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Home My WebLink AboutBuilding Permit #727 - 122 FOREST STREET 4/12/2012 Nvn,ry BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION T •1' � eb T Permit NO: / Date Received 9SSACHUS�� Date Issued: a items on this ae IMPORTANT Applicant must completez pT g NNW � LQATIDFN� � ^� '^ P 4 Y I F r S � 3 frM , }£ X' J x PROPERTiX 0WNER, , e^ p� .? ,� ..,�;:.�s s S - a r k'r Jags�,?-:N Mfr 7f Prr,f r♦t.fi�,.,-.� ar' °r 6 v+a :" t'' �,k � "z r✓ a.. -r t¢v F 1 MAPNtOA �' PARCEL nror; ZONING DISTRICT�� sx�ti3� Historac Distllct �,<yesl�� ?a' , t x ' achtirie}Shop'Urllagee �< 'no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family . ❑ Industrial ❑Alteration No. of units: Q Commercial ;F.E2epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ' ` fl Watershed`Drstrict ❑Feptrc Welt t ❑=Sflo�dplafn '❑31Net{ands r4 f +5 1 DESCRIPTION OF WORK TO BE PREFORMED \o Q�;A_vv"' _ a ' Identification Please Type or Print Clearly) 5 3 OWNER: Name�Y\_ �S -F- s b Phong 7 Address CONTRACTOR 'NaivePhones r t i r A3dd1'ess J 16. { � � x Supervisor's CanstruGtion License `�' Exp ate 3 T ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ s�1 FEE: $ Check No.: o1Ql01 �=e Receipt No.: S I NOTE: Persons contracting with unregistered contractors do not have access to the uuranty fund S�% nature of co_tractor Signature �f`Agent/Owner �.._._ n Location /C � No. Date • TOWN OF NORTH ANDOVER r Certificate of Occupancy $ Building/Frame Permit Fee $ ' Foundation Permit Fee $. Other Permit Fee $ ` TOTAL $ Check# a� G 25179 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Seng 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit Located at 384 Osgood Street FIRS DEPAfiTMENT Tem Du �_ Pe no+ mpster on site Located at'124IVlam St S ' E { }t I 1 Fire i7epartment signatur...e e z a } f r 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 ❑ Notified for pickup - Date i Doc.Building Permit Revised 2007 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 2.2007 XAORTH ® o oveTr No. Z _ _ m. _604 y �.. �- LAKE OL dover, Mass., • COCMICKEWICK Ids RATED 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........... .............. .... ... .. .....�... 1 . ................ ....................... Foundation has permission to erect........................................ buildings on .. L...... ... .. .. -.0............. Rough tobe occupied as......�.�.................P. .. .ri............ .k ....................................................... ........... chimney E provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Aftefation and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR i VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough __ ..... 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.- I Burner - Street No. SEE REVERSE SIDE smoke Det. 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 j oint 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 with 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-contractors)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 maybe 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 permit/license number which will be used as a reference number. Iu 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. Anew 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 Massachv.:sotts Department of Industrial Accidents, 4ff`ice of westigations 600 Washingtoa Street Boston,MA,02111 Tel,#61777-4900 est 406 or 1- 77;MASSAFB Revised 5-26-05 Bax#617-727-7749 _ wv�vt�.zx�ass,g4v/d:�a The Commonwealth of Massachusetts - Department of lndustriq[Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly Name(Business/Organization/Individual): J C— C C Address: oQ v Q So City/State/Zip-oms ems- d Z l by Phone#: �l 7 C( F j Are you an employer?Check the appropriate box: Type of project(required): 1.F�!N am a employer with 2"-' 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.x 7• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, El Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing.repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.E]Roof repairs insurance required.]i employees.[No workers' 131i Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy anal job site information. Insurance Company Name:. Policy#or Self-ins.Lic. Z//2-4°3 3 5'S o 2 r Expiration Date: 7 r Z Job Site Address: GZ� `��`�� CiZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 civilpenalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert' er t epains andpenaldes ofperjury that the information provided above is true and correct. Si ature: Date: _ — �— Phone#: V e�/ �/C) Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: JB Sash & Door Co., Inc. JB Replacement Windows CHARGE COPY Manufacturers&Distributors Andersen Excellence Dealer Ord #: 157754-0 DOORS•WINDOWS•FRAMES•MILLWORK Marvin Showcase Dealer Velux Skylights 280 Second Street,Chelsea,MA 02150 Interior&Exterior Doors Route: NONE ® (617)884-8940 1-800-648-9339 Fax#(617)884-9288 Therma-Tru/Jeid-Wen/Simpson Page: 1 of 2 www.jbsash.com Custom Manufacturing Shop Order: 03/05/12 To: BAT299 Ship To: Sched: DENNIS BATTERSBY DENNIS BATTERSBY 122 FOREST ST 122 FOREST ST Printed NORTH ANDOVER MA 01845 NORTH ANDOVER MA 01845 Date: 04/03/12 Time: 10:57 AM Phone: (978) 685-4439 Phone: Attn: / Cell: Entd: AAJJ 77 : 07 / Out: 07 Perms: COD Cust PO#: BATTERSBY DENNIS Customer Instructions Line # Item Number Description Quantity Shipped Comments 0001.00 *157754001.00 MARVIN 6068 - OX 1.00 HAMPTON SAGE CLAD EXTERIOR PINE INTERIOR - LOW E GLASS WITH ARGON - SLIDING SCREEN ANTIQUE BRASS HANDLE SET WITH ANTIQUE BRASS HINGES AND KEYLOCK F/D - 71 X 79 1/2 EXISTING F/D - 71 1/8 X 80 5/4 AZEK EXTERIOR CASING JB SASH WILL ATTEMPT TO REMOVE AND RE-INSTALL INTERIOR FLUTED TRIM - IF THE TRIM CANNOTBE REMOVED AND RE-INSTALLED NEW PINE TRIM WILL BE INSTALLED FOR AN ADDITIONAL $109.00. 15 LITE SIMULATED DIVIDED LITE WITH SPACER BAR - 3W5H 0002.00 INSTALL INSTALLATION OF ABOVE 1.00 TO INCLUDE: * REMOVAL OF EXISTING DOOR * INSTALLTION OF NEW DOOR * INSULATING AROUND NEW UNIT * INSTALL EXISTING INTERIOR TRIM IF POSSIBLE * PERMIT FEE * REMOVAL OF DEBRIS FROM SITE JB Sash & Door Co., Inc. JB Replacement Windows Proposal Manufacturers&Distributors Andersen Excellence Dealer Quo #: 089969 DOORS•WINDOWS•FRAMES•MILLWORK Marvin Showcase Dealer Velux Skylights 280 Second Street,Chelsea,MA 02150 Interior&Exterior Doors ® (617)884-8940 1-800-648-9339 Fax#(617)884-9288 Therma-Tru/Jeld-Wen/Simpson Route: NONE Custom Manufacturing Page: 2 Of 2 www.jbsash.com 9 Sho P Quote: 02/23/12 To: PR0300 Ship To: Sched: SUSAN BATTERSBY SUSAN BATTERSBY j 122 FOREST ST 122 FOREST ST Printed NORTH ANDOVER MA 01845 NORTH ANDOVER MA 01845 Date: 02/27/12 Phone: (978) 685-4439 Phone: IL Time: 03:16 PM Attn: / Cell : I Entd: AAJJ In: 07 / Out: 07 Terms: COD Your Order: SUSAN BATTERSBY JB Sash & Door Company is a Lead-Safe Certified Firm, has fulfilled the requirements of the Toxic Substances Control Act (TSCA) Section 402, and has received certification to conduct lead-based paint renovation, repair and painting activities pursuant to 40 CFR Part 745.89 as required by the United States Environmental Protection Agency. Certification # NAT-21346-0 J.B. Sash & Door Co. takes no responsibility for unforeseen deterioration of structural members in walls in which new window or door units are to be installed. We also will not be held responsible for changes to plumbing or electrical systems. Furthermore, existing shutters, storm windows, and shades may not fit once your new replacement windows are installed, and as such is the responsibility of the homeowner. Payment in full is to be collected by installers at the conclusion of all jobs. In situations where punch list items exist at the completion of installation, JB Sash will determine a reasonable amount of the balance due to be retained by the customer until punch list item(s) have been completed. Any and all costs incurred in collection of outstanding balances, whether or not resulting in litigation, including but not limited to reasonable attorney's fees are the responsibility of the undersigned. We PROPOSE hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: I FOUR THOUSAND FOUR HUNDRED FIFTY-NINE DOLLARS AND 81 CENTS 4.459.81 Payment to be made as follows: 33 1/3% DEPOSIT BALANCE DUE C.O.D. e� Authorized Signature: f_ I JBS MASS. HOME IMPROVEMENT CONTRACTOR REGISTRATION #152085 ACCEPTANCE OF PROPOSAL - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specifie ` Payment will be made as outlined a j _ - � rJ� i Date of acceptance: _�J Signature: �-y PRICES SUBJECT TO CHANGE WITHOUT NOTICE Merchandise. . .: 4,251.00 t ,. .. ? Tax. . . . . .. . . . . : 208.81 Misc Charges. . : 0.00 Quote Total . . . : 4,459.81 Client#: 131473 JBSASHDOOR ACORDr. CERTIFICATE OF LIABILITY INSURANCE 3 ;;2011/ ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HUB International New England LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 600 Longwater Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Norwell,MA 02061 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 781792-3200 INSURERS AFFORDING COVERAGE NAIC# INSURED J B Sash 8r Door INSURER A Employers Fire Insurance Co 20648 Ellie Dail INSURER B: 280 Second Street INSURER C: Chelsea,MA 02150 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. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MM/DD/YYYY DATE(MWDDNYM LIMITS A GENERAL LIABILITY 7100265980001 03/23/2010 03123/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY and renewal of 03/23/2011 03/23/2012 DAMAGE TO RENTED SES(Ea occurrence) s500 000 CLAIMS MADE FAOCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $t 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 000 000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY ANY AUTO (Ea accint)INGLE LIMIT e $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $H AUTO ONLY: AGG $ A EXCESS I UMBRELLA LIABILITY 7100265980001 03/23/2010 03/23/2011 EACH OCCURRENCE s3,000,000 _X1 OCCUR EICLAIMS MADE AGGREGATE s3,000,000 and renewal 03/23/2011 03/23/2012 $ DEDUCTIBLE E RETENTION $ $ WORKERS COMPENSATION ANDWC STATU- OTH- EMPLOYERS'LIABILITY Y I I ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in If yes,describe under E.L.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations usual to the insured. Except ten(10)days notice applies to non-payment of premium CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Insureds Ci3zpy as EV!sence o DATE THEREOF,THE ISSUING INSURER.WILL ENDEAVOR TO MAIL 3n DAYS%NRITTEI`I I'n su ran CB' NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHAIA I I IMPOSE NO OBLIGATION OR LiA.BILITY OF A,,,'.y K.I'D UPON`;THE!N!SURER.IT: Au;=FITS Oa i E I REPRESENTATIVES. AUTHORIZEp REPRESENTATIVE ..'/ f�: ice"'✓.,f. f,�i .f�� - � /,�v .r�r�.sl �_.�/,r:./----- 4; Office of Consumer Affairs and Business Regulation_ S5 FA� 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 152085 Type: Private Corporation Expiration: 7/28/2012 Tr# 200023 J B SASH & DOOR CO, INC. x _r RICHARD BERTOLAMI 280 SECOND STREET CHELSEA, MA 02150 - i - Update Address and return card.Mark reason for change. Address Renewal F, Employment Lost Card DPS-CA1 0 50M-04104-G10OII216 Office of"OA—.e`r XWWR- djness egu a"ti.. License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: -152085 Type: Office of Consumer Affairs and Business Regulation F~" TJSH Expiration: 7J�812012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 &DOOR:IQWI Cs_::-;_. r, r3 RICHARD BERTOLAMI 280 SECOND STREET g jam_ CHELSEA, MA 02150'.11Undersecretary Not valid without signature To:{J B Sash&DOer CO Incj Page 2 of 3 2011-07-01 GO-41111(GMT) 18186880-505 From:Kenneth Menon Client#:635081 JBSASHDO ACORDn, CERTIFICATE- OF LIABILITY INSURANCE DATE�(wIl1D01° M THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON.THE CERTIFICATE.:HOLDER:Tks CERTIFICATE DOES NOT AFFIRMATIVELY OR NEOATWELY AMEND;EXTEND.OR ALTER THE COVERAGE AFFORDED BY THE t'OL1gES BELOW.THIS CERTIFICATE OF 11ISURANGE DOES NOT CONSTITUTE A CbNTRACT BETWIE N THE•ISSUING INSURER S),.AUTHORIZEO REPRESENTATIVE OR PRODUCER,ANO THE CERTIFICATE HOLDER. IMPORTANT:if the Certificate holder is an ADDITIONAL INSURED,thepo6cy(ies)must bq.endorsed ff SUBROGATION IS WANED sut>'ectto theaenns and conditions of the policy,certain policies may_regVire an endorsement A statement on ttus certificate does not cvofer tights to the certificateholder in lieu of such endorS6M6nt(s). PRODUCER WCT USI Ins Sery of MA, Inc P� Ax 12 Gill Street (AJC;No,E ,781 938-7500 ( No);781-3164035 Suite 5500 ADDRESS: Woburn,MA 01801 CUSTOMER ID t: INSURER(S)AFFORDING COVERAGE NAIC If INSURED J 8 Sash 8r Door Co Inc 04SURERA:Liberty Mutual Insurance Compan 123043 280 Second Street INSURERB:First Liberty Insurance Corpora 33588 Chelsea, MA 02150-710 INSURER C: INSURER D: 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 FORTHE 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. TYPE OF INSURANCE OUCY EFF POLICYEXP LIMITS TR SR POLICY NUMBER MMIDO MMfDO GENERAL LIABILITY EACH OCCURRENCE s COMMERCIAL GENERAL LIABILITY PREMISES EaoccurrenceS CLAIMS-MADE 1-1 OCCUR MED EXP(My one person) S - PERSONAL 6 ADV INJURY S GENERAL AGGREGATE ' S GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPfOP AGG S -IFCTIPOLICY PRO- LOC S B AUTO MOBILE LIABILITY AS6Z11243358031 1/01/2011 0110112012 COMB INED S INGLE LIMIT S X ANY AUTO (Ea accident) 1,000,000 X ALL OWNED AUTOS BODILY INJURY(Per person) S BODILY INJURY(Per accident) S SCHEDULED AUTOS PROPERTY DAMAGE 5 HIRED AUTOS (Per accident) X NON-OW NEO AUTOS S S UMBRELLALIAB OCCUR EACH OCCURRENCE EXCESS LIABLl S CLAIMS-MADE AGGREGATE S DEDUCTIBLE S RETENTION S S A WORKERS COMPENSATIONWC1Z11243358011 7/01/2011 07101/201 XwcsTA7u- OTH- ANDEMPLOYERS'LIABILITY YIN TORY IMITS I ER ANYPROPRIETORRARTNERIEXECUTIVE E.L.EACH ACCIDENT S500,000 OFF(CER/MEMBER EXCLUDED? a WA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5500,000 DESCRIPTION OF OPERATIONS LOCATIONS(VEHICLES(AttachACORD 101,Additional Remarks Schedule,W more space is required) CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED EEFORE THE EXPIRATION DRTE THEREOF,NOTICE YVILL BE DELIVERED IN ! ACCORDANCE 1rL!TH THE POLICY PROVISIONS: I i r ' €PJTHJ4 Zer Rrr'R a u:TIV� � j - r .� s i� ,�1 +� ' f1.i rUii;uti �u�)cfl i.ut' \ CS FA-067268 RICHARD L BERTOLAMI 35 SUNSET DR BURLINGTON MA,.b803'r Commissioner 11/21/2013 Restricted-One-and two-family dwellings or any accessory building thereto, irrespective of size. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: wway.Mass.Gov/DPS December 12,2011 To Whom It May Concern, Gary Troy is authorized to be an agent for Rick Bertolami and JB Sash and Door Company as it pertains to the application of permits. Thank you, R7a- 5;�� . Rick Bertolami JB Sash and Door Company 617-884-8940