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HomeMy WebLinkAboutBuilding Permit #052-2016 - 59 JETWOOD STREET 7/10/2015 BUILDING PERMIT NORTH OF�t_eo bq�0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ O Permit No#: ��_ � I � nO ey Date Received gSSACHU`��� Date Issued: 1011-5 IMPORTANT: Applicant must complete all items on this page LOCATION 67. ptiwob4 w Print PROPERTY OWNER V (r Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no 007 Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Re idential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑61teration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: _/0 Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer t DESCRIPTION OF WO TO BE PERFORMED: 1 prin >fclp Identific tion- Please Type or Print Clearly OWNER: Name: Phone: IS Address: & f Contractor Name:at) 0? Phone: LI-7_ 59 ,2-Y309 Email: Address: ILS DQet��S Supervisor's Construction License: 6 ?l Exp. Date: Home Improvement License: 2� Exp. Date: ARCHITECT/ENGINEER N�l�' Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 P -I E: $ER$11000.00 OF THE TOTAL ESTIMATE OST BASED ON$125.00 PER S.F. - Total Project Cost: $ -7 . 116 • � FE Check No.:'2 5-5?Ap Receipt No.: �� �'L+7 NOTE: Persons contracting with unregistered contractors do not have ace es uaran fund 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 :aF 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application �. Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan ;r Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 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 lies No DANGER ZONE LITERATURE: lyes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) 1 ❑ Notified for pickup Call Email Date Time Contact Name n Doc.Building Permit Revised 2014 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 - 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 b Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street yF;IREDEPAR�TMENT s-Temp�DurnpsteronlEsite= }yes ��Locatedat r124iMainStreet � { F<ir*e�epartment� gr�ature/date _ __ - �S6-0MMEN0811 Location 'V37 I No. v`J — 0�� Date ter. • - TOWN OF NORTH ANDOVER • a. Certificate of Occupancy $ ON Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check '` /, 7 Building Inspector NORTH own of E , ndover ;. _ 1 0% , h ver, Mass, coc"Ic Ml WICK OATIED J"' S U BOARD OF HEALTH Food/Kitchen PERT D Septic System THIS CERTIFIES THAT ,,,,,, ,,,,,,,,, BUILDING INSPECTOR ..................... �Acopw-to..... �-...................................... has permission to erect .. buildings on .....scl. 4 Foundation ..................... ....` ..� ...�................... Rough � V to be occupied as ........1.. .............. ...... ......................... 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 MONT ELECTRICAL INSPECTOR UNLESS CONSTRUC S TS Rough Service ............ . ..... ....................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildin 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. r 1 ''�j."1„ '+� �r- C `W6.. �'M..i L✓' 'ar" 1.J `e.! ,..+a • V 1B ® iA �J 1 8010290169 RR Donnelley®2013.All rights reserved.—0667 s CONTRACT# 00 V 3 4 Q MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT LOW 'S UTHOIZED REPRESENTATIVE NUMBER CUS MMR C� i m 0�r STORE NO. .-7 STREET ADDRESS - STRE ADDRESS 3 � Gdu @fes Sir ?' CI STATE ZIP CITY STAT ZIP TELEPHONE TELEPHONE DPTE' � 4Ut W�14��S 07 83$ENTERS,LLC'S MA HIC NO.: 148688 ASH BARp L�� CHA GE 'This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment. Upon payment,the entire agreement,including the specifically completed pages of this document,the Terms and Conditions included with this document and any othdr addenda and attachments hereto,shall be referred to herein as this"Contract" PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION EET ADDRESS CITY STATE ZIP ot NOTICE TO CUSTOMER—PRICE CALCULATIONS: Inr order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these hosts which may not be refunded once the Installation Services are performed. Contract Total 00 _ Are permits required for this installation?: [pL�'Yes [ ] No '`applicable tax included i NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right. By signing this aontract, Customer acknowledges havingh-eceived a copy of this pamphlet before work began informing Customer of the potential,risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order must be completed and signed by the customer for any additional charges. Customer must initial. "Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees-and-independent contractors the right to tak hotographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocabTy grants to Lowe's all night,title and interest in and to the photographs for use in all markets and media,worldwide, in perpetuity.Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,-imiuding,but not limited to,marketing, advertising, publicity,illustration,training and-Web content. By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. F Work&tq/?6//nr}tep�upon reasonable availability of Contractor and/or any special oy�leY mer made Good(s)which is anticipated to be ��UU // [fill in date].Estimated completion date is [fill[fill in date]. Said estimated substantial completion datey¢pptt f the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: V �z4 (if applicable, insert a statement of such contingencies). IF-:ACONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE TRM SECT1eN-QW—Y THE CONTRACT TOTAL EXCEEDS$1,000.00: [ ]Customer to Pay in Full; OR '["')-6 er to use the following payment schedule: (1)Deposit $ to be paid upon sig ct.Deposit should be 1/3 the total contract price;and 4 (2)Payment of $ to be paid anytime after this Con ed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Con ot-is, jgned; or ( ]Deposit my/our check for the amount of the_payment indicated above.anyti a after the il�te thtp Contract-is s ned�'..antl (3)Final payment of$100.00 to be paid upon c'mp�etior�of tM1 an*4aVe on oth"p3rti7� ' a Is ciion. s IbOTICE REGARD G ARBITPATION kGREEIMENT FOR CLAIMS COVERED BY M.G.L.c.142A This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment. Upon payment,She enOre agreement,including the specifically completed pages of this documen"r the Terms and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this"Contract" + PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION EET ADDRESS CITY STATE ZIP Inc Srrxz<.e- �s a� / r 'es ,'� `�' 611 O(` 4 6 S ;/"z /15 A Side- e n ,rla�dtti 5 G GU f .' .G fc f7,✓t c nlJ c NOTICE TO CUSTOMER—PRICE CALCULATIONS: In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes thes�osts which may not be refunded once the Installation Services are performed. r Contract Total a� Are permits required for this installation?: (p4 Yes [ ] No *applicable tax included NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right. By signing this Zontract, Customer acknowledges havingtreceived a copy of this pamphlet before work began informing Customer of the potential,Fisk-of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order must be completed and signed by the customer for any additional charges. Customer must initial. *Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and.independent contractors the right to tak hotographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocar grants to Lowe's all sight,title and interest in and to the photographs for use in all markets and media,worldwide, in perpetuity.Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically,and agrees that Lowe's may.use such photographs for any lawful purpose,including, but not limited to,marketing, advertising, publicity, illustration,training and-Web content. By initialing here;Customer agrees to the foregoing. [Customer to initial to the left]. Work tq/cp In ep�e upon reasonable-availability of Contractor and/or any special go mer made Good(s)which is anticipated to be �� ��(U� [fill in date]. Estimated completion date is [fill y _[fill in date]. Said estimated substantial completion d of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable, insert a statement of such contingencies). I CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE T—FffTSECT*N4AU—Y-WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [ ]Customer to Pay in Full; OR_—T er to use the following payment schedule: (1)Deposit $ to be paid upon sig ct. Deposit should be 1/3 the total contract price;and (2)Payment of $ to be paid anytime after this Con"t�gggd and before commencement of installation,I/WVe authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Con r ned; or [ ]Deposit my/our check for the amount of thepayment*indicated aboveanytin after the dpte the Contractus saiaedi and �t s (3)Final payment pf$100.00 to be:paid upon pietiortiof tle in agaCdri and oth parties' tis"ction. L4 ` 1149TICE REGARDING RBIT TION AGREEUENT FOR'CLAIMS-COVERED BY M.131.c 142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO,SUBMIT TO SUCH ARBITRATION AS ID L.c.142A. By: Date: Lowe's Home Centers,L Cr By: Date: ('t 1t) Owner Signature !� l i THE SIGNATURES OF THE APTTES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE-ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COP1f,QF THIS CONT C^AT THE TIME OF SIGNATURE. WITNESS,OUR HAND(S)AND SEAL(S)BELOW THIS 1�= DAY OF Lode",� rs, LLC /,4J Lowe's Authorized ep a Owner ( Co-owner or Witness Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction:See the attached notice of cancellation form for an explanation of this right. '55102 REV. 12/13 FILE COPY ©2004 by Lowe's.®Lowe's and the gable design are registered trademarks of LF Corporation. The Commonwealth of Massachusetts Department of IndustrialAccidents Ir Office oflnvestigations i `�" ! 600 Washington Street Boston,MA 02111 �? rE% www.mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apifficant Information Please Print Lexiblv Name(Business/organizatiioonMdividual): nKl C7'IIQ�nQ Address: (D Qi�'0. Dt' City/State/Zip: In'1 f0� of D A 131- Phone#: 617- 5%a—(430 Q Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. [:] I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition work' for me in an capacity. employees and have workers' � Y P tS'• 9. ❑Building addition [No workers'comp.insurance comp. insurance.; required.] 5. E] We are a corporation and its 10. Electrical repairs or additions ffihexercised officers have exercsetheir 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work g reaP mysel€.[No workers'comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152, §1(4),and we have no 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 a new affidavit indicating such. =Contractors 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 have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: (1 A ( Sunm(L �• Policy#or Self-ins.Lic.#: A WC` 1400-7 0-1 5 5 Iy oZol Expiration Date: Job Site Address: g s DOq City/State/Zip: 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 c. 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 ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 doh cernu der he and penalties ofperjury that the information provided above is true and correct Si e. 61- 7- 5 Date: Phone#: b 17" c519-!Y0 p Official use only. Do not write in this area,to be completed by city or town oftlicial. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health.2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ^" GREEINS-01 KMCMAHON AL`vIty CERTIFICATE OF LIABILITY INSURANCE FDAT61;12 DIYYYO �--'"�� S/8l2015 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: M the certificate holder Is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. H SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an andorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s PRODUCER CONTACT NAM Salem Five insurance Services,LLC PHONE E --__....----- FAX - - ---..-. _-- 448 Main Street µmc,NP, J:(781)933-3100 ( too) (781)933-9048 Woburn,MA 01801 ADDREss:insurance.services@salemf'Ive.com - INSURERS)AFFORDING COVERAGE NAIC• Nsus _AL_ afety Insurance Company-- 39454 — - --- -— — - --- 139 — INSURED INSURER 9:3afety Indemnity Ins.Co. ;33818 Groono Instailatlon Co.Inc. &=Rmc AIM Mutual Insurance Co. 10913 10 Rita Drive INSURER D_ Medford,MA 02155 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 BY PAID CLAIMS. SUGNCE R— -FMPM LTR TYPEOFINPOliCY EXP POLICY NUM,eRLIMITS _. A X COMMERCIAL GENERAL LIABILITYLIABILITYTV I EACH OCCURRENCE S 1,000,OQO -OAMAGETORENTED CLAIMS MADE ; OCCUR BMAOOOs51s 0 510812 0 1 5 OS/08/ZOi6 pREM6E5{En oaurrsnog S _ __---------.------'_--. MED EXP(Any one person) 'S 10,000 __.__--_--- PERSONALaADViNJURY 5 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE !S 2,000,000 .X...,POLICY 'PRO- ..- ._ . _ _ JEC7 1 LOC ( PRODUCTS-COMPIOPAGO 5 2,000,000 OTHER: AUTOMOBILE UAa0.JTY COMBINED SINGLE LIMIT 5 11000101" --- ._IE.agidwrt)- , _ . NON-OWNED _ - .... B ALL AUTOOWNESCHEDULED 12015 01/3012016 BODILY INJURY(Per person) S -- --AUTOS AUTOS I `-- --— - -- - - ANY AUTO X 01!30 pODiLY INJURY(Psr acadanQ S �iibPERN DAifAG€ X HIRED AUTOS X AUTOS `IPerewEerV___--- S -_. -UMBRELLA LIAR I_OCCUR i EACH OCCURRENCE S EXCESS LUfl CWMS-MADE i AGGREGATE_ S DED .RETENTION S 5 WORKERS COMPENSATIONPER TH- ANO EMPLOYERS LIABILITY X STATUTE ER C ANY ��tE�PFAARRTNEDRJEXECUTNE Yup)N/A (AWC-400-7025594-2015A 03I M2015 03R)4J2016 E EACH ACCIDENT 5 500,000 - - (Mandatory In NH) EL DISEASE EA EMPLOYEE 3 $00,00`0 I,!Yea.dnambe under . DESCRIPTION OF OPERATIONS below E L.DISEASE POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS(VEHICLES(ACORO III,Adddional RamvU$medals,may to smelled B more apace Is requi(m) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Winchester THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 71 Mount Vernon Street ACCORDANCE WITH THE POLICY PROVISIONS. Winchester,MA 01890 AUTHORIZED REPRESENTATIVE L 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD � 1 Massachusetts -DepaRrnent Ll ''ubf— Safety Board of Building Regulations and Standards License: CSFA-061719 RONALD A GREgigE 10 RITA DRIVE MEDFORD Mrd 0215 nr+uzsaner 10/27/2015 1-1:3.1 FAX 781 391 0624 (WENE INSTALLATION LOWES IV INST vj 1)1 4�' Office of Consumer Affairs&Businerts Regulation ME IMPROVEMENT CONTRACTOR agistration: 102957 Type; xpiration: 7/312016 Private Corporatio GREENE INSTALLATION CO.;INC. Ronald Greene 10 RITA DRIVE MEDFORD,MA 02155 Undetsccretary