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HomeMy WebLinkAboutBuilding Permit #762-2017 - 15 MAPLE AVENUE 8/29/2016 NORTH `? �D BUILDING PERMIT CP���� ✓ �ro� � '6L 1L� TOWN OF NORTH ANDOVER S ° p A APPLICATION FOR PLAN EXAMINATION " ey Permit N0: Date Received a0l -�• " A 9q ce� 7 DNA !D o (r Q 10 am 9SSACHUS�t Date Issued IMPORTANT Applicant must complete all items on this page ,bw Nx •.dz, -,•':h W - 4_4yZwoffl, fir.. XxROPER��OWNEy � ♦ a : F & i� ' '�ay-j, 'P� _ _� `n '. 1 1P NC) � CEL ZC �N C31STl �t; stor+c ct r yes oA . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition Ik4wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other floF tr Septc� lCVell ry Floopl +n �letlanti� � tNa#ers > QIst # Wster/Sewerk :r .4 - rx r e a' ph Identification Please Type or Print Clearly) C� OWNER: Name: ��b�� v\ �r�pod f,S Phone: t ?�-2-73- 2/3� Address. s I V`et Jr - e @ �uperV.J -1 's.Con-ft— n L42e1ase x mate d ARCHITECT/ENGINEER 1 Phone: / Address: FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ;g 0 U " FEE: $ a Check No.. Receipt No.: ` NOTE: Persons contractin with unregistered contractors do not have access to the gua ty fund 1 I �q Plans . ubmitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OY SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ + Well ❑ ❑ Tobacco Sales Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On )(o SignaturNil�--' e_ COMMS NTS N I CONSERVATION Reviewed on 4 Si nature i OMMENTS T--0 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: ,FIRE DEPART Located 4 O - MENT 38 Osgood Street n _ P� ��� Tempi,Dump�sterkon�site.ixyes,�a �. s.'��..�:_.. '�o� �''• 43_ � _i 4LItocatedjat%l24IM5m�Street e`{De partmentsgnature/date, 'COMMENTS. . . k '' Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. 1, 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 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 f 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 l 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 the i f ce must stamp In all cases if a variance or special permit was required trenthe Town Clerks et this recorded aft the Registry of Deeds. onecopy and proof of rsion from the Board of ecording that the appeal period is over. The applicant m g must be submitted with the building application Doc:Building Permit Revised 2014 NOTICE OF ASSIGNMENT LETTER Iq: Iyv I e -p4e /5-- 17 Woe -5� 06 atlon Rating and Inspection Bureau of mossachusOtts The WorkArs Compens wcrlbma.org 101 Arch Street 39-s6�55 MW�1� (611)439.9030- FAX(617) Z /T £009££6SL6 og 'dtu00—z-4u-es9'au0K -ID-49d Wa 6T=L0 9TOZ'0£ ' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stam ed Plans Stamped ans ❑ FPubhc SEWERAGE DI7[SAL Swim,nin Poolnni-ug/Massage/BodYArt ❑ g obacco Sales �] c tank etc Food Packaging/Sales ❑ ❑ Permanent Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On 1 � Signature' _ COMMENTS N CONSERVATION Reviewed on Signature COMMENTS VEL �J iv\ Q© 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/si nature& Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE bEPAR4TMENT �T' iouM stet onsite es 5s:rt � r-;- � 1tLoc at"e�d at 124 Ma�inS�t+.reet *� r 3 ; -'s•p�L .w kY_ ��cr..�ssr,� tno '' gat ► z ` i a "W r Fipre Deypart�ment�stignature/date }at {Y* ,.,LLF,,� ,k.�fA y� �I k..�.1•YF='�q.�� 1 o-Fy� i�� j' i�tT ` ; 15r�f��FM�...n•; . r•sK.•ll:t Mi ....+n+......�_... ~ i k!s ' u ttj { t v wi::.r �,`r.� }�Y� •n'k"' ���_ � � • "�'}'�f tiF��4'�� .a`R�`:P-•� !.-y�'tM z`-iy.+� r�4e�..�::�..-�...�.��;-.�..: fir, t t�+,• i�. yi � !}Y COMMENTS: '�''�',•��'�'i'`` ,:�.., �..!� �•�_ her �4�r.� ��s s . �ca:v y y�` 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 ®ARIGER Z®IVE LITERATURE: yes No MGL Chapter 166 Section 21A—F and G min.$1o0-$1000 fine NOTES and DATA-- (For department use) Q Notified for pickup Call Email Date _ Ty� Time Contact Name Doc-Building Permit Revised 2014 t4ORTH Town of dAndover : z 4 R h ver, Mass, 'P Coc CNlWKK 1- A0RwTEO S V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT ........ ET 0 N s N BUILDING INSPECTOR ....................................................�......�..................................... has permission to erect .......................... buildings on ...... .. ........� ........VM^12.L� Foundation,,,,,,:5„�,,,,, ft ARough to be occupied as !'' ti c p ,,, , ,,, Chimney ........D......................6 �.�...� .!�.:�.�................................. ...�....... provided that the person accepting this_permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TAR7A.-- Rough r - ..........'......... 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. : � Town of North Andover, MA September 8, 2016 ii i i°' ::t�: :t: :7 X : : ^if:: :15:1 :: ' L. :aJ' #1: fl' ' i::::::::::::::'•.......:, is .. T S [� t:S:::::::::::: ::5:::.• :' .. 1 'b. y.i:: '"w':::::::::::::: �L:: t:: ... ::_. ::;L. ::f11.: :::t:' w't: 7, � ''y� ..{' 7L1 . :} i :i:: 5:. )L f:: :7'L :i:: ::Y.:::::::: {{� ::Lam—:: ;a:: :: ::x�:: i. :�' ::::: ..2': w :1{:: :1{:: ::47 ,:::::::::::::::::::::::::::::4::::::::::::::::. I., t :. 9. :.> :>`: 1 . �... :'3�' ..5.: .Y i iii:: .Y a: L: =it:: i as �.. '�= i.. [$ ::L: .L.., ..SF:... 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T 6 S `:%iiiiiiiiiiiiiii F i:7:: '.:�1�: : -S.. .:4:::::::::::::::::::..C� .5, 'a�� :a::::::...... 7I: :} ::' �• a :'1:' ::s::` :: :'1.' •+$ i:l'•. :: ::5:. : �s.�o-rl�ir�:: _ :...' :�: :r.: .z i i? T. `:r.: .., ::ice ::c :: :::: c::::::::I.': u ft; ........................ 1 $. P�X09t.1—::::'... s iii —�^ . Property Information Property 210/019.0-0023-0000.0 " " ID Location 15-17 MAPLE AVENUE Owner TRIPODIS,JOHN MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover, MA makes no claims and no warranties, expressed or implied,concerning the validity or accuracy of the GIS data presented on this map. -fes prVIV .2 17 ;fOA f t ' - F t a 4-77 11 4 r Y) r t, 11. Jii qv Ja — --- aRill (21 . 57 771� d 7 ° °; a � �,,,"gid � •'`Y' ��-e g I ILI -517 46 IYW f a 8 Nissitissit Lane Pepperell,MA 01463 Office:978-433-5003 Cell:978-265-4206 Customer Name: John Tripodis Job adderss: 15-17 Maple ave ,North Andover MA Phone number: 978-273-2138 Job Description: Deck -Note : Due to fire damage to the major structure components of this existing front deck,we recommend full replacement.This structure is un safe to walk on at this time. -Obtain all necc. Building permits. -Provide building plans to town hall to obtain building permit. -Have a 15 yard dumpster delivered, and dispose of all waste into,container. -There may be lead paint on this deck and we will have to take procautions to remove it. -Build new 18x8 front farmers porch out of pressure treated lumber . -Install new beams and posts under deck. -Remove existing footings and replace with new ones 4 feet down,the concrete can be compromised by the heat of the fire and will cause concrete to breakdown . -Install new 5I4 pressure treated decking. -Install all new railing systems out of pressure treated. -Install all new lattice underneath and trim all around to look like existing. -Replace existing 2 large front columns,one got damaged from fire and new one wont match,so we will replace both custom columns. -All fasteners and metal adjacent hardware will be new simpson products to handle the chemical in the pressure treated. - r M 8 Nissitissit Lane Pepperell,NA 01463 Office:978-433-5003 Cell:978-265-4206 -Have the dumpster removed after job is completed. -Total cost of demo ,framing,and deck completion,labor,materials,permit,plans are all included in price $6,900 -1St payment of$4,000 due with permit -2"d payment of$2900 due when completed. -Any questions call Peter 978-265-4206 thank you. A8 Commonwealth of M assay husetts :.z Depa-ftment of IndushiaZAccidents 1 Congress Street,Suite 100 #° Boston,MA 02. 14 2017 www.masssgovldica Workers'Compi sation lusmrance A€fzdavit:Builders/Contractors J eetxiciarts/L'l�cobers. TO BE AILED WXTH TEl!P3MMTING AUTHORTI'Y. A_ licant Information Please Print Leerily Name(Business/Orgaaizaiion/Iudividual): C-6VLke te.� Address: SS 4- City/Sta-te%Zip: Phone#: (`��' co s-- - T A.reyou an employer? Meckth appropriate box: Type of project(req*"" 'ed): 1. II am a employer &hMemployees(full and/or part time). 7.• New coAstr lctlon I am a sole proprietor or partnership and have no employees working for me in 8. Remo de1i11g any capacity.END woticers'comp.insurance required.] 9, ❑Demolition IQ l azn a homeowner doing all wo-rk nwelZ[No workers'comp.diismanca required]t 10 FIEuil#g.addition 4.0 I am a homeowner and will.be hiring contractors to conduct all work on my property: I will 11 Electrical repairs or.additions ers'com enation fiasurance or are sole Q p contractors either have work p that an ., ensure , proprietors witb.no employees. 12[[Plumbing repairs or additions 5.❑I am agpneral contractor and I have hired the sub-eontracturs listed on the attached sheet. 13:Q Roof rep airs These snb-coniracinrsliaveeiuployees andhaveworkers'comp_insurance 14�Otlier ^ / 6.0 We are a corporat qa ancl*officershave exorcisedtheirright of'egemption perMene GL c. 152,§1(4),andwehaveno..ev plc2yees.lNoworkers'comp.insurance required.] �R r *Any applicautthatchecksbdmulmust also*Moutthesectionbelowshovngtheirworkers>compensanonpolicymfomiaiian. i Homeowners vtlio sulisiifPhis afndavit indicalingthey are doing all work andthenhire outside contractors must sOmit anew affidavit Indicating such_ ?Coufractos that checkthig bog must ap(t hed.an additional sheet showing the name of the sub-contmtors and state whether ornotthose entities have employees.Ifthe sub-coria c'tors Tuve emp16yees,1hey must pravidethe r workers'comp.policy number. X ain an employer tfzat is pi•ovidirzg Yorkers"compensation h7suTancefOr my employees.'Belo9v is thepolicy and, site infoiTrcation. � Q (/lk Insurance Company1jame: Policy#or Self-ins.lir-#: 7 S�O U U >3-2 g 7Expira onDate: lob Site Address: (� ctI L5—) A--( e City/State/Zip: ack, Attach a copy of the workers' coanpensationpo ey declaration page(Showing the polleynumber and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A,copy of this statement may be forwarded to the Off ca of Investigations of the DIA for insurance coverage verifi0adOIL. X do hereby certify under' zi• and perzaiti s et' tl3 e info. niton provided above is -me and tori eco "9 Si ature: �+ Phone#: —2-G S--YL-9� Official r se only Do not-wiite in this area,to be completed by city or to7vn official City or Town: Permit/License# Issuing Authori.iy(circle one): i 1.Board of Health 2.BuildingDepartment 3.City/Town Clerk fir'.Electrical Inspector 5.Plumbing luspector 6.Other Coxatact Person: Phone#: Information and Instructions Massachusetts General Laws chapter X52 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract bf hire, expxess 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 enf&prise,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 accupant 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 ox 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 lias not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to the contracting authority." Applicants Please fill-out-the workers' compensation affidavit completely,by checking le boxes that apply to your situation and,if necessary,supply sub-'contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees'otherthan the members orpartnexs,arenotrequiredto canyworkers'compensationinsurance. If au LLC or LLP doeshave employees,a policy is required. Be advised that this affidavit may be submitted to the Department of JAdustdal Accidents for confirmation ofinsurance 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 yoiu'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 size that the affidavit is complete and printed legibly. The Department hag 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 inthe penuMiceuse number which will be used as areference 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(if necessary)and under"Job Site Address"the applicant should-write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth.of Massachusetts - Department of IndustrialAccidmts 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext.7406 or 1-877--MASSA.FE Fax#617.727-7749 Revised 02-23-15 wwwmass.gov/dia i NOTICE OF ASSIGNMENT COMBO I.D. STATUS OF EMPLOYER ---.....—•--..•--•---•-- EMPLOYER: 000211374 Corporation COMPLETE HOMO IMPROVEMENTS INC 8 NISSITISSIT LINE COVERAGE GROUP PEPPERELL, MA 01463 0211374 Coverage under this assignment applies to Massachusetta The Waiver of Our light to operations only. Fur coverage Recover from Othdrs Er►dorsrartiexlt outside of Massachusetts, contact in available on Pool policies. the appropriate Pool or Plan for Contact your agent for details. that state. INSURANCE COMPANY: HARTFORD UNDERWRITERS INS CO AGENT BYAM BROS MAHONEY INS AGENCY Jonathan SCharnber-g OR RYAN COULTZR p 0 BOX 3556 PRODUCER: 191 PAWTUCKET 13LVD ORLANDO, FL 32802-3556 LOWELL, MA 01.654 (500) 453-9843 AGENCY FEIN: 042083954 — RATE EgTIMATED CLASS ESTIMATED PREMIUM CLASSIFICATION OF OPERATION CODE TOTAL ANNUAL REMUNERATION ---------- ------------------I------------ ------ ----------I------------ ----- -- $O 5.90 $0 9402 $0 8,06 5651 $O STREET CLEANING & DRIVERS $0 0.06 $0 CARPENTRY-DWELLINGS - THREE STORIES OR LESS $ 0 31.79 $0 CARPENTRY--DETACHED ONE OR TWO FAMILY DWELLINGS 5645 9,86 $1,025 ROOFING NOC & YARD EMP, DRIVERS 5403 $10,400 CARPENTRY NOC 9845 $1,025 EMPLOYERS LIABILITY 100/100/500 $338 STANDARD PREMIUM 0900 $3 EXPENSE CONSTANT 9740 $500 TERRORISM CHARGE $1,366 TOTAL POLICY MINIMUM PREMIUM $57 TOTAL ESTIMATED PREMIUM ---------- _- DIA ASSESS. 5.6% $1,423 DEPOSIT PREMIUM: $1,423 TOTAL EST, PREMIUM PLUS ASSESSMENT THIS 19 NOT A BILI. INSTALLMENT BASIS: Annual — ter•--'��r y� COMMENTeon 09/27/16. Coverage effecl:ive 12:01 AM Subject to 04/04 Anniversary Rate Date. PREPARED BY; Maryellen Nee EXT 532 DATE OF NOTICE., 09/21/16 « VOLUNTARY DIRECT ASSIGNMENT yr ers'Compensation Rating and I,Bpectlon 13ureau of Massachusetts The Work 101 Arch Street•Boston,MA 02110 (617)439.9030 •FAX(617)439-6085 'Wcrlbma.org Z /Z '3f)vd COOSC bSL6 off -dtu03-TjU2S9gU0W .za-jad NcT 9T= L0 9TOZ '0C 'daS ,08-'16 14:34 FROM-Byam BrosMahony Inc 978-937-0745 T-116 F0001/0002 F-059 Byam Brothers—Mahoney Insurance Agency,Inc. 191 Pawtucket Boulevard Lowell, MA 01854 Byarn Brothers 1-800-508-2926 fax: 1-978-937-0745 Insurance Fax To: Town of North Andover From: Colleen Esposito Attn: Maura Faxc 978-688-9542 Pages: 2 Phone: Date: o9/oaM6 ' Re: Complete Home Improvement Inc. POW Replacement Certificate:WC Urgent O For Review ❑Please Comment O Please Reply ❑Please Recycle • Comments: Hello Maura: Please find attached a replacement certificate of insurance for the one you previously received. Please be aware that this agency did not issue the certificate that you received with the issue date of 12/21/15. Also note the expiration of the policy on the certificate I have issued today. Policy has cancelled effective 1/13/16 with no coverage in place at this time with our agency, Thank you. P ►VZLY C5 L-2 09-08-'16 14;34 FROM-Byam BrosMahony Inc 978-937-0745 T-116 P0002/0002 F-059 IL a® CERTIFICATE OF LIABILITY INSURANCE DATE tMMIDDMIrY) 09/08/2016 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 13Y TH9 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 pollcy(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 NAME:CT Colleen Es silo BYAM EROS MAHONEY INS.AGENCY PH0 E 978 454-2825 IA Nol. FAl n oRl�sB: colleen b aminsurance,com 191 PAVMCKET BLVD INSURERS AFFORDING COVERAGE NAZCA LOWELL MA 01854 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B I COMPLETE HOME IMPROVEMENT INC INSURER Q. INSURER D 8 NISSITISSIT LN IN§VRER 1:: PEPPERELL MA 01463 FINSURER F: COVERAGES CERTIFICATE NUMBER: 83337 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 DF$CRISED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBq TYPE OF INSURANCE AUDI.SUER P OLICY EXP pODCYNUMBER MM/bD(YYYY1 (MWDDfvrM LIMITS COMMERCIAL GENERAL LIABILITY FACHOCCURRENCE $ CLAIMS-MADE r_1 OCCUR PREMISES ea occurmnca $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY S GEN'LAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 jpCw EILOC PRODUCTS-COMP/OPAGG $ $ I OTHER: COMBINED SIN L I AUTOMOBILE LIABILITY arnlAanl S BODILY INJURY(Per parson) $ ANY AUTO I ALL SCHEDULED N/A BODILY INJURY(Par accident) $ I AUTOS NON-OWNED PROPERTY DAMAGE S HIREDAUTOS gUY08 Parnmadant S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS Me CLAIMS-MADE N/A AGGREGAYC $ DED RETENTION$ $ WORKERS COMPENSATION X TEFrUT I I ORH- AND EMPLOYERS'LIABILITV YIN A OFCEOPRIET R/PART ERVf ECVTIVF NIA N/A NIA 6S60UB0G33778715 10/0212015 01/13/2016 E.L.EACH ACCIDENT $ 1000,000 (Mandatory In NH) E.L,DISEASE-EA EMPLOYEE $ 1,000,000 11 yyes,dawAba under DESCRIPTION OF DPI=RAYIONS 1.1— FL.DISEASE-POLICY LIMIT $ 1,004,400 7,1N/A I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,AddRlonol Konnorks Schedule,may be attached Ir more space is►epulrso) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy In force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govflwd/workere-compensation/lnvestigationa. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEA13OVE 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 AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M-Croy,CPCU,vice President—Residual Market—WCRIBMA ®1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks Of ACORD AC R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/21/2015 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 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 NAMEACT : Colleen Esposito BYAM BROS MAHONEY INS. AGENCY PHON978)454-2926 FaAiC E No: ADDRESS: colleen@byaminsurance.com 191 PAWTUCKET BLVD INSURERS AFFORDING COVERAGE NAIC# LOWELL MA 01854 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: COMPLETE HOME IMPROVEMENT INC INSURER C: INSURER D: 8 NISSITISSIT LN INSURER E: PEPPERELL MA 01463 INSURER F: COVERAGES CERTIFICATE NUMBER: 19783 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, EXGL-t�$iQNSJN!fl ONDtTIONS OF SUCH-FOLICIES.L!MSTS_SIiOWRihi?Y HBVE @GFN,@EA !TED f Y_.PAID CLAIM$ INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMD MEFF M POLICY EXP LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE FlOCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑jEo- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NO OWNED PRerOPERT DAMAGE $ HIRED AUTOS AUTOS accid $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY YIN A OF CER/MEMT ER EXCLUDED?ECLITIVE NIA NIA NIA 6S60UBOG33778715 10/02/2015 10/02/2016 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFf)CD CANCELLATION • \' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE l THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 6 �l + ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 0305 _ — Daniel M.Cr c/v By,CPCU,Vice President–Residual Market–WCR►BMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 014/01) The 6r.G�nameand to o e registered marks of ACORD N9 0826V;�5A� 1 � 0-1 10/4/2016 10 : 08 : 31 AM PAGE 2/002 Fax Server rTHISCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE RODUCER 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BYAM BROS MAHONEY INS PHONE FAX 191 PAWTUCKET BLVD (Aro,No,Ext): (A/C,No): E-MAIL LOWELL,MA 01854 ADDRESS: 285RH INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: HARTFORD UNDERWRITERS INSURANCE COMPANY COMPLETE HOME IMPROVEMENTS INC INSURER B: INSURER C: INSURER D: 8 NISSITISSIT LANE INSURER E: PEPPERELL,MA 01463 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM�DDIYYYY) (MM6DDIYYYY) LMIT S GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. REMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 PROJECT 0 LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR M OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X �WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-7H696819-16 09/27/2016 09/27/2017 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE N/A E.L EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatoryin NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. 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 1600 OSGOOD ST SUITE 2035 IN ACCORDANCE WITH THE POLICY PROVISIO1, ._ AUTHORIZED REPRESENTATIVE _ NORTH ANDOVER,MA 01845 t• r� ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPdA fI'JI1F`Wf alits reserved. L 4-'16 09;49 FROM-Byam BrosMahony Inc 978-937-0745 T-191 P0001/0001 F-270 CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD/YYYY) TE 15 155UED 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),AUTNORIYFO REPRESENTATIVE OR PROULICER,AND TIJE CFRTIFICAT5 HOLDER. MPORTANT:It the Certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,6ubject to :he terms and conditions of the policy,certain policies may require and endorsement. A statement on this ceititicate does not confer rights to ;he certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME: BYAM BROS MAHONEY INS PHONE FAX 191 PAWTUCKET BLVD (A/C,No,Ext): (AIC,No): EMAIL LOWRLL,MA 0 18 54 ADDRE88: 285RH INBURE6R(S)AFFOROINO COVERAGE NAIC iF INSURED INSURGR A: HARTFORD UNDER WRTTBRS TNSMANCE COMPANY COMPLETE HOME IMPROVEMENTS INC INSURER 6: INSURER C: INSURER 0: 8 NISSITISSITLANE INSURER E: LE PEPPEREI_L,MA 01463 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO C91VTIFV TtTHAT THE POLICIES OF INSURANCE LISTED 6ELOW HAVE BEEN ISSUED TO THE INsUAFD NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REDUIREMENT,TERM OR CONDITION OF ANT CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INsuRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. [NrWi ADD SUB POLICY EFF DATE POLICY ElP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (FWDDIYYYY) (MMDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCVRRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. [ER50NAL EMISES(Ea occurrence) D EXP(Any one erson) $ i d AOV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: NERAL AGGREGATE S POLICY 1:1 PROJECT a LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ee gocident) ALL OWNED AUTOS BODILY INJURY S SCHEOULE AUT08 (Per person) BODILY INJURY $ HIRED AUTOS (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE S (Per accident) UMBRELLA LIAR M OCCUR EACH OCCURRENCE $ I EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION S WORKER'S COMPENSATION AND wC STATUTORY OTHER AEMPLOYER'S LIABILITY YIN US-7H696819-16 09/27/2016 09/27/2017 X ITS ANY PkOPFRITOR1PARTNtR/EXECUr1V5a NIA E.L EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? IM4ndelerylnNH) E.L.DISEASE-EAEMPLOVEE $ 100,000 if y.s,oewioe under E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS DeIOW OESCRIPTION OF OPERATIONS/LOCAYIONSA/EHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTg`(CATE ISSUED TO WE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION m"m TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIGS BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL GE DELIVERED 1600 OSGOOD ST IN ACCORDANCE VVItH THE POLICY PROVISIOW-'-'w SUITE 2035 AUTHORIZED REPRUGGENTATIVE NORTH ANDOVER,MA 01845 V f ACORO 26(2010/06) The ACOR11 name and logo are registered marks ofACO 1888-Y010 ACORO CORPtO Yft7'N:A1 Its reserved, .. i Massachusetts Department of Public Safety `y Board of Building Regulations and Standards License: CSFA-086292 f 1 Construction Supervisor 1 & 2 ,f Family 1 PETER D MONTESANTI ' i 8 NISSITISSIT LANE PEPPERELL MA 01643 i i j l� Expiration: i Commissioner 04108/2017 U '�f2G' ((iCY/9?iJ72QJ'f./!,t(Cl.(��Q�C��PCCC:i�C7G/LCL68��iJ Office of Consumer Affairs&Business Regulation I HOME IMPROVEMENT CONTRACTOR Registration 122838 Type: Expiration•`�1016 DBA COMPLETE HOME IMPROW-JIENT PETER MONTESANTI-=..a,---- 8 NISSITISSIT LN PEPPERELL,MA 01463"- Undersecretary q. Location 0 S No. () a G 1 7 t Date a • • TOWN OF NORTH ANDOVER . a Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 4 7 S. i 7G/ Building Inspector