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HomeMy WebLinkAboutMiscellaneous - 66 BRENTWOOD CIRCLE 4/30/2018 (2) 66 BRENTWOOD CIRCLE 210/063.0-0035-0000.0 PO Box 55098 Boston,MA 022055098 657-951-0600 I : r Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N ANDOVER,MA 01845 N ANDOVER, MA 01845 RE: Insured: KRISTIN COSTA.and THOMAS A COSTA Property Address: 66 BRENTWOOD CIR,N ANDOVER, MA Policy Number: HMA 0214935 Claim Number: BOS00053418 Date of Loss: 3/3/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable:. If;any notice under,Mass. Gen. Laws, Chapter 139, Section 3B is appropriate,please direct itto the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Eric Gill Claim Examiner 3/11/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3321 Fax: (617) 5310-5774 I Email: EticGill@Safe.tyInsurance.com. P©Sox 55098 Boston,MA 02205-5098 617-951-0600 _ --- -- - –— - .e Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall ,City Hall N ANDOVER, MA 01845 N ANDOVER, MA 01845 RE: Insured: KRISTIN COSTA and THOMAS A COSTA Property Address: 66 BRENTWOOD CIR,N ANDOVER, MA Policy Number: HMA 0214935 Claim Number: BOS00048120 Date of Loss: 2/11/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss;damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice'under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Thomas DiMarzio Claim Examiner 2/12/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 2043 Fax: ;(617) 531-8864 Email: ThomasDiMarzio@Safetylnsurance.com Safety Insurance Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N ANDOVER MA 01845 N ANDOVER MA 01845 Re: Insured(s): KRISTIN COSTA&THOMAS A COSTA Property Address: 66 BRENTWOOD CIR, N ANDOVER MA 01845 - Policy Number: 0214935 Claim Number: BOS00018679 Date of Loss: 02-03-2011 Company: Safety Indemnity Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number. Date of loss and claim or file number. John Pergentile,Adjuster 04/26/11 Safety Insurace Company Homeowners Claims Unit P.O. Box 55098 Boston, MA 02205-5098 Phone: (800)951-21100x3439 Fax: I CC012.001 Town of North, Andover she t4ED 16 40 Office of the Planning Department 0 Community Developmentand Services Division 27 Charles Street North Andover, Massachusetts 01845 C k Tehepho.i.ie (978)688-90-351 Fax (978)688-9542 September 19, 2002 Jeff& Ellen Arsenault 66 Brentwood Circle North Andover MA 01845 Re: Property Renovations& Watershed District Dear Mr. & Mrs. Arsenault, I am in receipt of your dated September 12, 2002. Allison McKay of the Conservation Commission office and myself preformed a site walk and I have completed an extensive review of other Watershed Permit files and the original subdivision files. As a result of this research, with Allison's on-site inspection, it is my opinion that there are no wetlands within 325' of the proposed work area. Although the property at issue (referenced above) lies within the overlay area of the Watershed Protection District, the proposed improvements are over 325' of wetlands. Since your lot was created before 1994, the edge of the Watershed Protection District non-discharge zone is 325' from jurisdictional wetlands in the Watershed District. North Andover Zoning Bylaw, § 4.136(2)(f). As such,the proposed work is within the General Zone of the District and does not require a Special Permit from the Planning Board. Id. at § 4.136(3)(a). I will file this letter in your building file, but please keep a copy for when you decide to apply for a building permit. urs, chell Town Planner cc: Kathy McKenna. Town Planner Y3(-)AIZDOF,;kPPI'ALS6F8-9541 IAC LNNGY69,R-954'� IT EALFIT688-9540 PL\-NNTN(36n-qv� September 12,2002 Mr. Clay Mitchell,Town Planner Town of North Andover Planning Department 27 Charles Street North Andover, MA 0 1.845 RE: 66 Brentwood Circle We would like to submit this proposal for making various renovations to our home at 66 Brentwood Circle. We propose to add a two-car garage, a mudroom and half bath on the side of our home. We would also be adding a six-foot addition,a screened porch and a deck off of the back. These would be the only areas that would affect the footprint of the home. Attached is a copy of our proposed plans. We are aware that we are in.a watershed area. To our knowledge, we are outside of the 350' wetlands restriction set forth in the by laws for the town. We understand the concern of the town with regard to watershed areas,therefore,we will be certain to make our contractors aware of the environmental concern and insist that they perform all of the renovations in.an environmentally friendly manner. If you have any further questions, please feel free to contact us at 978-683-0564. Thank you for your attention.to this matter. ,Sincerely, f s Je d Ellen Arsenault RECEIVED SFP 1 7 2002 i OATH ANb6VER PLANNING, PF-QAATMEN-f i � ' NOTES I 1. SEE TOWN OF NORTH ANE>©VER ASSESSORS MAP #63 L03 /J35 I FOR S1-TE REFERENCE. I ' 2. UTILITIES FROM TOWN OF ---4ORTH ANDOVER EXISTING PLANS. j 3. DATUMBJ BASE IS U.S.G.S. NAM.S.L. (N.G.V.D.). j xn - m,Y/1N�IG1MEfly � - i LEGEIIT� EDGE OF WOODS - - I S SEWER PIPELINE D DRAIN PIPELINE ,ears W WATER PIPELINE N18'54'30"W—(REC) x %1B" 163.65' (REC) - G GAS PIPELINE x nan N18'53'56"W-- CAL - —77g-- ELEVATION CONTOUR (CAL) 163.74' (�AL) — J 178X23 ELEVATION GRADE n0. n0.,1 �S'SMH SEWER MANHOLE ❑C8 CATCH BASIN Z N/F NOW OR FORMERLY x,>e.as xns.ze , rn PVC. POLYVINYL CHLORIDE - ne.x, x nos. xnass a? CAL .CALCULATED 1 o REC RECORD LOT 31 xm.v - AREA=44,298 S.F. =1.02 AC. w 97,x, \� �•61.90 �• �� 74.41 X 17444 yam_-- 205.68' / r - --S20'00'00"E / ---- A=5'43'46" �_—.. 1 1.>>°BRENTWOOD 'CIRCLE �1 -- TOPOGRAPHIC PLAN OF LA1%rD \ \ JN NORM ANDD VER, MASSACHUSETTS = PREPARED ."R JEFFR-EY AND ALLEN ARSENAULT BB BMA'7 1VOD CIRCLE NORM.ANDROVER, MASSACHUSETTS 01845 s DATE.' JULY 8, 2002. e SCALA 1'=20' o' zo' zo' aoeo' MER241MACK ENGINEERING SERVICES 9 88:PAFsIC STREET I( ANDOVER,, MASSACHUSL 01810 DONALD P. LEONARD ARCHITECT V Ni m x i a\ - I • i =ak u.waw. wig i I - 41 - 1 I— N MITCHELL G. L G.DRIVE TEWKSBURY MA 01876 TELEPHONE 978 asI 0549 Ji Gk5" - ISSUE: zgv1 lilt .. - aF'-e�t9+c.. r�.ir�- I — — ! t — SCALE: PROJECT- NUMBER: TNUMBER: ' DONALD P. LEONARD ARCHITECT K 41 MITCHELL G.DRNE a MA 01876 TELEPHON$;,., I: 978 851 0049 _ FM a - ISSUE: MITIE1� 11 - r. , - ; - ----- -._.. - - --EXCLIa----�L�Ot15E——-- ` - —- : —--- --- .:L4�`�=NETU_At�JSCOIJ» a-.__ !o .�. 0 NT _E L- VA_ I Q_ -_ PRIM' UMBER: DRAWING NUMBER: A-7 - DONALD ' P. LEONARD ARCHITECT a 41MITCHELL G.DRIVE Y MA 1 TEWI{SBUR 0876 - - � TELEPHONE, ONE 978 ' — _ — 851 0 ,: \3 549 a r s- _ •' ; . ; _ - - 1 i — - u art 'II ,,• - - • fl{( _ .M L _•_ 1 .-: 2.111 { FIL ;iii ,� �,L; - -' • '( j 1 t l— I f i i v:r iI 1 you i _ SCALE. i o_ PROJECT . NUMBER: 4 ✓ !/ !/I i .[ loll C+/V f (/v V 4/ a , Location VV 1lY /VJ //rte .: No. Date jolt, TOWN OF NORTH ANDOVER F p + ; : Certificate of Occupancy $ Building/Frame Permit Fee $ s�ck:us Foundation Permit Fee $ r Other Permit Fee $ ' TOTAL $ Check # s 15062 /1Buildi,96 Inspecto`r' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT IAPPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING � BUILDING PERMIT NUMBER: !!q DATE ISSUED: © / a f SIGNATURE: 4J9 ; Building Commissioner/I r of Building' Date SECTION 1-SITE INFORMATION Qt 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ! Map Number Parcel Number \' 1.3 Zoning Information: 1.4 Property Dimensions: t v _'. Zoning District Proposed Use Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.GL.C.40.§54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ e. SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT r 2.1 Owner of Record Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: r Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ as Licensed Construction Supervisor: License Number r Address f Expiration Date s Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name �c Registration Number Address es Expiration Date o Signature Telephone i I SECTION 4-WORKERS COMPENSATION(NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. I Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ � I Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 1/ 10 x 14 S4, cl- ( )aG2 cL ho Nn���, a-± a. I N� j�nt ,A-e—A V)e SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by it applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction (( 3 Plumbing Building Permit fee(a)X (b) r 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT // , Y:l t' T-s' nML)i as Owner/Authorized Agent of subject property Hereby authorize to act on My be if in all mattes relative to work authorized by this building permit application. 09A (�Q A%0 d Q4— �— q )2D�61 Si ature of(honer Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, As Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DRAENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I I FORM U .- LOT RELEASE FORM k oX� y �N��� ttj z-v -at INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE Z -b LOCATION: Assessor's Map Number /0 PARCEL= SUBDIVISION LOT(S) J STREET ST. NUMBER *****************************************OFFICIAL USE ONLY*********************************** RECO DATIONS OF T WN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVE=D to CD DATE REJECTED COMMENTS ./Y\-7 — 0Y) mC/tk-- 1C>Ck,0 *F,iL TOWNANNER DATE APPROVED - DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED BokT,,E REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm JUL-30-01 02 :24 ,AM: E K SURVEY 9794697046 — P. 03 E K SURVEY INC " 4 HAVERHILL,MA 1 pr4no 978-4M 1685 4 Fax 978-469.7DQ i MORTGAGORf �r.I ' EL��,V AAJAuLT DEED REF. _ C/Goo pG• ADDRESS OF PRINCIPLE BUILDING PLAN REF r�I �0 a •+J�l 2G[°_ ... ., DATE OFIN5PECni _ .'f(/L fs: � -e!--- M AW00 A SCALE: V • j 1 i I ddb 3l I E d111161 Sim C) y SIN- ' . cQ i I f' . I • f I i . I .3pr0�0•� � . baa c l i�Gi-Ifs I I I � RUDEL I CERTIFICATION TO � (� 3C'W N ' f t0 t The location :�l tho nnc�Nr !' this Mort a e Nlol Plan was r P I �h��Fh!rcls 8 p(pared s ifi ly for mortgage purposes Only and it is not intended or<epresonled `m.1' fC15il�ti to be a ro line or land survey.This plan s'o Ss� Wfth the local zening'bylaws in offecl whon conslrucled p � ' Y pan is not to be used kw! s t,x0 from I to eslabh&h any or the property linos for 66y purpose. No rind/orfs exempt violation enforcemnent rewincibiAty in emended to the jar, owner or action under Mass B.L. Title VII,Chap,40A•sec;. 7 Thls ccrtirication Is based on the loontion of survey ma ker 6 sum building Is not in a Flood Hazard Area. of others. 0 SAW building Is In Flood Hazard determined from the >X IRM rnapa Flood Hazard Area. Dated I i i NORTH LED � Town of dover No. 9 Coc4,C I dover, Mass., —00(j/ ORA TED P'99\, C� S H � BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System �N �� /� �/+�.�J✓,q U / BUILDING INSPECTOR THIS CERTIFIES THAT...... ............................................. Foundation ,,/ c has permission to erect... d.X.�. .............. buildings on .......��... ....... .�''. -?......4. .�"�............�.. ... Rough p' pray ! Y / N I'� � 2 l� f R /Z CX Chimney to be occupied as ..... ... ....... ..... ............... rr ......................................... ............................................................ lS..Vit................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in 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. G /3 �4 a.�7_., ­__ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough " 0 PERMIT EXPIRES IN 6 MONTHS Final `' w UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough C N y ............. ......................... . .................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building • , GAS INSPECTOR Rough Display in a Conspicuous Place on Wall Premises — Do Not Remove Fina, No Lathing or Dry YYall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Dec. JUL-30-01 02 !24 -AW E K SURVEY 9794697046 P. 03 E K SURVEY INC ' 4 HAVERHILL,MA 4 PhOno 978-460 t WS 4 Fax 978-4%-71}46 li MORTGAGOR _,it"lr'T�Gt. !FI,L1,O A&6*jLT DEED REF. C/Cad PG. 11r - ADDRGS$ OF PRINCIPLE BUILDING PLAN REF DATE OF INSPECriON__ 7ui r AMC( -- r h►cJ4oJ X111 �� SCALE: V°(►D' �n� I NY,�1s0 5.f• Q' Its A lti� Sim i' ' I I r, '3 t^ l�C�►'JS�l.400,p cti�Gi. j • 6 T.'• riUOEL URTI1"ICAT10N 1'0 � µo 56W '^ f his Morl a e{I t PI a The location ar tho mnc )k. s ni g u an w3,pr@porcd s iri for I I 1 Gh.rcls Mort o e r R h � S an i F f 1. _ 9 9 Pu Po'� ry and t�s not intendod or represonled 3 �iii(1� + - to be a property line or lane 6urve .This I. s% S, wlTh the local zening�bylaws in crlccl whop oonslrucicd Y pan is not to be used kAt �s x0 and!or Is from vi exempt to eslash any or the property finos far arty purpose. No D violation enforcemnen! bii responsibility is extended to the land owner or wowpani, action under Mass B.L. Title VII,Chap,40A, Sec. 7 This ccrtirication Is based on the location of survey merkbe 0 3ubJeot building Is not in a Flaad Hazard Area, of olhers. Ftaod Hazard delerminedSAW building om ththe IRM 19 Ina Flood Hazard Area. mpg Cated I i ii Location 6 G l3 C-ow �cti o ac 1 r v� No. Date /V—E) 3 `I a NORTH TOWN OF NORTH ANDOVER F 9 ' ' Certificate of Occupancy $ Building/Frame Permit Fee $ — sACNus Foundation Permit Fee $ Other Permit Fee $ TOTAL Check N a 16155 � � - Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DgEMOLISH A ONE OR TWO FAMILY DWELLING t 4^._ ;err- x� ':': %- 777 � rlC :. BUILDING PERMIT NUMBER. 3 6 DATE ISSUED. w _r o3 M 15 ic SIGNATURE: C I BuildinE Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 6(o B rer 4(,jpod co 3 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Z oS. G8 Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided v 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record �J/",-,) -VC,/ Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 0 M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ �Q-1,d 'p—i i M6�+-� C)��y- Licensed ' Licensed Construction Supervisor: S O 7 30 O Z�0 wlO Y V1 License Number Address Expiration Date Signature Telephone Al 3.2 Regisred Home Improvement Contractor Not Applicable ❑ v c m alp y Company Name V 1 1 0"3 3 (og M Registration Number r Address 0,3962 Expiration Date ^� Signature Tele hone V SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes...... ' No.......0 SECTION 5 Descri tion of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: a� � �', �09� t © Olt", SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAI.USE(FNi.Y Completed by permit applicant wY 1. Building (a) Building Permit Fee Multiplier 2 Electrical �_ (b) Estimated Total Cost of Construction 3 PlumbinE Building Permit fee(e)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AG NT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby aWoe to act on My behalatters relative to work authorized by this building permit application. �Z \i Si natur'6 of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Siature of Owner/A ent Date NQ NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 s 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHINMEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE DIf"CST CUMVACT AC IRE i ING, INC. P.O. ox1' ' :8 North Hampton, NH 03862 November 13,2002 ' ��� (603) 964 5822 ® 2 20U2 : fax(603)9645324. Mr.Jeff Arsenault By. 66 Brentwood Circle North'Andover,MA.01845 RE: Home Addition—Kitchen,Sunroom,and Screened-Id Porch 66.Brentwood Circle North'Apdover;Massachusetts Dear Mr.Arsenault: Thank you very much for allowing Dellmont Contracting,Inc.the opportunity to.provide you with an estimate to complete your home addition as specified below. We will supply all necessary labor,equipment,and materials to complete the following scope of work. 22'x 29'Kitchen and Sunroom Addition and 14'z 14''Screened-In Porch Addition-P1ans Provided By Owner: 1. . Removal and disposal of the existing cabinets,countertop,appliances,and flooring,etc. 2: Remove existing walls between'dining room and new addition and the kitchen and new addition. 3. Excavate for-new crawl,space.foundation.asspecified:in plans: 4. Install crawl space foundation as specified in plansfor kitchen/sunroom addition and sonotubes for screened porch: - 5.. Frame 22 x 29'addition and 14'x 14' screened porch addition with flat roof as specified in plans: 6:. Install rubber roof as specified below. a) Install 1/2"Structodek over roof;to be mechanically attached. b) Install.060 EPDM,fully adhered to substrate. - c) .Install.032 drip edge ori.perimeter of roof.. d) Strip in 6 :060 EPDM over aluminum drip edge. e) Lap seal all joints. 7. Install Pella windows and Doors in Kitchen and Sunroom- a). Six(6)--two wide.Casement windows consisting of two size 35"x 71"windows! b). One(1). single Casement"Windows size35"X 71 C) One(1)—single Casement Window-size 29"x 47" d) One(1)French Door size 36"x 82. e) One(1)Sliding Door with Transom Over--Size 72"x 82"door with 72 x 17"transom. Above Doors:and Windows to be Designer Series;Clad,Model 2,`White. Casement Windows have White Rolscreens,R&L Slimshade,and muntins.. Doors have R&:L Slimshades and muntins. fl One(1)Primed Steel Entry Door with Half Lite,'Model 2=Size 3'x 8. Supplyand install_siding and trim on exterior: 9: Install electrical as needed,to MA code,and as specified in plans and kitchen design: 10. Install plumbing as needed,to MA code,and as specified in plans and kitchen design. 11. Install gas forced:water.baseboard heat in kitchen and sunroom addition. 12. Install insulation as needed,.to MA code. - 13. Supply and install direct vent.gas fireplace in sunroom: 14. Supply and install necessary drywall and drywall finish. Mr.Jeff Arsenault November 13,2002 Page 2 15. Supply and install interior trim around doors;windows and entryways. 16. Dovetailed Kitchens, in Inc.will design,supply,.and install kitchen cabinets and countertops: 17. Supply and install new.sink and faucets to manufacturer's specifications. 18. Supply and install appliances: 19. Paint walls,doors,and`trim. Onecoat of primer and two coats of paint.. 20. Supply and install electrical fixtures. 24. Supply and install new.tile or hardwood floor in kitchen andsunroom(see allowance): 22..Installdecking on screened porch. 23. Install beaded panel on the ceiling of screen ed'porch: 24..:InstalI fan/light on screened porch _ 25. Install new steps from screened porch. 26. Do necessary post and rail-baluster as needed. 27. Install one screen door;and"screens on porch. Price: .$155,830.00 The following allowances are included in thisproposal, 1, ALLOWANCES Electrical—includes electrical fixtures and installation of $k0,000:00 appliances Plumbing=includes installation of appliances,sink,and faucet $3,000 00 Kitchen Cabinets and Countertops—Installed Appliances(cook top,refri erator'microwav $37,000,00 g _ e,trash compactor,: $6;500;00. I oven,disposal Flooring $7,500.00 Direct Vent Gas"Fireplace—Installed Fixtures—Kitchen Sink and faucet $2)500.00 $1,500:00 Tota!Allowances in Contract $68,000AW -Y� r UIYU C "- Mr.Jeff Arsenault November.13,2002 Page 3 Oualifications: 1. All work will be done in a workman-like manner,according to industrystandards: 2. Job site to be cleaned.on a daily basis..Materials to be removed from job site at completion of project. 3. Owner to provide necessary electricity: 4. : Contractor has workman's compensation and general liability insurance. Copies will be provided; upon request. 5. H necessary,plywood will be replaced at an additional charge of$100,per square foot with a' minimum charge of$64.00. 6. This proposal is good for thirty(30)days. 7. This proposal,consists;of 3 pages. 8 . Warranty: 3 year on,workmanship;;&6ratedmanufacturer's warrat ty on materials prorated 9. Warranty:EPDM:3 year on workmanship,prorated 2"0:y manufacturer's warranty on materials; .. prorated. 10. Payment Terms: 45%down payment upon commencement of work,45%at start of cabinets, balance due upon completion.Credit cards(Master Card,Visa,and:American Express)are.accepted with an additional service charge of 5%(five percent)of contract.amount.o. 1.5%interest will accrue on any balance over 30-days. Owner;agrees;to pay all court and legal costs`associated with collection. If you have any additional questions or concerns;please do not hesitate to call. Sincerely, Wendell Montgomery President I HAVE READ THE ABOVE SCOPE AND TERMS AND FIND ALL ACCEPTABLE. YOU ARE HEREBY AUTHORIZED TO PROCEED'WITH CONTRACT WORK MR. F ARSENAULT . DATE CEPTANCE If you wish Dellmont Contracting,Inc.to proceed with the above-referenced mor.k,please sign and return" one copy of this contract: Tei: 978483-0564(home); 978-688-7300(work) . own. of North Andover � %AORT k O S1�eo brt�'O ffirce of the Flanning Department Co ni-,r .evelopment and Services Division � .n 27 Charles Street North Andover, Massachusetts 01845 ass e52� 'q us Telephone (978)688-9535 Fax(978)688-9542 September 19, 2002 Jeff&Ellen Arsenault 66 Brentwood Circle North Andover MA 01845 Re: Property Renovations& Watershed District Dear Mr. &Mrs. Arsenault, I am in receipt of your dated September 12, 2002. Allison McKay of the Conservation Commission office and myself reformed a site walk and I have Y P completed an extensive review p of other Watershed Permit files and the original subdivision files. g As a result of this research, with Allison's on-site inspection, it is my opinion that there are no wetlands within 325' of the proposed work area. Although the property at issue referenced above lies within the o P rtY ( vena area of the Watershed Y ed Protection District, the proposed improvements are over 325' of wetlands. SinceY our lot was created before 1994, the edge of the Watershed,Protection District non-discharge zone is 325' from jurisdictional wetlands in the Watershed District. North Andover Zoning Bylaw, § 4.136(2)(f). As such, the proposed work is within the General Zone of the District and does not require a Special Permit from the Planning Board. Id. at § 4.136(3)(a). I will file this letter in your building file, but please keep a copy for when you decide to apply for a building permit. urs, chell Town Planner cc: Kathy McKenna. Town Planner BOARD OF APPEALS 689-9541 BUILDING 688-9545 CONSERVATION 688-9530 HE.ILTH 688-9540 PLANNING 688-9535 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector tilt-'• Tj --A Board of Building Jtr gulatiot".s and Standards HOME IMPRpVEMENT CONTRACTORLicense Registration: or registration valid for individul use only 103365 before the expiration date. If found return to: Expiration: 7/7/2004 Board of Building One Ashburton Regulations and Standards TYpe: Individual rton Place Rm 1301 WENDELL MONTGOMERYBoston,Ma.02108 WENDELL MONTGOMERY 12 LAFAYETTE ROAD NO. HAMPTON, NH 03862 ` —'"--- Administrator without si w ,�ierruiArrruva�zl p� BOPAD OF grl p{NG 2H LlI T��' Pon e::GONSTRUO S � P. Number CS X445381 . f3trthdaCe 06/2611959 �•? Expires 46/28/200 3 Tr. 703 tests Ao d.: WENDELL L,MONTGOMERY'; WE L '� ... 82 ESKER-RD -• Adfimstratns HAMPTON !K 43842 134i x w ' M 3 The Commonwealth of Massachusetts W d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 SV1b Workers'Compensation Insurance Affidavit Name Please Print Name: Location: Cl Phone # 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: D 42_1 1 rn.o rt¢ C c� tv Qcfi ice. SNC. Address U o g ► ( Z �-G�FCz y e-� {�0 0.a City: l v 0 r + c e p +c)V' AJ Phone#• b 3 E-9.2--2— Insurance. Insurance.Co. L I Policv# W 1 3 I s - 333 Z2Y---oiZ Company name: Address City: Phone# Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,5oo.00 and/or one years'imprisonment.as welLas_ciol penaftminthe-fnrmcfASTOP WORK ORDERAndafine.of_($J.00M)-aday.aga Wnw I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensin i Building Dept []Check if immediate response is required Building Licensing Board Contact person: E] Selectman's Office "Phone#: ❑ Health Department Other i . FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT PHONE LOCATION: Assessor's Map Number PARCEL 35_ SUBDIVISION LOT(S) STREET 3 CQ_A 4 w o o cl i r C 2 ST. NUMBER OFFICIAL USE �R:E C ^MENDATIONS OF TOWN AGENTS: CONSERVATION ADMINIS ATORDATE APPROVED 03 � DATE REJECTED COMMENTS /VO (0" �ted S cf/ ' /�� pSCo� TO N PLANNER DATE APPROVED_ Z DATE REJECTED - COMMENTS J011d j�_�aw_ff-o c��. �� I FOOD INSPECTOR-HEALTH DATE APPROVED -�� DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 im NORTH Town of ,. ind®veer 0 vl`- No. 0 It- LA 0 dover, Mass., OCOCHICHEWICK RATED C2 BOARD OF HEALTH Food/Kitchen PERMIT . T D Septic System .6 vk",....A f-b BUILDING INSPECTOR THISCERTIFIES THAT.....7�.o....................... ..... ........................................................................................ii.......... . Foundation has permission to erect 7............ buildings on ....4...4.......lar. W-0.6-el..... Rough ....... .. .... .......... ..... ... ... ...... ....... .. 1914 opq*4 DLCk_ —Nx1q Srt**A> A"4 * a X.)a W Chimney to be occupied as..&............................................................................................................................................ ..... 11 provided that the person accepting this permit shall in every respect conform to the terms of the application on file in 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. r PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION aTARTS ELECTRICAL INSPECTOR Rough .ct'�� .. ... .................... .... ........ ................................. ...... Service BUILDING INSPECTOR Final Occupancy Permit Required to 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. Smoke Det. SEE REVERSE SIDE Date. ORT„ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that . .� 0'. :e . . .r.0 �-z. . . . . . . . has permission to perform plumbing in the buildings of . . . . . . . . . . . . . . . . at. .6/6�.^ �.l..'<:. !.�.4 . . .. J.o . . . . ;Pt North Andover, Mass. Fee'�� ? L . II . Lic. No. 7 ° PL WING INSPECTOit Check # G 5 5558 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS / ` Date- - t >� Building Locationyawners NamePermit Amount 17 J-1Type of Occupancy New ® Renovation Replacement ® Plans Submitted Yes ® No ri FIXTURES w � a a � w E a a �" rA M a lS'L FIOQt � . 21`n FIDQZ 3t FLfOCR 4IH HIM 5IH FIaR 6M H M 7M HIM SIFT Rfm (Print,or type) ��� P�# Check one: Certificate Installing Company Name OI/ eg ) ® Corp. Address -S7 �i9�i� rK Partner. Business Telephone V Sia 7 (( �—Fimvco. Name of Licensed Plumber: f /I Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type.of indemnity Bond Insurance Waiver: I t de i ,ha a ade aware that the licensee of this application does not have any one of the above three insuranc signature �-� Owner Agent I here certify that all of the details and information I have submittal(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installa' -pe ssued for this application will be in compliance with all pertinent provisions of the Massac S n hapter 142 of the General Laws. By: Ign o erisea Flumuer Title Type ofPlumbing License . City/Town icense NumDer Master ® Journeyman C13- APPROVED(OFFICE USE ONLY Date.. .: . ?... . ,aORTH ar °` TOWN OF NORTH ANDOVER .. PERMIT FOR GAS INSTALLATION •' h CHUSESS This certifies that . . c .-?. . . �{ c .� rf� c 1. . . . . . . . . has permission for gas installation :r. . . . . . . . . . . . . . . . . . in the buildings of . .?.h. s' ::. !. . !. . . . . . . . . . . . . . . . . . . at . . .4%. .l?A::. ?' .4 .:�. . . . . . , North Andover, Mass. Fee. . .?. . . . Lic. No.. .? . . . . . . . . . GASINSPECTOR Check# < <= 4323 I 7 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS HI I (Type or print) Date �3 NORTH ANDOVER,MASSACHUSETTS Y3 L Building Locations Permit# Amount$ 3 Z o! Owner's Name r 47 arLZ ( .� New Renovation�— Replacement rl Plans Submitted 0 x w � � a a a F O C O F O w Q u+ a > p E' O 3 A cQ7 U a 0 OR H O SUB-BASEM ENT ASEM ENT 1ST. FLOOR / 2ND. FLOOR 3 D. FLOOR 4' H. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type "110 �� h k one: Certificate Installing Company Name AA �� Li Corp. Address L� �1 Vim!` Partner. SPA 67k)L* ti _ 03 F7 Business Telephone 6C3 L)r7Y 12, 7 i/Co. Name of Licensed Plumber or Gas Fitter �wwo INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes U] No If you have checked yes,please indicate the type coverage by checking the appropriate box.. Liability insurance policy 1—a Other type of indemnity 0 Bond 0 4� Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe Mass.General Laws,and that my signature on this permit application waives this requirement.. Check one: Signature of Owner or Owner's Agent Owner ❑: Agent" Q 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations perforin this application will be in compliance with all pertinent provisions of the Massachusetts State odea to a General Laws. By: Signature o icensed Plumber Or Gas Fitter Title Plumber 2��// City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman Date.... ... . D�.... NORTF, TOWN OF NORTH ANDOVER 00 PERMIT FOR WIRING 2� �N ()PC_ This certifies that ............. .`�...................... ................................................. has permission to perform 4 {� wiringin the building of..._..I. ......................................................................... (' l0 �a 1 tr 00 JQ C Fee...........�.'—... Lic.No..... .... ............... AA ........4........ .............. .............. ELECTRICAL INSPECTOR Check # 4388 TJ&CVJW0JVfFF ALTJJ0FJJJA.SS44CJJJJSE77S Office Use only DEPARTMENI'0FPUBLICS4FM Permit No. 3 BOARD OFMEPREVEW0NRWMT1ONS 527CMR 1Z-W Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMA'T'ION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 6p ��"� �� /,—? Owner or Tenant Owner's Addressis Ems' Te1,-1-16,%-J00 D C)2 Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building IN-1�1)iT�t(�M Utility Authorization No. _Existing Service Amps / Volts Overhead Underground No.of Meters New Service �� Amps Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 2)17-4,! � No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets l/ No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals / No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers / Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalQ Municipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• h>StrmoeCa Ptasuantbthelagtmanai��GalaalLaws Iha�eaa> Li�nidyh�str�oePotityerludu�gCattp Co�a`dgeoriLs �iala4ttivalaY YES M-/NO lhawsuhnim JvMpmofofsamemtheOffioe.YESINO Ifj utmeduiwdYES,pleaseudic*thetypecfw&aWbydtadurgthe appcp b% 11��/1 INSURANCE BOND O`R-gR a (PkmSpeciiy) Expiatim D* Est m*d VahtedHectriral Wcik$ WcrkmSlatt3 hspecxmD*RgxsWd Rough Feral FSIRRMMN ME � � �GG I�a�seNa ��0'9 /,//E— __ sigt>aane TioaseNo BtsimTel.Na Ackir�r AItTdNa OWNER'SINSURANCEWAIVER-IamawatethattheLiarwde owt eitnualoet aageorAssu�r�ialequi�i astegtmtxlbyiviassa<iu G alLaws and that my sg�taeon this pts app)iCadian this tequaatlettt. (Please check one) Owner a Agent a Telephone No. PERMIT FEE$ � r -{ mw ~ ;0 -G 17-0 ND 0 o m 70 a. Q > c, z r 0 n -t r m n O L4 VI D _� Z 3 Z n O o 0 Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS BOARD OF ELECTRICIANS EL REGISTERED MASTER ELECTRICIAN ISSUES THIS LICENSE TO TYPE JOSEPH L REGAN MR 94 LANGDON STREET cn 4 PORTSMOUTH NH 03801-3967 i 412005 689MR 07/31/04 4120 Fold,-Then Detach Along All Perforations Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS BOARD OF ELECTRICIANS EL AS A REG JOURNEYMAN ELECTRICIAN ISSUES THIS LICENSE TO TYPE JOSEPH L REGAN I � j C JR 94 LANGOON STREET1 N I PORTSMOUTH . NH 03801 3967 412006 973JR 07/31/04 412006 I Fold,Then Detach Along All Perforations (603) 415 Fax:(6.0.03)3)4336-3125 REGAN ELECTRIC COMPANY, INC. Electrical Contractors Since 1953 24 Hour Emergency Service PAUL W.WINKLEY 94 Langdon Street Estimator,Project Manager Portsmouth,NH 03801 • �l ..1 Tn �Y ...��� DATE(MVIDNYY! A-9-0U CERTIFICATE OF LIABILITY INSURANCE 03/13/2003 vA00ucrA (603)436-lli'S FAX (603)436-5766 THIS CERTIFICATE I5 is U D?1 AVIA�Fi CIF iNFORMA7lbN D.B, Warlick & Co, ONLY AND CONFERS NO RIt3HTS UPON THE CERTIFICATE 2069 Lafayette Road HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,. Portsmouth, NH 03801 INSURERS AFFORDING COVERAGE Irasuaen Regan:E ec#ric Company, Inc, INSURERA: Peerless Insurance Company 94 Langdon Street INSURER E: Portsmouth, NH 03801 INSURER C: s ^ INSURER E; COVERAGES THE POLICIES GF INSURANCE LISTED BELOW HAVE BEEN!$SUED TO THE INSURED NAm5C ABOVE FOR THE POLICY PERIOD INDiCATFE).NOTvv;TtiSTANDING ANY REQUIREMENT:.,T ERM'IR(.nI,InITIOIL!OF AN"OCNTRACT OR OTHER DOCUMEp.7 WITH RCS('COT TO Al I:CH T-IS CERT'FICAT=MAY Be ISSUED UH MAY P=-R-,WN,THE INSURANCE AFFORDED BY THE POLICIES DZSCRIBED HEREIN IS SJBJECT 70 ALL THE TERMS,EXCLUSIO'sS AND CONDITION$OF SUCH POLICIES.AGGREGATE LIM TS SHOWN MAY HAVE DEEN fiEDUCED BY PAID CLAIMS. IL q§RR TYPE OF INSURANCE�� POLIGY NUMBER LI Y FECYIVE POLICY EXFIRATION DATE M lDD+ „p1+•TE1MPhDGrYY _„ LIVnY5 GENERAL LIABILITY Bi'93Iz17t 06/08/2002 06/08/2003 It iOCCURRFNCE 5 1.000,00 X C P91AERCIAL GENCRAL L AR;I.IT`i ( FIfiE JAMAGG(Any Gra are) D 100,000 CI.A@'15 MANE ( A I OCCI)R �� - _ ®0 IAEr EXP;Any the pn:spn;� A X AUt[YmaL1C A(1dT xns PERSONAL&AD'VINJURY $ 11000,000 L�w/l4ritten Contract_ GcNERAL.AG3REGAYE 4 2 000,000 GaN'L ACGR-HGATE LIMB A?PLIES PER; 00 _ oucY1 X rRp- PROCucrs-cpIOP,a s 2,000000 LOC - AWOMOEILELIABILITY BA9312671 06/08/2002 06/08/2003 COiVEINE031NGLEL:MtT X ANY AI ITO ('rs eGCidenl} M1- I S � 000 a 00 ALL QWNE(I AUTOS .+—�L•+ BODILY INJURY $ A SCHECULEDAUTOS (Pa'oarsnn) HIRED ALROS1 —� II+III ECDILY',NAIRY f1 NON- ',NNED AUTOS I (Ppr 9cclo nt) RROPEFIY DAMAGE & (P:x a.cinenl) G;1 LIA&LITY—� AU IO ONLY.EAAGCIOEKT 5 �• ANY AJTO -- OTHER THAN AUTO ONLY: AW $ EXCESS LIA61LRY TU9313171 - 06/08/2002 (�/Q$/ZOU3 EACH OCCURRENCE 13 Z,QQQ r QQQ X I OCCUR CLANS MADE � A0GR_GATE� 5 2.000,000� elf Retention s 10,000 I WORKERS COWPNSATIONAND �WC9313071 1 06/08/2002 06/08/2003 X TomU!AfU- EP _ EMPLOY'EAVLIACRJIY .-,1.:EACHACCiGENT � 1®0�----;511—;0-0 �0;00 00 .A I ! E.L.01S=ASE-cA EM,°,.EL.Oli^J!SE,o.:�I ICY I Iu OTHER �-. - �. DESCRIPTION OFERATIONSlLOCATIONBNEHICIES/EXCLUSIONS ADDED BY EN00RSEMff4YlSPECIAL PROVISIONS Electrical Contractor E: ELECTRICAL WORK , 66 BRENTWOOD CR NORTH ANDOVER MA -PAGF. CERTIFICATE TAXED TO 0)-436-3125. NAILED ORIGINAL TO CERTIFICATE HOLVER d CERTIFICATE HOLDER 1 gOCI'ION�L IN$t RI=D,INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEC19EFORE THE EXPIRATION DATE THEREOF,THE IEEUING GOMI`AHV WILL ENDEAVOR TO MAIL 10 DAYS 4VRITTE4 NOTICE TO THE CERTWICATE HOLDER NAMED TO THE:LE%T, 3EFF & ELLEN ARSENAULT I BUT FAILURE TOMAILSUCH NOTICESMALL IMPOSE NOOBLK:A.TIONOR,LIABILITY 66 BRENTWOOD CIRCLE OR ANY�IIIIYD Vr`ON TI IC COMPANY,IT9 AQENTS OK RCCRESENTA-IVES. NORTH ANDOVER, MA 01845 AWTOC KED REPRESENTATIVE ACORD 25.5(7197) FAX• (603)436-3125Cin oR G RPORATION 1898 T 'd 99LB9Eb E09 q%nowsad %u1 "joiTien HG IRTE :01 ED CT 1AeW i IMPORTANT If the certificate holder is an ADD71ONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the Certiticat9 holder in lieu of such or.dorsement(s). If SUBROGATION IS WAIVED:subject to the terms and conditions of the policy,certain policies may roc,i.rire an endcrsemFnt,A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). r DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the poiicies listed thereon. i i I ORD 25-S(7l97) - —�—� 2. 'd 99L.89EiF 609 q%nowsa,d Sul �aljiet7 g❑ eIEaOT E0 ET ,aew rz��it�tl EZ ECrr�IC COMI .41VY, rNC. 94 Langdon Street PORTSMOUTH, NH 03801 Phone: (603) 436-9015 Fax: (603) 436-3125 Electrical Contractors Since 1953 January 2, 2003 TO WHOM IT MAY CONCERN: This letter is to certify that PAUL W. WINKLEY is an authorized agent of Regan Electric Co., Inc.- JOSE REGAN, VI PRESIDENT PAUL W. WINKLEY Project Manager