Loading...
HomeMy WebLinkAboutBuilding Permit #824-2017 - 50 HIGH STREET 5/1/2018 NORTFf BUILDING PERMIT O�ctLeD b q't'o h. 6 OWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION V L �R I., y1ua Permit No#: Date Received p°Rwreo Date Issued: �� � (✓� �� "�""'1✓ �L� gSSACHUs�( IMPORTANT: Ap cant must complete all items on this page LOCATION loon— � �'t ��N �� �"' W CSS-y 1� V l l 19 iinnt PROPERTY OWNER � Print L100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District a no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition ❑Two or more family ❑ Industrial Iteration No. of units: 6ommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ fl:Septic ❑Well � m D Floodplain �Wetlands � ❑ Watershed District D Water/Sewer - ` I DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name-3 SFVQNf G" 6,I+J a ter,&N Phone:6 C7"6 Zs��� Address: u m�- C7 ( 4 Vr9 0 6 tj6- 'W Contractor Name-7:T,W- CuAJD21n c in w locPhone: G 1 -7 —�—cQ 2 '6 —7-7-:3-- E m a 7-7-:3-Ema il: K t t.5 `_ K- 6,Q 11t 6rt-M C4- J r- , Cr 6 f Address:Eu ' © H(G AJ-679,0 0 L101 - Supervisor's Construction License: (f6t 622 4— Exp. Date: Z 6 ` f r Home Improvement License: Exp. Date:- ARCH ITECT/ENGI NEE ate:ARCHITECT/ENGINEEJgj�� t6l—C$J' Phone: Z Address: �'+�8�� m Reg. No. Q� FEE SCHEDULE.BULDING PERMIT.•$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PE S.F. Total Project Cost: $ "7 d (� 3�' FEE. $ Check No.: , 140Receipt No.: :�; ((Lot)( NOTE: Persons contracts g with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL k Public Sewer ❑ Tanning/Massage/Body 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 Revi n Signature_ COMMENTS CONSERVATION Revi wed on Signature COMMENTS i I HEALTH Reviewed on Signature COMMENTS r 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 DEP/�RTt ME IT ,�. } -7t-- - 3-r »: ye n0� _dam T:�ernDu r�o- sity t _ mpste n. e�> jkLo te000, dMainStre Faire Dep,artment�igr�atWe Y riR.+i+`�Fa4iau...s. �` �P '. i �..: t;�}. t '".•f 4*4? `{'i ♦ i ,.; - ' ,} CQMMENTS4 _ 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: lies No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) tl✓Ag)g(l�v ❑ Notified for pickup Call Email Date Time Contact Name Doc.Suilding Permit Revised 2014 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 j 4� Copy of Contract � Floor Plan Or Proposed Interior Work a. 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 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 I Location Y r: No.(�a �? / Date J( � . - TOWN OF NORTH ANDOVER Certificate of Occupancy $�� G Building/Frame Permit Fee Foundation Permit Fee $ ,� Other Permit Fee $ TOTAL $rl"�— `' n l Check# Building Inspector J ! .J 6/28/2017 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number: 824-2017 Date: June 28, 2017 CO Permit Number: 26186 THIS CERTIFIES THAT THE BUILDING LOCATED ON: 50 HIGH STREET MAY BE OCCUPIED AS Tenant Fitup for Sonexis - Suite 27 - Floor 2 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: MANSUR INVESTMENTS Al ctor 0 .Q This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/26186 -�, IV&r0A 1/1 6/28/2017 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER r Building Permit Number: 824-2017 Date: June 28, 2017 CO Permit Number: 26186 THIS CERTIFIES THAT THE BUILDING LOCATED ON: 50 HIGH STREET MAY BE OCCUPIED AS Tenant Fitup for Sonexis - Suite 27 - Floor 2 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: MANSUR INVESTMENTS ctor This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/26186 1/1 6/28/2017 - ''- CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER BuildingPermit Number: 824-2017 Date: June 28 2017 � CO Permit Number: 26186 THIS CERTIFIES THAT THE BUILDING LOCATED ON: 50 HIGH STREET MAY BE OCCUPIED AS Tenant Fitup for Sonexis - Suite 27 - Floor 2 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: MANSUR INVESTMENTS 'I ctor This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/26186 , 1/1 6/28/2017 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number: 824-2017 Date: June 28, 2017 CO Permit Number: 26186 THIS CERTIFIES THAT THE BUILDING LOCATED ON: 50 HIGH STREET MAY BE OCCUPIED AS Tenant Fitup for Sonexis - Suite 27 - Floor 2 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: MANSUR INVESTMENTS ro"I ' ctor This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/26186_ 0 1/1 NORTH Town Of � _ ,, sAn#,_ oYer nk, 0 No. &4 �a nth ver, Mass, 1 A_ c0c NIC NIWICK �'�• 7a ADRArED ►Pa,��(� lS U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .,.. � ....�41r,,,, BUILDING INSPECTOR ..................... ....... .... .. ........ . has permission to erect .......................... buildings on .. ` �!., 1 Foundation /' ...... ... .... ... .. . ......... -Rough ,1°`MIf c2k- to be occupied as ...... .............. ........... 7.L.2...., 1 Chimney provided that the person accepting S! permit shall in every respect conform to the terms of the application r/�-e�� C, Final X38 ?mak on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and v6 Construction of Buildings in the Town of North Andover. UMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough �/w/A/7 Final �3 S' .S �I t 7 ( ' PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPEC7.P91R,. UNLESS CONST TIO I Service ... .. ............. BUILDI SPEC OR 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 To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Buildi-ng-Inspector. Burner Street No. Smoke Det. Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 709636.00 m $ 847.63 Plumbing Fee $ 105.95 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 105.95 Total fees collected $ 1,159.54 50 High Street Suite 27 - Sonexis 824-2017 on 3/7/2017 Tenant Fit up I 4 NORT#j Town of s ndover No. 0ver, Mass, A11 COCNIC«l W#Cn 7' p0 AT S U BOARD OF HEALTH PERMIT D Food/Kitchen Septic System .. h THIS CERTIFIES THAT ................. ........... �.. ........ ....... .... .................................... BUILDING INSPECTOR has permission to erect buildin s on .. Foundation g ...�- t ....... . . .. . .......... , .. 1 • Rou h g to be occupied as ........ .14ftti- l.::...:P � � Chimney ...... ....... ........... ... �.. .... y provided that the person accepting t ' permit shall in every respect conform to the terms of thea application pp 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 CONST TIO Rough Service ... .. Final BUILDI SPEC OR 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. OFFICE OF BUILDING INSPECTOR w TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 15-0718 PROJECTTITLE: SONEXIS PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant improvement/tit out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, _REGISTRATION N0._ 9,153 BEING A�R"EGISTERED PROFESSIONAL ENGINEER/ARCHITECH 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) i 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 PERMITiAND 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 progress and quality of the work and to determine, in general, if the work is be'. -— � `4-.� performed in a manner consistent with the construction documents. �5�4' C.tir PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS R 9 TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDIN� Ids! � �' 4 O E. D d 5 � UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO T s� a SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPA `J r~ [r OF0$ VV SUBSCRIBED AND SWORM TO BEFORE ME THIS / )DAY OF S� aT 20 ._ U CA LL___ � CHE YL L. BURKINSHAW Notary Public NOTARY Pttl1LIC MY COMMISSION EIEC < mmonweaith of Massachusetts My Commission Expires March r, 2019 X Contracting Inc. Proposal High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Proposal Date: 2/20/2017 Proposal#: 203-89 Project: 50 High St, Sonex... Bill To: Ship To RCG West Mill NA LLC Scnexis Daviid Steinbergh North Andover.NIA 01845 17 Ivaloo Street Somerville, MA 02143 description Est. Hours/Qty. Rate Total Project Location/Description: 50 High St,',2nd Flour, Sonexis, North Andover, MA :.Permit and,.0 of O 868.00 868.00 Demo2,500.00 2,500.00 ;General Conditions, Dumpsters, floor protection, ..... 3,500.00 3,50000 Wall Framing 31800.00 3,800.00 Doors&Trim 3,700.00 3,700.00 Plumbing,[Estimate] 5,500.00 5,500.00 Heating &Cooling [Estimate]Ductwork only2,500.00 2,500.00 Electrical & Lighting, [Estimate] 10,000.00 10,000.00 Tele/Data[Estimate] 5;000.00 . . 5,000.00 Insulation 750.00 750.00 Interior Walls, Board. 1,800.00 1,800 04 Interior Walls, Tape, Compound, sand, 3,600.00 3,600.00 Cabinets&Vanities, including Formica.tops. 4,300,00, 4,300.00 Floor Coverings, [Estimate] 7,500.00 7,500.00 Painting, Including ductwork. 6,500.00 6,5-0.00 Sprinkler Work 1,300.00 1,300.00 Glass ,Windows. 800.0 -800.00 Cleanup& Final Clean 500.00 500.00 Supervision 6,441.80` 6,44'1..80 Insurance 644.18 644.18 II Estimate for your review and approval . Total $71,503.98 Approved:_ (Initials) t SIGNATURE . The Commonwealth of Massachusetts Department of IndustrialAccidents - d 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): VV '' - Address c\cl 10,5- 0 ( , Lt— City/State/Zip: t— ty p �i9 Phone f e7 ' d�()�l'� #: S? Z--"b �.. Ci /State/Zi :' Nd d u�. Are you an employer?Check the appropriate box: Type of project(required): 1.01,am a employer with employees(full and/or part-time).* 7, Q New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8.-.Q Remo delirig any capacity.[No workers'comp.insurance required.] 1 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6QWe are a corporation and its ofCcers have exercised their right of exemption per MGL c. 14. Other oyees.[No workers'comp.insurance required.] 152,§1(4),and we have na,empl *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 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-coriisaciors 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: Y%P CA Policy#'or Self-ins.Lie.#: ��5� 4'Z— Expiration Date: f fob Site Address: s `G-ri —To N L �,� City/State/Zip: !" t f 0 d 1/d-."-4 1 e) 1 Attach a copy of the workers'compensation policy declaration page(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 cer 'y under thepains and{peenaallties ofperjury that the information provided b is t ue and correct. Signature: / — Date: L �'= `-7 Phone#: l j Z- `7? J 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 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-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 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 MCON-1 OP ID:LK �...- CERTIFICATE OF LIABILITY INSURANCE DATE(MIDDMWY) THIS CERTIFICATE IS ISSUED ASA MATTER 2017 OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.1THIS 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 endorsements. PRODUCER CONTACT DeSanctis Insurance Agcy,Inc. NAME: 100 Unicorn Park drive PHONE Woburn,MA 01801 ap AIL •€>R1� -135-8480 cac.No):781.933.5645 EM ADDRESS: INSURERS)AFFORDING COVERAGE NFAIC INSURED INSURER A:Star Insurance Com anEEE 012246 JK Contracting,Inc. INSURER B:Selective Insurance Company 19259 4 High Street Suite 108 ------ -- � i North Andover,MA 01845 YISURER C_ INSURER D: INSURER E; INSURER F: COV GES CERTIFICATE NUMBER: REVISION NUMBER: I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD s INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH-THIS G CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, d EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. (INSR j ADDL SJT$Rj'-- —" ?OIJCY EFF POLICY P iLTR TYPE OF INSURANCE T POLICYNUMBER _-`_ MMlDD MM/DD/YYYY LIMITS i X , COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE $ 11000,00 CLAIMS MADE i I 152205113 102/101201X0211012018 t li PREMISE' Ea occurrence $ 100,00 t I MED EXP(Any one person) $ 10,00 PERSONAL 8 ADV INJURY $ 11000100 GEN'L AGGREGATE LIMIT APPLIES PER: ! { _ aiGENERAL AGGREGATE 3,000,00POLICY 7 JCT n LOC I OTHER: I I PRODUCTS-COMP/OP AGG S 3,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _ cident) $ ANY AUTO (Ea ac DILY INJURY(Per Person) $ALL OWNED SCHEDULED AUTOS AUTOS O BODILY INJURY(Per accident) $ HIRED AUTOS 11N OWNED _____ AUTOS ! r PROPERTY DAMAG S C(Par accident) I i UMBRELLA UAB OCCUR I' j $ 1 I EXCESS LAS EACH OCCURRENCE $ 3 I CLAIMS-MADE� — DED RETENTION$ WORKERS COMPENSATION j $ AND EMPLOYERS'LIABILITY Y/N I I x ,STATUTE 0 H _ A ANY PROPRIETCRlPARTNER/EXECL?IVE IWCOSS3742 j J211712017l 02/17/2018�� {PASoryEn NH)EXCLUDED? ��IN/Ai MA E.L.EACH ACCIDENT $ _ 10Q�00 If yes,describe under I E.L.DISEASE-EA EMPLOYEE $ 100,00 4. ,DESCRIPTION OF OPERATIGNS below E.L.DISEASE-POLICY LIMIT $ 500,00 i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES{ACCPX 101,Additional Remarks Schedule,may be attached If more space is required) s"ADDITIONAL INSURED LIMITS ARE NO GREATER THAN THOSE REQUIRED BY WRITTEN 1CONTRACT'Illustration of Coverage;Town of North Andover is add'I ins'd as respects to the GL policy. it CERTIFICATE HOLDER - CANCELLATION NORT HA- I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover ) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 43 High Street ACCORDANCE WITH THE POLICY PROVISIONS. N.Andover,MA 01845 i--- AUTHORi2ED REPRESENTATIVE i; ; 'I ©1988-2014 ACORD CORPORATION. Aft rights reserved. .., ACORD 25(20141013 The ACORD name atr d to o are registered 9 9 marks of ACORD Massachusetts Departmerit of Public Safety i 'S. Board of Building Regulations and Standards License: CS-066334 Construction Supervisor o KIERAN T WHELAN` 31 RICHMOND STR WEYMOUTH MA-021: M fn A, �lt4t 1.i rt ' tExpiration.' Commissioner 09/26/2617 } /Il' Office of Consumer Affairs&Business Regulation 6PHOME IMPROVEMENT CONTRACTOR kl :f Registration: 17.1393 Type: - Expiration: 3/f5/'918 Individual KIERAN WHELAN j KIERAN WHELAN 1 31 RICHMOND ST WEYMOUTH,MA 02188 Undersecretary _ 1 Z License or registration valid for indivit;'.;tal use only before the expiration date. If found return to: Of&e of Consumer Affairs and Business Regulation. k Park Plaza-Suite 5170 Boston,AIA 02116 Not valid without signature i :=�1'zc u%nirreraojrruea��a6�P./�r�Jcxc,/iaiael�• paceof Cihsmr Affairs&Business Regulation HOME IMPROVEMENT,C'6N7RACTbR RegiseaVon, V71893 TYPe Expiration .3 t6t 8 Corporatiolt I X CONTRACTING L-LEi KIERAN WHELAN - 3h RIJCHMMD ST = :� R •c,, __ WEYMOUTH,MA 02188 Undersecretary