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Building Permit #631-2017 - 531 FOREST STREET 12/27/2016
Permit N0: I I •X017 Date Issued: NORTH O��T�au i6�ti0 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received ;-7 - 2-0 B% �9A�AATto IMPORTANT: Applicant must complete all items on this TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VOne family ❑ Addition ❑ Two or more family ❑ Industrial &'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ep4ic ell ❑Floodplain o 1Natlands = "`I. Watershed Distrtc# d Water/Sewer ' Remodel 1 st floor kitchen approx. 270 SF in reconfigured footprint. Remove non load bearing dividing partition between kitchen and dining room. Remove entry door into sun room. Relocate existing window, construct new opening, and re -install double casement window in new location. Remove 2 windows in dining area and construct new opening 72x80- fbr double doors. Relocate baseboard heat in dining rourn to adjacent wall. Construct now 0 ening approx 60x48" and install new 2 casement windows in dining area. Install new cabinets and counterops, appliances fixtures and finishes perplan. Identification Please Type or Print Clearly) OWNER: Name: Ben & Lindsay Johnson Phone: 978 314 7857 Address: 531 Forest St North Andover MA 01845 y" ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 72,000 FEE: $ F � Y ---- Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund A J Permit No#: data 1,zczi ipri- BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family 0 Addition El Two or more family El Industrial Alteration No. of units: El Commercial —0 11 Repair, replacement Ej Assessory Bldg 0 Others: 0 Demolition El Other btc 0et�� Watershed rpl DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly' OWNER: Name: Arfdrt-.q.c;- C C .122 ontactor Nqmef 4,A CAR C L Exp uper License M MY Ch fMT n r 14:2kM cah L Ir,G 1(z4n; ARCHITECTIENGINEER Phone: Address: Req. No. Phone: FEE SCHEDULE; B ULDING PERMIT: 12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S. F. I. _,Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have. access to the guar arty fund h k Of anatUre' co n Location No. -7 U-7 I - ;;�o i Date D 01 Check# TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL $ Building inspector Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ .TYPE bF SEWERAGE DISPOSAL �{ t Public Sewer ❑ Tanning/MassageBody Art ❑ Swin ring pools ❑ well ❑ Tobacco Sales - ❑ Food Packaging/Sales ❑ Private (septic tack, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature. CONSERVATION Reviewed on Signature COMMENTS F -;HEALTH COMMENTS Reviewed Sianature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Conn ection/Sianature & Date Driveway Permit DPW Town. ]Engineer: Signature: t -IRE DEPARTMENT' - Temp Dumpster on site yes Loeated at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no -imension 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 ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.$10D-$1000 fine No Doc.Building Permit Revised 2014 11 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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 o 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/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 1IOTE: 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 act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products aOTE: 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 ofAppeals 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 4�. Doc: Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 725000.00 m $ - $ 864.00 Plumbing Fee $ 108.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 108.00 Total fees collected $ 1,180.00 531 Forest Street Kitchen Remodel 671-2017 on 12/27/2016 C � a O CD D C CL r Cha D t0. to �0�, vCD CD. Cr =r CD rMOL CD O CD CD v N' CC. CD iv 0 z CD 0 0r-O'�. O CD a 0 CCD z� r— m m;a ic cn — 0 M z cn -v � m C cn n z o � ) O "Zam z cn F: 44cn:fFZ y <, m y N 0, 0 ca�D 0 rt� �2 m 0' 3 y Co. -q � N ,O,F �H 0 0 n 0m c°a )cin 0 SD �p CD 2 CL m -� D S. = 0 o —� cc r -L = Noc � CD CD -0 -, c o U) =r d -wy-a :0 O 0, a D�rt N� o n Q. 00(Q O N C ) C CD CD W �- r D as co y O O o to o dIP 0 -OL 3WCD :� c 'O► o co =r - D0 CD CL 1 J L fD N L rt z O W l '-� v v a 3EA z -a ? O _ N Z L 70o T O N (D n' fD A O 3 m m A a n 0 T ]J O o C C W z G) n 0 T r) _S 3 (DS G .Z1 O 04 T O 3 w G z m 00 L/)T fD �. N -< 3 O Q rr 3 W z o o m _ s I c �s 214 Sutton Hill Rd $% North Andover MA 01845 -16K 978 852-4491 Tm www.TMKremodeling.com REMODELING CONTRACTOR AGREEMENT Contract Johnson-531—Forest—st—Kitchen—remodel THIS AGREEMENT made this 12 20 lb by and between TMK Remodeling, LLC Construction Supervisor License # 105086, 214 Sutton Hill Rd, North Andover MA 01845 hereinafter called the Contractor, and Ben & Lindsay Johnson hereinafter called the Homeowner. WITNESSETH, that the Contractor and the Homeowner for the consideration named herein agree as follows: ARTICLE 1. SCOPE OF THE WORK The Contractor shall perform all of the work described in the specifications entitled Exhibit A — Statement of Work, as annexed hereto as it pertains to work to be performed on property located at 531 Forest St North Andover MA 01845. Work Scope Summary:Remodel 1st floor kitchen approx. 270 SF in reconfigured footprint. Remove dividing partition between kitchen and dining room. Remove entry door into sun room. Remove existing window, construct new opening, and install'double casement window in new location. Remove 2 windows in dining area and construct new opening for double French doors. Relocate baseboard heat in dining room to adjacent wall. Construct new opening and install new 2 unit double hung window in dining area. Construct peninsula with half wall for cabinets. Remove existing cabinets and countertops. Remove appliances and reinstall in new locations per plan. Install new finished ceiling over strapping, plaster skim and painted. Install new wall finishes, plaster skim and painted. Install 16 new cabinets, including peninsula as shown on plan. Install new countertops approx. 90 SF. Install appliances supplied by Owner. Install 240 SF of new hardwood flooring on new sub floor. Update electrical and plumbing. Paint walls and trim. Install toe kick heater in kitchen area. Install tile backsplash approx. 40 SF. Widen existing wall openings to 42x80" and 84x80" ARTICLE 2. TIME OF COMPLETION 27 The work to be performed under this Contract shall be commenced on or before December W2016 and shall be substantially completed on or before February 12017 21Y ARTICLE 3. THE CONTRACT PRICE The Homeowner shall pay the Contractor for the labor and materials to be performed and supplied under the Contract the estimated sum of Seventy Two Thousand Dollars and No Cents ($72,000.00), subject to additions and deductions pursuant to authorized change orders. The contract price includes two components; Fixed cost of Forty Nine Thousand Eight Hundred Twenty Dollars and No Cents ($49,820. 00) for the building materials and construction labor as specified in Exhibits A and B. Variable cost of Twenty Two Thousand One Hundred Eighty Dollars and No Cents ($22,180.00) for the allowance items listed in Exhibit B Allowances and will be 110% of the actual invoice price paid by the Contractor to his suppliers. Exhibit B lists the allowance items and budget costs the Contractor will purchase for the Homeowner. Sales tax and freight are not inlcuded in allowance budget. Contractor will furnish and install all building materials, fixtures and finish items unless noted otherwise. Any Homeowner supplied materials will be charged a 15% handling and coordination fee based on actual invoice. ARTICLE 4. PROGRESS PAYMENTS Payments of the Contract price shall be paid in the following manner from the Homeowner to the Contractor: Payment 1: 25% upon contract acceptance and signature; $18,000.00 Payment 2: 25% upon rough building inspection; $18,000.00 Payment 3: 25% up D b' et installation;$18,000.00 � � ©� 0 00 Payment 4: 2�upon final building inspection and 95% completion of finish;'($4,180.00) plus the actual contract price for allowance items as defined in Article 3; Budget: $22,180.00 Pal yi.k.i+r-5— /o/ (UPON '@-i'✓ia� CGcM17�2✓�'t 6C�n� CJt,Ji�p� 5'�f?t� '7,D0 Copyright TMK Remodeling, LLC Initials All Rights Reserved Page 1 214 Sutton Hill Rd Contract North Andover MA 01845 • Johnson_531_Forest_st_Kitchen_remodel 978 852-4491 TRK www.TMKremodeling.com REMODELING The contract cost for mutually agreed to change orders will be paid 50% at time of change order signature and 50% after completion and Homeowner sign -off. ARTICLE 5. GENERAL PROVISIONS 1. All work shall be completed in a workmanship like manner and in compliance with all building codes and other applicable laws. 2. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 3. Contractor may at its discretion engage subcontractors to perform work hereunder, provided Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this 4. Contractor shall furnish Homeowner appropriate releases or waivers of lien for all work performed or materials provided at the time the next periodic payment shall be due. 5. All change orders shall be in writing and signed by both Homeowner and Contractor. The cost for mutually agreed to additional work, required due to unknown conditions or substantive change orders, will based on the current bill rates for the actual time used. Additional materials will be billed at contractor cost. All change orders subject to 15% markup for overhead. 6. Contractor warrants it is adequately insured for injury to its employees and others incurring loss or injury as a result of the acts of Contractor or its employees and subcontractors. 7. Contractor shall at its own expense obtain all permits necessary for the work to be performed. 8. Contractor agrees to place all debris in an on-site trash receptacle (dumpster) and leave the premises in broom clean condition. 9. In the event Homeowner shall fail to pay any periodic or installment payment due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 10. The Contractor and the Homeowner hereby mutually agree in advance that in the event that the Contractor has a dispute concerning this contract, the Contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the Homeowner shall be requirKto submit to such arbitration as provided in MGL c 142A. r Notice: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the Contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed by the parties. 11. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials, or inclement weather. 12. Contractor warrants all work for a period of 12 months following completion. Copyright TMK Remodeling, LLC Initials All Rights Reserved Page 2 214 Sutton Hill Rd Contract North Andover MA 01845 Johnson_531_Forest_st_Kitchen_remodel 978 852-4491 www.TMKremodeling.com ItFMODFLING 13. Contractor may post small signage (36x36°) on property advertising services during the duration of the project. 14. The Contractor and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: (617) 973-8700 15. The Contractor or Homeowner may terminate this contract at any time for reasonable cause by giving 3 days notice in writing to the other party. If either party terminates the contract as provided herein, then the contractor will be paid for work (labor and materials) completed as of the date of termination plus any materials or equipment that are backordered and not delivered. Payment is defined as actual job costs for the project plus 15% overhead plus 15% profit. The contractor will provide a written report detailing actual job costs plus overhead for payment. The Contractor will refund any funds paid by the Homeowner that are a remaining balance for the labor and materials used as of the date of termination, plus any materials or equipment that are backordered and not delivered, plus 15% overhead plus 15% profit. The Contractor will make arrangements for the backordered items to be delivered to the Homeowner. 16. The Homeowner is responsible for maintaining adequate access to the property including snow removal, personal property storage, and working doorways, stairways and walkways. In the event the contractor is required to provide access or repair to the doorways, stairways and walkways, then the Contractor will bill the Homeowner at the hourly bill rate for same. ARTICLE 6. OTHER TERMS g p kko � cc? — C"r ; �� 8-1( 1 W 6—C V' 1 S o s Ik�e-c�Gi' ARTICLE 7. ACCEPTANCE Signed this(2 day of bo C 0 '^ , 20 t 6 H NOTICE: The signatures of Ke parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Copyright TMK Remodeling, LLC Initials S All Rights Reserved Page 3 v U o � 0 E o v Y ¢L� L CO CO Z 0) v N rn m a 0— U— c - '++ U) 01 m O'O.'t0 LO'O:O`10.LL) t0 in N`.-.0 10,;h �h`�r�AT- m) ,T h h Oro) m (D co CO m m r O'W IM1 CA0 O O`' -O r— 10 .:N �,U) 11- AT- Hi; L'O. LO'0 it() _ N 3 w o CO O 00 6FI.60 -.M vl M,M M to fR 0'CC) fir. .- �,viE»f» va 6»w cn:o"0V3, ICY �. 19 -. fR ' V! to co .,.6191 w s. " . h 2.° c — m m _ N OIC M e+� 'm0 N U E C to C I LL C • .. 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A (D _ 3, D m \ m O1 N m N N -51/211 A o `t 4 \ - 0 00 CL r 3 Up\ 1 (D 7 �• O O N ODl O N Oi 11'-6" W R. m Z w m ` z v y N a i 3 o o m 02 < C (D O C > X G O 3 < d (D 'O O' FFl�yy 0 D�j `L O O O O N /r 2 0m \ < n 3N (p 7 �. 7 - 1n 2 N (n �O A r OD 3 cDiq (D O 2 A .Oli ✓ C N m go A O O 6 O F 2. O r 3 a AUl H n •' The Commonwealth of Massachusetts { ,Department of IndustrialAceldents M - r 1 Congress Street, Suite 100 021X4 2017 Boston, MA ' ` 7 • 9�C www mass.gov/dia IQ�� SJ'ti� Warkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plwn ers. TO BE FILED WITH THE PERMUTING Name (Business/Oigariization/Individual): Address: City/State/Zip: .� •` 1/ — /i/1� Phone #: Z N , !1; � Are you an employer? Check tiie appropriate box: Type of project (recluuirec em to ees (RAI and/or part-time).'-' 7. ❑ Nevi constru6iion 1. I am a employer with P Y ( 2.I am a sole proprietor or partnership and have no employees Working forma in $. �,Reino deX]Tlg arty capacity. [No workers' comp. insurance required.] 9. El 'Demolition. 3.E] I am ahomeowner doing all workmysel£ [No workers' comp. insurance required.] t 10 0 Building addition 4.❑I am ahomeowner andwill be hiring contractors to conduct al work on my property. Iwill 11.❑ Electrical repairs or additions ensurethat all contractors either have workers' compensation insurance or are sole I proprietors wish no employees. 12_Gj'1?1.i mT iug repairs or additions 5.F]I am a general contractor and I have hued the sub -contractors listed on the attached sheet 13.. 0 Kb6f repair§ These sub-contractozs have employees and have workers' comp. insurance.t 14.M Other 6. Q We area corporation and iris, officers have exercised their right of'exemption per MGL c- 152, §1(4), and five have no empldyees. [No workers' comp. insurance required.] *tluy applicant that check§ box#1 must also fill outthe sectionbelow showing their workers' compensafionpolicy infommation.' t Homeovmers who Submii•this affdavrt indicating they are doing all work audthen hire outside contractors must submit anew affidavit indicating such (Contractors that checkthis box rimust attaclied an additional sheet showing the name of the sub -contractors and state whether or not' hose entities have employees. If the sub-coniractorshave employees, they 'do their workers 'comp.policynumber. I- am an employer' that is pr'ovidingworkerrs' compensation insurance for° my employees 8elory is the policy arzd join site information. Insurance Company Name: /! Policy # or Self -ins. Lic. #: �GL �b S—D /' 2 - 16 A-( I)ExpirationDatel � � lob Site Address: �3 ��2�S / ST _ City/state/Zip: %� 1 %�✓�� o ✓o P . x(/14 1 �i�`� 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 fiti.e 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 maybe forwarded to the Office of Investigdtions of the DIA. for insurance coverage verification. X do hereby certify nd thepains andpenald of eYjury that tTie informotion provided move is true and correct Date: �Z 711(a Si ature: Phone #: Official use only. Do not -write in this area, to be completed by city or town offzciaL City or Town: Permit[License # IssuingAuthoxity (circle one): i 1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other ContactPerson- 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 6fan individual, partnership, association or oilier 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 leas not produced -acceptable evidence of compliance with the insurance coverage xequited." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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) andphone 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. Ba advised that this affidavit maybe 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 TndustrialAccidents. 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 con paries 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 (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 stamp ed 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 bum 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-MASSAFE Fax # 617-727•-7749 Revised 02-23-I5 www.mass.gov/dia OP ID: JG 144cOA EV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/27/2016 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 Segreve & Hall Insur.Assoc.lnc 305 North Main St. Andover, MA 01810 Lawrence J. Hall CONTACT NAME: JFAX a/CONt o Ext): AIC, IC No): E-MAIL ADDRESS: PRODUCER TMKRE-1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED TMK Remodeling LLC 214 Sutton Hill Rd North Andover, MA 01845 INSURERA:Arbella Protection Ins. Co. 41360 INSURER B:AEIC 11104 EACH OCCURRENCE $ 1,000,000 A INSURER C : INSURER D: INSURER E: INSURER F: MA E ORE TED PREMISES Ea occurrence $ 100,000 COVERAGES CERTIFICATE NUMBFR! RFVIGInW N[IMRI=R- 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 LTR TYPE OF INSURANCE North Andover, MA 01845 POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR MA E ORE TED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 9520037133 03/18/2016 03/18/2017 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICYLIJECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (PER ACCIDENT) $ $ NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- B AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y /❑YN OFFICER/MEMBER EXCLUDED? N / A WCC -500-5011872 04/01/2016 04/01/2017 TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HC)LDFR t AAIPC'I I ATWIKI U 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE AQJ� U 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards i License: CS -105086 Construction Supervisor THEODORE M KELLEY 214 SUTTON HILL RDo fj� i NORTH ANDOVER— 5 ,.. r Commissioner Expiration: I �.��r. (✓r�>i:��zc:�uanczlff r1�C�%�� 4—a_- _Office of Consumer Affairs &Business Regulation eldi �7 a- gj: *'HOME IMPROVEMENT CONTRACTOR . l _ Registration j'65887 Type: ko„ y7 a Expiration4/5%20:1;8; DBA rte_. TMK REMODEI Mir:':.= - THEODORE KELLEY 214 SUTTON HILL RD'" } NORTH ANDOVER, MA t Undersecretary