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HomeMy WebLinkAboutBuilding Permit #408-12 - Great Pond Road 11/10/2011 TOWN OF NORTH ANDOVER p APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTAN T:Applicant must complete all items on this age LOCATION I Print PROPERTY OWNER I C- JV Unit# Print MAP NO: 9 PARCEL: Q�7 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE EOFIMPREOVIEMEWT- PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition & Two or more family ❑ Industrial 9.<Iteration No. of units: 3 ❑ Commercial lrepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑;Septics 0 Welk` I grFloodplain? 0 Wetlands; ; D' WatersfiedlDistnet _ ❑ Water/SewerF s _ DESCRIPTION OF WO TO BE PERFORMED: 4 f (Identification Please Type or Print Clearly) OWNER: Name:_ IV Z &a! S f xg6 S Phone Address: 2 9 HOR c,4. ID S 7 /vr 19,AJ Z>Oue R CONTRACTOR Name:L e noy r.,oa-1 CC) U-AJC Phone: 926-- '97y- /93c5 Address: C'u fL 71 S u 011 t7 DL c 7"0.0 U 19el- Supervisor's Construction License: / 6Y6 3 Exp. Date: / X013 Home Improvement License: ,0 :2 6 7 9 Exp. Date: 7 ? ®!, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ �' ��L/ r O� FEE: $ ��(�° Check No.: �'o y(f7 Receipt No.: `?�kou/ NOTE: Persons contracting with unregistered contractors do have ccess to the guaranty fund - - S' -A- ^9 Signatures ont ---Orr -------------------------------------------- r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swinunmg 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 i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit i DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dempster 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 I DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— For department use I I i ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi J 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/Crossection/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) ❑ Copy of Contract o 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 Doc: Doc.Building Permit Revised 2008mi Location i No. 410,0- 12- Date 1 NORTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ ,SsACHUs Building/Frame Permit Fee $ d Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24805B61 Inspector XAORTH Town of �_ Andover ., No. - D� X = _ 0 o , over, Mass., Y Q LAKE COCKICKE WICK %S0RATE D BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. ..... -?�YG� ....................................................mac d'C�.................................................................. Foundation V 7 has permission to erect........ ...:.......................... buildings on . y...�.....lw.5 ............................................ Rough tobe occupied as....................... c? /. 4�1C.!-C.. ....ft..:.. FCv... G23.....................................I..... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUCTION STARTS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. u Massachusetts- Department of Public safetl Board of Buildiwl, Regulations and tandat ds Construction Supervisor License License: CS 51698 ROGER A LEMAY 9 CURTIS AVE MIDDLETON, MA 01949 Expiration: 6/19/2013 ( mniisi.ner Tr#: 16468 ` Office Gf'Cott�ifHiii S� ffi HOME IMPROVEMENT CONTRACTOR - Registration,. ,102679 Type Expiration: :tl2 12 Private Corporatio L CbNSTRIICTfis' C INC Roger LeMaY t 9 Curtis Ave Middleton,MA 01948 Undersecretary p, OSHA 002311573 US,Department of Labor t7ccupational.Safety and health Administration Roger. 'A. LeMay has succeW64y completed a 1t}fiour occupational Safety.and.Health Training Course in Construction Safety&Health James R©dger 9/11 /11 (Trainer) (Date) 16 Contract COMMERCIAL. • RESIDENTIAL � Page 1 of 1 9 Curtis Avenue•Middleton,MA 01949•Phone/Fax:(978)774-1430•Email:lemaycc@gmail.com•www.lemaycc.com Submitted To: Nickolas Brings Date: 11/07/11 39 Harold St Location: 39 Harold St. North Andover MA 01845 Work Phone:978-979-2885 We hereby submit specifications and estimates for: Exterior work Strip existing roof shingles from complete house. Complete minor repairs as needed. Ice and water at all leading edge and install GAF timberline roofing. Scrape bad areas on complete house,prime and paint areas to match existing. Remove existing gutters and install new. Replace railings on front stairs. Interior work Remove existing kitchen cabinets and fixtures. Install new electrical and plumbing for new kitchen layout. Install new window unit and patch to match existing. Insulate walls as needed and install 1/2 drywall,Tape ready for paint. Install new cabinets and counters. Complete trim Install new vinyl floor. Remove existing bathroom fixtures. Re plumb and wire to meet new layout. Sheetrock walls and ceiling,tape ready for paint. Install new vinyl flooring. Install new fixtures and complete electrical. Finish existing storage area to become new laundry room. Install new plumbing and electrical as needed. Paint walls,ceiling and trim. Clean area and haul away all trash All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviation from above specifications involving extra cost will be executed ,J only upon written orders,and will become an extra charge over and above the Authorized Signature: �i' estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tomado,and other necessary insurance. Our This Contract may be withdrawn by us if not accepted within 45 days. workers are fully covered by Workmen's Compensation Insurance. ACCEPTANCE OF CONTRACT-The prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. PgWent will be made as outlined above. Signature Date A C� j� Contract COMMERCIAL • RESIDENTIAL 9 Curtis Avenue•Middleton,MA 01949•Phone/fax:(978)774-1430•Email:lemaycc@gmail.com•www.lemaycc.com Page 1 of 1 Submitted To: Nickolas Brings Date: 11/07/11 39 Harold St Location: 39 Harold St. North Andover MA 01845 Work Phone:978-979-2885 COST BREAKDOWN Roofing and gutters $9760.00 Exterior repairs and painting $5300.00 Plumbing $6000.00 Electrical $5300.00 Flooring $5140.00 Cabinets $7330.00 Carpentry work $11,010.00 Sub Total $49,840.00 Overhead and profit $4984.00 Total $54.824.00 Price does not Include permits. Any additional work needed will be based on material cost and labor cost of$45.00 per man Hr. Payable as follows..30%deposit at start of project.30%after rough inspections with balance upon completion. Terms: All accounts are due and payable upon receipt. Finance charge of 1.5%per month,which is an annual percentage of 18%on all accounts over 30 days. All material is guaranteed to be as specified. All work to be completed in a �-- workmanlike manner according to standard practices. Any alterations or Y ✓ deviation from above specifications involving extra cost will be executed only upon written orders,and will become an extra charge over and above the Authorized Signature: c estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tomado,and other necessary insurance. Our This Contract may be withdrawn by us`if not a4-ted within 45 days. workers are fully covered by Workmen's Compensation Insurance. ACCEPTANCE OF CONTRACT-The prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above, Signature ��`� Date 7' 7 �_ - w 77 1 ...:.,�..._.,-.w......,,.,_..._.yv.ra.w,.,.. �._��._..®„�................_�:.i�:.-....d..�.x...,.......A.....,._...__...........,...a.�.�.a..s,...:a:n,.f�_.a._....�...__.....n..,._._....,.kY.....>._,.._..�.__.,_«..__.........�....�.........,..e,.,. .. _ ...._. ...� .- _. ._... .., t...- ..._._.. .... k This is to certify that a 3 Roger A. LeMay 9 Curtis Avenue, Middleton, MA 01949 , ,.e has successfully completed the 8-hour course Renovator Initial - English "a Pursuant to 40 CFR Part 745.225 f -� Course Location Institute for Environmental Education 16 Upton Drive Wilmington, MA 01887 . . U. May 28, 2010 May 28, 2010 Ole " Course Dates Examination Date R-1-18398-10-06486 Ma 28,_2015 t Certificate Number Expiration Date Training Director 16 U-to i Drive, VViiming#on, iYiA 08,6,7 Tela hone 978,658.5272 eetrat;. .. CCr.. BRt�w w.F �a =^se�.,�y^+ wm.* .. r.*` •rry ��.�.. .,"i* "✓:. Vi { � ,�.'. __ � ✓� s-.,� 4 y'kfa 4 77 �� ._ s S;, s� `:,�.. . . '.,: ,� .'+F� ....—m�«.iE�,+�.«a:.:. .;r �.rr�r� «..,.-A,A•. 4�,y�� �` �.-,& � ��..��,�.,, �+H.s•,` Required Contract Terms Page 1 of 2 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regulation Home>Consumer>Home Improvement Contracting> I. ......................................................................... �'. ............................................................................................................................................................................. ......................... ...................... Required Contract Terms Contracts-all contracts over$1,000(One Thousand Dollars)must be in writing. NEWS&UPDATES The law requires the following FOURTEEN items to be included in any contract between a homeowner and a registered home improvement contractor for home improvement work subject to MGL c.142A: OCA Survey Finds One in Five Home Improvement Contractor 1. The complete agreement between the contractor and the owner and a clear description of any other documents Advertisements Placed by which are part of the agreement. Unregistered Entity 2. The full names,federal I.D.number(if applicable),addresses(NOT P.O.Box numbers),of the parties,the More... contractors registration number,the name(s)of the salesperson(s)involved,if any and the date the contract was executed by the parties. WSubscribe I Learn more 3. The date on which the work is scheduled to begin and the date the work is scheduled to be substantially completed. — RELATED LINKS 4. A detailed description of the work to be done and the materials to be used. Yon Gid Konsomat6 5. The total amount agreed to be paid for the work to be performed under the contract. Massachusetts you Reparasyon 6. A time schedule of payments to be made under the contract and the amount of each payment stated in dollars, nan Kay including any finance charges.Any deposit required to be paid in advance of the start of the work SHALL NOT D D D D D D D D D D D O D exceed one-third of the total contract price or the actual cost of any material or equipment of a special order or custom ll made nature which must be ordered in advance of the start of the work to assure that the project will proceed on Gui a para a Consumidor de schedule. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. el MassHoa etts para Mejoras en � 7. All parties must sign the contract. ar Guia para el Consumidor de 8. A clear and conspicuous notice stating: i Massachusetts para Mejoras en el Hogar a.That all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza,Suite 5170 Boston,MA 02116 Phone:(617)973-8700 b.The contractor's registration number must be on the first page of the contract. c.The homeowner's three day cancellation rights under MGL c 93 s 48; MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. d.All warranties on the owner's rights under the provisions of and MGL c.142A. e.In ten point bold type or larger,directly above the space provided for the signature,the following statement: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. f. Whether any lien or security interest is on the residence as a consequence of the contract. 9. An enumeration of such other matters upon which the owner and contractor may lawfully agree. 10. Any other provisions otherwise required by the applicable laws of the Commonwealth. 11. Permit Notice:Every contract shall contain a clause informing the owner of the following: a.any and all necessary construction-related permits; b.that it shall be the obligation of the contractor to obtain such permits. c.that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access_to the Guarantee Fund. httn://www.macq onv/9„arrPTTI—n,,.,f ,ri,;,,�11 PT—2 JP T n-TT,..Y_D_T , Required Contract Terms Page 2 of 2 12. Acceleration of payment: No contract shall contain an acceleration clause under which any part or all of the balance not yet due maybe declared due and payable because the holder deems himself to be insecure. However, where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance of funds due under the contract,which are in possession of the owner,shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 13. No work shall begin prior to the signing of the contract and-transmittal to the owner of a.copy of such contract. 14. Arbitration: If the contractor determines that in the event of a dispute,the contractor wishes the dispute to be settled by arbitration,this fact must be signified on the contract and both the contractor and owner shall sign this clause separately. The following format is acceptable(in 10 point type or larger); "The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to aprivate arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c I42A. Owner. �-^- Contra6tor: NOTICE. The.. atures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiate by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separate&by the parties." ©2011 Commonwealth of Massachusetts http://www.mass.LlOV/?DdaelD=ocatermin.qIk.T.='I�T.O=T-TnmP�T 1 The Commonwealth ofMassachusetts Department of IndustrialAccldents Office of Investigations, 600 Washington Street Boston,MA 021X1 SY www mass gov/dia Workers' Compensation Insurance Affidavit: i Builders/Contractors/Electrcians/Plumbers A licant Information � Please Print Legibly Nan7.e(Business/Organizafion/Individual):_ �� � • Ccs. .vC Address: UA City/State/Zip:Mr 9 I-)Ze 1,ca,V M d U/?e g phone#: E an employer?Check the appropriate box: a employer er with—T 4. Type of project(required): p Y ❑ I am a general contractor and I loyees(full and/or part-tune).* have hired the sub-contractors 6 El New construction a sole proprietor or partner- listed on the attached sligget. t 7. ❑Remodeling and have no employees These sub-contractors have king forme in any capacity. workers'comp,insurance, g' ❑Demolition workers'comp,insurance 5. ❑ We are a corporation and its 9• ❑Building addition ired.] .officers have exercised their 10•❑Electrical repairs or additions a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions Myself [No workers'comp. C. 152, §1(4),and we have no in required.]t' employees. 12•❑Roof repairs [No workers' comp,insurance required.] 13•0 Other !Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 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 their workers'comp,policy information. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: (JTz-e A 710 A; AL �N�crit�art a r, Policy#or Self-ins.Lic.#: /j/y Expiration Date: Job Site Address:_ 2 2 N/3 Yz Attach a copy of the wCity/State/Zip: AJ 4,u66Uew MA OfBY�' orkers'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 D9 for insurance coverage verification. Ido Izereb cer ' ` J' the pains an penalties ofperjury that the information provided above is true and correct. Si ature: � •. • Date: j/A// 'none#: 7 ^ 192_/^ N-3 O F:47use only. Do not write in this area,to be completed by city or town official own: Permit/License# uthority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbin 6.Other g Inspector Contact Person: Phone#: Information and Instructions structlons Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers''compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy.;please call the Department at the number listed below. Self-insured companies should enter their ,self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permithicense number which will be used as a referencd number. In addition,an applicant that must submit multiple permit/license applications in any ny given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related for any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The ConUDDA-wealth of.lNjassaehllsetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston;MA- Q2l 11 Tel.#617-727-.4900 ext 406 oA 1..877-MASS.AFE Revised 5-26-05 Fax#617-727-•7749 WWw.mass.�av/dia A� CERTIFICATE OF LIABILITY INSURANCE 7J13/D/13/201/DOIY1 1 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 AFFORDE=D 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 holler Is an ADDITIONAL INSURED,Bre policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the term 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 NAME: Kristin Linnane Elliot Whittier Insurance PHONE (978)977-4884 AM,Ne),(978)977-0e50 3 Centennial Drive AD AItESS L glinnaneOElliotWhittier.com CUM CUMMCRID,00044533 Peabody MA 01960 INSURER(S)AFFORDING COVERAGE NAICs INSURED INSURERA:Ma,X Specialty Insurance INSURER B:Travelers Ins. Cos. F2322 Lemay Construction Co. , Inc. INSURF-RC:UtiCa National Insurance Group 9 Curtis Ave. INSURER D, INSURER E: Middleton MA 01949 t R F: COVERAGES CERTIFICATE NUMBER:11/12 GL/WC 10/11 BA 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 POLICY NUMBER M UCY M C UMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 7C COMMERCIAL GENERAL LIABILITY { DAMAGE PREMISES� O R oExmtence $ 50,000 A CLAIMS-MADE I—XI OCCUR MhXO13100002433 /14/2011 /14/2022 MED EXP ^__ (Arty one Pelson) $ 5,000 PERSONAL a ADV INJURY S 1,000,000 GENERAL AGGREGATE s 2,000,000 GEN'poUey GATELIMITAPPLIESPER: PRODUCTS-COMPIOPAGG $ 1,000,000 X POLICY ROCT L-1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Es accident) $ 1,000,000 $ ALL OWNED AUTOS DA204OP236 1/23/20101/23/2011 BODILY INJURY(Per person) $ x SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE X HIRED AUTOS II (per accident) $ $ NON-OWNEOAUTOS Medxw payments S 5,000 PIP.Baela S 8,000 UMBRELLA UAB (SUR EACH OCCURRENCE $ EXCESS U �AB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ F1 RETENTION i C WORKERS COMPENSATIONWC STATU H- AND EMPLOYERS'LIABILITY YIN X I ANY PROPRIETOR(PARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? Q N iA E.L.EACH ACCIDENT $ ZOO OOD (Mandatary In NH) 444431012 /14/2011 /14/2012 E L DISEASE-EA EMPLOYEE $ 100,000 d descPTION dbs under OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRI i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addiional Rsmatks Sdsduls,N more apace Is required) SVIDXKC8 OF INSUPA1NCE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE K Linnane/KLTNNA ACORD 28(2009109) ®1988-2009 ACORD CORPORATION. All rights reserved. INS025(2ooeos) The ACORD name and logo are registered marks of ACORD