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HomeMy WebLinkAboutBuilding Permit #805-14 - 49 OLD VILLAGE LANE 5/8/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: J -1 Date. Received I Date Issued: I1VI ORTANT: Applicant must complete all items on this page LOCATION 4 P PROPERTY OWNER Wil, VS--_ Print 100 Year Old Structure yes. MAP NO: PARCEL- ZONING DISTRICT: -Historic District yes 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 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands 0 Watershed District ❑ Water/Sewer OWNER: Name: Address: DESCRIPTION OF WORK TO BE PERFORMED: Please Type or Print Clearly) I CONTRACTOR Name: !( _r` _ __ Phone: 7 47 o` ?772 Address: zw QL Supervisor's Construction License: ___ Exp. Date: Home Improvement Licens 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: $ FEE: $ Check No.: Receipt No.:_ q56 NOTE: Persons cont cting with unregistered contractors do not have access to the guarantyfund �Signatureof Agent%Owner - g-iature of contractor Plans Submitted E Plans Waived ❑ Ce 'fled Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ -Plans Waived ❑. , Certified Plot Plan ❑ Stamped Plans ❑ -TWPE OF:;SEWERAGE DiSP-OSAL- Public Sewer ❑ Tanning/Massage/BodyArt ❑ .. Swimming Pools ❑ Well El Tobacco Sales E Food Packaging/Sales El_-. : P�-ivate'(septic tank, 'etc._ . 0.— ._ -permanent D'iunpster on Site ❑ THE,FOLLOWING SECTIONS FOR -OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT` ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed nature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Com Conservation Decision: Comments Water .& Sewer Connection/Signature & Date Driveway Permit ]DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIRE EPARTMIENT Temp Dumpster on site yes , no . Located at'.124iMairi Street Fire�Depa�rtmerif�signature/date Y . ,_.,.-�,��., a• �.-��, .;.:. xro.�.:, , • ., ><��, . {, . : , ;.. �. i7 COMMENTS; r Dimension Number of Stories: :_Total land area; sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: -Movement of Mete r.l.ocation,^'roast or service drop requires approval of .Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL-.Ch'apter-166.Section 21A._F and G min.$100=$1000 fine NOTES and DATA — (For danartmPnt umpl i C � bw I Id ® Notified for pickup - Date E � f Doc.Building Permit Revised 2010 Building Department ,The foHlowing is'a]ist of the required.forms to be filled ouf.for. the appropriate. permit to: be obtained. Roofing, Siding, Interior Rehabilitation Permits L B,pilding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. Andl0rG.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 At ❑ Photo Copy of H.I.C. And C.S.L. Licenses- Li s,-❑ 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 Li 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apwr al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 0 ENO J w 2 LL 0 Q O m C t Y O LL E °�' Q N a H Z Z 0 J >> m Q LL d' E U LL O W a Lf Z Z m a bo 7 O LLI a LA Z v u W W N _ cc V LU Z Q l7 _ m Z 2 Q a W W LL cu_ CO O Z a+ N N 4j Q v Y O N TTi�n Vl 0 a. d .r = o r Ste' CL Y � yOi O A J V Q • �_ •` Q C M' pop Q- �� o 10 CD CL y c N — o '0 > y O Eoo � CL 4- tm yoo •� nc c o0 n CD CL .� m L � m ' y 0 tm c _ /1 ~ca '_ � o N .2 m CILJMJ l) �«- W 2 LJi '�N C O v m�m Q J 'Z N CL cho >o c O a � CLov > O LU z Z m //�/ V V/ Z 0Z O Z V Cl) Cl) a Z WO CO �w a Z C-. ;v N 5 r -M7 Pat ;, CORP 201 -41W- GENERAL CONTRACTORS Skillville Corp. 4 Jewel Dr Unit 4 Wilmington, MA 01887 Phone: 781 526 7772 Fax: Email: nelson@skillvillecorp.com TO Jinming Chen 49 Old Village Lane North Andover, MA 01845 Quote valid through: 3/10/2014 Description: Strip and roof Quote Customer ID: PR409 Date: 3/7/2014 r Date: 3/7/2014 Subtotal $10,490.00 Sales Tax $ 0.00 Total $ 10,490.00 Strip and remove of 1 layer of existing roof on entire house. Install 6 feet of ice and water shield underlayment along all eves. Roof Install 2,600.0 square feet Install synthetic underlayment across entire roof deck. $ 3.65 $ 9,490.00 Install GAF Timberline Series "Lifetime warranty" shingles in Barkwood Install ridge vent and pipe flashings. Extra 100.0 feet Supply and install new gutters and downspouts approximately 100 feet. (House only has one gutter on the front, which is to remain) $ ►0.00 $ 1,000.00 r Date: 3/7/2014 Subtotal $10,490.00 Sales Tax $ 0.00 Total $ 10,490.00 a May 9, 2014 Skillville Corporation 4 Jewel Drive Unit # 4 Wilmington, MA 01887 Nelson Valada Phone: 781-526-7772 Nelson@SkiliviIleCorp.com Bruce Veliz Phone: 857-829-0067 Bruce@SkillvilleCorp.com www.SkillvilleCorp.com ILL ILLI CoFtp/- 2,010 ,GENERAL CONTRACTORS License, Registration and Insurance Info: Nelson Valada MA Home improvement Contractors Registration # 171365 MA Construction Supervisors License # CS — 08900 Workman's Compensation Policy # WC2-31S-385808-014 General Liability Policy # HGL569512 FID #273057774 Home Owners Contact Info: Jinming Chen 49 Old Village Lane North Andover, MA Phone: 978 794 1981 chen iinming(cDhotmail.com Job Location: 49 Old Village Lane North Andover, MA Scope of work: Strip and remove 2 layers of existing roof on entire house. Install 6 feet of ice and water shield underlayment along all eves. Install synthetic underlayment across entire roof deck. Install GAF Timberline Series "Lifetime warranty" shingles in Bark -wood color. Install ridge vent and pipe flashings. Supply and install new gutters and downspouts approximately 100 feet. (House only has one gutter on the front, which is to remain). Schedule: Work is scheduled to be performed on May 151h 2014 and is estimated to take approximately 3 working days to substantially complete which includes having dumpsters and equipment removed from jobsite. All estimated start dates are weather permitting. Duration of project is estimated without unforeseen delays= due to complications such as weather, discovery of rotted wood and / or change orders. Payment Schedule 1/3 deposit required schedule work, pull permits and order stock in color specified. Special Exclusions Any alternation or deviation from above specifications involving extra costs will be executed only upon homeowner's orders, and will become an extra charge upon home owners' approval, Billed separately by Skillville Corp. as extra work not included in this contract. Cost to replace excessive rotted roof deck is 5 dollars per foot if any is discovered. No interior cleanup of unfinished attic spaces. If we are stripping your roof it is advised that you cover belongings in unfinished attic spaces in plastic as small pieces of roof debris and dust does fall though. Contractor Inquiry Notice All Home Improvement Contractors and subcontractors shall be registered and any inquires about a contractors and / or subcontractors should be directed to. Office of Consumer Affairs and Business Regulations Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone 617-973-8700 Permit Notice It is the contractor's obligation to obtain any and all construction related permits. Homeowners obtaining construction related permits for unlicensed unregistered contractors are excluded from access to the Massachusetts Guarantee Fund. Contract Total We hereby propose to furnish labor and materials in accordance with the scope of work specified for the sum of: $11,490.00 Acceptance of Proposal The above prices, specifications and conditions are satisfactory and are hereby accepted by the home owner. Skillville Corporation is hereby authorized to do the work as specified herein. Customer / Homeowner Jinming Chen Skillville Corp. General Contractor Nelson Yalada Ak"'U The Commonwealth of Massachusetts - Department of lndustri tt Accidiiits Office of Investigations 600 Washington. Street Boston, MA 02111 www.mass.gov/clia Workers' Compensation Insurance Affidavit: Builders/Cont.actors/Electricians/Plumbers Applicant Information Please Print Lee bly Name (Business!Organization/Cndividual).Y-S/U/ly/ I e ( r j Address: 4 12r.2& D_2rV e City/State/Zip:_(AZ/pt g_za,u fiM phone #• Are yyu an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 4. 0 T am a general contractor and I 6. []Now construction employees (full and/or part lime).* 2. El am a sole proprietor or partner- have Hired the sub -contractors listed on the attached sheet. `!• E] Remodeling ship and'have no employees working for me in any capacity. These sub -contractors have workers' comp. insurance. 8. ❑ Demolition 9•Building addition [No workers' comp. insurance 5. F1 We are a corporation and its 10. F1 Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL ll.[1 Plumbing repairs or additions myself. [No workerscomp. c.152, §I(4), and we have no 12.Q Roofrepairs insurance re ed required.] employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. i'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis 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 Policy # or S elf ins. Lic. 9: WCZ —1l s '.��.3'8Ok ^l y Expiration Date: Job Site Address: V 060 0P_ /_A,Vt City/State/Zip: o 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 ofMGL 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 $250.00 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. fdollerehycertify der the pain and penalties ofperjury that the information provided above is true and correct. - signafore• Date: Phone #• 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. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers 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 of hire,• express or implied, oral or written." An employer 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 produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its 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-contractor(s)name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Do advised that this affidavit maybe submitted to the Department of Iudustrial Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a yvorkers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom 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 (ifnecessary) 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 fixture 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 or permit 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: °t'hooxr ixzozIW.caltbL OfMossach sP s DepartAneut ofIndustrial Accidents Office afTu�esii�a�io.�s 600 Wasbiggtton St:re < Boston, MA02111 TQL # 61.7-227_4.900 oA 406 or. 1-877-WSWCk Revised 5-26-05 Fay ,# 617-727-7749 Www.1><taagovNia SKILL -2 OP ID: JD2 ACORU° � CERTIFICATE OF LIABILITY INSURANCE DA 04/10/2014 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 North Andover Insurance Agency M.J. Foster Insurance Services 163 Main St. North Andover, MA 01845 Michael Lescord CONTACT Tracey Labbe PHONE FAX A/c No): 978-686-6410 Arc No Et):x978-686-2266(AIC, n D : tlabbe@fostersuilivangroup.com INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:SAFETY INSURANCE COMPANY 39454 INSURED Skillville Corp Bruce Veliz 4 Jewel Drive #4 Wilmington, MA 01887 INSURER B: Liberty Mutual Fire Ins. Co. INSURER C INSURER D: INSURER E: 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. !LTR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Commonwealth of MA POLICY NUMBER MM/DD EFF MM/DD EXP LIMITS Office of Investigations GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1-1 OCCUR Boston, MA 02114 EACH OCCURRENCE $ DA ED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE LIABILITY ANY AUTO SCHEDULED AUTOS AUTOS ALL OWNED Ix X HIRED AUTOS NON -OWNED AUTOS 0077783 04/05/2014 04/05/2015 COMBINED SINGLE LIMIT 1 000 Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDENT $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC2-31S-385808-014 04/03/2014 04/03/2015 WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Commonwealth of MA ACCORDANCE WITH THE POLICY PROVISIONS. Dept of Industrial Accidents AUTHORIZED REPRESENTATIVE Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AC40RO CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDlYYYY) 9/24/2013 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 T. Edmund Garrity & Co., Inc. 545 Concord Ave. Cambridge bTA 02138 �NEACT Cristina PHONE _ .(617) 354-4640 FAX (617)354-5828 ED RIE .cristina@garrity-insurance.com INSURER(S) AFFORDING COVERAGE NAIC 9 INSURER A.Hermi tae Ins Co INSURED Skillville Corporation 4 Jewel Dr Unit 4 Wilmington ice, 01887 INSURER B -Idberty Mutual Ins. INSURERC:COmmerce Ins Co INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBERVASTER COI 2013 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. k. ILiR TYPE OF INSURANCE B POLICY NUMBER POLICY EFF MMR)D POLICY EXP MMIDD LIMITS A GENERALLIABILI Y X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-J OCCUR EIGL569512 8/1/2013 /1/2014 EACH OCCURRENCE S 1,000,000 PRM OaaNTEnence S 100,000 MED EXP (Any one person) S 5,000 PERSONAL BADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: X POUCY PR,FCO- LOC PRODUCTS -COMPIOPAGG S 2,000,000 S C AUTOMOBILE X LIABILITY ANY AUTO SCHEDULED AUTOS AUTOS ALL OWNED Ix HIRED AUTOS NON -OWNED AUTOS DPPMM /5/2013 /5/2014 C a aB�iNdEMSINGLE LIMIT S 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE S Per accident S A X UMBRELLA UAB EXCESS LIAR X OCCUR CLAIMS -MADE ErUP569869 /1/2013 /1/2014 EACH OCCURRENCE S 1,000,000 AGGREGATE S 1,00010-00- DED RETENTIONS S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH)E.L. If es,descn'be under DESCRIPTION OF OPERATIONS below NIA �231085808-013 /3/2013 /3/2014 X WC STATU I III FR E.L EACH ACCIDENT $ 500,000 DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required) The Workers Compensation Policy does not provide coverage for Nelson Valada and Bruce Veliz. for your record ACORD 25 (20101051 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Garrity/CRISTI �'-� `l �� j - ©1988.2010 ACORD CORPORATION. All riahts reserved IN3025 /7Mnnst ni Tho anno 1 norna anti Innn own raniefarori rnnr4e of A(Inpn a/1!L V0111, 1011MCll11/! 1111CAlrs;acfu�rlli Rj -� Mee of Consumer Affairs & Business Regulation i ME IMPROVEMENT CONTRACTOR egistration:,,-1713115 Type Expiration; 311412014 Supplement SKILLVILLE CORPORATION, P NELSON VALADA 4 JEWEL DRIVE UNIT 4— WILMINGTON, MA 01887 Undersecretary l 3 Massachusetts - Department of Public Safety ' Board of Building Regulations and Standards . Conctrvction Supen-isor License: CS -089000 4 Jewel Drive #4 v Wilmington 11+11A -01887$1 Expiration Commissioner 05/1812014 Details Demographic Information Full Name: NELSON S. VALADA Gender: Owner Name: License Address Information Page 1 of 1 Address: Address 2: City: Wilmington State: MA Zipcode: 01887 Country: United States Ucense Information License No: CS -089000 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 4/23/2012 Issue Date: Expiration Date: 5/18/2014 License Status: Active Today's Date: 5/14/2014 Secondary License: Doing Business As: Status Change: ite Information No Prerequisite Information line No Discipline Information Documentum http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=277942& 5/14/2014 Office of Consumer Affairs & Business Regulation - Mass.Gov The Official Website of the Office of Consumer Affairs & Business Regulation (OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints Registration # 171365 Registrant SKILLVILLE CORPORATION Name BRUCE VELIZ Address 4 JEWEL DRIVE UNIT 4 City, State Zip WILMINGTON, MA 01887 Expiration Date 03/14/2016 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search © 2012 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. http://services. oca. state.ma.us/hic/licdetails.aspx?txtSearchLN=73249 Page 1 of 1 Home Improvement Contractor Registration Home Page 5/14/2014 Location � - No. ^ i;-- l Date i Check # ? SU(l TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ll�}•�i'. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ vP Building Inspector