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HomeMy WebLinkAboutBuilding Permit #1107-15 - 89 OLD VILLAGE LANE 6/25/2015 �10RTF/ q BUILDING PERMIT ao_ 3 TOWN OF NORTH ANDOVER I- o APPLICATION FOR PLAN EXAMINATION - o�—i 5 eb Permit NO: Date Received �9SSgcwuS t� Date Issued: =11 S IMPORTANT: Applicant must complete all items on this page LOCATION 9'9 OLck PROPERTY OWNER DGS%A t int ?k-\z w5 ? wS Print---' MAP NO: bq PARCELDDS ZONING DISTRICT: Historic District yesn Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9,One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer e 12e movv2 64 r `ace— e ,f S� "i,�acaS — 1st `la r IJ j C�O"te \v-\ un v,l\%yaaw Identification Please Type or Print Clearly) OWNER: Name ► U�! Phone: 7 7 3 t o - 8Sy`l Address �11621D) f I �'� ' '�' �r Di Y�/S CONTRACTOR Name: W Phone: �7$l 76a 20-96Address: 23 in 4q QV2L3 Supervisor's Construction License:C3 Exp. Date: J-71 2-G 1 Home Improvement License: .--� Exp. Date: t Zp 1S •a ARCHITECT/ENGINEER Phone: Address: — Reg. No. FEE SCHEDULE:BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ C( �F20 FEE: $ l� Check No.: LOgg-B Receipt No.: `2�1"11 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty u d ignature of Agent/Owner_.__.._ ignature of contractor r Plans Submitted ❑ y 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. ❑ PermanentDumpster 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 WEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: .� Comments g Conservation Decision: Comments "Vater & Sewer Connection/signature& Date Driveway Permit ]DPW Town Engineer: Signature: _ Located 384 Osgood street •�r nom . 6�6cated at 124 MaintStreet r k�•�" � �"�; t i4'F e'ID�epartmentsgnatur%d t� , ��. . �".• , ; ; ,ter;D = �d/ffi —77 `COMMENTS:. _ -.. mac.♦ww n { Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector yes No DANGER ZONE LITERATURE: yes No MGL Chapter 166 Section 21A—F and G min.$1oo-woo fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits } i 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 Ener Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: 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 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 NORTH own Of E ,, ndover 0 ,. _ , No. _ h ver, Mass fit, aO�h COCMICN•W.Ck L) BOARD OF HEALTH Food/Kitchen PERMIT D Septic System ppBUILDING INSPECTOR 2)k%AA THIS CERTIFIES THAT ...... ........ ......... .. ...... .. ... T..�.�. ...1.�4.... . �I Foundation has permission to ere .......................... buildings on ....... ...�/.1. . ... �r.. Jew to be occupied as ........ ...... ... � .1s111s�....... .....I.. .. . coney provided that the person accepting this permit shall in every rest conform to the terms of the application finalJ� 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 INSPEC OR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T 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. NORTH own of E ndover O - No. p * T 1 C,, h ver, Massj/lsJ! aolh Coc MIc"IWIC t yLAKS A. to U BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT .....2)kv4k. ..... ........ .. t,;,?I,,,, BUILDING INSPECTOR ..� .�. .................. .... .. . . Foundation has permission to ere .......................... buildings on ......... .. ...`Y.1. . ... �r..�............ . Rough to be occupied as ........ .. .. ...... ... �, .1�1,k1 .v.. .1l�.1....... ...... .. .`.�. Chimney provided that the person accepting this permit shall in every rest 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 Ilk UNLESS CONSTRUCTIO T 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. Page 1 of 5 Nexus II Carpentry and Construction Design P.O.Box 2823 Woburn,MA 01888 781 760 2031 Fax 978 9751263 nexu sca ryentryAaol.com Contract This is a contract between Nancy and David Phillips of 89 Old Village Lane,North Andover MA 01845 (Hereafter referred to as the "owners") and Nexus II Services (hereafter referred to as"Nexus") dated April lOt'2015. GENERAL SCOPE OF WORK DESCRIPTION WE HEREBY SUBMIT SPECIFICATIONS AND CONTRACT FOR: work as stated below to 1 St floor windows 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 ♦ Nexus will contact"Dig Safe"prior to commencing any excavation work for their clearance ♦ All work will be coordinated directly between"owners" and Nexus ♦ Nexus confirms that it is fully licensed, insured and ensures any sub-contractors utilized on this site will have the appropriate insurance coverage ♦ Nexus will be responsible for the safe storage of all its property and any materials to be used on the site ♦ Owner is responsible for removal and return of all items of the house in the areas that will be affected and their safe storage prior to our work commencing SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT Page 2 of 5 ♦ Owner will then be responsible for returning all items to these areas of the home after completion of the scope of work ♦ Remove and trash into Nexus supplied dumpster all trash associated with this project NOTE: appliances are not allowed to be put in dumpsters without additional costs "owners"are responsible for removal from site Scope of Work—Window project OTE: The new windows will be Andersen 200 series with the same grill pattern as the ` xisting windows with grills between the glass and pre-finished WHITE interior and clad exterior for all windows, OTE: The new interior trim being installed to the new windows only—will be"paint ade" so they can be painted"white']—Painting by"others" ♦ Remove and trash 2 x windows in Dining room ♦ Remove and trash 2 windows in Fireplace room ♦ Remove and trash 1 x window in Bathroom ♦ Remove and trash 1 x large window in Livingroom oom ♦ Re-frame openings in all 4 rooms noted, to prepare for installation of new windows under this scope of work—total 6 windows ♦ Furnish and install new Andersen 200 series window x 5 (pre-finished WHITE interior and clad exterior)to opening in 3 rooms ♦ Furnish and install new"Bay Window"to front of living room and to drawing provided for approval on 4/9/2015—2 double hung windows with 1 center picture window—all windows with grills to drawing and between the glass ♦ Furnish and install new paint grade trim to 6 x windows in all 4 rooms NOTE: trim to match as closely as possible to existing trim in girls bathroom Work not included in this contract Building department fees Engineering or architect costs —Permit costs Unseen conditions Painting or staining work —Customer supplied electrical fixtures -wall sconce x 1 —Mirror or medicine cabinet —Customer supplied items as noted above —Bathroom toilet, cabinets, countertops, faucet and sink —Tile and grout as noted PERMITS "Nexus"will accept 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.Nexus will pass the cost of the permit directly on to the"Owners"once advised by the Building department. SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT Page 3 of 5 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 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 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". SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT Page 4 of 5 Warranties All the components supplied by'plexus"as part of the original order are covered under the warranty exercised by"Nexue,.and supported by the vendors.All labor and materials Purchased from other suppliers to achieve completion of contract are warranted(l)one year from completion of the construction. Expi_�tam wf tltis�� 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. Chan es 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 uU be added to"Nexus"profit and overlieead. Peotaie Authorized to Sign Change+orders: The following people are authorized to sign Change Orders: "Nei Mark G aobed or( ed %Thite ,Client?*:Nancy or David Phillips Concealed Conditions: This Agreement is based solely on the observations"Nexmake with the area in us"-vas able to its current condition at the time this Agreement was bid. if additional Concealed Conditions are mmenced which were not visible at the time this proposal was bid, discovered once work has co .,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_ f Schedule ofwork 11 be coordinated with the"Owners"and Itis agreed by both parties that this work .n "Nexus"to be undertaken in various stages to avoid complete disruption of the home environment."Nexus"will give"OvAmers"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. � SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECWUST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT r Contract Cost and ga Page 5 of 5 - trent Sc�edo�e: 'Total cost of work de C_ _.tion.and,materials.ineluded in.the materials/w rk stated loin and the ro osal exce t and zero cents) amine thousand eight hundred and twenty dollars PAYMENT SCHEDULE - 1st I'a trent due a ctn s nin tkris contract 3`�� TOTA $4,910.00 Final, a anent due u on com letion;of sco a of work Amount due Upon signing TOTAL$4,910.00 F gnin this contract-' 910.00 I have read and understand,and I agree to,all the terms and conditions contained in the proposal above. Dace...., "Nexus"Authorization ............................ t .•� 6 Date.. ...."Client"Authorization. ........:" ............................. Date..............................."Client"Authorization...................................................... SPECIAUZING IN QUALITY FINISH CARPENTRY,REMODEUNG,SPECIAUSi ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT The Commonwealth of.M'assachuseffs - _. .Departmjilt of ndgsfr1g1 Aec1d&fS Offlee of Inpesfigaftons 600 Washington.Street Boston,MA 02111 www.mass govldra Workers' Compensation J[nsuxanceA.fiida�if:Sunder.,/Contractorsylectriezaus]Plrambe A Mani Information Please Prat Le b Name(Business/©rgauizationlXndividual):^ Address: �� �• ��X ( ` 01T&8_ Phone#: I R t `760 2 03 t city/State/Zip: W AI LII Ara you an employer?Cb.eek the appropriatType of_project(required):e ox: 1.❑ 1 am a employer withd•• I ate.a general contractor and 1 6. [l New construction --J llaveliiredthe sub-contractors employees(full and/or part-time).* listed on the attached sheet. �. ❑Remodeling 2,E] 1 am a sole proprietor or partner ship and'have no employees These sub-contractors hav 8. [(Demolition capacity. workers'comp.insurance.�� g• ❑Building addition working for me an.any p tY (No workers'comp.insurance 5. ❑We are a corporation and Its 10,l Electrical repairs or additions required.] officers have exercised their 11.❑Plum-bing.xepairs or additions 3.[] J:am a homeowner doing all work right of exemption per MGL myself. §1(4),and we have no 12.p Roof repairs myself.[No vrorkers comp. employees.Wo workers' insuran.cerequired.] igll Other comp.insurance required.] Any applicant that checks box#1 mustaisa fill eutthe section below showingtheir workers'eompensationpolloy information. Homeowners who submit this affidavitindicatingthey R¢ doing allworlc and then hire outside contractors must submit a new affidavit indicating such. TContractors that checkthis box milt attached an additional sheet showing the name of the sub-conixacfors and their workers'comp,policy information. orke,rs.,eomperzsatr•on insurance for racy employees' Below is thepoliey Unci j0h site X am are employer'that is providing w information. fusurance CompanyName:. Expiration Date: Policy#or Self ins.Lic. • Sob Site Address: City/State/Zip: Attach.a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). as xe ' edunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a Failure to secure coverage � fine up to$1,500.00 and/or one-year imprisonment,as wellas civil:penalties in the form.of a STOP-WORK ORDER.and a fine ofup 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. ^ X do tier eliy cert uz2deN tl• Incl penaXtres ofperrury 0 at the zrtfbrmatzon provzclecl alcove rs true and carrec� Date• ZZ Si afore• Phone#: -760 03 official use only. Do not write in this area,to he completed ny city or town official. City or Town: Permit/License# IssuingA.uthority(circle one): t 3.Ci /Town Clerk �.Electrical Inspector 5,plumbingluspeetor .Board of Health 2.BuildxngDepartnaen ty _ x _ 6.Other y 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 defied as"...every person in the service of anothek underany contract of hire,- express orimplied,oral oxwritten:' 4 An employee 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 legalrepresentatives of a•deceased employer,or the receiver or fustee'of anrindividual,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 tct iio Maintenance,constraetlon.orxep*work on such.dwelling house or ou the grounds or building appurtenant thereto shall not because of such employment be deemed to,be an employer." « �pL ' t Aryp' MOL chapter 152 §75C(6)also states that every state or local licensing agency shahwithhold the islsuance or, renewal of a llcensao�permit to operataa busWess or construct buffdWg�athe coSn.in nwealth for aioy' applicant who has not prod-aced-acceptable evidence of compliance with the insurance co v rage required." s Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shalt enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapterhave been presented ta the contracting authority." Applicants Please till out the workers'compensation affidavit 6omtbietely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phonenumber(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are notregaked to carry workers'compensation insurance. If an LLC or LLP does have employees,apolloyis required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents fo;confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumedto the city or town thatthe application for thepemiit 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 obtaia 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 pezmit/license number which will be used as a reference number. In addition,an applicant thatmust submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policy Information(ifnecessaty)and under«Jab Site Address"the applicant shouldwrite"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 fico for future permits or licenses. Anew affidavit must be filled out each year.Vhere a homeowner or citizen is obtaining a license ox hermit not related to any business or commercial venture (i.e.a dog license ori ermit to burn leaves etc)said person is NOTrequired to complete this affidavit. The Office of Investigations would Moto thank you in advance for your cooperation and shquld you have any gaesffons, please do not hesitate to give us a call. The Department's address,telephone and fax uumber: Tho CoiM.Onwalth o ?assachusPt `' PeTax(mDuOf �tt Of fa duMal p�t � s�{, co ^�/�y�old �a� dQ wa gtw ftoet Boston,M.A 42111 617-72,7^4.900 ext 40,6 or 1-877WASSAM Revised 5-26-05 Fax#617-727-7749 YYY ATE Aco 6/22/CERTIFICATE OF LIABILITY INSURANCE D/22/201IDD/Y5 �►� 5 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 Lauren Goldman NAME: Cross Insurance-Peabody PHONE (978)532-5445 ac No:(978)532-2217 139 Lynnfield Street E-MAIL 1 oldman@crossa en ADDRESS: 4 4 cy- com INSURER(S)AFFORDING COVERAGE NAIC# Peabody MA 01960 INSURER AWestern World Ins. Co. INSURED INSURERB:Safety Indemnity 3618 Nexus II Services LLC INSURERC: P.O. Box 2823 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 POLICY EXP SU LTR TYPE OF INSURANCE JU& D POLICY NUMBER POLICY MM /DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrenceL_ A CLAIMS-MADE a OCCUR NPP8236669 /12/2014 8/12/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 }� POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ 500,000 B ALL OWNED SCHEDULED 116632 1/10/2014 1/10/2015 AUTOS X AUTOS BODILY INJURY(Per accident) $ 500,000 NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ 100,000 Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LABILITY Y/N JQRY LIMITS EB__ ANY PROPRIETOR/PARTNER/EXECUTIVEF-1E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 David and Nancy Phillips ACCORDANCE WITH THE POLICY PROVISIONS. 89 Old Village Lane North Andover, MA 01845 AUTHORIZED REPRESENTATIVE y Timothy Tramonte/Ml ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025l7ninnsi ni Tho Ar nOn nnma nnri Inn^mra ranieforori mor4e^f arnon 1� Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supercisor. License: CS-073991 GERALD WHITE 23 GLENDALE DR DANVERS MA 01923 ,#{ +� Expiration 04/07/2016 Commissioner _,rte• rdna,erv�rneti�/�,r/2llr.urr�rr�r//�Si -�. Office of Consumer Affairs&Business Regulation ; License or registration valid.for individul use only before the expiration date. If found return to: _!TOME IMPROVEMENT CONTRACTOR i IAegistration: 129177 Type: Office of Consumer Affairs and Business Regulation i 10 Park Plaza-Suite 5170 y Expiration ::7/19/2015 Individual Boston,MA 02116 Gerald White t I Gerald White j I 23 Glendale Dr Danvers,MA 01923 Undersecretary Not valid without signature i i e i Location No. h — Date / TOWN OF NORTH ANDOVER .< Certificate of Occupancy $ 1 Building/Frame Permit Fee $ -- Foundation Permit Fee $ c Other Permit Fee $ x:47 TOTAL $ Check#. A Building Inspector