HomeMy WebLinkAboutMiscellaneous - 910 SALEM STREET 4/30/2018i
Date... ...............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... ....�e 0�
has permission to pe ........
......................................
wiring in the building of.....
at
.......................... ,North Andover, Mass.
...............................................................................
FeeLic. No. I.,,< ... ....................................................................................
r,7 ELECTRICAL INSPECTOR
Check ,4
13 3 6 7
L
Official Use Only
Commonwealth of Massachusetts
Permit No
Department of Fire Services
Occupancy and Fee Checked
-�' BOARD OF FIRE PREVENTION REGULATIONS: [Rev. 1/07](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 IN INK OR TYPE ALL I,TVFORMATION) Date: 5/4/15
City or Town of: NORTH ANDOVER 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) 910 Salem Street
Owner or Tenant Paula lannazzi Telephone No. (978) 689-2410
Owner's Address 910 Salem Street, North Andover MA 01845
Is this permit in conjunction with a building permit? Yes W No ❑ (Check Appropriate Box)
Purpose of Building Residential Utility Authorization No.
Existing Service Amps 1 Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd U No. of Meters
Location and Nature of Proposed Electrical Work: Install Roof Mounted 9.6 K-W/AC Solar Electric PV
e- SGrv,Cc
2
Comnletion of the fnllowinu table may he ivnivod by tho h9J?rtnr nfWiroc
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.
No. of Luminaires
Swimming Pool Above -
rnd. rnd. F,
No. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection an
Initiating Devices
No, of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers
Heat Pump
Number
Tons
KW
....
o. ofSelf-Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating .KW
Local ❑ Municipal El other
Connection
No. of Dryers
Heating Appliances K`,l,
Security Systems:*
No. of Devices or Equivalent
No. of Water K
W
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of .Motors Total HP
Telecommunications Wiring:
No. of Devices or Eg uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $55,908.00 (When required by municipal policy.)
Work to Start: TBl? 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 [I BOND El OTHER ❑ (Specify:) 010 `'1, `
I certify, under the pains and penalties of perjury, that the information on this application is true and comple t n ,�
FIRM NAME: FirstMark Advantage, LLC DLIC. NO.:
Licensee: FirstMark Advantage, LLC Signature LIC. NO.:
(If applicable, enter "exempt" in the license number line) Bus. Tel. No.:
Address: PO Box 297 New Boston NH 03070 Alt. Tel. No.:
*Per M.G.L c. 147,, s. 57-b1, security work requires Department of Public Safety "S" License: Lic. 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 Elowner'sagent.
owne PERWT FEE: $
ve
ftta� T�Ie��N�.
M
T he commonweatm of massacnuseus
Department of IndustrialAccidents
Office .of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/iiia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
First Mark Advantage, LLC
Name (Business/Organization/Individual):
Address: PO Box 297
New Boston NH 03070
Phone 4: 603-714-0440
Are you an employer? Check the appropriate box:
. ❑ I am a employer with 5 4. ❑ I am a general contractor and I
employees .(full and/or part-time).*
2. ❑ 1 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ 1 am a homeowner doing all work
myself. [No workers' comp.
insurance. required.] +
have hired the sub -contractors
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance
5. ❑ We are a corporation and its
officers have exercised their
right of exemption. per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required,]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑Electrical repairs or additions
11.❑ Plumbing .repairs or additions
12.❑ Roof repairs.
13.e❑ Other Solar _PV Installation
*Any applicant that checks box '1 must also fill out the section below showing their workers' compensation policy information.:
Homeo%viiers who submit this'affidavit indicating they are doing all work and then lure outside contractors must submit a new affidavit indicating such..
+Contractors that check this box must attached an additional sheet shoNNing the name of the subcontractors and state whether or not those entities have
employees.. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am: an employer that is providing worriers' compensation insurance for my employees .Below is the policy and job site
information:
Insurance Company Name: Paychex Insurance Agency Inc. r Hartford Fire Insurance Co..
Policy # or Self -ins. Lic. #:
76 WEG GH0421
Expiration Date: 9/6/.2015
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 DI.A for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
one #: 6037 1 40440
Official use only.. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
f
Issuing Authority (circle .one):
1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
l
Contact Person: Phone #:
ACORO® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
5/8/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT Cheryl Oja
Infantine InsurancePHONE
(603) 669-0704 FVC No:
E-MAIL
ADDRESS: coj a@infantine.com
P. O. Box 5125
INSURERS AFFORDING COVERAGE NAIC #
1,000,000
EACH OCCURRENCE $ACLAIMS-MADE
INSURERA:Continental Western Ins. Co. 10804
Manchester NH 03108
INSURED
INSURERB:Union Insurance Co. 25844
INSURER C Acadia Insurance Co. 31325
GENERAL AGGREGATE $ 2,000,000
INSURERD:
FirstMark Advantage LLC
INSURER E:
PO BOX 297
1 INSURER F: i
New Boston NH 03070
COVERAGES CERTIFICATE NUMBER:15-16 Master REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR
TYPE OF INSURANCE
ADDOL
B VDR
POLICY NUMBER
POLICY EFF
MM/DD EXP
LIMITS
TMERCIAL GENERAL LIABILITY
a OCCUR
X
BOA515235211
4/23/2015
4/23/2016
1,000,000
EACH OCCURRENCE $ACLAIMS-MADE
DAMAGE TO RENTED 50,000
PREMISES Ea occurrence $
MED EXP (Anyone person) $ 5,000
PERSONAL &ADV INJURY $ 1,600,000
GENT AGGREGATE LIMIT APPLIES PER:
X. POLICYF PRO-
JECT F-1 LOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS -COMP/OPAGG $ 2,000,000
_ $
B
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALL SCHED
AUTOS AUTOSULED
HIRED AUTOS X NON -OWNED
AUTOS
X
CAA518349711
4/23/2015
4/23/2016
COMBINED SINGLE LIMIT
Ea accident $ 1,000,000
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
Non -owned $
C
X
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS -MADE
CUA518394511
4/23/2015
9/23/2015
EACH OCCURRENCE $ 2,000,000
AGGREGATE $ 2,000 000
DED I I RETENTION$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANV PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
PER OTH-
STATUTE I I ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYE $
E.L. DISEASE - POLICY LIMIT 1 $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Various work throughout the policy term. It is agreed and understood that SunEdison Inc is included as
additional insured on General Liability and Automobile when required by written contract.
SunEdison, Inc.
,600 Clipper Dr
Belmont, CA 94002
ACORD 25 (2014101)
1NS025 /9014011
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
les Hamlin/COA
U 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
BOA F OF
E;LIrCTR;I E l A,N"S -
I SSU.E'S THE F(3LL0W I.NG L t"CENSE
t
„
AS R,E"G ".J"OURN EYkAN, .ELECTRICLAN.,,"',
A4
�
�CEVN P SOUCYv
1,25A.OUD COACH
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DENNIS COLWELL ARCHITECTS,' INC.
Commercial Residential Struc#ural
58 Burt Sfr'eet Norton iA 02766
www.dc-arciiitect.com
May 26, 2015
Project Information:
lannazi Residence
910 Salem Street, North Andover, MA 01845
Client:
First Mark Advantage
PO Box 297, New Boston, NH 03070
To Whom it May Concern:
This is to confirm that Dennis Colwell Architects, Inc. has completed structural design - including: review, and
certification of location arrangement, and mounting for roof panels of this project as shown on First Mark
Advantage's. drawings PV -1.0, PV-2.0,PV-3.0 and PV -5.0. We hereby certify that all elements, arrangements, and
structural systems shown on the design documents do conform to the following code load requirements:
1. Design in accordance to 8th Edition of the Commonwealth of Massachusetts State One & Two Family
Building Code R301, R802 & all applicable sections.
2. Max spacing of the L -Foot is 4'-0"
3. Exposure category is exposure C
4. Wind loads with respect to 100 mph wind velocity
5. Snow loads as equivalent to 50psf ground snow load
6. Dead load of the added elements 4 psf max..
7. Dead load of the existing roof 15 psf max.
8. Allowable stresses in the existing framing are all within acceptable values including as applicable:
a. Rafters
b. Roof trusses
c. Hurricane clips, toe nailing, nail plates and other connections
The PV panels are to be mounted to the roof using the Solar Mount system and connections as manufactured by
UNIRAC, and following the procedures specified in the UNIRAC Solar Mount Code -Compliant Installation Manual
227.3 and First Mark Advantage's drawings. The drawings locate the proposed panels and all connection points to
the roof framing. These have been reviewed and certified by Dennis Colwell Architects, Inc. and are included with
this submission. The proposed system to be added to the roof includes the following:
1. Sun Edison 270W photovoltaic panels
2. Top mounting clamps, grounding clips, and logs for connecting the panels to the rails.
3. Aluminum extrusion Solar Mount rails and splices with #10 x3/4" self -drilling screws.
4. Stainless 3/8" x3/4" long to fasten the rails to the L -foot.
5. Alum. serrated 3x2x2" wide L -Foot with a stainless 5/16 x 4" lag screw sealed and driven into the center of
the rafter through a 8xl 24.032" aluminum , flashing which is sealed to the roofing with roof cement. We herby
certify that the existing roof structure and framing elements of the subject residential dwelling will support the
proposed photovoltaic system in conformance with accepted industry practice and in conformance with governing
construction codes. , . 1 a e i ,
Please feel free to contact us with any fu
rt c��u�a�pOSWF'T
Sincer 1,
4
Dennis M. Colwell, Jr, RA 4,11
NCARB 70895 Serving MA RI CT NH
1-2122 11.508-455-4466 info@dc-architect.com
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TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
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STRUMUFAI&MOM&ORI)MOUSB AONB.ORTWOSAMILYI)WLLLING
BUILDING PERMH
NUNMER DATE ISSUED40., � ; 1126
SIGNATURE:
Bu1�
nen of Bitiidin Date
SECTION 1 -SITE_
RMATION
1.1 Property Mdr
1:2 As sets Map endTaroel Number:
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MepNumber Pared Number
1.3 Zoning lyd'on:
1.4 PropatyDimensions:
Zooinp,Dittrid 2
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Lot Area Frena $.
1.6 BUIIDINC SE
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SECTION 2 -PROP
OWNE'RSMIAUTHORIZED AGENT
2.1 Owner of Record
Name (Print)
Address for. Service
Signature
Telephone
,j
2:2 Owner 040
Name Print
Address for Servim-
Signature
Tel hone
STICTION 3 - CONST
UCTION SERVICES
3.1 . odCunstntctio
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NotAppficnble C
'sor:
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Licensed Cantruetian SU
License Number
P
Address
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Sknamt&
Telephone.
3.2 Registered Home bV
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Workers Ca cation lnsurrum affidavit mast be coinpkted end submotted vritb.this nppkstiou. Failure to provide this affidavit wilt result
in iha daniai the ssuanes of tion bw'ldia •
No:...:.55Deign
tion ofPro "•sed Woik(checkon
P*:=1wrYBJJg-
0
ExistingBuilding )( Repair(s) 0 Alterations(s)0
0
Demolition 0 Other 0 SP%*
Brief Descii "onofProposetl Worlc
SECTION
Item
- I STiitiIAT13D CONSTRUMONGOSTS
Estimated Cost (Dollar) to be
Completed by tIicsnt
t v,
t
I. Buil• i
000
(a) Building Permit Fee
Maw
2 Electri
(b) Estimated Total Cost of
construction
3 Pjumb'
Building Pwnit fee (r) a.(e)
�G1i0A
+2+3+4.5
CheckNumber 33a
JAC
OW RAUMORMTI0N TO BE COMPLETED WHIN
GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as 0-mer/Authorized Agog of subject property
Hereby auth orim—Lamigzd.t to and on
191 iCllai%i n all matters relative to wrk authorized by this builft peYItut applicati
0'
o ture'o Owner Da
sSGfION
oWNEItLAUTHORIZEDAGENTDECLARATION
I
proPelly
Hamby dee,
and belief
I �-
L C,1 a✓ as Owner/Authorized Agent of subject
am that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
L
ct 7
P .. Name I!
i fust em Date.
140. OF STORIES Sim
AA—SEMEW
OR SLAB
SIZE OF
R TBviBERS I Z 3
SPAN •
MIENSIOINS
OF SJLLS
DRE,NSI
OF POSTS
t311 81
OF GIRDERS .
HEIGHT OF FOUNDATION THICKNESS
SIZE OF F
TING X
MA
OF CHRvIkTEY
IS IiU1LI9
G ON SOLID OR FILLED LAND
IS BU1LD
G CONNECTED TO NATURAL OAS LINE
North Andover Building Department
Tel
DEBRIS DISPOSAL FORM
5
In accordance with the provision of MGL c 40 S 54, a condition of Builc ing Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defind by MGL
c11,S150A.
The debris will be
of in:
1� ✓ do-rey M
(Location of Facile
r
NOTE: Demolition permit from the Town of North Andover must be ob ained for
this project through the Office of the Building Inspector
4 Keg. plE 9f 1 L 1701 arnbert %2 ii�(i N
k UL UCS 078130 - $
ngle-ply UL # 1711 Gcoring " o y
n.aP 7. 932 �O.
265 Winter Street, Haverhill, MA 01830 MEMBER
We are: ✓ Licensed ✓ Insured ✓ Factory Trained ✓ Factory Certified Installers
Date: Estimate for �• l ev'
Telephone 1: 1�a "f v� ? Telephone 2:
Address: I I � ��" City/Town: A lldlyw ' State:._ %A
Job location: City/Town: State.-
A.C.
tate:A.C. agrees to commence described work on / or about . and described work will be completed in about working days. L.R.C. shall not be held liable
K delays due to circumstances beyond our control. L.R.C. shall not be liable for any damage to landscape, attics and/or fixtures due to circumstances beyond our control. L.R.C. can
at and will not be held liable for any damage to the surface that the disposal container is placed on. L.R.C. shall not be held liable for pre-existing conditions including but not
mited to mold and/or wood rot, defective, faulty, rotted or worn building counterparts such as but not limited to siding, gutters, masonry, plumbing, and windows that jeopardize
to watertight integrity of the building and are not covered under the roofing warranty.
he following work includes all labor and materials needed to complete your job in a professional workmanship Hike manner.
teep slope Quick -quote proposal to furnish and install the following. Approximate roof areay -� 7'
Drew Roof ❑ Re -roof ❑ Gutter ❑ Repair C3�Ven dation ❑ Re -sheathing of roof deck using 1U plywood.
e re for re -roofing by ensuring all safety measures are taken in accordance to OSHA standard regulations and landscape is properly protected.
Remove existing layers of roof material down to roof deck and inspect wood. If upon inspection we discover any rotted wood replacement will be performed at
$ 3 ` er SE If wood is sound we will re -nail any loose wood to rafters, sweep deck and prepare for installation. ( J
146118" Drip edge ❑ Install 5" Drip Edge ❑ Install Hug edge (Re -roofs only) /4/1 a G Color %Kt (1
r
"pply ice & watetshield (UNDERLAYMENT) as per manufacturers specifications and or % ]
Apply�# felt paper (UNDERLAYMENT) to the balance of the exposed wood deck.
3' Reflash all stack pipes, tie-ins, chimneys and/or any roof penetrations as required and dictated by good roof practice to ensure water tightness.
;,!e- eal chimney base using cement & fabric. ❑ Re -Lead & point chimney ❑ Re -build chimney $ N f► ,�
Install
anew _ Year @/Traditional ❑ Architectural style shingle roof system Color DU4 / 6/1
Manf.
2/Furnish and Install a new shingle over style ridge vent system ❑ Soffit vent system $ /
J"A'JI debris generated by Lambert Roofing Co., Inc. will be cleaned up and disposed of from the job site in a legal fashion. Under no circumstances will the watertight
integrity of the building be compromised.
Special Notes:
Warranty options: Standard LRC ❑ #2J %! Manufacturers Upgrade
UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF TEN YEARS HONORED AND ISSUED BY THE LAMBERT
ROOFING COMPANY AND YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER.
This document can serve as a contract, however if a more elaborate contract is desired we w if issue R at the owners request
Please sign and return one copy upon acceptance. MOTE: if this contract is not accepted in 6 days it may be withdrawn by LRC
NOTE: We accept major credit cards* & financing is available! *Due to merchant related costs there Al be a 2.3% service charge.
A finance charge of 13% ,,pperr month (18% per year) will he charged on post due accounts over 30 days.
S- 0d0 i 0,0 Date of Acceptance %/ ' 2- T s�
Total Estimate Price: $
J �
Payment ro be mode as follows �% 0YI OL* I G I % (Home/Business owner)
nature
(LRC)
Signature
Haverhill MA 978 374-9224 • Lawrence MA 978-687-7339 • Atkinson NH 603-362-9500 • 1 -888 -SOS -ROOF (767-7663) - fax: 978 521-5791
"Our Proof is on Your Roof"
www.lamberfroofinq.net
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RODUCER
BOYLE INS AGENCY INC
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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
445 MAIN STREET
COMPANY
WOBURN MA 01801
A NAUTI'LIUS INSURANCE CO
SURED
COMPANY
LAMBERT ROOFING CO
B COMMERCE INSURANCE COMPANY
COMPANY
T G L R C INC D/B/A
265 WINTER ST
C
COMPANY
HAVERHILL MA 01830
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE 'LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
TubraATED, NOTWITFISTANDIN-ANY-REQi7IRLIGIt-ft -. -I RM OR COND JON-OF ANY-OONTRAGT; OR-OTHER=-DOCUMENT WITK.:RESt'ECT TQ 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.
R TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDD/YY)
POLICY. EXPIRATION
DATE (MMMD/YY)
LIMITS
GENERAL LIABILITY
] C3 7 4 9 5 7
10/12/05
10/12/06
GENERAL AGGREGATE s2 0 0 0 0 0 0
X COMMERCIAL GENERAL LIABILITY
PRODUCTS - COMP/OP AGO $1,000,000
CLAIMS MADE FX OCCUR
PERSONAL 6 ADV INJURY $1,000,000
OWNER'S 6 CONTRACTOR'S PILOT
EACH OCCURRENCE $1,000, 000
FIRE DAMAGE (Arty one firs) $1,000, 000
MED EXP (Any one parson) i 5 000
AUTOMOBILE LIABILITY
ZT 6 915
7/16[05
ANY AUTO
COMBINED MN OLE.UMIT;
(er pe INJURY
=
5'00 000
ALL OWNED AUTOS
X SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
BODILY INJURY
(Par s.widant) 11, 000, 00-0
PROPERTY DAMAGE s 500,000
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY: #:
ANY AUTO
EACH ACCIDENT s
AGGREGATE $
EXCESS LIABILITY
EACH OCCURRENCE s
AGGREGATE s
UMBRELLA FORM
;
OTHER THAN UMBRELLA FORM.
WORKERS COMPENSATION AND
I TORY LIMIT ER
EMPLOYERS' LIABILITY
EL EACH ACCIDENT
EL PISEASE-POLICY LIMIT
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL
EL DISEASE-EA EMPLOYEE $
OTHER
CRIPTION OF OPERAITOMMOCATIONSNEMCLESISPECULL ITEMS
WORK COMP CERTIFICATE WILL BESENTFROM A.I.M.' MUTUAL INS PER WC BUREAU
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAR
1. V DAYS WRITTEN It NOTIC 'TE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL'$UCH OTIC IMP E NO OBLIGATION OR LIABILITY'
OF ANY KIND UJQ NTS OR REPRESENTATIVES.
AU1tiHORIIED REPR A
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CERTIFICATE OF INrSU�tA.NCE09/012/2005
ISSUE DATE (MM/DD/YY)
THISy CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
PRODUCER
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
Boyle Insurance Agency Inc
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
06
P O Box 606
Woburn, 01801
INSURED
T G L R C Inc
COMPANY A.I.M. Mutual Insurance Co
A
dba Lambert Roofing Co.
LE'P'ER
37 Stevens Street
Haverhill, MA 01830
COVERAGES' �M
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 RESPECTTO WHICH TIRS
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
DATE(MM/DD/YY)
POLICY EXPIRATIO
DATE(MM/DD/YY)
LIMITS .
L
GENERAL LIABILITY
GENERAL AGGREGATE
$
PRODUCTS-COMP/OP AGO.
$
COMMERCIAL GENERAL LIABILITY
PERSONAL & ADV. INJURY
$
A�CLAIMS MADEE�CCUR
EACH OCCURRENCE
$
OWNER'S & CONTRACTOR'S PROT.
FIRE DAMAGE (Any one Rte)
S
MED. EXPENSE (Any one person)
S
AUTOMOBILE LIABILITY
COMBINED SINGLE
S
ANY AUTO
LIMIT
BODILY INJURY
$
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person))
BODILY INJURY
$
HIRED AUTOS
NON -OWNED AUTOS
(Per wcident)
PROPERTY DAMAGE
$
ARAGE LIABILITY
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
MBRELLA FORM
+i ,. x 7
7777-
THER THAN UMBRELLA FORM
ORKER'S COMPENSATION AND
MIPLOYERSI LIABILITY
TUMRY
X
500,000
6009966012005 08/28/2005.
08/28/2006
EL EACH ACCIDENT
$
EL DISEASE—POLICY LIMIT
$ 500,000
A
HE PROPRIETOR/ INCL
ARTNERS/BXECUTIVE
FFICERS ARE: EXCL
EL DISEASE—EACH EMPLOYEE
$ 500 000
OTMR
DESCRIPTION OF OPERATIONS!LOCATIONS/VEMCIRS/SPECIAL ITEMS
CERTIFICATE. HOLDER`
" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
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EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 15 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.
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