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HomeMy WebLinkAboutBuilding Permit #668 - 550 SALEM STREET 5/3/2010TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential New Building 1,tne family Addition Two or more family Industrial Alteration No. of units: Commercial Others: Repair, replacement Assessory Bldg Demolitions ve vi,(c Other S.ep!ic Well Floadplain . 'Wetlands. Watershed,District wateriSewer OWNER: Name: V 11UN Ut- YYUKK iU t3E PKEFORMED: ,I -L. A— /)L— i I -n. I_ o d i m hPr'I, Please Type or Print Clearly) ARCHITECT/ENGINEER Phone: Address: VZ/ Reg. No. FEE SCHEDULE. BULDING PERMIT. $92.00 PER $1000.00 OF THE TOTAL ESTIMATED ST BASED ON $925.0 P S.F. J Total Project Cast: $ FEE: $ Y,�i- Check No.: 6 Receipt No.: NOTE: Persons contracting ulfrebistered contractors do not have access to uarantl fui:d Signature of Agent/Owner Signature of contractor j•d 88 G6 N3AoaWU Hl escciT oZ ED Rew 0 Plans Submitted Plans Waived Certified Plot Pian Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools I 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 FIRE DEPARTMENT - Temp Dumpster on site .yes no Located at 124 Main Street . Fire Department signature/date Street r-OMMF_NTS _ i z'd N3AOQNd HINOW eS£:IT OT 60 ReW Location5�5yi/� No. a Date NORT" TOWN OF NORTH O'.�•e ANDOVER :•stip �? • . _ • pL ' Certificate Occupancy $ of Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22967 Building Inspector 4 W W cd W-4 O CG t4 ° w° e >, cn a U) w z a or- w° n°' , v U G w w 4 a°' `� w a U W � V) cd w � a C7 `d w w w a w' cn cn o CD s o • C N G C �v •n'a Cc ev c CD ID Ea • L c OR N c C2 �C CD 0 ; m c E �• d = L a�to a L o Z' 3 Ag = C m O =C C Nm E ca w m m 0 0 act m CD= o cm c o Q :e _ ca z m m o� fdl O G !O � Z -0 cm V : 0 CL _C m to m C •C = m :® 3 N a0`a5 z V ® p ®;C C V� Q m O O z 0 -6 9 L co O O v co O. O CO) p G ICO G CM CCO2CD p� W ca co O co CL~ co 0) O p O i—C O d CL Q CO2 C O +r c CcG V J •fl O C Z CD CD CL. C.3 y O G — • G Q. D 0 U) W'e� W U) 11 Dimension o:�''�- 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 app,Foval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No V MGL Chapter 166 Section 21A —F and G min.s100-s1000 fine Doc.Building Permit Revised 2010 6'd 2bS6BB96L6 83AOQWd HIdOW eSE:TT OT 60 ReW Dropo y,vr Page No. of Pages ?=VrOpuu hereby to furnish. material Wd labor - complete ,in. accordance with Specifications below; lar the sum of: • , dollars aymem to be n:aao as Iollows: One Third Deposit One Third Mid Job Balance Upon Completion, OR NOTICE: All home improvement contractors and subcontractors engaged In home Allt . improvement contracting, unless specifically exempt from registration by provisions Signa Ure of Chapter 142A of the General Laws, must be registered with the Commonwealth. ^J of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 'trfl'f r %I IT." ofpropose, f may bet' 1301, Boston, MA 02108. withdrawn accepted within days. We hereby submit, specifications and estimates for, ROOF WORK_, .+,• [TRIP ROOF OF 144/ �- � LAYERS OF ASPHALT SHINGLES, COVER EXTERIOR WALLS AND —/FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE. ADDITIONAL LAYERS WILL BE EXTRA, SEE BELOW It� OVER DECK WITH UNDERLAYMENT FELT. 1w f, ,`� Mt:rR1 ,t3;or 0 4> x ( tfytq NSTALL ICE & WATER SHIELD AT LEADING EDGE, VALLEYS AND ALL ROOF PENETRATIONS. �TANDARD APPLICATION AT EAVES IS 3 FEET. ALL LOWER SLOPED RO EAS TO RECEIVE 6 FEET. OVER ALL PERIMETERS WITH 8 INCH ALUMINUM DRIP EDGE, COLOR: WHITE BROWN SILVER COPPER INSTALL RIDGE VENT OR ❑ ROOF LOUVERS FOR ADDED ATTIC ILATION.' i ' STALL SOFFIT VENTS WHERE NECESSARY. SOFFIT SIZE TO DETERMINE SIZE OF VENT. Ly.11C OVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS. .OUNTER FLASH CHIMNEY(S) WITH ALUMINUM FLASHING AS NEEDED. 01 RELEAD'CHIMNEY. CUT ALL EXISTING TAR AND LEAD FROM 1_ CHIMNEY(S); C T E REGLET CEMENT AAZA NEW LEAD IN PLACE WITH MORTAR. IF NEEDED FOR A WATERTIGHT JOB,}TfYPF{f�`�. EBUILD CHIMNEY FROM ROOF DECK UP WITH NEW OR USED BRICK. ADD "'I' TO ABOVE PRICE. Er REPLACE DEFECTIVE ROOF DECKING WHERE NECESSARY AT CONTRACTORS DISCRETION. DEFECTIVE ROOF DECKING REPLACED WITH SPRUCE, FIRST /�2%� FEET FREE AND THEN � PER FOO -r THEREAFTER. PLYWOOD DECKS REPLACE SHEET(S) FREE THEN: PER., SHEET, BUY,AND,INST LL, HICKNESS COVER ROOF SURFACE WIT STORM NAIL ALL SHINGLES WHEN APPLICABLE SEE'MFG: IN R(TCTIO S). INSTALL SKYLIGHTS PROVIDED BY CONTRACTOR OR CUSTOMER; FRAME ROOF DECK' 'As 'NEEDED, PROPERLY FLASH UNITS WITH FLASHING KIT(S) PROVIDED, ADD TO PRIC.E.FCUSTOMER TO DO •;INTE;RIOF{FINISH WORK,,JNLESS SPECIFIED OTHERWISE. �s Id IF MORE LAYERS ARE FOUND THAN INDICATED ABOVE, AN ADDITIONAL CHARGE.01` : - S�S0.21.I WILL BE ADDED PER LAYER. IN THE EVENT OF MULTIPLE LAYERS IN RANDOM AREAS OF ROOF,.COST IS PER SQUARE (10'X 10 AREA TO REMOVE AND'DISPOSEIOF ADDITIONAL LAYERS. [CLEAN ALL•JOB RELATED DEBRIS FROM OUTSIDE WORK AREA. OBTAIN ALL PERMITS AND CARRYALL NECESSARY INSURANCES AS REQUIRED BY LAW. WE CANNOTACCEPT RESPONSIBILITYPOR DEBRIS FALLING LN.IQ37J1C AREAS CUSTOMER SHOULD COVER VALUABLES GREAT CARE WILL BE USED TO PROTECT rrrF ST UC RE AND LANDSCAPING DURING THE STRIPPING HOWEVER SOME MARRING COULD OCCUR t''•:1IEi'-:. .'1.1 ii r.rtt.,gtA it' ii+H/. WARRANTY /All work arranteed to be free of installation defects for �d years, limited to installed Item and its repair only. Material warranteed by mfg, to be free of defects for years, see mfg. warranty for exact warranty performance. Acts. of nature, including ice damming, are not covered under warranty. While under warranty if the homeowner hires any other contractor to perform work which may compromise the roof system without first contacting Joseph S. Savini, Inc. the warranty could be voided. Any repairs required due to the roof system being compromised by another contractor will be billable." Customer has legal right under federal law to cancel this contract without penalty or obligation within three business days from acceptance jdate by mail or telegram sent to Joseph Savini Roofing & Gutter Contractors, 40 Canal Street, Medford, MA 02155. See reverse side for'cancellation'procedures. Once all items in this contract are completed as agreed, customer has 3 days to fulfill payment schedule or pay all attorney and legal fees incurred by Joseph Savini with interest of 1.5% per month on the unpaid balance. All parties agree that all disputes will be settled through binding arbitration as provided by the Better Business Bureau or the Secretary or the Executive Office of Consumer Affairs and Business Regulations, MGLC._ 142A. Please see reverse side, Arbitration o' Disputes. t.,,1 • , ! e,l 'u ' •n t... Zicceptance,.of PropoSat -The above process, specifications:,. n t . ^ and conditions are satisfactory and are hereby accepted. You are authorized ,t„ ,, Signature to do the work as specified. Paymenj will be made as outlined above. Date of Acceptance: 7 / � Z U Signal Joseph S. Savini Incorporated D/B/A Joseph S. Savini Roofing & Gutter Contractors MASS BUILDERS 40 Canal Street, Medford, MA 02155 CONTRACTORS LICENSE #036954 (781) 395-3954 Fax (781) 3934926 pr� REG. 135743 ,�; t �d- -- M •PHONE PROPOSAL SUBMITTEDJO I DAT STREET i .. ,. ,. JOB NAME-. ,..s ... �.. r. ,,.. .. .,. ., • .. CITY, STATE M Z ODE •.. - JOB LOCATION r - • - - , Il,, I V ARCHITECT ATE bFrNS . - .. •I: ± JOB PHONE •. ?=VrOpuu hereby to furnish. material Wd labor - complete ,in. accordance with Specifications below; lar the sum of: • , dollars aymem to be n:aao as Iollows: One Third Deposit One Third Mid Job Balance Upon Completion, OR NOTICE: All home improvement contractors and subcontractors engaged In home Allt . improvement contracting, unless specifically exempt from registration by provisions Signa Ure of Chapter 142A of the General Laws, must be registered with the Commonwealth. ^J of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 'trfl'f r %I IT." ofpropose, f may bet' 1301, Boston, MA 02108. withdrawn accepted within days. We hereby submit, specifications and estimates for, ROOF WORK_, .+,• [TRIP ROOF OF 144/ �- � LAYERS OF ASPHALT SHINGLES, COVER EXTERIOR WALLS AND —/FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE. ADDITIONAL LAYERS WILL BE EXTRA, SEE BELOW It� OVER DECK WITH UNDERLAYMENT FELT. 1w f, ,`� Mt:rR1 ,t3;or 0 4> x ( tfytq NSTALL ICE & WATER SHIELD AT LEADING EDGE, VALLEYS AND ALL ROOF PENETRATIONS. �TANDARD APPLICATION AT EAVES IS 3 FEET. ALL LOWER SLOPED RO EAS TO RECEIVE 6 FEET. OVER ALL PERIMETERS WITH 8 INCH ALUMINUM DRIP EDGE, COLOR: WHITE BROWN SILVER COPPER INSTALL RIDGE VENT OR ❑ ROOF LOUVERS FOR ADDED ATTIC ILATION.' i ' STALL SOFFIT VENTS WHERE NECESSARY. SOFFIT SIZE TO DETERMINE SIZE OF VENT. Ly.11C OVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS. .OUNTER FLASH CHIMNEY(S) WITH ALUMINUM FLASHING AS NEEDED. 01 RELEAD'CHIMNEY. CUT ALL EXISTING TAR AND LEAD FROM 1_ CHIMNEY(S); C T E REGLET CEMENT AAZA NEW LEAD IN PLACE WITH MORTAR. IF NEEDED FOR A WATERTIGHT JOB,}TfYPF{f�`�. EBUILD CHIMNEY FROM ROOF DECK UP WITH NEW OR USED BRICK. ADD "'I' TO ABOVE PRICE. Er REPLACE DEFECTIVE ROOF DECKING WHERE NECESSARY AT CONTRACTORS DISCRETION. DEFECTIVE ROOF DECKING REPLACED WITH SPRUCE, FIRST /�2%� FEET FREE AND THEN � PER FOO -r THEREAFTER. PLYWOOD DECKS REPLACE SHEET(S) FREE THEN: PER., SHEET, BUY,AND,INST LL, HICKNESS COVER ROOF SURFACE WIT STORM NAIL ALL SHINGLES WHEN APPLICABLE SEE'MFG: IN R(TCTIO S). INSTALL SKYLIGHTS PROVIDED BY CONTRACTOR OR CUSTOMER; FRAME ROOF DECK' 'As 'NEEDED, PROPERLY FLASH UNITS WITH FLASHING KIT(S) PROVIDED, ADD TO PRIC.E.FCUSTOMER TO DO •;INTE;RIOF{FINISH WORK,,JNLESS SPECIFIED OTHERWISE. �s Id IF MORE LAYERS ARE FOUND THAN INDICATED ABOVE, AN ADDITIONAL CHARGE.01` : - S�S0.21.I WILL BE ADDED PER LAYER. IN THE EVENT OF MULTIPLE LAYERS IN RANDOM AREAS OF ROOF,.COST IS PER SQUARE (10'X 10 AREA TO REMOVE AND'DISPOSEIOF ADDITIONAL LAYERS. [CLEAN ALL•JOB RELATED DEBRIS FROM OUTSIDE WORK AREA. OBTAIN ALL PERMITS AND CARRYALL NECESSARY INSURANCES AS REQUIRED BY LAW. WE CANNOTACCEPT RESPONSIBILITYPOR DEBRIS FALLING LN.IQ37J1C AREAS CUSTOMER SHOULD COVER VALUABLES GREAT CARE WILL BE USED TO PROTECT rrrF ST UC RE AND LANDSCAPING DURING THE STRIPPING HOWEVER SOME MARRING COULD OCCUR t''•:1IEi'-:. .'1.1 ii r.rtt.,gtA it' ii+H/. WARRANTY /All work arranteed to be free of installation defects for �d years, limited to installed Item and its repair only. Material warranteed by mfg, to be free of defects for years, see mfg. warranty for exact warranty performance. Acts. of nature, including ice damming, are not covered under warranty. While under warranty if the homeowner hires any other contractor to perform work which may compromise the roof system without first contacting Joseph S. Savini, Inc. the warranty could be voided. Any repairs required due to the roof system being compromised by another contractor will be billable." Customer has legal right under federal law to cancel this contract without penalty or obligation within three business days from acceptance jdate by mail or telegram sent to Joseph Savini Roofing & Gutter Contractors, 40 Canal Street, Medford, MA 02155. See reverse side for'cancellation'procedures. Once all items in this contract are completed as agreed, customer has 3 days to fulfill payment schedule or pay all attorney and legal fees incurred by Joseph Savini with interest of 1.5% per month on the unpaid balance. All parties agree that all disputes will be settled through binding arbitration as provided by the Better Business Bureau or the Secretary or the Executive Office of Consumer Affairs and Business Regulations, MGLC._ 142A. Please see reverse side, Arbitration o' Disputes. t.,,1 • , ! e,l 'u ' •n t... Zicceptance,.of PropoSat -The above process, specifications:,. n t . ^ and conditions are satisfactory and are hereby accepted. You are authorized ,t„ ,, Signature to do the work as specified. Paymenj will be made as outlined above. Date of Acceptance: 7 / � Z U Signal Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofi Siding, Interior Rehabilitation Permits ilding Permit Application orkers Comp Affidavit jhoto Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract ❑ Floor Pian Or Proposed Interior Work.)V/, - ❑ Engineering Affidavits for Engineered products /V/, NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 1U114, 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 ❑ Fioor/Crossection/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 NOTE: 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 u Photo of H.I.G. 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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 mast 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 2008 S -d 2i►S68898L6 d3AOaWd HINOW ege c t T 01 60 ReW The Conimoti wea tli of .4lassach usetts Department of In<lustrial AccMents Office of Ili l,estiaatioiis 600 Washington Street Boston, I fA 02111 ��='�'s�� rvww,IllltSS',oOt�/tlil! Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plunlber•� Applicant Information Please Print Legibly Mille (Business Oreanizanon Individual): Addt'ess: : -(o I .. City/State/Zip: Phone #; Are ypIdan employer? Check the appropriate box: I. 1 am a emplcyer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).` -- have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. i ship and have no employees These sub -contractors have working for me in any capacity, workers' comp, insurance. fN'o workers' comp. insurance 5. ❑ We are a corporation and its i required.) officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL i myself. (No �.,orkers' comp. e. 152, §1(4), and we have no insurance req.,ired.)' employees, [No workers' comp. insurance required,] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additio:•, I l.❑ Plumbing repairs or addition. 12.7 Roof repairs 13.❑ Other *Any applicant that chcc;;s box 91 must also fill out the section below showing their workers' compensation policy information. ' Homcossners who submit :his affidavit indinting they are doing all work and then hire outside contractors must submit a new affidavit indicating sucn. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy infomtation. I am an employer that is providing workers' compensation insurance for mY employees. Below is the policy and job site information. , _ Insurance Company Nlame: Policy k or Self -ins. Lic. 9: C_ 95S 3a Sa,A Expiration Date: ­,�o10 Job Site Address: 5�So &Nefn SA- City/State/Zip: b64 -4X, �;aJ e V— Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MCL 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 foal( of a STOP WORK ORDER and ; fne of up to 5250.00 a da . against the violator. Be advised that a copy of this statement may be forwarded 4o the Office of Investigations of the DIA for insurance coverage verification, I do hereb.t' certify " the pains and gnalties of perjurl' that the information provided above is true and Correct n Official use only. Do not write in this area, to be completed b.p cith or town official. Ciry or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3, Ciry/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other � •��,V!G.r, I �\ � li i � !fit �i�`%4`y � �� " `r i� �'7`�y ,r •. �,�t�. , :-` j�i4'.'- rK f,,�{1�i,'i,.7i ltl�:r lYa�l i ly' ` �f I '�`5�P',•,;Jx� .f i 1jOIv1E MPROYEIY= CONTRACTOR LAW Supplement to Permit Application MGL 1.124 R'-�uires U} u u1.1___�_It G CER25"T'��_�aion rcnpvatiQD, =air, mpdMizarion 4o��n¢ imoro�cmcnt rtrnov-e dcnwlidpnQr coruuvstion of �n WN n w ury zlnina oWnct-4c iso �,Adjn¢ wn;4nins u Isw ons bus w mors char four �weilin¢ wiu or M"VZ mss. which vs �d;.; ne W such r,s*WSMa or buildlrm be done by rvy sTcr coaoaenrz w,� • � .-,.•,'...:, ilan� vetch. j , .� � rtgtjrcmcna. T oca�on ofProperry: c Owacr Name and An nav) b Da: c of P crr-t A.pp k at i o a: Est_ Cost: i � �l 9 Typc of Work: I Eby certify that: RFGiSTR MN IS NOT REQUIRED FOR THE FOLLOWNG REASONS: work =hLdcd by law job under S 1, 000 buLdmg not owner -occupied 1�:.�ir.�j:i.. �Y::��, ... .... ,� �,',�.�r'+.4'd^"fit ''�`�`?.yl', '°•"' ', �/ .. other tspcct<y Notitt is h.crcby given tfr� .. �.••'J.:•J`f is �, �• .: •,� OWNERS., PULLING THEIR OWN PERlvff' .0R DEALING �TTH UNREQI� `CONTRACTORS��FOR"APPI.�CABa' �£ HOME 2 RQY��NT WORK DO NOT HAVE ACCESS TO TSE AR.BITR.ATION PROGRAM OR GUARANTY FUND MGL c 142A. S4ncd Lmdcr peashics ofprr7uzy, I hs�reby'apply for a permit as the agttrt of LHC owner- - Cmautyr Name (print) Daze :2 C-0 Co aczcto r S igrartzrc _ Rcgistratio n N umbe r OR Norwkhs ai the above notice, I hereby apply for a permit as the owner of the above property: Owner Name (priest) Dtzc Ow= S ignazurc �... � it � al�if� �'�'•!:. , ' .•. .. ✓rk l�J(YJlliJll(YJZCU2CLGlIl 4��!'GCi06CLCIGG[O(KGo .^_�—_. _.... - _ Oflice of Consumer Affairs &Business Regulation License or registration valid for individul use only —�` before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation kJ f?egisiration::— 135743 10 Park Plaza - Suite 5170 E'ixpiration: 5)3/2012 Tr# 294393 Boston, MA 02116 7YPe JOSEPH S. SAVINk.CONTRACTING CO. JOSEPH S:,VINI 40 CANAL:]"' O MEDFORD %1A 02155 Undersecretary of valid with ut signature ,.a r 1VVIa ct►usettx ` .'0epartment of Public SufeO, iw $oard`:of Building Regulations and,Standards U pu�jp1 ervisor .7. LlUcense M1 t 1 - i J-•��'t . 4 1-yfK1Y dfr t FII '1' 7 1 1 i, ' '' �" i �f i - t fdt.. a ,.:M Ff 114 3 Nt2; ��>:'^7+f -• r . 1. stt ��sraFf{�'p ti{ ti yt r r+ . ,i .gyp DFOD 7 /=01 i1 f ..,• .: 1 : , .,,,C.uauulstiQile r \ ; et -Tr# 1%%32 if LAr A�. R St•^"+ y _ t�' a 'i'. of r t '.: • 9 J•..` i ` .r �yi,r ,!J : '�° Fµ 4r„ v kw �.: c {r!, r � �: x i,.l s � 1 a} ,V-. 7 �`•p '•' �" '' '( •"'iSht�:. bJd ^sq° {Wctid{WW rG - �lf.�gE�Q�•' r t 11 � 4 i I r. 1 Z.: � Fa ti d � �1 { .- 4 } `1 .. - t $ �71'��1�1P lt �aY _ � •icy,! tc t q it � r y�.r}x 1 '�S amtrr'r s ,,F c t r r, , • i . IY v y jt, "i ^ t'1,�.� �y .t a ••, T �,# s2 ft 't tr.{117. t - t'• vE r ., 1 Yd � �G ���j�ROChr iflksevi=tLta �.}��are, Ja nor y7 1� Y .7 { i�Ssrz.r�..(1 {�f}{G ,SE.4v !4�517��`�y "' Sh d•fi}r i 1� t ttd 4 r,i .. 1 y v^: rykls•°t lr� I'E.'f✓ i' z i �� YI s'F n aar4 Tr,E - �f ti�t{,SC"4 1l'iis{ Y wi yrsT rk , Y .!i i„ 11z{✓ 1 t1 t t a:1 1 t Y ssess a current'edi on`of the r lrl Faliure to po'C�de Massachusetts State Buil 1 x is cause for revocation of this license. aS�,ti N MVV ov%DPS � ,f Refer to 7 E r � ins d .L' g Jk�•'S - '9 3s tt .. .tAtiw . v.. w.. i ti ,n F t1:+".-..•'A'.M1}.T✓S•Yi/.... .ry+•,.s. � M .:dJ". -'� R ' Iw .!rv+NY � .. Y U V Y CHAU C:7 ACORD. ,: CERTIFICATE OF LIABILITY INSURANCEiDAT TER ice» VANU0El1, , Phone- 508-651-7700 Fax: 309-653-9009 Eastern Insurance Group LLC-Commerc+al Linos 233 West Central St-eet - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick MA 01760 Y XPIRATION + LIMITS VEPsys POLICY NUMBER INSURERS AFFORDING COVERAGE NAIL # INSURED INSURBA:Max Specialty Inslarance Cc INSUIPIER&HanOver insuranceco. 22292 Joseph S. Savir,i, Inc. 40 Canal Street Medford MA 02155 IARC. 1 E USA INSURER D: INSURER E: r4 V U V Y CHAU C:7 THE PJLICIES 0? INSURAi�C? LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOC INDICATED. N0:'AI:HSTANDING ANY REQUIREMENT, TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUISNT WITH RESPECT TO WHICH THIS ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, SHE I'�suRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN :S SUBJECT TO ALL THE TERMS,:EXCLUSIOVS AND CONOIT.CN9 OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Y XPIRATION + LIMITS VEPsys POLICY NUMBER TYPF OF INSURANCE GFNERALUABIUTY bLA]C013100vG1667 .0! 21%20'G9 1G 21 J2O� O ; EACHOCCURRENCE 11. 00,31 000 _ COAA)11ERCUU GEN ErTAILJAEILRY PREMISESIEa00a s ' 1 S 5. 000 CLA!►/SUAOEI� OCCUR 11EDEXP oro i 1. 0 3. 000 I I : PERSONAL a ADV IMURY I ; GENERAL AGGREGATE s2;000,000 AGCiftEGATE LILU T APPLIES PER: s'00 -.00c I PROOUCYS • COMPIOP AGG FGENL POUCY PRO LOC AIITOMMLELIABILITY i•L2N870061:02 4/251-'20L9 4i25/2010 COMBINED SINGLE U.aTI I S 1, 00'J, +� v+- ANYAUTO (Eaacddwi) ALLOWIEDAUTOS BODLYW,AIRY s (Pat PocuU SCHEDUUEOAUTOS IL HIREOAUTOS j GODLYKAAtY MONOWNEDAIITCG i PROPERTY DAMAGE fu &ODOM) i S GARAGE LIABILITY ALITOONLY •EAACCIDENT s ANYALrrO } OTHER THAN EAACC S �' ; AUTOONLY: AGG S EXCESSUWSRELLAUA84UTY HOCCURRENCE S OCCUR CCW 1 tS MADE AGGREGATE S , S + DEOuCTiaLE is RETENTION s S C :WORKERSC011PENSATSoNAho C4583282A 9!12/2009 9 /12 /2010 IX } "- EYPLOYERr U&NUTY ANYPROPRI TOWPAXNEN1-: ECUTIVE E.L EACHACCIDENT 3 tk��...._.._ i OFFICERAAEMBEREXCLUDED? E.L. DISEASE • EA EMPLOYEE S 500. 22 00 -`- : B ds FRONT m 09Uw E.L. DISEASE • POLICY LIMIT ssoa. 500 'OTHER DESCIVIVN OF OPERATIONS 1 LOCATIONS 1 VEiCLES I EXCLUSIONS ADDED BY @LOOMMENTY SPEC ALPwwwo"s i �iI33�1�T�711Td'_Gl<n N��rN�urc.r. AC DRD 25 (2001 /081 O AGORD CORPORATION 1985 + SHOULD ANY OF THE ABOVE-DESCRIBED POLICIES HE CANCEL -EC BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILT, VINDEAVOR TO MAIL 30 DAYS WRITTEN ?NOTICE TC 711E CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILUR2 TO W '0 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE AC DRD 25 (2001 /081 O AGORD CORPORATION 1985 +