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HomeMy WebLinkAboutBuilding Permit #475 - 35 PETERS STREET 1/30/2008Permit NO: 12<_ Date Issued: % h el BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page 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 SepticWell Floodplain Wetlands,. . z'.. 1Natershed District . `WaterlSewer b •.: DE5GRiPTiON OF WORK TO BE PREFORMED: eyy�o.rP Ol� vlNv�v,�� RWM A-11 YJ)-eSlvne��e IR oc, Identification Please Type or Print Clearly) OWNER: Name:jk...�an r\ mon (a64, -e Phone: Gt' AddrPcc- 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: $ <5;,j a n FEE: $� Check No.: 161 7 41 Receipt No.: �rl'33 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .g ��9 - Si nature�of contractor < et & C d.-u6-Y- Plans Submitted Plans Waived Certified Plot P 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 - U FORM PLANNING & DEVELOPMENT COMMENTS_ CONSERVATION COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: DATE REJECTED. DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED Comments Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street .FIRE `DEPARTMENT 'Temp Dumpster on *site -yes no:, `Located at a24'Main"Street Fire- Department,tjanotureldate ` COMMENTS - 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 for pickup - Date Doc.Building Penn it Revised 2007 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit u 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 o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Locatio n S/ - No. Date0 4/40 z TOWN OF NORTH ANDOVER Certificate of Occupancy $ ,,Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 20963 /Buildin6 Inspector z P CQ v w sr cn a ci a �7 A ,.a or. w° a�' ;� U cd a w a 0 c� a w U o � a C, w w w a w o cn •� o cn TV T O uj 0 y 19 W W ad W LLI U) c� o � C y O C 7 C_Ni V CL ev ev c L O r M O � �a c r m �+ ` ES o p t1 r cm ©� 6 a �m cm c � � �m s N O O Eco 0 m`o Q CLU �: m CC `\y m Q! N _ O.c OR r ' O - V N O Z r•+ C O CL C m o N m= c •O m 0=3 N f•.• � N � WMD •vyi •`m C.Z =r m•N Z O LU v®gam %g aaH VD a R o'c � � •� J = �=0aO-m> TV T O uj 0 y 19 W W ad W LLI U) Pe jJrvpv,Sje hereby to furnish material and labor - complete in accordance with specifications below, for the sum of: Twelve Thousand Nixie Hundred Seventy Five Dollars and 80/100 we, e $12,975.80 Payment to be made as follows: Authorized Signature - Note: this proposal maybe withdrawn by us it not accepted within ,� ,V,, days. We hereby submit specifications and estimates for: J -N -R WILL STRIP THE SHINGLES FROM SAID BUILDING AND DISPOSE OF IN A LEGAL FASHION. XATE WILL BE APPLYING AN ALUMINUM DRIP EDGE AROUND THE PERIMETER OF THE ROOF. THEN A. I 51-B, WEIGHT FELT„PAPER WILL BE -APPLIED TO ROOF DECK. THE SHAIVGli ES THAT WILL BE USED WILL BE A 30 YEAR ARCHITECTURAL DESIGNER STYLE. (CUSTOMER WILL HAVE THE CHOICE OF THE SHINGLE COLOR) ANY ROOF BOARDS NEEDING REPLACING WILL BE AN EXTRA CHARGE AT THE END OF THE YOB. THE JOB SITE AREA WILL BE CLEANED ON A DAILY BASIS, ANY (REMAINING OR STRAY NAILS WILL BE PICKED UP USING A MAGNET, THIS IS OF COURSE TO PREVENT ANY tNjUR-[ES FROM HAPPENING. WE CARRY $'2 MILLION DOLLARS LIABILITY IN ADDITION TO WOR -KERS COMPENSATION INSURANCE. THIS IS TO PROTECT YOUR EXPENSIVE INVESTMENT AND TO PUT YOUR MINDS AT EASE KNOWING THAT I TRLTLY PUT FORTH EVERY EFFORT TO PROVIDE ALL CUSTOMERS WITH TWE HIGHEST QUALITY STOCK AND PROFESSIONAL SERVICES. PRICE INCLUDES STET OF ICE AND WATER SHIELD. NOTE: vif- ADDITIONAL :.CHARGES FOR CERTAINTEED SURESTAR PLOS 5 STAR COVERAGE (WHICH IS 100% COIVERAGE FOR 15 YEARS ON MATERIALS, LABOR, TEAR -OFF, DISPOSAL and WORKMANSHIP). NOTE: WHEN WE DO THE ROOF ESPE CIALLY IF YOU ]HAVE, A SPACE IN BETWEEN YOUR ROOF -BOARDS, THERE WILL BE SOME BLACK SOOT ((DEBRIS) F901VI THE ROOF, WE RECOMMEND THAT YOU COVE, k YOUR POSSESSIONS WITH PLASTIC. JNR 'CANNOT BE HELD RE, SPONSIBLE FOR ANYTHING THAT IS IN YOUR ATTIC NOR THE DEBRIS CAUSED FROM REMOVING THE SHINGLES. �rrrptanrr alf JJr-apasal - The prices, specifications I and conditions listed above and an the back of this form are satisfactory and are hereby accepted. Yod are authorized to do the work as specified. Payment will be.made as outlined above. Signature -i/' Date of Acceptance: Signature Proposal, J*Ni,R 3 All Types of Home Improvement 114 Hale Street, Suite 204 Haverhill, MA 0 1830 Haverhill, MA: (978) 372-4088 Boston, MA: (617) 423-3559 Andover, MA: :(978) 475-3723 Woburn, Nashua, NH: (603) 595-2272 MA: (781) 937-4212 Portsmouth, NH: (603) 433-1811 Natick, MA: (508) 653-2200 Manchester, NH: (603) 666-5502 www.jnrgutters.com Fax: (978) 372-0360 Toll Free Nationwide: (800) 966-9238 PROPOSAL SUVJ�TdEkT Pay PHONE 978-828-7835 DATE 01/22/08 STREET JOB NAME 35 Peter Street Roof CITY, STATE and ZIP CODE JOB LOCATION Wortb A-ndowr, MA ()I SAS ARCHITECT JOB PHONE Pe jJrvpv,Sje hereby to furnish material and labor - complete in accordance with specifications below, for the sum of: Twelve Thousand Nixie Hundred Seventy Five Dollars and 80/100 we, e $12,975.80 Payment to be made as follows: Authorized Signature - Note: this proposal maybe withdrawn by us it not accepted within ,� ,V,, days. We hereby submit specifications and estimates for: J -N -R WILL STRIP THE SHINGLES FROM SAID BUILDING AND DISPOSE OF IN A LEGAL FASHION. XATE WILL BE APPLYING AN ALUMINUM DRIP EDGE AROUND THE PERIMETER OF THE ROOF. THEN A. I 51-B, WEIGHT FELT„PAPER WILL BE -APPLIED TO ROOF DECK. THE SHAIVGli ES THAT WILL BE USED WILL BE A 30 YEAR ARCHITECTURAL DESIGNER STYLE. (CUSTOMER WILL HAVE THE CHOICE OF THE SHINGLE COLOR) ANY ROOF BOARDS NEEDING REPLACING WILL BE AN EXTRA CHARGE AT THE END OF THE YOB. THE JOB SITE AREA WILL BE CLEANED ON A DAILY BASIS, ANY (REMAINING OR STRAY NAILS WILL BE PICKED UP USING A MAGNET, THIS IS OF COURSE TO PREVENT ANY tNjUR-[ES FROM HAPPENING. WE CARRY $'2 MILLION DOLLARS LIABILITY IN ADDITION TO WOR -KERS COMPENSATION INSURANCE. THIS IS TO PROTECT YOUR EXPENSIVE INVESTMENT AND TO PUT YOUR MINDS AT EASE KNOWING THAT I TRLTLY PUT FORTH EVERY EFFORT TO PROVIDE ALL CUSTOMERS WITH TWE HIGHEST QUALITY STOCK AND PROFESSIONAL SERVICES. PRICE INCLUDES STET OF ICE AND WATER SHIELD. NOTE: vif- ADDITIONAL :.CHARGES FOR CERTAINTEED SURESTAR PLOS 5 STAR COVERAGE (WHICH IS 100% COIVERAGE FOR 15 YEARS ON MATERIALS, LABOR, TEAR -OFF, DISPOSAL and WORKMANSHIP). NOTE: WHEN WE DO THE ROOF ESPE CIALLY IF YOU ]HAVE, A SPACE IN BETWEEN YOUR ROOF -BOARDS, THERE WILL BE SOME BLACK SOOT ((DEBRIS) F901VI THE ROOF, WE RECOMMEND THAT YOU COVE, k YOUR POSSESSIONS WITH PLASTIC. JNR 'CANNOT BE HELD RE, SPONSIBLE FOR ANYTHING THAT IS IN YOUR ATTIC NOR THE DEBRIS CAUSED FROM REMOVING THE SHINGLES. �rrrptanrr alf JJr-apasal - The prices, specifications I and conditions listed above and an the back of this form are satisfactory and are hereby accepted. Yod are authorized to do the work as specified. Payment will be.made as outlined above. Signature -i/' Date of Acceptance: Signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 9 ' 600 Washington Street .Boston, MA 02111 www.mass.gov/dia Workers'. Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ::Z- Aj -`Q Address:. 3 p, (o Lc, vv 1 , City/State/Zip: 1i✓t A Phone.#: R-)�3?Z'jO'�6' Are you an employer? Check the appropriate boa: 1. [� I am a employer with 2 0 -'Z 57- 4• ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a` sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp, insurance comp• insurance.$ required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 5. ❑ We are a corporation and its officers have exercised, their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' Comp. insurance reouired.l Type of project (required):. 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building -addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowrners 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-contractorshave employees, they must provide their workers' comp: policy number. I am. an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: � ` _L Vl/\ Policy # or Self -ins. Lic. #:' o ( 3 �{ '� �� 1 Z vow Expiration Date:_ - z U - Zoo l Job Site Address: 3 5 2-e �5t City/State/Zip: Mtin o O t�`1S Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure, to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct Signature: Date 7 v Z 0 c� Phone #: 11cuu..use only. Do not write in this area, to City or Town: Issuing Authority (circle one): 'L Board of Health 2. Building Department 6.Other Contact Person: or town officiaL Permit/License # City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 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 "ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to,opera"tera 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 maybe 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 youare 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 subin t 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 bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone -and fax number: The Conunonwealth of Massachusetts Department df industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext.4.06 or 1-877-IvIASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mass•gov/cli$ NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 3s' s -t- is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date 01/30/2008 12:43 FAX y (3 532 221 ( C K MCUAH I HY giA';. ASSOCIATED INSURANCC _.,.w.._... _.� ---NU, '2632---P. 1 IgJU02/UO2 ISSUE DATE 01/04/7006 RODUCEW THIS C ERTTICATL• IS ISSUED ASA ATTER O' INFORMAT1ON ONLY AND FI K McCtiithy Posurslllcc Agency CONFERS NO RUTS UPON THE CE .1•I171CATr F101-DtW. TIIIS CCkTIrIC:ATE- Inc UUP..S NOT AMENO, EXTEND OR ALT •R THE COV OLACrI AFFORDED AY T148 POLICIES BELOW. 10 Ccmeattinl brivc ... - - .,,,,,.• COMPANMS ANFORDING �... _ , COVERAGE Peabody, MA 01960 N K Guttae lrlc 18-40 Lancaster Street COhSPANY A A,LM. Mutual, Insura =8 Co LG LWkk Haverhill, MA 0160 ; THIS IS TO CERTIFY TRAT TI:(p POLICY S OF 111WRANCE LISTED 14ELOW 14AVC BEF.N ISSUED TOT E INSUR150 NAMF,.) AIJOVC FOR TI -If -POLICY PF,VIOD rNDIC_AT.6b. NOTWITFIS'CANDINO ANY RCQUIRPMLNT, TF,RM OR CONDII'tON OF ANv'Y CON FLACT OIL o ,n�il;R U()IJr,4vNi, W ITkI RIsSPFC'C TO WHICH THIS CERTIFICATE MAY 513 5SVED OR ri1AY PCRTAIN, T1iE 11vSUIiaNCl3 AI T'ORDL'C1 BY .IE POLICIeS r)[St'R1oCD IIGItEIK IS SI.IFl1)dCf TC.t h1_L TNG 1.,:xC:LU;(ONS AND r,ONT)ITIONS OF 31) -1 POWCIEi, LL\1I (5 SHONArN MAY HAV , OF N Rr(,ll1CCD DY PAID CLAIMS, ^^•^— CO L.Tq TYPO OD 1M4V;ItARCE XiuCVNL'MYCA Po UrYECPLCYLYL GAT➢ (NWDDN) M021CYL1(P(AATIVN 0479 NMIPM-) LIMITS GlRNf.RAL LLAOIL!"IY M KAL AGCaar:ATC 06WMBNCW.04NRRALLIAMLITY rRL C . <'OMI') AGq. , .r —..,-..1—_,_,�...•V-• .a nALeu+v.nrRxv VAC OL'CUaaeNce ., - WNCAS A CONTJkACTOA'! xis• _ ,— • ��„, F34E CO (Abram GLS 17�O �..J..Wr••.._^�— r - ,..,,.�,.,...` MLO R.KPLIiSB Wryare pM�d .- Com WIDALMILN1 Avn)MObkL,c W"ILITV LM ANY AUTO 4LOWNSWALMA BOD YWuRT ScltlzLlldltl AUTON 'v HtILGO AUTO! NOY4VwNL'DAUTO4 roof cwMV G4WtCs L1n)1C17V (Pa chk, ) _ .,.�,.., FIND W a .,4. — - --- CKCCSSLIA�uJ.tr •�.�•,••• cAcL DCCUR)18NCa � �� u►�oaBLul'ORb Atk �� ._ ,,, DTIIFJL MAN WSULL.A PORM WORKERS COMPENSATION AND s,rm jiowr t1Mrrs 7IIEI3 XMI'MOY&I B MAIRILITY X Bl. CH ACCIDENY 100,400 it rLQr6k :ION A AkNtca�aery+'Ivo rj L U.1 ARIL )�mcl. [,�dxr.L 7013435012007 09/20/2007 09/20/2008 IZL I r5EAs;;-poL)cyLTkdr S 500,000 CL � 8-til+CH i 100 000 04 Yri r COMMENTS/ b CKIYTIoN OF OPPUAVONS OR Lt)(:XrIONSi i I L)(1LD ANY OP THE ACOvE LA.SCRIAF.D POLI nn CAMMLLED I16�� TNF EXPL LAT10Ar PATO �il•L GUTTr RS iN C I OY, THS LI S'1 MI COWANY `r"'l" C-80 ORTO MAIL &WRRTEN NOTME TO TILE CLOIFICAl 1Ol DER )IAMPA TO Tl($ LrrT, fM FAlLUAE T MAIL SUGJ N4TiCC 6)1ALL jMNSU I46 091.10ATICIV LIA lLITY OP ANY YIA1D 11h�NTCItI c�11.1F Y, ITS AOl 4r& OR nL!'1LLSi ATIVel b�I0 LANCASTER S -r 1- 01�� ,- L�Invnit«x z„ L►1A ols3o _,,.�,,,_,,, UTFmA1ZT� RFrRE r?, A•rlYe. __., i/ vim/ c_vvv ice. ",v , ,,., ..,v .:v< «„ .. ,. ,, .. ,. ,,,, ,,,, �,. ,. r .•.•... Client#: 13716 JNRGU OATF (MMIDDIYYYY) AcoRoIM CERTIFICATE OF LIABILITY INSURANCE 01104/0S ODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION K. McCarthy Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR I Centennial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW1 3abody, MA 01960 '8 532-5445 JNR Gutters, Inc. 38-40 Lancaster Strout Haverhill, MA 01830 DVERAGES INSURERS AFFORDING COVERAGE N; IJRLRA•. ProSuilders Speciality Insurance Co_ N;I,Ihr.'I; ct• Safety Indemnity Insurance Co. INCUREr C: IN`iLJRI;,R D: INI}IJRI-k F• NAIL # 33618 'TI•II;: PC)I.lClr-'[; Or IN�LJRANCL 1-18I'LO BELOW FIAVE BEEN 13031-11."DTp'rru;: IN;;IJGiF.L) NAMED ABOv( r• n):'rrl( r'DI,ICY Pt_IZIOD INDICA"IED. NO'I'Wlrra:;rnNi)INc; ANY i,ItUIJIKf MENT, TERM OR CONDITION OF ANY (_ON TRACT OR OTHER DOCUMENT WITH R�Sr•'kC%I f0 WHIi:H'I"FIP3l.ER'1'If lC A'fi- MAY 611x, I; GUI. U OR MAY PERTAIN, THE INSURANCE A[,'I-ORLIkI.) tHY IHk P(m.JCES DESCRIBED I4FRI.:IN e; ;;UU.IetC'1" TO ALL THE TERMS, EXCLUSION;, AND r,ON[.)[IIONS ()F Ski (:';H FAC:H OCCURRENCE' --- ... ....... ......... --...... .__...,... .......... _................. AGG1-'(ECATE LIMITS SHOWN MAY HAVE BEEN PtEDIJ(,:hi� HY PAIIJ CLAIMS. AGC.*- F(-,/LT!'ti ......._.....____..,,.,.,—_._.. ..0 ........... LIMITS i...... i I ........... A _ ................... . _.._-.,...,,,.,..,...I-.--.--...-_...._......_. NULICY Ef FI:CTIVI 1tI''('x.l(:Y [IXPII:ATION R ,NSR._.. TYPE OP INSURANCL POLICY NVMI*H ............................ _ Ciaf1:1MMIDD(YYL.._`.,,(?�TF.LMMr nrvr _......... GENERAL LIABILITY FACHQt;CIIF;FtFNt;:G S1,000,000 ry NB5015590 06121/07 :06121/08_..__... DAMAGL'I RENTLID I_i Lt�l's'Iliv.l�4.9Gr,URCf1GC)••,.... .1 0 OQ 1 L.L.Dll;L iL-EA(.A4("LI)Y(:(r• ............................... ---• X COMMERCIAL GENERAL I. ABILITY i F'.L. 1JIaF.ASC RULICYLIMIT $ OCCUR CI.AIMs MACK' I XJ by_ti G:xla (Any arm Der".tT)-'--...... ........._..__.._.._ Ilt,I-(5()NALe..ADV INJURY X I BI/PD Dod*2,500 i s1�000tO0O C,ENF.J $2,000,000_ �— AGOREGATF LIMIT APPLIFiS PER: PROD UCTS • COM MOP AGC, fi11000,000 ........,_.....I. tel...._....I_.,.....1.1;Ot:..... ........................_ _ -- - I AUTOMOBILE LIABILITY 3945441 06/21/07 06/21/08 COMOINED SIN(Al'=