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HomeMy WebLinkAboutBuilding Permit #1045-2016 - 50 HIGH STREET 4/5/2016 L J l BUILDING PERMIT NORT►1 q �t LED !6 +� TOWN OF NORTH ANDOVER 3= h�. ,6 �CP�0PPLICATION FOR PLAN EXAMINATION n0 ,1. en Permit No#: Date Received �R°oRArf, gSSACHUs�'( Date Issued: I ORTANT:Applicant must complete all items on this page LOCATION S"rCD Prin t PROPERTY OWNER � CG- i� l� (-It I t- NS-�- H% Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:_ Historic Districts no Machine Shop Village no t i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial Iteration No. of units: Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ I ptic ❑V11ell' ❑ Flootlplain o Wetlantlsfl 1Natershed ®istnct F WateSewer .m ^DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: ,a V 1 0 -1 6-AL Cr H Phone: Ili Address: �v o-C t 0 b 1-7- LU a s �'�M Syw I Id, � Ll 4-a Contractor Name:T< &Kamen tjc- LLC- Phone: LI -7— S- 1 Email: �-, L�V,4e-j r� CZ t\J G'i'g c.6y �0 yvx Address: Supervisor's Construction License: e—S 6 b 6 Lt' Exp. Date: L &1 It Home Improvement License: Exp. Date: ARCHITECT/ENGINEER GDP-4F H t+'I(Phone: ?"7th - 4-q q —Z 7 g q f`l ve, ot9 � a Address:2A 0 t�BY,,_k�t . � TIn1b�r- i �.�'� Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER 61000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. I Total Project Cost: $ 26 , 01"7 . FEE: $ 452 -V- k� = Check No.: Receipt No.: 6 zb�o NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 71M C_ Non ure nature of 6n a _._.. 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 ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENT'S CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes .w P.lanning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street MENT ,i 1j ern W- ,gyp. 10NI D ----._ EP R+T _ Located of 124 Main Street•, r F" Fire Dep m gfir�afure/date �i'x��.l.G6`+t+L'.�. -+` _t�, r ^ �� ` ��'� !`�vds.F�tc'=�' i .`�. t ` rho ,• ,,. 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i I 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 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/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 and Two Family) i New Construction (Single y) 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 Doe:Building Permit Revised 2014 i /V Location /,k , 4it�d Q�A-, No. �S Date N /� • • TOWN OF NORTH ANDOVER �rz fCertificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ 4_ ' Other Permit Fee $ TOTAL $ �� "* Check# `t�1 :1 r, r % '' L -• :j ��Building Inspector O,MORTk 1ti . I °ono N^"19' �SSACROsbt CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 1045-2016 on 4/5/2016 Date: May 10, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street— Suite 10 MAY BE OCCUPIED AS a tenant fit up —NELMS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG NA Mills,West Mills LLC 50 High Street North Andover,MA 01845 Buil ng Inspector Fee: PrePaid $100.00 Receipt: 30206 Check : 2457 .tAORTFi Town of No. lo46 .� * - _ - - - - - - - - h ver, Mass 6 COC MIC MI WK 1' �'9S RATED 'Pa�,�'(5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......... A .. � � �� LLL BUILDING INSPECTOR .... .............................. ............................................�..................... has permission to erect ........ buildings on .. . .... .. Foundation .................. ':. ......... ............. ....... o gh l /�g/ z� to be occupied as l ...... .. . ... ... �.... ....t......�... .. � ....................................... Chimney provided that the person accepting this it shalll i�very respect conform to the terms of the application inal on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTSRou 6 1LQ,a -7-2--( 1- Service �^ ............... .. .. Final � � cf— —'�tC 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 '►"� Ot p0 8711 1H , O p it 1 see..-......,r �7S ACHU54t49 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 1045-2016 on 4/5/2016 Date: May 10, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street— Suite 10 MAY BE OCCUPIED AS a tenant fit up —NELMS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG NA Mills,West Mills LLC 50 High Street North Andover,MA 01845 Building Inspector Fee: PrePaid $100.00 Receipt: 30206 Check : 2457 •NORTH �� own o F n over lzi- 0 No. ver, Mass ( Z�� COC«IC K.WICK a• -wy'P�OO - I,ps D I P 5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT (2 � 1 � t �, �`. BUILDING INSPECTOR .............(24 ............................. ........................1 .. Foundation has permission to erect .......................... buildings on 5.. . .. . .... .. ......... ..... �T .�� ` o gh pi .. ..� •�!. y to be occupied as ............. Chimney . ...... .. �. . ry . ......� L........... ........................................... final- -on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rou G��� Service �^ ... .. .. .. .. Final .......... / ! ✓ 5� � 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 I , Enter construction cost for fee cal - North Andover Fee Cakulat%011 Construction Cost 361,017.00 m $ - $ 432.20 Plumbing Fee $ 54.03 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 54.03 Total fees collected $ 640.26 50 High Street Suite 10 1045-2016 on 4/5/16 Tenant Fit Up I I I NORTH Town of �.. : _� . F, Andover h ver, Mass ( Z�� Coc"Ic Ml WICK ��' All I x.45 RATED U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......... � :We* �1 �� BUILDING INSPECTOR .... .......................... .. ....... .................................................. PO Foundation has permission to erect .......................... buildings on . .. ......... . .... .............. ..... 77.. Rough to be occupied asAChimney provided that the person accepting this55. t shall inlevery respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough ....,... Service ~ ............... .. .. .. ..�...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises Do Not Remove Final No Lathing or.Dry Wall 1'0 Be Done — FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. q "T" x OFFICE OF BUILDING INSPECTOR ° ►°•ED aRcy'�I TOWN OF NORTH ANDOVER rFc h CONSTRUCTION CONTROL r e o. 536 ► j o Cf UATE. tz_ ► PROJECT NUMBER: 1 -0718 e X02 ZJ � PG PROJECT TITLE: West Mill - Suite 10 - New England league of Middle Schools . of Mase,♦ 1 .. PROJECT LOCATION: 50 Nigh Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant demising and tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1, m M . LJ REGISTRATION NO. Q�`�_ I BEING A REGISTERED PROFESSIONAL ENGINEERfARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ` ARCHITECTURAL STRUCTURAL ° MECHANICAL ° FIRE PROTECTION ° ELECTRICAL ` OTHER(SPECIFY) _ C FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE 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 I 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. I 2. Review and approval of the quality control procedufes for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with&& progress 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, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. SIG AT RE SUBSCRIBED ANDS M TO BEFOR E THISDAY OF 20� CHERYL L. BURKINS14AW Notary Public NOTARY PUBLI MY COMMISSION EX Commonwealth of Massachusetts y ommission Expires March 7,2019 I i X Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 617-592-6775 (Kieran) 781-254-2862 (Judy) Proposal Date: 4/4/2016 Proposal#: 203-7 Project: Bill To: David Streinbergh NELMS, Suite 101,50 High St N.Andover,MA 01845 Description Est -Hours/Qty. Rate Total Permit, C of 0490.00 490.00 ... ... _. Demo.. x:, .-. 500.00 _ 5-06-'66-- Wall Framing, includes building cubicles 2,000.00 2,000.00 Doors&`Tnm .... 750.00 7%.00 - Heating &Cooling,[Estimate] 9,150.00 9,150.00 3gtectrical &Lighting _ 3,500.00 A3,500.M z Tele/Data1 750.00 1,750 00 1.Interior UValls, Board;Tape, sand 5,000,00 ... 5,000 00 Insulation 500.00 500.00 Millwork&Trim,maple cap '750.00 750.00 Floor Coverings 4,300.00 4,300 00 3,500.00 3,500.00"° Cleanup&Restoration200.00 200.00 Gertoral Conditions ; 500.fl0 _ 500.00. Su ervision3 289.00 3,289.00 31n urance 1%, _ 328.90 328.90 CHANGE ORDER ,April 5,`2016< , 3>Removed 129_Supervision.,(42,833.00) >Removed 1 30- Insurance.(4283.30) F (>Increased price of 15�HVAC from$5,000.00 to ,p 1$9,1'50.00, (+$4,150.00,) .:. i'Added 1 29 Supervision. (+$3,289.00) >Added 1'30;- Insurance."'(+$328.0,0) Totai change to,estimate+$4;651.60 Estimate for your review and approval . Total $36,507.90 ry The Commonwealth of Massachusetts , Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 qV www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): W t`'1 N 6"' Address:_�U 1015- 4 (4- 6-14 AV 0 Ott - City/State/Zip: ff ND d Vi-r- i 01 Y Phone#: 7 T . 7 -7S-_. , h v Are 7S- Are you an employer?Check the appropriate box: Typo of project(required): 1.EQ I am a employer with_ 4. ❑ I am a general contractor and I 6. ❑New construction � p employees full and/or part-time).* have hired the sub-contractors 7. 2.El am a sole proprietor or partner- listed on the attached sheet.# Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g El Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.El I am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]1 employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they ire 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 their workers'comp.policy information. I am an employee that is providing workers'compensation insurance for my employees Below is the policy and job site information. 2 Insurance Company Name:. C-il f4 4 Ow C VL Policy#or Self-ins.Lic.#: W L ► `.✓� Expiration Date: f © `7 Job Site Address:,_ 141 . hq ry Oy-n". City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MCL 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. Ido hereby cert4p under the pains andpenalties ofperjury that the information provided above is true and correct. Signafore• Date: f-fb-h 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 Instruction's 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 ofhire,- 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicahts Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)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 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(ifnecessary)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 CoDUAO wealth of Massachusetts Department of fadustrial.Accidents Office of Tavestigatlons 604 Washington Sheet Boston}MA.42111 Tel,#617-727-4900 ext 406 or 1-877,MASS.AFB Revised 5-26-05 Fax#617-727-7749 WULW.maC.C'anzrfri;A MZ. JKCON-1 OP ID:HS ACORU� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)02/17/2016 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,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: DeSanctis Insurance Agcy,Inc. PHONE FAX 100 Unicorn Park Drive (A/C.No Ext): (AIC, AIC No): Woburn,MA 01801 ADDRESS: INSURERS AFFORDING COVERAGE NAIC q INSURER A:Star Insurance Company 012245 INSURED JK Contracting,LLC. INSURER B:Selective Insurance Company 19259 4 High Street Suite 108 INSURER C: North Andover,MA 01845 INSURER 0: INSURER E: INSURER F: COVERAGES 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. INSR ADDLITYPE OF INSURANCE IVSD SUB POLICY EXP LTR POLICY NUMBER (MMIDD rrrM EFF MM DDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE �OCCUR 52205113 02/10/2016 02/10/2017 DAMAG o RENTED 100,00 PREMISES Ea occurrence $ MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEN-L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 X POLICY a PJERCT O- ❑LOC PRODUCTS-COMPIOP AGG $ 3,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED F RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N A ANY PROPRIETOR/PARTNER/EXECUTIVE WC0853742 02/17/2016 02/17/2017 E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? N I A MA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Evidence of coverage. CERTIFICATE HOLDER CANCELLATION TO WHOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TO WHOM IT MAY CONCERN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 Construction Supervisor KIERAN-T WHELA14 a r� 31 RICHMOND STkFff WEYMOUTH MA=02188;t r, r'1 ,, . Expiration: Commissioner 09/26/2017