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HomeMy WebLinkAboutBuilding Permit #78-16 - 23 OLD FARM ROAD 7/16/2015q�J�l I/ BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: I 9 6 r Date Issued: : 6 ( S IMPORTANT: Date Received must complete all items on this v tt LED �61•N� PROPOSED USE � Z Residential LOCATION 0 1 Print PROPERTY OWNER V� ,! t _ .e I I'C 4A,+-2_ Print 100 Year Structure yes no MAP .� PARCEL7 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 90ne family ❑ Addition ❑ Two or more family ❑ Industrial JkAIteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well p Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Address: g Contractor Name:Phone: P• '74'g Email: kAA ; U, Address: A o i .y( I--�r..� Supervisor's Construction License: Exp. Date:I)301 :2ti 16 -Home Improvement License: U Exp. Date: I [ ao ^ 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: $_:26, d ?0 FEE: $ Check No.: Receipt No.: L d �-- NOTE: Persons contracting with unregistered contractors do nom access to,t*�anty_fud 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 Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH COMMENTS, Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Siqnature & Date Driveway Permit DPW Town Engineer: Signature: Located M4 Usgooq Street FIREDEPAR+TMENT -- Tempi®um_ ps_ter gm.site_ byes_ _ Locatediat 124MainrSt�eet _ vr___._w� Fito0epartment signature/d'a"te COMMENTS 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 t - 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 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 7 No. �— Date i J Check # t 2> 0 77 TOWN OF NORTH ANDOVER Certificate of Occupancy $� Building/Frame Permit Fee_. Foundation Permit Fee $ Other Permit Fee ' TOTAL $ Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 269670.00 m $ - $ 320.04 Plumbing Fee $ 40.01 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 40.01 Total fees collected $ 500.05 23 Old Farm Road 078-2016 on 7/16/2015 bath and closet remodel 0 31. m X a m U) z CO O -I N O" O Z m z o W C O 0) O = O a N CD CL o CD �CD CLC O O r -0y' T N O co) - " to 4. FD 0 0 O S CL 0. A Oq s T 3 Q v �* m 0CD N o S. CD CD CD 0:• 0)0 CL ' CL = fm V z rt� C S CD CD CD - O O cQ H M 0 O 0. N z CD o = m D _ CD N a 0 = °' S' Q O = o n N O CD y �' 3 CD WC rN -0 CD :1 `°PLI O co 0 0 <D CD ch .-► N � CD C.) y o �, D CD CD -0 0' � _rt a) O CL O *** 0 1 N OT. m p m Z m z o W C O O T RL 0 pOq S H T _. 2 N rD (i m O O mr 70 T N o7 C Oq m 0o T Ci m < A Oq s T 3 Q v �* m W C v N n - (D T O - E7 ro W D m Z V z H nrn H M 0 M H V n 0 o = m D _ * bS 1 J M ow 0 c rD 0s 0011:ppwowtiono-A W''ConstrucCo., Ina Mr./Mrs. Mike Katz 23 Old Farm Road No Andover, MA 01845-1132 Mj ABOUT US DOAWL CONSTRUCTION Co., Inc. DO-AWL Construction CO INC in Saugus, MA was established in 1951 and is a private ; company specializing in' General Contractor New July 15, 2015 Construction & Remodeling of Commercial Institutional & Industrial Buildings & Single Family Homes. We are fully licensed in the State of Massachusetts and guarantee the utmost efficiency and accuracy in work. Proposal Do-Awl Construction Co., Inc. proposes to furnish all labor and materials as per plans. All Trade licenses, Insurances and Permits will all be completed by Do-Awl Construction Co., Inc — Permit cost to be determined. Total Proposal Cost: $26,670.00 i j,. DO -AWL CONSTRUCTION CO., INC. WORK SCOPE: Re: Bath Remodel Demo ✓ Gut existing bath (master) and 2 closets in master bed room including tile, fixtures ✓ Remove hall linen closet and frame ✓ Remove rugs in master bed room and 2 additional bedrooms ✓ Remove existing the in lower level foyer/hall ✓ Frame new bath and master bedroom walk in closet as per plan option #1 Electrical ✓ Demo electric as needed (per plan) ✓ Master Bathroom: one twenty amp gfci circuit for the vanity receptacle one Panasonic fan light only(vent work by others) four recessed lights, install owner supplied vanity lights ✓ Master bedroom closet: two single pole switches for two closet lights ✓ Master bedroom: five old work recessed lights on two single pole dimmers ✓ Two girls rooms: cut in eight old work recessed lights on two single pole dimmers Page 1. p WORK SCOPE: Plumbing ✓ Disconnect existing three piece bath and heating baseboard ✓ Relocate drainage piping and hot and cold water piping for one lavatory sink and one shower stall ✓ Furnish and install new heating baseboard ✓ Install all fixtures, supplied by others as per plans Insulate - exterior walls where needed ✓ Furnish and install % Durock in shower area ✓ Frame seat in shower and shampoo niche as per owner Tile ✓ Install owner furnished marble, the and grouts on bath floor, shower floor and shower walls — Contractor will furnish all felt, wire, cement and inset Blue Board/Plaster ✓ Furnish and install '/2" blue board and thin -coat plaster on all walls, ceiling in mater bath and walk-in closet area NOTE: Smooth walls, ceiling to match existing Page 2. Trim ✓ Furnish and Install (2) 30"x80" 6 panel solid jamb smooth pro - core ✓ Furnish and Install 2 1/2 colonial casing and baseboard to match existing NOTE: doors may differ very little from existing Master Bed Closet ✓ Furnish and install (2) double rows of hanging clothes racks with 1x4 cleats KV brackets, closet poles and sockets Hardwood ✓ Furnish and install 2 1/4 oak red flooring in master bedroom, 2 additional bedrooms (2nd level) and foyer and hall on lower level NOTE: All hardwood to be sanded and applied 2 coats of clear poly -additional coat or staining will be an upcharge. Once foyer tile is removed if additional floor work is needed such as plywood and additional demo cost TBD Re -Finish ✓ Sand and apply 2 coats of clear poly on lower level living room and dining room, 2nd floor hall and stair case. Page 3. 'Wk t !. '4ff`. eTt9+v f n • WORK Trim ✓ Furnish and Install (2) 30"x80" 6 panel solid jamb smooth pro - core ✓ Furnish and Install 2 1/2 colonial casing and baseboard to match existing NOTE: doors may differ very little from existing Master Bed Closet ✓ Furnish and install (2) double rows of hanging clothes racks with 1x4 cleats KV brackets, closet poles and sockets Hardwood ✓ Furnish and install 2 1/4 oak red flooring in master bedroom, 2 additional bedrooms (2nd level) and foyer and hall on lower level NOTE: All hardwood to be sanded and applied 2 coats of clear poly -additional coat or staining will be an upcharge. Once foyer tile is removed if additional floor work is needed such as plywood and additional demo cost TBD Re -Finish ✓ Sand and apply 2 coats of clear poly on lower level living room and dining room, 2nd floor hall and stair case. Page 3. WORK SCOPE: Painting ✓ Sand, prime and paint master bath, master bedroom, closets walls and trim NOTE: Specialty mixed colors may be additional Remove all construction debris Any extras, requests, additional plans or demands by ISD, cost TBD NOTE: All permits to be secured by Do -Awl and to be reimbursed by owner Page 4. �z a� s x c ACCEPTANCE OF AGREEMENT This contract is for immediate acceptance. Any delay in acceptance beyond 8/15/2015 will require renegotiation of the terms of this agreement. You are entitled to a completely filled in copy of this agreement, signed by both you and the contractor, before any work may be started. This agreement is made on the date written beside our signatures between Do -Awl Construction Co., Inc. (Contractor) and (Owner). Owner has read the entire proposal and agrees to the statements above within monetary standards as well as scope of project. This agreement is entered into as of the date written below. Mr. and Mrs. Mike Katz (Signature) (Date) (Printed Name Craig Giardu i v 7_ j 4 ._ '22 (Signa r) (Date) c6;�' c� 64,0 (Printe Na Do- wl Cos ction, Co., 17c., Contractor (Sigf9,atur (Date (Printed Name and Title) t -Irv, ChangeOrder Do-AwlConstruction Date - 25 HowatdSt. Owner: Saugus, MA 01906 Contractor: 781-233-1029 Projectname. Change ordernumber. ' Originalcontractdate: --- You are directed to make the following changes to this contract Theoriginalcontractsumwas: Netamountofprevious changeorders: Totaloriginalcontract amountplusorminus netchangeorders: Totalamountofthi sch angeorder: Thenewcontractamountincludingthischangeorderwillbe: Thecontracttime will bechangedbythefollowing numberof days: Thedate of completion as of the date of this change order is: Contractor: Owner: Companyname Name Address Address City.State.Zip City.State.Zip Date Signature Date Signature NOTES: Payment Schedule: ✓ Payment schedule will be set up between customer and Do -Awl Constructions Co., Inc. Payment schedule must be signed by both parties before work will begin. ✓ Any unpaid balances at the time of completion will be subject to interest rates in accordance to the federal short-term rate. Interest rates will increase accordingly every 6 months from the time of payment due. Job Duration: ✓ Approximate job duration is worked out among parties once a deposit is made; this is subject to change according to issues such as inspections, back orders, change orders, weather, illness and other unforeseen delays may prolong completion time. Billing and Extras: ✓ Any extras requested during renovations will require a separate change order and require signatures from all parties involved. ✓ Enclosed please find a copy of our current Change Order Form. ✓ Any Change Orders must be paid in full prior to that work being started. ✓ Differences or unpaid balances at completion of the job must be closed and paid in full prior to signature on final occupancy permit. ✓ Owner is responsible for any and all attorney fees as well as court fees if litigation is required due to a monetary discrepancy or discrepancy within the work scope. ✓ Any request or demands by Inspectional Services not originally figured on the contract will be an upcharge and will be priced accordingly. ✓ Police detail is only needed for Water and Sewer work, if further details are required owner will pay directly to the town police department. The Commonwealth of Massa chusetts Department of IndustrialAccidents 4� d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. _Applicant Information Please Print Legibly Name (Business/Organization/Individual): / , 0- ^,`W L Co- Ay T Address:_ c J� %�U (,ora SyT`. Phone #: IC>-// '' G �� ^` 0a� City/State/Zip: -S%� U S, In. Are you an employer? Check the appropriate box: 1. ❑ I am a employer with : employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 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 proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 6. ❑ We are a corporation and its officers have exercised their right of'exemption per MGL c. 152, § 1(4), and we have no. employees. [No workers' comp, insurance required.] Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. I 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. x Insurance Company Name: / V 2. V Policy # or Self -ins. Lic. #: /Vn f Expiration Date: Job Site Address: -�—C-rrr,, /R /) City/State/Zip: ffG /,OF.Ii V �� 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 en es ofperjury that the information provided above is true and correct. Signature: Date: Phone #: " 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. PIumbing Inspector 6. Other Contact Person: Phone 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 of hire, 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=contractors) 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 Depar=tment 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' compensatiori'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 multiple permit/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 bum 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 # 617-727-7749 Revised 02-23-15 www.mass.gov/dia ACORD CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) rw 07116/15 PRODUCER Rizzo Insurance Group Agency, Inc. 310 Broadway Revere MA 02161 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED DO -Awl Construction Co. Inc. 26 Howard Street Saugus MA 01906 INSURERA Nautilus Insurance INSURER B: AIM Mutual INSURER C: INSURER D INSURER E: I E� COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' LTR INS rVPF Qf: INSURANCEDATE POLICY NUMBER POLICY EFFECTIVE (MMIDOMI POLICY EXPIRATION DATE 1MM/DnfVYI LIMITS AUTHORIZED REPRESENTATIVE <CR> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED ( I. $100,000 A MERCIAL GENERAL LIABILITY NNS12435 11127/2014 11/27/2015 CLAIMS MADE a OCCUR MED EXP An one $5,000 PERSONAL & ADV INJURY S1,000,000 rGEIL GENERAL AGGREGATE s2,000,000 GREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG S2,000,000 CY PRO- LOC AUTOMOBILE i LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Es eockIenl) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) S BODILY INJURY S HIRED AUTOS NON -OWNED AUTOS (Pef eccKleM) PROPERTY DAMAGE S (Per swideM) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S i ANY AUTO P AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR FICLAIMS MADE AGGREGATE $ S S DEDUCTIBLE $ RETENTION S (WC WORKERS COMPENSATION AND STAT r OPTRH X - B EMPLOYERS' LIABILITY VWC 100 601507501 2014A 02102/2015 02/0212016 ElEACH ACCIDENT $100,000 ANY PROPRIETORIPARTNERIEXECUTIVE E L. DISEASE - EA EMPLOYEE $100,000 OFFICERIMEMBER EXCLUDED? If yesdeaaibe under SP , A PR VI NS tI. El DISEASE -POLICY LIMIT $600,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Bath Remodel CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) ®ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MR & MRS Michael Katz DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 23 Old Farm Road NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL North Andover, MA IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE <CR> ACORD 25 (2001/08) ®ACORD CORPORATION 1988 Rizzo Insurance Group Agency, Inc. 310 -Broadway Revere MA 02151 ONLY AND CONFERS NO RIGHTS •UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR —ALTER THE-COVERAGE-AFFORDED-B•Y—THC--POL--IC1ES-SEL•OW.••- INSURERS AFFORDING COVERAGE NAIL # NSURED Do -Awl Construction Co. Inc. 25 Howard Street Saugus MA 01906 INSURER • Nautilus Insurance INSURER Q; AIM Mutual INSURER C: INSURER D! INSURER I - 'AVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISR ADWL POLICY NUMBER M&M. POLICY EXPIRATION LIMNS GENERAL LIABILITY EACH OCCURRENCE 10001000 — DAMAGE TO RENTED $100,000 MED EXP oneperson) $5,000 L x COMMERCIAL GENERAL LIABILITY CLAIMS MADE I X l OCCUR NN5124S5 11/27/2014 11/27/2015 PERSONAL & ADV INJURY S1,000,000 GENERAL AGGREGATE $ 2,000,000 N9 AGGREGATE'CIMITAP l'IES'PER: UCTS=COMP/OPAGG--$ 2-000.000.... . '---- "- __..._.... .._._.___._...__......___....__ .._.._...--•--------.._...___._..._.-PRO POLICY71 PR I I LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Fs Aeddent) $ BODILY INJURY (Per Pe—) 3 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY edW4 $ (Pmcu HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY • EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUYO ONLY: AGO S EXCESSRIMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE EACH OCCURRENCE GREGATE S s • DEoUCTIBLE s RETENTION S WORKERS COMPENSATION AND X WC STATU• OTW FR PLOYERS' LIABILITY AN AN Y PROPRIETORIPARTNERJEXECUTIVE VWC 100 601507501 2014A 02/02/2015 02/02/2016 E.L EACH ACCIDENT 100,000 E.L.DISFASH • EA FJNPLO $100,000 OyFgFICERIMEMBER EXCLUDED? e&be undo SPECIAL PMO IS w —r E.L. DISEASE - POLICY LIMIT $600,000 OTHER =BCRIPTION OF OPERATIONS LOCATIONS 1 VE?tICLES / EXCL11SlONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS E. - ISHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE (2001/08) ACORD Office of Consumer Affairs & Business Regulation - Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs & Business Regulation (OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Search by Registration Number 1111140 Search To search by other fields, enter the search criteria in the fields below and click the 'Search Registrants' button. For the State field, use the two character state abbreviation such as "MA "for Massachusetts and "RI" for Rhode Island. All search fields allow partial text so the search will look for any values that begin with what was entered. For example, if you enter "Fr" in the City/Town field and "MA" in the State field then the search will return records for Framingham, Franklin, and Freetown which all begin with "Fr" and are located in Massachusetts. To return less information enter in more criteria. For instance, entering in a state of "MA" will return a large number of records but entering in a state of "MA" and a city/town of "Medford" will lower the results. Search by Registrant's company's name Search by Registrant's last I name City/Town State �— Zip code Search Registrants Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund . history. The list is current as of Thursday, July 16, 2015. Search Results REGISTRANT RESPONSIBLE REGISTRATION NAME INDIVIDUAL NUMBER DO -AWL CONSTR. CO GIARDULLO, 111140 INC CRAIG ADDRESS 25 HOWARD ST SAUGUS, MA 01906 © 2012 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. 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