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HomeMy WebLinkAboutBuilding Permit #738-14 - 37 CHESTNUT STREET 5/1/2018 ✓ pORTH Oftt�ao ,a'�q.0 BUILDING PERMIT TOWN OF NORTH ANDOVER ° ' APPLICATION FOR PLAN EXAMINATION a ; Permit NO: C Date ReceivedATED Date Issued: pssA`"osti` IMPORTANT:Applicant must complete all items on this page LOCATION c-, Print PROPERTY OWNER A-lP k l/I/ 0S/// 0 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building AOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition El Other ❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Is— /))0-/�, ge Oe Aze, 2(_9 ILA Identification Please Type or,Print Clear OWNER: Name: & c ia rY � Phone: Address: CONTRACTOR Name: Phone:` =.��y �� 3 -Z 2- Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 65 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ( • t} 3_ j FEE: $ V b Check No.: Receipt No_: NOTE: Pers s contracting with unregistered contractors do not have aWess to the guaranty fund Signature of Agent/Owner Signature of contractor 7X4 R 1 ~r TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION r Permit N0: : Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCAT (V IO - _ IPROPERTY QWNER — PnntYear Old Structure: yes Ono MAP NO: ,PARCEL: ZONING.DISTRICT: Historic District yes no _ _ Machine Shop Village ,.yes no X .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 D Septic ❑Well (IFloodplain q`W RIand.s ❑ Watershed tBigtrict Cf WaterlSewer-_ DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: P C.ONTRACt'OR Name',_ _. �. _ -- :Phone: Adre$s Supervisor's 2 ,,,.0 6h Exp. 'Date v Home Improvement tLicense; -- . _ z. . Exp.. Da to ,w u. ARCHITECT/ENGINEER Phone: Address: Reg. No. 9 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: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered cgntractors do not have access to the guaranty fund Sgnatreof Agent/Qwner_' ._ nafure of contractor__ '� Plans Submitted Fj Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ . .. _ . .. .. .. - I . _ : x.. _ ;. . _ :. x = x _ - _ -_. . . . . - . . . . . _ _ .. . , :_ . 1. . . Location�� ( fd'�T 5' - - . .: t .::.....�:� <1%------� t j �. . No. — ZZ 7 Date .. _ _:- . - • . .11 TOWN OF NORTH ANDOVER ,. . b - . - „ .' . . 6 .-.. ' ; � _.. • .:.,. __ ' '" • Certificate of Occupancy $ Building/Frame Permit Fee $— r- - Foundation Permit Fee $ R Other Permit Fee TOTAL $ n I. .. Check# `' _ .. Y [��� --- - 1. .. t /�J�f ^�M �-� Building Inspector . - ...-.:... ..'..: ' ,,. - - r:. ... ., ,fir - .. - M .::. -.. .. - - e"- - _ - _ - .. .. -- :11 .I. ., ., .. . . .' . . .. .. _.....,.h .. ..... .. T :.a,. . .. ..... .. ... .. _ .. . -.� �: .. -.' Y ''.::' - _..::.. '..r ."-. .... -.. ... .:.. - ... .. :. -...'.. .. .. ...... .... .. .. - _ - - - I _..,_- -. _ - ... .. .. - ... _: .. ..- .. - r t: : �':' _ "— - .. - - Z�4__t__, �� I - ...... ... .-.. ... - _ _ ':. .. - _ ..: ./.. - ..�.r ; - - _. _ .,. ... .. - �.. �,� tx - ._ .. ,. .. .. is .' ., _ .. ... 1 .'Plans-Submitted ❑ PlansWaive'd-❑. - ..;_Certified Plot Plan ❑ Stamped Plans ❑ .TYPE OYSEWERAGEDISROSAL- Public Sewer ElTanning/MassageMody Art ❑ - Swimming Pools ❑ Well ❑ Tobacco.Sales ....Food Packaging/Sales ❑ .-Private-,(septic;tank,-etc:_ . ❑._- permarient-DIumpster on Site El THf..FOLLOWING SECTION'S FOR OFFICE USE ONLY _ INTERDEPARTMENTAL SIGN OFF'- U FORM -DATE REJECTED DATE:APPR=OVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS ,CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature . r CAOMMENTS 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 TovvO Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMY'At �Tehip Dump'sferon:site yes­. no Locatedat:124;Mair Street:. Fire De partme►�fsignatu"reldate ` COMMENTS `" -Dim en. . Number of Stories: Total square feet of floor area, based on Exterior dimensions._ :Total land area, sq. ft. ELECTRICAL: -Movement:of.Meter Locationst orsery ce drop requires approval of Electrical Inspector Yes No DANGER.Z®NE LITERATURE: -Yes No MGL-Chapter-166. — _ p A ,F and G min. 1 00 $ $1000.fin.e i N®TES and DATA— (For department use i i El Notified for pickup - Date F Doc.Building Permit Revised 2010 i i Building Department -`-The fol;-3wing'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 G.S.L.Licenses ❑ Copy of Contract Li 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 o 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 r inkler Plan And p 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) a 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 ❑ 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-W period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tfed with the building application Doc: Doc.Building Permit Revised 2012 . Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 36:148:3.0011 m $ - $ 437.80 Plumbing Fee $ 54.72 Gas Fee 100 comm. $: 100:00 Electrical Fee $ 54.72 Total fees collected $ 647.25 37 Chestnut Street �] X14 on 4/23/2014 Bath Remodel gaORTFj Town of s E '' jxndover O w' No. t - o h ver, Mass, COc"ICNtwlt.t S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • j 0 if THIS CERTIFIES THAT ... ......� . „ BUILDING INSPECTOR ................ .................. ............ ..................... has permission to er ct .............. buildin s on ....Q: h .s. r� �� Foundation ...... ......... ..�. .. ....... Rough to be occupied as .9-oro-4W.. ........... oil.. ......wi(L_944-k. ..... .t...& Chimney 0 provided that the person accepting this permit shall in eA respect conform to the terms o�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. a • PLUMBING INSPECTOR � VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI S (t� S 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. S GER SON, INC. Remodeling and Development Co. Specializing in Top Quality Kitchen&Bath Remodeling Lowell,Massachusetts 01852 (978)250-2322 This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter ]42A). Any person planning home improvements should first obtain a copy "A Consumer Guide to the Home Improvement Contractor Law" before agreeing to any work on your residence. The guide will inform you of your rights and responsibilities as well as provide you with important information about what to do if a dispute arises. You may obtain a free copy by calling the Executive Office of Consumer Affairs'information Hotline at 617-727-7780. Homeowner Information Contractor Information Nameg.� Company Name Street Address (Do not use a Post Office Address) Contractor/Salesperson/Owner Name v✓ i4�A 04 Sof eP— City /� State Zip Code Business Address Must ind derma teet address) D , / jo&10&0 e /V e�fJ/GOA/ rL7 aydme Phone Evening Phone Cityfrown State Zip Code Mailing Address(if different from above) Business Phone �er Em loyer D or S.S.N4ml�r S S Law requires that all home Homei vement Contractor Reg.Number rat Date Improvement contractors have avalid /j� registration number. The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to be completed,specifying the type,brand and grade of materials to be used.) i° ell--A e, Check this box if additional pages are used for this section. Required Permits - The following building permits are required and Proposed Start and completion schedule - The following schedule will be will be secured by the contractor as the homeowner's agent. Owners adhered to unless circumstances beyond the contractor's control arise. who secure their own permits will be excluded from the Guaranty '�A; ? Fund provisions of MGL chapter 142A. �� � d'••o 14-Date when contractor will begin work -Date when contracted work will be substantially completed. 13,w1,01A­,KU/yl Q�ti ll/ii 6 Total Contract Price land Payment Schedu a The contractor agrees to perform the work'77S he material and labor specified above for the total sum of:$ Payments will be made acct i' a follow , ,schedule: 9 la 615 $ upon signing contract(nit exceed 1/3 of the total contract price or the cost of special order items,whichever is greaterz.) $ jo ✓ by / / or upon completion of rS $% r0 by / / or upon completion of % y $ 6,5 upon completion of the contract. (Law forbids demanding final payment until contract is completed to both party's satisfaction.) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.z $ to be paid for Notes:(1)Including all finance charges (2)Law requires that any depositor down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty being provided by the contractor? 4 No ❑ Yes (all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,this contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. Don't be pressured into signing the contract, Take time to read and fully understand it. Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires all home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the director at One Ashburton Place,Room 1301,Boston,MA,02108 or by calling 617-727-8598 or 617-727-3200. Does the contractor have insurance? While not required by law,it is a good idea and an additional protection. Know your rights and responsibilities. Read the important information on the reverse side of this form and get a copy of the Consumer Guide. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK S . meow is Signature Date Contractor's Signa re Date r£' tir)r :i' 11 1, iL vnv"1f Cp''F:i(tC)I !,c%V prt7Vldf"; lfJnl'C�,"t'(5 WIC}1 C;7F'. Itr�) [O f7:tlii:e cu- r1I?31I"it'.7oil 4�CIOf1 'rt.S di' l) E'tllrirfve Eo co, it r!,.,n(, ! f ,r e-v na`.'v d c .3()L< e tti'lIh a Convactcr. c..-v e r;a?'!t S r,o' aurornar(ally of O"Of'11 Lo a c:)n',rc'.t?t'r. huv,e,,er fl(.' 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Room 141 1, Boston, MA 02108 1617) 727-7780 If you want to verify the registration of a contractor if you have questions or need additional information specifically about the contractor reyi.-Aration component of the Home Improvement Contractor Law. contact Director of Home; Improvement Contractor Registration Bureau of Building Regulations and Standard One Ashburton trace. Room 1301, Boston. MA OZ 108 ,617; 727-8598 or 1617) 727-3200 For assistance with Informal mediation of disputes or to register formal complaints against a business, cail Consumer Complaint Division Offit-e of:ht_" A ,Uorne) General 6: /1 12 18400 0 s S4GER SONO INCO Remodeling and Development Co. M Specializing in Top Quality Kitchen & Bath Remodeling Jennifer&Kevin Costello 37 Chestnut Street March 24, 2014 North Andover, MA Dear Jennifer&Kevin, Thank you for allowing us the opportunity to quote on remodeling 3 bathrooms at your home. We would like to assure you that the work will be completed in a timely and professional manner. Please review the following factors we discussed with you,that would apply to the work being done. SCOPE OF WORK: Boys Bath: Remove and dispose of the vanity, sinks,faucets and toilet. Remove and dispose of existing tile flooring and sub-floor. Remove and dispose of shower trim and valve Install new valve and trim through the closet and leave an access panel Install new cement board sub-floor for tile. Install new the flooring($6.Per sq ft...Allowance for tile). Install new Toilet(supplied by the Homeowner). Install new vanity, sinks and faucets(supplied by the Homeowner). One coat of primer and two coats of premium latex finish paint to be applied to all walls and ceilings (paint supplied by contractor color selected by homeowner). Install new light/fan unit vented to exterior of home(supplied by the contractor). Any wall framing that is rotted or undersized will be replaced to code at extra cost. Any plumbing code issues hidden behind existing walls will be corrected at extra cost. First floor bath: Remove and dispose of the toilet,pedestal sink and faucet. Install new toilet,pedestal sink and faucet. (Fixtures supplied by the homeowner). r Master bath: Remove and dispose of existing free standing tub,the and framing. Remove and dispose of existing vanity, sinks and faucets. Remove and save existing mirror for reuse. Remove and dispose of the existing file and sub-floor. Remove and dispose of freestanding fiberglass shower and increase the size. Remove and dispose of the toilet. Install new free standing tub with the drain and spout on the left interior wall, (Homeowner). The walls around the tub to be Plaster skim-coat. Install new vanity on a platform,sinks and faucets(Homeowner). Supply and install new frame for the existing mirror. Install cement-board on the shower walls for tile base. Install the walls in the shower area. Install Tile base in the shower area. Install valve,rain head and hand held spray. (Homeowner) Install 3/8 glass door and panel with chrome trim. (Contractor) Install toilet/bidet combo. (Homeowner) Install new sub-floor to coincide with the flooring. Install new Tear hardwood flooring with tile border in tub area and tile in shower area Install new fan vented to the exterior. Includes wiring for new toilet and installation of light bar at the vanity. Any walls that are rotted or undersized will be replaced to code at extra.cost. Any plumbing code issues located behind existing walls will be corrected at extra cost. Price includes all permitting and inspections. PRICING: We propose to provide labor and certain materials to complete this project for: $36,483.60 TERMS: 25%at contract,25%after boy's bath,250%after rough plumbing and electric in the master,balance on completion. We are registered, and in compliance with the MA Home Improvement Contractor Law (MGL chapter 142A)our registration number is 292968. Insurance certificates and references are available upon request. If you have any questions feel free to contact us www.sagerandson.com Sincerely, Lt JVt_'.-4' Ed Sager Alan Sager 6%W.m '"7 AX,olala:raackv,,e. r 4fi'ice of Constimr Affairs&Business Regulation F OME IMPROVEMENT CONTRACTOR egistration: •165266 Type: x on: -.1f27120:16 - ira'r P ti Corporation ,v SAGER&SON INC::: EDMUND SAGER 37A DUNSTABLE RD: NORTH CHELMSFORD,MA 61863• �— Undersecretary 1 Massachuse##s Departrne `"'" Board of Building Re n#of Public Safe#y ul"erVikor C��nctrtartir�p SReg and Standards License: C"79413 SND L SAG 37q p�stable �� - •;�- North�ableR4d SMA 01863 / / NO COn'MIssicr,Qr Expiration 05/18/2015 0,5 e i URNS CD s -,'Aco Er CERTIFICATE OF LIABILITY INSURANCE 711j(M"O"m1512013 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 terns 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 Phone: (978)562-5652 Fax: 978-562-7120 CONTACT NAMEWelsh&Parker Insurance Agency,Inc. WELSH&PARKER INSURANCE AGENCY,INC. PHONE 978-562-7120 131 COOLIDGE STREET,SUITE 100 AIA N Ext: 978 562.5652 ac•No): E-MAIL HUDSON MA 01749 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER :Merchants Mutual 23329 INSURED SAGER&SON INC INSURER B :Merchants Mutual 23329 37A DUNSTABLE ROAD INSURER :Merchants Mutual 23329 NORTH CHELMSFORD MA 01863 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 56598 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 ADDI SUBR POLICY EFF POLICY EXP LTH INSR wv0 POLICY NUMBER MryypO MMIpO LIMITS A GENERAL LIABILITY BOP1071262 03/19/13 03/19/14 EACH OCCURRENCE $ 1,000,000 X I COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurence) $ 500,000 CLAIMS-MADE I X OCCUR MED.EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ Included ff7 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC $ B AUTOMOBILE LIABILITY MCA0000015 02117/13 02/17/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED KNON-OWNED CHEDULEDAUTOSUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS PROPERTY DAMAGE $ UTOS (per accident) C UMBRELLA UAB X OCCUR CUP9145613 03/19/13 03/19114 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X RETENTION$ 10,000 WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS' LIABILITY TORY LIMITS ER__L ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ OFFICERMEM13ER EXCLUDED? NIA (Mandatory in NN) E.L.DISEASE-EA EMPLOYEE $ If DESCRIPTIONyes, Obe rPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) PROOF OF WORKERS COMPENSATION COVERAGE WILL BE SENT DIRECTLY BY THE CARRIER CERTIFICATE HOLDER CANCELLATION Kevin&Jennifer Costello SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 37 Chestnut Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: Adalia Newell ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Rightfax C3-1 11/18/2013 6:58:28 AM PAGE 2/002 Fax Server CERTIFI CAT Eup"IRMMA_ ETE(Mmom"MOF LIABILITY INSURANCE ONLY AND CONS NO CERTIFICATE DOES NOT AFRRMAIIVELT Y OR NEGATiVEL AMEND,OREND OR ROM 6 ON THE AFFORDEDmA I-MQLJNK Into POUdES B TMS CERTIFICATE OF t NSURANCE DOES NOT CONSnMALTER THE COVERAGE E A CONTRACT BETWEEN THE ISSUING INSUR FACS),AUTHORIZED RITATIVE MPO if the oertdicsta holder is an AD0171 term and and coconditi0NAL INSURED,the polie}(0s)must be endorsed, if SUBROGATION IS WAIVED,subject to the ons of the Po ft certain policies may require ertd irate holder in flea of such endersemtM A statement on this certifieete does not confer r�hts to the s PRODUCER COWACT WELSH&PARKER L1S NAME: 131 COOLIDGF.STREET SM 100 PHONE FAX lA►G ND' (ASC,Nor HUDSON.SSA 01749 E4=L 73M ADDRESS: INSURED INSURER(S)AFFORDWGCOVERAGE wuCE SAGER&SON L\C INSURER A: HntrrFORD tMERWRt W yysuttANcE Pww INSURER lk INSURER C: 37A DU\STABLE ROAD INSURER D. NORTH CHELMSFORD,MA 01863 INSURER E: INSURERP:RAGES CERIIRCATE NUI�ER REVISION NUMBEi MtYREOul tI18RT1MORC0CMONOPJNY00NRMCrORO1H91DOQ11 VRMR TiOWrQR7Fi8 P�IID �7FE�CUOE50E$tOSwFBBN6SJBJ@.TIDALLTrIETM^19CUM A DC01CfItONBOFSALII U%LBE= Rk Y P9RML 7MNMJWM _ Hf ZoewR®UCEDBY QN TYPE�aR'aURI1NCE ADD p PCUI N R POUL EFFWE POLILYmp=E (AalDAYYYiq (MIDDYYYY) LUM GENERAL LIABLLITY C0MMERC1ALGENERALLIABIUrY :ACIIOCCURRENCE IS CLAIMS MADE F]OCCLRL AMAGETORENTED S REMISES(Ea a,,,,rrce) EXP(Anyamperecn) Is GENL PAM9EGATE LIMIT APPLIES pER FEASINNAL.8 ADV INJURY i S POLICY F]PRD JECT DLOC ENERALAGGRECiATE is ROOUCTS-COMPlOPA(9G S AUTOMOBILE UABIUW ANYAUTo oaue+NEDSnuDLC js ALLOWNEDAUTOS LVAt(Ee ) I SCHEDULEAUTOS BODILY INJURY $ NNW (Pear Pena HIRED AUTOS BODILYIWURY S NON•OWNEO AUTOS (Pet te) PROPERTY DAMAGE S (Par accident) UMBRELLA UAB OCCUR EXCESS L.IAD CLAIMS-MADE EACH OCCURRENCE S DEDUCTIBLE REtiNTE S RETEVTIDV S s WORKERS OOMPENSATLCPI AND s A EMPLOYERS LIABRRY VM Lase99Z5E613 04bZ/1013 041082014 X !Q jrSAnR DOCUND? a WA W, E L EACH ACCIDENT s 100 0W00 R 0E.L.DISEASE-EA EMR DYEE S 100.000 LIMB 5 50PIICNCF CPEPATICNs bw w E.L.DISEASE-POLICY 0.000 DESCRIPIM OF OPERAIIONSILOCAl1ObISIVEHICLESW&STFWnONS!SPECIAL TIM T1eSRPPLACFSANY PRIOR cmrnFICATEMUMITOTHECERn1aCATEH0IJIEJRAME.CIVa6wpRKMtSL%iPCaV GE. CERTIFICATE CANCELLAnoN KEVIN&IFN,1'IFER COSTIIIO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 37 C MSTN TT STREET BEFORETIIE ExPutnON DATE THEREOF,NOETIC WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISI NORTH ANDOVER,MA 01845 AUINOFUZWREPRESENrATIVE ACORD Z(201 0" lite ACORD rtanls and I \� ogo are registered marks of ACORD 1888-20111 ACORO CO reserved