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HomeMy WebLinkAboutBuilding Permit #165-14 - 255 FOREST STREET 8/20/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �J 1 Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION ,_ Y10y Print PROPERTY OWNER �v - Print lob Year Old Structure yes no MAP NO" PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alt ration No. of units: ❑ Commercial epair, replacement RewC- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION F W RK 7 BE PERFORMED: ��Ul�r'/1�► � r?�' �' r �1/ fT f'1'( r 1 �eJE%ntification Please Type or Print Clearly) OWNER: Name: f= t3 naw Phone: �� -��) �o��x� Address: � CONTRACTOR Name: ��/In /' ��S C Phone: Address: Fa r UC fI,/Acle, (:4 ,-to,* Supervisor's Construction License: C S " Exp. Date: / L Home Improvement License: q q) y ( Exp. Date: ( �3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $� I�if� FEE: $f(dq X Z :f Check No.: f Receipt No.: NOTE: Persons contractin' unregistered cont ctors do not have access to the guaranty fund Signatureof Agent/Owner Signature of contractor Plans Submitted ❑ I ns Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location No. Date '010 • - TOWN OF NORTH ANDOVER • six . ti Certificate of Occupancy,, Building/Frame Permit Fee Foundation Permit Fee d $ Other Permit Fee $ TOTAL Check 46-1&� 4Ul Building Inspector I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE:OFSEWERAGE DISPOSAL I Public Sewer ❑ Tanning/Massage/BodyArt ❑. . Swimming Pools 0 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS .CONSERVATION Reviewed on Signature f R COMMENTS HEALTH Reviewed on Signature fa i COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow;2 Engineer: Signature: � Located 384 Osgood Street FIRE DEPARTMENT -Temp Dunipster on site yes no Located at 124 Mair, Street Fire Departmeritsignature/date COMMENTS I Dimension Number of Stories: Totals square feet of floor area based on Exterior dimensio �— q ns._ �ESO l.S/- 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 i NOTES and DATA- (For department use E3 Notified for pickup - Date Doc.Building Permit Revised 2010 i Building Department The foE'o. wing is-:a list of the required forms to be filled out for the appropriate permit to be obtained. Roofiv,g, Siding, Interior Rehabilitation Permits o Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit , Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o 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) o Copy of Contract ❑ Mass check Energy Compliance Report L, Engineering Affidavits for Engineered products All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit NOTE. q 9 p p 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 apw al 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: Doc.Bui)ding Permit Revised 2012 y � _O Y Et ! Custom Fabricated Sheet Metal FABRICATION / I.NSLUI.ATION OFFICE/978-663-2563 FAX /978-663-2564 Date: July 22, 2013 Customer: Jeff& Libby Re: Roofing Proposal Project: Forrest St. job #: 081617 N. Andover, MA We propose to provide and install metal roofing to the above- mentioned project according to the following scope of work. • Fabrication and installation of new Standing Seam Panel roof system. • Remove and properly dispose of exiting 2 layers of shingles. • Furnish and install the following: 1. High Temperature ice and water shield to all eaves. 2. Roof Top guard metal underlayment to the rest of roof area. 3. Drip edge to all eaves. 4. C-channel to the ridge and wall tie-ins. 5. Ridge cap to all ridge areas. i 6. Roof to wall flashings to all wall tie-ins. 7. 1 %z" Snap Lock Panels to entire roof area. 8. New metal to chimney to match color of roof. 9. White K-style gutter over 2 doors. 10.5-5 Color Guard Snow Rail over gutters. • Panel width to be 16" wide. • Properly flash all areas to ensure water tight situation. • Twin Metals Inc. workmanship to be warranted for a period of 5 years. • Twin Metals Inc. is a Massachusetts licensed sheet metal company. • Panel finish to be warranted by the manufacture for a period of 35 years. • All material to be used in 24ga steel. Drexel DARK Bronze. We propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum of: BASE BID: THIRTEEN THOUSAND SIX HUNDRED EIGHTY DOLLARS $13,680.00 y Payments to be made as follows: 33% ($4,560.00) due upon singing contract and 66% ($9,120.00) due upon completion. All legal and or collection fees will be paid by the binding holder of this contract. Authorized signature: Jim Gordon, Owner Note: We may withdraw this proposal if not accepted within (30) days. Acceptance of proposal — the above prices, specifications��nd conditions are satisfactory and are hereby accepted. Twin Metals is authotized to do the work as specified. Payments will be made as outlined above.,"ThiVproposal will become part of the contract unless stricken by the owner. Date: Signatu e � NORTF� Town of s E ,� Andover U� h , ver, Mass, 0 • 13 coc Nlc"IWICK x.95 R�reo �P���S U BOARD OF HEALTH Food/Kitchen PERM !j T LD Septic System THIS CERTIFIES THATZ.. WQ ...... BUILDING INSPECTOR has permission to erect .......................... buildings on .....at.Ir......... . . ... . . wor.......... ....!!`..... Foundation jo Rough to be occupied as ....... ...................... Chimney .. ...........'. ......... .. ............ .... .... i provided that the person accepting this permit shall in every respect conform to the rms 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 Io PERMIT EXPIRES IN ONTHS ELECTRICAL INSPECTOR b UNLESS CONSTRU S S 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. SEE REVERSE SIDE NORTH Town of ? EAndover O - 0 49 iA�, h , ver, Mass, g' • ao • 13 COC MIC.2WICK y1. �.9s R�►rEo �,P�`�,�5 U BOARD OF HEALTH PERM%Q!I T Food/Kitchen Septic System THIS CERTIFIES THAT ................ BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ......� ......... .. . ........ ...... '!:.... Rough to be occupied as ....... . .. . ............ .......... ..... .�.. ...................... chimney provided that the person accepting this permit shall in every respect conform to therms 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 Io PERMIT EXPIRES IN ONTHS ELECTRICAL INSPECTOR b -� UNLESS CONSTRU S S 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. SEE REVERSE SIDE The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations quo 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: B_ uilders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): 110(VL fi)C T C Address: 0p ; r If>Z"(✓� aQ U City/State/Zip: R;11M1-(A Af O/JO Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with I S? 4. ❑ I am a general contractor and I 6. ❑New construction ( art-time) employees full and/or .* have hired the sub-contractors p � 7. E]Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12. oof repairs insurance required.]t employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 1 Homeowners who submit this affidavit indicating they aie 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name:. Y141C --v ilU C6 Policy#or Self-ins.Lic.#: L AQ c 0 0 Expiration Date: 3 d� Job Site Address: SS (LC S I S City/State/Zip: �• � �U � M Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 DIP,for insurance coverage verification. I do hereby certify under the�painssaa enalties of perjury that the information provided ab, ve is tr a and correct Si mature: �� �- 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 j oint 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 for 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 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth,of Massachvsetts Department of Industrial Accidents Office of InVestigatlons 600 Washington Street Boston,M.A.02111 Tel,#617-727-4900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fax#617-727-7749 wWW.Masa,gov/dia �ovemem.t S e LOM�ae This satisfies all basic requirements of the skate's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. SeeI�;Iegal advice if necessary. Any person planning home improvements should first obtain a copy standard Massachusetts Consumer Guide tO Home Improvement"before agreeing to any woxlc on your residence,You may obtain.s free copy by calling the Office of Consumer Affairs and Business 12,egulation's ConsumerInformation Hotline at 617-973-8787 or 1-888-283-3757 or on ourwebsite. ' E10IIleowner Inform diol Contraclol'][=rmatioll Name . 1 Comp-( StreetAddress o notuse aPost Oil<ce Box address �7/l 2 ) Contractor/Salesperson/Owner Name City/TownState Zip Code C BpsAL iness AddressPu st include.a street ad1ddress) / (�Dayt,trtePhone i t(Z�C)4" 0 0 I U 4 o2 // �,/ Evenin�;Phonet� . 6y �' 6 ( �6 al�d `00 e��L��G� tate Zip Code Mailing Address(It different from above) 43^ �� Business Phone federal>rmpIoyer ID orS.S.Number HomelmpmvamentT=C0nt;mct0rXLeZ-Vumber kkpiratiandate • X.nw rcgttires that mostitome improvcmentcontractorsitave nvalid registrationmtmher � � Z/ A The Contractor agrees to do the following work for the$omeowner: 11 - C S (Describe in detail the worlcto completed,speifyingthe type,brand,and grade of materials tobe used,use additional sheets ifnecessa /I S f 4 A V V1, c S-e A O-A 9W�' • . SEC �9- 'flFl �f•, r�/ �0�/1 t��� Required Permits-The following building permits are required Proposed Start and Completion Schedule-The followin and will be secured by the.contractor as-the homeowner's agent: be adhered to unless circumstances ghedule will (Owners who secure their own permits SVM be beyond the contractor' control schedule excluded from the Guaranty Fund provisions of MGL chapter 142A.) U Date when contractor will begin contracted work. Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to pezformthe work,furnish the material and labor specMed above for the total sum o£ Payments will be made according to the following schedule: $ 60.G o 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 ofy k4 ia A-r•T $ --by / / or upon completion of upon completion Of the contract. (Law forbids demanding full payment. g ymentuntit contractis completed to both party's satisfaction) . The following material/equipment must be special $ ordered before the contracted work begins in order to be paid for to meet the completion schedule.(.r•n) S to be paid for 11T®TES:(:i)Including all finance charges . g ('r.:r.)Law requires that any deposit or down- not exceed the greater of(a)one-third of the total contract price or(b)the actual cost ment re quire f any special tegaipile c r before stolcbegins may which must be special ordered in advande to meet the completion schedule. yquipment or custom made material ress Warran -Xs an e: ress w,mrint bein rovided b the contractor? Subcontractors-The contractor agrees t•be solelyresponsible for completion of h work described regardless ofmttst be attached t•the contract party/subcontractor utilized by the contractor. The contractor Curllier agrees to be solely responsible for all payments to act subcontractorsns ofafor ateriais and laborimder this a Bement Contract Acceptance-Upon signing,this document becomes abinding contract under law. Unless otherwise noted within,tbis do contract shall not implythat any lien or other security interest has been placed on the residence. Review the following cautions cument,the and notices carefully before signing this contract. C Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. 0 1 ub ce surae the contractor has a valid$ome Tm rovement Contractor Registration, The law requires most home improvement contractors and subcontractors to IMI with the D>xector of ome Improvement Contractor Registration. You may inquire about contractor registration by writing to the at 10 ParkPlaza,Room 51.70,Boston,MA.02116 or by ealling.617-973-8787 or 888-283-3757. o 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. 1�n ow your rights and responsibilities. Read the Important Information on the reverse side of this forty.and Guide to the Home Improvement Contractor Law: get a copy of the Consumer YOum c elthis agreement.if it has been signed at aplace other than the contractor's normal Lace ofbusines contr for' ting at his/her*r+ain office or branch office b ordin p s,provided you notify the •thin using s day following the signing y ary mail posted,by telegram sent or by delivery,not latter than midnight of the going ofthis agreement. seethe attached notice of cancellation form for an explanation ofthis right ®Npies of ZGN 7C'7fb CONTRACT IF TI-ERE ARE Two identical copies of the contractmust be completed and signed. One c ANY BLANK S-PAC �'S i i r opy should go to tIte homeowner. The other copy nhotildbe kept the contractor, I3 co ne 's Signature Contractor's Signa e ate C) / Date Co niracio:r Arbitration The Hoare Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)ifthey have a dispute with a contractor. The same right.is not automatically affordedto 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 ht to arbitration as is afforded to the homeowner by the Home improvement Contractor Law. saline rig The ontrac rand the homeowner hereby mutually agree in advance that in the event the contractor has a dispute co eerniug is contract;the contractor may submit the dispute to a private arbitration 171=which has been approved by t Secret' of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to su 't t such arbitration as.provided In Massachusetts Greneral Laws', chapter 142A.. me er s Signature Contractor`s Signature 0 CE:The signatures of the pares above apply only-to the agreement of the patties to alternative dispute es u aon initiated by the contractor: The homeowner may initiate alternative dispute resolution even where section is not separately signed by the parties. ere this 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 maybe exchtded from certain rights if thcontractor they choose is not properly registered as prescribed bylaw. Homeowners who secure their own building permits are automatically excluded'Crom all Gutaranty Fund provisions of the Home Improvement Contractor-Law. The contractor is responsible for completing the work as described,in a timely and worlcmanlilte manner. HomeMmers 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 entimeration 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 Consu7m er Information Hotline(listed below). Execution of Contract The contract must be executed in cl' icate and should not be signed until a copy of all exhibits and referenced documents have been attached. PazUes are.also advised not to sign the document until all blank sections have been tilled 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 parries. Contracted work may not begin until both parties have received a fally executed copy of the contract,and the three day rescission period has expired. Accelerated Paymelats • I 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 insectii e. 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 j oint escrow account as a prerequisite to continuing the contracted wozlt. Withdrawal of Rinds:E:om said-account would require the signatures of both parties. :kdditional Information ,If you have general questions or need additional information about the Horne 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 I&ormationHotline Office of Consiuner Affairs and Business Regulation 10 Pa&Plaza,Roam 5170,Baston,MA 02116 617-973-8787,' 888-283-3757 oz'visitthe OCABRwebsite at11ti1:)://vAVwmass Dov/ocabx/ if you want to verify the registration of a contractor or if you have questions or need additional information specTacally 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 lb ,Room 5170,Boston16 617-973-8787, 888-283-3757 oravisit the 1-UC website, atU 02%www.r nass.dov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: 11tti1://db.state.ma nG/�ZOYaeimuroveinealt/licetlseelist asb For assistance with informal mediation of disputes or to register:Copal complaints against a business calx: C0nsumex Complaint Section Office of the Attoiney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,50&755-2548 or 413-734-3 i h4 Version 2.1-11 L7.9.19 n 1 n 4/15/2013 11:44 AM FROM: North Andover INS,M.J. .foster Insurance Services, Inc. PAGE: 001 OF 001 AC®O CERTIFICATE OF LIABILITY INSURANCEDATE °&SDWY" �....�'' 04/12/2013 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. It 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 eONTACT RAMS: NORTH ANDOVER INSURANCE AGENCY, INC. PN� No. E (978) 686-2266 (IA"1 Na:(918) 686-6410 M.J. FOSTER INSURANCE SERVICES ADdIiac cfernandez@nafins.com FRODUCFA 163 MAIN STREET CUSTOMER o rTWIN METALS INC NORTH ANDOVER MA 01845-21508 INSURER(S)AFFORDING COVERAGE NAIL f INEVAED INSURER A :HMOVER INSURANCE CO 22292 TWIN METALS,-INC. INSURER B -XERCHANTS INSURANCE GROUP 86 BI-LLERICA AVENUE INSURER'C :STAR INSURANCE COMPANY SUITE 6 IHstim D ASSOCIATED nM INSURANCE CO INSURER E NORTH BILLERICA MA 101862— 1 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 4NSURED 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 SEEN ftEDUCEO BY PAID CLAIMS. LTR TYPE OF INSURANCE HER WYD POLICY NUA�'ER M%wwiYYY) "AublY POLICY EFF J Ex LiHETE A OENERAL LIABILITY y y I R94eS0163 1/19/2013 1/49/2014 EACH OCCURRENCE Is 1,000,000 :POLICY MERCIAL GENERAL LIABILITY / / ! / PREMISES E oaune $ 300,000 CLAIMS-MADE DOCCUR MMEWJAnyoneperson) $ 5,000 PERSONAL 8 ADV INJIRY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GREGATELBAI'APPLIESPER PRODUCTS-COMP/OPAGG $ 2,000,000 F—I T0' �LOC j ! / I. / / $ B AVTOM013U LaDI.ITY y y TCA701.SI14 S/21/2012 S/21/2013 COMBINED SINGLE LIMIT $ 1,ow,000 ANY AUTO / / / / (EB axxleN) ALL OVvNEO AUTOS BODILY WJJRY(Per person) I$ I X SCHEDULED AUTOS BODILY BNJJRY(Per acadenq $ PROPERTY DAMAGE rxx— HIRED AUTOS (Peracaeerd) $ NON•OV.NED AUTOS D T ELLA UAB X OCCUR y Y trBW43e3713 3/14/2013 3/14/2014 EACH OCCURRENCE S 5,000,000 " Lab CWMS-MADE .AGGREGATE $ 5,000,000 CTIBLENTION S 10,000 C tvoRNERs eoNwENBATAIN y C07207T7 3/24/2013 3/24/2014 Y,CST:ATU- OTH AND 1W YERS' LIABILITY YIN X I FR ANY PR0WEI0:BFANTNHbfl(EWf1VE / / / / EL EACH ACCIDENT S 1,000,000 OFNCERNEMBER excwi)Eff O NIA (Mandatory In NH) / / / / E.L.DISEASE-EA EMPLOYEE 1,000,000 II yes.Oesmbe Lncer I DESCRIPTION OF OPERATIONS below / ! / / E.L.DISEASE-POLY LIMIT $ 'A00,000 A RENTED/LEASED EQUIPMENT 0eB4B50163 1/19/2013 01/19/2014 LIMIT OF 6NSURANCE 120,000 FROM OTHERS / / / / I DEDUCTIBLE 1,000 DEBCRIPT W OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Ad86aw Reauks 130"Aa, d Mm Spada Is r.TA dl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TWIN MMS,INC. 86 BILLERICA AVENUE AUTHORMD REPRESENTATIVE SUITE 6 NORTH B=ERICA MA 01862- ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(20090y) The ACORD name and logo are registered marks of ACORD d� � � o o � � , d ► d o 3goarb of Regiotraction of *beet l eta t Vorkero 30abiug sattofteb the requirements of ;ftla0garbuOettz Ocnerar RaW Cbapter 112, bertion 237 tbrougb 251 4 igereb ' � p grauteb tfjt!g rerttfttate no. 295 a6 ebfbettce to prarttce az a *beet etc wqtneg;,q on tbi5s 22n1 bap of fKarrb 2011 In Teottmoup if ,ereof, io bereuuto afftxeb the name of the (Executibe Mirector of the 39oarb fterutibe director Mate COMMONWEALTH OF MASSACHUSETTS SHEET METALWORKERS AS A MASTER—UNRESTRICTED ISSUES THE ABOVE LICENSE TO: I' JAMES R GORDON s„ TWIN METALS INC 86' BILLERICA AVE $ UNIT :6 BILLER`LCA MA 01862- 1266' f 6397 07/28/14 196675 Fold,Then Detach Along All Perforations �� �G'onvnzozueal��a��'/��ra�aclii�.tls Oftice or Consumer A ffa I rs&]Business Regulation ME IMPROVEMENT CONTRACTOR txe;! istration: 174281ration: 1!23%2015TYPe: Corporation TWIN METALS,INC. THOMAS GORDON ' 154 NEWI3URY ST. DRACUT,MA 01826 Undersecretary Massachusetts Department of public Safety Stan oa:rd of Building Regulations and dards B V. Construction$uper�'isor a License:CS-09-%53 TMOTM R MO AN 56 ROGERS STREET.f _�� I 8U,jVTCA MA-01862 :j � b��f �.�.�.•�- " 09/2812014 Commissioner i i I I I i