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HomeMy WebLinkAboutBuilding Permit #269-2017 - 0 Blue Ridge Road 9/13/2016 �ll�nJ 5 NG tSe�N nJC^D VtORTy BUILDING PERMIT TOWN OF NORTH ANDOVER -� APPLICATION FOR PLAN EXAMINATION _ °# 7 Permit No#: 210 ( Date Received �,yssgcHUs�,�.c5 Date Issued: 910 I RTANT: Applicant must complete all items on this page LOCATION 1 '�q++ A tPROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: (0 ZONING DISTRICT: Historic District yes 0 D 6 6� , ®d © 3 , 000 Machine Shop Village yes r0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition [I Two or more family [I Industrial 11 Alteration No. of units: El Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition [IOther _ [ISeptic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: cr�l �dnC�eW, ��u b d h 6 �` CY U-7 Identification- Plea a Type or Print Clearly OWNER: Name: Mal+ �4 ("19J5 Phone: I Address: S g l ve V I 9.,0— Contractor Name: (J Mvwvvi Phone: Email: r & po/ • ` ' Address: n "�r �� y5_ Supervisor's Construction License: t! S 00 �tf 2 l Exp. Date: C� d l Home Improvement License: I / ` Exp. Date: 7 ARCHITECT/ENGINEER e h+5 6�c« Phone: W? 3 g g � X514 xvV Address: 1 `�q�� I ► ►RPh rwa Reg. No. �Q �` FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSABASED ON$125.00 PER S.F. � �. Total Project Cost: $ FEE: $ P-&6 Check No.: Receipt No.:- NOTE: Persons contracting with unr i tered contractors do not have access to the guaranty fund Location Gr �dl. r� V No. c?/O�- '/ 7 Dateo g 1� � r . - TOWN OF NORTH ANDOVER � CHH Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector y Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM /LANNING & DEVELOPMENT Reviewed On%)�Z�l b oia v COMMENTS �J'l .� 2� - �UyYIU ' (11��� �G� �� dun J__ V` CONSERVATION Reviewed on (2 L Signature COMMENTS HEALTH Reviewed on_ Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: - - - -- FIREIDEPARTMENT TempDumpster onsite �y'es...�_ _ 3noo w Located Osgood Street Located;af•�124�Maieet. i Fi`reiDepar"�tment signature/date - -- - COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop q Pp requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract :rr Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) �. Copy. of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 NORT0i Town of f .f. sAndover 0 No. a �_a a 1 * _ ,� 1 � z y � h ver, Mass, � O 4c a 1, y A_ COC NIC NlWKK � 7d A�R'�TEO PP���S S BOARD OF HEALTH Food/Kitchen PERM IT _T LD Septic System THIS CERTIFIES THAT .......... 4.�......:.....f`�... ............................................................... BUILDING INSPECTOR ... , .. ..ej.'!............... Foundation has permission to erect .......................... buildings on . .. w Rough tobe occupied as ......��.... .. ....Lt. ... ............... ............ ..................�..� ........ Chimney provided that the person accepting this perfit shall in every respec 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. ()M PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO START Rough Service . .. .. ...... ..... .................. Final B LDIN INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans F1 TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuiug/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Di mpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM LA►NNING & DEVELOPMENT Reviewed On - ! ��j 'L���0 Signature " V/P — COMMENTS � 111 2� Z tun Y�N l CONSERVATION Reviewed on icinature ' ( - COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ,.Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: FIREDEPARTMENT`r 'Tern Located 3_84 Osgood •rU, 'r , _ s.9i sq p.��umps~te'r$ons�tew� r3y25}�..i .1 '.;i1:.2aix;�fnt O,L`_'_,. _� tatr_re;.e_-t Lcated at�1.� MamlSteet 24 - FireiDe artment,si ,~ V r -4, pgnature/date _ � ; • s ,. + 1 j .. � � �.. . ,� ~�''�� }' 1e•; .. -`i l' #�x '" .•—• o" -.. a .. COMMENTS ' =� _ . CONSTRUCTION A CREEMENT September 8, 2016 BETWEEN THE OWNER: Matthew Bush 35 Blue Ridge Road North Andover, MA 01845 Cell 617.388.8350 BushM127(a%gmail com AND THE CONTRACTOR: Court Builders of America (CBA) 1.5 Geneva Road Andover, MA 0 18 10 THE PROJECT: Construction of Sport Court 12 Backyard Court SCOPE OF WORK 1.0 CONSTRUCTION OF CONCRETE BASE 1.1 Access Path to Site • This will come under separate cover with David Gulezian. 1.2 Site Preparation & Grading • Court Builders of America (CBA) will prepare court site by stripping sod and topsoil which will be stockpiled at the site. CBA will also grade site with a pitch of l" in 10'. • Owner recognizes that any undiscovered soil conditions requiring extra labor; machine tirne, fill dirt or other expense shall be the responsibility of Owner. • CBA shall import and place 6 inches of 3/4-inch stone (not compacted) and stone required for 12 inches x 12 inches Infiltration Trench in accordance with site plan: "Proposed Sports Court Layout and . Grading Plan 35 Blue Ridge e Road NorthAndover. Mass" dated August 9 2016. • Stone will be bucketed in. 1.3 Concrete Installation Information • CBA will arrange for a concrete mixing truck to be driven to the site. • w 0 ner understands that small amounts of concrete may be spilled onto the driveway and lawn, and Will be cleaned up by CBA. • Concrete mixing r truck must be able to clean chute run-off into a wooded area on the Owner's property. Owner shall specify exact location for residue (which will not harm vegetation) to be placed. • Concrete pump will be necessary. Wash out of chute necessary. i 1.4 Concrete Base Construction • CBA will form and pour a concrete base that is 4" thick, using 4000 psi concrete, with fiber mesh reinforcement and a perimeter rebar which is wet set. Base shall be approximately 35 feet wide x 75 feet long and positioned in accordance with site plan: "Proposed Sports Court Layout and Grading Plan 35 Blue Ridge Road North Andover, Mass" dated August 9, 2016. 2.0 MULTI-SPORT COURT COMPONENTS 2.1 Modular Suspended Surfacing System • CBA shall install a Sport Court® "Sport GameTM" surfacing system directly over the cured concrete base. • CBA will install the following colored tiles: TBD. • CBA will paint 2"-wide playing lines for hockey and basketball foul lane markings, top-of-key and high school 3-point line in color: TBD • CBA will paint a 2"-wide playing line onto surfacing for short tennis court or pickleball in color: TBD • CBA will paint shuffleboard court in color TBD. NOTE: Sport Court surface will expand in every direction in sun and heat. 2.2 Basketball Goal CBA will install a Sport Court® "Pro" Basketball Goal at slid-court. 2.3 Sport Court a Multi-Sport p Net & Adjustment System J CBA will install Sport Court& Multi-Sport Net & Adjustment System between the basketball goal and light system. 2.5 Sport Court@ "Court Light" System Double Lamp (2 x 1000w) System • Light post shall be supplied and anchor installed at net-line on court. • Subsequent wiring from post to house shall be the responsibility of Owner. • Unit has multi-tap (1 IOv /208v /240v /277v service. • Light shields will be included. • Any follow up adjustments/pointing of light shall be by Owner's electrician. i 2.6 Court Fencing Fencing Specification: Sport Court® "Soft Fencing' System • Black.netting, 6 Leet.. 6 inches above dasher. • Posts and rails are polyester resin over galvanized steel. • Posts are 2 'i'-inch, spaced closely. `lop rails are 1 5/8. Fencing Design: Fencing shall be installed as follows: Fence to be placed all around the dasher boards except between blue lines on house sides. D1 Dasher Board System A Tall Board Configuration features(42") Boards Around entire rink with Rounded Corners and a Gate. 3.0 CLEAN-UP • CBA shall place the original topsoil, machine graded, around the court perimeter. • CBA shall place sod clumps from the site at the downhill side of the court site. • CBA can haul away any remaining sod clumps at a cost. • You the homeowner; or your landscaper, is responsible for repairing the access path and exposed soils around the court perimeter. 4.0 MATERIALS, WORKMANSHIP All materials in this Agreement are guaranteed to be as specified. All work shall be performed in a neat and workmanlike manner, in accordance with the best standards of construction. 5.0 SCOPE OF CONTRACTED WORK Contracted work shall include only the items and procedures specifically listed in this Agreement. No other items.. procedures. or amendments are to be included without the written agreement of both Owner and CBA. 6.0 COMMENCMENT The work to be performed under this Agreement shall commence ASAP, 2016, subject to authorized adjustments. All agreements are contingent upon strikes, accidents and delays beyond contractor's control. Weather conditions must allow for painting. Furthermore, homeowner understands that paint requires 72 hours to dry. 7.0 SUPPLEMENTARY CONDITIONS Listed below are the supplementary conditions agreed upon between the Owner and the CBA to be supplied by the Owner for successful completion of the specified work: • 7.1 Owner must approve of court location, and is responsible for verifying that court does not extend across property lines, applicable setbacks or septic drain fields and reserves. CBA & DG Contracting responsible of court positioning in accordance with site plan.: "Proposed Sports Court Layout and Grading Plan 35 Blue Ridge Road. North Andover, Mass" dated August 9, 2016. 7.2 Owner is responsible for all necessary legal approvals. 7.3 Owner recognizes the potential of damage to the access path to the court site (rutting of lawn, compression of asphalt) due to the weight of the construction equipment, and holds CBA blameless. CBA shall take all proper precautions to minimize disruption. 7.4 Owner understands that any previously undiscovered soil conditions requiring extra labor, fill dirt, machine time or other expense shall be the responsibility of Owner or CBA will be pleased to provide a quote. 7.5 Owner must provide access to water and electricity from primary residence. 7.6 Onset of cold weather may necessitate added charge for concrete additives. SUMMARY OF CHARGES Excavation, sub-surface and concrete... $23,275 Sport Court SportGame surface... $13;000 72 inch Pro Slam Basketball hoop... $3,000 Net pole system... $1,750 Sport Light Double Lamp (2 x 1000w) System... $3,500 Dl Dasher system... Price includes shipping and installation... $19,800 Net fencing above dasher... Opening between blue lines on one side... $7,800 $72,125 DEPOSIT INCENTIVE: 20%. For example, a 2,000 credit will be earned on a $10,000 down payment. $4,000 credit off a $20,000 down payment. Etc. FINANCING will be made available. Terms TBD 8.0 CONTRACT SUM 8.1 Specified Work The Owner shall pay CBA for the specified work the Contract Sum of: $72,125 9.0 PAYMENT TERMS 9.1 The Owner shall make progress payments in the following manner: • $ TBD deposit, check payable to Connor Sport Court International. • $ TBD 15 days after invoice receipt for poured concrete pad, check payable to DG Contracting • $ TBD 15 days after invoice receipt for completion of specified work, check payable to CBA. 9.2 All materials remain the property of CBA until final payment is made. 9.3 Payments due and unpaid under the Agreement shall bear interest from the date payment is due at 4%per month. 9.4 Owner agrees to pay legal fees of CBA if litigation is required to secure final payment, except in the event of non-performance by CBA. 10.0 WARRANTIES Sport Court® surfacing carries a 15-year limited warranty from Connor Sport Court, International, Salt Lake City, Utah. Basketball hoops and components carry a 10-year limited warranty. Application for warranty shall be submitted to Owner upon CBA's receipt of final payment. CBA shall warranty materials and workmanship for two years after completion. CBA and David Gulezian shall supply current Certificates of Insurance. I t.0 OWNER'S ACCEPTANT OF M,REENIEN'r Above term,,anti' cjl(*-pec'j- I I 1011's"We I-lood for ',0 lws. Vold thcr�:allcr at 1.'XeCLlti0lI OfiiLlrccljjejjj Cjijjtjj)oejjt hpt,Fl ;jp,,ro \tt( i Building Permit I]FC)III Lhe JoNsil North Andovor. 11"Yel- MaN car-1c,21 this transaction al, am I InIc pno], lo Im Jniuht of 111k: third buNiness day aller the date of this11"alls"IctiOn. Vo cancel this Q00t[;,Ci 1\OU fl.IUS( 11oIJI'v .11111 Arnold- icneva Ro' Andover. MA 0'1 8 1 o Abovc tern.1--l"Ild S-ccificatiolldIN and ugreed R) hv Oy,ner atm C'.13A, 0 WN, _R: Date: Printed Name. j"" atc� IITII Arnold n8 Commonwealth ofMass�chusetts z.. • . Department of.ndustraal Aceldents 1 Congress,S`txeet,Suite 104 - — d f Boston,SIM 02114-2017 , www.mass.govldia WoVke.&,Compe, ationZnsurance,Affidavit:Builders!Contractors/EIectddans/Plmnbexs. TO BB FffM)WITH TEE PMUVHf GAUMORI7.'Y. Applicanthformation Please Print Leably Name, (Business/oiganizationlludividual): T � (C)I l f .Address: City/State/Zip: 0 re V ma of Phone#: Are you an employer?L�cecktlie appropriate bor. Type of protect(required): T l.[31 a employff VV t a— _.._employees(fall and/or part-time).* 7. []New coristraction am a sole propdetororpartaersbip and have no employees working forme in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3F]lam a homeownerdoing all workmyself[No workers'co"R dnsmance required" 10 F1 Building addition 4.❑I am a homeownerand vM be hiring contractors to conduct all work on my properly. 'will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electricalre pairs or.additions proprietors-wnno employees. 12:0 Plumbing repairs or additions 5.❑Iamageneralconta-0torandIhayehiredthesub-contractorslistedontbeatEachedsbeet 7g.��•. Roofxepails These sab-cnniractors have employees andhave workers'comp.msurance. 14.E]Othe .❑Other 6.[J We are acorporatip pndifs,of�cers.have axercisedtheirright of exemptionperMGL c. - 152,§I(4),andwefiavena.employegs.[No workers'comp.inein•anrerequired.] �• :Anyapplicanttbatchecks b&411must also'fd outthesuction below showingtheirworkers'wrapensationpolicy iufomiation. igomeewnersv�liosuIn6R4nafddaeindicatmgtheyaredoingallworkandthenhireoutsidecontractorsmustsiibmitane,'affidavitindicatingsuch. ?Contractors That--heck- bog mnsr.atEagbeci an additional sheet showing 4 name of the sub-contractors and state whether or, diose entities have employees. Ifthe sub-con$6.ctors have emplflyees,EBY must pravidetheir workers'comp.policy number. t`a,a an employer&cd'ispYovidi tgworkers'compensation insurance for my employees.'BeZoiv is thepoli�y ariljob site in arrnation. ��� l 0� �l Fes( ne Insurance Company Name: qPolicy#or Self-ins.Zia. ExpirationDate: / pp /V City/State/Zip Job Site Address: �� (7 I e R(d g-e = cy declaration page(showing the policy number and Wirati[oa date). Attach a copyoftlleWo�rkexs' coanpensationpoli Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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 up to$250.00 a day against the-violator.A,copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u cler paiM andpenaldes ofperjry tlaat the informaiionprovided above isarae Mn/co/r,I,ect (9 Date: � Si atare: J// Phone#: � Y/4'77� Official rise only. Do not-Write in this area,to lie completed by city or town official City or Town: Permit/License# Issuing Authority'(circle one): i 1.Board afklealffi 2.)3vAdingDepartm.ent 3.City/Towu Clerk 4.Electrical Xnspector 5.Plumbing lusp ector 6.Other CO)D tact Person- Phone#: OP ID:GOGL CERTIFICATE OF LIABILITY INSURANCE DATE081241201 I� 08/24/2016 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 endorseme s. CONTACT PRODUCER Macdonald&Pangione Insurance Phone:978-688-6921 �Ne Hannah Courtemanche,AAI,CISR 104 Main Street Fax: 978-688-5350 A/c No Ext:978-688-6921 AIC NI:978-688-5350 North Andover,MA 01845 ADDRESS:hannah@mpins.net Donald Schemack PRODUCER CUSTOMER ID#:DGCON-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED D G Contracting,Inc ID 646648 INSURER A:Travelers Prop&Casualty CL 25674 428 Pleasant St INSURER B;Safety Insurance Company 39454 North Andover,MA 01845 ►NsuRERc:National Liability&Fire Ins 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 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. ILTSR L TYPE OF INSURANCE POLICY NUMBER MSUOR PMIDDI EFF MPMfD EXP RLIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11,000,000. A X COMMERCIAL GENERAL LIABILITY 680-1553R18 05117/2016 05/17/2017 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,00 CLAIMS-MADE FKOCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X O PRLOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULEDAUTOS 3116538 07112/2016 07112/2017 PROPERTY DAMAGE— X X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,00 A CUP-0090153321 05117/2016 05117/2017 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X I WC STATU- I OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER C ANY PROPRIETOR/PARTNEWEXECUTIVE Y/N V9WC704542 03131/2016 03/31/2017 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑N N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 A Property 680-1553R18 7� 05/17/2016 05/1712017 Lsd/Rent 20,00 Equip DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Fax: 978-688-9542 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 ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Building Dept 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD - r Fua.,c. gui+�nytis LrR �, tion tai Standards ;wense:CS-001821 sor GOn trUCti0t1 SUperli J' GULEZIAN �.. DAVID P . N.428 PLEASANT ST ORTH ANDOVER MA'0480 e` FXPirat`•�• '10102120i7 Gainrnissioner an trAffiirs&BwiumReg [io. ROVE M Cf?W'I'R/►CTOR stwtf19 !"fttf7Type• ' gay Indjvw s DAVID DAVID GUt,E21AN 428 PLEASANT ST NORTH ANDOVER,MA 01845 Underseeretary - , LCE J� ` ae plq NOW 7 . � �_T/ 10`02.195 _ f/ a 428 Pi,EA n _ N��V R MA 018452920 TM >sq } e°D�•ttmu�,o�•�aoos ftice of Consumer Affairs&Business Regulation _ ME IMPROVEMENT CONTRACTOR Y Istmdon. 120199 Type: expiration: 11/1M17 Wividual DAVID GULEZIAN 1 DAVID GULEZIAN 428 PLEASANT ST NORTH ANDOVER,NIA 01845 Undersecretary 1