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HomeMy WebLinkAboutBuilding Permit #663-2017 - 50 HIGH STREET 5/1/2018 BUILDING PERMIT � q ®�Rt'E° ���`�o TOWN OF NORTH ANDOVER �� �-'�`' �-° l... ..- .• y , '� APPLICATION FOR PLAN EXAMINATION Permit No#: IQ / Date Received RArSD �Ssact+ussq Date Issued: IMPORTANT: Applicant must complete all items on this p,ge L CA I®N [;ROPER Y ©W RE P,�rin 1 100 Yea str''cur lyes no MAPPA�RCEL°-_ � Z�®NI_N,G ©ISTRICT _ Historic®istr�ictl e no Machine Shop Village e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building g ElOne family ❑Addition ❑Two or more family ❑ Industrial O'Alteration No. of units: Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other YStics Well ® Floo�,d�plain t®W..etlands I �� Wa��ter hed Dtsfr�ctP L er/ ewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please T pe or Print Clearly OWNER: Name: l2 Cr IAI u47- 111 . IV'.A4 . L.i. L . Phone: b ►� � ZS" � �/cam Address: Contractor Narne _� r` ! T_)r!-41 Phone Erna - Ad Z-3 t 7z. R. Zr74 1Z i ✓ , -- -- - Super isorsCons ructio ..,*— .� Home Im r ve n ,L2e seryx 4 Date= - 4 ARCHITECT/ENGINEER Phone: qZ – `t-1 't ,g olgs 0 Address'ZA l' MSK L�Q', uW'+3cJ��l��n�` Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOT44.EST/MATED COST BASED ON$925.00 PER S.F. 8r 3sZ c� Total Project Cost: $ J FEE: $ / fivd �0 Check No.: 01-569 Receipt No.: 313 NOTE: Persons contracting with unregistered contractors do not have access to the g77- uaranty fund Slg`nature`of'Agent/,Owier Signature of,confractor . `` Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Mas sage/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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 4 ' Conservation Decision: Comments Water& Sewer Connection/Signature&Date . Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street AFIRE DE N-I-n, Tyry _ w . �.�. �PARTME �. Lo ated at.1�241111a`nStreet� � Fire De�b ' g partment si natur,�e/date, ., l_ e { r "lav���4 �c itt.Fa .xT���iK+ r it, - c, l i i~•q' x#t.9'g'► 1' ,�1 C;� i. 3 n �,i�� J CO11/IMENTS„ ,�;.�. 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) II ❑ Notified for pickup Call Email Date Time Contact Name Doe.Building 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 a Building Permit Application a Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan a Workers Comp Affidavit j o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract a Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Klass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products DTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) a Building Perm it'Application ❑ Certified Proposed Plot Plan U Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products ATE: 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 No. (01 � G G Date • - TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ 0 Building/Frame Permit Fee $ R�! Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ltd Check# ;; Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 81 ,352.00 m $ - $ 976.22 Plumbing Fee $ 122.03 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 122.03 Total fees collected $ 1,320.28 50 High Street Tenant Fit Up Suite 47 Mouls and Tanner 663-2017 on 12/21/2016 Town oAndover No. (Aq. C. 0. ."�- h , ver, Mass, O GOCHIG I �,WICK , mlid 't ' h ' � U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ... ..... .�. *VG ......... BUILDING INSPECTOR VJgf...At ................ Foundation has permission to erect .......................... buildings on .r0..#J.4e. ...., • ••• •' •••••• "099 Rough tobe occupied as ... ,f ow,* . •. r:tA1 .................................................................. 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 Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. � � �PECTOR PERMIT EXPIRES IN 6 MONTHS 't �W S UNLESS CONST TION Uy\ cA­r� BUILDING eliNS TOR ' GAS INSPECTOR Occupancy Permit-Required to Occupy Building Rough Display in a Conspicuous Place on the Premises -Do Not Remove Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT A Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. ttO R Tfy Town of ndover 0 0 o h , ver, Mass, �p cocNic«ewic.c �7s RATED I'Pa�,`�y U BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT 4101 !r�... ���.�„y I'�1�r .....�„ .�,.,...,,. BUILDING INSPECTOR . ... .. .... ......... ........... has permission to erect 2.p� Foundation R.Ja.......... .............................................. Rough to be occupied as ............a .r. ...... �, ....... P �...... . ,o.. .. s ! .......... t . ... .. . ... Chimney provided that the person accepting this permit shall in every respect conform to the terms.of.the. .applica ion 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 CONSTRUCTIO T Rough Service ............. ... .. .. ..... .. ............... BUILDING�INSPECTOR. Final 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. Final Construction Control Document W To be submitted at completion of construction by a w a Registered Design Professional for work per the 8' edition of the p1M SJev Massachusetts State Building Code, 780 CMR, Section 107 Project Title: West Mill—Hoyle&Tanner Date: 3/2/2017 Permit No.663-2017 Property Address: 50 High Street North Andover,Ma 01845 Project: Check(x) one or both as applicable: New construction X Existing Construction Project description: Renovation of existing office space I,Donald M Walter,MA Registration Number: 9536 Expiration date: 8/31/2017, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: X Architectural Structural Mechanical Fire Protection Electrical Other: Describe for the above named project. 1, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provision� 107. Enter in the space to the right a"wet"or G electronic signature and seal: * No 536 r �� p S • -qi TE i a' s Phone number: (718)499-2999 Email: dwalter@doreandwhittier.com ° 4 rH or- Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 A o • 4 �dsAcnK�� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 665-2017 on 12/22/2016 Date: February 28, 2017 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street—Fourth Floor - Suite 49 MAY BE OCCUPIED AS a tenant fit up —Hoyle and Tanner 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 50 High Street North Andover,MA 01845 Building Inspector Fee:Prepaid $100.00 Receipt: 31369 Check : 2569 � NORTl9 q O �t�e° rbx•y O .S�'t yE•r '•6 APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION K � ayy 0� COCNICN�WKK ` � /� � 1 BUILDING PERMIT# &&g NW/S/,o, 17 SACHU �• 1 �/� ,0 ADDRESS/LOCATION OF PROPERTY: �J v ✓ � V;��z,zj Map S 4 Parcel P Lot Number SUBDIVISION: DATE REQUESTED FILEDMEADY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED --( 1 O ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00)WILL BE CHARGED IF THE-STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. APPLICANT SIGNATURE Permit Issued to: Address: ROUTING TOWN ENGINEER, SITE PLAN—DRIVE-WAY REVIEW ❑ CONSERVATION)?-- PLANNMG RlL1N 1Nv�Y�.� N� �iiUP Q�UIJ�U� 3J1)Zv�t DPW-WATER METER— ❑ SEWER CONNECTIAA, DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW SIGNATURE File:Application for PC form revised Jan 2007/2011 F NORTIi Town oAndover 4 o - ,� o h , ver, Mass, 00#4 COCNIC M[WICK 1• A�RATEO S V BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT AV . . ... .'���.^... .. .I�..,,�! .��!' ,,,,,�„t BUILDING INSPECTOR ..... . ..... . .... .... .. ...a........... ... ., .,.. Foundation has permission to erect .......................... Ii�rWmefw+�r......... .............................................. AJ Rough Q/ "Z�J' to be occupied as ...........�0.1�........ip 4T.......*�ft4.0..........f/:' Afth.:. .. .. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the applica ion 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. �_ FW-MBING INSPE f e k Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. � Final��SS PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOz T Oervpice � � �� 3_4 ............. ... . .. ......................................... �� Fina BUILDG 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 DE RTNIEP,IT Until Inspected and Approved by the Building Inspector. Burners _ Street No: Smoke De ? ` t r v' CT M?SYN�hQ, F T L •� t 1 dSACM15� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 665-2017 on 12/22/2016 Date: February 28, 2017 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street—Fourth Floor - Suite 49 MAY BE OCCUPIED AS a tenant fit up —Hoyle le and Tanner 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 50 High Street North Andover,MA 01845 Building Inspector Fee:Prepaid $100.00 Receipt: 31369 Check : 2569 FNORTH own of ndover No. oh , ver, Mass, tOCNIc Nl WI[.! � 0 *4 U BOARD OF HEALTH Food/Kitchen PER T L D Septic System THIS CERTIFIES THAT s 01 . . .�. "� ��.�,.y.. .P..o h¢:#....,16„t BUILDING INSPECTOR ............... . Foundation has permission to erect.......................... brriiWl,�■ar. .. .... &............................................ Rough©/ to be occupied as �! 16.�.� ro. javt............%!*. ...... . .........����. ......... ..�4.... ...... .. � Chimney provided that the person accepting this permit shall in every respect conform to the terms of the applica ion 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. P�VIVIBING INSPE TO W* k /&�4q Rough t I°7 VIOLATION of the Zoning or Building Regulations Voids this Permit. Final a)SS - PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T RoughAIF ervice ............. ... ..... ...... .. ..................................... BUILDING INSPECTOR Fina GAS INSPECTOR Occupancy Permit Required to Occupy Buildinje Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry all To Be, Done FIRE DE RTIVIE9��T Wall Until Inspected and Approved by the Building Inspector. Burner Street No: i. c t. Smoke D_ a I ' JK Contracting LLC Proposal 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Proposal Date: 12/14/2016 Proposal#: 203-72 1 Project: 50 High, 4th FI, H... Bill To: Ship To RCG West Mill NA LLC Hoyle&Tanner Daviid Steinbergh North Andover,MA 01845 17 Ivaloo Street Somerville, MA 02143 I Description %Est. Hours/Qty. Rate Total Permits, Cof 0. 976.00 976.00 General Conditions` 2,500.00 2, 00,00 Demo, Includes removing to 1 st floor and dumpster 4,000.00 4,0'-0'0.00 fees Dust Containment, Sealing.holes and perimeter 400.00 400.00 caulking Heating & Cooling 1 19,790.0019,790.00 Wall.Framing 3,500.00 W 3,50D.00 Doors &Trim 3,000.00 3,000.00 Windows&Trim, Install 1-inch,insulated glass in large 1,300.00 1,300.00 window. _ I Plumbing [Estimate], 4,500.00 4,500.00_ Electrical'&Lighting(Estimate] 8,000,00, 8,000.00 Tele/Data 3,000.00 3,000.00 Insulation' 700.00 700.00 Interior Walls, Board 2,500.00 2,500.00 lnterlor Walls,.tape sand 3,500.00 3 500.00 Cabinets&Vanities,1 Including granite tops 3,500.00 3,500.00 Floor Coverings , 6,500:00 A,506.06 . Painting i 4,000.00 4,000.00 Sprinkler Work, Remove,piping in closet from old 2;500.00' 2,500.00 system. Supervision 7,416.60 7,416.60 Insurance 741.66 741.66 I Estimate for your review and approval . Total $82,324.26 Approved: (Initials) SIGNATURE OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER ..�..• CONSTRUCTION CONTROL PROJECT NUMBER: 15-0718 PROJECTTITLE: West Mill - 50 High St. 4th Floor PROJECT LOCATION: 50 High 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, I, REGISTRATION NO. BEING A REGISTERED PPOFESSIONAL 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) 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 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 mDA >_ 3. 3. Be present at intervals appropriate to the stage of construction to become, generally fa iar with6the progress and quality of the work and to determine, in general, if the work is be' g9 Nol 6 performed in a manner ccrisistent with the construction documents. ;0 SCIT A E. r PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPORT SPG�a TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSP OF reg UPON COMPLETION OF TIME WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLE ION AND READINESS OF THE PROJECT FOR OCCUPANCY. �� SIGNATURE SUBSCRIBED AND SW�ORM .`0 BEFORE ME THIS DAY OF /1 e URKINSHAW 6 • Notary Pul3i;t 71 _.-- Commonwealth of i~ ussaehusel NOTA P BLIC MY COMMISSION EXPI ' ' n Expires March 7, 2019 Sx The Commonwealth bfMassachuseas . - eparlment oflndustrialAccidenfs Office oflnvestigations 600 Washington Street Roston,lblA 02111 www mass gov/dia Workers' Compensation Insurance A#'fidavit:,Builders/Contractors/Electricians&lumbers Applicant Information PIease Print Leisibly Name(Business/owa zation/lndividual): -- — Nc`LLQ j a (r— Address:_ _S L) 1 " H( 041 A � t City/State/Zip: 0Phone - Z- -G"T-4-� Are you an employer?Check the appropriate box: Typo of project(required): I- I am a employer with 17— 4. [] I am a general contractor and I ' employees(full and/or part-time),* have.hired the sub-contractors . 6. [1 New construction 2.❑ 1 am a soleproprietor or partner- listed on the attached sheet. 7.Tg Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp,insurance. 9. ❑Building addition [No workers'comp,insurance 5. D We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised their 3.❑I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself.[No workers'comp. c•. 152,§1(4),and we have no 12.E]Roof repairs insurance required.]t 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 are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infomation. X am an employer that is providing workers'cornpensadon insurance for my employees. Below is the policy mtd job site information. Insurance Company Name:. C %rr$,Cv,c--S C�;M f JnV-r Y Policy#or Self-ins.Lie.M W (� Expiration Date: Z 1i -7 A -7 ,- �c Job Site Address• r n .. cxty/state/zip: 0� � M Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25.4,of MGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year im risonnmen as well as civil penalties in the form of a STOP WORK p � ORDER and a fine P ofu to$250.00 a da against the violator. Be advised p Y ag v that a cony of this statement maybe forwarded to the Office of Investigations of the DTA.for insurance coverage verification. r do hereby ce ityy under the airs andpenaltie,y cfpe.Jur iltrrt tr a information provided abov is true d correct. Date: f L 1 J 16 ?hone#: Official l ff use only. Do not write in this area,to he completed by city or town o,fficiaz City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: JKCON-1 OP ID:CD ACpR',t7YCERTIFICATE OF LIABILITY INSURANCE DATE(MM �--� o7/2s1201 YY) 2o1s 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 my require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT DeSanctis Insurance Agcy,Inc. PHONE- ---�--- -- -�--- - -- 100 Unicorn Park Drive (AIC.No.Exit __. _I(is j Woburn,MA 01801 E-MAIL ADDRESS: _ INSURERS AFFORDING COVERAGE NAIC# --- --- �)Al±_ 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 D; 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 PERIZ56 INDICATED. NOTWITHSTANDING ANY REQ(JIREMENT, 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 -- ------�AZD-C�`SUKI ---- -- POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE I -- I OCCUR 1 52205113 02/10/2016 02/10/2017 3D PREMISES(Ea re�nce $ 100,00 MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: EG NERAL AGGREGATE $ 3,000,00 X� POLICY F I PRO. I LOC (- - — JECTPRODUCTS-COMPIOP AGG $ 3,000,00 OTHER: F $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ I(Ea accil dent/ ___ ANY AUTO I I BODILY.INJURY(Per person) $ ALL OWNED r - SCHEDULED ! BODILY INJURY(Per accident) $ AUTOS I-�-1 AUTOS NON-OWNED PROPERTYDAMAGE HIRED AUTOS i AUTOS I (Per accident) $ $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I I X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N I IWC0853742 02/17/2016 02/17/2017_ OFFICER/MEMBER EXCLUDE ®)NIA, E.L.EACH ACCIDENT $ 100,00 (Mandatory In NH) i IMA I E.L.DISEASE-EA EMPLOYEE $ 100,00 Ifes under describe IDESCRIPTIUN OF OPERATIONS oelow i E.L.DISEASE-POLICY LIMIT $ 500100 I � � DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) "ADDITIONAL INSURED LIMITS ARE NO GREATER THAN THOSE REQUIRED BY WRITTEN CONTRACT" Illustration of Coverage; Town of North Andover is add'i ins'd as respects to the GL policy. CERTIFICATE HOLDER CANCELLATION NORTHA- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 43 High Street N.Andover, MA 01845 AUTHORR PRESENTArnE C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 Construction Supervisor KIERAN T WHELAN` 31 RICHMOND STREE WEYMOUTH MA-021 _ 1 )I •.Si i. `omm sinner Expiration: L_ 09/26/2617 . -------------- ; -WIC �.r.,rrrurrrrirrri�/�r/^l rz.tr�itlax/J;.o Office of Consumer Affairs&Business Regulation 7 '?HOME IMPROVEMENT CONTRACTOR yl ` ^Registration: 1`7.1393 Type: Expiration:.. 3/15/201;8 Individual KIERAN WHELAN KIERAN WHELAN 31 RICHMOND ST WEYMOUTH,MA 02188 44�� �— Undersecretary License or registration valid for fiRdividlial use only .:efore the expiration date. If found return to: Office of Consumer Affairs and Business Regulation. g 6 Park Plaza-Suite 5170 Boston,MA 02116 Not valid without signature �, ���e�iinrrr.�uorrunal-ll a`�C'/�a,�Jnc�iccJeGlJ L Office:of Cot<sAtr Affairs&Business Regulation -_' isa'one 9 171393ROMEIMPfriJVMEMENT.GONTRACTOR Re trT ype' • Expiration::=_3L5E2418 Corporation JKnCONTRACTING LCG.. KIERAN WHELAN 31 RICHMOND ST WEYMOUTH,MA 02188 Undersecretary