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HomeMy WebLinkAboutBuilding Permit # 8/25/2016 OORTH BUILDING PERMIT O*�tLltl TOWN OF NORTH ANDOVER o= APPLICATION FOR PLAN EXAMINATION e Permit No#: — bate Received, ` �Rnrea+'ea .[5 � � RSS�ICHU`'�� Date Issued: ZS IMPORTANT: Applicant must complete all items on this page ° ., �%�� LOCATION � � "�`���� ��°.��,� . .1 Print PROPERTY OWNER 643 'la 5+-C 4 , S Print 100 Year Structure yes MAP C? 9 0 PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes 49) TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building KOne family ❑Addition ❑ Two or more family ❑ Industrial gAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other II Septic l We1I f ' C1 Floadp�a�n, D Wetlands ,` 0 Vlfaterskaed`D�stnct F II Water/Se a '" s y ` 'Ay "xA pw4 DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: � :ie + .6 s 54- Phone: Address: �4 i r c Contractor Name: Phone: - Email: �r�.. � •� ��„� . , . I Address: . � Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: ` 3 Address: Reg. No. `t 1 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F, Total Project Cost: $ 0 0 FEE: $ � ' Check No.: Receipt No.: ­�1161'4_03 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ..... ............... IAORTI '4 Town of c1 _ 11, 6 over 0 Pik. - to No. a d.07 AILs� � p ver, Mass, Ap� .q p04ATED. SN u BOARD OF HEALTH Food/Kitchen PER L D Septic System THIS CERTIFIES THAT ................ IT � .................... � BUILDING INSPECTOR ... ... � ............ ........... . ..........,....,....... has permission to erect ..... ................... buildings on 4 .., .#., , ... ! .,,, Foundation Rough C)A t0 be occupied as ..... .....� .,...lt. n}r , .. . !!.�.Aft��,.,� . !!: ....rlication ..... Chimney provided that the person accepting this permit shall in every repect conform to the terms of the Final on file in this office, and to the provisions of the Codes and By-Laws reling to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. ij PLUMBING INSPECTOR f"W" VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONS CTI® Rough Service . ...... .. ......Pa...... ....., Final N SPE OR GAS INSPECTOR Occupancy Permit Required to Occupj7 Building 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 Approved by the Building Inspector. Burner Street No. Smoke Det. 7ESTA Building and Remodeling Start date 5 APPI.E"['ON S 1"REET F"Inish date NO1° '141 AND()VER, MA 01845 HIC 1-ic. 120296 Explires, 11/19/17 (978) 682 2023 CSL I.Jc. CS 54718 Expires 6/8/16 Proposal March 28,201.6 Proposal Submitted To: Gaye and Chris Stevens Phone: (978) 974-0073 42 Tangle wood Lane North Andover, MA 01845 Job: Remodel kitchen Obtain building permit Complete removal of all demolition and construction materials Generated by Testa Building and Remodeling and its subcontractors. DEMOLITION: Remove all cabinets, counter tops, appliances,tile floor and underlayment, walls, ceiling And remove all insulation. CONSTRUCTION: Move the door opening that goes into the family room. Patch the wall to match the existing room. Block up the doorway in the current dining room into the family room. Remove the existing window and frame a larger opening to receive a new Anderson 400 series Casement. Patch the siding and trim on the back of the house. Remove the center wall that divides the kitchen and the dining room. Install a steel beam that was designed by the structural engineer.Add a Lally column in the basement under the new point load. PLUMBING: Kitchen sinks to stay in same general location.Add plumbing in the island for the prep sink. Hook up the rest of the kitchen plumbing fixtures. Vent the hood over the cook top vent to be in the back yard. Install new toilet and vanity in half bathroom. Note: There is no allowances for plumbing fixtures ELECTRICAL: Add new circuits in the kitchen area where needed. Rewire kitchen to code. Supply and install 18 recessed lights. Wire all new appliances. Wire and supply one angle plug strips on the island. 3 pendants over the island. Install a now sub panel in the garage or the closet in the basement. Note: There is no allowances for light fixture other than the Recessed. INSULATION Insulate the walls and the ceiling to code. PLASTER: Hang %blue board and plaster all walls and ceiling. CARPENTRY: Install all the kitchen cabinets and molding as per the designers drawings. Install new trim in the kitchen around the windows and dors to match the existing trim in the house. Installation of all kitchen appliances and wood fronts. �'vA%S 5v zwt-�u��s 1'3v�t out A K3% Jhall, t:.�L f b Z `�`EF C- 1' LF-s ,nac� N -Vq'ENote: There is no allowance for cabinets and or countertops.FLOOR: Prep the floor for tile. Install Ditra underlayment throughout the kitchen area the back laundry and half bathroom. Install large format tile allowing grout lines as expansion joints. TILE: Install tile along the back splash. Labor and adhesive supplied by contractor. Note: There is no allowance for tile or grout. PAINTING: Prime and paint the ceiling, walls, and new trim in the kitchen and in foyer. Paint any areas in the basement that gets disturbed. 0 9 ITEMS YOU NEED TO SUPPLY: i Kitchen Cabinet Granite Appliances Lighting such as: Pendants for island Under cabinet lights Plumbing fixtures such as: Sink Faucet Disposal Tile for backsplash and floor Grout Bathroom Vanity Vanity top Sink Faucet Toilet Aftnance charge of 11/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of: 59,790 Fifty Nine Thousand Seven Hundred Ninety Dollars One- third to start, one-third after rough inspection, one-third u o completion. 'e-""rc' u 0 signature Authorized 7sign ture fj� r I reserve the right to cancel this contra if not accepted in_30 days Signature Signature4! DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES This form satisfies all basic requirements of the state's I lome Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners.Seek legal advice if necessary.Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) Express Warranty-Is an express warranty being provided by the contractor? El No 0"' Yes(all terms of the warranty must be attached to the contract) Subcontractors -The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract. Don't be pressured into signing the contract,Take time to read and fully understand it.Ask questions if something is unclear. Make sure the contractor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. 9 Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. 9 Know your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DC7 T SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES111 Two ies of the coti-actul the completed and signed.One copy should go to the homeown .—he other copy should be kept bye thea contractor. Home er s S ire on rac r s Si tore , 7761 Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor, however.The contractor would have to resolve any dispute be/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit the dispute to a private arbitration firm which has - be if a proved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the co sut er shall b required to submit to such arbitration as provided tn Massachusetts General Laws,chapter 14 A. I oi e wrier' Signature Contractor's Signature ----------------------- FINALCOPY 304.00" 25.50" 227.50" 125.50" W22.536 WZ2.53b T623.590' 6 X 54 END PJEL WH4824-21 TO3090;OVENS 18"DEEP 3654 FRIDGE W!PANELS (4)TRAY DiUS FLUSH TOE 15"DP 54"X 84"OPE NG 625;D53 28;D53 FLUSH TOE R 1,5 B36;DS3 3 ADD 637;COOKTOP SPICE DRA CUTLERY TB23,590 ESIt 1.S WAIHS.75-9026 (2)POD LEFT SIDE 18"DEEP 26"DEEP FLUSH TOE W18 TEP.75�0 26 ESR 2 97.50 81S 36 D/W PANEL 2-SIDED COLUMN 2-SIDED COLUMN 6.75 X 34.5 X 6.75 6,75X34.5X6.75 B24; 648;(4)POD 824;PIC SINK KNIFE INSERT 194.25" SB36; BEP 6 X 34-1,12 X 56-3/4 5ItdKWAINSCOT PANEL BEP 6 X 34-1/2 X 56-3/4 INTEGRATED ON SIDE WAINSCOT PANEL WAINSCOT PANEL } 96 X 34.5 INTEGRATED ON SIDE B24; I POWB2 2-SIDED COLUMN 2-SIDED COLUMN 6.75 X 34.5 X 6.75 f 6.75 X 34.5 X 6.75 VV1S B18 36 3654; G� RA 15"DP 836;DS3 LASS L STILE DOWN DEC L i DEC L f 0 1 4 z For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800, 508-755-2548 or 413-734-3114 Version 2.E---11/22/201 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPISE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place of Business] NOT LATER THAN MIDNIGHT OF (date). I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: p0 3 a i 0 i NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Conti-actor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A) may not be waived in any way, even by agreement. However, homeowners may be excluded from certain rights if the contractor they choose is not property registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described, in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your cons utner/homeowner rights, contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract, and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170,Boston, MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the HIC website at littp-,//www,iii,,iss.gov/c)cabt•/ Go online to view the status of a Home Improvement Contractor's Registration: JOB ., ",... FIX ENGINEERING 2 Silver Led Road Ne M 01951 CALCMArEO DUE Email: jflx@comcast.net CHWhCEDBY._ DA't'L. ....w._. ..........��, ._w�a.. s�rrrm. .... .. .. ..... ..... n . "ell Of N4 OI . tiffs T 1 .3 � wIle to) ooze w ,7 s a 1 . 4, 1 M i .... „N f �.u, i�.mowaowo Nuw!�urrc�mm�m Ql�Niw�ru.�wm+dwt tp wvwow�o�ortawrao�r'a� �µ � V � � ... "� e . ....1�................o.. u " -8 FIX ENGINEERING JOB--- 2 Silver Le e Road 1901951 DATE- 978-462-4331 Email: jf1x@comcast,net CHECKEDDY ....... ............... uN r 7.......... Pv, M� W. Mol, #,47? A JOSE x X" v CG :- C�T/rc l('c:rJ[naca�r[r+�c[��i[c/n/�GrrJ3rtc�dSefCJ pffice of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registrati0n 120296 Type: v - Expiration: 1 i11'4/2017 DBA TESTA BUILDING&REMODELING ' ! JAMES TESTA 5 APPL:ETON STREET r- N.ANDOVER,MA 01845 Undersecretary � I ==' Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-054718 Construction Supervisor JAMES M TESTA 5 APPLETON 5T N ANDOVER MA 01845 Expiration: Commissioner 0610812018 _ The commonwealth of ma_ssachelts z .•• F Department of ndustrialAccidents a I Congre-SS street, suite 100 =:f Rostog,M. 02114.20. 7 -w www.mass gov/dia W4a?&exs'Coanpe)nsationfi suraxLceAffida-vit:)3uRdexs/ContractorsLEXec4lczansf'Iumhers. TO BY YMED WI E1 T G'PERWT TMG AU'7 RORiT ' A licant Information Please Print Le ` I a qe (Susmess/osgamzattowT div-tdual): A.d:dross: City/State/zip: n1C1a'c- M lel n 1,64� Mons 1 • Axeyou an employer? Check,tiie aj)i opriaie'hox: Type of project(xgquit'ed)` 1.0 1 am.a employervJith I euupinyees Gall audlorpart time).* 7.• Q New co-jisttuction 241 am a sole proprietororparinersHp andhave no employees nvorking Berme in 8. gRemodelirig any capacity.[No workers'comp.insurance required.] 9 Demolition 3.❑I am a homeumer doing all workmysei£[No workers'eomp..insurauce required]t 10 Fj Building addition. 4.❑1 am a homeownax and wilt be hiring contractors to conduct all work an my properly. 1-WE' 1. Electrical Te airs oradditions dditians ensure that all contractors either have workers'compensationiosurance orare sole 1.!1 1 p proprictors withno employees. 12:C[Plumbing repairs or additions 5.❑I am a general contractor and I haye hired the s€€b-contractors Listed on the attaohod sheet 13.O Raof repairs 'I°hese sub-contractorsiiave employees andhaveworkers'comp.insivanae.� 14.❑Offer 6.0 We are aoorporation and its off�eers'have exercisedtl e light of'exemption perMGl,c, 152,§1(Q),audwehaveno.,ernployees.[Noworkers'comp.insuranoerequired.j ^Any applicant that checksbdx*1 must alsordl.out the section below showiugihe' workers'comp ens ationpolicyinformation. i Homeowners vvho sulirjuf�tvs at�davit indicaftthey are doing all work and thenhLr outside contractors mussts4bmit anew affidavit indicating such. ?Contractors thttcjed an additional sheet showizsg thG name of the sub-contractors and state whether oznotthose entities have at check this box must'aa employees. 7CBtho sub corlliac`tors have employees,[liey must providetheir workers'comp.policy number. X uizx an eraxployer tliat kprovidir2g-workers'compensation insuvancefor my employees.'Below is thepolicy aridjob site infai�rzatiori. - Insurance Company Name: Policy#or Salf ins.Lic.#: Expiration Date: Sob site Address: City/state/Zip: Attach a copy of the workers'cbmpensaflon policy declaration page(showing the policy number and expiration.date). Failure to secure coverage as required imderMGL c. 152, §25A is a criminal violation punishable by a fmc up to$1,5GM0 and/or one--year imprisonment,as well as civil penalties in the form of a STOW WORK ORDER and a fine dup to$250.00 a dap against the violator..A,copy of this statement may be forwarded to'the Office,ofSnvestigatians of the DTA for insurance coverage vexii~[catiazi.. ' X da hereby cerci under the pains andpenalties ofpetjr�ry t1tat the in forrrtcction provided above is true and correct Si atare_ D.o Jr' f Phone#: 7 Q,--+3 offzczar use only. Do not Wite in this area,to be completed by city or tolvn official City or Town: Permit/License# IssuingAuthority(circle one): i I.Board of ffealth 2.)BuildimgDepartment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other Contact Person: Phone#c � CERTIFICATE OF LIABILITY INSURANCE DATE[MMf�D�I ,16 ACORO 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(!es) 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[leu of such endorsement(s). PRODUCER CONTACT NAME: Testa R.W. Testa Insurance Agency, I PHONE FAx Egil (9781 6551150 A! N9: (978) 681-90U2 855 Turnpike Street ADDRESS: rich@testainsurance.cam North Andover, MA 01845 INSURE R(SJ AFFORDING COVERAGE NAIC# INSURER A:COMMERCE INS CO INSURED INSURER 13: Testa Building And Remodeling INSURERC: 5 Appleton Street INSURER D: North Andover, MA 01845 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. AWL AL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE p POLICY NUMBER MIDDIY MMIDDIYYYY LIMITS A GENERAL LIABILITY 516388 6/1/16 6/1/17 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PRPMISFS(Eanrruffy $ 100,000 CLAIMS-MADE I-XI OCCUR MED EXP(Anyone person) $ 5 000 PERSONAL&ADV INJURY $ 1 000 000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-GO MP/OPAGG $ 2,000,000 POLICY n PRO- n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT aaccidenl $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNEDPROPERTY DAMAGE $ HIREDAUTOS _ AUTOS eraccident UMBRELLALIAB OOGUR FACHOCCURRENCE $ EXCESS LIAB .. CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN I FR ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDEINT $ OFFICERWEMSER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ IV es,describe under DSCRP€IOiN OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD tot,Additional Remarks Schedule,If more space is requi red) 42 TANGLEWOOD LANE, NORTH ANDOVER, MA 01845 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 STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE RICHARD W TESTA JR © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: