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Building Permit #1091-15 - 77 ELM STREET 6/23/2015
■ NORTH �. U. BUILDING PERMIT '6.�"0 TOWN OF NORTH ANDOVER - A APPLICATION FOR PLAN EXAMINATION Permit No#•= Date Received � � � N �'ls4Q�^n7ED�P �SSACHU5�4 Date Issued: ll 57 IMPORTANT: Applicant must complete all items on this page LOCATION �.. w"�` i Print PROPERTY OWNER Gl L. zem-A IrsM/Q 5 O Print lob Year Structure yes no MAP 05 PARCEL:O ZONING DISTRICT: Historic District no. Machine.Shop Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building g One family 11 Addition [I Two or more family 11 Industrial Alteration No. of units: ❑ Commercial ptRepair, replacement ElAssessory Bldg ❑ Others: Demolition ❑ Other Septic El Well, ❑ Floodplain Wetlands ❑ V1latershe'dp District El Water/Se ,p DESCRIPTION OF WORK TO BE PERFORMED: (Z,lLA1' P2ux bF ✓714QJV1"flAyYt I�(r£0 D eCK ANLI (�EPvhG� OI.D GrllnPas:T b�e* 'nJ fes/• ,8 n1ST�'LV moi' (� X 1 t'o 5 ECS�N b AZPi 7-�'p N 4 Identification- Please Type or Print Clearly OWNER: Name:J VAL- T ZC T"TA •FfElYA),65 S V Phone: 01 / Address: EL-A4 ST Contractor Name: -n.ANnt t GsNSN q- 'o�!Phone: 663 3IS-9864 ; 1) Zg• 2J0 -09Ig Email: G tr7' �kTt-/{.Nlie JJ 5 ut_T iuni : e-0 Address: �-© 3�x 8 C.rtc,�.tst=a �� d� 2Y 6Z. Supervisor's Construction License: ExpDate: Ex 8s o l . Date: .� / p Home Improvement License. - ARCH T/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: $ Z D 3 d -/� FEE: $ Check No.: `1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access o the guaranty fund . - - Location No. boll—, 4 Date 6L� • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ , Foundation Permit Fee $ f Other Permit Fee $ r TOTAL $ Check �� Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL .Public Sewer ❑ Tanning/Massage/Body Art ❑ Sv'imIning 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 /7 IS Signature &%A. COMMENTS_ CONSERVATION Reviewed on Si natur COMMENTS O HEALTH-) , Revie►wed stn ;, <_ .:z. , • Signature, _ r- COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes !''anning Board Decision: Comments r 66nservation Decision: Comments Water & Sewer Connection/Signature Date Driveway Permifi DPW Town Engineer: Signature: Located 384 Osgood Street FIRED �T��MENT ,Temp Dumpster�o y ' EPAR n sifed �e _ 1� �ocateci at,%, Main Stree 3 pa tme • A dire De si-griature i 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) i LJ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 i 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 Engineered � Engineering Affidavits for products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application 4 Certified Surveyed Plot Plan 4 Workers Comp Affidavit 4 Photo Copy of H.I.C. And C.S.L. Licenses 4, Copy Of Contract 4 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 1 NORTH own of E Andover o h ver, Mass, uit. Z zo( s COC NIC Nl WICK S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT 1�.i.. � & . �C �L� BUILDING INSPECTOR has permission to erect ... ......... buildings onhn. Foundation ... ..... .... ... ...... ...... ...6rftA.................... Rough llll::!.xto be occupied as ......... .... 1�� ....... .t.Vy..................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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 MONT S ELECTRICAL INSPECTOR UNLESS CONSTRUC Wt TS Rough 1� • y t,ti 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. .F 1 COPY #4937 ArLANTfG "YB CONSTRUCTION Services - Inc. P.O. Box 68 Chelmsford, MA 01824 Tele: 978-250-0919 - Fax: 603-654-9200 A Full-Service Licensed and 117sure.d General Contracting Cor}). MA. CS#085162 MA Reg.#g#144401 C(OYVYRACT00 AGREEMENT DATE: October 14, 2014 SUBMITTED TO: Liz&Jamie Fennesy Tete: 77 Elm Street Cell:781-710-2667 North Andover,MA 01845 Email:lizettafennesy@yahoo.com We, Atlantic WB Construction Services Inc. , hereby contract to furnish the materials and Perform the labor necessary for the completion of- DEC C f:DECK EXTENSION WORK +DECK RAILING REPAIR&DECK BOARD REPLACEMENT: Work based on a preliminary site visit and review of the viewable locations.All work listed is conceptual. 1.) RAILS-REPLACE 2 DAMAGED RAILING SECTIONS+1 RAIL POST 2.) DECKING-REPLACE ALL DECK BOARDS(MAIN DECK SURFACES+TREADS AT 2 STAIRS) 3.) ALTER AND EXTEND DECK(6' REAR-WARD x 16'WIDTH) GENERAL PROJECT SCOPE:Clients desire to enlarge deck area(along rear edge—facing backyard).Location of extension is between the outside corner of the deck to the existing rear stairs(overall width is 18'-T'.Clients desire to extend this location approximately 6'-0"rearward x approx. 16'-0"width). - DRAWINGS:Atlantic to create project plan drawings(overhead-framing and up-to 3 side elevations)for deck design in order to acquire related Building permit.Clients to provide.necessary Plot Map for application process. - RAILING MATERIAL REMOVALS:Removal of the remnants of (2)damaged railing sections(1)43-7/8"+(1) 69-1/2"Length sections(rail sections are made-up of,upper rail caps,lower balustrade sections,custom-balusters+ 1 outside-corner rail post). Remove(2)additional railing sections(to left of stairs),and attempt to salvage(for-re- use at deck extension areas. This is conceptual and remains to be fully determined—if it is possible). - SOIL EXCAVATION&CONCRETE WORK:Excavate soil to create(3)new 12"x 4' footing holes. Insert sono- tubes,backfill location,fill with onsite-mixed concrete into tubes. - FRAMING WORK:Install(3)2x10 x 16 PT Framing to create new structural-support beam,to support new 2x10 PT deck-extension joists(approx.6'x 16' footprint).Deck extension joists to be run back into existing deck area,to allow support over the existing(3)x 1x10 PT deck-support beam.Use of standard PT lumber&galvanized brackets &fasteners.(3)6"x 6"Beam supports mechanically attached to(3)new concrete pier-footings using galy.brackets. - UNDERSKIRT:Fabricate&install new PT lattice&PVC trim components(along 3 sides of deck extension). Attempt to salvage and re-use old access door at new deck extension rear location(TBC/TBD). - OTHER UNDERSKIRT WORK:Reinstall removed lattice panel&trim boards at outside-corner rail post location(related to the repair of the. - RAILING REPAIR WORK:Acquire/Fabricate& install(1)new 48"Custom-ordered rail post+approx. (9) Custom-ordered balusters onto custom fabricated upper rail cap+lower balustrade materials = to create(1)new 43-7/8"rail section. Work will require modifications to the deck-level location(under the new rail post).New rail post would be secured to the deck joists using blocking and lag attachments. [Continued on page 2] Initial 2 'I ##4937 [Continued from page 1) - DECK-EXTENSION RAILING WORK:Attempt to salvage and re-use(2)69-1/2"existing rear deck rail sections to create(2)new 6'rail sections.Attempt to salvage and re-use(l)2'damaged rail section to create(1)new 2'rail section(assuming that the old rail components will be able to be re-used as described.This is to be determined). - NEW DECK BOARD WORK:Install new slate-gray type composite 5/4"x 6"deck boards using color-matched stainless steel screws to fasten to existing deck frame(joists)and 2 sets of existing stair-stringers(1 leading to backyard and 1 leading to basement level entry door). - PAINT/STAIN WORK:Paint related work(including surface-cleaning,caulking,primer,paint,and/or stain applications—would be left for the Clients to arrange Others to perform.If requested,such work may be performed for an added cost. - PERMIT(Sl:A building permit is required for the project.Permit fee(s)would be separate from project costs. - DEBRIS DISPOSAL:Work-related debris would be disposed-of to an onsite,Atlantic provided dumpster.Costs are based on an estimated,conceptual weight-load,that may adjust at time of work completion NOTES FOR PROJECT WORK: • NOTE 1: Work is based on the Atlantic provision of the following drawings(to acquire a Deck Extension Building Permit);over-head view of framing+left side elevation framing view+rear elevation framing view.At time of documentation,no other drawings,or document-creations are assumed/planned. Engineering stamps and certifications are not assumed/planned.If applicable,such additional work would result in added costs.Clients to provide most recent plot map for building permit application packet. • NOTE 2:Work is based on the general processes listed,and the location-dimensions&specified materials. Work beyond the proposed dimensions,number of railing-sections/parts,and the quantity of footing-holes, etc.—are not assumed/planned. Changes in types material may result in cost adjustments(+/-). • NOTE 3:Railing materials are based on approximate costs and should be viewed as general allowance(s). At time of documentation,additional information is still needed,for rail-cap&lower-balustrade costs. • NOTE 4:Some materials and/or components—will require custom-ordering and shipping. Once ordered, such components may not be able to be changed,or would result in additional charges(from the Supplier, or Manufacturer). Order and shipping time(lead times)may vary(TBC/TBD). • NOTE 5:Deck extension work(excavation and concrete phase)-would require access to outside water, and a designated mixing+clean-up location. • NOTE 6:Work is based on standard&typical pier footings dimensions of 12"diameter x 48"depth. Use of specialized footing designs,components&configurations(including bigfoot-type,over-sized footings, etc.),and/or creation of a landing-support pad(s) —are not assumed/planned. • NOTE 7:As applicable;New Deck Extension PT materials,railings(and parts),underskirt panels/trim,etc. -would be installed and left as-is(not treated,painted,cleaned,sealed,sanded,etc.).Sealing,priming, paint,etc. —would be left for Clients to arrange for Others to perform. • NOTE 8:As applicable for Deck Extension Work;This is based on standard and typical soil conditions at the location(s).Obstacles(such as boulders,old deck pier footings,at the location,granite,ledge,septic components,irrigation lines,man-made objects&debris,water,etc.—are not assumed/planned to be encountered. No special excavation services are assumed/planned to be required,including the pumping and removal of water(whether generated from below ground,or due to rain/snow weather). • NOTE 9:Repairs,modifications,additions-to,etc.—Existing deck frame&rails—is not assumed/planned. • NOTE 10:All listed work would disrupt surrounding locations surfaces(such as mulch beds,grass,etc.). Such areas may become matted-down,generally-disrupted,and will also likely contain small,work-related debris(wood chips/splinters,paint chips,and other smaller particles).Unfortunately,there is no other way around this happening,simply due to the nature of the work process. See Note I I in below. [Continued on page 31 ,_�,, Initial 3 #4937 [Continued from page 21 • NOTE 11:Landscape related work,exterior-detailed grounds-cleaning,gravellother provisions,and similar work-is not included with the project work(examples:sod,seeding,shrubs,trees,plants,flowers,re- plantings,addition of soil/mulch,drainage installation(below/above ground),soil retention,etc.).Atlantic does not possess the skills,nor the equipment to perform/provide-such specialized services. • NOTE 12:As applicable for Deck Extension Work;Excavated-soil would be used to backfill around new footing forms.However,Client should be aware that excess-soil will be produced during the process. Excess soil would be left on-property(and placed underneath the existing deck&extension areas). • NOTE 13:All work is based on favorable seasonal conditions(including temperatures&weather patterns). • NOTE 14:As applicable for Deck Extension Work;Clients to discuss&finalize underskirt work preferences.Work assumes/plans are based on the install of a 2x4 PT sub-frame under the new deck extension location+the install of PT lattice panels& 1x6& 1x12 PVC trim boards.Determination of plans for access door location(including ability to re-use old door&hardware).At time of documentation —ability to;remove,salvage+ re-use old lattice panels,trim-boards,access panel,hardware,etc. —is not assumed/planned(old lattice/trim may not be compatible-with the new deck extension grade heights). • NOTE 15:Removal of the 1 specific area of lattice&trim work(related to the storm-damaged railing section repair),would be to allow access to install the new 48"rail post(to be inserted into the deck joist area,and directly bolted to the frame&structure).This is a more secure anchoring method that meets current Building Code for barrier requirements. • NOTE 16:Standard Atlantic Policy,as applicable:Issues regarding Manufacturer defects would be handled between the.Manufacturer,and the Client(with the aid of Atlantic,and Atlantic's Supplier Rep).Any costs and expenses related to such Manufacturer issues&defect,would be the responsibility of the Supplier and/or the Manufacturer.Atlantic cannot be held liable/responsible for such costs and expenses. • NOTE 17:Work is based on all project materials being acquired&provided by Atlantic(not Others). • NOTE 18: At time of documentation,work is based on the use of either AZEK or WOLF brand,slate-gray colored,composite-type,5/4"x 6"deck boards with color-matched stainless-steel screws.Use of a hidden fasteners and/or plug-system is not assumed/planned. Such may be discussed(and used),but would result in added costs.Work is based on materials being acquired&provided by Atlantic(not Others). • NOTE 19:All newly installed railing components will require paint related work—to properly seal and weatherize(protect).This includes;caulking,primer&finish-coat paint applications(using a quality exterior grade paint).This should be done in a timely manner.Atlantic cannot be held liable/responsible— for failures and damages,that are caused by a failure to perform such protective work(for any reason). Such failures may be;split,cracked,warped,rotted,stained,mildewed,molded,unsightly wood surfaces and fasteners-related issues caused by softened or decayed wood. • NOTE 20:Creation of drawings,plans and/or diagrams—is not assumed/planned for the project work. • NOTE 21:Debris cost is based on an onsite dumpster being present,at time of work project(start to finish). In the event that such a dumpster(whether provided by Atlantic,the Clients,or Others),is not present during the work process—added costs may apply for a project-dedicated dumpster rental+dumpster permit • NOTE 22:Efforts would be made to clean-up the general areas affected by the project work.Clients to be aware that some small debris particles(including paint chips&wood splinters)may be missed(and may not be able to be cleaned).Extensive or detailed grounds-cleaning,raking,mulching,and other landscape- work is not included.These may be performed by a Client-hired landscape maintenance service. �' Initial 5 #4937 ESTIMATED PROJECT COSTS: WORKPHASE: CHARGE: DRAWINGS: Creation of (3)Deck Framing Plans(and up-to 4 Plans) $100.00** MATERIAL-REMOVAL WORK: For New Deck Extension(Rails,Underskirt,Rim Joist,Brackets,etc.) EST.LABOR:As Listed—Conceptual Allowance(also attempt to salvage 2 old rail sections) $480.00* EXCAVATION&CONCRETE WORK:3Holes-Soil Removal/Back-filling+Concrete Work EST.LABOR:Digging&Back-filling-(3)x 12"x 4'depth holes $450.00* EST.LABOR:Concrete-mixing&Form-setting,etc. $240.00 EST.MATERIALS:12"Sono-Tubes,Concrete,I-Bolts,Washers/Nuts,Rebar,etc. + 222.00* $912.00 DECK-EXTENSION FRAMING WORK: Approx. 12'Extension x 18'Width Area EST.LABOR:As Listed-Conceptual $1290.00 EST.MATERIALS:4x4,6x6, PT,2x10 PT,Joist Hanger,Galy.Brackets,Fasteners,etc. +$911.18 $2,201..18 DECK BOARD WORK: Removals+Installation(Existing Deck Area+Deck Extension+2 Stairs) EST.REMOVAL LABOR:As Listed—Conceptual Allowance $590.00* EST.INSTALL LABOR:As Listed—Conceptual Allowance $1050.00 EST.MATERIALS:5/4"x 6"Comp.Deck Boards+Color-matched SS Screws-Allowance +$7668.08* $9,308.08 DECK RAILING WORK: (1)Repair Section+(4)Extension Sections+(2-1/2)Salvaged Sections EST.LABOR:As Listed—Conceptual Allowance $1290.00 EST.MATERIALS:Custom-Ordered Rail Components—Conceptual Allowance $2908.59+/- EST.MATERIALS:Custom-Fabricated Components+Install Components—Allowance(TBC) +S1110.00+/-* DECK UNDERSKIRT WORK: Along New Deck Extension Areas-Conceptual $5,308.59 EST.LABOR:Fabrications&Installations(PT Sub-frame,Lattice+Trim+Access Door) $1050.00+/-* EST.MATERIALS:2x4 PT,PT Lattice,Ix6+Ix12 PVC Trim,Fasteners,etc. $719.25+/-* $1,769.25 DEBRIS DISPOSAL: Estimated Quantity/Weight-Based on Onsite/Existing Dumpster Use $309.00+/-*** SUBTOTAL OF ABOVE WORK: $20,388.10 ESTIMATED PERMIT FEES: Based on Project Value(Permit Fee)= ADD + $275.00+/- **** * Estimated Prices:All costs should be recognized as"allowance"amounts.This is derived from known and possibly unknown project aspects,that will be affected by actual site conditions,Client preferences,and any additional project details. Materials Costs are based on the estimated,conceptual quantity of materials needed for the assumed project phase(and scope), and on Supplier provided pricing at time of Original Proposal.Costs include MA Sales Tax with Cost-Plus pricing. ** Drawings Assumed&Planned:Up-to(4)Depiction Plans total.No other drawings are assumed/planned. *** Debris Costs:Are based on the estimated and assumed total quantity(and weight+/-)of project related debris(from demolition phase and project waste,for the specified work.In the event that additional debris is generated during the course of project work,such may result in added weight cost. ***Permit Fee is separate from projects costs.Actual permit fee totals may adjust upon completion of project [Continued on page 61 �� initial 6 #4937 [Continued from page 51 The contracted work would be completed for the sum: $20,388.10 ' Twenty Thousand, Three-Hundred, Eighty-eight Dollars and Ten Cents. Payments would be made as follows: Progress Payment Schedule PAYMENT#1: $4,018.59 - At Contract Agreement-For Special/Custom-order Components z PAYMENT#2: $5,450.00 - At Start of Project Work.3 PAYMENT#3: $5,450.00 - At Completion of Deck-board Removal Work. 4 t PAYMENT#4: $5,469.51 - At Completion of Original Listed Project Work. 5 (�✓ � $20,388.10 - TOTAL 6rdtfs c 1)s¢om STANDARD PAYMENT POLICY# 1:In the event of any kind of delay,an invoice would be submitted for they . work completed up to the start of the delay,or,comparable difference in the Progress Payment Schedule.Payment would be due at that time for the invoiced charge(s).Al)Progress milestone descriptions should be recognized as an TLC approximation of the described work,and its level of completion+/- . ,7/'7 C/O a ( f0 In order to meet a timely schedule of progress, the following Materials & 0 d r Components, must be special-ordered and onsite prior to the start or project work: • Special-Order/Custom Order Railing Components;New Rail Post, New Balusters, Upper Rail Caps with balustrade, and Lower Balustrade components. The following Building Permits would be required: Building Permit(Related to Deck Extension Work. FOR c- -THANK :YOU FOR `s'C?UR�GPSi�vES... Amount is based on currently listed costs for material,components&labor.Some custom&special-order component costs may adjust(+/-),at time of ordering and acquisition,based on Manufacturer/Supplier related set-up&shipping fees. 2 Payment#1 required prior to placement of order for the specified special-order and custom-order components&materials. Such materials and components require 3 weeks lead time+shipping time(according to Suppliers).Shipping costs are based on approximations as supplied by Suppliers,but may adjust(+/-)at time of order placement(based on weight of shipment). 3 Start of Project Work is defined as the start of any portion of the listed work,and/or first onsite delivery of project materials. 4 Completion of Deck board removal process—is based on the first phase of work(general Material Removals),which includes deck board removals.This would be prior to railing work and new deck-board installation work start phases. 5 Completion of Contract work is defined as the Original project scope,and is not contingent on the completion of any additionally requested(added)work.This process includes(1)effort(visit)to address the Client's punch list item(s),or point(s), (as discussed and compiled in written format),between Atlantic&Clients. Additional punch list efforts visits may be P (visits) Y perform3O,but would not hold up the final payment. _L�itial 7 #4937 General Contractor Information: OSHA CERTIFIED - EPA Certified FM Lead Renovator(TSCA Section 402) - MA LR License#LWO01100 An Accredited Better Business Bureau Company Name: Atlantic WB Construction Services-Incorporated Mailing Address:P.O. Box 68 City/Town: Chelmsford State: MA Zip Code: 01824 Business Phone: 978-250-0919 Alt. Phone: 603-315-9866 Fax: 603-654-9200 Email: Services@Atianticwbconstruction.com F.I.D.: 20-4035165 MA General Contractor License: CS#085162 Exp. Date: 09/04/16 MA H.I.C.Contractor Registration: # 144401 Exp.Date:09/30/16 Established in 1985 " • ' Serving New England over 25 years BBB. TERMS AND CONDITIONS [1]PRICES: Project Estimates involving Labor Quotes can only be honored for a period of 29 days from date listed on the proposal. Fuel and material increases may occur on a daily basis and would appear on final invoice(s).Allowance amounts include estimated quantities of material and/or labor and may also include tax,shipping,and other overhead costs.If Applicable with Atlantic Permit Work;(1)Simple Drawing and application- are included with the Permit Work Process. Additional costs may apply,based on any required additional drawings/other services required in order to obtain permit(s)and approvals.Town Permit Fees are based on information provided by the Local Building Dept.and are a separate cost from any Contract Total. [2]PAYMENTS:The designation of'Client'or'Customer'in this document shall be recognized as the person or company listed on page one(1)following the subheading line;'submitted to'. Unless otherwise specified on this document,Atlantic WB Construction Services Inc.recognizes the afore listed designee as the party responsible for all payments as outlined on this Legal Contract. Payments are to be made as follows:Amount will be due upon completion of the work listed. In the event of more than one Payment,the terms are as described in the"Payment(s)would be made as follows"section. MA Law stipulates,that aside from special order material costs,any work related deposit amounts,may not accede one-third of the contract total. If necessary,Invoice(s)may be submitted by Atlantic to the client for payment. If Invoiced,Payment is due upon receipt and is considered past due five(5)business days from the receipt of invoice. If the Client has valid reason for disputing any portion of an invoice,Client will so notify Atlantic within five(5)calendar days of receipt of invoice,if no such notification is given,the invoice will be deemed valid. The portion of this Company's invoice which is not in dispute shall be paid in full. Final Payment: This payment would be due immediately upon substantial completion of the scope of work as outlined in this contract. At the time of project completion,a walk-through would be performed with the Clients. Any defects,touch ups,and ONE(1)final"action'(efforttvisit to complete the contracted work to the client's satisfaction)are included as part of this contract. Upon the completion walk thru,a punch list may be compiled,with an equitable monetary amount applied for the points listed.The final payment would be released,and the equitable amount then held by the Client,until the compiled list is completed.Additions to the list may not necessarily be applicable to the original monetary amount held by Client,as these were not part of the initial arrangement.Atlantic is not responsible for any consequential damages.The Final Payment is NOT a retainer,and cannot be held back,by the Client,as such.A Retainer Arrangement must be so listed,and agreed upon in writing,in the original contract,and would not exceed I%of the overall project cost. When work falls under the description of a 'commercial contract',Payment schedule may be subject to a Company approved change. If payment of invoices is not current, Atlantic may suspend performing further work until such payment is received. Payments not received after 30 days may be considered a breach of contract. Amounts not received after 31 days may be considered delinquent and subject to finance charges(including Supplier charges&late fees),all attorney fees(Atlantic&Others),court costs,as well as all additional collection charges. All late payments will be assessed a 2%monthly late fee in addition to the aforementioned costs. Late fee amounts will be begin with the date of the original invoice. All such expenses shall be the responsibility of the Client and paid by the Client.Atlantic is not responsible for any delays directly or indirectly caused by the Client or Town. Any aforementioned delays shall not hold up the listed payment schedule or any demand for payment when work has been finished to the furthest extent possible of a work phase. In the event that a singular repair project,service call,series of projectsftobs- generates an invoice balance over$5,000.00,such an amount,would be subject to an advanced payment schedule.In the event that project aspects result in Hourly Rate charges,a total labor cost may be invoiced,along with project material charges (an itemized charge list may not be supplied).Client to be aware that labor hours are rounded-up to the nearest half hour increment(s).Commute travel time"to"the work locations),and material/parts acquisition time,will be charged.In addition, there would be a separate charge towards fuel costs at a flat rate of$20 per 8 hour work period and$10 per 4 hour work period(such fuel costs may increase according to actual amount of total driving distance&fuel required to perform work tasks, and current fuel prices at pump).Workers are allowed(2) 15-minute paid coffee breaks,resulting in 30 minutes or more(+/-) through the course of a 7 to 8 hour work shift(or 15 minutes per 4 hour work shift),and may use such break time(s)as they prefer&see fit. All workers are allowed to answern and communicate on their cellphones(at any time). In some instances �� Initial 12 #4937 Required State Notification: Do not sign this contract if there are any blank spaces. HomeowneriProaerty Owner Information: Name: Fe 0 YlQ5S L4 zry JW1 u Street address 1 City/Town: N 0 I, _/4yer State: Zip Code: ,.— Daytime Phone: .� Evening Phone: Cell: � to o y447 Email (optional): U ZE77.4 f61UAJ4!SS 0 VA44 6- tdKA General Contractor Information: Name: Atlantic WB Construction Services-Incorporated Mailing Address: P.O. Bo x 68 City/Town: Chelmsford State: MA Zip Code: 01824 Business Phone: 978-250-0919 Alt. Phone: 603-315-9866 Fax: 603-654-9200 Email: Services@,Atlanticwbconstruction.com F.I.D.: 20-4035165 Required State Notification: Do not sign this contract if there are any blank spaces. Company Representative: Craig Tarbox MA General Contractor License: CS#085162 Exp. Date: 09109116 MA H.I.C. Contractor Registration: #144401 Exp. Date: 09130116 ARBITRATION: The General 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 Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c 142A. General Contractor. Date: Home Owner: Date: NOTICE: The signature of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed by the parties. 1 Initial 13 #4937 HOUSE/STRUCTURE INFORMATION: DECK STRUCTURE Property Owner/Client testifies to the best of their knowledge,that the age of the home,or structure, listed in this contract,and,to be worked on-is as stated below. (Per TSCA Section 402) �1 Dip YEAR OF ORIGINAL BUILD or Age of Structure = DECK AREA ONLY Home wner's Signature Dat ACCEPTANCE OF CONTRACT: The listed prices,specifications and conditions are satisfactory and are hereby accepted.Atlantic WB Construction Services Inc.is authorized to do the work as specified. Payment will be made as outlined in this document. Home ner's Signature Date Property Owner's Representative's Signature Date General Contractor's Signature Date NOTE TO CLIENTS: Atlantic recognizes that either one(1)of the signing agent(s), listed Owners (of Town Record),or authorized Owner Representative- is individually,duly, approved (as the Representative, Client,or Owner)to make decision(s)related to specific worksite aspects& choices. In the event that a decision is made related to project details, by one(1)of the authorized agents,whose name&signature may appears above(or listed as party to ownership of the project address),Atlantic will accept the decision as final,and proceed with the work process. Atlantic may likely not attempt to contact all individuals involved with the overall project,or,all Owners of the property,prior to continuing work-based on the provided decision. -THANK YOU FOR YOUR BUSINESS- C Initial 14 #4937 NOTE: Massachusetts State Law allows you, as the property owner,the ability to cancel this agreement if it has been signed by a party thereto at a place other than an 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, posted by telegram sent or by delivery, not later than midnight of the third (3'd)day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. Under the provisions of MGL c 93 s 48;MGL c 140D s 10 or MGL c 255D s 14,this Notice has been posted on Pages eleven(11)and fourteen(14)of this Agreement Document: NOTICE OF CANCELLATION: You may cancel this transaction,without penalty or obligation, within three(3) business days from the listed date. If you cancel, any property traded in, any payments made by you under the contract or sale, and any negotiable instruments executed by you will be returned within ten (10) business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel,you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this contract or sale; or you may, if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty (20)days of the date of cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller, or if you agree to return the goods to the seller and fail to do so,then you remain liable for the performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Atlantic WB Construction Services Inc., at P.O. Box#68 Chelmsford, MA 01824, not later than midnight of (date) I hereby cancel this transaction. Buyer's Signature: Date: Initial MORTGAGE INSPECTION PLANFILE NO.: ,38300 UNREGISTERED LANG ADDRESS- 17 ELM STREET, NORTH ANDOVER MA DEED BOOK:5381 PAGE:325 ATTORNEY: LAW OFFICE OF DANIEL LADD 22237 PLAN BOOK: PA(E: LOTS} PLAN NUMBER: OF LENDER: OWNER:RUMACK FAMILY REALTY TRUST REGISTERED LAND APPLICANT: LIZETTA & JAMES FENNESSY REGISTRATION BOOK: PAGE: DATE:. 08/07/2002 SCALE: 1"=40' CERTIFICATE OF TI71_Ei PLAN NUMBER: LOT(S): FLOOD HAZARD INFORMATION FLOOD MAP COMMUNITY NO.: 250098 ZONE: X ASSESSORS MAP PANEL: 0003C DATED; 06/0271993 MAP. 55 BLOC K; PARCEL: 8 N/F DAVIS & FURBER MACHINE CO. 53:76' Stlm T` C •10.45' LOT 8 15,438 S.F. N/F WRIGHT N/F SAUNDERS P&G P0$a o D£c-E.XTEUsq'oN r j PORCH 0 2 1/2 STORY DWELLING/ PORCH 67.33' MORTGAGE E:ENDER ELM STREET USE ONLY THIS IS THE RESULT OF TAPE MEASUREMENT, NOT THE RESULTDB L�CAERS OF AN INSTRUMENT SURVEY AND IS CERTIFIED TO THE TITLE �1 INSURANCE COMPANY AND ABOVE LISTED ATTORNEY AND LENDER. &ASSOCIAIU'NC- 40 KENWOOD CIRCLE, SUITE 8, FRANKLIN, MA 02038 THERE ARE NO DEEDED EASEMENTS IN THE ABOVE REFERENCED TE,;(800)287-B800. FAX.:(508)528-4011 DEED OR ENCROACHMENTS WITH RESPECT TO BUILDINGS SITUATED ON THIS LOT EXCEPT AS SHOWN. tH OF &, THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN ROBERT A SPECIAL FLOOD HAZARD ZONE. o EDWARD BISSONNETT H THE LOCATION OF THE DWELLING AS SHOWN HEREON EITHER N0. 31.300 WAS IN COMPLIANCE WITH THE LOCAL ZONING BY—LAWS IN �F�rsTo EFFECT WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL AL LAO SETBACK REQUIREMENTS ONLY), OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. G.L. TITLE VII. CHAPTER 40A,. SECTION 7. GENERAL NOTES: (1) The declarations made above are on the basis of my knowledge information,and bel t as the result of a mortgage inspection tape survey mu to the normal standard of care of registered land surveyors Practicing in M=ochuselts. (2)Declarations are made to the above named client only as of this dale. (3) This plan was not made for retarding purposes, for use in preparing deed descriptions or for construction. (4) Verlrications-of property I'me dsnensions,building offsets, fences, or lot configuration may be accomplished by on accurate instrument survey. (5) No responsibility is assumed herein to the land owner or occupant Residential Property Record Card PARCEL ID:210/055.0-0008-0000.0 MAP:055.0 BLOCK:0008 LOT:0000.0 PARCEL ADDRESS:77-79 ELM STREET FY:2014 PARCEL INFORMATION Use-Code: 104 Sale Price: 490,000 Book: 07047 Road Type: T Inspect Date: 05/29/2003 Tax Class: T Sale Date: 08/29/02 Page: 0113 Rd Condition: P Meas Date: 05/29/2003 Owner: Tot Fin Area: 3261 Sale Type: P Cert/Doc: Traffic: M Entrance: X FENNESSY,JAMES O Tot Land Area: 0.35 Sale Valid: Y Water: Collect Id: RRC FENNESSY, LIZETTA M Grantor: RUMACK FAMILY Sewer: Inspect Reas: C Address: 77 ELM STREET Exempt-B/L% I Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% I NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: DK Tot Rooms: 9 Main Fn Area: 1559 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R4 Story Height: 2.35 Bedrooms: 5 Up Fn Area: 1702 Bsmt Area: 1559 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: H Full Baths: 3 Add Fn Area: Fn Bsmt Area: 1 P 104 S 15438 0.350 171,176 Ext Wall: FB Half Baths: Unfin Area: Bsmt Grade: VALUATION INFORMATION Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 3261 Current Total: 342,200 Bldg: 171,000 Land: 171,200 MktLnd: 171,200 Foundation: ST Bath Qua[: T RCNLD: 170960 Prior Total: 356,000 Bldg: 184,800 Land: 171,200 MktLnd: 171,200 Kitch Qual: T Eff Yr Built: 1975 Mkt Adj: Heat Type: ST Ext Kitch: Year Built: 1900 Sound Value: Fuel Type: G Grade: AG Cost Bldg: 171,000 Fireplace: 0 Bsmt Gar Cap: Condition: AG Aft Str Val 1: Central AC: N Bsmt Gar SF: Pct Complete: Aft Str Val2: Aft Gar SF; %Good P/F/E/R: /100//79 Porch Tvoe Porch Area Porch Grade Factor P 401 W 81 SKETCH PHOTO 4 15r > s 138 Sq.Ft r ` FM 29 1559Sgxt 13 B 1412.S +► 4 4 FtJ �.R r t q.R 1261 Sq.Ft r! s 17 13 �q.Ft 9 4 26 «x._ - r 34 235 15 ;� ��-, +".°?s`.^r."-'�.w"."�'..:...r� s d,'✓"z�'ek ssr�1*� i�f g�y; k W . a 11 li o P 77 ELM STREET 242 Sq.Ft 8 32 Parcel ID:210/055.0-0008-0000.0 as of 8/4/14 Page 1 of 1 40 1 - y� HOP MOW alp Ws i i i.. 'a r �F {� - ':•tad � � �� � �,� - .x f { , 4 y - may, � � a.-. �,'` �ry � 5•m.3 - p �+�'�-rad}•�� �t �+y S 'a i r � ,�,� ATLANTIC WB_ CONSTRUCTION SERVICES-INC. Chelmsford, MA 01824 MA. CS#085162 MA Reg.# 144401 AREA OF WORK: NEW DECK EXTENSION with RAILINGS PROJECT DESCRIPTION&SCOPE: Add 6'W x 16%rear deck extension area. Replace all e>asting decking with new composite decking.Perform repairs to 1 side section of storrn-damaged custom rail. EXISTING DECK STRUCTURE: —� 2'-6" 16'-0" Conventional design&materials-1x10 -_ „ fasts ng 16”O.C.supported by PT �--4-2 —�---4'-6"�' S-2 5'-2 5-2 carrying beams on pier footings.. o DECKING DEMO WORK:Remove all eAsting deck boards from existing deck frame&Stair treads. ip ( ZX1 o JOIST DEMO:Remove rear rim joist(to cp io right of stairs).Remove left side rim joist EXCAVATION&CONCRETE WORK: Excavate sal to creat(3)12"dia.x 48" depth holes.Insert Sono tube&back-fill. Mix concrete onsite&insert into tubes. NEW BEAM INSTALLATION: Construct .— &install one(3)2x10x16 PT beam at 1' c cantilver.Install(3)6x6x2'PTcolumns for Q new beam supports. EXIS NG(3 2x10 EAM d FOI TING NEW DECK AREA JOIST INSTALLS: - co Install new 2x10x9(approx.)PT joists at 16"O.C.-Supported by existing centered beam and new rearward beam. NEW DECKING:Install 6"Composite Decking NEW RAILINGS:Install railing E STIN (3) 10 g components(Custom-milled;rail posts,rail caps,balusters,upper and lower balustrade segments) RAILING REPAIR:Remove storm- damaged section of railing&replace with same Custom-milled railing parts. 0 DECK UNDERSKIRT:Construct 2x4 PT acli subfname.Install 1x PVC Trim Boards& tQ0 PT Lattice work along rear deck extension area;(2)6'x2'lengths+(1) (REAR OF HOUSE) 16'x2'length. PAINT WORK:Surface Prep&Paint work to be performed by Others Fennessy Home PROPOSED DECK EXTENSION 3 of 3 77 Elm Street FRAMING DIAGRAM&INFO. N. Andover,MA 01845 Deck Extension &Repair Project 06/08/15 ATLANTIC WB CONSTRUCTION SERVICES-INC. Chelmsford, MA 01824 MA. CS#085162 MA Reg.# 144401 (BACKYARD AREA) 18'-6" 2'-6„ 16'-0„ i. �-5'-2" + 5'-2" NEW DECK EXTENSION Q zQ (Approx.6'x 16') 4 io co N CO EXISTING DECK AREA N er LO co Basement o Door M ' r-e x6'-8"9u 2 e^=s-e^co io (REAR OF HOUSE) R Fennessy Home PROPOSED DECK EXTENSION 2 of 3 77 Elm Street (6' Rear Projection x 16'Length) N. Andover,MA 01845 Deck Extension&Repair Project 06/08/15 ATLANTIC W® CONSTRUCTION SERVICES-INC. Chelmsford, MA 01824 MA. CS#085162 MA Reg.# 144401 1�-41-2„_d/4,W' / W-6 (BACK YARD AREA) co 6F-O” 6'--0" 6'-0'0 N O � EXISTING DECK 00 FOOT PRINT 00 N LO r N Basement Q a Door M 2'e^x 6'-8'9Lf r-8-x 8=8^co (REAR OF HOUSE) 4 Fennessy Home EXISTING DECK LAYOUT 1 of 3 77 Elm Street N. Andover, MA 01845 Deck Extension& Repair Project 06/08/15 The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia 01M SVS Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Legibly Applicant Information Name(Business/Organization/Individual): Address: City/State/Zip: S� Phone#: 7Y7 Are you an employer?Check the appropriate box: Type Of project(required): / em ]o ees full andlorpait-time).* 7. ❑New'construction 1.�am a employer with- F- P y 2.F]I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9• ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 1Z_nPlumbing repairs or additions 5•❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.❑Other t2el�►'t ��'� � 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL C. r ((0 AA' 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. eet showing the name of the sub-contractors and state whether or not those entities have #Contractors that check this box must attached an additional sh 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: 0 7 7 Expiration Date: Policy#or Self-ins.Lie.#: �9�._ 5--�� Ci /State/Zip: �. Rio 'l� !"'"'T �I�L/•� Job Site Address: -77 I,'-� 3' City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). e up to$1,500.00 Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fin and/or one-year imprisonment,as well as civil penalties in the form of a S'T'OP 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. Ido hereby certify under the and penal• f perjury th�thnformation provided above is true and correct. Date: �s Signature: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver'or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings-in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)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' compensatiori 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 AC oRa CERTIFICATE OF LIABILITY INSURANCE DA�061021 I5(MMMOfYYYY' 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(les)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 OONNTT CardynACOugHin Charles J Coug Nin Insurance 14DinieyStreet p�"p Ext): (978)957-3588 i(AIC, No): P.O.Box 10 ADDRESS: Cardyrl@Ca�ghlirrir►s.Com Dracut,MA 01826 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Main Street America Assurance Company 29939 INSURED 466899 INSURER s: NGM Insurance Company 14788 Atlantic Wallboard Construction,Inc. INSURER c: Travelers InderrrtityCompanyof America TPC Craig Tarbox P.O.BOX 68 INSURER D_ .� Chelmsford,MA 01824 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 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 ADDL G5U8R POLFCY EFF POLICY EXP LTR TYPE OF INSURANCE ' I POLICY NUMBER C MMlDDJYYYY I IMMIDDIYYYY1 LIMITS A GENERAL I-LA&LITY i MPT7842R j 04/17/2015 ! 04/17/2016 I EACH OCCuzRENCE S 1,000,000 AGETORENTECOMMERCIAL GENERAL LARLITY PREMISES Ea occu encs S 5W'OW I _ CLAUSSMADE D\,/ OCCUR— i MED EXP(Any one person) $ 10,000 PERSONAL S ADV RILMY Is 1,0!10,000 i t GENERAL AGGREGATE S Z000.0w GENL AGGREGATE LIMfT APPLES PER: ! PRODUCTS-COMPK)P AGG S 2,0�,� kcT POLICY 1-1 PRO- I 'LOC B AUTOMOBILE LIABILITY i i BIT1736R 02/17/2015 102117!2016 COMBCEDSIf LELIM" 1,000,000 � i Ea accitlent ANY AUTO i j BODILY INIURY(Per person) is ALL OWNED SCt€DULED / ! BODILY IN. RY(Per accident) S AUTOS V AUTOS I i NDN-OWNED PROPERTY DAMAGE MRED AUTOS \ AUTOS i I , Per accident)__ S I UMBRE.LALIAB ; OccuR CUT7842R 04/17/2015 04/17/2016 EACH OCCURRENCE S 4,000,000 —I EXCESS LIAS CLAIMS-MADEI ) I A) GGREGATE S---- 4,000,000 DED RETENTION S I 5 C WORKERS COMPENSATION 00057507 05/22/2015 05/12!2016 WGSTATLI OTA+ AND EMPLOYERS'LIABILITY Y!N I 1 TORY IM ER t _ ANY PROPRETOWPARThERVEOUTIVEI I E.L.EAq-tAOC IDENT_ I S 1,000,000 OFFICEWMEMBEREXCLUDEW N!A (mandatory InNN) f (ME.L.DISEASE-EA EMPLOYEE S 1,0w,000 describe urRIPTIONOFFO OPERATIONS below EL.DSEASE-POLICY LiMrr G S 100,000 i DESCRIPTION OF OPERATIONS!LOCATIONS/VB41CLES(Attach ACORD 1(",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 POLICYPROVISLONS. AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards �Q\, office of Consumer Affairs& Business Regulation QNW4404OME IMPROVEMENT CONTRACTOR _0 P Con4ttruction Supen,isor � 1 6�W", egistr -ation: 144401 Type: fa License: CS-085162 MI . xpiration: 9130/2016 DBA Craig V Tarbox ATLANTIC WALLBOARD CONST CO. 209 Forest Road Wilton NH 03086 CRAIG TARBOX 137 OLD WESTFORD RD 0 Expiration CHELMSFORD,MA 01824 Undersecretary Commissioner 09/0912016 002203302 EPA RRP Certified Renovator OSHATmininW gnawo Test 3 U S.Nparlment oatA" 0,,,4,f,0"aj Sa!ey and Hearth AdMOIN(8111M Craig Tem. I iaAox 137 Old Westford Rd- has IC4,0 OCCUpalCM1 Safety and Health has S'CzeswtOf 0-ver. ChehnsftA MA 01924 Trmning Govm-e in Constuction Safety&Health E*tm:3MO15 Ii-I-18692-10-01116 (Dale) a 6Q3 74¢5775 e (T(wne,l oLead4du 23 NuW Rd MW".NH This is to coMfy that Craig Tarbox has received the ovescrilped training reqtfired and is quAlliffled to operate the 1TW Rmnset'Red Head Powder Actuated traces fisted Wow. I I 10 e Tarbox t 0 rb that 'b -9 7W t -red 4 W Head d tooll 0()62 (370444 SA27() COBRA R A Racket Date issued-. 6/28/2007 Date of birth.. WWI 966 Lie.No.00628070444 Tooll, VIPER,D60,D45A,Auto/ SA270,COBRA '6 1721,M70,MD380,L1600,HD22,RS22,Rocket r r 0 He flanmd ftd NeW