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HomeMy WebLinkAboutBuilding Permit # 8/18/2015 pF �ORTpi 9� BUILDING PERMIT z LED..,," TOWN OF NORTH ANDOVER �� h...... o APPLICATION FOR PLAN EXAMINATION ` ptl 0. b� Y Permit No#: Date Received �,R -rED µWPP^5 gSSAC HU`���� tt� Date Issued: 1 IMPORTANT: Applicant must complete all items on this page LOCATION5-3o .S' . s.7- /t om��lam - x,44-- Print PROPERTY OWNER 17W'D e y P0,f-V/Y-2 Print 100 Year Structure yes ng, MAP PARCELS 2-Z-Z- ZONING DISTRICT: Historic District yes HiQ, Machine Shop Village yes n 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 Se' tics .❑ylell ❑ Flood Iain ❑Wetlands ❑ Watershed District IlIle, p3' J/6 e, a �r r f f t {r { rrr r I ri,l'a. U.r.- tf;r / r cs fr- s r r '' a6 ✓ 'i' r d / f r DESCRIPTION OFWORK TO/B�E_ PERFORMED: x Identification- Please,T P Print Clearly OWNER: Name: %V Phone: Address:' Contractor Name: _Pow Phone: Email: cl-te11 - v c✓- e .-tl Address: Z/ Ale- le— I Supervisor's Construction License: l Exp. Date: ��//S Home Improvement License: / Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /6, 7 00 FEE: $ Check No.: I C' 1 Receipt No.: .9-9 2�2- NOTE: Persons contracting with unregistered contractors do not have access to th uaranty fund �P------- - -- I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/Massage/Body Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNIN DEVELOPMENT Reviewed On Signature_ MMENTS CONSERVATION Reviewed on � �� l � Si nature COMMENTS Nll- 01�` -<-Q 1 HEALTH Reviewed on l Si nature i/ COMMENTS ft4C))(njD,0A Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street EIRE>DE,PARTIWENT - TempDempster on site yes no Located_at J24Main.Street , Fire.Department signature/date ., COMMENTS F SORT H It Town ofE. :..'..,.' ndover ® No. jo ver, Mass, coc"IcHewecx Pay QATIE® � U BOARD OF HEALTH Food/Kitchen PERMIT Septic System THIS CERTIFIES THAT Q, e BUILDING INSPECTOR .. ... .......... ... ...... . .. . ...... ... ...... ....... ..... ... .. .... ............... Foundation has permission to erect.......................... buildings on .... ... �............�.... ." .... ......,... °� ® ® Rough to be occupied as ..... .. .... ..`.�.. ......... ...... .... ........ ... .. ...�.......... 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 ® UNLESST :BT R. Rough Service ......... ..... .� BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy BuilclinRough Displayin a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedy the Building Inspector. Burner Street No. Smoke Det. TMK Remodeling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 Jeffrey_530_Foster Repairs_Shed HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com CONTRACTOR AGREEMENT THIS AGREEMENT made this Z�u LAS i l7 20Lry and between Theodore Kelley dba TMK Remodeling, Construction Supervisor License#105086, 214 Sutton Hill Rd, North Andover MA 01845 hereinafter called the Contractor, and Andy& Dorothy Jeffrey hereinafter called the Homeowner. WITNESSETH, that the Contractor and the Homeowner for the consideration named herein agree as follows: ARTICLE 1. SCOPE OF THE WORK The Contractor shall perform all of the work described in the specifications entitled Exhibit A—Statement of Work, as annexed hereto as it pertains to work to be performed on property located at 530 Foster St North Andover MA. ARTICLE 2.TIME OF COMPLETION The work to be performed under this Contract shall be commenced on or before August 17, 2015 and shall be substantially completed on or before September 04, 2015 ARTICLE 3.THE CONTRACT PRICE The Homeowner shall pay the Contractor for the labor and materials to be performed and supplied under the Contract the estimated sum of Sixteen Thousand Seven Hundred Dollars and No Cents ($16,700.00),subject to additions and deductions pursuant to authorized change orders. Contractor will furnish and install all building materials, fixtures and finish items unless noted otherwise. ARTICLE 4. PROGRESS PAYMENTS Payments of the Contract price shall be paid in the following manner from the Homeowner to the Contractor: 33% upon contract acceptance and signature; $5,566.67 33% upon rough building inspection;$5,566.67 33% upon final building inspection and 90% completion of finish; $5,566.67 The contract cost for mutually agreed to change orders will be paid 50% at time of change order signature and 50% after completion and Homeowner sign-off. ARTICLE 5. GENERAL PROVISIONS 1. All work shall be completed in a workmanship like manner and in compliance with all building codes and other applicable laws. 2. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 3. Contractor may at its discretion engage subcontractors to perform work hereunder, provided Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this Contract. 4. Contractor shall furnish Homeowner appropriate releases or waivers of lien for all work performed or materials provided at the time the next periodic payment shall be due. 5. All change orders shall be in writing and signed by both Homeowner and Contractor. The cost for mutually agreed to additional work, required due to unknown conditions or substantive change orders, will based on the current bill rates for the actual time used. Additional materials will be billed at contractor cost. All change orders subject to 10% markup for overhead. Copyright TMK Remodeling 2014 Initials , All Rights Reserved Page 1 TMK Remodeling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 Jeffrey_530_Foster Repairs_Shed HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com 6. Contractor warrants it is adequately insured for injury to its employees and others incurring loss or injury as a result of the acts of Contractor or its employees and subcontractors. 7. Contractor shall at its own expense obtain all permits necessary for the work to be performed. 8. Contractor agrees to place all debris in an on-site trash receptacle(dumpster) and leave the premises in broom clean condition. 9. In the event Homeowner shall fail to pay any periodic or installment payment due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 10, The Contractor and the Homeowner hereby mutually agree in advance that in the event that the Contractor has a dispute concerning this contract, the Contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the Homeowner shall be required to submit to such rbitration as provided in MGL c 142A. j s Ho o er r V Date: Co rac or Date: Notice: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the Contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed by the parties. 11. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials, or inclement weather. 12. Contractor warrants all work for a period of 12 months following completion. 13. Contractor may post small signage(18x24")on property advertising services during the duration of the project. 14. The Contractor and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: (617)973-8700 15. The Contractor or Homeowner may terminate this contract at any time for any reason by giving 3 days notice in writing to the other party. If either party terminates the contract as provided herein, then the contractor will be paid for work(labor and materials)completed as of the date of termination plus any materials or equipment that are backordered and not delivered. Payment is defined as actual job costs for the project plus 10%overhead charge. The contractor will provide a written report detailing actual job costs plus overhead for payment. The Contractor will refund any funds paid by the Homeowner that are a remaining balance for the labor and materials used as of the date of termination, plus any materials or equipment that are backordered and not delivered, plus 10%overhead charge. The Contractor will make arrangements for the backordered items to be delivered to the Homeowner. Copyright TMK Remodeling 2014 Initials All Rights Reserved Page 2 TMK Remodeling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 Jeffrey_530_Foster_Repairs_Shed HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com 16. The Homeowner is responsible for maintaining adequate access to the property including snow removal, personal property storage, and working doorways, stairways and walkways. In the event the contractor is required to provide access or repair to the doorways, stairways and walkways, then the Contractor will bill the Homeowner at the hourly bill rate for same. ARTICLE 6. OTHER TERMS ARTICLE 7.ACCEPTANCE Signed thisday of 20 / 1' kiome wner ontractor NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Copyright TMK Remodeling 2014 Initials All Rights Reserved Page 3 Licenses: TMK Remodeling Exhibit A-Statement of Work CSL 105086 214 Sutton Hill Rd Jeffrey_530_Foster Repairs_Shed HIC 165887 North Andover MA 01845 RRP LR000106 978 852-4491 www.tmkremodeling.com A B C D E F G I 1 Owner: 2 Andy&Dorothy Jeffrey Estimate: 2015-033 Estimate valid for 30 days 3 andy(a)..mentalpilates.com Estimate Date: 08/17/15 Expiration Date: 09/16/15 4 530 Foster St 5 North Andover MA 6 508284-25 7 7 8 Scope of Work Repair exterior window case molding.Remove existing trim materials.Install PVC trim materials:case molding,sill nosing,aprons.Construct shed attached to garage approx 60x36"similar to existing.Relocate 9 electrical connection for generator.Remove hot tub.Construct 10x8'deck.Remove existingdeckingand hand rails.Install new PVC deckingand composite hand rails. 10 Notes: 11 Pricing includes labor and materials to install finished item+allowances. EA=Each LF=Lineal Feet SF=Square Feet 12 EA LF SF Total Cost 13 „ ___---___ __. .- ,____ __ Quantity Cost Quantity Cost Quantity Cost 14 1.0 Administration „. 3 $2,837 $2,837 - - - -- - - - - - -- - .-- -- -- . _ -- -- -�__ -- -$-2-0--0- 15 01 Plans and Permits:01.2 Building Permits _ . _-___ ___ ___- ______._.__._-.___. -----.-1 $200- $200 16 Building Permit< 1` $200 $200 17 02 Site Work 1 $468 $468 18 15 Yd'Dumpster 1 $468 $468 19 31 Overhead&Expenses 1 $2,169 $2,169 20 Overhead and project administration 1' $2,169 $2,169 21 Deck Expansion-80 SF 4 $547 10 $679 160 $1,143 $2,369 22 ®3 Excavation` ___�___ 2-_ $247 ---$247 23 Excavation for 4'deep 12"wide footing 2 $247 $247 24 04 Concrete 2 $300 $300 25 Concrete 4000 PSI 2 $300 $300 26 10 Exterior Trim&Decks 10 $679 160 $1,143 '+ $1,822 27 Install PT 2x10 joists,rim boards,fascia,beams,ground posts 80 $540 $540 28 Install TimberTech silver maple 1x5 finished decking materials 80 $603 $603 29 Install Radiance rails and balusters, 10 $679 $679 30 Deck Improvements-180 SF - _ - - - --- - --28 $1,900 - ^360 $2,122 $4,_023 31 02 Site Work:02.10 Demo 180 $765 $765 32 Remove finished floor 180 $765 $765 33 10 Exterior Trim&Decks 28 $1,900 180 $1,357 $3,258 34 Install TimberTech silver maple 1x5 finisheddecking materials 180 $1,357 $1,357 35 Install Radiance rails and balusters 28 $1,900 $1,900 36 Exterior Repairs $3,150 $3,150 37 20 Millwork&Trim 13 $3,150 $3,150 38 Remove and replace window case moldings and sill nosing approx 5045"w/PVC materials. 2' $500 $500 39 Remove and replace window case moldings and sill nosing approx 54x46"w/PVC materials. 1 $250 $250 40 Remove and replace window case moldings and sill nosing approx 66x35"w/PVC materials. 4 $900 $900 41 Remove and replace window case moldings,sill nosing and aprons approx 9045"w/PVC materials 6 $1,500 $1,500 42 Shed $1,394 15 $2,248 40 $680 $4,321 -- -- - - - 43 04 Concrete -___ ____ .__ __._ _____ _ - -__-_ ----- -- 8 $200 ___-_ ------ -------- - ---$200 44 Concrete 4000 PSI 8 $200 $200 45 07 Wall Frame 15 $2,248 $2,248 46 Exterior 2x4 Wall Construction''8'high,paint,PVC trim,sheathing,' siding,VB,R15 15 $2;248 $2,248 ©Copyright TMK Remodeling �" All Rights Reserved Page-4 Unlawful to distribute without permission Licenses: TMK Remodeling Exhibit A-Statement of Work CSL 105086 214 Sutton Hill Rd Jeffrey_530_Foster Repairs_Shed HIC 165887 North Andover MA 01845 RRP LR000106 978 852-4491 www.tmkremodeling.com A B C D E F G I 47 08 Roof Frame 20 $440 $440 48 Frame roof 2x8'rafters,sheathing 20 $440 $440 49 09 Roof Finish 20 $240 $240 50 Roofing install:6'ice&water shield,architectural asphalt shingles' 20 $240 $240 51 12 Doors&Trim 1 $814 $814 52 Furnish and install Pair 15/18/21_!24x78/80"interior doors,frame,trim,handset,painted 1i $814 $814 53 16 Electrical&Lighting 1 $380 $380 54 Relocate generator electrical box to new location 14 $380 $380 --- - -- — 55 Grand Total -- ___ -_ -- . ____-- ----._-_- — --- 30 $7,928 ---53 $4,827 _566___S3,646-- $16,700 ©Copyright TMK Remodeling All Rights Reserved Page-5 Unlawful to distribute without permission -FSP Doug rr s� D OL'o ti m +kouS-' q� ROOM DECK 4 9 2..x t 4- -Fou r a (�4 X t`a �.'r- - UEC - � C oPE" INS Hxtmc> e 51-;-,CA w� FSP, CC�LIu� 3 a �E 1 '74 S 8S°93'02"E 1177°23 209.47' 13 S 93°30'07"W a 37.98' �G LOT 48B X7,268 S.F. S 5°43'58"W 4° 18.87' 0 tib co 0 0 tL 0* 'y . House ## 530 or � 131�t2 0 ,f1 x 0(Z-7 O1 z SEPTIC CERTIFIED 8/27/98 p c � 9 ELEVATION TABLE OUTOFm � Ni HSE. 78 IN TANK138 OUT TANK =138.01 ' IN BOX =137.76 1 CERTIFY THAT THE OFFSETS SHOWN COMPLY OUT BOX =137.82 WITH THE ZONING BY-LAWS OF #1 TRENCH =13730 WHEN BUILT. I HEREBY CERTIFY THAT I HAVE INSPECTED THE #2 TRENCH =137.30 OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING CONSTRUCTION OF THIS DISPOSAL SYSTEM AND INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION THAT THE CONSTRUCTION AND THE FINAL GRADING OF ZONING CONFORMITY OR NON-CONFORMITY WHEN CONSTRUCTED. HAS BEEN IN ACCORDANCE WITH THE DESIGNERS INTENT AND THAT THE MATERIALS USED CONFORM Assessors Map 104B Parcel 222 TO THE PLAN SPECIFICATIONS AND 310 CMR 95.00. ^------ - ® � ..---- - ----_ - -- - - - 6124/98 The Commonwealth of Massachusetts Department of IndustrialAceldents t o. : X Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/EXectricians/Plumbers. TO BE PILED WITH THP,PERMITTING AUTHORITY- Applicant Information / // Please Print Le 'b l Name(Business/Organization/fndividual): �? �a,C__ Address: Z/ � <S(_% � Z(_ /Z-Q City/State/Zip: /L!. �a�/ 41A— Phone#: -9?67 y CZ Are you an employer?Checktlie appropriate box: Type of project(required): 1.1 am.a employer with employees(full and/or part-time).* 7. F1 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in &. [1 Remodelilig any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.No workers'comp.insurance required.]t 10 []Building addition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I1.❑Electrical repairs or additions propiietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insruance.t • 14�Other 1'��� 6.Q We area corporation and its officers have exercised their right of exemption perMGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. T Homeowners who subn if this affidavit indicating they are doing all work and then hire outside contractors must s4bmit 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 ave employees,% 'must provide their workers'comp.policy number. employees. Ifthe sub con3racfors h I am an employer th at is pioviding w orkem'compensation insurancefor my employees.'Below is thepolicy andjoh site information. Insurance Company Name: 4"�_ G Policy#or Self-ins.Lie. ST 0-S-0 Expiration Date: �/` / r Job Site Address:��3 ��tom/ ' — � City/State/Zip; / �Q�l/� ' !JP ®/G'�r'J Attach a copy of the workers'compensation'policy declaration page(showing the policy number and expiration elate). Failure to secure coverage as required under MGL o. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. X do hereby certfy u er t/ie painsandpenalties o perj that the information provided above is true and correct Signature: - Date: e S Phone 2y Offrcial use only. Do not write in this area,to be completed by city oi-town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OP ID:JG DATE(MMIDDNYYY) ,a►CCERTIFICATE OF LIABILITY INSURANCE 07/01115 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certlflcate holder Is an ADDITIONAL INSURED,require tn endotr y(ies)m A statement ust ndorsed.on this Cep fit does noGATION ISt CANED, sub to the ect to the terms and conditions Of the policy,certain policies may q ra certificate holder in lieu of such endorsomen s, CONTACT PRODUCER 978-975-1300 NA E: Segreve&Hall Insur.A33oo.Inc, 978-975-7596 PNC°No Ext FAc No` 306 North Matin St. E-MAIL Andover,MA 01810 ADDRESS: DUCER .TMKRE-1 Lawrence J.Halt cuss INSURERSo AFFORDING COVERAGE NAIClI INSURERA:Arbella Protection Ins. Co. 41360 INSURED TMK Remodeling 11104 214 Sutton Hill Rd INSURFRB:AEIC North Andover,MA 01846 INSURER 0: INSURER D INSURER E; INSURER 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 PFRIOD 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, IMS, LIMITS ILTRR TYPE OF INSURANCE LICY POLICY NUMBER MMIDD MM/DD 1,000,00( EACH OCCURRENCE $ GENERAL LIABILITY 100,001 PREMISES E2 ccurrence $ A X COMMERCIAL GENERAL LIA131LITY MED EXP(Any one person) $ 5,001 CLAIMS-MADE El OCCUR 03/08/15 03/0$/16 1 000 00, 9520037133 PERSONAL $ > > GENERAL AGGREGATE $ 2,000,00 PRODUCTS-COMP/OP AOG $ 2,000,00 GEN'L AGGRE©Ari;LIMITAPPLIES PER: $ P o POLICY LOC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Par amldant) $ SCHEDULED AUTOS PROPERTY DAMAGE $ (Per accident) HIRED AUTOS S NON-OWNED AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAR OCCUR AGGREGATE $ — EXCESS LIAB CLAIMS-MADE DEDUCTIBLE $ RETENTI N 3 7DISEABE OTH- WORKER$COMPENSATION AND QMPLOYERV LIA13ILTTY YIN NT $ B OFFICERIMEM EREXCI,UDSD7 ANY CUTIVE N!A (Mandatory m NH) 5005011872 04/01/15 04101116 EMPLOYE $ If yee,dascr b®under LICY LIMIT $ DESCRIPTION OF OPERATIONS WI— DESORI"10N OF OPERA'nONS I LOCATIONS!VEHICLES (AH3ch ACORD 101,Additional 1lemerks 3chedulc,if more aPce Is roqu'red) 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. 1600 Osgood St North Andover, MA 01845 AUTHORIZED DRREJ,P,R�jE�S�ENTTAAINE Csi11988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2008109) The ACORD name and logo are registered marks of ACORD 31> Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Superllsor License: CS-105086 THEODORE M IC�LLEX 214 SUTTONH[LLRD NORTH ANDOVER MA;0185 Expiration 10!0812015• Commissioner �1ZG' 1p0'J17DIL671 L(IBCC��lL O�C���uJ9000lLCCJe�f Mee of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR f gistration: 165887 Type: xpiration: 4/512016-- DBA TMK REMODELING THEODORE KELLEY 214 SUTTON HILL RD. 4 NORTHANDOVER, MA 01845 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid without signature