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HomeMy WebLinkAboutBuilding Permit #610-2017 - 1 SCOTT CIRCLE 12/6/2016 ^ r s Q O� r10RT#I 9 BUILDING PERMIT �� ��"`� `y°�°� TOWN OF NORTH ANDOVER ° /�- APPLICATION FOR PLAN EXAMINATION - Permit NO: l&/ _` o / Date Received !�` �o � aG,/0 * q <x+crcc..rc. 1. / �9SSACHt1`����y Date Issued: 1 v� ' i� ` /d-o t IMPORTANT: Applicant must com Tete all items on this page LOCATION nn U�, ZuirKin Print PROPERTY OWNER1� hur Print MAP NO: 0 - PARCEL: Q� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑ Addition ❑ Two or more family ❑ Industrial 'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer emndel nP Kk�chen f Ouc +o � 11C�J. ow UQ wao bP-+ taeen 01k-&\1PWTV1t M,4n l I LvL t4W u i o d o w-,-#__�Ulu, b o a cJg, ilc& K P I amb r na rel cry a, S Ana atauod e444 !r d - m ours, Identification Please Type or Print Clearly) OWNER: Name: -Ar4kUr I�flrl<irl Phone: Address: Se© ���'c��-, Nor+k �Indavcr- CONTRACTOR Name:,Qonaldf5on o rYl rovenmr one: 97 - off- t ; ' �� Tdd `A©nr�ir�san _ Address: 5a Supervisor's Construction License: Exp. Dater CS- 16Jy'l(J fl^ 30 20f ? Home Improvement License: 1 ,.x,7 7 a Exp. Date:- 1 � a0�v � ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -9 0702) FEE: $ q70 �— Check No.: 'd-i�-a4 j Receipt No.: 3 f a= NOTE: Persons contracting with unregistered contractors do not have acces t the uar ty fund Signature of Agent/Owner Signature of contractor BUILDING PERMIT " of00 R hoT qti TOWN OF NORTH ANDOVER 32 y �` APPLICATION FOR PLAN EXAMINATION10 Permit No#: Date Received °R.S rED RSS•acHusec Date Issued: IWORTANT:Applicant must complete all items on this page y Pnnt. �1 DD�Year St�uctu e�� syes_. rio 1PARCEI ._____ _ _ZONINGIDISTRICT ` fHis_torici-Dstnef byes' �n'o } — r � ..> T R y rS j •.`....'."•'r"." -s••�� I V I I I .c N 'Mame Shop.Villa e* esno c ' 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 0 Septic '0 1Nell_4 0 Floodplain El Wetlands 0 Watershed Disfict ❑Water-Sewer DESCRIPTION OF WORK TO DE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name Phone:V. , Supervisor'sConstructionxLicense -_ '" Exp 7 Date � e v a Home�ImprovemerittL` ',ense . . t Exp Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No,: NOTE: Persons contracting with unregistered contractors do not have.access to the guaranty fund _- -.-.......-- --_ --- - -------,-- -------------- -— -- - - - ---- ------- -- ----------- S_ignatu�e of AgetLflti� ier Signature of contractor 1 ' Plans Submitted ❑ Plans Waived D Certified Plot Plan ❑ Stamped Plans ❑ TYPB'bF SEWERAGE DISPOSAL Public Sewer ❑ Swimm ng Pools 11Tanning/MassageBody Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ .COMMENTS I i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS f � 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: Located 384 Osgood Street FIRE DEPARTMENT' -,Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS J, limension 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',requires approval of Electrical Inspector fres Ido = DANGER ZONE LITERATURE: fres No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email ate 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 ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit a Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o 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) o Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 Location S C o 4 4- C t r s No. (0 0- OL-) Date 10- ' fC A O ((o • - TOWN OF NORTH ANDOVER F.: Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ,'Building Inspector Enter construction cost for flee cal - North Andover Fee Cakulation Construction Cost $ 39,221 .00 m $ - $ 470.65 Plumbing Fee $ 58.83 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 58.83 Total fees collected $ 688.32 1 Scott Circle Kitchen remodel 610-2017 on 12/6/2016 NORTi-r own Of 2 ndover . o .0 No. a � i h ver, Mass, / COCNICNIWICK �1• �as RNTED V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System rQ �� BUILDING INSPECTOR THIS CERTIFIES THAT .D 0.M4AAS AI. V....I!' 0-KC.....I.� ............................................ ti has permission to erect .. 5&.04 `E Foundation ........................ buildings on ..... ...... ..............C. . ...IA �.. ........ Rough to be occupied as ................. "..�� .......KAI�.�..�............................................. 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 CONSTRUCTIO A TS Rough Service .............. ... ......�.... .. ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. 12/5/2016 Donaldson,Todd for Durkin,Arthur and Michelle opt 3.jpg(1557x667) ---� - .t '24- 38' 38- _ 38' _ •_38' 431 I 44 ,os- s 38- -._ j2. 1 ,S ALL EXPOSED ENDS ON THE ISLAND AND WALL CABINETS'- -- - - END PANELS AND DECO DOORS ARE INCLUDED W3030 BUTT W3615 BUTT W3630 BUUF3{ 3612 X 24 DP BUTT - - — N TALL END PANEL I— V36SH DISH-K]6 _ 'OB ADD W2TCDAK24 APRON SINK BASE.TRASH BWBT1 - 4 - TT 1 WOOD 71ERED FOR 3033"APRON PULLOL ,�f mjCUTLERY DIVIDERSINK�' I— {I- m' ni a r tta 830 2 DRAWER 645E I _.._ - I - --HAS DISH PEGS IN TDP DRAWER - SMALLER DRAWER - 00-. -,�. _..�.�..-4 .TOPDRAWER INSIDE _-Ir "� lf: 8NIC36 vI �P 1 V --[- far 2dmdb„ e ��'n DB3020NYR SFWT PDO 2dmdb12 I - - __ -- __ __ '�• 2 �'SHELF CASINETS ONEITHER. b30rh 5 O RECESSED TOE KICK 1'mcL A fw bah bo2434 1 S30FH RECx FOR CONTINUOUS- TOE KICK APPLICATION -add,PGP _ - - f ? m I( t ________ _ - -a____ __ V � IB30 BUTT t xy I 830 BUTT FH CC2FWT ._ _ _ _ _ ;+ -4.. .. t•-SPICE PULL - I Maw 1 I _ WALL EN W — -- --t - - -�-__-TTT•-' 4' - I ---�O- I7--a-}'(�---�I� I - ' I EF4Z2U4 36 B 7 ,+- 30' 11 -29r,1+N 237 _--_ -- ---'-------------- - - --^-- __ ___-•___-'__---_ 2 zSQUAREFEETVNOE8836' � ? - _ -}- w 2724 HAVE GLrss AND rtsi��Rir�'rN't�til -- https://webmail4.networksolutionsemail.com/appsuite/api/mail/Donaldson%2C%2OTodd%20for%2ODurkin%2C%2OArthur%20and%2OMichelle%20opt%203 jpg?action=attachment&folder=defaultO%2FINBOX&id=1&a.. 1/1 Donaldson Home Improvement Contract for Services This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A)but does not include standard language to protect homeowners. Seek legal advice if necessary. You may obtain a copy of the Massachusetts Consumer Guide to Home Improvement by calling the Office of Consumer Affairs and Business Regulations Consumer Information hotline at 617-973-8787• 1. HOME OWNER INFORMATION CONTRACTOR INFORMATION Arthur Durkin MAHome MA Unrestricted Improvement O�'AL� Construction License#177721 / supervisor CS-105410 1 Scott Circle Expires 1/28/2018 Expires 11/30/2017 Donaldson Home Improvement,LLC—Emp#45-3364045 North Andover, MA 01845 525 Woburn Street,Stet,Tewksbury MA 01876 (978)502-4325 Diane Donaldson,Owner D.Todd Donaldson,General Contractor,Licensee 2. Donaldson Home Improvement, LLC agrees to do the work detailed in attached estimate for the homeowner: Proposed Start Date:when permits are obtained Date work will be substantially completed: 6-8 weeks Required Permits-The following building permits are required: (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter i42A) 3. Donaldson Home Improvement agrees to perform the work,furnish materials and labor specified above and in the attached documents for the total sum of: $39,221.15 Payment Schedule: (Initiates scheduling,permitting etc.$500.00 of this amount is non-refundable) 4. The following material/equipment must be special ordered before the contracted work begins in order to meet the completion schedule.Special payment arrangements if needed noted below: Page 2 of Donaldson Home Improvement Contract for Services 5.CHANGE ORDERS Both parties acknowledge that unforeseen items may arise during the project that can impact the timeframe and cost of the project. If and when any of these items arise,it is agreed that any items requiring additional work will be addressed in writing with a representative of Donaldson Home Improvement prior to beginning said work. A customer may initiate additional work orders as well,and they will be addressed in a similar fashion. These change orders must be accepted before the work begins,or in some instances before the contracted work continues if said work impacts the completion of the project. 6. WARRANTY Warranty Terms as Follows: Donaldson Home Improvement,LLC agrees to be solely responsible for the completion of the work described regardless of the actions of any third party/subcontractor that is contracted by Donaldson Home Improvement,LLC and utilized in the scope of work of the project. Donaldson Home Improvement,LLC agrees to be solely responsible for payments to all subcontractors for materials and labor under this agreement unless otherwise negotiated prior to acceptance. (See section 4) Donaldson Home Improvement,LLC offers a One-year Express Warranty of workmanship and installation(all labor)associated with the scope of work and materials described in the project,normal wear and tear excepted. Materials and products utilized in the project are the responsibility of the individualproduct manufacturer/supplier. (Customer is responsible for retaining and registering all products procured for project) 7. ADDITIONAL CONSIDERATIONS Donaldson Home Improvement,LLC reserves the right to use photographs taken of our projects for use in media, advertising and web use. Donaldson Home Improvement will not use personal information or specific locations to describe the work featured in any of these areas without express written consent of disclosure. 8. CONTRACT ACCEPTANCE Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. Neither party should sign this document if there are any blank spaces. This contract is to be signed in DUPLICATE. One copy is to go to the customer/homeowner or business owner, the other copy to be on file at Donaldson Home Improvement,LLC. You may cancel this agreement if it has been signed provided you notify an officer of Donaldson Home Improvement,LLC in writing at his/her main office or by ordinary mail posted,by telegram or personal delivery,not later than midnight of the third business day following the signing of this agreement. Customer/ o JwnerSignature: Date: �n V ' Donaldson Ho a Impro em Representative: Title: Date: 1 Scott Circle 11-3-16 yBean 10:40am N.Andover, M.A 1 of I CS Beam 4.11.26.1 lcmBeamEngine 4.1126.1 Materials]Database 1516 Member Data Description: Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom Lateral Bracing: Continuous Standard Load: Moisture Condition: Dry Building Code: IBC/IRC Live Load: 40 PLF Deflection Criteria: U360 live, U240 total 1.000" max. LL Dead Load: ' fO PLF Deck Connection: Nailed Member Weight: 15.6 PLF Filename: Beam] Other Loads Type Trib. Other Dead (Description) Side Begin End Width Start End Start End Category Additional Uniform(PSF) Top 0' 0.00" 12' 0.00" 16 0.00" 30 10 Live Additional Uniform(PLF) Top a 0.00" 12' 0.00" 0 65 Live Additional Uniform(PSF) To 0' 0.00" 12' 0.00" 16 0.00" 20 10 Live rT_ 12 0 0 12 0 0 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 a 0.000" Wall SPF Plate(425psi) WA 3.404" 7595# — 2 12' 0.000" Wall SPF Plate(425psi) N/A 3.404" 7595# — Maximum Load Case Reactions Used for applying point loads(orline loads)to carrying members Live Dead 1 5101# 2494# 2 5101# 2494# Design spans 12 1.750" Product: 2.0 RigidLam LVL 1-314 x 11-718 3 ply PASSES DESIGN CHECKS Connect members with 2 rows of 16d common nails at 12.0"oc NOTE:Nails must be applied from both sides Minimum 3.40"bearing required at bearing#I Minimum 3.40"bearing required at bearing#2 Design assumes continuous lateral bracing along the top chord. Design assumes continuous lateral bracing along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 23061.# 33194.# 69% 6' Total Load D+L Shear 63574 12053.# 52% -0.06 Total Load D+L TL Deflection 0.4179" 0.6073" U348 6 Total Load D+L LL Deflection 0.2807" 0.4049" U519 6 Total Load L control: Positive Moment DOLS: Live=100°/6 Snw--1150/. Roof-1250/. Wind=1600/. Design assumes a repetitive member use irrcrease in bending stress: 4 6/6 All product names are trademarks of their respective owners Copyright(C)2013 by Simpson Strong-Tie Company Inc.ALL RIGHTS RESERVED. ••Posing is defined aswhen the member,floorjoist,beam orgirde[shown on this drawing meeticable design criteria for Loads,L=ng Condifions,arM Spanslisted on this sheat.The dell must be reviewed a uallfied deg r order tes4onal as rod fora al.-=design assumes uct installatron accortr to the mamdacan rs ificalions The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le2ibly Name (Business/Organization/Individual): 11b e, `rnrbvemerx d - Address: 595eb ern S City/State/Zip: r 1�0 Phone #: � Awon an employer? Check the a ropriate box: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any;capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. ❑ Building addition required.] 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] "Any applicant that checks box#1 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. tContractors 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. Insurance Company Name: �C4M afi Policy#or Self-ins. Lic. #:__ r I gg Expiration Date:3 Job Site Address: 1 SCo City/State/Zip: IV 0 041 ,AnlQ vk( MA wq5 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 MGL 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 up 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 fy inWrance coverage verification. I do hereby ce un the ains and penalties ofperjuurry{ that the information provided above is true and correct. Signature: _ aC� Q Date: Phone#: y Q a— �T�S 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#• �1 OP ID:JG ACORO° DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/05/2016 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 Segreve&Hall Insur.ASSOC.InC NAME: Todd Donaldson 305 North Main St. ac°Nr o E:t:978-502-7789 FAX No): Andover,MA 01810 E-MAIL Patrick D.Hall ADDRESS: PRODUCER TODDD-1 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Donaldson Home Improvement LLC INSURER A:Commerce Insurance Co. 34754 525 Woburn St Suite 2 Tewksbury, MA 01876 INSURER B: INSURER C: 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. INSR TYPE OF INSURANCEBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 BGPYKG 06/25/2016 06/25/2017 PERSONAL&ADV INJURY $ 1,000,000 A GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO BGMMZH 02/15/2016 02/1712017 (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (PER ACCIDENT) $ X NON-OWNED AUTOS Underinsured $ 100/30 Uninsured $ 100/30 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS! CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONWC YS OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is 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 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD i CERTIFICATE OF LIABILITY INSURANCE 112/05/2016D/YYYY) 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). )DUCER CONTACT Paychex Insurance Agency Inc NAMEY PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE PHONE 10,EXT), 877-266-6850 FAX NO). 585-389-7426 ROCHESTER, NY 14620 E-MAIL Certs@paychex.com INSURER(S)AFFORDING COVERAGE NAIC# URED INSURER A: NorGUARD Insurance Company 31470 DONALDSON HOME IMPROVEMENT LLC INSURER B: 525 Woburn Street Suite 2 Tewksbury,MA 01876 INSURER C: INSURER D: INSURER E: INSURER F: IVERAGES 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. TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS NSR WVD (MM/DDIYYYY) (MMIDD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED �LAIMS-MADE�CCURPR'MISES(Ea o $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: POLICY =PROJECT=LOC PRODUCTS-COMP/OP AGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED SCHEDULED BODILY INJURY AUTOS AUTOS (Per person) $ N -0WNED BODILY INJURY HIRED AUTOS AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION ANDX WC STATU- OTH- EMPLOYERS'LIABILITY DOWC700188 03/10/2016 03/10/2017 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000.00 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000.00 (Mandatory in NH) Y N/A E.L.DISEASE-POLICY LIMIT $ 500,000.00 It yes,describe under CRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) :RTIFICATE HOLDER CANCELLATION Town Of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 120 Main Street DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY North Andover,MA 01845 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ORD 25(2010/05) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD y Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-105410 Construction Supervisor D T DONALDSON 23 ELLIOT DRIVE ` LOWELL MA 01852 Expiration: ' Commissioner 11/30/2017 ��e�Cni�rrrea�rnrn,��I�o�nrTlm,Uric%ru;cl(3 Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Istration: 1.77721 Type: xpiration: _Ft28l2Ft& LLC DONALDSON HOME[MPR'(IVeME-NT;LLC. TODD DONALDSON 98 BILLERICA AVE.SUITE-A-' NORTH BILLERICA,MA 01862-. Undersecretary