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HomeMy WebLinkAboutBuilding Permit #862 - 206 MAIN STREET 6/29/2007Permit NO: a l7 Z Date Issued: rhgh BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 7 `� �? �'` a �L °tto y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ flew Building Addition ❑ Iteration ❑ One family VTwo or more family No. of units: ❑ Industrial ❑ Commercial Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Other ❑ Others: otic ❑ Well VPWaler/Sewer,,,.,, ❑ oodpl 4n' etlandsi 0 watersh ' Aistrict . DESCRIPTION OF WORK TOB REFORMED: Sl'G7j> �v OWNER: Name: Type or Print Clearly) ARCHITECT/ENGINEER ��� e/O�d�'S Phone: Address: .?`l �!i/ /i S�� ���7 �� Reg. No. 17;e—gW --3'6L6 FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $_ so �ro FEE: $ Check No.: Receipt No.: 7 NOTE: Persons contrac ' ith unregister contractors do not have accesst h ar ry and Signature of Agent/Own Z ignature of contractor Plans Submitted ��Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM yle LANNING & DEVELOPMENT ❑11 COMMENTS CONSERVA COMMENTS DATE REJECTED DATE APPROVED gfE REJECTED DATE APPROVED 22� 0297 DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS r TYPE 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 ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPAF tM'ENT -,Tulp D rlpster on site Located at 124 Main Street Fire Depart ienf'signature/dat4` 77 red., y nE) { u n 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine No Doc.Building Permit Revised 2007 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 o Building Permit Application o Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract L, Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products Addition Or Decks u Building Permit Application o Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) a Engineering Affidavits for Engineered products New Construction (Single and Two Family) Li Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report Li Engineering Affidavits for Engineered products 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 0 6 Location No. F46.2, Date AORTpf TOWN OF NORTH ANDOVER Certificate of Occupancy $ -0 ACHU Building/Frame Permit Fee $ Foundation Permit Fee $ 9 Other Permit Fee $ TOTAL $ Check # 47*7 2 0 j -,-i / A// Building Inspector m m m m YI m mm v y CD C � O n Z y O 'v a r �. CL y a(0 -0 �� CD o p CD o CL CT -0 CD CSo vo �•CD CD CLO CO) O ' CD a v H O CD O CD O CCD W n O cn cn b n� 7d . C_ 0 �"Hc?CQgw omaist C2 CL C -j . - 5'p H ...►� •O'�m H d...► d BE CD �?m m c O � CL C:- O m H : �-om CL CDa - i H !\� d H :v CL cm -.� c go � 19 H CAm d CCA CD 'O O a� .� CD H CD O :� o. ?m co) CD � O . 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G) y O C C C _c CL 0 Y/ LLI to W W W U) 220 Abbott Street North Andover, Massachusetts 01845 December 14, 2007 Building Department Division of Community Development & Services 1600 Osgood Street North Andover, Massachusetts 01845 Attention: Gerald Brown, Inspector of Buildings Dear Mr. Brown: I am hereby requesting a six month extension regarding Permit to Build No. 862, issued June 29, 2007. This permit was issued for 206 — 208 Main Street to Repair/Rebuild Existing Barn. The work was anticipated to commence next week, but present weather conditions preclude starting at this time. This request is consistent with our recent discussions. submitted, James C. Burke 17 DEC 1:.ZU07 1.1 b- Board of Building Regulatio sand Standards Construction Supervisor License License: CS 42212 Birthdate:" 4/29/1959 -Ez °Ree" ROBERT A BONEN q 1806 SALEM ST N ANDOVER, MA 01 Tr# 9059 Commissioner ,per fie TOomvmoozsuecc�i a�._/�aaa¢ciu�aelta �\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrafion;, 157687 Expiration.._ 1p/29/2009 Tr# 260807 Type: Individual t ROBERT A BONENEAOT ,t ROBERT BONENEANT 1806 SALEM ST NORTH ANDOVER, MA 01845 Administrator i ✓!e �aminzavicuealC� �,/�aaoac/u�aelZa Board of Building Regulatio s and Standards Construction Supervisor License Licefte: CS 42212 Bi rthdate., 4/29/ 1959 Expiratian 4/29/,2008 Tr# 9059 'Resfnctioh 00'" ROBERT A BONI N i 1806 SALEM ST N ANDOVER, MA 018� "� Commissioner ,,pper� ✓lze Uo�remwmulP,A,/•d o��c�ciutde�a �\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration-, 157687. Expiration .- 1:0/29/2009 Tr# 260807 Type Individual z: rh ROBERT A BONENEAUT ROBERT BONENEANT, 1806 SALEM ST NORTH ANDOVER, MA 01845 Administrator ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIY MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 11/29/077 PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Madeleine I. Brooks Insurance ONLYAND CONFERS NO RIGHTS UPON T HECERTIFICATE 22 South Broadway Lawrence, MA 01843 HOLDER THIS CERTIFICATEDOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. LIMITS REPRESENTATIVES. INSURERS AFFORDING COVERAGE NAIC # INSURED Elizabeth Bonenfant DBA Bonenfant Construction Co 1806 Salem St. INSURERA: Underwriters at Lloyds, Londo INSURER B: INSURER C: INSURER D: No. Andover, MA 01845 INSURER E: X COMMERCIAL GENERAL LIABILITY WOW $7_TN:�.9 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 CONTRACTOR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR D' NSR TYPE OF INSURANCE POLICYNUMBER POUCYEFFECTIVE DATE MM/DD/YY PDUCY EXPIRAT1ON DATE MMIDD/ LIMITS REPRESENTATIVES. AUTHO E EPRESENTATIVE GENERAL LIABILITY EACH OCCURRENCE $ A X COMMERCIAL GENERAL LIABILITY LGL0612815 3/9/07 3/9/08 _300,_000 PREMSES Eaoccurence $ CLAMS MADE F-1 OCCUR MED EXP (Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 300,000 GENERAL AGGREGATE $ 300,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 300,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILYINJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILYINJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ EAACC $ OTHER THAN ANYAUTO AUTO ONLY: AGG $ EXCESS/UMBRELLALIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE DEDUCTIBLE $ RETENTION $ $ WORKESCOMPENSATIONAND WC STATU- DTI+ TORYUMITS ER EMPLOY EMPLOYERS' LIABILITY ANY PROFl2IETOR/PARTNER/IXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLU DED? E.L. DISEASE- EA EMPLOYEE $ If des d escd be under SPECIAL PROVISI ON S below E.L. DISEASE -POLICY LIMIT $ OTHER D ESCRIPTIO N OF OPERATIONS / LOCATIONS / VEH ICLES / EXCLUSIONS ADDED BY END ORSEMENT / SPECIAL PROVISIONS Carpentry and Siding Installation M,_Vrcu ca kAVV !1U0) © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRI BED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS W RITTEN Jim Burke NOTIC ETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TOD OSO SHALL North Andover, MA 01845 INIPOSENO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHO E EPRESENTATIVE M,_Vrcu ca kAVV !1U0) © ACORD CORPORATION 1988 RightFax H1--3 10/4/2007 4:18:47 PM PAUL UU:3/0UJ tax berver' POLICY EFF POLICY EXP ACCORD. CERTIFICATE OF INSURANCE DATE(MM0D1YY) 10-04-07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GENERAL AGGREGATE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HAP NGTON I NS AGCY LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 150 MAI N ST'REE'T ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PERSONAL &8- ADV. INJURY COMPANIES AFFORDING COVERAGE NORTH ANDOVER, M A 01,945 EACH OCCURRENCE C COMPmY 25DJP A HARTFORD GROUP INSURED COMPANY - Y B 'NT -'IR JOHN A& BONENFANT ROBERT COMPANY 39 BFIGHTWOOD AVE C N ANDOVER, NiA 01845 COMPANY SCHEDULEAU703 D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREON AMED ABOVE FOR'rHE 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. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE (MMWDWY) DATE (MMIDDIY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE S COMMERCIAL GENERAL PRODUCTS-COMPIOP AGG. $ CLAIMS MADE OCCUR. PERSONAL &8- ADV. INJURY g OWNER':-, && CONTRACTOR'S PROT. EACH OCCURRENCE C FIRE DAMAGE (Any one fire) g MED. EXPENSE (Anyone person) Y AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT g ALL OWNED AUTOS BODILY INJURY (Per Person) $ SCHEDULEAU703 BODILY INJURY (Per Arcident) $ HIRED AUTOS PROPERTY DAMAGE A NON -OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE s WORKER'S COMPENSATION AND A EMPOLYER'SLIABILITY U13-51EEC9933-07 06-01-07 06-01-08 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERS/EXECUTIVE INCL DISEASE - POLICY LIMIT $ 500,000 OFFICERS ARE: X EXCL DISEASE - EACH EMPLOYEE 100.000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACF•,S ANY PRIOR CERT 'LF'IC:AFF ISSUED TO THECF,RIIFICATE liQLDER AFFECTING WORKERS CONIP COVERAGE. Ni_) P4C HERS ATtl COVERED BY THE WORKERS'CONIPENSAl'i!lN POLICY. CERTIFICATE HOLDER CANCELLATION S-ICUL D AN'i OF THE ABOVE DESCRIBEO PO_:'CIES B'c C :NCE/ -LED BEFORE THE E:<P:P.ATIO`, CA.TE TOWN OF NORTH ANDOVER THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE 1'0 THE CERTIF:CATE HOLDER NAMEC. TO THF' -EFT BUT FAILURE T^ MAk SUCH NOT'CE SHALL mAPOSE AT'TiN: BUILDING INSPECTOR NO OBLIGAT:CN OR LIABtUTY OF ANY !'IND UPON THE COMPANY. ITS AGEN•i 5 OR 1600 OSGOOD ST, REPP,ESENTATIVE S. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE Raman-, Ayer ACORD 25-5 (3193) 220 Abbott Street North Andover, Massachusetts 01845 December 11, 2007 Building Department Division of Community Development & Services 1600 Osgood Street North Andover, Massachusetts 01845 Attention: Gerald Brown, Inspector of Buildings Dear Mr. Brown: I am providing formal notification of a request for change regarding Permit to Build No. 862, issued June 29, 2007. This permit was issued for 206 — 208 Main Street to Repair/Rebuild Existing Barn. The change requested is to remove the Contractor identified on the Building Permit Application. Robert A. Bohondoney Construction will not perform work against Permit to Build No. 862. A number of circumstances resulted in this decision, none of which should reflect in any way adversely, on Mr. Bohondoney's reputation or abilities. I have employed Mr. Bohondoney's services in the past with most favorable results. Respectfully submitted, James C. Burke BARBARA A. ROLFES Notary Public 11 Commonwealth of Massachusetts My Commission Expires April 9, 2010 o � o co ° o 41 0 00 �-1 � O o 0 41 co R°. o ° ~ 4-e O Cd W m a W �� c� +-J W m 93 �i a aO Cd M N 1-4 'er Q a O OA c O w o cd W N z Q, � > W 0 a� Z w 4J w °cd Cd o� v a3 o o ani a `" N 0 -4C'3 c9 a N cq a z A rT. 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Payment to be made as follows: n D vi u vv/ Pr a r roc, PA- v m A j All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Our workers are fully cov- ered by Workmen's Compensation Insurance.lf Zicceptance of prlopuzal —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorizehe work as specified. Payment willlb/be made as outlined above. Date ofAcceotance: R'�� aW__ 0 / % Authorized Signature Note: This proposal may by us if not accepted within days. -- ^\ - -tZ ISf 8:'u Of B� lr .!� PC5=1Iat f l egistr..�i }' valid for individul use cql_: ,iGt.1E Itr7r�%�3VEiJIEiJT CON, c ,Irr :piration a-tr.. ;f faund return to: ! s, and of B..ildin; Repalations and Standards Regist 1 icr:. 11.238 -011,eAshburtoii .'lace Rm 1301. EXpirat oi: 8l1'_6.'2007 } anis; A-la. 02108 T/rC: DBA is BOHONDONEY CONST CO ROBERT BOHONDONEY.. '•, �4 'ALL ST G t_THULty, ? 018.a f a ithout aitiisaiure ✓lze Uia�r>lnwouoea� ociclucieita BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: -CS 000979 # Birth-date,'-z04121-1,1.953 ter; Expires 04(21%2008 Tr. no: 21658 Restr—te a. 00. ROBERT A BOHON©ONEY 12 HALL ST c, METHUEN, MA 01844 Commissioner FROM AN.25. 2007, 7:08P Degnan insurance Agency Inc 85 Salem Street Lawrence, MA 01843 Robert A Bohondoncy dba Roben A Bohondoncy Construction Co 12 Hall Strcct Methuen, MA 01844 (TU6)JUN 20 2007 0.*I IST. 0:01/Mo.00000000" P 1 SSOCIATED INSURANC NO. 8704 P. 1/1 ISSUE DATE 0612SI2007 THIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION ONLY AND CONPF,RS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A A.I.M. Mutual Insurance CO LIsTMR t'Gt10D iNDlCATt t), Nr)'I•W t I'HSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ChIC11FICATEMAY BB JSSI IRD OR MAY PERTAIN, THE INSURANCE AFFORDED BY THB POUCIES DESCRIBED HEREIN IS SUBJECT TO A H. . I'H!'I'ERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICI I;S. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MucT sFMCMU roLICY L)rMMflON LIMITSLTI TYI'RAKOf>:11RANCE fOWCYNUMetR 0A1V(MM0DIYY) DAT!(NIIImv) CiNeRALLIAOIItri QCOMMMCIAI GrNM,%L MUMMY 0 QCLAMSNAnF.Otx-(,'UA rjOWNares A CoNnarrog S OKo r C&UALA0Q1k MTE fVWUCr9-CQWWAOQ PINONAL A ADV. INJURY RACD OCCURRENCE rots DAMAOE (AWoM M6) ROBRRT A BOHONDONF.Y IS NOT COVERED BY THE WORKERSICOMPENSATION POUCV. TOWN OK NORTII ANDOVER ATTN: 1NJILDING INSPC(:7'OR 27 CHARLES S'I- )ULD ANY OF 711E ABOVE DESCRIBED POLICiEE 6E GANCELLEU ISPXURU THIS CAPInA"UN VAM msoF.'rms ISSuM CO14PAFIY WILL GNDP.AVOR TO MAIL &WRI'ITEN NOTICETO THE CORTIFtV ArA NAMQDTq THE LEFT. BUT PAILURETO MAIL. NUM I NOTICTSUALL IMPOSE NOOBUGATION LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. wI/10TfJ ♦At11f%%IVD MA Mid[ L..nunnr2nstmnocm�*.7nn: LMR RODILY ("MY ANY AVID ALL OWNCD AUTW (POrpsmenj SL11LuULED AUTOS WAR) —us YUDILY IMURY Ng)"41WlAMD Alred! fro town) 0AQA!%1 miLn V FROFRRIY DAMaUR LAC0S LIAMLIT'Y SACH OCCURRENCe AGGRECATE UMORELLA FORA( nMER I HAW UMaRELLA FORM 9ATUTORY LIMITS )TREK W( KFR$ CAMPEN&k YON r.MPLow" LIABILITY X EL EACH ACQDENT 100,000 NE "GrAfTrO tI A PARNFM%XLCVr1\'E Indata ARE 7006062012006 08/09/2006 08/09/2007 EL DIKASE•-POLICY L(Mrr 500,000 INC1. &xCL RL DLWASE--SACH /�/�/� AVCC 100,0w ROBRRT A BOHONDONF.Y IS NOT COVERED BY THE WORKERSICOMPENSATION POUCV. TOWN OK NORTII ANDOVER ATTN: 1NJILDING INSPC(:7'OR 27 CHARLES S'I- )ULD ANY OF 711E ABOVE DESCRIBED POLICiEE 6E GANCELLEU ISPXURU THIS CAPInA"UN VAM msoF.'rms ISSuM CO14PAFIY WILL GNDP.AVOR TO MAIL &WRI'ITEN NOTICETO THE CORTIFtV ArA NAMQDTq THE LEFT. BUT PAILURETO MAIL. NUM I NOTICTSUALL IMPOSE NOOBUGATION LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. wI/10TfJ ♦At11f%%IVD MA Mid[ L..nunnr2nstmnocm�*.7nn: PROM 06/24/2007 18;49 6178470006 <MON)JIAM " 2007 11: 18/ST. 11: 18/1NIa. 0000000010 P 1 COMMClWALTH INS PAR PAGE 01/01 AR4. CERTIFICATE OF LIABILITY INSURANCE PATRiUMuODfYYrrl sora- 06/2S o7 FRODDCER IBilingsCommonwealth ins. Partners LLC 1 Billings Road, 3sd Floer M. Quincy NK 02171 Phone: 617-847-0005 >?ax:617-847-0006 THIS CERTIWATE Is ISSUED Al FORMATION ONLY AND CONFERS NO ROM UPON THE CERTFCATE KTIND OR HOLDER. E CCOHIS VI=EAAGE WORDED BY THE PFICATE DOES NOT +�NFS BELOW. @MRERSAFFORDIMCOVERAGE NAICS U D ppyy $�Ai Coe �42►On A«Y onsttT a Cn. iNltha� $ 01844 NIURERA: Am.u* tesa�u-n sn�as.en NSURER S: N6UP£D C: INSURER D: LAMER E: THE POLIMS OF INSURANCE LISTED BELOW HAVE BIER ISSUED TO TME INSURED HAWD ABOVE FOR THE POL"PiRIOD NOICAT!!D. NOTMTHSTANDINI1 ANY R6nLRRDAINT. TWA OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CSRTS'"12 NAY BE OWED OR MAY FERTAIN TN4 NSURANCI AFFORDED IY THE L4 SUBJECT TO ALL THE TERM. EXCLUSIONS AND CONDITIONS OF SUCH POLICES. AGGREGATE M4T6 SHOWN NAY HAVE SEW REDUCES eY PAID CAMS. LTR DATETHERBOP. 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