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Home My WebLink AboutBuilding Permit #1203-2016 - 575 OSGOOD STREET 5/17/2016 0� �ORYl1 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINA-11GR * e7b4q Permit IVo#. Date Received_ ��S�gcHus �cy Date Issued: I RTANT: Applicant must complete all item§:on thus-page LOCATION _ qnt PROPERTY OWNER Print 100 Year'Struchire yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shap 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 Is Repair, replacement ElAssessory Bldg El Others: ❑ Demolitioner xr D Septic. ❑�Well�� ❑ Floodplain D�Wetl'ands. �( ❑ �1Natershed:IE:istnct� � - - q ESCRIPTION'OF WORK TO BE PERFORMED: � W t n C4O I e"74 rn a ccJ - r Identification- P ease Type or Print Clearly OWNER: Name:_Z�eUncl We iA -e + Phone: t r.agL�-� jf (I Address: S ®0 5jre�t. Contractor Name: G Phone: '� `J19 Email: r-eo c Address"'J ® t ib ' 3 Supervisor's Construction License: L' S -47®2c�p p Exp_. Date: 3�1�� Home Improvement License: l a6 57 5 Exp:..,Date:::. . ARCHITECT/ENGINEER Phone: "-� Re .No Address: ge FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED cas-r [SH)FO 4125.00 PER S.F. (20 Total Project Cost: $ - FEE: $ Check No.: Receipt No:.:,-.` NOTE: Persons contracting with unregistered contractors do not havc_,access-.to..the guaranty fund 4, 3 -- Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work NA Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit �)A 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) 4- 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 Jr 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 J Plans Submitted ❑ Plans Waived 19---_� Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ rilnlnmg Pools ❑ Tanning/Massage/Body Art ❑ 4 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS c '.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: t "m""" -7,3�'- ��.,^ s i _ �y�z Located 384 Osgood Street SIRE DEF?`AIZ+TMEIVTTem Dum stet on situ # ill 10, at 124 Mam Str e T �'� �` _ ' �� `" R* 17 ±,Fileepartment�ignafure/ted fe ..� F ,. t.. f n � a��"�� v ate --•-".�. rte} - "'L rec ,- tp1. riy fAl `�}. + t+ �'. s-,•i `M+„' Ti T41 Z4 _ i �CMMENT �� .3. r ^ .� Dimension Number of Stories: Total square feet of floor area, basef: ` terior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, wast or service dres 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.Bnilding Permit Revised 2014 Location "r ocat o K No: / 2 b al Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ f Foundation Permit.Fee $ �. Other Permit Fee $ TOTAL Check# 30304 Building Inspector NORTft _,own of ndover o : :. - � �► 141 - h Ma y � ver,� � � , ss, ri1 'Q COC NIG Nl W1CN V , x.95 GATED V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System �.�''0.�� .. ... BUILDING INSPECTOR THIS CERTIFIES THAT ............. ... ................... � ..... ............... has permission to erect buildings on .... - 5 Foundation .. QWL Rough to be occupied as ........a...... ....... .... ......�.�.. . . .�.�................................. 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. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service .............. ....... ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. ZALANSKAS CONSTRUCTION 34 BIRCH ROAD ANDOVER MA 01810 978-835-5194 GREG.ZALANSKAS anCOMCAST NET QUOTE# 3 Order# Date 1/25/2016 QUOTE SUBMITTED TO: WORK TO BE PERFORMED AT: Name Ed ewood Retirement aft Rick McCloskey) NameStora a Sam Address 575 Os ood Street Address city-state North Andover Planned Date Phone email RE loskey ed ewoododre.com Job Description: Remove 8 window sashes from top of Barn and install 8 New fixed Vinyl extended half round unit,White,grills between the glass,The grill between the glass will match the existing design.The new windows will be Harvey Industries. All debris will be removed from site.$50.00 ermits$175.00 Product cost$$704.00 x 8 units=$5632.00 Installation and materials$1100.00 Windows take roughly 4 weeks from order date. Painting not included. Due to the inconsistency of the openings,I will order 1 window as a markup.Then order the other 7. All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of: $6,957.00 PLEASE MAKE CHECK OUT TO ZALANSKAS CONSTRUCTION with payments to be as follows $5200.00 deposit to order $ 1365.00 due at completion Submitted by: GREGORY ZALANSKAS OF ZALANSKAS CONSTRUCTION Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work specified above. Payments will be made as outlined above. Accepted by: �3 Please note: This proposal may be withdrawnr6y us if dot ac9fipted within 30 days �--� HARVEY Manufacturing !� ® ACKNOWLEDGEMENT= BUILDING PRODUCTS Harvey Industries..Inc. 1400 Main Street.Waltham,MA 02451-1689 (781)899-3500 harveybp.com Salem Q Raymond Road SALEM.NH 03079-9283 Phone:(603)893-1611 Fax:(603)893-8196 BILL TO: SHIP TO: 34 BIRCH R CONSTRUCTION 34 BIRCH R CONSTRUCTION AIm 34 BIRCH ROAD 34 BIRCH ROAD ul��l� b 'vllung III' 'U ANDOVER,MA 01810-0000 ANDOVER MA 01810-0000 Ph o e: 978-409-1773 Fax: 9783730736 Phone: 978409-1773 Fax: (978)373-0736 QUOTE NBR CUST NBR CUSTOMER P01 DATE CREATEq DATE ORDERED ORDER TYPE 3909863 1036881 -0 11/20/2015 Quote Not Ordered Cash ORDERED.BY STATUS . SHIP VIA DELIVERY AREA None Whse Pickup SALEM WAREHOUSE CLERK JOB NAME COUPON rail -CoryJolicoeur None LINE# DESCRIPTION QTY 10000-1 Vinyl Shapes Extended Half Round,Unit Size 36.5 x60.5,RO 37 x 61,- 1 EXTENDED LEADTMffi ....w,..>, Frame Short Side=42.25,Frame Radius=18.25 ^ ` Window Label=None Overall Glass Thickness=7/8"Insulated,.Double Glazed,Low E Argon Fill DSB,Custom Annealed IG=Yes IG MFG= CL Unit 1:U-Factor=0.28,SHGC=0.3 1,VT=0.57,NFRC CPD Number=HII M 30 00177 00002,Replacement Unit 1 Glass:NFRC CPD Number=HII M 30 00177 00002 Energy Star — Base Color=White Contour In-Glass,Colonial,Match Frame,3W4H Overall Rough Opening Width=37,Overall Rough Opening Height=61 Room Location: None Assigned "Note:Delivery charges may apply and are not included on this quote. This quotation is based on our interpretation of the information provided. All quantities,sizes,extensions,grand totals,and specifications should be verified by the contractor prior to his/her bidding or ordering of materials. Harvey Industries,Inc.,is responsible only for the items as quoted above. Any changes or addendums will be subject to a requote. We propose to supply the materials as described above,subject to the terms and conditions as required by our credit department. The prices are guaranteed for 90 days from the date of quotation unless otherwise noted Delivery charges may apply and are not reflected on this quote.We appreciate the opportunity to quote this job. If you have any questions,please call your local warehouse. CUSTOMER SIGNATURE DATE I IMPORTANT NOTE Please be aware the Energy Star requirements are changing for the Northern zone On January 1,2016. Orders placed after 12/31/15 will be subject to additional costs to meet hese new Energy Star guidelines,If applicable. Last Update:11/20/2015 8:41 AM Page 1 Of 1 Printed:11/25/2015 10:24 AM The Commonwealth of Massachusetts F Department oflndustrialAceldents F 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 Legib Name (Business/Organization/Iiidividual): a ✓� Address: MV City/State/Zip: � k4&9 AMOPhone Are you an employer?Checktlie appropriate box: Type of project()required): 1.®.lama employer with_j2 , employees(full and/or part-time).` 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in S. Remodeling any capacity.[No workers'comp.insurance required.] 9. F!Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t [�4.4.F] m I aa homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12..FJ Plumbing repairs or additions 5. I am a general contractor and I have hired sub -contractors the su -contractlid attachedt ors steon the sheet.❑ 13.�]Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 ' 6.[I We are a corporation and its officers have exercised their right of'exemption per MGL c. 14. Other 1,J l rr 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who snbuiif 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-contractors fiaye employees,they,crust provido them-workers'romp.policy wimber. X am an employer that is providing workers'compensation insurance for my employees.'Below is thepolicy and job site information. 1i Insurance Company Name: .t'1 Q- �'t.C, �► Policy#or Self-ins.Lic.#: WC_LD 0_-5 4000 Expiration Date: /0 a l I i6 Job Site Address:_, (0-,"04 Jte 1 City/State/Zip: /y (19 / 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. Ido hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Sign Date: l� Phone#: �� Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone#: Information and Instructs®ns 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 OHre, expres's 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 enferprise,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. Howdver 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=contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited.Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(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 I AC RO V CERTIFICATE OF LIABILITY INSURANCE °ATEM"°°°"""' 05/16/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy.certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NONTACT AME: Diane LeBlanc _ DOHERTY INSURANCE AGENCY INC PHON•o•EIO; (978)475-0260 FAX N,). _ ADDRESS: dleblancGdoheqinsurance.com _ P.0 BOX 1985 INSURERS AFFORDING COVERAGE NAIC a ANDOVER MA 01810 INSURER A: ATLANTIC CHARTER INS CO 44326_ INSURED INSURER 8: GREGORY ZALANSKAS INSURER C ZALANSKAS CONSTRUCTION INSURER D: 34 BIRCH ROAD INSURER E: ANDOVER MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER: 53280 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 REOUIREMENT,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. ILTR NSR ADDLSUUN TYPE OF INSURANCE POLICY NUMBER MMfporfYYYIPOLIO EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S _ CLAIMS-MADE OCCUR DAMAGE TO REN Ihu PREMISES fEa occurrence) S MED EXP JAny cno n) S — N/A PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY JE D LOC PRODUCTS.COMP/OP AGO S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGL LIMIT S Ea e..nl _ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per acudeal) S AUTOS NON-OWNED PROPERTTOS (Para Y DAMAGE HIRED AUTOS Paramacnt S S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MAOE N/A AGGREGATE S DEO RETENT.ONS $ WORKERS COMPENSATION X PER DTH• AND EMPLOYERS'LIABILITY /� STAT Y l N UTE ER ANYPROPRIETOR/PARTNEIUEXECVTIVE A OFFICERIMEMBEREXCLUDEDT NIA NIA NIA WCV01264000 10/02/2015 10/02/2016 E L.EACH ACCIDENT S 500,000 (Mandatory in NH) E.L.DISEASE.EA EMPLOYEE S 500,000 If describe under E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS below NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.AddManal ROMAs Sahodute,may be suachod it more space Is required) Walkers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by aocessing the Proof of Coverage-Coverage Verification Search tool at www.moss.govlMrd/workers-compensadonrrnvestigationsl. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Edgewood Retirement Community ACCORDANCE WITH THE POLICY PROVISIONS. 575 Osgood Street AUTHORIZED REPRESENTATIVE North Andover MA 01845 ( ` Daniel M.Croy.CPCU,Vice President—Residual Market—WC RIBMA f 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD Client#: 10322 ZALANSKASCONST ACORM CERTIFICATE OF LIABILITY INSURANCE 5/16/2016""' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 1985 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 21 Elm Street Andover,MA 01810 INSURERS AFFORDING COVERAGE NAIC# INSURED Zalanskas Construction INSURER A: Artlelia Protection Ins Company INSURER B: Gregory Zalanskas (DBA) INSURER C: 34 Birch Road INSURER D: Andover,MA 01810 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AWYN Tp TYPE OF INSURANCE POLICY NUMBER PIDUCV Ei VE POLICY EXPIRATION LIMITS A GENERAL LIABILITY 8500022056 06/15h 5 06/15/16 EACH OCCURRENCE $1.000.000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S QQ 000 ISE CLAIMS MADE F_x]OCCUR MED EXP(Any me person) $5,000 PERSONAL d ADV INJURY $1 000 000 GENERAL AGGREGATE s2.000.000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMROP AGG $2,000,000 X1 POLICY j LOC AUTOMOBILE UA131UTY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Pet person) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGELIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO EA ACC S OTHER THAN AUTO ONLY, AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR D CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S $ WORKERS COMPENSATION AND WC STATU DTH• EMPLOYERS'LIABILITY LLIYlIa ANY PROPRtETOMPARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYEE S II yes.dewitte under SPECIAL.PROVISIONS balm E.L.DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Covering operations usual to Zalanskas Construction... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION EdgeWOOd Retirement Community DATE THEREOF,THE ISSUING INSURER WALL ENDEAVOR TO MAIL In DAYS WRITTEN 575 Osgood Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$O SHALL North Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPR TA ACORD 25(2001/06)1 of 2 #S33584/M32350 DML O CORD CORPORATION 1988 n Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-072201 Construction Supervisor GREGORY J ZALANSKAS 34 BIRCH RD J ANDOVER MA 01810 v,— Expiration: ' Commissioner 03/18/2018 eamozzo�zcaea�t�o��aa acluaetta Office of Consumer Affairs&Business Regulation License or registration valid for individul use only WI' elgistration: ME IMPROVEMENT CONTRACTOR before the'expiration date. If found return to: 126875 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 iration: 8/3/2 :18_ Individual t r Boston,MA 02116 GREGORY J.ZALANSKAS =- GREGORY ZALANSKAlk-- 34 BIRCH RD . ANDOVER,MA 01810 Undersecretary t valid without signature