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HomeMy WebLinkAboutBuilding Permit #632-2017 - 790 DALE STREET 12/12/2016r O`�te° 6y BUILDING PERMIT �� b,:: 16 o� TOWN OF NORTH ANDOVER _��-- APPLICATION FOR PLAN EXAMINATIO b Permit NO: Z- Date Received I J TYPE OF IMPROVEMENT ❑ New Building F-1 Addition Alteration 'Repair, replacement ❑ Demolition PROPOSED USE Residential i(One family ❑ Two or more family No. of units: ❑ Assessory Bldg _ ❑ Other Rffy)yrncCnS to k► ichor ar-9 Ov i na R ocan Non- Residential Industrial L Commercial Others: Identification Please Type or Print Clearly) OWNER: Name: Carl [-,),I QVY-1rrtL Phone: cRB-85-�-:S 199 R It Ire, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 81 FEE: $ 91 �, - Check No.: ,6 0-2 Receipt No.: 11 .37�-_ NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Location P^e No. 4�;7— —06119. Date 17— IZ—ZWX5� TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check # Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ rf'YTJ 'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Mas sageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature. CONSERVATION Reviewed on Signature COMMENTS HEALTH �y COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comm !Nater & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no -)imension 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.1requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.sloo-sl000 fine Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40 TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording must be submitted with the building application ` Doe: Building Permit Revised 2014 7 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 81 �005.00 m $ - $ 972.06 Plumbing Fee $ 121.51 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 121.51 Total fees collected $ 1,315.08 790 Dale Street 632-2017 on 12/12/2016 kitchen and LR remodel z m O Z < 00-0 "o a) x 0 O � < m N y O r CDo m 0 n 03 rn O o= - N Z -n0 N o' O' O O r► C 0 Fn',. -- (D ., CD CD 0 U) O —i N MD 0 m D to CL C .� = CD CD CD W 0 d onto 0, = y to Z v, CD c C D m vi U) 0� C CL Q 911 <CD 7 CL CDN C � .� C < �- CD N W � CD C;D M rr N at CD C - O y 0 J (= " it cD rt pl< 7 S '� CL s a� 3 (D r+' .O-' O v. -f7 m O .c =r 7 v O rD rD O c 'O 7 v C � S 3 7 O 3 C :3 C -O r*. N rD 3 O n N 3 O cn Z 0 o N o •� ;z Q �• Z 0 2) IW O D to •� O o vM CD 0 CL :3cr �. c a C CD OCD rS W CD �. Z 'v CL = CD k CO CD ;"Z* — v A 0 z CD 0 0 � O CD cD z m O Z < 00-0 "o a) x 0 O � < m N y O r CDo m 0 n 03 rn O o= - N Z -n0 N o' O' O O r► C 0 Fn',. -- (D ., CD CD 0 U) O —i N MD 0 m D to CL C .� = CD CD CD W 0 d onto 0, = y to Z v, CD c C D m vi U) 0� C CL Q 911 <CD 7 CL CDN C � .� C < �- CD N W � CD C;D M rr N at CD C - O y 0 J (= " it cD rt pl< 7 S '� CL s a� 3 (D r+' .O-' O W (D -f7 m O .c =r 7 v O rD rD O c m 7 v O w 3 O m S 3 7 O 3 C :3 C -O r*. N rD 3 O n N 3 O Z N O Z 0 Z A r m 0 �I Costello Construction & Remodeling, Inc. 185 John Wise Ave. Essex, MA 01929 Phone (978) 768-7015 Fax (978) 768-7459 www.costelloconstruction.us Sent via email cwi hag_rdtg emini tp com July 27, 2016 Estimate C16-0714 This Agreement (hereinafter referred to as "Agreement") made by and between Costello Construction & Remodeling, Inc., CSL License #CS86882 and HIC #145642 hereinafter called "Contractor", and Carl Wighardt, of 790 Dale Street, North Andover, MA 01845 hereinafter called "Owner". Job Location: 790 Dale Street, North Andover, MA 01845 (hereinafter referred to as the "Premises") Section 1. Scope of the Work. Renovations General Conditions $1,740.00 1 dumpster and portable toilet, zip wall Framing $8,900.00 Install 2 flush beams, temp walls, sleepers framed for new floor height. Demo/Disposal $2,200.00 Electrical $4,880.00 Removing existing ceiling heaters, install 11 new ceiling can lights and switches in kitchen and den and living room. Electrical fixtures $500.00 Plumbing $4,920.00 Plumbing for new kitchen sink and faucet install. Raised baseboard heat in living room. Existing plumbing stack to be inspected upon opening wall. Plumbing fixture allotment $1,000.00 Sink, faucet Insulation $1,500.00 Fiberglass in ceiling in living room and wall in garage between garage and mudroom. Costello 1 of 7 11 Blueboard/Plaster $3,810.00 Living room ceiling, kitchen and mudroom. Cabinetry Allotment $25,000.00 Builder will work with homeowner to design kitchen on 3d CAD design software. Counter Allotment $8,000.00 Cabinet hardware $1,500.00 Kitchen Wood Flooring $3,920.00 3 '/a" oak kitchen, living room and hallway Interior Trim $2,950.00 Living room, kitchen and hallway Interior Painting $3,300.00 Living room, kitchen and hallway Appliance. cost to be determined based on homeowner selections. Clean up $500.00 Garage Entry Door $1,800.00 Install fire rated garage entry door to mud room includes hardware and install. Subtotal $76,420.00 Profit/Overhead 6% $4,585.20 Total $81,005.20 Permits/Fees cost to be determined based on total job cost. Usually $12 per $1,000. If possible, cabinet order should be placed in August so they are in when we are ready to install. Anticipated number of weeks for construction is 10 weeks from date of issuance of building permit. Anticipated date of commencement January 2017. Section 2. Contract Documents. The Contract Documents consist of the following documents which are hereby incorporated Costello 2 of 7 by reference into this Agreement: 1. This Agreement 2. Section 3. Exclusions. This Agreement does not include labor or materials for the following work: A. Project -Specific Exclusions: An ing unforeseeable. B. 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: Plans, engineering fees, or governmental permits and fees of any kind. Testing, 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. Labor or materials required to repair or replace any Owner -supplied materials. Repair of concealed underground utilities not located on prints or physically staked out by Owner which are damaged during construction. Final construction cleaning (Contractor will leave site in "broom swept" condition). Landscaping and irrigation work of any kind. Temporary sanitation, power, or fencing. 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. Failure of surrounding part of existing structure, despite Contractor's good faith efforts to minimize damage, such as plaster or drywall cracking and popped nails in adjacent rooms or blockage of pipes or plumbing fixtures caused by loosened rust within pipes. Public or private utility connection fees. Cost of correcting errors and omissions by the owner's design professionals and separate contractors. Cost of correcting/testing/remediating mold/fungus/mildew and organic pathogens. C. If your Fire Department requires an upgrade of whole house smoke alarms, price to be provided. D. If you City Building Inspector requires Stretch Code Compliance, Stretch Code price to be provided for said requirements. Section 4. Date of Work Commencement and Substantial Completion. Commence Work: Approximately January 2016. Construction Time through Substantial Completion: Approximately 10 weeks from commencement of work, not including delays and adjustments for delays caused by: holidays; inclement weather; permits, shortage of material; delays caused by Owner, Owner's design professionals, agents, and separate contractors; and other delays unavoidable or beyond the control of the Contractor. Section 5. Job Cost/Change Orders. Change Orders directly affect the estimated cost of this Agreement. A Change Order is anything that is not described in this Agreement with an estimated cost. Change Orders also extend the time for completion. Payment for the work outlined in the Change Order is due upon completion of the items outlined in the Change Order. Owner agrees to pay a 6% Profit and Overhead fee on total job costs and any Change Order Amounts and Add Alternate Amounts. A $150 administration fee will also be charged for each Change Order and Add Alternate Amounts. All Change Orders must be in Costello 3 of 7 writing and signed by Owner and Contractor. Change Orders will include cost and any time effects where possible. Section 6. Deposits/Progress Payments. A deposit of $5,000.00 is due upon signing this Agreement. Upon receipt of deposit and signed Agreement, Contractor will start building permit application process and job will be placed on Contractors schedule, pending issuance of obtaining Building Permit. Progress Payments will be billed weekly or bi-weekly based on progress and deposits needed for subcontracting and ordering of materials and are due within seven (7) days from receipt of invoice. Section 7. Cost of Time Spent Picking 0 Materials and Mobilizing Job Time spent by Contractor and his subcontractors at lumberyards and material supply houses (including travel time to and from) to pick up materials, and time required to move tools and equipment onto the job site at the start of the project and away from the site at the end of the project, is part of the Cost of Work. Section 8.Subcontract Costs. Payments made to Subcontractors to properly advance the project work is part of the Cost of Work for the project. Section 9. Cost of Materials Incorporated into the Project. The cost of materials and equipment (and applicable sales tax, freight, or delivery charges) incorporated into the completed project is part of the Cost of the Work for the project. Contractor to supply all materials. Section 10. Owner Coordination with Contractor. Owner agrees to promptly furnish Contractor with all details and decisions about unspecified construction finishes, and to consent to or deny changes in the Scope of Work that may arise so as not to delay the progress of the Work. The cost of any delays in furnishing design decisions after construction has commenced will increase the contract amount consistent with any additional costs incurred by Contractor. Delays in furnishing design decisions after construction has commenced will also increase the contract time for completion. Owner agrees to furnish Contractor with continual access to the job site. Owner agrees that Contractor is hired to general contract the whole project, including but not limited to supplying owner selected materials and hiring Contractors own subcontractors. Owner's material allotment amounts are shown on this Agreement. Contractor will provide Owner with timeline for material selections. Once Owner makes material selections, Contractor will provide pricing for said selections. Contractor will get Owner approval prior to ordering any allotment items. Owner will only be charged the amount of the allotment that they have used based on their selections. Section 11. Contractor not to be relied Upon as Architect or Engineer. Contractor is not an architect or engineer. Contractor is not being hired to perform any of these services. To the extent that Contractor makes any suggestions in these areas, Owner Costello 4 of 7 acknowledges and agrees that Contractor's suggestions are merely options that Owner may want to review with the appropriate engineer or architect professional for consideration. Contractor's suggestions are not a substitute for professional engineering or architectural services, and are not to be relied on as such by Owner. Contractor is not responsible for the cost of correcting errors and omissions by Owner's design professionals and separate Contractors. Section 12. Warranty. Thank you for choosing our company to perform this work for you. Your satisfaction with our work is a high priority for us, however, not all possible complaints are covered by our 1 year warranty. Contractor does provide a limited warranty against material defects on all Contractor- and Contractors' subcontractor -supplied labor and materials used in this project for a period of one year following Substantial Completion of all work. This warranty covers normal usage only. You must contact the Contractor at the address on page one of this Agreement in writing for warranty service immediately upon discovering an item in need of warranty service. If the matter is urgent, you must also call the Contractor and send written notice of the need for warranty service. Failure to notify the Contractor of the need for warranty service within seven (7) days of discovery of a warranty item may void this warranty. Additionally, Owner's hiring of others or direct actions by Owner or Owner's separate Contractors to repair a warranty item are not covered by this warranty and will not be reimbursed by Contractor. No warranty is provided by Contractor on any materials furnished by the Owner for installation. No warranty is provided on any existing materials that are moved and/or reinstalled by the Contractor within the dwelling or the property (including any warranty that existing/used materials will not be damaged during the removal and reinstallation process). One year after Substantial Completion of the project, the Owner's sole remedy (for materials and labor) on all materials that are covered by a manufacturer's warranty is strictly with the manufacturer, not with the Contractor. Repair of the following items and related damages of every kind are specifically excluded from Contractor's warranty: problems caused by lack of Owner maintenance; problems caused by Owner abuse, Owner misuse, vandalism, Owner modification, or alteration; and ordinary wear and tear. Damages resulting from water, mold, fungus, and other organic pathogens are excluded from this warranty unless caused by the sole and active negligence of Contractor as a direct result of a construction defect which caused sudden and significant amounts of water infiltration into a part of the structure. Deviations that arise such as the minor cracking of concrete, stucco, and plaster; minor stress fractures in drywall due to the curing of lumber; warping and deflection of wood; shrinking/cracking of grouts and caulking; dry basement, wet basement, fading of paints and finishes exposed to sunlight are all typical (not material) defects in construction and are strictly excluded from Contractor's warranty. THE EXPRESS WARRANTIES CONTAINED HEREIN ARE IN LIEU OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED, INCLUDING ANY WARRANTIES OF Costello 5 of 7 MERCHANTABILITY, HABITABILITY, OR FITNESS FOR A PARTICULAR USE OR PURPOSE. THIS LIMITED WARRANTY EXCLUDES CONSEQUENTIAL, INCIDENTAL, AND SPECIAL DAMAGES AND LIMITS THE DURATION OF IMPLIED WARRANTIES TO THE FULLEST EXTENT PERMISSIBLE UNDER STATE AND FEDERAL LAW. SOME STATES RESTRICT LIMITATIONS ON VARIOUS WARRANTIES AND SO A CONSUMER'S RIGHTS UNDER THIS WARRANTY MAY VARY. THIS LIMITED WARRANTY MAY NOT BE VERBALLY MODIFIED BY ANY PERSON. THIS LIMITED WARRANTY IS GOVERNED BY THE LAWS OF THE STATE WHERE THE WORK WAS PERFORMED. Section 13. General Provisions. 1. All work shall be completed in a workmanship like manner. 2. Contractor may at his discretion engage subcontractors to perform work hereunder, provided Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this Agreement. 3. Contractor warrants that any subcontractors shall be adequately insured. 4. Contractor agrees to remove all debris related to the work conducted under this. 5. Agreement and leave the premises in broom clean condition. 6. In the event Owner shall fail to pay any payment disbursement due hereunder, Contractor and any subcontractors may cease work without breach pending payment by Owner to Contractor or resolution of any dispute between both parties. 7. The parties shall endeavor to resolve their disputes by mediation which, unless the parties mutually agree otherwise, shall be administered by the American Arbitration Association in accordance with their Construction Industry Mediation Procedures in effect on the date of the Agreement. A request for mediation shall be made in writing, delivered to the other party to this Agreement, and filed with the person or entity administering the mediation. 8. Interest will accrue on unpaid balances 30 days overdue at a rate of 1 '/2% monthly 18% annually or the maximum allowed under Massachusetts law. 9. Contractor shall not be liable for any delay due to circumstances beyond his control including but not limited to, weather conditions, inability to obtain permits, casualty or general unavailability of materials. 10. Owner agrees to allow Contractor to put a 2' x 3' business sign on the premises while the work is being performed. Owner agrees to allow Contractor to use photos of the work done for advertising. 11. Contractor is MA licensed, is a registered Home Improvement Contractor and is insured. 12. Contractor agrees to submit the building permit application to the local building department for the work to be performed. If zoning, fire department, board of health, variance, conservation, engineering or some other special permit is required, Owner agrees to obtain or pay Contractor to obtain. 13. Owner acknowledges and accepts the relationship of trust implicit in this Agreement. Owner agrees to give Contractor full authority to complete the work according to the Contract Documents referred to in this Agreement. Contractor agrees to furnish competent construction management and administration and to adequately supervise the work in progress. Costello 6 of 7 14. The Contractor has allowed time in this Contract for weekly meetings (meetings, emails, and conference calls) (approximately 2 hours per week) with Owner and/or Architect regarding the specifics of the scope of work included in this Agreement, including scheduling of the work and subcontractors, construction techniques, and minor variations to the scope of work. Said 2 hours per week meetings are no additional costs to the Owner. Time that extends beyond the allotted 2 hours a week will be billed at $75.00 per hour. Section 14. Entire Agreement, Severability, and Modification. This Agreement represents and contains the entire agreement between the parties. Prior discussions or verbal representations by the parties that are not contained in this Agreement are not a part of this Agreement. I have read and understood, and I agree to, all of the terms and conditions in the Agreement above. Signed this day of OCO& 2016. Costello Construction & Remodeling, Inc. By Owner: Costello 7 of 7 _.—_-132,'–...------------ - --- I i i t I f cs 80oo.a crCD i I .. i CD i 1 � i _.—_-132,'–...------------ - --- I i cs 80oo.a crCD i ! .. CD s� oc ug i r:h (h i t N >r �� - pcorA y�� l(b ? I ' ~ IBJ .zs (J r^3S O A W >Iw (n n .S SOD j w O r) i I I ! ! w f co - 'i w O t W I Q p _.—_-132,'–...------------ - --- I O Al O rJ i cs N A ! .. oc ug i W (h i t N i PSD .zs (J A A W >Iw (n 0 41 N O Al O rJ i cs N A ! .. oc ug i OD o -y i t N i .zs ! (n 0 41 w w w O t W I p � i s j v/£d a O N a a8 t+ -me M a 5 a. W REP3/4 as ££LZ MT as J ! oc ug i �;o« - .zs p � The Commonwealth of Massachusetts Department of IndustrialAccidents ' Office of Investigations ' I Congress Street, Suite 100 ? Boston, MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlican f Information Please Print Legibly Name (Business/Organization5ndividual): CMt�I In CQO-4n 2c.bm tizt�rnr�lPlsna y �X', Address:,185 T-Qbo PNer 6 City/State/Zip: X,tja Q)Claq Phone #: 8 - o1 Are you an employer? Check the appropriate box: Type of project (required): 1, 01 am a employer with a 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees (full and/or part-time),* 2. ❑ 1 am a sole proprietor or parmer- have hired the sub -contractors listed on the attached sheet, 7. [Remodeling ship and have no employees These sub -contractors have g, ❑ Demolition workingfor me in an capacity, Y Pa tY• employees and have workers' 9, [� Building addition [No workers' comp• insurance required.] comp. insurance. = 5. E] We are a corporation and its 10.0 Electrical repairs or additions 3. [3 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13,❑ Other employees. [No workers' comp. insurance required.] *Arry 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 affidavit indicating such, tContractors that check this box must attached art 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 ani an employer that Isproviding workers' compensation Insurance for my employees. Below is the policy and job site Information. Insurance Company Name:�arSt �fG1(iC,e Cp'Y1(�( Policy# or Self -ins. Lic. #: k, y a(' DM Expiration Date: 05/aWaL51,4 Job Site Address. -490 ►e City/State/Zip:NX-rth j'YJCUPx,t1A ©i$'}'S 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. 7 do hereby certYunerthe pains andpenaltles of perjury that the Information provided abovve is true and correct. Sip-nature:i/-� Date: 1I1°2 9� Off etal use only. Do not write In this area, to be completed by city or town ofJlcial. City or Town: Permit/License # Issuing Authority (circle one): !. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: page 3 of 4 rACTrAW AA TDA RA1DC7 ACOROm CERTIFICATE OF LIABILITY INSURANCE � DATE IMM/2 11 / 23/2016 Y) 016 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 have ADDITIONAL INSURED provisions or 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 Mason & Mason Insurance Agency, Inc. 458 South Ave. Whitman MA 02382 CONTACT NAME: PHONE FAX (ANC, No, Ext): (781) 447-5531 lac Ne),(781) 447-7230 E-MAIL ADDRESS; L. cert//�� ificatesmasonandmasoninsurance.com INSURERS AFFORDING COVERAGE NAIC # 05/19/2016 INSURER A: Main Street America Assurance 29939 EACH OCCURRENCE $ 1,000,000 INSURED INSURERB:Star Insurance Company 18023 INSURERC: Costello Construction & Remodeling, Inc. D: 185 John Wise AvenueINSURER Essex, MA 01929 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER- REVISION NtIMRFR- 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 TYPE OF INSURANCE ADDL IN D SUBR POLICY NUMBER POLICY EFF I POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR MPP0308V 05/19/2016 05/19/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500 ��� PREMISES Ea occurrence $ MED EXP An one person)$ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F7 %gf r] LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOSONLY AUTOS SSWNEp AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PR DAMAGE $ $ A X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE CUT9382P 05/19/2016 05/19/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ DED I X I RETENTION$ 10,000 aggregate $ 2,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A C08432OZOO 05/20/2016 05/20/2017 X STATUTE EERH E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 500 000 E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Town of North Andover 120 Main Street North Andover, MA 01845 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ! Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construcf;on supervisor License: CS -M6882 aJSgT^1;S O o SEAN A COSTE V 7 89 JOHN WISE An I:= # 3 ESSEX MA 0192$ v -r Expiration Commissioner 07/16!20117 i i qCficeadstu atATfa�.ft l;i�(slrrcssit'c Fi Nti+ •it4+t'M MMONT CIDxvrw�c rz R gl'str�tlt�rt, d�64� Type% E'Xip tditrt: C�047 Private Gcipora t✓ I=LLO dON �. INE. SARI CQSl ELL tosio,ki�I YAI#SEE A: _ < ESSEX, MSR 01529 Undgrs@cretary 12/12/2016 20161212 090725.jpg https://maiI.google.com/maiI/Mnbox/l58f363ble5a3314?projector=I 1 /1