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Building Permit #915-14 - 66 CEDAR LANE 6/16/2014
.:; IL BUILDING PERMIT �? 4` _°n TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: tie Ili �9ssac►+us IMPORTANT: Applicant must complete all items on this nage LOCATION (-,,b CF-i\aR , :wvt rent PROPERTY OWNER W -40%. -AS Amar!, Print MAP NO:P CEL:../ -e/ DISTRICT: Historic District yes no Machine Shop Village ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ®j Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic C) Well ❑ Floodplain ❑ Wetlands ❑ Watershed District 0 Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: A/lehbL4S C.c_P,r! Phone- 146 - Address: -U/L1 CONTRACTOR Name: Phone: ` -I 6 4-7i 9 1 S2 C 12a co 3u� L�'�Iv 12�mop,,-i lw C2 Address: Ic 1, No aZ T " Arli b/,Zf)? 1'►'aA Supervisor's Construction License: _ Exp. Date: Ioyw2� - 3 •2 t 6 Home Improvement License: Exp. Date: 168 z 1 is 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. r Total Project Cost: $ ILA, -115.00 FEE: $ Cp • , Check No.: 1Z-`-3 Receipt No.: Q-1 (.o $I ' NOTE: Persons contracting With r 'stered contractors do not have access to t e guaranty fund gnature of Agent/Owner _____ Signature of contractor - = a BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print v- tt Lev .6*-ryO\ 32 y .; . a L o 4 `* �0 ea � PROPERTY OWNER Print 100 Year Stiucture_ yes no MAP PARCEL:.. ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain [ Wetlands ❑ Watershed District ❑ Water/Sewer OWNER: Name: Address: Contractor Name: Address: DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly Phone: Phone: Supervisor's Construction License: Exp. Date Home Improvement License: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access�to4h? guaranty fund o � Si na ut re of A ent/O ner Si nature of contractor �� i BUILDING PERMIT TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: I Date Received Date Issued: 6� 9ss^c►mus�tt`, IlVIPORTANT: Applicant must complete all items on this page LOCATION 46 ceh' AR '- t Iy ,Print PROPERTY OWNER ©%AS f Print MAP NO: P+CEL ZONING 'DISTRICT: Historic District yes- no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other [] Septic 0el ` ❑ Floodplain 11, etan s ❑Watershed District ❑' Water./Sewer OWNER: Name: Address: Identification Please Type or Print Clearly) r ief' oo-s Phone: 946 -7p -3-0I 54 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $1200 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ I L I-II r& L')O FEE: $ { �P Check No.: 12-4} Receipt No.: a.1 to $I NOTE: Persons contracting ' hr ' tered contractors do not have access to t e guaranty fund ti ianature ofi'AQent/OWrier Signature of contractor1 Loc ation a -n I- A--,, (L - No. 61 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check# �243 2 7 05 U Building Inspector Building/Frame Permit Fee $ b- Foundation Permit Fee $ Other Permit Fee TOTAL 6 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature_ CONSERVATION Reviewed on Sianature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department srgna1ure/date COMMENTS Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS CONSERVATION COMMENTS Signature_ Reviewed on Signature HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt-submitted yes Planning Board Decision: Comme Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: �. -� 9 r FIRE �DEPAR�TMENaT aTemp ®urns terms n site _ ye --� _ Located — a e Osgood Street �Locatetl at 124 Main Sfreef: ,ps ono ;iier!FDeer%date x �� Y 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 Pen -nit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ 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) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract - - - ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 0 ENO 0 x ~ Q x LL p � Q CO u o LL v V)o Ln U a N V) p C~J W to Z Z m I '6 � O LL -C o L U E LL O W N Z z m C J a � o K S LL O W (A Z J V J W m o ` cu V) 75 -C: LL O U W fa Z Q :3 K LL Z W F - oC Q W W LL CO Z vo V1 N a) o V1 O JJ =' M O V :4+ Q L Q c or - 0 0� EQ C CD CD T =tet I oo = �r 0 4t: V i t5 w •�0� �CL C`o . m = > M CD (A m o r- m > cn —�� O t U q (n CDa =-ma y o Z o •r 3 c L F• - CL CD r � w � mo o cn ~ N / O r a L Hca x 0 CL tq -W m V m LV =O y O O ui 0 W VV V d = L v a O a) N •a O H t .S CLOU z m co z W x LLIW a. 0-7 •.v v v O V/ze �parraoirareutea�� a�/'C?.:�'la.rlac�uscl�3 Office of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR. " - egistration: 168512 Type: piration: - 3/112015.-, LLC "T BRICO BUILDING AND REMODELING LLC ADAM BRIEN 417 WAVERLY RD_ NORTH ANDOVER, MA 01845' ' Undersecretary i- �a Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor r� License: CS -104428 ..e ADAM J BRIEN 417 WAVERLY READ ° s North Andover.M 0f q - �� �� j41Expiration 05/12/2016 Commissioner 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 fitst obtain a copy of "A Massachusetts Consumer Guide to I3omc Improvement" before agreeing to any work on your residence. You may obtain a flee copy by calling the Office of Consumer Affairs and Business Reguladon's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. . Homeowner Information Contractor Information ivame -, Company Name MIC, :. K 1 o lo tO iL Street Address (do not use a Post Office Box address) Av Contractor/ salesperson/ Owner Name M D N'e MA City/Town p• D c 1 r State I Zi Code P Business Address (must include a sheet address) < 7 Wh � Ly iv•aNAav 'R Daytime Phone Evening Phone City/Town State Zip Code Mailing Address (It different from abuse) Bnsiness Phone Federal Employer M or S.S. Number uires that most home Homeimprowment Cont_or Reg,Number Expiration date mcnt contrnctom brava LIAWgistration number L s raga w w uu me loiiowing worx Ior the Homeowner: (Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets if neces ary ) � �1P+C,Lz :�W114MW5 I' Required Permits -The followinglbuilding 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 Date when contractor will begin contracted work MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Paymedt;Schedule The Contractor agrees to perform tAe work, famish the material and labor specified above for the total sum of: Payments will be made according to;Yhe following schedule: $ upon signing contraict (not to exceed 1/3 of the total contract price pr the cost of special order items, whichever is greater) $ by / / or upon completion of $ by /_! or upon completion of $+� X) upon completion i i 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 tvo�dc begias in order to meet the completion schedule (**) $ to be paid for NOTES: (*) Including all finance charges (**) Law requires that a� depositor down -payment not exceed the required by the contractor before work begins may greater ofi (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special or&red in advance to meet the completion schedule. ---- - ••- ��••••^�•� --� es au reams the arran my be attac ed to the contr Subcontractors - The contractor agrbes to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the edntraetor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this aprAt,A" t Contract Acceptance -Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this contract shall not imply that any liendocument the or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this eontract� Ip - Don't -be pressured -into signing the contract. Take time to read and fully understand it-A-sk questions if something is unclear. = Make sure the contractor has alvalid Home Imorovement Contractor Re ' Mation. The law requires most home improvement contractors and subcontractors to be regrstered�with the Director of Home Improvement Contractor Registration. You may m registration by writing to the Director at 10 Park Plaza,g Y 7 quire about contractor 7 or 888-283-3757, Does the contractor have insurance? Ask the Contractor for his insurancencompany fi fnrmahon16 or by calling slo that you can8confirm coverage, or ask to • see a copy of a "proof of insurance" document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. ;i You may cancel this agreement if it contractor in writing at his/her mair third bif3Yness day fnllnwinv rh,. =:n been signed at a place other than the contractors normal place of business, provided you notify the ice or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the of this agreement Seethe attached notice of cancellation form for an explanation of this right THIS CONTRACT IF THERE ARE ANY BLANK SPACESM t must be completed and signed. One copy shodd ao eothe hoaeenw a,. The other eo h.otdd bo 1 PYs sap[by tho vonaactor. Contactor s Signature 6 1 Date bl lo Date ,W06 Ll W �'2G20 _ 3' = The Commonwealth ofMassachusetts .Department of.IndustrialAccidents Office of Investigations 600 Washington Street Boston, .limed 02111 ivimrnass gov/dia ` Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectriciangfRIii cabers AVP Type of project (required): Name (Business/Organization/l'ndividual): ICO j�g)1 LD 1 Ny Atm ® ZePAQZ i W6 Ll C Address: 411-1 WA-VigR LY Rb MORIN &tiaaVKI City/State/Zip: Phone #: '11$ Wn 626 Are you an employer? Check the appropriate box: Type of project (required): 1 A I am a employer with :.3 d• ❑ I am a general contractor and I 6. F1 Now consirtYctiort employees (full and/or park time).* 2. [( I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. UjfRemodalmg ship and have no employees These sub -contractors have S. [( Demolition working forme in any capacttY employees and have workers' insurance? 9. [] Building addition [No workers' comp. insurance required.] comp. 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 ofexemptionperMGL 12.0 Roof repairs insurance required.] t C.152, §1(A'), and we have no 13.[]. Other' employees. [No workers' comp. insurance required.] 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy inforinaVon, T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and sfate whether or not those entities have employees. If thf, sub -contractors have erzployees, they mustprovide their workers' comp. policy number. I'am an employer that isproviding workers' compensation insurance for my employees .Below is the policy and joie site information. Insurance Company Name: ��i1'AV�L� Cyd Policy # or Self-ing. Llo. #: -1 �V� -14 61$ P60 - 7 .1 �i Expiration Date: L► ) Yob Site Address: ( rmx [./ N 6 City/State/Zip: N -A A)DOVi`P /VA 00 s Attach, aycopy of the workers' compensation policy declaration page (skowingthepolicynumber and expiration date). Failure to secure coverage as required under Section 25A of MGI, 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. X do hereby certify uAder true pains and. penalties ofperjury that the information pYovide d above is trite and correct. Phone #: !JJi `1`17 1526 Official use only, Do not write in this area, to he completed by city or town of fzciaZ City or Town: Permialcense Issuing Authority (circle one): 1. Board of•Elealth 2. BuildingDepartment 3. City/Town, Clerk 4. Electrical Inspector S. Plumbinglnspector 6. Other ` Contact Person: 72hone #: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation fox their employees. Pursuant to this statute, an employee is defined as "...everyperson in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, patnership, association, corporation or other legal entity, or any two or more of the- o e - - - - --- - — -- -tha . 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 bion thegroundss orbuiiding appurtenant thereto shalt not because of such employmentbe 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 necegsary, supply sub -contractors) name(s), address(es) and phonenumber(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 ox LLP does have employees, apolicyis required. Be 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 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-insuragoo licensenumber 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 i a the event the Office of Investigations has to contact you regarding the applicant. Please be sate 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 W- ormation (ifnecessary) and under "Tob 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, maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit mustbe 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 permittobumleaves etc.) saidpersonisNOT requited to complete this affidavit. The Office of Tuvestigations 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 D epartnient's address, telephone and fax number; OHIO, d rni`est gatlQua 6GO w'a4 .gtam StQ1 Bwtat, M, A 02-111 TQ13V 617-4-2-7-4900 ext, 40.6 a -1-a' � SS S Revised4-24-07 F 617-727,774 www'Mmagul a, 06/12/2014 13:56 9787945409 PAGE 01/01 �c4Riti CERTIFICATE. OF LIABILITY INSURANCE I6 1z�i TI4S 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, ANDj THE CERTIFICATE HOLDER. IMPORTANT: P the certificate holder Won ADDITIONAL INSURED, the poiicy(ies) must be endorsed. It 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 rortiftcate holder in lieu of such endorsernengs). �t PRODUCER Nancy Greenwood Ins. A91ency 11 Haverhill Street Methuen, MA 01944 B: INsuRF.n gRYCO Building & Remodeling LL Adam J Brien 417 Waverley Rd N Andover, MA 01845 OVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BROW HAVE BEEN ISSUED 70 THE INSURI INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUID OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By TPAID,CLA IMt A • GENOtAL UAMUTY ,;COMMERCIAL GENE RAL LIAR ILITY 7CugwS- MADE lJ OCCUR GEN'L AGGREr.ATTE L WNT APP LISS PER 7 POLICY ( ] PR T LOC AUTOMOBILE UABIUTY ANYAUTO ALLOWNED SCHEDULED AUTOS AUTO MIRED AUTOS — UMBRELLA UAB EXCE9$UAB DED RETENTION S VORKERS COMPENSATION AND EMPLOYERS' UABIUTY AWY PROM OFFICEPAM OEREKCLUDEDXECl1TNE : NI 72 4/1.3/141 4/13/15 pEBCRIPTION,OF OPRRATIONS ! LOCATK)NS / VEI#CL64 (Attach ACORD 1011, AdYtlonat Remertl9 Sc1,edWa, IrmrHa eWae is regllred) Nick Kline 66 Cedar Lame N Andover, MA 01845 N (979) 794-5409 net ......,�.n I url,utleQ. :O NAMrMABOVE FOR THE POLICY PERIOD )oCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMIT6 EACH OCCURRENCE $ 1 00 000 bIgGE ENTE 6 100 000 MED Exp (Ary ore Dersan 6 000 PERSONAL&ADVINJURY a 1 000 000 GENERALAGGREGATE a 2 000 000 PRODUCTS-COMPlOPAGG 5 2 000 OOO S ete�ccl DSIII N LM S rt BODILYINJURY(PerpBwon) S BODILY INJURY (Per aecldent) S orrSC11dom AMA S 9 EACH OCCURRENCE, 6 AGGRFGATE 6 3 WC STATU- OTH- E,L,EACH AC DEM B.L. DIS E -EA PLOYE E.L. DIS EASE - POLICY LIMIT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXpIRATTON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATM 1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25 (201 W05) The ACORD name and logo are registered marks of ACORD Phone: Far. (978) 258-6953 E -Mall: AdaaHricoggmail. eom Rightfax C3-1 6/13/2014 7:51:00 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) q/ T . IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TQW1 HIS 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 CERTIFICATEOR-MDUCER. AND THE IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 (AIC, No, Ext): (A/C, No): METHUEN, MA 01844 E-MAIL ADDRESS: 726KN INSURER(S) AFFORDING COVERAGE NAIC i INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA BRICO BUILDING & REMODELING LLC INSURER B: INSURER C: 417 WAVERLEY RD INSURER D: INSURER E: N ANDOVER, MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: FY THAT THE POLICES 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 TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAN) CLAIMS. NSR LTR TYPE OF INSURANCE ADD L SUB R POLICY NUMBER POLICY EFF DATE (MIADDIYYYY) POLICY EXP DATE (MIADDIYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE ID OCCUR. AMAGE TO RENTED $ REMISES (Ea occurrence) ED EXP (Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a PROJECT ❑LOC 15 ERSONAL & ADV INJURY $ ENERAL AGGREGATE $ RODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAS[]OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ A WORKER'S COMPENSATION ANDWC EMPLOYER'S LIABILITY YM UB-461OP507-14 04/19/2014 04/19/2015 STATUTORY OTHER X LIMITS ANY PROCER E MBER/PXCLUDE/EXECUTIVE OFFICER/MEMBER EXCLUDED? WA E. L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCA'IONS/VEHICLES/RESTRICT(ONSJSPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION NICK KLINE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 66 CEDAR LANE BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT _1 N. ANDOVER, MA 01845 - ;;fE:::<::;104,; Acvnu zQ (zuiuruo) I ne Awnu name ano logo are reglsterea marKs of ACORD 1966.2010 ACORD CORPORATION. All rights reserved. Adam Brien 417 Waverly Rd. North Andover, MA 01845 978-479-1526 adambrico@gmail Nick Kline 66 Cedar Lane N.Andover MA BriCo, Building& Remodelin i? CSL 104428 HIC 168512 LLC 5/5/14 1.) Job Description: New Construction Windows • Installation of "Harvey Vinyl Vicon Slim line" Windows • All windows to have energy star ratings in glass, half screens, grids between glass (matching existing) locking mechanisms • Old windows and all construction debris to be disposed of off site • Exterior of windows to wrapped with Ice and water shield, and trimmed out with PVC trim boards and "cortex" concealed screws • Surrounding window space to receive insulation • Interior to receive primed extension jambs and Windsor style casing with stool and apron. • Installation of 2 basement, hopper style windows • Installation of new Casement window • Painting not include • Most of the work performed from exterior • Removal of siding • Framing of window opening with structural header • Window, trim and siding re -installed to match • Interior drywall patch and trim • Insulation around windows • Permit Fees Total Estimated cost $14,715.00 Total Estimated cost $14,715.00 The Owner agrees to pay BriCo Building and Remodeling $14715.00, for doing the work outlined above. The following payments will be paid to the contractor in the following manner: Deposit of $3800.00 is due at contract signing Final payment of $10,915.00 balance at the completion of contract. 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 New Hampshire building code. BriCo takes on full responsibility of all necessary inspections. All Sub contractors must carry the appropriate licensing and insurance to perform work to there specific field. Any unforeseen work or necessary repairs found during this project to be brought to the home owners 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 Building and Remodeling is a fully licensed and insured LLC company. License numbers are provided in the header above and current insurance documentation upon request. Dated: Signature of Owner:�dr,- Signature of Contractor: I