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Home My WebLink AboutBuilding Permit #966-15 - 242 DALE STREET 5/27/2015bUILUINU FtKMI I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINAT N�: Date Received Datelssued: IMPORTANT: AMicant must comt)lete all items on C LOCATION :fz Print PROPERTY OWNER*- JULI E NkGP_0 Print MAP NO:QDq PARCELtUW ZONING DISTRICT: Historic District yes no 0 Machine Shop Village yes rno TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 0 One family El Addition 11 Two or more family El Industrial XAlteration No. of units: 11 Commercial El Repair, replacement El Assessory Bldg El Others: El Demolition El Other 0 Septic 0 Well D Floodplain 0 Wetlands 0 Watershed District D Water/Sewer I qx 'S (a vr�- 'Of -C Y_ i F-cr-A0b'EL (Ir In 15 -t I I�A 6, -'s t.;,Iu Ro r-�' DEW WINbow 1, C KE A-Tuz- C-215ho I N 6 ren, ic _S U DiEt - Identification Please Type or Print Clearly) OWNER: Name: "Jwke— 1A Address: '42- D3Xe_ S-h�+ AyAdC�jz_(- y-yNp� TRACTOR Name: —Phone: 'j7F' '1 -?9 - t, Address: IP7 WNWIct-Y rt� kjat'IH AvQPWtriQ MA 0)245 Supervisor's Construction License: Exp. Date: C., �. I CLi Ll ?.'16' 5112 a Home Improvement License: Exp. Date: ni ARCH ITECT/ENGIN EER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. MOO PER $1000.00 OF THE TOTAL ESTFMATED COST 13ASED ON $125.00 PER S.F. Total Project Cost: $ Ig � L4W. ou FEE: $_ Check No.: Receipt No.: Qj��V2_9 NOTE: Persons contracti�",iih_ unregistered cqptmefors do not have access to the guarantyfund i�a_tu �gent/Owne of contractor 7 %01 Location "-x/ -)- No. 9&(p -It5, Check # 2 f' ', L, rj) , Date 5 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Sr Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $- TOTAL $ Building Inspector __j Plans Submitted [I Plans Waived [I TYPE OF SEV� �RAGE�DjSpOSA L Public Sewer well El Private (septic tank, etc. F1 Certified Plot Plan 0 Stamped Plans Tanning/Massage/Body Art E] Tobacco Sales El Pennanent Dumpstex on Site E] Swhnmiugpools 11 Food Packaging/Sales 0 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature�� COMMENTS—L C -I L A �'L- k CVNI I-, �S\ A 91� � A A KCONSERVATION COMMENTS �H a COMMENTS Reviewed on Q' -- d S -j /,-s Reviewed on Signature Zoning Board of Appeals. Variance, Petition No: "7 oning Decisionlreceipt submitted yes Planning Board Decision: omments Conservation Decision: Comments Water & Sewer Connedi0n/s Driveway Permit 1D -PW Town Kagineer: Signature: :71:;;�7;; I I '' I 'I , j , '' -, Located 384 Osgood Street UR -JOE POARN�k—q ff N ;IV __Lj �ed 5 -!?4 gin&-aagf-' F; i Rd fttW-eZn jt9i g n Cu ffi�/�g P Q 0 Fzl NiT S ------------------------------ 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.$100-$l 000 fine NOTES and DATA — (For dena rims-nf i mial Doe.Building Pen -nit 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 10TE: 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 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) ,44 Copy of Contract 4; 2012 IECC Energy code ,-I Engineering Affidavits for Engineered products 10TE: 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 I — CD 0 z r"Ilk o CD CL CL > cm 0 00 C < D CL CD 0 CD CL 0 S' = CC CD CD 0 f -OL 0 7 LW7 0 0 U) 0 0 =r CD a U) CD U) z 0 CD 3 0 CD 'It ccl cn a m 0 --I 0 X 5im- Z -0 r- m m Cl) o M X v Cl) 56 ;u m U) Z z 0 h .-I- =r CD N 0 to 0 co M CD co r_ 0 0 U) 0 2: CD 0 0 ma — --I 0 " 0 0 r .r m -0 CD rL 0 CD 0 CD 0 -4 M 0 CL C-) a ;o = -,� — a o =-o 8. CD 0 0 CL 0 Fn CD 0) Cl) M 0 CD '0 CD CD CL 0) @ @ 0 (a CL cn —10. 0 CD CD o .04 tm= 0 CD o 0 Cr =r =r CD U) > 0 =- CL cm 0 CL CD 0 U) Ct' CD CD 0 r -L CD -cn r% ca co) rb CD CD CD C') U) - o =r > CD 0 2) CL Ln un co -n x -n Ln x -n ;;o -n n ;u -n Ln -n 3 0 X, (D (D (D z c M m m > m z w o c m 0 < (D 0 =r m r* m M m 0 2L 0 M c m 0 RL 3 (D 0 r_ 0 w 0 =3 c 2 z z m 0 (D r) Ln rD 3 0 0 (D Go \9 0 0 Adam Brien 417 Waverly Rd. North Andover, MA 01845 978-479-1526 3 -f i Co. Building & Remodeling CSL 104428 HIC 168512 LLC 5/17/15 adambrico@gmail Contract Rob Barter 242 Dale St North Andover MA Job Description: Installation of new Pressure Treated Deck 0 Plot Plan provided with deck footprint 0 Deck to be started 10' by 30' joists to be framed parallel to the house. Deck to be built to code 2xl 0 joists and beams. 0 # 5, 12"x 4' deep holes with sauna tube and concrete poured. 4x6 PT posts used for structural supports. 0 At 20' corner, deck to be stepped up creating head room below. And to extend 10' against the house making backside dimensions 20'. Outside rim to be cut into house to rest on foundation to avoid an additional footing a All material to be pressure treated lumber nailed with galvanized nails including decking. All hangers and fasteners to be galvanized. Rails to be designed in the field with appropriate fastening Stairs to be on deck side D with a 3'x3' platform step down. 1, 12" sauna tube to be dug for platform support Permit fee included Sill fence and hay bales must be installed before construction can begin Total Amount $7800.00 Job Description 2: Sunroom Remodel Sunroom to be demoed to studs all debris disposed off site Floor to be built up for from existing slab to receive insulation and moisture barrier. Floor to receive "hardi backer" underlayment and tile. Tile and grout supplied by owner • Wall A to be removed and new structural LVL installed posted to foundation and existing structural beam in basement. ff beam does not land on existing structural beam a footing and lally column may need to be installed in basement and priced accordingly • Wall B to receive new vinyl casement windows, new insulation sheet rock and plaster. • Wall C to receive 8' Vinyl slider (action tbd), insulation, sheetrock and plaster, Wall D, to have 4 -sided cased opening Ceiling is quoted to receive new insulation, blue board and plaster. If ceiling can be raised priced to be adjusted in the field. Room to be wired to code, 1 exterior plug, ceiling fan to be setup and installed, Fan provided by owner Heat to be provided in new space along wall B Interior trim to match existing house. Exterior to remain white vinyl. Any exterior trim to be PVC boards 0 Painting not included Total Amount $8700.00 Job Description 3: Framing of basement walls, all finishs by other. Walls to be studded all openings framed out. Soffits built around plumbing stack. 2 Windows replaced Total Estimated cost: $2900.00 Total Contracted Amount $19,400-00 The Owner agrees to pay BriCo Building and Remodeling $19,400.00, for doing the work outlined above. The following payments will be paid to the contractor in the following manner: Deposit of $2500.00 is due on contract signing. Second Payment of $3500.00is due at completion of framing and decking is being installed Third Payment $1800.00 is due at completion of deck Payments for sunroom and basement will be due once construction has begun in those designated areas. Sunroom payments will coincide with the ordering of windows and doors. Window and door orders can take 2 weeks for item to be manufactured. Any unforeseen work or necessary repairs found during this project to be brought to the owners attention as soon as possible. Any extra work resulting from unforeseen problems will be priced accordingly on site and be done with written approval. BriCo is not responsible for anything that occurs on site that is not directly involved with the construction of this project. BfiCo Building and Remodeling is a fully licensed and insured LLC company. License numbers are provided in the header above and current insurance documentation upon request. All subcontractors must carry the appropriate license and insurance to perform work in the state of Massachusetts. The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices, and all work performed shall be subject to final approval by Owner. All work to be done incompliance with Massachusetts building code. BriCo takes on full responsibility of a/I necessary inspections. . BriCo warranties all construction related to this project for two years after completion. Dated Signal Sianai This form satisfies all basic requirements ofthe state's Home Improvement Conti -actor Law (MGL chapter 142A), but does not include standard language to protect homeowners! 18eck legal advice if necessary. Any person planning home improvements should first obtain a copy of "A Massachusetts Consumer Guide to I Ilonic Improvement" before agreeing to any Work on your residence. You may obtain a fi-ec copy by calling the Office of Consumer Affairs and B I I nsiness RegulationJs Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our wobsite. liomeowner idormation Contractor Information x4anie Comp Name �S. 5ggaloq_ G & I C a Stred Address (do not use a Post Offidle ; Box address) Contractor/ Salesperson/ owner Name N2. DALe S -r �: Nb A M et,) City/Town State Zip Code Busin= Address (must include a street address) P, toboyr L41-7 WAVErL,/ r15 DaythricPhone Evgjhing Phone City/Town State Zip Code Mailing Address (It different from abo�e) Business Phone Federal Fmployer ID or S.S. Number _T L—quimiliatmosihoeas 11--hrnpae—tC-lueto Re&Nunaber Fxpaaahan date finmeuacetcantraa..I�iva �H� �uuiruuur agrees to ao Ine tollowingworlc for the Homeowner. ODescribe in detail the work to comple4dl, spec&jing the type, brand, and grade of materials to be used, Mai-, additional sheets ifnecess=) %6 50 f -T '6CCC VVAOht�-' oF CX15-r)#00 5UAA0or_4, Required Permits -The following1tuilding permits are required Proposed Start and Completion Schedule -The following schedule and will be secured by the contractbi as the homeowners agent: be adhered to unless circumstances beyond the contractor's control �Viu arise (Owners who secure their 6ivn permits will be excluded from the Guarani' ,y Fund provisions of ------Pate when contractor will begin contracted work MGL chapter 142.A-) : : -----__Pate when contracted work will be substantially completed. Total Contract Price and PayinetitiSchedule The Contractor agrees to perform tA6 work, furnish the material and labor specified above for the total sum of. Lk)o . to Payments will be made according t6 the following schedule: upon signing contract (not to exceed 1/3 ofthe total contract pric e or the cost ofspecial order items, whichever is greater) by or upon completion of by or upon completion of upon completion ofthe contract (Law forbids demanding full payment until contract is completed to both party's satisfaction) 11 The following materia i in t be special $ to be paid for ordered before the con I rk begins in order to meet the completion sch a., $ to be paid for NOTES: (*) including all finance charl� es (**) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of! (a) ono�tbird ofthe total contract price or (b) the actual cost of any special equipment custom made in al which must be special ord6red in advance to meet the completion schedule. or ateri gxl2re�s Warrinty - Ts in mress wai'6ntv being nrovided by the contmetor? EIN.A[Y. an tenns Of thewfl Lra-Rly must be attached to Subcontractors - The contractor ag —L the contrActi rices to be solely responsible for completion ofthe workdesenbed regardless ofthe actions ofany third Party/subcOntractoruffli dbythe ctor. The contractor fin-ther agrees to be solely responsible for all payments to all subcontractors for materi land labor under this alrre,29,nrl Contract Acceptance - Upon signin' . k, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lieh 'or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this coidraLl I � Don't be Pressured into signini the contract Take time to read and fully understand it. Ask questio s so e g cl Make sure the contra 11 if to thin is un ear c as a Valid Homme !Ln-provemOL-ContractorRepistration The law requires most home improvement contractors and subcontractors to be I gistere6Mth the Director ofHome Improvement Contractor Registration. You may inquire about contractor re registration by writing to the ;ne-t-r at 10 Park Pla-il Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. * Does the contractor have insur�ce? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proofof insunld&' document. * Know your rights and responsibilities. Read the Important Information on the reverse side ofthis form and get a copy ofthe Consumer Guide tc) the Home Impro-�ement Contractor Law. : j You may cancel this agreement ifit has b signed at a place other than the contractor's normal place ofbusiness, provided you notify the contractor in writing at his/her mainJiffice or branch office by ordinary mail posted, by telegram sent or by delivery, not later then midnight ofthe tIVNsiness day following the sig�ih;g ofthis agreement. Seethe attached notice ofeancellation form for an explanation 0 t fthis righ NOT SP"S� TEIIS CONTRACT IF THERE ARE ANy BLANK SpACES!!l Two 'de'a copiesofthem", —at bftompleted and signed, one wvY should go to the hem— Tha 16— py �h�Ad b, k�p,by the suouestur, S� A4__ contractor's Signature Ualz Date 2,19 16 2 0 Figure 24: Typical Guard Detail Z:t V -VI ma4mum spacing a '4 W 5-< r 4X4 post, Wical W or 514 board DO NOT NOTCH rralicap - �- a, 0 CL 9 W @<0 9- C Q (D 0 a CL 00 minimum 2x4 top and boflotM 3 Z� .1 -t� SW 12 plI & Ofte0h to 9UMd PDSt Will MW conanon naft or 3 (2#8 wood scmws-on 0 inside farg- 0 - co Mq attach plokets at top and bottom (2) eie� -opedngt shag not allow r- hru-bolh;and the.passage of a 41 with (1)98 wood screw or (2)Bd n Washms diametersphere post-framp-L ring shank nalls VM 0.135"nornbal diameter Arneeican Forest& Paper Association L IIVG 6 0-c- If* 0 2o' .,Sxot vOk'L-`�, 15 POST t 2) FIT 4A r v )--n ---�p- BriCo Building & Remodeling, L At 417 Waverley Road ' North Andover, MA 0 1845 78 7. Ets darnbrikoftmoil.corn Local 103 MEW Ln I10, z V, I 91 40 P4 Ile 0 INM r— '%A '01�1 JOB SHEET NO. CF CALCULATED BY CHECKED BY SCALE Ik �' W4 FA .WNW ,e� 96-W -"L% IWAW - 0. lqp� kto 4% C> 044 CONSERVATION DEPARTMENT Community Development Division May 14,2015 Julie Nigro 242 Dale Street North Andover, MA 01845 242 Dale Street,, North Andover Construction of a deck on Sono -tube Footings Conservation Conditions of Approval, NACC #141 Pursuant to section 4.4.2 (A) of the North Andover Wetlands Protection Regulations, Julie Nigro, filed for a smaU project for work proposed at 242 Dale Street� North Andover. The proposed work includes the construction of a deck (402 sq. ft. total — only 100 sq. ft. is within the Buffer Zone) on sono -tube supports. The deck is approximately 95 feet from the edge of Bordering Vegetated Wedand (BVW) as shown on the herein referenced plan. During the May 13, 2015 public meeting, the NACC voted unanimously to approve this project. All work shall. conform to the following: RECORD DOCUMENTS: SmaH Project Filing Including: Application Checklist, narrative, sketch plan and MIMAP aerial image. Filing received: 4/29/15. 'fhe following conditions are hereby mandated: CONDITIONS: 1. Prior to the start of construction the applicant shall ensure that the site contractor has reviewed the small project permit and is aware of the wedand resource area and the limits of the proposed work. 2. No erosion controls are necessary. 3. Excess construction material shO be properly disposed of offsite and accepted engineering and construction standards and procedures shall be foRowed in the completion of the project. 1600 Osgood Street, Building 20, Suite 2-36, North -Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www- http://www.townofnord=dover.com/conservel.htm 4. Upon completion of the approved project and site stabilization, please contact the Conservation Department for a final inspection. 5. This permit shall Mite six months from the date of issuance. Should you have any question or comments -regarding the contents of this letter, please do not hesitate to contact the undersigned at 978.688.9530 at your earliest convenience. Thanking you in advance for your anticipated cooperationwith this matter. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT Heidi Gaffney Conservation Field Inspector 1600 Osgood Street�, Bw1ding 20, Sutte 2-36, North -Andovex� M2552ChWettS 018473 Phone 9778.688.9530 Fax 978.688-9542 Web www- httF//vvw-tomnofnordumdo"x-com/conservel-htm The Commonwealth ofMassachusetts Department ofIndustrialAccidents Office of Investigations 0 1 Congress Street, Suite 100 Boston, AM 02114-2017 wwwmass.gov1dia Workers' Compensation Insurance Affidavit: Buflders/Contractors/Electricians/Plumbers Avylicant Information Please Print Le2ibly Name (Business/Organization/Individual): Brico Building and Remodeling LLC Address: 417 Waverly Rd : North Andover, MA 0 1845 Phone #: 978 479 1526 Are you an employer? Check the appropriate box: 1. 1 am a employer with 3 4. E] I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' Wo workers' como. insurance comp. insurance.T required.] El I am a homeowner doing all work myself [No workers' comp. insurance required.] t F1 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' comD. insurance reauired.] Type of project (required): 6. 0 New construction 7. M Remodeling 8. E] Demolition 9. E] Building addition I O.M Electrical repairs or additions 11.[] Plumbing repairs or additions 12.E] Roof repairs 13.171 Other -*Any applicant-thatchwks box #1 must also fill out -the section below showing their workers' compensation policyinformation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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'compensadon insurancefor my employees. Below is thepolicy andjob site information. Insurance Company Name: Traveiers Insurance Policy # or Self -ins. Lic. #: 7pjub4618p5O7 Expiration Date: 402'046 qV 014 Job Site Address:— 2 9 J_�)A L ir City/State/Zip: N.Awt>ovti-t MA 605 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 andpenaldes ofpedury that the informadonprovided above is true and correct. Signature: Date: Phone #: 9784791526 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 CERTIFICATE OF LIABILITY INSURANCE I nPiohr, THS CER7IFICA7E IS ISSUED AS A MATrER OF INFORMATION ONLY AND CONFERS NO RIGAM UPON YHE CER111FICATE HOLDER. THIS CERTIFICA7E DOES NOT AFFIMA71VELY OR NEGATIVELY AMBID, MMND OR AL7ER THE COVERAGE AFFORDED BY THE POLICIES 13ELOW THS CERnRCATE OF INSURANCE DOES NDT CONSTITU71E A CONMACT WMIEEN THE ISSUING INSURE!"), AUrHOFIZED NTA71VE OR PRODUCER, MD THE CERnFICATE HOLDER. IMPMfA—NT-. If the certIficate holder Is an ADDITI&K INSURED, ft pollcypes) must be endorsed. If SUBROGAMON IS WANEI), subject to ft forms and cmd1dons of the pollcy. certain policies nay require an endorserneft A stalement on #ds certflicate does not cooler ri&b Io Ihe cerllftsts holder in lieu of such endorsemeril(q). PRODUCER Michaud Insurance 105 Haverhill St Methuen, MA 01844 MICT T Lawler PHONE (978) 685-25 9 —.0-":(978) 794-0822 A trudylawlor@aichaudi"urance.com 2=1 AM Ulm RMSEW)AFFORDING COVERAGE NAIC 9 INSUPARA:Northland Insurance y PSURED BRICO Building & Rsuodeling LL Ads- J Brien 417 Waverley Rd N Andover, MA 01845 INSURER 8 INSURER C INSURER 0: INSURERE: INSURER F: wvtmms GEWFIFICATIE NUNIBER. RFMON UHNMPR- THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVM49TAND14G ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INWWr-E AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT To ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOV*4 MAY HAVE BEEN REDUCED BY PAID CLANS INSR LTR TYPE OF INSURANCE AML J= SUOR VAOD Poucr WNBER i2va 2=1 AM Ulm A GENERAL LIABILITY y W8201172 4/13/15 4/13/16 EACH OCCURRENCE 5 11000,000 CO X OMMERCIALGENERALLIASILITY CLAW -MADE F—x1OOCUR OAMAGETOf�D � Ea apmgmrA $ 100,000 ME D EXP (Any ore paim) S 5,000 PERSONAL&ADVINJURY 11;- 11000,000 GENERAL GREGATE 5 2,000,000 GEN'L AGGREGATE LUT APPLIES PER 7 POLICY F-1 79 E-1 LOC PRODUCTS - cowiop AGG 6 2,000,000 AUTONOBU UAW" BODILY INJURY (Per peawn) S ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per madent) $ NON-OVMED HIREDAUTOS AUTOS OPE P.1 GE .=DAIIA UMBIIEUA I" OCCU EACHOCCURRENCE EKCESS LL48 CLAIMS-MOE, AGGREGATE $ DED RETENTION INORKEFA COMNSATION AND EMPLOYERS' LIAB11JTY YIN ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERAIEMBER DICLUDED? 7 VIC STATU- TORY I IMI'm FR E.L. EACH ACC113EW $ E L. DISEASE - EA EMPLOY9q (1111andeftq In KH) �dembo under MRIPTION OF OPERATIONS below E.L. DISEASE - YLIMIT CESMF"ONOFOPBWMSILOCATMMIVENCLES (Aftch ACORD 101, Aftdonal Rmmdm Schedule. 11awre space breqdred) Rob Barter 242 Dale St North Andover, SHOULD ANY OF 7HE ABOVE DE SCRIBED POLICES BE CANCELLE D BEFORE THE EXPIRATIION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WnH YHE POLICY PROVISIONS. Mh 01845 1 AUTICIRIZED REFRESENTAWE 0 IM -MO ACI ACORD 25 (2010105) The AC ORD nano and logo are registered marks of ACORD reserved. CERTIFICATE OF LIABILITY INSURANCE lo'"ICA-TE 18 ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS RI C CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE PRODUC 0 THE CERTIFICATE HO DER. I IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollay(les) must be endorsed. " SUBROGATION IS WAIVED, subject to the IV M P eirms and conditions of the policy, certain policies may require and endorsement A statement on this certificate does not confer rights to the cart Certificate holder In lieu of such endorsernent[s� PRODUCER P CONTACT NAME: PHONE FAX NANCY GREENWOOD SMITH I I HAVERHILL ST (M No, Ext): (AIC, No): MEMUEN, MA 01844 E-MAIL ADDRESS: 726KN INSURER(S) AFFORDING COVERAGE NAIC I INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA BRICO BUILDING & REMODELING LLC INSURER B: INSURER C: 417 WAVERLEY RD N ANDOVER, MA 01845 INSURER 0: IINSURER INSURER E: F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: HE POLICIE$ OF IN OW HAVE BEEN ISSUED TO THE IMFIED NAMED ABOVE FOR TINE POLICY PERIM INDICATED. NOTIMITHSTAND04 MY REOUIREMENT, TERM ON CONDITION OF MY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAYBE I= ORMAYpEIrrAKyHEINSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 6 SUBJECT TO ALL T14E TERMS, EXCILUSIONS AM CONDITIONS OF SUCH POLICUML Luffs SHOWN MAY HAVE BEEN REDUCED By PAR) CLAIMS. LTR TYPE OF INSURANCE ADD L SUB 8 POLICY NUMBER POLICY EFF DATE (LWMYYM POLICY EW DATE 1MI1MMYYM LIMITS GENERAL LIABIIUTY CO, COMMERCIAL GENERAL LIABILITY CH 0 C HOCCURRENCE $ 'MAGI AMAGE TO RENTED $ IS REMISES (Ea occurrewo) rRODUCTS CLAIMS MADE OCCUR. r I ED EXP (Any one person) $ So ERSONAL & ADV INJURY $ GEHL AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY F-1 PROJECT LOC 0 LX - COMP/OP AGG S AUTOMOBILE UABILITY ANY AUTO COMBINEDSINGLE $ LIMIT (Ea accidett) ALL OWNED AUTOS BODILY INJURY $ SCHEDULEAUTOS (per penton) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accklert) PROPERTYDAMAGE H(Per accidwrt) UMBRELLA LIAB []OCCUR EACH OCCURRENCE $ EXCESS LIAB L_JCLAIMS-MADE AGGREGATE $ I DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AM EMPLOYER'S LIABILITY YM US-4618PS07-14 041119/2014 0411WMIS X . f;W;CSTATUTOfl LIMITS RY LIMITS OTHER ANY PROPERITOPJPARTNERIEXECUTIVE OFFICERMEMBER EXCLUDED? NIA E. L EACH ACCIDENT $ 100.000 (Movdalary In NH) it yes, describe under E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT S 500,000 DESCRIPTION OF OPERATONS belcrw DESCRIPTION OF OPERATIONSILOCAIIONSIVENICLE&qEgTR=ONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CER11FICAIM ISSUED TO THE CER7MCATE HOLDER AFFECTING WORKERS COMP COVERAGE JOB SITE: KANES DOUGHNUTS 10 OLIVER ST BOSTON MA CERTIFICATE HOLDER CANCELLATION ROB BARTER SHOULD ANY OF THE A13OVE DESCRIBED POUCIES BE CANCELLED 242 DALE ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESEKO�E . .... IV=-ZUTU AIXML) GORPORA1110M All fights reserved- Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 168512 Type: LLC Expiration: 3/1/2017 Tr# 262883 BRICO BUILDING AND REMODELING LLC.� - ADAM BRIEN 417 WAVERLY RD NORTH ANDOVER, MA 01845 Update Address and return card. Mark reason for change. SCA I Ca 20M-05/11 Address [:] Renewal [] Employment E] Lost Card Office of Consumer Affairs & Business Regulation OME IMPROVEMENT CONTRACTOR egistration: � .168512 Type: Expiration: 3/1/2017: LLC BRICO BUILDING AND REMODELING LLC ADAM BRIEN 417 WAVERLY RD — NORTH ANDOVER, MA 01845 Undersecretary Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -104428 ADAM J BRIEN 417 WAIMRLy j(DAD 1,D of U7 North Andover WA Ilk Expiration Commissioner 0511212016 License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature