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Home My WebLink AboutBuilding Permit #580 - 4 FIELDSTONE COURT 3/29/2010 BUILDING PERMIT NORTy o;,��b° ;6 6 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit N0:5-�oDate Received 3 • VP ��Ssgc►+us�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Tit I A`tat ur v (Y1 1N ooki PROPERTY OWNER w-6 6J 21Tdy e P we '7 ow Print MAP 210 PARCEL_ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg OthersAmiwy J Demolition Other (O � Q Q 1 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: ui luwdih c)i-- -P-r peftgY4m Iden 'ficatiop Please hype or Print Clearly) 2 7UQ OWNER: Name: I �)o L (lagC doywe 5 Phone: Address: U wood 2('d Pf �Lo— CONTRACTOR Name: Phone: �t Address: `l 6-ta, Y 0 tri V t a , Supervisor's Construction License: C7 Exp. 'Date Home Improvement License:_ .Lfl Exp. Dater j ar �+ � x ARCHITECT/ENGINEER Phone: Address: q 1,-,t 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: $ FEE: $ q.�� Check No.: 41011 Receipt No.: NOTE: Perso s contracting with unregistered contractors do not have access to the g a my fund Signature of Agent/Owner Signature of contractor Location —/e-///j No. v Date - • !� MORTIy TOWN OF NORTH ANDOVER Of "'O '•,h0 � 9 Certificate of Occupancy $ �'�s'••'°•E<� Building/Frame Permit Fee $ _s_— ACNUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / 22 U" 0 `� Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL 4 � Public Sewer Tanning/Massage/Body Art Swimming Pools ' Well Tobacco Sales Food PackagingAles Private(septic tank,etc. Permanent Dumpster on Site b — Y ' THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORV f DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on � Si nature l &W-", COMMENTS in A n� I 'a kl�� H 016AZ 6zh L'a=gL- 3 h P W nA9. (/ I HEALTH Reviewed on Signature k 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: ." ..46cate6 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes 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 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 - Date Doc.Building Permit Revised 2010 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the 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 2008 NORTH ToVM of 4Andover ,_ ti:,. . No. 01 o =- A E dover, Mass., . to COCHICKEWICK V 7- RATED P" `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .... ...A. 0 0...........��..... L.da.t................................................................................ Foundation has permission to erect........................................ buildings on ...I.......6.4.14-19-6A.CW....................................... Rough to be occupied as............ .v1l.fi*4..�...........ID&..ASAI......... .R Chimney . . . .................................provided that the person accepting this permit shall in every respect conform tterms of the application on file in Final 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 CONSTRU StTS Rough . ..... .............................................................................. Service ..... BUILDING INSPECTOR Final Occupancy Permit RegUIred to Occj.cpy Building GAS INSPECTOR 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 Approves by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. U � North Andover MIMAP March 29, 2010 r r �i I a t z o o *. o: t .t Ai, . t �^ fi Interstates Interstate Major Roads Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Mernmack C,Easements t tkORTIy q Valley Planning Commission(MVPC)using data provided by the Town of O �tva o ,n .�. North Andover.Additional data provided by the Executive Office of Q MVPC Boundary yc .S GO Environmental AffairslMassGIS.The information depicted on this map is Parcels C 9 for planning purposes only.It may not be adequate for legal boundary definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ♦ • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY #?,o a{# OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 9 .o„ ,wY, �. ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 4SSgCHUSE 1"=129 ft D.G. Contracting Inc. Additions, Kitchens, Baths , Decks , Home repairs ,Excavation work Commercial fit ups* finished basements* Dumpsters paved (fjRLeZ%av%. PYtadewt 428 Pleasant st. N Andover Ma.01845 Office 978 689 4797 Home 978 683 0397 Fax 978 686 6337 Cell 978 815 7745 Ma. License # 001821 * Insured * Home improvement # 120199 Dgbuilding@aol. com Woodridge Homes 1 fieldstone March 29, 10 landing and ramp project Remove the existing stairs , railings and section of deck. Install 4 new footings 4 feet down. Build a landing at the doorway over the concrete landing and extending toward the parking . Dig out the area for the ramp and create a ramp leading to the existing sidewalk. install a new set of pressure treated stairs with railings on them. We will need to remove some landscaping to do this job. Loam and seed all disturbed areas. Install drainage under the sidewalk. Hire an architect to draw plans for the building dept. Labor and materials $7,890. 00 rr V v Site Plan Q Aw, ."A ,. I� -\�i�rr.��, yr'j� L '� .�4► �'A�"�'�+ry�"''.y�► '(b ' „ 4 ':iF/��tr L '� ,moi� , ��`.� r t �,! I;.`,� t\' �� ,:t•1�M. l' �•.,.: .► pkat � .' •��. -�a, ,^ i�tom. J o l V 1.,� 3 � • - �� _ _ . qty.. NN -`.M% �'' ° ? •O -4 E' 1 Community l Faciities r6& b - _ ,•{•'• � ,�'-��^•�� 11�U 41 ah ,�.':. VAP `.F' •[� Wood Ridge Site Plan Wood Ridge is a community that consists of 230 townhouses in seven 4 clusters.The centrally located community :- `' xfacilities include a swimming pool, tennis courts and a large clubhouse/ a a 1 - »_ meeting hall. ' ` I� 1.4 � A;' Equal Housing Opportunity ® t? rATIIN i-4 —�� Waverly Road �' FINISH FLOOR LEVEL AT DOOR NEW PT.AND COMPOSITE DECKING TO BE CONSTRUCTED OVER EXISTING +100.00' CONCRETE PAD. PAD TO REMAIN +100.0 +99 4 +100.00 ; EXISTING GAS METER TO REMAIN g. SLOPE NEW <--EXISTING LANDSCAPING TO REMAIN $( REMOVE EXISTING SHRUBS P.T DECK EXISTI ,__. u •,.,: +99.38' +99. ao gym . , . Q a 81fl ----+ B2- i i--- FOOT GS TYPICAL'' $ a REMOVE LOAM AND i SLOPE DSC � � � � r� `''b� � 4 AT L CATIONS O E- -4 PREPARE BASE WITH m O + 1.98' �� NEW GRAVEL FOR +99 MOVE EXISTING STAIRS COMA` NEW SIDEWALK ' ' D HANDRAILS AND PORTION Q ° ° 1T-0' LONG RAMP GQ 1:20 �Lo-E ' ' F EXISTING SIDEWALK EXISTING CHERRY I FLAT ' ' EW 38"HIGH GUARDRAIL TREE TO REMAIN IT.PAVING OR o . +98 ONCRETE SID EW K o 99.81' +91.84' + 81 EXTEND LANDSCAPED AREA Q ° PERF. 8"DIAM SONOTUBE W N NEW LANDSCAPED AREA plpE DRAIN i 4 RISERS A 1/2"EACH UNDER UT GRANITE STEPS Of PATCH REPAIR LAWN i a SIDEWALK u AROUND NEW SIDEWAL r +9i b� 0 ° NEW NEW PIPE RAIL HANDRAIL Z �? GRASS LAWN NEW GRADES ON BOTH SIDES Q ORIGINAL GRADES U' +98x3' +98:35'{98.�f3' +98;1(Y+98. 16' +91.82' +9l b8' + +91.81 '1 2 +99:03' — EXISTING SIDEWALK NEW BIT.PAVING Q �- EXISTING BIT PAVING �-- ".MAX SLOPE OF 1:20 W U +98.50" a+9835' +98. +e7 +9i.ba EXISTING CURB LJ W E, NEW CURB RAMP _ — BIT.CONC. ° U� ULo QI +95.8T W OO Z pip Q _ EXISTING STRIPPED U O O NEW BIT CURB TO MA PARTING 10'X 18' Q Z Q J Q EXISTINGLLJ fir- NEW PAINTED LINES AT O 0- W < W W W W ACCESS AISLE ACCESSIBLE Q p PARKING SPACE N U W O Z O m — o O REMOVE PORTION OF EXISTIN i ONLY — Z Z O 0 Q U ~ cl CURB AND GRASS AREA PREPARE BASE FOR NEW N Z o Q U Q W Z Q BIT PAVING FOR ACCESS _ _ U) _ = Q AISLEQ = ' � r Q H I� I � W Kf � WQO � Q w - O OO LL- LCL ' NEW PAINTED ACCESSIBLE PARKING SIGN -------=- ON EASTING PAVING FINISH FLOOR LEVEL AT DOOR NEW PT.AND COMPOSITE DECKING TO BE CONSTRUCTED OVER EXISTING +100.00' CONCRETE PAD. PAD TO REMAIN +99 4 +100.00'h EXISTING GAS METER TO REMAIN EXISTING LANDSCAPING TO REMAIN SLOPE NEW N NO REMOVE EXISTING SHRUBS P.T DECK EXISTI lLo x... +99.36' ---- --- +99. o a r 3 ., �°` ' -< _ _ _. ,Q 8_lfl NEW O-TUBE ,y �- REMOVE LOAM AND QI ��99U I _O° SLOPE DSC ----+ �� - i I F00 GS TYPICAL ris`p'�'9 sc�Q PREPARE BASE WITH � � I ___ + �j98-4S- AT L CATIONS p ` � � + b NEW GRAVEL FOR iii I 1.98' OVE EXISTING STAIRS CO�� NEW SIDEWALK + I I D HANDRAILS AND PORTION 1T-0' LONG RAMP 1:20 L' d E ; F EXISTING SIDEWALK Q EXISTING CHERRY FLAT ' ' EW 36"HIGH GUARDRAIL TREE TOREMAIN IT.PAVING ORF— o +98.96' .o. NCRETE SIDEW K o �. 99.81'1 +91.8q' 1 + .81' EXTEND LANDSCAPED AREA Q d +91w i PERF. 8"DIAM SONOTUBE o NEW LANDSCAPED AREA PIPE DRAIN i Q UNDER 4 RISERS A U2"EACH PATCH REPAIR LAWN MSIDEWALK u N UT GRANITE STEPS Q AROUND NEW SIDEWAL NEW a NEW PIPE RAIL HANDRAIL Z �? GRASS LAWN NEW GRADES ON BOTH SIDES Q ORIGINAL GRADES U' +98:35+98..la` . + +98:Ib' +9"1.82' +91.68' +91.81 _ +99:03 0 - � EXISTING SIDEWALK *q1.3 NEW BR.PAVING EXISTING BIT PAVING Q WITJ WX SLOPE OF 1:20 U +98.25 . +98. + 7. +91 60� EXISTING CURB J W NEW CURB RAMP ' +910 ° — BIT.CONC. —�°. c/) � U U Lo I +95.8T W 00 Z OHO - , EXISTING STRIPPED U O Q O PARKING 10'X 18' Q C� NEW BIT CURB TO MA Z J < EXISTING a L CD W I— NEW PAINTED LINES AT _ O W ¢ W W W W ACCESS AISLE ACCESSIBLE c) Lu PARKING SPACE O UW QO Z O Q � REMOVE PORTION OF EXISTIN i ONLY CN Q Z Z O Q U ~ CURB AND GRASS AREALo PREPARE BASE FOR NEW Cy Z 0 Q U Q W U Z Q BIS PAVING FOR ACCESS _LE _ CQ = ( = < U) Q w _ O u u I NEW PAINTED - - ACCESSIBLE PARKING SIGN ON EXISTING PAVING i i 4 ii tar.u.husetts lDc tairtment A Puhlic S;ilf >, � oa�d of B�iiltlEn;.:l3egulat�ons.end Stunda�tf5° ` ;Consthiction,S4pervisor License' - Ucense:7CS.'•1821 Restricted to: 00 :.. . . DAVID P.,GULEZIAN 420 PLEASANT ST'. N ANDOVER,MA 01845 ' >. Expiration: .10/2/2011 Cull i Tr# 6076 I i 54- The Commonwealth of Massachusetts Department o f rndustrial Accidents Office of Investigations ..600 Washington Street Boston, MA 02111 www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Avolicant Information Please Print Legibly Name (Business/Orgmization/Indididual): U 4 i/y) Address: (NO f City/State/Zip: Q�A( f'— A4'12 d �5 Phone#: Q� �7 7 Are you an employer?Check the appropriate box: 1. am a employer with �j 4. 7 I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 ?• ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. workers' comp.insurance. [No workers comp. insurance 5. 9. Building addition ' p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL .11-El Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no insurance required.] t 12.❑Roof repairs Q ] employees_ [No workers' comp,insurance required.] 13.❑ Other .=W}'applicant that checks box*i must also fill out fee sects n+be, shOY.ma T,nyr K.��'comps^, sa_Op Y�::O� ^.�,W;;tIOu. Homeowners who submit this afitdavit indicating they are doing all work and thea hire outside contractors mustsubmit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policyinformation. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: !`I ni v(,0z4 o (T Q �L aGl y u d CO Policy#or Self-ins.Lie.#: �� C 150 7 + / Expiration Date: 77` �� Job Site Address: City/State/Zip: (1'(/'2 r lh Q 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 under the p and penalties of perjury that the information provided above is true and correct Sr ature: Datemons .:-- Phone#: 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 Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including tae legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartruents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the perruitor license is being requested,not the Deparament of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number m the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 021.11 Tel. # 617-72.7-4900 ext 406 or 1-8 77-MASSAFE Revised 5-26-05 Fax# 617-72.7-7749 wvvw.mass-gov/dia i f Ogee of Cons P HOME IMPR ur°er.Affairs �` e�curaGZ gistratio` �€HENT NTnsiness Reiulahon Fo Re Expirai— �=1,20199 RACTpR T1 2�11 T- 4�1,1ia�v ., DAVID GULEZiAj� -� - af�'+ t Tr# 290224 DAVID GULEZIq �R - 428 PLEASANT NORTH ANDOVER;- 1Jnde rsecre et � o 9/21/2009 10:72 AN FROM: NACDONALD PANGIONE H,ocDonald _Pangione Insurance Agency,, Inc. PAGE: 001 OF 002 li CERTIFICATE OF LIABILITY INS {�� (� DATE(MWDDIfyM :PRO[TiICEg U��`�"'E 11/07/2008 MacDonald&Pangione Insurance Agency inc, THiS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 428 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 104 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED North Andover,MA 01845 INSURERS AFFORDING COVERAGE I MAIC# Q G Contracting,Inc '"SURF- RA Preferred Mutual Insurance Compgny 428 Pleasant St. INSURER B[ SAfetyIndemnity Insurance Company `N Andover,MA 01845 A—rican Home Assurance Com an INSURER C: - INSURER Dr. COVERAGES IINSURER E: THE POLICIES OF INSURANCE LISTED BEL 0{lV 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 TE Lim CE AFFQRDED BY THE SLK IES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHDwN MAY HAVE BEEN REnucED BY PAID CLAIMS, LFR � POLICY NUMBER POLICYEFFECTIVE POUCYEXPIRATION A GENERAL LIABILITY Y uYRs COMMERCIAL GENERAL LVt& EACH OCCURRENCE LflY $ 1,000,000. CLAIMS MADE OCCUR GPPDG001 07/18/09 07/18/10 PREMISES Ee occurence $ 50,000. MED EXP Anyone Person) $ U00. PERSONAL&ADV INJURY S 1,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000. POUCY PROT. Loc - PRODUCTS-COMP/OPAGG $ 2000000. B AUTOMOBILE LIABILITY ANY AUTO I - - COMBINED SINGLE LIMIT 3116538 07/18/09 07/18/10 . MeeccBletlt) $ 1,000,000. ALL OWNED AUTOS ...SCHEDULEDAUTOS ! BODILY INJURY $ . HIREDAUTOS ( I - - person) x NON-OWNED AUTOS � BODILY INJURY (Per ealtlent) $ PROPERTY DAMAGE $ GARAGE LIABILITY (Per accident) ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA AOC $ : EXCESS/UAUTO ONLY MBRELLA LIABILITY I AGG $ OCCUR CLAIMS MADE I EACH OCCURRENCE $ fff AGGREGATE S t........ DEDUCTIBLE i I $ BETENTK)N y i $ C WORKER+COYPENSATIpp AND $ ........................................................................... ............ EMPLO)ERS'LAIR ITy I WC STATLL GTI+ ANY PlIZO IETORIPARTNERIEXECUTNE I VVC:OU3-53-'1475 OFFIGER/MFJNBER EXCLUDED? U3!•.37109 U3f37/1U - 100000 If��s5 tles. untler - I E.L.DISEASEyEA EMP�S3V B _ OTHER L PROVISIONS below I 100 00 OTHER EL.DISEASE-POLICY LIMB- $ i 0 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES i EXCLUSIONS ADDED BYENDORSEMENT/SPECUNL PROVL4pNS Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI M/ Pinnacle DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAA 10 DAYS WWrTM 880 Main�Sttreet, Unit G NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO Do so SHALL Woburn,MA 01801 IIIIPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,RS AGENTS OR REPRESENTATIVE$ AUTHORIZEDREPRESENTATNE + ' ACORD 25-(20-01-1-0-8-) ,L7 OACORDCORPORATION IOW