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HomeMy WebLinkAboutBuilding Permit #887-14 - 350 WINTHROP AVENUE 5/6/2014 BUILDING PERMIT st,.Eo NORTH,aAtio , TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION __. 4 _ z 1 Permit No#: O y Date Received "�R,ArEo �p gSSACHus�� Date Issued: �/ IMPy,ORTANT:Applicant must complete all items on this page LOCATION (;O(plW)o �r Print PROPERTY OWNER - 'Jx 6CV-1Q�n/�C Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: Xcommercial V�Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District D Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER.- Name: TX Phone 'S(.K=34U-3rd Address: 0 Rio r �►I kc," G U( Contractor Name: ,,&_9-&L40Phone: 617—(FY2- e Add ress:z�T Supervisor's Construction License: C J U ql�Z Exp. Date: 10 20t 4i Home Improvement License: Exp. Date: ARCHITECT/ENGINEER_Jk r Phone: Address: 'S7Z 11,1 &1ga�rta� 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- $ FEE: $ I(Jo Check No.: Receipt No.: -2 -2 6--3 NOTE: Persons contracting with unregistered contractors do not have access to the guaran fun Signature of Agent/Owner Signature of contractor -�� J 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 - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Siqnature& Date Driveway Permit DPW Town Engineer: Signature: � Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS i iDimension 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 Call Email 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. I Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work a 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 j o Certified Surveyed Plot Plan o Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 Clerics 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 v � No. Date f , . TOWN OF NORTH ANDOVER • S r}fib�t��c, e • �" , Certificate of Occupancy $ Building/Frame Permit Fee C� J ar Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check It J � /' Building Inspector J ��� ��� i Enter construction cost for fee cal- North Andover Fee Cakulatlon Construction Cost $ 55,000.00 m $ - $ 660.00 Plumbing Fee $ 82.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 82.50 Total fees collected $ 925.00 Foundation 100 350 Winthrop Avenue 887-14 on 6/6/2014 Bathroom Remodel at TJ Maxx-350 Winthrop Street I i I i � NORTH i own o 2Andover . . 0 I ver, Mass,cocLRN-A.. h w,c« yq. A. U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT �, .. �...... ,, , . BUILDING INSPECTOR has permission to erect .......................... buildings on . � t� ..................... Foundation /• Rough l`7'ia ,,r� �/.. yLi s tobe occupied as .......................................... -?..................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONTARTS 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. NORTH 9 BUILDING PERMIT a`ro`t ``D '60 TOWN OF NORTH ANDOVER ° A APPLICATION FOR PLAN EXAMINATION Y !0, _ T � 1 � Permit NO: Date Received °q + �sysS,r,o 0"try Date Issued: '•�i,7'� L Ac►+u IMPORTANT: A2plicant must com Tete all items on this 2age LOCATION 3Eh r � ' Print PROPERTY OWNER . r- ewl Trot Pent MAP N.O; PAFtCELI ZONING DISTRICT" � Historic Districtyes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: 11 Demolition Ll Other ❑ Septic C Well ❑Flooc#plain ❑UVetlands IW Watershed District XWater/Sewer 1�4&uw rt~mild jmAJ«; /leloc.►w" ok CieA anz M4-ia,xrso(6 ees, fens-W &F AmAmKi fiIhm rux^s, c-Alm c4-- mj&Hr rabwds all Ak4w 1 n)o* Pana, anola owt 0,( PWC44mo 4•z" , Mw ude tt sate► hti�sL 5A4- ee,�•1 a.,,—' L �d •� i Identification Please Type or Print Clearly) OWNER: Name: +DeI/R Gi4 Tt.,+ Phone: Address: ,%w T PS m lL CONTRACTOR Name: „ Phone: 6 ���-A N � tutME akve- &Hccd- Address; 'Supervisor's Construction Licenser Exp. Date: � r 20 Horne,Improvement License: Exp. 17ate: y� TT ARCHITECT/ENGINEER,�e4cnc& l,jor Phone: ?/If-2*i'MiI Address: .-/ wl� cyy IOQ5J Reg. No. j(e 26o FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 175 ,tw .CXR FEE: $ W<()O Check No.: Receipt o.: NOTE: Persons contracti g with unregistered contractors do not have access to the guaranty fund Signature of ASignature of contractor i tA 0 Plans Submitted ❑ Plans Waived-❑ `_Certified Plot Plan ❑ Stamped Plans ❑ 'TYPE-0F:3EWBRAGEDiSP0SA1 Public Sewer ❑ Tanning/MassageBodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Brivate:(septic tank,etc_ . ❑ Pdrmaneint D rmpster ori Site El - THE..FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM . DATE REJECTED DATE:APPROVED PLANNING & DEVELOPMENT ❑ ❑ l COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit DPW Tow,i Engineer: Signature: Located 384 Osgood Street FIREDEPAFi!m,-,,Nt -:Temp Durrips er on site yes'' .. - no Located at:124Mair Street: ``` . . . •: Fire'D" `ft " ``� 'F' ;'� COMMENTS — I � -Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. .Total-land area;sq. ft.; =ELECTRICAL: Movement of.Meter Iocatlbn;'rriast-or service drop requires approval of Electrical Inspector Yes No DANGER.Z®NE LITERATURE: -Yes No MGL.Chapter 1B6.Section 21A-F and G min.$100=$1000 fine NOTES and DATA— For department use [ D Notified for pickup - Date - { i Doc.Building Permit Revised 2010 Building Department The following is a-list of,the.requi"red,forms to be filled out for:the appropriate.permit to.be obtained. Roofii,g, Siding, Interior Rehabilitation Permits o` B,ailding Permit Application ❑ Viorkers Comp Affidavit ❑ Photo Copy Of H.I.C. And%Or C.S.L Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster..permits require sign off from Fire'Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract Li 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 apw-gal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm-tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 f Location No. ` Date o - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ n, Other Permit Fee� TOTAL $ Check# � 27 ,4 U J Building Inspector Stephen Barrett sbarrett@combuild.com Project Manager Cell:(617)592-3996 �mnCOMMONWEALTH BUILDING, INC. Building for Business Since 1979 265 Willard Street • Quincy,MA 02169 617-770-0050 • Fax 617-472-4734 www.combuild.com Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 1]7/51,00 i.00) m $ - $ 2,100.00 Plumbing Fee $ 262.50 Gas Fee 100 comm. 1$� 1.10:0.110:0) Electrical Fee $ 262.50 Total fees collected $ 2,725.00 350 Winthrop Street 744-14 on 4/23/2014 Tenant Fit Up for AT&T Store to #I Town of Andover No. K-44 t _ o �h ver, Mass, Z3 la COC NIC HI WICK �1. Ll BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ............... ... ....... ... .............................................................................. has permission to erect ...................... buildings on ...3.50.......�o� h haw... Foundation ... . .... ....... .... Rough to be occupied as: ......6.0.11AP4..OY . ....A.010.....�........................ Chimney provided that the person accepting this permit shall in every respe 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 a Q d PERMIT EXPIRES IN 6 MONTH ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STS 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. 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT --Temp Dumpster on site yes -. off- Cho Located at 124 Main Street Fire Department signature/date 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 �C 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 Permit Revised 2012 i Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 81h edition of the 5 Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: T.J.Maxx Remodel Date:April 16, 2014 Property Address: T.J.Maxx,North Andover Mall, 350 Winthrop Ave,North Andover, MA 01845 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Minor Interior Remodel-Dressing Room&Learning Center I Jeffrey Taylor MA Registration Number: 9626 Expiration date: 8/31/2014 ,am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submit to t e b ilding official a `Final Construction Control Document'. Enter in the space to the right a"wet" ��k�E14 T. electronic signature and seal: <o o. 9E26 m C7 IT PLAINS, .� NY a�yw APR 1 6 2019 Phone number: 914-289-0011 ylorarchitects.com Bui ing Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen,provide a description. Trial Version 10 09 2012 RECEIVED BY APR 17 2014 COMMONWEALTH BUILDING.INC. Delta & Delta Realty Trust 875 East Street,Tewksbury,Massachusetts 01876 Telephone(978)851-8000 TO: Town of North Andover, Building Dept. DATE: April 7, 2014 SUBJECT: North Andover Mall, 350 Winthrop Avenue, North Andover, MA T J Maxx, Tenant's Interior Renovation Project I John P. Matthews as owner representative of the subject property located at 350 Winthrop Avenue, hereby authorize: TJX Corporation and Commonwealth Building Inc. to act on my behalf, in all matters relative to work authorized by this building permit application. The general scope of work is a cosmetic improvement and various merchandise fixture replacements within the T J Maxx Leased Premises. Please contact me if you have any questions. Since y, Jo n . Matthews Delta and Delta Realty Trust, owner 875 East Street Tewksbury, MA 01876 CC: Tenant CBI RECEIVED BY APR 0 9 2014 COMMONWEALTH tSE-DING, INC. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 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/fndividual): Commonwealth Building Inc Address: 265 Willard Street City/State/Zip: Quincy, MA 02169 Phone#: (617) 774-0054 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.# 7. ®Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for the in any capacity. workers'comp,insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.7 Roof repairs insurance required.]t employees. [No workers' I 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Howewvoers who submit this arfidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Conti-actors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site iiz formation. .i i Insurance Company Name: Valley Forge Insurance Company i Policy#or Self-ins.Lic.#: 4020089074 Expiration Date: 12/31/14 l Job Site Address:350 Winthrop Ave (TJ Maxx) City/State/zip:North Andover, MA 01845 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 line 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 t e pains and penalties ofperjury that the information provided bov is true and correct. Si nater ' Date: yt / ` zl Phone#: G17- ?"10- ex4-Z I . 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: COMMBUI-03 MKDALY LIABILITY D Y)CERTIFICATE OF LIABILITYINSURANCE 1212312013 — 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: Matthew Dal Arthur J.Gallagher&Co.Insurance Brokers of CA.,Inc. PHHcN Ext (617)531-7764 ac No):(617)531-7764 1255 Battery Street 9450 EMAIL San Francisco,CA 94111 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC N INSURER A:Travelers Insurance Company of Canada INSURED INSURER B:Travelers Insurance Company Limited Commonwealth Building,Inc. I INSURER C:Travelers Excess and Surplus Lines Co 29696 265 Willard Street INSURER D: Quincy,MA 02169 - (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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF P LICY EXP LTR POLICYNUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY I CO-9D697565.IND 12/31/2013 12/31/2014 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE a OCCUR I MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X E C LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B X ANY AUTO 1810-OE34458A-COF 12131/2013 12/31/2014 BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS I ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS I PER ACCIDENT $ X UMBRELLA LIAB X $ OCCUR EACH OCCURRENCE $ 10,000,000 C EXCESS LIAB CLAIMS-MADE ICUP-OE344591 -TIL 12131/2013 12/31/2014 AGGREGATE $ 10,000,000 DED j X I RETENTION$ 10,000 $ l WORKERS COMPENSATION X I WC STATU- JOTH. AND EMPLOYERS'LIABILITY TORY LIMITS I ER A ANY PROPRIETOR/PARTNERIEXECUTIVE YIN UB-SD67226-7-COF 12/31/2013 12/31/2014 E-L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N f A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 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 MASTER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 ©1988-2010 ACORD CORPORATION. All rights reserved. 4CORD 26(2010105) The ACORD name and logo are registered marks of ACORD } i ' 1#fes mal t A 4 $TEPM l t8t1N AR`Sfi r � "gSINr; N;MA k � Massachusetts-Department of public Safety i, Board of Building Regulations and Standards C(instructian Supervisor License:CS-084962 STEPHEN G BAP$ET 18 DUNBAR ST zl ABINGTON MA%0235 cJ w 11 lit`` Expiration i Cornmissioner 10/08/2014 I Waste Disposal Affidavit In accordance with the provisions of HGL c 40, S S4, on conditions of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by the HGL c 111, S 150A. The debris will be disposed of at: E.L. Harvey & Sons, Inc. 68 Hopkinton Road Westborough, MA 01581 Signature 4/21/2014 Date