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HomeMy WebLinkAboutBuilding Permit #688-2016 - 267 MASSACHUSETTS AVENUE 12/4/2015NORTM BUILDING PERMIT O�tg1 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION * M C %r� �0Q. PermitNo#: Date Received RATED. m" 'ePy�9 gSSACHus�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �1�5_ PROPERTY OWNER V 1h no int 100 Year Structure yes no MAP_PARCEL:5 ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes .. no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Industrial El Addition El Two or more family El Alteration No. of units: ❑Commercial ❑ Others: -Repair, replacement ❑ Assessory Bldg Demolition ❑ Other s ❑ ;Septic, ❑ 1Nell; 04FIo'odplarn Wetlan'tls, 4 0 C1Nate shedlrD:istrwl ' a 01Natel,/Sewer_ I IVw yr vvvr%rx iv v� ���� ■���• do Identification - Please Type or Print Clearly OWNER: Name: Address: Contractor JName: l Email: .(C 3,e -,z- none: 19 Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Ix 7 p. Date: /U ARCHITECT/ENGINEER A91 -e__ 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: $ ��� FEE: $ 166— Check 66—Check No.: 1 Receipt No.: 2_q -11 A - NOTE: Persons contracting with unregistered contractors do not have access ��heaiyund 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 TOTE: 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 -6 Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ SwiDaming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature. COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature c Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes a Planning Board Decision: Comments Conservation Decision: Comme Water & Sewer Connection/Signature & Date Driveway Permit DPW Town ]Engineer: Signature: ...� < EP4ARTIVIE fT t � Located Osgood Street FIRE�De cps „ - s on, si e esus 4 ; Located at' 1624 Main Street ��.�"�Y.'r�. 3 �{ .� z-+#�.. Jta . ��ta � ,`� y � a a � . r = vs, a , :1• �,F'ire �Departmen�sign re/dafe�.� ���. '� Y�4'�� �. ?. atU w ..s..,, �-s..t�:.t..s. �-.�..'ftii�.i4,�: �.+ti... �_.Aiw^: � .. • . �'.:' k .� �a 4 .'� .� :�'Y4Y r� i - } n °` �,x '.•n.,4�'�� `"�i`G";wY°`.»�a-.-d.....�.� �1,; .� � A a.4G7 � `U � `{^ f. t. yS .r � 'x ,r•, gt Yu`�r'"+T '1 S + ' � J C011/IMEN+.�..1` ..�.,._d,, �,. „ ._._.*`�'..�...,,..�,r.•�._�,� -t�^ �ir-`�...�F:"..', t t.�;N �' �', a �f' >: Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ff.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE. Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine Doc.Building Permit Revised 2014 Location 24491 1 1 �� C SP L/ No. " 2-61 Date Check # � -3-11 29774 TOWN OF NORTH ANDOVER Certificate of Occupancy $ A Building/Frame Permit Fee shK—. Foundation Permit Fee $ Other Permit Fee $ , TOTAL $ Building Inspector A O n' 0 N CD CD CD9 U) CD U) O O CD a O CD �3 C Z� m C: 0 X Z � 'O cnm cn z 0 0� Z C Z Z N 'a e o=-° 0 _ r0 Mo = < CD. .a v, •�-I O• c$D C CD n r0 CL C.) rt C Z p' O' S .0. y _I °, O. TI o� O -CL m (D 00 v°1) p N O. CD `) CD 2 ° CL su @ @ D v � O � CQ. y CL rt O O 3 CD CD _ CD ,o Q 2 co N: ; °moi �► Z o, v. o D =r cn N O 0 O. 96 cv 0 0 °v- _. U) N CD� 300 • CL CD CD `° U) J. ID U) rt U) S O 5.O . � co t=r r+ CD yCD O N DC D O O. O � Q N X, rD 0 O rr N - (D z O co C O 7o c M zr T N A W S G) N '° z to T N (D n A OOa S r, m D r 00 T �. A OOQ S r C °° z +n 0 T d n 7 rD A m S T Q O O W C v 'a m 0 N "06 n N ((D 3 T 0. \ —� . W M v O m x �i \ 4 William McKay Construction 18 Academy Avenue Bradford, MA 01835 Phone: (978) 361-6402 Email: wmc3cons@msn.com Find us on Facebook! PROPOSAL 12/3/15 Project name: John Gaffney 267 Mass Ave North Andover, MA 01845 Scope of Work: • Provide permit. ANNiv %i" Niywuuu uve► di,spesros shingles on s existing dormas. • Peel back existing shingles around 3 existing dormas. • Apply ice and water sheid on roof and sidewalls of existing dormas. • Patch roof shingles removed to properly flash dormas. Shingles may not match exactly. • Apply metal trim around existing windows. • Apply new siding on dormas. "-,Disposal will be done daily to a dumpster provided by the WMC. WMC work will be completed in a timely and clean manner and in observance of OSHA regulations.' GRAND TOTAL: $ 8,965.00 **A deposit of 50% of $4,482.50 is due prior to the start of work.** w mcuav rnnc+rvvp+Qn» ii r a` WILLIAM MCKAY CONSTR UcTION LLC. 18 Academy Ave Haverhill, MA 01835 # 978-361-6402 I KUUrION CONTRACT This Construction Contract (hereinafter the "Contract") is hereby made on 12/3/15 by and between John Gaffney (hereinafter "Client") and W McKay Construction LLC of 18 Academy Aven� �?; Haverhill, MA 01835 (hereinafter "Contractor") collectively referred to herein as the "Parties". ARTICLE 1 A. Contractor shall provide the following Construction Services (the "Project"), as agreed to in a signed Proposal related to said scope. B. Client engages Contractor and Contractor agrees to provide to Client all necessary service , materials, and labor necessary for the completion of the Project including, but not limited to , all building and construction materials outlined in the signed scope. Material estimate and all necessary tools and machinery needed for Project completion. All construction materials should be new and of the highest quality, unless previously specified by the Client. C. Contractor shall provide the construction services for the Project at the property located at 267 Mass Ave., North Andover, MA 01845. D. The Contract shall be comprised of the following: this Construction Contract, Plans, Specifications, Addenda, Drawings, Photos, Proposal, materials estimate if applicable all signed and witnessed, all of which are attached hereto and are a part of this Contract as exhibits. ARTICLE II A. Contractor will be scheduled once deposit is received. B. In the event that Client and Contractor agree on changes to the Project after this Contract is executed, the Parties will agree to new time deadlines that are reasonable in light of the modifications and that schedule change will be signed and witnessed and become a part of this Contract. A. !n consideration of the performance of this Contract, Client agrees to pay Contractor the sum of $ 8,965.00 (the "Contract Price") on the following payment schedule for the services. Contractor shall receive a 50% deposit of $ 4,482.50 before the start of the Project to be used for initial material purchases, etc.. Thereafter, a final payment of the balance shall be made of the Contractor's services at the completion. B. After receiving notification by Contractor of each stage of completion, Client or its designee will inspect and approve the work or request any necessary adjustments to same. Client agrees to make payments to Contractor after approving work. Payment shall only be adjusted upon the mutual consent of both Parties if due to unseen events or the parameters of the work are expended materially beyond the terms of the Contract. This Contract and associated fees will be modified accordingly in the form of Extra Work Orders which once signed and witnessed to shall become a part of this Contract. ARTICLE 116 A. All changes or modifications to the work ordered by Client must be made in writing, with appropriate adjustments made to total payment and payment schedule. The approval of both Parties shall be required in the form of an Extra Work Order for substantial Project changes as these changes will effect date of completion, Project price, and notifications of these changes must be made in a timely manner. B. If these changes should require additional expense to Contractor, Contractor must make a claim for increase in payment, in writing to Client in a timely manner. Client must approve this claim for increase in writing prior to any changes to the work, Project or schedule. All such documents relating to changes to this Project must be signed and witnessed to and will become a part of this Contract. ARTICLE V A. If Contractor is delayed from completing required work due too unavoidable casualties, Client shall grant Contractor an extension for the completion of work equal to the delay. Unavoidable casualties include, but are not limited to, fire, Hood or natural disasters, delayed acquisition of materials or material delivery, and negligence or non- payment on the part of the Client. _ IIF the event of unavoidable casualties; Contractor shall properly document both the event and the impact of the event on Project completion. Documentation shall be presented to Client in a timely manner. ARTICLE VI A. If Contractor fails to correct defective work or persistently fails to supply materials or equipment in accordance with the Contract documents, Client may order Contractor to stop the work or any portion thereof, until the cause for such order has been eliminated. ARTICLE VII A. Free access to the work and the Project site shall be granted by Contractor to Client, the designated agents of the Client, and all necessa ;, blic authorities. B. Contractor agrees to keep the premises clean and orderly. Contractor shall remove all debris as needed during the hours of work in order to maintain work conditions free of health or safety hazards. ARTICLE VII A. Contractor shall conduct its activities in a professional manner and adhere to reasonable wishes of Client in relation to its working schedule. Additionally, Contractor's work shall adhere to and be in compliance with both the Standard Practices of the Trades and any relevant Manufacturers Specifications. B. Contractor shall protect all work adjacent to the Project site from any damage resulting from the work of Contractor and shall repair or replace any damaged work at its own expenses. Contractor shall take all precautions to protect persons from injury and unnecessary interference or inconvenience. ARTICLE IX A. Client agrees to hold harmless, indemnify and defend Contractor and each individual or entity that is an agent, affiliate, partner, officer, or stockholder of same against any and all claims, losses, liabilities, damages, and expenses, including legal fees, fines, judgments, settlement amounts all made in connection with , or arising from errors in any representation or warranty made by Client under this Contract, any breach of the Contract by Client, or any omission or negligent act or error by Client in connection with this Contract, provided by such negligent act, omission, or error was not done at the direction of Contractor. B. Contractor agrees to hold harmless, indemnify and defend Client and each individual or entity that is an agent, affiliate, partner, officer, or stockholder of same against any and all claims, losses, liabilities, damages, and expenses, including legal fees, fines, judgments, settlement amounts all made in connection with , or arising from errors in any representation or warranty made by Contractor under this Contract, any breach of the Contract by Contractor, or any omission or negligent act or error by Contractor in connection with this Contract, provided by such negligent act, omission, or error was not done at the direction of Client. ARTICLE X A. Contractor is responsible for insurance to protect against any property damage, bodily injury, death, or other claims for damages that may result from the commission of the work, including general liability insurance and workers compensation insurance for its employees and/or subcontractors. Contactor will supply Client with said Certificates of Insurance before the Project begins. B. COVERAGES: (Apply only to actual work performed as set forth in contract) 1. Structure: For a period of one year after the date of completion, the floors, ceilings, walls and other internal structural components of the dwelling, which are not covered by other parts of this Limited Warranty, will be free of substantial defects in materials or workmanshiN. 2. Systems: For a period of one year after the date of possession, the plumbing, heating and electric wiring systems will be free of substantial defects in materials or workmanship. 3. Roof: For a period of one (1) year after the date of roof installation, the roof will be free of leaks caused by defects .in materials or workmanship, but not those caused by ice back-up. C- E!$CLUSIONS FROM COVERAGE: We specifically do not assume responsibility for any of the following items, each of which is specifically excluded from this Limited Warranty: 1. De-fects in appliances or pieces of equipment which are covered by manufacturer's warranties including furnace and hot water tank. 2. Damage due to ordinary wear and tear, abusive use, misuse or lack of property maintenance of the dwelling or its component parts or systems. 3. Defects which arp the reSLI!t of nhMranfari�+ino nn.v.ra,nn in .,..-4-~;-I- ,a ' ._• .vwawrJ VVI �� IVI 1 N./ I1 tQlCrl IQ17 useu. 4. D� 6-cts in items installed, supplied or work done by you or anyone other than by us or our subcontractors at our order. 6. Any loss or injury due to ground water. 6. Loss or injury due to elements, including, but not limited to weather and other acts of God. 7. Conditions resulting from condensation on, or expansion/contraction of materials. 8. Your failure to properly care for lawns. S. Consequential or incidental damages. 10. Due to large trucks, equipment, dumpsters, etc., driveway may crack, create divots etc. Also during construction, lawn may be damaged. Contractor is not responsioie Tor the same. ARTICLE XI A. Contractor will be responsible for obtaining all the necessary permits and licenses to tultill the services specified in this Contract. ARTICLE XII A. Contractor is responsible for maintaining proper work, safety and environmental protection standards. Contractor agrees to hold Client harmless for all fines from federal, state or local agencies and regulators. Contractor will work in compliance with all standards required by EPA, OSHA and other applicable federal agencies. Contractor will be responsible for paying all fines and judgments levied by these agencies resultant from the performance of this Contract. ARTICLE XIII A. The relationship created between the Parties shall be limited to that of independent contractors. Neither party shall undertake any actions that would imply or seek to establish, any partnership, ownership, employment, joint venture, or trust relationship between the Parties, except by amendment to this Contract. ARTICLE XIV A. Any dispute or claim related to or arising from this Contract, its performance, breach, interpretation, validity, or enforceability, shall be exclusively(except as provided below) resolved by final binding arbitration before AAA American Arbitration Association utilizing AAA Commercial Arbitration Rules. B. The arbitrator shall be selected using AAA procedures. The arbitrator shall render a written decision within thirty calendar days of the hearing. The arbitrator may award attorneys' fees or punitive, incidental, consequential, treble, or other multiple or exemplary damages. C. Awards shall be final, binding, and non -appealable, with the exception of the grounds for appeal guaranteed by the Federal Arbitration Act and applicable laws. All awards may be filed with one or more courts, state, federal or foreign navong iunsdiction over the party against whom such award is rendered or its property, as a basis of judgment and the issuance of execution of its collection. ARTICLE XV A. Both Parties are expressly prohibited from assigning this Contract or any rights or interest flowing therefrom. Assignment will only occur with the express written consent of both Parties. 8. 1 his Contract contains the entire agreement and understanding between the Parties and supersedes any prior or contemporaneous written or oral Contracts, representations, and warranties between them respecting the subject matter of this Contract. C. This Contract will be interpreted and enforced under the laws of the State of MA, without regard to conflict of laws. IN WITNESS WHEREOF, the Parties hereto execute this Contract: CLIENT W Name and Title CONTRACTOR Authorized Signature Name and Title License # 179265 The Commonwealth of Massachusetts z . Department of IndiustrialAccidents .. . d 1 Congress Street, Suite 100 Boston, MA. 02114-2017 v't www mass.gov/dia yV• Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information jjPlleasee Print Lezibly Name (Business/Organization/ludividual):�� 1#6t,L3e4 Cao94—oc �Td%% L Address: �l6 dll/ . // k%., City/State/Zip:,/ V,,o/ ✓� A&. Phone Are you an employer? Check the appropriate box: 1.§aIama employer with _ employees(full and/or part-time).* 2. EJ 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. Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have nq employees. [No workers' comp. insurance required.] Type of project (required): 7. [] New construction 8. [:1 Remodeling 9. ❑ Demolition 10 Building addition 11.❑ Electrical repairs or additions 12. [j Plumbing repairs or additions 13.0 Roof repairs 14.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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, rtiey must provide their workers' comp. policy number. • lam an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lie. #: Expiration Date; Job Site Address:—A& 71Va65 AVP City/State/Zip: /V10./�% D� /U� 'Q%o��— 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 cextifj d, the pa* a��aaldes ofpeijury that the information provided above is true and correct. 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 Inspeetor 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 b6 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 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 gou'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 burn 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 A� O CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY 12/4/2015 ) 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Risk Strategies Company 15 Pacella Park Drive Suite 240 Randolph MA 02368 CONTACT NAME: Kim Ly PHONE . (781) 986-4400 FAX . (781)963-4420 ADD Es.kly@risk-strategies.coln INSURER(S) AFFORDING COVERAGE NAIC# INSURERANorGuard Insurance Co 31470 INSURED W McKay Construction LLC 18 Academy Avenue Bradford MA 01835 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBERCL154892045 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 LTR TYPE OF INSURANCE ADDLSUBR WV0 POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS -MADE � OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIABOCCUR HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N R WC STATU- OTH E.L. EACH ACCIDENT $ 100,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? a (Mandatory In NH) N / A NMC634557 /29/2015 /29/2016 E.L. DISEASE - EA EMPLOYE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Job Location:John Gaffney 267 Mass Ave. North Andover, MA CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INSD95 r9mnnr;i m ©1988-2010 ACORD CORPORATION. All rights reserved. The arnon noma mnrl (nnn ora rania4ararl morlra of Arir%pn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Michael Christian/KIL/'-' ACORD 25 (2010/05) INSD95 r9mnnr;i m ©1988-2010 ACORD CORPORATION. All rights reserved. The arnon noma mnrl (nnn ora rania4ararl morlra of Arir%pn CnVFRAAFS CFRTIFICATF NIIMRFR• RFVISInM N11a,1RFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DATE(MMIDM'YYY) ��..//ill CERTIFICATE OF LIABILITY INSURANCE 12/4/2015 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS TYPE OFINSURANCE CERTIFICATE DOES NOT AFFIRMATTVELYOR 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 POLICY EFF REPRESENTATIVBDR PRODUCER, AND THE CERTIFICATEHOLDER. UNITS IMPORTANT: H the certlficateholder Is an ADDITIONALINSURED,the pollcy(les)nust be endorsed. N SUBROGATIONIS WAIVED, subject to X COMMERCIALGENERAL LIABILITY the terms andcondi lonsofthe policypertaln polkiemayrequlreanendorsement. A statememon thlscertiticatedoesnot conferdghts to the eertlRcateholderin lieu of such endorsement(s). PRODUCER CNONTACTAM1E Sandi Munroe M P ROBERTS INS AGCY INC 1060 Osgood Street North Andover, MA 01845 PHONE FA't No, Ext. (978 683-8073 ,Ne. (978)683-3147 �E�: sandi@mprobertsinsurance.com PREMISES amrrrerrce $ 100,000 INSURER(S) AFFORDING COVERAGE NAICi INSURERA: MERCHANTS INSURANCE INSURED W MCKAY CONSTRUCTION LLC INSURER B: INSURERC: 18 ACADEMY AVENUE INSURERD: BRADFORD, MA 01835 INSURER E : A INSURERF: BOP9097489 CnVFRAAFS CFRTIFICATF NIIMRFR• RFVISInM N11a,1RFR- 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, EXCLUSIONSANDCONDITIONS OF SUCHPOUCIES. LIMITS SHOWNMAY HAVEBEEN REDUCED BYPAID CLAIMS. erm �m TYPE OFINSURANCE NORTH ANDOVER MA 01845 POLICY NUMBER POLICY EFF POLICY EXP UNITS X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES amrrrerrce $ 100,000 CLAIMSAIMEOCCUR MED EXP(Ar0'—prion) $ 15,000 PERSONAL& ADV INJURY $ INCLUDED A BOP9097489 8/14/158/14/16 GENL AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 X POLICY M,J DLOC PRODUCTS-COMPIOPAGG s 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED eSINGLE UNIT $ 1,000,000 BODILY INJURY (Per person) $ A ANYAUTO ALL OWNEDSCHEDULED AUTOS X AUTOS MCAI002126 8/06/15 8/06/16 BODILY INJURY (Per ddent) $ NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE $ Per auxident s X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMSMADE CUP9097489 8/14/15 8/14/16 AGGREGATE $ 1,000,000 DED X RETENTION $10,000 $ WORKERS COMPENSATIONVIq PER OT14 D EMPLOYERS'LIABILT' STATUTE ER NIA EL EACH ACCIDENT $ EL DISEASE -EA EMPLOYEE $ exttuoem r-E:S--CPJP'nON OFOPERATIONS below EL DISEASE -POLICY LIMIT $ DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Addit1wel Remarks Sduedde, may be anadued it r—e space is required) JOB LOCATION: JOHN GAFFNEY, 267 MASS AVE., NO. ANDOVER MA CFRTIFICATF Hot nFR CAMCFI I ATIn1J TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL aE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS NORTH ANDOVER MA 01845 AUTHORIZE) REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25 (2014/01) The ACORD name and logo are registered marks of ACORD y 8 2 m n o D D O 72. 9' n am < Z cn to eo �' ma -v w _I .::v O M i l/ H Z A QQ F y ' I CD 4 =i c W. MCKAY CONSTRUCTION LLC.. WILLIAM MCKAY 18 ACADEMY AVE. HAVERHILL, MA 01835 Undersecretary Not valid without signature 9 Viassaci?useiis - Department ru5iic Sa:ec Eur c. S�slul~y^ Rcuivao s <^ u S«uz:, Lollstructinil Supervisor License: CS -089332 � WILLIAM MCKAV 18 Academy Avenue Haverhill MA 01835 Commissioner 0310812016 DRIVER'S'_ LICENSE 9a END Ad NUMBER , . —otos 2012 NONE S109338.. 4b � n 3 D03 ri Lo Os 2016 0M81980 12RESTi5SEx'M • slHpT�00 is D NONE IP c 4. y r z WILLIAM L 111 22 ESSEX STREET PT 14 HAVERHILL-, MA 01832. 5 ODP01.104D12 Rev 07.15-2009