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HomeMy WebLinkAboutBuilding Permit #135-2016 - 5-9 Alcott Way 7/31/2015 4 �,� tsulLullvu rtrcml l 3? 6 oG ` TOWN OF NORTH ANDOVER l� APPLICATION FOR PLAN EXAMINATION " r Permit NO: I�p Date Received � �9SSAc"us�tlh Date Issued: --7--IMPORTANT: A licant must complete all items on this page l OGATON' Alcott liltay,North Andover ` Print PRt?t?ERTY.4W4VER 5 Alr. tt Village Cond6minlum Trust" Print MAP NO; PARCEL: I ZONING DISTRICT, 4. istonc istrict yes no .. Machine'Shop Village' .=yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 91 Repair, replacement C Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic Well l podplain x`,' Wetlands .111latersfied District :�Water/Sewer - Roofing related trim and siding replacement. I Identification Please Type or Print Clearly) OWNER: Name: AlcottVillage Condominium Trust/C/O MSG Management Phone: 603-235-9188 Address: 231 Hampstead St. Methuen, Ma 01844 CO CT OR a508.6 s170 ° Prime>ou h Service s c#dress 4 ,Huron&.-•Natick,,MA 417Fi7 Supervisor's�Construction License: - Exp. Date. 06897 2 - 9/03/2016 'Horne tmprz vement License Exp; Date: 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: $ 11 oa,> FEE: $ Check No.: 12121♦ Receipt No.: QA I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ORTII BUILDING PERMIT 0 NtED " e TOWN OF NORTH ANDOVER F = p APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 7�.64ATEY SS US Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION I Print j PROPERTY OWNER f Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:-Historic District yes no Machine Shop Village yes no 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 ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: I Home Improvement License: Exp. Date: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access"ta th,-'guaranty fund gria ire of Agent/Owner Signature of nontractor Location No. 1 77 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee t f Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ R ; ;i Check#� l r+ ,� Building Inspector r3 J - ' 4 Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dmnpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature M COMMENTS t HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes A Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/S.ignature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street 4tLocated at1:24tMainfStr e 4 - Y ... Fir�elDepartmentlsi ,tdture/date COMMENITIS,� ' i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. j Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10o-$1 000 fine NOTES and DATA— (For department use) i i l ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 I I I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4 Copy of Contract Floor Plan Or Proposed Interior Work :rs Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) � Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan �. Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance ors special permit was required the Town Clerks office must stamp the decision from the Board of Appeals P that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe:Building Permit Revised 2014 NORTII Tof � � own � .. : .-.�.. Andover No. - a - y C, 15 h ver, Mass, �� 4 coc NIc"twic �.95 RATED U BOARD OF HEALTH Food/Kitchen P E 7w Septic System LD THIS CERTIFIES THAT ............... BUILDING INSPECTOR ��. �_o... .. ........o 4.................... Foundation has permission to ere ....�................ b 'Idings on ............5 ... .. .. C.. .. ....��14. ............. g Q. Rou h to be occupied as ...... ! .. J!.... �. .. .. ....... ..... Q. p �� �� � � � Chimney provided that the person accepting this permit sl�aA in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S TS Rough Service ........................ ... .... .... .. .... ................1 Final BUILDING INSPECTOR GAS INSPECTOR i Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or D Wall To Be Done FIRE DEPARTMENT Dry Until Inspected and Approved by the Building Inspector. - Burner Street No. Smoke Det. i II TOWN OF NORTH ANDOVER i AFFIDAVIT I Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: Roofing related trim and siding Est. Cost 1 13 Address of Work SA Alcott Way, North Andover Owner Name: Alcott Village Condominium Trust Date of Permit Application: 7/31/15 I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Permit No. Job under$1,000 Date Building not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: 7/31/15 Primetouch Services 155685 Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name i Proposal for Pre and Post roof Carpentry Work of Alcott Village Condominium Complex North Andover,MA Property Manager: Brian Oulette MGS Management LLC 40 Alcott Way North Andover,MA 01845 603-235-9188 MGS.management4 a)verizon.net General Description of work to be performed: Carpentry replacement to rakes and fascias prior o roofing and above roof corners and siding after roofing work to exterior stained and painted surfaces of buildings A,B, C, D,E,F and G located at Alcott Village Condominiums, Alcott Way,North Andover,MA. Specific Description: Areas Included: Above roof clapboard siding,corner boards and rake boards,fascia boards. Areas Excluded: Window sash,inner window sills,doorjambs,entry doors,decks,railings, stairways,items listed under unit resident responsibilities;any porch enclosures;any other area not specifically included. Unit Resident Responsibilities: Removal and replacement of personal property from deck,parking cars well away from building during production, unlocking windows, removal & replacement of storm windows, removal and replacement of window screens & slider screens and providing timely access to entry doors.Non-cooperation will result in exclusion of these surfaces. Prime Touch shall not be liable for any property that is not removed by the Unit Resident. Production Process: Timing: The job will be completed in the 2015 painting season (April to October, 2015 weather permitting). The crew will remain on the job site from start to finish of the project.Prime Touch will not leave the job site prior to completion. Each building will be completed in a continuous fashion to minimize the disruption of the unit owners. Communication: Prime Touch will designate a Project Manager. The trustees are requested to designate one Property Manager and one Board Member to be the project contacts for unit owners to communicate questions,issues and problems.Clear controlled communication and swift remedy will provide all parties with a positive experience. Prime Touch will utilize two way door hangers for the unit owners or tenants to communicate actions required to facilitate the painting of their unit. 1 6 Huron Drive PRIMEtouch Natick,MA 01760 5 E R " ' c E s 800-767-8910 Alcott Village 2015 Exterior Carpentry Proposal 06/12/15 Page l of 6 I Pre-Paint Carpentry Selection of Work Levels: Demolition: Inspect exterior siding and trim surfaces. Remove deteriorated siding and trim boards Remove deteriorated underlayment and flashings Remove deteriorated sheathing,insulation and framing(billed @ time&materials) Properly dispose of all debris Rake and clean the jobsite daily Carpentry Work: Install new framing, insulation and sheathing(billed @ time&materials) Install Ice&Water Shield where applicable at window&door openings,rooflines and decks Install new underlayment and flashings Install new siding&trim(billed per unit pricing table below) Install aluminum flashing between all clapboard siding joints Install new materials with stainless steel or galvanized fasteners Prime all cut wood Miter all joints to shed water Caulk all new work with paintable caulk Materials: Framing Kiln Dried Spruce-Pine-Fur Sheathing %Z"CDX Plywood Underlayment Tyvek Home Wrap/15 lb,Felt Paper Ice&Water Shield Grace Ice&Water Shield or Equal Flashings Aluminum and lead flashing Siding Pre-Primed Non Finger Jointed CVG Cedar Siding Trim boards PVC Trim Boards Interior Repairs: Interior repairs(repairs inside the sheathing of the building)which may be needed caused by the Work which are to be reasonably expected due to the nature of the Work, for example, interior wall cracks,nail pops,electrical, plumbing,and hvac lines hit by nails,etc,shall be addressed upon request of the Owner by Change Orders. The determination of whether an interior repair was to be reasonably expected due to the nature of the work or as a result of the negligence or other failure of the Contractor shall be decided by the designated Principles/Contacts of the Owner and the Contractor. i 6 Huron Drive PRIME'LOUc 2 Natick,MA 01760 SERVICES 800-767-8910 I Alcott Village 2015 Exterior Carpentry Proposal 06/12/15 Page 2 of 6 PRIME TOUCH CARPENTRY PRICING: Price includes Labor,Materials,Equipment and Two-year Guarantee The amounts listed as estimated work are based upon a ground level inspection of the property.Actual amounts of work will vary from unit to unit. The billing for all work performed will be submitted to the Property Manager/Condominium Association Representative for approval on a weekly basis.No additional work exceeding the cost of the Estimated Carpentry Work will be performed without the written approval of the Property Manager/Condominium Association Representative. All Dormer fascias will be removed prior to roofing as to install proper blocking and sheathing behind the soffit and fascia,then covered in ice and water-shield and properly flashed by the roofer. All front entrance lower roofs will have the siding and trim removed to be fully covered in ice & water-shield by the roofer. All roof to wall transitions will have the siding and trim removed to be covered 18"up the side wall with ice and water- shield by the roofer. Pre roofing pricing is to replace ALL rakes and fascia.We will replace rakes and fascia,as needed using PVC trim invoiced at the unit pricing below.The reason for the full replacement pricing is to give the option for total replacement. Pre-Roofing Work Labor Cost Material Cost Total A 1-4 $4,680 $2,340 $7,020 B 5-9 $5,850 $2,925 $8,775 C 10-15 $7,020 $3,510 $10,530 D 16-21 $7,020 $3,510 $10,530 E 22-29 $9,360 $4,680 $14,040 F 30-33 $4,680 $2,340 $7,020 G 34-39 $7,020 $3,510 $10,530 Total S-45,630 $22,813 $68,445 Post roofing work includes all above roof corner boards and clapboard siding.Short chimneys will have comers and siding replaced in full.Large rear chimneys removed by roofer. Post-Roofing Work Labor Cost Material Cost Total A 1-4 $6,098 $3,700 $9,798 B 5-9 $7,623 $4,625 $12,248 C 10-15 $9,147 $5,550 $14,697 D 16-21 $9,147 $5,550 $14,697 E 22-29 $12,196 $7,400 $19,596 F 30-33 $6,098 $3,700 $9,798 G 34.39 $9 147 $5 550 $14,697 Total $59,456 $36,077 $95,532 Painting includes one coat to re- rimed re laced areas of trim and siding Painting Labor Cost Material Cost Total A 1-4 $1,830 $450 $2280 B 5-9 $2288 $563 $2,850 C 10-15 $2,745 $675 $3,420 D 16-21 $2,745 $675 $3,420 E 22-29 $3,660 $900 $4,560 F 30-33 $1,830 $450 $2,280 G 34-39 $2,745 $675 $3,420 Total $17,843 $4,388 $22,230 Optional work: • Second coat of painting if chosen would be an additional$16,675 • Changing front small chimneys to vinyl siding instead of cedar clapboard -$225 per chimney • At dormer fascia to roof transitions,removing sheathing to install blocking underneath$40/area 6 Huron Drive PRIM'Et4vuc Z Natick,MA 01760 S "E d V ; C E s 800-767-8910 Alcott Village 2015 Exterior Carpentry Proposal 06/12/15 Page 3 of 6 Additional arpentry Work will be billed at the Unit Pricing listed below: Item Unit Labor/Unit Material/Unit Cost/Unit T 1-11 sq.ft $75.00 $150.00 $225.00 Clapboard Siding lin.ft $2.00 $1.75 $3.75 1x3 PVC lin.ft $4.50 $1.50 $6.00 1x4 PVC lin.ft $4.50 $1.65 $6.15 1x5 PVC lin.ft $4.50 $1.85 $6.35 Ix6 PVC lin.ft $4.50 $2.25 $6.75 1x8 PVC lin.ft $4.50 $3.00 $7.50 1x10 PVC lin.ft $4.50 $3.75 $8.25 1x12 PVC lin.ft $4.50 $4.50 $9.00 5/44 PVC lin.ft $4.50 $2.50 $7.00 wa a Door Stop lin.ft $4.50 $3.00 $7.50 PVC Sill Nosing lin.ft $4.50 $3.50 $8.00 908 Casing PVC lin.ft $4.50 $3.50 $8.00 Hourly Rate hour $48.00 $48.00 Material Mark U % $0.15 $0.15 *All repair work not included but not limited to sheathing,framing,window&door installation(including measurement),interior window or door trim work,interior repairs due to sheathing or framing replacement,leak investigation&repairs,deck/deck repairs and moving utilities will be billed at time&materials. 6 Huron Drive PRIMEtOUCh Natick,MA 01760 5 E R V I S-. E 5 800-767-8910 Alcott Village 2015 Exterior Carpentry Proposal 06/12/15 Page 4 of 6 Prime Touch Guarantee: Prime Touch guarantees our workmanship and materials will not fail for two(2)years from the date your project is completed as determined by the date that the specific building was accepted and invoiced. There are some limitations to the Guarantee.Please see below. Definition of Workmanship: The intent of this guarantee is to protect the customer from faulty application by Prime Touch or faulty materials provided by Prime Touch. The intent of this guarantee is not to transfer liability of existing deficiencies in building design, construction, or previous workmanship and previous materials provided by other contractors, from the property owner to Prime Touch. Areas where there has been a history of failure are not guaranteed unless corrective measures have been taken to eliminate the root cause of the historical failure. Prime Touch guarantees to remedy failed areas, at no cost to the owner. Guarantee work shall be scheduled in the production schedule after verification and completed in the order of the production schedule,weather permitting. I Definition of"remedy":Prime Touch will repair the failed area, and only the failed area. Due to fading,the fresh coating applied to the failed area may not match exactly.All guarantee repair work will be performed at the same level of preparation as performed in the original contract. Service Limitations: This guarantee does not cover any damage resulting from external cause such as, but not limited to, negligence, misuse, abuse, unauthorized repair by others; defects in design, construction, or previous workmanship; fire, water, windstorm,sand abrasion,hail or any other act of God. Work necessitated by any of the foregoing will be subject to charge at our prevailing demand service rates. IN NO EVENT SHALL PRIME TOUCH BE LIABLE FOR SPECIAL,INDIRECT,INCIDENTAL OR CONSEQUENTIAL DAMAGES. Limitations to the Guarantee: Guarantee applies to all areas except: -Any area not specifically included in the contract -Galvanized metal -Varnished or transparent stained surfaces -Walked-on surfaces,flat horizontal surfaces,windowsills -Mildew or Algae -Painted or stained roofs or gutters -T- 111 siding,finger jointed trim and siding areas -Sap stain bleeding,Knot staining -Rotted or deteriorated substrates -Coatings applied to factory finishes,plastic,vinyl or glass -Any area or surface specifically excluded from guarantee in the above proposal 7, 6 Huron Drive PRIMEtauCh Natick,MA 01760 S E R V f C. E s 800-767-8910 Alcott Village 2015 Exterior Carpentry Proposal 06/12/15 Page 5 of 6 I �I The Fine Print Deposit: A 10%deposit and the return of a signed proposal is required to secure a position in the production schedule.20%payment is required upon start of the project. Payment Schedule: Prime Touch will submit invoices on a section-by-section basis. Invoices are due and payable seven(7)days from date of submission. Prime Touch and the Property Manager/Condominium Association Representative will agree upon the submission procedure prior to the start of the project. Past due amounts are subject to a service charge of 1.5%per month,which is an annual rate of 18%. Utilities: Pricing is based on the Condominium Association providing free and clear access on a unit-by-unit basis to water and electricity required to perform the proposed service. Unit Resident Responsibilities/Water Infiltration: Removal and replacement of personal property from deck,parking cars well away from building during production, unlocking windows, removal & replacement of storm windows, removal and replacement of window screens & slider screens and providing timely access to entry doors.Non-cooperation will result in exclusion of these surfaces. Prime Touch shall not be liable for any property that is not removed by the Unit Resident.Prime Touch shall not be held responsible for water infiltrating any double pane window or door seal during power washing. Sign Off Procedure: Prime Touch requests and the Property Manager/Condominium Association Representative agree that each building or section of a building will be signed off after an inspection by the Prime Touch Project Manager and either the Property Manager/Condominium Association Representative. These inspections will be completed in a prompt manner not exceeding forty-eight(48)hours from notification. i Proposal Validity: I This proposal expires thirty(30)days from the date found on Page 1. Due to ongoing requests for painting service, acceptance of this proposal for production by Prime Touch is subject to the sole discretion of Prime Touch based on available production capacity.Once accepted by Prime Touch,the project will be completed within the season. Acceptance: 1 Alcott Village Condominium Association having met on �/ agree to request that the above- described work be accepted for completion for the above price. 49 Signed: my auth rized Representative of Alcott Village Condominium Association ', Signed• Property MAnager,Duly authorized Agent of Alcott Village Condominium Association. i I I 6 Huron Drive PRIME fl. f~<Z Natick,MA 01760 5 E R V 1 C E s 800-767-8910 Alcott Village 2015 Exterior Carpentry Proposal 06/12/15 Page 6 of 6 The Commonwealth of Massachusetts Department of IndustrialAccidents a 1 Congress Street,Suite 100 < Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERM HTTING AUTHORITY. Annlicant Information Please Print Legibiy Name(Business/Organization/Individual): Primetouch Services Address: 6 Huron Dr. j City/State/Zip:Natick, MA 01767 Phone#: Are you an employer?Check the appropriate box: Type of project(required): L®I am a employer with 60 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 8. ❑Remodeling any capacity.[No workers'comp.insurance required] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F1 Building addition i 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.❑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. Roof repairs These sub-contractors have employees and have workers'comp.insurance.= ❑ p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL e. 14.®OtherTrim/Siding 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. i I am au employer that is providitig ivorlfers'compensation insurance for my employees. Below is thepollcy and job site Information. Insurance Company Name:Star insurance Co. Policy#or Self-ins.Lic.#:WC0452496 Expiration Date:4/1/2016 Job Site Address: Alcott Way, City/State/Zip:North Andover MA Attach a copy of the workers'compensation policy declaration page(showingthe 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 thepains andpenalties ofper jury that the informationprovided above is true and correct. Signature: /�'�'l� Date:7/31/15 Phone#: 508-652-9170 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: PRIMI=-7 UP IU:SUR ,�✓ DATE(MM/DD/YYYY) -.. CERTIFICATE OF LIABILITY INSURANCE F07/30/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTACT NAME: Loretta Brown FBinsure,LLC DBA FBinsure AIC, o Ell:508-824-8666 1 AIC No): 508-880-0142 PO Box 509 ADDRESS:Taunton,MA 02780 SS:loretta fbinsure.com Tom Rogers,CIC,CRM,CWCA — INSURERS)AFFORDING COVERAGE _ NAIC# INSURER A:Selective Insurance Group 39926 INSURED Prime Touch Services Inc INSURER B:Star Insurance Company 18023 Attn: Mr. North 6 Huron Dr INSURER C: Natick,MA 01760 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. /LTR TYPE OF INSURANCE ADD) CY EXP POLICY NUMBER MMLDDNYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE - OCCUR 51916323 10/15/2014 10/15/2015 PREMISES DAMAGE T a occurrence) 500,000 X Blkt Add'I Ins PREMISES Ea occurrence $ � i MED EXP(Any one person) $ 10,000 X Blkt Waiver PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY JECFI T LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: PD Ded $ 250 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A ANY AUTO A9092598 10/15/2014 10/15/2015 BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ X UMBRELLA UABX OCCUR EACH OCCURRENCE $ 51000,00 A EXCESS LIAR CLAIMS-MADE S1916323 10/1512014 10/1512015 AGGREGATE $ 5,000,00 DED X RETENTION$ 0 $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER B ANY PRCPRIETORIPARTNER/EXECUTIVE Y� N/A WC0452496 04/0112015 04/01/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Equipment Floater S1916323 10/15/2014 10/15/2015 Lsd Equip 100,000 ACVISpecial Form Ded 500 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Painting and Carpentry Contractor. CERTIFICATE HOLDER CANCELLATION ALCOTTI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Alcott Village ACCORDANCE WITH THE POLICY PROVISIONS. C/O MGS Management LLC 40 Alcott Way AUTHORIZED REPRESENTATIVE Andover,MA 01845 Tom Rogers,CIC,CRM,CWCA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD h AINIL Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-068912 " MATTIPWT Lil�iV •�� 13 Dana park Hopedale MA 01747 ` ✓.�..» ��GGe�. _ Expir gion Comrnissioner 09/0W016 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massae efts 02116 Home Improvement � �� for Registration Registration: 155665 Tvpe: Private Corporation Expiration_ 5/1/2017 Tr# 265024 , PRIME TOUCH SERVICES INC WILLIAM NORTH ' 6 HURON DRIVE - - NATI-CK, MA 01760 -- Update Address and return card.Mark reason for change. 90A1 O ZOM- nl Address [3 Renewal 0 Employment Lost Card 1 C-�i.'�oarwrwsrwera�oaCC-3�aasaa�i�� ' , Ocoee of Consumer Attain do Hus cess Regulation License or registration valid for Individul use only OME IMPROV MENT CONTRACTOR before the expiration date. If found return to: i Istration: t 85 'typo: Office of Consumer Affairs and Business Regulation Expiration Private Corporation 10 Park Plaza•Suite 5170 r Boston,MA 01116 PRIME TOUCH SE F rsW, N �1 Wit.UAM N 0 �- B HURON DRIVE' NATICK,MA 01760 Undersecretary Not valid without signature