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HomeMy WebLinkAboutBuilding Permit #735-2017 - 94 PETERS STREET 5/1/2018 O�BUILDING PERMIT H w�"- 1 ,fit t.E D�,ORT TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION - " np b" Permit No#: 73 X01 ,Date Received �® 'ls,4ssq�H�SE��� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION CJq 1 � 'S �7�• A nt PROPERTY OWNER61-11 I�wr�-erg��R�,e! i l�aS�)s� Print 100 eY ar Structure yes Ono MAP PARCEL:O �20NING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition El Two or more family [I Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �.Septpt��U1%elli �T -- ��Flo,©dp ial nr � WefPandsF �r�YlUater�hed�Ds�r�ct DESCRIPTION OF WORK TO BE PERFORMED: Identification- PI ase Type or Print Clearly OWNER. : Name: 'l1 -ems 7 6� Phone: r Address: Iy A,1 C -S Et— , Contractor Name: rfri C; ra IA-.., Phone: 9 7�`7tfW- k>/y 3 Email: At4P,4;[G (,Ve6,.d-e,e,-i z a.*av— ��ma i / • C'ON Address: 3 f t;/ S� Sa/mak-. 17714 (7/9 70 Supervisor's Construction License: g 79 7-7 Exp. Date: 3 Home improvement License: 119 61 Exp. Date: -311711 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: $ 3600 . s- FEE: $ ` Check No.: / 3 0 7 R Receipt No.: / NOTE: Persons contracting. ith unregistered contractors do not have access tot e guaranty fund Flans 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 PLANNING & DEVELOPMENT Reviewed On _ Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature �I COMMENTS Z,,)ning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Flanning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit )DPW Town Engineer: Signature: Osgood EIRE D ART r.rant _ Located Street SEP a `MEN Temp�D ` tA- �es s ;$ ,- • umpste on,si e��y - 'e gLocated a124 Main --Street ;4;A/ —� fi> �gs ,� A i }aF t t �t t443` r ♦ `4'171 4 y {s'e!" t`y7Y'"- l�i s,R F�i�" , Fir De artrnen signature_/date(1r p k ` , "'#'Y i,�r. . `s MENTS7f :3w,- clY�tr 4 y{ '4i 1R �+ t � g y {e � lai. t { a1 + yYr-'t44> ty `fF'm s,.. �'n COM 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.$1oo-$loon fine NOTES and DATA-- (For department use) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 I 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 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 4- 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 d Hydraulic Calculations (If Applicable) Mass check Energy 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) 16 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 h NORTH own of s ndover O..................... No. ; t e14 - �..t,IL h ver, Mass,O d-017 A_ CoCNICNEW/CK 1• 7� CRATED pP��,�S S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System r• P61!�/� BUILDING INSPECTOR THIS CERTIFIES THAT ..... ....�..�...... ....................................................................................... has permission to erect buildings on ......... • Foundation •. Rough lloAo. 1to be occupied as ....... 31mo.........c�. .........�.........-I.//Op..lrs 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. PLUMBING INSPECTOR VIOLATION of the\Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S ART 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. 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Z2 J cna� aLa. tr�c�_ baz�olefyr,sasolef,��yor'tke�C_on,OF aYtai.-d caatrct sLal1 no_i �@ s;1vs dG r��t os abi o"�!aaymcats to a 11 S1bco `mplythat :,. coat _ Sokol - carefi iy lreob liming tins C Q a a;of teTs .riht =; Sn1E; -tund.S Ia�.�m rnhernri:e not , �e tL' beet <ce3 on then rri . Ul is do RttdmiiY;efallcTringntioasandn ES the ' LJu t he 'a tStln Mrosi• otcz, coSt1ie conte ate time _ n��eta 3RSa;21id f°` mtdfut" ��bc tr�taSEabe •gsteretifataeBirznr�wlnentCont�stnrF,eslrun � `sslia*eoasifsometningistmcl .rE;tlOIIbyi:Ttin(�ri0tlt0�lrP.CtGT,� t orofIiotaeintpra=,, �tCoa„zstc IncI.,r me* „ Lt>ztesraastbo t!a caa,ua ac:or im asn:'�tc;:? `•_1=,acGJa1 Si 7D,LooKon,:si+i p .`aa.YLn aaa3r in tom-, ru, Cat c aCactors2nd �P?'a R �> 1G er i1y1ii,g ; n ctor i na..jn rr °f r u'cn 'aaata�� 'rLW-Mct` G_7�73 v78i 37$7. rG aL aa7psh)Za1GS7�a�OD ca jam,:0II can t Can arb$$-� Gufde to;, Fw1nu1.11I'1iCi3•=t:Ydd the- arm COV'-ae�0;?S'�•t0 to ielae "nzmer:tCsn tr'tPCt-+:te3n51ano arty n iacrav,;sedofthifmr,1`Gn 1a.,cwcelLs and€c'-acopy OrLho Consmnc; con!!'ctorin:;riL*a a�rf3ta bei med �aPl of third basiac} C`t11 fn a morn o,$acn :a beT thzc'am:t ao , d 7 ot7oulag the sig er to rialc ova .. or's �1 pl-1 of�a� ^ ' �Pa• �� ' Yrn.ii�p `kYtele seatar by-,I! F�vtd-aycuaaixfyrhe Z'croi� it C.oliceofcsac:Ualionfr,is7ir t`m3'natlar.,thmruidailta�itlta tr.f TIM7,, Oflh sri r t.� as!�CE,sul Contractor Arbitration The Home Improvement Contractor Lav provides homeowner;with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right isnot automatically afforded to a contractor,however. The contractor-would have to resolve any dispute he/she has Width as homeowner in court.unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor Mayr 3i a 1# a dispute to a private arbitration firm which has been approved by the Secretary of t(tExgcge Qfce t? �dnsumer Affairs and Business Regulation and the consumer shall be required to submit to such arb ratio as'pfro cl r Kn`�1k'sachusetts General Laws,chapter 142A_ Homeowner's Signature Conn'c o s i nuamu: NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's sights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived io any way,even by agreement However,bomeovners- may be excluded from certain rights if the contractor they choose is not properly registered as prescribed bylaw. Homeoi=rs who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described_in a timely and worlmtanlilce manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for worlananship or materials. In addition toratan tees or warranties provided by the contractor,all goods sold in Massachusetts carry as implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matter on which the homeowner and contractor laivfttlly We may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in dunIicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or narked as void,deleted,or not applicable. One orig&l signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted workmay not begin until both parties have received a fully executed copy of the contract and the three day rescission period has expired; Asceierated Pawneat, A contractor may not demand payments in advance of the dies specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However.in instances tonere a contractor deems him/herself to be financially iosecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work:. lVithdrawai of funds fom said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Lativ,or other consumer rights,or ifyou tivish to obtain.a fine copy of "A Massachusetts Consumer Guide to home Improvement!' contact: Consumer Information Hotline Office of Consumer A- fair and Business Regulation 10 Part:Plaza,Room 5170,Boston,viA 02116 617-973-0787,888-283-3757 or visit titre OCASR website at hitoah�rn�v mass av/ocaUr/ If you want to verify the registration of contractor or ifyou have questions or need additional information specifically about the contractor registration component of the Home in, Contractor Law,contact Director of Horne Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-97007-888-233-3757 or visit the HiC vrebsite at httn:I��t��nv.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: htto://dbstate.ma_us/homeimp rovement/l censeelistaso For assistance with informal mediation of disputes or to register formal complaints against a business,call: -y.. Const -WComplaint Section O ct7 Vii Attorney General 617-i27-8400 AND/OR Better Business Bureau 500'-652-4800,508-755-2548 or413-734-31 14 Versi al-Ilp-molo The t'oFtli9i'.Ompealth of Massactilisetts Departinent of IndustriralAccidents Office of Invesligadow 1 C0119ress Street,Suite 100 �= BostOn,MA 02114-2017 V mmass goildaa Markers'CaMPensatiion Insurance Affidavit:Builders/Con t>tactors/EIect;reeilluslPlumbers �icaaat ff>r>lfor>ivat�ora Please Print Y,e ibl Name(Business/OrganizationAndividual): Afla l$Ic Weg>thegjzaldon5 LLQ Address: 61 R,le 'MOD Avenue City/State/Zip: Phone - #. Are e yo an Check the appropriate box: l: I am a employer with—a-5L 4. 0 1 am a general contractor and I FTy;[D.�Njew f project(required): 2.❑ employees(full and/or part-time).* have hired the sub-contractors h construction 1 am a sole proprietor or partner- listed on the attached sheet. 7. [ Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' �' Q Demolition [No workers' comp. insurance comp.insurance? 9• [ Building addition 3.Qrequired.] 5. (.. We are a corporation and its 10.0 Electrical repairs or additions 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL 11.0 plumbing repairs or additions insurance required.)t c. 152,§1(4),and we have no 12.0.Roof repairs employees. [No workers13-FO<Other i u/moi comp, insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers' t Homeowner who submit this affidavit indicating they compensation policy information. tContractors that check this are doing a work and then hire outside contractors must submit a new affidavir indicating such. 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. 1 arzt an errrploYer drat is provitlirzg workers'cotlrperrsatio►a instrratrce for my ernplovees Below is Elie policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.##: / q Expiration Date:_3�2 p f r7 Job Site Address: 9" .� S . Attach a co City/State/Zip: /V ��,P�L /7 . 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 Offi Investigations of the DIA for insurance coverage verification. ce of 1 do hereby certify der t/re pains oil enalties ofperjwy that the information provided above is true and correct 6 Si nature: Date: Phone#• Cf 7 701Y-�''/ty 3 Official rose only. Do not write irz this area,to be completed by city or town official. City or Town: Permit/]License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: Phone#: page 3 Of 4 �C4:>R®® i D OOYYCERDATE OF LIABILIW INSURANCE 3/9/2016 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 isan 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 CONTACT NAME: Construction Eastern Insurance Group LLC' PHDNE {800)333-7234 uc ,_ 233 West Central St ADDRESS:i A RESS: i INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER AArbella Protection Ins. Co. 41360 INSURED INSURER B NautlluS Insurance CO Atlantic Weatherization INSURERC: 61 Rear Jefferson Avenue t I INSURER D: INSURER E: Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER;Naster 2016 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 ARDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MWDDf—YYYVI (MWDQ1YYYYJ LIMITS GENERAL LIABILITY j EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY ( DA MT ENTED PREMISES Ea occurrence S 50,000 A CLAIMS-MADE a OCCUR ! 500042816 /20/2016 /20/2017 MED EXP(Any one person) S 5,000 X CONTRACTUAL LIABILITY PERSONAL& IN 1,000,000 i ADV JURY S X CG0001 10/01 FORM 3 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 POLICY X JFCT PRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident S 1,000,000 A ANY AUTO { BODILY INJURY(Per person) S ALL OWNED X SCHEDULED t 1020015871 /20/2016 /20/2017 AUTOS AUTOS BODILY INJURY(Peraccident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS { Per accident S PIP-Basic S X UMBRELLA UAB X OCCUR i EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS-MADE t AGGREGATE S 1,000,000 DED RETENTIONS 10,00 } 600058654 /20/2016 /20/2017 S WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN C'ATU ANY PROPRIETOR/PARTNER/EXECUTIVE ' rR OFFICER/MEMBER EXCLUDED? N IA EL.EACH ACCIDENT S (Mandatory In If yes,describe ander E.L.DISEASE-EA EMPLOYE $ . under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S B POLLUTION PL200378614 0/1/2015 0/1/2016 EA POLLUTION CONDITION $1,000,000 GENERAL AGGREGATE $1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES,(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) I i 3 { Z i I I t CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET j NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE i r John Roegel/SME _ --- �- ACORD 25(2010/05) I ©1988-2010 ACORD CORPORATION- All rights reserved. INS025r7mnostrtt Tho AnciRn name ami*Innn aro rania*ararl marlrc of AnARr1 MVI k'ft%I1:, 41 VV6 rdA DurvCI- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYYY) TIFICATE IS ISSUED ASA 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 P UCER THECERTIFICATE f HO DER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT ( NAME: EASTERN INS GROUP LLC PHONE FAX 233 W CENTRAL STREET (A1C,No,Ext): (AIC,No): i E-MAIL NATICK,MA 01760 ADDRESS: 22MLW r INSURER(S)AFFORDING COVERAGE MAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B: f INSURER C: INSURER O: 61 REAR JEFFERSON AVE INSURER E SALEM,MA 01970 f 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!CONTRACTOR 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. NSR ADO SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE i L R POLICY NUMBER IMWMDIYYYY) IM ADD%YYYYI LIMITS GENERAL LIABILITY i ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE ®OCCUR.; REMISES(Ea occurrence) [RODUCTS D EXP(Anyone person) $ GEN..'L AGGREGATE LIMIT APPLIES PER:1 RSONAL 8 ADV INJURY $ ENERAL AGGREGATE S POLICY PROJECT LOC -COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) 3 ALL OWNED AUTOS BODILY INJURY SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) 71 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIABCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $' RETENTION $ $ A WORKER'S COMPENSATION AND i WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B270121-16 03/202016 03120/2017 % LIMITSANY PROFERITORIPARTNERIEXECUTIVE OFFICER(MEMBER EXCLUDED? NIA E.L EACH ACCIDENT $ 500,000 Mandatory In If yes,describeaunder } E.L_DISEASE-EA EMPLOYEE $ 500,000 � DESCRIPTION OF OPERATIQ—below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFECATE HOLDER AFFECITNG WORKERS COMP COVERAGE. i k i f I CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST j BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED F IN ACCORDANCE WITH THE POLICY PROVISIONS. l N.ANDOVER,MA 01845 AUTHORIZED REPR "T& VS 4. .: ACORD 25(2010105) The ACO RD named nd logo ate registered marks of ACORD 19883=2010 ACORD CORPORATION. All rights reserved. t 4 Massachusetts Department of Public SafetyConstruction Supervisor ' Board of Building Regulations and Standards Restricted to: License: CS-087977 Unrestricted-Buildings of any use group which contain Construction Supervisors less than 35,000 cubic feet(991 cubic meters)of . enclosed space. ERIC W PALM 3 MILTON ST SALEM MA 01970 Falum to possess a-current edition ofthe Massachusetts Expiration: State Building Code is cause for revocation of 1l»s llcense. Commissioner 04/23/2018WtMl�MASS.GOVIE?PS DPS Licensing information visite Jar. ,n,,,orpr• r/�1 n'fs.f��;t,,Irr,�fj License or registration valid for individnl use only Office of Consumer Affairs&Business Regulation before the expiration date. if found return to:- iME IMPROVEMENT CONTRACTOR Office of Coasnmer Affairs and Business Regulation egistrabon: 142089 Type: 10 Park i'laza-Suite 5170 e xpiration: .3f12f201W Ltd LiabMly Corpor Boston,MA 02116 } ATLANTIC WEATHERIZATIONiL L:C. - ERIC PALM 61R JEFFERSON AVE iQ SALEM,MA 01970 Undersecretnrq Mot valid without signature � f