HomeMy WebLinkAboutBuilding Permit #1102-15 - 890 JOHNSON STREET 6/25/2015 �.
BUILDING PERMIT OFttLED NORTH 6�'t'p
TOWN OF NORTH ANDOVER �� 5 ``- '°
O A
APPLICATION FOR PLAN EXAMINATION
Permit No#: I Date Received
�— 1SSACHUSfc
Date Issued: �-� 1 1
IMPORTANT:Applicant must complete all items on this page
LOCATION 990 'JO 114-1Sd ti
Print
PROPERTY OWNER &t;°fl/ +7 ���/�
Print 100 Year Structure yes Cno
MAP 107 PARCEL: 00 �Z ZONING DISTRICT: Historic District yes
Machine Shop Village yes
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
Septic n Well ❑ Floodpla.in ❑Wetlands 0 Watershed=District
D Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: gf �4/s A/?ole Phone:
Address: '9D To F1.0e&I S� /yo�7"�/ -✓ dr/��Z
Contractor Name:
<r7 'R Gam ` Phone: �/�'8/S - 7876
Email: itif
Address: l f�
Supervisor's Construction License: Exp. Date:
(r
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: LQ g— �� %� S// e Ze0 f, 0' WA-' Reg. No. 776
FEE SCHEDULE.BULDING PERMIT.f$,12�.00,PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �1.� -- FEE: $ b'55-n
Check No.: Receipt No.: 21
NOTE: Persons contracting with unregistered ontrac" n h acce to the guaranty fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dempster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m 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
P
Planning Board Decision: Comments
a
Conservation Decision: Comments
Water& Sewer Connection/signature& Date Driveway Permit
]DPW Town Engineer: Signature:
84
F�I_REDEPAR+TMEN;T T,emp�Dumpster on.,sitp ►yeses_ fno¢
Located Osgood Street
LocatedLat424t_MainfSt�ee't _-
'Fi,r`eaDepar�tment signature/date° _
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.$10041000 fine
NOTES and DATA— (For department use)
® Notified for pickup Call Email
Date Time Contact Name
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
4� 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
OTE: 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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
i
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
Doe:Building Permit Revised 2014
Location ��V J 1� 1.150�C✓���
No. Date
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
r
Other Permit Fee $
TOTAL $
Check 4t J �`
`� Building Inspector
LAWRENCE H. OGDEN,P.E.
198 EAST MAIN STREET
GEORGETOWN,MA 01833
978-352-8318 fax 978 352-2858
cell: 978-502-5921.
July 17,2015
Mr. Scott Lemay
Scott Lemay Contracting
RE: Welch Residence 890 Johnson St.North Andover
Dear Mr.Lemay
As you requested I conducted a site visit 7/17/15 to review the installation of the
Engineered Materials consisting of LVLs,beams utilized in the framing of the above
project.. The Lvls are shown on SK-1 prepared by me,dated 3/28/15, certified 6/21/15
and revised 7/5/15.
Based on the above site visit and based on what I could visibly see. I can certify
that to the best of my knowledge the LVLs members and details utilized in the framing
as shown on the drawings are installed properly and meet the loading conditions of the
8th Edition of the Massachusetts State Building Code for 1&2 Family Residences,
provided the following work is performed.
All other framing requirements of the drawings and code,including but not
limited to materials,nailing schedules,blocking,connections,manufacturers installation
requirements and other details are the responsibility of the licensed construction.
supervisor responsible for the project.
Should you have any questions please do not hesitate to call.
Yours truly,
14-"
Lawrence H. Ogden P.E. Structural 27765 tN of
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Enter construction cost for fee cal- North Andover Fee Calculation
Construction Cost
$ 543450.00 m
$ - $ 653.40
Plumbing Fee $ 81.68
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 81.68
Total fees collected $ 916.75
890 Johnson Street
1102-15 on 6/25/2015
Reno Bath Removal Load Bearing Wall
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BOARD OF HEALTH
Food/Kitchen
PER T L D Septic System
W.
THIS CERTIFIES THAT ............ .......... .. ...... ............ ... .
�,l ek BUILDING INSPECTOR
Foundation
has permission to erect .......................... buildin son ...��.. w�. .A.....................
�il I L Q,N Rough
to be occupied as ... ....................................................jAC.(A...........�.. ....... ............... .. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the app�ation Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,kiteration and
Construction of Buildings in the Town of North Andover. tow 6 wis PLUMBING INSPECTOR
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU9Tj2k SS Rough
Service
.......... ...... �T%00�...................... .................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildink 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.
r
Page: 1
Scott LeMay Contracting Estimate
11 Allen Rd.
Windham NH. 03087 Number: E101
978-815-7876
Date: May 26,2015
Bill To:
Chris & Kelly Welch
890 Johnson St.
North Andover, Ma.
Project
Remodel
Description Amount
Scott LeMaY g Contractin proposes the following.
lst. floor bathroom:
Demo entire bathroom to the studs.
Install Panasonic fan only on a new switch and vent outside.
Install (2) 4" LED recessed cans and switching.
Install new vanity light and switching.
Relocate dryer plug.
Wire and install (2) LED undercabinet lights.
Relocate dryer exhaust.
Relocate plumbing for washer machine inside one of the cabinets.
Reframe closet inoder to accomodate hidden washer/ dryer configuration.
Insulate exterior wall if needed.
Blue board and plaster bathroom.
Prep. floor for tile install.
Paint walls 1 color and 1 color ceiling. (owner to choose colors)
Page: 2
Scott LeMay Contracting Estimate
11 Allen Rd.
Windham NH. 03087 Number: E101
978-815-7876
Date: May 26, 2015
Bill To:
Chris & Kelly Welch
890 Johnson St.
North Andover, Ma.
Project
Remodel
Description Amount
Install Beadboard on walls with 1" chair rail.
Install tile on floor, per owner stock list. (owner to supply tile and
grout)
Install new toilet and pedestal sink with new faucet. (owner to supply)
Install custom made byfold style doors to hide washer dryer.
Install granite top. ( allowance $1050 owner to choose color)
Install (3) cabinets above granite top. (2) full lenght cabinets and (1)
shorter lenght, with a decorative crown molding. (allowance $2200)
Install hamper system. TBD
Install new trim.
Living room load bearing wall.
Remove approximately 11' 3" of wall to install (2) 1 3/4" LVLs.
Inorder to accomplish this task, sections of both the living room and
dining room ceilings will need to be removed and then patched back in.
New crown molding will be installed in the dining room.
Entire ceiling will be painted in the dining room.
(2) sections of the living room will be repainted.
Page: 3
Scott LeMay Contracting691ftL Estimate
11 Allen Rd.
Windham NH. 03087 Number: E101
978-815-7876
Date: May 26, 2015
Bill To:
Chris & Kelly Welch
890 Johnson St.
North Andover, Ma.
Project
Remodel
Description Amount
The proper framing and supports will be installed, if needed, per
Structural Engineers recommondations. (drawings to be paid for by
owners)
Kitchen:
Entire floor tile will be removed inorder to prep floor correctly for
the new tile install.
New the will be installed, per owners stock list. (tile and grout to be
supplied by owner)
Relocate disposal switch.
Install (4) new LED under cabinet lights on a new switch.
Install new 3-way switch for kitchen cans and combine all cans together.
Rework counter top outlets for tilw backsplash.
Add 3-way switch for sitting area cans.
Install tile backsplash, per owners stock list. ( owner to supply tile
and grout)
Finish off backside of sitting area and paint. TBD on style of finish
work.
Install new Cabico Pantry cabinet. (allowance $3200)
' Page: 4
Scott LeMay ContractingM99ftL Estimate
11 Allen Rd.
Windham NH. 03087 Number: E101
978-815-7876
Date: May 26,2015
Bill To:
Chris & Kelly Welch
890 Johnson St.
North Andover, Ma.
Project
Remodel
Description Amount
Mudroom:
Remove and cap a section of baseboard heat.
Demo entire mudroom to the studs.
Install (2) new slider windows approximately 5' wide by 4' tall.
Windows will be vinyl, new construction windows.
Exterior walls will be insulated, if needed.
Concrete floor will be leveled, as best as possible.
Mudroom will be Blueboardered and Plastered.
(2) LED recessed lights will be installed.
New exterior light wil be installed. (owner to supply)
(2) new 15 light Therma-True doors will be installed. (owner to choose
color)
1 color for trim and doors, 1 color for walls and 1 color for ceiling.
(owner to choose colors)
Exrterior trim may need to be trimmed inorder to install new door,
Beadboard or molding design will be installed. TBD
Page: 5
Scott LeMay Contracting Estimate
11 Allen Rd.
Windham NH. 03087 Number: E101
978-815-7876
Date: May 26, 2015
Bill To:
Chris & Kelly Welch
890 Johnson St.
North Andover, Ma.
Project
Remodel
Description Amount
Floor tile to be installed per owners stock list. (owner to supply tile
and grout)
A new 200 Amp service will be installed to handle all the electrical
upgrades.
All work in occordance with the Ma. Building Code, in a workmans like 55,300.00
fashion for the total sum of.
Minus Ditra Matting (750.00)
Minus wiring for Ditra Matting (150.00)
Minus the labor to install matting. (100.00)
Revisions to extisting quote:
When living room wall is removed, floor will be patched in, as best as
possible, with a close matching floor material.
Living room opening will be finish framed to match sunroom opening, as
best as possible.
Breakfast bar will be finished off with moulding and toe-kick moulding
on lower base cabinets.
Mudroom windows will be removed and opening will be windened on 1 side
and opened up on the other. If possible.
Opening will then be finished off with decorative mouldings.
Scott LeMay Contracting
5t1111c`�te%
11 Allen Rd.
Windham NH. 03087 Number: E101
978-815-7876
Date: May 26,2015
Bill To: _
Chris & Kelly Welch
890 Johnson St.
North Andover, Ma.
Project
Remodel
Description Amount
Mudroom/diningroom window will be removed and patched in on dining room 150.00
side. 1 wall to be painted. Scott LeMay Contracting will not charge any
labor cost, but will charge for patch band paint materials only.
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Quote includes all materials and labor stated.
Quote does not include any unforseens,such as water or insect damage. j
Quote does not include the cost of the permit. I
Any changes,to said agreement,will be agreed and signed upon by both parties
Work to be completed,from start date to completioon in an 8 week span,unless there are change orders,additional request from Building
Officials or homeowners.
Total $54,450.00
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The Commonwealth of Massachusetts
{ Department of Industrial Accidents
M r I Congress Sheet,Suite 100
_ Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERNHTTING AUTHORITY. Please Print Le 'bl
A Wicant Information C�/�
4411 Name(Business/Organization/lndividual): t
Address: l � Q
City/State/Zip: 1,dJND¢� Phone#: Mr.S`�7_ 7�
Are you an employer?Check the appropriate box:
Type of project(vequired):
em to ees Rill and/or part-time).* 7. [:1NeVd6nstru0tlon
I.Q I am a employer with P y
20. 1 am a sole proprietor or partnership and have no employees Working for me in 8. E]Remodeling
any capacity.[No workers'comp.insurance required.] 9, ❑Demolition
3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 0 Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions
ensure that all contractors either have workers'compensation insurance or are sole
proprietors with no employees. 12.E]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•,E]Ro6f repairs
These sub-contractors have employees and have workers'comp.insurance.$ 14.0 Other
6,❑We are a corporation and its,officers have exercised their right of exemption per MGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
i 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. .te
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job sa
information.
Insurance Company Name:
Expiration Date:.
Policy#or Self-ins.Lic.#:
City/State/Zip:
Job Site Address:
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.
I v hereby cer' under tliepains nd penalties of peijuay tlaat the information provided above is true and correct.
Date:
Si ature:
Phone#: �/,5-
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): i
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Phone#:
Contact Person:
I
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 em
• g g p 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 b6 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(1)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.an e. Lum' 'te
dLiability 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'
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 te
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 wwwmass.gov/dia
VHIS
5 11:03 FAX 100001
LEMASC1 OP ID: LG
CERTIFICATE OF LIABILITY INSURANCE DATE(M 1201506/25/2015FICATE 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
NAME: Linda Gallant
Gallant Insurance Inc PHONE FAX
1364 Route 3A AIc No Ext): 603-224-0993 AIC,No): 603-224-7710
Bow, NH 03304 AooREss: linda@gailant-insurance.com
Linda T Gallant
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:MMG Insurance 15997
INSURED Scott Lemay INSURERS:
11 Allen Road
Windham, NH 03087 INSURERC:
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.
NSR TYPE OF INSURANCE POLICY FF POLICY EXP LIMITS
LTR INSD WVD POLICYNUMBER MMIDD MMIDD
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
DAMAGE TO
CLAIMS-MADE FxIREMI
PREMIOCCUR SC12108044 09/08/2014 09/08/2015 RENTED25'50,000
SES Ea occurrence) $
MED EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00
X POLICY 1 JE� F—]LOCPRODUCTS-COMP/OPAGG $ 2,000,00
OTHER:
AUTOMOBILE LIABILITY CEa accident OMBINED SINGLE LIMIT $ 500,000
A ANY AUTO KA12108044 03/12/2015 09/08/2015 BODILY INJURY(Per person) $
ALL OWNEDX SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB HCLAIMS-MADE AGGREGATE $
DE I I RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE I ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? ❑ N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
PROPERTY 5,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
Carpentry(No Rooding)
CERTIFICATE HOLDER CANCELLATION
NORTHAN-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
North Andover
Building Department
AUTHORIZED REPRESENTATIVE
Brian 12
1600 Osgood St Building 20
North Andover MA 01845 1ns �t
re)1aaR_7n1A Art117r)r()R0(11RATI(1N All rinh4c rncnraicfl
rt 1e
License or registration valid for individul use only
n.. Office of Consumer Affairs&Business Regulation before the expiration date. If found return to:
(DOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation
I registration 155556 Type' 10 Park Plaza-Suite 5170
�; Expiration 4/371017; DBA Boston,MA 02116
SCOTT LEMAY CO1Jf,RA�T1(1
�Y�f
SCOTT LEMAY
11 ALLEN ROAD - x ---
WINDHAM,NH 03087 Undersecretary Not valid without signature
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-085235
,:.� rti
SCOTT D LEMAY;-'
11 ALLEN RD
Windham NH 03887
Expiration
01/21/2017
commissioner
I