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HomeMy WebLinkAboutBuilding Permit #254-15 - 50 WILD ROSE DRIVE 9/15/2014 A ,� Of No oTFf b q4 BUILDING PERMIT 3? b�;;t'. •_' OL TOWN OF NORTH ANDOVER t APPLICATION FOR PLAN EXAMINATION - b � Permit NO: �'1 Date Received +` Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 5D 1&)i 14 f.ojp— or l Ve Print PROPERTY OWNER 0,A (3 la Ae- Print MAP NO: 0 PARCEL002-1 ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building OrOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial [YRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed District ❑Water/Sewer 1 eytoyr-k CK I'S Jy'�tr, JA4adk-1I0c4h aun . P1C41Vvt d- /W&�C e �-Sm 'fie�rr� /'+2�V►tiuvt /1CdlaGe .�acc��e i' � UG-nI'1/, �^C ti Identification Please Type or Print Clearly) OWNER: Name: Acx 'I- Syian Ise"e Phone: 51$ - 171-`I93D Address: wi,Id pop, o rvc CONTRACTOR Name: Phone: 7S1-3.)P-1 odd Ke i1y ���1vt���►�. Address: Supervisor's Construction License: Exp. Date: C S -61 r7 70 /C), 9 do/I/ Home Improvement License: Exp.. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1 �� oZ y� FEE: $ Check No.: ail(d Receipt No.: Qk 0() NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �ignare of Agent/Ownerignature'of contractor -_ _ _ V Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS r s Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: 3 Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ 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 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 o 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 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 cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location i�D 0 (AJn�-C-- � �No. Date • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ���o Building Inspector /reoorvrrra�uveu./f/a�C�/f/�irraac/uJe(f License or registration valid for individul use only ! Office of Consumer Affairs&Business Regulation g j before the expiration date. if found return to: OME IMPROVEMENT CONTRACTOR _i.egistration: 152373 Type: Office of Consumer Affairs and Business Regulation xpiration 8/23/2016 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 KELLY REMODELING INCORPORATED JAMES KELLY 39 DONALD ROAD BURLINGTON, MA 01803 " Undersecretary oalid without sig e , , .N1LI5SaChUSettS - Department of rJublic Safety Board of Building Pegulations n nd Stanciaids C',mstructi,,n Buyers ism. License; CS-078770 JAMES G KELLY= „ 39 DONALD ROAD BURLINGTON MA 01803 C orn+,usswn<r 10/09/2014 ---dAO.VLye.- i vi a t ylm-f L C(os of i i iI Mas ter I c � Ila -J- o V1 0 G los of e.Xisfi�9 Skawer ly /Master- Inc fk SU -7-h Sys The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (� Please Print Legibly Name(Business/Organization/Individual): I u dC-P4rto&(y L q .1 C Address: 3cl `VOY,o.V ado' City/State/Zip: u r/n& M d'0 Phone #: -? 1 I - 3 ;W' -/666 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. aRemodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.: 9. E]Building addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers right of exemption per MGL comp. p p 12.R Roof repairs insurance required.]t c. 152, §1(4),and we have no 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. 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: 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 sec coverage secure co a age 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sinature- PL&_ Date: y Phone#: `2 Lr/ 3 ollY— l o UU 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#: Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 171247.00 m $ - $ 206.96 Plumbing Fee $ 25.87 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 25.87 Total fees collected $ 358.71 50 Wild Rose Drive 254-15 on 9/15/14 Renovate Master Bathroom NORTfy Town, of Andover No. O T = - ?,, >�h ver, Mass, -1.1, 1 1 C/ COCNKMt WICK �' -Al �w 1 1. 0RAtE 0 /.Pa���5 U BOARD OF HEALTH . PERMIT T Food/Kitchen LD Septic System THIS CERTIFIES THAT .........�V.S.�r�..!..... I.�.A.0114r BUILDING INSPECTOR ..................... ................................ has permission to erect .......................... buildings on 1 Foundation ., Rough tobe occupied as .....f.A....16-4.fAw..... ........... ................................................................... 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 ap� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T T Rough Service ..................... .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. KR OD Ll N z Remodeling Quotation 8/19/2014 Prepared for Alex and Susan Blane 50 Wild Rose Drive North Andover,MA Scope of work The Contractor will coordinate with the customer on all aspects of the remodeling project as stated below in the scope of work. A building permit will be pulled with the Town of Andover for the second floor master bathroom. All rough and final inspections are included within the scope of work. Trash will be removed from the site on a daily basis. All areas adjacent to construction will have flooring covered for protection. Dust and floor protection will be used to isolate the construction area from the rest of house. HEPA air scrubbers will be used throughout the project. Master Bathroom • Demo existing vanity, top, mirrors and light fixtures. • Demo existing shower unit and sheetrock to ceiling. • Install cement board on shower walls with rubber shower pan and concrete curb. • Water membrane on shower walls and mud job for shower floor. • Install new the on shower floor and walls to ceiling. • Prepare existing tile floor for installation of the over existing. • Install new vanity and counter with back and side splashes. • Install new light fixtures over vanity and new Panasonic fan. • Install new mirrors over vanity. • Coordinate with subcontractors on associated work. • Provide electrician for all necessary work. • Update plumbing within bathroom space as required, install new plumbing fixtures. • Remove and dispose of all construction debris. Total Cost $17,247 I agree to the terms of the scope of work: 9i I DATE NTRACTO SIGNATURE (ik liq A 0 �lu- DATE OWNER'S SIGNATURE FIXED PRICE AGREEMENT CONTRACTOR'S NAME: Kelly Remodeling Inc. ADDRESS: 39 Donald Road, Burlington MA PHONE: 781-328-1000 FAX: 781-328-0993 E-MAIL: jkelly@kellyremodel.com LIC #: CS 078770 DATE: 8/19/14 OWNER'S NAME: Alex and Susan Blane ADDRESS: 50 Wild Rose Drive, N. Andover MA PROJECT ADDRESS: same I. PARTIES This contract (hereinafter referred to as "Agreement") is made and entered into on this 19th day of August by and between Alex and Susan Blane, (hereinafter referred to as "Owner"); and Kelly Remodeling Inc., (hereinafter referred to as ""Contractor"). This contract shall supersede any contracts previously signed prior to this date for the project specified below. In consideration of the mutual promises contained herein, Contractor agrees to perform the following work subject to the terms and conditions below: II. GENERAL SCOPE OF WORK DESCRIPTION • Generate and coordinate documents and drawings for use in construction and building permit. • Pull building permit with the Town of North Andover. • All work completed as detailed in the original project quotation and scope of work documents. A. Estimated LUMP SUM PRICE FOR ALL WORK ABOVE: $17,247 B. NOTES AND CLARIFICATIONS If any conflict should arise between the plans, specifications, addenda to plans, and this Agreement, then the terms and conditions of this Agreement shall be controlling and binding upon the parties to this Agreement. (C. QV ntractor Owner Owner III. GENERAL CONDITIONS FOR THE AGREEMENT ABOVE A. EXCLUSIONS This Agreement does not include labor or materials for the following work: 1. PROJECT-SPECIFIC EXCLUSIONS: pipes concealed within walls that would impact removal of wall adjacent to toilet or installation of new pocket door. (the scope of work does include rewiring the existing switches located where the pocket door is to be located.) 2. STANDARD EXCLUSIONS: Unless specifically included in the "General Scope of Work" section above, this Agreement does not include labor or materials for the following work: Plans, engineering fees, or governmental permits and fees of any kind. A Testing, removal and disposal of any materials containing asbestos (or any other hazardous material as defined by the EPA). Custom milling of any wood for use in project. Moving Owner's property around the site. Labor or materials required to repair or replace any Owner-supplied materials. Correction of concealed substandard framing. Rerouting/removal of vents, pipes, ducts, structural members, wiring or conduits, steel mesh which may be discovered in the removal of walls or the cutting of openings in walls. Removal and replacement of existing rot or insect infestation. Failure of surrounding part of existing structure, despite Contractor's good faith efforts to minimize damage, such as plaster or drywall cracking and popped nails in adjacent rooms or blockage of pipes or plumbing fixtures caused by loosened rust within pipes. Construction of a continuously level foundation around structure (if lot is sloped more than 6 inches from front to back or side to side, Contractor will step the foundation in accordance with the slope of the lot). Exact matching of existing finishes. Public or private utility connection fees. Repair of damage to roadways, driveways, or sidewalks that could occur when construction equipment and vehicles are being used in the normal course of construction. Cost of correcting errors and omissions by the Owner's design professionals and separate contractors. Cost of correcting/testing/remediating mold/fungus/mildew and organic pathogens unless caused by the sole and active negligence of Contractor as a direct result of a construction defect that caused sudden and significant water infiltration into a part of the structure. Cost of removing ponding ground water or other unusual concealed site conditions during excavation. Extra costs associated with refusal of caisson drilling, cave- ins, etc. Cost to modify and/or remanufacture custom brackets and other b ntractor Owner Owner custom-fabricated materials that are manufactured per plans and/or specifications but do not fit properly into the structure. B. DATE OF WORK COMMENCEMENT AND SUBSTANTIAL COMPLETION Commence work: 09/15/14. Construction time through substantial completion: Approximately 4 weeks, not including delays and adjustments for delays caused by: holidays; inclement weather; accidents; shortage of labor or materials; additional time required for Change Order and additional work; delays caused by Owner, Owner's design professionals, agents, and separate contractors; and other delays unavoidable or beyond the control of the Contractor. C. CHARGES FOR ADDITIONAL WORK: CONCEALED CONDITIONS, DEVIATION FROM SCOPE OF WORK, AND CHANGES IN THE WORK 1. CONCEALED CONDITIONS: This Agreement is based solely on the observations Contractor was able to make with the project in its condition at the time the work of this Agreement was bid. If additional concealed conditions are discovered once work has commenced or after this Agreement is executed which were not visible at the time this Agreement was bid, Contractor will point out these concealed conditions to Owner, and these concealed conditions will be treated as Additional Work under this Agreement. Contractor and Owner may execute a Change Order for this Additional Work. Contractor is released, held harmless, and indemnified by Owner from all pre-existing mold, fungus, mildew, and organic pathogen problems and is not responsible for costs or damages associated with correcting, containing, testing, or remediating the same. The electrical and plumbing portion of this project are limited to the areas specified within the scope of work document. Any upgrades in electrical or plumbing outside of the scope of work will be billed at on a time and material basis. 2. DEVIATION FROM SCOPE OF WORK: Any alteration or deviation from the Scope of Work referred to in this Agreement involving extra costs of materials or labor (including any overage on ALLOWANCE work and any changes in the Scope of Work required by Owner, Owner's design professional, Owner's agent, or governmental plan checkers or field building inspectors) will be treated as Additional Work under this Agreement resulting in an additional charge to Owner as set forth herein. Contractor and Owner may execute a Change Order for this Additional Work. ntractor Owner Owner Contractor to supervise, coordinate, and charge 24% profit and overhead on the following: all Additional Work under this Agreement, Additional Work caused by concealed conditions, all overages on ALLOWANCE work, all Owner-furnished materials, and all work of Owner's separate contractors who are working on site at same time as Contractor (any time in between when Contractor has commenced work and when the work is 100% complete by Contractor). The amount of the Additional Work will be reasonably determined by the Contractor. 3. RATES CHARGED FOR ALLOWANCE-ONLY AND TIME-AND- MATERIALS WORK: Jim Kelly: $65 per hour; Journeyman Carpenter: $40 per hour; Subcontractor: Amount charged by Subcontractor. Note: Contractor will charge for profit and overhead at the rate of 24% on all work performed on a Time-and-Materials basis (on both materials and labor rates set forth in Section III.C. of this Agreement) and on all costs that exceed specifically stated ALLOWANCE estimates in the Agreement. D. PAYMENT SCHEDULE AND PAYMENT TERMS 1. PAYMENT SCHEDULE: * First Payment: $4,000 due when Agreement is signed and returned to Contractor. *Subsequent payments: To be paid at the end of every week for work completed within that time frame. 2. PAYMENT OF CHANGE ORDERSJADDITIONAL WORK: Payment for Additional Work is due upon completion of either all or part of the Additional Work and submittal of invoice by Contractor. E. WARRANTY Contractor does provide a limited warranty against material defects on all Contractor and subcontractor supplied material used in this project for a period of one year following substantial completion of all work. Contractor will warranty all labor for 1 year following completion of work. This warranty covers normal usage only. You must contact the Contractor at the address on page one of this Agreement in writing for warranty service immediately upon discovering an item in need of warranty service. If the matter is urgent, you must also call the Contractor and send written notice of the need for warranty service. Failure to notify the Contractor of the need for warranty service within ten days of discovery of a warranty item may void this warranty. Additionally, Owner's hiring of others or direct actions by Owner or ntractor Owner Owner Owners separate contractors to repair a warranty item are not covered by this warranty and will not be reimbursed by Contractor. No warranty is provided by Contractor on any materials furnished by the Owner for installation. No warranty is provided on any existing materials that are moved and/or reinstalled by the Contractor within the dwelling or the property (including any warranty that existing/used materials will not be damaged during the removal and reinstallation process). One year after substantial completion of the project, the Owner's sole remedy (for materials and labor) on all materials that are covered by a manufacturer's warranty is strictly with the manufacturer, not with the Contractor. Repair of the following items and related damages of every kind are specifically excluded from Contractor's warranty: problems caused by lack of Owner maintenance; problems caused by Owner abuse, Owner misuse, vandalism, Owner modification, or alteration; and ordinary wear and tear. Damages resulting from mold, fungus, and other organic pathogens are excluded from this warranty unless caused by the sole and active negligence of contractor as a direct result of a construction defect which caused sudden and significant amounts of water infiltration into a part of the structure. Deviations that arise such as the minor cracking of concrete, stucco, and plaster; minor stress fractures in drywall due to the curing of lumber; warping and deflection of wood; shrinking/cracking of grouts and caulking; fading of paints and finishes exposed to sunlight are all typical (not material) defects in construction, and are strictly excluded from Contractor's warranty. THE EXPRESS WARRANTIES CONTAINED HEREIN ARE IN LIEU OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED, INCLUDING ANY WARRANTIES OF MERCHANTABILITY, HABITABILITY, OR FITNESS FOR A PARTICULAR USE OR PURPOSE. THIS LIMITED WARRANTY EXCLUDES CONSEQUENTIAL, INCIDENTAL, AND SPECIAL DAMAGES AND LIMITS THE DURATION OF IMPLIED WARRANTIES TO THE FULLEST EXTENT PERMISSIBLE UNDER STATE AND FEDERAL LAW. SOME STATES RESTRICT LIMITATIONS ON VARIOUS WARRANTIES, AND SO A CONSUMER'S RIGHTS UNDER THIS WARRANTY MAY VARY. THIS LIMITED WARRANTY MAY NOT BE VERBALLY MODIFIED BY ANY PERSON. THIS LIMITED WARRANTY IS GOVERNED BY THE LAWS OF THE STATE WHERE THE WORK WAS PERFORMED. F. WORK STOPPAGE AND TERMINATION OF CONTRACT FOR DEFAULT ntract r Owner Owner Contractor shall have the right to stop all work on the project and keep the job idle if payments are not made to Contractor strictly in accordance with the Payment Schedule in this Agreement, or if Owner repeatedly fails or refuses to furnish Contractor with access to the job site and/or product selections or information necessary for the advancement of Contractor's work. Simultaneous with stopping work on the project, the Contractor must give Owner written notice of the nature of Owner's material breach of this Agreement and must also give the Owner a 14-day period in which to cure this breach of contract. Owner to follow this same notice procedure with Contractor if Owner alleges Contractor is in material breach of this Agreement. If work is stopped due to any of the above reasons (or for any other material breach of contract by Owner) for a period of 14 days, and the Owner has failed to take significant steps to cure his default, then Contractor may, without prejudicing any other remedies Contractor may have, give written notice of termination of the Agreement to Owner and demand payment for all completed work and materials ordered through the date of work stoppage, and any other reasonable loss sustained by Contractor, including Contractor's Profit and Overhead at the rate of 20% on the balance of the incomplete work under the Agreement. Thereafter, Contractor is relieved from all other contractual duties, including all Punch List and warranty work. G. DISPUTE RESOLUTION AND ATTORNEY'S FEES Any controversy or claim arising out of or related to this Agreement involving an amount less than $5,000 (or the maximum limit of the Small Claims court) must be heard in the Small Claims Division of the Municipal Court in the county where the Contractor's office is located. Any dispute over the dollar limit of the Small Claims Court arising out of this Agreement shall be submitted to an experienced private construction arbitrator that shall be mutually selected by the parties to conduct a binding arbitration in accordance with the arbitration laws of the state where the project is located. The arbitrator shall be either a licensed attorney or retired judge who is familiar with construction law. If the parties can not mutually agree on an arbitrator within 30 days of written demand for arbitration, then either of the parties shall submit the dispute to binding arbitration before the American Arbitration Association in accordance with the Construction Industry Rules of the American Arbitration Association then in effect. Judgment upon the award may be entered in any Court having jurisdiction thereof. The prevailing party in any legal proceeding related to this Agreement shall be entitled to payment of reasonable attorney's fees, costs, and tractor Owner Owner post-judgment interest at the legal rate. H. ENTIRE AGREEMENT, SEVERABILITY, AND MODIFICATION This Agreement represents and contains the entire agreement and understanding between the parties. Prior discussions or verbal representations by Contractor or Owner that are not contained in this Agreement are not a part of this Agreement. In the event that any provision of this Agreement is at any time held by a Court to be invalid or unenforceable, the parties agree that all other provisions of this Agreement will remain in full force and effect. Any future modification of this Agreement should be made in writing and executed by Owner and Contractor. I have read and understood, and I agree to, all the terms and conditions contained in the Agreement above. &j, -la - DATE C RACTOR'S GNATURE DATE OWNER'S SIGNATURE DATE OWNER'S SIGNATURE C tr ctor Owner Owner AC40RDCERTIFICATE OF LIABILITY INSURANCE D/15/201IDD/Y 1/15/ 4 4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Robert Gilliatt MacDonald & Vaccaro Insurance Agency, Inc. PHONE (781)273-1630 1pAXC.No:(7e1)27o-aoa7 9 Bedford Street ADDRESS:IL RGilliatt@macvac.com P.O. BOX 799 INSURERS AFFORDING COVERAGE NAIC# Burlington MA 01803-5799 INSURERA:Preferred Mutual Insurance Co 15024 INSURED INSURER B-.LibertyMutual Ins CO 23043 Kelly Remodeling, Inc. INSURERC: 39 Donald Road INSURER D: INSURER E: Burlington MA 01803 INSURERF: COVERAGES CERTIFICATE NUMBER aster REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER fMWDDIYYYYI 1MMIDDfYYYY`ILIMITS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RE NTEff— PREMISES Ea occurrence $ 50,000 A CLAIMS-MADEEZ OCCUR CPP0170588975 0/20/2013 0/20/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 MX P POLICY RO- LOC $ AUTOMOBILE LIABILITY EOMBBIINNdEDISINGLE LI IT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED i P Y I I BODLNJURY(Per accident)AUTOS AUTOS ( ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ $ WORKERS COMPENSATION X I WC STATU- I OTH- AND EMPLOYERS!LIABILITY YIN FIL ANY PROPRIETOR/PARTNER/EXECUTIVEE.L EACH ACCIDENT $ 100,000 OFFICERWEMBER EXCLUDED? N� N1 A (Mandatory in NH) WC131S374852013 /17/2013 /17/2014 E.L DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,ti more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Robert Gilliatt/BOBG W�-f— ez! ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. ItJCf19t.i�n�nnF�nt Tt.w AfVYOI'1 —4——IF Ad`^Or%