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HomeMy WebLinkAboutBuilding Permit #1225-2016 - 79 MARBLEHEAD STREET 5/24/2016 1 N O� ORTH q BUILDING PERMIT .4'. �o TOWN OF NORTH ANDOVER to APPLICATION FOR PLAN EXAMINATION �• Z e Permit No#: Irl Date Received 7 ^TED CHUs�,t ty gSSA Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION fin Ckv �Orin��� PROPERTY OWNER � Print 100 Year Structure yes(. n MAP PARCEL: ZONING DISTRICT: Historic District ye Machine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential El New Building One family ❑ Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑1Nell ❑-Floodp-lain C3 Wetlands ❑ Watershed,District 0 Water/Sewer -- - DESCRIFTION OF WORK TO BE PERFORMED: r,,ZTea y pcn. O bb j / q_ bb�y 0 r a OWNER: Name: � Tr� hone: Address: `MCw�O Contractor Name: Email: - Address- Supervisor's Construction License: C5 Exp. Date: l . Date: Home .Improvement License: Ex� 6 p ARCHITECT/ENGINEER Phone: _ Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -7050 .—J0 FEE: $ Check No.: IL4619 Receipt No.: 1 NOTE: Persons contractingwi h unregistered contractors do not have acces o t guaranty and J 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 4 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) ;6 Engineering Affidavits for Engineered products OTE: All dumpster p require uire sign off from Fire Department prior to issuance of Bldg Permit q New Construction (Single and Two Family) Building Permit Application 1 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 Doc:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL f Public Sewer ❑ Swimming Pools ❑ Tanning/MassageBody Art ❑ g Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed.ori Signature j COMMENTS f i 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 FIRES DEP TMEN _j exp peps r on sit ILocated at 124 n Street r —--, Fire Dep ms. g, a a/ ej . kfQ {' , t ------ ----- -- I RTFI _ II) � 1 f Dimension Number of Stories:__ Total square feet of floor area, based on Exterior dimensions.__ Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, creast or service drop requires approval Electrical Inspector yes pp I of No DANCER ZONE LITERATURE: yes MGL Chapter 166 section 21A—F and G min.vo0-$1o00 fine No 1 NOTES and DATA,— (For department use) I i ❑ Notified for pickup Call Email Date Time Contact Name Doc-Building Permit Revised 2014 -------- -- --- Location No. ! ; v c Date 2v h . a • - TOWN OF NORTH ANDOVER � y Certificate of Occupancy $ li Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $L 1- Check# 'f 30416 Building Inspector NORTH Town of3� _ L ndover O �+ �61 s 6L., a 2A 1 o h � ver, Mass, $lp cocHUHew,cw �1' x.95 J 'ATEO 0kr tl BOARD OF HEALTH Food/Kitchen P Ell R Septic System THIS CERTIFIES THATBUILDING INSPECTOR ............NEI. ..... .�r...4! .............. ........................ ........ j ......... Foundation has permission to erect .......................... buildings on ... ......... ..... ... ®® Rough tobe occupied as ................. ..... ...... .... 4. ......... ...................................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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. � NORTF� Town of �� : ndover O 0 s oh ver, Mass, V` COC HIc»t WIC 1' dao a�� RATED s U BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT ....... BUILDING INSPECTOR ..... .. . .......' ...... . . . . ... . .......... . ....... '.......... Foundation has permission to erect .......................... buildings on .. .. ......... ..... ... ... Rough tobe occupied as .............. .. ..... ...... ........ . ......... ...................................................................... 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 INSPECT- , VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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. Raysiaie Roofers,Inc. Proposal F.O. Box 189 North Reading,MA 01864 Date Estimate# Tel. 978-664-0668 5/6/2016 16554 Fax 978-664-4333 ff .., -,Bay State�Roofers Inc proposes: ffe approximately . 1600 square feet of the existing asphaltand around all he roof penetrations.eking. new ice and water shield along the 6 roof edge,valley Install riew 151V felt paper througho%if.roof area. perimeter. Install new white aluminum drip edge along the roof p new Lifetime GAF Architectural asphalt shingle will be installed on.r the prepared substrate. new ridge vent will be installed to ensure the proper roof ven endation, specification A g manufacturers recomm P acture All roof penetrations and flashing will be installed according to manuf and details. Cut and install new lead flashing on the roof chimney. (1) Install new pipe flanges. Bay State Roofers will properly, disposewill wilall l be an add in $2 50 per linealootn waste s Any wood decking that needs replacement Flat roofs will be done with poly glas rolled roofing. New Shingle Roof Add an additional$2550.00 to include the garage roof to match. (700sgft). Tear Off Authorized signature: Total $7,050.00. Waste containers supplied by Bay State Roofers,Inc. are for sole purpose of roof debris. Ltiicler iio" Cfctifr%stalli✓e fs the hWhed er°to iise these ct i tailiers for personal'iise: 10 Year Workmanship Warranty on all roofs. (Except Repair-Jobs) CONTRACT ACCEPTANCE CE The specifications,prices,payment schedule,are.satisfactory and.hereby accepted. Date' Jr� I fo BAY STATE ROOFERS,1'NG is authorized to perform work as specified. " Payment will be made as previously outlined. ,Signature All bills over 30 days are subject to 1 1/2%finance charge per month(18'% color ✓ ��iN 1 e P rr r 4 annual). I PROVISIONS OF THE AGREEMENT I.PROJECT PROVISIONS e. Damage to Project: Contractor will not be responsible for any a.Guideline:The Project will be constructed in strict conformance damage caused by the Owner. or other causes beyond the control of to the plans and specifications which have been examined and the Contractor.Owner will pay for any restoration work. approved by the Owner. b.Compliance:The Project will be completed in strict compliance IV.CONTRACTOR'S RIGHTS AND RESPONSIBILITIES with all laws, ordinances, rules and regulations of the applicable a. Delay: Contractor will be excused for any delay beyond his government authorities. I reasonable control. These delays may include, but are not limited to c. Control:The Agreement plans and specifications are intended Acts of God, labor disputes, inclement weather, acts of public authority, to supplement each other. In case of conflict, the plans will control the acts of the Owner.or other unforeseen contingencies. specifications and the Agreement provisions will control both. b. Right to Stop Work: If any payment under this Agreement is d.Charge Orders:As directed by the Owner,construction lender, not made when due,the Contractor may suspend work on the job until public body or inspector,any alteration or deviation from the specifications such time as all payments due have been made. Any failure to make that involves extra cost(subcontract, labor, materials)will be executed payment is subject to a claim enforced. against the property in only upon the parties entering into a written change'order. Expense accordance with the applicable lien laws.. incurred because of unusual or unanticipated conditions will be paid for c.Substitution of Materials:Contractor may substitute materials by the Owner. without notice to the Owner in order to allow work to proceed, provided e. Allowances: If the Agreement price includes allowances, and that the substituted materials are of no lesser quality than those listed the cost of performing the work is greater or less than this allowance, in the specifications' then the Agreement price will be adjusted accordingly. d.Salvage:All salvage resulting from work under this Agreement It.FINANCIAL RIGHTS AND RESPONSIBILITIES is to be retained by the Contractor unless other agreements are a. Labor and Material: Contractor will provide and pay for all contained in the written specifications. labor and materials necessary to complete the Project. Contractor is e. Insurance: Contractor will maintain workers' disability released from this obligation for expenses incurred when•the Owner is compensation insurance for his employees and comprehensive public in arrears in making progress payments. liability insurance policies. b. Permits:Contractor will obtain and pay for all required building V.COMPLETION OF PROJECT permits and licenses. a. Notice: Owner agrees to sign a Notice of Completion within 5 c.Taxes,Assessments and Charges:Taxes.special assessments days after completion of the project. If project passes final inspection of all descriptions, and charges required by public bodies and utilities and the Owner does not sign the Notice,the Contractor may act as the will be paid for by the Owner. Owner's agent and sign the Notice. d. Deposit of Payments: Contractor is required to deposit all b. Clean-up: Contractor is responsible for removing debris and payments received prior to completion in an escrow account. In lieu of surplus material from the property, and leaving the property in a neat such a deposit,the Contractor may post a bond or,contract of indemnity and orderly condition. with the Owner guaranteeing the return.or proper application of such VI.CONFLICT PROVISIONS payments to the purposes of the contract. All advanced funds will be deposited as indicated under Special Provisions. Monies used in a. Arbitration: Any controversy or claim arising out of this escrow become the property of the Contractor when they are applied Agreement that cannot be resolved, is subject to arbitration, with according to the Agreement payment schedule, when a breach of an arbitrator of mutual agreement, and all parties (including contract by the Owner occurs, or when the Agreement has been Owner, Contractor, Architect and Sub-Contractors) are bound to substantially performed. this arbitration, If any party does not appear at arbitration proceedings, the arbitrator is empowered to decide the controversy e. Bankruptcy: It either party becomes bankrupt. the other party in accordance with whatever evidence is presented by the has the right to cancel this Agreement. party(ies)that do participate. III.OWNER'S RIGHTS AND RESPONSIBILITIES b. Attorney Fees: If either party becomes involved in litigation a. Cancellation: Owner has an unconditional right to cancel the arising out of Agreement, the Court shall award costs/expenses Agreement, without penalty or obligation, until midnight of the third including attorney fees to the party justly entitled to them. business day after the Agreement was signed. Cancellation must be c. Limitations: No action related to this Project may be made done in writing. Upon cancellation, any property traded in, any by either party against the other more. than 2, years after the payments made under this Agreement, and any negotiated instrument completion of work. executed will be returned within 10 business days following receipt by VII,GENERAL PROVISIONS the Contractor of cancellation notice. b. Property Lines: Owner shall locate and point out property a. Notice:Any notice required or permitted under this Agreement lines to the Contractor.Contractor may,at his option,require the Owner may be given by certified or registered mail at the addresses contained to provide a licensed land surveyor's map of the property. in the Agreement. c. Liens: Failure to pay persons supplying materials or services b. Prohibition of Assignment: Neither party may assign this according to the terms of this Agreement may result in the filing of Agreement or payment due under this Agreement without the written mechanic's liens on the affected property. Owner has the right to ask consent of the other party. the Contractor for lien waivers from all persons supplying these c. Qualification:This document constitutes the entire agreement materials or services. In the event any mechanic's lien is filed through of the parties. No other agreements exist. This Agreement can be no fault of the Owner, then the Contractor agrees to take all steps modified only by written agreement signed by both parties. necessary for the release and discharge of such lien. d.Insurance:Owner will maintain property damage insurance at d.Governance:This Agreement shall be construed in accordance least equal to the Agreerr, price. with and governed by, the laws of the state in which the Project is located. We welcome, d/SA ...., !Duc�.veR PayAa! .. �R.. The Commonwealth of Massachusetts z. . f Department of IndustrialAccidents c =_• �- d 1 Congress Street,Suite 100 Boston,IIIA 02114-2017 www rnass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information F Please Print Legib NaMe(Business/Organization/ludividual): O Address: City/State/Zip: N.V Q Aa 1 Phone#: Are you an employer?Checktlie appropriate box: Type of project(required): 1. 4�,Ildm a employer with _employees(full and/oz part-time).* 7. Q New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] • 9. ❑Demolition 3..❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ � # 13.�Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and ifs ofters.have exercised their right of exemption per MGL c. 14.❑OtheY 152,§1(4),and we ha e no,employees.[No workers'comp.insurance required.] :7; *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who subniif•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-co' itractors have employees %diey rinust provide their workers'comp.policy number.• I aria an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. � Insurance Company Name: L i C Policy#or Self-ins.Lie.#: (c �2 u fD% I.I b21 1a Expiration Date: ` 1^12 Job Site Address: `� ` a�� "����A �� City/State/Zip: 6 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA.for insurance coverage verificatio Y do hereby ce ` un e/r_thh 'e ai an nal ofpei ury that the information provided above is true and correct. signature: ��/��"G Date: Phone# T U Offzcial 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 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 ofhire, 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 aft 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 commoawealth 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=contractors)name(s),address(es)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-insuranice 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 burn 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-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia � 7 ® MM/DD/Yl'YY CERTIFICATE OF LIABILITY INSURANCE 4�DATE is/2o16 ) 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(les) must be endorsed-. If SUBROGATION IS WAIVED,subject to the terms and conditions of the Policy,.certain policies may require an endorsement. A statement oc1,thZs certificate does nofk col)fer rigf)ts,to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: A 6 K Fowler Insurance NOON o Ext: (976)664-0366 FAX No:197x1664-zzo9 200 Park St. EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# North Reading MA 01864 INSURER A.-We stern World Insurance INSURED INSURERB:Merchants Mutual Baystate Roofers Inc. INSURERCACE American Insurance Com an P.O. BOX 189 INSURERD. INSURER E: North Reading MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1641311868 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 ISSUEDR O MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE DDL R PO C UMB R_ J YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A50 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 000 NPP1403646 6/15/2015 6/15/2016 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY� PRO- ❑ JECT LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E;accide� $ 1,000,000, B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED rx SCHEDULED MCA7015534 6 15/2015 6/15/2016 BODILY INJURY Per accident $ AUTOS AUTOS / ( )X HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ .$ WORKERS COMPENSATION PER OTH- AND`EMPLOYERS'LIA191LITY Y/N STA717TEI ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED9 F (Mandatory in NH) 6S62UB4609P06216 4/12/2016 4/12/2017 E.L.DISEASE-EA EMPLOYE- $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional.Remarks Schedule,may be attached:If mare.space:Is.required) Insurance verification - Please refer to actual policy for all other terms, conditions and exclusions. I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BayState Roofers, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 189 ACCORDANCE WITH THE POLICY PROVISIONS. North Reading, MA 01864 AUTHORIZED REPRESENTATIVE Nicole Orlanzo/NMO ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 2512014/01) The ACORD name and logo are registered marks of ACORD 111S025;(201401,) i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099895 Construction Supervisor Specialty ROBERT E OKEEF:E 21 FRANCIS STREET ©UtO17'388764 i P r NORTH READING Mt Expiration: Commissioner 09/29/2017 .. _. . -- ✓1re Office of Consumer Affairs&Business Regulati UVHOME IMPROVEMENT CONTRACTOR Registration:-vl 37193 Expiration {10/15/20-1.6 SupF BAY STATE ROOFER INC. ROBERT O'KEEFE -.r € .r �= g PO BOX 189 N.READING, MA 01864 Undersecretar Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099895 Construction Supervisor Specialty ROBERT E OKEEEE ,�„ � ^°"` 21 FRANCIS STREET o I), NORTH READING MA 018641' — --- �' Expiration: Commissioner 09/29/2017 Office of Consumer Affairs&Business Regulati UVIHOIVIE IMPROVEMENT CONTRACTOR Registration:x'137,193 Expiration_`10/1512016 Supp BAY STATE ROOFER LNC ROBERT O'KEEFi,1 � PO BOX 189 N.READING, MA 01864- '` Undersecretar