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HomeMy WebLinkAboutBuilding Permit #256 - 100 EDGELAWN AVENUE 8/31/2015 BUILDING PERMIT o� NORrN // SgLED /6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION J Y Zo ey Permit NO: Date Received �SSACHLISE� Date Issued: t— 1 . IMPORTANT:Applicant must complete all items on this page gggt 'Cti ;YF 1 M P� Y wy�' 'SF"yJ�.�x,` trl�- d P { �-�, �-•�w �x.e.t '+.-J tr t �l�l. y,�{ w 4 _r.T a -. 'a r �{ ,�' 't FlaN 410dt ,�-'�F 3r-fg,r '"xy ••"��:� 1,>a ,� s.�w. _-1 JI�, -+:�."y " 4 fi r.+ '1- r � �,,L r a tip a ��y� I �� ��t ? •�S. r .+'�-•s' �"" h r�t.y '',t� r - a. .t x... n r t`�•�.�_,'r,�i .�Gr, 7Fr u r a��'x.r�, -? r's, a. r� �'.,` v t °�5=~``h���7F�.ak' -,r: �.j�.�t _.�.d-'' r-s. ✓i tr l.. ,�jec':.ti=,?�`' � $�-Zti":-- t-,r r y, f�.tic��,�� a�u:::,,�izcv:•'.-,n, iF,,..an�� 'h'. 4'ystl .�,,.,�. k � L h5 J (}'�.: re .- ,1• li- 1 9 5��I�y���aw`2� lY a'iF 5 ^4r y,* .Ya.<F.7 .c.14 c Y � _^� �r.•.yf�- t'r�`uni> � 5.r_`C'r.5 C+` er�ar<- _-'F�1.�'�"' t Ja"Y� �'".r"n""'^*-f'a nti '�`- Ei �`�": '+v' '4f am,_. ..0 r :,n r�•Y f?�, ;.r 7 r, h' T� ' �.J_, �.T ¢r l..�.,�,,•, Yt-"3+> i t y-c�wy3 �a.^�.. -vs r �� 1tT-'><r5` 'aM r"..��,..7� I F.''z_-r4�... ht,' 4,i, -c;<', a m.�•e � mac,+ �- �"'�c-- s 7i :� -�,� t "moi ?-.� � t f t .t a, '� �''`-'.t*iR.;a'1'�•.i, lir�� "�i ern._ � �� T C�rYr`� �-- m ;�,� f -4 +rl;J�-rr+:i`y�''.a:�'n`;x-i��:rr!���.t.»:'+n..A„ui''v�r-_tir_5s J7�.-Sd'i .t �^^!, Ztai 2 .q x-Zd•��.tzz t`��'-' 11/1>a�i�� �� :�Y�� e� � a�.�i � r6 = 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 t•�� w�-Ry� p 1}���z�t�”�l t� '3:• .k- � f h "r^'sr=�rL. .� a:. is_. i"'u' ��� ���� +��i,��-•r��•''��.r�✓��3^�.�vr'�? �tK �� ����I�� -y�"� t���+.t1lr����+��1��-?}'��rl"l �?P`����i..�s��AY1��s71L�lfii� S�,�c .r.,,� 's +. � �--,7^ 'c^F�1� �.,rr '4�-•.^`� ,�rF.•�� e `tt.� `�,:i',x�if,,�aF,o�'a.�.�;� 53� f'R 4�-�ri.� r i�i1 3 >� e. !-, ,srr'�- i�-� � �` ��.a���l`1�7E rs�t �r�� ``�`��,��'i ��r' u=,,�,a�4�, e 1< �� y��}. �, �3 �ti',-�.'i �x•��c�5 'T'''",�a',�'�� ��t'r���•,",��t+.w'�ea 51•-T`�"lr„� DESCRIPTION OF WORK TO BE PREFORMED: Q R��1cp- a 00A�o foo (-s Identification Please Type or Print Clearly) OWNER: Name: Zc)ar) L.GirI_se Phone:-7Z) - )5--3c)0 Address: 1W �Qwr1 �� , u�° 8 NOr4�h �ndoveS' 01�y5 -- .a, e-e, r - T t�,J'v.3 r^s�' "Y;y1 ik�rK.�s-<-'"r' G'; '' J'+•',ns y<1J,-`�.'S. tit R .flmc�., a;r,; <ct 5 R.rizst , ��..�# 1���r,`"�ir�'•sa qty s� 7a. .�Jq -�'�'f:. � '•--,.�`i.�-rr�r .� F�'i Is'�� -a ? - F - --�gr�}:� Tn }a. i ">`✓zi�. - "�." ,x' s_ � 0 _ 1 1 ' "y�,-��,--";�•,v�r Y,• F.��}y- '��' i;RtS:-.! y:.1. -r a%2'.`" B.-mak f r `'' -sw.F bt`�� K x. s st rc s t '+1.�`' i�'�,, -Xti z'" 4 4 �.-t•a - �� �•.. .a� Ft;<� -���,e e} 1 � t� �rgra���i5',x," ��F t�i1 �k ��a� '''��;�� }Q' :g-� ��r�r �,yi.�;�:�-�tfcGr>iv..''s:�`�,7'r•���.L't^,�! . i .�7'YAJ 3 LLW ,e��. •�;����scb�%,=- � '�'� :��r" ���t,'x <t. ..rr •.?•,1c}�:ry- ;1 't 7e�r ua: `.`a2:fin �fv- .�.�. ,�,.r �..,�=5 Mme,, 3ri..,c2�-t�- "M".x�'.xc'•'.•r_6_t3-'l... t�} ��(C.2c.>r'�'t.�:�,.4'-a. r""J,. Nr['r<7nvPs^ '�.�c-�."w''i+,ai.1',1-T''•Y'�7��'4*-tr'.:�'E�. ancvkrrh}a ,Lp�'..K d41G/v�i.<i,W'^���i...P.."a.,.��-ru--7m��I ssF'h���'F.w��.t#��.',o-{.r�'�f`r�'�tlrf�'l S'J"h ir'titYC�N".ri.r5�'.�,-R.t��rr�a-�te+-'Sin�._�S 7ru_t�.�A1}.w_.._�,i..:_.aT:'V R ;,.T.t�,5..�k._.'.,ro'...•.,--:11.:_:�v«�,"r.'._w•t,�.p'i,'«;:T��-::�`7-.ir�,dr<- .b_n.r. ID � 1,(�TY�7�ls ?7�11t1'Se ryY�r€ n-�° t Sy ` 7Ce '� "��'ti rr ARCHITECT/ENGINEER Phone: ' Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON S125.00 PER S.F. Tota( Project Cost $ FEE: $ -10 � Check No.: f O Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the •anty fund Signatur� frlgen / uuneT -i 'Snature�ofcoract /O/ 70 Location } No. / Dat • -{ TOWN OF NORTH) ANDOVER • ^VIED - • Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $�� TOTAL $ Check# �Y h Building Inspector Plans Submitted Plans Waived Certified Plot.Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools d 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENT-6 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 1 F Conservation Decision: Comments Water & Sewer ConnectioniSignature$Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street YRE ► 111E POP Dm ae 7: . ��� o -�_ocated�t�� YJair Stream# 4 � . :a n Ix. - y Dimension Number of Stories: Totals ware feet et 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) ❑ Notified for pickup - Date � 1 Doc.Building Permit Revised 2010 ' 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 ❑ 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) ❑ IVI "'ass 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 ,----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 ) - ❑ 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 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 2008 NORTH Town Of t_E : ,, Andover o :. .� i No. sib, ?Il C) h . ver, Mass, 9 c oc NIC Ml W IC K S U BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System 0 THIS CERTIFIES THAT ......................... ... 4640.... . BUILDING INSPECTOR has permission to erect buildings on �.... , Foundation � ...>�................... Rough to be occupied as .........�............ .. ...'.. ..... ...-........ 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 654MNHSL ELECTRICAL INSPECTOR 6;/r • UNLESS CONSTRUCTIg Rou h Service ............... .............................................. Final BUILDING 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. 0 S) O O Owner's Name:. _ Joan L.arisey 781-315-3909 SIDING - WINDOWS - DOORS Job Address:_ 101 EdgelaWn Ave. Unit#8 r Phone: North Andover, MA 01845 — Family Owned And Operated li'vre the owner(s)of the premises mentioned below hereby contract with and authorize you to furnish all necessary materials,wuuf cavo vrur nwunar..p, to install,construct and place the improvements according to me following specifications,term and conditions,on premises below described Brand: r ` fr2 (WINDOW)SPECIFICATIONS Quantity: A Build Tie Into Low-E Metal PVC New Inside TOTAL$ Roof Overhang Argon Screens Grids Trim Trim Finish Color: Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Double Hung 1/3 Deposit$ Picture Slider Y. X" X Bow/Bay 113 Start of Job$ Garden 1/3 Balance Upon Cas/Awn Completion$ NOTES: nt3 r .e< s illy+ a fr r �J�r�` „r1'4�_ (SIDING)SPECIFICATIONS Apply over body area of house.Type of insulation Items not covered or installed: Yes No Yes No Yes No Strip off Existing Siding Vinyl Shutters Roof Provide Container and remove all Window Mantels New Gutters debris Cover Fascia&Soffit Door Surrounds Gutter off&on Door Window Casing Ceiling Fluted Post 51/2 Vinyl Fixture Accessories if needed PVC Trim Traditional Post 514 4”Corners -61 Q It ON START OF ALL JOBS-HOMEOWNERS MUST REMOVE ALL ITEMS FROM WALLS&SHELVES Construction related permits:if the homeowner obtains his own construction-related permits for the work described under this agreement,the homeowner is here by advised that in the event of dispute,judgment and nonpayment of the contractorthe homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A,M.G.L. WARRANTY The Cormaactor warrants that the work furnished hereunder shall be free from deflects in riaaerials antl worrmansh!b for a Derma of 1 Year following competon and shat;conA wllh the rtroa,renn s of this Ayroemenf In the event any defect mkman worship or materals.or damage caused by me Contractorhs subcontracto s.e pbyees v agems.is dixow-red vial;n one year alter ccmpie- for.of ani oG.irclud mg Caaoua.re COMC41ar Sha".at his cvrn ezpense,fonhwfth rerr4,,repair,conec,,replace.or cause to be remedied,reparred,or rep!eced,sictb damages or such direct h materials or workmanship.The foregoing wamantles she,sur;,R in nspec^x+performed in connection eh the agreed-urian work.No goaranfae on gutter back up in roof,no guarartee on lee back uv aid no guarantee on facing of Jnyi s:d rm.BROOKS does not do any paint ria of staining BRICKS is cwt resgonsVp for the eordton;or cncumstaxes beyond its control resultno from or due io pre-existing con?dions.BROOKS is not responsible far any rotten:wood from any"sting work H rotted wood is fmndan adittiorai charge w:.it W,,:red.BROOKS w:,chaW'or reoace ner:parts.BROOKS is riot responsible for mad or midew.WI warranties or guarantees relate back io Me manufacture.Under such manufacturers warram,:es,the Owner rq,be recurred to feaster x ma:r a xa^al card or Crier gv:dence of ownershrp and use of such equiomert in order to activate such waTanlies No moray should be he!d back:due to marufacture,'s sernce and repair.The Owner's faf!ure to mell as a regoer ad docurenW;on r,t tn'x'ure volas"he manufacturer's xamantishall not create any respons:b9ty for the Gonbacier to.varranty such squpment.MANUFACTURER GUAfWJTEF LABOR AND MATER ALSAOT BROOKS SIDING.4 service charge of 2%of the unpaa balance per month w:'be added to balance if not paid according to terms of contractor,complehon of contract.Maximum,holdback 10%rema4leng balance or last payment whichever amant is fess or the 2%sewe craw wr-roe a4p:,ed.Add`tionaf dirge toradding iron;iob site related mahimis into dumpster. TOTAL$ Brooks Vinyl Siding•Windows•Doors Name of Commctor/Designated Registrars Payment to be mane as follows: 254 N.Broadway-Breckenridge Mail 1/3 (S. 1 Upon signing Contract; street Address 1/3 (S t Start of Job Salem,NH 03079 (603)894-4488 www.brooksswd.com ohy/State Phone Moshe 1/3 (S t Balance upon completion 101682 99730 HICY J Registration M CSL p Note:Ii Came"ed After 3 Days,50%Of Rerrailera Balance Is Non-Refuntlable. ,C Neace:No agreem«rt for home improvement contracting work shall require a down payment(advance Name of Salesman oepoil of more than-501a-of the total contract price or the.total amount of all deposits or payments which the conlaci or must make,in aclQnce.to order ardior premise obtain delivery of special order mmenafs and equ:prna,Lwt'omr amamt is oreatte A&—,ed S gnaws - -. Acceptance of Proposal-I accept the pnces,speciftations and conditions stated.I understand net upon&gning,mis proposal becomes a Unding contract.You are authorized to do the work as specfied.Payment watl be made as artrned above.You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day atter the date of this transaction.Cancellation must be done in writing.We reserve the right to check your credit DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. IN WITNESS WHEREOF of the parties hereunto have signed their names this day of 7(l I-r 20 ✓� Signed . „''i=> --^ A servos charge of 245 al the unpaid h;lande per manor xdilbe added to bslance ilnot Yes.I am tivi "wrier paid acarding to terms of com act or.comp,'eton of contract.Manmum hold back 10% rema rang balance or lastpayment ry'cnever amount is less or me 2%serwcs charge Signed ws;7be ax!,ed.Addiwal charoe foraddng iron-job site related materiais into cumpsler. Yes.I am the owner Inrtlel Tom' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston, AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eaectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): B t"p0 Con 54, co,. _iy)C. Address: grG'Geclw City/State/Zip:S� m �r�_1� �� Phone #: (o 0S-�9`� n q L1 Aree u an employer? Check tbe-appropriate box: Type of project(required): I.&I am a employer with 4 _ 4. [:11 am a general contractor and I b. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.(1 I am a sole proprietor or partaer- listed on the attached sheet t [vj Remodeling ship and have no employees These sub-contractors have 8. Demolition worldng for me in any capacity. workers' comp. insurance. 9. Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have.exercised their 10.El Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roofrepairs insurance required.] t employees. [No workers' 13.0 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. rContractors that check this box must attached an additional sheet showing the name o€the sub-contractors and their workers'comp.policy information. I ant an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site information. Insurance Company Name: E X C e)S i Qr * Y-1 SiO 0,►1 C t Policy#or Self-ins.Lic. #: C8 1 Expiration Date:_ 5/1 ke rob Site Address: O h° 1 8 City/State/z, :_L.AMC) attach a copy of the workers' compensation policy declaration page(sbowing the policy number and expiration date). :ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a :me 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 &up to $250.00 a day against6e violator-:-Be advised that a copy of this statement may be forwarded t6 the Office of nvestigations of the DIA for insurancr.cover�g§yerification. do hereby certify under airs andpenalties ofpeijury that the information provided above is true and correct ;16 ature: Date: 'hone 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): I-Board of Health 2.Building Department 3. City/Town Clerk 4-Electrical inspector 5.Plumbing Inspector 5. Other j Contact Person: Phone#: �I A6 ® CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDtYYYY) 7/6/2015 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 CONTNAME:CT Linda Bogdanowicz Insurance Solutions Corporation PHONE (603)382-4600 FAx C o (603)382-2034 60 Westville Rd EMAIL .lindab@isc-insurance.com .A SSINSURERS AFFORDING COVERAGE NAIC IY Plaistow NH 03865 INSURERA:Peerless Indemnity Insurance 18333 INSURED INSURER B: Brooks Construction Co. of Lawrence Inc, DBA: INSURERC:Excelsior Insurance 11045 254 N. Broadway INSURER D: INSURER E: Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1552621745 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY AM AGE T NTED PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE FX OCCUR ZBP8945793 /16/2015 /16/2016 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 TPOLICY PRO-JFrT LOC I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Par person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED HIRED AUTOS AUTOS Per accident $ 1 Medical payments $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATIONWC STATU- 0TH- AND EMPLOYERS'LIABILITY Y/NER IQRY_UMtTANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) C8836275 /16/2015 /16/2016 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Joan Larisey ACCORDANCE WITH THE POLICY PROVISIONS. 101 Edgelawn Ave, Unit 8 N. Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/CLS ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. Irucn�si�nnncn+ TL. •//�I'tf1-_-.V- -._-i _•._ _.._ ..__.._a_..__ .__ r aww...s. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen icor Specialty License: CSSL-099730 MARK DIP RIMA` _ _ ,�, �.!.-,• 18 HAWK DRIVE ° � s SALEM NH 03011 Expiration Commissioner 02/20/2016 = Office of Consumer Affairs&Business Regulation �4nME IMPROVEMENT CONTRACTOR X Registration: 101682 Type. t;F" Expiration: 6129/2016 Supplement BROOKS CONST.CO:,INC.OF LAW MARK DI PRIMA y 254C N. BROADWAY STE 110 SALEM,NH 03079 ti ndcrsecreta ry