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HomeMy WebLinkAboutBuilding Permit # 6/18/2015 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER ° o APPLICATION FOR PLAN EXAMINATION (� Date Received Permit NO: 9Ss U`+�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATCN �` � 1 ' .,,Fant PRdPERTY'aWNER NE,AP NO PF�RGEL' ZONING DISTRICT: Historic District yes no` Machine Shop Village yes rxo. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential r ❑ New Building 4--r6ne family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District o Water/Sewer Identification Please a or Print Clearly) OWNER: Name: �10L,�r4 Phone: 3^ U Address: Ct CONTRACTOR; Narn Phone: , (� Address: (. Sup, er ror's Construetion�>Licehs'e. Exp. Date: „ 7 Horine;Improvement License Exp: ,Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEESC IEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Proj ct Cost: $ FEE: $ Check No.: :4 4 :;Z- Receipt No.: :�4 S'- NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fun g Signature of A ent/Owner Signature of contract : t%ORTH ­ftdover -Town of O ® h ver, Mass, COC NI C MI W'CK y1' S u BOARD OF HEALTH ER ,,MIT Food/Kitchen Septic System THIS CERTIFIES THAT . �v— G.. b'' .... BUILDING INSPECTOR has permission to erect .......................... buildings on . .. ... .. %fl...Glfr�......,l..Ct.l�!.C�:!> .. 6Foundation� . Rough to be occupied as .......... .....1x . ...... ..,��.�:�,,1-,r.:�:�Q.n!L4�......................................... 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ........................... . .............. ..... G�� � Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BulldinRough 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. Vub�zN�[u3 101 ricl efts\till Road Hampstead,\H 03S�1 Phone:(601 329.50__ Fax::(603)329.7026 ACCEPTANCE/PROPOSAL LETTER Revision #2 Date: May 14,2015 Client Name: Rob & Susan Rogers Job Location: 60 Reliegh Tavern Lane, North Andover, MA Telephone Number: 617-943-2176 Job Description: Bathrooms Remodel & Interior Millwork Dear Mr. & Mrs. Rogers; We propose hereby to furnish labor and materials in accordance with the customer provided specifications (as discussed), for the scope of work as follows: Powder Room Remodel Tear Out 1. Remove and dispose of existing toilet. 2. Remove and dispose of existing baseboard molding, and door casing. 3. Remove and dispose of existing the flooring and underlayment 4. Remove and dispose of existing pedestal sink and faucet. 5. Remove and dispose of existing mirror. 6. Remove and dispose of existing wall sconces. 7. Strip and remove existing wallpaper. 8. Remove and dispose of existing FHW baseboard heat trim, and end caps. Install Bathroom- 1. Supply materials for and patch drywall as necessary due to wire relocation, tape and sand. 2. Skim walls as required to prep for new wallpaper installation. 3. Supply materials for and skim coat remaining wall areas. 4. Supply and install new underlayment and tile flooring. (Allowance included for tile, is $120.00) Customer Initials: 5. Install customer supplied mirror, above pedestal sink. 6. Supply and install new primed colonial baseboard trim. 7. Supply and install new primed 2 Y2" colonial door trim. 8. Prepare walls and install new client provided wallpaper. 9. Install new towel bar, toilet paper holder. (Allowance included for accessories is $65.00). 10.No priming, painting or staining, has been included in this estimate. Plumbin4- 1. Install new toilet, same location. (Allowance included for Kohler toilet is $342.70) 2. Provide materials for, install and new "White Gerber" pedestal sink, and Tanze" brushed nichol faucet and make final connections to same. (Allowance included for new pedestal sink is $254.00 and new faucet is $227.23). 3. Supply materials for and replace FHW baseboard heat trim and end caps. Electrical- 1. lectrical-1. Relocate wiring and install new single light bar above new mirror. Light bar to be provided by client. 2. Update outlet to GFI, as per code. 3. Provide wiring for and install new fan/light unit. (Allowance for fan/light unit included is $251.77). 4. Provide materials for and vent new fan unit to exterior. Debris Removal- 1. Remove and dispose of all construction debris from site. 2. Apply for building permit, call for inspections as required. Building permit fee to be billed at face value, cost of permit has not been included in this estimate. Powder Room Remodel Total $6,185.00 2"d Floor Bathroom Remodel Tear Out 1. Remove and dispose of existing toilet 2. Remove and dispose of existing vanity, vanity top, sink, and faucet 3. Remove and dispose of existing light bar. 4. Remove and dispose of existing medicine cabinet, and light bar 5. Remove and dispose of room center light fixture. Customer Initials: ���- 6. Remove and dispose of existing drywall on all walls, and ceiling. 7. Remove and dispose of existing exterior wall insulation. 8. Remove and dispose of existing cast iron tub unit 9. Remove and dispose of existing tile on half walls, and tile on shower walls, and shower ceiling. 10.Remove and dispose of existing shower head, valve, trim, tub spout, and drain assembly. 11.Remove and dispose of tub/shower header. 12.Remove and dispose of existing FHW baseboard heat trim cover and end caps 13.Remove and dispose of existing baseboard, door and window trim. 14.Remove and dispose of existing tile flooring, and underlayment. Install 2nd Floor Bathroom 1. Aid plumber with installation of new 60" X 32"tub unit with tile flange. 2. Provide and install new exterior wall insulation. 3. Provide and install new tile substrate at shower area, tape and waterproof. 4. Provide and install (1) recessed shower niche at shower area. 5. Provide and install drywall on all walls. 6. Provide and install drywall on ceiling, tape and sand. New ceiling to have smooth textured finish. Drywall on ceiling is to be applied to existing strapping; no leveling of ceiling has been included in this estimate. 7. Provide and install new the flooring, including underlayment. (Tile allowance included in this estimate is $275.00) 8. Install new Woodpro Ashford Maple vanity base cabinet, including toe kick molding and hardware. (Vanity and hardware allowance included in this estimate is $893.00). Shim cabinetry as necessary due to tile floor installation. 9. Install new Palette granite vanity top, with bowl, with left side splash. (Vanity top allowance included in this estimate is $245.00). 10.Install new client provided mirror above new vanity bowl. 11.Provide blocking for curtain rod, and install client provided rod. 12.Install new towel bar, toilet paper holder. (Allowance included for accessories is $65.00). 13.Supply and install clear pine colonial baseboard molding 14.Provide and install new primed colonial 2 '/2" door and window molding. 15.No priming/painting or staining has been included in this estimate. Plumbing-/H 1. Install new toilet, (12" rough), at existing location. (Toilet allowance included its $438.00). 2. Rework existing plumbing as required, and make final connections to new vanity bowl and "Danze" Fairmont faucet. (Faucet allowance included is $257.59). Customer Initials: -S2- 3. Provide materials for and rework tub drain as required. 4. Provide materials for and install new 60 X 32" 3 piece tub and wall unit. (Tub allowance included in this estimate is $1,306.00). 5. Provide materials for and rework and install new "Danze"Fairmont showerhead, valve, trim kit, tub spout, and drain assembly. (Showerhead and valve allowance included in this estimate is $233.00). 6. Provide materials for and install new FHW baseboard trim and end caps. Electrical- 1. lectrical-1. Install new client provided light bar above new medicine cabinet, rework line as required. Wire to existing switch. Light to be raised higher than existing. . 2. Provide materials for and install new GFCI outlet, at existing standard outlet location, as per code. 3. Provide wiring for and install new fan/light unit. (Allowance for fan/light unit included is$251.77). 4. Provide materials for and vent new fan unit to exterior. 5. Provide and install new sealed recessed light in shower area, wire to appropriate switching. Debris Removal- 1. Remove and dispose of all construction debris from site. 2. Apply for building permit, call for inspections as required. Building permit fee to be billed at face value, cost of permit has not been included in this estimate. 2nd Floor Bathroom Installation Total $13.935.00 2nd Floor Master Bathroom Remodel Tear Out 1. Remove and dispose of existing toilet 2. Remove and dispose of existing vanity, vanity top, sink, and faucet 3. Remove and dispose of existing mirror, and light bar 4. Remove and dispose of shower light fixture. 5. Remove and dispose of existing drywall on all wails, and ceiling. 6. Remove and dispose of existing exterior wall insulation. 7. Remove and save for reinstallation existing fan/light unit. 8. Remove and dispose of existing heat lamp, wiring and switch.. 9. Remove and dispose of existing the on walls, and tile on shower walls. 10.Remove and dispose of existing showerhead,valve,trim,and drain Customer Initials: l !�-- assembly. 11.Remove and dispose of shower header and wall framing. 12.Remove and dispose of existing FHW baseboard heat trim cover and end caps 13.Remove and dispose of existing baseboard, door and window trim. 14.Remove and dispose of existing the flooring, and underlayment. 15.Remove existing closet framing, door and shelving. 16.No rot or mold repairs have been included in this estimate. Install 2nd Floor Master Bathroom 1. Provide materials for and frame half wall at shower area, approximately 34" length, 42" in height. 2. Aid plumber with installation of new 64" X 34" shower pan, center drain. 3. Provide and install new exterior wall insulation. 4. Provide and install new tile substrate at shower area, tape and waterproof. 5. Provide and install (1) recessed shower niche at shower area. 6. Provide and install drywall on all walls. 7. Provide and install drywall on ceiling, tape and sand. New ceiling to have smooth textured finish. Drywall on ceiling is to be applied to existing strapping; no leveling of ceiling has been included in this estimate. 8. Provide and install new the flooring, including underlayment. (Tile allowance included in this estimate is $365.00) 9. Provide and install new shower wall tile and floor tile (tile to ceiling). Wall tile pattern installation included (Wall tile allowance included in this estimate is $800.00) 10.Install new Woodpro Ashford maple double bowl vanity base cabinet, including toe kick molding and hardware. (Vanity and hardware allowance included in this estimate is $1,545.00 ). Shim cabinetry as necessary due to tile floor installation. 11.Install new Palette granite vanity top, with (2) bowl, with left side splash. (Vanity top allowance included in this estimate is $498.00 ). 12.Install (2) new client provided mirrors above new vanity bowls. 13.Template for and Install new frameless shower door. (Shower door allowance included is $1,600.00) 14.lnstall new towel bar, toilet paper holder. (Allowance included for accessories is $65.00). 15.Supply and install clear pine colonial baseboard molding 16.Provide and install new primed colonial 2 '/z" door and window molding. 17.No priming/painting or staining has been included in this estimate. Plumbing-/Heating 1. Install new toilet, (12" rough), at existing location. (Toilet allowance included is $438.00 ). 2. Rework existing plumbing as required for new double bowl, and make final Customer Initials: SSC 2- connections to new vanity bowls and "Danze" Fairmont faucets. (Faucet allowance included is $515.18). 3. Provide materials for and shower drain as required. 4. Provide materials for and install new 64 X 34" shower pan unit. 5. Provide materials for and rework and install new "Danze" Fairmont showerhead, valve, trim kit, and drain assembly. Shower control valve to be installed at half wall location. (Showerhead and valve allowance included in this estimate is $273.00). 6. Provide materials for and install new FHW baseboard trim and end caps. Electrical- 1. lectrical-1. Wire for and install new client provided light bars above new medicine cabinets, wire to appropriate switch 2. Provide materials for and install (1) new GFCI outlet, as per code. 3. Provide materials for and relocate existing outlet and switch as per new layout. 4. Re-install existing fanHlight unit, connect to existing exterior duct work. 5. Provide and install new sealed recessed light in shower area, wire to appropriate switching. Debris Removal- 1. Remove and dispose of all construction debris from site. 2. Apply for building permit, call for inspections as required. Building permit fee to be billed at face value, cost of permit has not been included in this estimate. 2nd Floor Master Bathroom Installation Total $19,700.00 Grand Total $ 39.820.00 TERMS OF PAYMENT $ 4,000.00 To be paid at signing of this contract. $ 3,000.00 To be paid upon start of project S 5,000.00 To be paid at delivery of product $ 5,000.00 To be paid at the start of demo of master bathroom $ 5,000.00 To be paid at the start of installation of drywall main bathroom. $ 4,000.00 To be paid upon start of the work in main bathroom. Customer Initials: O/ $ 5,000.00 To be paid upon installation of finish trim and product installation of main bathroom and powder room. $ 5,000.00 To be paid upon start of the work in master bathroom $ 2,000.00 To be paid upon template of master shower door. $ 1,000.00 To be paid upon substantial completion. $ 820.00 To be paid upon completion of job. Substantial completion-Area in which work has been performed is functional,or occupancy can occur,and only punch list items remain to be addressed. Completion-When job has been completed as described in scope of work. Warranty- (3) year warranty begins upon completion of contracted work. Warranty covers: - Defective workmanship,performed by Dube-Plus Construction. - All products are covered under manufacturer's warranties. - Items purchased by the client for install are not covered by the Dube-Plus warranty. Proposal price is valid for 30 days from receipt of contract. No rot repair has been included in this estimate, unless otherwise noted above. If rot is discovered, additional repair cost will be discussed with the client at time of discovery. 5qX initial Unless otherwise noted above all construction debris is to be disposed of in a dumpster that is to be located in a mutually acceptable location on the client's property. It is common for a dumpster and/or the truck servicing the dumpster, to leave marks and /or damage the lawn and/or driveway. Repairing the lawn and/ or the driveway is not included in this agreement; it is the total responsibility of the HOMEOWNER. The dumpster company is not to be held responsible: this is a standard term of their agreement and policy. Z initial Any unforeseen problems uncovered at the time of excavation such as underground electrical, ledge, etc. may result in additional charges AND if the existing material is not suitable for the backfill of the new foundation or slab, additional charges may be incurred. 5-L initial The homeowner is responsible to remove any and all furniture,pictures and Mures in or around the work area prior to the installation process.All cabinetry must be emptied and appliances removed from the countertops. All pictures and valuable items should be removed from the vicinity of the work area as the installation Customer Initials: f1 process often creates small vibrations that may cause these items to fall from the walls or shelves. While our workers take the utmost care to prevent incidental damage,we cannot be held responsible for damage to items that the homeowner neglected to remove. 55Z initial Out of Network Materials or Sub Contractors—Although not preferred, Dube will allow the use of materials from an approved out of network supplier or use of approved subcontractors that are not Dube Subcontractors; However,Dube can not guarantee the quality of the materials / installation or prevent delays that may occur. Dube reserves the right to apply additional charges in the form of a "change order" if costs are incurred to Dube while using "out of network"materials or subcontractors. 5L initial SERVICE CHARGE: A service charge on past due accounts will be computed at "Periodic Rate" of 2%) per month,which is an "Annual Percentage Rate" of 24%). Customers shall be and are responsible for all costs of collection, including reasonable attorney's fees, arising from any breech of this agreement or failure to pay any amount due and owing. Changes to the above specifications will be accepted only if a written request is made. We will then complete a "Change Order" to supply you with the additional charges or credits. No work can be changed, altered, or cancelled without an authorized "Change Order". Payment of "Change Order" is as follows: Full Payment will be due Upon Signature of Change Order. ACCEPTANCE: the price (s), specifications and conditions above are satisfactory and are hereby accepted. You are hereby authorized to proceed with the work as specified. I/We agree to make payment as detailed above. My/our (the customer's signature below constitutes full agreement. Wood Related Products- Wood is a product of nature and includes a variety of species with various densities,colors and grain patterns. Through this natural process,graining differences,mineral streaks and color variations should be expected. Color variation within a wood species is influenced by a number of factors such as moisture and mineral content of the soil, exposure to sunlight and genetic makeup. All of these variations combine to produce unique characteristics that provide the beauty and essence of natural wood. All woods change color over time,and no two pieces are exactly the same. The amount of change varies depending on the wood species,type of cut,and amount and color of stain pigment used. Customer Initials: --K While color samples give a general idea of the appearance of specific stain color and wood species combination,it is impossible to represent all of the grain patterns,wood and stain colors, and natural variations that will occur. I bave`"1W and folly under:r nd the above desoibed irfor;nation Clients'Sagnalure llate Mtn Rob Rogers Date " Mr . Susan Rogers Date �10 Q ori anganr Date Dube-Plus & struction, PLEASE INITIAL THE BOTTOM OF EACH PAGE BEFORE SIGNING Customer Initials: �� -4 . _...._......_.._.. .. .... . . .. . . . .. .. . al: nLket t Van a� nu �ui.�8 yl` �� ..6' J6.'- v� c�•a o d l _ _ r I �i _ — r y I Il r r t - r 1'Jl II �0. � a q � 6 a Ap - Lx: _ � -� B Pte 4-Urn iurtweUttlt UJ 1V7[diSSUVr'ttt8't;tt9' 1 "-------____- - Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 z ,13,E Boston, AM 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 0 °� L- . (-kl U., 11) City/State/Zip: I Phone M -K2-!-7 `®' 7 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with* ��g 4. [] I am a general contractor and I ❑ have hired the sub-contractors 6. N w'construction employees(full and/or part-time),* ' 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' insurance.I 9. Q Building addition [No workers cornp'comp, insurance 10.❑Electrical repairs or additions required.] S. We are a.corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 'employees. [No workers' 13F] Other, comp.insurance required.] ' Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. j Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, :ontractors that check this box must attached an additional sheet Showing the name of the'sub-contractors and state whether or not those entities have nployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. atm an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site s formation. isurance Company Name: _ olicy#or Self-ins. Lia#:\KrK -'50 !2SL`! Expiration Date: >b Site Address: 1 City/State/Zip: ttach a copy of the workers' comp nation policy declaration page(showing the policy number and expiration date), r,ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the'imposition of criminal penalties of a ne up to$1,500.00 and/or one-year imprisomnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine .'up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of j .vestigations of the D for insurance coverage verification. j to hereby certify un er thepai s ndpenalti s�fperjury that the information provided above is true and correct. ---- --- - - .......... — .._.._.._ Date:(.. { lone#: i Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# I { Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/'Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: i DATE tMM[DDNYYY) AC CERTIFICATE F LIABILITY INSURANCE 4/24/2015 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), AUTHORISED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the poilcy(tes)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 NAMEACT Judith George CTC,CPIA,CPIW FIAT/Cross Insurance PHONE (603)669-3218 FAC e:(603)645-4331 1100 Elm Street ADDRJESS:JC eorge@erossagency.corn INSURERS AFFORDING COVERAGE NAIL# Manchester NH 03101 1NSURERA:Union Insurance Company 25844 INSURED iNSURERBAcadia Iris Co THOMAS A. DUBE CONSTRUCTION-PLUS INC. ABA INSURERC: Dube Plus & Dirt Pro; Watertown Village, LLC -INSURER D- 10 BRICKETTS MILL ROAD SUITE C INSURERE: HAMPSTEAD NH 03841 1 INSURERF: COVERAGES CERTIFICATE NUMBER:15-16 All 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. IBR IM1VDD LIMITS TYPEOFINSURANCE VIND POLICYNUdHER MDAT EFF MYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGETORENTED 250 000 A CLAIMVAADE X❑OCCUR PREMISES Eaoccu encs $ r X No GL Deductible X CPA5028190-13 4/26/2015 4/26/2016 MED EXP(Any om persoO $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENLAGGREGATE LIMITAPPLIES PER' GENERAL AGGREGATE $ 2,000,000 PPOLICY JEC7 LOC PRODUCTS-COMPIOPAGO $ 2,000,000 OTHER: Al-ownerA.essee)Conlractor-A $ AUTOMOBILE LIABILITY COMBINED accident) LEUIatT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B AUTOS SCHEDULED AUTOS X CAA5028191-13 4/26/2035 9/2612016 BODILY INJURY(Peraaident) $ NON-OWNED PROP tDATTAGE $ HIREDAUTOS AUTOS UrfrisurodmoloristoroDerty $ 25,000 X UMBRELLALTAB X OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAS CIAiMS4hADE AGGREGATE $ 1,000,000 RETENTIONS ICUA502e192-13 4/26/2015 4/26/2016 $ WORKERS COMPENSATION WPA5028193-13 X STA UTE ER AND EMPLOYERST LIABILITY - ANYPROPRIETORIPARTNERtEXECUTNE YIN IIIA (3a.) MITR EL FICHACCIDENT S 500,000 OF ICER/1.1EId8EREXCLUDED? Thomas Dube excluded 4/26/2015 4/26/2016 E.L.DISEASE-EA EMPLOYE S 500,000 B (Mandatory In NH) Hyes.describounderE.L DISFASE-POLICY LIMIT $ 500,000 MonDESCRIPTION OF OPERATIONS Mon DESCRIPTION OF OPERATIONS/LOCATIONS]VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is requTred) Covering work performed by the Named Insured during the policy period. Lowe's Companies, Inc. and any and all subsidiaries are Additional insured under General Liability and Auto Liability policies as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lowers Companies, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Installed Sales Insurance ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 111 N. Wilkesboro, NC 28656 AUTHORIZED REPRESENTATIVE <� ,T George CIC,CPIA,CPI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD tNS025 l9t114p tT Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-094372 LORIANN J LANqAN 7 CREST ROAD KINGSTON NH '03848 Tl f E J,,(,�,..,�i�• Expiration -� Commissioner 07/31/2015 (rice of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: 119623 Type : `b Expiration: 8/6/2015 Supplement Dube Construction-Plus,Inc: LORIANN LANGAN 10 Bricketts Mill Road,Suite"C" -9' Hampstead,NH 03841 Undersecretary