The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 11/2/2016 NORTH 1�50 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 10 SS CHUS Date Issued: 0^4_0L IMPORTANT: Applicant must complete all items on this page i 2 .............. ................ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Li New Building i-r6ne family Li Addition Li Two or more family 01 Industrial iteration No. of units: .1-1 Commercial w4epair, replacement D Assessory Bldg 0 Others: L1 Demolition Ll Other t<ft l_C L%4e A_ .4,,t.A (7 Z L,_L/i (4r_L%.c tA e� -4- AA Identification Please Type or Print Clearly) OWNER: Name: �e.. ........q t V-, Phone- I?X- YZ3- 0_31 ........... Address: r. .......... ARCH ITECT/ENGIN EER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ Check No.: a, Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty Plans Submitted 11 Plans Waived ❑ Certified Plot Plan El Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 17 Well Tobacco Sales ❑ Food Packaging/Sales El Private(septic tank,etc. Permanent Dumpster on Site F] THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT F-1 11 COMENTS EM 1 E REJEC I ED C37K 1 L AHHKUVEU- CONSERVATION F1 ❑ COMMENTS DATE REJECTED DATE APPROVED I ( / 7) =HEALTH F❑I Vl COMMENTS VV) (01A &"t) Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit Located at 384 Osgood Street F r F %�ORTf q own of s �f, b ndover ® - � �� ok No. �i ver LAKE h " * ver, Mass, COCN.CKEwICn V �sqs BATED U BOARD OF HEALTH Food/Kitchen PER-MIT T LD r Septic System THIS CERTIFIES THAT .....W...P..C........ ..................... BUILDING INSPECTOR has permission to erect .......................... buildings on ......7.21.............0 AIS 0 AJ.. .......... Foundation Rough to be occupied as .kA t.....4 !Xsl.......111tCP"AA.. P!?4�.............. 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 16 MONTHS ELECTRICAL INSPECTOR. . UNLESS CONSTRUC. START Rough Service ......... ......... ..,...... .......... - . Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit R uired to Occupy Buildin Rough 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 Det. Darren JSturtevant Home Improvements Description of work to be performed: Kitchen Gut Kitchen 1200.0 Remove interior wall(s)and install LVL 1500.00 Frame in existing door/window and insulate 75.00 Install subfloor 550.00 Install%" Hardiebacker to floor 460.00 Tile floor(tile not included) 1296.00 install kitchen cabinets 1300.00 Install backsplash (tile not included) 475.00 Bathroom (main floor) Gut bathroom 250.00 Install Hardibacker to shower surround 275.00 Install Hardiebacker to floor 250.00 install shower tile (labor only) 500.00 Install floor the (labor only) 450.00 Dining room Frame opening and install French door (includes door, knobs,trim) 920.00 Basement Gut basement 420.00 Strap as needed to receive new plaster 645.00 Frame walls for laundry/utility and new bathroom 1000.00 Install 3 pre-hung door (labor only) 300.00 Sunroom Remove and replace existing roof rafters 2775.55 Replace rolled roofing 450.00 Insulate-walls and ceiling 600.00 Frame and install 30" door(includes door, hardware) 440.00 Wrap exterior trim and sills with coil stock. 600.00 Install laminate flooring(labor only) 1836.00 Dumpster 1200.00 Permit 300.00 Plaster 4100.00 Finish trim work(Fireplace Mantles) 2400.00 ALL MATERIALS TO BE PROVIDED BY HOMEOWNER 22000.00(estimated value) Contractor to supply insurance binder, copy of licenses and building permit. Terms: 1/2 down and final payment upon completion. Total: 46,567.55 r Sue Gavin Darren Sturtevant I i V 3 2r 39 g" I 14614" � 72" 21-81" - W3036B W3036B N - ti V\1t�UtWF396-3/4 [3$24(3}. t B3 B WP2490d €DWR i f J ri LS3309R ' : � �s - m w , � I 1 SB30B DWR33412 _ I REP2496-3/4" � ' �� B18-L DISH-iQ3 CO EPB24D R, pg2Q j _ EPB2 EPB24D R I � QWR33412 DWR33412 - WF3-3/4 - - -T REP2496-3/4" All dimensions_size designations This is an original design and must Designed: 9/26/2016 given are subject to verification on not be released or copied unless Printed: 10/3/2016 lob site and adjustment to fit job applicable fee has been paid or job conditions. _ order placed_ Design B i All Drawing#: 1 Scale : 0 3/8"= 1' kr1�-k1 i 00 d _ I \;+vary ke CIO furp�.N tity11' _ - M ` ! 41YX i . : i .r _ 4� r-,rovA "loom : 17�r2, j I W A I} Ot �e wtaVAr�G / b da&r 3 Wli�1 w dJ: C1�5 QTIF _ . 77 =" -I I • IT 3t}" �liltinnpt S/wA-E1 CA {2ewio�lA�� 33" T100"— re�u►: I Z .00me slol./4 A*-w 4%W d"- m a� I:•�a�ti vel W Tlpq VIA _... ' � -:::�K' ...�°'�...—.�� F��–�•_�%� �r,�r y`" if I✓'� _ �'k < n'��:3!; �• M - _ �5 L 1. :. Lia . * + asc � 3��ek= 5" : (i05rAi A- V a!1�, taw -- 15 4 44-1 Lo oo4bl-y hoof cl Wav'k : Z4 r.: C6,ar jr`}3c vuf e AT " TAtt 47,„ �rafs ' taorr Client: D.yle,Lumber Date: 9120/2016 Project: Designer: isDesign," Address: 371 Johnson Street Job Name: Barter C) North Andover,MA Project#: FB01 2.10E PWLVL 1.760" X 18.00001 2-Ply PASSED lLevel:Level .............. 7T� =1 SPF 2 SPF 20' ' t3 1/21, 20' Member Information Reactions Type: Girder Application: Floor Brg Live Dead Snow Wind Const Plies: 2 Design Method: ASD 1 4800 1761 0 0 0 Moisture Condition: Dry Building Code: IBC1IRC 2009 2 4800 1761 0 0 0 Deflection LL: 360 Load Sharing: No Deflection TL: 240 Deck: Not Checked Importance: Normal Vibration: Not Checked Temperature: Temp<=1001F Bearings Bearing Input In Cap. React DIL Total Ld.Case Ld.Comb. Length Analysis lb I-SPF 4.500" 4.500" 98% 1761/4800 6561 L D+L Analysis Results 2-SPF 4,500" 4.500" 98% 176114800 6561 L D+L Analysis Actual Location Allowed Capacity Comb. Case Moment 31599 fl-lb 10' 45022 ft-lb 0.702(70%)D+L L Unbraced 31599 ft-lb 10' 31641 ft-lb 0.999 D+I- L (100%) Shear 5456 lb 1'8 114" 11970 lb 0,456(46%)D+L L LL Deflinch 0.471(1-/500) 10!1/16" 0.654(1-/360) 0.720(72%) L L TL Deft inch 0.644(1-1366) 10'1/16" 0.981(1-/240) 0.660(66%)D+L L Design Notes 1 Girders are designed to be supported on the bottom edge only. 2 Multiple plies must be fastened together as per manufacturer's details. 3 Top loads must be supported equally by all plies. 4 Compression edge bracing required at 3110"o.c.or less. 5 Lateral slenderness ratio based on single ply width. ID Load Type Location Trib Width Side Dead 0.9 Live 1 Snow 1.15 Wind 1.6 Const.1.26 Comments 1 Uniform 16-0-0 Top 10 PSF 30 PSF 0 PSF 0 PSF 0 PSF Self Weight 16 PLF 4A f I Q,,v( v") '0-23-2016 rY Manufadurer Info Notes 6,For flat Toole irmavide proper drainage to prevent ro Paneling % Palo Woodtech Corp 7 Catculated strut urea Designs[a respons3ele a*of the Handling&Installation 1 1", 1 1 c structural adequacy of Itis component based an the I Lift beams roust net W at or domed 1850 Park Lane r"pwsiNI of I sustom.r grult.,the ount-1. to esitin criteria and teadirgs 1havar. It Is the 2:Refer to manufactures product Information Burlington,WA 98233 .nram saourty of fire hteo�d yvra4 da�nstaltuoo rewfeeneeft, nualroy -2285 4 eneole th's" em'p, f.freN iels,beam strength values,and coda (888)707 arojAaa,and toverHythadmensiong"loads. approvals www.padficwoodtecti.com Lumber 3.Damaged Beams must not te,used APA:PR-1-233,ICC-ES:ESR-2909 I MY n 1.Dry ammo conoldions,unless noted sll—w S. ,,,,:a Isla, —val eal I' P, 'd Fuel supped,a bearing points In ov.41 2.LA net to be treated forso,landnd.,-ruesue. lateral ftplawment and rotation Beta Otrix Version 16.4.041 Powered by iStruct- VDAC ZURICH WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (GZZUB-7H70737-7-16) NEW-1 6 INSURER: AMERICAN ZURICH INSURANCE COMPANY 1 NCCI CO CODE: 17965 INSURED, PRODUCER: STURTEVANT, DARREN J MONICA INSURANCE AGENCY 25 ADAMS TERRACE 19 MILL ST LOWELL MA 01852 LOWELL MA 01852 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 10-04-16 to 10--04-17 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Pari One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA R O h B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A, The limits of our liability under Part Two are: o� Bodily Injury by Accident: $ 1000000 Each Accident o Bodily Injury by Disease: $ 1000000 Policy Limit Bodily Injury by Disease: $ 1000000 Each Employee m C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 OGB m D. This policy includes these endorsements and schedules: o'.= SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE oma_ 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 10-07-16 RT ST ASSIGN: MA OFFICE: ZURICH-ORLAN 809 PRODUCER: MONICA INSURANCE AGENCY 78D4C 010650 i i VDAC ZURICH WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6ZZUB-7H70737-7-16) CLASSIFICATION SCHEDULE: PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATIONS CODE NO REMUNERATION REMUNERATION PREMIUM SEE EXTENSION OF INFORMATION PAGE - SCHEDULE(S) SIC-CODE: 1751 NAICS : 238350 --------------------------------...----------------------------------__-__...___--_----- STANDARD TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ 737 PREMIUM DISCOUNT NONE 0900-20 EXPENSE CONSTANT 250 TERRORISM 3 TOTAL ESTIMATED PREMIUM 990 TAXES AND SURCHARGES 37 DEPOSIT AMOUNT DUE 1027MP A/R (WCIP) # Minimum Premium: $ 500 EMPLOYERS LIABILITY MINIMUM: $ 75 ST ASSIGN: MA DATE= OF ISSUE: 10-07-16 RT OFFICE: ZURICH-ORLAN 809 PRODUCER: MONICA INSURANCE AGENCY 78D4C WORKERS COMPENSATION ZURICH AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (6ZZUB-7H70737--7-16) INSURER: AMERICAN ZURICH INSURANCE COMPANY 17965-MA INSUREDS. NAME : STURTEVANT, DARREN J RATE BUREAU I D: 001 071877 PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 012608294 ENTITY CD 001 STURTEVANT, DARREN J 25 ADAMS TERRACE LOWELL, MA 01852 SIC CODE : 1751 NAICS : 238350 MASONRY NOC 5022 IF ANY 9.70 STONE , MOSAIC, TERRAZZO OR TILE WORK - INSIDE 5348 5000 5.12 256 CARPENTRY NOC 5403 IF ANY 11 .00 CARPENTRY DETACHED ONE OR o--• TWO FAMILY DWELLINGS 5645 5000 8.11 406 O D m �M m n m r...w m � �r oma'" V i DATE OF ISSUE: 10-07-16 RT ST ASSIGN: MA SCHEDULE NO: 1 OF MORE Q10851 , q WORKERS COMPENSATION ZURICH AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE—SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (6ZZUB-7H70737-7-16) PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 (CONT'D) CARPENTRY — DWELLINGS — THREE STORIES OR LESS 5651 IF ANY 8.11 s ----------------------------------------------------------------------------------- i I� 2 .00% EMPL . LIAR. INCREASED LIMITS(9812) $ 13 8 ADD FOR INCREASED LIMITS MINIMUM (9848) 62 MERIT RATING/EXPERIENCE MOD: NONE MODIFIED PREMIUM NONE TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 737 EXPENSE CONSTANT(0900) 250 0.0300 TERRORISM (9740) 3 5.60% MA WC SPECIAL FUND AND TRUST FUND 37 TOTAL ESTIMATED PREMIUM 1027 DEPOSIT AMOUNT DUE 1027 'i DATE OF ISSUE: 10-07-16 RT ST ASSIGN: MA SCHEDULE NO: 2 OF LAST I WORKERS COMPENSATION ZURICH AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 00 01 (A) POLICY NUMBER: (GZZUB-7H70737-7-16) LISTING OF ENDORSEMENTS EXTENSION OF INFO PAGE We agree that the following listed endorsements form a part of this policy on its effective date. WC 00 00 01 A - 00i INFORMATION PAGE WC 00 00 01 A - 001 INFORMATION PAGE 2 WC 00 00 01 A - 00i EXTENSION OF INFORMATION PAGE - SCHEDULE WC 00 00 01 A - 001 ENDORSEMENT LISTING WC 00 04 14 00 - 001 NOTIFICATION OF CHANGE IN OWNERSHIP ENDT WC 00 04 22 B - 001 TERRORISM RISK INS FROG REAUTH ACT ENDT WC 20 03 01 00 - 001 MA LIMITS OF LIABILITY ENDORSEMENT WC 20 03 02 A - 001 MASSACHUSETTS - ASSESMENT CHARGE WC 20 03 03 D - 001 MA NOTICE TO POLICYHOLDER ENDORSEMENT WC 20 03 06 B - 001 MA LIMITED OTHER STATES BENEFIT ENDT WC 20 03 07 00 - 001 MA ASSIGNED RISK POOL ELIGIBILITY WC 20 04 03 00 - 001 MA . CONST. CLASS PREM. ADJ. PROGRAM WC 20 04 05 00 - 001 MASSACHUSETTS PREMIUM DUE DATE ENDT WC 20 06 01 A - 001 MA CANCELLATION ENDORSEMENT WC 20 06 04 00 - 001 MA POLICY DEFINITION ENDT 0 m m nom"■ m w.�ws �r ate• m�..e n � Orrr� V t �r VH� l DATE OF ISSUE: 10-07-16 ST ASSIGN: MA Page 1 of LAST j W0652 i i The Commonwealth of Massacltrrsetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 ° ;v►vrv.mtiss.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Tlectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leizibl Name (Business/Oiganization/ln(lividual): Address: City/State/Zip: L.,P-V--C-l i vv�q cjYQ Phone#: Are you an employer?Check the appropriate box: Type of project(required): l.[]41K0m a employer with E employees(full and/or part-time).* 7. ❑Now construction 2.Q I am a sole proprietor or partnership and have no employees workiug for me in 8. *ermodeling any capacity.[No workers'comp,insuraticc required.] 9. [!Demolition 3.01 am a homeowner doing all work myself.[No workers'comp,insurance required.]t JOE]Building addition 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either havo Nvoikers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors wilt no employees. 12.0 Plumbing repairs or additions 5,❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 Roof repairs Theso sub-contractors have employees and have workers'comp,insktrance 1 C.Q We are a corporation and its officers have exercised their right of'exemption per MGI.c. 14.❑Other 152,§1(4),and wo have no employers.[No workers'camp.insurance required.] *Any applicant that checks box 41 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, If the sub-contractors have employees,they most provide their workers'comp.policy number. 1'air:air eirtployer tltat is provitliirg wor leers'eoitipeltsatloit itisitr•artce for/try eiiiployees. Below is floe policy and job site information. Insurance Company Name: {✓ G j K v/ e fir✓ Policy#or Self-ins.Lie.i€: C) G �� Expiration Date: N` ZG> Job Site Address: 1 ��' _ __ City/state/Zip: /`�6-4u Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c, 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cel1i y rrrtder the pains acid penalties of peiftiq that the information provided above is tale and correct. Signature: Date: 4it �+ Phone#: P01-1142-3 ` Zia Official rise only. Do not write in this area,to be completed by city or town offletaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.U,lcetrical Inspector 5.Plumbing Inspector G.Other Contact Person: Phone#: DATE(MM/DD/YYYY) ACCOR& CERTIFICATE OF LIABILITY INSURANCE 9)w2Lip201 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), AUTHORIZE11 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 t the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to th certificate holder In lieu of such endorsement(s). PRODUCER CONTACT A.I.I. InSUrance Brokerage Of Mass.,Inc. NAME: PHONEFAX -M 183 Davis Street AIL . ............. .MAC O: I .O.BOX 1139 ADDRESS: _..___...._...__.__ PRODUCER Douglas MA 01516 CUSTOMER ID#: —�� INSURERS AFFORDING COVERAGE MAIC# INSURED INSURER A: Darren Sturtevant ................ 25 25 Adams Terrace INSURER 8: Lowell ll MA 01852 INSURER C: -- INSURER D: 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. 1�.SR TYPE OF INSURANCE L U POLICY EFF POLICY EXP �-- LIMITS L R POLICY NUMBER MM/DD/YY MWDDIYYYY GENERAL LIABILITY AF"P61414103 09/2f/2016 09128/20117 EACH OCCURRENCE $ 1,000,000 DAMA ffTGRENTED COMMERCIAL GENERAL LIABILITY 100^000 CLAIMS-MADE t X OCCUR MED EXP(Any one person) $ — 5,€700 PERSONAL&ADV INJURY $ 1,,000,000 GENERAL AGGREGATE $ 2,000,000 ......... _..._..... _.......__.._ .. _..... GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM!I iP AGG $ 2,000,000 X POLICY PRO- Ll LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ w__ ALL OWNED AUTOS BODILY "" BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ — -- DEDUCTIBLE $ - RETENTION $ WORKERS COMPENSATION WC 5TATU- OTH- AND EMPLOYERS'LIABILITY Y/N Tb�RY_LIM ITI.i ANY PROPRIETORIPARTNER/EXECUTIVEE,LmmEACHACCIDENT $ OFFICER/MEMBEREXCLUDED? � N/A .. .. ............ ..........._------ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,I1 more space is required) Remodeling Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town ofNot atAndOVOr' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 384 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover MA 0,1845 AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD