HomeMy WebLinkAboutBuilding Permit #123-16 - 148 MAIN STREET 7/29/2015 BUILDING PERMIT NORTft q
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
—Ice o
Permit No Date Received "
SgcHus���y
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
� Print
PROPERTY OWNER 2
Print 100 Year Structure yes J
MAP04PARCEL: L ZONING DISTRICT: Historic District s Machine Shop Village yes
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
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer '
DESCRIPTION OF WORK TO BE PERFORMED:
LiacP Z,) i Av C) c) I.J S /CSD _C04t'kcdaytct,� �A
Idem' ication- lease Type or Print Clearly
OWNER: Name: Q N' oP2 Phone: 97��1v�.2 � ✓'✓�
Address:
Contractor Name: �J^Iw49 010 PIA^ Phone: &1 -71G C� D �1 2,
Email:
Address: o or, ,9S r ��
Supervisor's Construction License: D�l'D/ � Exp. Date:
Home Improvement License: /70 Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ /02, ���• Oy FEE: $
Check No.: $0 3Z Receipt No.:NOTE: Persons Persons contracting with unregistered contractors do not have access"e guaranty fund
9�ature gent/owner -lee Obry!'
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning 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
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
r
w Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Wafter& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
;FIRE DEPARaTiME NtT, TenlpDumpsterontsite: Lykes
Ifvb atedLdtwo2;4(Main#Street �----
°.Fine:€D'epartmeritas�gnafure%date
COMMENTS. ,
i
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)
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
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
:rF Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Permit Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
Building Permit Application
Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:Building Permit Revised 2014
Location�7'� /7 5V7
No. ' " Date
. - TOWN OF NORTH ANDOVER
EDI
•
Certificate of Occupancy $ .�
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
p: TOTAL $_ r
Checka
i % B156ding Inspector
NORTH
Town of 1 EAndover
No. 3 ��6 * t -
a
h ver, Mass, oZ
COC»ic»!WICK A.
�d AERATED
S
U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT ..... .C�......... ............................................................................. ........
r ,
Foundation
has permission to ere.$t ....... .................. buildings on ...../(14Lf....M-4.14......5'x......... :.......
Rough
Taal to be occupied as . ...A-0t... 1_...&-J-�-nA'of .......7®.... Rehe
��...!.... Chimney
provided that the pe n cepting t s.permit shall in every respect conform to the terms opplication Final
on file in this office, and to the provisions of the Codes and By-Laws relating t the Inspection, Alteration and
Construction of Buildings in the Town of North Andover. 0 PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
1536 UNLESS CONSTRUC S TS Rough
Service
.......... .. ..... .... ...... .......................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. - Burner
Street No.
Smoke Det.
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30 Forbes Rd.
Northborough,IA,01532
Phone(508)351-2733 f
FOX(508)985-7477
Webatso;x�vw.reaewalb nderscacom "
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IRenewa
bYAndersen. - MA Home Improvement Contractor
WINDOW Rap"'-- ,"A�,,��„- Renewal by Andersen Corporation License#170810(Expires 12/23/2015)
."Y
30 Forbes Rd. Northborough,MA 01532 Federal Tax ID#41-1918413
(508)351-2200 Fax(508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
Buyer(s)Name
Date:
STEPHEN COTTER - ROSE DELUCA
Bu er s Street Address Cit MAY 5, 2015
State
Zip Code
148 MAIN ST. UNIT K 112
Email Address NORTH ANDOVER MA
Home Tele hone Number o 1845
Work/Cell Tele hone Number
NONE 978-682-8955
Buyers)hereby jointly and severally agrees to purchase the goods'and/or services of Renewal by Andersen Corporation("Contractor"),fin accordance with
90
the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this"Agreement").
90
Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement.
Total Job Amount $ 12,724mount Financed$ 0 Est. tart Date Method of Payment
Deposit Received(33/)$ 4,241.33
� Deposit at signing$ 0.00 Check/Cash
Balance Start of Job(33%)$_ 4,24i.33 8-10 weeks
Balance on Substantial At Substantial Est Install Time Check#
Completion of Job(33%)$ 4,241.33
Completion$ 0.00 V Credit Card
No final Payment shall be demanded until all panies are satisfied 1-2 days
If credit card is selected,please
see Credit Card Payment form
Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings
changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed,written consent A
of both Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has
received a completed,signed and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first writt
orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. en above and 2)was
Renewal by Andersen Corporation
77�� 7� \puger(s) Buyer(s)
By: ,[7r� L�CCKi �,v'
Signature of Consultant
Signature
X BRUCE PECK Signature
Printed Name of Consultant STEPHEN COTTER ROSE DELUCA
Printed Name
Printed Name
YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.
SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.
------------
-I-----------
NOTICE OF CANCELLATION
---------------
ELLATION --
OF CANCELLATION
Date of Transaction I
5/� 5/I5�. You may cancel this I
transaction,without any penalty or obligation,within three business days from the I Data of Transaction 5/5/15
above date.If you cancel,an ro e i transaction,without any penalty or obligation,within ti, You may cancel this
Y P Property traded in,any payments made by you under 1 above date.If you cancel,anproperty three business days from the
the Contract of Sale,and any negotiable instrument executed by you will be Y P P rty traded in,anpayments
returned within 10 days following receipts the Contractor d eller") of ur I the Contract of Sale and any negotiable instrument a ected b made will
you under
cancellation notice,and any security interest arising out of the transaction will be I Y you will be
Yo I returned within 10 days following receipt by the Contractor("Seller") of your
canceled. If you cancel, u m cancellation notice,and any security interest arising out of the transaction will be
You most make available to the Seller at your residence,in I canceled. If you cancel,you most make available to the Seller at your residence,in
substantially as good condition as when received,any goods delivered to you under
this Contract or Sale; or you may,if you wish,comply with the instructions of the 1 substantially as good condition when received,an
elivered to you
Seller regarding the return shipment of the goods at the Seller's expense and risk. I Seller regarding the return shipment of the goods at the Selley goods r's expense ti and risk.
If you do make the goods available to the Seller and the Seller does not pick them u I If Contract or Sale;or Ymay,if You wish,comply with the instructions of the
within 20 days of the date of your Notice of Cancellation, u may p, You do make the goods available to the Seller and the Seller does not pick them up
of the goods without anIf you fail to Yt y retain availablee the goods dispose 1 within 20 days of the date r your Notice of Cancellation,you may retain or dispose
to the Seller,or if you agreeertoo returngthe goods to the Sellertand fail to do so the1 to the goods without any further obligation.
goo
go. If g
you remain liable for performance of all obligations under the Contract. To cancel g You fail to make the cods available
1 to the Seller,or if you agree o return the ods to the Seller and fail to do sohe Contract. ,then
this transaction,mail or deliver a signed and dated copy of this cancellation notice
or any other written notice,or send a telegram to Contractor:Renewal by Andersen,1 or any other hwritten notice performance
send a telegrams o Contractotions under r; c Renewal ti nn of en,
cancel
I this transaction,mail or deliver a signed and dated copy of this cancellation notice
30 Forbes Rd. Northborough,MA 01532.
1 HEREBY CANCEL THIS TRAM 1 30 Forbes Rd.Northborough,MA 01532.
SACTION, I
I HEREBY CANCEL THIS TRANSACTION.
Buyer's Signature I
PrIM Name
Date 1
1 Buyers signature
Print Name Date
Renewal Renewal b AAndersen Corporation
byAndersen. 30 Forbes rd Northborough,MA 01532 MA Home Improve1_191
ontractor
WINDOW REPLACEMENT , tLicense#170810 (Exp /23/2015)
(508)351-2200 Fax:(508)-986-7072
Bu er s Name
Window Specification Sheet Federal 8413
STEPHEN COTTER Date of A reement
ROSE DELUCA TUE, MAY 5, 2015
The buyer(s)listed above t and the
irontly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described
on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,of which
the Specification Sheet is part. i
WINDOW&DOOR DETAILS
Room App- Ap. Aapx Exterior interior s width he ht U.J. Window/Door St Is Detail Color Hardware Hardware LowE4/
Casin s Ext-Int Color Grille Grille Glass
Famll 101 29 47 le Screens Smartsun Grilles Sash 1/3 Sash Lifts O dons
76 DB s rail a ual insert slo etl sill Sto s H/W White
Famil 102 29 47 76 Standard FFG martsu INTW 3/2
DB s rail a ual insert sloped ed sill Sto s 3/2 Yes
Lwin 103 29 47 76DB---'-- H/W White Standard FFG martSu INTW 3/2 3/2 Yes
riual insert slo ed sill Sto s
H/W White Standard FFG manSu INTW 3/2 3/2 Yes
Livin 104 29 47 76 DB s rail a ual insert slo etl sill Stops Uvin 105 29 47 76 DB s rail equal insert slo ed sill HNV White Stantlartl FFG martsu INTW 3/2 3/2 Yes
Sto S H/W White Standard FFG martsu INTW 3/2 3/2 , Yes
Livin ]06 29 47 76 DB s rail a Lal insert slo ed sill Sto S
Bed 1 107 29 47 76 DB s rail a ual insert slo etl sill Sto s HNy White Standard FFG martSur INTW 3/2 3/2 Yes
Bed 1 10829 47 76 DB s rail a ual insert sloped ed sill Sto s HNy White Standard FFG martSu INTW 3/2 3/2 yes
H/W White Standard FFG martsu INTW 3/2 3/2 Yes
Total 8
BAY BOW&BUILD OUT DETAILS
Style Detail/ APProx
Room Count le Flankers width/ APProx. Number Frame Window
Casin s An Is Lites Interior Ext/Int Color End Center LOWS/ Roof/ Hardware
Grilles sashes sashes Screens smartsun Soffit Color
SPECIALTY WINDOW DETAILS
Room Count S Is Inslert Approx. LowE/ Specialty BAY/BOW ADDITIONAL
U.I. SmartSuo Grilles Grille S Is WORK NOTES
Extent Color Customer is aware that with ba/bow windows under 72 inches
there will be si ificant lass lose.
ADDITIONAL WORK DETAILS:
RBA will remove and re lace shades as needed to a install and is not responsible for damn e.
I No Contractor will wra0 exterior casings with Coil stock color of
Owner is aware that Contractor does not do an g g
the homeowner to have the alarm system and window treatments/hardware removed prior to installation. We make no guarantee as to whether alarms or window
y parotin /stmen or n=moval/installation of alarm system or window tn=atments/hardware.It is the n=sponsibility of
2 treatments/hardware will Tit after replacement. Customer is also aware in some cases there will be glass loss. /f there is,the amount will be dependent on the type
of existing windows,type of installation and window style.We make no guarantee as to the amount of glass loss.Customer is aware and understands any and all
unseen rot is not included in this contract.Should any rot be found there will bean additional charge for time and materials unless so stated in this contract.
3 Yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.Removal and disposal of all job related debris,
windows,doors,storm windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued.
4 Yes Building Permit--Contractor will secure any and all necessary ry permits. The fee for the permit(s)is included in the total contract price.
Yes All discounts have been applied to this agreement.
6 ✓ Yes No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s).
It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM
WINDOW AND DOOR REMODELING AGREEMENT,constitutes the entire
understanding between the parties,and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in
any way unless such changes are in writing and signed by both the Buyer(s)and Contractor. Buyers)hereby acknowledge that Buyer(s)has read this Specification Sheet.
Renewal by Andersen Corporation
�(V\ Buyer(s)
BY Brtzz P66 1
Signature of Consultant
Nuyer(s)
BRUCE PECK Signature
STEPHEN COTSignature
Print Net.. TER e of Consultant ROSEDELUCA
Print Name
Print Name
RenewalJ�,
rr�r
Nrkc: § bya �Y leder sen. r'%'
{4 WINDOW REPLACEMENT Pm AftdemaCompTn,4„
WoodAlirryl Composite IF
n3: rte:F3!c' Dual Argon Low E4 SmartSun
3 w"iii il:fCi> 3
Double Hung
100-00473518-010
ERERGY PERFORMANCE RATINGS
U-Factor(U.S)/I-P Solar Heat Gain Coefficient
U a: 291
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
Ott
� 4'2'
Manufacturer atiputates that these rungs conform to appfi-abk NFRC procedures for determining whole product
performance.NFRC stege are determined for a fated set of environmental conditions and a specific product sae.
NFRC does not recommend any product and does not warn the suitability of any product for any specific use.
Consul manufacturer's 0erature for other product peAormance information.
1�AWWW.nitb.oIII
The product meats Olsen
Seafs environdrental tMMq , ,y3�- -:,.,m
statldnrds governing anergy �•�^�.j... r�^L.
efficiency,Many metals in
M frame and aatA +ft, h�"!•z7:. •�
material.pactmging,and 0:••..,..y-.p`,'�\'`+�<"y';
YM consumeradugliorial a
0.a.♦R0. 'r':{S:+l::{qr j.
i
�y matereek. .w v.a. •sn�--„ �'"'<1-f
DESIGN PRESSURE(PSF) Im
a w w ana osa
xmwfaeltrers/ssocbuon
.. RbA DB Sloped Sill DH IN
iaMeO lonAfSMaANdMWNNCSAtOtASrM1tWS MarsilxUars tact wrtarmarweta ttea finblt stan0artn.
leets or exceeds M.E.C.,C.E.C,L I.E.C.C.Air Infeluation requirements WENA Hallmark CedOC-ation Program.
.. r
The Commonweaith of Massachusetts
Department oflndustrWAccidents
Office of Investigadons
1 Congress Street,Suite 100
Boston,MA 02114-2017
www massgov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Aanlicant Information Please Print Lesibly
Name (Business/Organization/lndividualy RENEWAL BY ANDERSEN
Address:30 FORBES ROAD
City/State/Zip:NORTHBORO, MA 01532 Phone#:508-351-2200
Are you an employer?Check the appropriate box: Type of project(required):
]. ■� I am a employer with 30 4. 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).' have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling
ship and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. employees and have workers' q
[No workers' comp.insurance comp.insurance.# ElBuilding addition
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their ]l.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12, Roof
rs
insurance required.]t c. 152, §1(4),and we have no ❑ �
employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that decks box fl must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they ace doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that aback this box must attached an additional sheet showing the name of the sub-convactors and state whether or not those entities have
employees. If the sub-contrwims have employees,they must provide their workers'comp.policy number.
I
lam an employer that Is providing workers'compensation Insurance for my employees Below is the policy and job s&e
Information.
Insurance Company Name:OLD REPUBLIC INS.CO.
Policy#or Self-ins. Lic.#:MWC 30293800 Expiration Date:10/01/15
Job Site Address: 148 Main ST. Unit K 112 City/State/Zip:North Andover, MAO 1845
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$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.
I do kereby eer16 under the pains and penalties of perjury that the itnformatlon provided above is true and co
SiwiaturL
Dat �� —� rre `
Ph
-moa
OjYkial use only. Do not write In this area,to be completed by city or town offWal.
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#:
I
ANDECOR-01 YADAVYO
'4 CERTIFICATE OF LIABILITY INSURANCE 1011120 4 n
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 corder rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT certlflca ills.com
W11119 of Minrm^Inc. PHONE F . 888 487-2378
c/o 26 Century Blvd Mr-N E>d:(6�945-7378 Ne
P.O.Box 305191 Amoss,
Nashville,TN 37230-5191
INSURER(S)AFFORDING COVERAGE NAICN
INSURER A:Old Republic Insurance Company 24147
INSURED INSURER B:
Renewal by Andersen Corporation INSURER C
30 Forbes Road INSURER D:
Northborough,MA 01532 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AWL OR
TYPE OF INSURANCE
Im POLICY NUMBER (WIDDlIffm LN1BT8
A X COMMERCIAL GENERAL UAMLITY EACH OCCURRENCE _S 1,000,000
CLAIMS-MADE a OCCUR NWZY302940 10101!21114 1010112015 PREMISES occurrence $ 600,001
MED EXP(Any one person) 3 10,00
PERSONAL&ADV INJURY 4 11000100
GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00
X POLICY 7 JECT LOC PRODUCTS-COMPIOPAGG $ 4,000,00
OTHER: 4
AuroMoenJ<LIABILITY C1a accaa,t $ 5,000,00
A X Am AUTO NVVM302575 10/01/2014 10/0112015 BODILY INJURY(Per pwwn) s
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per aoddwM 4
HIREDAUTOS �0 � E s
4
UMBRELLALUU3 OCCUR EACH OCCURRENCE 4
EXCESS LIAR CLAIMS-MADE AGGREGATE 4
DED RETENTION S $
WORKERS COMPENSATION X STATUTE
AND EAM�LOY F LIABILITY ER
A ANY PROPRIETORIPARTNERIEXECUTIVE YIN MWC30293500 10!0112014 10/0112015 E.L.EACH ACCIDENT $ 1,000,00
OFFICERNEMBER EXCLUDED? N❑ NIA
(Mandrdory In NN) E.L.DISEASE-EA EMPLOYEE 1,000,00(
Kdesaunder
DESCbe RIPTION OF OPERAI IONS bdlow E.L.DISEASE-POLICY UMIT S 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addtbml Ramarb SchadrAe,may be ettedwd N mon specs Is requWQ
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZ DREPRESEiTATIVE
Evilidence of Insurance
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supen-iwr
License:CS-09012b
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JAIML L MORIN,
86 GARDINBR ST �fV.-VV.
LYNN MA 01905
Expiration
.fwCommissioner
mplemimcn � 10/08!2018
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fhce of COasamer Affairs&Basiaess ItMal:6on
IIMPROVIONENT CONTRACTOR
ReQlstration: IMilt) TYPe i
ExPlration: 12/2312015 Supplement 1,
RENEWAL BY ANDERSON CORPORATION
,
JAIME MORIN :3
104 OTIS STREET t,
NORTHBOROUGH,MA 01532 moo. ;
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