Loading...
14 LINCOLN RD - BUILDING INSPECTION The Commonwealth of Massachusetts �y Board of Building Regulations and Standards Town of kj Massachusetts State Building Code, 780 CMR, 7"edition Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Tteo-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: t d Signature: Building ommissioner/Inspector of Buildings Date SECTION I: SITE INFORMATION 1.1P7e2y/Vrgsser /_ 4,�? 1.2 Assessors Map& Parcel Numbers 41.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(R) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone?Check ifyes0 Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' .l w of Redd: Name(Print) y� /,/�'r/��q/ T Address for Service: GivL wJ `���� Signature ;A-� Telephone �Consuucfion TION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) NeExisting Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work: /iv SlieGC c Cce-T S ?-av � SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ I. Building Permit Fee: $ Indicate how fee is determined: J6. . Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x . Plumbing $ 2. Other Fees: $ j / ` �� . Mechanical (HVAC) $ List: `� 0 . Mechanical (Fire $ u ression Total All Fees:$ Check No. Check Amount: Cash Amount: Total Project Cost: $ S"Yl F 3 ❑ Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) h: , License Number Expiration Dme N.4mc of CSL- Helder List CSL Type(see below) T Description Address U Unrestricted(up to 35,000 Cu. Ft.) R Restricted 1&2 Family Dwelling Signature M Masonry Only RC Residential Roofing Covering Teleph one WS Residential Window and Sidin I � 1 Solid Fuel Burning Appliance Installation D Residential D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.; 25C(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached? Yes .......... ❑ No........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 , as Owner of the subject property hereby ' authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Cam, _!I��� � 3 zGo Signature of Owner �� D to SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 1 ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and 2enaltics of r u NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.115,respectively. 2. When substantial work is planned, provide the information below: Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Habitable room count Number of Fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open }. "Total Project Square Footage"may be substituted for"Total Project Cost' ` .��� l•., ram,, r. -. �,. PRODUCT53 USEWR14T/1ENVELOPE PRINTED IN U.S.A. 1 WARM TRADITIONS STOVE SHOPPE SALES 144 Pine Street P.O. Box ORDER DANVERS, MASSACHUSETTS 019 01923 CUSTOMER ORDER NO. DATE 978-777-5562 FAX 978.777.5887 / TAX EXEMPT NO. SALESPERSON 6� SOLD TO: ,,��11 • ' tos SHIP TO: II'1� 5. -fhR. F./> LI.rN V'h', •C11 _ IY _ixccLru. -_ _07 ki-o _-- _ ___ `l7fr— 7yS-- 2160 SA N,r Al A TERMS' CASH CHARGE C.O.D. MDSE.RETD PAID OUT SHIP VIA F.O.B.POINT ;UAN77TY STOCK NUMBER - < DESCRIPTION - UNIT PRICE. AMOUNT Q�rvOoa T%�?r _Mi -i�F. �lrcox A.F.-_ f�S__ G3Lac�r ®�cr�.' SroHz 3699_ 00 11 q$_`'_ Cc6?w. r Pao MiC`a ... _---- Sio. o 0 + o0 _ I 77%�CLiivNo..— gy OO < n -!- Notes,- r30':3 c h7T,-- a,?. 1 oo _ y6o 00 Sj, 7A o� c/6 oo 30 /S Ir _ _ -- - -- ---- -- - — -- -- — 767w L sYs 3. I s- /. jP05 I Cirvr ,0 I Drj �/� S/9 SOU- O0 HOMEOWNER IS RESPONSIBLE FOR OBTAINING BUILDING PERMIT PRICING SUBJECT TO CHANGE AFTER 30 DAYS RECEIVED BY TOTAL Warm Traditions.. Stove Sho hpe Thank you for your recent stove order. Please be advised that you, as the homeowner, are responsible. for obtaining a building.pennit for the installation of the stove. We are enclosing information that is necessary to obtain a building permit and our insurance agent will also be sending you a certificate of insurance. Once you have received the certificate you should apply for a.building pennit. If you have any questions, please call us at 978-777-5562. 'RQOCC 1 144 Pine Street, P.O. Box 2081 Danvers, MA 01923 978-777-5562 i WARM TRADITIONS STOVE SHOPPE A Division of AQUA TERRA PROPERTY MANAGEMENT, INC. Contractors License # 032756 Edward A. Ferguson, Jr. r ir<fra Construction Supervisor License License: CS 32756 B i rt h d ate: 10/15/19 54 Expiration: 10/15/2009 Tr# 5454 t Restriction: 00 EDWARDA FERGUSON 15 PICKERING ST DANVERS, MA 01923 Commissioner Home Improvement Contractors License # 134399 Aqua Terra Property Management, Inc. Edward Ferguson ,per J� �a�, /.�c o�,/�a4aac�i•� �.\ Board or Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 134399 lug Expiration: 11/13/2009 Tr# 260392 .Type: Private corporation AQUA TERRA PROPERTY MANAGEMENT,INC. EDWARD FERGUSON 144 PINE ST. <"� DANVERS,MA 01923 Administrator 144 Pine Street, P. O. Box 2081 Danvers, MA 01923 978-777-5562 1-800-286-5662 Mt. Vernon Pellet Stove (AE) QU9DR Congratufations 1��� - and Welcome to the Quadra-Fire Family! Hearth & Home Technologies welcomes you to our tradi- meticulously fabricated and gold and nickel surfaces are tion of excellence! In choosing a Quadra-Fire appliance, hand-finished for lasting beauty and enjoyment. Our pledge you have our assurance of commitment to quality, durabil- to quality is completed as each model undergoes a quality ity, and performance. control inspection. From design, to fabrication, to shipping This commitment begins with our research of the market, Our guarantee of quality is more than a word, it's Quadra- including 'Voice of the Customer' contacts, ensuring we Fire tradition, and we proudly back this tradition with a Lim- make products that will satisfy ited Lifetime Warranty. p ty your needs. Our Research and Development facility then employs the world's most We wish you and your family many years of enjoyment in the advanced technology to achieve the optimum operation of warmth and comfort of your hearth appliance. Thank you for our stoves, inserts and fireplaces. And yet we are old- choosing Quadra-Fire. fashioned when it comes to craftsmanship. Each unit is With warm regards, Alan Trusler Oa— n Hen v— Jason Olmstead Vice President Vice President Vice President& Stew Tate Dealer Channel Advanced Technolgies Quadra-Firs General Manager Brand Manager LOCATION OF SAMPLE SERIAL NUMBER / SAFETY LABEL: Back of Stove Serial Model No. Name CAUTION-MOT WHILE IN MMaMUMCLEARANC TO COMBUSTIBLE 1ATIERIALS OPERATION DO NOT TOUCH, OUfIOQR• 1pE 8dll FW Rmn^tI rFY1tI ALCOY!llalK I aNw. Abl bi,NN umN rAIN1.up KEEP CHILDREN, CLOTHING ' "'""""'°" IN, '^t ow rapt.., MI.Vemon Pellet II MINN M IN, b uN n AND FURNITURE AWAY. IIbNlirtl lb,NNttmO I.M `„"", , Stove AE OM n4111oo0 bo,a1147 Im. ,r.Aw.IM�: � • NAA•Yo N,Y wou N^Flo, A UCHER. ON,CHAUD LORS DE L'OPERATION. NE PA 'n ,N1 007 TOUCHER.GARDEZ LE$ Dk UINS A LET VN. LE C Nl01 a NeTeN Y NNpFO EEair •^m NN DE L'ESPACE DESIGNE D� L'INSTALiATION. LE CONTACT N��1i0m f.o..iMaN . INnI�, � \ PEUT CAUSER DES BRULURES A LA PEAU. VOIR INN ' "j11Y°RIeV:M,mp BVMIL f1101LN C IkPIAy .. In Nc.MN,sm fA,e•.AP o 3.maN 1 ElPACEe LORE$MINIMUM DES MATERU1UII C0M na : IIAIPE I INII�, RAN tPN MNi INJ1dN S yY1 A tNPlrl l IA 11ESN1 IAN ANYNw : a IAl1YA) _ E , Yi[MINN) I IAa1Yr1 eKlfiea: Rtl eNi C IN.pI l a 1NnMNl RUMN, lsN YI�/NMI 0 1M.nMAI RNYN M ,MN vMM ^N'^'rM1 1 I MnNUA NL'KcOLT Ir.. NmnN nuttrw.^rrN 1 MIIYFNiPAIAiN 0WNiN, —Ar NN,.N 4yw•Nrp•Nt A , y N.NN..�.wrcw ertls IAnMry VIIII AVbF k/LSNq bhNAPw.I^mr < O • N•.._.NN6IIl Will. A^I blWw qN Y,gNM1Y�J�p\jy_-�Q ) xoPw r,M0.nv r.eNrrlY,tw+lurr..YMYYN.tI rn NIMNr F. wNP N ^AYAAy=alw IN NlaNmMN W rNINNIe _ `qq "�r Irwlrv.NN.NNNow•N.wl.t .1 A mvt WrwNAJ^I wNAL ,INxAwNe.N��V� m O \\_-•Lpr'JJ b4DAlY�wtNrNNr•lwbArArr •ArNw•I,N,reM -�✓,✓�" LL , � , 1 n Lvw•PNYA NAt I•IYYUNtI IMII wnA.l w{y M,t =t�-y,,,�,w,yrN NNNI I,TMAIIw.Iw a j . (INANtLrl.rlreNY ,NMIw.NrusNgr• 1^ > •NYNO 40ytY i i J •lit-AA N r•t••N{r,1 w NIFw111A 1 . 1.. �•mua•w••INI to•w•NYN M1 n!•'r•AYtt lsYl�ltA^• pe 1„OT A IN W y M1^aN>Iw• r••s oNVAr WNete N,F•bMT: PROTECTION OU SOL „••••�� w•IN.PINN1 J. EN.W—) f ,uFNnr,FSA UYF•IN.Il1aMw1 fM4.VA N„• IMm,^,YNY Ip pOm.t•YN•�fmm y�(/f�\ �•.FN.Iflmml ^•^"•^�•'r• swn NN,4vbwLwovr �•• T j�•A 11w' J•IN.Illmml 1 F MIMnVNU4A MYY•MN1Yp}IIITM1YIMNM1 �0\�Vl M•IM.111]mml PN NY RNW.RIOGo� FA4Au•flNl-UNt trmbYM uNset1rn OO�.Sdei OO Her lIIMOVE rNE WE VtPM ,o_r N'Y\AwN l IY IML[VIE t'leNlTr! t1aU4•rr•N •�rs•RC01AE)1-f 7034.107 Mfg Date Test Lab & Report No. Page 2 7034-106 September 12, 2006 i f , �� -�H°yaR^ �'fiG fI• .)dt4r` � , fv 28-7/16 32-5-16 29-1/16 425 up to to 60 200 14 620 1.7 to 7 81 $e 220 .. compliant /4 28-7116 22-15/16 258 UP W 12,,400 900 1,475 to 34 1.5 to 40 760 .7 28-1/2 31-5/8 27-518 349 up to 17,,300 200 2,350 to 47 2.0 to 5.5 80 160 .9 27-3/4 up to 12,900 25-7/16 a U ss/e„1 21-3/16 240 j 475 to 34,400 1.5 to 4 52 160 .7 ..E°se) CLEARANCES Mt.Vernon AE ° A Back Wall to Appliance......................2" ALCOVE INSTALLATION FLOOR B Side Wall to Appliance......................6" Min Alcove Height...............43' pROTECfION Corner Installation: Min Alcove Side Wall.............6• r C Wall to Appliance..............................2- Min Alcove Width................40- 1............2" u• With Top Vent Kit: Max Alcove Depth.......... ..36• ). 2• D Back Wall Flue Pipe.......................3" K...........6" L{(��`[� II E Side Wall too Cast Top........................6' I i F Back Wall to Appliance......................8• CORNER HEARTH PAD SIZE IR ' ° Corner with Top Vent Kit: 38-3/4"w x 38-3/4"d x Advanced Energy G Wails to Appliance............................3' Use a noncombustible Floor �I - protector,extending beneath Castile I A Back Wall to Appliance......................2• heater and to the front/sides/ B Side Wall to Cast To ALCOVE INSTALLATION p........liar............6' rear as indicated.Measure C Corner Install Walls to Appliance.......2" Min Alcove Height...............43• front distance(K)from the I, c With Vertical 3"-6"Adapter Kit Installed Min Alcove Side Wall.............6: surface of the glass door. D Back Wall to Flue Pipe.......................3• Min Alcove Width................38 E Side Wall to Cast Tap........................6' Max Alcove Depth...............36' F Back Wall to Appliance......................80 e G Corner Install Walls to Appliance.......2 CORNER HEARTH PAD SIZE Original Energy now o H Corner Install Walls to Flue Pipe........3' ;4.1/8"w x 34-1/8'd IMPORTANT—READ BEFORE YOU INSTALLI Classic Bay ,�—, A Back Wall to Appliance......................2" ALCOVE INSTALLATION Refer to the Owner/Installation 1200 /�\ I B Side Wall to Appliance...................:..6' Min Alcove Height...............44" Manual for complete clearance C Corner Install Walls to Appliance.......2" Min Alcove Side Wall............. 6• requirements and specifications. With Vertical Adapter Kit Min Alcove width.........40-112" The images and descriptions in D Back Wall to Flue Pipe.......................3" Max Alcove Depth...............36" this brochure are provided to E Side Wall to Appliance......................6" assist you in product selection F Back Wall to Appliance................7-1/2" only. G Corner Install Walls to Appliance.......2' CORNER HEARTH PAD SIZE 'Heating capacity(in square feet)Is a 40-5/8"wx40-5/8"d guideline only and may differ slightly due to climate,building construction Original Energy and condition,amount and quality of insulation,location of the heater,and air movement In the room.Based on Santa Fe j EBack Wall to Appliance......................2' ALCOVE INSTALLATION maximum square feet of Energy Star IL`aJJ/�i ;JSIde Side Wall to Cast To ,6" equivalent home with 8 ft.ceilings P ••ppla��ce...... Min Alcove Height...............43' and framed insulated floors in heating Corner Install Walls to Appliancelled.2' Min Alcove Side Wall.............6• zone 1. h Back Wall 3"-Flue Adapter Kit Installed Min Alcove Width................38' Back Wallo Flue Pipe.......................3° 'See Owner's ut calcanualulated laor ed usinons. P Max Alcove Depth............. 36•Wall to Cas[Top........................6' ••Btu/Hourinput calculated using' Back Wall to Appliance......................7" premium wood pellets at 8,600 Btu/Ib. Corner Install Walls-toA liance.......2" Btu output will vary,depending on the PP CORNER HEARTH PAD SIZE brand of fuel used.For best results, gy Corner Install Walls to Flue Pipe........3" 38-7/8"w x 38-7/8'd consult your authorized Quadra-Fire dealer. . t •'I eatingfiance, fPw your Warm Traditions Stove Shoppe LIUAD/7E7- /RE 144 Pine Street Danvers,MA 01923 Visit our Web site at www.quadrafire.com 978-777-5562 Quadra-Fire is a registered trademark of Hearth&Home Technologies.Product specifications and pricing subject to change without notice. All Quadra-Fire pellet appliances shown are tested and listed with OMN I-Test Laboratories,Inc.,of Beaverton,Oregon to ASTM El309,ULC 5627-00 and ULC/ORD-CI482 Room Heater Pellet Fuel Burning Type(UM)84-HUO.Suitable for use In mobile homes.These products are covered by US Patents Nos.5000100 and 5582117 and other patents pending. Product specifications and pricing subject to change without notice. nnr.tnseunan. Y • CITY OF SA EUM PUBLIC PROPERTY DEPARTMENT uJfOF1t1Y nw-^• MAYM 131 WAoONGTON STURST 9 SAS StA9MA0%'S M 01970 7V1.971045 9S"9 FAL 978.74&964 HOMEOWNER LICENSE EXEMMON Puea..itrhat j Date Job Location Home Owner Address Home Owner Telephone Present Mailing Address The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two Units or lea and to allow such homeowners to engsWan'idividual for hire who.does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which time is, or is intended to be, a one or two family dwelling, attached or detached . structures accessory to such use and/or farm structures. A person who constructs more than one home in a two year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official,on a form acceptable to,the Building Official, that he/she be responsible for all such work performed under the Building Permit The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned "homeowner"certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INSPECTOR See other side for state code The Commonwealth ofMassoehusetts Department ojlndustrlaf Accldenfs o icc 011Arv<at x1virs 91 600 Washinl'ton&rest Boston,MA 02111 Www.Arastyotr INN Workers' Compeosadon Jusuraoce Affidavit: Bulld.ers/Contractors/Electriciam/Pluanbers Applicant fpf lease Psi nt LaidDij Oct. 'Te(rct r *A Name (Butt $Cr oP l` ►^a Amen tar+ixeaavfndlidwA: +7� �tfrt "ff'ads , ,s 'r ,lacss:_____► `f`I �*A 1e. fiM¢o-- 1,P. O• &A O?Del _ Ciry/State/Zip: �tA— -- f} 019 Phone a: q78 »'� SSGa Art you too employer' Cbatk the appropriate boll type of project (rrgWre+d): 1.2"1.am a eraplryer with d. El am a general contractor and I rmplayeet(full aod/or pan•dme)• hsvebtred thesub-countxon 6. 0 New construction 1.0 1 am t We proprietor or parmer• listed on the*ruched sheet t 7• ❑ Remodeliag ahip and bete no employee These alb-contractors have 8. Oemolidoa working for me in say capachy. Workers'comp.ineunoce 9. (] Building addition workal' wasp. ineuraacc S• We are tioorporsdon and its required.) ofiicon have exercisai their 0.C] Elecoital repairs or addition. y.L_ 1 Am.a homeowner doing all work right of exempoloa per MGL 11.C] Plumbing repairs or additions nryielt No workers, comp. o. 132, 11(4),sod we have no 12.0 Roofrepabs insurance roluirod:)f employeea. (No woman' l3 Other op c . insurance required.] •Any.mn•aw ort ehw3�Sox al VON iep All ow A:•000oa below riwwfna tAelr vohrn'vongMaonoN i .elrompnon t Hviwrewaon who,iulomt mar oAtgrvit inaia:ina they on doing all wmk.nd lli o Mir mode oonwctwn:nuu�atraft a Mp aftidart adisstine epos,ltonrrcior.J:d ei,oey iAir Sus awn mrrbod p,ddldnaal A011 oDawlnt tN aaRp ertbr:rvPCanmgaa and thou when'wRaL Polies:ntinrryt(ou ..�.,r.,,rr♦r,,.,� mmmommo _ 1 am an rarployer that b providing workers'roropensal►as kviorsnce fornly o npioysrt Bafow it the polfry and fob alas injermaritua �^ IasursoceCompanyName._ -rat% �nSi7ft ' �� 4>✓'C� Policy N or Shcf-hut. Lie. M• (2, (pglJ i a c) Uptndoa Dolt: blob Site Addras:_ i�LI rol .00,Ciryistard2:ip: �t(nn. M C'�D Attacb o copy of th o workers'eompeatatlon policy declaradob pale(showing the potiey, number sod expiration date(!e,+ of. I nS Falhre to aenua oaeenle eta ngtttred under Secdoa 23A of MCL c. 152 can laid to the bapoefdon orcrimia4 peraslties of a t5nc up to S I.SOq.Oo etld/arone•year crlprisoomen4 at Weil st eiv17 penalties iu the form of STOP WORK ORDER sod a fine of up to$250.00 a day againt the violstor. Be advised that a copy ortbis atelemcat may he forwarded to the Ot1Sce o f lovestitsdoas ofibe VIA forinrweace coverage verification 1 do hereby rert{Jy tordtr the psNtr art/�rnalfiao�pei�ury char the firformorfoR proYfdef obow Is trot and correct. �lc.�s�8�77- SSl�L� ojJkld use salt' Do Rat wrtre In this area,to be eompierea'by mly wwtrn ef9'lefaf City or Town:_ Parmit/IJeense g lsstllog Authority(drde hoe); I.Board of Hallo 2. Building Departmeat 3,Cityfrotra Clerk d.Eleeiricsl Inspector S.Plumblag lnspeetpr L Other 11 Caetan?Riont, Phone Y: Department of Code Enforcement Debris Disposal Affidavit In accordance with the provisions of GL,C.40, sec. 564,a condition of permit p is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defingd by 6L,c. 111, sec. 150A. The debris will,or has been disposed of at: 14 Location of Facility / I `I 11 nc?eln R�xtd til°m . NA- 0 Location ofactiowjobsite (Street Address) Signature of connatoll Dale ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) PRODUCER 01/08/2009 (9(8)887-4900 FAX (978)887-2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. 0. Box 457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Topsfield, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED Aqua Terra Property Management, Inc. INSURER A: One Beacon Insurance Co. 21970 DBA: Warm Traditions Stove Shoppe INSURERS: Employers Fire Insurance P 0 Box 2081 INSURERC: The Ins Co of the State of PA Danvers, MA 01923 NSUKER D: NSURER 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 OD' TYPE OF INSURANCE P LICY EFFECTIVE POLI Y EXPIRATION LTR NSR POLICY NUMBER DATE MMR]D/VY DATE MM/DDlYY LIMITS GENERAL LIABILITY 1U11863 04/14/2008 Q4/14/2009 EACH OCCURRENCE $ 1 000 r 00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea-Rx u�ence _ $ 500,00 CLAIMS MADE O OCCUR MED EXP(Any one person) $ S OD A PERSONAL 8 ADV INJURY $ 1,000.00 GENERAL AGGREGATE $ 2,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,0001 POLICY PRO- JECT OC AUTOMOBILE LIABILITY IE64294 04/14/2008 04/14/2009 COMBINED SINGLE LIMIT S ANY AUTO (Ea eccitlenq ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY $B (Per person) X HIRED AUTOS 500.00 X NONOWNED AUTOS BODILY INJURY $(Per accident) 500,00 PROPERTY DAMAGE $(Per accident) 500.00 GARAGE LIABILITY � ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE g DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC6951205 04/14/2008 04/14/2009 X EMPLOYERS'LIABILITY TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S SOQ QO OFFICER/MEMBER EXCLUDED? I/yes,describe under E.L.DISEASE-EA EMPLOYE $ 50O OQ SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ SQQ QQ OTHER t 01 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ApDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION EAUTHORIZEDREP'K=btNIAIIVE Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL S WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Mr A Mrs Edwin Phillips E TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 14 Lincoln Rd D UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Salem, MA 01970 PRESENTATIVEnott LA ACORD 25(2001/08) ©ACORD CORPORATION 1988