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HomeMy WebLinkAboutBuilding Permit #024-14 - 1018 OSGOOD STREET 7/8/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 41—lel Received e Date Date Issued: I PORTANT:Applicant must complete all items on this page v LOCATION Cyi O Pri t. PROPERTY ER 1 `?C Print 1.00 Year Old Structure yes no: E ZONING DISTRICT: Historic District yes no ' MAP NO: _PARC U ' Machine Shop Village es. no i p g Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building ❑ One family B 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 DESCRIPTION OF WORK TO BE PERFORMED: a Identification Please Type or Print Clearly) OWNER: Name:��i L .LL Phone: 0 -S1 7 Address: Z20 Zje—rc MrcV S+� �� e,-t6etz A oIo4 q,-q+ f✓l, vel GvV%S r.QG ;a r-, —7 CONTRACTOR Name: e- �c. Phone: --312--0 Z. cc J Address: 4� /�e� rK�G S - J ' �'� ,/`�"IP. GiVP h-,_,/�= 6 q U. Supervisor's Construction License: (Cf� R1 5?9 Exp. Date: 14 /2-3 / 13 Home Im rovement License: l sq3 Exp. Date: f ILl ; p ARCH ITECT/ENGINEER� 0 Vh Phone: d`�-- �— � f Address: ��" -'—v- ,S LP, Reg. No. � FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Did /y Receipt No.: a� �o,irP9y I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund � ignafui�e_ofAgent/Ovvner S�g' ature.'of eonfractor ' __ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plan i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF.SEWERAGE.DISP.OSAL Public Sewer ❑ Tanning/MassageBodyArt ❑. . Swimming Pools ❑ 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 COMMENTS b HEALTH Reviewed on Si nature COMMENTS o oning 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 Tow;! ]Engineer: Signature: Located 384 Osgood Street FIRE'DEPARTM Temp Dumpster on site yes no Located at'124 Mair`Street Fire DepartMer 4-signature/date COMMENTS i 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 Ido MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— For department use 0 Notified for pickup - Date Doc.Building Permit Revised 2010 f Building Department The fol;owing is a dist 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) i ❑ 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 New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L.License_ s ❑ 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.aa-1 e s s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apuaal period is over. The applicant must then get this recorded at the Registry of Leeds. One copy and proof of recording must be subrnAted with the building application`. Doc: Doc.Building permit Revised 2012 Location No. �l/ 7 Date r • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $37 �yoa Foundation Permit Fee $ Other Permit Fee $ TOTAL �� Check 26594 Building Inspector t%0RTFj own of .. : Andover Y No. OW211M. -1 14 4 - soh , ver, Mass, 7 COCAKI Kic"RWICK U BOARD OF HEAJT s, Food/Kitch� � '�,� Septic System I BUILDING I CTOR PERMIT T LD THIS CERTIFIES THAT ..................................��.X.k.. has permission to erect Fo ndatio , . buildings on ...:'.`.?lam.... ........................... ......................... .... ..�� .. 0 � to be occupied as ...........L�epv_s7dL�t� c �... .�1 ....... C1..r!Y..ij;Y... Ma ' provided that the person accepting this permit shall in every respect conform to the terms of the application l� 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 1 PECTO Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. �3 Final � '���//j PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough elk �F_z4--rS Service ............. ..... .. , f� .. �� .............................. Final BUILDING INSPECTOR GASINSPECTO Occupancy Permit Required to Occupy Building Rough :23�r3 Display in a Conspicuous Place on the Premises —,Do Not Remove Final f'rz44, No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. �c*t SEE REVERSE SIDE J O,O IN 1 54 SSACH`E TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 024-14 on 7/8/2013 Date: September 26, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1018 Osgood Street (Final CO will be issued when punch list is completed. 1. Handicapped Parking Signage 2. Handicapped Handrails 3. Handrails for each set of stairs.) MAY BE OCCUPIED AS Dunkin Donuts Restaurant_IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: CRT XL,LLC 280 Merrimack Street, Suite A Methuen,MA 01844 Building Inspector Fee: Prepaid $100.00 Receipt: 26594 Check : 1413 s� September 10,2014 James D_ Smith,Archit' 35 Lothrop's Ln. W.Barnstable,MA 026'5 508-367-•8920 Building Inspector Building Department ro Town of Not Andover 1600 Osgood St. North Andover, MA 01845 RE: Final Affidavit New Dunkin' Donuts 1018 Osgood St.,North Andover Dear Inspector: This letter is to serve as my final affidavit that the work performed at the subject Dunkin' Donuts was performed in conformance with the plans prepared by me and with all applicable codes and that in my opinion the store is ready for occupancy. If you have any questions,please feel free to contact me anytime. Sincerely, R� LY Y ` ...� r` James D. Smith,Architect, AIA o a i r LSSA'.USi CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 024-14 on 7/8/2013 Date: October 22, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1018 Osgood Street MAY BE OCCUPIED AS a Dunkin Donuts Restaurant_IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: CRT XL, LLC 280 Merrimack Street, Suite A Methuen,MA 01844 Building Inspector Fee: PrePaid $100.00 Receipt: 26594 Check : 1413 F µORTN 0.1 •�t o y �,SACN�Sf 49 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER /8/2013 Date: October 22,2014 Building Permit Number 024-14 on THIS CERTIFIES THAT THE BUILDING LOCATED ON 1018 Osgood Street MAY BE OCCUPIED AS Dunkin Donuts Restaurant IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. k Certificate Issued to: CRT LX,LLC ' 280 Merrimack Street, Suite A Methuen,MA 01844 i Building Insp ctor Fee: PrePaid$100.00 Receipt: 26594 Check : 1413 i (4 I I i. I °. 4oRY" O T ` ti E } •�'S ACHUS 449 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER r' I Building Permit Number 024-14 on 7/8/2013 Date: October 22,2014 � THIS CERTIFIES THAT THE BUILDING LOCATED ON 1018 Osgood Street AS Dunkin Donuts Restaurant IN ACCORDANCE WITHER E MAY BE OCCUPIED , PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OT REGULATIONS AS MAY APPLY. Certificate Issued to: CRT L2 LLC 0 Merrimack Street, Suite A Methuen,MA 01844 i Building Insp ctor Fee: PrePaid $100.00 Receipt: 26594 Cheek : 1413 f G#Np p7M 1N F `��S3.1CHU5'149J CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Date: October 22, 2014 Building Permit Number 024-14 on THIS CERTIFIES THAT THE BUILDING LOCATED ON 1018 Osgood Street MAY BE OCCUPIED AS Dunkin Donuts Restau -ant IN ACCORDANCE WITH UILDING COD AND SUCH OTHER E PROVISIONS OF THE MASSACHUSETTS STATE B REGULATIONS AS MAY APPLY. Certificate Issued to: CRT LLLC 280 Merrimack Street, Suite A Methuen,MA 01844 Buildin�Ini c t o r Fee: PrePaid$100.00 Receipt: 26594 Check : 1413 f �ACNUy CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER M �y 1 Building Permit Number 024-14 on 7/8/2013 Date: October 22,2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1018 Osgood Street MAY BE OCCUPIED AS a Dunkin Donuts Restaurant—IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE ,A$ SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: CRT XL,LLC 280 Merrimack Street, Suite A Methuen,MA 01844 Building Inspector Fee: PrePaid$100.00 Receipt: 26594 Check : 1413 Town of . s ndover No. �° h ," ver, Mass, 7 e� ib C OC.MIC"I A°RATEo P'PP,��(5 S U BOARD OF HE.PER IT T Food/Kitdhe � , � Septic System j�j % 7 THIS CERTIFIES THAT �,, ,��,,.. ..,.: BUILDING I CTOR Id- Fo ndatio has permission to erect .......................... buildings on ...::�... ....... &............................... o to be occupied as ........... ..... . ................... c ey provided thatthe person accepting this permit shall in every respect conform to the terms of the application Fina ` Ql� � �. 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 ItPE�cTo� Rough' VIOLATION of the Zoning or Building Regulations Voids this Permit. FinalL?r�/1-11;PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOARTS Rough ���� � Service .............c...... ..®,.� .: ................................ 40& Final B6'1LD INSPECTOR GASINSPECTO Occupancy Permit Required to Occupy Building Rough �� Display in a Conspicuous Place on the Premises —Jpo Not Remove Final flpw qltol^p No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. -7 SEE REVERSE SIDE Cc,t IVKi • OMp o'�1N 3t.•.t�• ,•.OpL ti Y s s o ••`49 ��9 ACIM15Et TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 024-14 on 7/8/2013 Date: September 26, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1018 Osgood Street (Final CO will be issued when punch list is completed. 1. Handicapped Parking Signage 2. Handicapped Handrails 3. Handrails for each set of stairs.) MAY BE OCCUPIED AS Dunkin Donuts Restaurant IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: CRT XL,LLC 280 Merrimack Street, Suite A Methuen,MA 01844 BuilTing Inspector Fee: PrePaid $100.00 Receipt: 26594 Check : 1413 September 10, 2014 James D. Smith, Architect 35 Lothrop's Ln: W. Barnstable,MA 02668 508-367-8920 Building Inspector Building Department Town of North Andover 1600 Osgood St. North Andover,M.A. 01845 .. . RE: Final Affidavit New Dunkin' Donuts 1018 Osgood St.,North Andover Dear Inspector: This letter is to serve as my final-affidavit that the work.performed at the subject Dunkin' Donuts was performed in conformance with the plans prepared by me and with all applicable codes and that in my opinion the store.is ready for occupancy. If you have any.questions,please feel free to contact me anytime. Sincerely, James D. Smith, Architect, AIA -NORTH Town - of ndover 0 � - No. 14 h , ver, Mass, 7 COCNIC Nl WICK A. �d ADR�TED S U BOARD OF HIT E T e k+ Food/Kitchen °'' Septic System THIS CERTIFIES THAT -„PER T k BUILDING I CTOR ........................................ ... ....... .... ............................................................. . Fo ndatio has permission to erect . buildings on ......................... ...: :...�........ � .... ........................... o � r �� � to be occupied as .... C 1 ' provided that the person accepting this permit shall in eve respect conform to the terms of the application �'� p p p 9 p rY p pp � 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 PECT g� RoughJ VIOLATION of the.-Zoning-or Building Regulations Voids this Permit. )3 Final /�/� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTSRough 10k AL Service .............l...... .. .. .............................. J � _ Final (9k BUILDING INSPECTOR `7 GASINSPECTO Occupancy Permit Required to Occupy Building Rough--23--r3 Display in a Conspicuous Place on the Premises —LDo 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. ert SEE REVERSE SIDE � OE NORTH 1ti t SSACNOSE ' TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 024-14 on 7/8/2013 Date: September 26, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1018 Osgood Street (Final CO will be issued when punch list is completed. 1. Handicapped Parking Signage 2. Handicapped Handrails 3. Handrails for each set of stairs.) MAY BE OCCUPIED AS Dunkin Donuts Restaurant_IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: CRT XL,LLC 280 Merrimack Street, Suite A Methuen, MA 01844 �L Building Inspector Fee: PrePaid $100.00 Receipt: 26594 Check : 1413 .r- R Enter construction cost for fee cal - North Andover Fee Cakulatlon Construction Cost $ - $ 5,400.00 Plumbing Fee $ 675.00 Gas Fee 100 comm. Electrical Fee $ 675.00 Total fees collected $ 6,850.00 1018 Osgood Street 024-14 on 7/8/13 Build a new Dunkin Donuts I. Enter'construction cost for fee cal North-Andover Fee Calculation Construction Cost �$ 450,000.00 Building Fee $ 5,400.00 Plumbing Fee $ 675.00 Gas Fee 100 comm. E$=100!001 Electrical Fee $ 675.00 Total fees collected $ 6,850.00 04 NQS �+ Initial Construction Control Document . o To be submitted with the building permit application by a Registered Design Professional �5 for work per the a edition of the .AWDING DIEPARTIMT Massachusetts State Building Code,780 CMR,Section 107.6.2 Project Title: �� til �� 0 1 t/D!JA4-: Date:—' Property Address: _ �, pj 01`J1)V( U6(_1 MA Project: Check one or both as applicable: ew construction 0 Existing Construction Project description: _ N&,( FLA 12' uN N ` r4yu-s I S V, S 11►1 �-{ MA Registration Number: '�(6 / Expiration date: $ 3� ?j ,am a registered design professional,and hereby certify that I have prepardd or directly supervised the preparation of all design plans,computations and specifications concerning: -Entire Project j ] Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection j ] Electrical j ] Other for the above named project and that such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),'and accepted engineering practices for the proposed project i understand and agree that i(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents.- 2. Perforce the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to detemilne if the work is being performed in a manner consistent with the approved construction documents and this code. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building:official a `Final Construction Control Document'. Enter in the space to the right a"wet"or electronic signature and seal: Phone number. Email: TcA me5 D sry,ay , LLP CO iFT- Building OfficialUse Only Building Official Name: Permit No.: Date: 16M flsgood Street,North Andover,Massochusetts 01845 Wilma 07P 4911 MAC t:.....070 LOO ALAR tV..&w...„.s...,.....t„.,�tt..._d_.....__`. t%O R Tli Town of t ndover 0 No. h , ver, Mass, 7 i cocwicHew�c� �1' �d A�RATEtv) S V BOARD OF HEALTH PER IT T D Food/Kitchen Septic System \� , THIS CERTIFIES THAT �c �., /� �`, BUILDING INSPECTOR ...................................... ... y....... .... ............................................................. .... has permission to erect .......................... buildings on .........../.........�! cx �.. �............................ Foundation Rough ��C� G to be occupied as �J .... .Z?l�(!,1�.:............... 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 Rough VIOLATION of-the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR O UNLESS CONSTRUCTIARTS Rough � .. Service ............. ...... .. .....:.. .................... Final BUILD G INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE i +� Massachusetts- Department of Public Safet% Board of Buildin- Regulations and Standards 1 Construction Supervisor License License: CS 81897 GREGORY J NOLAN 13 WOODLAND AVE KINGSTON, MA 02364 �--�— Expiration: 10/23/2013 Commissioner Tr#: 7115 ne'7 j /• 1 J r r . DATE(MMDD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 0429/2013 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(les)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 Elaine Dozois,AAI Fred C.Church,Inc. NAME: 41 Wellman Street PHONE 978 3227243 FAC. C No): (978)454-1865 Lowell,MA 01851 E-MAIL (800)225-1865 ADDRESS: edozois@fredcchurch.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Charter Oak Fire Ins.Co. 25615 INSUREDINSURER B; Commerce&Industry Ins.Co. 19410 St.Miguel Construction,LLC INSURER C: 280 Merrimack Street Methuen,MA 01844 INSURER D: - INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:23616 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 ADDTYPE OF INSURANCE JbM SUER POLICY NUMBER MM DDNYYY MY EFF MID Y EXP LTR D/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 300,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F'�]OCCUR MED EXP(Any one person) $ Excluded A 680192M8710 10/52012 10/52013 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 17 POLICY PRO LOC $ AUTOMOBILE LIABILITY COEaMacciBINdentSED INGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ 1.AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB. OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY E ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1.000,000 B OFFICER/Mv MBER EXCLUDED? F—] NIA WC3250371 7/212012 7/212013 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 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) job site-1018 Osgood St.,North Andover,MA .CERTIFICATE HOLDER CANCELLATION Town of Andover Building Dept 36 Bartlett St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Client# 3411 Mst# 23616CertHolder# 36181 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD