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HomeMy WebLinkAboutBuilding Permit #079-15 - 37 UNION STREET 7/20/2015 NORTH BUILDING PERMIT o� �tLED 16'a�� 1 4 TOWN OF NORTH ANDOVER h `'`- �=, •= APPLICATION FOR PLAN EXAMINATION = ,� Date Received Permit No#: �qs R.TED�Qa��g SACHUS� Date Issued: Z� J IMPORTANT: Applicant must complete all items on this/page LOCATION 377-3?? Prin PROPERTY OWNER "Print 100 Year Structure yes MAP _PARCEL:3 Z ZONING DISTRICT: Historic District yes n Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building E19Wf6mily ❑Addition wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other --id—sop—tic ..fl Well ❑ FI'oodplain ❑Wetlands, ❑,.Watershed Qistnct,:; u � �Water/Sewer « � ASCRIPTION OF WORK TO BE PERFORMED: 10/1 Ide tifica ion- Please Typeor Print Clearly OWNER: Name: cz,-24t� Phoned Address: 64efa ✓ Gc—, ,. X.3"7_ Contractor Name: Phone: Email: Address: 5'" Supervisor's Construction License: P>s2.:�.'r� Exp. Date: Home Improvement License. Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING P IT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ C! Check No.: I Receipt No.: ,- / oq�k NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL r Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent 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 HEALTH Reviewed on Signature COMMENTS G 7�)ning 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 Town Engineer: Signature: Located 384 Osgood Street ,}FIRE tDEPARTMENT f ,T;empjDumpsfer, }Located atS124(MdintSt `F eDepartment�signafure/date, .. r 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 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. 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 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 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) 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 "� 1 UNP No.—)q Date (2,a1 (. • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#k�� i r� r 7 Building Inspector NORTH Town ' of � _E 1. Andover y h �h , ver, Mass, -7 a COC NICKl WICK q0RAT E D J"V S U BOARD OF HEALTH Food/Kitchen . PERMIT T LD Septic System e THIS CERTIFIES THAT ............ ... k e.,c..../ULt.J,(.I --.. ...................................................... BUILDING INSPECTOR ..:... has permission to erect .......................... buildings on .... q.........�"V r..F..................... Foundation Rough tobe occupied as ... .. .......` ....................4 ........... .............................................................. Chimney provided that the person accepting this permit shall i very 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 l UNLESS CONSTRUCTION T TS Rough Service .................. .. .... ..... .................................... BUILDING INSPECTOR Fina - 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. l P a9e# of pages CS # 022680 �j 978-688-6737 HIC# 103358 Ar Jr Walsh & Sons or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Propose!Subm' o: Job Name Job# ✓K.. Address Job Location --3 .' -mac... �� /r� ',� G%' ��C•/ (,�,� Date � ,,...- Date of Plans Phone# �f ,� Fax# Architect We hereby submit specificatfons and estimates for. / Ie2 . J `'�,t Oa i" d We propW hereby to furnish material and labor—complete in accordance with the above specifications fo he sum�O $ ® ✓ Dollars with payments to be de as follows: Any alteration or deviation tram above specifications involving extra costs will be Respectfully �i A.Z;4,14 executed only'upon written order,and w�become an extra charge over and above the esfi'nate.AN a ments conn tsubmitted fee strikes,accidents.or delays 9 niter � Y beyond our cdturol. Note—this proposal may be withdrawn by us'rt not accepted within days. The above prices,specifications and conditions are satisfactory and areC' Signature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies:all basicrr�uirements of the state's Home Improvement Contractor Law(MGL chapter 142A),butdoei not Include standard language to protect>homeowners. Seek legal advice if necessary. Any personplanoing home ihmprovements shouid first obtain a copy of"a Massachusetwoonsutnerguide to homeimprovement•before agreeing to any work on yourrisidence.You may obtain-a fico Office of Consumer..:AfFairs:and Business:Ro copy by calling the: guletion s Consumer IAformation Hotline at6i7-9738787 or 1:888:?83-3759: . Homeowner Information Contractor Information sore PmY Name . Street Address(do not use Post Office Box address) LAMtractor/S er Name . aryR Zip Code usiness Address(must include a an address) . Daytim Phone EveaingPhone 3tyfrown Zirbode ��- �! a4Z444 Gv Mailing Address(It different from above) 3usiness Phone Iftliff2l EmplOyer M or T.S.Nt Wb lave q autmM hemeim A•me tComieQ Rea N�tie Batmadmdttt i••VISM co oontretatt hrve� Rrumtic=bcr The Contractor agrees to do the following work for the Homeo ner. �I✓ � (J ` / MclunDlin me 1CM,Spec Required'PeriWts The-following building permits are required Proposed Start"a tgmpletion Schedule-The following schedule will and will besecured.iry the contractor as tlre'homeowner s agent be adhered to unless circumstances beyond:the contractotscomtrol arise (Owners who'secure their own permits will be excluded:from-the Guaranty Fun*d`orovisions of Date when contractorwill begin contracted work. MGL chapter 142A:) Date when contracted .work will be substantially completed Total Contract Price and PaymentSchedule , The Contractor.agrees to perform the work,furnish the material and tabor specified above for the total sum of (s) Payments will be made according to the following schedule: $ uponsigning contract'(notdb exceed 15 of the total.contract price.4r the cost.of special orderitems,whichever is-greater) S by / / or upon completion of �_. $ by or upon completion of $_��upon completion of the contract (Law forbids demanding full payment until.contract is completed to both party's satisfaction) (f The following matenal/equipmentmust bespecial STbopaidior ordered before theeontractod worlabegms in order5 to be paid for to meet the,completion schedule.(**) 'NOTES:(h incuding all finance charges(•s)law requires that any deposit Of down-payment required by the contractor before work begins may notexceed the greater of(a)one-third of the total contract price or(b)the actual con of any special equipment or custom made material which must be special ordered in advance to meet the cempletion Whedule. Express warranty-Is an express warranty beim,provided by the contractor^ No Yes falit • f the tit a ed to L• o pet Subcontractors The contractor agrees to be solely responsible for completion of the work described regarrIleas of the actions ofs my thrid Party/subcontractor utilized by the contractor. The contractor fiuther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this aereement Contract Acceptance-Upon signing this document becomes a binding contract under law, Unless otherwise noted within this document,the contract shall not imply that any lien or other security intemst�haa 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. Ask'questions it .... . is unclear. • Make sure the contractor has a valid Home Immovement ontrac Re¢i�+*a+ The hiw requires most home improvement contractors and. subcontractors to be registered with the Director ofHome Improvement Contractor Regisnstica. You may inquire aboutconuactor registration by writing to the Director it One Ashburton Placc,Room 13Q1,.Boston,-MA 02108 or by.calling 617-727-3200 or . 1-800.223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Reed the]mporten"nfonnation on ihirievaw side of this form and get a copy of the Consumer Guide to the Home In*ovemmt Contractor Law. You may cancel this agreement if it has been signed at a place otherthan the coutracides'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 the.aaached notice of cancellation form for an explanation of.this right D NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identira c*cs of the contract be c opleed and maned Onc copy should ao to die ham,=.7 JT copy should be .. / kepttrytbeooatragor. ' Y Homeowner's Si tune ^ . :Connector's tore / �~ 01 Dau )�4 Date V `J�� Contractor Arbitration The Home Improvement Contractor Law Wovides homeowners with the nalivtoinitiate an arbitration action(as an alterriahve to court action)if they have a-dispute.with a contractor. The.same:t'ightis not'automatically afforded to a. contractor,_however.A. a contractor.-would have tp resolve any,dispute helshe.ltas with a homeowner in court unless both parties agree to.the optionaLolause provided below:.This clause would give the contractor the.same.right to arbitration as is afforded to the homeowner -by the Home Improvement Contractor Law.. . ' The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a-private arbitration firm which has-.been.approved by the S of the Executive Office of Consumer'Aifairsand Business Regulation and�the consumer shall be required to it such arbitration as provided InMassachusetts General Laws,ch a 142A44 G , omeownees Signdture Contractor's Signature NOTICV.The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. Thetomeowner.may initiate alternative.dispute resolution even where this section:is not s erste] si ed the esu:'. Homeowner's Rights A homeowner's rights tm('f& he Home-improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(Le.MGL chapter 93A)may not be waived in any way,even by agreement: However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible-for completing the work as described,in a timely and-;wotkmanlike:manner. Homeewnets.may be entitled to other specific legal--rights if the contractor guarantees or provides an.express warranty for-workmanship oi•materials. In addition to.guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability_and:fitness.for:a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agrmmaybe added to the. terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all'exhibits and referenced documents have been attached Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by.the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have,'received a fully executed copy of the contract,and the three day recission period has expired Accelerated Payments A contractor ropy not demand payments inadvance.of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a.contractor deems him/herself to be financially insecure,the contractor may require thatthe.balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or.need additional information about the Home ImprovementContractorLaw or other consumer rights;or if you wish to:obtain .6613YOf"A Consumer Guide to the Home Improvement Contractor Law,"•contact. . Cgnsumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the,registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards - One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 ort-800-223-0933 For assistant=with informal mediation of disputes or to register formal complaints against a busii;ess,call:' Coirsb6eeComplaint`Sec ion Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 Contractor Arbitration: The Home Improvement,ContractorL-awpmvid;§homeowners with:thenght-to4nitiate•an arbitration action(as an alternattve to court;action)if they,have.a,dispate with.e contractor. The,same.tightis riot'automaticslly affo to a. contractor,how.ever.-:•Ttie:contractor would have tp reaolxe any Zipute heJshe.Itas with a homeowner in courtunless .... both parties agree to,the optional,clause piovided below:.This clause would.give the.contractor.the.same.right to arbitration as is afforded to the•homeowner.by the Home Improvement Contractor Law.... ` The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a.private arbitration firm which hag:been approved.by the S ,tary of the Executive Office of Consumer Affairs and Business Regulation and'the consumer shall be required to bniit' such arbitration as provided InMassachusetts General Laws,ch a 142A. omeowner's Siggni;1 tura Contractors Signature NOTICE:`The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor .The:homeowner;may initiate alternative-dispute resolution even where this sectton;is not separately signed'by the pt{rties::; Homeowner's-Rights A homeowner's rights undef•the I orpe-Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(Le.MGL chapter 93A)may not be waived in any way,even by agreement! However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and•.;workmanlilce:mannel. Homeowner;.may be entitled to.other specific legal:rights,if the.contractor guarantees. or provides an.express warranty for:workmanship o'r materials. In addition to.guaranteas or waicanties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability:and fitness,for:a particular purpose. An enumeration of other matters on which:the homeowner and contractor lawfully agree;maybe added to the. terms.of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your : nsumer/homeowner rights;contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in_d ticate and should not be signed until a copy of allexhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other keptby.the contractor. Any modification.to the Inginafcontract must be in writing and agreed to by both parties.Contracted work may not begin until both parties havereceiveda fully executed copy of the contract,and the three day recission period has expired. Accelerated Payments A contractor may not demand payments inadvance.of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where:a.contractor deems him/herself to be financially insecure,the contractor may require thatthe.balance of funds not yet due be placed in a joint escrow .. account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account wouldTequire the signatures of both parties. Additional Information If you have:general questions or..need:additional information about the Home Improvement-Contractor Law or other consumer ng]itS;or rf you wish to;obtam a.free:copy.of."A Consumer Guide to.the.Home.Improvement Contractor Law,"-contact J Cgnsirnier Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)28.3..3757 If you want to verify the.-mgistration of a contractor or if you have.questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 . s (617)727-3200 or-1-800-223•.0933 For assistance with informal medratron'of ftlitesor to-regi ter formal complaints against,:a busiiiessj consininei`Complairit`Section Office of the Attorney General ; (617)727-8400 AND/OR Better Business Bureau z (508)652-4800 (508)755-2548 (413)734-3114 The Commonwealth of Massachusetts Department of Industrial Accidents F Office of Investigations t� j-• � 600 Wctsleengtortf street Boston A 02111 www.chess.gov/die Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): qgv_Z��q - Address: City/Mate/Zip: . ti Phone #: c7Z (���&737 Are you a Mployer? Check the appropriate box: ?. 2-Iam a employer with 4. ❑ I am a general contractor and l Type of project(required): employees (full and/or part-tune).* have hired the sub-contractors 6. ❑ New construction 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 me in any capacity. employees and have workers' T10 workers' comp. insurance comp. insurance.t 4. Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions I am a homeowner doingall work officers have exercised their 11. ❑ Plum �ng repairs or additions myself. [No workers' comp. right of exemption per MGL I2. oof re airs insurance required.] i c. 152, §1(4), and we have no p employees. [No workers' 13•❑ Other comp insurance required.] ..Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check:this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees_ If the sub-contractors have employees,they must provide their workers'comp_policy number. am on employer that is providing workers'compensation insurance for nab emplcgees. Below is the policy crud job site information- insurance � - / Insurance Company Name: / i'�//L ^��G�! � � ak—, Policy# or Self-ins. Lie.#: -7 D/51�-9kd AZOO �� Expiration Date: .lob Site Address: — (3 7 -2 ? l /9,\J f 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 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 fonn 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. 1 do hereby cern der the pains and penalties of erjury that the information provided above is true and correct Signature: Date: < Phone#: -7r 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 inspeptor 5. Plumbing Inspector 6. Other E Contact Person: Phone#: - Tlie Comirioii-wealt of Massaci.<<setts_., f Saar of B�iilding-Rega1_Qtions and Standards I chusetts State Building.Code,780-CMR,�"'l clition Buildifng Permit-_Ap_p_Uatidfi T6 Construct, Repair,Renovate Or Demolish a One-or Two-Family Dwelling SECTION 8: ADDITIONAL APPROVALS 1.jBal1Lairdv1,,1Iistortc DYsrtct Commission: Date:t applicat =#_(s) _./ 2. Board of Health: I ate: Comments: 3. Conservation Commission: !' Date: Comments: f pplication,k(s); 4. Design Review Board: Date: Comments: application # (s) 5. Electrical Perrmit Number: Date: Comments: . 6. Fire Prevention: Comments:.. - f - - 7. Planning Board / Date" Lbt lease: _ /❑'Yes._ ❑No Decision 4 (s): 8. Preservation`Commission: Date:-- l Comrnen'ts: application# (s) 9. Zoning oard of appeals: Date:l Comments: Application # (s) SECTION 9: CHECKLIST 11 Plans'Submitted 'D Yes El No Stamped Plans ] Yey ❑ No Q Plans)Rived ❑ Yes ❑\Noo CertificAlot Ian ©'Yes ❑ o ® Dumpster quired Y`es I o o ire Dept. Permit ❑ Ye' s ❑ Nva o H alth\Div. Permit ❑ Ye ❑ NO w w Febris be disposed of`? If no, ho will p Certificate of Lib l ty Insurance-filed with the.To=n Clerk's dffrce.-for a sign project.q Zer a public right-of-way in the amount of$2,000,000 ❑ Yes ❑ No t-rom: 01112/2015 14:48 #151 P.013/016 TE(MMtD acoRD® CERTIFICATE OF LIABILITY INSURANCE DA01/121YYYY) ��• 01!12/200115 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 'RODUCER 00775-001 NH2op�NN�A��CT Durso&Jankowski Insurance Agency Inc A/C.No.Ex1: (978)682-5175 amo.: (978)794-0313 198 Mass Ave Suite 1018 North Andover,MA 01845 Rnhss: IN UgEgA, A.I.M.Mutual Insurance Company 33758 VSURED INSURER B Arthur Walsh A J Walsh & Sons INSURE C, 55 Pleasant Street INSURER North Andover, MA 01845 INSURER E: INRURFIR F! COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 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 C BY PAID CLAIMS.pp TYPE OF INSURANCE INDSRBp POLICY NUMBER MM1bO F MIL �DnyW LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIALGENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS-MADE F—]OCCUR MED EXP(Any one person) $ PREMISES(Ea occurrence) PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ OLICY RO- OC 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 i nt $ UMBRELLALIAH OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS MADE AGGREGATE S {�aR{DEERE) Cp RETEENN11ON $ y�c g7 7H $ AND EMPLOYE sVL&JJ1LITY X TORY LI I S OER A at��1C�1�1�I���nwAlt>uIFOI ��CECUTNE7 NIA AWC-400-7014648-2014A 11!1412014 11/14/2015 YIN E.L.EACH ACCIDENT $ 100,000.00 (Mandatory IIn NH) u E.L.DISEASE•EA EMPLOYEE $ 100,000.00 DE��RIN12§ 9PERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) The workers compensation policy does not provide coverage for Arthur J Walsh CERTIFICATE HOLDER CANCELLATION Town Of North Andover 1600 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD omrrizn�uaeaiaaaacuca'' ` Off ce of Consumer Affairs&Business Regulation -4: ME ME IMPROVEMENT-CONTRACTOR egistration: 035 • Type: xpiration: _ Commissioner Private Gorporatipr rs� A.J.WALSH&SONllI ;- Arthur Walsh i' ``�i 55 Pleasant St �`., ;' � - - NAndover,MA 01845 ` 4 Undersecretary Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-022680 61t,r rs ARTfiUR J 159A WAVERLY RD N ANDOVER MA 01 z Expiration 06/09/2016 W