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HomeMy WebLinkAboutBuilding Permit # 1/30/2017 BUILDING PERMIT HORry O�tTie� bgti4 TOWN OF NORTH ANDOVER �2 rye' - .:_:..=6 oL APPLICATION FOR PLAN EXAMINATION Date Received + ��AOR`msnsW,P¢4 � Permit No#: '� 7 �rcu F 4SSRClit35Ft Date Issued: IMPORTANT Applicant must complete all items on this page , ..a r" ✓� a �,w:s'`r .,- �,; �z�s,�^p"cJ n/.�✓ ..'r," .�- .:F;3"z. .'^y✓ yr� �v`` ''. :�u. of _,f "�r ✓ `�'�aar+�r ./ r'�,.,:, ✓✓=^t c „ �/�f ';G< 4 5� f ,..,r �G'.,ci�`^ r"��`h��%� LOOATIONy G„� � F �" � ,, r �3<� '; i�rw�:i�����v"��w����` ?r ✓ter "``��,���i�i a�✓u, ���'���mi�; „� ` ' r� -., � � �'���"✓ _ r��t �v ✓,✓�,.y✓ l G c � a ' �. %C � � � Sc j.,:ya'-` mow. ,i . �ROP,ER��' OWNER � ��� f�� ,. y✓✓ f �` �f li �' l -- ✓' "'�''`PrJflt c r r� ''` `e `�OOeH]':St -7CtElf�` '�� � T@S� �7'10 MAP E PARCEL ZONINOIISTRICTrH�sortcb�strictes no : ...I111achme Shap Uiflage .;�Yes...�. po :. ... 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 ❑ Others: ❑ Demolition ❑ Other 11 Se, ❑VIIeII ❑ Floodplain CJ Wetlands ❑ 1JVatershed Dlstnct ✓ 7. i❑1NaterlSewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: o Pik eRa,f P14- r��� ✓' Contracto Phone - c `- rName Email. . Adorers w W. Superu�sor's Construction License Exp Date Ex Home Imp�ro�ement License �- _ _. ... . _ ARCHITECT/ENGINEER Phone.- Address- hone:Address: Reg. No. FEF SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 7'PER S.F. Total Project Cost: $ /!0 -d ry FEE: $ Check No.: ,> Receipt No.: NOTE: Persons contracting with unregistered contractors do not have atter to the guaranty fund 5ig ature ofi AgentlOwner LLSignature, of contractor P"""I own of r.- -, \Am,% -2411 /h ver, lVlass, LAI E C ac"ICriC wt[w •Q A°'qa re a A79$���6s S U BOARD OF HEALTH PERMIT TLLD Food/Kitchen 1 rr Septic System THIS CERTIFIES THAT .........Pe."T.....�.........e.. .'I��.4�..........................._........._....., BUILDING INSPECTOR .... ... .... . ............ doh has permission to erect .......................... buildings on .....Y.Q.......#WA.o"MA4 .ar Foundation .. ..� i'���.!!�°�.. ...., T�.. ..... .�t ..�. Rough to be occupied as .... ............................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS C®NSTRUCTI® R Rough Service ............ ............. .. ........................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy.Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Miall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Fodaral ID#05-0406629 RI ContractorRe[jistrillon No 0106 R[SE Engillecling MA Contractor Registration NO 120979 CT Contractor Railistrition No 620120 RISE (ill S1111%vollit Road,C1111110",C111h 02021 CONTRACT ENGINEERING' 339-502.5197 339-502-63.0 Page I1k0(JRANl1 TJIIS IS CoU I RACT IS 001V tea WTO Or 71irEfi"'a E r JOIREPRIU0 AND THE CUSTO"01 FOR WORK AS CNIA-HES N!SGIDDED BELOW PHONE DATE CLIENT 0 WORK ORDER CUSTOMER (97VI)590-0662 01/12/2017 4,14949 NOW Patrick ositillivall BILLIHO STREET SERVICE S7REFT 40 Pheasan( Brook Road ,10 plicilsant Brook Road qr.RVICE CITY,STATE,ZIP BILLING CI1y.$TAT6,ZII` North Andover, MA 0 184 5 North Andover, MA 01845 JOB DESCRIPTION 11,�\s E c)NI for r WIl lis,c t I e�n,k I r I I .Rod Do)terk ................................... ....... . ....&Io:,.................... al................. t"'I'l.................---­....... eltil,excesi Dir let!�;lge, 'I his wort:will lie ' emc... w,�ol`�,ollr lRolle'19�,Iilit; pelforme(lin concert will,Oie use of specilil Tools and(filignoslic lots 1()assure will)oRrhoum:will lie tall With 11 heillIllifill level 4)), air oulmnee mO indoor air qmth1%,Malcriok to be Iked to seal your home call include caljlks,i'oums mill oilier products. Priolan' memi fill se Mille,iticlukle ilii ical"age to altaclic(I L,arogcs ood other IIIIII-NA Galt.I,Ovillilf"""Ic addir"sed.) 'ritis hill require(12)wolkin't"loowi.A mlliction in Collie I'm per mioule left),)of,m infillnition vvill occur,bla the uloal nunibeI,ofelln is not uualalllcer([ At the Completion of the %wik,and lit Do aklditiollal com to the 110111c4:1mma filuil bliover door andlor Combustion "011ely tillillysis hill be clulducto lay ilic.sul)-cositnictor to emurc the sallety of the indoor air t1lullity, 5I,wosm AIR SEALING ADDFR: (2)worldog hours, $170.00 XITIC ACCESS:Provide IOb0f IURI BIRteliltle,to inst"ll(1) cosily IDDI,ecl,ill.slillifing,cover for the little access lotding stair, A samll flat surface of plyiNmul will be created around the openirll,,wjtlljll tilt!:11tic. I,Ilis will aIjto,,y the cover's ilitel."tal vVeniher- sitipping to restrict all ICA $237.65 H cc E= 0 V E Federal ID#06,0405629 RI Contractor Registration No 8186 JUSE Engineering MA Contractor Registration No 120979 CT contractor Registration No 620120 RISE (In SinlyVIIIIII hoot),(%onon,MA 02021 FT (A4ON'TRACT ENGINEERING 339-5021-5 197 FAN 339-502-63,15 Page 2 PROGRANI TIPS CONTRACT 19 ENTEREDINTO"ETIVEr"B'Se' EimuMMUNG A140 THE CUSTOMER FOR WOUX AS CM A-I I[-.*S 011SCRISEDIMLOW PHONE BATE CLICNT 0 WORKORD9H CUMMER (9U)590-0662 01/12/2017 4449,N) 2002 i.040 STREET REET i;I Sc 5� 40 I)IIet1S,,1111 Brook Road 40 Pheasant Brook Road ............... UILLUM CITY,STATE,ZIP 9FIIVICC CITY,STATE,ZIP North Andover, M A 0113 45 North Andover, MA 0 18,15 JOB DE SCRIPTION I ISH Elqtincerinj."~vitt apply all tipplicaltiv,elij,ible incentives to this conullct, YoU Will only be billed Ifie Net arnonflL Ct"Milly, lor eligible measures,ColkIIIII)iII(itui offers 751111,incentive,not toexceed S2,000 per calelIdUT year,Bell an 10ce'llive UI the Air Sealing timmires 111)to the ON$680 Rall an addiliollat S11()ifsavirws urejt Istilied by the auditor. _, For the sal'ch and IMI1111 01)(Mr home's indoor air quaint,%w Will is conducting,a btowcr door(IjUqUoslic r,l'tile available air llmv in your home both I)eJUre the work is begon, aid atter the weaiticrizatioo work,is Complete,We will also conduct a 1111)mwssloern ol'the combustion tardy ol'your heming,system and water liontmThis has it VAlle 01'$90 all(]is at III)Cost to you. Total incentive k S3,1 10. The Imok will be smiled by the insolillion cofllowlor,;ff no additional Cost,h is lite 1101neowners responsibility 11)cl'MeOln(ilk IwIlail by contacting their"U'llicilMlitV it the colollicti(Cl ol'diis%wrl;, W(M)0 CC, E 0\V [i!HHa 11 JAN ............. Total: $'1,617.66 proyarn Incentive: $1,383.86 CLIStOnlel"rotai: $133.79 WE AGrIEE HEREVY TO F(JIMISH SERVICES COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF '"One Hundred *mirty-Three&791100 Dollars "133.79 11110N FRIAL 111CUON AND APPROVAL RY RISE CUSTO MVP AGREES 10 RVAIT Jq,koUNT BUt'lli ptjj.l,,IN TERM Or I'V,VflLL BE CHAFWED MONTHLY ON AUY LI E'5 Q 114 6r.necaU011. I'IIIAL Uel AU)UAL V.AFIEU 30 UAYIJ-SEE REVERSE felt IMPOMAIII MMIMATI(M)OU GUAVA"' I' C I VI NAM AC AUTIJORIZITO SlOeATURE'• 13C E1101n (110 NOTE':71110 COMMACTMAY BE WITIMPAWN BY US IF NOT EXECUTED vinUM DAMOFACCEPTAVOU _... .,.,..._. ,��. f .. _�......_._,_.., -.-,._._.�.., AV.CCPTAt4CCOFCOt4ftOCT."IG AUOVI:l+RICES nPECIPICA110t!3AILD COa01110tiSAI4r 3AIISFACTORY TO US A40 All r.BE IIEUY ACCEP YOU ARE An It IOBIZCD TO 00 THEE WORK 30 DAYS. 60 Shawrnut Road,Unit 21 Canton,MA 020211339-602-6335 RISE ENGINEERING* www.RISEengitieering.coni OWNER AUTHORIZATION FORM Patrick OSullivan (Owner's Name) owner of the property located at: 1-jeasant Brook Rd, North Andover, MA 40 P (property Address) (Property Address) hereby authorize 421� (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. re 11+ � �= Date y Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration ReWstration: 142726 Type: DBA Expiration: 7/212018 7r; 419281 POLAR BEAR INSULATION GO. Vincent LeBlanc P.O. BOx 958 ANDOVER, MA 011810 Update Address and return card.Mark reason for change. E]Address ❑ Renewal E] Employment E] Lost Card SCA t ca 20WO 11 IJlC tlf+!!7J)7(J7f7rf'ff1'f!!!1 f�''[lffe(Jf!/ll1C�ri Fffce of Consumer Affairs&�usioess Regulation License or regi34ration valid for individual use only nofinne4,210 FIOM>s Ii1pP1¢OV�tUIEM CONTRACTOR before the expiration date. If found return to.- HOME g F omee of Consumer Affairs and RvAness Regnintion s- Registration: 102720" Tyle: 10 Fark Plaza-Suite 5170 .~ Expiration: 71ti20iS 08A Boston,MA 02216r POLAR BEAR INSULATION CO.. Vincent LeBlanc 51 5o.CANAL ST.45A LAWRENCE,MA 01841 Undersecretary Nat valid without siguatare 4 " - cSSc'iC:ilti5 ::5 --.+w7cr,li:5''! " i1I.'. u.3cr'i�'�,{ -' 01r U�3uiidin0 F�aLr"ru atIans -nC1c PETER A LEBI ANC 2 EAST PINE STRE>E'T _ Plaistow 1H 03$65 04128/2018 0 Tile Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UV 640 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El lectricians/Plumbers AP licant Information Please Print Legibly Tl N Name(Business/OrganizatioNIndividual): PO BOX 958 ANDOVER,MA 01810 Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with_ ,.,� 4. ❑ I am a general contractor and 1 G ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' g ❑Building addition [No workers' comp.insurance comp.insurance.$ 10.❑Electrical repairs or additions required.] 5. E] We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL 12.[] RooFrepairs myself. [No workers' comp. insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp, insurance required.] *Any applicant that checks box 91 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. iContractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. hh Insurance Company Name: M A SA. v 4 r Y t Policy#or Self-ins.Lie.#: t�L �' a Expiration Date: Ot ® 24)k Sob Site Address: ` h r'f T i` d d City/State/Zip: 7 6,4 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 MOL 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 tip 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 certify under the sins and penalties of perjury that tl:e information provided above is true and correct. Si ature: -� Date: 3® t Phone#: Official 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#. 302017 Insurance Services ACC?® CERTIFICATE OF LIABILITY INSURANCE DAT1/03(MM12017 Yi 0118312017 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 ?FAME; PHONE FAX AIC No Automatic Data Processing Insurance Agency,Inc. Arc Na Ext' 1 Adp Boulevard ADDRESS: Roseland,NJ 07088 INSURER Si AFFORDING COVERAGE NAIC V INSURERA• NorGUARD insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 958 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 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. TRW ADLJL -icy P LTR TYPE OF INSURANCE IN SD y,NO POUCYNUMBER MINDDIYYYY MIDNYYYY LiM17S COMMERCIAL GENERAL LIABILITY DRM OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES Ea occurrence)$ MED EXP(Any ane person) $ PERSONAL&ADV INJURY $ s GENERAL AGGREGATE GENL AGGREGATE LIMIT APPLIES PER: $ POLICY E]PRG- LOC PRODUCTS•COMPiOP AGG $ OTHER: AUTOMOBILE LIABILITY Ea ccident $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per nccldenU S AUTOS AUTOS NON-""F (Per accident) $ HIREDAUTOS AUTOS I UMBRELLALIAB OCCUR EACH OCCURRENCE $ j EXCESS LIAB CLAIMS-MAOE AGGREGATE $ DEO RETENTION$ X WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABiLiTY1,000,000 ANY PROPRIETOPWARrNER+EXECUTWI] Y!N E.L.EACH ACCIDENT S 0 N r A N pOWC84g3B1 01101!2017 01101!2018 A OFFICERIMMBER EXCLUDED? E 1,000,000 (Mandatory in NH) EL. -EA EMPLOYEE $ 1{yes,describe under F.L.DISEASE-POLICY UMIT S 1,000,000 DESCRIPTION OF OPERATIONS b''aw DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be atlacW M more apace is required] Contractor License:CSL 106017 HEC 102726 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH T14E POLICY PROVISIONS. 120 Main st North Andover,MA 01845 AUTHORIZED REPRESENTATIVE 001988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 111 � -�V INSURANCE ® �v DATE(MWDDIYYYY) AC® ® _ CERTIFICATE LIABILIe i ��a� AN4mE 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, EXTENT) 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 polloy(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 andorsement e. PRODUCER NAMEACT Linda Bogdanowi.cz Insurance Solutions Corporation PHONE . (603)382-4600 F�No:(603?382-2034 60 Westville Rd AnD(AIC No P'S:lindab@iso-inauleanaa.coar iNSURER S AFFORDING COVERAGE: NAIL* Plaistow MR 03865 INaUREp A Flesteru World INSURED - INsunE1B:Hautilus insurance Group Polar Bear Insulation Company Inc INSURER C: PO Box 958 IN&URERD.- INSURER E: Andover MA 01910 INSURER F, COVERAGES CERTIFICATE NUMBER:CL1632326134 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 VVHICH 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 SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS- INSR TYPE OF INSURANCE ADD S pCLECY NUMBEROLICY EYFYF MOLMIn�YYYp LIMITS L X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 OAMAGETORENTED A CLAIMS-MADE ®OCCUR PREMISES Ea occurs nca S 100,000 NPP627d967 3/24/2016 3/24/2017 MEG EXP Any one person $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 A POLICY 1:1LOC J£C PRODUCTS-COMPIOPAGG S 2,006,000 S OTHER: AUTOMOBILE LIABILITY CFaaacclda ISINGLELIMIT $ ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED BODILY INJURY(PeraccEdant) S TOS HIRED AUTOS NON OWNED PROPERTY DAMAGE S AUTOS er accident 5 $ UMBRELLA LIAROCCUR EACH OCCURRENCE $ 3.,000,000 B EXCESS LIAR HCLAIMS-MADE AGGREGATE S 1,000,000 DEO RETENTIONS AK026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETORMARTNERC-XECUTNE YIN MIA E.L.EACH ACCIDENT $ OFF[CERlMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S It yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES{ACORD 101,Addltlenal Remarks Schedule,may be attached If more space la required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Magli.a/SSA ©198&2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered rnarks of ACORD INSD25 roman it