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HomeMy WebLinkAboutBuilding Permit # 12/4/2015 %AORTFI BUILDING PERMIT , TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: w Date Received TED Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ?—(a 17 M665 ("n J0 hn intU 100 Year Structure yes no PROPERTY OWNER '\ MAP PARCEL:0b+5 ZONING DISTRICT: Historic District yes no Machine Shop Village yes �, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 0 One family El Addition El Two or more family El Industrial El Alteration No. of units: 0 commercial -KRepair, replacement 0 Assessory Bldg 0 Others: 0 Demolition 0 Other — 91®rda", r(j�[NO,Ft,I o 0 d p I r,C:SCRIPTION OF WORK TO BE PERFORMED: ox Identification- Please Type or Print Clearly 0 OWNER: Name: 1151" Phone: Address: Contractor Name: A11_1_1z4__4r.4 g1M, Phone: e:9�2 Email: Address: loo Supervisor's Construction License: Date: Home Improvement License: Exp. Date: Z�11_�04P ARCHITECT/ENGINEERS Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASE,D ON$125.00 PER S.F. Total Project Cost: $ FEE. Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the g ar and 7—� 7,77,__"7777/7, 777 '77 %gha 7 nat 10AORTH of Andover ® .y. 0 L_ _n 'mD ® ec, 20 h [per Ver, SSS C, LAK■ 1 9 ®�RATE0 U BOARD OF HEALTH PER ! T LD Food/Kitchen Septic System THIS CERTIFIES THAT . BUILDING INSPECTOR Foundation has permission to erect . ........... buildings on � .. .e ........ . . .. ........ ............ .... Rough to be occupied as ............ . ... ....zkkirq, .. ....... ..!! ... .... .. ... ........ Chimney provided that the person acre ing this permit shall in every respect conform the terms of the applica ion Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Lspection,Altera 'on and Construction of Buildings in the Town of North Andover. Qv N PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. ISO Final EXPIRESPERMIT I ® T ELECTRICAL INSPECTOR UNLESS CONSTRU ® STA Rough Service ............ ....... .................. ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. William McKay Construction 18 Academy Avenue Bradford, MA 01835 Phone: (978)361-6402 Email:wrnc3cons@msn.com Find us on Facebook! PROPOSAL 12/3/15 Pwjeci ndnie: .iu in udrrney 267 Mass Ave North Andover, MA 01845 Scope of Work: a Provide permit. ® Mpply r2 Niywuuu uver aospes[os sningies on s existing dormas. ® Peel back existing shingles around 3 existing dormas. * Apply ice and water sheid on roof and sidewalls of existing dormas. * Patch roof shingles removed to properly flash dormas.Shingles may not match exactly. * Apply metal trim around existing windows. * Apply new siding on dormas. Uisposal will be done daily to a dumpster provided by the WMC. WMC work will be completed in a timely and clean manner and in observance of OSHA regulations.** GRAND TOTAL:$8,965.00 **A deposit of SO%of$4,48250 is due prior to the start of work.** WILLIAM MCKNY CONSTRUCTION LLC. 13 Academy Ave Haverhill, MA 01335 973-361-6402 CONTRACT This Construction Contract (hereinafter the "Contract") is hereby made on 12/3/15 by and between John Gaffney (hereinafter"Client") and W McKay Construction LLC of 18 Academv Aven,ip, Hnitarhill, MA 01835 (hereinafter "Contractor") collectively referred to herein as the "Parties". ARTICLE I A. Contractor shall provide the following Construction Services (the "Project"), as agreed to in a signed Proposal related to said scope. B. Client engages Contractor and Contractor agrees to provide to Client all necessary service , materials, and labor necessary for the completion of the Project including, but not limited to , all building and construction materials outlined in the signed scope. Material estimate and all necessary tools and machinery needed for Project completion. All construction materials should be new and of the highest quality, unless previously specified by the Client. C. Contractor shall provide the construction services for the Project at the property located at 267 Mass Ave., North Andover, MA 01845. D. The Contract shall be comprised of the following: this Construction Contract, Plans, Specifications, Addenda, Drawings, Photos, Proposal, materials estimate if applicable all signed and witnessed, all of which are attached hereto and are a part of this Contract as exhibits. ARTICLE Il A. Contractor will be scheduled once deposit is received. B. In the event that Client and Contractor agree on changes to the Project after this Contract is executed, the Parties will agree to new time deadlines that are reasonable in light of the modifications and that schedule change will be signed and witnessed and become a part of this Contract. . 'n consideration of the performance of this Contract, Client agrees to pay Contractor the sum of$ 8,965.00 (the "Contract Price") on the following payment schedule for the services. Contractor shall receive a 50% deposit of$4,482.50 before the start of the Project to be used for initial material purchases, etc.. Thereafter, a final payment of the balance shall be made of the Contractor's services at the completion. B. After receiving notification by Contractor of each stage of completion, Client or its designee will inspect and approve the work or request any necessary adjustments to same. Client agrees to make payments to Contractor after approving work. Payment shall only be adjusted upon the mutual consent of both Parties if due to unseen events or the parameters of the work are expended materially beyond the terms of the Contract. This Contract and associated fees will be modified accordingly in the form of Extra Work Orders which once signed and witnessed to shall become a part of this Contract. ARTICLE IV A. All changes or modifications to the work ordered by Client must be made in writing, with appropriate adjustments made to total payment and payment schedule. The approval of both Parties shall be required in the form of an Extra Work Order for substantial Project changes as these changes will effect date of completion, Project price, and notifications of these changes must be made in a timely manner. B. If these changes should require additional expense to Contractor, Contractor must make a claim for increase in payment, in writing to Client in a timely manner. Client must approve this claim for increase in writing prior to any changes to the work, Project or schedule. All such documents relating to changes to this Project must be signed and witnessed to and will become a part of this Contract. ARTICLE V A. If Contractor is delayed from completing required work due too unavoidable casualties, Client shall grant Contractor an extension for the completion of work equal to the delay. Unavoidable casualties include, but are not limited to, fire, flood or natural disasters, delayed acquisition of materials or material delivery, and negligence or non- payment on the pari of the Client. r= fhe event of unavoidable casualties; Contractor shall properly document both the event and the impact of the event on Project completion. Documentation shall be presented to Client in a timely manner. ARTICLE- V1 A. If Contractor fails to correct defective work or persistently rails to supply materials or equipment in accordance with the Contract documents, Client may order Contractor to stop the work or any portion thereof, until the cause for such order has been eliminated. ARTICLE VII A. Free access to the work and the Project site shall be granted by Contractor to Client, the designated agents of the Client, and all necessary, public authorities. B. Contractor agrees to keep the premises clean and orderly. Contractor shall remove all debris as needed during the hours of work in order to maintain work conditions free of health or safety hazards. ARTICLE VII A. Contractor shall conduct its activities in a professional manner and adhere to reasonable wishes of Client in relation to its working schedule. Additionally, Contractor's work shall adhere to and be in compliance with both the Standard Practices of the Trades and any relevant Manufacturers Specifications. B. Contractor shall protect all work adjacent to the Project site from any damage resulting from the work of Contractor and shall repair or replace any damaged work at its own expenses. Contractor shall take all precautions to protect persons from injury and unnecessary interference or inconvenience. ARTICLE 1A A. Client agrees to hold harmless, indemnify and defend Contractor and each individual or entity that is an agent, affiliate, partner, officer, or stockholder of same against any and all claims, losses, liabilities, damages, and expenses, including legal fees, fines, judgments, settlement amounts all made in connection with , or arising from errors in any representation or warranty made by Client under this Contract, any breach of the Contract by Client, or any omission or negligent act or error by Client in connection with this Contract, provided by such negligent act, omission, or error was not done at the direction of Contractor. B. Contractor agrees to hold harmless, indemnify and defend Client and each individual or entity that is an agent, affiliate, partner, officer, or stockholder of same against any and all claims, losses, liabilities, damages, and expenses, including legal fees, fines, judgments, settlement amounts all made in connection with , or arising from errors in any representation or warranty made by Contractor under this Contract, any breach of the Contract by Contractor, or any omission or negligent act or error by Contractor in connection with this Contract, provided by such negligent act, omission, or error was not done at the direction of Client. ARTICLE X A. Contractor is responsible for insurance to protect against any property damage, bodily injury, death, or other claims for damages that may result from the commission of the work, including general liability insurance and workers compensation insurance for its employees and/or subcontractors. Contactor will supply Client with said Certificates of Insurance before the Project begins. B. COVERAGES: (Apply only to actual work performed as set forth in contract) 1. Structure: For a period of one year after the date of completion, the floors, ceilings, walls and other internal structural components of the dwelling, which are not covered by other parts of this Limited Warranty, will be free of substantial defects in materials or workmanship. 2. Systems: For a period of one year after the date of possession, the plumbing, heating and electric wiring systems will be free of substantial defects in materials or workmanship. 3. Roof: For a period of one (1) year after the date of roof installation, the roof will be free of leaks caused by defects in materials or workmanship, but not those caused by ice back-up. r- r X-CLUSI®ISS FROM COVERAGE: We specifically do not assume responsibility for any of the following items, each of which is specifically excluded from this Limited Warranty: 1. Untects in appliances or pieces of equipment which are covered by manufacturer's warranties including furnace and hot water tank. 2. Damage due to ordinary wear and tear, abusive use, misuse or lack of property maintenance of the dwelling or its component parts or systems. 3. Defects which arp tho r=Qi il+ of cl-,a�r�ntoPio�inc+ nnrv�vw'an fn +w.+b..r:.+l. A v.wuvv vva wl lV 111CM--1 IQL7 use U. L)afects in items installed. supplied or work done by you or anyone other than by us or our subcontractors at our order. o. Any loss or injury due to ground watr-r. 6. Loss or injury due to elements, including, but not limited to weather and other acts of God. 7. Conditions resulting from condensation on, or expansion/contraction of materials. ti. Your failure to properly care for lawns. 9. Consequential or incidental damages. 10.Due to large trucks, equipment, dumpsters, etc., driveway may crack, create divots etc. Also during construction, lawn may be damaged. Contractor is not responsioie Tor the same. ARTICLE XI A. Contractor will be responsible for obtaining all the necessary permits and licenses to tultW the services specified in this Contract. ARTICLE XII A. Contractor is responsible for maintaining proper work, safety and environmental protection standards. Contractor agrees to hold Client harmless for all fines from federal, state or local agencies and regulators. Contractor will work in compliance with all standards required by EPA, OSHA and other applicable federal agencies. Contractor will be responsible for paying all fines and judgments levied by these agencies resultant from the performance of this Contract. ARTICLE XIII A. The relationship created between the Parties shall be limited to that of independent contractors. Neither party shall undertake any actions that would imply or seek to establish, any partnership, ownership, employment, joint venture, or trust relationship between the Parties, except by amendment to this Contract. ARTICLE XIV A. Any dispute or claim related to or arising from this Contract, its performance, breach, interpretation, validity, or enforceability, shall be exclusively(except as provided below) resolved by final binding arbitration before AAA American Arbitration Association utilizing AAA Commercial Arbitration Rules. B. The arbitrator shall be selected using AAA procedures. The arbitrator shall render a written decision within thirty calendar days of the hearing. The arbitrator may award attorneys' fees or punitive, incidental, consequential, treble, or other multiple or exemplary damages. C. Awards shall be final, binding, and non-appealable, with the exception of the grounds for appeal guaranteed by the Federal Arbitration Act and applicable laws. All awards may be filed with one or more courts, state, federal or foreign t:eying iunsaiction over the party against whom such award is rendered or its property, as a basis of judgment and the issuance of execution of its collection. ARTICLE XV A. Both Parties are expressly prohibited from assigning this Contract or any rights or interest flowing therefrom. Assignment will only occur with the express written consent of both Parties. rd. I his Contract contains the entire agreement and understanding between the Parties and supersedes any prior or contemporaneous written or oral Contracts, representations, and warranties between them respecting the subject matter of this Contract. C. This Contract will be interpreted and enforced under the laws of the State of MA, without regard to conflict of laws. IN WITNESS WHEREOF, the Parties hereto execute this Contract: CLIENT Authorized` i9 nature t- Name and Title CONTRACTOR Authorized Signature ��.��-:�.� Name and Title License 179265 The Commonwealth of Massachusetts z . Department of IndlustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 :.•s����� www.mass.gov/dia Workers'Compensation Insurance.Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERMI'T'TING AUTHORITY. Applicant Information b� ]Please Print Le0 Name(Business/Organization/Individual):(-)m C`/ n000 1yCl�TCl L Address: ACa_oz�el/ City/State/Zip:lellAy®/`f,1/ & D?�SS® Phone Are you an employer?Check the appropriate box: Type of project(required): 1.541 am a employer with employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. EI Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.FJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 [)Building addition 4.❑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.C1 Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors fiave einployee's and have workers'comp.insurance. ' 6.F1 We are a corporation and its officers� have exercised their right of exemption per MGL c. 14.[]Other oyees.[No workers'comp.insurance required.] 152,§1(4),and we have na empl *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submif 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-conlracfors have employees,'tliep must provide their workeis'comp.policy number. X am an employer Mat is providing ivorkers'compensation insurance for•my employees.'..below is the policy and,/ob site information. Insurance Company Name: Policy#or Self-ins,Lie.#: ExpirationDate:� Job Site Address: /��� ���� City/State/Zip: /�, a 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 d 'the pa' s a ialties ofpeijnry that the information provided above is true and correct. Si ature: Date: Phone# Official use only. Do not ivrite in this area,to be completed by city ortown official., City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MMIDDIYYY Y) AC � I I II INSURANCE 12/4/2015 THE CERTIFICATE HOLDER. THIS HE THIS CERTIFI CATE IS ISSUED AS A MATTER OF INFORMATION END EXTEND OR ALTER TIHE COVERAGE AFFORDED gURERBS)TAUTHORIZED CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN[ , BELOW. THIS CERTIFICATE OF INSURANCE AND THE CERTIFICATE HOLDERS NOT UTE A CONTRACT BETWEEN Tlf SUBROGATION 1S WAIVED,subject to REPRESENTATIVE OR PRODUCER, olic fes must' e endorsed. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the p Y( ) the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights tot e certificate holder in lieu of such endorsement(s). CONTACT Kim Ly NAME: FAX (781)963-4420 PRODUCER PHONE ('18l)986-4400 A1C No Risk Strategies Company E-MAIL kly @risk-strategies.com DDRESS: NAI31470 # A 15 Pacella Park Drive INSURERS AFFORDING COVERAGE 314 AI Suite 240 MA 02368 INsuReRA NorGuard Insurance Co Randolph INSURER B INSURED INSURER C W McKay Construction LLC INSURER D 18 Academy Avenue INSURER E MA 01835 INSURER F BradfordREVISION NUMBER: COVERAGES CERTIFICATE NUMBER-.CL154892045THIS RM OR CONDITION OF ANY CONTRACT OR OTHREB D HEREN Is SUBJECT PTO ALL ECT O THE TERMS, CH THIS ISG CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THESCSUR DOCUMENT NAMED ABOVE FOR THE POLICY PER INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES D TYPE OF INSURANCE LIMITS D CLAIMS- IDY EO EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.1 MM LIMITS SHOWN MAY HAVE BEE �N REDUCED BY PFF Prnnll ooLICY EXP/YYYY INSR POLICY NUMBER EACH OCCURRENCE $ LTR ooL suBR DAMAGE TO RE TED GENERAL LIABILITY PREMISES Ea occurrence $ COMMERCIAL GENERAL LIABILITY MED EXP(Any one person) $ CLAIMS-MADE OCCUR PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS-COMPIOP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: COMBINED SINGLE LIMIT OLICY PRO- LOC Ea accident P AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ ANY AUTO ALL OWNED SCHEDULED PROPERTY DAMAGE $ AUTOS AUTOS Per accident NON-OWNED $ HIRED AUTOS AUTOS EACH OCCURRENCE $ UMBRELLA LIAB OCCUR AGGREGATE $ EXCESS LIAB CLAIMS-MADE $ WC STATU- OTH- DED RETENTION$ x 100 000 A WORKERS COMPENSATION E.L.EACH ACCIDENT $ AND EMPLOYERS'LIABILITY Y/N /29/2015 /29/2016 E.L.DISEASE-EA EMPLOYE $ 100 000 ANY PROPRIETORIPARTNER/EXECUTIVE f NIA C634557 500 000 (Mandatory In NH) OFFICER/MEMBER EXCLUDED? E.L.DISEASE-POLICY LIMIT If yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION ob�Location JTIOtIS I LOCATIONS I GaffneyV267 VEHICLES (Attach Ave. Nor job s required) Andoversclredule,If more space I J CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ION ETHEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THEPOLICY PROVISIONS North Andover Building Dept. AUTHORIZED REPRESENTATIVE 1600 Osgood Street North Andover, MA 01845 Michael Christian/KIL ©1988-2010 ACORD CORPORATION. All rights reserved ACORD 25(2010105) Thn ACA17fl n�mn�nrl Innn Oro of ACf1R INR095 19ninl n+ DATE(wAMDYYYY) CAR CERTIFICATE OF LIABILITY INSURANCE 12/4/2015 THIS CERTIFICATEW ISSUED ASA MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELYOR 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 REPRESENTATIBIMR PRODUCER,AND THE CERTIFICATEHOLDER. IMPORTANT:If the certificeteholder is an ADDITIONAUNSURED,Ihe pollcy(ies)nust be endorsed.N SUBROGATIOIS WAIVED,subject to the terms andconditions ofthe polioyperlainpoliciaa symquireanendomementAstatementon thlscertHieatedoesnot conferrightstothe ceRNicateholder in lieu of such endomement(s). PRODUCER CONTACTNAME Sandi Munroe M P ROBERTS INS AGCY INC PHONE978>683-3147 .,.: (978)683-8073 ,Na: 1060 Osgood Street E-MA" sandi@mprobertsinsurance.com ES North Andover, MA 01845 INSURER(S)AFFORDING COVERAGE NAICW INSURERA: MERCHANTS INSURANCE INSURED W MCKAY CONSTRUCTION LLC INSURER B: 18 ACADEMY AVENUE INSURERC: BRADFORD, MA 01835 INSURERD: INSURER E INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEINOD 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, D(CLUSIONSANDCONDITIONSOF SUCH POLICIES.LIMITS SHOWNMAY HAVEBEENREDUCED BYPAID CLANS. POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER x COMMERCUU.GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CINMSL.V�DE ' y' OCCUR PREMISES Ea ocarrence $ 100,000 MEDEXP(Anyonepersan) $ 15,000 PERSONAL B ADV INJURY S INCLUDED '.. p' BOP9097489 8/14/15 8/14/16 GENL AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X Poucv LTJ JE�GT LOC PRODUCTS-COMPIOPAGG 3 2,000,000 S OTHER _ AUTOMOBILE LIABILITY ECejaWdeM SINGLELIMIT 3 1,000,000 BODILY INJURY(Per person) S ANYAUTO MCAI002126 8/06/15 8/06/16 ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ A AUTOS X AUTOS NON-OWNED PROPERTY DM,IAGE 3 X HIRED AUTOS X AUTOS Pe acddent S X UMBRELLA LUIS X BAR I EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CWM.q,MgpE AGGREGATE S 1,000,000 CUP9097489 8/14/15 8/14/16 DED I X I RETENTION $ 10 OOO 3 PER ) WORKERS COMPENSATION STATUTE I I ER D EMPLOYERS'LIABILITY YIN Paomeraevurrr.w.��r� EL EACH ACGDENL $ _ ev NIA (MandatonJn NH)rws E.L.DISEASE-EA EMPLOYEE $ If yes,desaibe under EL DISEASE-POLICY UMI S DESCRIPTION OFOPERATIONS below DESCRIPTION OFOPERATIONS I LOCATIONS/VEHICLES(AGORD 101,Ad ffd—I R...ks Schedule,may be a0ad d'd—.P—is nsTdred) JOB LOCATION: JOHN GAFFNEY, 267 MASS AVE., NO. ANDOVER 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 ACCORDANCE WITHTHE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE M y ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD �vruAffairs�eeuuv&ral/Business�o�/C?/Rel�rt.lcrc�rrdc/%1 Win.\ Office of Consumer gulation License or registration valid for individul use only „SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 179265 Type: Office of Consumer Affairs and Business Regulation - „ xpiration: 7/10/2016 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 W. MCKAY CONSTRUCTION LLC, WILLIAM MCKAY 18 ACADEMY AVE. HAVERHILL,MA 01835— ------------ Undersecretary Not valid without signature W.MCKAY CONSTRUCTION LLC WILLIAM MCKAY �'"G' 18 ACADEMY AVE. g--�` — —� lyot valid without signatJ HAVERHILL,MA 01835 Undersecretary 91. t biaSSZChLfsetts - Debar^ enL of Public � slipelISOF License: CS-089332 ' ' ,1 l 18 Academy Avenue Haverhill MA 01935 om issioi,er 03/08/2016 I P 1 SSA—=—T. ;' a ^3 DRIVER'S LICENSE uH 4.ISS 9a END 4d NUMBER - -01.09.2012 NONE 51e10933 SU EXP 3 DOB 03708-2016 03-081980 KClASS 12 REST 15 SEX M 1F.467 rmo D` NONE 7x - A � z WILLIAM L IIIA B 22 ESSEX STREET PT 14 HAVERHILL,MA 01832 50001.10.2012 Rev 07.15-2009 P;�,