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HomeMy WebLinkAboutBuilding Permit #176-2016 - 179 HAY MEADOW ROAD 8/10/2015 BUILDING PERMIT N tUV*eO' O�� /6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ 9q ^` Permit No#: Date Received � ORATED,'Qp4y gSSACHUs�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION .H 10�6Q " b bDUOYL HII 01945- Print PROPERTY OWNER G E�+ I di E"LLL- C Print 100 Year Structure yesQD MAP PARCEL: ZONING DISTRICT: Historic District yeMachine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building *,One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial �1 Repair, replacement Stbi n ❑Assessory Bldg ❑ Others: ❑ Demolition _ ElOther El Septic El Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED:7*�,CCM l I G l a � ova r A�" CcsN do G � ,US �[ -nor, c�fd3a�'I' JC-1f -57Y -MMDUSI- H (�u-n , 5 PYA25 v(-�V lt--� L ' r-QE 1r- I A H9W S' C� Identification- Please Type or Print Clearly C ✓ OWNER: Name: 4 EI RGE 4 M I S k&q� 216 '0,S Phone: 14 --)—oo Address: Ptq\1w- C>1945 +-vrn 65 S, �C I rUk) Contractor Name: Q&IA/N 5507 S cr7m Phone: q l-?"94 2-1-200 ff1'fC6f- Email: Address: AI Supervisor's Construction Licensef-5-0,� Ug Exp. Dater 4,510 016 Home Improvement License: Id 160 Exp. Date:_S-bY4016 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: $ qz qw.. r30 FEE: $ / Check No.: 13 77Ta Receipt No.: Z—� 1-7 1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sia�t �r of Aaent/Owner�r of Aaent/Owner IT- re of contractor J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/MassageBody Art ❑ Swvntumg 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature i COMMENTS HEALTH Reviewed on Signature COMMENTS I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments d Conservation Decision: Comments Wafter& Sewer Connection/snature& Date Drivewav Permit DPW Town Engineer: Signature: 84 FIRE�DEPARdTME Te - - Located 3 a Osgood Street - l NT �1 MDA-D mpster,+on site ,yeses,_ -(no _ }�Locateat Fre�D°epartmentrsignafure%Cate, i, `C®MMENT�S. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ® Notified for pickup Call Email Date Time Contact Name DocHailding Pen-nit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofin Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe:Building Permit Revised 2014 Location PG CD No. Date . - TOWN OF NORTH ANDOVER xsqMMS, Certificate of Occupancy $ Building/Frame Permit Fee $ 50 - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# q uilding Inspector 2979 . ! : r 1 - NORTN -c ve, O No. _ 2b1 - t ti b z �` h ver Mass 2 �� o ".K. > > COCMICMIwCK A�R4reo S U BOARD OF HEALTH Food/Kitchen PER. IT TSeptic System �A THIS CERTIFIES THAT ....... .. ......... ............................ ....`,,,`,,, cNs , .. BUILDING INSPECTOR ►�� Foundation has permission to erect .......................... buildings on ..� .I .......... Q. ......... ........ . �....�...... ,� Rough a1r) to be occupied as ....... .......!aA�..... �.. .�..... . . .... .................... Chimney provided that the person acceptin this permit shall ry 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 CONSTRUCTION STA TS Rough Service .........................e r r.• :: ............ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Contract 7/,Y Tom Quinn UINN'S CONSTRUCTION Employer 27-1639714 O: 978) 957-1200 C: (617) 939-1353 �` ��'u� c�c3 ' • Dracut, MA 01826 tom@quinnsconstruction.com � www.quinnsconsbvetion.com Page l of 3 I Property Owner Information Name �'+ "'�~f,.,r�lc-(_^•=!-"7" /``3 I�j-1 f-'�L.�. „a ',1��,}t�f�,�'`'�.,/� ..,:} /� ..l � 1 J Street Address(of rPost Office Box) f�' Date c , �i l /Jr•� L/�J�! ,�. J Ii.j1�"•.,c; —7<< —st,.j City/Town State Zip Code Job Name X11 2 e/." f%-x €J i Homme Phone Cell P"I'le" Email >; r �S n �j � > % / >3 .1 Job Location Mailing Address(If Different From Above) Salesperson(s): Contractor Registration#: CS-039732 Ex.Date:_�� ✓'' REQUIRED PERMITS The following building permits are required. It is the obligation of the contractor to secure such permits as the homeowner's agent: List any and all necessary construction-related permits. Note: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. Is an EXPRESS WARRANTY being provided by the contractor? NO Y S "All terms of the warranty must be attached to the contract" ` NOTE: All home improvement contractors and subcontractors shall be registered and any inquires about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,MA 02108 617-727-8598 Unless otherwise noted-within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Secret ry of( g Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to s b it o s"ugh ar itr 'on as Provided in M.G.L.c.142A. !�1) Homeowner: " Contractor:1z ✓' "" ,,. Jr +�,,y moi,c, Date: .,!..—: Date: {/ NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity-A Contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.. Contractor's Financial Insecurity-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 from said account would requireuire the signatures of both parties. THE CONTRACT MUST ALSO CONTAIN: 1. A Complete Description of any other documents which are part of the agreement; 2. A List and Description of other matters upon which the contractor and homeowner lawfully agree; 3. Any Other Provisions otherwise required by applicable laws of the Commonwealth. Remember,the Contract must be the Complete Agreement Between the contractor and the homeowner. COlItlCaCt Employer ID# Tom (9 Quinn -1200 �I,�INN'S CONSTRUCTION 27-1639714 lO�y s�Ke+�� 01826 C: (617) 939-1353 read Dracut, MA tom@quinnsconsbvction.com � gvww.quinnsconstniction.com Page 2 of 3 Modifications There shall be no modification, amendment, or change order made relative to this Construction Contract, Contractor's Work, or the Plans and Specifications without the express mutual modification signed by Owner and Contractor. a. Required Change Orders: The Specifications represent Contractor's best effort to be complete in detailing the scope of work to be performed. However, this contract is based solely on observable conditions of the structure in its status at time of Contract preparation. If additional concealed unknown conditions are discovered in the course of construction,Contractor shall point out these conditions to Owner so Owner and Contractor can execute a signed Change Order for any additional work.Such orders shall specify additional fees, materials, labor and services, and become part of this contract. Additional costs, if any, shall be paid for by Owner in advance of execution of work specified in said Change Order. Failure of Contractor to request such payments in advance shall not be deemed a waiver of payments due. Any delays in Contractor's Work caused by required change orders shall not be deemed the responsibility of Contractor,and shall automatically extend the time of completion.Additional time required shall be stipulated within the Change Order. b. Additional Work Authorizations: In the event that required work cannot be priced in advance of completion of such work, (i.e. discovery of rot needing repair), an Additional Work Authorization shall be executed. Such orders shall describe work to be completed, tin additional fees.materials, labor and services to be charged upon completion, and become part of and shall specify method of calculating this contract.Payment shall be due upon presentation of Contractor invoice.Any delays in Contractor's Work caused by required change orders shall not be deemed the responsibility of Contractor, and shall automatically extend the time of completion. Additional time required shall be estimated and stated within the Additional Work Authorization. I 1,the Homeow r have read an and rstand the above mentioned modification section and agree to the terms. Owner's Signature Contractor's Signature J V Date ate The following schedule will be adhered t,�oimess rcumstances beyond the contractor's control arise: / / Work Scheduled To Begin: / / / Expected Date Of Completion: (Date Contractor will begin contracted work) (Date when contracted work will be substantially completed) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE , The Contractor agrees to perform the work, furnish the material and labor specified above for the SUM o£ $ i (*Include all finance charges in this amount*) ----------------- Pa ents will be trade according to the following SCHEDULE: / � --- c•/ u on signing contract(*Not to exceed 1/3 of the total contract price OR the cost of special order items, g wh eliever is_ga`eater*). F $ c lF5U by / / or upon completion of tEC/rte": $ y 6'by / / or upon completion of $ r [ [•^�itpon completion of the contract(*Law forbids demanding full payment until contract is completed to both parties'satisfaction*) In order to meet the completion schedule,the following material/equipment must be special ordered before the contracted work begins (*Law requires that any deposit or down payment required by the contractor before work begins may not exceed the greater of(a) one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must -^,bee to ordered in advance to meet the completion schedule*): $ to be paid for_$"/,r�/X� f/u C L '='G O NOT I T IS ONTRACT IF THERE ARE ANY BLANK SPACES I enti al copi s o e contract should go to the homeowner and the contractor. wner's Si Contractor's Signature / to ate You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his mai his main office or branch b office or branch thereof,provided you notify the seller m writing at Y ordinary mail posted,by telegram sent of by delivery,not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. ` Contract Tom Quinn tJINN'S CONSTRUCTION Employer ID 4 (617) 939.1353 y9 (978) 265-2390 1� 4 ev` • Dracut, MA 01826 tom@quinnsconstructimcom --'W- q,�ww.quinnsconstnictimcom Page 3 of 3 WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor Agrees To Do The Following Work For Owner:^�/7, (–(1"4'--71j'-.1---1--2- >i-�✓��� ✓r��<ir ( s=�,J'�'`� t1r 1/✓Ui-<� 1 �{./f cJ� ..�c ��. :::J r? ^7.J .G�t%1�=�fii/-% i.�[i,"�G c /;t1i:� :r��.,�,��i 1 �'�/ �. ::J��' /fcJ ✓L%;c fi-'�Z ) ?.-.� -5c %i'7C{c:1E=^$� /-3iy� /J'�S,r-f�lS�C G f`�yiS'.'r'.;...G s/•:7i^�' ..�-/<:��' ..�;:.�� �i 1 j ar c 'G 1-cam,'?: ✓:a G-.s 1�t�v`��� !�r✓s /r:r�;<'r�r� ;5 /��/ %� ii'.i� �!'2i.�ti' /rJ.�G i.s'r,�.Lr7 Gl.�/r✓r._.7�C�/.j ��--ri/.a� �is:� �U•�%..jj=��� �: ''/:��r /,'✓.>%-�!C'!�/��J/t/ �T �:..��'"i/j.,S!+��� /c:�G'�i�-I.i%J v/✓ f�f//�i�LGU.sj LSJ'��..- �1y:i i�=fir / �'�ylL./ Gli� �Gs'S /�J.i—` 1`���- tf�(JC./r� S�,✓.��.��lc�� C f%�" /'vSr%�i''C 7 r-� !�1��y li/' Lfr'��--%i f�-�:%�r/ SJ�--�-�-/�S t�%%�..:' /i+%S �j% ` ��i��✓!✓ _fir l /�!G Jt/ 1ar•1s ' LL Ale- SGi G C/ ,/G Sst��'�i—'�z S Gf✓ r��2�i-�ice, C%i r ✓] � �r ��"1'1.��'/��is � .1 _..i_!�:L t' .��.�'`s :-=�f-=y;!y�C.%%'I<c � LL612 -C> /,�/}"Z r^����,,�ly"/t�� v t.!`'�r�r—j-,Cr.l/�-1 TCi/� /"'1✓—��/r— `'1��=r'� i/�%.J �i %';",lJ�'`7 /%)CJlJ Cj The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ' M S �(,1 (y-7al Address: /(� �--V/a �}'1/Z—' 3 City/State/Zip: Mn ,6 Phone #: 00i , Are you an employer?Check the appropriate box: Type of project(required): I.;n I am a employer with -2 4. ❑ I am a general contractor and I employees full nd/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in ancapacity. employees and have workers' y p Ty insurance.: 9. ❑ Building addition. [No workers' comp.comp. insurance p required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no " employees. [No workers' 13.,K Other-'S TI/fK U lie comp. insurance required.] lC S ib *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ L41�3w Z's&&tna: Policy#or Self-ins.L--ic.#: _G6f1-1)q Expiration Date: Job Site Address:--� _q I"I F 11.�H034rJtj k mo City/State/Zip:4k Wf Ry Q"yK rn A 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 MGL 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 of the DIA for insurance coverage verification. I do hereby cerci under the pains a d en !ties o er'u that thein ormation provided above is true and correct. Signature:- --- �-Q - - -- - —-- ------ I Date I --- --- - � Phone#: T_ ` ::�2,pc7 u=� Oficial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OP ID:JO '4 R CERTIFICATE OF LIABILITY INSURANCE DAT 0810 O/YYYY) 06/06/15 THIS CERTIFICATE 1S 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 poliny(ioa) 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 doge not confer rights to the certificate holder In lieu of such endomemen s. ON PROOVCER 978-975-1300 NAME cr SeBreve&Hall Insur.Asvoc.InC 8T8-8T5 7586 RHONE Fplc Nd 305 North Main SttAig N. Andover MA01810 ADE-MD IREss: Edward ht mlraz PRODUCERcuSTpmEgIpp,THOMAS INSURE S AFFORDING COVERA6E NAIOX INSURED Thomas Quinn INSURER A:Atlantic Casualty Insurance 42848 dba Quinn's Construldlon INSURER B.-Hartford Ins Co. 1048 Lakeview Avenue,Unit INSURER C;Arbella Protection ins.Co. 41360 Dracut,MA 01828 INSURER 0:Commerce 34754 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY.BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MM 0� MM/O CY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 1,000,00 0. A X COMMERCIALOENERALLUAIUTv M0350001230 01/15115 01/11/18 PREMISES Eaoeeut/enM s 100,00 CLAIMS -MAOE FRI OCCUR MED EXP(Anyone,poison) b 6,00 BGLLYN 11/26/14 11126116 PERSONALAADVIWURY s 1,000,00 D X Snow Plow OFNERALAGGREOATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AUG 6 2,000,00 17 DOUCY PRO LOC 3 JECT F-1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E 1,000,00 (p,.pacddarb ANY AUTO BODILY INJURY(Pet person) S ALL OWNED AUTOS BODILY INJURY(Par aoddent) S C X SO4EDULEDAUTOS 1020029603 06107/16 06107H6 PROPERTY DAMAGE X NIREDAUUnderinsured $ 10013 X NOWOWNED EDAUTOS Uninsured 6 100/3 UMBRELLA UAB OCCUR EACH OCCURRENCE S #DE1771C useCLAIMS-MADE AGGREGATE S IBLE S TEMYIDN S s WORKERS COMPENSATION X WCSTATU• I JOT11- AND RMPLOYRW LIABILITY LIMITS FR B ANYPROPRIETOPJPARTNE..R/FJ(ECUTIVEYIN N,A 116P704 01115/16 01/16/16 1.1.,EACMACCIDENT E 100,00 OFFICERNEMSER EXCLUOE07 O (Mandatory to NN) E.L DISEASE-EA EMPI,DYEE S 100.00 IPyes,dewAbe under 500,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Attaah ACORD 101,Additional Remarks Schedule,R moro space le roglthad) Sole Proprietor Thomas Quinn is Excluded under /workers Camp CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS- AUTHORIZED ROVISIONS-AUTHORIZED REPRESENTATIVE A444- @ 1988-2008 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD OP ID.J0 C T I FIC T E OF UAB � I NCE 011011 TRIS CERTIFICATE€S 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 FtEPRESENTA 1IVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the caslificato 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 certiliicatse does not confer rights to the cel iiffcate holder in lieu of such endorsemengs PRODUCER 91.8-9754301) ;AraACT $egreve Nati€nsur fasscclnc5�75°15g6 PHOON c Ext F xo 3Q5 Nonh Main SL Andover,MA 04890 E-MAIL Edward Ramirez FRD R T i-ICIi1itA CU MERID.7: MSU S AFFORDING COVERAGE NA1CR INSURED i&11=113S Quinn INSURERA:AVanfic Casualty Insurance 142846 dba Quinn's Construction wsuRERs:d-dardord drys Co. gc4mmmsftRead l(}y� (- I — iNsu mc:Arbe€ta'Protection fns.Co. 141360 0rac4 FUA 09826 INSURERD:Cornmerce insurance Co. 1,4764 INSURERS: INSURER F COVERAGES CERTIFICATE mumsEA REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE U BELOW HAVE BEEN ISSUED T THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT(MTHSTANDING ANY REQUIREMENT,TERM O CONDITION OF ANY CONTRA OR OTHER DOCUMENT V1IlIIi RESPECT TO wFItCH THIS CER i IFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURAN E AFFORDED BY THE FOU ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHO WAY HAVE BEEN REDUCED Y PAID CLAIMS. ILS j INPEOFINSUPANCE PO11CY MBER h1f9R F A4AfWll M i Lwass GENERALLfABILISY EACH OCCURRENCE S 9,000,00 AC COMMERCIAL 1 I�®360i113123t3 091 51'€s 09116"" PRMISES(E. s 900,000 CLAWS-MADE FRIOCCUR + MED EXP(Any one person) {S 5,000 I ! PeRSONAL&ADVINJURY 5 •1,000,00 E) Snow Plow BDRiA i1126f14 � 91/26/95 (GENERALAGGREGATE Is 2,0001000 GIDMAGGRE�GATjEUMfTAPPl�.esPiR PRODUCTS-COMPIOPAGG I S 2,000,00 POLICY 1 '�a f( I LOC , Is iiiI AUTOMOSILELIAMUTY 1 {CO?ASINEDSINGLE LIMIT I S 1,000100 ANY AUTO `(Ea accident) + I AU.OWNED AUTOS _ 'aODILYINJURY(Ferpeaon) Is C iia SCHEDULED AUTOS 1020029a03 05107144 0510 1?5 BODILY INJURY(Perecddent)I SPROPERTYDAMAGE li HIRED AUTOS (Perawdent) S NON-OWNED AUTOS Underinsured Is 100130 1 Uninsured is 1001;0 l� Un1BRELLA),IABHCLAIMU%DE OCCUR EACH OCCURRENCE S &TESS LIRE !AGGREGATE Is ` DEDUCTIBLE fis 1 RETENTION S ! i 5 41(ORKERSCOMPENSATION sr WCSiATU. 0TH- AND E7IPLOYERS LfABILTTY YIN n O Y LI a ANY PROPRtETORIPARTNER1ExECUTIVE �r NIA � ��� 0919 195 04146/96 �ELEACHACCIDENT S '100,0041 OFFiCERRiEA1BER EXCLUDED? IMandatuly la NH) f I If Yes.desca-be under I E.L.DISEASE-EA EM S I00,00 t DCSCRIPTIONOFOPERATIONS below I ELDISEASE-POUCYLINT I S 600,00 DESCRIPTION OFOPERATIONS ILOCATIONS1VEHtCLES(Attach CORD 907.Add0IonaiRonamUsSebedule,ffmorespaez cequitetS) Sole P�onr etco� Phomas .;r,n is g uce@ a7ad�s cSoskexs Comp CERTIFICATE HOLDER CANCELLATION � 000011011 SHOULD ANY OF TME ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE EXPMAXION r3ATE THEREOF, NO-nCE %WLL 3E T)ELAfSRED U3 ACCORDMCE WM4 T1 m POLICY PROVIsioNS. AU T H�ORIZED RD REEPRESENTAMUE 1 ©4958-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) i Ize ACORD name and[ago are registered marks of ACORD 6�� Wommvwwwa" Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 121604 Type: DBA Expiration: 5/24/2016 Tr# 250393 QUINN'S CONSTRUCTION THOMAS QUINN 868 MAMMOTH RD. -_ DRACUT, MA 01826 Update Address and return card.Mark reason for change. SCA 1 0 2OM-05111 F1 Address El Renewal n Employment ❑ Lost Card -- -- --- - - - -- - - - -- - ------...--- 62e VQ/&0,,X..W1 -- —- --- -- - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. 1f found return to: • 121604 Type: Office of Consumer Affairs and Business Regulation fxegistrabon-, piration: 5/24/2016 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 QUINN'S CONSTRUCTION THOMAS QUINN 868 MAMMOTH RD. DRACUT,MA 01826 Undersecretary Not valid withou si nature g ::�Ub --. CS439732 r: IHOMASJQUIW 868 MAMKOIH2D DRACUT IMA 01926 _. 0312MO16 ` CERTIFIED VINYL SIDING } INSTALLER GRASTNID-:756 Spa- ed ey me vs,r,a s+&rs[-Mute Quinn,Thomas Expires:4/1/2017 868 Mammoth Rd ID#:17412 Dracut,MA 01826 Certified Since:2014