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HomeMy WebLinkAboutBuilding Permit #346 - 116 BRIDGES LANE 10/31/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION O� "ORTH , Permit NO: t '► Date Received D:A)' o Date Issued: (� SACNus���� IMPORTANT: Applicant must complete all items on this page LOCATION 116 ejelb GET L11 , Print PROPERTY OWNER_ A/EC2 /k4G4.I6CYG7'72 Print MAP NO.: D� 4 PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building k0ne family ❑ Addition ❑ Two or more family ❑ Industrial L Alteration No. of units: repair, replacement ❑ Assessory Bldg i_,Commercial Demolition ❑ Moving(relocation) - ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED �1°eia/�ce- exiy A)G ike� cva /d`x do dec/c Identification Please Type or Print Clearly) OWNER: Name: A btf Phone: 99?-77Y-8,3 6-/ Address: //4 6/Q/b G Cc S, CONTRACTOR Name: /yl41eC- lebVAI-DO Phone Address: /o)- /I-nU 5,10 4W , Supervisor's Construction License:_0 4/.3701 Exp. Date: ////9107 Home Improvement License: /0// 79 Exp. Date: 6/dl/o? ARCHITECT'/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING PE IT. $12.00 PER 51000.00 OF THE TOT,4L ESTIMATED COST BASED ON 5725.00 PER S.F. Total Project Cost :$ / , 4-00 FEE:$ Check No.: Receipt No:: Page I of 4 I Location j No. Date j NORTh TOWN OF NORTH ANDOVER a Certificate of Occupancy $ ,SJACMUStt� Building/Frame Permit Fee $ Foundation Permit Fee $ may:; Other Permit Fee $ TOTAL $ Check # 19747 Building Inspector TYPE OF SEWERAGE DISPOSAL Swimming Pools C Tanning/Massage/Body Art Public Sewer Well 7 Tobacco Sales ❑ Food Packaging/Sales Permanent Dumpster on Site Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner e aha q,Qc ezQ Signature of contractor AOA'4-�1461 Plans Submitted 9' Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS _yT i FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection/Siiznature& Date Driveway Permit Building Setback ( Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created wC.J:m2006 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.$100-$1000 fine NOTES and DATA—(For department use i B Notified for pickup - Date 1)0c-Building Permit Revised 2010 s 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 El Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application U Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses a 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) o Engineering Affidavits for Engineered products MOTE: 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 o 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 gOTE: All dumpster permits require signn offrom 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 thea appeal period is over. The applicant PP P pp t must then get this recorded at the Registry of Deeds. One copy androof of recording g must be submitted with the building application Doc: Doc.Building Permit Revised 2012 . i NORTH IN Town of LAndover N o 10 4 0 LA over, Mass.,Ih /� COCMICMEWICK 014'ATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... ..................................................................... ......................................................... Foundation has permission to erect........................................ buildings on ..!..........e0l 0!Wy 044......10,of NC Rough to be occupied as sym. ...... .............. Chimney provided that the -idolela!&ceptiAng -t-h--is permit fbiln every respect c.o-(imrff to the terms of the a on file in Final 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 PERMU EXPIRES IN 6 MONTHS Final UNLESS CONSTRU TARTS ELECTRICAL INSPECTOR Rough Service ........ .................... �B U II D.ING INSPECTORFinal Occupancy Permit Required to Owtpy 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 SIDE Smoke Det. i A1ICE ^:,,41k ® eIt'� a :Peck ooe �Nr i or A-)) xy To is 4V. � y . ovbL f e. i lbs t� FTT7 r 17U 7146es a � e-r�vv An ooh ST1r'01`��PO"`S ,A�'►AdR w�w�w��ew w +'� wr a s ' ACO RIDTA CERTIFICATE OF LIABILITY INSR, CE ` 2008 PRo°ucm 9'8=686-Q826 TfiIt-CERTIFICATE-IS ISSUED AS A MATTER OF INFORMATION JOANNE K MILLS INS AGENCY ONLY ANQ CONFERS NO RIGHTS UPON THE CERTIFICATE 166 HAVERHILL ST HOLDER `THiS C>RTIFIGAT.E DOES NOT AMEND EXTEND OR METHUEN,MA 01844 ALTER THE COYERAGE'AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE MAIC#t ° INSURER A. M GROElP FITCHBURG MUTUAL INS MARC RINALDO DBA __. _ _`----_..___._.._..._14S._.__^.._..___._._....._._...... RING ENTERPRISES mEUReRB: INSURER C: 1210EN$INGTONAVE -- __......_..__...__........_....__.._____;.._....__....---.-_...._.._...... METHUEN,MA 0184.4 :INSURER 0: ..INSURER E: COVERAGES :.. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED gBC�°E,=Okt'I( I?CIIJY PE:�'OD tNDICATED.NOTWITHSTP.NDING ANY REQUIREMENT,TERM OR'CONDITION OF ANY CONTRACT OR OTHER DOCUMENT-WITH RESFSCT TC WIlCr�T}I(S C£RT(FICAT�MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL:THE 7ERidlS>�(CLIiSlONS AkD CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID WI M8. TYPECIFINSURANCS PDLICYNUhm5t Y N; ' LIMITS 6ENERALLIABE.ITY EACHOCCURREHCE L 50O OOO A X:CO-WERCIALGENERALLWBIUTY 202-264010482 05107/06 06/07/07 PR EfhISjEaoecureEee) §_._......._. 50,000 u: CLAIMS MADE OCCUR' MEDEXP ..--_--�._.._._.__..._.....__..._ ...._ PERSONAL tADV INJURv t .....: ........_.__.__..____.._._.._.... = GENERAL AGGREGATE ^S .. 1,000,000 GEWLAGGREGATE LIMIT APPUESPER: _.CT _.._..._...._. ..__-... _�...._.... 17-! PRODUGTS:COMP/JPAeG S 1,000 QUO I POLICY PRO, LOC AUTOMOB8:E LABILITY COMWNEG SINGLE LIMB ANY AJTO (Eaaandm!) $ ALL OWNED AUTOS '....' BOOMY INJURY SCNEDULEDAUTOS - lPifP6R0I>I S HIREDAUTOS _._....._._............_......_..................... BODILYINJURY S NONAYYNEDAUTOS (Pracdit ) ........._-...._...._... ....._._.._........ PROPERSYOAMAGE S _oARAGE LIABILITY aUT0014LY�Ea ACCiDENt S _ AHY AUTO AUTbt " A QIlCE88NMBRELLAUABRRY - EACHOCCURRENCE S j OCCUR CLAIMS MADE A^+GI�GATE S Y.._.. _._ .__...._ ............................ .. DEOUCTWLE S RETENTION S I WORKERS COMPENSATION AND ATU� N� EMPLOYERS,LIABILITY T - -L iWl7T$:....._.fE. _._..—_..._.._.._..._-----•� ANY PROPRIETORIPARTNERFI XECUTIVE EL EACH ACCKIENT S OfFK'ER/11ENBfiR fiRCLUDEO7 iTa�tla�cnb�upyar E L DISEASE s 'A EMPLOYEE S SPECIAL PROVISIONS t t EL.DISEASE,POLICY LIMIT 5 'OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEV BY ENDORSEMENT aSPECIALPF OWMAS i CRT ICT OLDER GANG _Tt l'_:6HOUIJ)ANYOF THE ABOVE DESCRIBED POUQMB BECANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUNG INSURER WILL:ENDEAVOR.TO MAIL DANS WRITTEN MIKE MAGLIOCHETTI z"TICE TO THE CERTIlrICATT HCLIMRNAMEDTO THE.LEFT,BUTtALURE TO 00 50 SHALL 116 BRIIDGE LADE uposE ND oBLIOAT(ON OR WIBIUTY DF ANY kw6.I pON THE INSURER,ITS AGENTS OR NO ANDOVER MASS 01845 fePREaeNTATrvEs LUTHORQEO REPR$SENTATRIE oanne K MlilS ACORD 26(ZOQil�) 'AC4RD CORPORATION 1988 I 7 [ r P {.Tim '•it , i Mmpq b - z`°* _ zt / ,;/fte '�ar�t>,urncurcz�l/a r�`C'�,/��,��sarlitlrtelt'd � `' Bdard:uf Hugding RegulAttoos orad 8tsrtdards C HpMIMPROVEMENTCONTRACTOR Reylatrattcn 1(11177 Y �plrab6h 6!2512008 TYPE Indtvtdual MARC.RIMALDO r, f � Marc Rinaldo 12 Kensington Ave y ` Methuen NtA 01844 Depaty Administrator E , t j per, i 7z lw 4 � �- ➢ K 1§0A13ba00�UIL wt ,Re(3ULAfil0N5 t� F 1»Icon�ot Cs01uSTRUCI'��iV ���RtiIjS©ft TI X801 rth�I 1 18/i��2 h �Xpl�ea 11114/20117 7"r no: $3J1 0, R+ tritrktl Show r M1 �; ". , b ,+ K�NStw�art�w r�v� M rhtuw ty c"I,M§ AS S(OnB� CONTRACTORS INVOICE WORK PERFORMED AT: 1 TO: All �1,, r �(lr. tri at Vii! 3o ,z- DATE DATE YOUR WORK ORDER NO. )If 4'*7S7 OUR BID NO. � /of a.7/6 ,DESCRIPTI ON OF WORK PERFORMED : 7-, z i i r r„ 'S0 0 ' Cf 1` ��b d O "0"300 0 4�t _ i All Materialis guaranteed to be'as specifidd, and the above work was performed in accordance with the drawings and specifications provided7lor the above work and was completed in a substantial workmanlike manner for the agreed sum of Dollars($ ). This is a ❑ Partial ❑ Full invoice due and payable by: Month Day Year in accordance with our ❑Agreement ❑ Proposal No. Dated Month Day Year N 3822 CONTRACTORS .INVOICE 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:INSPU TIONAL SERVICES DF.PARTN1EN'r:BPF0RA105 Page 4 of 4 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: ; /3 IMPORTANT:Applicant must complete all items on this page ri�.si s4 ttr F 'V,11,1111 111TI, h t X TIMr t f ,t r �� ,.L��--u 'S` F�l?� I I.Q��l3':. � PR®PERTWO' WIVERM/ 6. .�,� � ..�n.... .- .00 i _PMI ;,s f 100 Year Rd Structure MAP�,�NOrO�I,�I� PARCEL x x 3Z®NING DST++RIOT: �t) .. Histone ®is net r t x . =tom Fz *6 � ,�. MachineShopV';illage . .. , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building '�rOne family ❑Addition ❑Two or more family ❑ Industrial 1 / Iteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: C�/Demolition ❑ Other -F - t r'u'+ x ', r is d Fz, Y f a- .? 7.a. f - .':.�, �,.., -. '. -- 0. e tic ❑Well y , 2 Floodplain 'To Wetlands �w� �rf7 Watershed District 4 :rig r t..� �r f ,.+�'. �•'-.s"t�.:- " ``+ F..,,�`"'''.."x€ *.�"3 n'"` A+ ' +c} ; ..-+g-�%V :`•k •�-Siii � -}'�' vxFYv'`' "`r �CIVater/.Sewer _ {. ti to =L a T. _ .e. - DESCRIPTION OF WO K TO BE PERFORMED: �v s r�R c�a 11 Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: *�-� ti�Y•�. s �td;<ry'*L,�.�..r .:�' '.�5 Ii -;- f`e �...^k yi^ '.`t��dS `.i�-.9t rfi.'.s.;?yfhC.'"'' x ,. t. d,�.3 soT, 5- s' y5,. �f'... i'ti' ak'+� 7 NAM' 2' aL Y x n Kv, aF^' -, r '�QF`4 '3x+P.rlael r �.,f ;w+ioy--i aP x:. 3 a;. zr CONTRAC�T�OR Namew '�- Ks �f�, � a ar�� .sPhone575 , S?a � 0s<�9q �f- <4Zs`.$r � arS . ° rxs�aS� : i' may, asy h�' y` jxr63} +L a:;. rx,0 1`• fi'�. r'ta s Yt w-fy ,.lYy4. � . A dare! s, s; :. ' 'fi�'LrZ <• il�`- a"i* t.; d,y .�dti3:.1" 'C.' j k...-+.dt `.' Lv,�, ��' "3•.'S'a rX .74� 341 f'.,' F,yH, ` l.'l � 4' 4l Supervisors>ConstructionxLicense ' { q 'r HomeilmprovementLieense ARCHITECT/ENGINEER Phone: Address: Reg. No. k FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ a 4-1q 6' 0 Z7 FEE: $ Check No.: �l k� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund _Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waive ❑ Certified Plot Plan ❑ St ped Plans ❑ f Location �'���' is Al No. :1 7�— /� Date • ' TOWN OF NORTH ANDOVER • S StiFb l6 F��w�2�-•r,age • Certificate of Occupancy $ Building/Frame Permit Fee $ 74 F Foundation Permit Fee $ r-- - Other Permit Fee TOTAL i 1 Check#�� 26169 -' Building Inspector Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site " ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW TbwL.Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT _ Temp Dumpster onsite yes no Located at IM Mai `Street Fire Departm' tsignatute re/da COMMENTS Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 32,446.00 m $ - $ 389.35 Plumbing Fee $ 48.67 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 48.67 Total fees collected $ 586.69 116 Bridges Lane 571-13 on 2/22/13 Kitchen Remodel � �10RT1i � oven o � � _ 6Andover G ". 10 NO. O TAKE h ver, Mass, coc NIc"IW1c.c ��' A�4ATEO S U BOARD OF HEALTH LD Food/Kitchen Septic System PE RMIT T �./..... .`//.. - � BUILDING INSPECTOR THIS CERTIFIES THAT ....... ........................................................... /!E� �6`f � �e Y. . Foundation has permission to erect .......................... buildings on ............ ...... .. ....... . .................................. Rough to be occupied as ..............&4076.0 !..-.. !.4�G y��................................................................ Chimney 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TARTS Rough �j ............ Service ............... .w� 1.�`^.r.,�,...................... 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. SEE REVERSE SIDE Proposal WEST TEWKSBURY CONTRACTORS 79 James Ave. Tewksbury MA 01876 978-808-0599 DATE 10/17/2012 Revised 12/10/2012 Marie& Mike Magliocheti 116 Bridges Ln. North Andover MA 01845 978-794-5495 home 978-621-1734 cell UANITY DESCRIPTION AMOUNT TOTALS 1 Cabinets (JSI Wheaton) Green island $12,976.00 $12,976.00 1 Granite counter tops with sink(faucet&sink allowance 350.00) $3,830.00 $3,830.00 1 Install Cabinates $1,600.00 $1,600.00 1 Demo And dispose of old cabinetry $750.00 $750.00 1 Lighting Install recessed lights (10) $980.00 $980.00 415 Sq.Ft. Remove &Replace ceiling Tape corners $8.00 $3,320.00 44 Sq. ft. the backsplash (tile allowance $4.00 per sq. ft.) $15.00 $660.00 415 Sq. ft. tile Kitchen and Bath (tile allowance $4.00 per sq. ft.) $17.00 $7,055.00 1 T-0"x 6'-8" door $375.00 $375.00 1 T-0"x 6'-8" custom pull out unit $900.00 $900.00 $0.00 Painting not included in bid Included in pricing for tile; backer board, adhesive, and grout Tile. Submitted TOTAL BID $32,446.00 Comments Notes I accept above-pricing and autporize work to be done ' Datk>/I)/- e Signature(s) Please sign and return yrgg�� 9 yam! 4 D i7 '~ DO(9.oD G),v.A � 'TA JI j R&Lj �L t if 3/19/2013 11:17 AM FROM: John A. Pierce Insur TO: 19786889592 PAGE: 002 OF 003 ACOR® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03/14/2013 PRODUCER 781.729.8770 FAX 781.729.0053 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION John A. Pierce Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 93Winchester, MA 01890-1994 4 Main St. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Jay Stamp INSURERA: Utica Mutual Ins Co 0019 DBA: West Tewksbury Contractors INSURER e: 79 James Ave INSURER C: Tewksbury, MA 01876 INSURER D: 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 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. I 'L R DD LTPOLICYEFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMIDD LIMITS GENERAL LIABILITYEACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY LU PREMISES Ea occurrence $ CLAIMS MADE F—I OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ HAUTO ONLY: AGG $ EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION 4611053 03/11/2013 03/11/2014 X WC STATU OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY A OFFICEOPRIET ER EXCLUDER/E ECUTIVE E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 50Q,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Operations usual to interior carpentry. Jay Stamp has not elected coverage under the workers compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN North Andover, Town of NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Attn Building Dept IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 49 Garnet Cir REPRESENTATIVES. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Kevin Pierce ACORD 25(2009/01) FAX: 978.688.9542 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i I I 2/20/2013 1 :30:15 AM PST (GMT-8) FROM: 100005-TO: 19388510106 Page: 2 of 2 A�O CERTIFICATE OF LIABILITY INSURANCE DATE(MhVDD/YYYY, 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(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). PRODUCER BYETTE INSURANCE AGENCY INC CONTACT ME• 853 MAIN STREET PHONE , 7INC.No: 7 851-0106 TEWKSBURY, MA 01876 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC S INSURERA: INSURED JAY STAMP IISURERB: DBA WEST TEWKSBURY CONTRACTORS INSURERC: 79 JAMES AVENUE INSURERD: TEWKSBURY MA 01876 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 15542371 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR INSR WVO POLICY NUMBER MM/DD/YY MM/DWYYYV LIMITS GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F OCCUR MED EXP(Any one parson) S PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG f POLICY PRO- LOC $ JFCT AUTOMOBILE LIABILITY FM aiB.LI EEHDIIj INGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED 8 SCHEDULED BODILY INJURY(Per acrident) AUTOS AUTOS S HIRED AUTOS NON-OWNED PROPERTYpAMAGE AUTOS (PoracudeM) $ S E UMBRELLA UAB OCCUR EACH OCCURRENCE E EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTIONS S S S A WORKERS COMPENSATION WC5-31 S-348361-022 3111/2012 3/11/2013ORV T,MITs �� AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTNE YIN E.L.EACH ACCIDENT S 100000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR JAY STAMP. Workers compensation insurance coverage applies only to the workers compensation laws of the state MA. CERTIFICATE HOLDER CANCEL TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NORTH ANDOVER BUILDING DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 OSGOOD ST BLDG 20 STE 2-36 ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE - ffflll / y Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are,registered marks of ACORD �FfRT NO.: 155Y371 CLIENT C E: 135 968 Didi ng 5 Z/20/201' 7:2°:45 An Pae 1 Of 1, l s certificate cancers anY supersedes1LL previously issUs�d certificates. 2/19/2013 2:35 PM FROM: Risman Syette Insurance Agency Inc TO: +1 (978) 688-9592 PAGE: 002 OF 002 A 'OR ® CERTIFICATE OF LIABILITY INSURANCE D IDDIY 2/19//19/20133 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Commercial Lines NAME: Byette Insurance Agency, Inc. PHONE (978)$51-6678 A1C No: (676)851-0106 853 Main St. E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Tewksbury MA 01876 INSURER A:National Grange Mutual Ins Co 14788 INSURED INSURER B: Jay Stamp, DBA: -West Tewksbury Contractors INSURERC: 79 James Avenue INSURER D: - INSURER E Tewksbury MA 01876 INSURER F: COVERAGES CERTIFICATE NUMBER:City of Lowell 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. IPO LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DD YEFF MM ICY EXP YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES E ( RENTED PREMISESS Ea occurrence) $ 5,000 A CLAIMS-MADE a OCCUR MP013913 8/10/2012 8/10/2013 MED EXP(Any one person) $ 500,000 - PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY P�- ElLOC $ AUTOMOBILE LIABILITY Ea aBcl aEDtSINGLE LIMIT 500,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED M9013913 0/1/2012 10/1/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Underinsured motorist $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/N TORY I IMITS I I LR ANY PRO PR IETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Bldg 20, Shite 2-36 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 j i'U!`.S.Y x:J Jae^—Sf.' '�S ..4..-i.• S Lamarche/3HAWNA ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(20.7005).01 The ACORD name and logo are registered marks of ACORD 2/20/2013 10:35 AM FROM: Risman Byette Insurance Agency Inc TO: +1_(-978) 688-9542 PAGE: 002 OF 002 3 - 2/20/201N 7:30:15 AM PST (GMT-8) FROM: 100005-TO: 19788510106 Page: 2 of 2 A�V CERTIFICATE OF LIABILITY INSURANCE DATE(PAWDDIYYYY) 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(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). PRODUCER BYETTE INSURANCE AGENCY INC CONTACT NAMEl 853 MAIN STREET • TEWKSBURY, MA 01876 PHONE Ne l 7 ac No: 7 -- E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC S PLS U RER A: - INSURED JAY STAMP INSURERB: DBA WEST TEWKSBURY CONTRACTORS PLSURERC: 79 JAMES AVENUE I RLSURERD: - TEWKSBURY MA 01876 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 15542371 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 S TYPE OF INSURANCEADDL SUBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MMMwYYYY MMMO/YYYY LIMITS GENERAL LWBIUTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea ocalrrenxS CLAIMS-MADE F—I OCCUR ME D EXP(Any one person) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE S GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PRO- LOC - $ AUTOMOBILE LIABILITY CCOMBINED SINGLE LIMIT IEa acciddent) S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOSHAUTOS NON-OWNED PROPERTY 1Per�cu entDAMAGE $ $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAe CLAIMS-MADE I AGGREGATE g DEO RETENTION$ $ 5 $ A WORKERS COMPENSATION AND EMPLOYERS'LIABIuTY WC5-315-348361-022 3111/2012 3/11/2013 RV T WcsTU;iI - / rARS ANY FROPRIETORJPARTNERIEXFCUTNE Y/H IM OFFICERIMEMBER EXCLUOE67 NIA E.L EACH ACCIDENT S 100000 (Mandatory in d n) - E.L.DISEASE-EA EMPLOYEE $ It yea,describe aunder 100000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 500000 OESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach AC ORD 101,Additional Rernarks Schedule,it more space is required) THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR JAY STAMP. Workers compensation insurance coverage applies only to the workers compensation laws of the state MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NORTH ANDOVER BUILDING DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 OSGOOD ST BLDG 20 STE 2-36 ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE �r 1 Jeff Eldridge J V J ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are.registered marks of ACORD LERIT NO.: 155L17r1 CLLEt4r C E: 175-960 DLdL nqdS 2/20/201° T:2°:a5 Ist Pae 1 Of IIs certiticate cance�9 and`sUperse es AL previously issu�d certificates. ,p� ✓�ae �omvneareiuea�z o�./v/.aaaacfivaet�a ?�\ Office of Consumer Affairs&BiAineSS Regulation HOME IMPROVEMENT CONTRACTOR Registration:, 131756 Type: ; Expiration:__9/1:112014 DBA W T TEWK66URl'CONTRf� TORS JAY STAMP. 79 JAMES AVE r TEWKSBURY,MA Ofi870s; ,`•." Undersecretary Massachusetts-Department of Public Safety ' Board of Building'Regulations and Standards Construction Supers icor License: CS-077224 JAY M STAMIe 79 JAMES AVE � TEWKSBUI Y MA 018 6 r Expiration } i Commissioner 05/09/ 014 .1 .Az i j•