Loading...
HomeMy WebLinkAboutBuilding Permit #1052 - 265 BEAR HILL ROAD 6/15/2015 � - - L BUILDING PERMIT F tkoRrk �E- r6T 0 TOWN OF NORTH ANDOVER a� °` ° APPLICATION FOR PLAN EXAMINATION �- ^o �` Permit NO: 0 Date Received 4•�=�—�• ' Date Issued: 4/iRTANT: �SSgcHus���y Applicant must complete all items on this page � rf•.J✓y��Y' �- ._C_,ru-c1}c-;a:r J �'������J"-�.»�a�� atW •t+� �� 'F 4',:� 1- � � � Mr`'. 7 1 ''r s.r--, t.�..i}ti, r -r>, . 7 - l'7"G� . Y'...,< r'r >.• ra.y e L. _ L ,�, x (r ;. s r s r dS J rr '' r��-a.ty. �y yt n t,�, RIS�J+1 �i.1-rzc-'--1f,.sF ,t'�--"tl5 L'• , .. �y' E z;'�(. r`4r i,n t� },;I .-e `_ t �s.•,Ee2� K hFSi,`•.,,', sZu 4••'4 �LJ i.l ra, _'4.n4 v...�-.• �,.,�q,.fil ri�#, 'j'�t ��.!h��"S -'�,. IN 1.�-' �` 'dc + r �.••,1 'Ir me4S- a� �II �trl.�l�l��� .T �'. !,s:C�i •„ � -, �.: .,�• 3s. '- � r¢'x i�.a'�.- -r � ��r��3..rn, r� FZ� � �.'t h'S?,"� .x-t�r� ',�,i.„�'¢.w'-f�,�' .a; .�. .s,,z..vl�r.,'m - � r,- iF.--r ku�•,i�.tL�k�n J c+ra, E 4 t_ � � .��nrtl-�`,�S�T4Ji'.y j'.�fy" ��� k..-> ,���•.v.....Mj:r"r.��r'�rf� ',�'s[� u,•t i�a.�i�s+.,�1't'+t+L�n� �,••�-�•��,► F�• v .a'>+,c ix' �c �'_k'sf.;�wFn'r 't Z- �au;ke. i:lxC.'�-'daiiTrj`�Ctt.,f.u�. .,,F �. Yom"=! �.-�'- 4 a ,a� `^i -� •�-:7ii 's w�_+1.3w`��.':1��'v"�'?"�=' �«' r�`fid`��,��'t,�rt�`r,"'�lcd � ,3,•��'ili$r'��.: .�f .�-�'s�i'.+;T'`u C�c� •wc F-s i,�s•�'� -�- �"�''="���ty��c, ti,,.,. �,w�1'�•,�f, '�..'r��.o^-r�j .Ti.k` _��'�'aj;,� _ n �i 7��� ag 'g J•n�h�E �-'tf.�'�Y' ,C"�'�.a�ifd,�2y' ^•2j�'o— 'h.- ,/�J,�fs�il�,�..w3-M�r•���•. ia`��r� f1151" IirST 'SnS.11}y��'f.+pYsr•y� y�vS ••,, MSL t�' �V. L .f T,, T�AJJ11:� TJI St,vc'RI Y' .k•-: .Vt Y, 'q�; V. gag"-*' 1" +f J:,� r } LI r •LJ.G' V. "f 1.[7 ��r y _+_ i` �- ^t)J "r'�;•/r,{,,yY•� �q�t ar'09 {I::*�.p , �r.,4G5( ...rr Sn--i:T� n ,P_:�.v r�..'J:..:G.�'-•: ', � +ti 'S10 ,T 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 s..�nr �•n "-'�-J'�,& Y i �7,-r vti's'x r.I�"z �.rL^S ,.., .k .. ..-s,.. y. G;3.- ���� i�, .a�p•�����fi .a= tr'"a�P �u�',u� � ��� _»-��n ; r .�.7 �,,-��_ ;..;~�•�%t?:.a?:=. � �,�•P-:S^�j.T, .f=.,�1L�te.l,�,r,^`. �� �.i.".^r '�" •ia�. +IJ;� 7 �3, y y7' INN �- i.S442-gt��,yy3"N''��,....Yf,._�'.�S...f,c.,u..,�. cr "L-`4+.•,- 7ti,. �' I DESCRIPTION OF WORK TO BE PREFORMED: Md-zu iN Identification PIease Type or Print Clearly) OWNER: Name:_ Phone: �1� 5 SObS Address: "'.�-`r,�•. ' LAk,•�"s al- :. '..``kr.�, ti �'cr 4lr'3'�'k' ..F .-;:�fs:7.7S:i:��P.ta'r.`.a="e 7^ _::K.• �v - � IY t�•Y=S 'nom' *erx. :�?.a.� "�� .��s,,rJ,�rs �.�`�,�a3�a Vii'.`h.�•3�'1'h� i�r '^n`}jg.-�¢�� Irv" F� �� �i{ ��'��.nt. ^rt•a � 'S ��,-_rW r`s� x�-:!_ry :qs. 4 �.c!`�i r�•o�'�`3 'it�L2�. �'c.� '�.�'� � ������ 1'J�I�-�- � - � 5�l }� R�.9`�t ^�. � Y �,�� ,�x��,/� Y' M1 � •"¢�'s•;� �-2��i � ^^,J'9•.. �J. �at'£ yG� y>-..� _ '` W 'YI•,'.i1���.G o-l.������. �.' 3 "^ +LeLsl ., rylnwiy.":.P ..is-v.k4ia"+e�a^.r•�'s�",, Y- .r �,rsr .. r - �'r�,`{,# ,e ... -sn ��� '�J�L- -�� 1�7rr J• e>� �: ,�"�>!�}�.- �. � nrx7>~t,.,-•�-._ � r � , ,,y; ���Mf"'' r ��" te,,,. ,,y,�7. ",v.•i � 's.3"Yp� �`,�u."'�.wA'r�','Ts ��'Fil�� jT 'S{.�, 1.��.��,�. ,�ry�,..:F;��..__.s���•_-i� '' ,131'{''"S -- . "`�� •� °'' Js Kx .v..,... �rs.,'s. . � '���e^a,i-+ � sl fl.S�"�,r "t^•c�• 7 Tf GfY sb�ji-`'�0-t�4 ''1♦5L��4'N'Y��, R'r'k"'t�„3o-e. L L' :I+YT M1 g r �, •f", � }' }f�LJ�L ����15 x4 31, °Fa`- 1�ro.'Y^.it`a's` . f3�. L..rPr•,n.F�r'I ^-•F t'.�fa-L�F...Y�3Lv} }. !s-,,.g q7s 5rr _�.....-3;5.34'::.r'}�J.c'. r R "a!, �i ?t"e_• ;k i a,,,. - %'k�i��":.Y�' [r��`%„i��7Lfx 5 r -f ��:,"fir:.• yS".;•� , •.. t• •i } 14.r• 3'E_- ���'' ] l ., k s •r Ix 5 car e •b Y'� rL,'� i�;} .��-•-S l:'��, ,�},�•. I �2'4�c1 4'�"�h�,,�• ,:. 7 � a Yyu,.i-� yrc �� '}�' "="..Jtl c'-1,.J.'� '*� �-k tw.i,-,k a1 yS ��• ,�+ •�,� t11 y7�+ ��},.�.•�,�. ''rr:..,'I+� �,:�1t.!!� s p7`R1f"�Mg,�,�f�. � i uRY'_� ��`���"�. '�` � '�7 �{�,��i£'•-•1 pJ- �.1Jha"7' ''AJLiu�'t;ti� ��LA��'l�}s”' � a � tl � J � L_g-r�"�Jfli A "a'r--r7 r}• - 7'� 1�1 -F tit,.r.�� r �.rv. rs� ' ,-• �J•'-,y�a�,t� "'"-e�.(�Su x.�.,�,1t�.✓ . ��. '�- � �-ti�,'�r��"�wT�h-SJr�L_�?.����.c �� - '��� i ��3�G����',�„�' m^xa,' „fit,�q,u�*7': "Yfc t,�xr c:fi� '�'��,.L��r�'et`.d'-u'ct'�r`4.r�'1�v2•'� '� ,+" 1 .r ^, s,.. -a v-,4h 4••_ 7 .E.t`.•-?�(,.'a`c`0��.','r"•. -�•�.a�"��•r`fI' r,Fa•i,.�*! "�r,�? '�.r1�+�S. „_,J�-'n' eri. E'�.K{��f'� �-r- -a-L�-r �,s�a�T r"'''� L 1���w- 4•- Ri •E.,=a••�J� . � .•1,�� —•� !� 'wti'2�k'f- - LfR s; �-�.z+'^F 4�.FA?r'r:-„= L'S 4 '3 TJ �ti•�7�._:' ,�•a.4-`- °}7I� �Y1v7.�.,Y fJ rl -zr s s ..^4 v,d''}kL?u c�' T M :•-. S�;r 4 d''`it r-F�`� 1 ,�"- �.a•v^S�• 1 fr {� { ���'M1+�,G��f'J.. -1-��_����."'J.`�'JF' ... ��� t`Y���A f�R •� -.r{' K,q ��� N tv'S�S;L1"+ J ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL EST/MATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ no FEE: Check No.: Z Receipt No.: 0SI�4-eP NOTE: Persons contracting with unregistered contractors do not have access to the beru fund .��.,. --- gT4.� _ � � -�;,: •; Sannatureaf�co� ract�r����. _ } �.::_. _�:� Locatiori�-�c�7 No. r Date I . - TOWN OF NORTH ANDOVER I Certificate of Occupancy $ Building/Frame Permit Fee � Foundation Permit Fee $! ' ' Other Permit Fee $ TOTAL $ Check# 20 3 Building Inspector i I Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools t 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 Cu—MiviENTS HEALTH Reviewed on Sionature COMMENTS Zoning Board of Appeals: Variance Petition No: PP Zoning Decision/receipt submittedY es Planning Board Decision: Comments a x Conservation Decision: Comments 1 Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: r..,..._._:.5:.:..: Located 384 Osgood Street =,�'s�R��EiP����IIIEfN�' ;:LrocatedPti�24UMin Str-ee# �r r r� r .i.� •'3 d.. .ir-. r- �.-� r� _ 5 �G' - t }�.• t $ a �` 5 t i y gre,,�gparrnents� nac��eld�te y _. 4 i a ._>((''�� �lil.r�MliVd '.TS c { 4 Y .. ..: e•. .:{ 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 foricku - Date P P Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. V 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) ❑ "ass 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 .1 J Plr J Plot Pll ❑ Ce :tl Ll1i d rroposec� F�o� real;_ ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 NORTH own of E 1. . ndover o - .:�: 1 0% No. —'5 - h ver, Mass, C0C"1C"1WICK 1_ �d pDRgTED ►'Pp��S S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT .0�!�... ........ BUILDING INSPECTOR ......... ...!�.... .. ......... ..,.. ....... ......... .. ... .. . .... . ... .. Foundation has permission to erect .......................... buildings on r .........A.f •�..•........••• ••• •• •W• p Rough to be occupied as ........I. V ....... .141!4/.�.. '..................... Chimney provided that the person accepting this p rmit 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 11L Rough UNLESS CONSTRUCTION A Service ................... ... ... ... .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildinz 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. D p Owner's Nan Q Q Beatrice Cutler 978-685-5065 t Job Address: 265 Bear Hill Rd. SIDING - WINDOWS - DOORS Phone._ North Andover, MA 01845 • . e Family Owned And Operated IAve the ownerisl of the premises mentioned below hereby contract with and authorize you to furnish all necessary materials.labor and workmanship. to install,construct and place the improvements according to me following specifications.term and conditions.on premises below described: Brand: j ��. jj �.� (WINDOW)SPECIFICATIONS Quantity: j5' Build Tie Into Low-E Metal PVC New Inside TOTAL$ Roof Overhang Argon Screens Grids Trim Trim Finish Color: U,L-,k. Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes I No Double Hung /S k X �` X 1/3 Deposit S Picture Slider _ EFTiompletion /3 Start of Job$ Garden /3 Balance Upon Cas/Awn S NOTES: (SIDING)SPECIFICATIONS Apply_ over body area of house.Type of insulation Items not covered or installed: Yes No Yes No Yes No Strip off Existing Siding Vinyl Shutters Roof Provide Container and remove all Window Mantels New Gutters debris Cover Fascia&Soffit Door Surrounds Gutter off&on Door Window Casing Ceiling Fluted Post 5'/2 Vinyl Fixture Accessories if needed PVC Trim Traditional Post 51/2 4'Corners ON START OF ALL JOBS-HOMEOWNERS MUST REMOVE ALL ITEMS FROM WALLS&SHELVES Construction related permits:if the homeowner obtains his own construction-related permits for the work described under this agreement,the homeowner is here by advised that in the event of dispute,judgment and nonpayment of the contractor,the homeowner will not be entitled to make a claim to or collect from the guaranty fund establiftill by Chapter 142A,M.G.L. WARRANTY 'e�ontartor vriantszttat tn6 vxtfu hea reunder ha'be tree from.x:e ,n r-a:ena s arz vlaak ans:p a a pe oo ell Year c yr g mm a ro z c sna.:corp, r- tna „„r,.e.,.c LSAg,e_._.;.;nr.e,.n,<nide'a�.ns,kK.<^sh�c..�e,as.erdaraaeczned�y�_Cm.z.Ean__:,,,ca..a.to5z�pa;eesoraee s. aco:ared-r..no,e,earz.a cc „e. to,.z y od^c'.7^g ciaan.p I^e�z.a_.<at ns;,:n e,�v::^se tc^r:,to rr^�y epa-r corer::ec�cecr ca;rse to be reTaA;ed:ew:ed.:.reaacad � .�;,zg�a s,:c;oe'ec:^^at_z:.o.•;raFTa.,at.,, _t::cyc�^y ua�a^t as 8'1 Sced cr.pedor:wd.n ror^ac:.an rri'^s zgeedmcen tie:t.No guzrantea on gcsr Baca u�n rcotna .za".e es Ke carx cP aea^c .<a..ae rn"z7.,:.or,^•rd^c S?vC.RS dxs :.z,�z.-^•g a s:3^•c. B4' Sr�i'asee^Sh'ekr!'10 C0]9n:aGrC.:frs:en;<,CP/Orlds�..ota„r9ti]46m Or(lbe to p;PenC'IvJ r]Ln'4M.HFfI(iKC:�G..e.(N'rRu.!Pfr.•icy•f."?rt9Mn''ff�R^}ev<1G,04",n+?n rroM iS i(k�^7.a�ad'1 i1ra:C'arp2 „ pe ncu"ec.BR3 5 L cn<. r are aril parts BROOKS is rc spos . .:e foroC rror n de• A srananlies o guz a!gas rely e b� !o z e r c urer.unox suer.ai j�faa,,ers var �a. ne oxne. 'y Da wu'ed!o _ rec,`or a..a"z;oi'C or.._9,Bence Of C.:nersne and use of_X,equp.^'_,u.'1or.8rto aava:e sarsvarcaM1.:.a.No Tway 5,.6d De^e ll t'am. L .a%`:Ctiers serva arl'epta:',re vf^.>`z..se lo'a'i a•egsN .n,c'+'a-re V"s d'e maru'acve•s vz'ra-tt._tiaJ not crez•,e any e_porstc-y to,,re Con—mor m,:anany such ecuom_.t.W,111.A i;'9ER GCARANTEES LABOR AND hl,4;IRA;S.NG-B=OCKS SO"S 4 Sero ca Cha'ga C'2fi Of the uno2'd be farce per month i:'.be added to b2.s"5Ce'1 Wt Aa d accord,q to terms 01 co,"rac:or,come,e:,an ofC'ntaact.1,fa rral ho:d beck iv""r nem.a:^^g^a'an,:d c:mast payment I'Rb2hevie,amernI s'ess a'.'.rs 2°e s.'".Te C..'a'y^a,t be aro,ed Adld.'.ioral c`n"rge for add;"g rc,R,'ob s;!e revved mate ais 0.10 dumas!er TOTAL.$ Brooks Vinyl Siding•Windows-Doors Name of Contractor 7 Designated P.egistrant Payment to be made as follows: 254 N.Broadway-Breckenridge Mall 1/3 IS i Upon signing Contract; Street address t/3 IS J Start of Job Salem,NH 03079 (603)894-4488 www.brooksswd.com City/State Phone Website 1/3 IS i Balance upon completion 101682 99730 Registration Note:C Nn au'.:p Ater 3 Gals.501;Of Rema'ruri arrtulce Is rk sto fraWrPe. �1 rJ`, C,, /J/ c, Nnrre�tm apreemens frit nano imprrnmmen•Lnnu2r.Gtlg xo:k sSa11 raniura a dorm paymem?adrznce Name of satesmae deocis';of more than-50'0-o`lie tots'contract once or lite total amount of all deposits or payments 11,+ h the contract or mus:make]^advanceto order ardor odtermse ob:a.n deCven,of special order matenas and eq-.:pmen;.::nL:here amount�s create c nutlbnzed Signal., Acceptance of Proposal•I accept ne pnceSSPaci!Katans and conditions Stated.I understand trial Upon s'gningihis proposal Deeomes a b:natno co.:drat Ye,are adttw^Zed Mote the B9rK zs spec.".ed.Paymert 4:1 Demade as out;-ed etcl e.You,the Buyer may cancel this transaction at any time prior to midnight of the third business day after the date ni this transaction.Cancellation must be done In writing.We reserve the right to Check your credit. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. _ 1 t IN WITNESS WH EOF f th armnies hereunto ave signed their names this ! 6 day of p'r'/' 20 f Signed / �'L ` 7/ f iy� ��v 4 sero ca rharge o124a'Me be added to ba'arcz,r no; .I am the Omer paid 8,cordingto,e'msOfcor,ra:r oncc77aretbdo;CRcnacf.6iar.miumno'db.ak105 a man,.rg tl4awe 01-V payment ivtt cnever amount is fess a.tie 2%servC9 ct,rge Signed ,mane 3w ed Add'ors'chage'e,2dTnion-job sulerelatadn:arva'sinto wrnpste! Y..1 am the owner InlNel The Commonwealth of Massachusetts —x — Department of Industrial Accidents 6 � Office of Investigations 600 Washington Street Boston, MA 02111 _ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Conti-actors/Electricians/Plumbers Applicant Information Please Print Lezibly Hartle (Business/organization/Individual): RmAsA-1 `,,..,p, Xnc Address: City/State/Zip: I� 1 N" of-SOPhone #: 663- 9"4MS Are you an employer? Check the appropriate box: Type of project(required): 1.Y1 ant a employer with 4• 4. ❑ I am a general contractor and 1 ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 7. 2.ElI am a sole proprietor or partner- listed on the attached sheet. i Rennodeline ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp, insurance. 9. Building addition W . [No workers' comp. insurance 5. ❑ e are a corporation and its o b required.] officers have exercised their 10.❑ Electrical repairs ar additions 3.❑ I am a homeowner doing all work right of exemption per MGL I l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have.no 12.0 Roof repairs insurance required.) t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I 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 showingthe name of the sub-contractors and their workers'camp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: E 'ors-tAmhce Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: r'o�RQ (` N�,1 City/State/Zip: ,RA-k& �(S 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, l do hereby certify and, 'ns and penalties of perjury that the information provided above is to-tie and correct. Signa re: Cir' I I Date: fO s 15- Phone#: Of use only. Do not write in this area, to be completed by citj}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#: AC40 CERTIFICATE OF LIABILITY INSURANCE5A 2015 E(M Y) ii 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 CONTACT Linda Bogdanowicz Insurance Solutions Corporation PHONE . (603)382-4600 FAX AIC. A/C o• (603)382-2034 60 Westville Rd E-MAIL .lindab@isc-insurance.com A DRESS INSURERS AFFORDING COVERAGE NAIC fl Plaistow NH 03865 INSURERA:Peerless Indemnity Insurance 18333 INSURED INSURERB:MMG Insurance Company 15997 Brooks Construction Co. of Lawrence Inc, DBA: INSURERC:Excelsior Insurance 11045 254 N. Broadway INSURER D: INSURER E: Salem NH 03079 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1552621745 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. ILICY EXP TNR A DR TYPE OF INSURANCE POLICY NUMBER MM LSUBR DD/YCY YYY MMFF /DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY A A E To RENTED PREMISES(Ea occurrence) $ 100,000 A CLAIMS-MADE FX OCCUR CBP8945793 /16/2015 /16/2016 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PROj r LOC $ AUTOMOBILE LIABILITY Ea aBINEDISINGLE LIMIT 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED (Per accident)0116090 9/28/2014 9/28/2015 BODILY INJURY Pi $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE a NIA A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? C8836275 /16/2015 /16/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Beatrice Cutler ACCORDANCE WITH THE POLICY PROVISIONS. 265 Bear Hill RD N. Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/LJB - ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD I r-�/��r.�irnrr.�rirr�«�f/n/''7i�llJJrrr�rtdr//1 Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 101682 Type- '?s Expiration: 6/29/2016 Supplement 1 BROOKS CONST.CO:,INC.OF LAW MARK DI PRIMA 254C N. BROADWAY STE 110 SALEM, NH 03079 Undersecretary ti Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Speci..lty License: CSSL-099730 w- MARK DIPRIMA, 18 HAWK DRMK SALEM NH 03019 Expiration Commissioner 02/20/2016 {