HomeMy WebLinkAboutBuilding Permit #165-11 - 84 JOHNSON STREET 8/25/2010 E
BUILDING-PERMITf NORTil
o
5 tT`E�`n6r6/V
TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION '
Permit NO: *,��p e� 4
Date Received �>
Argo
Date Issued: 0 ACHU5 •
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
I � Residential Non- Residential
New Building One family
Addi ion Two or more family Industrial
ir"A No. of units: Commercial
Repair, replacement As sessory Other Bldg
Demolition Others:
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DESCRIPTION OF WORK TO BE PREFORME®;
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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: $ lrj FEE: $
Check No.: 2- Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access o
he barcanty fund
S a ne A3A. en ar ner - h P w
5.igna ur-e �t.bn,R r
Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools'
-Well Tobacco SalesQ
Food Packagin-g/.ales' "-
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED'
PLANNING DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
I.IJIVIIVIEI�I I S
HEALTH Reviewed on Signature
COMMENTS
I
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
'Conservation Decision: Comments
I
Water$ Sewer Connection/Signature&Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
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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
I
a
I
❑ Notified for pickup - Date
Doc.Building Permit Revised 2010
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
❑ 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
Li Floor/Crossection/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. g Permit I
i New Construction (Single and Two Family)
❑ Building Permit Application
❑ Ceifled Proposed Plot Plan.
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
j ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler
Hydraulic Calculations (If Applicable) Plan And
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town CIerks office must stain the decision
that the appeal period is over. The applicant must then get this recorded at the Regis of D from the Board of Appeals
must be submitted with the building application s 3' eeds. One copy and proof of recording
Doc:Building Permit Revised 2008 I
I
� - F
Location ! To Il ns do
No. � Date
MORT" TOWN OF NORTH ANDOVER
9
* : Certificate of Occupancy $
J,�MUSE< Building/Frame Permit Fee $ •
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
2 g J 6 4 Building Inspector
NORTH
0 0
Andover
No. _
o __ A K E -o over, Mass., � •?1-s l O
COCHIC...CK
7,p0RATED
7 BOARD OF HEALTH
Food/Kitchen
i
Septic System
PERMIT T D
• BUILDING INSPECTOR
THIS CERTIFIES THAT............... �..�?..
...... .. ............... �• ............................................................................. Foundation
has permission to erect.. .......... buildings on .... 7 q �I Rough
Jto be occupied as..�-e.6.Q.d.a.... 1!!!1..4..1. .........-ea.a.LF?s.,............C.�,��...fii•�l.rlQ..d!!v.2.`......�,.). .5.�� Chimney
provided that the person accepting this permit shaft m eve respect conform to tl-ie terms of the application on file in
P P P g P every P PP Final
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 CONSTRC O TARTS Rough
..................... Service
........... ..................................... ..........................
B INCr=iLVSPECTOR
Final
Occupancy Permit Required t0 Occupy Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.
1
NORT#q
i
TO'" of
No.__ _
_ A K E -o dower, Mass., g -2: ' 10
COCMICMEWICK y1.
21,95 RATED
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
Y_ 0
BUILDING INSPECTOR
THIS CERTIFIES THAT
•'••••'•••••••• Foundation
has permission to erect.. buildings on ....S .. . / aS..0A L "
................................. Rough
Chi
11 \ 1a/yvmney
to be occupied as.. . ................. .C�.�.�............(..-�J...L.,��.!�tGl..........�.-.....��..�...5..�.
provided that the person accepting this permit shall in eve respect conform to Me terms of the application on file in
P P P 9 P every P PP Final
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 CONSTR1,-
C O TARTS Rough
_ Service
........... ..................................... ..........................
B SPECTOR
Final
Occupancy Permit Required to Ocaipy Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.
Licensed&Insured
ORTHEAST . y
- -- -
Joe Brangiforte Jim Streeter
31 Mt. Vernon Street 25 Adams Rd.
Saugus, MA 01906 Dracut, MA 01826
Phone: 781.389.0595 Phone: 978 866-4652
Fax: 781.558.1736 Fax: 978 957-8009
Construction Contract
This agreement made this SP day of 2010 by and between Jeff O'Brien of 84 Johnson St.
North Andover, Ma herein referred to as"owner", and Northeast Building&Renovations,
LLC. of 31 Mt. Vernon St., Saugus,MA 01906 herein referred to as"contractor".
Owner and contractor in consideration of the mutual covenants hereinafter set forth agree
as follows:
Contractor shall furnish all labor and materials necessary to perform and complete the
work described below upon the following described property,which owner warrants he
owns free and clear of liens and encumbrances:
Job Description:
The work, which shall include all of the labor and materials necessary for the completion
thereof, shall consist of the following: Tape& drape plastic in areas to prevent dust.
Demo existing room approx. 23X22 down to framing member on walls and ceiling.
Remove carpet, demo windows, cut&cap base board heat and reinstall later. Remove
wet bar cap water lines permanently. Cut exterior wall and install AC unit supplied by
homeowner. Install 4 new Harvey vinyl windows with grids between the glass. Install
new white vinyl patio sliding door,no grids. Install blue board and plaster to wall and
ceiling areas. Install 2 '/z" Colonial, pre-primed white casing trim on interior windows
and doors. Install "Harvey Board"trim on exterior around new windows and door.
Install white prime base board 4 'h inch where needed in room. Remove brick hearth,
frame, board and plaster around fireplace and install"Newport" prebuilt mantle. New
hearth and surround to be supplied and installed by others.
Electrical: Install 6 new ICU rated, hihats and trim, wire AC wall unit and move interior
wall light to screen porch area.
Contractor shall perform the work in conformance with such plans and specifications, if
any, as have been provided by the owner or the contractor,which plans and specifications
shall be deemed incorporated into this contract by reference, and will do so in a
workmanlike manner. Contractor is not responsible for performing any work not
specifically referred to in this contract.
Owner shall pay the contractor the sum of$15,500.00 in 3 installments as follows.
($4,767.00)upon signing this contract.
($5366.50)Once rough work is complete.
($5366.50)upon completion of the remainder of the work called for under this contract.
In the event any installment is not paid when due, contractor may stop work without
breach until payment is made. In the event any installment is not paid, contractor may, in
its option deem this contract terminated by the owner and may take such action as may be
necessary, including initiating legal proceedings,to enforce its rights hereunder.
At all times during construction, owner shall provide and maintain free and unobstructed
access to all areas of the site where the work will be performed and shall provide, at
owner's sole expense,water and electrical service,including 220 amp outlet.
Contractor shall not be responsible for claims for damages to persons or property
occasioned by owner or his agents,third parties, acts of God or other causes beyond
contractor's control. Owner shall hold contractor completely harmless from, and shall
indemnify contractor for, all costs, damages, losses, and expenses, including judgments
and attorneys fees, resulting from claims arising from causes enumerated in this
paragraph.
1. All work shall be completed in a workmanlike manner and in compliance with all
building codes and other applicable laws.
2. To the extent required by law all work shall be performed by individuals duly
licensed and authorized by law to perform said work.
3. Contractor may at its 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 Contract.
4. All change orders shall be in writing and signed by both owner and Contractor.
Contractor shall be responsible to provide only the work described in this contract
and in such change orders as may form time to time be agreed to between
Contractor and Owner. All change orders shall specify in detail any additional
work called for and the price for such labor and materials as shall be necessary to
complete such additional work.
5. Contractor warrants it is adequately insured for injury to its employees and any
others incurring loss or injury as a result of the acts of Contractor or its employees
and subcontractors.
6. Contractor shall at its own expense obtain all permits necessary for the work to be
performed. Contractor shall not, however, be responsible for obtaining any
variances for other zoning relief, or for the cost thereof, as may be required to
enable the Contractor to obtain a building permit.
7. Contractor agrees to remove all debris and leave the premises in a broom clean
condition.
8. Contractor shall not be liable for any delay due to circumstances beyond its
control including strikes, casualty or general unavailability of materials or the
discovery of the conditions or defects upon the site or the structure(s)thereon not
known to the Contractor at the time of execution of this contract and which may
be discovered during the course of the Contractor's completion of the work. In
addition, the Owner acknowledges and agrees that in certain remodeling work the
demolition of portions of the pre-existing structure may reveal additional defects,
conditions or the need for additional work which must be repaired, altered, or
carried out in order to commence or complete the work called for in this contract.
In such case, the Owner agrees that the duration of the work and any scheduled
date of completion may vary from that which has may be set forth herein and
Owner agrees execute a change order detailing the cost and scope of the
additional work necessary to repair, correct, or alter such additional defects and
conditions.
9. Contractor warrants all work for a period of 12 (twelve) months following
completion.
10. Owner agrees that in the event it becomes necessary for Contractor to collect any
payments called for hereunder or to enforce any provision of this agreement,
owner shall be responsible for the costs of such collection or enforcement,
including reasonable attorney's fees.
All contractors and subcontractors, unless exempt from the requirements of G.L c.142A,
must be registered by the Administrator of Home Improvement Contract Registration,
One Ashburton Place, Room 1301, Boston, MA 02108, (617)727-8598 and that any
inquiries about a contractor or subcontractor relating to a registration should be directed
to the Administrator.
You may 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 this main office or branch by ordinary mail posted, by
telegram sent or by delivery, not later than midnight of the third business day following
the signing of this agreement.
Homeowners who secure their own permits for the work to be performed under this
agreement will be excluded from the guarantee fund provisions of G.L. chapter 142A
By entering into this contract you are giving the Contractor a lien upon your property
pursuant to G.L. Chapter 254, section 2 and other applicable provisions of law.
Signed this 6th day of August.
Contractor-
w
The Commonwealth of Massachusetts
Department o f IJ2dast.ial Accidents
Office OfFnvestigations
600 YVashineoton Street
o Boston, 1124 02111
WWWensation insurance �a 4Sseov/dig
Workers' Com
P vitt: Builders/Contractors/Electricians/Plumbers
Ao licant Information
Please Print LeQibl
Name (Business/Organization/Individ ml): n e-q S'-�
1 V� 1nr
Address: �( 1�1Dt� User rJh S�
City/State/Zip: SqA-
v Phone#:-M M
Are you an employer?Check the appropriate boa:
1 I am a employer with q, ❑ I am a Q Type of project(required):
creneral contractor and I
2.❑ employees(ftrI]and/orpart-time).* have hired the sub-contractors 6 New co
I am a sole proprietor or partner_ listed ❑ nstruction
the attached sheet t [7. Remodeling
ship and have no employees These sub-contractors have
working for me in any capacity. workers' coin g• ❑Demolition
[No workers' c P insurance. 9. Building
comp. insurance 5. ❑ We are a corporation and its b addition
required] officers have exercised their 10•❑Electrical repairs3.[] or additions
myself. [No workers'comp. ric. 152 �nptron per MGL I LE]Plumbing repairs or additions
insurance required] t ' I('`I):and we have no
employees. [No workers' 12'❑Roof repairs
C
omp.instil-ance required,] 13.❑ Other
=.ay�Iic:�t Lhat.^.h�ks box-J mut s?so � _
Flomeown nu og fhc sectio i eg'aU wort and y~ work s`comr....s�o�-Ec,
ers who submit this affidavit indite
'Contractors t- �°�c"am doing „
that ch c,this box mt:o`"`.attached au additional sheet showin ¢ �hue nutsidE cogs tor"di=,i,;submit a new am
g the davit
gage of the sub-contractors and their work= co indicating such.
I am an employer that is providing workers'compensation insurance for my a ee� Po�Y mformatron
information. mPh'Y Below is the policy and job site
Insurance Company Name: ac-g
Policy#or Self-ins.Lic.#: D J
Expiration Date: — 1 -7—
Job Site Address: 0 n g
Attach a copy of the workers' compensation policy declaration page(showing City/State/Zip: SgF1 S mg
wing the policy numb ante d
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the ' expiration date).
fine up to$1,500.00 and/or one-yeas imprisonment,as well as c" imposition of criminal
Of up to $250.00 a da a civil penalties in the form of a STOP WORT{ORDER saes of a
Y against the violator. Be advised that a co and a fine
Investigations of the DIA for insurance coverage verification. PY of statement may be forwarded to the Office of
I do hereby c under the pains and penalties o.fP iurl,er that the information provided above is true and correct
Signa oo
Phone#:
Official use only. Do not write in this area, to be completed bj,ctij,or town official
Cit37 or Town:
Permit/license#
Issuinl',Authority(circle one):
1. Board of Health Z.Building Department 3. City/Town
6. Other Clerk 4.Electrical Inspector S.PIumbi g
fib Inspector
Contact Person:
- Phone ,
i
i
Information an d Instructions
Massachusetts General Laws chapt.-r 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 t7Qe Iega1 representatives of a deceased employer, or the
receiver or trustee of an individual,partnership, association oX-other legal entity,employing employees. However the
owner of a dwellint.g house having not more than three apartnl eIlts and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintemance,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 10.4�al licensing agency shall withhold the issuance or
renewal of it license or permit to operate a business or to Construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of mimpliance 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 unl--il acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contractingauthority."
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 certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' comp enation 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 store to sign and date the affidavit. The affidavit should
be iet'viuvd t0 the vitt'4r toKrFi that the applicalon iIr the^e1nait or license Ls being requested,not F..^.e DepartWent.of
Industrial Accidents. Should you haveany euesbons regardiab the law or if you are mitred to o7min a workers'
compensation 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 permiits 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 Office of Investigations would like to than you in ach-mc_e for your cooperation and should you have any questions,
please do not hesitate to give us a call-
The
allThe Department's address,telephone and.fammumber:.._
TTie Commonwealth of Massachusetts.
T?epartment of Industrial Accidents
Office of Ittv-estibateons
600 Washing-bn Street
Bacton,MA 02111
Tel. 617-72.7-4900 ext 406 or 1-8 7 7-MASSAA,FE
Revised 5-26-05 Fax It 6.17-72.7-7749
vrww.mass..aov/dia
8/25/2010 08:38 FAX 6038835529 CORRIVEAU Ij001/001
ACO-80. CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDIYYYY)
08/25/2010
PRODUCER (603) 883-5528 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
CORRIVEAU INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
115 MAIN ST ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW.
P 0 BOX 369
NASHUA NH 03061-0369 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A:HARTFORD UNDERWRITER INS.
NORTHEAST BUILDING 6 RESTORATION, LLC INSURER B;PEERLESS INSURANCE CO.
31 MOUNT VERNON ST INSURER C;
INSURER D;
SAUGUS MA 01906— INSURER E;
COVERAGES
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,
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR a0o'L 0YEPD � 0WNATEMM101TYPE OF INSURANCE POLICY NUMBER POLICY EE(MV0YLImiTfi
A GENERAL LIABILITY CEPS635309 03/30/2010 03/30/2011 EACH OCCURRENCE $ 500,000
X COMMERCIALGENERALL.IABILITY PRE I Ea NTEDfteurraMee $ 100,000
CLAIMS MADE LK OCCUR / / / / MED EXP(Any one arson 9 5,000
PERSONAL B ADV INJURY 5 500,000
GENERAL AGGREGATE $ 11000,000
GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP APO S 11000,000
POLICY X PRT LDC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea aGdidunt) $
ALL OWNED AUTOS / / / / BODILY INJURY
SCHEDULED AUTOS (Per parson) 8
MIRED AUTOS / / / /
BODILY INJURY S
NON-OWNED AUTOS (Par accident)
PROPERTY DAMAGE
(Per adoldenl)
GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S
RANYAUTO / / / / OTHERTHAN EA ACC S
AUTO ONLY:
AGO 8
EXCESS/UMBRELLA LIABILITY / / / / EACH R S
OCCUR 7 CLAIMS MADE AGGREGATE S
S
DEDUCTIBLE
RETENTION S
S
A WORKERS COMPENSATION AND 03131133409 03/17/2010 03/17/2011 _XIT
I S
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE E L,EACH ACCIDENT $ 100,000
OFFICER/MEMSEREXCLUDED? Y MASS WC ONLY / / / / EL.DISEASE-EAEMPLOYEES x00 000
If yea,desoAbe under r
SPECIAL PROVISIONS below EL DISEASE-POLICYLtMIT g 500,000
OTHER
DESCRIPTION OF OPERATIONSILOCATION3NEMICLISIEXCLU910N8 ADDED BY 13NDORSEMENT19PECIAL PROVISIONS
CARPENTRY.
JOS EYN BRANGIFORTE AND PHILIP J. STREETSR ARID NOT INCLUDED
IN THE OpppJMg 0 COQdPEATBATION POLICY.
CERTIFICATE HOLDER CANCELLATION
— (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THB
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT.BUT
TOWN OF NO. ANDOVER BUILDING DEPT. FAILURE TO DO SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
1600 OSGOOD ST ITS AGENTS OR REPRESENTATIVES.
AUTHOR,TD REPRESENTATIVE
NO. ANDOVER MA 01845—
A
CORD 25(2001/08) ®ACORD CORPORATION 1988
IN9025(o�oe).oe Page 1 012
07-
ioarnmxoruue¢�/ o�,/ oaac�u�aek`a i
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
Registration: ;"140757
Expiration:=-�=11/20/2011 Tr# 291759
Type:-,F--lndividual='
JOE BRANGIFORTE. f
JOSEPH BRANGIFORTE__
31 MT VERNON ST.F; -7
SAUGUS, MA 01906«=:= Undersecretary
Nlussuchusetts- Depat-trnent of Public Safet,
Board of Buildin- Regulations and Standards j
Construction Supervisor License
License: CS 78145
Restricted to: 00
JOSEPH R BRANGIFORTE
31 MT. VERNON ST
SAUGUS, MA 01906
Expiration: 3/16/2012
Commissioner T r#: 18573
1