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HomeMy WebLinkAboutBuilding Permit #1009-2016 - 16 ALCOTT WAY 3/22/2016 A1114 �,�/ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Z / �9SSAGNt1s�� Date Issued: �)7, i 11 IMP RTANT:Applicant must complete all items on this page LOCATION MCC 4 �✓� Print PROPERTYOWNER d=z�i�S OZ5 i� Print MAP NO: PARCEL:—W1��-ZONING DISTRICT: Historic District yesnn Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building gOne family ❑Addition ❑Two or more family ❑ Industrial 'Alteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 1i Water/Sewer I(XAn41 ZN cl ('IG's' iirr ,— /�!?W v�� Vz a S(ve kTrR : U t lcr✓ n� ` � k t✓�i !:Lf� /���1 �,�r,+.-c�a�` yu c� �t'�- •><1 G i.i_ F1.t w N r f`�`i'E �.^ � �,r r� � r ���'-� �c(:� .� c.uiS' , /tJ{✓ C1C,tr rz�� � yhSt� l�•Yd Identification Please Type or Print Clearly) OWNER: Name: Fz-IdS Phone: Address: tG rsicr•-i- U CONTRACTOR Name:0t -,,-y Phone: `i 7J-3-7 3--G3°z Address: 3,� w�t- �h-��-�I•- i�t�-��, t I1 r.��� c�r'�'3Cs Supervisor's Construction License: 3 '5_ Exp. Date: 3iG//P Home Improvement License: �, -� I 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: $ s �'� `t FEE: $ 13'Z Check No.: 10Gz1 Receipt No.: 36\t&G NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner.8 �6� :-�4•-�l�' Signature of contractor t Of BUILDING PERMIT NaRTy q TtteD r6 + TOWN OF NORTH ANDOVER fo - APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 79 Q�RATED wPpt�q`7 SSRCHUSE Date Issued: IMPORTANT:Applicant must complete all items on this>page .1' y U t J 'M`,,' k•�"tr,�, s w +k t:� rf'' d ' LOCATION �. r♦ ' l t t x tr."t r, ♦ ..{ Y. -,'a .�r yy x $y � ,t ;. O PRPERTrY�OWNER 4 K 7 flfl y ',9.00 treat Structure' g Yes" no .. kZONING DISTRICT 4torncd I� istria yes no r ...s •fP, , r !' .., . Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other [7-:7 '-©�,Fkl®od=lain I�'1Ne;tlantls. _ _ ❑ `W�te►�he ,�is �� i DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: f Contractor Name one, T R 'Email-; � `-h wg. :?A ,.n.,vW ,�r Fx + ak:•r li, .r w..tri v . f n w .-sF s snJ k.W.as i PhW. saFY �� L�wx 'Adtliess a - � .i: !�` ., x ;�Y..r F.9 y ',fir a •x .fia' r �..-a,s;. .... t' y . �• d.�. T=" a s�tt __ . - �:. iff' s-q�.:., '`�g„ z`::- . Su 'per " DercCr r �.Exp"�Date* ,�HomeJmprovemer1t License _ k.• k .� �... ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Y Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location No. �U `.�C%I Date t • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 4 t j v r` Building Inspector Plans Submitted_❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales El Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori Signature COMMENTS i Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments s i !Nater& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARtTMENT, 1N- - Dwrnpster on sit yes Loca ed at 1.24. ain Street; a., ,' Fire Depart .ent sign tur Ma 4 ta tAt- TS 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 i ❑ Notified for pickup Call Email z Date Time Contact Name Doc.Building 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 I 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 J Addition Or Decks -r 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) 4z Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit 4. 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 4. 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 Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ - $ 132.00 Plumbing Fee $ 16.50 Gas Fee 100 comm. $ 110:0).00) Electrical Fee $ 16.50 Total fees collected $ 265.00 16 Alcott way 1009-2016 on 3/28/2016 Second floor bath and powder room remodel NORTH Town of 2 : Andover Q o X11 h ver, Mass, 2 � � "1 COC MICCMI WICK It. �7V �liQs RATED U BOARD OF HEALTH Food/Kitchen LD Septic System THIS CERTIFIES THAT ...... ���...�PERMIIJ ,,, .....,. BUILDING INSPECTOR ....... ................ . has permission to erect.......................... buildings on ....1.�..... ... .. .. . ....0.... ,........... Foundation Rough t0 be Occupied as Y."Ao"....... ....?i !.. �...!�Z.. ...... ... .. ........... 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 CONSTRUCTI N STARTS Rough ... Service ........... .... ................................. .. Final BUILDING INSPECTOR GASINSPECTOR 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. !i G. Pirofit Const>rucdo , Rnco 38 Whittier St. Haverhill, MA 01830 978-373-2302 Agreement between Client and Contractor. Client information: Bill and Sheila Foulds 16 Alcott Way N.Andover,MA 01845 978-764-7176 Contractor information: G.Profit Construction,Inc. Gurney Profit 38 Whittier St. Haverhill,MA 01830 978-373-2302 Federal Employer ID#20-3892904 Home Improvement Contractor registration# 156781-8/06/17 Construction Supervisor's license# 73895-3/06/18 Agreement date: 3/25/16. Proposed start and completion schedule.The following will be adhered to unless circumstances beyond the contractor's control arises. Start date: 3/28/16. Finish date:4/8/16 (when contracted work will be substantially completed). The following building permits are required and will be secured by the contractor: Building and plumbing. 1 1(0clel-ao Total contract sum: $7—,385-.O"he contractor agrees to perform the work,furnish the materials and labor as specified on the scope of work page except where noted. Any alteration or deviation from the specifications involving extra costs will be executed only upon written orders. The change order will become an extra charge over and above the contract. All change orders must be in writing and signed by both Bill and Sheila Foulds and G.Profit Construction,Inc.The change order will be charged an hourly rate of $95.00 plus any additional materials. The cost of the change order will be due upon completion of the change order. Building and Remodeling Commercial and Residential G. Profit (Construction, Rllllce 38 Whittier St. Haverhill, ISA 01830 978-373-2302 The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration(as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to the contractor,however.The contractor will have to resolve any dispute he has with a 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 the homeowner by the Home Improvement Law. The contractor and homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit this dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in Massachusetts General Laws,chapter 142A. Client/Homeowner Aj", 41L' n Contractor The signatures 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 the parties do not separately sign this section. A homeowner's right s under the Home Improvement Contractor Law (MGL chapter 142A) and 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 a warranty for workmanship or materials. In addition to guarantees and 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 homeowner's basic consumers rights.If you have questions about your consumers/homeowners rights contact the Consumer Information Hotline listed below. Building and Remodeling Commercial and Residential it ,3 Go Profit (Construction, Rnco 38 Whittier St. Haverhill, IIIA 01830 978-373-2302 Upon signing,,this document becomes a binding contract under taw. You may cancel this agreement provided you notify the contractor in writing at his main office no later than midnight of the third business day following the signing of this agreement. Do not sign this contract if there are any blank spaces. Client/Homeowner Date S t Z -P 6 Contractor -4" Date-JL?,;-IA I look forward to working with you on this project. Sincerely, "�r , -/ Gurney Profit Building and Remodeling Commercial and Residential o i Go Profit Construction, Rnco 38 Whittier St. Haverhill, MA 01830 978-373-2302 The scope of work is as follows. Powder room. Disconnect the sink,remove the countertop,vanity,toilet,baseboard and the file floor. Install cement board over the existing subfloor. Install a ceramic tile floor in a diagonal pattern and grout the tile. Install a vanity,countertop,sink and faucet. Install bead board,paneling and a chair rail around the room at the height of the backsplash. Install new baseboard. Install a mirror over the vanity and bathroom accessories. Install a new toilet. Guest bathroom. Disconnect the sink and the faucet.Remove the countertop,vanity,tub/shower unit, baseboard and the tile floor. Install a new tub/shower unit. Install cement board over the existing subfloor. Patch the drywall around the tub/shower unit. Install a ceramic tile floor in a diagonal pattern and grout the tile. Install a vanity,countertop,sink and faucet. Install a mirror and bathroom accessories. Building and Remodeling Commercial and Residential G. Profit Construction, Rnco 38 Whittier St. Haverhill, MA 01830 978-373-2302 The contractor's labor warranty is 1 year after the completion date.Subject to normal use. Manufacturer's warranty where applicable. There is no warranty on products not provided by the contractor. The contractor is not responsible for materials that are reused. The contractor is not responsible for unforeseen issues uncovered during the remodeling process. The contractor will remove all of his construction debris from the site and adequately keep the property safe and clean.All work shall be completed in a professional manner and in compliance with all building codes and applicable laws.The contractor shall adequately protect the work,adjacent property and the public. The contractor agrees to be solely responsible for the completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Payments will be made according to the following schedule: $2,000.00 upon signing contract. $2,000.00 upon completion of the powder room. $3,525.00 upon completion of the project. Building and Remodeling Commercial and Residential G. Profit Const1I°ucton, Inco 38 Whittier St. Haverhill, MA 01830 978-373-2302 The contract must be executed in duplicate and should not be signed until all 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 contract with attachments is to be given to the owner and the other to be kept by the contractor.Any modification to the original contract must be in writing and agreed by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three-day rescission period has expired. A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems himself/herself financially insecure. However,in instances where a contractor deems himself to be financially insecure,the contractor may require that the balance of the funds not yet due to be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. 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 Massachusetts Guide to Home Improvement"contact: Consumer Affairs Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http://www.mass.gov/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 component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/ Building and Remodeling Commercial and Residential Ga Profit Construction, Inco 38 Whittier St. Haverhill, ISA 01830 978-373-2302 Go Online to view the status of a Home Improvement Contractor Registration: htip-1/db.state.ma.us/homeinWrovement/licenseelist.asii. 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 and/or Better Business Bureau 508-652-4800, 508-755-2548,413-734-3114 Building and Remodeling Commercial and Residential The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers .Applicant Information Please Print Legibly _ Name(Business/Organization/Individual): Q,6, At- Address: 3 k Z-4;fh e,- 4l� City/State/Zip: /-r v—z,-k It AA 043 oPhone#: 7f'3-73- Are you an employer?Check the appropriate box: Type of project(required}: 1.X 1 am a employer with l 4. El am a general contractor and I 6E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t 7• (� Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp,insurance. g, ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required] officers have exercised their 10.Ll 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 12T[ Roof repairs insurance required.]t employees.-[No workers' 13.❑Other comp. insurance required.] —. Any applicant that checks box Hl must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ,Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: C AIA / Policy d or Self-ins. Lie.#: SS�it23— �v�' ?el - lr`1 . _ Expiration Date: &"//G, Job Site Address:. (G A(Cirf f li✓cyy City/State/Zip:_/V< !Jl,fff Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations.ofthe DIA for insurance coverage verification. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: G Date. 3/2 ­'-6 Phone#: `? 7P­3 "73--2 3 C,)2 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person; Phone#: -rom:Chase & Lunt Insurance 978 465 6204 03/28/2016 09:55 #580 P.001/001 GPROF-1 OP ID:AC DATE(MMMDiYYYY) �. CERTIFICATE OF LIABILITY INSURANCE 03/28/2016 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 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). PRODUCERCONTACT Select Business Unit Chase&Lunt LLC NAME: 65 Parker Street PHONE FPX 8-065-6204 A/C No El•978-062.4434 97 A/C No New buryport,MA 01950 E-MAIL Select Business Unit ADDRESS: INSURER(S)AFFORDING COVERAGE NAC F INSURER A:Nautilus Insurance Company INSURED G.Profit Construction Inc INSURER B: Gurney Profit 38 Whittier Street INSURER C: Haverhill,MA 01830 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDIL U8RPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYV) (MMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY NN594516 08/12/2015 08/12/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 60,00 CLAJMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,00 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINOLE LIMIT Ea accident $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accidenq $ HIRED AUTOS NON-OWNED PRDPERTYDAMAGE AUTOS PER ACCIDENT $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ [ANY RKERS COMPENSATION WC STATU- OTH- D EMPLOYERS'LIABILITY TORY LIMITS E PR OPRIETOR/PARTNER/EXE CUTIVE Y/N TO BE SENT BY CARRIERE.L.EACH ACCIDENTICERIMEMBER EXCLUDED? ❑ N/A ndtory in NH) E.L.DISEASE-EA EMPLOYEE $s,describe under SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) via fax 978-688-9542 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. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD LIVI—.t-11 J/ 6.`7/ GVlU 1) YU. YG "'A vt%%J G/ vv'L 1 a.n v%.1A. nnty CERTIFICATE OF LIABILITY INSURANCE DATEIMM/9n1F; YYI T TIFICATE 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 ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: CHASE&LUNT,LLC PHONE FAX 65 PARKER STREET (A/C,No,Ext): (A/C,No): E-MAIL NEWBURYPORT,MA 01950 ADDRESS: 722MF INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: CONTINENTAL CASUALTY COMPANY G PROFIT CONSTRUCTION INC INSURER B: INSURER C: INSURER D: 38 WHITTIER ST INSURER E: HAVERHILL,MA 01830 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DD\YYYY) (MN�DD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE �OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F]PROJECT E]LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND XWC STATUTORY i OTHER EMPLOYER'S LIABILITY YIN UB-9506MO18-15 06/02/2015 06/02/2016 LIMBS ANY PROPERITOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ED (Mandatoryin NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.LDISEASE-POLICY LIMIT S 500,000 DES DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. ---------------- CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED , 1600 OSGOOD ST SUITE 2034,BUILDING 20 IN ACCORD E WITH THE POLICY PRO N . AUTHO IR RESENTATIVE r F NORTH ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION- All rig reserved. Massachusetts De artment of Public Safety ,Q, 7Board of Building Regulations and Standards License: CS-073895 - - Construction Supervisor � GURNEY " 38 WHITTIER STREET ; HAVERHILL MA 01830 L_ l , Cofnmission Expiration: 03/06/2018 r-Jl��onrrrrairuecrlrl�a1C�l�tcslat�rr.��ll' office of Consumer Affairs&Business Regulation License or registration valid for individul use only «1 T' OME IMPROVEMENT CONTRACTOR before Cie expiration date. If ioultd return t): egistration: '166781 Type: Office of Consumer Affairs and Business Regulation - ;Expiration: $1672017 Private Corporation 10 fai lc Plaza-Suite 5170 Y Boston,MA 02116 G.PROFIT CONSTRUCTION INC.- i GURNEY PROFIT 38 WHITTER ST - HAVERHILL,MA 01830 Undersecretary _ Not v lid without signature