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Home My WebLink AboutBuilding Permit #250-2016 - 4 High Street 207, 209, 211, 213 8/20/2015 BUILDING PERMIT o�No D 6�tio r TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �gSSACHU`��h Date Issued: I 69 IMPORTANT:Applicant must complete all items on this page oo 2 n LOCATION lqt�-N. Jam. IV.A. I Y-70 a _ � `cam 2� I Z O �( ( Z-0 � ' I r' PROPERTY OWNER /t- �-�s' hl tS.{G� /'�t P11t, /y,A , L,-L- . C_ Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District ryy no Machine Shop Village 1 no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: — \ a"\kcd -2_-'�- , 2, 0`1- Z Identification- Please Type or Print Clearly OWNER: Name: L 1,lyr> Phone: Addres q r6� t>O U�la o .� SJ rt owtr 0 j Contractor Name:_V rwz� Phone: q,2. — lb Email: , t.-t,% c,—& ca-rri A,c.,e m ` Address: T 3 '310&^ I`A .2 l id L<,A N , /41v'0 Of Supervisor's Construction License:<f,� 0 Lt" Exp. Date: Z- Home Improvement License: Exp. Date: ARCHITECT/ENGINEERPhone: 1'7 -)_-70 -32-02 y Address: JnnLW— CLoiaffyC Reg. No. t o v ' FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$,V5-00 PER S.F. X x- Total Project Cost: $ 2w91 &e.. FEE: Check No.: C�a 5!5 Receipt No.: �g 9 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Fnature 7i� _�ture of �� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Sody 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 1 CONSERVATION Reviewed on Siqnature COMMENTS HEALTH TH Reviewed on Signature COMMENTS A Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes , V Planning Board Decision: Comments G Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPS'Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARdTMENT r- Temp ®_ um_ p .11,- lte° ,yes ilot ;,FIR Locat6djaPilQ4I.Main,EStreet, y _ r_ F 1 Fir -1010"rtment =.: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 DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) I ❑ Notified for pickup Call Email Date Time Contact Name ; I ' Doc.Building Permit Revised 2014 i i Building Department The followingis a list of the required forms to be filled out for the appropriate permit to be obtained. q Roofing, Siding, Interior Rehabilitation Permits i 4 Building Permit Application ,4. Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4 Copy of Contract Floor Plan Or Proposed Interior Work 4 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks i Building Permit Application Certified Surveyed Plot Plan :r. 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 i New Construction (Single and Two Family) 4 Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location S/ cx7 rcy"1 -o// No. � a`�° Date . - TOWN OF NORTH ANDOVER • S LED 14s • ' • d ti Certificate of Occupancy $ Building/Frame Permit Fee " *y Foundation Permit Fee $ Other Permit Fee $ AFS 'Int)NO�s�' TOTAL i Check#, w r. r O Building Inspector 2 y 6.91 201701) 2.111 G� 3_ Location 4,41,A No. G �' Date . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ �A "rrfi Other Permit Fee $ TOTAL $ a�a� Check G r� r0 ! Building Inspector ✓ ,+ } µ0 off• .heti Ma•o `i M�SSACHII`'Et,3 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 250-2106 on 8/28/2015 Date: September 23, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED at 4 High Street— Suites 207,209,211,213 MAY BE OCCUPIED AS a tenant fit up IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill,NA LLC 4 High Street North Andover,MA 01845 Building Inspector Fee: $100.00 Receipt: 29407 Cheek : 2292 NORTH own of E ndover O Q Z h oh No. mop 26) 02b ver, Mass, g �J- COC LAKI Jd ADR�tTED PP�,`�5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • THIS CERTIFIES THAT ........a0.6.t. . .ls. *A. . ..... BUILDING INSPECTOR p g ....�1� ... " .a.��. OPI... Foundation has permission to ere .......................... bu4,, son ... . .....: /� ugh, L1 to be occu led as ((�� a p ......1�..f�� ... ........ ...... .. ... ....... ..N��.. .... ....... 1�.........�!.'... .. imney provided that the n accepting this permall in eve res ect'confor the terms of the application rY p pp � 4'A1on 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MO S ELECTRICAL INSPECTOR 3 UNLESS CONSTRUC S TS � Service �l� u ln4i'C-1 � BUILDING INSPECTOR '.�L► 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. Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 29,902.00 m $ - $ 490.00 Plumbing Fee $ 44.85 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 44.85 Total fees collected $ 679.71 4 High Street Suite 207,209,211 ,213 250-2016 on 8/28/15 Tenant Fit Up NORTH own of E ndover o - ..,: "fW' NNW Z _ 26) EE- ss, g LAKE ICHIWIC" y�• �.9 A°R�rEo ►�P�,��(5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • THIS CERTIFIES THAT . . . . . . ....... $#.N ,,. , BUILDING INSPECTOR p gA,...' .... � . ® 0�. s Foundation / has permission to ere .......................... buildi so -� �� ugh. to be o-cu led as ((�� a p ......1►..� ... ............ ........ ..... ?t�e .... !... imney provided that the n accepting this permits all in eve res ect'confor terms of thea licationrY ppp 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONNS ELECTRICAL INSPECTOR • 3 UNLESS CONSTRUC S TS R � �C� ................................ Service BUILDING INSPECTOR Fi ` 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. , I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 29,902.00 m $ - $ 358.82 Plumbing Fee $ 44.85 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 44.85 Total fees collected $ 548.53 4 High Street 250-2016 on 8/28/15 creat new suites, 207,209,211,213 l M4� RTH own of E ndover No. h E h , ver, Mass, COC NIC Nl WICN �� Z1,9 A°RAreo j"P�,��(5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System o THIS CERTIFIES THAT e.c.6ftis........&1d...MON. ..... BUILDING INSPECTOR has permission to ere g .... '►, ,, �, 0�, Foundation .......................... buildi son ... . .. ......:. . ..... ..® Rough (� 1 s a to be occupied as ......1►..�.'!�M ............ ........ .. ... .......{��.N .. ....... ,.`.........T.... .... Chimney provided that the n accepting this permit s all in eve respect'confor the terms of the.... he 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final 2(o PERMIT EXPIRES IN 6 M047jrIS ELECTRICAL INSPECTOR UNLESS CONSTRUC S TS Rough Service .......... .. ...... ......................00 �............................ 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. JK Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 Proposal Date: 8/28/2015 Proposal#: 173 Project: Bill To: David Steinbergh, Suites 207,209,211,213.West Mill N.Andover, MA 01845 Description Est. Hours/Qty. Rate Total Plans and Permits 360.00 360.00 Demo, includes plenum wall and carpet 2,000.00 2,000.00 Masonry, Seal Brick, 2 coats 500.00 500.00 Wall Framing 2,500.00 2,500.00 Doors &Trim 2,000.00 2,000.00 Heating &Cooling 700.00 700.00 Electrical, 2,000.00 2,000.00 Interior Walls,Sheetrock, Tape ,sand, 5,000.00 5,000.00 Insulation 500.00 500.00 Floor Coverings 5,000.00 5,000.00 Painting, Includes hallway outside,d uctwork, piping. 5,000.00 5,000.00 General Conditions 1,500.00 1,500.00 Cleanup-final clean 300.00 300.00 Supervision 2,542.00 2,542.00 Total $29,902.00 J _ OFFICE OF BUILDING INSPECTOR �+ TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL •..R..r �sa,Kw*a PROJECT NUMBER: 1406002.34 PROJECT TITLE: 4 High Street Floor 2 Suites 204, 207, 209, 211,213, 216 PROJECT LOCATION: 4 High Street, Suite 201, North Andover NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant Fit Out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1, WaS,SWiley REGISTRATION NO. 10080 BEING A REGISTERED PROFESSIONAL ENGINEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN G PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL R STRUCTURAL ❑ MECHANICAL ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPUCA13LE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control. procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar with6the pro;gress and quality of the work and to determine,in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, t SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. SIGAt SUBSCRI AND SWORN TO BEFORE ME THIScx)o_DAY OF r �19 uf NO ARY PUBLIC MY COMMISSION I� F- , PATHICIA E. BARKER o Notary Public COMh^.�NWEALTF;OF MASSACHUSETTS My Commission Expires A'-'ju zt 1,2018 The Commonwealth of Massachusetts u . Department oflndustrialAccidents .t, 1 Congress Street,Suite 100 Boston,MA 02114-2017 ,��`'•t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): <, ..a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8.;!fZemodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3..Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 El Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repair's These sub-contractors have employees and have workers'comp.insuranceJ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-con6ciors have employees,they,must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Q Mr-q' Y U GV ff9 Policy#or Self-ins.Lie.#: W Z f L Z Expiration Date: Job Site Address: `'r AW D 0 t City/State/Zip: Attach a copy of the workers'compensation policy declaration age(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 pains andpenalties of perjury that the information provided ab ve is tru 6 and correct. Si nature: /- /V1 Date: 1 Phone# l-2 ^T Z � ^ 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): i 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 the 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 apartments 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-contractoi(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 foi•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 permit or license is being requested,not the Department 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 on 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia � I 3/3/2015 7:22:03 AM PST (GMT-8) FROM: 100005—TO: Z6]°"t799121 Page: 2 of 2 DATE p1ssIDD/smrj - IEPCERTIFICATE OF LIA ILITY INSURANCE 3W015 THIS CERTIFICATE IS ISSUED AS A NATTER 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 INSUREIR(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the eartlficate holder is an ADDITIONAL INSURED,the polloy(ies)must be endorsed. H SUBROGATION IS WAIVED,subject to the teems and conditions of the po ft,certain policies may require an endorsement. A statement on this esdifleate does not confer rights to the certificate holder in lieu of such endorse to 0). PRODUCE! DUPONT INSURANCE AGENCY INC 18 COPELAND ST Rom rAx QUINCY,MA 02169 0-M ft INSUREsMAMROMCCIVERAGE Nw E MmuRaR • Libeft Mutual FIL9 Insurance 230:15 WHINED INSURIVID: JK CONTRACTING LLC 31 RICHMOND STREET WEYMOUTH MA 02188 INSURER E: COVERAGES CERTIFICATE NUMBER: 23977622 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. LTR IIIIIIJBIR LTRTYPE OF Mm1ARANCEVM WWO E Lwffnl COMMIERCIAL GENERAL IJABLITY EACH OCCURRENCE $ DAMAGE TO PIRTIff-- CLAW-MADE F�OCCUR MED EV one S PERSONAL RIADV INJURY 11 GENt AGGREGATE LINT APPLIES PER; GENAL AGGREGATE POLICY❑PRO- JECT1:1 LOO PRODUCTS-COMPIOP AGG OTHER; $ AUTONCOLIN UAINIM S ANY AUTO BODILY INJURY(Par N +1 $ ALL O�WNED �LED BODILY INJURY(Per aadit!lAUTOs HIRED AUTOS AAUUTOSWNED _ S t J1 LIAR OAR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MACE AGGREGATE A wo Irmo cormrsm+►TnoeR - 5 1696-015 :7/=207!2016 V AM AEMPLOYERS'LlAaalrY ANY PROPRIEfORIPARTNERIF�CUTNE YIN E.L.EACH ACCIDENT S 100000 OFFICERINEMSEREXCLUD®7 a NIA (M and n"y in El.DISEASE•EA S 100000 N SGRRONOF�� RATIONSbobw El.DISEASE`-POLICY LIMIT 500000 DTI M OF OPERATIONM/LCC 1100/VBBG.IS(ACORD 101,AddMOMI RNIM $dW*d,nary be aeaahod If Aare epwa In r**drnd► Workers compensedon insurance coverage applies only to ft workers canpeneadon Ism Df the State of MA. This certificate rs r a s and supersedes all previously Issued cardficstes,only as thsy relste to workers Compensation coverage. CERTIFICATE HOLDER CANCELLATION THE EXPIRATION DATE THEREOF, WILL`BE DEL�IVE�IN ACCORDANCE WITH THE POLICY PROVISIONS. .'.4"*'v •.• ADT1R0102b0REPRtEENTAI7YE 7/f1 UbwW Mutual Fire Insurance 01888.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD rams and logo are mgh>;t and marks of ACORD CS&S NO.: 23677622 CLIENT 0708: 1634469 Lucy Uzfiald 3/3/2015 10:19:07 AN (SSS) .Fags 1 of 1 Mlassachusetts-Department Cf Pub!;;:Safety ding Reg;;lations and StanCards Board of Buil (•on..truction super"-isor License: CS : KMRAN'T WHEI AN 31RICFIMOND ST , wEYMOM MA FXp!ration .1..�.•- 091261`2015 ' Commissioner,