Loading...
HomeMy WebLinkAboutBuilding Permit #117-12 - 84 JOHNSON STREET 8/10/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Z Date Received Date Issued: A — ORTANT:Applicant must complete all items on this age LOCATION _I 73©A%f)Qn S�' nDc-41) Anc, OAA Print PROPERTY OWNER �� 4 M 1 C)�,e I l C, 0 Br 1 en Unit# Print MAP NO: PARCEL:—(a—CZONING DISTRICT: Historic District yes Machine Shop Village yes no 100 year-old structure 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 M SWie, MWell ❑Floodplain t]aWetlandst f p,W tershedDistrict ` ._ Water%Sewerr� ; .{ 1 7 DES CRIPTI N OF WORK Z�0 BE PERFORMED- a uy v 1� 6J 9 It S lx _T(L(f Aldo(' (Identifieatioh Please Type or Print Clearly) OWNER: Name: Pr Phone• Address: '34 :SM\ i5c3,r, Sf" (1 D 67 �(� �Yrdth.Wt CONTRACTOR Name: � �aSf L�� Phone: Address: Supervisor's Construction License: 8 I Exp. Date: Home Improvement License: Li 0 I Exp. Date: - 20-2D l{ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ �-f�,0 FEE: $ od' Check No.: �C � Receipt No.: O NOTE: Persons contracting with unregistered contractors do not have access to guaranty fund .Sianature.of Aaerit/Owner_ Signature of contractor I, Plans Submitted ❑ Plans Waived ElCertified Plot Plan ❑ Stamped Plans El 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 ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTO, Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 1 Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit t n DPW Town Engineer: Signature: . Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast 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 - Date Doc:.Building Permit Revised 2011 June/mi 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 ❑ 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 I ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Fioor/Crossection/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: Doc.BuiIdiug Permit Revised 2008mi 7-(:1JiV11VM1v i u' Location �f nc�y�J No. Date '40R701TOWN OF NORTH ANDOVER F? • • 0 A a Certificate of Occupancy $ Building/Frame Permit Fee $ ncMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2446v Building Inspector ACORD„ CERTIFICATE OF LIABILITY INSURANCE °ATe04/2/011 B9�O��2011 PRODUCER (603) 883-5528 THIS CERTIFICATE 13 ISSUED AS A MAR OF INFO MATION CORRIVEAU INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 115 MAIN ST HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POBOX369 NASHUA NH 03061-0369 INSURERS AFFORDING COVERAGE NAIC0 INSURED NORTHEAST BUILDING 6 RENOVATIONS, INSURER A,HARTFORD UNDERWRITER INS. LLCINSURER 0PEERLESS INSURANCE CO, 31 MOUNT VE;WON ST INSURER C• INSURER 0: snvcvs MA, 01906- INSURER E. COVERAGES 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADO'L POLICY EFFECTIVE POLICY EXPIRATION LTR INR TYPE OF INSURANCE POLICY NUMBER DATE MWOOM VATg(MM190ffn I mrm A GENERAL LIABILITY CBP0635309 03/30/2011 03/30/2012 EACH OCCURRENCE i 500,000 X COMMERCIAL GENERAL LIABILITY Pi7EMIBE9 EN EN IxTED'nee i 500,000 CLAIMS MADE LX OCCUR / / / / MED EXP(Atly one arson S 5,000 PERSONAL&ADV INJURY S 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 6 1,000,000 POLICY f XE O LOC PRODUCTS•COMPIOP AG-0- $ 1'000,000 J / / / / AUTOMOBILE LIABtUTY ANY AUTO COMBINED SINGLE LIMIT S (Eo occ*nU ALL OWNEO AUTOS / BODILY INJURY SCHEOULEDAUTOS (PW wbon) S HIRED AUTOS NON-OWNED AUTOS BODILY 6 (Per aecldens)dent) PROPERTY DAMAGE (Pat 6ectdenl) i GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY AGO S EXCESSIUMBRELLA LIABILITY EACH OCC RR N E S OCCUR CLAIMS MADE AGOREOATE 0 S DEDUCTIBLE RETENTION S A WORRER3COMPENSATION AND 0513135409 03/17/2011 03/17/2012 X S EMPLOYERS'UA91UTY uM s ANY PROPRIETOR/PARTNER/BXECUTIVE E,L EACH ACCIDENT i 100,000 OFFICER/MEMBEREXCLUOE07 Y MASS WC ONLY If yea,dawft undw / / / / E L„DISEASE-EA EMPLOYEE 6 100,000 SPECIAL PROVISIONS blew OTHER E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONWLCCATIONSNEHICLES/PJICLVSIONS ADDED BY ENDORSEMENWSPRCIAL PROVISIONS CARPENTRY. JOSSFN BRAMIFORTZ AND PHILIP .TI STRUTZR AM NOT INCLVDIID IN TIM VOW=*9 COMPSNSATION POLICY. CERTIFICATE HOLDER CANCELLATION ( ) - (761) 558-1736 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAY6 WRITTEN NOTICE TO THE CERTIFICATE 0404061%NAM90 TO THE LEFT,BUT TOWN OF NO. ANDOVER BUILDING DEPT. FAILURE TO 00 90 SHALL IMPOSE NO OBLIGATION OR UA&LITY OF ANY KIND UPON THE 1600 OSGOOD ST INI JRRIIL ITS ApENT8ORREPRESENTATIVES. AUT IORIMO REPRES ATIVE _ No. ANDOVER MA 01845- ACORD 25(2001108) 0 ACORD CORPORATION 1988 IN5026(°+osl.00 Pago 1 a 2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_ 5f PC 1 6 _t V RCn� Address: rh ou n-t V er nv-)', -sf City/State/Zip:_ �'�v Aft- Phone 03-7 Are you an employer?Check the appropriate box: Type of project(required): 1.[YJ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 EJ New construction 2.❑ I am a sole proprietor or partner- listed on the attached shget. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No workers' comp.insurance 5. 9• EJ Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.El Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: k,"r401,6d ( fev Policy#or Self-ins.Lic.#: t�j b j 3 3�� 0� Expiration Date: Job Site Address:_ (1ic1 p(n n ar-,, City/State/Zip:(76 tt�h 9 Q Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c ify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: — Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Per # Issuing Authority(circle one): [6. .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other ontact 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 of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),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-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Comt monwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia NORTH Town of over 0 No. 000, o , dover, IVMass., A. COCMICMEWICK y DRATED PPS\ '9S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......................... . .G. :. ....D... �,�'�"r � ......... ................... . ................... Foundation has permission to erect........................... buildings on ..........54...... . ... �............ ............�..... Rough to be occupied as...........1 j. . v� " ��/1� I .. .. . .. ....... Chimney -�� e provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 aL PERMIT EXPIRES IN b MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTI TS �,J1 V Rough ................. ....... .................................................... .......... Service BUILDING INS Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIR_ E-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE S1 D E Smoke Det. Licensed&Insured NORTHIEAST BuY rte Renonador� VF Joe Brangiforte Jim Streeter 31 Mt. Vernon Street 25 Adams Rd. Saugus, MA 01906 Dracut, MA 01826 Phone: 781.389.0595 Phone: 978 866-4652 Fax: 781.558.1736 Fax: 978 957-8009 Construction Contract This agreement made this 9h day of August 2011 by and between Jeff Obrien herein $ 56S referred to as"owner", and Northeast Building& Renovations, LLC. of 31 Mt. Vernon St., Saugus, MA 01906 herein referred to as "contractor". Owner and contractor in consideration of the mutual covenants hereinafter set forth agree as follows: Contractor shall furnish all labor and materials necessary to perform and complete the work described below upon the following described property,which owner warrants he owns, free and clear of liens and encumbrances: Job Description: The work,which shall include all of the labor and materials necessary for the completion thereof, shall consist of the following: Second floor bathroom: • Demolition of tub,tub walls,vanity,and bathroom floor • Removal of toilet • Install copper pan for shower area • Install %2 inch hardyboard on shower walls and 1/4 inch on bathroom floor both to accept tile • Prep walls and floors as needed • Plumb drains,water line,etc... • Plumb vanity,water line etc... • Remove all debris • Homeowner to purchase vanity,tile,and install • Contractor will complete plumbing necessary to finish bathroom • Reinstall toilet • Price does not include building permit • Dumpster will be on site 4 Contractor shall perform the work in conformance with such plans and specifications, if any, as have been provided by the owner or the contractor,which plans and specifications shall be deemed incorporated into this contract by reference, and will do so in a workmanlike manner. Contractor is not responsible for performing any work not specifically referred to in this contract. Owner shall pay the contractor the sum of $6300), in installments as follows. $2500)upon signing this contract. $2500) Once rough plumbing, walls, and floor are complete. $1300)upon completion of the remainder of the work called for under this contract. In the event any installment is not paid when due, contractor may stop work without breach until payment is made. In the event any installment is not paid, contractor may, in its option deem this contract terminated by the owner and may take such action as may be necessary, including initiating legal proceedings, to enforce its rights hereunder. At all times during construction, owner shall provide and maintain free and unobstructed access to all areas of the site where the work will be performed and shall provide, at owner's sole expense, water and electrical service, including 220 amp outlet. Contractor shall not be responsible for claims for damages to persons or property occasioned by owner or his agents,third parties, acts of God or other causes beyond contractor's control. Owner shall hold contractor completely harmless from, and shall indemnify contractor for, all costs, damages, losses, and expenses, including judgments and attorneys fees,resulting from claims arising from causes enumerated in this paragraph. 1. All work shall be completed in a workmanlike manner and in compliance with all building codes and other applicable laws. 2. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 3. Contractor may at its discretion engage subcontractors to perform work hereunder, provided Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this Contract. 4. All change orders shall be in writing and signed by both owner and Contractor. Contractor shall be responsible to provide only the work described in this contract and in such change orders as may form time to time be agreed to between Contractor and Owner. All change orders shall specify in detail any additional work called for and the price for such labor and materials as shall be necessary to complete such additional work. 5. Contractor warrants it is adequately insured for injury to its employees and any others incurring loss or injury as a result of the acts of Contractor or its employees and subcontractors. 6. Contractor shall at its own expense obtain all permits necessary for the work to be performed. Contractor shall not,however, be responsible for obtaining any variances for other zoning relief, or for the cost thereof, as may be required to enable the Contractor to obtain a building permit. 7. Contractor agrees to remove all debris and leave the premises in a broom clean condition. 8. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials or the discovery of the conditions or defects upon the site or the structure(s)thereon not known to the Contractor at the time of execution of this contract and which may be discovered during the course of the Contractor's completion of the work. In addition,the Owner acknowledges and agrees that in certain remodeling work the demolition of portions of the pre-existing structure may reveal additional defects, conditions or the need for additional work which must be repaired, altered, or carried out in order to commence or complete the work called for in this contract. In such case,the Owner agrees that the duration of the work and any scheduled date of completion may vary from that which has may be set forth herein and Owner agrees execute a change order detailing the cost and scope of the additional work necessary to repair, correct, or alter such additional defects and conditions. 9. Contractor warrants all work for a period of 12 (twelve)months following completion. 10. Owner agrees that in the event it becomes necessary for Contractor to collect any payments called for hereunder or to enforce any provision of this agreement, owner shall be responsible for the costs of such collection or enforcement, including reasonable attorney's fees. All contractors and subcontractors, unless exempt from the requirements of G.L c.142A, must be registered by the Administrator of Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108, (617)727-8598 and that any inquiries about a contractor or subcontractor relating to a registration should be directed to the Administrator. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof,provided you notify the seller in writing at this main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Homeowners who secure their own permits for the work to be performed under this agreement will be excluded from the guarantee fund provisions of G.L. chapter 142A By entering into this contract you are giving the Contractor a lien upon your property pursuant to G.L. Chapter 254, section 2 and other applicable provisions of law. Signed this Zoday of---(�JITU -5� 201l Co act r _ N JU,J Owner i ' Nlussachtisetts.-Department of Public Safety Boal-d Of Building Re..oulations :ttid.Stjtndards Construction Supervisor License License: CS 78145 Restricted to: 00 s . JOSEPH R .BRANGIFORTE 31 MT. VERNON ST SAUGUS, MA 01906 Expiration: 3/16/2012 ;, ('unmussiuner Tr#: 18573 ✓4 - Office of consumer /� z�`kz 6GQ�Ta'- _ HOME IMPROVEMENT &Business Regula Hon ' Registration- EMENT CONTRACTOR Expiration:= '140757 11/20/2011 TYPe ' lrrdivtdual,_ J Tr# 291759 JOE BRANGIFORTE 3 oMTBRANGIFORTE_- {-.i VERNONE SAUGUS, MA 019ST,. a. 06:` Undersecretary' ACORD„ CERTIFICATE OF LIABILITY INSURANCEDATR'(MMIDDIYYYI') PRODUCER (603) 883-5528 D6/04/2011 THIS CERTIFICATE IS ISSUED A$ A�MA R OF INFO MATION CORRIVEAU INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 115 MAIN 5T HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P0BOX 369 NASHUA NH 03062-0369 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURER A.HARTFORD UNDERWRITER INS. NORTHEAST BUILDING 6 RENOVATIONS, LLC INSURER BPEERLESS INSURANCE CO. 31 MOUNT VERNON 9T INsuRcR C. SAVGV5 MA 01906— INSURER 0:INSUREgE. COVERAGES 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 CONDITION$ OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADO'L POLICY EFFECTIVE POUCY EXPIRATION LTR INR TYPE OF INSURANCE POLICY NUMBER OAT2 MAA/DOIYY DATE MMIDD LIMITH A GENERALLIABILITY CBPS635309 03/30/2011 03/30/2012 EACH OCCURRENCE s 500,000 X COMMERCIAL OENERAL LIADILITY qq 100,000 PgEMI8E9 IEs occur enol S CLAIMS MADE LX OCCUR / / / MED ERP(Any one anon S 5,000 PERSONAL d ADV INJURY S 500,000 GENERAL AGGREGATE 6 1,OOO,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO. PRODUCTS•COMP/OP AGO $ 1,000,00 POLICY X JECT I ILOC AUTOMOBILE LIABILITY / / ANY AUTO COMBINED SINGLE LIMB I !Ea eocldeny ALL OVMEO AUTOS / BODILY INJURY SCHEOULEDAUTOS (PWparoon) t HIRED AUTOS / / NON-OWNED AUTOS BODILY 6 (Perneddonodenq PROPERTYDAMAGE (Pat 60e1denl) S GARAGE UABILITY ANY AUTO AUTO ONLY.EA ACCIDENT 6 � � � / OTHER THAN EAACC S AUTO ONLY AGO S EXCESSIUMBRELLA LIABILITY / / / / EACH OCC RR ENQE S OCCUR 13 CLAIMS MAGE AGOReoArE DEDUCTIBLE / / / / s---R6 RETENTION 3 A WORKERS COMPENSATION AND 0513N35409 03/17/2011 03/17/2012 R E EMPLOYJ;RS`IJA9ILITY UM S ANY PROPRIETOR/PARTNER/BXECUTIVE E,L EACH ACCIDENT = 100,000 OFFICERIMEMSER EXCLUDE07 Y MASS iic ONLY Yea,deaenbe undo / / / / E L,DISEASE-EA EMPLOYEE 6 100,000 SPECIAL PROVISIONS below p�R E,LDISEASE•POLICYLIMIT S 500,000 DESCRIPTION OF OPERATIO"ILOCAT10NSIVEHICLES/EXCLUSIONS ADDED BY ENDORSBMENTISPeCIAL PROVISIONS CARPENTRY. JOSEPH SRANGISORTY AND PHILIP J, STR=T$R ARE NOT INCLUDZD IN THE VORK&R*9 COMPwSATION POLICY. CERTIFICATE HOLDER CANCELLATION ( ) — (761) 558-1736 SHOULD ANY OF THE ABOVE DESCRIBED POUCIEB SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THe CERTIPICAre HOI,DeR NAMED TO THE LEFT,BUT TOWN OF No. ANDOVER BUILDING DEPT. FAILURE TO DO 90$HALL IMPOSE NO OBUOATION OR LABILITY OF ANY KIND UPON THE 1600 OSGOOD ST rlNlRflRITSAOENTSOnREPRESENTATIVES. ORIZED REPRES TATIVE _ NO. ANDOVER MA 01945— ACORD 25(2001/06) I N5026(o+oe}oo 0 ACORD CORPORATION 1988 Paseo I W 2