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Building Permit # 2/22/2017
NbRTf1 BUILDING PERMIT 6 +0 TOWN OF NORTH ANDOVER S APPLICATION FOR PLAN EXAMINATION r (+Q�aoR p b5-� Permx. it No#: .... �. Date Received ° � �;� tirro a `� 4CHUfc DateIssued r v, ._. - t cam. lete all items o�this ae c t rnus z an ]IMPORTANT: .Apel p ,�,,,,r,,,, 5 �, / ✓„ ,,,, „fi,:" f r /L.- r, � ':,/r"tl,r rr r/"f�rrrY1 i //rl,r/ / 5,,,; ,L✓r'l r'H ri /!r r7 G 1/ I r rr lr"c,, / // r ,,a, f r /r/a /%✓i rrr reWi y r f/r rfjr�„%l✓ WA✓�i..,IiayI d,l r ; /<r rlk�'d,:..; / /r9dr,,.y ,,:;v .�r' (q ",,,r „- ," ;,;:: ,.,:. r r` .,� r, �TGr>y/5 ✓":.r"+G�/r/, ��/i, .✓r!/. % K /rfr ry rf..� /r ,�,r,. r1 rT � ,✓,;Y/ f Jl�+ ,�/G /✓ + m,,/` r .. it n't >'.T ✓ / ..:• ,,,rr ,,r r ril r ��.-1 err ,,,� ,,,,,i r, „„ �,, c ,.;. r. ✓ /:. ,,. //I, „x' r rv,.,.,:r/ / >',if;,qd/f„,,..v/v /frJy. f ,�, r' r�rf�lm�,�, / ,, �„ „<„,. ✓/.r, „h d,,, ,„r ,,,,,+(e ;„, ,, - , , �„ r r,„ r, � ///w r,, +I�rY r lFr6i 7 //r 1', /t f/r,l� , p; �,y, G ;., �„d, �. < r /,;, rd�✓r"�l-�rY��;�Grri7Gll�b;�skv����f�;£r,�"' r�/��M�u��rr,/�, ��,� I� //✓..,.r f,.... r<✓ r Gr �r�, .,y;z.� r riG,�r f� f/T,.ur«„1,���t,,, C)CATJON,r rr� r�� �_ r.:.! / r r r r � ,,,fir//r r�G: Cl/ ✓G'%/',.r / 11�i”/�,r r J o �,, rr rr a..r�/JYdrm' ,�.;C�/'/ 1,,,oa ,;,;,,/r Au r rJ /„':N rl rF /r l „„ /, �r ,, r, ,''rr ,.,�T7 ,,,�%,>/�� ,� ."ef�r�//%.,i r� r�.�r<r„ lr/r>�„r✓,r/ %i „ / -../l� � i:fi / !,,,,,< / r F / r✓,..r ,,, ,, ,Pnnt rrr rr .,'%�y rdJ/«,. ,�/lT,r,c.,�11 ,i,, /r/ lr/{r,/ /d1r.r G�f ����%r r A ..<:.; r e /;:,%l°,,, �i,til alc�/✓ ,r ! F,,";/„ ,,dl r:' / r :/ ,,l?'rd ��l�r'W ', � dJJ J;r,J 1p!(��,j4���,11,,t�1��/�y r ,y r✓ rr�l�'I/%r /a'�// �-/v�/✓,/ .: � .� /i ;,r% �� fG�; �ri^ ��/,.r %��5, r,„�r9! �,`j ✓✓ la r y �a1„ r rrr,� �l,�fJ�V2 r%irJ ,,,,,,i;. .I r,. n >',fr G 1w!P!l m,M1'r r7i,✓ "nn;Jv. °f�:e�ee car rrr11,/ r /Jr��'°117�'nremw,✓m���� ,�, sr ,l N. ✓' /I 1 / o��1'E21 .587C�tire ryBSrlr s�� : �,,,r„� if/ r r ,,,,,, rF 1. f,,, �i /✓rG G✓r "YY7nnC 1/G c,�r i4;rLr G �/irr, F !fpJ �ra,?Y�Y::.; rr:” /r�� 5 ✓/i r, -. Machine Shop Vi��lag e °' yes no TYPE OF IMPROVEMENTPROPOSED USE _ Residential Non- Residential - ❑ New Building - 0 One family -- ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: - ❑ Commercial [I Repair, replacement 11Assessory Bldg ❑ Others: ❑ Demolition ❑ Other SL7 Floodplain IWetCands ❑ 'wlVatershed �7�stnct / El 1NaterlSewe r; ,F DESCRIPTION OF WORK rTO BE E PERFORMED: , Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: - YJ S-4 Contra 'tor N; rim6we- r k � w �w_� � 1 � c Phos e I l� ✓ Emeil Address l Supervisor's Cons ruetir�n,Lreense: l „ „ , / D�te7 r rr , 6 0 Exp ; Date t Licerise Home Improvemen ARCHITECT/ENGINEER Phone: Address: Reg. No. FEF'SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED DIV$125.00 PER S.F. _ r Total Project Coag: $ _..� � .. FEE: $ Check No.: W Receipt No.:_ fr NOTE: Persons contractingwhiz unregistered contractors clo t h � to the guaranty fund � g cess v� zc .. � nnati ire of Anent/Owner _ Stgngture (f COV -t -_ JA®Town of . -1 RT� !!. 6Andover ® H`. 0 �AK. h y veer, Mass, al COCMlC Me W1CN � . �_ O AlImbL Ramo �p ��5 BOARD OF HEALTH PE Food/Kitchen F L M Septic System THIS CERTIFIES THAT ..... . . . . .. . .... BUILDING INSPECTOR has permission to erect ............ .., buildings on ...� ..QL.... pcir5 ! 1. ,_ A. Foundation p ..... .... . . �. I . Rough t0 be occupied as .. .... .. ... .., .... .�/ .. ............... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the plication 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 PERMITIN 6 MONTH ELECTRICAL INSPECTOR UNLESS TI T S Rough Service .............. .. ......................... Final BUILDING INSPECTOR GAS INSPECTOR ccu uue Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wali To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. OWNER AUTHORIZATION FORD s 9 X Nicholas Rethman (Owner's Name) owner of the property located at 102 Spring Hill Road, North Andover, MA (Property Address) 102 Spring Hill Road, North Andover, MA (Property Address) Merrimack Valley Insulatlon 23A Sullivan Rd (� Billerica,MA 01862 hereby authorize m'R c�c W o—L ev (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. L Owner's Signature Date Federal to#054405629 RISE Engineering RI Contractor Registration No BiRG MA Contractor Registration No 120979 RIS Ew A division of"I'hielselt EnginerriNg CT Contractor Registration No 62020 ENGINFERMY 60 Shawtolut,CAnton,NIA 02021 CON'rRAC"T 339-502-5197 FAX 13'-502-6345 Page NWm PROGRAM TRIS CON114ACY IS ENTERED INTO BFJWEEN 109C CMA-11E5 ENGINVERM AND ME CUSTOME.R FOR Won](AS OESCRIDED BELOW CUSTOMER PIME DATE CUM 0 WORK ORDMI Nichokei Rethman (978)836-0884 11/27/2015 420290 00003 SEAWCE STREET BILUNG STREEI 102 Spring Hill Road 102 Spring I I ill Road SERVICE!CITY,STATE,ZIP UILLING CITY,STATE,ZIP Nor(h Andover, MA 01845 North Andover, MA 01845 DAISC , IIIIASETWO-proposal[Or next year's wealherization project.Prices and program incentives not guaraoleed. $0.00 Alit SEALING:provide hthor land nrutcriellc to seat areas oryour honle against wastelill,excess air leakage, This work will be performed in conceit with tile rise orspecial tools and diagnostic test,,to assure that your borne will be left with a healthful level ofair exclumf,'c load indoor air quality,Materials to be usedto scat your home Call include caulks,foams and other prod acts. primary ateas for scaling include air lcukage (o allies,basements,attached garages and other unheated Ineas(windows are not generally addressed.) This will require(8)working hours. A reduction in cobie feet per minute(efin)ol'air infiltration will occur,bill the actual number ofti'm is not guaranteed. At the completion of the,wealherivirtion work,and tit no additional cost to tile homeowner,a final blower door and/or combustion safi:ty analysis will Ile Conducted by the sub-contractor to ensure the sai'Qty of'llre indoor air quality. $680.00 7®R S MA—t1—NG:1'rovi(101,=boran d'it I—atel i ills toscat arCtls Lnfycaerr luart—cagainst wasteful,excess It i r leakage. 'I'll is work will be perfon iiet]its concert with tile use orstlecial tools and diagurostic tests to assure(flat yner hereto will be loll with It herithful level ofairexchrulge and illilmr air quality.Materials to lie used to seat your home can include coulks,foams total other products. Primary,ire as for waling include air leakage to attics,hasenlents,altachcd garages and other unheated ajvee;(windows are nor genemllyarithmed) *)'his will require(4)making boors. A reduction in collie feet per lointac(cin)of air iNfiltration will occur,bill the actual number ol'olin is not guaranteed, At the complOron ortfic weatherization work,and tit no additional cost to the homeowner,It final blower door and/car CoMbLISh011 Salely analysis will be conducted by the sub-corooletor to ensure the safety ol'tho indoor air quality. $340.00 NVHC ACCESS:provide labor and materials to insulate(t) back offlic knemoll hatch with 2" board,and seal tile edge of the hatch will)wcathersigipping. $60,00 ATHC ACCESS:provide labor and materials to install(1) easily moved,insulating cover for(lie aUic access lithlingstair. A small flat surface,of plywood will be Cleared aground tile Opening within tile attic. 'I'llis will allow the carver's inlegral weather-suipping,to restrict air le,akage. $237.65 COMMON WALLS:Provide labor and nomerials to histell 2"FSK faced s'Cloli-rigid fiberg"hoss board insulation to(90)square AA,,t ol`cAnrnnon wall area. $315.00 7— OVNI IANC:Provide lahor and tnalcrials to install 4"R-14(loosely packed Oass I Cellulose insulation to(160)s(purre feet orextertor ovediang localed below it heated floor area,by drilling holes ill the ovetigleg front below, holes drilled%Vill be plugged. Plugs will be scaled with exterior grade spackle and left in a relatively stilooll)Condition.Finish sanding and(ouch-up priminjAminting will be the customer's KI responsibility, - 0 -rule), $609.60 RISE Vogillecting will apply all applicable,eligible incentives to this contract, You will only be hilled the Net amount. CRT really,for eligible measures,Columbia Gas offbts 75%incentive,not to exceed$2,000 per calendar year,and as incentive of 100%for The Air Scaling measures tip to the first$680 ourd an additional$340 if savings arejuslified by the auditor, For the safety and ficailb of'your horse's ilakwr Ilil,quality,we will be Conducting It blower door diagnostic offlic available air flow in yonr home both before fire work is begun,and after the weatherivation work is coallplele.We will also conduct:1 rull assessment of the combustion mtruly ol'your heating system and water heater.This has it Value ol'S90 and is tit no cost to you. incentive is$3,110. Faduril ID#06-0406629 RISE Engincering RI Contractor Rogistration No 8,106 MA Contractor Regis(ratIon No 120979 RISE A division ol"I'WeIsch Ent incering CTContractor Rojilstrallon No 620120 ENGINELRING 60 Shmmot,(:anton,MA 02021 CONTRACT 339-502-511)7 FAX 339-502-6345 Page 2 PROGRAM T3 C flONURArf 15 EfIERIEDINIO OLIWEEN RISE CMA-IIES ('1NMNECRING AND I'loW CUSTOMER FOR WORK AS DEWIMEDUELOW CUSTOMER PROBE OAIE CLIC"ro WORK UNDER Nicl)(flas Retlinun (978)836-0884 11/27/2)15 420290 00003 ----------- ------ SERVICE STREET STREET 102 Spring I I ill Road 102 Spring hill Road SERVICE CITY,STATE,ZIP HIL LING CITY,8 WE,ZIP North Andover, MA 01845 Norili Andover, MA 01845 JOB DESCRIPTION $90.00 Total* $2,332.25 Program Incentive: $2,026.69 Customer Total: $305.56 WE AGREE HEREBYTO FURNISH SERVICES-COMPLETE IN ACCORDANCE VATH A0OVF SPECIFICATIONS.FOR THE SLIM OF ""Three Hundred Five& 561100 Dollars $305.56 UPON FINAL INSP,EpTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO kEMIT AMDU4(OUr IN FULL.INTEREST OF I%VALL HE CHARGES)MONNILY ON ANY I P 10-LAINA "TER M DAYS,SEE REVERSE FOR IMPORTANT INFORMAIRON ON GUARANTEES,RICH ITS 6P REWIND,SCHE GU1,1140,AND CONI RAC I OR RI GISI RATION. 00 NOT SIGN THIS CONTRACT IF THERE 7A -=ANY BLANK SPACES Zi N O-RIZ,E—D S,'1-0 NA-T"'R-I iE--N ISE`E 1-19 11 1",)- ONB.11 ACCI50WICE NOT15:TRIS CONTRACT MAY Or-,VATVIDRAWN BY US IF NOT CXECUTEDWRIN DATE OrACCCPtANC1 ACCEPTANCE OFCON IBACY-oflp Aft(WEPRICES,5PECIFICATIONS WI)CONOUTIONS ARE 30 DAYS. N SASFAG tONYIOOS AND ARE NiRCAYACCIEPTE-D.YOUARE'AWHORMEO 70 DO BRIWORK ASSPr,,CIFIED,PAYMCt4t4'61LLOEMAI)CASOtITLINEI)ASME The Commonwealth of'. axssaxchusetts Delrtartment of.ndustt�italAccftlents ' y Office of Investigations wf, lid 600 Washingro�z�'t�eat ." ,' Boston, A 021.11 w R iwww.inassl;ov/clia Workers' Compensation Insurance affidavit: 1 uilders/C Cofactors/ lectricians/Plumbers A,Applicant Information Please Plrint . jibl Name (Business/Organi&-ition/I.rtdividual):_Merrimack Valley Insulation Corp. m� ....__ Address: 23 A Sullivan lid. City/State:/lip:,._Billerica,,_MA 0.186 _ ._....__._ _.. f'hone 4: 978-888-3495 w. { Are you au employer?Check the appropriate box: � Type of project(required): 1. 1 am a employer with_w 18 4. E] I am a general contractor and 1 6. New construction employees(full and/or part-time).` have Hired the sub-contractors ?.( I din a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sola-contractors have g. E] Demolition working for me in any capacity. employees and have workers' s,. 9. Buildingaddition [No workers' camp,insurance comp, insu.rance.1, � are a corp required.] S. We oration arid its 10. Electrical repairs or additions 3.0 l am a homeowner doing all work officers have exercised their 11.[] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGI 12.n :Roof repairs insurance required.]i c. 152, §1(4),and we have no employees. [No workers' 13.0 Other..Insulation comp.insurance required.) Any applicant that cheeks box#l must also fill out tlrc;sec:tion below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a rrew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have enrpioyces. If the sub-contactors have employees,they roust provide their workers'comp.policy number. l(iiia crag earal)loyer tlatat is provirlitig woo-kea-s'coanpensratioaa iaistinraace fou°taay etaaployec,,s. Below is the policy randJob site information. Insurance Company Name:, _BStar V3 AAIC American Alternative Insurance Policy W.or Self-ins. l,ic.#: V9WC749118 . _. _. I3xpiration hate: 6/18/2017 ....._ ,lob Site Address: ���� � /t/� ;..,�'�f � _ City/State/Z49— <,M ✓i� 60 Y'� ' 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 MGI,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 tap to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DDA for'insurance coverage verification. I do hereby c(e'r�tify unclear the pains and pen aWas oJ*perymy that the hifcrrntation provided above is true an correct. Saenatute Date: i Phone#:w __8-888-349 C�.ficical arse only. Do not write in this area,to be completed by city or town officio!, City or Town: _ ..__w._._. Permit/License 9, Issuing Authority(circle one): 1.. board of Health 2. Building Department 3.City/Town Clerk 4. electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone k: MERRVAL-03 WEJE CERTWMA` E F LLA ILITY INSURANCE DATE1 � 5/9133122096016Y!) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OF� NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy{)es) 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 NAM@� Automatic Data processing Insurance Agency,Inc PHONE � � �-- FAX 7 ADP Boulevard M AIL AIC.No Roseland,NJ 07068 ADDRESS: INSURER(S)AITOROINGCOVERAGE _ NAICV tN URERA:SSfar V3 AAIC American Alternative insuran. INSURED Merrimack Valley Insulation Corp INSURERS. �- 238 Sullivan Rd INSURER C: North Billerica,MA 01862 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 IN€11CATE;O_ NOTWITHSTANDING ANY REQUIREMENT,TERM OR COND[TION OF ANY CONTRACT OR OTHER DOCUMENT WrrH 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. ADDLSUB -----'"—'_-..._.._.____�..Y__._...__- P6LTOYEFF Pi}1MVwp LT I V-----_-- TYPE 4F INSURANCE 11 5R IIA POLICYNUTAHER MPAIDWYYY I MNfDD)YVYY LIMITS IGENERALABILITY EACH OCCURRENCE 15 RCIALGENERALLIABILITYDAIIAS-t'AADEGOCCUR MED EXP(Any one person) !S PERSONALaADVINJGENERALEGATELIMITAPPLIESPER: PRQDUCTS-COIAPlOPAGG 5 ( I P O I-]LOG I I i _. _ 5 AUTOh108ILELIABILITY i } } I COi181NEDSINGLEU1dTr , Ea accident 5 ANY AUTO 1 BODILY INJURY{Perperaon) S ALL OWNED SCHEDULED I i BODILY IN3URY(Pet accidr:nt) g AUTOS AUTOS JgON OWNED i PROPERTY OAIAAGE S mREU AUTOS AUTOS WARRELLA LIAR OCCUR EACHOCCURRENCE 5 - EKCES! CLAIMS4AADEJg AGGREGATE ----_ S -- DE0 RETENTIONS 1 ------ S WORKERSCOM1IPENSATION _TORYTA'n)TS R _ A �AND EtAPLOYCRS'LIABILITY ADIYPROPRIETOR1PARINERIEXECUTIVc YIN N!A IVSVVC749118 6/7812046 6118120/7 ELEACHACCIDENT — $ '1,000,000 OFFICERRARABIR EXCLUDED? ---�—— - - {0taedataryinNHl - E.L.)ISEASP-EAEMPLOYEE tfyyes,describe under CIESCRIPTIONOFOPERATIONSIrelvi I I E.LDISEASE-POLICY LIMIT 5 9,440,44 I DESCRIPTION OF OPERATIONS rLOCATIONS IVEIiiCLES(AttachACDRD101,Additional Remarks Schedele,ifmore space Ismquimd) 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,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 M ain Street North Andover,MA 01845 THORIZED REPRESENTATIVE O 9988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD DATE(MMIDA�YYW) �°►C®R®I CERTIFICATE OF LIABILITY INSURANCE 02/18/2017 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($), 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 C�EACT Carolyn A Coughlin Charles J Coughlin Insurance PHONE (978)957-3588 wa Not, 14 Dinley Street EMIL R O.Box 10 ADDRESS: carolynQcoughHnins.com Dracut,MA 01826 INSURERS)AFFORDING COVERAGE -_--NAIC# - INSURERA: Northiand Insurance Company 24015 INSURED Merrimack Valley Insulation Corporation INSURERS; Safety Standard — 39454 Joseph A.Ryan,Jr. INSURERC, Starstone Specialty Insurance Corrpany A0242 23A Sullivan Road -....._. __.._. ----------___--- N. Bii€erica,MA 01862 IRsuReaD. 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. iiO—LICINSR TYPE OF INSURANCE APOL3UBR POLICYNUMBER YEFF fP YEXP LIMITS LTR A COMMERCIALGENERALLIABIUTY M304833 01012017 1/21/2018 EACH OCCURRENCE $ 1,000,000 GE CLAIMS-MADE F2 OCCUR PREMSEIS�Eaax .". $ 100,000 MED EXP(Ary one person) $ 5,000 PERSONAL$6 ADV INJURY $ 1,000,000 GENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO 11 LOC PRODUCTS-COMNOPAGO $ 2,000,000 ,fECT OTHER: $ B AIrrOMOBILE LIABILITY 6205006 11/25/2016 11/25/2017 COMBINED SINGLE LIMIT $ 1,000,000 Ea accI! ANY AUTO BODILY INJURY(Per person) $ . OVM+ 0 SCHEDULED BODILY INJURY{Per accident) $ AUTOS ONLY V AUTOS HIRED / NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY V AUTOS ONLY Per aim -- C UMBRELLALMB OCCUR 87693L172ALI 01/21/2017 01/21/2018 EACH OCCURRENCE $ 1,000,000 EXCESSLIAB HCLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION$0 $ WORKERS COMPENSATION PER OTH. AND EMPLOYERS'LJABILITYSTATER ANY PROPMETORIPARTNERIEXECUTIVE —1 UTEN f A E.L.F.ACHACCIDENT $ OFFICERNEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTIONOF OPERATIONS I LOCATIONS IVEMCLES(ACCIRD 1 D1,AddMonal Remarks Schedule,maybe attached If more-space Is requIred) Insulation Installation CERTIFICATE 14OLDER CANCELLATION Fax#:(978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of North Andover,Nbssachusetts ACCORDANCE WfTH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHOMUD REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD h� . Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 I-lome Improvement;Contractor Registration Type: Corporation Registration: 180506 Merrimack"Valley Insulation Corp Expiration: 11/23/2018 28 A Sullivan Rd Billerica, MA 01862 Update Address and return card. Mark reason for change. WAt 0 MA-05!11 Addres-r 0 Rsnq�nr?a 0 Em�tr�yment 1.1!,c'sff Y I"�rr1 rG�yirr��dusrr^self r. '_.,/lss3l�s��ss�r/lY __ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type: Corporaficn before the expiration date. If found return to: ° Office of Consumer Affairs and Business Regulation a,,'.. Rgistrpticn Fxfaiwatcsr 1805Q6 11/23/2018 B park P -Suite 5170 Boston,MAA 02.116 Merrimack Valiey Insulation 0orp Joseph Ryan ^, 23 A Sullivan Rd .( � Billerica,MA 01862 Undersecretary // Not v Iiti ithout signature Massachusetts Department of public Safety Board of Building Regulations and Standards License: CS-475541 Construction Supervisor JOSEPH ALEXANDER RYAN,JR 356 OLD WESTFORD RD CHELMSFORD MA 01824 Expiration: dommissioner 02/04/2019