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Home My WebLink AboutBuilding Permit #688-13 - 57 BERKELEY ROAD 4/19/2012Permit NO: Date Issued: &�1� BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received ORTANT: Applicant must complete all items on this page vr-•• •' 1q,t,s-- T,. `.x'*.t ,�c:,.+ Zit *'"kc,. -r, t- n 'fit .. .^g'^`. .r fix= '-r„ r ♦-� �4 .r- w. +rr�;-..r*^' s'q rev , ,a .s:.w.r .s-�c, � '`'; � � �r-7-ri + # .� + � s' _d :C�.ski . 1� ♦.F� 'S.'4 �'j �'r F i 'r.2. � '`RNA �l {PROPERT Y)`'OWNERr MAP{NOPARCEL�'ZONINGtDISTRICT ,NistoncEDistnct_ a �, yes .nom i ''IVlachine Sh6o-t illage ;yes +Ki o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne ami Addition Two or more family Industrial Alteration No. of units: Commercial epair, replacement Assessory Bldg Others: DemolitionOther Septics `UVell; 1� i,�4 Floo�clp(a "z { ;UVetlan s j== E� �`` 'F Watershed District °y� `t Y _ DESGKIF 1 IUN Uh VVUKK 1 u est rKerumivicu: I1J 1� 1S CH - 11�JeTS ItJ)r)0\N \-%kn> - WDUb -IF- oz's M1 "-T% 1 Identification Please Type or Print Clearly) OWNER: Name: Phone: ••l HQUreSS. jCONTRi4CTOFZ `Name Flione a TS �StapervisorsConstructionLicensea f lt-14� �f Expo +Date 1 A =" + .�. .. r _ 4 HorieImprov�ementiLic nse' `�ra� fj� `r. a�.�� s- W �Exp`Dat ZZ20:1 .f ARCHITECT/ENGINEER x.11 -9y Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $92.00 PER ,$1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. --7 Q�6 A!O io Total Project Cost: $ FEE: $ (��) r Check No.: �, Receipt No.: NOTE: arsons contracting pqh unregistered contractors do not have access to the guaranty fund Signature,77- o Agent/Owner *x ,� �;;Si nature of contractors _. g... _ -.._- Location 3 1 �(_' ' No.—�0 � - 11 £ Date t Check # ✓ 1 ✓ 26305 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ T- Other Permit Fee -$. TOTAL $ Building Inspector 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 HEALTH. col COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm Conservation Decision: Comments Water & Sewer Connection/Signature & Date. Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street 5V ent1sli t'r Id 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 followingis a list of the required forms to be filled out fo �Mwprrop riaf�e' 13x -to be obtained. G Roofing, Siding, Interior Rehabilitation Per -&:'t"9 ❑ Building Permit Application ❑ Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 LLI O o fd V N S2 O. (%j °G GW Z Z m C o v � U- s 7 d' v c E U (6 U- O r 7 bo O' �° LL o Z Q v G W t j K �_ N 4 I�1 a� s j K _ c0 13_ LLI O o fd CJ N o LCL N S2 O. (%j °G GW Z Z m C o v � U- s 7 d' v c E U (6 U- p Z C7 Z d r 7 bo O' �° LL o Z Q v G W t j K �_ N '° LL o aLL. Z - s j K _ c0 13_ Z W a C S5 U. v p] Z W ( j v �c O ul Q `a R 1HG 2: L O v 3 R O = J •C- �. �• i �� Cc C. a+ > R L 'an) O 4 a ♦: Q: w C mco�a .Q. O+ D H V o C. Z Q L CD l -c•0 �- O • C. Q `a R 1HG 2: L O �J O c E to O Z t (n w W X w 0 c W I., -a w 00 L- C- CL 0a J � O Z U) c v 3 = J �. �• �� Cc > R L 'an) O E O mco�a D o Z Q -c•0 U) O O • C. CL - ol Z c R .N a �; L�R p} c0) o = c _ NU Q�;•� m C R w O O W_ LL .N 'a d R N C O ,= O r.+:E :rO v v v o� a N � �s -� o � Q.ov �J O c E to O Z t (n w W X w 0 c W I., -a w 00 L- C- CL 0a J � O Z U) c Date: March 3, 2013 Customer: Lynne Jackobek 57 Berkeley Road North Andover, MA 01845 Re: Wellborn Cabinetry for Kitchen 3e/�rpi( iaer4a, t CUSTOM CABINETRY & MILLWORK 109 Sutton Street, North Andover, MA 01845 Tel: 978-685-2831 Fax: 978-685-0852 Email: info@pridecraftinc.com The following is a preliminary specification sheet and budget for the proposed Wellborn cabinetry for your kitchen. Wellborn Select Cabinetry for Kitchen $10,250.00 Kitchen Cabinetry per proposed designs Specifications: Series: Select Wood Species: Poplar Door Style: Bedford Square Finish: Divinity for "L" / Sienna for "Island" Drawer Front: Slab w/ Dovetail drawer box with soft close under mount slides Granite Countertops $3,000.00 - $5,000.00 Estimate is based on promotional Group A color only, from our preferred fabricator, National Stone. Actual costs can vary based on final granite selection, distributor and fabricator. Payment Schedule • 10% non-refundable deposit with signed preliminary budget and specification sheet. This is a deposit on the job and will be applied to the last payment. • 50 % at placement of order. • All outstanding balances will be due prior to delivery and/or installation. J, Note: MA Sales Tax, drawer and door pulls, installation, delivery not included in price. 14 Please Note: We have an extensive line of drawer and door pulls — come by to browse our showroom! Respectfully submitted: Paul DiSalvo Pridecraft, Inc. The above prices and specifications are satisfactory and are hereby accepted. Pridecraft, Inc. is authorized to do the work as specified. Customer agrees to their responsibilities. Payments will be made as outlined above. Customer Signature Date: Enter construction cost for fee cal - North Andover -Fee Calculation Construction Cost $ 75'5,000.00 m $ - $ 900.00 Plumbing Fee $ 112.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 112.50 Total fees collected $ 1,225.00 57 Berkley Road 688-13 on 4/19/2013. Kitchen Remodel � rico. Building &, Remodeling Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 North Andover, MA 01845 LLC 978-479-1526 04/09/13 adambrico@gmail CONTRACT Lynn Jacobek 57 Berkley Rd North Andover, MA 978-686-2665 Job Description 1: Installation of new 31/a" red oak hardwood floors. Installation of Hall the and 1/2 bath • New 31/a" oak hardwood floors installed throughout entire house excluding side mud room. • Rosin underlayment and refastening of sub -floor where it is necessary . • Floors to be sanded, sealed and poly coated for a natural finish. • All entrance ways to have smooth transitions, eliminating thresholds • Tile floors to receive new "Hardy Backer" sub floor • New tile installed in hall closets and half bath • Allowance of $1000.00 is included for the cost. Total Estimated cost: $13,850.00 Job Description 2: Demolition • Remove all existing flooring down to the sub -floor • Remove all cabinetry • On-site dumpster to be placed for debris Fl • Kitchen ceiling to be removed for new kitchen lighting • Removal of all interior doors, jams and casing • Removal of all interior window casing except where new windows were previously installed • Removal of existing stair treads, risers and railings • Removal of all base board throughout • Living room pine boards to be removed. • Double door and casing between living rooms to be removed Total Estimated cost: $3,535.00 Job Description 3: Finish Work, Doors and Windows • Installation of 12 new primed 6 panel solid core doors with 2'/2 colonial casing, nickel hinges and colonial brushed nickel Schlage locks • Installation of 4 new primed sets of bi fold doors, 6 panel solid core doors with 2'/2 colonial casing • 9 new double hung "Harvey" windows with federal energy efficient glass, half screened, grids in both sashes • Installation of new pre primed 2 1/2 colonial casing on all windows and doors with traditional window stops and sill • Resurfacing of mantle • Installation of new 5'/a pre primed colonial baseboard throughout entire house • Installation of oak stair treads and hand rail with white pine risers, skirts and balusters • New baseboard heat trim kits throughout house • New Tamper proof white outlets and switches • Install 4 new windows previously purchased • New closet pole and shelving throughout • HVAC trunks to be boxed in • Painting not included Total Estimated Cost $20,936.00 Job Description 4: Kitchen Installation and Half Bath • Installation of new cabinets and trim provided by owner per plan • New Harvey Casement window, windows with federal energy efficient glass grids • Sink to re -plumbed for better efficiencies and cabinet install • Lighting to have 3 pendants and 4, 5" recessed cans and outlets brought up to code Recessed lights provided with white trim kits, pendants to be purchased by owner • Cabinet knobs or pulls installed knobs and or pulls purchased by homeowner • Counter -tops to be granite, an allowance of $4000 is included • Microwave installed • All permits and inspections included • New ceiling and plaster touch ups • A $1800.00 allowance is included for new vanity, toilet, sink and top Total Estimated Cost: $23,800.00 Total Cost For All Jobs With Permits: $65,000.00 Items with a given allowance is an estimated cost if the cost of any allowance is not met a credit will be given on the final invoice. If the cost is exceeded the homeowner would be responsible for the difference. All Sub contractors must carry the appropriate licensing and insurance to work in the state of Massachusetts Any unforeseen work or necessary repairs found during this project to be brought to the owner's attention as soon as possible. Any extra work resulting from unforeseen problems will be priced accordingly on site and be done with written approval. BriCo is not responsible for anything that occurs on site that is not directly involved with the construction of this project. BriCo warranties all workmanship for 2 years. The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices, and all work performed shall be subject to final approval by Owner. All work to be done incompliance with Massachusetts building code. BriCo takes on full responsibility of all necessary inspections. The Owner agrees to pay BriCo Building and Remodeling $65,000.00, for doing the work outlined above. The following payments will be paid to the contractor in the following manner: Deposit of $15,000.00 is due on contract signing. This payment will go to ordering windows, finish work, dumpster, permit fees and deposit on flooring. Second Payment of $25,000.00 after completion of floor, doors and window installation, finish work will have begun on remaining trim. Third Payment $15,000.00 completion 90% of finish work and cabinet installation has begun. Final Payment: Will be based on allowance totals after final punch list and completion of project. Estimated $10,000.00 BriCo Building and Remodeling is a fully licensed and insured LLC company in the state of Massachusetts. License numbers are provided in the header above and current insurance documentation upon request. We would like to thank you for the opportunity to bid on your project and would look forward for the opportunity to work with you. Dated: Signature of Owner:ell Signature of Contractor: \M Sk gx o \ �\ q k\ � \ /■L. Sao _ §§.7 4 A $2 rA § �S/. /oƒ :ƒƒ�. u� rA /)\\ � r CN2 2 q � 0 0 . /4 0 r7 7J§ / N2 W §�2 c % \00 / The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 kwim www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): &ILbING Amb FZP_tA01=1I iV G LLC Address: ti 1-1 0.116 1( t_'Y City/State/Zip: Mmr-+1 �NDOUf.� MA o i%q 1; Phone #: 91$ LI -719 - 15 Zt; Are you an employer? Check the appropriate box: 1RKI I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: _rz ME I -r— zr> Policy # or Self -ins. Lic. #: �17() M` �(�1 1 Expiration Date: » 0 ILA Job Site Address: _5 l City/State/Zip: , N.Wg(R MA 018% Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). 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 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. 1 do hereby certify under the pains and penalties of perjury that the information provided ff above is true and correct. Signature: Q LP) Date: y l U I R 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 #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of'a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) 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. Be 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 Town Officials , Please be sure that the affidavit is cbr%plete 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-numbir 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia This form satisfies all basic requirements ofthe state's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard language to protect homeowners[ 18eck legal advice if necessary. Any person planning home improvements should first obtain a copy of "A Massachusetts Consumer Guide to !Ionic Improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Ratline at 617-973-8787 or 1-888-283-3757 or on our website. . Homeowner Ilormation Contractor Information 4,iame I I Company Name Litim ' Street Address (do not use a Post Office Box address) Contractor/ Salesperson/ Owner Name City/TownState Zip Code Business Address (must include a sheet address) o o Daytime Phone Evening Phone City/fown State Zip Code V o18Lis Mailing Address (It different from above) Business PhoneI Federal Employer ID or S.S. Number l/1"IQ, Home tmpmenrcnt Contactor Reg Number bomrion date' i v Hdo cyhentlstmnrn I�' n ,did nmtiocnumbs• /1 17 U y I • . agrw w uu we sorrowing worst ror the Homeowner: (Describe in detail the workto completed, specifying the type, brand, and grade of materials to be used, use additional sheets if ri s ) NSW XI-rcr{�N1 t��l.flC r�ect�' W�rvt�aWS MISC "%IM warK W50 WA2AW00LD f'100iZ5 Required Permits -The followinglliuilding permits are required Proposed Start and Completion Schedule -The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty fund provisions of I b-4 Date when contractor will begin contracted work MGL chapter 142A.) !a / Date when contracted work will be substantially completed. i Total Contract Mee and PaymentiSchodule The Contractor apeeS t0 perform the wnrk fitrnich fl,, —4.1 , A tit ..... ........:.c.. - /• t �_ ,n-.� Payments will be made according to ;the following schedule: $ OrJ upon signing contract not to exceed 1/3 ofthe total contract price p–r the cost of special order items, whichever is greater) $ by / /_; or upon completion of F IU 0 Q S W 1 UK Met rA $j—&D fl U by / / or upon completion of 1 M K ITC 1a a w t $_10000 upon completion' f the contract (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted ,�o'rk begins in order to meet the completion schedule.(**) $ to be paid for NOTES: M Including all finance charges (**) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of I (h) one-third of the total contract price or (b) the actual cost of airy special equipment or custom made material which must bespecial oraelred in advance to meet the completion schedule. lExnress warranty -Ts an exoress wairanty being provided by the conbnctoro ❑ No Ycc (all terms ofthe wnrranhr ntus[ be nMehed to the contract Subcontractors The contractor agrees to be solely responsible for completion oft1le work described regardless ofthe actions of any third party/subcontractor utilizedby the edntractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor ander this aeree'. Contract Acceptance Upon srgnihj , this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lieh'or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contrac'.tl l; Doa't be pressured -into signing the contract -Take time to read-and-faliy understand it-) questions if something is�unclear. ° I Iy eke sure the contractor has alvalid Home Improvement Contractor Remstrahon. The law requires most home improvement contractors and Subcontractors to be registeredlwith the Director of Home Improvement Contractor Registration. You may m registration by writing to the Director at 10 Park P - quire about contractor Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. ° Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm covers a or ask to see a copy of a "proof of ins re[d&' document. Y g • ICnow yobs rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy ofthe Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main1office or branch office by ordinary mail posted, by xpla tele gram sent or by delivery,third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanot later than midnight ofthe nation ofthis right DO NOT SI TT THIS CONTRACT IF THERE ARI; ANy BLANK SPACES!!! T" identical copies of the contract must be completed and signed. One eew should so to the immeov mer- The ocher eery abould be keps iry tho oontmutyr. Homeown r s Signature l Uffluraaor s Signature— Date % _ Date g2G2v Rightfax N2-1 4/19/2013 8:11:54 AM PAGE 2/002 Fax Server �'� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) TM&PERTIFICATE IS ISSUED ASA 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX NANCY GREENWOOD SMITH 11 HAVERHILL ST (A/C, No, Ext): (A/C, No): E-MAIL METHUEN, MA 01844 ADDRESS: 726KN INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA BRICO BUILDING & REMODELING LLC INSURER B: INSURER C: INSURER D: 417 WAVERLEY RD -- INSURER E: N ANDOVER, MA 01845 - INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN_ THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE , LTR TYPE OF INSURANCE L R POLICY NUMBER (MM%DD\YYYY) (MM1DD\YYYY) LIMITS GENERAL LIABILITY nACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE 0 OCCUR. DAMAGE TO RENTED $ REMISES (Ea occurrence) ED EXP (Arty one person) $ ERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY =PROJECT [—] LOC ENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) BODILY INJURY $ (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY Y/N UB -4618P507-13 04/19/2013 04/19/2014 XWC STATUTORY LIMITS OTHER ANY PROPER ITOR/PARTNER/EXECUT NE OFFICER/MEMBER EXCLUDED? N/A E. L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION NORTH ANDOVER BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD 5T BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER, MA 01845 Ii�.�- AUTHORIZED REPRESENTATIVE f , t At.VKU ZD tZUIU/UO) ine A�,vKu name ana Togo are reglsierea marKS oT AUUKD 19S8-2010 ACORD CORPORATION. All rights reserved. - 11 t�sachus _ Bo: ttt� Dclrartntcnt rtl' ►t'd of Bttildrn� Bt.,, 1'uhlic j,tl�:t� construction Sup." u .ulations ant! Standards. License: Pervisor License CS. 104428 ADAM 13RIEN T 417 WAVERLY R .' NOR7f H pADANDOVER, MA 01845 r„ner EX Piration: 5/12/ . X114 104428 Office of Consumer Affairs and Business Regulation 10 Park Plaza. - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration BRICO BUILDING AND REMODELING -LLC ADAM BRIEN 417 WAVERLY RD NORTH ANDOVER, MA 01845 SCA 1 0 20M-05/11 UJJC T a��2mzo�rrae�rl.(� o�V<�GCraJac�cr7e� -: Office of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR egistration: .168512 Type: xpiration. 3/1/2015 LLC BRICO BUILDING AND REMODELING LLC Registration: 168512 Type: LLC Expiration: 3/112015 Tr# 235601 Update Address and return card. Mark reason for change. ❑ Address E] Renewal E] Employment [1] Lost Card License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 ADAM BRIEN 417 WAVERLY RD NORTH ANDOVER, MA 01845 Undersecretary Not. without signature The Co'.0n�� na t Of Massachusetts Departmeh.t of Fire Services Office of the State Fire -Marshal P. 0. Box 10?5 St ate Road, Staw, NU 01775 PERMIT Date: North Andover City ( City of Tawn) ( Lf Applicable.) Dig Safe Number In accordance with the provisions of N G_Ll 4 8 Chapter 10 as provided in section_ 5 2 R 3 4 7 (' MStart Dale This Permit is granted to:jt' 4/'7/' { �fj1�D�Ye,I �vic Fullname ofpersoa, Firm'or Corporation Peraussionto locate dumpster for construction/renovation/demolition of building. Comments;' dumpster must be. 25from structure if unable to place with require Reslrtctzotu: clearance dumps -ter must be 'covered with plywood or tarp end of work -day at ( Give location by scree and no., or FccPaidS 50.00 This Pcrmit will expire-�j- 3� j ( Si aturc ru-�cn��manner as c`p's oviea aaequate tdcatitication of 1'ccation ) G4i(,(�,✓ /' 9 Fire Chief granting permit) Ofzical grantingpcmut ( Title ) M ai p M id O C!1 N N O Q b � Oa A Ln .� rA a En O rA 4•"' O cC y U d U .d Q Cd O Vl 0 Q° f \u F :i Rf O O x biIV. O b Q Q >� W U No� ti •� U 7 ,� r