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HomeMy WebLinkAboutBuilding Permit #105-16 - 335 WILLOW STREET 7/24/2015 TOWN OF NORTH ANDOVER , APPLICATION FOR PLAN EXAMINATION a � Permit NO: _ Date Received / s+ Date Issued: �9SSACHUS PORTANT Applicant must complete all items on this page lFK _ pnn PIOPRfiYOWNERlS' f �•: U� MAP N0 . PARCEL. ZONING DISTRICT Historic District yes no , :Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ® Commercial �. A Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic [�1N�11 ❑ FloodplainfllfVetlaf�ds Watershed District Li.Water/Sewer 1{ e C x e-c H17't AC-,1 A- jf 1 Identification Please Type or Print Clearly) OWNER: Name: KGt I l.�-e / Phone: — 6 lo2'-37?1"2 Address: C� 15-77 0�chi f'S7��r IM 0� CONTRACTOR Name: F' 1fi �► �`��� Adclres ,�4 � vc �N" 5WpervisnrFsConstruction .License ', n = _­Exp. [�ate O . Home Improvement License: c Exp. Date I ARCHITECT/ENGINEER Phone: 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: $ 20, voy FEE: $ d � Check No.: Receipt No.: X02 NOTE: Persons contracting with unregistered contractors do not have access to he guaranty fu E _gnature o_f_Agent/Owner. Signature tf`contractor I i 6 tfORT{ BUILDING PERMIT 0 'CUED #61't'p TOWN OF NORTH ANDOVER 6 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received QDgATfD ""c5 SSACHUsti Date Issued: IMPORTANT: Applicant must complete all items on this page .LOCATION Print PROPERTY OWNER Print 10o Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 El Septic Well' El F=.loodplain} ❑Wetlands El 'Watershed"Distract; - - dWater/Sewerl �` F A i DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: i Supervisor's Construction License: Exp. Date: 1 l' Home Improvement License: 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. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sianatrare of Aantl fi I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS I HEALTH Reviewed on Signature COMMENTS a j Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes G Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit ' I DPW Town Engineer: signature: Located 384 Osgood Street FIRE DEPIARTM T Temp Du�nipste onsite ' Lo ted at 1®24 Main Street` '' 'r . °fit . n ' S. �, xx ,yt1,r- 'r' ti I a i'y .'�!t %t ��: a'.t 'x f $ �" �'.erk'>£' Departmentsignature/date � :;, w,g x j f� 1# � s a { f' � 5 �t.� '4 x } fq.•,� "R y .x''1r�. .� 's" A' -� �°�`a 3�° � 3 r. �_ ��;;� � ,•� � �,'*�r-t r tii�� J�� ww � '�'� F,'�� a'`- k x� 1 9�'� ��� • . I T.V®MM1=NT.S� PE4- r '•-'a ' ..t�..ee- .'w W..._A-•.k.�r.,._si ::r..,..s.�ki�:cs.a,..�...,.`.-2: Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land areasq. 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) Ll Notified for pickup Call Email I _ I Date Time Contact Name - 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 4 Building Permit Application 4, 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, 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) t� 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 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 Location '� � �DW � No. Date • - TOWN OF NORTH ANDOVER • e���TGEb°1s4� . Certificate of Occupancy $ A Building/Frame Permit Fee Foundation Permit Fee $ 1 Other Permit Fee $ TOTAL . $ Check# 00 uilding Inspector OORTH Town of E ndover O ;5.. 0 � Z r Mass, � o h ver, S A- cocH�cnew�c.c y1• 7�p�RAT E D S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ....... ..... .L BUILDING INSPECTOR has permission to erect buildings on . .......t/.�...t.I.�.l,�... ................... Foundation .........:................ ...... .. Rough to be occupied as . P.. .4c... .� .p,! .. ....PC....f ........��:!' ........... Chimneyy 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. e--;-1—,q bG loo) o- � 7r-aAr4Js PLUMBING INSPECTOR Ca�� • �fl� � Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR .UNLESS CONSTRUCTM ARTS Rough Service ............. ................................................................. Final BUILDING INSPECTOR 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. Summit Construction Management, LLC 60 Summer Street Manchester, MA 01944 Phone: 978-704-9022 July 22,2015 Inspector of Buildings 1600 Osgood Street Building 20,Suite 2035 North Andover,MA 01845 RE:Building permit application for 335 Willow Street,North Andover,MA Dear Inspector of Buildings, This letter is to inform you that Cliff Taylor will be doing the following scopes of work at our building: 1. Replace kitchen cabinets 2. Replace kitchen counter 3. Replace bathroom partitions The total cost of this work is$20,000. Please let me know if you have any questions or if you need additional information. Sinc ely, s Scott R Rouisse President Summit Construction Management, LLC 60 Summer Street Manchester, MA 01944 Phone: 978-704-9022 July 22,2015 Inspector of Buildings 1600 Osgood Street Building 20,Suite 2035 North Andover,MA 01845 RE:Building permit application for 335 Willow Street,North Andover,MA Dear Inspector of Buildings, This letter is to inform you that Cliff Taylor will be doing the following scopes of work at our building: 1. Replace kitchen cabinets 2. Replace kitchen counter 3. Replace bathroom partitions The total cost of this work is$20,000. Please let me know if you have any questions or if you need additional information. Sinc rely, s Scott R Rouisse President Age ement This agreement(the"Agreement") is made as of thisO day of June,2015 by and between Summit Construction Management,LLC,a Massachusetts limited liability company having a usual place of business at 60 Summer Street,Manchester,MA 01944(the"Contractor") and Kai Juel,III,Trustee of Eastcon Realty Trust, a Massachusetts real estate trust having a usual place of business c/o P.O. Box 1599,Manchester-by-the-Sea,MA 01944 (the"Owner"). 1. Scone. As used herein,the"Project"means and includes the renovation of the real property known and numbered as 335 Willow Street,North Andover,MA. The Contractor shall complete the Work(as defined below) described in the Contract Documents for the Project in a good and workmanlike manner.The"Contract Documents"consist of: a. this Agreement signed by the Owner and Contractor; b. the specifications and any product descriptions(so-called"catalog cut sheets") attached hereto as Exhibit"A"; and C. any written Change Orders,as defined below,for changes in the Work issued after execution of this Agreement. 2. Time of Commencement and Completion. a. Schedule. The Contractor shall start the Work promptly upon receiving prosecute the Work with diligence and dispatch so as notice to proceed from the Owner and shall to keep to the schedule that is attached hereto as Exhibit"B" (the"Contractor's Progress Schedule"). The Contractor agrees to complete the whole of the Project no later than August 15, 2015 (the"Scheduled Completion Date"). b. Extensions. The Contractor shall be entitled to reasonable time extensions of the Scheduled Completion Date for any delay in the progress of the Work caused by the Owner or by an cause beyond the Contractor's reasonable control. As a condition precedent to Y such time extension,the Contractor shall submit to the Owner a written notice of such delay within 48 hours of the commencement of such delay, and shall include in said notice a request for a time extension. An extension of time shall be the Contractor's sole and exclusive remedy for any delay caused by the Owner or any person or entity for whom the Owner is responsible. 3. PaXment• a. Contract Sum. The Owner agrees to pay the Contractor for the satisfactory performance of the Work the total sum of Ninety-Three Thousand,Four Hundred and Two Dollars($93,402)(the"Contract Sum"). The Contract Sum may be increased or decreased as agreed by the parries or as otherwise set forth herein to reflect changes in the Work. �I i g. Pavment by Owner. The Owner shall pay to the Contractor the amount of each weekly requisition,to the extent confirmed by the Owner's reasonable, good faith inspection,within seven(7) days after receiving the same from the Contractor. h. Final Payment. The Contractor's final requisition,to be submitted after Substantial Completion and satisfactory completion of all Punch List items, as defined below, shall be paid together with the$10,000 retainage or such other part of the Contract Sum as may then be held by the Owner. 4. Insurance and Indemnification. a. Insurance. The Contractor shall obtain from one or more companies qualified to do business in Massachusetts and with a Best's Superior to Excellent rating, and keep in force until completion of the Project,insurance as follows: i. Comprehensive general liability insurance against all claims for bodily injury,death and personal injury in amounts no less than One Million Dollars ($1,000,000)per occurrence, ($3,000,000) in the aggregate per year, and workers'compensation insurance as required by law. ii. The Owner shall be named as an additional insured on the said general liability insurance policy or policies. b. Certificates. The Contractor shall furnish the Owner with certificates of the said insurance policy or policies,reflecting the amount and scope of coverage and the status of the Owner as an additional insured. The Contractor shall require all carriers to give the Owner not less than ten(10)days'written notice prior to cancelation of any insurance with respect to which the Owner is an additional insured. C. Indemnification. To the fullest extent permitted by law,the Contractor shall indemnify and hold harmless the Owner and the Owner's consultants, agents and employees from and against any and all claims,damages,costs,liabilities,judgments,losses and expenses, including but not limited to attorneys'fees, arising out of or resulting from performance of the Work or the Contractor's failure to perform the Work,regardless whether or not such claim,damage, cost, liability,judgment,loss or expense is caused in part by a person or entity indemnified hereunder. 5. Owner's Responsibilities. The Owner shall not give instructions or orders to employees,workers, independent contractors or subcontractors of the Contractor, except to j persons designated as authorized representatives of the Contractor. 3 its tools, construction equipment,machinery and surplus material;and shall properly dispose of waste materials. 9. Substantial Completion. Substantial Completion is the stage in the progress of the Work when the Work is sufficiently complete in accordance with the Contract Documents so the Owner can occupy and/or utilize the Project for its intended use and can obtain a certificate of occupancy therefor. When the Work is substantially complete,the Contractor will so notify the Owner and the Owner will make an inspection to confirm the same.When the Owner determines that the Work is substantially complete and the building inspector issues a certificate of occupancy,the Owner and the Contractor shall jointly prepare a Certificate of Substantial Completion that shall establish the date of Substantial Completion and shall fix the time within which the Contractor shall finish all items on a list accompanying the Certificate of remaining, minor Work items to be completed(the"Punch List").Warranties required by the Contract Documents shall commence on the date of Substantial Completion of the Work unless otherwise - provided in the Certificate of Substantial Completion. 10. Protection of Persons and Property. The Contractor shall be responsible for initiating,maintaining and supervising all safety precautions and programs,including all those required by law in connection with performance of this Agreement.The Contractor shall take reasonable precautions to prevent damage,injury or loss to employees on the Work,the Work and materials and equipment to be incorporated therein, and other property at the site or adjacent thereto.The Contractor shall promptly remedy damage and loss to property caused in whole or in part by the Contractor, or by anyone for whose acts the Contractor may be liable. 11. Correction of Work. The Contractor shall promptly correct Work rejected by the Owner as failing to conform to the requirements of the Contract Documents.The Contractor shall bear the cost of correcting such rejected Work,including the costs of uncovering, replacement and additional testing. In addition to the Contractor's other obligations including warranties under this Agreement,the Contractor shall, for a period of one year after Substantial Completion,correct work not conforming to the requirements of the Contract Documents. 12. Change Orders. The Owner,without invalidating this Agreement,may order changes in the Work within the general scope of the Contract consisting of additions,deletions or other revisions,the Contract Sum and Contract Time being adjusted accordingly in writing(each such change of Work and adjustment,a"Change Order").If the Owner and Contractor cannot agree to a change in the Contract Sum,the Owner shall pay the Contractor its actual, demonstrated cost plus reasonable overhead and profit of ten percent(100/6). The Owner will have authority to order minor changes in the Work not involving changes in the Contract Sum or the Contract Time and not inconsistent with the intent of the Contract Documents. Such orders shall also be in writing and shall also constitute Change Orders.The Contractor shall carry out all Change Orders promptly. If concealed or unknown physical conditions are encountered at the site that differ materially from those indicated in the Contract Documents or from those 5 iv. is otherwise guilty of a substantial breach of any provision of the Contract Documents. When any of the above reasons exist,the Owner may without prejudice to any other rights or remedies of the Owner and after giving the Contractor seven days'written notice,terminate employment of the Contractor and may take possession of the site and of all materials thereon owned by the Contractor, and finish the Work by whatever reasonable method the Owner may deem expedient. If the Owner terminates this Agreement for one of the reasons stated in this section,the Contractor shall not be entitled to receive further payment until the Work is finished. If the unpaid balance of the Contract Sum exceeds the sum of all the costs of finishing the Work, such excess shall be paid to the Contractor.If such costs exceed the unpaid balance,the Contractor shall pay the difference to the Owner.This obligation for payment shall survive termination of this Agreement. 16. General. a. Assignment. Neither party may assign its rights or delegate its obligations hereunder without the prior,written agreement of the other party. b. Binding on Successors. This Agreement shall be binding upon the parties hereto and their permitted successors, assigns and transferees. C. Severabilitv. If any provision of this Agreement is held by a court of competent jurisdiction to be invalid,illegal or unenforceable,or if any such term is so held when applied to any particular circumstance, such invalidity,illegality or unenforceability shall not affect any other provision of this Agreement,or affect the application of such provision to any other circumstances, and this Agreement shall be construed and enforced as if such invalid, r unenforceable provision were not contained herein. illegal o Waiver. The obligations and conditions set forth in this Agreement may be d. . . b the waiving such obligation or condition. Forbearance b a writing signed y party g waived only y $ � or indulgence by a party shall not be construed as a waiver,nor limit the remedies that would otherwise be available to that party under this Agreement or applicable law. No waiver of any breach or default shall constitute or be deemed evidence of a waiver of any subsequent breach or default. b a writing signed en dment. This Agreement may be amended only y g g e. Am � by both parties. f. Governing—Law. This Agreement shall be governed by and construed in accordance with the laws of the Commonwealth of Massachusetts. 7 IN WITNESS WHEREOF,the parties have set their hands and seals as of the date first written above. SUMMIT CONSTRUCTION MANAGE NT,LLC By: _ /A" Scott Rouisse,Manager EASTCON AL Y TRUST By: lKaiJuel., I,T tee cNuehConstructionContract i 9 The Commonwealth of Massachusetts Department oflndustrialAccidents a. . d 1 Congress Street,Suite 100 Boston,MA 02114--2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information Please Print Legib Name(Business/Organization/Individual): .--- Address: Y A&A Vu S 0)A-Ce- City/State/Zip: J) d-LjLt �fe-4 - 61 3D Phone#: Are yon an employer?Check the appropriate box: Type Of project(required): L❑I am a employer withemployees(full and/or part-time).* 7, New Construction 2.®I am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling any capacity.[No workers'comp.insurance required_] 9. ❑Demolition 3-FJ I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 []Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insurance) 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.Q Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit'this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box mustattached 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 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.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA,for insurance coverage verification. I do hereby certify u er the pains andpenalties ofperjury that the information provided above is true and correct. 1 Si afore: Date: 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia --""1 SUMM113 OP ID:SH ACCIRO" (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE DATE07/1312015 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 NAME: Rodman Insurance Agency,Inc. PHONE FAX 145 Rosemary St.,Bldg.A IC No ExQ: (AIC, AIC No): Needham,MA 02494-3238 E-MAIL Jim Stoller ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC A INSURERA:Nautilus INSURED Summit Construction Mgmt LLC INSURER B:Travelers IndemnityCo. 25658 60 Summer St Manchester, MA 01944 INSURER C: INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. / ICY EXP LTR TYPE OF INSURANCE INSR POLICY NUMBER MMOILDID CY E MMIFF LDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY NN483503 07/22/2014 07/22/2015AMAG RENTED PREMISES Ea occurrence $ 100,00 CLAIMS-MADE EX-1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ included POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY X TORY LIMITS B ANY PROPRIETORIPARTNEREXECUTIVE Y 1 N 6HUB2E37266514 07/2212014 07/22/2015 EL.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? F-1NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re 335 Willow St North Andover MA / Certificate holder named additional insured ATIMA. 10 day cancellation notice. I CERTIFICATE HOLDER CANCELLATION EASTCON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Kai Juel III trustee Of THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Eastcon Realty Trust PO Box 1599 AUTHORIZED REPRESENTATIVE Manchester by the Sea, MA 01944 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-101934 CLIFFORD J TAY-ORd r j 8 ADAMS PLACli; Gloucester MA 01930 1 U v Expiration Commissioner 07/26/2016