Loading...
HomeMy WebLinkAboutBuilding Permit # 8/20/2015 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �� �.r' ,a. Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page r r rr rrr ,,�� ...... ,LOCATION � r // / f rr rr ri rr r / :r/ r. /✓r/ / c.,. /r,,,,,<i r „/ /„// rii/. r //ii ./r r /r r rr / r >i ,G, rr r /�// / ..Int, / r, /ta /oi/ ,.... „ G�li ,// //� ,,. .;z„/ / ,;, rr r r r ri/ „V� D/,r r / r// //r�,j r,//,lii%D%.!r, ,r,r/�%r%%�r�,.%�rri /,PROPERT/Y OWNER �'I/ ,MAP NO ' /r, �„ /PARCEL.:, r 'i ZONING DISTRICT r;��/ , r %//�Historic'Disfnct rr ' yes no r, ine h0 Uillag y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial eration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other CJI ❑ Septic. -0 Well '11'Floodplain ,'' ❑Wetlands ❑ Watershed District r d Waiee/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: i Phone: 7 `68 7- Address: ox PLCoa,� . r Phon CONTRACTOR,Name e: Address: r r "d, a Supervisor's Construction License' /��' � %' �' '� p r �/ Ex Date �/ r/ r '<�/ //��rr,..r / 7r %r //Q/i/r✓.. //ii if J,, rJ, %l// rr/ r:: rr ,+r ,, ,” Homie Improvement License ;�' ;;' ' xp Date p�/ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ ' Check No.: Receipt No.: ,..` NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund AW g_ g _ l Signature of A ent/Owner nature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F oORTH Town of t E :_ 1� , Andover ® - 10 ® 92,1l y / Yl o - LAE h ver, ass, o` COCNICHTWICK AERATED S U BOARD OF HEALTH Food/Kitchen ERMIT T LU Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ...........c................................................................................................................. �5`fro Foundation has permission to erect .......................... buildings on �/ .......................................................... Rough g to be occupied as �' �� fps � , : .... y ............. .... .. .....:.�f'.. .L .............. . ............................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONTARTS Rough Service ................. o. .�._ ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy BuildinZ 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. b��t'`r� �ci1�tI i iE r" L't,, Its(t�T lL Trgn n, knncuormsa�Ssa�baTie I 1 rrltG�fTQrt�Gng 3d`•1mn^1_,'0'0 �`at°Pm�L-n �4vrrcacaGo£dteszvte's33 LL iwcha�!!&Consuctolil— _rG � ludvie: amelvemeatC�tactarlssY t C��ofCansltater uraetoHomelmn_o e'er]'-AnYpersaa t '142A?5nfdn tsatd13a3ilZ' ateaE»bcf�eac�gto PTt;hame etltssitauId =sdnada;z �'�ttic"hlai$Caaslm2u �S'sIItM aar xMpiovetn fire, laui Irfonn2622Ir iliaeat617-973 3 yor1 0m�abt ttafr� a� �"t3 coPYbylling the Psi 3757 arca OE c:rb�t� cwtAddre,�3(donottt,,p / wrt Omr:san addles) ������ (��r Sr Cit!itona �Contr�tarlSalsadOlvtBr g ° Cadc 3�._ ��1d3e Da,timeihoa: I'Gincts�ddrQ(Qt�tncud -�` il , f/l�fit v 1 E =a .$) 9?g �97 �,Pltaae Mailing?-ad.�c(rtdilrer�tE / Statc tdare) �P Cedc Busirr�Phaae _ TL__ (U:sr-iEe in de•' `�'a o8�e£alla-' y sldleemt.tornnaitegr.erriorzttn i J �ZJr_ d,sP�.ifiiagtite�ty�ta-,•atsan`tIFiII2G: /SJ 'u'-�.r+•:.:ultGtional:.1 roti irncr-�.V Y , i.> r D�3L end will, eultmi-by the Uoringn It7d:n `Dr/ e��52'�+ocL„J— C�Ci�CIA`astbebaa tszrr , 3 pOsedStir) -. v��..,.� Rates < �-�' -�' sande GJ S/- l :SCz_Ceti<i� � �'ni;'i'r3t?€? E V,-t a t hesdlrx,ZdtatID3�S °,zn�3DRSize`7Z1e-T�tglali a``' 3eY_? fib_ Isdiiaa hyandtheCant °slag=^.hedide nmi Zt3c. _�vCrji2CtaE`s ypniN�aIls< I1alc whao coaizac n; i :sz1oeg contracted ttvtl To-iCaat� ?_ TlaCoattztctora d�Y��2Bsi�¢;e -`-"'-•`--13ata�•uencoaaac;edttvri:an2lbe�o,.�.n�i *'-^iaP�,"ort:hcvrort,;it_^iti�%ttEte Y�apleicd, POR I6aIs V.i11 b3.ntcd3nCCa�,:ta �edzioOdlebDrsa:;.inedabovef-• gtotaeloL•nvnn c o„he(nvlM000f S.c elate: ) --'�'�--.� by / -_ `=w:adsl3oftuei�it2-cct�ica ar c S------ ora° `'n en�PIeraa aF �hDe"t af4?--n?°'tierit�Eiaic6evw•is�trr) nPoo camnletioa of ' apnn toinmefaETle-age:tra�1�claar o: PaCoolalelmtafiIec�� 717(te"farhids de-1nd ng� 3�ard � .aenft$rcanacanr �j speciet oniayiscoale°Ctobo i ptieu �a -;Action) 1"3 Ine(uding all grar or Mir, rtLa (a) r r� ac?=aatam 111kna.c�requtuo-irtae yd Ps.a�rdtbo)r,t�it.eaa_ ai.' o=-Il.=eaclryct:oeta' Lxnr.•_.:li_r..;'[v_saoc^rc.-^ "tamPl: aaRnc3clC mlaF�psP lcaaiPm ta:ca:tom6eeum'nv $aJ^ '—� rat=rnyb arademztha( tini+n-t>!3 �t ?�3��n17C0tI4 Ct_rte Canita ad V .�rCU^LO t::Gbr? `a or*Jdlj-;d Q� 6CSnIelJ;wb r.�a^z L?i:n��:r3dr71 materiJsatdteiaroad�thisacc�°n .^a o �nlaForgnint:tion ienre ?ctiri,a�_ aanE r T'uccanoritadt�arr� ry oFheat>d oedFc m satE_.rtCScrntnevaLaa) c,atract.ea!laarmplY� cns(pin,,thisdowmtoaib bdsalcIs.' F�stbl �tLe cza;saf�, n Stfl}•GsEar si. s'lien or c =eomM a (s2aall�tLcou�actor,:� mmgtldscoaErn oKers�"Fin sbeW49 <r t t ca )IF Ianili gid` Unlmol- envi:znote3 zri t w d atosiz; ence 1?en�,y-el(t t ,- tltisdncaneZt!be I�.,,_ faLm.sngcautioasand3orca v t�p1.L tisbac3attacl- atimeto tht cone�rtorl:rs subceagnctors to be. a Vatto r�ome' mtandls�und t ragrsv-radanbi,t5i z€-'WMd'AlhtheIlsr s atCon m.p a dit Fsl.gt ionsif Lestitt cn r anSLeUleIIire�orsrI 2o❑afi:Sc-'�2rc;acnr-e=vl;,•a.,r::.ir�mct:e ua�rn.l�tef��iav_b-$iac� ao;>o:tnPlIractefiknMn vr �Ly Co t�,at,canti°it tnS�'eita3170, yc-% goQ50l021IybursynL�nt�II Ssnuacl cantra ct or.s„ ad 26utc�7g3 Lots �9I797377iwento ?el : 1mIDaorS3C3T57•r^ d orfas pvc rt It on Govanars;to2there ..gid@Ditlllg I'n„"1, a Ca r• :7l5 ''%-xl'u7tlflt n� c.ndc2i8 CapS,OftIlC n tr<car to s;Tting a h'hem�-me, - Consumer tlliz% (hire bus' ue-a once �arssnu ulE,:stis'3,feilotiiagLes a"`',eac-as%c,:h 0+�tbrccntrG:tat's _ itt rz � 'af �° wt a aLca c ¢6 bYizlc -at or ---.I dA',o,no i:L; L:_ C a' T,vt awa�nrz" ij' u4�ttl rz ,r-� the natio a<'r-._acelL. all 3d iva;;no:ia ^dirm Wclb_w uni i a z �171�sono€th n `ntof he _ � JI..•. �� �V�[,.0?fit ;toms aat utc ��` Date ' v ` Con.raeto-Arc�#ation Tire Home Improvement Contractor Law provides homeormers t ritlr the na6t to mate an arbitration action(e an alternative to court.action)ifthey have a dispute withs contractor. teehe/s ahs sth a homeona rr in cion eunless contractor_however- The contractor would have to resolve any drip both parties agree to the optional clause provided below.`_his clause would ave the contractor the same ri&L to arbitration as is afforded to the homed n-erby the_Tome Improvement Cone actorLaly The contractor and the homeowner herabyuptually agree m advance that in the event the contractor has a dispute concerning this aoni.the eonrinctar-attay submit the dispute to aprivate arbiirati°n firm which has been approve]by the Secretary of the F.stecutt�*z eeo��onsumer Artaus an¢Busu[e;s Re,�at3on andthe consumer shall be requ to submit to sucli.aiortralon as pYoid`cled In Iyfassachusets General Lavr_- ch ter I y?A Contractor's Signature Homeovnces Signature t,�Tis y:i he signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor_The homeowner may initiate alternative dispute resolution even where this section is not,separately signed by the par ties_ Horaeownees Righs A homeolmers rights under the Home Improvement Contractor Law(MGL chanter 142A)and other consumer pe_ protection lavts(i. TWGI.chapter 93A)may not be wai ved in any-way.even by agreement Hovever,homeovners perly registered as-prescribed by law. ma;be excladedRom.certalarial[ts iftli. contractor areaut maticalb%eaose is xcluded r1'om all Guaranty Fund pro visions of Hoer emNmeM who secure their ovn building p ' the dome linprovement Contractor Law: The contractor is responsible for completing the U:orlc as described,in a timely and v:o;lm[anlilce manner_ Homeovmers may be entitled to other specific legal rights if the conri actor guarantees or provides an&.\-press iwarraaty for tivor'.•cmansbip or materials. h addition to guKantees or warranties providzdby the contraetor_all goods sold inn iYIasachusetts amTy an implied lvasanty of merchantability andze m fitnessbe r a particular purpose. An enumeration of othermatters on-which the homeowner and contractor lacvfullj agr ay be to the term of the contract as long s they do not resuict a horneovners basic consumer rights. If you have questions about your consumedhomeovherriehts,contact the Consumer Information hotline(listed belo-t). fvsecL'VGa of Contract The contract must be executed in duolicate and should notbe signed until a copy of all exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or mar zed as YoicL deleted,or not applicable. One original sired copy of the contract Evith a`tachments is to be given to the owner and the othe-I kept oy the cont*actar Any modification to the original contractmust be in oV y Of and ag<zed to by both parties.Contracted worlcmay not begin until both parties have received a airily exeeuted copy of the contract,and the three day rescission period has expired zeeele?¢ted?av z e?es A contractor may not demand paymen&s in advance of the dates specified on the paymentschedule in eyes where the honeoiimer deems biminerselfio be financially insecure. However,in instances ;:here a contractor deems himhorself ttocbefinanciallynsecnrrrequire -!hecontradevo�VTthdrawal4 fnidsfomsaidaeat the balance of finids noty-et due be eount ouldrequirethe asapra gtrsiacontna simatures of bor-�parties. ndtlitionzl information If you have general questions or need additnonal inforanatioa about the home Improvement Contractor Law oe other consumer riQ13,s or if you swish to obtain a fee copy of"Al-Massachusetts G[ide to Dome Improvmen�' contact: Consurner Inforsnadonllo`r+irne Oar ce of Consumer A fairs and Business Regulation 10 Darla.Plaza,Room.5170,Boston,Iva&02116 617-973-8 V.888?S3 3757 orvisittile oCr-BRv.absit$at hrtn:llvn:nlr.-B ao./ocabrl If you v:a,[tto ve[i y tI;e reastation of a contracttororifyou have questions or need additional information 3pec[fically about the contractor registration compop'eut of the Home Improvement ContractorLa3,contaci L`irector of Home frnprGv,_ ent Coritraotor Regis tion Of lice of Consumer A-fairs and Business Regulation 10 Tark-A za,Room 5170,Boston,IL-4-02116 617-973-007007,08$?i 33757 or visit fire PITC i1rebsite at httn:fh;n.nv mass aovlosaUr; Go online to view the status of a dome;L-npro+ement Contractoes Registration:- httr,:IldU.statema.usthomennnrovementllicznseelistasn Por assistance vAth informal mediatior>of disputes or to regster formal complaints against a business,call: Consumer Complaint Section Office of the Attor toy General 617_7?7-S?00 . ANDIOR Better Business Bureau 5.9-652-4800,508-755-254. t.$-o'$2=i800,70u-735?$".or 4!33-73 Ji i't Ycrian2.1-I[!�73G[a f:ALI n7m � �, 0 t7 Qualified Lamm- 1 Oft-Lite NERC Bringing gaaGty ro(tghr. VINYL DOUBLE HUNG NatlorelFenestratlon IMPERIAL LS rint;nyrrvinpllO Double Glazing.Argon Eill.Low E.Grids su.-.a-zg-ont6z-0000z ENERGY PERFORMANCE RATINGS U-Factor (U.S./I-P) Solar Heat Gain Coef icient 0., 28 Om 25 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Condensation Resistance e OAS hlarnufacturer stipulates that these railings conform to applicable NFRC procedures For fieirrm��i:.q •��,le prpduCt performance. NFRC raitinns are determined for a fl.<ed Pr at <., `- _,iddions and a soedfic prod7ct size. NFK dere not rezamme!!d any prwl-rCt a:;u Joes not warrant the suitability or any product for any;periric Iea.Consult manu`a_turer's literature fo,other product performance information. wnM1•r.nfrc.o 1318555.060 r Tire 0Qa�rrazonwealal of Ry-a s"ei'l,133 V�5 e � �eprrl� zef ofta +rrsiliafrcc� eFzts 1 corgi ess st'leg,.bra#e _100 `q -30st0i!,1WA- 021174-2017 '"T yItiwl�v.17tass gov/dirr �+`arkers'Cornpe;isa� on ttsura)ice Affidavit:Buildersleo3 AIt Iicantlnforfnation traetors/Eiesi tscians/P[a�mijer TO BE FILED WI T 13 THE°EMNIT T ING A dJT TORI—1y. s !Name(Business/o ganization/Individual): Atko$Ec fes•,t p - + please Print Letribly t, Address: ! R Cit}r/Stale/Zip: Phone#: i w Arc 1.0o art employer?Chech the appropriate box: 1.®1 am a employer nth�mployees(full and/or part-time).* Type of project:(requiladditions 2.®I am a sole proprietor or partnership and have no employees%vorking for,ne in 7. 0 New constructio any capacity.[No,,workers'comp.insurance required-] �• [�Remodeling 3.01 am a homeowner doing all work myself.[No workers`comp.iruurance required.]fi 9• ❑Demolition f.®I am a homeownerand%till be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 1 I.0 Electrical repairs 5.E]I am a general contmctorand 1 have hired the sub-contractors listed on the attached sheet. 12. Plumbing p These sub-contractors have employees and have workers'comp.insurances: airs 13-❑Roo•repairs6.17 we are a corporation and its officers have exercised their right of exemption per MGL c. 153;§I(4),and we have no employees.[ito workers`comp.insurance 2quired] I�' Outer J � 'Any applicant that checks box [must also felt out the section below shoug their worker'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing 211 work and then hire outside contractors mustsubmit a newaffidavit indicating such. �Cmttractors that check this box must attached an additional sheetshowing the name of the sub-contractors and state whetheror notthose entities employees. If the sub-contractors have employees,they must provide their workers'comp,polihavecy number. 1 af)t an ei)tptojrer tltQt is JJFOVIfJ!)Ig 7VOF/ferS'COI)lj7et)SQ11p)Z I))S)SFQ)tCefOr i)ip e3tlplO�teeS. Belot*is firepolice Qndjob sife i)tforivalio)). Insurance Company Name_ u.r c Policy-t or Self-ins.Lie. : "X123 X70 (A Expiration Date: Job Site Address: . t�o �, S -— S/ /n Attach a copy. 17 / City/State/Zip: Al, r h� of the svorAers'cosanpensatton policy declarat[oan page(showing the policy,lumber and exlalrae.o air ate). Failure to secure coverage as required under fVIGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do I)erebn Cortin, ,rc[ Lu JJ ICG^_a.. , ll Ire))zfor)nation provided above is true and correct Phone T: _7 ,� , Date: [fJ'70111yDo.Do not sprite it,tlris area,to be co)))plefed bjr citJr or folpn off)cial. Permit/License r{circle one):h 2.Building Department 3.Ci' / 'own�'rY terk a.;✓lec>Clea! ns€recto€ lumbitlg €lspecto;+ Phone#• ACCOREP CERTIFICATE LIABILITY DATE(MWDDNYYY) 3/3/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME CT Construction Eastern Insurance Group LLC PHONE (800)333-7234 e: 233 West Central St E-MAIL .ADDRESS: INSURER($)AFFORDING COVERAGE NAIC# Natick MA 01760 INSURERA:iiirbella Protection Ins. Co. 41360 INSURED INSURERB.NaUtll.uS Insurance Co Atlantic Weat herization INSURER C: 61 Rear Jefferson Avenue INSURER D: INSURER E: Salem MA 01970 1 SURERF: COVERAGES CERTIFICATE NUMBERMASTER 2015 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR LTR TYPE OF INSURANCE INRR WVQ POLICY NUMBERMOM/LIIpYEFF POLIC EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY _F)_A1M__dE O RENTED PREMISES Eaoccu encs $ 50,000 A CLAIMS MADE a OCCUR 8500042816 /20/2015 /20/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 POLICY ]{ PRO- LOC g AUTOMOBILE LIABILITY Ea COMBINED I dEDtSSINGLE LIMIT s 11000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS ED SCHEDULED 020015871 /20/2015 /20/2016 BODILY INJURY(Per acddent) $ X HIRED AUTOS $ NON-OWNED PROPERTY DAMAGE AUTOS Peraccident S PIP-basic S X UMBRELLA X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIARB CLAIMS-MADE -1:1AGGREGATE $ 1,000,000 DED RETENTIONS 4600058654 /20/2015 /20/2016 S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORYLIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S B POLLUTION LIABILITY CPL200378613 0/1/2014 0/1/2015 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE John Koegel/PMA ACORD 26(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS02517n1nmmnl Tha Antimn name anti Innn era ranictarari mancc of Or:npn Rightfax N2-1 3/10/2015 10: 11 :37 AM PAGE !/V1J • �� -- DATE ® 03-10-2015 AC CERTIFICATE OF LIABILITY INSURANCE IHIH0E CERTIFICATE S CR. TIHISACERTIFIC ISSUED AS A DOES NOTTER OF AFF AFFIRMATIVELY ORN0 LY NEGATIVENLY ®CAME[dDSE?CTENNO [D OR ALTERGHTS UPON TIITHE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING BY POLICIES AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. must be NISiAlVEDl IM PORI to the terms and eondit ons of the policy,certain erate holder is an ainAL 1pol ciiesDmay requirelan)endorsement endorsed. statement aOn this certificate does subject not confer rights to the certificate holder in Lieu of such endorsement(s). CONTACT F233 DUCER NAME: FAX STERN INS GROUP LLC PHONE AtC No AfC No E ><i W CENTRAL STREET E-MAIL TICK,MA 01760 INSURERS)AFFORDING COVE RAGE NAIC N INSURER A:AMERICAN ZURICH INSURANCE COMPANY INSURER 8 INSURED ATLANTIC WEATHERIZATION LLC INSURER C 61 REAR JEFFERSON AVE INSURER 0: SALEM,MA 01970 INSURER E INSURER F: E O E COV S E T . 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 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE CONTRACT OR OTHER DO INSURANCE AFFORDED C THE POTTIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUB POLICY EFF POLICY EXP LIMBS POLICY NUMBER (MMIDOIYYYY ME INSR TYPE OF INSURANCE INSR WV EACH 01YYYY LTR EACH OCCURRENCE S GENERAL LIABILITY DAMAGE TO RENTED S COMMERCIAL GENERAL LIABILITY p E o uue CLAIMS-MADE OCCUR MED EXP(Any oneperson) S PERSONAL 8 ADV INJURY S GENERALAGGREGATE S PRODUCTS-COMPIOPAGG S GENL AGGREGATE LIMIT APPLIES PER: $ - PRO POLICY JECT LOC OMBINEO SRJGLE lJM1T $ AUTOMOBILE LIABILITY a acadent BODILY INJURY(Per pe(son) $ ANY AUTO S ALL OWNED SCHEOULED BODILY INJURY(Per accdenl) AUTOS ppgR�Y AMAGE S AUTOS NON-OWNED �� HIRED AUTOS gUTOS $ EACH OCCURRENCE S UMBRELLALIAS OCCUR AGGREGATE $ EXCESS LIAB CLAIMS-MADE S DED RETENTION$ X WGSTATU• DTH_ WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYERS'LIABILITY500,000 ANY pROPR1ET0%PARTNERIEXECUTIV YM E.L.EACH ACCIDENT OFFICERMIEMBER EXCLUDED? N A 6ZZUB 03-20.2015 03-20-2016 E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory in NH) 5B270121 II yes, describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space to required) CERT C E HOLDER C L O TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 1600 OSGOOD 5T CANCELLED BEFORE THE EXPIRATION DATE THEREOF, N. 0 OSGOOD S 01845 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POL[CY PROVISIONS. AUTHOR2ED REPRESENTATIVE ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Deoartrnan��"'n. sa"Stny' Inv Board&BuHrHng RegU1GJH10T1S ilii� License: CS-087977 ERIC W PALM 3 11ILTON ST Salem MA 01!Y70F 0412312016 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For OPS Licensing information visit- www.Mass.Gov/DPS ..Office of Consumer Affairs&Business Regulation M ME IMPROVEMENT CONTRACTOR gistration: 142089 Type: xp!Tation: , 3/12/2016 Ltd Liability CorpD*, ATLANTIC WEATHERIZATION L.L.C. ERIC PALM 61R JEFFERSON AVE SALEM,MA 01970 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 park plaza-Suite 5170 Boston,MA 02116 Not valid without signature