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HomeMy WebLinkAboutBuilding Permit #084-2017 - 1 OAK AVENUE 7/26/2016 NORTH 9 BUILDING PERMIT o .t�`" TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0:4Qk Date Received ��SSACHU Date Issued: : IMPORTANT:Applicant must complete all items on this page LOCATION Q A1r- . t R1 Cday2 M�! Q (zq 5 PROPERTY OWNERan i Print Print MAP 210 -PARCEL: ZONING DISTRICT: Historic District yes no !Machine Shop Village yes no IJ 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 PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: A�Qn RimipPhone:91g- 86- W48 Address: oray, Me, Nor* NYJ(3vt\ tAA � (' i3 CONTRACTOR Name:BTO KS ConStrUCi01 Co. Phone: - -qy E8. Supervisor's Construction License: Exp. Date: -a /wDlaniq Home Improvement License: 10 &8a Exp. Date: slag/( C, 18 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 i 5001 CO FEE: $ Check No.: Receipt No.: NOTE: Persons con racting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner S i a n a fu re of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DIF.JSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes —ro Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT' - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS ""° 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: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA- (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 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 ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: 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/Crossection/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 NOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals 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 Doc:Building Permit Revised 2008 I Location NO.04 —Q ! — Date 0:;7- TOWN :;7TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check# ' ;Zrl Building Inspect BUILDING PERMIT OORry TOWN OF NORTH ANDOVER O o``t`eD APPLICATION FOR PLAN EXAMINATION � - m Permit N0: —20Date Received Argo Date Issued: Zre �! ��SSACHUs t IMPORTANT• Applicant must complete all items on this page �,OCA� Ohlkt '-.fy g ra � �*"t�,����• �.m.r .,���" �at�a.r'' � ••���.'�'� t W ���;;1� `��. PAI1;�.� ��n ONING�RI�TRIGT���1��stor.+c:I�fstncf= ; ����,�/�cc�• r�,� 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 z 5P la�rl 1Neiiarads_° aka r, � ,1��ae�e�nrer c `s'�`�•. ��'s�'s�w''�•�-. �� s S �,•,..lrr~�a*�'we�+��g �a`tershed x.13 pct � ��,..X'w;� DESCRIPTION OF WORK TO BE PREFORMED: , r 1 \ �'VYA \ ' Identification Please Type or Print Clearly) OWNER: Name: Phone:9�&'8�S- TF48 Address. aG Ale IVO * lendv-(JN OA IgL( yr.;: R �- -^,�. r•'`�k - ,��its .,,� �e';v.,i , .�-,� .� -'�'�; :aIrME8 p 41 I Ll W—F,J� 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: $ 11,5W,(30 FEE: $_ f,4 4 �1 Check No.:—LINIff Receipt No.: 70 NOTE: Persons con ratting with unregistered contractors do not have access to the guaranty fund Sr `iaatureofi fl'ent/Ow"er � S� naurerof.coritraclor ' ... _ ,._ ... ��;.g� I r 1 V *t,OFRTI, ,� ve" 'o 0 ID 94-2617 'i , d4. � o h ver Mass �o I COC NICNIWICK �s.9s R�reo �Pa���S U BOARD OF HEALTH Food/Kitchen T LDSeptic System PERMIT, + BUILDING INSPECTOR THIS CERTIFIES THAT ........................ ............................... .......Ai .................................... � `` Foundation has permission to erect ........................... buildings on .... ........6.�..................�4!��1�..... ............... Rough to be occupied as ........5I...... .............. Chimney provided that the person accepting this permit shall in eve Ibis ect conform to the terms of the application p p p g p � pp � 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 CONS TIO Rough Service .. .. ... ............ Final BUILD G I ECTO GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Uaimgoows � owneesAlan Bingel978-815-8848 JobAdt1 Oak Ave. e�fDING - DOORS Phone: North Andover, MA 01j"45 Family Owned And Operated me the ownerts)of the premises mentioned be'm hereby contract with and authorize you to funsh a! necessary materials,labor and workmansNSp, to insta.construct and place the improvements according!o me fCov,'ng specifications,term and cerd ons,on premises be:o:Y described: Brand: (WINDOW)SPECIFICATIONS Quantity: Burd Tie Into I low-E Metal PVC New Inside TOTAL$ Roof Overhang Argon Screens Grids Trim Trim Finish ' Color: Yes No Yes No Yes No Yes No Yes No Yes I No Yes No Yes No Double Hung 1/3 Deposit$ Plcturs Slider B,/Beiy 1/3 Start of Job S Garden 1/3 Balance Upon Cas/Awn Completion S NOTES: .0 e r t k tx( e- rk/t (SIDING)SPECIFICATIONS Apply C,ed ori r 0;5c cue 0 n over body area of house.Type of insulation 711a L Items not covered or installed: Yes No Yes No Yes No Strip off Existing Siding x Vinyl Shutters Roof k Provide Container and remove all X Window Mantels X New Gutters debris Cover Fascia&Soffit k Door Surrounds x Gutter off&on Door Window Casing Ceiling )( Fluted Post 51/2 Vinyl Fixture Accessories if needed 1`4 PVC Trim X Traditional Post 5'h o'�- 1 V Corners .� c A cli c CfC✓ ON START OF ALL JOBS-HOMEOWNERS MUST REMOVE ALL ITEMS FROM WALLS&SHELVES Construction related permits:if the homeowner obtains his own construction-related permits for the work described under this agreement the homeowner is here by advised Mat in the event of dispute,judgment and nonpayment of the contractothe homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A,M.G.L. WARRANTY "E fir' axis tit r e Aak tsrshed hove n- sra de r tie herr de'as rr-x=old AUkrm-sr�'of a oenw a 1 Year t ,,mr,_ arose carp,A n tRe recF.'t^2"3 d�';Ada;^r.^.h",�,eve^ivy da:3a n�arkmztis7D a�'3•�iz's.a tlz!"a ca.s'd trr C�Ce^2^,a�s s "."�: s.e^C:S}eas a zg[rs s lt:':Orrrp r.•^i err yt~r a"�!C'r*pro. -W M:; 'e-d^3 c=_X"e ca" a s^.;.at,s¢:, raP::`owea.nze.a ra,.s z ore wr.,ost,rem:".or rcr=ed.:. ris or S-e ce�-.t^m! Ms or Avtx a^­:The'aeyar2 r.:rx^!a • ;,,:r+d d:r r_-Yoram oev--d',uvrnc,^M w-^tre a;eed-won wok fb garvxe on gursr ack Lip h rod m y.,rz^^er on ice heck.v=,'z gvze_ or faa,g of. s N BROOVS]rs rLI W n pm.:'1 a ra!'g, RR'.'kC5 s^rp roat�"r-•'m!ro rnv!-me n wn•mra^rec tym!+c rm?ra rex:�n�from v mu m ya.nxu+q uxtaL�m 3ROn/'S K rct,esptlx^,to z^,mer v000`ra^err;ecing vak d ro'!x�+aoa a`wW.Y+add'aorm e�rge t oa.C ed BKOKS:. c v tore m—r'P=.Moors s net resvor=E"or r—W a rr dex.A'vara;.es or F arz:ees rea'a oacs:o t"e a actxr.tin3ef sic-w:xvn.:err-_s,:Re Ot v-ay to*...red ta .. '-•r- - .a.:�+x-^,c:b cxt'fPr eVide•.VdR:.^.k's"pa'dw:ads�a;eo..,a:_r:nader*dw,ra sxhwx:x^.es Ab r^•atys"n..7ce'e�t>x,.tc-a'�m.^:�.:*z's szti:,,ea+d rata•^ ?.�s<:-ew^�.�a'e;.;d nx�tlx:'C"''::m rr"m`:re R s G•e=:::':IY��rartZ^'y.F z:na a&:a a^/raSP�'=.'.y'ar GRE C,(r'.^7fYx�'7."3+sa"y:vd1 atp:.p^'°^:A'.t'.LFSCTI.REa(7J4iJv'.` �$.i.BQR M9\1 TFR'.'d$.h'OT B?OS1K$$:O;`..G.A�'rY.LB L2a:q'a z�C1!h8 uryY:'d G:'.,rxY pe'rtkyr;h Y'Le err/w fo A:;=fr,ot p"aixorat'g,b tP.7n5�(SX:;n�(Or p?Tµ"s:-n dl Ca'-'^w^L i.(.:z.TJlf�hA'd 62dr 10t rMz,V&''3 CE or.:Sp meat 0.:heveraur nt is less a rn^2•,S Y 2 G^ g if bear,Pd Ao7 zv charge o Zdd':O ab-1tt S'a rP3ted m,P r2S r.'o dL'.^,75;e: TOTAL$ &Stt e S,no Brooks Vinyl Siding-Windows•Doors Payment to be made as forows: Nmre of contractor r oesionated Reg strent 1/3 ($�? G I Uperrrg rtgg/tract,+��t1r 254 Broadway-Breckenridge Mall stoat Ad daas 1/3 (s .) t-r(:r t Start of Job F1 h Salem,NH 03079 (603)894-4488 wwwbrooksswd.com city/stat. Rene Mom. 1/3 ($ 1 Balance upon completion 101682 99730 • ^ C vo'e:y+Cane O",C cE ed After 3 Da, 5 +ReTa:^'g 6a'2rce'a t.^r-Re!urtCa6'e. N:C e'Ragaim— SL e/ . 4=e.W 29ree.Tant for tto"r3.R1Prarem•.^.!=r=q r ca.sha"reouifa a omm payment;adr^ce none a sWessswn 60POS!)of more M-1-50'.-Of TO 1:,2.:COr W p¢e Or Inti!=amount of a:00=12;or pa msms At 0!'1e Cd&W or'r•:6!M- ke,'mance n ora,-a-dor oTerAse ob:d.n de'very of 5paC3'order ,^..�::s d^A°P+7me-t,'"'L^3.4r •^tit al..f Authortzetl SpMiU Acceptance of Proposal-i acm;he poces,spowia!VS and Cond,'WS stiaed.I under£,3nd trial ,ipp,n Sg-.`Vjfk5 proposal beCC1te5 a V N M"."2�l yw P:e a:t::gnzed to do the%vk as speclzd.Pal nerl A'De made as ot..ned aWn.You,tha atWinzy cancel this transaction at any imus prior to midnight of the third bushesa day after the date of this transaction.C2nedistion must be done in writing.We reserve the right to check your credit DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES, IN WITNESS WHEREOF of th artlllareu I eir names-this, '/ day of - t:(/ 20 /C• r. _. Signed - Asarr,:e charge L424 of t/a u^padha:arcvpeem ,J;w`bP=Vadto AaWw;fnrx res./sri tfie Ovmer �- rue aaxrd:.g b re.•mS w ttr.YPa m cwna�',a,afmnn ate..-n:.7 raaeaca too retry^:'g ta'c^.X x;st C ymtr:;W-nke er am rt S kiss or Me 2%sem..,v charge Sign -; s' / J w.X,amaAXAad^ for addVnon-job s:^e'e;lredmxe:.3si^zdu cstar Yes,t em the o'", 1 The commonwealth ofVlassachzrsetts - DepaetmintofXrtdustrucl. ccidents 00ke of.Investigationg r. 609 Wavhwglon meet . Boston,lt?A 02111 K".YMsgov1dxa Workers'Compensation Insurance Affidavit:BuilderslCont'actora)EIedfle andPlmmbers Apulicant information ! Please___Print_L& Name(Busine 0rganIzation&dMdual): B►ro��s 66 n Address: a5 (vva City/State/Zip: [3nj Zjaan employer2 Deck e appropriate box:employer with 4. ❑I am a ' 'Pe ofprojeet(required): gen contractor and I 6 loyees(futt aud/orpart time)." have h'hd Ihe sub-contractors ; ,��w constt a sole proprietor orpariner- listed on the attached sheet;,� fi. Lf RemodeligI and have no employees These sub-contractors have. -8. ❑Demolitio ing forme in any capacity. workers'romp.instrranee. " 9. ❑Building addition workers'comp.h mrance 5. ❑ We area corporation and its ired.] ofcers Dave exercised their 10.El Electrical rea homaowaerdoing alt workright of exemptionpt r MGL l l.�Phtnibing Re lf[No workers'comp. c.152,§10),andwehaveno12.Q Roofrepairsance required.]t employees,[No Woikers' comp.insurance required.] -13.�Other eAnYaBlicantdiet che&box0I nUMM so#ill out ffie.secdonbelow gffierrwa 'ao�pensafiEii£poliayi�imsiion tHomeowners who submitthls&�idavitindieatingffieynce ilou►galltvorkandffiea titre outside coatractonIadstsa8mit ate'affidayffludicaUng such fContractorsthatcheckthisbo mnef attaGbedansdditeanai.seetsho gthe�aemeofthOsub-Dontmcbmsaadfi*w.o&,'comppDliGyiafbmatiDn I am an employee that is pevvftl w wamas'compensa&n3' �t ltisueartce oP I ees Belaty is tltepolicy. c8 jab site infarPnation. .fF o3' Insurance Company Name:. ' T r1 f�Gl I'1C Policy#or self-ins.Lic.#: Vy C (� � Cj B�piraittonDate� 5��b 1 Job Site Address• 1 LX.1� �° iCriyJS`tatelZip: �• t1,._I����I g y S Attach a copy of the workers'compewationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL c.152 can lead to they imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,-as well as clvitpenaldens in the form of Sppp WORK QRbIIR and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement tray be forwarded to the OMce o£ Investigations of the DIA for4surance coverage verfcation, caoHerebycert rc�iriep a per�altreso.�.pe&rythat the!If�rnurtiortproP&dabove istrueand Correa - Si ature '7 •� Phone : rID l rase©ply. Do roof write in flus area,to be coypleterlby city or tolm officlaZ t Town: # Authority(circle one):d ofHealth 2.Building Department 3.CitylTaw.n Clerk 4:.l�ee#ricallnspector 5.PIumbingluspector r - _ Contact Person: Phone#; - . C Information and Instructions Massachusetts General Laws chapter 152 requires allemployers topxovide workers'compensation for their employees_. Pursuant to this statute,an employee is defined as"...evetyperson inthe service ofanotherunder any contract ofhire, express or implied,oral or written." An eVloyeiis defined as"an inftpartnership,associate g tity,or any tyro or more, � on,corpoxafion or ofliez legal en of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual partnership,association or other legal entity,employing employees. However the owner of a dwe bg house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds orbuilding appurtenant thereto shall not because of such employment be deemed to bean employer." MCL chapter 152,925C(6)also states that"every state or local licensing agency shalt withhold the issuance or renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any applicant who has not produced•acceptable evidence of compliance with the Insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neuer the commonwealth nor any of its political sub sons shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority," Applicants Please fill out the workers'compensation affidavit completely,by checking tho boxes that apply to your situation and,If necessary,supply sub-cont metor(s)name(s),addresses)audphone numbers)along with their certif'ioate(s)of Insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation fusurance. If an LLC or LLP does have employees,apolicyis required. Be advisedthatthis affidavit maybe submiftedto the Department of Industrial Accidents for confirmation of insurance coverage. Also be sere to sign and date the affidavit. The affidavit should be returned to the o*or town that the application for the peamit or license is being requestr4 not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensationpolicy,please call the Department attire number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line — City or Town officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event1he office ofJuvestigations has to contact you regarding the applicant. Please be sure to fill in the patmif icense number which will be used as a reference number. In addition,an applicant that must submit multiple pmm Micense applications is any given year,need only submit one affidavit Indicating current policy information(if necessary)and under"Sob Site Address"the applicant should write"all locations in (city or town)°'A copy of the affidavit that has been of stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on Erle for future perp fts or licenses. Anew affidavit must be fiitled out each year.Vere a homeowner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT xequhed to complete this affidavit. The Office of Investigations would hke to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a oall. The Department's address,telephone and fax number. Tho GOMIAOUwaalth of massac usetts Dapaztmextt:cifI duMal Accldmts oface ofInvestagattom 600:Wasbiogtw Stmt Boston.M&02111 TO.#617-72Z4900 at 406 or 1-877A SSAM _ Revised 5-26-05 Fax#617;,72 "77¢9 www.MaSS.gov/dia AC(-->RV CERTIFICATE OF LIABILITY INSURANCE DE / 6 D1 ) 7/25/2016 i25 i 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). PRODUCER CONTACT Linda BO danowicZ NAME: g Insurance Solutions Corporation PHONE (603)382-4600 Fax AIC, IC No: (603)382-2034 60 Westville Rd E-MAIL ADDRESS:lindab@isc-insurance.com INSURERS AFFORDING COVERAGE NAIC# Plaistow NH 03865 INSURERA:Peerless Indemnity Insurance 18333 INSURED INSURER B Brooks Construction Co. of Lawrence Inc, INSURERC:Excelsior Insurance 11045 dba Brooks Vinyl Siding, Doors and Windows Company INSURER D: 254 N. Broadway INSURER E: Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER:CL165926838 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER IMMIDDIY IDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGE TO RENT DEa occurrence 100 000 PREMISES $ CBP8945793 5/16/2016 5/16/2017 MED EXP(Any one person) $ 15,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- LOC LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per acc dent $ Medical payments $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A C (Mandatory in NH) WC8836275 5/16/2016 5/16/2017 E.L.DISEASE-EA EMPLOYEE, $ 500,000 Hes,describe under PTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRI DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Alan Singel THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 Oak Ave ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ,�A - Keith Maglia/LJB ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099730 Construction Supervisor Specialty MARK DIPRIMA 18 HAWK DRIVE SALEM NH 03079 1 ��'� - Expiration: Commissioner 02/20/2018 =Office of Consumer Affairs&Business Regulation -fiOME IMPROVEMENT CONTRACTOR " egistration: 101682 Type: Expiration: 629/2018 Supplement Card BROOKS CONST.CO.,INC.OF LAW MARK DI PRIMA 254C N.BROADWAY STE 110 — -_ SALEM,NH 03079 Undersecretan•