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HomeMy WebLinkAboutBuilding Permit #738-13 - 157 GREENE STREET 5/7/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION. Permit NO: Date Received 1 Date Issued: IMPORTANT:Applicant must com Tete all items on this page LOCATION 15"'? (� ( e--e- e S �- Print — PROPERTY OWNER �� i �e .� - I ) , o - Unit# �( Print MAP NO:_G 33 PARCEL: �� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no nit Machine year-old structure yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building ane family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r-, C .1�. `� lji�j I I '-' �►-.. t t n t r 1 t Y. u YV ALUiIJl;WG I i DESCRIPTION OF WORK TO BE PERFORMED: ��� �, c_ � 11 � (� .�� �•� els �- rs" /� � ,� �� (Identification Please Type or Print Clearly) OWNER: Name: E, [ e e --? L=7 )110 k Address: Gc GP --? 51"-- Erie W.Palm CONTRACTOR Name: Phone: 3 H&A n�►�uwi Address: Salem IA QW0 Supervisor's Construction License: 7 9 7 Exp. Date: 3 Home Improvement License: / `I lo S Exp. Date: AL 1Z L ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � 00 e� FEE: $ K� Check No.: Receipt No.: r (o ho 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of A ent/Owner __�_g _ _ Signature_of contracto - �, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ElSv✓immir�g Kok El Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Penmanent Durnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS .ev orf dad Fo:a d•-i i :'..�.f 9 r\L.�i�i{I4l:.0 Uf VIUI IGI�..II V COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/Signature& Date Driveway Permit i DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located 384 Osgood Streetno Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, =used 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.s1oo-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Perr Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses coir/ of 001i0a'aci. CI I. iooi-iCi-oss ct;joi`i/EievaLioi1 Plan 0'i' i-'i'OPOSeCi VVUI-K VVIWI 6PHAKlef i—1 ail Ana Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permi New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permi 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: Doc.Building Permit Revised 2008mi Location No. Date • ' TOWN OF NORTH ANDOVER • 4��`!'LtfT j�46` O Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ a Other Permit Fee $ TOTAL $ ' Check#��(7)" 26360 Building Inspector I t r 1- NORTH - W" ' ve. may, p Y O L/.KE h ver, Mass, 1 COCKICKEWICK ��• �i9 ARRA TED 5 S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT . � �<e_A . BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ...... .a............ ................. _ 1 Rough to be occupied as .....a.f\,s.o .. O?r1......T..... �. K..t 4. ?. ! ................................. Chimney provided that the person accepting this permit shall in 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T R IS Rough Service ���................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations y` 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Atlantic Weatherizatlnn, 1,1,,C 61 R Jefferson Avenue Address: Salem MA 01970 City/State/Zip: Phone #: y— 8-/Y Ar�yonemployer?Check the appropriate box: Type of project(required): employer with a S� 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance. 9. ❑ Building addition 5. oration and its 10.0 Electrical repairs or additions required.] ❑ We are a corporation 3.Elofcers have exercised their I am a homeowner doing all work 11.❑Plumbing repairs or additions myself. o workers' com right of exemption per MGL y t p c. 152 1(4),and we have no 12.❑Roof repairs insurance required.] ' § employees, [No workers' 13.❑ Other 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 indicating such. :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. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: L(,4--( G Policy#or.Self-ins.Lic.#: e Expiration Date: Job Site Address: /J�7 C�r-e If .-1 / City/State/Zip:A /�,l CfaJ2/1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer*uunder the pains and/punalltiies of perjury that the information provided above is true and correct. Signature: G Date: h 3 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 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 of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)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 other than the members or partners,are not required to cavy workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the.Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-irisured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(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 may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Bostori,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax## 617-727-7749 Revised 4-24-07 Wvww,mass.gov/dia. ii Ras—sac h usetts Home Improvement Sample Contract i� is form satisfies all basic requu'eirnents of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners Seck legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617.973.8787 or 1-888-283.3757 or on our website.. Homeowner Wormation Contractor Information N°p10 ri C I i I O Company Name :eetAddress(do not use a Post Office ox address Atlantic W he ,7�1 j Jn LC) Contractor/Salesperson/Owner Name . . 1 R Jefferson Avenue ownCity r State Zip Code Business Address(must include a street address) a em e DaytimePhone Evciling Phone City/Town State Zip Code Mailing Address(It different from abode) Business Phone Federal Employer ID or S.S.Number .. Hamelmprove m contrsetor Rog.Numbu Expirsdondee I.mr mquiros nmt most home Improvc,gi,tr nt olanbhnvo n vnlid rsglsmnHon mimbor The Contractor agrees to do the following work for the Homeowner: tDescribe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary) c lots . (1 (��acs / Ar 50.\ G� fEr c�t(ar �JIDwn Ce�I �G52 tea( ( S - Required Permits-The followingil uilding permits arerequired Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their ta�vn permits will be I sxel>tded from the Guarattty Fund provisions of L613 Date when contactor will begin contracted work � K%. apter 142A�Fgenq�chcd ) , 4�"_%_Date when contracted work will be substantially completed. TotalConh act Price aeContractorgeestoperthe worly furnish the material and labor specified above for the total sum of: 7 X0.6. �� (*� Payments will be made according to the following schedule: S upon signing edn raot`(not'to'ex"ceed773 ofthe Mal on6act piece or the-cosy'of special cider it'eros,'wnib5av'eiF' gFdattV--'- -- $ by / or upon completion of by -LL/L/121 or upon completion of -TZ>4,&— $ ,& ��J U upon completion bf the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) �I The following material/equipmCbt must be special $ to be.paid for ordered before the contracted ittolk begins in order / to meet the completion schedule.'(**) $ to be paid for NOTES:(*)Including all finance charges(*')Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of!(e)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. ktecs Warrnnly-rs an exore waF nnty beina provided by the cantrnetor? 0 No❑Yes all terms of thtwarrinntyMMst be attached to tnx eontret Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third parly/subcontractor utilized by the Idntractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for rnatd eol Consmet Acceptance-Upon signilig,this document becomes a binding contract under law, Unless otherwise noted within this document,the contract shall not imply that any lienor other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contralti I * Don't be pressured into signing the contract.Take time to read and fiilly understand it. Ask questions if something is unclear. * Make'sui•e the contractor has a'ual'id Home hMrovement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered�4ith the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the D,ircctor at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888.283-3757. * Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insure6ce"document. * Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it}hs been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her mainldffice or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the siOing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIdN THIS CONTRACT IF TIM RE ARE ANY BLANK SPACES!!! nTwo 1ddomicaI copiers'of the oonhact must be completed and signed.Ono copy should go to the homeowner.The other copy should be kept by the contractor. Homeowner's Signature Contractor's Signature Date I Date li Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate anjarbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not aiutomatically 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 cont.V for the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm]' h'ch has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapte 142A. Homeowner's 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 reso11 ation 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 142A)..and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement.i However,homeowners may be excluded from certain rights if the contractor they choose is not properly registere4 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 ii ork as described,in a timely and workmanlike 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 du licate and should not be signed until a copy of all exl"bits 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..bAin.writing and agreed to by-bothpwties:-Contracted'WOrk-mdy not begin until 6ofh parties have reced 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 sehedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a epntractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet duel e placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from sa'd account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home lmproveraerf Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: i Consumer Information Hotline Office of Consumer Affairs and Business Regulation j 10 Park Plaza,Room 5170,Boston,MA 02116 j 617-973-8787,888-283-3757 or visit the OCABR website at hM://www.Tnass.gov/ocabr/ ://www.rnass. ov/ocabr/ 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,cPptact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 1 617-973-8787,888-283-3757 or visit the HIC website at http://www.lnass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: hM:Hdb.state.ma.us/homeimprovement/licenseelist asp For assistance with informal mediation of disputes or to register formal complaints against!a business,call: Consumer Complaint Section Office of the Attorney General I I 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 11 Version 2.1-11/22/2010 l d�YL 5� a�i3 z6y"t 4,v\ 05/01/2013 12:40 FAX 9787452200 ATLANTIC WEATHERIZATION R 002/002 Rightfax N2-1 3/11/201355 : 57 AM PAGE 2/002 Fax Server " CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT 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 o PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:If tho certificate holder Is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to thf:terms and conditlons of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the ccrtlflcate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME; EASTERN INS GROUP LLC PHONE FAX 233 JJFST CENTRAL ST (A/C,No,Ext); (A/C.No): E-MAIL NATICK,MA 01760 ADDRESS; 22MLW INSURERS)AFFORDING COVERAGE NAIC u INSURED INSURER A; AMERICAN ZUFUCH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B; INSURER C: INSURER D: 61 RI✓AR.T FFERSIO AVE INSURER E; SAL8M,MA 01971) INSURER F; COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: 1 1 HE IN U NAMED ABOVE FDR THE POLICY PERIOD INDICATED. NOTWITHSTANDINQ ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT DR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS.El(CLU51ON5 AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BE2N REDUCED BY-PAID CLAIMS, INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MKODWYYY) (MKl5D%YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE g COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED `G CLAIMS MADE OCCUR. nREMISES(Ea occurrence) ED EXP(Ary one person) S ERSONAL&ADV INJURY $ GHN'L AGGREGATE LIMIT APPLIES PER ENERAL AGGREGATE S POLICY L1 PROJECT ❑Loc ODUOTS-OOMR(OP AGG 5 AUTOMOBILE LIABILITY COMBINED SINGLE S ANY AUTO LIMIT(Ea acolcneln) ALL OWNED AUTOS 60LOILY INJURY & SCHEDULE AUTOS (Pcr person) HIRED AUTOS BODILY INJURY S (Poraccident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Por accidcnt) UMBRELLA L.IAB OCCUR EACH OCCURRENCE s EXCESS LAB CLAIMS•MADE AGGREGATE s DEDUCTIBLE $ RETENTIONS S A WORKER'S COMPENSATION AND X WC STATVTORV OTHER EMP LOYER'SLIABILITY Y/N UB-58270121-13 03120/2013 M32MrzO1< LIMITS ANY PROPERITOR/PARTNERIExFCuTiVEI-1 NIA E L.EACH ACclol:-M• S 500,000 OFFICERIME41BER @XCL'JDEO') (MondAlory In NH) E L DISEASE•EA EMPLOYEE S 500,000 (ryes.aeww Unov DEBCRIPYION OF OPE=RATIONS below E.L.DISEAsk•laOLIc;Y LIMIT $ 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACRS ANY PRIOR CERTIFICATE ISSUED TO THR CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE, CERTIFICATE HOLDER CANCELLATION T OWN OF NORTH ANDD VER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1600 0SC7000 ST IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR TA .VE NO RTR ANDOVER,MA 01845 Y'� ACOR 2 (2 1 0 ) The ACORD name and logo are regl9tered marks of ACORD 119513-2010 ACORD CORPORATION. All rights reserved. 5/01/2013 12: 40 FAX 9787452200 ATLANTIC WEATHERIZATION IA0011002 FAX COVER SHEET Atlantic Weatherization, LLC 61 R Jefferson Avenue Salem, MA 01970 Tel: 978-744-8143 Fax: 978-745-2200 Date: # Of Pages Inc. Cover: Sent To: ?�k�� Sent By: W4 CL, dy-yy, L) h� i Rightfax N2-1 3/11/2013 6 : 55 : 57 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(M11/?01 YYY) T TIFICATE IS ISSUED ASA 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAX 233 WEST CENTRAL ST (A/C,No,Ext): (A/C,No): E-MAIL NATICK,MA 01760 ADDRESS: 22MLW INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B: INSURER C: INSURER D: 61 REAR JEFFERSON AVE INSURER E: SALEM,MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: HIS IS TO CERTI THA THE POLICIESOF INSURANCE LISTED BELOW HAVEBEEN ISSUEDTO 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 (MKDD\YYYY) (MM\DD\YYYY) LIMITS GENERAL LIABILITY =ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE []OCCUR. REMISES(Ea occurrence) MED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY E PROJECT 0 LOC DRODUCTS-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 $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-513270121-13 03/20/2013 03/20/2014 LIMITS ANY PROPER IT OR/PARTNER/EXECUTIVE FN_1 N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 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 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR TAPE NORTH ANDOVER,MA 01845 wA. ° ~ ~ ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. u Unrestricted-Buildings of any use group which Massachusetts-�y?=rr!2.- ; 3 �"- �aY D"� ! LEo t contain less than 35,000 cubic feet(99 In?)of a .•._,ula?Cns and.a"'and contain enclosed space. icai7sa:CS-087977 . ERIC W PALM-' .: 3 HILTON ST SALEM MA-01970 - Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. sf. = For Dps ucensinginformation visit www.Mass.Gov/DPS 04!23/2014 License or registration valid for individul use only fj �osY� cues/�/ ap✓�f,, on before the expiration date. If found return to: Office ofonsumer` a�rsc;ga�Cness-R � Office of Consumer Affairs and Business RegulationQ-HOME IMPROVEMENT CONTRACTOR T - ' g Registration: , 142089 7rpe: 10 Park Plaza-Suite 5170 @ ; Boston,MA 02116 .6 Expiration: 3112/2014 Ltd LiabilityCorl�or ; TIC WEATHERiZAMON U-C. ERIC PALM i 61RJEFFERSON AVE `-; ,° Not valid without sign re SALEM,MA 01970 Underseeretw7 UnresWcted-Buildings of any use group which Y i3 ScDJ :ac c8 ?3'1' ??S?''Ci _b :'c_f cocain less than 35,000 cubic feet(99 In?)of i-fyC Board i; 3� �d� � �� �fa�crs a:�S a��a-us enclosed space. : Licansa:CS-087977 ERIC W PALM' 3 HILTON ST, SALEM MA-01970 r Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS lieensinginformatian visit: www.Mass Gov{OPS = N '�};G `ore' 04123/2014 _ License or registration valid for individul use only �fo „e�s �Q ✓n on before the expiration date. If found return to: Office o nsnmer -, Office of Consumer Affairs and Business Regulation I HOME IMPROVEMENT CONTRACTOR 10 Park Plaza-Suite 5170Registration• .,142089 Type: @ _ Boston MA 02116 Expiration: 3!1212014 Ltd Liabirdy Corpor i =,# AT C WEATFIERIZAMON L-LC. ERIC PALM .1=,•� ,� �-- 61R JEFFERSON AVE ,' Not valid without signs a SALEM,MA 01970 Undersecretar9 AC40REP CERTIFICATE OF LIABILITY IN D26/IDD/Y3 � INSURANCE 4//26/2013 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 NAME CT Construction Eastern Insurance Group LLC PHONE (508)651-7700 FAX o: 233 West Central Street A-MARIE INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A Arbella Protection Ins. Co. 41360 INSURED INSURER B Arbella Indemnity Ins Co. 10017 Atlantic Weatherization INSURERCNautilus Insurance Cc 61 Rear Jefferson Avenue INSURER D: INSURER E: Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBERMASTER 2013 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. ILiRR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MM/DD EXP YM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE Fil PREMISES E occu encs $ 50,000 A CLAIMS-MADE OCCUR 8500042816 /20/2013 /20/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYFX PRO- LOC $ AUTOMOBILE LIABILITY Ee BI EDISINGLE LIMIT 11000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X AUTOS BODILY 020015871 /20/2013 /20/2014 BODILYINJURY(Peraccident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ PIP-Basic $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 I` A EXCESS LU16 CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ 4600047820 /20/2013 /20/2014 $ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY Y/N ,Ry ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ C POLLUTION LIABILITY PL2003786001 0/1/2012 0/1/2013 LEA NERALAGGREGATE $1,000,000 POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 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 Rosemary Fulham/PIM, "'�'^"'� 'V '"' ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 rgntnnsi m The Af'rtpn name 2nri Innn aro renicferorl marlrc of Anion Rightfax N2-1 3/11/2013 6- 55 : 57 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE 3/11/6 /YYYY1 T TIFICATE IS ISSUED ASA 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAX 233 WEST CENTRAL ST (A/C,No,Ext): (A/C,No); EMAIL NATICK,MA 01760 ADDRESS: 22MLW INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B; INSURER C: INSURER D: 61 REAR JEFFERSON AVE INSURER E: SALEM,MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: IS IS TO CERTIFY THATTHE POLICIESOF INSURANCE LISTED BELOW HAVEBEEN 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 (MMIDDIYYYY) (MKDD1YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR. DAMAGE RENTED $ REMISESS((Ea occurrence) MED EXP(Arty one person) $ HERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY [:]PROJECT 0 LOC DRODUCTS-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 $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR Fj CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND XWe STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-513270121-13 03/20/2013 03/20/2014 LIMITS ANY PROPER ITOR/PARTNER/EXECUT IVEN/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 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 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR .TAPVE NORTH ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved.