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HomeMy WebLinkAboutBuilding Permit #364-15 - 200 BRENTWOOD CIRCLE 10/16/2014 AORTH j BUILDING PERMIT OFSt�en "ti TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit No#: �f'S Date Received dkl ACHl1`JDate Issued: IMPORTANT:Applicant must complete all items on this page !LOCATION' 020, �r¢,n` k �_�.d; �nw` V2nr, 4 01SYS 3 { -_ Pnnt 100 - ar,S ryb ure yes = no r 4MAPPARCEL . ZONING_ DISIr, 1Mistoric ®istnct �ysst A - .. IMachine Sho Udla"e' esu R 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 ❑`SepticRWell. - �Flootlplanh We atl nd's W�atersDist�ict 1 --a Water/Sewer s q � r l DESCRIPTION OF WORK TO BE PERFORMED: - �E C-Q_ a/ S AX S of rLL b L e,— Jr')©`f V IV Identification- Please Type or Print Clearly OWNER: Name: �`.'i+�'(`l� lYl QrS�y'>? � Phone: q�$-Z13S-38d Address: )LO O Brf n wFaod AI. Amdwtn Yk II 0189s, Conti,actor►Name i, ��r� rRhone ?g a6$7�,14 y 7 iA�ddress II +S�p�er�ls�r Const��,ct, onLiense�,ir�$,:10�6G�34 �Xp� l®�te:�,: _r _ l <Wome 1.ftpa,V.ege�nt� ibWpo Date �� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: r�-e(Llo NOTE: Persons contracting with unregistered contractors do not have access to the aranty fund -°F"_.�Wit: � --�• .� .--� r..-� _.- • - _ - Signature of Agent/Owner _ _ r. r �... (Signature o" f�car cto Location No Date jq��10/ J . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ • Building/Frame Permit Fee $l'"} _ Foundation Permit Fee $ Other Permit Fee $ VaiT ae� . TOTAL $ Check# -Pr 28140 &uilding Inspector 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date DriveW2V Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRED:EPAW TMENT Temp Du:inpste:r on safe yes_ no - Located.-ar t 24 Main S#reet r A. Fare D-epartment signature/date. I A4 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pen-nit Revised 2014 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 j 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 Addition Or Decks ❑ Building Permit Application ❑ 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 Hydraulil Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) 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 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 Dnc:I\SPt:CTIONAL SERVICES DEPART NIENL•DPFORNII5 fare 4 of-4 The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 www mass govldia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): L*?-S Wr(A)T Address: 35b 84,rc j. cs City/State/Zip:X P-LyPN', eh lq c9dYS- Phone#: 9 2 o 68 ��aa1-y7 AF an employer?Check the appropriate box: Type of project(required): 1. m a employer with 3 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling ship and'have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El 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.❑ of repairs insurance required.]i employees.[No workers' ra OIL comp.insurance required.] 13. Other "t p-Y'e- *Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating tbcy aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Q Insurance Company Name:. L G �� {�'t.cA-* :Q Policy#or Self-ins.Lie.# C-5--31 S -3 9219 7-101Y Expiration Date: Job Site Address: -�-00 6r-2►+',0©�, C-4r, City/State/Zip: kAetWL,4-, /f'Ltd`OlBYC . Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 cert fy n er tl pai a, s-- dpenalties of Jury that the information provided above is true and correct Si ature: Date: 110 Ll6 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other -- rr II _ - - JJ- Contact Person: W Phone#: 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 or local licensing 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 maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. i'he 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 the permit/license number which will be used as a reference 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like 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 02111 Tel,#617.727-4900 ext 406 or 1-877�,MASSAFE Revised 5-26-05 Fax#617-727-7749 www.�ass,�evldia Coni racior A:rbi rifion The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an 'alternative to eomt action)if they have a dispute with a contractor. The same right is not:automatically affordedto 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:C m which has been approved by the Secretary of the Executive Office of Consumer A-ffairs and Business R.egLi ation and the cons=er shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapte 14.2A.. _. Ho owner's Signature ontractor's Si ire NOTICE,-The signatures of the parties above apply only-to the agreement of the pantie to o alternative dispute resolution initiated by the contractor:.The homeowner may initiate alternative disputeresolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor L4.w(M(3L chapter 14.2A)and other consumer protection laws(i.e.MGL chapter 93A)may not be,waived in any way,evert 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 ail Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and worlmranlike manner..Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials, In addition to guarantees or warranties provided by the contractor,all goods sold•in Massachusetts carry an implied vlarranty of mer chautability and fituess for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfirlly agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. IT you have questions about your eonsuner/homeowner rights,contact the Consumer Infoimation Hotline(listed below). Execution of Contract- The ontractThe contract must be executed in du 1lcate and should not be signed until a copy of all exhibits and referenced doo=ents have been attached. Parties are also advised not:to sign the document=i1 all blank sections have been :Called 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 partes,Contracted work may not begin until both pardes have received a hilly executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the.payment schedule in cases where the homeowner deems him/herselfto be financially insecure. However,in instmoes where a conlTactor deems him/herself to be financially insecure,the 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 fLmds from said-account would require the signatures of both parties. Additional formation .If you have general questions or need additional information ab out the Hoare Improvement Contractor Law or other consuamer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home I•mp�ovemeaf contact:: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Baston,Mk 02116 617-973-8787, 888-283-3757 or visitthe OCABRwebsite at lam://wwvv.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or gleed additional iuformat ion specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and-Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 orvisittheEUCwebsite atlati: :/p /www.mass.gov/ocabr/ Go online to view the status of a Hoarse Improvement Contractors Registration: . ht:Lp://dU.state.ma.t2s/liolneimorovement/licenseelist asp 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 508-652-4.800,508-755-2548 or4.13-734-3114 Version 2.1-11/22/2010 i This form satisfies all basic requirements of the slate's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard Ianguage to protect homeowners. Seek Iegal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeingto any work on your residence.You may obtain afree copy by callingthe Office of ConsumerACfairs and Business Regulation`s Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner hnform tion Contractor 1p ol3mation Name _trn �� }�- CompanyName Street Address(do not use aPost Office Box address) Contractor)Sale erson/OwnerName 02 0 �Y2n l Wo�c�. Cir1- 6 C'a 'f W t` CitylTown State Zip Code BpsmessAddress(must mclude.astreet address) N. .1 rhav- M6 6I SY5- 350 8 S-r DiFytimePhone BveningPhone City/Town State Zip Code ??y-ns--jay S m /lf 4n c Ove✓• Mailing Address(It different from above (a�J-, Sr I'ederalEmployerIDorS.S.Number I-- ( 11 cc ) BusinessPhone92�, 5 S8dG6G CO h s Tr U C P l O n U p 2r V 1 S o r t I°S C fN e-C Tmwrcviresthat most llama HomeImprevement Contractoriteg:Number Expiration date I ` / improvemnntcontrantersImya ' 3 Q� 1/// /� / � Ja / o�t¢b a valid rcgisteatian nnmver 0 tj / The Contractor agrees to do the following work for the Homeowner: S'+r;'p -1/0s1°o 'eA%s�+'n� asyah a sti. n0 awn /0 e-ckt°+to (bescnbein detailtheworlcto completed, ecifyingthe e,brand,and grade of material to ben'sed,use additional sheets ifnecessa Ia�erS a Ree(ace cca ratle•1 deck 6ov4 e of S of f wo htL,n c l ud¢ . , S � o f �c e a ncl� J � ply l neer n1+rte ma�o a U e 6 wa Fer sh;etdl°Ona 112aves,va t(evysj lira its�and bene lra���ns,U,lSB 3di b fe(f paper v'apo4, baYrI�t-or, ,zS of deck. U5,e 9;AC+ a.tkw.inflm d,- ecdo�Ce Mew0n Ewes-At'(r2w•ven�l-spite-e. 611ofs,,La,dcwh 3o V, GAf arc,,`f•ccf 11 f Sk n%k w,Wl. If6mph w+tott:Ir'•aji.n .Van•i- ridx�tw,4i, c-brc.ven.t at,&c- *. C(,ean rt,p —et lna.u.( 0. de6✓•'S -Aa Aes��na ecl Lam C� t( us-it�ey Lee a5So,-i o� t�IaveYl`,`tt, tmsf ofrubber �001� raw n u of ah and r ce tvt r boatel bo to"r rubber and yInc A dr, e Required Permits-The followiiigbuilding permits are required ]Proposed Start and Completion,Schedule-The following schedule will and will be secured bythe contractor as-the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise ®waters who secure their own pe>rulnits wiTi be excluded from the Guaranty Fund provisions of i 0/S Date when contractor will begin contracted work. MGL chapter 142A.) � S" Date when contracted woxlc-wM be substantially completed. ota Contract Price and Payment Schedule ILA e ontractor agrees to perform,the work,furnish the material and labor specified above for the total sur,of: iUkl 0 D > z Pa eats will be made according to the following schedule: 535.-00 upon signing contract(not topxceed W Ofthe total contract price or the cost of special order items,whichever is greater) $ by I or upon completion of $-- _by / _ or upon completion of $ 65 t9O upon completion,Of the contract, (Law forbids demanding full payment until contract is completed to both party's satisfaction). The following material/equipmentmust be special $ _to be paid for ordered before the contractedworlcbegins in order to meetthe completion schedule.CU) $_ to be paid£or NOTES:(")Including all finance charges(4ni)Law requires that any depositor down-payment required by the contractor before workbegins may not exceed the greater of(a)one--third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedute. ra -- ress Warren -Is an ex rens wgri-anty being provided the contractor? No ❑'Yes a1I terms ofthe wnyrartlrrnmt be attached to the contract Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. Tile contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this a cement Contract Acceptance-Upon signing,this do cument be c omes a binding c ontract under law. Vale ssotherwisanote dwithinthis document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. a Don't be pressured into signing the contract-Take time to read and fully understand it. Ask questions if something is unclear., a Make sure the contractor has avalid Homelrrt rovement Contractor Re 'stration. The law requires most home improvement contractors and subcontractors to be registered with the Director ofl3ome Improvement Contractor Registration. You may inquire about contractor registration by writing e imuraahe Director? at 10ParlcPlaza,Room 5170,$oston,MA.02116 or by calling 617-973-8787 or 888-283-3757. c Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confam coverage,or aslc to see a copy of a"proof of insurance"document. a XnowYour rights and responsibilities. Read the Important information Guide to the T-1ome Improvement Contractor Law: onthereverse side of this form and get a copy of the Consumer 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 is writing at his/her main ofixce third business day following or branch ofCce by ordinary mail posted,by telegram sent or by delivery,not later than.midnight of the the signing oftbis agreement. See the attached notice of cancellation form for an explanation of this right. JD®NOT'SIGN TMI S CONTRACT IF THEM.ARE.A.IYY]BLANK,SRACE+S 1! Two identical copies ofthecontract mnstbeCompleted andsigned. One copy should go to thehomeovmer.The other COPY shotddbeIceptbythe contractor. HOmeO efs Signature 4111rctces*Signak Date /ry �1 f I Date DATE(M IDD ) ACCIII CERTIFICATE OF LIABILITY INSURANCE 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(ios)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 T A SULLIVAN INSURANCE AGENCY INC NAME:ACT 135 MERRIMACK ST PHONE FAX METHUEN, MA 01844 EMAIL AIC No: ADDRESS: INSURERS)AFFORDING COVERAGE NAIC If INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: SCOTT WRIGHT DBA WRIGHT GUTTERS INSURER C: 350 BERRY STREET !NSURER D: NORTH ANDOVER MA 01845 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER; 21153469 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 TYPE OF INSURANCE ADDL SUBW POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMfDD/YYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S CLAIMS-MADE FIOCCUR DAMAGE TO REN ED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s JECT POLICY PRO_ LOC PRODUCTS-COMPIOPAGG S OTHER: S AUTOMOBILE LIABILITY COMaccBINED SINGLE LIMIT S Ea ident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED F SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ �J NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accident I S UMBRELLA LIAB HOCCUR EACH OCCURRENCE s EXCESS LIAR CLAIMS-MAGE - 1 AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION iWC5-31S-387187-013 9130/2013. 9130/2014 1PEAEMPLOYERS'LIABILITY YIN ✓ STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 100000 OFFICERIMEMBER EXCLUDED? �Y NIA - (Mandatory In NH) E,L.DISEASE-EA EMPLOYE S 100000 If yes,describe under DESCRIPTION OF OPERATIONS below I 1 E .DISEASE-POLICY LIMIT $ 500000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR SCOTT WRIGHT. This certificate cancels and supersedes all previously issued certificates,dnly as they relate to workers compensation coverage. Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BLD INSPECTOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 OSGOOD ST BLD 20 STE 2035 ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 'ERT NO.: 21153469 CLIENT CODE: 1623570 Didi Dangas 8/7/2014 7:31:21 PM (EDT) Page 1 Of 1 c10RTHTown o ndover No. h ver, Mass, A- coc L-K6 7.A p�R�TED r'PP�'�5 S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System V000 THIS CERTIFIES THATBUILDING INSPECTOR ...............I...I.w�.......... ....... �. AR"' l . Foundation has permission to erect .......................... buildings on oD.a... f 'T .�i.... ... .............. Rough tobe occupied as ........W. ... ...... .......... .... ......................................................... Chimney provided that the person acce tin this permit shall in eve res b!t conform to the terms of the a lication p p p p rY p pp 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 WNTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI S 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. r Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS402663 .% 1 Is .j : SCOTT W WRIGI#T 350 BERRY ST ° s NORTH ANDOVERMA 0184 Expiration Commissioner 08/12/2015 ���pama�wortoealCf a,�C-�/�aalacfaulel�i Office of Consumer Affairs&Busibess Regulation WxME IMPROVEMENT CONTRACTOR jistratlon: 138569 �TYPe piradon: 4/14/2015 DBA - - l WRIGHT GUTTERS `M i SCOTT WRIGHT 350 BERRY ST. NO.ANDOVER,MA 01845 Undersecretary