HomeMy WebLinkAboutBuilding Permit #698-15 - 104 MILK STREET 3/4/2015 (3) �a0RTh
BUILDING PERMIT o` BLED
TOWN OF NORTH ANDOVER -� -
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APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date;Received:
gDRA7ED�Pa
gSSHC H115f¢
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION,
Prjn
PROPERTY OWNER
Print 100 Year�Strueture. yes -- bio
MAP - _ PARCEL: _ _ ZONING DISTRICT: Historic District yes � - no.
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District_
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or'Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name Phone:
Address: _
Supervisor's Construction License: _._ - _ ;Exp. Date:
Home Improvement License _..... - =Exp.. 'Date
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: $ FEE::.$ y
Check No.: Receipt,N6.:''r_ w
NOTE: Persons contracting with unregistered contractors.da-not have.access to the guaranty fiend
Signature ofA ent/Owner _ _ Si nature,of contractor
_ . g _..w g u
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
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
Li 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
Li Workers Comp Affidavit
a Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
❑ Mass check Energy Compliance Report
o 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 2014
e
Plans Submifted ❑r Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans.❑
OF SEWERAGE DISPOSAL
Public Sew
TYPFer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
G'
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 Town Engineer: Signature:
Located 384 Osgood Street
.FIRE DEPARTMENT Temp+Dumpster on site yes
Located at U4,Main Street ~�
Fire'Depactment.sig;nature/date
COMMENTS, { ..
Dimension
i
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 Call Email
i g
Date Time Contact Name
Doc.Building Permit Revised 2014
Location q
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No. Date
n
• - TOWN OF NORTH ANDOVER
fi Certificate of Occupancy $
ro Building/Frame Permit Fee $L
��. Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
26540Building Inspector
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h1• ver, Mass,
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BOARD OF HEALTH
Food/Kitchen
PERN 4T LD Septic System
THIS CERTIFIES THAT .............. .. ... AM............. ....... .&.. ........... ..............................
BUILDING INSPECTOR
has permission to erect .......................... buildings on ....�.M... ...... ......................... Foundation
Rough
to be occupied as ...... .fit .... .. ............a........... .................................................. Chimney
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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 MO T ELECTRICAL INSPECTOR
UNLESS CONSTRUCT S SRough
Service
............ .. ................................... ........................
BUILDING INSPECTOR Final
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.
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BUILDING&REMODELING
CONTRACTOR
MASSACHUSETTS HOME IMPROVEMENTS CONTRACT
This form satisfies all basic requirements of the state's Home Improvement Contractor law(MGL chapter 142A),but does not include standard
language to protect homeowners.Seek legal advice if necessary.Any person planning home improvements should first obtain a copy of"A
Massachusetts Consumer Guide to Home Improvement'before agreeing to any work on your residence.You may obtain a free copy by calling
the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website.
Homeowner Information Contractor Information
Name
Mr.&Mrs.McLeary Company Name
Joscon Management,Inc
Street Address(do not use a Post Office Box address) Contractor/Owner Name
104 Milk Street Jonathan O'Sullivan
City/Town State Zip Code Business Address(must include a street address)
North Andover,MA 01845 185 Atlantic Avenue
Daytime Phone Evening Phone 918-688-2223 City/Town State Zip Code
dennis.mccleary@gg.com
Salisbury,MA 01952
Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number
603489-1568 61-1403121
Home Improvement Contractor Reg.Number 159444
Expiration date 4-30-2016
The Contractor agrees to do the following work for the Homeowner:
Scope of Work
The following scope of work is to renovate the existing second floor hall bathroom. The existing tub unit to remain. Several items below have
Allowance amounts provided and will be adjusted accordingly once all materials have been selected.
• Building permit per the Town of North Andover,MA
4 Due to the age of the home Renovate Right Lead Safe Remodeling practices will be implemented unless tested by a V party to
determine if lead is present This is the Law and being a Lead certified licensed contractor I need to comply. Please visit
www.mass.gov�eadsafe for additional info. TBD
• Temporary protection and daily cleanup throughout the remodeled area.
• Demolition work to include the following: Removal of the vanity cabinets,shower tub walls,file ceiling in shower and the bathroom
flooring. Remove the tub wall on the opposite side of the shower valves for preparation for a new half wall with a clear glass panel to
sit on. Remove the existing wall file and wall paper. Disposal of all construction related debris. Asbestos removal not included.
• Soffit above the tub unit will be opened up to see if it an be eliminated. Further exploratory work is needed to determine what is
above.
• Rough carpentry to include building a half wall at the shower 1 tub area and framing adjustments at the existing shower 1 tub soffit
• Prepare the bathroom floor for new ceramic file by installing file backer board throughout the floor area. Tile materials per the
homeowner's selections and Allowance amount listed below.
• Prepare the shower area for new ceramic tile by installing new file backer board. Tile area has been figured on 2 full walls and the half
wall on the opposite side of the shower valves. Tile labor has been figured on a basic pattern and no chair rail,boarder and diagonal
patterns. Chair rail,boarders,diagonal patterns will be considered additional labor and will be priced accordingly, Wall file to end at
the ceiling area. No file on the ceiling. (1)4°boarder approx.11'has been figured.
• Install new ceramic tile throughout the bathroom floor area. Figured on a square pattern.
• Plumbing work to include the following: Remove 1 reinstall a new toilet,install new sink 1 faucet,install new shower trim and valve,
Plumbing work has an allowance amount of$1,200.00. Allowance has been based on installing new fixtures at the existing locations.
Any code upgrades,venting or fixture relocations may exceed the Allowance amount provided. Further exploratory work needed.
• Electrical work to consist of any code upgrades and new lighting fixture installs. Electrical work has an allowance amount of$800.00
figured into the total below. Electrical work Allowance figured on installing new fixtures at the existing locations. Any code upgrades
may exceed the Allowance amount provided. All lighting fixtures to be purchased by the homeowner. Further exploratory work is
needed to determine if the existing electrical is to code in the bathroom area.
• Install a new bathroom fan 1 light unit Fan unit to be vented to the exterior of the house.Fixture to be purchased by the homeowner
with Joscon's assistance.
• Carpentry work to include the installation of b board approx.4'high off the floor along the walls approx.22'in length. B board system
will include base board,b board panels and a chair rail.
• Vanity unit by others.
• Drywall repairs as needed throughout the bathroom area including the ceiling above the shower I tub unit.
• Painting throughout the bathroom area for the walls and ceilings. Prepare wall papered walls to be painted.
• Install new homeowner supplied finishes. Towel bar,toilet paper holder and robe hooks.
• Install anew shower glass enclosure along the front and install a glass panel on top of the shower/tub half wall, Half wall glass to sit
on top of a marble cap. Final selection will determine the actual price.
• Supply and install a new Anderson Woodwright Replacement window in the bathroom. Window,to have a 2 over 1 grill pattern with
divided light with spacer bars,white exterior and clear pine interior,high performance Low E and a white insect screen. Window at
cost and no install charge.
• Final post construction cleaning throughout the bathroom area.
Allowances listed above:
• Plumbing @$1,200.00
• Electrical @$800.00
• Shower enclosure&half wall glass Allowance @$1,500.00
• Shower 1 tub walls including boarder,grout,half wall cap and the bathroom floor the material amount including tax @$2,342.00(Extra
file will be returned to Tony's Tile for a credit and will be credited back to the owner.
• Shower valve and trim by others. Toilet by others. Sink and faucet by others
• B board work @$750.00
• Vanity including the countertop by others
• Medicine cabinet @$150.00
Total for the above project scope of work and specifications: $15,912.00
Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following
And will be secured by the contractor as the homeowners agent:
Building permit schedule will be adhered to unless circumstances beyond the
contractor's control arise.
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of 3/212015 Date when contractor will begin contracted worts.
MGL chapter 142A.)
312712015 Date when contracted work will be substantially
completed. Shower glass enclosure install date to be longer due to
template and install. Including the shower valve trim.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of$15,912.00 (*)
Payments will be made according to the following schedule:
$4,773.60 30%Upon the signing of the contract and the start of the project
$4,773.60 30%Upon the of the completion of demolition and rough ins
$4,773.60 30%Upon the completion of tile work
$1,591.20 10%upon substantial completion of the contract. (Law forbids demanding full payment until contract is completed to both patty's
satisfaction)
The following material/equipment must be special $0 to be paid for N/A
ordered before the contracted work begins in order to meet the completion schedule. (**)$0 to be paid for N/A)
NOTES:(*)Including all finance charges(**)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 contract 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.
Express Warranty-Is an express warranty being provided by the contractor? oNo 0 Yes(all terms of the warranty must be attached to
the contract)Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of
any third party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all
subcontractors for materials and labor under this agreement.
Contract Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the
contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices
carefully before signing this contract.
Don't be pressured into signing the contract.Take time to read and fully understand it Ask questions if something is unclear.
Make sure the contractor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor
registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617.973-8787 or 888-283-3757.
Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to
see a oopy of a"proof of insurance'document.
Know your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the
contractor in writing at his/her main office or brand office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the
third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Two identical copies of the contract must be completed and signed.One copy should go to the homeowner.The other copy should be kept by the
contractor.
H eo is n r. Contractors ignature
00tr Date
Contractor Arbitration
The Home Improvement Contractor Law provides homeowners with th right to initiate an arbitration action(as an altemative to court action)if
they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve
any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the
contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
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 the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer
Affairs and Business Regulation and the consumer shall be required to submitkE6-0--� to su arbitration as provided In Massachusetts General Laws,
cha 4
Homeow is Signature Con is Signature
NOTICE:The signatures of the parties above apply only to the agreement of the parties to altemative dispute resolution initiated by the
contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties.
Homeowners Rights
A homeowners rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter
93A)may not be waived in any way,even by agreement.However,homeowners may be excluded from certain rights if the contractor they
choose is not properly registered as prescribed by law.Homeowners who secure their own building permits are automatically excluded from all
Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described,in a
timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express
warranty for workmanship or materials.In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry
an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and
contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you
have questions about your consumedhomeowner rights,contact the Consumer Information Hotline(listed below).
Execution of Contract
The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached.
Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One
original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the
original contract must be in writing and agreed to by both parties,Contracted work may not begin until both parties have received a fully executed
copy of the contract,and the three day rescission period has expired.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems
him/herself to be financially insecure.However,in instances where a contractor deems himlherself to 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
of funds from said account would require the signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you
wish to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement"contact
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
617-973-8787,888-283-3757 or visit the OCABR website at http:/Mww.rnass.gov/ocabr/
If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor
registration component of the Home Improvement Contractor taw,contact:
Director of Home Improvement Contractor Registration
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
617-973-8787,888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:http://db.state.ma.usmomeimprovemenMicenseelist.asp
For assistance with informal mediation of disputes or to register formal complaints against a business,call:
Consumer Complaint Section
Office of the Attorney General
617-727-8400
AND/OR
Better Business Bureau
508-6524800,508-755-2548 or 413-734-3114
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
`r www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Annlicant Information Please Print Legibly
Name(Business/Organization/Individual): —TpS(_ch P)6q)C1y rft,4 -:TRc.
Address: 7a, Prcv,JencL W( QJ
City/State/Zip: N H O 3 e f I Phone#: G CGS- q e S- ( 16 0
Are you an employer?Check the appropriate box:
Type of project(required):
1.[dl am a employer with a employees(full and/or part-time).* 7. ❑New construction
2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. UrRemodeling
any capacity.[No workers'comp.insurance required.]
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. ❑Demolition
10❑Building addition
4.❑l am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.,
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E]Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
3Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
Iain an employer t/:at isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site
information.
Insurance Company Name: &-wir. lire ke4cam rR S
Policy#or Self-ins.Lic.#: f 1 (O 1 01), Expiration Date: CV R
Job Site Address: 104 'moi S� City/State/Zip: N.A,-Jt'y�� 1
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance
coverage verification.
I do hereby cert4fy under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date: r+
Phone#: e l - I S-6 f
Offt 1 use only. Do not write in this area,to be completed by city or tmvn 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#:
, �e �naaazaawrrcueaClsi o���rraa�uaelli;'• �'r
ffice of Consumer Affairs&Business Regulation .
ME IMPROVEMENT CONTRACTOR
gistration: 159W - Type:
xpiratron _4130/2015.. Private Corporatio
JOSCON MANAGEMENT----INC.
JONATHAN O'SULLIVAU. = 1
72 PROVIDENCE HILL RD.'
ATKINSON,NH 03811 Undersecretary
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supen�isor
License: CS-07 0043
JONATHAN OSU .iV. .-
185 Atlantic Ave#4 µ�
Salisbury MA 01952 1
a1 0 Expiration,.,
Commissioner
08/2612016' .
it
Jan.29.2015 02:17 PM Advantage Insurance Agenc 978 794 4833 PAGE. 1/ 1
CERTIFICATE CE LIABILITY INSURANCE DAU( MI°►Y"'"1
11 01/29/2015
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CEF(TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVEt_Y 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
REPRE8ENTATIVE OR PRODUCER,AND THE CERTIFMATE HOLDER.
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INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VUTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 16 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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X GENERALLJAaILITY 85Q0055690 05/30/201 05/30/2015 mxOCCURRENCF $ 1,000,000
COMMERCIAL GENERAL LIABILITY PREMISES(EnclFuporca S 100,000
CLAIMS-MADE( Ix (OCCUR MED EAP(Any dnapwwn) $ 10,000
PEReaNALaAOVINJURY $ 1,000,000
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CERTIFICATE HOLDER CANCELLATION
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1600 OSGOOD $TRSET ACCORDANCE WITH THE POLICY PROVISIONS.
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