HomeMy WebLinkAboutBuilding Permit # 8/29/2016 BUILDING PERMIY A1
0
M�* 4
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received
............
Date Issued:
IMPORTANT.Applicant must complete all items on this page.........
LOCATION 7'
Print
PROPERTY OWNER L1,(L
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT:,-_ is
District yes
Machine Shop Village yes no mA
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
K New Building ii�One family
[I Addition ii Two or more family El Industrial
D
EJ Alteration No. of units: 0 Commercial
[--I Repair, replacement - m D Assessory Bldg El Others:
E Demolition 11 Other
DESCRIPTION OF WORK TO BE PERFORMED:
entification- Please Type or Print Clearly
OWNER: Name: -2,, LL c, Phone
- <1 'e-,
Address: 4A Z41
Contractor Nam tk zlekv Phone: ±92-
Email: z'
Address: 166
Supervisor's Construction License: Exp. Date:
Home Improvement License: °°µ ' ' Exp. Date: .......
ARr"-'ITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.,BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.0 PERS.F.
Total Project Cost: $ 74(ra) - C(Ale-, FEE: $ I- q'(+ kY) C-0 PV;fil)
Check No.:--- Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty
---------......------- ----------
-------------------41111,9 --
NQRT11 '�
Town of �� s ndover
® 0
No. . 2 b l
o � h ver, Mass, Z
l zo/;L
COC LIC.K.1 .. y1'
"OATE o
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BOARD OF HEALTH
Food/Kitchen
PERMIT T LD/� Septic System
THIS CERTIFIES THAT ... .ma.......4`!q pmo.v ......................... BUILDING INSPECTOR
..........................................
has permission to erect .... buildings on .. r .... Foundation
/ �� Rough
to be occupied as . ..... . .. ..........v :e+Ili.Acon
.. .................................. Chimney
provided that the person accepting this permit shall in every r m 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 ® TNS ELECTRICAL INSPECTOR.
UNLESS CONST N S Rough
Service
.... .. .. .1111111F.W1 WNW .... ...P ......
......
.. Final
BUILDING INS TOR
GAS INSPECTOR
Occupancy Permit Required to Occupy BuRough
Display in a Conspicuous Place on the Premises — Do Not Remove Fina'
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke bet.
Plans Submitted Plans Waived ❑ Certified Plot flan l Stamped Plans ❑
FP,ublic
PE Off'SEWERAGE DISPOSAL t.
Sewer Tanning/Massage/Body Art ❑ Swimming fools ❑
Il ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑
TIME FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SICK OFF n U FORM
5k:�- AL-S6 AVA-�Jkn Wiz, Fz9 wi j
PLANNING C DEVELOPMENT Reviewed On MN Sig'hature�
COMMENTS ! 40 %nm %
CONSERVATION Reviewed on <� laq A G Signature
COMMENTS
HEALTH J\j 1A Reviewed on Si nafure
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
z
Water & Sewer Conneotr®n/Si nature &Date Driveway Permit
DPW Town Engineer: Signature:
F Located 384 Osgood Street
FIREDEPARTMEIIITTem {Duret lifer en;slte: , es
s S s r # Sga 1 px p 7., s"�... �otnos,� a3 s P ;a
Lacatetl at 124 Male Street N `
a {
Fire®e artmet signuu ,
p a reldate a �
C
o�iiviENTs :,
I
Dimension
Number of Stories: Totals care Feet of floor area based a
� n Exterior dtmer-xslons.M
Total land area, sq. ft.: ��' 003 s ,
ELECTRICAL; Movement of[deter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL.Chapter 166 Section 21A--F and G rnin.$10041000 fine
NOTES and DATA- For department use)
f S� F Laa 2 I a SS:
S g q5 Z S�
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066
L 0 0
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Buffding Permit Revised 2014
z
Town of A% ndover
No. -
Ver, Mass,
EEtE i:GE tiE aE#
0 'rE D A,
BOARD OF HEALTH
Food/Kitchen
IL Aff
PERM-IT,, T %O D Septic System
THIS CERTIFIES THAT ........ . . ..:K............:..;..........................
.,..........:...........,....,. ING IMSP eroR
has permission to erect ...................... buildings on .c.:.r ,.. .,:... ..............................................
—� � � Rough
t0 be Occupied as .... ..:....,.;'.....:....... ..... .,....,.,........,..................,.....,................... y
,i . Er. . ; Chimney
provided that the person accepting this permit shall in every respect conform 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 MON711-HS ELECTRICAL INSPECTOR
UNLESS
Rough
Service
............................. :`: ........ ..............................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Oce 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.
1' Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
T' PF--r OF SEWERAGE DISPOSAL
Public Sower ❑ TanninglMassage/Body Art ❑ Swft'a�g fools ❑
well ❑ Tobacco Sales El Food Packaging/Sales ❑
Pri-vato(septic tants,etc. ❑ Permanent lDuropster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEP'ARTMENT.ALSIGN CPP - U FORM
PLANNING & DEVELOPMENT Reviewed On t11111& Signature
f"2 tdlu (G')UTY'UL jfu e'T-C-V'�Gr
CONSERVATION Reviewed on � '� � Signature ,. � C
COMMENTS amv,,,44
HEALTH Reviewed on�__ ❑
COMMENTS
i
Zoning Hoard of Appeals:Variance, Petition No:, Zoning Decision/receipt submitted yes
i
Planning Board Decision: aj& Ij(l - _Comments
Conservation Decision: SL(2-- [6 : Comments
Wafer& Sewer ConneG lon/Sinatures. rate Drivewa Permit
Ak�
DPW Town J4nginee)r: Signata e: _-
Located 384 Osgood Street
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10 Gkeat Lak6 Lane 8-16-1
Key. Bel-fl ma North Andover,MA 9:36arr
MM 0 1 Of
CS Beam 4.17.0.2
kinJ3eaudHmp)no 4.13.11
-W',jrinlsDatabase 1527
Member Data
Description:Main 2nd Floor Member Type: Beam Application. Floor
Top Lateral Bracing: Continuous
Bottom Lateral Bracing. Continuous
Standard Load: Moisture Condition: Dry Building Code: IBC/IRC
Live Load: 40 PLF Deflection Criteria: U360 live, U240 total 1.000" max. LL
Dead Load: 10 PLF Deck Connection: Nailed Member Weight: 15.6 PLF
Filename: Beaml
Other Loads
Type Trib. Other Dead
(Description) Side Begin End Width Start End Start End Category
Additional Uniform(PSF) Top 01 0.001, 22 0.00" 151 0.00, 30 10 Live
Additional Uniform(PSF) Top 22' 0.00" 36' 0.00" 16' 0.00" 30 10 Live
Additional Uniform(PLF) Top 01 0.001, 36' 0.00" 0 65 Live
Additional Uniform(PSF) Top Y 0.001, 22 0.00" 15, 0.001, 20 10 Live
Additional Uniform(PSF) Top 22 0.00" 36' 0.00" 16' 0,00" 20 10 Live
10 0 0 12 0 0 A 14 0 0 1
G
3600
Bearings and Reactions
Input Min Gravity Gravity
Location Type Material Length Required Reaction Uplift
1 01 0.0001, Wall SPF Plate(425psi) 3.500" 2.346" 5234#
2 10, 0.0001, wall Steel 11.0001, 3,718" 14641#
3 22' 0.000" wall Steel 11.0001, 4.790,, 18860#
4 36! 0.000" Wall SPF Plate(425psil.._ 3.500" 3.280" 7318#
Maximum Load Case Reactions
used for applying point loads(or lino loads)to carrying members
Live Dead
1 3721# 1513#
2 10298# 4343#
3 12829# 6031#
4 5038# 2279#
Design spans
9 9.375" 12 0.0001, 1 a 9.376'
Product: 2.0 Rigidl-arn LVL 1-3/4 X 11-7/8 3 ply PASSES DESIGN CHECKS
Connect members with 2 rows of 16d common nails at 12.0"oc
NOTE,Nails must be applied from both sides
Design assumes continuous lateral bracing along the top chord.
Design assumes continuous lateral bracing along the bottom chord.
I
Allowable Stress Design
Actual Allowable Capacity Location Loading
Positive Moment 21336.# 33194.# 64% 30.27' Odd Spans D+l_
Negative Moment 24093.# 33194.# 72% 22' Adjacent 2 D+L
Shear 9128.# 120534 75% 22.01' Adjacent 2 D+L
Max.Reaction 73184 78094 93% 36' Odd Spans D+L
TL Deflection 0.4444" 0.6891" 0372 29.58' Odd Spans D+L
LL Deflection 0.3212" 0.4694!' U514 29.58' Odd Spans L
Control: Max.Reaction
DOL,: UVO=100% SnOW=1116% Roof-125% Wind-1609/6
Design assumes a repetitive member use increase in banding stress- 4%
All Pmducl narmasare tradermoksof theirmT.ective owners
Call)),uly 111C.ALL KIGHIS HLSERVW.
'PaSsing is defined as when the rnernber,flocriolst,bown orgirdet shown on this drawing meats applicable design criteria for Loads,Loading Conditions,and Spans listed on this sheet.The
si nrofossi mdaereggirodfora roval,'Thisdesi installation aallatio
.9 -- --- _,SqOAfipA_tothknianufactt)ieessnecificationo
1.0 Great LakL-Lane 8-16-1(
lce',Y-B `,a"mul North Andover,MA 9:38am
1 Of'
CSBcarn4.17.0.2
kwJ1emnFnghve4.13.7.1
Ma&rialsrlatibase 1527
Member Data
Description:Garage Header Member Type, Beam Application: Floor
Top Lateral Bracing: Continuous
Bottom Lateral Bracing: Continuous
Standard Load: Moisture Condition: Dry Building Code: IBC/IRC
Live Load: 40 PLF Deflection Criteria: U360 live, 0240 total 1.000" max. LL
Dead Load: 10 PLF Deck Connection: Nailed Member Weight: 12.5 PLF
Filename: Beam2
Other Loads
Type Trib. Other Dead
(Description) Side Begin End Width Start End Start End Category
Additional Uniform (PSF) Top 01 0.001, 36' 0.00" 12' 0.09, 40 10 Live
Additional Uniform(PSF) Top 9 0.09, 36' 0.00" 12 0.001, 10 10 Live
Additional Uniform (PSF) To 01 0.001, 36' 0.00" 12' 0,00" 55 15 Snow
12 6 0 11 00 1260
36 0 0
Bearings and Reactions
Input Min Gravity Gravity
Location Type Material Length Required Reaction Uplift
1 01 0.000l Wall SPF Plate(425psi) 30.000" 2.773" 6188#
2 12' 6.000" Wall SPF Plate(425psi) 24,000" 7.791" 17385#
3 23' 6.000" Wall SPF Plate(425psi) 24.009' 7.791" 17385#
4 36 0.000" Wall SPF Plate(425psi) 30.0001, 6188#
Maximum Load Case Reactions
Used for applying point loads(or line loads)locarrying members
Live Snow Dead
1 2918# 3009# 1742#
2 8032# 8283# 5149#
3 80321t 8283# 5149#
4 291.0 3009# 1742#
Design spans
10' 0.875" ill 0.000Y 10' 0.875"
Product: 2.0 RigidLarn LVL 1-3/4 x 9-1/2 3 ply PASSES DESIGN CHECKS
Connect members with 2 rows of 16d common nails at 12.0"oc
NOTE:Nails must be applied from both sides
Design assumes continuous lateral bracing along the top chord.
Design assumes continuous lateral bracing along the bottom chord.
Allowable Stress Design
Actual Allowable Capacity Location Loading
Positive Moment 13485.'# 25122.# 53% 29.04' Odd Spans D+0.75(L+S)
Negative Moment 17345.'# 25122.# 69% 23.5' Adjacent 2 D+0,76(L+S)
Shear 77394 110891 69% 23.61' Adjacent 2 D+0.76(L+S)
Max.Reaction 17385.# 535504 32% 23.5' Adjacent 2 D+0.75(L+S)
TL Deflection 0.2984" 0.5036, U405 6.96, Odd Spans D+0.75(L+S)
LL Deflection 0.232611 0.33681, U519 28.64' Odd Spans 0.75(L+S)
Control: Shear
DOLS: Live-Ml. Snow=1159% Roof=1250/. Wind.1600/.
Design assumes a repetitive member use increase in bending stress: 4%
All product names ate hadetnasksof their rejective owners
G0RYngl1l(G)2015bY Sl"nStrong-TreCompany Inc.ALL RIGHTS MEWED.
"f Tsang Is defined as when tho membor,floorjoist,beam orgifde(shown on this drawing meets applicable design criteria for Loads,Loading Conditions,and Spans listed on this street The
pEduclimioationaccoAn tothernanutactumr�s2- eciticatmim
Home Energy Rating -
PropertyHERS
- A v 3=
� - �sf,
Rating Type: Projected Rating Certified Energy Rater: Peter Virchick
10 Great Lake Lane Rating Date: 7/25/16 Rating Number:
North Andover,MA 01845 Registry ID:
f ed R;aaa m 0n Na-is p _ ro fl-Em Remig�
UEsest>Imate nnMMuaBtu nergyCost s
Percent
HERS Index; 53 Heating 38.5 $1753 45%
General Information Cooling 11.1 $180 5%
Conditioned Area 3291 sq. ft. House Type Single-family detached Hot Water 5.3 $426 11%
Conditioned Volume 28046 cubic ft. Foundation Stab Lights/Appliances 28.7 $1383 36%
Bedrooms 4 Photovoltaics -0.0 $-0 -0%
Service Charges $137 4%
i McChant'Cal $llStemS FeatUreS Total 83.7 $3880 100%
Heating: Fuet-fired air distribution, Propane, 96.1 AFUE.
Heating: Fuel-fired air distribution, Propane, 96.1 AFUE. Criteria
Cooling: Air conditioner, Electric, 13,0 SEER. This home meets or exceeds the minimum criteria for the fotlowing:
Duct Leakage to Outside 98.73 CFM25. Massachusetts Stretch Energy Code"
Ventilation System Exhaust Only: 56 cfm, 11.0 watts. *Compliance is determined by the rater.
Programmable Thermostat Heat=Yes; Coal=Yes
Building Shell Features
Ceiling Flat R-44.4 Slab R-9.0 Edge, R-18.0 Under
Seated Attic NA Exposed Floor NA
Vaulted Ceiling R-39.5 Window Type U-Value: 0.290, SHGC: 0.300
Above Grade Walls R-21.0 Infiltration Rate Htg: 3.00 Clg: 3.00 ACH50
Foundation Watts NA Method Blower door test Conservation Services Group
50 Washington St
Lights and Appliance Features J Suite 3000
Percent Interior Lighting 80.00 Range/Oven Fuel Electric Westborough,MA 01581
Percent Garage Lighting 0.00 Clothes Dryer Fuel Electric 508-836-9500
Refrigerator (kWhlyr) 691 Clothes Dryer EF 3.01 www.csgrp.com
Dishwasher Energy Factor 0.46 Ceiling Fan (cfm/Watt) 0.00 Certified Energy Rater: � � �
REED,Saye-Res-d e n Iiai E`ere n Ivs i_an d Ra no.S of-ow are v 14.t>.3
This information does not constitute any warranty of energy cost or savings. CD 1985-2016 Noresco, Boulder, Colorado.
The Home Energy Rating Standard Disclosure for this home is available from the rating provider.
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SERGI m
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CERTIFY PRIMARY
CONFORMS TO
PPCO LREQUIREMENTS LOCALFw
FOUNDATION LOCATIONAIABLZONING AWS N EFFECT WHEN CONSTRUCTED.
CLIENT: TKZ,LLC RESTCCRTIFICATION TIONSSUCHAOCSNOTCO€S.WERAN OTI S,EASR
RESTRICTIONS SUCH AS COVEi�lAN75.4YETLANDS,EASEMENTS,
ORDERS OF CONDITIONS.ETC.)THIS DRAWING SHALL NOT BE USED
THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED
ABOVE,EXCEPTWITH THE WRITTEN PERMSSSIONOFCHRiSTIANSEN
LOCATION: NORTH ANC]OVER,MASS.
&SERGI INC.FURTHERMORE THIS DRAWING€S THE COPYRiGHTEO
PROPERTY OF CHRISTIANSEN&SERGI INC.AND ANY
DATE: 7121116 SCALE: 1"=40' UNAUTHORIZED USE IS PROF€IBITED.CHRISTIANSEN&SERGI TAKES
NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS
DRAWING OR ANY INFORMATION CONTAINED HEREON.
--- PROFESSIONAL ENGINEERS & LAND SURVEYORS
CHRIS TIA NSEN & SERGI, INC.
160 SUMMER STREET, HAVERHILL, MASSACHUSETTS 01830
WWW.CSI-ENGR.COM TEL. 978-373-0310 FAX. 978-372-3960
1 DWG.NO.:13114.001.014
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-055417
Construction Szame v;sor
THOMAS D ZAHORUIKO ��
4 HIGH STREET SUITE 201
NORTH ANDOVER MA 01846 -
1=xpiration:
Commissioner 0410512018
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AC: CERTIFICATE O� F LIABILITY I BATT Hv%wrlIYYYYY)
6/21/16
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 CEIzrIFiCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
.,,.__-_--- ._..._. AON
IMNl1RTANT �lf the cortifrcato�lrolilor it;an ADDIT1ONAt.IAd�tfRED,the Policy(i�)!Host ho�ldorr;od. If SUBROGATION IS WAIVED,subject O
the forms and condiUOns of the PolicY,certain Policies nny require ran endorsement. A Statement on this certificate rices riot confer rights to the
certificate holder in ROD of such ondorsenTonf s.
PRODUCER C ONL:
NAME ._..... SandiMt__ ",.G3
M.P. Roberts Insurance Agency PHONE 571 frfi3_,ptl_73 j�ac,flu)_(srU) f,R3 3141
._
1060 Oscic,Ta>ct Street AODRE 6_. sandiftPro or L in,e4Trance.com
AL
North Andover, MA 01.845 Ira ora r�s)nrEorlolnr COVERAGE- � NAlcn
INSURr:RA:Esseel Insurance Co
INSURED uosuR@R e:Asasociated E`'mploversInsurance j
TKZ, 1,T.(' rwseraERc:
c/o TOM LAEORUIKO INSURER D:
`78 GREAT POND ROAD INSURER C:
NORTH ANDOVER, MA 01845 INSURrMF:
COVERAGE CERTIFICATE NUMBER REVISION NUMBER
-...._ _ _..._ _ _ _ m _ ...
ll IIS IS TO CEjr,IILY rl IA'r INT:PR.IC 11 S OF INSURANCE.LIST D f3IAAM HAVE BEEN IS,IJLIJ I'O TI IL INSIJR D NAME[)AE IT"YrFI RTOIPI HE G.(�I T'G)IICY W114f�IIE�R1C)G�7 I
INNGATED, NOTWITF°ISIANDING ANY REQUIREMENT',TERM OR C,C NDIrION(X ANY CONTRACT OR O111I I'R DO OMFN W Ilil r �
CERTIFICATE
SI AMDL.BE ISS(7 D OF,�MAY
F OLICIIN, (.TITIN SI RAN MAY HAVE
1)Y f IE 101.1(IEk; IJLEr(7dIIfil:'1.)I II'I'dLIN IS SUBJECT T`GJ At.L I'I IL TERM
C'LI"2TIE ICA rF MAYBE ISSUEDOR C)R MAY r'F fd'rAIN,TH( IN,,URAhdC;t''AF 6 OrEI
E BEEwN IRE DUCR)BY PAID CLAIMS.
IPSSrab A00 tieERl r OUA.Y Err POUCY rJ(r
tAt L E,Nr.1aAE LlAUIEITvw...- __IN9II'SUB? roue rafsvAeeR.._... ._. Trlrn cx>lyvrvt rve
_.w
1YrE04 lN"1CIRdVif'Q .....,...._. _.___.......__.
3DX�iSTEi 7/0/15 r/13/1G 1AAHOCCURRINlc_ S 7.,000,0013
X I,O%vAF CIA(G0V;RAI.LIIAfnl.l'rY I n MiSI s a 60 Nrt l
1 a ([dlvuGwaNt+:v) ) _ 50_,600
(;IAINIS MAD1- ( ,'x OCC7UN h"I IJ rwr(Aryoal pixnarf $.._ b,000
PIR$QNAl.eAOVIN,IURY S 7.,0OD,OUD
ul NIAW AI,IaOJ A1c S 2,000,000
4.fiN l A(C Rf GA If L INTI F A11111 W'S f r R I I R1)ONf ff MAP If tr AIG 1 f
ryltfr. ( � )
_ ......_...... _.......-....,_...... .................._.._.._.._..-.-..,....._.....,. l.t>SJatIN1,I)„IN(rt(I.II+IIi.
-�µAN TOME MIA:HAMMY i (1.a nrr,d)(1) 9
a OCIIIII Y INJURY lPw f'mon) IL
ANY AU TO ....
All<YVUMAS CY ``CHIAM LLN BOali Y INJURY IN11 ai'0011) $
nalT'L>. AUTOMS
NON OAANf'i17 I I MtlJr FJTI Y IlA➢,MA4"I e
HIREDAMOS, AIJI03 (1 n,nrtilelerel}
s
ti FdarU-i,LA LIAk1 C1GG Ll la � 1 l nl I I frl)6;uRRF N(".r �S.....
EXf ESSLIAD .. AGON GAll- ce
r!nen hM.l7i ._. )0fi.'i1.7 �101�IA
171N ENSATIIXJNS _....,,..._ _..... CC5005( 0/1/151 1C)/: I.ORYLIMI IoIYh
Ti raRl R'S Cc)MI r N nTrON _ W A.�, T. � � zY L ionu �...__
AND EMPLOYERS,IN1e161TY
t
ANY PROPRIETQ MIN4INUIXXI-COI VE `�! I t FN;HAt CAdY'Nr S 1,000,000
fW,I""ItA-ILfAx'IAIf"11 FXC!tllEa"}1 .� NIA
(FnmxA,IO lir NIT) -. F I DISI ,l I n 1;7A1`ulvr l f S 1.,000,000
It IOrd btAa v , .__,.,..___,._,,.......IImr.S 1,000,_0,08
.. -
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fziF)Tato o_�
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1
WSORIPTION OF OPE RANONS I LO(,R'TIONS IV V111CI,ri(lUlacl,ACORD 101,Ai19d0un ll 111"111 11%SO VA110,ll rnnnY sisr 0 k Tru'Ili 111)
1
CERTIFICATE MOLDER
CANCELLATION
�I SHOULD ANYOE T'NE ABOVE DE SCRIBED POLICIES BE CANCELLED UFFORE
THE EXPIRA,fION DATE "r'HEREOF, NOTICE WILL a'aE DE.UVERED IN
TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS.
BU11,T)ING DEPT
1600 OSGOOD STRBBT AUTNORIZ a EPECSE14TA71
NORTH ANDOVER, MA 01845
01998-2010 ACORD CORPORATION. All rights reserved.
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