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HomeMy WebLinkAboutBuilding Permit #338-2016 - 554 FOSTER STREET 9/16/2015 c� e_Ali/All- �+ c NORTh 9/2,/lis 4 Of ct�eD �6'9{' 7 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * - Permit NO: I Date Received .950 ATE° Date Issued: SACHUS� 'IMPORTANT: Applicant must complete all items on this page LOCATION Print -PROPERTY OWNER _ Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yeno Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 5t One family ❑Addition ❑ Two or more family 0 Industrial ❑Alteration No. of units: ❑ Commercial )(Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Watershed District 0 Water/Sewer �� / (,[/riYT 2 J'/�z au/r-Z-34'1it,11�/t. ,Ti✓J`T7►1,4- tl M�t.�-t�✓� /1�.C�h'(�-t.�tin,/'4i �/7n/G-t�? �Ls�.� � Clfy Identification Please Type or Print Clearly) OWNER: Name: Y lbl/ ucy Phone: (�Zi 7,q 4/ -/92-/ Address: CONTRACTOR Name: = _� Phone:� ? 1 - SS'1 : crn/it tom- /TWkJrtnwyC__.' Address: a I / f,✓ N^� - 0190. r Supervisor's Construction License: Exp. -Date: Home Improvement License: - Exp, Date:- fto ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER .F. Total Project Cost: $ J � r FEE: $ Check No.: 2&1 V Receipt No.: lZl NOTE: Persons contracting with unregistered contractors do not have access to th aranty fund ignature of Agent/Qwnerr. u0Signature of contractorJ U ' J BUILDING PERMITo "O oT"�tio TOWN OF NORTH ANDOVER or APPLICATION FOR PLAN EXAMINATION h �O « 1m Permit No#: Date Received 7q RA I•P ,�'(� SSACHU`�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 31 _ rmt, P - - PROPERTY,OWNER . P, St` its 1 o0 Yeari ruc ure yes, no MAP' PARCEL ". '. ZONING DISTRICT _ -`_Historic District, yes. no- 77. Machine Sho Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other TO_Septic ❑Well p;VVetlands El1Natersli:ed District` 11 Water/Sewer �' '� DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: #Coritractor"Name ;. r. z Email: ' Address ; ,Supervisor's Gonstruction,License Exp; 2Date: : - _ - i } Homeklmprovement;Licen§e Exp Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the gullrano fund Signature of Agent/Owner Signature of contractor . -- --- - - - -- Location _ No. �U �4�7 Date c - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $7 Other Permit Fee ,/✓� $ TOTAL $ Check# �� , Building Inspector 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ 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 Osgood Street EFIRE}DEPAR2TMENTf ;Temp Dum _ ,� Locatetl at 1241MainsStreet : ` r1S e4 eYp Aster o it Fi"re�Departmebt /date':. COMMENTS,' -----------LL r E 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 Building Department j 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 NOTE: 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 o 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 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 ❑ 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 ❑ 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 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 r 1 NORTH - c ve . 0 h ver, Mass [OC NIC«ew,cK y1. A04ATED J"r s � BOARD OF HEALTH Food/Kitchen PER.M1 LD Septic System THIS CERTIFIES THAT ................... BUILDING INSPECTOR ....................... ... ........ ...... .. ............ ....... . ............... .. .... Foundation has permission to erect ........ ................. buildings on ..... ... ....... .... ..,................ ................................................................... Rough to be occupied as .......... .. .....��......... ....��.... Chimney provided that the person accepting this permi 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. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TS 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 To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. National Management Team Inc. This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not Include standard language to protect homeowners. Seek legal advice If necessary. Any person plamhing home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Iinprovement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name ComppaanyNameAAAq / Street Address do not use a st Office Bos address 1 Contractor/Salespersoa;0mier Name ON City.fovea State ,/ /Zip Code Business Address(must inc hide a street address) 0 0 ANO(JV�T — ®Igo Daytime P e Evening Phone CityToav State Zip Code -79-Y y , x770 Mailing AAW99 at fiom above) Business PlLone I Federal Enhployer ID or S.S.Nuunber ~ oo Home Luprotrontem Contractor Nanem �,�y �/�,^, Low requa�rs last moN hour eaa�tronare OWk amproremetlt olonMiaui b r / A t•and rrBhtlNtlOtl tltlIOUlr (r,/ o0000 The Contractor agrees to do the following work for the Homeowner. O t Mescrbe in detail the work to cot tete up d specifying dhe qpe,brand;and grade of materials to be used nae additional sheets if necessary.) 00 z S(-Ahe OvO fik�_Aois- Aot„✓ 1Nr1rd o.,vq .12_v,Jr� G r.� 0,,(-- w as w ( � e►t�c�`-e,t wee�-�?su�.> -Jryi,✓ S, Inerecop E&qt Q O Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will G �tiY and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise Z a a tn (Owners who secure their own per•ntits will be 6 ZA excluded from the Guaranty Fund pro�Rsions of ( l Date when contractor will begin contracted work. a 03 tom, 0000 MGL chapter 142A.) Z a"„�� 7 Date when contracted work will be substantially completed tT Total Contract Price and Payment Schedule C,+ 0 •� The Contractor agrees to perform the work,furnish the material and labor specified above for due total stun of. Payments will be made according to the following schedule: t7e N Qt $ 0 o upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) S by—1_/or upon completion of S by_I I or upon completion of S�upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion scliedude.(°ih $ to be paid for NOTES:(')Including all finance charges(°e)Law requires that any deposit or down-payment required by the contractor before work begins niay not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made anterial which must be special ordered in advance to meet the couupletion schedule. Express Warranty-Is an express warranty beim t/fs provided by the contractor? No 11 Yes tali terms of the warranty must be attached to the contract) Subcontractors-Ile contractor agrees to be solely responsible for completion of the work described regardless.of the actions of arty third party/subcontractor utilized by the.contractor. The contractor further agrees to be solely responsible for all payrnents to all subcontractors for serials and labor under this a--reement Contract Acceptance Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document•the contract shall not imply that any lien or other security interest has been placed on the residence. Re,.iety the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Inhnroyement Contractor The law requires most home improvement contractors and subcontractors to be registered with due Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston.MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance?Ask the Contractor for his insurance company information so that)rou can confirm coverage,or ask to see a copy of s"proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on die reverse side of this form and get a copy of the Consumer Guide to the Home hnprorement Contractor Law. You may cancel this agreement if it has been signed at a place other.than the contractor's normal place of business,provided you notify due contractor in writing at his/her main office or brach office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellati2l form for an explana' his right. DO NOT SIGN THIS CONTRACT IF THERE AREVANK1ro i enticat copies ofthe contract must be emutptetedand sipred Ouecopyshadd go ro the Ironro. omcow Signature Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an ' alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has wit-ho homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the cons r shall be required to submit to such arbitration as provided In Massachusetts General Laws,ch 142A. i Homeown r ignature on o s tgna NOTICE:Th signatur s f the parties above apply only to the agre en f the parties to alternative dispute resolution initiated by th contractor. The homeowner may initiate a ative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Horne Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts cavy an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been tilled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a firlly executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/lrerself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of fiords not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of fiinds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at btto://www.nnass.izov/ocabr/ If you want to verify the registration of a contractorpr if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at htro://ww'y.miss.Lov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state,ma.usAioineiniproveinent/liceiiseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/22/2010 The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusiaesslOrganization/Individual)'✓•'/�,�f�i%�ic//�7 � .%IA1�1Y�/1'?r�Ni ice/' �-� /6l/L° Address: , City/State/Zip: A fI/ �� S�Phone#: � � � � � 7© Are you an employer?Check the appropriate box: 1.0�11,am a employer with /O 4. El I am a general contractor and 1 T'pe of projects required): employees(full and/opart-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling .- ---ship-and-have_no-employees- These_sub=contractors-have- or g for me m _... addition- - - - _ [No workers'comp.insrance - coin nsrnce. required.] :•. 5. E] We are a corporation-and its. 10.Ej. l hncalrepairs or additions 3..0 I am a homeowner doing all work officers have exercised their 11: Plumb' [,� mg repairs or additions myself.,[Noworkers'comp, right ofexemptioaper MGL insurance required.]tc.152,.§1(4),and we have no 12•[ oof repairs employees.[No workers' 13.❑Asher comp.insurance required.] *Any applicant that checla box#1 must also fill out the section below showing their workers'compensation policy information. Iiomeowne:s who submit this affidavit indicating they are doing all work and then hire cut*c Ontmotom must submit a new dEdul indicating such. ;Contracbrs that check this box must attached as additional sheet showing the name of tho sub-contractors and stats whether or not those entities have employees. If the sub-contractors have employees,they must provide their wodmrs' comp.policynumber. I am are employer That L4 providing workers'-compensatlon insurance for my employees Below is the o information. p lky and Job site Insurance Company Name:_ AA/d.'com -0,NVJ Policy#or Self-ins.Lie.#: [ 7 Z 23 7_� Expiration Date: Job Site Address• City/Statcaip: JV�/� 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 MGL a 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 DRDER and a fine of to$250:00-a •— ---- - ----- _uP —_-----day_agawstthevio r. Be-advised Office of Inv ti shops o t-h ... e�IAormsuran vera a erification. I do hereby certify under the pa d enalties of perjure!that the information provided above is true and correct Si are: ate• one i v Offici7eDoo not write in this are , o be completed by city or town officiaL City oPermit/I,icense# Issuinircle one): 1.Bg2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.O�tContPhone#• A CERTIFICATE OF LIABILITY INSURANCE W) THIS TMS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CON 8/14/15 FERS NO IGHTS UPON THE CE9rIFICATE 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 re an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERCONTACT Circle Business. Ins. Agcy, Inc PHONE 247 Newbury Street 978 777-5619 aX No; (978) 771-4896 EMAIL Danvers, MA 01923 ADDRESS: INSURE ---------NO COVERAGE NAIC# INSURED INSURER A:Hartford Underwriters Ins. CO. National INSURERB:Main Street America t oval Management Team Inc. 2 Austin Square INSURERC:Torus National Insurance Co. Lynn, MA 01905 INSURER D:Merrimack Mutual Insurance 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 SR BY PAID CLAIMS. INADDL SUER LTR TYPE OF INSURANCE POLICY EFF POLICY EXP INSR WVD POLICY NUMBER M/DD/Y MMIDD/YYYY UMTS $ GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY 24/16 y Y MPT7965M 2/24/15 2/24/16 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE �OCCUR E u ce $ 500,000 MED EXP Mona person) $ 10 000 PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY x— PROT- LOC -PRODUCTS-DOMP/OPAGG $ 2,000,000 B AUTOMOBILE LIABILITY $ Y Y MPT7965M 2/24/15 2/24/16 CeaBINEDSINGLELIMIT ANYAU70 $ 1,000,000 ALLOWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS % NON-OWNAUTOS ED P eOPERTaccidnD�GE $ C JUMBRE;JI LIAB OOCMS Y Y 85824I140ALI 2/26/15 2/26/16 EACH OCCURRENCE $ 5000 000CESLIAB CLAIMS-MADE DED RETENTION$ AGGREGATE $ 5,000,000 A WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY UB2E71937-6 2/21/15 2/21/16 1{ WCSTATU- OTH- ANY PROPRIETOR/PARTNERIEXECUTVE Y/N OFFICE(Mandatory In NH)MBER EXCLUDED? 7 N I A E.L.EACH ACO DENT $ 1 000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ 1,000,000D ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Rental Equipment cover IMC8-454-711 5/21/15 5/21/16 Limit 100,000 REPLACEMENT COST Deductible 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR ZED REPRESENTATIVE Janet Nichols ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: s Office Wf Consumer Affairs WWBu�sine�ss �egula�tjon ®r . 10 Park Plaza - Suite 5170 Boston, M sachusetts 02116 Home Improve� g ontractor Registration � � �– Registration: 178188 m Type: Supplement Card NATIONAL MANAGEMENT TEAM Expiration: 3/24/2016 GEORGE VASILIADES ; 2 AUSTIN SQUARE LYNN, MA 01905 S.' Update Address and return card.Mark reason for change. SCA 1 0 zoM-osnI � Address E] Renewal El Employment F-1 Lost Card ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROV ENT CONTRACTOR before the expiration date. If found return to: egistrati Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expire I — Supplement Card Boston,MA 02116 WW i NATIONAL MANAA�NC. w GEORGE VASILIA P.O.BOX 365 `�,,•� � _ T/1r1l.rl rl I1 •wA w�www _Zk S N. • _ � Massachusetts_ t • Board o Buitdin Department df Public safety g Regulatidns and standards •f Coris�rucklon;Supervisor '.License:AT CS.{180iet5 i • �OXtGE YASII1�kb ;:'� :i. �; s � 7(Cki[MA.OJ§38 Commissioner Expiration 10bZ6/2dg5 t