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Home My WebLink AboutBuilding Permit #424 - Suite 335 11/18/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO- .1 `� Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWPrintNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic Districtyes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition [I Two or more ❑ In stria) re famil y � Il/Alteration No. of units: Y-1!�ommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other '9"` r ' 't ` ®tFloodplam� "��` AWetlandsl �;® WatershedlDistr'ict � � - D RIPTION OF WO TO BE PERFO � D: i n O CJ C 0-n A0 ' Identification Please a or Print Clearly) OWNER: Name: /V G Phone: �P ,33� Address: (/�ID1'> S� �� 2ZC , /v�ifct'/�6?? V6 CONTRACTOR Name: �✓ /Y r' " .J�P�' i Phone: � �°70� Address: Supervisor's Construction License:63A t,op,6 je7„�DExp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER �`�� //• Ln �rc,ss�, Aill Phone: Address:Q=A--,aG Y� . /�Ll le2 Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ lJ oo FEE: $ �r /00 �Y'"' Check No.: �l�-LReceipt No.: NOTE: •.on ontracting with unregistered contractors dlo not hay to the Panty fund zS a'e VIM n a t r '` - - terx � � - Location No. Date NORT1y TOWN OF NORTH ANDOVER F Certificate of Occupancy $ Permit Fee $ /Frame Buildin s�cMust 9 Foundation Permit Fee $ i s ....- Other Permit Fee $ TOTAL Check # 2 4 82- 6 uilding Inspector Plans Stamped Plans ❑ n Submitted ❑� Plans Waived ❑ Certified Plot Plan ❑ St mp TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature r COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 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 D ter on site yes o Located at 124 Main Street Fire Department signature/date = COA/EWENTS 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.$10041000 fine NOTES and DATA-- For department use I I ® Notified for pickup - Date Doc:.Building Permit Revised 2008 y V 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 t ❑ 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 i ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ - Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) i ❑ 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 Calculationslicable If Applicable) pp ) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording !ust be submitted with the building application Doc: Doc.Building permit Revised 2008mi RightFax N2-1 11/17/2011 7:23:57 AM PAGE 3/003 Fax Server .:....,:..�_ �f.. .,,.... :,.✓:�..:a,;><.-,�,. : . . ,. >., ..� ,; r .�-�: . :rr_vs�:zv.��:'�:�;z="s�<z:��3 ISSUE DATE ."�."5 - s 11/17!2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CE 11FICATE 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),AUTHORUED 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 MAN— N"KINA UILL16 1N6 ' 85 MAIN STREET C7 PHONE FAX (A(C,No,Ext): (A/C,No): PEAOBODY,MA 01960 E-MAIL ADDRESS: PRODUCER CUSTOMER ID V. INSURED INSURER(S)AFFORDING COVERAGE NAIC ft STAR TOUCH PROPERTY SERVICES INSURER A THE TRAVELERS INDEMNITY COMPANY INC LNSURER B 515 LOWELL ST STE 3 INSURER C PEABODY,MA 01960 INSURER D ENSURER 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAAIS. INSR TYPE OF INSURANCE ADDL SUER POLICY NU BER POLICY EFF POLICY EXP LIMITS I LTR I I INSR I WVD I 1 (MM/DD/YYYY) I (NIWDDNYYY) I 1 GENERAL LIABILITY EACH OCCURRENCE S ❑COMMII2CEAL GENERAL IIABII .DAMAGETORENTED S.rCY PREMISES(Each occurrence CLAIMS MADE O OCCUR IM).EXPENSE(Arty one S sm 0 PERSONAL&ADV. S INILAIY 0 GEM ALAOOREOATE $ OENL AGGREGATE LAID'APPLIES PER: PRODUCTS-COMP/OP $ 0 POLICY O PROJECT 0 LOC AGO AUTOMOBILE LIABILITY COMBINED MNOLE S LIMIT accident 0 ANY AUTO BODILYINJURY S er Person) 0 ALL OWNED AUTOS BODILYINJURY S (PerAceidari) 0 SCHEDULED AUTOS PROPERTY DAMAGE S er accident 0 HIRED AUTOS S 0 NON-OWNEDAUTOS S 0 UMBRELLALIAB 0 OCCUR EACH OCCURRENCE S 0 EXCESS UAB 0 CIAMLS-MADE AGGREGATE S 0 DEDUCTIBLE S 0 RETENTION S S WORKERS'COMPENSATION WC A AND EMPLOYERS LIABILITY NIA STATUTORY YIN LIMITS ANY PROPRIETORIPARTNEW EXECUTIVE OFFICERIIAEbIBER Y NIA 6KUB4902P95A 10/28/11 10/28/12 F.L.EACH ACCIDENT S100,000 EXCLUDED? 04ANDATORYINNH) E.L.DISEASE—EACH 5100,000 EMPLOYEE If yes,desmbe under DESCRIPTION OF EL.DISEASE-POLICY OPERATIONS bela'A LIMIT 5100,000 UE�I:RIl'!l VlY V C vrnec++��Un��Lu�;n!lUn��vCeuLLaa i.6uam gLvw V�,gadmonm ttanmrs Jcneau�e,��more syace�s reyinrea) THUS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECMG WORIUM COMP COVERAGE NAOP LLC 415 ANDOVER ST tbMOULU ANY Oh Tht AtIOVt Ur%SL;KltftU FULIGIMS C6 GANUtLLM)t5t11OKt THE EXPIRATION DATE THEREOF,NOTICE VALL BE DELIVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE NTH THE POLICY PROVISIONS. AMORUM RFPRESFMATM .',��3: lft2, k a YZI'N'�X>J;iJ➢.K�,.: ^�^ ,y�x qy :: ./+r>—�� y yj �j� r,{.'k.;' Architects LaGrasse & Associates, Inc. Joseph D.LaGrasse,ALA `= Architects, Engineers & Land Planners Thomas E Galvin,AIA Julianna E.Hoch,RA CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: 2161—Suite 335 PROJECT LOCATION: 451 Andover Street,North Andover,MA NAME OF BUILDING:North Andover Office Park SCOPE OF PROJECT:Interior office remodeling for Unit 335, Suite 335 In accordance with the Massachusetts State Building Code Amendment Section 107.6 "Construction Control under IBC 2009 Section 7"submittal documents". I, Joseph D.LaGrasse,AIA MA.Reg.# 4153 being a registered professional engineer/architect hereby certify that I have prepared or directly supervised the preparation of all design Tans,computations as specifications concerning: concernin P P P g Entire Project X Architectural Structural Mechanical Fire Protection Electrical Other For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 107.6.2.2: 1. Review of shop drawings, samples, and other submittals of the contractor as required by the construction contract documents as submitted for buildingpermit,and approval for conformance to the design n p pp g concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix 1. Pursuant to Section 107.6 as stated above,I shall submit periodically,a progress report together with pertinent comments to the Building Inspector. Upon completion of the work,I shall submit a final report as to the satisfactory completion and readiness of the project for occupancy. D qRc Joseph D.LaGrasse,AIA \y� D.Le MA 6,11111 � No.4153 ca ANDOVER L-aSignature of Architect Date One Elm Square MA h T 978.470.3675 1420 Celebration Blvd. Andover,MA 01810q( PSSP F 978.470.3670 Celebration,FL 34747 file:2161 -335 OF M AA26001333 F:Hconstruction control affidavit. www.lagrassearchitects.com AN The Commonwealth of Massachusetts Department oflndustrialAccidents ► l Office of Investigations '•l�':.ti 600 Washington Street UM. Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Prinf Le0bly Name (Business/Organization/Individual): G k J /�� t - 1 AIC Address: ( G2 f Ci /State/Zi : f/ �O Phone#: T V61 / ty P T Are ou an employer?Check the appropriate box: Type of project(required): 1.9I am a employer with 4. ❑ I am a general contractor and I 6. ❑new construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. # � Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9_ ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its I0.❑Electrical repairs or additions required.] officers have exercised their 3.F1 I am homeowner doingall work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp, c. 152,§1(4),and we have no 12.❑Roof repairs insurance d.re re uiemployees.[No workers' required.]� 13.❑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 check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. J /� Insurance Company Name: ��.✓�12+/S J?Oyl'IYI/� Y1 Policy#or Self-ins.Lie.#:� (! Expiration Date: c2L -2 Job Site Address: J 7'?(�C�l�C r S City/State/Zip: r Ayt 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 fonn 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 maybe forwarded to the Office of Investigations of the DIA for insurance*coverage verification. I do hereby certify under n nd penalties ofpesjury that the information provided above is true and colrect., Si ature• 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#: 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 fill out the workers'compensationaffidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)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 cavy 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 confinnation 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 pennit/lieense number which will be used as a reference number. In addition,an applicant that must submit multipl&,pernit/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 pen-nit 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 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 tali. The Department's address,telephone and fax number: The Commonwealth of Massachusetts 1]epartrnmt of Industrial A.oeidents Office of Tnvestiptions 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia RightFax N2-1 11/17/2011 7:23:57 AM PAGE 3/003 Fax Server I r��s ISSUE DATE MY 61ux 3 11/17/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CER'rITCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,KXrhND OR ALTERTHE COVERAGE AF-FORDED 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(les)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 ileu of such endorsement(s). PRODUCER CONTACT NAME: NABICiNA UILL1J JNJ .- . 85 MAIN STREET C7 PHONNE FAX (AIC,No,Ext): (AlC,No): PEAOBODY,MA 01960 E-MAIL ADDRESS: PRODUCER CUSTOMER ID V. INSURED INSURER(S)AFFORDING COVERAGE MAIC# STAR TOUCH PROPERTY SERVICES INSURER A THE TRAVELERS INDEMNITY COMPANY INC INSURER B 515 LOWELL ST STE 3 INSURER C PEABODY,MA 01960 INSURER D INSURER E I 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUNR POLICY NUMBER POLICY EFF POLICY EXP LIMITS I LTR 1 I INSR I WVD I I (MM(DD/YYYY) I MUWD_DNYYY) I I GENERAL LIABILITY EACH OCCURRENCE S ❑COMMERCIAL OENFIZAL,LIABILITY .DAMAGETORENTED S P12IIvfI51iS lEad? occurrence ❑ CLAIMS MADE ❑ OCCUR bene EXPENSE(Arty one 4 on 0 PERSONAL&ADV. S INIVAY 0 OENTAALAOGREOATE S GEHL AGGREGATE LAeHI'APPLIES PER: PRODUCTS-COMPIOP S 0 POLICY 0PROJECT 0 IAC AGO AUTOMOBILE LIABILITY COMBINED SINGLE S LIMIT (Each acciderd 0 ANY AUTO BODILYINJURY S (Per Person O ALL OWNED AUTOS BODILYINJURY i (Per AcciderL) 0 SCHEDULED AUTOS PROPERTY DAMAGE S (Per accident 0 HIRED AUTOS S 0 NON-OWNEDAUTOS S 0 0 UMBRELLA LIAB 0 OCCUR EACH OCCURRENCE S 0 EXCESS LAB 0 CLAIMS-MADE AGGREGATE S 0 DEDUCTIBLE S 0 RETfN loN S S WORKERS'COWEPENSATION WC A AND EMPLOYERS LIABILITY N/A STATUTORY YIN LIMITS ANY PROPRIETOR/PARTNERI EXECUINEOFFTCEM"FMBER Y N/A 6KUB49021`95A 10/28/11 10/28/12 LEACH ACCIDENT 5100,000 EXCLUDED9 (MANDATORY IN NH) LDISEASE—EACH 5100,000 EMPLOYEE If yes,desmbe ander DESCRIPTION OF .L.DISEASE-POLICY OPERATIONS below it 00,000 UA�I:t(li"/IVCI VF VYHKA'11VI�J/LVl:Al1Vf�J/YEt11�:LCJ 1xum A�v/cu r�r,auaudirer ecemmrs�aw_ane,umore space/s reginrea) THIS REPLACES ANY PRIOR CERTEFTCATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORE3M COMP COVERAGE NAOP LLC 415 ANDOVER ST SMUULU ANY OF i HE ABOVE DESCRIBED FriLIGiES BE GAWFLLED SEFUM: THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RTPRESOTATTVE $Y----- . GiNIi ......� �Y'..�♦.�' �� I1.�A „,..�.Y 3"-T..Y�_? Y.,J..5..1..w�jfJfX9)513.<_ __:s.%c:`:Z`��'k:J'>':�J Y, --- ._�?.:< :2 #��.f!.Yq 9 3�.._ ..'.....: ��.1.� )> .� I•��l�ii'� "u"u TM. CERTIFICATE OF LIABILITY INSURANCE ii�osi2o» PRODUCER Phone: 413-781-7475 Fax (413)781-0050 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE CENTER SPECIAL RISKS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 20 GOLD STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O BOX 1250 ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL=. AGAWAM MA 01001 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Essex Insurance Company STAR TOUCH PROPERTY SERVICES INC INSURER B: 515 LOWELL STREET,STE 3 INSURER C: P-EABODY MA 01960 -- ------ INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL POLICY EFFECTIVE POLICY EXPIRATION LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE MID DATE MMID OMITS GENERAL LIABILITY 3DJ2231 10/19/11 10/19/12 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50 000 PREMISES(Ea ocwmnce) CLAIMS MADE❑X OCCUR MED.EXP(Any one person) $ 1,000 A X SPAR A-1—tihlw PERSONAL&ADV INJURY $ 1.800,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 1,000,000 X POLICY Eo- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE g (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LLABIL17Y EACH OCCURRENCE $ OCCUR L J CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND VAC STATU- TORY TATLL OTHER EMPLOYERS'LIABILITY TORY LIMITS ANY PROPRIETORIPARTNERIEXECUTNE F L FAP-N ARRIFFidT W OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yea,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER: CERTIFICATE HOLDER CANCELLATION NAOP,LLC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS 451 ANDOVER STREET WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO NORTH ANDOVER,MA 01845 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE f Attention: av d T. Iona l/�-� A;- Nlassachusctts- Dcpartnx•nt of Public Safct. Board of Building„ Re,,aulations and Standards VTMV Construction Supervisor License License: CS 104350 r LISA GOMES 40 HIGHLAND ST PEABODY, MA 01960 A-1 ��- Expiration: 911/2013 ( nnmi.�i,nci Tr,": 104350