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HomeMy WebLinkAboutBuilding Permit #676-16 - 21 RUSSETT LANE 12/1/2015vt tIORT11 i BUILDING PERMIT R r► 3?°U�```�� �° 6�°� TOWN OF NORTH ANDOVER 0 0 APPLICATION FOR PLAN EXAMINATION IfPermit NO: o Date ReceivedArea '� °4 •+` Date Issued: '1 �9SSACNUS���y IMPORTANT: Applicant must complete all items on this page LOCATION 21 PA:Ssj&,�Ae . PROPERTY OWNER 1l i A �� Print nt Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes 49 Machine Shop Village ves AD TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building ,KOne family ❑ Addition ❑ Two or more family ❑ Industrial 0 Alteration No. of units: ❑ Commercial KRepair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition 0 Other 0 Septic 0 Well 0 Floodplain 0 Wetlands 0 Watershed District 0 Water/Sewer 4- --s ik a4,,qC ee T Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: A �Q Phone: gRll -gf7r Address: Supervisor's Construction License Home Improvement License: o41 Exp. Date: t/, ©/.6 Exp. Date: 121 7-116 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: $ 6/, 5G?� . �D FEE: Check No.:� & _ Receipt No.: �lq NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor t C, C:Al 01 r_&� 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 ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY ' INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS CONSERVATION COMMENTS t HEALTH COMMENTS Signature, Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments r Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: 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 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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 Locatio.,?- ` b,— No. Check #J 29761 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Building Inspector N CD 0Z �D O Cr CL n co. O 00 C� a� CD O 03 1" CLO cm CD N CD O N 0 a CCD CD CD �• CD v Z CCD O CD 9 O O O O = F =" � CD p c�•CrDLg o Q- n m O Er ? cN/i --1O N wCD m O. T O O rt O m W n O O CO) C <D "a <D 2 Q; ag Ha D ca Q- 0 �' w --1 CD -0 _ N rt c0 U3 .N Z o 0, c rt M D `D �. rL0 0 CL —i 0 CD ��` 0CMD C� y �1 su coCD A CD U) CD •� s, CD n N 0 -h * •� r � rt aC C D - n o �J A) o CL (f) 77 tD L (D z :c5) D z O Z O_ .o O 04 S Z n 700 CD O n A O QO S co o � Z rn m W C. F 'bCD (� CD -< .Z7 O m S �. 0 0 m Z o N fi �• ;om c Cl) Q y 0 CD eZ' 9 O O O O = F =" � CD p c�•CrDLg o Q- n m O Er ? cN/i --1O N wCD m O. T O O rt O m W n O O CO) C <D "a <D 2 Q; ag Ha D ca Q- 0 �' w --1 CD -0 _ N rt c0 U3 .N Z o 0, c rt M D `D �. rL0 0 CL —i 0 CD ��` 0CMD C� y �1 su coCD A CD U) CD •� s, CD n N 0 -h * •� r � rt aC C D - n o �J A) o CL (f) 77 tD L (D z W C O M D z T S. .o O 04 S Z n 700 T 7 N N (D N A O QO S m D H m O T ]' m O m S Z iZi+ n 0 T O'0 O Ol (� CD -< .Z7 O m S T O 7 O_ n, p O M � a 0 N M n (n N T O Q ?q n S O O 2 m 2 1 Construction Contract A. Date of Execution 11/11/15 UdLD]EA B. Parties Contractor., Steeplechase Builders, Inc. P.O. Box 1358 Andover, MA, 01810 (978)688-5036 MA Home Improvement Contractor Registration # 145042 Federal Identification # 20-1906118 Contract executed by: Joseph M. Clementi Principal, Production Manager Steeplechase Builders, Inc. Homeowner: Tim Lane and Amy Bergeron 21 Russett Lane North Andover Mass. 01845 C. Project Address 21 Russett Lane D. Project Summary 1. Exterior renovation including siding and trim and and exterior stair. E. Project Cost $61,500.00 X �m Homeov6fier Signatures) Con asi Mures g 31710 V" Date ��s Dat CONSTRUCTION CONTRACT Contract prepared on 11/11/15 F. Contract Agreement The parties agree that this contract and the documents listed in Section G below form the entirety of the agreement and that there are no verbal agreements. G. Project Specifications The following, listed by construction phase, are the work specifications that the par- ties agree to: 1. Project preparation to include: • Placement of lockbox at suitable location for ready access to property (home- owner to provide key and/or entry codes as necessary) • Placement of dumpster as required throughout the duration of the project NOTE: Dumpsters are budgeted for the project based on the anticipated requirements of the contractual work. No additional household materials are to be placed in dumpsters throughout the duration of the project without the prior approval of the Production Manager. Disregard for this policy will result in extra charges to the homeowner. 2. Selective demolition to include: Temporary structural shoring and/or weather protection will be installed as necessary in support of the following selective demolition activities: • Demo all exterior siding and trim, windows to remain. • Demo four exterior doors. • Demo all board and battan siding from garage. • Demo existing stairs and landing on side of garage. • Demo false wood pile from front of garage. • Demo arches on front of breezeway and garage. • Demo beam and pulley at garage. 3. Framing • Install new plywood on garage, pressure treated from the sill to 4 feet. • Frame new landing and stairs at side of garage. Post landing to 4' concrete piers. Stair Framing to match existing. 4. Siding, to include: Install Tyvek House wrap where missing and flashing where needed. Install new 6" Hardie Plank cedar mill finish (pre -finished in "Monterey Taupe") clapboard siding on house and garage. 4. Exterior trim to include: Contractor Initials Page 2 of 10 Homeowner Initials CONSTRUMON CONTRACT' Contract prepared on 11/11/15 • Install new vinyl sills on all windows. • Install new AZEK water table, casing, corner boards, soffits and facia. All arched finishes to be squared off. • Install continuous soffit vent at rear of house and side of garage. • All AZEK to be installed using hidden fasteners. 5. Doors and Windows. Install four new exterior doors and one storm door. $2400.00 total allowance included 6. Decks and rails • Trim out skirts and risers with AZEK. • Install AZEK decking on landing and treads. • Install Timber Tek rails in white. 7. Clean up and debris removal • Removal of dumpster and all construction debris • Final cleanup of project areas to broom clean The parties acknowledge that they have read and understand the Project Specifications listed above and that they have been afforded the opportunity to discuss any possible misunderstandings related the specifications. H. Allowance Items Items designated in the Project Specifications with allowances are to be selected at the homeowner's discretion following the signing of this contract. Selections are to be reported to the Production Manager (see Section J below), and Steeplechase Builders, Inc. will purchase the item through its selected vendor. A variation in cost for an allowance item will be reflected appropriately as a charge or credit in subsequent invoicing, or will be reflected in an Allowance Reconciliation Report prior to final invoicing at the completion of the project. The homeowner may elect to purchase an allowance item and supply that item to Steeplechase Builders, Inc. for installation. In such cases, the following will apply: i. The entire allowance amount will be credited in subsequent invoic- ing ii. Steeplechase Builders, Inc. may, at its sole discretion, elect not to warranty the item or service the manufacturer's warranty Contractor Initials Page 3 of 10 Homeowner Initials CONSTRUCTION CONTRACT Contract prepared on 11/11/15 I. Design Specifications and Product Selections The owner will be provided with a list of Design Selection Deadlines for each phase of construction to facilitate the timely completion of the project. The homeowner is responsible to confirm and submit design specifications and product selections in writing (or e-mail) to the contractor before the deadlines indicated. The contractor will provide general assistance or advice as a courtesy to the home- owner; however, the contractor will not be held responsible for delays to the project schedule which may arise due to incomplete or untimely submission of the selections to the contractor. Should the homeowner resort to verbal transmission of information related to the de- sign specifications and request that the contractor proceed without written instruc- tions, the homeowner shall assume responsibility for any errors in selections or de- sign that may arise. If, in such cases, the homeowner requests corrective action, the contractor will inform the homeowner of the cost to make the corrections and no cor- rection will be made until a change order has been approved with the homeowner's signature and payment in full for the corrections has been made. J. Change Orders i. Concealed Conditions Change Order The parties recognize that the contractor reviewed and bid the project based solely on observation of the existing site and struc- ture in their current state at the time this contract was signed prior to any excavation or selective demolition prescribed by this con- tract. Any conditions in the site or structure which cannot be ob- served prior to excavation or selective demolition are considered "Concealed Conditions". Concealed Conditions may include, but are not limited to the fol- lowing: • Soil conditions • Ledge • High water table • Hazardous materials • Rot or mold within the structure • Infestation within the structure or surrounding soils • Acceptability of existing plumbing, electrical wiring or other existing utilities Contractor Initials 1 7 Page 4 of 10 Homeowner Initials CONSTRUCTION CONTRACT Contract prepared on 11/11/15 • Routing of existing plumbing or electrical wiring that does not accommodate the proposed project renovations • Existing structural members that do not accommodate the proposed project renovations Upon discovery of adverse Concealed Conditions, the contractor will be responsible to stop work and notify the homeowner of the conditions. No related work will resume until the parties have agreed upon a course of action and a Change Order has been draft- ed and signed by both parties which clearly specifies the new work ordered and the entire additional cost of that work. ii. Discretionary Change Order Any change or addition to the Project Specifications listed in Sec- tion H which does not derive from the discovery of adverse Con- cealed Conditions will be classified as a Discretionary Change Or- der. A Change Order will be drafted and signed by both parties which will clearly specify the change or addition to the Project Specifica- tions and indicate the total amount of the change in cost, if applic- able. No related work will begin until the Change Order has been signed and payment has been made, as applicable. iii. Invoicing instructions, including payment terms or credits, will be specified on the written Change Order and be approved by both parties before performing the work. iv. The contractor will make every reasonable effort to expedite Change Orders; however, the parties recognize that Change Orders may result in delays to the project schedule, and the parties agree that the contractor will not be held responsible for such delays. K. Payment Schedule The payment schedule outlined below is not intended to represent the exact cost of each of the items indicated. Rather, it is a convenient breakdown of the total sum to be paid, with "milestone" events establishing the schedule for payment. An invoice will be pro- vided by Steeplechase Builders, Inc. for each payment in the schedule below. Payments are due within (48) hours of delivery of the invoice. The homeowner shall pay the con- tractor, in consideration of the work and materials described herein, the sum of Sixly One Thousand Five Hundred (561.500.00), subject to additions and deductions as provided for in Sections I and K above, to be paid as follows: 1/0y�v%s Ann Contractor Initials Page 5 of 10 Homeowner Initials CONSTRUCTION CONTRACT Contract prepared on 11/11/15 L. Project Schedule The anticipated project schedule is as follows: Commencement of contractual work Within (10) business days after signing the contract No work shall begin prior to the signing of the contract and transmittal to the homeowner of a copy of the contract. No work shall begin prior to the receipt of a Building Permit. Substantial Completion* of contractual work Within (8) weeks of commencement * "Substantial Completion" is defined by the AIA as follows "Substantial com- pletion is the stage in the progress of the Work when the Work or designated portion thereof is sufficiently complete in accordance with the Contract Doc- uments so that Client can occupy or utilize the Work for its intended use." This term is prescribed by the Home Improvement Contractor Registration V 1 14 i,5- / Alb.26,.5— ke3 Contractor Initials Page 6 of 10 Homeowner Initials Amount Payment Payment Event 1 Upon Signing of contract $3,000.00 2 Upon ordering the siding and trim stock $22,000.00 3 Upon substantial completion of demo of front and gable end $4000.00 4 Upon substantial completion of demo of rear of house $3500.00 5 Upon substantial completion of installation of trim and siding $8000.00 on front and gable end 6 Upon substantial completion of installation of trim and siding $7000.00 on rear of house 7 Upon substantial completing of installation of doors. $4000.00 8 Upon substantial completion of stairs and railings $8000.00 9 Upon completion of punch list $2000.00 Total $61,500.00 L. Project Schedule The anticipated project schedule is as follows: Commencement of contractual work Within (10) business days after signing the contract No work shall begin prior to the signing of the contract and transmittal to the homeowner of a copy of the contract. No work shall begin prior to the receipt of a Building Permit. Substantial Completion* of contractual work Within (8) weeks of commencement * "Substantial Completion" is defined by the AIA as follows "Substantial com- pletion is the stage in the progress of the Work when the Work or designated portion thereof is sufficiently complete in accordance with the Contract Doc- uments so that Client can occupy or utilize the Work for its intended use." This term is prescribed by the Home Improvement Contractor Registration V 1 14 i,5- / Alb.26,.5— ke3 Contractor Initials Page 6 of 10 Homeowner Initials CONSTRUCTION CONTRACT Contract prepared on 11/11/15 Program and is intended to recognize the potential for delays in backordered products or other minor punch list items that may be subject to scheduling or weather considerations. The contractor expects to have the project, in its en- tire scope, virtually completed by the date set forth above. The contractor will provide written notification of Substantial Completion to the homeowner. Punch List Items The homeowner agrees to provide a final written Punch List of incomplete items within (5) days of notification of Substantial Completion. The home- owner further agrees not to occupy or utilize the project areas prior to supply- ing the final written Punch List to the contractor. The contractor will make every reasonable effort to expedite completion of the Punch List items. M. Personal Property The homeowner is responsible to have all personal items removed prior to the com- mencement of work. The contractor will not be responsible for the removal of any of the homeowner's personal belongings from the work area. Such belongings may in- clude, but are not limited to, the following: • Furniture (indoor or outdoor) • Appliances • Window treatments or other decorative accessories Steeplechase Builders, Inc., or its subcontractors may, as a courtesy, agree to move an item at the homeowner's request; however, Steeplechase Builders, Inc. will not be held responsible for damage to any item under such circumstances. The homeowner agrees not to move personal items back in to the work areas prior to notification of Substantial Completion and submission of the final written Punch List. N. Driveway Waiver The parties acknowledge that there is a normal risk of damage when driving trucks and heavy equipment, such as is normally used in construction, over paved surfaces. The parties also acknowledge that it is impractical to confirm the suitability of the substrate of a previously installed driveway or to guarantee that a previously installed driveway will not sustain damage when subjected to any given load. The homeowner agrees to hold the contractor harmless for normal wear and tear to the driveway. The homeowner also agrees to hold the contractor harmless for any A /,3�S— / .20/5— AJC Contractor Initials Page 7 of 10 Homeowner Initials CONSTRUCTION CONTRACT Contract prepared on 11/11/15 damage that arises not because of neglect or abuse, but due to the unsuitability of the existing driveway to sustain heavy loads. The contractor agrees to repair damage to the existing driveway that arises out of ne- glect or abuse, whether caused by the contractor or any of its subcontractors. For the purposes of this waiver, the inability to determine the weight bearing capacity of the driveway shall not be construed as neglect. O. Promotion. Photography and Publication Homeowner agrees to placement of Steeplechase Builders, Inc. company sign on the front lawn, near the street for the duration of the project. The Contractor is free to photograph the jobsite before the project begins and throughout the duration of the project. Following completion of the project, the Homeowner agrees to provide a minimum of one opportunity for the Contractor to photograph the finished project, including the interior after the project spaces have been furnished and the exterior after landscaping has been completed. The Contractor is free to publish any photographs in its private portfolio, promotional materials or advertisements provided neither the Homeowners' names or project ad- dress are identified, except the town or city the project is located in. Published pho- tographs may include those taken before, during or after the project is complete. P. Right to Cancel The homeowner has the right to cancel this agreement under MGL c 93 s 48; MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. The homeowner may cancel the agreement at any time before midnight of the third business day after this agree- ment is signed. Notification of cancellation to the contractor must be in writing sent by certified mail to the address provided in Section B above and must be postmarked by the cancellation deadline. Q. Warranly Steeplechase Builders, Inc. agrees to warranty all work and materials for (12) months from the completion of substantial work. During construction, Steeplechase Builders, Inc. warrantees the site and structure against any damage caused by Steeplechase Builders, Inc. or its subcontractors. Repair of the following items is specifically excluded from the warranty: • Damages resulting from homeowner neglect • Damages due to normal wear and tear ///8//,5— Z/v0 V2D/5' Contractor Initials Page 8 of 10 Homeowner Initials CONSTRUCTION CONTRACT Contract prepared on 11/11/15 • Minor cracks in concrete (1/a' or less) • Minor fractures in plaster board due to curing of lumber (1/a" or less) • Minor warping or deflection of wood (%a" or less) • Minor shrinking or cracking of grout (1/8" or less) • Minor shrinking or gapping of hardwood flooring (1/8" or less) • Minor shrinking or gapping of interior trim boards (1/8" or less) • Fading of paint and finish exposed to sunlight The homeowner must contact Steeplechase Builders, Inc. regarding any work to be covered under the warranty. Steeplechase will service the warranty item or subcon- tract it at its discretion. Steeplechase will not accept bills submitted by the home- owner for warranty work performed by a third party. Any issues that arise subsequent to submission of the written Punch List (referenced in Section M above) will be addressed as warranty items. R. Statutory Disclosures The following disclosures are required by the Massachusetts Home Improvement Contractor Registration Program: All home improvement contractors and subcontractors shall be registered. Any in- quiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration P.O. Box 871 Taunton, MA 02780-0871 Tel: (508) 821-9375 No lien or security interest is on the residence as a consequence of this contract. Homeowners who secure their own construction related permits or who deal with un- registered contractors shall be excluded from access to the Guarantee Fund. No contract shall contain an acceleration clause under which any part or all of the balance not yet due may be declared due and payable because the holder deems him- self to be insecure. However, where the contractor deems himself to be insecure, he may require as a prerequisite to continue said work, that the balance of funds due un- der the contract, which are in the possession of the owner, shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and owner for withdrawal. / v 2v/S AC3 Contractor Initials Page 9 of 10 Homeowner Initials CONSTRUCTION CONTRACT Contract prepared on 11/11/15 S. Dispute Resolution The contractor and the homeowner hereby mutually agree in advance that in the event that 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 Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. x 13A1dV2 d�� HomeownL�r Signatures) Date 6 , ;; vc Contractor Signatures I1ate NOTICE: The signatures of the parties above apply only to the agreement of the par- ties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. T. Approval By signing below, the parties agree to be legally bound by this agreement in its entire- ty. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. x 131A10 V10 Homeown Signature(s) Date �lt�C/ ll�"3' Con actor Signatures Date Contractor Initials Page 10 of 10 Homeowner Initials The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print v<s-e 14 w, F-1 am a homeowner performing all work myself. FZ'j 1 am a sole proprietor and have no one working in any capacity 71 1 am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #: Insurance Co. Policy # Company name: S -}r .•nb r} SY. 2 vY % G er C :nuc Address 15 3 l e 6H City: fi°.-'hye W Phone #: 22F, Insurance Co. '—e- rl UC 1'e r Policy # 2P Joa 'off cOSSG 41 -S-/r Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify un ce tthe pains and penalties of perjury that the information provided above is true and correct. Signatu J/Za1S Print namk,-/ -71 /77 _ leO?l✓1 / / Phone # 97F• VfS, I F00 Official use only do not write in this area to be completed by city or town official' M Building Dept E] Check if immediate response is required Building Dept p Licensing Board E] Selectman's Office Contact person*/�/_�_ Phone #: FS''�S/97V E] Health Department ❑ Other FORM WORKMAN'S COMPENSATION ACORV CERTIFICATE OF LIABILITY INSURANCE 5i2i/2oi5 Y) 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). PRODUCER Prescott and Son Insurance Agency, Inc. 963 Eastern Avenue Malden MA 02148 CONTACT Commercial Lines NAME: P"oNE (781)322 -23 50 Fax E-MAIL INSURERS AFFORDING COVERAGE NAIC a INSURER A:Western World Insurance Co INSURED Steeplechase Builders, Inc 153 Maple St Methuen MA 01844 INSURER B: INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:CL1451918630 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 LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF IMMIDDIYYYYI POLICY EXP IMMIDD/YYYYILIMITS Town Hall ACLAIMS-MADE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY a OCCUR Andover, MA PP1375294 /21/2015 /21/2016 EACH OCCURRENCE S 1,000,000 TO RENTrff__ DAMR 1i ES Me occurrence)$ 50,000 MED EXP Anone person)$ 5,000 PERSONAL R ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-0WNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT en BODILY INJURY (Per person) S BODILY INJURY (Per acadeni) $ PROPER7o'eccidY DAMAGE S S UMBRELLA LIA8 EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DEO I I RETENTION S 5 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y i N ANY PROPRIETOR/PARTNERIEXECUTIVE aN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes. describe under DESCRIPTION OF OPERATIONS below 1 A WC STATI)- OTH- E L. EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE S E L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS /.LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICOE HOLDER CANCELLATION ACORD 25 (2010/05)®1988-201OrCORO CORPORATION. All rights reserved. INS025 poiom)o1 The ACORD name and logo are registered marks of AC RD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Andover Town Hall AUTHORIZED REPRESENTATIVE Andover, MA J S Scholnick/MPB o-� _'z P .'"� ACORD 25 (2010/05)®1988-201OrCORO CORPORATION. All rights reserved. INS025 poiom)o1 The ACORD name and logo are registered marks of AC RD A� " CERTIFICATE OF LIABILITY INSURANCE TE FDA09/2�201sm 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). PRODUCER CONTACT NAME: Steven Salerno PRESCOTT & SON INS. AGENCY INC. PHONE 781 322-2350 ac No: E-MAIL ADDRESS: ssalerno@prescottandson.com INSURERS AFFORDING COVERAGE NAICA 963 EASTERN AVENUE INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 MALDEN MA 02148 INSURED INSURER B STEEPLECHASE BUILDERS INC INSURER C: INSURER D: INSURER E : PO BOX 1358 INSURER F : ANDOVER MA 01810 COVERAGES CERTIFICATE NUMBER: 1490 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. ILTR TYPE OF INSURANCE ADDL SUBR NUMBER POLIPOLICY MM/DDY EFF MSD/ EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F-1 OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ N/A GEN'L AGGREGATE LIMIT APPLIES PER- - POLICY JPECROT LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS N/A BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE N/A DED I I RETENTION $ $ WORKERS COMPENSATION X STATUTE AND EMPLOYERS' LIABILITY Y / N ETH EACH ACCIDENT $ 500,000 A ANYPROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBEREXCLUDED? WA (Mandatory in NH) If yes, describe under WA WA 7PJUB2E05504515 03/03/2015 03/03/2016 E.L. DISEASE -EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space is required) Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage -Coverage Verification Search tool at www.mass.gov/Iwdtworkers-compensation/investigations/. vin � n wi+ Town of Andover 36 Bartlett St 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 REPRESENTATIVE MA 01810 Daniel M. Cr ey, CPCU, Vice President —Residual Market — WCRIBMA U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1 fit Massachusetts - Department of Public Safety Board of Building Regulations and Standards Coristruc ' "-pervis-- i.�nr�u u�iririi oulrer vr��n License: CS400722 �r ris ERIC E LEE `' 12 POLLARD ROAD �, 6 PLAISTOW NH 838Ivi J�..� jrlia`X' Expiration Commissioner 04/13/2016 6/; i�a7�mooxuseczi o�../�/iaaaactauae%i`a Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR t Reg istratiori'- 45042 Type! w Expiration=12I2i2016 Supplement Card STEEPLE CHA8t@ ILDE ,S 1 ERIC LEE' 153 MAPLE ST METHUEN, MA 01844'3_ ` Undersecretary License or registration valid for individul use oply before the expiration date. If found return to: . Office of Consumer Affairs and Business Regulae: . 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature