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HomeMy WebLinkAboutBuilding Permit #166-11 - 175 MAIN STREET 8/25/2010 V BUILDING'PERMIT of rlORTKL!D TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO&K Date Received y,. Q�. ��SSA Date Issued: d 0 CHUS IMPORTANT:Applicant must complete all items on this page =',t,1hF`j.;S'�yP1". ',;c..y,;{�}- - - _ 'tt '...:•+a _ - R ,.^i�:� - : 'rf„p. V� . .t _ cr "'s ?��..r-,t;•'__ r .vim J .h`�_.. :1 tjy mfz::i'.[.,- - _.v _ r' . .,�. •'"13— IN _ .(,- `. _,. %�5:...c ..1.. _ c-.:lz-,,. y-�...._ .'d~.�••= .�F7 •'.''^".r l=..Yr. :.._ .C5• q `'ate. t:vi`Y1'i^�`: .;J;'. r::.r':'::L{-�... ,1 .::Y.:`2Y[ir_•�ti?_.:.-'=r•��='.�+M.,l:...'>L.... .I.�:.e _ tY.t! _\ ,`•...'"`'r.ST; '[.S h i r'SL• i-fst' - r_`[.. KL.=� �iv�i-�a-4> _ ,,.n - .smoea=• �:.:•i•.-- � -T �' `-� =�i"••i= fir- Y��- .r'"+-,. "Eta,"e• � .a n i F - _ .�xr --Y 7 J F ..y. 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K!Ftt ,�1 :;.t. !.C�x -y:,r��� tc,'r�:..9•-,� , 1�r ey..�':rv:-e,2.-q.4..f--.'"} 1.�r. .31 ,a'? .tel c.��r`��r`.:•..x�t�...:-,�¢;_���`��. -- j� :G"L. �.+.. f-'a�4-Y .�. :k,��£-rtnet<z��nxr?~r,�r�;•r�<i,-_�'���,.17�npz :r��g�T.?C S' .t�� ��r� �' ='� �4�y3� la�� �� I f� '��p Ti..,.F^. a,=�:� �,: ��L_..•�- a�,:.�_.� _ _ _.l?. IJa. •sem �s�;�:�' , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more.family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition_ Other r .tr;5i�.- ,ty I T•.x..". r r 4 "4 r-. '•��'s•S:�r 'v.� a i •-�,a 3r=_„- y - - •�c' >yrMr-y"S',`r.-c .z�r: '�%, .y •^'m`,y '-;�^;=,�'�::4K-_-y ..':;�,:>rr�i_.. ;:•-•:c'i �t �, �I r a � 1 S D B� t� 3. A-1- ';�,��x7�1JP I irJ7�`?* �?aS � •_F .. �Tr`'��, >, --aV ."x�. i 'p "� '"-°e .,S e;.�`., �5 � I�:e� {}`C_.;2•r._�-:'rr7?�d%x`s-'"s_.-r�i4?[� ?`�,'� �iR- .'��.%� .�f� 1.�.a�;Y•e:��'�`�-��.�r_-moi•`-��-ft'r�'?..e.��l�-•��r�.��� _"g:`tvt..^-.4 �.5`�.�.�{�.1�s1���-LV�t,�if gd�5c'a`> mss[-•' DESCRIPTION OF WORK TO BE PREFORMED: roo 0 v( Identification PIeas Type or Print Clearly) OWNER: Name:_51 l ve 50C jc- 4 " Ph-one: Address: j2t� ��-c�yjlZl fGfi�CG�� ' 1 "01 rm'_u;...ec�'T.-v�.. .._-cy,.,; _ _ L°3'w°,'. ,7s}w'"a°• r`+'2's+r''N'rL��s'i •y�y�,-F� '='9s 'vcM`dsss ai`Y` y, -+>r. 9i€F 'r ''P' �r= �a '_'dt<"%rr" k 7& *y�„ i ' �EY.{^,�,,,LH¢§'n " � -Q'.' 'y � h5� Gc p�'- U Tm.).. y��kr�f�`K` �� ��e''r +Sr ilSMr. 1 ij 1- {vu..`'(N_'aKM20101-1 3P" ��^f+:}"`'S'T1t5'` J.r " l£.� r 't' lLL-1 _'u"v M7 E �-+S![� � tih2�� Ye�yff� a� t s � ��,y'c"• � t r �`3. a - ,ri����.J-i '�� .. - 1' c k1Y �"' 5m,I Vf a� '?m4,t y.:..1 ai_,ny.e': •i `i"7 , M-1. 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',��•��u , J� ;.ryxe�.:r`:�•.!_DG.�z-:_�:• T..��a.7,-c.r,.sr:r��Y�f+rrut>s.:,�?m•`Y;�•;f•-2L'.c;Il��f`30+'L.•'•:-,�T3.r.,I:�:'4�-�s11'-rI�I'-�,'„a�=x'31cSL�''�.,rr�yi%.t,'br�.Lr4�.,'=u4'%k:,'n....�- a 1.e$ •rr- +/•.�.�aa'o•t.:,cr',��i,-.',"�”S=�;.,�xia';ynK�'_;-��ttv>,�r1".a-l;l'��'�1S�'�'�''�__r,'X'�.,�Zi�+"r,<..;rn;`�,iXre,''a':+�n'WiIf�]rs"'n''^:.'T°;�J9-'-`��z^"i'S3�7¢-��':_:.;��,.-r,•,i.''i.•�i.S'c_t[_-I •.__rI.-_!^.n=�''•=s"''?3-r_r:";y,,:v{t..=,:.,�,0`�".s3x'r-'<�;-",�,'rN.'^.�.a.r,.i�l ar,��f�`:'�1.�$� : ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLD/NG PERMIT.$12,00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Tota! Project Cost: $___ � 3 2 FEE: $ - Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th -an aureo# enYaniner Sgnatuie ofcorator _ ` � R J Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tann ing/MassageBody Art Swimming Pools ' .Well � e Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED- PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature C 0 M M ME N I S 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 lS gnature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street i 7ti "# .-if.� 5. ::iiY.f.}3.,— -y r• _ _ .'.::Y: .`..T_"�'t.'V':S:•aS::4.' - .411 l.Y.IM ..Tit`.=x .la^ Pi_T3ME#I�iT '�Te. .Di�;r 'slier: :yt- y s� 1 �,raw ! nsrt �zes_ . � r `sY:.i-- �„ _v�. _ - � 3'I c:` f:: .. -._ - ._ ._ :.. .- ...,��r;.:.. ..... ....-:.:_�._•-:r.:;.:_,�;�.:._...:�"-="T� 'tea:_ - .�L-ocated�at.�2�'�1 :_�. - _ - :�;':: .c:r -arc^ --%'rlr - _ .,•..:.._rr:�...r.. , :v->..,._, -.•t :mss - 4 ME { - s x�a�r��te• _ - ........... - a .F. - • "5 M '. L 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) i i i ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 i J 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 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 ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check.Energy Compliance Report (If Applicable) ❑ Engineering g eering Affldavlts for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit --New Construction (Single and Two Family) ❑ Building Permit Application ❑ 'Ceiif;ef Proposed Plot Plan. ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit j ❑ 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 Permit I In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the-building application Doc:Building Permit Revised 2008 f Location No. Date 46---,3() NORTq TOWN OF NORTH ANDOVER 0 9 a Certificate of Occupancy $ MUs t�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 � j " , Building Inspector SmartZone Communications Center Page 1 of 1 '4 SmartZone Communications Center woosterroofing@comcast.ne +Font size- Re: 173-175 Main St. From:Liz Fennessy<lizettafennessy@yahoo.com> Wed Aug 25 2010 2:31:20 PM Subject:Re: 173-175 Main St. =1 attachment To:woosterroofing@comcast.net,Brian Leathe<bleathe@townofnorthandover.wm> Hi Stephen, Thank you for submitting a thorough application so quickly. Attached is the exemption form for 173-175 Main Street.This should be all you need to get a building permit,from a historical standpoint. Please let me know if you have any questions. Liz From:"woosterroofing@comcast.net"<woosterroofing@comcast.net> To:lizettafennessy@yahoo.com Sent:Wed,August 25,20101:39:05 PM Subject: 173-175 Main St. Ms.Fennessy, Thank you for calling me back this morning.I dropped off the forms in your mailbox this afternoon,same time as the postman. Call me if you have any questions.You can E-mail me back or send it to the building department or I can swing by and pick them up or the U.S.mail. Thank you Stephen Wooster MSVNCDC Exemption 173-175 Main Street 082510.pdf 83 KB http://sz0126.wc.mail.comcast.net/zimbra/h/printmessage?id=51420&xim=1 8/25/2010 r O q �tORTI} Town of North Andover } :' Machine Shop Village Neighborhood Conservation District Commission 1600 Osgood Street North Andover,MA 01845 s•.t[Ntls Application For EXCLUSION From Certificate to Alter Certain alterationsare excluded from review by the Machine Shop Village Neighborhood Conservation District Commission in accordance with the.bylaw. Applicants for exempt projects must fill out the form belowand submit to the Commission Chairperson(contact info below). Date: --�r b-S/)I T Contact Name&Address: Project Address: l 3 +l�� i/ ��� • : A4.9 Project Description(attach additional pages,if needed): nc��A '�O/ er .•cd cz r'r�D .3 �` � 3d �' Exclusion From Review Requested For. ❑ 1.Interior Alterations existing conditions including materials, design and dimensions. ROO� ��a L� Ll2.Storm windows and doors,scteea I t kt Ma'lCriA P W windows and doors. ❑ 9.Replacement of existing Substttutr S doors,substitute siding or substitute ❑ 3.Removal,replacement or installation of windows with new materials that are gutters and downspouts. substantially similar to the existing condition- ❑ 4.Removal,replacement or installation of window and door shutters. ❑ 10.Replacement of original fabric windows or doors with substitute ❑ 5.Accessory buildings of less than 100 windows or doors that maintain the square feet of floor area. architectural integrity with respect to form,fit and function of the original ❑ 6.Removal of substitute siding. windows or doors. ❑ 7.Alterations not visible from a public ❑ 11.Reconstruction,substantially similar in way. exterior design,of a building,damaged or. destroyed by fire,storm or other disaster, 8.Ordinary maintenance and repair of provided such reconstruction is begun architectural features that match the within one year thereafter. •�en•vnnn n___. n.__..__.r.+____t:_r._______. nn.-,.__e..___. •e__.._r_____�.�_._t__ __._. nnn eno nme M� KORTH 1 Town of North Andover Machine Shop Village Neighborhood Conservation District Commission ��a•,.o•s� 1600 Osgood Street North Andover,MA 01845 s� Application For EXCLUSION From Certificate to Alter For Items 9,10 or 11,provide the following documentation: Photos/drawings of existing doors,windows or siding,as applicable Description/Catalog Cuts of proposed materials to be used for doors,windows or siding Plan and elevation of reconstruction for Item 11 Determination: AKUMpt This project is determined to be ❑not exempt from review by the Machine Shop Village Neighborhood Conservation District Commission. Projects that are not exempt must complete the Application for Certificate to Alter, available from the Building Department and be reviewed by the Commission. Dete 'on made Signature Neighborhood Conservation District Commission �S Date MSV NCDC Page 2 Ciurent Chair:Liz Fennessy,77 Elm Street,lizeWennessv@vahoo.com.978-688-2915 � ORTIy ovm 0f Andover 0 No. t LAKE -O dover, Mass., O COCHICHEWICK y1. 7d ADRATED SS BOARD BOARD OF HEALTH PERM IT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..................5..,.�UAO............ L' +lY. ................................�.............. ........ Foundation has permission to erect........................................ buildings on .I�3... I' ................!��!!f........ ...a...... Rough • t0 be OCCUpled aS........5......... ......... ....... Chimney ............ ....................................................................................... provided that the person accepti g this permit shall in every re ect conform to the terms of the application on file in Final 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 cow PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTR STARTS ELECTRICAL INSPECTOR Rough ....... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. d ' •� Oat/06/2008 03:55 FAX 9789373927 WOOSTER ROOFING [ 001 WOOSTER ROOFING PROPOSAL ALL TYPES OF ROOFS DATE: 7/28/10 &ROOF RELATED ©� SERVICES Always Hand Nailed Liceuse Numbers: Charlie and Steve Wooster Construction Supervisors 54268 - 1.888 ROOFIN-1(766-3461) Home Improvement Contractor Main.978 251-7181 Registration 100712 Serving MA&NN since 1984 Fax:978 251-0159 cats For Our References Proposal Submitted To Work To Be Performed At Name Alan - Name Sturhridge Ams Company Name Silva Aaandates Company Name Street 12 is Main St.-# 121 Street 173-175 MninSt. City Tie1YMau State MA Zip Code Olg7 City No_Andover Mate MA Z p Code s Home# Mobile#603 505-6850 Work#279§58-3500 Fax#978 858-0145 We here reose to furnish the materials and rfornl the labor nece for the com letian of the followin 'ob. Strip both roofs to the roof deck. I. Renail any loose decking and replace any rotted at$2.00 per foot. 2. Install white dripedge. 3. Install 9'of terrace ice and water barrier on alt eaves. 4. Paper remainder of roof with Grace Tri-Flex Xtreme roofing underlayment. S. Install Certainteed Landmark Woodscape 30 year shingles,hand nailed. 6. Install new pipe flanges. 15t- 7. Install new hood vents. 8. Install new lead flashings on chimney. "D 9. Clean and dispose of all debris. C Ldp Workmanship aranteed for 10 years.We are fidly insured with workers'compensation as well as Habil' insurance. Please return copy of proposal: -Alt material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications submitted.All work will be completed in a substantial workmanlike manner for the sum of Dollars($32,504.00), with payments to be made as f ow :Job paid ups comple 'on. Respectfully submitted Note-This ma be wl us if ao acc tcd within 30 da ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satistbetory ereby accepted.Y u authors djAe crit tied O 1 6 Payment will as outli abs . Date g�� 7—a��1 signature Mailing Address: P.O. Box 8051 -Lowell, MA 01853 Location:5 Wob n Street-Tewksbury, MA 01876 E-Mail:Infa Wooster-RooSn .com Wet�site: Woo r-Roofln .Cot11 /3/25/ 010 11 : 09 : 39 AM 8982 12 02/02 DATE(MIvi/DD/YY10 LIABILITY INSURANCE /25/2010 CERTIFICATE OF LIA o3 THIS CERTIFICATE IS ISSIIED AS A NATTER 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 CMkT McSweeney & Ricci Insurance NAME. pu Agency Inc (cct. Ne. Ext): (Nva ■.): P O Box 850984 ADDRESS: Braintree, MA 02185 USTa en wIw. USUMDIS) WFORDING COrERAOE RAIC R as.era A:A.I.K. Mutual Insurance Co Charles J Wooster nTsmm A: dba Wooster Roofing XESV=C: P O Box 8051 INSURER D: Lowell, MA 01853 TNERRm E: LNERNm r: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER, THIS IS TO CERTIFY THAT TIM POLMCffi OF INSURAMCE LISTED BRUM SAVE 8E301 ISSUED TO THE INSURED MANED ABOVE FOR THE POLICY PERIOD INDICARSI). NOTWITHSTANDING AMY MVIREMENT, TERM OR CONDITION Or ANY ODSTNACP OR OTHER DOCOMSXT WMX RESPZCr TO WHICH THIS CBQTM=TS MAY BE ISSUED OR MAY r PERTAIM, TM INSURANCE AFFORDW BY TM POLDCINS DCSCR' IBMD Son= IS SVSMVT 1O ALL TB=Tom, MACLDE=NS AMD COMDITlONS OF SUIS POLDcIBS. LTlIITS SHOWN MAY HAVE BEEN REDUCED BY PAW CLAIMS. iL.�ez TYPE OF INSURANCE POLICY MER POLICY EFF PGLICY MW Waa/tnTM LIMITS GRMERAL LIABILITY Each 0CCU1=CE 6 nCQHERCIAL GENERAL LIABILITY DIRGE TO 10•J1E0 PROILSE S(6 n.o oaaae nae) ❑❑CLAIM6 MADE �OCCOR IIISD Ba (Any one person) S PERTOMAL c mV Ialm(Y i MmRAL SOUREGME S GEN'L AGGREGATE LIMIT APPLIES ER: ? ❑POLICY EIPROOECT❑LOC PRODUCTS-cmw/NP MG B S AMI MMEXLE LIABILITY CORnaD SINGLE LIMIT (ea aoaldenc) i n-AUTO -- BODILY IMIURY (Der persa:) S ' EIALL OWNED AUTOS nSCEEDUf.ED AU'I03 BODILY DQURY(Dae aeDld-0 S ❑HIRED.A0105 PROP DAMAGE i (Der aucleent) ❑HOA-BRED AUTOS i 6 []...AL. n OCCUR - EACH OCCURRENCE i El----LIAR O GLADES MADS !O®EOATE B nDEDUCTIB LE i �RETEarxoA 6 6 WORMERS COMPENSATION AND E LOYMaS L33UM TY THE PROPRIETOR/PARTNERS/ E.L. EACH ACCIDENT i 1,000,000 A EXECUTIVE OFFICERS ARE ❑ incl ® excl 701021201200910/17/2009 10/17/2010 E.L. DISEESE-EAE)PLOIEE i 1,000,000 E.L. DISEASE-EA EMPLOYEE i 1,000,000 CON®TS I DESCRD)TION Or OPERATIONS OR LOCATImi: CHARLES J WOOSTER IS NOT COVERED BY THE WORKERSICOMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION EVIDENCE OF COVERAGE SHOULD ANY OF THE ABOVE DESCRt POLICIES BE CANCELLED BEFORE THE EXPIRATION DAM TM)EOF, MOTXC'M WILL BE DII.IV=ED IN ACCORDANCE WITH Tim POLICY PROVISIONS. AUTHORIZED 02PRBSEHTATi9E�C `- 9980 -rom:Diana Santadcas Fax1D:McSVeeny Mcd Page 2 of 3 Date:31*25=10 08:26 AM Page:2 of q�p 703"4/M21DSDNjy1yy0 CERTIFICATE OF LIABILITY INSURANCE WOODST 1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McSweeney & Ricci Ins Ag Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 420 Washington Street HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR P.O. Box 850984 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Braintree MA 02185 Phone: 781-848-8600 Fax:781-843-8807 INSURERS AFFORDING COVERAGE MAIC# ISTD INSURERA: .Arcadia Insurance Companies Charles J. Wooster dba Wooster INSURER B: safety Yndemity insurance Co Roofing INSURER C: Charlie Wooster LPO owell �M 01853 INSURER D' INSURER E: COVERAGES 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 MID CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER DATE(NMR 8 YY) DATE IYYYY) LIMIT'S GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CPA0083583 10/17/09 10/17/10 PREMISES(Ea occurence) f 250,000 CLAIMS MADEX❑OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 X Per Project Aggre GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY P1ECT LOC AUTOMOBILE LIABI nY $ COMBINED SINGLE LIMIT f ANY AUTO 5053629 03/21/10 03/21/11 (Esaccidenq ALL OWNED AUTOS BODILY INJURY S1,000,000 X SCHEOULEDAUTOS (P-person) X HIRED AUTOS BODILY INJURY $1,000,000 X NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $500,000 GARAGE L IABILRY AUTO ONLY-EA ACCIDENT f ANY AUTO OTHER THAN EA ACC f AUTO ONLY: AGG f EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE f OCCUR M CLAIMS MADE AGGREGATE f f DEDUCTIBLE f RETENTION f f WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORPARTNERYEXECUTIVE ❑ E.L EACH ACCIDENT f OFFICERi EMBER EXCLUDED? (Mandatory In NH) ELL DISEASE-EA EMPLOYEE f IT yes.describe under SPECIAL PROVISIONS bebw E.L.DISEASE-POLICY LIMIT f OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEM OU I SPECIAL PROVISIONS The Workers Compensation will be forwarded to you under seperate cover by the insurance carrier as per Massachusetts Pool Performance Standards agents are no longer allowed to issue certificates of insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION EVIDEM DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAI. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAME)TO THE LEFT,BUT FAILURE TO DO SO$HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KID UPON THE INSURER.ITS AGENTS OR Evidence Of Coverage REPRESENTATIVES. AU1H REPRESENTATIVE ACORD 25(2009101) 0 19M2009 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD a '� �slie Off e o onsumer A aiqra ndusinessegulatlon - 10 Park Plaza - Suite 5170 «. Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100712 / Type: Supplement Card -. CHARLES J. WOOSTER ROOFING. Expiration: 6/23!2012 STEPHEN WOOSTER 525 WOBURN ST h TEWKSBURY, MA 01876 Update Address and return card.Mark reason for chane. Address ❑ Renewal ❑ Employment F-] Lost Card DPS-CA1 0 50M-04/04-G101216 MOM Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100712 - Type: DBA ti Expiration: 6/23/2012 Tr# 299388 CHARLES J. WOOSTER ROOFING Charles Wooster P.O. BOX 8051 LOWELL, MA 01853 Update Address and return card.Mark reason for change. E] Address [] Renewal Employment Lost Card DPS-CA1 0 50M-04/04-6101216 Massachusetts- Department of Public Safety Board of Building Regulations and Standards Construction supervisor License License: CS 54268 CHARLES J WOOSTER PO BOX 8051 LOWELL, MA 01853 Expiration: 5/11/2012 t'ununissi,,,tt.t• Tr#: 28341 I