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HomeMy WebLinkAboutBuilding Permit #212-2017 - 69 WATER STREET 8/29/2016 a 9 �ti ` ` r : •, V// �, r1ORTN 9 n o BUILDING PERMIT •, �s�e ` V1 oa ��: o TOWN OF NORTH ANDOVER `( 91 APPLICATION FOR PLAN EXAMINATION Permit NO: ����� Date Received 04, �/ �9SSgcNus Date Issued: <Z 09 IMPORTANT: Applicant must complete all items on this page �e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition o Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0/110 .1/0,0 ® i c r w 1 C,\' /\ WL,V,-Vv I L)h W�(A(p Afto PAs (I V\g v v 1 / Identification e Type or Vrint Clearly OWNER: Name: /d Phone: Address: 10, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED 'ON$125��S.F. Total Project Cost: $ C� FEE: $ / Check No.: Receipt No.: roie 60 NOTE: Persons contractin with unr gistered con actors do not have acce s t the gu and BUILDING PERMIT oNORTH � S, i ��:� e Za ��SLED TOWN OF NORTH ANDOVER 02 y - `:a °� APPLICATION FOR PLAN EXAMINATION e« Permit No#: Date Received �QA�RA7¢o !TAC US Date Issued: IMPORTANT: Applicant must complete all items on this page 1,OCATI,OU - - - _ -- - -- - -- Priot PR'QPERTY OWNER` Pring TOY; sttu.cture yes, nm - , MAP' _ —PARCEL _ ZQ:NINGDISTRICT: _ Histone Dis-trict yes, no, Machine ShopViLLac�e__yes no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p Septic C71NeJl' ❑ FI'oodplainn Wetlands ❑ Water`shedflD�stnct; 0 Water/Sewer. ---- DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: y Contractor Narne: __Phone r - -- r_ Supervisor's,Construction License _ - - �rExp:, Date: Horne Improvement.License 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 5J"ignature of:Agent/Ownort :: ' __. - Signature of�contractor �. 4� _. 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 DATE REJECTED DATE APPROVE PI/,,. PLANNING & DEVELOPMENT ❑ ❑ �)L�� I(D COMENTS 4-6* CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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 Located at 384 Osgood Street i A + G F/ 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. ❑ Pennanent 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 I HEALTH Reviewed on Signature COMMENTS 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 FIRE�DEPARTMENT Ttem ®umpsteron�site�yes �no �_� r FLocated;at 12'4 Main�St�eetf V ' 'F,rp,P." artment�signature/date �C'O M IVI E N�S i 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 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 i 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 NOTE: 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 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 ❑ 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 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 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 .Location , Date M TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 12C!2 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check it 8 p �/` VBu Iding Inspector NORT#1 Town of t_ Andover AIL T �O ;AHE h 1. ver, Mass, LOCH CHlwKK V S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT I ,�.. W. .................................... BUILDING INSPECTOR ....... ....... . .. . . • Foundation has permission to erect ...... buildings on ......... x • ................. . 6 ...... .....�i'............... Rough to be occupied as! .. ..... ... W... .. .�. rowChimney provided that the person accepting this permit shall in every resp t conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS N Rough Service .. .. ..... . ... ................... ........ . Final BUILDING I ECTO GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. f Construction 317 south Broadway Street Lawrence MA, 01843 Fax: 978-683-4017 Cell: 978-242-2707 Caconstruction01 @hotmail.com Jonathan Zapata 69 Water Street North Andover, MA 01845 617-816-1369 The undersigned proposes to furnish all material and necessary equipment and perform all labor necessary to complete the following work; Exterior • Install two entrance white door • Replace porch with rubber roof membrane • Replace drip edge flashing • Raise porch floor to not be less than 1 step height • Bottom of porch to be cover with latter • Install soffit at porch ceiling • Stairs railing to be 2 by 2 matching porch railing All the above work is to be completed in a substantial and workman like manner for the sum three thousand dollars ($3,000)to be paid at the actual cost of labor at completion of the project.Any alteration of derivation from the plans and specifications will be executed only upon writing orders by the owner and will be added to/or deducted for the sum quoted in this contract. All additional agreements must be in writing The contractor agrees to carry the Workman's Compensation and Public Liability Insurance and they are to pay all taxes on material and labor, furnished under this contract as required by Federal Law and the Laws of the State in which this work is performed. Estimates are based on plans provided. If client would like any changes made to the plans, the client must discuss this with the contractor and provide written documentation stating the changes. There will be a new estimate done. Both the contractor and the client must sign upon agreement. Plan price will vary according to changes. Price may also change due to unforeseen -obstacles. In other words, if the contractor has to do extra work for things that are not visible, the client is the one to pay for this. The client will be informed of any unforeseen obstacles. Respectfully summited by Construction Supervisor Acceptance You are hereby authorized to furnished all materials, equipment and labor required to complete the work described in the above proposal, for which the undersigned agreed to pay the amount stated in the proposal and according to the terms thereof. Client Date NoRTH 9 o t,.Eo ,° ao �� ° - '° °A Town of North Andover - r _ L *�o : Machine Shop Village Neighborhood Conservation District Commission 9 1600 Osgood Street North Andover,MA 01845 SACHU`� Certificate to Alter Date: August 25,2016 Contact Name&Address: Jonathan Zapata Project Address: 69 Water Street Project Description (attach additional pages,if needed): d o tX • vv2s �-� g t w�1 2� w ®ys41 L l 0JAa w in ° ' p l r9 C JL. P o tca-1 R o v e w J rev b hes- A&R- 4 b v uA-c rry v F 1A A S t4 bus.*-. Rd r CkL t-Zy v tL- rn Qft& n,-bt bg- Less 7NA r✓ ! STEP H i16�' 86tiaA& or- Qoia� n &,g- CyvsaFb W laHrCe_• qLa els.a,,,), Ib L">D O €lam 008 0(1'6L W j�ayCib� c1L11� -fes lana Vl✓� Y a VtrltF-a '5Opp,fi. Commission Vote: I STfl 112- RA/L JN5 7V be, 2-10,1 L C,� ATLN i n.6 Ped , Voted J to a '00Vdeny Certificate to Alter on 7.6 2,0 lL R A)e,, Comments (attach additional pages,if needed): oLtA 6 97S Signed: • ZS'• Zv to 8,2 Coo Machine Shop Village Neighborhood Conservation District Commission MSV NCDC Page 1 Iry El Cl 0 Q 110- Ili_ iiiI IIIiW _ ri PROJECT DESCRIPTION: PROJECT OWNER B ADDRESS: SHEET TITLE: DATE: Ju j 21th.I2016 SHEET#: PROPOSED JONATHAN ZAPATA ILLUSTRATION SCALE: EXISTING PORCH 69 WATER STREET NEW PORCH RESTORATION NORTH ANDOVER.MA. PRaEcr: flfS.281�0 ate' Pl �.v ol PORCH 30, DN 59. d.r I, i ,.4' � PROJECT DESCRIPTION: PROJECT OWNER 6 ADDRESS: 5H ET TITLE: DATE: 1u1 2 1th/.2016v SHEET#: PROPOSED JONATHAN ZAPATA EXISTING PORCH scALE: 1/a" 1'-0" EXISTING PORCH 69 WATER STREET FLOOR PLAN RESTORATION NORTH ANDOVER.MA. PROJECT: The Commonwealth of Massa'chusefts z ,•• Depotment ofindust-iaZAccidents . - X Congress Sheet,Suite 100 _ Boston,HA OZ1Y42017 ww w.mass.govldia *,a kers'Compexisation Insurance Affidavit:Builders/Contractors/EjggiTiciaas/PlAmbers. TO BE MED WffF(TEF,PERIIRTT'NG AU MORTZ Y. A licant Information Please Px�mt I,e ' Z Name, (Business/Osgally 1: nization1ual): - l d L6 City/State/zip: W Phone#: 07k -7 q1 - 7k0y Areyou m employer?Checkt- appropriate box: Type of protect(Yequir8d): 1.❑I am a employervutlo_ employees(full and/or pazt time). 7. []New cozistxTacfzon 2-EII am a sole proprietor or partnership and have no employees working for me in 8. E!Remo delitig any capacity.[No woAers'comp.insurance required.] 9, ❑Demolition 3-Q I am a homemnerdoingall workmysel£[No workers'comp.inenrance required-] 10 ❑Euil(�ng 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 waJors'compensation insurauce or are sole 11.[[Electrical repairs or additions propkietors wi:dr no employees. 12-,[(Plumbing repairs or additions 5.Q I am-general contractor and I have hiredthe sub-contractors listed on attached sheet 13:Q Roof repairs These snb-contractorshave employees andhave workers'comp.5nmirance t 14.F]Other, 6.[[We are a corporation_pd ifs offigers have exercisedtheir right of exemption perMGL c. 15%§1(4),-4wehsiveno.mployees.woworkers'comp.insuranoerequired] 'Any a pplicaottfi tchecksbox#1mustalso X11outthesection below showiagtherworkers'compensation policy iffomiation. i Homeowners vrho siiliniifi�is,affidavit indicafnrgthey are doing all work andthenhire outside contractors must sulmit anew affidavr't indicating suclr. ?Contractors that ch eckthis bog mtt ti 'taehed an additional sheet showing the name of the sub-contractors and state whether oznotthose entities have employees. Ifthe sub-conga ctors have employees,Ecy must pravide their workers'comp.policy number. an erriployeY t1i at is jioviding-rvoYkers9 compensation insurance for my employees.'Beloiv is the policy aYid job site infotrnation. MAIInsurance Company Name: \ Policy#or Self-ins.Zic.#: t t1G2 " 5;(e) 135.'2:/;- 0/4' Expiration Date: 7/30,//k Job Site Address: l(J 1.()(��1 P� S� City/State/Zip: Nt�X �/�(1�d✓rA Attach a copy of the workers' coxnpep4ationpolicy declaration page(showing thepolicynumber 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 weal as civil penalties in the form of a STOP WORK ORDER.and a fine of up to$250.0 0 a day against the-viola-tor.A,copy of this statement may b e forwarded to the Office ofInvestigations of the DIA for insurance coverage ver' ation. Y do hereby tify u ns and penalties ofperjzm that the information provided alcove is r�ae � correct Y Si Date: afore: ' Phone# 00 I g Official use only. Do not-wr to in this area,to be completed by city or toviz official. City or Town: permit/License# Issuing Authority'(circle one): i 1.Board ox Health 2,.-Buzldi ugDepaxbnent 3.City/Town Clerk 4.Electrical Lisp ector 5.Plumb:iugluspector 6.Other Contact Person: Phone#. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhrre, express or implied,oral or written." An.employer is defined as"an indiividual,partnership,ass ciation,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 ofati 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-Withholdthe issuance or renewal of a license or permit to op erate a business or to construct buildings in the convnonweal-t,4 for any applicantvvb o lias riot 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 checkinglo boxes that apply to your situation and,if necessary, supply sub=contractoi(s)name(s),addresses)and-phone numbers)along with their certiftcate(s)of insurance. Limited Liability Companies(LLC)orLimited 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. B e advised that this affidavit maybe submitted to the Department of• Adustrial Accidents foi•confnmation ofh=ance coverage. Also be sure to sign and date the affidavit. The,affidavit should be retained 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 ox if yoiu'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 ill in the permit/license number which will be used as areference number. Tn 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 maybe 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 p ermit 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--AIASSAFE Fax#617•-727-7749 Revised 02-23-15 wwwnnass.gov/dia 3, Of 4 -84431262 v V 10 2 3/2 1'6 7 6-0 9 P M I P S T (G M 0'n 0 0 AC40RO CERTIFICATE OF LIABILITY INSURANCE 812312016 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:I I If the Certificate holder Is an ADDITIONAL INSURED,the policy(tes)must have ADDITIONAL INSURED provisions or 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 on orsemengs), PRODur- MONICA INSURANCE AGENCY N.0;rr-ly 19 MILL STREET PHONE ............... LOWELL,MA 01852 EIVIVI. .................... AORRES& INSURER PTT!!aq.......... INSURER A: Liberty Mutual Fire InsLwance., 23M INSURED CA CABINETS AND CONSTRUCTION INC INSURER C� ..................... 317 SOUTH BROADWAY 1.1-1-1-11.............------------------------------------—------------------- ........ .............. LAWRENCE MA 01843 INSUREER D t -�v I. ----I................. .................. INSURER F COVERAGES CERTIFICATE NUMBER:3146233(1 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAVSD ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY C-01r,RACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE VAy BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED Hem.,4 is SUBJECT TO ALL TH T FRVS, EXCLUSIONS ANL!comrtio.,NS OF SUCH POLIES.umrrs SHOWNIMAY HAVE BEENREOUCED BY PAID CLAIMS. .......... ............. .................. R ..............T I Y'PE F INSURANCE YNWEER POU EFF i POLICY EXP UwTt LTR 0 _-10tic COMMERCIAL GENERAL UABAM FA0iOC"RFNOF S CLANS-MAGE 17 OCCUR PRFMisFS tFp&,Z�V WOEXP&yzoomlor) S ............... rr-'RqOW't.&AOV MjURV GFWt,AG 3ORFGATF LIMIT API"IJES Prk OPWRAL AGGIrEGATE. PRO. POLICY El JECT 0LCC PRODUCTS-COW,'OP AGG S .NFC SMET,MUT ANY AUTO ROOMY NJURY(Por S OWNED i nOrIly iNJURY(Pof accie'ttrA) S AUTOS ONLY ALITOS HAW NON40WNFD PROPERTY CAIAAf-E, AUTOS ONLY AUTOS ONLY UMBRELLA UAS CC ,CUR ..................... ....... ........... EXCESS LIAS CLAUS MADE AGORFGAT A WORKERS COMPENSAMN -613551-0116 'If30(2016 11 012017 PFR WC2-31S 5 T] I QTH� Tjn�u FR_,4............................. AND EW LOVERT UABILffY Y�N i NIA E,L.EACH AM'DENT' MHER EXCI.UOV0 (Matwaftfv in NH) 1000000 os arca dot a OPFRATONSbAbw 011FASE-Pct,,;Iy UMT 1 S 1000000 Iii DESCRIPTION OF OPE"T"S ILOCATIONS IVEHICIES(ACORD 10t Additiona;RWWkg$Otdullt,may ba aflOCtt-ed 4MWO MCI@ Is rtqu'ftdl V40RKERS COMPENSATION INSURANCE COVERAGE APPLES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. T 5 'ou Ks Certificate cancels and supersedes all prev� sly issued Certificates,only as They relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE JONATHAN ZAPATA THE EXPIRATION DAYE THEREOF, NOTICE IVILL BE DELIVERED IN 69 WATER STREET ACCORDANCE WTH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORUEDREP"SENTATME Lb2!a Mutual Fire Insuranclr 9)1985-2015 ACORD CORPORATION, All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ACO® DAIS(MM/DD/YYYY) 40 CERTIFICATE OF LIABILITY INSURANCE 08/29/2016 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(lies) 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 NAME: Johanna Gutierrez Silverio Insurance Agency AICNN Ext): (978)685 0209 Alc No: (978)685-0310 10 S.Broadway E-MAIL ADDRESS: @ info silverioinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Lawrence MA 01843 INSURER A: WESTERN WORLD INSURANCE INSURED INSURER B: LIBERTY MUTUAL FIRE CA Construction INSURER C: CA CONSTRUCTION INSURER D: 317 So.Broadway-Suite 154 INSURER E: LAWRENCE MA 01843 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. INSR TR TYPE OF INSURANCE IVSD WVD POLICY NUMBER MM DD/YYYY POLICY EFF MMLDD� LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 0 OCCUR - DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A NPP8326275 05/18/2016 05/18/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY F7 PRO ❑ PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? ❑N N/A WC2-31 S-365147-036 02/24/2016 02/24/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below -7E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured is added automatically as long as there is a written agreement requesting to be added. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD ST AUTHORIZED REPRESENTATIVE NORTH ANDOVER,MA 01845 z _711 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 9LQZ!£LJtit .. :� � `��`�� �e�pp��urizanrueu�✓i a�C�l�as6ac/rc�eC�i Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR :� STO Registration : 178375 . Type: Expiration, .4 �ka8 individual *' ESMIRNA ENCAF*�E� t«4M.saadw�;U#)U-'rL1J-'jj0 ESMIRNA ENCARt ( p.epums PUL,S..a°aetn+F Eug It^ n 436 BUTLER STREET 46;eS'3f1gn6 40 du3UJ'Ue+sarj• suasrayaessen LAWRENCE,AAA 01841 Undersecretary