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HomeMy WebLinkAboutBuilding Permit #405-2017 - 655 SOUTH BRADFORD STREET 10/17/2016 - BUILDING PERMIT O&REy093tORYp-f O� 1 N TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIO _ Permit No#: �� Date Received ��Q�RaTEoWP4�'y�� �SSRCHUS�'C Date Issued: �a '� IMPORTANT: Applicant must complete all items on this page L©CATI®N 6s 0V - NPI Ent F . Pf�®P-�ER�TY OWNER � ' 0n 0©Year strut pre yes no MAP SPA.R ELS ZONING ®ISTR'ICT: steric District yes ye;p 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 7Y fp .� ry `t..:2+'�'r� - i. �'rp"..;.`°�. ,Cr'�h. " '' ."x� *x:i� ® Watershed ®i"sf`ri.ct`2' .`'� ❑ Se tick; ❑Wel ❑ Flood latn "' �❑Wetly � ; Water/ewer DESCRIPTION OF WORK TO BE PERFORMED: g Identification- Please Type or Print Clearly OWNER: Name: Phone: ` -W:50D4Q©`, Address: 6 S S NIpf, } � $_1 .+ 4`tt f\./s.� � �x "{Coracto.r N, arne . hone 1,y. X1.'[i .{yY �A4. ♦-.i <. .. Supervise s Constr�uc ion Licensee x'0 � •�uG_ E Dante' �.� ----- M.F1ome Irove, ,_. Date �sg p 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: $ i �� �-�-� FEE: $ f � C ck C 6 Receipt No.: 310 ( - 7— ITT Per s contrzg wl unregistered contraact e access to the guarantyfund and - � I _R _- - - -_- 17 Si9na�ure of.coritractor:° `' I atiare: f� gen ries __ __—_----- Plans Submitted ❑ Plans Waived_❑ Certified Plot Plan ❑ Stamped Plans F1 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 a U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS I CONSERVATION Reviewed onSignature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes P Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connectioneway Permit DPW Town Engineer: Signature: FIRE Located 384 Osgood Street a DEPAR;TMERITTemp�Dumpster onsite eyes F y Located at,1,24iMam Street � `F , ` , -f , ` '„ ; •_ ti ;Fire3Dep mearfint�s gnatureidate, j 1 } r r , 1 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 drops 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 Doe.Building Permit Revised 2014 Building Department The following is a list of the required forms to he gilled 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 DTE: 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 )TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Perm it"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 )TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit n all cases if a variance or special permit was rewired the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording oust be submitted with the building application Doc:Building Permit Revised 2014 � pORT1� Tow n o _ s ndover O h ver, Mass, A— cOCALINemcw 7i9s RATED U BOARD 0 Food/Kitchen PERMIT T So,tic System THIS CERTIFIES THAT BUILDING has permission to erect .......................... buildings on ..Cfs.......��...�*.... .. ,,. ,�.�F.��,..� 4 Foundation � Rough to be occupied as ...... T. A.•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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL' UNLESS CONST ON ST Rough Service .. .. ........ .. ............ Final BUILDING INSPECT GAS INS 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 DEPP Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 kvi www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEPMTTING AUTHORITY. Api3licant Information Please Print Leeib y Name (Business/Organization/Individual): UoO'l /rFf— t!`i c, Address: ➢ /Veit ti- S T- City/State/Zip: f 1 Phone#: "Th"? 1 9 2 I I Are you an employer?Check the appropriate box: Type of project(required): 1�am a employer with 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 g. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doingall work myself 9. ❑Demolition y [No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1.1.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance) 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'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. 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 have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:���p i� lV Policy#or Self-ins.Lic.#: t.-C Zp. 90:3 y - Expiration Date:J Job Site Address: 6 S5 ��'' + 1 \ JOY`'�Gq(•�� City/State/Zip: /�./• A 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. I do hereby certify under the pains and penalties of perjury that the information providedt. above is true and correct. j Si ature: Date: V Ilool t-- Phone#: CJ 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.Plumbing Inspector 6.Other Contact Person: Phone#: PROPOSAL/ESTIMATE 170 Main St,North Reading,MA,01864 / f 'I T _ R Fi l+ L L781-321-1991 bf �f Claudio Araujo—License CS 105185 < r<.ear,'rtn►, :ryt*�'t'FCfA+M.rcot, re�rc-. www.winterhillgc.com i STACEY TRINGALI Email: STACEY.TAGERMAN@GMAIL.COM 655 SOUTH BRADFORD ST NORTH ANDOVLR Phone:! 785000902 Date: 09/16/16 Job Location: Shingle Roof Tear Off: The following paragraphs describe the work that will be performed. • Protect wall,decks,patio,plants using tarps(winter hill is not responsible to protect any belongs into de attic and clean up) • Remove existing shingle roof on the entire house • Install an 8 inch drip edge on all leading edges(Color:___) • Install 6 feet of ice&water shield on front leading edges&valleys • Hurricane Nailing:6 Nails per Shingle • Install starter strip on all leading edges. • Install felt buster on all areas not covered by ice&water shield • Install New Ridge Vent • Install new vent pipe flanges • Replace any rotten or damaged roof decking plywood(we allow 32SF at no chargee,$65.00/sheet thereafter) • Replace any rotten or damaged roof decking ledger boanj(we allow 32 ft.at no charge,$3.50/ft.thereafter). • Install new GAF Timberline High Definition Architecture Shingles Remove existing lead(lashing on chimney,install Ice&Water Shield,step flashing,and grind New Lead Flashing into C11imnry • Warranty included in contract -(x ) System Plus • Shingle Color= • All debris will be removed from the property o- iz 4? f CAi Ct- S VIN 1-11(C'_ a 1— Cost Cost for Labor iMaterial for New Shir3gle Roof: $ '14,400.00 Payment Terms: J' ,� I 1-6 , 113 deposit due upon signing contract: 113 payment due upon start of job: $ 1/3 payment due upon completion of job: $ -- Total Amount Agreed To Be Paid: $ Work Scheduled to Begin: TBD Warranty:GAF.guarantees all material for lifetime and work performed for a period of fifteen(15)years.If any problems occur we will cover the cost of all labor and material to correct the problem and meet the customer's satisfaction. 0 9,/ M Claudio AraGjo,Project Manager z r� i Ninter Hill General Contractor,Inc. Date Home Owner Date °IS oac�vex f Financing Payment types accepted k--_ �� Available The law requires the following FOURTEEN items to be included in any contract between a homeowner and a registered home improvement contractor for home improvement work subject to MGL c.142A: 1.The complete agreement between the contractor and the owner and a clear description of any other documents which are part of the agreement. 2.The full names,federal I.D.number(if applicable),addresses(NOT P.O.Box numbers),of the parties,the contractors registration number,the name(s)of the salesperson(s)involved,if any and the date the contract was executed by the parties. 3.The date on which the work is scheduled to begin and the date the work is scheduled to be substantially completed. 4.A detailed description of the work to be done and the materials to be used. 5.'Che total amount agreed to be paid for the work to be performed under the contract. 6.A time schedule of payments to be made under the contract and the amount of each payment stated in dollars,including any finance charges.Any deposit required to be paid in advance of the start of the work SHALL NOT exceed one-third of the total contract price or the actual cost of any material or equipment of a special order or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule.No final payment shall be demanded until the contract is completed to the satisfaction of all parties. 7.All parties must sign the contract. 8.A clear and conspicuous notice stating: a.That all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza,Suite 5170 Boston,MA 02116 Phone:(617)973-8700 b.The contractor's registration number must be on the first page of the contract. c.The homeowner's three day cancellation rights under MGL c 93 s 48;MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. d.All warranties on the owner's rights under the provisions of and MGL c.142A. e.In ten point bold type or larger,directly above the space provided for the signature,the following statement: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. f Whether any lien or security interest is on the residence as a consequence of the contract. 9.An enumeration of such other matters upon which the owner and contractor may lawfully agree. 10.Any other provisions otherwise required by the applicable laws of the Commonwealth. 11.Permit Notice:Every contract shall contain a clause informing the owner of the following: EL.any and all necessary construction-related permits; b.that it shall be the obligation of the contractor to obtain such permits. that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 12.Acceleration of payment No contract shall contain an acceleration clause under which any part or all of the balance not yet due may be declared due and payable because the holder deems himself to be insecure.However,where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance of funds due under the contract, which are in possession of the owner,shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 13.No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. 14.Arbitration:If the contractor determines that in the event of a dispute,the contractor wishes the dispute to be settled by arbitration,this fact must be signified on the contract and both the -ontractor and owner shall sign this clause separately.The following format is acceptable(in 10 point type or larger); "The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of'Consumer Ajjairs and Business Regulation and the consumer shall be required to submit to such arbitration as vrovided in MCI,c 142A. Owner: r� l Contractor: LVOT/CE:The signatures of'the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute -esohition even where this section is not signed separately by the parties." North Andover MIMAP October 17, 2016 ti f 5 I .. �'.;°', r pad`'" - � •. _ Wit'' ,�',• y ,r _, � ��� - `y. ,:.,,�: .t,, - r '17",ltt.. ,, .1.... ,t,.. sal. 1 gal^ -:`.i-: - " .��._ .• : lir :a; •._4,, �••�i� .ai Rip f/ ..:'....ill({• �� ��� ti�, ..1.. � �U,.�. 1,,. '?�� _. R1 (D;< Oad /� atr a~ ai r -:'Bea ti t .... . Cane- 77 A& I :-5, ine=Rid g., sir = Roa d _..._ _.. . ."._ Wk Claster- _ �I, i r •_ ..._. - .... _. i,, �llFt atlf " • .1,::.:. ;`���� as Q MVPC Bo Zoning Overlay Zoning I✓Municipal Boundary B Adult Entertainment Distric -- Busine s 1 District p Machine Shop Village Ove Q Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, -• Rail Line 2 Watershed Protection Dist G Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack Historic Mill Area G Busine s 4 District I Interstates 13 HipORTH Valley Planning Commission(MVPC)using data provided by the Town of _I Q Medical Marijuana R Genera Business District Ot '90 'a , North Andover.Additional data provided by the Executive Office of —SR ©Downtown Overlay District 0 Planne Commercial Dev a<<< s�a OQ Environmental Affairs/MassGIS.The information depicted on this map is Roads ©Historic District ::Comdo Development Dist 3 ( for planning purposes only.It may not be adequate for legal boundary Osgood Smart Growth(40 i!Corrido Development Dist Q .__. 1u definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER t Easements U Hydrographic Features G Corrido Development Dist f 9 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ❑ Industri I 1 District 41 * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Parcels -Streams Ir Industri 12 District _ # i ,^, {r OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands O Industri 13 DisMct # r, � f ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 13 Industri 4 S District deo°`""""` THIS INFORMATION 33 Exempt Lands Residei ce 1 District #1 �A,,o•�t,�y Reside ce 2 District SSACMUS� G Reside ce 3 District A de ce 4 District 1"=576 ft w�prde ce 5 Dist ct YY de ce 6 District e esidential District VJ North Andover MIMAP October 17, 2016 Ak .__.::_. ..• -=:104".D.=01_'45•-:::.::: ' :�i=:_•flu•:::_::•::''.'::�:::_••�11!�r•:::_:._:•��1�•:_: ? _:::_ , ;' `.-_.. 1 :: __.' ':'':..stltt • ':::?" i,::'tlt` 104.D-0147 ' � •:_•_•., ,--: , ,;..:,., .-:=: 643 SOUTH BRADFORD ST :::: .fir.•;`•>....ktlti. •• :::: _J,f..:'`-:...�3u�•• :::-�tct.'`°:,.:.�J.0 -- ' . ke...:.::'�ktLr:-`.-'..atlu:`°:.::'s3Jrr:•`.-'.: :::.::"vu�i i ...... aL••• ••• '•_:: d, - --_ til, S,tfe '� .::.._i altr'::•-->Ltr :::::k6c� -;..atJ tr,. 104.D-001 :i�ict :.. .. i,_ :::"�31tc..•.i,::. ltr::"::" kilt: .._.,yam ..-:,..._;.._:---:..:all(t. •.-:;.:";`.:_:==-::':'sbJt! •::::.:': 655 SOUTH BRADFORD ST ' R 1 sk it —':....-104:;D-0148_ ..... t,--,� •- I; --ate d,-'sit JLC. .'__. ..�� ;:. :�l..:_._.•i.�i�_:_.-?�// :_._.':' � m 10,4"D .0013 :..•__-•1 ._.`.`.; '' 667 SOUTH BRADFORD ST V) :'salt :`"`.:::' Ott r i,..::�.t+� '::::::"ultr.. ,i• 104.D-0149 .. _ :::...-• _ .::.':f_}L ..'fir f y3J11 - 1�tfl - , ':: ssJtr•: ;: ,�du':'':..akti 104.D-0150 ❑MVPC So Zoning Overlay Zoning ©Municipal Boundary C3 Adult Entertainment Distric :.Busine s 1 District 0 Machine Shop Village Ove O Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Rail Line ❑Watershed Protection Dist O Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack Interstates ©Historic Mill Area O Businei s 4 District AORTH Valley Planning Commission(MVPC)using data provided by the Town of —I Q Medical Marijuana O Genera Business District Of ,,a° q� North Andover.Additional data provided by the Executive Office of —SR B Downtown Overlay District 0 PlannedCommercial Dev �t '��°O Environmental Affairs/MassGIS.The information depicted on this map is Roads 0 Historic District ::Corrido Development Dist 3? OL for planning purposes only.It may not be adequate for legal boundary ❑Osgood Smart Growth(40 G Corrido Development Dist 0 to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER k r Easements _^• Hydrographic Features O Corrido Development Dist Ii % MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING IndusM I 1 District ❑Parcels Streams 4 • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY i= Industd 12 District s •, !r OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands A Industn 13 DisMct * o ���t ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF O Industrf I S District �� Q Exempt Lands Reside ce 1 District �/ °��rt°•���q5 THIS INFORMATION C: Reside ce 2 District ,SSACMUS�� 8 Rnclde ce 3 District d de ce 4 District 1"=61 ft d y.de ce5District YYYY de ce 6 District '--e Residential District VO//17/2016 11:12 FAX Michals Insurance [j0001/0001 WINTE-2 OP ID:JJ CERTIFICATE OF LIABILITY INSURANCE FD10/17ATE /2016 Y) 10/17/2016TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT PHONE- Crown Insurance Agency, Irtc. Bradly S.Michals Insurance _ FAX Agency,Inc. (AA C No Ext:617-924-1100 �c Na);617-926-2162 85 Main Street -E-MAIL ----`---_.___....-•- -- -- —.__._....... Watertown, MA 02472 ADDRESS: . Crown Insurance Agency,Inc. INSURER(S)AFFORDINGCOVERAGE — NAIC# ................ -------— INSURERA:Acadia Insurance Company — _ ........... - ................. INSURED Winter Hill General Contractor INSURERB:Arbella Insurance Co. 17000 ClaudioMcuhna Araujo — ------._--.--..._.__._..._._..... ._............._..:...-.--.-----.--............ 170 Main St INSURER c:North land Insurance North Reading, MA 01864 _!!!SURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THI3 13 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. __........_........._...._._._.______._....._..__..__.._.____.__._.—.___..T._.._.______._ —._.__—_ __.___...._.----.....__— —.;d_...- ---_._._. _...---------------- --------- INSR: .ADDL•.SUBR� POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MM/DO/YYYY LIMITS C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 AMAG 7 RENTED----I CLAIMS-MADE Xj OCCUR WS274235 02/13/2016!02113!2017 PREMISES_(Eaocarrence) $,.•,.-..,_....._-_-..._..`100,000 i i ! - - e person) $ 5,000 - -... ---- — -- -- --' MED EXP(Any on _.. - __..... _ .._0 I , ! PERSONAL 8 ADV INJURY A$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: j GENERAL AGGREGATE_ $ 2,000,000 1X i POLICY' PE0 LOC ! i ! PRODUCTS-COMP/OP AG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY ! COMBINED SINGLE LIMIT ............. .5- -- - ,000,000 B ___:ANY AUTO ;1020001551 04/09/2016•;04/09/2017 BODILY INJURY(Per person) ! S ( ALL OWNED -...-� SCHEDULED ! -----------.—._.._.._.__.._..�____....__...__..._..._....._............... AUTOS x AUTOS BODILY INJURY(Per accident) S X -X NON-OWNED PROPERTY DAMAGE HIRED AUTOS ... !AUTOS (Per accident---..._.---__--- - -----------.... .� UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR ! CLAIMS-MADE] -----•--_._ _—___..........._—__— AGGREGATE DED RETENTION$ {5 !WORKERS COMPENSATIONi V ' PER I 0TH- AND EMPLOYERS'LIABILITY ! A ANYPROPRIETOR/PARTNER/EXECUTIVE YIN ; 'MAARP301079 i 03126/2016;03/26/2017 E.L,EACH ACCIDENT ER--�5 500,000 OFFICER/MEMBER EXCLUDED? �i N/A --- -- ------------ ---- i(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE! S500,000 If yes,describe under —'......... — -- :DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT!S 500,000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Operations of The Named Insured CERTIFICATE HOLDER CANCELLATION NORTHAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department North Andover, MA AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1� WINTE-2 OP ID:JJ ,acoRO CERTIFICATE OF LIABILITY INSURANCE DATE 05//171201617/2016 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(ies) 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 CONTACT BBradt S.Michels Insurance NAME: Crown Insurance Agency, Inc. radly PHONE -__..._.—_.._.-_.._.__._-.-...—.—_._._....._.-...._...___FAX_.__...._._.......m_......_..........._._._.._...._m_., Agency,Inc. A/C No Ext:617-924-1100 A/cNo): 617-926-2162 85 Main Street E-MAIL �`- -- _ """ - Watertown,MA 02472 ADDRESS: _ _ Crown Insurance Agency,Inc. INSURER(S)AFFORDING COVERAGE _ T - NAIC# INSURER A:Acadia Insurance Company INSURER Ba: INSURED Winter Hill General Contractor — : .Northland -'-'-"...--_-Insurance----*..,-•-'-----.-___.____.___...-_._.._.._.__- Claudio Mcuhna Araujo -"— -------- —- -- ------ 170 Main St INSURER C:Arbella Insurance Co. -- — 17000 mm North Reading, MA 01864 INSURE D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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. POLICY EFF POLICY EXP /LTR TYPE OF INSURANCE U-15C IN ORFPOLICY NUMBER MM/DDIYYYY MMIDD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 15AMAA�E TO RENTECS _..._._.. CLAIMS-MADE XJ OCCUR WS27423$ 02/13/2016 0211312017 .PREMISES- _occwience�_ $ 100,00 —_- MED EXP(Any one person) $ __.__..5,00 ..._..----.._._'-----........_-._.,......_-.-_....._..—.-.__-..................._.__.." ... PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY PRO- _..__._._..------.._.._._......._....._....__..__.._.._.._.._.._. PRO- LOC ........._........................_._ JECTPRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT EL L_— $ 1,000,00 C f ANY AUTO 1020001551 04/09/2016 04/09/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED _.....__....._....___._.._._....__..__....,,..,_..- ._._...__...,. AUTOS AUTOS BODILY INJURY(Per accident) $ .•--___m..._..,.-- . NON-OWNED PROPERTY DAMAGE '..__ X HIRED AUTOS X AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR _..____...._..._._..__._._....__..__.._.__.. CLAIMS-MADE ............._....._....----.._._........._........... . _ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER O i- AND EMPLOYERS'LIABILITY Y/N _( STATUTEJ. ER A ANY PROPRIETOR/PARTNER/EXECUTIVE INIA A WC-20-20-003174-03 03/26/2016 03/26/2017 E.L.EACH ACCIDENI $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ......-....................._...,.. If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500 00 DESCRIPTION OF OPERATIONS below I IE.L.DISEASE-POLICY LIMIT $ 500,00 _T DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Operations of The Named Insured CERTIFICATE HOLDER CANCELLATION XXXXXXX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR BIDDING ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR BIDDING ONLY FOR BIDDING ONLY FOR BIDDING ONLY AUTHORIZED REPRESENTATIVE FOR BIDDING ONLY FOR BIDDIN ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ,,ssem� Ufie Tpomz�naancaea�C�--Office of of Gonsumer-Affairs.&_Busiaess Regulation OME IMPROVEMENT.CONTRACTOR egistration: 1,68583 Type: Expiration 3/812017__ Corporation Vf/INTER HILL GENERAL CONTRACTOR INC.' OLAUDIO ARAUJO 170 MAIN ST NORTH READING, MA 0,1889 { _Undersecretary, dMassachusetts -Department of Public Safety Board of Building Regulations and Standar I 1.�/111tI 1111111 l'JUI/CI V11111 , License: CS-105185(, c><aua;o b1�aujo; 163 Hancock St ae Everett MA 02144 ' Expiration 07/13/2017 Commissioner