-,. M<.,` a o APPLICATION FOR PLAN EXAMINATION _ Permit No#: Date Received 1l( 10 t�b �Jy°°a rED�Pa1�(y ssq ue CHs Date Issued: ll X101 16 EVIPORTANT: Applicant must complete.all items on this page LOCATION. RICA —c� / Print PROPERTY OWNER_Mas a c �f', rint 1 oo Year structure yes no MAP S 3 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Qne family ❑ Addition W Iwo or more family ❑ Industrial Iteration No. of units: 3 ❑ Commercial ❑ Repair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well D Floodplain ' ❑Wetlands ❑ Watershed District 0 Water/Sewer- - DESCRIPTION OF WORK TO BE PERFORMED: [JCdolen electrical , n 1 L,)rn V— nQ n & n-)ndeJ 1 23 . rvnro ULW�e_5 , See J?r()0QLG,\ aoac)a� for Identification- PleaseType or Print Clearly OWNER: Name:��G�Q ,- Phone: Address: I CQ H Inn ro t Ne. � Contractor Name: N MCMQ (Dobj]j f'130hone: U Email: VY7 Address: 17 Supervisor's Construction License: (fir ms- Exp. Date: �2p 1� Home Improvement License: �� a(�1 J� Exp. Date: 1 O 1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ p� ' FEE: $ J� Check No.: I'f Receipt No.: NOTE: Persons contracting with unregistered contractors donot h Waccess to the guaranty fund — --- -- -- -- - ----- --- -- -- -- ----... - -'--------- ------ .. - ----- '- ---- ------- --- --- -- - - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ SwiaLi ing 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 m U FORM PLANNING a DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature r ,COMMENTS s HEALTH 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/SDriveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster onsite yes no Located at 12.4 Main Street Fire Department signature/date COMMENTS 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 ease) ® Notified for pickup Call Email Date Time Contact Name Doc.Bualding Permit 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) T Building Permit Application 4� Certified Proposed Plot Plan T 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 Location No. 1' �1 G `t ` • Date + !'L`ho • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# H00 '? 1 �' Building Inspector L rQn,9 we ,, trS ��fJ`c.r � I VLJ4�t �a�M�yl ccw p��D�oM 0 J v Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 473377.50 m $ - $ 568.53 Plumbing Fee $ 71.07 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 71.07 Total fees collected $ 810.66 116-118 High Street remodel apartment 498-2017 on 11/10/2016 r 1 NORTH . . 0. .c . : ve, . No. -901 .T - h ver, Mass, COC "Ic nl WK« x.95 RATe I'P���(5 U BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT GA. `/ �J Cil BUILDING INSPECTOR `-x' � L�`.. ......� �............ has permission to erect . g l�o.. �... --� �� ......... Foundation ......................... buildings ....... ......... .. ........ . ........... .................. Rough nl f� to be occupied as ...... .. c ��.�ll.......'.......�... . :�! ... .. ....................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT STA TS 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. WMC IY CONSTRUCTION :t8 ACADEMY HAWAMLL 9 MAOIL835 www•wal�aanan •, • clgyconstrUCt!o ®conn PHONE]# 978-89'L-2-303 PROPOSAL 11/2/16 I Project name: Matt Cote 116 Hi�h Street North Xndover, MA 01845 i SCOPE: PERMIT: S 750.00 DEMO • After acceptance of new floor plan by homeowner, remove all walls and floors on interior t�fit new layout. • Removal of existing kitchen and bathroom. • Strip wallpaper. • Disposal of all debris to a WMC supplied du pster. Labor: $ 21800.00 Materials: $ 1,438.00 Subtotal: $ 4,238.00 FRAMING: • Supply and install all framing for new opening at living room, new bathroom and ne�'' window in kitchen. • Install LVL beams ir, new Living room opening and provide engineer for stamp for building department. • Frame new bathroom walls. Engineer: $ 500.00 Labor: $ 2,100 Materials: $ 1,661.00 Subtotal: $ 4,261.00 INSULATION j • Fill all wall cavities with cellulose insulation blown in from the outside. Subtotal: 2,187.50 ELECTRICAL • Update all existing outlets and switches. • Install new fixtures in each room, kitchen, dini ig room, living room and a bath/fan light combo in the bathroom. Subtotal: $ 8,000.00 PLUMBING • Disconnect all existi 1 g plumbing to kitchen an bathroom. • Supply and install all rough plumbing for new kitchen layout and new bathroom layout. • Supply and install toilet, vanity and shower enclosure. • Install all fixtures. Toilet, bath, sink faucet, sh wer valve and head, kitchen sink, garbage disposal and dishwasher. Subtotal: $ 8,201.00 SHEETROCK • Apply%" blue board on all ceilings and plaster. Labor: $ 2,500.00 Materials: $ 750.00 Subtotal: $ 3,250.00 KITCHEN • Supply and install kitchen cabinets and countE rtops of client's choosing. Labor: $ 2,520.00 Materials: $ 8,438.00 Subtotal: $ 10,958.00 FLOORING • Install %Z" underlayment in kitchen and dining room. • Install 12x12 self-adhesive linoleum tiles. Labor: $ 1,120.00 Materials: $ 1,250.00 Subtotal: $ 2,370.00 DOORS • Supply and install insulated entry doors and h 311 entry and basement. Labor: $ 575.00 1 Materials: $ 551.00 Subtotal: $ 1,126.00 FINISH WORK • Install casing on new opening to living room. • Install baseboard onIl new walls in bath and nywhere affected. • Install door on bathroom. Labor: 1,680.00 Materials: $ 356.00 Subtotal: $ 2,036.00 **PLEASE NOTE: Disposal will be done daily to a dumpster provided by the WMC. WMC work will be completed in a timely and clean manner and in observance of OSHA regulations. ** TOTAL: $47,377.50 i a IP McKay Construction LLC Betsy and Matt Coe i i � a m u ado Q �� � Vr 0o Massachusetts Home Im rovement Sa le Contract This form satisfies all basic requirements of the}rate's Home Improvement P�t�D mit pYCm cols bould fibut rst obtain include not copy of standard d language to protect homeowners. Seek legal dvice ir necessary tvodc On our reside You tray obtain a flee copy by calling the Massachusetts Consumer Guide to Home Improvement"before r Information to any Y non's Consumer Information Hotline at 617-973-87:17 or 1-888-283-3757 or on ow website. Office of Consumer Affairs and Business Regut ^ C traCto+ Info tion seo n r Info a o t f CompanyNamc rr" Name F. ca �r ' t use a Post Office Box addmss Contractor/Satespersonl pwrtcr NeI rte Street Address( f Y State tip Co c Business Address(must include a 1 O f Citylfmt tt 1 r 1 /A / tale Zip Code Evening Phone Cityvwn �� 9 7 7S 3?Ihytitne Phone 7 Business Phone Fcdctal Employer ID n[S.S.Number t from above i rtncot Employ toy M1[a[t[et �'pn dat Mailing Addicts(It different ) nomc� la•rcreat[es tort cont Iro,[n (mPrnvrraa[cenna<r•rslue A t a road[eaistrs[bv mmnn �� I a�5 / / The Contractor agrees to do the following ork for the Homeowner. (Describe in detail the wrork to completed,spcci' I' the type,brand.and grade of matcriats to be used,tKt" ditiona�l sh— t5 if naxc`arv•) Required PLbllowing building�gmits are required Proposed Start and Comple an Schedule-The following schedule will and will be ntractor as the homeowner's agent: be adhered to unless circumst txs beyond the contraccofs control ansa(Owners their own pelflnits will beDate when w traet0r will begin contracted work.excludeduaranty Fund provisions ofMGL ch ) I _Date when cotractcd work will be substantially comptetcd. Total Contract Price and Payment Schedule t (f) The Contractor agrees to perform the work,famish the material and labor specified above for-,J total Is of: payments will be made according to the fol owing schedule: g-Z�poo upon signing contract(n�uu to exceed1/3 ofthe total contract pace 9I the cosofspecial order items,whichever is greater) I1 or completion ofa y_-- j. Sly f q. by—!!or t ptm completion of �3 comp letion of the writract. (law forbids demanding full payment until ntract is completed to both party's satisfaction) The following materiallegaipment must be special 5 to be paid for ordered before the contracted work beg as in orderS to be paid for to meet the completion schedule.(") NOTES:(*)Including all finance charges(")Sew rquires that any depositor down-payment required 4y the contractor before work begins may not exceed the grater of(a)one 4hird 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. 1i( o ❑No❑Yes t W tkrms or the`v'rrann mu tit c atlnehed fo the eanntramt) Fjytress warranh Is an express warmnh ficin vided by the contractor less of the actions of any third Subcontractors-The contractor agrees t0 be solely responsible for completion of the work de�edbed regard C contractor further agrees to be solely respatsible for all payments to all subcontractors for party/Subcontractor utilized by the contractor. Th materials and labor under this a mcnt Cantrnet Accept.nee-Upon sienna.this document becomes a binding contract under law. I mess otherwise noted within this document.the contract shall not imply that any Her,or oither security interest has been placed on the residueI —ic tbl rte""^>;eaatiom and.,e<.eee carefully before sighing this contract. I • Don't be pressured into signing the ,ntrad Take time to read and fully understand it. �k questions if something is unclear. Make sure the contractor has a valjdalHome haurovement Contractor Registration. The lily requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Regis ton. You may inquire about contractor registration by writing to the Directdr at 10 Park Plaza,Room 5170,Boston,MA 02116 Ir by calling 617-973-8787 or 888-283-3757. Does the contractor have insurance? Ask the Contractor for his insurance company infon nation so that you can confirm coverage;or ask to see a copy of a'proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse sic a of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Iaty- I You may cancel this agreement if it has liven signed at a place other than the contractors no place of business,provided you notify the contractor in writing at hislhcr main offi a or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing f this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Tav•rdmdcl eoFics of the contract rn%hu be ceagiemf and sig d.One copy sh-ld go[o the The msber wPY sh-ld be lc p[b.'[ho crntme[er. Homeowner's Signature Can s Signator 7 /fo Date Date Contractor Arbitration The Home Improvement Contractor Lair provides homeowners with the right to' is t a arbitration action(e an alternative to court action)if they have a dispute with a contractor. The same righ is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give he contractor the same right to arbitration as is afforded to the homeo�rter by the Home Improvement Contractor Law. The contractor and the homeowner herby mutually agree in advance that in the a rent the contractor has a dispute concerning this contract,the contracto may submit the dispute to a private arbitra'on firm which has been approved by the Secretary of the Executive Office df(Consumer Affairs and Business Regulation and the consumer shall be required to submit to ch arbitration as providod In Massachusetts General Laws,chap r 4toal Homeowner's Signa reCon aNOTICE:The signatures of the path above apply only to the agreement o thetive dispute resolution initiated by the contractor. he homeowner may initiate alternative di ute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 9310 may not be waived in any way,even by i greement. However,homeowners may be excluded from certain rights i'the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own bi ii1ding permits are automatically excluded I irom all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for comp eting the work as described,in a timely and workmanlike manner. Ho neowners may be entitled to other specific egal rights if the contractor guarantees or provides an express wairaatty for workmanship or materials. In ad ition to guarantees or warranties provided by the contractor,all goodsold in Massachusetts carry an implied war anty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner Md contractor lawfully agree maybe added to the terms of the contract as long as they do not restrict a homeowner's It asic consumer rights. if you have questions about your consumer/homei wner rights,contact the Consumer Inform tion Hotline(listed below). Execution of Contract The contract must be executed in du licate and should not be signed until a cop) of all exhibits and referenced documents have been attached. Parti s are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,cI not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other klept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescisjion period has expired. Accelerated Payments A contractor may not demand ps in advance of the dates specified on the payment schedule in cases where the homeowner deems himlherself to be(financially insecure. However,in instane where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds of yet due be placed in a joint escrow account as a prerequisite to continut g the contracted work. Withdrawal of fun from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home provement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Massachusetts Co umer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Re lation 10 Park Plaza,Room 5170,Boston,MA 0 116 617-973-8787,8884,83-3757�83-3757 or visit the OCABR website at jilt ocabr If you want to verify the registration►of a contractor or if you have questions or need additional information specifically about the contractor registration cotnponent of the Home Improvement Contra for Law,contact: Director of Home Improvement Contractor Re istration Office of Consumer Affairs and Business Re anon 10 Park Plaza,Room 5170,Boston,MA 0 116 617-973-8787,88�283-3757 or visit the HIC website at jilt roll' tr.mass.vov.'ocabr Go online to view the status of a Home Ii vrovement Contractor's Registratio : hgp: db.state.ma.usliomeimnnove i ntlic nseelist.asn For assistance with informal mediation of disputes or to register formal compl ints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 509-652-4800,508-755-2548 or 413-73413114 version 2t•t t>z2rzoto The Commonweidth ofMassachusetts Department of lndustriOd Acerdet2ts 1 Congress Street,Suite 100 Boston,MA.02114-2017 www.massgoh/dia ' 0,pkers,Compensation Insurance Affidavit:Builders/Contractors/Fiect?r:icians/Plumbers. TO BE FILED WITH THE PERMITTING AUTJE[0P TY' Please Print Le 'b] Ap cant Information n/fndividual . C Name(Business/organzatio Ave-. Address: Ll City/State/Zip: ) M� 1� fh one#: �7 qua Areyon Ch an employer? ecktfieeaappropriatebox; Type of project(required): 1.�Iamaemployerwith employees(full and/or ParE time). 7. []New construction ' 2.0 employees Wor I am a sole proprietor or Partnership and have no p y for me in 8. � Remodeling any capacity.[Noworkers'comp.insurance required.] 9. F1 Demolition 3.[]I am a homeowner doing all workmyself[No workers'comp.insurance required.]t 10 E]$ufldjng addition <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will l l []Electrical repairs or additions that all contractors either have workers,compensation insurance or are sole ensures or additions propiietrs withno employees. 12.[]Plumbing repairs 5.C]I am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13•E]Roof repairs Z`hese sub-contractors Bade employees and have workers'comp.insurancoi 14.❑Other 6.❑We are a corporation and its gf gers have exercised their right of exempfion per MGL c. ` 152,§1(4),and we have na employees.[No workers'comp.fi m ee required.] aA—applicant that checks box#1 must also fill out the section below showand ing their woroutside contmetors must kers'compensation policy infora now mation. t Flomeowners who submit`,this affidavit indicating they are doing all workth name a o£he sub contract rs and state whether or nowt those entitiesdavit b have, $Contractors that check this box mutattached an additional sheet showing employees. If the sub-co�raejors Tuve employees,'they must pro9ide their workers'comp.policy mmmber. X am an employer drat is providing workers'compensation insurance for my emplo.Yees'Below is the policy and jolt site information. Insurance Company Name: �'�11(,t A 'C �(���� Expiration Date. � Policy#or Self-ins,Lic.#• M City/State/Zip: lob Site Address-_J crnpensation policy declaration page(showing the policy number and expiration date). Attach a copy of the workers' Failure to secure coverage as required under M enalties m§he f is of a 5 ��°wl�on Vianishablend a fine of up fo$25y a fine Up to 00.00 a and/or one-year imprisonment,as well as civic p day against the violator.A copy of tbis statement may be forwarded to the Office of Iuvestigations of the DTA.for insurance coverage verifioation- �do hereby certify u r the andpenalties o/pe'7Ur1 treat the znfoymationprovided above is true and cotrecz � Date: �I -7/1 Si ature: Phone LL6.Other only. Do not write in this area,to be completed by city or town offieiaL. Town: Permit/License# hority(circle one): Inspector Board Health 2.13uz1dingDepartment 3.City/Town Clerk 4.Electrical Inspector 5.PlumbingInsp .Jf?hone#•rson• WILL" OP ID:LANK ,�►coRn DATE(MM/DDNYYY)CERTIFICATE OF LIABILITY IN URANCE 11107/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF(INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT iETWEEN 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 bi endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A sta ement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Macdonald&Pangione Insurance NAME: Kim Lar dry 104 Main Street PHONE 978-6 8-6921 North Andover MA 01845 4 IL Ell: Ne:978-688-5350 Lisa Ross a DRESS:kim@m ins.net INS RER(S)AFFORDING COVERAGE MAIC# INSURED W Mckay Construction, LLC INSURER A:Guard nsurance Group Billy INSURER 8: 18 Academy Avenue INSURER C: Haverhill,MA 01832 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 TC THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,E ENT,TERMOR 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 POLICIES.CONDITIONS OF SUCH POLIC S.LIMNS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. (NSR LTR TYPE OF INSURANCE IPOLICY NUMBERIP DpY EFF POOLIC EXP YYYI LIMITS GENERAL LIABILITY I EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY MAGE 10 I PREMISES R occurrenceS CLAIMS-MADE OCCUR I MED EXP(Any one person) 5 s PERSONAL 8 ADV INJURY 5 GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMP/OP AGG S POLICY PRO LOC 5 AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT Ea accident S ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS i PER ACCIDENT) $ ' S UMBRELLA LIAB OCCUR ( EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE i AGGREGATE $ DED RETENTION S I S WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS,LIABILITY X TORY IMITS ER A ANY PROPRIETOR/PARTNEWEXECUTIVE Y/N WM C700002 03129/2016 03/2912017 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT S 500,00 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) 1 i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF I HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESE TATIVE ©1988 010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD I name and logo are registered marks I f ACORD f ACORD► CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDOIYYYY) 11/7/16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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: sandl munroe M.P. Roberts Insurance Agency PHONE (978 683-8073 FAX (978) 683-3147 A No: 1060 Osgood StreetE-MAIL ADDRESS: sandi@*probertsinsurance.com North Andover, MA 01845 INSURER(S)AFFOROING CO_VERAGE_ NAIC# INSURER A:Merchants Mutual Insurance Co INSURED - INSURER B:-- -- W MCKAY CONSTRUCTION LLC INSURER C: ATTN: BILL MCKAY INSURER D: _ 18 ACADEMY AVENUE INSURER E: BRADFORD, MA 01835 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. 1NSR AODL SUER POLJCY EFF POLICY EXP r LTR TYPEOFINSURANCE POLICY NUMBER MMIODIYYYY MMIDDIYYYY 1 UMTS A GENERALLIABIUTY BOP9097489 8/14/16 8/14/171 EACH OCCURRENCE $ 11000,000 �{ COMMERCIALGENEPAL LIABILITYDAMAGE TO RENTED eB�ll n $ 500,000 CLAIMS-MADE a OCCUR MED_EXP(Anyone person) $ 15,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 }{ POLICY PRCj 0 LOC $ A AUTOMOBILE LIABILITY MCAI002126 8/6/16 8/6/17Eaac'NE ert IN LIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNEO X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS Paraccidenf A X UMBRELLA UAB }{ OCCUR CUP9147266 8/14/16 8/14/17 EACH OCCURRENCE $ 1,000,000 EXCESSUAS CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 10.000 $ WORKERS COMPENSATION I I WC STATU- OTH- AND EMPLOYERS'UABIUTY ANY PROPRIETORIPARTNER/EXECUTNE YIN OFFICERMIEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-Flt EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 10i,Additional Remarks Schedule,if more space is required) 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. NORTH ANDOVER, MA 01845 AUTHORIZED EPRESENTATIVE © *88-20h b ACORD CORPORATI N. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: • 1 �IlP ((Cr JJt JJIBitJi•PQI��c/CC'(( r' I llre��J —'--- Office of Consumer Affairs&Business Regulation License or registration valid for individual use only 310 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: I , Registration: 179265 Type: Office of Consumer Affairs and Business Regulation .;y Expiration: 7/10/2018 LLC 10 Park Plaza-Suite 5170 Boston,NIA 02116 W.MCKAY CONSTRUCTION LLC. WILLIAM MCKAY 18 ACADEMY AVE. HAVERHILL,MA 01835 Undersecretary Not v lid ut signature it 10 8LOZ/801£0 Jau0issiWWO3 ti uoue:Iox= � w 9£810 VW 111H213AVH 3nN3AV AW3aVOV 8L AVNDW WVI111M JosinladnS uoilonjisuo� i:fiNWSJ :asuaoil spaepugS pue suot}eln6aa 6uippn8}o pae08 I(ta;eS oilgnd }o tuawpedap sj4asny3essew'