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HomeMy WebLinkAboutBuilding Permit #645 - 54 Harold Street 3/8/2012Permit NO: WA Date Issued: , n -A ' BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION IMPORTANT:A Date Received t must complete all items on this LOCATION 67(o jh6AjQLJ2 Print PROPERTY OWNER -AO-0-3 jA CAbgAC.WSY l..►t y/AA t Print MAP NO/® PARCEL: ZONING DISTRICT: Historic District yes Machine Shoo Villaoe ves TYPE OF IMPROVEMENT PROPOSED USE 0%4A01 Residenti I Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: l N ST�4et .tom I�S6tl� �L©OIC• LZ G� 1.�� rJ [,� l ►.1 �-1 INS' t.L tr�� 1 N pDa" •- t � �s,1 t� w Citi- 4,4NA5 It-Z&�S Identification Please T e or Print Clearly) OWNER: Name: XVI 1 ",?f Phone: 7 $• b8�- "7 Address: 516 tikes-0LAP cz< A4ac>worL, aA o184'< CONTRACTOR Name G�tA!'Phone:-76t C(5-1 8 Address: 1 O to gZIJ 0%4A01 Supervisor's Construction License: Exp. r pate:__ ` `I A Home ImprovementLicense: 12-' Q1 (o Exp. Date: 2/1k / 1 ARCHITECTNEER 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: $ 3 -z-9 Check No.: -1 &� NOTE: Persons contracting ith un Signature of Agent/Rei- - C - Receipt No.: Ia U contractors do not have access to the g anty fund _ure of contractor -, c. Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE:ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS FALTH. Reviewed on Signature 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 Drivewav Permit DPW Town Engineer: Signature: - Located '384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report .❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No. �z Date Check 25080 TOWN OF NORTH ANDOVER Certificate of Occupancy $ ! Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Building Inspector ri W ui o w u n, cn w CA 0 'ti r. w °o° w U �' w w a rx � w CSG U W r U W � w u cn Cd w w O O .c � o r� w" Z ate' w: r E ocd z cn v Q o E C/) ui Oil Ri 7 O O co L O V Z CD CL O y Q C CD C C CO) Q 'O O :— h O O 'g m m CD 0 CD CL .0 O � CD Q o _Ca o a Cc a cDa c cca s c v J .� c Z s CL �..� y ccC CL C C CO) Q o o c o = L C y O_ C Q V O.C. m c V :Z O O � Eam m o o c i y 0= c :L; E a CD a O L L y y •:�3 .. os y czipm� _m o =C4 O O Ce m CD CLS� m fA O : t 0 - 0' cm cc, .d O O � _ m V y Z LO S O O •� L O C CL QI C Q � i m C •O = o IS p N o Q 0 COO Ccv m •_' O .y C _ � =2:5 -0 H .E = = !.s .y z W v4-- 10 CD Q O V m o �:t C y d m O '� D O t- t Oil Ri 7 O O co L O V Z CD CL O y Q C CD C C CO) Q 'O O :— h O O 'g m m CD 0 CD CL .0 O � CD Q o _Ca o a Cc a cDa c cca s c v J .� c Z s CL �..� y ccC CL C C CO) Q Massachusetts - Department of Public Safet, Board of Building Regulations and Standards Construction Supervisor License License: CS 79181 WILLIAM C PENNY 4 EMERSON PLACE #514 BOSTON, MA 02114 ('ununissiuner Expiration: 11/6/2012 Tr#: 7791 J%te Vr omvm�ouuea 0 ✓� 0aclzuoel�6 office of Consumer Affairs & B mess Regulation HOME IMPROVEMENT CONTRACTOR Type: Registration: 41:28016 private Corporation Expiration: -2i X11 013 . SNS, INC AN VER RENO [" WILLIAM PENNY° 110 Vi/INN ST�� WOBURN, MA 01801 Undersecretary J ANDOVER RENOVATION SOLUTIONS ANDOVER RENOVATION SOLUTIONS, INC. 110 Winn Street, Suite 203 Woburn, Massachusetts 01801 781 937-8805 FAX 781 932-1174 04-342338 MA Home Improvement Contractor 128016 MA Construction Supervisors License 079181 Number l dated March 5, 2012 Name: Ahren and Chrissy Lippman Project Address: 56 Harold Street, North Andover, MA 01845 Home Phone: 978 688-4047 Mailing Address: Same e-mail: alippman@statestreet.com Day Phone: Ahren Work 617 664-1829 Ahren Cell 617 571-3841 Add/Delete the following work from Purchase Order dated: 03-03-12 Number Description Price 1 Delete remove door to basement and close -in opening. $ (3,112.50) Delete frame new door to basement in rear hall Delete remove door to rear deck, close -in opening and furnish and install Harvey CTR 2826 transom window. Patch exterior siding and plaster patch interior. Case window with B 100 belly band casing 2 Furnish and install clear pine belly casing on bay window in computer $ 358.33 room and replace basecap in computer room with clear pine cap. 3 Remove decorative beam in kitchen. $ 0.00 4 Re -use (2) lock sets (bath and second floor stairs) and delete furnish $ (86.00) Schlage Plymouth polished brass for these doors. Delete Schlage Plymouth polished brass locksets on basement and pantry door and furnish Kwikset antique brass locksets to match existing. 5 Delete Masonite 2 panel door to second floor stairs and furnish 15 -lite $ 168.56 interior pine french door. 6 Delete 7-1/4" primed speed base and furnish 1 x8 base with 1-1/8" cap. $ 0.00 Total Adjustment Price $ (2,671.61) This change order supercedes all conversations, statements, and agreements expressed or implied between the parties, their agents and representatives. Do not sign this Change Order if there are any t IR blank spaces. Change Order payment is due upon signing this agreement. This Change Order will add/delete time required to complete the project. Owner Date own/ Date 3,6/y Andover Renovation Solutions, Inc Date Revised Payment Schedule With the Above Listed Change Order #1 dated March 5, 2012 Payment Description Percent of Total Amount Original Contract Amount $ 30,063.01 Change Order 1 $ (2,671.61) $ 0.00 $ 0.00 $ 0.00 Revised Contract Amount 100.00% $ 27,391.40 With Order Deposit 30.00% $ 9,018.90 (Due At Placement of Order) Paid Visa 03-03-12 At completion of demolition 20.00% $ 5,078.28 At blueboard and plaster 20.00% $ 5,078.28 At installation of trim 20.00% $ 5,478.28 Substantial completion 8.00% $ 2,191.31 Completion of punch list 2.00% $ 546.35 RENOVATION SOLUTIONS Date: March 3, 2012 ANDOVER RENOVATION SOLUTIONS, INC. 110 Winn Street, Suite 203 Woburn, Massachusetts 01801 781 937-8805 FAX 781 932-1174 04-3452338 MA Home Improvement Contractor 128016 MA Construction Supervisors License 079181 Name: Ahren and Chrissy Lippman Project Address: 56 Harold Street, North Andover, MA 01845 Home Phone: 978 688-4047 Mailing Address: Same e-mail: alippman@statestreet.com Day Phone: Ahren Work 617 664-1829 Ahren Cell 617 571-3841 Work To Be Performed under this Agreement: 1. We will furnish and install in a workmanlike manner the remodeling project according to the scope of work attached, and the terms and conditions made part of this agreement. 2. The final price listed below will change based on the final scope of work determined at the pre -construction meeting and will be adjusted by Change Order #1 outlining additions and deletions to this agreement. Anticipated Construction Schedule at time this agreement is signed: Approximate Start Date of Work: March 19, 2012 Approximate Substantial Completion Date: Apri130, 2012 The above schedule are approximate dates for overall planing purposes only. We can not be held responsible. for circumstances arising during the course of construction beyond our control Price: $30,063.01 Payment Payments are to be made as per the payment schedule on page 5 of this Schedule: agreement. The parties agree to the attached schedule. This agreement supercedes all conversations, statements, and agreements expressed or implied between the parties, their agents and representatives. Do not sign this Agreement if there are any"ilk spaces. UWner Andover Renovation Solutions, Date Date 3. e3. 1y - Date Page 1 of 5 r March 3, 2012 Kitchen Renovation Project Remove suspended ceiling in kitchen, eating area and study. Remove existing upper wall cabinets in kitchen. Remove casings, baseboard and plaster walls in eating area of kitchen. 2 Remove door to basement and close -in opening. Frame new door to basement in rear hall and install Masonite two panel primed solid core molded door with Schlage Plymouth polished brass lockset and primed B 100 belly band casing trim. 4 Remove door to rear deck, close -in opening and furnish and install Harvey CTR 2826 transom window. Patch exterior siding and plaster patch interior. Case window with B 100 belly band casing. Install new primed B 100 belly band casing on existing windows in eating area. 6 Furnish and install (4) Masonite two panel primed solid core molded door with Schlage Plymouth polished brass lockset and primed B 100 belly band casing trim. 7 Remove vinyl floor and underlayment, take major dip in floor out with leveling compound and furnish and install Shon Engineered Natural Red Oak Hardwood Floor over foam pad in kitchen, eating area and study. 8 Furnish and install (8) Halo 5" recessed downlights. 9 Strap over existing plaster ceiling and install '`/2" blueboard with smooth finish veneer plaster. 10 Plaster over beam in kitchen. 11 Re -install existing kitchen wall cabinets with new 2-1/2" cherry crown molding on top. Hang pennisula cabinets from threaded rod and enclose in cherry framed box. 12 Furnish and install new 7-1/4" primed LGM57 baseboard in renovated areas over new engineered flooring. 13 Install electrical to include relocation of all wiring in disturbed walls and ceilings and installation of (3) client supplied light fixtures. Does not include upgrade of service or code deficiencies in existing wiring. 14 Does not include painting. 15 Remove all construction debris in supplied dumpster. 16 Includes building permit and permit fees. Page 2 of 5 ................................................................................................................. 1. Parties: "You" refers to the buyer or buyers. "We" or "Us" refers to the seller. Andover Renovation Solutions, Inc. 2. Access: You will permit us to go into the premises. the premises includes the land and the buildings. You will get any consent needed for us to go onto any other premises in order to do the job. You are responsible and hold us harmless and accept all risks for access through adjacent properties. If we are not allowed to go onto the premises and are prevented from completing the work, then we have no further duty to perfbrm this contract. 3. Insurance: We and all our subcontractors agree to carry the necessary Workntans' Compensation Insurance and Public Liability Insurance as required by law. They cover the work to be performed under this agreement. 4. Warranties: We warranty all materials and workmanship for a period of one (I ) year from date of substantial completion on all work and materials supplied by us. This warranty does not cover damages beyond our control such as misuse or failure to follow maintenance instructions or Acts of God. If a replacement product is unavailable will we provide a substitute of equal value. You may not withhold any portion of tile final payment for guaranteed performance under this warranty. No service under this warranty is available if payments have not been made under this agreement. The only remedies for breach of warranty are stated in this paragraph. It is understood that we will not be liable for incidental, special or consequential damages in any way connected with the products or their installation whether for breach of warranty express or implied, negligence orother reason. The limitation of damages under this warranty are for repair, replacement or abatement only. 5. Changes and Alterations: No additional work will be performed without the prior written authorization by you. Any such authorization will be done on a written Change Order form approved by both parties. Corrections of existing building code violations not specified in the project description, or hidden structural, electrical or plumbing defects will be an addition to this Agreement and paid by you. Any changes requested by inspecting Public Authorities not covered in the Project Description will be billed to you as additional work. You agree that the duration of work and the scheduled date of completion may differ from the date as indicated on page one, because of changes, alterations, hidden conditions, inspectional delays, etc. which are unavoidable by us and shall not be considered to be a violation of this agreement. Change orders are paid at time of approval and prior to such work. v 6. Survey: You are solely responsible for the location of all lot lines and shall provide at your own cost a survey showing buildings and property lines unless a certified plot plan is included in the attached scope of work. 7. Matching Existing: Where materials are to be matched, we will make every effort to do so, using standard materials, but we cannot guarantee a perfect match. We are not responsible for. the existing conditions of the structure with regard to the level and plumb of walls. ceilings and floors and work to be done to existing conditions will be done in a workmanlike manner without re -plumbing existing- conditions xistingconditions unless specified in the Project Description. 8. Landscaping and Ledge: This agreement does not cover the blasting or removal of ledge during excavation and will be billed separately to you. We will bring the grade back to a rough grade condition after excavation, which does not include loam, seed or sod. We are not responsible for damages to landscaping or grounds due to the use of vehicles or heavy equipment. 9. Payment Schedule: Payments shall be made by you as per the attached Payment Schedule. We have the right to stop work if payments are not made to us when due. Overdue payments will include a finance charge of 18 percent per year. We shall pay all invoices authorized by us arising out of the construction and will hold YOU harmless against any liens for labor or material filed against the property provided you have made all payments due us under the payment schedule. 10. Owner Supplied Services: You agree to provide electricity, water, toilet and telephone as may be required by us to perform the work under this Agreement. 11. Advertising: You grant us the right to display a job sign at the property and take photographs of our work for the use in our advertising. 12. Complete Agreement: This contract is the entire agreement, and it is agreed by both parties that the entire Understanding is contained in this written contract between you and us. It is further agreed that any subsequent changes to this agreement must be in writing and signed by the parties. No oral agreements not specifically stated in this agreement will have any force or effect. You are advised not to sign this agreement unless all blank sections have been tilled in or marked as void. deleted or not applicable, and until all exhibits and related documents that are incorporated herein are attached. 13. Subcontractors: We have the right to subcontract any percentage of the work to be performed under this agreement. You will not during the course of the project hire any of our designated subcontractors forother or additional work without our written approval. You may hire your own subcontractors to perform selected work at our approval during the course of our construction process. You are responsible for their supervision and their clean-up of the work site. You must have them provide us with insurance certificates prior to starting their work, if they are working during the course of our construction period.We are not responsible for delays caused by your subcontractors. 14. Cancellation: You may cancel this agreement within three business days as required by law if this agreement is signed outside our place of business. We retain the same right of cancellation. Any deposit received from you will be returned. See attached notice of cancellation (if signed by the parties at a place other than our place of business) for an explanation of this right. 15. Registration: All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by provisions of Chapter 142A of the general laws, must be registered with the Commmomvealth of Massachusetts. Inquires about registration and status should be made to the Office of Consumer Affairs and Business Regulations. Ten Park Plaza, Suite 5170, Boston, MA 02116, Phone (617)973-8700 16. Permits: We agree to obtain as your agent the building, plumbing, and electrical permits necessary to complete the scope of work under this agreement. We shall not be held responsible for delays in the work described in this agreement caused by regulatory, permit granting or inspectional agencies, or authorities. Under Chapter 142A, homeowners that obtain their own construction related permits or contract with unregistered contractors will be excluded from the guaranty fund. 17. Copy of Agreement: This agreement in governed by the Laws of Massachusetts. It must be executed in duplicate, and an original signed copy will be given to you at the time of execution. No work under this agreement shall begin prior to the signing of this agreement and transmittal to you. 18. Arbitration: The contractor and the homeowner mutually agree in advance that in the event of a dispute concerning this agreement, the parties shall submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations as provided in MGL c. 142A, and the decision of the arbitrator will be final. In the event of a dispute, and we have to retain an attorney to collect monies due us, and we prevail, you will be responsible for all attorney fees. 19. Cleaning: We will keep the job site broom clean. At the end of thejob we will broom clean all disturbed areas. 21. Unknown Conditions: We will advise you in writing of any unknown conditions discovered during the course of construction; ie. moisture, mold/mildew, rotted wood, insect damage, or any existing structural damage. We will provide a separate cost to you for those repairs. 22. Living at the House During Construction It is recommended by us that you vacate the house during construction, however if you decide to live at the house we are not responsible for any health related problems due to dust. or adverse moisture conditions. You are responsible to keep children and pets away from the construction site. 23. Quality and Workmanship Standard Quality and workmanship standard for this contract are defined by the National Association of Horne Builders, Residential Construction Performance Guidelines for Professional Builders & Remodelers,2" Edition, ISBN 0-86718-495-7. In the event of a dispute these standards will be used. 20. Approval of these terms and conditions is indicated by your signature on the first page of this agreement. Page 3 of 5 Page 4 of 5 ' ' ° Andover Renovation Solutions, Inc. March 3, 2012 Name: Lippman Project Address: 56 Harold Street, North Andover, MA 01845 Phone: 978 688-4047 Payment Description Percent of Total Amount Original Contract Amount $ 30,063.01 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Revised Contract Amount 100.00% $ 30,063.01 With Order Deposit 30.00% $ 9,018.90 (Due At Placement of Order) At completion of demolition 20.00% $ 6,012.60 At blueboard and plaster 20.00% $ 6,012.60 At installation of trim 20.00% $ 61012.60 Substantial completion 8.00% $ 2,405.04 Completion of punch list 2.00% $ 601.26 Definitions: Substantial Completion is obtained when all areas of the addition/renovations are functional and habitable. Does not include any town inspections. Punch List Items -.-Material or weather dependent items that cannot be completed until received or done until weather permits. Punch list payment amount held by client should not exceed one and one half times cost of items not completed. Page 5 of 5 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/ ): A so pp�—yL PO-�rAT k oN Geo W tl cZ*:o5 LA L Address:I(C=o V) J,yN City/State/Zip: AAA, Q(501 Phone #: 1 N A,r_e.,%ou an employer? Check the appropriate box: c13-7 5&0 Type of project (required): 1.1 I am a employer with 6_ 4. ❑ I am a general contractor and I 6. ❑ employees (full and/or part-time).* have hired the sub -contractors w construction 2. [1 I am a sole proprietor or partner- listed on the attached sheet. 7.Remodeling ship and have no employees These sub -contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. E]Building addition [No workers' comp. insurance comp. insurance. 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' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.0 Other employees. [No workers' comp. insurance reauired.l *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. #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: Y (u'14C, 5D O $'1s4 6 o l Z..o 1 C> Expiration Date: � � � 2-S , j Policy # or Self -ins. Lic. #: Job Site Address: ' City/State/Zip: 110_ A -N P 04M /CAA Attach a copy of the workers' compensation policy declaration page (showing the policy number and expira iolh ate Failure to secure coverage 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 thviolator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins tt�nce coverage verification. I do hereby certify under the pi4r?and penalties of perjury that the information provided above is true and correct. e., Phone #: -75 ( `12,51 5 $Off ' �— 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 #: OP ID: MS '`'� RLY CERTIFICATE OF LIABILITY INSURANCE DAT 0310 D/YYYY) 03/06/12 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 781-729-9200 Scott! 8r Company, Inc. 19 Mount Vernon Street 781-729-9500 P.O. BOX 1000 Winchester, MA 01890-8300 Michael P SCotti NAME: NTACT PHONE (A/C, Ext): AIC, No E-MAIL ADDRESS: PRODUCER ANDOV-1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Andover Renovation Solutions, Inc. 110 Winn Street, Ste. 207 INSURER A: Endurance American 41718 INSURERB:Associated Employers Woburn, MA 01801 INSURER C INSURER D: A INSURER E: INSURER F NN186805 COVERAGES CERTIFICATE NUMBER: RIPWRION NI IMRFR- 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 POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX_1 OCCUR NN186805 02/06/12 02/06/13 DAMAGE 0 RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 1,00 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $ HIRED AUTOS NON -OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIABH CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N /A CC 5008746012010 11/23/11 11/23/12 STATU- OTH- X 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) PROOF02 For Insurance Information Purposes Only For verification please call 781-729-9200 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 W IVUts-zuua ACUKU GURPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public SafetN Board of Building, Regulations and Standards Construction Supervisor License License: CS 79181 WILLIAM C PENNY 4 EMERSON PLACE #514 BOSTON, MA 02114 Expiration: 11/6/2012 ('ommissioner Tr#: 7791 92. � � n Office of Consumer Affairs & B ►ness Regulation HOME IMPROVEMENT CONTRACTOR Type: Registration: ,428016 Expiration:-21�11p13. Private Corporation _ 1 AN VER RENO19NS, INC .'.+ _+'t. WILLIAM PENNY''„=°I 110 WINN ST WOBURN, MA 01801 ::<;_,,r- Undersecretary