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HomeMy WebLinkAboutBuilding Permit #935-15 - 370 CANDLESTICK ROAD 5/18/2015 w TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: i 1 ORTANT:Applicant(must co mplete all items on this age LOCATION Z l o � T�`'� Print PROPERTY OWNER Unit# Print MAP NO: 16G;, PARCEL:62—VZONING DISTRICT: Historic District yesOno Machine Shop Village ye100 year-old structure ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ ?�`.4.,s='i.❑Rr�++WDea_—mt.t.e1rt_�ol..iS.t.Ji_.eo..I.�.,,wn�.,.. -30 ❑.f Other ��1u►.s��" ;�Y� S�?H:. " ahd M_ �aIe-r- 1t ' tS .� .a DESC TION F W RK TO BE PERFORWED- (Identifications Please hype or Print Clearly) � NCO OWNER: Name: yJ td�--torfP- Phone: l `7 Address:_ CONTRACTOR Name: ��`� Ul/� ��t< Phone: Address: "./tel Supervisor's Construction License: �����C ,� Exp. Date: Home Improvement License: l�d � Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$1Z00$12.@00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. 00 - - 3 Total Project Cost: $ l-l 3 6� d FEE: $ Check No.: 1 a-� Receipt No.:- NOTE: Persons contracting with unregistered contractors do not have access to the aranty,fund Si nature of�A`'e` ©w - t =,'7` . .. - - ' - ,-.- x ,.: } 11 .� - , , - _ - . .-,...._, ,.. _ . .. 1. . <, `:: M -- -:. ... . - _ � ,...... .. -- __ .. ~• 1. l 4 4 .. v - ti 555 .rt - - � {',.r -4 _ Location C331 C4 St�L� I '� / - . j No Date . __ I. 1 - • • TOWN OF NORTH ANDOVER • j 6 ., �-„ 0 ..�:.r I . - Certificate of Occupancy $ c 1 Building/Frame Permit Fee $ s 1-1 Foundation Permit Fee $ I Other Permit Fee $ , i TOTAL $ - 1 ? 1 4�, Check# _ I - 95 }}: Buil rng Inspector a ,r.,- _ .,� . c s. e v .u, F a ....-..: .... ._,....._.____- _ .... .. .. -. r -: - IAI--��� k, I. 1,d 7._ .,.. _ -_ ..- -a:. - _ .r:�:- _ - ., r : - - - .: .:. ', Z /. :. ... . . ., .. - i.�. l� ..- .. - '. b.,_..J.. .. :. .. .. .. _..V ... .. .... h..- •. .. 2 .�. - . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer swimmingPools ❑ ❑' Tanning/Massage/Body ❑ 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 ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature - E COMMENTS n, q. . 1 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 Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster o ite yes Z no 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 servicedroprequires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.W041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks ❑ Building Permit Application o Certified Surveyed,Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) o Building Permit Application L3 Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products MOTE: 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. Doe: Doc.Building Permit Revised 2008mi NORTH Town of . � E �. Andover No. 93 soh ," ver, Mass, CoC»IC»IWICK �1 �.Q A�R'�TEO NPa��S S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ...................I.................. ............ ... .......................... has permission to erect .......................... buildin on .� �.... ... Foundation Rough C to be occupied as ......(.�1.. . *�ig ..................... . .0 ................................................................... Chimney provided that the person accehis permit shall in eve 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 I� 3 PERMIT EXPIRES IN .6 MONTH§ ELECTRICAL INSPECTOR UNLESS CONSTRUCTI0 Rough .................. INFSSService ................................................... 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. Offices: 383(Rear)Lowell Street,Suite 2G77 � . Wakefield,MA 01880 . h ;..:.. Tel: 617-571-9056 PETER RYAN,,^., 352 Main Street,Suite 3C t mid SON Gloucester,MA 0'1930 Tel: 978-559-7333 ' �oO 'NGy '��W www.PeterRyanAndSonRoofing.com Submitted To: lob Location: Kenny Diatorre 370 Candlestick Road 370 Candlestick Road North Andover,MA 01845 North Ander#er,ISA 01$45 Phone#: 617-717-8634 Email: AVictorD@Comeast.net Proposal date: May 8,2015 We are pleased to hereby submit this proposal to furnish materials and labor,completely in accordance with the below specifications; (Additional charges may apply for any change's not included below in proposal either by request of owner,or if Peter Ryan and Son Roofing funds unforeseen circumstances that will affect the performance,quality or integrity of this job).In the event legal action is taken to enforce any provision of this agreement, the prevailing party shall be entitled to all its reasonable costs, including reasonable in-house or outside atlornev's fees. Not responsible for debris in attic. SIC OF 19 r Strip entire roof to bare wood and re-shingle: $13,740.00 • Strip existing shingles down to bare wood • Check for rotted wood on roof decking,and replace as needed • Nail down any loose wood > _ 0 Install ice&water shield to first 6-feet,and in all valleys and around any protrusions w • Install premium synthetic underlayment(in place of standard 301b.felt paper) BBBLInstall all new 8"white drip edge on perimeter and step flashing,where needed & Install manufacturer suggested starter course of shingles • Install IKO or GAF Lifetime/architectural shingles in color of your choice • Install ridge vent • Cap ridge vent properly with manufacturers suggested cap(GAP Timbertex&or IKO I-lip&Ridge 12) • Properly flash any protrusions and all new pipe flanges,if any on roof Re-lead 2-Chimneys:$650.00 Repair fascia w/pre-primed pine:Cost to be for Time&Material/TBD Clean Up: • Will cover area with tarps to minimize debris and remove debris related to work • NOTE: Please cover any belongings in the attic,as they will get dusty,if applicable PAYMENT T RM �s ��j �aav "f ��n �.'P0-(' n �1�foRallc a t=les c t nf, :t 4a, ,'duin:, 'r* terrnl7 P� Itldtlt Schedule: ... Is` payment due upon signing: $3,740.00 Total Cost: $14390.00aluscost torepair fascia(TBBI Total balance due upon completion Kin dIly emilt payment to°Peter Ryan`. Thank you tt Respectfully Submitted by: %,'d _.�!� - Accepted by: Our craftsmanship is 100%guaranteed i&",10-years. Alk "" 'titiairaz.tees are throueh the manufacturer.All warrantee 'll e null&void if job is not paid in full. Peter R1an and z F fotiran,Inc License#178871 —Thank you for letting us serve you!!! �( l� ec+� Cr,�w--) The s' I 'C'angr'es.s'Sr'e,e t, �S-1,1t x, 10. M' ,Bt7Va:n, f11A 0211-4-2-0-1-7 "�-t+`�^+ � lr�rrjrl�.tr-�rrs's,4�t��/rl�rr • W0:0-urs' Coxn f I 111surance Aff- i--chavit: N1�71:1.�fB'�isiness/ 1 �rliznti�lirIla.elivi �arli); Peter Ryan and Son Roofing, [no, �C, ,At:.iEiivss: 383 (rear) Lowell Street,Suite 20 CitylSWakefield,MA 0188.0 ;'ll #; 617.571.9056 A1"e you au euiiployel'? C%beck t'I,Ie njsjJ'T'ojJl'ilF:te bo11 a. 1.a11i a re' T�'17e o:i`jJi�aj'ec'f (1 ecJalit eci): 1..� I a111 a>raxple�ycl�vvit'll ® ,, llel'al entl`TiaCtn9'k121Ct I. 1 iln'��ti lur�•�I fille 4tlla �k7lltl•�lctars �' ❑ IV�xvl co'rlstt:tict:iel:n �ll1l)1py,rCS(.EZlll aTit�/ql j3a1,C:�tTti11��. ' ,.❑ Z am 11 -5,01t pl'n7�I'lt:vot or pa-mlctr• 11 tctl l)Fl file titt,aClleGl 511e+rt:. �. �I1:1.o l�liT1 , ship alltii have rao�llljal�ly�as Tlt�s� sl:it�-c��rltr,�ct.015 i°it1�-c S, [] D-cuaolit:iof, ��fnr'kitl:� fo:1'utc irl ally calaa:4.:ity, ezril7ic,�l�.�s arlel Ilrlare ��rctl'l�:e.I's' (olt13 i115iE1 9, El Build -dditio ll [No�n+o:rlt�'r.ti.' �:o11i1�, u�.4t.u•�rlc� 1. :'r�:lice.l t rjYkil4�rl.) 5.. Q Wt nvt n"I'(ovation ruld it,,, IQ-,M 1•c:pa•i•1'IS 01'tltltliflolls :�.0 I nal ra ltoiticommer doing:all rsr.ock t11eal' 1'1.[] P.l.tcltIU11Y�.cal�a.irs 111"iitl�lrtious myself. [; o lvolk�cs' 1:11:113}). right.of cx+:lllptioli PCI, t;:� � irlsu.11i1rcc lcclnlr•ert,,] T e. 152, 51(Q),.nti.d��e Ila..Kz tIr> ❑.Roo#'ivpiil•s e:lanilxlclyecs., [No 13.D O tllt,t, - c:otllla.:ill.sl•11;11:134.tr 1'erll.rir+rtl ] "tel:Y a.l>}�licnllt tliat chcekx leo`..#:l 1111:1se also fill otrttli�scerie,n tse:io�r 31tol�f:iit$their�varkenv'c.arti�cns ltlon t?c�)xcy i7l.tbrrlr t3-ro,i.. t ticlli.00���lers ivho stlb.nrit tills afTitiltiv.it.tndirlrGiat tlley.lrP do.illg all r ol*1.11-1 tlie:a:llrre cillsiicle:coutr..tlGtors nt>1st.srll)ltlit i:1ae.1� 1:tiictlui:t indicnl:hlg stlrh. il'allkrnctUrs t.Il1t cheek t.11.0s WX ttinxta.tt relied'all..additiolml sheet�rllQwiflg 11w l,18m.e.of the wi -con•t:ra(,,t>:ars aad vivle.wiletlle:r or not:Mose.ellrit:ica IlAw.. e1Ztl'aloyaea: 'If the$O-colrtl•actors llflve:eni pl:oyev tl q 111un provide their 4vorkzrs'comp.policy aw.11ber. I.r1rn,art en.7,pl'ayelrOuTr.ls pf'01+0111:a r1�<arleHl�s' t nrra�zt�rr•srillorr lrlsr�l�rlattre l`or'rrrl a�rrl1�rvjrc�E� , Blvrc l,s the po'l-Ir',l'rarlrl,M)s-lre' 11tfibrvlattnll:, 111suval:cc C011I1Jci'IT.y�tilal.le; N/A (I am not required'to carry W.O.as I have no emPloyees) Please see the Su b•Cotitractor's W,C,.affldaylt atta Policy 0 or Sekf4ns,I:i.s., #� r+/A ]rhl�il.ati.las3 Dti.te: Job S-itt Adclic•ss'..�.?0 .:C���t/`�"'f'�'7.:H'z-VC (�/'.""`. .... _�t �✓lt�J`t��! v Atttascll ra.copy ai the 1`rovIzel:rs' coulpe':sz"00r1 p"Oli y clerlill:>1.tloul page, tlae pfolky rlit:I,,nbe'-v 11.114 dn.it-e), Fail utv.tt7 xe:.clalye cove•cn:e t95 1'�v!I'1i1:11`�cl tuTcle.1 Sit tio:la 2��i1 erf ivIC7L c. i..il wali le•r�:d tea t..l:i.: b-T-1 ac'sit'r.oF1 (if c.l'rtttltlr1.I'j.)enrtJ.flc.s of n •t nt-11p to U!,500.00,i1ltlro:r p1:iC-yeal kI:};ll:)I'15g11T13C1it, 115't,vi 1.1 ascivil p7:11:E•l.ttic!s iii-fl-In fb.,Il i q:f la STOP `A1'ORK ORDER nvvl a time of lip to$250,40_a,{lay aga:i"nst th- viE7,lt�:.toa'. Bcadv•ls,cl1 tflat n t opy of 0.1i's sV,1W-111C:1)t 111fly t'Jt tl'ie Office .nf 11 a.N+e.stigatiolrs of the DIA fol: insil.i'ela:tce eovv--zl e.vc:r.i.ti:ea:ticrn. I do lw,-e;l,,l',of"11 .vr.17•r.0Y(I.W.parrttt's rrrarl pk"Itnitr'es o. p:c�frar;)' tlrrll til:e.11lJnr rlrntic�r:11�.1'�w1:c��r�(1fr:(7ve is w1u; and c,c>rr:eo, : 617.571.9056 .:.n..._.._:.................•... .........................�_.............,..,...................,........_..._.....,,......_...................._...........�:......._...M.:..........: ......................•......... fllllclrt.r trsez nlatl� Do:twt- 111, falls,rarvr1.,, to N? roiitpleiled by clfp pry J.t7"1i�r1 a�f<#�rl.. 1.5s.-.'I':hiigoale):1 1, $oalcl or.Henjtll_ 1., Btlilr11h3 Pe,jJnu'tx1le,nt r C;li�'1T0s�11 C1evk 4 >rle�triclil'2a1�i�actol' , Picerrl� jll,r Iuslrectol:' C'C)tiler C:o17:vapevsoa•1.i The Cani;r.i-towvealth of Qfpve Strvef, SON 100. qq Boston:, MA 02114-20.17 mvpv,inass,govNIa Wo rk evsl Comp,enuition I:ilii Affida..vit: Ap gzat 1affovi-riato-ii. '.J) .qilt PI ge Pi,fixt Lggli Lema: Constructlon, ]no, .Nimne. 71 Prospect Street C"Ity/Stnts/zip: Brvokloni, MA 02:301 508-232-1194 Ave yon nn employ 'heek the. npli-wopi,.. late box; , ev?,C Type of jn,oject(required): I ME I mil With 10 4. [W Imn a-gvnertil 6, [] New oojiviuotion cmj�iloym(filli md/oir limt-timc),41 In", hirld the .2.❑ 1.mil A.Sok propl'ictor hfstcd.oil thimtta,olw.d.shov. 7, E] Remodc-ling ship and have. lit)Olivloym," Tlw,�: 11q),o 3, Q Demo.liticmi wol,,killgg fol,ITIC ill ally Qnpkwity, alid have \.vorktls' 9-, [No wmkey.s I romp, bi.%ivimoe Collip., 11tXj11i1..:d.) 5: ❑ Wt am �i colporiltioll.mid its WE B1,:aVitnI vepail"S 01'11<14itioll-s I.am a holl1eoNNq1er doing all Wcnk 4'A'fim's have;"emis.ld their 11,Q or ndditiolls myself [Noworkcv-s' Qce nip, r4ht of CXel,11,1tiol, lnrlAeL 12Q.Rw1*n:ptxiv,� t�� 15.2, §1(4), Alid \,Nr,: have. ii.�) iC111jAOyc:c.s, (No workcvs' AQlllp. illskqran:ce "Ally applicur tfiat,,chmis box#1 mw9talso fill out the are0Se'tivu below vhowftig ibeir workers'campensmion policy Luforninfloll. t Hwmmmm wligsuba�ittlifi5 M-Avit i1i4iQ,1fi.mgMCy doing ill t'�oll; ultl ureal hfre.otafstde>.oittr.actors niatst stltnnid z:trea�'rci davit iucticating such. tContrntors 111M dierklhis box Must:attached mi additionarslieV salons 41g the imuit of1he sub-cowrac.tors.and�,,wme whether or not those elitNes have. employees, If giewub-coatmooTS 11aVteO1P1OYee3, policy number, I mn an etriployei,that ls'ppovldlng wopfiem` com.pavSadon.Jpisrowncefip iny Below I.-$,the polloy andjob Infiopin arlon, Insurmict: Comp I mlyNkllyw,: Insurer A: Northland Insurance, Insurer B; Arbella Protection, Insurer C: Travelers A/R I 6560U6-5686069-2-15 Polk 4 or Self-ins, Lic, 4 Bxpivnfion DM.c- 03-01-2016 e-1--,%(D C e 'A LA_ you Sitq.Addrcs�,:. Zip: Affach n.copy of the wodi-ev-s' compeiiintloll plo-1-4V.-y dedamition.1myge,(4101WAUg.the POW)" mi-mbel, m)(1 (111U). Faili,imlo secure.Qo)":Tmgt m.reqllil,ed Vitic1tr Section 25A of M:CTL Q. 15.2,call lead to the ililpositioll In-milties of I fine 111) to$1.500,00 ml-ClJor 011�:-Ye:tl.r wt�ll as Qiyil limn-Iti-ts, in the fwm of a:STOP WOM ORDER.mid a ffill of up tk)$2.50,00 n dtlyqgwv11l.st the.violator', BI: actviscd thang Copy of this stat ement:may be f6nvavdetl tv,) the Offit�e of hwist(,gstioas of th,:DIA for Q.ovtwge, yeli:Fmation, I do homby e;evtlfp under th-v p a.lriy on N )(Vomy tlhat the Inf. 0m.-adoll pvvvided ObO'14' is tPHT (117d(70-FI 4, 232-1194 ............ OVUM.a,se only. Do nor wr1re In Ild-T ofeft, to bt,oompletvff&y C.,10)O's'10:1vil qfjklal, OR,)'or TOW1111 Pev"VLfoease # Isstfl-mg A-whovity(4dr-de one)-, 1. Bonrd of H�.nith 2, Rullolugg.Dep-mIrrieut 3.'C Cluk. 4, 1U.-Splecto), nAT CERTIFICATE OF LIABILITY INSURANCE OA/0912015 YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON-THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES. NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the oertiflcate holder Is an ADDITIONAL INSURED, the polioy(IQ$)must be endorsed, If SUBROOATI N IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this oortificato does not confer rights to th( cerlilloate holder In lieu of such ondorsement s , PRODUCER COQ JOyoe M Kellor Ma"Paylnsurance Seri ces,LLC ^MaU HONE 978 774.4338x116 - ---....•...___.•.rFA"...--978 M1318 27 Garden Slreel,Unit 13 ( ) I (ac,No):( )77 I. Danvers,MA 01923 AnDREss: JOyQe@masspaylnsurance,Com INSURERW AP FORDING OOVERAGE NNC N __ INSVRfiRAI Norihlandlnsuranco NOR J INSURED Lome Construction,Inc INSURER B: Arbolla Prolecllon 41360 Jews Loma INSURER C: TRAVELERSA/R _ TRC 71 Prospect Slreal BrooNon,MA 02301 INSURER D INSURER E, IN5URER P t COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BFLOW HAVE BEEN ISSUED TO THF INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEb, NOTWITHSTANDING ANY REOUIREMEM', 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 BECN RFO_UCE;O BY PAID CLAIMS. fwvll TR TYPE OF INSURANCP. 'OL CY EPP P041C E P EACH OC (I.ICY NVMRER MMIDD/YYY�I MM10O/Y YY CURRENCE LIMITS A GENERAL LIABILITY WS230101 01/31/2015 01/31/2010 CV __2,000,( $ _ COMMERCALGENERAL LIABILITY IPREMISES r CLAIMS MAOM © OCCUR MED EXP(Any one erson _ $ 5,( PERSONAL&ADV INJURY $ 2,000,( GENERAL AGGREGATE GENL AGGREGATE LIMIT'APPLIE5 PER: I PRODUCTS•COMP/OP AUG S 3,DOD,C POLICY PMOTRO LOC i g B AUTOMOBILE LIABILITY 1020009?.74 11/20/2014 11/28/2015 Co Idon o IIIN IFAIT 11000,( ANY AUTO BODILY INJURY(Per parson) S ALL OWNED / SCHEOULED --- AUTOS v AUTOS BODILY INJURY(Por mldenl) $ J NON•OWNEO ._.. _.._.... "'*".... . . .. '.''._.... HIRED AUTOS AUTOS PROPERTY t)Afv AGE S r leer accldenll „_—,- 5 VMBRELLALIAJ3 DECUB EACH OCCURRENCE $ MXCM59 UAB CLAIMS MADE AGGREGATE S DEC, RETENTION$ _ (, AND 6MRS COMPENSATION 6S6OU6.5B86069.2-15 03/01/2015 103 01/2016 WC S7ATLL I1071,+ S AND eMPL0YMR5'LIA131LITY Y 1 N , � TORYLIMITS —1 ER ANY CERIMEMB R/PA VDE0XECVTIVEr � NIA A E,L,EACH AC............. If Kn eloryln and E,L,DISEASE.EA EMPLOYEE If yea describe under 500,( DESGIRIPTIONOF OPERATIONS below E.L.DISEASE•POLICY LIMIT S DESCRIPTIONOP OPERATIONS/LOCATIONS/VEHICLES (Nisch ACORD 101,Addlllonal Romerks Schedule,II morn apace la required) _ . Proof of Insurance CERTIFICATE HOLDER ^ CAN( LLATION — SHOULD ANY OF THE ABOVE DESCRIS•ED POLICIES BE CANCELLED BEFORE Peter Ryan and Son Roofing,Inc THE; EXPIRATION DATE THEREOF, NOTICE WILt, SF DELIVERED IN 383(Reer)Lowell Street ACCORDANCE VVITH THE POLICY PROVISIONS, Sulte 20 Wakefield,MA 01880 AUTHORIZED RPPRESENTA•rIVE ail C7 1988.2010 ACORD CORPORATION, All rights reserve ACORD 26(2010/05) The ACORD name and logo are regls.tered marks of ACORQ LICENSURE Ferns Construed®n, Inc, k-C#; 15910'6 Jesus Lema t1 r•nr/+/v/raga/!/v,�i'Gt��r.rran/1r�x•I!r Utaov t-fK.on,umrrk0'nh;+rQ tfuelness llrguleNou 1,Icunsti or rogtstrnlionvi f d for inrlividul oso only ¢.�} �iOMEXPROVEMOVOONTRACTOR bol'ory thv oxplrnttfnl pate. 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