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HomeMy WebLinkAboutBuilding Permit #817-2017 - 29 ROCK ROAD 3/2/2017TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: r O -U Date Received ` TYPE OF IMPROVEMENT PROPOSED USE CONTRA `�TOR�Name �_�� Resid ntial Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial WAffe'ration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other --�P��..rG�� - ., ,.. �❑ Se tic Welk , Ft4�� y_ Yom• . Floodplain �ilNetlan . - � - O Matersied „©Water/Sewe�Z++FFrss•�L� �ICl r� _.�5 i" v t rH C -M DESCRIPTION OF WORK TO BE PERFORMED: Identification ,,Please Type or Print Clearly) OWNER: Name: ArgrJracc ne: / - W 681-/ 0 7s7) '^r. c t -r 7; Yi�'.1M'tr",.--*n,..y^5- `ti •� i� Y �f.ft c. .GJ''�i` •%ne*t+r+.', 'ryr'?'7'� .�. 4r '_'.iY w 1't`tr<i_ *v�'.: PriMl',,,1"_ �r7x.+Zh_°-�,�,y ,.1• ♦ a - 4 r a _ i. •' n'- ♦ '�+"5 `�.. %9:'< y '�.✓,.E CONTRA `�TOR�Name �_�� Phone�j�_�_C _ _ x az - Superviso s;ConstrucfionjiLi ec nsek , .cEXp :Date-Ij.."� Horne Im rov mentLicense.w --�P��..rG�� - ., ,.. ARCHITECT/ENGINEER �Zg Phone: Address: Reg. No. y:. FEE SCHEDULE. BOLDING PERMIT. $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ gL-) eo-o " 01 _ FEE: $ /® Check No.: a S 31i° Receipt No.: NOTE: Persons contracting with Inregistereil contractors -do not have access to th uaranty fund ;signature of Agent/.Own Sig nature, of .contractor : . Plans Submitted 0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department 'rine folowing 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit a 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 ❑ Engineering Affidavits for Engineered products 10TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cs ses if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the app --al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be- subm_tted with the building application Doc: Doc.Buhding Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE:OF-SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ ... ,Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes P`; nning Board Decision: Comments r. Conservation Decision: Comments V��ater & Sewer Connection/Signature &Date Driveway Permit ]DPW 'I owz, Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at'l24 Maim Street Fire Departmerit signatureldate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions_ Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast 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 Nu I i=5 and DA I A — Igor cilevartment use Il Notified for pickup - Date Doc.Building Permit Revised 2010 Location No. 7- 9Y Date 3- of ' 4-(117 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee --'Other Permit Fee TOTAL Check # 2- J. ° P 44 4r 1 5 3 8 Building Inspector $ aY Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 20,000.00 m $ 240.00 Plumbing Fee $ 30.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.00 Total fees collected $ 400.00 29 Rock Road 817-2017 on 3/2/2017 kitchen remodel v C � n O Z U) D 0-0 CL 2 r. �• N '0 O CD CDC� Cr CD •CD O ••� • W W CDCD CD Q O N. (Q M I � v y O � Z � o X CD 0 m O n < o OO 2) mc5_<<D N O � CD m o n O 0 � v' 0 3 � rt C Z o-Or- o �• =n - O 0 N rt rD m -•, O o ,,,,, Q O• m -h v O -- W CD 'v CO)� _ v�c cfl 1 CQ y O O ' Cl) _ CDMM Q. 0 O O o v, • '� _., = to o o a o D CD N a v v, v 0=-�' < v. O ° CO) 0 CL CD CL 0 ��W CD CD CL CD rN D e-►' rt * . SoC y pat! co� o^' . O _ o :: so CD C 7 CD Cn CD � y �S s :70: c C O o Q v Ln (D Ln `� - Z a C A Z7 O an S TVI n N �7 O OQ S Z 'n j' O S 3. rn � O R N j rn (D f7 N O CL \ T. Cfj T G D z (A z Ln A z m m n m to M C W z M n o C v � M O 3 M Z m 0- o Z O e� Z z D:rZ 0 O < o OO 2) mc5_<<D N O � CD m o n O 0 � v' 0 3 � rt C Z o-Or- o �• =n - O 0 N rt rD m -•, O o ,,,,, Q O• m -h v O -- W CD 'v CO)� _ v�c cfl 1 CQ y O O ' Cl) _ CDMM Q. 0 O O o v, • '� _., = to o o a o D CD N a v v, v 0=-�' < v. O ° CO) 0 CL CD CL 0 ��W CD CD CL CD rN D e-►' rt * . SoC y pat! co� o^' . O _ o :: so CD C 7 CD Cn CD � y �S s :70: c C O o Q v Ln (D Ln `� - Z a W ( T Z7 O an S TVI n N �7 O OQ S 'n j' O S 3. S_ 7 N O S O R N j (D f7 N O CL \ T. T G D z (A z Ln A z m m n m to M C W z M n C v � M O 3 W z v O T m = I 0 Z' �O m ow 0 c AMS Pfordresher Preliminary Contract 2/16117 29 Rock Road, North Andover, MA Parties Aaron M. Scarpello Home Improvements, LLC the "Contractor" Full Identification, The TAX ID of principal is 20-3306885 Contractor address: 2 Magnolia Ave Salem NH, 03079 The Contractor's Massachusetts HIC registration number is 153859 The Contractor's Massachusetts Construction Supervisor's number is CSFA-096462 The Contractor hereby proposes to perform the work described below for: Heather Pfordresher, homeowner, 29 Rock Road, North Andover, Massachusetts. 1. This preliminary estimate consisting of the following: Heather Pfordresher wishes to Aaron M. Scarpello Home Improvements LLC. to perform the work listed below: Kitchen Remodel: Permits @ 1.1 % Demolition done prior to start Plumbing of: Sink Dish washer Garbage disposal Gas lines for Stove/Oven Water line for the refrigerator Electrical To be supplied by other Cabinet installation Granite coordination This is an estimate to be used by the North Andover Building department. a. Estimated total kitchen costs 1. Aboomm von coo ii. Note this is an estimate only all final costs will be generated on a time plus materials basis. Finish Materials approx. $ (This amount is subject to change based on actual choices of finished materials made by the homeowner) 100% due at time of order (finished materials will be ordered and purchased at various times during the duration of the job) Some finished materials may not be able to be returned or cancelled once the order is placed and some may be subject to a 20% restocking fee. These charges will be the responsibility of the homeowner if it is the homeowner requests the exchange or return. 11Page 3. This remodel is scheduled to begin 2/2317, and be completed by TBD depending on scope of work approved by the homeowner. 4. The Contractor agrees to provide and pay for all materials, tools and equipment required for the prosecution and timely completion of the work. Unless otherwise specified All materials shall be new and of good quality. There is a one year warranty on materials and craftsmanship, if manufactures warranty does not apply. 5. In the prosecution of the work, the Contractor shall employ a sufficient number of workers skilled in their trades to suitably perform the work. 6. All changes and deviations in the work ordered by the Owner should be presented to the Contractor, by the homeowner in writing, the contract sum being increased or decreased accordingly by the Contractor. 7. The Owner, Owner's representative and public authorities shall at all times have access to the work. 8. Construction and Jobsite Details: Existing lawn & driveway may suffer some damage due to construction trucking; every attempt is made to minimize the damage, however the homeowner shall not hold the contractors liable for the extra cost if damage situations appear. Any unforeseen discoveries that may affect the construction costs are they responsibilities of the homeowner. For example: asbestos, mold, ledge, high water table etc. 9. In the event the Contractor is delayed in the prosecution of the work by acts of God, fire, flood or any other unavoidable casualties; or by labor strikes, late delivery of materials; or by neglect of the Owner; the time for completion of the work shall be extended for the same period as the delay occasioned by any of the aforementioned causes. 10. The Contractor agrees to obtain insurance to protect himself, his workers and subcontractors against claims for property damage, bodily injury or death due to his performance of this agreement. 11. This agreement shall be interpreted under laws of the State of Massachusetts. 12. Attorney's fees and court costs shall be paid by the defendant in the event that judgment must be, and is, obtained to enforce this agreement or any breach thereof. 13. Insurance: Liability Insurance certificate available upon request 14. NOTICE to Homeowner: All contractors must be registered and display the contractor's registration number. You have the right to rescind this contract within three days of signing. The Home Improvement Contractor Regulation Statute, M.G.L.A. c. 142A gives you certain warranties and homeowner's rights under the act. In the event of a dispute, your or the contractor have the right to request non-binding arbitration. NOTICE: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. IN WITNESS WHEREOF, the parties hereto set their hands and seals the day and year written abo e. *ERI'S MEOWNER'S SIGNATURE DATE OWNER'S NAME ADDRESS 2 1 P a g e OWNER'S SIGNATURE DATE Aaron Scarpello CONTRACTOR'S NA CTOR'S SIGNATURE 2 Magnolia Ave Salem .NH 03079 CONTRACTOR'S ADDRESS 3 1 P a g e DATE 'Wia�:kers' CompensationbsurancdA.£fid�avit B d�I�IGAUI�t0s13I7'Y-tracians/�'lTxnat ers. TO BE MKI) V �g T�Tc � ra Print Name (Business/Ozgabizaiionllnd ividual) Address: City/State/Zip: �>''t Ct' Are yon an employer? Cltecktlie appropriate box: a 1. ❑ I mployer with employees (fuII and/or pari time). artnership and have no employees working forme in 2.am a sole proprietor or p any capacity_ WOWOrkers' comp. insurance required] 3-E]I am. aho n owner doing all workmyseli Vqb-Workers' comp. insurancerequired ] r 4.❑I am ahomeowner andmM be hiring cmt aatorsto condneiall work onmy proPertY- I Va ensdaethe all coniaacto±s eitherhave, workers' compensation insurance or are sole proprietors wifhno employees. 5.❑Tama general contractor and I Kaye biredthe sub -contractors ]fisted the attached sheet These sub -contractors lrave employees andhave workers' comp. iIsm ance.? 6,❑ We are a corporation and ifs, officers have wxdsedtheir rigbt of exemption perMGL o. and' have no e oldyees. [No workers' comp. insurance -required.] N Type ofzproject (req&ed)' 7. [[ NdVd6ngiridiiOR g, �emodelliig 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12_grpramb ug repairs or additions 13•. Ro6fr4airs 14 -El Other _ _ . aPPhcaut chat check box#1 must aisd fill outthe sertioaboare doing alt work and thenhireOufs tde oontracto�s 3mzt ssubmitolloy �a new affidav'R indicating such. i HomeownerswhasnbmiEthis affidavitindicafingthey _ tCo�ractors chat checkthis 1ioX must atxaclied'an addifional sh r ode their workers' come �li nr¢nber.�d §fate whether or notthose er�ifies aye - PP - employees. ifthe sub-coniiactors have employees, theymust p - • X axrt an employer t7iat is providing-rvorkers' compensation insr�rance for my employees, Belo-fv zs tFiepolicy arZd j-o.� 'site information. Insurance Company Name: Expiration]Date' policy # or Self ins. Lir-. #: State/Zip: Rock Job Site Address: oiicy number and expiration date). ttach a copy of�te-workers' com-pe:psattonpolicy decl anon page (showing the p Failure to secure coverage as requv ed underM enalixes2xn§he f im of STOP -WORK OpDHR and � of4 to $250.00 a and/or one year imprisonment; as well as civil p day against the violator. A copy of this statement may be the to the Office of Investigdtlons of the DIA for insurance coverage verification. cle�tliepL9ns andpenalfies ofperjury.gjat t7ie infor7naiion provided above is / e^ , / o £do herehy certify � M Do notIffite in this area, to be cOMPZeted by city or toTvn officzaL Of f�cial rise only- Permit/License # City or Town- fssuiug A.nthoxitY (circle one): ector 5. plumbing Inspector I. Board of Realth Z- Building Departuent 3_ CitylTown Clerk 4. Faectricalfusp 6. Other Phone #; Contact Person- ZZ—C The Common -wealth Of jyjassachusetts _ _ Department of IndustrialAccidents = � _ = `" e 100 I Congress ,S`treet, Susi ' d = Boston, MA 02114-2017 _ w mass govMa 'Wia�:kers' CompensationbsurancdA.£fid�avit B d�I�IGAUI�t0s13I7'Y-tracians/�'lTxnat ers. TO BE MKI) V �g T�Tc � ra Print Name (Business/Ozgabizaiionllnd ividual) Address: City/State/Zip: �>''t Ct' Are yon an employer? Cltecktlie appropriate box: a 1. ❑ I mployer with employees (fuII and/or pari time). artnership and have no employees working forme in 2.am a sole proprietor or p any capacity_ WOWOrkers' comp. insurance required] 3-E]I am. aho n owner doing all workmyseli Vqb-Workers' comp. insurancerequired ] r 4.❑I am ahomeowner andmM be hiring cmt aatorsto condneiall work onmy proPertY- I Va ensdaethe all coniaacto±s eitherhave, workers' compensation insurance or are sole proprietors wifhno employees. 5.❑Tama general contractor and I Kaye biredthe sub -contractors ]fisted the attached sheet These sub -contractors lrave employees andhave workers' comp. iIsm ance.? 6,❑ We are a corporation and ifs, officers have wxdsedtheir rigbt of exemption perMGL o. and' have no e oldyees. [No workers' comp. insurance -required.] N Type ofzproject (req&ed)' 7. [[ NdVd6ngiridiiOR g, �emodelliig 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12_grpramb ug repairs or additions 13•. Ro6fr4airs 14 -El Other _ _ . aPPhcaut chat check box#1 must aisd fill outthe sertioaboare doing alt work and thenhireOufs tde oontracto�s 3mzt ssubmitolloy �a new affidav'R indicating such. i HomeownerswhasnbmiEthis affidavitindicafingthey _ tCo�ractors chat checkthis 1ioX must atxaclied'an addifional sh r ode their workers' come �li nr¢nber.�d §fate whether or notthose er�ifies aye - PP - employees. ifthe sub-coniiactors have employees, theymust p - • X axrt an employer t7iat is providing-rvorkers' compensation insr�rance for my employees, Belo-fv zs tFiepolicy arZd j-o.� 'site information. Insurance Company Name: Expiration]Date' policy # or Self ins. Lir-. #: State/Zip: Rock Job Site Address: oiicy number and expiration date). ttach a copy of�te-workers' com-pe:psattonpolicy decl anon page (showing the p Failure to secure coverage as requv ed underM enalixes2xn§he f im of STOP -WORK OpDHR and � of4 to $250.00 a and/or one year imprisonment; as well as civil p day against the violator. A copy of this statement may be the to the Office of Investigdtlons of the DIA for insurance coverage verification. cle�tliepL9ns andpenalfies ofperjury.gjat t7ie infor7naiion provided above is / e^ , / o £do herehy certify � M Do notIffite in this area, to be cOMPZeted by city or toTvn officzaL Of f�cial rise only- Permit/License # City or Town- fssuiug A.nthoxitY (circle one): ector 5. plumbing Inspector I. Board of Realth Z- Building Departuent 3_ CitylTown Clerk 4. Faectricalfusp 6. Other Phone #; Contact Person- ZZ—C Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their empl6yees. Pursuant to this statute, an e7iTfoyee is defined as "...every person in the service of another under any contract of bite, express or implied, oral or written." An enzPZoyer is defined as "an individual; partnership, association, corporation or other legal entity, or any two or more Of the foregoing engaged in a joint enferprhe, and including the legal representatives of a deceased employer, or the receivet•ortrastee of 'an individual, partnership, ass ociation or other legal entity, employing emplbyees. •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 Wh6 has not produced -acceptable evidence of compliaucewith the insurance coverage xeq ked." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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=contractox(s)uame(s), address(es) and phonenumber(s) along with theircertificate(s) of insurance. Limited -Liability Companies (LLC) or Limited Liability Partnerships (LLP) with i o employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC ox LLP d6es have employees, a policy is required. B e advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation ofinsurance 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-Accidenis. Should you have any questions regarding the law or if you are xequired to obtain a-6xkers' 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 ofthe affidavit for you to fill out in the event the Office ofInvestigations has to contact you regarding the applicant. Please be sure to fill in the p ermitAicense 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 (ifnecessaty) and under "lob 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. Anew affidavit must be filed out each Year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i. e. a dog license or p ermit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-•2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia 03-02-'17 09:34 FROM- 9785572130 T-777 P0002/0003 F-472 r 1 AAKUN-T Ur Iu: r-Im , 6ft R' CERTIFICATE OF LIABILITY INSURANCE /Yl�� P03/02/2017 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT, If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, Subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ndorsement(s)- PRODUCER PRODUCER Michaud, Rowe And Ruscak Ins_ P.O. Box 188 North Andover, MA 01845 Mark S. Rowe, CIC CT Mark S. Rowe, CIC 22M. PN NE g78 688 8829 A/C No Ext : No): 978 557 2130 E-MAIL ADDRESS: j INSURERS AFFORDING COVERAGE NAIC III INSURER A ; AmGuard INSURED Aaron Scarpello Home Imp, LLC , 2 Magnolia Ave. Salem, NH 03079 INsupot a: Libe Mutual INSURER C: INSURER D OCCUR INSURER F: INSURER F ; 1.Vvr-I%A%Ir-a CtKI IFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ADD 4 URANCE WVD POLICY NUMBER LTRRr001MMERCIAL P LICY EFF MM/DD MM/DG/YYYy LIMITS A ERAL LIABILITY OCCUR 12/10/2016 EACH OCCURRENCE $ 1,000,00 AABP741011 12/10/2017Er p EMISES Ee occurcence$ 10010 MED EXP (Any one person) $ 5,00 PERSONAL&ADV INJURY 1 $ 11000,00 _ I GEN'L AGGREGATE LIMIT APPLIES PER: F GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 1,000,00 POLICY❑ PECTRO-- LOC OTHER: $ AUTOMOBILE UABILn`/ COMBINED SINGLE LIMIT Es steidenl $ ANY AUTO BODILY INJURY (Per peraon) S ALL NED CHED AUTOS AUTOSULEO BODILY INJURY (Per eociderd) $ HIRED AUTOS NOWOWNED AUTOS PROPERTY $ Per acs dent i $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EzcessuA9 CLAIMS -MADE+ j AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY S7AT�UT ER S ANY YIN PROPMETOR/PARTNER/EXECUTIVE TO BE ISSUED SEPARATELY E.L. W OFFICER/MEMBER EXCLUDED? a N / A EACH ACCIDENT $ (MandaWry in NH) I If yea, describe under E.L DISEASE - EA EMPLOYE $ DESCRIPTION OF OPERATIONS below I I E.L. DISEASE - POLICY LIMIT $ ' I DESCRIPTION OF OPERATIONS / LOCATIONS / VFNICLES (ACORD 101, Additional RernaM schedule, may be ataehed if more sp ae Is required) Interior carpentry and residential remodeling CERTIFICATE HOLDER CANCELLATION NORTH13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. Paul Hutchins 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 2/f C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 03-02-'17 09:34 FROW 9785572130 T-777 P0003/0003 F-472 AeCIIR ® CERTIFICATE OF LIABILITY INSURANCE �• -� DATE(MM/DDNYYY) 03/0212017 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 CONTACT NAME: Krista McMahon MICHAUD, ROWE AND RUSCAK INSURANCE ASSOCIATES, INC, PHONE (9781688-8829 FAx N E-MAILIpR, kmcmahon mrrinsuranoe.com P.O. BOX 188 NORTH ANDOVER MA 01845 INSURERS AFFORDING COVERAGE NAIC d INSURER A I LIBERTY MUTUAL FIRE INS CO 23035 INSURED AARON SCARPELLO HOME IMP LLC INSURER B: INSURER C: INSURER D: 2 MAGNOLIAAVE INSURER E: SALEM NH 03079 INSURER F: 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. IL7 R' TYPE OF INSURANCE ADD Q SU WV I POLICY NUMBER PCf MMOLID YEF POCK MMIDLIDY LIMITS COMMERCIAL GENERAL LIABILITY I CLAIMS-MADEOCCUR EACH OCCURRENCE $ N I EU PREMISES E8 occurren $ MED EXP (Anyone Person) S i N/A PERSONAL& AOvINJURY $ GEN'POLICY GATEUMITAPPLIES PER: PFR GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG S POLICY LOC OTHER: AUTOM061LE LIABILITY M INFD 5IN11LE L CEOIMIT S ANY AUTO BODILY INJURY (Per person) Is ALL OWNED SCHEDULED AUTOS AUTOS N/A - BODILY INJURY (Per acadenr) $ MI RED AUTOS NON -OWNED AUTO$ PROPERTYDAMA $ I Per eccident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIM&MADE` N/A AGGREGATE $ OED I I RETENTION $ S WORKERS COMPENSATION_ AND EMPLOYERS' LIABILITY I X PER ERH .ANYPROPR12TORrPARTNERIEXECUnVE A iOFFICER/MEMBERFXC4UDEO? Y/ N N/A N/A NIA WC231S380493026 04/19/2016 04/19/2017 E,LEACHACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 (Mandatory in NH) Iryy8Baa describe under DE$�RIFI ION OF OPERATIONS below I I E.L. DISEASE - POLICY LIMIT S 500,000 N/A I DESCRIPTION OF OPERATIONa / LOCATIONS I VEHICLES (ACCRD 101, Additional Remarks Schedule, maybe attached N mora space is required) Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage -Coverage Verification Search tool at www.mass.gov/lwd/workers-OOMperizationrinvestigations/. Town of North Andover Building Department 1600 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE North Andover MA 01845� Daniel M: Cro4v�y, CPCU, Vice President— Residual Market— WCRIBMA (9 7988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD d� jp LP , CL77Z?11NYAUIG?,.fSl 6 \ office.of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR r s" TYPE: Individual e I' a-ation Exairation 11 X859 01/17/2019 l z/s Aaron Scarpello� AARON SCARPELLO 4; 2 Magnolia Ave Salem, NH 03079 y� Undersecretary i I / Massachusetts Department of Public Safety 'Board of Building Regulations and Standards License: CSFA-096462 Construction Supervisor 1 & 2 Family - ' ' ` AARON M SCARPE'LLO 2 MAGNOLIA AVENUEa SALEM NH 03079 .: Expiration: Commissipner 07/07/2018 { — CJ�re T�aino�raaar«ec�l(� a���/l�a4dcrr,�u�elli.� ? Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: Individual R I 1� -: Re iastr.-anon Expiration € ; 15859'/3 01/17/2019 Aaron Scarpello' AARON SCARPELLO } _ 2 Magnolia ' Salem, NH 03079;7,Undersecretary Massachusetts Department of Public Safety OF - Board of Building Regulations and Standards l License: CSFA-096462 -- Construction Supervisor 1 8{ 2, Family AARON M SCARPELLO ' _ 2 MAGNOLIA AVENUEf 1a'�� t :� SALEM NH 03079 .�. I Expiration: Commissioner 07/07/2018