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HomeMy WebLinkAboutBuilding Permit #1069-15 - 393 SALEM STREET 5/1/2018 r' 1 / t4ORTy q ( Ot�t�a0 ._ BUILDING PERMIT TOWN OF NORTH ANDOVER � 0 /� APPLICATION FOR PLAN EXAMINATION � = d Permit NO: (J 6� �� Date Received 09A<xwcwi A.. * • �9SSA Date Issued: CHUS IMPORTANT: Applicant must complete all items on this page W� Print PROPERTY OWNER°'Y ---�1 erg Print r� MAP NO:,�7 PARCEt. - ZONING DISTRICT: District yes Machine Shop.Village., yes n7i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ' ❑ Others: ❑ Demolition ❑ Other l"Septici 1Ne11 ,❑ Floodplair► Wetlands ❑ 1Natershed`Distnct , 1Nater.LSewOr Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRAC70RNa.' , Phone b�<_ o G G /ra�,2 � �-rr ,r/ ,r Ad :;41,:_S_ f SA Supervisor's Cori"tt , Tori License. t Exp. Date , Home IC: 57 617 mpr�o�vement License, Date: ARCHITECT/ENGINEER Phone: _ •t Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ G �� FEE: $ /�y— 4 Check No.: L/©. Receipt No.: ::� k NOTE: Persons contracting with unregistere ontractors do not have access to the guarantyfund 1 nature,of _Agent/Ownet-= Signature ofi`contractor BUILDING PERMIT o* NORTH qw- 3? hit lfLED.F646 rO TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �gssAc►+us���y Date Issued: IMPORTANT• Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes. no Machine Shop Village yes 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 D Se tic �.Well _ ❑ Floodplain ❑Wetlands r p -- Watershed District Water/Sewer DESCRIPTION OF WORK TO DE PERFORMED: i Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date:: Home Improvement License: Exp. Date: ID ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund idn f, r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tob ❑ acco Sales Food Packaging/Sales El Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ w THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance Petition n No: Zoning D ecision/receipt submitted yes 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 Dump er or�siteyes, � Located Fire *a �oL+r /daet©eparte , sL � .��E a�<._ n 4�^s,•,' �� 5' �., � yL+. � �P 9 {�`�.J'i 4t�t.� 5� 5F t;� t f=��. `"+'g s`�° 'k1P` ` (� r li�M� T�,.� £, � ,. ,�- p.': . •� --� *s, a"t�`. c �a.. #i " ,�,� r�t ��.i .�,,,:;.,.et..rs•...�x. - ....w.,..: .:.a- -- �- ...�w,.;�..._.�.:.f..4t..-.'�'���._i....-d��ic.v� �• ���"�lr£.,....,�--.i.,tt<: r �� q e i 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) i i ® Notified for pickup Call Email Date Time Contact Name = F ` Doc.Bnilding 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 Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I Addition Or Decks i Building Permit Application j Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) � Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit • Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) • Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 thea appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be s I pp ubmitted with the building application Doc:Building Permit Revised 2014 Location No. ; Date f Zo �0- • - TOWN OF NORTH ANDOVER � Certificate of Occupancy $ Building/Frame Permit Fee $ �' . Foundation Permit Fee $ � Other Permit Fee $ ` TOTAL $ Check# 28943 U Dilding Inspector NORT#j Town o ., ndover 0 No. t = h�� i oLAKE h ver, Mass, ('z/ � � �s COC"K.R..'.. ��' ADRA TE D't0'P�,`'�5 S V BOARD OF HEALTH PE IT T D Food/Kitchen i Septic System THIS CERTIFIES THAT M.. . . ../11 .....4BUILDING INSPECTOR 4- Tl— Foundation �,� S .. .... has permission to erect .......................... buildings on J ...............:�t ......................................... Rough tobe 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 CONSTRUCTION S ARTS Rough Service ...... ....... ........... ....... L�� J` "^'"'"".'........ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildin 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. i n 1 LeClair hoofing Weatherproofing Inc. 830 Livingston Street#13 Tewksbury MA,01876 (978)851-8304 FAX(978)851-98 .PROPOSAL Prate#S «zr i' : Phone: Date: John � (978 ) 681-0638 May 15,2015 Sr .z Salesman: Contact Person: 393 Salem Stet. Gerard Nolan John Draper Cit}-.Stzze aze,Up Code Job Location a North .--ndover Ma.01845 393 Salem Street,North Andover MA Massachusetts Home Improvement Contractors Registration Number: 121050 Expiration Date April 1,2016 Federal Identification Number 04-314-1810 N e hereby-propose to furnish labor and materials to install new shingle roof to manufacturer's specifications by the following: This estimate covers the following roof areas: Front -lain Roof, Two rear Sidewalls, Rear Dormer and Front and Side Bays. Preparation: a Tarp the building for the removal process. a Protest all shrubbery as required a Tarp and protect the rear deck as required a Leave any existing ice and water shield in place. a Cert a new, opening in the existing sheathing for the new ridge vent on the main ridge only. a Inspect for and replace any broken,rotted, or missing roof sheathing. Any sheathing replacement cost depends on the type of sheathing. Any ledger board sheathing replacement will be installed at an additional $6.00er linear foot and an plywood sheathing will be installed at an additional $75.00 for p Y P Yom' g replacement of%inch CDX plywood per partial or full 4 foot x 8 foot sheet. We will try to match the existing sheathing as closely as possible. a Inspect and re-secure the any loose sheathing as required. Installation: a Install new White,C' umBirown o Mill finish 8 inch aluminum drip edge along all eaves and rakes. a Install Ice & Water Shield 6 feet along the eaves of the roof. a Install.Ice&Water Shield 18 inches around all penetrations. a Install Ice &Water Shield at flush to the wall at all roof and wall junctures. a Install Ice&Water Shield 18 inches at the chimney. Install Ice& Water 100 % coverage over the rear dormer roof. a Cover the balance of the roof with 15 lb. Felt. a Install a starter course on all eaves. a The shingles will be installed using roofing nails by pneumatic roofing tools. Page i of 6 k e • :,.e shingles that will be used are GAF Timberline HD (Architectural). Y ski choice of standard manufacturer colors: • 1� h a new GAF Cobra Rolled Ridge Vent at the existing ridge openings and extend to the ends of rt building • =t ll Seal A Ridge cap shingles on all ridge and bay hips. • 1 - 1 new vent pipe flashing up to 4 inches. Any larger will be properly sealed. • ?te-=3s-;�and seal the existing chimney flashing and counter flashing. Any new would result in an w LL-al cost to the contract. • Vii- �e and seal the existing sidewall flashing. Any new step flashing replacement may require siding Oval. T h s would result in an additional cost to the contract. • Re- se and seal the existing heat stacks and other penetrations. Any new would result in an additional To the contract. • Cieann and re-secure existing gutters. Skylights: • Remove the existing Veluex skylight and pitch kit. • � mil a 2x-'. nailer at the perimeter of the opening. • Miall new ti eluex ECL skylight flashing kit. (Supplied by others.) • - tall the Veluex skylight. (Supplied by others.) • i ,h1 ice and a ater shiel as re uired and ro e�r tie into the new r. �,,.d r r ./ /V fit) Our Proposal Includes The Following: • Clean and legally remove 99.9%of outside job-related debris. The jobsite will be cleaned daily. • Wm -will require space for a dumpster. The placement area will be agreed upon before placement. • Prov ide standard GAF Limited Lifetime shingle manufacturer's warranty. • Provide ide standard LeClair Roofing& Weatherproofing Inc. (2)year workmanship warranty. • Cara- all necessary workers' compensation and liability insurance. Contract Requirements: • will require electrical power in close proximity to the work site. • Ani- electrical wiring on rakes,eaves or other areas that will endanger LeClair Roofing& Weatherproofing Inc.personnel will be removed or covered by others before the start of the project and reinstalled by others after completion. Unit Pricina for Unforeseen Conditions: • To cut a reglet and install new lead counter flashing on one chimney would be an additional $395.00 during the roofing project. • Any sidewall flashing will be at $25.00 per linear foot. Additional Labor and Material Costs for Unforeseen Conditions if there is NO CHAGE ORDER: • A signed change order with a description of the work and the proposed cost will be provided before the work is started. If there is no signed change order any additional work beyond the above scope of work will be done at a rate of$75.00 per man per hour for roofing and$80.00 per man per hour for sheet metal and carpentry (rates subject to change),plus materials,portal to portal and$.58 per mile travel expense and any per diem charges UNDER NO CIRCUMSTANCES SHALL ANY ADDITIONAL WORK TAKE PLACE WITHOUT THE OWNER'S AUTHORIZATION Page 2 of 6 Contact Notes: m This proposal is subject to change unless acceptance is made within 30 days of the date of issue. d All MI,assachusetts Sales taxes are included in our proposal. e Subject to manufacturer's price increases as they occur. • All NNork X311 be performed per OSHA safety standards. Skylight Notes: Ater consulting Veluex about the pitch kits the solution expired above was way to install new Veluex Tights on a pitch of 2 percent or greater. Required Permits: aur proposal covers the cost of any required permits and will be secured by the contractor as the homeowner"s agent. (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A.) Contract Acceptance o Upon signing, this document becomes a binding contract under law. Unless otherwise noted within thisdocument, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. E. imated Start Date: Estimated Completion Date: hL Start Dates Given Are Weather Dependant And Will Be Decided Upon Acceptance Of The Proposal. I'e propose hereby to furnish materials and labor, complete in accordance with above specifications, or the sum o Eight Thousand Six hundred Twenty Five Dollars ($8,625.00) Payment terms are to be as follows: 113 Deposit $ 2,875.00 *113 At Start $ 2,875.00 *Balance Upon Completion $ 2,875.00_ *Total Payments $ 8,625.00 DO NOT SIGN THIS PROPOSAL IF THERE ARE ANY BLANK SPACES LeClair Authorized Signature Sign Here Date: May 15.2015 }ate Here ACCEPTANCE OF PROPOSAL—The above prices, specifications, conditions and additional terms are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance Js-/-Z Signature: Date_ ere] ign Here Signature: 5ign Here Please Make Checks Payable To Steve LeClair Pace 3 of 6 Contract Arbitration The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in Massachusetts General Laws, chapter 142A. Ho e Nner's Srgla e Contractors Signature Sign Hare Sign Here NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Additional Proposal Conditions Proposal Contingencies o All agreements are contingent upon strikes, floods, accidents,fires and other delays beyond the control of the roofing contractor.LeClair Roofing& Weatherproofing Inc. maintains required levels of Workers Compensation and General Liability Insurance. e It is agreed that all payments will be made when due. Warranties will be void if full payment is not received. It is further agreed that the customer will pay all costs of collections incurred by LeClair Roofing& Weatherproofing Inc. including but not limited to attorney fees, any cost associated with recording liens,and any other associated charges. It is also agreed that any late payments will accrue finance charges a 1.5%per month finance charge will be added to all invoices on the 315`day. All legal and/or collection fees will be paid by Buyer. o Any alteration or deviation from the plans and specifications involving extra costs not specified in the contract will be agreed upon in verbal or written format prior to performance of additional work. o All materials to be as specified(or equal to or superior in performance). o All work to be conducted in a workmanlike manner. o This proposal MAY NOT be used for any legal or lawsuit cases unless approved by LeClair Roofing & Weatherproofing Inc in advance and any costs approved in advance. o Although the execution of this contract does not initiate the filing of a lien,LeClair Roofing& Weatherproofing Inc. reserves the right to file liens for non-payment as allowed by law. Structural Concerns o Contractor is not responsible for structural soundness and shall have no liability whatsoever for the supporting structure to support men,materials, equipment,ice, snow or water. This clause shall apply regardless of the timing between the occurrence and the performance of the work. a Contractor is not responsible for interior damages resulting from structural deficiencies as outlined above. Exclusions a Contractor's scope of work shall not include the detection, abatement, encapsulation or removal of asbestos or similar hazardous substances. The contractor has the right to discontinue work if and when hazardous materials are discovered. Contractor shall be entitled to receive compensation for changes in the scope of work or length delays encountered as a result of hazardous materials as detailed above. ® Bonds, snow removal,painting and cleaning of dust and or particles in attic after roof removal, acts of nature,winter conditions and snow shoveling. Page 4 of 6 '® Other Warranty Information ® All warrantees will be issued after payment has been received in full. o All warranties will be null and void if any work such as snow removal and ice removal, satellite dish or antenna installation, electrical heat tape, guide wires, gutter work,or any work requiring roof traffic or construction takes place on the roof in any way. Any work on the roof should only be done after consulting with LeClair Roofing& Weatherproofing Inc. to make sure the work will not void the warranty or guaranty. o All warranties on materials and workmanship are with the original owner and may be transferred to the next owner with permission from LeClair Roofing& Weatherproofing Inc. o The warranties mentioned above shall have no effect on the owner's rights under the provisions of MGL c. 142A. Other Information o In some communities all property taxes must be paid in full or the permit may be denied. o If LeClair Roofing allows the owner to place any additional debris in the dumpster o There will be NO HAZARDED WAISTE MATREIALS ALLOWED Homeowner's Rights LeClair Roofing& Weatherproofing Inc is registered Home Improvement Contractor with the Commonwealth of Massachusetts. Should you need to make any inquiries about LeClair Roofing& Weatherproofing Inc (or any other contractor or subcontractor)relating to a registration,they should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston,MA 02116 Phone: (617) 973-8700 Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Page 5 of 6 Cancellation: Under sections, MGL c 93 s 48; MGL c 140D s 10 or MGL c 255D s 14 as may be applicable, you may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the"Notice of Cancellation Form" as well as the"Waiver of Right to Cancel Form"below for additional information. NOTICE OF CANCELLATION REQUIRED BY FEDERAL and STATE LAW Date of Transaction lelr—�e You may cancel this transaction without penalty or obligation,within three business days from the above date. If you cancel, any property traded in, any payments made by you under the contract or sale, and any negotiable instruments executed by you will be returned within ten business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this contract or sale; or you may, if you wish,comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller or you agree to return the goods to the seller and fail to do so,then you remain liable for the performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other any other written notice, or send a telegram to: LeClair Roofing& Weatherproofing Inc. 830 Livingston Street Tewksbury MA, 01876 Not later than midnight of Wil " f ,-" V`�ate). I hereby cancel this transaction. Date: Buyer's Signature: Page 6 of 6 �r The Commonwealth of Massachusettsa Print Form " Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 _ Boston,MA 02114-2017 - www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual):LeClair Roofing&Weatherproofing Inc. Address:830 Livingston Street Unit 13 City/State/Zip:Tewksbury MA,01876 Phone#:(978)851-8304 Are you an employer?Check the appropriate box: Type of project(required): 1.El I am a employer with 25 4. n I am a general contractor and 1 6 0 New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers'comp.insurance comp.insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0✓ Roof repairs insurance required.]t c. 152,§1(4),and we have no 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Star Insurance Company Policy#or Self-ins.Lic.#:WC0707947 Expiration Date:1/01/16 Job Site Address: g ���14 '57 City/State/Zip: 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 cern under the pains.and Eenalfies o e 'u that the information provided above is true and correct. Signature -- Date Phone#:(978)851-8304 Official use only. Do not write in this area,to be completed by city or town offciaL 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#• r OP ID:AT �...,.. - CERTIFICATE 8F LIABILITY INSURANCEDATE(MM/DD/YYYY) 01/14/15 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 ONCTACT DeSanctis Insurance Agcy,Inc: Phone:789-935-8480 NAME; 100.Unicorn Park Drive Fax:781-933-6645 PHONE ac,No): Woburn,MA 01801 EMAIL ADDRESS: 90S—MER ID 0;LECLA41 INSURERS)AFFORDING COVERAGE NAIL 0 INSURED LeClair Roofing , INSURER A.Acadia Insurance Company 131325 _ Weatherproofing,Street INSURERS:Star Insurafice CC� 092245 830 Livingston Street --- — Tewksbury,MA 01876 INSURER C- { INSURER D: �TM INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 75IS 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: h TRUBR;' POLICY EFF POLICY EXP TR TYPE OF INSURANCE, POLICY NUMBER MMlOD/YYYY MM/DDIYYYY LIMITS GENERAL LIABILITY �i - {4 EACH OCCURRENCE $ 1,000,00. A X COMMERCIAL GENERAL LIABILITY 1 iCPAS077662 01/01/15 01/01/16 PER MISkGES(fie Ea occurrence) $_ 280,00 CLAIMS MADE OCCUR j MED EXP(Any One person) I$, 5,00 X I Blkt Contractual ! t X XCU Hazards 'GENERAL S ADV INJURY $ 1,000,00 GENERA'LAGGREGATE S 2,006,00 17 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG_j$ 2,000,00 POLICY jX PRO• LOC I — I S AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT I A ANY AUTO. (Ea accident) 1$ 1,000,00 I BODILY INJURY(Per person) Is ALL OWNED AUTOS ] I 1 i BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS CAA507166412 I 01/01/15 01101/16 I A HIRED AUTOS PROPERTY DAMAGE $ X i(Per accident)- _-------+— A X NON-OWNED AUTOS X UMBRELLA LIAR I X 1 t OCCUR ( EACH OCCURRENCE $ 8 000 00 EXCESS UAB I _ A CLAIMS-AAADE � UA5077865 E 01101115 01101/16 j AGGREGATE $ 51000,00 jl—_ DEDUCTIBLE t Ic {{} ►$ X RETENTION $ NONE i ! I$ WORKERS COMPENSATION E WC STATU- I OTH- AND EMPLOYERS'LIABILITY X I TORY,LIMrrs I I3 ANY PROPRIETOR/PXCLUDED? CUTME YIN N WC707947 01/O7/15 � 01/01/16 (Mandatory In EREXCLUbEO? a N./AI jMA,0NHE.L.EACHACCIDENT tt$(Mandatory)n andNH) E.L.DISEASE-EA EMPLOYEE;S_ 1 000 00If ppas describe under I j _ , , DESCRIPTION OF OPERATIONS below , E.L.DISEASE-POLICY LIMIT I S 1,000,00 A Installation Float CPAS077662 01/01115 01/01/16 (Limit 100,00 Stored Materials t (Deduct 50 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) ILLUSTRATION OF COVERAGE CERTIFICATE HOLDER CANCELLATION ILLUS-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ILLUSTRATION OF COVERAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED AEPRESENTATIV E O 1988-2009 ACORD CORPORATIO ..Ail rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD f c�ti Massachusetts -Uepartment of Pumic SafeEy ? �J Board of Building Regulations and Standards Construction Supervisor License: CS-079509 , IN STEPBEN P LEC" 38 BRETT CIR It L2 PELHAM NH Q3$76 ✓, ..�' " "`l L Expiration Commissioner 09/27/2016 :•.. �lt.L�OlN�l6Nf!!C!!d!!l.-n�,ff�?/6GlI:f9(lCllliC!'ri�6ftee of Consumer Affairs&Busibess Regulation i ME IMPROVEMENT CONTRACTOR � egistration; 921050 lope: zpiraGon: ,.4/t%2016•: Private Corporatic LECLAIR ROOFING*;w INC STEVE LECLAIR 830 LIVINGSTON ST TEWKSBURY,MA 01876 #3lftitsecretary i 7.1 Q1► TH Off, ti3SET�S r SHEEN' SEAL 1SSUfS 7'#[{CE t�}OCL;LtO,Wfflt #i��`{:1r-C- '15E 'A-STER � F.S�'lil'l. r STPE#lrN J,P LE Cf.R i:R i J' r t r f z a 3S Dh C r '�'= • sz