HomeMy WebLinkAboutBuilding Permit #485-16 - 91 AUTRAN AVENUE 10/15/2015NORTH
BUILDING PERMIT o��z,eo ,6gtio
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
H
Permit No#: j Date Received ATEo,Pa��S
SSACHUS�
Date Issued: / 1
IMPORTANT: Applicant must complete all items on this page
q
.LOCATION
Print
PROPERTY OWNER `t j� Tf/Y��cJZcc��tC
Print 100 Year Structure yes o
MAP PARCEL:ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
Demolition_
ElOther
El Septic ❑ Well
❑ Floodplain. p Wetlands
❑ Watershed District
❑ Water/Sewer
OWNER: Name:
Address:
Contractor Name:
Email:
Address:
OF WORK TO BE PERFORMED:
ov.? .--r(s4ii
- �0— It ,
s
Pleaseps or Print Clearly
Iu2a,4
Phone: q -7r—a 73-1360
b?W(1�3��
0 T 1�tePhone:A1-DESCRIPTION
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6;t%
Supervisor's Construction License: D 7 2.57 3 Exp. Date: a? �
Home Improvement License:
Date:
ARCHITECT/ENGINEER Pitt Phone:
Address:
Reg. No.
FEE SCHEDULE: BULDING PERMIT. $122.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: EE: R
Check No.: C� 3 L) 0 0 -7L( O Receipt No.: 2 '1
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Location—/
t
No. �' Date/0 7-A J r f J
TOWN OF NORTH ANDOVER
Certificate of Occupancy �$��
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check,-#
G J3
Bu ding or
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. ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On
COMMENTS
Signature_
CONSERVATION Reviewed on Signature
COMMENTS
t
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
Wafter & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
_ Located 384 Osgood Street
-" �EPAR«TtMENT9 Te tS er iter `,,� z
ed at 1% =-� rnp Durnp,�o�n ?Y�' ,�[.no -- `-
ain�treetF;
De rtment >- 4
p ,; s��gnatu e dated .
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.$10o-$1000 fine
M
Doc.Bnilding Permit Revised 2014
r
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
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
TOTE: 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
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
Doe: Building Permit Revised 2014
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8010290169 RR Donnelley 02013. All rights reserved. — 0667
NOTICE TO CUSTOMER — PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more
Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump -sum Price
stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract (including waste), which may exceed the actual
square footage of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the Contract (including waste).
By signing this Contract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may
not be refunded once the Installation Services are performed.
Contract Total 42
Are permits required for this installation?: Yes [ ] No *applicable tax included
•-�••�� ......+vv.•�. ra agog raw reyunCs wwe:s to prowae you wim me pamplet Renovate Right. By signing this Contract, Customer
acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure
from rennvatinn ar_tivitu fn ha narf—A i.. . _-.a
NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order
must be completed and signed by the customer for any additional charges. Customer must initial.
*Any work or material not specified is not included in this contract. Any changes or additions will be at an additional charge for the material and labor.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where
Installation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title and
interest in and to the photographs for use in all markets and media, worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the
photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including, but not limited to, marketing,
advertising, publicity, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. [Customer to initial to the left].
Work is to compiencejupon reasonable availability of Contractor and/or any special order or ttst er made. Good(s) which is anticipated to be
ZO 3CJ 1 r [fill in date]. Estimated completioi [fill in date].
Said estimated substantial completion date is npt� of the essence. A statement of any contingencies that would materially change said estimated substantial
completion date is as follows: 11)J•, -r l -if""
(if applicable, insert a statement of such contingencies).
IF THE CONTRACT TOTALIS $1,000.00 OR LESS Customer must pay in full.
COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00:
Customer to Pay in Full; OR [ ] Customer to use the following payment schedule:
(1)'Deposit $ to be paid upon signing contract. Deposit should be 1/3 the total contract price; and
(2) Payment of $ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's
to do one of the following (check appropriate box below):
[ ) Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
or
[ ] Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed; and
(3) Final payment of $100.00 to be paid upon completion of the installation and both parties' satisfaction.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M G L c,14
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7 i w p ct.Yr SG %e r• //{/ Car; 5 oul TI c ctG�
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`�e Ifs roc! ' L>,-LzzwO�d�'�
NOTICE TO CUSTOMER — PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more
Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump -sum Price
stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract (including waste), which may exceed the actual
square footage of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the Contract (including waste).
By signing this Contract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may
not be refunded once the Installation Services are performed.
Contract Total 42
Are permits required for this installation?: Yes [ ] No *applicable tax included
•-�••�� ......+vv.•�. ra agog raw reyunCs wwe:s to prowae you wim me pamplet Renovate Right. By signing this Contract, Customer
acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure
from rennvatinn ar_tivitu fn ha narf—A i.. . _-.a
NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order
must be completed and signed by the customer for any additional charges. Customer must initial.
*Any work or material not specified is not included in this contract. Any changes or additions will be at an additional charge for the material and labor.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where
Installation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title and
interest in and to the photographs for use in all markets and media, worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the
photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including, but not limited to, marketing,
advertising, publicity, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. [Customer to initial to the left].
Work is to compiencejupon reasonable availability of Contractor and/or any special order or ttst er made. Good(s) which is anticipated to be
ZO 3CJ 1 r [fill in date]. Estimated completioi [fill in date].
Said estimated substantial completion date is npt� of the essence. A statement of any contingencies that would materially change said estimated substantial
completion date is as follows: 11)J•, -r l -if""
(if applicable, insert a statement of such contingencies).
IF THE CONTRACT TOTALIS $1,000.00 OR LESS Customer must pay in full.
COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00:
Customer to Pay in Full; OR [ ] Customer to use the following payment schedule:
(1)'Deposit $ to be paid upon signing contract. Deposit should be 1/3 the total contract price; and
(2) Payment of $ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's
to do one of the following (check appropriate box below):
[ ) Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
or
[ ] Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed; and
(3) Final payment of $100.00 to be paid upon completion of the installation and both parties' satisfaction.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M G L c,14
tr75 • / f r
d, Y",
X wl-o f,)
NOTICE TO CUSTOMER — PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more
Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump -sum Price
stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract (including waste), which may exceed the actual
square footage of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the Contract (including waste).
By signing this Contract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may
not be refunded once the Installation Services are performed.
Are permits required for this installation?: Yes / * Contract Total s
[ ] No applicable tax included
NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right By signing this Contract, Customer
acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure
from renovation activity to be performed in Customer's dwelling unit.
NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order
must be completed and signed by the customer for any additional charges. Customer must initial. .
'Any work or material not specified is not included in this contract. Any changes or additions will be at an additional charge for the material and labor.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where
Installation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title and
interest in and to the photographs for use in all markets and media, worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the
photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including, but not limited to, marketing,
advertising, publicity, illustration, training and Web content. By initialing here. Customer agrees to the foregoing. [Customer to initial to the left].
Work is to com en upon reasonable availability of Contractor and/or any special order or ugt er made Good(s) which is anticipated to be
fn �30// T' [fill in date]. Estimated completion date is ,/1 //� C3
Said estimated substantial completion date is n . t of the e
completion date is as follows: � "�
ssence. A statement of any contingencies that would materially clhange said estimated substantial
1�) �... ��,•.
IF THE CONTRACT TOTALIS $1,000.00 OR LESS Customer must pay in full. (if applicable, insert a statement of such contingencies).
COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00:
[I Customer to Pay in Full; OR [ ] Customer to use the following payment schedule:
(1)`Deposit $ to be paid upon signing contract. Deposit should be 1/3 the total contract price; and
(2) Payment of $ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's
to do one of the following (check appropriate box below):
[ ] Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
or
[ ] Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed; and
(3) Final payment of $100.00 to be paid upon completion of the installation and both parties' satisfaction.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c 142A
LOWE'S AND OWNER HEREBY MUTE LY AGREE IN�ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT, THAT
LOWE'S MAY SUBMIT SUCH DISP TE O A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT-
IVE OFFICE OF CO AFXIR AND BUSINESS REGULATIONS AND THE OWNER SIjALL REQUIRED TO SUBMIT TO SUCH ARBITRATION
AS PROVIt��1N-M. a
By.
Low 's a Date:
By.. Date:
Owner i nature
THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED
BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE
SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES.
[BDO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE. TERMS AND
CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.
Y SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THEERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS
ONTRACT. YOU ARPENTITLED TO A COPY OF THIS CONTRACT AT.THE TIME OF SIGNATURE.
WITNESS OUR HAND(S AND. L(S) BELOW THIS -•�y�? DAY OF h>
Low's Home 'tgrs, C ,. .
Lowe's Authorized Re es t live Owner �' '
Customer acknowledges receipt of a true co Co-owner or Witness
cancel this transaction at any time prior to midnight of the third business day completely
the date filled �ofthis rtra transacto t! See the uattached notice of cancetion hereof. You, the llation
55102.
form for an explanation of this right.
55102 REV. 12/13 FILE COPY ® 2004 by Lowe's.® Lowe's and the gable design
_ are registered trademarks of LF Corporation.
A The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
` 1 f
Boston MA 0211,1
www. mass govIdia
Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumhers
Applicant Information -�1 ^ t Please Print Legibly
Nc` me (Business/Organization/.Individual): Fl 410 t -e r ihck cc i b
Address: Irl C.Vi r._.s-• _.
CC MA 02161 Phone#: 7Ft_-39$-161 b
Are you an employer? Check the appropriate box:
CQ l am a employer with
4• ❑ I. ani a general contractor and I
_I
employees (full. and/or part-time).'
have hired the sub -contractors
2. ElI am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees anal .have workers'
f No workers' comp. insurance
comp. insurance.}
required.]
5. ❑ We are a corporation and its
1 ❑ I am a homeowner doing all work
officers have exercised their
myself, No workers' corp.
right of exemption per MGL
insurance required.] t
c. 152, §1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. Q New construction
7. ❑ Remodeling
8. ❑ Demolition
9. Q Building addition
10.❑ Electrical repairs or additions
.111] Plumbing repairs or additions
12.Q Roof repairs
13.❑ Other
' Any applicant that chocks box #1 mast also till out the section below showing their workers' compensation policy information.
? Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mast submit a new, affidavit indicating such.
`+Contractors that check this box must attached an additional sheet showing the name ofthe sub -contractors and state whether or not those entities have
employees. if the sub -contractors have employees, they mast provide their workers' comp. policy number.
I am an employer that is providing workers' cornpensadon Insurance for my empployees. Below is the policy and job site
information. A'' r ,p7�
Insurance Company Name: Alaii�UA- Tj sumlt'1C2
Policy # or Self -ins. Lie. #: 1< W D 414 lit 0 Expiration Date:_ _ 11 1-311,6
Job Site Address: D AT ran AUX, City/Statc/Zip:Q igv1y�M is Ifivs
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 S 1,500.00 and/or one-year imprisonment, as wellascivil 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
that the information provided above is true and correct.
Official use only. Do not write in this area, to be completed by city or town ofcial.
City or Town:
Permit/License #
Issuing Autbority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector .5. Plumbing Inspector
6. Other - -- —-
Contact Person: Phone #:
HPH-10-2015 11:08 From: 7814803825 To:9788800023 P;,ye:1/1
SV/ LUIJ/ r1LS Ua%•j(] NJti
SAX No, P, 00!
CERTIFICATE OF LIABILITY INSURANCE
THIS GgRTIF(QATE 18 ISSUED AS A MATTER OF INFORMATION ONLY ANIS CQNFERS No RIGHTS UPON THE CERTIFICATE HO1 pi R_ TT1I1S
CERTIFICATE DOES NOT APFIRMAT(VELY OR NI GAMLILY AMENDi EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES
BLOW. THIS CERTIFICATI+ OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETt1YEEN Tata ISSUING INSURER(S), AUTHORIZED
REPRESENTKInVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
1tdi�ORTANT: M the certificate holder i3 8n ADDlTIDNgI, ENSUREDpal. tt1F3 poS1Cy{Ifasj mast bA enclarsed If SUBROt>aATION IS WAIVEp,ubect to
the tams and conditions of the en'ry, certain P4(icll s MY requiM anendorsarnenf. A sfetgtn�t an flus aertifioata floes not earrtaT tl8hfs to the
CErtIfLCat9 holder !n Ileo of 8ftch endorseme n s
PRODUCER --
Jour► E 8iggio Insurance Agency
399 Winthrop St sat
Win.thrnP, Mii 02152
INSURED
Philip LT -Vera-%cahiv, �ZZ
17 Cli£tOA Ntrj-et
RevQ;re, MA 02151 -.
y Alla
617) 8,
(617M6 -6-42e
�•�.....� P:41 v�ocv REVISION NUMBER:
IS 15 T{) CERTi1 Y THAT THE POUCiES OF I LIRAIdCE UST[ p 6ElOW HAVE BEpN IS5UEp Yo THE INSURED NAfutEi] A3L)VE FOii TIiE= POUCY PERIQC
INn1CATEM %OTWITHSTANDING ANY REQUIREhtF_I+f. . TEPJA OR CONDITION OF ANY CONTRACT OR OTMER DOCUMENT 90 la RESPECT TO cY- T10c
CERTIFICATE !utAY $E I$9U1:t3 OR MAY POLICIN, THE tNSUP,ANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS -SUBJECT TO ALL THE TERIt4S.
k�XCLU3IQN5 AND CONDITIONS OF SUCH POLICIES. LIMI79 SHOWN MAY NAVA BEEN REDUCED BY PAID CLAIMS.
wsa
Tit TYPE CP tt29i3fiA.1G?= a AOI, tlUNO Mu P PDL!
GENER4L Lull UTY o LIMITS
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MACH 0CCUr%MNC£ ¢ :L 0
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1111 tlt�1 EXP(ARy Ego awson)
'L AGSGREaATE LWIT APPUF-- PER,
Pan" MM n tM
Af4V aIPLOYimr- uABIfRY
ANY
7C i� OiiMtXCLUDED m Ni
lMfundaran.
595720
6/18/2014
DESCRIPTIC:4tF oPpRAtw�S I LOCAi2ON81V6NICLEs (At—Is ACORD 101.Addtt I)aoj Re barky QRhUWjb, Rmora MO jv,agw,dl
Vendor 024305
tmmLYINdURY
eOwLY INJURY
Lower* Co Paan'ios, Tht:, and any and all subsidiaries �-M named add5.tiobal ins=4d Be respect to C nesaT
and Automobile Liability
(781) 480--3625
LOW* t 6 0o0par1i,es, Inc. and any and all
subsidiaries
P.O. Box 1111
N. NC 28656
SHOULD ANY OF Tlit AgDYE DESCRIBED POLIC18S BE CAN(;kLL W BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCOPOA)JCE WITH THE POLICY PR0140IONS.
A0MC1RtW13ftKA,:F.SEu ATOM
ANY{pjAuro
AU flSmM X lT�UJLEO
A�
HREDAVTOS X nix.�or.TlEa
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UMBRELLALtAS OCCJR
EXCESS UA6 ro .,.. ..
Af4V aIPLOYimr- uABIfRY
ANY
7C i� OiiMtXCLUDED m Ni
lMfundaran.
595720
6/18/2014
DESCRIPTIC:4tF oPpRAtw�S I LOCAi2ON81V6NICLEs (At—Is ACORD 101.Addtt I)aoj Re barky QRhUWjb, Rmora MO jv,agw,dl
Vendor 024305
tmmLYINdURY
eOwLY INJURY
Lower* Co Paan'ios, Tht:, and any and all subsidiaries �-M named add5.tiobal ins=4d Be respect to C nesaT
and Automobile Liability
(781) 480--3625
LOW* t 6 0o0par1i,es, Inc. and any and all
subsidiaries
P.O. Box 1111
N. NC 28656
SHOULD ANY OF Tlit AgDYE DESCRIBED POLIC18S BE CAN(;kLL W BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCOPOA)JCE WITH THE POLICY PR0140IONS.
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Massachusetts - 0epartment of Public Safety
Board of Building regulations and
Standards
- Construction Supemi%or
License: CS-072573~
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PHILLIP
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17 CLIFTON ST
Revere hU 0215F 1
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Conwissioner
04/27/2016
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