Loading...
HomeMy WebLinkAboutBuilding Permit #310-2017 - 108 Kingston Street 9/22/2016 .�� NoRTl1 BUILDING PERMIT o��LED TOWN OF NORTH ANDOVER 32 g}—F1• 6 � APPLICATION FOR PLAN EXAMINATION A permit No#: l� 1 Date Received ( ..ATED P �gSSgc HusE��S Date Issued: I ORTANT:Applicant must complete all items on this page j �a LOCATION s _ /1 i1 �+�3% s% 1�jA Print _ PROPERTY OWNER Print 100 Year Structure yes no 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 _ Septics ❑Well! ❑ Floodplan -7 El ��.M , q>WateTshed;�D�strJc� F � R v r DESCRIPTION OF WORK TO BE PERFORMED: Identification- Plea"-T pe or Print Clearly OWNER: Name: J c, s� (s/���'t � �S I Phone: 9V -3 - Address: 2 00 I< ►-I G-sT6 I ,, f Contractor Name: I�ILI 2 g ,j Phone: Email: Address: 3U 't ttom-zh Supervisor's Construction License: (2 f Z Exp. Dater 12�� Home Improvement License: J / Exp.. Date: 1424 Z-I � ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING ERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 2_z�� _�t 3�1 Total Project Cost: $ , FEE: $ 3� - Check No.: 1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund e_ . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/S`-ales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM (PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS f •f CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature i COMMENTS F �r 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 [F.IRE DEPARTMENT, S;Temp;Dumpster qn site :yes_ .. Loated a 024�Nla n;Street x� ty: c ;"' j _ t •:, °',';T�;- -- -.., -r' .✓^• �.-::�xF '.- i a. < i. • t •a�<,.-� is '' •�^ _..—,�..,.� FiretDe�{ryyartment•signature%date 44 COMMENTS. ,V �. 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.$10041000 fine NOTES and DATA— (For department ase) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 4, Building Permit Application 4. Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses .46 Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products ®TE: 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 NORTh '9 Town of 1 a 6 ndover No. h ver, Mass, A;r ,Q COCKICKl WICK �• J,9 A04ATE D S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT ....PERM BUILDING INSPECTOR �.... .Q .17... '............................ has permission to erect ........................... buildings on .....U0.91n...Loa.... . . „�, ,�,�, Foundation cc Rough tobe occupied as ..................rw.J ....... ... �. .............................................................. Chimney provided that the person accepir ting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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. • '1•i ��'�I���{�I���:�.Li'}t' :11>-i++�:�.�.,g:.d �. }�.yRi�riP' 7�, 0�'�' p G C� � v ' ,f i tt •d;l'y i Ti. ��••a f.tt�'nIS•••�t•,'la' ,:jt•:n41�44T', # y 1�n'1 � ,. , •�. Q � �,il,,tt •t».+'+" ,,� Yf-, i '�t� ,i•Yyy�'�'�•y,,��},.rn•�1,^e.¢�tt;bt 1 •C:�+It,Y+''fl�t�+'`F,+�„�v`f;����ptt'nKp+�,t''� 1.;,}?1 5a1 y1 � � �r�' ('� � � • Ij :,, , ,,`','�, 1.j.. �:�' !'t r"'''' a''"'ii; 'i,1' al'Iti t•r jl, 1 oi',5} 1, ,wJ q+ l11 iY •`�Z7rq t41" f L+i u7 '„ti', ,., ,• �• ,•te•'1 .,,, + y t'+1 cy +fit °•'� • "t •I ”^';{Ij•�,jr;:.; ij '' p+'i,; f �;';a fY,ar`!�''''t �{ ��t(,����L�;. �; � •:' +�fv,w. ,+';' t'`"A'* tp., qr '', ' `�,`�S�j'�l'� �,P. {,i � ��+ '4' a' ,,.++- t' ;� ,..1S�r;','tit+�.FS�� ,�' i '''"' �'} ;��t'• t,, ��l�� �!4��5f' ` Q 4 �� (( y ' �+� �' ., �.j, •` , ''''., '''r''`'�; '�1; � �; �, .L t `(j'��M1 V)�nit�' �'` ~�:i, Vl 'DS' S�C ti• , �; N �,� � ": ,t�� !�•�l� ', �� '�,'.•��i� ,00 �"• it .,, +41 (d' t y,,,, •f..�. }•� 1 � . 1 , , a• `•*, *, '•tIF u"�, ' Tt�'}»,9LIt+.l�{,Ilb1 fir'i '.}• ' -lALa4ri,, 'M+µ ,d� E It '»h r,5, i• � � '"t,it++{'ice�.1�'t'' '� ' `�•• ('y�•� •;'' •'ryl�i'��j �,�IS�i�.'t{}+1�'', fes[ t J'I t�. - C� ' ,�� S} �t •".'+�r1 t��,,) .� '•iik '; 'e 1:t•� t'17.,.f ; � .1 � ."f i+, �'ki„�)(((r�,tf t 5�1�'] ,U ���''i•J 1 i 1y � �� �'�'.ft 'V �15Q{1�� ��'t; a' � �� t�. ) 't' � �y�j��}u�''���"•' � t'' i 1' �� 1 �+' ;, � lJt 'I' 41 r'• i`1r+f Air i, 1 �NX . ';' � ,'' ,r.,�•:,I'J. J �' '•v S ��.�1 �} 5rr 4J:.1 Alt %•�, ,' / i��!' � '; �r�';� t';i; �••' � tai. � , „r 'n .,c' '4•:vti' '' l.t.":•:wf:,i .. ^kms':,t,���p�'ti��jt tr.�' r�{�,'�J�'j,7, '�5 A�yn9 75 1(:tY.j '•1� 'i'� '�f+''t� �l. +1� � `��"1 i,�• ' •ril.�Q 3'✓:' nil tel`, •' '' �f•:. .LY•',i ,'r/�,r ,.C"��;1. �17tl., 'J.Tt�� J.ti r /"�:�+i � � � b,f '�'� .a � .� ii�''Jt ,: :t•,.i';:' '�}i;` .�� ',�4 'if'3tr �t"�;5 rVn(s'jr, ;` t11i,1t /yry �4 r }+ r ' ! '.rFi�'JRc�',,.{�s�', 1.+'�',} .�• ,�Jt�C1<',,,.�vi,':Y.���'��.L7r�°�,.,`,!(llr�,,,+R'1 t �� ,It rr �'n •t i 71.n'.lJ4L', :"k J'n �t ,�, .,�j�,�',+�' � � ,r���" ,.�.. �+ �;.F^,�fiF,�Lt;.R Y+�.:5•:'`''�I�i'' '��..�'� �xx(t� }!'1ra�Ii t�+�{ It Ir,t+ 1.. }. '�� � V .. ',. +,.:��ii.4r.•w•x;.�•��.1 Yt.'�?�;&;7;t�j!�fh+��5 � ,. ': :` .y s. J.. 11 .. LL UNIMER 40/VIE RtQ1O F Chimneys Residential & Commercial Roofing All Types Of Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work Mass Toll Free *Roof Leaks Experts * Licensed& Insured Locally Owned& Operated Sirce J976 1-800-WAIT-4-US m �-�a License#034200 (924-8487) IKO CZ& worm oe.9olsn We Work Year Round 1 - • . ' • • ' / � � � 1 •' - � - i 1 ori Proposal To: Village Green West Date 5/21/2016 Street: 200 Kingston St. N.Andover 603-382-6166 68-82, 108-138, 156-170 Roof proposal picaeng@comcast.net IKO Cambridge/Certainteed Landmark 1. Extra caution will be taken to protect all buildings, 11. Counter flash existing chimney lead,wall walkways and landscaping as best as possible. connections and all roof protrusions (pipe boots and Debris will be removed and magnets run daily. vents)with ice and water shield,tie into new shingles Not responsible to move tenants personal items. and sealed with clear Geo-Cel sealant. All installation procedures will follow state code 12.Bath Exhaust vents: Install all new black low and OSHA compliance. Caution tape outline all profile bath exhaust vents on roof line. Counter work areas. flashed with ice and water shield. One for each unit. 2. Remove all shingles and roofing materials as best No interior connection included. Will coordinate with as possible from all four buildings. Association for best locations per unit 3. Inspect and re-nail any loose or lifted plywood. 13.Wall connections: Remove existing siding or Any compromised plywood will be replaced at an aluminum trim as needed. Counter flash at least 18" additional cost. up the wall with ice and water shield. Install new 4. Install heavy gauge 8"white F8 .019 aluminum 5"x7"aluminum step flashing. Re-install siding and drip edge to all eaves and rakes. trim. Install new aluminum siding or trim if 5. Install 6' of IKO Storm Seal or Certainteed Winter compromised. Guard ice and water shield to all eaves and top to 14. Removal of all work related debris. Planks will be bottom in all valleys. All drip edge nails will be placed under dumpsters to prevent any damage to covered with 12"strip of ice and water shield. existing asphalt. Placement and removal of dumpsters (ASTM D6757 certified) will be coordinated with Association to minimize 6. Install IKO Storm Tite or Certainteed Diamond daily interruptions. Deck synthetic underlayment to remaining 15. Contractor Workmanship warranty: 15 years under sheathing up to the ridge. (ASTM D6757 certified) normal wind,rain, ice and snow conditions. 7. Install all new pipe boot flashings. Counter flashed (Please see extended warranty) with ice and water shield. 8. Install IKO or Certainteed starter shingles to all Extended Warranty: (Against material defect) eaves and rakes. *IKO Shield Pro Plus* 9. Install IKO Cambridge or Certainteed Landmark • Full 20 year coverage direct from MFG. Limited Lifetime architectural shingles to all four • Non pro rated buildings. All shingles and roofing materials will • Labor,material, debris removal and workmanship be fastened and installed per MFG specifications. All valleys will be woven. Commercial MFG *Certainteed 3 Star Sure Start Plus* warranty up to 40 years. (Please see extended • Full 20 year coverage direct from MFG. warranty) . Non pro rated 10. Cut and install all new(ASTM certified)nylon • Labor, material and workmanship.Debris removal mesh ridge vents to code to all four buildings and not available with 3 Star coverage capped with IKO or CertainTeed color matched 1,;•, Q"A A'Ana nan eh;nnlaa Rnth F.YtPndp..d warrantiPC inplur1IP.fi in nranllCal I Now LL MXX S 40E Chimneys Residential & Commercial Roofing Ail Types Of CHIMNEYS PoiNTED-REBUILT-CAPPED Expert Masonry Work Siding Roaf Leaks Experts * Licensed &Insured Mass Toll Free Locafty Owned do Operated Since 19,6 ; License#034200 1-800-WAIT-4-US IKO® Gjaee Wveew ac�'ohw =6 We Work Year hound (924-8487) 71P�rosal To: R. J Pica Engineering Date 5/21/2016 (Page 4) Street: Village Green West (Phase 1) 603-382-6166 68-82, 108-138, 156-170 Roof proposal picaeng@comcast.net IKO Cambridge/Certainteed Landmark Total cost and payment schedule Total IKO Cost: $1069000.00 Total Certainteed Cost: $1 4,000.00 / sem• ���' , Z� Total Gutter Cost: $15,000.00 (Balance due upon ompletion of all four buildings) * Upgraded ice and water shield options (For best defense against water infiltration caused by ice dams) -1K0 Premium Goldshield: $3,000.00 additional cost -Certainteed Premium HT : $2,600.00 additional cost _Payment schedule: Balance including any additional costs due at the completion of each building. No deposit required. IKO %76,500.00 per building • Certainteed $28,500.00 per buil g Commercial references: Jackson Lumber Heavenly Donuts CSI (Cementary Services Inc) Shaheen, Gurearra and O'Leary Law offices A Plus rated member of the Accredited BBB since 2001 5 year consecutive Super Service Award winner from Angie's list (Top 5% of all New England roofing contractors) s, specifications and conditions are satisfactory and are herby Acceptance of Proposal—The above price accepted. You are authorized to do the work as specified.Payment will a e as outlined above. Date of Acceptance: ( l (t � Signatu �\ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): OQLL Lfyl:Q e!{ 0v1.< Address: �2i"•`/�� 0KI �� -r- City/State/Zip: YM vihr,t s 41-4 Phone#: Are you in employer!Caeck the appropriate box: Type of project(required): l.[3 am a employ.with__T_anployees(full and/or part-time).* 7. ❑New construction 2.Q 1 am a sole proprietor or partnership and have no employees working for enc in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.) 3.[:]]am a homeowner doing all work myself.[No workers'comp.insurance required.)t 9. Demolition 10 Q Building addition 41:11 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 arc sole ILEJ Q Electrical repairs or additions proprietors with no employees' 12.❑Plumbing repairs or additions 5o 1 am a general contractor and I have hired the subcontractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.E]We arc a corporation and its officers have exercised their right of exemption per MGL c- 152, � 152,§1(4)�and we have no employees.[No workers'comp_insurance required.) *Any applicant that checks box#1 must also 611 out the section below showing their workers'compensation policy information_ t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sbeet 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 60 it iftvt rm o rvy)-� ] Policy#or Self-ins.Lic.#: �C - D� - o � ��- - "/J�Expiration Date: Job Site Address: 0 kN L,14:'r- C'no (..S­i F City/StatdZip: /J 14 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 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under ins and penalties of perjury that the information provided above is true and correct Si afore: Date: l/°/ lZ `'i Phone#: -0 -7-r-3I Official use only. Do not write in this area,to be completed by city or town offreiaL City or Town: Permil/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#: 9/21 /2016 9 : 07 : 39 AM 8975 p 02/02 i ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) ! 09/21/201,6 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 i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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). PRObUCER 02051-:00'1 NAoMEACT Branch 2051=1 Perry.lnsurance Agency LLC a7C.NNo.Ext): (978)685-7690 rt,6.No.t (978)687-0149 522 Chickering,RdEMAIL North Andover,MA 01845 ADDRESS: I F Z INSURERA: A.I.M.Mutual InsuranC@ Company -.33758 INSURED All Under One Roof INSURER B jNSURER C: C/O John Lanzafame INSURERD: 30 Temple Drive Methuen, MA 01844 INSURER E: INSURER F" COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS.TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE:FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED'OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN TYPE OF INSURANCE AtJSQR WVB� POLICY NUMBER MMlDOnYYY MMIDONYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMNIERCIAL GENERAL LIABILITY DAMAGE S. RENTED CLAIMS-MADE ❑OCCUR MED EXP(Any one person) ,$ PERSONAL&AOV INJURY $ GENERALAGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER PRODUCTS.-COMP/OP AGG $ OLICY ED& OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Peraccident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMSM.ADE AGGREGATE g DED I I RETENTION$ C UU 3 WORK PLOY MMPENSAT10N X TORY UhiI7S ER RAND EM ER$'LIABILITY Y N ANY PR.O0PRIETppR7PARTNEERRIEEXECUTIVE E.L EACH ACCIDENT 3 A OFFICER IMEMBEREXGLUCED� a NIA AWC-400-7009464-2015A 11/9/2015 11/9/2016 0 (Mandatory in NH) E,L.DISEASE•EA EMPLOYEE $ i.00 1 600000 It ygs de-tnbeun er DbSCRIPTION OF OPERATIONS below E-L_DISEASE-POLICY LIMIT f 000,000-00 DESCRIPTION OF OPERATIONS!LOCATIONS./VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) The workers compensation policy does not provide coverage for John Lanzafame I CERTIFICATE HOLDER CANCELLATION Village Green West Condominiums 200 Kingston Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE:WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ' ©1988-2010 ACORD CORPORATION.All riahts reservers. ATE CERTIFICATE OF INSURANCE D 09/20/2016 ) PRODUCER AND THE NAMED INSURED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Transworld Building Trades and Contractors Liability Association,Inc.Inc.,A Risk CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Retention Purchasing Group qualified under the Risk Retention Act of 1986;Federal CERTIFICATE OF INSURANCE DOES NOT AFFIRMATIVELY OR V Law 97x5.84091-0469 NEGATIVELY AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED Sandy,UT 8 P.O.Box BY THE INSURANCE POLICIES BELOW. 800-851-8364 INSURERS AFFORDING COVERAGE INSURED INSURER A: NOTICE:Coverage is being provided as part of a Master Group All Under One Roof INSURER B: Policy issued to members of the Transworld Building Trades and Contractors Liability Association,Inc. INSURER C: ,a Risk Retention'Purchasing Group'authorized under the Risk INSURER D: Retention Act of 1986:Federal Law 97-45. 30 Temple Drive Methuen, MA 01844 "LIMITS SHOWN ARE THOSE INPrime Insurance Company COVERAGES EFFECT AS OF POLICY INCEPTION" The policies of insurance listed below have been issued to the insured named above for the policy indicated. Notwithstanding any requirement,term or condition of any 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.Aggregate limits shown may have been reduced by paid claims. POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ $1,000,000.00 COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) s N/A rwn Claims Made PRC2656-16090011 09/13/2016 09/13/2017 MED EXP(Any one person $ N/A �/ Exclude Products PERSONAL ADV INJURY $ N/A V Exclude Completed Operations GENERAL AGGREGATE $ $2,000,000.00 H GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AG $ fi PRO- POLICY JE Per LOC Per Person $ $300,000.00 AUTO LIABILITY ANNUAL AGGREGATE $ $0.00 ANY AUTO BODILY INJURY ALL OWNED AUTOS (Per Person) s $0.00 ❑ SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per Accident) $ $0.00 ❑ NON-OWNEDAUTOS PROPERTY DAMAGE DRIVE AWAY (Per Accident) s $0.00 GARAGE LIABILITYIMANUSCRIPT FORM PER PERSON SCHEDULEAUTO $ $0.00 ❑ G.K.L.L. PER ACCIDENT s $0.00 ❑ O.T.R.P.D. AGGREGATE s $0.00 ❑ D.O.C. PROPERTY DAMAGE CARGO g $0.00 ❑ ON HOOK ❑ EMPLOYEE DISHONESTY ❑ WRONGFUL REPOSSESSIO EXCESS LIABILITY EACH OCCURRENCE $ $0 eOCCUR F-1CLAIMS MADE AGGREGATE s $0 RETENTION $ $ LIMITATION OF COVERAGE FOR ADDITIONAL INSURED DESCRIPTION OF OPERATIONILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISION Coverage is limited to only insured activities or operations on the Participant Member Declaration Certificate or as may be separately endorsed.Contractors-Executive Supervisors,Contracted Services-Using fully insured subcontractors. LvJ1 CERTIFICATE HOLDER ILIADDITIORAL INSURE Ll I LOSS PAYEE Village Green West SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 200 Kingston St. FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 Attn:Andrea Georgetti Y AUTHORIZED REPRESENT IVE Fax Number: 9785326023 ;ViassachusetYs - el:a irnF�:Or ?�ial:r,sa e'•: Board of 13uiiding RcgiAl ti no a' License: CS-069120 JOHN W LANZAFME . 30 TEMPLE DR = ' �r4 s METHUEN MA 111844`' `:QI''irnSSS'i.7f irrr 04/03/2017 Click on the registration number to view complaint history.You can also view,arbitration and Q- aranty Fund history. The list is current as of Wednesday, October 8, 2014, Search Results REGISTRANT RESPOMBLE REGISTRATION ADDRESS EXPIRAT110N STATUS NAME illMl`1lrID€fAL NUMBER DATER ALLumsRONE ROOF LANZAFAWE, 137057 166 A MERRIMACK ST 10/02/2016 Current JOHN METHEUN, MA 01844 _ 02012 Commonwealth of Massachusetts. Mass.GovQ is a registered service mark of the Commonarealth of Massachusetts, �04�`Lpp hb af�O A NORTH: MOVER BM.DWG DEP"D ENT 'q:rEn�uc5 x.600 Osgood Street �ssacHs�� . . Forth A- dover . Tel: 978.698-9545 Fax: 978-688-9542 .$TIfiWSSFORM FOR TOW'CLEW DATP, 1A11M: cr'i S 4F S .D.DREE89: l v l Mv. ZONMGMTRIO i: 'GYM OF13USMSS.. C- C_0 BUILDING LAYOUT PROVIDED: YES • �lO A.V'A1LA.�3�.L.E PAR MG SVA.CM ZONI GBYLA.WUSAGE: 'SES NO tumb&G MSPEOTC Off.SIGNA.TmE 13USMSS FORMFOR TOMCLERK 2.49 ?comae Occupation(1939132) An accessory use conducted within a dwelling by a resident wha resides in the dwelling as his principal address, which is clearly secondary to the use-of the-building for living ptuposes• Home occupations shall `iiicluide,"but not Butted to the following uses; personal services such as furnished by an artist or instructor, but not occupation involved with motor vehicle repairs, beau4r parlors, animal kennels, or the conduct of retail business,or the manufacturing agoods,which impacts the residential nature of the neighborhood 4. For use of a dwelling in any residential district or multi-fatuity district for a home occupation,the following conditions shall apply: a. Not more,than a total of three(3) people may be.employed in gjq&gme occupation, one of whom shall befilneowrier OftlieYome oc pation anal residing inn aid divelling; b. The use is carried on strictl3T vdthin.tho principal building; c. There shall be no mctexior alterations, accessory buildings, or display which are not customary with residential buildings; - d. Not more than twent,-five(25) percent of the existing gross floor area of;the dwellhag Init. so used, not to exceed one thousand (1000) square feet, is devoted, to'such. use. In connection with such use,there is to be kept no stock in trade, commodities or products which occupsr space beyond these limits; e. There will be no display ofgoods or wares visible from the street; £ The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbances, or in any other way become objectionable or detrimwtal to any residential use within the neighborhood; g. Any such building shall include no features of design not custbmaq in buildings for residential t?se. 615 . signature Date Location No. IV— ' rm�+` Date • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# f < Building Inspector