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HomeMy WebLinkAboutBuilding Permit #324-15 - 19 PHILLIPS COMMON 9/30/2014 BUILDING PERMIT "°RT bgti �- TOWN OF NORTH ANDOVER 02 PLICATION FOR PLAN EXAMINATION 7D Permit No#: Date Received 4 Al' SACHUDate Issued: PORTANT: Applicant must complete all items on this page LOCATION; _ toin, r = Print � k PROPERTY 0WNE1-,R_ _ 07rf t100 Year Structure yes k` no f - , MAP PARCEL:_tzZQNING RISTRI:CT Historic District yes mot I _ Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building RKOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other E Se tic p Well ❑ Flgodplan, p Wetl.antls ❑ :1Naters'hed D'istncfi DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: - - - - - 01 Contractor}Name: � �t�,� l Phone 79/-g ®'-�'9 � Address: � Supervisor's Construction¢;License S Zod - - �Home lrnprovement'Licen`se z_ r '. q _ Ex Date _ __ _ a a -��, — ARCHITECT/ENGINEER Phone: 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: $ El,Check No.: 41 Receipt No.: Q NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund � P Signature of - _Agen V w nener --___ Sig"n.afure ot'.confractor TM T Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL ' ' Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools [I 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature i i COMMENTS a4 d 'j Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I j Planning Board Decision: Comments { Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit I DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Tempi®tampsteron site- yes._ Located;at 124iMainxStreet= z-- Fire'Departmen`t signature10-4' 4 - _ A I 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 ❑ Notified for pickup Call Email i Date Time Contact Name Doc.Building Permit Revised 2014 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 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 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 NOTE: 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 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 2014 Location�� ��� v i No. `t e� Date !? 4 o - TOWN OF NORTH ANDOVER$ Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ `� ry I'l 1�'° TOTAL $ - Check it ! 2808 Building Inspector NORTH Town of s _ Andover O •`1. 1, No. i * _ - � Z h ver, Mass, a I COC NIC MI WICK V� V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT Mk'U. ......... !kd. BUILDING INSPECTOR o Foundation has permission to erect .......................... buildings on ...�. .... ��:4.�.�.�,�.....1 -A✓� J✓d ................................... o Rough to be occupied as ..(4)....... ...... ..✓! �'� .......41X1. � 5�.................................................... Chimney provided that the person accepting thi permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS 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. CHARGE COPY JB Sash & Door CO., Inc. Ord #: 181632-0 lianuiarnuers&Dismnutors DOOR-Z1TNTDOti'S ALLWORk j '-J 280 Second Street.Chelsea,MAA 02150 Route: NONE l Sb4(61, -3940 1-800-648-9339 Fax= 6i)884-9188 HOME OF THE WINDOW BOYS awwu'6jgsh. Page: 2 of 3 Order.: 08/16/14 To: SAD617 Ship To: Sthed: MICHAEL SADY INSTALLATION 19 PHILLIPS COMMON 19 PHILLIPS COMMON Printed NORTH ANDOVER MA 01845 NORTH ANDOVER MA 01845 Date: 09/24/14 j Time 08:47 AM Phone: (617) 840-5559 Phone: - - - Entd: AADK In: 21 / OUt: 21 1 Terms: COD Cust PO# MIKE SADY ' Line # Item Number Description_-� _ Quantic— Shipped Comments_ 0003,00 *181632003.00 MARVIN COCONUT CREAM CLAD 2.00 I ULTIMATE DOUBLE CASEMENT UNITS- 02460=2 (L-R) R/0--49 X 59 5/8" PAINTED WHITE INTERIOR LOE 366/ARGON INSULATING GLASS j 3/4" , 'INTERIOR.GRILLE (2W5H) ! SATIN NICKEL FOLDING HANDLE SATIN NICKEL MULTI POINT LOCK WHITE ALUM INTERIOR SCREEN CHARCOAL FIBERGLASS MESH 4 9/16" JAMB I 5/4 X 4 AZEK EXTERIOR CASING ; 6 LO08E. .CUT AND APPLIED AT s f JOBSITE . I $ PVC SILL NOSING 2 112" INTERIOR CASING AS E EXISTING ' -- 0.004.00 INSTALL INSTALLATION OF ABOVE 1.00 INCLUDING REMOVAL OF DEBRIS FROM JOBSITE. i 0005.00 INSTALL INSTALLATION DISCOUNT 4.00 i $100 PER UNIT- PER SAL j i 0006.00 INSTALL BUILDING PERMIT :FEE 1.00 0007.00 Remark: NOTE' MARVIN SPRING INSTALLATION PROMOTION IF THIS PROPOSAL 1S ACCEPTED BY JUNE 30.2014 DEDUCT $100.- PER WINDOW OR $500.00 FROM THE z ABOVE TOTAL DD 15MIE JB SaCHARGE COPY sh & Door Co., Inc. Ord 181632-0 Mmafac=as S Disnibmors DOOR-«nDOWS -MILLWORK 2S0 Second Street.Chelsea.MA 02150 anRoute: NONE 2 (61;)884-S940 1-800-648-1339 Fax=(617)SS4-!_SS Page: 1 of 3 HOME OF THE WINDOW BOYS www.)bs h.com 3 Order: 08/16/14 To SAD617 Ship To: Sched: MICHAEL SADY INSTALLATION 19 PHILLIPS COMMON 19 PHILLIPS COMMON I Printed NORTH ANDOVER MA 01845 NORTH ANDOVER MA 01845 { Date: 09/24/14 Time: 08:47 AM ' Phone: (617) 840-5559 Phone: Attn: / Cell : Entd: AADK In: 21 / Out: 21 Terms: COD Cust PO#: MIKE SADY Customer Instructions msady@comcast.net I i Line # Item Number — Description __ Quantity _ Shipped Comments 0001.00 Remark: 11T FLOOR 0002.00 *181632002.00 MARVIN COCONUT CREAM CLAD 2.00 ULTIMATE CASEMENT WINDOW UNITS-CN3060 1LEFT/1 RIGHT R/0=31 X 59 5/8" PAINTED WHITE INTERIOR LOE 366/ARGON INSULATING GLASS 3/4 " INTERIOR GRILLE(2W5H) SATIN NICKEL FOLDING HANDLE SATIN NICKEL MULTI POINT LOCK j WHITE ALUM INTERIOR SCREEN { CHARCOAL FIBERGLASS MESH 4 9/16" JAMB 5/4 X 4 AZEK EXTERIOR CASING ' LOOSE. CUT AND APPLIED AT j I { JOBSITE PVC SILL NOSING i 2 1/2" INTERIOR CASING AS j I i EXISTING I ' I I i I i i i + I __._. .......................................... A Sash & Door Co., Inc. I Proposal JBSASHQuo : 099276 Manu en&D;stA utors I # wr DOOR—TVINDOWS -1ELLSGORK &1vJ""00R 280 second silent,Cbelsea,MA 0215o Route: NONE (617)884-8940 1-800-648-9339 Fax#(617)884-9288 Page: 4 of 4 HOME OF THE WINDOW BOYS xvw.ibsashoom Quote: 05/08/14 Io: PRO300 Ship To: Sched: 1IKE SADY INSTALLATION !9 PHILLIPS COMMON 19 PHILLIPS COMMON - Printed JORTH ANDOVER MA 01845 NORTH ANDOVER MA 01845 Date: 08/14/14 _Time: 10_07.AM. 'hone: (617) 840-5559 Phone: Attn: / Cell: Entd: HALM In: 21 / Out: 21 Terms: COD Your Order: MIKE SADY JB Sash & Door Company is a Lead-Safe Certified Firma has fulfilled the requirements of the Toxic Substances Control Act (TSCA) Section 402, and has received certification to conduct lead-based paint renovation. repair and painting activities pursuant to 40 CFR Part 745.89 as required by the United States Environmental Protection Agency. Certification # NAT-21346-0 J.B. Sash & Door Co. takes no responsibility for unforeseen deterioration of structural '{ + members in walls in which new window or door units are to be installed. we also will not .I,;,i be held responsible for changes to plumbing or electrical systems. Furthermore, existing " shutters, storm windows, and shades may not fit once your new replacement windows are installed, and as such is the responsibility of the homeowner. Payment in full is to be collected by installers at the conclusion of all jobs. In ;`,f situations where punch list items exist at the completion of installation. JB Sash t will determine a reasonable amount of the balance due to be retained by the customer until punch list item(s) have been completed. Any and all costs incurred in collection i of, outstanding balances, whether. or not resulting in litigation, including but not limited to reasonable attorney's fees are the responsibility of the undersigned/purchaser: - --- t We PROPOSE hereby to furnish material and labor - complete in accordance with above specifications. for the sum of: -- - -- NINE THOUSAND SEVENTY-TWO DOLLARS AND 19 CENTS 9.072.19 Payment to be made as follows: 33 1/3% DEPOSIT BALANCE DUE C.Q.D. Authorized Signature. JBS MASS. HOME IMPROVEMENT CONTRACTOR REGISTRATION #152085 ACCEPTANCE OF PROPOSAL - The above prices. specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of acceptance: Signature: 'Warranty materials for product will be provided.as necessary. Install labor PRICES SUBJECT TO CHZE AOUT NOTICE warranty from]B Sash&Door Co.,Inc is for a period of bvo years from original installation date. Any service labor beyond the-tm year scope to be chargeable.' Merchandise.. 8.730.18 Tax...........: 342.01 Misc Charges..: .0 00 Quote Total...: 9.072.19 D JB Sash & Door Co., Inc. CHARGE COPY Ord #: 181632-0 Mmuiamaers&Disuibutors DOOR-WINMOWS -.v LLWORR f j 2S0 Second Street.Chelsea:A4A 02150 I Route: NONE (617)S84-S940 1-500-64S-9339 Fat u(617)S84-92S8 Page: 3 of 3 HOME OF THE WINDOW BOYS aww.Lbsash-corn Order: 08/16/14 To: SAD617 Ship To: Sched: MICHAEL SADY INSTALLATION 19 PHILLIPS COMMON 19 PHILLIPS COMMON Printed NORTH ANDOVER MA 01845 NORTH ANDOVER MA 01845 Date: 09/24/14 { Time: 08:47 AM v Phone: (617) 840-5559 Phone: Attn: / Cell: 4 Entd: AADK In: 21 / Out: 21 Terms: COD Cust PO#: MIKE SADY w Line # Item Number Description__ Quantity Shi ed Comments Received By: --> 1 i r i i i 1 3 i j f M r i I I i i 3 r I I l f t i I I i 1 i � AAff Cdr���c��veurth o,�'Ha,�,sa��. etts , Office o•ffAvesfigafiblys Roston,MA 02111 mmmuss go-PId rz ' Workoxecomp ematio�.bouxa>� eAftidavt:BuRdersfCOItraedox�gl�t���r��c�a��J�'����iex,� tfmnt Ploase. rktL �ixV Hama(Basinessf organization&&Idad): 1ea &r 044a L Address: f City/Watc)[A): Phar : Areyolxauemployer?C�eekthe appxopxzateho r Type of project(re%mlred) I.VJ S am.a exmployer with�� �� �I arn.a general confractor and S 6. EJ New c6nstmdloa employees(i�IlandloxpaxE~time).T have,nedthesuh-contractors listed on.the attached sheet T 7, El Remodeling ship and.`Itavena•employees These sub;`confxa-etaxs�:a�te 8. �X7emolitzoaz working forme in.any capacity: workers'comp.insurance, 9, 11 Bt7ilcTi%g additzon [To wOr�exS'comp. xauco 5• ❑ i are a corhave. G xatiorx and its 1;0.0 Electricalxepairs ox additions xecpzixed.] officers have exexcised.theix ' 3. Z am a homeowner doing all work right o'exemption per IVIG 11..�( lumling repairs or addz€zons myser ufOworkexs'comp. c,152,§1(4),andwehaven.o 1 .p?Pao%xe�ais ins anc ret ixed.�i employees.PT6workers' 13. fltliex comp.insurance xecluired.] =.Agyapplicanttliat cheoksbox#lmustalsoMdl itheseetionbeld�rshovring�iheirWarkerecompensation.policy'nf6 a&n. rommw.aerswba samitiftisawdavltlAoat�agiheyAtedoingallworkandthennooutsideconiraoforsmasasummitanentafddayi indieairngsizolz. TantractmsW,-chdkf box. mtistattachedaaadditionalsheetshowingthelame ofthssnl}-(;ontractors analfhek voikerie comp.policyiafomiation. I �exnp�oy��trirct i���ovicrir�g t�o�Xre�,�r cornpe.�asatian in�r��a�tcefox.�ny ernployees: .�e�ory�tr�e�alicy rcftr�,�a.�,sit'e ire,fvrmadon. hi smauce CormpanyName; Information and Instructions Massachtlseffs General Laws chapter 152 requires an employers to provide workers'comp ensation for their employees Varsuant to Ibis staf de,m e nproyee is dewed as"...everypOrson iu the service of another under any contract eA biro; • express onimplied,oral orwxitten!l Atter Iqe:jq defined as"an individual,parinexship,associatlon,coxpoxatifln o otherlegal,entity,ox anytwa ormoxe' . ofthO txQOo uj engaged in,a joint enterprise,andzncludingfhe Xegalxepxesentatzves ofWdeceased ppiployax,.ortTie receiver o tisfee o�an indzvzdua�paxtuersbip,association or ofthexlegal entity,employing employees. x6weverihe owner of a dwellinghousehavingnotmorothaaikeeapartmentsandwhaxesides'ihex 4oxthoocoupatitofthe dwellinghouse ofanotherwho employs persons to do maintenance,consrmctlon orrepaixwoxk ort such,dweTlxnghouse or onthegrounds orbuilding appurtOumttherefo shaTlnotbecause ofsuch employmeutbe deemedto be an employer:" IV[GL chapter 152,§25C(6)also states that"every state or to cal fleenskg agency shall withhold the issuance or renewal 09a license or permit to operate a busraess or to construct huildings eat,the commonwealth for arty appltcsxat who has riot pxoduced•acceptable evidence of complMnee Wn the insurance coverage req.-alred." Additionally,M-aL chaptex 152,§25C(7)stafes"geitherthe commonwealth nor any ofN political,subdivisions shall enter into any confractforihoperformance ofpubltcworkuntil acceptable evidence of compliance with the insurance requirements of this chaptexhavo bcoapxesentedto the conffacting autho&j., Applicants Mease, Il,out the workers'comp emanon affidavit completely,by checking ffie b ores that apple to your situation ani if iiecessaxy',supply sub-confractox(s)namo(s),addresses)andphortenumbex(s)along with their celtifzcate(s)of ingurance, LimitedLiabilifp Companies(LLC)orL7m&dLhbj1ityParfner4s AP)withno employees othertbumthe members oxpartners,arenotxequiredto canyworkers'campensaf%ozzinsttraztce. 1f8nyLC orUp doeshava employees,aJ?olicyiSxequired- Be advisedthattI6 affidavitamaybe,submittedto the l7eparfrnent of litdustrial, Acoidents for contimmtlon of insurance,coverage. Also be sure to sign and date the affldavi. The aMvitshould b e xetcm.edto the city or town that the application for thepexmzt or license is being requested,riot the D4artm ent of 3'ndm alAccidenfs, Shouldyouhavo any questionsxegaxding thelaw orifyou arexaquii:edto obtain,aworkexs' eompensationpolrey,please call thaDapartmentatthgm nberlistedbelow. SelEitisuxedcompai>iesshouldenfertheir • sol£jnsttrance license nnmbex on Ilio appxopeafe line. cls y or TOM 0ffCN19 i?leasebeswothatiheai zdavitiscomplete,andpxinfehogibly. TAA,Dopartmenthasprovided aspaceatthe,bottom oftho ai;H&V!tfoxyoutoMout inthe event-the Office ox7rivestigationshas to contactyottregardingthe applicant. 1'leasebesuxetazrllintbepemuf/]Zcensenumbexwhichvfillbeused asaxezerencen.umber* haddition mapp9cont that must snbmitmultiple pexmit/ltceme,applications iii any giYenyear,need only submit one affidavit indicating current paltry infoxmaiiov(ifnecessazy)and under"Tab Site Address"the applicant shouTdwxite"aTllocatlonsht .(city or tovrT.tr°': G o �` pp A&affidavit steam ed t o ' z Officially p p.h ozfy or�ow.nmay be.({�Jxovided to fbe� .t appltcazttasprflofthatavaTidafrtdavx4Yson J1 ow ,A,.newazfidavitxnustbetilledouieaclt year Moro"home Omer crci&6nisobtainingalicenseorpexmitnofxelatedtomybusinessoxcommercialventare (to.a d,09lzcense orpermitto burn leaves ete,)said person is NOTxe,gWxe,dto complete this afixdavit. The office of fnve4igavans would Ince to thank you in advance for your cooperation and should you leave any gizesfions, " please do not hesitate to give us a CO. Tho.T7epattmezit's address,telepl�.one aztd fa�nutnbex. Tha CoxnMonw—eafth ofM-Qwsarhwe,, Moe QUAVQWWou ) 09ton, 02111 Tell 617.72- -49,00 a 40,6 a-1-977 WMFE _ Revised 5 2605 FOSS A`� CERTIFICATE OF LIABILITY INSURANCE ��(MM 9�o YYYY)14 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 endorsemen s. PRODUCER ACT NAME: Steven M. Shenkel Shenkel Insurance Agency Inc. PHONE FAX 401-9995 1017 Turnpike STreet E-MAIL 781 575-9111 No): ( Suite 1-2B ADDRESS: steven@shenkel.com Canton, MA 02021 INSURE S AFFORDING COVERAGE NAIC# INSURER A:Travelers INSURED INSU RERB: Restauro Group LLC INSURERC: 1000 Turnpike Street INSURER D: Canton, MA 02021 INSIIRERE: 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. LTR TYPEOFINSURANCE ADD SUBR POUCYNUMBER P0�LICY EFF POLICY CYEY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENE RAL LIABILITY DAMAGE TO RENTED PREMISES Me occurrence) $ CLAIMS-MADE D OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ I GENERAL AGGREGATE $ GEN'L AGGR EGATE L IMI T APP LIES PE R PRODUCTS-OOMP/OPAGG $ POLICY PRO- LOC $ AUTOMOBILE LABILITY CO(EaMBINED�SINGLELIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY D�G $ HIREDAUTOS _AUTOS R $ UMBRELLA LIAB OOCUR EACH OCCURRENCE $ EXCESSLIAB 17 CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 7p,Ng-6B03817-0=14 6/7/14 6/7/15 WCSTATU- OTH- AND EMPLOYERS'LABILITY Y/N 1 ER ANY PROPRIETOREXCLIAED>XECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICE NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under ES6describDESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICYLIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rerrerks Schedule,If more space Is reqsul red) i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA AU7HOR2ED REPRESENTATIVE Steven M. Shenkel ©1988,2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: (781) 575-9111 Fax: (781) 401-9995 E-Mail: steven@shenkel.com i ACOD CERTIFICATE OF LIABILITY INSURANCEFDATE("M'°d""Y) L.� 8/4/14 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 endorsemen PRODUCER NAME:CONTACT Steven M. Shenkel Shenkel Insuranceenc PHONE Fax 1017 Turnpike STreet Y Inc. E4IIAIL 781 575-9111 N ; (781) 401-9995 Suite 1-28 ADDRESS: steven@shenkel.com Canton, MA 02021 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Travelers INSURED INSURER B Restauro Group LLC INSU RERC: 1000 Turnpike Street INSURER D: Canton, MA 02021 INSURER E: INSURER F: COVERAGES CERTIFICATE N UMBER: 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. INSR AML SUBR POLICY EFF POLICY EXP L TYPE OF INSURANCE TR POLICY NUMBER MIDDY MNA)dYYYY LIMITS GENERALLIABILI Y EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS-MADE rI OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENTAGGREGATE LIMITAPPUES PER PRODUCTS-CDMP/OPAGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALLOWWD SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY den DAMAGE $ HIRED AUTOS —AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 7p,7U$-6803817-0-14 6/7/14 6/7/15 WCSTATU- 0TH- AND EMPLOYERS'LIABILITY Y/N – ANYPROPRIETOR/PARTNER/EXECUTIVE E.LEACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? 7N/A (MandalDryIn NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yyes,describe under DESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space N requi red) CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Arlington ACCORDANCE WITH THE POLICY PROVISIONS. 51 Grove Street Arlington, MA 02476 AUTHORIZED REPRESENTATIVE Steven M. Shenkel c O 1988-2010 ACORD CORPORATION.O ORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: (781) 575-9111 Fax: (781) 401-9995 E-Mail: steven@shenkel.com R y" aNON Stagy �$ p11Q off'Call- Ohl�y `! i .. �, �J /Y/V V/V 09 V��VV 6 VVV VVif�V� ^/�/ {/ p/�y�/�/(.p�/•^�p/�, /�®q/,(,�^/' `. .. i iii V `��-����/� VV�W /V VP V IfVeJ'V 10i Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 176586 Type: LLC Expiration: 9/3/2015 Tr# 244517 RESTAURO GROUP LLC. STEPHEN WICKS 1000 TURNPIKE ST CANTON, MA 02021 Update Address and return card.Mark reason for change. scA 1 0 20M•05n1 Address E] Renewal El Employment LostCard Office of Consumer Affairs&Business Regulation License or registration valid for individul use only <, _ CONTRACTOR before the expiration date. 1f found return to: Registration: 176586 Type: Office of Consumer Affairs and Business Regulation xpiration: 9/3/2015 LLC 10 Park Plaza-Suite 5170 i ' RESTAURO GROUP LLC: Boston,MA 02116 STEPHEN WICKS / 1 1000 TURNPIKE ST j CANTON,MA 02021 Undersecretary of valid without signature