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HomeMy WebLinkAboutBuilding Permit # 10/5/2016 tO Ta, BUILDING PERMIT g° 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Bate Received �� rs,„ Permit NO: 221 Date Issued: Il✓II"� �A1W 11: locant inx�st c c�rr� late all itemsc�ta this a e 77777777777, �� 7777✓ r r , e G y 4r ,M' sIAw; ,y , TYPE OF IPRpVEMENT PROPOSED USE Non- Residential Residential LJ New Building Ll One family D Industrial D Addition wo or more family No. of units:m [J Commercial ❑alteration El Others: Repair, replacement 11 Assessory Bldg [I ®emolit�on Ci Other rlct If 77777 .. .,. (Le a" Identification Please'Type or Print Clearly) Phone: OWNER: fume: V I- 4 , � e Address: Z", '0'(6 � A`� � 09 I w z` Prite , p"" . 4 . I 'la �'t . �. °t Phone:__I .. . 6, S7 .C), ARCHITECT/ENGINEER� o Nca�.u .���..�. Address:, ' .. �. L_ �, FEE SCHEDULE:EULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. r� Total Project Cost-. FEE:$ — Receipt No.: Check No.: rxt rid NOTE: Persons ctrrrtr°rrc�trn worth unregistered contractors do not have access to the ,u .�f �Iettre of . `'of 9 � i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE SEWERAGE DISPOSAD Publzc Sewer ❑ Swil]�773i7F Pools Tanuiug/Massage/BodyAtf ❑ g ❑ WeI1 ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ 1'xzvafa(septzc to ds,etc. ❑ Permanent D impster ou Site ❑ a a THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING DEVELOPMENT Reviewed On Signature' ^ COMMENTS CONSERVATION Reviewed on c� 1 �Siature `COMMENTS VSO , . t J (0 O HEALTH Reviewed on' Si nature COMMENTS Zoning Board ofAppeais: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments .y - Water& Sewer Conn'ection/si nature& bate Driveway Permit DPW Town Engineer: Signature: FIRE DEPART Located84 0 MENT Temp,Dempster on site ,yes 3n Osgood Street Located at 123 Main Street FireEDepartment sigr�aturelcfate COMMENTS: F Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector yes No DANGER ZONE LITERATURE: lies No MGA Chapter 166 Section 21A--F'and G min.$100-$1000 fine NOTES and DATA..— (For department use) i1 V 9 u 0 C7 Notified for pickup Call Email Date Time Contact Name Doc.BUding Permit Revised 2014 Il - i. oORTFt Town of q A over � ver, Mass, 1 D cL.C. D BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ....... T .........VM.�„r� 4 a 'So ov� t . . BUILDING INSPECTOR has permission to erect Foundation p ........................ buildings on .......,.......................... .... ......4.. ...+ �Q Rough to be occupied as ........ !f-...............� �' � 1�'� �A C .0 .... ............................................. ................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TART Rough .,.. Service ............... .. ... ..�.. ... .... ............., BUILDING INSPECTOR Final GAS INSPECTOR Oce ° Rough Display Ong icuous Place on the Premises - Do Not Remove Final No Lathing Or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Town of North Andover, MA September 8, 2016 r :9:C IS7 i i` :4; d ^4'i :4" r` 1., 7, tlr.: C .S ;2« P: <: :S: z7 fdS i's<i iiiii:i:iiiEiiii:i ic. P I p!s+ .Y: }i« :E. .S' ^f: 1 }; :1:: «4: 'i: 1 ar I !i e: ti az: , 4 3« .4. f Ef .4. 't. fi 7: .1. .4: f .1 y 1' 1' .f' .T S: :} C: I :S: S: ::is I i fS. I F S". :'S:: is 4 R P. 'S. .2 «S' S. ;i1' :1: = ft' ]. 48 ...Sii" iE�a .... a7i}: ar Property information Property 7101019.0-0023-0000,0 I Location 15-17 MAPLE AVENUE Owner TRIPODIS,JOHN MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover, MA makes no claims and no warranties, expressed or implied, concerning the validity or accuracy of the GIS data presented on this map. i a Y 4' x � )'If3 �7 cA q t ti Ali M. j � m , .y l+f 4 I r r 1 Ty _ v � � Y yj Alf o e w IF w 1 711, 07 y.e7p TV-if J 0 I 0 8 Nissitissit Lame Pepperell,MA 01463 Office: 975-433-5003 _Cell:978-265-4206 Customer Name: John Tripodis Job adderss: 15-17 Maple ave,North.Andover MA Phone number: 978.273-2138 Job Description: Deck -Note : Due to fire damage to the major structure components of this existing front deck,we recommend full replacement.This structure is un safe to walk on at this time. -Obtain all necc. Building permits. -Provide building plans to town hall to obtain building permit. -Have a 15 yard dumpster delivered, and dispose of all waste into.container. -There may be lead paint on this deck and we will have to take procautions to remove it. -Build new 18x8 front farmers porch out of pressure treated lumber . -Install new beams and posts under deck. -Remove existing footings and replace with new ones 4 feet down,the concrete can be compromised by the heat of the fire and will cause concrete to breakdown . -Install new 514 pressure treated decking. -Install all new railing systems out of pressure treated. -Install all new lattice underneath and trim all around to look like existing. -Replace existing 2 large front columns,one got damaged from fire and new one wont match,so we will replace both custom columns. -All fasteners and metal adjacent hardware will be new simpson products to handle the chemical in the pressure treated. i e� r 8 Nissitissit Lane Pepperell,MA 01463 Office: 978433-5003 Cell: 978-265-4206 -Have the dumpster removed after job is completed. -Total cost of demo ,framing,and deck completion,labor,materials,permit,plans are all included in price $6,900 -I St payment of$4,000 due with permit -2nd payment of$2900 due when completed. -Any questions call Peter 978-2654206 thank you. f� p 'ht,Co monvearth ofmfilrssa� usetts I)epartment ofIndustrialAceldents X Congrays Street, ,Smite 100 Roston,MA 82114 20.1'`'7` , R wwfv mass gov7dza o kexsl Compensation Insurance Affidavit:l3uildexs/Co��rae�axslEiect�zciansll'Irr�zbexs, TO:BE YMED-MMI IM R+I RVffTTING All XRO7R. RY. A 1xGant Tn�orxa atian Please Print Le ibly Name sa�siess/f7sg 'aiionCFndzrrxdua7):_ \i C 65 fir- m ' ( 6 Phony . City/State.�:�p. t _ '- . .. Arayou m.employer? CheckfT 4,4x1pr4afebox; Type of project I�bd): 1 I am a employoz itla employees(faill and/ar park time).* /,' New colis-fruction 2. I am a sole proprietox or partnership and havo no employees working for me in $" F Remo tioiirig any capacity-[Na workers'comp.insurance required.] 9. [�Demolition 3 I am ahomeownerdaiagali workmyssl£END workers'cazap..insurancD requited.]f 10 $tzilding addition 4,0 I am a homeownex•arad wiII be hiring contractors to conduct all work an my properly. I will. cusure that all contractors either have workers'compensation insurance or are sole 11:LI Electdcal repait's or:additions proprietors with uo eine Ioyees, 12:E]Plumbing repairs or additions 5.E]I ami a genoral contactor and f have 1}ired the sub-contractors listed ou tho attached sheet. ,oi;f'xepaixs 'Whose sub-eontractorshave employees andhavoworkers'comp.insuranoe.� s e orkodt coin , to arxemp • 6.❑Vssc are a cos. ora a dif Ca�cers lsaye oxezcisedtheir right of'exempfxon perMCxL 1.52,§1(4),audwehsivana.ezn Any applicant that checlab&11 must•also'fril ontthc sectionbelowshowingtheirworkers'compansationpolioyinfamsaffon. i Homeowners v6o sulirriitqsis 4fidaystindiaatingthsy are doing all workandthenhire outside contractors must s4bndt anew affidavi'tiudicatiog such. Corxfractozs fbat check lox smash aitac)Sec an aclditaonal sheet showing the rsame ofthe sub-cautractors and stats whether ornot hoso entities have r. employees. Ifthe sub-cos5trar ors have employees,tliey mustprwidetheir workers'comp,policy number, faro an er ployerfitat is piovjdir�g�orkers'compensation irzsurancefor my emplriyees'Belo,r'.s,tliepolicy and- site irzfar�rzatiarz. w. Insurance Company Name: -- Policy#or Self-his. sic. : _ F�pira�tonDate:... c :fab Site Address:,. ° ..`. ... City/star=e/dip �Y,444 C) .'afxor� cd . Attach a copy of' ets' coxnlrensattonpo cy declaration (showing the lxaltcynumlxac and ) Failure to secure coverage,as req=cdunderMGL c. 152, §25A is a criminal violation punishable by a frn.e up to$1,500.00 anti/or on.e,�year itupr:scsrtrn ent,as Well as civil penalties in the form of a STOP WORK ORDM.and a ffia ofup to$250.00 a day against the viola--or.Ay ofthis statement may foxwardGd to'die Offf to-I Investigations ofthe lbM for ins�amce coverageyeriftGatioix. f anct Pena 1,99 X I y` J „ p d rx7rave is/tire cucl carr ect, tier tlz az Jea thalyean Ur azzor racXe Ido hereby cer t�u� U.ate. Phone#: - OffZclal use 011ty. _po not-write in this area,xa be completed by city or 10V7Z af�icz'ar Permit-(License City or Town: _.___ ------ IssllingAutlxor#y(crxele one): i 1.,Board ox:ffealtiix 2, B 9ldingllepartment 3.City/ToWX Clerl� 4.Llectrical Ix2speetax 5.P111xxiirixcglnspt ctox 6.tither _ Contact Person: --- NOTICE OF ASSIGNMENT --"— CSTATUS OF EMPLOYER _-,�.....—_.,�-�---........—.-.---- ------•-�__..—......—_.----•• --_ OMBO LD. EMPLOYER: COMPLETE HOME IMPROVEMENTS INC 000211.379 Corporation 8 NISSITISSIT LANE COVERAGE GROUP )?n,ppERELL, MA 01463 0211374 Coverage under this assignment applies to MaS0aQhu0atta The Waiver of Our Right to operations only. Foy coverage Recover i'ront Others E11dJry'am&r,t outside of Massachusetts, contact is available on Pool policies. the appropriate Pool or Plan for Contact your agent for details. that state. ------------- INBURANG6 COMPANY: H7�Ii7'! ORt) UNDERWRITERS INS CO AGENTBYAM BROS MAHONEY INS .AGENCY Jonathan Schamberg OR RYAN COULTF'R P 0 BOX 3556 PRODUCER: 1 g1 1yP.WTUCKLT )3LVD 0 L1�t)DO )i`L 32802-3556 LOWELL, Mn 01.$54 (800) 4539843 AGE:NCYFEIN: 042063954 -- -- """ " ESTIMATED CLASS ESTIMATED CyATE PREMIUM CLASSIFICATION OF OPERATION CODE TOTAL ANNUAL REMUNERATIQN ---------- -------------------------------------------- -- -- ------ ----- _-------------- -- -- -- -------- - 9902 $0 8.06 $0 STREET CLEANING & DRIVERS $0 6.06 40 CARPENTRY-DWELLINGS - 'THREE STORIES OR LESS 5645 $0 31,79 *}0 CARPENTRY-DETACHED 013E OR TWO FAMILY DWELLINGS 5545 $10,400 9.66 $1,025 ROOFING NOC & YARD EMP, DRIVERS 5403 CARPENTRY NOC9845 $1,025 EMPLOYERS LIABILITY 100/100/500 $338 STANDARD PREMIUM 0900 $3 EXPENSE CONSTANT 9'140 $500 TERRORISM CHARGE $1,366 TOTAL POLICY MINIMUM PREM10M $57 TOTAL ESTIMATED PREMIUM '-__41,423 pIp ASSESS, 5,6* DEPOSIT $1,423 TOTAL EST, PREMIUM PLUS Ag5E3SMENT THIS NOT A q!L_L INSTALLMENT 13ASIS: Annual_ .......�..w••-rte COMMENTS Coverage effective 12:01 TQM on 09/27/16. SIAM eot to 04/04 Anniversary Rate Date. PREPARF-D 13Y: Maryellen Nee EXT 532 DATE OV NOTICE' « rr VOLVN'1`14R1 'DlmrT ASSIONMLNT s'CompensatlOn Rating as}d lnapectlrn 0ureau of Masaachuiatta She Worker Briton,MA 101 Arch Street• 02110 (647)439.9030• FAX(617439-6066• www•wcrlbma.arg Z /Z £009£CV8L6 OH •dw00-T'4u"esa'4u0N za49d w(I ST : L,O 9TO2; "0£ -das -08-'16 14:34 F130M-Byam BrosMahony Inc 978-937-0745 T-1.16 P0001/0002 F-059 Byam Brothers--Mahoney Insurance Agency, Inc. 191 Pawtucket Boulevard Lowell, MA 01854 ; 1-800-508-2926 Byarn thers Ansurance fax: 1-978-937-0745 Fbx To: Town of North Andover from; Colleen Esposito Attn: Maura Faxc 978-688-954.2 Pages: 2 Phone., Date: 09108/16 Re: complete Home Improvement Inc. Pot# Replacement Certificate!WC )<Ur,qent Q For Review ❑Please Comment ©Please Reply ©Please Recycle • comments: Hello Maura: Please find attached a replacement certificate of insurance for the one you previously received. Please be aware that this agency did not issue the certificate that you received with the issue date of 12121115. Also note the expiration of the policy on the certificate I have issued today. Policy has cancelled effective 1113116 with no coverage in place at this time with our agency, Thank you. V V s 09-08-'16 14:34 FROM-Byam BrosMahony Inc 978-937--0745 T-116 P0002/0002 F-059 r ® CERTIFICATE OF LIABLIT INSURANCE pATE(MMIDDIYYYYi 09/0812016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CIERTIFJOATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATiVI=LY OR NEGATiVi LY AMEND, EXTEND OR AL71512 THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTC 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 pohay(ies)must be ondorsed, it SUBROOATiON IS WAIVED,subject to the terms and conditions of the pollcy,certain policles may require an endloreernant. A statement on Ihls oeriffloate does not confer rlghis to the certificate holder In lieu of suoh endorsemonl(S). PRODUOER NAME! Colfeen E'S DSIiO BYAM EROS MAHONEY INS.AGENCY PHO 97B 454-2W6 FAX A:D!D A SS. COIIgarl Qbyarn Insurance,com 101 PAWTUCKET BLVD [NOURC-111211 AFFORDING GOVERAOF NAZCA LOWELL MA 01854 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER e t COMPLETE HOME IMPROVEMENT INC INSWWRCI ! INSURER D. a MISSITisSIT LN IN Err 1 PEPPERELL MA 01463 1 INSURER F I COVERAGES CERTIFICATE NUMBFR. 03337 REVISION NUMBER: THIS I$TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RGOvIREMENr TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BC IS$UW OR MAY PERTAIN, THE. INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ErXCLOSION$AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIL)CLAIMS, I.TRR TYPEOFINBURANG6 AOAkSUBR POLICYNUMBER MMNoM[YY MIOULDD ERP LIMITS COMMERCIAL GENERAL LIABILITY EACHOCOURRENCE S CLAIMS-MADE D OCCUR PREM PS 9A encu Onen $ MED EXP(Any one person) $ N/A PERSONAL A ADV INJURY S GEN'LAOOREGATeLIMITAPPLIESPCR: GENFRALAGGREGATE. $ POLICY❑JEOT LOC PRODUCTS-COMPlOPAGG S $ I OTHER: COM" €NEDbIN L I $ AUTOMOBILE LIABILITY dIVTITL ANY AUTO BODILY INJURY(Pdr paraoni $ I ALL O TOS NED AVULED NIA ooDILY INJURY(Per aoG;danq s NON•OwNrl) PROPERTYDlAMAGE $ Par arr]Aan HIREOAVTAS AUTOS $ ' UMBRELLALfAB OCCUR F.ACH000URRENCE $ EXCESS LIA13 CLAIM8-MADE NIA AoeREGAYE $ DED I I RETENTION$ _ $ WORKERS COMPENSATION P" KR 11 AND EMPLOYERS'LIAI4ITY Y f N ANYPROPRIETORIPARTNEWEXIOVTIYE 8S$OUB0G337787't5 10/0212015 011131201(1 E'L'EACHACGIAENT S 1000,000 A OFFIOERPAEMBEPEXCLUDID1 NIA NIA NIA E•L,DISEASE-GAGMPLOYEE $ 11000,000 (MandatoryIn NH) If yyes,dtuuba undar E.L.DIBEA8E-POLICY LIMIT $ 1,000,000 DESCRIPTIAN OF OYEFAYIONB below NIA I DESCRIPT(ON OP OPERATIONS r LOCATIONS I VEHICLES (ACORD 101,AddRlonol Rontorks Schedule,maybu uUuchad irmore UP C($is raQulreol Workers`Compensailon beneftG will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Maseaohwsstts If the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the polioy In force on the slate that this certifioale was ISsuad(unless the expiration date on the above policy precedes the issue date of this certificate of ineurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification search tool At www.mass.gov/iwd/workem-romponsationtinvestigations/. CERTIFICATE HOLDER CANCELLATION $HOULD ANY OF7HEABOVEDESCRIBED POLICIES BE CANCELLtl)BEFORE THE EXPIRATION DATE THERCOF, NOTICE W11-L BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Town of North Andover 1600 Osgood street AUTHORIZEDREPAVENTATIVE MA 01846 North Andover DoAtel M.Cr $y,CPCU,Vice President—Residual Market—WCRIBMA ®19138.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORO . i1CL NlJaDATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12121/2015 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(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). INTACT PRODUCER pA{ylE; Colleen ESpOSItO BYAM EROS MAHONEY {NS. AGENCY PHONE l r0X454-2926 �agjor -__- -MAIL colleen@byaminsurance.com 191 PAWTUCKET BLVD _ INSURER(S)AFFORDING COVEMgK... _ ___ NAICIf LOWELL MA 01864 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: COMPLETE HOME IMPROVEMENT INC INSURERC: -,_-_-___.. INSURER D: _ 8 NISSITISSIT LN INSURER E: ---___-_ PEPPERELL MA 01463 INSURER F: COVERAGES CERTIFICATE NUMBER: 19783 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.L!MITS.SHOWN-MA`..HAYE._OEr.N Rrr)I,)C.ED BY PAID CLAIMS. .. INSR ADDLITYPE OF INSURANCE IVSD WVD B POLICY NUMBER POLICY E MMIDD YYY LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ t)A ADAGE �.� �----- CLAWS-MADE 1:1 OCCUR PREMISES_(Ea accunen0)_,_, $ MED EXP(Any one persons _$- N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY JECT Ir�1 LOC PRODUCTS-COMPIOPAGG $ OTHER: _._.__,._ .$ MIN AUTOMOBILE LIABILITY EOaaccidecrij REDNGLE OMIT $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) $ . AUTOS AUTOS NON-OWNED PROPER TYpA4iAQE - '--- $ HIRED AUTOS _ AUTOS Per dent $ UMBRELLA LIAB OCCUR EACHOCCURREN! E $ _.- EXCESS LIAB - CLAIMS-MADE NIA -AGGREGATE $ ...m.._...._._.._ DED RETENTION $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE E.L,EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A NIA 6S60UBOG33778715 10102/2015 10/02/2016 E L.DISEASE-EA EMPLOYEE $ 1,QOp,OQO (Mandatory In NH) __,.. ._._ If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts If the insured hires,or has hired those employees outside of Massachusetts. This certipcate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www,mass,gov/fwd/workers-compensationlinvestigatians/. ". CERTI m,ICA.tk HOLDER _ CANCELLATION „ "� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN '° /k I► ACCORDANCE WITH THE POLICY PROVISIONS, WIr"i'61a _ AUTHORIZED REPRESENTATIVE --'''I 0305 Al, Davie!M.Crt G, y,CPCU,Vice President—Residual Market—WCRIBMA O 1988.2814 ACORD CORPORATION. All rights reserved. ACOR6`25.(9014/01) The ACOR1 "name and 10re registered marks of ACORD 0-1 10/4/2016 10 : 08 : 3.1 AM PAGE 2/002 Fax Server = CERTIFICATE OF LIABILITY INSURANCE bATE(MMIDDIYYYY) T TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIF=ICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 15SUING INSURER(S),AUTHORIZE=D REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE OLDER. 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BYAM BROS MAHONEY INS PHONE FAX 191 PAWTUCKEI"BLVD {AIC,No,Ext): (AIC,No): E-MAIL LOWELL,MA 01854 ADDRESS: 285RH INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A: HARTFORD UNDERWR17ERS INSURANCE COMPANY COMPLETE HOME IMPROVEMENTS INC INSURER B: INSURER C: INSURER D: S NISSITISSIT LANE INSVRERE: PEPPERELL,MA 01463 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 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 HE 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. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMtDDIYYYY) (MFADDXYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABLITY DAMAGE TO RENTED $ CLAIMS MADE �OCCUR. PREMISES(Ea occurrence) MED FXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POUCY 0 PROJECT LOC PRODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ A WORKER'S COMPENSATION AND =W0STAT1U1TORyEMPLOYER'S LIABILITY YIN UB-7H696819-16 09127120'16 09/27/2017 ANY PROPFRITORIPARTNERIEXECUTIVE NIA E.L EACH ACCIDENT w $ 100,000 ' OFFICER/MEMHER EXCLUDED? (Mantlatoryin NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE, 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 1600 OSGOOD ST SUITE 2035 IN ACCORDANCE WITH THE POLICY PROVISIOT'0- AUTHORIZED REPRESENTATIVE NORTH ANDOVER,MA 01845 ACORD 25(2010105) The ACDRD name and logo are registered marks of ACORD m� 1988-2090 AC CORP 1 t'Yltt'.'A%dig ti reserved, 10-04-'16 09:49 FROM-Byaln BrosMah©ny Inc 978-937-0745 T-191 P0001/0001 F-270 '"'� CERTIFICATE 4F LIABILITY INSURANCE DRTErN1M1OolYvvY) T • TIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H01 p>•R. TH15 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THIS CE=RTIFICATE OF INSURANCK DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE ORpgogucag NnTHjEgF-RTIFIQATr!9HOLI3r!R. MPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policypes)must be endorsed. U SUSROGATION IS WAIVED,SGbisct to :he terms And conditions of the policy,Certain policies may require acid endorsement. A titatement on this certificate does not Confer rightis tO ;MC Certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: RYAM BROS MAHONEY INS PHONfi FAX 19 1 PAWTUCkEET BLVD (A/C,No,Ext): E-TAAI L LOWELL.MA 01854 AODREOG: 28522 INSURER($)AFFORDING COVERAGE NAIL A INS URGR A. NARTFOTO UNDERWR7TARS IOMMANC8 COMPANY INSURED COMPUTE HOME IMPROVEMENTS WC INSURER e: INSURE=R C: INSURER 0, 8 NISSITISSIT LANE 1NSURER9: PEPPERRI-L,MA 01463 INSURER F: COVERAGES NUMBER' IREVrSI[1N NUMEtER: THIS ES TO ct TIDY THAT TNI:PO LlClli%OF INSURANe6 LE5TED eFLOw NAVE B€EN ISSUED TO TNF NSURED NAMED ABOvE FOR TNL POLICY PERIOD IND ICATED- NDiWITHSTANDING ANY REQUIREMENT,TFRM OR CONDITION OF ANY GONYRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY dE ISSUED OR WY PERTAIN. THE INSURANC€ AFFORDEDBY THE POLICIES OESCRIBEO HEREIN Is 5UliJECT TO ALL THE TERM5.VKGLUSIONS AND CONOITION5 of SUCH POLICIES.LiMIT5 SHoWri MAY NAVE BEEN REDUCEO BY PAID CLAIMS• INSR AOo PUB POLICY EFF DATE POLIGYEXP DATE LTR TYPE OF INSURANCC L R POLIGY NUMBER (MM7DW1 IMNADDIYYYY) LIMITS Yry GENERAL LIABILITY ACM OCCVRR�#�CE g COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MAGE= OCCUR- t REWSES(Ea occurrence) MED EXP(Arty Or16 mon) $ i Eft50NAL S AOV INJURY $ GEML AGGREGATE.LIMIT APPLIES PER'. GENERAL AGGREGATE S B POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIARIILITY COM8SINGLE & I ANY AUTO LIMIT(EEBa sOOIp0r1T) ALL OWNED AUTOS BODILY INJURY $ (Per Defacn) 8CHEOULE AUTO$ 1300ILY INJURY $ H[RE0 AUTOS (Per acodent) °r NON-OWNED AUTOS PROPERTY DAMAGE S (Per accident) EACHOCCURRr�NCE !C VMBRELLA UAB OCCUR i EXCESS LIAR CLAIMS-MAGE AGGREGATE »$ DEDUCTIBLE g RETENTION % WORKERW$COMPENSATION RNLI UVC STaTUTORY OTHER A EMPLOYER'S LIA[31LITV Y!N UB-7H1398tit9-16 O9P2712016 09/27120 7 x LIMITS I ANY PROPERITOPJPARTNRrUE>€ECUrIVE NIA E.L.EACH ACCIDENT $ 100 Dg0 El OFFIC;I= EM@ER EJCCLL€r)E"D? E.L.DISEASE-EA EMPLOYEE $ 100,000 o IMphAAlery rrt NH} Iryra,oescrioo�noer E.(- D1EiEASE-POLICY LIMIT S 500,000 I� DE3CRFPTION OF 0MRATIONS bel 01=9CRIPTION OF OPERATIONSILOCAYION$A/EHICLI2eiRGOTRICTIONSrSPraCIA1-ITEMl3 THIS REPLACES ANY PRIOR CERTIPvICATB ISSU8D TO ITE CBRTMcAT9IYOLI01311 AFFECTING WOAKBRS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER VHOVLO ANY OF THRABOVE D6'SCRIBEO POLICIES 05CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTjOra WILL BE DELIVERRD 1600 OS1300D ST IN ACCORDANCE INTI I THEPOLICY PROViSIOt �r w SUITE 2035 AUT14OR19GO REPRESENTATIVE �.J� ��/Cm NORTH ANDOVER,MA 01845 � ~ AeoRD 26(2010106) The AGOR17 name and f-13-are registered marks of ACORD 1988.2010 ACOKD GOR '{ iA T is reserved. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSFA-086292 Construction Supervisor 1 & 2 � Family PETER D MONTESANTI 8 NISSITISSIT LANE PEPPERELL MA 01643 Expiration: Colum€ssioner 0410812017 J ' a? ���e r�nrllnioiril,erlt��c�C?l�rlst:Frrct+[lJe��J Office of ConsumerArfairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 122838 Type: j Expiration;: 10#2 /2016 DBA COMPLETE HOME 1MPROMEMENT PETER MONTESANTI - 8 NlSSITISSIT LNn�, _5 PEPPERELL,MA 01463 - Undersecretary f