Loading...
B-19-971 - 0010 UNION STREET - Building Permit The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling i(Ttus Section For Official Use Orily) `" " Building Permit Number Date Apphe i Buildin Official t SECTI JN 1:LOCATION Please°indicate Block:# ( r, andrLot#forlocahoris-forPawhich a street.address is not available) `i No.and Street City/Town Zip Code Name of Building(if applic9je) SECTION 2 PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rombs belorov ' Existing Building❑ Repair❑ Alteration '❑ Addition❑ Demolition ❑ (Please fill out and submit Ap4dix 105 , 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�LK Is an Independent Structural Engineering Peer Review required? Yes ❑ No�� 9 Brief Descri lion of Pro osed Work: A' _ y-t p S r: QLA SECTION 3:COMPLETE THIS SECTION'IF EXISTING-BUILDING UNDERGOINGRENOVATION,-ADDITIONi:�OR CHANGE IN USE OR OCCUPANCY X . 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 :$tHLDING HEIGHT AND,.AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) --,> L4-Lo-v rrfv&ve- LlZ�sa Total Area(sq.ft.)a otal Height(ft.) SECTION 5 USE GROUP(Clieck`as apphaable), A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational❑ F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-111 R-2 R-3❑ R-4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:=CONSTRUCTION TYPE,(Check as applicable)` IA 11113 IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA VB ❑ SECTION 7 SITE INFORMATION(refer to 780'CMR 1110 for.detaiis'on each item) �. .. - .. Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Public CI Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site' Private C:] or indentify Zone: or on site system❑ required❑or trench or specify: —70permit is enclosed❑ N Railroad right-of-way: Hazards to Air Navigation: MA Historic Conunission 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 Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: k >rx SEMI ION 9: PROPERTY OWNER AUTHORIZATION y. Name and Address of Pro erty Owner u m�,,_, SA- S a Name(Print) r No.and Street City/Town Zip Property Owner Contact Information: S c_. R­n 2'10 g Go 4 - - is Title Telephone No.(business) Telephone No. (cell) e-mail address c@ If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10.CONSTRUCTION CONTROL(Please fill out Appendix 2), if buildin is less than 35,000 cu.ft.of enclosedis ace and%or;iiot under Construction Control then check Ikere❑and ski Seehon,101 " 10:1 Re 'stered P.rufessional Res onsible'for Consfruction°.Control=' � &:j ajr, 10 WC 0l-JBr 422 9 tb y meccas} 12 S� Name(Registrant) Telephone No. e-mail address Registration Number q :Ti a� -�}S b Y\\My-s A/�Pt n_�_a23 E+1 G 202 Street Address City/Town State Zip Discipline Expiration Date CS -51'1 10.2 Ge,iieral Confrad6t Company Name F?V_i GL_V_1_ lsL�La V�G CS—b Sz-lR fi�Z 1.��rvr-eS' t C c� Name of Person Responsible for Construction License No. and Type if Applicable IDD � Street Address 43-W k 1 3 E- City/Town State Zip Telephone No. business Telephone No. cell e-mail address SECTION"':WORKERS`.C.OMPl?,IyS.r�1It.N INSIIRANCt t11 Tlt��V,11 MGL: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❑ No ❑ SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE . Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ 029 G'o 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 6.Total Cost $al O( (contact municipality)and write check number here SECTION 13 SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Y—SA — SW` v,,A e Jr- V2-Z q 0 I )19 Please print and sign name Title Telephone No. Date Street Address �l_e- T l 3 E-S City/Town State Zip Mu pal Inspectorto fill-outthis'secdon'upon application Name Date' C� Oi ►,�.,L'�4Iy tT �JS, 1 A� i,.W� • BUMDGUG DEPARTti1E14T i 120 WASHINGTON STREET,3-0 FLOOR TEL (978)745-9595 FAX(978)740.9846 KI,,%IBERLEY DAISCOLL MAYOR. THomAs ST.PtERas DIRECTOR of PlusuC PROPERTY/I3L'ILDIINGr COMMSSIONER Workers'Compensation Insurance Affidavit: Builders/ContraetorsiElectricianis/Plumbers Annlicant Information rt Please Print Leei lv Name(BusimssiOrganizatiotvindividual): _c- Lyt$ C CTV\ c . ---v-7v\-c_ Address:._.. CstylSta elZip: �� ! M a O la l SPhone#: G''l!" -a 22-"k$o y Are you ayl employer?Check the appropriate box,;,' Type of protect(required): 1.0 l am as employer with 4. Warn a general contractor and 1 6. (1 New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.+ 7• ❑Remodeling ship and have no employees These sub-contractors have S. [Q Demolition working for ma in any capacity, workers'comp,insurance. 9, ❑Building addition [No ryorkers`comp.insurance S. C3 We are a corporation and its 10.0 EIectrical repairs or additions requ�ed.j officers have exercised their 3.n 1 am;a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself"[No workers'comp. c. 152,91(4),and we have no 12.(]Roof repairs insurance required.)t employees.[i\ro workers' 13gaer Ire L1�4 } comp.insurance required.) 'Any applicant that checks box#1 must also till out the section below slowing their workers'compensation policy information. t Ifomeowners who submit this affidavit indicating they am doing all wont and then hire outside contractors mast submit a new affidavit indicating such. ;Contractors duOt check this box mush attached an additional sheet showing the name of the sub-comrneton and their wotkets'comp.policy intormatio", �i t tjr rn stsietr B-o+V\- 'PrC Cp_9 -Le Fs1�1oGov�-hr �C'E-r-y- s� a�q,�2_ lnsurrice Crtmpany:Name: Policy#or Celf-ins.Lic.#: 1n3'tSt� S CCS- - PoLJ�C�D�L1 _ y Expiration Date: Job Site Aclriress: ' u1/\\ S47 City/State/Zip S��-� NNA O\CC7 O Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to sc;ure coverage as required under Section 25A of MGL.c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 S250.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Office of Investigations ufthe DIA for insurance coverage verification, f rho hereby c,."r i y trader the pains a id ra/tf rs of�erJ that ormathan provided above is true and correct 54,M111re: i&4 l) t : Li Phone#: 2 2— [6. 4her se only. Do not write in thus area,to he camphtted by city or town nffiraL orun:--- Permit/lAcense# uthority(circle one): of Health 2.Building;Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector °erson� _ Phone#' CITY OF &Uxum, NWSACHUSE I BU DIING DEPARTMENT 120 WASHINGTON STREET, 301'FLOOR L TF-L (978) 745-9595 FAX(978) 740-9846 KI.NIBER,L.IEY MUSCOLL IMAYOX "T"Ht t-w ST.PTEm DIRECTOR OF PL:BLIC PROPERTY/BUILDING COMMISSIONER 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 wi I l be transported by: (name of hauler) The debris will be disposed of in : (name of facility) (address of facility) signatuVope t applicant date q�,41KIlid},� �V'�1 � WI�+L A. "CASfiLECONSTRUCTi©N C£3 1NC r� i{ = At ME t>�R Telephone(800)505-LEAK(5325) Fax(O 92 4bb 7 i BrJariLaBtans President ��fi)ty Please,mail acoepoq proposal to;the office located at: _ f t00�Cumrning�-Centef,Suite113E-5- Beverly,MA01g15�� } a Unrestricted Mass Builders Ucense No.054982, Contractors Aegisiration,No CUSTOMER PNON VI 7�.",�. DA .STREET JOB NAME• , V u-�'��� CITY:STATE"AND;JP JOB LOCATION DATE W ORK 1 EDU' T BEGIN DATE WORK IS SCHEDULED:TO BE COMPLETED•,, ,) I .Ix >Sf me t 09 heaahyto fum�Eisfharrialsrist and,,labor plate In accgrdanrs wit cEhctiti ns below for the total s i;%1 p dollars ;payment to be as t lows ' 1/3 down,:the balance due upon completion. ---- _ -- -- .: _.._ ' ---NOTICEi''A I home improvement contractors end subwraractors engaged in home impr"tnera contracting untess speaficalty exempt hom registrailon by pma ns"of Chapter 142A :oi the 600eialLavaa:nlusi"-log Yegi&to!'ed:Wdh ttts;6WnitfotiWeatth of MasSacArraetf9:InpU1l}es ghoul footsuation ano status shtftlld ba`triode 4tl Ek%e,,fXl2cs al Comtumsr Ailsirs. and euskiess-ti9gulatioa,Ten ParlrPlaia Sune 5176i�i3osioi%:pgp 02116 5:. idoie:.7li s prflpasal may be withdrawn by us ii:not socepted wtfh,n days: tailed DescrtpYion,of Work to be.Dorie 8(M6teiWW tb be Used c0Z We will,cover the siding,bushes,and grasses with Blue,Tarps to order tgprotec(the propertq'tiunng siripp!ng: s =:We well 5irip up to 2layers of roofing and ierneve"all Halls;screwsaiid staples down td:-!he Bare Wood alxf renail all loose boards.:: "instaif t4,4 of Ise and Water Shield to all leading edges,and themotace ice and Water Shield at thb bottom of:ali Edges;under all Step #lashingsi,'under ail:Rolf lashing,aroundaii Chimneys,Skylights and into:ali Valleys,in heatactreas only. We wii�tW 1b-Synthefic Deck Protector UrWerlayment"to all other areas of the too#deck The 8 ummum npedge will when be install to all root edges Any szistt Pi s~yill be eve Wdh-new Aluminum Rubber Flanges: The oil anal to ba used will be � 1" The bottom of all' I edges will.have a Pro rter rse with a glued edge for wind uplift•Wa will StormaNaii shingles using 6 nails par shingle All:the:llotins vrtil,be;cisarted and"Dumped by us on a daily basis:We will cieanou#ail Gutters,Dcwiispauts and F�bpwS;Magneiic,brcmms will be used;to extract all nails frorn,yo, property We wilvprotect your property as!test ws can however some foliage matting breakage]or marring could occur Wa cannot accapf;responsibiitty for.possessions insideo#the house,or detms.falling-lino aitic areas Cusfolxler`shouid'Pro(sctpersonal'' I `VLEASE NOTE:Customers must,cali their electric rovider to cover any unsafe wires. ' ERTRA dVOA1C tN 1NHICH A 43T WItI BE ADCIED TO THE C3YE�PRICE. Replac ,477 tied Rcrofboard's,, "`` IristaihAtuminitm Gutters M fi Releari Chun (a),: Install•Aluminum Doiiii , Replata:f aria Boards_ install Skyllght(s) .V _ Install Ridgevant_ +� Rotted Roof 7o Wail F7ashings_,; Install Root Louvers W Gutter.Repalrs 1!LEJt3E,hiOTE any Utegal;layars'ot'rooflng beyond a`second layer will tte'ari extra cost of 5 cents per square toot for each layer tseyond a,setxmd layer, ,&6 L 52 Warranty by manufacturer to free of defects fo ¢ years see rianufacfurer s warranty for exact warranty;performance All labor perforrned,under this contract,'shail be cif good qualify and free from detects riot i'herent,ii the quality required;or permitted far a panorl, of =years This warranty excludes remedy for damage or Ablest caused,rby abuse;modification, Improper or irisu#iicfsnt mairits3rianca Improper operation or rtormai,wear and tear udder riiormal usage"This warranty shall,tie limited to the work.perfomted;by A.C, .Cast1E Gonstructiorr Co,Ills.and I1mReii to either,repair or rapiacemeni by A C.Cestl8,constrUCitort.Co'i,,Inc at its,sole discretion aru!eleetton: A C Castle`Construction Co:us not=fpsponsIliia for any intertor damage arise roof wodc is completed A C.Castle Construction Co.is:not- respopsibie for business interruption•damages,lost profits'o any otherconsequentialfdamages."Any and-'all claims are waived finless made m writing,to A.C.Castle Consiruction.Jd.-And within 21-days after ihacccurrence of the event giving nse to such claim This-warranty shall not extend bejaw' :e. i.: .... ynnd=:any Iiriliisimposad-by a�licabte law it is uurobiigatwn to obtain aqy and'aA necessary related permits PLEI►SE NOTE:owners who secure their own coiistrucfkin-related permits shall ba extruded from access to.the Massachusatts Nome Improvement Contractor Guarantee Fund. a Payment and1.i enattias,,Upon completion of all work under this contract,customer shalf.within E3 days make bnai;and full payment of the" cxxltract pnt Any and ail unpaid balances shall accrus with;interast at 50o tnterast per month You egzee to(layall court costs and cofiection _ expenses irrairteo t3y A C Castia Con5tructwn.Co_ Inc m.the colleCtrori of any amount you-nwa under this contract moluding without imlfatwn reasohaDie att . omey s foes. Customer,agrees to submit any claim or,controversy arising from;this agreement to erbitrabon �Pumuant to the Massachusetts Home' lmproveri ern`Ccktirsctar?ragulstldns,A.G Caastle Construgtiar Company(A.C.Castle)and Gustomer,tiere by mytuaily agree'iri:advance that in a Etta e�rent that A!✓.;Castle ha8 a dispuferconcerning this"agreement,It flan ttle`option tc submit suoh dispute to a prvate;arbitration-servmce which has been approved.by.the`pftioe of Consume"r Affairs anii.Business RegulaVon;and that the Gustoinet shall tie requfred.to subrrittto such; arbitrtfitin N&E:This section applies Dilly to the agreementKo#the parties to alternate dispute restlutiori initiated by A C,Castle The Customer may Inate alternative dispute;res lutiijh jspeciticall,arbitration;'as required}evert where+this'sectionIs fiot signa1.ci;separate3y;by the parties A C Castletgnstnre Customer,Signature The homeowner's.three day ea nation rights under MGL 93 s,_48;MGL.c 140D s 10•orMGL,c 255t7 s 14 as;may be applicable. :> . CLteyltaitCc a# tflpOgai -Srgruurtg this proposf means you have acCeptad:ati the terms as statadand that youhave auttiorized us,Eo act as gout�Ig9nf#or.permitting. No work can beginpriort ' ng oEihi ag ant;an t Customer racaiving,a cCpy of thisYagresmant: CustitMer Signature91 VIZAL, Dale of Acceptance" u, '�1�f;� � � 8?�.I_-n7)a��a t' 1•k�rr+„>"'�."`t'.».,'%. �ram:°;. . ` L—(2 S q (_cL�--e—s , y cedfir4imUr er A ir§and. us s'.R b0ation _. 100.0"WAMington.Stf, Sub 1 Re stration A.C.CASTtE CONS ` i ' ` REV . .1C .: 7 JMI "WE Imov, tW` `RA OR - `" ` .t(x` �vn�s�xs�r �ra� �t� irs�r� A is T s l0 VMS to -- . # tSSMRMUA �1r xr Nvt v�1rdwmo a�tur rift of:massarius -- WO re9; tiuit lciff and-Stud&" �Y3t 2- " w :. . ANALM A�r^"�^'f RV DATE /22120IYYYY) �a"r•✓�'"M''! CERTIFICATE OF LIABILITY INSURANCE 07/22/2019 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 have ADDITIONAL INSURED provisions or 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 Corinne M Resci no Tarpey Insurance Group,Inc. PHONE AX NAME: 9 442 Water Street WC,.0 Ext: (781)246 2677 (Alc,No): WaWeld,MA 01880 ADMDRESS: corinne@tarpey nsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Evanston Insurance Company A0730 INSURED A.C.Castle Construction Co.,Inc. INSURER B: Continental Casualty A0250 100 Cummngs Center INSURER C Suite 113E5 Beverly,MA 01915 INSURER D: 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A COMMERCIAL GENERAL LIABILITY 3EQ4669 07/20/2019 7/20/2020 EACH OCCURRENCE $ 1,000,E CLAIMS-MADE El OCCUR DAMAGE To RENTED 100 000 PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,WO POLICY JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 1,000,w OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION UBlKO2411517 11/13/2018 11/13/2019 ✓ PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PR.OPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION Proof of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Af ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD V;ERTIF'CT'1�i �f•O�'� �'�i./' .'TY '�• �'N. DATE(MflA/U.DIYYYYj,; SU CE 06/1812019 THIS GERTIF.ICATE ISISSbO:AS AiMATTER.OF•INFORMAT.,ION ONLY AND CONFERS NO`'RIGHT,S UPON TWE CERTIFICATE HOLDER: THIS CERTIFICATE•DOES NOT AFFIRMATIVELY Olk NEGATIVELY AMEND-;'EXTEND.OR ALTER THE COVERAGE AFFORDED,BY''THE,POLICIES BELOW'. THIS CERTIiFICATE OF INSURANCE;DOES NOT CONSTITUTE A C:QNTRACT BETWEEN,THE• ISSUING.INSURER($), AUTHORIZED'. REPRESENTATIVE OR PRODUCER,`AND THE'>CERTIFICATE.HOLDER. IMPORTANT If the certificate holder is an•ADDITIONAL INSURED,the policy(ibs)mist be endorsed. ff'SUBROGATIOWIS WAIVED,subject to', the terms and,conditioms of the;policy;certain policies n ay require an endorsement A" atemen`t'on Afiis;_certtfk to does:not,confer rights to the certificate holder inlimi of such:;endorsement"s., :PRODUCER "TA " LUCIANA LOUR> NCO ...... ......... ......... ...... . PINT INSURANCE'. PAIHCONENo:Ext. 617.381:6240 FAX 617.381.6326 _ G No E-MAIL _ 1886 REVERE BEACH",RoRK WAY E-MAILADDRESS; E-�/ERETTIMIA•dZ 149. INSURER$AFFORDIN©ct)vEaACE Nac ffi 'Evgnstosi Insumn&iI INSURER''A•: -.._..._. ....._.... ._._ _..__ INSURED INSURER'S: N64uard In"$i l'c' L&A iPR0PERTY SERV..ICES INC; 5THALLEY AVE APT I INSURERC,:_. " EYERETT,MA.02I49 INSURER D: IINSURER!E i INSURER-F-% COVERAGES CERTIFICATE`N,U,MB`ER:, PREVISION NUMBER; THIS IS TO',`CERTIFY THAT THE POLICIES QF INSURANCE LISTED BELOW HAVE BtEN ISSUED TO THE,INSURED;;NAMEU A13OVE IF RJHE'POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT;TERM:OR CQNDITION OF ANY CONTRACT OR•OTHER.DOCUMENT'WITH RESPECT TO WHICH THIS; CERTIFICATE.MAY'BE,ISSUEO:OR MAY P.,EFTAIN, THE"'INSURANCE.AFFORDED'BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,, EXCLUSIONSAND CONDITIONS OF:.SUCH POLICIES::LIMITS SHOWN MAY HAV.&BEEN REDUCED-BY PAID CLAIMS: INSR: -. - ADDL SUER - - .POLICY EFF POLICY EXP LTW TYPE,OF INSURANCE? POLICYNUMBER MM/DDIYYYY MMIDOYY' LIMITS: GENERALlIASILITY EACMOCCURRENCE $, 1,000000 COMMERCIAL;GENERAL:LIABILITY lGE TD R 50 OOO` PREMISES_(Eaocarcence $:. dAIMS-MADE�OCCIUR MED EXO:*A,one parson) $F 5,000 A 3EU547.:3 06107i2019 06107l2020 p€RsoNAL"-&AOV INJURY $ 1,000,00d GENERAL AGGREGATE° $:2,000;000 GEN'LAGGREGATE'LIMIT APPLIES PER: PRODUCTS;='COMPIOP,AGG, $;2 660:666' POLICY: PRO LOG $;` AUTOBAOBILE LIABILITY COMBINEDiSINGLE;LIMIT $, Ea acc�enl ANY AUTO BODILY INJURY(Per person) $ ALL OWNED []',SCHEDULED. AUTOS :AUTOS' L BODILY fNJURY Par,atxident) ... " . NON-OWNED: HIRED AUTO AUTOS .$ PROPER TOO MADE' $ ' ' Per wcIdenf AarOCCUR EACH OCCURRENCE EXCESS WAB 'CLAIMS=MADE AGGREGATE $, QED ;RETENTION' $, WORKERS COMPENSATION `. - WC STATU- OTH ANDFEMPLOYERS'LIASIUTY' TORY"LIMITS' ER Wl N ANY PROPRIETOR/PARTNERiEXECUTIVE, - OFFIGER'MEMBFREXCLUL)EU? ❑N A E;L,EACHACCIDENT $- 1000000 (Nhanda(oryinNH}"" LAWCO2770T 0¢/OSI2019 06%(i512020 E.L.DISEASE=EA;EMPLOYEE $ I,000,000 Dyyes,describe under' I;Ot10,000 ESCRIP,TION C3F OPERATIONS tieiow' EL.DISEASE-,POLICY LIMIT $; .DESCRIPTION�OF'OPER,,TIONS'i,LOCATIONS/,VEHICLES (Attech•ACORD'1,01-,;"kaditional,RemarkiSchedule,ifmore:space ie'rsquired) Y 'CERTIFICATt HOLD.EIt" CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED"POLICIES BE CANCELLED BEFORE A C:;CASTLE-ROOFING THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100°CUMMINGS GHNTER�STE,113E=5`+ AC"CO WILL 'IZDANC.E4fNTH THE POLICY'°PROVISIONS. BEi�ERY.IVIA0191�5 � - ` 'AUTHHORIZ'EDD REPRESENNTTA1IVE `1988-2010'ACORD CORPORATION..All,rights,reserved;, AGORD 2.5,(201©/05f' The AC,ORQ name and logo are'registered marks of AGORD'