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Home My WebLink AboutBuilding Permit # 6/9/2015 UUILUINU FLKMI I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINA'I, N. Permit NO: Date Received Date Issued:..3�7-* r— IMPORTANT: Applicant must complete all items on his page 111/01/1 / rrr /, /,/�, ,% // //� //i , �/ /ri/ , ir , /iii, //// / / , / // // ERIN, I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 11 One family 11 Addition 11 Two or more family 11 Industrial LYAlteration No. of units: 11 Commercial 11 Repair, replacement 11 Assessory Bldg El Others: 11 Demolition 11 Other J,,r ,,,„ , ,,i,,��,,r,,,/��i/i��f/��//iiir/�.rii�,/if/,,i/��i,�/�i�i/%i/ii%////!/,r,//�%f//i��/ //�i�%�/„i/�//�I/i�/„/,r. UEW N r>(°w E L71 i�� C)FCI N 6 Identification Please Type or Print Clearly) OWNER: Name: "'-Ywt Phone: 242- Ae— Address. Daftyl�d C--�J fe-C Y-Y� 0 ARCH ITECUENGIN EER i Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:VZOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ ?.25'� ,bO Check No.: r Receipt No.: P NOTE: Persons contracts A unregistered contractors do not have access to the guaranty fiend c”'tractor ;Of 61, l Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 4,� Starnped Plans ❑ Finblic F SEWERAGE DISPOSAL ewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ l] Tobacco Sales El Food Packaging/Sales El (septic tank, etc. ❑ Permanent Duxnpster on Site ❑ THE FdLLOWINO SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN ®EE' U FORM PLANNING & DEVELOPMENT Reviewed On Si nature `r COMMENTS—d-0 C�' L K 'N C ._ .. :, CONSERVATION Reviewed on_�°°�� Signature' COMMENTS- _° KZ n1Cf'-&j1,P d HE Reviewed on Signature COMMENTS 4. Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Si nature& Date Driveway Permit � � II DPW Town Engineer: Signature: Located 384 Osgood Street FIRE0,®EPAR :: : : p umpster qn site yep Located�at 124y/ treet �e /O r r a Fired®epar ,men's' A a,sfiur ldage ,rr%� '3 CUCI�IIIVTS, i Dimension Number of Stories: Total square feet of door area based Exterior dimenstons. Total land area, sq. fl.: ELECTRICAL: Movement of Metei° location, mast®r service drop requires approval ®f Electrical Inspector Yes No DANGER ZONE LITERATURE.- Yes No MGL.Chapter 166 Section 21A—F and G min.$1oo-$1o0o fine i NOTES and DATA— (For department use) LJ Notified foricku Call ----,Email P Email Date Time Contact Name Doc.Building Permit Revised 2014 �I t%O R TH Town of tTA" ndover o No. - ,� , h ver, Mass, c, LAKO A-qCOC NICHT WICK °°R.,TEo 01P�„��(y S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System �® BUILDING INSPECTOR THISCERTIFIES THAT ..........................................&...j.............................................................................. Foundation has permission to erect .......................... buildings on .. !:e:.. ....... ................................ �® Ae�fL �e"eJ . " '6Jri Rough tobe occupied as ......................t:............................ ........................................................................ Chimney provided that the person accepting this permit shall in every respect conform to 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 Final PERMIT EXPIRES IN 6 M NTH ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N' RT Rough Service ................ ........................ ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Building 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. Budding R'emo�'Ichn""l, Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 North Andover, MA 01845 LLC 978-479-1526 5/17/15 t adambrico@gmail IM1111101111111111HContrac Rob Barter 242 Dale St North Andover MA Job Description: Installation of new Pressure Treated Deck 0 Plot Plan provided with deck footprint 0 Deck to be started 10' by 30' joists to be framed parallel to the house. Deck to be built to code 2x10 joists and beams. 0 # 5, 12"x 4' deep holes with sauna tube and concrete poured. 4x6 PT posts used for structural supports. 0 At 20' corner, deck to be stepped up creating head room below. And to extend 10' against the house making backside dimensions 20'. Outside rim to be cut into house to rest on foundation to avoid an additional footing • All material to be pressure treated lumber nailed with galvanized nails including decking. All hangers and fasteners to be galvanized. • Rails to be designed in the field with appropriate fastening • Stairs to be on deck side D with a 3'x3' platform step down. 1, 12" sauna tube to be dug for platform support • Permit fee included • Sill fence and hay bales must be installed before construction can begin Total Amount$7800.00 Job Description 2: Sunroom Remodel • Sunroorn to be demoed to studs all debris disposed off site • Floor to be built up for from existing slab to receive insulation and moisture barrier. Floor to receive "hardi backer" underlayment and tile. Tile and grout supplied by owner • Wall A to be removed and new structural LVL installed posted to foundation and existing structural beam in basement. If beam does not land on existing structural beam a footing and tally column may need to be installed in basement and priced accordingly • Wall B to receive new vinyl casement windows, new insulation sheet rock and plaster. • Wall C to receive 8' Vinyl slider (action tbd), insulation, sheetrock and plaster, • Wall D, to have 4-sided cased opening • Ceiling is quoted to receive new insulation, blue board and plaster. If ceiling can be raised priced to be adjusted in the field. • Room to be wired to code, 1 exterior plug, ceiling fan to be setup and installed, Fan provided by owner • Heat to be provided in new space along wall B • Interior trim to match existing house. Exterior to remain white vinyl. Any exterior trim to be PVC boards • Painting not included Total Amount $8700.00 Job Description 3: Framing of basement walls, all finishs by other. • Walls to be studded all openings framed out. • Soffits built around plumbing stack. • 2 Windows replaced Total Estimated cost: $2900.00 Total Contracted Amount $19,400.00 The Owner agrees to pay BriCo Building and Remodeling $19,400.00, for doing the work outlined above. The following payments will be paid to the contractor in the following manner: Deposit of$2500.00 is due on contract signing. Second Payment of$3500.00is due at completion of framing and decking is being installed Third Payment $1800.00 is due at completion of deck Payments for sunroom and basement will be due once construction has begun in those designated areas. Sunroom payments will coincide with the ordering of windows and doors. Window and door orders can take 2 weeks for item to be manufactured. Any unforeseen work or necessary repairs found during this project to be brought to the owners attention as soon as possible. Any extra work resulting from unforeseen problems will be priced accordingly on site and be done with written approval. BriCo is not responsible for anything that occurs on site that is not directly involved with the construction of this project. BrICo Building and Remodeling is a fully licensed and insured LLC company. License numbers are provided in the header above and current insurance documentation upon request. All subcontractors must carry the appropriate license and insurance to perform work in the state of Massachusetts. The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices, and all work performed shall be subject to final approval by Owner. All work to be done incompliance with Massachusetts building code. BrICo, takes on full responsibility of all necessary inspections. . BriCo, warranties all construction related to this project for two years after completion. Dated: Signature of Owner: Signature of Contra rr: ii Massachusetts Home Improvement Sample Contract ii This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect liomoawncrsjSecic legal advice ifnecessary. Any person planning home improvements should first obtain a ropy of"A Massachusetts Consurner Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by gulling the I Office ofComumerAffairs and liusiness Regulation's Consumer WormationHotlino at 617.973-8787 or 1-888-283-3757 or on our website. Homeowner I II ormation Contractor Information 'Name CompanyName TOR, -1,6L ii St=tAddress(do not use a PostOfficlo!Box address) Contractor/Salesperson/Owner Name xlv,� City/Town State Zip Code Business Address(must include a street address) Tv yr C M A 018 9 Lj I—j c r,L Daytime Phone Ev,M'ing Phone Citytrown State Zip Code rk Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number K916 2 o H.-1,9-t Cont=lor Reg.NuwNofin& r Ex � frdo.].,IV' VM1d ghtr.,fl..uWv The Contractor agrees to do the following workfar the Homeowner: (Describe in detail the work to compleQ,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary �tk 5w ry 'o c c,ic , 'V01k)h&. 0 F CY,1511 A)(d :50 A)0 CAD YNA, Required Permits-The followingibuilding permits are required Proposed Start and Completion Schedule-'The following schedule:will and will be sdoured by the contactor as the homeowner's agent: be adhered to unless circumstances beyond the conftactoes control arise (Owners who secure their own Permits will be excluded from the Guarani Y,Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and PayniefitSchodule The Contractor agrees to perform the worl;furnish the material and labor specified above for the total sum of: Luo,0 4) Payments;will be made according t0he following schedule: upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) by or upon completion of by or upon completion of upon completion 6fthe contract (Law forbids demanding full payment until contract is completed to both party's satisfaction) I I The following materiallequipm1ek must be special to be paid for ordered before the contracted rvWrk begins in order to meet the completion schedrde!,(**) to be paid for NOTES:(*)including all finance charges('*)Law requires that any deposit or down-payment required by the contractor before work begins may net exceed the greater of!(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. I, Pxnress Warranty-Is in.oxin-ess wa'rr'anty. bduzi)rovidedbvtlieconti,nctoi,? El NoZYcs Lail terms ofthe war rante mg5tbenttachcd to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the&ntractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agree6ent Conti-act Acceptance-Upon sigi4g,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any Eefi'or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract • DonX be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Malce sure the contractor has alvalid Home Improvement Contractor Registration. The lam,requires most home improvement contractors and subcontractors to be registered'&ith the Director of Home Improvement Contractor Registration,You may inquire about contractor registration by writing to the D�plpctor at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757, • Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of "proof ofinsuradco"document. • Know your rights and responsibilities. Read the Important Information on the reverse side ofthis form and get a copy of the Consumer Guide to the Rome Improveine!lht Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractoes normal place of business,provided you 7n= contractor in writing at his/her main or branch office by ordinar),mail posted,by telegram sent or by delivery,not later sines daY"1'; - ' n 'dn7Pghtfthc ir -ofthis agreement. Seethe attached notice of cancellation form for an explanation o t. I right. DO NOT SIO THIS CONTRACT IF ',RE' ARE' ANY BLAND SPACES!!! Twoidenfic ooplorthew` ctmmtbelwmplewdandsig.M.0acwPYsb0uld9otoomhomV if ffm tuner'sSi to Contractor's Signature ate 15 f Figure 24:Typical Guard pefaii °RZ:t Q maximum spacingP� tlicks, YP 2x2 t ical. 3 T 4x4 post,typical Wor 514 board R->n p i Do NOT NOTG rafl cap o"m T 0 a o Q7 0o Q � minimum 7x4 top and bottom; 3 6� Q" attach to guard post Wth (2)8d common nails or 3 (2)#ti wood screws on 0 inside fere � A �0 (2)i12"diameter openings shat►no€allow attach pickets at top and bottom rr- lhru-bolls and them sage 11 a 4" with(1)#£t wood screw or(2)Bd n washers the.pdiameter sphere post-frame ring shank nails with 0.130"nominal diameter American Forest&Paper Association ------------ ®® f 20 q LL � - , s C "oi ? I ;p, ,1oB BrCo Building & Remodeling, LLC 6 SHEET No. CF 417 Waverley Road North Andover,MA 01845 78 CALCULATED BY DATE Ps adambrico@gmail.com CHECKED BY DATE Local 103 IBEW """ SCALE IVA ago— too— i a pan r ,ten. �✓��r'@..... � �� `�� ',... l 47 � ,� P sem• • CONSERVATION DEPARTMENT Community Development Division May 14,2015 Julie Nigro 242 Dale Street North Andover,MA 01845 242 Dale Street, North Andover Construction of a deck on Sono-tube Footings Conservation Conditions of Approval,NACC #141 Pursuant to section 4.4.2 (A) of the North Andover Wetlands Protection Regulations,Julie Nigro, filed for a small project for work proposed at 242 Dale Street,North Andover.The proposed work includes the construction of a deck(402 sq. ft. total—only 100 sq. ft.is within the Buffer Zone) on sono-tube supports.The deck is approximately 95 feet from the edge of Bordering Vegetated Wetland (BVW) as shown on the herein referenced plan. During the May 13, 2015 public meeting, the NACC voted unanimously to approve this project.All work shall conform to the following: RECORD DOCUMENTS: Small Project Filing Including: Application Checklist, narrative, sketch plan and MIMAP aerial image. Filing received: 4/29/15. The following conditions are hereby mandated: CONDITIONS: 1. Prior to the start of construction the applicant shall ensure drat the site contractor has reviewed the small project permit and is aware of the wetland resource area and the limits of the proposed work. 2. No erosion controls are necessary. 3. Excess construction material shall be properly disposed of offsite and accepted engineering and construction standards and procedures shall be followed in the completion of the project. 1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www.http://www.townofiiorthandover.com/conservel.htm 4. Upon completion of the approved project and site stabilization,please contact the Conservation Department for a final inspection. 5. This permit shall expire six months from the date of issuance. Should you have any question or comments regarding the contents of this letter,please do not hesitate to contact the undersigned at 978.688.9530 at your earliest convenience.Thanking you in advance for your anticipated cooperation with this matter. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT Heidi Gaffney Conservation Field Inspector 1600 Osgood Street Budding 20,Suite 236,North-Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688-9542 Web NVWW htV-/Js�w-tomaofnordundovercom/consertelhtm The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 wwwmass.gov1dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Brico Building and Remodeling LLC Address:417 Waverly Rd City/State/Zip:North Andover, MA 01845 phone#:978 479 1526 Are you an employer? Check the appropriate box: Type of project(required): 1.IN I am a employer with 3 4. E] I am a general contractor and 1 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp.insurance.t required.] 5. 0 We are a corporation and its 10.El Electrical repairs or additions 3.M I am a homeowner doing all work officers have exercised their I LF1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.n Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.[:] Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Travelers Insurance Policy#or Self-ins.Lic.#:7pjub4618p507 Expiration Date:*20*5 4fboll, Job Site Address: d L r:, City/State/Zip: eta.Ara 6vr �'t MA 6�Flj< Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date Phone ff: 9784791526 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector .gc.vEru CERTIFICATE OF LIABILITY INSURANCE I ""i 5/19/15 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 CERnRCATE HOLDER. IMPORTANT: If the certificate holder Is an ADD17IONAL INSURED,the pollcy(ies) must be endorsed. if SUBROGAM N IS WAIVED,subject to the terns and conditions of the policy,certain policies any require an endorsement A dafeawnt on this certificate does not confer rights tD the certificate holder in lieu of such endorsemen PRODUCER NAME: Tru Lawler Michaud Insurance PHONE 105 Haverhill St 978 FA 685-2 49 N • (978) 794-0822 Methuen, MA 01844 A4D Ss: tru lawler@aichaudinsurance.com INSURE S AFFORDING COVERAGE NAIC IF INSURER A:Northland Insurance INURED INSURER B: BRICO Building b Remodeling LL INSURERC: Adam J Brien INSURER D: 417 Waverley Rd INSURER E.- N Andover, MA 01845 INSURER E. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 ANDCONDiTIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. LTR TYPEOFINSURANCE POLICY NUMB SR AWL SUER MIDD iMIDO�fY LIMITS A GENERALLIABILTTY X WS201172 4/13/15 4/13/16 EACH OCCURRENCE s 1,000,000 X COMiMERCIALGENERALLLABMJTY DAMVIGETORENTED $ 100 000 CLAM-MADE a OCCUR MED EXP(Ary ore person) $ 5,000 PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE $ `Z 000 000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COWIOPAGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY a eccidert L $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS, BODILY INJURY(Per exdent) $ HIREDAU70S N -OWNED PROMAMAGE $AUTOS S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS{MOE AGGREGATE $ DED RETENTION S WDRKERS COMPENSATION WC STATU OTH- AND EMPLOYERSLABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTNE OFFI(ERINEMBER EXCLUDED? NIA EL.EACH ACCIDENT $ (Mandabq In NH) EL.DISEASE-EA EMPLOYE Nyyes dew bo under DRUIPTION OF OPERATX)NSWo. E.L.DISEASE-POLICY LIM S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHCLES(Atbeh ACORD 101,AdMicnal Rar arks Sdndula.If mon space is rsgrhsd) CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N Rob Barter ACCORDANCE WITH THE POLICY PROVISIONS. 242 Dale St North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Konnie Phifer ®1988,2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE V2112n7YY) T IFICATE 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 IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the arms and conditions of the policy,certain poples may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsemen s PRODUCER CONTACT NAME: NANCY GREENWOOD SMITH PHONE FAX I 1 HAVERHILL ST (A1C,No,Ext): E-MAIL METHUEN,MA 01844 ADDRESS: 726KN INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA BRICO BUILDING&REMODELING LLC INSURER e: INSURER C: INSURER D: 417 WAVERLEY RD INSURER E: N ANDOVER,MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: FY 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 07HER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN B SUBJECT TO ALL THE TEAMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. NSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MIRAIDDIYYYY) (LNADDIYYYY) LIMITS GENERAL LIABILITY :ACH OCCURRENCE $ rGOTL MMERCIAL GENERAL LIABILITY o AMAGETO RENTED $ CLAIMS MADE ❑OCCUR. REMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ ICY [:3 PROJECT❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) _ ALL OWNED AUTOS BODILY INJURY ,$ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accent) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB 11 CLAMAS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ ®®$ A WORKER'S COMPENSATION AND XWC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-461SP607-14 04/19/2014 04119(2015 LIMITS ANY PROPERITORIPARTNERIEXECLITIVE Q OFFICERIMEMBER EXCLUDED? N/A E.L EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 II yes,desrrlbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERA71ONSILOCA710NSNEHICLESIRESTRiCTIONS/SPECIAL ITEMS TUB REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. JOB SrrE:KANES DOUGHNUTS 10 OLIVER ST BOSTON MA CERTIFICATE HOLDER CANCELLATION ROB BARTER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 242 DALE ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT .VE NORTH ANDOVER,MA 01845 4.0 , ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1288-2010 ACORD CORPORATION. All rights reserved. wo/ymnoww*-,a////;Y// 0,1,4 _ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 168512 Type: LLC Expiration: 3/1/2017 Tr# 262883 BRICO BUILDING AND REMODELING LLC ADAM BRIEN 417 WAVERLY RD NORTH ANDOVER, MA 01845 Update Address and return card.Mark reason for change. SCA 9 0 20M-05/1 s Address ❑ Renewal Employment Lost Card _-..._Office of Consumer Affairs&Business Regulation License or registration valid for individul use only =` OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 168512 Type: Office of Consumer Affairs and Business Regulation ,'Expiration: 3/1/2017 LLC 10 Park Plaza-suite 5170 Boston,MA 02116 BRICO BUILDING AND REMODELING LLC ADAM BRIEN 417 WAVERLY RD NORTH ANDOVER, MA 01845 Undersecretary Not valid without signature Massachusetts -Department of Puadlua.�;safety Board of Building Regualatjo,js and Standards ConwCa•uction supervjwa Luc-en'se: CS-104428 " �, •.tr r,w �Ar v '� ADAM J BRIEN --` I ",j 417 WAVERLY Ri0A D North Andover mA, 4 m,a+9ir fir �0 fib' --' �aC leu a°alatk o u.0 Commissioner 05/12/201$