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HomeMy WebLinkAboutBuilding Permit #1107-2016 - 28 MIDDLESEX STREET 4/25/2016 V' o��O DT 64gH0 ��,� BUILDING PERMIT �� y�_..,,, TOWN OF NORTH ANDOVER o A APPLICATION FOR PLAN EXAMINATION �o . Sp Date Received '1s 4ADRA7ED Permit No#: �ssACHus�C Date Issued: I IZ5 II�ORTA­NT: Applicant must complete all items on this page LOCATION on b S� Print aft� PROPERTY OWNER ��'�` Print 100 Yeatg yes no �PARCEL:�ZONING DISTRICT:_ Historicy no MAP Machiny s no TYPE OF IMPROVEMENT PROPOSED USE l Rvn�w_ ❑ New Building ❑Two or more family ❑Ad tion ❑ Commercial teration No. of units: [I Others: ❑ Repair, replacement ❑Assessory Bldg ❑ Demolition ❑ Other _ - p^Flo©dplain, 'Wetlands a ��� m ❑ Septic �Well _ � ❑ 1Natersheda'®istnct DESCRIPTION OF WORK TO BE PERFORMED: Ide tification- Please Type or Print Clearly a OWNER: Name: �e oV, f� -� Phone: Address: Contractor Name: Eric W.Palm Phone: Email: Address: Supervisor's Construction License: g7 97 Exp. Date: Z Home Improvement License: (I Z-0 �'! Exp. Date: 31, I Z r ps ARCHITECT/ENGINEER Phone: I 4 Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ o�I (� FEE: $ Receipt No.: Check No.: � l ��2� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ry -- _ 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 � g� 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 E Engineered eered products Engineering Affidavits forg p . Engl g OTE: 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 Ener 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 1 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 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools Tanning/Massage/Body Art ❑ g ❑ Well ❑ Tobacco Sales ❑ ❑ Food Packaging/Sales g/Sales ❑ Private(septic tank,etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Si nature COMMENTS HEALTH Reviewed on Signature COMMENTS AV, rrt;lr;r' 1 Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments conservation Decision: Comments Water& Sewer Connection/signature&®ate Driveway Permit DPW Town]Engineer: Signature: kFIRE DEPARTNIENT �_ Located 384 Osgood Street r t, at d s no �, #> Tem Dumpster onsite �. ; QV, .; Lo ted at'124 Mam Street *�€ " Dep � & Fire 1 1. > ''t.r..'t. +1°MS^k .r #..,.+, ..:.4.,r•+._ ..aa.: u.'ae—.k4!' ${ i .c.*44,1..4.na4A.rX* t "' 1 .v4±?` .eti"r - •x to -Yt ' k =:` i tv _ ts. S �i� �. s,...� ° .€_;-- ' CMMEONTS::_ = r a E Ff a , F 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 I NOTES and DATA— (For department ease) f i i ® Notified for pickup Call Email { DateY ____`�^ Time Contact Name Doc.Building Permit Revised 2014 r; Location G41Y1,15-cl No. 1 01--ZC4 Date P • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ ��,,�� Building/Frame Permit Fee $3 t Foundation Permit Fee Other Permit Fee $ TOTAL $ 1 Check# l� 30278 lBuildmg Inspector r NORTH . . ver No. Ami t 63 ver, COCNtc"aw WIN S lJ BOARD OF HEALTH Food/Kitchen PER D Septic System THIS CERTIFIES THAT ......... ToW� BUILDING INSPECTOR ...... ...... .. ............................................ I ...................... ........... Foundation has permission to erect ....................... buildings on ..... 4; � X...... . fir.. ... • Rough to be occupied as .. .... ..� ..ii.. . . ....�. ............................................ Chimney provided that the person accepting this permit shall in e�iery respect conform 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 11N 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS Rough 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. ��satis&ts '- movement topyatec �i e� �softhestaEcs m-14 144Stmc ' l' chMRS hO wne� adxs� ovemeFtr yZ I MceoFCcros�mtrr lo8omerm>my � FY AWpeomnplan;w a).tRrdoPsaag; gpID �� 3atioasConsinaeragtt�g �Ywaskanyoa',Wdmce yj Sbm"ftebFirinacwGf"A ri IIromboaftadineat61 ,g787or3.8&Y2a-- a freecepybycanjilgg, Comte 3737arcuo>zi 2 � cgo�I�o�tiola StrcatAddrest USCI Company {d°oatuseapa� �r'� ceBozaddress} At�Itic Bath rizatltii2 Ci on;t -eSQ,>C �' Cotm��� Lt,L A Code B �iV�p�� DaytimeFhurie`'- ..:_:�'�/l;- asmeaAddr�inavtin Mats: Ad' C �� Stale S °t (hditierent ► Ba�pa� tip FedaalT�plQietIDarS$NamSo ihCont actor to do sxad a „ „ � a:e tDescibetind�theaarlctoro�eFaTda�g-trarfr�'ortbe r�,n�� !�Stobro��drke>x,, iFn and will besecio bYtheco owhgbasjh {fbcrBaswho��tbeir. toehome�ees bei Start andComgl oaSak le-Ihefoll sritideti -Om I���ti��+'�tFtt epito'mlessacesbyandtLe e�gschemowm -`r1GL '1412,3 Fuad visstat9so; �'aaotsctrclat, Date zciren conte yrm beein Tow ntract wnhactcd worL �' onotratxo,-grict:attdPaYmtatftedule .I euit® .�beery eompleted- Fa3�nentsw7lheareftmMade �'ftnishthe matMa7aboz gto efolhiv�g edaIe �tfred totj mm OE S upon sigabg I `� S (not teems 3/3 of the total ton `_by or uocn completion oftpnce or thecost ofspecial whiclte„�rs l;rratg- S , or &Yco�Ptetien op� upon completionoftTte Taefalt � contras�farbidsdemaa� _ ord!befOte � /nneat+mstbs�eciat S gfnII eottmh7c��iscomp xIto mmeetthe �lan m� fa; Psstisfaction) NO-smg.M indedia S 17Mes{==IIr m d wfachIMM bei (a)°tlhsl a€thea� dP*'asit o dorsa paymem __ Eznr 7- a 4 mm dm CGmNeIInaschedul, can egtti�t�tar� r bepas r," - matom n may Sobcontr- as material clots-ine ° Party/SUbnAn co xorag�s� dad�thc �t CoelaterialS bnCtnrutil�d b='solely �'airutfae2 P:a $q all - _ dla orrmderthisythecon 4axor. Thetamnh..aobIcfor�pletionoftbe zrasa Yhesv be» ctl cnatractsbPn�-Uponsignla stir 4fhrtbwa `�mbesotety ossafthe+ totksaoatr care atlnotimPlYthat �t1os'docnmentbecamesaty bioFansrble,SordlPaymtmtstaaIl�Of-Y�d frdlybamesimia �Ylieaarothpma �sfor 0 Daagbe g8rrs��t f s �P onffierwd�euc� � now�tldrtthisdacttmec4the ° n,a$e if'0 mgcaztticnsandnt doe; �1 n suretheco -lorhasava3idHtitae-la��E° dandfnll rVestmuall toberzg- UUhtht',Dt� �t—M-- Y ddd r4�sFionsiF ° DoesthecobY�szitiagtotlteDL�ctara¢ orofHome �eristraTron•Tkclaw �Itingisnnctear, aq Know hzsiaaatt � torform 7 Ba o�nn p2lI CIL°umayingttataabarteac ^�rcOnt>zetorand ° PYofa byrIliog637A Yourrighfsaad gym'-mmmca mmtYiaf 73-gT&7or888- Gtpde to thelfema i ��iocs•� the mmai'm so tkatyan 3-3757 wpm remenY Coatragcrl �Pmiatttadoa on the re C° or to i'oum= �sideoflhis mer conirzcto; cel t--: -1n-0 fitlras aadget ac�yoftheC thitdbusine �g2tl°�he:rAaiaO s'nedataplamel Y following the si or bract h a ce , the taabMill I; �gQfagreem� ° mYmat7 "CubE NO �161V fl a ono bYdeli Ymrnotifgthe Taroi�,: �c� �3'1�� , ��Ia3ioa fam frac Iau �thmffidWgbtofthe ARE SPACUm Homeoumees5igoaftrrc a sus 4--:dbe we • } k C Date 2-0 aoYs Sim Daze Z r i 4 Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an aribitrafion action(as an alternative to court action)if they have a dispute with a contractor. The same right is not autorrlaticatly afforded to a contractor,however_ The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties We to the optional clause provided below. This clause would give the eontractoi the salve right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contract ff.f( X5vbi4Offie dispute to a private arbitration firm which has been approved by the Secretaryof the Exeeut ve"6&Of "o nAffairs and Business Regulation and the consumer shall be required to submit to such arbit�tipp:aslpYola achusetts General Laws,ch er 142A. 0 Homeowner's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Nights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as'prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner- Homeowners may be entitled to other specific legal rights the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractdr lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumrir rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibi s and referenced documents have been attached Fatties are also advised not to sign the document until all bladk 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 kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment sche dole in cases where the homeowner deems himtherself to be financially insecure. However,in instances where a contactor deems him/herself to be financially insecure,the contractor may require that the balance of fiords not yet due be Oaced in a joint escrow account as a prerequisite to continuing the contracted work Virithdrawal of fiords from 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 if you wish to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement" contact Consumer Information Hotline J Office of Consumer Affair and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-83787i 888-283-3757 or visit the OCABR website at httn:/hvu%v.mass.eov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need addition IIbl information specifically about the contractor registration component of the Home Improvement Contractor Law,contact Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at ltttu://xNnvnv.mass.2ov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: htto://db state nia.us/homeimi)rovement/ficenseelist.asp For assistance with informal mediation of disputes or to red ster fbrmal complaints against a business,call: onsumer plaint Section 4 ffi ney General w r'` 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Vemion 7-1-11/22P-010 Contractor Arbitration i The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitrafion action(as an alternative to court action)if they have a dispute with a contractor. The same right is not autouiatically 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 contractus the same right to arbitration as is afforded to the homeowner by the 1lome Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the conteactor has a dispute concerning this contract,the-ppp5aotor- Mt�r}�;tit6e dispute to a private arbitration firm which has been approved by the Secretary of the Executiv=0ftGib* ner Affairs and Business Regulation and the consumer shall be required to submit to such aro t ipp: sachusetts General Latus,ch r 142A. AAA Homeowner's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alt ative dispute 1�©TICE P PP :Pl resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed;by the parties. Homeowner's Rights A homeowners rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights i the contractor guarantees or provides an express warranty for workmanship or materials. 111 addition to guarantees or warranties provided by the contractor,all goods-sold in Massachusetts cavy an implied waaanty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contra t lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic co um rights. If you have questions aboutyour consumer/homeowner rights,contact the Consumer Information Hotline I listed below). Execution of Contract I The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached Parties aro 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 eontraL with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties_Contracted work may not begin until both parties have received!a fully executed copy of the contract,and the three day rescission period has expired Accelerated Payrraeats ^ r may not demand payments in advance of the dates specified on the payment schedule in cases where the n contiacto y Pym i homeowner deems him/herself 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}Dint escrow account as a prerequisite to continuing the contracted work withdrawal of funds fpm Bald 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 if you wish to obtain a free copy of"A Massachusetts Consumer Gude tb Home Improvement" contact: Consumer Information Hotline G Office of Consumer Affair and Business Regulation 10 Park Plaza,Room 5170,Boston,,'-NLA 02116 617-973 0'187;888-283-3757 or visit the OCABR website at hits:/hvnlw.mass aovfocabr•/ if you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractorregistration component of the Home Improvement'Contractor Law,contact Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 ParkPlaza,Room 5170,Boston,MA 02116 617-973-8791,888-293-3757 or visit the NIC website at htb: mass.dov/oeabrl Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.nia-us/homeimprovement/ficenseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: onsuriler plaint Section fffic.' oneyGeneral 617-727-5400 AND/OR Better Business Bureau 508-652-4800,503-755-2548 or 413-734-3114 Version 2.1-11/2'_010 The Commonwealth ofMassacltusetts Department q f Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information .1I Please Print Legibly Name(Business/Organization/Individual): Adatic Wi tauir rizwAiuti,LLC, 01 K e or5m) venue ! Address: she � M A 91070 City/State/Zip: Phone#: J 7 Sl- F,Areyown employer?Check the appropriate box: employer with , ,/ 4. ❑ 1 am a general contractor and I Type,of project(required): yees(full and/or art time .* have hired the sub-contracto JF6. ©New construction p } rs2. I am a sole proprietor or partner- listed on the attached sheet. 7. 4 Remodeling ship and have no employees These sub-contractors haveg• Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.# 9. ❑ Building addition required.] S. ❑ We are a corporation and its 10.[J Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12.❑1 Roof r pairs employees.[No workers' 13. cher comp. insurance required.] "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. lam 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.#: Expiration Date 31 70/1 -7 Job Site Address: gS{ '" -y/nr` "` J/e_i-e_x City/State/Zip: i4/. 4)� dA-44_ Attach a copy of the workers'compensation policy declaration page(showing the policy nuiber 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 forwlatded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided abov is true and correct. Signature: �bt y � L Date: j Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I I.Board of Health 2.Building Department 3. City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person; Phone#• A CERTIFICATE OF LIABILITY INSURANCE °ATE' "'°°'Y"""' 3/9/2016 THIS CERTIFICATE IS ISSUED AS A M�TTER 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 isan 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 endorsg6ent(s). PRODUCER CONTACT NAME: Construction Eastern Insurance Group LLC PHONE IAIC-No (800)333-7234 (AIFAR No 233 West Central St E-MAIL ADDRESS: 1NSU 3 AFFORDING COVERAGE NAtC# Natick MA 01760 INSURED INSURER A:Arbella Protection Ins. Co. 41360 INSURERB:Nautilus Insurance Co Atlantic Weatherization INSURER C: 61 Rear Jefferson Avenue INSURER D: INSURER E Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 2016 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. INSRA ,1 L TYPE OF INSURANCE POLICY NUMBER ,, CDY EFF MPOLICY EXP VATS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO Rfff— PREMI ES EaEccurrence $_ 50,000 A CLAIMS-MADE Q OCCUR 8500042816 /20/2016 /20/2017 MED EXP(Any one person) $ 5,000 X CONTRACTUAL LIABILITY PERSONAL&ADVINJURY $ 1,000,000 X CG0001 10/01 FORM GENERAL AGGREGATE $ 2,000,000 GEN-LALIMITAPPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY (Ea accident) O BIINED SINGLE LIMIT 1,000,000 A ANY AUTO BODILY INJURY(Per penton) S ALL OWNED X SCHEDULED 020015871 /20/2016 /20/2017 BODILY INJURY NON-OWNEDPROPERTY accident) $ X HIRED AUTOS X ACOS PROPERTY DAMAGE $ Per accident) LUl6 PIP-Basic $ EXCESS X UMBRELLA B X OCCUR EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTIONS 10'000 600058654 /20/2016 /20/2017 $ WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS'LIABILITY I RY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N(A (Mandatory in It yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S B POLLUTIONPL200378614 0/1/2015 0/1/2016 EA POLLUTION CONDITION $1,000,000 GENERAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS t 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 TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POUCY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE John Koegel/SME ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r�nimnns�m Tji�o O(_nPn namn anA Innn aro raniaf-mtl m�r4c of e(`ARrI ••`�� �-• -•�+_ 4/ 4JI LV1V O JY GY tw, 1:'t%%xz L./vvG raA oux-vur CERTIFICATE OF LIABILITY INSURANCE r DATE(MM/DDIYYYYI 021223/7171 TwE.EeKTIFICATE 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 CERTIFICAT16 HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy((es)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder in lieu of such end6rsemen s . PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAX 233 W CENTRAL STREET (AIC,No,Ext): (A1C,No): E-MAIL NATICK,MA 01760 ADDRESS: 22MLW INSURER(S)AFFORDING COVERAGE MAIC# INSURED I INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B: INSURER C: 61 REAR JEFFERSON AVE INSURERD: E. SALEM,MA 01970 INSURER F: COVERAGES CERTIFlCATE NUMBER: 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 PAD CLAIMS. INSR ADD ISUB I POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE I L R POLICY NUMBER (MMIDDIYYYY) IWADDIYYYY) LIMITS GENERAL LIABILITY =ACH OCCURRENCE $ rGENL MMERCIAL GENERAL LIABILITY CLAIMS MADE F]OCCUR. DAMAGE TO RENTED $ REMISES(Ea occurrence) ED EXP(Any one person) $ RSONAL&ADV INJURY $ GREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ ICY E]PROJECT❑LO RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE i $ RETENTION$ I $ A WORKER'S COMPENSATION AND wC STATUTORY OTHER EMPLOYER'S LIABILITY YI'N UB-513270121-16 0320/2016 03/20/2017 X LIMITS ANY PROPERITORIPARTNERIEXECUTIVE SOO,DOO OFFICERRAEMBER EXCLUDED? a NIA E.L EACH ACCIDENT $ (Mandatoryln NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERT[RCATE ISS UfiD TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER ( CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIB ED POLICIES BE CANCELLED 1600 OSGOOD ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR N.ANDOVER,MA 01845 ACORD 25(2010/051 The ACORD name a{nd logo are registered marks of ACORD 1988=2010 ACORD CORPORATION. All rights reserved. Ik I --77 Massachusetts Department of Public Safely Construction Supervisor + Board of Building Regulations and Standards Restricted to: License:CS-087977 Unrestricted-Buildings of any use group which coin Construc;tioa Supervise' " less than 36,000 cubic feet(991 cubic meters)of . enclosed space. EPJC W PALM_ 3 HILTON ST SALEM MA 019,70 r'-e[, CKCA, Expiration: Pa�lure to possess a current ed"Rion ofthe Massachusetts Commissioner 0412312098 State Building Code is cause for revocation ofthis license. DPS Licensing information visit:W W WMASS-GOViDPS i l r_arc-rrr»mirrnrrrls n��' f rrr.lrn;�?f; License or registration valid for individul use only . Ofllce of Consumer Affairs&Business Regulation before the expiration date. Wound return to:_ . i F ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business ReVdation a �RJegistration: 142089 Type- 10 Park Plaza-Suite 5170 �Exp)ration: 311212018- Ltd Liability Corpor Boston,MA 02116 ATLANTIC WEATHERlW- bV LL.C_ ERIC PALM 61 R JEFFERSON AVE Not valid without signature SALEM,MA 01970 Undersecretary I