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HomeMy WebLinkAboutBuilding Permit #90-15 - 100 STEVENS STREET 5/1/2018 a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ® Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page _ .- „f - - -� - i Wr PROPERTY OV1lNER.� _ _moo ,� Print 100 Yea Old Structure ye n.o• `; MAP4NO: PARCE1 �_.ZONINGDISTRICT = ,Histone Dlstnct ye; �noa IF Machine:Shop_Vlllag'e _yes no�T _ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 1)(One family ❑Addition ❑Two or more family 11 Industrial 11 Alteration No. of units: [i Commercial Repair, replacement Rw - ❑Assessory Bldg ❑ Others: ❑ Demolition U40- ❑ Other =.- �.-, Septic ❑1Nel). 'Floodplain 0`Wetlands } ❑ `Watershed=©istrict ❑«1Nater'/Sevverx DESCRIPTION OF WORK TO BE PERFORMED: -� - - bra - - - - — ED: S NIP � AS Cfr- r'0 3 Op, iD4Y,Ff of xgwooz E Soh o� CnWViifLT/ - 14P16 , l � ,�-��rnGc,ve� �4 r'I, Slf/ - l S7�+C(/aTv 60 es wAhl a4e 01--CxIA7 MC-41 # dentification Please Type or Print Clearly) `9'�� 1p /179 OWNER: Name: Phone: J-7- Add 7 Address: 1-x ANA- - 45 - _ CONTRACTOR Name:a&-I;/ �S Address: i%/�/�� � - � J -Hd"]1!ip(ovement,'License:- l al- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ )�, DO 'Do FEE: �— Check No.: Receipt No.: 2`�S1` cess to the uaran and r do not have ac t1'.f contractors g NOTE: Persons contracting with unregistered cont , Rofcontractor" ��� °L,�uw✓L_. Signature of Agent/Owner F PInne IMaivarl Fl (:Prtified Plot Plan ❑ Stamped Plans ❑ b Plans Submitted ❑ PlansWaived-0 Certified Plot Plan ❑ Stamped Plans ❑ TYPEOF.SE—TRAGE.DiSP-OSAL Public Sewer ❑ Tannin Swimmin Pools ❑ g/MassageBodyArt ❑. . . g 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: DATEA_PPROVED PLANNING & DEVELOPMENT ❑ COMMENTS i CONSERVATION Reviewed on Signature COMMENTS 'i HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW TowL engineer: Signature: Located 384 Osgood Street FIRE DEPARI'iillfeNi` _Temp Dumpster on site yes i/ no Located-at 124 Mair,Street Fire Dep' ffinerit signature/date`l _a�/ 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-Chapter166.Section 21A-F and G min.$100-$1000.fin.e NOTES and DATA— (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 4 Building Department •The foh'swing 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 ❑ or/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Flo p Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products (VOTE: 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 MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the aprral period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 y Contract Tom Quinn Employer ID # (617) 939-1353 QUINNYS CONSTRUCTION 27.1639714 (978) 265-2390 868 Mammoth Road • Dracut, MA 01826 tam@quinnsconsbwtion.com www.quinnsconstruction.com Page 1 of 3 Property Owner Information Name - Cy Street Address(Not Post Office Box) Date 1,,.vim:r/s City/Town r State Zip Code Job Name Home Phone Cell Phone Email !��'�?'�` 9 - _5 Y�c 9P6) Job Location Mailing Address(If Different From Above) Salesperson(s): Contractor Registration#: CS-039732 Ex.Date: REQUIRED PERMITS The following building permits are required. It is the obligation of the contractor to secure such permits as the homeowner's agent: List any and all necessary construction-related hermits. Note: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. Is an EXPRESS WARRANTY being provided by the contractor? NO YES **All terms of the warranty must be attached to the contract** NOTE: All home improvement contractors and subcontractors shall be registered and any inquires about a contractor or subcontractor relating to a registration should be directed to: „ Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 - - Boston,MA 02108- 617-.727-8598 _. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c.142A. C Homeowner: Contractor: - - ,, 'C, Date:--s c / le 1�2..01 L+ Date: / X/ . � NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR.THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity-A Contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems himlherself to be financially insecure Contractor's Financiallnsecu'*-M instances where a contactor deems him/herself-t6 be financially insecure,the contractor may require that the balance of funds not yet due be;placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal from said account would require the signatures of both parties. THE CONTRACT MUST ALSO CONTAIN: 1. A Complete Description of any other documents which are part of the agreement; 2. A List and Description of other matters upon which the contractor and homeowner lawfully agree; 3. Any Other Provisions otherwise required by applicable laws of the Commonwealth. Remember,the Contract must be the Complete Agreement Between the contractor and the homeowner. ;.� Contract Tom Quinn :s Employer e r ID# (617) 939-1353 QUINN'S CONSTRUCTION 27-1639714 (978) 265-2390868 Mammoth Road • Dracut, MA 01826 tom@quinnscwmtn ction.com www.quinnsconstnxtion.com Page 2 of 3 Modifications There shall be no modification, amendment, or change order made relative to this Construction Contract, Contractor's Work, or the Plans and Specifications without the express mutual modification signed by Owner and Contractor. a. Required Change Orders: The Specifications represent Contractor's best effort to be complete in detailing the scope of work to be performed. However, this contract is based solely on observable conditions of the structure in its status at time of Contract preparation. If additional concealed,unknown conditions are discovered in thecourse of construction,Contractor shall point out these conditions to Owner so Owner and Contractor can execute a signed Change Order for any additional work. Such orders shall specify additional fees, materials, labor and services, and become part of this contract. Additional costs, if any, shall be paid for by Owner in advance of execution of work specified in said Change Order.Failure of Contractor to request such payments in advance shall not be deemed a waiver of payments due. Any delays in Contractor's Work caused by required change orders shall not be deemed the responsibility of Contractor,and shall automatically extend the time of completion.Additional time required shall be stipulated within the Change Order. b. Additional Work Authorizations: In the event that required work cannot be priced in advance of completion of such work, (i.e. discovery of rot needing repair),an Additional Work Authorization shall be executed. Such orders shall describe work to be completed, and shall specify method of calculating additional fees,materials, labor and services to be charged upon completion,and become part of this contract.Payment shall be due upon presentation of Contractor invoice.Any delays in Contractor's Work caused by required change orders shall not be deemed the responsibility of Contractor, and shall automatically extend the time of completion. Additional time required shall be.estimated and stated within the Additional Work Authorization. I,the Homeowner have read and understand the above mentioned modification section and agree to the terms. f Homeowner's Signature Contractor's Signature Date r Date The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work Scheduled To Begin: f / Expected Date Of Completion: Date Contractor will begin in contracted work _. ( )-: (Date when contracted work will be substantially'completed) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULEr�, The Contractor agrees to perform the work, furnish the material and labor specified above for the SUM of: $ (*Include all finance charges in this amount*) Payments will be made according to the following SCHEDULE: -°'fg0 ._'' C/C 99 $ U �i upon signing contract(*Not to exceed 1/3 of the total contract price OR the cost of special order items, whichever is greater*). $ by / / or upon completion of $ by / / or upon completion of r $ /� Pon completion of the contract(*Law forbids demanding full puym`ent un til contract is completed to-,— both partiessatisfaction In order to meet the completion schedule,the following material/equipment must be special ordered before the contracted work begins(*Law requires that any deposit or down payment required by the contractor before work begins may not exceed the greater of(a) one-third of the total�pontract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule*): $ to be paid for DO.NOT SIG;_$THIS CONTRACT I THERE ARE-ANY BLANK:Si:A-CES x Identicaf copies of the contract should go to the homeowner and the contractor. Homeowner's Signature Contractor's Signature " Date Date You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you notify.the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. Contract Tom Quinoyer E 27.1639714 (617) 939-1353 QUINN'S CONSTRUCTION pl (978) 265.2390 868 Mammoth Road • Dracut, MA 01826 tom@quannswnstruct .com www.quinnsconstnwtion.com Page 3 of 3 WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor Agrees To Do The Following Work For Owner: .�H / S%��C /�j/ J,,/ �/' /-9 L Mf=r= 1 r� �1r�� /c/r ✓�� CST A j 2r AlS A-9-/t—l1 r>c����'JSi :2 ��' 1>>Gi.=C v%✓�J ��T 1�Y�./!''J l/✓r�/r�d� %�%�r-2 '�J�.1Q �,G �i�/_='�L.L//%>�" �'.j�c:/' �� hr��r�_ G�s�ivG sig�L- ,_.�:�/yicJ G,r' V�'�C.�3r''r"rr� l'1r�G.� (./�i�.y� l..0��� l�/.�•� /��,'��r= Gr /7`i i,� �/�D /•'l�,<�t-' C.�r�S G� >�<' C. /�� �=�< �-/tom t.� �2/s.�G r�S J d2�iC�r� ,�"7G3-j,s 2/✓�-C S �u y/.�� ..�U G.���2r �,.3'C �:/.-.�,�,��:�C � ......1'5p �" �2t�`:'_'i2 � ��/f�5 i t�l C,���•1,� vi`_"/��._L,C_i ��f��/.CJ� �-/��' 6'Aqk/ - of 0nJL_ Contract Employer ID# (617) 939-1353 QUINN'S Tom Quinn CONSTRUCTION 27-1639714 (978) 265-2390 868 Mammoth Road • Dracut, MA 01826 toYn@quinnscomtntction.cmn uxivw.quinnsconstmction.com Page 3 of 3 WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor Agrees To Do The Following Work For Owner: /-9 C . �r U�? /..)c.0.�.�S��12 c�=����'''1:.1 S �" ��r= .S-i:��J-�C/�of✓C, G� S ��R �::— .J:�.lG° rai ��_ ✓f %_!/ �` ff�r % %_ i �.��C;���i_/ i� <Ji ` /UG SC�/.C�?�''i1t-- �r_'��o 'r�C 1L•'ilJu' t'�<%Ui— ��—C'/:—/ii�� i�l�U�/�= %/f- C Gi— �C ��.s2 6 rc'i=i L�1/��fLii r�'iv:��-'�2 ��== S:�J�Gf_r C��1%��/•vs'i��c C.i� ��c...- C,� �hr CCyS.'Si� ✓i7t�iCii�c1G •�,�ci . :_Ci t��C. S��i�c�GCr:s�i/�rJ lJr� /�`/r-� �i�.� �l eJGr C'r�t�S G i✓ =�< C- /�i ,-�C ifi/u rD /2/.,G�_S ?.� `�� r'�C C- !L./Cri/L/� � G!*'.�^i✓�`����-.� � /��i/�''�.11.5J C l',=�!'� /G7-=fes✓�/iii Ji y�����.CL�S./�l L r�%f ui✓ rri�/ `�./�fX � i-�/' ��/�' !�"1'��y Q�C•�/iC�G �,ZCJ!C/f ,. �'� U�� Ci✓.- cJ J�����'/�lC..�✓��- HJT .��''; S /iu�i /7r`�C f�iiL%(^ -�' %a/j,r/? %�I1.✓S i i'S` ' �,�`i•,� •iL� yi-'ftp;-- i ��/�fi� :�"/G� o 0 fv L_ Location No. _ Ci Date o - TOWN OF NORTH ANDOVER h Certificate of Occupancy $ Building/Frame Permit Fee $ � i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 27817 Building Inspector t%O R Tti Town of 2 . � ndover soh ver, Mass, CCCNICHf WIC' y1' U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......... .................................................................................... BUILDING INSPECTOR / Foundation , has permission to erect .......................... buildings on ..i.0. ..........4 ........&. ................ w Rough tobe occupied as ..... .. ...... :'.. .......... ...... .-............................................................... Chimney provided that the person accepting this permit shall in a ery 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 UNLESS CONSTRUCTIONS A T Rough Service ............................................ Final BUILDING INSPECTOR 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. The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl as g v I Name (Business/Organization/Individual): Address: A da-n mo nt lA D r--n City/State/Zip a)9ar Phone #: Are you an employer?Check the appropriate box: Type of project(required): LN I am a emplo er with� 4. ❑ I am a general contractor and I employees full nd/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor in an capacity. employees and have workers' y p t'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: q ] uired. re 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.® Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other 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. :Contractors 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. jI am an employer that is providing workers'confensation insurancefor my employees. Below is the policy andJob site information. Insurance Company Name: Policy#or Self-ins. . Expiration Date:Lic #: `1���D��DU f 5 i01� I � Job Site Address: I(=Ns 'C.` City/State/Zip:AoVnt 61&U__A ma U/v,� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern under the pains and penalties o er'ury that the information provided above is true and correct. Signature: `'� Date yJ7771 Phone#: E79_ 26'7 -"() r A—t1`l C Oficial 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#: VG� 0i o/� Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 121604 -- ra Type: DBA Expiration: 5/24/2016 Tr# 250393 QUINN'S CONSTRUCTION THOMAS QUINN - ' 'y 868 MAMMOTH RD. DRACUT, MA 01826 Update Address and return card.Mark reason for change. SCA 1 u 20M-05/11 Address 0 Renewal E] Employment Lost Card VJie �fmi)L�IibITIIICO,CIiL o�C��ra�n�raretl"3 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: .121604 Type: Office of Consumer Affairs and Business Regulation xpiration:,.5%2412016_ DBA 10 Park Plaza-Suite 5170 _ - Boston,MA 02116 QUINN'S CONSTRUbtf'o-N THOMAS QUINN 868 MAMMOTH RD. �a4 04 MA 01826 Undersecretary Not withou�si/fnat r��e � _ L)i best ;fid-I 7F ;-I'm OZ my ii Se group This' comm--.3 1858 ilim-35-000cubic _.canse:CS-0397.32 868 MAMMOTH-RD - DRACUT MA OW6 >==_ilr:rr Lo passsa---a cure n,edition a.the�i��tssus=�s• �'^auli ciililg Cade is ct-�gar revocation s this lic`i `_ ; .�i•' _ For DPS Lieen--insL-orrmaun:� en z Mass Gov/{IPS giro. "e. M• �-„1t; 0312512016 CERTIFIED VINYL SIDING INSTALLER ' AS711 Ju 756 Sponsored by d-V-A Skft InstlhrEe Quinn,Thomas Expires:4/1/2017 868 Mammoth Rd ID#:17412 Dracut,MA 01826 Certified Since:2014 OP ID:WC CERTIFICATE OF LIABILITY INSURANCE DATE 0511201x42011�) � 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 WANED,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 978-975-1300 RONNT,Acr Segrove 8,Hail Insur.Assoc.inc 305 North Main St. 978-975-7596 PHONE FAX No): Andover,MA 01810 E rMIL Edward Ramirez ADDRESS: P THOMA-3 ER1 CU # INSURER(S) AFFORDING COVERAGE NAIL N INSURED Thomas Quinn INSURERA:Atlantic Casualty insurance 42846 dba Quinn's Construction INSURERB:Hartford Ins Co. 868 Mammoth Road Dracut,MA 01826 INSURERc:Arbella Protection Ins.Co. 41360 INSURER D: INSURER E: INSURFR - 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. I`SR TYPE OF INSURANCE POLICY NUMBERM LIC CY EFF POLI O UCY EXP LIMITS GENERALLIABILnY EACH OCCURRENCE S 1,000,00 DAMAGE TO RENTEty— A X COMMERCIAL GENERAL LIABILITY M021000227 01115/14 01/15115 PREMISES Ea occurrenceS 100,00 CLAIMS-MADE a OCCUR MED EXP(Arty one person) $ 5,00 PERSONAL&ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG S 2,000,00 POLICY F—IJECI PRC LOC S AUTOMOBILE LIABILITY COMBINED S INGLE LIMIT accident) S 1,000,00 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) 5 C X SCHEDULED AUTOS 1020002331 05/07/14 05107115 PROPERTY DAMAGE 5 X HIRED AUTOS (Peracciderd) X NON-OWNED AUTOS Underinsured s 100130 Uninsured 5 100130 UMBRELLA UAB HOCCUR EACH OCCURRENCE S EXCESS LIAS CLAIMS-MADE AGGREGATE S DEDUCTIBLE - g RETENTION S g WORKERS COMPENSATION XWCSTATU- TH- AND EMPLOYERS'LIABILITY YIN TOR MR PER B ANY PROPRIETOR/PARTNERIEXECUnVE 4116/3704 01/15/14 01M5115 EL EACH ACCIDENT 5 100,00 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.LDISEASE-EAEMPLOYEE S 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 5 500,00 Sole Propr Proprietor ThomasOQuinn tExclude�d�undder A rkers�Coupmore space isrequired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE OW4ERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD F�JRCAIIOUTE F UV2131" ING r;(15H 020i7,1 L= is ISSIZU-9:0 As A riga 1_0_OF IMMWAITIOM ONT-V AND COMM-M No RIG14TS Upop%j THE GERTFIGAAM HOLDER ijQ 42 r�o�; B*c-S OR TQ1F-C%AT1V2LX Ai".1END, EX-MMID OR AL-i-ER TpiF v I CONST=M A CO UCT igGYMS-1 THE ISSUINC-1j4SjjR-mR[S),A Ii INSURANce VOE$ WO CO FERAC-3 AFFORD=2 By r, REPRMS&VATIVE OR PRODUCER.AND THA CER-11FICA',I-HOLDER. UT Opj?—=D If 4;1*C61iift_,Sb 11MOr IS�WIADDMOKIAI.INSURED, 1101(mal elllac7g0u- W WBRWAT ubliect_V0 aha L�I tv and Goilditions W;citeNIcy, rff my require_nr.eng4op-eny ant. A StGkGn.Wj cry th Mae-). Is celvf7cate 409B ftt can-11W dghts to Osie IZ aci Fie 11 pma, Fa A.11cloVer, IPA 01610 111::! 'q. ri L ss; uxu V I-- I - I ) ORM11 dba Quhn's Gorm-2mr.9mv 06 Plerrinr @[LhRcq@._j In ISO iiV'SUR@R p: RAVE REEK tssUED -1148 INSURED NAMED ABOVEFORTHE POLICY PEPIOD DITION OF ANY CON j OR OMEP,DOCUMENT VIATH RESPECT TO MCH THIS FORDED BY ME P0 IF.8 DESCRIBED HEREAT IS SUBJECT To ALL Ttqe HAVE BEER REDije TERm... EDUC BY PAID C[AIN76. umaGp p .LamaRALUAGILITr Irb PACK OCCUPPENGE p 1,000gii MUNN= oil e95 GLAWSAIADE ®R OCCUR PIED EXP Ong 0 m nnrl PSRGONAL&AVVWJURyq 11,00100; as IrL AGGR90A".:WAWAPPUES PER; (04r-IRAL ACGREQAre" 11: 2109010 PRO- _gRODUCTS-COMWOPAGG I C Ps1i POLICY Js LOC I HAU10..',021L9L1AST1JW ArVAUTO t (Be accidant) ALL OVOIED AVMS B001I.V INJURM,(Per pemn) s 'X. SCWFDUWM AV-,OS 0 1 DILY INIM?Wer--=m HIRSDAUT05 FROPEFTYDAIL-AGE 0 al",0 EACH(0) RMICE Ts- AG"EGATs RET—ENTION S Y-FDRIG0 AND 67PLOVE-WWASIU)V 1?. vr6stATU 0TH_Is AMr PROPREMRIPIA ERr 0XICE'RAMMORR D 01116174 ('r-lend"Zoir 1:1 RK) 5.1,MH ACCIDEUT V yzp,t1b1;..r:Z;g widgh- OESCRIPTION 0;:OPERATION'S barally rmf)pool 5,Nja Prapiiiator-t homes Quinn is Encludera ujil36P1fEI19File omp --C_rM--0 POLICIES BIECANC-51LED 131ROPE OF, NOTICE tqM.L 86 MLIVpReD ROWBIGNS. COMIPOUMIDWI. All KIR514s reserv-,-tj. The ACORD name r3ld logo are sag'!mME1 ni erm ef ACO.Ro