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HomeMy WebLinkAboutBuilding Permit #580-2017 - 41 PERLEY ROAD 11/30/2016 L O� NH ORT BUILDING PERMIT Ett`E° 'b9"a TOWN OF NORTH ANDOVER F -: APPLICATION FOR PLAN EXAMINATION - : m" 0 G f . ,. Date Received 11 3 SQA co Permit No#• q�sACHUS���S Date Issued: IMPORTANT: A licant must complete all items on this page pP LOCATION 40 r le Ol Print PROPERTY OWNERJaM GS 100 Year Structure yesOno G� Prin MAP ✓ j PARCEL:ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0�family [I Addition El Two or more family ❑ Industrial p-lferation No. of units: ❑ Comm rcial ❑ Repair, replacement ❑Assessory Bldg ❑ Demolition ❑ Other - - Septc Welh - Flo©dplan Wefl"antls; ❑ V1latershed'.Distrlct i _ DESCRIPTION OF WORK TO BE PERFORM E ED: Identification- Please Type or Print Clearly OWNER: Name: J cine S / Phone: 7 ?(o?--3'q73 Address: Contractor Name: �h f� �w► Phone' Email: Address:_ 5 HtSL �� ''' AvT Supervisor's Construction License: 8--7 1 ^7 7 Exp. Date: Home Improvement License: !t'1 2-0 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTED ON$125.00 PER S.F. Total Project Cost: $ 3000 , -- FEE: $ Check No.: /a8QR Receipt No.: '512-(P0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund . 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 4. Building Permit Application 4. 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) A 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 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 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 ❑ 1 I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed ewed On Signature'_ i COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEATH Reviewed on Signature f 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 DEF Af,<TKMENT. Temp Dumpsfer on=sifie'.2r, es ' s{� � s y� .�.� 4�1i. .. �t`124 Mam�Street _• � �, ��,• : ,}��•� ��,g* �► arfrnent si � ° •A:, tl i7� ;� Y ti�'y♦� r f � r �{ �� i s $xf.;'$�,"�,. ���. '�.q'x. �`t.`:F"'�ar=--s:w :.� ."_t ..C"^`�...�--,—a Dimension C EeN Ysi®9 I 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: lies No MGL Chapter 166 Section 21A—F and G min.sloo-$1000 fine NOTES and DATA— (For department use) Notified for pickup Call Email `Date_...____..__._.____.___ Time Contact Name Doe.Building Permit Revised 2014 r Location �►� t No. � Date • - TOWN OF NORTH ANDOVER n � � • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# tl Building Inspector :712G0 NORTIy Town of 2 ndover No. to 17o h ver, Mass, COC«IC Nl WIC. 1' '�Si9s aATEO U BOARD OF HEALTH Food/Kitchen PERMI D Septic System THIS CERTIFIES THAT TAd^. I ... .. 4 .. . .�:'r. Il, ,,,, BUILDING INSPECTOR Foundation has permission to erect .. ..................... buildings on ......... ..�...... ... .. . .. ... .... `.................... xq*SqJq� % Rough to be occupied as ....�.. e... �-.. ..W.�!....�`!�. ��..�� 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 In ction, Alteration and Construction of Buildings in the Town of North Andover. 1 PLUMBING INSPECTOR VIOLATION of the"Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIAIN ST R S Rough Service ........ .................. ... ..... :............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin:; 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 Thisftrtmsmis5esallirzsioteQtit>:meaLsofdtestaatEsHnme. , InrprovemeatC ���inatt�itomeosvnetsSeek ,•,adviceif °n� g��-�ter242A),Imtdorsnotiadudest:taidarrd "°� GnideioHome AnyAm m l� hmeimprostmite�lsshouldfmobtdaacogyofnA lojficaofCum=CrAffdr,md]3,,i,,,,R,,. Mrbe,oaes teeinglom wnrl:oayoarrzsid�e�Yontna obtama&-- y wPybyg the on'sConntmO lnfonn2iongotiiaeet6l7.973-8787ori-8882.83-3757arono�,,b>k �olneo�es�oy�lgt~ettn Name onA4' o1L3$lot3 Street Address(do tusenPostQt�g dt� . argil: argae A . 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To a# ont�a t ce and } The Contractor ratLritedeti¢ a to perform the work,famish them ft-aI and?=bor s!--iaedabovefmihetoml germ of �j Pa)voats will bemade according to the foIIowingschedaie: 5 uaon silting contr=(Pat to eMr_ed 13 ofihe to al coaCaci Price of a costoectal f order g � rtemStvbicbaverisgrzaits) by!!Prupoa cork nledon of S ny--1!or upon completion of - f SLfGfCSL�_4013 Complt;titm ofthe (Imvforbids demm&g•mga}mentmt watr-�ctisc ple;ediaboibgarfy'ssctist�etion Taefdhmingl>�riaVgw teentaitsstbe$tccial S ordsed'cefcrthc caata-ted act homes frr o der to .-id f to mast the coatpyzeta,sch dwg4„j S b„ ' for Nsss tam4 galtfinandrar3 [?°)Iairrstirt nc.�cecdthsgre`t�of a¢� any deposit Q:dauapaym,ttrcgtdtedby& camr=r6lorratbeginstnaY ss ticimustbc'P:i�urde"ed"'ditorneet stficiulm ttaJemtafaaysp�Iequipmentossustomarsttem2tetial the compltaian sch�ule is•Fl^sc't�%nt+�nt -Z4L t-r . pabconituctars-2ltecaatracor a a3trttrc©nt� nfr !_lido ;��attlsrsuifficcaarrcnfnmrr f x Ya�radtafireeonirtctl part, '•n e�'stohssTielyt ponsblcforwmgleticnaftbewadzdosctib�ra e;,oftbeaaIIoasof *t'tT dby6ecQa�acL The con _artabesoletyryFoasiole�Jl �Ytitird oterialsUte-,parund Uisatneeaent PaY.ttcttsto'allSubwntractorsfor ContrnetAcepianslythatmYlieteltrotheo�tmeaFbecarttsabindingcaat;Pctnnd�law Letts;otltettnsenatedtvtt5rathtsdatarmerr>;the contracts@allnotimply'UsCO;•Iienarotherse ii;r yt �alarzdaather�idenc�RevfevrtfiefQIIativmgcanBonsandaotic¢ carefully Ucfate signing tfiis contract v Don't be, <°ured iaco signing the cantracL Tat a iafnl:esurethe wntracicr'�avaii mdtttetormciimtdiullyttade:standit Ase;aaetionsifsamethiagisancfear suhconir�ttsstobe ome vemetttCnntratitnr, ttnfrbn.7-neI mrrPgnitestnosthamcimprsvementarnPncrorsand egist ation gto the rofIioaeimpmyemeat Contrzctcr b}K;zttn toibe7.?tra-tQraSiOParlcPl^ baa.Youtrta}'intitsireabctticoatsactor 9 as:;fere CQnaat4or#t;?t,�insturttc t �t1 Ute Can °2,RQum 3'170,BP an,tett&62116 orb,tag 617-97 7 eeacoryo.2.1p fafins w^aac�mL trzciorforhismsuata cem 3-8787or888_&3-3757. paay infonnadoo so thatyon can confnin coverage,oras to Y"mor=yaLrr?rd&and r apmmbi)ities.Road rhe lmoagmt hXu n!moa on the tzvmsesideaf fnisfasar and Guide to the Rome 3mr-;avementCoatta>7orizw getacopy ofthe Consumer You P.jcancel isa�r-mmtifitbesb= ' p cantt2ctorinevritiagattti/hermaiaoftinceorbtaocdttofrtceb}rot �`Nor'snoaayp)�apfbusints, thirdbPs#nessdaayfollowingthesi_min•of.. R byidemscetor Provided you notify the ttrtSaCttetaaaL Sea Facettectdnotieeof �' :not later thanmidaigbtafthe QiiTT+T t:±tl >�(rLtr tt_ , cane°.lattonfomttmaackpiatrationo€tbisrigaL Taro i1�:.�rcaQruseo:Sccc:tb- e-3.�.`- Gi ...nnt Cn,.�±:.�'•&.�Ij 3ir§K pAC `J9?r �'7it :a3� a- I3y�ra t":bxa-.. ITti ctfr• Hornces sigtrnue Conn-Pctts's sigh--fig 1 �2� Date it G Z / Dote 1. Contractor Arbitration I The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)ifthey have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute be/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right n arbitration as is afforded to the homeowner by the Home impto rovement Contractor Laic The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract;the co for a dispute to a private arbitration firm which has been the Secretary of".Em, e.�J 8 s approved b} 1 gym,W er Affairs and Business Regulation and the consumer shall be required to submit to such arbr lt' do asap to AIRtchusetts General Laws,chapter 142A. . tit<s-�llt &co owners Signature NOTICE:The signatures of the parties above 1 onl to the Corgnature resolution initiated by the contractor. The homeowner ay initiates altteernatia disent of e pute resolution even ve where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in anyway,even by agreement However,homeowners may be excluded from certain rights if the contractor they choose is not properlyrogisEred as prescribed bylaw. e Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contactor Law. The contractor is responsible for completing the work as described.in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an ex warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts cart'an implied warranty of mann merchantability a particular purpose. An enumeration of other matters on which the homeowner and contractorfinerantabill and fitness for added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.Ifyyoou have be questions about your consumer/hOmeownerrights,contact the Consumer Information Hotline(listed belrnv). Execution of Contract The contract must be executed in duLcate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blankseetions have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the otherkept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract;and the three day rescission period has expired: Accelerated Faynreats A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractormay require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work- Vlrithdrawal of fiords f?om said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a flee copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affair.,-and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-2832757 or visit the OCABR website at hitp://w�5nv mass sov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additionotion specif ally about the contractor registration component of the Dome Improvement Contractor Law,coronet al infrma Director of Home Improvement ContractorRegistration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8737,888-283-3757 or visit the HIC website at htin:lht�vtv.mass Qoi/ocabr/ home Improvement Contractor's Registration: Go online to view the status of a htto://db.state.ma.us/]tomeim roti-ement/lic nsee)istaso For assistance with informal mediation of disputes orto register formal complaints against a business,call: c Coitsue omplaint Section s " Of trftiib Attorney General 617-727-8400 AND/OR Better Business Bureau $08-652-4800,508-755-2548 or 413-734-3114 Version 2J-]MMP-010 The Cominzonwea th ofMassachaeseas Depaa thzent ofbadastir ial r4ccidents Office of Investigadons 1 600 Wasleirigdon Steeet Boston,AM 02111 %,wiv.in€ass gov1d to Workers' Compensation Insurance Affidavit: Builders/Cont>raetorsfElect ricia»s/Plumbers .A P121icant information Please Print Legibly Nagle (Business/Organization/Individual): hdar=- i�'��'-��-'cr''-'���t{�LLC Address: 97i en Vit, 111970 City/State/Zip: Phone#: Are yoi�employer?Check the appropriate box: I am a employer with 4- ❑ 1 am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired die sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers [No workers' comp.insurance comp. insurance.= 9. ❑ Building addition required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3 ❑ I am a homeowner doing all work officers have exercised their l I.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL insurance required.] c. 152, §1(4),and we have no 12.❑�ther pairs employees.[No workers' 13. comp.insurance required.] "Any applicant that cliecks box i"I must also fill out the section below showing their workers'compensation policy information. 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 and state whether or not those entities have emplovees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Ir ain an employer-that is providing workers'compensation insurance for azy employees Below is the policy and job site information. Insurance Company Name: Policy 7 or Self-ins.Lic.r: Expiration Date: 31Z-01)Iob Site Address: �I' 1� City/State/Zip: /V An Attach a copy of the workers' compensaln policy declaration page(showing the policy number and expiration date). Fai 1 Lire 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 51,500.00 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 cert ft under the pains andpeitalties of peijury that the hzforination provided above is true and correct. .lam•. Sianature: a r>7 �,fid. Date: ll Z Phone F': %? 7G/L/- F[O-f1f7cial only. Do rootwrite in this area,to be completed by city or town offlclaL n: Permit/Licensessung uthority(circle orae): 1.Board of health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person- Phone#: ACCM0DATE(MMIDDIYYYII) CERTIFICATE �.- ; OF LIABILITY INSURANCE 3/9/2016 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, ertain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorse�ment(s). PRODUCER CONTACT Construction NAME: Eastern Insurance Group LLC PHONE (800)333-7234 FAX 233 West Central St E-MAIL (AIC. IC No A E INSURE S AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A-Arbella Protection Ins. CO. 1360 INSURED INSURERS Nautilus Insurance Co Atlantic Weatherization INSURERC: 61 Rear Jefferson Avenue INSURER D: INSURER E Salmi MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBERXaster 2016 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. INSR L TYPE OF INSURANCE POLICY NUMBER �ppY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES T oRENTEDnce $ 50,000 A CLAIMS-MADE a OCCUR 8500042816 /20/2016 /20/2017 MED EXP(Anyone person) $ 5,000 X CONTRACTUAL LIABILITY PERSONALBADV INJURY S 1,000,000 X CG0001 10/01 FORM GENERAL AGGREGATE $ 2,000,000 GEN'LAG13REGATELIMIT APPLIES PER: PRODUCTS-COMPlOPAGG $ 2,000,000 POLICY X1.1rCT El PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 A ANY AUTO BODILY INJURY(Per person) S AUTOS AOX SCHEDULED 020015871 /20/2016 /20/2017 AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED P AUTOS ROPERTY DAMAGE Per accident S PIP-Basic $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE_ $ 1,000,000 A EXCESS UAB CLAIMS-MADE DED RETENTION$ 10,00 600058654 /20/2016 /20/2017 AGGREGATE $ 1,000,000 S WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? F—] N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If as,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B POLLUTION PL200378614 0/1/2015 0/1/2016 EA POLLUTION CONDITION $1,000,000 GENERALAGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER C CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER, MA 0184 AUTHORIZED REPRESENTATIVE I { John Koegel/SM8 ACORD 25(2010/05) INS025 r7ninnsi m ©1988-2010 ACORD CORPORATION. All rights reserved. nt Tho ARtlRr1 Hama and Innn aro runicfrcrorl mar4c of ARARr1 •••,• � �� �., wi c.viv o..�z ,aY eui rrwrr cr vvc rax DGl V'C! C. RTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYYI TIFICATE 15 ISSUED AS A MA TER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.. THIS CERTIFICATE OF INSURANCE DOS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE 0 PRODUCER-AND THE I O ER. IMPORTANT:If the certificate holder is IIn ADDITIONAL INSURED,the po)icy(ies)must be endorsed. If SUBROGATION IS WANED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder in lieu of such end6rsemen s . PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAX 233 W CENTRAL STREET (AIC,No,Ext): (A1C,No): NATICK,MA 01760 E-MAIL ADORES$: 22MLW INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LL C INSURER B: INSURER C: 61 REAR JEFFERSON AVE INSURER D: SALEM,MA 01970 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: HIS 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 MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN(I SS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY D PACLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMU)DIYYYY) IMMDDIYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE M OCCUR. DAMAGE TO RENTED $ REMISES(Ea occurrence) ED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER:f ERSONAL&ADV INJURY $ POLICY F]PROJECT[:]L O I [E 'EN $ RODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBMED SINGLE $ ANY AUTO ( LIMIT(Ea accident) ALL OWNED AUTOS DILY INJURY $ SCHEDULE AUTOS l (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ I (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LiAB CLAIMS-MADEAGGREGATE $ DEDUCTIBLE $ RETENTION$ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY Y11N UMB270121-15 03/202016 03120/2017 LIMITS ANY PROPERITOR/PARTNER/EJ(ECUTIVE OFFICER/MEMBER EXCLUDED7 NIA and E.L EACH ACCIDENT $ 500,000 It yes,describe und (Manddtoryln E.L.DISEASE-EA EMPLOYEE $ 500,000 er DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER ( CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL.BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED N.ANDOVER,MA 01845 ice. ACORD 25(2010/06) ----------_ ----------------------- The ACORD name and logo are registered marks of ACORD 1988=2090 ACORD CORPORATION. All rights reserved. I Massachusetts Department of Public Safety Construction Supervisor Board of Building Regulations and Standards Restricted to: License: CS-087977 Unrestricted-Buildings of any use group which cor*ain 35,000 cubic feet{991 cubic meters)of Construction Supervisor less than . enclosed space. ERIC W PALM 3 HILTON ST SALEM MA 01970 ' �+ Failure to Possess a-current edition ofthe Massachusef -^^ Expiration: State Building Code is cause for revocation of tEris Ticense- Commissioner 04/23/2018 DPS Licensing information visit:WMM.MASS-GOV/DPS License or reghtration vatid for ind'n►idnt use only ()Mee of Consumer Affhirs&Business Regulation before theas i ration date. U found return to-- - . 1� ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation e istration:11 Type.� 142089 yP 10 Park Plaza-Suite 5170 ration: 3/1 Tri I2121018• Ltd UabM y Corpor Boston,MA 02116 ATLANTIC WEATHERIZATION.-LLC. : . • ERIC PALM 61 R JEFFERSON AVE .� -SALEM,MAA 01970 Undersecremry Not valid without signature Ar f i