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HomeMy WebLinkAboutBuilding Permit #300 - 176 FRENCH FARM ROAD 10/14/2009 BUILDING PERMIT o "°oT 6 TOWN OF NORTH ANDOVER �? b ..''. •_'.�° 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ,04ATED �SSAGH1`��� Date Issued: `D IMPORTANT:Applicant must complete all items on this page LOCATIONi C P PROPERTY OWNER <.A r--,(Z.<) Print Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no ©C)(, Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family V Addition Two or more family Industrial Alteration No..of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identiification Please Type or Print Clearly) OWNER: Name: Phone: Address: 1 �� f��cL� ���"4l CONTRACTOR Name: " 0 2�1 '' s" Phone: 917,99176-A7s^ Address: < Supervisor's Construction License: C.9 j 2 O Exp. Date: 3 / :2 ° tt Home Improvement License: t ` �' 571? Exp, Date: I`I it ze lei ARCHITECT/ENGINEER Phone: i Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ S Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund j LSignature of Agent/Owner Signature of contractor -�� i I i 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. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS I I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS w 3 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 FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 j DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA– (For department use f� I I ❑ Notified for pickup - Date _..........._..._.... ............... ._.......-. — --........ .......... . _._......................._._.__. Doc.Building Permit Revised 2008 Location . e,-, t No. Date to - /Y,- TOWN `TOWN OF NORTH ANDOVER f 9 ,. Certificate of Occupancy $ sACMUs<� Building/Frame Permit Fee $ J/L Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # - 22529 `Building Inspector NORTH ® of 4 - __ o z= A K E dover, Mass., COC HIC HEwICK �� ORATED PPS\ �C.1 `s BOARD OF HEALTH PERMIT T D, Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........�i../.1 ..... ....................................................................................................................... Foundation has permission to erect........................................ buildings on .f 71/ ........ ... ... ....... .. . ........................... Rough to be occupied as....�� ... . .. . . . . o Chimney . . . . ... ... .. .. . . . . . .. . . ... . . ........................................................................................................ provided that the person ccepting this permit shall i very respect 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS 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. Q&IL CO E)13 M �Mm� E) (D Chimneys Residential & Commercial Roofing All Types Of Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work Mass Toll Free Roof Leaks Experts *1 Licensed & Insured 1-800-WAIT-4-US ® Locally Owned&Operated Since !976 =' License#034200 (924-8487) IKO czee *"Vem or 1qolsn We Work Year Round Proposal To: Ellen Ford Date 9/14/09 Street: 176 French Farm Rd. N.Andover, MA Roofro osal P P 1. Strip all shingles from entire main roof and ga- 15. Shield Pro Plus extended mfg.warranty.Fully rage, etc. transferable 100% coverage for stock and labor 2. Re–nail any loose or lifted plywood. for a full 10 years,included in this proposal at no 3. Any compromised plywood will be replaced at an additional cost. additional cost of$40.00 per sheet. 4. Install heavy gauge 8"aluminum white drip edge Total cost: $ 9,600.00 to all eaves and rakes. 5. Install 6' of IKO Armourguard ice and water shield along all eaves. 6' MA state code. 6. Install all new pipe boots. 7. Above the ice and water, install heavy 301b felt Balance due upon completion base sheet. 8. Install IKO Cambridge AR-30year architectural shingles to entire roof and garage, etc. Referrals available upon request 9. Install new GAF Cobra ridge vents. 10. Counter-flash chimney with ice and water shield (in your neighborhood) and seal with clear sealant. Highly rated member of the BBB 11. Building permit included. 12. Removal of all work related debris. Clean gutters and run magnet in yard and driveway. Thank you! 13. Shingles are covered by the manufacturer up to 30yrs.(Pro-rated after 5 years.) 14. Contractor workmanship warranty=10 years un- der normal conditions. In— House Crew, NO Sub Contractors! cceptance of Proposal—The above prices, specifications and conditions are satisfactory and are herby ac- epted. You are authorized to do the work as specified. I layment will be made as outlined above. Date of Acceptance: Z2/,07 Signaturq/K Qicmafiira• /1 OPP Massachusetts Home Ira r-ovement Sana le Contract 1 This form satisfiesall tribe requirements of the state's Home Improvement Contractor Low(MGL chapter I42A),but does not include standard •i language to protect homeowners, Seek legal advice ltnecessary. Any person.platming home improvements should first obtain a copy of"a Massachuseas 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. Homeowner Information Contractor Information Name mpatny ame Street Address(do not use a Post Office Box.address) Coatraetar/Salesperson/Owner Name k) /1-t06Jc=YI, i41/"-J J al.� Cirylfown state zip Code usiness Address(must include a street address) Dayume Phone �� _ - - Evening Phone ty/I own Stott Zip Code Mal-E,Address(lt differeat from above) usiaess Phone ederal Emphrver ID 1 r S.S.Number �`"Rgvites mut mnotu�m,- Hame>mt vov®at'Coomnmricg.NamUv ti . W➢nLGM hLVCC � pasnn0 N5 The Contractor agrees to do the following work for the Homeo S7t0 Required Permits-The following buildiag..permits are required Proposed Start and Completion Schedule-The followingschedule will. and will be secured by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the contractors watrol arise (Owners who secure-their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A:) --_Date when contractor will begin contracted work. Date when contracted wort will be substantially completed Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of XJCJIM Payments will be made according to the following schedule:: (*) $ upon signing contract(not to exceed 1/3 of the total con tract price or the co _ st of special order' whichever� - hrchever is greater) $ t'_/_/ or upon completion of Y _+ /_ or upon completion of f/' $ 9GpB o• (x/ J upon completion of the contract (Law forbids demanding.full payment until contract is completed to both parry's satisfaction The following material/equipment must.be special S. ) ordered before the contracted work to be paid for to mat the completion scheduie.( **) m offer .S 6L_ to be paid for NOTES:(•j Including all finance charges 1**)Law requires that any deposit or down-pavmeut required by the contractor before work begins may . not exceed the greater of(a)one=card ofthe total contract.price or(b)the acetal cost of any special egidpmentor which must be special ordered m advance to meet the completion schedule: errs ora made materiae E renswarrahty-is an ress:wit 71tv.M rttvided.bv.the,con trottor^ .. - Subcontractors-The contractor agrees to be solely responsible for co ► No Yes all termsof thewarranrv.most,be attached to the contract parly/subcontractor utilized by the contractor. The contractor further a euon of the work described regardless of the actions of any third steel is and arbor under this a_rcem nt - brteas to be sdleiy responsible for all Payments to all subcontractors for . Contract Acceptance-Upon signing,this document becomes a binding contract under law, unless otherwise noted within this document the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautiousinthi and notices carefully before signing this contract • Dont be pressured into signing the contract Take time to read and full • Meke sure the contractor has a valid Home y understand it Ask questions if something is unclear. lmnrovernent Contractor tZte rtt no .The law requires most home improvement contractors and subcontractors to be registered with the Director ofHome improvement Contractor Registration. You may inquire about contractor registration b3'writing to the Directorat One Ashburton Place,Room 1301,Boston,MA.02108 or 1-800-223-0933. n by calling 617-727-3200 or • Does the contractor have insurance? Check to see that your contractor is properly insured.Know your rights and responsibilities. Read the Information on the reverse-side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor 1.a-important You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing.at his/her main office or branch office by ordinary mail posted by telegram sent or delivery,third business day following the sighing of this agreement See the attached notice of cancellation form for an. �'not later than midnight of the DO NOT SIGN THIS CoNT1t ACT'IF T explanation of this right Two idetgiral 'les err a. t beeumplated and signed.'one R ARE IVVY BLANK SPACES!!! SPY shotdd go to the honmoimer.The py should be kept by the nontrattor. Omeowner's Signature n etor's Signature f® Date f J( Z o Date • j ,m . Contractor Arbitration . The Home Improvement Contractor Law provides homeowners with the right to initiate an.arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically 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 contractor 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 fun which 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,chapter 142A. Homeowners 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 resolution 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 However,homeowners MAY be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners-who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Hoare Improvement"Contractor'Law: The contractor is responsible for completing the work as described in,a timely and workmanlike manner. Homeowner;maybe entitled to other specific legal rights if the contractor guarantees. or provides an express warrant .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 tbe-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 dunlicate and should not be signed until a copy of all exhibits 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 be in writing . and agreed to by both parties,Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day recission period has expired. Accelerated Payrnents A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems.him/hemelf to be financially insecure. However,.m instances where a contractor deems him/herself to be financially insecure,time contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumerrights,or if you wish to obtain a free copy of"A Consumer Guide.to the Home Improvement Contractor Law,"contact: Consumer Information Hotline. Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1- 888 ( )2833757 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,contact: Director of Home:Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 or 1-800=223-0933 For assistance with informal mediation.of disputes or to register formal complaints against a business,call: . Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AZ4-02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): at i Lr'L� Address: o City/State/Zip: 11,�) Phone#: Are you an employer? Check the appropriate bog: Type of project(required)- 1.0-1 required):1.0-1 am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E] New construction 2.El am a sole proprietor or partner- listed on the attached sheet. E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. No workers' 13.0 Other comp.insurance required.] r..,,o,.,that checks box n, ,..;:.>.a.s.,.,11 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. 1contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy olic information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information- Insurance nf ormation.Insurance Company Name: I r` t.-1 Nt L r Y✓11 Policy#or Self-ins.Lic.#: rl'j C- 7�� o� _Z`° Expiration Date: I Job Site Address: City/State/Zip: /V 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under a pains and penalties of perjury that the information provided above is true and correct. Si ature: _ Date: Phone#: r Offwial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ISSUE DATE 09118/209 _ i . THL� AS'A MAM MATTER OF INFORMATION ONLY AND THE;ERTTFICATE HOLDER-THIS CERTIFICA I IMMnce Agency LLC . DOR ALTER THE COVERAGE AFFORDED BY THI: bidwing Rd.Rt 125 ' ' ----- Atuluver,MA 0 184 5 l C ]�11E.5 AFFORDING COVERAGE { ceder One Roofmca in Peace OOWA I�A!A l.l+ j MjMW 11tsucance Co rwe Drive LETTER i Vmm,MA 01944 { OF&1� NA1j"ABOVE FOIL THE POLICY 15 TO CERTIFY THAT THE POLIC#1� 'ANY CONTRACT OR OTHER DOCUMENT W ITFI RES Pf,Cr � ftW INDICATED,NOTW'H'MANDING ANY Rte.T'�t>f+i BY THE POLICIES DESCRIBED HEREIfd IS St}B itrCi" I tiWHtCIi THIS CERTIFICATE!4.AY BE ISSUED OR MAY PERTAIN, Zr I LAYS gEm REDUCED BY PAID CLAD14S. J #J41.}.THE TERMS,EXCLUSIONS AND�OFSUCH � � E �� tn IaMns lOUCY Tym OF INSURANCE MAet6A DA M DAT �' ! j C.V*Lk"L1ABOUTY {_ {?1WOl.cTS•COAQtOP it t - f � p�QYALtADY.pO1RIY ��yyyutfyCFAL �i UABBi7Y i -j � I +� _ { j ��t�T-��•-� r.AQI tvLvupjtENa �CLUMb MAt1EG�pCCtBt j 1 j { l i TSE DAMAGE IAnwoc o+el i pyVNl;AS t C(N+TRACTOfCS TROT i A 11tOR1t.E LlAQ11JTY` ` (! IJWT y ( i � 6DnY.l 0UU1t�Y � ANY AUTO t t (�ppxvrj _ ALL OWNED A1170J 1' AUTOS SptEOItLLT) ,i! !RU11RY IFIEDAUTOSosop4rXNED AUTOS ' (ptrao¢S3aO s _ GARAGE IJMItM I ! VWMTY DAMAGE _ i i t 1 claoE M-6 LIABILITY Te AflGRIY:A RI tl)RM i t — �'}ief wT E.nKrts sTaz$ R t WORKERS COMpZWAT10N AND I t E MA t! + f I1!L OVER5I V ! i i� I }(111,000 { 1 � EI.E/aC'ti ACCIDENT f ► "� T gbgO i ZpOg }1 i 11! 409 E�DISEASE.pp-ICY utatT 5011,000 n+cL ���ct. 1;.1 ( ESeASEC�T 10�),000 ' is # MumIm DES('RIP'£ION OF OPERAT>flNS OR IACATIONS: t L UNDEit ONE ROOF/PF.ST IN PL=#CE IS"T CO FRED ff Tm W(WmatoxitYN POL1t Y. 5 is i i f � ! p 9EC TwEF)O*ATIONDATE 0009"A 1!�Yt1TtZC?MAt6 jQVIIEf[71NCTTSCLf{YTMLCER{'ll'ICA1"#1 I.AN%AFAMk 9Q tIlR8TAl11aA.St?CK�SHALL tAfI�Ofi .tROOHt,IG�Fit,7� I ' fflE COId'1'ANIY,ITS At3HNT8OR RSTttF.9R,St'fnTTVlS4. =1' t1EIV.MA UIfi4>a Ut Alik lI?VtE r i 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 orlocal Iicensing 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 carry 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-insured 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 thepermit/license number which will be used as a refer ence 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 bum leaves etc_)said person is NOT required to complete this affidavit. The Office of Investigations would Iike 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 Boston, MA. 0:2111. Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 vv.mass.-Aw.mass.gov/dia dia .som:PERRY INSURANCE AGENCY 97868701.49; 1U113/LUU9 Ua:4r rw f I .VVL i uRtE�AfDOIYYYY) AW—RA., CER-nFiCATE OF LU011 (INSURANCE ,aeno� CERTIFICATE fS ISSUEDAS A MATTER OF I N. ATION IFep Y Anka CONFERS NO RIGHTS UPON THE CEFMFICATE R.TM CERTIFICATE DOES NOT AMEND,EXTEND OR Box 1419fl THE COVERAGE AFFORDED BY THE POLICIES BELOW. 450 East ftmdence East provideDce,Ri 02914 1 RERS AFFORDING COVERAGE A Aqmilk Oasuf7111y IIs Co lila Under One Roof.John Lanzatame.DBA 30 Temple Or C t AABMuerl.MA 01844 ER E �v�ACEs TME POIJC"OF NSURANCE LISTED BELOW HAVE BEEN ISSUED TOTIIE �IAiMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF AHV CONTRACT OR O WETH RESPECT TO WHICH THIS CERTIFICATE MAY at ISSUED OR fiIfAYPERTAN,THE wwRAUCEAFFORDED BYTHE POLK�ESZ!>�GR SUBiECiTOALL THE TEM.EXCLUStONSAND COHGP31`MSOFSUC-H POt CIES.AsmEGATE umrrs SHOWN WAY HAVE KEN REDUCED BY ,CIA POUCY fIf111�F3t ►OLR7 E�WCi10lV LOGT6 A t t UMM L118=227 1 09 9/1112010 �"occuRRENCE - X COMMERCA GENERALUA9UTY PREMISES IF01( r CLAIMS MAX LX j w-UR i ? MED E7v�(wry ores Osrsan) t PERSONAL$ADV 04JJR" GENERAL AGGREGATE { tiENl P.pPt.IES PER 1 PRODLIi.T$ CUM'R)N ACG AoOREGATE LMVT - t PULL-Y r'RO- LOC AUTOUDWE UAGR ffY } COMBtNED SINtit F umil 1 (Eeecod'nt I� ANY AUTC OsWNED AUT I BODILY Inl.,R1RY ALL Ot t _ (Per oenon) SCHEDULtO AUTO S i I MIEN AUTOS 80111Y ItvAtRY t iPmxodenU NON OWNED/N)T05 ! — t PROPERT Y DAMAGE - (per acaeent) 6ARA6E lumm f AUl O OKI.V_EA ACCKYEaT B ._ - PNY Al/7Q 1 07HFT4 THAN rj°A"C (— AUTO OM Y P(3f> 4 i rxc Rmffv ) EACHOCCURRENCE I 1 OCCUR Ci AN*MADE At,GREGATE OEDUCI 16L f RETENTION i MORKERS cDurE 4ATION A1® NL STATU- OFA Tt as"wrow LIAOLnv F.L F1+Cn ACCiDENi S AwFR0PRIE'TORfPARTfMUEACUT1VF OTF1MR&*JM R EXC LUDWl E L DISEASE-EA EwzoLOYEE I^ Ifye 6.Otsrnbe t,nea E t. DISEASE P'iI.C LIMIT f bl'EC3AL PIiOV[St0n5 Oetow ' � 1 DIKWIMN OF ORATDOM f L.00ATf M 7 V1HKUM I EXCLUMfS ADDED Vf , R00HW AND F0XX)ELM C0NTRAC M 1 I CeRnRCATE WXO£R n0N .:_•—•--•--.�. MALO AMY OF THE AWVE69W.MW POUCES 00 CAW-MA.E n evons T.'@ f-ArwAnom TE?161EOF.T!E I1 w"rmxw NRE eorAvm TO MNL 10 PAYS wmn v" TO TME CERnFICATE HOLM NAMED TO THE LM.SLIT FAILURE TO DD$0"LL MO 0@LWKfM OR UASSYN Of ANY HIED UPON THi INSURlrtl,lT S AGENTS OR ATtVE9. u rYYvc s 1 i 3 0 F One A.hbiumn - R 1301 Boswa. MaLsWm mextj 02 108 # Ionic Improvement Ccwi sr Regismation Reqiubchon 137067 ! Type OM E torj*2010 its , ALL UNUIEK uN t_ KUUF ! 1OHN LAIti ZAFAME 166 A MERRIMACK ST � METHEUN.!MA 01 PAA /i�w.address tutd r"urs card, "SOL r ca—e k.+ II ti 3 t►oard of owban oel4bommOft sed Itadardb *at, ! war a•iy ITa "r'4Dme0tElt:�►- i 3 ,9 saemad sbo dkWift lOw 10 11wQ011) iA ?7'.6f0i1f0� T�mc tom- 1 i �4tt tiJ .:rrE t wqo"AcK s I j r f Rei UA 6 f fiat WOMEN!w� i E ! c �Ia, .ithts%c11e•If.frra►rfff ,� 1'titttit Roji'if n{Buiidioz, Fac ,►�laliuitt Alld eta+►tfAVOk 1,�c)n$t7r1{_ttOn iSar �.fCerls(� License Cs a912C) ! Ressmied to. W i �/.����/ ��y��� t JOHN R LANZ f" i t 30 TEMKE OR ; METNUEK MA(Me" e" i 5 - �t.N„ati.,fr 4r3MI t • .....r134Q i 1 �f.r��.ri hu+,tt� f1t'ff.;iYt�►c'f11 .,f�Nf�!><iei �.tlt't� fl.rartl r,t�utftl►n;; ftrtu�:elhat. ft►tl �taftti:t�rl. Construction Suvery,sor L,cen„> t.ra e•rr.e CS 69120 j E kr!/rrrfwf 10. 00 j ' t s i ! 1 � i