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HomeMy WebLinkAboutBuilding Permit # 10/6/2015 NoRrH Af�tLit rd��0 BUILDING PERMIT ��::,. . '^•'4 0 TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION 4 - - Permit N®: 2.. 4y Date Receivedonareo �SSACHUS�� Date Issued: � ' IMPORTANT:Applicant must complete all items on this page LI I I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition N Two or more family ❑ Industrial IN Alteration No, of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Renovate bathroom Identification Please Type or Print Clearly) OWNER: Name: Judith walker Phone: 978-682-4328 Address: 78D Jefferson St, N.Andover, MA 01845 s ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 22,230.00 FEE: $ 267.00 Check No.: Receipt No.: Z NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund w 4 !�,.Jr '<,,.;// {' (. ! ,� �`�` ' �'r;�'.r,yr by.:'r�� � � !�>/' -+ID// �/�/ ��,jj f/;;.,'l,, ✓ ,/ ,�r .,�i tkORTH '� E. :_ 1* Hdover ® No. �O LAKE h ver, Mass, /0 6 CQCKIC"t WICK y1. ORATED � RMIT U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT �r�LI LZ 'r�l..!)..� .. BUILDING INSPECTOR has permission to erect .......I................. buildings on .. f ��.... ........ ................................. Foundation Rough to be occupied as .............. r-:r.�. �1..c/.�-�: .../24. .f..........1.:?� .%�.../ � r.: c.. .� �' Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application'7 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 S Rough . Service J ................ ... . ....... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay 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. - w CROSSROADS CONTRACTING OF DERRY, TD. 15 Londonderry Road, Londonderry, NH 03053 603-434-1611 FAX 603-434-9391 PROPOSAL SUBMITTED TO: Judy Walker Phone: 978-682-4328 WORK TO BE PERFORMED AT: 78 Jefferson St, North Andover, MA 01845 DATE: September 18, 2015 EMAIL: judyw976@gmail.com SPECIFICATIONS THANK YOU FOR ALLOWING CROSSROADS CONTRACTING TO SUBMIT THE FOLLOWING PROPOSAL. WE WILL SUPPLY THE MATERIAL, LABOR AND EQUIPMENT TO PERFORM THE FOLLOWING WORK: INTERIOR REMODELING LEAD SAFETY FOR RENOVATION REPAIR AND PAINTING 1. Determine if Lead-Based Paint is present using an EPA recognized test kit in all homes built before 1978: 2. If it is determined that Lead-Based Paint is present, all work will be performed according to EPA lead safe renovation guidelines. 3. Pricing to be determined and reported within 48 hours of test results. 4. Payment for lead testing to be made directly to the lead testing contractor per Massachusetts state law. PROJECT PREPARATION and DEMOLITION Customer to remove all items from walls.Customer to pack books,decorations,and lose items in boxes so that they can be moved around during construction without damage.Customer to move items in closet to allow access to the attic scuttle hole.Crossroads Contracting to move and cover furniture and packed boxes only.Crossroads Contracting cannot be held liable for damage to any belongings left in the work area. 1. Remove and dispose of all items in the Bathroom to the existing wall studs, ceiling joists, and floor sheathing. 2. Remove and dispose of the drywall and water damaged insulation from the entire Living Room exterior wall. ELECTRICAL Supply and install the following as per National Electrical Code 2011: This proposal assumes that the existing electrical panel will not need to be upgraded. BATHROOM 1. One (1)vanity light with switch. ($100 material allowance for light fixture) 2. One (1)fan/light with switch connected to the existing vent duct. Note: Property Management Company is responsible for supplying and installation of roof termination. 3. One (1) GFCI outlet. HALL 1. One(1)4" LED recessed light with switch. BASEMENT 1. Relocate the existing dryer outlet to the exterior basement wall. PLUMBING Supply and install the following: 1. One (1) 30"X 21" Foundation Malden Sarsaparilla vanity cabinet. 2. One (1) 31"X 22"White/White Cultured Marble vanity top with 4" backsplash and right side splash. 3. One (1) Kohler Devonshire (K-394-4-BN) Devonshire Widespread Brushed Nickel bathroom sink faucet. 4. One (1)Sterling Accord Smooth Series 60"x 30" Bath with Right-hand Drain (71240120-0). 5. One(1) Devonshire Valve Trim (K-T397-4-BN). 6. One(1) Kohler Rite Temp valve(K-304-K-NA). 7. One(1) Devonshire Bath Spout(K-389-BN). 8. One(1) Kohler Hydrorail Bath and Shower Column (K-45905-BN). 9. Install hot and Coldwater shut offs from the main water lines into the house in the wall behind the shower)C'K I R�"�0 AL�If-ow fi,r Gu y` �i , � � , Page Judy Walker 7OJefferson St. N.Andover, M4 PLUMBING (Continued) 10. One(1) Kohler Flipside 2.5gpmmultifunction shovverheod (K-15SS6-BN). � 11. One(1) Kohler Flipside 2.50pmmultifunction hondehovver(K-17493'BN). 12. One(1) K800te[shower6O" metal hose (K-S514-BN). 13. One(1) Kohler Cimarron White Comfort Height two-piece round front toilet(h-3887-O)with trip lever(K-04O0-L'BN), � and Cachet seat(K-483S'D). Note:Crossroads to install Customer supplied towel racks, paper holder and mirror or medicine cabinet. INSULATION and DRYWALL � 1. Fiberglass insulation to code where the water damaged insulation is removed. 2 }6d[y�o|}toth��xteriorvva||vvhmr�[hadrywai| ie [e0�v�d� � � 3. 1/2" moiotu,ereoiGbontd[yvva|| tothevva||sandoa||iDQoofthoBothroom. � 4. Patch and repair the water damaged drywall inthe Bedroom. � 5. Mud, tape, and sand toapaint ready condition. � INTERIOR FINISH � 1. 3Y2" pre-primed colonial baseboard trim hmthe Bathroom and reworked exterior walls. 2. Remove and reinstall two (2) air conditioners, and install new i finish. 3. Suppi andinstall one (1)Uuehwoud iO unfinished hardwood interiodo |abind)eBathnoom �� oe 4 � | ��u �«�^ C4 �/ � ƒfvv�` �� 8���/cx�� ���� , TILE 1. Install cement backer board and 12x12 Ashland HL05 tile with Laticrete Dusty Grey P acolor grout onthe Master Bathroom O 1 � P61-041 b|° INTERIOR PAINTING 1. One/1\coat nfKUlz primer tothe water stained areas ufceiling drywall. 2. One(1) coat mfprimer hoall new and reworked drywall. 3. Two ( ) coats offinish paint tothe Kitchen, Bathroom, and Bedroom ceilings.f' L4Vtl'� /d��\'�-~ 4. Two(2) coats uffinish paint b)all new trim hmmatch the existing eeclose aepossible. MISCELLANEOUS 1. Any changes needed due to building code issues that are not included in the scope of work outlined in this proposal, � will be billed accordingly. 2. We will clean up and remove our construction debris, and leave the site vacuum clean. 3. Permits will bgobtained bvCrossroads Contracting and billed a[face value hothe customer. 4. $600 Partner Agreement retainer fee has been applied to the contract and is reflected in final price below. Page 3 Judy Walker 78 Jefferson St. N.Andover, MA 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 homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of a "Massachusetts Consumer Guide to Home Improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757. PERMIT NOTICE: 1. The following permits will be required to complete the agreed scope of work: a. Building Permit, Plumbing Permit, Electrical Permit 2. Permits will be obtained by Crossroads Contracting and the face value will be billed to the customer. 3. It is the obligation of the Contractor to obtain such permits as the Owner's Agent. 4. Owner's who secure their own construction-related permits or deal with unregistered Contractors shall be excluded from access to the Guarantee Fund provisions of MGL Chapter 142A. Total Contract Price and Payment Schedule: The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of: $22,230.00 Payments will be made according to the following schedule: $4,446.00 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater) $4,446.00 upon Start of PROJECT $4,446.00 upon Start of DRYWALL $4,446.00 upon Start of TILE $4,446.00 upon SUBSTANTIAL COMPLETION (Law forbids demanding full payment until contract is completed to both party's satisfaction.) The following material/equipment must be special ordered before the contracted work begins in order to meet the completion schedule. Not applicable. (Law forbids demanding full payment until contract is completed to both party's satisfaction.) The following material/equipment must be special ordered before the contracted work begins in order to meet the completion schedule. Not applicable. NOTE: Including all finance charges law requires that any deposit or down-payment required by the Contractor before work begins may not 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. Proposed Start and Completion Schedule: The following schedule will be adhered to unless circumstances beyond the contractor's control arise. Contractor will begin contracted work in: October, 2015 Contracted work will be substantially complete (At least 95%) in: November. 2015 EXPRESS WARRANTY—Is an express warranty being provided by the Contractor? Yes (all terms of the warranty must be attached to the contract.) Contractor warrants that Work will be of good quality, free from defects and in compliance with the requirements of the Contract Documents, as well as applicable local, state and federal laws, ordinances, rules and regulations. At the Owner's request Contractor shall promptly repair or replace defective work for a period of one year after the date of Work is substantially complete. All other statutory or common law warranties are specially disclaimed. | ^ ' Page Judy Walker 78Jefferson St. � N.Andover, M4 � Subcontractors—The Contractor agrees to be solely responsible for completion of the work described regardless of the � actions ofany third portv/oubcOntnaotorVti|i�adbythecontnmchor The. � � for all payments to all subcontractors for materials and labor under this agreement. � � Contract Acceptance—Upon signing, this document becomes a binding contract under law. Unless otherwise noted with this document, the contract shall not imply that any lien or other security interest has been placed on the residence. � | Review the following cautions and notices carefully before signing this contract. | * Don't bepressured into signing the contract. Take time bJread and fully understand it. Ask questions if � something is unclear. � w Make sure the Contractor has avo|id Home Improvement Contractor Registration. The law requires most home � improvement Contractors and Subcontractors to be registered with the Director ofHome Improvement Contractor | Registration. You may inquire about contractor registration by writing to the Director atOne Ashburton P|aoa' / � Room 13O1. Boston, K8AO21O8Orbycalling G17-727-32OUor1-OOO-223-0Q33. * Does the Contractor have insurance? Check hosee that your Contractor inproperly insured. � w Know your rights and responsibilities, Read the Important information that follows oOthis form and get mcopy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement ifithas been signed ateplace other than the Contractor's normal place ofbusiness, � provided you notify the Contractor in writing at his/her main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See the attached notice ofcancellation form for anexplanation ofthis right. OKJ NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES' (Two identical copies ofthe contract must becompleted and signed. The other should b kept bh Contra Date Date ' ' JB/HSUP89 � | Contractor Arbitration The Home Improvement Contractor Law provides Homeowners with the right to initiate an arbitration action (as an alternative to court action) if they have a dispute with a Contractor. The same right is not automatically afforded to a contractor, however. The Contractor would have to resolve any dispute he/she has with a Homeowner in court unless both parties agree to the optional clause provided below. This clause would give the Contractor the omnne right to arbitration as is afforded to the Homeowner by the Home Improvement Contractor Law. The Contractor and the Homeowner hereby mutually agree in advance that in the event the Contractor has a dispute concerning this contract, the contractor may submit the dispute to a private arbitration firm which has bedhy the Secretary of the Executive Office oyConsumer Affairs and B i required � submit to such arbitrationd in Massachusetts General L cha r 142 � � . � o, .=,°^.,. ",g=`".e """" � ~ ^ � � � , | � ' Page S Judy Walker 7DJefferson St, N.Andover, MA NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution � initiated by the Contractor, The Homeowner may initiate dispute resolution even where this section ifnot separately � signed bythe parties � � Homeowner's Rights � A Homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A) and other consumer protection laws (ie. MGL chapter S3A) maynotb�vv�iv�dinanyvvoy. ev�ObyegFeam�nL However, � � excluded from certain rights if the Contractor they choose is not properly registered as prescribed by law. Homeowners � who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home � � Improvement Contractor Law. The Contractor is responsible for completing the work as described, in a timely and ' workmanlike manner. Homeowners may be entitled to other specific legal rights if the Contractor guarantees or provides � mnexpress warranty for workmanship ormaterials. )naddition toguarantees orwarranties provided bvthe Contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An � enumeration of other matters on which the Homeowner and Contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a Homeowner's basic consumer rights. |fyou have questions about you � consumer/Homeowner rights, contact the Consumer Information Hotline (listed below). Execution of Contract | The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled jnormarked anvoid, deleted, ornot applicable. One original signed copy ofthe contract with attachments iohzbegiven h)the Owner and the other kept bythe Contractor. Any modification tothe original contract must bainwriting and agreed tnbyboth parties. Contracted work may not begin until both parties have received a fully executed copy of the contract, and the three day recision period has expired. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or if you wish to obtain a free copy of"A Consumer Guide to the home Improvement Contractor Law" contact: Consumer Information Hotline Office ofConsumer Affairs and Business Regulation 10 Park Plaza, Room 5170 Boston, MA 02118 (617) 973-8787 or 1-888-283-3757 If you want to verify the registration of a Contractor or if you have questions or need additional information specifically about the Contractor Registration component of the Home Improvement Contractor Law, contact: Director ofHome Improvement Contractor Registration Bureau ofBuilding Regulations and Standards One Ashburton Place, Room 13O1 Boston, MA 02100 | (617)-727-3200 or 1'800-223-0833 � � For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Section Office of the Attorney General 817-727-8400 � AND/OR � Better Business Bureau 508'052-4800 508'755'2548 413-734-3114 !I Ir 777 4 f r } { Condo Property Record Card PARCEL—ID:210/046.0-0096-0051.G MAP:046.0 BLOCK:0096 LOT:0051.G PARCEL ADDRESS:78 JEFFERSON STREET FY:2015 PARCEL INFORMATION Use-Code: 102 Sale Price: 47,500 Book: 04898 ' Road Type: T Inspect Date: Tax Class: T Sale Date: 11/23197 Page: 0299 Rd Condition: P Meas Date: Owner: Tot Fin Area: 650 Sale Type: B Cert/Doc: Traffic: M Entrance: WALKER,JUDITH D Tot Land Area: 0.00 Sale Valid: Y Water: Collect Id: Address: 78D JEFFERSON STREET Grantor: DAVID FROTHINGHAM Sewer: Inspect Rees: NORTH ANDOVER MA 01845 Exempt-B/L% Resid-B/L%100/100 Comm-B/LP/. Indust-B/L% Open Sp-B/L,/. CONDO INFORMATION VALUATION INFORMATION Style: TH Tot Rooms: 3 Fn Liv Area: 650 Bsmt Area: 0 Current Total: 85,400 Bldg: 85,400 Land: 0 MktLnd: 0 Apt Unitif: 51 Full Bed: I Unf Liv Area: Fin Bsmt SF: Prior Total: 81,300 Bldg: 81,300 Land: 0 MktLnd: 0 Unit Desc: Den/Part Bed: Load Dock SF: Fn Bsmt Grd: Res Unit Type: Full Baths: 1 Bldg Escaltrs: Parking Class: C CA Unt Type: Halt Baths: 1 Bldg Elevaltrs: Parking Rstr: N Comp.Name: VILLAMM Quality: M No Ovrhd Dr: Parking Open: GREEN Comp.Cocle: Kitchen Type: 0 Parking Covrd: Comp.Class: Kitchen Qual: M Atypical: Parking Gar: Condo Type: BI Wall Height: Eff Yr Built: 1979 Pot Com.Int: Value Method: Flooring: Year Built: 1966 Pct Int Ownd: Base Floon 2 , Ceillings: Grade: A Int Adj Fctr: Num Floors: 1 Fire Alarm: Condition: A Val Adj Pot: Pot Sprinkirs: Pot Complete: Val Adj Amt: Heat Type: HW View Quality: Heat Control: I View Adj: AC Control: Unit Loc Adj: Fireplaces: 0 Market Adj: Stacks: 0 Condo Val: Hearths: Sound Val: 0 Misc Struc: Misc Str Val: 0 SKETCH PHOTO No Sketch No Picture Available Available Parcel 11):210/046.0-0096-005LG as of 9/29/15 Page 1 of 1 The Commonwealth of Massachusetts Department of,IndustrialAccidents X Congress Street,Suite 100 Boston,MA 02119-2017 °e www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/ElE lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Le0blX Name(Business/Organization/Individual); Crossroads Contracting of Derry,Ltd Address: 15 Londonderry Rd, Unit#6 City/State/Zip: Londonderry, NH 03053 Phone#: 603-434-1611 Are you an employer?Cheelt the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10❑Building addition 4.Q I 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 11,❑Electrical repairs or additions proprietors with no employees. 12,E]Plumbing repairs or additions 5. xJ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13, Roof repairs These sub-contractors have employees and have workers'comp.insurance. t p 6,0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.F1 Other 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 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. tContractors 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, j I am an employer that is providing workers'compensation insurance for my employees, Below is the policy and job site information. Insurance Company Name: Netherlands j Policy#or Self-ins,Lie.#t WC8875773 Expiration Date: 11/01/15 Job Site Address: 78D Jefferson Rd City/State/Zip: N.Andover, MA 01845 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 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. I do hereby certify under the pains and penalties ofperjrcry that the information provided above is true and correct, Signature: Date' , j Phone#: 603-434-1611 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CROSS-2 OP ID: SG A� DAy)CERTIFICATE OF LIABILITY INSURANCE 11/18/2014 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(les)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 NAME: Jason M Mlocek Planright Insurance-Salem PHONE 603-890-6439 (FAX,No;603-890-6521 224 Main Street Suite 3C AIC No ExtAIC Salem,NH 03079 E-MAIaeon santoinsurance.com Jason M Miocek ADDRLESS:! INSURER(S)AFFORDING COVERAGE NAIC tt INSURER A:Peerless Indemnity Ins Co 18333 INSURED Crossroads Contracting of INSURER B:Excelsior 11045 Derry Ltd INSURER C:Netherlands 24171 15 Londonderry Road Unit 6 Londonderry,NH 03053 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBR INR TYPE OF INSURANCE POLICY NUMBER MM/DDYY MMIDDYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE FKIOCCUR BKS55672507 11/01/2014 11/01/2015 PDA REMISCT Ea occurrence 3 300,00 MED EXP(Any one person) $ 15,00 PERSONAL BADV INJURY $ 1,000,00 GEN'LAGGREGATELIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,00 POLICY _Kj PRO- a LOG PRODUCTS-COMP/OPAGG $ 2,000,00 OTHER: $ ED AUTOMOBILE LIABILITY Ea acdd.n)SINGLE LIMIT $ 1,000,00 B ANY AUTO BA8814314 11/01/2014 11/01/2015 BODILY INJURY(Par parson) $ ALLOWNED1XX SCHEDULED BODILY INJURY(Per acddent) $ AUTOAUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $. AUTOS Per accident a UMBRELLA L1AB HOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE I JER C ANY PROPRIEfOR/PARTNERIEXECUTIVE YIN C8875773 11/01/2014 11/01/2015 E.LEACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) 3A: MA NH E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attached It more space Is required) Jan Jacome as elected to be excluded from work comp coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Information Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE / ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Crossroads CONTRACTING A Woman-Owned Business...Changing the face of Remodeling. Subcontractor List Job Location: Judith Walker 78D Jefferson St N. Andover, MA 01845 JW Chick Electric 3563 Brown Ave Manchester, NH 03103 Shanley Plumbing & Heating, LLC 71 Pleasant St Danville, NH 03819 15 Londonderry Road Unit#6 Londonderry, NH 03053 Phone:603.434.1611 www.crossroadscontracting.com Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement CRtor Registration Registration: 160986 Type: Private Corporation M Iw Expiration: 9/17/2016 Tr# 256801 CROSSROADS CONTRACTING O JAN JACOME h 15 LONDONDERRY RD. #6 LONDONDERRY, NH 03053 4 A f,• s�$`�� Update Address and return card.Mark reason for change. SCA 1 0 20M-05111 H Address E] Renewal F-1 Employment F-] Lost Card (fie t(larrirrzarecuea �z o1L`' cr��tztitrAefZ? 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: x16g986 Type: Office of Consumer Affairs and Business Regulation Expiration ) Private Corporation 10 Park Plaza-Suite 5170 Boston MA 02116 CROSSROAQS CO'`ti ERRY LTD T JAN JACOME 15 LONDONDERRY Ftb, LONDONDERRY,NH d3t75{3Undersecretary Not Awithotsignature C�/yre t(�arwrna�rcuea%lt�o����Gaadac�ccrte(Za _ ' I ice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to; Office of Consumer Affairs and Business Regulation egistration�' Type: 10 Park Plaza-Suite 5170 Expiryn#i13 Supplement Card Boston,MA 02116 CROSSROADS {{PERRY LTD JOHNNY HAWKES 15 LONDONDERRY LONDONDERRY,NH 03053 Undersecretary N valid out signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards. - Constraciion 1une1 YiStIr i License: CS-090487 a`titiTI:S 4p JOHNNY P HA' IOS 37 TATO 10 iamp Derry NH 03038 s . i Expiration Commissioner 01/21/2017