Loading...
HomeMy WebLinkAboutBuilding Permit # 8/31/2016 BUIL0q.DING PERMIT bw 'r.I TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Date Received Permit No#: CHO Date Issued: L t �1 R T: Applicant must complete all items on this page LOCATION C Print PROPERTY OWNER Print iOO Year Structure yesno MAP PARCEL: ZONING DISTRICT:-Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Li New Building *ne family Li Addition Fj Two or more family F] Industrial [.1 Alteration No. of units: UI Commercial >�,Repair, replacement El Assessory Bldg [I Others: 11 Demolition Li Other F1' Is F1 p.P/i n", E], 0"Wetl 59�( e xo§ a Al P bewe, DESCRIPTION OF WORK TO BE PERFORMED: rJ Identification - Please Type or Print OWNER: Name:_,-_-z,' Adl Address: z� 2'PIneContractor Nane-< ,--f E rn a i Address: ::55! n Supervisor's Construction License:<:% . Em Date: LHome Improvement License_ ARCHITECT/ENGINEER Phone: Address: Reg, No. FEE SCHEDULE. BULDINGPERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contractinivith unregistered contractors tiro not have access to the guaran1tynd rz 777 ®RTHTown of .9 ndover No. RAKR h '�' ver, Mass, •QA SaS�S ne wec rc` S U BOARD OF HEALTH Food/Kitchen PE IT T LD Septic System THIS CERTIFIES THAT ... IN .... . . . . .4. . . „ BUILDING INSPECTOR Foundation has permission to erect .......................... b4i.lbddgs an ..�...� .�,�� ..... ..��r�:...... .. Rough to be occupied as .. . . .....6 , 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 B -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 S IN 6 MONTHS ELECTRICAL INSPECTOR CESS CONS TION Rough Service . ... ........ Final B I INSPE TOR 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 Approved by the Building Inspector, Burner Street No. Smoke Det. www.Rovise£nergy.com Revise Energy Ifo no Performance Contractor 5 South Summer Street,Bradford,NIA 01835 cO NTS r�+(�CT 978-9I4-2214 FAX(401)784-3710 Page 1 PROGRAM CMA-HPC •� QIItE P110RE nATE WENT*Y ORK 6110rk Olivia Lagrassa (978)655-5294 07/27/2016 437952 21203 SERVICE STREET BILLING STREET 50 Elmwood Street 50 Elmwood Street SERVICE CITY,STATE.71P BILLM MY,ITXTE,ZIP North Andover, MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to sell areas of your home against wasteful,excess air leakage. This work wilkbe perronned in concert with the use of special tools and diagnostic tests to assure that your home will be lett with a health Ful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for seating include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(10)working hours,A reduction in cubic feet per minute(cfin)of air infiltration will occur,but the actual number ofctim is not guaranteed. At the completion of the wealhorization work,and at no additional cost to the homeowner,a final blower doer andlor combustion safety analysis wif l be conducted by the sub-contractor to ensure the safely of the indoor air quality. S850.00 ATTIC FLAT:Provide labor and materials to install a 6.25"layer of'R-19 un1?tced Fiberglass baits to(1 100)square feet orattic space. 11,628.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 on faced fiberglass batts to(12)square feet for damming purposes. 524.60 ATTIC ACCESS:Provide labor and materials to insulate the back of(I)attic hatch with 2"rigid Thennax board.Weatherstrip the perimeter. 560.00 VENTILATION:Provide labor and materials to install(I)insulated exhaust hose to existing bathroom fan(s). $50.00 VENTILATION:Provide labor and ma€erials to install ventilation chutes in(66)caller bays to maintain air flow. $132.00 Planview Diagram r arner. Advisor Name: ess . r f l`t ��' Advisor Phone #: C) V a _ I�� � 3 �� _ Any limitations to access y truck? D 1 7 7 NOTES Any work scoped outside of Best P ctices? Approved by:01 �,i+ OV (� �nS�ti��r� t%�(;IfrS U�� rk SCO e <'_ G 1 -812612016 50 Elmwood Street North Andover MA 01845-Salesforce-Professional Edition Z— e Close Window _ rg�� Print This Pane ® Expand All I Collapse All 50 Elmwood Street North Andover MA 01845 Account Name 50 Elmwood Street North Andover MA 01845 Contact game Ken Campisi Parent Account Rise Engineering Phone 978-852-7942 Account Owner Dana Hills Phone Type Home Preferred Time to Call Email campisik@verizon.net Address Information Billing Address 50 Elmwood Street Shipping Address North Andover,MA 1845 Building Information Living Space Sq Ft 1,400 Type of Home Ranch Number of Units 1 Year Built Condo Association No Years in Home 1988 Owner 1 Landlord/Renter Owner Number of Occupants Utility Information Primary Heating Fuel Natural Gas Gas Account# Primary DHW Fuel Electric Account# Gas Utility Columbia Gas Last Name on Utility Bill Lagrass Electric Utility National Grid First Name on Utility Bill Olivia Fuel Assistance No EBR/EFR/EAC -Advisor Heating System Eligibility Customer EAC Rebate Form Customer Has EBR/EFR Cooling System Type Rebate Form Heating System Type Cooling System Year https:,'/na30.salesforce.com/0013600000SFA61/p?retU RL=/0013600000SFA61 116 ....................... ... ................................. . 8/26/2016 50 Elmwood Street North Andover MA 01845—Salesforce-Professional Edition Heating System Year EBR I EFR!EAC Notes Heating System Manufacturer EBR I EFR!EAC Submitted to Clearesult Heating System Model Number Heating Serial Name Photos Submitted System Information Created By Dana Hills,7/11/2016 12:34 PM Last Modified By Sam Webb,8/26/2016 10:02 AM Custom Links Google Maps Google News Goo-gleSearch Opportunities 50 Elmwood Street North Andover MA 01845--Rise HEA Opportunity Record Type HEA Stage Closed Won Amount $585.56 Close Date 81912015 Probability(%) 100 Lead Source DiPietro Referral Owner Full Name Tara Carroll Won :,f Fiscal Period Q3-2016 Next Step Type Last Modified Date 811612016 Description 50 Elmwood Street North Andover MA 01845 -Weatherization Opportunity Record Type Weatherization Stage Opportunity Identified Amount Close Date 8/9/2016 Probability(%) 5 Lead Source DiPietro Referral Owner Full Name Dana Hills https:1/na30.salesforce.com10013600000SFA611p?retURL=/0013600000SFA61 216 8/26/2016 50 Elmwood Street North Andover MA 01845--Salesforce-Professional Edition Won Fiscal Period Q3-2016 Next Step Type Last Modified [date 8122/2016 Description Contacts Ken Campisi Landlord/Owner/Renter Owner Email campisik@verizon.net Phone 978-852-7942 Phone Type Home Fax Mobile Open Activities WX Install -Revise Energy Truck 1 Name Ken Campisi Task Due Date 9/2/2016 8.00 AM Status Assigned To Revise Energy Truck Location Related To 50 Elmwood Street North Andover MA 01845 Comments the homes for 911 and 912 are right next to each other and owned by same homeowner so if needed can work on both on both days if one is faster than the other Activity History Rise HEA-Do Not Move Name Task Due Date 7/2712016 12.00 PM Location Assigned To Kyle Meredith Related To 50 Elmwood Street North Andover MA 01845--Rise HEA Comments Please call&email to confirm the day prior Email: Pre Visit Email 7/27/2016 12noon Name Kyle Meredith https:tlna30.salesforce.com/0013600000SFA61/p?retU R L=/0013600OMSFA6] 316 8/26/2016 50 Elmwood Street North Andover MA 01845—Salesforce-Professional Edition Task ,l Due Date 712612016 Location Assigned To Dana Hills Related To 50 Elmwood Street North Andover MA 01845--Rise HEA To:kyle.meredith@reviseenergy.com CC: BCC:dana.hills@reviseenergy.com Attachment: --none-- Subject: Pre Visit Email 7/27/201612noon Body: EM Status: Not Submitted SitelD: Name: Ken Campisi Landlord!Owner 1 Renter:Owner Email:campisik@verizon.net Phone: 978-852-7942 Address: 50 Elmwood Street Comments North Andover,MA 1845 Primary Heating Fuel: Natural Gas Gas Utility: Columbia Gas Gas Account#: Electric Utility: National Grid Electric Account#: On Fuel Assistance: No Last Name on Utility Bills: Lagrass First Name on Utility Bills: Olivia Living Space Sq Ft: 1,400 Year Built: Number of Units: 1 Condo Association: No How did they hear about us?DiPietro Referral Notes to Home Energy Manager:Weatherization.Referral from Donnie Briggs,DHC Install Mgr Email: Revise Energy: Scheduled Appointment Name Ken Campisi Task -/ Due Date 7/18/2016 Location Assigned To Tara Carroll Related To 50 Elmwood Street North Andover MA 01845--Rise HEA To:campisik@verizon.net CC. harry.black@reviseenergy.com BCC:tara.carroll@reviseenergy.com;dana.hills@reviseenergy.com Attachment:--none-- https://na3O,salesforce.com10013600000SFA61Ip?retURL=/0013600000SFA61 416 8/26/2016 50 Elmwood Street North Andover MA 01845—Salesforce-Professional Edition Subject: Revise Energy:Scheduled Appointment Body: Hi Ken, Thank you for scheduling a home energy assessment with Revise Energy.You are confirmed for the following date and time.Please do not hesitate to contact me with any questions. Comments Date:Wednesday,July 27th 2016 Time:Noon Energy Manager: Harry Black Address: 50 Elmwood Street North Andover MA 01845 North Andover,MA 1845 Thank you, Tara Carroll Revise Energy tara.carroll@reviseenergy.com Call -Outbound 1 Name Ken Campisi Task -/ Due Date 7118/2016 Location Assigned To Tara Carroll Related To 50 Elmwood Street North Andover MA 01845--Rise HEA Comments Columbia Gas Customer-Called to reschedule HEA Files 0079 001 Ken campisi elmwood Program Disclosure Last Modified 8/23/2016 11:39 AM Last Modified 8/9/2016 4:36 PM Created By Dana Hills Created By Dana Hills Ken campisi elmwood Material Install Summary Ken campisi elmwood CST Last Modified 8/9/2016 4:36 PM Last Modified 8/9/2016 4:36 PM Created By Dana Hills Created By Dana Hills Ken campisi elmwood Last Modified 819120161:12 PM Created By Kyle Meredith Copyright©2000-2016 salesforce.com,inc.All rights reserved. https:11na30.sal esforce.com10013600000SFA61/p?retU RL=/0013600000SFA61 516 REVIS, E ENERGY DIPIETRO COMPANY As an employee of Revise Energy (DiPietro Home Energy) holding an Unrestricted Construction Supervisor Llcense (CS-056846), I hereby grant permission for either Dan Carroll, Matt Hammer or George Desroches of Revise Energy to apply for and or pull a permit in my name and under my license for Weatherization work. Weatherization work may include, air sealing, blown cellulose insulation, installation of weather stripping, door sweeps, thermax, etc. I approve this permit to be filed under my name by either gentlemen listed above in the town of: ,/V,-:),,,z Sincerely, John Cullen License # CS-056846 Cell: 781-526-5581 Information Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s), address(es)and phone number(s)along with their ccrtificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give.us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 021142017 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 7-2010 www.mass.gov/dia 414 4=41oatoad6po 49©b699g88Z9941xoquW/I!awlwoo•al6006-!!a°wq:sdllq M ME - r C S 3 JdFS090 9WI 940Mz/)_ Massachusetts - Department of Pub=ic Safery Unrestricted-Buildings of any use group which tip 35,D40 c ward o; contain less �u,idt"5 �er�uiaT�cr s anc iia„uar s cubic feet(991m3)of L.11�tiEl aLLy lYi til€3k�f5Gi enclosed space. License GS-056W JOEINN D CU1CLEtV� 46'VALLEY S'1 = '? W.kefield MA OA80 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Cor�krnissinner 04103120' For DPS Licensing information visit: www.iMass.Gov/DPS lt + Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite S 170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 185083 Type: Corporation Expiration: 4/2512018 Tr## 288111 DIPIETRO HOME ENERGY JOSEPH DIPIETRO 5 SOUTH SUMMER ST. HAVERHILL, MA 01830 ---- Update Address and return card.Marls reason for change. SCA 1 C5 20M-05111 [� Address [_] Renewal Employment Lost Car /r.e m�a�nai�rt�etr���of gulat oon ft1 Office of Consumer Affairs&Busrue CiROR HOME IMPROVEMENT CONTRA Type: Registration: '185083 Corporation Expiratiaa . 120.78 NPIETRO HOME EN SOLUTIONS,INC. JOSEPH DIPIETRO SUMMER 9T r� �SOUTH Undersecretary HAVERHILL,MA 01830 i I The C'orntnonwealtlt o 1 assachusetts -fent vorm ;a w 1Depyartnxent of Industrial Aecidents oface of'In vestigations w l Congress Street, ,Suite 100 Boston, MA 021.14-2017 www.nmss.gov/dia Workers' Compensation Insurance Affidavit: Build ers/Con tra cto rs/E lectricians/ 'lumbers Alllicant Information Please Print ULAN Narne (Busittess/Ot-gatrtxation/Indiviclua))-- ^- Addr ss: ._ City/State/Zip;, " """Phone f" -12 ` Are ou an employer? Check the appropriate box", .1 Type of project(required): I. I am a employer with 4. E] I am a"-general contractor and I __. have hired the sub-contractors6. E] New construction employees (full and/or part-time).' 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand have no employees ees These sub-contractors have ` p y 8. ❑ Demolition working for me in any capacity, employees and have workers' 9. insurance.l ❑ Building addition [No workers' c€.�mp. insurancecomp. required.] 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1.1.0 Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.[—] Roof repairs insurance required.] 152, ,employees.14), and we have not [No workers' 13 .❑ Other, e, , ..v" Ad comp, insurance 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 indicating such. 1Contractors 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. I ant an employer that is providing workers'compensation insurance,for my employees. Below is the policy and job site information. Insurance Company Name: -"`" ��":V\_' _ C w>t w iw� ., Policy ft or Self-ins. Lic # "`w � �� Expiration Date: C'�C1 I " Job Site Address ? :'u � ... _ --_-. City/State/Lip:,A.l ,�� � �� 9 <1 j Attach a copy of the workers compensa on policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern ut der the ain�and nalties o ' e iur that the in firr ntatiott provided above is true and correct. Si mature: ' - ' Date - , Phone#: Of 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#: DATE(MMIDDNYYY) A�RL> CERTIFICATE OF LIABILITY INSURANCE a/30/2016 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 COONTACT Emily Costello Costello Insurance Agency, Inc. PHONE (978}374-6352 FAAlC No;(978)521-5127 2 S. Kimball St. E-MAI ADLDRESS:ecostello@costelloinsurance.com PO BOX 5248 INSURERS AFFORDING COVERAGE NAIC# Bradford MA 01835 INSURER A:Colony Insurance Company INSURED INSURERB:COmmerCe Insurance Co. 34754 Dipietro Home Energy Solutions, Inc. INSURERc;Star Insurance Company ABA: Revise Energy INSURER D: 5 South Summer St INSURERS: Bradford MA 01835 INSURER F: COVERAGES CERTIFICATE NUMBER-CLI642500527 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCElull 2M POLICY NUMBER MMIDDNY-YY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT A CLAIMS-MADE [A] OCCUR PREMISES Ea occcurrence $ 50,000 PACEP305047 4/25/2016 4/25/2017 MED EXP(Any one person) $ 10,000 -PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JERCOT- ❑LOC PRODUCTS-COMPIOP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED HS6325 4/18/2016 4/18/2017 BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED X I RETFNTION 10,000 EXC305048 4/25/2016 4/25/2017 $ WORKERS COMPENSATION X TH- AND EMPLOYERS'LIABILITY YIN STATUTE FOR ANY PROPRIETORIPARTNERIEXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 C (MandatoMEnNH)EXCLUDE07 WC 0856525 00 4/20/2016 4/20/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE,$ 1,000,000 Ifes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1-000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addltfenal Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION (978) 688-9542 dbelanger@northandoverma.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Inspector of Buildings Don Belanger ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St, Suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Emily Costello/HOYEC1 ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS02fi t9nuniti