Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
STRIP AND REROOF (3)
Noar� BUILDING PERMIT O��YlE4 'gs��O TOWN OF NORTH ANDOVER o °~. APPLICATION FOR PLAN EXAMINATION Permit No#: — 1� Date Received �Ss ac►Dus�t�5 Date Issued: I RTANT: Applicant must complete all items on this page a s'% NA LOCATION - f�r� Print PROPERTY OWNER Q C 04L-e— Print 100 Year Structure yes no MAP j2,1_PARCEL: D 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 [i Alteration No. of units: ElCommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Wetlands ©v5l1latershed Disfirict Well ❑ Floodplain 5 mWm er� f l �. . SGRIPTION OF VIIORK TO BE PERFORME©: Identification- Please Type or Print Clearly �2 � OWNER: Name: c't� C� ' �,, �3 I Phone: ` �� -� " �" 3 Address: �� f t ►� Cxs i cS�'! J �" Contractor Name: G-' Phone: Email: Address: 3U Supervisor's Construction License: 91 Z ` Exp. Date: 12 � Homep Improvement License: S I Exp. Date: ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDIN PERMIT:$12.00 PER$91100.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 2-�2'� Total Project Cost: =71 FEE: $ Check No.: Receipt No.: -� �" NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �.. --.. ............ ....... .. . th®R'TH Town of 2 _ * 6Andover 0 No. C761 o h ver, Massol , SQA C"aw". _ % �R4TIE o o, y S � L) BOARD OF HEALTH Food/Kitchen PER W T LD Septic System THIS CERTIFIES THAT �. . . . .....� ,C 0 ,f�, T BUILDING INSPECTOR has permission to erect ................. ........ buildings on .1 ...21`YA3.. .,..W03a&a.'z&.'V... Foundation Rough tobe occupied as .................... P...... ...................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover, PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service ............................................................................ Final BUILDING INSPECTOR GAS INSPECTOR ®eeupancy Permit Required t® 0ecupy RuRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Null To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. kly,• � . . .''• r `' „ ISI l8 Ya N. • , ,rid:t' l l•Lmi'(,;..: s.rt c ?..��.�.'t7r .� •1t:, �� \1 •� 'Y.•,7,:f; •I�x r.+^'II {:i�l','•1 ''�,Jn �'. ['t:S�y lq rYt^v 1, ,r , �x `�' � C •r' It r.. �'(tl•'rl� r„i�Y.••r �!;�sr.t•►�YI�ry h' < 9 ,f2�s{ S"t� .F,1,.�vY t 1>•.x y . ;�i! Ys' �r.l„.r'+ ,t. Ts'' rF.�":�y 1'7'F."'' ,�s•r�n"f':���Ek>r'47��• 4 r•„s«'ka ^�rl�l . t, Y`••�vp�(`i�s'`ry}�'.'��,t� •• '�p'C? I'm PC :r, 'l . �' f}rr J;I,S 'n.';Jt�c'a:)1,`' ^, ✓7„ .klrnfitfJ }s'"ti�'� �SEyL ?� oL \ ��13`tiJ� 1x ��j rJf r 6�'� yF.• t+'s(tl 3t Z } • •f• t:. •r"' r.�e• ,L r Y •fel i` ,yl C,f:} �• 3 I�+' + �2'4J d'1+�7'. Me +a• •' •� :.. r••. l ss, ��y/ �yrl 4'^I CH 1t1'S+� • i,•'`r �I�; ��.• ,' ,[�7 t�r�yr� �,i.(7t.�'' i.ti' Y' r�W�11 •J ' • r.Y ••1. ,,•;�•l l";�}•�+�'{y�1•�i: •t .1 , .•!. .'�'! v Vfr Irr,' Y�I,�j ' ,(� r r VX �f ' •+I •j 'i' �''`' t Ili t.'.I� ��,' •�• • { 'iV � ��" !1 � '� �y� ' � �q • ;!�'i'{S t,.�,i t tn, '• •f•�'y �S§��1 •R�{ r. ',`t•tib`�� ., l"� �.` � CX � -K " } , ,1�+�'��k ., � � .I v � • �� ��: � ��,•,t' / V r tys�yl�y)�• �r� r y�g, 1�1� ! .J. ,,s,J7 A •Fy'1 '�� C ,'i' �',fS C � VI � - •J V' • �,” •.S rI J� }'l 5 I "I 1Yry� V�' 'lw F� }+. V ,�-f�'�`y • sY:�r* r {S J�'�fd",'.`i�li;.,' ,�� � ;N- y1t�cr ly,�l+ J, rt`Y`(x;;�-rel' '"'4 �S31§f?� {P {h �.. � .`T* ' �tta••rlr ,•t ''t'�F' �� •�Y r•:it % .J,.h,• :,4j �riOl STT ' 1 ark 1 !lt ti >iM' ti!1 1` () aMR: -; t1 1 V �.....w"rrr .1 I.' 'i Y 5, t � r�•r: -C�.J '�1,1� - � ' cu !�'`; t` '!f• � y{ r, r l,} " r �•t . � 1'�`ty'CZ. .J'T'• 'a.F.• f'.�C'Y l 1� at4F..§tlltr:'C�k .+ r. I L51 ,{:? kjU ip1t „ ' ,•Y Fes'f" ' S'1', ,iy* F' ''at's ,Y'ti'�'i \', 1 ! J79w• t , .. •„a'!t a''+, r •+ �l .'41i y''!ii':'ii•� ..S 's1 'P. {�-� +6J� �• ,��'i'tF` t� 42 5 1 to � '� �T � � �. ! ((r� y�,f;�1�i � � ,� � r3.H�• � � � 1\Ir++» -13 r�.��� ,j' �• "•:rT1:' ,r•�S 1 "M � r ',� � •�'• y2 '�• �� "it I.ry”' r' 1�R��Y�,y ,yy 1�. �T�• �} ffil wi ` t'„p.�t:' � 7,'lc�rrt ,��' a \\\ � � 'I, � '�[, �� � ' .}r.4 "�• � t �+.'�.1"1� �r � � •• {�+4$ h�� ` t v.`3 ,� t�3�(��'��'�'I � .y�►i p� �'' n1 :,r ' t � 'y'; Y 4 h�l���''•'i , �' r.r� rk i•- � � �.5 ?+7' j s i,: ':% S } 1 ti`' gym 1Y �`.ti51 • R”i” t�T` ��:; s- •1' �i;',•'3.;'�i. f ' !j r ;Y; K`l1}� �} �tr�n,s 4''r ry�'� ��' 'r { ,,', ,s. 1'::,�k•: r.rr ' 'tr s .,' ,, {,-�_f ,i,, �•''i L','+�JJ s„.'{fti„r i�ri.t�r '1�!T1fit�',�,u,J,r S'a8r•. .p''N�'yJ,sf'':.ur•,�'•,e, t”§.fi:�.� ri tt! Jj•'�#iaS. �L+ ' ' 'Lr'.r'.' 'r y r1^1F:•'. ' �`y� f � : '1 ' �l att't 1 R �' ` �'' `�`4 l'''• �� ��' ...� ,.. _ I ,Y•,�:�;,t,�+t,�^t i4'+:Y fir 3'�,', �i� ; � ��� -+ .:rtt'. .. .Y,1 •.S•..1';':';,;# :�,•1��,sif;,$s::.C.1`,�,��`s"1��1. x/u�[' �I ,'�ii `' i:,1' �ri rte' �� �'r r4 � %•. �. �' { y I' J� Vti•.l�+i C'' 14�a+�.7:�J��.�' IU �� t �,1! •+' � ,\ 'r /1�,y � �1 ��gy cl,e� f 'Y�+'.1 , 'Jtrty , r, -' •l'.' 't.:,.r" .i .F.!.• ,� sf..,�i/�1}ff.-pR'''f1�f i� •It hr 't :`Yl,n'.354k '".`, 4 trrt, ", 1 yi .. '•r,, r..t''; .���,.t�•��.3..,t :�`,il�:;�'r.�4,"�'4„�,�•C� �;�SI'fi:'C�1�%�;�;'�"�+S?�71'1FY� ' .. ':' �I �� �'"}� Il � �" d i i 0 Law .M =f Pocchimn4-mys Residential & Commercial Roofing Types Of Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work Mass Toil Free *Roof Leaks Experts * Licensed& Insured Locally Owned do Dperated Sh-ce J976 �"-"-"s 1-800-WAIT-4-US sem: License#034200 (924-8487) IKO crxee wazw oe 19ohn we- Work Year Round rj'�" ARM-- lProposal r1 - F1 :! 1 To: Village Green West Date 5/21/2016 Street: 200 Kingston St. N.Andover 603-382-6166 68-82, 108-138, 156-170 Roof proposal picaeng@comcast.net IKO Cambridge/Certainteed Landmark 1. Extra caution will be taken to protect all buildings, 11. Counter flash existing chimney lead,wall walkways and landscaping as best as possible. connections and all roof protrusions (pipe boots and Debris will be removed and magnets run daily. vents)with ice and water shield,tie into new shingles Not responsible to move tenants personal items. and sealed with clear Geo-Cel sealant. All installation procedures will follow state code 12. Bath Exhaust vents: Install all new black low and OSHA compliance. Caution tape outline all profile bath exhaust vents on roof line. Counter work areas. flashed with ice and water shield. One for each unit. 2. Remove all shingles and roofing materials as best No interior connection included. Will coordinate with as possible from all four buildings. Association for best locations per unit 3. Inspect and re-nail any loose or lifted plywood. 13. Wall connections: Remove existing siding or Any compromised plywood will be replaced at an aluminum trim as needed. Counter flash at least 18" additional cost. up the wall with ice and water shield. Install new 4. Install heavy gauge 8"white F8 .019 aluminum 5"x7"aluminum step flashing. Re-install siding and drip edge to all eaves and rakes. trim. Install new aluminum siding or trim if 5. Install 6' of IKO Storm Seal or Certainteed Winter compromised. Guard ice and water shield to all eaves and top to 14. Removal of all work related debris. Planks will be bottom in all valleys. All drip edge nails will be placed under dumpsters to prevent any damage to covered with 12"strip of ice and water shield. existing asphalt. Placement and removal of dumpsters (ASTM D6757 certified) will be coordinated with Association to minimize 6. Install IKO Storm Tite or Certainteed Diamond daily interruptions. Deck synthetic underlayment to remaining 15. Contractor Workmanship warranty: 15 years under sheathing up to the ridge. (ASTM D6757 certified) normal wind,rain, ice and snow conditions. 7. Install all new pipe boot flashings. Counter flashed (Please see extended warranty) with ice and water shield. 8. Install IKO or Certainteed starter shingles to all Extended Warranty: (Against material defect) eaves and rakes. *IKO Shield Pro Plus* 9. Install 1KO Cambridge or Certainteed Landmark • Full 20 year coverage direct from MFG. Limited Lifetime architectural shingles to all four - Non pro rated buildings. All shingles and roofing materials will - Labor, material, debris removal and workmanship be fastened and installed per MFG specifications. All valleys will be woven. Commercial MFG *Certainteed 3 Star Sure Start Plus* warranty up to 40 years. (Please see extended • Full 20 year coverage direct from MFG. warranty) • Non pro rated 10. Cut and install all new(ASTM certified)nylon Labor, material and workmanship. Debris removal mesh ridge vents to code to all four buildings and not available with 3 Star coverage capped with JK0 or CertainTeed color matched 1,:" Q"A V;Aty^nor% e1,;.,rrIAc+ Rnth F.Ytpndp..rl wnrrnntipc inebid d in nranncal • LN. W— E IMIE R404O Chi�rnn�y$ Residential & CommercialRoofing All .Types Of SidingCHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work Mass To[! Free �4 Roof �' s Experts �I- Licensed & Insured Locally Owned de OPerawc;S ... 1976OK 5 License#034200 i-800-WAIT-4-US IKO® G'aee 'j2o�rn n��nlin - � We Work Year Round (924-8481) , " a Proposal To: R. J Pica Engineering Date 5/21/2016 (Page 4) Street: Village Green West (Phase 1) 603-382-6166 68-82, 108-138, 156-170 Roof proposal picaeng@comcast.net IKO Cambridge/Certainteed Landmark Total cost and pa went schedule Total IKO Cost: $1.069000.00 Total Certainteed Cost: $1 4,000.00 3 • Total Gutter Cost: $15,000.00 (Balance due uponrpion of all four buildings) * Upgraded ice and water shield options (For best defense against water infiltration caused by ice dams) -IKO Premium Goldshield: $3,000.00 additional cost i _Certainteed Premium HT ; $2,600.00 additional cost I i Pa meet schedule: Balance including any additional costs due at the completion of each buildrug. No deposit required. IK er building Certainteed $28,500.00 per buil g Commercial references: . Jackson Lumber Heavenly Donuts . CSI (Cementary Services Inc) . Shaheen, Gurearra and O'Leary Law offices A Plus rated member of the Accredited BBB since 2001 5 year consecutive Super Service Award winner from Angles list (Top 5% of all New England roofing contractors} specifications and conditions are Acceptance of Proposal—The above prices, satisfactory and are herby e accepted. You are authorized to do the work as specified.Payment will a e as outlined above. Date of Acceptance: Signatu l i 3 i u ° The Commonwealth of Massachusetts a Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www masKgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. g TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrganizationMdividual):�au- lf✓lo'eA cv\,< IZ 3 j Address: I City/State/Zip: VWi Phone#: 9 1,-J, `7-3( Arc yon"employer?Check tyle zppropriste box: Type of project(required): I.[3-fam a employer with_ rmployccs(full and/or part-time).* 7. New construction 2.❑l am a sole proprietor orpartncrAip and have no employees working for me in 8. E]Remodeling i any capacity.[No workers'comp.insurance required.] 3.F 1 am s ho.cr doing all work myself.[No workers'comp.insurance required.]t 9. [j Demolition 3 10❑Building addition j 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will crLsrrre that all contractors either have workers'compensation insurance or are sok l 1. Electrical repairs or additions proprietors with no cmpbyees. 12.❑Plumbing repairs or additions 5�I am a general contractor and I have hired the sub-contraciars listed on the attached shoot. 13.�Roof repairs 3 These sub-contractors have employees and have workers'comp_insurance.t Wy Oth 6.Orc We aa corporation and its officers have exereised their right of exemption per MGL c. 14.[ReT,}— W' 152.§I(4),and we have no employes_fNo workers'comp_insuraocr required.] f •Any apptir_aut that chocks box#1 must also 611 out the section b0ow showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such_ p =Contractors that check this box nest attached an additional sheet showing the name of the sub-connamrs and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site information. i Insurance Company Name: tf i+ + or j ) B ,rl+ - ata - 9 v o W 2"/��E piration Date: Policy#or Self-ins.Lic-#: � �P Job Site Address: J s��'1 t`� L` in�,� `� % City/StatdZip: /'J Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 8 Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51,500.00 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 it coverage verification. I do hereby certify under dinpains and penalties of perjury that the information provided above is true and correct. Si afore: Date: 9 I/� 12 Phone#: Qfilcial 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: d i I 3 9/21 /2016 9 : 07 : 39 AM 8975 2 02/02 . +cv CERTIFICATE OF LIABILITY INSURANCE DATE{MM7001YYYY) E 09121/2016 g 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 o REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cattl0cate holder is an ADDITIONAL INSURED, the policy(los)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 endorsemerit(s). PRObucot 02051-,601 hRUTeCT Branch 2051-1 Perry_Insurancegency LLC A7CNNo.Ex€: (978)685-7690 1 AMNo.: (97B)887-0149 522 Chlckering,Rd MIL North Andover,MA 01845 o�Ress: I F y INSURERA: A.I.M.Mutual Insurance Company iNSUREO Alk. Under One Roof INs RER : C/O John Lanzafame INSURE O: 30 Temple Drive Methuen, MA 01044 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 PAIDCLAWS, •CTR TYPE OF INSURANCE IN&W D POLICY NUMBER IsmsayYY MM_D YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PREMISES. a occurrence S CLAIMS,MADE F OCCUR MED EXP(Any one peraanl .$ PERSONAL&ADV INJURY f GENERAL AGGREGATE S UEKAGGREGATELIMIITAPPLIESPER PRODUCTS-COMPIOP-AGG 3 OLICY F--PRO- OC AUTOMOBILE LIABILITY -aa, OI'll, D SINGLE LIKT $ Ea accitlen - ANY AUTO BODILY INJURY(Pet person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ . KRED AUTOS NON•OWNED PROPERTY DAMAGE ' AUTOS Rer-awd,w S S UMBRELLA L€ABJOCCUR EACH OCCURRENCE $ EXCESSL€AB CLAIMSMADE AGGREGATE S` DED I RETENTION F C {� 77 WORKEF SCE?,PENSATIDN X TORY LIMIT$ OER ANO EM LOY RS'LIAML TY A€�IY PRRpPRIET ROVRI R!EXECUTIVE Y IN E.L EACH ACCIDENT 4 A RFFICERlMEMB�REXCLU EOE NIA AWC-400-7009464-2015A '111912015 11181201E (Mandatory iipn NnH)) E.L.DISEASE•EA EMPLOYEE S EsCR1P�(DNOFOPERATIONSbelow E.L_DISEASE•POLICY LIMIT i 060 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AHach ACORO 101,Addifional Rerrlarkz Schedule,Ir mon$pact Is rsquirtd) The workers compensation policy does not provide coverage for John Lanzafame CERTIFICATE HOLDER CANCELLATION Village Green West Condominiums 200 Kingston Street SHOULD ANY OF THE ABOVE:DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA 01645 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRE$ENTATNE ' ©1988-2010 ACORD CORPORATION.All riahls raservnd_ 3 I i ofo j I DATE(MMIDDIYY) CERTIFICATE OF INSURANCE 09/20/2016 PRODUCER AND THE NAMED INSURED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Transworld Building Trades and Contractors Liability Association,Inc,Inc.,A Risk CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS I, Retention Purchasing Group qualified under the Risk Retention Act of 1986;Federal CERTIFICATE OF INSURANCE DOES NOT AFFIRMATIVELY OR Ii Law Box 5. 469 P.O.Sox 4NEGATIVELY AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED p Sandy,UT 84091-0469 BY THE INSURANCE POLICIES BELOW, 800-851-8364 INSURERS AFFORDING COVERAGE INSURED INSURER A: NOTICE:Coverage is being provided as part of a Master Group All Under One Roof INSURER B: Policy issued to members of the Transworid Building Trades and Contractors LiabilityAssociat€on,Inc, INSURER C; a Risk Retention'Purchasing Group'authorized under the Risk INSURER D: Retention Act of 1986:Federal Law 97-45. 30 Temple Drive Methuen, MA 01844 "LIMITS SHOWN ARE THOSE IN Prime Insurance Company EFFECT AS OF POLICY INCEPTION" COVERAGES The policies of Insurance listed below have been issued to the insured named above for the policy indicated. Notwithstanding any requirement,term or condition of any contractor j 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.Aggregate limits shown may have been reduced by paid claims. i POLICY EFFECTIVE POLICY EXPIRATION i TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(M51/ADNY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S $1,000,000.00 I COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one Piro) S NIA Claims Made PRC2656-16090011 09/13/2016 09/13/2017 MED EXP{Any one person S NIA Exclude Products PERSONAL ADV INJURY S NIA Exclude Completed Operations GENERAL AGGREGATE S $2,000,000.00 9 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AG S F— FJPRO- D POLICY JECT El LOC Per Person S $300,000.00 AUTO LIABILITY ANNUAL AGGREGATE S $0.00 ANY AUTO BODILY INJURY ALL OWNED AUTOS (Per Person) S $0.00 ❑ SCHEDULED AUTOS I BODILY INJURY MREDAUTOS (PerAccldent) S $0.00 ❑ NON-OWNEDAUTOS PROPERTY DAMAGE DRIVE AWAY (Per Accident) S $0,00 GARAGE LIABILITYIMANUSCRIPT FORM PER PERSON SCHEDUL5AUTO 3 $0,00 ❑ G.K.L.L. PER ACCIDENT g $0.00 ❑ O.T.R.P.D. AGGREGATE ❑ D.O.C. 5 $0.00 ❑ CARGO PROPERTY DAMAGE S $0.00 i I ❑ ON HOOK ❑ EMPLOYEE DISHONESTY ❑ WRONGFUL REPOSSESSIO EXCESS LIABILITY EACH OCCURRENCE S $0 eOCCUR ❑CLAIMS MADE AGGREGATE S $O RETENTION $ S LIMITATION OF COVERAGE FOR ADDITIONAL INSURED DESCRIPTION OF OPERATIONILOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISION Coverage is limited to only insured activities or operations on the Participant Member Declaration Certificate or as may be separately endorsed,Contractors-Executive Supervisors,Contracted Services-Using fully insured subcontractors. / CERTIFICATE HOLDER ILI I ADDITIONAL INSURE LJ I LOSS PAYEE Village Green West SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER FAMED TO THE LEFT,BUT 200 Kingston St, FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 Attn:Andrea Georgetti AUTHORIZED REPRESENTAKIVE FaX Number: 9785326023 i iVlassanizuseYts -Dee;arti-ne,) or ?L1,)i,:r: SoRrd of rBulidin0 Regal-xi o- • t')n;t�•�,:ti„i� Sun�tz•#,ur . License: CS-069120 `\tet t r, rf JOHN W LANZAVIA W,_:;,--. 30 TEMPLE DR ASTHUEN MA 01844 �y r wz�1T1�"(1S5$F,7ili:r 04103/2017 Click on the registration number to view complaint history. You u can also �u�rarttFund history. The Ilst is current: as of Wednesday, October•8, 2014, $oareh Results REGISTRANT RESPOMtBLE REG[STRATtON EXPIRATION NAME 1#$D FIS iAI. NUMBER'tBER ADDRESS STATUS HATE w.t:.uMIDeR ME ROOF #ANZAFAk4E, 137057 166 A i4E33ERRIMACK ST 10/02/2016 Current .JOHN METHEUN, MA 01844 ��--•___ �2Q12 Commarnvealtt�flf Massacttuset[s, • Mass-GOVO is a registered service mark of the Commonkwej)ith of Massechuse##s. t n rn ren� e