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HomeMy WebLinkAboutBuilding Permit #466-15 - 90 SURREY DRIVE 11/13/2014Permit No#: 1 __ i 5 Date Issued: I 1 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received ' IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER MAP 1 PARCEL Pont C Print 100 Year Structure ZONING DISTRICT: Historic District Machine Shop Village yes no yes no 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 epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Su !' g .-� 0... L� 7 St lr-c�u Com.. Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: a �` Contractor Name:":37,- q_G-4f Phone: � c� Address: A - Supervisor's Construction License: 0765_1 <'_ Exp. Date: 74116 Home Improvement License: 10 b Sz3 ARCHITECT/ENGINEER Date - _U_6 6 Phone: 4. 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: $ ! o 6'oo, FEE: $ /ot)_ '7. t Check No.: I� Receipt No.: o� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor jam-- 5� I Plans Submitted ❑ Plans Waived [I Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Comments �. Conservation Decision: Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit 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, 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 department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 No 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 ❑ 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 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) o 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 Doe: Building Permit Revised 2014 Location 1 " r 12- � C "" !, ),-�2 k" 'k' No. - t mor C5 1 Date Check # I S03 • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector r L I=- J yaj LL! O GC co aJ u Y LL (n {n 00 d fA Z Z O m O N LL OO CL' T E U LL 00 d Z z Z m J Ca CC — LL O H ?d Q U J W Ca d' U In LL O ui Z H Q to d' LL Z W Q W 0 W Y. Co O z a) N N N o� O •� L Q � Q t � O N�``� Q v C cD L N CD 04lip: Qi so cn (CDL M O' J US N . > C i ON N C tC.)Q N d 0 Z CL _ _ ,N O t top : c O H L Q Q v 0 .5 0 a� O = c Q � U) CL d '� I- � m N 2co m uml LL .y N N C Q t12,2 aM WE 0 - V m 0-0 0 N N 04 c O 1- .O 0 U 0 a Z c!) W O Cl) Z U N W `0 ' ^ ' CL z O W O � �CC G cn c W J a z m � 0 c 0 N (D t O Z O a J O 2 O CD L 0 O z N O = �o- �E m m a0 CD 0 �+ 0 O �. ai Q .CL O ,a; =z UCl) CL U) 2 IF The Commonwealth of Massachusetts - DepartmentofIndustrinlAccW�is Office of Investigations 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Prim Lembly Name (Business/Organization/individual): Address: a t City/State/Zip: tA w Vv k&, k l V" A o t ti 3 Phone #: 01 Zy 3 Z Z "t v �5 Are you an employer? Check the appropriate box: Type of project (required): 1. [�fI am a employer with iy 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. El am a sole proprietor or partner- have ]fired the sub -contractors listed on the attached sheet. Tt �• F1 Remodeling ship and'have no employees working for me in any capacity. These sub -contractors have workers' comp. insurance. 8. ❑ Demolition 9. 0 Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10. F1 Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11.❑ Plumbing. repairs or additions myself. [No workers' comp. c. 152, §I(4),and wehave no 12. Q Roofrepairs insurance required.] t employees. [No workers' 1311 Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showingtheir workers' compensation policy information. i -Homeowners who submit this affidavit indicating they 2te doing all work and then hire outside contractors must submit anew affidavit indicating such. ?Contractors that checkthis 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 thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. M Cry L C0 i 5 Z Expiration Date: Job Site Address: 4) 6 - 5 'i-- S v r n - 4 "D zta� City/State/Zip: lK3. Nk n ao...... w t't 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 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 ver cation. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Sianature• `'----•� Date: I l I t Phone #: Official 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. EIectrical Inspector 5. Plumbing Inspector 6. 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I 1% -4u' --u 1 4iJ1l.a I l •II- • uk,- L Vii tall alit R -t 1e 4UUIc IQ trl97V %06v 11 toL.#I&I 'P VV Iso '..iii e:ir` ided fro --m aria Guar -my Fund provisions oti i �GJ. chaptar 142A.j Authorized j — - - -- --- Note: this proposal may be�-�' Signature (t--�� '- withdrawn by us if not accepted within days. We hereby submit specifications and estimates for: Izope of r'lom I Tarp and ca •r:.rrl av-a:, at f rorh aria to h7 -!p protect against dcrn ger. G U --ed by utrip:ng, • Removc wthiting roofing uyutem down to roof dec.; ,. nd cf -pot-u of in a Lgdl f_Lhiun. • Chech existing nccathing and roplaco and runsii as neccas3ary. • Install 2 foWv" c.f Icic and N4lutei Sh-old along bottom, 3' along rakeu, 3' in vallcy. and a minin,ura of 12" up all adjoining ':c:. • In:,ta!1 n:; -.v •:tc-p fld!,hinn at all roof tranuitio.m..- • Int;tcll B" wh :e aluminum drip r_d to All 0 :1 riot 4dgnn, th^n apply 6" cttip of icy xrsl c afar ani rld o%,or cxpotuad edgu of drip ct:go, • Inutdii 3' lco cnd urate: rVald around nit czh ting roof pcnc,trationsl. • Instt.tl now pips fl-n9t. ; around all u;d tinct ;.ori pip;;I*, -stall 15ft fall paper to remaining roof curfece. • itatt nc.sCertainteed Ufb1.-.+:u .,rc.h-'e0u4at -t►ing,,;-; to roof t,urfac_- nailing in a hurricanu raft!no "tttern. • Chccic ridge v-nt for Estop..•( %,:;nti!s'.ton rrd rut -!n n :::.ry, thc-n in..tstl --tihigle t -crit li ridg:: •.vnt. Ctsrt;ob t>i.0 on ::fail% ba- ihz and rim m:as,+ru.1 around catim hou^e to rr.nin o nall-i lsft belvad from ruuf t'fsuval. • P(ik-u includru n..r plyesml. e • `'"ADDITIONAL CHARGE TO REPLACE Ai ' Y ROTTED SHFATHING WOULD BE AT A COST OF $3.50 PER SO FT AND ROTTED FRAL::,dG i,'.1=i. BJ:ZS WOULD BE $12-2$ PER BOARD TOOT. AND IABOR RATE FOR ; :!SCE+.A"1'EOUS REPA#Rf, WOULD BE -00 F R VAN HOU.11 PLUS rATURIALS Ve ca�rj $2 tr_: zn dollars Gab!;;ty• and a $5 rr-21lon dk!lar umlreo"a ;r;sv, :n; ,r :.i a.i�: iorr :a , Urku.' componsaian J -N -R GUTTFRS CAt"17 :3r I-II:i.D RESPO�tC, t! t.F EQR DEBRIS 6ND AR DUST la! YOUR ATTIC. %VF-RECM.:,,END RF, OlsAl., A" n OR COVFRt _r,, AtY ,jIAUSLF!10 'Acriept rtcr of "t'opusal - The prices, specifications and Do not sign this contract conditions listed above and on the back of this form are satisfactory and are if there are any blank spaces: hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Three day cancellation rights under section forty-eight of chapter ninety three, sec- tion fourteen of chapter two hundred and fifty five, D or section ten of chapter one Signature hundred and forty D as may be applicable. / t / Date of Acceptance: Signature 1. ACCEPTANCE. This agreement is expressly limited to and made conditional upon your acceptance of its terms and conditions. Any of your terms and conditions which are in addition to or different from those contained herein which are not separately agreed to in writing (except additional provisions specifying quantity, description of the products or work ordered and shipping instructions) are deemed material and are hereby objected to and rejected. You waive your objection to any terms and conditions contained herein if Contractor does not receive written notice of your objection within ten business days of the date of this agreement. You will in any event be deemed to have assented to all terms and conditions contained herein if any part of the products or work described herein are provided or performed. Please note particularly the Limited Warranty, Limitation of Remedies and Limitations on Actions and Liability provisions set forth below. You acknowledge that the prices stated are based on the enforceability of these terms and conditions, and on the limited Warranty, Limitation of Remedies and Limitation of Actions and Liability provisions below, that the price would be substantially higher if Contractor could not limit its liability as herein provided, and that you accept these provisions in exchange for such lower prices. 2. LIMITED WARRANTY. All work performed by Contractor is warranted to be free from defects in material and workmanship for one year from the date of completion of the installation subject to the terms below. Contractor makes no warranties regarding products sold but assigns to you any manufacturer warranties relating to the products. THIS EXPRESS WARRANTY IS IN LIEU OFAND EXCLUDES ALLOTHER WARRANTIES, WHETHER EXPRESSED, IMPLIED OR STATUTORY, INCLUDING IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. This limited warranty does not cover damages relating to (a) accident, misuse, abuse, neglect, or, normal wear and tear; (b) failure to use or maintain the product in accordance with manufacturer's instructions; and (c) alteration, repair or attempted repair by anyone other than Contractor or its authorized representa- tive. You shall be solely responsible for the correctness of the plans and specifications and shall release and hold harmless Contractor from any damages resulting from improper, inadequate or vague information supplied by you. Contractor does not take on any obligation to inspect or evaluate the work of other parties in any manner or aspect. This warranty is not transferable. 3. INSURANCE. Contractor shall maintain workers' compensation (employer liability), as required by law, and $2,000,000 in general liability insurance while performing the work. Contractor reserves the right to be self insured to the extent allowed by applicable law. Contractor does not agree to name any other persons or entities as additional insureds. 4. LIMITATION OF REMEDIES. Your sole and exclusive remedy against Contractor for any and all claims for damages arising out of or alleged to have arisen out of the Work will be limited to the repair or replacement by Contractor, at Contractor's option, of any nonconforming work or to the issuance of a credit for such nonconforming work in accordance with these terms and conditions provided Contractor is given a reasonable opportunity to inspect the work and confirms such nonconformity. This exclusive remedy shall not be deemed to have failed its essential purpose so long as Contractor is will- ing and able to repair or replace the nonconforming work and, in any event, Contractor's maximum liability for any damages shall be limited to the total amount paid to Contractor for the Work under this agreement. This Limitation of Remedies clause shall apply to the parties to this agreement as well as to the current owner(s) of the project and its/ their respective successors and assigns. If you receive a claim for damages by any owner arising out of or alleged to have arisen out of the Work, you agree to give written notice to Contractor of the claim and provide Contractor an opportunity to inspect the alleged damages within 30 days after Contractor receipt of the notice. If you fail to give the required notice and/or fail to pillow Contractor an opportunity to inspect the alleged damages within 30 days, you hereby waive any and all rights for damages and/or correction of work against Contractor. This Limitations of Remedies may be plead as a complete bar to any action in violation of this clause. 5. LIMITATIONS ON ACTIONS AND LIABILITY. All claims and/or lawsuits including but not limited to claims or lawsuits for indemnity and/or contribution against Contractor arising under this agreement must be made within 13 months from the date of completion of the installation. CONTRACTOR WILL NOT BE LIABLE FOR ANY LOSS, DAMAGE OR INJURY RESULTING FROM DELAY IN DELIVERY OF THE PRODUCTS OR FOR ANY FAILURE TO PERFORM THAT IS DUE TO CIRCUMSTANCES BEYOND ITS CONTROL. CONTRACTOR DISCLAIMS ALL LIABILITY FOR ANY AND ALL DAMAGE WHICH MIGHT BE SUSTAINED BY ANY PERSON WHO MAY BE ALLERGIC TO OR AFFECTED BY THE EMANATION OF PARTICLES FROM CERTAIN TYPES OF INSULATION. THE MAXIMUM LIABILITY, IF ANY, OF CONTRACTOR FOR ALL DAMAGES, INCLUDING WITHOUT LIMITATION CONTRACT DAMAGES AND DAMAGES FOR INJURIES TO PERSONS OR PROPERTY, WHETHER ARISING FROM CONTRACTOR'S BREACH OF THIS AGREEMENT, BREACH OF WARRANTY, NEGLIGENCE, STRICT LIABILITY OR OTHER TORT WITH RESPECT TO THE PRODUCTS, OR ANY SERVICES IN CONNECTION WITH THE PRODUCTS, IS LIMITED TO AN AMOUNT NOT TO EXCEED THE CONTRACT PRICE. IN NO EVENT SHALL CONTRACTOR BE LIABLE FOR ANY INCIDENTAL, CONSEQUENTIAL, LIQUIDATED, OR SPECIAL DAMAGES, INCLUDING WITHOUT LIMITATION, LOST REVENUES AND PROFITS, ATTORNEYS FEES AND/OR COSTS EVEN IF IT HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. THE RIGHT TO RECOVER DAMAGES WITHIN THE LIMITATIONS SPECIFIED IS YOUR EXCLUSIVE REMEDY IN THE EVENT THAT ANY OTHER CONTRACTUAL REMEDY FAILS OF ITS ESSENTIAL PURPOSE. 6. PRICES, TERMS AND SHIPMENT. No cash discounts, back charges, set offs or counterclaims are allowed unless specified by Contractor. In addition to the prices specified, you agree to pay any federal, state or local excise, use, occupational, or similar tax now in force or to be enacted in the future, assessed against Contractor or you by reason of this transaction. No retention is permitted unless Contractor agrees otherwise in writing. Any past due payment will be, at Contractor's option, subject to interest at 1.5% per month (18% per annum) to the extent permitted by law. You agree to receive (or permit Contractor to receive) near the work site, any materials needed to complete the Work. You agree to protect such materials from damage or loss and provide Contractor, free of charge, with reasonable use of light, heat, water, power, storage space and use of available elevators and hoists as needed. Title to all materials under this agreement shall not transfer to you until Contractor receives payment in full. Contractor may charge you a fee and its actual expense if the job site is not ready for work on the date you specify. 7. FORCE MAJEURE. Contractor shall not be liable for any delay, failures, or default in performance of this agreement or otherwise, in whole or in part, caused by the occurrence of any contingency beyond the control either of Contractor or of suppliers to the Contractor. Such contingencies include but are not limited to failure or delay in transportation, acts of any government or any agency or subdivision thereof, judicial action, labor disputes, fire, accident, acts of nature, severe weather, product allocation or shortages, labor shortages, fuel shortages, raw material shortages, machinery or technical failure, or work that cannot be completed because of another contractor covering the pertinent portion of the building. If any contingency occurs, Contractor may allocate production, deliveries, and performance of work among its customers or substitute substantially similar materials, in its sole discretion, without liability for doing so. 8. CONFIDENTIALITY. If you visit Contractor's premises or you otherwise receive any proprietary or confidential information from Contractor, you shall retain such information as confidential and not use or disclose it to any third party without Contractor's written consent. 9. CREDIT APPROVAL. Shipment and delivery of goods and performance of work shall at all times be subject to the approval of Contractor's credit department and Contractor may at any time decline to make any shipment or delivery or perform any work except upon receipt of payment or upon terms and conditions or security satisfactory to Contractor. By signing this agreement, you authorize Contractor to check your credit and references. 10. CANCELLATION. This agreement, or any part of it, may only be cancelled with Contractor's written approval. In the event of cancellation of this agreement, any part hereof, you shall pay: (a) the contract price of all completed items; (b) that portion of the contract price that is equal to the degree of completion of products or work in process, effective on the date Contractor receives notice of cancellation; (c) the cost of any materials and supplies which Contractor shall have purchased to perform and which cannot be readily resold or used for other or similar purposes; (d) a restocking fee; and (e) any expenses incurred by Contractor (including legal fees and judgments) as a result of the cancellation of subcontracts or purchases related to this agreement. 11. DEFAULT. You may terminate this agreement for Contractor's default, wholly or in part, by giving Contractor written notice of termination as follows. You may give written notice of termination only if Contractor has received a written notice from you specifying such default, the default is not excus- able under any provision hereof, and the default has not been remedied within thirty (30) days (or such longer period as maybe reasonable under the circumstances) after Contractor's receipt of the notice of default. Delivery of nonconforming products or work by Contractor shall give you the rights set forth in paragraph 4 hereof but shall not be deemed a default for purposes of termination. In the event of termination for default, you shall be relieved of the obligation to pay for work not performed by Contractor prior to the effective date of such termination. A default on Contractor's part shall not sub- ject Contractor to liability, through payment by Contractor, set off or otherwise, for any other damages, whether direct, consequential or incidental, and whether sought under theories of contract or tort. If customer breaches this agreement the Contractor is entitled to reasonable attorneys' fees and litiga- tion expenses as determined by a "Court of Law." 12. ASSIGNMENT. You may not assign this agreement or any claim against Contractor relating to this agreement. 13. GOVERNING LAW. This agreement shall be construed, interpreted and the rights of the parties determined in accordance with the laws of the State of Contractor's address first listed on the front of this agreement. 14. DISPUTES AND MANDATORY MEDIATION. In the event that a dispute arises over the reasonableness of or entitlement to fees charged by Contractor, the prevailing party will be entitled to reasonable attorneys fees and costs. In all other disputes of any nature, each party shall pay its own fees and costs. Except as required to protect confidential information and to obtain preliminary injunctive relief to prevent irreparable harm, you and the Contractor agree that prior to the initiation of any legal action the parties will engage in facilitative mediation of any and all disputes in anyway related to this agreement. If the parties cannot agree upon a facilitative mediator within 30 days of when the dispute arose, one will be selected pursuant to the Commercial Mediation Rules of the American Arbitration Association. Each party will share equally the fees of the facilitative mediator and costs of the mediation. 15. Three day cancellation rights under section forty-eight of chapter ninety three, section fourteen of chapter two hundred and fifty five, D or section ten of chapter one hundred and forty D as may be applicable. 16. SEVERABILITY. If any provision on this agreement is not enforceable, that provision shall be effective only to the extent permitted by law and all other provisions of the agreement shall remain. 17. ENTIRE AGREEMENT. This instrument contains the entire agreement of the parties relating to the subject matter hereof and may only be waived, changed, modified, extended or discharged orally by a writing signed by the party against whom enforcement of any such waiver, change, mortification, extension or discharge is sought the terms and conditions of this agreement supersede any agreement to which it is attached. 18. INDEMNITY. Each of the parties to this agreement agrees to defend and indemnify one another from any and all claims, actions and/or lawsuits caused by the party's negligent acts or omissions. This indemnity clause and the obligations created herein shall control and take priority over any con- trary indemnity agreement entered into prior to this agreement. Furthermore, this indemnity clause and the obligations created herein shall control and take priority over any contrary indemnity agreement entered into subsequent to this agreement unless the subsequent agreement specifically refers to this indemnity clause and declares it null and void. AC� V CERTIFICATE OF LIABILITY INSURANCE 11/3 014 ) 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 Insurance -Peabody CONTACT Sarah Goyette -NAMECross PHONE (9 ]B) 532-5445 PAX N ; (978) 532-2217 EDpARE :sgoyette@crossagency.com 139 Lynnfield Street INSURER(S) AFFORDING COVERAGE NAIC 0 GENERAL AGGREGATE $ 2,000,000 INSURER A'Berkle ' Regional Specialty Ins Peabody MA 01960 INSURED INSURER B Merchants Mutual Ins Co 23329 INSURER CA I G JNR Gutters, Inc. 38-40 Lancaster Street INSURERD: INSURER E : INSURERF: Haverhill MA 01830 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. IN A TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR DL S B POLICY NUMBER GL0050174 POLICY EFF MMIDD/YYYY /20/2014 POLICY EXP MM/DD/YYYY /20/2015 LIMITS EACH OCCURRENCE $ 1,000,000 DARENTED5O, OOO PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYX PRO- LOC AUTOMOBILE LIABILITY $ a accideDISINGLE LIMIT E 1,000,000 BODILY INJURY (Per person) $ 20,000 B ANY AUTO ALLOWNED X SCHEDULED AUTOS AUTOS X HIRED AUTOS X AO ED UTOS 7015134 6/21/2014 6/21/2015 BODILY INJURY (Per accident) $ 40,000 PROPERTY DAMAGE Per accitd $ PIP -Basic $ 8 000 A X UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE L0050684 /20/2014 /20/2015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ WC STATIC OTH- DED RETENTION$ C WORKERS COMPENSATIONLIMITS AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER(MEMBER EXCLUDED? (Mandatory In NH) If yes, desafbe under DESCRIPTION OF OPERATIONS below N/A 009774192 9/20/2014 /20/2015 E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ff more space Is required) Refer to policy for exclusionary endorsements and special provisions. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Insureds Purpose �r I AUTHORIZED REPRESENTATIVE (Timothy Tramonte/NIDI Y� `le + ©1988 2010 ACORD CORPORATION All rights reserved ACORD 25 (2010105) ^f A(`ARII INS025 (sntnmi n1 Tho Ar`e)Pn n�ma onrl Inn^ mra ronieforart m�rire 0 V etc �(J(1?lL111,Q/t[tK'ltl�„ a' Office of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR Type: on'. 108503 privateCorporatior piration:. 811912016 J N R GUTTERS, INC. Jonathon Raymond 38.40 LANCASTER ST Haverhill, MA 01830 Undersecretary Massachusetts -Department of Public Safety Board of Building uilding Regulations and Standards Construction Supervisor License: CS -080515 ]KEVIN MFRANC �3 _ 64 GROVE STREET' Haverhill MA 01$32 7 i Expiration Commissioner 07/21/2015