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HomeMy WebLinkAboutBuilding Permit #630-2011 - 1820 TURNPIKE STREET 3/23/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �� ,20// Permit NO: Date Issued• IMPORTANT: Date Received must comulete all items on this LOCATION �-� Tv r r n to Print PROPERTY OWNER e -u-` c- 11 ? C" Z E L 1. C Print MAP N0:4a�PARCEL:_J�k_ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ®Septic ®Well z �aFlood lain 1©�Wetl'ands ' z.. - _ 'M Watershe'd(District T K { ®fWater/Sewer: _:_ . _....-_.t_.� , ,- _. - - - - - - - - r - = - -Jr,- nF,qC.RiPTION OF WORK TO BE PERFORMED: T_eI'l6'.4 v n > s� sr/�� U'l,f _z7__ �® 3 Identification Please Type or Print OWNER: N 2 i x'963 Address:_!s /4�,i�i�a,� S4; vn,�d/���� CONTRACTOR Name: -Fc-a yr c e r e- o Phone: Address: �j 2 Yj /�• ct t 0 5,/., U n . /G7 ice, '04 ©l F Y q Supervisor's Construction License: ry S 1 7 9 3 ,i� Exp. Date: -7 V -z ®! / Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 'Reirla i-17�t,r S_ i'_`/pc� S�� �� Phone:_ 6a Z— 3&— 22 -Z Address: Y JD ✓t <�+N-► n e� ury► . 9A017,01 Reg. No 1 5?o �1 6 FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ -�. J�.$°,wo- O�EE: $ (,0- �7 6 9' Receipt No.: Check No.: _ NOTE: Persons contracting, with unregistered contractors do not have access to theguaranty fund Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE F SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Z-aning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main. Street Fire Department signature/date COMMENTS Located 384 Osgood Street no Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions.3 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.$10041000 fine NOTES and DATA — For department use El Notified for pickup - Date Doc:.Building Permit Revised 2008 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 ❑ Floor/Crossection/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 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 ❑ 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from. the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording . Lust be submitted with the building application Doo: Doc.Building Permit Revised 2008mi Location AP� No 6ff 62 —,;;� Date 14ORTil TOWN OF NORTH ANDOVER Certificate of Occupancy $ /zq 0 ,.+at CHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $/ Check #/. -6.! 2390 66ilding Inspector P A LijM z am cm m c �O WN yL co o 0 Mo \3� : a y a U a .0 � � = C V� c� O u ;' y o +� a ,,a G z 7 bo kNmo CLL.)m (� F�1 ��1 G �ct� C7 oD G W Ri O7 V)c L� O A LijM z am co 0 CD L O t..s Z Q, O h CO Q C C C to Q 'C O 2 G> �E m m CD O CD .O 0 � ; 0 0 Q o a Co a D7 Q c cc d O,D ca C Z � V t/) R C C C d 0 cm m c �O WN yL co o 0 Mo \3� : 0 eJ C y •O y .0 � � = C V� '00W kNmo CLL.)m m �� a C=Dr m W :go o ' o ,.. : coo cm c O -o CD 0 'c 4- L CL:s y O ~ N 0 COD LLA 'fl C .y O LU .E CLC- O O -LJJ V1 m a O ®. cm c O� O. O g _ c` N �O cz yam.. 0.,- m co 0 CD L O t..s Z Q, O h CO Q C C C to Q 'C O 2 G> �E m m CD O CD .O 0 � ; 0 0 Q o a Co a D7 Q c cc d O,D ca C Z � V t/) R C C C d 0 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER '•� Lx. F� CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: 65- F P, J t y7 e—co' h -/—r o� C- PROJECT LOCATION: NAME OF BUILDING: S� /'� �—. (J✓ cJ�- f' I ��q Z c� L NATURE OF PROJECT: T2. ✓1 a t — U T WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, �c.� Styes �. c•c�. S c� d REGISTRATION NO. V2 8 0 96 BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT g ARCHITECTURAL 0 STRUCTURAL 0 MECHANICAL 0 FIRE PROTECTION 0 ELECTRICAL 0 OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being pPE" ed in a manner consistent with the construction documents. �O SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS IVITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUII�a1 > 9 s sR4MAASASTRY �y M ETION OF THE WORK, I SHALL SUBMIT INAL REPORT 11'1 RASAD rn I CT RY COMPLETION AND READINESS OF THE ROJECT FO NQY6 ''•••qRY PU0 �� �S I SUBSCRIBED ,D,SiNORN TO B FORE ME THIS �'� DAY OF n?h �-�, L, o % I C -- MY COMMISSION EXPIRES 22 f 13 M.E.A. Engineering Associates Inc. Consulting Mechanical Engineers 20 Felton Street, Waltham, MA 02453 781/894-6730 FAX 781/647-3542 CONSTRUCTION CONTROL AFFIDAVIT START OF PROJECT PROJECT TITLE: Tenant Fit Up La Bottega Wine & beer PROJECT LOCATION: 1820 Turnpike Street North Andover MA NAME OF BUILDING: Stone Wall Plaza North Andover MA In accordance with Section 116 of the Massachusetts Building Code, I, Alfred E. Muccini, Registration No. 23539, hereby certify that I am a Registered Professional Engineer. I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL ✓ FIRE PROTECTION ✓ ELECTRICAL ✓ OTHER (SPECIFY) PLUMBING ✓ FIRE ALARM ✓ for the above named project, and that, to the best of my knowledge, such plans, computations, and specifications meet the applicable provisions of the Massachusetts State Building Code '16 edition, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy. I shall perform the necessary professional services and be present on the construction site in accordance with my contract with the owner to determine that the work is proceeding in accordance. with the documents approved for the building permit, and I shall be responsible for the following: Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Special engineering professional inspection if critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix B. 4. Periodic progress report with comments to the Building Inspector. UPON COMPLETION OF THE WORK, I SATISFACTORY COMPLETION AND REAI Signature Subscribed and sworn to before me this Public A F REPORT AS TO THE 1 OR OCCUPANCY. W- __q 23S,,V' 20ILTr e_ = Will ERI.x A- C-01_1 — mmissNatDiViftbiiC 'COMMONWEALTH OF MASSACNUSE"S My.C90mb lon Espins'F@WuwV 25. 2011 M.E.A. Engineering Associates Inc. Consulting Mechanical Engineers 1k 20 Felton Street, Waltham, MA 02453 781/894-6730 FAX 781/647-3542 Document Ref. No.: Stonewall North Andover MA La Bottega wine and beer. doc March 21, 2011 Fire Prevention Office City of North Andover Fire Prevention Department 124 Main Street North Andover, MA 01845 Attention: Fire prevention officer. Reference: Fire Alarm and Sprinkler Narrative Ise Floor Tenant Fit Up for La Bottega Wine and Beer Stonewall Plaza 1820 Turnpike St. North Andover MA Dear Fire Prevention Officer: (1.a) BASIS (METHODOLOGI) OF DESIGN Section 1— Building Description a) Building "Use" group: Business b) Total footage of building: 38,430 c) Building height: d) Number of floors above grade:) 3 e) Number of floors below grade: 1 f) 1St floor tenant square area: 1,700 g) Access type of occupancies within the building: Business h) Type(s) of construction:2C Unprotected with an automatic sprinkler system i) Hazardous material usage and storage: none j) High storage of commodities within the building: none 1 k) Site access arrangement for emergency vehicles is through: Front access Type Section 2 — Applicable Laws, Regulations and Standards The following is a list of reference standards that shall be used in system design, operation and maintenance. a) M.B.0 780 CMR 7th edition.). b) N.F.P.A. 13 (2007 Edition) c) 527 CMR 12.0, the Mass Electric Code 2008, N.F.P.A. 70 with Mass. Amendments. d) N.F.P.A. 72 2007 Edition e) ADA strobe meeting code reference 780 CMR N.F.P.A. 72-2007, and 521 CMR. The Massachusetts Architectural Access Code. f) Authority Having Jurisdiction — City of North Andover Section 3 — Design Responsibility for Fire Protection Systems MEA Engineering associates; Inc. is responsible for 1st level only. The Fire alarm contractor shall submit complete information regarding the fire alarm notifications devices shop drawing to the engineer for approval. The Sprinkler Contractor shall submit and shop drawings and proposed sprinkler equipment to the engineer for approval. The contractor will submit all approved shop drawings and product information to the North Andover Fire Department for approval. Section 4 — Fire Protection Systems to be installed The proposed new work is summarized as follows: A. Sprinklers 1. New sprinkler heads shall be utilized in all locations. (Quick response type sprinkler heads to be installed with an ordinary temperature rating.) Stonewall North Andover la bottega wine and beer. doc 2. New seismic support for new sprinkler piping. 3. Sprinklers shall connect to existing zone flow station currently serving space. The existing sprinkler grid shall be reused and modified for new floor plan. 4. Existing sprinkler service is provided with a backflow preventer. 5. Existing system serving adjacent space shall be kept live. B. Fire Alarm System 1. The proposed first floor tenant fit up shall tie the fire alarm device to existing landlord building main fire alarm control panel. 2. Smoke detectors located in electrical, telephone equipment room and similar rooms and are provided throughout as required per code. Audible alarms in common areas shall be sized to insure maximum sound levels throughout the tenant space. 3. The existing Fire alarm system shall be activated thru new manual pull . stations, and common area smoke detectors. 4. The new Notifications fire alarm devices shall meet N.F.P.A. 72, 2002 ADA and local Fire Department requirements. 5. Manual pull station shall be located at exits, ADA strobes shall be in the public common areas and horn/strobes shall be in accordance with N.F. P.A. 72 2007. 6. Common areas shall contain system smoke detectors wire to F.A.C.P 7. Tie ansul system to fire alarm control panel Section 5 — Features used in the Design Methodology A. Basis Of Design New portions of the sprinkler piping have been designed using the pipe schedule method for Light Hazard occupancies. Stonewall North Andover la bottega wine and beer. doc B. Sequence Of Operation Upon actuation of a sprinkler head (designed to release at 155°F) water shall start to discharge from the sprinkler head and water flow switch shall signal a water flow condition to the fire alarm panel. C. Testing Criteria Sprinkler System The new piping and heads shall be tested in accordance with all applicable codes. At a minimum this shall include notifying the Building Inspector and Engineer of Record of the time and date testing will be performed, completion of the contractor's material and test certificate (N.F.P.A. 13, Figures 8-1a and 8-1 b). The system shall be hydrostatically tested in accordance with N.F.P.A. 13 Section 8-2.2.1 "hydrostatically tested at 200 PSI and shall maintain that pressure without loss for two (2) hours." (1.b) SEQUENCE OF OPERATION Section 1 The operation of a manual station or activation of any automatic alarm initiating device (system smoke, system heat detector) shall initiate a system- wide response as follows: a. Initiate the transmission of the alarm to master box and central station. b. Sound a code 3 temporal evacuation signal over all audio circuits and shall be in sync. c. Flash all visual signals throughout the building. Visual notification shall be synchronous in accordance with NFPA 72 guidelines. Synchronization shall be system -wide, and shall be subject to the N.F.P.A. 72 2007 edition adopted as Massachusetts code. The failure of one visual NAC shall not cause a failure of other NACs serving the same evacuation zone. 2. The operation of any activation of other device designated to initiate a system Supervisory condition shall cause the following to occur: a. Duct smoke detectors shall be installed in accordance with manufacturer spec's NFPA72 and NFPA90 they shall be resettable at the fire alarm control or other location approved by the local fire department. Remote duct smoke indicators shut down latching supervisory signals for all remote duct smoke indicators shall report to a central supervising station. The station shall notify the building owner. Stonewall North Andover la bottega wine and beer. doc (1.c) TESTING CRITERIA Section 1— Testing Criteria A. The fire alarm system shall be completely tested in accordance with N.F.P.A.-72 by the Contractor when the tenant renovation is complete in the presence of the Owner. Upon completion of a successful test, the Contractor shall so certify in writing to the Owner and General Contractor. Section 2 — Equipment and Tools A. The complete fire alarm system shall be installed in accordance with manufacturer's recommendations. All necessary equipment needed for a complete installation shall be available at the site. Section 3 — Approval Requirements A. Upon completion of fire alarm and fire protection system installation, the Contractor shall obtain written approval from the Owner stating that systems satisfy all operational code compliance requirements. B. Owner shall provide to the City of North Andover Fire Department, the name and address of the Fire Alarm Contractor responsible for relocation of existing equipment and installation of new equipment. If you have any questions or comments, kindly contact our office. Sincerely yours, M.E ENGINEERING ASSOC LTH op j C41 n A red E. Muccini, P.E. President �t ENO", Stonewall North Andover la bottega wine and beer doc DATE (MWDDrrM1 ACORD ® CERTIFICATE OF LIABILITY INSURANCE 3/22/2011 THIS CICDOES IS ISAFFIRMATIVELY EOR NEGATIVELY AMENDY EXTEND OR R OF INFQKMAIiON ONLAND RASLTER NF—TIHE OVERAGE AFFORDED GHTS, UPON ABY THETE DPOLICIES CERTIFICATE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHOR[ ZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the toms 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). codTncT JwnniYer Dodge .else PRODUCER Employers Insurance Group, Inc. 281 Main Street Suite 7B Fitchburg MA 01420 INSURED Reaource Management, Inc. Alt Employer: GBM General Contracting 281 Main Street, Suite 5 (978) 696-0007 F 1478)315-6811 i (AIC,No):.. .. ADDRE$$:.. DRZSDUCER p00001,85 CU3TOMER ID.0.7 ""' ""' IN6URER(91 AFFORDING COVBRAOE.. , NAIC M wsuRRaaSavors ProperCy 6 Casualty Co. i INSURER 6 :.. . INSURER C: ...INSURER.0: .. _ _.. INSURER E: .... _. ... _._I _ Fitchburg MA 01420 INSURERF COVERAGES CERTIFICATE NUMBER:CL10123003276 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 AFFORt]ED 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. ...._... POLtGY EFF �LIt3V EXP A6 BRI ...._.. LIMITS I TR TYPE TYPE OF INSURANCE RZ WVD 1� POLICY NUM9ER (N)M1pDlYYYY) MMtDD YYv T RAL UA9IL ITY I 7., I EACI'I OCCURRENCE BhMA'i:TQ'hEF1TE6 pREMt8E5.(Es occugpnvf) _I COMMERCIAL CkFNERAL I.IAOIUTY MEO EXP (Any on- pnraonl .. E I I CI.AIMS•MAOE j PERSONAL 6 ADV INJURY R GENERAL AGGREGATEI S PRODUCTS OMPOP AGO GEN'L AGGREGATE LIMIT APPLIES PCR' POLICY (PRS• LOC COMOINEO SINGLE LIMIT E AUTOMOOILE LIABILITY (FM accro!nry .. ANY AUTO ! i o ODII.Y INJURY (Por person).., _ _. . _.... ...._.... .. ( j AU. ONMEO AUTOS i � I BODILY INJURY (Pnr neudenq E _.. _ 1 SCHEDUlFn AUTOS r1ROPGRTY DAMAGE i I {Pa, aCCld9nt) HIRCO AUTOS E NON-OVAE13 AUTOS i } f—r CACH OCCURRENCC E UMC BRE�LA LIAD OCCUR EXCESS LI AD I j AGGREOATF. I1 CLAIMS•MAUE F OEDUCTIRLIS I� RCTENTION S VUC $TATO• .DTH•' 10RY UM11S X..._ER A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N I C.I. EACH ACCIDENT E 1, QOO ,_OOC ANY PROPRIETORMARTNERIEXECUTIVE OFFICERAAEMBERCXCLUDED7 DiNIAI �C0002526 " • - 7./1/2011 1/1/2012 El DISEASE- LAEMPLOYC 11 ,1_,.000,,.,OOC (MontJpOory In NR) i I C L. DISEASE •POLICY LIMIT S 1.000 OOC If YyqP dn:crlbe un!'0 ' DESCRIPTION Or• OPERATIONS new I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES [Attach ACORD 101, Additional Rannrkn Selteduln• It mero epima It ratIttlrnd) Covets the employmee of Lhp named ineunAd leoiod to: cr•M GENERAL CONTRACTING CORvoRATION 325 NORTH MAIN STRRET - UNIT 15 H tRIDDLSTON, M7L 01949 CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TME EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE o� Kathy Morgan/JEN'+fJ�.�.a� 1988-2009 ACORD CORPORATION, All rights reserved ACORD 25 (2009109)ID The ACORD name and logo are registered marks of ACORD INS025(2000 9) ACORD„ CERTIFICATE OF LIABILITY INSURANCE OP ID SW OATE(MM/DDmwl �DUCER Gi'IIIlCO-1 01/07/11 THI Dadgar Insurance Ag�nc Inc . S CERTIFICATE IS 155UED AS A MATTER OF INFORMATION Y ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 400 hest Cummings Park HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR iSuite 6725 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Woburn MA 01801 Phone:781-933-2626 Fax:781-932-6341 3SContract}ngggtt Middleton 1m1819a4 Unit 158 w.wueYw. www INSURERS AFFORDING COVERAGE INSURER A MOLY01. Nucuel Ine CO LA INSURER B' INSURER C — INSURER 0. INSURER E NAIC 0 TWE POLICIES OF INSURANCE LIBTEO BELOW HAVE BEEN ISSUED TO TWE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING SHOULD ANY OF THE ABOVE DIbCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION 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 QESCRISED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAW HAVE BEEN REDUCED BY PAR) CLAIMS. R[PRlSENTATAIEb, LTR NSR 'TYPE OF INSURANCE POUCV NUMBER PATE DMY �I DATE WIDDIMLIMIT$ 4 — 1 GENERAL LIABILITY _1 I EACH OCCURRENCE S 1000000 A I �( I coMMERCIAL GENERAL, ABILITY . CPP7017804 01 /O1 / 11 O1 / 01 / 12 I PaEM13E5 (E ) S lOOOOO CLAMS MADE ( X 1 OCCUR i MED EXP (Any one peleonl S 5000 PERSONAL A ADV INJURY 3 1000000 AGGREGATE S 2000000 j—,GENERAL 1 GEN'L AGGREGATE LIOA17 APPLIES PER PRODUCTS - COMP/OP AGO 8 2000000 I POLICY jE& LOC AUTOMOBILE LIABILITY ANY AUTO I 01/01/12f I COMBINED SINGLE f 100000001/01/11 ALL OWNED AUTOS X SCHEOVLE D AUTOS { eQILY a) 8 HIRED AUTOS I "' -X - X..INON I -OWNED AUTOS I BODILY INJURY (Per e1x10Ynt) S --•1 PROPERTY DAMAGE -- (Per ecowlen) OARAOE LIABILITY AUTO ONLr - EA ACCIDENT f ANY AUTO 1 � OTHER THAN EA ACC 8 I _• „•_ AUTO ONLY. AGG i 4 EXCESSNMSRQLLA LIABILITY EACH OCCURRENCE f 1000000 AI occuR L� CLAIMS MADE 1 CV0006054185 I 01/01/11 01/01/12 1 AGGREGATE _ s 1000000 7 s i DEDUCTIBLE S X RETENTION f 1 OOOO 1 WORKER" COMPENSATION AND EMPLOYERS' LIAWLITY T Y UMITy ER E.L. EACH ACCIDENT S ANY PROPRIETOR/PARTNER/EXECUTIVE OF%. ebe SERwAd EXCLUOEOT If ref. C1ECIiDe under I doo I E.L DISEASE - EA EMPLOYEE i _ E.L DISEASE •POLICY LIMIT A 6PECIAL PROVISIONS below OTHER i 0911CRtPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Masonry Contractor fax: 978-374-2337 CITHAaS SHOULD ANY OF THE ABOVE DIbCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRI"FN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SMALL IMPOSE NO OBLIOATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AOENTS OR R[PRlSENTATAIEb, 4 R¢ED AEP TATIVE W ^1616JK V G UK V W KA TIUN 1154 Gri M metal Gontrac(i1j,,. C ()6 Uf� 325 North Main Street Unit 15-B Middleton, MA 01949 Office: 978-777-8007 Fax: 978-777-5004 -pt�- �� V . -1/ / // **-"o -�Lqh4 U AN 0 47 5 6/-/ -- f� / o' J 9.3 i vm >1 17 1 p a 6611�r4,.X a ,,-, IZ4,0 000.00 l Total 6,9"o.00 j