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HomeMy WebLinkAboutBuilding Permit # 12/2/2016 ,4o RT14 BUILDING PERMIT TOWN OF NORTH ANDOVER J0 -: APPLICATION FOR PLAN EXAMINATION � i n � ` permit No#: ©ate Received ��ssAc�+us���y Date Issued: ORTANT Applicant must complete all items o a this page 31 r pROPfHR1g YVN1 nR � �� � �� �h BQ M,E�C �f11C lJf r �ES � MAPS f 5, ' � PARCEL `- ZONING DISTRICT�x1�Es ar�cy is,r�cy � <�ye r�o achirie Shop 1/ilfage_ `yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building %)one family El Addition El Two or more family ❑ Industrial ❑Alteration No, of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition Cher ❑Septic ❑Vtleli L Floodp[a�n p Wetlands D JV W. District DESGRIPTION OF WORK TO BE PERFORMED: Identification- Please Z`ype or Print Clearly OWNER: Name: � C�G� e L_1 L IC ��� ��ck 2,Z I Cit Phone: - 1, - ��1... � Address: P C V C :Y cry Contrad tnr Namerc�xr ���t6eu =Phone � �- r d C vr ail -z.,: -Sf Address SU WeNiSOr's Cbnstri3ction Lrcense EP Datek s Horne Improvemen"k License ARCH ITECTIENG[NEER Phone: Address: Reg. No. FEE SCHEDULE:SULDING PERWIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ , & �S b� FEE: $ c,�. 2�1213 Check No.: D. I I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Snnati ErP of Ac�pnflOwner Signature of contractor 'T ctORTH owe. of � ndover. O mph 4 ver, Mass, t%r [p[MiC Mlw C. 1' �AO Rev RATED S U BOARD OF WEALTH Food/Kitchen PERMIT Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ...+h�r;.............. .................. `� .!rl... ... ...... has permission to erect .................... buildings on .... ...7 .... . � ... ..... Foundation .f, Rough to be occupied as ..��. + ......................................................I 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 QNTHS ELECTRICAL INSPECTOR UNLESS CONSTRUArt AR Rough Service ...... , .................I........................., BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to OccupV Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det_ rudora IID#05-0305529 RISE Enginceiing RI Coil tractor Rogistration Re 8186 MA Co itractor Registration No 120079 RISE69 Shnnt iviil Road,Cimtoii,MA 11202 1 C"r CO:itractor Registration NoG20120 ENGINEERING' 339-502-6335 FAX 339-502-63-15 CONTRACT Page 1 PI'06RIMM 1)113 COUTRACTIS ERTEREGUMOFTWEEN RISE A-I I F.S EMMEERING ANDRIE CUSMOX-R�6fl WORK AS DESCRIBED UELOW' CUSIMER PHORE DATE CLIENTO WORK ORDER Vwdrick Spin rola (978)681-9394 W/2912016 424356 23941 SERVICE SIREET rAWN0 SMEET i7 Ilincridge Road 57 Pineridge Road (("",. .............. ... ............. GERVICE C�TY'314TEJJP 0111ING CITY.31ATE�za' p North Andover,MA 018,15 Noill,Andover,NIA 018,15 .1013 DESCRIFFION I IAZARD BA RRI FR:We have itlem ified elect I here al c rec"sed liolls la esent ill Your llolllc�tall"'s the rcccs�od lio,it s arti I ified 'It ion Contact Rated)Nw t611 Create a 3'Olomouc spaco,around the fixture by using fij�erglw as IC'-rated(Insul, a rl,lllnlilig material,It()insulation"ill IV installed aeons the(op mid closoo cavitio%%hich col Itain recessed lipjIts%%illI I ot h&' ill'allated. SOAR) ............. HEALTI I ck,SAFETY:Weatherization vauk cannot proceed trolil the spillage ofcombustioll jpici is fixed S0AM AIR SEALING:Pfovide I:ilx)r and materials to Sent atea%ol'vollf home Splillst Masteflll,excess air teakage, This"orl,%vill b". per-formcd it)coliccil %aitli tire wc of spacial look mid diagnwi to icsLs to assure that your home%vill bo left %villl a healthful level ill, air exchange and indoor air(Imlity.Materials to IV mcd to seal your hollic can inclm!e caulks,Coams SIM other products. Primary areas for walinur indodc air leakage to attics, jtt ke�elljcr ll�,,� aelled garage;;and other unheated aroa,0%%indow,are nor g,.cnerally addressed) This%Wi require(Ill)wirking hour,.A iedu.1ion it)cubic feet per Illintite(din)of air infiltration%rill oec(w,bill the actilal number ofelin is not gm,'Irailleo'd At the completion of the%wathrarizalion%Nork.and at flo additional cost l(w the hoincowier. I final blmm door amuor colillAw ion sarcly analysis%01 IV conducted by the silb-comfulor It)ensiffe the safety of the indoor air qllalily. $850,00 DMONIINO:Provhlc latm-aid materials to install a 12"laver of R-38 unlaced fitsagloss Nits to(p 1())sqkure feet for damming jmrpososKITT OFSIONATFI)20XI2 FL()OR, S225-50 AT fit:'FIAT:Provide latx)i and Inalclials to install all 8"Myer of R-30 Glass I Cellolo5c athkd to(1068)sxjmrc feel ofollen all icstlace" S1,463.16 STORAGF�I3AHRH,'R:Homeovner is respoosiblo Im the removal of the Suited ilems btockilig the installa(iolt of 1,011 nitials) wnrk III tire attic, Removal nitm occur prior it)the elmiuled kwtk start I VM0 $0.00 ATTIC AC CEA's I'lovide lal,or and Illalcriak to install(I) easily moved,iasulating cover for the atiie occcst folding stair. A smalf flat wrface ofplymmd trill I%-cretltccl iroancl div opellitig%rithio I lie attic. This%vill alkm the vovcr'!+intcgal%%eather- stripping to restrict air lcaL'ap.-, S23T65 VFMAIATION:Provide lat'xw and inateflal.,,to install(I)insulated exhaust hose will roof mounted flapper vent is exhatim future ImIllroolli lam(s), 5118 75 ,tINAWYNtirv.,, fav, Fecloral 10 0 05-0405629 RISE Engineering RI Contractor Registration No 81116 FAAConlractor Registration No 120979 RISE�, 611 Shawintif Road, MA 02021 CT Contractor Rogistration NcI620120 ENGINEERING 339-502-6335I°,15;339-5112-G346CONTRACT Paige 2 PRTRAM IMS CCVIVIAC113 OFIERVO 1A VJ D UTMEN RISE ("A I,k-I I E-S ENGINEEMINGAND"Dir CUSIVVIER FC)AWCRK AS VESCRIBEG REMW C113T.VA4Wt PIRXIE DATE cuVito V4 CS K aWE IT Fredrick Spinazyoh (978)681-9394 09/29/2016 424.356 ZMA SEMCC GTREET SILL010 STREET 57 11ineridge Row] 5 57 Pincridge Road SERVICE CI1Y,81A1t,4P UILLIRG Cire,STA-M,ZIP Milli Andover,MA 01845North Andover,MA 018,15 ,1013 DESCRIMION VEN IALATICIN:Provide lalw mid awlQriI—IN–io Install ventilation cloiles in(106)Faller bays 14)nwinlain air flow $212,00 COMMON WALIS Provide:h1w and materink to install 2" VSK Iaccil semi-rigid filierghiss IsMILI insulation W 11114)qjuarc feet oNorrinton woll oras. 7—%Y1Tl,,Tr(T-1 L-1 N47 and materials t1r install(103)linear feet of R-19 unlaced filvrgkv,s insolm ion to the Imillicter ol'the NwIRVIR ceilint-'at the llocle sill. 5294.00 RISII'tiginecrin,44111 apply all opplicable,cliL!ible Ricentives to this contract. Yoti%611 mily Iv billed the Net amount. Currelitly, for cligible measures,Columbia(his o)ters 75Y4 Riceni ive,not to exceed S2,01)0 per calendn year,and on incentive of I()M) ,for the Air:soaling measures up to the first%80 and an additional$340 ifsavint,s tire jumificd by die mulitor, For the sarety und heAlli ol'your llouw,s indoor Sir qmllity,"t will Iv conducting a Hokkvr door diat'wm ic oft lie tivaflable air Ibm in your home Iolh hetore the%%14 is Wgim,and aller the%mitherimlion wO-�is complete,We%%ill also condoci a(till a,,;,vcswciR, o1*11le combmition SA'cty ol'your heaiing,,, ,,Meru ansa witer heater.This has;I Value oI,S()0 and is al no Cost to)'oil, Totat allowable%watherintiort incentive is$3,1 M ............ En ................ 0 0 1(5 Tota 1: $3,855.06 afro ram Incentive: $2,940.00 Customer Total: $9,15,06 WEAGREE14ERESY TO FOR T14E sur,,i or ""Nine HUn red Fifteen &06/100 Dollars $915.06 rte H L"n, rod Fifteen UPON FIRALIMFFli6i R)VAL SY RISE ENVNEERM�SU' ER AGREES 7DREIVITAMAMTOUE'.IR FUU-1141CREMOF 1%VIR-1.01'CHARGeDIXXMILY VIANY TIM -U� 0 D ,SEE REVERSE KA UMC%%,M- CISMAIVI:W GUARAN CO.ROM Cf RECISION,S CHEDUUNG,AJID C"oRAC=REMSTIATM Ut,?AIDBALAR0,AVX:03 *1 N I C,/ SIGN THIS CONT I SIGN THIS CONTRACT IF THERE;fj .,, Y 11L41.K ES u ROM:NIS CQiVArT?,IAY HE W1140RAV411 BY U3 IF NOTEXECUTED WINN UAMCrACCEPIANC&i ACCEPTANCE CF CONTIACT.PICABOVI!VIOGED OPEWICIA11"M AND W10IT063 ARE 303AIMSFACORYM 3 AND ARE HEREBY ACCEI'ii(),YOU ARE A011CRU40 70 00-HC VXQK DAYS. ASUPECInED.IPAYUtl."PltW[U.DEIAAI)C-AG(>U�UtiEDAG(WC NRnAi.N-., ,fSYI%m, RISE 60 Shawmut Road, Unit 2 Canton, MA 020211339-502-6335 ENGINEERING` www.RIEengineering.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: �J t'► . 1''G / \\17 I (Prope A dress) . (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. Ther Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. e s Signature i f 'x -( Dat I r 6.2016 The Cornntonmpealth o 'Massachtasetts Depai-anent o f Intlttstrictl Accidents ,myfi ., t Office of�D7VE'4t1 [7tl(1ir,S �w r u 600 Washington ,�"t`�eet `k iia$ pN llostorr, KA 021.11 tv w w.nartss.,;av/clia Workers' C;olrlr>Ipetisatimi histiratric;e Affidavit: lluilclers/C"o>ntractofrs/Electricians/Pitimbet-s A Dlieant hiformatiolli Please l"runt Legibly Name (rosiness/Organi:cation/lndividiral): Merrimack Valley Insulation Corp. Addi,ess: 23 A Sullivan Rd. Ga.t;y/`>t.ate/Zip:_Billerica,,MA 01.86.2 Phoiie 4 978-888-3495 Are you.in employer?Check the appropriate box: Type of project(required): I 1.0 I am a employer with 18--- - 4• © I am a general contractor and 1 -- 6. ❑ New construction employees (full and/or part-time,).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner_ listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. employees and have workers' 10. Icling additiota �o wC)t'kef`S' Cot11j�?. tl'tSUCstttCe Comp. t[1st11'i1nGe.� 5. we are a corporation and its ❑ Electrical repairs or additions re:cluircd.j � 1 3.[l I am a homeowner doing all work officers have exercised their 11.[:] Plumbing,repairs or additions myself. [frim workers' comp. right of exemption per MGL 1.2.❑ Roof repairs insurance required] t e.. 152, §1(4), and we have no employees. [No workers' 13.X1 Other Insulation _ comp. insurance required.] "Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy inforn7ation. I lomcowner;s who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit,indicating such. (.'ontractors that check this box must attached an additional sheet showing the nsnne of the sub-contractors and state whether or not those entities have employees. 1f"the sub-contractors have employees,they must provide their workers'comp.policy number. T am an employer that is providing workers,Compensation insurance fim trays employees. Below is the policy and job site information. Insurance Company Name: SStar V3 AAIC American Alternative Insurance Policy#or Self-ins. Lic.#: V9WC74911 _.___..._ _.._..__. Expiration Date: 6/1812-0-1-7-- Job /181201? .Job Site Address: [ \.C,k ...__�'.�. _ ..._..._._� City/State/lip:I I F�I�C,4(J"�1 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage:as required under Section 25A of MGL e. .152 can'lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-yeas-imprisonment, as well as civil penalties in the form of a S'rOP wolu,C,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. X do hereby cert%f y7 mider the pains and penalties o f perjuq that the information provided above is true and correct Signature. Data;,,..._ )_ ..` UL ._ ._. __.. _........ ..__ Phone#: 8-888-349 U,ficial use on1j). Do not write in this area, to be cirnrpleteel by city or 1mvii officdal City or Towvu: .. _ Permit/License# _ Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: The Common-we�.Eh a=llw ss�ri seE Qanzftneaf of AUSM x AWderds QJE-RCc ofQ� � 600 'z�n �.: St =30Si L3f17_�1 Uil VVorker's Com, pe€tsal oa Insurance 3-f---ida-vft- tai?IEGyrS��(3Tx �Ci0w5r' ')�Ci�?CI 9 u�`�D2�S k7.l[zC2i7CE llafOi�-c�uOY'- ?j�av-M egP'' t T— (�t3Si?25�14rc' :z��,DLf=FiEYI vELiE 3I{�aFiEE�=s�- '71.n iFlr;: 't�j �iti 4i[ ��7�T1� rr3�-1� LAA LI I z�.L•E you an X. =an,^_a e*'Jpjo 6r zwM--LLembIELveeS < i 20 a sole prupi?Ctor❑L perLPera?Zirp&i2�•�'v 51D pt�]LIjovy S., r1kinE for me in art?capr-ity— ` f a c h.luJlei3 t='1Zc1 C'i'�I� uZ ivU=1i u%`3Gj { C 'Di�ieT;C4ueaszz on�i'Tisuraur-e renuired-3 { '{ u.?'Ct c 67^?el•4_'.CarrL7, or-z'T ham MW C'• Q sj.,;a-Conum e yi.s UO,Ci a he ato-E:hed sheet f� =- -- f 1 hese coI3.,_aefbI=-havc-wark b efl=e p_tas-iaar---a--ld Til:v-a."r=L:xclied'G CO-0T pt ihilr In e�. .r�D� T ( : and.Te h2le M 8 TI'er5. =I9tiE:thL'CAlG^.Ectw---toraGw tthifir warimTz•Camp-PDI!q i,-6rvgzNait• O M Lti'=alam-a -FY•[-.r*fi[i_l.tc_iu,.vilsiti�v...-x aucai S-u'uii.w-.M..•• l rfTd'aviIi_diatelFstr-&- ' i • � CO R'1-dG�i'3�2.".0�¢eC`i Thf7O�si;lSSr;Tiw:Cel:tri S��iZCG^_1 Out Shi1S:t,oW?[T^:1��xle D'. • - I enztaeTTsuattnol:�itT���rra;ie�_ T1ne��Bi��ec�frC3il?TE{1J: Gfi°CI:��L'€TrE1G?-I��� i _ u. ._=3 :?o e ,l"v4' ...t7_ !�.'r.,i��L.t`[3.... r atm art emgla3�erthat 4 ore-24th rcrlcers'cn�ar�SsaQ iTLxt xzuec x.yr�t�.,m IP�e s-Eel.,,r is heaalic fora si«ire_ ------ jib Site JraNv'D.`. a LtRCCf�i cop a i i?Rs t2i's CO[RF38Ttt'uL�OII�U IGS-dell^rati --P".'- ¢�S D elif�a etre poliq;rwiubrr L t eiF7Ti1RQR=tz- � r7} Y n ' $ �+a 2? �itl 1 d L'F�d,arSec�Oa25 ii.o L1-S C_1.5----=[1 e A W Che.t s UQ9Cn of�'E-� %LISLv 3' uv+"it�F �c..a. w pentaCt=u5 of a iai+2 Qr to S150010 ai'[Wo"One=eau Lam:E 0varmaq will as Cl-41 76R2liLEs M.--rhe form el €op KV0Q4 0REM aad a We Qi vp to S250-00 a d y nEm7jns=_;:h; iolallov- Be rdtqsad that--cn;,=of ffiis eta merit-, n-y ba Fonwarded tO 2e 0 Ak a a a Fr ves49110Rs CIL el?u DIA for ie3SuraaCe cGlie=a-r0ElficaVIOe z ua hp-aby zei ci 1;53 eT Iles ulna wZC•i 6rz_?,Awn o fed .!ba-la iiti:_i rne1."an pi6's red&may 4'm 2i:G:.t3MOZ. Rho ,a�` ( 1 Gtr r�oF'�J��.�� _ L ; e' ._._.._,fi•_F-3- did=s"`r.�G Tau owa uld b-,'City Gi iQfr'? ,3�Lia!_ !_!,%t icl i"54 Qs Y1: �G �p� tiw I�.%���� r� r ;I t7rvTE'`i:l=v'C..ve cOis !_G?- C;C 0:11�,; - { i._ DaCd WIN _BuilCilag J?p'` 'CA,...�Sv mm CM BieCi.E(.^.:�3=.SR. -_'PIuipb iL'Gas I'__Oihe__ 1 t f--;GntecrPOn-- ( i - 1 DATE(MMIDONYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 11/07/2016 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 have ADDITIONAL INSURED provisions or 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 on PRODUCER GONTACT Carolyn A Coughlin Charles J Coughlin Insurance PHONE FAX >tt: (978)957-3588 ,uC,No): �.. 14 Dinley5treet ESL P.O.Box 10 ADDRE$s;...._carolyn@coughlinins.com Dracut,MA 01826 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Northland Insurance Company 24015 INSURED M err imack Valley Insulation Corporation Joseph A.Ryan,Jr. INSURER B: Safety Standard 39454 23A Sullivan Road INSURERC: Torus Specialty Insurance Company A0159 N. Billerica,MA 01862 I ...._.._ 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. INSIR ADDL SUBR POLICYEFF PQUCYEXP ._..._..-._,�., LTR TYPE OF INSURANCE INSD WVD POUCYNUMDER fM&VDDIyYYYJ (MMlOD LIMITS A COMMERCIAL GENERAL LIABILITY W8274182 01121!2016 1/21/2017 EACH occL RRENCE $ 1,000,000 FA DAIWIGE CLAIMS-MADE I v E OCCUR _PREMISES Ea occurrence $ 100,000 MED FXP(Any one Person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GFNI_AGGREGATE LIMIT APPLI ES PER, GENERAL AGGREGATE $ 2,000,000 J POLICY I 1 PJECT ROT � Pl LOC PRODUCTS-COMOPAGG $ 2,000,000 __ OTHER, $ B AUTOMOBILE LMILrrY 6205006 11/25/2015 11/25/2016 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS / HIRED NON-OWNED PROPERTY DAMAGE $ V AUTOS ONLY AUTOS ONLY C J UMBRELLALIAB gccHR 87593L161ALI 01/21/2016 01/21/2017 EACHOcCURRENCE $ 1,000,000 _.._ EXCESS LIAR CLAIMS-MADE AGATE $ 1,000,000 DED I 1 RETEtMON $0 $ WORKERS COMPENSATION IPER OTH AND EMPLOYERS'LLABILTTY YIN STATUi ER ANYPROPRIETOWPARTNERIEXECUTIVFE.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? NIA ......---- (Mandatory in NH) E.L,DISEASE-FA EMPLOYEE $ If yes,descrihe under DESCRIPTION OF OPERATIONS below Ek.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES(ACORD 101,Addi,iiorralftmarks Schedule,maybe attached if more space is required) Insulation Installation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover,Massachusetts 120 Mai n Street AUTHORIZED REPRESENTATIVE North Andover,MA 01845 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD i I i i MERRVAL-03 UVEJE ® - CERTI CATS OF LIAR TY INSURANCE I gA1�DoNYYY, � 6 6 193113/ 416 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 114SURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate Bolder is an ADDITIONAL INSURED,the policy(ies) mast 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 conger rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Automatic Data Processing Insurance Agency,Inc PHONE ----— FAX 1 ADP Boulevard e-(At9a Lo Exc: AIG.�+� Roseland,NJ 07066 ADDRESS: INSURER(S)AFFORDING COVERAGE _NA1C=_ INSURERA.5Star V3 AAIC Arnerlcan Alternative Insuran. — - �INSUREED - --Merrimack Valley Insulation Corp INSUAI=RS: - 23a Sullivan Rd INSURERC: North Billerica, MA 01862 INSURER➢: ___ _ --- ---- ---_-- -- _ — PININSURERF': COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO GF-RTIFY 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 4VHICIi 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. LTR —---' TYPE4FINSURANCE-y--- ---�SR L917n� POLICY NUIhBER v—--h1 NDU1S^FIYY 1 fPl1.11 DDIy llhlff5 GENERAL LIABILITY EACH OCCURRENCE I S 10 -�COVIMERCIALGENERAL.LIABILr1Y f PREt115�S�EaoctusLznta�-_i S--.——N;CLA1I•AS4AAOE 1-1 OCCUR 1 i'0EDEXP(Any unape_isan}__t 5-----.—- -_ - PERSONAL&ADV IAIJURY- ;•5 - —_ �- GEN'LAGGREGATE UMI APPL)ESPER.� ! rPRODUCTS-COMPIOPAGO S POLICY I IECT I�LOC - --- 5 j AUTOMOBILE LABLITY i COnIBINEDSINGLE LIMIT Eaaccldent -- s A14YAUTO i BODILY INJURY(Perpersan) �S ALLOWNED SCHEOULEO I [BODILY INJURY(Per acddent} 5 AUTOS AUTOS — HINt;LI AUTOS NON-OWNED 4 If PROPERTY DAMAGEAUTOS S UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCESS LIAS CLAIMS-MAGE AGGRECATE S DED RETENTIQN S I _ --- S _ WORKERS COMx WCSTATU- DTH- AND EMPLOYERS'LIABILITY _T6RYLSA1lT5 ER A ANY PROPMETORIPAR1NEWFXECUitV YIN IV 9)IVC749118 6!4812016 611812017 E.L.EACH ACCIDENT — ST— —3,000,000 j OFFICEUI nhNH)EXCLUDED? E NIA EL.. — - DISEASE-EAEMPLOYIFs 4,000,000 { If ye%describe under t DESC6I1`7I0NOFOPEFUVRONSb0mll ! E,LDISEASE-POUCYLIMIT- $ 3,000,000 [ DESCRIPTIO OF OPEFEAT16NS I LOCATIONS I VEHICLES(Attach-ACORD 10-11AddiUMIRemarRsSchedule,irmnrespacciarequired) OE.RTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DF-SCR113ED POLICIES BE CANCELLED.BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN Town of North Andater,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street NTHDRIZED REPRESEIIFATIVE North Andover,MA 01845 1 p 1988-2010 ACORD CORPORAT ION. All rights reserved. ACORD 25(2010106) The ACORD name and Ingo are registered marks of ACORD aa\�".:, '�C%t,%' C./'�" �d"/rff✓" ff 'C.''r 1 1" 0 , ( /' vl Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvem6h,t' distractor Registration Type: Corporation Registration: 180506 Merrimack Valley Insulation Corp�j Expiration: 11/23/2018 23 A Sullivan Rd Billerica, MA 01862f �.._ Update Address and return card. Mark reason for change. SCA 1 0 20M-05/1 t :J_AddreF.1 Pen ewmn! F ;pinym�rt t r`arrl �"�":/✓rr `f'rerrrrrrarrrracrr�f✓r c+�'fC"+/�ri,iar>Jrrjr^/!i 1� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type; Corporation before the expiration date. If found return to: RdaisArplign Expiration Office of Consumer Affairs and Business Regulation r10 Park Plaza-suite 5170 180506 11/28/2018 Boston,MA 02116 Merrimack Valley Insulation Corp Joseph Ryan 23 A Sullivan Rd Billerica,MA 01862 Undersecretary Not V "hout signature Yi,,i.jssachuseits 4e"pmtment of G-G31 f. c sa eetti'), Sca;d of a r'6iw Y,3tc3nr it r3ui,' isn S' Pmt ,cense CS-075541 u' JOSFPHARS'Ar% � 200 Kina Rail Dr.'AP `20t Lyanfield MA 0040 Con:nao:.r oats.r 02/0412017