HomeMy WebLinkAboutBuilding Permit #680-14 - 7 INGALLS STREET 4/13/2014T -i
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BUILDING PERMIT �? dt;�-- {°•
TOWN OF NORTH ANDOVER
Q v APPLICATION FOR PLAN EXAMINATION WIT
ey
Permit NO: Date Received0 Argo
Date Issued:
l3 /r �4SSACHUS
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
U Septic . 0Well—, _
..D. Floodplain ',❑.Wetlands
❑'Vllatersh d District
f
❑ Water/Sewer
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C4eAA�,, S "e t-IWr�r-
Identification Please Type or Print Clearly)
OWNER: Name: KQl-,)-e
Address:
L'7d -5—
ARCH ITECT/ENGI NEER
5"
ARCHITECT/ENGINEER IJ 1 e 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: $ �{- Q t�Q O FEE: $
Check No.: t 1 / ? i Id Receipt No.:
NOTE: Pers s c ntr ct^-111 g with unregistered contractors do not have ac ess to the guaranty fund
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
y
Permit NO: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOGATIONi _ 7P { rg
PROPERTY,01111NER _ - - — _
Y`" Print U 1"00 Year ®1tl,St�ucture ye"s, >n�
MAFENO;FAR.
CEL- ZON_LNGDIfSTtRITH�storc®istncth yes" ono a
p Vil age tye
n
: ilVlachi.ne Sho
TYPE OF IMPROVEMENT. PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition El Two or more family ElIndustrial
❑ Alteration No. of units: ❑ Commercial
❑ Assesso
r Bld ❑ Others:
❑ Repair, replacement Y 9
❑ Demolition ❑ Other
�e tics 0 �UVell'0 Flo:odpl rig OWetCands� 1Natersled'�®istrict `
P
,{ $
m ❑ 1NerkSew_
at - - -
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
_7
CONTRACT®RName_
rie R
h,
e
Sup{ervis�otr-s C:onstruction'License =`Expo, Date:,
.,
a
€FYn:, nate-
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 to the guaranty fund
S gena ure of Agent%®wner►� TTSS�gature of�cortraetor�� L x
`
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El
.. - Plans Submitted ❑'plans Waived [T;
i •TYPE OF:.SE
`.Certified Plot Plan 0
Stamped Plans 0
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco -Sales ❑
Private (septic tank, etc._ ale
Food Packaging/S. s 11❑ Permanent Diunpster on -Site ❑
THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT`
COMME
CONSERVATION
COMMENTS
HEALTH
COMMENTS
_:-._-DATE. REJECTED, DATE.APPROVED
Reviewed on Siokure
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No:
Planning Board Decision:
Conservation Decision:
Comments
Comments
Zoning Decision/receipt submitted yes
Water & Sewer Connectioi1lSianature &Date
Driveway Permit
`a.
DPW Tow;-, Engineer: Signature:
a
• .FIRE DEPARTMr IST Temp Dumpst6f on site :
Located 384 Osgood Street
yes
Located at`124;Mair{ Street � � ��
no
.,
Fire De'partme►�t
signature`
/date
.. ..
.°( it H i 59. •y 4Yky�
SOY• �i
?.
COMMENTS
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area; sq. ft.:
ELECTRICAL: Movement of. Meter1ocation-, rriast or service drop requires approval of
'.Electrical Inspector Yes No
DANGER -ZONE LITERATURE: Yes No
MGL.Chapter 166. Section 21A. --F and G min.$1o0=$1000:fine
Doc.Building Permit Revised 2010
Building Department
The fol+wing is a list of the required=forms to be filled out for:theappropriate-permit to be obtained.
Roofil�g, Siding, Interior Rehabilitation Permits
a , Building Permit Application
o
Workers Comp -Affidavit
o Photo Copy Of R.I.C. And/Or C.S.L :Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
NOTE: All dumpster..permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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) �.
Li Building Permit Application
Li Certified Proposed Plot Plan
E, Photo of H.I.C. And C.S.L. Licenses
El Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
a Copy of Contract
o Mass check Energy Compliance Report
o 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 tli'e decision from the Board of Appeals
that the apo,�al period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording
must be submAted with the building application
Doc: Doc.Building Permit Revised 2012
Location
No.
Check #t_
27406
Date
r
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee $ `�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
,�9� 4��� -
uilding Inspector
A
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 409000.00
m
$ -
$
480.00
Plumbing Fee
$
60.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
60.00
Total fees collected
$
700.00
7 Ingalls Street
680-14 on 4/3/2014
Kitchen Remodel
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Page 1 of 6
Nexus H Carpentry and
Construction Design
P.O. Box 2823
Woburn, MA 01888
781760 2031
Fax 978 9751263 cz
n,ark(c�,a�exusca�•pentt•w.com
www.nexuscarpentrV.co m 79) N
CS # - 073991
RIC # 129177
Contract
This is a contract between Ray and Rosemary Saracusa of 7 Ingalls , North
Andover MA 01845 (Hereafter referred to as the "owners" or "owner") and Nexus H
Services (hereafter referred to as "Nexus") dated March 21St 2014.
GENERAL SCOPE OF WORK DESCRIPTION
WE HEREBY SUBMIT SPECIFICATIONS AND CONTRACT FOR: work as stated
j below for new kitchen and associated work as noted below
Scope of work:
General details
♦ Meet with local building official and apply for permits
♦ All work will be in accordance with local building code regulations and will be
inspected by local officials prior to continuing with the next phase — Nexus will be
responsible for arranging and being available for all inspections
♦ All work will be coordinated directly between "owners", architect if required and
Nexus
♦ Nexus confirms that it is licensed, insured as required and ensures any sub-
contractors utilized on this site will have the appropriate insurance coverage
♦ Nexus will be responsible for the safe storage of all its property and any materials to
be used on the site. Any items left on site will be covered under Nexus insurances
♦ Owner is responsible for removal and return where necessary of all items within the
work area and their safe storage prior to our work commencing
SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND
PROJECT MANAGEMENT
rage Z of 6
♦ Owner will then be responsible for returning all items to the area after completion of
the scope of work
♦ Nexus will remove all trash associated with this project into a Nexus supplied
dumpster and arrange for safe disposal in to a registered site — if required
♦ Nexus will contact Dig Safe" and confirm all utilities location — if required
Scone of work; No -Tv ;SOME CA61Nc r s f o �C
♦ Provide a dumpster for the collection of all debris associated with this project
♦ Demolish and trash the existing kitchen cabinets and counters
♦ Save existing electric stove, dishwasher and refrigerator
♦ Remove and trash existin , waste disposal and a small section of baseboard
heat to the LH side of the existing slider to accommodate the extended cabinet layout
♦ Remove and trash existing sheetrock of area above planned new counters/under new
wall cabinets for ease of electrical installation
♦ Remove and trash existing sheetrock ceiling in kitchen, fireplace room, laundry room
and hallway NOTE: SAVE existing trim detail at ceiling location for later use after
installation of new sheetrock ceiling
♦ Remove and trash the existing flooring in the kitchen, fireplace room, laundry room,
hallway and small closet
♦ Furnish and install plumbing to code and to accommodate a sink with faucet, a
dishwasher and a waste disposal NOTE: fixtures supplied by 'owners"
♦ Furnish and install a kick space heater to the underside of the new sink location
NOTE: this will be on the same zone and feed as the existing baseboard heat in the
area ADD c,�AeV 6 LM ;Ac- a&' s1: � ej �c C � e� 18,1 --t/— "t'. P
♦ Furnish and install electrics to code inclusive of circuits, GFI outlets, outlet
electric stove, feed for microwave, 6 recessed cans (5" with White trim , eed for
waste disposal, under cabinet lighting (LED fixtures also supplied by "Nexus") and
"in -cabinet" lighting to one glass fronted cabinet+ l C& W cw, over Sink , W Ta:
♦ Connect new microwave to existing exterior venting pipe OW".
♦ Furnish and install sheetrock with smooth plaster finish to walls above planned new
counters
♦ Furnish and install sheetrock to ceiling of kitchen and existing fireplace room out into
the hall Lv�
♦ Furnish and install a plaster with swirl finis to this new sheetrock ceiling Par♦ Install cabinets supplied by Family Kitchens and to their planned layout
♦ Coordinate with 'owners" counter top company, for templates and the installation of
the counters
♦ Furnish and install cement board to floor in preparation for new tile and grout
♦ Install 'owners" tile and grout to floor of kitchen, fireplace room, hallway and
laundry room 4 gfy\ca e`Gsp�
♦ Install "owners" tile and grout to back splash area in kitchen
♦ Install trim detail (Crown molding, toe kicks; flat stock, and scribe moldings), to all
kitchen cabinets as supplied by Family Kitchen
SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND
PROJECT MANAGEMENT
TO
-MCI
Page 3 of 6
♦ Furnish and install any needed stain grade baseboard trim to new kitchen layout,
fireplace room, hallway or laundry room NOTE: design of baseboard to match to
existing style
♦ Re -install any trim that needed to be removed to allow the installation of the new
sheetrock ceilings
♦ Install all hardware, appliances and fixtures supplied by 'owners" to renovated areas
♦ Leave renovated area in "broomswept" condition
Proposed cost including materials and labor is
The above quotation does not include the cost of any of the following and in some
cases where stated allowances have been given to assist you in selection. If
requested, we would be happy to provide any costs on items listed below, if not here
stated;
Permit costs (plan for $500.00) or unseen conditions
Painting or staining or prep work beyond specifically noted in the scope of work above
Upgrades to existing utility conditions or structure
Light fixture in fireplace room
Electrical work in fireplace room
Upgrades to mechanicals and any heating changes beyond those required to complete
the scope of work
— moving of personal properly — NOTE: we are happy to help, but would not want to be
wholly responsible
Any work in existing %2 bath
Asbestos remediation of any kind
— Insulation
Window or door replacement
Cabinets or counters supply
Appliances, hardware or fixtures
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any
alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an
extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control owner to
carry fire, tornado and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance.
PERMITS
"Nexus" has accepted the responsibility to obtain the necessary building permits. "Nexus" will act as a GC
and work in accordance with fair and reasonable practices, and cooperate fully and under the guidance of
the "Owners" and authorized parties.
Standard Exclusions:
Unless specifically included in the "General Scope of Work" section above, this agreement does not
include labor or materials for the following work (any Exclusions in this paragraph which have been lined
out and initialed by the parties do not apply to this Agreement): Removal and disposal of any materials
containing asbestos or any other hazardous material as defined by the EPA. Custom milling of any wood
for use in project. Moving "Owners" property around the site. Labor or materials required repairing or
replacing any "Owners" - supplied materials. Repair of concealed underground utilities not located on
prints or physically staked out by "Owners", which are damaged during construction. Surveying that may
be required to establish accurate property boundaries for setback purposes (fences and old stakes may not
SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND
PROJECT MANAGEMENT
Page 4 of 6
be located on actual property lines). Final construction cleaning ("Nexus" will leave site in "broom swept"
condition). Landscaping and irrigation work of any kind. Temporary sanitation, power, or fencing.
Removal of soils under house in order to obtain 18 inches (or code -required height) of
clear space between bottom of joists and soil. Removal of filled ground or rock or any other materials not
removable by ordinary hand tools (unless heavy equipment is specified in scope of work section above),
correction of existing out -of -plumb or out -of -level conditions in existing structure. Correction of concealed
substandard framing. Removal and replacement of existing rot or insect infestation. Construction of a
continuously level foundation around structure (if lot is sloped more than 6 inches from front to back or
side to side, "Nexus" step the foundation in accordance with the slope of the lot). Exact matching of
existing finishes. Repair of damage to roadways, sidewalks, or driveways that could occur when
construction equipment and vehicles are being used in the normal course of construction. The "Owner" is
to enter into contracts for all of the above-mentioned services and provide direct payment to "Nexus" for all
of the services we are to provide. "Nexus" will be responsible for removing all components and all
construction materials relevant to the "scope of work" in this contract.
Dumpsters, trailers and signs
"Nexus" will provide as included in the cost of this project, a dumpster for the sole purpose of the removal
of trash associated with this project. This dumpster should not be used by any persons for any other waste
items or for any purpose outside of the specific use under the scope of work, unless authorization is
received from "Nexus". Nexus may have on site for part, or the whole of the project, a trailer containing
materials and tools belonging to "Nexus". This trailer will be parked in a position agreed to in coordination
with the "Owners" and will be covered under the insurances of "Nexus" at all times. "Nexus" will have on
site, a sign, with our contact details, in the event that anyone, including your neighbors, has a need to
contact us directly.
Photographs
"Nexus" reserves the right to, from time to time, take photographs of the contracted work for use in its
general marketing or for production on its web site. At no time will "Nexus" share any personal contact
details of the "owner" for any photographs that it may use without seeking authorization from the "owner".
Warranties
All the components supplied by "Nexus" as part of the original order are covered under the warranty
exercised by "Nexus" and supported by the vendors or sub -contractors. All labor and materials purchased
from other suppliers to achieve completion of contract are warranted (1) one year from completion of the
construction.
Owner appointed sub contractors
From time to time an "owner" may request that we incorporate a sub -contractor of the "owners" choosing
on a project. "Nexus" will facilitate this request provided the assigned sub -contractor is connected directly
with "Nexus" for all scheduling requirements and "nexus" will manage this sub -contractor in a fashion
comparable with any other sub -contractor. All sub -contractors must be licensed and insured in accordance
with State law. "Nexus" will meet with these sub -contractors and will ask them to submit a written
proposal of all the work that will be included which "Nexus" will then confirm with the "owner". "Nexus"
will oversee this scope of work and ensure that it is completed in a professional manner but the sub-
contractor will be responsible for any future warranty issues directly with the "owners". All sub -contractors
are responsible for the safe and clean upkeep of the working environment and will be responsible to remove
their associated trash on a daily basis.
Deliveries
"Nexus" will be responsible for the safe arrival to site of all materials required for construction purposes for
items contained within the scope of work. The "owners" shall be responsible for the safe arrival to site of
other items outside of construction materials, however, should "owners" require "Nexus" to collect and
bring to site, any of these items, "Nexus" will accommodate as able and add a minimal cost to cover time
and fuel to a change order.
SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND
PROJECT MANAGEMENT
Page 5 of 6
Allowances with the contract cost
Within the cost structure of this contract, certain cost allowances may have been given for the "owners" to
purchase items chosen by them — these allowances will be noted above with the amount allowed clearly
noted. If the "owners" do not spend the full allowance in an area, this amount will be credited back to the
customer and not included in the final contracted amount. If the "owners" spend beyond the allowance
noted, then the "owners" shall be responsible for this balance and a payment made to cover this amount
either to the vendor, the sub -contractor or to "Nexus"
Expiration of this Agreement:
This Agreement will expire 30 days after the date at the top of page one of this agreement if not accepted in
writing by "Owners" and returned to "Nexus" along with the necessary deposits within that time frame.
People Authorized to Sign Change Orders:
The following peWle are authorized to sign Change Orders:
: Ray or Rosemary Saracusa
Concealed Conditions:
This Agreement is based solely on the observations "Nexus" was able to make with the area in its current
condition at the time this Agreement was bid. If additional Concealed Conditions are discovered once
work has commenced which were not visible at the time this proposal was bid, "Nexus" will stop work and
point out these unforeseen Concealed Conditions to "Owners" so that "Owners" and "Nexus" can execute a
Change Order for any Additional Work.
Changes in the Work:
During the course of the project, "Owners" may order changes in the work (both additions and deletions).
"Nexus" will determine the cost of these changes and the cost of this additional work will be added to
"Nexus" profit and overhead.
Schedule of work
It is agreed by both parties that this work will be coordinated with the "Owners" and "Nexus" to be
undertaken in various stages to avoid complete disruption of the home environment. "Nexus" will
give "Owners" no less than 2 days notice prior to arriving on site for commencement of any of the
agreed stages of work to allow "Owners" to prepare. "Owners" commits to have sites identified for
construction work available for start at the beginning of the scheduled day so as to avoid any
unnecessary delays.
SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND
PROJECT MANAGEMENT
Page 6 of 6
n,V
Contract Cost and Payment Schedule: ,\`� �6
Total cost of work description and materials included in the proposal (except
materials/work stated) - $26, 780.00 (Twenty six thousand seven hundred and eighty
dollars and zero cents) .
PAYMENT SCHEDUL
1st Payment due upon signing this contract
Pon completion of 1St week of,
Don completion of 2"1 week of
)on completion of 3rd week of
)on completion of 4th week of
)on completion of 5th week of,
upon completion of SCODe of w
.f11 -
E
flay ��S'-;-6 4 SSU
�d-W TOTAL $8 .00
"x TOTAL $3, 500.00
TOTAL $3, 500.00
TOTAL $3,500.00
TOTAL $3,500.00
TOTAL $1,940.00
TOTAL $1, 940.00
I have read and understand, and I agree to, all the terms and conditions contained
m the proposal above.
Date..' ..`!� k ............ «Nexus" Authorizai
Date,)—
ate. c ..,.,,1 ,,Owner/Owners" A
AND/OR
Date ............................... "Owner/Owners" Authorization......................
...............................
SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND
PROJECT MANAGEMENT
E
flay ��S'-;-6 4 SSU
�d-W TOTAL $8 .00
"x TOTAL $3, 500.00
TOTAL $3, 500.00
TOTAL $3,500.00
TOTAL $3,500.00
TOTAL $1,940.00
TOTAL $1, 940.00
I have read and understand, and I agree to, all the terms and conditions contained
m the proposal above.
Date..' ..`!� k ............ «Nexus" Authorizai
Date,)—
ate. c ..,.,,1 ,,Owner/Owners" A
AND/OR
Date ............................... "Owner/Owners" Authorization......................
...............................
SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND
PROJECT MANAGEMENT
The Commonwealth of Massachusetts p Pnnt.Form
Department of Industrial Accidents
Office of Investigations
F I Congress Street, Suite 100
Boston, MA 02114-2017
www. mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):5
Address: ? 0 BOY, 22-23
/State/Zip:1_4Vt;1r(\ MA 0I� Phone #: -781 `760 2-030
Are you an employer? Check the appropriator:
1. El am a employer with
4. I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.$
required.]
5. ❑ We are a corporation and its
3. ❑ I am a homeowner doing all work
officers have exercised their
myself [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. El Electrical repairs or additions
11. ❑ Plumbing repairs or additions
1.2.0 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 state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #:
Job Site Address:
Expiration Date:
City/State/Zip:
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.
Ido hereby ce erins and penalties o penury that the information provided above is true and correct.
)�( %c ,go 5
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
. l..-� R CERTIFICATE OF LIABILITY INSURANCEF3/
`
D IDD/YYY1�
28/28/ 2014
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, subiect to
the terns 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
Cross Insurance -Peabody
139 Lynnfield Street
NAMECT Lauren Goldman
PHONE . (978)532-5445 FAX o. (978)532-2217
ADDRESS:lgoldman@crossagency.com
INSURERS AFFORDING COVERAGE NAIC #
Peabody MA 01960
INSURER A: Western World Ins. Co.
INSURED
INSURERB:Safety Indemnity 33618
Nexus II Services LLC
INSURER C:
P.O. BOX 2823
INSURER D:
INSURER E:
Woburn NA 01888
INSURER F:
COVERAGES CERTIFICATE NUMBER:CL142602352 RFvICInN til IIURP-.
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
DL
SUB
POLICY NUMBER
MM/DDY EFF
POLICYEXP YYYI
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
X COM GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES
PREMISES Ea occurrence $
MED EXP (Any one person) $ 5,000
A
CLAIMS -MADE Fx_1 OCCUR
NPPS183741
8/12/2013
8/12/2014
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 1,000,000
X POLICY PRO- LOC
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
BODILY INJURY (Per person) $ 500,000
B
ANY AUTO
ALL OWNED SCHEDULED
AUTOS X AUTOS
116632
11/10/2013
110
//2014
BODILY $
X
HIRED AUTOS X NON -OWNED
AUTOS
500 000
PROPERTY DAMAGE
Per accident $ 100,000
Medical Dayments $ cj 000
UMBRELLA UAB
HOCCUR
EACH OCCURRENCE $
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
DED RETENTION
$
WORKERS COMPENSATIONWC
STATU- OTH-
AND EMPLOYERS' LIABILITY Y / N
E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTWE
OFFICER/MEMBER EXCLUDED? ❑
N / A
(Mandatory In NH)
If yes, describe under
E.L. DISEASE - EA EMPLOYE $
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Refer to policy for exclusionary endorsements and special provisions.
f�C�TICIf��Tr IIAI w�e.
Ray and Rosemary Saracusa
7 Ingalls Road
North Andover, MA 01845
ar_nRn,3G fgn4nlnrl
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
imothy Tramonte/NIDI
W I.7aa-[uTu AL VKU CUKPUKAI ION. All rights reserved.
u
1 Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supcn icor
License: CS -073991 ,
GERALD WHITE;`
23 GLENDALE DR
DANVERS MA 0=1923'
N )J 0 \\ ._ Expiration\
Commissioner 04/07/2014
C-_'��('- (T'CR'//I•I//('/I(/SCC/�II- (� I((IJ.J!/C'�/(.i(.'M }� _
\ _ Office of Consumer Affairs &Business Regulation
(iOME' IMPROVEMENT CONTRACTOR
l7 jl2egis1rabon 129177 Type:'•
Expiration 7L19/2015 Individual
Gerald White }
Gerald White
23 Glendale Or
Danvers, MA 01923 Undersecretary
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
4�
Not valid without signature