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Building Permit #657 - 39 HEPATICA DRIVE 3/15/2012
Permit N0: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this twe LOCATION R�VIt /('ofzi-� q Byere, V0 4- mtffi�� Print PROPERTY OWNER Ke%l sm v- J,. vt c , Unit # a28 Print MAP N0: / 0? -'S PARCEL: lie ZONING DISTRICT: Historic District yes �' Machine Shop Village yes6no 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE mock 44oye,Q ►'I'lG+ m/BSS Resid tial Non- Residential ew Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other mise ick UWell ®Floodplain 01W.etlanclst _ � WatershedJD strict` I ,ater/Sewer %� . DESCRIPTION OF WORK TO BE PERFORMED: t�6#V4ieUC�'(Dtv mr'- 4 3my) i20on. SS' A"C L.y 6�orMf�, F(90 A (2&a S {- ey c �e 0 0 it b e 2 J00e-' P- of � A-- q., ( -.10 t I (Identification Please Type or Print Clearly) OWNER: Name: K g y g c' &ft e T4 C . Phone: Address:_ 10 1 ePAJ C(4 bki'y(Z OoetL- 4tv,0oder2, �h4 m18 r CONTRACTOR Name: Ke loft C X21 On t�s phone: 6-0j9 -3 XS -* (0 30 Address: Lack ©a V4 46-9 401r— , mock 44oye,Q ►'I'lG+ m/BSS Supervisor's Construction License: 7530 ,>-- )3xp. Date: Jot /.1 (D /IL Home Improvement License: Exp. Date: ARCH ITECT/ENGINEER S.Sv�W✓" 4LO Phone: 7&1 -PO /(47 � 14u,( 640 146-1�w P. C .977vs Address: �' yG, W!�• ire°Q�`3t°u'K�'"`� Reg. No. 6010 FEE SCHEDULE. BULDING PERMIT. $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST/BASED ON $925.00 S.F. Total Project Cost: $ Z? FEE: @ .+ Check No.: �J�� Receipt No.: ��--- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted IJ Plans Waived ❑ Certified Plot Plan E Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL 11 Public Sewer u Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales , ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ �`g d��n� °w aPe TH FOLLOWING SECTIONS FOR OFFICE USE ONLY woe r INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ Reviewed on Signature HEALTH Reviewed on Signature CONIAAENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Water & Sewer Connectio DPW Town Engineer: Signature: Comm L/ uwctucu oo-r vayvvu VLIGGI FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS } Dimension Number of Stories: c9— Total square feet of floor area, based on Exterior dimensions. `{D 44-5' Total land area, sq. ft. C4on rb a 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 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 ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) r 'Building Permit Application d Certified Proposed Plot Plan E( Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit a 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 611" She u( 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 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: Doc.Building Permit Revised 2008mi Location,5q gee 4 EW No. 6.5- --7– Check# 25102 Date 3. If - ) 2— TOWN OF NORTH ANDOVER Certificate of Occupancy $10---- Building/Frame Permit Fee �$ Foundation Permit Fee $ Other Permit Fee TOTAL $ Building Inspector %D 0 N C12 c a O O C3 u p_ cv CD =CD a WrL W :IEEE 0 CD cy) r LE N 19 cD 7ci cm CA6 CD.3 ;cs E �M l cc CLC'0J La c D CML'S C E.W- ca. m C3 CDca - CDa 0 CLI- 0 W co 4D.S M= ui -E CL= L=U ca ;; • co) C3 JCD le cm C.3 CD a.0 C2E CL cb.g -0 (A m CO cc Q 4— CL4— a R I o CD 41:1 co 0 CD O ca CD -CM 0— A 0 r - u CIS co to r, C, x —Cd L2 co u2. cn CE C12 c a O O C3 u p_ cv CD =CD a WrL W :IEEE 0 CD cy) r LE N 19 cD 7ci cm CA6 CD.3 ;cs E �M l cc CLC'0J La c D CML'S C E.W- ca. m C3 CDca - CDa 0 CLI- 0 W co 4D.S M= ui -E CL= L=U ca ;; • co) C3 JCD le cm C.3 CD a.0 C2E CL cb.g -0 (A m CO cc Q 4— CL4— a R I co3� O t% co CD 0 cc 0 0. CM< c= c cv cc GO z ts u cc o CD 41:1 co 0 CD O ca CD -CM 0— co3� O t% co CD 0 cc 0 0. CM< c= c cv cc GO z ts u cc O •E 41:1 co 0 CD co3� O t% co CD 0 cc 0 0. 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O t :moo 0 V a m :• +, m 0 . � .0 c Co _ 0 CL F- O v) v CO w o�oo LL 0 •� w . y- W E V .r L > 0 H -0O F- aw Z 0. 0 CJ co Z U) uiw CL W H W CL Z U J • cu w E 0 �a Z 0• 0 0 � I = � W Q .E m m CL F- s v0O O O• �a s J •a Cc • 0 CL 0 4) = Z O CL cc V � a ._ C c CL U) is LLI YI y W W 19 W APPLICATION FOR CERTIFICATE OF OCCUPANCYANS ECTION BUILDING PERMIT # .sla ADDRESS/LOCATION OF PROPERTY: 3 f Hca Map Parcel Lot Number oZ� SUBDIVISION: DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. AIF ESTRUCTURE REINSPECTION FEE OF TWENTY DOLLAR ($20.00) DOES NOT MEET ALL APPLICABL ODES. Permit Issued Address: ROUTING TOWN ENGINEER, SITE PL —RIVE -WAY REVIEW 3��1 �►f CONSERVATION PLANNING DPW -WATER METER pd 7j_v� Z -7' SEWER CONNECTION , . DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST �3�27-C DPW SIGNATURE File: Application for OC form revised Jan 2007/2011 O� M? .rM 11• . O • F 7�D �SSACINSE4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 657-12 on 3/15/2012 & 560-14 on 1/27/2014 Date: March 28, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 39 Hepatica Drive MAY BE OCCUPIED AS a single family home with finished basement_IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Key Lime, Inc. 10 Hepatica Drive North Andover, MA 01845 Building Inspector Fee: Prepaid Receipt: 25102 Check: 5366 b' q uml c CD � ��. 1 C H O O C�7 V Z ac i • . 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SOV > Z _z LLIw CL W cH G W O.• I.f CO O U U) J 0 40 C3 0 a Z C!) 0 5 m LI E DC v Z Q o U) = C A� O • W Q N • •� MA+ M� E 4) CL Q v O o CL Q 0a .S Cc Cc Cc _v J •a •r.L O = Z U t/1 c CL 0 d O� gtED fb � ht \t - =6 APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPEC)TION ° coen�c ewu� 1 a�A°RwrED f`Pa\it5 BUILDING PERMIT it 'T40 M /'V 6#c ) ADDRESS/LOCATION OF PROPERTY: 3 % �. c 4 Map Parcel Lot Number o76 SUBDIVISION: �� J e'+� U� �► I��G''� DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: Diel/ / l f( "t age tj.-) 0.140die '?_ FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A . REINSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLF�ODES. Permit Issued to: Address: ROU LNG TOWN ENGINEER, SITE PL RIVE -WAY REVIEW 4-! 1`f CONSERVATION 00 PLANNING DPW -WATER METER 1 3 - Z -7 i SEWER CONNECTION i Tj__W 3 --27 — I,? DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW 3 � 217 - SIGNATURE 7 -SIGNATURE File: Application for OC form revised Jan 2007/2011 O TH �SSACNOSEt CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 657-12 on 3/15/2012 & 560-14 on 1/27/2014 Date: March 28, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 39 Hepatica Drive MAY BE OCCUPIED AS a single family home with finished basement_IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Key Lime, Inc. 10 Hepatica Drive North Andover, MA 01845 Building Inspector Fee: PrePaid Receipt: 25102 Cheek: 5366 APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION C0-7 BUILDING PERMIT #_6400 -!x/ 6#"w ADDRESS/LOCATION OF PROPERTY: 3 % e e4l C.4 Map Parcel Lot Number A9 SUBDIVISION: DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: 4r ��/ / /fe �,J age t -D I ILile.f- FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED_ ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A . REINSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABL�ODES.A „ Permit Issued to: Address: ROUTING TOWN ENGINEER, SITE PL —DRIVE -WAY REVIEW CONSERVATION PLANNING DPW -WATER METER 1 Tt - Z7 — I SEWER CONNECTIONU! DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYANSPECTION REQUEST V4.DPW �3 2 7 - I SIGNATURE File: Application for OC form revised Jan 2007/2011 01 USE AND OCCUPANCY AGREEMENT AGREEMENT made this _ day of March, 2014, by and between Key Lime, Inc., (hereinafter called "Seller"), and Teresa Swimm, (hereinafter "Buyer"). WHEREAS, Buyer and Seller have entered into a Purchase and Sale Agreement dated March 11, 2014, ("Purchase and Sale Agreement") wherein Buyer has agreed to purchase the land with the buildings thereon known and numbered as Lot 28, 39 Hepatica Drive, Old Salem Village of North Andover, North Andover, MA, (the "Premises"). Whereas said closing is anticipated to take place no later than Monday, April 14, 2014. NOW, THEREFORE, in consideration of the mutual promises herein expressed, Seller and Buyer agree as follows: 1. Seller hereby grants to Buyer permission to move personal property into the premises on Thursday, March 27, 2014. 2. During the period of occupancy, Buyer shall hold harmless and indemnify Seller from and against all damage to the Premises and from and against any claim for damage to property or person arising out of Buyer's use and occupancy of the Premises. 3. Personal property of the Buyer on the Premises shall be stored at Buyer's own risk and shall not be Seller's responsibility. 4. Said occupants and owner have agreed to no additional compensation to the owner other than the mutual consideration associated with the transaction. 5. Not later than 5:00 PM of the 14th day of April, 2014, the Buyer shall (unless the anticipated closing has occurred) forthwith and without demand or further notice, remove all personal property, vacate the Premises and allow Seller to take possession. 6. The Buyer shall pay and indemnify the Seller against all legal costs and charges, including counsel fees lawfully and reasonably incurred, in obtaining possession of the Premises in the event of a default by Buyer pursuant hereto or after the Buyer's default in surrendering possession pursuant to Paragraph 5 of this Agreement or enforcing any covenant of the Buyer herein contained. 7. In addition to Paragraph 2 & 6, it is further agreed that in the event the Buyer does not vacate by the agreed-upon date, the Buyer shall pay to the Seller damages in the amount of $100.00 for each day of occupancy beyond the said termination date. Additionally, all expenses and cost of suit to initiate and maintain eviction proceedings to include attorney's fees will be assumed by said occupants including any and all consequential damages. 8. The Parties hereto agree that neither this instrument nor the proposed period of Use and Occupancy establishes any relationship of landlord and tenant between Seller and Buyer. 9. This Agreement may be modified only by a written instrument executed by both parties. I " WITNESS our hands and seals this Oi _ day of March, 2014. Teresa Swimm, BUYER Key Lime, Inc. J. B , President, SELLER 1 Beri ' C. Osgood,asurer, SELLER uniform Sn®rgY Rating 2 to m rs plus 1 Star 1 Star .251 � 500.40'•,, . _ . _ . HERE Vndax� Generallnforniation Condtboned Area �cndihO� 13tl o Sol" ,39 HePa6ca Onve NoroAndovat MA01845 3 y -tars 2 bars Plus 2151 250.201... 2380sQyu iCR 23338' t4 �Ivt � d stdOf 893037333 299 Ra,jog r: A ets K. VO"3 de�5ed Ene bY9 Date.S1@ 12012 sten Ra Rating peered Vol w1matedArtnuatEuero Get CanSnr: Rating Cost Mr11Btu 51870 C0n11Mg"RSbn9 EnarOY�lclent rs?�ss '. is 4 Stag .... 7 4 Stars PWg6 0 0f 85-71 3 Stars Plus 100•91 g0 8 150.10? Single- amity detached HouseTyfe Uncondl8oned basement Fourrdatl°n'' 3 g81 AFUE �hsnfcal SYstania Faahtres Heating'. tooting. Niy ar Nesting pu Gua teafiage w em" "Jenttiauon Sy> t. programmable il,amtiostg it Features fuel,f..red air di iectr cn 14 0 SEER. 0 Gal. ner, E 1 EF 40 Arr CO'1pi5o I Profane, 0.8 Conventions 49.00 CN18.0 wao- ExhatsstOntY= Cooiing•.Yes Heating: Yes sad Floor. a gulldim She Cyiling Flat: R- 3 R-32 Vaut�sd Ceiling R 24 p.21, R_20. R.15 Above Grade tfdails; R 0.0 Founda'aon'hlails'. Rona slab: dApPpanceFseturea 100.00 Mins Expo Window TYPe: Irdlatlon Rai Method Use 55S $141 Heating 2 18.6 $hoe �ooling 22.8 51126 }lotvVa�r Appliances .0.0 g.0 $12 1.lgh Phato`roltalcs SsNice Charges -Tote' tlni de me Meg he or 41x009 foltloW tng m Thi ho for eft of the n ,node Crtter nal Energy Consertatio 20091ne3ma5o $3817 l' VOO. R_35 U:0.30. SHG0:0.29 g43 Clg. g43 CFM50 Slower door 1est propane RangetovenFuei: Eleclnc ss Dryer Fuel". 3.01 Cloth er EF U9hts as Clothes DN 0.00 eftnPNaKY ar. Percantlnt'ag �l9 100.00 Fant Lightin9 provtd ParcentGara95 xWh1Yr1: 709.00 Ceiling vslabletromthar,A3. tDr WIS home is Gish yes 416 er9y Factor' �tm9 ndard oisdosureAnafor t►Ysis a aP etIng °orado D i ne Ham® Energy ndal Ene 971 e18rrarAY 6a uldar• Co REMR® 20�nrtu'Wte"� CorP°rabon, tae, Aso Rater C Sersporrta sie, 1. 040"ced Sulld" WW 2 Woodlawn 01913 Amesbury' 1148'm (50816`'81 cedbuitdin9analyaia.cA sara(�� Sri G: U 2009 IECC Certificate Lot 28,39 Hepatica Drive, North Andover, MA 01845 Building Envelope Insulation Ceiling Flat: R-38, R-30, R-20 Vaulted Ceiling: R-33, R-32 Above Grade Walls: R-24, R-21, R-20, R-15 Foundation Walls: R-0.0 Exposed Floor: R-30, R-35 Slab: None Infiltration: Htg: 943 Clg: 943 CFM50 Duct: R-6.0 Duct Leakage to Outside: 49.00 CFM @ 25 Pascals Window Data U -Factor SHGC Window: 0.300 0.290 Madhanical Equipment HEAT: Fuel -fired air distribution, Propane, 96.1 AFUE. COOL: Air conditioner, Electric, 14,0 SEER. DHW: Conventional, Propane, 0.67 EF, 40.0 Gal. Builder or Design Professional Signature REM/Ra1-slntial EnergyAnalysl d Rating Software v13.0 I` ESNE i HOME ENERGY RATING Standard/ Disclosure s For hone located at Lot 28, 39 Hepatica Drive City: North Andover State: MA 1. !V. The Rater or the Rotor's employer is receiving a tee for providing the rating on this home. 2. In addition to the rating, the Rater or Raises employer has also provided the following consulting services for this home: A. Mechanical system design B. Moisture control or indoor air quaiity consulting C. Performance Nesting and/or commissioning other than required for the rating itself D. Training for sales or construction personnel E. Other (specify below) 3. The Rater or Rater's employer is: A. The seller of this home or their agent B. The mortgagor for some portion of the financed payments on this home C. An employee, contractor or consultant of the electric and/or natural gas utility serving this home 4, The Rater or Raters employer is a supplier or installer of products, which may include: HVAC systems Thermal insulation systems Air sealing of envelope or•duct systems Windows orwindow shading systems Energy efficient appliances Construction (builder, developer, construction contractor, etc.) Other (specify below): Installed to this home by: Rater I Employer Raver ! Employer L.. i Rater J Employer Ratter I I Employer i I Rater Employer Rater I Employer .._..__, RaterL Employer OR Is In the business of: l._.....1 Rater Employer Rater Employer Rater Employer Rater Employer Rater ( Employer f Rater Employer Rater 1 Employer I attestthatthe above information is true and oorrectto the bestof my knowledge. As a Rateror Rating Provider I abide by the rating quality control provisions of the Mortgage Industry National Home Energy Rating Standard as set forth by the Residential Energy Services Network (RESNET). The national rating quality control provisions of the rating standard are contained in Chapter One 4.C.8 of the standard and are posted athttp:IMrwwnatresnetorgtaocredlstandards.pdt This home may have been verified under the provisions of Chapter Six, Section 603, "Technical Requirements for Sampling" of the Sta3ndard. Sara K. Forristall Rater's 'nted Name -..-.......—.......—.........- -- -......... ... ... . ........ - ... - .. _._.__ ..... . Rater's ignature 5372011 Certification # March 06, 2013 Date RESNEr Form 0300-2 I Property/Builder: f Owners Name: j Property Address: 04"St,Zip: Phone No.. Builder's fume: Model: Development: Phone No.. Hating Daae: Rating No.. BUILDER'S AFFIDANIT Lot 28, 39 Hepatica Drive North Arufover, MA 01845 Key Lime, Inc - Ben Osgood C Model Old Salem Village 978-683-3183 11/21/2012 ABA1299-5-3 IMPORTANT -NOTICE TO BUILDER Builder affirms in this affidavit that all components fisted in the Building File Report are accurate and incorporated into this New Home. Builder agrees to permit home energy rating system (HERS) Provider and/or Rater, to randomly verify components solely for the benefit of the HERS Provider's and/or Rater's interest. The HERS Provider and Rater do not create or imply any duty or obligations to Builder or any subsequent owmer. Builder Isresponsible for making any inspections to protect Builder's interest. There is no GUARANTEE or WARRANTY, expressed or implied, from the HERS Provider or Rater as to this Now Home. Builder's Si nature: Date:I ./ 1 1 HERS Index: 57 Rating Reason: Confirmed Rating Ratsrs signature: gate: I REW11Rabe - Residential Energy Arwiyste and Rating software V13.0 This information does not aomi tuts any warranty of energy cost or savings, 01911.5-2012 Architectural EnargyCorporow, Boulder, Colorado. I*� o C y O Q y = d0Sm y CL Oa'® 0 CD C) C co 0 C. C7 T Z S� H 0 .d -r m N T CD nod O y O -40 m N p .o ' -I O_ IE O a O'p 0 . 0o C o Zc.n0=3 o =r ='= c ��CO CL U2 0 � grC CUP e \ co n �_ a vcD� H N Q cn oCL CA CCD $- � ti n ®®Q cl� Q z CACD bd o C' o caca O C CD �q o 7cp 7 o PCJ o � x o o Vi d C d r po w ` 0 W CO2 O q n Z y CD m r ==� m C�rorJ o. y m > to �� < c v CD M CD o �o to c =rm Co y CD o CD I'1'I O CD y a v c° co CD � CO) v O CD �° Z o O CD C CD I*� o C y O Q y = d0Sm y CL Oa'® 0 CD C) C co 0 C. 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C7 n 0 0; o � : y O ; C O C-3 o O !� r v 'Cf) O Al n UQ W M +1 N '� C G? +l Cn �1 C '17_ w / C Z z w n /" C "p C r z C CIS 91 O n O d 70 • s R CL 0 c •'" Rlassachusetts - Department of PUIDIic Safets Board of Building Regulations and Standards Construction Supervisor License License: Cs 75302 BENJAMIN C OSGOOD 69 OLD VILLAGE LANE NO ANDOVER; MA 01845 v— J�- Expiration: 12/4/2012 <'unnni,xiune� Tr#: 6267 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/2/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If *SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER M P ROBERTS INS AGCY INC 1060 Osgood Street North Andover, MA 01845 ADDLISUTYPE INSR NAME: aC, No, Ext: 978 683-8073 (,PHONE v , No): (978) 683-3147 ADDRESS:mike@mprobertsinsurance.com INSURERS) AFFORDING COVERAGE NAIC9 INSURER A: INSURED CENTER REALTY TRUST P.O. BOX 876 NORTH ANDOVER, MA 01845 GENERAL LIABILITY INSURER B: INSURER C: INSURER D: ZURICH INSURER E: INSURER F: GUVERAGES 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. 1 TRR OF INSURANCE ADDLISUTYPE INSR IN1ID POLICY NUMBER POLICY EFF (MM/DD/YYYY) rVULT rAr (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY ICLAIMS -MADE CI OCCUR MED EXP (Anyoneperson) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY jE 4 LOC $ AUTOMOBILE LIABIUTY Ea accident $ _ BODILY INJURY (Per person) $ ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORMARTNERIEXECUTNE OFF(MalCERIMEMBER ndatory In NH) CLUDED? NIA WC005095106 02/10/12 02/10/13 WC STATU OTH- TORY X TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE- EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if morespace is required) CERTIFICATE HOLDER r:ANr:FI I ATInN SAMPLE 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD25 (2010/05) The ACORD name and logo are registered marks of ACORD r ?im AOa:J m a�tY �C'•' Cv •<nm. �m ZN N-INa �Zf SIT �'= D _ -Di fal lSn +l OD mN y. yF A nD�� �U ��?NF ocm� F Y m(j Np°A >F �Ar c s"p o n >F>n gg LL^191 csm o�aFp11Fnno y.nz ���>> > <`i'•ny yiai n� Tmx ag mOAym Aoo 11< _.DOO A fn" yN D m'1 DD •`-10 -'Z�-i a0 m,ZD �mDnmrmi0 r�CA rzofn m m Nn A=O TNr. �mN� aim uli n'm �I yoz� mA UcU11 0°� �N Oc oa aD �C1AtA m<m �n!' 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