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HomeMy WebLinkAboutBuilding Permit #450-2017 - 35 MEADOWVIEW ROAD 10/26/2016 V BUILDING PERMIT u� NORTH q ,1l.ED 16 TOWN OF NORTH ANDOVER F�cry`''` '` o 4fJtYAPPLICATION FOR PLAN EXAMINATION : fy� Permit No#: Date Received 1 0 ` a,(Q s ) C`Ct X04 h T �gSSACHUs���� Date Issued: 10- a(o - a{3 I(P IMPORTANT:Applicant must complete all items on this page LOCATION -- Print PROPERTY OWNER/"11 kt ;5 _�. c;- C�Rt��►.tt 1,, Print 100 Year Structure . y: _r yes no MAP It ?j .. PARCEL. d0 ! ZONING DISTRICT:_Historic District yes no Machine Shop Villageyes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well ❑ Floodplain; ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name:_ I K C r rv%tZ I lyg Phone' Address: ,� �I o,✓ I�'7>- Contractor Name:R DP,1A 4) Phone:_ °l'7 3_ ?i'7%7 _-1 f Cts Address: 4 l WA A-r,l ,��( �� NlnAtu Supervisor's Construction License: C :S 1 qhs as Exp. Date:___ 5112L F -Home Improvement License: J. ' _ Exp. Date: ARCHITECT/ENGINEER 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: $ QIC00 FEE: $_ (9 bU Check No.: 1 U3(O Receipt No.: '310-913 NOTE: Persons contracting with unreg' ere c tractors do not have access to the guaranty fund Signature of Agent/Owner ignature of contractor �] 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes d Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes a :no Located at 124 Main Street Fire Department signature/date --- © _ '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, 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 NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application u Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract u Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) a 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: 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 Location 3�5' Aft 0 J�i \�41( w -RJI No. aUt-7 Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $6g0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ' r' u a (, Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 56,590.00 m $ - $ 679.08 Plumbing Fee $ 84.89 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 84.89 Total fees collected $ 948.85 35 Meadoview Road 450-2017 on 10/26/2016 Kitchen remodel r -i NORTH . � . : 1c . : ver No. - h ver, Mass, • a • COCMICNlWK.I y1. �as RATED o'P�,�'(� V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........ b' ........ IrA.. BUILDING INSPECTOR ..... �® has permission to erect .......................... buildings on .............. W..� Foundation . ..... 4CA'f#V.....AM .e Rough to be occupied as • ...... Chimney provided that the person accepting this permit shall in every respect conform to the terms 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service ........... . . .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. NQ FD 11541 NorrrM 0 TOWN OF NORTH ANDOVER # RECEIPT This certifies ................... haspaid....� .................................................................................. /......................................... Received by .......... . .......................... Department......... �A-1.. . .......................................................... WHITE: Applicant CANARY:Department PINK:Treasurer s The Commonwealth of Massachusetts Department of Fine Services Office of the State Fire Marshal P.0.Box 1025 State Road,Stow,MA 01775 PERMIT Date: Permit NO Dig Safe NumberCity of Town) 1£Applicable} . In accordance with the provisions of MGL. Chapter 10 as provided in section 5 2 7 CMR 34 01 Stmt Date This Pent is granted to: /���� &'Lz . Full name of person,Firm or Corporation Permission to Locate dumpst:er for construction/renovation/demolition of structure Comments: dumpster be 25 ' from structure or covered with tarp or plywood Restrictions: at end of workday at (Give location by street and no.,or describe in such manner a toprovied adequate identification of location) Fee Paid S i57� LIZ � This Permit will expire 1/,ZV—,Ii( (Signature of ofcal granting permit} Offical granting permit ` r (Titl �� TWIC D;:PMIT MI ICT FSP r-nhIRPI['_I InI IRI V PnJgTPn 110ntJ THF ' The Commonwealth of Massachusetts _ �r Department of Fire Services Office of the State Fire Marshal P.O.Box 1025 State Road,Stow,MA 01775 PERMIT Date: '110�9 Permit No Dig Safe Number (City of Town) (If Applicable) In accordance with the provisions of MGL. Chapter � 10as provideedd in section 5 2 7 CMR 34 �J�__ Start Date This Permit is granted to: i/�� ��a 4its Full name of person,Firm or Corporation Permission to locate dumpster for construction/renovation/demolition of structure Comments: dumpster be 25 ' from structure or covered with tarp or plywood Restrictions: at end of workday at (Givo location by street and no.,or describe in such manner ner a to provied adequate identification of location) Fee Paid r � This Permit will expire �f,�U/� (Signature of offioal granting pezmit) Offical granting permit (Titl mmw** TWIA PRPMIT MI tCT'Ftl= [_nhI-gPI['_l ItIl Ie:I V Of)-QTI=n 1 lPr)M T411= PRFMtCP1R "��� 188" r L---30"—30" 27" • 30" 0 21" 27" V 46" 5 .. 80" 33;" —74 29" " V CJ 342 UR 42 U 2 29' 8 2 St v' W30368D W2136R - W2718 CW273 �[=�4XSO 24AISHW —EXTftA-EXTRAINC B21L---131,S B D.WR6.....r..3133�D 1�1$. _ , 2)TOUCHUP KITS DOGGIE(�1 - ARVAL36 i v 2)SCRIBE=BAT1S DOOR BTL34 Bu1NIQo�y} 1)FILLER=UF342 JJJ BTL34 O W POST=3 1/2"x 3 1/2" CROWN MOLDING lad ��� CUT PANEL/FILLER {+ p A 6)FURNITURE BASE ING=ASBS 4 1/2 WIDE tt�� 7)SMALL COVE CRO $SMCCB i HARWARE INSTALL PANEL 01WES1542) A CUP PULL ON DRAWE -BP53010-FB `aV �� ON RIGHT SIDE w (a Cn KNOB ON DOORS=B �5 FB `J ke�, OF STACKED WALL S 1h�� ( Q,L iLP CABINETS TO HIDE SEAM - - NZ" Ch i -------------------------- w -- — --_ R--r_--- BDE24- DB30 4BFRDG � 0 !01 MMZ D -V3BOE36 WDE36 _ O _. ... . Z 3 ' 44 -------------4?- }Ne. 4 k2"J-30'��2 30" ...I C= .. 645"58 19" a ca us .. 30" 36° 30"UL CD , *i[ 2 z °" 24" , i Na. .w O 102 .., — CL 834" .8 All dimensions_size designations 20 on This is an original design and must Designed: 10/13/2016 C3.C given are subject to verification on r o 0G� / not be released or copied unless Printed: 10/1.3/2016 ,a ,lob site and adjustment to fit.job applicable fee has been paid or job conditions. order placed. a PJF Crumrine Beth and Mike All Drawing#: 1 I No Scale. 4. T:UCZN%"TmP, 8A-5F, MC71AI THIS IS A FINAL LAYOUT Approval below constitutes Note:This drawing is an artistic �)j'��C�����,� Designed: 10/13/.2016 interpretation of the general , rscHNo►oeiesG/ Printed: 10/]3/2016 your acceptance and understanding appearance of the design.It is of this layout not meant to be an exact rendition. PJF Crumrine Beth and Mike All Drawing#: I .o WMA L 1 YF-- Roo'COM3 o • - 0 e e a 4 Rat '• you THIS IS A FINAL LAYOUT 3'' per,,, EA� R 11 THIS below constitutes Note:This drawing is an artistic 2� yuractpt�nt and understanding Designed: 10/13/2016 interpretation of the general secH►ao�oc�Esi� Printed: 10/13/2016 this ��layOute appearance of the design.1t is not meant to be an exact rendition. X PJF Crurnrine Beth and Mike Ail Drawing#: 1 AN • e QDX11/ TTQD FFlkr.>Ge- ®PEN IN loop T I ISA VFlNAL LAYOUT Note:This drawing is an artistic LOGIESDesigned: 10/13/2016 ApPf0VGl`Now constitutes interpretation of the general P20& Printed 10113/2016 t+�FF' tanoq and undemtandin � � g - appearance of the design..It is a of fhips layout! not meant to be an exact rendition. R: 7 PJF Crumrine Beth and Mike All Drawing#: 1 i y u THIS IS A FINAL LAYOUT Approval below constitutes Note:Note:'This drawing is an artistic j Des10/7/2016 your accTECHlIOiOG1 eptance and understanding ° interpretation of the general Printed: 10/12/2016 1� .E5 of this layout. LD appearance of the design.It is not meant to be an exact rendition. x PJF Crumrine Beth and Mike All Drawing#: 1 BriCo. Building&R m d lis e o e )g 4 T Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 North Andover, MA 01845 LLC 978-479-1526 9/1/16 adambrico@gmail CONSTRUCTION CONTRACT This Construction contract dated as of 9/1/2016 By and between Mike and Beth Crumrine of 35 Meadowview rd North Andover MA 01845 Owner and contractor in consideration of the mutual covenants hereinafter set forth, agree as follows Article 1 Contractor shall construct the items in Exhibit A in accordance with contract documents, as identified in this contract on property which is located at 35 Meadowview rd North Andover MA Article 2 Contract Price The Owner agrees to pay BriCo Building and Remodeling $56,590.00, for doing the work outlined above. See exhibit A for payment Schedule details. Article 3 Change Orders Both parties shall agree any unforeseen work or changes requested during this project to be granted with written approval. Any extra work resulting from unforeseen problems will be priced accordingly on site and be done with written approval Article 4: Contractor's Representation Contactor has familiarized itself with the nature and extent of the contract documents, work site, and all local conditions and regulations that in any r manner affect cost, progress and performance of the work. Contractor is duly licensed to perform the work as required by laws and regulations. Article 6: Contractors Responsibilities The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices, and all work performed shall be subject to final approval by Owner. All work to be done incompliance with Massachusetts building code. All materials and equipment shall be of good quality and new. All materials and equipment shall be installed in accordance with manufactured specs. Contractor shall be fully responsible to owner for all acts and omissions of its subcontractors, suppliers and other persons performing or furnishing any work under contract with contractor. Contractor shall be responsible for initiating maintaining and supervising all safety precautions in connections with work. Contractor shall comply with all applicable laws and regulations relating to the safety of persons on the property Contractor shall repair or replace at Contractors sole expense every portion of the work that is damaged or destroyed before final completion. Contractor warrants and guarantees to Owner that all work will be in accordance with the contract documents and will not be defective. If within one year after the date of the final completion or such longer periods of time as may be described by laws or regulations or by the terms of any specific provisions or applicable special guarantee in the contract documents and work is found to be defective. Contractor shall promptly without cost to owner and in accordance with written approval correct such defective work. Article 7: Insurance Contractor shall maintain general liability and work-mans comp insurance for the work being performed at 35 Meadowview rd North Andover MA. Contractor shall deliver to Owner certificates of proof. Owner shall be responsible for purchasing and maintaining Owners Liability insurance and or other reasonably appropriate insurance. Article 8 Termination Termination by Owner. If Contractor breaches any obligations under this agreement then owner may give Contractor written notification identifying such breach. If Owner has not cured such breach within 7 days from written receipt or if breach cannot be cured or Contractor does not begin to cure or fails to diligently prosecuted cure to completion Owner may terminate contract and take possession of work. Termination by Contractor. If Owner breaches any obligations under this agreement then Contractor may give the Owner written notification identifying such breach. If breach is not cured in 7 days or Owner has not agreed to resolve such breach then contract may be terminated. Exhibit 9 Owner and Contractor each bind itself, its partners, successors, assigns legal representatives, to the party hereto, its partners successors, assigns and legal representatives in respect to all covenants, agreements and obligations contained in the Contract Documents. This contract and all issues disputes and matters arising out of it shall be governed by and construed in accordance with the laws of the state in which the Property is located, exclusive of the body of the law governing conflicts of laws. IN WITNESS WHERE OF, Owner and Contractor have signed this Contract This Contact will be eff a on September 8, 2016 P Owner. Address of Property_35 Meadowview rd N. Andover MA Contractor: A.am Brien BrOO Build andlRemodeelin - 'g g Address:417 Waverley Rd North Andover MA 01845 Title: Owner Operator D riCo. Buildi;l &Remodeling g k . Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 North Andover, MA 01845 LLC 978-479-1526 9/8/16 adambrico@gmail Contract Mike and Beth Crumrine 35 Meadowview rd N. Andover MA 01845 978 886 3509 Exhibit A: Job Description: Kitchen remodel with removal of wall • Demolition of kitchen including 2 walls (Sheetrock only) ceiling and floor. All debris to be demoed and disposed. Wall between dining room and kitchen to be removed. 15 Yard dumpster will be placed on site for debris • Dining room hardwood floor removed. Transition strip to be installed at dinning room if necessary • At the removal of wall between dining room and kitchen. Structural beam installed to support attic ceiling above. Engineered beam size to be calculated. If it is determined and the wall is not structural a credit will be given. • New kitchen casement window installed, window location tbd. Area to be framed • All exterior walls that are opened to be insulated. All demoed areas to be blue-board and plastered. • New 3 '/a" hardwood floor installed, sanded, stained and polyurethane. Stain color to be determined • Electrical layout to coincide with kitchen design. Including, led recessed lights, under cabinet lights, 3 pendant location (pendants supplied by owner). Cable location, all outlets to code. • Installation of cabinets an allowance of$12,000.00 is included for cabinetry purchase. http://norfoikkitchenandbath.com Handles or knobs install but purchased and supplied by owner. Kitchen layout designed by a professional cabinet company and to include 3D designs. Permit will not be granted until design is finalized • Granite counter tops supplied and installed and allowance of$4,000.00 is included. Stainless steel sink included with granite purchase. If farmers sink is desired, customer is responsible for purchase. Faucet and disposal supplied by owner and installed by plumber. • New trim work installed to match remaining house. • Entry floor area to receive the and underlayment. An allowance of$400.00 is included for purchasing of tile and grout. • New entry door Therma tru http://thermatru.com entry door install with new exterior trim to be PVC, interior trim to match remaining house. An allowance of$1500.00 is included for purchasing of the door. Knob supplied by owner installed by BriCo Supply and install new sliding patio door. • Remove and dispose existing door system and all trim work. • Install new white vinyl Harvey Sliding Patio door with grids (only grid patterns are 151-ite and Praire) • All new interior and exterior trim. • White handle locking mechanism included • Painting not included. • Permit fee included. Allowance Total $17,900.00 Total combined Estimated Cost $53,470.00 Job Description 2 Bathroom remodel. • Demo and remove existing tub shower tile. New fiberglass tub unit installed. An allowance of$600.00 is included for the purchase of the tub.(curved) New shower valve installed. An allowance of$500.00 is included for new showerhead and tub finishes. Walls to be tiled one niche installed in wall. An allowance of$300.00 • Installation of recessed light over shower and switching. • Exhaust fan supplied, installed and vented • Floor to be demoed and receive new tile and underlaY ment. An allowance of$300.00 is included for purchasing of tile and grout. • Baseboard Heat to be cut back and shortened. • Bead board blended in • Painting not included Allowance total $1700.00 Total combined estimated cost $5900.00 Grand Total including all allowance is $56,490.00 h The Owner agrees to pay BriCo Building and Remodeling $56,590.00, for doing the work outlined above. The following payments will be paid to the contractor in the following manner: • First Payment is of$1,500.00 is due once contract is signed. Secure permit fees, kitchen design appointments, dumpster, window order and product organization. Deposit of cabinet total will be due prior to construction beginning. Cabinet balance will be due at shipping date. This cost is not included in the payment schedule because it is an allowance. • Second Payment of 12,000.00 is due permit has been obtained and construction is scheduled to begin. • Third Payment $10,000.00 Once walls are sheet rocked and plastered. • Fourth payment of 8,000.00 is once flooring is complete and finish's are beginning • Final payment at completion of project. Allowance totals to be calculated and credit or extra cost will be presented. Purchasing of products with an Allowance may cause payment schedule to change. An "Allowance" is an average cost for products that need to be purchased and are based on style.The cost is calculated to the dimensions of your project. If your item exceeds the allowance cost you are responsible for the difference. If the item is lower then the allowance cost a credit for the difference is applied. All subcontractors that are hired by BriCo or the homeowner must carry the appropriate license and insurance to perform work in the state of Massachusetts. The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices, and all work performed shall be subject to final approval by Owner. All work to be done incompliance with Massachusetts building code. BriCo takes on full responsibility of all necessary inspections. All craftsmanship is warrantied for one full year from completion of construction. Warranty is voided if repairs are necessary due to a natural disaster. All glass installed meets state energy code for performance and efficiency. Each glass unit will contain its own energy certificate. R Any unforeseen work or necessary repairs found during this project to be brought to the owners attention as soon as possible. Any extra work resulting from unforeseen problems will be priced accordingly on site and be done with written approval. BriCo is not responsible for anything that occurs on site that is not directly involved with the construction of this project. BriCo Building and Remodeling is a fully licensed and insured LLC company. License numbers are provided in the header above and current insurance documentation upon request. BriCo is a full service general contracting company. We take pride in our work look forward to the opportunity to work with you. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ADAm rl Address: 91-1 V✓A� rC.by 61b City/State/Zipt AN hOAA<'. 618145 Phone#: 77&:! �4 7 Are you an employer?Check the appropriate box: Type of project(required): 1 9I am a employer with—�-- 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 7. Remodeling _ t g 2. I am a 1 listed on the attached sheet. ❑ sole proprietor or partner 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 required.] officers have exercised their 10. Electrical repairs or additions 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.❑Roof repairs insurance required.]f 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. t Homeowners who submit this affidavit indicating they are 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 the policy and job site information. Insurance Company Name: ��,,/� L,, r S Policy#or Self-ins.Lic.#: T?_. U346 to P-5o`z 16 Expiration Date: Job Site Address:5 rl, ZW k 7— IC 4> City/State/Zip: AIx...novifft Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: V U Phone#: 78 �-7�/ ).5 ?K 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#: AC40RO CERTIFICATE OF LIABILITY INSURANCEDATE(M"IIDDfYYYY) `� 1 7/11/16 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: Tricia Sabulis Armand P. Michaud Insurance Ag PHONEFAX 105 Haverhill StreetE-MAIL (978) 685-2549 N : (978) 794-0822 ADDRESS: triciasabulis@michaudinsurance.com Methuen, MA 01844 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Green Mountain Insurance Co. INSURED INSURER B:Norfolk & Dedham MA BRICO Building & Remodeling LL INSURER C: Adam J Brien INSURER D: 417 Waverley Rd INSURER E: N Andover, MA 01845 INSURER F: COVERAGES CERTIFICATE 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. INSR AWL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M/DD/Y MM/DONYYY LIMITS A GENERALLU1BILnY20009201 4/13/16 4/13/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY MrGEISETORENTED ocrurrencel $ CLAIMS-MADE Fx—]OCCUR MED EXP(Arty one person) $ 5,000 PERSONAL&ADVINJURY $ GENERAL AGGREGATE $ 2,000,000 GENTAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRO- LOC $ B AUTOMOBILE LIABILITY 91561617A 6/18/16 6/18/17 COMB ideDNSINGLELIMIT $ ANYAUTO BODILY INJURY(Per person) $ 100.000 ALLOWAUTOS NED SCHED2, AUTOS BODILY INJURY(Per accident) $ 300,000 HIREDAUTOS _AUTOS P er.UdTY Dmt)AMAGE $ 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LWBILITY Y/N ANY PROPRIETOR/PARTNEWEXECUTNE E.L.EACH ACC[DENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yyes,describe under DESCRIPTIONOFOPE RATIONS below E.L.DISEASE-POLICYLIMTT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Renerks Schedule,if more space is regri red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Tricia Sabulis ©1988 2010 ACO RD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: (978) 685-2549 Fax: (978) 794-0822 E-Mail: triciasabulis@michaudinsurance.com ACC)RV® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD"YYY) 07/11/2016 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(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). PRODUCER CONTACT NAME: Trudy Lawler MICHAUD INSURANCE AGENCY BC.ONN : (978)685-2549 FA(AIX No: ADDRESS:Itrudylawler@michaudinsurance.com 105 HAVERHILL ST. INSURER(S)AFFORDING COVERAGE NAIC# METHUEN MA 01844 INSURERA: TRAVELERS PROPERTY CASCO OF AM 25674 INSURED INSURER B BRICO BUILDING&REMODELING LLC INSURER C: INSURER D: 417 WAVERLEY RD INSURER E: N ANDOVER MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 67853 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. INSRTYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYY MMID LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ DAMAGE O N ED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO POLICY JECT LOC PRODUCTS-COMWOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIREDAUTOS AUTOS ED PROPERTY DAMAGE $ Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ � DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTEETH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100,000 A OFFICEWMEMBEREXCLUDED? NA NIA NIA 7PJUB4618P50716 04/19/2016 04/19/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more 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.govfwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover MA 01845 (_1 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • �' Massachusetts Department of Public Safety ® Board of Building Regulations and Standards 4 License: CS-104428 Construction Supervisor 1 1 ` ADAM J BRIEN �� Y 417 WAVERLY ROAD t NORTH ANDOVER MA 018451 CA__l� Expiration: Commissioner 05/12/2018 �H. : ♦mninistrrtton , This card acknowledges that the recipient has successfully completed a I 10-hour Occupational Safety and Health Training Course in ¢ Construction Safety and Health Adam Brien Marcus Nerino 1 /19/10 (Trainer name—print or type) (Course end date) ( Numt` lu1RaQ�137� F�zpires 7!2712020 13RIEN AM,:� C1�ie�panvr�w�iacueaC�o�Coa�ua t , '\ 'Office-of Consumer Affairs&B'us► t s�Regulation { '; pNfB IMPROVEMENT CONTRACTOR egistration 168512 TYI _ r — . Expiration `3/1/201:7 LLC BRICO BUILDING AND REMO��D``E-ING LLC l:� � �Ste•;i �" ADAM BRIEN 417 WAVERLY RD NORTH ANbOVER;MA.01845 Undersecretary, f