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HomeMy WebLinkAboutBuilding Permit #650 - 131 DUNCAN DRIVE 4/13/2006 T Of S,AORTH 1N . O O F t TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION CHU � Permit NO: Date Received3%�79Q Date Issued:— IMPORTANT: Applicant must complete all items on this page LOCATION 13lbDuncan Drive _ Print PROPERTY OWNER Dan and Linda Burns Print MAPNO.: 104R PARCEL: 185 ZONING DISTRICT: R-1 TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building -(Xt- One family XX,l Addition = Two or more family E-: Industrial Alteration No. of units: Repair, replacement Assessory Bldg h Commercial F'; Demolition EF: Moving(relocation) Other E, Others: -! Foundation only DESCRIPTION OF WORK TO BE PREFORMED i a Construct 2-car Garage Addition w/ GreatRoom and Office-Study (' lest ?'.00m Above . Identification Please Tyne or Print Clearly) OWNER: Name:_ Pan and Linda Burns Phone978 . 975 7'�0�a Signature Address: 131 Duncan Drive North Andover , MA CONTRACTOR Name:_ Starboard Design/Build Phonch17 . 242 . 7300 C►— (`l` Z'25 '2500 Address: P. O. Box 7.90666 Charlestown , MA 02129 Supervisor's Construction License: C S 0 5 0 3 7 4 Exp. Date: 10/09/06 Home Improvement License: 134677 Exp. Date: 01 /02/08 + ARCIIITECT-F.NGINEER Sami Kassis P. E. Name: Phone: 617 4cp i0i+ 1 r .,kddress: 28 Old Town Rd . Walpole , MA Reg. No. 35094 FEE SCHEDULE:BOLDING PERMIT.S10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST B)SED ON $125.00 PER S.F. /�7 Total Project Cost :$-_� ,i8 0 xI0.00 =FEE:$�j�� Check No.: Receipt No.: � I Location�,�� Ounc keel On,/ No. S"� Date NORTIy TOWN OF NORTH ANDOVER 3:0�,,`•o I•,h0 F41 s 9 ` Certificate of Occupancy $ CMUs<�' Building/Frame Permit Fee $ l 6 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i Check # I 1 , G Building Inspector TYPE OF SEWARGE DISPOSAL Tanning ltassage,Body Airt Swimming Pools Public Sewer _. ell Tobacco Sales -- Food Packaging;Sales Permanent Dempster on Site Private(septic tank, etc. XXXX NOTE: Persort.c c•ontrtieling ,)ih unrei;islered contractors(it)not have ace•e*- X Signature. ofAgentiOwne Signature of C Plans Submitted )UX Plans Waived ❑ Certified Plot Plan C THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ []Water Shed Special Pen-nit Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED 6 / f •jCONSERVATI COMMENTS L3Ay DATE REJECTED DATE APPROV D//11 HEALTH �3 �3/ -pfo /U i COMMENT /U '�- l��l !i - �ie� Zoning Board ;appeals: Varia ce, Petition No: Zoning Decision,receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments abater& Sewer connection siunature& date Temp Dempster on site yes__no_ Fire Department signature.'date Building Permit Approved and Issued by: Y Building Setback (ft.) I Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area,sq. ft.: NOTE'S and DATA—(For department use) i 4 all I n I �. I � t o / c,. ,•i i.�u J,m_ao„ 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 :i Building Permit Application o Debris Removal Form ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Pen-nit Application ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Form ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) 1 New Construction (Single and Two Family) ❑ Building Permit Application ❑ Form U ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraul Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report 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 prop of recording must be submitted with the building application Doc:1\S11EC'r10NAL SER%ICES DF.P.IRT\9F:.\'I':Rt'FORN1115 MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.01 Checked by/Date CITY: North Andover " STATE: Massachusetts HDD: 6322 CONSTRJCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 8-19-2005 DATE OF PLANS: August 20 2005 TITLE: Duncan Residence PROJECT INFORMATION: Garage/living room addition COMPLIANCE: PASSES Dequired UA = 169 Your Home = 158 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 850 30.0 0.0 30 WALLS: Wood Frame, 16" O.C. 752 13.0 0.0 62 GLAZING: Windows or Doors 115 0.300 35 GLAZING: Skylights 15 0.300 5 FLOORS: Over Unconditioned Space 850 30.0 0.0 28 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to' meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date SAYI F., ���. R4$M a 5100 i 40,36ft4 �bitAt tMl6� { � Q�W'■ �. � ¥ �y .a va ^� ~` \ S� \ �4 © �\). �• :� f &.y � -AM\P ° � | I MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Duncan Residence DATE: 8-19-2005 Bldg. Dept. Use CEILINGS: [ ] ( 1. R-30 Comments/Location WALLS: [ ] I 1. Wood Frame, 16" O.C. , R-13 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0.3 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location SKYLIGHTS: [ ] 1. U-value: 0.3 For skylights without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-30 Comments/Location AIR LEAKAGE: [ ] ( Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or Basketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be 1 � provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] ( Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: [ ] All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ J Rated output capacity of the heating/cooling system is not greater than 125°* of the design load as specified in Sections 780CMR 1310 and J4.4. [ ] SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. [ ] 9 HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in. ) : PIPE SIZES (in. ) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 i [ ] CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in. ) : PIPE SIZES (in. ) NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F) : RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1.0 1.5 2.0 p 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 ----NGTES TO FIELD (Building Department Use Only) ----------------- starboard A Design/Build Construction Company CONSTRUCTION AGREEMENT THIS DOCUMENT, INCLUDING ALL ATTACHED EXHIBITS AND REFERENCED DOCUM rNTS, CONSTITUTES THE ENTIRE AGREEMENT BY AND BETWEEN JOSEPH MCKEOWN / ARCHISTRUCT PDDG / STARBOARD DESIGN-BUILD (HEREINAFTER THE BUILDER)AND LINDA AND DAN BURNS (HEREINAFTER THE CLIENT). ANY CHANGE, AMENDMENT, OR ALTERATION TO ANY PART OF THIS AGREEMENT SHALL BE MADE IN WRITTEN FORM AND SHALL BECOME INCLUSIVE ONLY BY SIGNATURE OF BOTH THE BUILDER AND THE CLIENT. CLIENT INFORMATION BUILDER INFORMATION LINDA AND DAN BURNS JOSEPH MCKEOWN 131 DUNCAN DRIVE ARCHISTRUCT PDDG / NORTH ANDOVER, MA STARBOARD DESIGN-BUILD 978.975.7909 P.O. BOX 290666 BUNKER HILL INDUSTRIAL PARK CHARLESTOWN, MA 02129 617.242.7300 / 617.923.7500 PROJECT LOCATION: BUILDERS LICENSE#CS 050374 LOT 5 131 DUNCAN DRIVE CONTRACTORS REG #HIC134677 NORTH ANDOVER, MA EXP 01 /06 PROJECT DESCRIPTION ONE AND ONE-HALF STORY ATTACHED FAMILY/GREAT ROOM ADDITION WITH TWO- CAR GARAGE UNDER SCOPE OF THE PROJECT THE BUILDER WILL PERFORM THE WORK DESCRIBED ABOVE, AND IN ANY REFERENCED DOCUMENTS OR BLUEPRINTS, BASED UPON A VISUAL INSPECTION OF THE PROPERTY AND NORMAL ASSUMPTIONS ABOUT NON-VISIBLE DAMAGE AND DETERIORATION. ANY AND ALL ADDITIONAL WORK, THE COMPLETION OF WHICH IS DETERMINED TO BE NECESSARY BY THE CLIENT, THE BUILDER, OR AN APPROPRIATE BUILDING OR PUBLIC SAFETY OFFICIAL, AND IS DISCOVERED DURING THE COMPLETION OF THE WORK SPECIFIED IN THIS AGREEMENT, SHALL BE UNDERTAKEN BY THE BUILDER ONLY UPON THE EXECUTION OF A CHANGE WORK AUTHORIZATION PROVIDED TO THE CLIENT BY THE BUILDER. 1 . SEE PROJECT SCOPE (ATTACHMENT ONE) AND SPECIFICATIONS (ATTACHMENT TWO) FOR DETAILS ON THE EXTENT OF THE WORK INVOLVED IN THIS PROJECT. 2. DELIVER DUMPSTER TO THE PROJECT SITE FOR THE COLLECTION OF CONSTRUCTION RELATED DEBRIS. REMOVE DUMPSTER FROM JOBSITE AT THE COMPLETION OF THE PROJECT. AT THE BUILDERS OPTION, OTHER ARRANGEMENTS TO COLLECT AND HAUL AWAY JOBSITE DEBRIS MAY BE MADE. 3. AT COMPLETION OF THE PROJECT, CORRECT ANY CONSTRUCTION RELATED DISTURBANCE TO THE PROPERTY. 4. COMPLETION OF THE MODIFICATION, ADDITION AND RENOVATIONS WILL BE ACCORDING TO PROJECT DOCUMENTS IDENTIFIED AS: ATTACHMENT ONE (1) PROJECT SCOPE ATTACHMENT TWO (2) PROJECT SPECIFICATIONS (TBD) ATTACHMENT THREE (3) PROJECT BUILDING PLANS (TBD) WITH THE FOLLOWING SPECIFIC EXCLUSIONS: UNLESS SPECIFICALLY INCLUDED IN THE "SCOPE OF PROJECT" OR THE "PROJECT SPECIFICATIONS", THIS AGREEMENT DOES NOT INCLUDE LABOR OR MATERIALS FOR THE FOLLOWING WORK: CORRECTION OF EXISTING OUT-OF-PLUMB OR OUT-OF-LEVEL CONDITIONS IN THE EXISTING (OR ADJACENT) STRUCTURE(S). CORRECTION OF CONCEALED SUBSTANDARD FRAMING OR MECHANICAL WORK. REMOVAL OR REPLACEMENT OF EXISTING ROT OR INSECT INFESTATION. REMOVAL, REPLACEMENT OR RELOCATION OF BURIED OR CONCEALED UTILITY LINES, TANKS OR OTHER STRUCTURES, UNLESS THE BUILDER WAS GIVEN WRITTEN ADVANCE NOTIFICATION OF THEIR EXISTENCE BY THE HOMEOWNER, AND SUCH REMOVAL, RELOCATION OR REPLACEMENT IS INCLUDED IN THE "SCOPE OF PROJECT" OR "PROJECT SPECIFICATIONS". REQUIRED PERMITS THE BUILDER WILL APPLY FOR AND OBTAIN A BUILDING PERMIT FROM THE TOWN OF NORTH ANDOVER, INSPECTIONAL SERVICES DEPARTMENT. ANY ADDITIONAL PERMITS OR APPROVALS REQUIRED WILL BE THE SOLE RESPONSIBILITY OF THE CLIENT (INCLUDING BUT NOT LIMITED TO ANY UTILITY RELOCATION PERMITS). AT THIS TIME THE BUILDER DOES NOT REASONABLY ANTICIPATE THE NECESSITY FOR ADDITIONAL PERMITS. THE BUILDER SHALL IMMEDIATELY NOTIFY THE CLIENTS SHOULD ANY OTHER PERMITS FOR THIS PROJECT BECOME NECESSARY TO OBTAIN. PROPOSED START AND COMPLETION DATE THE FOLLOWING SCHEDULE WILL BE FOLLOWED UNLESS CIRCUMSTANCES BEYOND THE BUILDERS CONTROL SHOULD ARISE: DATE WHEN THE BUILDER WILL BEGIN CONTRACTED WORK AS DEFINED BY THE SCOPE: JUNE 15 (OR WITHIN 30 DAYS OF PERMIT ISSUE) DATE WHEN CONTRACTED WORK WILL BE SUBSTANTIALLY COMPLETED: 65-90 WORKING DAYS AFTER COMMENCEMENT OF WORK IT IS UNDERSTOOD BY ALL PARTIES THAT THIS IS NOT A "TIME IS OF THE ESSENCE"AGREEMENT. CHANGE ORDERS AND ADDITIONAL WORK AUTHORIZATIONS ADD TO THE COST AND THE AMOUNT OF TIME NECESSARY FOR THE COMPLETION OF THE PROJECT. THE BUILDER IS NOT RESPONSIBLE OR LIABLE FOR DELAYS IN THE COMMENCEMENT OR THE COMPLETION OF THE WORK THAT ARE THE RESULT OF CONDITIONS BEYOND THE BUILDERS CONTROL(INCLUDING FOR EXAMPLE WEATHER, STRIKES, SUPPLIERS INABILITY TO OBTAIN OR DELIVER MATERIALS, OR A THIRD PARTY'S INABILITY TO COMPLY WITH THE TERMS OF THIS CONTRACT). PROJECT PRICE AND PAYMENT SCHEDULE BASE COST 157800.00 CONSTRUCTION DEPOSIT 31560.00 PROJECT START 7890.00 FOUNDATION/SITE WORK 15780.00 ADDITION FRAMED 23670.00, SHELL CLOSED -WINDOWS AND DOORS 15780.00 / 9 SHELL CLOSED-SIDING AND EXTERIOR TRIM 23670.00 ROUGH MECHANICALS (ELECTRIC-HVAC-PLMBG) 15780.00 INSULATION-WALLS/CEILINGS FINISHED 7890.00 TRIM/CABINETS/COUNTERS/FIXTURES 7890.00 FLOORING / SUBSTANTIAL COMPLETION 7890.00 THE WORK IS SUBSTANTIALLY COMPLETE WHEN ALL ITEMS DESCRIBED IN THE SCOPE OF WORK HAVE BEEN CONSTRUCTED OR INSTALLED. SUBSTANTIAL COMPLETION SHALL NOT INCLUDE ADJUSTMENT, REPAIR, REPLACEMENT OR CLEANING OF ANY ITEM SO CONSTRUCTED OR INSTALLED OR FINAL INSPECTION BY CODE OFFICIALS. THE CLIENT SHALL BE ENTITLED TO ONE PUNCHLIST PRIOR TO FINAL PAYMENT. REQUESTS FOR ADJUSTMENT, REPAIR, REPLACEMENT, OR CLEANING OF ANY CONSTRUCTED OR INSTALLED ITEM RESULTING FROM A DEFECT IN AN ITEM ORDERED DIRECTLY BY THE CLIENT SHALL NOT BE CAUSE FOR DELAY OF THE FINAL PAYMENT, BUT RATHER SHALL BE CONSIDERED WARRANTY ITEMS. BUILDER WILL PROVIDE EXECUTED LIEN WAIVERS TO THE CLIENT FOR EACH CURRENT PAYMENT / REQUISITION AND ALL PREVIOUS PAYMENTS. CONSTRUCTION CONTIGENCY BASED UPON THE UNKNOWN / UNEXPECTED NATURE OF SOME ELEMENTS OF THIS PROJECT, THE CLIENT SHOULD BE PREPARED TO ASSUME RESPONSIBILITY FOR AND PAY THE ADDITIONAL COST OF NON-DISCRETIONARY ADDITIONS TO THE SCOPE OF THIS PROJECT. IT IS REASONABLE TO ASSUME THAT THIS CONTIGENCY MAY AMOUNT TO 5-8%OFTHE SPECIFIED PROJECT TOTAL. THE BUILDER SHALL NOTIFY THE CLIENT IMMEDIATELY SHOULD THESE CONDITIONS PRESENT THEMSELVES. THE CLIENT SHALL NOT DELAY THE PROGRESS OF THE PROJECT IN ORDER TO MAKE A DECISION ABOUT ANY CHANCE WORK AUTHORIZATION THAT THE BUILDER MAY PRESENT TO THE CLIENT UNDER THESE CIRCUMSTANCES. WARRANTY THE BUILDER AGREES TO BE SOLELY RESPONSIBLE FOR THE COMPLETION OF THE PROJECT AS DESCRIBED REGARDLESS OF THE ACTIONS OF ANY THIRD PARTY / SUBCONTRACTOR UTILIZED BY THE BUILDER. THE BUILDER FURTHER AGREES TO BE SOLELY RESPONSIBLE FOR ALL PAYMENTS TO SAID THIRD PARTIES / SUBCONTRACTORS FOR MATERIALS AND / OR LABOR FURNISHED UNDER THIS AGREEMENT. NO EXPRESS WARRANTY IS PROVIDED BY THE BUILDER. CLIENT ACKNOWLEDGES THAT THE BUILDER SHALL BE HELD HARMLESS, AND SHALL NOT BE LIABLE NOR HELD RESPONSIBLE FOR ANY WORK AND / OR MATERIALS PROVIDED AND / OR INSTALLED BY ANY OTHER THIRD PARTY / SUBCONTRACTOR / CONTRACTOR EITHER PRIOR TO, DURING, OR SUBSEQUENT TO THE TERM OF THIS AGREEMENT, UNLESS SAID THIRD PARTY / SUBCONTRACTOR / CONTRACTOR WAS SPECIFICALLY ENGAGED BY THE BUILDER TO COMPLETE WORK FOR THE CLIENT. ADDITIONAL CONTRACT TERMS 1 . CLIENT AGREES TO FULLY DISCLOSE TO BUILDER ANY AND ALL EXISTING PROBLEMS WITH, OR DAMAGE TO, THE STRUCTURE THAT THE CLIENT COULD REASONABLY BE EXPECTED TO BE AWARE OF. 2. CLIENT AUTHORIZES BUILDER TO PLACE A TEMPORARY PROJECT SIGN ON THE PROPERTY OF THE CLIENT. SUCH SIGN SHALL BE LEFT IN PLACE FROM 14 DAYS PRIOR TO THE START OF THE PROJECT UNTIL 30 DAYS AFTER THE SCHEDULED COMPLETION OF THE JOB. THE SIGN WILL BE THE SOLE RESPONSIBILITY OF THE BUILDER WHILE IT IS ON THE PROPERTY OF THE CLIENT. 3. IT SHALL BE THE BUILDERS RESPONSIBILITY TO PROVIDE TEMPORARY SANITARY FACILITIES FOR HIS EMPLOYEES AND SUBCONTRACTORS ONLY. THE HOMEOWNER AUTHORIZES THE BUILDER TO DELIVER AND MAINTAIN A PORTABLE TOILET ON THE PROPERTY OF THE HOMEOWNER IF, AND AS, ALLOWABLE. 4. BUILDER SHALL USE BEST EFFORTS TO MATCH EXISTING FINISHES AND MATERIALS WHERE APPLICABLE. HOWEVER, AN EXACT MATCH IS NOT GUARANTEED BY THE CONTRACTOR DUE TO SUCH FACTORS AS DISCOLORATION FROM AGING, DIFFERENCES IN DYE/COLOR LOTS, AND THE DIFFICULTY OF EXACTLY MATCHING CERTAIN FINISHES, COLORS, AND SURFACES. S. ANY PRELIMINARY SPECIFICATIONS, DRAWINGS, CORRESPONDENCE, PRICING, OR CONVERSATIONS BETWEEN THE CLIENTS AND THE BUILDER PRIOR TO AGREEMENT EXECUTION AND / OR THROUGHOUT THE DURATION OF THE PROJECT ARE TO BE USED AS GUIDELINES ONLY, AND ARE NOT BINDING UPON THE BUILDER OR THE CLIENT UNLESS THEY ARE INCLUDED IN THE AGREEMENT SPECIFICATIONS OR ARE INCLUDED IN A REVISED SCOPE OF CONTRACT BY A DULY EXECUTED CHANGE WORK AUTHORIZATION. 6. THE CLIENTS WARRANT THAT THEY HAVE THE PRESENT, AS WELL AS ONGOING, FINANCIAL ABILITY TO PAY THE BUILDER WITHIN THE TERMS OF THE AGREEMENT. THE CLIENTS SHALL IMMEDIATELY NOTIFY THE BUILDER OF ANY CHANGE IN FINANCIAL CONDITION WHICH MAY IMPAIR OR IMPEDE THEIR ABILITY TO PAY THE BUILDER IN FULL. 7. THE CLIENT RECOGNIZES AND ACKNOWLEDGES THAT DURING THE PERFORMANCE OF THE WORK, CERTAIN HAZARDOUS CONDITIONS COULD EXIST IN THE AREA OF THE WORK. BUILDER AGREES TO TAKE ALL REASONABLE STEPS TO MAKE SUCH CONDITIONS KNOWN AND OBVOIUS TO THE CLIENT AND TO PREVENT THE CLIENT AND OTHERS FROM ENTERING THE HAZARDOUS AREAS. THE CLIENT SHALL INDEMNIFY AND HOLD THE BUILDER HARMLESS FROM ANY LIABILITY, DAMAGE CLAIM OR EXPENSE ARISING OUT OF THE CLIENTS , OR OTHER NON-PROJECT RELATED THIRD PARTY'S DISREGARD OF A CLEAR, OPEN AND OBVIOUS DANGER IN THE WORK AREA; PROVIDED, THAT CLIENT SHALL NOT BE RESPONSIBLE FOR AND SHALL NOT INDEMNIFY BUILDER FOR ANY LIABILITY, DAMAGE, CLAIM OR EXPENSE RESULTING FROM BUILDER'S OWN NEGLIGENCE. AGREEMENT ACCEPTANCE UPON SIGNING, THIS AGREEMENT BECOMES A BINDING CONTRACT UNDER THE LAW. UNLESS OTHERWISE NOTED WITHIN THIS DOCUMENT, THE AGREEMENT SHALL NOT IMPLY THAT ANY LIEN HAS BEEN PLACED ON, OR OTHER SECURITY INTEREST HAS BEEN TAKEN IN THE PROPERTY OF THE CLIENT. YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED AT A PLACE OTHER THAN THE BUILDERS NORMAL PLACE OF BUSINESS, PROVIDED YOU NOTIFY THE BUILDER IN WRITING AT HIS MAIN OFFICE 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 OF THIS AGREEMENT DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES LINDA BURNS DATE ItNS- --- ------ p s� DATE OSEPHI CKE CONTRACTOR ARBITRATION THE HOME IMPROVEMENT CONTRACTOR LAW PROVIDES HOMEOWNERS WITH THE RIGHT TO INITIATE AN ARBITRATION ACTION (AS AN ALTERNATIVE TO COURT ACTION) IF THEY HAVE A DISPUTE WITH A CONTRACTOR. THE SAME RIGHT IS NOT AUTOMATICALLY AFFORDED TO A CONTRACTOR, HOWEVER. THE CONTRACTOR WOULD HAVE TO RESOLVE ANY DISPUTE HE HAS WITH THE HOMEOWNER IN COURT UNLESS BOTH PARTIES AGREE TO THE OPTIONAL CLAUSE PROVIDED BELOW. THIS CLAUSE WOULD GIVE THE CONTRACTOR THE SAME RIGHT TO ARBITRATION AS IS AFFORDED TO THE HOMEOWNER BY THE HOME IMPROVEMENT CONTRACTOR LAW THE CONTRACTOR AND THE CLIENT HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THE CONTRACTOR HAS A t'ES VEE ING THIS CONTRACT, THE CONTRACTOR MAY SUBMIT THE DISPUARBITRATION FIRM WHICH HAS BEEN APPROVED BY THE SECRETAIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION, HALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDEDS GENERAL LAW, CHAPTER 42A. ---- - - - - --------------- LINDA or DAN BURNS N NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY THE CONTRACTOR. THE HOMEOWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. HOMEOWNERS RIGHTS A HOMEOWNERS RIGHTS UNDER THE HOME IMPROVEMENT CONTRACTOR LAW (MGL CHAPTER 142A)AND ANY OTHER CONSUMER PROTECTION LAWS (I.E. MGL CHAPTER 93A) MAY NOT BE WAIVED IN ANY WAY, EVEN BY AGREEMENT. HOWEVER, HOMEOWNERS MAY BE EXCLUDED FROM CERTAIN RIGHTS IF THE CONTRACTOR THEY CHOOSE IS NOT PROPERLY REGISTERED AS PRESCRIBED BY LAW. HOMEOWNERS WHO SECURE THEIR OWN BUILDING PERMITS ARE AUTOMATICALLY EXCLUDED FROM ALL GUARANTY FUND PROVISIONS OF THE HOME IMPROVEMENT CONTRACTOR LAW. THE CONTRACTOR IS RESPONSIBLE FOR COMPLETING THE WORK AS DESCRIBED, IN A TIMELY AND WORKMANLIKE MANNER. HOMEOWNERS MAY BE ENTITLED TO OTHER SPECIFIC LEGAL RIGHTS IF THE CONTRACTOR GUARANTEES OR PROVIDES AN EXPRESS WARRANTY FOR WORKMANSHIP OR MATERIALS. IN ADDITION TO THE GUARANTEES OR WARRANTIES PROVIDED BY THE CONTRACTOR, ALL GOODS SOLD IN MASSACHUSETTS CARRY AN IMPLIED WARRANTY OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. AN ENUMERATION OF OTHER MATTERS ON WHICH THE HOMEOWNER AND CONTRACTOR LAWFULLY AGREE MAY BE ADDED TO THE TERMS OF THE CONTRACT AS LONG AS THEY DO NOT RESTRICT A HOMEOWNERS BASIC CONSUMER RIGHTS. IF YOU HAVE QUESTIONS ABOUT YOUR CONSUMER / HOMEOWNER RIGHTS, CONTACT THE CONSUMER INFORMATION HOTLINE LISTED BELOW. EXECUTION OF CONTRACT THE CONTRACT MUST BE EXECUTED IN DUPLICATE AND SHOULD NOT BE SIGNED UNTIL A COPY OF ALL EXHIBITS AND REFERENCED DOCUMENTS HAVE BEEN ATTACHED. PARTIES ARE ALSO ADVISED NOT TO SIGN THE DOCUMENT UNTIL ALL BLANK SECTIONS HAVE BEEN FILLED IN OR MARKED AS VOID, DELETED, OR NOT APPLICABLE. ONE ORIGINAL SIGNED COPY OF THE CONTRACT WITH ATTACHMENTS IS TO BE GIVEN TO THE HOMEOWNER AND THE OTHER KEPT 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 RECISSION PERIOD HAS EXPIRED. ACCELERATED PAYMENTS A CONTRACTOR MAY NOT DEMAND PAYMENTS IN ADVANCE OF THE DATE SPECIFIED ON THE PAYMENT SCHEDULE IN CASES WHERE THE HOMEOWNER DEEMS HIM/HERSELF TO BE FINANCIALLY INSECURE. HOWEVER, IN INSTANCES WHERE A CONTRACTOR DEEMS HIM/HERSELF TO BE FINANCIALLY INSECURE, THE CONTRACTOR MAY REQUIRE THAT THE BALANCE OF FUNDS NOT YET DUE BE PLACED IN A JOINT ESCROW ACCOUNT AS A PREREQUISITE TO CONTINUING THE CONTRACTED WORK. WITHDRAWAL OF FUNDS FROM SAID ACCOUNT WOULD REQUIRE THE SIGNATURE OF BOTH PARTIES.. ADDITIONAL INFORMATION IF YOU HAVE GENERAL QUESTIONS OR NEED ADDITIONAL INFORMATION ABOUT THE HOME IMPROVEMENT CONTRACTOR LAW OR OTHER CONSUMER RIGHTS, OR IF YOU WISH TO OBTAIN A FREE COPY OF "A CONSUMER GUIDE TO THE HOME IMPROVEMENT CONTRACTOR LAW", CONTACT; CONSUMER INFORMATION HOTLINE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION ONE ASHBURTON PLACE ROOM 1411 BOSTON, MA 02108 IF YOU HAVE QUESTIONS OR NEED ADDITIONAL INFORMATION SPECIFICALLY ABOUT THE CONTRACTOR REGISTRATION COMPONENT OF THE HOME IMPROVEMENT CONTRACTOR LAW, CONTACT: DIRECTOR OF HOME IMPROVEMENT CONTRACTOR REGISTRATION BUREAU OF BUILDING REGULATIONS AND STANDARDS ONE ASHBURTON PLACE ROOM 1301 BOSTON, MA 02108 FOR ASSISTANCE WITH INFORMAL MEDIATION OF DISPUTES OR TO REGISTER FORMAL COMPLAINTS AGAINST A BUSINESS, CALL: CONSUMER COMPLAINT SECTION OFFICE OF THE ATTORNEY GENERAL 617.727.8400 BOARD<OF BUILDING-REGULATIONS. } L-icense*CONSTRUCTION SUPERVISOR . Nurn er:-5CS . 050374 I xpres'ib/092006 Tr.no: 5073.0 : � RAstricted �0("�1 C FRANCIS JOSEHCKEOWN PC,BOX 290666 :s4� f i G` CHARLESTOW;N, MA 02199 Commissioner I \ __ C za�Nuea� o�✓�aaaaaiude�° Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR i Registration; 134677 lug Expiration: 1/2/2008 ,Type: DBA STARBOARD BUILDERS&HOEIVIWORKS FRANCIS MCKEOWNI 20 AUBURN STREET ; LG--� CHARLESTOWN,MA 02129 Administrator l it Town of North Andover &ORTS OFFICE OF 3a oy' COMMUNITY DEVELOPMENT AND SERVICES ° . p 27 Charles Street �9' '`; •^; WILLIAM J. SCOTT North Andover, Massachusetts 01845 �� °4•..° °'��5 SSACHUSE Director (978)688-9531 Fax(978)688-9542 March 10, 1999 John Morin Neve Associates, Inc. 447 Boston Street Topsfield, MA 01983 RE: 131 Duncan Drive, North Andover Dear Mr. Morin: This letter is to inform you that the proposed septic plans dated 3/8/99 for the repair of the system located at 131 Duncan Drive have been approved. It appears that an addition to the existing dwelling is proposed. Your client should be aware that the Health Department will need to determine if this septic system is sized correctly for the final build out of the house. This will be dealt with during the application process for the addition. Please do not hesitate to call the office at the number below if you have any questions. Sincerely, Sandra Starr, R.S. Health Administrator Cc: James Murphy BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 iniormatiun diiu 11131 U%;Uvi1<a Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or mmre of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or.trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer•" MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth or any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicant Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addrzss(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is requirod. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to alga and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Dept at the number listed below. Self-insured companies should enter their self-insurance license.mnmmnber on the appropriate.line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perm it/licensc number which will be used as a reference number. In addition,an applicant that must submit multiple pem ut/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid a=is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 wwwmL=.gov/dia Department of Industrial Accidents Office ofInvestigations 600 Washington Strut Boston,M4 02m www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lenibly Name (Business/Organization/Individual): S t a r b o a r d D e s i g n/'9 u i 1 d Address: P . O. Box 290666 City/State/Zip: Charlestown , MA 02129 Phone#: 617 . 2 4 2 . 7300 Are you an employer?Check the appropriate box: Type of project(required): 1.UXI am a employer with 4. ❑ I am a general contractor and I employee's(full and/or part-time).' have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7. ❑ Remodeling ship and have no employees These sub-contractors have s. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers'comp.insurance 5• ❑ We are a corporation and its . required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12. Roof repairs insurance required.]t employees. [No workers' ❑ comp.insurance required.] 13.❑ Other Any applicant tot checks box#1 nine also fin out the section below,showing their workers'compensation Pony information t Homeowners wbo submit ibis affidavit indicating they are doing all work and then hire outside eouhaotois must submit a new affidavit indicating suck tContrsam tot check this box must attacbed m additional suet showing de name of the sub-eonhactors and thea workers'con4.policy information. I am an employer that Is providing workers'compensation insurance for my employees. Below is eke policy and,fob ska information. . Insurance Company Name: Zurich Ins.ti.r a n c e Company Policy#or Self-ins.Lic.M WC 4310418200 Expiration Date: 0 3/0 4/0 7 Job Site Address: 131 Duncan Drive North Andover City/State/Zip: N Andover , MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to segue coverage as requireunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-yearprisonment,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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of th IA for insurance coverage verification. I do herebyerd,y jder t ins and nakks of r,jury that the 1nformotlon provided above b true and correct S1 • 02/15/05 Phou #: "617 . 242 . 7300 Qfflchd useloolly. Do not write in thlt area,to be completed by city or town oJyleial City or Town: Permit/Liceuse Issuing Authority(circle one): 1.Board of Health t.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone N: Q o � V O 1 , l OI c` Q�OQO��� a Nff' � i� ��- ,�0,1 O. s lb v .9_ LOT#>85 AREA=49,581 S.F. =1.138 AC. /p0 NOTES: 1) SEE TOWN ASSESSOR'S MAP #1046, LOT 185 p LAN 0 F LAND FOR SITE LOCUS. 2) SEE DEED BOOK #5864, PAGE #250, RECORDED AT IN E.N.D.R.D. FOR DEED REFERENCE. 3) PLAN REFERENCE: E.N.D.R.D. PLAN #8525 NORTH ANDOVER, MASSACHUSETTS 4) ZONE DISTRICT: R-1 DRAWN FOR 0 JOSEPH McKEOWN BUNKERHILL INDUSTRIAL PARK 3 j CHARLESTOWN, MASSACHUSETTS 02129 o � El SCALE: 1"=40' DATE: MARCH 15, 2006 co 0 20' 40' 80' 120' CL a V MERRIMACK ENGINEERING SERVICES a 3/13/06 66 PARK STREET STEPHEN '. I, R.L.S. DATE ANDOVER, MASSACHUSETTS 01810 } D E S I G N B Y 1 Sami E. Kassis, P. E. Civil — Structure — Architecture — New Home Construction/Additions Residential — Commercial February 15, 2006 To Whom It May Concern: This letter is regarding the addition to the structure located at 131 Duncan Drive North Ar.;lover, MA. I have visited the site on occasion during foundation construction and stns ctural framing and to the best of my knowledge the foundation and the framing are coi i structed as designed. SAMI E. �e+t KASSiS Ca STRUCTURAL u W.35091 -+ A c� 508-660-8409 Office 617-460-1041 Cell Email: Sami_Kass is_PE@yahoo.corn 28 Old Town Road Walpole, MA 02081 03-27-'06 11:36 FROM-DOREN INSURANCE 7813268577 T-5L6 - POOZ/OOZ r-4; 0 PRODUCER (781) 326-9900 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doren Insuz`ariC® AgeriCy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR '0 Ea.atbxao s Road ALTER THE COVERAGE AFFORDED BY THE POLICIkS BELOW. Dedham, Ma 02026 - INSURERS AFFORDING COVERAGE NAIC# MUM INSURERk ZURICH INSURANCE CO Starboard P D D G INSURER 8: FG Box 290656 INSURERC: 2 Thompson St INSURER N Chaxl*stoars MA 02129- SUR RE:ZURICH INSURANCE CO C THE'POLICIES O!1 INSURANCE LISTED BELOW HAVE BEEN IS3UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REGUIREMFENT.TGRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, �Ar ME INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES GREGATE UHIin SmM*MAY HAVE BEEN REDUCED 13Y PAID CLAIMS. L POUCYrrFFECTIVE POUCYEXPIRDAI ON LIMITS TYPt;OFINSURANCE POLICY NUMBER DATE(MM1DDfYYI DATE IMMIDDlYY) CCN'tW,LIABILITY / / / I EACH OCCURRENCE s 1,000,0w X CowERCWL GENERAL LIABILITY N'1�'E r c 1,000,000 P MMISES Ea 06MM oo CLAIMSMADE ❑OCCUR PAS43110510 03/03/2006 03/03/2007 MED EXP( OW DOWN s 10,000 PERSONAL&AOV INJURY a 1,000,000 GENERALAGGREGATE 5 2,000,000 GENL AGGREGATE LiMpIIT,APPUES PER: RODU -C PLOP AGO 6 2,000,000 POLICY PR LO AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT (Ea acdclent) 6 ANY AUTO ALL OVuNEO AUTOS (P6r B 9 p9fberbOn) SCHEDULED AUYOS HIRED AUYOS / / / / BODILY INJURY (Por mcddanl) d N044-OWNED AUTOS PROPERTY DAMAGE (Pe;aCcidanq GARAGE LWAINUTY AUTO ONLY-EA ACCIDENT P ANY ALITO / / / / OTHERTHAN EAACC 6 AUTO ONLY, AGG 6 EXOES$fUMBRELLA UAMI J rY EACH OCCU RENCE 11, OCCUR CLAIMS MADE AGGREGATE 6 DEDUCTIBLE R T NT Se VMPXERSCOWrAGATIONAND WC 43104182 02 03/04/2006 03/04/2007 '0RS Ea' 1 I EMPLOYERS'LIABILITY E.L.EACH ACCIDENTJ 100,009 ANY rRorRffro"AATNEAiEXECUTiVE 500 000 OFFICERIMEMBEREXCLUDED? I / / / E.L.DISEASE-EA EMPLOYEES + If vas,dtl80ADe ucaer E.L.DISEASE-POLICY LIMIT 6 100,000 pECIAL PROVISIONS below OTHER PROP pA9d3110S10 03/03/2006 03/03/20Q7 O=SCpIPTION OF OPERATiONSILOCAnONSNEHICLESIEXCLUSIONS ADDED 9Y ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION _ r — SHOULD ANY OF THE ABOVE DESCRIBRD POLICIES BE.CANCELLED BEFORE THE 5ZARBOAM PDDG EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTiC TH ERTIPICATE HOLDER NAMED TO THE LEFT,BUT DBA ARCHI—STRVCT FAILURE TO Q SO SHALL IM OSE NO 0 LIGATION OR LIABILITY OF ANY IOND UPON THE INSURE AGENTS OR REP ESE VES. PO BOX 290666 613 REPRESQNTATIlVE CHARLESTOW MA 02129- ACORD 26(2001148) 6 ACORD CO TION 1985 �,,•INS025(00805 ELECTRONIC LASER FORME,INC.-(800)3I7-0w Page I of 2