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Home My WebLink AboutBuilding Permit #170-2016 - 4 High Street Suite 206 5/1/2018 I I Ad NORTH BUILDING PERMIT ., o�,t,.Eo ,bg1'G TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION_..: Permit No#: / f Date Received ,''. 1 ��SSACHUS��S Date Issued: IMPORTANT:Applicant must complete all items on this`page (( M asp N i T Y - LOCATION 4' -i{_ S3 r U i ic_.. _. 2,06 PROPERTY OWNER- :�-�' • , A , Print _ t,3sSC �-- ,� Print 100 Year Structure yes no MAP -�-- PARCEL: ZONING DISTRICT: Historic District (:ED no Machine Shop Village es no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial 9 Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: o'ac eel-- ki Identification- Please Type or Print Clearly OWNER: Name: ,Dowl,o .Phone: Address: Lilo-f 11) 01 thy rt k 44 .c_ - Contractor Name: s,v 4 Kv— Phone: -7 - Z '- -4-4-F Address: L t GtrL N, 0�� 1 Ill Supervisor's Construction License: Exp. Date Z 6 t Home Improvement License: Exp. Date,: ARCHITECT/ENGINEER `�Phone.. c 92 ( y Address: �S - u g-,. GU,� 0 L�c� ".Re No 1) C FEE SCHEDULE:BULDING PERMIT:$12.00 PER$10p0.f0 OF THE TOTAL ESTIMATED'COST'BASED ON$125.00 PER S.F. Total Project Cost: $ 2J �— FEE: ReceiN t"No:r 7 Check No.: r NOTE: Persons contracting with unregistered contractors.do>not:hav 'access to the guaranty fund Signature of Agent/Qwn r Signature-ofcontractorj' E i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swinnning Pools ❑ Tanning/Massage/Body Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY y INTERDEPARTMENTAL SIGN OFF - U FORM i i PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: zoning Decision/receipt submitted yes f y Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& 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 Departr�nent signature/date", COMMENTS 49' Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: jELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No i MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i i _ l I ❑ Notified for pickup Call Email Date Time Contact Name 3 Doc.Building Permit Revised 2014 r.. 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 ❑ 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 NATE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan Li Workers Comp Affidavit I ❑ 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 1 ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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 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 i I Doe:Building Permit Revised 2014 a Location / /7 /G No. X1/6 Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee '�2 �, i ,. Foundation Permit Fee $ e Other Permit Fee $ ra TOTALl Check#�2) 7 2 ` 1 7 2 Building Inspector NO,rh O p 1 'jJ, •O4im •M4g SS.'CHUS CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 170-2016 on 8/6/2015 Date: September 23, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED at 4 High Street— Suite 206 —Boston Indemnity MAY BE OCCUPIED AS IN a tenant fit up ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG NA West Mills LLC 4 High Street North Andover, MA 01845 Building Inspector Fee: PrePaid $100.00 Receipt: 29172 Check : 224 NORTH Q own of E �� . Andover O : 0 In No. ver, Mass, G 4" coc"Ic„ew,cK.�1' 11 2 S tl BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System //�� / BUILDING INSPECTOR �.J.. THIS CERTIFIES THAT ....... .. . ...f..� :.... ..E:S. ..�,�C.45............�..X..t,�....................... Foundation has permission to erect .......................... buildings on ....� ..... ........ ...... .................................... / Rough to be occupied as ....J.��G`lhl ..l...... v �......... .,�j?1di .......... 4�1., ..t1�/.Y. k::lC.1/.�d.�f Chimney d provided that the person accepting this permit shall in every respect conform to the terms of the application Final �v 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. MBIr INSPECT R VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Cl Final k44"I 041 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough)O A�S-1,04 . 1 s ..........,. 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 StreetNo. Smoke Det. � , r- , � y � �, � ��3a �E zS �� .9az_ � � F NORT11 o � E n over Towno 10 h , ver, Mass, 6 cocHicHew.cw � �d AOOATED I'P�,`�� S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System a THIS CERTIFIES THAT ....... &-...�.?:.. :.... ..E:,��✓�..��!,��:.4 ............�..X..4.�/........................ BUILDING INSPECTOR / has permission to erect .......................... buildings on ....Gf...,l.... .... Foundation _ / �. to be occupied as ....l..�` !`.' .. .. e�fz r-40." � s'f. :. ijn4nlyif�� Chimne p ...... %............ ............................. 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 ZA Construction of Buildings in the Town of North Andover. MBI IlsPPEC R I� VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final4,t4l, PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT10 ARTS Rough d� �Z, • C a .................... Service ............. ...... ... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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 ; StreetNo. Smoke Det. caves .�z— NORTH Town of o - No. R. h , ver, Mass, // 4 o L.HE 1. COCHICHl WICH V S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......If..�. ....� E.s...,f/� °4 �, ,,,t/....................... BUILDING INSPECTOR y.�1� /. Foundation has permission to erect .............-.. .. buildings on ... / z7 -1 ..... ................................... ...... .... .... . .... ,� / � Rough to be occupied as .J �' T' v�' '� � ��'"' ��y may, ....! ........... .............. ............... ..................................¢.s` �. :.�.,�N :!!.1/.�f:� 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS 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. JK Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 Proposal Date: 6/30/2015 Proposal#: 157 Project: Bill To: David Steinbergh, Suite 206,4 High St,Boston Indemnity N.Andover, MA 01845 Description Est. Hours/Qty. Rate Total Plans and Permits 1,100.00 1,100.00 Demo, Carpet removal and disposal, demo and dispose 2,500.00 2,500.00 of ductwork Wall Framing, Includes hallway demising walls to 5,500.00 5,500.00 space. Doors&Trim,[Includes glass in all office doors and 6,000.00 6,000.00 conference room,glass in transoms Window treatment 150.00 150.00 Plumbing 4,500.00 4,500.00 Heating &Cooling 17,800.00 17,800.00 Electrical[No lighting fixtures] Rough Estimate. 3,500.00 3,500.00 tel/data 3,000.00 3,000.00 Insulation 2,000.00 2,000.00 Board/tape, compound, make paint ready, interior. 7,500.00 7,500.00 Cabinets &Vanities[estimate] 3,000.00 3,000.00 Floor Coverings 10,932.32 10,932.32 Includes piping, no ductwork 5,000.00 5,000.00 Clean and Seal exterior brick,2 coats 1,000.00 1,000.00 Final Clean 500.00 500.00 Sprinkler Work, Change out old heads to new,etc 900.00 900.00 General Conditions 3,000.00 3,000.00 Supervision 8,247.23 8,247.23 Specialties, Barn door in conference room 1,696.25 1,696.25 Thank you for the opportunity to bid this work. Total $87,825.80 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 1406002.33 PROJECT TITLE: 4 High Street Floor 2 Suite 206 Boston Indemnity PROJECT LOCATION: 4 High Street, Floor 2, North Andover NAME OF BUILDING: West Mill NATURE OF PROJECT:_Tenant Fit-Out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I,,.Ljnda S. Smiley REGISTRATION NO. 10080 BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL STRUCTURAL ❑ MECHANICAL ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. 1 FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar with6the progress and quality of the work and to determine, in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 118.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR, UPON COMPLETION OF THE WORK,I SHALT.SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. 1 TURE; 7h'� jt1D AND SWORN TO BEFORE ME-THIS �DAY OF yg� PUBLtC MY COMMISSION EXPIRES 6 i� V The Commonwealth of Massachusetts r . Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,AM 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):�r K– �rN^� A-e�/�^'e, u_ C_ Address:']%a,S `� t� �ri t db -1 1 t YdBdC fit' S City/State/Zip:_ p J (.I xv - Phone '7- -6 -� Are von a employer?Check the appropriate box: Type of project(required): 1.6 I am a employer with employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition IF]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box##1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: t �L r9 v0i Policy#or Self-ins.Lie.#: �f —3 1S'Gl a 6 q 15 0 1 J , Expiration Date: G rt �, 1" ''\J - Ci /State/Zi H11044 Job Site Address: t3' P� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby cert'y under the pains and penalties of perjury that the information provided above . true and correct Signature: Date: Phone# 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#: V Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." ' An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fillout the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and•printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations.has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will 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 under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts J Department of Industrial Accidents / 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia 1 .4co CERTIFICATE OF LIABILITY INSURANCE °"'�(' �°°'m"' 3215 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 CERTIRCATE HOLDER. IMPORTANT: If the certificate hdder is an ADDITIONAL INSURED,the pollcy(ies) must Si endorsed. N 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 endormne PRODUCER WNT T Maria Dupont Insurance Agency, Inc. PHONE 16 Copeland Street 17 376-0795 . (617) 479-9121 Quincy, MA 02169 145 me@dupontinsuranosaaency.com INSUPE S AFFORDING COVERAGE NAIC A INSURMA:Main Street America INSURED INSURERS: JR Contracting, LLC INWRERC: 31 Richmond Street INSURERD: Weymouth, MA 02188 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 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 CONCITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POUCY N IABERPW Ipp YyyY Lar1T5 A GENERALLIABILRY MPT7794M 2/10/15 2/10/16 EACH OCCURRENCE $ 11000,000 X CCMMERCLALGENERALLMILITY DANAGE TO RENTED $ 500,000 CLAIMSWADE OCCUR MED EXP Onyore person) $ 10,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2 000 OO GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-ODMP/OPAGG s 2.000,000 POLICY 71 P LOC $ AUTOMOBILE LIABILITY a accident S ANYAUTO BODILY INJURY(Per person) $ ALLOWHEDULED AUTOS NED AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS —AUTOS�ED PeraEadDAMAGERrY S $ UMBRELiJ1L1/IB OCCUR EACH OCCURRENCE $ EKCESSLIAB CLAIMS-MACE AGGREGATE $ DED RETENTION WORKERS COWENSATKIN WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/NT. ANY PROPRIEIOR/PARTNER/EXECUTNE E.L.EACH ACO CE Nr OFFICE WMEMBER EXCLUDED? NIA E.L.DI EA LOYEE fAardalory in NH) Hyyeess IPTIOe under E.L.DISEASE-POUCY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCITKINS/VEMCLES(Mach ACORD 101,AdMional Rameb Sd adrda,Nmon apaea lancIdmd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 04 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATAIE Bridget McGowan 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: apedranti@crowninshield.com 'Y3/2015 7:22:03 AM PST (GMT-8) FROM: 100005-TO: 1`6174799121 Page: 2 of 2 co CERTIFICATE OF LIABILITY INSURANCE F 3WO15 THIS CERTIFICATE (S 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 IMSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: K the eertificob bolder is an ADDITIONAL.INSURED,the policy(tes)must be endorsed. if SUBROGATION IS WANED,subjed to theta.. and conditions of**poky,eertsln policies may require an endorsement. A Statement on this oeRifkats does not confer rights to the certificate holder in lieu of such endorserns s. PRODUCER DUPONT INSURANCE AGENCY INC 18 COPELAND ST PHONE QUINCY,MA 02169 AI;PDRDINO COWIHiA6E Uwe MUMMA: Libift Mutual Fire Insurance 23035 e K CONTRACTING LLC 31 RICHMOND STREET INSUREaC WEYMOUTH MA 02188 D: INSURERE: COVERAGES CERTIFICATE NUMBER: 2367M2 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. IIN R TYPE OF l NICE E Leare COMMERCIAL GENERAL LIABLBY EACH OCCURRENCE S CLAa494AADE 7 OCCURMimi MED EXP Wj me ram S PERSONAL 6 ADV INJURY S GE'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE S POLICY❑JE7 LOC PRODUCTS-COMP/OPAGG OTHER $ AurOM08RE LrbLrrY S ANY AUrO BODILY INJURY(Per person) S ALL OVAUTOSVAEO n'MLED BCDILY INJURY(Per aadftm S HIRED AUTOS AUTOS S $ IaaHRBJALIAB OCCUR EACH OCCURRENCE S EXCESS 1JAB CLAMM MADE AGGREGATE A woRREr+e COMPENSATION WC2-31 1 S"15 2M 7 15 7/2016 Bow',ow',am'LIABLITY ANY PROPRIETORIPARniERiEXECVTNE YIN E.L.EACH ACCIDENT s 100000 DFFICETt/MMEMNREXCUIDEDE a NIA -- wandlimy M me E.L.DISEASE-EA EMPLOYS 100000 M daeerbe under AIPTION OF OPERATIONS bokm E.L.DISEASE POLICY LIMIT S 500000 DIBCRrT=OFOPMTNMILDUTMWIVENNIM(ACORD IOI,Adita [N ce de,reap a aeeeMd Kroom aPaae le req�tred) Workers compensation insurance ODversDe implies only to ft workers compensation laws d the stab of MA. This certificate cancels and supersedes all previously Issued certificates,only as they relate to workers compensdon coverage. l f CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AWE DESCRIBED POLICIES BE CANCELLED BEFORE THE M(PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. � i4"°""` .• /MTi}IOIIBOFD I�I�NTATNE �� Uberly Mutual Flre Inwmnce ®19M-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are reglatered marks of ACORD CERT 110.: 29677622 CLIENT 0008: 1644469 Lucy Canfield 9/9/2019 10:19:07 AK (ESS) .page 1 of 1 lassactusetts -Department cf Pub!'—Safety Regulations and Standards Re I Board of Building g ��,,r ('on%truction Super Licensc CS4663 KUZRpN'T WHEIAN � 31 RICHMOND STQIV , WZYMOM MA �� • =xpiraticn c .�1 0912612015 J�rnmissioner 1 I