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HomeMy WebLinkAboutBuilding Permit # 9/8/2016 F XAORTFI BUILDING PEI IT �o TOWN OF NORTH ANDOVER p APPLICATION FOR PLAN EXAMINATION Permit h9£7: Date Received Date Issued: " SACHU I PORTANT AEplicant rczust com fete all mems on this page /i �✓iii � �� // / /i � ., o� iii//// �. /✓ . �/i � / /,_ / � / �� � � �,,,,,, ///✓ / % /. r / /a %%iiia,.. � ai ri ,,,��� / �� ,. �.i. � /.�//iii/ ,�..! �/ /..✓ / i/;,.. ,,,;, ,,,.,/,i //s i� , /�: P//-`'��RGEL��,� �/���ONI'N �/ ,,, / iii /ii �, � /i / ,; �, ///G lei,/ice/ ,,,off.//,,.ii �/,�i,✓,i,,,a//,,,,�,/r..aiii ,orc,ea/,./ ���il�//i///�F,va�/fir//c,�/!f,�i%�//r.: / ,,,,,� i�o�.. - i,i�i✓,�/V��Ia,g�ii,�/✓L7;?"`�'�i, � r„/ TYPE.. OF IMPROVEMENT PROPOSED USE Residential Non- Residential CI New Building LJ One family 11 Addition E-I Two or more family ❑ Industrial El Alteration No. of units: 1 Commercial ❑ Repair, replacement I:] Assessory Bldg F1 Others: 1J Demolition I therL- b Septac Well/ l l Floodplain r�/Wetlands l Watershed District / ter/,Sewer Identification Please Type or Print Clearly) OWNER: Name: SC. v �a�i� Phone:l,7t` q 71-062 Address: ren r CCJNTRACTO Name Phone ,. / �/ / Address / / ?// f�� u erul ar or true ion, 0 Cy r t�tcense; /� // /i„�,/% /i a ////„ '�;� /E a / / ' // // „i ;;�,�„ //i/a/ ///ilii�����a�r/a%//o =a „ !..:,,,, ,� /✓; / a//,.�,a/ �/ ,,,,,///,/////%// ;,-ri„c' ,;�,,; ai�i: // ,/ ��,. /, ,,i% ,,ai ai„� ,Hoe I rose an/,,Llense / v ,3 ;, ,, '`E ”""Dote /� /iii,;/l�j////:j//ii%//� „//ai�,✓;; r /i a /vii � i / r / ��� ✓r �/ /%///i/,� ARCHITECT/ENGINEER _ r 5� La_e Phone: 6—( 775— Address:-113%, . 77Address: l %, 5 ,S e Reg. No. 4*77yo FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED,COSTBASED ON$125,00 PER S.F. Total Project Cost: $ FEE: $ ' . Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �� Signature of contractc�r "" 4 __. txH oR e "1 Town of _ 6ndover 1 '�rh ver Mass O LAKE ? cac.,Ic«ew.cK � ORATED N4�,t'�5 S U BOARD OF HEALTH Food/Kitchen PER IT . LD Septic System THIS CERTIFIES THAT ......... ` , .........., BUILDING INSPECTOR ...... .... ....................................... A��L Foundation has permission to erect .......................... buildings on ... .............. ..... .,..............,... .,......................... . . ....,. ... l .. .... ..'. Rough t0 be occupied as ... .......... Chimney provided that the person accepting this pe it shall in every respect conforV to the terms 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS C®NST I®N Rough Service ., .. .. .... ....... ... Final BUIL G ! ECTOR GAS INSPECTOR Occupancy Permit Required to ®ecu RuRough 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. ECTOR1n Project Number: U1883-0216-161 September 1,2016 RevoluSun I North Avenue Burlington,MA 01803 ATTENTION: lan Clifford REFERENCE: Sanjay Kudtakar Residence: 105 Leanne Dr,North Andover,MA 01845 Solar Panel Installation Dear Mr.Clifford: Per your request, we have reviewed the layout and photos relating to the installation of solar panels at the above- referenced site.The following materials and components are proposed in the installation of the solar panels. Roof Structure: 2x10 Rafters at 16"O.C. Roof Material: Composite Shingles Based upon our review, it is our conclusion that the installation of solar panels on this existing roof will not adversely affect the structure of this house. The design of solar panel supporting members and connections is by the manufacturer and/or installer. The adopted building code in this jurisdiction is the 2009 International Building Code and ASCE 7-05. Appropriate design parameters which must be used in the design of the Supporting members and connections are listed below: Ground snow load:50 psf per Massachusetts amendments to the IRC(verify with local building departryient) Design wind speed for risk category 11 structures: 101 mph(3-sec gust) Wind exposure:Category C Our conclusion regarding the adequacy of the existing roof is based on the fact that the additional weight related to the solar panels is less than 3 pounds per square foot. In the area of the solar panels,no 20 psf live loads will be present. Regarding snow loads, it is our conclusion that since the panels are slippery and dark, effective snow loads will likely be reduced in the areas of the panels.Solar panels will be flush-mounted,parallel to and no more than 6"above the roof Regarding wind loads, we conclude that any additional forces will be negligible due to the low profile of the flush-mounted panel system. It is our conclusion that any additional seismic loadings related to the addition of these solar panels is negligible. During design and installation,particular attention must be paid to the maximum allowable spacing of attachments and the location of solar panels relative to roof edges. The use of solar panel support span tables provided by the manufacturer is allowed only where the building type, site conditions, and solar panel configuration match the description of the span tables.Attachments to existing roof joist or rafters must be staggered so as not to over load any existing structural member. Waterproofing around the roof penetration is the responsibility of others. All work performed must be in accordance with accepted industry-wide methods and applicable safety standards, Vector Structural Engineering assumes no responsibility for improper installation of the solar panels. Please note a representative of Vector Structural Engineering has not physically observed the roof framing. Our conclusions are based upon the site assessment and information provided by Revolusun and the understanding that all structural roof components and other supporting elements are in good condition, free of damage and deterioration,and are sized and spaced as outlined in the site assessment performed by Revolusun. Very truly yours, vEc'rOR STRUCTURAL ENGINEERING,LLC -1%OF AQGER T. A H Roger T.Alworth,P.E. IVI Principal 0 RTA/wsp NAL, 09/01/2016 -1775 F (801) 990-1776/www.vectorse.com 9138 S. State St., Suite 101 Sandy, UT 84070 T(801) 990 [� [�\ //�I | | � ��J� T� [ V �/Lk) � ����0`� THIS HOME IMPROVEMENT SOLAR ENERGY CONTRACT(this'Contmct1|GBETWEEN:Sanjay Kodtarkar&MomtaLohla("OUient")located mt1O5 Leanne DrNorth Andover,MAOi845('CUmnt'sPmporty") -AND- Northeast Solar Services, |no/WDBA nevo|uSun Burlington,MAV1803,with Home Improvement Contractor Reg. No, 17W137.which expires onMarch 17.3U18,and Federal Employer|D46056g85D.Contractor's sales person for this contract|mBrian Sadler. The parties mthis Agreement agree msfollows: 1.BCORE OF WORK A. The above Client(s)has engaged Contractor to perform the following residential contracting work(the"Work")in connection with the Installation of the following photovoltaic solar energy system(the"PV System"): 29 Panasonic-Panasonic N325 watt modules(pr aqu|v*|anV with 1 Solar Edge-Solar Edge SE 7600A Inverter(onaqu| | d all mounting, disconnects,and all other PV System components necessary for a National Electric Code compliant PV System,totaling 9.426kW,located at Client's Property. R'Other JndusluomThe Work shall further Include: Installation of the PV System in accordance with all State of Massachusetts Interconnection standards. ,All reasonable engineering and permitting costs. The following building permits are required and will be secured by Contractor as Client's agent:Building and Electrical Permit. Following the Installation,Client will receive a PV System orientation and a PV System Client's manual. NuVoa: It shall be the obligation of the Contractor to obtain all permits related to the Work. Clients who secure their own permits will hmexcluded from the guaranty fund provisions nfChapter 142Auythe Massachusetts General Laws. 11,COMPENSAIION AND SCHEDULE A.Contract Price For Contractor's performance of the Work under this Contract,Client will pay Contractor a total of.' $84.4g6.0V(THIRTY FOUR THOUSAND FOUR HUNDRED NINETY SIX AND 9R/10V)DOLLARS USD(the"Contract Pdoe1. B.Payment 5ghedulp The Contract Price will bnpayable|naccordance with the following payment schedule: Date Paid: $17.248.49 Initial Payment-50Y6 (Due upon Contract signing,which|oanamount leas than the cost ofthe materials and equipment . which must be specially ordered In advance of commencement of PV System installation) S 15,523J64 Progress Payment-45& (Due upon Substantial Completion) XL1JI4J85 Final Payment-5% (Due upon Final Completion) C.�chedulp The"Start Date"of this Contract Is the date Contractor receives the full amount of Client's Initial payment of 60%of the Contract Price. Subject hoadjustment for any Force Majeure reason stated In Section IV.J.,the Work is estimated to begin within 12-16 weeks from the Start Date of this Contract.The parties agree that this date shall be automatically extended to the date of delivery of all materials and equipment which mut be specially ordered. Substantial Comi2letion |mestimated hooccur within 18'2$weeks from the Start Date ofthis Contract,but the parties agree that this date shall bn automatically shortened u/extended tothe date onwhich all racking and electrical work are complete ondihePVSystem|o capable of generating power and ready and available for use subject to final government and utility approval. £ingijQQuDplo0u Is defined as the date on which all punch list Items are complete,all permits are closed,all other government and utility approvals are obtained and the Work iacomplete mthe satisfaction nyContractor and Client. | Client acknowledges and agrees that the Work Involves permits,Inspections and approvals from various governmentagencies and utilities,and therefore the timing v[the Work may very and|onot within Contractor's control. Client further agrees that Contractor shall not buliable for any losses, / ooetan/domogemm|utedhnnnyda|eymformaounobayundCont/adu/scmntrr|,inc|ud|nOoUoeuoenm*ted|n(hePoru*Majeueaact|ooufth|m Contract below. | Northeast Solar _ 1NodhAve Suite A Burlington.MAO1803 781�24V�$5n5 Orr ��UsuR.Conl A. Ag_qm: To enable Contractor to perform its Work hereunder, Client shall grant during daylight hours adequate space on Client's property, as mutually designated by Contractor and Client, for the complete and proper installation, operation, maintenance and repair of the PV System as well as rights of ingress and egress to, through and from such property and the space designated for the PV System, B. Scarcity of Materials: Rights of Termination: The PV System components tobuobtained Linder this Contract are scarce commodities. In order to meet the performance requirements o f the PV System described In this Contract, Contractor may substitute (he specified brand of solar module or inverter for a similar brand of module or inverter that allows for more timely completion of the installation. Such substitution, if necessary, shall be of UL approved devices, with aggregate performance criteria the same as equipment specified. The governing body for determining performance criteria shall be the CEC (California Energy Commission) that rates all UL approved modules. The key module statistic used for performance criteria will be the DC STC rating of the SLIM of the modules. The key inverter statistic used for performance criteria will be the AC output of the device. It, due (ocode requirements, equipment substitution, final mgincednQ availability, etc..the size ofmPvSystem decreases, Contractor shall re- calculate iheConkaoiPdceua|ng|1a*enderUphcingmm|hndonV|haCon(mctpdceohoUbaoutonmUoullym4ucwg.Qientahexumomd|ted by the reduced amount. If due to Substitution the DC STC size of the PV System Increases slightly, then Client shall not have to pay Contractor similarly. Contractor shall make every reasonable effort Wensure that PV System size does not decrease from the specifications. ifthe DCSTC size ufthe pv System decreases more than 15%from the Contract's specification amount for any fthe reasons stated |othis paragraph, Client shall have the right o terminate this Contract within ten (10) days of Contractor's written notification to Client of Such decrease, and Contractor shall then refund in full all funds paid todate Linder this Contract, but shall have noother liability to Client. Contractor reserves U"erightkounUatemUytenninotemiaCon|mc\vW(Mn45daymof8eeppmvavw|xnmo liability mClient U any of the PV System components required for the completion of Contractor's Work |nutimely manner are not available. |nthe event ofsuch termination, Contractor shall refund all monies paid by Client to Contractor as of the date of termination. C. Limitation of LIWIft: In no event shall Contractor be liable In an amount exceeding compensation paid by Client toContractor kinder this Contract. Contractor shall not be liable for any Incidental, consequential or special damages or for economic loss or expense of for loss or profits or income of Client, or ClienCs consultants or agents or employees, or any of them, including but not limited to any electricity costs incurred should Installation ofthe PV System be delayed beyond the commencement or completion schedule set forth above. D. Zoning: Client shall pay for all variances, special permits, mother costs related Wzoning, including without limitation any fees mcosts related to attorneys orengineers. E. Client's Property: Client agrees to remove or to protect any of Client's inside or out, which may interfere with or obstruct the Work, including but not limited to landscaping, and Contractor shall not be held responsible for damage to Such property. Client understands and acknowledges that proper operation of the PV System purchased hereunder is dependent on Client's existing roof and equipment and Contractor shall have no obligation or liability for the condition thereof. or any other part of Client's improvements or equipment not Purchased hereunder. Client expressly represents that the roof of the property upon which the PV System will be installed is In good condition, with no known water infiltration problems or other structural defects. F. lnamjrg[lc� Client Must carry all fire, Casualty, hurricane, earthquake, theft, and other insurance related to Client's real and personal property. G. Cancellation of Contract: If Client cancels or breaches this Contract after the opportunity to execute three rescission has ed but before commencement of construction, Client shall pay Contractor the arnount of expenses incurred to that date plus 20% of the Contract Price. xClient falls m pay said amounts within thirty (30)days vfContractor's demand for payment andContractor files suit, Contractor shall hnentitled torecover a||u(|h damages including its loss nfnet pmfi|sand attorneys' fees and costs UContractor |othe prevailing party. H. |[ Client fails |opay any amounts owed to Contractor when due, Client shall be liable for all costs of collection, including reasonable attorneys' fewx.o|m18%|mereu per annum onthe unpaid balance, Contractor also shall have option o(removing all nnpart n{the pV System from Client's premises In addition to receiving payment equal to the value of the unpaid balance |ocover all nraportion ufContractor's consequential damages, |.Lbms: Cnnhov(or, any subcontractor(s) and any other persons or entities supplying labor and materials to Client Linder this Contract, have the right under applicable law ^oImpose ulien nnClient's al property for the Value o[the labor ormaterials provided, Upon Client's payment u[all amounts due tinder this Contf act, Contractor will provide, upon Client's request, a release and waiver of any liens. J Contractor shall not bmliable for any delay |vmaterial and/or equipment de|*eryurforhaUomtodo|iwa'o/fai|ummpadmmi»eWmrk which results from any cause beyond the Contractor's control. Such causes include but shall not bolimited to: anact n{God oru/the public enemy; an floodact (or failure to act) of any government or utility; a fire, quarantine, restriction, Nw freight embargomxodmm thnRnronoeuany severe weather; Contractor's Inability to obtain necessary materials, labor or transportation; custom permitting caused by Client's site conditions; homeowner association review ". "pr"=.building "' other code requirements relating to Client's existing electrical system or buil--n=------' and any other Impediments to the installation of the PV System arising from Client's acts or emissions and/or the condition of Client's property. Northeast Solar 1 North Ave Suite A Burlington, MA W803 781240.05e5 $08176 VA 5.0io 06112/205 I '6UN REVOLU(, I"* iffima4MUMM!"I If you decide that YOU do not want the goods or services described above, you may cancel this Contract by mailing or delivering a signed and dated copy of the cancellation notice, or any other similar written notice, to Contractor at the address set forth above no later than midnight of the third business day following the date on which you signed this Contract. If YOU cancel by the date and time indicated, any payment made by YOU Linder this Contract will be returned within ten (10) business days following receipt of your cancellation by Contractor, and any security interest arising Out of the transaction will be released. If you cancel, you must make available to Contractor, at your residence, In Substantially as good condition as when YOU received, any goods delivered to you under this Contract; or YOU May, If YOU Wish, comply with Contractor's written Instructions regarding the return shipment of the goods at Contractor's risk and expense. If you fail to make the goods available to Contractor, or if YOU agree to return the goods to Contractor and fail to do so, then you remain liable for performance of all obligations under this Contract. If we do not pick up, or attempt to pick up, the goods within 20 days of the date of your notice of cancellation, you may retain or dispose of them without further obligation. I HEREBY CANCEL THIS TRANSACTION: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Client's Signature (sign here PWY if YOU wish to bate cancel this transaction) Client's Signature (sign here " iT-you wish to Date cancel this transaction) b-Cifffff `A5KN6WL-W6iES RECEIPT OF ORIGINAL OF THIS CANCELLATION FORM: Signature QV\I\ (Client Initials): Northeast Solar 1 North Ave Suite A Burlington, MA 01803 781.240,6555 weva Vet 6 01,1 OW M0115 0 0 7- a. W U) D 0 7- V) =Z m Lx CL > LL o . 0 IU8 7 V) w w Z) Z 0 z A9'.4"uj CL 0 z D Z 0) 0 CL 0UJ LU Ul 0 W U) 0w W , (n W :E (,) Z < 1� WJO a. —Z (09 CL 010 O'n Orr CL Ld oft0 U. < 0 00) co tLl CL co CL > 0 CL z 0 0 n, z d. LLJ U) 0 -id -- "I'll- ---- — ---- - of CL 06 Z z z :E =agIL Hr ii ui .0 z w - 0 z I -z 0 0 7- a. W U) D 0 7- V) =Z m Lx CL > LL o . 0 IU8 7 V) w w Z) Z 0 z A9'.4"uj CL 0 z D Z 0) 0 CL 0UJ LU Ul 0 W U) 0w W , (n W :E (,) Z < 1� WJO a. —Z (09 CL 010 O'n Orr CL Ld oft0 U. < 0 00) co tLl CL co CL > 0 CL z 0 0 n, z d. 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Check the appropriate box; 1. E) 16111 a employer with `12 4. ❑ I ani a general contractor and i employees (Rill and/or port tinte).* 2. Q I aha a sole proprietor or partner- ship and have no enhployees working forme in any capacity, (No workers' comp. insurance required.] 311 1 am a hoineomer doing all work myself. (No workers' comp, insurance required,] t havo hired the sub -contractors listed on the attached sheet. Theso sulk -contractors have employees and have workers' comp. insurance.# 5. ❑ We arB a corporation and its officers have exorolsed their right of exemption per MOL o. 152, § 1(4), and we have no employees. (No workers' comp. Pnsuraneo required,] Type of project (required): 6, [] New consituotion 7. ❑ Remodeling 8, ❑ Demolition 9. ❑ Building addition 10.[:j Electrical repairs or additions 1113 Plumbing repairs or additions 12.❑ Roof repairs 13.0 Olhersolar Ay 'My appticoat that checks box bl mast also fill out lite secilon below sttohvht8 their wotkets' compensation policy Information. t homeowners %9110 submli this amdaelt Indicallag Ibey aro doingall +vork and then hlro oulsldo eontrectors nnust submit a nuva(Mav[l Indioatinsmoh. 1CoMractors that check this box must eltactted an addhlonal sheet showingthe name orthe sub-conlrocton and state tvlxtheror nol Most entities have atnployces. If tho sub-contrmclors have tinployeos, they must provide /heir workers' comp, polloy number. Iatilall ett1proyerllNIsprovlr/lltgrvotkers'corttpettsrrrlonhisuranceformyemployees. Below Isdlepollcyatl4ja6slte htforniallou, Insttrance Company Mine: Federated Mutual Insurance Company Policy 9 or SeiF ins,1,10, U.9884088 1 � Expiration Date, 12/31/2016 Job Site Address: ,�� �PGnn �r, �r It /►f�PrCitylStatelZip: Atlaclh a cony of file workers' compensation policy deelar'allou page (shotving tlho policy tuntiber and expiration dato). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine tip to $1,500.00 and/or one-year Imprisonment, as well as civil penalties in the form of o STOP WORK ORDER and aline of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of The DIA for PltsllWN coverage verifioatlon. I rlo hereby cer/6 ertrrter llrltltt his_ mrd penaldes oftretlrrty 11)a1111e 111 ortttallotr provided above 1s trite and correct. r U ln...] 4/ re/p L a /r Offlelal use aptly. Do rsolrvrlle In lilts area, to be cosrplefed by elly ortohvtt ofjlehii City or Town,. 1'erniltiLicenso � Issuing Authority (circle ones 1. hostel otHealth 2, ilnllding Dcparltneut 3. Clfytrown Cleric 4, Mectricnl Inspecfor 5, Plumbing Inspector Contact Persoill PholteM A a CERTIFICATE OF LIABILITY INSURANCE DAT09/04/2016 9/04/ DIYYYY{ 9loalzo l 6 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P,O. BOX 328 CONTACT NAME: CLIENT CONTACT -CENTER No Ext): 888-333-4949 AIC A CNmol: 507-446-4664 E-MAIL CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURERISI AFFORDING COVERAGE NAIL N 12/31/2015 INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 EACH OCCURRENCE $1,000,000 INSURED 297-673-6 INSURER B: NORTHEAST ELECTRICAL INC, NORTHEAST SOLAR SERVICES INC 1 NORTH AVE INSURER C: INSURER D: BURLINGTON, MA 01803 INSURER E: INSURER F: AUTOMOBILE CUVERACskS CERTIFICATE NUMBER: 89 REVISION NUMBER: 0 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 LTR TYPE OF INSURANCE DDL INSR SUER WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD1 Y LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR N N 9884084 12/31/2015 12/31/2016 EACH OCCURRENCE $1,000,000 GEN'L X NOTHER: DAMAGE TO RENTED $100,000 PREMISES Ea oc a ce MED EXP (Any one person) EXCLUDED PERSONAL & ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT ❑LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP AGO $2,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT Eaacciticnfl.. BODILY INJURY 1Per person) BODILY INJURY 1Per accident) PROPERTY DAMAGE accident A X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE N N 9884087 12/31/2015 12131/2016 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN ANY PROPRIETORIPARTNERIEXECUTIVE E OFFICERIMEMBER EXCLUDED? (Mandatory in NH)E.L. If yes, describe under DESCRIPTION OF OPERATIONS below NIA i N 9884086 12/31/2015 12/31/2016 OTH- X PER STATUTE ER E.L. EACH ACCIDENT $1,000,000 DISEASE - EA EMPLOYEE $1,000,000 E.L DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) REF: 105 Leanne Dr, North Andover MA 01845 CERTIFICATE HOLDER CANCELLATION 297-673-6 890 TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 OSGOOD ST STE 2035 BLDG 20 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER, MA 01845-1057 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE 4�76, ID 1908-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD o 00 °o� ' ¢ 07 - Oxo r,11 > :j 111 L,00 z©z9m Pi .1 E V 7 M /kms } q" @ )§ , CL k\ c Sw$ ) �t 02 A ®$CL `e ° e ;0 �4' �� �k k■2 °� }