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HomeMy WebLinkAboutBuilding Permit #587-13 - 93 MAIN STREET 3/1/2013 _ ✓f o f NORTh q BUILDING PERMIT ��o��;`�o °•6�°� TOWN OF NORTH ANDOVER •/�J7� APPLICATION FOR PLAN EXAMINATION - - J H Permit NO: �� Date Received AP Date Issued: ,� `_ �CHUS�� IMPORTANT: Applicant must com a all items this page LOCATION 92 0x,17 Print PROPERTY OWNER A51--S ' - S Qfe Tojwl '2; f . ,.— Print MAP NO: PARCEL ZONING DISTRICT: Historic District ye no Machine Shop Village 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 ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer I C�N�yr9T1 oN -7U 3 F-I-CM, ��N6i�', 44&/ Pr;k) 1T�EN ��/ �r9T�'1 u�K1 �'T"r !/1�l7 1• Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: 6V3A31--Chone: C74 n/Dl.G60.3-,;z3 1-5009 Address: P© �D /V LIVI1L IV 5-416,1 A Al 14. Supervisor's Construction License: Exp. Date: GS -0772592J).311 1 Home Improvement License: A&41�a-' A Exp. Date: ARCHITECT/ENGINEER /V0/V16_... 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: $ 000 FEE: $ 0 Check No.: Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fund Signature of Agent/Owner _ignature of contractor TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION , Print PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village 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 ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund ;SignatureFof Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified F-iot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ 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. ❑ 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 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wates' & Sewer Connection/Signature& Date Driveway Permit DPW Tows ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 MainStreet Fire Departhient 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 No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use U Notified for pickup - Date 6 f Doc.Building Permit Revised 2010 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 u Building Permit Application u Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan u Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) u- 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) u Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract u Mass check Energy Compliance Report Li 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 subm:¢ted with the building application Doc: Doc.Bui!ding permit Revised 2012 —�} 0-�- Location 1 � ??� S/ No. ��U Date • = TOWN OF NORTH ANDOVER k� '4Certificate of Occupancy $ � . Building/Frame Permit Fee $� .- `; ` Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �j Check#-:(e�s 26185 Bu ding Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 30,000.00 m $ - $ 360.00 Plumbing Fee $ 45.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 45.00 Total fees collected $ 550.00 93 Main Street 587-13 on 3/1/2013 Renovate Third Floor Apartment New Kitchen, New Bath tAORTH Town of Andover 0 No. 07 4 - . - C,D h ver, Mass, COCMICHI.C. y1• �d RATED S U BOARD OF HEALTH Food/Kitchen .PERMIT T LD) Septic System THIS CERTIFIES THAT ........... Dt..... � ....... ..1 a�r....5 .�.....� ..:�:e v*!�........ BUILDING INSPECTOR qq Foundation has permission to erect .......................... buildings on ..:.J.z...... al..... ...: ............................. . Rough to be occupied as ✓' p� .....�....l.L-: ....�';�!�d!�.r....... r�l. .(.................................. ............. Chimney provided that the person accepting this permit shall in every respect 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. te4t­-/ /04,44—• Flw0x0 _ PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final ) PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service ..................... .... ................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in atorispicuous 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. SEE REVERSE SIDE C cT o Gio Realty LLC P.O. Box 1016 - Salem,NH 03079 Phone: (603) 894-4444 - Fax: (603) 894-5732 February 21, 2013 Dr. John Rizza 7 First Street No.Andover, Ma 01845 RE: New Roof over office &Renovation of 2"d Floor Apartment Proposal Dear John, Here is a proposal for the work at the above address. The following items represent the scope of work as I understand it to be; Included in this bid: I. Replace Roof; Strip existing roof above your office and replace with new 30 year architectural shingles. This work includes ice and water shield in valleys and on roof edge and install aluminum drip edge. It also includes removing the exiting air conditioning condenser and rebuilding the rack prior to replacement. Price $4,928.00 H. Install/Replace Windows/Doors; Replace the existing basement door. Replace a 2"d floor window to match existing. Price $ 875.00 1H.Apartment Renovation: 1) Scope of Work: Includes estimates for materials and labor for renovating this 4 room apartment. This will include demo of one bedroom ceiling which is beyond repair, patch and repair existing walls and ceilings considered to be repairable. Demolition of the bathroom and kitchen. Upgrade electrical and plumbing as required per the North Andover Building Department. Purchase and install new doors and knobs. Prime and paint all ceilings,walls and. woodwork. Install new carpeting and vinyl flooring. Install new bath fixtures and kitchen cabinets and counters. Install new appliances. Price $34,180.00 IV.Miscellaneous: 2) Cleaning: General cleanup of site daily so as to maintain a safe environment. 3) Rubbish removal: Gio Realty LLC will provide daily rubbish removal with the use of an onsite dumpster. 4) Permits: Permit will be paid for by Gio Realty LLC. i V. Not included in this bid: a. Does not include any fire alarm or sprinkler work. VI.AIlowances for Apartment 1) Lighting: $ 600.00 2) Plumbing Fixtures $ 950.00 3) Flooring: $17700.00 4) Cabinets/Counters: $3,000.00 5) Appliances $1,200.00 Schedule: This project should be complete 60-90 days after start date. Time&Material Contract: This contract will be a cost plus contract where invoices will be submitted as actual costs and a fee of 12.5% paid to Gio Realty LLC. Any material purchased by the customer will be the responsibility of the customer and not warranted by Gio Realty LLC. The estimated cost for the above work is $39,983.00 Deposit due at signing of contract will be$5,000.00 Invoices will be submitted every two weeks. If and when this proposal meets with your approval,please sign below,returning an original and keeping a copy for your records. Thank you for giving us the opportunity to perform this work, and we look forward to working with you. Sincerely, Thomas A. Gioseffi Date r John Rizza 4rDate Gio Realty LLC r T� Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License:CS-077258 SETTS ��A THOMAS A G SEFF4 - 5 DUNRAVFiLfI WINDHAMH z Expiration Commissioner 03/13/2014 I .0 i^ _ - T The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 µ www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /'` , / Please Print Legibly Name(Business/Organization/individual): C/'C7 RSA�, [L Address: f (3 O / / yfl �V w u City/State/Zip: Phone#: o3074 Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with 4. K I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. F]New construction 2zX I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.F]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.D?Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 cer yjkder the pains andpeyqdes of perhtrythat the information provided above is true and correct. Signature: Date 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: GIOPR-1 OP ID: NN CERTIFICATE OF LI DATE(MM/DD/YYYY) ABILITY INSURANCE 02/25/2013 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(ies) 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 Phone: 603-890-6439 CONTACT I Planright Insurance-Salem NAME: 224 Main Street Suite 3C Fax:603-890-6521 HONK Ext): FAX Salem,NH 03079 E-MAIL A/C No): James A Santo ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED GIO Properties LLC INSURER A:Travelers Casualty Ins Co Am 19046 & GIO Realty LLC INSURER B: 40 Lowell Road INSURER C: Salem,NH 03079 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A_DffE SM POLICY NUMBER MM/DDYIYYYY MM DDY� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 68016794853 01/01/2013 01/01/2014 PDAMAGE 10 RFN REMISES Ea occurrence $ 300,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7X POLICYPRODUCTS-COMP/OP AGG $ 2,000,00 PRO LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT Ea accident $ ALL OWNEDDULED BODILY INJURY(Per person) $ AUTOS SUS9 LOQ .INJUMaer_accident HIREDAUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE ENTION$ AGGREGATE $ DED RET WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC STATU- O R ANY PROPRIETOR/PARTNER/EXECUTIVE YIN TORY LIMITS ER OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Dr.John Rizza ACCORDANCE WITH THE POLICY PROVISIONS. 7 First Street N.Andover, MA 01845 AUTHORIZED-REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD FEE-12-2013 04 :98 PM INTER STATE PLE 603 893 8147 P. 01 Rlchsrd Mignat4t, L.M.P. P.O, Box 757 faster Uc. # Windham, IVH 03087 M -9748 Tel/Fac: (603)893-8147 ' NM • 68S IN� � Rr Tel rm0591*yahoo-com SIA Construction Supervisors#GS 027401 PLUM® EATING MA Sprinkler Contractors# CS 003844 NH Gas tic. #GFE 0802588 February 12 2013 Gio Malty LLC 1 RE;North Andover job Supply and install the following 4-$uniham hot waster boilers 85,004 BTL ea. Remove existing boilers off site Secure all necessary permits All electrical try others Total $13,200.OQ Supply and install the following: 1-Tub/shower with valve (allowance$350.00) 1-Toilet wl seat (allowance$700.40) 1-self rimming lav *%,/4"centers (allowance$150.00) F' 9sd 1-Kit sink w/famet (allowance$250.00) Re-pipe drainage and denting. Water pipe In PEX or equal Total $6300.00 i i "For All Your Plumbing • Heating - Budding Needs" Established 19 72 ._.tte ,2/4%2013 ; Time: 12,:,46 PMI. . ,3.... o @,' 16038945732 . .. Page.1. 002 . , 1. . . s- AC�® ^�q DATE(MM DDN". �,,,,. CERITICATE. OF LIABILITY INSURANCE - 2/4/2013 . THIA:CERTIFICATE:IS ISSUED AS,A MATTER.OF IN FORMAT1.ION,.ON LY'AND CONFERS.NO RIGHTS,.UPON..THE CERTIFICATE HOLDER.,THIS -- -.--CERT!:FICATE�OES-NOT_AFFI-RMAT1V-ELY-OR-:NEGAIVELY-AMEND-.EXTEND-_O.R--ALTER-THE-COVERAGE--AFFORDED BY THE_PO.LI.CIE8 BELOW.-_ THIS.CERTIFICATE OF INSURANCE DOES! , .. CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHI.ORIZED REPRESENTATIVE OR PRODUCER;AND THE CERTIFICATE HOLDER: . . IMPORTANT:.. tithe certiticate holder is ali ADDITIONAL INSURED;the.policy(Iesl must be endorsed. If SUBROGATION 15 WAIVED, subject to the terms and conditlons of tha pollt:y,certaln poilclas may require an endorsement A statement on this certif)cate doe1.s not confer rlghts to the certlfleate.holder in lieu of such efldorsefnent(s►. ,: .11 . PRODUCER] ., . . ._ ruh..,' CISR, ACGR": NA Tetr T ":`Foy-Insurancr.e 5atlem pHehs 1. t (60s)898-6320 )C Noi.{60?jE99 8269':' 130 1K3in S,t" Suite 103I. terri.;truhn@foyi?isurance.Com . IN SURERI9!AFFORDING COVERAGE NAIL 0 Salem'. 2N[ 03.079 INSJREiA Mtn Street'AwBriCa'Asautanae _'. 9935 .lZ .` IMSURt3tI1, NOURER9..Na aal' C3raII a MIAtual 4786' . Richard Wigaault .DBA: Interstate P1uTDbinq & IrisulteRc : Heatinq tNsiiReR D . PO BO]C 757:: '. - W7.IIddll3m 1 '` 03097. iNSURe"RF. COVERAGES. ' :• CERTIFICATE NUMBER:071212.`: I. . i:: -I�:.�,!'[`I.p-'..r.,..I L7�I-."..r,:r,,-,, ;. REVISION NUMBER. ..I,.�1,.-I,�.�.I�,..;.rL.II,,,"�:rj.�.I r THIS IS TO CERTIFY THAT THE POLICIES OF.INSURANCE,LISTED BELOW HAVE BEEN.ISSUED TO THE INSURED NAMED ABOVE.FOR THE POL'CY.PERIOD < INDICATED;_NOTWITHSTANDING ANY REQUIREEMENT,;TERMOR CONDITION OF�ANY.CONTRACT,OR,OTHER_DOCUMENT WITH.RESPECT TO MICH.THIS-. CERTIFICATE BE.ISSUED OR MAY;PERTAIN;THE INSURANCE AFFORDED BY.THE POLICIES DESCRIBED.HEREIN IS SUBJECT TO ALL'THE TERMS 'E)iCLiJSIONS AND CONNDITIONS OF SUCH:?OLICIES,LWITS SHOWN MAY HAVE BEM REDUCED BY;PAID CLAIMS':'>` -- - TYPE OF INSURANCE POLICY NUM63i PM I)Dr l PM ODf EaT' LIMITS :` NERA_LABILITY :' En-N��.CURREh^C. g .::, 500,000 GE - . X' .Gt MMErCtAL r 7JEP.AL'J BILIT"'' 7'- 500 04O PRE 11 E?`Ea�Y.urance £ A C_ LAms_ Aic rr.R' E'68377 /,,j2,-2 /1i/2013 6�[D EF Any one,e son?; :10,000 _ 5.4� N,pJ.f £ :'. 500;,000 F_R UNA :;` 3EhtkA A;r,RE� rE'. 1,000. 000 -EN`L oP-REGATE LI+i T PAPL Ec PtR: '. P:WDUCI'$-COhdFK.�P!+GG £: . 1•,000,OO �' . I>.. .. - a 0 X P'UCY ,(T. LOc-:. I £. AI.TOMOBILE LIA31LITY '. _, <,n oo coo -^cid 5 ''.8 51r r�U7t, ;.; : %+ ` B�DI i IN�JFi �e p run £ FILO\d ED o FEDJLEDk 1P95512 3 e012 AJT4� Ap 'AJiva / +' j3/2013 gJG,_;INJJrt Re^aa�A?t £ , NC 4�VVED'.' „ . .....:.o- : . Pk0 ERT C: c ., Linrsue,meton-troT i1 a5 500 000 UMBRELLA LIAB.'. ;CH.,r-1.1 ikRC,ICE ; . OCCUR .a EXCESI .IAB �Q1M3i!1ArE A,CRt�-1.7 £' DED ETEN7IDN£ e:., $ 'WOR'(ERSCOMPENSATION ICHAHD Ila24AULT L*FCLCDED X ML:?.A-T, 4TH AND EMPLOYERS'LIAB rY Y 1 N J' ' 4;1 ?'CPP!=TCRIFARTTE�/ CJTIJ- "TATE NH 6 PLA ,. I - N hCC DENTh 144 000 L>FRICFR WlvaT,. x�,Ll,TED'% 141A (MandatcryInNH� P95512 . :,', /11/2012 /'1/2013. pl TSE- FL4 E L tyres dee.t,6 ,n er E:l EA EM £ 100 000 o-SCRIFTIvV'0'r,F°RATIONS bnbrr : . 3:L:1ixAAE-R�Llvvit'vIr £ °00`t.00 ' ": , . �- . . i :. .0 .: : . DPSCPoI''VON OF OPERATIONSf LOCAnONS t VEHiCLEG(Attach ACORD 101,Addltlonal Remarka Schedule,If more spece.Is requlrod} i, �, i CERTIFICATE HOLDER ,; °. . CANCELLATION (603)894 5732r ' ,: - SHOULD ANY OF THE.ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ', THE ,EXPBTATTON„ DATE':THEItEOF, NOTICE WILL: BE DELIVERED IN Dio Realtv:.7�,C ACCORDANCE WITH T}fEPOLICY PROVISIONS . PO eox.1016' Salem, .t3FI 03079 AUT RZEDREPRESENTATIVE T Tittrni,:.CISR ACS_ ST.:. ACORD 25(2010105) @1988-2010 ACdRD CORPORATION.All rights reserved Zr INS02511oia,ol e TheACORD name'and5ogo:ars regisTaretl marks of�Lt:ORD r r. : �,� :.r':, ,r . � , I I I .., .., _r, , ,.." .. � I. - - L r'...... . N."O� ��� _� ,,J 1. . I 7.% . ' h� �s ,11 i ' =r s a " " .k 1 A Ah '' faE,r Ii 4 �` M. }i - -- �a I,, . ,­'­�.'­­ , 1 ,) zs rM � � i ate" " y q � r 1 " i ? �, �,.. 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L:., ,_ri........`-.d. 3 ,.w, .. ua ....., ,c..,,.. ,..o.....__...,..s,�t 1i.: __.,,_..n ,a...,�,...i'„.„„,s„.�.[�.xG..t> ...w...,,,.w r<ud......,_.,._# _ ._..._ ._..___ __._-- Feb 5 2013 12:40 P, 01 Y ® DATE IMWDQNYYY) �CORCERTIFICATE OF LIABILITY' INSURANCE 2/5/Z013 THIS CERTIR4CATE IS ISSUED,AS•A.MATTER OF INFORMATION ONLY AND CONFER$ NO RIGHTS, UPON THE CERTIFICATE HOLDEN.THIS CEmr-KATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, El MID OR ALTER THE COVERAGE AFFORDED BY THE POLICIES MOW�..THIS:CERiIFICIFTE. OF.INSURkMCI±...D_,dE9,H_OT_,COPdSTITIfTE A.CONTRACT BETW15EN THE ISSUING INSUR_ER(S), AUTHORIZED REPRESENTATIVE OR PROpUCER,AND THE CERTIFICAI HOLDER. 1 IMPORTANT: If the.G#rHTca*holdar Is.an ADDITIONAL INSURED,the policy(ics)must be endorsed. if SUBROGATION IS WANED,oubject to ' tht terms and cC i:1416KIk 04 the,pOlicy,certaln policies may require an endorsement A statement on this certificate does notconfer rights to the certificate holder In ll®u cf such'endorsement(s). ! 'R0017C@R NAILCT Cynthia St. Amand ENSURANCEISOLU'TION'S CO"ORATION PHONE (503}392�$64C A!Cta:(003)393-2036 50. 'Restville Rd. catamanewisaincures.eom INSL1 S AFFORDING COVERAGE NAIL d Plaistow NET 03865 23329 N3URED. INSU RER B j DT Xlectric, LLC ' INSURER CL 53 HigbJand Dr INSURER 0: iNbU rtER E: �,, Danville NS 03519 INSURER F: COVERAGES CERtIFICATE NUM8FR:cr-d312409214 REVISION NUMBER: _ THIS 15 TO CERTIFY THAT'THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD )NOICATED. NOTVItITHsrAND77VG.ANY REOUIREMENT, TERM OR CONDMON OF ANY CONTRACT OR OT)9ER DOGWI ENT WITH.RESPECT TO WHICH THIS CERTIFId TE MAY BE ISSt1ED:OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCR7SED HEREIN IS.SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH.POLICIES.LIMITS SHOWN MAY.HAVE BEEN.REDUCED BY PAID CLAIMS ADD LTR' TYPE OF MUMN09 MOT ME{ H brt PMlbD LIMITS GENERA!.LIABIUTY EAC} OCCURRENCE I 30D,000 X COMMERCIAL GENERAL LIABILrY 500,00 0 A �.IAIIatS41AD11 1z,0CCUR 0>?9RB9097 /23/2012 /23/2013 McDExp(M? Ono p.Q Qn` 1 ,000 PERSONAL d.40V INJURY 3 _. inoludA OENERALAOGREGAW I 600,000 GEN'L:AGGREGATELIMITAPPLIESPM. PRODUC'T5-COM°/OPACV) 8 600,000 X POLICYf—I PRA• LOC 6 AUTOl1081LE t EAQIE n Y O BINED SINGLE t1A11 A:rY AUTO - 90DIL.Y INJURY(Pei pGmcn)' I ALL OWNED �O ULED i SODI!Y INJURY(Perardaent: I AUYOu HIFEDAUTOS AUTON-S;t'1ED PROPF117Y DAMAGE I �A LAIGCCUR EACrI OCCURPENCE S EXMS8 LIA.B CLAIMS- 6 AGGREGATE S _ DED. RETENTION I YI011159R6 00MOrNSATION YIC STATU OTH- ANDmvL.GYEWLLA6IU7V Y;N ANY PR0PRITTCRIPARTNERIEXECLMVE E.L FACHACCIDENT 3 OFFIUERMEMaM EXZLUOE7? j N 1 A (Mal10a0uy In NN) E L DISEASE-EA EMPLOYF- 3 MUfYI,Y, OEBYy'eeddaeaSDe F OPERATION6 belmY E.1-DISEASE-POLI:Y LIMIT .$ . I DE3cPoPT10N OF OPERATIONS/W=TIONS/VEMCLES(Attach ACORD 101,Add!Vc nal Ramirinl Schedule.,it marc space is required) .CERTIFICATE HOLDER CANCELLATION (603)894-5732 SHOULD ANY OF THE:A13OVE DESCRIPE.D•POLICI7°S OF-CANCELLED BEFORE THE EYPIRATION DATE THEREOF, N07'(C6 WILL' 73E DELIVERED IN Gio Realty .LLC ACCORDANCE WITH'HE POLICY PROVISIONS, p:0 BOX 1016 7Salflln,, 1CB 03079 AUTHORIZEDREPRESENTATPIE Karen MaLinden/F.LM ,...�- ACORD 25(20.10)05} C 1998-201 O.ACORD CORPORATION Aft rights reserved. INS0281201COS)•01' -The ACORD name and.logb.ere,reglSlered.marks nf:ACORD I I