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HomeMy WebLinkAboutBuilding Permit # 11/18/2015 BUILDING PERMIT "o��H qq'' O�R.t�,EU �g�•y® TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION VVVx Permit No#: 1 w Date Received °Rareo neat^(� Date Issued: �. , � OCHl1`S P6--rAl®T: Applicant must complete all items on this page r r / / 1 / / J I / , 1 l r l es is TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other rr,/rm/,.:• /i/ r,,,/' r�rrr�,.; r/ ///, / ;r/,✓ir ci//,v ,,.//r, �" r/ ///l „, ..,,. /.. ,. r,. .. ,G,. /.,.. ,,, � , / /,, / , ,,, Wetlands a,, , /,r ❑/Water h t,� DESCRIPTION OF WORK TO BE PERFORMED: isffT�Q�aP �ittC w'►`rN =�Llwl2� s K+�a °�6"I�t� r Xtom) Identification- Please Type or Print Clearly OWNER: Name: A1CAAZvL :% KJ Phone: Address: v6 t r r / ✓ /� r, ,, / ri. / r / // r r r r,, F / / I / / ✓ /, / /,, / r ,„ rrr.... , ,r , / / � /i // �/ rr m , /i/ Will /r, /r r/ r / / i i r r,r r „ir ✓i � r r r / rr r r �rrl//�//Nrlll,!/�allnlr,�l/rYfNIfN%rA.fr;lY�PINr,�Nl,lrr,Ln rrr if Y�,/ill/�prx„alC;'///%//Grl„I/l/./. ARCH ITECT/ENGINEER /�h� Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0-t FEE: $ 42(-) — Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to tl ran fund . �.. Signature`of Agent/OwnerSignature of contractor , Plans Submitted ❑ Plans Waived 1K Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DIS POS Public Sewer Tanning/Massage/Body Art ❑ Swinuning Pools ❑ Well ❑ 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 PLANNING & DEVELOPMENT Reviewed On 11�����5 Signature_ OMMENTS 6tct6-(" C-cw.T--(�) e-1( Lt Som bc� `a��� 1 ry ONSERVATION Reviewed on — 1`7 — Si nature COMMENTS gLTH Reviewed on Signature COMMENTS c�—, 1 i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT Temp Dum ster on site Located 3s4 Osgood Street Located at 124 Main Street rlo yes Fire Department signature/date CMM OENTS ,. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, wast or service drop requires approval of Electrical Inspector yes No DANGER ZONE LITERATURE: yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine � �j� NOTES and DATA— (For department use) �,'-�?�� (t 11 I�� I � ,/,e_,, At.J ' A �VrZ p c PSS e,CJ 5��Jj L.Q_ �Vv_A ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 F FORTH of Andover No. (low h verO®yram 6� �1 a.ss O L/1KE ' , COC HIC HI w�[K y1• ®S RATED P"V C7 fJ BOARD OF HEALTH Food/Kitchen rERMIT T LD Septic System THIS CERTIFIES THAT ... �! ,,........ .. ,,, �............. BUILDING INSPECTOR ...... buildings on 6..... � , Foundation has permission to erect .................... ... �. .. ......., .... Rough to be occupied as .gv&..... ............ ..... ...... .. .. .. ... ......... ......1ko....... Chimney provided that the person accepting this permit shall in every respect form to the terms o the application Final on file in this office, and to the provisions of the Codes and B -Laws re ating 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 ONTHS ELECTRICAL INSPECTOR ® LESS CONSTRUCT ST S Rough Service ........... ....... ...... .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. Massachusetts Home improvement Sample Contract This ibrm salis6es all basto regdvancnis of the slate'aHomelmproyanerttContmetorlaw(M([Lchapta 142AI but does not include efandard tanguago to protect bom townera,Stmh legal advice if neceasory.Any person planning home improvements shouldfiret obtain a copy of•A Massealruse(ts Consumer Guido to Home LnprovammV before agreeingto any workonyour rasitimm You may obtain a fro copy by calling the officeofConsumer Affairs and Business Regutatitxw's CoawmerTaformatior Hotline at 617473-8787 or 1.888.283-3757 or on ourwebsfto, l3omeowner Information Contractor Information aro C4MpanyWkW0 y % f Oki {`eKww'W'—e StrettAddreas(donotwaitft%?ffceBoxsddttss) Contractor! Owner Name ta4`t. COylfotvn Stito Zipcode BwiamAddress(must Include adttetaddress) iJeMA, ojqqt;- . Daylhnephom I.heningpbono city/liner Stele ZlpCode- Mdlug Iron(11difRtntttkweAm) Business woo lrodenl&apkyu113orS Munbor tSaarmpnar.Yel cemaneclayNsmaar Eptabrdae MAI roux p,ira o ar mat am e lrpmxcaataafnclon hxo ..rad rgtNatia o•abv 9 I� The Contractor agrees to do thefoltowing work for the Homeowner: (Describe in detail the work to computed,spedWn the lypq brand,and grade of materials to be used,use addilianalsheeL ifnaessarv.) 2t�wQ,QGPchctftSl��x cw,sugFwo�zalRooRu�a4.'�kjkAw' ?L45r6e, Required Permits-The following building permits are requhxd ProposedSfartandCompletionSeNdule-The followingschedulewill and will be secured by tho contlaetoras the homeownefs agent: be adhered to unless eiretmutancts beyond the contmeloes contra!arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of l 1 Datewhmcontmotorwfll begin contracted work. MGL chapter 142A,) IJZIS[16� Date-when eantractedtwrkwillbesubstantially completrA Total ContratUrlce andPaynreni Sehcduta Tho Contractor agues to perform Oho work,funlialt the material and labor specified above for tete total sum og l l o (a) Payments will be made acrnrdingtothefollowingschedule: L06AP SQOX $ upon signing contract:(not to exceed 1/3 of the total oontraclprke Qr the cost of special order items,wvhlchever is greater) S try // or upon comptetionof S by_,f^f Oruponcompletionof S upon completionofthecontmet(Lawforbids demanding fall paymontunfilcontrad Is completed to both party's sdisfiuctlon) TbolbIlowtingnmtaid/oWtpmeotmust bespecid f to beodrot ordered Wore the oantractod wwrk be8m+ln order to meet the complcdw acbedule.(n) S to be paid for Nam;(s)Liauding ail Bnenco charges(ae)Law regetres Ural any dtpWt or down-peyment required by the conhtxtor betbrewnork begins may not exceed the greater of(a)oneAw of Uwe beau contract price or(b)the aebul rut of wwspwId egolpnunt a custom rudemetedd YM&must be special ordered In advance to mut the completion scltedula Riyrem warranty V an oxnr uswurranty Nina provided by the tolracfor'i Q No❑Yea fall tc a of th4wn!inty ntuat be attaxhtd to the touh-acB '..... Subcontractors-Tbe contractor agrees to be solely resposaiblo for oompletlonofthe work described roguciloss of in;actions of onythird partylsubconlraaorudlfWbylhewl*acter.The contractor fbrtfier agren to be solely responsibto 1br all payntents to all subcontractors for materids and labor under this emrcement - ConteactAcceptanee-Upon signing,this document becomes a binding contract under few.Unless otherwise noted within this document,the contract shell not imply that any lion or other security interest has ireen placed on the residence.itevicwv iho following cauldors and notices cuohily beforo signing this contract • Don't be pressured into signing the contract Take time to read and My understand it Ask questions if something h unclear. • Make sure the contractor hes a valid Homo ImnroyMotContractorNsbtratden Thalswvrequfrtsmosthomolmprownutntcontractors and subcontractors tobaregtnteredwith thoDirmtorofHomalmprovtmertContmctorRegistration.You way irWreabout wnhector registration by vaiting to thePfreotor at 10-ParkPlaza,Room 5170,Boston,MA 02116 or by celling617-973.8787 or 888-283-3757. • Docs the oontractor have f wranoe7 Ask the Contractor for his Insurance company information so that you can confirm coverago,a oak to see a copy of a"proofof insttranee"doctmtutr • Ynowyourrights andresponsibllitics.Read the ImportantInfamationonthereversesideofthisrormandgotacopyofthaConsumer Guide to thoHomoTmprovement ConhWor Tsw. You may cancel this agreement ifit has bean signed at a place other than Oro contractor's normal place of business,provided you notfty the contractor fn writing athislhumain oftloe or branch office by ordinary mail posted,by telegram sett or by delivery,not lata than midnight of the third(wshimdayfollowing the aigningoftil'u agrement See the aifachodnotieeofcancellatioa far an explanation ofthis right DO NOT SIGN TWS CONTRACT Il?THERE ARE C I1 I 7tw lap! Nnetmmlba tanpieted and elated.Orc wpyslauld ao biM mYby 1ha oos Signature Con oris Dam Data Contractor Arbitration The Home Tmprovement 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 rho automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with ahomeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor fire same right to arbitration as is afforded to the homeowner by the Nome 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 farm which has been,approved by the Secretary of the Farecufiv Nice of Consumer Af lairs and Business Regul on the consumer shall bo required to subigit t a c arbitr ti as provided Iii Massachusetts Cenral Laws,alt er 1 o e ra r' i attire N CE: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 alternative dispute resolution even where this section is not separately signed by the parties. Ilorateivncr's Rights A homeowner's rights under the biome Improvement Contractor Law(MGL chapter 142&)and other consumer protection laws(i.e.MOL chapter 93A)may not be waived in any way,even by agreement. However,homeowners maybe excluded from certain rights if the.contractor they chgose is not property registered as prescribed bylaw. Homeowners who secure thelrown btiildirig peirdits are automatically excluded from all Guaninty 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 entitiedto other specific legal rights ifthe contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for apartieularpurpose. 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. If you have questions about your consumerlhomeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract most be executed in dupjigate and should not be signed unfit a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until at[blank sections have bean filled in ormarked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand paynienfs in advance of the dates specified on the payment schedule in cases where the homeowner deems himhrerself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require thatthe balance of funds not yet due be placed in a joint escrow account as aprerequisite to continuing the contracted work Withdrawal of funds from said account would require the signatures of both parties. 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 Massachusetts Consumer Guide to home Improvement" contact Consumer Information hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,M&02116 617-973.8787,888-283-3757 or visit the OCABRvmbsite at ht(p:([www.nrass.s•ov/ocabr/ 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 of Nome Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HTC website at htlp;!/www.mMs.aoy/ocabr/ Go online to view the status of a Rome rinprovement Contractor's Registrafion: gip•//db tate ma u omeim rp ovemen fcenseeliskasp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 . AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version z,t•ttnvzoio r —w3��, , S��'x`�'d �.la?1�Ctilo��� ► S d31s (' 9%oi 'n.y fJ s s � 1801 otvos t -� - cr)OW— a per e '1lv�acv� 1 n-113Vol15 IG ac� bs -4601„S 09� y t wi qq � d � � i t� � Close Window 16 0 26 F M8 0 Sq ft" 988- q:ft BI 248w'-SAA B$ .3$ 270-0„S4fIC 3.. . -.2 A lo,. North Andover MIMAP November 17,2015 I, ................... a I 9 1 i i 0 MVPC Be Interslates I Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —SR Meters Data Sources:The data for this map was produced by Merrimack pARTH Valley Planning Commission(MVPC)using data provided by the Tovrn of RoadsNorth Andover.Additional data provided by the Executive Office of Cr Easements �74ao rb.1 0 Environmental Affaim/MassGIS.The Information depicted on this map is '. Parcels L for planning purposes only.It may not be adequate for legal boundary ti0definition or regulatory Interpretation.THE TOWN OF NORTH ANDOVER ~ MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING 1t * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF '.. THIS INFORMATION '... AC WO 1"=91 ft "- Y° p4FTp Q� tti�e i,�+P4 M M c i 1� scrfU Q MVPC Boundary Interstates —I a SR Roads 'r Easements Parcels Horizontal Datum:MA Staleplane Coordinate System,Datum NAD83,Meters Data Sources:The data for this map was produced by Merrimack Valley Planning Commission(MVPC) - using data provided by the Town of North Andover,Additional data provided by the Executive Office of Environmental Affairs/MassGiS.The Information depicted on this map is for - planning purposes only.It may not be adequate for legal boundary definition or regulatory Interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING THEACCURACY, COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION ?s< 1"=33ft s3 9R North Andover MIMAP November 17,2015 North Andover MIMAP November 17, 2015 1 fr f ................ i I Q MVPC Be - s; Interstates Horizontal Datum:MA Slaleplane Coordinate System,Datum NAD83, I Meters Data Sources:The data for this map was produced by Merrimack '.. —SR. pORTM Valley Planning Commission(MVPC)using data provided by the Town of Roads Of Stu r 'q� North Andover.Additional data provided by the Executive Office of q"r Easements } �O�t `'s 00 Environmental Affairs/MassGIS,The Information depicted on this map is Parcels .1Z L for planning purposes only.It may not be adequate for legal boundary definition orregulatoryinterpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING {t * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY 4L's K OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT �► °o' .rr M ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �1S3ACHU5�t 1"=45ft ^�-E Residential Property Record Card PARCELID:2101037.A-0019-0000.0 MAP:037.A BLOCK:00119 LOT:0000.0 PARCEL ADD RESSAO COAC HMANS LANE FY:2015 F_ PARCEL INFORMATION Use-Code: 101 Sale Price: 0 Book: 01354 Road Type: T Inspect Date: 06/15/2008 Owner: Tax Class: T Sale Date: 12/31/77 Page: 0612 Rd Condition: P Meas Date: 06/15/2008 Tot Fin Area: 5180 Sale Type: Cert/Doc: Traffic: M Entrance: X KETTENBACH,MICHAEL L&FRANCES D Tot Land Area: 2.20 Sale Valid: N Water: Collect Id: RRC C/O RMD Address: Grantor. Sewer Inspect Reas: C 881 EAST STREET Exempt-B/L% Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% Open Sp-B/L% TEWKSBURY MA 01876 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 8 Main Fn Area: 2480 Attic: NlBHD CODE: 8 N13HD CLASS: 8 ZONE: RI Story Height: 2.00 Bedrooms: 4 Up Fn Area: 2700 Bsmt Area: 2480 Seg Type Code Method Sq-Ft Acres lnflu-Y/N Value Class Roof: H Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1240 1 P 101 S 43560 1.000 219,718 Ext Wall: BV Half Baths: 2 Unfin Area: Bsmt Grade: G 2 R 101 A 0 1.200 9,120 Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 5180 DETACHED STRUCTURE INFORMATION Foundation: CN Bath Qual: T RCNLD: 595616 Kitch Qual: T Eff Yr Built: 1974 Mkt Adj: Str Unit Msr-1 Msr-2 E-YR-BIt Grade Cond%Good P/F/E1R Cost Class Heat Type: HW Ext Kitch: Year Built: 1967 Sound Value: PT S 760 0.00 1988 A A ///85 4,000 Fuel Type: G Grade: GV Cost Bldg: 595,600 VALUATION INFORMATION Fireplace: I Bsmt Gar Cap: Condition: A Aft Str Val 1: Current Total: 828,400 Bldg: 599,600 Land: 228,800 MktLnd: 228,800 Central AC: Y Bsmt Gar SF: Pct Complete: Aft Str Va12: Prior Total: 818,200 Bldg: 581,400 Land: 236,800 MktLnd: 236,800 Att Gar SF: 988%Good P/F/E/R: /100/100/80 Porch Type Porch Area Porch Grade Factor P 31 W 16 SKETCH PHOTO 4 4, 16 16 7 3326 FM 2480 Sq.Ft G B 988 Sq.Ft 31 2480 Sq.Ft 28 Fu 38 38 2700 Sq.Ft A-3 Ft 10 26 _j 40 COACHMAN'S LANE Parcel ID:210/037.A-0019-0000.0 as of 11/17/15 Page 1 of 1 �`�ie Commonwealth ofHassgChusetts' Department of fnalusi'lal-Aceidents u' a X Congress Street,Suite 100 _ °yd Boston,MM 02. 14.2017 www mass�s.goY�/dza 2 $y1 Vorkexs'CompensatiozxXusnxaxice Affxc�avzt:Builders/Contxactoxsfflectricians/kXumiuexs. TO BE MED WZTIC THE l'ERIO�ITTTNG AUTJ�ORITX. App lzcant Information Please)Print LeAbiy Namo(Business/Organizationadividual):- ►t�1�hA�i i�'���-rte t� Address: - 0 I A-00 om' Cxty/State/Zip: )1AJEL(e.—_y�6+4- Phone Areyou an employer?Checktiie appropriate box: Type of p):Oject(x'equired): I.Al am a employer with ;•`7: employees(full and/or part-time).' 7. ❑Now constriction 2.E]I am'a,sole proprietor or partnership and have no employees working forme in 8. Ll Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3_.E]1`am a homeowner doing all work myself [No workers'comp.nisurauee required.]t 10�Building addition 4-ll am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that alt contractors either have workers'compensation insurance or are sole 11.[[Electxical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hiredthe sub-contractors listed on the attached sheet. 13.E]Roofrepairs These sub-contractors have employees andhaveworkers'comp.insurance,* 14.❑Othbr 6.E]We are a corporation and ifs offfcers have exerclsedtheir right of exemptionperMGL e. 152,§1(4),and we have nc,e*rn'' " es.[No workers'comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showingtheirworkers'compensation policy information. t Homeowners who subniit this affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such. ?Contractors that cheek 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-coniractors have employees,ihey must provide(heir workers'comp.policy number. I am an employer Matispi'dviding-worlter�s'compensation insur�ancefor�my employees 'below is thepolicy andjob site information. TrlsuranGe CompanyN•ame: Policy#or Self ins.Lic.#: ExpirationDate: Job Site Address:_`7't'J�/1 �/�J /' City/Statemp:116 J l d Attaffi a copy of the workers'coanpensatiowpolicy declaration.page(showing the policy number and OViration(late). 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 impxisonm.ent,as yell 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 fuvestigations of the DIA for insurance coverage verification. X do Iie>'eby e _f u er t1i p a p alties ofperjuiy that the informadon provided above is true and correct. Si nature: Date: L✓/O Phone#: official use only. _00 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.BuildingDepartm.ent 3.City/Town Clem'. 4.Electrical Inspector 5.Plumbinglnspector 6. Other Contact Person. Phone#: PERFBUI-01 CLEDDUKE CERTIFICATE OF LIP► ILITY INSU NCE DATD/YYYY) 91111612612 015 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: Kelly Estano,AAI, CISR Rogers&Gray Insurance Agency,Inc. PHONE FAX No): (877)816-2156 434 Rte 134 E-MAIL Ext South Dennis,MA 02660 ADDRESS:mail@rogersgray.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company INSURED INSURERB:Arbella Protection Performance Building Company,Inc. INSURER C:Navigators Insurance Company 50 Tanner Street INSURER D:National Liability&Fire Insurance Company Lowell,MA 01852-4419 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. ADDL SUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 1 OCCUR CBP8051843 07/03/2015 07/03/2016 PREMISES EaoccurLrence $ 100,000 X XCU Included MED EXP(Any one person) $ 5,000 X Contractual Liab PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 F—] PRO- ❑ PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JECT LOC $ OTHER: AUTOMOBILE LIABILITY Ea acCMBcidentSINGLE LIMIT $ 1,000,000 B ANY AUTO 1020004067 07/03/2015 07/03/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS XX NON-OWNED P.rra cRdenTY DAMAGE $ HIREDAUTOS AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 ''.......... C EXCESS SSL CLAIMS-MADE NY15EXC7310221V 07/03/2015 07/03/2016 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X PER OTH- STATUTE I ER AND EMPLOYERS'LIABILITY 1,000,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE ® NIA V9WC651428 07/06/2015 07/06/2016 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below A Leased Rented Equip CBP8051843 07/03/2015 07/03/2016 200,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached 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 No.Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD !mffe�nmvjeoitturrtlli[1/(11h/aJJCrcX*1fjC//J Office of Consumer Affairs&Business Regulation License or registration valid for individul use only l �POME IMPROVEMENT CONTRACTOR before Elie expiration date. If found return to: egistratlon: 161993 Type; Office of Consumer Affairs and Business Regulation 'Expiration:;..:12l22/2Q16 Private Corporation 10 ParIt Plaza-Suite 5270 Boston,MA 02116 PERFORMANCE BUILDING CO:INC. JAMES MCCLUCHY"( `�.: 50 TANNER ST — LOWELL,MA 01852 Undersecretary Not valid NvR out sig ature fv�assac�u� �. pub lif, ruc 77� d Lice nog Supervis,r "' `` yarn= Li�ense: cs-077847 ,t'r 17, GAEL p{BRI • -I,. 8FARNSTREETI 1* ` E�_ -� c Lp4sF06 MA f Commission" -xpiratio 06/29/2096