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HomeMy WebLinkAboutBuilding Permit # 12/20/2016 TOWN OF NORTH ANDOVER µORTM APPLICATION FOR PLAN EXAMINATION °`��``° ,6•'"0 Permit NO: 6 Date Received "A���,r« r�. • s$wcHuse Date issued: /O '-Z0 IMPORTANT: Applicant must complete all items on this age LOCATION ®� )6U S �" Print PROPERTY OWNERC01's _.__..._._..� Print MAP NO.: PARCEL: ZONING.DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF.IMPROVEMENT PROPOSED USE Residential Non-Residential New Building One family Addition Two or more family Lndustriai Alteration No. of units: Repair,replacement L Assessory Bldg Commercial Demolition 7 Moving(relocation) ther P&ItS -PIS Others: i Foundation only DESCRIPTION OF WORK TO BE PREF RMED �}9S Grra 0 l Identification Pliasefype©i/Print Clearly) OWNER: Name: C-149. 11 Phone: Address: qU t4js P— /-tnthvpie AM- 0l CONTRACTOR Name: 't° 9�-� Phone: Address Supervisor's Construction License: () 10. Exp. Date: -3 Home Improvement License: 3 � Exp. Date: ARCHITECT/ENGINEER _Name: Phone: Address: Reg. No. FEE SCHEDULE:B ULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL.ESTIMATED COST BASED ON$125.00 PER S.F; Total Project Cost :$ .3 o9• (11. x12.40—FEE:$ Z Check No.: fz Receipt No.: Page Iof4 OORTH own of �? _ : _ :_ . ndover No. C, h ver Mass , 1?011 2oV oe 0 "K1 cac.a'c ne woc K P � l3 BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .........C.A LS;........CArV BUILDING INSPECTOR w .................................... has permission to erect. ................ buildings on .........J. .... �. .'.'�. ,,tir Foundation Rough to be occupied as ..........P oe4l " ..... $;W.W. ....400 +1 . /� .. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration a Construction of Buildings in the Town of North Andover. V PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL,INSPECTOR UNLESS CON CTI N T Rough e .. . . . ...... ................... ' Final UILDING IN PE R GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. WOOD STOVE (NSTALL,A HON CHECKLIST. Permit A building permit is required for the installation of any solid.fuel burning appliance. The building permit and installation Inspection are limited to the stove installation and not to the stove construction. Stove a' A. New Us?d B. Type/radiant Circulating C. Manufacturer _Lab.No, Name/Model No. ktoim J5 Cnuar size _ yg Dimensions/Height _Length Width Chimney A. New Existing T T S. Size(flus area) C. Other appliances attached to flue(Number and flue size) ._ 0.-Prefab(Manufacturer—name and type) E. Masonry/Lined .Flueiiner r I�rLC Unlined rVpo 3 manutactUe4v) F. Height(refer to diagrams) 2 r ).rh2r cap avEfL lo' OVER to I f2tt Ntft1. MiK "i 13 MIK Ion \.to 12" \` �- MIN. 00, i$tr Mil a��Fy jg1G`� -. HEARTH CHIMNEY HEIGHT I ( Hearth(non-combustible) r A. Materials u B. Sub-floor construction C. Minimum dimensions(refer to diagram) Clearances and Wail Protection(see stove installation clearances chart) A. Type of wall protection provided B. Clearances(refer to diagrams) FIREPLACE COIRNER WALLICENTER I i ' 780 CMR: STATE BUILDING CODE COMMISSION Figure 2139-4 CLEARANCES VOR SOLID FUEL HElPiNING APPLIANCES d Car FACTORY-BUILT CHIRNEY i - C(DP hoop CVpPOnT a 11UiroNY IRACNRT - HOH••LOHBUSTIBLE � WALL PROlecr1UH � `�—Co11NCCT6R.Plp[ ti CONI!CTOR OYBNLAP e -t [ J ��- TIOOOEORNINO - t $TOYE - k t a . - A _ M AIR SPACE 1* rJ^ 121' 1 - la 12„ HON-COMBUSTIBLE - FLOOR PROTECTION STOVE INSTALLATION CLEARANCES Camhustlbla &" Asbestos Mlltborrd Coocrate/Masonry 4"Brick Veneer Stove Components Materia-1 spaced Out 1" Foundation Val) SpPtPF%,d Out: L" Itadl ant Steve 1. —Front Circulating Stove !. 2#,. —Front. A. Radiant Stove 4. 3600 tb" 6'• lb'• --Side/we c1L Circulating Stove 12" 640 . ti•P �• —slde/Back S. Singlw Vett 2. lb•• 1200 6" b" Connector V e M;urseed 211 211 211 211 Connector ►l e Chtnner Height Three (3) ret t above adJpctnt reef and {Intel or Hasonry)' ?1 0. (2) feet .above anx roof ridge within 10 feet 0 eat I a at"per Is not nc u e n 'testove construction. a"p It must be Installed In the connector p1pe. 1. front! Fuel or ash access side. 2. Thimble required for passage through combustible constructlo"'. ). Ilon-combustible spatters required. 4. Clearances on each side of a radlmnt-stave with a heat shit-Id shall he mlhasured as If a tlrculattng type. I .......... .......... Jl_ ------------ ........... .......... k t J i ............ 6t- 7r M-m- bg �t ME 20"fireplace opening 47516 N 13,800• 1.5 Iblhr min f 900-2,600 i Woad a 1450 lbs.with E 4"PL pellet vent pipe Stan 81.7% 1.5 gfhr 1(2i 134 CFM' 22"fireplace opening.5816 41-13116", 32-118" 29.15116" ` 53,000 5.816s1hr max sq(t } pelleu 24"fireplace opening:64.51b surround i 3"PL pellet vent pipe opsi � n € Front View Top View — 24-718. �. ro N m m fI�"AT 1a-3ra• 41-13116" Side View 27-5f8' $ a f~12-314" x Zero Clearance Side View i i-..-.,.14" fb Y.// _ Wi When using 3"ov 4"PL �-13116" vent pipe,there must be 3" 15-911fi— 14-3r8" clearance to combustibles. a 29-15116' -----`- ar � Bt j FlaPCOECfier Case surraund to Cast stet round 40 Spark and Etpber : J Umti0$idewali: Llnittoptomantel F a 319 trips 314 trim �PFotectlon drily no 12" 12., �,. 6„ 6„ from glass)e A „ Floor protection:Minimum 16.112”deep by 30"wide. - T E E YOUR HARMAN DEALER 1S: a • 1 =F TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ Tanning/Massage/body Art F1Public Sewer Tobacco Sales ❑ Food Packaging/Sales L Well ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner �(� 4� Signature of contractor x'�'4/ Plans Submitted ❑ Plans Waived ❑ Certified Plot flan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING&DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals.Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Sianature&Date Driveway Permit Temp Dumpster on site yes no_ Fire Department signature/date The Colvallo;! peaTth '9f 1" Musa-1-hZIECUs 1�ep a mfrn 6W ofjFadrfstr'ii:j Accidas s 0ce of-4vesttgadons '! 600 fTrs�7iTIV,0,i Zi'eGi r;car ers° a ape satin sl;z ce:±.fffidatit: L1 'IdersfContraetos s/Elect1 Lc a sl hr=6exs Please Pr•IntLeaibi;' _'s_:)f.1L?CG:!.lf-�itl.Q3 EL��i4rl ;aLSI?le5sio g8[uzatiori inah fdnail: d !�� F L✓ � '`� y' �' ' iTLail fix ipIG3,er`'Che-c-, ap 3r4L rr� r-i?43': `T 1'pt'_Gr project(required): 4. i 3111 a general conrmctor and T ?. I aim a eniployer;vitli 5, El New construction! have bired the sub-contactors Crn�ln�r��5(fu-!!4i�uCJ:�.',?i--:'_:n��..' iisred or,the attached sheat... � ❑ 2-❑ i apt a solve proprierar or parnic_- - T tress sub-contractors neve S. ❑ Demolition sElip and have no e nwovess o; and l?�;.;;-or__ _ ' v:l 4 15WC hai— i',rC i ! on rrorl.ME, fo;im b:any capa —t V' � . �.....] Building ade.,' o workers' compinsurance. cork1p. insurance.- I0. ' �• ih%e are a cgrporarion and its ❑ Electrical repairs or additiozls rel�t]iCvCi.] ! i -, a llarneot�ile=doin4 all�,ork officers lla; e erased their l I.❑Plumbing,renairs a_additions - at.. ^ Ltt;selz. ltic workers- conin. rI¢llt or e�emniiari per I�fGL l2,❑Roo�'renairs t " §I(A), and v.---dare no insurance required.] ' c• -; ! I 13Lie. ,r S ernplayees. �lyo workers' � . - cori;... insurance reo�:ired.' Lqn:cit.—chs box.�l nm_:eiso fill ou.the st=;or.b-io;v 5nrt;'i� Their wailm.— CO ms tTls2Elor,p�ftCi']3lS3rfr&it:Jr-. :-ioilmL^Dkvners who suami:tilts aff'law r.indICalim,hl'_`•'.:re doinw al!wori:aM Chin Ibli�otlES<de conti'�C[orS n1Usl SUblrl[t 2 iICR',^. Dat'IC iF'kfl7C.9[7T: SUCS:. ;ccmtmcTo1's Chat eh-,& his box musi ntaelltci an additlonai ElieU sbotvins il,s nante of the sub-contractor and smte whetber or noE(nose eatlties hlWe Cll,oi4;'ee5. Li the suit-contr''c.etors nal�e emplovecs,the},must provide their wor3<ers`comp.policy number. I am Clic eiaryworkers' co peirsadoiz h,;S ratzce far ifdy employees. Below is thepolicy and job site lLii1lcU t r d jC,•d'itl>"•'�L r7 FF> Insurance Campa_ny Name: 0 — Jl policy or Sel ina. T ic. ': �IU�V, 10, J Expiration Date: !� g I -2 Tots Site Address: d '✓ U U LAS City/State/Zip:/V01VK AJ1bru-er A'14 OIVvf Attach a colli'3f the mwkers�co:Ctpensat=Gn polio'declar,fiO '. (sham"Ing,t-he polEcy BIT—mb$T d?aEs expLCaiICFe1 date). Failure to secure coVeracle as required under Section 25A of 1AGL.c. I52 can.lead to the imposition of criminal penalties of a Fine Elp to S i,SQQ.OQ andfar alle-year inlprisonlneny as well as cite ii panalCles in the form of a STOP INOR K,ORDER and a fide of up to 1250.00 a dap against the violator. Be.advised that a copy of this statemeait may be forwarded to the Office of Investiaaiions of the,DIA for insurance cove=age Veri-fication. r rl%l hareby Cerli edfdClLl'ifFe pLfi[s fZFdCI'�piSCr I o�peijuly that the b1fartilation Provided above is lf'dlc'and Correct. \��U -f- )ate: Phone �3- � Gfjacic:l zcse ojEjy. -o wi write in tldis area, tQ or rolv,d o}fIciA C?t4 or Town.. pe_nLIUL cense 9 Is-Min;,�,.uthority(Circle One): 1.Board of wealth 2,Building'Departmer=t 3.City l''oWn Clens 4.�lecfirical inspector 5.l�luflabi>ib inspector Contact Person: Ph One�`: Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contructor Law(MGLchopler 142A),but does not include standard language to protect immeownem Seek legal advice ifnecessary. Any person planning]ionic improvements should first obtain a copy of"a Massachuscus consumer guide to home improvement"before agreeing to any work on Your residence.You may obtain a free copy by culling the Office of Consumer Allairs and Business Regulation's Consumer Information Hollins at 617-973-8787 or 1-889-283-3757. Eton Contr a-Information C 14 meowneLOnformpon is W 6 -------- i&Ae Panic ornpin—y flanno do el tAs fi? �fa 61-N Street Address(do nW use a Post Office Box address) ntractor/Salesperson/Owricr Name 1W City/Town Slate Zip code hisiness Address(must include a street address) 9 9­0 M 70-- p-Wl Daytimel'bona Lverring1phone Zip CA)dc lablAb-Will Mailing Address(It differiart from BusinesslIhnne 1P_a.1J1mplec., or Mania N"".'I Emkwiondsa pure i rent eorfr teas hs— ,,did iiinmu......bcr 4 7 The Contractor agrees to do the following work for the Homein net I ojescrMc I Walall the wotmK 10Campiclea,sjxciung tile We,brall 8F de or materials to cc use(i Required Permits-The following building permits are requiredProposed Start and Completion Schedule-The following schedule will and will besocurod by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits'will be A excluded front the Guaranty Fund provisions of 1. ine when contractor will begin contracted work. MGL chapter 142A.) /A�'MoDate when contracted work will be substantially completed. Total Contract Price and Payntenk Schedule The Contractor agrees to perform the work,famish the material and labor specified above for the total Stan of. --------- Payments will be,made according to the following schedule: S1�19l upon signing contract(not to eked 11.3 of the total contract price or the cost of special order items,Whichever is greater) by or upon completion of___....... ——— by or upon completion of ---------- billion C01110letion of the contract. (I-Aiw forbids demanding fall payment mail contract is completed to both purty's satisfaction) 'file following material/equipinalt"lust he special S to be paid for ordicrod before the contracted work begins in order S to be paid for___----------- to nicet the completion schedule.(**) NOTES:(*)including all finance charges(**)Law requires that any deposit or down payment rquired by the contractor before work-begins may not cxceed the greater of(a)one-third of the total contract price or(b)the actual cast of any special equipment or custom made natcrial which nuist he special ordered in advance to meet the completion schedule, No _W% Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. ()illessoliterwiscj)ofcdwithin this docuiiieiittlic contract shall not imply that any lien or outer security interest has been placed on tire residence. Review the following cautious said notices carefully before Signing this C011tTOCt. Don't be pressured into signing the con(racf.'rake time to read and fully understand it. Ask questions if something is unclear. hwi.LMlid flonic Imnrovcnrcttt Cgitirrucl,pr Idcaistrntinn. The law requires most)ionic iniprovument contactors and subcoutractors to be registcred with the.Director off Ionic finfujovenient Contractor[Zegistration. You may inquire about con traelor t-800-223-0933. Does the contractor have hisurance? Check to sea that your contractor is properly insured, Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractot's norma)place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See lite attached notice of cancellation font for an explanation of this tight. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY LANK SP�ACES.11,1 Two �raicalcopiq One copy.shouldg.t. hon r.lU o e,copy uluk!be Lc mvxadcl. I % ,! 04-- Homeowmcr"s gnat Contractor's Signature Date Date Contractor Arbitration Tire Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,(lie contractor may submit the dispute to a private arbitration firm which has been approved the rota of the Executive Office of Consumer Affairs and Business Regulation and the consumer slu quired "timlit to Alich atrifflonwi vi d In Massachusetts General Law cha ter 142A Homeowner's Sign tare Contractor's Signature NOTICE:The signtures of the parties abikeapply artly to the agreement of the parties to afte.Viedisputeresolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do riot restrict a homeowner's basic consumer rights. If you have questions about your consurner/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day recission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems hinitherself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require(lie signatures of both parties. Additional Information If you have general questions or need additional information about the Horne Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Consumer Guide to the Home Improvement Contractor Law,"contact: Consumer Information Hotline Office of Consumer Affairs,and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration coinponent of the I-Ionic finprovenicat Contiactor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (017)727-3200 or 1-800-223-0933 Far assistance with informal mediation of disputes or to register fornial complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)6524800 (508)755-2548 (413)734-3114 AC RDS CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) 12/19/2016 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(ies) 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 COME:NTACT Robert Bean NA ,_., Bean Insurance Agency LLC PH(AIONE o Ext. (603)926-3830c,No1; (603)926-0203 151 Winnacunnet Road E-MAIL ADDRESS:bob@beaninsurance.com _ P.O. Box 660 INSURER(S)AFFORDING COVERAGE NAIC# Hampton NH 03843-0660 INSURERA:Ohio ,_Security Ins Co 24082 INSURED _NSURER B:The Ohio Casualty Ins Co __ 24074 Home & Hearth Conservation Inc INSURERc:Wesco Insurance Company 102 Lafayette Rd INSURER D: INSURER E: Hampton Falls NH 03844 INSURERF: COVERAGES CERTIFICATE NUMBER:2016-17 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BE=LOW 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 TYPE OF INSURANCE _ADD 5 BR —, POLICY EFf POLICY EXP -- LTR SD D POLICY NUMBER MMIDD[YYYY MMIDDIYYYY LIMITS X COMMERCIAL.GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE DAMAGE TO RENTED OCCUR PREMISES Ea occurrence S 300,000 BK$55508551 4/23/2016 4/23/2017 MED EXP(Any one person) $ 15,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMPlOP AGG s 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident)„ A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BAS55508551 4/23/2016 4/Y3/2017 BODILY INJURY(Pet accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS PeraWdent $ SACEE $ — X UMBRELLA LIABOCCUR EACH OCCURRENCE s __1'_000'000 H— CLAIMS-MADE EXCESS LIAR AGGREGATE $ 1 000,000 DED X RETENTIONS 10,000 US065508551 4/23/2016 4/23/2017 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY --..I,.STATUTE ER ANY PROPRIETORWARTNEWEXECU"fIVE Y� N/A E.L.EACHACCIDENT $ 1 000 000 C OFF[CEtory In H)P..JCCLUOED7 WWC3193124 4/23/2016 4/23/2017 (Mandafory In NH] E.L.DISEASE-EA EMPLOYE $ � 1 000 000 If yes,des'flhe under DESCR€PTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Job Location 14 Douglas Rd, North Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town OE North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Bob Bean O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marl's of ACORD INS025 0n14m) Massachusetts Department of Pubiic Sarety Board of Building Regulations and Standards License: CSSL-099169 ROBERT D KING 8 SPRING HILL ROAD GREENLAND NH 0384D Expiration: Commissioner 0312812018 _—"_Office of ConsarnerAffairs&Business Regulation itWE IMPROVEMENT CONTRACTOR ecgistration: 930052 Type: Expiration: 12/21/2017 Supplement Car NOME&HEARTH INC. ROBERT KING 102 LAFAYETTE RD. HAMPTONFALLS, NH 03844 Undersecretary