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HomeMy WebLinkAboutPermits - 22 HARWOOD STREET 0 TOWN OF NORTH ANDOVER 01 tko APPLICATION FOR PLAN EXAMINATION ,,, q 0 C, I Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 22 "arwocA (�3kree� Print PROPERTY OWNER �-awrercp- -4�ay o ,L-A Print MAP NO.: �—PARCEL: ouZONING DISTRICT: I TYPE AND USE OF BUILDING HISTORIC DISTRICT YES Cl TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building [ I One family Addition I❑I Two or more family I Industrial Alteration No. of units: ,'Repair, replacement Assessory Bldg I Commercial F I Demolition ,I Moving(relocation) 11 Other F! Others: 1� l Foundation only DESCRIPTION OF WORK TO BE PREFORMED r-c-move ex,!�ter-\C\x\� .1 S's s vep� ,A 4 Va4rc�,IS Ae 0-�ck vUI o nec,) 'tAS'Amo Corrs-',112 cleck r \,\a�AAAA2 . kll rvoc- over S;k Qrkm OVA e0&Gz*, AM-VN CA !AoLkrs. L�lIdentification Pleasej Type or Print Clearly) OWNER- Name-- bA (t4q Phone: Address: CONTRACTOR Name: r�eyuS "ff! (2rV%Ces /car Phone: W1 760 Address: .O. `30A ,32-S VA o\bw rs (Mt 0 1 9fy& Supervisor's Construction License:-,4= C S- 0-7 3 991—Exp. Date:--& 1 -7/1 ? Horne Improvement License: Exp. Date: -7119 10 ARCHITECT/ENGINEER Name: Phone: Address: t�� o, Reg. No. FEE SCHEDULE:BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 TE R S.F. Total Project Cost :$ 131 !;R-0 xl2.00=FEE:$ tb'6,00 5l Check No. 1 Receipt No. fq : V Page I of 4 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped flans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM U/L-,PLANNING & DEVELOPMENT Reviewed On � Signature � COMMENTS 1� �.z )Y 'CONSERVATION Reviewed on Si natureL COMMENTS �� � l/� �J�; rr� a C) HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Firs Department signeiture/date COMMEi\ITS � _- AM NORTH Town of iticiover E. ... �" ® ";" 0 .000010 No. 2b I , tr,.ca it ver, Mass,j COCHICHEW.0 �A°Rgr€o r1Cl U LPERBOARD OF HEALTH Food/Kitchen Septic System T T_ THIS CERTIFIES THAT BUILDING INSPECTOR Foundation. has permission to erect ......... buildings on ......:. ................. ......,...... ................ . ® ` ......... ................... Rough Tl\ to be occupied as . ...... .. . ...:..... 1n"44L11%..... . .. .... Chimney .............. ............ ..... . provided that the person accepting this permits II ina!s.' pectconform to the terms of the applicat on 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. ` ri� fb+T ®�� s® PLUMBING INSPECTOR �""TK1 S{ • Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. 1 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS C T I T Rough Service .. ......`. .. .. ..71A�P�EiCTOR ......... Final ,4 BUIL G GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedy the Building Inspector. Burner Street No. Smoke Det. Page 1 of 5 Nexus II Carpentry and Construction Design P.O.Box 2823 Woburn,MA 01888 781 760 2031 Fax 978 9751263 niarWnexuscarpentry.corn www.nexuscarpentry. CS#-073991 MC#129177 Contract This is a contract between Lawrence Savoia of 22 Harwood Street, North Andover MA 01845 (Hereafter referred to as the"owners" or"owner") and Nexus II Services (hereafter referred to as "Nexus") dated June 27t'2016. GENERAL SCOPE OF WORK DESCRIPTION WE HEREBY SUBMIT SPECIFICATIONS AND CONTRACT FOR: work as stated below for deck and side entry upgrades Scope of work: General details o Meet with local building official and apply for permits ® All work will be in accordance with local building code regulations and will be inspected by local officials prior to continuing with the next phase—Nexus will be responsible for arranging and being available for all inspections ® All work will be coordinated directly between"owners", architect if required and Nexus ® Nexus confirms that it is licensed,insured as required and ensures any sub- contractors utilized on this site will have the appropriate insurance coverage ® Nexus will be responsible for the safe storage of all its property and any materials to be used on the site. Any items left on site will be covered under Nexus insurances ♦ Owner is responsible for removal and return where necessary of all items within the work area and their safe storage prior to our work commencing 0 Owner will then be responsible for returning all items to the area after completion of the scope of work SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT Page 2 of 5 ® Nexus will remove all trash associated with this project into a Nexus supplied dumpster and arrange for safe disposal in to a registered site—if required ® Nexus will contact Dig Safe" and confirm all utilities location—if required Scope of work—rear deck; ® Remove and trash the existing deck boards and handrails from the existing frame work ® NOTE: the existing joists and posts, supports and foundations to remain"as is", however, if issues are found,then this is to be brought to the attention of the"owners" and the building inspector for advise on how to proceed ® Furnish and install Azek Slate grey with hidden fasteners NOTE: per' eter boards and stair treads cannot have hidden fasteners _ S ��s , ® Furnish and install White vinyl post sleeves CA Com' y ® Furnish and install white solid vinyl handrails with square stock ballesters - http://www.intexmillwork.com/pro ducts/railing-system s/lib erty-extruded-rail- s stem ® Furnish and install white composite trim boards to shirt boards, risers and stringers Of— * NOTE: the underside of the deck will not have any lattice work, but will be"open plan' ® Proposed cost including materials and labor as noted above is $8, 870.00 S Scope of work—side entry with new roof; VD s Remove and trash the existing deck boards and handrails from the existing frame work ® NOTE: the existing joists and posts, supports and foundations to remain"as is", however, if issues are found,then this is to be brought to the attention of the"owners" and the building inspector for advise on how to proceed ® Furnish and install Azek Slate grey with hidden fasteners NOTE: perimeter boards and stair treads cannot have hidden fasteners 0 Furnish and install White vinyl post sleeves ® Furnish and install white solid vinyl handrails with square stock ballesters - http://www.intexmillwork.co.p/products/railin igy-systems/liberly-extruded-rail- sstern ® Furnish and install white composite trim boards to skirt boards,risers and stringers ® Furnish and install a white vinyl lattice to underside of existing framing and onto the surface of the existing foundation of the entry area only ® Furnish and install framework to create an angled roof over the staircase utilizing the existing layout ® Furnish and install exterior grade sheathing to the new roof framing ® Furnish and install flashing detail to the new roof sheathing ® Furnish and install a roof shingle to match as closely as possible to the existing roof shingles on the home ® Proposed cost including materials and labor as noted above is $4, 710.00 SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT Page 3 of 5 The above quotation does not include the cost of any of the following and in some cases where stated allowances have been given to assist you in selection. If requested,we would be happy to provide any costs on items listed below,if not here stated; Permit costs,unseen conditions, and architect or engineering costs Painting or staining or prep work Changes to any existing plumbing or electrical fixtures Upgrades to existing utility conditions or structure moving of personal property —Asbestos remediation of any land All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control owner to carry fire,tornado and other necessary insurance.Our workers are fully covered by Workman's Compensation Insurance. PERMITS "Nexus"has accepted the responsibility to obtain the necessary building permits."Nexus"will act as a GC and work in accordance with fair and reasonable practices,and cooperate fully and under the guidance of the"Owners"and authorized parties. Standard Exclusions: Unless specifically included in the"General Scope of Work"section above,this agreement does not include labor or materials for the following work(any Exclusions in this paragraph which have been lined out and initialed by the parties do not apply to this Agreement): Removal and disposal of any materials containing asbestos or any other hazardous material as defined by the EPA. Custom milling of any wood for use in project. Moving"Owners"property around the site. Labor or materials required repairing or replacing any"Owners"-supplied materials. Repair of concealed underground utilities not located on prints or physically staked out by"Owners",which are damaged during construction. Surveying that may be required to establish accurate property boundaries for setback purposes(fences and old stakes may not be located on actual property lines). Final construction cleaning("Nexus"will leave site in "broom swept"condition). Landscaping and irrigation work of any kind. Temporary sanitation,power,or fencing. Removal of soils under house in order to obtain 18 inches(or code-required height)of clear space between bottom of joists and soil. Removal of filled ground or rock or any other materials not removable by ordinary hand tools(unless heavy equipment is specified in scope of work section above),correction of existing out-of-plumb or out-of-level conditions in existing structure. Correction of concealed substandard framing. Removal and replacement of existing rot or insect infestation. Construction of a continuously level foundation around structure(if lot is sloped more than 6 inches from front to back or side to side,"Nexus"step the foundation in accordance with the slope of the lot). Exact matching of existing finishes. Repair of damage to roadways,sidewalks,or driveways that could occur when construction equipment and vehicles are being used in the normal course of construction.The"Owner"is to enter into contracts for all of the above-mentioned services and provide direct payment to"Nexus"for all of the services we are to provide."Nexus"will be responsible for removing all components and all construction materials relevant to the "scope of work"in this contract. Dumpsters,trailers and suns "Nexus"will provide as included in the cost of this project,a dumpster for the sole purpose of the removal of trash associated with this project.This dumpster should not be used by any persons for any other waste items or for any purpose outside of the specific use under the scope of work,unless authorization is received from"Nexus".Nexus may have on site for part,or the whole of the project,a trailer containing materials and tools belonging to"Nexus".This trailer will be parked in a position agreed to in coordination with the"Owners"and will be covered under the insurances of"Nexus"at all times."Nexus"will have on site,a sign,with our contact details,in the event that anyone, including your neighbors,has a need to contact us directly. Photographs "Nexus"reserves the right to,from time to time,take photographs of the contracted work for use in its general marketing or for production on its web site.At no time will"Nexus"share any personal contact details of the"owner" for any photographs that it may use without seeking authorization from the"owner". SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT Page 4 of 5 Warranties All the components supplied by"Nexus"as part of the original order are covered under the warranty exercised by"Nexus"and supported by the vendors or sub-contractors.All labor and materials purchased from other suppliers to achieve completion of contract are warranted(1)one year from completion of the construction. Owner appointed sub contractors From time to time an"owner"may request that we incorporate a sub-contractor of the"owners"choosing on a project."Nexus"will facilitate this request provided the assigned sub-contractor is connected directly with"Nexus"for all scheduling requirements and "nexus"will manage this sub-contractor in a fashion comparable with any other sub-contractor.All sub-contractors must be licensed and insured in accordance with State law."Nexus"will meet with these sub-contractors and will ask them to submit a written proposal of all the work that will be included which"Nexus"will then confirm with the"owner"."Nexus"will oversee this scope of work and ensure that it is completed in a professional manner but the sub-contractor will be responsible for any future warranty issues directly with the"owners".All sub-contractors are responsible for the safe and clean upkeep of the working environment and will be responsible to remove their associated trash on a daily basis. Deliveries "Nexus"will be responsible for the safe arrival to site of all materials required for construction purposes for items contained within the scope of work.The"owners"shall be responsible for the safe arrival to site of other items outside of construction materials, however,should"owners"require"Nexus"to collect and bring to site,any of these items,"Nexus"will accommodate as able and add a minimal cost to cover time and fuel to a change order. Weather Delays Nexus has made provision to attend the site throughout the project,and as weather allows—any changes to this schedule will be advised to the client as appropriate.Inclement weather,inclusive of hurricanes,tomado's,snow storms and other events,will affect the ability of Nexus to attend the site,and will therefore affect the ability of Nexus to perform those tasks assigned within this contract.In the event of an unplanned weather event,it is the responsibility of the`owner"to ensure that access to the site is maintained,so as to allow for work to recommence as soon as possible. Personal Property,Pets and Children "Nexus"will be respectful at all tunes,of the personal property of the"owners"but does ask that all personal items be removed by the "owners",prior to commencement of the scope of work,and not returned to the area until the scope of work is complete.It is the responsibility of the"owners"to make alternative arrangements for the safety of any pets that dwell in the residence,or facility,and "Nexus"will not be responsible for the care of these pets,or other live animals,during the duration of the scope of work.Children living in the residence,or facility,should be advised by the"owners"of the dangers connected with construction projects and the need to stay clear of the areas being worked upon,as well as away from any tools that will be on site. Allowances with the contract cost Within the cost structure of this contract,certain cost allowances may have been given for the"owners"to purchase items chosen by them—these allowances will be noted above with the amount allowed clearly noted.If the"owners"do not spend the full allowance in an area,this amount will be credited back to the customer and not included in the final contracted amount.If the"owners"spend beyond the allowance noted,then the"owners"shall be responsible for this balance and a payment made to cover this amount either to the vendor,the sub-contractor or to"Nexus" Expiration of this Agreement. This Agreement will expire 30 days after the date at the top of page one of this agreement if not accepted in writing by"Owners"and returned to"Nexus"along with the necessary deposits within that time frame. People Authorized to Sign Change Orders: The following people are authorized to sign Change Orders: "Nexu ? 1 /otobed or Ged White "Owner/Owners": La46,edce Savoia SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT Page 5 of 5 Concealed Conditions: This Agreement is based solely on the observations"Nexus"was able to make with the area in its current condition at the time this Agreement was bid. If additional Concealed Conditions are discovered once work has commenced which were not visible at the time this proposal was bid,"Nexus"will stop work,and point out these unforeseen Concealed Conditions to"Owners"so that"Owners"and"Nexus"can execute a Change Order for any Additional Work. Changes in the Work: During the course of the project,"Owners"may order changes in the work(both additions and deletions). "Nexus"will determine the cost of these changes and the cost of this additional work will be added to "Nexus"profit and overhead. Schedule of work It is agreed by both parties that this work will be coordinated with the"Owners"and "Nexus"to be undertaken in various stages to avoid complete disruption of the home environment. "Nexus"will give"Owners"no less than 2 days notice prior to arriving on site for commencement of any,of the agreed stages of work to allow"Owners"to prepare."Owners"commits to have sites identiied for construction work available for start at the beginning of the scheduled day so as to avoid any unnecessary delays. Contract Cost and Payment Schedule: Total cost of work description and materials included in the proposal(except materials/work stated) - $13, 580.00 (Thirteen thousand, five hundred and eighty CY dollars and zero cents) jo PAYMENT SCHEDULE 1st Payment due upon signing this contract TOTAL $4, 000.00 2nd Payment due upon substantial completion of 1 phase TOTAL $4, 000.00 3rd Payment due upon substantial completion of 1 phase TOTAL $4, 000.00 Final payment due upon completion of scope of work TOTAL$1, 580.00 Amount due upon signing this contrac is $4 000.00 I have read and understand, and I agree to, all the terms and conditions contained in the pro osa above. 3d 1-6 Date A .. ......... .............. "Nexus"Authorization................. . .......... ....................... Date.......... ................. Owner/Owners Authorization ........................ ............. ............ SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT �-\ The Commonwealth of Massachusetts Department of IndustrialAccidents > X Congress Street,Suite 100 Boston,MA 021.14-2017 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers. TO BE FMEA WITH THE PERM TTING AUTHORITY. Applicant Information c Please Print Lezibly Name(Business/Organizaati /In ondividual): ANe—YU S ��d Ice S Address: Y .O • `Z(Zoo(, 2�L--�� City/State/Zip: V�d b r\ " O 1 qlao&- Phone #: --)?1 . -760 :Z03 Are you an employer?Check the appropriate box: Type of project(required): ' L❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp-irrsur3rrce required-] 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required_]t 9. ❑Demolition - �~-ry 1Q ❑Building addition 4.u I am a homeowner and will be hiring contractors to conduct all work on my property_ I wilt ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.�am a general contractor and I have hired the sub-contractors listed on the attached sAt. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance? ON (41 e- 6. 6.F]We aro a corporation and its officers have exercised their right of exemption per MGL c. 14.E]Other 152,§1(4),and we have no employees.[No workers'comp.insuranc-e required-] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information_ t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indimi ing such_ tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number, lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/StatelZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A 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 of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and d penalties ofperjury that the information provided above is true and correct Si ature: Date: 6[Z-7116 . Phone#: 'l 9-( -760 20 3 k Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACOOR00 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/28/2016 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lauren Goldman NAME: Cross Insurance-Peabody arc°NNo Ext: (978)532-5445 �� No):(978)532 139 Lynnfield Street AIL ADDRESS:lgoldman@crossagency.com INSURERS AFFORDING COVERAGE NAIC# Peabody MA 01960 INSURER A:Western World Ins. Co. INSURED INSURERB:Safety Indemnity 33618 Nexus II Services LLC INSURER C: P.O. BOX 2823 INSURER D: INSURER E: Woburn MA 01888 INSURER F COVERAGES CERTIFICATE NUMBER:CL15102253381 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 -rypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR NSD WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ NPPS290737 8/12/2015 8/12/2016 MED EXP(Any one person) $ 5,000 PERSONAL R ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: Damage to Rented $ 50,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident B ANY AUTO BODILY INJURY(Per person) $ 500,000 ALL OWNED X SCHEDULED 3116632 11/10/2015 11/10/2016 BODILY INJURY(Per accident) $ 500,000 AUTOS AUTOS NON-OWNED PenER a cident DAMAGE $ 100,000 HIRED AUTOS AUTOS Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PERT OTH- AND EMPLOYERS'LIABILITY Y/N STAUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A - (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ T_ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lawrence Savoia THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 22 Harwood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Lauren Goldman/MD1Q ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 onl4mt / /, / G / / /. r y i/ / r/✓/ // ./, ., 1, i, ,,...... IN ✓,/ r. / of / /„1” / / �,,, r. / fr Or .,:,// rc,.r e, .,," ., .„r / r,; /„ ,/1 , ,:,/ „✓/ // e ,,. %/ /,rr,.,r..� // / /yOr r a, �/nr/�..- �i/�:/ / �/! ,.: / ", a ,:,. 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