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HomeMy WebLinkAboutMiscellaneous - 550 TURNPIKE STREET 4/30/2018 (23)L; lob Office Use Only -- 01 4i �'iII11tIIiDItIUEttI 11f Permit No. i9epartment of puhiit: —A fettt Occupancy ,& Fee Checked ' f BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3190 (leave blank) �w APPLICATION FOR PERMIT TO PERFORM ELECTRICALWORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 4 (%* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for //a��permit to perfo t e electrical work described below. 14 Location (Street & Numbe?7�� l✓ - til Owner or Tenant_ Owner's Address Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building \%l, Sd32 r -e__ Utility Authorization No. Existing Service Amps /20 ;LQR Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity � Location and Nature of Proposed Electrical Work ./fin&AZ7_ ��-- OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws ^ I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES "' NO I have submitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE -�!_ BOND �_ OTHER Z� (Please Specify) (Expiration Date) Estimated Value of El e trical Work S Work to Start Inspection Date Requested: Rough r7 4 Final Signed under the Penalties of per'ury: A--Iq77 6 FIRM NAME104-1-J" e7t-r-t tG to L GOtn�-r Gf`v� �✓t G . LIC. NO. / LIC. NO. Licensee tMt'C11-Ac�J OVe4 Signature Bus. Tel. No. a o— G q f —pG L`7 Alt. Tel. No. N01 .7 N'7 Address OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner ^ Agent (Please check one) ()\�l Telephone No. PERMIT FEE S (Signature of Owner or Agent) X-6565 Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures 9 9 > /G I i O Swimming Pool Above grnd. ❑ In - grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets 2 No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ran Ranges 9 No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals Dis p No.of Heat Total Total Pumps Tons KW No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices Local Municipal [I Other ❑ Connection No. of Dryers I Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws ^ I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES "' NO I have submitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE -�!_ BOND �_ OTHER Z� (Please Specify) (Expiration Date) Estimated Value of El e trical Work S Work to Start Inspection Date Requested: Rough r7 4 Final Signed under the Penalties of per'ury: A--Iq77 6 FIRM NAME104-1-J" e7t-r-t tG to L GOtn�-r Gf`v� �✓t G . LIC. NO. / LIC. NO. Licensee tMt'C11-Ac�J OVe4 Signature Bus. Tel. No. a o— G q f —pG L`7 Alt. Tel. No. N01 .7 N'7 Address OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner ^ Agent (Please check one) ()\�l Telephone No. PERMIT FEE S (Signature of Owner or Agent) X-6565 _.: *.F4; �t 2979 Date.. .. f9�.. .......... t HORLH 1 TOWN OF NORTH ANDOVER PEFMCR APR 11 1996 ,SSAcmUS� - This certifies that ../ �!,°�AR...4 ..• `L has permissionto perforin ... wiring in the building of . ./< ...l?"t,? ..'ar/r/.... r 47.��/�1 X. t .11..L...t ,!,! It t.. ✓l.$. ......... , North Andover, ass.� Fee.. �..... Lic. No�L . �7 �J.............. ....:..tT FA RICAL INSPEC R WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File "o- 7.1, V, �c'U Location SS 2 rU ►2u.) R, kt: Sfi2cz No. 104— Date 's o TOWN OF NORTH ANDOVER } - p Certificate of Occupancy $ o w ea Building/Frame Permit Fee $ 73z, ^° A �►�,� oundation Permit Fee $ SJACH 4ermit Fee $ Nd 041`V yr �%bion Fee $ Wateir nectti'on Fee $ L $ `� Bui t�lAg.l pector T u Fu C.C.. 9667 Div. Public Works ` Location 225" 11'NeQl, kS T �o. ° Date gORT" TOWN OF NORTH ANDOVER Ott«w y'�tio �� • O� CY> p Certificate of Occupancy $ # Building/Frame Permit Fee $ x a � ♦ '^° Foundation Permit Fee $ CMUS Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ rze4 L Building Inspector l9E�li /ppp PAID 1A 9668 ��' —Div. 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Z 001 NJa C Z5N Omu zLL Og INw Z �0u► UNI QZF- WjW 38N HX� jWIR W fZW ZQllf ONW UW WZ_ W N U N F0� 0 I F- I O col III I I l l i ^l lI I� I I. 0 =n�lll� Z 0 W `I1�FFFT J Q F Z Y Z f i Z 0 m LL O 2 W N0 W w 0 6 OK w 2 0 O 0 K I I I Z Z5< �0f c eC 0 101 0 0 < LL I I 1 d 3 m "0 Q ZU �o oaO Z �=a Z Wa° Z G LL V Y N Z LL o<c0 0 N O N m0 '.�m^ LL O�Q V U O N y Z m< a V? p 5= U Q a O N N ? a a z z i 0 p� 0 a a 0 Z � m �iiwi�w O a x d 0 p u, LL ,� Z U w x V< < mmVNN 0 I F- I O U 0 Z 0 W y J Q F Z Y Z f i Z 0 m LL LL LL 2 W N0 W w 0 6 OK o f uFi Q Oma; N y 00 Z Z5< �0f c eC a. R 0 T 0 r ci Z IisFAE m1— 0 W J Q W Z 1O w ! Z Z W LL d < _ f 2 W N0 0 6 OK uFi Q ; Z �0f c eC a. °c w 0 0 i m "0 Q ZU �o oaO Z �=a N Z �F Z Z 0V 0V G LL V x "' Z LL o<c0 0 N O N m0 '.�m^ LL O�Q LLw - <n1JONOO O O000 - mao1 k0x �n' vZu Z WZ Z � m �iiwi�w O mw p Q Z mmVNN 0 O 3 r- N 3 R 0 T 0 r ci Z IisFAE m1— _J• TO Z *.. Or i o U tf • O QJ �� O W 1 0 N � C � CD CD r on -0 0 co n Al -G m 3 m ° Z > mo > 00 w -nm O n m 3 -p �►CD o c Z CD m I m M m 5 ` co = p 6964(A,69fA6 n CD z o CD/ W o p W a � Ul aQ m h Location,. So'tZ:+ No. l o4"' Date T S q4 NORTh TOWN OF NORTH ANDOVER p Certificat;1ramye Occupancy $ / �v cry Building Permit Fee $ 73s �7s''^°'''<�ou ation Permit Fee $ s�CHuse it 0 er Permit Fee $ _ e ` Sewer Connection Fee $ iz �h V Water Connection Fee $ TOTAL ^, $ 35 1�iq a i—c. r L L— 1 1 ding Inspector 966 �� Div. Public Works Location <; S- 'T No. Date "ORTq TOWN OF NORTH ANDOVER ?� •gyp Certificate o Occupancy $ vu' + ; Buildin came Permit Fee $ 733 Permit Fee $ cM �IoZu6on P"OtPermit Fee $ t Sewer Connection Fee $` Water Connection Fee $ TOTAL $ L-41:71, �'— •• ilding Inspector mss, 9566 Div. Public Works Location- t--= `" + t No. Date MpRT1q TOWN OF NORTH ANDOVER - p Certificate o Occupancy $ 1 { =" Building/, rame Permit Fee $" Ioufnd'ation Permit Fee $ JACMUSE 1 Other Permit Fee $ ` f/Sewer Connection Fee $ Water Connection Fee $ TOTAL $ `'"Building Inspector C ")'I Div. Public Works 31,1719C- Ft /,17/9C- (= t 0 ON rA W s•. O v O W CN 0 ON rA W s•. p 'ami ci : A ; ... co cc 0 2 cn Si ca COco cA:Ci C-311 J42 : s C-2-0IPA,b ci ca cc co Z a U O N = v J m J i C a p vJ •O` _cm a N A O W SEN N U Ic nv ED t ` N m o c, W CMO � Fa= z C=3 m t: CO.) Ncc cm O Z tj _ O O N d tlC m$~ m pC~n CLJJ m /� O tv w• V C� O � MD � C_,,, •� N g:5 W C Z O r m 'Vl cm W E v'O v cm L) m 0.0=mc g COD d m 0:6 _ ca m i N= 0 O 0 13 M O v O W G .- z 0 Q U W � V i G ci GO c/)(D-10 G a u1-4 IL y' oa w° cin � 7 U w �' co w W w w r vi w° a°' cn cn p 'ami ci : A ; ... co cc 0 2 cn Si ca COco cA:Ci C-311 J42 : s C-2-0IPA,b ci ca cc co Z a U O N = v J m J i C a p vJ •O` _cm a N A O W SEN N U Ic nv ED t ` N m o c, W CMO � Fa= z C=3 m t: CO.) Ncc cm O Z tj _ O O N d tlC m$~ m pC~n CLJJ m /� O tv w• V C� O � MD � C_,,, •� N g:5 W C Z O r m 'Vl cm W E v'O v cm L) m 0.0=mc g COD d m 0:6 _ ca m i N= 0 O 0 13 M O v O W G .- z p 'ami ci : A ; ... co cc 0 2 cn Si ca COco cA:Ci C-311 J42 : s C-2-0IPA,b ci ca cc co Z a U O N = v J m J i C a p vJ •O` _cm a N A O W SEN N U Ic nv ED t ` N m o c, W CMO � Fa= z C=3 m t: CO.) Ncc cm O Z tj _ O O N d tlC m$~ m pC~n CLJJ m /� O tv w• V C� O � MD � C_,,, •� N g:5 W C Z O r m 'Vl cm W E v'O v cm L) m 0.0=mc g COD d m 0:6 _ ca m i N= 0 O 0 13 M 04/01/96 40N 17: 43 FAX 617 472 6161 CRO11'1r CONST: 2002 ►" r-01-95 6bN-`. 03 :33 "PM TOWN OF NORTH RNBOVER 19 5Q$ 68� 95y42 AP �..:�. OFFICE 0p DUILDI.NG INSI1GCIOR . ,.,.,.... 3 _ • -TOWN;Or Nt1Rl;t1 ��Il24vF,�t �`- .�;"°• r 1 =CONSTRUCTION CONTROL �elAL ,1y �PROJECT NUi!$ER=` PRUJECh TITLE! t `DIET- Ve- 0 PROJECT LOCATION: �'aV1 .11+ - AWDW6 P, MA HAKE OF BUILDINC: TKt C 'OSS $.S- • • SN7E:R ,-. NAYURR of PRoal m 166 1JT 7.00 1H ACCORDANCE VITR SECTION 127.0 OF THE HASSACHUSETTS STATE BUILDING CODE, 10 VVILSDW PbLLO C{C Registration No. aq�'o — --- BEING A REGISTERED PROFESSIONAL ENGINEER/ARC441T&CI THEREBY CEP TIFT TI AT l _ HAVE PREPARED OR DIRRCTLY SUPERVISED I111 PREPARATION OF ALL bESIGN PLA -17S, CUMPUTATIONS Al;D SPECIFICA— ", TIQN5 4(jtiCEFLVI:1Gt - I ENTIRZ PROJECT C= ARCHITECTURAL STRUCTURAL © MECIWiICAL r, FIRE PROTFCYiON Cl ELECTRICAL. [) UTHER (speci f y) = I FOR THE ABOVE VAHED PROJECT ASiII THAT, TO THE EGSY OF k1Y 14,'a0W1.ECGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS HZET 'TIIE' APFLICABLE PROVISIONS OF THE hASSACHUSEI?S SIAI£ BUILDING CODE, ALL ACCEPTABLE E"GINEERING PRACTICES." AND APPLICABLE LAi1S AND ORDINANCES FOR TkE PROPOSED USE AND OCCU?ANCY. I FURTHER CERIIP'Y THAT I SHALL PERFORM THE NECESSARY PROFESSICNAL SERVICES AND BE PRESENT ON THE C0115TRUCTION SITE OR A REGULAR &ND PERIODIC BASIS TO DETERIIINE THAT THE 'CORK IS PROCEEDING IN ACCOADMCI VITH THE DOCUMENTS APPROVED FOR TIIE BUILDIIIG ?EMIT AND SHALL BE RESPORSIBI.E FOR 'THE FOLLOWING AS SPECIFIED IN .SECTION 127.2.1: 1. Review of shop drawings; saaples and e0ar sulydttels of the e-ntraetor as required by Ups consttve A= erntrsct doommts as sub=ltted fc: bsildtr$ pea,ir, aro approval for coritorusme to the design c=ept. 2. Review end agp=.Zl 01 the gdalitp ecru-oi procethmes for all tode-required ccrtrolled II9tRrialS. 3. Special architectural or englneeriss3 icnal,inspectIm of critical eensrmnrion carpcmres requiring controlled materials or eersmttirn sFetiEied in Gee accepted ergirneeri.N practice standards IfAted in Appendix B. TWO PURSUANT TO SECTION 127.3.31 I SHALL SUBHIT � , -A. PROGRESS REPORTSTOGETHER PITH PERTINENT COK ENTS TO IHE NORTH ANUUVER BUILDINC 1NSFE(7 UR_ UPON COHMETION OF IHE YORK, I SHALL SUBMIT A 1'INAL REPORT AS 0 TIIEAT SFACTORY COFIPLEZ'ION AND ht.L&,131•NEg$ OF TIM PROSECT FOR OCCUPANCY. SIGIrATVF.E . SUBSCRIBEDSWOPS SEFORS ISE Till$ UAY O 1996 NPTARYOBLIC : � MY CORMISSION EXPIRES ....���, .. . i `�lR��►�a4!!�1 ttt�eti�,� ;l 1 al a.... .. 04:04%96 ?Ht, 17:07 FAX 617 472 6161 CROWN CONST. .T *A&/ CROWN CONSTRUCTION CO.. INC. April 4, 1996 To: Bob Nicetta, Building Commisssioner From: Tony Papantonis, Project NManager-�(/__ J Crown Construction Company, Inc. 150 WOOD HOAU BRAINTREE MA 02184 TEL.: (617) 328-8200 FAK (617) 472-6161 The following are Worker's Compensation numbers and Insurer's for the proposed Big planet Video construction project at Cross Roads Plaza. Company insurer Policy No. Exp. mate Crown Construction Co. Great American #WC8903554 12/31/96 Wall -Tech Systems Liberty Mutual #WCI311225190015 5/1/96 Boston Mechanical 'Travelers TBI 9/15/96 General Glass CNA OWCI235399993 6/1/96 W.T.Kenney Co, Hanover #WHN426842802 8/1/96 Business Interiors Phoenix #6NUB517E8690 4/1/97 R -D Developers Liberty Mutual AWCI312241381025 5/20/96 Phoenix Electrical Phoenix #799K869A 7/27/96 Should you have any further questions, please do not hesitate to contact me. N qr APR - 5 �g s F ' 04/04,,96 THU 17:06 FAX 617 472 61.61 GROWN1 CONST. CROWN CONSTRUCTION April 4, 1996 To- Bob Nicevu, Building Comarusssioner From. Tony Papantonis, Project Manager—o: Crown Construction Company, lite. r.� 61 150 WOOD ROAD BRAINTREE, MA 02184 T'EL- (617) 328-8200 FAX: (617) 472-6161 The following are Worker's Compensation numbers and Insurer's for the proposed Big Planet Video construction project at Crass Road's Plaza Company Insurer Policy No. Exp. Date Crown Construction Co. Great American #WC8903554 12/31/96 Wall -Tech Systems liberty Mutual #WCI311225190O15 5/1/96 Boston Mechanical Travelers TBI 9/15/96 General Glass CNA #WCI235399893 6/1/96 W.T.Kenney Co. Hanover 4WEN426842802 8/l/96 Business interiors Phoenix #6MJB517F8690 4/1/97 R -D Developers Liberty Mutual #WC1312241381025 5/20/96 Phoenix Electrical Phoenix #799K869A 7127/96 Should you have any further questions, please do not hesitate to contact me. APR — 5 1996 I 4 4 � X ADD fnc, Axch;tacturs Desigri D0v*l0Vmr"t APR - 5 1996 COPIER TRANS.MMAo oi� A Projecc N2n'c No. of p2ges, Mclod-,ng uo'Ver page From MESSAGE TO Tclecapier Numl>cr �N ��z- Al? 1 Firm/ComparlY - 0 — hc j uk Comments .A t AA tllt�?v uelvi #i/Job #/fX so Prospoa Strobl Cambridge MmsgochusdW 02139 617661 0166 1 40 i CHANNELS AMER AN STANDARD Dimensi0fris APR - 5 1996 A I Nom- inal wt. Lb 40 33.9339 30 25 20.7 30 25 20 153 20 15 13A 13.75 14.75 12-25 Q.8 13 10,5 8.2 9 6-1 7,25 5.4 6 6 4.1 Fin r; t IS 'M A i Average Wld4Floe ten. 21 In 716 40 113,7!6 Ij 3s14 1 0 520 % 3.520 I % I ,' 10,6501 Y. �,i 12 1 3.400 34� 0 850 j Y, .2 C 2y.:xl82, 1 2.00 10.5 1 G X 20 3170 3 50, 00; 0 367 13,0471 3 ' ' 50 7 1 6 09 112,00 0,282 12.9,6 3 0.60" 1 8 82 J, 10.00 3 1,3!; 1 1 fj 00 0 436 8 1,20 1255. 3 2:886 C-436 8 j1 10, i 00 "79 12.739 10-436, 8 4A9 1000 I 0,2401 1,,b 1 0 93,20 ,115 5,68! 9,00 13,448 i I i 1,31 7,' 1 �,/, 1 1104 it , 9 Oc 0 28S i I Ito f ,,-13,4 (4.41 2,485 2 OA13 1 7 94; 9 �00 C,:233 12.433 4131 C 8x 1[575 1 5,6", 8.0c u 487 F , 2.5272,,� 1 13.75 !03 4.04 8:0010.303' go! 12,3431 2�% 103901 �,6 5 a 3.38 6.0010:220 1 A ' 2-26C 12% rj'3r, 4,75 12.25 4.331 7 00 10 41 g ,t 2.2991 21/, 1 0,3M, i ;,6 1 5 360 7 01' 0,314 i 516 1A,I 12,194 1 0 366! V� 2,871 7.0010,21 'At 1 2.00I c 13 4 0,36x5 3.83 '0 110.5 600 4V 12,157 1 2 0-30 0-i 3-09 6�00 0�81 120341 2 8,2 j 0.3431 4 1/i f 2401 6,00 0.200 1 O- 0 - 343 C 9 1 10 B.7 2.64 S.M. 325 1 6 i j 1.885 I I 197 i 11 i D. 3 x M 11 a,! go i i,no 1 C 4)e 7,25 0.320 3";- i 2.13; 4,0010.32) i,.t t. 4 i 1,591 4.00 C.184 2% 1.584 I.e 0-296! V, C 3)' x 1 76 3.00+ 0 356 273 14' 3rm 1)";IU i V I , I I --L6"—L 4. 1 1.21 3-00 � 0 170 4 0 M 10,273, ( "At APR - 5 1996 A I Nom- inal wt. Lb 40 33.9339 30 25 20.7 30 25 20 153 20 15 13A 13.75 14.75 12-25 Q.8 13 10,5 8.2 9 6-1 7,25 5.4 6 6 4.1 APR -01-96 MON 03:34 PM TOWN Or NORTH•ANDOVER 508 688 9542 P.03 The Commonwealth ofAfassachuse= ' -- - Depamnem of bitdmizrial Accidents MW tllrl /Aw 600 Washington Street Boston, ,glass 02111 Workers' Compensadoa Insurance AMdavit i am a homeowner rer;orming all work mvseI I am a sole xccne:or and have no one woricng in anv =rae:v I am a soia propretor, general contractor. or homeowner icirc:r and and "have hirsc :he conEmc:ors listed ba:ow who have the oilowins workers' compensation poiic.s: SNSM). cornD�v name- C.POGt/.y CONST�1/GT70it! CA�lfio/¢N)! addr�sa- /✓�"D LriGbD �D .. ,.. '. ....: •. .... .... : C1�V" ��/ti,�jZ�' /�'!� 't���V I ... -• CitORI �• .... .. tn9Ur311Ct COMDanv ?lam= address: r .z:.: , ........: - •.:...,....: i .<....... . Ctrv, Dban* 4. ' ....... insarsnce Q. ofr' a IIoaa s e• IIeetasa F311ure m secure coverzge 1S required ander $ccdon �,cA of NIGL IS: =a iesd to rae impo ido-n of ttlmtnai penaidu of a tine up to SI -00.00 and/or one •ran' imprisonment aS weil as civil penalties in clic roan of a STOP WORK ORDER and a fine of SI00.00 a day against Inc— I understand that a cap. of this statement may he ror*:trdod to the Office of IovestiVdaes of the DL-► :or coverage verification. I do hcrebY cerrllyer,•1Jc rs tk= t infer�e oit provided above is re and Correa Rdrr pains end ptaalrler of p Print name x 4 3-9G ?Zoo romdal use only do not write in this area to be completed by city or ww aMeW city or tarn: perMit'llemse', -.Building Department (p' CLietrAing 3oard check if ltsmediate response is rcquircd CScirctmca'S Office [Health Department tonOct person" - ➢bee ►; —Other, L - 3 19A� J (n- and LA'S VIA) _. iCOMPANY' LETTER A THE PHOENIX INSURANCE COMPANY 28M6H -- _ COMPANY INSURED LETTER B PHOENIX ELECTRICAL COMPANY C CONTRACTORS INC LETTER _ P 0 BOX 50 COMPANY LETTER ARLINGTON MA 02175 -- COMPANY E LETTER CQVRAGES .,. 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. COIPOLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YY) DATE (MM/DD/YY) LIMITS Iq(�F DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS c THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CROWN CONSTRUCTION INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 150 WOOD ROAD EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICETOTHE CERTIFICATE HOLDER NAMEDTOTHE BRAINTREE MA 02184 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR. OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE S PRODUCTS-COMP/OP AGG. S PERSONAL & ADV. INJURY S EACH OCCURRENCE S FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY COMBINED SINGLE LIMIT S BODILY INJURY (Per Person) S I BODILY INJURY (Per Accident) S PROPERTY DAMAGE EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE S AGGREGATE S A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY 799K869A 07-31-95 07-27-96 STATUTORY LIMITS EACH ACCIDENT - S 000100000 DISEASE -POLICY LIMIT S 000500000 DISEASE -EACH EMPLOYEE S 000100000 OTHER Iq(�F DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS c THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CROWN CONSTRUCTION INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 150 WOOD ROAD EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICETOTHE CERTIFICATE HOLDER NAMEDTOTHE BRAINTREE MA 02184 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Al;orn® .................................... PRODUCER THE INSURANCE EXCHANGE JENNISON CROSSCUP PO BOX 4310 MANCHESTER NH 03108-431 WALL—TECH SYSTEMS INC 78 RIVER ROAD HUDSON NH 03051 ................ I................ DATE (MMIDD/YY) 10/19/95 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND Oft ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A INTERNATIONAL EXCESS & TREATY COMPANY B LIBERTY MUT COMPANY. _ COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDNAME I)RIOD 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONI ,�„� LTR DATE (MM/DD/YY) DATE (MM/DD/YY) A GENAL LIABILITY GLO 0 0 6 2 2 6/15/95 6/15/96 BODILY INJURY OCC s DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS CERTIFICATE HOLDER NAMED AS ADDITIONAL INSURED IN REFERENCE TO THE GENERAL LIABILITY ONLY FOR THE JOB AT 1 CONSTITUTION PLAZA, CHARLESTOWN MA CROWN CONSTRUCTION CO INC 150 WOOD ROAD BRAINTREE MA 02184 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO.THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MALL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COM 4Y, V 0ENTS1 OR �RESWATIVES. E AUTHORD REPRESENTATIVE .7 1 ; I Peter R. Milnes 1110 h,11 . AhShVh ,X COMPREHENSIVE FORM BODILY INJURY AGG $ DAMAGE OCC $ PREMISES/OPERATIONSPROPERTY P�R EXPLOSIOLLAPSE HAZARD PROPERTY DAMAGE AGG S X PRODUCTS/COMPLETED OPER BI 6 PD COMBINED 000 $ 1,000,000 BI & PD COMBINED AGG s 2,000,000 CONTRACTUAL X INDEPENDENT CONTRACTORS PERSONAL INJURY AGG S X BROAD FORM PROPERTY DAMAGE X PERSONAL INJURY AUTOMOBILE. L IABIlim ANY AUTO BODILY INJURY (Per pe(son) Ni BODILY INJURY $ (Per eocww) ALL OWNED AUTOS (Private Pass) ALL OWNED AUTOS (Other than Private Passenger) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE S BODILY INJURY GARAGE LIABILITY PROPERTY DAMAGE S PR COMBINED EXCESS LIABILITY EACH OCCURRENCE S AGGREGATE S UMBRELLA FORM 6 OTHER THAN UMBRELLA FORM B WORKERS COMPENSATION AND WC 13112 2 519 0 015 5/01/95 5/01/96 X STAMORY LIMITS EMPLOYERS' LIABILITY EACH ACCIDENT S:z::> S:O.O;>.::0<O.:<: THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL i r DISEASE - POLICY LIMIT S 500,00 DISEASE - EACH EMPLOYEE $ 500,000 OTHER � - 3 1996 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS CERTIFICATE HOLDER NAMED AS ADDITIONAL INSURED IN REFERENCE TO THE GENERAL LIABILITY ONLY FOR THE JOB AT 1 CONSTITUTION PLAZA, CHARLESTOWN MA CROWN CONSTRUCTION CO INC 150 WOOD ROAD BRAINTREE MA 02184 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO.THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MALL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COM 4Y, V 0ENTS1 OR �RESWATIVES. E AUTHORD REPRESENTATIVE .7 1 ; I Peter R. Milnes 1110 h,11 . AhShVh :;:..:�>:.. •:.:.. •.•:. J. :<:.:. •:.. :.�:: . i:.i:.i:.i:.i:.?:.?:.i:•.>>:.:::...;::.:::..:.>:.:::..:;:.:.::;.::..:•;:::•;:::::::::::::::::::.:::::::::.:::::::..:::::::::::::.;::.:::.:.:::::.>:i::•i:.>:::;4::;':.:•::. LRSUE/1DATE MDD/Y .......... .. ...•:..::.:.•......:.:...(:i:.... ..:..i:.s.._:.:...•.:.�:.:.:.:.:.:.:.:.:.:.:.:.:.:..:.�:.::...:::.i:...:�:..}:}:.::::.::. .:::.:.:: :.: .:::•::::<...:.:; •: 11 5 PRODUCER THIS CERTIFICATE IS ISSURD AS A MATTER OF INFORMATION ONLY AND $ Hastings -Tapley Insurance Agcy CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDRR THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 8/01/95 271 Cambridge Street POLICIES BELOW ANY AUTO P. O. Box 410128 COMPANIES AFFORDING COVERAGE LIMIT COMPANY LETTER A Hanover Insurance Co. ALL OWNED AUTOS Cambridge, MA 02141-0901 COMPANY LETTER B Hanover Insurance Co. INSURED COMPANY LETTER C Hanover Insurance Co. W. T. Kenney Co., Inc. P.O. Box 14 BODILY COMPANY LETTER D Hanover Insurance Co. Arlington MA 02174-0001 COMPANY LETTER E THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I INDICATED.. NOTWITUSTANT)ING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT on OTHER DOCUMENT WITH RESPECT TO WHICII THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERRIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFF. POLICY RXP. LIMITS TR DATE (MM/DD/YY) DATE (MM/DD/YY) A GENERAL LIABILITY BIND054400 8/01/95 8/01/962000000 GENERAL AGGREGATE X COMM. GENERAL LIABILITY PROD-COMP/OP AGG. 2000000 CLAIMS MADE ®OCC. PERS. & ADV. INJURY 1000000 OWNER'S & CONTRACTS PROT EACH OCCURRENCE I M0000 FIRE DAMAGE(One Fire) 5(N)nn Crown Construction Co. Inc. 150 Wood Rd. Braintree, MA 02184 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED MED. EXP. One Per 5000 $ AUTOMOBILE LIABILITY AMN426852102 8/01/95 8/01/96 COMBINED SINGLE ANY AUTO LIMIT ALL OWNED AUTOS BODILY X SCHEDULED AUTOS (Per person)1000000 X HIRED AUTOS BODILY INJURY AUTOS (Per accident) 1000000 ,NON-OWNRD GARAGE LIABILITY 500000 PROPERTY DAMAGE C EXCESS LIABILITY U4268516 8/01/95 8/01/96 EACH OCCURRENCE 3000000 X UMBRELLA FORM AGGREGATE 3000000 OTHER THAN UMBRELLA FORM DX WHN426842802 8/01/95 8/01/96 STATUTORY LIMITS WORKERS' COMPENSATION EACH ACCIDENT 500000 AND DISEASE -POLICY LIMrr 500000 EMPLOYER'S LIABILITY DISEASE -EACH EMP. 500000 OTHER i Vpi is 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS APR 20f Crown Construction Company Inc. is added as Additional Insured with NOV 1 7 1995 _ _ _ _. .._ _ , _ � , respects to work perfromed by the Named Insured at Bank of Boston #95095 n. . Crown Construction Co. Inc. 150 Wood Rd. Braintree, MA 02184 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED C`.:, ORD $ PRODUCER $ RICHARD R. PROVENCHER - INSURANCE AGENCY 680 LAKEVIEW AVE. LOWELL, MA. 01850 INSURED ROYAL DESCOTEAUX & ROLAND DOMINIQUE R/D DEVELOPERS P.O. BOX 334 DRACUT, MA. 01826 DATE (MM/DD/YY) . THIS CERTIFICATE IS ISSUED AS A MATTER OF II FORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND O ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A COMPANY B COMPANY C COMPANY D 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. LT TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIAI CLAIMS MADE F—] 0 OWNER'S & CONTRACTOR'S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ PERSONAL & ADV INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ COMBINED SINGLE LIMIT 1 $ BODILY INJURY I $ (Per person) (Per accidBODILY ent) I $ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS CONTRACTORS CROWN CONSTRUCTION T -T.: TONY PAPONTONIE . .-.0 WOODS ROAD BRAINTREE, MA 02184 m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL -40 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. THORII ED REPR@SrE�YlIVEE> PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: xx­ EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- OTH TORY LIMITS ER EL EACH ACCIDENT EL DISEASE - POLICY LIMIT EL DISEASE - EA EMPLOYEE $ $ oo $ Jon THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL WC 1- 312 - 2 413 81- 0 2 5 5 / 2 0 / 9 5 "- — 5/20/961 OTHER nn 1 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS CONTRACTORS CROWN CONSTRUCTION T -T.: TONY PAPONTONIE . .-.0 WOODS ROAD BRAINTREE, MA 02184 m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL -40 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. THORII ED REPR@SrE�YlIVEE> R A WRDri� PRODUCER L. Robert DeSanctis Insurance Agency, Inc. Ten Walnut Hill Park burn, MA 01801 INSURED General Glass & Mirror Corp. PO Box 836 Medford, MA 02155 ...?'' DATE (MM/DD/YY) 2/23/96 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND; EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A CNA Insurance Companies COMPANY B COMPANY C COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED 1. 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. LTR TYPE OF INSURANCE POLICY NUMBER I DATE (MM/DD/YY) POLICY (MM/DD/YY)N LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY 8505865854 6/1/95 6/1/96 CLAIMS MADE X occuR Additional Insured • C own Construction OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY i ANY AUTO A X ALL OWNED AUTOS SCHEDULED AUTOS !� HIRED AUTOS NON OWNED AUTOS MP000358174 f6i75. 6/1/96 A n r n i GENERAL AGGREGATE 1$1,000,000 PRODUCTS - COMP/OP AGG 1$1,000,000 PERSONAL & ADV INJURY 1$1,000,000 EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Any one fire) $ 50,000 MED EXP (Any one person) $ 5,000 COMBINED SINGLE LIMIT I$ 500,000 BODILY INJURY $ (Per person) i BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY t{ s C E 't '• AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY ANY AUTO EACH ACCIDENT $ v j I I -f AGGREGATE $ 1, EXCESS LIABILITY EACH OCCURRENCE I $ 2 , 000 , 000 AIUMBRELLAFORM B110769206 6/1/95 6/1/96 AGGREGATE $2,000,000 $ j OTHER THAN UMBRELLA FORM WORKERS COMPENSATION ANDY WC STAOTH EMPLOYERS' LIABILITY A WC123539893 ! 6/1/95 TORLIMITS ER i 6/1/96 EL EACH ACCIDENT E $100 000 THE PROPRIETOR/ �� INCL PARTNERSIEXECUTIVE (MA, NH F L , NY , CT) Ice EL DISEASE - POLICY LIMIT $ 5001-60 0 , 00 OFFICERS ARE: EXCL i Ten days notice of CBnCe1 at i on cancellation applies i e5 EL DISEASE EA EMPLOYEE $ 1EAEMPLOYEE $ 100 000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS Bank of Boston, Franklin 1, Canton, MA Glass & Glazing -' "Additional Insured.Iimits are no greater than those required by Contracts" own Construction .1.0 Wood Road Braintree, MA 02185 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE ANCELLED BEFORE THE E . ►TION DATE THEREOF, THE ISSUING COMPA WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTI TE HOLDER NAMED TO THE LEFT, TOFAN ILURE TO MAIL SUCH NOTICE SH IMPOSE NO OBLIGATION OR LIABILITY Y KINUP, N THE COMP ]f, ITS AGENTS OR REPRESENTATIVES. ;: :::;; ...:: " ::::::: :....: �'?:•.�.. '%.::: 2:: ... }: ,. ;? 's .. ':' ;, ': `:%;::....:':.<3'::::::::DATEA CORD .:::::.::::::::::::....................:..::":::�.�:::::::::::::::::::::: ma.:LRIN :... 03 15/1996f. / ::::::::::.::::............................................................................................. PRODUCER (508)366-8736 FAX (508)898-0403 Davis Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 21 East Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ^ O. Box 870 COMPANIES AFFORDING COVERAGE .tborough, MA 01581 COMPANY Aetna Casualty & Surety-Com Attn: Ext: A INSURED Business Interiors Floorcovering ANY Phoenix Ins COMPANY B 73 Olympia Ave p C O VIE Woburn, MA 01752 COMPANY MAR 21 iSSb COMPANY D Et3E8...............................................:.::::::.:::.......................................................................:.::::::::::::::..................................................................................................................... ............................. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMOD................:.. 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. LTT R : ' TYPE OF INSURANCE POLICY NUMBER : POLICY EFFECTIVE : POLICY EXPIRATION:: LIMITS DATE (MM/DDIYY) DATE (MM/DD/YY) GENERAL LIABILITY ....... : GENERAL AGGREGATE $ 2,000,000 COMMERCIAL GENERAL LIABILITY :....................................................... : PRODUCTS - COMP/OP AGG : $ 2,000,000 s:£%•`:# CLAIMS MADE X :OCCUR A ::::::>;......; :...O 009BQ24377270FWI PERSONAL & ADV INJURY $ 1, OOO , OOO 04/01/1996: 04/01/1997......................................... ... ......... OWNER'S &CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 ............................................................ FIRE DAMAGE (Any one fire) $ 300,000 ................................ MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT CO $ ALL OWNED AUTOS INJURY AUTOS ? (PDIe $SCHEDULED HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) I i .......:.....................................................: i i PROPERTY DAMAGE '. $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT : $ ANY AUTO ............................................ ....................................:. ? OTHER THAN AUTO ONLY: :$:::::............................. EACH ACCIDENT: ...................................................................................... AGGREGATE:$ EXCESS LIABILITY EACH OCCURRENCE $ 5,000,000 :....... AX UMBRELLA FORM 009XS24377270CWA ...................................................................................... 04/01/1996 04/01/1997: AGGREGATE :$ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION ANDVV A H- :TORY LIMITS : ER:%::%::?:i::::::?:::::::................•••.•.. EMPLOYERS' LIABILITY B ; THE PROPRIETOR/ 6NUB517E869O 100 ' 04/01/1996 04/01/1997 EL EACH ACCIDENT ..s ,.000 PARTNERS/EXECUTIVE INCL : EL DISEASE -POLICY LIMIT $ 500,000 OFFICERS ARE: EXCL : EL DISEASE - EA EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS Idditional Insured _Crown Construction Crown Construction 150 Wood Rd Braintree, MA 02184 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL _30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Daniels THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD :.:::.::.: E�1CfL�(MMID IYY) ................................................. :::.:::::::::.:::::..........................................................................:::::::... ..a PRODUCQt THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND ' CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE :POLICY EXPIRATION LIMITS LTR CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DATE (MM/DD/YY) DATE (MM/DD/YY) DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE J Bary Driscoll Ins Agcy, Inc POLICIES BELOW. '5 Braintree HILI Office Park ................................... ........ ..... ............ ._......... ... ..._.......... _... .... .................... ,.o. Box 9058 COMPANIES AFFORDING COVERAGE Braintree MA 02184-9058 1000000 FIRE DAMAGE (Any one fire) $ ...............................................................:................................................ ;......................... CCOOMPR Y A THE TRAVELERS ................................................................................................................................ ............ .................. _.._.... ........... ............ _...... ......... ...... ...... _ ....... ........._.......... ........ _.. COMPANY B INSURED LETTER Boston Mechanical Contracting Co. C C LETTER POBox 2207 ..................... ........................ ......_.. _ .... _ ..............._.... 4 Read Ave. COMPANY D Quincy MA 02269 LETTER COMPANY E LETTER 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, ANY AUTO EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ............_......_................_...__......._.......-........................ . LIMIT ' CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE :POLICY EXPIRATION LIMITS LTR DATE (MM/DD/YY) DATE (MM/DD/YY) ._.._...._................__................................;. __........ _._..._......... GENERAL LIABILITY TBI A :......... 09/18/95 09/18/96 GENERAL AGGREGATE $ .: .................2000000.... _.... X : COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP)OP AGG. $ 200= ............................ • CLAIMS MADE X : OCCUR.: PERSONAL & ADV. INJURY $ ;;»»».... 1000000 .............................................. .............. X OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ .................... 1000000 FIRE DAMAGE (Any one fire) $ ...............................................................:................................................ ;......................... 50000 MED. EXPENSE (Any one person); $ ........... $000 ;................................................................ AUTOMOBILE LIABILITY M COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS ............. .............. : BODILY INJURY ........... _................. SCHEDULED AUTOS ; (Per person) $ HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) $ GARAGE LIABILITY__......_....._....__...__.- ......_ ................. .:.................._. PROPERTY DAMAGE $ ........:......................._................................ :........ ...... -_............. .......... ......._............ ........ EXCESS LIABILITY .......... .._....... ......... ............._.........._.......................... .... ........ -.....__...........:..... :EACH OCCURRENCE ...._....._..._........_.. $ UMBRELLA FORM .............................................. AGGREGATE ...................................... $ OTHER THAN UMBRELLA FORM ..... .. :.....................................................................................................................................:................................... WORKER'S COMPENSATION ::::::..:..STATUTORY LIMITS.......... ...................... ..........;:::::::::::............................. »: ,.,,,,,,,,,,,,,,,•,, ::,:.:, AAND TBI 09/15/95 09/15/96 EACH ACCIDENT a 100000 DISEASE - POLICY LIMIT $ 500000 EMPLOYERS LIABILITY __... .............. _.............. ............................................................... DISEASE - EACH EMPLOYEE $ 100000 :...................................................................:................................:.................................:....................................................................................... OTHER _ . i DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS APR .._ ..3... �gg� ........ Certificate holder Is added as an additional Insured as respects general liability for work being perfonned for them at various locations. Certificate Is also revised to Indicate correct effective date on SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO r=rown Construction Co., Inc. € MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 1 Wood Road LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGAT ON OR LIABILITY OF ANY KIND ON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Braintree MA 02184 AUTHORIZED REPRESENTek, J. Barry Driscoll Insurance Ag cy, Inc. N QA7.% "4V CROWN CONSTRUCTION COMPANY, INC. 150 Wood Road, Braintree, Massachusetts 02184 Tel: (617)328-8200 Fax: (617)472-6161 Transmittal Form L -. G Trans. No.: Date: -.101-0- f-0 Prof- No.: 95022 Attention: pp Project: ,Z l We are sending you via: [ ] Federal Express [ ] U.S. Mail [ ] Courier [ K Hand Delivered Copies Date No. Description These are transmitted as checked below: [ ] for approval [) Approved as submitted [ ] Resubmit copies for approval {) For your information [) Approved as noted [ ] Submit copies for distribution [JrAs requested [) Returned for corrections [ ] Return corrected prints [ ] For review and comment [) Final Execution [) Forbids due 19_j ] Printed returned after loan to us Remarks: X30,4 �ucGDSED /S ME iu AV4o*--97AW .l5/�y� si'� OY W&A 125i RICCZ• �i/G72YT7�/�tYr IS ir/' OWOeW, /?.4�' O3ee /l1E' ulml �it/Y Fy/2ThFJ� QuA-TnavS v,¢ cc�,r&2us 9 &i�J).3z8-82GO XZZ I. (- Of Signed: Copy to: mr, W CL F3" IV 1 3 Q <D K "n o O m 0 0 mmk Z � 0 C I �M 0. o0 C C Z 0 H O d 40 t� 0 Cy o Hcn d z� o z cn x CA kCA >yIt y n CA y x y z z c o ca m z � d W CL F3" IV 1 3 Q <D K "n o O m 0 0 mmk Z � 0 C I �M 0. o0 C C Z 0 Town of North Andover Massachusetts ARCHITECTURAL FINAL AFFIDAVIT To the Building Commissioner: I certify that I, or my authorized representative, have inspected the work associated with Permit No. /QV dated AP2/4,locus Precinct (on the dated used below or on at least _:�_7 occasions during construction), and that to the best of my knowledge, information and belief, the work has been done in conformance with the Permit and plans approved by the Building Depart- ment and with the provisions of the Massachusetts State Building Code and all other pertinent laws and ordinances. Inspection Dates: L)11_�404 r- P-9L1,06k- -4:P 2y&® ARCHITECT - MASS. REG. NO. App Wt., - COMPANY (Pb l -011P PHONE Ae 126 A v Z 19.9 Then personally appeared the above-named and made oath that the above statement by him is Before me C�20a Cl1NST�v��N Ca . My Commissi t, - r Occe, (Y? 0 crown consTRucrIon co., INC. May 8, 1996 Bob Nicetta Building Department Town of North Andover 120 Main Street North Andover, MA 01845 Re: Final Affidavit Big Planet Video 550 Turnpike Street North Andover, MA 01845 150 WOOD ROAD BRAINTREE, MA 02184 TEL (617) 328-8200 FAX: (617) 472-6161 Please be advised that all construction work for the Big Planet Video store located at the above referenced address has been completed in accordance with the architectural drawings and specifications dated 3/11/96, the HVAC drawing and specifications dated 3/19/96, the fire protection drawing dated 2/5/96, and the electrical drawings dated 2/5/96. Furthermore, all work has been performed in accordance with state and local codes and current construction practices. Signed Crown Construction Company Anthony N. Papantonis Project Manager Sworn and SgubeNotary Publ i Commission Expires: 4 Before Me This C9 -e -ar/ Day of , 1996 0 0% I eL. c LZL Cc Or� �a,0 = I co�u� 02 v I co Q . ~ ' a CFD cjC CD =E CL=car � L : CD d C H o ca A 'O ZE — m ' CO) y C R E `" m �. m O Co G•c.3cr m MO m ' Qf C CL. p C m V N1 Z o .� cm Q y m c o aCIO W C 4;: t LL- MD IG vs at as C Z cm V m O m C y d I=Mo 2t -- O (6J �1 01 C +;r cc y 0 O U \- J u 1 (13.1O -37- U w° U) C w° c�° U w 7 C w°' W ° V) G o°' ° V) V) I eL. c LZL Cc Or� �a,0 = I co�u� 02 v I co Q . ~ ' a CFD cjC CD =E CL=car � L : CD d C H o ca A 'O ZE — m ' CO) y C R E `" m �. m O Co G•c.3cr m MO m ' Qf C CL. p C m V N1 Z o .� cm Q y m c o aCIO W C 4;: t LL- MD IG vs at as C Z cm V m O m C y d I=Mo 2t -- O (6J �1 01 C +;r cc y