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HomeMy WebLinkAboutBuilding Permit #957-2014 - 18 ALCOTT WAY 3/8/2016 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION c� NORTh �?a r. ...m • OL FO- p Permit NO: Date Received 9SSACNU`'E�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION '1 � C21 cam, NQ Ma 0 PJ C&P@C�, pnt NN PROPERTY OWNER U `d-Q llezl Cb Print MAP NO.:©ZrD PARCEL: , ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family L1 Addition �?'Two or more family ❑Industrial .!'J Alteration No.of units: ❑Repair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Moving relocation ❑Other ❑ Others: ❑Foundation only DESCRIPTIO OF WORK TOIE PREFORMED Ke, yi29- VA - Njk) ALA :bp- :b r— I� Identification Please Type or Print Clearly) ,21 OWNER: Name: &_% Phone: Address: CAL\ C WON AW6 as&M= CONTRACTOR Name: 1�X11�a L IL l�1 r4 Phone:(D�J:3J A—56q Address: A() h1(�GK\h Ob Kryid 17 Ad L C2 g Supervisor's Construction License: I Exp. Date: Home Improvement License: l 'l 2� Exp. Date: 5 ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST,4ASEp ON$125.00 PER S.F. Total Project Cost 131. �� x12.00=FEE:$ Check No.: Receipt No.: 10 0 Pagel of 4 BUILDING PERMIT caoRr bq�c\ TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION _y r�3 mH Permit No#: Date Received AC 05 Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition 11 Two or more family 11 Industrial ❑Alteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ IFl:ood Iain qt Wetly dS ® tllU,ate nshec7 ®i trict 1 �®r1lU�er//Sewer �� DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: Y,;OTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 1 �-.sa"P^^�-. 9F Tr-xa.^.,c 'L' - n Y l 4- .r. i•. -j �/ . .- I f ., - I �. 3 �,..��,-....>,-✓.-A'..$:-www r—,-�.r !� 0 n 1, Location . I� t No. 6 Date 5� • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ -�— Foundation Permit Fee $ Other Permit Fee $_�; TOTAL $ 4,�Check# ; 32— ti Building Inspector r - �' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plates ❑' TYPE OF SEWERAGE DISPOSAL +' Public Sewer ❑ `I'alllling/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORD PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS r j Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes Manning Board Decision: Comments 6onservation Decision: Comments Water&Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARrTMEMT `'Tem 'Dum stet on site, , ,ano' r Locatedl'at 124 Main Street En 9s 'vedx kt t+f C'�h a i��L/ Iti. �. 1? Fire ©epartmentignatureldate� r+y� , t, � ,� � , ' rt '$ zl► y, IA", t! }} 1 i�t�''' dei $ t yN y/ t K Tx^.fir Tt*<+►r' S t+ �.-qtr 1;�? 1�{ S��< �g . f r .. ti L ."'� .+��`.�'K��'`�et+-i`�;¢'� 1 �+ y+`,,•...�{j�r P 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 Doc.Building Paimit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit j 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 ®TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks a 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) 4- Engineering Affidavits for Engineered products ®TE: 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 IECC Energy code Engineering Affidavits for Engineered products ®TE: 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 Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 317428.00 m $ - $ 377.14 Plumbing Fee $ 47.14 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 47.14 Total fees collected $ 571.42 18 Alcott Way 957-2016 on 3/8/2016 Bath Remodel, Kitchen Counters and Floor ' � �.10RT1y Town o � ...: :. .,,. ¢ ndover 07 Yr . 2 ver, Mass, COC MI�HlWKM �' '1sgS°R�reo �Pa���S U BOARD OF HEALTH PER IT Food/Kitchen Septic System THIS CERTIFIES THAT ......... ! 114.E... , •� BUILDING INSPECTOR . has permission to erect ...... .:........... buildings on ..........Akprw.....W...... Foundation 10 9Rough to be occupied as ..... � .. �! G� .. ... ........ .. ...............�.... ......................��.. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final 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 PPO UNLESS CONSTRUCTI T6111Rough Service ............... .. ... .... ... .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. d TYPE OF SEWERAGE DISPOSAL Swimming Pools El Art ❑ Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales H ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guara ty fund Signature of Agent/Owner L1m Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING&DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Signature&Date Driveway Permit Temp Dumpster on site yes—no— Fire Department signature/date ' 1013ricketts 41111 Rood �4a Han,lsrc ) 03541 O:{6060 3)32329-5117% DubePh 1+:(603)329-7026 CONSTRUCTION dubcplusxorj, ACCEPTANCE/PROPOSAL LETTER February 4,2016 Client Name: Denise Goldberg Job Location: 18 Alcott Way North Andover,MA 01845-5818 Telephone Number: Home:(978)686-8747 Cellular:(978)604-0683 Business:(978)899-2695 E-mail:denise.goldberg@gniail.com gmail.com Job Description: Remodel of Master Bathroom and Kitchen w/House Painting. Dear Ms.Goldberg; We propose hereby to furnish labor and materials in accordance with specifications(as discussed and illustrated in the Xactimate Estimate document dated 01/27/2016),for the scope of work as follows: Master bathroom work: 1. Remove and dispose of existing shower,Jacuzzi tub and tile flooring.Demo out wall between old shower and toilet. Partial tear out of subfloor to allow access to reconfigure plumbing drains &supple from shower being eliminated. 2. Supply and install new Fiberglass shower base at location of old Jacuzzi. 3. Supply and install newtile surround at shower with recess shelf.Note:Material allowance for new file surround is$4.501sf 4. Supply and install new tile underlayment and new tile floor.Note:Material allowance for new floor is$4.50%f. 5. Supply and install new toilet w/standard 12"offset.Note:Material allowance for new Toilet is $330.00. 6. Supple and install new valve and shower head assemble.Note:Material allowance for new Valve and head assembly is$180.00. 7. Supply and install new shower door and panel assembly.Niue.Material allowance for new Shower Door assembly is$800.00. 8. Remove existing door and modify trim.Supply and install new`Barn Style"interior surface mount by-pass door.Note:Material allowance for new"Barn-Style door"is$190.00. 9. Remove existing sink,countertop and cabinet hardware. 10. Supply and install new granite countertop w/4"back-splash at existing vanity.Note:Material allowance for new granite vanity top is$26.00/sf I ]. Supply and install new under mount vanity sink.Note:Material allowance for new sink is $140.00. 12. Supply and install new bathroom faucet.Note:Material allowance for new bathroom faucet is $150.00. 13. Supply and install new vanity cabinet hardware.Note material allowance per f vure is$5.00 ea w/5 total at$25.00. Kitchen: 1. Remove existing countertops,sink,faucet and garbage disposal as well as existing cabinet hardware. Customer's Initials l 10 Nicken-s'tili),o:i l DublePIUST" I lamhsr(60 N-1111311-}I CONSTRUCTION I 603)320 ;t.;r> Julrrnlus.r�ati 2. Supply and install new granite countertops with 4"backsplash.Note:Material allowance for new countertop is$26.00/sf 3. Supply and install new under mount enamel or stainless kitchen sink Note:Material allowance for new sink is$280.00 4. .Supply and install new kitchen sink faucet w1 hand spray.Note:Material allowance for new kitchen faucet assembly is$18000. 5. Supply and install new garbage disposer under sink.Note:Material allowance for new garbage disposer is$180.00. 6. Supply and install new cabinet hardware.Note material allowance per fixture is$5.00 ea iv/ 38 total at$190.00. Paintina: 1. Finish coat painting on entire home surfaces. 2. Includes all remaining areas not already covered in bathroom or kitchen scope or areas covered by insurance loss repairs.Note:(Only covers single finish coat of'same color oil all walls&ceilings)as well as trim work finish coat). Cleaning and debris removal: 1. Work area to be kept neat and clean at all times. 2. 'Dube Construction will provide trucks for debris transport off site and clean-up and dispose of all construction debris through-out the project. Grand Total Price: $31,428.00 (Thirty One Thousand Four Hundred and Twentv Eight dollars--00/100) TERMS OF PAYMENT: $ 10,000.00 To be paid at start of the job . $ .6,500.00 To be paid at start of plumbing $ 6,500.00 To be paid at the start of tile install $ 6,500.00 To be paid at the start of painting $ 1,928.00 To be paid at substantial job completion Substantial completion-Area in which work has been performed is functional,or occupancy can occur,and only punch list items remain to be addressed. Completion-When job has been complete as described in scope of Nvork,and punch list items have been addressed,and completed. Warranty-(3)year warranty begins upon completion of contracted work. Warranty covers: - Defective workmanship,performed by Dube-Plus Construction. - All products are covered under manufacturer's warranties. - hems purchased by the client for install are not covered by the Dube-Plus warranty. Proposal price is valid for 30 days from receipt of contract. SERVICE CHARGE:A service charge on past due accounts will be computed at"Periodic Rate"of 2% per month,which is an"Annual Percentage Rate"of 24%. Customer's Initials 41( 2 10 Nickc'tts dill Road f Dube I l;tnti0st:( )32 -5671 (�.rC(l.$)�?9-iii,,' irml us' CONSTRUCTION 1': dL11);i1U-.0O26 dtibclwlt��.cum Cusioners shall be and arc responsible for all costs of collection,including reasonable attorney's fees, arising from any breech ofthis agreement ter failure to pay any amount duc and owing. Changes to the abovee specifications twill be acccpicd only if a written request is made. We will then complete it"Change Order"to supply you with the additional charges or credits. No work can he changed, altered,or cancelled twilhout an authorized"Change Order". I'aymcnt of"(:bans c Order"is as follows: Full payuwent of change Order is duc at customer signing prior to start of wt ork, ACCEPTANCE.:the price(s),specifications and conditions above are satisfactory and are hereby accepted. You are hereby authorized to proceed with the work as specified. I/N1`c agree to make payment as detailed above. ;Iw'/Our(the cusloiner's signature below constitutes full agreement. Denise G61d� Date � k February 4,2016 Paul E. Saint-Cyr Date PLEASE INITIAL THE BOTTOM OF EACH PAGE BEFORE SIGNING Customer's Initials A .__,� .,,.-�..,.�.a,�-.._ ._......�„� y .� -� , �, 1 b t � 1 � �- '� it � .�—__ � 3 41 � �� � _.__ � � � � � �, . 1 �� ��� Fr-. ��� �' �� �, � l `z� ��`t 4 `' t--� Y Y � - �_ jhe Commonwealth of Massachusetts Department of industrrial.Accidefats 1 Congress Street,Suite 100 Boston,MA.02114-2017 r www mass.gov/dia ensatlon Insurance Affidavit:Builders/Contrractors/BlectricianslPluwbers. VPorker§'Comp TO BE FILED WITH THE PERMITTING AUTHOF Please print Le 'bI A '�licant Information 1' Name(Businessld ga?iizationlfindividual): Address: , (1 a&) �" (� �"_ZGI Ci /State/Zip: � A.reyou as employer?Checl the apgropriatebox: Type of project(jecluzred) m to (fiilland/orparE time). 7. l]Nd-W`d6nstrd6tlOn l,,famaemployerwith�e.P yees de emolii7i� 2•❑I am a sole proprietor or partnership and have no employees Working for mein Sem g any capacity.[Noworkers'comp.insurance required] 9, ❑Demolition 3,❑I am a homeowner doing all work myself[No workers'comp.insurance required]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will l l❑Electrical repairs or additions ensure that all contracf b either have workers'compensation insurance or are sole G{r �r ,, • l2. ;'Pluinbi ag repairs Or additions proprietors with#employees. 5.❑I am a general contractor and I liana hkedthe sub-coi>lzactors listed onthe attached sheet. 13:[(R06f repairs These sub-contract's have employees and have workers'comp.insurance 14. Other 6.❑We are a corporation ani its,officers have exercised their right of exemption per MGL c. 152 §1(4) and'we MIA iio employees:[No workers'comp.insurance required] *.Any applicant that checks bbx#1 must also 5ll out the section below showing thele workers'compensatioapolicytnformation: ind 1�ating they me t homeowners whoesub s b X ?fnust art attache an additional sheedoingshowing tr nameall work and then Othe ub conks to�s and state whetters must submit a r of now iot Phos ea ties have tContractors that ch employees. If the sub-contractors have employees,they must In their workers'comp.policy number. X am an employer that is providing workers'compensation insurance for my employees Below is the policy and jab site information. C C Insurance Company Name- (2 L. ExpirationDate: Policy#or Self-ins. elf ins.Lia.#: City/State/Zip: Job Site Address: workers'compensation policy declaration page(showing the policy number and expiratzon date). Attach a copy of thee by Failure to secure coverage as regtwed ell as incl enaltles inerMGL o.152,§he form of criminal25A is a OP WORK ORDEl.2.land a�m Of UP to$250.00 a and/or one-year imprisonment,asw p day against the vio�for.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verific tiOtt I do hereb c d under t pat ndpenaldes of perjury that the information provided alcove is true and correct. Date: Si ature• r �\ Phone r V offzcial use only. Do not write in this area,to be completed by city Or town official Permit)License# City or Town: Issuing Authority(circle one): 1.Board of Realth 2.Building pepartment 3.City/`I'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person' Information and Instrucdons Massachusetts General Laws chapter 152 requires all emplbyers to provide workers'compensation for their eznllgye Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of liize, express or implied,oral or written." An employer is d'eftned as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enf&pri'se,and including the legal representatives of a deceased employer,or the receivet'6ttruste6 Qfan 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 occdf i of id dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelluig house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employee" 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•w1i6jhas not produced-acceptable evidence of compliance with the insurance coverage r:equired." Additionally,MGA;ah:aptgr 152,§25C(7)states"Neither the commonwealth nor 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." .Applicants Please fill out th6,`workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and phone number(s)along with their certificate's)bf 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 required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign 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 wiozkers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their selfLinsmanoe license number 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 Iuvestigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"lob Site Address"the applicant should write•"all locations in (city or town)."A copy of'the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit 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 burn leaves etc)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.##617-727-4900 ext.7406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 02-23-15 Vvww.m.ass.gov/dia 11114 03-09-'16 10:07 FROM- 603-641-5062 T-101 P0001/0001 F-571 CORtQ� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM(YY) 3/9/2016 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME: Judith George CIC,CPIA,CPIW FIAT/Cross Insurance PHONE FAX (609)648-4991 1100 Elm StraatE-MAIL ,]george@croaaagency.com ADDRE INSURER(S) AFFORDING COVERAGE NATO a Manchester NIH 03101 INSURERA:Union Insurance Company 25844 INSURED INSURER B Acadia Ins Co. THOMAS A. DUKE CONSTRUCTION-PLUS INC. DBA INSURI:R0: Dube Plus 6 Dirt Pro; Watertown village, LLC INSURERD: 10 BRICKETTS MILL RQAD $IUITE C INSURER E: HAMPSTEAD NH 03841 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 All 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. BR IIoTR TYPEOFINSURANCE POLICY NUMBER MMD CY EWF MMo � LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE F OCCUR DAMAGE ( REN 250r 000 PREMISES Ee oxurYnnca $ R No at, Deductible CPA5028190-13 4/26/2015 4/26/2016 MED EXP(Anyone rion) $ 5,000 PER80NAL&ADV INJURY $ 1,000,000 MOTHER: IAGGREGATELIMITAPPLIESPER: GENERALA06REGATE $ 2,000,000 JE rxLOC PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY AI-Owner/Lessee/Contractor-A $ AUTOMOBILE LIABIUTY COMBIN(EoDtSINGLE LIMIT $ 1,000,000 H X ANY AUTO BODILY INJURY(Per person) $ AALL UTOS IED SCHEDULED AUTOSCAA9028191-13 4/26/2015 4/26/2016 BODILY INJURY(Par attrdenl) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Unimmad motorist r • $ 25,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 H EXCESS LUIS CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTIONS CUA5028192-13 4/26/2015 4/26/2016 $ WORKERS COMPENSATION WPA5028192-13 X PER OT AND EMPLOYERS'LIABILITY STA_UTe ANY PROPRIETOR/PARTNER/EXECUTIVE YIN (3a.) HA G N8 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDE09 FY N(A B (Mandatory In NH) Thoma& Dube excluded 4/26/2015 4/26/2016 E.L.DISEASE-EA EMPLOYE $ 500 000 H es, cc deribourdeY DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMN $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached it more spate is required) Ra: 18 Alcot way in North Andover, MA. CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover, MA. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE J George CIC,CPIA,CPI 4� 81988.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r?ntanrl VrMassachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-094372 Construction Supervisor L. LORIANN J LANGAN 7 CREST ROAD � ' KINGSTON NH 03848 . } (�-�^K CA_ Expiration: Commissioner 07/31/2017 __ ' "ice of Consumer J Affairs&Business Regnlatic ME IMPROVEMENT CONTRACT'OR -� -Registration: -1`19623... ;y 9 Expiration Type: 8/6/2017 Dube Construction-Plus; Supplement Card -Inc. : -_ ': LORIANN LANGAN X10 Bricketts Mill Road Sude"C" Hampstead, NH 03841 - Undersecretary I I I