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HomeMy WebLinkAboutBuilding Permit #091-2016 - 24 EDMANDS ROAD 7/22/2015 X11 l( +0 BUILDING PERMIT NORTk O� ���eo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION — µ� Date Receive Permit No#: d �SsgcHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION G`f Fa v, As J4• t A0t,,^r mA O f e+s Print PROPERTY OWNER N�I�e. C -Y Print 100 Year Structure yes Dno MAP�_PARCEL�4� ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building g One family ❑Addition ❑Two or more family ❑ Industrial j8(;,Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: "Demolition _ __❑ Other ❑ Septic El Well ❑ Floodplain. ❑Wetlands ❑ Watershed District ❑Water/Sewer --- CRIPTION OF WORK TO BE-PERFORMED: feM ove- W 6, e � D � q/ya" r C-i9,f- .t-c�n 'f 1 os r b cQ a.s' o r•c�n y,�a i� z CQ_� t A� ` o�Aa M+Sc. A e-�-p CA:x =n P-taM fv s Identification- Please Type or Print Clearly OWNER: Name: iNl►cua£l -z-• arocay Phone: 508 �a�8 Address: 971 ,*yv9S RD Contractor Name: FES C.o T_rA\J QN Ll.C- Phone: 1-1 IZ„e'0 Email: -VQ\,e.�' - � P_ Yo,-.,o� . corn Address: 441 Kin3 CNV Iry nx cQ Pat- M/a O I @ S-r Supervisor's Construction License: CS o`oq 6 9 Exp. Date: 09- I'i - Zo 0b -Home Improvement License: 117r7 o?I Exp. Date: I o- Zg'-- 701§ 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: $ 3 3, 2So •00 FEE: $ Check No.: �_ �,Z. Receipt No.: Lrn'1Cc'1 1 NOTE: Persons contracting with unregistered contractors do not have cc ess helguaranty fund Location 24 No. MI— Z.,Ok Date Z-Z f r - • - TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee $ '" . - Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check#`?; 2 �� {� Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ SwilUlDing Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 'tanning Board Decision: Comments t Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street RyE - �Sy+DEPARTM�`ENw,, ,�,Tem Dumpster;onrsite_ �y�es + Locat�edj4ati 1�24�Mai��Street �;, L.• - - :, �.. .r' _ men L4 afure%date _ 4 ., X : ,+• r ' ' 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 rnin.$100-$1000 fine NOTES and DATA— (For department use) i ® Notified for pickup Call Email Date Time Contact Name Doc.Bnilding Pennit 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 ---4,/Photo Copy Of H.I.C. And/Or C.S.L. Licenses ,4k-,-Copy of Contract —zL-/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 4 Building Permit Application 4, 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 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 Doe:Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 33,250.00 m 399.00 Plumbing Fee $ 49.88 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 49.88 Total fees collected $ 598.75 24 Edmands Road 091-2016 on 7/22/2015 Kitchen Remodel t10RT#j - E .,. ver 0 No. * - � 0 l h ver, Mass, y [O[KICHIWKK y1. A0RgTE0 P4�,`'ty S U BOARD OF HEALTH Food/Kitchen PERMI T LD Septic System ��Tltx THIS CERTIFIES THAT Nmr C BUILDING INSPECTOR ............................................ . ......... ..... ........................................................ ..M� s.. dation has permission to erect.......................... buildings on .... �i....Si.Si... . ......I qq ^ I /,, y Rough to be occupied as ..... 1.�.ttc6l.r.....-.�h ?x<<r!.... ....�u4t!'�:........`.�:.4 .. !..r.1. Chimney provided that the person ac'ce tin this permit shall in eve sect conform to the terms of the application cepting p p Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION Rough Service ................... ............................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. Smoke Det. US G'moftw1imt, RM 441 Ninp6uW Clue 2udfovd., Ata V1835 homeowner Information Contrac or Information C. e ro✓� �� Natne; Company Name jc) Da Street Address(do not use a Post Office Boa address) Contractor/Salesperson/Owner Name A A4,1 14N Business Address must me Jude a street a dress City/Town State Zip Code ( ) 3 Daytime Phone Evening Phone City/Town State Zip Code Mailing Address(It different from above) B siness Phone Fcdcral Employer 1D or S.S.Number Honer:Improvcnura Contractor Reg Number Expiration chic Law requircc that roue,hoer¢ ./ iaprovengist atiou tl bhave 1 -77031 a va4d rc�istrntiuu number / 'f he Contractor agrees to do the following work for the Houieowuer: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) zy r/� w // �/l frail ��R >'� �''rx-/� z1^C� /r/o3 r l3aci/� /d/Qir, �o"i ct,4l/t ` Le///hj a4tl j4,71 ', /I-w 1�ilell-eli G'Ila,154 Required Peruhits-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 2 g- Date when contractor will begin contracted work. NIGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: 3 3, c,2 S © Ga S-) Payments will be made according to the following schedule: $ upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by /_/_ or upon completion of S ( 3 by //41//<—or upon completion of /71 Lya; $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) ri•1/e ui ment must be special $ to be paid for The following man a q p p 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 thes reater 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. l'v tris~Warranty-Is to express warranty heine Provided by the contractor? No❑Yes(all terms ofthe warranty trout he �ttachvd to the contractl Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third parry/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes 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 caretully before signing this contract. * Don't be pressured into signing the contract.Take time to read and fully understand it. Ask glttestons if something is unclear. Iyhike sure the contractor has a valid Homy Improvement Contractor Registration. 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,NIA 02116 or by calling 617-973-8787 or 888-283-3757. * Does the contractor have insurance? Ask the Cpntractor 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 die 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 later 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 SPACES!!! Two identical copies of the contract mast be completed and signed. One copy should go to dv homeowner. The other copy should be kept by the contractor. 7 liumeowner's ig atu Con ractor's ignature Date Date NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR '. OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE , INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY,IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place of Business] NOT LATER THAN MIDNIGHT OF (date). I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: i Page: 1 F & S Construction 441 Kingsbury Ave. Bradford, MA 01835 Estimate Fax 978 702 4629 Number: E691 Dave 978 886 1250 Todd 781953 1211 Date: July 15, 2015 Bill To: Ship To: Mike Caffrey 24 Edmands st i N Andover, MA 01845 PO Number Terms Description Amount demo ceiling and walll paneling in porch area (remove heating element temporarily) demo dividing wall between porch and kitchen (temporarily suupport load above) install triple 7-1/4 Ivl beam to existing house sills demo flooring in porch area to joists below as necessary sister porch floor joists(to level floor with kitchen ) using 2 x 8 k.d. spruce and install hangers as necessary install 3/4 sturdi-floor system being sure to glue to floor joists remove and replace existing bathroom door and jamb (change to 214 x 6/8 RH inswing) insulate walls and ceiling as necessary to maximize R-value install 1/2" blue board on walls, ceiling and new beam apply skim coat plaster to walls and ceiling that have new board install new trim on windows to match existing interior door trim Page: 2 F & S Construction 441 Kingsbury Ave. Bradford, MA 01835 Estimate Fax 978 702 4629 Number: E691 Dave 978 886 1250 Todd 781 953 1211 Date: July 15, 2015 Bill To: Ship To: Mike Caffrey 24 Edmands st N Andover, MA 01845 PO Number Terms Description Amount re-install existing porch heating element Install island cabinets (approx 24" x 60") install upper cabinet at infilled bathroom window area above sink install two base cabinets on each side of oven aqpprox 9" and 18" install three upper cabinets on oven and fridge wall install new granite counter tops on existing cabinets, island and on oven wall new cabinetry is to be made of paint grade materials Island counter will overang back side of cabinets by approx 12" Install new narrow door slab approx. 14-1l2x 80 install shelves as necessary in old ironing board cabinet to create pantry cabinet install under mounted stainless steel sink and faucet prep, prime and paint walls, ceilings, cabinets and trim in kitchen and porch area hardwood flooring material and installation by others Page: 3 F & S Construction 441 Kingsbury Ave. Bradford, MA 01835 Estimate Fax 978 702 4629 Number: E691 Dave 978 886 1250 Todd 781953 1211 Date: July 15, 2015 Bill To: Ship To: Mike Caffrey 24 Edmands st N Andover, MA 01845 PO Number Terms Description Amount harwood floor sanding and finish by others electrical lighting, switching and outlets etc. by others all labor and material provided by F & S Construction unless otherwise noted 33,250.00 Total 33,250.00 lip H. K►- � - ,—s =�r6 __�_�_,wi 8 East Ogden P.E. r _ Main St - �- — -- Geargeiown;MPi 01 x333 —; - --- - 97 e. 352. f$3E6. C41 D. RE FI-COa Zai� E. I - ._ �. - - �, LSH Of•,yt �--�—=- . —� tr,'r•s�t�.: �:,. �� _ RDF 5���:+ _, - � r �� _._. too PS' p j lz 2 �.F e� ._.��---_-_w- -v- ` c -^ - _- � n i._ ^`___a �� - -- -_,'_.-. i�k-._ � rte_= -_r_.•"'fl=- _-�_.. ._ - - _,_ �M-= _ - -' gym_ _-_ i, .. .i __.. �- .� vo t. _ - a---� f._.__ - _.- - •_•_-•s -- •` _ -.T�__w-_.. �._ To--_-.` _q� -. � r ��.-mac-'— s__�-��s� _�.�_...�_� __ - -�._-�_v-�_•. _ s_ __ i.- r 1 _ t ���y.. a h � ,,� is � • _ .. � l 5 r - 71, IF The Commonwealth of Massa chusetts Department of IndustrialAccidents d 1 Congress Street,Suite 100 Boston,AM 02114-2017 www mass.gov/dia yJ• Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information / / / ` Please Print Legibly Name(Business/Organization/Individual): Ef C, ST J r�c:T A h Address: L/� / �i h s6 r Y Z/-�' City/State/Zip: ,e q� 41iz Gi t-? l� Phone#: Are you an employer?Check the appropriate box: Type of project(required)' 1. I ani a employer with_. : employees(full and/or part-time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition I❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑1 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. 12.0 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.insmance.1 6.❑We are a corporation and its officers have exercised their right of exemption per MGL G. 14.❑Other 152,§1(4),and we have nQ 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 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,'tliey must provide their workeis'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: L4 S Ca �.� `f I� S,�✓`�/� -- Policy#or Self-ins.Lie.#: S' / 7 !a 2 Expiration Date: J ©� Job Site Address: 9L Cg fn 4t✓d� Sf City/State/Zip: UR /�74 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. 152,125A 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 thepains andpenalties ofpeijury that the information provided above is true and correct. Si afore: 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.Plumbing 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 Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retained 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 F&SCONS-01 KMCMAHON ACORO" CERTIFICATE OF LIABILITY INSURANCE DAT D/YYYY) `—►'� 71121/22112015 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 terns 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: Salem Five Insurance Services,LLC PHONE -F ) 445 Main Street A/c No.Fact:(781)933-3100 A/ (781 No: 933-9048 Woburn,MA 01801 ADDRESS:insurance.services alemfive.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Selective Ins Co of the Southeast 39926 INSURED INSURER B:Citation Insurance 40274 F&S Construction LLC INSURERC:TWin City Fire Ins.Company 29459 441 Kingsbury Ave INSURER D: Bradford,MA 01835 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF PO CY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE N OCCUR S1887422 03/29/2015 03/29/2016 PREMISES�(Ea ce $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY❑JEa [--]LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ 500,000 Ea aocident B ANY AUTO HSY382 11/15/2014 11115/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Pet acatlent) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLALJAB OCCUR EACH OCCURRENCE $ EXCESS LJAB CLAIMS-MADE AGGREGATE $ DEO RETENTION$ $ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C. ANY PROPRIETOR/PARTNER/EXECUTiVE Y/N 08WECIW2882 04/01/2015 04/01/2016 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? FN—] NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mike Caffrey THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 24Ed ands Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD F&SCONS-01 KMCMAHON FACORO" DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/21/2015 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: Salem Five Insurance Services,LLC PHONE FAX 445 Main Street ac No EI:(781)933-3100 A/c No):(781)933-9048 Woburn,MA 01801 DDRE SS:i Ansurance.services@salemfive.com ADDRE INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Selective Ins Co of the Southeast 39926 INSURED INSURER B:Citation Insurance 40274 F&S Construction LLC INSURER C.Twin City Fire Ins.Company 29459 441 Kingsbury Ave INSURER D: Bradford,MA 01835 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLISUOR POLICY EFF POUCYFXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S1887422 03/29/2015 03/29/2016 PREMISES Ea occurrence $DAMAGE TO RENTED- 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COaid D SINGLE LIMIT $ 500,000 B ANYAUTO HSY382 11/15/2014 11/15/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per. dent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE I I ER C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NOSWECIW2882 04/01/2015 04/01/2016 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ® NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 Ifes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover Building Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building#20,Ste 2035 ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved:, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ✓V/te �pa717mxa4xlcr aC%l�la4Jaciaude '2 Massachusetts-Department of Public Safety Office of Consumer Affa rs&kgsmess Regulation Board of Building Regulations and Standards ME IMPROVEMENT CONTRACTORg Construction Supen'isor all istration 177031 Type: License: CS-064893 ; s iration .10/23/2015 Individual TODD B.STEVENSON TODD B STEVEN,Sb rj n 26 SUN MM Ayr _ WAKEFIELD NIA 01880yy TODD STEVENSON 26 SUMMIT AVE U WAKEFIELD,MA 01880 � Expiration Undersecretary. Commissioner 09119/2016 , I i I