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HomeMy WebLinkAboutBuilding Permit #443-13 - 12 ROYAL CREST DRIVE 12/4/2012 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: PORTANT:Applicant must complete all items on this page LOCATION Ro al Cres BUILDING_# Print _PROPERTY OWNER AIMCO Royal Crest Estates LLC UNIT# 1 Print MAP NO: ���PARCELQ ZONING DISTRICT: Historic District yes no X Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition 11 Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 011 Septic z Well ` ®Fioodplainetlands 'r-` 'Wat shed D strict p af LMate/ewer k _ §; fr DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Thomas H. Kinnal Phone: 978-360-0Q.51 Address: 286 Broadway, Haverhill MA 01832 Supervisor's Construction License: CS 82747 Exp. Date: 6/20/201' Home Improvement License: Exp. Date: 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: $ 2—gi Cobb FEE: $ L Check No.: Receipt No.: ��� NOTE: Persons contracting with unregistered contractors do not have access to the guars 7fund Sign tore ofAgent/Owner .�� .� � __ I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on_ Signature COMMENTS HEALTH Reviewed on Signature ' COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes q Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPS'Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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.$100-$1000 fine NOTES and DATA— For department use I ❑ Notified for pickup - Date i Doc:.Building Permit Revised 2008mi I 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 j ❑ 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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 NOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit d [n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals :hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording nust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location No. Date,04?— fil � - TOWN OF NORTH ANDOVER .;, Certificate of Occupancy $ Building/Frame Permit Fee $ J Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 26006 Building Inspector n i ' 5 O D To: Tom Kinnal at East Coast General Contracting From: MATULA,DAN, Executive Vice President Redevelopment&Construction Services ORGAN, TONY,Vice President of Construction,Construction Services STEICH, MATTHEW,Regional Director of Construction,Construction Services Milinazzo, Dan, Project Manager, Construction Services Date: December 3,2012 Re: Executed Contract and Related Matters Attached is your copy of the executed contract with AIMCO NORTH ANDOVER, L.L.C., an affiliate of Apartment Investment and Management Company("Aimco"),for construction services at Royal Crest Estates (North Andover). We want to take this opportunity to inform you that Aimco is committed to conducting its business in accordance with applicable laws, rules and regulations and the highest standards of business ethics. If during the period of your business relationship with Aimco, you believe the Aimco team members with whom you are dealing are not living up to these standards,we ask that you report such conduct to one of the following: MATULA,DAN, Executive Vice President Redevelopment&Construction Services: (303) 691-4547 COHN,LISA, Executive Vice President and General Counsel: (303)691-4415 • HANSON,MIKE,Vice President—Internal Audit: (303)691-4376 If you prefer to remain anonymous, you may make a report using Aimco's anonymous and confidential reporting system, MySafeWorkplace, which is available 24 hours a day, seven days a week via the Internet at www.MySafeWorkplace.com or by calling 1-888-481-7123. We encourage you to use MySafeWorkplace only if you do not feel comfortable reporting issues directly to an Aimco representative. We would also like to remind you that Aimco has a Code of Business Conduct and Ethics,which prohibits Aimco employees from accepting meals, entertainment, services or gifts from anyone who does business with Aimco unless the amount of such item is less than $25. AIMCO Construction Services has a$0 policy. This provision is to specifically include, but is not limited to, suppliers or other contracted labor utilized under this project. It is the responsibility of this Contractor to advise any subcontracts or suppliers of the AIMCO Code of Business Conduct and Ethics. v 1 Page Form,GC,Lump Sum,Contract,2-Jan-12 t NORTl� own of E �, sAndover O No. O h ver, Mass . � 1, cocC"I HewIcw � AORATED J"Q¢��5 • S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT PERVIT .. BUILDING INSPECTOR is • Foundation haspermission to erect ..........2 ......�.... buildings on .. . . ......... ... ....... ........ .•• .•••• Rough to be occupied as ...... ......... .....f.m..I....... ............................................. Chimney provided that the person accep ng this permit shall In every resp conform to the terms o"f"t' f 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final • PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC S TS Rough Service ............. . ..................... Final BUILDI ECTOR 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. SEE REVERSE SIDE EXHIBIT "A" SCOPE OF WORK CONTRACTOR shall perform the following Work in strict accordance with the terms of the Contract: 1.0 WORK SYNOPSIS Garage Reconstruction 2.0 SCOPE OF WORK Document Number Title or Description Rev. No. Estimate: 1000081408 Engle Martin &Assoc. Loss Scope—Claim: P120423913482 11/7/12 SCOPE OF WORK Standards and Description of Work Performance ROYAL CREST ESTATES(NORTH ANDOVER) GARAGE RECONSTRUCTION Construction Requirements: The work of the CONTRACTOR and their employees shall be performed in a good and workmanlike manner. Workmanlike quality is defined as workmanship that meets or betters those criteria indicated in applicable building codes, using materials and installation methods identified in the construction plans and this Scope of Work. Code Requirements: All jobs shall conform to those standards stipulated in the building code, health code, mechanical code, plumbing code, and electrical code applicable in the local jurisdiction. All construction on the OWNER'S properties shall meet or exceed NAHB Performance and Building Standards. CONTRACTOR is responsible for acquiring any and all needed permits/certificates for the work and any associated costs. Safety: CONTRACTOR agrees to comply with OSHA and/or any other governmental agency's safety rules and regulations. Should any citations, fines, and/or penalties, etc., be incurred by the OWNER due to the negligence of the CONTRACTOR,the CONTRACTOR agrees to indemnify the OWNER for any and all penalties, fines, etc., incurred. CONTRACTOR shall perform the following Work in strict accordance with the terms of the Contract: Location: Royal Crest Estates(North Andover), North Andover, MA 01845. Garages 11-15 near Building 19. Turnkey Job: The CONTRACTOR will furnish all equipment, supervision, material and labor necessary to deliver a finished project/product which completes the scope of work and successfully addresses the projects intentions. Intent: Restore building damage resulting from a fallen tree during recent storm events to the OWNER'S quality standards, such that the unit and building can be used and occupied comfortably after the work. Approved: OWNER/MGMT CO: CONTRACTOR: GC,ExhbiLs"A"and`B",22-Nov-05 Pagc 1 of 8 Contract No.14710-N'V'.l'N-01 Scope of Work: 1. Adhere to scope items outlined in Engle Martin Associate's Adjusters Scope provided, including but not limited to the following clarifications. 2. Removal and replacement of all of the specified structural elements of the damaged garages (framing,sheathing, bracing, etc.). a. Note: New garages shall be modeled after existing adjacent garage spaces. No design modifications shall be allowed unless expressly approved in writing by Owner/Owners Representative. 3. Removal and replacement of damage facade finishes(siding paneling, masonry veneer, etc). 4. Removal of entire roofing system including shingles, underlayment, flashing components, etc at garages 12 through 15. 5. Replacement of roofing system with new architectural roofing system and necessary underlayment products and flashing components. 6. Removal and replacement of damaged garage door at garage 13. 7. Reparation of damaged electrical components to ensure full power restoration to affected garages. 8. Dispose of all construction and demo debris in contractor provided container, use of on site dumpsters is unacceptable. 9. Provide a written schedule for the project. 10. Provide a minimum 1 year workmanship warranty effective starting from the date of final acceptance by OWNER and all manufacturer warranties. 11. Compile and provide all original Manufacturer Warranties& Manuals into both a hard copy as well as a digital copy of an O&M Binder inclusive of all applicable products/systems utilized during the project contained within this scope of work. 12. Attend a mandatory pre-construction meeting on site with OWNER and site personnel prepared to discuss scheduling, staging, and other site specific requirements prior to commencing any work. ALTERNATE 1 —GARAGE DOOR AT GARAGE 12 1. Removal, replacement, paint, and installation of garage door at garage 12 in lieu of repair only ALTERNATE 2—ROOF REPAIR AT GARAGE 11 1. Installation of plywood patch to voids in existing roof,flush with surrounding roof decking 2. Installation of new shingles to repair damaged sections. Inspection Reports: (APPLIES TO PROJECT REGARDLESS OF SCOPED 1. The CONTRACTOR and the OWNER must walk the job together and complete the pre-work section of the inspection report(s)before work may begin. The pre-work section of the inspection report(s) must be signed-off by both parties. 2. The CONTRACTOR and the OWNER shall walk the job together and complete each section of the inspection report(s). Approved: OWNER/MGMT CO: CONTRACTOR: GC,Exhilits"A"and`B";22-Nov-05 Pago 2 of 8 Contract No.14710-XXXXXX-01 3. The CONTRACTOR and the OWNER must sign-off on all sections of the inspection report(s) attesting that the job is 100-percent complete and is correct per the job requirements found in this Scope of Work. The final section of the inspection report(s)must be completed and signed-off on by both parties. 4. The CONTRACTOR must correct any deficiency found during the inspections and the job must be 100-percent complete before payment will be made. Project Requirements: (APPLIES TO PROJECT REGARDLESS OF SCOPE) 1. Provide all materials,tools, equipment and labor, in appropriate quantities,to complete the following work in a workman-like manner to the best of industry standards,following all Manufactures(see contractors proposal)required material installation specifications 2. Provide protection of all surrounding areas, including, but not limited to landscaping,driveways, gutter systems,walkways, doors, roof overhangs, windows, masonry, etc., from falling debris and or material maneuvers during work in progress, or any material storage. 3. Additional work(if required due to unforeseen conditions)must be brought to the attention of Construction Services and be approved in writing prior to the commencement of additional work outside of this scope. 4. All new materials must be installed securely, and show good appearance including,but not limited to being installed straight and true. 5. All work must follow CONTRACTOR provided schedule, with daily updates through the site management team,with a minimum of 48 hours notice of any changes to schedule. This allows management to notify residents that this work will be taking place and whatever restrictions to normal traffic and or pedestrian traffic flow. 6. All work related debris must be kept clear of walkways and must be cleaned-up and removed to the dumpster or to an area designated by the OWNER at the end of each day of work. CONTRACTOR is responsible for removing all scraps and debris and placing them in the dumpster or designated trash site. The job will not be considered complete and payment will not be issued until all trash and debris are removed from the house and/or site. 7. Upon passing inspection by Owners Rep(Construction Services Rep), contractor may request payment for work completed by submitting an invoice accompanied by a waiver of lien identifying the same dollar amount as invoiced and indicating the percent of the contract amount that is due and payable. 8. Building/Property will be occupied during the project. CONTRACTOR shall make all reasonable efforts to limit the disruption and impact on regular users of the Building/Property, including but not limited to,the OWNER and its employees, residents, guests,visitors, etc. 9. CONTRACTOR is responsible to field verify all quantities,dimensions, and layouts. Actuals may not match those provided to the CONTRACTOR by the OWNER, or any third parties. Third party information may not be all-inclusive of the specified scope or the project intentions. 10. CONTRACTOR is responsible for temporary utilities, facilities, storage containers and signage as necessary unless otherwise specified. Some site utilities MAY be offered temporarily at the OWNERS discretion, but may be withdrawn by OWNER with minimal advanced notice. Approved: OWNER/MGMT CO: CONTRACTOR: GC,Exhibits"A"and`S",22-Nov-05 Page 3 of 8 Contract No.14710-XXXXXX-01 Project Bidding Details Page 1 of 2 Invitation To Bid Give Us Your Feedback on this Page duke D-H" IS Bidding Information Bidding for this package has passed the due date. Project: &3al Crest Estates(North Andover)-Repair of Damaged Garages(12 Bid Package:Garage Reconstruction Pre-Bid Meeting Date/Time: 11.16.201211:30 AM Pre-Bid Meeting Location: Bid Package Status:Open Bid Contact:AIMCO Bid Start Date>Tme: 11.15.201212:00 PM Bid Submitted:Yes Bid Due Daterrime: 11.21.20125:00 PM Bidding Status:Will Bid &d Thne Zone:(GMT-05:00)Eastern Trme(US&Canada) Bid Instructions Document: Documents 108 Bidding 1 Aimco-e-Builder Bid Instructions-Bid Nlodule.doc Attention Bidder: You are hereby invited to submit pricing for a Garage Reconstruction project Royal Crest Estates,in North Andover. - Pleass be sure to follow the link provided in this email to access speck project documentation needed to assemble your bid. The scope of work may include,but not be limited to,replacement of framing,sheathing,garage doors,electrical repairs and roofing. Description:A Pre-Bid will be on site Friday 11!16712 at 11:30am.We will meet near the garages by Building 19,see map in bidding documents folder. Please be sure to tog into eBuilder and acknowledge receipt by using the dropdown menu to select"Will bid"or'%Mil not bid". Thank you for your time. Dan Mflinaao Director of Construction Aimco Bid Submission Bid Documents Addenda(o) QuestionsM-,.nses Bid Submission Submitted on 11.21.2012 03:24PM(GMT-05:00)Eastern Time(US&Canada) Base Bid-All Items Reference EMA Report Sections Number Description Spec Reference Part Number Total Cost 1 Exterior Facade-Garage 2,444.00 2 Garages 1,311.00 3 15 200:00 4 14 200.OG 5 13 5,620.00 6 12 4,570.00 7 Roof! 4,200.00 8 General 5,355.00 9 Overhead-Dollar Amount 2,390.00 10 Profit-Dollar Amount 2,390.00 Base Bi I4Ul Items Reference EMA Report 28,680.00 Sections Sub-Total Alternate 1 Number Description Spec Reference Part Number Total Cost 1 Garage 12 Door replacement in lieu 950.00 of repair Alternate 1 Sub-Total 950.00 1 Alternate 2 Number (Description f 5pec Reference Part Number Total Cost 1 Garage 11 Roof Repairs 400.00 Ahernate 2 Sub-Total 400.00 Unit Pricing Number Description Spec Reference Part Number Quantity UoM Unit Cost Total Cost 1 Hourly Rate-General Laborer 1.0000 HR 45.00 45.00 92 Mark-up for Profit(in case of Change Orders) 1.OD00 LS 10.00 10.00 Q 3 Mark-up for Overhead lin case of 1. 00 LS 10.00 10.00 Change Orders) Unit Pricing Sub-Total 65.00 a Bid Summary Description Base Bh1 Total Alternate 1 Total Alternate 2 Total Unit Pricing Total Additional Information PrompUQuestion Answer Anticipated Start Date(mmtddfyy) as soon as contract is issued Anticipated Duration(work days) 121 https:Happ.e-builder.net/BiddersBidPackage.aspx?BidPackagelD={415bbb 1 i-ad4e-47d5-... 12/3/2012 f i CONSTRUCTION SERVICES LETTER OF INTENT j December 3,2012 i i East Coast General Contracting Tom Kinnal 286 Broadway St Haverhill,MA 01832 Reference: Property No.: 042391 Property Name: Royal Crest Estates(North Andover) . Address: 50 Royal Crest Dr { North Andover,MA 01845 Subject:Contract Award Number: 14710—404879—CP—00001 Dear Mr.Kamal: In consideration of the mutual promises contained herein, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, AIMCO NORTH ANDOVER,L.L.C.("Owner")and East Coast General Contracting ("Contractor")enter into this Letter of Intent with respect to restoration of storm damaged garages at the above referenced property (the"Project"). 1 Pursuant to the express terms of the Letter of Intent,both Owner and Contractor agree as follows: 1. Owner hereby authorizes Contractor solely to perform the following work related to the Project while Owner and Contractor complete and execute the contract final agreement for the construction of the Project: staging and coordination of site activities and manpower allocation, ordering of materials, minor selective demo as necessary and minor construction to commence project. Owner shall pay Contractor, based upon proper monthly applications for payment j accompanied by such backup documentation as Owner may request, for Contractor's actual cost of the aforementioned construction materials and labor,not to exceed the aggregate sum of$10,000.00. j Such payment shall be made within 30 days of Owner's receipt and approval of each application for payment. 2. Owner may terminate this LOI at any time upon written notice to Contractor. Upon such termination,Owner's sole obligation to Contractor shall be to pay for such materials ordered by Contractor pursuant to paragraph 2 herein prior to such date of termination;provided,however,if such materials are returnable Owner may request that Contractor return such materials, in which case Owner shall be responsible for paying any such restocking or return fee charged by the applicable supplier. 3. Contractor will provide Owner with evidence reasonably satisfactory to Owner of the following insurance policies: (i) commercial general liability insurance covering all operations by,or on behalf of,Contractor with limits not less than$1,000,000 per occurrence and$2,000,000 in the aggregate; (ii) automobile liability not less than $1,000,000 combined single limit per accident for bodily injury and property damage; (iii) worker's compensation as required by law; and (iv) employer's liability with limits not less than $500,000. The general and automobile liability policies shall name as Owner and its affiliates, parent and subsidiary entities (including, Two Greenwood Square,3331 Street Road Suite 450 Bensalem,PA 19020 i i without limitation, Apartment Investment and Management Company (AIMCO)), and any of AIMCO's subsidiaries and affiliates that directly or indirectly own or manage the property as additional insured. Contractor shall provide the foregoing evidence of insurance prior to any materials being delivered to the Project site. 4. Contractor will indemnify, defend and hold Owner and its affiliates, and their respective officers, directors, members, managers, agents, and employees (collectively, the "Indemnified Parties")free and harmless from any and all claims and actions for injuries-to persons or for damage to property and for all liabilities, claims,demands, actions, costs(including reasonable attorney's fees) suits or matters in connection therewith, caused by reason of or as a result of Contractor's actions, inactions, conduct, or performance under this Letter of Intent, whether based upon or claimed to be based upon statutory, contractual, tort or other liability. 5. Owner and Contractor intend to negotiate the terms of a formal written contract for the complete construction of the Project by the Contractor. The mutual execution of a final written contract is a condition precedent to payment for any material or supplies or performance of any work by the Contractor outside of the limited scope of the Letter of Intent. Contractor shall not perform any other work with respect to the Project other than ordering the materials specified herein unless and until a final written agreement is fully executed by the parties. Contractor hereby waives all claims to which it may be entitled as a result of such failure, including,but not limited to,those pertaining to Owner's alleged bad faith,if Owner and Contractor are unable to reach agreement on a final written contract,for any reason. Please indicate your agreement with the foregoing by countersigning and dating this letter in the space provided below and returning a copy to me. Sincerely AIMCO NORTH ANDOVER,L.L.C. By: EN02415-OP Property Mgmt, LLC,solely as authorized representative of Owner By; d / 3li L.-- Matt Steich,Regional Director of Construction ACCEPTED AND AGREED: East Coast General Contracting }3y: Name: Title: ow JJ X Date: December 2 R� 2012 Two Greenwood Square,3331 Street Road Suite 450 Bensalem,PA 19020 ,foil 18 a d d4 It t Inn FX e S 7 The Coymmweafth of assachuseffs .7�e�artment o,�IndustriaZ'.�cc�'enfs Of,fire of nvvesfigadow 600 Z< ay4rngton Street Boston,MA 02111 U1. 7yww mrrssgov/dia Workers' Coinpensationlnsmraurz Affidavit:Bmilders/Contractors/FXectricaam)Plu nbers App cant Information Flease Print Le Nam(Rusfiwdthgaahgon&dM&a1D: -*-�ST d 60.V 4.' Address:— 2-r6 6 Ud 0UJAJ City/Stdelzap: 0 ty z- none A 9 7C &e 6 ��l Are yon ant employer?Check the appropriate box: Type of project(required): 1.9I am a employer with ! 4. ❑I an a general contractor and I 6. ❑New construction employees(foll-ancl/orpart time).* have hired ihe sub••eontractors 2.011 am a soleproprietor orpar5aex- lasted on the attached sheet* 7. ❑�o�� ship aad have no employees These sub-conhwtoars have 8. ❑DemoliGton working for me in.any capacity. workers'comp.insurance. 9. []Building addition [No workers'comp.insuranw= 5. ❑ We are a corporotirna and its 10.❑Electrical repairs or additions regt�red.] officers have exercised thole 3.El I am ahomeowner doing allwork right of exemption par MGL. 11.[(Plumbing repairs or additions myself [No workers'comp. o.152,§I(4),andwehave no 12.[]Roofrepairs insurance required.]t employees.[No workers' 13.0 Other e mp.insmsnce required.] !Any applicantthat cbeaksboxilmnstalwfillouttheseoHonbdlowshowingfieicwoAMWcompensationpdfaytiftmom tHomeawnw who submftthfs dMavitWIas&gtheyire dokgaU work and then hire outddsconfiaatms mnstsabmitanew affidavitIndicating sn'ab. #ConhwWretmt eheokMs boxmwtattached as additfonatsheetsbowmg thsuams ofthe sub-ooh andthakworlm'camp.poi{W ht%rmation. -. l apn an mWloyer fiW fs providir workers'coPnperrsation ir/�srsra weforrny mr,royees: Yetow is 0e yoRcy andjoh sate . iiz,formadores rin mwze CompanyNamte: z c Policy#or Self ins.Lia# G,1 C-�5 —3 3, 83 rob MAddress: -50 44 4� ��tesr �� - C ►/ tate p: •�� , A f Attach a copy of the workers'compensation policy declaration page(showing the policy tnumber and expi rattoxx date). Fail=to secure,coverage as required under Sectiost.25A of MGL c 152 cern leadto ibe imposition of criminal penalties of a - fine up to$1,500.00 and/or one-year innPhonnent,as well as"penalties Who foam of a STOP WORK ORDBR and a fare ofup to$250.00 a day agaatsttha violator. Be advised fiat a copy of•Hus statement=3y be forwarded to the Office of raves#igerdons ofthe DIA for insurance coverage verification. Ido hereby certify underthepaarls an penahte.s of erfury thatthe infor ortppovided above�'s fr a aazdcorrec S• e. ate- /°Z 3 t Z- Phone#- - 36a 4 ffzdaZ use only. Do not write in this area,to be Complied by city or town goWd City or Town: Perinfrt/Y.feense# TssuingAuthorrty(eircte one): 1.Board of Health 2.BualdnngDepartmtent 3.City/Town Clerk 4.MectrIcal rspector 5.PlumbingImpector 6.Other Contactrerson: . Phone#: CERTIFICATE DATE PUM3�yM �c®�zr, ® TE Of LIABILITY INSURI�RCE � 9/m 3tpN OI.Y AND COMMS No R imill,S t�OAI'��'f iflC 'Itp3 CHty1PiCATE IS ISStAF AS ATMA OR Y AMM. �OR ALIM'� GE A�{p� CatTIFICATE DOES NOT BAA NOT CONSTiTtl7E A COKMACT BEWJM THE MMM MURER(S) BELOW TM C�CATB OF MURANCE DOES ItEPRESEiTATNE OR PROt)t10ER AND THE C��F �n he endorsed. N StfBROt3ATiON 1S WAIVl�,S is IMPOR iANi: 8 the oeAifscate holder is an ADDtTi01t-1T A does not tl to the ON terms and�of the policy,t p 1NY rel an endol'> ennut stateffielt On "ri holder in Geu of such endorseff1e A2• GONTpCT NIDE pRaallcEx REO C CHURCH 1NC � F � '�" �'' p NjAIELELC,TMA 0P'18855141 Vi(Ell-MP►N ST r�oxE +-AVlmacs v1sulmA: mss: MAS H KINNALf c: DBA EAST COAST GENERAL CONTRACTING nrs D- 286 BROADWAY Ige1HtB1E: HAVERHIL.L MA 01 M2 CER7IFlCATE NUMB>:1� 1 SUEM TO THE INSUi�D NAMFB ABOVE FOR THE POLICY INS F, PERIOD i 4;IS TO CERTIFY THAT THE P011CIES OF cowmani]STED AW RAS OR OTHER�MENT�H RESPECT TO WHICH Tt113 NO HSTANDING ANY REQUIREM8NT,T�OR )ED Bl(THE pp11CIE3 MW HEREIN IS SUBJECT TO Ali THE TERMS, INDICATED. UED OR MAY PERTAIN,THE BYPAdDClAmS- CERTIFICATE MAY BE IONS OF�POLICIES.LIMITS SHOMVN#iAY HAVE B£EAi;�l10EQ p({2..USIONS At+ID CONDIT JEFF PCflf:Y ilLRi9 L 'iY OMSURANCE EP934 OCC.URR $ GBIERAL 1JA®LIZY S COPBLIeRCIALGDOM UASIU Y MED EXP nc amp CLAMIS41AM 1 -1 OCCUR_J PF32 &/IDVHiJURY $ �aLAcoA� a Pll AM S GO&ApGREIGNIE UM APPLIES P&C S POLICY PRO- Lac $ pU!ply01911AUASUM mmye"MY01-pal $ ANY.AUTO somyfNAJWowaecimmo$ AMOYMMAUlW escmmuuw Im axWe Y fi{REMAUfOS AUTOS S S agm OGCURil S U"RI&AAUAB OCCUR AGGREMM $ EICCESS 11Aa CLAIM POIX S Den RETS"s $ Li- on VUG"1S-353876022 2f2312012 2 13 uNu7s A AM EWnJWMWUA91111Y Yin ELFACNAOCIDEXT $ 51 OpgWRETORWECUTIM� a NIA EL LIISEASE-EA EMPLOY $ I EXCLUDEW oba"yI"mQ E.1,Imgemm-POUCYLIfi11T S te >rF PnaN� below �OPERA7fOf1S I LOCA'RQNB 1 V[:1YG.£S{Ahad+ p1et,A Raoerkesebadulaamorespaceie*e9ubefi VWflfef5 poM*ngaftn R18=mm 0" aV applies to the vm*ws oonpensation lavas of the state hm SHO"AW OF TM Agan CESCREW pol IM CAt4l. l BOOM Im mAI"InM DA7E TyWWOF. NOT= Vali. BE DEidi►ERM IN A11400 NORTH ANDOVER LLC. AltrwrntPoi�cY� 50 ROYAL CREST DRIVE NORTH ANDOVER MA O'1845p /TA71VE n e ®t8g8.�09ti ACORD CORPORATION. All ngMs reser ACORD 26(2010 Ths ACOM name mid"o are r awks of ACORD cm Ho.:,3sa359si sathPxine Niclw7oe yta7la0_ �T i �rti9f I £ltee. -Ads&artafieate cancels and superesdes 7ltSL. AC©44.� ® CERTIFICATE OF LIABILITY INSURANCE D>�DATE M/DDIYXVY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 'POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),:AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Andrea Gallagher Fred C.Church,Inc. NAME: 41 Wellman Street ' PHONE 978 3227172 FAX 978 4541865 •Lowell,MA 01851 A/C No E : A/C No): _ 1800)225-1865 E-MAIL agallagher&redcchurch.com' ADDRESS: _ iNSU S AFFORDING COVERAGE NAiC W INSURER A: Peerless Insurance Company 24198 INSURER 8: - Thomas H Kinnal DBA East Coast General Contracting 286 Broadway INSURER C: Haverhill.MA 01832-29M INSURER 0: INSURER E: :INSURER F: COVERAGES CERTIFICATE NUMBER:21125 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. 'TTRR OLICY EXP TYPE OF INSURANCE AINSR DDL VwnSUBR POLICYNUMBER MMIDPOLICYEFF PMIDDrfYYY. LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1:000:000 X PREMISES TO RENTED COMMERCIAL GENERr—AL LIABILITY PREMISES(Ea ocarnenoeL S 1 '� _ CLAIMS-MADE �OCCUR ; MED EXP(Any one person) S 5:00D A _j CBP8364091 711512012 2/1512013 PERSONAL&ADV INJURY g 1'000;000 GENERAL AGGREGATE $ 2,000.000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG: S 2:tX)0,0(Xl POLICY PRO-CT LOC j 5 AUTOMOBILE UA$IUTY i _.. . _ 81N SINGLE LIMIT S 1.000.000_..—I ANY AUTO BODILY INJURY(Per person) $ A ALL OWNEDrx SCHEDULED BA8W2891 2!13/2012 2/731.2013 I+ i AUTOS AUTOS BODILY INJURY(Par accident) $ HIRED 01 AUTOSNON-OWNED PRaOPE�RDANIAGE $ I S UMBRELLA UAB OCCUR - EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S . DED 1 1 RETENTIONS I S WORKERS COMPENSATION INC STATU- OTH AND EMPLOYERS'LIABILITY YIN _ TORY LIMIM ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? F N t A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 It yes•describe under --- DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS i LOCATIONS/VEHICLES(AMach ACORD 101,Additional Remarks:Schedute,.if more spaoe is required) Property Name:Royal Crest Estates(North Andover) Contract No:14592-404879 CP-00003 Coverage inrludes,OWNER as Additional Insureds. CERTIFICATE HOLDER CANCELLATION AIMCO I:ORTH ANDOVER LLC 50 Royal Crest Drive SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Norm Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE P Client# Mstit21125Cert Holder# @ 1988-2010 ACORD CORPORATION. Ail rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen isor License-, CS-082747 THOMAS H KINN ►I, ; 286 BROADWAY' ' x� HAVERHILL MA 01832 Expiration Commissioner 06/20/2014 J P � VA Office of Consumer Affairs&Business Regulation. HOME IMPROVEMENT CONTRACTOR Registration „148212 Expiration DBA EAST COAST GENERAL CQNTRACTING } THOMAS KINNAL 286 BROADWAY _ HAVERHILL,MA Undersecretary