HomeMy WebLinkAboutBuilding Permit #032-2016 - 7 INGALLS STREET 7/6/2015 BUILDING PERMIT
' TOWN OF NORTH ANDOVER ° p
APPLICATION FOR PLAN EXAMINATION * -
Permit NO: t✓ �� �� Date Received A°� <�• -� • �y."
7 A�gwTeo nPP`'l-
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Pri C
PROPERTY OWNERZSSOf
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MAP NO• ARCEL: ONING DISTRICT: Historic District yesno
Machine Shop Village. es no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building Kone family
❑ Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
u Septic o Well ❑ Floodplain ❑Wetlands ❑ .Watershed District
0 Water/Sewer .
�_-X;s \ ecps eco ce snow eve4- — rice
kese 2 JeccS 6 c"c 447 1-mens%0r\S vJ ;
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Identification Please Yype or Print Clearly)
OWNER_ Name: Phone
d ress:
CONTRACTOR Name: Phone:
Address:
m
Supervisor's Construction LicenserExp. Date:
,S 0'7 3991 *1_7 12-016
Home Improvement License: Exp. Date:
2Iq 29 „ 20 IS .
ARCHITECT/ENGINEER I� I Phone:
Address: Reg. No. t
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
6 I
Total Project Cost: $ 32-I 5 4* FEE: $ S
Check No.: �,, Receipt No.: d
NOTE: Persons contractingiVith unregistered contractors do not have access totze guaranty fund
Signature of Agenf/Owner�' `� ��� �� Signature.of contractor
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 APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMENTS
CONSERVATION ❑
COMMENTS \` 4J2WC0Acc �k
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS L S
Koh 6%J cw u
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
FIRE DEPARTMENT -Temp'Dumpster on-site yes no
Located at 124 Main Street
Faire Department-signature/date
COMMENTS
Location
-711:V15
No.No. � Date /
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $ �.
Other Permit Fee $
TOTAL $
h
.ChOck f
Building Inspector
NORTH
own ofAndover
,
0 �•. 1 0% f'
C, ver Mass
T O LANE ' '
A- COC MICl/EWICK
S u
BOARD OF HEALTH
Food/Kitchen
PER IT T LD Septic System
E
THIS CERTIFIES THAT P �� ....,..'_. a:�z VS PL—, BUILDING INSPECTOR
has permission to erect .......................... buildings on ..�.......� ,1,��..,.�, Foundation
............... .... .......... ......................
Rough
to be occupied as ....... ..... . .t!/. .... -�it� :s..I.....IMAW ......K.!` ...�.........�!�1��. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
I UNLESS CONSTRUCTIO AR Rough
Service
.................... ........................................................... Final
BUILDING INSPECTOR
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.
1
Page 1 of 7
a
Nexus II Carpentry and
Construction Design
P.O.Box 2823
Woburn,MA 01888
781 760 2031
Fax 978 9751263 Q p
markknexuscarpentry.com
www.nexusearpentry.com
CS#-073991
MC#129177
Contract
This is a contract between Rosemary Saracusa of 7 Ingalls Street,North Andover MA
01845 (Hereafter referred to as the"owners" or"owner") and Nexus II Services
(hereafter referred to as"Nexus") dated June 8th 2015.
GENERAL SCOPE OF WORK DESCRIPTION
WE HEREBY SUBMIT SPECIFICATIONS AND CONTRACT FOR: work as stated
below for deck replacement and other work required to repair ice/snow damage as noted
below
Scope of work:
General details
♦ Meet with local building official and apply for permits
♦ All work will be in accordance with local building code regulations and will be
inspected by local officials prior to continuing with the next phase—Nexus will be
responsible for arranging and being available for all inspections
o All work will be coordinated directly between"owners", architect if required and
Nexus
♦ Nexus confirms that it is licensed,insured as required and ensures any sub-
contractors utilized on this site will have the appropriate insurance coverage
SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND
PROJECT MANAGEMENT
Page 2 of 7
s Nexus will be responsible for the safe storage of all its property and any materials to
be used on the site. Any items left on site will be covered under Nexus insurances
♦ Owner is responsible for removal and return where necessary of all items within the
work area and their safe storage prior to our work commencing
♦ Owner will then be responsible for returning all items to the area after completion of
the scope of work
♦ Nexus will remove all trash associated with this project into a Nexus supplied
dumpster and arrange for safe disposal in to a registered site—if required
♦ Nexus will contact Dig Safe" and confirm all utilities location—if required
Scope of work;
DECKS;
NOTE—all decking to be secured to the framing using hidden screws with plugs to
hide these screws -- no screws or nails to be left exposed on the deck boards NOTE
2—stainless steel finish nails to be used to secure the trim boards and risers—no
plugs required to fill these holes
♦ Provide a dumpster for the collection of all debris associated with this project
♦ Make"safe"the existing collapsed deck and carefully remove the trapped furniture,
grill etc. setting to one side for Rosemary
♦ Remove and trash the existing 2 deck structures
♦ Do an investigation dig to establish whether or not the existing"tube" foundations are
4' deep NOTE: if these are not 4' deep then the client must be informed so she can
authorize the installation of concrete lona tubes to code NOTE 2: If the existing tubes
are 4' to code, it should be noted that Nexus is not responsible for the condition or
performance of these existing sona tubes
♦ Furnish and install a new dryer vent cover to replace the one damaged during the
storm
♦ Furnish and install pressure treated(PT)frame work to create a new deck to the
existing layout 19' 2"x 10' 4" from the kitchen sliding door and to layout drawings
Furnish and install PT framework for steps from this new deck to another deck as
shown on the plans and to layout drawings
o Furnish and install PT frame work to create a new deck to the existing layout 8' 2"x
18' 3"and to layout drawings NOTE: existing granite step to LH side of existing
deck to be utilized as a step to yard
e Furnish and install PT framework for steps from this new smaller deck to grade as
shown on the plans
o Furnish and install aluminum flashing detail to the intersection at the house walls
o Furnish and install "Azek Morado"deck boards to both new replacement decks
e Furnish and install "Azek Morado"deck boards with"White"composite risers to
both new replacement stair systems
o Furnish and install "Radiance White"vinyl hand rails with square ballesters and
white PVC sleeves over all PT posts r1VOTE,,DO NOT USE"Radiance Rail
Express"as this has exposed brackets
SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND
PROJECT MANAGEMENT
Page 3 of 7
o Furnish and install composite trim boards to the skirt boards around the perimeter of
the deck and the kick plate going into the house and garage
o Furnish and install new cedar shingles around the deck connection area to replace
those damaged
o Cost for materials and labor is $22, 763.00
Dining room window;
o Remove and trash the 3 windows (1 picture window and 2 double hung flankers), in
the"bay area" at the rear of the house in the dining room
o Furnish and install 1 Andersen picture window—no grills—with a clad exterior finish
and a prefinished"white"interior finish—NOTE; existing dimensions to be utilized
as closely as possible
o Furnish and install 2 Andersen double hung windows—no grills—with a clad exterior
finish and a prefinished"white" interior finish—NOTE; existing dimensions to be
utilized as closely as possible
o Furnish and install insulation to these new window set ups
o Furnish and install any interior or exterior trim to these new windows
o Furnish and paint the new trim only
o Cost for materials and labor is $3, 555.00
Dumpster;
o Supply and remove trash- $650.00
Kitchen cabinets;
NOTE: wall cabinets x 2 and trim pieces to be SAVED and given to Rosemary to
arrange for collection by the insurance company
o Remove and SAVE 3 part trim over the wall cabinets over the sink and to the right of
the sink
o Remove and SAVE 1 wall cabinet and 1 glass cabinet to the RH side of the sink
o Furnish and install 2 new wall cabinets and a run of 3 part trim through Family
Kitchens
o Cost for materials and labor is $4, 970.00
Sitting area repairs;
o Compound the crack in the wall over the top of the existing slider
o Sand the compound to blend into the existing plaster
o Furnish a primer coat to prepare for paint
o Furnish and paint with 2 coats the entire wall with the same color as previously used
o Cost for materials and labor is$610.00
General;
o Leave construction areas in "broomswept" condition
SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND
PROJECT MANAGEMENT
Y
Page 4 of 7
The above quotation does not include the cost of any of the following and in some
cases where stated allowances have been given to assist you in selection. If
requested,we would be happy to provide any costs on items listed below, if not here
stated;
Permit costs (plan for$400.00-500.00) or unseen conditions
Painting or staining or prep work beyond specifically noted in the scope of work above
Upgrades to existing utility conditions or structure
Dryer vent pipe work beyond the cover repair noted
Upgrades to mechanicals and any heating changes beyond those required to complete
the scope of work
moving of personal property—NOTE: we are happy to help, but would not want to be
wholly responsible
Asbestos remediation of any kind
—Insulation unless specifically noted in scope of work above
Window or door replacement unless noted above
Cabinets or counters supply unless noted above
Appliances,hardware or fixtures
—Concrete song tubes or foundation if required - $2, 100.00 quoted
All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any
alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an
extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control owner to
carry fire,tornado and other necessary insurance.Our workers are fully covered by Workman's Compensation Insurance.
PERMITS
"Nexus"has accepted the responsibility to obtain the necessary building permits."Nexus"will act as a GC
and work in accordance with fair and reasonable practices,and cooperate fully and under the guidance of
the"Owners"and authorized parties.
Standard Exclusions:
Unless specifically included in the"General Scope of Work"section above,this agreement does not
include labor or materials for the following work(any Exclusions in this paragraph which have been lined
out and initialed by the parties do not apply to this Agreement): Removal and disposal of any materials
containing asbestos or any other hazardous material as defined by the EPA. Custom milling of any wood
for use in project. Moving"Owners"property around the site. Labor or materials required repairing or
replacing any"Owners"-supplied materials. Repair of concealed underground utilities not located on
prints or physically staked out by"Owners",which are damaged during construction. Surveying that may
be required to establish accurate property boundaries for setback purposes(fences and old stakes may not
be located on actual property lines). Final construction cleaning("Nexus"will leave site in"broom swept"
condition). Landscaping and irrigation work of any kind. Temporary sanitation,power,or fencing.
Removal of soils under house in order to obtain 18 inches(or code-required height)of clear space between
bottom of joists and soil. Removal of filled ground or rock or any other materials not removable by
ordinary hand tools(unless heavy equipment is specified in scope of work section above),correction of
existing out-of-plumb or out-of-level conditions in existing structure. Correction of concealed substandard
framing. Removal and replacement of existing rot or insect infestation. Construction of a continuously
level foundation around structure(if lot is sloped more than 6 inches from front to back or side to side,
"Nexus"step the foundation in accordance with the slope of the lot). Exact matching of existing finishes.
Repair of damage to roadways,sidewalks,or driveways that could occur when construction equipment and
SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND
PROJECT MANAGEMENT
• Page 5 of 7
vehicles are being used in the normal course of construction.The"Owner"is to enter into contracts for all
of the above-mentioned services and provide direct payment to"Nexus"for all of the services we are to
provide."Nexus"will be responsible for removing all components and all construction materials relevant to
the"scope of work" in this contract.
Dumpsters,trailers and signs
"Nexus"will provide as included in the cost of this project,a dumpster for the sole purpose of the removal
of trash associated with this project.This dumpster should not be used by any persons for any other waste
items or for any purpose outside of the specific use under the scope of work,unless authorization is
received from"Nexus".Nexus may have on site for part,or the whole of the project,a trailer containing
materials and tools belonging to"Nexus".This trailer will be parked in a position agreed to in coordination
with the"Owners"and will be covered under the insurances of"Nexus"at all times."Nexus"will have on
site,a sign,with our contact details,in the event that anyone,including your neighbors,has a need to
contact us directly.
Photographs
"Nexus"reserves the right to,from time to time,take photographs of the contracted work for use in its
general marketing or for production on its web site.At no time will"Nexus"share any personal contact
details of the"owner"for any photographs that it may use without seeking authorization from the"owner".
Warranties
All the components supplied by"Nexus"as part of the original order are covered under the warranty
exercised by"Nexus"and supported by the vendors or sub-contractors.All labor and materials purchased
from other suppliers to achieve completion of contract are warranted(1)one year from completion of the
construction.
Owner appointed sub contractors
From time to time an"owner"may request that we incorporate a sub-contractor of the"owners"choosing
on a project."Nexus"will facilitate this request provided the assigned sub-contractor is connected directly
with"Nexus"for all scheduling requirements and"nexus"will manage this sub-contractor in a fashion
comparable with any other sub-contractor.All sub-contractors must be licensed and insured in accordance
with State law."Nexus"will meet with these sub-contractors and will ask them to submit a written
proposal of all the work that will be included which"Nexus"will then confirm with the"owner"."Nexus"
will oversee this scope of work and ensure that it is completed in a professional manner but the sub-
contractor will be responsible for any future warranty issues directly with the"owners".All sub-contractors
are responsible for the safe and clean upkeep of the working environment and will be responsible to remove
their associated trash on a daily basis.
Deliveries
"Nexus"will be responsible for the safe arrival to site of all materials required for construction purposes for
items contained within the scope of work.The"owners"shall be responsible for the safe arrival to site of
other items outside of construction materials,however,should"owners"require"Nexus"to collect and
bring to site,any of these items,"Nexus"will accommodate as able and add a minimal cost to cover time
and fuel to a change order.
Allowances with the contract cost
Within the cost structure of this contract,certain cost allowances may have been given for the"owners"to
purchase items chosen by them—these allowances will be noted above with the amount allowed clearly
SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND
PROJECT MANAGEMENT
Page 6 of 7
noted.If the"owners"do not spend the full allowance in an area,this amount will be credited back to the
customer and not included in the final contracted amount.If the"owners"spend beyond the allowance
noted,then the"owners"shall be responsible for this balance and a payment made to cover this amount
either to the vendor,the sub-contractor or to"Nexus"
Expiration of this Agreement:
This Agreement will expire 30 days after the date at the top of page one of this agreement if not accepted in
writing by"Owners"and returned to"Nexus"along with the necessary deposits within that time frame.
I
People Authorized to Sign Change Orders:
The following people are authorized to sign Change Orders:
"N us": Mark Gotobed or Ged White
"Owner/Owne ": Rosemary Saracusa
Concealed Conditions:
This Agreement is based solely on the observations"Nexus"was able to make with the area in its current
condition at the time this Agreement was bid. If additional Concealed Conditions are discovered once
work has commenced which were not visible at the time this proposal was bid,"Nexus"will stop work and
point out these unforeseen Concealed Conditions to"Owners"so that"Owners"and"Nexus"can execute a
Change Order for any Additional Work.
I
Changes in the Work:
During the course of the project,"Owners"may order changes in the work(both additions and deletions).
"Nexus"will determine the cost of these changes and the cost of this additional work will be added to
"Nexus"profit and overhead.
Schedule of work
It is agreed by both parties that this work will be coordinated with the"Owners"and"Nexus"to be
undertaken in various stages to avoid complete disruption of the home environment."Nexus"will
give"Owners"no less than 2 days notice prior to arriving on site for commencement of any of the
agreed stages of work to allow"Owners"to prepare."Owners"commits to have sites identified for
construction work available for start at the beginning of the scheduled day so as to avoid any
unnecessary delays_
• Page 7of7
Contract Cost and Payment Schedule:
Total cost of work description and materials included in the proposal (except
materials/work stated) - $32, 548.00 (Thirty Two thousand five hundred and forty
eight dollars and zero cents)
ck
PAYMENT SCHEDULE Z
1st Payment due upon signing this contract
TOT $7,000.00
2nd Payment due upon receipt of permit
TOTAL $6,000.00
3rd Payment due upon completion of deck framing
TOTAL$6,000.00
44th Payment due upon completion of hand rails
TOTAL $6,000.00
5th Payment due upon completion installation of window, and cabinets and trim
TOTAL $6,000.00
Final payment due upon completion of scope of work
TOTAL $1,548.00
Amount due upon signing this contract i=-000.00
�� c(c X32
I have read and understand and I agree to all the terms and conditions contained
in the proposal above.
0 �
Date..... ..... ........... ........ "Nexus"Authorization.............. .........................................
Date...6.12/1,5...... "Owner/Owners"Authorizatio-d' . Z.?1 11.4aa-1
AND/OR
Date............................... "Owner/Owners"Authorization.....................................................
SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND
PROJECT MANAGEMENT
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Name,(Businesslorg livid Address* ` �2 d lft Phone#: X60 ®`3
City/Sfate/Zip:
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Are yomx an employer?check the appropriate x am a general contractor and 1 6. [l New contraction.
1.Q am a employer with__ t�1 have�iiredthe sub-contracfoxs ,�. p g emodelu�g
employees(fulland/orpax�time}.
listedonthe attachedsheet.r $. ❑Demolition
2,[[I am a sole proprietor or partner- These sub-contractors ha,v _r
ship and have no employees vroxkers'comp.insurance G'�� 9. ❑Building addition
working £oxine in any capacity.
[No workers' comp.jnsuxance 5• ❑We are a corporation and i s 10.n Ejectrical repairs or
adclitions
offtcexs have exexeI ed their
required.] right of exemptionperMGL 11•�p1�.bingxepairs oradditions
3,❑ 1 am a homeowner doing all work and we have no 12,[]Roof repairs
G.152,§l(4), � � �
myself.LNo workers' comp. employees.Lffo workers' 13Othex
insurancerequired.]' comp.insurancerequired.]
x�Y aPpucantthat checks box#1 mustalso fill o e rare doing allworlc and hen hire outside cmonizac ors mustsubmit a new affidavit indicating such.
'Homeowners who submitthis aff7davit mdi ting Y oli information.
rCoritractors that checkthis box mustattached an.additionatsheetshowing hename ofthesub-confractors andtheu workers comp.p �`
at is Yoviding worXrers'camper2sation insurance fog my er�ployee�: Below is thepolicy aptc�job site
�am�eraptoyer th p
information.
Insurance CompauyName:.
B�pirationDate• .
Policy#or Self.-ins.Mo.#:
CityJState/?ip: '
rob Site Address:
Attach a copy of the workers'comp -policy declaration page(showing the Polley numler and expiration date).
lead to the imposition of criminal penalties of a
'on 25A of 1VIGL c.152 can
Failure to secure coverage as required-under Secy
fine u to$1,50 0.0 one-year imprisonment,as wells cxvii o f t1lb nt may be forwaxdedoo the Office o£d a fine,
p ainsttheviolator. Be advisedihat a copy
o£up to$250.00 a day against
Investigations of the DIA for insurance coverage verification. ^
antler the cans d penalties ofperiacry duct the information provided above is true and correct-
X do itereby certify P
Date:
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Officialuse only. Do 7201 writE are this area,t0 l7e C0791p1e y �Y .
City or Town: Bernnif/License#
issuingA-athoritY(eircle one): ecto�r 5.Plmnbingluspector
1.Board of health 2..Building Department 3.CitylTowzt Clerk �.Electrical InspJ
6.Other y
Phone#:
A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
• 6/9/2015
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 CONTNAME: Lauren Goldman
Cross Insurance-Peabody PHONE (978)532-5445 ANo:(978)532-2217
139 Lynnfield Street AIL
ADDRESS:lgoldman@crossagency.com
INSURERS AFFORDING COVERAGE NAIC#
Peabody MA 01960 INSURER A:Wes tern World Ins. Co..
INSURED INSURERB:Saf ty Indemnity 3618
Nexus II Services LLC INSURER C:
P.O. BOX 2 823 INSURER D:
INSURER E:
Woburn MA 01888 INSURER F:
COVERAGES CERTIFICATE NUMBER:CL14121825721 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 TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP
LTR 1 POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea occurrence $
A CLAIMS-MADE F OCCUR PP8236669 8/12/2014 /12/2015 MED EXP(Any one person) $ 5,000
PERSONAL BADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000
X POLICY PRO- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident
B ANY AUTO ALL OWNED BODILY INJURY(Per person) $ 500,000
AUTOS X SCHEDULED AUTOS 116632 1/10/2014 1/10/2015 BODILY INJURY(Per accident) $ 500,000
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
AUTOS Per accident $ 100 000
UMBRELLA LIAB Medical a ments $ 5,000
OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS MADE
i AGGREGATE $
DED I I RETENTIONS $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $
(Mandatory in
If yes,describeaunder E.L.DISEASE-EA EMPLOYE $
under
TION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIP
111 -
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
Refer to policy for exclusionary endorsements and special provisions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Rosemary Saracusa ACCORDANCE WITH THE POLICY PROVISIONS.
7 Ingalls Street
North Andover, MA 01845 AUTHORIZED REPRESENTATIVE
Timothy Tramonte/MD1
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u Massachusetts -Department of Public Safety
I. Board of Building Regulations and Standards .
Construction Supervisor
License: CS-073991
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GERALD WHITE-` _
23 GLENDALE DR ,
DANVERS MA 61923
Expiration
04/07/2016
Commissioner
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Expiration:-3/19/2015 , Individual 1
Gerald White
Gerald White
23 Glendale Dr
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Danvers,MA 01923„ Undersecretary
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Office.of Consumer Affairs and*Business Reguta'tron°
10.Park Plaza-Suite 5170
`Boston,MA 02116
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