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Home My WebLink AboutBuilding Permit #1320-2016 - 210 CANDLESTICK ROAD 6/21/2016 + �►ORTF� BUILDING PERMIT °��t`!° T. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION //�/) _ /� Permit No#: o GJJ•/� ✓zeltI7 Date Received 9SSACHUS�t Date Issued: 00 IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER�e.-, e; r,,,t Print In 100 Year Structure yes o ` `c c ZONING DISTRICT: Historic District yes o` l .A MAP %�'�:� PARCEL�_. _ - Macliine Shop Village yes. o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 21bne family El Addition El Two or more family El Industrial WAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .t — - -" 9 °ates a ed s r rt j Sep is � 111e11 Q Flood;, cup , W tland �. w to�lSewer � X DESCRIPTION OF WORK TO BE PERFORMED: l r Identification- Please Type or Print Clearly OWNER: Name: C: �,� Phone: �PI" °f Y 73 D Address:,e/c Contractor Name l�y r✓�asso/)'r„ 9,44(e/'S' Phone 7� 3 Address: vy . , Ex Date iZ�7 SuperVis_or s Const[uction'License. Home Improvement License. Exp ' Dater' .t. - ARCHITECT/ENGINEER Phone: A 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: $ P"� o ® _FEE: $ ,/ Check No.:�t�� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I Locationj�/�Jy Dated—� I 1 No. Z TOWN OF NORTH.ANDOVER j 1 A • $ I+ Certificate of Occupancy. • Building/Frame Permit Fee Y �I Foundation Permit Fee $ Other Permit Fee $ TOTAL 1 j Check# Building inspector 3G2 f i i I f I I Plans Submitted.❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ F sageBody Art ❑ Swimming Pools ❑ Well ❑ s ❑ 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_ j COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed ed On - Signature COMMENTS i i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments r Conservation Decision: Comments Wafter& Sewer Connection's i nature& Date Driveway Permif DPW Town Engineer: Signature: FIRE D Located 384 Osgood Street EPARTMENT Temp Durnpster on sit eyes ... C n i r Located at 1.24 Main S reet � � o artmen sigdate _ Fire Dep n ture/ :s ,k ' €; - — — - = _-'mss 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 de®p.ruires l o Electrical Inspector yes N® qapprovafw f DANGER ZONE LITERATURE: yes N® MGL Chapter 166 Section 21A—F and G min.$1oo- 1oo0 fine ne NOTES and DATA-- (For department use) ❑ Notified for pickup Call Email Date Time Contact Name F Doc.Building Permit Revised 2014 La- Building Department The following Ilowin is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 4. Building Permit Application Workers Comp Affidavit 4 Photo Copy Of H.I.C. And/Or C.S.L. Licenses .•Copy of Contra S Floor Plan Or Proposed Interior Work 4 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. 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) 4, 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) 4 Building Permit Application 4 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 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 $ 803000.00 m $ - $ 960.00 Plumbing Fee $ 120.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 120.00 Total fees collected $ 1,300.00 I 210 Candlestick Road 1320-2016 on 6/21/16 Kitchen remodel I i t%ORTH Town of ndover O 0 o h ver, Mass, Al COC KICKE WICK y1. '�si4s R�TEO P'Pa,`'�5 11 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT (SA0&611...... :r*-*A4M ............... BUILDING INSPECTOR Foundation has permission to erect . buildings on .. .�.v�.... ..... . . ..f/./..� .... ................ ugh to be occupied as A. . oes...%crw..0? .... Chimney ev 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 CONST Rough Service ............... ............... . ..... ... Final BUILDING ECT R 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. Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. $omeow er Inf tion Contractor Information Name Company Name Q�p Cor,4,a 1f,�-hlC t e 8J�Uefr GLC Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name yVr ks c 6�.s s 0 City/Powntat Zip Code Business Address(must include a street address) �`��8�dS�-�'tZn i,�2 o�t�► �-�n-e,N. '�/ �' ol�yS` !f' Daytime Phone Evening Phone City/Tom State Zip Code Mailing Address(It different from above) Business Phone I Federal Employer ID or S.S.Number Home lmpro—eaCo.fmct.rRe&Number &phatumdata Taw nquires that most home impmemcnt cootncton have —lid Mistrafion number .The Contractor agrees to do the following work for the Homeowner: (Describe in detail the vmrk to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) I i Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of �7 /� Date when contractor will begin contracted work. MGL chapter 142A.) /44//4 Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform die work,furnish the material and labor specified above for the total sum of: edr e 6 o (k) Payments will be made according to the following schedule: $!?ei 61 7 upon signing contract(not to exceed 1/3 of the total contract price or die cost of special order items,whichever is greater) $J-�,Oo d by7 /��/��► or upon completion of $-20,000 by or upon completion of $dX,000 upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following materiallequipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.('*) $ to be paid for NOTES:(°)Including all finance charges('*)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 be special ordered in advance to meet the completion schedule. Ex r ess Warr ante Is an express wart ante beingprovided by the contractor? IlJ yNo[]Yes(all terms of the warranty must be attached to the conh•actl Subcontractors-The contractor agrees to be solely responsible for 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 E materials and labor under this aereement Contract Acceptance-Upon signing,this document heroines a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Reeistration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not 1 ater than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical c 'es of the contract must be completed and signed.One copy should go to die homeowner.The other copy should be kept by the contractor. M" "v 11omeowner's Signature Contra s Signature iGk-N eto Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the salve right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. 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 the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required submit to such arbitration as provided In Massachusetts General Laws,chapter 42A. n omeowner.'s Signature Co tor's Signature NOTICE:The signatures of the parties above apply only to the agreemenYof the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights 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 an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments 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. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information 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 littp://www.niass.Rov/ocabl•/ 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/ocabl-/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homeiiiiprovement/licenseelist.asp 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 or 413-734-3114 Version 2.1-11/22/2010 Ray's Cabinet Shop Inc. Grasso 153 Foundry Street 210 Candlestick Road Wakefield, MA 01880 North Andover, MA (781)-245-0428 5/20/2016 01845 Room 1 Not To Scale #, 2755/8 —4813116 4411116 24 9 V 365 81/16k 0 '36 2'41,11 1/.1,61 24 —24— E`48 ---- ---- [[—,, G` """.45 li #2 l 1/2 vJ� #8 18 84 66 93 p #10 #9 0 30,� f2U 32 24 #Y 91/220D p6� 18-98, V8C898LT— EnE.W91 1615/8 �Pce�.°ano..v Enis�eE 8— 181 #6 77 221/4 22,/4 41 #S #Ili 35 35 5/8 24 30 y 77 -----,i 221/4 221/4 #4 201 3/4 I i f The Commonwealth of Massqchusetts A Department oflndustrialAccidents _ 1 Congress Street Suite 100 :t g , Boston,MA 02114-2017 - www mass.gov/dia sV• Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / Please Print Legibly Name(Business/Organization/Individual): Address: If CAvv.-ce 411-1 7,40 City/State/Zip: G✓6 4,11^ SIA OlAO Phone#: f fop 3 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.Warn a sole proprietor or partnership and have no employees working for me in 8. remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp..insurance required.]t 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.F1We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.E]Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submif'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 I am an employer that is providing workers'compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: Str t�sk 4A4/4, 6,14 Policy#or Self-ins.Lic.#: A Z W G G o off° Expiration Date: 410 V, /f Job Site Address:�� no��Gf Glc /1V 11 ,4a,4✓eY-p1d0)K'Citv1State1Zip:A 4N WB/ 4YF)"5 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofpef jufy that the information provided above is true and correct. Signature: Date: Phone# 19 36.2-7 9.5—e 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract or lure, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth 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 the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi•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 workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their ' self-insurance 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 Investigations 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 multiplepermit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit 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 NO e P ) p T 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-MAS SAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia I CERTIFICATE OF LIABILITY INSURANCE DATE'MMM01YY ') F06/03/2016 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(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 CONTACT NAME: PAUL DEVIN ADVANTAGE INSURANCE AGENCY INC. PHONE A (AIC,No,Ext): 978-661-1055 JAIC,No1978-794-4833 184 PLEASANT VALLEY STREET E-MAIL i ADDRESS: ` METHUEN, MA 01844 INSURER(S)AFFORDING COVERAGE NAIC0 INSURERA:WESTERN WORLD INSURANCE COMPANY r INSURED INSURER s:BERKSHIRE HATHAWAY PRIME BUILDERS, LLC INSURER C: 18 COMMERCE WAY SUITE 7250 INSURER 0: WOBURN MA 01801 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: j 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. 1 LTR TYPE OF INSURANCE MR W,D POLICY NUMBER (MMIDCDIYYIlV) (MM/DD/YY7Y) LIMITS � A GENERAL LIABILITY NPP1427169 11/18/201511/18/2016 EACH OCCURRENCE S 2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocarrence) S 100,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) S 5,000 PERSONAL 6 ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO S 2,000,000 PRO- POLICY ECT LOC i AUTOMOBILE LIABILITY (Ea accident) S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGES HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAS CLAIMS-MADE AGGREGATE $ DED RETENTION S $ B N/ORNERSCOMPENSATION R2WC600704 11/19/201511/19/2016 CSTA - O H- AND EMPLOYERS'LIABILITY YIN TORY LIMRS X ER 1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? YD NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 U yea,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedu*if more space is required) GENERAL CONTRACTORS, E)MCUTIVE SUPERVISORS I CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER 1600 OSGOOD STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING 20, SUITE 2035 ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety .y;r Board of Building Regulations and Standards Construction Supervisor License: CS-108209 =_ RYAN GRASSO = ' I 12 BONNY LANIr , s North Andover i 01845 r � Expiration. Commissioner 12/071201$ ISI I .i I i i Unrestricted-Buildings of any use group which_ i;o Wn less than 35,000 cubic feet(991ih )of enclosed space. I I Failure to possess a current edition of the Massachusetts I� State Building Code is cause for revocation of this license. { For DPS Licensing information visit: www.Mass.Gov/DPS I i f l i I 6;7 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration .,_ _ . = - Registration: 185393 Type: LLC Expiration: 6/7/2018 Tr# 289245 PRIME BUILDERS LLC -. RYAN GRASSO .r ' 12 BONNY LN. NO. ANDOVER, MA 01845 `Update Address and return card.Mark reason for change. SCA 1 Co 20M-05/11 ❑ Address 0 Renewal 0 Employment Lost Card V�G' QU%77g7/.O/ZGU(',C(.GL�O�U��.1JQ.C�LLQG'�CJ Office of Consumer Affairs&Busidess Regulation License or registration valid for individual use only _ TOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 185393 Type: Office of Consumer Affairs and Business Regulation Expiration; 6/7/2018 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 PRIME BUILDERS LLC C E