HomeMy WebLinkAboutBuilding Permit # 5/1/2015 11
BUILDING PERMIT LED
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TOWN OF NORTH ANDOVERRa
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APPLICATION FOR PLAN EXAMINATION _
Date Received
Permit IVO#: NTED P R
�SSgcHus��
Date Issued: .
PORTANT: Applicant must complete all items on this page
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LOCATION Old, 'd
Print'
PROPERTY OWNER ` 1410,11, �etll
Print 100 Year Structure yesCno
MAP PARCEL:r ZONING DISTRICT: Historic District ye
Machine Shop Village ye
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
Erws-E-16"
_0 _ �
_ DESCRIPTION OF WORK T BE PERFORMED:
1 n.53�j/ C'�-Gi�` wild i
%AOTFC
Town of Andover
0
+ �
now
ver, ass
o LAKE 9 9
COCHIC"a WvCK
°x?ArE® P*T \S'�(�
BOARD OF HEALTH
rER. Food/Kitchen
LD Septic System
THIS CERTIFIES THAT ,. ..I„ BUILDING INSPECTOR
... . .. .
has permission to erect ......... buildings on �`
Foundation
...... . ..... .. .................... .
... ....
Rough
to be occupied as ....... .....�.. . ... ...... �Inlegvery
'.. .. .. ...........s...................... Chimney
provided that the person accepting this permitsha res t confor o the terms of 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 ,t
Final
PERMIT EXPIRES IN 6 MONTHS �s
ELECTRICAL INSPECTOR
UNLESS CONSTRUC S __® Rough
Service
... ... .................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy er Z Required toOccupy Lidding Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final AN
No Lathing or ry Wall To Be Done
FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
Street No.
Smoke Det.
AIA Me it 111 AIr)
Form
Between Owner and Contractor
for a It Project
u.-bere the Basis of Agwnettl is a,5771't=T1.ATED SU'.44
1993 SMALL PROJECTS EDITION
Ikee se I S docutTtew hcls h2lyw1eva legal colueljttelrce c ICe('11courokl )'ol[10 Consul/it-ill;tw
einw71ep hefbre signhig it..So7)IG'stcllC?Q 1)lctilli[fle el celliceltallon period Or recjld"(1 Otbe)'4)eci k
lllsCld51[t'C!S,hlCludilJi tr7t1'llilT�tivl /)o))le lr7)jJ1(1t'P111e1T1 contracts. when a docit111en'suchCI+tl.)ls 1t'111
he ltsecl fb•Wlork O11 the 01olC r'sp.'r.,mied residence. 11bur L[IIC117ZC}'sfJol[lll illsL•)Y C[ll lclll{Itc1gq' i-('q red
hr State 0).k ral Icue to he included in tb&.,\,reentellt.StIcb stfileMeuh MOV he entewd in the.,peace
provided hclvu; dl f(rrclrtilr d ht'law.afic»e the si,��lllttt[r<'s of't{x�pcnYic�c.
This AGREEMENT is made:
tlkru`) I
April 27, 2015
BETWEEN the Owner:
Kevin Martin
136 Old Farm Rd.
North Andover, MA 01 845
and the Contractor:
Summit Design Build
29 Eames St
North Reading, MA 01864
for the following Project:
Furnish and install new roofing,gutters,windows,siding, and entry doors
as outlined in attached pricing proposal
The.Architect is:
N/A
The Ow.ner and Contractor agree as follows.
-)Pcright 1993 h.,'I$e:VllCr(trttt lttmittste ur3rchitcels, h{�Vets lark-wrov.NNV..Wa+lbriglorl, r).{: 4MMIA-W2.Itrpruelu.tn+n of tLc tstater'r.tl her'Vin
t>r tiuh�i:attlJ quntRtiar)t aatt of it,pruriiionr %WN101 OR'Wille')Ilemt,irm of the AIAtEui:tte.the r+tP.TtgE:[ans"f the t'nia ti 5t:rt�s a rl x:hfcel thr�9r;anrr t+
rcpil pro:cruliau. .
AIA DOCUMENT A105 •t)A.%I;IM'ONIK.{ Ij t.It') tir,Er-�ll?ti7 aNIAIJ-rltr?,It:Cra
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violalea US,copyright laws and will subject the violator to legal prosecution.
ARTICLE 1
THE CONTRACT DOCUMENTS
The Contractor shall complete the Work described in the Contract t)ocuments for the project.The Contract Document--z consist of.
.1 this Agreement signed by the Owner and Contractor-.
.2 AAA Document A205.General Conditions Of the Contract for Construction of a Small Project,current edition;
.3 the Drawings and Specifications prepared by the arcitirect.ct ttcd
a))d enumerated as folio-s:
Dr uinl s:
None
specifications:
None
.4 addenda prepared by the:lrchitcct as follows:
None
.5 written change orders or orders for minor chang(e-;in the Work issued after execution of this Agreement:and
.S other(lucuments.if any,identified as follows:
Customer may request changes in the work, and if agreed to by contractor, same will be
documented by a written change order, prepared by the contractor, which will document
the changes to be made, the resulting change in the contracted price, and the anticipated
delay in the completion of the work due to the change. In the event that the change order
request delays the progress of the work, verbal approval from the client is sufficient to
begin the change. Contractor shall not be obligated to perform any change in the work
unless and until customer signs such change order. Customer agrees to make payment
of i 00%of cost of the change, as shown on the change order at the time of next milestone
payment.
AIA ooCUMENT A105•Ott'.NER-CO\Tio1CTOlt AGRFE?tF\T—a,\SAt.I.PR<)1FCTs
L:r)1T1p1• 1i:1,•e\1`}�3•7YiE l),\lERIral\tNSriTC'nS OF AKI11'niC TS,t 3i\f1K'1"C)Rt:
VTt1\Cri'U\,Z).t ltk>tr5_)3-WARNING:unlicensed photocopying A105-1993 2
vioiates U.S.copyright laws and wilt subject the violator to legal prosecution.
Ati t IULC L
DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION DATE
The true of Contrt!eAcemant shall be the(late of this Agreement unless orlterwise indict red helntt.Tlu C;Ontrtctor shall suhstanrialll'
complete the NN%Ofk not later th.:n Work to begin mid May,2015 (roof sooner)
Or(ler.
subject to adjustment by Change
11rret'rla,edate ormnttherofcalexdnrdrn.raft rtut date•ofin,ttnu'ttt'eni',tt.,
Work to be completed 4 weeks after start date
ARTICLE 3
CONTRACT SUM
3.1 SubjecE toaddition'and deductions lid•Change Order.the Contract Sunt i.":
$68,848.03 (Sixty eight thousand eight hundred forty eight dollars and 03/100 cents)
the Contract Sum includes the follow'in"Values related to portions of the Work:
3.2 l or putposeti oFlrryment,
�':tlue
Portion of Work
Deposit due at signing of contract $10,000.00
Due on completion of roof $6,175.00
Due on completion of door installation $3,700.00
Due on completion of window installation $14,800-00
Due on completion of siding $21,200.00
Due on completion of gutters $2,250.00
Due on completion of project $10,723.03
3.3 Tile Con trt Sutn sl)sll iuciude ali items tart scn•ices 11"essan•for the proper rxecution"(1Con�!'irtic>:�Of tile\Vork.
Alk DOCUMENT A105•()WSrtZ.00STR,1�('T0R ZG11H%tVN'f S+IAI!.euustr,T�
tl)t170�•A1A"•g,!}q;• rl1H:Lt1)iltlC\�I\STIT[ri-L OF ARIA Ir IVIS,i-35�F.tC'\Z)R6 8105---1983 3
A VJji,UF.NAV,WAST I�tic-rox.M_1f%Hkr5292-WARRING:Ualicenved photocopying
violates U.S.copyright latus and will subject the violator to legal prosecution.
1/
PAYMENT
4.1 Ba sect on Contractor's Applications for Parrnent certiflecl by tine Architect,the U(vner shall t):t} die C;on[rac ux:ts;i)Itlm:,:
(llr+k�lrtirt Juttvrmut¢raa'drr/C'3lgirl jTrbrla7(rrrc fgrra'!alrt[t�r:flt0ft')
Check due at times outlined in article 3.2
4.2 Payrnents(tilt~tinct tinpai(I under tliv Contract 00cunumts shall hear interest from the(Cllr paptatel:t is title at zhe rate of
g% or in theabsent thereof,at the legal).rte prc(ailin,9 at the Place of lot('1'foi(t-
rl a7fr1'lrtrt:c rtntl ratjrtlrr•nrerr�c rrrrdrr r/x l'arlernl TnrlL m!.r•rtrliu};:1c'!..•irrrilrrr rlrttr a+rrl jnrarl tort+rrnrcr cn_•rlit torr,trod other n;Calrrharr,err tLm t)rr rrrr:.and Con.
trtrctor i principal pfacCs t1711rsitle'v.Use location r rale t-ny•c f acrd cr.C'It heiv rrStrl'[rfjlYT IPC t aliflin't j II,V prnrlsrnrl.,
ARTICLE 5
INSURANCE
5.1 17te Contractor shall provide:C ontrwtors Liability and other Itl:;urtt cea:5 foihms:
rDr<e+l3frcc1,+iCImotr'rtnt–r"llai dlp.thefruieri
Complete liability and workers compensation insurance for the duration of the project
Insurance provided by:
JJ Murphy Insurance Agency
1 Centre St.
Malden, MA. 02148
5.2 The Owner shall provide Oivitees LlabiIitV and owner's Pronert}•Insurance:u follow":
rht:cr7 ijh Ci!iC hmurancoJitrrrl.Jt W 1tt•rite 011 tier r
5.3 The Cori trtcror~hall ohctin an endo". Irent to its gcner:tl liability insurance policy to cover the contnictor's ohli„:uloms ntidcr
Paragr:tph 3.12 of AIA Ducumtrnt A2117.(.general Con(litions of tile;Contract for Cons[r cr.ion of Small Protects.
5.4 C;ertilicates of insurance shall be provided by each Pau[} shcswin�;their respective coverages prior to commence;t)e If
the Work.
AIA DOCUMENT A105•()t1^v�R-4O.17TtAClYlte.t(iRF.F.�1�T-511 V,1 P[tU)ECI'S
EDITION-ALV• 1993-'alit: Rt(iLti INISITIVIT.0VArit:IHTE(:tti.1-3-M-WYORK
rt�T1t.'-;:. .1C.,lC'�tiHiXGToti.D.C.3{et}SYti5193•WARNING:Unlit ensed photocopying Al Q5-1993 a
violates U.S.copyright laws and will subject the violator to legal prosecution.
ff �'
ARTICLE 6
OTHER TERMS AND COtdDIVONS
!lfrn rt ar+t ol-c•r t"Mt.:nr i urrrlitnnrr ltrdnrt.J
None
This<14reentent entered inic)as of the(lay and year first written above.
rlJregnUY•rltn•Irrtr:lrrSvrrcrrxer•Udrlo)tJ>e�Y:xl rff+itri5lrr�s�r,�1JY.'rrrr+nrruq.Urrrvu+rrrr.rdrst'ra=t�i�ruUrrm�)
April 27,2015
t� 1rltlrt('J
rti;t�r77rlttrr l
Ke in Mann Summit Design Build
(PrinlClllUame,wlc and aelrlre.,w)
lYriraed rurrae,title a!trl a<Irlr�ss7
136 Old Farm Rd. 29 Eames St.
North Andover,MA 01845 North Reading, MA 01864
I.ICFNSE No. 083853
,-w.,,)iCTin Massachusetts
G'fg�4 �t�s�: �Oti uli^uL3�Ci StC}t; an Grigiral :i Hs r.'`•GL`urne: t `-y yiCl, has fhl--�> C^.:t-'tion Prii2ied in red.
Roff WaWl
Fart original assures fi��r crisrges cS(ll flat e Gi7�Ct»Ccn its F t I f3Gf ur when Ciacutl?anis;arre CPj�C�ral10E
see Instrudiorl Sh e-eA or Limited LiCel iSe fb �t�,�,�dt sctia;t at this dOCLMOStIt.
AIA DOCUMENT AIRS•0xx,NClt.001,'T1LAtT0R AGRF iF.\T--1-5MA1.l,PROP(Mi
�z>mo�.:u� . tS93. �r.t;SFRtCA�ftisTiTl?FgFr�>rt[ttF(, .173iN1- A105-1993 5
�I\• v1S1.41t1\L7tlS.!)t:.31xKk+i_'9_'•WARNING,Unlicensed nhotocaPYiofl
violatesAti7t�1+13.O.S..copyright trews and will subject the violator to legal prosecution. /
Pricing Proposal
Date:April 22,2015
TO:Kevin Martin
Job code:136 Old Farm Rd.
North Andover,MA
General Contractor: Architect:
Summit Design Build Summit Design Build
29 Eames St. 29 Eames St.
North Reading,MA 01864 North Reading,MA 01864
Tel:781.507.0135 Tel:781.607.0`135
We are pleased to submit the following bid:
Job Remove all existing wood siding and windows Install new lyvek housewrap and James Hardie Phar cement
sidingwith James Hardie vented soffit(white). SidingIs priced as James Hardie smooth Hardie Plank with
ColorPlus 5"exposure(Boothbay Blue) We will also remove all existing nine fascia and replace it with new Azek_
fascia. Strip existing roof shin les install 6'of lee and water sheild,GAF Deck Armor and new lifetime GAF
architectural shingles Pewter Gra).
SEPVICE - SO
pESCRIPTION 4UANTnY Unit UNIT PRICE TOTAL
DWI E S
Trash removal-20 Yard sale dun stet 2.00 Loads $160,00 $920.00
All aluminum sidin to tae set aside for owner
BY owner
role Utilities jBV owner
Parkln -for three crew trucks dal Bv owner
Site telephones 6.00 Hrs $25.00 $150.00 $1,070.00
Final Cleaning Construction Cleaning
DIV 2 SITEWORK
Demolition Incl. $0.00
Remove all existingsidin
DIV 5 METALS 1.00 LS $200.00 $200.00 $200,00
Fumish all nails and fasteners
DIV 6 WOODS&PLASTICS
Sidin 32.00 SQ $235.88 $7 548.16
Furnish new 6-1/4"x12'smooth Hardie Plank with ColorPlus Boothba
Blue i.00 LS $2.497.58 92,497.58
Fumish and Install new Hardie soffit with Azek fascia white 10.00 EA $164.76 51 647.60
Furnish new Har;; PVC corners w/J channel 18.00 EA $20.93 $362.34
Furnish new Harve PVC 9x3 to of walls and inside comer ri s 3 QO EA S55.39
$166.17
Furnish new Harve PVC 1x8 1.00 EA $86.59 386.59
Furnish new Harve PVC 5/4x10 for ll ht blacks and outlets) 6,00 EA $7.99 $47.94
Furnish new Harvev PVC therms-sto s(garage doors 1.00 L5 5335.58 $335.58
Furnish and install new custom PVC front door surround to match
icture r ' ad b owner and first floor win ows12,00 Das $880.00 $10 560.00 $23,451.96
install ne vin idinn
DIV 7 THERMAL AND MOISTURE PROTECTION 12,00 roils 519.32 3231.84
Furnish 6" eel and stick window and door flashing 2.00 Tube $6.38 $25.52
Fumish Geocel 50 r silicone cautkin to match sidin 3,100.00 SF $0.20 S620.00 5877.36
Furnish and install new Tyvek hcusewra and to e--
Diva
DIVa DOORS AND WINDOWS
All window and or ricin Is Included In window and door uote
DIV 16 ELECTRICAL1.00 Sub $300.00 €300.60 $300.00
Re-install exterior li its and GFGI outlets
Gonadal Conditions Nhiijj
Pro act Mana er
Structural engineer review N/A
Planning/Development includes meeting with kitchen designer) NIA
Shop Drawin s&Reproductions NIA
Project meetings NIA
Construction Subtotal525.699.32
436.8 $436.69
Overhead 10°!0 $2,569.93
Construction Foe 10% S2 569.93
Construction TOTAL $31,276.07
Supplied Dv Other or Paid Via Purchase Order
All furniture fixtures,and equipment
Gutters
Furnish and install new 5"white gutters with 2x3 downspouts 1.00 Sub 53 200.00 $3,200.00
Roof
Strip existing roofshin las down to the wood deckin .Install new 1.00 Sub $8820.00 S8,820,00.
Ice and water sheild along the 6'roof edge.valleys,and around all
penetrations. Install GAF Deck Armor throughout roof area. installnew
white aluminum drip edge. install new Lifetime GAF architectural—
shingles,
rchitecturalshin les.ride vent and new i e Ilan es. Price includes dis osat
of all old shingles. Pewter Gra
Credits
Credit to bring overhead and construction fee to original 1.00 LS S1 000.0051,000.00
Subtotal:
TOTAL: $42,296.07
r
Pricing Proposal
Date:April 22,2015
TO:Kevin Martin
Job code:136 Old Farm Rd.
North Andover,MA
General Contractor:
Summit Design Build
29 Eames St.
North Reading,MA 01864
Tel;781.507.0135
We are pleased to submit the following bid.'
Job Furnish and install Harvey Tribute series new construction windows. Ali windows are white vinyl with double_____
low-E argon filled plass They have 616gridsbetween the glass with applied lift handles. All windows come with
Views locking half screen, 3"flat exterior casincis with built in J-channel in a picture frame confi uration a fled
to all windows. Furnish and install exterior doors as listed.
S1=RVICE
SEEMINEMEN-1 IN
DESCRIPTIONQU NTiTY M.
UNIT PRICE TOTAL
D 1 E UIREMENTS
Trash removal dis ose of afi old windows 1.00 incl
Project Utilities Bv owner
Parkin -for three crew trucks dallyy owner
Siteprotection-floor mask finishes protections 1.00 LS $200.00 $200.00
Final CleaningConstruction Cleaning4.00 His $25.00 $100.00 $300,OQ
DIV 6 WOODS&PLASTICS
Furnish white cedar shim shin les 2.00 Bndls $12,34 $24.68
Furnish new 2-1/2"colonial casing trim kits with sill and apron(TME) 1.00 LS $1,788-91 $1.788.91 $1,813.59
DIV 7 THERMAL AND MOISTURE PROTECTION
Furnish Geocel silicone caulkin 8.00 Tubes $7.54 $60.32
Furnish fiberglass insulation for around window frames 1.00 LS $60.00 $60.00 $120.32
DIV a DOORSAND WINDOWS
Windows
Furnish and install Velux fared sk it ht w/flashing kit 2.00 EA $475.00 $950.00
Furnish new construction windows 1.00 LS $10,247,71 $10,247.71
Furnish Rams Crown molding above first floor front windows 4.00 EA $56.38 $225.52
Install windows and trim kits install price based on existing siding being 23.00 EA $125.00 $2,875.00 $14,298.23
removed and new siding and housewrap installed
Doors
Furnish new 3068 Therma-Tru CCA260 entry door with matchirq 1.00 EA $3,159.88 $3,159.88
CCA220SL sidelights. Door is hinged on the left as viewed from the
exterior,vinyl cornow ambs,with ad'ustable sill and brushed Wicket
hardware. Exterior casin s have been left off so door can be trimed to
match picture Provided by owner. Includes Natural Oak stain kit
Furnish new Harvey H904 aluminum storm door white with Dakota 1.00 EA $457.93 $457.93
Plated pull handle and keyed deadbolt Brushed nickel
Furnish new 2-1/2"colonial casin s 3.00 EA $9.30 $27.90
Furnish Schla a Century handleset wl deadbolt satin nickel 1.00 EA $209.00 $209.00
Install en door 1.00 FAX $225.00 $225.00
Install storm door1.00 EA $100.00 $100.00
Furnish new 2868 Therma-Tru FC10 entry door. Door Is hinged on the 1.00 EA $830.20 $830.20
richt as viewed from the exterior vinyl corn osiie'ambs ad'ustabie
sill and brushed nickel hardware. 3"vinyl exterior casing factory
applied to match windows. Includes Natural Oak stain kit
Furnish new 2-112"colonial casings 3.00 EA $9.30 $27,90
Fuish Sch1a e Plymouth entry knob wt deadbolt satin nlcke 1.00 EA 572.60 $72.60
m
Install entrydoor 1.Q0 EA 5175.OtS a975.OD
Div 9 FINISHES
Paint/Wall covering and Spactaltv finishes
Ai/ ainGh /stain/n done by owner
General Conditions
Protect Mana er N/A
Planning/Development INIA
Shop Drawings&Reproductions N/A
Project meelin s N/A
Construction Subtotal $21.817.55
PERMIT AND APPLICATION FEE 1.00 LS $370.90 $370.90
Overhead 10% $2181.76
C nstruction F 0° $2181.76
C nstructl n T TA 2 561. &
Supolled By OtherorPard Via Purchase Order
All fumiture,fixtures,and equipment
Subtotal:
TOTAL: $26,551.96
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�. 29 South Moin Street,Newton,NH 03858
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NOT TO SCALL
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035 0--D005 r T- 7- //,
- Rail Line Wetlands Zoning
Interstates Exempt Lands Bu:ine!a I District
Busine a 2 Di lid"t Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
I R IS Busine!a 3 District M.I..Dada Sources:The data for this map was produced by Merrimack
0 -Busia 4 Distirict OORTH Valley tanning Commission(MVPC)using data provided by the Twin of
Roses 0 G.n...Business District OfSo North Andover.Additional data provided by the Executive Office of
�'4 E.smperd� N "
Planne,I Commercial Dev Environmental Affairs/MassGIS.The information depicted on this map is
, Colido Development Dist
LMVPC Boundary for planning purposes only.It may not be adequate for legal boundary
j Corrido Developmen Dis OA definition or regulatory'Interpretation.THE TOWN OF NORTH ANDOVER
Q Municipal Boundary III C-do Development Dls� MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
Zoning 0 eday Indusbi I1 District THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
(3 Ad.t v Industrid 2 District
Entertainment OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
0 Davint wn Overlay District El Indusin if 3 District ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
(3 Historic District W Industri it S District THIS INFORMATION
(3 Water Protection Reside,cel Olstrrt
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CERTIFICATE OF LIABILITY INS U NCE 515115E(MMrDarYYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 Laf Gowan
_NAME:—__. ._ _.-..
PHONE ..-7 FA%.- 978-5214669
Cowan Insurance Agency,Inc. .o'EXt)(9788 3721451
359 Main Street EMAIL la cowaninsurance,com
DRESS:._RY,@-- ----
Haverhill MA 01830 --_---- INSURERIS)AFFORDING COVERAGE — ------ NAI.0#!
INSURER A:Associated Employers Insurance Compa>
INSURED INLIRR-@ .
Summit Design Build Inc. INSURER c __....., _.
29 Eames StreetNSV.ar=R_a:
North Reading MA 01864
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.
IMSR DDLSUBR - -- - ! POLICY EFF ( P01.1CY EXP
TR�: TYPE OF INSURANCE POLICY NUMBER I M LIMITS
11 I.GENERAL LIABILITY `EACH OCCURRENCE V�._.....-.. .
-----=--._.. .........
t
DAMAGE TO RENTED
MERCIAL GEhYEi2„dtL k7ABiLTG'Y I ,
�6 REM SES(EEt crcterw Z b 1.
CLAIMS-MADE OCCUR I } MEED EXP PAa orm wson S
„_,... R PERSCDNAI=B.A$SV tN.PP.dRY y
4_C=ENEWL.AGGREGATE I ........ __,..... _
I
r—GENBGATEYMiTAPPLIE PRODUCTS_.,C MPdOTAGG J SS
_.
PRO-
CT �LfCPOUCY _
AUTOMOBILE LIABILITY COMBINED SINGLE LBMbT
person) 1 —
_ ANY AUTO BODILYINJLIRY(Per i
At.L,OWNED r—..SCHEDULED BODILY INJURY Per ac d”. t1
5
AUTOS AUTOS _.
HIREDAUTOS AUTCSED
PROPERTY DAMAGE 1 S
T UMBRELLA LtAB i OCCUR I EACH OCCURRENCE i s
CLAIMS-MADE -
� t
EXCESS LNAB ..—_
� ....d......_. ._ — ___ f p r r AGGREGATE I S
DEa ?RETENTIONS l S
ANY PROPRIF,TORIPARTNERPExECUT L Y STATI @ OTH
WORKERS COMPENSATION '
AND EMPLOYERS'LIABILITY Y, T14RY9IMfTS .. ...ER
_,.. -
A oFFIr.ERrMEMaER ExOR.uDEa� � N I Al WCC5010993012015 10511212015 j 0511212016 EACH ACCIDENT1$10 0r000
j(Mandatory in NH)
E.L.DISEASE-EA EMPLOYEE!$100,000 ..�,.
f If yyes,describe under j , ... _. ......
DESCRIPTION OF OPERATIONS be%ow E i E..L.DISEASE-POLICY LWIT f s 500,000
i k �
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required)
Residential carpentry contractor. Michael Coughlin in not covered by the worker's compensation policy.
CERTIFICATE HOLDER CANCELLATION
Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10600 Osgood Street ACCORDANCE WITH THE POLICY PROVISION .
North Andover,MA 01845 AUTHORIZED REP E TATNE ��)Fax:(978)688-9542
OO 1988-201 CORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks �ACORD
� T6 F LIABILITY DATE(MM/DD/YYYY)
aC/�1.6 d
05/01/2015
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
JAMES J MURPHY INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ONE CENTRE STREET, 2ND FL ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
MALDEN, MA. 02148
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A' WESTERN WORLD INS.COM.
SUMMIT DESIGN BUILD INC. INSURER B:
29 EAMES STREET INSURER C:
NO. READING, MA 01864 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR AUU L TYPE OF INSURANCE POLICY NUMBER DATE( MIDDIY ) UC IR
DATE( IDD YYN LIMITS
A GENERAL LIABILITY NPP1375522 05/18/2014 05!18/2015 EACH OCCURRENCE $ 1,000,000.00
COMMERCIAL GENERAL LIABILITY PREM E TO RENTED 50,000.00
PREMISES Ea occur.".) $
CLAIMS MADE ® OCCUR MED EXP(Any one person) $ 5,000.00
PERSONAL&ADV INJURY $ 1,000,000.00
GENERAL AGGREGATE $ 2,000,000.00
PRODUCTS-COMPIOP AGG $ 2,000,000.00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROJECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
(Per person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY $
(Per accident)
NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $_
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT _
OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $
OTHER
-DISCR]PTION OF OPERATIONS ILOCAT
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
TOWN OF NORTH ANDOVER DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
1600 OSGOOD STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
NORTH ANDOVER, MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
JO-ANN P. DICHIARA
ACORD 26(2001/08) O ACORD CORPORATION 1988
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Convstruction Supervisor
License: CS-083853
MICHAEL S COiT6I37L0� �.
29 Eames Street
North Reading MA 018114„7 %
r
`c
n�`` Expiration
Commissioner
05/20/2016
&lie�pa.nt��2oozcaeal�l a���aJaccc�tccQel
Off'tee of Consumer Affairs&Business Regulation
OME IMPROVEMENT CONTRACTOR
egistration: 166149 Type:
xpiration: -412-9/2-016 Private Corporatic'
SUMMIT DESIGN BUILD INC.
MICHAEL COUGHLIN
29 E'AMES ST �
NORTH READING, MA 018641
Undersecretary
f