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HomeMy WebLinkAboutBuilding Permit #611-16 - 595 CHICKERING ROAD 11/8/2015NORTFj BUILDING PERMIT*.,,, -ED TOWN OF NORTH ANDOVER 32 h `'. :.,,. APPLICATION FOR PLAN EXAMINATION A r �°$ Permit No#: 1 Date Received �q A0oArEU SSACHUS Date Issued: !, fNIFO- Applicant must complete all items on this page Ste-++ LOC�4TION -� ''"""elm_ `.�"ai _ Print 777 #� PROPER<TrY�OOWN R n ' tint :1 OO�YearS� MAP. pARCE ONING 17.51.8 6-1, Histori Des riot `es ' Maefjire ShopVillage TYPE OF IMPROVEMENT PROPOSED USE 11 Address: S 5 &Rov -%r Residential Non- Residential ❑ New Building ❑ One family o _ ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: N Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Phone: El Septic ; ❑Well Floodplain Wetland"s �. ❑Watershed District, , , . nwate / ewer FEE: $ L / '. >Y , o<- DESCRIPTION OF WORK TO BEP RFORMED: Iar YQ► PM. .,r, Id Ylic� t' Please T e r P 'nt Cle�rl en i a ion - yp o Qri y Name:' Phone:` 3% 91s 3a00 OWNER: -->h,^ 11 Address: S 5 &Rov -%r , Contractor Name: Email o _ Address '� Su ervisor's C®nstructton License t3 $-=� p n# ri d -. Ex = Date `' ► , .z Home Im®vemy- Lii3 , Exp Date � _P .. ARCHITECT/ENGINEER 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: $I sl c� FEE: $ L Check No.: j051, Receipt No.:C% NOTE: Persons contracting with unre ' tered contractors do not have access to the guaranty fund rSignature of Ag_ent/Ow ' T _ Sgnafure of contractor" Location H-) & V, -IA' I L/�-" V& No. L Date IN Check # � b k 25" ';- Ur) 83 TOWN OF'NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee s. T7,V,I- Foundation Permit Fee $ Other Permit Fee TOTAL $ / / Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Slimming 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 COMMENTS CONSERVATION COMMENTS hEALTH COMMENTS Reviewed On Signature, Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments, Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osqood Street i_FCC4-W F%-BXTJMENT� - Temp Dumpster�pn site lyes ��ocatetl;at- F;"re Dep*artment signature/d'ate�_ __ , �. 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 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 o Building Permit Application ❑ Workers Comp Affidavit o 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 VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products DOTE: 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 o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o 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 o Engineering Affidavits for Engineered products DOTE: 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 Doe: Building Permit Revised 2014 YY� �qc 41 q7 v 0. C � N 0 O Z U) O CLO mL D co. v=i m O v� cD O CL c sv cCDD O W W � O N. t• M � v O mo Z 0 O O CCD O CD 0 0 N . m N Z O cn C0=-1 O 0 -.0 CD Cl) -DCD -1 CD 0 - n O rt � CL ,f OHO �C O m cn W 0 O y 0 � N C CD '0 . 0 CD<D 2 O 0 0 m 0 N O. O : O W "� S CD O C C CD Q 0 pCo O CDto cr rt 0' D m v, 9: cn 0=- 9: DI j�f/^� y CD 0 O O rt = C r S O (D CLQ CD 0 CD r 41 C'1 y fu S I � O C O. O O _rt O O � O N 3 O 77 (D 0 (D N 1 fD z 0 co O O T 3 :;a O OU T 3 VI O0 m .Z7 Oq ^ ;'S7 O Dq T j (j S D Z7 O OU T O 3 p O S N fD C v p��.s U) lD • `. ' �► C'1 y fu S I � O C O. O O _rt O O � O N 3 O 77 (D 0 (D N 1 fD z 0 co O O T 3 :;a O OU T 3 VI O0 m .Z7 Oq T O' ;'S7 O Dq T j (j S D Z7 O OU T O 3 p N fD C v T O Q M n ' '—� v mn' D m N y n O m m H m 00 C W Z N m 0 = C O Z V m 0 3 s W O O m 2 m � q 6s "M 0 c MASSACHUSETTS HOME IMPROVEMENT CONTRACT Homeowner Information SE Fitness LLC Sean Nickerson & Eric Broadhurst North Andover, MA 01845 - 4)-+13 '& 2--&8 11 Contractor Information Giant Construction Corp. 29 Lamoille Ave Haverhill, MA 01835 978-994-1059 License Holder CSL # 108738 EXP 10/17/2018 Ryan Turner HIC # 178626 EXP 5/5/2016 17 Baypoint Ln. Tax ID 46-4976419 Haverhill, MA 01835 978-478-7756 WORK TO BE PERFORMED AND MATERIALS TO BE USED Work to be done by contractor: Contractor agrees to do the following work for homeowner: Hang tape and finish 288 sf of drywall. Hang 832 sf of sound board. Remove chairrail and trim. Install 1 steel exterior door. Wall framing. Install 360 sf of drop ceiling. Electrical work to include 3 outlets, 6 wall sconces, 2 LED ceiling lights, drop ceiling fan. Painting. Vinyl baseboard. Materials Expected to be used: Gypsum sound board, drywall, steel exterior door, KD framing lumber, Armstrong ceiling tile and grid, paint, vinyl baseboard Work Scheduled To Begin 11/12/2015 Expected Date of Completion: 11 /26/2015 1 The following warranty will be provided by the contractor under this contract: 1 Year Workmanship and material warranty any materials under warranty will be through manufacturer of such materials. Please note that all home improvement contractors and subcontractor shall be registered and any inquiries about a contractor or subcontractor relating to registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1310, Boston, MA 02108, 617-727-8598. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law (MGL chapter 142A) and other consumer protection laws (i.e. MGL chapter 93A) may not be waived in any way, even by agreement. However, homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights, contact the Consumer Information Hotline (listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract, and the three day rescission period has expired. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event 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 Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided for in MGL C. 142A. Contractor: Homeowner: Date: Date: ni,� NOTICE: the signatures of the parties above apply only to the agreement of the parties to alternative dispute settlement initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not separately signed by the parties. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity. A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. Contractor's Financial Insecurity. In instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal from said account would require the signatures of both parties. Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at http://www.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283- 3757 or visit the HIC website at http://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homeimprovement/licenseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800, 508-755-2548 or 413-734-3114 OTHER CONTRACTUAL DOCUMENTS This contract includes as contract documents the following additional enumerated documents: 4 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to provide the work, furnish the material and labor specified above for the sum of $15,412.00 Payments will be made according to the following SCHEDULE: $5,085.96 before work is started. $10,326.04 upon completion of the contract. In order to meet the completion schedule, the following material/equipment must be special ordered before the contracted work begins: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 4 Customer Signature Contractor's Signature Sean Nickerson or Eric Broadhurst Ryan Turner k1\n\15 DatetD� e You may cancel this agreement if it has been signed by a party thereto at a place other than at the address of the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. REQUIRED PERMITS The following building permits are required: Town of North Andover, MA Building Permit. It is the obligation of the contractor to secure such permits as the homeowner's agent and any costs which contractor will incur in doing so are included in the price for this job as set forth above. Please note that homeowners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL C. 142A. Is an EXPRESS WARRANTY being provided by the contractor? No Yes X 2 The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 t Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: City/State/Zip :,ay V( ,\� MMPI O 1'35 Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with : employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. Q I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5)Q I am a general contractor and I have hired the sub -contractors listed on the attached sheet. '''' These sub -contractors have employees and have workers' comp. insurance.: 6.❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. R New construction 8. KRemodeling 9. ❑ Demolition 10 Building addition 11. E] Electrical repairs or additions 12. E] Plumbing repairs or additions 13.0 Roof repairs 14. ❑ Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submif 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,'aiey 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. Lie. #: %._-r_1_\A CiVZ S Expiration Dat :03 Job Site Address • 5 \ City/State/Zip Attach a copy of the workers' compensationplolicy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. 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 �.pains and penalties of perjury that the information provided aboveis true and correct. Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # /A 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 like, 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 complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia '`�O RV® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/3/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 Slawsby Insurance Agency 3 Mound Ct, Suite B PO BOX 1807 Merrimack NH 03054-1807 CONTACT Lisa Lambert NAME: a/CNE xt: (800)258-1776 NC No: (603)429-1843 E-MAILs:llambert@minutemangroup.com ADDRE INSURERS AFFORDING COVERAGE NAIC # INSURERA:Merchants Mutual Insurance 23329 INSURED Giant Construction Cory 29 Lamoille Avenue Haverhill MA 01835 INSURERB:Guard Insurance Group, Inc. INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2015 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL R POLICY NUMBER POLICY EFF MM/DD/YYY POLICY EXP MM/DDIY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR MA PREM SES Ea occu RENTED nce $ 500,000 MED EXP (Any one person) $ 15,000 BOPI087846 11/3/2015 11/3/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ JEFILOC PRODUCTS - COMP/OP AGG $ 2,000,000 Employment Practices Liab Ins $ 100,000 OTHER: AUTOMOBILE LIABILITY COEa acaMBdent INED SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident NON -OWNED HIRED AUTOS AUTOS UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANFICER/MPROPREMBER EXCLUDED? ECUTIVE y (Mandatory in NH) N / A GIWC654056 11/3/2015 11/3/2016 X PER OTH- STATUTE ER _ E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYE $ 100,000 ff yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Adam Carlson is excluded from the workers comp policy. Lft4Z4IlaLey-A1a;Lai 9Ua;1 SE Fitness LLC. 595 Chickering Road North Andover, MA 01845 ACORD 25 (2014/01) INS025 (201401) 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 Lisa Lambert/LISA .__X •- `z— ---7-A-- ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC4C>R D® CERTIFICATE OF LIABILITY INSURANCE°A (MM/D0 ) 5 THIS CERTIFICATE 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 pollcy(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 New England Excess Exchange, Ltd PO Box 650 Barre VT 05641 COKIACT NAME: Man Schaarschmidt ACNE Ext): (802) 661-5401 c No): 800-347-4935 ADDRESS: mari@neee.com INSURERS AFFORDING COVERAGE NAIC 0 INSURERA: Nautilus Insurance Company 17370 INSURED Ryan Turner Turner Carpentry 17 Baypoint Lane Bradford MA 01835 INSURER B : INSURERC : INSURER D : INSURER E : 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AULIMLIBN INSR VOID POLICY NUMBER POLICY EFF MM/DDNYYY EXP PMIDDNYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIAB CLAIMS -MADE �OCCUR NN582525 06242015 06242016 EACH OCCURRENCE 1,000,000 DAMAGE ToIENIED EaILITY PREMISES occurrence50.000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY 1,000,000 GENERALAGGREGATE 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: POLICYjFrTPRO X1- —1 LOC PRODUCTS - COMP/OPAGG 2,000,000 $ AUTOMOBILE LIABILITYCOMBINED ANYAUTO ALL OWNEDSCHEDULED AUTOS AUTOS HIREDAUTOS NON -OWNED AUTOS SINGLE LIMIT Ea ..dent BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peracadent UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE. EACH OCCURRENCE $ _ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PAP.TNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑N (Mandatory in NH) Ifye s, describe under DESCRIPTIONOFOPERATIONS below NIA WC STATU- OTH- E.L EACH ACCIDENT E.L DISEASE -EA EMPLOYE $ E.L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Town of North Andover Building Department 120 Main Street North Andover 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 REPRES NT MA 01845 ©19R8.2n40 A J *n CORPORATION all rinhfe trncur—el ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD i �zc l/:arrrmzartTaeril� a Office of Consumer radar/ruaI&IkF �OME IMPROVEMENT CONTasiness Regalation eg"ttion: 178626RACTOR xpiration: Type: 5/5/2016 DBA TURNER CARPENTRY RYAN TURNER 17 BAY POINT LN HAVERHILL, MA 01835 4----��� z�- Undersecretary 1t � Massachusetts _ ` Board c Department of Public Safet Building Regulations and Stand Y Cun%tructinn Superr iy„r ards License: CS_108738 RYAN TURNER 17 BAY POINT LA N1 Haverhill DIA 01835 Commissioner Expiration �� 10/17/2018 13'-6 1/2N -4 5/81, 3'-4 5/8N m OIL, A - - 011, IF 5/81 0 In U 5'-1 5I8N z e I'-10 5/8N L En m za I I l6'-4 5/8N MECHANICAL 016 PQ e_ t S RETCHING/ABS BENCH N ROOM cd t CN c 015 t � 10'-3 I/8N i i t i } s • DRINKING FOUNTAINS: (D HANDICAP ACCESSIf 00 9'—IN 3'—ON A SPOUT HEIGHT OF 3'—01 A.F.F. 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