HomeMy WebLinkAboutBuilding Permit #848 - 33 RIDGE WAY 6/28/2006TOV4'v OF NORTH ANDOVER
APPLICATION FOR PLAN EX-MMINATION
ssc Musa
Permit N0:Date Received: �� ' ���
Date Issued: 61-21,7106
UNIPOR1,0T:Applicant must complete all items on this page
LOCATION 33 x ,IDC
Print
PROPERTY OWNER (p ✓C I C-/<-
Print
N•IAP NO.: 6 F?ff PARCEL: if4 ZONING DISTRICT:
TYPE AND USE OF BUILDING
HISTORIC DISTRICT vFc n
TYPE OF IMPROVEMENT
PROPOSED USE
Residen ial
Non- Residential
= New Building
Z Addition
?eA**-Iteration
- ne family
= Two or more family
No. of units:
Industrial
= Repair, replacement
= Demolition
= Assessory Bldg
" Commercial
Moving (relocation)
Other
Others:
Foundation only
DESCRIPTION OF WORK TO BE PREFORMED 'OlrlcT—fA/Jb I -Ax v 'r
/.LAS'/ �� aC'� V W ,S"110 4/z s, -,4,&L
Identification Please Type or Print Clearly)
OWNER: Name: ����� 16 le S,
ilddress: -5i4'knlee '--� 5
CONTRACTOR Name: t�S Phone: 6�)3-
address: 6e'c® 0 --aerie Alt�✓/C-�fi.�'Z W,
Supervisor's Construction License: ��f���7 Exp. Date:
Home fmprovement License: Exp. bate:
,1.RCHITECT. ENC,fNEER ti.amc: Phone:
kddress:
Reg. No.
FEE :SC'HED L LE: B LDI NG PERMIT. 510.0FER 5 i 100.00 OF THE TOT.1 L ESTIJI-1 TED OUST 3ASED A 31=5.60 PER .5.1':
Total Project Cost A � —3-3-5--2 �� x 10.00= FEE:$ 3� 6�
C?teck No.: . W67 Receipt No.:
'n'PE OF SEWARGE DISPOSAL
-
Tannin g'%iassage Body .art
SaimmimT Pools -
Public Seuer
-
_
Tobacco Sales --
Food Packaeint; Sales
Well -
-
Permanent Dumpster on Site _
Private (septic tank, etc. _
Electric Meter location to
project
NOTE: Persons contracting with unregistered contracto do not Crave access to the g
Si nature of A ent Owner f z Signature of Cuntracto+�
g g
Plans Submitted ^'Lel Plans WaivedCertified Plot Plan
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPINIENT
COMMENTS
CONSERVATION
COMMENTS
.)un«
Stamped 9ffKs",
DATE REJECTED DATE APPROVED
❑ - ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
Other
DATE REJECTED DATE APPROVED
F1 110
DATE REJECTED DATE APPROVED
HEALTH
CUNTMENTS
toning Board of Appeals: % ariance, Petition No:
honing Decision receipt submitted , es
P!:mning Board Decision: -- - -------�_��mmc
-'mScr�:1ticn Dcci ion: — _ `---�_onunen
k':acr S,;tiS(.r connection c R datL
Ccrnp Dempster cn � ite . es _no-_ Pire Department !mature .late
Building Permit Appro,-ed and Issued by:
Building Setback(
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required
Provided
DIMENSION
N umber of Stories: Total square feet of floor area, based on Exterior dimensions._.______
Total land area, sq. It.:
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
�Tufoirkers
ilding Permit Application
Comp AffiidaN,it
Photo CoP� Of H.I.C. And/Or C.S.L. Licenses
41�py of Contract
Floor Plan Or Proposed interior'h"ork
Addition Or Decks
a Building Permit Application
Surveyed Plot Plan
a 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 Hydraul:
Calculations (If Applicable)
a Mass check Energy Compliance Report (If Applicable)
New Construction (Single and Two Family)
Building Permit Application
a Certified Proposed Plot Plan
a Photo of H.I.C. And C.S.L. Licenses
a Workers Comp Affidavit
a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
a Copy of Contract
j Mass check Energy Compliance Report
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
:ne I'VA1I•.0 10%,.kL tilAVICEi OFT `.R'I'?IPt*!': IPFOR1!05
P.r'e 4 c l' 1
Location x �P—a , , "
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # --�tPN
475 Building Inspector
m
m
m
Ic
m
m
m
v
m
CO)
CD
C Z
CD O
ar
dd
CL
aco
o v
CL
Q
.• ..
FL, CD
cc CD
CA
10
CD
O
y
d
O
y
cm)
0
y
d
CD
�rt
CD
CD
3,
CA
CD
CA
O
CCD
CD
O
z
°Cl.5
w11
w
w
Cl.�
C/)^^
C
1-4
M
�..
9
J
O
v J
•
VJ
M
o
�
p
O�
O
W
•�
•
cn
Oy i
d
o.
r«
m
0
m
0
UP
c.
CD
ccRL
0
H
O
CL
N
N
ti
C)
m
W
m
CO2
ow
z
°Cl.5
w11
w
w
Cl.�
r
C
1-4
M
0
9
M
7d
z
by
0
19
0
c
Section I I
Construction Contract
of the
Contract/Proposal
for
Patrick and Lisa Shin
06/16/2006 Contract Proposal — Page 6 of 23
BUSINESS CONDITIONS TO THIS
CONSTRUCTION CONTRACT
This Contract, dated 6/16/2006 is by and between:
Patrick and Lisa Shin
33 Ridge Way
North Andover, MA 01845
Blackdog project code SHIN -6450-B
(Hereafter referred to as OWNER), and
Blackdog Builders, Inc.
7 Redroof Lane, Unit #1
Salem, NH 03079
(603) 898-0868
(Hereafter referred to as CONTRACTOR). Work will be performed at:
33 Ridge Way, North Andover, MA 01845
(Hereafter referred to as PROPERTY)
1. GENERAL
This CONTRACT is for the following work and materials to be performed by the CONTRACTOR on the
PROPERTY address shown above. The project is generally described as follows:
Miscellaneous Construction Work
(Hereafter referred to as WORK)
The CONTRACT consists of this document, any plans, the specifications, the Blackdog client package and the
Construction Contract. (Hereafter collectively referred to as the "CONTRACT")
2. PRICE
The total price for the WORK agreed upon is $33,572.16: Payment terms are set out below in Paragraph 6. This
proposal may be withdrawn by us if not accepted within thirty (30) days.
3. STARTING AND COMPLETION PROVISIONS
The WORK will begin on approximately 7/2006 and will be completed, absent unusual or unforeseen
circumstances, on 9/2006 providing this CONTRACT and any related CONTRACT documents are accepted when
presented. Projects requiring two contracts (one for construction work and one for bath or kitchen product) will not
be slotted into the schedule until both agreements have been executed. The aforementioned dates reflect our
present workload. Projects are assigned a slot in our work schedule as they are accepted, on a first come first
served basis. These dates may move based on the completion time of the project that immediately preceded
yours.
4. PERMITS AND APPLICABLE CODES; COMPLIANCE WITH LOCAL LAW
a. All work to be done under this CONTRACT will be in accordance with local, state and county building code.
The CONTRACTOR shall obtain all necessary permits and pay all required permit and plan fees from the
CONTRACT sum, unless otherwise agreed. The CONTRACT price does not include any fees, which may be
incurred to obtain a variance, if required. The CONTRACT price does not include any unbid items required by any
local building official to bring the project into compliance with any relevant local, state and county building code.
06/16/2006 Contract Proposal — Page 4 of 23
b. All home improvement contractors/subcontractors working in the state of Massachusetts must be licensed and
registered by the Bureau of Building Regulations and Standards. All inquiries concerning the CONTRACTOR
should be transmitted to that office. In Massachusetts Blackdog Builders, Inc. operates under License number
CSO48847 and Registration number 106877.
5. SPECIFIC REQUIREMENTS FOR MATERIALS AND WORKMANSHIP
a. This CONTRACT will be completed by the CONTRACTOR in a good and workmanlike manner, using quality
materials.
b. If applicable, the CONTRACT price includes the following allowances: See allowances under specifications.
6. PAYMENT
a. Timely payment by the OWNER of all sums due under this CONTRACT is of the essence to this
CONTRACT. The parties agree to the following schedule of payments:
Deposit with this contract: $1,678.61
Payment Schedule amounts reflect a Partner Plan credit of $2,500.00
b. Payment Schedule
Start of project
Start of framing
Start of Plumbing
Start of drywall hanging
Start of trim
Start of painting
Substantial Completion
Completion of Punch List
c. Allowances for Owner Selected Components
Ironing Board
Laundry Shelving
$360.00
$400.00
$4,507.01
$4,507.01
$4,507.01
$4,507.01
$4,507.01
$4,507.01
$1,469.68
$881.81
d. The CONTRACTOR may cease operations if any payment is not made by the OWNER as required herein,
and proceed to collect any balance due through any remedy provided by law. Payments are due when the
aforementioned progress milestones have been reached. It is understood that minor adjustments to the
payments schedule may be necessary due to the flow of work or delays beyond the control of the
CONTRACTOR.
e. DEFINITIONS
Substantially complete - The space or project is substantially complete when the space or project can be used
for its intended purpose and only punch list items remain.
Punch list - Work or product that has not been performed or provided.
Warranty item - A product or service that has been provided or performed that does not meet or exceed industry
standards.
THESE CONDITIONS MUST BE ACCOMPANIED BY THE CONSTRUCTION CONTRACT
06/16/2006 Contract Proposal - Page 5 of 23
CONSTRUCTION CONTRACT
This Contract is by and between:
Patrick and Lisa Shin hereafter referred to as "OWNER", and Blackdog Builders, Inc hereafter referred to as
"CONTRACTOR" for work at 33 Ridge Way, North Andover, MA 01845 dated 6/16/2006. This CONTRACT
consists of this document, any plans, the Specifications and Business Terms that are enclosed and the Blackdog
Builders Client Package. (Hereafter collectively referred to as the "CONTRACT")
1. CONTRACTOR'S DUTIES -- GENERAL
a. To direct and control the work contracted for in accordance with the terms of this CONTRACT and all
applicable codes, laws, and regulations, and as the building permits issued for this project, if any, require.
b. To inspect the site, examine the plans and specifications, if any, and supervise all of CONTRACTOR's
employees, and to direct the work of all subcontractors selected by CONTRACTOR.
c. To maintain the work site in a safe and clean condition, to the extent consistent with the CONTRACT.
d. To advise the OWNER promptly if concealed conditions are ascertained which require additional or different
work, and to proceed in such event in accordance with this CONTRACT.
e. To provide locked storage for any equipment, tools, or other PROPERTY used in the performance of this
CONTRACT, unless otherwise agreed in writing.
2. OWNER'S DUTIES -- GENERAL
a. To provide adequate utilities for the work agreed upon.
b. To advise the CONTRACTOR of any condition of the PROPERTY which affects CONTRACTOR's ability to
perform.
c. To provide secure storage areas for materials delivered to the work site.
d. OWNER shall be entitled to make periodic inspections of the work site, provided such inspections do not
interfere with the work and can, in the judgment of the CONTRACTOR, be made safely. Any other entry onto the
construction site shall be at OWNER's risk.
e. OWNER shall notify his insurance agent of the execution of this agreement and obtain any necessary riders to
his current coverage or any locally customary forms of coverage, such as builders risk, to cover OWNER's
interests and liabilities during the construction process.
If. To perform no work on the project without a written agreement with the CONTRACTOR.
g. To make no agreements with any trades person, subcontractor, or CONTRACTOR'S employees outside the
scope of this CONTRACT without the written consent of the CONTRACTOR.
06/16/2006 Contract Proposal — Page 7 of 23
3. MATERIAL SUBSTITUTION
CONTRACTOR reserves the right to substitute other materials, products and/or labor of equal or superior quality,
utility, or similar color.
4. DELAY
CONTRACTOR shall not be responsible for delays caused by events beyond the control of the CONTRACTOR,
including but not limited to: strikes, war, acts of God, riots, governmental regulations and restrictions. Delays
caused by OWNER's failure to make allowance materials selections or caused by the performance by
CONTRACTOR of extras or necessary work (as described in Paragraph 6) shall likewise be excusable delays.
& INSURANCE
CONTRACTOR agrees to maintain all necessary forms of insurance to protect the OWNER from liability for any
occurrence arising from the performance of this Contract. CONTRACTOR agrees that he shall cover his own
employees for worker's compensation and carry general liability insurance, and that all forms of insurance
referenced herein shall be with reputable companies licensed to do business in the state where the project is
located.
6. HIDDEN, CONCEALED and UNFORESEEN CONDITIONS
a. The parties agree that in the event CONTRACTOR discovers a hidden, concealed or unforeseen condition
requiring an extra cost that they shall proceed as follows: The CONTRACTOR shall notify the OWNER verbally
to expedite agreement as to any charge necessary to correct or cure such condition, and provide a written Work
Order (as described in paragraph 7a) as soon as practicable. The parties must agree to such extra charges, or
agree to a resolution method, or this CONTRACT may be cancelled by either of them.
b. For purposes of this section, a "hidden, concealed and unforeseeable condition" shall mean a condition not
readily observable to a prudent CONTRACTOR inspecting the subject PROPERTY for the purpose of performing
this Contract. Examples of such conditions can include, but are not limited to; rot under siding; ledge below grade;
pre-existing plumbing or electrical work not performed to code and pre-existing mold.
c. Any change in the WORK required by building officials assigned to this project, including structural and/or any
environmental hazards will be billed as an EXTRA charge to this CONTRACT and paid for by the OWNER as a
Work Order. CONTRACTOR may cease operations if OWNER refuses to pay
7. EXTRAS
a. Any extra work or materials desired by the OWNER shall be agreed upon in writing and such extras shall
become a part of this CONTRACT as if fully set forth herein. Unless otherwise agreed, extra work shall be paid
for as performed. Failure of the OWNER to sign a change order shall not preclude recovery for any work
performed by CONTRACTOR, and acceptance of said extra work or materials shall be presumed, unless there is
written notice to the contrary.
b. CONTRACTOR shall advise OWNER, at the time of agreement on an extra, as to any additional time required
to perform this CONTRACT.
06/16/2006 Contract Proposal - Page 8 of 23
8. ESCALATION
CONTRACTOR reserves the right to pass on additional costs to OWNER resulting from the escalation of the cost
of lumber or lumber byproducts. This cost may be passed on only, if after the CONTRACT is signed but before
the construction commences, an increase in lumber costs is experienced. The CONTRACTOR must substantiate
the change with evidence of the difference between lumber costs at the time of the CONTRACT and lumber costs
at the time of construction. Only direct cost differences may be passed on, no allowances for overhead and profit
shall be included. Any additional costs will be collected per Work Order (as described in paragraph 7a.).
9. EXCESS MATERIALS ON SITE
CONTRACTOR routinely stores extra materials on site to improve efficiency and reduce the likelihood of running
out of stock in the middle of a task. Unless otherwise specified in writing all excess materials on site at the end of
the project are the PROPERTY of CONTRACTOR.
10. SUBCONTRACTORS
a. CONTRACTOR shall select subcontractors as required to complete this CONTRACT. OWNER acknowledges
that subcontractors will do various portions of the work. Any subcontractor selected by the CONTRACTOR shall
have all requisite licenses for the work to be done by such subcontractor.
b. It shall be the duty of the CONTRACTOR to use reasonable care in the selection of subcontractors. Absent
objectionable performance by any subcontractor, the selection of subcontractors shall be an exclusive right of the
CONTRACTOR. The CONTRACTOR shall require all subcontractors to have workmans compensation and
liability insurance in force.
c. CONTRACTOR shall pay subcontractors in a timely manner and obtain from subcontractors any necessary
documentation required to release their liens, if any, as the work proceeds..
11. TERMINATION AND CANCELLATION
The CONTRACTOR may terminate and cancel this CONTRACT if any payment called for hereunder is not
received as scheduled, provided that notice is given to the OWNER as provided below. Upon such termination,
the CONTRACTOR shall have all remedies provided by law, including such lien rights as then apply.
The OWNER may terminate this CONTRACT upon the following conditions:
a. Failure of the CONTRACTOR, or his subcontractors, to pursue the work contracted for, absent excusable
delay, as provided in Paragraph 4 above, for a continuous period of fourteen (14) days, without a written
agreement permitting same, such agreement may be satisfied by a single notation to this CONTRACT.
b. Failure of the CONTRACTOR to rectify any condition for which building code enforcement authority has issued
a citation of violation notice, within fourteen (14) days notice of such violation, unless OWNER and
CONTRACTOR otherwise agree.
c. Any other failure to perform this CONTRACT required by the terms of this CONTRACT.
06/16/2006 Contract Proposal — Page 9 of 23
d. No termination shall be effective unless 10 days notice of OWNER's intent is given as required below, during
which time the default may be cured by the CONTRACTOR.
e. Deposit monies - Cancellation of this CONTRACT prior to the commencement of work shall result in the
forfeiture of any and all deposit monies collected. All deposits are non-refundable. The parties hereby agree that
upon such cancellation, the CONTRACTOR shall suffer damages including but not limited to the cost associated
with designing and preparing the project for commencement.
f. You may cancel this agreement by observing the requirements of The Notice of cancellation you have
received.
g. If a dispute arises out of or is related to this Contract, or the breach thereof, the parties shall endeavor to
settle the dispute first through direct discussions. If the dispute cannot be settled though direct discussions, the
parties agree the dispute shall be settled by arbitration administered by the American Arbitration Association
under its Construction Industry Arbitration Rules. In the event that arbitration is necessary, the parties agree that
arbitration proceedings shall be conducted by a mutually agreed on arbitrator in Rockingham County, New
Hampshire. If the parties cannot agree on an arbitrator, either party may file a written demand for arbitration in
accordance with the rules of the American Arbitration Association. The arbitration award shall be final and
judgment on the award may be entered in any court having jurisdiction thereof. This CONTRACT shall be
governed and interpreted in accordance with the laws of the State of New Hampshire. The parties acknowledge
that this agreement to arbitrate shall be governed by Chapter 542 of the New Hampshire Revised Statutes
Annotated. Either party may, without waiving any remedy under this CONTRACT, seek from any court having
jurisdiction any interim or provisional relief that is necessary to protect the rights or PROPERTY of that party,
including but not limited to the right to seek liens or attachment. The prevailing party in any dispute arising out of
or relating to this CONTRACT or its breach that is resolved by a binding dispute resolution process shall be
entitled to recover from other party reasonable attorneys' fees, costs and expenses incurred by the prevailing
party in connection with such dispute resolution process. Consumers in Massachusetts shall be required to
submit to such arbitration as provided in MGL c. 142A.
(2x-�o
Patrick and Lisa Shin d hn i holson
6eesign onsultant
Blackdog Builders, Inc.
Notice: The signature of the parties above constitutes an acknowledgement of the agreement between the parties
to alternative dispute resolution. Massachusetts consumers may have the right to initiate alternative dispute
resolution even where this section is not signed by the parties.
h. Unless otherwise agreed in writing, CONTRACTOR shall continue the WORK and maintain the agreed work
schedule during any dispute resolution proceedings. If CONTRACTOR continues to perform, Owner shall
continue to make payments in accordance with this Contract.
12. ENVIRONMENTAL HAZARDS
06/16/2006 Contract Proposal - Page 10 of 23
a. The CONTRACTOR is NOT responsible for the inspection, discovery, abatement or removal of any
environmental hazard including, but not limited to: asbestos; mold; lead; radon; ground water or environmental
pollution at the work site, unless specifically covered in the specifications.
b. In the event that any hazardous material is discovered during the course of construction, the testing,
abatement and/or removal shall be the sole responsibility of the OWNER.
c. Any additional costs incurred on account of suspension of the construction or changes to the specifications
due to a hazard or its removal are the responsibility of the OWNER and will be handled by a Work Order.
d. In the event that work does not resume within 30 days of the stoppage, OWNER agrees to immediately pay
the CONTRACTOR the pro rated amount of the CONTRACT price applicable to work done up to that point
pursuant to the Contract.
WARRANTY
OWNER warrants that as of the date of this CONTRACT: (1) the PROPERTY (including the land, surface
water, ground water, and improvements to the land) is, and will continue to be, free of all contamination,
including (a) "oil, petroleum products, and their by-products" (b) any "hazardous waste" as defined by
the Resource Conservation and Recovery Act of 1976, as amended from time to time, and regulations
promulgated thereunder; (c) any "hazardous substance" as defined by the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980, as amended from time to time, and regulations
promulgated thereunder, specifically including asbestos and mold; and (d) any other "hazardous
substance" (2) the PROPERTY is in compliance with all environmental laws and regulations; and (3) there
are no underground tanks on the PROPERTY
INDEMNITY
OWNER expressly acknowledges and agrees that it will reimburse, defend, indemnify and hold harmless
CONTRACTOR, all Sub -contractors, their successors, assigns and employees from and against any and all
liabilities, claims, damages, penalties, expenditures, losses or charges (including, but not limited to, all costs of
investigation, monitoring, legal fees, remedial response, removal, restoration or permit acquisition) which may,
now or in the future, be undertaken, suffered, paid, awarded, assessed, or otherwise incurred as the result of:
(a) any contamination, existing in, on, above or under the PROPERTY (including, but not limited to, contaminated
soil, mold, buildings, facilities and/or ground water);
(b) any investigation, monitoring, clean up, removal, restoration, remedial response or remedial work undertaken
on the PROPERTY; and
(c) OWNER'S breach of any warranty given herein.
13. WARRANTIES
a. The work of the CONTRACTOR, including materials and labor, shall be warranteed for a period of three (3)
years, during which period CONTRACTOR shall at its own expense correct any defect arising from its work .
unless it is a non -warrantable condition as set out in the Blackdog Builders Client Package. That package shall
become a part of this CONTRACT as if fully set forth herein.
b. Any and all warranties for appliances or mechanical systems shall be delivered to OWNER as the
CONTRACTOR receives them.
06/16/2006 Contract Proposal - Page 11 of 23
r
c. Notwithstanding any manufacturer's warranty of any component, appliance, or system, no action may be
brought against the CONTRACTOR on this CONTRACT for the performance of this work, except as provided
above.
14. SEVERABILITY
If any portion of this agreement is found invalid or unenforceable by any court, the remaining provisions shall
remain in force between the parties.
15. ENTIRE AGREEMENT
This CONTRACT consists of the documents defined herein, and constitutes the entire agreement of the parties.
It can be modified only by a written document. OWNER acknowledges that he has read and received a legible
copy of this agreement signed by CONTRACTOR, before any work was done, and that he has read and received
a legible copy of every other document that OWNER has signed during the negotiation of this Contract..
SUBM17 .
JOHn Ni holson
D signVConsultant
Blackdog Builders, Inc.
ACCEPTED:
DATE: Le
616/ 006
�Z DATE: C ((6 l o
Patrick Shin
DATE:
Lisa Shin
06/16/2006 Contract Proposal — Page 12 of 23
BOARD OF BUILDING, REGULATIONS
License: CONSTRUCT] O,NSUPERVISOR
Numb6r.,,,,-C 048847
Birtbdae. 08/34964
k 71
E'xp--Rr-e—s',:-08NV, -007 Tr. no: 11"93 0
DAVID -K BRYAN,"
7 RED ROOF LN #T
SALEM, NH 03079
Commissioner
Board of Building.Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Regist4lbn'", 1081977
BLACkDOG BUI'b 1pt cii
DAVID BRYAN
7 RED ROOF LN.
Salem, NH 03079
Corporation
i00 -�315,000 Cf enclosed space
(MGL C:112 S,66L)
j1A - Masonry only..
7;`IG
Family:
ornes
'Fa
fluret
s Pss a current edition of the
s late Building. Code
Js ss . tion
of this license.
DIG SAFE CALL CENTER: (888) 344-7233
liteuse or registration valid for individull- use only
before the expiration date. Iff0und-returntot
I Board of Building Regulations and Standard$.
One Ashburton Place Rm 1301
Boston;.Ma, 02108-
Administrator i nt s*ature
Not vali i uts*ature
06/30/2005 TRIT R-99 WAY
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
LWAI UU1/002
ACORD. CERTIFICATE OF LIABILITY
DATE(MMIDDIYYYy)
INSURANCE06/30/2005
PRODUCER (603) 669-0704 FAX, (603)669-6831
Infantine Insurance, Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE -
P.O. Box 5125
Manchester, NH 03108
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER TH E COVERAGE AFFORDED BY THE POLICIES BELOW.
Joyce Dunlap
INSURERS AFFORDING COVERAGE NAIC #
INSURED Blackdog Builders, Inc.
7 Red Roof Lane Unit 1
Salem, NH 03079
INSURERA: Peerless Insurance 24198
INSURERS: Acadia Insurance Co. 31325
INSURER C:
CBP9969957
INSURER D:
INSURER E:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR-;R
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
.. - TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
07/01/2006
LIMITS
EACH OCCURRENCE E 1,000,00
'000OO
AUTHORIZ RESENTATIV
GENERAL LIABILITY
CBP9969957
07/01/2005
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $r. 100,000
PR
CLAIMS MADE Fy I OCCUR
MED EXP
(Any one person) $ 5,00(
A
PERSONAL & ADV INJURY $ 1,000,00(
GENERAL AGGREGATE $ 2,000,00(
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,00(
POLICY PRO-
JECT LOC
AUTOMOBILE
LIABILITY
BA9860458
07/01/2005
67/01/2006
X
ANY AUTO
COMBINED SINGLE LIMIT
$
(Ea accident)
1,000,00
ALL OWNED AUTOS
—
SOD LY $
A
SCHEDULED AUTOS
(Per person)
X
HIRED AUTOS
X
BODILY INJURY
$
NON -OWNED AUTOS
(Peraccident)
PROPERTY DAMAGE $
(Per accideo
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANY AUTO
OTHER THAN EA ACC S
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE $
OCCUR CLAIMS MADE
AGGREGATE-
GGREGATEDEDUCTIBLE
DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION AND
WCA006920414
07/01/2005
07/01/2006
X WC STATU- OTH-
EMPLOYERS LIABILITY
E.L. EACH ACCIDENT $ 100,000
B
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICEPJMEMBER EXCLUDED?
E.L. DISEASE -EA EMPLOYEE 5 100,000
N yes. describe under
E.L. DISEASE -POLICY LIMB S 500,000
SPECIAL PROVISIONS below
OTHER
DESCjUPTION OF O ERA IONS I L CATIONS I VEHICLE4 /,EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Various worK throughout the policy term.
CEKI iplua 11- HOI ItFR r n1-1
AGUKU LO (LUUIIUSI rP+A- . U0"DjAOU-yoct OACORD CORPORATION 1988
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
ServEXPIRATION
Inc.
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Att: Insuran
Att: Insurance Dept
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
14203 Denver West Parkway
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Building 64, Suite 200
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Golden, CO 80401
AUTHORIZ RESENTATIV
AGUKU LO (LUUIIUSI rP+A- . U0"DjAOU-yoct OACORD CORPORATION 1988
U
O
•O �+ �
O CZ >
C
d O
XCD
5LU ca
C
.0 O) Q
U)
J+ fo
0Y
O
Lca
L O
� U
a
(h Q
caO
2 -cn
cof—c+)Z2
mm
i
SIN
t
L14
W I
114211 / I
.A -
VI
.A -