Loading...
HomeMy WebLinkAboutBuilding Permit #115-16 - 88 MABLIN AVENUE 7/28/2015 BUILDING PERMITo`N°oT 6�a TOWN OF NORTH ANDOVER �� h� '° 0 APPLICATION FOR PLAN EXAMINATION ' b'y� Permit No#: Date Received '1sQpOH\TED Pr`�g gSSACHUSE� ✓ � Date Issued: is,` IMPORTANT:Applicant must complete all items on this page LOCATION 8 8. /44456111V _ Ry_ _Z o z4w Print PROPERTY OWNER %��212/ Lj OE-0L--Q Print 106 Year Structure yes no MAP -PARCEL: ZONING DISTRICT:. Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition /Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic D Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 6 Y G Q wl�✓ wVA-11— � �3�I � / N u�/ SAI%lt Identification- Please pe or Print Clearly \ �6 OWNER: Name: (' �.�c g T�-� Phone: (99 P' )'A-75- Address: , � _k" /1 Contractor Name: Phone: _ Address: % �L N. /SGC /�,� / a dy A44- Supervisor's Construction License: / 0-3--b-e6 Exp. Date: . Home Improvement License: 7 Exp. Date: _._. G r ARCHITECT/ENGINEER Phone: r, 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: $ .7 0 FEE: $ Check No.: 1 (.,0 Receipt No.: CQ� NOTE: Persons contracting with unre5jisterpteontractors do not have access to the guaranty fun Signature of Agent/Owner Signature of contracto 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp 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 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ —T_Y_P_E OESEWMRAGE_D.1SP_O.S.AL_ Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning 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 Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes y I Planning Board Decision: Comments r. Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS _ ®ni an.sion 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) ❑ Notified for pickup Call Email Date Time Contact Name i Doc.Building Permit Revised 2014 Location No. Date a i TOWN OF NORTH ANDOVER � p1:TL1°j64 ` . Certificate of Occupancy $ Building/Frame Permit Fee $ - d-; Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector ector 29113 NORTH E Town of p - 0 No. 1195 --loN 40 Z a 4 �h , ver, Mas oZ coc"Ic«ew�ca y1. �ds RATEO ''P�,`�y U BOARD OF HEALTH Food/Kitchen PERMIT1 11 LD Septic System THIS CERTIFIES THAT R 1 "' Z O`� ...................................................... BUILDING INSPECTOR has permission to erect ........ ................. buildings on .... ..... 1 ..................................... Foundation Rough to be occupied as ... . . ...... 0...... .1lI�IC M,1.... ....!:w �� Chimney provided that the person accepting this permit shall in every respeto the terms o 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 I 6 MO HS ELECTRICAL INSPECTOR UNLESS CONSTRU ON RTS Rough 4111111F 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. TMK Remodeling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 88_Mablin_Window_R2 HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com CONTRACTOR AGREEMENT THIS AGREEMENT made this Zos — 1 20\5 by and between Theodore Kelley dba TMK Remodeling, Construction Supervisor License# 105086,214 Sutton Hill Rd, North Andover MA 01845 hereinafter called the Contractor, and Jaw%s-AAeBea�hereinafter called the Homeowner. WITNESSETH,that the Contractor and the Homeowner for the consideration named herein agree as follows: ARTICLE 1.SCOPE OF THE WORK The Contractor shall perform all of the work described in the specifications entitled Exhibit A—Statement of Work, as annexed hereto as it pertains to work to be performed on property located at 88 Mablin St North Andover MA 01845. ARTICLE 2.TIME OF COMPLETION The work to be performed under this Contract shall be commenced on or before July 13, 2015 and shall be substantially completed on or before July 17,2015 ARTICLE 3.THE CONTRACT PRICE The Homeowner shall pa the Contractor for the labor and materials to be performed and supplied under the Y P PP on C tract the estimated sum of Three Thousand Seven Hundred Forty Dollars and No Cents($3,740.00), subject to additions and deductions pursuant to authorized change orders. Contractor will furnish and install all building materials,fixtures and finish items unless noted otherwise. ARTICLE 4. PROGRESS PAYMENTS Payments of the Contract price shall be paid in the following manner from the Homeowner to the Contractor: 50% upon contract acceptance and signature;$1,870.00 50% upon completion and building inspection;$1,870.00 The contract cost for mutually agreed to change orders will be paid 50%at time of change order signature and 50% after completion and Homeowner sign-off. ARTICLE 5.GENERAL PROVISIONS 1. All work shall be completed in a workmanship like 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. Contractor shall furnish Homeowner appropriate releases or waivers of lien for all work performed or materials provided at the time the next periodic payment:shall be due. 5. All change orders shall be in writing and signed by both Homeowner and Contractor. The cost for mutually agreed to additional work, required due to unknown conditions or substantive change orders,will based on the current bill rates for the actual time used.Additional materials will be billed at contractor cost.All change orders subject to 10% markup for overhead. Copyright TMK Remodeling 2014 Initials �� All Rights Reserved Page 1 TMK Remodeling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 88_Mablin_Window_R2 HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com 6. Contractor warrants it is adequately insured for injury to its employees and others incurring loss or injury as a result of the acts of Contractor or its employees and subcontractors. 7. Contractor shall at its own expense obtain all permits necessary for the work to be performed. 8. Contractor agrees to place all debris in an on-site trash receptacle(dumpster)and leave the premises in broom clean condition. 9. In the event Homeowner shall fail to pay any periodic or installment payment due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 10.The Contractor and the Homeowner hereby mutually agree in advance that in the event that 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 Office of Consumer Affairs and Business Regulation and the Homeowner shall be required to submit to such arbitration as provided in MGL c 142A. Home owne Date: Contra or Date: Notice: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the Contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed by the parties. 11. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials,or inclement weather. 12. Contractor warrants all work for a period of 12 months following completion. 13. Contractor may post small signage(18x24")on property advertising services during the duration of the project. 14. The Contractor and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: (617)973-8700 15. The Contractor or Homeowner may terminate this contract at any time for any reason by giving 3 days notice in writing to the other party. If either party terminates the contract as provided herein,then the contractor will be paid for work(labor and materials)completed as of the date of termination plus any materials or equipment that are backordered and not delivered. Payment is defined as actual job costs for the project plus 10%overhead charge. The contractor will provide a written report detailing actual job costs plus overhead for payment. The Contractor will refund any funds paid by the Homeowner that are a remaining balance for the labor and materials used as of the date of termination,plus any materials or equipment that are backordered and not delivered, plus 10%overhead charge. The Contractor will make arrangements for the backordered items to be delivered to the Homeowner. Copyright TMK Remodeling 2014 Initials E All Rights Reserved Page 2 TMK Remodeling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 88_Mablin_Window_R2 HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com 16.The Homeowner is responsible for maintaining adequate access to the property including snow removal, personal property storage,and working doorways,stairways and walkways. In the event the contractor is required to provide access or repair to the doorways, stairways and walkways,then the Contractor will bill the Homeowner at the hourly bill rate for same. ARTICLE 6.OTHER TERMS ARTICLE 7.ACCEPTANCE Signed this \0 day of S 20 �5 Homeown CoKtractor NOTICE: The signatures of t±iesabovepply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES I Copyright TMK Remodeling 2014 Initials All Rights Reserved Page 3 Licenses: TMK Remodeling Exhibit A-Statement of Work CSL 105086 214 Sutton Hill Rd 88_Mablin_Window_R2 HIC 165887 North Andover MA 01845 RRP LR000106 978 852-4491 www.tmkremodeling.com A B C E F G 1 Owner: 2 James McDonough Estimate: 2015-028 Estimate valid for 30 days 3 iamesimcd(o)cs.com Date: 06/14/15 Expires: 07/14/15 4 88 Mablin St 5 North Andover MA 01845 6 978 973-3497 7 8 Scope of Work Remove existing 9640"bay window. Prepare rough opening and install new Harvey vinyl bay window as shown on attached specification.Trim interior and exterior to match 9 existing. 10 Notes: 11 Pricing includes labor and materials to install finished item+allowances. EA=Each 12 EA Total Cost 13 r uan os 14 1..0 Administration.: _- _ ... .._ ,.. $942 15 01 Plans and Permits:01.2 Building Permits 1 $44 $44 16 Bbilding`Permit 1 $44 $44 17 02 Site Work 3 $303 $303 18 -Adjacent spaces;to be.protected by-aemporary barriers:from:dustinfiltration: 1. $132 $132 19 All floor coverings and hand rails between the work area and primary 1.entrance to be covered with protective covering material 1 $171 $171 20 Owner responsible-for stun.g any items to�e-installed 1'. $0 $0 21 02 Site Work 02.10 Demo 1 $250 $250 22 ;Disposal of debris and scrap'mate►ials :. $2501-. $250 23 31 Overhead&Expenses_ e . P... ..._. _ 1 345 $345 24 "Overhead antl pro'ect administration 1 _ .1 $3415.., . $345 25 1st Fir Bay Window Replacement 8x5' '77 g $2,798 $2,798 26 02 Site Work 02 m 10 Deo ?_ ' 105 27 Remove existin1 b g door/window and frame 1 $105 _ $105 2813 Wind©ws&Tnmti 29 Furnish&install 9640"HarveyYinyl Bay Window,frame trim,weather stripped,flashed,painted 1$2,694_ $2,694 30 Grand Total" W 8 $3,740 $3,740 ©Copyright TMK Remodeling All Rights Reserved Page-4 Unlawful to distribute without permission The Commonwealth of Massachusetts . ' Department oflndustrialAccidents 1 Congress Street,Suite 100 -` Boston,MA.02114-2017 www.mass.gov/dia YV� Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE Fff ED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): P Address: �'/cf S�%�(1,f 14�4�f'_ /" /�"�l /l Phone City/State/Zip: j Are you an employer?Check the appropriate box: Type of project(required): 91. I am a employer with : employees(full and/or part-time).* 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in $, Remodeling ❑any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3..❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12..❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.E]Roof repairs I These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have na employees.[No workers'comp.insurance required.] 'kAny 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. tContractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that ispioviding workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: f C-- Policy#or Self-ins.Lic.#: ( / 7 C _ Expiration Date: Job Site Address: 90 A'�&-/A/ 11V/U Q 0 At k/4- City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. / Y do hereby certify u er t ie pains and penalties of e ury that the information provided above is true and correct. r Sign e: Date: _eZlJ Phone#- � Y7 "�`%/ f Official use only. Do not write in this area,to he 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 emp,oyees. 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 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 cavy 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 Depaftment of Industrial Accidents fox 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' 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 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-NUSSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 1--m"1111 OP ID;J( '4�a� CERTIFICATE OF LIABILITY INSURANCE 707128115 / 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 pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this Certificate does not confer rights to the eertlfloate holder In(leu of such endorsement(s). PRODUCER 978-975-1300 CNAME:ONTACT Seyreve&Hall Insur.Assoc.InC 978-875-7596 P" �No 305 North Main St. c°NE e Andover,MA 01810 E-MAIL AD SS: Lawrence J.Hall DODUCER TMKRE-1 GUSTO INSURERS AFFORDING COVERAGE NAIL 0 INSURED TMK R®rnodeling INSURER A!Arbella Protection Ins.Co- 41360 214 Sutton Hill Rd INsuRr_R B:AEIC 11104 North Andover,MA 01845 INSURER C: INSURER D: 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. (LTR TYPE OF INSURANCE a POLICY EFF P MILIMITS POLICY NUMBER MDDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0( A X COMMERCIAL GENERAL LIABILITY DAMAG6 TO PREMIS acRENTED encs $ 100,0( CLAIMS-MADE 71 OCCUR MED EXP(Any one person $ 5,0( 9520037133 03/08/15 03108116 PERSONAL&AOV INJURY $ 1100010(. GENE RALAGGREGATE $ 2,000,0( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,0( POLICY PRO- F7 RO LOC $ AUTOMORiLE LIAMILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Par perscn) $ ALL OWNED AUTOS BODILY INJURY(Pu®caident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS ( Peraccldent) $ NON-OWNED AUTO9 $ $ UMBRELLA LIAM OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMSWADE AGGREGATE S HDEDUCTIBLE $ RETENTION $ WORKPRS COMPENSATION I WC STATU- OTRH - AND EMPLOYERS'LIAMILITY TORY LIMI IS ANTORMARTNERI ECUTIVE Y� E.L.EACH ACCIDENT FICER/ME 7NIA $ (Mandatory in NH) 5005011872 04101116 04101118 E.L.DISEASE-EA EMPLOYEE $ 4ndescribe under RIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACORA 101,Additional Remarka aohedule,if mote apace Is requlrad) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Lawrence J. Hall ®1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety \) Board of Building Regulations and Standards Construction Super-isor License: CS-105086 THEODORE M KELLEY-- 214 SUTTON HILT,RbLI NORTH ANDO�R c �0-IS/415 Expiration Commissioner 10/08/2015 CtIL (Pd/79/JYI.Gv/Zevea4/Z - � �\ fliice of Consumer Affairs&Business Regulation w ME IMPROVEMENT CONTRACTOR gistration: 165887 Type: xi ratio P n: ':4/ 5% 2-0f6 DBA TMK REMODELING THEODORE KELLEY,.-,, 214 SUTTON HILL RD. NORTHANDOVER, MA 01845 Undersecretary - r License or registration valid for individul use only it before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation II 10 Park Plaza-Suite 5170 Boston,MA 02116 ! 'I t signature Not valid withou