HomeMy WebLinkAboutBuilding Permit #404 - 10 HEATH CIRCLE 11/28/2007 i
BUILDING PERMIT of "°erN
TOWN OF NORTH ANDOVER ? '`y'- _,6,6 a°^,
APPLICATION FOR PLAN EXAMINATION
Permit NO: Q Date Received
\ �SSACHU`����
Date Issued: "_a
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
` _Re ' Non- Residential
Iding - ne famil
Addition wo or more family Industrial
n No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
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DESCRIPTION OF BE PREFORMED: "�-
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crlclelc t- ro"3 �e eowes o T% �Plo n-,
Identicatti�on Please Type or Print Clearly)
OWNER: Name: Mark 4 Mfia. Dok-ef Phone: 779
Address: /0 /1«-I-x
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ARCHITECT/ENGINEER ��u� le�/1 Phone: c�r8
Address: 5k C/-'R/e Sfoi� a. Reg. No.
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FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 3 Sr FEE: $ /„
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Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access guaran fund
x2l If
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Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE WERAGE DISPOSAL
Public Sewer Swimming Pools Y �•
Tanning/Massage/Body ody Art
" 1 l
e 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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
DATER ECTED DATE APPROVED
CONSERVATIO 13 !UG1� app
COMMENTS_
til
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
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Planning Board Decision: Comments
Conservation Decision: Comments
i
Water & Sewer Connection/Signature&Date Drivewav Permit
Located at 384 Osgood Street
FIREEPARTII�IEN emp DumpSteT on Slte
ire no :
Located at 12 /lafn
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Fare�Deparnaelr�t��graaturei'.�ate w a
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COIUJIE'(�7' MR. f
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 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)
com
CA-- �.
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
I
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
o 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
❑ 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/Crossection/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
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i
New Construction (Single and Two Family)
i
❑ Building Permit Application
I
❑ 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 Calculationslicable If Applicable)
PP )
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products !
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
I
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
f
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
ll t
Location 1 HE, t Ir r
No. Date
!&ORTM TOWN OF NORTH ANDOVER
0���.ao a,ti0
� n
4L Certificate of Occupancy $
Building/Frame Permit Fee $ � � � 4 ..
4CMU5
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # Q g
20825 � �-�
Building Inspector )
NORTH
0 0 f Andover
No. q6$4 74
Q LAK
0L dower, MaAl., J J- ' 7`
lsCOCKICHEWICK V
7�S RATED
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
`�/� �1, BUILDING INSPECTOR
THIS CERTIFIES THAT....t.C.�cnA...�...De,� fot...^�-�.a.. �e
` ......................................... Foundation
1 ,,pper�, L. 1
p g He f.4. g
has permission to erect. ....s �!�. ...gd..... buildin s on ........�.....: .1.... .. ............................. Rough
l 1 _ .
to be occupied as. ).......S11. .. ...... c ..1�...p�► ....R.�d....- ..! No!.:' ov ....V..'�' h..F�... 1►�!I�.�.�lq a Chimney
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provided that the person accept' this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes ayd BY-Laws rely in to the Inspectn, Alteration and Construction of
Buildings in the Town of North Andover. eiC -Orl% V,. LIA" ov1 �r#*fi 4C , . PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
........... .:.... ... Service
BUILD G INSPECTOR
Final
Occupancy Permit Required to Ocmpy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final T
No Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
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NEWUOUSE & SUN
CONSTRUCTION
David Newhouse,Jr.
Brandon Newhouse
3 West Jamaica Avenue
Wilmington,MA 01887
Phone:978-657-7274
Fax:978-988-8894
November 1,2007
Work Order
Mark&Debbie Bohrer
10 Heath Circle
North Andover,MA
(M)978-289-0393
(D)978-273-3625
(H)978-322-4100
RE:3-Story Addition
1) Plans Drawn paid by owner
2) Building Permit(allow$4,320)Structural Engineering,drawings&inspections(allow$3,000)
3) Demolition: Remove rear wall[allow$500)
4) Beam Installation: Install micro-lam beams in(2)locations on 14 floor. Building affidavit(allow$300]
5) Existing Garage Doors: by owner
6) Excavation: Excavate for foundation,strip loam&sub soil.No soils to be removed from site.Structural fill not included
if needed.
7) Foundation: Pour"stepped"footing&B"Nudura®walls to kitchen floor height.6"walls top two floors to eaves
8) Backfill Foundation:use onsite materials
9) Grade Floor: 2"rigid foam insulation.Install 6-6-10 wire mats. Pour 6"concrete slab
10) Frame Addition: 1'&2'°floors,partitions&roof to plan.
11) Steel I-Beam: Install steel I-Beams steel column to support 1'&2'floors
121 Windows&Exterior Doors(Existing Home): Front Windows(extra thick,frames bumped out): Relocate(9)front
window locations&install(9)new windows($800 for materials)&[$3,600 for new windows]. Install(2)fixed windows
either side of front door bumped out(window allow$500)*Install triple French door on rear of house(door allow
$1,800),Install(1)32"right side door(door allow$200),Install(2)windows on right side(window allow$600). Install
(3)windows on left side(window allow$900). Install(2)windows in existing garage(window allow$400). Install(2)
windows in rear breezeway(window allow$400). Install(1)window to right side top of house(window allow$300).
Install(2)awning windows&(1)fixed window above sliding door in living room(window allow$800). Install(2)awning
windows on right side of living room[window allow$600).Installation labor&clear pine colonial trims&stools to
windows&doors mentioned above$7,150.Install 6'French wood slider with two 18"sidelights(door material allow
$2,600)
13) Windows&Exterior Doors(Addition): Install(6)9 over 9 light windows in addition(window allow$2,400). Install(9)
double hung windows(window allow$2,700).Install(8)casements(window allow$3,200). Install(4)awning windows
(window allow$1,400). Install(2]overhead garage doors, 1 row glass w/openers(door&labor allow$2,800). Install
(1]insulated 9 light steel exterior door(door allow$250). Install(1)transom over 9 light door(door allow$250).
Install(1]steel insulated door in garage to house(door allow$250). Install(1)skylight light in addition at top of stairs
(sky light allow$350).Install 2 double hung double mullion units for garage bump-outs(allow$1,200)Labor to install
addition doors&windows[$2,250]
14) Roofing: Install architectural shingles on new roof&new garage overhang only (allow$3,375)
15) Siding: Install primed finger jointed cedar clapboard to entire home&addition. (allow$19,500 for labor&materials)
(allow$500 for debris) (allow$2,000 for strip labor)
16) A/C: Install central A/C in existing home and addition. ($14,500)
17) Plumbing: Kitchen: Install stainless sink&faucet(allow.$1001,garbage disposal(allow.$125),prep sink&faucet
(allow.$150),dishwasher(see line 281&gas cook top(see line 28). Bathroom: Install shower&valve(allow.$425),
tub&valve(allow.$900),w/c,(allow.$100),2 drop in bath sinks&faucets(allow.$200),gas dryer&washer hook-up
&laundry sink&faucet(allow.$100). Install new tub sprayer[allow$125)Additional sink allow.See line 30
Mark&Debbie Bohrer
10 Heath Circle
North Andover,MA
(M)978-289-0393
(D)978-273-3625
(H)978-322-4100
RE:3-Story Addition(page 2)
18) Heat:Radiant floor heat climate panels on 1"&2'floor.Remove base heat in Dining room&Living room entering
addition(sunroom TBD at a later date)
19) Electrical:Please see attached breakdown of electric(all Electric Allow.$11,100]no underground electric.Relocate
wires in walls for new windows
20) Electrical Fixtures: By Owner
21) Insulation: R-30 in ceilings,R-19 in garage ceiling
22) Blueboard&Plaster (allow$9,5001
23) Interior Doors(Solid Core Pre-Primed): Install(10]in bedroom floor(allow$1,250). Install[1]in kitchen to basement
(allow$125).
24) Finish Materials for New Addition: 2-Piece wide primed pine baseboard (materials allow $625). 3 1/2" Col. Pine
Casing for doors&windows [materials allow$875). Oak top & bottom rails on stairs from kitchen to bedroom w/
balusters for the first 4' (materials allow$400). Oak treads & painted risers (materials allow$1,500). Stairs from
kitchen to garage to be bullnose pine treads, with pine risers, simple pine handrail. No side skirt boards (materials
Allow.$325)
PAINTABLE EXTENSION JAMBS FOR ALL WINDOWS&DOORS ON NUDURA WALLS
25) Finish Labor New Addition: (allow$5,500)not including cabinets
26) Cabinets: (allow$20,000)
27) Cabinet Labor (allow$1,800)subject to change depending on crown&or decorative moldings
28) Counters&Backsplash [allow$5,000)
29) Appliances: Dishwasher (allow$500),Cook top(allow$1,000),Double Oven(allow$2,000),Sinks (allow$1,200)
30) Paint Interior:by owner
31) Paint Exterior: Paint entire existing home&addition
32) Entry & Front Stairs: Remove entry roof, support posts, concrete platform & step. Install new colonial entry trim
around doorway.(allow$500 material,$560 labor) Install(2)5'granite treads-no platform.
33) Deck&Porch: by owner,contractor to install(3)safety rails(allow$900)
34) Cut Foundation:Cut 2 door entries in existing foundation
35) Hardwood Floors: Install wide pine or oak boards in kitchen &dining room (allow labor& materials$6,000). Install
wide pine or oak boards in bedroom(allow labor&materials$3,400)
36) Sub Floors: Install Hardibacker Board in bath&laundry
37) Tile: Install tile in bath&laundry (material allow$350 for tile]
38) Bath Mirrors: Install bathroom mirrors (allow$150)
39) Vanity: Install(1)vanity in bathroom(allow$450). Install[1)counter in bathroom($250).
40) Driveway Prep: Excavate loam & subsoil & spread on site. Grade (6) Loads of re-processed (allow $1,500). Clear
brush for driveway(allow$500)
41) Pave Driveway:1 1/2"binder coat. 1 1/2"finish coat.2 cars wide in front of garage with turnaround&10'wide driveway
to street.(Remove paving&dispose of existing front driveway$700)
42) Landscaping: Install landscape terraced wall. Labor & material (allow $5,000) *Does not include finish landscaping.
Existing top soil to be machine graded.Rake,seed,&fertilizer proposal upon request
43) Miscellaneous: Gut existing kitchen - remove floor, cap off plumbing (allow $750). Wall, ceiling &floor finishes not
included.
44) Debris Removal:Related to construction work only,by contractor
45) Certified Plot Plan: by owner
46) Balcony (interior 5' x 15') Frame floor, frame partition & closet, Blueboard & plaster walls, wide pine or oak board
floors,oak railings&balusters,trim baseboards.
47) Ceiling Beams:Kitchen.Wrap steel I-Beam,3 beams evenly spaced both sides of steel beam to outer walls.Perimeter
beams all 4 walls. Beams to be made from rough sawn pine &corners to be mitered to give solid rustic beam look.
Master Bedroom beams to be similar construction with 2 beams in the cathedral area of ceiling,&both ends of ceiling
cathedral.Lateral beams at bottom of cathedral both sides,&one ridge beam.[material allow.$3,500)(labor$2,170)
48) Exclusions: If it is not printed in the proposal, no allowance has been made. Please check to make sure everything is
included.
Mark&Debbie Bohrer
10 Heath Circle
North Andover,MA
(M)978-289-0393
(D)978-273-3625
(H)978-322-4100
RE:3-Story Addition(page 3)
*Please keep in mind that allowances may be high or low.I would suggest keeping 5%reserve for contingencies.
Total Job Cost: $305,000
v
NEWHOUSE & SUN
CONSTRUCTION
CONTRACTOR AGREEMENT
THIS AGREEMENT made the 5'day of November, 2007,by and between David Newhouse Jr.,
hereinafter called the Contractor and Mark and Debra Bohrer,hereinafter called the Owner.
Witnesseth that the Contractor and the Owner for the considerations named agree as follows:
Article 1. Scope of Work
The Contractor shall furnish all of the materials and perform all of the work shown on the
Drawings and/or described in the Specifications entitled Proposal, as annexed hereto as it pertains to
work to be performed on property at 10 Heath Circle,North Andover,Massachusetts.
Article 2. Time of Completion
The work to be performed under this Contract shall be commenced on or about the
5"day of November, 2007,and shall be substantially completed on or about the 3"day of April, 2007.
Time is of the essence.
The following constitutes substantial completion of work pursuant to this proposal and contract:
(SEE ATTACHED WORK ORDER)
Article 3. The Contract Price
The Owner shall pay the Contractor for the material and labor to be performed under the
Contract,the sum of three hundred and five thousand dollars($305,000.00) subject to additions and
deductions pursuant to authorized change orders.
Article 4. Progress Payments
Payments of the Contract Price shall be paid in the manner following (this schedule is a
guideline only and is subject to change dependent upon job progression):
1. $40,000 Payment to Start
2. $27,000 7 Consecutive Bi-Weekly Payments As Job Progresses
3. $28,000 2 Consecutive Bi-Weekly Payments As Job Progresses
4. $20,000 Balance to be paid within 2 weeks after inspection
Article 5. General Provisions
Any alteration or deviation from the above specifications, including but not limited to any such
alteration or deviation involving additional material and/or labor costs,will be executed only upon written
order for same, signed by Owner and Contractor, and if there is any charge for such alteration or
deviation,the additional charge will be added to the contract price of this contract.
If payment is not made when due,Contractor may suspend work on the job until such time as all
payments due have been made. A failure to make payment for a period in excess of 5 workdays from
the due date of the payment shall be deemed a material breach of this contract.
0
In addition,the following general provisions apply:
All work shall be completed in a workman-like manner and in compliance with all building codes and
other applicable laws.
A plan and scale drawing showing the shape, size dimensions, and construction and equipment
specifications for home improvements, a description of the work to be done and description of the
materials to be used and the equipment to be used or installed, and the agreed consideration for
the work
To the extent required by law all work shall be performed by individuals duly licensed and authorized by
law to perform said work.
Contractor may at its discretion engage subcontractors to perform work hereunder, provided
Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper
completion of this Contract.
Contractor shall furnish Owner appropriate releases or waivers of lien of all work performed or
materials provided at the time the next periodic payment shall be due(upon owner's request).
All change orders shall be in writing and signed by both Owner and Contractor, and shall be
incorporated in,and become part of the contract.
Contractor shall at its own expense obtain all permits necessary for the work to be performed.
Contractor agrees to remove all debris and leave the premises in broom clean condition.
In the event Owner shall fail to pay any periodic or installment payment due hereunder, Contractor may
cease work without breach pending payment or resolution of any dispute.
All disputes hereunder shall be resolved by binding arbitration in accordance with rules of the American
Arbitration Association.
Contractor shall not be liable for any delay due to circumstances beyond its control including strikes,
casualty or general unavailability of materials and subcontractors who fail to perform work when
promised.
Contractor warrants all work for a period of twelve months following completion.
Article 6. Indemnification
To the fullest extent permitted by law,the Contractor shall indemnify,defend and hold harmless
Mark and Debra Bohrer and their agents and employees, from and against claims, damages, losses
and expenses,including but not limited to attorney's fees,arising out of or resulting from performance of
the work or providing of materials to the extent caused in whole or in part by negligent or wrongful acts
or omissions of, or a breach of this agreement by, the Contractor, subcontractor, anyone directly or
indirectly employed by them or anyone whose acts they are legally responsible.
Article 7. Insurance
The Contractor represents that it has purchased and agrees that it will keep in force for the
duration of the performance of the work or for such longer term as may be required by this agreement,
in a company or companies lawfully authorized to do business in the State of Massachusetts, such
insurance as will protect David Newhouse Jr. of Newhouse & Sun Construction and the Owner of the
site, if the site is not owned by Mark and Debra Bohrer,,from claims for loss or injury which might arise
out of or result from the Contractor's operations under this project,whether such operations be by the
Contractor or by a subcontractor or its subcontractors.
The Contractor represents and agrees that said insurance is written for and shall be
maintained in an amount not less than the limits of the liability specified below or required by law,
whichever coverage is greater. The Contractor certifies that coverage written on a"claims made"form
will be maintained without interruption from the commencement of work until the expiration of all
applicable statutes of limitation.
Comprehensive General Aggregate Liability limit of$2,000,000. $1,000,000 each occurrence.
Comprehensive Automobile Liability(owned,non-owned,hired)of$300,000 each accident.
The Contractor shall file Certificates of Insurance with TL Southmayd Insurance Agency,
Wilmington, Massachusetts, prior to commencement of work, which shall contain a provision that
coverage's under the policies shall not be cancelled or allowed to expire or permit material changes until
at least Ten(10)days written notice has been given to Owner.
Article S. Additional Terms
No allowance has been made for Blasting,if necessary.
Signed this 1" day of November,2007.
ark Rohrer (Contractor,Davi Newhouse Jr. .
Newhouse&Sun Construction
Debbi ohrer 3 West Jamaica Avenue
Wilmington,MA 01887
978-657-7274
Contractor license No.042389
Home Improvement Contractor No. 117760
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
+� Boston, MA 02111
M sv www.mass.gov/dia ,
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Name(Business/Organization/Individual): ��✓ B � �h S ruC /0�1
Address: � G✓ >,-#1-1 ►ca Ave
City/State/Zip: 62.11/01 t� d4 Phone#:IV1g
Are you an employer?Check the appropriate box: Type of project(required):
1.[9/I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P tY• 9. Building addition ,
[No workers' comp.insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions
officers have exercised their 11. Plumbing repairs or additions
3.❑ I am a homeowner doing all work ❑ g P
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:
Policy#or Self-ins. Lic.#:' Expiration Date:
Job Site Address: City/State/Zip:
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 for insurance coverage verification.
I do here b certify und'err thee ain d penalties 7L5-
ury that the information provided above is true and correct.
Siena 'e: c��i� � Ld�*�� Date: -(!57
Phone#: ( 15'G 5 — 7.?77` <st11 57 7 S? ;I S7 7�ylD 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
6.1 Other
Contact.Person: Phone#:
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I ' x°1/05/2007 17:06 5087527172
PAGE 02
Q�:o CERTIFICATE OF LIABILITY INSURANCE OATE(MMfDD/YYYY)
�.•� 11/06/2007
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Blackstone Insurance&Financial Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
37 Harvard Street Suite 213 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Worcester, MA 01609
INSURERS AFFORDING COVERAGE NAIL IT
INSURED INSURERA: A.E.I.C.
David Newhouse&Sun Construction INSURER 8:
3 West Jamaica Avenue INSURER C:
Wilmington, MA 01887 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR 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 SUWECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS Or SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR INSPo TYPE OF INSURANCE POLICY NUMBER OAATAYN LIMITS
GENERAL LIABILITY EACH OCCURRENCE S j
COMMERCIAL GENERAL LIABILITY DAMIA"
EMU'--
PRISES Ee eau 4
11 CLAIMS MADE Fj OCCUR MED EXP(Any one person) S
PERSONAL B AOV INJURY 4
GENERAL AGGREGATE S
GEWL AGGREGATE LIMIT APPLIES PER! PRODUCTS-COMP/0P AGG S
rj POLICY r7 PROJECT M LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMB S
ANY AUTO (Es acrAderM
ALL OWNED AUTOS
BODILY INJURY 0
SCHEDULED AUTOS (per person)
HIREOAVTOS BODILY INJURY g
NON•OWNEO AUTOS (Par accident)
PROPERTY DAMAGE s
(Per erdom)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN EA ACG $
ALIT ONLY: AGG x
EXCESSfUMBRELLA LIABILITYEACH OCCURRENCE S
OCCUR El CLAIMS MADE AGGREGATE S
S
DEDUCTIBLE S
RETENTION S S
WORKERS COLIPENSATKIN AND
GM r;F LIABILITY TORY LIMITSMOT
£R
A ANY PROPRIETORWARTNERIEXECUTIVE WCC5006524012007 10/0312007 10/03/2008 E.L.EACH ACCIDENT is - 100,000
OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EA EMPI.af,7 S 100,000
yyeese ddescribeS
aE.L.DISEASE-POLICY LIMIT S
PEGIIAL PROVISIONS below $00,000
OTHER
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Mark&Debra Rohrer DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 GAYS WRITTEN
10 Heath Circle
North Andover, MA 01845 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SMALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25(2801108) 0 ACORD CORPORATION 1988
v .r
11/05/2007 17:06 5087527172 PAGE 03
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
R ATION IS WAIVED subject to the terms and conditions of the policy,certain policies may
If SUB OG � po Y. Po Y
require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of insurance on the reverse side of this form does not constitute a contract between the
issuing insurer(s),authorized representative or producer,and the certificate holder.nor does it
affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon.
ACORD 25(2001108)
�' '� �/ze -oon�r�zonuiea/�/ a�, ,aoaaelzua�,/,la
Board of Building Regulations and/'Standards
Construction Supervisor License
LicenGS 42389
Eirthdat� 8/1,1/1956
Expirat' 8/1.1/2009
sTrr% 2719 l
# RetnCfion �t
f
DAVID G NEWHOUSE JR
3 W JAMAICA AVE
.WILMINGTON,MA 01887 T` Commissioner
✓lie �anvm-auuea� o�i�asdxfivaelta�t
Board of Building Regulations and Standards,
° HOME IMPROVEMENT CONTRACTOR
Registratron 117760
,.,.Expiration 11-/15/200$ Tr# 126041 ,
f, Type Individual
DAVID G.NEWHOUSE JR �`•
NO TES.• 2 p�
1) THIS PLAN IS NOT TO BE CONSIDERED AN Rpp
ALTA/A CSM LAND TITLE SURVEY. 252.28'(C) 114 H
2) BUILDING OFFSETS ARE TO WOOD CORNER BOARD. ,� (Fp•)'FLAS
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MICHAEL N•E•R'0 PLA 5'18 5�"E ,v E�A� � �I
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REFE"RENCES.•
DEED BOOK 4733 PAGE 6
M E.R.D. PLAN ,#3764
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No Q) _ GRILL HOLE, (FD.)
Q)
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l CERTIFY TO THE NORTH ANDOVER
BUILDING INSPECTOR THAT THE DWELLING
SHOWN HEREON /S L OCA TED ON THE
GROUND AS SHOWN, AND IS THE RESULT OF
AN INSTRUMENT SURVEY. 1 11/7/07 ADD DECKS CWG CWG
NO. DA l E REVISION DESCRIPTION BY APP.
PLOT PLAN CHK. BY
MICHAEL OF LAND CWG
D. 10 HEATH CIRCLE, NORTH ANDOVER, MA
BOvIo PREPARED FOR: MARK ✓. & DEBRABOHRER DA TE'
NO.34609 9/25/07
H�cocK
`i Survey Associates, Inc. SCALE.• 1" - 30' JOB
185 CENTRE STREET, DANVERS, MA. 01923 NO.
PR
VOICE (978) 777-3050, FAX (978 774-7816 FESSIONAL LAND SURVEYOR � 0
15 30 so 13938
F.• Land P-Jbcta R2jfJ=jdW7I IMXPP.dwg Nov 07 207— 9.14 am