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HomeMy WebLinkAboutBuilding Permit # 1/12/2017 NORTH BUILDING PERMIT °` e,q'�'o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION aF op ` Permit No#: Date Received '4'r.o lI �SSHCHti`-''fc� flDate Issued: IMPORTANT: Applicant must complete all items on this page LOCATION r�C�e - Print PROPERTY OWNER �tJre/i Print 100 Year Structure yes no MAP _PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg 9 Others: ❑ Demolition ❑ Other ❑ Septic ❑WeII � '❑ Flond�la�n ❑Wetlantls F lr❑ l,Natershedr4D�str�ct `� TION OF WORK TO BE PERFORME©: Identification- Please Type or Print Clearly OWNER: Name: v}` e �° Phone: Address: ht*1` c Contractor Name: Peter Le I lane Phone: Email: z East Address: 978-4 .7- Exp. Date: Supervisor's Construction ice -�, Home Improvement License. f��?� 6 Exp. Date: � -f ARCHITECT/ENGINEER 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: $ 3 10®-00 .FEE: $ Check No.: € Receipt No.: NOTE: Persons contracting with unregistered contractors do not have accel to to guaranty fund �g0RTH Town ondover_ 0 No. nh ver, Mass Pj- 0 L-6 a. COC M[C MC wICR 4 BOARD OF HEALTH Food/Kitchen Septic System .... . .. „., BUILDING INSPECTOR THIS CERTIFIES THAT ............ ....... .. ......., ................, Foundation has permission to erect..........................build' sort. .,... .. ,.................... . � w Rough tobe occupied as .. ..W ......... ........... ..... .... ,.,.......,......,.......,,.................,,.......... chimney provided that the person accepting this it 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT I E IN 6 INSPECTOR-,-- LESS C T CST Rough - CService ...... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permax Required to ccu vuiLdin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Mall To Be Done FIRE DEPARTMENT Until-Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. �~I r i=arlcrrnl" R1 C.11,111,11 NO 8186 MAccootracror inuoistration NO 120970 111SE DginecAlIg CT C001ronitor R091,; ,nation No020120 ISE60 ShMvillilt Road,C11"lill"I kN IA 02021 CON"TRAC"r ENGINEERING' 339.502-6335 FA4339,502-6345 Page I 111MORANI ,11t,cCA1;1 AOG'1111 1V11lBrC1%13)1410"CIM1191 103a 'a,,r 4 TX;r..a to WORK 60 r ffir 10 a CINIA-11F.IS timcnivormutoW wclojoictulclt PWO-na 23902 (617)515-8017 1?J22/2016 44,1671 — Kevin 0111leY CIERyloat OMEET 63 Helfick ROad 63 vierrick I(oad u1ni CM,OTAW,ZP strivice Criy,31AMEJ31' North Andover,MA GIM5 North AndOM,MA(0115 ,1013 1)[�,�CRIIYFION .......... 7,,ro—j,.,7,daI—y,,,,, 11101111C of tel HARRIER,A Blom,DOOCI`Cs�11 F11 IT"" rjutcccs��d lightsurc certified ified that(licre are roceved Irklits prCscra in your holne.lit) - allatioll its H�75il)BARRIER:We Ila"'dell' • 11cespaco around(Ile fixture li),tiing llllelghai Hallut ills i('-rated Onsul moor onjact Mited)N%u i0i MMQ3 3"cical` it olljoinfiv.,inaterrill,no i0i'llinioll"ill be in"'tidled"J'joss the lop and clits�not cavities wIlicjj cotimar recessed hPlas 611 not IV insahned, ist N�aslcrjlj,vxcv,�,s. an-teakage� 'I'll)$stork 011 ls: as n I yonr I lo"loatoll it'of arld allact"rols to'will ate' )ilissure that your]Ionic trill IV lei)"all a lleall"rol level of performed in concert with the rise of special tools.and diqylostic tests to c ny�M m all ineInje CatftS,t'oaratilind OtioCr prodrosts, Primary air excliange and indoor air qual , aterials to tx,,t I to wal your lionle s and other unhealcd Invols 061(h)"s tire"(it penerally aLe to at,ics,txlw areas for sealing inclade air Icals . . ,,car��;,al jaclic(I garaVs per alinale(cfln)of air infiltration%%ill Occlor,Nit tire adollresso.ol) This will rciltlifv(12)�NorLjng hours,A redaction ill Cribic,feet ilctnal nand.,cc ofupm is not 9tra"ralleed 11,no additional cost to the ljorlermacr,it r1rad J)Icowr door andlor corabOstiOn At Ile collapletion oftile�Ncailrcrizlliorr work,Anil �ty of the indoor air timility, safety aludysismill IV cordwred Pry the silb-cordrutor to ensure tile',,art $I,wirmo "'Ilis owrl�%611 IV cc�s itir leaUL- I Alit S' proyr(le lahtr and materials 10 Wilt io'ci,, � �Oar lionle aI�alnsl c% le voll h:left Will it hekilthrul level of perforated in concert o�itll the u of 5PQciill tools,iand'iagnostic tests to assure tha your hon uwd at hoal e can jore(kle canflis.fo�nojs nold njiler prodtwis. air exchange and ilrikmr air tpulity,MMertals In bc s and olliclir arlicatedorvas(%%ind(Ms;ire not tCllcrally try ureas for scaling include air Icilkage to vlltrcs,1xisvilields,1Intached V�Iray fids mill vcqtare(2)working limirs,A reduction in cubic feet per inivalle(cf1a)ofarr illillmaroll%%ill occur,1'.01 tile arctrcd trol�Irl�nal 11 oVd' 11111TINC of Cl'"'is d in lit)ildolitionall cost to the Imillcomier,a Ilaill Ho%tur door itilivor collllxtsGrl At the of the mathchution stork,an Ctcd by the to t!llsore the s �a(ejy ofthe indoor lir quiditv saM y ollidy sis mill IV c000du $170.00 V� to filling to Lircsrlcr%call tile et oil F�l 070) j �twlw feet -mr and materials to illsl;dl vilp I',1NIT,WALI fr,wik I'll of kircovall areaA NOTI131)11,'1, CONTRACTOR IriscRVATION S 1,424,50 7�1 tored it cois Illocljog,IIIc itist ollat ron o %iC�tt Ileri7al Ron ti u1s) for lie removal of the's - ORAGE 135RIVR. ..asd'lc to the scheduled w)rh start, %torl,in the knevwMI areas. Removal"'list oQcul prior radoral ID 1$05.0400629 Contractor 13001911fatioll No 6166 1115E 1lighleeling FAAcontractor RoUlstraflO 11 No 120919 CT Contractor Rogistrallon tjo620120 RISE60 SluMokil R01111, ,tila\Q'21121 CONTRACT ENGINEERIM(Y 339-502-633.5 1,A\339-502-6345 page 2 PROGRAM wseaCCNIRA0715 CLIA-111 cnemEERMCIAND Dig CUSUaR fef"'C"'(AS 1's OVOCRID90 Man WClIDE R rangy ORX CUENTO 23(X)2 PRONE 12/22/2016 44,101 Crj3T,)hVR (617)515-8017 Kevin Ork'VICY rieRvIC(I sTRUT 63 Herrick Road 63 IjLrriek Road iiiLuilt;CITY,37AW,EP North Andover,ryi A 01845 North Aadovw:r,'1viA 018,15 '10B DESCRUmON at F�-T(T.v"I' i� (,V,,,,talor 4a,,(2-) 1 11,1; tit' "Tric A(*U-'1SS,Pr age of the hatcli W111 NkkWIlc1'Afippi0�' tiacrccttdrurll'aru truing, and seal OAC 51,10.110 f7v 0Wk, NOW �7,t e r 7777-71C�rls �,t y 170,U0 ninterials sirtlikir to lhosv ornistioL! finish salldilIg and pailij jilq iS rM indvlcd. it-19 'capstilated "'Sulatioll Io the f- or BASMNSINT CFIIJI'�(i�"r0v'(l4-tal'or and malerm s rltv,ttilcle tile contractor W11 haVC CtA Elic end of tile W(Us dUrilig SOIIIC C'kposvll fijlvq�hvq, uncal sulat Cit. k1sollellt ceifirl!" t trete lvdgeruent anda9tecillcol III"It tlli�''lls"llatioll is flot rtAiv el insitillillion. Your signature oil this contract is Your adilmN 'I'111SIS RIM J(NI', ------- ----------- tile Iliwilkheawi%Nitill rig�jd board T"ljlcjcj�ot-Illet)jsciliclit dooricadingl(I I c of tulitdirtilco(L S",cal aill )OC R..'Provide laboriiii(I riateriall Io iost'll t olecls tile a ',ectiolls It-3 16.5 4 alitil J16,6 at 1� , -11)or grCater ktith the we'llirck''"Ile rat'"g tit' CdLpi and scams NNith INlittle. $110.00 Tll�o'ulwl. Currently, acC �Qjj�kijj Iy Vic tfilled tire NcF incentives to this collir , 1001/0 6)r III qz,t�,'Ilginka:riog Wit aPPIY all 81"Plicat"e,c' to escce(j$2.000 per calendar 5,car,and ilww illeell""cof `oI the Air tit)to the first$630 and cur a(Miliollat$.;,to it'Sav in Ils;arejuil I fied by the auditor. For the Safety and hcaltll of Your holoO;iodoor a it(Imilily,%kv k611 tv coodlictinga blomr dool (lit morik is comfilcic%We"ill also cowl"Ct a foil ic"sesa lei I after lite%kvathcriniti 'I')tal lit your home IX)tIl before the%Norli is NT'Iul,at)('ill flos om of the cotiti,itioll ,licty al your heal i119 w(j has a valov o($90 alld I'at Ilk)Co I to ajIQkNtjI)jc%Nvatherizat ko, r�lelor'at no additional cost�It is tile rcsI)owQ"t)iiiik to t)La(11 i� 'I'llc Perm!I Wil IN',4L!cklrcd tV tile c(Int ....... 11crinit by comacling their noulicipality at the completion 777 II F00001 ID 0 06-0405620 R1 Contractor Ro(jlstration No 8106 RISE' 10111incerilv, fmcontractor RQUIstration No 120979 CT Contractor Ro0istra0an 11020120 ENGINEERING ISE (j()SjIR%vRIjj(it(III(j,(',RjItRjj,,MA 02021 CONTRACT ENGINEERING 339-502-6335 FAU39-502-6345 Page 3 11ROGRANI ilia C0411RACTIO UMMINTOOEYN"Il Rlor URCAREERINGANDAIR CUBVIVER FOR WORK AS DESCRIBED BEL(Al cu39vmR (617)515-8017 12/22/2016 444671 23902 Kevin Orkney -- DI UNG SIREET 63 Herrick Road 63 11CITick Road uILUNG CITY,SIAM.2W' 'swe'w North Andover,MA 018,15 North Andover,MA 01845 j013 DESCRIlyrION Tota 1: $3,192.60 Program incenflve: $2,6163,07 Customer Total: $529A2 -f MA OF V1 H AGREL HERMY TO pURRjSjI cvRVjCFS.COMPLETE RI AC`XORDANCEWITH MOVE EprCINCATIONS,FOft'VHr *41FIve Hundred Twenty-Wine &421100 D tj)ars $529.42 WFUI 01190 STOFMV LLUISCRARGEWIMMLYWIANY UPONFIRALINSP9CIONAND"PR •NtOFRae I004%,16ou LLRC�r RE!S1RA%C0I- " "Doo pMe� IRICUMACIM UNFAIR UALM4CE AMR 10 DAYS.. 00 NOTSION THIS coNTRICT IF MERE ANY N SP E 2, Clis ACCEP NCE AM IM01va z uo It 'CUr VAIMCPACCEPTANCE MOM US CUIIRACff AWARY U3 WHOTEXII "OV11111" ACCEPTANCE CCCOMACT-IIIE ADUVE PRICED,SPECCF10ATCUS AND C(XjoITWI3 ARE SAWAOMY 7OU3 AND ARE,REREDYACCUIED,YCXI ARE AUIHOR'Zro"Do""On K 30 DAYS, A$DprciriED,PAYtXIITWII,J.VCM%DEAO(WIUNIIDAEIOVr s RIS 60 Shawmut Road,Unit 2 N Canton,SIA 020211339-502-6335 IN SRF. www.RIS engineerin .com ENINGr"t!cisc[aEneo�,izf�a. OWNER AUTHORIZATION (towner s Na owner of the property located at: (Property Address) (Property Address) ., ..... ... Nd .� 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. The Permit will be secured by Ainsulaontractor, at no additional cost. It is the homeowner's responsibility to close out this ctincg their municipality at the completion of this work. re Bate 6,7.016 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contraetors/Elecctrici nsePrintase Le ibl ,� licant Information Name(Businesslorganization/Individual): PO BOX 858 ANDDVr.M,1141m 01810 Address: City/State/Zip: Phone rl�' Type of project{required}: F011 employer?Check the appropa4ate❑b S a a general contractor and I 6. ❑New construction a employer with_�,._ have hired the sub-contractors oyees(full and/or part-time). 7. Remodeling listed on the attached sheet. ❑ a sole proprietor or partner- These sub-contractors have 8. ❑Demolition and have no employees employees and have workers' 9 Building addition ing for me in any capacity. comp insurance orkers' comp.insurance 5 ❑ We are a corporation and its10.❑Electrical repairs or additionsired.] officers have exercised theirl l ❑Plumbing xepairs or additions a homeowner doing all work right of exemption per MGL l2.[]Roof repairs elf.[No workers'comp. c. 152, §1(4),and we have no 13.n Other insurance required.]t employees.[Noworkers' comp,insurance required.] pensation icy *Any applicant that checks box this affidavitilndicatingttheystire doing all work and then hire outside ection below showing their workers' contractors must submit aanew affidavit indicating such, t Homeowners who submit [Contractors that check this box must attached an additiona,sheet provide theirworkers'o kers'comp.policy number. and State whether or not those entities have employees. If the subcontractors have employees, Y !' Yarn an employer that is providing[workers'compensation insurance for my employees. Below is the policy andjob site information, Y� t Insurance Company Name: Expiration Date;—,, o .210Policy#or Self-ins.Lie.#: 7 C 3 ip:City/State/Z /1.,. _ . �/�� Job Site Address: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration daof a te). penal Failure to secure coverage as required under'Section 25A of MGL c. 152 can the to the imposition of criminal e form of a STOP WORK ORDER and a Erne fine up to$1,500.00 and/or one-year imprisonment,as well as civil 1£kriist statement may be forwarded to the Office of es in of up to$250.00 a day against the violator. Be advised that a copy Investigations of the DIA for insurance coverage verification. I do hereby certify under the girt and penalties of perjury that the information provided above is true and correct. Date: /,u Si nature: Phone#: L/6;> Official use only. Do not rurite in this area,to be completed by city or town official Permit/License# City or Town: Issuing Authority{circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing'Inspect or 6.Other Rhone#: Contact Person: 1/3/2017 Insurance Services DATE tMMIDOIYYYY) Ciiijui CERTIFICATE OF LIABILITY INSURANCE 01/03/2017 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 tld he certificate hoer 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 endorsoment(s). CONTACT PRODUCER NAME: PHONE A1C,No Automatic Data Processing Insurance Agency,Inc. AJC E-MA)L EzI 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERA E NAEC It INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 9558 INSURER D: Andover,MA 01810 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 598370 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 TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED.NOTWITHSTANDING ANY REQUIREMENT, 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. TYPE OF INSURANCE POLICY NUMBER MWDD1YYYY MMIDDPYYYY LIMITS LTR IVSD wVo COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ E CLAIA§S-MADE OCCUR PREMISES{Ea occurmnce S €,. MED EXP(Any one person) S PERSONAL&ADV iNJUftY S GENERAL AGGREGATE $ GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S POLICY❑ PRO- PRODUCTS 0 LOC $ OTHER: $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Pc*pefwO S ANY AUTO ALL OWNED SCHEDUL£O BODILY INJURY(Ptx accident) $ AUTOS AUTOS Iv`ON-0Wt�ED (Por—Id anl $ HIRED AUTOS AUTOS $ UMBRELLALIAe OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ $ DED RETENTIONS X WORKERS COMPENSATION STATUTE ER ANO EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ 1,000,DDO A OFFICERAtR£IMSE XCI.UD n?£ourlvE NIA N POWC840361 0110112017 01/0112018 1,000,000 EL.DISEASE-EA EMPLOYEE $ (Mandatory in NH) E.L.DISEASE-Pot LIMIT S 1,{100,000 II yes,d—a db.under DESCRIPTION OF OPERATIONS brow DESCRIPTION OF OPERATIONS I LOCATIONS I WHICLES{ACORD 101,Adtfi lonal Remarks Schedule,may be attached N more apace Is required) Contractor License:CSL 106017 HIC 102726 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 120 Main at North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 111 https:liadpia.adp.corni[SExternallappliUdex.hirci?clientid 2037315&requestFrom=rvD#1home AC R® T® CE IFICATE OF LIABILITY INSURANCE DATE{MM�DDVYYYY) 6/10/2016 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 peiicy(iss)must be endorsed. If SUBROGATION 18 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not comer rights to the certificate holder In lieu of such endorsemen s. PRODUCER CONTACT Linda Bogdanowi.cz NAME' Insurance Solutions corporation PHONE 4. (603)382-4600 (603)382-2034 60 Westville Rd ADDRESS adab@isc-3neuraace.coci INSURERS AFFORDING COVERAGE NAIC4 Plaistow NR 03865 INSURERAMOStern world INSURED INSURERB:Hautilus Insurance Grou Polar Bear Insulation Company Inc INSURER 0- PO Boil 958 INSURER D.- INSURER :INSURER E Andover t�tlL 01010 INSURER F: COVERAGES CERTIFICATE NUMBERXCL16323261341 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. €SSR A !] 51, B POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER M1tfD/YYY MMrtiNYYV R COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000.000 OAMAGETORENTEO 100,000 A CLAIMS-MADE OCCUR PREMISES Me occ encu 5 NPP8274467 3/24/2016 3/24/2017 MED EXP Any Brie rwn) S 5,000 PERSONAL&ADVINJURY 5 1,000,000 GEN'L AGGREGATE LIMITAPPLiES PER: GENERAL AGGREGATE= S 2,000,000 I POLICY PROJECT- LOC PRODUCTS-COMPIOPAGG S 2,OOD,000 F S OTHER: AUTOMOBILE LIABILITY EOMSINGLE LIMIT goelden S BODILY INJURY(Per person) S ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTO$ NED PROPERTY DAMAGENON-OW5 (Peraccidgria HIRED AUTOS AUTOS S K UMBRELLA LIAR OCCUR EACH OCCURRENCE S 1,000,000 8 EXCESS LI AB J.CLAIMS-MADE AGGREGATE" $ 1,000,00G. OED RETENTIONS AN086107 3/24/2016 3/24/2017 S PER DTH- WORKERS COMPENSATION STA E E AND EMPLOYERS'LIABILITY Y/N ANY PROPRI6TORIPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A E.L.DISEASE-EA EMPLOY $ (Mandatory In NH) It yes,describe under EL.DISEASE.POLICY LIMIT S DESCRIPTION OF OPERATIONS beloW Ll DESCRIPTION OFOPERATIONS/LOCATIONS IVEHICLES(ACORD 101,Addillonal Rarrunko Schedule,may be fflinchad It more sp000 ID required) CERTIFICATE MOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To00 O$ NOYtI) Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN T o n Osgood St` Ste r ACCORDANCE VAT14 THE POLICY PROVISIONS. North Andover, BMS 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/S1JA r � " ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS0250014rr11 P9L Wownmw4 t, J Office of Consumer Affairs and Business Regulation 10 Park plaza @ Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration FRepistratlon: 102726 Type: DBA Expiration: 71212018 Tr4 419291 POLAR BEAR IN SULOON CO. Vincent LeBlanc P.O. BOX 958 ANDOVER, MA 01810 Update Address and return card.Mark reason for cyan®e. ®Address n Renewal (� Employment E) Lost Card SCA 1 €5 M-06111 JjtC !r!)/))!{r/lttrCC/�ff/Cif (IIJSIIC✓l0llClr.G Olfiee of Consumer Atfairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR OR before the expiration date. If found return to: Registration: -102726 Types office of Consumer Affairs and business Regltlotion ' Expiration 7/2!2098 DBA 10 ParkPlaza-Suite5170 a; 5� Boston,MA 02116 POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO.CANAL.ST.45A LAWRENCE,MA 01841 undersecretary root valid without signature 1 'L Massachusetts -'Caplrti mart 0!PU;3iC-Satet'/ S L�LaiVdi11g Regulationsand S'tarsc,Ra�•a1v � maa-�o-;6�tiaullA•`»'a9iID�"&"hi'�+et°�iwo:aitiaB�;�` CSSL406097 i PETER A 1C..1:BL.ANC � 2 EAST PINE STREET _ Plaistow NH 03865 e'r�n zr�'ans a�a�s7aWr 04/2812018 0