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HomeMy WebLinkAboutBuilding Permit #890-15 - 148 STONECLEAVE ROAD 5/7/2015 ` BUILDING PERMIT o`No oT 6'�a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit Nog-;-� / Date Received o �.9 A�RATEO PPp�'�y SSACHUS� Date Issued: MPORTANT:Applicant must complete all items on this page IC�GI LOCATION QQ mt l PROPERTY OWNER GY► 1 Print 100 Year Structure yes no MAP1���ARCEL:, ZONING DISTRICT: Historic District yes no - - Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residenti Non- Residential ❑ New Building e family ❑Addition ❑Two or more family ❑ Industrial teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition, El Other ❑ Septic ❑ ell El Floodplain E-1 Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: A/s Identification- Please Type or Print Clearly OWNER: Name: 9e12 iarn Se r—b ci Phone: g15-687-,o2 y Address: S}#YI fG 1 to vC- f Contractor Name: Eric W.Pbne 78� � - --Stree>I _ - _ Address-. Salem MA 01970- Supervisor's Construction License: ._. 9-7X17-7„ -Exp. Date: �1�a23`/rri J Home Improvement License: _ t'I7�lJ y -P xp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ IOU FEE: $ y Check No.: 16 Sti 2 Receipt No.: �2q b 'y NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fud r - AAAA.... A C'- - A� r"T b - Signature of Agent/Owner " nature of contractor 1 r4 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature g COMMENTS 4 " 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 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on, site yes no _- Located at 124 Main Street - - Fire.Department signature/date 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 use) Notified for pickup Call 9 *71114- R1 t _Email Date Time Contact Name Doc.Building Pennit 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 o Building Permit Application a Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application Li Certified Surveyed Plot Plan u Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract Li Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) Li Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ol o Copy of Contract u Mass check Energy Compliance Report o 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:Building Permit Revised 2014 Location No. Date . - TOWN OF NORTH ANDbVER �\ Certificate of Occupancy $ Building/Frame Permit Fee � _ � Foundation Permit Fee Other Permit Fee $ �'k.rrcn a��t TOTAL $ Checl 0 2 ft 41 Building Inspector r 1 NORTH Andover O 0% ;=m V No. - 4 i : - y Ah ver, Mass, 0 Rc. AKI COCNICNl WICK Q ` s U BOARD OF HEALTH PER IT T Food/Kitchen % LD Septic System THIS CERTIFIES THAT .......... ., ,�, ' „•„ •', BUILDING INSPECTOR has permission to erect .......................... ulldings on .1. . ............STS. . ��,�qy.. ........ Foundation Rough to be occupied as ............ ... .L�.. ... AA .... ...,�, 1r1.�l ,t'' .. .. Chimney provided that the person accepting this permit sha 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 Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 NT S ELECTRICAL INSPECTOR • UNLESS CONSTRUCT T S 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. Massachusetts Home Im rovement Sam Ie Contract This fort satisfies ail basic requirements ofthe language to proteet honreow,ers.Seep i states Horne improvement ContractorLaw -legal advice if necessa planning (MGL chapter l92A),but does not include standard . Massachusetts Consumer Guide to Home �' Any Person lanrtirt home int improvements should 5rst obtain Office of Consumer.A$11irs and Business�Pmv�ent"before agreeing to any woik on a copy of•A ess Regtrlation's Consumer Infonnadon Hotline at 67 7913 8787 You may obtain a free copy by W U g the $omeowner Information or 1,888-2833757 or an our a-ebsite. \am Contractor Information Compam-\ame Street Ad do not use a Post Office BMX addtess /f A Contractor/SalespLLC orsontOwner?Vame ] pq City/fours State " [fid Zi Code BusinessAddrea (must include a street address) Da}4ime Phone - Erening Phone Cityffona Slate Zip code Llaiiin�Address{It diffvetn from above) Business Phone Federal1 EmP overID orS.S-Number �+*eegatm eta most rmeae a0m` O".3O3 Coutrartpr[--xnb� emp�ewneraaon tare - EV+�ndse - The Contractor agram araed.�heru+m n®tQ grass M do the following work for the Homeowner. (Describe in detail the nar1:to corn 1 P eted,specifying the type,brand,and glade of materials to be used,ed.to additional sheets if neecssa ,) q9 Required Permits-Toe followingbuildintr 9-15 and will be securedby the contractor as the homeo�vAers agent be adhered to unless re pissed Start and Completion Schedule -The following schedule will who securetheir own permits evil!be "urc10Sta°0e bed the cot, excluded from the Guaran yO° tractat's control arise MGL chapter 142A.) �`Fund Provisions of ,� Date Mien contractorwil)begin contracted%vo& Date when contracted uvdt trill be substantial) Total Contract Price and PnymentSchedule Y completed. The Contractor agrees to par('pnn the uv t,- ' r ,furnish the material and labor specified above for the total sum Pav'm7enn(ts�u�illbbe made according to the followingschethil, of ��f, + 1•� ,—W—V --upon_upon signing contract(not to exceed 113 of the total contract price or the cost of Sb}, / f special order item;whichever is greater) or upon completion of SJ—=� by / or upon completion of '' D.FQ 'J upon completion of the contract. {1.1111 forbids demandin g full Pa cot until contract is completed to both party's satisf11txien) The toNm�ing materiaUequipment must be special ordered before the contracted aur)begins in order s — paid for to meet the completion schedule(•sl ' S to be paid for 'VOTES:(s)Including all finance chary (ss)Lzw requires that am, not exceed the greater of(a)one-third ofthe total contract price or b)the m.Yoalor ent required by c11 which must be special ordered in ad cost of ntrapm before nark bt4nr ma} advance to meet the completion schedule- special equipment or custom made material s ress wa ntv.1s an Subcontractors- narrants Nein r vided b•the con m tar? Q No 07.1 all terms of the+vamrnty must he arm The contractor agrees to be solely responsible for completion of the work desrn3ed Part}/subcontractor utilized by the contractor- The co ed tot a rontract arerial an !hoc m this "-fintheragrees to be sole i citta actions of any third Contract Acceptance-U on signing, t h responsible for ail payments to all subcontractors Far contract shall not imply that anyLmmg tots document becomes abenbinding contras under law.unless odtenvisc noted within this doc carefully before signing this contraen or other security interest has been placed on the residence.Review the foflotvin whit the g cautions and notices • Don't be pressured into signing the contract Take time to read and full-and • Make sure the contractor h a valid Home Int Y erstand it Ask questions ifsomethia subcontractors to be rovemeW Contractor Registration. The hot fits unclear. registration by�tritin to the� toe lore—of Home Improvement Coattactor R tri roar home improvement contractors and g actor at i0 Park PI egi�rdtitm_You may inquire about contractor • Does the contractor have insurance) �Room SI70,Boston,MA 0211b or see a copy ofa`�rroofof insnrda1ce do k that ontractor forhis inswmcecorn by calling 617-973-8787 or 888 283 3731. • Pent information so that you can confirm coverage,or ask to Know vow rights and responsibilities.Read the Important Information on the reverse side oftltis form and Guide to the Home Improvement Contractor Law. get a copy of the Consumer You may cancel this agreement if it has ben ro gdataplaceotherthanWeconnactorsnorma( third business day following the si branch office by ordinary ost b Place ofbusiness,provided you notify the fining of this agreement See the attached notice f t�ncelan farrri for asmt or by n r not later titan midnight of the serit DO NOT SIGN THIS CpNI RACT .t explanation offhis right 7wn idrotiW eopss oCthc contra mem 6c •1r+1>�e ARE A j�iy$LAt�iv r� aompiaoaandsk_d-tAee�'slenatdgoto hamcounctheotha BLANK Sp t .., w cOW shanid be Lips - Homeonuer 'ignature Contractor's Signature Date 3 � Date i i Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would gave the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the, hereby mutually agree in advance that in the event the contractor has a dispute cbricer tbk46 ctor may submit the dispute to a private arbitration firm which has been approved by the eu��e Office of Consumer Affairs and Business Regulation and the consumer shall be required lc to subnut.to such ,arbitration as provided In Massachusetts General Laws,chapgRkl42A. 1 '° , r Homeo� is Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. i Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(Le.MGL chapter 93A)may not 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 lay. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described.in a timely and worlanarili a manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may 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 consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted;or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of fimds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work Withdrawal of fiords from said account would require the siinratures of both parties. Additional Information if you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement" contact Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Part:Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at .mass.so.:'ncaL•L 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 Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston MA 02116 617-973-8787.888-283-3757 or visit the HIC website at hap::'r «.crass: iocabr/ Go online to view the status of a Home Improvement Contractor's Registration: ttr,:i'dc_seste.rna.us{troreinnmrearer..tt7icenseelist.asn . For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section " Office of the Attorney General 61-7-727-8400 AND/OR Better Business Bureau 508-65211800,508-7552548 or 413-734-3114 version Z1-1IMP-olo Contractor Arbitration The Home improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor-however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the-same right to arbitration as is afforded to the homeowner by the Home improvement Contractor Law. The contractor and theome9)+Aei hereby mutually agree in advance that in the event the contractor has a dispute c`onccetiillr § aiac th crltractor may submit the dispute to a private arbitration firm which has been approved by ket u fire Office of Consumer Affairs and Business Regulation and the consumer shall be requued the; l T v to submit to sack bitraogn as provided In Massachusetts General Laws,cha 142A. .ri za4%. , f Homeo� s's Siguat Contractor's Signature \OTICE: only to the agreement of the parties to alternative dispute The signatures of the parties above apply resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter I42A)and other consumer protection taws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement However;homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and worIonanfike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree maybe . added to the terms of the contract as long as they do not restrict a homeo-miees basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced ot to sign the document until all blank sections have been documents have been attached. Parties are also advised n filled in or marked as void:deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties ha%T received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds notyet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Massachusetts Consumer Guide to Home improvement" contact Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park PIaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 orvisit the OCABRwebsite at i:ltr:hi;lt,; cafr 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 Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,898-283-3757 or visit the HIC website at:rtru:' =���:mass�o�°tocabr! Go online to view the status of a Home Improvement Contractor's Registration: {r.:!ldiS=3't�.7u.lLl;?(31e1Ci7i7e"lro�"Llill'i?r!�1l'CnSe�11St:��T1 For assistance with informal mediation of disputes or to register formal complaints against a business.call: Consumer Complaint Section - " Office of the Attorney General 617727-8400 AND/OR Better Business Bureau 508-652-48001 508-755-2548 or 413-734-3114 Version?.1-11r-1'2010 The Cofnimonwealth of MassachusettsPrint Form Department of Industrial Accidents - - - y; ' - : � Office of Investigations 1 Congress Street, Suite 100 :_' Boston, MA 02114-2017 www.ma Workers' Compensation Insurance Affidavit:SBov/dia A licant Information Builders/Contractors/Electricians/Plumbers Nance(Business/Organization/Individual): Atlantic WeAo[" Uvt,, Please Print Leaibl Address: ° SR1em;MA 01470 City/State/Zip: Areyo n employer?Check thea phone#: g7 9--71-0/-944/3 appropriate box: 1• am a employer with_Z�c 4. I am a general contractor and I Type of project(required): employees full and/or or art-t' have 2.❑ I am a sole proprietor oppartner--) listed hired nthe the sheet. 6. �New construction ship and have no employees These sub-contractors have Remodeling working for me in any capacity. employees and have workers' g' E]Demolition [No workers'comp.insurance comp.insurance.' 9. ❑Building addition required.] 5. [� We are a corporation and its 10.[1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their myself.[No workers'comp. right of exemption per MGL 11'0 Plumbing repairs or additions insurance required.]t c. 152, §1(4),and we have no 12 ❑Ro epairs employees. [No workers' 13. Other ��y� comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicati $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. ng such. I am an employer that is providing i workers'compensation insurancefor my employees Below is the policy and reformation, job site Insurance Company Name: 47 r ' Policy#or Self-ins.Lic.#:_ Expiration Date: j Job Site Address:_ �h2 .Q r I ea ve. (�,1 City/State/Zip: Attach a copy of the workers'compensation policy declaration page N �^ `�� Failure to secure Covera p g (showing the one num e e her a11 xPir t' g as required under Section 2SA of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one imprisonment as well Of u as civil penalties in the of a STOP p to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded the Office Rand a fine Investigations of the DIA for insurance coverage verification. I do hereby cerci u rte a' t ttls,and-enirlties of erjuq that the information provided above is ue and correct Si ature: -w � t4?� Date 6P Phone#: 7,77ley,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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: Rightfax N2-1 3/10/2015- 10:11 :37 AM PAGE 7/013 rax z)(,rvci TE AC& CERTIFICATE OF LIABILITY INSURANCE 03-10 -2015 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 poticy(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 endorsoment(s). CONTACT PRODUCER NAME: EASTERN INS GROUP LLC PHONE FAX A/C No Eat): No): 233 W CENTRAL STREET E-MAIL NATICK,MA 01760 NAIC# INSURER(S)AFFORDING COVERAGE INSURER A:AMERICAN ZURICH INSURANCE COMPANY INSURED INSURER 8: ATLANTIC WEATHERIZATION LLC INSURER C: 61 REAR JEFFERSON AVE SALEM,MA 01970 INSURER D INSURER E ' INSURER F: E NUMBER:COVERAGES CERTIFICATE 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 PEFjiTAIN,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. ADO SU POLICY EFF POLICY EXP LIMITS INSR LTR TYPE OF INSURANCE MSR SUB POLICY NUMBER YY WDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES lEaQccusien CLAIMS-MADE❑ OCCUR MED EXP(Arty onepersnn) s PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE b GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S $ POLICY JEECCT n LOC IMBINEO SINGLE LIMIT t AUTOMOBILE LIABILITY Ea acadent ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS R AUTO AUTOS NOWOWNED OPE AMAGE S HIREDAUTOS $ 4UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE US OED I I RETENTION$ $ WORKERS COMPENSATION X VdC STATU- OTH- AND EMPLOYERS,LIABILITY TORY LQu11TS ER ANY PROPRIETORIPARTNERIEXEtUTIV Y/N E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? N N y A 6ZZUB 03-20-2015 0320-2016 S.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory in NH) 5B270121 It yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(Attaeh ACORD 101,Additional Remarks Scheduls,it more space is required) HOLDER WN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE TOWN OF NO TH CANCELLED BEFORE THE EXPIRATION DATE THEREOF, N. 0 OSGOOD S 01845 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD ACOREPCERTIFICATEDATE(MWDD/YYYY) OF LIABILITY INSURANCEF3/3/2015 THIS CERTIFICATE 1S 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 NAME: Construction Eastern Insurance Group LLC PHONE (800)333-7234 Fax 233 West Central St EMAIL a o: D i Natick NA 01760 INSURE s AFFORMNGCOVERAGE NAIC9 INSURED INSURER AArbella Protection Ins. Co. 41360 Atlantic Weatherization INSURERS Nautilus Insurance Co 61 Rear Jefferson Avenue INSURER c: INSURER 0: SalemINSURER E: PSA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER:tWTER 2015 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 A S LTR TYPE OF INSURANCEam POLICY NUMBER POLICY EFF POLICY EXP GENERAL LIABILITY MM/DD MM/DO LIMITS EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMA RE A CLAIMS-MADE PREMISES Ea occurrence $ 50,000 X OCCUR 500042816 /20/2015 /20/2016 MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS-COMPIOPAGG $ 2,000,000 AUTOMOBILE LIABILITY $ COMBINED SINGLE OMIT ANY AUTO Ea dent 1 1,000,000 `� ALL OWNED SCHEDULED BODILY INJURY(Per person) $ X AUTOS X AUTOS L020015871 020015871 /20/2015 /20/2016 BODILY INJURY(Per accident) $ HIRED AUTOS X AUTOS PROPERTY DAMAGE Peracadant $ X UMBRELLA UAB X PIP-Basic $ OCCUR EXCESS LIAB EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE AGGREGATE DED RETENTIONS 600058654 $ 1,000,000 /20/2015 /20/2016 WORKERS COMPENSATION $ AND EMPLOYERS•LIABILITY WIC STATU-YIN OTH- OFFICER/MEMBEANY R�EjCLUDED?ECUnVE❑ N!A ` (Mandatory in NH) E.L EACH ACCIDENT $ If s,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B POLLUTION LIABILITY BL200378613 0/1/2014 0/1/2015 GENERAL AGGREGATE $1,000,000 EA POIlUT10N CONDITION $1,OOQ,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE John Roegel/PMA INS025 r�ntnn5i ni ACORD 25(si 5) ©1988-2010 ACORD CORPORATION. All rights reserved. M Tha Arnion norma and Innn gra raniatararl m2rlre of ArnRn 1 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Super%isor License:CS-087977 ERIC w PALM 3 H MTON ST Salem MA 01970-- "10L 1970 . Expiration Commissioner 04/23/2016 Office of consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR >' istration: 142089 Type: K expiration: 311212016 Ltd Liability Corpo- ATLANTIC WEATHERIZATION L.L.C. 3 ERIC PALM 61R JEFFERSON AVE SALEM,MA 01970 Undersecretary