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HomeMy WebLinkAboutBuilding Permit #698-2016 - 161 HILLSIDE ROAD 12/8/2015 BUILDING PERMIT NORTH TOWN OF NORTH ANDOVER 02 y� `_ _ b o� APPLICATION FOR PLAN EXAMINATION01- del Permit Not#. 0 Date Received �ySSgrEous���y Date Issued: Z CH IMPORTANT: Applicant must complete all items on this page e LOCATION; _l �. _ S 1 1 P.nnt J PROPERTY OWNER _w v. Pnn 100 Year Struc'uce yes nor i MAP' 02 PARCEL /=ZONING DISTR.I`CTHistonc District ye no - -- Machine Shop Village yes. no; TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building BKOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑`Well, ❑ Floodplain' 0 Wetlands ❑ 1Natershed District Water. er DESCRIPTION OF WORK TO BE PERFORMED: r `2 t itis l Id n fiyonjil;ease T peorPrintClearly ��OWNER: Name: Phone: > Address: Contractor NamePhone: - - Email __..-. _ Address:_ . _-✓ - 6 `�-.. LL Supervisor's Construction! License:'��o?d f f Exp. ®ate: Home Improvement License: - �(��.1 �_ __ .. __Exp;_ :Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $da (/4 .3 _FEE: $ 15 Check No.: Syl Receipt No.: L� NOTE: Persons contracting with re rAt "virLactors do not have access to the kuaran nd �Signafure of Agent/Owner _ Signature of contractor Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I 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 Permit Addition Or Decks ❑ Building pp Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerics office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email I Date Time Contact Name Doc.Building Pennit Revised 2014 Plans Submitted ❑ Plans Waived.[] Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street .IFIRE f,DEPARTMENT -TempDumpster o,n,sife, yes Located,at 124Main Street �'*� ` Fi.re.Departmen`tsignature/d`_ate, C011�I�1,:.yNTS, Location No. U Date • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ _ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 2 f 3 Building Inspector NORTH Town of EAndover . 0 zol - h r h ver, Mass, 2A5 A COCMICMl WICK y1. �L1,9 °R�rEo ►�fa,��(5 S U _ BOARD OF HEALTH Food/Kitchen PER T LD Septic System _ _A THIS CERTIFIES THAT ..............:_........... ... .:• ....... ... . BUILDING INSPECTOR .. .........A ........ ...... Foundation has permission to erect .......................... buitdn`s on ..�.. ..`......... �. . .�r........ .�............ Rough to be occupied as ................ ..... ..... ..llrws ................................... Chimney provided that the person accepting this permit shall ' ery respect conform to theterms 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 CONSTRUCTION ; ;ART , Rough Service ..................... ....... ................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. IS- next step living® home energy solutions This agreement is made by and among Next Step Living, Inc.("NSL") Linda Borland 21 Drydock Avenue,2nd floor 161 Hillside Rd Boston,MA 02210 North Andover, MA 01845 phone: (866)867-8729 Site ID: 425716 16-Oct-15 1. DESCRIPTION OF WORK TO BE PERFORMED NSL will perform or cause to be performed the following work on the customer's address above,in a professional manner and in accordance with the terms of this Contract, Including the attached recommendationstwork order describing the work in detail(the Vork")which are incorporated herein by reference.Pricing reflected below may be subject to adjustments in program pdclng and offerings and is guaranteed for 30 days from the date the Contract Is printed.. ,Description Quantity �Air Sealing Recommendations $1,020,00 Work Location: + Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 12 $85.00 Hr $1,020.00 RecommendationsWeatherization Work Location: Slope Attic Slope Enclosed Cellulose Dense Pack 6" 184 $1.86 sgft $342.24 �Y�Ck Ld�atlr�n Walt L '< � �- s r fi r ,� � ,>✓ s r a, ✓ ' 0 f�1+>3fin R ..�:: �} 6!`4 'p ✓ 't-'_ 'f.�l1*o,_. Grt p. T� a s.>t' o>s� {..! fi r` f $ tt R t ✓ ,y t� ,. r.. Insulate Vinyl Sided Wail With 4"Dense Pack Cellulose 678 $1.85 sgft $1,254.30 Work Location: Knee Wall Install 2"Thermal Barrier Polyiso on Open Kneewall Slope 332 $3.50 sqft $1,162.00 •(' � 1t - h ? zr a�'+ yra t t��E .+' .?h+ o u,•. �> ? -- ✓,. i a",!'r� t. } y '�. lCrstgll��The�malBa�rrerP$lym;3aoh;�j����rlkneetivallSlo)�e<, x� ;,°�t 46�� � $3��O,,t�` ;�s�gftk, � $�61�OQA Install 3.5"Fiberglass Batting In Open Kneewall 50 $1.32 sgft $66.00 Install 6"Fiberglass Batting In Open Kneewall Slope 332 $1.80 sgft $597.60 j .. .S .R, �.L,.A ,..•'.. .. c.r t.. ... .a;w� .G�3'ti _ ,�,+&: ,y, .:s aR,> ,�. -� A r.v4-n t.;t': Temporary Access 5 $85.00 Each $425.00 4.rh u, y. ✓ ° 7,„� .5 t °.ez q..4. - L, Y^tL+; Work Location: Foundation Insulate Rim Joist With 2”Thermal Barrier Polyiso 194 $3.70 sqft $717.80 ,4. "}. r J. \, iJ ,;.1, ".i 1.�. �p.,n R^ -.4 v4 �ltF(��i�•.��,y Door Weatherstripping w1 Sweep 2 $75.00 Each $150.004 Initial Investment: $6,290.35::, ..« i .0 l..,.i.,., ��� ..*:'C:?. ..4'.5.4. �� . { A' Y ix, �' a 9.... ?.�✓�i,ri�rtr�'.y A ,i 4 2 r^ Y 'Customer Sig ature Date 16 Oct 2015 Edward Yaracz NSL Signature Date Name of NSL Representative A1322350 The Terms of this Agreement are contained on both sides of this page Next Step Living 21 Drydock Avenue^2nd floor o Boston,MA 02210 0(866)867-8729 o inquiry@nextsteplivinginc.com a www.nextstepliving.com `i[yC3llpa Ca(�f,E�l�!_4eG�z�au�! 3. fjtC)'C35GL.-SIARt E ANS'� M' T�Oi\3C[f[y"��LG NSL CJ l'conieCi custorner to Wncdule the lblog,at c;En uall+;agracaU0 frilly iiiG1. Ie.t sf c �r,'xk rn'r'd ins' a)�•„lc i"�IL•(i 5:.0 Ui`tfo..tL.�0:'"!1c'te.la.S, 't_ 'G-c,d� wSai:Stacl'c` to tic sJ::ather.,.cti'.cl,e'Jenic I',SL'. c'-'..".,.. c., CONTRACTOR REGISTRATION Massacilusetty law requirec home improvement cortirac ors ariC':5ur7LCiltFadiOrz'r L"e K: fsterB'LJ!t1 tJe Ca41'ector o'i!-lofiie lr'r!provenieii':ontrac'toi I�Cgiistiation. You may may inquire about contractor regisiration by Utlllil'lGc( fiiinC i� at(�wtouvior Fryli"c 0[..-cV!t l�!u�rae..€iCG�pLliatioii;Tofu I avl, n ( IS 74, 5. PERMITS Ie! TAY he responsible.for obtaining ani eress-,n.r pem* as L r:C'usto..'re`'s c:gert. C storoe?'Nrt°"•ceolwr their oUul pn-•[;flit`c-dinar lr?itii ar unregistered contractor wil:be e;ciude;d Tian Uf vl!aran h,Jil pFCIOSioia ^. !C I Iwi ;ipy. +.d i •.?e�U.mJctUi s.dLi. F. PERFORMANCE OF THE WORK AND CtJANGES. ;'.1 NSL wil!riot commend;;tic 14(ork prior to signing this Agreerileni and t ansrnittal of cop!'o-.`!Agreementto vie.Customer. .2 !tats,1e.rPer+i2ni me lr 4 e Sup(fen icnieCf,of ier1d80;Or G tDdiileCi f:rl'b;` i'iC i?1pil!a(c;grCri}iC:i lr t.'r 1 tc:l.la!"C?G',.IVO Si}pi'1!:ii,9i ll;orl?Elldl rleiTi,0 S �. !e t E 5 n•.rn a iilJdeficat once of thi AgrGeiTr�1t shall J finding unless it( in W'riivn uud'sign'cd ll:al,jJarties, CS.', At times,NSL's weatierization tenni discovers situations in tie-s'ir C4cture,during; he cour3E of eix,VIi0ri;'tihal't indicate"'a ri5i(for E.healtdh or safety concern for residents.Such Conceins cart include.•but are not limited to veniiiaton,potentialhr hazardous ialaderials Sud-1 a£°liioid Ur asbes'ios,Or stl'ucimm; Concerns. in tie case of Ihealta or safety concerns being identified,NSL reserves vie rigi'it,per section 9.2 of this contract,is^v cornraurlicato xncern5 io the Customer and halt VFod",!nail such cancers have been addressed. C.CThe rebates and i cer'vos available fonn i�e Masa S-,)lS'@'U`r(Energy S.'rarvicss, a- Crl:£ an"'. due.G elc!_totoror are,based, on the best estimate Of lite 51Lhia Tulp Il'i Ile SiI'uCiufe by the NSL Ih0fale energy`advisor. However,at bifreE our WOatrL'dZatlUfi iearrl discovws situations in fns• -10?-ne during&IC course of't ie Worl(that inipact the availabiliii-of febaies c?I'tG incan'iiire5''tri;;lite M€:s£'Save ProgFarl In such 5iWa{lons,NSL Will a3rnmunicate Such dial fpw to the Liusion'ler,inciudilly ant;`impact On,arnr'+Lrft tiic'CC? 't0 torr'we rdi be e)lpccted to pay for the lillork. 7he Custorriei wii! .`ie.?UC'u'fe OpUOih tU rel front t1C l;f,il Fa,_�the�Ntoi:sien'ients ti?€i i'3eeL'alfllEStiii�^-,-37;0:'<oi tri;c.sepamtG-contraci'ior ps'!ioiTrlirlt,, ''!e c"IdJuSCe.i 6"rorl:, 6.66 NSL represents and warrants to tihe Gustorner tia't(a)the rnate,hc^:lS and.GquipinGnt fur,IISiKrt Widertdi Agreement will he of good qualify and neut', (b)'�Kiat lite.Wort(will be free from defects,and(c that the Won,,will conlanil whir tate descripki ,,.of th,:Wort:descdberi.in Pafagrap,•i. 6.6 NSI.May deternilne in'iiie course of pre-insialiaiiori Techriicaf Revielfv'that rr!odiiicall0n;".are necessary to Rsa scop c of tlUorl:if:c+rder tc ensure professional qualify of they installation. In i the event of such n1odilications,l'6L will requesi a wrii:ici7 ioadittca'tion Oi UiG Agreement to be signed by alt parties.In the event that Customer and NSL cannot agree on the modificaiion,i'tc Acreerne!r may be terhiinated b',r either pariY. 7. INSURANCE AND REGISTRATION NSL represents and.warrants to the Customer that it has a valid Horne Improvement Contractor Registration(No:152111)and the necessary insurance required by applieabic law and normally maintained by:prudent contractors in NSL's Heid,including,but not liraiicc;to,tNcrkers Compensation Insurance for all employees who will perfol7ri the Worl(. E. QUALITY OF WORK. NSL agrees that the Work will be performed in a good and workmanlike manner,and fiat NSL will repair alio;replace,at its own expense,and promptly upon Cusiorner's re.-quest,any defects in workmanship and materials provided by NSL which appear up to one year after cornplet'iort(i the Wari(or within any longer period as perrnitted or required under applicable law,provided NSL has received final payment as provide[herein. 9. PRE-EXISTING CONDITIONS a",PROPERTY PROTECTION 9.1 NSL shall not be responsible for any damages as a consequence of the Woric per for lied in the home due to pre-axisting.conditions. These conditions include but arc not limited to poorly fastened or broken drywall,moisture damage,non-code c-onsiTuciiorl.cracked or fiagile siding,or shingles,old pipes and fittings,rotting wood,etc. 9.2 NSL reserves the dghi not to perforiiii Work upon the discovery of asbestos,mold,or any otlier potential health risk(to the Custorncr. In this event,the Customer is responsible ibr rernedying the at-risk situation,including any necessary removal of hazardous materials and all bilis for services to date shall be paid immediately. Worl(cannot resume until remediation is complete. 9.3 While NSL will make best efforts to protect any property of Che Customer, it is the Custorne!'s responsibility to remove or protect,including dust protection,any personal property including the home itself. NSL will not be responsible for damages to or iosses of any of the above mentioned property not properly protected prior to the commencement of the Work. 10. GENERAL PROVISIONS. 10.1 NSL reserves the right, the extent permitted by applicable law,to have,file or maintain a mechanic's or material men's lien,or to file a notice of intention to lien,and to take any other steps to perfect and enforce such a lien,if Customer fails to pay NSL as provided herein. 10.2 This Agreement shall be construed in accordancc with the laws of the Commonwealfti of Massachusetts. 10.5 This Agreement forms the complete integrated agreement between NSL and Customer. "1 the parties represent and warrant that in executing this Agreement,they are not relying on any representations,warranties or terms other than as expressly contained herein. This Agreement supersedes all prior agreements between the Customer and Contractor and may not be altered absent a,subsequent written agreement signed by both parties. 11. ENERGY BENEFITS. The Sponsoring Utility Company(the Utility)is entitled to 100%of the energy benefits associated with all Energy Conservatio=n Measures,excluding the value of energy cost savings by the Customer,but including all rights to all associated ISO-NE Energy,Capacity and Reserves Products.NSL agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products. 12. NOTICE CONCERNING SPONSORSHIP. 12.1 Customer understands and acknowledges that NSL is not an agent,vendor or sub-vendor of The Sponsoring Utility Company(the Utility)with respect to the installation of an energy efficiency measures.In the event of the failure of an energy conservation device to perform as expected, Customer's sole recourse is to Contractor and not to Conservation Services Group(CSG)or to the Utility.The Utility and its operating companies shall not maintain,remove or perform any work whatsoever on the energy conservation measures installed. 12.2 Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have consented for Contractor to install the proposed energy conservation measures. 12.3 Customer agrees that it shall not hold CSG,the Utility,their affiliates or operating companies liable for Contractor's to perform its obligations under this agreement,for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 13. LIMITED TIME OFFER. The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Nome Energy Services Program offers. 14. CONTRACT CANCELLATION Under Massachusetts law,you rhray cancel this agreeraaont if,it has been sigymd,by a parftr thereto at ai place other than an address of uhe se9Ger, whicii may be hos mah-,office of a Wan6i thereof,provided you no€ills the seller in writing at his main office or branch by ordinaalr nmil pasted, by Gas.,or fav c-rrialf sent or by deliveryy,raot later Than midnighi of tGtic uliwd business dal;Following tGhc r,l€fwl ftgi of this agreerlaen'i, i Plainview Diagram Customer iW� Borlo&A Advisor Name: E�Wara Y�rotZ Address int ii-ms:4e, R4 Advisor Phone #: l•5-7 Town NAny limitations to access by truck? Site ID Wl5.'116 'No' NOTES Any work scoped outside of Best Practices? v/oll t AIS tApproved by: 6� Z" Po� 'w,s} y C. �� 1 kers FGAai�lzo� Accm 5 z �"p P rhe l\ P►t\, SloPe 1841 >/ W QP Ce\\ Vinyl \405 P0\1 KWstoPe, b�1 F G3 2^ fm Dormer q n Z :b _ F G9 s' �, HT 4 I 1'SI �'i 5 titwsG . D -- SW Qor^.er �0 glntk �7ao_ N'1� SHrt LQ��J The Commonwealth of Massachusetts Department oflndustrialAccidents a I Congress Street, Suite 100 Boston, MA 02114-2017 kv ti ww.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aualicant Information Please Print Leeibly Name (Business/Organization/Individual): Next Step Living Address: 21 Drydock Ave City/State/Zip: Boston MA 02210 Phone#: (866)867-8729 Are you an employer?Check the appropriate box: Type of project(required): 1.Q✓ I am a employer with 850 employees(frill and/or part-time).' 7. ❑New construction 2.M I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8. n Remodeling 9. ❑Demolition 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.�✓ Other Weatherization 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL C. 152,§1(4),and we have no 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 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 the policy and job site information. Insurance Company Name: A.I.M Mutual Insurance Company Policy#or Self-ins.Lic.#: AWC-400-7030025 Expiration Date: 9/30/16 Job Site Address: 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 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 stat me may be forwarded to the Office of Investigations of the DIA for insurance coverage verification_ I do hereby certify under the pains d p/ alties ofperjury that the informationprovided above is true and correct Signature: 'tel. Date: 1 O Phone#: (866)867-8729 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#: NEXTS-1 OP ID: EL CERTIFICATE OF LIABILITY INSURANCE DATE09130/2015Y) 09/30/2015 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(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 McLaughlin Insurance Agency NAME: 828 Lynn Fells Parkway PHONE No, o Ext:781-665-2775A/C N,:781-665-0295 Melrose,MA 02176 ADDRESS: John E.McLaughlin Jr. INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Nautilus Insurance Company 17370 INSURED Next Step Living, Inc. INSURERB:A.I.M.Mutual Insurance Co. ,M Avenue,2nd Floor CI B INSURER C:Commerce Insurance Company Boston,MA 02210 p y 34754 INSURER D:AXIS U.S.Insurance Company 15610 INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE DLI BR POLICY NUMBER MM/DDPOLICY/YYYY MEFF PMIDCD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FRI OCCUR ECP2010198-13 09/30/2015 09/30/2016 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ee aBINEDiSINGLE LIMIT $ 1,000,000 C ANY AUTO 15MMBGKKDM 09/30/2015 09/30/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED X HIRED AUTOS PROPERTY DAMAGE X AUTOS Paraccident $ X Comp$1000 X Coll$1000 $ UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000 D EXCESS LIAB CLAIMS-MADE ELU783547/01/2015 09/30/2015 09/30/2016 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N TO BE ISSUED BY CARRIER 09/30/2015 09/30/2016 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 D DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) FOR INFORMATION ONLY CERTIFICATE HOLDER CANCELLATION INFO-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1�Ido VVV ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ==( glteOffiacemo�onsumerAff4( n 10 Park Plaza e Suite 5 170 �;• �� Boston, Massachusetts 02116 Home Improvement Contractor registration Registration: 162111 Type: Supplement Card Expiration: 1/14/2017 NEXT STEP LIVING INC. ROGER OUELLETTE _ - 21 DRYDOCK AVE. 2TH FL BOSTON, MA 02210 Update Address and return card.Mark reason for change. Address F] Renewal 0 (Employment ❑ Lost Card DPS-CA1 0 50M-04104-G101216 ,,. :Jlie tram rrea�w�ec�(�r ���. -Gt'aaeac���lta ( Office of Consumer!affairs&Business Regulation License or registration valid for individul use only E` 7 HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: t ).�P' Reistration: 162111 Type: Office of Consumer Affairs and Business Regulation 9 10 Park Plaza-Su to 5190 Expiration: 1/14/2017 Supplement Card Boston,MA 021 6 NEXT STEP LIVING INC. ROGER OUELLETTE 21 DRYDOCK AVE.2TH FL BOSTON,MA 02210 Undersecretary /rf o_tvalid without signature Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Suptr%isor Specialty r` F License: CSSL-102911 ROGER A OV IId1LE TTj r, 55 STA ®RIE ROAD.. WaTr dek RI 0280 Expiration Crxnrtiissionei 0911312016 Restricted To: CSSL-6C e lnsulation Contractor Failure to possess a current edition of the(Massachusetts State Building Code iscause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS