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HomeMy WebLinkAboutBuilding Permit #080-2016 - 675 FOSTER STREET 7/20/2015 - TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ��-`_l� Date Received Date Issued: —7 K IMPORTANT: Applicant must complete all items on this page LOCATION P . O -� r nt PROPERTY°01NNER la 0�j �OLI Print 1-00 Year 01d Structure yes m-- :MAP NO: PARCEL ZONING DISTRICT Historic District yes no iMach ne Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ire family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ S,eptic ❑1Nell Floodplain Wetlands ❑ Watershed District 0_Water/Sewer._; - DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: P�Lt Phone:C17P697 -/30 / Address: 67.E :CON.TRACTOR Name: � �i''+ G � 'q ��? �,_ --Phone: �1 Address: J1 �}' �G�� ► ��'� Supervisors Construction License _$-7 q 7_ Exp `Date: .__ 6-1 ExDate: 3 .�L - } Home.lm .rovement License ' /LI Zd 3"", �_..r_ = p ;'Y b , 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: $ OV• f FEE: $ Check No.: 0�4 7 Receipt No.: biel NOTE: .Persons contracting with unregistered contractors do not have access,4o the guran d SZgng,ture of.A ent/Ownertf . . f'�6A§4-7jt1Q—re—of.contractor Plans Submitted L.j Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location N Dq O —2-6� Date —7 G� 1 15 . - TOWN OF NORTH ANDOVER • � � • Certificate of Occupancy $ tl` Building/Frame Permit Fee $ �a_ Foundation Permit Fee $ . . ° Other Permit Fee TOTAL $ Check J ` ql Building Inspector 29079 Plans Submitted ❑ . ._`Plans Waived ❑ .':.Certified Plot Plan ❑ Stamped Plans ❑ - •..;TYPE OF SEVi�RACrEDiSPOSAL ; _- , . Public Sewer ❑ Tanning/Massage/Body Art ❑. . .Swimming Pools ❑ Well ElTobacco.Sales 0 Food Packaging/Sales El• � : Private{septic tank,etc._ -- ._permanent Durnpster on�Site - THE-FOLLOWING SECTIONS FOROFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM - DATE REJECTED DATE.APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . a Plarh g Board Decision: Comments Conservation Decision: :Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW'I oiw Engineer: Signature: Located 384 Osgood Street 'FIRE DEPARTMT-` f:,--;Temp Dumpster on site yes no Located at124AMair Street; Fire Departure;►it signature/date ' COMMENTS . ,. -Dimen.sion' 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.Z®NE LITERATURE: Yes No MGL-Chapter 166.Section 21A--F and G min.$100-$1000..fine NOTE and DATA— (For department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The fol wing is'a=list ofahe requir+ed.forms to be-filled ouf for-the.appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits U , Ruilding Permit Application o Workers, Comp Affidavit o 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 a Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 o Workers Comp Affidavit o 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 apu:,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 r , NORTH - 2 � sEA-A: . ver o . - No. T o Ch ver, Mass, COC LAKI "I CHIWICK OC"ICHIWICK A0RAT E O PIfo �9 S V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System { THIS CERTIFIES THAT .Q. BUILDING INSPECTOR . . .....L,.......�............... -l. ,.�..................... ....................................... Foundation -7T has permission to erect .......................... buildings on ..... :........ ?.5.................5.. .................. may ....... �'l• Chimney provided that the person accepting this permit shall in eve respect conform to the term. the application Final p p p g p every 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOpil.tL TRough Service .................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Required to Occupy BuildinPermit 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. Lg---, tot T rrkmest�sg o:e omwue oraese D4 ttf�Cas erQd6toHOML utas �� entCoaaactar�, Q Cansttmer s�B °vetaeotnbafb" �nmghatae erI4?q}.ba�" aat' @az,,�t1 °smessReg 6�sCo :n"°anYK�l;au �O �lssnauld f -'surd Mme oo Tho ear6I 4*3�87orI,8 8aS3-1 2�f ' mgthe / �¢l��,r+���,����F7s aETeZg �QIIQIIt'tiL'Ch3t4 Strcetnddrem dnrat Jilltffn Std ) SIC Ci[ylfavr, > � CuF1L'ctntlSalaR3aa/Qti. Elul,,1,1,( J�� C .Y C Laysifae-lolle< �/JLI!/1.•�i 1 Hf�iacss6ddf oil venue ZC�Q / /oIIe n ai(Ing,sdy (Itdi' 3a/ Cihflr� trent lid tea) state Grp Code ���Fkone F -"L� n~ i Attie IDarS4 i7feConcta<-o /g mac'�FS-x (D� 6e indc-ai(Mat;afgtoso:bsf `rfcr ram' ��1�®CS comptre3 ti19 £o' e o eE: fS� /Z arm 8ts"?L� 01.3- e 3bea3ue,�dto 'IL crosb_ the 0 gse6 mhde on 3 ea.,SEC•yr O; OQDLZCiQ.'s c.7p�pl � Fotiai Con n- -7/g? 13a1e en�n6 Wrrr�begin_alF►nl thecon trwora B mea`et4 nla �aata�sb®c> eted�t °fO�1atherr o ralbest�baYGmpleted. 1�c13'aICatS K'iII be afrde n�j�h tbe'pt..t�Ol IIad IBbOP S nc�Qtt�t0thefoli mm" at:sa' ednle_ �=es6edabave�.tbeta�I�or Won S by sirso° , saat<vt(nntta (`) ed i/3 oftbe;a-�,i - SJ�'`� a3 7/yj uooa csmple icm CF � ern °fs order im.4 vrhicfsev is --L &zatcr) uponca�pietionof �'1LLz� upon comptetioa oftbe r2foL�c,;srt �t tra,{farbi ran to " ) in Lgr S` da'to PaYmatttm ana ��mnletedtobntbpg��-s "VOTE C")Ireiefrfg a1F' S arm, 10t 4�a>•ai• ��`-�tr Of(a)�,Flllfft OltttCiG �d�.ZSir C:dmia �rlxfna r~ica (bltbp'-}a�iul�yy�.6ptt_gy .-t'4aRCCt07al^. t J:,] �r2Cf7!�jOfC t4a ap cortiptatran srindeIC. !of�.YSP=::EI Snb Ors- sana�t�t'Trfanbg e9C+PaenY per./ ctor m..dm tf agc •oraos!oauf� 3lticonti'> tle ao"tCeS tO be mntrc�rq . R1atCI7215 •.Chi:alit!Md SGI:.I.uPttD l;o F?r and tabu--mde 'S 2by Lae coa r oval Makin- onoil r rtrte-,s° camtr, et F? nh3__Ehasi e � r `ac,�es� � cn'aedr a fc�the�� �:nsi,eca,�,n tc&abaotiwplyoilt � doe.mtcatb �+Fsrsiole Jt oasofaoYBrra Ybefomyj 5:fisconp C� o�er�w,.it r°atoSr si.�uads P nrmtsioayarjcoab ctorsr"q bzs h-"ea ntaced oa titer,g JWCZ otn ° Don't ba ennsenntedea;tba mn nz2rn'DStmfagthefa �2e�fe�tfefollcfidagwithin ail do cantioas2ndnoG �bcators Its c0liarw b sa n idH =a.�hme�Viand ft eSssrtfnr< ziPste�ditiutheD' tCon— Yunde.�od L H-st. e?es bYt i' or c Ltecoa octorngtathe l}ireccarlorofffomeFmpmon.2be I °� sametttiaBisunfdc c ol f aa� ,a - '.rof- a as ttte a 3liD g cost ^t��tl �ct�czs ua m er�p eatc4:1ooiand V �7rC�r�fMs rL-C-•Cd- Vo7jCr•• - Gnidetoth.-?f.meTp, 043iQiffes Readtneit� g'a'�n�f�p,�,� O..6 ozTfij'', I7-�J33 3787-1888boof-3 r i'oaor7 noel s, enrCo a �'� atiaaonfitcrzveWegdeo Fbisf fmt s coofa �y7. zroraskto C�tr2etOr lrt: rtao_.`° eai ifithsb - ° �daetaCnpyafineC third baslaE;s a�tlj--- face �pcdatap otbE:lh- on'amer daz=foIIosvia ami oi, :b t;f•`csZpdagoftidsa cebYortiinay�eoat,�'snt�jpl;,r,� Tiz# ea`see tfi, � do b'• P rid�I `irate r,.;_ maxoat cf ` 7°�orl;Ydetev Svano' the �. °n= ti !'� caacell�r anf 7.not la E: •�.� �€�e �r< u 1 tri .1men a of mu€a''atoftbe -ate OsrapFcs.3 r... "CrC 111r.�f'•i C FlOnieO.;gE fPl'XI Lm / �s;�r, �-;`"Z:irr t"a �Vl SIIEtr'.4.s+L X41;1 —_ —7 / 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 auomatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless bout parties Wee to the optional clause provided below. This clause would eve the contractor the same riot to arbitration as is afforded to the homeowner by the Home Improvement Contractor Lain. The contractor and the homeowner hereby,mutually agree in advance that in the event the contractor has a dispute concerning this contract,,the__vonftcw tiida�%submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive> ffiee a tronsumer Affair and Business Regulation and the consumer shall be required to submit to such arllyrha onlay avide In Massachusetts General Laws,ehap�er 142A. r ll y Homem ivnAsSignature40 Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. ?oneowner's Rights A homeousees rights under the Home Improvement Contractor Law(IvIGL 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. Homeoumers who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completin.c,the work as described,in a timely and worlmtanlrlm manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or pro-trides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts cmw. an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor ImMy agree may be added to the teals of the contract as long as they do not restrict a homeowners basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer infomiatior.Hotline(listed below). Execution of Contract The contract must be executed in dtmHcate 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 filled 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~voting and agreed to by both parties.Contracted work may not bei until both parties have received a fiilly executed copy of the contract,and the three day rescission period has expireds , Accelerated Pa_vrtrents A contractor may not demand payments in advance of the dates spect5ed on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However_in instances where a contractor deems himlirerself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. lYthdrawal of funds£om said account would require the siguatures ofboth parties. Additional If you have general questions or need additional information about the home Improvement Contractor Law or other consumerrights,or if you wish to obtain a fine copy of"A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of ConsumerAfMrs and Business Regulation 10 ParkPlaza,Room 3170,Boston,MA 0211_6 617-973-80 787.858 283 3737 or visit the OCABR~website at cabr/ If you want to verify the regis4-rrtion of a contractor or if you have questions or need additional information speerfically about the contractor registration component of, Home improvement Contractor Law,contact: Director of Dome Improvement Contractor Registration OM=of Consumer Affairs and Business:Regrrlation 10 Park-Mam Room 5170,Boston,MA 02116 617-973-8787,828-283-37:557 or visit the HIi website at htm:lhvsv%v mass Rov/ocabr/ Go online to view the status of a Home Lmprovement Contractors Registration: httcJ/db state.mausflromeimprovemenOicenseelist asm For assistance with informal mediation of disputes or to register formai complaints against a business,calk Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR- Better Business Bureau 308-652-1800,508-755-2548 or 413-734,3114 Version 2r-1 11=2010 Corit-.mcs,or Arbiftiltion Tile Home'Improvement Contractor ja-,v provides homeowners with the ri�to,initiate an arbitration action(as an me right is not automatically afforded to a alternative to court action)if they have a disputeWith a cOntradtOL The sa eriu urturdes, contractor Nvould have to resolve any dispute helshe.has with a h0meOwn co s contracto however- The to th sarn riji -rr nal clause proirided below. Thisolause,.yould-ivp-the contrac r e C 2 U0 both parties agree to the 000 arbitration as is affbrded to the homeowner by the Home Improvement Contractor LaNv- te wner herebyp agree in advance that in the event the contracto,has a dispute �Py en a private arbiiration film wbich bag been approved by, The contrac or and the homeo -d concerning this contract Yd iy t bbmit the&sp u te to and Business Regulation and the consumer shall be required the Secretary'of the Executive Dffict�-* 4�onsumerAffairs In Massachusetts General Laws cb,%ItcrI42A- a to submittDsUcXiff'tt—U—— Al !'-", k Homeoi-vanier's Sip Contractor's Sismature NOTICE:The signatures of the parties above apply only to the agreement of th'e p&tirs to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution evenwhere this I section is not separately eWd by the parties. Horneowner's Mights ly ch er 142A)and other consumer A homeowners rights under the Home improvement ContractOrlaw( 1GL apt tion laws(i.e.MGL chapter 9�A)may not be waived in-any ix-dy,even by agreement However,bomeovMers Drotec Ouse is not prop w. inay be excluded frora.certain rights if the contractor they ch erly registeredas prescribed by la rmits are automatically excluded from D Guaranty Fund provisions of Homeov,mers vvbo secure their own building pe the work as described.in a the Home 1knorovement Contractor Law. The contractor is iesponsible for completing ded to other specific le�gal rights if the contractor timely and viork-manlilce mmne--- Homeowners may be entit hip or materials- In addition to guarantees or warranties guarantees orpro-tides an express Al'afrantY for-%vOrlomaus I chusetts carry an implied warranty of merchantability aid fitness for provided by the contracto;;-all goods sold in M=a vfiw agweemaybe a parti6ulAr purpose. An enumeration of other matters on which the homeowner and contractor la- Y added to the terms of the contract as long as they do not restrict a horneowner's basic consumer rights. if you have craestions about your consurnerlhomeowner rights,contact the Consumer Infbmation.Hotline(listed beloii�)- L,e_-utjon of Contract The conffiact musL be executed in_dwlicate and should not be signed until a copy of all exhibits and referenced also advised not to sip the document until 0 blank-sections have been do cuments have been attached. Parties= in signed copy of the contract with attachments is to filled in or marked as voicL deletecL or not applicable. One Grigg al dif ca on to the original contract.must be in writing be given to the owner and the otherk-eptby the contractoL Anymo fi ti and ageed toby both parties-Contracted.Nvorkmay notbegin until both parties ha-vereceivedafallyexecuted copyof the contract,and the three dayrescission.period has expired-1 ecelerated P--Ynl eRts cases where the lk contractor-may not demand payments in advance of the dates specified on pie payment schedule in hin-dh honicowner deems him/herself to be financially insecure. Howeverl in instances voiliere a contractor deems 6rS ay require that the balance of-ftmds not yett due be placed in ajoint escrow to be fmancially insecure.the contractor m account as a prere Lo continuing!he contracted worlL Withdrawal of f imds t.om said ac-countwould require the - quisite signatures of both parties- Additional In-l"Orm2tiOn additional information about the Rome Improvement Contractor Laf or other Ifyou have general questions or need '"A Massachusetts Consumer Guide to Home Improvement! consumer rights,or ifyou wish to obtain a&e WPY OT contact. consumer Information Haffine. Office of Consumer Afflair--and Business Regulation 10 parjr-Plaza,Room 5170.Boston,MA 0211-6 6179 1 1 188-283-3757 or visit the OCABR website at hft-lilk'v-,Tr--�nass.gollocabrI -D73-8787.No J If you vvan-Lto verify the regds M. 'on of a contractor or.ifyouhave questions orneedadditional infbrmation specifically aboutthe contractorrepistratio-a component of1he HomelroPrOvement CofitatorLaw,contact Director of Home finPrGv--Mcnt CO=ctorRegistrafion Office of Consumer Affuirs and Business,Regulation I o park-pjaza�Room 5170,Boston,MA 02116 6 17-9 7 3-SO 7 So 7 US 2 no-2 8 3-3 7 5 7 o r v i s i t fl HI C voeb s i i--at 11 t 1 P j:jv.- uass.- ocabri ofa Home Improvement CouUactoes Registration: GO online to vie,,N,the status L bitr,://db.stateniausiqlomeimDrox,ement/licenseel-istasD , tergurmal complaints againsta business-calk For assistance With informal mediation or'disputes or to reVs Consumer Complaht Section off ic--of the Attorney General 617-7277-8400 ANDIOR Better Business Bureau 508-652-"00�508-755-254S or 413-734-31-14 The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations 600 Mashfngton street Boston,MA 02111 ty wrtnv.mtass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information LLC Please Print Legibly tiT Name(Busincssforganizationftndividual): A"Ific ^ e�1i0I1� LC Address: RON= Vert111e City/State/Zip: Phone M 7 p Jgll- V U-j Are you an employer?Check the appropriate box: Type of project(retial 1• am a employer with— 4. Q 1 am a general contractor and I �: employees(full and/or part-time).* have hired the sub-contracto6. E]New construction rs 2.Q I am a sole proprietor or partner- listed on the attached sheet.1 7. Q Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. workers'comp.insurance. 9. Q Building addition [No workers'comp.insurance S. Q We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.Q I am a homeowner doing all work right of exemption per MGL ILEI Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑R90repairs insurance required.]t employees.[No workers' comp.insurance required.] 13. . Other_ s t r ,l e 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 subcontractors and their workers'comp.policy information. Iain an employer tlwt tsprovidtng workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:_ ` ZLl lei. j16JoPolicy#or Self-ins. //Lic.#r ✓ A70/2 I Expiration Date:_O3�oZ 0116- Job b Site Address: (O 7 J f�+C� City/State/Zip./v- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of 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 ga DIA for insurance coverage verification. !do Jiereby certify under the pa and ofperfury that the information protnded above is a and correct f j Si nature: Date: l0 .2 y Phone#: Q7 k- 71/ft — f Official use only. Do not write fir tins 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# Rightfax N2=1 3/10/2015- 10: 11 :37 AM PAGE 7/013 rax ot;z-VGl Ac R CERTIFICATE OF LIABILITY INSURANCE o3;o:zo,5 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 TAFFORDED BY THE HE ISSUING INSURER(S),POLICIES BETWEEN AUTHORIZED ZED RERESENTATVE OR PRODUCER,AND HE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. R 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). CONTACT PRODUCER NAME: EASTERN INS GROUP LLC PHGNE FAx A!C No Ezt: No 233 W CENTRAL STREET E-MAIL NATICK,MA 01760 INSURER(S)AFFORDING COVERAGE NAIC k INSURER A:AMERICAN ZURICH INSURANCE COMPANY INSURED INSURER 8: ATLANTIC WEATHERIZATION LLC INSURER C 61 REAR JEFFERSON AVE INSURER D: SALEM,MA 01970 INSURER E . INSURER F: CE V N 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. INSR ADD SUB POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MNVDDNM GEACH OCCURRENCE $ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S p o CLAIMS-MADEa OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE S GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPADP AGG S S PR0- LOC POLICY JECT MBIIJED SMGLE LIMIT S AUTOMOBILE LIABILITY a acddant ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident)UTOS S AUTOS NON-0WNED OPE Yt AMAGE S HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS•MAOE AGGREGATE S S DED I WC RETENTION$ TH- WORKERS COMPENSATION X TORY LIMITS ER TORY LOAITS F.Fi AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVYM N/AE.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? 6ZZUB 03-20-2015 03-20-2016 E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory in NH) 5B270121 It yes,desraibe under E.L.DISEASE-POLICY LIMIT 1$500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Romarks Schedule,H more apace is required) T I 1 E )1E WN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE TOWN BEFORE HE EXPIRATION DATE THEREOF, N. 0 OSGOOD OSGOOD ST ST 845 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Q ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD.name and logo are registered marks of ACORD i.. ., � - . '- --- _ - � -} �- ,� - - ._. .. .. � �) '. ,� I ,. � _ .r ' .. i c t 1 1 , r' ` a. � 1 .__.. �._ ..._. .. ...�.. r � — ,. ._ -. � � t J ijassc'chusetts-Department;,%f."Publ.0.3ai8 f Board of Building Reguiations and Standards comtr ucHon Supti -ilior Li .eense:CS-W977 :y ' ERIC W PALM r- �'- 1 3 HILTON ST Salem MA 01970- °� �f1.�. • >'� ' Expiration Commissioner 04123/2016 - :-- ._. --rl/re�an�n�o�itoea/fl a�C'.f�nsacfn�eltr =: Office of Consumer Affairs&Business-Regulation ME IMPROVEMENT CONTRACTOR i§tration: 1.42089 Type= 1 pira6on: ;:311212016 Ltd Liabirdy Colpo ATLANTIC WEATHERiZATION L.L.C. ERIC PALM 61 R JEFFERSON AVE SALEM,MA 01970. Undersecretary • f