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HomeMy WebLinkAboutBuilding Permit # 6/30/2015 O� "ORTh q BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR.PIAN EXAMINATION - Permit NO: Date Received Date Issued: �9SSpcHuS'���y `' MPORTANT: Applicant must complete all items on this page LOCATION 76 5- .6111d_00L d PROPERTY OWNER AML /r"'tts r b L Print MAP NO � PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building C ne family F&Kd—dition ❑Two or more family ❑ Industrial I/Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: Wbemolition ❑ Other r ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑f Water/Sewer i kki_wl k4�'J Identification Please Type or Print Clearly) OWNER: Name: Phone: G17® 7? '/203 Address: aq4 6— /V„Lyi CONTRACTOR Name: Phone:� 717-GOo— Address:' Supervisor's Construction License: ^O6 7 _ Exp. Date: i Home Improvement License: Exp. Date: /7-;)L579 /� ARCHITECT/ENGINEER 3` 6111,raJa4.Xtf� Phone: (7 'ef'51- yam Address: S3 L a { Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATE OST BASED ON$125.00 PER S.F. Total Project Cost: $ ad� /0 FEE: $ Viel. Check No.: !y Receipt No.: 4 ' NOTE: Persons contracting 1with, eunregistered contractors do not have a s to he guaranty fund Signature of Agent/Owner Signature of contractor i Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning(Massage/Body Art ❑ Swumn'ng Pools ❑ JWell ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I i CANNING & DEVELOPMENT Reviewed On Signature_ C MENTS C®NPERVA.TION Reviewed on Si nature�l U, I COMMENTS Ujc) "-L HEALTH Reviewed on Signature COMMENTSC"J") Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments p C. nservation Decision: Comments Yater& Sewer Connection/Signature c& Date Driveway Permit J DPW Town Engineer: Signature: LocateT 384 Osgood Street SIE DEPAR ,N1EN;T - Temp Dumpster on site yesno; Locatedat124'MainStreet � ` '. P Fire Departnient�sig�ah i/d $e . . COMMENTS FORTH own ot Andover 0 NoT ' T O Verb ass, c oc"I c He w,c. 0Rareo V BOARD OF HEALTH Food/Kitchen PE� RMIT Lftff Septic System . a THIS CERTIFIES THAT .....4�S .. .. BUILDING INSPECTOR . .................................. ................... 6 Foundation has permission to erect .......................... buildings on .�... ..... � .. ..............*..... p ...K4-� J�..."� Rough to be occupied as ............ .... ...G...... . .......:�:.......I�..�.....�- ........... ....................... . 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 CO STRUCTIO A S Rough Service ....................... ... ........ .................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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. HOME IMPROVEMENT AGREEMENT I Agreement made this 17th day of June, 2015 between Henehan Construction LLC. , having a principal place of business located at 61 Brown Street, Andover, Massachusetts (hereinafter `Contractor") and Anthony and Courtney Hutchins of North Andover, Mass . (hereinafter "Homeowner") . SECTION ONE SCOPE AND DESCRIPTION OF WORK Contractor agrees to perform for the Homeowner certain alteration's and improvements in and upon the home of the Homeowner located at 265 Blue Ridge, North Andover Mass. in accordance with the specifications set forth in the attached list of labor and materials which is hereby incorporated into this Agreement by reference. See Attached Exhibit "A,' Estimate #304 i, SECTION TWO CONTRACT PRICE Homeowner will pay Contractor for the performance of the work described in the specifications set forth in the attached list of labor and materials as follows: $44, 982 . 00 � 20% upon the execution of this agreement. I $22, 491. 001 loo upon foundation complete $22, 491 . 001 10% upon framing complete i $22, 491. 001 10% upon siding complete $22, 491. 001 10% upon rough inspections complete i $22, 491. 00 10% upon plastering complete $22, 491 . 00 loo upon hardwood flooring Installation complete i $22, 491. 001 10% upon Trim Installation complete 1 Initials: Contractor Homeowner j Homeowne , I li $22, 491 . 00 10o upon final completion of the II work (refer to Section two) $224, 910 . 010 Total Payment If any installment under this Agreement is not paid when due, ;Contractor may require as a prerequisite to continuingjsaid work that the balance of funds due under the contract, which are in the possession of the Homeowner, shall be paced in a joint escrow account requiring the signature 'of the Contractor and the Homeowner for withdrawal,. No payment due shall be detained due to any particular item(s) needing special attention i. e. : defective, damaged or backordered items such as cabinet doors, moldings, drawers orfixtures provided work is in progress . The plrice agreed upon herein does not include possible expenses entailed in coping with hidden, unknown, or incidental items not included in pricing. (example: inspector or engineer requirements or overlooked conditions found afte' Contractor has commenced the work. ) In the event that such hidden or unknown conditions are found after Contractor has commenced work, and Contractor is required to perform additional alterations and improvements not set forth in the attached list of labor and materials . Homeowner ;agrees to pay all costs thereof upon completion of any such work. The Contractor shall inform homeowner of any such conditions in the form of an additional work authorizat''ion. (see attached copy) . i In the event that the Homeowner does not pay any installment or billing when due, the Homeowner agrees to pay eighteen percent (180) per annum upon any unpaid balance. If it is necessary to file suit for the collection! of any amounts due from the Homeowner under this Agreement, the Homeowner shall pay the reasonable Attorney' s; fees, together with court costs for this collection. I At the completion of the agreement the Contractor with the Homeow�er will prepare a punchlist of any work needing special attention ie: miscellaneous adjustments, replacements or repairs to any item(s) , and/or the installation of any item which might be backordered. Once 2 Initials : Contractor iHomeowner Homeowner i I i � I i i i a punchlist is agreed upon, final payment must be paid, less a hold back for the punchlist items . Completion of Agreement Io be defined as a space or remodeled area that is operable and functional. Miscellaneous items to be completed are part of the "punchlist". The hold back amount will be equal to the value amounts of any item(s) , which have been backordered or needs to be replaced or repaired. The hold back amount will include any labor involved and will be determined by the Contractor at that time . If after the initial punchlist additional items are found to need attention, they will be considered "Warranty Work" which will be followed up after the balance of the contract hIs been paid in full. SECTION THREE TIME OF PERFORMANCE i The work shall commence on or about the 06/22/2015 and shall be substantially completed on the 10/29/2015 Contractorshall not be liable for any delay or nonperformance caused by weather, strikes, unavailability of materiails, alterations or modifications initiated by the Homeowner, or any other contingency beyond his control . i SECTION FOUR CANCELLATION In thle event Homeowner cancels this Agreement after the execution of this Agreement, Homeowner shall forfeit the amountlof the down payment given to the Contractor at the time of the execution of this Agreement, and in addition, shall pay to the Contractor such proportion of the total Agreement price as the amount of labor and materials furnished bears to the total amount of labor and materials �greed upon to be furnished under this Agreement, including any and all items on order which cannot be returned for full credit, the same to be paid within thirty (30) days �rom the date of such cancellation. In the event the Contractor is unable to complete the performance of its obligation under this Agreement due to act of God, strikes, unavailability of supplies or materials, or any other contingency beyond its control, Homeowner may at its option cancel this contract, in which event, Homeowner shall be liable to pay Contractor the amount of labor and materia Ls 3 I Initials: Contracto Homeowner Homeowner I I I already furnished. Such payment is to be made within thirty (30 days after the date of such cancellation. SECTION FINE ALTERATIONS OR MODIFICATIONS i j Any alterations or modifications initiated by the Homeowner must be agreed upon between the parties and the price fixed by them before work on such alteration or modification shall commence. Payment for such alteration or modification shall be made before the order is placed or the work is commenced. SECTION SIX PERMITS AND LICENSES Contractor is responsible for securing the following necessary permits and licenses for the work at its own cost and expense: Buil�ng Permits Electrical Permits Plumb2ng Permits i I Homeowner acknowledges that Homeowners who secure their own permits will be excluded from the guarantee fund provisionsof Massachusetts General Laws Chapter 142A. j SECTION SEVEN LIMITED WARRANTY Contractor guarantees that the work will be constructed in accordance with accepted home improvement practices, jand it will guarantee against defects in workmanship and materials for a period of one (1) year from the date o'r its completion. This Limited Warranty does not cover damages or defects which are the result of characteristics common to the materials used, or conditions resulting Ifrom condensation, expansion, or contraction of such materials. Warranty work will be completed within sixty (60) days from the date of receipt of written request from Homeowner. t this Limited Warrant s Please note that Y specifically Y excludes consequential and incidental damages and there are limitation Ib in the duration of implied warranties . Th' 4 Initials : Contractor Homeowner Homeowners j i warranty is extended to the above Homeowner and is not transferable to succeeding homeowners . Contractor hereby passes thr�bugh and assigns to Homeowner any and all manufacturers' warranties on all appliances and equipment supplied by Contractor in the home. Contriactor specifically does not assume responsibility for any ofithe following items, each of which is specifically excluded from this Limited Warranty: 1. Most people are aware of the "natural" characteristics of wood. since no two trees are exactly the same, wood is a unique material and natural variations in grain, texture and color are the ingredients that create the "beauty of wood" . These variations can also cause noticeable differencers between your sample and your finished cabinets . These grain and tone differences are a natural and acceptable condition of quality wood finishes and will be even more pronounced in a complete kitchen. Our suppliers only use si elect woods to insure their quality. 2 . Defects in appliances or pieces of equipment which are covered by manufacturers' warranties . As these will have been assigned directly to Homeowner, each manufacturer' s warranty claim procedure must be followed where a defect appears in any of those items. 3. Damage due to ordinary wear and tear, abusive use, misuse, or; lack of proper maintenance or the home or its component parts or system. 4 . Defects which are the result of characteristic common to materials used. Such as, but not limited to: i a) warping or deflection of wood; b) fading, chalking and checking or paint or stain due to sunlight; C) tracks in concrete due to drying and curing of concrete plaster, brick or masonry; and d) drying, shrinking and cracking of caulking and weather stripping. 5. Defects in items installed by Homeowner or anyone other than1Contractor or its subcontractors at Contractor' s order. i 5 Initials : Contracto Homeowner 1 Homeowner I i 6. Work done by Homeowner or anyone other than Contractor or its subcontractors at Contractor' s order. 7 . Defects in items supplied by Homeowner. 8 . Loss or injury due to elements. 9. Conditions resulting from condensation on, or contraction of materials . All implied warranties including, but not limited to warrantieslof merchantability and fitness for a particular purpose, are limited to the one year warranty period as set forth above. This Limited Warranty is the only expressed warranty given. InIthe event that any of the provisions of this Limited Warranty shall be held to be invalid, the remainder of the provision of this Limited Warranty shall remain in full forcejand effect. I SECTION EIGHT ALTERNATIVE DISPUTE RESOLUTION PURSUANT TO MASSACHUSETTS GENERAL LAWS CHAPTER 142A I The p�' rties acknowledge and declare that the Contractor may initiate alternative dispute resolution through any private arbitration services program approved by the secretary of the executive office of consumer affairs and business regulation under Massachusetts General Laws Chapt r 142A, sub-section 4, to consider any dispute between the parties concerning or arising from this Agreement. We, the Contractor and the Homeowner, have read the above prov�sion and both have signed it as our free act and deed, ther'eb as senti.t,t� the procedure. HOMEOWNER ---- Date HOMEOWNER Date i / O CONTRACT / Date / i I 6 Initials : Contracto Homeowner Homeowne I� i SECTION NINE OTHER NOTIICES REQUIRED PURSUANT TO MASSACHUSETTS GENERAL LAWS CHAPTER 142A j All contractors and subcontractors must be registered by the chief administrator of the board of building regulationis and standards, an agency within the executive office of public safety, established by Massachusetts General Laws 6A, sub-section 19. The Contractor holds Home Improvement Registration Number 172582 The salesperson who solicited and/or negotiated this Agreement lis John Henehan i Liability insurance is provided by Henehan Construction, LLC. for their employees and subcontractors . A certificate of insurance will be provided to the customer upon request. SECTION TEN ENTIRE AGREEMENT i The parties acknowledge and declare that this Agreement !contains the entire agreement between the parties hereto andthat there are no agreements, promises, terms, conditions, or understandings and representations or inducements leading to the execution hereof, expressed or implied, other than those herein set forth and that no oral statement or prior written matter extrinsic to this Agreement ;shall have any force or effect. Any changes or alterations in this Agreement shall be valid and effective only if agreed upon in writing between the parties. i Please review carefully all parts of your agreement which includes your kitchen/bath agreement, drawings, and quote, to assure their accuracy for scope of work, cabinetry layout, pricing, and terms of agreement . With kitchen planning, design, and/or remodeling the work scope is quite detailed and individualized, in some cases more than others, and our agreements are presented and formatted to describe the work proposed as best as possible in a simplifiedl�Iand descriptive manner. Several options, ideas, and suggestions have been presented and this agreement summarizes all the final decisions discussed and agreed upon and aIny verbal discussions are not part of this 7 Initials : Contracto Il— Homeowne � Homeowner i I I i i agreement and if purchaser feels anything needs clarification, we would be happy to put it in writing at this time I The attached Exhibit "A" which may include drawings and list of labor and materials, if any, are hereby incorporated into this Agreement by reference. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES! We, the Contractor and the Homeowner, have read the above Agreement on this 17th day of June, 2015 and understand its terms and both have signed it as our free act and deed at 265 Blue Ridge Road, North Andover Massachusetts . HOMEOWNER CONTRACT I HOMEOWNER I THE HOMEOWNER ACKNOWLEDGES RECEIPT OF A COPY OF THIS AGREEMENT I HOMEOWNER I _ DATE HOMEOWNER DATE I I i f i I i i i 8 j Initials : Contracto i Homeowner Homeowner i I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information // Please Print Legibly Name (Business/Organization/Individual): . Address: r I lbfow/( City/State/Zip: G �' '' 09/0 Phone#: 7.>7-4®GJ"� Are you an employer?Check the appropriate box; Type of project(required): 1.El am a employer with 4. E] I am a general contractor and I euiOoyees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. F-1 Demolition workingfor me in an capacity. employees and have workers' Y p h'• 9. F-1 Building addition [No workers' comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 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.]I c. 152, §1(4),and we have no employees. [No workers' 131-1 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. $Contractors 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 certi unde the pain and penalties of perjury that the informationprovided above its tr to and correct. Signature: Date: Phone#: 9-7 7/_ / , '7—d ASS 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 6. Other Contact Person: Phone#: TE jM.IDD_YY CERTIFICATE OF LIABILITY INSURANCE 1 6/15/2015Y) 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 t70an Street NAME: SOUCY INSURANCE AGENCY PHONE (978}744_7110 FA No:(978)791-2039 P. 0. Box 4467 E-MAIL ADDRESS: soucy Qsoucyinsurance.cum 85 Lafayette Street INSURERS AFFORDING COVERAGE NAICB Salem MA 01970 INSURER A:WeStern World INSURED INSURERB:Safety Indemnity 33618 Henehan Construction, LLC INSURERC: 61 Brown Street INSURERD: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1522302396 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. INSRLTR ADDLTYPE OF INSURANCE Ism SUBR POLICY NUMBER POLICY A DDIYYYY MM/DDnYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE aOCCUR RPP1375865 /1/2014 /1/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 11 000,000 '.. GENERAL AGGREGATE $ 2,000,000 '.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 1,000,000 X POLICY D PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaac6denl 1,000 000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 6226071 11/13/201411/13/2015 BODILY INJURY(Per accleent) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident PIP-Basic $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- T1_ AND EMPLOYERS'LIABILITY YIN JORY LIMITS ''. ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ '.. H yes,desa ibe under bESGRIPTION OF OPERATIONS below E. DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schodulo,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 1600 Osgood Street AUTHORIZED REPRESENTATIVE_ Bldg 20, Suite 2035 North Andover, MA 01845 y ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD ":_5 P-J. AC�® r��. CERTIFICATE OF LIABILITY INSURANCE ATE(MMIDDIYYYY)6/29/2015 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), 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). CONTACT PRODUCER SOUCY INSURANCE AGENCY INC NAME: P O BOX 4467 PHONE I FAX 85 LAFAYETTE STREET E-MAILo E t: A!C No SALEM, MA 019706467 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Liberty Mutual Fire Insurance 33600 INSURED INSURER B: HENEHAN CONSTRUCTION LLC 61 BROWN STREET INSURER C: ANDOVER MA 01810 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 25342731 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. INSR TY OF INSURANCE ADDLLIC F POLICY EXP SUER POLICY NUMBER MM DDM'YY MM/DD/YYYY LIMITS LTRINSD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE El OCCUR PREMISES Ea occurrence S MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROP accident) DAMAGE $ HIREDAUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC2-31S-384098-015 1/6/2015 1/6/2016 �/ STATUTE EERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100000 NIA OFFICER/MEMBER EXCLUDED? ❑Y (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. 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 1600 OSGOOD STREET BUILDING 20 SUITE 2035 ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE Liberty Mutual Fire Insurance (J Q ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 25342731 1 1578933 1 2015-2016 1 Anne Chandler 16/29/2015 12:21:15 PPt (EDT) I Page 1 of 1 lilt Massachusetts - Cepartroent©� Pu�lec ie y tl3oard of Suildi g egulation nc, �. Construction Superl*isor e , License. CS-061755 JOHN J HENEHAN 61 Brown Street- Andover MA y` -' ill 0612015 comp' issioi-ler Business Regulation �It C' 071d Ul[I1 CU�[Ilf Office of Consumer Affairs& CTOR Type' OME IMPROVEMENT GONT� egistration: 172582 LLC a��xp719(2016 , iration: CONSTRUGTION, HENEHAN LVC- 3OHN HENEHAN ga 61 BROWN STREET TTnderseeretar9 ANOOVER,MA X1810