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HomeMy WebLinkAboutBuilding Permit #423-2016 - 370 BEAR HILL ROAD 10/5/2015 _,SeA�vw ED NORTy BUILDING PERMIT °`�tLE° 6 TOWN OF NORTH ANDOVER J - p APPLICATION FOR PLAN EXAMINATION Z e" Permit No#: �� Date Received �'qs R^TEO SACHUS Date Issued: t _A6kd IMPORTANT:Applicant must complete all items on this page LOCATION 370 /AI4AS Print PROPERTY OWNER J �4/4P� Print 100 Year Structure yes no MAP _0104- PARCEL: 0 /01- ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition 11 Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed-District o Water/Sewer_ DESCRIPTION OF WORK TO BE PERFO�RM�j D: l(le) cS�r � R- 1/ 9 Identification- Please Type or Print Clearly i�� OWNER: Name: T6 �nV /`���064 s Phone: to�7 7�' Address: 70 RtD Contractor Name:\,1it� Phone: 7 — Email: 201 ydress q �, Supervisor's Construction License: ©9y Exp. Date: Home Improvement License: 170 510 Exp. Date: 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: $ a 1 607, 00 FEE: $ 2 ' Check No.: �� Receipt No.: �� (a NOTE: Persons contracting wi h unregistered contractors do not have access to e guaranty fund „, _ _ _ -- Location / v ' No. Y2.3 Date /')/t://� . - TOWN OF NORTH ANDOVER LRD o Certificate of Occupancy $ Building/Frame Permit Fee $ 75� �3 Foundation Permit Fee $ Other Permit Feer $ TOTAL $ • Check#1�v� `Li / �1 �' Building Inspector 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 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 Connectionisi�nature ®ate Driveway Permit DPW Town Engineer: Signature: FIRE DEPA aLocated 384 Osgood Street RTMENT Teinpl©umpster onaite - Locate I t`.124IMainrStreet Fire{Department!0i" 'n 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.$1oo-$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 dCertified 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 NORTH own of EAndover o No. h ver, Mass, Coc"ICHEWKIt 1_1• A04ATED APP,�'�5 S V - BOARD OF HEALTH Food/Kitchen PERMLT T LD Septic System THIS CERTIFIES THAT �. .� W.......... l..A......,5i�i BUILDING INSPECTOR ..................... .....has permission to erect .......................... buildings on , .. (�. � .`" 'I�.... Foundation . � ` J CCEJ.............................. Rough to be occupied as ............. .. ........... ... .. .. ..... ..... )1!!!!. .�.�f 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 CONSTRUCTIO ARTS Rough �j Service ............. ;..... .. Y.I.F.... ............................. 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. Renewal MA Home Improvement Contractor bxAndersen, �+� Renewal by Andersen Corporation License#170810(Expires 12123/2015) WI'.ap4w Nae L11CtAFLNt mM�ln w"f r,-n, Federal Tax 10#41.1918413 30 Forbes Rd. Northborough,MA 01532 (508)351.2200 Fax(508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Buyers Name Date; JOHN PLIAKAS - AUGUST 18, 2015 Buyer(s)Street Address CitV State Zip Code 370 BEAR HILL ROAD NORTH ANDOVER MA 1 01845 (Email Address Home Telephone Number Work/Cell Telephone Number JPILAKAB CO CAST.NET 617-678.8662 Buyer(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation("Contraclor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount $ 21,607 mount Fa tnand$ 0 sttoDate Methgo gf ERment Deposit Received 33% 7,202.33 Da ChecklCash p ( )$ posit at symg$ 0.00 8-i0 weeks Balance Sian of Job(33%)$ 7,202.33 Chock 8 Balance on Substantial At Substantial Est.-Insiall Mme ✓ Credit Card Completion of Job(33°k)$ 7,202.33 Completion$ 0.00 1-2 days a txadIt card Is selected,please No float ,snarl be demanded unt a9 les ere aetisrred see Credit Card Payment form Buyor(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing or modifying any of the terms of this AgrOoment. No alteration to or deviation from this Agreement will be valid without the signed,written consent of both Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyor(s)1)has road this Agreement,understands the terms of this Agreement,and has received a completed,signed and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation Buyers) Buyer(s) BT -- Signature of Consultant Signature Signature x CARL BRYSON JOHN PLIAKAS Printed Name of Consultant Printed Name Printed Nemo YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANYTIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. =-------------------------------------------------------------------------- I NOTICE OF CANCELLATION NOTICE OF CANCELLATION ; IlatcofTeammoloo 11/1fulA .lnumaycancelthlkI Dote ofT}ankaction It/111/1:5 .Youmayconeelibla transaction,without any penalty or obligation,within three business days from.the I transaction,without any penalty or obligation,within three business drys from the almve date.If you cancel,any property traded In,any payments made by you under ahow date.if you cancel,any property traded in,any payments made by you under the Contract of Sale,and any negotiahle instrument executed by you%ill be I the Contract of Sate,and any negotiable instrument executed by you will be returned within 10 da"following receiptby the Contractor("Setter")*(your t returned within 10 days following receipt by the Contractor("Seller") of your cancellation notice,and any security Interest arising out of the transaction will be ; Cancellation notice,and any security interest arising out of the transaction will be caa"ied. Ir you cancel,you must make available to the Seller at your residence,in I canceled, If you conceit you nauxt make available to the Seller at your residence,In aubatandally ax gond condition as when received,any goods delivered to you under I smintandally an good condition ■a when received,any goods delivered to you under this Contract or Sale;or you may,If you wish,comply with Ute Inswctlons of the 1 this Contract or Sale;or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk. I Setter regarding the return shipment of the goods at the seller's expense and risk. If you do snake the goods available to the Seller and the Seller does not pick them up I If you do make the goods available to the Seiler and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose I within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods without any further obligation. if you fail to stake the goods available I of flit goods without any further obligation. if you fail to make the goods available to the Noll",or if you agree to return dtr goods to the Seller and fail to do pet then I fo the Seller,or if you ogrep to return,the goods to the Seller and fall to do s4,then you remain liable for perMrmance or all obligations under the Contract.Tb cancel you remain liable for performance of all obligations under Ate Contract.To cancel this transaction,mail or deliver a signed and dated copy of this cancellation natice ; this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other written notice,or send a telegram to Contractor.Renewal by Andersea,1 or any other written notice,or send a telegram to Contractor. Renewal by Andersen, �30 Forbes Rd. Northborough,NIA 01532. t 30 Forbes Rd.Northborough,:NA 01532. 1 TIEREBY CANCEL THIS TRANSACTION. /ITEREBV CANCEL TATS TRANSACTION. 1f I nysrx6'•7uawt PAM Nates .nom 1 aupr's SpnMre Print Nims 0161 1 Renewal Renewal by Andersen Corporation MA biome Improvement Contractor .'�'�- 30 Forbes rd Northborough,MA 01532 License#170810 (Expires 12/23/2015 byAndersen. � g c � ) WINDOW REPLACEMENT (508)351.2200 Fax:(508x986-7072 Federal ID iF41-1918413 Window Specification Sheet Buyer(s)lame Date of Agreement JOHN PLIAKA5 TUE,AUG 18, 201 S The buyers)fisted above hereby jointly and severally agree to purchase the goods and/or sewices listed below,in areotdancc ttith the pricey and terms described on the Specification Sheet and the front and the reverse of the accompan}ing GUSTONI NVENDOW A\'D DOOR REN'IODELINIG AGREPMEN'T,of which the Specification Sheet is part. WINDOW&DOOR DETA1 S APP APP• Appx 6tterwArdenor Color Hard Ware Hot-we LWEL/ _. Crib* Qi5e Glass Room >: tvltrJt hetrt Ut. WindowlDoa S le Detail Cali Fxt-Int Color style Swear.Srrartsun Grll7es sash tri sash Ufts options Bed 1 101 36 '62 98 DB rail equal insert sl sa L Trim WHMN Stone standard FFG rtsu war 42 4/2 Bed 1 102 36 fit 98 Da rail equal insert sloped sit L-Trim WwpN Stone Standard FFG ttatty 412 4/2 Bed 1 103 36 46 82 oa rail equal insert sloped sa L Trim wHmN Stone Standard FFG simnsur wow 42 4/2 Bed 1 104 36 46 82 DB sq rail equal insert sloped sa L-Trim WHMN Stone Standard FFG u trAtyv 412 4/2 Closet Must 105 28 45 73 DB sq rail equal insert sloped sa L-Trim wFwN Stone Standard FFGLd&' oirw 32 3/2 Bath 1 106 36 46 82 DB sq rail equal insert sloped sa L Trim WH/PN Stone Standard FFG Dow 412 4/2 Temper Bath 2 107 28 46 74 DB rail equal insert sloped sa L-Trim wH/PN State Standard FFGwrw 312 3/2 Temper Bath 2 108 28 46 74 DB rail equal insert sloped sil LTrim wHmN Stone Standard FFGmw 32 3/2 Temper Bed 2 109 36 45 81 DB rail equal insert sloped sa L-Trim wwPN Stone Standard FFG04M 42 4/2 Bed 2 110 36 45 81 DB rail equal insert sloped sa L-Trim WHIM Stone Standard FFGRaw 42 4/2 Bed 2 111 36 45 81 DB sq rail equal insert sloped sa L-Trim wRiPN Stone Standard FFG Su MrW 42 4/2 Bed 3 1 t 2 36 45 81 DB rail equal insert sl sa L-Trim wwpN Stone Standard FFG mm 42 42 Bed 3 113 36 1,3 81 DB sq rail equal insert sloped sill L Trim WRTH Stone Standard FFG rtsu wrw 4/2 4/2 Bed 3 114 36 62 98 08 rail equal insert sloped sa L-Trim wwPN Stone Standard FFG "M4/2 4/2 Total 0 BA4 BOW&MUD OUT DETAILS Appy StyleDotail/ width! Apptox Number Frarne WMdow End Center l.owli/ Roof/ Hardware Room count we FANters Casings Arng'e utas Anterior ExtMt Gator Groes sashes sashes Screens Smargun Sofro Color SPECIALTY WINDOW DETAIIS Full/ Approx_ tcwE/ specialty BAY/BOWADDMONALWORKNOTES Room Count Styli Insert Ul Scrorsm Grilles Grille Style E¢rtrtt Color Ctmarrr is aware rho t.d,b,y,/b v ua,".under-.2 inrncc tnrre will tr,.s=nitnot d—lt.sc ADDITIONAL WORKDETAILS: I No Contractor will wrap exterior casings with coil stock color of Owneris aware that Contractor does not do any painting/staining or removallinstallation of alarm system or window treatmentslhardware.It is the fesponsibilfty of the homeowner to have the alarm system and window treatments/hardware removed prior to installation. ft make no guarantee as to whetheralarts or window 2 treatments/hardwane well fit after replacement. Customer is also aware in some rases there will be glass loss. N there is,the amount wilt be dependent on the type of existing windows,We of installation aux/window style.We make no guarantee as to the amount of glass loss.Customer is aware and understands any and all unseen not is not included in this contract.Should any rot be found thane will bean additions!charge tot time and materials unless so stated in this contract 3 Yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infi1ration.Removal and disposal of all job related debris, windows,doors,storm windows and vacuum nightly included. Upon completion of the job and payment in fug,a limited warranty shall be issued. 4 Yes Building Permit--Contractor will secure any and ail necessary permits. The fee for the permit(s)is included in the total contract price. 5 Yes All discounts have been applied to this agreement. 6 ✓ Yes No Owner agrees to be present an the final day of installation for final Inspection and to delver final payment/finance form(s). It ix agreed and utn&aswod by artd lx%%ven the panies that this Specification Sheet,along with the CUSMM AVIN"DGIV ANT)DOOR REMODELING AGREDILNT,conmtmes the entire un(kmanding between due parties.and them an no terhal understandings charnging or modifying am of the terror.This Slxtif"lion Sheet nay not be clanged oT its terns modificd or varied in am aav unites;utch dangt.sare in uTiting and signed by imth the Bulvujst mKl Contractor. Bu),e,,q l beret%•acknmwkdgt:that Bugs)has read dui;Spurifieation Silted_ Renewal by Andersen Corporation 13u Bttyen(s) Signature of Consultant Signature Signature CARL BRYSON JOHN PLIAKAS Print Name of Consultant Print Name Print Name I Renewa byAndersene •:. WINDOW REPLACEMENT AnMdetSM 101PAny WoodNinyl Composite IF Dual Argon Low E4 SmartSun F •:.:c1��a:^' Double Hung 100-00473518-010 ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient i I 0001 . . 9, ADDITIONAL PERFORMANCE RATINGS Visible Transmittance OA2 hdanufactumr stipulates that these stings conform to appkaala NFRC procedures for determiningwhole product performance.NFRC ratings are determined for a reed set of environmental conditions and a spacili;product size. NFRC does not recommend any product and does not warrant the audahipty of any product for any specific use. eonssh manufacturer's literature for other product performance information. www,nifc.org 'R A+f "s product meets Green Sears environmental c.n•e> 3 y I standards governing energy �,�a^,�,°!,°. tj•:.r �...� i:• i eK.:ancy,Mavy metals in f'•the trams and sash t""'"t"'ly:•. material,packmand 't•,• + consumer educational y;;...y;;:;:,;:'�.••o• .h, materals. ut.r t.a y:;;^ •.. ,.:.,.;..ar ��.,. 41 R-t DESIGN PRESSURE(PSF) r t I Wild" RbA DB Sloped Smit b1n Dee HI INH-LC25 Testadtol1AFS42ofANaARAACS101ASA4404S AWKve=ted 0000rin"00 le Tea sMartoerds. diets or exceeds hf.E.C.,C.E.C.A I.E.C.C.Air InfMcatioa requirements WDAIA NaAnark CerlifiWion Program. i d • r • 11 e e r • • e t-vNWyf—jy��2,1� `K s7I•lrtl,"`IL .!-a;i:.r,A�'h...x.�:_..,k+t�a�u:.y� iv,it,�ir ¢•.� F•.� R t' J y ox6a, Do Pr F't'I e..,,,,,1 �i t Lr,1e-ti TJ^f{•.14?:. �c�•s'�� ��y�� -aa � tx► L 1 ,g,* � .. � !k � rar^�y�.^3��C3",7 tP Lf 't-�r�� :�s• ° 7 r's� 'f �a. rI i}� r'dam'ID"+,-��,�Jx4 ..} F 'jam �`4", x u 036 Sfyie i�� � t �W.. .l`yn � •': ` MIN�y 4 1 n 1 rh�X f rolat'•L.nC--�,1�•�'1f�""f'+'} ••r � �E^.t�^ � h ���^...,r,�>y �� ..o-.,l�... + .�. ..,� -�_. 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The C'ommonwealtt of.111'assachusetts Department of Industrial Accidents Office of Investigations qV 604 H ashingion Street Boston,.MA 021.11 www.rnass.gorldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leidblv Name (Business/Organization/Individual): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD City/State/7ip: NORTHBORONA 01532 Phone#: 508-3351-2200 Arejou an employer"Check the appropriate box: Type of project(required): 1.91 am a employer with 30 4. ❑ I am a general contractor and I 6. F1 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.t 7. `tRemodeling ship and have no employees These sub-contractors have $. ❑Demolition worki> for me in an capacity. workers'comp.insurance. y P tY 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.❑ 1 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 12.0 Roof repairs insurance required.]t employees. [No workers' 13 ❑Other comp. insurance required.] "Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information, t 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 mid 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 information. Insurance Company Name: OLD REPUBLIC INS. CO. Policy#or Self-ins. Lic.#: 30543700 Expiration Date:_10-01-16 Job Site Address: 376 �� r City/State/Zip:/ I AICOVe L Vq* 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 u r the pains and penalties of perjury that the information provided above is true and correct, Signature: Date: Phone#: 508-351-2200 Official use only. Do not write in this area,to be completed by city or town officiaC 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#: ANDECOR-01 YADAVYO '4C"—R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/1/2015 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). PRODUCER CONTACT Willis of Minnesota,Inc. NAME: Willis Certificate Center PHONE (877)945-7378 c/o 26 Centu►Y Blvd ac No Ext): FAX No): (888)467-2378 P.O.Bol,TN 37 1--MAI'ss:Certificates willis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A..Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC INSURER C; 30 Forbes Road INSURER D: Northborough,MA 01532 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. TN­SR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBERPOLICY EFF POLICY EXP MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS-MADE a OCCUR MWZY 30544010/01/2015 10/01/2016 PREMISES Ea occurrence $ 500,000 MED EXP(Anyone person) $ 10,000 PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY❑ PRO LOC PRO- JECT PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A XEa accident $ 5,000,000 ANY AUTO MWTB 305438 10/01/2015 10/01/2016 BODILY INJURY(Per person) -i - AUTOSOWNED SCHEDULED _ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY X STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N MWC30543700 10/01/2015 10/01/2016 $ 1,000,000 OFFICER/MEMBER EXCLUDED? I� N/A E.L.EACH ACCIDENT (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety �! Board of Building Regulations and Standards Construction Supervisor License: CS-090125 JAI30 L MORINS` 86 GARDINER S7E ,. LYNN MA 0190 �- Expiration Commissioner 10/06/2016 I C-Dfie�p' useac o��ac�u�oetla fttCe of Consumer Affairs Business R4gmlation dMAE IMPts OVOWNT CONTRACTDR 'j- Regis'trata� $ ? Type. Exorat4bp. t / ti+k5 Supplement RENEWAL BY ANAI 940ORPORATION I JAIME MO21N k V' - -77 904 OTIS STREET NORTHBOROUGH,MA 09532 `tltldersecre;ary t