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HomeMy WebLinkAboutBuilding Permit #237-13 - 13 CHESTNUT STREET 9/24/2012 pORTh BUILDING PERMIT °F�t�1D i TOWN OF NORTH ANDOVER 3� y `''- -J ° F t .,� APPLICATION FOR PLAN EXAMINATION b � <s:�,`' p .� opo a.c::.K. Permit NO: I Date Received oR^reo,Pa ,fig �SSACHUS�� Date Issued: el�' )k---- MPORTANT:Applicant must complete all items on this page r�,W-^g�4�► T"' sy-+ -�. ...F' .yr,.�..- -....- � .,,,. +.. - - :'k_' '-"-c s•�,r'y..-'.•„»- r--- -`-'t-�vt`.r..^�++ -�S..S' , A 10 PIN,43. Fin PROPERTY OWNER'. MAF:NO' 'f__ _PARCEL: � Z .`ZONI_NG'DISTRIC_yT'. 4Histonc,District' no �` MOP'hihe�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 Y Septic = Well Floodplain ";�VUetiands `` ` Watershed�Disf ict 1Nate�%Sewed ; - .. DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: �9f'�/y C f} G1/J`/ l�Gl�-% Phone: Address: �5� /�G1� ��r ,L� � %�� �Y D1/��2 /VM- a lk� CONTRACTQR ';Name: Gt� 4s �ayS Phone 9rf X0'-67?7 ,,. L pew Supervisor.s Construction yLicense Expo ;Home Im,provemehfQicense:� � 3? .. G _ 'EXp !Date., ? - ���✓_. .m� ,,: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERW.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASEDON 025.00 PER S.F. 75 © Total Project Cost: $ � ��D, � FEE: $ `� Check No.: � , Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access 2thZuaranlyfun dO Signa"tore of Agent/Owner .:Signature of contractor -.. - .s .. ' - 11 I .-. 1. is - . -. ..... ,.,.1.. .. .. .. -. .. .. .,....... ., . .:. .. ..�. ... .. ._: .._.. .:..... _. ..-- _ - - ... ... .. . ....... . . ._ ... .-. .,. ---. ....-.. ..._.. ._.. . . - .. .. ....... _. ... ..._. .. .. - ... -- __ _ '-^—^rte h.e+rrw;;1`.rc_ - _ / � h } Location �/�117��heir's+a7-- v , . 11" � f No Date - 4 f • TOWN OF NORTH ANDOVER �'. C • �a - �y4• -:J -- - • Certificate of Occupancy $ Building/Frame Permit Fee $ y! Foundation Permit Fee $_r Other Permit Fee $ ;,` TOTAL $ >_ Check#_� - m. L2574 2 Building Inspector �, I.. - -.. :.. ". . .< ,_ .. �. .. .. y. '{ v�. ..... ..... .. ... - ... _.. - .. -:. ..Y... t - � r.. -. .. ... .. '...:... - .-.. x, . .. - -..r. .. .... .: .. .. i ... _ -. .. _ ...._.. .. ... ._ .. .. .., .. - .,. .,...... _. :_ . . ......I ... ao ...,.r. � i. �... ..: ..: .... . :. ._. .. . - 3 - . 1. _ . lk �. ..: .:; ..' x .._._.._ _.- ......' .. - ._ _- .. . .:- .,_..: ,,: .. .,.. ..... ._ , .,_.... .. 7 i ,r, : ' -. % - f. - -. .. _ .. _ _ -.-. .. . . - ... . r. le .� : .. .. .,a .. • .. 11 :: .. r:... - :. _, .,+ ... ., - :��- 1. . n. .. , C% 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 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: . Located Os ood Street FIRE:DEPARTMENT Temp Dumpsteron`site yes no�ti r :Located at.-y1J' 2�.4..(.M� ainStreet ,. �_ +r °y *r� 4 tt�yiits C+iyse +;�""3� ;W,lXV �.. i Fire Department signature/date;z. cia'ri, 70'44 T'! { r COMMENTS 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 p t use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 DEPARTMENTMFORM07 Revised 2.2008 ikopoml Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH .North Andover, MA 01845 Proposal Submitted To: Job Name Job# _j Address 7 Job location U GJ„ r� ® f '.- Date 9 Date of Plans Phone# c•u. Fax# ` Architect FFheeb, bmit spec cations and estimates for _ Gly r,oa, - o-� v We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: Q0 a $ ��yr�Qi�f /J� Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order,and will become an extra charge over and submitted -- above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our cdhtrol. Note—this proposal may be withdrawn by us fi not accepted within days. acceptance ]DOrap gar The above prices,specifications and conditions are satisfactory and are SI nature Ow hereby accepted.You are authorized to do the work as specified. 8 Payments will be made as outlined above. Date of Acceptance Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies all basic requirements of the state's Home Improvemurt Contractor Law(MGI chapter 142A),butdoec not include atapdard language to protect homeowners. Seek.'Iegal advice if necessary. Any person'plantii ag hoine"intnprovements should. fiisf obtain a copy of"a Massachusetts>oonsumer.goide to home•improvement"before agreeing.to any work on yourresldenec,You may obtain-a free co py Office of Consuma;Affairs:snd Business Regulation's Consumer Information Hotline at6i7-973 8787 pr 1.8'88.283-3759: by calling the ' Homeowner Information Contractor Information Name sine' ... Street Address(do not use,a Post Office Boa address) tractor/SatespQaoa/.OwnetName ✓ �w L4N0 . !f:OR: VAILt50 Cityfrown state Zip Code lusiness Address(must include a street address) . Daytime Phone Evening Phone fry?own State Zip Code Mailing Address(It efiffermt from above) usiness Phoneedcral Employer ID or S.$,Number In Rpuiin Iluemoa Some im• Aame Cnmador sea:Needier :�&Phsuondeb< ' MW M9iffintim amber po�eat exmnexem hive� ' The Contractor agrees to do the following work for the Homeowner: W and grade woe Ugn cc D4 c�� �vt3L I'e, Required Permits-The-following building pcimits are required Proposed Start and Completion Sebednle The following schedule will and will be secured:by the contractor as the'homcoivner's agent; be a ered tpuilesa circumstances beyond:the contractor's control arise (Owners who:secure their own permits will be C� / excluded from;the Guaranty Fund,provisions of / /r to when eoiitraetorwill begin contracted work. MGL chapter 142A.) /"D when contracted .work will be substantially completed.. Total Contract Price and Payment Schedule The Contractor.a grecs to perform the work famish the material and tabor specified abovefor the total sum of. M *melts will be made according to the following schedule: $ u� upon signing contract'(not•to exceed 1/3 of the total.bontract price.of the costof special order items,whichever is.gneater) S by �or upon completion of or upon completion of 0� S !�"' upon completion of the contract (taw forbids demandingfull a payment until.contract is completed to both party's.satisfaction) The following material/equipment must be special S5 be paid for ordered before theconnacted Work'begins in order S_�- to be paid for to meet the completion schedule.(*-) NOTES:(•)Including all finance charges(••)Law requires that any deposit or down-payment requited by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual con of any special.equipment or custom made material which must be special ordered in advance to meet the completion schedule. tixpress Warranty Is on express warranty being provided by thernntrad r? No (a0 terms of fie t d o the eon c Subcontractors agrees to be sol The contractor ely responsible for completion if:e work descnbed regardless of the actions-fates third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor un —f Contract Acceptance Upon signing,thus document becomes a binding contract under.law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest)ms been placed on the residence. Review the following cautions and notices carefully before signing this contract • Don't be pressured into signing the contract.Take time to tmd'and fully understand it'Ask'quesdo»s if something is unclear. • Make sure the contrast r has a valid Home Improvement Contracrar Re 'c;,•r a The b&quires most home improvement contractors and. subcontractors to be registered with the Director offlohne Improvement Contractor Registration, You may registration by writing to the Director at:One Ashburton Place,Room 13Q1,.Boston,,MA 02108 or. y mgaue about contractor 1-800.223-0933. by.ealling 617-727-3200 or • Does the contractor have insurance? Check to see that your contractor is proPealy i=um& • Know your rights and responsibilities. Read the Important Information on the' uide to the Home InVmcment Contractor Law: reverse side of this form and get a copy of the Consumer You may cancel this agreement if it hes been signed at a place other than the-contractors'normal place of business,provided you notdify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the. third business day following the signing of this agreement.Seethe attached notice of cancellation form for an explanation of.this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the epwNct must be camp, d sWw&One copy.shm dd go to are bommwnc, coPY Id be kept by the contractor. Ho wner's Signatu a!// Contractor's S lure ✓ Dau -:Date Contractor Arbitraiion The Home Improvement Contractor Law:provides;homeownets with thenghvto-initiate an arbitration action(as an alternative to court acttoia)if they have a.d spute:with a'contractor. The.same:tighf is obi'automatically afforded to a. contractor,how.ever.:..Ne..contractor;would hav6"tp resolve any,dispute helshe.has,with.a homeowner in court unless both parties agree to,the optional•elause provided below..This clause would.give the contractor the same.right to arbitration as is afforded to the homeownenby 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 aridthe consumer shall be required to s iNt to such tion as provided In sachusetts General Laws,ch l4 MOW Homeowne?s Signature Contractor's sipatuiv NOTICE:The signatures of the parties ove apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.':The homeo or,may initiate alternative dispute resolution even where this section is not s arately signed'by',the parties: Homeowner's Rights A homeowner's tights unde%th_eHome-Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(Lt.MGL c6pti f 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. Thecontractor is responsible for completing the work as described,in a timely andmorkmanlike manner. Homeowners-may be entitled to.other specific legalrights if the contractor guarantees. or provides.an.expiess warranty for:workmanship or materials. In.addition to.guarantees or•waizanties 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 whichthe homeowner and contractor lawfully agree;may be added to the. terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your co nsumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in du li e e 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,thel contractor. Any modificationto the grin]coniract 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 mgy not demand payments inadvance.of the dates specified on the payment schedule in eases where the homeowner deems him/herself to be financially insecure. However,in instances where.a contractor deems him/herself to be financially insecure,the contractor may require thatthe.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,,oi if you wish to obtain a free;copy of A Consumer Guide to the Home.Improvememt Contractor Law,"•contact: . Cgnsumer 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 ort-800-223-0933 For assistance witli informal mediation'o'f disputes or to registerformal complaints against a business;'ca12 Cojti"e Complaint'Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 The Commonwealth ofMassachusetis . - DepartmentoflndustriglAccidents Office of investigations 600 Washington.Street Boston,MA 02111 www.massgov1d1a Workers'Compensation Insurance Affidavit:Builders/ContractorsIElectritcians/Plumbers Applicant Information Please Print Legibly Name,(Business/Organization/Indivldual): Address: &-S Y� ,1y,41Y SJ ' Ci /Stat O 6 ia7 - — 6 City/.State,/Zip: �✓Yl� U 9'` � tY p. /� rt' / � �k�nc�: /�' h� 7 Are you n employer?Check the appropriate box: Type ofproject(required): 1.PTam employer with I 4. ❑ X am a general contractor and I 6. ❑New construction employees(full and/orpart-time)* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.x 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We area corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑I am a homeowner doing all work right of exemption per MGL 11.❑Plumb' g repairs or additions myself.[No workers comp. c.152,§1(4),and we have no 12, oof repairs insurance required.]i employees.[No workers comp,insurance required.] 13.❑Other "Any applicant that checks box#I mustalso fill outthe section bel6w showingtheir workers'compensationpolicy information. i Homeowners who submit this affidavit indicating they fire 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 and job site information. Insurance Company Name% #,//v Policy#or S elf-ins.LIG.#: 729/e/�5,TO 12- Expiration Date: Job Site Address-, 0_, 6S! ,,,`yF S7- City/State/Zip: ®�✓ yU '' 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 o.152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cerci . /u�ndl-er thepains andpeenallfies gfperjury that the information provided above is true and correct. - Signature: R ��cL- G [� Date: Phone#: / �� �� 7 FOther only. Do not write in this area,to be completed by city or town official. n:_ Permit/License# hority(circle one): Health 2.Building Department 3.CitylTown Clerk 4.EIectrical Inspector 5.Plumbing Inspector - - son: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,anemployeeis defined as"...everyperson in the service of mother under any contract ofhire,• 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 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 ofpublic 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),addresses)and phone numbers)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. Han LLC or LLP does have employees,apolicyis 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 printedlegibly. 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(ifnecessary)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 maybe 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 orpermit 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 Commottwea.A of M-a ssaehimotts Dop.artment o£Xndustdat,A,ccxdonts offlee of1"OstigatJiou. 600Wa.sWugtola.Street Boston,MA 02111 Tel#617-72,7.4900 ut 406 or 1-877,MA.SS.AFB Revised 5-26-05 Fay,#617-727-7749 DATE(MM/DD/YYY) CERTIFICATE OF LIABILITY INSURANCE 12/12/2011 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 CONTACT Durso & Jankowski Insurance NRH ! IncPHONE FAX Agency I (A/C. No. Ext): (A/C. No): E-HAIL 198 Mass Ave Suite 101B ADDRESS: PRODUCER North Andover, MA 01845 CUSTOMER ID#. INSURED INSUREDS) AFFORDING COVERAGE MAIC P _ Arthur Walsh INSURER A: A.I.M. Mutual Insurance Co 33758 dba A J Walsh & Sons INSURER B: INSURER C: 55 Pleasant Street INSURER D: North Andover, MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCU14ENT 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. LI19ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Lt rf TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS (M-'1{pp/YYYY) (Mf/pp/YYYYI GENERAL LIABILITY EACH OCCURANCE $ ❑COXMIERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Ea.occurrence) [In CLAIMS!1\D'n ❑OCCUR ❑ MED EXP (Any one person) $ PERSONAL G ADV INJURY $ AGGREGATE GEN'L AGGREGATE LIMIT APPLIES ER: GENERAL A $ ❑POLICY ❑PROSECT ❑LOC PRODUCTS -COMP/OP AGG $ $ AUTOMOBILE LIABILITY COMiBINED SINGLE LIMIT ❑ANY AUTO (ea accident) $ QALL OWNED AUTOS BODILY INJURY (per person) $ SCHEDULED AUTOS BODILY INJURY(per accident) $ HIRED AUTOS PROPERTY DAMAGE (per c 'dent) $ ❑NON-.;1N.D AUTOS $ $ ❑UM:BRELL4 LIAR ❑ OCCUR EACH OCCURRENCE $ ❑EY.CESS LIAR ❑ CLAIM:S AADS AGGREGATE $ DEDUCTIBLE 1:1-1 5 WORKERS COMPENSATION sraru- orx- AND EMPLOYEES LIABILITY ® xc TpRY LIH[T9 ER THE PROPRIETOR/PARTNERS/ A EXECUTIVE OFFICERS ARE E.L. EACH ACCIDENT $ 100,000 [9 ❑ incl ® eXCl 7014648012011 11/14/2011 11/19/2012 E.L. DISEASE-POLICY LIMIT $ 500,000 E.L. DISEASE-EA EMPLOYEE $ 100,000 COMMENTS / DESCRIPTION OF OPERATIONS OR LOCATIONS: ARTHUR WALSH IS NOT COVERED BY THE WORKERSMCOMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 1600 OSGOOD STREET POLICY PROVISIONS. NORTH ANDOVER, MA 01845 `rV— AUTHORIZED REPRESENTATIVE ? '/` -'\ . CS-022680 r ARTHUR J WALSH JR 159A WAVERLY RD N ANDOVER MA 01845 06/09/2014 >._. Office of Consumer Affairs&Busihess Regulation BOME IMPROVEMENT CONTRACTOR Registration: 103358 Type: Expiration: 7/7/2014 Private Corporatic, A.J.WALSH&SONS,INC. Arthur Walsh,Jr. 55 Pleasant St N Andover, MA 01845 � — Undersecretar3, - i NORTH rNo. Town OfAndover jr. Q_ �O LAN! h y ver, Mass, - , • COC NIC Nl WICK �r,9 A01?AreD Jk*' S S IJ BOARD OF HEALTH PERMIT Food/Kitchen T LD Septic System IN THIS CERTIFIES THAT �I.1 '14.. �. BUILDING INSPECTOR S has permission to erect ......1.2.......Ci4.r��'�"' Foundation .......................... buildings on .... ......... Rough to be occupied as ........ ..Xp'ermit ! ��..... ............ ......... .. ... .............................................. Chimney provided that the person acceptinshall in every respect c orm 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 Insp ction,Alteration and Construction of Buildings in the Town of North Andover. j PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN MONTHS ELECTRICAL INSPECTOR • UNLESS CONSTRU TS Rough g Service ........... .... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. IL—SEE REVERSE SIDE smoke Det.