Loading...
HomeMy WebLinkAboutBuilding Permit #882-2016 - 820 TURNPIKE STREET 2/11/2014Bul INCa PERMIT AP 1fNINORTH ANDOVER PLICATION F PLAN EXAMINATION - Permit No#: ` "' Date Received f� Date Issued: \l 1 I ORTANT: Applicant must complete all items on this LOCATION SZ6 Print _ PROPERTY OWNER R,-< �a,JS,, G rv.e„ J n C. - Print 100 Year Structure yes no MAP Zl)_� PARCEL: ZONING DISTRICT: '" _ Historic District yes I� r/ Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Phone: Residential Non- Residential ❑ New Building ❑ One family oigS3 Reg. No. ❑ Addition ❑ Two or more family ❑ Industrial [Alteration No. of units: A -Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑!Septic ❑"UUell'� FJoodlam� q': _etl`ancJs D WNatersh.ed¢EDcstnct'~ �, ! J ci�u'` -7 DESCRIPTION OF WORK TO (B�(E PERFORMED: 0 / 0. 11 f Pa �l�r.� �rn1d dfr_),CLj Ti'b••• C�^� Iar�G d f h'cC /Tsa m 6,J. rdo,-% In An Q i'J�ir�y edist F Identification - Please Type or Print Clearly OWNER: Name: L,Ar Phone: 97R--3 Address: Z (f4.4 -,r_ I S+., , b 13ox j'99' 177,4 4119W_�7 Contractor Name: Ae;> c.-- hsr• <ls,► I Email • <4,e-- ec r, Address: 2.t'-4. ?d i3ox 9! Supervisor's Construction License: CS— /03SY6 Home Improvement License: - 7r31, - GG2 6 _Exp. Date: 7� . Date: ARCH ITECT/ENGINEER %J�`l� f j.�%��as Phone: Address: S4-.i6Ps 'e i� i%?A oigS3 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: $ 1 1, 5663 FEE: $ 13$ Check No.: � Receipt No.: C`!2jc NOTE: Persons contracting withgisteed contractors do not have access tguaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiunming 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature, COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH _ Reviewed on Signature COMMENTS Zor-�. j 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 FI�DEPARI�MENN di Tenip'Dumpster onsiteY�yes:�`a_�no' Y" LocFle at 124 Main Street j� f'. ;=�: ; `,"' 4,. = w. , +:z `✓ + . ,r���'xi�t`ia�.#"s+�#3 liL,i 3i xks Y ,� t�': 7Firepa{rtmentsignatu�rye/dateb ��;��+;�;�s��►;"f F ,� nt 9,r. 4 �'`•'a4���_t, {n 4,.�s� j�4t tS s t' _� - ' ,. t � F 'f.::ts a'c dyy ;� f.:�� �,�i�, r �,1�}•��. 5��s�r �%j:��, CO MMENI?5�� �f4yf'3�J Pi)r`Wt 2riTtJ t "sem •"ttl5�ei `� r,i1`'4v�}taiS?�!'4fMr/y��y5`��a ��`T} EtiY"t 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For clepartment use ® Notified for pickup Call Email Date Doc.Building Permit Revised 2014 Time Contact Name MM 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 IOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4 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 TOTE: 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 C1 4- 2 C) "It k -A Locatio No. -)2 --- 2 Date �2- Check # TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL $ BuAding Inspector -mm U) 0 0 1.4 P—r4 z cq Con LU LIJ C', 1c, M.0 q L– 0 cep,-� C.? co 0? C6 ob Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 11,500.00 m $ - $ 138.00 Plumbing Fee $ 17.25 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 17.25 Total fees collected $ 272.50 820 Turnpike Street 882-2016 on 2/11/2016 Build a wall to create two offices J w U. O m C O O LL T V) U o. Ul N Wa z z Z 0 J O + 'O 7 O LL L Z O C' C E L V _ C LL O a z Z E J L D O _ 5 O LL O a z a V cl: C W W L :3? O d' V _ N V) _ m C LL O- a cna z a L to .O O 2' _ � C LL Z H W W LL 41 7 m O z aj N �- (% N O Y O E N *1 uj am i z G to z CO x LLIN W A O W :a U) Z Cl) o F 0 C0 W z N E CD o z CD O 0 M MM •E W W CL = ccv � O O O' CL CY) Q OM _v J Cc •CL O d =z 0 v U) a i CL U) 23 0 cc, 40 Cc O •��Ls am �a CL i H _ i • t N m 3 CL M �L W -a d `° L ami o' = W > W 0,0 en CQ N CL W �.0 T) o 0 3 o0 Q CD Q N cj r �0__ Q L L cc $ m Cf) _ •a O O 4-1 LL 'N• W = N � w L) v w v Ci .= i Wo. o� N O w CLov i z G to z CO x LLIN W A O W :a U) Z Cl) o F 0 C0 W z N E CD o z CD O 0 M MM •E W W CL = ccv � O O O' CL CY) Q OM _v J Cc •CL O d =z 0 v U) a i CL U) 23 ADDRESS Richardsons Green 2 central street middleton, ma 01949 usa ACTIVITY , , '' 0 RATENAMOIJNT� Labor 1,500.00 1,500.00 Installation of four new duplex receptacles in newwall relocate switch for office and rewire lighting in the office to new switch location also add bathroom GFCI switch vanity liqht and fan liqht in bathroom Accepted By Accepted Date We hereby submit specifications and estimates far: Plumbing for bathroom $20 T4rnpike. Road Suite 101 Norte Andover, ,A: All material is guaranteed to be as .specified. All work to be completed in a workmanlike. marineraccording to standard practices.. Any alteration or devAuthorized iation from above spear{rcations Ature 'involving extra costs, will be executed only upon written orders, and, wilt beooine an extra Signa charge over and above the estimate. All agreements contingent upon strikes; accidents or delays beyond our control. Owner to carry fire; tornado and othet. neressar� insurance. Note ihis:.proposal may be `Our workers are tufty covered by Workman's Compensation insurance. withdrawn by us if not accepted within 3�: days; gg Arc�`laurQ��l ��1Q���i�� Thei"aboveprice's,specifications and conditions are satisfactory and are thereby accepted. You: are authorized Signature to do the work: as specified. Payment will be. made as ouffirieci shove. Date of,Acceptance Signature .� M �y'vrry tom. ✓ y�' ��. { •�r ' Vy U W I 1- bt z C,w 0) W Z �O J w O� zN �N Z �0 oti 0 Q w a �o $v W 4=- SRIVI'II34d 1 DX9'1 aNV V HLISV o Nn OU ONIGlina ` S.L.LffSf1HDHSSVW `HgAOUNd H L2ION } Zg3NIS 9MICINsfil OU xx�a Sa o uosxLrILL woc(0 F -FY V-clw Z 4t-� Q �U. z mJlw J Q� � I w o�() aujZ W U Qp �n� w w�_� Q j 05 o Qo Z ocCaw �o� w C p IL Q z?pw z� 3w �Q� D N � ° v ` O Ut k) V.- w ol o o g o o Q o 0 Q�3j �IIY �Q J�J� D til�lzl� 1! DEQ W d w�O� gZ het z o YU-o���"° wo L�Uz 0 o� W W O�Q� d 0 '�t=�� D Amo E► - N a 6 O � pot 0Ul�=� 0 tq, OW (YwOON J Q�V-f-w Z mz� N Owtw z < o 13 wZa� Q oQ� 3 Qa ui �3� - U- oz �o at() NW of o00�9 O Q�UOt- QC NO �m wW Qu 0 �pw Z �fl 3 W Nw Z I� �3waw 0 0 3 fl� p=WV Q Nz ?FCIL -I ONu�m OL W cat v��� Q �� Z ww U AZ_ Y OwO�� Wap 0� OC o U- 0 0 wUa?N iW- JUw k- zzw O 00 � W ww pL flC 0 A Qu�� Z �� Z �N D > ty OL u. w w 1 ZO vo 0 woo ►- t- fl�z wwY� fl , W �� who�y- oZ CL0O z� j� j z �w Z1 ?mol <g Qo w o w� °w wo�-c WWF o� tY °� Q wa Dov 0O m z �m Z ZLu zdn OL - oc pwQ to �w O =o z �, �D Ca.-uz °w Zoo 00 �o zo o z oz J w 3 oQJ �fl wa at- op z r olYN w� J� J� Zf� �ky t" vOz m Qp �w pw N0 >� (� nUtf1 �U OL a0 Z J: W() U Z� Ow LLa Ow� Z ZCW m�0 w 0 v ►� 3m wZw O W W� k-- ww 0 w°L 1�~ �w w F- QOQ }-J� W Oz .. �m N �m D w T- m o _ Z w D �z z > O Q o �ot � Z o ��- z ut w 0 J � ZO °Qp D QQ 0 °FQ3� �o IL luvow >- 0 Q `) U QzZ Ow �Z �— 00 �O U of — �w to tY W Bt H Q J }- }- j U — N O > z Q > D t o W �� mw �vw 4 toDt y z�N �Z 0) o d =o D z z.ov zo 00 p z� �- o3ov > o0 v �~w 0 0� .i � RL F �a W w Z N Z -1 E zo <�w �� D Z Om1� oWtli o= Z Q. �O 0 � Om �. QZ z�> ���� O N z 0 vW U Z Q~ 0 QwU Qz 3�z O m� QW� zo0 ZflodU OC �Wi _ E- �Q W w >Q �ovv N Zw -1n zdz y- w�v c0 w p- w W J °LivwN = ow Z Q0Q �wQti Z �wQ p wQ pJ�' of W DU �-- �� J�vw5z �z=n. mW o� J O>�>�> p Q wowv Q O� tslc°voi �(iva JwQ =Jot o W 13� d°U 4- i�tWS1 S wi 3zd�z cllU w z • w v w 0 W w m � m J tY z z U }- W LQ Q w� z w -� U d z3 Q SRIVI'II34d 1 DX9'1 aNV V HLISV o Nn OU ONIGlina ` S.L.LffSf1HDHSSVW `HgAOUNd H L2ION } Zg3NIS 9MICINsfil OU xx�a Sa o uosxLrILL woc(0 F -FY V-clw Z 4t-� Q �U. z mJlw J Q� � I w o�() aujZ W U Qp �n� w w�_� Q j 05 o Qo Z ocCaw �o� w C p IL Q z?pw z� 3w �Q� D N � ° v ` O Ut k) V.- w ol o o g o o Q o 0 Q�3j �IIY �Q J�J� D til�lzl� 1! DEQ W d w�O� gZ het z o YU-o���"° wo L�Uz 0 o� W W O�Q� d 0 '�t=�� D Amo E► - N a 6 O � pot 0Ul�=� 0 tq, OW (YwOON J Q�V-f-w Z mz� N Owtw z < o 13 wZa� Q oQ� 3 Qa ui �3� - U- oz �o at() NW of o00�9 O Q�UOt- QC NO �m wW Qu 0 �pw Z �fl 3 W Nw Z I� �3waw 0 0 3 fl� p=WV Q Nz ?FCIL -I ONu�m OL W cat v��� Q �� Z ww U AZ_ Y OwO�� Wap 0� OC o U- 0 0 wUa?N iW- JUw k- zzw O 00 � W ww pL flC 0 A Qu�� Z �� Z �N D > ty OL u. w w 1 ZO vo 0 woo ►- t- fl�z wwY� fl , W �� who�y- oZ CL0O z� j� j z �w Z1 ?mol <g Qo w o w� °w wo�-c WWF o� tY °� Q wa Dov 0O m z �m Z ZLu zdn OL - oc pwQ to �w O =o z �, �D Ca.-uz °w Zoo 00 �o zo o z oz J w 3 oQJ �fl wa at- op z r olYN w� J� J� Zf� �ky t" vOz m Qp �w pw N0 >� (� nUtf1 �U OL a0 Z J: W() U Z� Ow LLa Ow� Z ZCW m�0 w 0 v ►� 3m wZw O W W� k-- ww 0 w°L 1�~ �w w F- QOQ }-J� W Oz .. �m N �m D w T- m o _ Z w D �z z > O Q o �ot � Z o ��- z ut w 0 J � ZO °Qp D QQ 0 °FQ3� �o IL luvow >- 0 Q `) U QzZ Ow �Z �— 00 �O U of — �w to tY W Bt H Q J }- }- j U — N O > z Q > D t o W �� mw �vw 4 toDt y z�N �Z 0) o d =o D z z.ov zo 00 p z� �- o3ov > o0 v �~w 0 0� .i � RL F �a W w Z N Z -1 E zo <�w �� D Z Om1� oWtli o= Z Q. �O 0 � Om �. QZ z�> ���� O N z 0 vW U Z Q~ 0 QwU Qz 3�z O m� QW� zo0 ZflodU OC �Wi _ E- �Q W w >Q �ovv N Zw -1n zdz y- w�v c0 w p- w W J °LivwN = ow Z Q0Q �wQti Z �wQ p wQ pJ�' of W DU �-- �� J�vw5z �z=n. mW o� J O>�>�> p Q wowv Q O� tslc°voi �(iva JwQ =Jot o W 13� d°U 4- i�tWS1 S wi 3zd�z cllU 0 b SRIVI'IId3d ADUE111V QNd F+WH.LSV 10I J lNfl OZ8 ONIG II 9 S,LLgSfIHDVSSVW `SSAOQNV HINON JEIRWIS 33IIdNSfll OZ8 7 7 �T .gyp 0 -.1 MEN oL ot a SRIVIII3-4V XDH911V UNV VWHISV 101 JAM OZE ONIGIII 9 ti S,Ll,gSfIHDVSSVW 'SHAO(INV HIIHON 1399,LS axidN'dfl.L OZ8 XWVd HJLIAO N6SHaU2[f oL ot a SRIVIII3-4V XDH911V UNV VWHISV 101 JAM OZE ONIGIII 9 S,Ll,gSfIHDVSSVW 'SHAO(INV HIIHON 1399,LS axidN'dfl.L OZ8 XWVd HJLIAO N6SHaU2[f oL ot a The Commonwealth ofMassachusetts Department of Industrial.A ccidents : I Congress Street, Suite 100 - Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation insurance Affidavit: BuiXders/Contractors/Electricians/Plumbers. TO BE FMFI) ITH THE PERMITTING A UTJTOMY. Applicant Information Please Print Legibly Name (Business/orgauization/lndividuai): , c A Ad&ess: '76 36r Jb '` /'ns� Ol y�/f Phone #: %% - 3� - G Z 3 City/State/Zip: Areyou an employer? 6eck6e appropriate box: Type of project (required): 1.❑ I am a employer with employees (full and/or pari thne).* 7. 0 New construction 2.C] I am a sole proprietor or partnership and have no employees working for me in 8,modelirig any capacity. [No workers' comp. insurance required.] 9, ❑ Demolition 3. L] I am a homeowner doing all work myself, [No workers' comp. insurance required.] t 10 ❑ Building addition 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will have workers' compensation insurance or are sole 11.❑ Electrical repairs or additions ensure that all contractors either proprietors wrthno employees. ----12:E]-Plumbing repaiTs.ox additions.,_ 5. gI am a general contractor and I have hired the sub -contractors listed on the attached sheet. insurance.t 13, Q Roof repairs These sub -contractors bade employees and have workers' comp. 14. Other [] 6. Q We are a corporation and its ofrigers have exercised their right of exemption per MGL G. 152, § 1(4), and we have no, employees. [No workers' comp. insurance required.] YAny applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information Homeowners who checksmit this affidavit indicating they are doing all work andthen hire outside contractors must submit anew 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, ley mast provide their workers' comp. policy number. I- am an employer that is pidvidhig workers' compensation insurance for my employees ' Below is the policy and job site information. Insurance Company Name: a d ,^ �"•�'' <'` CJ . Policy # or Self -ins, Lic. #: _�,,,A /�� A Q 3Z7"%(�G — Co ExpirationDate: Z / i ke City/State/Zip: N` A ` ul r / 4 fob Site Address- ��� I&, n � compensation policy declaration page (showing the policy number and expiration date). Attach a copy of the workers' 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 DIA for insurance coverage verification. fon rmatiof ovided ahnve is true and correct. X do hereby certii fy Phone #: Fs 3 — &&Z3- ofpe�yur,� t as e xn p Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitlLicense # 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 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 of Aire, express or implied, oral or written." Axl 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 enferprise, 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. Hovrever 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 b6 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 covexage 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'coi tractox(s) name(s), address(es) and -phone number(s) along with their certificate(s) of insurance.—Limited Liability-Crompanies-(LLC)-or-L-imitectLiabSilii r?artnerslups (LI;P) �vxth no emp ogees o er an 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 ofinsurance 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 ox 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 insuranc' e 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. Iu 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 02114-201.7 Tel. # 617.727-4900 ext. 7406 or 1-877-NUSSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia ACC) E® CERTIFICATE OF LIABILITY INSURANCE D1�z8/2o16 ) 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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jo Anne Layhe EA Stevens Company, Inc. PHONE(781)322_2324 FAX (781)397-7672 AIC No): ADDRESS: Joannel@eastevensins . Com. 389 Main St. INSURERS AFFORDING COVERAGE NAIC # P. 0. BOX 188 INSURERA:Union Insurance Company 25844 Malden MA 02148 INSURED INSURER B Acadia 31325 INSURERC Acadia Insurance Company Richardson Green Inc INSURER D: 2 Central Street PO BOX 499 INSURERE: Middleton MA 01949-2452 INSURER F COVERAGES CERTIFICATE NUMBER:16-17 Master 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY) POLICY EXP (MM/DDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 250,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 CPA0327763-16 2/1/2016 2/1/2017 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO ❑ LOC JECT GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY Ea aBINEDtSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OSCHEDULED AUUTOSS AUTOS MAA0327764-16 2/1/2016 2/1/2017 BODILY INJURY Pid$ (er accent) NON -OWNED HIRED AUTOS AUTOS IX PROPERTYDAMAGEX Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 C EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ CUA0327765-16 2/1/2016 2/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/B (Mandatory In MBER EXCLUDED? ( n ) K es, describe under DESCRIPTION OF OPERATIONS below N/A WCA0327766-16 2/1/2016 2/1/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - E4 EMPLOYE $ 1 000 000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) a.rrciirwr►tc nvLucm GANGtLL.AIIUN peter@richardsongreen.com Town of North Andover Building Department 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 ACORD 25 (2014/01) INSf125 roniann SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD u. Massachusetts - Department of Public Safety Board of Building Regulations and Standards LIIIIILI ULLII�11 Jt UII_CI V1�111 y�� License: CS%- 35M u PETER M RICHA)hD 15 FOREST ST ";` A, MIDDLETON MA 010V r .�.•�1.'+' irJ-a�.,'. Expiration Commissioner 06/08/2017