HomeMy WebLinkAboutBuilding Permit #302 - 108 LIBERTY STREET 10/31/2008 I - NORTFr BUILDING PERMIT 3?0�tt�to hb"tioL TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION x ,� Permit NO: Z Date Received ,9 wren�aQ`�g9 SSA�HU`+E Date Issued: a IMPORTANT:Applicant must complete all items on this page "'LOCATION' Print PRORERTY OWNER 'Pnnt ; MAP�NO: 'PARCELS ZONING.DISTRICT: Historic District P yes no 'Machine,a hpp Village des no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne family Addition - wo or more family Industrial Alt No. of units: I Commercial Repair, replacemen Assessory Bldg Others: Demo i ion Other "Septic . -Well Floodplain Wetlands Watershed District Water/Sower DESCRIP ION OF WORK TO BE PREFORMED: ..7: IdentificationPlease Type or Print Clearly) ,r OWNER: Name: {�c,4 Q[J Phone:(97'�') Address: )? L - t CONTRACTOR Narne_-rm 1 ✓E' 'd r C Phone.-(97 ) a 9l r Address. k wa Supervisor's CoriStruction license: Exp. Date' • a /2 Home Improvementticense; �! 7 7" Exi) `Date: I ARCHITECT/ENGINEER Phone: i f 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: $ /_3. 706, oo FEE: $ a� � Check No.: �f O`� Receipt No.: yk • NOTE: Persons contractin with unregistered contractors do not have access to the guaranty fund gnatureiof Agerit/Owner �( afore of contracto a 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 J 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/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 t CONSERVATION Reviewed on Signature COMMENTS 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 Town Engineer: Signature: l Located 384 Os ood Street FIRE DEPARTMENT -Temp Dumpster onsite'. yes no Located at 124=Maim Street Fire Department signatureldate COMMENTS f� I 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 f I I I NOTES and DATA— For department use) Ie II I ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location 1 oe Zzi, A No. 30et Date NORTH TOWN OF NORTH ANDOVER F r �. • pw -fes. p Certificate of Occupancy $ s.CMUsEs� Building/Frame Permit Fee $ Foundation Permit Fee $ 4 Other Permit Fee $ TOTAL $ Check # 21646 Building Inspector TH c Town of 6Andover , 0 { No. 30 ?W0 T 00000' Q LA o �` dover, IVMass. • COC OC MI CMEWICK ORATED P' "V t `' 7 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT...... ................. .w. .............. ..:............................................. Foundation has permission to erect..................:..................... ildings on ....�. r...... .b� .. .. � .....:..............._... Rough tobe occupied as..................�. ...... ......f................. .........amp :..............:....................:............._................. Chimney thprovided that the person acceptin t s permit shall in every r act conform to the terms of the application on file in Final is office, and to he provisios 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 CONSTRU TARTS .. - Rough i .... ............................................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDLJ smoke Det. --- J J E�OO�IIt� . This form satisfies all basic tegairemmts of the statds Home Imptwamoat Contractor law(MGL chapter 142AX but does not include sttmdmA language to protect homeowners,Seek kgal advice ifneces sa*y Any person Phn°ing home impmveazmis should first obtain a copy of"a Mnssat husctts conlmm r guide to home impmvemear"before agrwmg to any work on your rosishace.You may obtain a fine copy by calling the Office ofConsumer Affairs and Business Regulation's Consumer Information Hotline at 617-9734x&7 or 1-8118-W-3757. Homeowner Information Contractor Information Name aY are Street Address(do not use a Post Office Box address) Contractor?Salesperson/Owner Name S4 a Ciiy/fown istate Zip Codc usincss Address(must include a street address) r4c, o 45a Daytime Phone Evening Phone ity/I'oam - State Zip Code (977 687-0 33 Der+ H'. o 03�9- Mailing Address(It different from above) u»aess P )'rd4 ederal Fmployer ID or S.S.Number '%t/'607'j tamagotm,n.rmmttnme®. amen Caaraeeraen Ncmaer rrataea ane The Contractor agrees to do the following work for the Homed ner: G / Srl� re)d reroo'� See A-kccbed. of defe,ile-d to be dcinr- Required Permits-The following building permits are required Proposed Start tend Completion Schedule-The following schedule will and will be secured by the contractor as the bomeowruces agent, be adhered to unless cucrmtsmnces beyond the contruchn's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of U6 Date when contractor wall begin contracted work. MCL chapter 142A.) L �V16 C Date when contracted work will be substantially completed. Total Contract Price and Payeneut Schedule Thu Contractor agrees to perform the work,furnish the material and tabor specified above for the total sum of 206, (') T Payments will be made according to the following schedule: S upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) ti S by / /or upon completion of I S by / / or upon completion of upon completion of the contract(Law forbids demanding full payment until contract is completed to both party's satisfaction) The fdlowmg mauriaLrequipmeat must be special S to be paid for ordered before the contracted work b*as in order S to be paid for to meet the completion mbodul&(••) NOTES-(•)Including all finance charges(••)law requires that any deposit or down-paymem required by the contractor before work begins may not exceed The greater of(a)one-third of the total contract price or(b)the ectal cost of any special equipment or custom made material which rust be special ordered in advance to mea the completion sehedule. . Exlre.s revs ed by the contradorT So V (an terms oftbe Wareaetr must he anadred to the contract Subcontractors-The contractor agrees to be solely responsible for comp{atiaa of the work described regardless,of the actions of any thud 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 Acceptaaee-Upon signing,this document becomes a binding contract under low. 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 caref idly before signing this contract. Don't be press r-ed 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 Reg stration 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 One Ashburton Place,Room 13D 1.Boston,MA 02109 or by calling 617-727-3200 or 1-800-223.0933. • Does the contractor have insurance?Check to see that your contractor is properly insured. • 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 ocntracmts normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted.by telegram seat 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!!! rue identical orgies oi'Iheewtraa�'a/��De�m�mpld�e(da(od�ai�ad.(boaopy aLouW deo Uce tmmea�acc Theolheroopy sAoald 6ckCpt try hhe mnaaanr. Homeowner's Signature ntmctor's Signature J�OF lv�_?l a;- Date r I Dat Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative 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 77tItsuch arbitration as provided In Massachusetts General Laws,ch ter 142A.. Homeowner's Signature ntractoes Signature NOTICE:The signatures of the parties above apply only to the agree ent of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's 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 worlananlike 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 he 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 consumer/homeowner 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 recission 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/berself to be financially insecure. However,in instances where a contractor deems him/herself 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 Consumer Guide to the Home Improvement Contractor Law,"contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)2833757 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 Law,contact Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 or 1-800-223-0933 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)652-4800 (508)755-2548 (413)734-3114 Pgoour-T tta � rQ�ID'Bt�l Page No. -of Pages J & J RoofingMft — IiQ➢n>:In_AD Types of -------- -- __. — Vent�abOn-Caipentry 6••�•-a 97"83-2968 603.898-1058 PROPOSAL SUBtMTT®-o PHONE GATE Pa+ ia. e i6r7- 3 5 O STREET JOB NAME o? CITY,STATE Z W ZIP COCE f JOB WCAT ON r (Y)ao 5 ARCHITECT GATE OF PLANS JOB PHONE We hereby submit spedGcahans arnl estil ales for n x -$ -� _c.c sem__s�!�s'1c �ct_c►2 �a� S�inc�1 .. ---------- - i RePlC4ce.a_ty__r.1C CCL._oi_.d. ya-'sr-taa:irF!YO'(.A.renwct�s---r�a�-------_.._..-- _s .__.._.__ n...s. -as.l_I..__..o lucniOt,tri_,dra �eCIS, cocinc eca,N.__ _o_ r A pp I-- ----1. __.C:.1+-- r `_ Rer uji Z._ o Cu�?'�.b _, ?}� urs sf�Am6uca�L.s�ilid- --- - -- - - pes-1 t2y�-_ _LCQ en ',f4t.;.[,.cS�:..-of-rsc� Or prOposr hereby to futmish material-arld labor—fCOM pfete in t coordance with above specifications,for the sum of: C•rjdtPc/C'/? �( tZl� dollars(S Payment to be made as Idiom: i 1 All materiel is gua'anteed to be as Specified AD wwk io.be twmPleted n a wpWrbnpte ' manner atcerdrfg f0 Sfardard pmc9r—_Arlt'eneralbn Or d0v1a11011 tMfll�ibOW NO[44 c inv*Ang GM MsIS we Ds executed ordy 1pOf1 vtDtett Orders Olid vtlt blCom9'�n'®dri eharge over and above the estimate, AN agmemerft.canlUlgurA Wbp 3Tdtes smderiw Of delays beyond our aontrot Owns to carry I".twrtado:ard oera•0e2essery liftaiii".. ol§This Proppsal.may be Our workers are tutly covered by Wwfartan a Gstnpen;attoh Irourarti e: 1NNIIdfdwfl by us M trot aid rvhltkt _�[� days, FcondMons urt of Propmal—The atwvePrices.st►edtitatiors are satisfactory and-ere hereby at�epted.lbu.are 8uthorized SignaNre as specified. �!�( /}J�MOD naris as otidinttd above. =w. / // _ $i8oatrife i Board of Building Regulations and-Standards i Construction Supervisor Licerise .' a, L en4e: CS 65870 _ , .x- Birthdate 4�2/17/1974 s. r`Ex rrat�n =14/1'r7/20iWf1 Til 8119 - JAMES P FREDERICK f 352 ISLAND POND" RQ�� 1 G— DERRY,NH 03038 Commissioner /,���,,ac�uraP� } ryutte °i ns ai✓v andw_. LSoard of building T CONTR`CTOR HOME IMPROVEMEN ; Registration 126777 _ Tr# 271801 ExPiton 7►1912010 s IpdduaiI ju a y �T�e 3,Y1 JAti1E5 P.FREDERIeK tom . JAMES FREDERI�CsIF +�a1 tr- 352 ISLAND pdtninistrator 1 ,NH 03038 DERRY - i The Commonwealth of Massachusetts t ! Department of Industrial Accidents MCI- f Office of Investigations 600 Washington Street Boston, MA 02111 www.nzass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lembb Name (Business/Organization/Individual): E P r If Address: City/State/Zip: /'� P&�t �(J f-� Phone#: 70 Are ou an employer?Check the appropriate box: Type of project(required): 1. i an a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 3 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its required.] officers have exercised.their 10:❑.Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself [No,workers' comp. c. 152, §1(4),and we have no 12.[D,�,00f repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.❑Other 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Humeowners who submit Ribs affidavit indicating L'teY af'B uuine i E;..Ewre;&!-,-!then hire outsi&wriiau Curs must submit a new afnuavit indicating such. $Contractors that check this box must attached an additional sbeet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for m3'employees. Below is the policy and job site information. Insurance Company Name: / yG L/If S _112S Policy#.or Self=ins. Lic.#: Expiration Date: Job Site Address: 10t L Z e-/74i 1S-74 City/State/Zip:_eL-A L —, mr, 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 5250.00 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 I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Siatur • Date: Q " Phone#: 92tf ��•? �(, Official use only. Do I 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#: Information and Instructions � Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more 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 dwelling 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 or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall 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 witb the insurance coverage required." Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public 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 the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(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 insurance. If an_LLC or LLP does have _ employees, a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date-the affidavit. The,affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the 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 event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitilicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year, Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26=05 Fax . Client#: 3854 JJROOFING ACORD,. CERTIFICATE OF LIABILITY INSURANCE 10/07/08on ) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HUB Int'I New England(WILSB) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 299 Ballardvale St HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Wilmington, MA 01887 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World Ins Co JRoofing INSURER B: Travelers Indemnity Jim m Frederick 352 Island Pond Rd INSURER C: Argonaut Insurance Co. INSURER D: Derry, NH 03038 INSURER E: COVERAGES 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 CONTRACTOR 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. INSR OD POLICY EFFECTIVE POLICY EXPIRATION LTR NSR - TYPE OF.INSURANCE., POLICY NUMBER DATE MM/DDIYY DATE MM/DD/YY LIMITS A GENERAL LIABILITY NPP1145221 04/04/08 04/04/09 EACH OCCURRENCE 51,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED REMISES(Fa occurrence) $5O OOO CLAIMS MADE a OCCUR MED EXP(Anyone person) $5 OOO X P-11 PD Ded:1+500 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $1,000,000 POLICY PRO- J CT LOC C AUTOMOBILE LIABILITY RENLBA3351409 05/22/08 05/22/09 COMBINED SINGLE LIMIT ANY AUTO (Es accident) .$100,000 ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY(Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ Is DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND 6KUB611OB70108 01/28/08 01128/09 X J� MIT WC STATU- OTH- EMPLOYERS'LIABILITY PR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 Ify iOEWnrbnE.L. ISEASE-EA EMPLOYEE $10000 , 0 If yes,describeeunder unddExGLuueo? D er I SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Patricia Quinn DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1Q_ DAYS WRITTEN 108 Liberty Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL North Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZE REPRESENTATIVE - ACORD 25(2001/08)1 of 2 #S202466/M190889 WRO01 © ACORD CORPORATION 1988