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HomeMy WebLinkAboutBuilding Permit # 2/1/2016 BUILDING PERMIT IOST" � �tLeo +a TOWN OF NORTH ANDOVER o� 5A - -g6 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received TED PPp�y�S 9SSACHUS�� Date Issued: , IMPORTANT:Applicant must complete all items on this page LOCATION a ? Q-� , Print PROPERTY OWNERP- I,- 9 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes n0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 19 One family ❑Addition ❑Two or more family ❑ Industrial A Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ai.�:r Se fttc{fir Wells "xf ,r F ❑ Flood ln ,f ❑Wetlands s U1/ I? r f r❑-��� atershed D�str►ct ,, n.� �r J"'r,.:.;,� .� ,�,:r ,✓ r -.� :5a. rr mr�j t � u` F r ,Y`.,x.,.�, ��r�r �`.;'X!rz� �c s,r .c ? . p � .�..+ � .;% � � na ..l �' r":s ✓s {r�.a> �v ..✓rr G �2.:.i,,z'w-J.,r/`�F ��° ���" !G :k, NI �' *Yri.� �,�/� ,( y_ � ❑1/1/ater/Sewer= �,, �r, � ���f ��, �-���� r���� �� 1 � r,�,,,,: ��, r ��,y� � �� 5 �, :���f� � � � � �, c; DESCRIPTION OF WORK TO BE PERFORMED: \ � o \• c� "A c vol 4 b WO Identification- Please Type or Print Clearly OWNER: Name: ��rc ur �T �- L ���. a��� Phone:00%,u%,l- -79cl(,0 Address:_ i2 f"oss Contractor Name: 9,,,-AL, p", PhoneM. j-(�2t� tips cc Address: rc =, c—I, 02-OTC Supervisor's Construction License: iowiL4 0 Exp. Date: p�j igjj% Home Improvement License:__►Loo cod Exp. Date: cDut2u(to ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ c1SFEE: $ Check No.: Receipt No.: `) Lf NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund -Town of %AORT H 2 -Andover O �. �+► ® _ ?, h Ver, ass, I _t2,6 O LAKE �, COCMIC Kl WICP dough, K V U BOARD OF HEALTH RM T�� T LD Food/Kitchen Septic System C6THIS CERTIFIES THAT .%0-n........................... BUILDING INSPECTOR . . .... ......... Foundation has permission to erect.......................... buildings on ............. ..........� ..:...... . ............................ Rough to be occupied as ........ .. ............... ........ ....... .... .. ........ '.'i,�%. ............ ...,.. ..... Chimney provided that the person accepting this permit shall in every respect conform to the erre of the.,application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXP-IRES IN 6 NT ELECTRICAL INSPECTOR CONSTRUCTUNLESS / Rough Service ............. ...... '........................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Building Rough Display in aons icuous Place on the Premises — Do Not Remove Final No Lathing in or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 21 Drydock Avenue, 2"" floor ri next Step Living rM Boston, MA 02210-2384 home energy solutions 866-867-8729 NextStepl-iving.com August 20, 2015 Town of North Andover Building Department 1600 Osgood Street Building 20,Suite 2035 North Andover,MA 01845 RE: Christopher Bowe Residence Solar Panel Installation 12 Foss Road North Andover,MA 01845 Structural Assessment of Roof Framing NSL Project No: SP2S2090 Dear Sirs, Next Step Living, Inc. has performed a limited structural evaluation of the roof framing at the above referenced site to determine if the roof has adequate capacity to support proposed solar PV panels.This analysis has been based on field measurements,framing information and configurations observed at the proposed site. The existing residence is located at 12 Foss Road, North Andover,MA 01845. Structural Data and Code information Our analysis was performed in accordance with the requirements of the MA Residential Building Code 780 CMR M Eighth Edition.The main roof of this residence is framed with conventional roof rafters with some collar ties in a gable configuration.The existing roof structure is in good condition and currently has one layer of asphalt shingles as roof covering. The pertinent data is listed below: Main Roof Rafters:I%"x 7 Y"(#2 Spruce Pine Fir,Hem Fir, D.Fir Larch Assumed) Rafter Spacing:16"on center Roof Slope: 30 Degrees Horizontal Projected Length of Rafter:14.83 feet Ceiling Joists:Present Collar Ties: Present every third rafter Roof Sheathing:Plywood sheathing Roof Covering: Asphalt shingles Condition of Framing: Good Ground Snow Load,Pg:50 PSF from Table R301.2(5) Importance Factor,l: 1.0 Exposure Factor,Ce: 1.0(Partially Exposed) Christopher Bowe Residence Solar Panel Installation 12 Foss Road North Andover,MA 01845 Page 2 Thermal Factor Ct: 1.0 Existing condition(Warm Roof) 1.1 With panels(Cold Roof) Design Snow Loads: 35 PSF(Existing—Unobstructed Warm Roof) 25.68 PSF(New Condition—Slippery Surface on Cold Roof) Basic Wind Speed: 100 MPH from Table R301.2(4) Importance Factor: 1.0 Exposure: B Analysis Results General The proposed solar panels impose a total weight of approximately 3 pounds per square foot(PSF)on the roof surface.The International Residential Building Code allows up to two(2) roof coverings on a residential dwelling. Each roofing layer of asphalt shingles imposes a dead load of 2.5 to 3.0(PSF)on the roof. Because the existing roof has only one layer of shingles,the code allows a second layer to be added without analysis.The weight of the second layer of shingles is approximately the same as the solar panels which will be installed instead of the second layer of shingles. Solar panels are considered a slippery surface and are mounted a small distance above the existing roof. Therefore, one would be cautious in considering a thermal factor,Ct,of 1.1,treating the panel surface as a cold roof, rather than a warm roof.After considering the roof slope factor,Cs,from figure 7-2,ASCE 7-10,the snow load is reduced by 27%for the main roof compared with the snow loading on the existing shingled roof,which is not considered a slippery surface.The reduction in snow load due to this consideration is about 9.32 PSF for the main roof,which essentially offsets the weight of the solar panels. Gravity Loading: Although the addition of solar panels results in a net reduction in the overall loading,the existing rafters are overstressed.As such,we recommend that a 2 x 6 collar tie be added at every set of rafters.The collar ties should be at least eight (8)feet long,cut flush to the roof sheathing,and shall be fastened to each existing rafter with a minimum of 6—16d nails OR 6 Ledger Lock screws as manufactured by Fasten Master. i The panels will be installed using Unirac Solar Mount rails with L-brackets in either a landscape or portrait configuration with a rail toward the top and bottom of each panel edge.The L-brackets will be fastened directly to the roof rafters with 5/16" diameter lag screws.The fastener layout shall start near each corner and for landscape orientation shall have a maximum spacing of 36"on center parallel to the roof slope and 32"on center perpendicular to the slope(e.g.,every other rafter), or for portrait orientation shall have a maximum spacing of 54"on center parallel to the roof slope and 32"on center perpendicular to the slope(e.g.,every other rafter). Christopher Bowe Residence Solar Panel Installation 12 Foss Road North Andover,MA 01845 Page 3 Each 5/16"diameter lag screw shall have a minimum of 3"thread penetration into the existing rafter. It is also important that the L-bracket attachment locations be staggered between adjacent rails so that no single rafter supports more load than under the existing conditions. Wind Loading• Provided the leveling feet attachments to the roof are made in a typical staggered pattern,the overall wind loading imposed on the structure will not be impacted to any great extent.The net wind loads imposed on the roof framing will be less than the current loading with an attachment spacing described above. Conclusions• Our evaluation of the proposed solar-electric installation has established that the framing is NOT adequate to support the addition of the solar panels to the existing roof as indicated on the Solar PV plans without strengthening the structure as previously discussed herein. Once the roof framing is reinforced,it will be adequate to support the solar panels.We have only reviewed the adequacy of the connection to the existing rafters and the capacity of the existing rafters to support the vertical and lateral loads from the solar electric system.We do not take responsibility for any other portion of the solar panel array support system,the existing roof framing construction,or the integrity of the structure as a whole. Do not hesitate to contact my office at 866-867-8729 should you have any questions or if you require any additional information. Respectfully, Next Step Living, Inc. g b yf Dean A.' o MA Prof. Eng. License#50405 21 Drydock Avenue, 2'd floor GBoston, MA 02210-2384 stengT, ext p Uvi home energy soLutions 866-867-8729 NextStepLiving.com January 19, 2016 To Whom This May Concern, With this letter, I Joseph Wyld-Chirico (CSL93115, HIC 162111) am notifying the Town of North Andover of our retraction as contractor and electrician for the rooftop PV Solar Installation located at 12 Foss Rd. This project has been reassigned to Certified Safe Electric, and they will be acting as contractor and electrician for the remainder of this project. Kind Regards, JosepWWyld-Ch1rlco CSL 93115 DocuSign Envelope ID:C295CA79-EDC3-4204-9D23-F021864232CD Attn: Town of North Andover, With this letter, I Chris/Laura Bowe of 12 Foss Rd., formally authorize Certified Safe Electric and Bruce Davis CL 104740 to act as agent and installer on my behalf and may apply for all permits pertaining to my NRG Solar System. I recognize that Certified Safe Electric is a sub- contractor of NRG Home Solar F DocuSigned by: DocuSigned by: 15m, �°7VuLt�outitS Customer Signature Bruce Davis ELECTRICAL DESIGN W PV MODULE RATINGS Caa STC SOURCE COMBINER RATINGS INVERTER RATINGS O uo Temperatures INVERTER MODEL:EnphaseMicroinverter m d' MODULE MANUFACTURER: Trina Average High:28" C MAX OCPD RATING(A):20 MODEL:M215-60-2LL-S22-IGDo .9" C w ❑ o MODULE MODEL#:TSM-260PA05.08 Record Low:-28OCPD AMPERAGE RATING(A):20 MAX DC VOLT RATING(V):45 = Q OPEN CIRCUIT VOLTAGE(Voc): 38.2 OCPD VOLTAGE RATING(V):240 MAX POWER @ 40°c(w):zzs ILO Q OPERATING VOLTAGE(Vmp): 30.6 NOMINAL AC VOLTAGE(V):240 , 0 W 0, 9A OPERATING CURRENT(Imp): 8.50 NOMINAL AC CURRENT(A):0. cn SHORT-CIRCUIT CURRENT Isc :9.00 2 x#10 THWN-2 Wire BLACK MAX BRANCH AC CURRENT(A):9.9A/6.3A 9 US W MAXIMUM POWER(VV):260( ) 2 x#10 THWN-2 Wire RED MAX BRANCH OCPD CURRENT(A):20A = 0 O 00 2 x#10 THWN-2 WHITE 10 Voc TEMP COEFF(%/°C)=-0.32%/°C0 N ❑ 00 1 x#6 THWN-2 EGC �1 1 L2 Isc TEMP COEFF(%/°C)=-0.05%/°C 1"EMT INDOORS �� N PV LOAD Z CENTER d 7 WIRES ________---------------------------__.__.___.____-'_-__'-_: (PVLC) O d .................... ----i O s End-Fed Branch of 11-M215 Inverters a z a T°el DI11 Pape11.c0 nneW M AC dl kbr°nch M°ximum°O V ut f.,I t c r—t 0.9A rm a p.r p°n.1 TSM-260 TSM-260 TSM 260 TSM-260 pg05.06 ° PA05.06 ° PADS.Ofi ° PAD$.D6 ° — i J-box 15A O Enplaa. 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O required only for M215-60-2LL.It is not required AC DISCO 60A RATING O ENVOY COMMUNICATIONS OUTSIDE 2yA FUSES z for M215-60-2LL-IG NON-FUSIBLE GATEWAY GF222N 30A RATING GNF321R L2 L N ETHERNE CONNECTION TO 1 x#10 THWN-2 Wire BLACK BROADBAND ROUTER 120 VAC POWER CABLE 1 x#10 THWN-2 Wire RED Symbol Conventions: 1 x#10 THWN-2 Wire WHITE lou m 1 x#6 THWN-2 EGC --s �_ 2-Pole Licensed Electrician Assumes All Responsibility For 1"EMT INDOORS ^— Circuit Breaker Determining Onsite Conditions and Executing 4WIRES MSP Installation In Accordance with NEC 2014 Codes -B-2 o__A Fuse Visible Break NEL RATINGS Knife Switch ICE SE CONDUIT SIZING RVPA AC DISCONNECT RATINGS t>�o 1"PVC OUTDOOR MEP BRAND:GO ULD --------------------- DISCONNECT AMP RATING(A):60 1"EMT INDOOR BUS AMP RATING(A):200 DISCONNECT VOLT RATING(V):240 SERVICE VOLTAGE(V):240 Equipment NEMA3R MAIN AMP RATING(A):200 Grounding BREAKER RATING(A):25 Conductor MODULE DATA DETAILS "HUniversal rMODULE ` a — x405,0 w � W CD D o _ ___ CSgw+�c�DvR!X+utYol�emrcco-C'�r.�x. 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'Ciorrtrtwxntrrxwr e`.w,RiSr^iwykt�€kr !,e't r�! „+"E^." r CUnm us® xx� ?xere r�ae. CrpmrnXiars�l Ycrespga�siurtt -Vit?^`+�35•� • a�nttattasa rrm'c yrcxc�rax rJ'aTs'rat'^{Ra� ::. � � vapXaao D a :*Aa,I s4wr cruto Palling ISA C= CSE t Ntb b44Yp+AY tAiC(YiWf i'OIYY QT CPi L a` a `d ,txts .rt_stQ"i_10ttICI�nF.`t.Si+3t3S�R.SC'r.'R"3 r: ARRAY DESIGN / SITE DIAGRAM HEIGHT OF HOUSE PANEL ORIENTATION (TRUE) ROOF PITCH (DEGREES) 225" 213' 30' W Quick Mount PV Solar Flashings FOSS ROAD o L, will be used on every roof penetrationX39.05 Mr DRIVEWAY W 0 o —ARRAY LAYOUT IS NOT TO SCALE"' � Q • 00 am W_ qg UTILITY METERUS v w PLACE PV LOAD CENTER OUTSIDE TO THE LEFT OF THE � � � � o > 00 LGATE120 x u. O _ UTILITY METER, THE CUSTOMER IS RESPONSIBLE FOR MOVING OBSTRUCTIONS 3' FRO 'i LOAD CENTER � AC DISCONNECT (D y a o N LOCATION; PLACE ENVOY MONITORING EQUIPMENT TO THE BIOPIC OF TSE MAIC ELECTRICAL PANEL 3 t O s PROPOSED CONDUIT THROUGH () Q Z a ATTIC, DOVOIJ EXTERIO RTO PVLC:ELECTRICIAN WILL FIELD PIPE TO BE RELOCATED ED II VERIFY O o QUICKMOUNT PV L 4-0 — 34'-8" (416") PORTRAIT/LANDSCAPE :> •- Total's J C) }' 12"TYP. Total#of Panels: 18 CL � � Total#of Splice Bars: 8 : L F-1 ❑ Total#of Bonding Jumpers: 8 U) (tj 12"TYP. 1(14�+1 11 � I Total#End Clamps: 14 -P-0 I Total#of Mid-Clamps: 36 X '" "° ®— See Engineer's Structural Assessment z O +1 0 N . 14-- -(14)'+1(11 - = z- x C)77 u .1*,; (_..). 777 7, 4-0 CE3 E Customer Signature: Date: TYPICAL ATTACHMENT DETAILS —TH.�r-,GE I-OWARDS ROOT. RIDGE -RACKING CCVK)NENTS IT51i INCLUDED "DE;CRIP111D i 17";01 B0 NO, �5 ) 4 ) 00 X -CC ,rLASSI, ;.I CAN AL.ME 3 PLUG,%A1JNrT, �o I IX 7 r`2',E T ki I-5 S I 4 -�G SC Yq'.H Ek fl E-A.D. 16 �'21 WAS R,Ff N D EF,5 D"IC,K 1-1!-01 0� 1 M SS! 2 4 50 Lag pull-out(withdrawal)capacities(lbs) iri typical lumber: Lag Belt Specifications Specific Grant 5/16"shaft per 3"ttread depth 5116*shaft per 1'threac depth Douglas Fir, Larch ?96 266 Douglas Fir,South .46 705 235 Engeirrea-i Spruce,Lodgex�le Pine(MSR 1650 f&higher) .46 705 235 Hem, F r 43 636 212 Hem, F r(No-thi .46 705 235 Southern Pini -55 921 307 Spruce,Pine.Fir 42 615 205 Spruce,Phe Fir(E cf 2 million psi and higi-er grades of MSR anc MEL) 50 798 266 ...SEE ENGINEERING Next Step Living Inc. Quick Mount PV REPORT FOR ATTACH IVE!,J QMSE-LAG:QMPV E-MOUNT SPACING"" [I enf t eD l UvingTM Module and Roof I home energy so[utions Attachment Detail WITH LAG BOLT DocuSign Envelope ID:7239A81C-709E-4CA5-8E9D-OFDC975083D8 The Commonwealth of Massezehusetts Department of IndustrlalAcczdents I Coni rests Street,Suite 1l1 fJ 1, Boston,YID 02114-2017 wwmmass.gov/dr'a Workers'Compensation Insurance Affidavit;Builders/ContractorstElectricians,'Plumbers. TO BE FILED WITH THE PEILl1TTTL\'G AUTHORITY, Applicant Information Please Print Legibly - s Mine Busi-iessi'Organizationlndividual):`� _�` 1 `t C _ ` Address: __. ... - Ciq,/StatelZip; ���y��`A, '• ,1 �� a `s._ 'Phone#:-J ? Are you an employer?Check the appropriate box: Type of project(required): 1. I ant a employer with ��employees(M]and/or part-tune),* 7, ❑New construction 2.F-1 T am a Sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No worker,'comp,insurance required.1 9. Demolition 3.(�f am a horneowner doing all work myself.[No workers'comp insura ace required] (�4,D 1 am homeowner and will be hiring contractors to conduct all worn.on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 1.i, Biectncal repairs or additions proprietors with no employees, 12.[�Plumbing repairs or additions 5,17 1 um a general contractor and I have hired the sub-contractors listed on the attached sheet. i 3. Roof repairs These sub-contractors have employees and have workers'comp,insurance.= Other b.�Lxr'-are a corporation and its of=.cern have exercised their right of exemption per,;dCrL c. 14, — 152,§1(4) and we have no employees.[No workers,comp.insurance required) *Any applicant that checks box n 1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit:his affidavit indicating they are doing all wort:and then hire outside contractors must submit a new affidavit indicating such. *Conn actors that check this vox must attached an additional sheet showing the name of the sub-contractors and stat-whether or not those entities have etnplovees. If the sub-contractors have employees,they must provide their workers'camp,policy namber. I am an employer that is providin'workers'compensation insurance f or my employees. Below is the policy and job site information. Insurance Company Name: en Policy I or Self-ins.Lic. : � j Expiration Date: > Job Site Address: Fomes Q,> City/State/Zip-.l\ ,���� MIN 0\106 Attach :1 cops'ofthe workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NIGL a 152,§25x1 is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to$250.00 a day against the violator.A copy of this statement may be f rwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerh�y under the pains and penalties of perjury that the information provided above is true and correct. ocuSigned by: Si--nature: iVUGI. m-s Date: 0 1- OL9-1lp Phone 4: oz z�gantc.. Official use only. Do not write in this area,to be completed by city or town offrciai. City or Town: Permit.fLicense 0' Issuing Authority(circle ane): 1.Board of health 2.Building Department 3.City?Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 5.Other Contact Person: Phone 4: A�®® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/15/2015 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 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 Darlene Mulcahy y Malcolm & Parsons Insurance Agency aCNNo Ext: (781)344-3200 FAX No;(781)344-1425 713 Washington Street AAIL DDRESS: P.O. Box 527 INSURERS AFFORDING COVERAGE NAIC q Stoughton MA 02072 INSURER A Northland Insurance Company INSURED INSURERB:Sentinel Insurance Company Ltd 39098 Certified Safe Electric, Inc. INSURER C Nautilus Insurance Company 50 Tower Avenue INSURERD:CNA Surety INSURER E: Marshfield MA 02050-5131 INSURERF: COVERAGES CERTIFICATE NUMBER:CL157602635 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGE ( RENTED 100,000 PREMISES Ea occurrence S x ISO Form CG0001 TBI 7/15/2015 7/15/2016 MED EXP(Any one person) $ 5,000 X Contractual Liab PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PRO- 2,000,000 POLICYF�JECT 1:1LOC OTHER: General Aggregate $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMITccident $ 1,000,000 Ea a ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS X AUTOS 08UECZJ8251 3/7/2015 3/7/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident x ISO CA0001 PIP-Basic $ 8,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 ',.. C X EXCESS LIAR X CLAIMS-MADE AGGREGATE $ 2,000,000 DED I I RETENTION$ TBI 7/15/2015 7/15/2016 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STERAT LITETE EER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D FIDELITY- EE DISHONESTY 62447764 7/1/2015 7/1/2016 $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION certifiedsafeoffice@gmail. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Amne Parsons/DARL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 ro01401i ® [—D�E(MM/DD/YYYY) ACOU? CERTIFICATE OF LIABILITY INSURANCE 16*� 01/14/2016 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 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 CONTNAME: Darlene Mulcahy MALCOLM & PARSONS INSURANCE AGENCY INC aoNro Ext: (781)344-3200 FAXNe: E-MAIL C P ADDRESS: dm malcolmand arsons.com 6 FREEMAN ST. INSURER(S)AFFORDING COVERAGE NAIC# STOUGHTON MA 02072 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: CERTIFIED SAFE ELECTRIC INC -INSURER C: INSURER D: 50 TOWER AVENUE INSURER E: MARSHFIELD MA 02050 INSURER F: COVERAGES CERTIFICATE NUMBER: 24268 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RNTED CLAIMS-MADE 11 OCCUR PREMISES (,.E Eoccurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY E] PRO JECT ❑LOC PRODUCTS-COMP/OP AGG $ '.. OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ '.. AUTOS AUTOS '.. NON-OWNED Perac den DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ '.. EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ �/ $ WORKERS COMPENSATION X STATUTE OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 '.. A OFFICER/MEMBEREXCLUDED? I N/A N/A NIA 7PJUBOG17773815 08/01/2015 08/01/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St Bldg 20 STE 2035 AUTHORIZED REPRESENTATIVE t J` North Andover MA 01845 D f t Daniel M.Crqey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ,�Aassachusetts Department f public S 3fetY Board of Building Regulations and Standards License! CS 104740 BRUCE A DAMS a 60 TOWER AVENUE MARSHFIELD MA 0301511 i s, �rtisslrrnr 0111912418 7 11 11 moll $ LIMA " 3 MWA < lM.TAl l i SA S :ECTRIC IK Y TOW-0`7,5 02050-513 0713 ./: FZA, / 7 "'41 140M C ANS �'7 ,y,s,��/` Fx Y i t1 DAVIS , 3 Fk 50 TOW ' 29� <.< 1#t i alb <: License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date, If found return to: 4�OME IMPROVEMENT CONTRACTOR office of Consumer Affairs and Business Regulation Ir t }registration: 140104 Type* Park Plaza-Suite 5170 10 x, xpiration: 612$12016 Private Gorporatio: Boston,MA 02116 CERTIFIED SAFE ELECTRIC,INC. BRUCE DAMS > 50 TOWER AVE .»»--Jk_ MARSHFIELD,MA 02050 Undersecretary Not�valid without signature