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Miscellaneous - 62 FARNUM STREET 4/30/2018 (2)
62 FARNUM STREET 210/107.A-0086-0000.0 i i Date.,< .s. .00.4--- .HOR7M tip TOWN OF NORTH ANDOVER p� •° , PERMIT FOR U-M ING t • o� r ,SSACMUSE� This certifies that 441 . . . . . . . . . . . . . . . . . has permission to perform . . :!` ' . . . �?/�- . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . (-'tJ?. Y.-.-.---- . . . . . . . . . . . . . at. . a . . n.st. .vrYt . . . 1. ) . . . . . . , North Andover, Mass. Fee �. .�. .Lic. No.. 7D . . . . . . . . . . . . . . . . . . . . . . . . . . . . .� ' PLUMBING INSPECTOR Check # 7821 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS �O Date — 3 '— Y Building Location (p;X% FO--�,-- , (11 4Owners Name Permit# Amount Type of Occupancy New ri Renovation �� Replacement Plans Submitted Yes No ri FIXTURES F W HD O - �" Oco CU � A cq Y �I�.BASEYEvl BE FLOCR � 1 ZDKJOCR l MH-OCIR 411Fijoaz F7a 6M RJOCR 7M FLOCR M LL),M (Print or type) \ Check one: Certificate Installing Company Named to �ne--4 �`C� f ���{ rtq-tcotp. 2qy � Address C Partner. usmess Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac et State Plumbi Code and Chapter 142 of the General Laws. By: Signaturea ��� mber 01 L1censtU- Title ''" Tape of Plumbing License �y O^ City/Town `icense umCee Master Journeyman ❑ APPROVED(OFFICE USE ONLY G� _ i Date.....7....ZCj..'o8. f NORTF�1 3?;•.�`` AL TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SS US This certifies that �,!!� LeGT/2iC. ................... ..................................................... has permission to perform ..........J`.,..ray ......................... ....................... wiring in the building of.......... ............................................... Z � 2/Lv ST..................... .North Andover,Mass. uv 4 �,3�$Z Fee..-$O . .............. .. �e ......, ELECTRICAL INSPECTOR ' Check # 8266 commonwealth of Massachusetts Official Use Only Permit N �, ✓f Department of Fire Services to, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 Qeave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN NK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER Ipector By this application the undersigned gives notice of his or her intention to perform the ele trical workies described below. Location(Street&Number) -1-1 1'1�41L)/Js'S-7 Owner or Tenant C /t,�S G' Th S Telephone No. Owner's Address f j4C Is this permit in conjunction with a building permit? Yes Purpose of Building ® NO ❑ (Check Appropriate Boz) S GIC oCi9� Utility Authorization No. Existing Service �w Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No,of Meters Number of Feeders and Ampacity 1 ` Location and Nature of Proposed Electrical Work: Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cert.-Susp.(Paddle)Fans 0.0 Transformers KVA Total No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of LuminairesSwimming Pool Above ❑ In- o.o mergency ig a d. ❑ Batte Units Fofeptacle Outlets No. of Oil Burners E ALAB_M_S No. of Zones tches No. of Gas Burners No. of Detection and India ' Devices i No.of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No.of Waste Disposers eat u111P Number Tons No. of Self:Contained Totals: ��"� �" "" '. Detection/Alertin a,Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑Other r No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters ' No.of Data Wiring: Signs Ballasts. No.of Devices or Equivalent No.Hydromassage Bathtubs No. of Motors Total gp Telecommunications i6W OTHER: No.of Devices or E ..;valent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑. OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury,that the information on this application is true and complete, FIRM NAME: f LIC.NO.:1.3/7 o261 Licensee: ^' I"_l Signature t ---� LIC.NO.: (If applicable, a er-exempt in the license num er Cne.) ,,,�1 Address: o;9cl� �Q Ce�II-s /"' �/ % Bus.Tel.No.: *Per M.G.L c 147,s 57 61,security work rec quires Department of Public Safety"S"License: Alt L l.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑owner's agent Owner/Agent Signature Telephone No. PERMIT FEE:$ s ' v The Common wealth o Massachusetts f errs kj r! Department of Industrial Accidents 1 Dice of Investigations 600 TVashington Street a.�a Boston, MA 02111 www massgov/dia Workers' Compensation Lnskranee Affidavit: Builders/Contractors/Eiectricians�pfambers Applicant Information f Please Print Lembf� Name(Busincss/OWization/Individual); Address• Co cL, City/State/Zip:_ ��� s�� 1W q4 Phone# .` W- Are you an employer?Check the appropriate box: 1.❑ 1 am a employer with 4. Type°f Pel (required): ❑ I am a general contractor and I employees(full and/or part-time).* have hired the subcontractors 6 ❑Naw construction 2. I am a.sole proprietor.or partner. Iisted on the attached sheet.= 7. ❑Remodeling ship and have no employees These sub-.contractors have 8. Q Demolition' working for me.in any capacity, workers, comp.insurance. [No workers com .insurance 5. 9• El Building addition p ❑ We are a corporation and its . required.] officers have exercised their 10•❑Electrical repairs oradditions 3.0 I am a homeowner doing all work right of exemption per MGL 1 I.❑Plumbing repairs or additions myself..[No•workersI comp, c..152, §I(4),'and we have no insurance required.) 12.[]Roof repairs reg � .. .employees. [No workers COMp. insurance required..] 13.[].Other `ALDY appiicartt that checks bo> l moat also fill out the section below showing their workers'bompensation policy information, t homeowners who submit this affidavit indicating they are doing all work and then hire outside conuacton must submit a new affidavit indicetiag each $Contractors that check this box rmwatmabed an additional sheet showing.the trams of the sub-conuactom and dmir workers'comp.policy in abut suci I fo an e eon. that.is pro vidiftrworkers'compensation insurance or a Lo eaL Below is the o infornwtion. f �' mP y p ficy and job site Insurance Company Name: ' Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip. Attach a copy of the.workers' coatpensation policy declaration page(showing the policy number and expiration date}. M Failure to secure coverage as requited under Section 25A of MGL c. 152 can lead to the imposition of criminal fine up to$1,500:00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerci er the pains p attics o.tPrlrJ' e 'u that the information provided above is true and correct Signature., Date: Phone#: [1B use only. do not write in.this area,to be completed by city or town olds( Town• Permit/License Authority(circle one): of Health Z Building Department 3.Cih'/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector Person: Phone#: Information and Instructions C 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=city,employing empioyem. *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 bnsmess or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence-of compliance with the insurance'coverage required." Additionally, MOL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public 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 afridavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-conttactor(s)name(s),address(es)Emd phone number(s)along with their•cercificate(s)'of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)witb 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.rnay be submitted to the Depwtrnent of industrial Accidents for confirmation of insurance coverage.. A.Iso'be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pe' or license is being requested,not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you am requirred to obtain a workers� compensation policy,pleasrcall the Department at the number.listed below. Self-insured companies should enter their self-insurance'.liemse 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 permit/license number which vvilI be used as a reference number. in addition,an applicant ` that.must submit multiple permit/license applications in any given year,need only submit one affidavit indicating-current policy'information(if necessary)and undw"Job Site Address"the applicant should write"all locations in (city or town)."A copy of1he affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a vaiid affidavit is on file for fi=t= permits or licenses. Anew affidavit must be filled out each year.When a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves ems.)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,teiephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Officeof Investigations 600 Washington Street Bosion, MA 02111 Tal.#617-72-74900 ext 406 or 1-8-77-MASSAFE Fax 4 617-727-7744 Revised 5-26-QS www.mass.gov/dia NORTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SACMUSEt This certifies that . . . �! f'�• • • •I• ,t has permission to perform . f -. . � //�K . . . . . . . . . . . . . . • plumbing in the buildings of . .�/2-. . . y ! x! . . ..5;-7--. . . atGf?T / . . �°S. �t.,•�-'-.. . • • • . • . . , North Andover, Mass. Fee.0.5--. . .Lic. No. . . . . . . . . . . . . . . . . . . . . . . . . .�? . . PLUMBING INSPECTOR Check # 103 7109 MASSACHUSETTS UNIFORM APPLICATION FOR-PERMIT TO DO PLUMBING {Print or Type) Mass. Date C� ( � 20 d� Permit # Building Location �.�.� . � � —r1�/-�—�-----�_._Owner's Name lJ ff 1 Type of Occupancy ' '�f', New 0 Renovation 0 Replacement.BG Plans Submitted: Yes ❑ No ❑ h, FIXTURES B.P. # SEWER # SEPTIC # r z Ln z Z Y Q~ zJ. -i L W Un t-n = V11- U W to LL z H a U Z a (n C"- ? Q F LU z L7 O z ` 0-1 0Q C r Ln Z n � LL -- 1 Q U Q O Z, d O z z � u Y D W U o 3 m o o _Q O o < o Q 0 m .o o SUB-BSMT M LL BASEMENT 1ST FLOOR i 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTH FLOOR 8TH FLOOR ;tailing Company Name , �/M ,� � �� J Check ong: Certificate dress ? oL D Corporation tiC3� we- siness Telephone tom` 00JPartnership me of Licensed Plumber or Gas Fitter_ 7 �3" �9��3�G yd' Firm/Co. VSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGLCh. 142. Yes ,�% No 0 you have checked es, please indicate the type of coverage by checking the appropriate box. T liability insurance policy Other type of indemnity 0 Bond ❑ iWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 42 of the Mass. General Laws, and that my signature on this permit application waives this requirement. ignature of Owner or Owner's Agent Check one: Owner 0 Agent 0 reby certify that all of the details and information I have subml ted (or entered)In above ap lication are tr e a d ac to to the best of knowledge and that all plumbing work and installations perfor ed under the p rmlt issue for th' applic ti will in compliance with )ertinent provisions of the Massachusetts State Plumbing Code d Chapter 1 of th era] w TtI< Signature of Lice ed Plum Ciry/Town APPROVED(OFFICE USE LY) I Type of Licens Z*aster ❑Journeyman License Num er_ Z6?17 / 4N Date.................................. f HORTI� ° t"`°:•'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �SS^CNusE� This certifies that S Ti�7Z�"L `GC T has permission to perform ..........S.t ^ .5 �� r '..—.*t. ... ...............................f... ........ wiring in the building of.. �! w...... at..................zr..F 2 7. /.N.......S.T........... ,North Andover,Mass. 747 Fee..�....�7.. Lic.No.............. .!¢.............. ....:< .� .. ELECTRICAL INSPECTOR l Check # 6r '(-' Commonwealth of Massachusetts Official Use Only UpDepartment of Fire Services Permit No. 6 7 C) 3 BOARD OF FIRE PREVENTION REGULATIONS [Rev.Occupancy and Fee Checked 91051 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATI011) Date: --/j 04 City or Town of: /V, ANS O d e-- To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) �, JCA IL N �1 q�►1 Owner or Tenant ?b6.y G b Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps 1 Volts OverheadEll Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Elec ical Work: Ile Completion of thefollowing table may be waived by the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above - o.o Emergency Lighting No,of Luminaires Swimming Pool nd. El d. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat Pump I Number I Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other No.of Dryers Heating Appliances KW SecuritySystems:* No.of Water o.o _ o.o No.of Devices or Equivalent Heaters ' Data Wiring: Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors. Total HP a ecommunicationsWiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of 97tres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 7--/ 'C! 6 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEBOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjuty, that the information on this application is true and complete. FIRM NAME: --A L Ct't✓tGt LIC.NO.: 9 41_;79A Licensee: h t . Q T7491VrV ' L-t-<; Signature LIC.NO.:-311y.i'li 1 (If applicable,enter "exempt"in the license number line) Bus.Tel. S J 7. Address: Alt.Tel.No.: 1 1 *Security System Contractor License required for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)E]owner ❑owner's anent. Owner/A ent Signature Telephone No. FPEZ HT FEE: $ L/Sr -a Location 6 2 t,,&//O 157— No. 7No. Date NORTH TOWN OF NORTH ANDOVER O ' p Certificate of Occupancy $ ° ; Building/Frame Permit Fee $ Foundation Permit Fee $ ACMUs Other Permit Fee $ ZS MWEMrPonnection Fee $ Water Connection Fee- /$ TOTAL E���";i`�; Building Inspector r 5 f Div. Public Works PERMIT`NO. 13-5- APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 440. I LOT NO. 2 RECORD OF OWNERSHIP 'DATE BOOK 'PAGE — ZONE SUB DIV. LOT NO. LOCATION PURPOSE. OWNER'S NAME �t_ r NO. OF STORIES SIZE\ OWNER'S ADDRESS BASEMENT OR SLAB - ARCHITECT'S NAME i0 Li SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME �\ p �� SPAN T -- DISTANCE TO NEARESBUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY /I S BUILDING ALTERATION �� �Pr IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �,Q S' IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST O C n G PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED ANLD�APPROVED BY BUILDING INSPECTOR ✓DATE FILED 2' 1 1/ BOARD OF HEALTH SIGNATU c OF OW E OR AUTHORIZED A ENT Q(� '702�o OWNER TEL.# (o l j FEE �i ( 14�i CONTR.LIC.#Qy PLANNING BOARD PERMIT GRANTED a 7 ,9 z +t BOARD OF SELECTMEN �. AR 2 3 W2 BUILDING iN c DR I E BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/. 1/2 l/, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMMON _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) _ FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES_J_ TILE FLOOR TILE DADO t 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING COMMONWEALTH JtkRTMENT OF PUBLIC SAFETY 1010 COMMONWEALTH AVE. OF BOSTON,MASS.02215 MASSACHUSETTS I CONSTRUCTION SUPERVISOR LICENSE EXPIRATION DATE 09/30/92 RESTRICTIONS 8 EFFECTIVE DATE LIC-NO. 0 10/01/87 046118 1G 1 & 2 Family Homes ° A John T. Ryan 12 Emerson Way Salem, NH 03079 PHOTO(BLASTING OPR ONLY) FEE:$25.00 HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: THIS DOCUMENT MUST BE IGN E OF LICENSEE CARRIED ON THE PERSON OF THE HOLDER WHEN ENGAG- OTHERS-RIGHT THUMB PRINT ED IN THIS OCCUPATION. k4SVOIDNER ; t, 1 i L r� t I APR 2 31992 I r U 1 71 i ;1 ! 1f C5- 1 ii I _ � 1 �I ,x :t �r ..,E a k Location 62 4 No. `j Date L7 !. s 14ORT1t TOWN OF NORTH ANDOVER Of��.�e ��ti0o 4 p Certificate of Occupancy $ ` Building/Frame Permit Fee $ C' .-a". « ',^O•''i�' Foundation Permit Fee $ s.�CHust Other Permit Fee $ Z-S' B"O Sewer Connection Fee $ Water Connection F TOTAL Elluild-ing Inspector 5 1 3 U Div. Public Works K Ji i i 8EE /If9AT ��RFINAL FIGS NORTH --- r own of OLAndover No. 1 o q DRIVEWAY ENTRY PERMIT .�y Ern d er, Mass. 7 19 Z NA \� F? 0R< P% s "r BOARD OF HEALTH PERMIT T 1 LD 1� r THIS CERTIFIES THAT........ .. . . ...... ..��........................................... BUILDING INSPECTOR has permission to erect ... buildings o�..CAZ... ". ��4.....�T Rough .. .. ......... g , Chimney tobe occupied as...... . . . .. z........... .. .. .................. Final 4 provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR A this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. } Final VIOLATION of the Zoning or Building Regulations Voids Permit PERMIT EXPIRES 6 N T H S ELECTRICAL INSPECTOR Rough UNLESS CCN -RUCTI '00Service Final BUILDING INSPECTOR GAS INSPECTOR +k Occupanc.v Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector NO RTIi BUILDING PERMIT TOWN OF NORTH ANDOVER �? APPLICATION FOR PLAN EXAMINATION h Permit No#• oT--?- Date Received D ACHU`-+���5 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION W(1M ( N ;C"l �Z AAQ� ,-�`�� Print PROPERTY OWNER Pnn 100 Year Structure yes no MAP/G--?— PARCEL: �oil��ZONING(21!T ICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic Q Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTI N OF WORK TO BE PERFORMED: � 1 � Identification- Please Type or Print Clearly OWNER: Name:` 1 Phone: Address: vi Contractor Nameg.�" 7� of - '�' � {,� lua�� one: Address: '' Supervisor's Con ction License: Exp. Date: Home Improvement License:--- ( Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $C-2 �1 FEE: $ �.-?() Check No.: 6.4 2.G 2,i Receipt No.: 6 NOTE: Persons contractingwith e i er ntractors do not have access to the n nd Signature of Agent/Owner Signature of contractor 1 Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiimning 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 COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Sicinature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located-at 124 Main Street Fire Department signature/date COIV�IVIET.S Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ 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 a 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) - ❑ Engineering Affidavits for Engineered products 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) o Copy of Contract ❑ 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 i 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 Location No. Date • - TOWN OF NORTH ANDOVER Q TS ED 2 . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ t TOTAL $ Check#&o2-05 `� `� uilding Inspector r , V NORTH - E I� c . : ver No. lblil'.iJ5 LAKI h ver, Mass, 00f uw C COC NIC Ml WICK S U BOARD OF HEALTH Food/Kitchen PERMIT 0 LD Septic System THIS CERTIFIES THAT „ �,�.1�........... „ „ „�,r, ....... BUILDING INSPECTOR ............................... ...r. 0 ............................. Foundation has permission to erect .......................... buildings on ...�ja ........ .I YWW . S� Rough to be occupied as ........... V...l:� A.cr . g.^Lis... .................. Chimney provided that the perso accepting this permit shall in every respect conform to the terms o e 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 MONTH ELECTRICAL INSPECTOR UNLESS CONSTRUC ST S 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. Burner Street No. Smoke Det. rr 0 nexz nep Living home energy solutions This agreement Is made by and among Next Step Living, Inc.("NSL") Brian Hickey 21 Drydock Avenue,2nd floor 62 Farnum St Boston,MA 02210 North Andover, MA 01845 phone: (866)867-8729 Site ID: A293927 29-May-15 1. DESCRIPTION OF WORK TO BE PERFORMED NSL will perform or cause to be performed the following work on the customer's address above,in a professional manner and in accordance with the terms of this Contract,including the attached recommendationstwork order describing the work in detail(the"Work")which are incorporated herein by reference.Pricing reflected below may be subject to adjustments in program pricing and offerings and is guaranteed for 30 days from the date the Contract is printed. v 3S fi Work Location: Attic Flat Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 6 $85.00 Hr $510.00 T.,z.. ' r kg �t. s 1n'Yp ,'fit yr'�r+t,� �,S' o- c'� s a e-t*1 7 % # +c • Work Location: Attic Flat Whole house fan box: Thermal Barrier Polyiso 2"(Attic) 1 $209.21 Each $209.21 Damming 68 $2.05 Lnft $139.40 Propavent 2'or 4' 57 $2.00 Each $114.00 Attic Floor Open Blow Cellulose 6" 672 $1.26 sqft $846.72 Work Location: Foundation Insulate Rim Joist with 6.25" Fiberglass Batting 62 $1.75 Lnft $108.50 Work Location: Doors Door: Thermal Barrier Polyiso 2"(Attic) 1 $73.91 Each $73.91 ` _.i! . s Y #MH.r _ �t- � ," t`' ~ 100%Airsealing Incentive up to Program~Max $510.00 75 %Weatherization Incentive up to Program Max $1,118.81 '.y" 'eY ry+ K g. k'C- 4exL,t ''+a..k B}d r 'nc' ,4r fi A-,- �. u x� A y 3, 'S 'a.tf' sl£ L'� Ey Y l v n� "k� �.`T �� T�f,cg 't � S€i .ji � a °^ ..».ra:. -'.0r.> .. x ?a`�.. .XL. `ra �°::, q. .i `•, a P �'t.! Estimated Annual Energy Savings from the Above Improvements F $127.00 2. PAYMENT: CUSTOMER agrees to pay NSL for the work as follows: Payment#1: $100.00 -Credit card or check deposit is due at the time the Work is scheduled.Required payment information wiN be collected over the phone by a customer service representative at the time of scheduling. Deposit is not to exceed 113 of the total retail costs.(Note:Mastercard,Visa,and Discover accepted). Additional Payments and Final Invoice: $272.93 -Additional payments for the Work shall be due upon pletion of the Work 7 tutoL Jun 1, 2015 + aria.,Hirkgg 9n+9 Customer Signature Date Courtney Hally Jun 1, 2015 Collxr'le 29 May 2015 Andrew Carpentier C11411 NSL Signature Date Name of NSL Representative A293927 The Terms of this Agreement are contained on both sides of this page ,. Next Step Living o 21 Drydock Avenue"2nd floor o Boston,MA 02210 o(866)867-8729"inquiry@nextsteplivinginc.com"www.nextstepliving.com i TERMS OF AGREEMENT 3. PROPOSED START DATE AND COMPLETION SCHEDULE NSL will contact customer to schedule the Work at a mutually agreeable time,subject to the availability of subcontractors or materials,or to delays attributable to the weather or other events beyond NSUs control. 4. CONTRACTOR REGISTRATION Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116.617.973.8700. 5. PERMITS NSL will be responsible for obtaining any necessary permits as the Customer's agent Customers who secure their own permits or deal with an unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law. 6. PERFORMANCE OF THE WORK AND CHANGES. 6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer. 6.2 This Agreement may be supplemented,amended,or modified only by the mutual agreement of the parties.No supplement,amendment,or modification of this Agreement shall be binding unless it is in writing and signed by all parties. 6.3 At times,NSL's weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern for residents.Such concerns can include but are not limited to ventilation,potentially hazardous materials such as mold or asbestos,or structural concerns. In the case of health or safety concerns being identified,NSL reserves the right,per section 9.2 of this contract,to communicate concerns to the Customer and halt work until such concerns have been addressed. 6.4 The rebates and incentives available from the Mass Save®Home Energy Services Program and amounts due from the Customer are based on the best estimate of the situation in the structure by the NSL home energy advisor. However,at times our weatherization team discovers situations in the home during the course of the Work that impact the availability of rebates and incentives from the Mass Save Program. In such situations,NSL will communicate such changes to the Customer,including any impact on amount the Customer would be expected to pay for the Work The Customer will have the option to remove from the Contract the work elements that need adjustment,or set up a separate contract for performing the adjusted work. 6.5 NSL represents and warrants to the Customer that(a)the materials and equipment furnished under this Agreement will be of good quality and new, (b)that the Work will be free from defects,and(c)that the Work will conform with the description of the Work described in Paragraph 1. 6.6 NSL may determine in the course of pre-installation Technical Review that modifications are necessary to the scope of Work in order to ensure professional quality of the installation. In the event of such modifications,NSL will request a written modification of the Agreement to be signed by all parties.In the event that Customer and NSL cannot agree on the modification,the Agreement may be terminated by either party. 7. INSURANCE AND REGISTRATION NSL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration(No:162111)and the necessary insurance required by applicable law and normally maintained by prudent contractors in NSL's field,including,but not limited to,Workers Compensation Insurance for all employees who will perform the Work. 8. QUALITY OF WORK. NSL agrees that the Work will be performed in a good and workmanlike manner,and that NSL will repair and replace,at its own expense,and promptly upon Customer's request,any defects in workmanship and materials provided by NSL which appear up to one year after completion of the Work or within any longer period as permitted or required under applicable law,provided NSL has received final payment as provided herein. 9. PRE-EXISTING CONDITIONS&PROPERTY PROTECTION 9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions. These conditions include but are not limited to poorly fastened or broken drywall,moisture damage,non-code construction,cracked or fragile siding or shingles,old pipes and fittings,rotting wood,eta 9.2 NSL reserves the right not to perform Work upon the discovery of asbestos,mold,or any other potential health risk to the Customer. In this event,the Customer is responsible for remedying the at-risk situation,including any necessary removal of hazardous materials and all bills for services to date shall be paid immediately. Work cannot resume until remediation is complete. 9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customer's responsibility to remove or protect,including dust protection,any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property not properly protected prior to the commencement of the Work. 10. GENERAL PROVISIONS. 10.1 NSL reserves the right, the extent permitted by applicable law,to have,file or maintain a mechanic's or material men's lien,or to file a notice of intention to lien,and to take any other steps to perfect and enforce such a lien,if Customer fails to pay NSL as provided herein. 10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts. 10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this Agreement,they are not relying on any representations,warranties or terms other than as expressly contained herein. This Agreement supersedes aff prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties. 11. ENERGY BENEFITS. The Sponsoring Utility Company(the Utility)is entitled to 100%of the energy benefits associated with all Energy Conservation Measures,excluding the value of energy cost savings by the Customer,but including all rights to all associated ISO-NE Energy,Capacity and Reserves Products.NSL agrees to provide the Utility with such further documentation as the Utility may request to confirm the Ufility's ownership of such benefits and Products. 12. NOTICE CONCERNING SPONSORSHIP. 12.1 Customer understands and acknowledges that NSL is not an agent,vendor or sub-vendor of The Sponsoring Utility Company(the Utility)with respect to the installation of an energy efficiency measures.In the event of the failure of an energy conservation device to perform as expected, Customer's sole recourse is to Contractor and not to Conservation Services Group(CSG)or to the Utility.The Utility and its operating companies shall not maintain,remove or perform any work whatsoever on the energy conservation measures installed. 12.2 Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have consented for Contractor to install the proposed energy conservation measures. 12.3 Customer agrees that it shall not hold CSG,the Ublity,their affiliates or operating companies liable for Contractors to perform its obligations under this agreement,for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 13. LIMITED TIME OFFER. The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy Services Program offers. 14. CONTRACT CANCELLATION Under Massachusetts law,you may cancel this agreement N it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or a branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by fax,or by e-mail sent or by delivery,not later than midnight of the third business day following the signing of this agreement. ` Pianview Diagram Team 1 2 ustomer '>✓-:an Advisor Name: aol pec Address -L2 &r,7 00") Advisor Phone # !l 78 Town " ), Any limitations to access by truck? Site ID ' Z�1 3 TZ 7 Aa NOTES Any work scoped outside of Gest Prdwce7 Approved by: 6 )&0 r — 2 k&1}, 1- "` 16 46 yrs k1s -A, + �1 wH fr C o Vef- - (� 62.j6 L 01-1 ' iS 3 $ 5�e n ,(J The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations ' d 1 Congress Street, Suite 100 W Boston,MA 02114-2017 n, J` www.mass.govIdia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizadon/Individual): Next Step Living Address: 21 Drydock Ave City/State/Zip: Boston, MA 02210 Phone#:(866)867-8729 Are you an employer?Check the appropriate box: Type of project(required): 1.[] I am a employer with 850 4. ❑ I am a general contractor and I employees(full and/or part-rime). have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. n We are a corporation and its I O.n Electrical repairs or additions 3.® I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.Q Other _ comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that clieck this box mist attached an additional sheet showing the name of the sub-contractors and state whether or i?oi those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: A.I.M Mutual Insurance Company Policy#or Self-ins. Lic.#:AWC-400-7030025-2014A Expiration Date: 9/30/15 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage v fi tion. Ido hereby certify under thepains and pen es periiury that the information provided above is true and correct, Signature: Date: Phone#: Alo(q, -9-7 2 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License.# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: a t Ate -_ ® Ilei ® C®nsu ner A�ffaIl ( fly 1 Park Pfl a Suite 5170 -. Boston, Massachusetts 02116 Home Improvement Contract®r Registration Registration: 162111 Type: Supplement Card NEXT STEP LIVING INC. Expiration: 1/14/2017 ROGER OUELLETTE 21 ®RY®OCK AVE. 2TH FL BOSTON, MA 02210 Update address and return card.Mark reason for change. F] Address F] Renewal ❑ Employment Lost Card DPS-CA' 0 50M-04!04-G10121C p� :�I�' 1n09TL/YIIl)IA,lMIZ4L/1 fl� l(.Q:k1GC/i f4SP� Office of Consumer Affairs&Business Regulation )License or registration valid for individul use only r HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return toe Office of Consumer Affairs and Business Regulation y y 4 Registration: 162111 Type: 10 Park Plaza-Suite 5170 Expiration: 1/1412017 Supplement Card Foston,MA 02116!1 NEXT STEP LIVING iNC. ROGER OUELLETTE 21 DRYDOCK AVE.2TN FL — BOSTON,MA 02210 Undersecretary Aot`valid without signature I L. Massachusetts Department of Public Safety Board of Building Regulations and Standards Comtruction Supenisor Specialh l..rcense CSSL=102811 ROGER A®VELLETCT 55 STAIM®RE RO Wandek R% 0280 % 9 Expiration O„mijssrone, 09113§20161 Rfistl cted TO: CSSWC a linsaulation Contractor Failure to possess a current edition tithe Massachusetts State Building code is cause for revocation ou this license. For®PS Licensing iPuu®rUlriaven visit: mgc^3,VMtass-G(nv00PS NEXTS-1 OP ID:EL ,a►`oR0 CERTIFICATE OF LIABILITY INSURANCE DAT1011D/ 100/01/201144 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OV AND CONFER$ NO RIGHT4 UPON Pig PORTIFIGATF HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR A(TER THE COVERAGE AFFORDED BY THE POI.IGIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REP PSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION 14 WIWISQ,gy(?jpg# g 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 AME CT Erin Lyons McLaughlin I�1surance Agency N 828 Lynn fells Parklyay PHONE;Ell:781.665-2775 AIC Ne; 565-02RO Melrose,MA 02176 E-MAIL John E.McLaughlin Jr. ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A;Nautilus Insurance INSURED Next Step�Iving,Inc. INSURERS:Commerce Insurance Company 34754 21 Drydock Avenue,2nd Floor Boston,MA 02210 INSURERC:A.I.M.Mutual Insurance Co. INSURER 0:AXIS Insurance Company 15610 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PPR((Q�p INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T l 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. ILTR TYPE OF INSURANCE ROOL B POLICY NUMBER INMIDDY EFF MMIDDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY FACH OCCURRENCE $ 1,000,00 CLAIMS-MADE ®OCCUR €CP2010198-12 09130/2014 09/30/2015 PREMISES Ea occurrence $ 190,00 i MED EXP(Any one person) $ 4100 PERSONAL&ADV INJURY $ 11409,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 000,00 POLICY❑JEC F—]LOC PRODUCTS-COMP/OP AGG $ ?1904100 OTHER $ AUTOMOBILE LIABIIEa BIKEDac SINGLE LIMIT $ 1�00p1ao .rR1 B ANY AUTO 14MMBGKKOM 09/30/2014 09/30/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( ) HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000 00 D EXCESS LIAR CLAIMS•MADE ELL1783547012014 09/30/2014 09/30/2015 AGGREGATE $ 019011119! DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE ERH C ANFICRERIMEMBEREXCLUD D?ECUTIVE Y�NIA TO BE ISSUED BY CARRIER 09/30/2014 08/30/2015 E.L.EACH ACCIDENT $ 500,00 (Mandatory In NH) EL.DISEASE-Eli EMPLOYE $ 500100 Ifyes,desaibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) FOR INFORMATION ONLY CERTIFICATE HOLDER CANCELLATION INFO-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(20141(!9) Tho AI ARR g0pPE1 IEagIa aro rggjs„¢er w �fACORIA;