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Home My WebLink AboutBuilding Permit #653-16 - 40 RIDGE WAY 11/25/2016,�)e/,7W,#vtrU -)-t-IZ, Permit N0: I Date Issued: /// .2'�- TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Y Date Received ` IMPORTANT: Applicant must complete all items on this page I LOCATION U. - . 906 . Print. PROPERTY OWNER y��/ /•' !� Print" 100 Year Old Structure yes Cno MAP NO: -qkPARCEL ZONING DISTRICT: Historic District yes Machine Shop Villaqe ves 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 ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: " NO Identification Please Type or Print Clearly) OWNER: Name: TS, PCULCs CftlCoytiL Phone: Address: 4_' 0 IL Ib (& 1vA-t/ N•AAvoovt�k , /;'74 CONTRACTOR Name: )AAkeiJ MAP-rll-O Phone: 7 16- qoz- 33 &n Address: �/�' /Y�w AV �_ �j� iv iy ll�q D/dye Supervisor's Construction License: 663 y� Exp. Date: ?)-/S"_- /7 Home Improvement License: ID y46/ Exp. Date: '� -/7 -/ ARCH ITECT/ENGINEERL�9,40�--y141600MEr'6t Phone: Address: 5 V 30f7a/J /Z -O N67301(y 1h?A 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: $ 500— FEE: $ �� Check No.: Receipt No.: ! ` NOTE: Persons cont acting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner / ¢/� Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF .SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION CON"i'MENTS 2 HEALTH a COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comme Comments Water iia Sewer Connection/Signature & Date Driveway Permit DPW ToNvi� Engineer: Signature: FIRE-DEPARTML-"-NT - Temp Dumpster on site yes, Located at 124 Mair.. Street Fire Department signature/date COMMENTS Located 384 no ood Street 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 V LI Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑ Building Permit Application orkers 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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 NOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw:, al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:tted with the building application Doc: Doc.Bui',Iiing Permit Revised 2012 Location �14 No. /.Z Date// -141;;�, Check 4tq-" 29735 TOWN OF NORTH ANDOVER' Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $— Other Permit Fee $ ff TOTAL $ — Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost - "$ 65,500.00 m $ - $ 786.00 Plumbing Fee $ 98.25 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 98.25 Total fees collected $ 1,082.50 40 Ridge Way 653-2016 on 11/25/15 Shed Dormer, Relocate Laundry r1 rA cl H J z LL O o to O G1 u j� OO. O LL N N u G1 N G vWai Z C7 Z > m C O m p 7 O LL 7 O cc ai c f0 c LL p a 'n ? Z 2 9595 > J d t 7 O (0 C LL O u a in Z Q u C W W t bo 7 p Q' u i!f0 N _ c LL GC 0 u OW. Z .7' 0c d' _ LL Z LU LU W LU LL L m Z O1 N y Y O N O LU z z 0 00 �a O~ E IL Z U N w� -I o' W O 5� V 0 W = W J m a = L O m O N as t w O O a J O E Z O O .E L a L: N O 0 _ DM Construction Building with the QUALITY and Character of yesteryear. 44 Addison Ave Ext. Methuen, MA 01844 (978) 685-3037 Estimate Submitted To: Bryce &Lori Chicoyne Construction Supervisors License 66342 40 Ridge Way Home Improvement Registration 124961 N. Andover, MA We hereby purpose to furnish the materials indicated and perform the labor necessary for the completion of: Workout room & laundry room (See specifications sheet and drawings) All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completion in a substantial workmanlike manner in the sum of: Sixty-five thousand five hundred dollars -$65,500.00 Payments to be made as follows: $ 1,000.00 Upon execution of contract. $10,000.00 When work begins. Remaining payments as work progresses. Respectfully submitted: Darren Martino Any alteration or deviation from the above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon accidents, or delays beyond our control. Note -This proposal may be withdrawn if not accepted within 10 days. Proposal Date 11/19/15 ACCEPTANCE OF PROPOSAL The above prices, specifications, and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be madam as outlined above. Date: 11L;Lif Signature: Date: ' Z ' l Cj Signature: X DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES UII..DING DEPT. COP CHICOYNE RESIDENCE Spec! cations Sheet GENERAL SCOPE OF WORK Construction of a shed dormer over the existing 3rd garage bay to house a new work out room. Rework adjacent area and closet to house new laundry room. PERMITTING DMConstruction will file all necessary paper work to obtain the following permits: building, electrical, plumbing, HVAC, and debris removal. The cost ofall permits and fees necessary is not included in this estimate and will be billed separately DESIGN/ENGINEERING This estimate is based on preliminary drawings dated 11/17/15 provided by Salley Associates. Salley Associates has been hired directly by the homeowner. The cost of any additional drawings or engineering required by the building department is the responsibility of the homeowner. If the building department requires items that are not on the drawings, DM Construction reserves the right to review the final annroved construction drawings and amend pricing of this contract if necessary. DEBRIS REMOVAL DM Construction is responsible for all debris generated. A container will be placed on site to ensure a clean work site. The container is for debris generated by DM Construction only, it is not intended for homeowner use. DEMOLITION The roof over the 3.d garage bay will be removed as shown on the submitted drawings. The existing closet and area of the eave will be gutted. FRAMING Framing shall take place according to the submitted drawings. Frame in any mechanical chases as necessary in the garage area. Any deviations from the submitted drawings could incur extra cost. DM Construction reserves the right to review the final construction drawings and adjust the pricing of this contract if necessary. ROOFING The new shed dormer will be roofed as follows: ice and water shield will be installed on the entire roof, installation of architectural shingles to match* existing conditions, and white aluminum drip edge. *Due to weathering and the age of the existing shingles, the newly installed shingles may not match. SIDING & EXTERIOR TRIM Installation of new white vinyl siding to match existing conditions. Installation of pvc trim boards for the fascia, soffit, and rake boards. CHICOYNE RESIDENCE Specifications Sheet WINDOWS UNITS Installation of six double hung window units. The cost of the windows and all their associated hardware is covered under an allowance. INSULATION Installation of the BIB system on the exterior walls and the interior laundry walls for soundproofing purposes. Installation of batted insulation for the floor and ceiling. DRYWALL Installation of %z" blue board on all new walls, ceilings, and chases. All new blue board will receive a skim coat of plaster. All new ceilings will have a smooth finish. PAINTING All new walls, ceilings, and trim will be primed and receive two coats offrnish. Paint colors to be determined. All paints will be Benjamin Moore, Sherwin Williams, or an equivalent. FINISH WORK Interior door unit: Solid jamb, solid core door, smooth finish, 2 panel arched top door style. (To match existing conditions on the main level.) Door hardware: To match existing conditions on the main level. Door trim: 3 %2 " colonial casing. Window trim: 3 %z " colonial casing with a sill. Baseboard. S %4 " speed base Installation of a wall cabinet ironing board. Location to be determined. Custom finish work & casework: Any built-in units, custom millwork, book cases, wainscoting, crown moldings, closet shelving, or storage units, other than those specifically mention above are covered under the custom millwork allowance. HEATING /AIR CONDITIONINGIVENTILATION Installation of one Fujitsu mini split heat pump system to provide heating and cooling for the new work out room. The outdoor unit will be located behind the garage. Provide necessary venting for the new electric dryer. PLUMBING Provide vent, drain, and water lines as necessary for the new washing machine location. Installation of a plastic spill pan draining into the main house drain. Installation of a trap primer for the spill pan. Installation of isolation shut off valves for the washing machine, near the water main. CHICOYNE RESIDENCE Specifications Sheet ELECTRICAL General — Provide switches and receptacles as required. Sub -Panel — Installation of a subpanel to service the new workout room and laundry room. Location of the panel to be determined. Exercise equipment -Provide dedicated circuits 3-4 pieces of exercise equipment. Mechanicals- Wiring as necessary for: one new mini split heat pump unit. Appliances — Provide necessary wiring far new sauna unit. Provide necessary wiring for new washing machine and electric dryer. Provide power for built in ironing board unit. Communications — Provide one cable outlet. Provide one CATS wire to the basement for future internet connection. NOTE: The cost ofall recess lighting, pendant lighting accent lights ceiling fixtures exhaust fans, etc is covered under an allowance. CHICOYNE RESIDENCE ALLOWANCES The following allowances are included in this estimate. The allowances exist to cover the purchase of materials only, unless otherwise specified. Any amount spent in excess of an allowance will incur extra cost. Any amount less than the allowance will warrant a credit. Upon completion of the project any extra cost or credits will be issued. FLOORING -$3,300.00 This allowance covers the cost ofmaterials & installation ofall flooring (hardwood, carpeting, engineered flooring, tile, rubber matting, etc.) LIGHT FIXTURES42, 000. 00 This allowance covers the cost of all light fixtures. This allowance covers the cost of labor and materials for recess lighting, under cabinet lighting, in -cabinet lighting, and any specialty fixtures, including timers, dimmers, etc. Example: 5"Recess light w/air tight trim, white baffle, and halogen bulb -$150.00 Complete WINDOW UNITS - $3,000.00 This allowance covers the cost of all window units including but not limited to: screens, grills, extension jambs, hardware, etc. CUSTOM MILLWORK - $1,500.00 This allowance covers the cost of materials and labor to build and finish custom millwork including but not limited to: built-ins, book cases, wainscoting, entertainment units, etc. SPRINKLER SYSTEM - $1,000.00 This allowance covers the cost of all materials and labor pertaining to the sprinkler system including but not limited to: relocating, adding, or modifying of sprinkler heads and the testing and refilling of the system. SAUNA INSTALLATION- $1,000.00 This allowance covers the cost of all materials and labor associated with the installation of the new sauna unit. CHICOYNE RESIDENCE MISCELLANEOUS This contract is subject to review upon receipt of the final construction drawings DM Construction reserves the right to adjust the price of the contract after reviewing these Cost could increase if any changes had an impact on plumbing, gas, HVAC, or electrical. Cost could increase if the new plan required additional structural work or change of framing plans Cost could increase if the new plan added more cabinetry or additional appliances Note. Due to the nature of wood and the drastic temperature and humidity changes in our region, you may notice the 'movement and shrinking of the flooring and exterior and interior trim. This is typical of the region and is not due to defective installation. Change Orders Any changes from the existing plans or increased scope of work involving extra costs will become an extra charge over and above the contract price. Change order agreements must be signed before any work commences The following schedule will be adhered to, unless circumstances beyond our control arise: Time frame for completion: When work begins to completion: 12 weeks * *Time for completion is subject to arrival of special order items or other delays beyond our control. All work to be done Monday -Friday between the hours of 7:00 am — 6: 00 pm. If deemed necessary to work any other times, the homeowner will be consulted first. MEMBER OF THE BETTER BUSINESS BUREAU HOME IMPROVEMENT CONTRACTOR: 124961 CONSTRUCTIONSUPER VISOR LICENSE: CS 066342 *All home improvement contractors and subcontractors shall be registered Any inquiries about a contractor or subcontractor relating to registration shall be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02113 Phone: (617) 973-8700 OftL- DM Construction imomm Building with the QUALITY and Character of yesteryear. 44 Addison Ave Ext. Methuen, MA 01844 (978) 685-3037 CONTRACTOR ARBTTRATAION AGREEMENT The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an alternative to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a contractor however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The Contractor (Darren Martino) and the Homeowners (Bryce & Lori Chicoyne) 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. a Hom ner's Signature ejl"- C6-,L�� \/,/ Homeowner's Signature Contra rs Signature BUILDING DEPT. COP NOTICE OF CANCELLATION November 19, 2015 You may cancel this transaction, without any 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 agreement, and any negotiable instrument 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 agreement; 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 your notice 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 if you agree to return the goods to the seller and fail to do so, then you remain liable for 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 written notice to: NAME OF SELLER: DARRENMARTINO ADDRESS: 44 ADDISONAVE EXT METHUEN, MA 01844 NOT LATER THANMIDNIGHT OF.• November 23 201 S I HEREBY CANCEL THIS TRANSCATION Date: Buyer's Signature I (we each) cknowledge cei two copies of this form. Buyer. X Buyer: DM Construction imp Building with the QUALITY and Character of yesteryear. 44 Addison Ave Ext. Methuen, MA 01844 (978) 685-3037 NOTICE OF CANCELLATION November 19, 2015 You may cancel this transaction, without any 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 agreement, and any negotiable instrument 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 agreement; 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 your notice 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 if you agree to return the goods to the seller and fail to do so, then you remain liable for 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 written notice to: NAME OF SELLER: DARRENMARTINO ADDRESS: 44 ADDISONAVE EXT METHUEN, MA 01844 NOT LATER THANMIDNIGHT OF.• November 23 201 S I HEREBY CANCEL THIS TRANSCATION Date: Buyer's Signature I (we each) cknowledge cei two copies of this form. Buyer. X Buyer: s t r*7 0 DORMER (6) TW2432 WITH 40 PSL POSTS BETWEEN Z (n00 2 E;Fz Q 0 �v� =' Zo �m oCz _0 Z �0 cm mo c A N rn iZTi t r*7 0 ryNYThe Commonwealth oflilassachusetts - Department of IndustriglAccidents Office of Investigations 600 Washington Street Boston, MA 02111 W. www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/.Plumbers Ai Information Please Paint Le ibly Name (Business/Organization/individual): N99& J / (A Address: City/State/Zip:,Phone #: Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and 1 ployees (full and/or part-time)" have hired the sub -contractors 2 1 am a sole proprietor or partner- listed on the attached sheet, g ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required] Type of project (required): 6. ❑ New construction 7. Wemodeling S. ❑ Demolition 9. ❑ Building addition J.O.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ Other 'Any applicant that checks box#1 must also fill out the section below showingtheir workers' compensation policy information. T Homeowners who submit this affidavit indicating they tie 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy 4 or Self-ins.Lic. #: ExpirationDate: Job Site Address: 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 requiredunder Section 25A of MGL o. 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 $250.0 0 a day against the violator. Be advised that a copy of this statement —may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. Ido hereby certIfy under the pains andpenalties ofperjury that the information provided above is true and correct. 19-/ 1 - Phone 4: lac — t; i 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 #: Information and ffastructions. Massachusetts General Laws chapter 152 requires allemployers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire,- express or implied, oral or written." An employeY is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not producedacceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any ofits political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are notrequired to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. De advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' . compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials -Please be sure that -the affidavit is -complete -and printed IegUy: The Departmentl�as provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be, sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license orpermit to burn leaves etc) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call., The Department's address, telephone and fax number: The Gommonweajth of MassachusPits Department offaduMal Accidents offiice ofTayestig-a4ozis. 6QU Washington Sfred Boslon,M&02111 Tel # 61.7-7-2.7-4900, ext.406 oz 1-877,Ni_ASSAk`, Revised 5-26-05 Fax# 617"727-7749 1+r .--.., ncoonc 11AD1I9MA09 — ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYM 1 9/29/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: Nth& certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certfficate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Insurance Services LLCCL CONTACT NAME: Terri Younes PHONE AIC No Ek855 ft - AC No877-775-0110 ADDREss: terri.younes@usi.biz 103 Main Street INSURE AFFORDING COVERAGE MAIC s South Glens Falls, NY 12803 855 874-0123 INSURER A: Nautilus Insurance Company 17370 INSUREO Darren Martino dba D M Construction 44 Adison Ave Ext Methuen, MA 01844 INSURER 8: INSURER C INSURER D INSURER E INSURER F rnveoer_cc f_FRTIFN'_ATF NIIURFR• KEVISJUN NUMtftK: 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 CONTRACTOR 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 LTR OF INSURANCE ADD INSR U8 WVD POLICY NUMBER POLICY EFF MMIDDIYYYY) POLICY EXP (MMID LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [A OCCUR X BIIPD Ded:500 NNS10631 9/21/2015 09/21/201EEACCHp�OECTCURRENCE $1,000,000 PREMISES a MDence $100,000 MED EXP (Any one person) $5,000 PERSONAL BADV INJURY $1000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT LOC OTHER GENERAL AGGREGATE s2,000,000 PRODUCTS -COMP/OPAGG 62,000,000 $ AUTOMOBILE LIABILITY AN AUTO ALL OWNEDSCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS fEa COMBINEidem) SINGLE LIMIT BODILY INJURY (Perperaon) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ ParaC Idem $ UMBRELLA LIAR EXCESS L IAB H CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS bebw N I A PEROTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached E more apace is required) SHOULD ABOVE Bryce Chicoyne THE EXP RATION DATE HEREOF, NOT CE WILL BE CBEFORE DELIVERED I 40 Ridge Way ACCORDANCE WITH THE POLICY PROVISIONS. Andover, MA 01640 AUTTH�OR,MED REPRESENTATIVE .d -`Z (0) 1888-2014 AGUKo GUKI-UKAI PUN. An rlgm8 reserVBO. ACORD 25 (2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD #S16306704/M16306571 TXYCX Massachusetts Department of Public Safety VW Board of Building Regulations and Standards License: CS -066342 Construction Supervisor DARREN MARTINO` F y x 44 ADDISON AVE EXf METHUEN MA 018" "Al ' lJl.— Expiration: Commissioner 08/16/2017 C�/Jre �az1z?ztazz[nerilff at C1��(,aJJnc�a3ef�a Office of Consumer Affairs & Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 124961 Type: — . Expiration: 9/1712017 Individual DARREN MARTINO Darren MARTINO 44 ADDISON AVE. EXT. METHUEN, MA 01844 Undersecretary Lj 44 LU Ln C31 C. j- tlt 16h Lj 44 LU Ln C31 11.3 16h u&.' ALL 44 Ln