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HomeMy WebLinkAboutBuilding Permit # 2/22/2017 %40RTII BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION " Permit #• Date Received �gsAcwaus��� Date Issued IM lif A- Applicant must complete all Items on this page ,,, , ,., r„: ;r r r^'::r"lz r;J"f. r fWi n�r,( q/i yrs! 4:�' Ji i/i%: frl rirY r"rir-.r Yi Y/l9tp��l f'r�(/ zrr✓"�,". ,w. ,,,, -,,.. rr it<;,,';,� ;; as r,a ��i 1, ,;, lfi r/ ?9r/% �/i`ll"" m'y>''�✓,r %,l�+z'h �.,q.%ir r� r/1 ".rF�//y ry�vl,"I �11 ,�I�SPraJ � c a c„ / r ✓' r r / „r.: r/ rJ” „F r s,J a°r r., r �.fil,/l 4R ✓ .r / c ! lr,�i„,; f lh! � � � �/,✓,, �/ y>r/ry � s/// /��r /Sf,r, /r� �r �,, J,�/� r�,%, ,,,/i .<;.. ,r r..e r✓,,,;; ,;,,, ,; ,, ,, ( ,,,r�/r / � ^.'�au,/ ;ri/,��1 r Y'!, i G;,%6'f//vr n„ �- ,/�1 r ,✓ „ r ly i ,, d fr i r, r Irdrr� /'.;k1a�E�Hr�„G�r���r�fGe�� '#��r✓rd�r,r�„���i,�rv�ra.�ul4�tlr '+�y�'.,�aik�r �✓lr��!(i�l✓1r r ri n� / �w,J �,i /rr�9. ,YJ.'�/�AES!G ✓r 1 if/l�?ll ;�//I� �r��irJu l ,'�, ,. ,. mre rr �/ zr:. Y re,,✓rr�.,irM✓vw„)J' irj!i;� /r ..rrl I rir%��ri WJ /J ,,,r ✓�✓r,,,,�,r �lr r ,,,.; ,, ,,,, ;✓% r rr ,i',,rrrr„ ////IrP,"xv/ l/illi/f lq r�.r�://,!'Yr /; / 1y //rl'.r/Y/ 11 „/, ,�;'; a r � rri ,„ ,,, �'/Il // /l✓ 1Y r t !r 1r.. /r r Ir v//at�'r nr>/ 9 -�%' fr r//” r f// ,,;- ,,,,, , ;; ,PI'9rVtr r !r r � r:r r rry r✓/- r/ri;, � / � / /pl r I f,'� .{ ,,,,.';. ,, rr ”„";' ,,,a; ,.,y6 r P/j�`�r�,!r�rf 1�,�/,,;h' Y'�d i, rrr%�r,o i I�.i r ✓/r /ii&iJ/'/i/✓/ry���ri�rr���d ,y>, ,, a ,ztz,, s mn rJ o1 it �� � r r " ,✓, r n, r�N� / m !� � /// rfrr./✓� w� � wr .-ROP€RT,Y iDWNER ,��,, : ��;:, f! E � 1 err,✓ % r . 1� /r / 1 yrlKN �a+�.wnza+Wy a r;i�r✓Jr / - ' / „r / j tiiii /rf I ! �rC Mfr! t iY/l „,� EBrGIICfUfB z n/ „i'u/r r/r CICS rJrl/ TICI ,,,. / ✓ ,-, t✓<; //rlra/, PrJr1�� / � %✓%Y' /rg l➢i � r rhr rJ r 1/ rl,,wuJ,r, „ir/vu ✓/IJiir 7r u;Qrrz /iireu v r ✓ lw ;r / MAP°r ;r,r P?ARCEL ZONING DISTRICT r/r /r 'rf /N�stor»rDlstnctrr ,rr rrr ,ir � no rie hopVI ,na //rr Machi TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family { 11 Addition ❑ Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 0 Other _ > Flood Iain L Wetlands ❑ Watershed D�strrct Well 0 Sepc n, P. , rr�u ,, 1/V6t&2Seuver r„ DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: _ Phone: Address: - Contractor Dame,�v � � . r les 1-ai / .� "�. r b r: ✓rr rr< uperv�sor's C-crnstructron L'�cense1 xp r�E Da � to J Horne 9mprovernenfi Lioense °° Exp '; date r 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. �`�,-I-) �"� FEE: Total Project Cost: $ , �� I � __ Check No. Receipt No. � � t7� NOTE: Persons contracting w itli unregistered contractor,�,,dp n t b ve access to the guaranty facncl tractor afi,r rif Anent/Owner Si'' re of con _.. .......... ............­­­­­­­ ­­­­­........... ............. ................... %40RTH Town of � _ IT. ower ® No. �_ . ;4 h ver, Mass, 4~ 0f LOC"IctLIEW-c" P 0 Ar' 'C62 rE C) - U BOARD OF HEALTH Food/Kitchen PERMIT. T LD Septic:System THIS CERTIFIES THAT AVW!J%A.CkAj*1(.?.1_=A4 V,1. 6"aft BUILDING INSPECTOR has permission to erect.......................... buildings on ........ .................... Foundation % Rough to be occupied as ..... ...... 0�4.;.Atdpf#to w '4448 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOPNGRT Rough I Service ...............­ .. I . .. ...II.... Final BUILDING INSPECTOR GASINSPECTOR Occypancy Permit Required t® Oceupy 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. RISE60 Sliawniut Road, Unit 2 1 Canton, MA 020211339-502-6336 ENGINE[RING' www.RIS Eon g 1 n ee ri ng.corn OWNER AUTHORIZATION FORM Rosalie Pulberen ti (Owner's Name) owner of the property located at: 110 Quail Run, North Andover, MA (Property Address) (Property Address) Merrimack valley insulation 23A Sullivan Rd Billerica,MA 01862 hereby authorize (Subcontractor) o an authorized subcontractor for RISE Engineering, to act on my behalf to`fr tair lbbuilding permit and to perform work on my property, This form is only valid with a signed contract. vx] Ownpr,'s1S1gnatLJre Date rodoral ID 0 05-0406629 RI Contractor Registration No 8186 PAA Contractor RoUlstration No 120979 RISE60 Shawimil Road,CaRtmi,NIA 02021 C'r Contractor RegIstration No 620,120 ENGINEEFtING' CONTRACT 339-502-5197 FAX 339-502-6345 Page I PROGRAM THIS CONTRACT 19 ENTERED INTO"ETWFENRISE 'MA-11ES .113INUAING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT 0 WORK ORDER Rosalie Pulverenti (978)685-0606 12/15/2016 444622 28602 SERVICE STREET DILUNG STREET I 10 Quai I Rkin 110 Quad Rull SERVICE CITY,STMF,Z111 BILLANG CITY,STAG E,ZRI North Andover, MA 01845 North Andover, MA 0 184 5 . .......... JOB DESCRIPTION AM SEALING:Provide labor and materials to scal areas ot'Your home against wasteful,excess air leakage. This wmk will be performed in $1,020,00 Concert With the use ofspecial tools and diagnostic tests to a."ore that Your home will be loll kvith it healthful level of air exchimgc Had indoor air quality.Materials to be used to seal your home can include caulks,foams and other products, Primary areas lot,scaling inchule air leakage to attics,bitsements,attached garages and other indicated areas(windows are not generally addressed.) This will ve(johe(12)working lictirs.A reduction in cubit;I'M per minute(cliff)of air infiltration will Occur,ITHI the actual number ofefin is not goaranteed, At the completion of the weatheriza(ion work,and at no additional cost to the honlemner,it final blower door and/or combustion salcty analysis will be conducted by the stib-contractor,to ensure the safety of the indoor air quality, AIR SEALING:Provide labor mad materials to install Q-Ion Nvetilherstripping and it(1m)mveep to(3)door(s)to restrict air leakiq!c' $240.00 ATTIC ITA-f:Provide hibor and materials to install o 5"payer of R-16 ChNs I ("Cl I it lose added to(288)squate lect ot'lloorcd attic space. $504,00 DAMMING:Provide labor and materials to install it 12"layer ol'IZ-38 unlaced fiberglass balls to(232)Square reel lbr danuning,11111posm $175.00 A'1-1'1(,'FLAT:Provide labor and materials to install it 10"layer Ot'(Z-37('[its",I C01010SC added to(644)squittre feet oropen attic space, $1,004.641 Aid HC ACCESS:provide labor and miacrials,to install(1) easily moved,insulatitig covet,I,or the attic access folding stair. A small Ilat surplice $237.65 of plywood will be created around the opening within the attic. This will ollow,the cover's integral weather-stripping to iestfict air leakage, VE.NTILATION:Provide labor Had Hinterials to install(2)instibited exhaust hose with roof mounted flapper veal to exhaust existing bathroom $237.50 fan(s).Bronn model 0 636 or equivalent, VF,NTILATION:Provide labor and materials to install ventilation chutes in(105)raller bays to naiintain air 11mv, 27,2 5 .......... Federal ID#0"406629 RISE Engineering R1 Contractor Registration No 8186 MA Contractor Registration No 120979 RISE60 Shawnint Road,Cannon,NIA 02021 CT Contractor Registration No 620120 ENGINEERING' CONTRACT 339-502-5197 FAX 339-502-63,45 Page 2 PROGRAM TIES CONTRACT as ENTERED NTO 8FI%YETN WE CNIA-11 ES CNOINrVIRING ANO THE CUSTOMER FOR VOORK AS DESCRIBED BELOW CUSTOMER PHUNC DATE CLIENT 0 WORK ORDER ROSak PUIVel-011i (978)685-0606 12/15/2016 444622 2002 SERVICE STREET BILLING STREET 110 Quail Rull 110 Quail Rull SERVICE CITY,87ATC,ZIP BILLING CITY,STATE,ZIP North Andover, MA 015115 North Andover,MA 01845 JOB DESCRIPT ION RISE?I'llgincering will apply all applicable,eligible incentives 11)this Contract. You will only be billed file Net aniould. Corrently,liar eligible $90,00 ITIC111sures,Columbia Gas offers,75%incentive,not to exceed$2,000 per Calendar year,and on inceinive of 100%,)for(lie Air Scaling measures III) IT)III(,,first 5690 and an additional$340 if saving's arejoslified by the auditor. For the safety and lkeldill of your home's indoor air quality,we will he condlictiog,it blower door diagnostic oftlic available Sir I'low in your home both befoic the work is bepin,and Idler the%mithuriZ.11tioll work is Complete.We will also conduct a full assessment of the colliblistion safely()I* yoof licatilij,"system and water heater.This has it value ol'S90 Rod is III no cost to you. Total allowable weatlictization incentive is$3,110. 'I'lie 11ci mit will Inc secured lay tile insulation Contractor,at no additional cost.It is the homeowner's responsibility in close out This pem mit by contacting their municipality at the Coloplefioll ofilliS%york. Total: $4,071.89 Program Incentive: $3,110.00 Customer,rotai: $961,89 WE AGREE HERE13Y TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'Nine Hundred Sixty.-Ono & 891100 Dollars $961.89 UPON FINAL INSPECTION AND APPROVAL BY R13C ENGINEERING,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF"M WILL CIE CHARGED M014UILY ON ANY UNPAID UALANcE.AFTER 30 DAYS,SEE REVERSE Felt IMPORTANT INFORMATION OR OUARANIELS,RIGHTS 013 RECIMON,SCUEDBLINO,AND CON"TRAC"IT)II . ..... ... ..... C'hT ME ACCEPTANCE 'XLCUIED WITHIN -PTANCF 1101T.:T1113 CONTRACT MAY BE V011HORAWN BY us IF NoT 1. OATF.OF ACCE v- AcCraITAfJGEOFCOt4THACT.TtIVAtIUVr.$IlllCE�), PECI�ICAltONSAtlDCOt4D$Tl()ti$Afir. SATISFACTORY TO US AP40 ARE BEREDY ACCEPTS.' YOUARE AUtIlORIZEDTOOOTtiEWOliK 10 DAYS, AS SPECIFIED.PAYMENT WILL.BE MADE AS OUTLINED MOVE „. w The Coir monwealth gfMassachu etts Department of Xr�r�uar ial Aecidents ,� two Office of hives atiorrs 600 Washington, ''tr eet Boston, MA 021.11 10M.111ass.govIdia Workers' Compensation Insurance Affidavit: Builders/C'ontr c tors/lectriciaprs/Pau mber~s r �i a uu aartrrat oar 'lease Print Legibiv Name (Business/0rtara izatiora/Individual): Merrimack Valley Insulation Corp. 1�,ddress. 23 A Sullivan [Rel. C;ttyy/Butte/ ip:.,,...8illerics, MA 01862 _._.. _ .w ... . Phone#: 978-888-3495 Are you an employer?Check the appropriate box: ��� 'hype of project(required): I,[X� I am a employer with_..'I 8 _ _ 4. 0 1 am a general contractor and I employees (full orad/car part-time).* have hired the sub-contractors Idew construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. [:] Demolition working for nae in any capacity. employees and have workers9. rj Building addition [No workers' comp.insurance comp. insurance.tr required.] 5. corporation We are a oration and its 10.0 Electrical repairs or additions � p 3.0 1 arra a homeowner doing all work officers have exercised their I I.[] Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.n Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.91 Other Insulation comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing,their workers'compensation policy information. liorneownurs Who submit this affidavit indicating they are doing all work mad then hire outside contractors must submit a new affidavit indieatint,such. ",Contractors that check this box inust attached an additional sheet showing the name of the sub-contractors and state*whether or root those entities have arnpioyces. If”the sub-commetors have:employees,they must provide their workers'comp,policy number. I attt ata employer that is providitt";avorkers'compen.vel fort insarcrttce for trtp erttlrloyees. Below is the policy andjob site information. insurance Company Name:,5Star.V3 AAIC American Alternative Insurance 9WC7490117 Policy#t car Self-ins.l.,ic.i/:..__..V118 Expiration Date: 6/18/2 __.. .. ..,... .... .__....�._.__u___..._ ._ . Job Site Address: -M) U I +....... ? _... _ W.._......__._City/State/"ip:�,�.a tl—k.—i�I:? _O.A..6I t1�y... Attach a copy of the workers' compensation policy declaration page(shorwing the policy number~and expiration date). Failure to secure coverage as required tender Section 25A of MCJ1.,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 harm of a STOP WO1tK ORDER and a fine of tap 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 clo hereby certify under the pains and penalties of petjzrty that the r"tijimmatkm provided above is trace and correct Ng! tJtle. t� .yam_ `. Date, Phone#.. __..e.._r ..8 888-349 Official rtse only. Do not write in this area,to be completed by city or town official City or Town: � Permit/License h Issuing;Authority(circle orae): l..Board of Health 2. Building;Department 3.Cityflbrwn Clerk 4.Electrical Inspector a.I'lumlring Inspector 6. Other Contact I'er~son: Phone 4: MERRVAL-03 WEJE DATEIIAFAIDDNYYY) CERTIFICATEOF LIABILITY INSURANCE 6113/2016 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. CONTACT NAME: _ Automatic Data Processing Insurance Agency,Inc PHONE —--- FAX 1 ADP Boulevard E-MAIL Extac No Roseland,NJ 07088 ADDRESS: INSURERS)AFFORDING COVERAGE NR1G rF INSURER A:JFStar V3 AAIC_American Alternative Insuran� INSURED Merrimack Valley insulation Corp IqSILRERB: 23a Sullivan Rd INSURER C,. North Billerica,MA 04862 INSURER D: INSURER E: INSURER F: I COVERAGES CERTIFICATE NUMBER; REVISION NUMBER_ THIS 15 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR OINSURANCE TYPE F INURANT p LIMITS LFR I [NI S I ln[V�1 POLICY NUT49ER fJihV!}DIYYYV L3AIi1DIIfYYYY GENERAL LIABILITY ]!I I EACH OCCURRENCE {5 I COMMERCLAL6ENERALLIA6iL11Y i ! PREMISE$�EapNTED ccurrancei-_ } CLAIMS-MADEEl OCCUR F MED EXP(Any one person) [S _--.-_,----.,,- PERSONAL. AOV IN4URY"#-8.Y_ , 1 I 1 G_EN_ERALAGGREGAT_E_— _ S PROr P'RODUCS—_NsP70PAGGGEN'LAGGREGATE LIA1ITAPPLIESPER! POLCY `ILOC S^^ 5 AUTOL€OBILE LIABILITY 1 I I COMBINED SINGLE LIIArr En accident s _ ANY AUTO BODILY INJURY(Par parson) S — —_ ALL OWNED SCHEDULEDi ! 80DILYINJURY(Per ac6deni) S AUTOS N0 OWNED I PROPERTYDATAAGE S 1-UREO AUTOS AUTOS UTAaRELLAUA9OCCUR ' EACHOCCURRENCE 5 __ - EXCESS LIAR HCLAIMS-IIADE AGGREGATE— »_— 5 DEP RETENTION S I S WORKERSCOh1PENSATiON WCSTATU- I JOTH. IAND EtAPLOYCRS'LIABILITY TORYLI-M ER A MY PROPRIEr4RFPARTNERIEXECUr1Uc YINV9WC749118 6118120i6 511812017 E,L-EACHACCt€FNT $ I OFFICERRAEMJBER EXCLUDED? Lei N!A ---__— ______ {&SnndamryinNHj E.LDISEASE-EAEMPLO S 1,00U,U4 iF yyes,describe under DESCRIP-nON OF OPERATIONS Belaw E.L.DISEASE-POLICY LIIAIT S 1,000,00 i I DESCRIPTION OF OPERATIONS i LOCATIONS 1 VEHICLES (Attach ACORD 707,Additional Remarks Schedule,irmom space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AB0V1=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 Mair)Street THDRI7,J=0 REPRESENTATIVE North Andow,MA 01845 ©'1985-2010 ACORD CORPORATION_ All rights reserved. ACORD 25{2010105} The ACORD name and logo are registered(narks of ACORD g AC"R" CERTIFICATE OF LIABILITY INSURANCE oA02118812017 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 13ETWEEN 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 endorsement(s). PRODUCER CONTACTCarolyn A Coughlin Charles J Coughlin Insurance NAMPHONEFax 14 Dnley StreetAIL (978)957-3588 ac P.O.Box 10 ADD , Carolyn@coughlinins.com Dracut,NA 01826 INSURERS AFFORDING COVERAGE MAIC N _ INsuRERA: Mrthland Insurance Company 24015 INSURED N brrimiack Valley Insulation Corporation f INSURERS: Safety Standard 39454 Joseph an,Jr. -___...._.__ ........_....__._._..__.__.__._ ._.._ p Ry INSUIRERC. Starstone Specialty hsurance Company A0242 23A Sullivan road - — -- N. Billerica,NA 01862 INSURERD; 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. INDR TYPEOFINSURANCE ADDLSUBR POLK:YNUMBER M�YEFF MYEXP LIMITS LTRWD A COMMERCIAL GENERAL LIABILITY WS304833 01/21/2017 0112112018 EACH OCCURRENCE $ 1,000,000 TO RENTED 100,000 CLAIMS-MADE OCCUR P EM SES Ea occirrencej $ MED EXP(Ary one person) $ 5,000 _ PERSONAL&ADV INJURY $ 1,000,000 GEHL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,0♦}0,004 POLICY❑jE0CT'_ D LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER $ B AUTOMOBILE LIABILITY 6205006 11/25/2016 11125/2017 COMSINGLE LIMIT $ 1,000,000 ANY AUTO BODILY IWU&RY(Per per" $ OVuNEDONLY V ASC AUTOS UTOSHEDUlEO BODILY IWURY{Par accident) $ HIRED NON-OWNED - PROPERTY AWAGE $ AUTOS ONLY AUTOS ONLY Per axidert $ C UMBRELLALlAO OCCUR 875931_172ALI 01/21/2017 01/21/2018 EACHOCCURRENCE $ 1,000,000 EXCESS LAS CLAMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$0 $ €NDRKERSCOMPENSAT[ON STA E� AND EMPLOYERS'LIABILITY Y f N AWPROPMETORIPARTNERJEAEWIVE ❑ NIA E.L.EACHACCIDENT $ W OFFICERA8ER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under - DESCRIPTTON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS l VEHICLES(ACORD 181,Addltlonal Remarks Sahedule,maybe attached Irmore space is required) Insulation Installation CERTIFICATE HOLDER CANCELLATION Fax#:(978)6M9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WLL. BE DELIVERED IN Town of North Andover,Massachusetts WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORLMO REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Corporation Registration: 1805176 Merrimack Valley insulation Corp, Expiration: 11/23/2018 23 A Sullivan Rd Billerica, MA 01362 �� Update Address and return card. Mark reason for change. =A1 0* 20MOV11 dd!'i'..'.? L1!"ei .s. 0 Rt!-?r 0 Em,pinyrnent F!f_,rlt f r": Address. -N Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only i •s Type: Corporation before the expiration date. If found return to: !, Office of Consumer Affairs and Business Regulation 180506 11/29!201 a10 Park Plaza-Suite 5170 Boston,MA 02'116 Merrimack Valley insulation Corp Joseph Ryan ,)3 A Sullivan Rd Billerica,MA 471862 Undersecretary Not v did ithout Signature r Massachusetts Departinent of Public Safety Board of Building Regulations and Standards License: CS-075541 n. Construction Supervisor �u ,r ,JOSEPH ALEXANDER RYAN,JR 356 OLD WESTFORD RD CHELMSFORD MA 01824 / I 6vr r Expiration: Commissioner 02104/2019