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HomeMy WebLinkAboutBuilding Permit #216-16 - 26 PLEASANT STREET 5/1/2018 s , '/ LF TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: —r/. Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION _ Pr int PROPERTY OWNER i-S, -} Print 900 Year Old Structure yes no MAP NO: PARCEL t. ZONING DISTRICT: Historic District yes o Machine Shop Village yes _ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 2-Crn-e family ❑Addit' n ❑Two or more family ❑ Industrial eration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well '❑ Floodplain ❑Wetlands ❑ Watershed District 11Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 'fir-✓Sfu. �1 �wc�s � )t�,!3L /-J14 NCr- f25 8L lei �/-60 u-r Identification Please Typ or Print Clearly) OWNER: Name: Pr�-Sc�`l/es-- -Z-4q � �4"—' Phone: F 7� 48 7-67�k Address: 6 _ -7114141 ti 3 CONTRACTOR Name: _ Eric W.Palm Phone: 3 Ripon Street Address: _Salem MA D1970 - --- Supervisor's Construction License: _ 7 7"7 _ _Exp. Date: Home Improvement Licenser _l Oy = Exp Date` ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. I Total Project Cost: $ FEE: $ j Do Check No.:� Receipt No.: NOTE: Persons contracting with unregister contractors do not have access to the guaranty fund Signature�of Agent%Qwneril _ nature of contractor.. _` - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all caws if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apu,-al 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: Doc.Bui�ding Permit Revised 2012 U l Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYP -;OF.SEWERAGE DiSP.OSAL 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 o Board f Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tovv . Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMENT =Temp Dump'steron site yes_. no Located at 124 Mair Street Fire Department signature/date ",� . 1 r [ COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Motor 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 El Notified for pickup - Date I � Doe.Building Permit Revised 2010 Location /! (=G _f G,y No.aO 4 -- /C--, Date • - TOWN OF NORTH ANDOVER w �-.. Certificate of Occupancy $ .e Building/Frame Permit Fee $ _ / Foundation Permit Fee $ " Other Permit Fee $. TOTAL $ ..k Check# l- Building Inspectorector2i� 23 NORTff Town of E A. ndover O A t 0 No. P 4 * I T - ,� oh ver, Mass, elg ell coc«�c«ew�c« A. �as RATED V BOARD OF HEALTH Food/Kitchen PERfAIT T LD Septic System C_ / 4 !._Cv'tyJ A BUILDING INSPECTOR THIS CERTIFIES THAT ............................................................................................................................ �4 SC.r.' �` Foundation has permission to erect .......................... buildings on � �.. ... . ............................................................ Rough to be occupied as ............. ....&:'Wva/7�z....... �� .,l� f::: ....................................... Chimney provided that the person accepting this 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 TARTS Rough Service ................... !�,—_�_—�'�.f.._.................................... BUILDING INSPECTOR Final 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. H fntmsaaart�mic ryll GiITwJ�ll�IE7f semi�•y _`°�2taPmt,.�y �"A�rntsoPtbas�rsHame �=•®�1I�� Mki I a�aGt%IICi�Cas�Ct,vr—g ' rl'ej'2t3�_�,. RFrn°1ttyclvt� a�eveeinm-ra¢toCatHmaiatlia°amt�19rA�73�-cbSa7P�oitrrO flocr- WHomelm �$ � =ag)� gb iIett2 arAY?ohbstaaazoa @�" Ison6vodSso Gttudes ,zt aa�Y A Ziatn_ '�' C°PY�ycolliao f �7 oron am. the ;S C/ / / / comlY��mr L'ffCe°ff� i��2�?an �te SrreetAdrt (d°ao*toeaPa^t a arteo"atlatj > � x Cityffana �G4 S S1 Cont�ctorlc t ' 3i�5 $ uh,.•U. t�rc' J� "tom Avenue Daytime" l�(j�^�iL r ' l� H+oihtalld (mus2ma I /1S ll rgnoa�e 7laden _ p^E�`mnS O l'Lwaa hrailia a � / ��llTawo s-tea.-�(adta kaat altoi2) zij,Ceti: 11:111111111 lic 1,1 tB a L.in do ail tFar ,Sa Sts QIL ttanv„�g to eeasprI � '=izrias` ea, .3 f j Zl�� to belL {�Asatractor b�e�vsa��'s' niza '-�,°s5rue�d /T r cJ S�— �PO Glt F —�zits 7' k beadb^, touaF� z°nre-T6gfaB go3c t�P3 �= e-b:Ymldtha °fig=cbt aleon� 3 k3s�iac+�+c—'rES,r w,7fi�CiOI`scon`�1SIy;7y s `I'n C°Do�CtCd 14Ur Tho Con ��cad?5atmeg csa�cted i�au an7!b trnclora�to s+4ea�e rF3lYrmanrelcd �the rmrl,fmnfsh ?a.a oats will be mad3 dmdlalors¢eciiiedz air,ingtorilefoltst�iagsc:edore: bom iiag,to:zlSlum Of = ar o2rct Price S aruom cemPleaf°n aF h•wsrafs� mar o,-trer- J i or UPaa costtiledan of anon camPiciiou ofihe G''� � TttaFttl?c :n C°" C` 7tidsdt 7 ord�edirk-:" acitt m sltc)r s FY,nmrlm ;alluno?is 21A comotcedtobath tom tteccaaln:tt ,k� m Win_ �� P21ys='!&&C4an) ZZ J acs c�'8s )T-t. urtica r���`-�Oi(nj�^yLcd aF���ti'��3'dc�asil o.-dc.;a Lsnr,.�1'I_r.-fav-s.:r rT�W3i"x tn.dlmmrlo t�L....h:r Pj'-o'Qa-:UClClC=Wj �P�G:r c?L•im..w� "O*b;gPitiSmV Sn5acar v_:*�r__necontr� «etoma� tr�L-gal trJSS��� �-I o h9`nbcon.:a.torlUl_3b,, s�ecstobesalel9rw`Ior `'at' �?,:o =- s a �nlcForcaar'• =crallrz� untc2 LS tt egp t Tlecaa fLlionCtiiteti rE ,rrtva¢�he� 2bad:at ieaFit: ��,...., o,'iatib�nalre=i-II lcir clemia_d�m-mm heoz.�cz) cant Gctse -r,acs-J cosi �ta7softLe clefitHY63iorsicming���O�erss����3�n-�he �F�7tie`�r:ilPn•�tcnLsi°all' r�ctothird�* uadskts_ ssotbery ° Jaa'r b,„ Pl=c d oa sevdeae�Revit L§efaZot, rrithin this dacaa ;be fat int asi�pgthe cao iogcattiom _'9akc dtccon _ r' _ zadaofee; sulz cahaclortarits `az:ryta o 5*1�an biJ to `ztLaDii tar ^atenn �n Y� dat:A=1cgz"9 all gtothLesfile cOnrror,'ry2eG„rU :PRnTmmer�cn�tCoaL��ta;-eel=a ,asns Ltlp° fissuacwr zcaR a<a Fascs'taee,As tQeC actSriQRn��: It�tlp e_MZ-,.-deu. Youma�,� �teaalnaesar and o Guic }u[ •!dl t tT tol7ima car a do z w orf°r cm, a ��g61?-)73�8?87ar82E 57. io the,ioae latpvc I'm L'. P r ° 3eti tna uaentc ariznt-°' on oa Ftc: conium cOv�°Tsa to oattauari.r;: •t:vr,se�dzGf � Ynu Fa-• - zndgzraw 7 �i aisa`r•� tLFirlrrsb - PYoftbeC4nsnmer cantrctoriat;��gntta�" ���ed diva 6tsiness da`c= ° °otcey `taP-�"'otbe in FatlaL4iaa tliC SS 'r,e�.r�Glee ilFe Canu fatsif'2Ci0ij o c= caace�oural ':'r nulisr •_ the. �amtantggtGfJte �-G@ewF-,.._.• _,� '�`'�.�;���sf-z�a, arsoaz F�ri� rlom f� '�cT•��-- DzIe �i ann-z^toi's .cam ` - Contractor A rbitrafiou The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)ifthey have a dispute with a contractor. The same right is not automatically afforded to 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 zsttt to arbitration as is afforded to the homeowner by the Rome Improvement Contractor Law. The contractor and the homeowner hereby;matually agree in advance that in the event the contractor has a dispute concerning this contract�tae contracmfbi tubmit the dispute to a private arbitration firm which has been approved by : :.�.. the Secretaryof the 1�xecutiveA�eep� onsumer Affai,s and Business liegriafion and the consumer shall be required to st€bmit to such.di3ttrati7in�as p}dvi In I1vIassachusetts General Laws,cha�/teyr 142A Iiomes Signature Contractors Signature y NOTICE.The signatures of the parties above apply only to the agreement of the parties to altemath c dispute where this The homeowner may initiate alternative dispute resaIution even resolution initiated by the contractor_ Th 3 section is not separately signed by the parties Honeownees Rights A homeowner's rights under the Home improvement Contractor Law(MGL chapter 142A)and other constmrer orotection laws(i.e.MGL chapter 93A)may not be waived in anyway,even by agreement. However,homcovrsers may be excluded tom certain rights iftl.e contractor they.choose is not properly registered as prescribed by law. Homeowner who secure their ownbulding permits are automatically excluded from all Guaranty fund provisions of the Home Improverent Contractor Law. The contractor is responsible for completing the vmrk as described,in a timely and workmanlike manner. Homeowners maybe entitled to other specific Iegal rights if the contractor for�vorlmianship or materials. In addition to guarantees or warranties guarantees or proAddes an express�vartabty provided by the contractor,all goods sold in Massachusetts defy an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree maybe added to the tams of the contract as long as they do not restrict a homeowners basic consumer rights. If you have questions about your consu merdhomeotivner rights,contact the Consumer information Hotline(listed below). Cxecutior of Contract The contract must be executed in duplicate acrd should not be signed until a copy of all exhibits and referenced documents have been attached Pages are also'advised not to sign the document until all blank sections have been filled 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 I,%pt by the contractor- Any modification to the original contract must be in writing and agreed to by both parties.Contracted workmay not begin until both parties have received a fully executed copy of the contract and the three day rescission period has expired' 4--ccele:rated?a41-1.e3t s A contractor may not demand payments.ia advance of the dates specified on the payment schedule in cases where the homeowner deems himlherself to be financially insecure. However,in instances where,a contractor 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 spray� isite to continuing tete contracted work_Withdrawal off ords£am said account would require the signatures of both parties. Additional information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or ifyou m ish to obtain a Lee copy of"A lviassachusetts Coustmter Guide to Home Improvement' contact Consumer Information Hotline Ofree of Consumer Affairs and Business Regulation 10 Part:Plaza,Room 5170,Boston,MA 02116 617-473 0737,888?83`175-iorvisittheOCABRr:ebsiteathtw-//I;n:nv-,nm.govlocabr/ If your:ant to veri_iy the registration ofa contractor orif you have questions or need additional information specifically about the contractor recistration component of the Home Improvement Contractor Law,contact:: Diredor of Home improvement Contractor Registration office of Consumer Affairs and Business Regulation 10 Faris Plaza,Room 5170,Boston,IVA,02116' 617-973-9787,*89-283-373-7 or visit the HiC website at htmJ/uI}nv-mass gov/osabr! Go online to view the status of a Home Improvement Contractor's Registration:- httn-lldbstatemaullhomeimnrovement/licenseelisLaw For assistance with informal mediatiori of disputes or to register thrmal complaints Against a business,call: Consumer Complaint Section 0fBce of the Attorney Generd 617-727-8400 . %-NTD/OR Better Business Bureau 50E-652-4840,503-755-254.0 or 413=73.1-3114 vc�s on,t-t tt�tsata Cont r-ae.o-A rb=t—tion The Home Improvement Contractor Lac}provides homeowners tviUf the right to uitnate an arbitration action alternative to court action)if they have a dispute with a contractor. eh l h nhaass ud not a homeownerlin ca afforded contractor,however The contractorw°uldhave to resolve any disp ute both parties agree to the optional clause provided below.This clause would a ve the contractor the same ri.Zttt to arbitration as is afforded to the homeowner by the Rome Improvement Contractor La-,v. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerningthis contract-the continctor• tray submit the dispute to aprivate arbitration firm which has been approved b} the Secretary ofilieExecuure.Q„fny.�c�� °��er�1'�°�m�s Re�llation and the consumer shall be required to submit to sucli aiiiitraizou as pfovlded In Massachusetts General Laws,chi ter 1�??A ie _ e . '�- ' Contractor 'madir 's Sr Homeownefs 51paim apply Pi v'onl to the am u em ent of th e arhe s to alternative dispute RDT1.E.The signatures the whera t his resolution initiated by the contractor_ The homeowner my rm_t_ae alternative dispute resolution even section is not separately signed by elle parties_ Horteorvner's R&AS A homeouvnees rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection lacus(i.e_MGL chapter 93A):nay not be waived in any way,even by agreement_1loivever,homovrser s ered as ma,be excluded fromcerudo.rights if the contractor automatically excluded o perly-, w. egifall Guarani}told provisionsrescribed by of Homeoti�nersivhosecuretheirowabuldingp ' the dome Improvement Contractor Late_ The contractor is responsible for completing the viork as desk,lied in a timely,and s olimianld a manner. ?Iomeo>amers may be entitled to other materials. In addition to cific legal rights i antees or waarranties a arantees or provides an e,,Wss�varrapty for tivorlcmanship provided by the contractor:all goods sola in Massachusetts carry an implied warranty of merchantability a-ad fitness for a particular purpose. An enumerasion of othermatters on ivhicn the homeowner and contractor Iae frilly agree may be added to the terms of the contract as long'as they do not restrict a homeavyner's basic consumer rights. If you have questions about your consumer/homeocvner nights,contact the Consumer h'lfaimation YI-otline(listed belot•:)- The contractmust be executed in duulieate acid should notbe signed until a copy of all exhibits and referenced are also ad ties irised not to sign the document until all blank sections have been documents have been attached-jaj tilled in or maeked 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 oy the contractor- Any modification to the ori_gi contract must be in cresting and agreed to by both parties.Contracted w°rIc Ytay not begin until both parties have received airily executed copy of the contract and the three day rescission period has expired; Accelerated?ay ensentschedule in cases where the A cor_tractor may not demand paylnents`in advance of the dates specified on the payor homeotimer deems him/herself to be financially insecure. However_in instances where a contracto•deems him/llerself to be financially insecure,the contractor may require that the balance of f1mds not yet due be placed in a joint quires account as a pre,,�Quisite to continuingtiecontracted evorI: - thdrav-ial of funds form said account ttroutd require the signatures of both parties. Additional_formation If you have general questions or freed additional infortvatien about the Home improvement Contractor Laty or other consumer rights,or if-you wish to obtain a fee copy of"Al assachusetts Consumer Guide to home impr°vement" contact. Consttmerinfoiraad°nHa`dine Office of Consumer fsitairs and Business Regulation 10 Dank plaza,Room 5170,Boston,iviA•02116 617-973-0787,81.9?83-3757 orvisit the OCABR-ebsite at httr_(tiin:�i:mass aav/ocabrl If you v:afttto verify the registration of a contractor or if you have Questions or ner=d additional information specntically about the contractor registration eolapohent of the Home Improvement Co�aetorLav,contact Director of Home improvement Co,-iietor Rcgisiration office of Consumer Affairs and,Business Regulation 10-Park 1'IA`a,Room 5170,Boston,hf A 02116 617 973-8787,0.88-293-3757 orvisitthe IIIC 11zbsite at hit): ass•sovlocabrl Go online to zdew the status of a F Tome L-nprovement Contractors Registration: httr:/Idb.state mausrhOmennnroveMentllicerseelist.20 For assistance with in-Moral mediatiori of disputes or to register formal complaints against a business,call: Consumer Complaint Section office off the Attorney Geners 617-727-8400 . ANDIOR Better Business BrTeau 5Uti-652-4$OOt70875525:uor4:13- 34-5-i`` Ycrian2f-tt13'1?dlo h von- o . - � � • � . } , �:E_;- s i +a ,E e 1 , 0 Qualified 1 NFRC 1Y1C10N'3 Bringurg quality wfight. VINYL DOUBLE HUNG NagamlFenedration IMPERIAL L� airy(7evin.iim Double Glazing.Argon F111.1-ow E.Grids — SLL-4-29.0n162-00002 PERFORMANCE.-RATINGSENERGY U-Factor (U.S./I-P) Solar Heat Gain Coefficient ADDITIONAL PERFORMANCE RATINGS Visible Transmittance :Condensation Resistance tD7n 1 fdarvrfacturer stipulates that these raitings conform M applicable NFRC procedures For dpirrmini:+Q •'+,ie product performance. NFRC railings are determined far a fi<e-cl at 01 �,•:.:...-+ -widitions and a snecific product size. NFPC der not retommer.d any creel:._ ar;u Does not warrant the suitability of any product fbr any-penfic c-e.Con3ult manu`acturer'<- literah+ro feu other product performance inf3rmat on. vr.,vr.nfrc.o 1318555.060 r Yoe Com moazweadtdz ofAlrassacFiaase is Departl�aert-0f1�dm�i,•al.4ccFde,,a J C .1 CoW-=01`tree,�5taite I00 BoS$oF?S IYA 02L74-20.17 c - Workers,Compensat Ivavl�taaas�@ Insu ovIdla TO F3Ir rance Affidavit.Bui der/Contractors/Electricians/plumbers. FILE')VtigII THE PEMMITTING A UT`HORY T E A Iicant lnforntation Name(Business/0 ganization&dividual : Adw_ IL s Please$'tint , 'bl `Jta to Address: `�.t �:_Terl'br,;KT-P7,r,rlMg,,f City/State/Zip: Phone#: & �t °� �{ E � � a �� a emplover.check theappropriate t Eos: m a employer with ~` Type og r0 P _employees(fait and/or part-time).= y- p I�(required): m a sole proprietor or partnership and have no employees v.orking forrsre in 7• 0 New construction y capacity_(It*o»rorkers'comp.insurance required.] S. Remodeling m a homeowner doing allwork myself.INo workers'cora 'ms 4. p utance rzquired-)t ❑DemoIition m a homeownerandwill be hiring contractors to conductallwork I0ure th on m B vat aI!contractors e' 3 Prope •- twill � utld)n additirther have workers'compensapon instuanceorare sotem � On prietors with no employees. 11.0 EIectrical repairs or additions a general contractorand I have hired the sub-contractors listed on thi"artached sheet 12-`_'PlumbtnQse sub-contractors have employees and have workers'comp.insurdnc..: repairs or additions oo-repairsare a corporation and its officers have e>xrcised their right ofeeemptionper MGL e§1{a,j,and w-c have no employees. 14- them [leo workers'comp.insurance required] *Any applicant that checks box I must also fist out Ute section below showing their worker'compensation policy information. t Homeotrmers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a mea'affidavit indicating such Contractors that check this box must attached an additional sheet showing employees. If the sub-contractors have employees,they must provide their Workers camp.gohry number. atoand�e whether or nottiwse entities hive iant an enrplol'el tltat ls provldzng workers'coinpeitsatton rust• atzcejor.tzl'ei)IPIOJJees. Below is the policy atzd job site titfOPittatl0ll. Insurance Company Name._ c Policy m or Self-ins.Lic•rjrz: Expiration Date: ,�� Job Site Address: - �o t Cl ✓1 �- S�' /'/7��r , /2' //` Attach a copy the workers'compensation policy declaration page(shotivint the polt�y-;lumber and e �a�o date. Failure to secure coverage as required under IVIGL C. I52,5�25A is a criminal violation punishable by a fine up to S1,500.00) and/or one-year imprisonment,as'veil as civil penalties in the form of a STOP Wpj ORDER and a fine of up to$?�p.pp a day against the violator.A copy ofthis statement may be forwarded to the Office oflnves6Qations ofthe DIA for insurance coverage verification. I do/terebl'cert,ander then;;- -- -, - — ' r fA ii ��­*e filo_"ZIMon prov Siided above i s trite mrd correc4 gnature: % (� ' .... Date• }/� a� Phone : 0�cial rise oizll: Do not write in tills area,to be completed b},ritjr or tolutt o}ftciaL City or Town: petrnit/License issuing Authority(circle one): -.- Board 6.Other of ti�ealth 2.Building Department 3.City/T'own Clerk c Electrical Inspector 5.Plumbingteas ectot• 6.Other _ F Contact PersoM I'itone#: A CERTIFICATE OF LIABILITY INSURANCE DATE(MMND/YYM 3/3/2015 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(les)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 CONTACT Construction Eastern Insurance Group LLC PHONE (800)333-7234 FAX VC,Nok 233 West Central St E pAA1L. INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER AArbella Protection Ins. Co. 41360 INSURED INSURER B NautlluS Insurance Co Atlantic Weatherization INSURER C: 61 Rear Jefferson Avenue INSURER D• INSURER E Salem MIL 01970 INSURER F: COVERAGES CERTIFICATE NUMBERMSTER 2015 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 ADDL SUBRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMID M D LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY RENTED- PREMISESoccurrence) S 50,000 A CLAIMS-MADE rx--1 OCCUR 8500042816 /20/2015 /20/2016 MED EXP one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY Ea COMBINED S LIMIT $ 1.000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED $ SCHEDULED 1020015871 /20/2015 /20/2016 AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS NON-OWNED PROPERTYAUTOS DAMAGE $ Per accident PIP-Basic S X UMBRELLA LUIB H-00::1-MU-:1V=E FACH OCCURRENCE S 1,OOO,000 AEXCEss uaB AGGREGATE S 1,000,000 OED RETENTION 600058654 /20/2015 /20/2016 S WORKERS COMPENSATION WC STA7U- OTH AND EMPLOYERS LIABILITY YIN ORY U ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ NIA E.L EACH ACCIDENT $ (Mandatoryfyes,dsc to and E.L.DISEASE-FA EMPLOYE S If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B POLLUTION LIABILITY PL200378613 0/1/20140/1/2015 GENERAL AGGREGATE $1,000,000 FA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,0 more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WMLL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE John Koegel/PMA ACORD 26(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25 rmmnnm m Tho AnnPn n2mra nnrl Innn n►n roniefamei mnrlre of Ar Aran Rightfax N2-1 3/10/2015- 10:11 :37 AM PAa>; DATE l�ulo iw" ACRO® CERTIFICATE OF LIABILITY INSURANCE W40-2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPOER N H CERTIFICA AFFORDED THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY THE POLICIES BELOW THIS CE TIFICATE OF INSURANCE DOES NOT CONSTITUTE AND OR LCONTRACT BVE'TWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. must be endorsed. it N IS IMPORTANT:he terms and conditions of the�cy,certainITIONAL 1pol cies may requirethe lan endorsement statemen on th s certificele does not not confer rights to the certificate holder in Geo of such endorsement(s). CONTACT PRODUCER NAME: FAX EASTERN INS GROUP LLCPHONE N . AIC No Ext 233 W CENTRAL STREET EMAIL NATICK,MA 01760 INSURER(S)AFFORDING COVERAGE NAICX INSURER A:AMERICAN ZURICH INSURANCE COMPANY INSURERS: ESALEM, IC WEATHERIZATION LLC INSURER C JEFFERSON AVE INSURER 0: MA 01970 INSURER E INSURER F: ClEfa IC IUMO 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 REOUIREMENT, TERM OR CONDITION OF ANY PECT TO WHICH CONTRACT OR OTHER DOCUMENT TWITH RESOLICIES DESCRIBED HEREIN THIS SUBJECT 70 ALCERTIFICATE MAY L THE TERMS,E ISSUED OR EXCLUS EXCLUSIONS AND INSURANCE AFFORDED CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS• AWL SUB POLICY EFF POLICY EXP LIMITS INSH TYPE OF INSURANCE )NSR WVD POLICY NUMBER MMIDD/YYYY DlYYYY LT EACH OCCURRENCE S GENERAL LIABILITY ppalp(�„E TO RENTED S COMM ERCtAL GENERAL LIABILITY nnt5a51Fa occmrrngl_, .--- CLAIMS MADE R OCCUR MED EXP(Arty DV INJUR PERSONAL 8 ADV INJURY S GENERALAGGREGATE S PRODUCTS.COMRIOP AGG $ GENL AGGREGATE LIMIT APPLIES PER: $ PRO- LOG POLICY JECT EeOOSQVGLE LIMIT S AUTOMOBILE LIABILITY BODILY INJURY(Per parson) S ANY AUTO S RY(Per accident) ALL OWNED SCHEDULED BODILY INJU AUTOS AUTOS ppE V AMAGE S NON OWNED HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAR OCCUR AGGREGATE $ EXCESS LIAS CLAIMS-MADE S DEC) RETENTION$ X WG67ATU- DTH• WORKERS COMPENSATION TORY LIMITS ER _ AND EMPLOYERS'LIABILITYYM E-L.EACH ACCIDENT $500,000 ANY PROPRIETOMPARTNERIEXECUTIV OFFICERMIEMBER EXCLUDED? N/A 6ZZUB 03 20-2015 03-20-2016 E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory in NM 58270121 If yes,describe under E.L DISEASE-POLICY LIMB $500.000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORDAddNbnal Remarks Schedule,H more space Is required) T OD C TOWN OF NORTH ANDOVER CANCSHOUELLED II BEFORE THEANY OF ABOVE OEXPIRATIIONB DATE THEREOF, 1600 OSGOOD ST NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE N.ANDOVER,MA 01845 POLICY PROVISIONS. AUTHORREDREPRESEN'T'AT�IV}E b—.,, ®1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD.name and logo are registered marks of ACORD Massachusetts-Department or.Public Sa`et'y `f Board of Building Reguiationsan d Standards C'onetruction Super-;lion License: CS-087977 `.. . ERIC w PALMI 3 HILTON ST , Salem MA 01970 ' ;f Expiration Co,mlis5 a n e r 04/23/2016 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(9914)of enclosed space. r Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license_ For DPS licensing information visit www_Mass.Gov/DPS �ca�uiun»raeall�a�C'ilauncli�;c/(s Oftice of Consumer Affairs&Business Regulation keME IMPROVEMENT CONTRACTOR . eglstration: 142089 Type, piration: 311212016 Ltd Liability Carpo-;; ATLANTIC WEATHERIZATION L.L.C. ERIC PALM 61R JEFFERSON AVE — SALEM,MA 01970 Undersecretary W License or registration valid for iadividul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MIA 02116 Not valid without signature