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HomeMy WebLinkAboutBuilding Permit #309-2017 - 68 Kingston Street 9/22/2016 t%ORTM BUILDING PERMIT O�S.�LED TOWN OF NORTH ANDOVER �� h ;: • •"' •,6 APPLICATION FOR PLAN EXAMINATION A Permit No#: r �� Date Received 7RpDRAre D �ssgc Hus�� Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION AaMIft - " /�I n Print PROPERTY OWNER Q i AC--P- C2--ti-t L'.'. ,�7a —ST Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop 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: 0 Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others- ❑ Demolition ❑ Other Septic 0 Well ❑ Floodplain ❑Wetlands ❑ 1Natersh,ed District i DESCRIPTION OF WORK TO BE PERFORMED: /3-(( r)t-J &A-T z/1 rJ LYAC- 6A)3 Identification- Please.T pe or Print Cleary. OWNER: Name: c`t�+ � -�<,I � L I Phone: 4V -5-52 `� 3 Address: �� ��� '� GsT'6-''1 S� f" Contractor Name: E6Lvi C-' Phone: Email �n� z. 1959 a �►� ✓ C� Address: -c-L kW45,3 Supervisor's Construction License: Cy-r? Z Exp. Date: '�3(� 7� Home Improvement License: � S / Exp. Date: rf U Z( 2- ARCH ITECT/ENGI NEER ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEEDD ON$125.00 PER S.F. Total Project Cost: $ / ° er n �122J� FEE: $ ✓6 Check No.:—� le � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Flans ❑ 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 t PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature " COMMENTS HEALTH Reviewed on Signature COMMENTS r Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 'Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREt PARTME(VY, Temp�D pp y y �, r= y - Y.rt.�� .� ,, •, a DE -� - um ster on site:t., es .a 'S- Locatetl at124IUla0kStreet FirelDep�ar�tmtent�s gnaturd date�;�° COMMENTS, Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, avast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine MOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 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 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 Doe:Building Permit Revised 2014 OO R TH Town of 6 ndover 0 C, ��K, h ver, Mass, ICU COC NIC"!WKII 1 1 ADRATED S U BOARD OF HEALTH Food/Kitchen Septic System PE IT Dl THIS CERTIFIES THAT ........... BUILDING INSPECTOR has permission to erect ............. buildings on ...�Q -.,�, .. �1V. �, Foundation • Rough to be occupied as .... .................................................................. ... Chimney on acpermit shall in every respect conform to the terms of the application that the pers. in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTVT T S Rough Service ... .... ... ........... ........ ................ Final BUIL ING SPECTOR 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. 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'� � �, ,� " !•R!'!t' �F ,'f"+Y u= 'i ft r '%����,I �„7 as ` ;v �.�,.r�,:7:.t^t�lA�`•♦ t.r= ft I�y.,t 1.. ,`�.. t • tj),C, .+ ';',1 ,r• :r, ... y "''_ i.t'': r.'•li"�j l'1 1 .t r j • ' •;''Y•:• OR �•J�,,T t•.•I�n J.S nlh •} =•,'t '�' itJ,I ,1 'S' "r4� ;il i'�' I: C.' �. .� ,,1 ';{;,',. ...�+�•Tt;•r., ,t'„=•�;• �;`�:�'1�^t•�„i tf r 4 =a�,y� �ip� ,t tt� ',,'` '• r ,, �!_�}Q�,� ' r '••, 1fl t`� '�'�'J,Q�,;1,.M1�i.;1",�fiL''V�T,��t• ,1.1•(I�4�}1�q����'LY.•.��iynq�� 1.���Ii�.�R'S f,,{i� •If `.h, 't �.n'.J>�. ,. !•,",�:rl�� Ir,f' �,j1 �i� � ` 5 ”"' .;'�',:4,•'4f:.t•+'C:7t •t .t'f1C.G �.I ° r}'„�y^j=h.Y• ,. 1«: t t (l zG �� 43ki LL U N o N r�o®� Chimneys Residential & Commercial Roofing All Types Of Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Mas my Work Mass Toll Free *-Roof Leaks Experts * Licensed & Insured 1-800-WAIT-4-US ® Locally Owned& Operated Since 1976 ....'t'o'= License#034200 (924-8487) IKO azee woem oZ,.�7o%/t 46=W i We Work Year Round it 1 Proposal To: Village Green West Date 5/21/2016 Street: 200 Kingston St. N.Andover 603-382-6166 68-82, 108-138, 156-170 Roof proposal picaeng@comcast.net IKO Cambridge/Certainteed Landmark 1. Extra caution will be taken to protect all buildings, 11. Counter flash existing chimney lead,wall walkways and landscaping as best as possible. connections and all roof protrusions (pipe boots and Debris will be removed and magnets run daily. vents)with ice and water shield,tie into new shingles Not responsible to move tenants personal items. and sealed with clear Geo-Cel sealant. All installation procedures will follow state code 12.Bath Exhaust vents: Install all new black low and OSHA compliance. Caution tape outline all profile bath exhaust vents on roof line. Counter work areas. flashed with ice and water shield. One for each unit. 2. Remove all shingles and roofing materials as best No interior connection included. Will coordinate with as possible from all four buildings. Association for best locations per unit 3. Inspect and re-nail any loose or lifted plywood. 13.Wall connections: Remove existing siding or Any compromised plywood will be replaced at an aluminum trim as needed. Counter flash at least 18" additional cost. up the wall with ice and water shield. Install new 4. Install heavy gauge 8"white F8 .019 aluminum 5"x7" aluminum step flashing. Re-install siding and drip edge to all eaves and rakes. trim. Install new aluminum siding or trim if 5. Install 6' of MO Storm Seal or Certainteed Winter compromised. Guard ice and water shield to all eaves and top to 14. Removal of all work related debris. Planks will be bottom in all valleys. All drip edge nails will be placed under dumpsters to prevent any damage to covered with 12"strip of ice and water shield. existing asphalt. Placement and removal of dumpsters (ASTM D6757 certified) will be coordinated with Association to minimize 6. Install IKO Storm Tite or Certainteed Diamond daily interruptions. Deck synthetic underlayment to remaining 15. Contractor Workmanship warranty: 15 years under sheathing up to the ridge. (ASTM D6757 certified) normal wind,rain, ice and snow conditions. 7. Install all new pipe boot flashings. Counter flashed (Please see extended warranty) with ice and water shield. 8. Install IKO or Certainteed starter shingles to all Extended Warranty: (Against material defect) eaves and rakes. *IKO Shield Pro Plus* 9. Install IKO Cambridge or Certainteed Landmark • Full 20 year coverage direct from MFG. Limited Lifetime architectural shingles to all four • Non pro rated buildings. All shingles and roofing materials will • Labor,material,debris removal and workmanship be fastened and installed per MFG specifications. All valleys will be woven. Commercial MFG *Certainteed 3 Star Sure Start Plus* warranty up to 40 years. (Please see extended • Full 20 year coverage direct from MFG. warranty) • Non pro rated 10. Cut and install all new(ASTM certified)nylon • Labor,material and workmanship. Debris removal mesh ridge vents to code to all four buildings and not available with 3 Star coverage capped with IKO or CertainTeed color matched 'kir% Q*%A ririna nor ch;" ►lne I Rnth F.Ytpndpd WArrnntiP.c int-lutip.d in nrnnneal Mom • r Chimneys Residential & Commercial Roofing All Types Of Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work Mass Toll Free �i'Roaf Leaks Experts Licensed&Insured Locally Owned 6c Operated Since l97G a'�o:P License#034200 1-800-WAIT-4-US IKO® Gjaee o��o WQ Work Y Round (924-8481) i -_ • ' i • . , ,.. -/ , .$fid ,-. ,.• ,. Proposal To: R. J Pica Engineering Date 5/21/2016 (Page 4) Street: Village Green West (Phase 1) 603-382-6166 68-82, 108-138, 156-170 Roof proposal picaeng@comcast.net IKO Cambridge/Certainteed Landmark Total cost and payment schedule Total IKO Cost: $1069000.00 l� b4o4 a� Total Certainteed Cost: $1 4,000.00 / s • , a 0 • Total Gutter Cost: $15,000.00 (Balance due upon ompletion of all four buildings) *Upgraded ice and water shield options(For best defense against water infiltration caused by ice dams) -IKO Premium Goldshield: $3,000.00 additional cost -Certainteed Premium HT : $2,600.00 additional cost • including an additional costs due at the completion of each building. Payment schedule. Balance� g y v No deposit required. IK per building Certainteed $289500.00 per bui g Commercial references: Jackson Lumber Heavenly Donuts CSI (Cementary Services Inc) Shaheen, Gurearra and O'Leary Law offices A Plus rated member of the Accredited BBB since 2001 5 year consecutive Super Service Award winner from Angie's list (Top 5% of all New England roofing contractors) Acceptance of Proposal—The above prices,specifications and conditions are satisfactory and are herby accepted.You are authorized to do the work as specified.Payment will a e as outlined above. Date of Acceptance: G I t (( '� Signatu The Commonwealth of Massachusetts Department of Industrial Accidents 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. Auolicant Information Please Print Lep-ibly Name(Business/OrganizationnMividual): ,QLL Lfpl�Q f1( Qvk< 2 mal Address: 3 Tom^/�� /]/q"i t City/State/Zip: rM A4"4-1-4 Phone#: `/'/)"" P'y-j--7 r Are you in employs?(beck the appropriate bot;: Type of project(required): I.Laorrn a employer with _employees(full and/or part-time).• 7. D New construction 2.[:]]am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself[No workers'oomp.insurance required.]t 9• []Demolition 10 Q Building addition 4.E]1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or arc sok I LE]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions S Q 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.DRoof repairs These sub-contractors have anployces and have workers'comp.insraaoce_t 6.0 We arc 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. '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. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Q tt OW M1 Policy#or Self-ins.Lic.#: W C- 'Z4 Dt, Z`1, E piration Date: I '`� f Z-1 Job Site Address: tk C snow i.J % City/State/Zip: /J/' 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 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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"s and penalties of perjury that the information provided above is true and correct Signa pa : 5+ / 12 Phone N: 4��' � 7f O,f'uial 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#: Information and Instructions Massachusetts General Laws chapter 1.52 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 of hire, express 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 enterprise,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. However 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-contractor(s)name(s),addresses)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 bum 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-NIASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 9/21 /2016 9 : 07 : 39 AM 8975 p 02/02 AC"RhP CERTIFICATE OF LIABILITY INSURANCE GATE(MM/OOIYYYY) 4 09121/2016 i 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 i 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 A the terms and conditions of the policy,certain policies may require an endorsement. statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 02051.601 CONTACT Branch 2051-1 NAE: Perry Insurance Agency LLC a18%'L .Est: (978)685-7690 A/CNo: (978)687-0149 522 Chickering Rd ADDRESS: North Andover,MA 01045 I F INSURERA: A.I.M.Mutual Insurance Company -33758 INSURED All Under One Roof INSURER 8: I C/O John Lanzafame 30 Temple Drive INSURERD: Methuen, MA 01844 INSURERE: INS LIRCR F, i 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 i 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 CONDITIONSOF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN?R TYPE OF INSURANCE 1gk D POLICY NUMBER PMOSCY YY 12i y VYV LIMITS GENERAL LIABILITY EACH OCCURRENCE f COMMERCIAL GENERAL LIABILITY - AMAX- f PR MIS a gccurrencel _ CLAIMS-MADE [--]OCCUR MED EXP(Any one person) 4 PERSONAL&ADV INJURY f GENERAL AGGREGATE f ENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ OLICY RO' OC AUTOMOBILE LIABILITY CONIBWED SINGLE LIMIT f E3 atcidan ANY AUTO BODILY INJURY(Per person) f ALL OWNED SCHEDULED BODILY INJURY Per atadent f AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED POP RTY AMA E AUTOS Peracddent - f S UMBRELLA LIAB OCCUR EACH OCCURRENCE f EXCESS UAB CLAIMS MADE AGGREGATE f yyyyppRRCEERD CC��rryy�� RETENTION$ C L� „ f ANDEMPl0YER88LIABILIN X TORY LIMITS DER• ANY PRROoPRIF�7B6 RIP.ARTNEERRIEEXECUTIVEYIN E.L EACH ACCIDENT $ A OFFICERIMENIBEREXCLUOED� Q NIA PWC 400.7009464-2015A 11!912015 11/9/2016 (Mandatory in NH) E.L.DISEASE•EA EMPLOYEE f 1 000 00n Do DESSCRIPI`ION OPUrPERATIONS below E.L..DISEASE•POLICY LIMIT 6 1,000 000-00- DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if mon space is required) i The workers compensation policy does not provide coverage for John Lanzafame ERTIFtC TE HOLDER CANCELLATION Village Green West Condominiums 200 Kingston Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ` North Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN f ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserver!. DATE(MM/DD/YY) PRODUCER AND THE NAMED INSURED CERTIFICATE OF INSURANCE 09/20/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND RetentionTransworP Building Trades and Contractors Liability Association,Inc.Inc.,F Risk CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Retention Purchasing Group qualified under the Risk Retention Act of 1986;Federal Box 469 CERTIFICATE OF INSURANCE DOES NOT AFFIRMATIVELY OR P.O.Box 4 Law NEGATIVELY AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED Sandy,UT 84091-0469 BY THE INSURANCE POLICIES BELOW. 800-851-8364 INSURERS AFFORDING COVERAGE INSURED INSURER A: NOTICE:Coverage is being provided as part of a Master Group All Under One Roof INSURER B: Policy issued to members of the Transworld Building Trades and Contractors Liability Association,Inc. INSURER C: ,a Risk Retention'Purchasing Group'authorized under the Risk INSURER D: Retention Act of 1986:Federal Law 9745. 30 Temple Drive Methuen, MA 01844 "LIMITS SHOWN ARE THOSE INPrime Insurance Company COVERAGES EFFECT AS OF POLICY INCEPTION" The policies of insurance listed below have been issued to the insured named above for the policy 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. POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ $1,000,000.00 COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ N/A Claims Made PRC2656-16090011 09/13/2016 09/13/2017 MED EXP(Any one person $ N/A Exclude Products PERSONAL ADV INJURY $ N/A Exclude Completed Operations GENERAL AGGREGATE $ $2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AG $ PRO- M POLICY JECT LOC Per Person $ $300,000.00 AUTO LIABILITY ANNUAL AGGREGATE $ $0.00 ANY AUTO BODILY INJURY ALL OWNED AUTOS (Per Person) $ $0.00 ❑ SCHEDULEDAUTOS BODILY INJURY HIRED AUTOS (Per Accident) $ $0.00 ❑ NON-OWNED AUTOS PROPERTY DAMAGE DRIVE AWAY (Per Accident) $ $0.00 GARAGE LIABILITY/MANUSCRIPT FORM PER PERSON $0.00 SCHEDULE AUTO $ Efl G.K.L.L. PER ACCIDENT $ $0.00 ❑I O.T.R.P.D. AGGREGATE $ $0.00 ❑ D.O.C. ❑ CARGO PROPERTY DAMAGE $ $0.00 ❑ ON HOOK ❑ EMPLOYEE DISHONESTY ❑ WRONGFUL REPOSSESSIO EXCESS LIABILITY EACH OCCURRENCE $ $0 OCCUR ❑CLAIMS MADE AGGREGATE $ $0 RETENTION $ $ LIMITATION OF COVERAGE FOR ADDITIONAL INSURED DESCRIPTION OF OPERATION/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISION Coverage is limited to only insured activities or operations on the Participant Member Declaration Certificate or as may be separately endorsed.Contractors-Executive Supervisors,Contracted Services-Using fully insured subcontractors. LVJI CERTIFICATE HOLDER JUI ADDITIONAL INSURE L I LOSS PAYEE Village Green West SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 200 Kingston St.., FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND North Andover, MA 01'845 UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. � Attn:Andrea Georgette \ AUTHORIZED REPRESENT IVE Fax Number: 978532602 � Massschusetts -1JEl.lrtmr'.l:o Board of Buiidiny Cloniti'liitiull Surit:l'Viiui• License: CS-069120 11� JOHN W LANZAFikME , 30 TEMPLE DR : ; s METHUENMA 01844' -1: ; t' 1 �uinm;ssiJilr,.r 04/03/2017 Click on the registration number to view complaint history.You can also view arbitration andltaranty Fund history.The list is current as of Wednesday, October 8, 2014, $earch Results REGISTRANT RESPONSI&E REGISTRATION ADDRESS EXPIRATION STATUS NAME INDM, DUAL NUMBER DATE ALL UNDER ONE ROOF LANZAFA 4E. L370FP L370166 A MERRIMACK ST 10/02/2016 Current JOHN METH5Ut4.MA 01044 _... 2012 Commonwealth of Massachusetts. Mass.GovG Is a.registered servios mark of the Commonwealth'of massachusetts:. i Location 'j Lt No. f Date rs7a I • - TOWN OF NORTH ANDOVER M 4.-7. Certificate of Occupancy $ Building/Frame Permit Fee $��,(ft' Foundation Permit Fee $ D Other Permit Fee $ TOTAL $ Check# :1, + �.._.0 1 //� Building Inspector