HomeMy WebLinkAboutBuilding Permit #769-16 - 50 JAY ROAD 12/28/2015/ NORTH.
BUILDING PERMIT 2o�Itl-ED.,,6
1 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received °oRA,Eo pea��5
SSACHUS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 50 Jay Road
f
Print
PROPERTY OWNER Allan M & Lori Marcus
Print 100 Year Structure yes
MAP 098,A PARCEL:_ ZONING DISTRICT: g3 Historic District yes
N
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
N One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
10 Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
_
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DESCRIPTION OF WORK TO BE PERFORMED:
Remove existing fixtures and ti l e surfaras in second fleer bath ar-eaj--
install new blueboard and skimcoat plaster, new plumbing fixtures to be
installed --locations remain unchanged. -Install new ceramic tile to
bathishower area and porcelain the to floor. No structural changes
to take place. Install new baseboard trim and casings (door & window).
Identification -Please Type or Print Clearly (please see attached contract
OWNER: Name: Allan M Marcus & Lori Marvus Phone: (9718) 6R5-5955
Agdress:
Contractor Name: Robert C Bailey Phone: (ug) 815-5103
Email: attentionrobert@aol.com
Address: 1071 Methuen Street_, Dracut, Mass 01826
Supervisor's Construction License: 025620 Exp. Date: 3/1n/2n16
Home Improvement License:
ARCH ITECT/ENGINEE
Address:
Date:
Phone:
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: $ 17 504.00 FEE: $
,:�/ G. OD
Check No.: 0W �� Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty
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
E: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
4, Building Permit Application
Certified Surveyed Plot Plan
4. Workers Comp Affidavit
4 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
TOTE: 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
Plans Submitted 0 Plans Waived 11 Certified Plot Plan F1 Stamped Plans 11
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Well ❑
Private (septic tank, etc.
Tanning/Massage/Body Art F1
Tobacco Sales 11
Permanent Dumpster on Site 11
Swimming Pools 11
Food Packaging/Sales 1-1
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature.
COMMENTS
-CONSERVATION Reviewed
COMMENTS
HEALTH
COMMENTS
Reviewed
Sianature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
11G( rll�- iservation Decision: Comments
Water & Sewer Con nection/Skinature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
emp U, ump"
X ON,-ak lie
JE E;P;,ARTMEiT�, T' Q 3 er4onsit6A,Wn-
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Located
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OWN
Fire ieplsignature/date
�71-17 �M.
129 1
11r,-1.", 60, ".Alt
COMMENTS:,:",.
,Oil,ria
Dimension
Number of Stories:_ Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.: /4
ELECTRICAL: Movement of Meter location, avast 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 I
Date Time Contact Name
Doc.Building Permit Revised 2014
Location
No. � � Date
v o /-
Check# Yb �/z
G9a6S'
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
—�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
wilding Inspector '
1
M
Location
1
No. —1("LA Date
Check # t
30223
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee ��p�•
TOTAL C1�?
Building Inspector
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Robert C. Bailey Finish Work a Specialty
Quality Workmanship
Building & Remodeling Inc. Free Estimates
P.O. Box 638 Builders License #025620
North Andover, MA 01845 Home Improvement
Telephone (978) 682-7087 Contractor #171905
TO
F 7 F
Mr. & Mrs. Allan Marcus
50 Jay Road
North Andover!, Mass. 01845 same
L I L
JOB LOCATION
DATE
DATE COMPLETED
TERMS
CONTRACT
PROPOSAL
BILLING
PAGE NO. 3
10 / 11 / 15
X U
OF 3 PAGES
JOB DESCRIPTION: Main Bath Remodeling
The contractor shall install porcelain tide on the flooring substrate. Overall
installation pattern shall be determined by the stock to be used. There is
no provision in this quote for any diagonal pattern or the use of decorativ
.inserts and/or borders. All flooring t�ile'shall be supplied by the owner
and iestalled by the contractor. Grouting stock shall be supplied by the
owner and installed by the contractor. Th.inset mortar shall be used to
secure the flooring tile to its plywood°substrate.
The contractor shall construct a two -door ca`b..i,net with an overall height of
approximately 24" and width of 30" to be mounted, -:in the proposed closet
area. The doors shall be a poplar face frame with the an MDF insert (Shake
style). Overall cabinet depth shall.-.be.14". The unit shall be equipped wit
two adjustable shelves along with an attached 6" drawer (full extension).
In addition:, the contractor shall provide and install a laminated counter surfac
in the.closet. The counter shall be 24"- in overall front to back length
and 30" in overall length. Counter height shall be determined by the
owner. All cabinet interior surfaces shall;.be prefinished melamine
material (white). Cabinet hardware (Anobs)_to be selected by the owner
and installed by the contractor. Door hardware shall be European style
concealed, soft close hinges and three-way adjustments. Knobs shall be
selected from the standard Amerock cola'ec't..i'on or similar.
Certificates of insurance shall be furni.shedrupon request,,and prior to work
commencement. All parts of this quote are based upon standard construction
. .
1 Hereby Propose to furnish labor and materials complete in accordance with the above specifications for the sum of
$ 9804.88 (Ninety-eight Hundred Four and - --------88/100 Dollars)
With paym nttobemadeasfollows: $2500 due upon obtaindelivery
i, permit,, dumpster deliver, and
removal of wall and ceiling surfaces; u67—upon completion ot re- naming o
•
e
upon completion of plastering;, installation of closet cabinet & counters wall
t
I matenal is guarantee to a as speci6 work is t e cro pe in a orkman r e upon completion of con1L1'dUt.
manner
anneraccording to standard practices. Any alteration or deviation from above Authorized •---�` /, �
specifications involving extra costs w' be executed only upon written
orders and will Signature
become an extra charge over and above the estimate. All agreements contingent upon d
strikes, accidents or delays beyound our control. Owner to carry Fre, tornado and other Note: This proposal mat be withdrawn by usisnot
necessary insurance.
accepted within days.
Acceptance of Proposal - The above proses, specifications and ,
conditions are satisfactory and are hereby accepted. You are
Signature
authorized to do the work as specified. Payment will be made g
as outlined above. jr Signature
Date Accepted —L2 /%_
Robert C. Baffle Finish Work a Specialty
Y Quality Workmanship
Building_§E Remodeling Inc. Free Estimates
P.O. Box 638
North Andover, MA 01845
Telephone (978) 682-7087
Builders License #025620
Home Improvement
Contractor #171905
TO r
I
Mr. & Mrs. Al.lan Marcus
50 Jay Road
North Andover!, Mass. 01845
same
JOB LOCATION
7
L L
DATE DATE COMPLETED TERMS CONTRACT PROPOSAL BILLING PAGE NO. 2
0111/115 X X X OF 3 PAGES -
JOB DESCRIPTION: Main Bath Remodeling
Upon completion of the insulating work as out:lined!, the contractor shall instal
'/2" gypsum blueboard to all wall and ceiling surfaces with the exception of
the three walls surrounding the shower area. Around the shower area, '/2"
Denshield tile underlayment shall be installed and secured to studded
surfaces through the use of manufacturer recommended fasteners.
There is no provision in this quote for the r.e:placement and/or repair of any
subflooring found to be rotted or otherwise compromised. The contractor
shall install 3/8" fir AC plywood under --I ayment over the existing sub -
.flooring to act as a proper substrate for the installation of porcelain
flooring tile. Newly installed plywood.shahl be secured to existing
subflooring through the use of 2" galvanized drywall screws at 8" on
center intervals along the length and.,wi;dth of the entire bath flooring
area.
Newly blueboarded wall and ceiling surfaces sha'11 be skimcoat plastered with
a smooth finish. There is no provision..in.`this quoteefor the priming
and/or finish painting of wall and cei1i.ng. surfaces. Such work shall be
performed by others and is not part of this quote.
'The exi..sting wood trim around the bath wi`ndo.w shall be removed during the
remodeling process and replaced with:i.new s -tock to match existing trim
around door and window units of the second floor.There is no provision,
in this quote for the replacement,.of the existing bathroom entry door.
A new.vanity unit and countertop shall be -u.pplied and installed by others
and is not part of this quote.
Any electrical work, fixtures,and wiring shaia be completed by others and
is not part of this q-uote.
Required electrical and plumbing permits shall: be obtained by and fees assumed
by others. Such work and the subsequent fees are not part of this quote.
The contractor shall be responsible for the ips.tallation of wall tile around
the three interfacing shower walls. There is no provision for any tile
work required on the shower base since-th.i's unit will be an acrylic pan.
There is no provision in this quote for the installation of ceiling tile
in the shower area. All wall tile and grouting stock shall be supplied
by the owner and installed by the contractor. Tile adhesive shall be
supplied by the contractor. There is no provision in this quote for the
installation of tile in a diagonal pattern or with separate borders and
decorative inlays. Any areas set aside in the shower for recessed
niches shall be appy priately framed bef re til,'n commen es.. Such niches
shall be either acry�ic or ceramic in na�ure and Seca casE unit.
Robert C. Bailey Finish Work aSpecialty
Quality Workmanship
Building & Remodeling Inc. Free Estimates
P.O. Box 638 Builders License #025620
North Andover, MA 01845 Home Improvement
Telephone (978) 682-7087 Contractor #171905
TO
_
Mr. & Mrs. Allan Marcus
50 Jay Road
North Andover, Mass. 01845
JOB LOCATION
J
same I-
L L
DATE DATE COMPLETED TERMS CONTRACT' PROPOSAL BILLING
10/11/15 PAGE No. 1
X X X OF 3 PAGES
JOB DESCRIPTION: Main Bath Remodeling
All parts,:of this quotation are based upon field measurements and preliminary
discussion with the homeowners regarding the overall scope of work and
materials to be used.
The contractor shall obtain the necessary building permit prior to any work
commencing on the bathroom remodeling as. outlined. The permit fee shall
be paid for by the contractor and is part of the quoted contract price.
An on-site dumpster shall be maintained dur.i.ng.,the course of remodeling to
dispose of associated construction debris.
The existing bathroom fixtures (both plumbing,and electrical) shall be disposed,
of during the remodeling process. AII,01:umbing drain piping and hot and
..cold water connections shall.be capped prior to -any -demolition work begin-
ning. Such capping and disconnecting,.work shall be completed by others
and are not part of this quote.
The existing cast iron tub shall be removed by others once the contractor has
removed existing ceramic tile and wal.i: surfaces from around the tub area.
All existing plastered wall and ceiling surfaces in the bath shall be removed
by the contractor. Existing ceramic/porcela.in tile flooring and its
underlayment shall also be removed during the demolition process.
In addition;, the existing vanity unit and countertop shall also be removed and
disposed of by the contractor.
The present closet wall that interfaces vi-W.the tub/shower wall shall be
moved to share a common piping wall w:it,h.the tub/shower area. Existing
piping for the forced hot water heat.ing'shal`1 be concealed beneath the
present closet floor rather than running alongside the exterior wall in t.he'
closet. Such plumbing work shall be,completed by others and is not part of
this quote.. The re -configuration of thi.s`p.lumbing chase shall increase
the overall width of the new closet area.
The overall length of the new shower area shah remain at 60" (the same as the.
existing cast iron tub. The overall depth shall also remain the same;
In.place of a new tub/shower unit, an acryli,e based shower pan shall be installe
The acrylic shower pan shall be supplied b.y others and installed by the
plumbing contractor. The overall location of plumbing fixtures shall not
change. All plumbing fixturesy facuets;, necessary drainage and water
connections shall be supplied and installed by others. Such work is not
part of this quote.
Once the bath wall and ceiling surfaces have been.removedi, the contractor shall
insulate the exterior rear wall with R-45 fiberglass kraft -faced insulation
Ceiling areas shall be insulated with R-32 fiberglass kraft -faced insulatio
in the flat ceiling portion of the bath. In the clipped ceiling area, it
will be necessary to install fiberglass insulating material and proper
venting stock as dictated by overall rafter depth.
The Commonwealth of Massachusetts
_ _ F Department of IndustrialAceldents
R^ :: I Congress Street, Suite 100
Boston, MA. o2114-2017
www mass.gov/dia
• °�hl sJ. V
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Z'lwgnbers.
TO BE FILED WITH THE PERMITTING AUTAORI'7,' '.
Name (Business/Oiganization/lndividual): Robert
Address: 1071 Methuen Streel,--:! �—
City/State/Zip: D r ac u t M a s s.
Are you an employer? Check the appropriate box:
Phone #: (9 7 8) 815-5103
1. Q I am a employer with employees (full and/or Part-time)'
2. ❑ I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3.Q I am a homeowner doing all work myself [No workers' comp. insurance required.]
4. ❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contrac#ois either have workers' compensation insurance or are sole
proprietors with no eruployees.
5.❑ I am a general contract or and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.t
Type of project (ve0ir6d):
7. ❑ New'd'onstruotion
8. ® Remodeling
9. ❑ Demolition
10 ❑ Building addition
11.❑ Electrical repairs or additions
12.0 PIM -Ding repairs or additions
Ro6f repairs
14.[] Other
6, W We are a corporation and its, officers have exercised their right of exemption per MGL c. I I
152, §1(4), and we have no employees' [No workers' comp. insurance required.]
!':.,, . t
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information'.
Homeowners who sri" - 1 this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box -
ox must attached an additional sheet showing the name comp. policy numof the sub -contractors and
ber.
state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers'
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name'
Expiration Date:.
Policy ## or Self -ins. Lic. #:
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 requited under MGL c. 152, §25A is a criminal violation punishable by a foie 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. A copy of this statement may be forwarded to the Office of Investigations of the AIA. for insurance
coverage verification.
Ido Hereby certify under the pains and�er�al��s of perjury that the information provided above is true and correct
(978) 815-51
official use only. Do not write in Mis 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
Phone
Contact Person'
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
receivetb r trustee of an individual, partnership, association or other legal entity, employing emplbyees. • However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant ofthe
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 Iocal 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•whd has not produced -acceptable evidence of compliance with the insurance coverage xequiired."
Additionally, MGL chapter 152, §25C(1) 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'contractors) 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. B e 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 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 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 Towns 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 (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 may be 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 or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-AIASSAFE
Fax # 61.7-727-7749
Revised 02-23-15 www.mass.go-v/dia
ACO i CERTIFICATE OF LIABILITY INSURANCE 13ATE(MhVDDIYYW)
12/29/2015
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: 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 endorsemant(s).
PRODUCER Co K. Laurin Kibildie
rllT'id Insurance Associates PHDNN (978) 681-5700 FAX No)i
(97B) 6ti-5777
1320 Osgood Street ennRlr�c.2aurink@mtminsure,com
North Andover MA 01845
INSURED
ROBERT BAXLE'Y REMODELING
PO BOX 638
l _ INuul 'RtS1 AFFPRDING COVERAGE I NAIC 0 1
tad
M3 Mut
IIVAUKGK e :
NORTH ANDOVER MA 03.845 INSURER F:
COVERAGES CERTIFICATE NUMBER:15-16 Master 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 POLICY NUMBER MPMLIDD EXE
MOUCY k LIMITS
X COMMERCIALOENERALLIABILITY EACH OCCURRENCE S 1,000,000
A CUUMSMAAE r-xlU OCCURS E8 Occurrence S 100,000
EOPDIO0716219 3/11/2015 3/11/2016 MEDEXP (Any oneperson) $ 10,000
PE=RSONAL& ADV INJURY $ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY D PRO, F7 LOC
PRODUCTS - COMP/OP AOO $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 7 -
Ea ac iden
ANY AUTO BODILY INJURY (Perperaon) $
AUrOSS AUTOS BODILY INJURY (Per mccident) $
HIRED AUTOSP — $
NON QVMED PROPERTY DAMAGES
AUTer ®caid¢n
UMBRELLA LIAO OCCUR EACH OCCURRENCE $
EXCESS UAB CLAIMS -MADE AGGREGATE $
DED RETENTION S
WORKERS COMPENSATION Robort C. Bailey X
AND E=MPLOYERS' LIABILITY YIN N STATUTE ERS
ANY PROPRIETOR/PARTNER/EXECUTIVE fI�v I is oiccluded, E,L. EACH ACCIDENT $ 1 000 OQQ
$ (MandattoryInN )E%CLUDEp? U N/A VNC-100-6011323-2015A 12/27/2015 12/27/2016
IPydescribe under E.L. DISEASE- EA EMPLOYE $ 1 000 000
es
DEMRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES (ACORD 1011 Additional Remarks Schoqule, may be attached if rnore Space ie required)
This certificate of insurance represents covriraga currently in effect and may or may not be in compliance
with any written contract.
CERTIFICATE HOLnFR ..._._..
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Building Department ACCORDANCE WITH THE POLICY PROVISIONS.
1600 Osgood St. Building 20
Suits 2035 AUTHORIZED REPRESENTATIVE
North Andover, MA 01845 /� �]
L Manclnel),x, CIC/CHA G,/%%«c*�a
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 (201401)
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: C"25620
ROBERT C BAEL_W
P,o . BOX 638
North Andover M -A 0 V
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•
Expiration
Commissioner 03110/2016
C��ie ipomvrrzoruUea� a�C?��czc�ivaeLT�
Office of Consumer Affairs & Business Regulation
WME IMPROVEMENT CONTRACTOR
legistration: fi71905pirabon 4/30/2015:; Private Coiporatic
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ROBERT C. BAILEY #'Ut.h NGBREMMODELING INC
ROBERT BAILEY
1071 METHUEN STREET^ g ��
DRACUT, MA 01826 Undersecretary