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71 OCEAN AVE - BUILDING INSPECTION The Commonwealth of Massacb V D Department of Public Sl�fie� EC ;EFVICES Massachusetts State Building Code(780 CMR) uj Building Permit Application for any Building other th jQtK-joAAvcRan;rlPawelling (This Section For Official Use Only) I I I `,. Building Permit Number: -^ Date Applied:, Building Official: -19q 4A 1 i _ _ - SECTION 1:LOCATION V ` txe 1 n City 1Vo.and Street /Town Zip Code Name of Buildingfi applicable) Assessors Map# Block#and/or Lot # 5 U t,-1 1 " '. SECTION 2:PROPOSED WORK V Edition of MA State Code used_ If New Construction check here ❑or check all that apply in the two rows below Existing Building Repair Ef I Alteration Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 2) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA . - -- Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ I-3❑ I_4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage Sl❑ S-2❑ U: Utility❑ 1 Special Use❑and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) t: IA O IB a HA O IIB O IHA O IHB ❑ IV ❑ 1 VA D VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) - - ! Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY - 1, Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner - K; e j I( UCW-K) Name(Print) 1iNo.and Street City/Town Zip Property Owner Contact Information: 7gy� T ti le Telephone No.(business) Telephone No. (cell) mail address If applicable,the roperty owner hereby authorizes: !! II I Name t Street Address City/Town State Zip to apply for and act on the property owners behalf,in all matters relative to work authorized by this building 't application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/cr not under Construction Control then check here O. Otherwise provide construction control forms see section 107 in the code as required. - 10.1 Registered Professional Responsible for Construction Control(the professional coordinatin do cument submittals) 1ptkrvGN !)fD Joy u l07 4-y- W6 DUOS &F, Coil Mao71 Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name TT ,e kl- Name of Person�onsible for Construction License No. and Type if Applicable 377 Lowell sT eu. fie/W /0# o/jL&� Street Address � n City/Towne State Zip Fi' Telephone No. (business) Tele hone No. cell e-mail address ",4 SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C(6) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes CI No 13 - SECTION 12:CONSTRUCTION COSTS AND PERMIT FEES Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to T? (-) 6.Total Cost $ (� (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT �. By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate tp4e best of my knowledge and understanding. Q S. an 6/7 _ Ti_ 90 r6 /o 45 Please print and sign name pp /�� �Tiittlle G �7 Telephone No.. Date 377 /Dwell �T G J4zP7`7P/C� i �r I0 U Street Address City/Town State Zip '� Email Address Municipal Inspector to fill out this section upon application approval: = - M ` r,- Is. .'. ., Name Date Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas Natural,Propane,Medical or other 10 Surveyed Site Plan(Utilities,Wetland,etc. 11 S ecifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Surve /Investi ation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other S ec' 21 Other S 22 Other S `Areas of Design or Construction for which plans are not complete at the time of application submittal most be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zi Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zi Discipline ExprationDate Please follow this link for construction control forms to be used by Registered Design Professionals. Appendix 2 (For total demolition only) For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location No. and Street City /Town Zip Name of Building (if applicable) Assessors Map # Block#and/or Lot# For the above described property the following action was taken: Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application to Construct,Repair,Renovate or Demolish a Building Other than a One-or Two-Family Dwelling Requirements for Building Permits Permit requirements are specified in Chapter 1 of the MA State Building Code. Applicants should review the requirements to avoid common problems. The standard form below incorporates the code requirements and is provided for use by municipalities to achieve permit consistency across the State. Municipalities may use a variant of this form but it must contain at least the same information. Please contact the municipality where the work will be done for the proper form or follow the instructions below if this standard form is acceptable. Filing Instructions • Complete the application. The application is available in Word or PDF format so check to see what is acceptable to the local building official. • Include construction documents, specifications, and other materials required. • Check if the local municipality requires confirmation that property taxes, water fees, etc. are not outstanding. • Also, check if the local building official requires construction control forms (see section 107 in the building code) with this application. • Submit the application package with a check made payable to the municipality for the fee as determined by the municipality. Marcia Kirkpatrick From: witchcitytara@verizon.net Sent: Tuesday, October 20, 2015 3:59 PM To: Marcia Kirkpatrick Subject: Re: 71 Ocean Ave Kirkpatrick K rk Dear Ms � p This email is to confirm that all of the association owners at 71 Ocean Ave are aware of the roof replacement(entire roof) .Thank you for your kind assistance. Please let me know if you require any further information. Sincerely, Tara Kiley,Manager, 71 Ocean Ave Association Sent on the new Sprint Network. ------ Original message------ From : Date: Tue, Oct 20,2015 7:27 AM To: �vitchcitytara(Pvverizou.net; Subject:Re: roofing project Hi Tara Just saw this...and I already left for the day. I don't get home until very late on Tuesdays. Can we mail the check? Thanks Katie On 10/19/15, Tara Kiley<witchuMara(aliverizon.net>wrote: Hi All, Ryan and Sons Roofing will be here tomorrow(10/20) to replace the roof. The tiles/materials have been delivered and are stored along the wall/fence. Please remove cars between 7:30-8:00 am as there will be a dumpster placed in the driveway to collect debris. This is anticipated to be completed in one day. Katie, could you please leave me a check for the balance. Julie, I've sent a text to Bryan. Thanks, Tara 1 Mailing Address/Maln Office: 377 Lowell Street, Wakefield,MA 01880 Tel: 781-245-4900 81-245-4999 MB 6YAN,.� Fax: nAndSonRoo T fa www.PeterRyaMndSonRoofing.com and 0 ROOFING, Inc. Submitted to: lob Location: Tara Kiley -71 Ocean Avenue 71 Ocean Avenue Salem.MA 01910 Salem, MA 01970 Pheneit 978-210-7947 Emil: witchcitytara@verizon.net Proposal dam: August 27,2015 Reufaeddate: October 1,2015 We are pleased to hereby submit this argonaut t0 furnish materials and labor,completely In accordance with the below Specglcations: (Additional charges may apply far any change's not included below in proposal either by request of owner,or if Peter Ryan and Son Roofingfinds unforeseen circumstances that will affect the performance,quality or integrity of this job).In the event legal action is taken to enforce any provision of this agreement, the prevailing party shall be entitled to all its reasonable costs, including reasonable in-house or outside attorney's fees. Not responsible for debris in attic. i3ad? h 11 Strip main roof to bare wood and re-shingle: • Strip existing shingles down to bare wood • Check for rotted wood and replace(at time&material) • Nail down any loose wood • Install ice&water shield to first 6-feet,and in all valleys and around any protrusions Moira • Install premium synthetic underlayment(in place ofstandard 301b.felt paper) BBB. • Install all new 8"white drip edge on perimeter and step flashing,where needed • Install manufacturer suggested starter course of shingles • Install TKO or GAF Lifetime/architectural shingles in color of your choice • Install ridge vent,where a ridge vent exists • Cap ridge vent properly with manufacturers suggested cap,where a ridge vent exists(GAF Timbertex® or IKO Hip&Ridge 12) • Properly flash any protrusions and all new pipe flanges,if any on roof - Clean Op: • Cover area with tarps to minimize debris and remove debris related to work • NOTE: Please cover any belongings in the attic,as they will get dusty,r(applicable um,1' 100U[ ll AIOoU� :' _, ° _ ; � C11�ti�- Iae1n`e c to rntt,liibu;dut5sterlali 1 `payment due upon signing: $2,980.00 Total COSL $8,980.00 Total balance due upon completion: $6,000.00 Midly ren',it )ayment io"Peter Ryan'. thank you! RespeetfullY Submitted by ✓ r Accepted by ati Our craftsmanship is 100%guaranteed for I Oyear . All other ees are through the manufacturer.All warrantees will be null&void if job i paid in full. Peter Ryan and Son Ro _,Inc. License#178871 1 Thank you for letting us serve you!!! cc, Peter - Please mail all correspondence to our Main Office: 377 Lowell St,Wakefield MA 01880 1 Tel: 781-245-4900 New Location:352 Main St,Gloucester MA 01930 1 Tel:978-559-7333 CITY OF SM EINI, L-kSSACHUSETTS • BUILDING DEPAR NT 120 WASHIINGTON STREET, Yo FLOOR At TEL. (978) 745-9595 PAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR T Hows ST.P[ERRB DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMSSIO,iER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in : Ct'1yvp (name of facility) (address of facility) signature of pe it applicant date Jcbrisatidce I Vie ['rrraaratrraawf> er7tlr DfrYltrsscrclrrrsartl..s D.e1;ar€tnxerat of litrfatshila.1 A:rricterat9 9 ' E t),f,�11'(' f2,f`"1�11:1'PSx��fiA13�Drt•3' 1 Ofl.gr•es,.i&1,eer, Scatter 100 l3DstDta, MA 02114-20.17 - ivsvr•rv,rrr•rrss,�twa/e11ra Wgrlcexl;,' Ca1tpti=ijai ton I.nswi'tliat:eAffT.x1aM•t: 3tliltlers/t:o.inhslet l^x/Electx°lrtaus/Pl�ti ttrers 7„,11c,nEl fai'., ,1<[ a Please e: .fb.l Name, cSn�;rlessra�.��rar�,t o,�I.,,rlivia�n,7; Peter Ryan anq Son Roofing, Inc. .�e Ac6eliess; 383 (rear) Lowell Street,Suite 20 C itylStttelZilr Wakefield,MA 0188.0 ptlolle #: 617-571-9050 Are you an 0013loyeV7 C:lteett the slipropritrte lroxi Tylae of.proJeci (reelarired): I..© I arri a lawfoyar, Wild 4• ® 1 aln a gelrel•al cOlin letor and I 6. ❑New construction employees (full and/ru•pajt"illse).o slave:Itiri it the sub-oi nractcus lasted oli the attached sheet.. 7• []Reillodeling ❑ 1 tuna sole ve iiii ttol -a oc's r' Thew stab-contractors have sllilr Irllcl have rro enl}>layees 9, [] 1?ttllol.ititna Working f0e•the .in all. cn. "wi ernployees nild have workers' 9. Buildlu addition Y i ty tiultq,, rnsrtla:nce.t ❑ [1IO Wol'kErs' collkj>� iii'suratice 1�.❑ E'leCTrical rtpnivs cir adld.itiotls ctcitnretl,] S. ��e are ncotlaotati,ul tact ifs 3.❑ 1. ran,ahalnernvllel eloing all lvcllfc ofticcvs N e e>,=isc ed their 11.[] P.hinking stpnn s or additions Myself OlYOlked'S� 00111p. lt$litof.excolption.lici 1VICCiL }.Z,�.1'\011.f92'f?ai M'' t c. 15'?. S 1(4)..nird rre have rn, insurancerequtsed..J 13.❑ Rthcr esllployees. [No lrtnl<ers" can3p. .ilstaraalct t aqufred,] "fitly app@'remit that eltceka Vox.#:l rnnsi also fill out the section tuelow showhlg thxir rvnrkrrs'coinpxwsntion policy intorination. t Holuemvilers who submit this af9dntrit.lildicnlulgtiny are.doing A work had tlreal hive otsfsidx:coutlactorstnust su)urit a:nely n#fldavil illdicading such. IC'matnctorsthatcheck th}sboxmastattecEotlnnnalditionnlsYlexl.siim.ingthxtlnluzafthesob conXractcra and:stalewt••lietheror not iStoscoarcitieshnve. employees. 1'f the sub-contractors haveenrploytes.they lrtost provide their wrni ers'comp.policy number. I.amr an errrplavev that Is lrravia ing warfcerr's'ctrrw.9vn-T rdara hasur rtvt:cre•/iir my t!lnlydvS r eS'. Br}v+r (;s the pat}r;i, artrjvb .sire lrEflxr'raa¢rrlarr, Insurance Cotnpaaily Tvnnlc; NSA (I am not required to carry WC,as I have no employees) Please see the Sub-Contractor's WC,.affldavlt a Policy i'i or Selfdns. .Lic. g: RSA Expiration Da.tt; Job Site C itY,`.`;ttttarZip; Atfiiirin a copy rfOn,ivorlcers' caritperlsnfiiora polley ckecinr afnou patge (sbeiiAng foie pol3� ntam ber anal espir ntion ri.te),. Failtiue to secant cavtraae as re itln'ed lindiel,section 25A Of lv C c, l:w� an lend to the uripOsitioll of ar•irlsinnl Pellnities of n 'lrn2 tip to .$1..500.00 MI'd/o:r Rnewyear ilujpri so11r11erlt, a5 WVIA as cl1'11 penalties ill.the form Of dl STOP ORDER inid n fit of nl) to$254.00 a day ardaillst the vialiltar'. Be'nd',iwdl Hail a copy of this gi1winnit Inny tie fol'wan.1tcl to site Of iCe of Investigations of the DT.A far insurrnnae eavermge W-16cation. !rl'a her6,t, of,"f} ri-arlerrhePatras andperrr#ritlesrifperYlrq.flair erlrotw is fare and rornfel. 617-571.9056 ___. ....- . nffletai wise vulp, Do not 11p[te IN-tH.ds 17:11eta, ita be, roitrlxlle.0 i b}!clap ar aowit affrrlrat.. City-or Tovini P'erwdtllicmnse. # I9:Stl.117g Fte11'thTt1.'it}'(eire:l:e olxeJ 1, Boatad of.Hiewith 1. Brail(Rag Delaawtinerut 3, City"/Tc n Clerk 4, ElectritaT IIsrslur t.or 5, P'9arzriM'd+irg lilipector d, 0-diev Contort Persrrai; P7tazir:4t The C,ommeniveal(h ofMa.ssrtcfitf-setts ITxperll�acsrat gflrtrE.trsGrdrllAt�c�tierlis . Office af.Fta.tleslf?;rlttvrrs _ 1 C'vltgr'eas Street, ,suite 100 k Bes.ton, M 3 oarr4-3©.1 � PI'IiIPW,Inass:gttU/<itcl Please Print Le il)1 ' Workers' Cvt ti3etisxtdlon Y.ti sla>srlire Affid'RAV Bill deVs/C 011tractos s/Flex tl icixlisiplttan>ers A tirxrltl9t.forTauxtion. i.emie Construction, inc. Name(Bngi7lasalOrgnrliznfioxsllnc(i.vidtlFl):. . Aridness: 71 Prospect Streat T)Cktoll, MA 02301 Phone#, 608-232-1'194 g I City/State/Zip: Ty[>E of project (reg11lt,e.d): Ave you nit e1ltPloyet'4 C'lwek the. nllitroPf nt 'I aui a.general oolUractor a1.td I G. New collsn'llction i•0 I.alu a culployer with 10 leave hired the sun"Contrnet.ors Remodeling employees 0411 al[dlo.r plu't•tiutie).t' listed on the a2tacllcd sheet, 2,❑ 1 Sill a sole Proprietor or nI.tner- These suit'-aonG nctors 'love 8, ❑ Delxiol.ikion ship anti have no 011*10yees elnp[oyees axed have walkers' � �Builciing adclitiotl working £ol the in any cl[)acity. comp, hlsurnnoe,i [No workers' CGinl), ttlSitl'11t1Ce ❑ We nJ'e fl COIl)OlkltlUtl and its I0,❑.E1e trlCal lYPalt'S 01'addIW0115 recplirecl.J nfficel''.have exel'c15ed S11C11' I I.❑Plumb repairs VY ndthtloiis 3.[� 1.alit a 11Ot11COw11e1' doing.all hark right of excmption pear 1viGL 12.[] .Roof mpall"S ury N co • . wodsers' n° i:i.❑.elf, 't K+ snsuralle reruired.J eniployes, (No LVlrlp, i719uranCe reClull'eCI.J Polley lilfo[ninilen. avit'�IlY apphCDa#tllat;hecM box 41 laust.elso All oat l'10 5EChoa below ffiIlow@Il�,tilell ll hireoWorkers,do oll[ridO S Po Y t Rome ntractorsrswhoeck this box ul iskattaclled tiusith an i frre A it 11mv ag the awele,of'tl a Sub wtrnclors and.late w1laether or notl tlloselendtiae 18iave�[s L'a to ees, the ax5al,rovidcl I IT tvorkels`ooalp.pollcynauiber. anlpbyees. If6hesub•aonlrnotcrshaveelnp Y Y 1 I alit.an er77Trlayer that is tw<rrirdtng reorlaers' Coll lnsarat7ee,(ur nt,y enlpio,Pees, Renoir l:r the poiira'nttAfob site Information. Insurer A: Northland Insurance, Insurer B; Arbells Protection, Insurer C, Travelers A/R Imurlince ComPally'Mine: Iixpitatirrn Date! 03-01.2016 6560UB-5B86069-2-15 Policy Nor Self-ills Lie #. City'"�tate/�ip: Job Site.address Attach a.C.apy of the wo-heS s, CoMpel-1501011 I tlU7l}2 a Vi1m1UL'e9Nge,2(clall 1ea 1.0 the iln V'Atioll of Ctilllil nllpe11F1l.ICStO£n Failwre.to secare coveiai } fine up to 41.SOU.00luxVor idle.-yens• in2Plasornnent, as well as civil laenaltiros in the i9lm of a.5'I(7P We)�{ORDER land F nit of e too$1-,00 a day agahrst the vio.tsrtor. Be nulv[secl t[lat a copy of this.statement may lae folvvardeil h)tiro CYltice of 11IVCSklgatiVltS Vf the DIA rot,111Stlyalwt CVYCCa4',,e Verl:flCattUll. I r10 h•oraGJ+ revttfi' urirder ttihiNatn.r art a re7'ltl;6-dfa't the il7forinnation providedabolie iS irate and COrI'e.CF. 508-232_1194 offdcdal rlso otTlY, DO not nwtre in 11t.is area, to be comlrleted b,3' 04Y rrr rorim tiff7ciad. Pevirg1lLlcense 9 t_aty or T'aa611 Issltl.ug Aut:hnrlty (circle oale)1 1, Board of IIealtil 1.Btl'ltlillg'�Epfl]'trllEnt. 3.'L:1't}'1TOwrl C:Lerlc. 4,.EPectx'1Ma1 illsiYeetOi' ,5, Piltltll)img IusPee as 6, Cutler Plxoene 91 coutne Persow ' DATE iMMIDDNYYY) _ �?. CERTIFICATE OF LIABILITY INSURANCE 1 04/6912015 HOLDER,THIS THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONF ER9 NO RIGHTS UP ONTHE CERTIFICATE CETIFIAEBELOWCTTHISDCOE$ NOT AFIRMATVELY OR NEGTIVELY AMEND, EXTEND OR ERT F CATEFOF INSURANCEDOESANOT CONSTITUTE A CONTRACT TBETWEEN T,HEER THE RISSUINGGE F POLICIES NSURER(8), AUTHORIZER REPRESENTATIVE ORPRODUCER,AND THE CERTIFICATE HOLDER• IMPORTANT! It the oartlfloala.holder Is an ADDITIONAL INSURED, Iho Polloy(los)must be aidoreed, It SUBRbOA cl N IS WAIVED,rights to to the terms and conditions of the Policy, certain policies may require an endorsement, A statement on this cortiticato dose not confer rights tD the certificate holder In Ileu of such endorsement s • C c Joyce M Kai or PRooviceR MsssPaylnauratloe Services, �E[aE....--.----------'- ---••---........___... �....—�878)77M1318 LLC P.HONO 1 (g78)774•A338 x115 _ I as No): 27 Gordon Street,Unit 10 Oaliss: IoyceQmesepa)insurancG,com . DanLera,MAO1g23 _ N INsUREPoe1M POPPING COVERAGE _ OR Norlhlandlnsuranc0 — NOR INSURER A: .---------- 41360 . INauRERE; ArbellaProleDllnn -- TRC INSURED LemaConslrucllon,lnc TRAVELERSAIR — Jesus Loma INSURER 71 Prospect Street Brockton,MA 02301 INeuaeR B 1 IN U e P: ATE COVERAGES is T EB I-S OF INSURANCE I URAN NUMBER! REVISION NUMBER! ICY NDICATEO.CNROTWITHSTAND NG ANY IREOUIREMEM'�TTERM R GONG ONN OF ANY CONTRACT OR OTHER DOCUMENT W TH RESPECT TO WHICH THIS D CERTIFICATE MAY OE ISSUED OR MAY PERTAIN, THE INSURANCE AFFUROEO BY THE POLICIES DESCWGED HEREIN IS SUBJECT TO ALL THE .TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIFS,LIMITS_SHOWN MAY HAVE BECN REOUCFD BY PAID CLAIMS. E P LIMIis OR S _ POLICY NUMBER _y„— fMM/DONV YJ,(JMMIOOIT _— TYPE OF INSURANCE -- 01/31/2016 01/31/2016 EACH OCCURRENCE _ ; 2'000'0( A WS236161 100_0( GENERAL LIABILItt MISES E _ COMMERCIAL GENERAL LIABILITY - 5,0( MED E70' An one Breen —, E CLAN&WOE 10 OCCUR PORED NAL a 2,000,OI ADV INJURY E .I GENERAL AGGREGATE E 3.000.01 PRoovcra•coMProP AUG E 3,000,0( OENL AOORSOATE UMITAPPUEB PER: i E PRO- L 1,000.0 POLIO LOC 1020009274 11126/2014 11/2012015 I B AUTOMOBILE LIABILITY 5 oIS,Y INJURY(Per_ parson) E ANY AUTO BODILY IN111RY(Par ecddenu.,. ALL OWNED SCHEDULEDPROP�RTY OlJvfAGE' ALTOS AUTOS leer eccldanU ., N'ONOWNED S HREOAUTOS V ALTOS I —�—_ EACH OCCURRENCE _ 8 -- UMBRELLA LIAP. OCCUR AGGREGATE E HXCOB&OAS CLAIMS•IOAOE S _ OED ROTE ION —' 3/0112015 03012016 , C 8 ATLL I OTH C WORKERS coMPENSATroN 8S60U8.6686068.2^15 01 500. ANDEMPLOYERa'LIA9ILITY �YIN ,a•L_EAGMACCIOEM„•-,_ 5._. ----'6001 ANY PROPRETONPARiNENEXECVIIV� L.J NIA E.L.DISEASE•EA EMPLOYEE E OFFICE WMEMBER EYfAUDED1 (M endslory In NH) E.L.OISEPBE•POLICY LIMITS 600, ' II yBId00CII00 V11d0r �-- --' DESCRIPTION OF OPeRATI0N8 below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLan ialech ACURD 101,Addlllanel Romerks fiche duls,it more oasoe I.mquln d) Proof of Insurance CERTIFICATE HOLDER _, CANCF,LLATION SHOULD ANY OF THE ABOVE DESCRIBE[)POLICIES BE CANCELLED BEFORC Paler Ryan and Bon RooMg,Inc ACCOROATHE INCEIWITHON p HE POLICY PROVISIONo,TICATE THEREOF, WILT. BE PELIVERED IN 553(Rear)LOWell Street _ Suite 2G AVn10RQED REPRESENTATIVE Wakefield,MA O1B80 ""'—'�'- 611886.2010 ACORD CORPORATION. All rights resan ACORD 26 (2010105) -rho ACORD name end logo Pro roglsterod marks of ACORD LICENSURE Peter Ryan and Son Hoofing, Inc. . •� r't+�i,•YAwunem•avYNr ✓GGn dw"/A' IAawsom rdYRtmRno Yo1w for lnNYldul asu duly OMIMdf(9arnlnrf Arcrlro a 1101 11opolnlirn Imforo tho v1dr1 daa data.Tf ronud tatum lyd aMpIA1PROYeMENit OONTRAOYOR TYPO afPloo of CmrOmur A@dn and OudnoulUpnlnllnn yUtmllon: YY0011 .Oor orNOon 101'nrk l'Iam•BuIR d"170 - ■plrallom OI3ph0A0; P Ilasmn,NA OFI'ld Pg1C RYA1i 6 Y0N'h00FIN0,IN0. /�//J,/�='//y)/y1•• f�['�.�yJG/''' I�. li Y(RM RYAN 3N pO )l0'A'SLLBT.OUIYCY nt"�.•••.t�.d .r Nm ralltl wlUY UYnnulro p/AKEFILMMA0"N Undsrsnnretnry Massachusetts Department of Public Safety Board of Building Regulations and Standards - License: CSSL-106054 Construction Supervisor Specialty PETER RYAN - 377 LOWELL Srt WAKEFIELD M0 = . f-<ZU CA— Expiration: Commissioner 05/17/2019 l Details Page 1 of 1 "rne Ofti da cSsfie o 5c cxecufi—Of ca of Fttk oafety an'acu itv(cOPSS) fAass.GoY Norse Stffie Agoncies ensee Details ion u ame: " ' PETER RYAN ll4Gender: er Name: ddress: ddress 2: ity: Wakefield State: MA ipcode: 01880 Copntry U ted tates License o: CSSL- 05 License Type: Construction Supervisor Specialty Profession: Building Licenses Date of Last Renewal: Issue Date: Expiration Date: 5/17/2019 License Status: Active Today's Date: 10/21/2015 Secondary License: Doing Business As: atus Chan e: License Issuance icensee: T Relationship: Attribute Of jc!nseN-o: --CSSL-106054 No Disci line Information ocumen um _ ----------_____ Close Window j ©2011 Commonwealth of Massachusetts Site Policies Contact Us http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=81620... 10/21/2015