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HomeMy WebLinkAboutBuilding Permit #832-15 - 1483 SALEM STREET 4/22/2015 LF ���TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page I LOCATION . . - not PROPERTY OWNER ,. _ w ,.a Print 100¢Year Old Structure yes no, MAP NO� _sPARCEL: ZONING DISTRICT a H.istonc District yes no _ Machine Shop Village ye - _ TYPE OF IMPROVEMENT. PROPOSED USE Resideial Non- Residential ❑ New Building R015ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑'Septic 0 Well � D Floodplain [I Wetlands o Watershed District. DESCRIPTION OF WORK TO BE PERFORMED: }y� S Identification le se ype or Print Clearly) r g - OWNER: Name. S a7 Phone:97� 3S 3/ sl Address: t'I 3 Ste./z/'.-, f CONTRACTOR' Name z-= ic W- ErPalm - -- Phone_ � N' _- 3 Hilton Street _ Address: Salem 9&01970- Su- 0197 s Su- rvisor's,Constructioii License. ? _'7 -7_ _.. _Exp: Date: = t - - Home Irpprovement License: ar.�I ZO�l _ _ Exp 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: $ o� UU FEE: $ �'�C Check No.: 104 l q Receipt No.: NOTE: Persons contracting 'th unre �' tere o tractors do not have access to he guaranty f d *+r-wry-�•�ie�f,"nL...°'�J _ Signature�;�of Agent%Qwnerr , _ __ _ n T.Iga^afure,of co_ntractor,- � � w.._»x Plans Submitted As Plans Waived ❑ Certified Plot Plan, Stamped Plans ❑ Building Department -'`rhe following it,a' ist of,the required-forms to be filled out for:the.appropriate.permitto.be obtained. Roofing, Siding, Interior Rehabilitation Permits 1 u ` Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.1.C. And/Or'C.S.L. Licenses o 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 o Building Permit Application Li Certified Surveyed Plot Plan Li 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) 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) ❑ Building Permit Application Li 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 o 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 was ors special permit required the Town Clerks office must stamp tlie•Aecision from the Board of Appeals P P that the apwal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.sted with the building application i Doc: Doc.Buhding Permit Revised 2012 Location 1 ! �e' 17"14- No. Z,,y Date �Z f . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee7 Ell Foundation Permit Fee $ w, Other Permit Fee $ TOTAL $ Check 4t 6�t 2 Ci 6 Y,7 Building Inspector NORTH Town of � � ^E 1, Andover O No. 42 C% h ,h ver, Mass, 14 COCMICKl WICK �� AOR�1TE0 1P5 S V BOARD OF HEALTH Food/Kitchen T LD Septic System A THIS CERTIFIES THAT .....PERR bv%ft (tot BUILDING INSPECTOR ............. . .......... .................................. Foundation has permission to erect .......................... buildings on ... .....S-Itlf-14....� � .e............... Rough to be occupied as ..1 + ....�r rw�. �� ... �.�.,.�.. ...�Y.�ej . ............... Chimney provided that the person accepting this permit shall in every respect confor 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 MONT S ELECTRICAL INSPECTOR UNLESS CONSTRUCT T S Rough Service Al ...................................................... 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. Tltisiotm satis&esa))boric ptvtecEBo ' eatsoftbe +�fassxcbusenssrimae OFttceaFCansCoOguaterWda utq� toli� ladvioeiFneeesaAny ,Ian-(DdGi ch2oteri=� °god wt'b P °np> Rhomcimpt>n �1 bardotsaoci�m �IaaleaSt�etIafa eibreaere�gtoaag onjurrmdence Yon onld O a ` _ t7a8I]oa �Qr`tte` °Tn�auRa�i at toaFob `Of 1► I7�73-8787 ar 1•EtSBabySihe / Coatraerorinforn� as Sys ti � : i dr4l a 3 >ues masad- C' IOtt" �H-1 �Centtxeto�`ra1sA` /1/• S'a'e2iA c' "' �n.PhoneaGnes+irtct(, §��l �e q7$- ,335°3% e j pI4?0 �tx3fin'dddma Rt di '/ �Curr3ana ftm sceve3 Sate rrA Coda - �CsinessPaane .. _ �ede'at Er°?IcrerM ars ��amt�� c�r'�� The Conrtaetorot � t / „ _(,Q R -mss rDe3crieein 3'>�todothe{oIl mt� / IG(, dept[[ket�mwmptct�°A'��orkfortk@i�otneotrner. ��n9tlteiccp�tumstLaad 3+adcaf r+Sxai'sto� Required Pe��_ � andnzllbe Thefollmsong1nn7dv► seeutedbythc gr mitsete (4traer�•hoSecttre��ctorasUteh° PrnPosxdStartandCom eactuded from t heirfl m�neisaewt h="��d to iheG�;:a :r _ mScbhedute-rnefoAotsatgs� JIG cha aad ess EYond the contractoPs. A rI A.J Pr'avisions of coanol Date when contract M beam�tixcted Tat n a1 Con nactPrtMI Z Dare Tne COoomctormerees to d Pa}meatSchednte men contracted morfi x$I be PecEorm �tbstattialla then '�+.Fmntsh the -completed. Pa}+mems I'll bemadeaxotdineaudlabor_ totireio!lmvine `7teciTedabat�fm-�ero►�swIIo� S7(�� �sthednle; - np0n Siplt,j S =`>tact([[ottoet It;ofthetotalcoanmctpim or - 5 =` tic K upon completion of otaerhe"viliucheverisviliaal 5, /�..,tL �/upon comPteDon of. a.I L1(��upon cotopletion oFtbeComilt 7hetallouingmy�Q�Fmmt�� (L."'Forbi05 dsdemau anlcb-Ton ' ed tobo tnoRlOWpl tbPan}'� [rte S dL_ tj)��__ tom�ttheeaypw° Ir �x+aSlnardC S connacrisC _�' [Ob6Patditrtt9nf T1 s:tit bur / tib s .TlFinancech bPy or resichatemi Ordioni n t aelnm oarderedtned%= hheaa''•etP+rcearlb)the caaircon-ihecamir to [ef coaofarc q`�'cba l• ErnrcrsrCarrnrt WmolepprtyrhedutG SPeeiategtdFmcatar Subcontro ars -an e; �owe 7iae"� rtantc rnvi P,'rh/subcon �stttrr zgrtp b_ nth raetor4❑r feria[ umaor un7izec bg the cank etor,sotetr�onsr7tl@ far °❑Y an r...ate aF he ' sand taborvn tbeiroP; tory Contract? er 7becoor2UarftarbPletioo of cceo ta°ce- to basal r��rdtess of °a`t' rn t cammnen lfooa siarBed canmctJtaltaothnPl• S.thfsdoeumwr Pansi6leForeu *e-donsofe udrt! careflUrbefaresi 4 d;et •lieaarother bec°m P470 Is to allsubco eA_v UT this comet- secant�vinnnzst�bbm19ca mct°nde:Lm;t3Narotb ors For PlUed an tberesidea ernise°otai ir[Itin dncmnw the ° �AzbeP+asstttedinta gffie ' P.etiatvt6cfollOIrmseatttioas t: rethecon �$1m c"Unt, aduoIIees subtoauactorstobearorhsa�•dX�e� etimetoreadaadfkrynd n sttarioa br i �a 14ith ffie I i Ica e� d it tf 4ua�oas tl' dug to the �rat 18p °FffomeImFmtemeot Cormmaor$elmw-th�oRrs°Adt� t7os the comractarhatiri nst¢m�o :the C 4:bio 02I16 'e see a cops.ofa Room sl' cat g� w TOO matin tm atr0n torxod Rnotr. 1'moiofinntraoce do 4°t�orurhisiosurau� arbYraliing517-M4MM,4W COnVWO ourri_ehtsandrrsports7bilip_ enr. compaR•infa orSSS_?S3;7577. COFde to the dome 1m Read the +nradon sD ihativu tea coniint,rotizta Protectant Call ctorLatt: Pomm�r rmation oa theree Sz ora, to side of this ions and ter y0tt IDLt'C''�DC21 dt"-a cont,Zctorinct' emeotifithasIntstoredata - acoPpoftheContiTtctct ddrid bttsin t �Orteat hisrherm e a d�'ioUonin• ell goF ranch a Min, �7 c°nrtacrot'sa place _[best _ otttLy ofbnfi D went Posted. est DO Se: by Frond IVB" We a ed , 'lY CCB cbeonoCc@rxa Ianon rwynr�bsd°li`'zr.aott� °`the =orczc,,:�t�ssbsx`-t ` 31'3EFEFAN yT 'm 'Imm°n°Fthishtta€rh@ 3:ai to :11 jlllr:lli�ll i0°1epnalif, Stmamre ° s i' b'tr�ttnoa L:7+• atC C�L `•�+�actar's •t•� Contractor ATbitra`r iOn Irides homeowners with the rust ro initiate an atbiaanon action las ar The Slome Improvement contractorLa�rPro ate nuts a contractor The same'i-Ot is�automaucally afforded to a 2iternative to cotta action)ift6ey have a dispute befit has wi t a itomeovmerin court unless contractor;11OWever.The contractor�votild have to resolve 80Y.die hath patties awe w theoptiowd eltmszpraddedbelow This clammotdOMtbe contractkrtilesemeri�tt to arblualdon as is dw- dedtO ihehOIIteo�'nerby the Home lttipmvemoutt Contractor Lan- Fon contractor and the homeolvherltereby muhtal�'a in advance that in the event the contractor hes a dispute erning this contract the coatractstr}nay submuYhe dispute to a private arbitration fsnn which has been approved by theSecretary of the Em.-- « of ConsinowAi�and Business Re_gstladon and the consumer shall be required ddeii3n IVTassacht>setts General T clsagter Ids , ubmitto sucharbitration:asprb% r LLL Kw �mow. ��I S/ •� � Contractor's sienabrre Ho neolvaet's Stgnahtra ras only to the arreement of thepartit s to alternative above app drswie DUCE:The SIVAMof the Parties don: y resolution initiated bN the contractor_The hotneovvrter may initiate alternative dispute resolution even tvher trr»s Isection is not separately signed by theparties. Homemtiaer'sltts A bomeovrnet's 'nuts underthe Home ImprovernentContractor Lti(i1iLPma ? and n �;�Er_- �ection laws(JI-e-MGL c�Pan'g,A}rt>;^I not be naitedin ani -dna ha e�clnded from Carlota ti ifft contractor they choose is not properly re&tere as. crlbed b- ia�. Romeotivaers who secum their own building contractor �cto �nsible forlcomoletina the i�GTk as descn`bee:.i,'t,sof the.home Improvement Contra timely and worlsttanMP-manner Homeon�ners mar m ship ndtl or to �eln addition to mtarantees orwumdes auzraatr es orprmzdes an ea-przzss�varran�y for tva�tanslnP liedtvarrattty of merchantability and nmeas for orovided by the contractor=allgaods sold in yla5sachurso Its cam hop a nericular pt»;iose.An enurnerstton of other matters on Ay1ch the homeotmer and contractor lights- ayou have be added ti the terms . the contract as long as they do not restrict a homeolvnees baste consumer ne_hts. Ryon have questions aboutyour consurnedhomeonvnerridtts,coutarxthe Consumer Infoanation Hotline(listed bela�v) Execution of ContMelt The contract must be execated in dunlicate and should notbe signed mail a copy of all exltlbits and raferenc documents have been attached.Parties are also advised norm sign waned t orp or tthe cbntratd.nhedocmentuntiI all �rM ons hatxachments is to hued+'nortnartmdast'oid,delet�&ornotanplicable. one origttal be ed in to the o d as and the otherlmpt b_v the contactor Airy modification to tae original contmctmust be in,,writing and agreed to by both parties..Contracted work may natbe�u until both parties have receiti'ed a fnUy�ecaued C8p`of the contract and thethree day rescission period has expired Accelerated Fannents A convactor may not demand payments in advance of the dates specified on the payment schedule in cases�vhetethe hortteortmer deems him1herself to be finauciallp insecure 1 Iotivet�r, iastaaces n3tere a contractor seems him/hereli m be irnancially itueatra the conuactormay tequire that the balance of funds not}'et due be placed in a joint escrow account as a prerequisite to continuing the coutmcted.rrortt Viti►drats'a1 of fronds fivm seal account vouldragttire rise siattamrres of both parties. Additional in%rmatian Contractor Lav or other If you have general questions or need additional infor:tta'Aa assn the Consilj=Guide to Iiotae Improvement" . consumer fthtst orifwnwish to obtain a free copy of contact Consurner7nformarian Hotline office of Consumer Aff it and Bushier Ire-tiadon 10 park plazas Room 317%Boston.i1r1A 02116 61 i 973-3757,S$8s 37�ii orvisitthe OCAB �:�:•.m=-::ter:::..• If;aL nWt to%redjy the r#ft-ation ofa.contractor orffyau have questions or need additional i0fOrmation speacally about the contractorrz§sttation component ofthe Horne jtnprovement Contractor Lan.i Wk Director of Home Improvemeat CatttractorRe:pAWon Office of Consumer Affairs and Bm~mess Regulation 10 parl;.Plaa,Roam 5170.Bosttur j A 02116 375rr or iisit ffiC.��bsite at anti 617-73-8 87,$$$-383- _ Go online to vien'thestatus of a Htnrte Imprwemeat Contractor's ReaisQation:- ---- cath• For assistance with iaibrmal mediation of disputes or to resister tonal complaints against a business Consumer complaint section Office gf the Attontev General 617--127-5400 ' NTIOR BenerBua MC sBurzae :OS-6 4800.30$-7.1-d-?549 or413 T4-a1I Contractor Arbit*aaoa y ne'Hose Improvement ConhaetorLavrprat4des homeotivns�s 13n a sna�coe right is automancany afforded ED s atrenative�a court action)ifthev have a disvute tvirha cnntractar; tehelshe rias with a homeownerin eourtunless conttactor_hover.'the conrraetorwouhi have to rsoh a am dispu 6othpat Sa ZtDth�ADPonalcl€useprav'ld?AH meTtfi io1e IWS ;0onha a`COnt33CtAftheSBt(terl�tio arnixaaon as is arMcdta Lilehomeo�}�terby tit 4 The contractor and.Ire I;omeativne:hetet}mutuaIl3•agree in adi once that in the eveIIt the con-,,actor has a dispute concetr»ri this contract the contraetorpiay su€?dt7he dispute to a pm'am athittarionn i;vich Iuis been approved by the Secratarg of the E�ecutiz�ice of CoaSumerA fu.andt3usiness --dation,and the cpaslu�eershaIi be rLeuird arottrati Prb<Rc�ei33n TTassachusetts Get!eri Lance,chter i A :._ to submit to such onas =1 OIILTdC2aY'S SI°�_na52re L Rti neoirzrer's Signature h onl �the agfeetnent o€ebeparties to aitarnatnre dispute ©LL;E:The signatures of the parties aho�e app re',olution initiated bi=tae contractor. The homeoumer may initiate alternative dispute resolution even n=her this section is aotseparateip sued by thepartiea. HomedwneT'sFfthts 4homeo►�ne�'sri`htsndertheHomelmprovementContmctori ati,(_1JteG ven b Pa fie t.Hoand ofer=homed;mer protection laws(i.e.MGL chapter 9a"Aj m�'ti not be tlaited in any"S"- vas;he ez eluded from certain•rrgins ifft contractor they choose is not prdits matomI -ra�stzred as prescribed br iav:. Homeowner-wnO secu Contractor La-w-di sire contractor s raspons bre faicompuded letrna the.or�icas desc ibst i,-�a s of the Nome lmpro _ timely and tivorlortaIIlil.�manner_ Homea�;=tier mar be anlitled to other soeCi{IC Ieral R�ht3]f the COII�aCtOr grrzrantees orprotRdes an e--press Warranty In addillon to Mlamtces or for warlmianship or materials ed�variantF of metehantab4lit r an t=ress£or Prov the contractor-all�aods sold in ivlaSsaehusetts cam` �P a aas icrla*pvraase An enuriieradon of other matters an"Mch the homeon�aer and contractor Ist;amu a e be tided to the terms of the contract as tong as they do not resnrct a homeowmees baste,consumer rie_hts.1 I€y) have questions aboptgour'consumer(home(mmerri_ents_contact the ConsumerinformatianHatline(listed 91 Exacu lon ai Contract ed rho contra IIust been adached Parties are also dvisednotto epft�docum document untii all blaWksseec ions hac been documents have doe o:the contractn=itfl attachments is to tilled in or marl.�d as z+nide deletetL or not applicable. One arig3nal signed copy be given to the o,.%mer and the otherk2pt by the contractor. An ��Dtt���eoi��a f ft'��ed cow o and agreed to b-'k!both parties.Contracted work may e the conuacL and the three da}rescission pert cceferated Payments A conwactor may not demand payments in advance of the dates specifiedon the payment schedule in cases Aherz alta homeon-nerdeems him/hereiftobennancialt}insecure..Hatvat�h►�cesh-h a contractnraeemshunrhereli to ben"fancialtglnse ,erre-t nntinractor stontmgctedwothat the'iithdmix-aloffrmdsbalance of Binds �ftomseidaat due be ceaouatwoutdrequirethe account as a Prerequisite elV ram-as ofbotu patties. dit26IIIII irtirOrmattaIIto Law or other about ate Hbmekqr0j%T=tCon1ric r If you have IIera1 questions orneed additional infotztra fassachusettis Consumer de to A me Improvemea consrtnrer ri°hts_or ifyou ct�islr to obtain a free caps contact-, Consumer7nformation Hotline flfce os Consumer fir,and BusinessRegulation 10Farl va-Room5170.Bastan071166" - 37$7_S8S?83 37�ii orvisitthe 6179i� _ If you awttoverit,the rrdstradonof a contractor orifyou have ve qu tionsContrneeDW dadditio ac nal��onsoecriroall about the contractoMi mstratiotrcomponent oftheHome linprn Director of Hone Improvement ConuactorRegisttaft Office of Con suMer Rffeks andBufinessRegttiati00 10 part,PI=6 Room-170,Bostorr,MA 03116 ti17-03-8787,888?83 3757 or tidsit the l3TC Websita at h-51 =nuc ' Go online to-view 1heStatus of a Home Improvement Contmctoev Rql stradon: - J, iLSlIa?�rdnr5'i]Y—ilanaerri'•.ita�:�s�:- a bu.�mess,�� ' For assiistance Avith i'a#omal mediation of disputes or to mmster fomai complaints am►ins[ Cn dtnrrer Complaint Section t3ffice� ftA torne;=General 617-737=8400 ANTIOR BetaerBusmewBurgon :08-652-4804:508-755--7549 or4U'T=i'-3II The Commonwealth ofMassachusetts DePWIMent oflndustrial Accidents Office ofLtvestigations 600 Washington Street Boston,MA 02111 wwlvmassgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information `' ,,•t Please Print Legibly Name(BusincsdOrganization/individual): AgenfiC Wcathe iZA6011s LLC Address: SWem MA 01970 e vemle City/State/Zip: Phone#: 97�Jqt/'- 9103 Are you employer?Check the appropriate box: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I 6. employees(full and/or part-time).* have hired the sub-contractors �New construction 2. I am a sole proprietor or partner- listed on the attached sheet.I �- ❑Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working forme in any capacity. workers'comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. ❑We are a corporation and its requi ] officers have exercised their 10.❑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 12.0 R repairs insurance required.]t employees.(No workers' 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 arc doing all work and then hire outside contractors must submit a new affidavit indicating such. ''Contractors that check this box must attached an additional sheet showing the name ofthe subcontractors and their workers'comp,policy information. I am an en:plover t/rat isproviding workers'competrsadon insurancefor my employees. Below is thepolicy and job site information. r ' � _ ... Insurance Company Name: ,C L4 ri Policy#or Self-ins.Lic.#: ✓ l�02-71/Z I Expiration Date: 02/x•0116 Job Site Address: JYO JGOlCt7 City/State/Zip: 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 ofa 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.Iiereby certtfyyunder the pains andt ofper�ury that the information provided above is true and correct Signature: r / 2. Date y/e2 Phone#: - t/fl�. (,i FFal only. Do not write in this area,to be completed by city or tonin or_;aL n• Permit/License# hority(circle one):Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son; Phone#. ACORO® `.r- CERTIFICATE OF LIABILITY INSURANCEDATE(MWI)D/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Construction Eastern Insurance Group LLC PHONE FAC 233 West Central St Fv"tk )333-7234 E-MAIL °' DD NatickINSURE S AFFORDING COVERAGE NAIC# MA 017 60 INSURED INSURER A Arbella Protection Ins. Co. 41360 Atlantic Weatherization INSURER B NaUtilu8 Insurance CO 61 Rear Jefferson Avenue INSURERC: INSURER D: Salem INSURER E: MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBERNASTER 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 LTR TYPE OF INSURANCE 1BUC POLICY NUMBER IM�M/LIDDY EFF iPaLIC E P LIMITS GENERAL LIABILITY OFAHCURRENCE $ 1'000,0001 X COMMERCIAL GENERAL LIABILITY A CLAIMS-MADE ®OCCUR 500042816 /20/2015 /20/2016 S Eaoccurrence $ 50,000(Any one person $ 5,000 L 8 ADV INJURY $ 1'000,000 000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 AFrT AUTOMOBILE LIABILITY $ COMBINED SIN. LE LIMIT ANY AUTO Eaacci ant 1 000 000 A ALLOWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS X AUTOS 020015871 /20/2015 /20/2016 BODILY INJURY(Per accident) $ X HIRED AUTOS X ON AUTOSWNED PROPERTY DAMAGE Per accident $ X UMBRELLA LIAR xPIP-Basic $ OCCUR A EXCESS LIAB CLAIMS-MADE 4AGGREGATE RRENCE $ 1,000,000 $ 1,000,000 DED RETENTION$ 600058654 /20/2015 L/20/2016 WORKERS COMPENSATION $ AND EMPLOYERS'UABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WIT OTH OFFICER/MEMBER EXCLUDED? ❑ N/A E.L EACH ACCIDENT (Mandatory in NH) $ If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B POLLUTION LIABILITY CPL200378613 0/1/2014 0/1/2015 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORO 101,Additional Remarks Schedule,if mon 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, NA 01845 AUTHORIZED REPRESENTATIVE I John Koegel/PMA INS025 r�rltnnsi ni ACORD 26(i 5) ©1988-2010 ACORD CORPORATION. All rights reserved. m TI Tho Atlnpn nnma nnrr Innn nra raniefamfi mnrtre of Aflnpn Rightfax N2=1 3/10/2015 10:11 :37 AM PAGE 7/013 rax Dpi-vGi ACa CERTIFICATE OF LIABILITY INSURANCE 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 TAFFORDED BY THE HE ISSUING NSURER(S)CA AUTHORIZED RE RESENTA71VE OR PRODIES BELOW. THIS CERTIFICATE OF UCER,NCE S ER,ANDHE CERTIFICATE OLDERS NOT CONSTIT UTE A .RACT BETWEEN IM PORTANT: 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). CONTACT " PRODUCER NAME: EASTERN INS GROUP LLC PHONE Fax A!C No E¢t: No 233 W CENTRAL STREET E-MAIL NATICK,MA 01760 INSURER(S)AFFORDING COVERAGE MAIC u INSURER A:AMERICAN ZURICH INSURANCE COMPANY INSURED INSURER 0: ATLANTIC WEATHERIZATION LLC INSURERC: 61 REAR JEFFERSON AVE INSURER D: SALEM,MA 01970 INSURER E INSURER F: - CO-YE AG _UMBERe BE 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 THIS CERTIFICATE MAY Y PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREINIS SUBJECT TO ALL THE TERMS,E ISSUED OR EXC EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AOD SUB POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE iNSR YlVD POLICY NUMBER MM/DDIYYYY M/DDrYYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ c ue CLAIMS-MADE F] OCCUR MED EXP(Any one person) PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEIVL AGGREGATE LIMIT APPLIES PER: PRODUCTS L COMP/OP AGG S POLICY ,ECT LOC $ AUTOMOBILE LIABILITY ROM SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEOULEO BODILY INJURY(Per accident) $ AUTOS AUTOS HIO EO AUTOS NON-OWNED OP e Y AMAGE $ AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S. DED RETENTION$ $ WORKERS COMPENSATION X WC StATU- OTH- AND EMPLOYERS'LIABILFTY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIV�Y E.L.EACH ACCIDENT $500,000 OFFICEMMEMBER EXCLUDED? L'J N/A 6ZZUB 03-20-2015 03-20-2016 (Mandalory in NH) 5B270121 E.L.DISEASE-EA EMPLOYEE $500,000 11 yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below I I F_ — I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 1 M,Additional Remarks Schedule,H more apace is required) O TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 1600 OSGOOD STCANCELLED BEFORE THE EXPIRATION DATE THEREOF, N.ANDOVER,MA 01845 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRES`ENTATIYE ` � '/�//ems''•—'^— 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD-name and logo are registered marks of ACORD Board o ..SuiiE ing Risguledons a?d st'a?dards CaP9.GEruction Smit ea-1-a Ucense:CS4XM ERIC WPALM rL, - 3 Hf LTON ST - Sal=MA 83470= !` •° 33-F41 1� Gay ensssa�le� 041230016 -- _ a of Coasmger Affairs&Ou"em REgalaftn z -OPROVBMNT CONTRACTOR 142089 TAM iration: _3/12'J2Q16 LtdUabftCotpo-' ATLANTIC WEATNERIZATION LLC. ERIC PALM 61R JEFFERSON AVE SALEM,MA 01970. _Undersecretary