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HomeMy WebLinkAboutBuilding Permit #82-16 - 237 WINTER STREET 7/21/2015BUILDING PERMIT TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION (� Date Receivedi Sc ArED c(� Permit No#: q Date Issued: 12-1 I15— IMPORTANT: Applicant must complete all items on this LOCATION a3 7 Wi, 7'fe,,r Sr A . 4P A06"- IM'4 0/0 Print _ PROPERTY OWNER 1J�, M 'In e- Print 100 Year Structure yes o MAP _PARCEL': ZONING DISTRICT: Historic District yes o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition Cher ®{ `�WatershedN#Distnct�° ¢ Se �ti,c� _ �WeIIN t❑talo©dplainw - p W,efl'antlsm� OWafe /Sewer_ K _ -- nGcrP1PT1nN nF wnRK TO BE PERFORMED: Identification - Please Type or Print Clearly �_q?yf P fo , ?w OWNER: Name: Q/gin V4 1111(L Phone: tQ Address: )-3r7 W n`f 24- Al , Agogvg v— Pill D (9W- Contractor Na e: �S�A`If (��r� o,h+ Phone' Email: Wrk 0M ¢{ Address:3 ✓!nC M4 04'Y ` y' Supervisor's Construction License: 5 /0d-66? - Exp. Date: Home Improvement License:-../ Exp. Date: ARCHITECT/ENGINEER Phone: Address: FEE SCHEDULE: SULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED O -$125.00P_ER S.F. Total Project Cost: $ r1 �-00r00 FEE: $ % 2 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I YPE OF SEWERAGE DISPOSAL [PublicSewer ❑ Tanning(Massage/Body Art ❑ Swimming Pools ❑ell ❑ Tobacco Sales ❑Food Packaging/Sales ❑ vate (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature, COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMLNTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Commen Water & Sewer Connection/signature & Date Driveway Permit ]DPW Town )Engineer: Signature: 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 ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$10o-$1000 fine 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. 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 TE: 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 OTE: 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 2012 I ECC Energy code Engineering Affidavits for Engineered products TOTE: 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 Y Location S)9 �1", 15r No. G. a 2, ' x. "5. Check 29082 Date 1 �5- TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector a • 'm ng -� LU LL.Z O o�c O m p vm LL 41 In O00 Q Z J p a: LL = U LL `V H Z z m J d : d' N LL cc 0 N Z Q W LU W : K i FREE ESTIMATES PROPOSAL Construction Supervisor Lic- # CS102663 FULLY INSURED H.T.C. Reg, # 138569 M UGH i GUI H �'�i�1 �1YiJrR�l V �`J�r i� i Specializing in Seamless. # All Calors Available 350 BERRY STREET. NORTH ANDOVER, MA 02845 TELEPHONE: 978-6187-2247 PROPOSALSUBMITTEDTO PHONE DATE STREET 3 , a nftr S+. JOB NAME It WATiON CITY, STATE MOZiP COOS IVB rAvtd6vw ►•bA o iOp JOB STARTDATE du -k+ n ke (0.01 aw tre+:(tck es-, zar-d S u `- 51►� G w�o 0' . dowh p' 1� ��f�Oyp—�v�-^�i {a�Pitt �tl\ �� �i�C C�+&a8f� ���� �°� i1T �'`lK e Llfcj I Jt�t -W1a o, [I C QJZi�Qsa 6 V\ ��`ir S (o w S P `�- i, i s l�• i v{ Y`8� Pt+ down wC4--'- u KJe.r s4ep '�-(CLILi 04CL�ks+ We t(s C-4-. armu.ncl CktMtk OLvA- (v\. vat) US 0- 2016 %re S e f 41,e- t k . Put & vjii 8 ,I LK rA lL'L w- d-tI �D ram i o- boefs_ Pv+ 0ai,v �� ��i R.S . . �. �� P Ifs �-- . 1 1j ,j� -1 ® (Na t l S fo Q t— cS �1nc G: C e o l'GQc /v V�1i il� Ih Qc`Tu S S`� �C sa I M i tk.b f-0 jhr-0 LQ �a Ue bo n'"4'V. lead- ke , ctm`,nn "QCGA c S- pst P We YTopoSC hereby to furnish -complete in accordance with above specifications, for the sum of: $ ! V,'10 ®o op. Payment to be mad flows: V % y 1 f Ir 6 0. o® Opst bc'&uPQ co- O'n a" �J'+ U -e— All material is guarantee be completed in a substantial workmanlike manneraccordingto specifications submitted; perstandard practices. Any alteration or deviationimm Auttli3ftetl above specifications involving extra costswitfbeexecuted ontyupon written orders, and will become an Signature. extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our aaiurol. Owner to carry fare, tomada arid.dther necessary insurance. Our warkars ar8 fully NOTE: This proposal maybe covered by Workmen's Compensation Insurance- Non payment by agreed party may result in litigation withdrawn by us if not accepted within days. with penalties including court cost and compensation both real and punitive. Acceptance of Proposal - The above prices, specifications and " conditions are satisfactory and are hereby accepted, making this a valid contract.. Signature 4 %Z `lou are authorized to do the work as specified. Payment will be made as outlined. Date of Acceptance: Signature 10Q Massachusetts Home Improvement Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard language 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 agreeing to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor lniormation Name Company Name — Homeowner's Signature Con actor's Signature tl 6 41 c/ Data Street Address (do Dot use aPost Office Box address) Contractor/Salesperson/0 erName � P,37 wh4cr S+: Sc - f v-,, r h Cityfrown State Zip Code Business Address (must include a street address) Iii, Prn&vw MA 01-355_ 35.0 P,0_rrtj. Sf. Daytimel'bone Evening Phone q7ff--69A-*Vag City/Town At AdAv,r il State Zip Code Altf ©(eyr Mailing Address (It differentfrom above) Business PhoneFederalEmploya]DorS.S.Number Ian requires tbat most home Homermorov=%ct Cwh-tcrRe.,1,=ber &phuon date improvementer nhave tnflon num=bb avalid repistio % O 1385 The Contractor agrees to do the following workfor the Homeowner:I r (Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets ifnecessarv.) S�t�('0 Y' irQ— !•04 .f_ P(.easQ �2e a'(facl�eoi ��t,Pas�- t 22equired Permits - Ybe. following building permits are required Proposed Start and Completion Schedule -The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond -die contractor's control arise (Owners who secure their own permits will be a excluded from the Guaranty Fund provisions of 07 lSatewhen contractor will begin contractedwork. MGL chapter 142A.) (� Datewhea contracted work will be substantially completed. Total Contract Price and Payment beneauie Tire Contractor agrees to perform the work, fiunish the material and labor specified above for the total sum of Payments will be made according to the following schedule: $ N00,490 upon signing contract (not to exceed 1/3 ofthe. total contract price or the cost of special order items, whichever is greater) $ by / / or upon completion of upon completion ofthe contract. (Law forbids demanding fiill payment until contract is completed to both party's satisfaction) The following material/equipmen... t must e s to be paid for ordered before the contracted work begins in order to meet the completionschedule.(t") �$_ to be pat r _ NOTES: (*) Including all finance charges (**)Law requires that any depositor down -payment required by the contractor befere-work_begins may not exceed the greater of (a) one-third ofthe 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 schedule. impress Warranty -Ts an express -yVarrantv bein¢ provided by the contractor? Ko ❑ Yes (all terms of the warranty must be attached to the contract) Subcontractors - The contractor agrees to be solely responsible for completion of the work described regardless ofthe actions ofany third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor Inas a valid Home Improvement Contractor Reeistration. The law requires most home improvement contractors and subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proof ofinsuaace" document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy ofthe Consumer Cnude to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation ofth is right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK NFACESH I Two identical copies oftbe t must be completed and sieped. One copy should go to the homeowner. The othercopyssbould be kept by the contractor. Homeowner's Signature Con actor's Signature tl 6 41 c/ Data Date Print Form The Commonwealth of Massachusetts __.-_.--.-.---_-__- a -- Department of Industrial Accidents �! -- 1 Office of Investigations 1 Congress Street, Suite 100 '+ Boston, MA 02114-2017 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): to Address: 3�'D 8"[ s City Phone #: 9 78 --6 Are you an employer? Check the appropriate box: 1. �m a employer with / 4. E]I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' coma. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs n 13. Other Sj/r-,' ,o f 1��� /� o° - *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. #: WC!;-- 3I $'-33 7/U- p/ y Expiration Date: 3 oh/ 5 - Job Job Site Address: cA 3'7 0i' n4iU- R. City/State/Zip: /V 0(j/ -c - Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi ,ender the pains and penalties of perjury `that the information provided above is true and correct. Phone #: C17 ,?— 6& 2—d AY 7 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 Contact Person: 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 may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in 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 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 7-2010 www.mass.gov/dia 7/22/2015 11:31:04 AM PST (GMT -8) FROM: 100005 -TO: 19786889542 Page: 2 of 2 ACC?R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDrYY,rY) 7/22/2015 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 endorsement(s). PRODUCER T A SULLIVAN INSURANCE AGENCY INC 135 MERRIMACK ST METHUEN, MA 01844 CONTACT NAME: PHONE FAX (AIC. Ext: Arc No: AIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: LM Insurance Corporation 33600 INSURED SCOTT WRIGHT INSURER B : EACH OCCURRENCE $ DBA WRIGHT GUTTERS INSURERC : INSURERD: 350 BERRY STREET NORTH ANDOVER MA 01845 INSURERE: INSURERF: DAMAGE TO RENTED CnVFRAGFR CERTIFICATE NUMBER- 9FRA97r,9 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS -MADE F-1 OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 7 PROJECT ❑ LCC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident NON -OWNED HIRED AUTOS AUTOS F $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N /A WC5-31 S-387187-014 9/30/2014 9/30/2015 IPER STATUTE ER_ E.L. EACH ACCIDENT $ 100000 E.L. DISEASE - EA EMPLOYEE $ 100000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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, only as they relate to workers' compensation coverage. WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. I"aCa11;1[hG\Ia:PP11J=1 0L"aIRAGUL@1C TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: LOCAL BUILDING INSPECTOR, BRIAN LEAF ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET, BLDG 20, SUITE 2035 NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE LM Insurance Corporation © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 25682752 1-387187 14-15 WC shankar.gadaLe@lLbertymutual.com 7/22/2015 11:28:27 Am (POT) Page 1 of 1 2015 8:35:05 AM A►Ca � CERTIFICATE OF LIABILITY INSURANCE DA h " THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE'HOLIOER. 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: It the certificate holder is an ADDITIONAL INSURED, the pollcy(iee) 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 a . PRODUCER T A SULLIVAN INSURANCE AGENCY INC 135 MERRIMACK ST METHUEN, MA 01844E • T P "I -MAIL slsuR AI<Foaoelo covERAce NAIc o 33800 INSURED SCOTT WRIGHT DBA WRIGHT GUTTERS 350 BERRY STREET NORTH ANDOVER MA 01845 1 -[INSURER Naveanlsnc IptERC INSURERS: F COVERAGE$ CERTIFICATE NUAABER:24319700 rcZV14NWN Rtv111{iCM; 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. TYPE OF 94SIRIANCE DR POLICY NUMBER LauT$ COMMERCIAL GENERAL LIABLRY CLAMS - MADE M OCCUR i _ EACH OCCURRENCE $TO RENTEIT ¢ DAVAG'ta tea ossalOM MED E)0' (Any one pri $ PERSONAL d ADV INJURY S GEN'L AGWIFGATF LMR APPLIES PER. POLICY ❑ , RrO LOC OT GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ AUTOMOBILE LABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AAUUTNOS WN� INGLE LIMIT $ SmUf 1riSURY Tor person) i $ BODILY INJURY (Per soolaent) $ - 0 of $ $ UMBRELLA UABOAR EXCESS UAB HCLAIMSMAN EACH OCCURRENCE $ AGGREGATE $ s A woRlcERs COMPEnsATwNrOTH- AND EMPLOYERS, Luaeam ANY PROPRIETORPAWNEREXECUTIVE YIN OFFICERMEMBEREXCLUDEI7 �Y (Mandatory In NN) if Ceaenba under DE CR OF 0 TIO w NIA 05.3 -397197-0 4 9130/2014 13 15 F1.EACHACCIDENT 100000 E.L. DISEASE - EA EMPLOY $ 100000 E1. DISEASE - POLICY LIMIT $ 500000 DESCRPTION OF OPERATIONS /LOCATIONS / VE ICLES tACORD 101, Additional Remarks scheduls, maybe seaohed i0 more apace is required► This certificate cancels and supersedes all previously issued certificates, only as they relate to workers' compensation coverage. Workers compensation insurance Coverage applies only to the workers compensation laws of the state of MA. - fowii p %C /lGdlr 417LC11/er SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE p/�L �(v ✓ Yy (� —i 'K(!'ryC All rights deserved. ACORD 25 (2014101) The ACORD name and logo are regMered marks of ACORD CERT NO.: 243191DO CLIENT CODE: 1623970 ' Massachusetts - Department of Public safety ` Board of Building Regulations and Standards License: C$-10203 '^ KOTT W WRIG"T 350 BERRY 6jr c� KORTH AM )OVER { r75 Exp ration Commissioner 0311212015 OfPeee of Consumer Affairs & Busun"s Regulation OME IMPROVEMENT CONTRACTOR = sgistration; 138560 Ty". Explratlan: 4/14/2017 DBA Vi RIGfIT G,UMRS SCAM VMIGHT 350 BERRY ST. NO. ANDOVER, MA 01845 �n>1er�eerel�r�