HomeMy WebLinkAboutBuilding Permit #166-2016 - 70 FURBER AVENUE 8/6/2015 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � i Permit N0: Date Received 4 , •-- ,�'« Date Issued: � �9SSgcHus���� F IMPORTANT: A2,plicant must complete all items on this page LOm : PRQPERTY Q11WNI=Rx. .SLC) Phht MAP Nb:' ON#4 TRIC11.1sibric Dl4ict fires rk no� rX e achl<nshop /iage y � ri o 'xa TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family �� Addition 11Two or more family ❑ Indy iaa Alteration No. of units: ❑,commercial Repair, re ement ❑ Assessory BI ❑ Others ❑ Dem ion ❑ Other ❑.Septic+ �� ❑ F(© dpla�rllettands C 1Nater d-flistrctF .3 �l...i $,ewe r) viylv I S'*,d (I Aq 0 n 0, Mi IV J') (A) CJ *1 0 i Identification Please Type or Print Clearly) OWNER: Name: C +` ? Phone. ,GO • S317,Address, �u,rb�,r AVeI) ue, CONTRA CYI"Olwt Irne -- gw �, ..IOIB'' Y/� A o aiYi tri Y-11i ,} w AUdress: ~j 04 supervisor's Exp _Date. c Home Ihiprovernent License EppI:J" 1777 ARCH ITECT/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: $ 1 z 5O0 "'— FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with nregistered contractors do not have access to a uaranty and Signature.of gept :vt ; Signature of'contract Location 1 -fit bee No. Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $I . Foundation Permit Fee $ Other Permit Fee TOTAL $ Check# �� +, n Building Inspector Plans Submitted Lj Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS —i HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes `Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTtME,N1T, - TempDumpster Qon�slte eyes ___ Ino w f T. _.� -. - w Locatedlat 124�MaintSt�eet F rei,,epartn ent�signature/date; V COMMENTS. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) El Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit 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 4 Building Permit Application ,4. 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application Certified Surveyed Plot Plan 4. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract ;rF 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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 r 1 µ0RTH - _ ve- 0 We -2_0 � i ti Am. �.s2a 15 16 h ver, Mass COCNIGMl WICK �d oRATEO P'? S U BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT Mlb 1 040 BUILDING INSPECTOR ............................ .f"""... .. ...... ...... .............N........................ has permission to erect ... buildings on ro M�,,,,... Foundation ....................... ..... ............. ............ .. ......... Rough � 1N tobe occupied as ........................... .. .......�.....�.!!�... .................................................................... Chimney provided that the person accepting this ermit shall in eve es ect conform to the terms of the application p p p 9 p p Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough Service ................. ............. . .... ............. ..... ............... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. CONTRACT WORK SPECIFICATION Mass HIC# 177704 GAF Authorized Roofer CE 18650 1 07 A it 954 hl-H—k Strad{Entry C,5u1te 500)•L--nce..MA 01840 808.498UOGF_T-Fax(978)29"128-www,8udgex-£x[e•"iors.com July 21, 2015 Joe Cuoto 70 Furber Ave North Andover, MA Proposed Vinyl Siding and Trim Project for Property: 1. Prepare exterior of home for foam insulation. 2. Install 3/8"expanded polystyrene underlayment to all walls. 3. Install heaviest gauge galvanized steel starter strip for installation of new vinyl siding. 4. Install Crane Market Square siding to home. Color C l l ,,j _ 5. Custom cover and counter flash into roof drip edge all wo d rakes with aluminum coil stock. 6. Add custom "architectural style bends" to window casings for a more attractive appearance. 7. Custom cover exterior door casings in same manner as windows where possible. 8. Drill soffit vents for proper roof ventilation and close in gable vents. 9. Close in any eaves and overhangs with custom heavy gauge hidden vent vinyl soffit. 10. Color match foundation wrap with PVC coil. 10. Add vinyl light blocks to all exterior wall light fixtures for a more attractive appearance. 11. Remove rear patio door and replace with window. Fill in space with 2x6 and sheet exterior for siding. Insulate remaining wall cavity and sheet rock interior. Tape walls in preparation for homeowner to paint . 12. Remove all work debris from job site upon completion. 13. When on premises,applicators will handle themselves in a professional manner at all times. 14. All manufacturer warrantees will be provided to homeowner. 15. Seven year quality workmanship warrantee by Budget Exteriors. 16. Budget Exteriors is responsible for all necessary permits. Corner Color 1<:' 4 Mount Box Color ,_ Vv.ti,�p, 5 ;11 4 ;l; Ij Total.Project Cost: Crane Market Square siding panel: $12,500(Vinyl Clapboard) 100%lifetime non-prorated transferable warrantee. Accepted by. Homeowner Date Budget Exteriors — 4 Date It j. CONTRACT TERMS AND REQUIRED NOTICES Notice: All home improvement contractors and subcontractors engaged in home improvement Contracting,unless specifically exempt from registration by the provisions of Chapter 1 42A of the general laws,must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the director,Home Improvement Contractor Registration,One Ashburton Place,Room 1301,Boston,MA 02108. �i//Q�/�(� de,/vel/c8 01 Wle'/1'01r kago 354 Merrimack Street(Entry C,Suite 500)•Lawrence,MA 01840 888-49BUDGET•Fax(978)299-0128•www.Budget-Exteriors.com I/We hereby agree and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the specifications,terms and conditions,on the premises below described which I/We represent that we have good record title in our own name. Owners Name: - 01� 00.~i /� ' Home Tel. No. l (. J- Bus.Tel.No. e-mail Job Site Address _� '�—_ �- i _ City , Vit*' ST11,t , Zip Massachusetts Contractor Registration#161932 Work Specifications described attached on pages of n Permits: The contractor agrees to apply for and obtain all construction related permits(building/electrical/plumbing)but shall not be deemed responsible for delays in the work described in this agreement caused by regulatory,permit granting,or inspection agencies,authorities or individuals. Notice: The homeowner who secures his own permits will be excluded from the guarantee fund of MGL Chapter 142A. Price:The contractor agrees to do all work described by the contract for the total price of$� , 3 C- Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of no more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must,in advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever is greater. Payment Terms: Advanced Deposit $ ') 0 C' Payable on signing of contract Interim Payment 1 $4Lt 11, tt Payable 6 kW c Final Balance $9 G i Payable on completi el ss otherwise specified. Work Schedule: The contractor will not be in work or order material before the third day following the signing of this agreement unless specified in writing. The contractor will begin work on or ataout / 7/4(date). Barring delays caused by circumstances beyond the contractor's control,the work will be substantially completed in weeks/ ys. The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by t Tractor shall not be considered as violations of this agreement. The contractor shall not be liable for any delay or non-performance caused by strikes,accidents,weather or any other contingency beyond its control. Insurance: The contractor agrees to maintain workers compensation and comprehensive general liability insurance during the operation of this job to cover the acts of its employees and or agents. Warranties: The contractor warranties its workmanship for up to a period of_�L years and assigns the rights to any manufacturers warranties to the homeowner after substantial completion and payment of the contract terms. You may cancel this agreement if it has not been consummated by a party thereto at a place other than an address of the contractor,which may be his main office or a branch thereof,provided you notify contractor in writing at his main office or branch by ordinary mail posted,by telegram sent or delivered,not later than Midnight of the third business day following the signing of this agreement. See the reverse side of this form for an explanation of this right. The instrument and any and all other documents attached hereto and signed by the parties set forth the entire contract between parties and may be modified only by written instrument executed by both parties. Receipt of a copy of this contract and duplicate notice of cancellation and explanation thereof is hereby acknowledged. Notice: Cancellation of this agreement after three business days will result in a restocking fee of up to 33%on custom products and 25%on non-custom order products. HOMEOWNER: Do not sign this contract if there are any blank spaces. IN WITNESS WHEREOF, the parties hereunto signed their names this day of , 201' . Budget Exteriors, Inc. Representative '' Homeown Accepted Budget Exteriors, Inc. Homeowner Page of Mi The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wwiv.mass•.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/orgwt zation/lndividual): Budget Exteriors—C/O Lou Milano Address: 354 Merrimack Street( Entry C,Suite 500) City/State/Zip: Lawrence, MA 01840 Phone #: 860-753-0452 Are you an employer?Check the appropriate box: Type of project(required): 1.pi I am a employer with (� 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors ❑ 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingforme in an capacity. workers' comp. insurance. Y9. E]Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof r epa:rs insurance required.]t employees. [No workers' 13K Other Vhl 1 _q/ U 1 comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew allidavit 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 emplo.yer•that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Atlantic Charter Insurance Co. / 781-593-1200 Policy#or Self-ins. Lic. #: WCV01161200 Expiration Date: 06105/2016 r-� 148 ,, , Nd h )�, - Job Site Address: _ l_Q �r e r eJr V l�I�(it,� City/State/ZiIdZUfd�:, Ua,-b 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. I do hereby cer 'y r the pat nd penalties of perjury that the information provided above is true and correct. Si na {Bud et Exteriors Auth.A ent) Date Phone #: Home—Fax : 860-315-5266 / Cell: 860-753-0452 Of 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 S.Plumbing Inspector 6. Other Contact Person: Phone#: =DATE(MM/DDINYI,4CORDN, CERTIFICATE QF LIABILITY INSURANCE 15 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES -ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. NPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ieS)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the ertificate holder in lieu of such endorsement(s). CONTACT- )DUCER NAME: 0000 — PHONE 781.593.1200 Vic,No):781.593.7260 iffy Insurance Agency, Inc. No Alc -- E- AIL L7 Broadway ADDRESS: __ _--_—._—...—.-------_-r---' — INSURER(SFFORDING COVERAGE NAIC q )A soma Square -- _--- -�--- ynn, MA 01904-2602 — _— FINS�URER : Endurance American Insurance URED Budget Exteriors : Atlantic Charter InsuranceCo. 000coo Lou Mi1ano 354 Merrimack St Entry C S 500 INSURER D: ----- ----- — - Lawrence, MA 01840 INSURER E INSURER F OVERAGES CERTIFICATE NUMBER: 74 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. 0000 P IC F 0 1 P LIMITS —� POLICY NUMBER MMIDDIYYYY MM/DDIYYYY R� TYPE OF INSURANCE INSR WVD1,000,000 GENERAL LIABILITY I CBC2000001740 07/3112015 07/31/2016 EACH OCCURRENCE $-- Td � $ 100,000 i PREMISES(Ea occurrence COMMERCIAL GENERAL LIABILITY7 I MED EXP(Any one person) $ _ 5,000 F.—1 CLAIMS-MADE OCCUR I I PERSONAL 8 ADV INJURY $ 1,000, .. GENERAL AGGREGATE $ 2,OOO,OO PRODUCTS- COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I I $ j PRO- LOC POLICY; JECT i Ea accident --_ $_—_----- AUTOMOBILE LIABILITY i �'--�— — BODILY INJURY(Per person) $ — ANY AUTO _ BODILY INJURY(Per accident) $ — ALL OWNED SCHEDULED -- AUTOS I 1 AUTOS IZSPEI�TY6AA E— $ NON-OWNED ( Per accident _ --..--- HIRED AUTOS �J AUTOS $ i UMBRELLA LIAROCCUR I 1 EACH OCCURRENCE $ L_1 I [AGGREGATE — $ — —_ EXCESS LIAR CLAIMS-MADE1 I i $ �— W 7AT - I T DED RETENTION$ I WORKERS COMPENSATION wcvO 12 3410 06/05I2015 06/0512016._I TORY LIMITS ER AND EMPLOYERS'LIABILITYE L EACH ACCIDENT $ _500,000 ANY PROPRIETOR/PARTNER/EXECUTIV YIN NIA5OO,OOO I — OFFICERIMEMBER EXCLUDED? 1 E.L.DISEASE-EA EMPLOYEE $ (Mandatory In NH) I I I IMIT $ 500000 — If yes,describe under E.L.DISEASE-POLICY L DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION 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 �- )oe Cuoto 70 Furber Ave North Andover, MA 01845 c 8-201 ORD CORPORATION. All rights reserved. er,nRn 25(2010105) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/OD/YYYY) 06/22/2015 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 CONTACT NAME: _ Duffy Insurance Agency, Inc. Pn"Ic°NNi2_00--_71 talc,Ne):781.593.7260 317 Broadway E-MAIL -- ` — —" —'— — _ Wyoma Square ADDRESS: _ INSURER(S)AFFORDINGCOVERAGE NAIC# Lynn, MA 01904-2602 INSURERA: Endurance American Insurance C NSURED Budget Exteriors INSURER B: Atlantic Charter Insurance Co. 0005 c/o Lou Milano INSURER i : 354 Merrimack St Entry C S 500 i--- - - ---- INSURER D: Lawrence, MA 01840 INSURER E - _ --- -- INSURER F: OVERAGES CERTIFICATE NUMBER: 71 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. JSR SII -- - — 1ICY EXP .TR TYPE OF INSURANCE INSR I WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS GENERAL LIABILITY CBC2000001740 07131/2014 0713112015 EACH OCCURRENCE $ "000'000 COMMERCIAL GENERAL LIABILITY AIE-TO -ED PREMISES(Ea occurcenca $ 100,000 CLAIMS-MADE 11 OCCUR I MED EXP(Any one person) $ 5,000 A PERSONAL 8 ADV INJURY 1$ 1,00000_0 ---...-- __ GENERAL AGGREGATE $ — 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $ 2,QOQ,00 POLICY —i JERo �' LOC -- —. .__.._ AUTOMOBILE LIABILITY {--, Ea accident) $ __ ANY AUTO BODILY INJURY(Per person) j$ 'I ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS r ( ) E HIRED AUTOS NON-OWNED R � A A - - AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADEI ---- i AGGREGATE -- DED ': I RETENTION$ $ WORKERS COMPENSATION TB 06105/2015 i 06/05/2016 TATO- ANDEMPLOYERS'LIABILITY Y/N TORY LIMITS JOTH- ER ----- ANY ANY PROPRIETOR/PARTNER/EXECUTIV E.L.I EACH ACCIDENT $ 500 QO B i OFFICER/MEMBER EXCLUDED? NIA , (Mandatory in NH) j E.L.DISEASE-EA EMPLOYEE $ 500,000 � If yes,describe under _.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ S00,000 � I i ESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space is required) ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Budget Exteriors ACCORDANCE WITH THE POLICY PROVISIONS. c/o Lou Milano 354 Merrimack St AUTHORIZED REPRESENTATIVE Entry C S 500 La rence, MA 01840 ©1988-2010 ACORD CORPORATION. All rights reserved. CORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I 1 CONTRACT TERMS AND REQUIRED NOTICES , Notice;: Ail home improvement contractors and subcontractors,engaged in home improvement Contracting,unless specifically exon1pt from registrtrtian ttry the Provisions Of Chapter 1 42A of the general taws,must be�gistered a avith thernmarstr�eealth of Massachuse"s, Inquiries about r istrat on and stades should be made to the director,Warne improvement Cotract0r Registration,One Ashburton Place,Room 1301,Pastan,MA(12108. af?�a 1,ve,,ue Of,�I&A1/ leec man 354 ftrerrimack Street(Entry C,Suite*00)•Lawronce,MA 61840 888.49BU€G T Fax(978)299-0128•www.Budgext-Exteriors.com g a 'W ti' stttslrr mtt trf e f'�tfr rr <swr7. Ofrtcc of Coosa owcr Affsim S Business'Krgutation I,icense or registrotion Valid for inelividui use only `�#DOME IMPROVEMENT CONTRACTOR before the expirationdate, if found return ter: �"egistratiW 177704 Type, Office of Consumer Affairs and E3usiurss Regulation-1', ��� xpiration. 1127/20,16DBA tU Park Plaza-'Suite 5170 s:_> !3o5(on,MAQ 116 RUOGET EXTERIORS r LOUIS MILANO � 354 MERRIMACK 3T ENTRY C °' /, '7 LAWRENCE,MA 61840 �4t valid ul signature 1�niier�rtrrtxsrr �� `vrrt uxiid w�hout srgnxture r Massachusetts - department of public Safety Board of Building RegUlations and Standards Construction Slshe l i j�or License. CS-097519 LUBOSSVEC 827 THOMPSONi0i i Thompson CT OQ77 f Expiration Commissioner 08/31/2016 1 i a - Ceu IOU �wr� 6